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Biomedical subjects

I Feller

Publications and source records attributed to I Feller.

At least 19 recordsLinked to original sources
PubMed1988

Rapid quantification of bacterial and fungal growth in burn wounds: biopsy homogenate Gram stain versus microbial culture results.

A prospective analysis of 370 burn wound biopsies was done to correlate Gram-stain results from biopsy homogenates with quantitative culture results. The number of bacteria seen in a total of 10 oil immersion microscope fields of Gram-stained homogenates was correlated with significant microbial growth (1 x 10(5) organisms/gram of tissue) of the same biopsy homogenate plated on trypticase soy agar. Of the biopsies examined, Gram-negative rods were present in 36.8 per cent, Gram-positive cocci in 49.7 per cent and yeast in 15.9 per cent. Mixtures of organisms were present in 24.3 per cent. When Gram stains showed one or more organisms per oil immersion microscope field, the correlation with significant microbial growth was 94.5 per cent or more. When five or more organisms were seen per field, the correlation with significant growth became 97 per cent or greater. When no organism was seen on Gram stain, the cultures grew significant numbers of organisms 19.1 per cent of the time or less. This false-negative rate was considered to be high. It is believed, however, that this method of early detection of significant burn wound microbial growth may prove to be valuable in the management of severely burned patients.

Agar↗
PubMed1987

Gastrointestinal haemorrhage in burn patients.

Gastrointestinal haemorrhage after burn injury remains a potentially lethal problem. A retrospective review of 3852 burn patients over 15 years revealed an incidence of gastrointestinal haemorrhage of 2.2 per cent and a mortality of 0.16 per cent. This low incidence of haemorrhage and mortality can be directly related to an aggressive prophylactic treatment with antacid and titration of the gastric pH to 5.5 or above. With this aggressive management programme, few operative procedures were required. A review of autopsy data showed that the site of haemorrhage was distributed throughout the gastrointestinal tract with the predominant site being the stomach.

Adolescent↗
PubMed1987

The National Burn Information Exchange. The use of a national burn registry to evaluate and address the burn problem.

The NBIE, a voluntary registry of specialized burn-care facilities that was founded in 1964, currently has 50 active participants representing 35 per cent of the nation's hospital beds for burned patients. Participating physicians submit information on the initial hospitalization of emergent and acute burn patients and, separately, on the reconstruction process for these patients. As of January 1986, a total of 94,594 patient's data are on file from 130 hospitals; 13,671 of these are reconstructive and 80,923 emergent and acute admissions. Information concerning new patients is submitted at a rate of about 6000 patients annually. The data are analyzed using INQUIRE, an original data retrieval system. Data on treatment methods and outcome have been used to establish baseline standards for the burned patient's care and survival. In addition, these data have been used to document institutional differences in mortality rates and indicate methods used by the more successful hospitals. The data also are being used to describe the long process of recovery from severe burns and to monitor changes in outcomes of burn accidents continually. The result of these analyses has been documentation of an overall improvement in survival and decline in hospitalization times at all levels of burn severity. Data also can be used with institution-specific data to look at organizational variables affecting survival. Use of this epidemiologic data allows prevention projects to be targeted at the groups at greatest risk. A newer application looks at the equity of the HCFA prospective payment system based on the DRGs assigned to burn severity. The NBIE is an example of how a voluntary, national registry, properly computerized and effectively managed, can contribute to resolving the problem it was established to study. The NBIE has been useful in increasing the understanding of health professionals and government decision makers of a complicated disease process. It has had a direct effect on the quality of patient care and on the process of controlling the incidence of burn injuries.

Adolescent↗
PubMed1987

A ten-year review of Candida sepsis and mortality in burn patients.

A retrospective analysis of Candida sepsis was carried out in 1722 burn patients admitted to this center from 1975 to 1984. Cultures were positive for Candida in 233 (13.5%) of these patients during their hospitalization. Candidemia was present in 70 (4.0%) of the 1722 patients. Of the 70 patients with candidemia, 38 (54%) died. However, only 11 patients (15.7%) died of Candida sepsis or mixed Candida and bacterial sepsis (less than 1% of the total patient population). The remaining 27 patients who had candidemia died of bacterial septicemia or organ system failure. The low incidence of Candida and the low incidence of mortality due to Candida was attributed to a comprehensive program of prevention, detection, and treatment. Early initiation of treatment with amphotericin B was an important aspect of the program.

Adult↗
PubMed1986

Use of amnion for the treatment of Stevens-Johnson syndrome.

Stevens-Johnson syndrome (toxic epidermal necrolysis) has similar pathophysiologic characteristics to extensive partial-thickness burns. Successful treatment of a 6-year-old with this syndrome denuding 95% of her body surface, with 6.5 square feet of amnion is reported.

Amnion↗
PubMed1986

Horizons in burn care.

The renaissance of burn care began during World War II. From 1960 to the present there has been a rapid advance in burn medicine that has resulted from a better understanding of the emotional, physical, and physiologic problems occurring in the severely burned individual. Now, even the most severely burned have an excellent chance of returning to a functioning, useful place in society. We foresee continued improvements in the organization and delivery of burn care and the results therefrom.

Burn Units↗
PubMed1984

Major burns during pregnancy: effects on fetal well-being.

The authors reviewed the fetal outcomes for 30 pregnant patients who required hospitalization for burns that involved 11 to 97% of the total body area. A positive relationship was found between the percentage of maternal total body burn and maternal mortality, fetal mortality, and premature delivery. Premature delivery and/or fetal mortality occurred primarily within the first five days and followed maternal complications of hypovolemic shock, sepsis, or respiratory insufficiency. In the eight cases in which maternal injury became lethal (20 to 97% total body burn), all fetuses were born spontaneously before maternal death, but seven were stillborn. After overcoming the immediate postburn period, a healthy-appearing term-size infant was likely to be born while the mother continued to receive intensive therapy. The ideal treatment to protect the fetus has not yet been determined.

Abnormalities, Multiple↗
PubMed1983

Mortality differences and speed of wound closure among specialized burn care facilities.

Burn patient mortality rates at 11 major American burn care units were investigated and were found to differ substantially after carefully adjusting for patient mix at each participating burn facility. The adjusted mortality rates differed by as much as a factor of two. Institution speed of full-thickness burn wound closure was found to be significantly associated with mortality experience, with lower mortality associated with quicker wound closure. The data analyzed were from the National Burn Information Exchange (12,000 cases).

Adolescent↗
PubMed1983

Burns and pregnancy.

Pregnancy does not predispose to thermal injuries. Most burns are minor, and erythema usually subsides within 24 hours during the outpatient therapy. Severe burns during pregnancy are rare but alarming events. Care should be provided at a regional facility with expert burn care and fetal monitoring. Attempts should be undertaken during maternal transport to avoid hypovolemia, hypotension, and hypoxia. The wound should be covered with sterile dressings to prevent further contamination. Maternal and fetal survival is directly related to the extent of the body surface injury. When maternal injury is lethal, fetal survival is very unlikely because of sudden in-utero death or complications from prematurity following spontaneous labor. Complications to be considered during the emergent and acute phases of recovery include fluid and electrolyte imbalance, respiratory difficulties, systemic and wound infection, inadequate nutrition, and emotional disturbances. Therapy should be directed to saving the mother. Whether fetal well being is compromised by the burn and resultant therapy is difficult to determine from prior published reports. Periodic ultrasonic examination and biophysical testing of the fetus are recommended. If conditions are considered unfavorable to meet fetal circulatory and oxygen demands, prompt delivery during the late second and third trimesters has been advocated if the mother's burn covers 50 per cent or more of the surface area. If the patient has instead recovered satisfactorily and there has been no evidence of fetal jeopardy or premature labor within the first week following the burn injury, the eventual delivery of a healthy-appearing, term-sized fetus is quite likely.

Bacterial Infections↗
PubMed1976

Baseline results of therapy for burned patients.

Baseline results of therapy for burned patients have been determined. The data (21,000 cases) from the National Burn Information Exchange have been analyzed by probit analysis to determine survival as it is influenced by the size and death of the burn, age and sex of patients, topical agents, and the institution providing treatment. The results demonstrate that survival is influenced by the size and depth of the burn; that there is increased survival of males, compared to that of females; that five differnent age categories can be identified that influence survival; that the topical agent used has little effect on survival; and that there is a significant difference in survival when the institution providing the treatment is considered.

Administration, Topical↗
PubMed1976

Effect of cyclophosphamide on the immune response to Pseudomonas aeruginosa in mice.

Natural resistance in mice to Pseudomonas aeruginosa was decreased 10-fold with a single dose of 300 mg of cyclophosphamide (CY) per kg intraperitoneally. Mice were resistant to infection when immunized actively with Pseudomonas vaccine or passively with Pseudomonas immune serum before receiving CY. Syngeneic spleen, thymus and/or bone marrow cells were transfused into CY-treated recipient mice. Protective anti-Pseudomonas antibody was elicited in the recipient mice when they were vaccinated 1 day after receiving normal spleen cells and challenged 8 days after vaccination. When 1.6 X 10(7) normal thymus and bone marrow cells were infused before vaccination, 69% of the recipients of both cell preparations responded serologically compared with 15 and 27% of those receiving either thymus or bone marrow cells, respectively. CY-treated thymus or bone marrow cell recipients were resistant to Pseudomonas infection when 6 X 10(7) of either cell population was transfused.

Animals↗