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Biomedical subjects

M J Krob

Publications and source records attributed to M J Krob.

10 recordsLinked to original sources
PubMed1988

Enhanced allograft survival in H-2 compatible cyclosporine-treated mice.

Skin allograft survival time has been prolonged in a variety of animal and human studies. Burn injury, histocompatibility matching, and cyclosporine administration each independently have been shown to increase skin allograft survival times. A mouse model was developed to study these relationships. Histocompatibility matching of mouse H-2 I showed a trend toward skin allograft prolongation when comparing nonburned and burned animals. When there was complete histocompatibility of mouse H-2 and H-4 allograft survival time was significantly prolonged. Cyclosporine administration to the optimally matched donor/recipient combination further enhanced allograft survival. This study demonstrated that histocompatibility matching for the entire H-2 locus correlated with prolonged allograft survival. Optimal histocompatibility and cyclosporine administration further enhanced skin allograft survival in burned mice.

Animals↗
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↗
PubMed1986

Immunosuppressive effects of burn injury and nonspecific blood transfusion.

Burn injuries and blood transfusions both have been implicated as causes of suppressed immune responses. Skin allograft survival in a burned mouse model was studied to determine the relationships among burn injury, blood transfusion, and phlebotomy before transfusion as they affected immunocompetence. At 7 days after 20% TBSA full-thickness burn injury, allograft skin survival was prolonged compared to nonburned control. When increasing volumes of blood were transfused, allograft survival times decreased accordingly. Phlebotomy before transfusion tended to enhance this response. Similar results were seen at 14 days after burn injury, although phlebotomy before transfusion did not further decrease allograft survival time at 14 days. This study demonstrated that blood transfusions were not additively immunosuppressive over burn injury alone. Increased amounts of transfused blood restore allogeneic responsiveness. Phlebotomy may enhance this response when performed early after burn injury.

Animals↗
PubMed1986

Transfusion-induced sensitization to skin allografts in burned mice.

Blood transfusions are known to improve allograft survival times, and this effect is enhanced with recipient immunosuppression. The focus of the present study was to determine the effect of pretransplant and perioperative donor-specific (DST) or nonspecific (NST) blood transfusion on skin allograft survival in thermally injured mice. Allogeneic immune responsiveness was suppressed in 20% TBSA burned mice, but not to a degree which was protective against DST-induced sensitization. Pretransplant DST resulted in accelerated graft rejection in burned recipients, although high-dose cyclosporine partially reversed this sensitization. Additionally, burn-related immunosuppression in this model did not enhance perioperative transfusion-induced graft prolongation. However, when burn-injured perioperatively transfused mice were further immunosuppressed with cyclosporine, significant graft prolongation occurred. These data suggest that perioperative NST may contribute to prolonged skin graft survival in burned recipients, provided that the mice are sufficiently immunosuppressed.

Animals↗
PubMed1984

Rural trauma care: a study of trauma care in a rural emergency medical services region.

Motor vehicle-related trauma deaths in a 21-county rural emergency medical services (EMS) system are reviewed. Injury severity scores (ISS) and Glasgow coma scores (GCS) were recorded to provide baseline data for future comparison as the system progresses. The majority of deaths (67%) were related to CNS injuries. ISS in this series was similar to data reported from Orange County, California. The average GCS for all patients in this series was 5, indicating the high prevalence and severity of head injuries in motor vehicle deaths. Patients treated only in community hospitals had a low average ISS of 28.5. Those transferred from community hospitals to the regional tertiary care center had an average ISS of 36.2. Those admitted directly to the tertiary center had an ISS of 38.9. The data suggest that the rural trauma system might improve if there were training programs that promote recognition of significant injury, more aggressive resuscitation, and expeditious transfer of the injured patients.

Accidents, Traffic↗
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

Fire prevention for teenage mothers enrolled in high school.

A fire prevention/burn education program has been developed, presented, and evaluated. The program was presented to teenage students in four inner city high schools who were also the parents of infants and toddlers. The program was judged to be effective based on testing results, classroom teacher response, and school administration endorsement.

Adolescent↗
PubMedDate not supplied

Do trauma scores accurately predict outcomes for patients with burns?

A highly refined quality assurance program relies on accurate outcome evaluations and the identification of patients who are truly worthy of peer review. In our hospital, the Glasgow Coma Score, the Trauma Score, and the Injury Severity Score are used to monitor patients with burns. A retrospective review of 511 admitted patients with burns was performed to determine whether the existing monitors (Trauma Score, Glasgow Coma Score, Injury Severity Score) or the use of the Baux Score, the Edlich Burn Score, and the Zawacki Score would provide a more precise monitoring system. Logistic regression techniques demonstrated that the Baux Score, the Edlich Burn Score, and the Zawacki Score were highly correlated with patient outcome (p less than 0.001). Linear regression techniques demonstrated that only the Baux Score, the Edlich Burn Score, and the Zawacki Score were correlated with length of stay (p less than 0.01). On the basis of this retrospective review, the Baux Score, the Edlich Burn Score, and the Zawacki Score more accurately predicted outcomes for patients with burns than did the Trauma Score, the Injury Severity Score, and the Glasgow Coma Score; these scores can thus provide the most valuable information for quality assurance activities.

Adult↗
PubMedDate not supplied

Immediate ambulation of patients with lower-extremity grafts.

Immediate ambulation of patients who have had lower-extremity skin grafting has been practiced in our burn center since 1987. A retrospective review of patients who had lower-extremity skin grafting only and a survey of burn centers in which 109 centers responded were conducted. Average skin graft take in our burn center was 96.4%. Patients in our burn center walked 30 feet independently by postoperative day 1.7, whereas the survey response average was 7.2 days (p less than 0.001). Average length of stay was 12.6 days (p less than 0.012). This review demonstrated that although immediate ambulation after lower-extremity grafting is not a widely adopted procedure, it does not impair graft take and may decrease the average length of stay.

Adolescent↗