Shriners Hospitals for Children - Galveston

About: Shriners Hospitals for Children - Galveston is a healthcare organization based out in Galveston, Texas, United States. It is known for research contribution in the topics: Burn injury & Lean body mass. The organization has 249 authors who have published 420 publications receiving 15311 citations.

Movements, Habitat Use, and Survival of Female Northern Pintails in Southwestern Louisiana.

Abstract: I developed portable platforms for setting rocket nets in open-water habitats, and used them to capture 1116 waterfowl of 7 species during winters 1991-92 and 1992-93 in southwestern Louisiana. Distance and duration of evening flights of female northern pintails (Anas acuta; hereafter pintails) from Lacassine National Wildlife Refuge increased with date within wintering period, and generally were greater than previously reported estimates for wintering waterfowl. I found that diurnal use of refuges by females increased during hunting seasons, contradicting Tamisier's hypothesis that use of refuges by pintails in southwestern Louisiana is not influenced by hunting. Female pintails extensively used privately owned rice and fallow (idle) agriculture, particularly at night. Use of mini-refuges was low relative to that of large permanent pools. This finding does not support Rave and Cordes' prediction that mini-refuges would prove to be more important than pools to wintering pintails. I attribute low use of mini-refuges during my study primarily to lack of water and cover management, but location, small size, and irregular shape of some of these areas may preclude extensive use by pintails. Early mortality (death within the first 4 days after radio-tagging) of females was related to flight quality (scored as good, moderate, or poor upon release). Early mortality and flight quality, in turn, were related to the interaction of holding time (time from capture until release) and number of waterfowl captured in rocket nets. Survival of females in southwestern Louisiana was lower during hunting than during non-hunting seasons, and immatures survived at lower rates than adults. Despite conservative hunting regulations (30-day season and 1 pintail daily), hunting mortality rates (0.165 $\pm$ 0.034 (SE) for adults and 0.315 $\pm$ 0.053 for immatures) of female pintails in southwestern Louisiana were higher than estimates for other female dabbling ducks (within age classes) during winter. If lower daily energy expenditure and hunting mortality of female pintails are management goals, I recommend that availability of moist-soil and agricultural foods on key refuges be increased as a first step.

Early Manipulation of Metabolic Changes due to Severe Burns in Children

Abstract: Burns account for around 700,000 emergency department visits every year resulting in around 50,000 admissions to hospital in the United States [1]. Around 50% of these admissions have burns of less than 10% total body surface area (TBSA) and, as such, have near normal metabolic rates. For the remainder, the rise in metabolic rate is linked to burn size and for those with severe thermal injuries (>40% TBSA) the change in patient metabolism is, if left unchecked, set to last for more than 12 months. The change contributes, at least in part, to long term deleterious effects on the individual. It has been previously shown that the ensuing period of hypermetabolism and catabolism following a severe burn leads to impaired immune function, decreased wound healing, erosion of lean body mass, and hinders rehabilitative efforts delaying reintegration into normal society. However, the magnitude and longevity of these changes has yet to be fully elucidated. Strategies for attenuating these maladaptive responses may be divided into pharmacological and non-pharmacological. Non-pharmacological approaches include prompt, early excision and closure of wounds, pertinacious surveillance for and treatment of sepsis, early commencement of high protein high carbohydrate enteral feeding, elevation of the immediate environmental temperature to 31.5°C (± 0.7°C), and early institution of an aerobic resistive exercise program. Several pharmacotherapeutic options are also available to further reduce metabolic rate and as such attenuate the erosion of lean body mass; these include anabolic agents such as recombinant human growth hormone, insulin, and oxandrolone and also beta blockade using propranolol.

Carotid smooth muscle contractility changes after severe burn

Abstract: Severe burns result in cardiovascular dysfunction, but responses in the peripheral vasculature are unclear. We hypothesize that severe burns disturb arterial contractility through acute changes in adrenergic and cholinergic receptor function. To address this, we investigated the changes in carotid artery contractility and relaxation following a severe burn. Thirty-four adult Sprague–Dawley male rats received a 40% total body surface area (TBSA) scald burn and fluid resuscitation using the Parkland formula. Control animals received sham burn procedure. Animals were serially euthanized between 6 h and 14 days after burn and endothelium-intact common carotid arteries were used for ex vivo force/relaxation measurements. At 6 h after burn, carotid arteries from burned animals demonstrated a > 50% decrease in cumulative dose-responses to norepinephrine (p < 0.05) and to 10−7 M angiotensin II (p < 0.05). Notably, pre-constricted carotid arteries also demonstrated reduced relaxation responses to acetylcholine (p < 0.05) 6 h after burn, but not to sodium nitroprusside. Histologic examination of cross-sectional planes revealed significant increases in carotid artery wall thickness in burned rats at 6 h versus 3 days, with increased collagen expression in tunica media at 3 days (p < 0.05). Carotid artery dysfunction occurs within 6 h after severe burn, demonstrating decreased sensitivity to adrenergic- and angiotensin II-induced vasoconstriction and acetylcholine-induced relaxation.

Treatment of a recurrent digital hyperkeratosis in a skin graft with a CO2 laser.

Abstract: Tourniquet use is typically very safe (Odinsson and Finsen, 2006). Most tourniquet complications are associated with either the duration of ischaemia or the pressure generated beneath the cuff. Sometimes prolonged tourniquet use is needed to address a complication during surgery or to undertake multiple procedures. The absolute safe limit of tourniquet duration has not been established. Overall our findings reflect those of Flatt (1972), who showed that 60 patients with a tourniquet duration of between 2 hours 45 minutes had no post-operative complications. This is important as many authorities quote time limits for upper limb tourniquet use of 1 hour 30 minutes or more reasonably 2 hours. This study and Flatt’s work appear to show that tourniquet use can be safely extended to well beyond 2 hours. The majority of our patients had tourniquet times between 2 hours 45 minutes, and even in these patients there was a trend to more short-term symptoms. These may simply reflect responses to more surgery but may also be due to swelling and soft tissue injury from longer tourniquet times. There were only 11 patients with tourniquet times >2 hours 45 minutes and these patients had an even stronger trend towards more short-term symptoms, and the only patient with possible long term symptoms from tourniquet use was in this group. The data more strongly support the use of an arm tourniquet up to, than beyond 2 hours 45 minutes. The ability to use a tourniquet for >2 hours gives greater flexibility to surgeons planning complex operations or addressing complications during operations by allowing longer tourniquet use. It should also help resist spurious medico-legal claims based solely on prolonged tourniquet times. Nonetheless we would strongly advocate minimizing tourniquet use as we do not know whether there may be subtle physiological changes that should be minimized for patient benefit.

Long-Term Sequelae of Burn Injury: Current Understanding of Pathophysiology, Therapeutic, and Rehabilitative Options with an Emphasis on Hypertrophic Scarring and Laser Therapy

Abstract: The chances of survival after a major burn injury have constantly increased over the past decades and further decreases in mortality rates seem to be out of reach [1]. Recent data shows that 96.8% of all patients treated in a US burn center survive [2]. However, many survivors suffer from disfiguring scarring, life-long physical disabilities, and adjustment difficulties. Focus has shifted more and more attempts to improve long-term outcomes with recent advances in discovering underlying mechanisms, treatment of scars, and early rehabilitation.