"Flaming Dr. Pepper"--another cause of recreational burn injury.
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Adolescent↗
Biomedical subjects
H N Himel
Publications and source records attributed to H N Himel.
Frostbite of the face after recreational misuse of nitrous oxide.
Exposure of the skin to nitrous oxide, a liquified gas stored under pressure in a cylinder, can occur in anaesthesiologists and in those involved in recreational misuse of the gas. A case is reported of a man who presented to the emergency department after sniffing nitrous oxide and sustaining frostbite injury to his left cheek. Conservative management of this injury allowed spontaneous separation of the necrotic tissue and healing of the granulating wound by contraction.
Facial Injuries↗
Severe burn injury from recreational gasoline use.
This report describes the case of a 13-year-old boy who suffered severe burns with inhalation injury during the recreational use of gasoline. Gasoline sniffing is a popular form of solvent abuse for young children and adolescents in isolated, rural communities. In addition to the neurological and physiological complications of gasoline inhalation, gasoline sniffers face the significant threat of severe burn injury or death resulting from ignition of the gasoline vapor as well as from extensive physical contact with the constituents of liquid gasoline.
Adolescent↗
Bilateral amputations following hydrotherapy tank burns in a paraplegic patient.
Hydrotherapy is an important part of wound care and physical therapy. The benefits of hydrotherapy are derived from water's cleansing ability, buoyancy, drag, inertia and temperature. If the temperature of the water is not adequately controlled, an immersion scald burn can occur. A paraplegic patient who was receiving hydrotherapy for treatment of his malleolar ulcers sustained immersion scald burns that ultimately necessitated below-the-knee amputations.
Adult↗
Surgeons', nurses' and bereaved families' attitudes toward dying in the burn centre.
Because death of a patient is one of the most emotionally disruptive events in the health professionals' life as well as the bereaved, it was hypothesized that surgeons' and nurses' attitudes in the burn centre would interfere with their emotional support of the bereaved family. Consequently, we performed a psychometric assessment of the surgeons', nurses' and bereaved families' attitudes about death and dying in the burn centre. A psychometric instrument was developed and validated that assessed 13 surgical directors' of burn centres, 13 burn nurses' and nine bereaved family members' attitudes on death and dying in the burn centre. In the case of the bereaved family member, this instrument was complemented by interviews to ensure that the respondents understood each question. All surgeons and nurses were experienced health professionals working for an average of 12 +/- 8 years and 3 +/- 1 years respectively. The majority of burn surgeons (six) and the burn nurses (seven) found it to be emotionally difficult to support emotionally the bereaved family after the death of the patient. Over half the burn surgeons (seven) and nurses (seven) felt that the process of dealing with the bereaved family was different from that experienced in other hospital settings. The surgeons attributed this difference to the long duration of the patients' illnesses, while the nurses felt that it was due to the traumatic and painful qualities of burn injury. These emotional difficulties experienced by the staff in dealing with the dying patients were associated with a relatively low frequency of contact with the bereaved families after the patients' death.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Biomechanical performance of a disposable graft stapler with absorbable skin tacs.
A stapler has been specially designed for fixing skin grafts to the underlying wound. The stapler has a loading unit which can be reloaded with cartridges of absorbable tacs. Each tac is made of a polymer which is biocompatible with tissue. The stapler ejects the tac into the graft, reliably securing it to the underlying tissue. The force and work required to eject the tacs were significantly less than that needed to form the metal staples. The most obvious advantage of the tac is that the majority of the tacs spontaneously extrude after the first dressing change. The performance of the disposable graft stapler with absorbable skin tacs has been compared to that of the disposable skin stapler with metal staples.
Biocompatible Materials↗
Non-insulin-dependent diabetes mellitus: diagnostic and therapeutic challenges in the severely burned patient--a case report.
The purpose of this paper is to describe the management of a previously undiagnosed non-insulin-dependent diabetic patient with a severe burn injury. The hyperglycaemia and glucose intolerance following burn injury was complicated by the hyperglycaemia of diabetes mellitus. Intravenous insulin infusion monitored by hourly glucose levels was required to manage this hyperglycaemia. During day 11 postburn injury, this patient required 2104 units of insulin to control his hyperglycaemia. Aggressive detection and management of infections complemented by early debridement and coverage of the burn wound were other important considerations in the management of this patient. The diagnosis of non-insulin-dependent diabetes mellitus (NIDDM) was made after the patient recovered from his burn injury. His rehabilitation programme has included primary prevention strategies for NIDDM that focus on health-improving behaviours such as improved diet, exercise, and weight control.
Adult↗
The use of recombinant human erythropoietin and cultured epithelial autografts in a Jehovah's Witness with a major thermal injury.
Haemostatic debridement, recombinant-human erythropoietin and cultured epithelial autografts have been used successfully in a Jehovah's Witness with a major burn injury. Tourniquet ischaemia complemented by a topical haemostatic agent minimized excisional blood loss, while recombinant-human erythropoietin accelerated erythropoiesis, thereby correcting postburn anaemia. Cultured epithelial autografts provided coverage of the granulating wounds without creating donor sites.
Adult↗
Herpesvirus infections in burn patients.
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Animals↗
A new device for securing meshed split-thickness skin grafts.
This report describes the design, operation, and biomechanical performance of the Auto Suture Multifire Graftac-S disposable surgical staplers and absorbable tacks. The performance of this reloadable stapler has been compared to that of the Auto Suture Multifire Premium disposable skin stapler. The Premium stapler forms stainless steel staples to close the wound. The Graftac-S ejects absorbable tacks into the graft from a cartridge, which can be reloaded during a single operation. In two clinical trials of 10 patients each, the Graftac-S delivered absorbable tacks which were biocompatible and successfully secured the graft to the wound. The most obvious advantage of this device is that it obviates the need to remove the staples from the wound later. By the tenth postoperative day, about 90% of the tacks had extruded spontaneously, thereby reducing the amount of postoperative care required; discomfort to the patient during removal of the stainless steel staples is eliminated.
Biocompatible Materials↗
New advances in automatic disposable rotating cartridge skin staplers.
This report describes the design, operation, and mechanical performance of Auto Suture Multifire Premium disposable skin staplers and staples in a biomechanical laboratory investigation and a clinical evaluation. The performance of this reloadable stapler has been compared with that of a new disposable skin stapler with a rotating cartridge, the Proximate RH stapler. The latter exemplifies a disposable skin stapler whose cartridge cannot be reloaded. The Auto Suture Multifire Premium disposable skin stapler has been designed so that its cartridge can be reloaded during a single surgical procedure. The most obvious advantage of this new device is that it substantially reduces the cost of skin stapling during surgery. Another unique benefit of this stapler is that it can accommodate either regular or wide staples, allowing the surgeon to use both size of staples without discarding the stapler. On the basis of this investigation, the Auto Suture Multifire Premium disposable skin stapler is recommended for skin incision and graft closure, since it provides maximal visualization of the wound as well as the staple during its formation. It delivers the staple into the skin or skin graft so that the topspan of the staple is above the skin or wound surface. In addition, the Auto Suture Multifire Premium disposable skin stapler has a prepositioning (precocking mechanism) that is controlled by the surgeon with minimal force, a mechanism which allows the stapler to hold its staple securely, even when its pointed legs extend beyond the delivery end of the stapler. The force required to form its staples is so low that the surgeon can staple repetitively without fatigue.(ABSTRACT TRUNCATED AT 250 WORDS)
Disposable Equipment↗
Electrical burn injuries of workers using portable aluminium ladders near overhead power lines.
The use of aluminium ladders around high voltage power lines has resulted in a significant number of electrical injuries and electrocutions. Workers often misjudge wire distances or lose control of fully extended ladders, thereby exposing themselves to electrocution hazard. High-voltage electrical burns of two workers using an aluminium ladder that contacted a high voltage power line are reported. The circumstances surrounding the injury, the clinical management of the case, and the methods of prevention are presented and discussed.
Accidents, Occupational↗
Salvage of a patient with burn inhalation injury and pancreatitis.
A multidisciplinary approach by the staffs of the Emergency Department and the Regional Burn Center saved the life of a burn patient with an inhalation injury and pancreatitis. This successful treatment is attributed to ventilatory management using fibreoptic bronchoscopy in the Emergency Department, followed by burn eschar excision with coverage by cultured skin and non-operative management of an enlarging pseudocyst by percutaneous transgastric drainage.
Adult↗
Mechanical performance of surgical needle holders.
A new quantitative measurement of surgical needle holder performance has been described that records the forces (clamping moment) applied by the needle holder jaws to curved surgical needles. This test has been used to determine the applied clamping forces of four different surgical needle holders made by one manufacturer. By relating the magnitude of the clamping moment of needle holder to the resistance to bending of curved surgical needles, we propose a new scientific basis for selecting surgical needle and needle holders for wound closure.
Elasticity↗
Infected breast reconstruction associated with Poland's syndrome.
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Adult↗
Effect of the timing of tourniquet release on postoperative hematoma formation: an experimental animal study.
There is a controversy over when to release a pneumatic tourniquet after completing a hand surgical procedure. To study this controversy, we performed a standardized operation with tourniquet inflow occlusion on both lower legs of a series of rabbits. Total tourniquet time and the procedure performed, including intraoperative Bovie electrocautery of actual and potential bleeding points identified with 2.5 X loupe magnification, were identical on the two sides, except for the method of tourniquet release. On one leg, the tourniquet was released and all new bleeding points were controlled prior to wound closure. On the other leg, the tourniquet was released after the wound had been closed and dressed. Animals were injected with technetium-99m-labeled red blood cells and scanned to measure hematoma formation. Qualitatively, we observed more label in the leg whose tourniquet was released after wound closure in 17 of the 20 animals (p less than 0.005). Quantitatively, we also measured more mean label in the leg whose tourniquet was released after the wound was closed (p less than 0.001). Tourniquet release after wound closure was associated with greater hematoma formation.
Animals↗
Adjuvant chemotherapy for breast cancer. A pooled estimate based on published randomized control trials.
The use of adjuvant chemotherapy for treating patients with operable breast cancer remains a worldwide controversy. Using the data from published randomized control trials with a minimum two-year follow-up, pooled estimates of relapse-free survival rates and overall survival rates were calculated. Relapse-free survival rates were improved by 12.5% (95% confidence interval [CI] +/- 4.5%) at three years and by 8% (CI +/- 6%) at five years, with studies using multiple agents showing a greater effect. A significant advantage was also present in overall survival rates at three years, but only for studies involving multiple agents (4% +/- 3.5%). Results from combining data for other types of trials were inconclusive. The use of this method is presented to illustrate its value as an explicit and systematic one for combining data from several randomized control trials in assessing a therapeutic controversy.
Antineoplastic Agents↗
A quality assessment of randomized control trials of primary treatment of breast cancer.
The methodology of randomized control trials (RCTs) of the primary treatment of early breast cancer has been reviewed using a quantitative method. Sixty-three RCTs comparing various treatment modalities tested on over 34,000 patients and reported in 119 papers were evaluated according to a standardized scoring system. A percentage score was developed to assess the internal validity of a study (referring to the quality of its design and execution) and its external validity (referring to presentation of information required to determine its generalizability). An overall score was also calculated as the combination of the two. The mean overall score for the 63 RCTs was 50% (95% confidence interval [CI] = 46% to 54%) with small and nonstatistically significant differences between types of trial. The most common methodologic deficiencies encountered in these studies were related to the randomization process (only 27 of the 63 RCTs adopted a truly blinded procedure), the handling of withdrawals (only 26 RCTs included all patients in the analyses), the description of the follow-up schedule (only 12 RCTs reported adequately), the report of side effects (adequate information given in 33 RCTs), and the description of the patient population (satisfactory in 29 RCTs). Telephone calls to the principal investigators improved the quality scores by seven points on a scale of 100, indicating that some of the deficiencies lay in reporting rather than performance. There was evidence that quality has improved over time and that the increasing tendency of involving a biostatistician in the research team was positively associated with the improvement of the internal validity but not with the external.
Breast Neoplasms↗