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Biomedical subjects

M H Jordan

Publications and source records attributed to M H Jordan.

At least 19 recordsLinked to original sources
PubMed2003

Laser Doppler imaging determines need for excision and grafting in advance of clinical judgment: a prospective blinded trial.

INTRODUCTION: Clinicians' judgment as to which burns require excision and grafting remains one aspect of burn care without objective measurements. This study presents a prospective, blinded trial to assess decision to operate by laser Doppler imaging (numerical criteria) versus the clinical judgment of an experienced burn surgeon. METHODS: A number of 23 patients were enrolled in this prospective trial and 41 representative wounds of indeterminate depth were selected for observation. Daily determination of need to operate (burn depth) was made by a single burn surgeon. Laser Doppler imager (LDI) scans of the same wounds were simultaneously obtained, and not revealed to the clinician. Data analysis compared quickness of decision to operate by LDI to the clinician's judgment. Concurrence of decisions by either method was compared. RESULTS: A total of 23 patients and 41 wounds were analyzed. LDI and the surgeon agreed in determination of wound depth 56% of the time (23/41, P=0.031). Biopsy confirmation was obtained for 21 wounds. The surgeon's determination of burn depth was accurate in 71.4% of wounds biopsied (15/21). When the LDI scan median flux indicated need for excision, it was 100% accurate (7/7). When both the surgeon and the LDI were correct in assessing wound depth, LDI would have saved median number of 2 days (minimum=0, maximum=4). CONCLUSION: LDI allowed for earlier, objective determination of need to operate. Concurrence with clinical judgment in this blinded study was excellent. LDI should be seen as an effective aid to clinical judgment when contemplating excision of burns with indeterminate depth.

Adolescent↗
PubMed2001

Analysis of motor vehicle ejection victims admitted to a level I trauma center.

OBJECTIVES: The objective of this study was to compare the injuries and outcomes of ejected victims who reached a Level I trauma center with nonejected MVC occupants. METHODS: Data from 6,909 MVC victims admitted to a Level I trauma center, over a 91/2-year period, were retrospectively reviewed. Three mutually exclusive groups were studied: ejected, nonejected nonrestrained, and nonejected restrained. RESULTS: The patient distribution was as follows: ejected 6.4% (n = 443), nonrestrained 50.1% (n = 3,461), and restrained 43.5% (n = 3,005). Ejected patients were younger, required ICU care more frequently, and a higher percentage were males compared with nonrestrained or restrained patients. Injury Severity Score (ISS) and length of stay (LOS) were significantly higher in ejected patients. Ejected patients suffered more injuries per anatomic region, and had a higher number of severe injuries in the head and neck region. The overall in-hospital mortality was 3.9% (272/6,909), and 10.8% (48/443) for the ejected group. The incidence of restrained patients increased during the study period but was not associated with a change in the incidence of ejected patients. CONCLUSION: Patients who were ejected after motor vehicle collisions were more severely injured and had a worse outcome than those not ejected. Efforts should be concentrated on enforcement and enactment of better seat belt laws, as well as the development of new strategies that will prevent ejection regardless of occupant behavior.

Accidents, Traffic↗
PubMed2000

Intraoperative assessment of colonic perfusion using scanning laser Doppler flowmetry during colonic resection.

BACKGROUND: Ischemia occurring on mobilization and mesenteric division is thought to be a major factor in the etiology of anastomotic dehiscence after colorectal resection. This study assessed the ability of the new technique of scanning laser Doppler flowmetry to measure changes in human colonic perfusion during mobilization at and adjacent to the anastomotic site. STUDY DESIGN: Colonic perfusion was measured in 10 patients undergoing large-bowel resection by making laser Doppler scans of the proximal bowel before mobilization, after mobilization and mesenteric division, and after resection of the specimen. Mean perfusion was calculated within 1-cm2 regions of interest, each of which contained 1,750 individual measurements of perfusion. These regions represented the anastomosis site and adjacent areas 1 cm and 2 cm proximal and distal to this. The results were expressed as mean perfusion units (PUs). RESULTS: After mobilization, there were significant decreases in perfusion in all the subjects between each time point and in all areas of the colon scanned. Median perfusion at the anastomosis site was 491 PUs before mobilization, and this fell to 212 PUs after mobilization, representing a decrease of 57%; the median within-person decrease was also 57% (p < 0.01). There was a gradient of reduced perfusion between the area 2 cm proximal to the mesenteric division (median within-person fall 25%; p < 0.05) and the area 2 cm distal to the mesenteric division (median within-person fall 84%; p < 0.01). After resection of the specimen, perfusion increased slightly at the anastomosis site to a median of 240 PUs (median within-person fall 41%; p < 0.01), but 2 cm proximal to this, median perfusion remained depressed at 330 PUs. CONCLUSIONS: This new technique can be used intraoperatively and appears to overcome the limitations of single-point laser Doppler flowmetry. In this small preliminary study, it measured large decreases in colonic perfusion during mobilization, and it may have widespread clinical applications.

Aged↗
PubMed1995

Late pulmonary sequela following burns: persistence of hyperprocalcitonemia using a 1-57 amino acid N-terminal flanking peptide assay.

Seven patients were evaluated at a mean duration of 8.4 yr after sustaining inhalational injury associated with burns. At the time of re-examination, the patients were asymptomatic and had normal chest X-rays, and arterial blood gases. Three of the seven patients had abnormally elevated serum calcitonin levels. The spirometry (FEV1) measurements showed an inverse trend to that of the serum calcitonin levels. The elevated calcitonin levels had an abnormal predominance of the procalcitonin component as assessed by several region specific antisera. The serum calcitonin also showed a significant correlation with the hormone level which had been obtained at the time of prior discharge from the hospital (r = 0.91). Although there appears to be no or minimal chronic pulmonary sequela to inhalational injury in burns by pulmonary testing, we speculate that the hyperprocalcitonemia in some of the patients may reflect a long-term hyperplastic response of the bronchio-epithelial pulmonary neuroendocrine cells. The potential significance of this and other lung-associated endocrine markers is discussed.

Biomarkers↗
PubMed1994

Lightning strike to the head: case report.

A case is presented of a teen-aged athlete who sustained a direct lightning strike to the head while wearing a football helmet. The helmet, the presence of sweat, and aggressive resuscitation were instrumental in his survival and complete recovery. This appears to be the first documentation of a lightning strike to an individual wearing protective headgear.

Adolescent↗
PubMed1992

Serum procalcitonin as an index of inhalation injury in burns.

The molecular heterogeneity of serum immunoreactive calcitonin (iCT) was analyzed from a prospective study of 41 burn patients. Using different region-specific anticalcitonin antisera, the ratio of mid-region-recognizing to carboxyl terminal-region-recognizing iCT was found to increase acutely in those who subsequently died. The highest ratios occurred in those who died early of respiratory complications. Sephadex chromatography and reversed-phase HPLC demonstrated that the serum iCT circulated predominantly in the large molecular mass prohormone form (16 kDa). In comparison, iCT of normal human lung and of normal thyroid was shown to consist primarily of smaller monomeric mass forms. Furthermore, in 12 normal volunteers who were evaluated with a calcium-pentagastrin infusion, the ratio of iCT levels did not differ from the baseline ratio despite a 50% increase in serum iCT. These results suggest that in burns, the inhalational injury-associated hypercalcitonemia is characterized by a preferential release of procalcitonin; a form of constitutive secretion. The measurement of serum procalcitonin levels would appear to be a useful prognostic indicator of the severity of inhalational injury occurring in burn patients.

Biomarkers↗
PubMed1992

Management of head and neck burns.

Successful treatment of acute head/neck burns requires assessment and protection of the airway, prevention of further injury to damaged surface structures, and timely and diligent debridement and wound closure. Rehabilitation methods and modalities help to preserve function and control scarring. Reconstructive surgery should be designed to improve function and appearance, primarily by correction of the skin/tissue defect which healed by scar contracture. Thoughtful timing and application of logical surgical principles offer the opportunity of recovery to a level better than merely acceptable.

Burns↗
PubMed1990

Patient tolerance study of topical chlorhexidine diphosphanilate: a new topical agent for burns.

Effective topical antimicrobial agents decrease infection and mortality in burn patients. Chlorhexidine phosphanilate (CHP), a new broad-spectrum antimicrobial agent, has been evaluated as a topical burn wound dressing in cream form, but preliminary clinical trials reported that it was painful upon application. This study compared various concentrations of CHP to determine if a tolerable concentration could be identified with retention of antimicrobial efficacy. Twenty-nine burn patients, each with two similar burns which could be separately treated, were given pairs of treatments at successive 12-h intervals over a 3-day period. One burn site was treated with each of four different CHP concentrations, from 0.25 per cent to 2 per cent, their vehicle, and 1 per cent silver sulphadiazine (AgSD) cream, an antimicrobial agent frequently used for topical treatment of burn wounds. The other site was always treated with AgSD cream. There was a direct relationship between CHP concentration and patients' ratings of pain on an analogue scale. The 0.25 per cent CHP cream was closest to AgSD in pain tolerance; however, none of the treatments differed statistically from AgSD or from each other. In addition, ease of application of CHP creams was less satisfactory than that of AgSD. It was concluded that formulations at or below 0.5 per cent CHP may prove acceptable for wound care, but the vehicle system needs pharmaceutical improvement to render it more tolerable and easier to use.

Administration, Topical↗
PubMed1987

Serial debridement and allografting of facial burns: a method of controlling spontaneous healing.

Management of severe partial-thickness facial burns is difficult and not ideal. Over the past 4 years, 18 patients have undergone serial debridements and allografting at regular intervals until re-epithelialization occurred. Twelve patients required one procedure and two patients required two procedures. Four patients also required autografts on portions of the facial burns. Fourteen patients have been followed for greater than 6 months. Only four patients required scar revision procedures. Three desired cosmetic improvement, and one required functional improvement. The use of serial debridements and allografting controls facial burn healing, as well as producing good cosmetic and functional results.

Burns↗
PubMed1979

Ambulatory surgery for pilonidal disease.

In conclusion, pilonidal cysts, sinuses, and abscesses appear to be acquired lesions, perhaps enhanced by the developmental presence of deep intergluteal clefts, dimples, or sinuses. The pahtophysiology depends upon physical invasion of hair, lint, and other foreign material into the subcutaneum and the formation of a foreign body reaction. Appropriate treatment is drainage of the infected cavity and removal of foreign material. Adherence to basic principles of treating surgical infection is necessary for a good result. Prevention of treatment failure demands a conscious attention by the patient to personal hygiene to avoid accumulation of debris and repeat occurrence of the pathophysiologic process. Adequate surgical management can be performed on ambulatory outpatients with tolerable discomfort. This method features a minimal loss of man-days and an acceptable recurrence rate. A major advantage is cost-effectiveness.

Ambulatory Care↗
PubMed1976

Pseudorejection: the Page kidney phenomenon in renal allografts.

A case of renal allograft pseudorejection owing to perinephric hematoma is presented and the Page kidney phenomenon is discussed as the pathophysiologic mechanism. The term pseudorejection is introduced and defined as a remediable form of graft dysfunction resulting from renal parenchymal compression. Sonography was helpful, in addition to the standard diagnostic modalities in making the diagnosis. Early recognition and decompression of a peritransplant hematoma or lymphocele may decrease graft loss from this insidious entity.

Adult↗
PubMedDate not supplied

Burned-and-battered adults.

The existence of a previously unrecognized group of patients, burned-and-battered adults, has been recognized. This retrospective review identifies some of the characteristics of the 41 burned-and-battered adults admitted to a burn center during a two-year period. The typical scenario was a domestic quarrel that included a male victim, a female assailant, and a scald injury involving the victims anterior trunk and upper extremity. The average burn size was 14% of the total body surface area. Four victims died as a result of their injuries. Although these victims represented only 10% of all patients admitted to the burn center, there may be many more undetected burned-and-battered adults. Only when the seriousness and magnitude of the problem are recognized can appropriate medical, legal, and social interventions be made to meet the needs of these burned patients.

Adult↗
PubMedDate not supplied

Burn patient registries in the United States: a survey.

The Committee on Organization and Delivery of Burn Care of the American Burn Association conducted a survey among burn care facilities to determine the extent of interest in development and maintenance of computerized patient registries. Initial questionnaires were mailed to 178 burn care facilities. Responses were obtained from 112 (62.9%). Eighty-seven (77%) of the responders indicated that they have some form of registry. Thirty-five of these registries were in the form of handwritten logbooks, while 43 were personal computers with a wide variety of hardware and software. Uses of these registries include patient census and reports (64% of responders), clinical research (62%), patient care (61%), and, less common, quality assurance and education. Twenty-five facilities stated that they do not maintain a registry, but 22 (88%) of them indicated interest in developing one. It seems unlikely that a single system could be designed to fill the needs of all facilities, nor is it likely that existing registries can be "networked" successfully. This is due not only to the diversity of data in the existing registries, but also to the important differences in the way basic terminology is used in different facilities. For burn care facilities interested in developing their own registry, a selected list of successful representative registries is provided.

Burn Units↗
PubMedDate not supplied

Cooking-related burn injuries in the elderly preventing the "granny gown" burn.

Cooking-related burn injuries accounted for 27% of the elderly female admissions at one burn center. The primary mode of injury was found to be ignition of clothing while reaching across a stove. To develop a prevention program for this problem, biologic and environmental hazards were identified. From this information, a two-phase prevention program was designed. Phase one, education, entailed the development, publication, and distribution of a pamphlet to a variety of local agencies. Phase two, an environment evaluation, consisted of contacting consumer relation departments of major stove manufacturers suggesting a product safety review. The community response to this program has been favorable. Its design should provide the foundation for preventing increased incidence of cooking-related burn injuries.

Aged↗
PubMedDate not supplied

Pontine myelinolysis after correction of hyponatremia during burn resuscitation.

Central pontine myelinolysis is a neurologic disease produced by the rapid correction of hyponatremia. This report describes the occurrence of central pontine myelinolysis in a patient with burns. The natural history of this paralyzing condition and suggestions for its prevention are discussed. Severely burned and hyponatremic patients are at risk for this disorder because a large amount of sodium ion is typically required for the treatment of burn shock. Awareness of this phenomenon and avoidance of rapid correction of hyponatremia are essential to its prevention.

Body Surface Area↗