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Biomedical subjects

J R Solomon

Publications and source records attributed to J R Solomon.

At least 19 recordsLinked to original sources
PubMed1989

Epithelial bridging on burn patients following primary excision and grafting.

Early tangential excision and primary grafting of full thickness and deep partial thickness burns has become a widely accepted practice, however, little attention has been paid to the epithelial bridging phenomenon, which occurs most frequently at the edge of these wounds. Over 5 years, 923 burn patients were treated and 407 were grafted, of whom 13 developed sufficiently severe epithelial bridging to require deroofing under general anaesthetic. Histological sections show that the bridges are derived from hair follicles. We advocate that patients with epithelial bridges should be observed in the outpatient department for many weeks and surgical intervention should only be used when they fail to resolve spontaneously.

Adolescent↗
PubMed1985

Pediatric burns.

The burned child requires a management that is different from that employed in the burned adult because of physiologic and psychological dissimilarities, although basic principles of management are the same. Particular problems and treatment of the burned child are highlighted.

Anti-Bacterial Agents↗
PubMed1984

Thyroglossal-duct lesions in childhood.

A retrospective review of 300 cases of thyroglossal duct lesions is presented, with emphasis on reasons for misdiagnosis and recurrence. Of 28 cases misdiagnosed, 20 presented in atypical sites. The recurrence rate after Sistrunk's operation was 5% but no special features could be identified to explain these recurrences. While previous surgery does reduce the chance of success, inflammation does not seem to affect the recurrence rate.

Adolescent↗
PubMed1983

Psychogenic mortality syndrome: choosing to die by the institutionalized elderly.

This article provides a literature review, conceptual framework, case history, and supportive data on the subject of psychogenic mortality, that is, the phenomenon of willing oneself to die that occurs among institutionalized elderly. The article is based on the observation of this phenomenon in a long-term care facility. The literature review provides background data from developmental studies in psychodynamic literature that may be applicable to this phenomenon as observed. The case history and supportive material suggests rationale and methods for intervention and treatment.

Aged↗
PubMed1981

Nutrition in the severely burned child.

Adequate nutrition in the severely burned child often determines the morbidity and mortality and its supervision demands a high priority in the management of the burn injury. A disciplined, detailed programme is required, but this is often neglected. The hypermetabolism experienced in the severe burn may require a calorie intake up to 2 1/2 times normal, and in the growing child, with extra requirements, a negative balance can easily eventuate if careful management is not instituted. A daily metabolic plan provides firstly, the basic calories and protein per kilogram depending on age as for a normal child and, secondly additional requirements depending on the surface area of the burn. With such a programme the weakness of treating all children, whatever their age, on the same formula related only to surface area burn, is overcome. Parenteral nutrition is commenced as soon as the shock phase has been controlled and is continued until enteral intake by gastric tube is sufficient to cover the requirements. Such tube feeding requires the selection of an isotonic liquid diet so as so limit the possibility of diarrhoea. Isocal (Mead Johnson) has been found generally acceptable. Gradually as the patient recovers, oral intake is introduced and the child returns home on a normal nutritional diet, expectantly without weight loss and even with some weight gain, which befits any normal child under treatment for some months. Preburn nutrition, disease and infection, hyperthermia, hypothermia, evaporative water loss, active exercise, psychological well being, social state, early skin cover and limitation of stress are important aspects affecting metabolism and require careful supervision and management. The limitation of metabolism is as important as increasing the caloric intake and this is exemplified at the time of operation, which should be as nonstressful as possible. Every two weeks an adjusted assessment is made of the burned area still to be grafted and the caloric requirements are reduced accordingly. Assessment as to the success of the regime is made upon the results of daily weighing. Extra vitamins and elements are given and blood electrolytes and urine glucose and protein are regularly monitored.

Adolescent↗
PubMed1981

Early surgical excision and grafting of burns including tangential excision.

Early excision and grafting of burns with the advent of infection control, has become a most important part of any successful therapy in burn management. By this technique, an open wound is primarily closed, and thus circumvents the possibility of infection. There is less discomfort, more rapid restoration of function, quicker discharge from hospital and earlier rehabilitation. Metabolic needs are lessened and with less scar, the cosmetic result is improved. Excision is made between the third and fifth day postburn if possible, but more delay may be necessary to determine which burns are superficial and able to spontaneously heal. No area greater than 10% of body surface area is excised and grafted at one operative session and for large burns staged excisions are necessary. A limitation of 1 1/2 hours on the operation is made so as to control shock and hypothermia and to assure a quick recovery with early re-establishment of nutrition. Ketamine is the common anaesthetic employed and viable fat is preferred as the surface on which to graft. Tangential excision is a complementary form of early excision grafting to a specific depth, and may be used alone or in conjunction with other techniques. It is of value in selected burns of the deep partial skin loss variety, especially scalds, which predominate in children. Several slices of necrotic skin are taken until a punctate bleeding surface is reached in the deep dermis and a thin to moderate thickness allograft is immediately applied. The conservation of the deep dermis limits the area to be grafted, with the likelihood of less scar formation and a resultant graft of improved texture.

Breast↗
PubMed1981

Care and needs in a children's burns unit.

The burned child requires an overall care that recognises the child not as a small adult, but as a person in his own right with special physiological and psychological needs. Proper management requires a team approach with each member having a recognised role, but all working with one aim in view -- the earliest return of the child to his home and school environment with well healed burns and an acceptance of his injury with as little psychological disturbance as possible. Each child must be recognized individually and care adjusted according to the child's age and background and in relationship with any associated specific psychological disturbance. Special fears, including death and apprehension as to treatment, pain and disfigurement, require understanding and sympathetic support. A child should not be isolated from other children or his family unless absolutely necessary. An early decision has to be made as to whether the seriously burned child should be resuscitated, and children presenting with burns may be at risk from maltreatment and need protection and supervision of their growth and development. Parent need to be fully informed of their child's injury and treatment, have easy access to staff with open visiting, and be able to attend therapy discussion groups. Provision of manuals and booklets from parents and children on burns and their treatment can relieve anxiety and secure a confident attitude to the total management of the burned child. Rehabilitation involves both the child and the family and requires careful management and, in the severely burned, a gradual reintroduction to normal home and school life.

Burns↗
PubMed1979

First aid treatment of burns.

A burn refers to the damage caused to the skin, and sometimes deeper structures, by heat (flame, scald, contact, electricity), chemical agents or radiation. Methods of first-aid treatment of burns are varied, imprecise and sometimes harmful. This article deals with the major principles involved in first-aid, which when implemented will limit the damage created by the burn. The medical profession must be aware of what can be achieved and the necessary steps in the initial treatment of the burn. The profession is called upon to offer first-aid, to give advice and to lecture on accidents in our community, so it is necessary to have a clear plan of treatment.

Analgesics↗
PubMed1976

Outreach services in "God's waiting room".

Miami Beach--or "God's Waiting Room" as some have flippantly named it--has an overwhelming number of elderly people living on low incomes. This article describes the community-based programs instituted by one long-term care facility that not only provide a viable alternative to institutionalization, but are cost effective as well.

Aged↗
PubMed1976

Therapeutic group process with the institutional elderly.

This paper reviews the status of geriatric group psychotherapy and the experience with such programs at the Miami Jewish Home and Hospital for the Aged. Specific ways are suggested for enhancing the administration of group psycho-therapy programs in the geriatric institutional setting. Group therapy techniques adapted to the specialized needs of the aged are of definite therapeutic benefit.

Aged↗