Biomedical subjects

L C Cancio

Publications and source records attributed to L C Cancio.

10 recordsLinked to original sources

PubMed2001

Distant pedicle flaps for soft tissue coverage of severely burned hands: an old idea revisited.

Burns to the hand that are complicated by exposure of bone, joint or tendon cannot be closed with conventional skin grafts and require flap procedures to prevent further damage. Local or regional flaps may be unavailable if electrical or blast trauma produces a large zone of injury, or when forearm burn injury extends beyond fascia. Free tissue transfer may not be tolerated by critically ill burn patients. In these circumstances, distant pedicle flaps are one option for safe and effective soft tissue coverage. Over a 5-year period, we have performed six distal pedicle flaps for coverage of exposed hand structures when local or free flaps were contraindicated or unavailable. The patients required an average of 4.5 surgical procedures to complete hand reconstruction and soft tissue coverage. Soft tissue coverage was completely successful in five patients and partially successful in one patient. Single stage local or free flaps remain the treatment of choice when burned hands cannot be covered with skin grafts. When these flap options are not available, distant pedicle flaps provide a safe alternative.

Adolescent↗

PubMed2001

Delayed partial liquid ventilation shows no efficacy in the treatment of smoke inhalation injury in swine.

In an earlier neonatal porcine model of smoke inhalation injury (SII), immediate postinjury application of partial liquid ventilation (PLV) had dramatic beneficial effects on lung compliance, oxygenation, and survival over a 24-h period. To explore the efficacy of PLV following SII, we treated animals at 2 and 6 h after SII and followed them for 72 h. Pigs weighing 8-12 kg were sedated and pharmacologically paralyzed, given a SII, and placed on volume-cycled, pressure-limited ventilation. Animals were randomized to three groups: group I (+SII, no PLV, n = 8), group II (+SII, PLV at 2 h, n = 6), and group III (+SII, PLV at 6 h, n = 7). Ventilatory parameters and arterial blood gasses were obtained at scheduled intervals. The PLV animals (groups II and III) followed a worse course than group I (no PLV); PLV groups had higher peak and mean airway pressures, oxygenation index, and rate-pressure product (a barotrauma index) and lower lung compliance and arterial partial pressure of oxygen-to-inspired oxygen fraction ratio (all P < 0.05). PLV conferred no survival advantage. The reported beneficial effects of PLV with other models of acute lung injury do not appear to extend to the treatment of SII when PLV is instituted in a delayed manner. This study was not able to validate the previously reported beneficial effects of PLV in SII and actually found deleterious effects, perhaps reflecting the predominance of airway over alveolar disease in SII.

Animals↗

PubMed1998

Heparin-induced thrombocytopenia and thrombosis.

Although heparin is widely used as the injectable anticoagulant of choice, it has several potential shortcomings. These include heparin resistance, excessive bleeding, allergic reactions, and, with longterm use, occasional osteoporosis or alopecia. Perhaps the most notorious complication is heparin-induced thrombocytopenia and thrombosis (HITT); although unusual, it often results in major morbidity or death. Until recently, reliable diagnostic tests and anticoagulation alternatives have not been widely available. After a review of the pharmacology of heparin and related drugs, advances in the prevention, diagnosis, and treatment of this problem are discussed.

Heparin↗

PubMed1998

Fatal and near-fatal complications of liposuction.

Cosmetic liposuction is considered to be safe and effective in properly selected patients and is widely done as an outpatient or office procedure. When major complications occur, office-based practitioners may refer patients to a hospital emergency department, where medical personnel unfamiliar with this procedure may underestimate the risk of serious infection or other major complications. We present two cases of massive necrotizing fasciitis treated in a burn center after liposuction surgery. One patient died, and the second required lengthy hospitalization, extensive debridement, and split-thickness skin grafting of 22% of the total body surface area. Pain out of proportion to clinical findings is a hallmark of necrotizing fasciitis and should prompt consideration of this entity even in the absence of cutaneous signs of infection. Definitive diagnosis is made by biopsy and rapid section histologic analysis. Liposuction may result in major complications or death. Emergency department physicians or general surgeons may be called upon to manage such complications and should be aware of these risks.

Abdominal Muscles↗

PubMed1994

Peritoneal dialysis to induce hypothermia in a head-injured patient: case report.

Hypothermia is of proven benefit in cerebral ischemia, and may be of benefit in blunt head injury. Peritoneal dialysis is a fast, effective method of inducing generalized hypothermia. A case is reported in which peritoneal dialysis was used to induce mild hypothermia (34.5-36 degrees C) in a patient who sustained a severe head injury, with intracranial hypertension unresponsive to hyperventilation, osmotic diuresis, and barbiturate coma. Hypothermia was associated with prompt control of temperature and intracranial pressure. Peritoneal dialysis is a useful method for inducing hypothermia in the blunt head-injured patient.

Adult↗

PubMed1994

Hypothermia in acute blunt head injury.

Mild to moderate hypothermia has been employed since the 1940s in the treatment of acute blunt head trauma. The utility of hypothermia in ischemic injury has been confirmed, by both animal studies and clinical experience, in cardiovascular and neurological surgery. In blunt injury, though, only one prospective, randomized study has shown a statistically significant improvement in long term outcome. Clinical experience, animal data, proposed mechanisms, technical considerations, and potential risks are reviewed. Hypothermia remains controversial in the setting of blunt head injury but may prove to be a useful treatment modality.

Acute Disease↗

PubMed1993

Managing the Foley catheter.

Urethral catheterization of the bladder is a commonly performed but potentially hazardous procedure. With proper patient preparation and catheter selection, difficult catheterizations can be accomplished without injuring the patient. Complications of catheterization include infection, injury to the urethra or bladder, and catheter malfunction. Physician supervision of catheter care is essential. Most of all, prompt replacement of the urethral catheter with an alternative method of bladder drainage, such as spontaneous voiding, external condom catheterization, clean intermittent catheterization or, possibly, suprapubic catheterization, is the best way to prevent the complications of urethral catheterization.

Adult↗

PubMed1993

Chemical casualty decontamination by medical platoons in the 82d Airborne Division.

Chemical casualty decontamination must be carried out as far forward as possible to limit spread of agents and to render aid as quickly as possible. Traditionally, decontamination in the 82d Airborne Division has been provided by the Forward Support Medical Company. During Operation Desert Shield, the Division's Medical Platoons acquired the ability to decontaminate casualties for the first time. The author describes a detailed plan for casualty decontamination by Medical Platoons developed for this purpose. Dedicated rehearsal of decontamination and other aspects of chemical casualty care is essential.

Chemical Warfare↗

PubMed1991

Stress and trance in freefall parachuting: a pilot study.

Freefall parachuting is a demanding activity which, at times, is profoundly stressful. Fifty-nine freefall parachutists completed a survey which dealt with parachuting experience, levels of perceived stress, sources of stress, episodes of altered consciousness, and use of hypnotic techniques in preparation for freefall. Over one third admitted to having experienced a "trance-like state" before, during, or after a jump; the same was true of a state of "altered consciousness." The great majority used mental imagery or another mental or physical technique to prepare for freefall. These results recall the theory that stress predisposes to hypnotic trance. Trance, when unconsciously evoked during emergencies (spontaneous dissociation), may account for some parachuting accidents. When consciously pursued, however, self-hypnosis may provide the jumper with a way to control his level of arousal, facilitate cognitive rehearsal, and enhance performance.

Adaptation, Psychological↗

PubMedDate not supplied

Emergency medical training in the 82d Airborne Division. The Gulf War experience.

The 82d Airborne Division, as the Army's worldwide contingency division, places unique demands on its medical personnel. This was true particularly during Operations Desert Shield and Desert Storm in 1990-1991. An unprecedented emergency medical training program was carried out in preparation for the Gulf War. All levels of expertise were involved: non-medical Combat Lifesavers, medics, physician assistants, and physicians. Courses provided included Combat Lifesaver provider and refresher training, Basic Trauma Life Support (BTLS) provider and instructor training, Chemical Casualty courses, and a Combat Surgical Skills course. Approximately 736 personnel, including 80 Saudi and allied physicians and medics, participated in these courses. Confidence and competence in handling war casualties at all levels was enhanced greatly. Prepackaged courses such as BTLS enabled the rapid training of large numbers of medical personnel under challenging conditions.

Curriculum↗