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Crawford J, Herndon D, Gmitter K, Weiss J. The impact of myelosuppression on quality of life of patients treated with chemotherapy. Future Oncol 2024. [PMID: 38587388 DOI: 10.2217/fon-2023-0513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2024] Open
Abstract
Side effects from chemotherapy-induced myelosuppression can negatively affect patients' quality of life (QoL). Neutropenia increases infection risk, and anemia frequently results in debilitating fatigue. Additionally, the bleeding risk associated with thrombocytopenia can lead to fear and anxiety. However, traditional interventions for myelosuppression fall short of the ideal. Granulocyte colony-stimulating factors reduce the risk of severe neutropenia but commonly lead to bone pain. Erythropoiesis-stimulating agents are not always effective and may cause thromboembolic events, while transfusions to correct anemia/thrombocytopenia are associated with transfusion reactions and volume overload. Trilaciclib, which is approved for reducing myelosuppression in patients with extensive-stage small cell lung cancer, together with several investigational agents in development for managing myelosuppression have the potential to improve QoL for patients on chemotherapy.
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Affiliation(s)
| | - Dana Herndon
- Cone Health Cancer Center, Greensboro, NC 27403, USA
| | | | - Jared Weiss
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC 27599, USA
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Mohamed MK, Herndon D, Schmidt M, Manning MA. The effect of under and uninsured status on survival in lung cancer while adjusting for other mortality risk factors. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e21734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e21734 Background: Lung cancer is the leading cause of cancer death in the US. Significant improvements in survival have occurred with improved treatments. Payer status has been recognized as a barrier to treatment access across multiple cancer types including lung. This study aims to evaluate the impact of payer on 2-year survival rates for patients presenting in one health system with newly diagnosed lung or bronchus cancer. Methods: This is a retrospective survival analysis. There were 1,681 patients with lung cancer (small and non-small) under observation from time of first diagnosis. The first diagnosis date in the Cone health system defined study entry. Failure was defined as death during the 2-year observation period with right censoring after 2-years. Patients were categorized as underinsured if they had no insurance or Medicaid while those with commercial and Medicare were considered having full coverage. Cox proportional hazard models were used reporting hazard ratios. Results: Mortality rates per 10 patients diagnosed with lung or bronchus cancers were 3.5 for those with commercial insurance, 3.8 for Medicare, 3.3 for Medicaid and 5.4 for uninsured patients. Of those patients considered underinsured, 56.7% presented with stage IV cancer compared to those with full coverage (41.4%)*. 40.7% of those without insurance or underinsured were current tobacco product users compared to 25.1% of those with full coverage. Cox proportional hazard models revealed the risk of death is 1.34* times (95% CI 1.07-1.68) greater for underinsured patients compared to those with full coverage. The model adjusted for age, race, gender, marital status, language, Gini coefficient, Elixhauser comorbidity index, illicit drug use, cigarette smoker, smokeless tobacco user, alcohol use, PCP on record, and religion. However, when we add the AJCC stage to this model, the underinsured estimate is no longer statistically significant (1.23; 95% CI 0.92-1.65). Conclusions: Patients without insurance are diagnosed at later stages of disease. This late diagnosis is the primary driver of poor survival. Although being underinsured or uninsured is associated with a greater risk of death after diagnosis, adjusting for stage mitigates this effect. These findings support the need for equal access to early screening and diagnosis regardless of payer. *statistically significant at p < 0.05.
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Plotkin E, Allen TC, Brown S, Gutman P, Herndon D, Nowak JA, Martin J, Mohamed M, Gandee M, Lucas L. Integration of pathology within the multidisciplinary cancer care team. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.27_suppl.49] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
49 Background: In an era of precision medicine the role of pathology in the diagnosis/management of cancer is evolving. Pathologists are positioned at the intersection of multiple points along the cancer care continuum. Starting at diagnosis pathologists provide expert interpretation and may recommend biomarker testing to guide treatment decisions. Methods: ACCC joined with partners AMP, ASCP, and CAP administered a survey in June 2018. 659 responses were received from a multidisciplinary group and a variety of cancer program settings. Results: Respondents reported that breakdowns in communication are most likely to occur when selecting and ordering biomarker tests (78%) and when reporting the results of the tests (34%). The top 5 challenges reported were coverage/reimbursement, insufficient quantity of material, turnaround time, test selection/ordering, and communication across the multidisciplinary team. There were sizable gaps in regular ordering of NGS among those with 1 tumor board (28%), 2-3 tumor boards (42%) and 4+ tumor boards (64%). Current use of liquid biopsy remains low with the majority (52%) reporting that clinicians rarely order ctDNA testing (12% “routinely”). Time to receiving test results varied with 58% reporting 5-10 business days, 19% reporting <5 business days and 24% >10 business days. 43% indicated pathologists are authorized to order all types of cancer biomarker tests. 56% have molecular pathologists on staff, 24% have a cancer genetics team. 62% report pathology has access to all inpatient records (38% outpatient records). Conclusions: Programs viewed as having integrated pathology participation feature pathologists leading institutional biomarker testing protocols, active participation at tumor boards and standardized reflexive testing pathways that reduce waste & turnaround time. Full integration is a critical piece to ensure patients receive appropriate and timely care.
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Affiliation(s)
- Elana Plotkin
- Association of Community Cancer Centers, Rockville, MD
| | | | | | | | | | - Jan A. Nowak
- Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | | | | | | | - Lorna Lucas
- Association of Community Cancer Centers, Rockville, MD
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Lee J, Herndon D, Finnerty C, Wolf S. 462 Determination of Selenium, Copper, and Zinc Deficiency in Pediatric Burn Patients: Quality Improvement Project. J Burn Care Res 2019. [DOI: 10.1093/jbcr/irz013.357] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- J Lee
- University of Texas Medical Branch, Galveston, TX
| | - D Herndon
- University of Texas Medical Branch, Galveston, TX
| | - C Finnerty
- University of Texas Medical Branch, Galveston, TX
| | - S Wolf
- University of Texas Medical Branch, Galveston, TX
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Nodoushani AY, Murphy JM, Wang SL, Stoddard FJ, Kazis L, Lydon M, Lee A, Warner P, Palmieri T, Herndon D, Sheridan RL. 269 Prevalence of Depressive Symptoms Over Time in Pediatric Burn Survivors. J Burn Care Res 2018. [DOI: 10.1093/jbcr/iry006.191] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- A Y Nodoushani
- Shriners Hospital For Children - Boston, Boston, MA; Massachusetts General Hospital, Boston, MA; Boston University School of Public Health, Boston, MA; Bentley University, Waltham, MA; Shriners Hospital For Children - Cincinnati, Cincinnati, OH; Shriners Hospital For Children - Northern California, Sacramento, CA; Shriners Hospital For Children - Galveston, Galveston, TX
| | - J M Murphy
- Shriners Hospital For Children - Boston, Boston, MA; Massachusetts General Hospital, Boston, MA; Boston University School of Public Health, Boston, MA; Bentley University, Waltham, MA; Shriners Hospital For Children - Cincinnati, Cincinnati, OH; Shriners Hospital For Children - Northern California, Sacramento, CA; Shriners Hospital For Children - Galveston, Galveston, TX
| | - S L Wang
- Shriners Hospital For Children - Boston, Boston, MA; Massachusetts General Hospital, Boston, MA; Boston University School of Public Health, Boston, MA; Bentley University, Waltham, MA; Shriners Hospital For Children - Cincinnati, Cincinnati, OH; Shriners Hospital For Children - Northern California, Sacramento, CA; Shriners Hospital For Children - Galveston, Galveston, TX
| | - F J Stoddard
- Shriners Hospital For Children - Boston, Boston, MA; Massachusetts General Hospital, Boston, MA; Boston University School of Public Health, Boston, MA; Bentley University, Waltham, MA; Shriners Hospital For Children - Cincinnati, Cincinnati, OH; Shriners Hospital For Children - Northern California, Sacramento, CA; Shriners Hospital For Children - Galveston, Galveston, TX
| | - L Kazis
- Shriners Hospital For Children - Boston, Boston, MA; Massachusetts General Hospital, Boston, MA; Boston University School of Public Health, Boston, MA; Bentley University, Waltham, MA; Shriners Hospital For Children - Cincinnati, Cincinnati, OH; Shriners Hospital For Children - Northern California, Sacramento, CA; Shriners Hospital For Children - Galveston, Galveston, TX
| | - M Lydon
- Shriners Hospital For Children - Boston, Boston, MA; Massachusetts General Hospital, Boston, MA; Boston University School of Public Health, Boston, MA; Bentley University, Waltham, MA; Shriners Hospital For Children - Cincinnati, Cincinnati, OH; Shriners Hospital For Children - Northern California, Sacramento, CA; Shriners Hospital For Children - Galveston, Galveston, TX
| | - A Lee
- Shriners Hospital For Children - Boston, Boston, MA; Massachusetts General Hospital, Boston, MA; Boston University School of Public Health, Boston, MA; Bentley University, Waltham, MA; Shriners Hospital For Children - Cincinnati, Cincinnati, OH; Shriners Hospital For Children - Northern California, Sacramento, CA; Shriners Hospital For Children - Galveston, Galveston, TX
| | - P Warner
- Shriners Hospital For Children - Boston, Boston, MA; Massachusetts General Hospital, Boston, MA; Boston University School of Public Health, Boston, MA; Bentley University, Waltham, MA; Shriners Hospital For Children - Cincinnati, Cincinnati, OH; Shriners Hospital For Children - Northern California, Sacramento, CA; Shriners Hospital For Children - Galveston, Galveston, TX
| | - T Palmieri
- Shriners Hospital For Children - Boston, Boston, MA; Massachusetts General Hospital, Boston, MA; Boston University School of Public Health, Boston, MA; Bentley University, Waltham, MA; Shriners Hospital For Children - Cincinnati, Cincinnati, OH; Shriners Hospital For Children - Northern California, Sacramento, CA; Shriners Hospital For Children - Galveston, Galveston, TX
| | - D Herndon
- Shriners Hospital For Children - Boston, Boston, MA; Massachusetts General Hospital, Boston, MA; Boston University School of Public Health, Boston, MA; Bentley University, Waltham, MA; Shriners Hospital For Children - Cincinnati, Cincinnati, OH; Shriners Hospital For Children - Northern California, Sacramento, CA; Shriners Hospital For Children - Galveston, Galveston, TX
| | - R L Sheridan
- Shriners Hospital For Children - Boston, Boston, MA; Massachusetts General Hospital, Boston, MA; Boston University School of Public Health, Boston, MA; Bentley University, Waltham, MA; Shriners Hospital For Children - Cincinnati, Cincinnati, OH; Shriners Hospital For Children - Northern California, Sacramento, CA; Shriners Hospital For Children - Galveston, Galveston, TX
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Goverman J, Mathews K, Nadler D, Henderson E, McMullen K, Herndon D, Meyer W, Fauerbach J, Wiechman S, Carrougher G, Ryan C, Schneider J. Satisfaction with life after burn: A Burn Model System National Database Study. Burns 2016; 42:1067-1073. [DOI: 10.1016/j.burns.2016.01.018] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 01/12/2016] [Accepted: 01/13/2016] [Indexed: 10/21/2022]
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Schrock AB, Frampton GM, Herndon D, Greenbowe JR, Wang K, Lipson D, Yelensky R, Chalmers ZR, Chmielecki J, Elvin JA, Wollner M, Dvir A, -Gutman LS, Bordoni R, Peled N, Braiteh F, Raez L, Erlich R, Ou SHI, Mohamed M, Ross JS, Stephens PJ, Ali SM, Miller VA. Comprehensive Genomic Profiling Identifies Frequent Drug-Sensitive EGFR Exon 19 Deletions in NSCLC not Identified by Prior Molecular Testing. Clin Cancer Res 2016; 22:3281-5. [PMID: 26933124 DOI: 10.1158/1078-0432.ccr-15-1668] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 01/23/2016] [Indexed: 11/16/2022]
Abstract
PURPOSE Reliable detection of drug-sensitive activating EGFR mutations is critical in the care of advanced non-small cell lung cancer (NSCLC), but such testing is commonly performed using a wide variety of platforms, many of which lack rigorous analytic validation. EXPERIMENTAL DESIGN A large pool of NSCLC cases was assayed with well-validated, hybrid capture-based comprehensive genomic profiling (CGP) at the request of the individual treating physicians in the course of clinical care for the purpose of making therapy decisions. From these, 400 cases harboring EGFR exon 19 deletions (Δex19) were identified, and available clinical history was reviewed. RESULTS Pathology reports were available for 250 consecutive cases with classical EGFR Δex19 (amino acids 743-754) and were reviewed to assess previous non-hybrid capture-based EGFR testing. Twelve of 71 (17%) cases with EGFR testing results available were negative by previous testing, including 8 of 46 (17%) cases for which the same biopsy was analyzed. Independently, five of six (83%) cases harboring C-helical EGFR Δex19 were previously negative. In a subset of these patients with available clinical outcome information, robust benefit from treatment with EGFR inhibitors was observed. CONCLUSIONS CGP identifies drug-sensitive EGFR Δex19 in NSCLC cases that have undergone prior EGFR testing and returned negative results. Given the proven benefit in progression-free survival conferred by EGFR tyrosine kinase inhibitors in patients with these alterations, CGP should be considered in the initial presentation of advanced NSCLC and when previous testing for EGFR mutations or other driver alterations is negative. Clin Cancer Res; 22(13); 3281-5. ©2016 AACR.
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Affiliation(s)
| | | | - Dana Herndon
- Cone Health, Cancer Center at Wesley Long, Greensboro, North Carolina
| | | | - Kai Wang
- Foundation Medicine Inc., Cambridge, Massachusetts
| | - Doron Lipson
- Foundation Medicine Inc., Cambridge, Massachusetts
| | | | | | | | | | - Mira Wollner
- Department of Oncology, Rambam Health Care Campus, Haifa, Israel
| | - Addie Dvir
- Teva Pharmaceuticals, Petah Tikva, Israel
| | | | | | - Nir Peled
- Thoracic Cancer Unit, Davidoff Cancer Center, Petach Tiqwa, Israel
| | - Fadi Braiteh
- Comprehensive Cancer Centers of Nevada, Las Vegas, Nevada
| | - Luis Raez
- Memorial Healthcare System, Pembroke Pines, Florida
| | | | | | - Mohamed Mohamed
- Cone Health, Cancer Center at Wesley Long, Greensboro, North Carolina
| | - Jeffrey S Ross
- Foundation Medicine Inc., Cambridge, Massachusetts. Albany Medical College, Albany, New York
| | | | - Siraj M Ali
- Foundation Medicine Inc., Cambridge, Massachusetts.
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Levy BP, Chioda MD, Herndon D, Longshore JW, Mohamed M, Ou SHI, Reynolds C, Singh J, Wistuba II, Bunn PA, Hirsch FR. Molecular Testing for Treatment of Metastatic Non-Small Cell Lung Cancer: How to Implement Evidence-Based Recommendations. Oncologist 2015; 20:1175-81. [PMID: 26330460 DOI: 10.1634/theoncologist.2015-0114] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 07/02/2015] [Indexed: 12/28/2022] Open
Abstract
The recent discovery of relevant biomarkers has reshaped our approach to therapy selection for patients with non-small cell lung cancer. The unprecedented outcomes demonstrated with tyrosine kinase inhibitors in molecularly defined cohorts of patients has underscored the importance of genetic profiling in this disease. Despite published guidelines on biomarker testing, successful tumor genotyping faces significant hurdles at both academic and community-based practices. Oncologists are now faced with interpreting large-scale genomic data from multiple tumor types, possibly making it difficult to stay current with practice standards in lung cancer. In addition, physicians' lack of time, resources, and face-to-face opportunities can interfere with the multidisciplinary approach that is essential to delivery of care. Finally, several challenges exist in optimizing the amount and quality of tissue for molecular testing. Recognizing the importance of biomarker testing, a series of advisory boards were recently convened to address these hurdles and clarify best practices. We reviewed these challenges and established recommendations to help optimize tissue acquisition, processing, and testing within the framework of a multidisciplinary approach.
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Affiliation(s)
- Benjamin P Levy
- Mount Sinai Health Systems, New York, New York, USA; Pfizer Oncology, New York, New York, USA; Cone Health Cancer Center, Greensboro, North Carolina, USA; Carolinas Pathology Group, Carolinas HealthCare System, Charlotte, North Carolina, USA; Chao Family Comprehensive Cancer Center, University of California at Irvine School of Medicine, Orange, California, USA; US Oncology Research, Ocala, Florida, USA; Carolinas HealthCare System, Charlotte, North Carolina, USA; The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; University of Colorado Cancer Center, Aurora, Colorado, USA
| | - Marc D Chioda
- Mount Sinai Health Systems, New York, New York, USA; Pfizer Oncology, New York, New York, USA; Cone Health Cancer Center, Greensboro, North Carolina, USA; Carolinas Pathology Group, Carolinas HealthCare System, Charlotte, North Carolina, USA; Chao Family Comprehensive Cancer Center, University of California at Irvine School of Medicine, Orange, California, USA; US Oncology Research, Ocala, Florida, USA; Carolinas HealthCare System, Charlotte, North Carolina, USA; The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; University of Colorado Cancer Center, Aurora, Colorado, USA
| | - Dana Herndon
- Mount Sinai Health Systems, New York, New York, USA; Pfizer Oncology, New York, New York, USA; Cone Health Cancer Center, Greensboro, North Carolina, USA; Carolinas Pathology Group, Carolinas HealthCare System, Charlotte, North Carolina, USA; Chao Family Comprehensive Cancer Center, University of California at Irvine School of Medicine, Orange, California, USA; US Oncology Research, Ocala, Florida, USA; Carolinas HealthCare System, Charlotte, North Carolina, USA; The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; University of Colorado Cancer Center, Aurora, Colorado, USA
| | - John W Longshore
- Mount Sinai Health Systems, New York, New York, USA; Pfizer Oncology, New York, New York, USA; Cone Health Cancer Center, Greensboro, North Carolina, USA; Carolinas Pathology Group, Carolinas HealthCare System, Charlotte, North Carolina, USA; Chao Family Comprehensive Cancer Center, University of California at Irvine School of Medicine, Orange, California, USA; US Oncology Research, Ocala, Florida, USA; Carolinas HealthCare System, Charlotte, North Carolina, USA; The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; University of Colorado Cancer Center, Aurora, Colorado, USA
| | - Mohamed Mohamed
- Mount Sinai Health Systems, New York, New York, USA; Pfizer Oncology, New York, New York, USA; Cone Health Cancer Center, Greensboro, North Carolina, USA; Carolinas Pathology Group, Carolinas HealthCare System, Charlotte, North Carolina, USA; Chao Family Comprehensive Cancer Center, University of California at Irvine School of Medicine, Orange, California, USA; US Oncology Research, Ocala, Florida, USA; Carolinas HealthCare System, Charlotte, North Carolina, USA; The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; University of Colorado Cancer Center, Aurora, Colorado, USA
| | - Sai-Hong Ignatius Ou
- Mount Sinai Health Systems, New York, New York, USA; Pfizer Oncology, New York, New York, USA; Cone Health Cancer Center, Greensboro, North Carolina, USA; Carolinas Pathology Group, Carolinas HealthCare System, Charlotte, North Carolina, USA; Chao Family Comprehensive Cancer Center, University of California at Irvine School of Medicine, Orange, California, USA; US Oncology Research, Ocala, Florida, USA; Carolinas HealthCare System, Charlotte, North Carolina, USA; The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; University of Colorado Cancer Center, Aurora, Colorado, USA
| | - Craig Reynolds
- Mount Sinai Health Systems, New York, New York, USA; Pfizer Oncology, New York, New York, USA; Cone Health Cancer Center, Greensboro, North Carolina, USA; Carolinas Pathology Group, Carolinas HealthCare System, Charlotte, North Carolina, USA; Chao Family Comprehensive Cancer Center, University of California at Irvine School of Medicine, Orange, California, USA; US Oncology Research, Ocala, Florida, USA; Carolinas HealthCare System, Charlotte, North Carolina, USA; The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; University of Colorado Cancer Center, Aurora, Colorado, USA
| | - Jaspal Singh
- Mount Sinai Health Systems, New York, New York, USA; Pfizer Oncology, New York, New York, USA; Cone Health Cancer Center, Greensboro, North Carolina, USA; Carolinas Pathology Group, Carolinas HealthCare System, Charlotte, North Carolina, USA; Chao Family Comprehensive Cancer Center, University of California at Irvine School of Medicine, Orange, California, USA; US Oncology Research, Ocala, Florida, USA; Carolinas HealthCare System, Charlotte, North Carolina, USA; The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; University of Colorado Cancer Center, Aurora, Colorado, USA
| | - Ignacio I Wistuba
- Mount Sinai Health Systems, New York, New York, USA; Pfizer Oncology, New York, New York, USA; Cone Health Cancer Center, Greensboro, North Carolina, USA; Carolinas Pathology Group, Carolinas HealthCare System, Charlotte, North Carolina, USA; Chao Family Comprehensive Cancer Center, University of California at Irvine School of Medicine, Orange, California, USA; US Oncology Research, Ocala, Florida, USA; Carolinas HealthCare System, Charlotte, North Carolina, USA; The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; University of Colorado Cancer Center, Aurora, Colorado, USA
| | - Paul A Bunn
- Mount Sinai Health Systems, New York, New York, USA; Pfizer Oncology, New York, New York, USA; Cone Health Cancer Center, Greensboro, North Carolina, USA; Carolinas Pathology Group, Carolinas HealthCare System, Charlotte, North Carolina, USA; Chao Family Comprehensive Cancer Center, University of California at Irvine School of Medicine, Orange, California, USA; US Oncology Research, Ocala, Florida, USA; Carolinas HealthCare System, Charlotte, North Carolina, USA; The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; University of Colorado Cancer Center, Aurora, Colorado, USA
| | - Fred R Hirsch
- Mount Sinai Health Systems, New York, New York, USA; Pfizer Oncology, New York, New York, USA; Cone Health Cancer Center, Greensboro, North Carolina, USA; Carolinas Pathology Group, Carolinas HealthCare System, Charlotte, North Carolina, USA; Chao Family Comprehensive Cancer Center, University of California at Irvine School of Medicine, Orange, California, USA; US Oncology Research, Ocala, Florida, USA; Carolinas HealthCare System, Charlotte, North Carolina, USA; The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; University of Colorado Cancer Center, Aurora, Colorado, USA
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Sousse L, Jonkam C, Traber D, Rehberg S, Traber L, Herndon D, Enkhbaatar P. Increased asymmetrical dimethyl-arginine suppresses nitric oxide production in Pseudomonas aeruginosa sepsis. Crit Care 2009. [PMCID: PMC2776207 DOI: 10.1186/cc8090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Rosenberg M, Meyer W, Herndon D, Holzer C, Rosenberg L, Huddleston V. Comparison of the epidemiology of burns of Mexican and American children. Burns 2007. [DOI: 10.1016/j.burns.2006.10.235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Sanford A, Herndon D, Jeschke M. Fluid requirements of large chemical burns are less than predicted by conventional formulas. Burns 2007. [DOI: 10.1016/j.burns.2006.10.342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Enkhbaatar P, Traber D, Traber D, Herndon D, Herndon D, Cox R, Huda R, Joncam C, Esechie A, Traber L, Nakano Y. Effects of intravenously administered recombinant human antithrombin (rhAT) and aerosolized heparin on burn and smoke inhalation-induced acute lung injury. Burns 2007. [DOI: 10.1016/j.burns.2006.10.337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Sanford A, Herndon D, Sanford S. Pregnancy outcomes in burned females. Burns 2007. [DOI: 10.1016/j.burns.2006.10.340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Sanford A, Herndon D, Jeschke M. Metabolic consequences of balanced skeletal traction. Burns 2007. [DOI: 10.1016/j.burns.2006.10.338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Meyer W, Herndon D, Chinkes D, Ojeda S, Przkora R. Effect of major burn injury on bone age progression. Burns 2007. [DOI: 10.1016/j.burns.2006.10.313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Jeschke M, Herndon D, Mlcak R, Finnerty C, Suman O, Przkora R, Sanford A. Gender differences in the long-term outcome after a severe thermal injury. Burns 2007. [DOI: 10.1016/j.burns.2006.10.345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Enkhbaatar P, Aimalohi E, Traber L, Joncam C, Connelly R, Lange M, Hamahata A, Herndon D, Traber D. Methicillin-resistant Staphylococcus aureus-induced vascular leakage is associated with excessive production of nitric oxide and vascular endothelial growth factor. Crit Care 2007. [PMCID: PMC3300676 DOI: 10.1186/cc6015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Saunders F, Westphal M, Enkhbaatar P, Wang J, Gonzalez M, Nakano Y, Hamahata A, Jonkam C, Connelly R, Cox R, Hawkins H, Schmalstieg F, Horvath E, Lange M, Szabo C, Traber L, Herndon D, Traber D. Effects of neuronal nitric oxide synthase in ovine lung injury. Crit Care 2007. [PMCID: PMC4095070 DOI: 10.1186/cc5176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Branski L, Jeschke M, Celis M, Norbury W, Herndon D. The treatment of partial-thickness burns: Amnion versus topical antimicrobial crème. J Surg Res 2006. [DOI: 10.1016/j.jss.2005.11.333] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Caruso D, Antimarino J, Bauer G, Blome-Eberwein S, Foster K, Herndon D, Luterman A, Silverstein P, Twomey J. Randomized Controlled Study of Silver Dressing Effects on Partial-Thickness Burn Outcomes. Ann Emerg Med 2005. [DOI: 10.1016/j.annemergmed.2005.06.182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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22
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Przkora R, Jeschke M, Haslbeck M, Heyde C, Ertel W, Herndon D, Bolder U, Herndon D. Heat stress modulates and protects hepatocyte membrane proteins during sepsis. J Surg Res 2004. [DOI: 10.1016/j.jss.2004.07.218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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23
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Abstract
Statistical methods for analyzing data from DNA microarray experiments are reviewed. Specifically, we discuss common experimental setups, methods for data reduction and clustering, and analysis of time-course experiments. While early microarray studies focused mainly on the basic methodological and technical aspects of DNA arrays, emphasis has shifted to biological, medical, and clinical applications. We mention several of these and present results from our recent research as illustrative examples. New developments in this ever-growing field are outlined.
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Affiliation(s)
- N M Svrakic
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri 63110, USA.
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24
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Oliveira G, Murakami K, Shimoda K, Enkhbaatar P, Jodoin J, Herndon D, Traber L, Traber D. POSSIBLE ROLE OF INDUCIBLE NITRIC OXIDE SYNTHASE IN SYSTEMIC EDEMA FORMATION AFTER BURN. Shock 2003. [DOI: 10.1097/00024382-200306001-00027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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25
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Murakami K, Katahira J, McGuire R, Cox R, Hawkins H, Herndon D, Traber L, Traber D. Heparin nebulization attenuates acute lung injury with sepsis after smoke inhalation in sheep. Crit Care 2001. [PMCID: PMC3333249 DOI: 10.1186/cc1129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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26
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McQuitty CK, Berman J, Cortiella J, Herndon D, Mathru M. beta-adrenergic desensitization after burn excision not affected by the use of epinephrine to limit blood loss. Anesthesiology 2000; 93:351-8. [PMID: 10910481 DOI: 10.1097/00000542-200008000-00012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Burn patients have impaired myocardial function and decreased beta-adrenergic responsiveness. Further beta-adrenergic dysfunction from systemic absorption of topically administered epinephrine that is given to limit blood loss during burn excision could affect perioperative management. The authors evaluated the effect of topical epinephrine administration to patients during burn excision on the lymphocytic beta-adrenergic response. METHODS Fifty-five patients (age, 2-18 yr) with 20-90% body surface area burns received a standardized anesthetic for a burn excision procedure. Lymphocyte samples were taken at baseline and 1 and 3 h after the initial use of epinephrine (n = 43) or thrombin (controls, n = 12). Plasma epinephrine levels were measured by high-performance liquid chromatography. Lymphocyte beta-adrenergic responsiveness was assessed by measuring production of cyclic adenosine monophosphate (cAMP) after stimulation with isoproterenol, prostaglandin E1 (PGE1), and forskolin. beta-adrenergic receptor binding assays using iodopindolol and CGP12177 yielded beta-adrenergic receptor density. RESULTS Epinephrine levels were elevated at 1 h (P < 0.01) and 3 h (P < 0.01) after epinephrine use but not in control patients. Production of cAMP in lymphocytes 1 h after epinephrine was greater in patients receiving epinephrine than in control patients on stimulation with isoproterenol (P < 0.05) and PGE1 (P < 0.05). Three hours after epinephrine administration, production of cAMP decreased when compared with baseline in both control patients and those receiving epinephrine after stimulation with isoproterenol (P < 0. 05), PGE1(P < 0.05), and forskolin (P < 0.05). Lymphocytic beta-adrenergic receptor content was not changed. CONCLUSIONS Topical epinephrine to limit blood loss during burn excision resulted in significant systemic absorption and increased plasma epinephrine levels. Acute sensitization of the lymphocytic beta-adrenergic cascade was induced by the administration of epinephrine reflected by increased cAMP production after stimulation with isoproterenol and PGE1. The lymphocytic beta-adrenergic cascade exhibited homologous and heterologous desensitization 3 h after the use of epinephrine or thrombin, indicating that epinephrine administration was not a causative factor.
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Affiliation(s)
- C K McQuitty
- Departments of Anesthesiology, Internal Medicine, and Surgery, The University of Texas Medical Branch and Shriners Burns Institute, Galveston, 77555-0591, USA.
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27
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Abstract
Our hypothesis is that gene transfer of an IGF-I CMV-cDNA with cholesterol containing cationic liposomes is an efficient tool for transient transfection of growth factors in vitro and in vivo. In vitro, we transiently cotransfected IGF-I cDNA with a CMV construct and a Lac Z beta-galactosidase cDNA/CMV construct using cholesterol containing cationic liposomes and measured beta-galactosidase and IGF-I mRNA and protein. In vivo, we subcutaneously injected 3-month-old male Sprague-Dawley rats with IGF-I cDNA and beta-galactosidase cDNA into rat skin. After IGF-I and beta-galactosidase were cotransfected into PC12 cells, Northern blot analysis showed that the peak time of IGF-I expression was 2 days for mRNA and 5 days for protein. In vivo, a cDNA/liposome ratio of 1:2 was most effective. IGF-I protein expression in IGF-I-transfected skin resulted in significant transfection from day 5 to day 7. In situ determination of beta-galactosidase activity confirmed that transfections resulted in a restricted expression area.
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Affiliation(s)
- Z Tao
- Department of Human Biological Chemistry and Genetics, University of Texas Medical Branch at Galveston 77555, USA
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28
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Meyers-Paal R, Blakeney P, Robert R, Murphy L, Chinkes D, Meyer W, Desai M, Herndon D. Physical and psychologic rehabilitation outcomes for pediatric patients who suffer 80% or more TBSA, 70% or more third degree burns. J Burn Care Rehabil 2000; 21:43-9. [PMID: 10661538 DOI: 10.1097/00004630-200021010-00009] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Advances in medical management have dramatically decreased the mortality of children with massive burn injuries, which raises many questions about the expected quality of life for these young survivors. In this article, we address this issue by examining the functional and psychological adaptation of 41 young survivors with 88% mean total body surface area (TBSA) burns and 85% mean third degree TBSA burns. Patient scores were compared with normative data on standardized psychological measures of adjustment and on performance of age appropriate activities of daily living (ADL) skills. Thirty-three of the 41 patients (80%) were independent in basic ADL skills. Eighty-six percent of the patients who were aged 10 years and older were independent in advanced ADL skills. Patients with amputated fingers were significantly more dependent in ADL skills than those without amputations (P < .05). Mean psychosocial adjustment scores were within normal limits and were not significantly related to functional independence in ADL skills.
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Affiliation(s)
- R Meyers-Paal
- Shriners Burn Hospital and the University of Texas Medical Branch, Galveston, USA
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29
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Abstract
The objective of this study was to present data that showed high frequency percussive ventilation (HFPV) was superior to traditional mechanical ventilation for the treatment of children with inhalation injuries. Inhalation injuries continue to be the number one cause of death of patients with thermal injuries in the United States. Therapy for this condition has consisted of conservative pulmonary toilet and mechanical ventilation. Despite improvements in the management of burn injury, patients with inhalation injury develop pneumonia and pneumothorax, leading to adult respiratory distress syndrome. Unfortunately, inhalation injury that is complicated by pneumonia has been shown to increase mortality by 60% in these patients. Cioffi has shown that prophylactic use of HFPV in adult patients with inhalation injury has been a successful method of reducing the incidence of pneumonia and mortality. The effects of HFPV on the incidence of pneumonia, peak inspiratory pressures, and arterial partial pressure of oxygen/fraction of inspired concentration of oxygen (P/F) ratios were retrospectively studied in 13 children with inhalation injuries and compared with historic controls treated with conventional mechanical ventilation. All patients were treated with our standard inhalation injury protocol and extubated when they met standard extubation criteria. Patients ranged in age from 6 to 9 years, and most had burns covering greater than 50% of their total body surface areas. No deaths occurred in either group, but the patients who were treated with HFPV had no cases of pneumonia (P < .05), better P/F ratios (P < .05), lower peak inspiratory pressures, and less work of breathing (P < .05) as compared with our control group. On the basis of our clinical experience and data, the use of HFPV seems to be an effective treatment for the reduction of pulmonary morbidity in pediatric patients with inhalation injuries.
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Affiliation(s)
- J Cortiella
- University of Texas Medical Branch at Galveston, USA
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30
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Abstract
A convergent postburn psychopharmacologic treatment for children for acute stress disorder (ASD) symptoms has not been established. Both the application of what has been learned through treatment of similar symptoms experienced by adults with posttraumatic stress disorder and the examination of safe treatment options for children led to the clinical decision to use imipramine for 25 pediatric patients with acute burns. The treatment histories of these patients were retrospectively reviewed to see if further exploration into the efficacy of imipramine was warranted. Eighty percent of the children experienced remission of hyperarousal symptoms (eg, trouble staying asleep, trouble falling asleep) and intrusive reexperiencing symptoms (eg, nightmares). Twelve percent of the children experienced a decrease in the frequency or intensity of ASD symptoms. Eight percent had no relief of ASD symptoms. Initial findings suggest that imipramine assists children who have postburn ASD symptoms by decreasing the hyperarousal and intrusive reexperiencing symptoms of ASD.
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Affiliation(s)
- R Robert
- Shriners Hospital for Children and the University of Texas Medical Branch, Galveston 77550, USA
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31
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Blakeney P, Meyer W, Robert R, Desai M, Wolf S, Herndon D. Long-term psychosocial adaptation of children who survive burns involving 80% or greater total body surface area. J Trauma 1998; 44:625-32; discussion 633-4. [PMID: 9555833 DOI: 10.1097/00005373-199804000-00011] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To examine the psychosocial adjustment of survivors of massive pediatric burn injuries, the change in adjustment across time, and the impact on parents. BACKGROUND Patients/parents were assessed at regular intervals postburn using standardized tests of adjustment. Patients who could not be included in standardized longitudinal assessments were administered questionnaires by mail/telephone. METHODS The Child Behavior Checklist, the Teacher Report Form, the Youth Self Report Form, and the Parenting Stress Index were utilized to assess adjustment. RESULTS On all objective measures, the group of survivors and their parents were within normal limits. Adjustment neither improved nor deteriorated over time. CONCLUSION Children who survive massive burn injuries can achieve positive psychosocial adaptation.
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Affiliation(s)
- P Blakeney
- Shriners Burns Hospital and the Department of Surgery, University of Texas Medical Branch, Galveston 77550, USA
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32
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Mlcak R, Cortiella J, Desai M, Herndon D. Lung compliance, airway resistance, and work of breathing in children after inhalation injury. J Burn Care Rehabil 1997; 18:531-4. [PMID: 9404988 DOI: 10.1097/00004630-199711000-00011] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Pathophysiologic changes associated with inhalation injury make mechanical ventilation in children a challenge. Decreased lung compliance and increased airway resistance after inhalation injury may lead to elevated airway pressures and barotrauma. Previous studies have shown significant decreases in the incidence of pneumonia and death in adult patients with inhalation injury treated with high-frequency percussive ventilation (HFPV) as compared with conventional mechanical ventilation (CMV). No studies to date have compared lung compliance, airway resistance, or work of breathing in children being treated with HFPV versus CMV. The purpose of this study was to evaluate lung compliance, airway resistance, and work of breathing in pediatric patients with inhalation injury who required mechanical ventilation. Ten children with bronchoscopically identified inhalation injury requiring mechanical ventilation were studied. Five children received CMV and five children received HFPV. All patients were treated according to our standard inhalation injury protocol. Based on our data and patient population, children receiving ventilation with the HFPV have a significant decrease in the work of breathing as compared with CMV.
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Affiliation(s)
- R Mlcak
- Shriners Burns Institute, Galveston, Texas 77550, USA
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33
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Abstract
Opiates remain the most common form of analgesic therapy in the burn patient today. Because of increased opiate requirements, optimal relief of burn pain continues to be a problem for these patients. The purpose of this article is to summarize those alternative pain control methods that appear in the literature. For instance, in minor burns acetominophen continues to be a useful first line analgesic. Non-steroidal anti-inflammatory drugs (NSAID) and benzodiazepine are generally combined with opiates while entonox seems to be used commonly in the adolescent patients to relieve procedural pain. Antidepressants appear to enhance opiate-induced analgesia while anticonvulsants are useful in the treatment of sympathetically maintained pain following burns. Ketamine has been extensively used during burn dressing changes but its psychological side-effects have limited its use. Clonidine, however, has shown promise in reducing pain without causing pruritus or respiratory depression. Other forms such as transcutaneous electrical nerve stimulation (TENS), psychological techniques, topical and systemic local anaesthetics are also useful adjuncts.
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Affiliation(s)
- S K Pal
- Department of Anaesthesiology, St Andrew's Hospital, Billericay, Essex, UK
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34
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Abstract
Statements by caregivers can be beneficial to paediatric burn patients, facilitating their psychological adaptation. However, the concerns of the burned child are not always obvious, and caregivers may flounder, not knowing how to elicit the concerns of the patient. The purpose of this paper is to examine whether universal concerns of the postburn survivor can be detected through one type of psychological assessment tool, a sentence completion task. Sixty paediatric burn survivors, ages 6-19, were administered a 30-item Incomplete Sentences measure. Five major aspects of postburn life were identified and proscribed the following descriptive labels: (1) preoccupation with health; (2) the struggle for internal acceptance; (3) reconstruction of one's life map; (4) changing relationships; and (5) redefining the world. These five dimensions of postburn life are discussed, as well as applications for each.
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Affiliation(s)
- R Robert
- Department of Family Services, Shriners Burns Institute, Galveston, Texas, USA
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35
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Moore P, Moore M, Blakeney P, Meyer W, Murphy L, Herndon D. Competence and physical impairment of pediatric survivors of burns of more than 80% total body surface area. J Burn Care Rehabil 1996; 17:547-51. [PMID: 8951543 DOI: 10.1097/00004630-199611000-00012] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Children who survive massive burn injuries are challenged by the physical sequelae of their injuries as they return to normal daily routines. The purpose of this study was to assess the impact of physical impairment on the competence of such children as they pursued their lives. It was hypothesized that children who survive burn injuries of more than 80% total body surface area would be less competent than their unburned peers, and that competence would decrease with increased physical impairment. Competence for the 19 patients was assessed by parental report using the Child Behavior Checklist and by the patient's self-report on the Youth Self-Report. Physical impairment scores were calculated from range of motion measurements of upper and lower extremities according to AMA guidelines. Competence scores for the sample were within normal ranges. Physical impairment was significantly related to competence only in the area of activity on both the Child Behavior Checklist and the Youth Self-Report.
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Affiliation(s)
- P Moore
- Shriners Burns Institute, Galveston, TX 77550, USA
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36
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Schinkel C, Faist E, Zimmer S, Piltz S, Walz A, Rose R, Höcherl E, Herndon D, Schildberg FW. Kinetics of circulating adhesion molecules and chemokines after mechanical trauma and burns. Eur J Surg 1996; 162:763-768. [PMID: 8934104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
OBJECTIVE To assess the role of circulating adhesion molecules and chemotactic cytokines within different settings of major trauma. DESIGN Retrospective study. SETTING Teaching hospitals, USA and Germany. SUBJECTS Two groups of patients with multiple injuries (group I n = 155 and group II n = 12) with mean (SEM) injury severity scores (ISS) of 35 (4) and 32 (4) points, respectively, and 18 burned patients with a mean of ISS 38 (9) points. INTERVENTIONS Serum samples were collected at the site of the accident and on admission to the (Group I) as well as during the post-trauma course in the hospital (Group II: days 1, 3, 5, 7, 10; Group III; weekly, up to week 10). MAIN OUTCOME MEASURES Measurement of concentrations of soluble (s) adhesion molecules (sE-selectin, sP-selectin), and chemotactic cytokines (interleukin-8 [IL-8], epithelial cell derived neutrophil activating peptide 78 [ENA-78]) in serum after major mechanical trauma and burns. RESULTS High concentrations of ENA-78 and sP-selectin were already present at the site of accident as well as one hour after injury. During recovery from the injuries, persistently high concentrations of IL-8, ENA-78, and sP-selectin were found, but sE-selectin was increased only during the first week after major trauma. CONCLUSION Massive tissue trauma causes immediate activation of selected chemokines and adhesion molecules within minutes of the injury which will then persist depending on the type and severity of the injury for a substantial length of time. There was, however, no correlation between serum concentrations of the mediators investigated and susceptibility to complications or outcome.
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Affiliation(s)
- C Schinkel
- Department of Surgery, Ludwig-Maximilians-University, Klinikum Grosshadern, Munich, Germany
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37
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LeDoux JM, Meyer WJ, Blakeney P, Herndon D. Positive self-regard as a coping mechanism for pediatric burn survivors. J Burn Care Rehabil 1996; 17:472-6; discussion 471-2. [PMID: 8889874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Pediatric burn survivors are reported to present optimistic pictures of themselves; it has been suggested that their reports of high self-esteem may reflects a coping mechanism. The purpose of this study was to compare burned children's self-perceptions of competence and adequacy to normative population with the use of two standardized instruments. A random sample of 32 pediatric burn survivors was administered two standardized instruments: the Piers-Harris and the Harter Self-Perception Profiles for children and adolescents. Paired t tests revealed significantly higher self-concepts by the burned children than the nonclinical reference groups on five of the six Piers-Harris clusters and on two of the nine Harter Self-Perception Profiles domains. Also, the relationship between the children's perceived self-worth in each domain, and the importance they attributed to that domain, indicate that the burned children are satisfied with themselves in those areas they perceive as important. Results from both tests suggest that the burn survivors' report of positive self-esteem may reflect a necessary defense mechanism in the adjustment process, which should be supported by the burn team.
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Affiliation(s)
- J M LeDoux
- Shriners Burn Institute, Galveston, TX 77550, USA
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38
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Wainwright D, Madden M, Luterman A, Hunt J, Monafo W, Heimbach D, Kagan R, Sittig K, Dimick A, Herndon D. Clinical evaluation of an acellular allograft dermal matrix in full-thickness burns. J Burn Care Rehabil 1996; 17:124-36. [PMID: 8675502 DOI: 10.1097/00004630-199603000-00006] [Citation(s) in RCA: 335] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
A multicenter clinical study assessed the ability of an acellular allograft dermal matrix to function as a permanent dermal transplant in full-thickness and deep partial-thickness burns. The study consisted of a pilot phase (24 patients) to identify the optimum protocol and a study phase (43 patients) to evaluate graft performance. Each patient had both a test and a mirror-image or contiguous control site. At the test site, the dermal matrix was grafted to the excised wound base and a split-thickness autograft was simultaneously applied over it. The control site was grafted with a split-thickness autograft alone. Fourteen-day take rates of the dermal matrix were statistically equivalent to the control autografts. Histology of the dermal matrix showed fibroblast infiltration, neovascularization, and neoepithelialization without evidence of rejection. Wound assessment over time showed that thin split-thickness autografts plus allograft dermal matrix were equivalent to thicker split-thickness autografts.
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Affiliation(s)
- D Wainwright
- Department of Plastic Surgery, University of Texas Health Science Center, Houston 77030, USA
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39
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Abstract
Evaluation of school reentry programs are rarely reported, and statements of the value of reentry programs are usually based on anecdotal information. No known reports of empiric data support claims of positive benefit for burned children. This article reports a multifaceted effort to evaluate the effectiveness of one reentry program involving three approaches: (1) questionnaire answered by the school contact person after reentry program, (2) interviews with a random sample of patients (n = 58) and parents (n = 44) 1 to 5 years after burn, and (3) assessment of patients' behavior problems by teachers on a standardized behavior checklist comparing 10 patients who had a school reentry program involving videos to introduce them to their classmates with 10 patients who were matched for age, sex, and total body surface area burned and had no reentry program beyond phone contact. Results indicate that school reentry programs are popular with teachers and parents. This pilot effort involving empiric data failed to demonstrate a positive effect on the adjustment of the child.
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Affiliation(s)
- P Blakeney
- Shriners Burns Institute, University of Texas Medical Branch, Galveston 77550, USA
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40
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Meyer WJ, Blakeney P, Moore P, Murphy L, Robson M, Herndon D. Parental well-being and behavioral adjustment of pediatric survivors of burns. J Burn Care Rehabil 1994; 15:62-8. [PMID: 8150845 DOI: 10.1097/00004630-199401000-00012] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Parents of pediatric patients with burns often perceive their children as troubled and having an increased number of problem behaviors. This study examines the relationship between these problem behaviors and the parent's own emotional well-being. Mothers of 38 burned children completed three standardized questionnaires: Child Behavior Checklist, Parental Stress Index, and the Eight State Questionnaire. The population was further divided into troubled and untroubled by a Child Behavior Checklist total problem T score of 60. Parents were not significantly different from reference populations on most of the scales. However, the Parental Stress Index results revealed that parents who report their children as troubled are themselves stressed, not only by their children's behaviors but in areas unrelated to their children. In addition, these mothers report often feeling depressed and guilty on the Eight State Questionnaire. This study emphasizes the need for psychological assessment of both parents and children.
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Affiliation(s)
- W J Meyer
- Shriners Burns Institute, Galveston, TX
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41
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Blakeney P, Meyer W, Moore P, Murphy L, Broemeling L, Robson M, Herndon D. Psychosocial sequelae of pediatric burns involving 80% or greater total body surface area. J Burn Care Rehabil 1993; 14:684-9. [PMID: 8300704 DOI: 10.1097/00004630-199311000-00015] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Important questions for pediatric burn care specialists relate to the quality of life for those children who survive the most severe burn injuries. This study examines the psychological adjustment of 25 children who survived injuries > or = 80% total body surface area and the impact of such injury on the families. Data were analyzed from the most recent assessment, with the Child Behavior Checklist, Teacher Report Form, Piers-Harris Children's Self-Concept Scale, Parenting Stress Index, and a parental questionnaire designed by the authors. As a group, the children's behavioral problems as reported by both parents and teachers were within normal limits. Measures of parental stress, however, clearly differentiated the burn population. These parents attributed more stress to characteristics of their children. Children with > or = 80% TBSA burns develop positive feelings about themselves and appear no more troubled than a comparable group of nonburned children. The impact on the families is significant, however, and must be considered of consequence in the rehabilitation of the burned child.
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Affiliation(s)
- P Blakeney
- Shriners Burns Institute, Galveston, TX 77550
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42
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Edgar P, McCauley R, Herndon D, Heggers J. Nosocomial infections in a pediatric burn unit. Am J Infect Control 1993. [DOI: 10.1016/0196-6553(93)90264-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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43
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Blakeney P, Meyer W, Moore P, Broemeling L, Hunt R, Robson M, Herndon D. Social competence and behavioral problems of pediatric survivors of burns. J Burn Care Rehabil 1993; 14:65-72. [PMID: 8454670 DOI: 10.1097/00004630-199301000-00015] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Sixty children (35 boys, 25 girls) with burns were surveyed at least 1 year after burn injury to assess the behavior problems and difficulties with competency that they were having. The Child Behavior Checklist, the Youth Self Report, and the Teacher Report Form developed by Achenbach were administered to obtain standardized measures of behavior and competence. The mean values for these scales were in the normal range for each age and sex. However, the Child Behavior Checklist revealed a statistically significant (p < 0.05) increase in problems and decrease in competency for most age groups and both sexes when compared with the reference population. In contrast, the Teacher Report Form and the Youth Self Report revealed very few differences from the reference population. The burn size (15% to 20% total body surface area, 35% to 50% total body surface area, and > 70% total body surface area) did not account for any of the group differences. Further studies involving detailed clinical interviews and other standardized measures are needed to understand the discrepancies between the Child Behavior Checklist and the other scales.
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Affiliation(s)
- P Blakeney
- Shriners Burns Institute Galveston, TX 77550
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44
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Abstract
Adrenergic receptor blockade has been shown to be of benefit in the treatment of adverse cardiovascular changes in patients with burns during the hypermetabolic phase. This article examines the stress response to cold exposure in adults and children with 33% to 95% total body surface area burns with and without beta-blockade. Resting energy expenditures were measured by indirect calorimetry; the test subjects were exposed to mean temperatures of 27.5 degrees C (room temperature) or 24.6 degrees C (cold). The mean resting energy expenditure at ambient room temperature in patients with burns without beta-blockade was 1411 +/- 70 kcal/m2/day (mean +/- SEM). This value was 142% of that predicted for normal control subjects without burns. When placed in a cold temperature, patients with burns significantly increased their resting energy expenditures by 160% of predicted values, whereas patients with similar burns and beta-blockade increased their resting energy expenditures by 156%. Adults with septic burns had a mean resting energy expenditure 198% of the predicted value. These patients did not significantly increase their resting energy expenditures when they were exposed to cold either with or without beta-blockade. Data suggest that patients with septic burns already have a maximal metabolic response and that cold stress does not further increase this response. Males, ages 17 to 54 years, were found to increase their resting energy expenditures by 11.4 kcal/m2/day for each percent total body surface area burn. We conclude that beta-blockade with propranolol in therapeutic doses may be used in patients with burns without adversely affecting the cold stress response.
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Affiliation(s)
- D Honeycutt
- Shriners Burns Institute, Galveston, TX 77550
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45
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Abdi S, Herndon D, McGuire J, Traber L, Traber DL. Time course of alterations in lung lymph and bronchial blood flows after inhalation injury. J Burn Care Rehabil 1990; 11:510-5. [PMID: 2286604 DOI: 10.1097/00004630-199011000-00005] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The effects of inhalation injury on the pulmonary microvascular fluid flux and bronchial blood flow were examined in a long-term study of sheep (N = 13). They were insufflated with either 48 breaths of cotton smoke (n = 8) or air (n = 5) while they were deeply anesthetized with halothane. After injury, anesthesia was discontinued and the animals were mechanically ventilated throughout the experimental period (24 hours). Bronchial blood flow increased significantly at all time points recorded and reached its peak 20 minutes after the inhalation trauma (11 +/- 1 ml/hr to 106 +/- 18 ml/hr; p less than 0.05). Thereafter, bronchial blood flow decreased to a value that was six to eight times above the baseline measurement for the remainder of the study period. With these changes in blood flow, there was a concomitant increase in lung lymph flow. This variable gradually increased and was 633% of the baseline value (6 +/- 1 ml/hr to 44 +/- 8 ml/hr) 24 hours after the challenge with smoke. The control animals showed little or no change in cardiopulmonary function during the experimental period. There is no correlation between the increase in bronchial blood flow and lung lymph flow patterns after cotton smoke inhalation injury.
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Affiliation(s)
- S Abdi
- Department of Anesthesiology, University of Texas Medical Branch, Galveston
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46
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Edgar P, Kravitz M, Heggers J, Herndon D. Emergence and control of a resistant organism in a pediatric burn center. Am J Infect Control 1989. [DOI: 10.1016/0196-6553(89)90085-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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47
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Heimbach D, Luterman A, Burke J, Cram A, Herndon D, Hunt J, Jordan M, McManus W, Solem L, Warden G. Artificial dermis for major burns. A multi-center randomized clinical trial. Ann Surg 1988; 208:313-20. [PMID: 3048216 PMCID: PMC1493652 DOI: 10.1097/00000658-198809000-00008] [Citation(s) in RCA: 431] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
This communication presents an 11-center prospective randomized trial using the artificial dermis invented by Burke and Yannas. Patients with life-threatening burns who underwent primary excision and grafting within 7 days of injury had comparable sites randomized to receive either the artificial dermis (study site) or the investigator's usual skin grafting material (control site). Control materials were autograft, allograft, xenograft, or a synthetic dressing. Epidermal grafts were applied to the study site during a second operation, and surviving patients were followed for 1 year after grafting. One hundred thirty-nine sites on 106 patients were studied. Mean burn size was 46.5 +/- 15% mean total body surface (TBSA). Overall mortality was 13%, and mean hospital stay was 68 +/- 45 days. Median artificial dermis take was 80% compared with 95% for all comparative sites, but the take was equivalent to that of all nonautograft control materials. Results with the artificial dermis improved slightly as the investigators became more familiar with the material. Donor site thickness for the study site averaged .006'' +/- .002'' compared to .013'' +/- .018'' for control (p less than .0001) and the epidermal donor site healed an average of 4 days sooner (10 +/- 6 vs. 14 +/- 8 days) (p less than .0001). As the wounds matured during the first year, both patients and surgeons felt that both sites became more comparable in appearance and function. At the completion of the study, there was less hypertrophic scarring of the artificial dermis, and more patients preferred the artificial dermis to the control graft. Artificial dermis with an epidermal graft provides a permanent cover that is at least as satisfactory as currently available skin grafting techniques, and uses donor grafts that are thinner and donor sites that heal faster.
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48
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Heimbach D, Herndon D, Luterman A, Ley R, Brcic A, Dietch E, Boswick J. Early excision of thermal burns--an international round-table discussion, Geneva, June 22, 1987. J Burn Care Rehabil 1988; 9:549-61. [PMID: 3056957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- D Heimbach
- Burn Center, University of Washington, Seattle
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49
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Godsoe A, Kimura R, Herndon D, Flynn JT, Schlag G, Traber L, Traber D. Cardiopulmonary changes with intermittent endotoxin administration in sheep. Circ Shock 1988; 25:61-74. [PMID: 3292076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Chronic sepsis was induced by administering endotoxin (lipopolysaccharide--LPS) at 12-hr intervals to sheep. The animals (n = 7) responded to the first dose of LPS with increased pulmonary arterial pressure (PAP), systemic vascular resistance, plasma and lymph thromboxane B2 (TxB2) concentrations, and lung lymph flow rate concurrent with a reduction in the cardiac index (CI). Subsequent doses of LPS produced an elevation of PAP and TxB2 which was progressively attenuated and eventually disappeared. With LPS the lung lymph flow was markedly elevated and CI increased. This latter was transient and associated with a reduction in systemic vascular resistance. Concomitant with the cardiopulmonary changes prekallikrein levels were not diminished, but there was a statistically significant reduction in C1-esterase inhibitor. The administration of LPS was discontinued after 5 days and the cardiopulmonary variables rapidly returned to baseline levels. Chronic endotoxemia appears to be associated with an elevated pulmonary microvascular permeability and a tendency toward a hyperdynamic circulation but with an appreciable degree of refractoriness associated with regional hemodynamics and eicosanoid biosynthesis.
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Affiliation(s)
- A Godsoe
- Ludwig Boltzman Institute of Traumatology, Vienna, Austria
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50
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Kimura R, Traber L, Herndon D, Niehaus G, Flynn J, Traber DL. Ibuprofen reduces the lung lymph flow changes associated with inhalation injury. Circ Shock 1988; 24:183-91. [PMID: 3383356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Inhalation injury was produced in sheep which were chronically prepared for study. The injury was induced by insufflating them with smoke from burning cotton cloth. One group of animals was treated with the cyclooxygenase inhibitor ibuprofen and another group was untreated. Eight hr following the administration of smoke, there was an elevation of lung lymph flow in both groups. These changes were not as severe in the animals which were treated with ibuprofen. The pulmonary changes which occur following smoke inhalation injury are associated with elevations of the metabolites of arachidonic acid, especially those generated by the cyclooxygenase pathway. These metabolites in some way contribute to the pathophysiological changes induced by the inhalation of smoke, since they are reduced by the administration of a cyclooxygenase inhibitor.
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Affiliation(s)
- R Kimura
- Department of Plastic Surgery, Tokyo Women's Medical College, Japan
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