Thoughts for the next 20 years.
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Career Choice↗
Biomedical subjects
W H Reid
Publications and source records attributed to W H Reid.
Management of congenital arteriovenous malformations.
Over a 6-year period, 12 patients with 14 congenital arteriovenous malformations were considered for a staged approach to include afferent vessel ligation (AVL) and/or intra-arterial embolization (IAE) and surgical excision where possible. Patients were followed for a period ranging from 3 to 60 months. Two patients had localized lesions which were completely excised. Five patients were treated by IAE followed by excision with a successful outcome in four. One patient had a transmetatarsal amputation for failed IAE. Two patients had both IAE and AVL before excision of the lesion. In one patient AVL alone was followed by a recurrence. Two patients with multiple lesions were kept under observation. It would appear that IAE and excision of an arteriovenous malformation can achieve cure or excellent palliation in most patients.
Adolescent↗
Serious assaults by inpatients.
Forty-nine hospital wards in the United States and Canada were surveyed during specified periods for one year to document assaults by inpatients on staff or other patients. Nine (5.7%) of the 158 assaults by adult psychiatric inpatients were sufficiently severe to require medical treatment. Four others occurred on the only children's service studied. Only one (2.6%) of 39 assaults on adult nonpsychiatric units required medical care. Injuries were rarely serious, with only four assaults in any setting leading to bedrest or missed workdays. The overall rate of assault (assaults per bed per year) on 27 adult psychiatric units was 1.36; for assaults requiring treatment, the rate was 0.08. The rate of assault of any kind on 22 adult nonpsychiatric units was 0.28 assaults per bed per year.
Adolescent↗
Role of pulmonary alveolar macrophage activation in acute lung injury after burns and smoke inhalation.
Bronchoalveolar lavage cells from 42 fire victims and from 18 patients who were smokers attending for diagnostic bronchoscopy (controls) were assessed morphologically and by chemiluminescence. 10 of the victims had inhaled smoke only; 15 had cutaneous burns only; and 17 had combined injury. The combined injury group had significant increases in polymorphonuclear leucocytes and macrophages, especially mature forms, compared with controls. These increases were higher than those expected from the individual injuries. The combined injury group had significantly greater spontaneous chemiluminescence than controls, again greater than that expected by the individual injuries. The chemiluminescence response to stimulation by opsonised bacteria was significantly higher in the combined injury group than in controls, but significantly lower than that in the smoke inhalation only group. The size of the alveolar cellular response to smoke and cutaneous burns suggests that lung damage follows from excess release of inflammatory mediators, exhaustion of the reserve of mature phagocytes and consequent reduced ability to fight bacteria, or both.
Acute Disease↗
Patient-controlled analgesia for burn patients: a preliminary report.
The introduction of patient-controlled analgesia for burn patients is reported. It has been used for 18 postoperative patients and five patients with acute thermal injury. The system has been found to be easy to use. Wide variations in patient morphine consumption have been seen. Patient-controlled analgesia may have a role in the management of pain associated with burns.
Adolescent↗
Physical assaults in a psychiatric unit of a general hospital.
The authors collected data concerning assaults, assaultive patients, and victims in a psychiatric unit during a 12-month period and compared them with data from a control group of patients. Thirty-seven assaults by 25 patients were recorded. Fourteen of the victims were patients and 23 were members of staff. The assaultive group contained a significantly higher proportion of schizophrenic patients than did the control group and significantly larger numbers of patients from lower socioeconomic classes, patients admitted involuntarily under a section of the Mental Health Act, and patients with a history of assaults.
Adult↗
Clinical evaluation of the violent patient.
Violence is a generic behavior whose evaluation must consider medical, emotional, social, and environmental factors. The evaluation setting should allow privacy (but not isolation), security (but not constriction), comfort (but not fragility), and respect (but not vulnerability). In addition to one's routine complete history, a very complete description of events and feelings before, during, and after the violent episode is critical. Organic causes and correlates of violent behavior must be carefully sought. Evaluation of future risk of violence is difficult but often necessary. The environment in which the patient will be placed, time limits of the prediction and stability of the patient's clinical condition are important factors. Acute risk is greater when certain conditions, such as acute psychosis, persecutory delusions, or intoxication, are present in an already-violent patient. The legal aspects of evaluation are briefly discussed, including basic recommendations for documenting one's good-faith efforts to weigh the risks and benefits of clinical actions and adhering to applicable laws.
Diagnosis, Differential↗
Mechanisms leading to hypogonadism in men with burns injuries.
A profound and persistent depression of serum testosterone concentrations was found in 19 men with burns injuries. This could not be explained by changes in sex hormone binding globulin capacity, hyperprolactinaemia, classical primary testicular failure, or a hypogonadotrophic state. Pulsatile release of luteinising hormone was found in control subjects but was absent or diminished in burnt patients with low serum testosterone concentrations. In addition, these patients showed reduced biological activity of luteinising hormone as measured by bioassay even though normal concentrations of luteinising hormone were detected by radioimmunoassay. The temporary hypogonadism after burns injury and possibly in other clinical states may be related to hypothalamic dysfunction, which leads to abnormal generation of luteinising hormone releasing hormone and non-pulsatile secretion of luteinising hormone of reduced biological activity.
Adult↗
The preclinical evaluation of the water vapour transmission rate through burn wound dressings.
The control of evaporative water loss, following burn injury, is of major importance to the overall condition of the patient, whether this control is by natural eschar or by a dressing. It is therefore important to preclinically determine the water vapour transmission rate of these dressings, firstly to make comparisons between different materials and secondly to screen prototype materials, under controlled conditions. A preclinical (in vitro) technique is described and the results are given for several commercially available dressings which encompass foam, film and hydrogel material categories.
Bandages↗
An in vitro assessment of wound dressing conformability.
An in vitro assessment technique has been developed to determine the conformability of wound dressings. The technique employed is based on an inflation technique which provides a measurement of the minimum radius of curvature which a specific dressing will adopt under pressure. A pressure of 40 mmHg was chosen as this had been shown to be the maximum tolerable pressure before the occurrence of tissue breakdown. This radius is then matched to the natural radii of the body surfaces and an assessment of conformability can be made. A series of commercially available dressings have been assessed with respect to their conformability, and to the enhancement of their conformability due to viscoelastic creep behaviour.
Bandages↗
Hypertrophic scarring and pressure therapy.
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Blood Gas Monitoring, Transcutaneous↗
Evaluation of gaseous transmission (O2 and CO2) through burn wound dressings.
The rates of transmission of oxygen and carbon dioxide through various burn wound dressing materials were determined. The British Standard Vacuum technique was used to determine the Gas Transmission Rate (GTR) of hydrophobic dressings. A Gas to Liquid technique was used to determine the GTR of hydrophilic (water containing) dressings. All the materials tested showed greater GTR values for carbon dioxide than for oxygen. The role of the transmission characteristics of the dressings to influence the wound healing environment is discussed.
Bandages↗
Burn wound dressings--a review.
Man has dressed wounds since life began many millions of years ago. Since this time many materials have been devised for the intention of dressing wounds. This review indicates the vast range presently available, providing a starting point for those seeking information on this subject.
Bandages↗
The in vitro gaseous transmission of wound dressings.
The permeation properties of dressings to gases are important to the healing processes. It is necessary that dressings are permeable to water vapour, oxygen and carbon dioxide. A series of commercially available dressings have been assessed in vitro in respect of their permeability characteristics to these gases.
Bandages↗
Mortality probability in victims of fire trauma: revised equation to include inhalation injury.
There are no clear guidelines on the early diagnosis of injury due to inhalation of smoke. A clinical scoring system in the form of a previously prepared questionnaire may be used in the accident and emergency department by staff who are inexperienced in the management of inhalation injury. By quantifying injury due to smoke inhalation, its contribution to mortality in a large group of fire victims was established and a revised mortality probability equation derived using age, percentage surface area of the burn, and extent of inhalation injury. This mortality probability equation may be used to divide patients into risk categories for early intensive care management and allows the comparison of mortality data between accident and emergency units receiving varying numbers of patients with injuries due to burns and smoke inhalation.
Adolescent↗
The physical effects of an adhesive dressing top layer on burn wound dressings.
Three hydrogels were assessed in respect of water-vapour transmission and conformability. These materials were tested alone and as part of a bilaminate dressing which incorporates an adhesive top layer. The adhesive layer used in this study was a compliant adhesive bandage, marketed under the name Mefix. It was observed that this layer reduced the normally high water-vapour transmission rates of the hydrogels to much lower, clinically more acceptable, levels. Mechanically, the Mefix layer protects the underlying hydrogel, prevents tearing and puncturing but decreases conformability by elastic restraint.
Acrylamides↗
Electrical burns--incidence and prognosis in Western Scotland.
A 10-year review of all patients admitted to the West of Scotland Regional Burns Unit with serious electrical burns indicated an incidence of only 2.6 cases per million of the population served by the Unit per year. Injuries following electrocution or electric flash, but excluding injuries caused by grasping the hot heating element of an electric fire, were suffered by 70 patients, 52 of whom sustained electrocution which was not immediately fatal. Ninety-one per cent of the patients were male. The patients who died in hospital did so as a result of sepsis rather than as a direct result of the electrical injury. All those patients who had ECG changes on admission recovered completely. In view of the very deep injuries, the amputation rate was high with 12 out of 52 patients (23 per cent) with electrocution injury requiring one or more amputations. The events preceding the serious electrical injury in our patients suggest that, 57 per cent of all the injuries could have been prevented, and in patients under 20 years of age this percentage rose to 91.
Adolescent↗
Preclinical assessment of burn wound dressings.
Preclinical assessment procedures for wound dressings have been established taking into account the important parameters of tensile mechanical properties, conformability to body surfaces, water-vapour transmission and gas permeability. A new test has been specifically developed to assess dressing conformability, while the other parameters were assessed using established techniques. The procedures aid clinicians by providing a screen reducing the number proceeding to full expensive clinical trials. They are also of assistance to manufacturers in their bid to optimize the characteristics of dressings and evaluate candidate materials.
Bandages↗