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G P Kealey

Publications and source records attributed to G P Kealey.

At least 19 recordsLinked to original sources
PubMed2003

The prevalence of venous thromboembolism of the lower extremity among thermally injured patients determined by duplex sonography.

BACKGROUND: Morbidity and mortality from venous thromboembolism (VTE) remains a significant problem for hospitalized patients. Despite the ample prospective literature defining the prevalence of VTE in hospitalized patient populations, the prevalence of VTE in the thermally injured population remains largely unknown. METHODS: We prospectively studied 148 thermally injured patients with hospital stays of greater than 3 days with lower extremity duplex ultrasonograms obtained at admission and discharge. RESULTS: Nine patients experienced VTE (6.08%). Eight of the nine deep venous thromboses were proximal. One of the two pulmonary embolisms was fatal. Treatment risk factors that were associated with VTE were the presence of a central venous line (p = 0.020) and transfusion of more than 4 units of packed red blood cells (p = 0.023). These treatment factors were significantly related to each other (p < 0.0001), to body surface area burned, and to intervention. CONCLUSION: The prevalence of VTE in burn patients is similar to that of moderate- to high-risk general surgical patients for whom VTE prophylaxis is recommended. VTE prophylaxis of burn patients, especially those requiring central venous lines and more than 4 units of packed red blood cells, should be considered.

Adolescent↗
PubMed2001

Predicting survival in an elderly burn patient population.

The purpose of this study was to analyze the outcome of elderly burn victims and to determine an instrument to predict survival in this population. Charts of three hundred and eight burn patients > or =60 yr of age who were admitted to a university-based hospital between the years of 1977-1996 were retrospectively analyzed. The mean age of the population was 71.5+/-8.6, with a male predominance (1.8 to 1, P < 0.001). The majority of the burns were secondary to flame injuries (210, 68.6%). The median body surface area (BSAB) was 13.0% with an in-hospital mortality rate of 30.2%. We demonstrated improved survival in patients aged 60-74 yr as compared to 1965-1971 national burn survival data. A similar trend could not be shown in the very old (> 75 yr of age). Only age and BSAB were related to death by multiple stepwise forward linear regression. The Baux score, which adds age and BSAB, was predictive of outcome in 87.0% of our population. In conclusion, this study reinforces the high mortality associated with burn injuries in the elderly and the superior ability of the Baux score (age + percent burn) in predicting outcome in this population.

Age Factors↗
PubMed2001

Contribution of age and gender to outcome of blunt splenic injury in adults: multicenter study of the eastern association for the surgery of trauma.

BACKGROUND: The purpose of this study was to examine the contribution of age and gender to outcome after treatment of blunt splenic injury in adults. METHODS: Through the Multi-Institutional Trials Committee of the Eastern Association for the Surgery of Trauma (EAST), 1488 adult patients from 27 trauma centers who suffered blunt splenic injury in 1997 were examined retrospectively. RESULTS: Fifteen percent of patients were 55 years of age or older. A similar proportion of patients > or = 55 went directly to the operating room compared with patients < 55 (41% vs. 38%) but the mortality for patients > or = 55 was significantly greater than patients < 55 (43% vs. 23%). Patients > or = 55 failed nonoperative management (NOM) more frequently than patients < 55 (19% vs. 10%) and had increased mortality for both successful NOM (8% vs. 4%, p < 0.05) and failed NOM (29% vs. 12%, p = 0.054). There were no differences in immediate operative treatment, successful NOM, and failed NOM between men and women. However, women > or = 55 failed NOM more frequently than women < 55 (20% vs. 7%) and this was associated with increased mortality (36% vs. 5%) (both p < 0.05). CONCLUSION: Patients > or = 55 had a greater mortality for all forms of treatment of their blunt splenic injury and failed NOM more frequently than patients < 55. Women > or = 55 had significantly greater mortality and failure of NOM than women < 55.

Adult↗
PubMed1999

Expression of thrombomodulin and consequences of thrombomodulin deficiency during healing of cutaneous wounds.

Thrombomodulin is a cell surface anticoagulant that is expressed by endothelial cells and epidermal keratinocytes. Using immunohistochemistry, we examined thrombomodulin expression during healing of partial-thickness wounds in human skin and full-thickness wounds in mouse skin. We also examined thrombomodulin expression and wound healing in heterozygous thrombomodulin-deficient mice, compound heterozygous mice that have <1% of normal thrombomodulin anticoagulant activity, and chimeric mice derived from homozygous thrombomodulin-deficient embryonic stem cells. In both human and murine wounds, thrombomodulin was absent in keratinocytes at the leading edge of the neoepidermis, but it was expressed strongly by stratifying keratinocytes within the neoepidermis. No differences in rate or extent of reepithelialization were observed between wild-type and thrombomodulin-deficient mice. In chimeric mice, both thrombomodulin-positive and thrombomodulin-negative keratinocytes were detected within the neoepidermis. Compared with wild-type mice, heterozygous and compound heterozygous thrombomodulin-deficient mice exhibited foci of increased collagen deposition in the wound matrix. These findings demonstrate that expression of thrombomodulin in keratinocytes is regulated during cutaneous wound healing. Severe deficiency of thrombomodulin anticoagulant activity does not appear to alter reepithelialization but may influence collagen production by fibroblasts in the wound matrix.

Animals↗
PubMed1998

Fournier's gangrene with an unusual urologic etiology.

Fournier's gangrene is a necrotizing infection affecting the male genitalia and perineum, caused by synergistic aerobic and anaerobic organisms. We report on a previously undescribed upper urinary tract etiology for this life-threatening infection.

Fournier Gangrene↗
PubMed1998

Long-term neuropsychological sequelae of severe burns.

Eight patients who suffered severe burns and protracted periods of amnesia following those burns were evaluated for neuropsychological and neuropsychiatric problems between 6 months and 4 years following their accidents. All were found to have significant problems as evidenced in neuropsychological testing, activities of daily living, and reports from relatives. Findings on these burn patients with postburn amnesia were quite different from those of five burn patients who did not develop amnesia. Problems observed and reported in the burn-amnesia patients appeared to reflect clear neuropathological etiologies, which was not unexpected because their initial amnestic syndromes must also have been the result of significant central nervous system dysfunction. It is recommended that severe burn patients have neuropsychological, psychiatric, and neurological exams as part of routine postburn care.

Clinical Conference↗
PubMed1996

Neurobehavioral sequelae of high voltage electrical injuries: comparison with traumatic brain injury.

Eighteen survivors of high voltage electrical injuries (HVEI) underwent neuropsychological evaluation in the acute, short-term or long-term epochs Deficits in verbal learning and delayed recall of verbal information were present across various epochs No other cognitive performances were in the impaired range for the HVEI group, although many individual patients also had compromised attention Depression, anxiety and irritability were widespread among HVEI patients, especially beyond the acute period Extreme irritability was accompanied by assaultive behavior in several patients The neurobehavioral effects of HVEI were very similar to those of a closely matched traumatic brain injury (TBI) control group in each epoch The only significant difference between the groups was less successful immediate visual retention by TBI patients in the long-term epoch.

Journal Article↗
PubMed1996

Cadaver skin allografts and transmission of human cytomegalovirus to burn patients.

BACKGROUND: The potential role of cadaver skin as a vehicle for CMV transmission to burn patients has never been clearly defined. We sought to determine if a cytomegalovirus (CMV)-positive cadaver allograft transmits CMV infections to CMV-seronegative burn patients. STUDY DESIGN: All patients in this study were CMV seronegative on admission. They received CMV-seronegative blood products, and cadaver allografts for temporary wound closure and management without regard to the donor's CMV serum status (positive or negative). RESULTS: Of 493 patients admitted from 1989 to 1993, 22 were CMV seronegative on admission and required cadaver allografts for their burn wounds. Five (22.7 percent) of 22 patients seroconverted during hospitalization: one of five had CMV pneumonia develop, two had CMV viruria develop, and three had persistent fever, abnormal liver enzymes, and diarrhea not ascribable to bacterial or other viral agents. CONCLUSIONS: Cytomegalovirus infections result from using CMV-seropositive cadaver allografts on seronegative burn patients.

Adolescent↗
PubMed1995

Analysis of changes in coagulation factors after postoperative blood loss in burn and non-burn patients.

A prospective study of the postoperative kinetics of coagulation factors was undertaken in 23 burn patients and in six non-burn patients. All procedures resulted in a large volume blood loss. Fibrinogen, platelets and factors V, VIII and IX were measured serially. Burn patients returned all parameters to preoperative levels by 48 h postoperation, while non-burn patients showed a slower rate of return of platelets and factor V. This study suggests that burn patients may safely undergo re-operation at 48 h intervals for successive wound debridements if clinically necessary.

Adolescent↗
PubMed1995

Prospective comparison of two management strategies of central venous catheters in burn patients.

OBJECTIVE: Central venous catheters (CVCs) are associated with sepsis in burn patients. This study was undertaken to compare two strategies of CVC management in patients with major burn injuries. DESIGN: Forty-two burn patients with major burn injuries were randomly assigned to undergo site change every 48 hours of the CVC or to undergo wire guide exchange of the CVC every 48 hours at the same site. MATERIALS AND METHODS: Catheter insertion site, distance from the burn wound, cultures of catheter tips, and blood cultures were obtained from all patients in a prospective manner. MEASUREMENTS AND MAIN RESULTS: There was no difference in the incidence of CVC sepsis between the two groups studied. CVCs inserted less than 5 cm from the burn wound developed bacterial contamination at an earlier time than CVCs inserted more than 5 cm from the burn wound. CONCLUSIONS: There was no advantage to changing the CVC insertion site every 48 hours. Changing the CVC using the wire guide technique did not prevent, nor predict, CVC bacterial contamination.

Bacteria↗
PubMed1993

Cushing's syndrome secondary to bronchial carcinoid secretion of ACTH: a review.

Cushing's syndrome as a result of the ectopic production of adrenocorticotrophic hormone by bronchial carcinoids is a rare phenomena. The clinical course of two patients is presented in depth, and a review of the literature is provided. A discussion of various forms of therapy and an algorithm for the evaluation and management of the patients is presented.

Adolescent↗
PubMed1992

Cytomegalovirus infection in a cyclosporine-treated burn patient: case report.

We report the case of a 45-year-old burned man (55% total body surface area full-thickness burn) who developed symptomatic cytomegalovirus infection during cyclosporine (CSA) therapy (3 mg/kg orally) for skin transplantation. During the sixth hospital week the patient developed signs compatible with CMV infection, and CMV was recovered from the urine and sputum. Examination of skin biopsy specimens from the transplanted cadaver allograft revealed inclusion bodies compatible with CMV infection, and CMV antigens were detected by immunohistochemical testing. The CMV infection of the skin was confirmed by recovery of infectious virus and by detection of CMV nucleic acids using in situ hybridization with a biotinylated HCMV DNA probe. Restriction enzyme analysis of a urine CMV isolate and two isolates from skin demonstrated differences in DNA patterns, suggesting that the patient was infected simultaneously with two different CMV strains.

Burns↗
PubMed1992

Value of the Candida antigen assay in diagnosis of systemic candidiasis in burn patients.

The Cand-tec latex agglutination test was used to analyze 2,575 serum samples from 47 consecutive burn patients at risk for systemic candidiasis and serum samples from 24 nonhospitalized control subjects. One burn patient had systemic candidiasis documented by culture of a deep biopsy specimen. In addition, blood culture produced positive results in one patient with no other evidence of systemic candidiasis. Wound, sputum, mucous membrane, or gastrointestinal tract specimens were cultured in 25 of 47 (53%) patients with no evidence of systemic candidiasis. Surveillance cultures were negative in 19 (40%) patients and there were no signs of systemic candidial infection. The sensitivity of the Candida antigen titer was 100% at titers of greater than or equal to 1:2, greater than or equal to 1:4, greater than or equal to 1:8, and greater than or equal to 1:16. Specificity was 77% at titers of greater than or equal to 1:4, 94% at titers of greater than or equal to 1:8, and 100% at titers of greater than or equal to 1:16. The positive predictive value ranged from 6.0% at greater than or equal to 1:4 to 100% at greater than or equal to 1:16. The negative predictive value was 100% for all titer values. The Cand-tec antigen test shows poor specificity and poor positive predictive value for the detection of systemic candidiasis in burn patients.

Adolescent↗
PubMed1992

An in vitro model for studying the effects of slime and nonslime-forming Staphylococcus epidermidis contamination of intravenous catheters.

An in vitro model was developed to study the relationship between intravenous catheters, bacteria, and the subcutaneous tunnel. Studies of both slime-forming and nonslime-forming coagulase negative Staphylococcus epidermidis show that slime formation enhances capillary action of coagulase negative S. epidermidis. This offers a possible explanation of the increased virulence associated with slime-forming coagulase negative S. epidermidis in the clinical situation.

Agar↗
PubMed1991

Laparotomy and multiple system organ failure.

A retrospective review of laparotomies was undertaken to define the indications for abdominal procedures in patients with multiple system organ failure. This study suggests patients with (MSOF) must be thoroughly evaluated with non-invasive technology to determine the presence of an intra-abdominal septic focus prior to consideration of exploratory laparotomy.

Abdomen, Acute↗