J Trauma
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This study reports on the effects of early cooling on the morphology of partial-thickness burns. After 10% body surface dorsal scald burns at 75 degrees C for 10 seconds, guinea pigs were treated by ice-water immersion at 10 minutes postburn of only the burned surface for 30 minutes. Skin samples from treated and untreated burn wounds were examined at 2, 8, 24, and 96 hours postburn by light and electron microscopy. ⋯ There was also less damage to the dermal microvasculature and less edema fluid compared to untreated burn wounds. At 96 hours, the cooled burn wounds demonstrated minimal dermal hemorrhage and polymorphonuclear leukocytic infiltration, compared to the untreated wounds. These results indicate that on a cellular level, cooling has beneficial effects on the experimental burn wound.
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The contribution of the reticuloendothelial system (RES) in pyridoxalated stroma-free hemoglobin (SFH-P) clearance may be insignificant. The magnitude of this is not at present clear. Any compromise of RES function would militate against its potential benefit as an oxygen-carrying resuscitation fluid. ⋯ Shock resuscitation with pyridoxalated stroma-free hemoglobin was equal to or better than all other resuscitation groups evaluated. Tolerance to a standard septic challenge 5 days after resuscitation was no different between resuscitation groups. There appears to be no compromise to host defense in general in tolerating intra-abdominal sepsis 5 days following shock resuscitation with pyridoxalated stroma-free hemoglobin.
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This report demonstrates prolonged effective release of silver sulfadiazine (AgSD) to experimental burns in rats from a solid dressing by mixtures of polyethylene glycol-400 and poly-2-hydroxyethyl methacrylate. The synthetic dressing, incorporating the antimicrobial drug, may be formed either directly on the burn wound or prepared as a preformed sheet and applied to the wound after it was contaminated with bacteria. The level of silver in the blood following treatment of the burn wound with topical AgSD (Silvadene, Marion Labs) is significantly less when the drug is presented in the dressing than when the drug is applied in a cream base; the concentration of the sulfadiazine moiety in the blood is similar for the two drug preparations. Improved survival of the burned and contaminated rats and reduced nursing care were observed in the burned animals when the synthetic dressing was used to deliver the drug relative to the results when the AgSD was applied in a cream base by standard procedures.
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A case of open dislocation of the interphalangeal joint of the thumb is presented. The anatomy of the injury is discussed as well as treatment options. ⋯ At operation the volar plate, which was blocking reduction, was repositioned through a dorsal incision as the flexor tendon was replaced in its correct position. Recovery has resulted.
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Ninety-seven of 763 patients admitted to a burn center during a 3-year period had histologically confirmed bacterial or fungal burn wound invasion. Nine of these 97 patients survived and 88 died. ⋯ The variety of mycotic and bacterial organisms identified, however, suggests that the compromise of the host is the critical factor, and not any particular microorganism. A variety of combinations of treatments are described: the selection of treatment depends upon the type and extent of infection.