Spiral fracture of the proximal phalanx of the index finger by finger wrestling.
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Adult↗
Biomedical subjects
H J Klasen
Publications and source records attributed to H J Klasen.
Colonization of burns and the duration of hospital stay of severely burned patients.
In a retrospective study the influence of several factors on the length of hospital stay of severely burned patients (at least 24% total body surface area) has been investigated. The influence of these factors was studied by means of the Cox model survival analysis with time-varying covariates. Seventy-one patients were included in this study. The mean age was 32 years (range 1-82 years), the mean total body surface area burned 40% (range 24-80%) and the mean full-thickness area burned 32% (range 10-70%). The length of hospital stay was positively correlated with the extent of the burned area and with the age of the patient. Wound colonization with Enterobacteriaceae or with a combination of Pseudomonas spp. and Staphylococcus aureus was also associated with a prolonged stay in hospital.
Adolescent↗
Selective intestinal decontamination for prevention of wound colonization in severely burned patients: a retrospective analysis.
In this study the effect of selective intestinal decontamination of the digestive tract (SDD) on wound colonization was investigated. Ninety-one patients with at least 25 per cent total burned surface area (TBSA) were included in this study. All patients received oral polymyxin. In 63 patients oral co-trimoxazole and amphotericin B were added to the regimen. The addition of co-trimoxazole decreased the incidence of Enterobacteriaceae wound colonization from 71 per cent to 11 per cent (P less than 0.005). Colonization with Proteus was eliminated in patients treated with co-trimoxazole, compared with an incidence of 36 per cent in the group treated with polymyxin alone (P less than 0.001). The addition of amphotericin B decreased yeast colonization of the burn wound from 39 per cent to 10 per cent (P less than 0.005). A close relation was observed between burn wound colonization and colonization of the gastrointestinal tract. No resistant bacterial strains emerged during the period of study. These results suggest that SDD is an effective method for prevention of wound colonization. Further controlled studies are needed to establish the role of SDD in preventing burn wound colonization and wound sepsis.
Adult↗
Dorsal carpometacarpal dislocation of the index finger: a report of three cases and a review of the English-language literature.
Isolated dorsal carpometacarpal dislocation of the index finger is a rare injury. We treated three patients with such an injury; two cases by delayed open reduction and internal fixation, and one case by direct closed reduction and internal fixation. Satisfactory functional results were obtained in two of the three cases (follow-up of 4 and 2 years, respectively). Anatomic factors, the mechanisms of injury, and management as discussed in the English-language literature are reviewed.
Adolescent↗
Intestinal bacterial translocation in experimentally burned mice with wounds colonized by Pseudomonas aeruginosa.
Translocation of micro-organisms from the gastrointestinal tract may play a role in the pathogenesis of septic complications in severely burned patients. We therefore investigated the influence of burn wound infection with Pseudomonas aeruginosa on translocation in experimentally burned mice. The P. aeruginosa disseminated in 15% of the animals on the second day and in 20% of the animals on the third day postburn in the Pseudomonas-seeded group. Wound colonization with P. aeruginosa, compared with a control group, led to an increased incidence of translocation of Escherichia coli from the GI tract to the spleen (p < 0.005), liver (p < 0.03), lungs (p < 0.005), and peritoneal cavity (p < 0.03) on the second day postburn but not on the third day postburn. On both the second and third days, the number of viable E. coli in the organs in the Pseudomonas-seeded group exceeded that in the organs in the control group. In this model translocation of E. coli from the GI tract played a more important role than did hematogeneous dissemination of P. aeruginosa from the burn wound.
Animals↗
Effect of polymyxin B on intestinal bacterial translocation in Pseudomonas aeruginosa wound-colonized burned mice.
Bacterial translocation (BT) from the gastrointestinal tract has been proposed to play a role in the pathogenesis of septic complications in severely burned patients. In a burn model the effect of a subtherapeutic dose of polymyxin B-sulfate (PB) at BT was examined in Escherichia coli-monoassociated mice with Pseudomonas aeruginosa-inoculated burn wounds. The BT incidence and number of translocating microorganisms to the spleen (p less than 0.01), liver (p less than 0.01), lung (p less than 0.05) and heart (p less than 0.05) were diminished significantly in the PB-treated versus the untreated group. Endotoxin in plasma was detectable in one of the 16 PB-treated versus 6 of the 17 control mice (p less than 0.05). The relation of Pseudomonas burn wound inoculation, BT, endotoxin and the endotoxin-neutralizing properties of PB will be discussed.
Animals↗
Anterior column fractures of the acetabulum.
We retrospectively reviewed 20 patients at three to 19 years after displaced anterior fracture-dislocations of the hip. Eighteen of them were treated by traction, after ensuring that the femoral head was adequately reduced beneath the undisrupted part of the weight-bearing dome. Two required operation. Although none of the 18 conservatively treated fractures was reduced anatomically, the results were good in ten patients and excellent in the seven in whom the fracture did not involve the weight-bearing dome. We conclude that anterior column fractures have a favourable prognosis after conservative treatment.
Acetabulum↗
Trends in sports injuries, 1982-1988: an in-depth study on four types of sport.
In this study, we analyzed the records of both inpatients and outpatients which were treated for acute sports injuries in the Trauma Department of the University of Groningen (The Netherlands) during the years 1982 to 1988. We examined whether there was a trend in sports injuries in this time period. The study comprised four types of sports, i.e., soccer, volleyball, gymnastics, and martial arts. The absolutely highest rates of injuries across the seven years were found in soccer, followed by gymnastics, volleyball, and martial arts. Injuries sustained at participating in soccer, volleyball, and gymnastics involved for the major part the lower extremities, followed by injuries of the upper extremities, whereas the reverse pattern was observed for patients who participated in martial arts. For all four types of sport, the ankle and foot were the most frequently site of injury of the lower extremities. Sprains and strains were the major types of injury. Most injuries were seen at ages between 10 and 30 years. The ratio of male to female patients within age groups did not differ significantly across the seven years. We concluded that, except for martial arts, the increased participation in sports in the last decade was not accompanied with a change in the patterns of sports injuries by the patients' age, sex, and number and nature of the injury. This consistency in results can be used to guide the development of prevention programs aimed at a reduction of injuries in specific sports.
Adolescent↗
Interleukin-6 and its relation to the humoral immune response and clinical parameters in burned patients.
The cytokine interleukin-6, which has been shown to be increased in patients with burn injuries, is produced by activated monocytes and endothelial cells and has many in vitro activities, including stimulation of acute-phase protein synthesis in hepatocytes, immunoglobulin synthesis in B lymphocytes, and stimulation of growth of megakaryocytes. In 13 patients with a mean of 31% full-thickness burns, we studied the relation of serum interleukin-6 to clinical parameters and parameters of the acute-phase response and immunoglobulin production. Interleukin-6 was already elevated within hours after the injury was sustained, and it remained elevated for several weeks. All components of the acute-phase response were observed: fever, tachycardia, leukocytosis with an associated left shift, elevation of C-reactive protein and alpha 1-antitrypsin, and a decrease in albumin levels. In the second week after burn injury, immunoglobulin M levels peaked, followed by a prolonged elevation of immunoglobulin G levels. Thrombocyte counts initially decreased and rebounded to supranormal levels after 2 weeks. Interleukin-6 levels were positively correlated with acute-phase responses. We believe that the production of interleukin-6 induces the synthesis of acute-phase proteins. High interleukin-6 levels may also be an etiologic factor in the marked immunoglobulin response observed. Likewise, the relation between the megakaryocyte-promoting activity of interleukin-6 and the rebound thrombocytosis requires further investigation.
Adult↗
Alteration of wound colonization by selective intestinal decontamination in thermally injured mice.
The effects of selective intestinal decontamination on the bacterial colonization of burn wounds were investigated in experimentally burned mice. Prior to scalding pathogen-free mice were pretreated with bacitracin to induce intestinal overgrowth of Enterobacteriaceae. Mice treated for 20 days postburn with oral aztreonam had significantly reduced enterobacterial wound colonization compared to untreated controls. This study indicates that burn wound colonization is altered by selective decontamination of the intestinal tract.
Animals↗
Successful homografting in an elderly patient with extensive burns using his identical twin brother as skin donor.
A 60-year-old patient with 50 per cent body surface area (BSA) flame burns (of which 46 per cent were full skin thickness loss) was treated successfully with skin grafts taken from his identical twin brother to cover 20 per cent of the wounds. On theoretical grounds, it can be assumed that the period in hospital was reduced by 28 days. Blood for tissue and blood group typing should be taken at an early stage, before the patient is given a blood transfusion.
Body Surface Area↗
Operative treatment for acetabular fractures.
We report a retrospective study of 54 acetabular fractures treated by open reduction and internal fixation, with an average follow-up of 9.6 years (3 to 17). Reduction leaving displacement of less than or equal to 2 mm was achieved in 36 hips (67%); good or excellent functional results were obtained in 33 patients (61%). Early complications requiring re-operation included postoperative loss of reduction in one case and an intra-articular screw in another. Arthrodesis or total hip arthroplasty had been performed in 10 patients (19%) who had late symptomatic degenerative changes. Failure to obtain accurate reduction was the most important factor leading to a poor result, but heterotopic calcification caused poor results in seven patients, five of whom had had an anatomical reduction.
Acetabulum↗
Poly(ether urethane) wound covering with high water vapour permeability compared with conventional tulle gras on split-skin donor sites.
The experimental poly(ether urethane) (PEU) wound covering with a high water vapour permeance was compared with tulle gras treatment on adjacent areas of the same 20 split-skin donor sites. All patients experienced little or no pain from the PEU-covered areas, while 70 per cent of the patients complained of more pain from the tulle gras-covered areas. The PEU covering did not absorb the wound exudate underneath, neither did it retain wound fluid, but turned the wound exudate into a jelly-like clot layer by allowing a high evaporative water loss from the wound. Tulle gras treatment also prevented wound desiccation, but the exudate was absorbed into the overlaying cotton pads, where it became dry at the outer surface. Microscopy revealed that re-epithelialization occurred at a similar rate under the PEU covering as under tulle gras. In conclusion, the high water vapour permeable PEU wound covering prevents fluid retention, induces clotting of the wound exudate and reduces pain in split-skin donor sites. Tulle gras dressed with gauzes and crêpe bandage prevents wound desiccation, but causes more pain.
Adolescent↗
Attempted suicide by means of burns.
A study was made of the results of treatment of 57 patients who made 68 suicide attempts by means of burns in the period between 1979 and 1987. They formed 14 per cent of the total patient population older than 16 years of age. Attempted suicide was observed most frequently in patients between 20 and 39 years of age. The sex incidence was equal. Most patients were in contact with or had been in contact with mental health care institutions at the time of their attempt, half of the attempts took place in a psychiatric hospital. Twelve patients died, in nine the prognosis was considered to be so poor that in view of the seriousness of the burns or the accompanying injuries no treatment was initiated. Follow-up took place after an average 3.8 years (1-8.25 years). Information was obtained on all 45 surviving patients. Eight patients had died, six of natural causes and two had committed suicide. Eighteen patients were living at home, 13 were residents at a psychiatric hospital, three were living in a protective commune, two were being detained during Her Majesty's pleasure and one was in prison. It appeared to be difficult to incorporate these patients in a closed follow-up regimen.
Adult↗
Traumatic hemipelvectomy.
Traumatic hemipelvectomy is rare, and is usually accompanied by injury to the genito-urinary tract and bowel. Recently, there have been an increasing number of reports of patients who have survived this injury, probably as a result of improved early care. We report three such cases and review the literature. The amputation wound should not be closed initially; early re-exploration to remove any dead tissue is indicated, and this should be repeated as necessary.
Adult↗
Acetabular fractures in children and adolescents.
A retrospective study of 23 acetabular fractures in patients up to 17 years of age is presented, with an average follow-up of eight years. Good or excellent functional results were achieved in 21 patients; radiographic results were good or excellent in 16. Conservative treatment gave consistently good results in fractures with minimal initial displacement, stable posterior fracture-dislocations and Salter-Harris type 1 and 2 triradiate cartilage fractures. Less favourable results were seen in type 5 triradiate cartilage fractures and in comminuted fractures, but operation was no better. Unstable posterior fracture-dislocations and irreducible central fracture-dislocations need operative treatment but the results may still be unsatisfactory.
Acetabulum↗
Evaporative water loss and epidermis regeneration in partial-thickness wounds dressed with a fluid-retaining versus a clot-inducing wound covering in guinea pigs.
The effects of a new high vapour permeable poly-(ether urethane) (PEU) wound covering on evaporative water loss (EWL) and epidermis regeneration in partial-thickness wounds in guinea pigs were investigated and compared with an occlusive wound covering (OpSite) and air-exposed controls. It was also assessed whether the EWL reflected the phases of epidermis regeneration. In PEU-covered wounds, the initially raised EWL of 100 gm-2h-1 decreased in four days to 30 gm-2h-1, the same level as in occluded wounds. In control wounds this level was only reached after seven days, reflecting slower epidermis regeneration. The results showed that triphasic EWL behaviour corresponded to the sequence of wound healing. There was (1) a constant raised EWL until epidermal resurfacing is complete, (2) a fast EWL decrease during parakeratotic keratinization, and (3) a gradual normalization of the EWL during maturation of the stratum corneum. In wounds covered with OpSite this phasic EWL behaviour did not occur, owing to forced reduction because of the relatively impermeable covering. It was concluded that the PEU wound covering has an ideal water vapour permeance of 22.2 gm-2h-1 kPa-1, as can be seen in the accelerated epidermis regeneration and fast EWL reduction in partial thickness wounds in guinea pigs.
Animals↗
Motor cycle injuries in speed sport for youngsters.
In speedsport motorcycling for youngsters (6-16 years) is gaining an increasing popularity. We had the impression that there was an increase in the number of injured young motorcyclists. Therefore we studied the kind, cause and severity of the injuries sustained to 32 young motorcyclists treated in the Department of Traumatology of the University Hospital Groningen. This group consisted of 31 boys and one girl, aged 7 to 16, with an average age of 13.3. The severity of the injuries varied from sprain and strain of joints to compound bone fractures and twice a rupture of the liver. 29% of all patients were treated as in patients. Our conclusion from this study is that there was a considerable increase in number of injured young motorcyclists as well as in severity of the injuries. In this study we discuss some suggestions for accident prevention.
Accident Prevention↗