Biomedical subjects
Publications and source records attributed to P F Parshley.
The management of severely burned and exposed supportive osseous tissues is not fully standardized. We present two patients in whom extensive debridement and decortication of the involved bone may have contributed to subsequent stress fractures. We propose an alternative therapeutic approach for this problem, including: minimal debridement of the bone, early coverage of the exposed bone with vascularized muscle, and adequate prophylactic protection.
Rats subjected to a standard electrical burn of 250 volts for 10 seconds receive a severe injury stimulating a pronounced systemic circulatory response. Initial postinjury hyperemia is replaced by a low perfusion state within 24 hours. Our study demonstrates the difficulty in isolating regional microcirculatory alterations under such circumstances. Modification of the burn model or the method of fluid resuscitation may minimize the influence of this dynamic systemic response.
Electrical current injuries involving the extremities occurred in 41 of 75 patients with electrical burns admitted to the Oregon Burn Center over an 11 year period. Based solely on physical findings, the muscle compartments of 27 limbs in 14 patients were promptly explored, decompressed, and debrided of necrotic tissue on admission. This resulted in the salvage of 10 useful extremities. Major amputation of 11 extremities was carried out during initial surgery. No extremity needing exploration was overlooked. After exploration and fasciotomy, exposed tissues were protected with biologic dressings until repeated explorations and debridements demonstrated the absence of necrotic tissues and closure could be accomplished. The use of both local and free flaps was helpful in closing the wounds. No evidence or renal failure and no deaths attributable to retained necrotic tissue occurred.
Three patients who were on the periphery of the pyroclastic flow of the Mount St. Helens eruption on May 18, 1980 were treated for severe thermal and inhalation injuries. Although exposed in identical manner, two patients arrived with heavily colonized burn wounds and developed adult respiratory distress syndrome leading directly to their death, whereas the third patient, with a noncolonized burn wound and little evidence of adult respiratory distress syndrome, survived. Evidence of inhaled ash complicating various stages of adult respiratory distress syndrome was confirmed by energy dispersive roentgenographic analysis. In the Pacific Northwest, Alaska, and the Aleutian Islands, potential for further injuries of this type in even larger numbers exists. Should these occur, those who treat the victims should be aware of the potential for severe inhalation problems in addition to the obvious burns.
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For what we believe are varied and compelling reasons, the majority of physicians in our hospital have abandoned the traditional inpatient approach to the evaluation and treatment of a woman with a breast mass. We attempt to tailor the diagnostic procedure to fit the most probable pathology. In general, we believe a patient with carcinoma should have the diagnosis established by needle biopsy. This allows complete staging, the development of an appropriate treatment plan and gives us the opportunity for frank and open discussion with our patients. Those patients with probable benign disease should have the diagnosis established by an outpatient biopsy performed using a local anesthetic.
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