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Biomedical subjects

J L Hunt

Publications and source records attributed to J L Hunt.

16 recordsLinked to original sources
PubMed1992

The elderly burn patient.

During a 16-year period, 547 patients who were older than 64 years of age with a mean total body surface area (TBSA) (third-degree burns) of 25% were treated. Etiologies were flame/flash in 81% of patients, scald in 11%, solids in 7%, and electrical/chemical in 1%. Seventeen percent of patients had significant causal factors. An inhalation injury was present in 13% of patients, and the mortality in these patients was 100%. Burn excision was performed 239 times in 165 patients. The majority of excisions were for full-thickness burns. Excision did not improve overall survival in patients with third-degree burns of 0% to 10%, but the length of stay (LOS) in excised and nonexcised survivors was improved (9 versus 21 days, respectively). The LOS and survival were not significantly different in patients with burns between 11% and 20%. Postburn complications occurred in 28% of patients. Overall mortality was 50% (mean age: 77 years; TBSA: 40%). There were no survivors with over 47% TBSA burns. The leading cause of death was pulmonary sepsis. Most surviving patients returned to a satisfactory lifestyle after discharge.

Aged↗
PubMed1992

Acute trauma of the femoral artery and vein.

Between 1974 and 1991, 233 patients were treated for 321 confirmed femoral vascular injuries. There were 112 patients (48%) with isolated arterial injuries, 36 (15%) with isolated venous injuries and 85 (36%) with combined arterial and venous injuries. Injury to the concomitant superficial or common vessels occurred in 27 (8.3%) and 9 (1.7%) patients, respectively. Associated extremity injuries included bone, 15%; soft tissue and muscle, 11%; and nerve, 7%. Sixty patients (26%) had fasciotomies. Arterial thrombosis occurred in five superficial repairs. Eighteen repaired veins thrombosed--eight of 61 simple (lateral venorrhaphy) and ten of 50 complex repairs. Thirty-four percent of patients with a repaired venous injury had clinical evidence of postoperative venous morbidity--deep vein thrombosis (DVT), edema, pulmonary embolus. Six patients (2.5%) had a documented pulmonary embolus--four in the 18 patients (22%) with clotted venous repairs. Eleven patients (4.7%) underwent an amputation. Five of the amputations were in patients with either inadequate or delayed fasciotomy. An inadequate fasciotomy was equally as deleterious as a delayed fasciotomy in terms of outcome. Six of 27 limbs (22%) with a femur fracture required an amputation. There were six deaths. Acute limb morbidity was related to the extent of associated limb trauma, i.e., soft-tissue, nerve, and bone damage. Chronic morbidity was related to neurologic deficits and venous sequelae. Vascular injury to the femoral vessels was associated with a high morbidity but low mortality.

Adolescent↗
PubMed1991

Paranasal sinusitis in burn patients following nasotracheal intubation.

Paranasal sinusitis is a complication of nasotracheal intubation. Of 99 nasally intubated adult patients who survived 48 hours after being burned, 22 who were intubated for more than 7 days underwent a computed tomographic scan of all paranasal sinuses, with timing dictated by the patient's clinical condition. Eight patients had computed tomographic and clinical findings consistent with sinusitis. Treatment consisted of removal of all nasal tubes, oral and topical nasal decongestants, and, when appropriate, culture-specific antibiotics. A subgroup of patients with preexisting sinus disease made up 50% of the patients with sinusitis; early conversion to an oral airway or a tracheostomy should be considered in such patients. Only one patient required surgical drainage of the sinuses. The frequency and morbidity of sinusitis in nasotracheally intubated burn patients does not justify the risk of routine conversion to an oral airway.

Adolescent↗
PubMed1991

Placement and complications of monitoring catheters.

Vascular access is a necessary evil in critically ill patients, a population that is at high risk for complications. Appropriate planning and attention to detail minimize the associated risks while maximizing the benefits derived from catheter use.

Catheterization↗
PubMed1979

Early tangential excision and immediate mesh autografting of deep dermal hand burns.

Thermal injuries to the hand constitute not only one of the most common burns, but one of the most difficult for the burn surgeon to treat. Early wound closure is mandatory if maximum functional return is to be attained and scarring minimized. Over the last three and one-half years, 60 patients with deep dermal dorsal hand and finger burns were treated by tangential excision and immediate mesh autografting. All patients were admitted to the hospital within 24 hours of injury and excision was performed between the third to the tenth post burn day. Operative technique consisted of sequential eschar excision using the Humby knife or Goulian-Weck dermatome until viable dermis was visible. Mesh autograft, ratio 1 to 1(1/2) without expansion, was applied. There was 100% graft take in all but four hands. Hand function with full range of motion returned by the tenth postoperative day. Complications were minor. Patient follow-up ranged from six months to three and one-half years. No patient has required subsequent surgery for scar revision or contracture release. Range of motion in all patients has been excellent and all patients have continued to maintain normal hand function. The cosmetic appearance has been good except for the early "mesh" appearance of the graft which has become less apparent with time. In summary, early tangential excision and immediate mesh autografting of deep dermal dorsal hand burns has fulfilled the following burn principles-preservation of tissue, prevention of wound infection, maintenance of function and early wound closure.

Adolescent↗
PubMed1979

Late false aneurysm of the carotid artery: repair with extra-intracranial arterial bypass.

A patient with a rapidly enlarging symptomatic false aneurysm of the internal carotid artery 30 years after nonoperative treatment of a penetrating neck injury is presented. Preoperative compression of the aneurysm precipitated transient cerebral ischemic attacks. Complete interruption of the right internal carotid artery inflow during aneurysmectomy was considered to be fraught with great danger. An extra-intracranial arterial bypass was therefore performed, and then aneurysmorrhaphy was easily performed and saphenous vein graft interposition accomplished. The importance of early definitive treatment of arterial injuries is emphasized. The bypass used allowed additional cerebral blood flow when complete occlusion of the carotid artery was contraindicated.

Aneurysm↗
PubMed1979

Liquid propane cold injury: a clinicopathologic and experimental study.

A case of liquid propane cold injury is described. This injury was produced by evaporative heat loss, without ignition, from skin and underlying tissues. The cutaneous appearance was that of a flame burn but underlying deep tissue damage was present. Acute vascular compromise and progressive wound sepsis were complications which required surgical intervention. A liquid propane animal model was created which defined the pathophysiology of the clinical injury. The potential for this injury exists wherever volatile liquified gases are used.

Adolescent↗
PubMed1978

Unusual intra-abdominal metastases from carcinoma of the lung.

Eleven patients with bronchogenic carcinoma underwent surgical treatment of metastatic abdominal visceral lesions. Successful surgical palliation was achieved in nine. In eight patients intraabdominal metastasis marked the first clinical sign of spread of the primary tumor outside the chest. The longest interval following diagnosis of the primary lung lesion and the appearance of the abdominal symptoms due to metastatic disease was three and one-half years.

Abdominal Neoplasms↗
PubMed1976

Use of 133xenon in early diagnosis of inhalation injury.

133Xenon lung scanning post-thermal injury was used to detect inhalation injury in 86 patients admitted to the United States Army Institute of Surgical Research during 1974. Inhalation injury was indicated by the 37 (43%) positive scans. Based on all available clinicopathologic evidence, 11 (13%) of the scans were erroneous with seven (8%) falsely positive and four (5%) falsely negative. Eighty-six per cent of the scans were "appropriate." Addition of bronchoscopy and/or pulmonary function testing appeared to improve diagnostic accuracy. By using any pair of tests, falsely negative diagnoses were virtually eliminated. Inhalation injury, as expected, had an adverse effect on survival rates. The group of patients whose expected mortality lay between 40 and 59% were most notably affected. One hundred per cent (five of five) of those with inhalation injury died; only one of eight without inhalation injury died.

Bronchoscopy↗
PubMed1976

The pathophysiology of acute electric injuries.

Results of the present investigation indicate that an electric burn is simply a thermal injury. The tissue damage associated with an electric injury occurs when electric energy is converted to thermal energy or heat. An electric burn is self limiting: once the current arcs, no further skin and muscle damage is possible because amperage falls to zero. Tissue temperature is the critical factor in determining the magnitude of tissue injury before the current arcs. With the exception of skin resistance, resistances of individual tissues seem not relevant to amount of tissue damage in electric injuries. Living tissue acts as a volume conductor; once skin resistance has been overcome all internal tissue resistance, with the exception of bone, is negligible to current flow. In the present study the volume of tissue traversed by the electric current was more closely related to the extent of tissue injury than the internal resistance of the individual tissues. Muscle injury occurred at the time of initial thermal insult and progressive or de novo muscle necrosis was not seen in this model.

Acute Disease↗
PubMed1976

Electrical injuries of the upper extremity.

Although electrical burns of the upper extremity comprise a small percentage of all thermal injuries, they present formidable clinical problems. The physician must not be lulled into a false sense of security because the visible cutaneous burn is not great. Sound surgical principles, such as the control of bacterial proliferation with topical chemotherapy, débridement of dead tissue, and timely wound closure, in conjunction with the expertise necessary in caring for thermally injured patients, are necessary for a maximally rehabilitated patient.

Adolescent↗
PubMed1975

Fiberoptic bronchoscopy in acute inhalation injury.

Fiberoptic bronchoscopy proved to be a simple, safe, and accurate method of diagnosing acute inhalation injury. Both the anatomic level and the severity of large airway injury were easily identified. The identification of a supraglottic and infraglottic component to inhalation injury was not only helpful in determining the appropriate therapy but also in predicting ultimate pulmonary complications. When bronchoscopy was used in conjunction with the 133Xenon scintiphotoscan, both large and small airway injuries could be identified. The only clinical situation where bronchoscopy failed to identify an inhalation injury was in the immediate postburn period if the patient wasin hypovolemic shock. In this particular clinical circumstance the characteristic mucosal alterations may be absent; yet if bronchoscopy is performed after hypovolemic shock has been corrected, mucosal changes characteristic of inhalation injury will be seen.

Acute Disease↗
PubMedDate not supplied

Ocular changes from electrical burn injuries. A literature review and report of cases.

One hundred fifty-nine consecutive patients with high-voltage burns were retrospectively reviewed to determine the ocular sequelae of these injuries. Five patients had ophthalmic changes (two had recurrent iritis, eight had cataracts, two had macular holes, and one had central retinal artery occlusion). All four patients with cataractous changes had characteristic anterior subcapsular opacifications, except for one patient who presented with a dense white opacified lens. All had bilateral lenticular changes in which the denser cataract developed earlier than the contact wound and ipsilateral to it. Central retinal artery occlusion has not been previously reported as a complication of electrical burns. Macular holes, formerly believed to be rare in these injuries, were found in two of the five patients. Ocular complications from electrical burn injuries are uncommon. Although a number of these ocular changes occur immediately after injury, many of the visually impairing changes develop days and even years after a severe electrical burn injury; thus, careful follow-up is mandated.

Adult↗