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Biomedical subjects

J R Saffle

Publications and source records attributed to J R Saffle.

At least 55 records · Page 3Linked to original sources
PubMed1984

The effect of plasma exchange on lymphocyte suppression after burn.

Circulating mediators have been implicated in the pathophysiology of immunodepression after burn injury, suggesting the beneficial effect of plasma exchange in immunorestoration. In this study, 19 adult patients with a mean burn size of 52.2% of total body surface area and mean age of 33.4 years underwent 51 plasma exchange procedures in five different clinical settings, without complication. The suppressive effect of burn serum was assayed in mixed lymphocyte cultures. The mean (+/- SEM) suppression by burn serum drawn prior to plasma exchange was 61.9% +/- 3.6%, while that following plasma exchange was 27.3% +/- 2.7%. The lymphocyte response decrease 55.1% +/- 4.4% in suppressive activity. The mean duration of improvement in lymphocyte function was 4.8 days. Plasma exchange has a significant beneficial effect in restoring lymphocyte immunocompetence in burned patients in a number of clinical settings.

Adolescent↗
PubMed1984

Cimetidine kinetics during resuscitation from burn shock.

Severely burned patients suffer from rapidly changing metabolic and hemodynamic abnormalities that could alter drug kinetics. The kinetics of cimetidine, commonly used in the prophylaxis of acute stress erosions, were studied during fluid resuscitation of 11 patients with mean burn sizes of 45% total body surface area. Six patients were studied after the completion of fluid resuscitation. Total clearance, steady-state volume of distribution, and cimetidine t1/2 did not change between the early period after burn and after fluid resuscitation, but before the completion of fluid resuscitation patients had lower renal and greater nonrenal cimetidine clearance than after resuscitation. The increase in nonrenal cimetidine clearance resulted in decreased urinary recovery of unchanged drug, 50.7 +/- 14% during fluid resuscitation and 81.0% +/- 6% after resuscitation.

Adult↗
PubMed1984

Transaminase elevations in patients receiving bovine or porcine heparin.

Eighty-six patients who required heparin therapy were randomly assigned to receive bovine or porcine heparin. Abnormal concentrations of alanine transaminase and aspartate transaminase developed during treatment in 59.3% and 26.7% of patients, respectively. Patient characteristics that significantly influenced the development of abnormal alanine transaminase concentrations were male sex and higher baseline enzyme values. Transaminase concentrations returned to normal in 80% of patients after heparin therapy was discontinued and in 20% during therapy. Analysis of transaminase concentrations in all 86 patients showed that 95% had some increase in enzymes during treatment. Mean maximal increase over baseline for all patients was 3.6 for alanine transaminase and 3.1 for aspartate transaminase (range, 1.0 to 15). Lactate dehydrogenase concentrations became abnormal in 35.7% of patients. Lactate dehydrogenase isoenzyme determinations in 6 patients showed elevated hepatic fractions. No clinical symptoms of hepatic dysfunction were seen.

Adolescent↗
PubMed1984

The effect of exchange therapy on postburn lymphocyte suppression.

Circulating mediators have been implicated in the pathophysiology of postburn immunologic depression, suggesting the restorative potential of exchange therapy. Previous reports have stressed the immunosuppressive effects of massive transfusions and major surgical procedures. The effect of plasma exchange (PLA/EX) and surgical excision and grafting (E/G) procedures on postburn lymphocyte function was evaluated retrospectively in one-way mixed lymphocyte reaction assays. Twenty one adult patients with a mean total body surface area (TBSA) burn of 52.6% underwent a total of 54 PLA/EX procedures without complications. The mean volume of plasma exchanged was 5079 ml. PLA/EX was performed at a mean time of 10.4 days after burn injury. Thirty adult patients with a mean TBSA burn of 42.8% underwent a total of 78 E/G procedures. The mean graft size was 2373 cm2 per E/G procedure or 7.25% TBSA. The mean transfusion requirement per E/G was 3355 ml. The initial E/G occurred at a mean of 7.5 days after burn injury. PLA/EX decreased suppression of normal lymphocyte blastogenesis by burn serum from 62.7% to 28.3% (p less than 0.001). The mean duration of improvement in lymphocyte function was 4.8 days. Similarly, the mean suppression by burn serum drawn pre-E/G was 42.2%, while serum suppressive activity post-E/G was 29.1% (p less than 0.05). The mean duration of mixed lymphocyte reaction improvement was 5.0 days. Both PLA/EX and E/G procedures have a significant beneficial effect in restoring lymphocyte function in burn patients.

Adolescent↗
PubMed1984

Exchange transfusion therapy in pediatric burn shock.

Irreversible burn shock, which persists despite fluid resuscitation, remains a significant cause of early mortality in thermally injured children. Since circulating serum factors have been implicated in the pathophysiology of burn shock, the use of exchange transfusion therapy was analyzed retrospectively in children filing to respond to conventional volume therapy during burn shock. Seven children with a mean burn size of 42.9% and a mean age of 3.2 years underwent exchange transfusion for ongoing burn shock after standard resuscitation failed. A therapeutic response was documented in all patients, characterized by a sharp decrease in fluid requirements from a mean of 332% of the predicted hourly volume to calculated requirements by 2.9 hr following exchange. Markedly improved urine output and resolution of lactic acidosis were also demonstrated. All patients recovered from shock with one late mortality. Exchange transfusion therapy facilitates resuscitation from burn shock in children who do not respond to conventional volume therapy.

Burns↗
PubMed1984

Creatine kinase and lactate dehydrogenase isoenzymes in serum of patients suffering burns, blunt trauma, or myocardial infarction.

Medical records of 53 burn and trauma patients were reviewed to assess the possibility of myocardial damage. Except for electrophoretically detectable creatine kinase MB isoenzyme, none showed evidence of myocardial injury. Lactate dehydrogenase isoenzyme tests, electrocardiograms, myocardial pyrophosphate scans, clinical course, and results of (two) autopsies were all negative for myocardial necrosis or ischemia. Types of patient, number, mean peak value (U/L) for serum creatine kinase, and ranges of percentage MB isoenzyme were as follows. Burns from direct electrical contact: 28, 16 600, 0-29; electrical flash or other thermal burns: 10, 4340, 0-22; blunt trauma (mostly from automobile accidents): 15, 3430, 0-18; myocardial infarction: 57, 1520, 4-46. Evidently creatine kinase MB isoenzyme is nonspecific in burn and trauma patients and should not be the only test result used to assess myocardial involvement.

Adolescent↗
PubMed1983

Management of tar and asphalt injuries.

Tar and asphalt burns are unique injuries because the chemical is difficult to remove without inflicting further tissue injury. Since 1978, 42 patients have been treated for hot tar or asphalt injuries, 30 of whom required hospitalization. Inpatients were all male with a mean age of 27.2 years and a mean burn size of 9.3 percent total body surface area (mean full-thickness injury 5.3 percent total body surface area). Burns of critical areas were present in 63.3 percent of the inpatients. A petroleum-based, surface-active solvent was used to remove the tar or asphalt. This solvent proved nonirritating and removed tar much faster than other agents. Early excisional therapy was performed in 63.4 percent of the patients, 80 percent of whom returned to work within 6 weeks of injury. Principles of management include rapid cooling of tar or asphalt to solidify the inciting agent and dissipate heat; removal with a new, non-toxic solvent; early excision and grafting of appropriate injuries; and an aggressive, early back-to-work philosophy.

Accidents, Occupational↗
PubMed1983

The management of fractures in thermally injured patients.

The occurrence of fractures in association with burn wounds has been considered a formidable combination which compromises the care of both types of injuries. During a 5-year period, 42 fractures were treated in 22 patients admitted to the burn center. A variety of fracture management techniques were used on an individualized basis. When fracture stabilization was necessary, external fixation provided acceptable fracture care while permitting access to the burn wound for dressings, grafting, and physical therapy. The presence of an overlying burn wound has been considered an absolute contraindication to the performance of internal fixation of fractures. However, we have found that this procedure can be performed safely provided that consideration is given to a number of factors, including timing of the operation, the importance of intraoperative fluid resuscitation, and the appropriate indications for this method of treatment.

Adolescent↗
PubMed1983

Thermal injury in an adrenalectomized patient.

The occurrence of thermal injury in an adrenalectomized patient on long-term steroid replacement therapy illustrated the role of adrenal hormones in the systemic responses to thermal injury. This unusual patient demonstrated an inadequate response to fluid resuscitation and excessive third-space fluid losses, defective thermogenesis, profound nutritional abnormalities, impaired wound healing, and compromised immunologic function. Nutritional support required correction of calorie-nitrogen proportions from 180:1 to 90:1, following which the patient was in positive nitrogen balance.

Adrenal Glands↗
PubMed1983

Plasma exchange therapy in patients failing to resuscitate from burn shock.

Irreversible burn shock results from failure of fluid resuscitation and is almost invariably fatal. Because of the implied role of circulating serum factors in the generation of burn shock, the use of plasma exchange was evaluated retrospectively in patients with major thermal injuries who had failed to respond to conventional therapy. Twenty-two patients with a mean burn size of 47.9% total body surface area and a mean age of 22.7 years underwent plasma exchange for ongoing burn shock after standard fluid resuscitation failed. A therapeutic response was documented in 95.4% of the patients, characterized by a sharp decrease in fluid requirements from a mean of 260% above the predicted hourly volume to within calculated requirements by 2.3 hours following plasma exchange. Markedly improved urine output and resolution of lactic acidosis were also demonstrated. No major complications occurred. We conclude that plasma exchange facilitates resuscitation from burn shock in a select group of patients who do not respond to conventional volume therapy.

Burns↗
PubMed1982

A two-stage technique for excision and grafting of burn wounds.

While the technique of early excision and grafting has many advantages in the treatment of thermal injuries, it is not without significant complications. Hemorrhage accompanying burn wound excision can be deceptively great, as can the metabolic stress of large surgical procedures performed in the postburn period. In an effort to minimize these complications, we have developed a two-stage technique for excision and grafting of burn wounds. This technique employs layered excision of eschar, followed by an overnight stabilization period for restoration of normal body temperature and blood volume. Continuous soaking of excised areas promotes hemostasis, and insures a viable base for autografting performed on the following day. During 1978-1979, 117 burn patients underwent 137 two-stage excision and grafting procedures. Mean graft size was 1,988 cm2. Eighty-two per cent of the patients had all necessary grafting performed in a single two-stage operation, including grafts as large as 5,700 cm2. No graft loss occurred as a result of graft hematoma formation. Mean blood loss calculated for each two-stage operation was 2,627 cc, one third of which resulted from the harvesting of autografts. Temperature decrease during surgery was also great, with significant hypothermia occurring in 51% of procedures exceeding 2 hours in length. We conclude that performing excision and grafting in two stages limits hemorrhage and heat loss from each individual surgery, thereby permitting the performance of larger procedures. Nonetheless, continued awareness of the magnitude of these complications remains an essential of successful excisional therapy.

Adult↗
PubMed1982

Technique for acute suprapubic catheterization of urinary bladder in the pig.

Accurate monitoring of the urine output of swine is important in many areas of research. Due to the oblique course of the urethra in the boar, transurethral catheterization of the bladder is usually impossible. A technique is described for placement of an indwelling suprapubic catheter in the porcine bladder. Complications with this technique and catheter displacements have not occurred in a series of 53 swine each monitored for 48 hours after catheter placement.

Abdomen↗
PubMed1981

Measurement of intramuscular pressure in the management of massive venous occlusion.

While controversy continues over the exact pathophysiology of and optimal therapy for phlegmasia cerulea dolens, increasing evidence favors the role of elevated interstitial pressure in the generation of extremity ischemia. We report the use of intramuscular pressure measurements in the assessment of a patient suffering massive venous occlusion of one leg. Significant elevations in pressure were found in association with symptomatic ischemia. Successful thrombectomy restored blood flow, relieved symptoms, and produced an immediate decrease in intramuscular pressure. In this disorder, measurement of compartment pressures can be useful in assessing the severity of venous insufficiency and in monitoring the response to therapy.

Adult↗
PubMed1980

Intramuscular pressure in the burned arm: measurement and response to escharotomy.

Using a wick catheter technique, sequential measurements of intramuscular pressure were obtained in 31 burned arms in 18 patients. Abnormally high pressures were recorded in 90 percent of extremities and exceeded the potentially harmful level of 30 mm Hg in 42 percent. Correlation of intramuscular pressure with signs and symptoms of extremity compression, including Doppler pulses, was poor. Intramuscular pressure elevation appeared to parallel edema formation beneath the burn wound. A high incidence of pressure measurements in excess of 30 mm Hg was found in patients who had 30 percent or greater total body surface area injury (67 percent), 10 percent or greater full-thickness burns (75 percent), and extremities with circumferential involvement (57 percent). In every case echarotomy produced a dramatic decrease in intramuscular pressure, while a randomized group of extremities that were not decompressed developed sustained pressures as high as 64 mm Hg despite the presence of intact Doppler pulses. Extremities treated in this manner appeared slower in resolving edema and regaining motion and strength. Measurement of intramuscular pressure beneath the burn eschar is recommended in evaluating all patients at risk from extremity burns.

Adolescent↗
PubMed1977

Prosthetic valve endocarditis. The case for prompt valve replacement.

Treatment of patients with prosthetic valve endocarditis with existing guidelines has failed to reduce the over-all mortality rate to below 50 per cent. However, subgroups with high or lower risk of death can be delineated on the basis of risk factors such as early onset following surgery, high-risk causative organisms, cardiodynamic failure, and septic emboli. High-risk patients comprise more than 70 per cent of those with prosthetic valve endocarditis in recent series. Analysis of previously reported series indicates that the mortality rate for high-risk patients with late onset of prosthetic valve endocarditis treated by valve replacement was less than that of patients receiving only medical therapy. We have treated 6 consecutive patients with prosthetic valve endocarditis (3 early onset, 3 late onset) by valve replacement before completion of a course of antibiotics. All patients survived surgery but one patient died after 4 1/2 months of noninfectious causes. Prompt valve replacement is technically feasible and should become the standard therapy for patients with prosthetic valve endocarditis who do not fall into the lower risk group.

Adult↗