[Brazilian Army nurses and transportation of the wounded: a challenge faced during World War II].

PubMed

Bernardes, Margarida Maria Rocha; Lopes, Gertrudes Teixeira

2007-01-01

This historic-sociologic study aims to analyse the challenges faced by the Brazilian Expeditionary Force's Air Transportation Nurses of the Army with the Theatre of Operations on the course of World War II. The primary source was comprised of a photograph from this time period and oral testimonies of those who participated in the conflict. Ideas by sociologist Pierre Bourdieu support the discussion. Results suggest that Brazilian nurses were challenged to transport the wounded without medical advice. We conclude that the challenge to fulfill the task imposed, which led to independent decision-making, gave confidence and autonomy to the ones already responsible for the transportation of the wounded.

Environmental Factors Related to Fungal Wound Contamination after Combat Trauma in Afghanistan, 2009–2011

PubMed Central

Rodriguez, Carlos J.; Weintrob, Amy C.; Shaikh, Faraz; Aggarwal, Deepak; Carson, M. Leigh; Murray, Clinton K.; Masuoka, Penny

2015-01-01

During the recent war in Afghanistan (2001–2014), invasive fungal wound infections (IFIs) among US combat casualties were associated with risk factors related to the mechanism and pattern of injury. Although previous studies recognized that IFI patients primarily sustained injuries in southern Afghanistan, environmental data were not examined. We compared environmental conditions of this region with those of an area in eastern Afghanistan that was not associated with observed IFIs after injury. A larger proportion of personnel injured in the south (61%) grew mold from wound cultures than those injured in the east (20%). In a multivariable analysis, the southern location, characterized by lower elevation, warmer temperatures, and greater isothermality, was independently associated with mold contamination of wounds. These environmental characteristics, along with known risk factors related to injury characteristics, may be useful in modeling the risk for IFIs after traumatic injury in other regions. PMID:26401897

War-related penile injuries in Libya: Single-institution experience.

PubMed

Etabbal, Abdalla M; Hussain, Fathi F; Benkhadoura, Mohamed O; Banni, Abdalla M

2018-06-01

To report on our initial experience in the management of war-related penile injuries; proper diagnosis and immediate treatment of penile injuries is essential to gain satisfactory results. Besides treating primary wounds and restoring penile function, the cosmetic result is also an important issue for the surgeon. The study was conducted in the Department of Urology at Benghazi Medical Center and comprised all patients who presented with a shotgun, gunshot or explosive penile injury between February 2011 and August 2017. The patient's age, cause of injury, site and severity of injuries, management, postoperative complications, and hospital stay, were recorded. In all, 29 males with war-related penile injuries were enrolled in the study. The mean (SD) age of these patients was 31.3 (10.5) years. The glans, urethra, and corporal bodies were involved in four (13.7%), 10 (34.4%), and 20 (68.9%) of the patients, respectively. According to the American Association for the Surgery of Trauma Penis Injury Scale, Grade III penile injuries were the most common (11 patients, 37.9%). The most common post-intervention complications were urethral stricture with or without proximal urethrocutaneous fistula (eight patients, 27.5%), followed by permanent erectile dysfunction (five patients, 17.2%). In patients who sustain war-related penile injuries the surgeon's efforts should not only be directed to restoring normal voiding and erectile function but also on the cosmetic appearance of the penis.

Bodily Pain, Combat, and the Politics of Memoirs: Between the American Civil War and the War in Vietnam.

PubMed

Bourke, Joanna

2013-05-01

This article analyses the languages of wartime pain as seen in British and American memoirs from the American Civil War to the present. How did the rhetoric of wounding in these war memoirs change over time? One of the central shifts lies in the way that wounded men presented themselves as stoic in spite of severe wounding. From 1939, and in an even more dramatic fashion by the war in Vietnam, physical suffering remained a test of manliness, but the tone was defiant and aggressive rather than stoic or resigned. The article also looks at the role of individual publishers and the introduction of psychological dimensions of wounding in latter memoirs.

Plastic Surgery Challenges in War Wounded I: Flap-Based Extremity Reconstruction

PubMed Central

Sabino, Jennifer M.; Slater, Julia; Valerio, Ian L.

2016-01-01

Scope and Significance: Reconstruction of traumatic injuries requiring tissue transfer begins with aggressive resuscitation and stabilization. Systematic advances in acute casualty care at the point of injury have improved survival and allowed for increasingly complex treatment before definitive reconstruction at tertiary medical facilities outside the combat zone. As a result, the complexity of the limb salvage algorithm has increased over 14 years of combat activities in Iraq and Afghanistan. Problem: Severe poly-extremity trauma in combat casualties has led to a large number of extremity salvage cases. Advanced reconstructive techniques coupled with regenerative medicine applications have played a critical role in the restoration, recovery, and rehabilitation of functional limb salvage. Translational Relevance: The past 14 years of war trauma have increased our understanding of tissue transfer for extremity reconstruction in the treatment of combat casualties. Injury patterns, flap choice, and reconstruction timing are critical variables to consider for optimal outcomes. Clinical Relevance: Subacute reconstruction with specifically chosen flap tissue and donor site location based on individual injuries result in successful tissue transfer, even in critically injured patients. These considerations can be combined with regenerative therapies to optimize massive wound coverage and limb salvage form and function in previously active patients. Summary: Traditional soft tissue reconstruction is integral in the treatment of war extremity trauma. Pedicle and free flaps are a critically important part of the reconstructive ladder for salvaging extreme extremity injuries that are seen as a result of the current practice of war. PMID:27679751

Bodily Pain, Combat, and the Politics of Memoirs: Between the American Civil War and the War in Vietnam

PubMed Central

Bourke, Joanna

2014-01-01

This article analyses the languages of wartime pain as seen in British and American memoirs from the American Civil War to the present. How did the rhetoric of wounding in these war memoirs change over time? One of the central shifts lies in the way that wounded men presented themselves as stoic in spite of severe wounding. From 1939, and in an even more dramatic fashion by the war in Vietnam, physical suffering remained a test of manliness, but the tone was defiant and aggressive rather than stoic or resigned. The article also looks at the role of individual publishers and the introduction of psychological dimensions of wounding in latter memoirs. PMID:24489402

Wound shock: a history of its study and treatment by military surgeons.

PubMed

Hardaway, Robert M

2004-04-01

The treatment of wounds has received considerable attention from the time of the Trojan War. However, it was not until the American Civil War that shock was described as an entity distinct from the wounds themselves and that efforts were directed at more than just treatment of the wound. The need for fluid resuscitation in the treatment of hemorrhagic shock was first recognized in the Spanish American War, as was the association of sepsis with shock. World War I showed the need for blood in the treatment of "wound shock," a lesson that had to be relearned in World War II through bitter experience. Studies in the Korean War described the concept of disseminated intravascular coagulation and multiple organ failure, and the existence of disseminated intravascular coagulation was confirmed by studies in Vietnam. The treatment of hemorrhagic shock is now very effective, but the treatment of traumatic and septic shock remains unsatisfactory.

Infection in conflict wounded

PubMed Central

Eardley, W. G. P.; Brown, K. V.; Bonner, T. J.; Green, A. D.; Clasper, J. C.

2011-01-01

Although mechanisms of modern military wounding may be distinct from those of ancient conflicts, the infectious sequelae of ballistic trauma and the evolving microbial flora of war wounds remain a considerable burden on both the injured combatant and their deployed medical systems. Battlefield surgeons of ancient times favoured suppuration in war wounding and as such Galenic encouragement of pus formation would hinder progress in wound care for centuries. Napoleonic surgeons eventually abandoned this mantra, embracing radical surgical intervention, primarily by amputation, to prevent infection. Later, microscopy enabled identification of microorganisms and characterization of wound flora. Concurrent advances in sanitation and evacuation enabled improved outcomes and establishment of modern military medical systems. Advances in medical doctrine and technology afford those injured in current conflicts with increasing survivability through rapid evacuation, sophisticated resuscitation and timely surgical intervention. Infectious complications in those that do survive, however, are a major concern. Addressing antibiotic use, nosocomial transmission and infectious sequelae are a current clinical management and research priority and will remain so in an era characterized by a massive burden of combat extremity injury. This paper provides a review of infection in combat wounding from a historical setting through to the modern evidence base. PMID:21149356

Long-term outcomes of war-related death of family members in Kosovar civilian war survivors.

PubMed

Morina, Nexhmedin; Reschke, Konrad; Hofmann, Stefan G

2011-04-01

Exposure to war-related experiences can comprise a broad variety of experiences and the very nature of certain war-related events has generally been neglected. To examine the long-term outcomes of war-related death of family members, the authors investigated the prevalence rates of major depressive episode (MDE), anxiety disorders, and quality of life among civilian war survivors with or without war-related death of first-degree family members 9 years after the war in Kosovo. Compared to participants without war-related death of family members, those who had experienced such loss had signficantly higher prevalence rates of MDE, posttraumatic stress disorder, and generalized anxiety disorder, and reported a lower quality of life 9 years after the war. These results indicate that bereaved civilian survivors of war experience significant mental health problems many years after the war.

In Flanders fields: the Great War, Antoine Depage, and the resurgence of débridement.

PubMed

Helling, T S; Daon, E

1998-08-01

The care of traumatic wounds has evolved over hundreds of years, largely as a result of armed conflicts. The lessons learned during World War I in the treatment of extensive soft-tissue injuries proved invaluable in reducing infection and preventing loss of limb and life. Foremost among these was the use of debridement. This report reviews the development of debridement as standard treatment of war wounds and highlights the surgeon largely responsible for its resurgence during one of this century's saddest chapters. Before World War I, the care of wounds consisted of minimal exploration and liberal use of then-new antiseptics. For limited injuries, this approach appeared adequate. World War I saw the introduction of devastating weapons that produced injuries that caused extensive devitalization of tissue. Standard treatment of these patients proved woefully inadequate to prevent life-threatening infections. This is a historical review of the conditions that occurred during World War I that prompted a change in wound management. One of those responsible for this change was the Belgian surgeon Antoine Depage. His life and contributions to the care of war wounds are profiled. Depage reintroduced the discarded French practice of wound incision and exploration (debridement) and combined it with excision of devitalized tissue. Through the use of debridement, excision, and delayed wound closure based on bacteriologic survey, Depage was able to reduce the incidence of infectious complications of soft-tissue injuries, particularly those involving fractures. Through his experiences in the Great War, Antoine Depage was able to formulate a treatment plan for wounds of war. All such injuries were assumed to be contaminated and, as such, they required early and careful debridement. Depage thought that wound closure should often be delayed and based his decision to close on the bacteriologic status of the wound. To him, we owe our current management of traumatic wounds.

Combat Wound Initiative Program

DTIC Science & Technology

2010-07-01

Government as part of that person’s official duties. Deliver~~ by Publishing Technology to: Waiter Reed Army Institute of R~l!il>~~vTP:11~1~:S6;!4!B1...develop a predictive model, which could serve as a clinical decision support tool in the management of complex war wounds. Bayesian belief networks...decisions regarding the surgical management of wounds and estimate overall out- come of patients on the basis of casualty-specific factors in wounded

Syria civil war: Outcomes of humanitarian neurosurgical care provided to Syrian wounded refugees in Israel.

PubMed

Barhoum, Masad; Tobias, Samuel; Elron, Moshe; Sharon, Aviram; Heija, Tariq; Soustiel, Jean F

2015-01-01

As an expected consequence of the civil war in Syria, emergent neurosurgical care for battlefield trauma has been provided for severely head-injured Syrians transferred to Northern Israel. Sixty-six patients suffering from brain injury were brought to the border and then referred to the institution after initial resuscitation. Both the time and type of injury were recorded based on paramedic testimony, forensic material or on details provided by patients. A retrospective analysis of all medical charts and imaging material was performed. Most injuries were combat-related, either caused by blast (13.6%), shrapnel (24.2%), assault (28.8%) or gunshot wound (15.2%). Only a minority of patients (18.2%) suffered from injuries that were not directly caused by weapon. A total of 55 surgical procedures were performed in 46 out of 66 patients, including craniotomies in 40 patients, burr hole alone for placement of intraparenchymal intracranial pressure (ICP) sensor in nine instances and ventricle peritoneal shunt in two patients. Decompressive craniectomy was used only for the treatment of gunshot wound and was performed in eight out of 10 patients. The most common complication consisted in cerebrospinal fluid fistulas (16.7%). Post-operative infections occurred in seven patients (10.6%). Short-term outcomes were favourable in 60.7%, with a mortality rate of 4.5%. The present findings suggest that aggressive surgery and neuro-intensive care measures may lead to good functional results, even in the presence of seemingly devastating injuries in some selected patients.

In Flanders fields: the Great War, Antoine Depage, and the resurgence of débridement.

PubMed Central

Helling, T S; Daon, E

1998-01-01

OBJECTIVE: The care of traumatic wounds has evolved over hundreds of years, largely as a result of armed conflicts. The lessons learned during World War I in the treatment of extensive soft-tissue injuries proved invaluable in reducing infection and preventing loss of limb and life. Foremost among these was the use of debridement. This report reviews the development of debridement as standard treatment of war wounds and highlights the surgeon largely responsible for its resurgence during one of this century's saddest chapters. SUMMARY BACKGROUND DATA: Before World War I, the care of wounds consisted of minimal exploration and liberal use of then-new antiseptics. For limited injuries, this approach appeared adequate. World War I saw the introduction of devastating weapons that produced injuries that caused extensive devitalization of tissue. Standard treatment of these patients proved woefully inadequate to prevent life-threatening infections. METHODS: This is a historical review of the conditions that occurred during World War I that prompted a change in wound management. One of those responsible for this change was the Belgian surgeon Antoine Depage. His life and contributions to the care of war wounds are profiled. Depage reintroduced the discarded French practice of wound incision and exploration (debridement) and combined it with excision of devitalized tissue. RESULTS: Through the use of debridement, excision, and delayed wound closure based on bacteriologic survey, Depage was able to reduce the incidence of infectious complications of soft-tissue injuries, particularly those involving fractures. CONCLUSIONS: Through his experiences in the Great War, Antoine Depage was able to formulate a treatment plan for wounds of war. All such injuries were assumed to be contaminated and, as such, they required early and careful debridement. Depage thought that wound closure should often be delayed and based his decision to close on the bacteriologic status of the wound

Interaction of penetrating missiles with tissues: some common misapprehensions and implications for wound management.

PubMed

Cooper, G J; Ryan, J M

1990-06-01

It is apparent from review of published papers and books that misunderstanding and confusion exists in the minds of many authors describing the interaction of penetrating missiles with tissues. These misapprehensions may influence the management of wounds by suggesting didactic approaches based upon a preconceived notion of the nature and severity of the wound for different types of projectiles. This review considers the biophysics of penetrating missile wounds, highlights some of the more common misconceptions and seeks to reconcile the conflicting and confusing management doctrines that are promulgated in the literature-differences that arise not only from two scenarios, peace and war, but also from misapprehensions of the wounding process. Wounds of war and of peacetime differ both in the nature of the wound and in the propensity for wound infection. Additionally, the limitations imposed by war dictate the type of management that may be practised and result in procedures that would be considered inappropriate by some in civilian clinical practice. Many of the procedures described in civilian peacetime settings, such as reliance on antibiotics alone for the control of infection in penetrating wounds, or minimal excision and debridement, can yield good results but would herald disaster if transposed to a war setting.

First report of blaNDM-1-producing Acinetobacter baumannii isolated in Lebanon from civilians wounded during the Syrian war.

PubMed

Rafei, Rayane; Dabboussi, Fouad; Hamze, Monzer; Eveillard, Matthieu; Lemarié, Carole; Mallat, Hassan; Rolain, Jean-Marc; Joly-Guillou, Marie-Laure; Kempf, Marie

2014-04-01

The emergence of carbapenem-resistant Acinetobacter baumannii has been observed worldwide. We describe the first detection of A. baumannii carrying the blaNDM-1 gene in Lebanon, isolated from Syrian patients wounded during the civil war. Four carbapenem-resistant A. baumannii strains isolated in 2012 in the Tripoli Government Hospital, Lebanon, from civilians wounded during the Syrian war, were analysed. Susceptibility was determined by disk diffusion testing, and resistance to carbapenems was confirmed by Etest. The presence of blaOXA-23-like, blaOXA-24-like, blaOXA-58-like, blaOXA-143-like, and blaNDM was investigated by PCR. Clonal relationships were studied by pulsed-field gel electrophoresis (PFGE), multilocus sequence typing (MLST), and blaOXA-51 sequence-based typing. All isolates harboured the blaNDM-1 gene and were negative for other tested carbapenemases. They all belonged to the sequence type 85 and formed a single cluster by PFGE. Finally, blaOXA-51-like gene sequencing revealed the presence of the blaOXA-94 variant in all four isolates. These findings show that Syria constitutes a reservoir for NDM-1-producing bacteria. These results also highlight the need for effective measures to stop the threatening spread of such strains. Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.

Debridement Techniques in Pediatric Trauma and Burn-Related Wounds

PubMed Central

Block, Lisa; King, Timothy W.; Gosain, Ankush

2015-01-01

Significance: Traumatic injuries are the leading cause of morbidity and mortality in children. The purpose of this review is to provide an overview of the initial assessment and management of traumatic and burn wounds in children. Special attention is given to wound cleansing, debridement techniques, and considerations for pain management and psychosocial support for children and families. Recent Advances: Basic and translational research over the last 5–7 years has advanced our knowledge related to the optimal care of acute pediatric traumatic and burn wounds. Data concerning methods, volume, solution and timing for irrigation of acute traumatic wounds, timing and methods of wound debridement, including hydrosurgery and plasma knife coblation, and wound dressings are presented. Additionally, data concerning the long-term psychosocial outcomes following acute injury are presented. Critical Issues: The care of pediatric trauma and burn-related wounds requires prompt assessment, pain control, cleansing, debridement, application of appropriate dressings, and close follow-up. Ideally, a knowledgeable multidisciplinary team cares for these patients. A limitation in the care of these patients is the relative paucity of data specific to the care of acute traumatic wounds in the pediatric population. Future Directions: Research is ongoing in the arenas of new debridement techniques and instruments, and in wound dressing technology. Dedicated research on these topics in the pediatric population will serve to strengthen and advance the care of pediatric patients with acute traumatic and burn wounds. PMID:26487978

Health-related outcomes of war in Nicaragua.

PubMed Central

Garfield, R M; Frieden, T; Vermund, S H

1987-01-01

Since 1983, war in Nicaragua has slowed improvements in health which had developed rapidly from 1979-82. The rate of war-related deaths among Nicaraguans now exceeds that of the United States citizens in either the Vietnam War or World War II. Forty-two of the 84 documented war-related casualties among Nicaraguan health workers have been deaths. This high case fatality rate reflects the targeting of health workers by contra troops. The number of staff and services of the public medical system decreased by approximately 10 per cent from 1983 to 1985. Population movements, the establishment of new settlements, and war-related destruction of the primary health infrastructure are associated with recent epidemics of malaria, dengue, measles, and leishmaniasis. The estimated rate of infant mortality in Nicaragua, which had declined from 120 per 1,000 in 1978 to 76/1,000 live births in 1983, has since shown no further decline. Internationally mandated protections enjoyed by civilians and health workers during times of war do not appear to operate in this so-called "low intensity" conflict. Further declines in infant mortality, prevention of epidemics, and improvement in other health indicators will likely await the cessation of military hostilities. PMID:3565659

Long-Term Outcomes of War-Related Death of Family Members in Kosovar Civilian War Survivors

ERIC Educational Resources Information Center

Morina, Nexhmedin; Reschke, Konrad; Hofmann, Stefan G.

2011-01-01

Exposure to war-related experiences can comprise a broad variety of experiences and the very nature of certain war-related events has generally been neglected. To examine the long-term outcomes of war-related death of family members, the authors investigated the prevalence rates of major depressive episode (MDE), anxiety disorders, and quality of…

The influence of war on the development of neurosurgery.

PubMed

Dowdy, Justin; Pait, T Glenn

2014-01-01

The treatment of craniospinal war wounds proved to be a significant driving force in the early growth of neurosurgery as a specialty. This publication explores the historical relationship between the evolution of combat methodology from antiquity through modern conflicts as it dovetails with and drives corresponding advancements in the field of neurosurgery. Whether it's the basic management principles for intracranial projectile wounds derived from World War I experiences, the drastic improvement in the outcomes and management of spinal cord injuries observed in World War II, or the fact that both of these wars played a crucial role in the development of a training system that is the origin of modern residency programs, the influence of wartime experiences is pervasive.

World War I psychoneuroses: hysteria goes to war.

PubMed

Tatu, Laurent; Bogousslavsky, Julien

2014-01-01

During the First World War, military physicians from the belligerent countries were faced with soldiers suffering from psychotrauma with often unheard of clinical signs, such as camptocormia. These varied clinical presentations took the form of abnormal movements, deaf-mutism, mental confusion, and delusional disorders. In Anglo-Saxon countries, the term 'shell shock' was used to define these disorders. The debate on whether the war was responsible for these disorders divided mobilized neuropsychiatrists. In psychological theories, war is seen as the principal causal factor. In hystero-pithiatism, developed by Joseph Babinski (1857-1932), trauma was not directly caused by the war. It was rather due to the unwillingness of the soldier to take part in the war. Permanent suspicion of malingering resulted in the establishment of a wide range of medical experiments. Many doctors used aggressive treatment methods to force the soldiers exhibiting war neuroses to return to the front as quickly as possible. Medicomilitary collusion ensued. Electrotherapy became the basis of repressive psychotherapy, such as 'torpillage', which was developed by Clovis Vincent (1879-1947), or psychofaradism, which was established by Gustave Roussy (1874-1948). Some soldiers refused such treatments, considering them a form of torture, and were brought before courts-martial. Famous cases, such as that of Baptiste Deschamps (1881-1953), raised the question of the rights of the wounded. Soldiers suffering from psychotrauma, ignored and regarded as malingerers or deserters, were sentenced to death by the courts-martial. Trials of soldiers or doctors were also held in Germany and Austria. After the war, psychoneurotics long haunted asylums and rehabilitation centers. Abuses related to the treatment of the Great War psychoneuroses nevertheless significantly changed medical concepts, leading to the modern definition of 'posttraumatic stress disorder'.

Being a neighbor to Syria: a retrospective analysis of patients brought to our clinic for cranial gunshot wounds in the Syrian civil war.

PubMed

Aras, M; Altaş, M; Yilmaz, A; Serarslan, Y; Yilmaz, N; Yengil, E; Urfali, B

2014-10-01

Toward the end of 2010, the Arab spring, the waves of revolutionary demonstrations and protests influenced also Syria, where violent clashes turned into a civil war. Hundreds of thousands of people became refugees. The use of excessive force unfortunately culminated in numerous deaths and injuries in many cities. Being the closest city to Aleppo, Damascus and Homs, the biggest cities of Syria, Antioch/Hatay has been the city where initial emergency treatments were performed. For this reason, we examined and retrospectively analyzed the medical records of the patients treated in the clinics of our hospital due to cranial gunshot wounds during the war. The medical records of 186 patients who were injured in the Syrian War and brought to, followed up and treated in the Neurosurgery Clinic of Mustafa Kemal University, Faculty of Medicine in Hatay, a Turkish city on the Syrian border, between April 2011 and June 2013. A total of 186 patients were evaluated in a period of more than 2 years. Of all 91.4% of the patients were adults (male/female: 152/18) and 8.6% of them were pediatric patients (male/female: 14/2). The average age of the patients was 31 years, with an age range of between 2 months and 67 years. According to Glasgow coma score (GCS) of the patients at the time of admission, GCS was 3 in 32 patients (17.2%), between 4 and 7 in 70 patients (37.6%), and between 8 and 15 in 84 patients (45.1%). We observed that the patients with GCS of 4-7 had a significantly lower mortality among the 56 patients treated surgically compared with the 14 patients treated medically. Cranial gunshot wounds are responsible for high mortality and morbidity. A multiplicity of factors plays a role on morbidity and mortality. These are the duration of transport, the injury pattern, the velocities of the weapons used, and the Glasgow Coma Scales of the patients at the time of admission. The authors recommend that the patients with cranial gunshot wounds who has GCS of 4-7 should be

Dermal Coverage of Traumatic War Wounds

DTIC Science & Technology

2017-01-01

Device for re-epithelialization of full thickness wounds treated with INTEGRA MBWM. The ReCell Device is a stand-alone, battery operated cell...standalone, battery operated cell separation device that enables preparation of a cell suspension from a small, thin, split-thickness skin biopsy

[World War II and current care provision: impact of war-related trauma on present professional care situations].

PubMed

Wilhelm, I; Zank, S

2014-07-01

This study represents the first empirical research into the impact of war-related trauma on present professional care situations in Germany. A total of 105 professional caregivers from North Rhine-Westphalia were questioned in a standardized form about the impact of war-related trauma on the daily work. Of the professional caregivers questioned 82%reported that they were already caring for a person suffering from post-war trauma and 77% stated that war-related trauma had an impact on the daily work. Altogether 63% reported that war-related trauma is highly significant for the daily work. The professional caregivers reported that there was often a lack of knowledge and awareness of the topic among colleagues. The study showed that there is a need for increasing awareness and providing further staff education and training regarding the treatment of people suffering from (war-related) trauma in order to ensure adequate care for those concerned.

"Heroes' invisible wounds of war:" constructions of posttraumatic stress disorder in the text of US federal legislation.

PubMed

Purtle, Jonathan

2016-01-01

Public policies contribute to the social construction of mental health problems. In this study, I use social constructivist theories of policy design and the methodology of ethnographic content analysis to qualitatively explore how posttraumatic stress disorder (PTSD) has been constructed as a problem in US federal legislation. I analyzed the text of 166 bills introduced between 1989 and 2009 and found that PTSD has been constructed as a problem unique to combat exposures and military populations. These constructions were produced through combat-related language and imagery (e.g., wounds, war, heroism), narratives describing PTSD as a military-specific phenomenon, and reinforced by the absence of PTSD in trauma-focused legislation targeting civilians. These constructions do not reflect the epidemiology of PTSD-the vast majority of people who develop the disorder have not experienced combat and many non-combat traumas (e.g., sexual assault) carry higher PTSD risk-and might constrain public and political discourse about the disorder and reify sociocultural barriers to the access of mental health services. Copyright © 2015 Elsevier Ltd. All rights reserved.

The nature and extent of war injuries sustained by combat specialty personnel killed and wounded in Afghanistan and Iraq, 2003-2011.

PubMed

Schoenfeld, Andrew J; Dunn, John C; Bader, Julia O; Belmont, Philip J

2013-08-01

Previous studies regarding combat wounding have a limited translational capacity due to inclusion of soldiers from all military branches and occupational specialties as well as a lack of information regarding soldiers who died in theater. A search was performed of the Department of Defense Trauma Registry and Armed Forces Medical Examiner data set for the years 2003 to 2011 to identify all injured personnel with the military specialty 19D (cavalry scout). A manual search was conducted for each record identified, and age, rank, location and manner of injury, mechanism of injury, Injury Severity Score (ISS), and extent of wounding were abstracted. The incidence of injuries by body region and rates for specific types of wounds were determined. Statistically significant associations between rank, location of injury, manner of injury, body region involved, and injury mechanism were assessed using χ2 analysis. Associations between ISS, rank, manner of injury, and survival were evaluated by t test with Satterthwaite correction. A total of 701 casualties were identified with 3,189 distinct injuries. Mean (SD) age of injured personnel was 25.9 (6.0) years. Thirty-five percent of the cohort was composed of soldiers who died in theater. Explosions were the most common mechanism of injury (70%), while 18% of wounds occurred owing to gunshot. Extremity wounds and injuries to the head and neck represented 34% of casualty burden. Thoracic trauma occurred in 16%, and abdominal injuries occurred in 17%. Wounds with a frequency exceeding 5% included skin, extremity, facial, brain, and gastrointestinal injuries. Vascular injury occurred in 4%. Gunshot wounds were a greater cause of injury in Afghanistan (p = 0.001) and resulted in a higher percentage of thoracic injuries (p < 0.001). The nature and extent of trauma sustained by combat-specific personnel seems to be different from that experienced by all soldiers deployed to a war zone.

Art in wartime: The First Wounded, London Hospital, August 1914.

PubMed

Park, M P; Park, R H R

2011-06-01

John Lavery's The First Wounded, London Hospital, August 1914 records a memorable event in the First World War. This painting and the archives of the Royal London Hospital provide a fascinating insight into the nursing and medical care of these early war casualties.

Wound infection after median sternotomy during the war in Croatia.

PubMed

Jelić, I; Anić, D; Alfirević, I; Kalinić, S; Ugljen, R; Letica, D; Ante Korda, Z; Vucemilo, I; Bulat, C; Predrijevac, M; Corić, V; Husar, J; Jelic, M; Hulina, D; Depina, I; Dadić, D

1996-12-01

From 1990 to 1994 at Clinical Hospital Center, Zagreb, 1904 median sternotomies were performed for cardiac operations. Patients shared the same intensive care unit (ICU) with the wounded persons, admitted to the hospital from battlefield. Infection developed in 124 patients, an incidence of 6.51%. Methicillin resistant Staphylococcus aureus (MRSA) was isolated from 90, methicillin resistant Staphylococcus epidermidis (MRSE) from 19, and gram negative bacilli (GNB) from 56 patients, Pseudomonas aeruginosa in 2, and Clostridium pneumoniae in 1 case. Ninety-six patients (5.04%) developed superficial localized infection of subcutaneous tissues and they were treated with frequent dressing changes with antibiotic-soaked gauze in combination with systemic antibiotics. Twenty-eight patients (1.47%) developed mediastinitis and sternal dehiscence. They were treated by operative debridement followed by reclosure of the sternum with continuous antibiotic irrigation. We obtained satisfactory results with our method of closure of sternum which is a modification of Robicsek's technique. Nine of them required further operation. In seven cases we performed muscle flaps and in two omentoplasty. One hundred and twenty patients were discharged in satisfactory condition. The uncontrolled mediastinal sepsis caused death in 4 patients. Higher infection rate after median sternotomy during 1991 and 1992 could be possibly explained with the war circumstances in Croatia, and especially with MRSA strain becoming endemic in surgical ICU.

Russian war surgery in 1812: 200 years since Russia's war triumph.

PubMed

Boсkeria, Leo A; Glyantsev, Sergey P; Kolesnikov, Yan G

2012-01-01

Specific wounds inflicted on soldiers and officers of the Russian Army by French firearms and cold weapon and wound treatment by Russian surgeons during 1812 Napoleon's invasion (better known in Russia as the Patriotic War of 1812) are discussed. An inference is made that the then surgical treatment was not only administered at a high level but was also versatile and efficient and thus could make a certain contribution to the victory of the Russian arms. Copyright © 2012 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.

CICATRIZATION OF WOUNDS : I. THE RELATION BETWEEN THE SIZE OF A WOUND AND THE RATE OF ITS CICATRIZATION.

PubMed

Carrel, A; Hartmann, A

1916-11-01

1. A method for measuring the area of a wound not geometric in form is described. 2. The rate of cicatrization of a wound is greater at the beginning than at the end of the period of repair. It depends on the area rather than on the age of the wound. There is a constant relation between the size of a wound and the rate of cicatrization. The larger the wound the greater is the rate of cicatrization. Two wounds of different size have a tendency to become equal. 3. The rate is proportional to the area, but diminishes less rapidly than the area. 4. The process of contraction is the more important factor in the repair of a wound. Epidermization completes the work of contraction. After the wound is healed, the cicatrix as a rule expands. 5. The curve representing the diminution of the size of an aseptic wound while it cicatrizes is regular and geometric.

[Pneumonia in wounded].

PubMed

Ovchinnikov, Iu V; Kharitonov, M A; Sadykov, R R; Shelukhin, V A; Gaĭduk, S V; Bogomolov, A B; Ivanov, V V; Dobrovol'skaia, L M

2015-02-01

Pneumonia is one of the common complications of wounds of any localization. Therapists are involved into the treatment of lung lesions in wounded in the ICU, in the surgical and if the patient arrives "on follow-up care,"--in the medical ward. The article analyzes the main statistical indicators reflecting the prevalence and clinical and pathogenetic characteristics of lung pathology in wounded during the Great Patriotic War, during the fighting Soviet troops in the Republic of Afghanistan, the 1st and 2nd Chechen campaign. Pneumonia as a manifestation of traumatic disease can occur in two ways. Primary pneumonia is in close connection with the pathogenetic traumatic injury. Secondary lung lesions complicate the injury at a later date and are due to the introduction of a nosocomial infection process flora. We describe the clinical picture of pneumonia in the affected, the basic pathogenesis, principles of therapy. Successful treatment of lung pathology in wounded depends on the performance of a complex of activities involving a wide range of doctors of various specialties.

Do inflammatory markers portend heterotopic ossification and wound failure in combat wounds?

PubMed

Forsberg, Jonathan A; Potter, Benjamin K; Polfer, Elizabeth M; Safford, Shawn D; Elster, Eric A

2014-09-01

After a decade of war in Iraq and Afghanistan, we have observed an increase in combat-related injury survival and a paradoxical increase in injury severity, mainly because of the effects of blasts. These severe injuries have a devastating effect on each patient's immune system resulting in massive upregulation of the systemic inflammatory response. By examining inflammatory mediators, preliminary data suggest that it may be possible to correlate complications such as wound failure and heterotopic ossification (HO) with distinct systemic and local inflammatory profiles, but this is a relatively new topic. We asked whether systemic or local markers of inflammation could be used as an objective means, independent of demographic and subjective factors, to estimate the likelihood of (1) HO and/or (2) wound failure (defined as wounds requiring surgical débridement after definitive closure, or wounds that were not closed or covered within 21 days of injury) in patients sustaining combat wounds. Two hundred combat wounded active-duty service members who sustained high-energy extremity injuries were prospectively enrolled between 2008 and 2012. Of these 200 patients, 189 had adequate followups to determine the presence or absence of HO, and 191 had adequate followups to determine the presence or absence of wound failure. In addition to injury-specific and demographic data, we quantified 24 cytokines and chemokines during each débridement. Patients were followed clinically for 6 weeks, and radiographs were obtained 3 months after definitive wound closure. Associations were investigated between these markers and wound failure or HO, while controlling for known confounders. The presence of an amputation (p < 0.001; odds ratio [OR], 6.1; 95% CI. 1.63-27.2), Injury Severity Score (p = 0.002; OR, 33.2; 95% CI, 4.2-413), wound surface area (p = 0.001; OR, 1.01; 95% CI, 1.002-1.009), serum interleukin (IL)-3 (p = 0.002; OR, 2.41; 95% CI, 1.5-4.5), serum IL-12p70 (p = 0.01; OR, 0

The Complicated Facial War Injury: Pitfalls and Mismanagement.

PubMed

Abu-Sittah, Ghassan S; Baroud, Joe; Hakim, Christopher; Wakil, Cynthia

2017-01-01

The aim of this paper is to share the authors' experience in the management of complicated facial war injuries using free tissue transfer. A discussion on the most commonly encountered pitfalls in management during the acute and complicated settings is presented in an effort to raise insight on facial war wound complications. Two patients of complicated facial war injuries are presented to exemplify the pitfalls in acute and chronic management of the mandibular region in the first patient and the orbito-maxillary region in the second. The examples demonstrate free tissue transfer for early as well as late definitive reconstructions. A reconstruction algorithm or consensus regarding the optimal management plan of complicated facial war injuries is not attainable. The main principles of treatment, however, remain to decrease bacterial burden by adequate aggressive debridement followed by revisit sessions, remove of all infected hardware followed by replacement with external bony fixation if necessary and reviving the affected area by coverage with well-vascularized tissues and bone. The later is feasible via local, regional, or distant tissue transfer depending on the extent of injury, surgeon's experience, and time and personnel available. Free tissue transfer has revolutionized the management of complicated facial war injuries associated with soft tissue or bone loss as it has allowed the introduction of well-vascularized tissues into a hostile wound environment. The end result is a reduced infection rate, faster recovery time, and better functional outcome compared with when loco-regional soft tissue coverage or bone grafting is used. When soft tissue or bone loss is present, free tissue transfer should be the first management plan if time and personnel are available. The ultimate treatment of a complicated war wound remains prevention by accurate initial management.

Neuropsychiatric Disturbances, Self-Mutilation and Malingering in the French Armies during World War I: War Strain or Cowardice?

PubMed

Tatu, Laurent; Bogousslavsky, Julien

2016-01-01

Between 1914 and 1918, war strain appeared under a number of guises and affected, to varying extents, the majority of French soldiers. The most frequent form of war strain was war psychoneurosis, but war strain also induced more paroxystic disorders, such as acute episodes of terror, self-mutilation, induced illnesses and even suicide. Fear was the constant companion of soldiers of the Great War: soldiers were either able to tame it or overwhelmed by an uncontrollable fear. Nonetheless, over the course of the war, some aspects of fear were recognised as syndromes. The French health service poorly anticipated the major consequences of war strain, as with many other types of injuries. After the establishment of wartime neuropsychiatric centres, two main medical stances emerged: listening to soldiers empathetically on the one hand and applying more repressive management on the other. For many physicians, the psychological consequences of this first modern war were synonymous with malingering or cowardice in the face of duty. The stance of French military physicians in relation to their command was not unequivocal and remained ambivalent, swaying between medico-military collusion and empathy towards soldiers experiencing psychological distress. The ubiquity of suspected malingering modified the already porous borders between neuropsychiatric disorders and disobedience. Several war psychoneurotic soldiers were sentenced by councils of war for deserting their posts in the face of the enemy and were shot. Many soldiers suspected of self-mutilation or suffering from induced illnesses were also sentenced and executed without an expert assessment of their wound or their psychological state. © 2016 S. Karger AG, Basel.

Physical and mental health costs of traumatic war experiences among Civil War veterans.

PubMed

Pizarro, Judith; Silver, Roxane Cohen; Prause, JoAnn

2006-02-01

Hundreds of thousands of soldiers face exposure to combat during wars across the globe. The health effects of traumatic war experiences have not been adequately assessed across the lifetime of these veterans. To identify the role of traumatic war experiences in predicting postwar nervous and physical disease and mortality using archival data from military and medical records of veterans from the Civil War. An archival examination of military and medical records of Civil War veterans was conducted. Degree of trauma experienced (prisoner-of-war experience, percentage of company killed, being wounded, and early age at enlistment), signs of lifetime physician-diagnosed disease, and age at death were recorded. The US Pension Board surgeons conducted standardized medical examinations of Civil War veterans over their postwar lifetimes. Military records of 17,700 Civil War veterans were matched to postwar medical records. Signs of physician-diagnosed disease, including cardiac, gastrointestinal, and nervous disease; number of unique ailments within each disease; and mortality. Military trauma was related to signs of disease and mortality. A greater percentage of company killed was associated with signs of postwar cardiac and gastrointestinal disease (incidence risk ratio [IRR], 1.34; P < .02), comorbid nervous and physical disease (IRR, 1.51; P < .005), and more unique ailments within each disease (IRR, 1.14; P < .005). Younger soldiers (<18 years), compared with older enlistees (>30 years), showed a higher mortality risk (hazard ratio, 1.52), signs of comorbid nervous and physical disease (IRR, 1.93), and more unique ailments within each disease (IRR, 1.32) (P < .005 for all), controlling for time lived and other covariates. Greater exposure to death of military comrades and younger exposure to war trauma were associated with increased signs of physician-diagnosed cardiac, gastrointestinal, and nervous disease and more unique disease ailments across the life of Civil War

Field surgery on a future conventional battlefield: strategy and wound management.

PubMed Central

Ryan, J. M.; Cooper, G. J.; Haywood, I. R.; Milner, S. M.

1991-01-01

Most papers appearing in the surgical literature dealing with wound ballistics concern themselves with wound management in the civilian setting. The pathophysiology of modern war wounds is contrasted with ballistic wounds commonly encountered in peacetime, but it should be noted that even in peacetime the modern terrorist may have access to sophisticated military weaponry, and that patients injured by them may fall within the catchment area of any civilian hospital. Management problems associated with both wound types are highlighted; areas of controversy are discussed. The orthodox military surgical approach to ballistic wounds is expounded and defended. Images Figure 2 Figure Figure 4 PMID:1996857

Improving Outcomes Following Penetrating Colon Wounds

PubMed Central

Miller, Preston R.; Fabian, Timothy C.; Croce, Martin A.; Magnotti, Louis J.; Elizabeth Pritchard, F.; Minard, Gayle; Stewart, Ronald M.

2002-01-01

Introduction During World War II, failure to treat penetrating colon injuries with diversion could result in court martial. Based on this wartime experience, colostomy for civilian colon wounds became the standard of care for the next 4 decades. Previous work from our institution demonstrated that primary repair was the optimal management for nondestructive colon wounds. Optimal management of destructive wounds requiring resection remains controversial. To address this issue, we performed a study that demonstrated risk factors (pre or intraoperative transfusion requirement of more than 6 units of packed red blood cells, significant comorbid diseases) that were associated with a suture line failure rate of 14%, and of whom 33% died. Based on these outcomes, a clinical pathway for management of destructive colon wounds was developed. The results of the implementation of this pathway are the focus of this report. Methods Patients with penetrating colon injury were identified from the registry of a level I trauma center over a 5-year period. Records were reviewed for demographics, injury characteristics, and outcome. Patients with nondestructive injuries underwent primary repair. Patients with destructive wounds but no comorbidities or large transfusion requirement underwent resection and anastomosis, while patients with destructive wounds and significant medical illness or transfusion requirements of more than 6 units/blood received end colostomy. The current patients (CP) were compared to the previous study (PS) to determine the impact of the clinical pathway. Outcomes examined included colon related mortality and morbidity (suture line leak and abscess). Results Over a 5.5-year period, 231 patients had penetrating colon wounds. 209 survived more 24 hours and comprise the study population. Primary repair was performed on 153 (73%) patients, and 56 patients had destructive injuries (27%). Of these, 40 (71%) had resection and anastomosis and 16 (29%) had diversion

How World War 1 changed global attitudes to war and infectious diseases.

PubMed

Shanks, G Dennis

2014-11-08

World War 1 was a key transition point towards scientific medicine. Medical officers incorporated Louis Pasteur's discoveries into their understanding of microorganisms as the cause of infectious diseases, which were therefore susceptible to rational control and treatment measures even in the pre-antibiotic era. Typhoid vaccination led to the successful evasion of the disastrous epidemics of previous wars. The incidence of tetanus was probably decreased by giving millions of doses of horse antitoxin to wounded soldiers. Quinine treated but could not control malaria; its use required mass compulsion. Tuberculosis was not a great military problem during World War 1, although mortality in civilian populations increased substantially. Treatment of sexually transmitted infections remained a matter of aversive conditioning, with invasive antiseptics used in the absence of antibiotics. Pandemic influenza in 1918-19 killed more people than died during the entire war, showing how much remained beyond the capability of the scientists and doctors who fought infectious diseases during World War 1. Copyright © 2014 Elsevier Ltd. All rights reserved.

Wound Bioburden and Infection-Related Complications in Diabetic Foot Ulcers

PubMed Central

Gardner, Sue E.; Frantz, Rita A.

2013-01-01

The identification and diagnosis of diabetic foot ulcer (DFU) infections remains a complex problem. Because inflammatory responses to microbial invasion may be diminished in persons with diabetes, clinical signs of infection are often absent in persons with DFUs when infection is limited to localized tissue. In the absence of these clinical signs, microbial load is believed to be the best indicator of infection. Some researchers, however, believe microbial load to be insignificant and type of organism growing in the ulcer to be most important. Previous studies on the microbiology of DFUs have not provided enough evidence to determine the microbiological parameters of importance. Infection-related complications of DFUs include wound deterioration, osteomyelitis, and amputation. Risk factors for amputation include age, peripheral vascular disease, low transcutaneous oxygen, smoking, and poor glycemic control. These risk factors are best measured directly with physiological measures of arterial perfusion, glycemic control, sensory neuropathy, plantar pressures, and activity level and by controlling off-loading. DFU bioburden has not been examined as a risk factor for infection-related complications. To address the relationship between wound bioburden and the development of infection-related complications in DFUs, tightly controlled prospective studies based on clearly defined, valid measures of wound bioburden and wound outcomes are needed. This article reviews the literature and proposes a model of hypothesized relationships between wound bioburden—including microbial load, microbial diversity, and pathogenicity of organisms—and the development of infection-related complications. PMID:18647759

Characterization of wound infections among patients injured during the 2011 Libyan conflict.

PubMed

Dau, A A; Tloba, S; Daw, M A

2013-04-01

Few studies have analysed the bacterial pathogenesis of infections associated with war-wound in the Eastern Mediterranean region. We analysed surgical wound infections of 1200 patients injured during the Libyan conflict in 2011 and admitted to the emergency services at Tripoli medical centre. Culture swabs or surgical wound debridement samples were collected and cultures were identified and tested for antimicrobial resistance. Of the 1200 patients studied, 498 (42%) were infected with at least 1 pathogen and 57 with >2 pathogens. The most common species were Acinetobacter spp. (isolated from 144 patients), coagulase-negative staphylococci (122), Escherichia coli (107), Pseudomnonas aeruginosa (92) and Klebsiella spp. (86). A high level of resistance to the antibiotics tested was found, especially among Acinetobacter spp. Multi-drug-resistant Gram-negative bacilli were an important complicating factor in wound infections associated with war injuries among injured patients in Libya. Effective policies are needed to control and treat such infections particularly in trauma and emergency services.

Military Adaptation in War

DTIC Science & Technology

2009-06-01

the rights of Germans who lived in the duchy of Schleswig- Holstein . This conflict certainly looked much more like the European conception of war...hitting more trees and cows than their intended targets. The first raid on the Ruhr on 15 May 1940 killed one dairyman in Cologne and wounded two people in

Costs of war: excess health care burdens during the wars in Afghanistan and Iraq (relative to the health care experience pre-war).

PubMed

2012-11-01

This report estimates the health care burden related to the wars in Iraq and Afghanistan by calculating the difference between the total health care delivered to U.S. military members during wartime (October 2001 to June 2012) and that which would have been delivered if pre-war (January 1998 to August 2001) rates of ambulatory visits, hospitalizations, and hospital bed days of active component members of the U.S. Armed Forces had persisted during the war. Overall, there were estimated excesses of 17,023,491 ambulatory visits, 66,768 hospitalizations, and 634,720 hospital bed days during the war period relative to that expected based on pre-war experience. Army and Marine Corps members and service members older than 30 accounted for the majority of excess medical care during the war period. The illness/injury-specific category of mental disorders was the single largest contributor to the total estimated excesses of ambulatory visits, hospitalizations, and bed days. The total health care burdens associated with the wars in Afghanistan and Iraq are undoubtedly greater than those enumerated in this report because this analysis did not address care delivered in deployment locations or at sea, care rendered by civilian providers to reserve component members in their home communities, care of veterans by the Departments of Defense and Veterans Affairs, preventive care for the sake of force health protection, and future health care associated with wartime injuries and illnesses.

Bacterial flora of combat wounds from eastern Ukraine and time-specified changes of bacterial recovery during treatment in Ukrainian military hospital.

PubMed

Valentine, Kovalchuk P; Viacheslav, Kondratiuk M

2017-04-07

positive swab-cultures after first week were nonfermentative Gram-negative bacilli (68% of swab-cultures), which in 53% of the swab-cultures belonged to the genus Acinetobacter, and in 15% to the genus Pseudomonas. The incidence of polymicrobial wound cultures increased from first week to second post-injury week. The most frequent microbial mixture were Acinetobacter baumannii with Enterobacteriaceae or other nonfermentative Gram negative rods with Enterococcus spp. We observed bacteria recovery from wounds during proliferation phase. These wounds had no pure inflammation signs and were free of devitalized tissues. Any wound is at some risk of becoming infected. In the event of infection, a wound fails to heal, treatment costs rise, and general wound management practices become more resource demanding. Determining the microorganisms which colonize battle wounds and cause wound infection is paramount. This information can help to treat battle wound infections or even changes infection control strategies. The fact of shifting in wound microbiology in the favor of bacteria responsible for healthcare-associated infections support to the proposition that these changes are nosocomially related [4, 14]. For Ukrainian military medicine this study is the first time-specified assessment of battle wound colonization from the World War II.

Management of War-Related Ballistic Craniocerebral Injuries in a French Role 3 Hospital During the Afghan Campaign.

PubMed

Dagain, Arnaud; Aoun, Olivier; Bordes, Julien; Roqueplo, Cédric; Joubert, Christophe; Esnault, Pierre; Sellier, Aurore; Delmas, Jean-Marc; Desse, Nicolas; Fouet, Mathilde; Pernot, Philippe; Dulou, Renaud

2017-06-01

France deployed to Afghanistan from 2001 to 2014 within the International Security and Assistance Force. A French role 3 hospital was built in 2009 in the vicinity of Kabul International Airport (KaIA). The objectives of this study were to describe the epidemiology, management, and outcome of war-related craniocerebral injuries during the Afghan campaign in a French role 3 hospital. From March 1, 2010 to September 30, 2012, we conducted a retrospective descriptive study in Kabul, Afghanistan. All patients presenting with a ballistic craniocerebral injury to the KaIA role 3 hospital were included. We analyzed 48 records. Mean age was 21.9 years (1-46 years) with a 37:11 (male:female) sex ratio and a majority Afghan population (n = 41). Civilians represented 64.6% (n = 31) of casualties. On the battlefield, mean Glasgow Coma Scale score was 9.4 [3-15]. On arrival at the KaIA field hospital, 20 of the 48 patients were hemodynamically unstable. All patients underwent a full-body computed tomography scan. The majority of our casualties had associated injuries. Neurosurgery was indicated for 42 (87.5%) patients. The surgery consisted of wound debridement plane by plane associated with decompressive craniectomy (n = 11), debridement craniectomy (n = 19), and craniotomy (n = 12). A total of 32.4% wounded died at the point of injury, 8.4% at the emergency department, and 16.9% after surgery. War casualties with ballistic head injuries were predominantly multitraumatized patients with hemodynamic compromise requiring neurosurgical damage control management and multidisciplinary care. The neurosurgeon has thus an essential role to play. Copyright © 2017 Elsevier Inc. All rights reserved.

Beyond Pathologizing Harm: Understanding PTSD in the Context of War Experience.

PubMed

Benner, Patricia; Halpern, Jodi; Gordon, Deborah R; Popell, Catherine Long; Kelley, Patricia W

2018-03-01

An alternative to objectifying approaches to understanding Post-traumatic Stress Disorder (PTSD) grounded in hermeneutic phenomenology is presented. Nurses who provided care for soldiers injured in the Iraq and Afghanistan wars, and sixty-seven wounded male servicemen in the rehabilitation phase of their recovery were interviewed. PTSD is the one major psychiatric diagnosis where social causation is established, yet PTSD is predominantly viewed in terms of the usual neuro-physiological causal models with traumatic social events viewed as pathogens with dose related effects. Biologic models of causation are applied reductively to both predisposing personal vulnerabilities and strengths that prevent PTSD, such as resiliency. However, framing PTSD as an objective disease state separates it from narrative historical details of the trauma. Personal stories and cultural meanings of the traumatic events are seen as epiphenomenal, unrelated to the understanding of, and ultimately, the therapeutic treatment of PTSD. Most wounded service members described classic symptoms of PTSD: flashbacks, insomnia, anxiety etc. All experienced disturbance in their sense of time and place. Rather than see the occurrence of these symptoms as decontextualized mechanistic reverberations of war, we consider how these symptoms meaningfully reflect actual war experiences and sense of displacement experienced by service members.

Wound-Related Allergic/Irritant Contact Dermatitis.

PubMed

Alavi, Afsaneh; Sibbald, R Gary; Ladizinski, Barry; Saraiya, Ami; Lee, Kachiu C; Skotnicki-Grant, Sandy; Maibach, Howard

2016-06-01

To provide information from a literature review about the prevention, recognition, and treatment for contact dermatitis. This continuing education activity is intended for physicians and nurses with an interest in skin and wound care. After participating in this educational activity, the participant should be better able to:1. Identify signs and symptoms of and diagnostic measures for contact dermatitis.2. Identify causes and risks for contact dermatitis.3. Select appropriate treatment for contact dermatitis and its prevention. Contact dermatitis to wound care products is a common, often neglected problem. A review was conducted to identify articles relevant to contact dermatitis.A PubMed English-language literature review was conducted for appropriate articles published between January 2000 and December 2015.Contact dermatitis is both irritant (80% of cases) or allergic (20% of cases). Frequent use of potential contact allergens and impaired barrier function of the skin can lead to rising sensitization in patients with chronic wounds. Common known allergens to avoid in wound care patients include fragrances, colophony, lanolin, and topical antibiotics.Clinicians should be cognizant of the allergens in wound care products and the potential for sensitization. All medical devices, including wound dressings, adhesives, and bandages, should be labeled with their complete ingredients, and manufacturers should be encouraged to remove common allergens from wound care products, including topical creams, ointments, and dressings.

[The prevalence of war-related post-traumatic stress disorder in children from Cundinamarca, Colombia].

PubMed

Pérez-Olmos, Isabel; Fernández-Piñeres, Patricia E; Rodado-Fuentes, Sonia

2005-01-01

Determining the prevalence of post-traumatic stress disorder (PTSD) related to the type of war exposure and associated factors in school-aged children from three Colombian towns. Cross-sectional epidemiological study. Representative randomised sample of 493 children aged 5-14. The children were evaluated during 2002 using semi-structured psychiatric interviews and the clinician administered PTSD scale. 167 children were evaluated in La Palma who had been chronically exposed to war, 164 in Arbeláez who had had recent war-exposure and 162 in Sopó who had not been exposed to war. War-related PTSD prevalence was calculated in each municipality. Odds ratio (OR) and chi-square were used for evaluating the association between exposure to war and PTSD and the related risk. Multivariate analysis used the logistic regression model. The affected children required specialised mental health counselling. The prevalence of PTSD resulting from war was 16,8 % in La Palma, 23,2 % in Arbeláez and 1.2% in Sopó. A 19.9 OR (CI 4.7, 119.2), 30,5 Chi-square and p = 0.000 revealed war-related PTSD association and risk for children when comparing the exposed towns to Sopó. The logistic regression showed that geographical closeness to war zone and intense emotional reaction to war increased the probability of war-related PTSD. Vulnerability factors were predominant in war-exposed towns. Poverty, parents' low educational level and child abuse predominated in La Palma. Attention-deficit and psychosomatic disorders were more prevalent in Arbeláez. War affects children's mental health; the children from the exposed towns had 19 times greater probability of war-related PTSD than those from a non-exposed town. Early therapeutic intervention is a public health priority. The results are useful for countries suffering from war, internal conflict and/or terrorism.

Outcomes of primary repair and primary anastomosis in war-related colon injuries.

PubMed

Vertrees, Amy; Wakefield, Matthew; Pickett, Chris; Greer, Lauren; Wilson, Abralena; Gillern, Sue; Nelson, Jeffery; Aydelotte, Jayson; Stojadinovic, Alexander; Shriver, Craig

2009-05-01

The role of primary repair (PR) of modern day war-related colon injuries remains controversial. Retrospective review of medical records of combat-wounded soldiers with colon injuries sustained during March 2003 to August 2006 was conducted. Injuries were analyzed according to location: right (n = 30), transverse (n = 13), and left (n = 24) sided colon injuries. Two-tailed Fisher's Exact or chi tests were used for statistical analysis. Seventy-seven soldiers returned to Walter Reed Army Medical Center with colon injuries suffered during Operations Enduring Freedom and Iraqi Freedom. Twelve patients with minor colon injuries were excluded. The remaining 65 patients (mean age, 28 +/- 7 years) sustained 67 colon injuries from secondary blast (n = 38); gunshot (n = 27); motor vehicle crash (n = 1) and crush injury (n = 1). Patients arrived at Walter Reed Army Medical Center 5 days (range, 2-16 days) after injury and damage control operations (n = 27, 42%), and were hospitalized for a median of 22 days (range, 1-306 days). Follow-up averaged 311 days (median, 198 days). PR was attempted in right (n = 18, 60%), transverse (n = 11, 85%), and left (n = 9, 38%) sided colon injuries. Delayed definitive treatment of colon injuries occurred in 42% of patients. Failure of repair occurred in 16% of patients and was more likely with concomitant pancreatic, stomach, splenic, diaphragm, and renal injuries. Overall morbidity for ostomy closure after primary ostomy formation was 30%, but increased to 75% for ostomy closure after primary anastomotic or repair failure. PR of war-related colon injuries can be performed safely in selected circumstances in the absence of concomitant organ injury. Delayed anastomosis can often be performed after damage control operations once the patient stabilizes. Ostomy closure complications are more likely after anastomotic failure.

HOLDING THE TORCH UP HIGH - A MEDICAL HISTORICAL EVALUATION OF SURGICAL ADVANCES DURING THE GREAT WAR 1914-1918, IN MEMORY OF THOSE THAT SERVED AND FELL.

PubMed

Scharf, G

2017-09-01

"How wide and varied is the experience of the battlefield and how fertile the blood of warriors in raising good surgeons" Sir Clifford Allbutt (1898). With these sentiments of the medical lessons learned in war and conflict, with the background of the poem of "In Flanders Field", written by a doctor who had South African War connections, reasons (the Somme and third Ypres battles) will be given that this was indeed a "GREAT WAR" as the world history, weapons, strategy, tactics and wounding patterns had changed dramatically. These changes are still affecting all at present, as eventually the Second World War came from it, as well as the Cold "Third World" War. In this war most casualties were caused by bomb fragments and the figures were enormous. It was the war of massive troop movements (railroads), the Schlieffen plan, trench warfare, artillery, the machine guns, end of cavalry and the initiation of tanks, air warfare/reconnaissance and gas/chemical warfare. The surgical experiences of previous wars were obsolete. Urgent rethinking of surgical principles and protocols had to be devised, with the death rates of dying due to wounds, sepsis and tetanus exceeding 60 percent of all casualties. Abdominal wounds were treated conservatively, but soon there came advances in resuscitation, anaesthetics, aggressive wound and exploratory surgery, orthopaedics, plastic and reconstructive surgery, physiology, wound pathology and microbiology. All sides concentrated on ambulance stations, field hospitals and then rapid transfer to bigger referral and base hospitals. It seems that lessons learned where indeed exchanged (? by the Red Cross to all combatant medical personal). Even to the present day, frameworks of this are still used effectively (Vietnam War, Falklands War and our recent border wars). The lessons are well learned and the Torch is ours to hold up high! Copyright© Authors.

Prevention of tetanus during the First World War.

PubMed

Wever, Peter Cornelis; van Bergen, Leo

2012-12-01

The emergence of tetanus in wounded soldiers during the first months of the First World War (WWI) resulted from combat on richly manured fields in Belgium and Northern France, the use of modern explosives that produced deep tissue wounds and the intimate contact between the soldier and the soil upon which he fought. In response, routine prophylactic injections with anti-tetanus serum were given to wounded soldiers removed from the firing line. Subsequently, a steep fall in the incidence of tetanus was observed on both sides of the conflict. Because of fatal serum anaphylaxis associated with administration of serum at a time when purification methods still needed to be improved, it must be presumed that tens to hundreds of men might have died as a result of the routine administration of anti-tetanus serum during WWI. Yet anti-tetanus serum undoubtedly prevented life threatening tetanus among several hundred thousands of wounded men, making it one of the most successful preventive interventions in wartime medicine. After the abrupt fall in tetanus incidence in 1914 due to introduction of anti-tetanus serum, the incidence of the disease tended to become even lower as the war went on. This was probably due to earlier and more thorough surgical treatment, consisting of opening, cleaning, excision and drainage of wounds as early as possible. In this overview, recent battlefield findings from the Meuse-Argonne offensive in 1918 are used to illustrate common practices employed in the prevention of tetanus during WWI.

Severe war-related trauma and personality pathology: a case-control study.

PubMed

Munjiza, Jasna; Britvic, Dolores; Radman, Maja; Crawford, Mike J

2017-03-21

Exposure to war-related trauma has long been recognised to have an adverse effect on mental health. We attempted to investigate whether people who have clinically significant personality-related problems 15 years after a war are more likely to have been exposed to severe war-related trauma than those who do not have significant personality difficulties. A case -control study was conducted in southern Croatia, fifteen years after the 1991-1995 war. We recruited 268 participants: 182 cases who scored positively on the International Personality Disorder Examination scale (IPDE), and 86 controls who were IPDE negative. Severity of war-related trauma was assessed according to the 17 items on the Harvard Trauma Questionnaire (HTQ) trauma event scale, which were considered to be of severe (catastrophic) nature based on the ICD-10 description of catastrophic trauma and the opinion of trauma experts. All participants also completed measures of mental health (depression, anxiety and PTSD), social functioning and current substance misuse. Cases (IPDE positive) were eight times more likely to report exposure to severe war-related trauma than controls. This association increased after adjustments for demographic factors (OR = 10.1, 95% CI 5.0 to 20.4). The types of severe trauma most frequently reported were either the participants'own life being in direct danger or witnessing extreme violence inflicted on others or the result of violence towards others (murder, torture, seeing burned or disfigured bodies). Prevalences of depression, anxiety and PTSD were high among IPDE positive participants 15 years after exposure to war trauma. Their level of interpersonal dysfunction was considerably higher than that in controls (OR = 10.39, 95% CI 3.51 to 30.75). Alcohol consumption in cases was significantly higher with a mean of 14.24 units per week (sd = 11.03) when compared to controls whose mean number of alcohol units was 9.24 (sd = 7.25), t (73) = 2.16, p < 0.05, mean

Disaster-Related Injury Management: High Prevalence of Wound Infection After Super Typhoon Haiyan.

PubMed

Kim, Yong Won; Kim, Seong Yeop; Kim, Hoon; Ahn, Moo Eob; Lee, Kang Hyun; Hong, Eun Seok

2016-02-01

After Super Typhoon Haiyan, a category 5 tropical cyclone, insufficient resources were available for medical management. Many patients in the Philippines were wounded as a result of the disaster. We examined the prevalence, risk factors, and consequences of disaster-related wounds and wound infection in the post-disaster period. We performed a retrospective review of consecutive patients admitted to a Korean Disaster Relief Team clinic at St. Paul's Hospital, Tacloban City, Republic of Philippines, between December 9 and 13, 2013. Traumatic injury patients were included; patients not exhibiting a wound were excluded. Of the 160 patients enrolled in the study, 71 (44.4%) had infected wounds. There were no significant differences in the age, sex, past medical history, wound site, wound depth, injury mechanism, or inducer of injury between the uninfected and infected groups. In the univariate analysis, a foreign-body-contaminated wound, a chronic wound, elapsed time from injury to medical contact, an inadequately cared for wound, and need for subsequent wound management were associated with wound infection (P<0.05). The multivariate analysis revealed that foreign body contamination and having an inadequately cared for wound were associated with wound infection (odds ratio [OR]: 10.12, 95% confidence interval [CI]: 3.59-28.56; OR: 3.51, 95% CI: 1.07-11.51, respectively). In the post-disaster situation, many wound infections required definitive care. Wound infection was associated with inadequately cared for wounds and foreign-body-contaminated wounds.

Management of war-related vascular injuries: experience from the second gulf war.

PubMed

Jawas, Ali; Abbas, Alaa K; Nazzal, Munier; Albader, Marzoog; Abu-Zidan, Fikri M

2013-07-01

To study the biomechanism, pattern of injury, management, and outcome of major vascular injuries treated at Mubarak Al-Kabeer Teaching Hospital, Kuwait during the Second Gulf War. This is a descriptive retrospective study. War-related injured patients who had major vascular injuries and were treated at Mubarak Al-Kabeer Teaching Hospital from August 1990 to September 1991 were studied. Studied variables included age, gender, anatomical site of vascular injury, mechanism of injury, associated injuries, type of vascular repair, and clinical outcome. 36 patients having a mean (SD) age of 29.8 (10.2) years were studied. 32 (89%) were males and 21 (58%) were civilians. Majority of injuries were caused by bullets (47.2%) and blast injuries (47.2%). Eight patients (22%) presented with shock.There were 31 arterial injuries, common and superficial femoral artery injuries were most common (10/31). Arterial repair included interposition saphenous vein graft in seven patients, thrombectomy with end-to-end / lateral repair in twelve patients, vein patch in two patients, and arterial ligation in four patients. Six patients had arterial ligation as part of primary amputation. 3/21 (14.3%) patients had secondary amputation after attempted arterial vascular repair of an extremity. There were a total of 17 venous injuries, 13 managed by lateral suture repair and 4 by ligation. The median (range) hospital stay was 8 (1-76) days. 5 patients died (14%). Major vascular injuries occurred in 10% of hospitalized war-related injured patients. Our secondary amputation rate of extremities was 14%. The presence of a vascular surgeon within a military surgical team is highly recommended. Basic principles and techniques of vascular repair remain an essential part of training general surgeons because it may be needed in unexpected wars.

Experimental missile wound to the brain.

PubMed

Carey, M E; Sarna, G S; Farrell, J B; Happel, L T

1989-11-01

Among civilians in the United States, 33,000 gunshot wound deaths occur each year; probably half of these involve the head. In combat, head wounds account for approximately half of the immediate mortality when death can be attributed to a single wound. No significant reduction in the neurosurgical mortality associated with these wounds has occurred between World War II and the Vietnam conflict, and very little research into missile wounds of the brain has been undertaken. An experimental model has been developed in the anesthetized cat whereby a ballistic injury to the brain may be painlessly reproduced in order that the pathophysiological effects of brain wounding may be studied and better treatments may be designed to lower the mortality and morbidity rates associated with gunshot wounds. Prominent among physiological effects observed in this model was respiratory arrest even though the missile did not injure the brain stem directly. The incidence of prolonged respiratory arrest increased with increasing missile energy, but arrest was often reversible provided respiratory support was given. It is possible that humans who receive a brain wound die from missile-induced apnea instead of brain damage per se. The mortality rate in humans with brain wounding might be reduced by prompt respiratory support. Brain wounding was associated with persistently increased intracranial pressure and reduced cerebral perfusion pressure not entirely attributable to intracranial bleeding. The magnitude of these derangements appeared to be missile energy-dependent and approached dangerous levels in higher-energy wounds. All wounded cats exhibited postwounding increases in blood glucose concentrations consistent with a generalized stress reaction. A transient rise in hematocrit also occurred immediately after wounding. Both of these phenomena could prove deleterious to optimal brain function after injury.

Childhood casualties during civil war: Syrian experience.

PubMed

Çelikel, Adnan; Karbeyaz, Kenan; Kararslan, Bekir; Arslan, M Mustafa; Zeren, Cem

2015-08-01

In war areas a lot of children die as well as adults. According to UNICEF, almost 2 million children have died in the wars took place in the last 10 years. In this study, we aimed to evaluate demographical data and injury characteristics of Syrian children who were wounded in Syria Civil War and died while being treated in Turkey. Postmortem examination and autopsy reports of 985 forensic deaths from Hatay -a Syrian neighborhood city of Turkey-between January 2012 and August 2014 were analyzed retrospectively. Among 763 Syrian people who were wounded in the war and died while being treated in Turkey, 140 cases (18.3%) who were younger than 18 years of age were taken into the scope of this study. Among those cases 77.9% (n = 109) were male and 22.1% were female. Median ages of female cases are 14 (min-max: 2-18) and median age of female cases are 9 (min-max: 1-18). Frequency distribution is highest between 13 and 18 years of age (n: 71, 50.7%). In 70% (n: 98) of cases, cause of death is bombing and shrapnel injuries, 13.6% (19) of them were killed by gunshot wounds. According to injury sites most of the injuries were reported to be on multiple body parts (54.3%, n: 76) and only head and neck injuries (%30). Cause of death was intracranial bleeding and cerebral parenchymal injury in most of the cases (n: 66, %47.1) followed by vascular damage with external bleeding (n: 15, %10.7) and internal organ damage with internal bleeding (n: 15, %10.7). The cases had very high level Abbreviated Injury Scales and Injury Severity Sores. In conclusion, a lot of children have died in the Civil War of Syria. Their average abbreviated injury scale and injury severity score values reported very high. Children that we evaluated were mostly died of head and neck injuries predominantly caused by bombing attacks and Autopsies of them revealed fatal intracranial hemorrhages and parenchymal injuries. Copyright © 2015 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights

Alice Welford (1887-1918), a nurse in World War I: The impact of kindness and compassion.

PubMed

Watkins, PeterJ; Watkins, Valerie J

2017-02-01

The contribution of nurses to the morale of wounded and dying young men during World War 1 was immense. Alice Welford came from the small North Yorkshire village of Crathorne, joined the Queen Alexandra Imperial Military Nursing Service in 1915 and spent the following two and one half years in nursing casualties from some of the fiercest battles of the war including Gallipoli and Salonika. She kept an autograph book inscribed by wounded and dying soldiers, with poignant verses and humorous drawings showing love, wit and tragedy. Despite the dreadful conditions, kindness and compassion brought them comfort and raised their morale - a critical message for today, and Alice's gift to us from World War I.

Ambroise Paré (1510-1590) and His Innovative Work on the Treatment of War Injuries.

PubMed

Markatos, Konstantinos; Tzivra, Anna; Tsoutsos, Spyridon; Tsourouflis, Gerasimos; Karamanou, Marianna; Androutsos, Georgios

2018-04-01

The purpose of this study is to summarize the innovations of Ambroise Paré (1510-1590) on the treatment of war wounds and improving amputation technique through ligature in arteries and veins. Ambroise Paré debunked the widely accepted idea that gun powder was poisonous for wounds. He also minimized the use of cautery of wounds by his dressing methods and the application of ligature during amputations. All these innovative rationales revolutionized the practice of war surgery during the Renaissance and paved the way for the introduction of modern surgery. Nevertheless, although his wound dressing innovations became widely accepted, the same did not happen with ligature and amputation; those techniques could become widely applicable if one could somehow control bleeding until the blood vessels had been tied. This became possible much later in the 18th century when Jean Louis Petit invented the first useful and efficient tourniquet.

Establishment of swine-penetrating craniocerebral gunshot wound model.

PubMed

Lu, Huchen; Wang, Lian; Zhong, Wuzhao; Qi, Rongfeng; Li, Ning; You, Wanchun; Su, Xingfeng; Zhuang, Zong; Cheng, Huilin; Shi, Jixin

2015-12-01

Bullet-induced brain wounds are common among military personnel in war zones and among civilians with gun accidents or crime-related gun injuries. The goal of this study was to develop a nonfatal porcine model of penetrating craniocerebral gunshot wound (PCGW) by firing a projectile in live swine to induce PCGW in such a realistic manner as to reconstruct their physical characteristics. We established a nonfatal porcine model of PCGW based on a custom-designed experimental gun that emulates the shooting of a 5.56-mm NATO standard rifle at 800 m (317 m/s; 200.9 J). Commercial swine (n = 20) were subjected to a ballistic wound to the bilateral frontal lobe, and four swine were used as controls. Surviving swine were used in subsequent first-aid, management, and monitoring experiments for neurosurgeons. Various physiological variables were measured continuously. After computed tomography (CT) scanning and three-dimensional CT reconstructions, all pigs underwent primary lifesaving emergency interventions, including emergency decompressive craniotomies and hemorrhage control. In our nonfatal porcine model of PCGW, injuries were comparable in their morphology to real gunshot wounds, as evidenced by analysis of wound characteristics and CT scan images. The survival rates of the pigs were 100% within 2 h, 95% within 6 h, 85% within 12 h, and 85% within 24 h (P < 0.01). Hemodynamics, hematology, blood routine biochemistry, coagulation, and other physiological parameters also exhibited significant changes in the PCGW pigs. This model makes possible the laboratory reproduction of real ballistic wounds in a live large animal model that is close to humans. Copyright © 2015 Elsevier Inc. All rights reserved.

Removal of cardiothoracic war-related shrapnel using video-assisted thoracoscopic surgery.

PubMed

Khalifa, Mohammed; Abu-Zidan, Fikri M; Khan, Navidul; Black, Edward

2017-07-01

This is the first report in the literature to describe removing war-related cardiothoracic shrapnel using video-assisted thoracoscopic surgery (VATS). War blast caused penetrating thoracic and extremity injuries in 30-year-old man. He was referred to our hospital after stabilization. Magnetic resonance imaging was required to evaluate brachial plexus injury. Large, penetrating shrapnel fragment in the right posterior chest wall, retained shrapnel in apex of the right lung, and another fragment in the pericardium were removed using VATS in staged approach. Postoperative period was uneventful. VATS is useful in managing complex, war-related cardiothoracic injuries.

Military medicine and the ethics of war: British colonial warfare during the Seven Years War (1756-63).

PubMed

Charters, Erica

2010-01-01

This article examines 18th-century European warfare, tracing the first formal codifications of conventions of war, frequently introduced by military physicians and initially regarding the treatment of the sick and wounded. It outlines to what extent these conventions were followed in practice, particularly in the challenging environment of American irregular warfare, with a focus on the most well-known incident of "biological warfare" in the period: the deliberate spread of smallpox by British officers among Amerindians in 1763. More broadly, it demonstrates that the history of military medicine provides a fruitful method with which to uncover assumptions about the ethics of war.

Metals detected by ICP/MS in wound tissue of war injuries without fragments in Gaza

PubMed Central

2010-01-01

Background The amount and identity of metals incorporated into "weapons without fragments" remain undisclosed to health personnel. This poses a long-term risk of assumption and contributes to additional hazards for victims because of increased difficulties with clinical management. We assessed if there was evidence that metals are embedded in "wounds without fragments" of victims of the Israeli military operations in Gaza in 2006 and 2009. Methods Biopsies of "wounds without fragments" from clinically classified injuries, amputation (A), charred (C), burns (B), multiple piercing wounds by White Phosphorus (WP) (M), were analyzed by ICP/MS for content in 32 metals. Results Toxic and carcinogenic metals were detected in folds over control tissues in wound tissues from all injuries: in A and C wounds (Al, Ti, Cu, Sr, Ba, Co, Hg, V, Cs and Sn), in M wounds (Al, Ti, Cu, Sr, Ba, Co and Hg) and in B wounds (Co, Hg, Cs, and Sn); Pb and U in wounds of all classes; B, As, Mn, Rb, Cd, Cr, Zn in wounds of all classes, but M; Ni was in wounds of class A. Kind and amounts of metals correlate with clinical classification of injuries, exposing a specific metal signature, similar for 2006 and 2009 samples. Conclusions The presence of toxic and carcinogenic metals in wound tissue is indicative of the presence in weapon inducing the injury. Metal contamination of wounds carries unknown long term risks for survivors, and can imply effects on populations from environmental contamination. We discuss remediation strategies, and believe that these data suggest the need for epidemiological and environmental surveys. PMID:20579349

Suicide among war veterans.

PubMed

Rozanov, Vsevolod; Carli, Vladimir

2012-07-01

Studies aiming to identify if war veterans are at higher risk of suicide have often produced inconsistent results; this could be due to the complexity of comparisons and different methodological approaches. It should be noted that this contingent has many risk factors, such as stressful exposures, wounds, brain trauma and pain syndrome. Most recent observations confirm that veterans are really more likely to die of suicide as compared to the general population; they are also more likely to experience suicidal ideation and suffer from mental health problems. Suicides are more frequent in those who develop PTSD, depression and comorbid states due to war exposure. Combat stress and its' frequency may be an important factor leading to suicide within the frame of the stress-vulnerability model. According to this model, the effects of stress may interact with social factors, interpersonal relations and psychological variables producing suicidal tendencies. Modern understanding of stress-vulnerability mechanisms based on genetic predispositions, early life development, level of exposure to stress and stress-reactivity together with interpersonal aspects may help to build more effective suicide prevention programs based on universal/selective/indicated prevention principles.

Suicide among War Veterans

PubMed Central

Rozanov, Vsevolod; Carli, Vladimir

2012-01-01

Studies aiming to identify if war veterans are at higher risk of suicide have often produced inconsistent results; this could be due to the complexity of comparisons and different methodological approaches. It should be noted that this contingent has many risk factors, such as stressful exposures, wounds, brain trauma and pain syndrome. Most recent observations confirm that veterans are really more likely to die of suicide as compared to the general population; they are also more likely to experience suicidal ideation and suffer from mental health problems. Suicides are more frequent in those who develop PTSD, depression and comorbid states due to war exposure. Combat stress and its’ frequency may be an important factor leading to suicide within the frame of the stress-vulnerability model. According to this model, the effects of stress may interact with social factors, interpersonal relations and psychological variables producing suicidal tendencies. Modern understanding of stress-vulnerability mechanisms based on genetic predispositions, early life development, level of exposure to stress and stress-reactivity together with interpersonal aspects may help to build more effective suicide prevention programs based on universal/selective/indicated prevention principles. PMID:22851956

Elaboration of the Visual Pathways from the Study of War-Related Cranial Injuries: The Period from the Russo-Japanese War to World War I.

PubMed

Lanska, Douglas J

2016-01-01

As a result of the wars in the early 20th century, elaboration of the visual pathways was greatly facilitated by the meticulous study of visual defects in soldiers who had suffered focal injuries to the visual cortex. Using relatively crude techniques, often under difficult wartime circumstances, investigators successfully mapped key features of the visual pathways. Studies during the Russo- Japanese War (1904-1905) by Tatsuji Inouye (1881-1976) and during World War I by Gordon Holmes (1876-1965), William Lister (1868-1944), and others produced increasingly refined retinotopic maps of the primary visual cortex, which were later supported and refined by studies during and after World War II. Studies by George Riddoch (1888-1947) during World War I also demonstrated that some patients could still perceive motion despite blindness caused by damage to their visual cortex and helped to establish the concept of functional partitioning of visual processes in the occipital cortex. © 2016 S. Karger AG, Basel.

Wound induces changes in nitric oxide related biologies putatively modulating tuber healing

USDA-ARS?s Scientific Manuscript database

Wound-related losses in harvested potatoes and cut seed are a serious and costly problem (losses > $320 m/yr). Our understanding of the regulation and modulation of the processes involved in wound healing (WH) are advancing and showing promise in the development of new approaches and technologies t...

[Errors in wound management].

PubMed

Filipović, Marinko; Novinscak, Tomislav

2014-10-01

Chronic ulcers have adverse effects on the patient quality of life and productivity, thus posing financial burden upon the healthcare system. Chronic wound healing is a complex process resulting from the interaction of the patient general health status, wound related factors, medical personnel skill and competence, and therapy related products. In clinical practice, considerable improvement has been made in the treatment of chronic wounds, which is evident in the reduced rate of the severe forms of chronic wounds in outpatient clinics. However, in spite of all the modern approaches, efforts invested by medical personnel and agents available for wound care, numerous problems are still encountered in daily practice. Most frequently, the problems arise from inappropriate education, of young personnel in particular, absence of multidisciplinary approach, and inadequate communication among the personnel directly involved in wound treatment. To perceive them more clearly, the potential problems or complications in the management of chronic wounds can be classified into the following groups: problems mostly related to the use of wound coverage and other etiology related specificities of wound treatment; problems related to incompatibility of the agents used in wound treatment; and problems arising from failure to ensure aseptic and antiseptic performance conditions.

Developing a toolbox for analysis of warrior wound biopsies: vibrational spectroscopy

NASA Astrophysics Data System (ADS)

Crane, Nicole J.; O'Brien, Frederick P.; Forsberg, Jonathan A.; Potter, Benjamin K.; Elster, Eric A.

2011-03-01

The management of modern traumatic war wounds remains a significant challenge for clinicians. This is a reflection of the extensive osseous and soft-tissue damage caused by blasts and high-energy projectiles. The ensuing inflammatory response ultimately dictates the pace of wound healing and tissue regeneration. Consequently, the eventual timing of wound closure or definitive coverage is often subjectively based. Some wounds require an extended period of time to close or fail to remain closed, despite the use and application of novel wound-specific treatment modalities. Aside from impaired wound healing, additional wound complications include wound infection, biofilm formation, and heterotopic ossification (the pathological mineralization of soft tissues). An understanding of the molecular environment of acute wounds throughout the debridement process can provide valuable insight into the mechanisms associated with the eventual wound outcome. The analysis of Raman spectra of ex vivo wound biopsy tissue obtained from serial traumatic wound debridements reveals a decreased 1665 cm-1/1445 cm-1 band area ratio in impaired healing wounds, indicative of an impaired remodeling process, in addition to a decreased 1240 cm-1/1270cm-1. The examination of debrided tissue exhibits mineralization during the early development of heterotopic ossification. Finally, preliminary results suggest that Fourier transform infrared (FT-IR) images of wound effluent may be able to provide early microbiological information about the wound.

Walter B. Cannon's World War I experience: treatment of traumatic shock then and now.

PubMed

Ryan, Kathy L

2018-06-01

Walter B. Cannon (1871-1945), perhaps America's preeminent physiologist, volunteered for service with the Army Expeditionary Force (AEF) during World War I. He initially served with Base Hospital No. 5, a unit made up of Harvard clinicians, before moving forward to the front lines to serve at a casualty clearing station run by the British. During his time there, he performed research on wounded soldiers to understand the nature and causes of traumatic shock. Subsequently, Cannon performed animal experimentation on the causes of traumatic shock in the London laboratory of Dr. William Bayliss before being assigned to the AEF Central Medical Laboratory in Dijon, France, where he continued his experimental studies. During this time, he also developed and taught a curriculum on resuscitation of wounded soldiers to medical providers. Although primarily a researcher and teacher, Cannon also performed clinical duties throughout the war, serving with distinction under fire. After the war, Cannon wrote a monograph entitled Traumatic Shock (New York: Appleton, 1923), which encapsulated the knowledge that had been gained during the war, both from direct observation of wounded soldiers, as well as laboratory experimentation on the causes and treatment of traumatic shock. In his monograph, Cannon elucidates a number of principles concerning hemorrhagic shock that were later forgotten, only to be "rediscovered" during the current conflicts in Iraq and Afghanistan. This paper summarizes Cannon's wartime experiences and the knowledge gained concerning traumatic shock during World War I, with a comparison of current combat casualty care practices and knowledge to that which Cannon and his colleagues understood a century ago.

[The visibility of the care given by a Brazilian Army nurse to a wounded soldier during World War II].

PubMed

Bernardes, Margarida Maria Rocha; Lopes, Gertrudes Teixeira; Santos, Tânia Cristina Franco

2005-03-01

A historical-sociological study aimed at analyzing and describing the visibility of the performance of a Brazilian Army nurse engaged in the Força Expedicionária Brasileira--FEB (Brazilian Expeditionary Force) during the Second World War. Primary source: a photograph taken at the time, along with the oral testimony of nineteen agents. This mode of gathering data resulted in the creation of a new method of research, which we named Oral-Photographic Analysis. The photo was picked in the Brazilian Army's iconographic collection, located at the Comando Militar do Leste (Eastern Military Command), in Rio de Janeiro. Secondary sources: literature on the sociohistorical context of the period. We used Pierre Bourdieu's concepts of habitus, power and cultural capital. The results showed that, in order to face such challenge and care for the wounded, the volunteer nurses had to acquire new habitus through mandatory training given by the military.

[Wounds and injuries to the colon].

PubMed

Sheianov, S D; Tsybuliak, G N

1997-01-01

On the basis of a retrospective analysis of results of treatment of 1097 patients with wounds and injuries of the colon of the peace and war time as well as of experiments in 160 dogs it has been established that the level of lethal outcomes and amount of complications are dependent on the size, number and localization of the colon wounds, severity of peritonitis by the moment of primary operation, degree of traumatic shock, blood loss volume, severity of the coexisting injuries and the chosen method of surgical treatment. A classification of the wounds according to the volume of injuries of the colon is proposed. Different variants of surgical treatment and outcomes are considered. Experiments in dogs have shown the indisputable effectiveness of precise one-row sero-musculo-submucous sutures with the present-day sutural material as compared with other methods of treatment of wounds of the colon. The peritoneal sorption with liquid colloid sorbents at the early postoperative period facilitate the prophylaxis and treatment of peritonitis, reduce lethality. A surgical classification of injuries of the colon is developed and types of operative interventions are recommended.

Course content related to chronic wounds in nursing degree programs in Spain.

PubMed

Romero-Collado, Angel; Raurell-Torreda, Marta; Zabaleta-del-Olmo, Edurne; Homs-Romero, Erica; Bertran-Noguer, Carme

2015-01-01

To analyze content related to chronic wounds in nursing degree programs in Spain. Cross-sectional descriptive study. Course descriptions available for online access during June and July of 2012 were reviewed for the 114 centers in Spain that offer a nursing degree, according to the official Registry of Universities, Centers, and Titles. Of the 114 centers with degree programs, 95 (83.3%) post course content online, which make it possible to analyze 2,258 courses. In 60 (63.1%) of these centers, none of the courses included the concept of pressure ulcer prevention, and the course content posted by 36 (37.9%) centers made no mention of their treatment. None of the course descriptions contained any reference to pain management in patients with chronic wounds. Of the 728 elective courses analyzed, only one was related to chronic wounds. This review of available information about nursing degree programs in Spain indicates that pain management in patients with chronic wounds is not addressed in any course, and more courses consider the treatment of pressure ulcers than their prevention. Degree programs responsible for the training of future nurses should be reviewed and revised as needed to ensure that graduates have acquired minimum basic competencies in the prevention and treatment of chronic wounds that help to decrease the theory-practice gap in this field. © 2014 Sigma Theta Tau International.

Field hospital treatment of blast wounds of the musculoskeletal system during the Yugoslav civil war.

PubMed

Covey, D C; Lurate, R B; Hatton, C T

2000-05-01

The spectrum of wounding and treatment of forty-one patients with musculoskeletal blast injuries at a U.S. military field hospital in the former Yugoslavia was reviewed. Patients underwent wound exploration, irrigation, debridement, broad-spectrum antibiotic therapy, early fracture stabilization, and appropriate reconstructive surgery. Four patients developed wound infections. Two patients died as a result of their injuries (overall mortality 5 percent). There were three below-knee amputations and five other amputations (above-knee, ankle, midtarsal, partial forefoot, and finger). Three patients sustained lumbar burst fractures from mines that exploded under their vehicles, resulting in paraplegia in one case. Our patients underwent 112 surgical procedures, an average of 2.1 per patient. Twenty-two patients (54 percent) had other injuries or conditions in addition to their orthopaedic wounds. There were wide variations in the bone and soft tissue injuries caused by detonating ordnance, and the tissue damage was qualitatively different from that caused by gunshot wounds. Early debridement, leaving wounds open, and treatment with broad-spectrum antibiotics were important factors in wound healing to allow subsequent successful reconstructive surgery in an austere field setting.

Negative Pressure Wound Therapy in the Management of Combat Wounds: A Critical Review

PubMed Central

Maurya, Sanjay; Bhandari, Prem Singh

2016-01-01

Significance: Wounds sustained in a combat trauma often result in a composite tissue loss. Combat injuries, due to high energy transfer to tissues, lead to trauma at multiple anatomical sites. An early wound cover is associated with lower rate of infections and a faster wound healing. The concept of negative pressure wound therapy (NPWT) in the management of combat-related wounds has evolved from the civilian trauma and the wounds from nontraumatic etiologies. Recent Advances: Encouraged by the results of NPWT in noncombat-related wounds, the military surgeons during Operation Iraqi Freedom and Operation Enduring Freedom used this novel method in a large percentage of combat wounds, with gratifying results. The mechanism of NPWT in wound healing is multifactorial and often complex reconstructive procedure can be avoided in a combat trauma setting. Critical Issues: Wounds sustained in military trauma are heavily contaminated with dirt, patient clothing, and frequently associated with extensive soft tissue loss and osseous destruction. Delay in evacuation during an ongoing conflict carries the risk of systemic infection. Early debridement is indicated followed by delayed closure of wounds. NPWT helps to provide temporary wound cover during the interim period of debridement and wound closure. Future Directions: Future area of research in combat wounds is related to abdominal trauma with loss of abdominal wall. The concept of negative pressure incisional management system in patients with a high risk of wound breakdown following surgery is under review, and may be of relevance in combat wounds. PMID:27679749

Negative Pressure Wound Therapy in the Management of Combat Wounds: A Critical Review.

PubMed

Maurya, Sanjay; Bhandari, Prem Singh

2016-09-01

Significance: Wounds sustained in a combat trauma often result in a composite tissue loss. Combat injuries, due to high energy transfer to tissues, lead to trauma at multiple anatomical sites. An early wound cover is associated with lower rate of infections and a faster wound healing. The concept of negative pressure wound therapy (NPWT) in the management of combat-related wounds has evolved from the civilian trauma and the wounds from nontraumatic etiologies. Recent Advances: Encouraged by the results of NPWT in noncombat-related wounds, the military surgeons during Operation Iraqi Freedom and Operation Enduring Freedom used this novel method in a large percentage of combat wounds, with gratifying results. The mechanism of NPWT in wound healing is multifactorial and often complex reconstructive procedure can be avoided in a combat trauma setting. Critical Issues: Wounds sustained in military trauma are heavily contaminated with dirt, patient clothing, and frequently associated with extensive soft tissue loss and osseous destruction. Delay in evacuation during an ongoing conflict carries the risk of systemic infection. Early debridement is indicated followed by delayed closure of wounds. NPWT helps to provide temporary wound cover during the interim period of debridement and wound closure. Future Directions: Future area of research in combat wounds is related to abdominal trauma with loss of abdominal wall. The concept of negative pressure incisional management system in patients with a high risk of wound breakdown following surgery is under review, and may be of relevance in combat wounds.

Rapid Dispersion of Polymicrobial Wound Biofilms with Depolymerase Enzymes

DTIC Science & Technology

2013-11-01

selective precipitation of proteins. Biotechnol. Techniques, 1999. 13:391-393. Otto M: Bacterial evasion of antimicrobial peptides by biofilm...bacterial pathogenesis mechanisms, virulence factors, and antimicrobial resistance vary greatly between pathogens associated with war wounds, one...bacteria from antimicrobials , antibodies, and circulating immune cells (figure, stage 5). Thus, approaches that disrupt or dissolve the biofilm

Improving outcomes following penetrating colon wounds: application of a clinical pathway.

PubMed

Miller, Preston R; Fabian, Timothy C; Croce, Martin A; Magnotti, Louis J; Elizabeth Pritchard, F; Minard, Gayle; Stewart, Ronald M

2002-06-01

During World War II, failure to treat penetrating colon injuries with diversion could result in court martial. Based on this wartime experience, colostomy for civilian colon wounds became the standard of care for the next 4 decades. Previous work from our institution demonstrated that primary repair was the optimal management for nondestructive colon wounds. Optimal management of destructive wounds requiring resection remains controversial. To address this issue, we performed a study that demonstrated risk factors (pre or intraoperative transfusion requirement of more than 6 units of packed red blood cells, significant comorbid diseases) that were associated with a suture line failure rate of 14%, and of whom 33% died. Based on these outcomes, a clinical pathway for management of destructive colon wounds was developed. The results of the implementation of this pathway are the focus of this report. Patients with penetrating colon injury were identified from the registry of a level I trauma center over a 5-year period. Records were reviewed for demographics, injury characteristics, and outcome. Patients with nondestructive injuries underwent primary repair. Patients with destructive wounds but no comorbidities or large transfusion requirement underwent resection and anastomosis, while patients with destructive wounds and significant medical illness or transfusion requirements of more than 6 units/blood received end colostomy. The current patients (CP) were compared to the previous study (PS) to determine the impact of the clinical pathway. Outcomes examined included colon related mortality and morbidity (suture line leak and abscess). Over a 5.5-year period, 231 patients had penetrating colon wounds. 209 survived more 24 hours and comprise the study population. Primary repair was performed on 153 (73%) patients, and 56 patients had destructive injuries (27%). Of these, 40 (71%) had resection and anastomosis and 16 (29%) had diversion. More destructive injuries were

Effects of Hydrogen Peroxide on Wound Healing in Mice in Relation to Oxidative Damage

PubMed Central

Ho, Rongjian; Wasser, Martin; Du, Tiehua; Ng, Wee Thong; Halliwell, Barry

2012-01-01

It has been established that low concentrations of hydrogen peroxide (H2O2) are produced in wounds and is required for optimal healing. Yet at the same time, there is evidence that excessive oxidative damage is correlated with poor-healing wounds. In this paper, we seek to determine whether topical application of H2O2 can modulate wound healing and if its effects are related to oxidative damage. Using a C57BL/6 mice excision wound model, H2O2 was found to enhance angiogenesis and wound closure at 10 mM but retarded wound closure at 166 mM. The delay in closure was also associated with decreased connective tissue formation, increased MMP-8 and persistent neutrophil infiltration. Wounding was found to increase oxidative lipid damage, as measured by F2-isoprostanes, and nitrative protein damage, as measured by 3-nitrotyrosine. However H2O2 treatment did not significantly increase oxidative and nitrative damage even at concentrations that delay wound healing. Hence the detrimental effects of H2O2 may not involve oxidative damage to the target molecules studied. PMID:23152875

For soldier and state: dual loyalty and World War One.

PubMed

van Bergen, Leo

2012-01-01

Military medicine has always been characterized by some form of dual loyalty: physicians have to consider the interests of the individual soldier--patient as well as the interests of the state and the military in general. The way in which each individual doctor responds to this dual loyalty has mostly been viewed as a product of war circumstances on the one hand, and the personal character and/or religious and ideological beliefs of the physician on the other. Taking World War One as an example, this article argues that the nature of the illness or wound also had a part to play in this. The article shows that the disfigured were looked upon mainly in relation to the patient's own interests; the invalided-out through a combination of the patient's as well as the state's interests; and the neurotic mainly out of concern for the interests of the state.

Negative pressure wound therapy combined with acoustic pressure wound therapy for infected post surgery wounds: a case series.

PubMed

Howell-Taylor, Melania; Hall, Macy G; Brownlee Iii, William J; Taylor, Mary

2008-09-01

Acute infection of surgical incision sites often requires specialized wound care in preparation for surgical closure. Optimal therapy for preparing such wounds for a secondary closure procedure remains uncertain. The authors report wound outcomes after administering acoustic pressure wound therapy in conjunction with negative pressure wound therapy with reticulated open-cell foam dressing changes to assist with bacteria removal from open, infected surgical-incision sites in preparation for secondary surgical closure in three patients. Before incorporating acoustic pressure wound therapy at the authors' facility, the average negative pressure wound therapy with reticulated open-cell foam dressing course prior to secondary surgical closure was 30 days; with its addition, two of three patients underwent successful surgical closure with no postoperative complications after 21 and 14 days, respectively; one patient succumbed to nonwound-related complications before wound closure. Larger, prospective studies are needed to evaluate combining negative pressure wound therapy with reticulated open-cell foam dressing and acoustic pressure wound therapy for infected, acute post surgery wounds.

Prevalence and incidence of chronic wounds and related complications: a protocol for a systematic review.

PubMed

Järbrink, Krister; Ni, Gao; Sönnergren, Henrik; Schmidtchen, Artur; Pang, Caroline; Bajpai, Ram; Car, Josip

2016-09-08

Chronic wounds impose a significant and often underappreciated burden to the individual, the healthcare system and the society as a whole. Preliminary literature search suggests that there are at present no reliable estimates on the total prevalence of chronic wounds for different settings and categories of chronic wounds. Such information is essential for policy and planning purposes as the increasing number of elderly and the prevalence of lifestyle diseases point in the direction of an increased burden. Knowledge about the prevalence and incidence of chronic wounds in relation to population characteristics is important for informing healthcare planning and resource allocation. The objective is to present a transparent process for how to review the existing literature on the prevalence and incidence rates of chronic wounds and resulting implications. We will search electronic bibliographic databases (MEDLINE, EMBASE, the EBM Reviews and Cochrane, Cumulative Index to Nursing and allied Health Literature (CINAHL), PsycINFO, Global Health) and reference lists of included articles. Two investigators will independently screen titles and abstracts and select studies involving adults with chronic wounds. These investigators will also independently extract data using a pre-designed data extraction form that will cover information on demographics, diagnostics including disease prevalence, medical history, hospital and community-based management and outcomes. Subgroup analysis and sensitivity analysis will be performed to address the heterogeneity across studies. Meta-analysis will also be performed if homogeneous group of studies will be found. The collective evidence will be further stratified according to the important background variables if allowed. This study will describe the available epidemiological evidence and summarise prevalence and incidence rates of chronic wounds and related complications. A better understanding of the relationship between population

Managing painful chronic wounds: the Wound Pain Management Model.

PubMed

Price, Patricia; Fogh, Karsten; Glynn, Chris; Krasner, Diane L; Osterbrink, Jürgen; Sibbald, R Gary

2007-04-01

Chronic wound pain is not well understood and the literature is limited. Six of 10 patients venous leg ulcer experience pain with their ulcer, and similar trends are observed for other chronic wounds. Chronic wound pain can lead to depression and the feeling of constant tiredness. Pain related to the wound should be handled as one of the main priorities in chronic wound management together with addressing the cause. Management of pain in chronic wounds depends on proper assessment, reporting and documenting patient experiences of pain. Assessment should be based on six critical dimensions of the pain experience: location, duration, intensity, quality, onset and impact on activities of daily living. Holistic management must be based on a safe and effective mix of psychosocial approaches together with local and systemic pain management. It is no longer acceptable to ignore or inadequately document persistent wound pain and not to develop a treatment and monitoring strategy to improve the lives of persons with chronic wounds. Unless wound pain is optimally managed, patient suffering and costs to health care systems will increase.

Principles of Wound Management and Wound Healing in Exotic Pets.

PubMed

Mickelson, Megan A; Mans, Christoph; Colopy, Sara A

2016-01-01

The care of wounds in exotic animal species can be a challenging endeavor. Special considerations must be made in regard to the animal's temperament and behavior, unique anatomy and small size, and tendency toward secondary stress-related health problems. It is important to assess the entire patient with adequate systemic evaluation and consideration of proper nutrition and husbandry, which could ultimately affect wound healing. This article summarizes the general phases of wound healing, factors that affect healing, and principles of wound management. Emphasis is placed on novel methods of treating wounds and species differences in wound management and healing. Copyright © 2016 Elsevier Inc. All rights reserved.

Incidence and severity of maxillofacial injuries during the Second Lebanon War among Israeli soldiers and civilians.

PubMed

Levin, Liran; Zadik, Yehuda; Peleg, Kobi; Bigman, Galya; Givon, Adi; Lin, Shaul

2008-08-01

To analyze the incidence and severity of maxillofacial injuries in the Second Lebanon War, that occurred during the summer of 2006, among Israeli soldiers and civilians. This is a retrospective cohort study of patients recorded in the Israel National Trauma Registry during the Second Lebanon War. Data refer to all general hospitals throughout the country. Data were analyzed according to the etiology of the injury, severity of trauma using the Injury Severity Score, trauma location, and duration of hospital stay. Cases with multiple injuries that included maxillofacial injuries were separated and further analyzed according to the above parameters. Patients with only dental injuries and superficial facial soft tissue lacerations were excluded because they were referred to the military dental clinics and not to general hospitals. Maxillofacial injuries were found in 36 (6.4%) of the 565 wounded. Patients with maxillofacial injuries ranged in age from 20 to 44 years (mean age, 25.5 +/- 5.7 years). Greater than 50% of the injuries required more than 3 hospitalization days. Mortality rate of the maxillofacial injured was 2.8%. Most of the maxillofacial injuries (33; 91.7%) were combined with other organ injuries; 9 (25%) patients also had dental injuries. In the Second Lebanon War, the incidence and severity of true maxillofacial injuries, without dental injuries alone, were relatively low compared with previous reports of other conflicts. However, because most injuries involved multiple organs, special attention is required when planning and providing emergency, as well as secondary and tertiary medical care to war wounded.

[Technological innovation and humanitarianism in the transport of war wounded: Nicasio Landa's report on a new elastic suspension system for stretchers (Pamplona, May 29, 1875)].

PubMed

Arrizabalaga, Jon; García-Reyes, Juan Carlos

2016-01-01

In May 1875, in the midst of a bloody civil conflict in Spain known as the Third Carlist War, Nicasio Landa, a medical officer with Military Health, wrote a report requesting authorization for the Spanish Red Cross, of which he was Inspector General, to adopt a new elastic suspension system for stretchers that he had designed, developed and tested. Intended above all for use in farm wagons - still the most widely-used method of transporting the wounded at the time - it was an inexpensive, sturdy mechanism that improved patient comfort and could also be installed in ambulance carriages, railway carriages and hospital ships. An annotated version of the report is included, preceded by a presentation of its contents.

Low Prevalence of carbapenem-resistant Enterobacteriaceae among wounded military personnel.

PubMed

Mende, Katrin; Beckius, Miriam L; Zera, Wendy C; Onmus-Leone, Fatma; Murray, Clinton K; Tribble, David R

2017-01-01

Multidrug-resistant organisms (MDROs) are a global health problem that affect both civilian and military populations. Among wounded warriors, MDROs further complicate the care of trauma-related infections, resulting in extended duration of hospitalization, as well as increased morbidity and mortality. During the wars in Iraq and Afghanistan, extended spectrum β-lactamase-producing Enterobacteriaceae were frequently isolated from wounded warriors. The potential emergence of difficult-to-treat carbapenem-resistant Enterobacteriaceae represented a serious challenge for clinicians. We examined carbapenem-resistant Enterobacteriaceae prevalence among wounded military personnel over a 6-year period (2009-2015). Among 4090 Enterobacteriaceae isolates collected, 16 (0.4%) were carbapenem-resistant, of which the majority was Enterobacter aerogenes (44%) followed by Klebsiella pneumoniae (37%), and Escherichia coli (19%). Five isolates (31%) collected from 2 patients were carbapenemase-producers with one associated with an infection. All 5 carbapenemase-producing isolates were resistant to all tested carbapenems and each carried one carbapenemase gene (4 with blaKPC-3 and 1 with blaNDM-1). Overall, although a large number of Enterobacteriaceae isolates were collected, only a small proportion was carbapenem-resistant and data indicate a lack of a cluster. Due to these limited numbers, it is difficult to make any conclusions regarding the association between carbapenem resistance, antibiotic exposure, and clinical outcomes.

Interdisciplinary prevention and management of wound-related complications in extracranial-to-intracranial bypass surgery.

PubMed

Yokoyama, Rintaro; Mikami, Takeshi; Ukai, Ryo; Komatsu, Katsuya; Kimura, Yusuke; Suzuki, Hime; Honma, Toshimi; Hirano, Toru; Saito, Tamotsu; Yamashita, Ken; Yotsuyanagi, Takatoshi; Houkin, Kiyohiro; Mikuni, Nobuhiro

2018-05-02

Extracranial-to-intracranial (EC-IC) bypass surgery may be necessary in patients with moyamoya disease and other ischemic conditions. However, there is a potential risk of wound-related complications in some cases. In this study, we report our approach to prevention of wound-related complications in EC-IC bypass, and technical consideration and pitfalls of surgery are discussed. This study included 89 patients with ischemic-onset moyamoya disease and atherosclerotic disease, who underwent 108 superficial temporal artery (STA)-to-middle cerebral artery bypass procedures. Our study emphasized 3 major features. First, 3-dimensional simulation imaging was used to confirm STA anatomy. Second, the STA was meticulously dissected on the epigaleal layer, and protected the galeal layer. Third, scalp skin ischemia was taken into consideration at each step until skin closure. There was no neurological morbidity or mortality in this series. There were 2 cases with major wound-related complications that needed plastic surgical intervention, and 4 cases with minor complications that were treated conservatively. In major complication cases, the scalp defect was treated with pedicle flap reconstruction. In EC-IC bypass surgery, interdisciplinary management involving neurosurgery, plastic surgery, and radiology should reduce wound-related complications, and achieve safe surgery. Copyright © 2018 Elsevier Inc. All rights reserved.

Principles of Wound Management and Wound Healing in the Exotic Pets

PubMed Central

Mickelson, Megan A.; Mans, Christoph; Colopy, Sara A.

2015-01-01

Synopsis The care of wounds in exotic animal species can be a challenging endeavor. Special considerations must be made in regards to the animal’s temperament and behavior, unique anatomy and small size, and tendency towards secondary stress-related health problems. It is important to assess the entire patient with adequate systemic evaluation and consideration of proper nutrition and husbandry, which could ultimately impact wound healing. This article summarizes the general phases of wound healing, factors that impact healing, and principles of wound management. Emphasis is placed on novel methods of treating wounds and species differences in wound management and healing. PMID:26611923

The Balkan beam - Florschütz frame and its use during the Great War.

PubMed

Fatović-Ferenčić, Stella; Pećina, Marko

2014-10-01

We remember the military medical practice of Croatian surgeon, Vatroslav Florschütz (1879-1967), known for his invention of the traction frame for repositioning bone fracture fragments of the upper and lower extremities. The method, known as the Balkan frame / beam or Balkan splint, was introduced and published in 1911 and used in war medicine thereafter. The memory of this invention adds to our orthopaedic heritage and sheds light on its creator working under the most demanding war circumstances. On the occasion of the 100th anniversary of the outbreak of World War I, reminiscence of Florschütz's war experience, his orthopaedic innovation and other innovations contributes to our understanding of human efforts to save lives and restore bodily function of the wounded during wars.

Factors affecting perioperative mortality and wound-related complications following major lower extremity amputations.

PubMed

Stone, Patrick A; Flaherty, Sarah K; Aburahma, Ali F; Hass, Stephen M; Jackson, J Michelle; Hayes, J David; Hofeldt, Matthew J; Hager, Casey S; Elmore, Michael S

2006-03-01

Major lower extremity amputations continue to be associated with significant morbidity and mortality, yet few recent large series have evaluated factors associated with perioperative mortality and wound complications. The purpose of this study was to examine factors affecting perioperative mortality and wound-related complications following major lower extremity amputation. A retrospective review was conducted of all adult patients who underwent nontraumatic major lower extremity amputations over a 5-year period at a single tertiary-care center in southern West Virginia. Demographic and clinical data, perioperative data, and outcomes were collected and analyzed to identify any relationship with perioperative mortality, as well as wound complications and early revisions (within 90 days) to a more proximal level. Variables were examined using chi-squared, two-tailed t-tests, and logistic regression. Three hundred eighty patients (61% male) underwent 412 major lower extremity amputations during 1999-2003. The initial level of amputation included 230 below-knee (BKA), 149 above-knee (AKA), and one hip disarticulation. Perioperative mortality was 15.5% (n = 59). From a regression model, age, albumin level, AKA, and lack of a previous coronary artery bypass graft (CABG) were independently related to mortality. Patients who did not have a previous CABG were nearly three times more likely to die than those who did (p = 0.038). Overall early wound complications were noted in 13.4% (n = 51). Four factors were independently related to experiencing a 90-day wound complication: BKA, community (rather than care facility) living, type of anesthesia, and preoperative hematocrit >30%. Major lower extremity amputation in patients with peripheral vascular disease continues to be associated with considerable perioperative morbidity and mortality. Even though the surgical procedure itself may not be challenging from a technical standpoint, underlying medical conditions put this group

Wound ballistics: recognizing wound potential. Part 1: Characteristics of missiles and weapons.

PubMed

Dufresne, G W

1995-01-01

In the United States the number of firearm-related deaths in 1989 was almost equal to the number of motor vehicle-related deaths. Trauma nurses could not imagine themselves caring for motor vehicle crash victims without any understanding of speed, vehicle damage, or collision angles. Gunshot wounds are becoming nearly as frequent as motor vehicle crashes, but the mechanism of injury for a gunshot wound is not as widely understood. This article explains the basics of wound ballistics, emergent care of the gunshot wound victim, and medicolegal concerns for the trauma nurse.

'His nerves gave way': Shell shock, history and the memory of the First World War in Britain.

PubMed

Reid, Fiona

2014-06-01

During the First World War soldiers suffered from a wide range of debilitating nervous complaints as a result of the stresses and strains of modern warfare. These complaints--widely known as shell shock--were the subject of much medical-military debate during the war and became emblematic of the war and its sufferings afterwards. One hundred years after the war the diagnosis of PTSD has not resolved the issues initially raised by First World War shell shock. The stigma of mental illness remains strong and it is still difficult to commemorate and remember the mental wounds of war in a culture which tend to glory or glamorise military heroes. Copyright © 2014. Published by Elsevier Ltd.

Symptoms and medical conditions in Australian veterans of the 1991 Gulf War: relation to immunisations and other Gulf War exposures.

PubMed

Kelsall, H L; Sim, M R; Forbes, A B; Glass, D C; McKenzie, D P; Ikin, J F; Abramson, M J; Blizzard, L; Ittak, P

2004-12-01

To investigate whether Australian Gulf War veterans have a higher than expected prevalence of recent symptoms and medical conditions that were first diagnosed in the period following the 1991 Gulf War; and if so, whether these effects were associated with exposures and experiences that occurred in the Gulf War. Cross-sectional study of 1456 Australian Gulf War veterans and a comparison group who were in operational units at the time of the Gulf War, but were not deployed to that conflict (n = 1588). A postal questionnaire was administered and the likelihood of the diagnosis of self-reported medical conditions was assessed and rated by a medical practitioner. Gulf War veterans had a higher prevalence of all self-reported health symptoms than the comparison group, and more of the Gulf War veterans had severe symptoms. Increased symptom reporting was associated with several exposures, including having more than 10 immunisations, pyridostigmine bromide tablets, anti-biological warfare tablets, pesticides, insect repellents, reportedly being in a chemical weapons area, and stressful military service experiences in a strong dose-response relation. Gulf War veterans reported psychological (particularly post-traumatic stress disorder), skin, eye, and sinus conditions first diagnosed in 1991 or later more commonly than the comparison group. Over 90% of medical conditions reported by both study groups were rated by a medical practitioner as having a high likelihood of diagnosis. More than 10 years after the 1991 Gulf War, Australian veterans self-report all symptoms and some medical conditions more commonly than the comparison group. Further analysis of the severity of symptoms and likelihood of the diagnosis of medical conditions suggested that these findings are not due to over-reporting or to participation bias.

Symptoms and medical conditions in Australian veterans of the 1991 Gulf War: relation to immunisations and other Gulf War exposures

PubMed Central

Kelsall, H; Sim, M; Forbes, A; Glass, D; McKenzie, D; Ikin, J; Abramson, M; Blizzard, L; Ittak, P

2004-01-01

Aims: To investigate whether Australian Gulf War veterans have a higher than expected prevalence of recent symptoms and medical conditions that were first diagnosed in the period following the 1991 Gulf War; and if so, whether these effects were associated with exposures and experiences that occurred in the Gulf War. Methods: Cross-sectional study of 1456 Australian Gulf War veterans and a comparison group who were in operational units at the time of the Gulf War, but were not deployed to that conflict (n = 1588). A postal questionnaire was administered and the likelihood of the diagnosis of self-reported medical conditions was assessed and rated by a medical practitioner. Results: Gulf War veterans had a higher prevalence of all self-reported health symptoms than the comparison group, and more of the Gulf War veterans had severe symptoms. Increased symptom reporting was associated with several exposures, including having more than 10 immunisations, pyridostigmine bromide tablets, anti-biological warfare tablets, pesticides, insect repellents, reportedly being in a chemical weapons area, and stressful military service experiences in a strong dose-response relation. Gulf War veterans reported psychological (particularly post-traumatic stress disorder), skin, eye, and sinus conditions first diagnosed in 1991 or later more commonly than the comparison group. Over 90% of medical conditions reported by both study groups were rated by a medical practitioner as having a high likelihood of diagnosis. Conclusion: More than 10 years after the 1991 Gulf War, Australian veterans self-report all symptoms and some medical conditions more commonly than the comparison group. Further analysis of the severity of symptoms and likelihood of the diagnosis of medical conditions suggested that these findings are not due to over-reporting or to participation bias. PMID:15550607

War and Peace in International Relations Theory: A Classroom Simulation

ERIC Educational Resources Information Center

Sears, Nathan Alexander

2018-01-01

Simulations are increasingly common pedagogical tools in political science and international relations courses. This article develops a classroom simulation that aims to facilitate students' theoretical understanding of the topic of war and peace in international relations, and accomplishes this by incorporating important theoretical concepts…

Teaching About Conflict as it Relates to War.

ERIC Educational Resources Information Center

Yandell, Wilson

This consultant paper for a war/peace curriculum development project is concerned with the challenge of preparing members of our society for a more rational approach to problems of inter-nation conflict. The nature of conflict and conflict solution in relation to the experience of learning are emphasized. Topics discussed include: 1) effect of…

CICATRIZATION OF WOUNDS

PubMed Central

Carrel, Alexis; Hartmann, Alice

1916-01-01

1. A method for measuring the area of a wound not geometric in form is described. 2. The rate of cicatrization of a wound is greater at the beginning than at the end of the period of repair. It depends on the area rather than on the age of the wound. There is a constant relation between the size of a wound and the rate of cicatrization. The larger the wound the greater is the rate of cicatrization. Two wounds of different size have a tendency to become equal. 3. The rate is proportional to the area, but diminishes less rapidly than the area. 4. The process of contraction is the more important factor in the repair of a wound. Epidermization completes the work of contraction. After the wound is healed, the cicatrix as a rule expands. 5. The curve representing the diminution of the size of an aseptic wound while it cicatrizes is regular and geometric. PMID:19868052

Triage of mass casualties in war conditions: realities and lessons learned.

PubMed

Rigal, Sylvain; Pons, François

2013-08-01

The authors made a retrospective analysis of three triage situations of war wounded in Chad and Rwanda in which mass casualties overwhelmed available medical facilities. The triage classification is based on the waiting period for surgery. The categories are: extreme, first, second and third emergencies, expectant, walking wounded. In Chad, 23 wounded adults were received in 24 hours, and 19 were operated up on within 48 hours. In Rwanda 1, 94 wounded were received in two hours, of whom 68 were operated upon, 23 on the first day. In Rwanda 2, 59 wounded were received in 12 hours, treatment of extreme and first emergencies required 48 hours, while second and third emergencies were treated during the three following days. These episodes were very different when considering the setting, the number of casualties, the type of wounds, the logistical and medical difficulties. The authors report the difficulties faced and the lessons learned. "Il faut toujours commencer par le plus douloureusement blessé sans avoir égard aux rangs et aux distinctions." You must always begin with those who are most seriously wounded without regard to rank or other distinction. Baron Larrey (1766-1842), surgeon to Napoléon's Imperial Guard.

Vitreoretinal surgery in the management of war-related open-globe injuries.

PubMed

Boiko, Ernest V; Churashov, Sergey V; Haritonova, Natalya N; Budko, Anatoly A

2013-03-01

Ranking among the most severe combat damages, war-related open-globe injuries (WROGIs) are not uniform, so the treatment approaches are sometimes unclear. The essential issue is to define exact indications for time- and resource-intensive vitreoretinal surgery (VRS), known to be an effective procedure for severe posterior segment injuries. We studied WROGI structure, and summarized the experience of specialized ophthalmologic care (SOC) management during local armed conflicts (LACs). This was a retrospective multicenter study that included case series of 203 wounded subjects (314 eyes) with WROGIs sustained during LACs treated in the hospitals of first, second and third echelons of SOC. Ocular trauma was classified according to the International Society of Ocular Trauma (ISOT) classification, and only open-globe injuries (OGI) made up two groups of study: injured eyes that underwent VRS, n = 135, and those eyes on which VRS was not performed, n = 119. Two subgroups according to stages of VRS were also included. We reviewed the demographic characteristics, the time between injury and surgery, the number of stages in which surgery was performed, and initial visual acuity (IVA) at arrival and final visual acuity (FVA), 12 months after surgery. WROGI constituted 65.1 % of all eyes injured. The visual outcomes after VRS were favorable in ruptures of the eye, penetrating WROGIs, intraocular foreign body (IOFB) WROGIs, perforating WROGIs (types A, B, C, D) of grades 1-4. Those WROGIs of grade 5 had poor visual outcomes irrespective of the surgeries. In 19.1% of all cases wherein either the eye wall or eye content were extensively damaged (included types A, C, D, E of grade 5), all attempts to save the eye through reconstructive surgery were unsuccessful and led to enucleation (evisceration). Medical service management in LACs demands to define groups of priority for VRS between the wounded with WROGI during triage at the first echelon of SOC. Multistage VRS determines

Cephalic region war injuries in children: Experience in French NATO hospital in Kabul Afghanistan.

PubMed

Chehab, Hussam El; Agard, Emilie; Dot, Corinne

2018-06-09

The NATO KAIA Hospital (Kabul International Airport), under French command, provided medical support for NATO forces in the Kabul region from 2009 to 2014. Medical assistance to civilians was an additional mission which included support for children who were war injured. The objective of this study was to analyze characteristics of cephalic injuries in children victims of war trauma. A retrospective study was conducted and commenced with the hospital opening (July 2009) to March 2012 on all children (<15years) with war trauma. We distinguished cephalic lesions in cranial (neuro-surgical), ophthalmological and neck regions. We analyzed mechanism, region, severity score, surgeries and resuscitation efforts. 217 children were operated on with 81 war traumas (mean age 10.2years). 36 children (44.4%) had a cephalic injury. 52.9% of the injured had an ophthalmological injury, 38.2% a cranial region injury and 29.4% a neck lesion. Mortality rate was 5.6% (1 hemorrhagic shock and 1 cerebral wound) in this cephalic lesion group. Ophthalmic injuries were the most common of cephalic injuries; 19 children of which 7 had a bilateral injury (26 eyes). In this group, fragmentary injuries were the most frequent (64% of eyes). In cerebral lesion group, the lesions were linked to a bullet or a shrapnel in 9 of 13 children. This mechanism systematically caused a crania-cerebral wound. Explosion (fragmentary and shrapnel) was the most important in the neck lesions (7 children of 10). The cephalic lesions were the second most common region in children during our experience in Afghanistan. Lack of protection (helmet) in children may explain the frequency of cephalic wounds. Copyright © 2018 Elsevier Ltd. All rights reserved.

Children and war.

PubMed

Pearn, J

2003-04-01

Children bear disproportionate consequences of armed conflict. The 21st century continues to see patterns of children enmeshed in international violence between opposing combatant forces, as victims of terrorist warfare, and, perhaps most tragically of all, as victims of civil wars. Innocent children so often are the victims of high-energy wounding from military ordinance. They sustain high-energy tissue damage and massive burns - injuries that are not commonly seen in civilian populations. Children have also been deliberately targeted victims in genocidal civil wars in Africa in the past decade, and hundreds of thousands have been killed and maimed in the context of close-quarter, hand-to-hand assaults of great ferocity. Paediatricians serve as uniformed military surgeons and as civilian doctors in both international and civil wars, and have a significant strategic role to play as advocates for the rights and welfare of children in the context of the evolving 'Laws of War'. One chronic legacy of contemporary warfare is blast injury to children from landmines. Such blasts leave children without feet or lower limbs, with genital injuries, blindness and deafness. This pattern of injury has become one of the post-civil war syndromes encountered by all intensivists and surgeons serving in four of the world's continents. The continued advocacy for the international ban on the manufacture, commerce and military use of antipersonnel landmines is a part of all paediatricians' obligation to promote the ethos of the Laws of War. Post-traumatic stress disorder remains an undertreated legacy of children who have been trapped in the shot and shell of battle as well as those displaced as refugees. An urgent, unfocused and unmet challenge has been the increase in, and plight of, child soldiers themselves. A new class of combatant comprises these children, who also become enmeshed in the triad of anarchic civil war, light-weight weaponry and drug or alcohol addiction. The

Epidemiological approach to surgical management of the casualties of war.

PubMed Central

Coupland, R. M.

1994-01-01

The nature of modern conflicts precludes adequate medical care for most people wounded in wars. The traditional military approach of echeloned care for those wounded on the battlefield has limited relevance. I present an alternative, epidemiological approach whereby some effective care may reach many more. For a surgical facility to have a positive impact by using surgical and anaesthetic competence there must be access to the wounded; security for staff and patients; and a functioning hospital infrastructure. These all depend on respect for the first Geneva convention. Early hospital admission for urgent surgery is not so important if there is adequate first aid beforehand. The hospitals of the International Committee of the Red Cross have provided surgical care for thousands of wounded people by fulfilling these conditions. People wounded in modern conflicts would fare better if these priorities were recognised and less emphasis was placed on the more spectacular aspects of surgical care that benefit only a few. Images p1695-a FIG 2 FIG 3 FIG 1 PMID:8025468

"Doomed to go in company with miserable pain": surgical recognition and treatment of amputation-related pain on the Western Front during World War 1.

PubMed

Edwards, Dafydd S; Mayhew, Emily R; Rice, Andrew S C

2014-11-08

The principal feature of injuries from World War 1 was musculoskeletal trauma and injury to peripheral nerves as a result of damage to the upper and lower limbs caused by gunshot wounds and fragments of artillery munitions. Amputation was used as a treatment in field hospitals to save lives; limb conservation was a secondary consideration. A century later, the principal feature of injuries to soldiers in today's wars in Iraq and Afghanistan is also musculoskeletal trauma and injury to the peripheral nerves caused by improvised explosive devices. Common to both types of injury is postamputation pain. We searched The Lancet's archives in this Series paper to show the efforts of surgeons in World War 1 to understand and treat postamputation pain in its own right both during and immediately after the war. Despite unprecedented patient numbers and levels of civilian medical expertise, little progress was made in providing relief from this type of pain, a grave concern to the surgeons treating these soldiers. Today postamputation pain is understood beyond a surgical context but remains a complex and poorly understood condition with few effective treatments. Copyright © 2014 Elsevier Ltd. All rights reserved.

Someone to watch over me: exposure to war events and trust in the armed forces in Israel as factors in war-related stress.

PubMed

Zysberg, Leehu; Kimhi, Shaul; Eshel, Yochanan

2013-01-01

This study examined the role of trust in the national armed and security forces in Israel as a potential protective factor in post-war stress symptoms, alongside other known correlates such as exposure to war events, sense of danger, and demographics. A cluster sample of 870 residents of the town of Kiryat-Shemona in Israel participated in this correlational study. The town was under heavy bombing during the second Lebanon war, and data collection took place about a year after the end of the war. Our results suggest that while sense of danger and exposure to war events are the strongest correlates of stress related symptoms, trust in the armed forces was negatively correlated with stress, even after controlling for demographics; therefore supporting our hypothesis. Theoretical, methodological and practical implications are discussed in light of our findings.

Bathing in Reeking Wounds: The Liberal Arts, Beauty, and War

ERIC Educational Resources Information Center

Stimpson, Catharine R.

2014-01-01

A historic dialectic exists between the beautiful and the bestial. The bestial destroys the beautiful, but in a bloody miracle, the beautiful emerges from the womb of the bestial, the "terrible beauty" of which the poet W. B. Yeats wrote. The liberal arts, so often thought to dwell in a remote ivory tower, embody this dialectic. Wars and…

Radiology in World War II (Medical Department, United States Army)

DTIC Science & Technology

1966-01-01

of infections . This technique proved unnecessary, partly because, with the expert initial wound surgery performed in World War II, infection was never... infections that did occur. Gas gangrene was also never a significant problem, and the Kelly technique developed for it was scarcely used after Pearl...313 111 Septic emboll .--------------------------------------------------- 314 112 Mycotic infection (actinomycosis

20 CFR 61.400 - Custody of records relating to claims under the War Hazards Compensation Act.

Code of Federal Regulations, 2010 CFR

2010-04-01

... the War Hazards Compensation Act. 61.400 Section 61.400 Employees' Benefits OFFICE OF WORKERS... EMPLOYEES OF CONTRACTORS WITH THE UNITED STATES CLAIMS FOR COMPENSATION UNDER THE WAR HAZARDS COMPENSATION ACT, AS AMENDED Miscellaneous Provisions § 61.400 Custody of records relating to claims under the War...

Insomnia in a displaced population is related to war-associated remembered stress.

PubMed

Basishvili, Tamar; Eliozishvili, Marine; Maisuradze, Lia; Lortkipanidze, Nani; Nachkebia, Nargiz; Oniani, Tengiz; Gvilia, Irma; Darchia, Nato

2012-08-01

Although traumatic events are presumed to cause sleep disturbances, particularly insomnia, sleep in populations subjected to forced displacement has received little attention. The present study examined the prevalence of insomnia and associated factors in internally displaced persons (IDPs) from Abkhazia 15 years after displacement to Tbilisi. Detailed subjective information about sleep-wake habits, sleep-related and stress-related parameters were obtained from 87 IDPs categorized into good sleepers and insomniacs. The Insomnia Severity Index, Perceived Stress Scale and Beck Depression Inventory were administered. The incidence of insomnia was 41.4%. The majority of insomniacs strongly believed that war-related stress accounted for the onset of their insomnia. Stepwise regression (95% confidence interval) revealed four variables significantly associated with insomnia status: self-estimated influence of war related stress (odds ratio (OR) = 2.51), frequency of nightmares (OR = 1.6), Perceived Stress Scale score (OR = 1.14) and Beck Depression Inventory score (OR = 1.12). Insomnia in IDPs was strongly related to war-associated remembered stress. ‛Over thinking' about major stress exposure enhanced IDPs' vulnerability to insomnia. These findings have implications for the management of insomnia and associated impairment of daytime functioning in IDPs. Copyright © 2011 John Wiley & Sons, Ltd.

Early Complications and Outcomes in Combat Injury Related Invasive Fungal Wound Infections: A Case-Control Analysis

PubMed Central

Lewandowski, Louis R.; Weintrob, Amy C.; Tribble, David R.; Rodriguez, Carlos J.; Petfield, Joseph; Lloyd, Bradley A.; Murray, Clinton K.; Stinner, Daniel; Aggarwal, Deepak; Shaikh, Faraz; Potter, Benjamin K.

2015-01-01

Objective Clinicians have anecdotally noted that combat-related invasive fungal wound infections (IFIs) lead to residual limb shortening, additional days and operative procedures prior to initial wound closure, and high early complication rates. We evaluated the validity of these observations and identified risk factors that may impact time to initial wound closure. Design Retrospective review and case-control analysis. Setting Military hospitals. Patients/Participants United States military personnel injured during combat operations (2009–2011). The IFI cases were identified based upon the presence of recurrent, necrotic extremity wounds with mold growth in culture and/or histopathologic fungal evidence. Non-IFI controls were matched on injury pattern and severity. In a supplemental matching analysis, non-IFI controls were also matched by blood volume transfused within 24 hours of injury. Intervention None. Main Outcome Measurements Amputation revision rate and loss of functional levels. Results Seventy-one IFI cases (112 fungal-infected extremity wounds) were identified and matched to 160 control patients (315 non-IFI extremity wounds). The IFI wounds resulted in significantly more changes in amputation level (p<0.001). Additionally, significantly (p<0.001) higher number of operative procedures and longer duration to initial wound closure was associated with IFI. A shorter duration to initial wound closure was significantly associated with wounds lacking IFIs (Hazard ratio: 1.53; 95% CI: 1.17, 2.01). The supplemental matching analysis found similar results. Conclusions Our analysis indicates that IFIs adversely impact wound healing and patient recovery, requiring more frequent proximal amputation revisions and leading to higher early complication rates. PMID:26360542

[Advances in the research of molecular mechanism of negative pressure wound therapy in improving wound healing].

PubMed

Liu, Y; Hu, D H

2017-11-20

Recently, negative pressure wound therapy (NPWT) is a rising technology to improve wound healing. In clinical application, it benefits fast debridement and wound close, limits infection, and promotes wound healing. It is an effective therapy for all kinds of acute or chronic wound. Currently, researches demonstrate that NPWT promotes angiogenesis, granulation tissue growth, and extracellular matrix remodeling through regulating the signaling of anti-inflammatory cytokines, mechanicalreceptor and chemoreceptor, which is related to several growth factors and inflammatory factors. Here we focus on the recent advances in the mechanism of NPWT in promoting wound healing, looking forward to providing a review of NPWT and related researches.

Young children's reactions to war-related stress: a survey and assessment of an innovative intervention.

PubMed

Sadeh, Avi; Hen-Gal, Shai; Tikotzky, Liat

2008-01-01

The goal was to assess stress reactions in young children during and after war and the effects of a new brief intervention. Two separate studies were conducted. In study I, we assessed war exposure and stress reactions of 74 children (2-7 years of age) in a sheltered camp during the second Israel-Lebanon war (July to August 2006). Their exposure to war experiences and their stress reactions were assessed through parental reports during the last week of the war. In addition to standard care, 35 children received a brief intervention (Huggy-Puppy intervention) aimed at encouraging them to care for a needy Huggy-Puppy doll that was given to them as a gift. The effects of the Huggy-Puppy intervention were assessed in a follow-up interview 3 weeks after the war. Study II assessed the efficacy of group administration of the Huggy-Puppy intervention to 191 young children, compared with 101 control subjects. The effects of the intervention on stress-related symptoms after the war were assessed in telephone interviews with the parents. Study I indicated that, during the war, most children had significant exposure to war-related experiences and had severe stress reactions. The Huggy-Puppy intervention was associated with significant reductions in stress reactions in the postwar assessment. A higher level of attachment and involvement with the doll was associated with better outcomes. The results of study II indicated that group administration of the Huggy-Puppy intervention was associated with significant reductions in stress reactions. These studies suggest that the Huggy-Puppy intervention may offer pediatricians and other child health care professionals a promising, cost-effective intervention for children during stressful times.

Trauma-related Infections in Battlefield Casualties From Iraq

PubMed Central

Petersen, Kyle; Riddle, Mark S.; Danko, Janine R.; Blazes, David L.; Hayden, Richard; Tasker, Sybil A.; Dunne, James R.

2007-01-01

Objective: To describe risks for, and microbiology and antimicrobial resistance patterns of, war trauma associated infections from Operation Iraqi Freedom. Background: The invasion of Iraq resulted in casualties from high-velocity gunshot, shrapnel, and blunt trauma injuries as well as burns. Infectious complications of these unique war trauma injuries have not been described since the 1970s. Methods: Retrospective record review of all trauma casualties 5 to 65 years of age evacuated from the Iraqi theatre to U.S. Navy hospital ship, USNS Comfort March to May 2003.War trauma-associated infection was defined by positive culture from a wound or sterile body fluid (ie, blood, cerebrospinal fluid) and at least two of the following infection-associated signs/symptoms: fever, dehiscence, foul smell, peri-wound erythema, hypotension, and leukocytosis. A comparison of mechanisms of injury, demographics, and clinical variables was done using multivariate analysis. Results: Of 211 patients, 56 met criteria for infection. Infections were more common in blast injuries, soft tissue injuries, >3 wound sites, loss of limb, abdominal trauma, and higher Injury Severity Score (ISS). Wound infections accounted for 84% of cases, followed by bloodstream infections (38%). Infected were more likely to have had fever prior to arrival, and had higher probability of ICU admission and more surgical procedures. Acinetobacter species (36%) were the predominant organisms followed by Escherichia coli and Pseudomonas species (14% each). Conclusions: Similar to the Vietnam War experience, gram-negative rods, particularly Acinetobacter species, accounted for the majority of wound infections cared for on USNS Comfort during Operation Iraqi Freedom. Multidrug resistance was common, with the exception of the carbapenem class, limiting antibiotic therapy options. PMID:17457175

Wound ballistics of firearm-related injuries--part 1: missile characteristics and mechanisms of soft tissue wounding.

PubMed

Stefanopoulos, P K; Filippakis, K; Soupiou, O T; Pazarakiotis, V C

2014-12-01

Firearm-related injuries are caused by a wide variety of weapons and projectiles. The kinetic energy of the penetrating projectile defines its ability to disrupt and displace tissue, whereas the actual tissue damage is determined by the mode of energy release during the projectile-tissue interaction and the particular characteristics of the tissues and organs involved. Certain projectile factors, namely shape, construction, and stability, greatly influence the rate of energy transfer to the tissues along the wound track. Two zones of tissue damage can be identified, the permanent cavity created by the passage of the bullet and a potential area of contused tissue surrounding it, produced mainly by temporary cavitation which is a manifestation of effective high-energy transfer to tissue. Due to the complex nature of these injuries, wound assessment and the type and extent of treatment required should be based on an understanding of the various mechanisms contributing to tissue damage. Copyright © 2014 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

New horizons: Australian nurses at work in World War I.

PubMed

Harris, Kirsty

2014-06-01

More than 3000 nurses from Australia served with the Australian Army Nursing Service or the British nursing services during World War I. These nurses served in various theatres of war including Egypt, France, India, Greece, Italy and England. They worked in numerous roles including as a surgical team nurse close to the front working under fire; nursing on hospital ships carrying the sick and wounded; or managing hospital wards overrun with patients whilst dealing with a lack of hospital necessities. The skills and roles needed to be a military nurse significantly differed to the skills required to nurse in Australia. Copyright © 2014 Elsevier Ltd. All rights reserved.

The british military hospitals in macedonia during the first world war.

PubMed

Cvetkovski, Vladimir

The paper focusses its attention to the medical work of the British Military hospitals stationed in Macedonia during the First World War, the surgical work carried out under very heavy conditions in improvised operating theatres as well as the treatment of the wounded and sick solders brought from the battlefields on the Macedonian Front.

Contemporary wars and their contributions to vascular injury management.

PubMed

Asensio, J A; Petrone, P; Pérez-Alonso, A; Verde, J M; Martin, M J; Sánchez, W; Smith, S; Marini, C P

2015-04-01

Man's inhumanity for man still knows no boundaries, as we continue as a species as a whole to engage in war. According to Kohn's Dictionary of Wars [1], of over 3,700 years of recorded history, there have been a total of 3,010 wars. One is hard pressed to actually find a period of time in which here has not been an active conflict in the globe. The world has experienced two world wars: WWI (1914-1918) and WWII (1939-1945). The total number of military casualties in WWI was over 37 million, while WWII so far, has been the deadliest military conflict in history with over 60 million people killed accounting for slightly over 2.5% of the world's population. The purpose of this study is to review contemporary wars and their contributions to vascular injury management. It is precisely wartime contributions that have led to the more precise identification and management of these injuries resulting in countless lives and extremities saved. However, surgeons dealing with vascular injuries have faced a tough and arduous road. Their journey was initiated by surgical mavericks which undaunted, pressed on against all odds guided by William Stewart Halsted's classic statement in 1912: "One of the chief fascinations in surgery is the management of wounded vessels." Contemporary wars of the XX-XXI centuries gave birth, defined and advanced the field of vascular injury management.

Use of Fat Grafts in Facial Reconstruction on the Wounded Soldiers From the First World War (WWI) by Hippolyte Morestin (1869-1919).

PubMed

Benmoussa, Nadia; Hansen, Kevin; Charlier, Philippe

2017-11-01

During the Great War of 1914 to 1918, spectacular progress was made in the field of facial reconstruction. The sheer number and severity of facial lesions inflicted during the fighting obliged French and German surgeons to take a close interest in the treatment of patients wounded in such a manner. As head surgeon of the fifth division "blessés de la face" at the hospital of Val-de-Grace, Hippolyte Morestin was responsible for one of the largest surgical departments specializing in facial surgery and reconstruction during the war. During his time of service, he developed various surgical techniques such as autoplasties using cartilaginous and adipose grafts to reconstruct tissue defects. This study focuses primarily on the adipose graft techniques and their aesthetic outcome used by Morestin during and in the aftermath of World War I. This is a historical descriptive study. Our research is based on documents available at the museum and archives of the Val-de-Grace Army Health Service (hospital activity reports, pre- and postoperative patient photographs, newspaper clippings, documented accounts of ward nurses, wax anatomy models). Thirty-four clinical cases published by Hippolyte Morestin dealing with facial reconstruction during the World War I were studied. Fat was mainly used to fill craniofacial substance losses after carrying out often complex reconstructions. The surgical technique is well documented and subdivided into 3 succeeding procedures. Most of the time, the grafts were of autologous origin but sometimes heterologous samples were used. Although the primary objective was to increase volume, an improved quality of skin healing and better skin flexibility were observed. The fat thus allowed the filling of substance losses, and its positive effects on scarring were noticed even before the regenerative properties of the stem cells present in body fat were discovered. Hippolyte Morestin can be named one of the pioneers of facial reconstruction. A

Epidemiology of moderate-to-severe penetrating versus closed traumatic brain injury in the Iraq and Afghanistan wars.

PubMed

Orman, Jean A; Geyer, Dennis; Jones, John; Schneider, Eric B; Grafman, Jordan; Pugh, Mary Jo; Dubose, Joseph

2012-12-01

US combat operations in Iraq and Afghanistan have resulted in a greater proportion of service members with head and neck wounds caused by explosions compared with that of previous wars. Although penetrating traumatic brain injury (TBI) is frequently associated with these wounds, the epidemiology of penetrating TBI from these conflicts has not been well described. The Joint Theater Trauma Registry was queried for January 2003 through December 2010 to identify all patients with moderate-to-severe brain injury with a maximum Abbreviated Injury Scale (AIS) score of the head of 3 or greater and a diagnosis of penetrating or closed TBI in accordance with the Department of Defense Traumatic Brain Injury Surveillance definition. The epidemiology of these injuries was examined, including demographics, TBI severity, overall injury severity, and surgical interventions provided. A total of 1,255 TBI patients (774 penetrating, 481 closed) meeting criteria were identified. Penetrating brain injuries were more severe, more likely to be battle related, and less likely to be isolated injuries than a group of moderate-to-severe closed TBIs within the same range of anatomic injury severity. During the 5-year period of the Iraq war with the largest numbers of TBIs (2004-2008), the numbers of penetrating TBIs exceeded closed TBIs by a ratio of 2:1. During the 3-year period of the Afghanistan war with the greatest numbers of TBIs (2008-2010), the ratio of penetrating to closed TBIs was substantially lower, approximately 1.3:1. This study represents the first comprehensive report on the epidemiology of moderate-to-severe penetrating and closed TBIs resulting from the wars in Iraq and Afghanistan using Joint Theater Trauma Registry data. With the maturing theater of conflicts, penetrating TBIs were substantially less predominant compared with closed TBIs. While this finding may reflect changes in the use of protective measures and tactics or improvements in diagnosis of closed TBIs

Prospective randomised controlled trial of nanocrystalline silver dressing versus plain gauze as the initial post-debridement management of military wounds on wound microbiology and healing.

PubMed

Fries, C A; Ayalew, Y; Penn-Barwell, J G; Porter, K; Jeffery, S L A; Midwinter, M J

2014-07-01

Recent conflicts have been characterised by the use of improvised explosive devices causing devastating injuries, including heavily contaminated wounds requiring meticulous surgical debridement. After being rendered surgical clean, these wounds are dressed and the patient transferred back to the UK for on-going treatment. A dressing that would prevent wounds from becoming colonised during transit would be desirable. The aim of this study was to establish whether using nanocrystalline silver dressings, as an adjunct to the initial debridement, would positively affect wound microbiology and wound healing compared to standard plain gauze dressings. Patients were prospectively randomised to receive either silver dressings, in a nanocrystalline preparation (Acticoat™), or standard of care dressings (plain gauze) following their initial debridement in the field hospital. On repatriation to the UK microbiological swabs were taken from the dressing and the wound, and an odour score recorded. Wounds were followed prospectively and time to wound healing was recorded. Additionally, patient demographic data were recorded, as well as the mechanism of injury and Injury Severity Score. 76 patients were recruited to the trial between February 2010 and February 2012. 39 received current dressings and 37 received the trial dressings. Eleven patients were not swabbed. There was no difference (p=0.1384, Fishers) in the primary outcome measure of wound colonisation between the treatment arm (14/33) and the control arm (20/32). Similarly time to wound healing was not statistically different (p=0.5009, Mann-Whitney). Wounds in the control group were scored as being significantly more malodorous (p=0.002, Mann-Whitney) than those in the treatment arm. This is the first randomised controlled trial to report results from an active theatre of war. Performing research under these conditions poses additional challenges to military clinicians. Meticulous debridement of wounds remains the

Media and Military Relations during the Mexican War

DTIC Science & Technology

2010-06-11

and Military Relations During the Mexican War 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR( S ) MAJ Matthew N...Metzel 5d. PROJECT NUMBER 5e. TASK NUMBER 5f. WORK UNIT NUMBER 7. PERFORMING ORGANIZATION NAME( S ) AND ADDRESS(ES) U.S. Army Command and... S ) AND ADDRESS(ES) 10. SPONSOR/MONITOR’S ACRONYM( S ) 11. SPONSOR/MONITOR’S REPORT NUMBER( S ) 12. DISTRIBUTION / AVAILABILITY STATEMENT

Long Range Transport of War-Related Burn Casualties

DTIC Science & Technology

2008-02-01

Long Range Transport of War-Related Burn Casualties Evan M. Renz, MD, FACS, Leopoldo C . Cancio, MD, FACS, David J. Barillo, MD, FACS, Christopher E...White, MD, FACS, Michael C . Albrecht, MD, Charles K. Thompson, PA- C , Jody L. Ennis, RN, BSN, Sandra M. Wanek, MD, James A. King, MD, FACEP, Kevin K...sched- Submitted for publication October 29, 2007. Accepted for publication October 30, 2007. Copyright © 2008 by Lippincott Williams & Wilkins From the

"An expedition to heal the wounds of war". The 1919 eclipse and Eddington as Quaker adventurer.

PubMed

Stanley, Matthew

2003-03-01

The 1919 eclipse expedition's confirmation of general relativity is often celebrated as a triumph of scientific internationalism. However, British scientific opinion during World War I leaned toward the permanent severance of intellectual ties with Germany. That the expedition came to be remembered as a progressive moment of internationalism was largely the result of the efforts of A. S. Eddington. A devout Quaker, Eddington imported into the scientific community the strategies being used by his coreligionists in the national dialogue: humanize the enemy through personal contact and dramatic projects that highlight the value of peace and cooperation. The essay also addresses the common misconception that Eddington's sympathy for Einstein led him intentionally to misinterpret the expedition's results. The evidence gives no reason to think that Eddington or his coworkers were anything but rigorous. Eddington's pacifism is reflected not in manipulated data but in the meaning of the expedition and the way it entered the collective memory as a celebration of international cooperation in the wake of war.

The dilemma of the wounded healer.

PubMed

Zerubavel, Noga; Wright, Margaret O'Dougherty

2012-12-01

The wounded healer is an archetype that suggests that a healer's own wounds can carry curative power for clients. This article reviews past research regarding the construct of the wounded healer. The unique benefits that a psychotherapist's personal struggles might have on work with clients are explored, as well as the potential vulnerability of some wounded healers with respect to stability of recovery, difficulty managing countertransference, compassion fatigue, and/or professional impairment. The review also explores psychologists' perceptions of and responses to wounded healers and examines factors relating to social stigma and self-stigma that may influence wounded healers' comfort in disclosing their wounds. We propose that the relative absence of dialogue in the field regarding wounded healers encourages secrecy and shame among the wounded, thereby preventing access to support and guidance and discouraging timely intervention when needed. We explore the complexities of navigating disclosure of wounds, given the atmosphere of silence and stigma. We suggest that the mental health field move toward an approach of greater openness and support regarding the wounded healer, and provide recommendations for cultivating the safety necessary to promote resilience and posttraumatic growth. (c) 2012 APA, all rights reserved.

Surgical outcomes of a civil war in a neighbouring country.

PubMed

Akkucuk, Seckin; Aydogan, A; Yetim, I; Ugur, M; Oruc, C; Kilic, E; Paltaci, I; Kaplan, A; Temiz, M

2016-08-01

The civil war in Syria began on 15 March 2011, and many of the injured were treated in the neighbouring country of Turkey. This study reports the surgical outcomes of this war, in a tertiary centre in Turkey. 159 patients with civilian war injuries in Syria who were admitted to the General Surgery Department in the Research and Training Hospital of the Medical School of Mustafa Kemal University, Hatay, Turkey, between 2011 and 2012 were analysed regarding the age, sex, injury type, history of previous surgery for the injury, types of abdominal injuries (solid or luminal organ), the status of isolated abdominal injuries or multiple injuries, mortality, length of hospital stay and injury severity scoring. The median age of the patients was 30.05 (18-66 years) years. Most of the injuries were gunshot wounds (99 of 116 patients, 85.3%). Primary and previously operated patients were transferred to our clinic in a median time of 6.28±4.44 h and 58.11±44.08 h, respectively. Most of the patients had intestinal injuries; although a limited number of patients with colorectal injuries were treated with primary repair, stoma was the major surgical option due to the gross peritoneal contamination secondary to prolonged transport time. Two women and 21 men died. The major cause of death was multiorgan failure secondary to sepsis (18 patients). In the case of civil war in the bordering countries, it is recommended that precautions are taken, such as transformation of nearby civilian hospitals into military ones and employment of experienced trauma surgeons in these hospitals to provide effective medical care. Damage control procedures can avoid fatalities especially before the lethal triad of physiological demise occurs. Rapid transport of the wounded to the nearest medical centre is the key point in countries neighbouring a civil war. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Hemipelvectomy images of loss caused by war

PubMed Central

Salamon, Tal; Kassis, Shokrey; Lerner, Alexander

2014-01-01

As we treat our 230th patient from the Syrian conflict, the pathology we see is more debilitating and the humanitarian needs of the wounded have become even more obvious. This case presents some graphic images of the realities of war. Care in the most advanced units cannot restore broken limbs, let alone broken lives. We present a case of a young war-injured man, who suffered severe crush injury to the pelvis and lower limb, arriving at our medical facility after a delay of hours. The lower limb was shattered from the pelvis down (essentially a traumatic hemipelvectomy). His life had been saved in Syria by ligation of the femoral vessels in an unknown facility by an unknown medical team. On arrival in a centre in Israel for definitive care of an unsalvageable leg, formal hemipelvectomy was performed. PMID:25008336

Military pain management in 21st century war.

PubMed

Buckenmaier, Chester C; Griffith, Scott

2010-07-01

Morphine and other opioid drugs have played a major role in austere environment pain management since the Civil War, particularly in the military. While the pre-eminence and success of such medications is without question, their use is accompanied by significant side effects that are undesirable in the most advanced medical settings, and are potentially devastating in the field environment. Recently, there have been significant improvements in pain care for America's wounded service members, along with a shift in how many care providers view pain management. An increasing number of healthcare providers are seeing pain not merely as a symptom, but as a disease process. In addition to dramatically improving care for wounded service members, the evolution in the military's approach to pain is enhancing care for civilians.

War related sexual violence and it's medical and psychological consequences as seen in Kitgum, Northern Uganda: A cross-sectional study

PubMed Central

2010-01-01

Background Despite the recent adoption of the UN resolution 1820 (2008) which calls for the cessation of war related sexual violence against civilians in conflict zones, Africa continues to see some of the worst cases of war related sexual violence including the mass sexual abuse of entire rural communities particularly in the Great Lakes region. In addition to calling for a complete halt to this abuse, there is a need for the systematic study of the reproductive, surgical and psychological effects of war related sexual violence in the African socio-cultural setting. This paper examines the specific long term health consequences of war related sexual violence among rural women living in two internally displaced person's camps in Kitgum district in war affected Northern Uganda who accessed the services of an Isis-Women's International Cross Cultural Exchange (Isis-WICCE) medical intervention. Methods The study employed a purposive cross-sectional study design where 813 respondents were subjected to a structured interview as part of a screening procedure for an emergency medical intervention to identify respondents who required psychological, gynaecological and surgical treatment. Results Over a quarter (28.6%) of the women (n = 573) reported having suffered at least one form of war related sexual violence. About three quarters of the respondents had 'at least one gynaecological complaint' (72.4%) and 'at least one surgical complaint' (75.6%), while 69.4% had significant psychological distress scores (scores greater than or equal to 6 on the WHO SRQ-20). The factors that were significantly associated with war related sexual violence were the age group of less than or equal to 44 years, being Catholic, having suffered other war related physical trauma, and having 'at least one gynaecological complaint'. The specific gynaecological complaints significantly associated with war related sexual violence were infertility, chronic lower abdominal pain, abnormal vaginal

Wound Repair: Toward Understanding and Integration of Single-Cell and Multicellular Wound Responses

PubMed Central

Sonnemann, Kevin J.; Bement, William M.

2016-01-01

The importance of wound healing to medicine and biology has long been evident, and consequently, wound healing has been the subject of intense investigation for many years. However, several relatively recent developments have added new impetus to wound repair research: the increasing application of model systems; the growing recognition that single cells have a robust, complex, and medically relevant wound healing response; and the emerging recognition that different modes of wound repair bear an uncanny resemblance to other basic biological processes such as morphogenesis and cytokinesis. In this review, each of these developments is described, and their significance for wound healing research is considered. In addition, overlapping mechanisms of single-cell and multicellular wound healing are highlighted, and it is argued that they are more similar than is often recognized. Based on this and other information, a simple model to explain the evolutionary relationships of cytokinesis, single-cell wound repair, multicellular wound repair, and developmental morphogenesis is proposed. Finally, a series of important, but as yet unanswered, questions is posed. PMID:21721944

Children exposed to war/terrorism.

PubMed

Shaw, Jon A

2003-12-01

This paper reviews the prevalence of psychological morbidities in children who have been exposed to war-related traumas or terrorism as well as the diversity of war-related casualties and their associated psychological responses. The psychological responses to war-related stressors are categorized as (1) little or no reaction, (2) acute emotional and behavioral effects, and (3) long-term effects. Specific categories of war-related casualties discussed include refugee status, traumatic bereavement, effects of parental absence, and child soldiers. Psychological responses associated with terrorism and bioterrorism are presented. Lastly, mediators of the psychological response to war-related stressors are discussed, to include exposure effects, gender effects, parental, family and social factors, and child-specific factors. Children exposed to war-related stressors experience a spectrum of psychological morbidities including posttraumatic stress symptomatology, mood disorders, externalizing and disruptive behaviors, and somatic symptoms determined by exposure dose effect. Specific questions for future research are identified.

Peroxide-based oxygen generating topical wound dressing for enhancing healing of dermal wounds.

PubMed

Chandra, Prafulla K; Ross, Christina L; Smith, Leona C; Jeong, Seon S; Kim, Jaehyun; Yoo, James J; Harrison, Benjamin S

2015-01-01

Oxygen generating biomaterials represent a new trend in regenerative medicine that aims to generate and supply oxygen at the site of requirement, to support tissue healing and regeneration. To enhance the healing of dermal wounds, we have developed a highly portable, in situ oxygen generating wound dressings that uses sodium percarbonate (SPO) and calcium peroxide (CPO) as chemical oxygen sources. The dressing continuously generated oxygen for more than 3 days, after which it was replaced. In the in vivo testing on porcine full-thickness porcine wound model, the SPO/CPO dressing showed enhanced wound healing during the 8 week study period. Quantitative measurements of wound healing related parameters, such as wound closure, reepithelialization, epidermal thickness and collagen content of dermis showed that supplying oxygen topically using the SPO/CPO dressing significantly accelerated the wound healing. An increase in neovascularization, as determined using Von Willebrand factor (vWF) and CD31 staining, was also observed in the presence of SPO/CPO dressing. This novel design for a wound dressing that contains oxygen generating biomaterials (SPO/CPO) for supplying topical oxygen, may find utility in treating various types of acute to chronic wounds. © 2015 by the Wound Healing Society.

Multidisciplinary approaches to stimulate wound healing.

PubMed

Businaro, Rita; Corsi, Mariangela; Di Raimo, Tania; Marasco, Sergio; Laskin, Debra L; Salvati, Bruno; Capoano, Raffaele; Ricci, Serafino; Siciliano, Camilla; Frati, Giacomo; De Falco, Elena

2016-08-01

New civil wars and waves of terrorism are causing crucial social changes, with consequences in all fields, including health care. In particular, skin injuries are evolving as an epidemic issue. From a physiological standpoint, although wound repair takes place more rapidly in the skin than in other tissues, it is still a complex organ to reconstruct. Genetic and clinical variables, such as diabetes, smoking, and inflammatory/immunological pathologies, are also important risk factors limiting the regenerative potential of many therapeutic applications. Therefore, optimization of current clinical strategies is critical. Here, we summarize the current state of the field by focusing on stem cell therapy applications in wound healing, with an emphasis on current clinical approaches being developed. These involve protocols for the ex vivo expansion of adipose tissue-derived mesenchymal stem cells by means of a patented Good Manufacturing Practice-compliant platelet lysate. Combinations of multiple strategies, including genetic modifications and stem cells, biomimetic scaffolds, and novel vehicles, such as nanoparticles, are also discussed as future approaches. © 2016 New York Academy of Sciences.

Psycho-social reactions of Palestinian families in Israel and the West Bank following war-related losses.

PubMed

Abu-Baker, Khwala

2012-01-01

to identify psycho-social reactions of Palestinian families to personal losses during the Second Intifada in the West Bank and the Second Lebanese war in Israel. Narratives were collected from support group participants in the west Bank and in individual and family therapy in Israel. the narratives were qualitatively analyzed to identify themes relating to psycho-social reactions to war losses. themes emerging from the west Bank support groups' narratives mostly mirrored those gathered in the therapy sessions in Israel. In both sites, bereaved families exhibited similar psycho-social reactions to war-related losses. Both groups coped with loss collectively and in congruence with their common ethno-cultural background. Also, religious beliefs provided explanations. the loss experiences were ongoing and accumulative for participants in the west Bank, while in Israel it was mostly a single event. Both studies referred solely to war-related losses. the relationships of each population group with the State of Israel shaped their political, national and personal reactions to the loss. Families of "shahids/martyrs" in the west Bank gained socio-political respect, while in Israel, Arab citizens suffering war-related losses did not receive the same political respect from Israeli society, but were awarded sympathy by their communities. In Israel the situation is further complicated since the State is both the enemy and provider of material support, comfort and rescue.

Titanium wound chambers for wound healing research.

PubMed

Nuutila, Kristo; Singh, Mansher; Kruse, Carla; Philip, Justin; Caterson, Edward J; Eriksson, Elof

2016-11-01

Standardized and reproducible animal models are crucial in medical research. Rodents are commonly used in wound healing studies since, they are easily available, affordable and simple to handle and house. However, the most significant limitation of rodent models is that the wounds heal by contraction while in humans the primary mechanisms of healing are reepithelialization and granulation tissue formation. The robust contraction results in faster wound closure that complicates the reproducibility of rodent studies in clinical trials. We have developed a titanium wound chamber for rodent wound healing research. The chamber is engineered from two pieces of titanium and is placed transcutaneously on the dorsum of a rodent. The chamber inhibits wound contraction and provides a means for controlled monitoring and sampling of the wound environment in vivo with minimal foreign body reaction. This technical report introduces two modalities utilizing the titanium chambers in rats: (1) Wound in a skin island model and, (2) Wound without skin model. Here, we demonstrate in rats how the "wound in a skin island model" slows down wound contraction and how the "wound without skin" model completely prevents the closure. The titanium wound chamber provides a reproducible standardized models for wound healing research in rodents. © 2016 by the Wound Healing Society.

Psychosocial Adjustment in Siblings of Children with War-Related Injuries

ERIC Educational Resources Information Center

Khamis, Vivian

2013-01-01

The study assessed the prevalence and predictors of post-traumatic symptomatology and emotional and behavioral difficulties in siblings of children who incurred war-related injuries. It was predicted that injury severity, gender and attributional style would account for a significant amount of the variance in post-traumatic stress symptoms and…

"To afford the wounded speedy assistance": Dominique Jean Larrey and Napoleon.

PubMed

Skandalakis, Panagiotis N; Lainas, Panagiotis; Zoras, Odyseas; Skandalakis, John E; Mirilas, Petros

2006-08-01

Dominique Jean Larrey (1766-1842) has been described as the father of modern military surgery and is considered even today as the model military surgeon. He developed a plan of rapid evacuation of wounded soldiers from the battlefield during combat, using flexible medical units which he named ambulances volantes ("flying ambulances"). He won the admiration of Napoleon Bonaparte (1769-1821), who was amazed by the results of Larrey's sanitary system. Larrey spent almost 18 years with Napoleon, accompanying him in 25 campaigns, 60 battles, and more than 400 engagements. Napoleon's enormous military success was due not only to his strategy and skill but also to the medical services provided by Larrey. The surgeon became a master of wound management and limb amputation. In his vivid battlefield journals, Larrey documented the course of tetanus, the pathophysiology of cold injury, the effective control of hemorrhage, the drainage of empyema and hemothorax, the aspiration of pericardial effusion or hemopericardium, and the packing of sucking chest wounds. Larrey established a categorical rule for the triage of war casualties, treating the wounded according to the observed gravity of their injuries and the urgency for medical care, regardless of their rank or nationality.

Malingering and PTSD: detecting malingering and war related PTSD by Miller Forensic Assessment of Symptoms Test (M-FAST).

PubMed

Ahmadi, Khodabakhsh; Lashani, Zeynab; Afzali, Mohammad Hassan; Tavalaie, S Abbas; Mirzaee, Jafar

2013-05-29

Malingering is prevalent in PTSD, especially in delayed-onset PTSD. Despite the attempts to detect it, indicators, tools and methods to accurately detect malingering need extensive scientific and clinical research. Therefore, this study was designed to validate a tool that can detect malingering of war-related PTSD by Miller Forensic Assessment of Symptoms Test (M-FAST). In this blind clinical diagnosis study, one hundred and twenty veterans referred to War Related PTSD Diagnosis Committee in Iran in 2011 were enrolled. In the first step, the clients received Psychiatry diagnosis and were divided into two groups based on the DSM-IV-TR, and in the second step, the participants completed M-FAST. The t-test score within two groups by M-FAST Scale showed a significant difference (t = 14.058, P < 0.0001), and 92% of malingering war-related PTSD participants scored more than 6 and %87 of PTSD group scored less than 6 in M-FAST Scale. M-FAST showed a significant difference between war-related PTSD and malingering participants. The ≥6 score cutoff was suggested by M-FAST to detect malingering of war-related PTSD.

Telemedicine for wound management

PubMed Central

Chittoria, Ravi K.

2012-01-01

The escalating physiological, psychological, social and financial burdens of wounds and wound care on patients, families and society demand the immediate attention of the health care sector. Many forces are affecting the changes in health care provision for patients with chronic wounds, including managed care, the limited number of wound care therapists, an increasingly ageing and disabled population, regulatory and malpractice issues, and compromised care. The physician is also faced with a number of difficult issues when caring for chronic wound patients because their conditions are time consuming and high risk, represent an unprofitable part of care practice and raise issues of liability. Telemedicine enhances communication with the surgical wound care specialist. Digital image for skin lesions is a safe, accurate and cost-effective referral pathway. The two basic modes of telemedicine applications, store and forward (asynchronous transfer) and real-time transmission (synchronous transfer, e.g. video conference), are utilized in the wound care setting. Telemedicine technology in the hands of an experienced physician can streamline management of a problem wound. Although there is always an element of anxiety related to technical change, the evolution of wound care telemedicine technology has demonstrated a predictable maturation process. PMID:23162242

Online Resources Related to Children Affected by War, Terrorism, and Disaster

ERIC Educational Resources Information Center

Masse, Anna L.

2009-01-01

This article provides a collection of websites related to children affected by war, terrorism, and disaster. These online resources are intended to provide information about various organizations and their efforts to improve the lives of children in crisis around the world.

The reality of war: wounded and fallen Norwegian soldiers in Afghanistan.

PubMed

Bjerkan, Geir; Iversen, Petter; Asak, Håkon; Pillgram-Larsen, Johan; Rolandsen, Bent-Åge

2012-05-15

Norway has been contributing military forces to Afghanistan since 2001. The following is an overview of all combat-related injuries and deaths among Norwegian soldiers in the period from 2002 to 2010. All medical records for Norwegian military personnel in Afghanistan in the period to January 2011 were reviewed and those who fell or were injured during combat were identified. The mechanism and anatomical region of the injury were registered and an injury severity score (ISS), revised trauma score (RTS) and probability of survival score were calculated. Deaths were classified according to military trauma terminology and were additionally assessed as either "non-survivable" or "potentially survivable". There were 45 injury incidents with nine deaths among 42 soldiers. The injury mechanism behind seven of the deaths was an improvised explosive device (IED). All injuries resulting in deaths were "non-survivable". Seven soldiers were severely injured. The mechanisms were bullet wounds, IED, splinters from grenades and landmine explosions. Twenty nine incidents involving 28 soldiers resulted in minor injuries. The most frequent mechanism was ricochet or splinter injury from shooting or an exploding grenade. The majority of conflict-related injuries in Afghanistan were due to explosions. The mechanism and anatomical distribution of the injuries was the same among Norwegian soldiers as among allies. The deaths were due to extensive injuries that were non-survivable.

The use of negative pressure wound therapy in the treatment of infected wounds. Case studies.

PubMed

Jones, Daniel de Alcântara; Neves Filho, Wilson Vasconcelos; Guimarães, Janice de Souza; Castro, Daniel de Araújo; Ferracini, Antonio Marcos

2016-01-01

To evaluate the results and benefits obtained from the topical use of negative pressure wound therapy (NPWT) in patients with infected wounds. This was a retrospective study of 20 patients (17 males and three females, mean age 42 years) with infected wounds treated using NPWT. The infected wounds were caused by trauma. The treatment system used was VAC. ® (Vacuum Assisted Closure, KCI, San Antonio, United States) applied to the wound in continuous mode from 100 to 125 mmHg. The parameters related to the wounds (location, number of VAC changes, the size of the defects in the soft parts, and the evolution of the state of the wound), length of hospital stay, length of intravenous antibiotic therapy, and complications related to the use of this therapy were evaluated. The mean length of the hospital stay, use of NPWT, and antibacterial therapy were 41 days, 22.5 days, and 20 days respectively. The use of the VAC led to a mean reduction of 29% in the wound area (95.65-68.1 cm 2 ; p  < 0.05). Only one patient did not show any improvement in the final appearance of the wound with complete eradication of the infection. No complication directly caused by NPWT was observed. NPWT stimulates infection-free scar tissue formation in a short time, and is a quick and comfortable alternative to conventional infected wounds treatment methods.

Modeled Microgravity Affects Fibroblast Functions Related to Wound Healing

NASA Astrophysics Data System (ADS)

Cialdai, Francesca; Vignali, Leonardo; Morbidelli, Lucia; Colciago, Alessandra; Celotti, Fabio; Santi, Alice; Caselli, Anna; Cirri, Paolo; Monici, Monica

2017-02-01

Wound healing is crucial for the survival of an organism. Therefore, in the perspective of space exploration missions, it is important to understand if and how microgravity conditions affect the behavior of the cell populations involved in wound healing and the evolution of the process. Since fibroblasts are the major players in tissue repair, this study was focused on the behavior of fibroblasts in microgravity conditions, modeled by a RCCS. Cell cytoskeleton was studied by immunofluorescence microscopy, the ability to migrate was assessed by microchemotaxis and scratch assay, and the expression of markers of fibroblast activation, angiogenesis, and inflammation was assessed by western blot. Results revealed that after cell exposure to modeled microgravity conditions, a thorough rearrangement of microtubules occurred and α-SMA bundles were replaced by a tight network of faulty and disorganized filaments. Exposure to modeled microgravity induced a decrease in α-SMA and E-CAD expressions. Also, the expression of the pro-angiogenic protein VEGF decreased, while that of the inflammatory signal COX-2 increased. Fibroblast ability to adhere, migrate, and respond to chemoattractants (PRP), closely related to cytoskeleton integrity and membrane junctions, was significantly impaired. Nevertheless, PRP was able to partially restore fibroblast migration.

The Syrian civil war: The experience of the Surgical Intensive Care Units.

PubMed

Ozdogan, Hatice Kaya; Karateke, Faruk; Ozdogan, Mehmet; Cetinalp, Sibel; Ozyazici, Sefa; Gezercan, Yurdal; Okten, Ali Ihsan; Celik, Muge; Satar, Salim

2016-01-01

Since the civilian war in Syria began, thousands of seriously injured trauma patients from Syria were brought to Turkey for emergency operations and/or postoperative intensive care. The aim of this study was to present the demographics and clinical features of the wounded patients in Syrian civil war admitted to the surgical intensive care units in a tertiary care centre. The records of 80 trauma patients admitted to the Anaesthesia, General Surgery and Neurosurgery ICUs between June 1, 2012 and July 15, 2014 were included in the study. The data were reviewed regarding the demographics, time of presentation, place of reference, Acute Physiology and Chronic Health Evaluation II (APACHE II) score and Injury Severity Score (ISS), surgical procedures, complications, length of stay and mortality. A total of 80 wounded patients (70 males and 10 females) with a mean age of 28.7 years were admitted to surgical ICUs. The most frequent cause of injury was gunshot injury. The mean time interval between the occurrence of injury and time of admission was 2.87 days. Mean ISS score on admission was 21, and mean APACHE II score was 15.7. APACHE II scores of non-survivors were significantly increased compared with those of survivors (P=0.001). No significant differences was found in the age, ISS, time interval before admission, length of stay in ICU, rate of surgery before or after admission. The most important factor affecting mortality in this particular trauma-ICU patient population from Syrian civil war was the physiological condition of patients on admission. Rapid transport and effective initial and on-road resuscitation are critical in decreasing the mortality rate in civil wars and military conflicts.

Event-Related Potential Patterns Associated with Hyperarousal in Gulf War Illness Syndrome Groups

PubMed Central

Tillman, Gail D.; Calley, Clifford S.; Green, Timothy A.; Buhl, Virginia I.; Biggs, Melanie M.; Spence, Jeffrey S.; Briggs, Richard W.; Haley, Robert W.; Hart, John; Kraut, Michael A.

2012-01-01

An exaggerated response to emotional stimuli is one of several symptoms widely reported by veterans of the 1991 Persian Gulf War. Many have attributed these symptoms to post-war stress; others have attributed the symptoms to deployment-related exposures and associated damage to cholinergic, dopaminergic, and white matter systems. We collected event-related potential (ERP) data from 20 veterans meeting Haley criteria for Gulf War Syndromes 1–3 and from 8 matched Gulf War veteran controls, who were deployed but not symptomatic, while they performed an auditory three-condition oddball task with gunshot and lion roar sounds as the distractor stimuli. Reports of hyperarousal from the ill veterans were significantly greater than those from the control veterans; different ERP profiles emerged to account for their hyperarousability. Syndromes 2 and 3, who have previously shown brainstem abnormalities, show significantly stronger auditory P1 amplitudes, purported to indicate compromised cholinergic inhibitory gating in the reticular activating system. Syndromes 1 and 2, who have previously shown basal ganglia dysfunction, show significantly weaker P3a response to distractor stimuli, purported to indicate dysfunction of the dopaminergic contribution to their ability to inhibit distraction by irrelevant stimuli. All three syndrome groups showed an attenuated P3b to target stimuli, which could be secondary to both cholinergic and dopaminergic contributions or disruption of white matter integrity. PMID:22691951

Proteomic Changes of Tissue-Tolerable Plasma Treated Airway Epithelial Cells and Their Relation to Wound Healing.

PubMed

Lendeckel, Derik; Eymann, Christine; Emicke, Philipp; Daeschlein, Georg; Darm, Katrin; O'Neil, Serena; Beule, Achim G; von Woedtke, Thomas; Völker, Uwe; Weltmann, Klaus-Dieter; Jünger, Michael; Hosemann, Werner; Scharf, Christian

2015-01-01

The worldwide increasing number of patients suffering from nonhealing wounds requires the development of new safe strategies for wound repair. Recent studies suggest the possibility of nonthermal (cold) plasma application for the acceleration of wound closure. An in vitro wound healing model with upper airway S9 epithelial cells was established to determine the macroscopically optimal dosage of tissue-tolerable plasma (TTP) for wound regeneration, while a 2D-difference gel electrophoresis (2D-DIGE) approach was used to quantify the proteomic changes in a hypothesis-free manner and to evaluate the balance of beneficial and adverse effects due to TTP application. Plasma doses from 30 s up to 360 s were tested in relation to wound closure after 24 h, 48 h, 72 h, 96 h, and 120 h, in which lower doses (30, 60, and 120 s) resulted in dose-dependent improved wound healing rate compared to untreated cells. Thereby, the 120 s dose caused significantly the best wound healing properties after 96 and 120 h. The proteome analysis combined with IPA revealed that a lot of affected stress adaptation responses are linked to oxidative stress response emphasizing oxidative stress as a possible key event in the regeneration process of epithelial cells as well as in the adaptation to plasma exposure. Further cellular and molecular functions like proliferation and apoptosis were significantly up- or downregulated by all TTP treatments but mostly by the 120 s dose. For the first time, we were able to show plasma effects on cellular adaptation of upper airway epithelial S9 cells improving wound healing. This is of particular interest for plasma application, for example, in the surgery field of otorhinolaryngology or internal medicine.

Proteomic Changes of Tissue-Tolerable Plasma Treated Airway Epithelial Cells and Their Relation to Wound Healing

PubMed Central

Lendeckel, Derik; Eymann, Christine; Emicke, Philipp; Daeschlein, Georg; Darm, Katrin; O'Neil, Serena; Beule, Achim G.; von Woedtke, Thomas; Völker, Uwe; Weltmann, Klaus-Dieter; Jünger, Michael; Hosemann, Werner; Scharf, Christian

2015-01-01

Background. The worldwide increasing number of patients suffering from nonhealing wounds requires the development of new safe strategies for wound repair. Recent studies suggest the possibility of nonthermal (cold) plasma application for the acceleration of wound closure. Methods. An in vitro wound healing model with upper airway S9 epithelial cells was established to determine the macroscopically optimal dosage of tissue-tolerable plasma (TTP) for wound regeneration, while a 2D-difference gel electrophoresis (2D-DIGE) approach was used to quantify the proteomic changes in a hypothesis-free manner and to evaluate the balance of beneficial and adverse effects due to TTP application. Results. Plasma doses from 30 s up to 360 s were tested in relation to wound closure after 24 h, 48 h, 72 h, 96 h, and 120 h, in which lower doses (30, 60, and 120 s) resulted in dose-dependent improved wound healing rate compared to untreated cells. Thereby, the 120 s dose caused significantly the best wound healing properties after 96 and 120 h. The proteome analysis combined with IPA revealed that a lot of affected stress adaptation responses are linked to oxidative stress response emphasizing oxidative stress as a possible key event in the regeneration process of epithelial cells as well as in the adaptation to plasma exposure. Further cellular and molecular functions like proliferation and apoptosis were significantly up- or downregulated by all TTP treatments but mostly by the 120 s dose. Conclusions. For the first time, we were able to show plasma effects on cellular adaptation of upper airway epithelial S9 cells improving wound healing. This is of particular interest for plasma application, for example, in the surgery field of otorhinolaryngology or internal medicine. PMID:26539504

The Role of Matrix Metalloproteinases in Diabetic Wound Healing in relation to Photobiomodulation.

PubMed

Ayuk, Sandra Matabi; Abrahamse, Heidi; Houreld, Nicolette Nadene

2016-01-01

The integration of several cellular responses initiates the process of wound healing. Matrix Metalloproteinases (MMPs) play an integral role in wound healing. Their main function is degradation, by removal of damaged extracellular matrix (ECM) during the inflammatory phase, breakdown of the capillary basement membrane for angiogenesis and cell migration during the proliferation phase, and contraction and remodelling of tissue in the remodelling phase. For effective healing to occur, all wounds require a certain amount of these enzymes, which on the contrary could be very damaging at high concentrations causing excessive degradation and impaired wound healing. The imbalance in MMPs may increase the chronicity of a wound, a familiar problem seen in diabetic patients. The association of diabetes with impaired wound healing and other vascular complications is a serious public health issue. These may eventually lead to chronic foot ulcers and amputation. Low intensity laser irradiation (LILI) or photobiomodulation (PBM) is known to stimulate several wound healing processes; however, its role in matrix proteins and diabetic wound healing has not been fully investigated. This review focuses on the role of MMPs in diabetic wound healing and their interaction in PBM.

Health-related quality of life and patient burden in patients with split-thickness skin graft donor site wounds.

PubMed

Humrich, Marco; Goepel, Lisa; Gutknecht, Mandy; Lohrberg, David; Blessmann, Marco; Bruning, Guido; Diener, Holger; Dissemond, Joachim; Hartmann, Bernd; Augustin, Matthias

2018-04-01

Split-thickness skin grafting is a common procedure to treat different kinds of wounds. This systematic, multicentre, observational, cross-sectional study of adult patients with split-thickness skin graft (STSG) donor site wounds was conducted to evaluate quality of life (QoL) impairments caused by donor site wounds following split-thickness skin grafting. Therefore, 112 patients from 12 wound centres in Germany were examined based on patient and physician questionnaires as well as a physical examination of the donor site wound. Most indications for skin grafting were postsurgical treatment (n = 51; 42.5%) and chronic wounds (n = 47; 39.2%). European QoL visual analoque scale (EQ VAS) averaged 64.7 ± 23.3, European QoL 5 dimensions (EQ-5D) averaged 77.4 ± 30.0. Wound-QoL (range: 0-4) was rated 0.8 ± 0.8 post-surgery and 0.4 ± 0.6 at the time of survey (on average 21 weeks between the time points). Compared to averaged Wound-QoL scores of chronic wounds donor site-related QoL impairments in split-thickness skin-graft patients were less pronounced. There were significant differences in patient burden immediately after surgery compared to the time of the survey, with medium effect sizes. This supports the hypothesis that faster healing of the donor site wound leads to more favourable patient-reported outcomes. © 2017 Medicalhelplines.com Inc and John Wiley & Sons Ltd.

National estimates of non-fatal firearm related injuries other than gunshot wounds

PubMed Central

Hootman, J; Annest, J; Mercy, J; Ryan, G; Hargarten, S

2000-01-01

Objective—To characterize non-fatal firearm related injuries other than gunshot wounds (non-GSWs) treated in hospital emergency departments in the United States that occur during routine gun handling and recreational use as well as violence related use of a firearm. Methods—Cases were identified through the National Electronic Injury Surveillance System (NEISS). During the study period, 1 January 1993 through 31 December 1996, NEISS consisted of a nationally representative sample of 91 hospitals in the United States having at least six beds and providing 24 hour emergency services. Results—An estimated 65 374, or an average of 16 300 per year, non-fatal, non-GSWs were treated in American hospital emergency departments during the four year study period. Fifty seven per cent of all the non-fatal, non-GSWs were violence related, most of which involved being struck by a firearm. The majority of unintentional non-fatal, non-GSWs were self inflicted and occurred during routine gun handling or recreational use of a firearm; 43% of these injuries resulted from gun recoils. Conclusions—Non-fatal, non-GSWs make a notable contribution to the public health burden of firearm related injuries. Firearm related injury prevention programs should focus on not only the reduction of gunshot wounds but also the reduction of unintentional and violence related non-GSWs. PMID:11144625

Active war in Sri Lanka: Children's war exposure, coping, and posttraumatic stress disorder symptom severity.

PubMed

Soysa, Champika K; Azar, Sandra T

2016-01-01

Posttraumatic stress disorder (PTSD) in response to active war is understudied among Sinhalese children in Sri Lanka. We investigated PTSD symptom severity in children using child (n = 60) and mother (n = 60) reports; child-reported war exposure and coping; as well as self-reported maternal PTSD symptom severity. The study addressed active war in 2 rural locations (acute and chronic community war exposure). Child-reports were significantly greater than mother-reports of child PTSD symptom severity. Furthermore, children's war exposure, child-reported and mother-reported child PTSD symptom severity, and maternal PTSD symptom severity were significantly greater in the acute versus chronic community war exposure location, but children's approach and avoidance coping did not significantly differ, indicating a potential ceiling effect. Children's war exposure significantly, positively predicted child-reported child PTSD symptom severity, controlling for age, gender, and maternal PTSD symptom severity, but only maternal PTSD symptom severity significantly, positively predicted mother-reported child PTSD symptom severity. Avoidance coping (in both acute and chronic war) significantly positively mediated the children's war exposure-child-reported child PTSD symptom severity relation, but not mother-reports of the same. Approach coping (in chronic but not acute war) significantly, positively mediated the children's war exposure-child-reported and mother-reported child PTSD symptom severity relations. We advanced the literature on long-term active war by confirming the value of children's self-reports, establishing that both approach and avoidance coping positively mediated the war-exposure-PTSD symptom severity relation, and that the mediation effect of approach coping was situationally moderated by acute verses chronic community war exposure among Sri Lankan children. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

Experimental closure of gunshot wounds by fibrin glue with antibiotics in pigs.

PubMed

Djenić, Nebojša; Višnjić, Milan; Dragović, Saša; Bojanić, Vladmila; Bojanić, Zoran; Djurdjević, Dragan; Djindjić, Boris; Kostov, Miloš

2015-09-01

Gunshot wounds caused by the automatic rifle M70AB2 (AK-47) 7.62 mm, after the primary surgical management, were closed with delayed primary suture during the next four to seven days. This period coincides with the fibroblastic phase of wound healing. Fibrin glue is used as a local hemostatic and as a matrix for the local dosed release of antibiotics. Antibiotics addition to fibrin glue resulted in continuous diffusion into the surrounding next 4 to 7 days. The aim of this study was to create the preconditions for gunshot wounds closing without complications by the application of fibrin glue with antibiotics 24 h after primary surgical treatment. A total of 14 pigs were wounded in the gluteofemoral region by the bullet M67, initial velocity of 720 m/s. All wounded animals were surgically treated according to the principles of the war-surgery doctrine. Seven wounds were closed with primary delayed suture four days after the primary surgical treatment (traditional approach). Fibrin glue with antibiotics was introduced in seven wounds during the primary surgical treatment and primary delayed suture was done after 24 h. The macroscopic appearance and the clinical assessment of the wound were done during the primary surgical treatment and during its revision after 24 h, as well as histopathological findings at the days 4 and 7 after wounding. Gunshot wounds caused by the automatic rifle M70AB2 (AK-47) 7.62 mm, and treated with fibrin glue with antibiotics after primary surgical management, were closed with primary delayed suture after 24 h. In further wound evolution there were no complications. Uncomplicated soft-tissue wounds caused by an automatic M70AB2 rifle may be closed primarily with delayed suture without the risk of developing complications if on revision, 24 h after primary surgery, there were no present necrotic tissues, hematoma, and any signs of infection when fibrin glue with antibiotics (ceftriaxone and clindamycin) was applied. The use of this method

Exposures to war-related traumatic events and post-traumatic stress disorder symptoms among displaced Darfuri female university students: an exploratory study.

PubMed

Badri, Alia; Crutzen, Rik; Van den Borne, H W

2012-08-03

With the deaths of hundreds of thousands and the displacement of up to three million Darfuris, the increasingly complex and on-going war in Darfur has warranted the need to investigate war-related severity and current mental health levels amongst its civilian population. The purpose of this study is to explore the association between war-related exposures and assess post-traumatic stress disorder (PTSD) symptoms amongst a sample of Darfuri female university students at Ahfad University for Women (AUW) in Omdurman city. An exploratory cross-sectional study among a representative sample of Darfuri female university students at AUW (N = 123) was conducted in February 2010. Using an adapted version of the Harvard Trauma Questionnaire (HTQ), war-related exposures and post-traumatic stress disorder (PTSD) symptoms were assessed. Means and standard deviations illustrated the experiential severity of war exposure dimensions and PTSD symptom sub-scales, while Pearson correlations tested for the strength of association between dimensions of war exposures and PTSD symptom sub-scales. Approximately 42 % of the Darfuri participants reported being displaced and 54 % have experienced war-related traumatic exposures either as victims or as witnesses (M = 28, SD = 14.24, range 0 - 40 events). Also, there was a strong association between the experiential dimension of war-related trauma exposures and the full symptom of PTSD. Moreover, the refugee-specific self-perception of functioning sub-scale within the PTSD measurement scored a mean of 3.2 (SD = .56), well above the 2.0 cut-off. This study provides evidence for a relationship between traumatic war-related exposures and symptom rates of PTSD among AUW Darfuri female students. Findings are discussed in terms of AUW counseling service improvement.

Challenges faced by former child soldiers in the aftermath of war in Uganda.

PubMed

Vindevogel, Sofie; De Schryver, Maarten; Broekaert, Eric; Derluyn, Ilse

2013-06-01

Warfare takes a profound toll of all layers of society, creating multiple and multilevel challenges that impinge on the psychosocial well-being of affected individuals. This study aims to assess the scope and salience of challenges confronting former child soldiers and at identifying additional challenges they face compared to non-recruited young people in war-affected northern Uganda. The study was carried out with a stratified random sample of northern Ugandan adolescents (n = 1,008), of whom a third had formerly been recruited (n = 330). The mixed-method comparison design consisted of a constrained free listing task to determine the challenges; a free sorting task to categorize them into clusters; and statistical analysis of their prevalence among formerly recruited youth and of how they compare with those of nonrecruited youth. Altogether, 237 challenges were identified and clustered into 15 categories, showing that formerly recruited participants mainly identified "emotional" and "training and skills"-related challenges. Compared with nonrecruited counterparts, they reported significantly more "emotional" and fewer "social and relational" challenges, with the exception of stigmatization. Overall, there was similarity between the challenges reported by both groups. The challenges confronting formerly recruited youths reach well beyond the effects of direct war exposure and emerge mainly from multiple influence spheres surrounding them. These challenges are largely shared in common with nonrecruited youths. This multidimensional and collective character of challenges calls for comprehensive psychosocial interventions through which healing the psychological wounds of war is complemented by mending the war-affected surroundings at all levels and in all life areas. Copyright © 2013 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

[Endovascular surgery in the war].

PubMed

Reva, V A; Samokhvalov, I M

2015-01-01

Rapid growth of medical technologies has led to implementation of endovascular methods of diagnosis and treatment into rapidly developing battlefield surgery. This work based on analysing all available current publications generalizes the data on using endovascular surgery in combat vascular injury. During the Korean war (1950-1953) American surgeons for the first time performed endovascular balloon occlusion of the aorta - the first intravascular intervention carried out in a zone of combat operations. Half a century thereafter, with the beginning of the war in Afghanistan (2001) and in Iraq (2003) surgeons of central hospitals of the USA Armed Forces began performing delayed endovascular operations to the wounded. The development of technologies, advent of mobile angiographs made it possible to later on implement high-tech endovascular interventions in a zone of combat operations. At first, more often they performed implantation of cava filters, somewhat afterward - angioembolization of damaged accessory vessels, stenting and endovascular repair of major arteries. The first in the theatre of war endovascular prosthetic repair of the thoracic aorta for severe closed injury was performed in 2008. Russian experience of using endovascular surgery in combat injuries is limited to diagnostic angiography and regional intraarterial perfusion. Despite the advent of stationary angiographs in large hospitals of the RF Ministry of Defence in the early 1990s, endovascular operations for combat vascular injury are casuistic. Foreign experience in active implementation of endovascular technologies to treatment of war-time injuries has substantiated feasibility of using intravascular interventions in tertiary care military hospitals. Carrying out basic training courses on endovascular surgery should become an organic part of preparing multimodality general battlefield surgeons rendering care on the theatre of combat operations.

Fungating wounds: management and treatment options.

PubMed

Tandler, Suzanne; Stephen-Haynes, Jackie

2017-06-22

This article defines fungating wounds and considers the underlying cause, location and presentation. The clinical challenges presented by fungating wounds are discussed, with reference to evidence-based care delivery. This includes wound assessment, cleansing, debridement and management of malodour, infection, bleeding and exudate. Guidance on the use of wound management dressings is considered in relation to symptom management. The importance of clinical decision-making and educational preparation in the delivery of evidenced-based care for those with fungating wounds is emphasised. A conclusion is made that the clinician can support the patient with a fungating wound by the delivery of evidenced-based care.

Wound healing and treating wounds: Differential diagnosis and evaluation of chronic wounds.

PubMed

Morton, Laurel M; Phillips, Tania J

2016-04-01

Wounds are an excellent example of how the field of dermatology represents a cross-section of many medical disciplines. For instance, wounds may be caused by trauma, vascular insufficiency, and underlying medical conditions, such as diabetes, hypertension, and rheumatologic and inflammatory disease. This continuing medical education article provides an overview of wound healing and the pathophysiology of chronic wounds and reviews the broad differential diagnosis of chronic wounds. It also describes the initial steps necessary in evaluating a chronic wound and determining its underlying etiology. Copyright © 2015 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

Estrogen Effects on Wound Healing

PubMed Central

Horng, Huann-Cheng; Chang, Wen-Hsun; Yeh, Chang-Ching; Huang, Ben-Shian; Chang, Chia-Pei; Chen, Yi-Jen; Tsui, Kuan-Hao

2017-01-01

Wound healing is a physiological process, involving three successive and overlapping phases—hemostasis/inflammation, proliferation, and remodeling—to maintain the integrity of skin after trauma, either by accident or by procedure. Any disruption or unbalanced distribution of these processes might result in abnormal wound healing. Many molecular and clinical data support the effects of estrogen on normal skin homeostasis and wound healing. Estrogen deficiency, for example in postmenopausal women, is detrimental to wound healing processes, notably inflammation and re-granulation, while exogenous estrogen treatment may reverse these effects. Understanding the role of estrogen on skin might provide further opportunities to develop estrogen-related therapy for assistance in wound healing. PMID:29099810

Medical Department, United States Army. Wound Ballistics for World War II.

DTIC Science & Technology

1962-01-01

Georgia Island at Zanana Beach between 2 and 6 July to pro- ceed to a line of departure on the Barike River. After considerable fighting, with heavy...1 mile of the Barike River along the Munda trail. At 1100 hours on 19 July, when the battalion was advancing along this trail, it came under...automatic weapons fire at the Barike River; several men were killed and several wounded. The river was not crossed until 20 July, CASUALTY SURVEY, NEW GEORGIA

[Wound information management system: a standardized scheme for acquisition, storage and management of wound information].

PubMed

Liu, Hu; Su, Rong-jia; Wu, Min-jie; Zhang, Yi; Qiu, Xiang-jun; Feng, Jian-gang; Xie, Ting; Lu, Shu-liang

2012-06-01

To form a wound information management scheme with objectivity, standardization, and convenience by means of wound information management system. A wound information management system was set up with the acquisition terminal, the defined wound description, the data bank, and related softwares. The efficacy of this system was evaluated in clinical practice. The acquisition terminal was composed of the third generation mobile phone and the software. It was feasible to get access to the wound information, including description, image, and therapeutic plan from the data bank by mobile phone. During 4 months, a collection of a total of 232 wound treatment information was entered, and accordingly standardized data of 38 patients were formed automatically. This system can provide standardized wound information management by standardized techniques of acquisition, transmission, and storage of wound information. It can be used widely in hospitals, especially primary medical institutions. Data resource of the system makes it possible for epidemiological study with large sample size in future.

Fatal injury epidemiology among the New Zealand military forces in the First World War.

PubMed

Wilson, Nick; Summers, Jennifer A; Baker, Michael G; Thomson, George; Harper, Glyn

2013-11-01

Despite the large mortality burden of First World War (WW1) on New Zealand (NZ) military forces, no analysis using modern epidemiological methods has ever been conducted. We therefore aimed to study injury-related mortality amongst NZ military forces in WW1. An electronic version of the Roll-of-Honour for NZ Expeditionary Force (NZEF) personnel was supplemented with further coding and analysed statistically. We also performed literature searches to provide context. Out of a total of 16,703 deaths occurring during the war (28 July 1914 to 11 November 1918), injury deaths predominated: 65.1% were "killed in action" (KIA), 23.4% "died of wounds" (DOW), 1.0% were other injuries (e.g. "accidents", drownings, suicides and executions), and 10.5% were other causes (mainly disease). During the course of the war, the annual mortality rate from injury (for KIA + DOW) per 10,000 NZEF personnel in the North Hemisphere peaked at 1335 in 1915 (Gallipoli campaign) and then peaked again in 1917 at 937 (largely the Battle of Passchendaele). Some of the offensive campaigns involved very high mortality peaks (e.g. 2 days with over 450 deaths per day in October 1917). Participation in First World War was by far the worst fatal injury event in New Zealand's history. Many of these injury deaths could be considered to have been preventable through: better diplomacy (to prevent the war), improved military planning to reduce failed campaigns (e.g. Gallipoli, Passchendaele), earlier use of protective equipment such as helmets, and improved healthcare services.

Burn Wound Healing and Tissue Engineering.

PubMed

Singer, Adam J; Boyce, Steven T

In 2016 the American Burn Association held a State of the Science conference to help identify burn research priorities for the next decade. The current paper summarizes the work of the sub-committee on Burn Wound Healing and Tissue Engineering. We first present the priorities in wound healing research over the next 10 years. We then summarize the current state of the science related to burn wound healing and tissue engineering including determination of burn depth, limiting burn injury progression, eschar removal, management of microbial contamination and wound infection, measuring wound closure, accelerating wound healing and durable wound closure, and skin substitutes and tissue engineering. Finally, a summary of the round table discussion is presented.

Incidence and severity of ocular and adnexal injuries during the Second Lebanon War among Israeli soldiers and civilians.

PubMed

Barak, Adiel; Elhalel, Amir; Pikkel, Joseph; Krauss, Eli; Miller, Benjamin

2011-12-01

To analyze the incidence and severity of ocular and adnexal injuries in the Second Lebanon War among Israeli soldiers and civilians. Retrospective cohort study. All patients recorded in the Israeli National Trauma Registry during the Second Lebanon War (July-August, 2006). Retrieval of all data relevant to ocular and adnexal injuries sustained during the study period, and differentiation between those associated with combat/terrorist and other events. Analysis of data according to the severity of trauma , anatomical location of the injury, and whether the patients were military personnel or civilians. A total of 69 war-related ocular trauma patients (58 military personnel and 11 civilians) were registered during the 34 days of war. The injuries involved the anterior segment injury (n = 25), posterior segment (n = 29) and the periocular region (n = 15, all severe). Twenty-seven of the patients had open-globe injuries, of which 18 involved intraocular foreign bodies, and 27 patients had closed-globe injuries. The rate of ocular injuries was 7% among all registered wounded military personnel and 1.2% among all injured civilians. The incidence and severity of ocular and adnexal injuries among military personnel during the Second Lebanon War were consistent with previous reports from American sources of ocular injuries sustained in Iraq and Afghanistan. The rates of ocular injury associated with wartime events sustained by civilians has not been investigated before, and it was relatively low, probably as a result of stringent government-mandated building regulations for passive defense that are discussed.

Wounds and weapons.

PubMed

Vogel, H; Dootz, B

2007-08-01

X-ray findings are described, which are typical for injuries due to conventional weapons. It is intended to demonstrate that radiographs can show findings characteristic for weapons. The radiograms have been collected in Vietnam, Croatia, Serbia, Bosnia, Chad, Iran, Afghanistan, USA, Great Britain, France, Israel, Palestine, and Germany. Radiograms of injuries due to hand grenades show their content (globes) and cover fragments. The globes are localized regionally in the victim's body. Survivors of cluster bombs show singular or few globes; having been hit by many globes would have been lethal. Shotguns produce characteristic distributions of the pallets and depth of penetration different from those of hand grenades and cluster bombs; cover fragments are lacking. Gunshot wounds (GSW) can be differentiated in those to low velocity bullets, high velocity projectiles, and projectiles, which disintegrate on impact. The radiogram furnishes the information about a dangerous shock and helps to recognize the weapon. Radiograms of victims of explosion show fragments and injuries due to the blast, information valid for therapy planning and prognosis. The radiogram shows details which can be used in therapy, forensic medicine and in war propaganda - examples could be findings typical for cluster bombs and for dumdum bullets; it shows the cruelty of the employment of weapons against humans and the conflict between the goal of medical care and those of military actions. Radiographs may show, which weapon has been employed; they can be read as war reports.

Girls and war: an extra vulnerability.

PubMed

Black, M

1998-01-01

It is no longer possible to consider the raping of girls as an isolated atrocity of war. In Uganda, guerrilla forces have kidnapped 6000-10,000 children and have forced the "most desirable" girls to become "wives" of warlords. Girls who manage to escape are deeply traumatized and suffer ill health as well as possible social ostracism. In refugee camps, recognition that adolescent girls face special risks of rape and of engaging in the informal prostitution that may expose them to HIV/AIDS has led to the introduction of new measures to increase female security. Families in refugee camps in Burundi and Somalia protect female honor by submitting their daughters to very early marriage, which also abuses the girls' rights. Girls conscripted to military groups are forced to transport materials, cook, or help loot villages. In conditions of war, even girls who remain at home protected by their families must assume extra responsibilities, especially if men go off to fight leaving women with the agricultural and livestock burdens. Girls will be the first children withdrawn from school to help keep the household afloat. Girls and women are also expected to tend those wounded by the very war that destroys the health care services that are vital to meet women's reproductive needs. Efforts are being made to identify rape as a specific war crime, and these efforts should be extended to the kidnapping and forced recruitment of children into combat roles. Moral codes must be reestablished, even if they are only nominal at present.

Visual event-related potentials as markers of hyperarousal in Gulf War Illness: evidence against a stress-related etiology

PubMed Central

Tillman, Gail D.; Calley, Clifford S.; Green, Timothy A.; Buhl, Virginia I.; Biggs, Melanie M.; Spence, Jeffrey S.; Briggs, Richard W.; Haley, Robert W.; Kraut, Michael A.; Hart, John

2012-01-01

An exaggerated response to emotional stimuli is among the many symptoms widely reported by veterans of the 1991 Persian Gulf War. These symptomologies have been attributed to damage and dysfunction associated with deployment-related exposures. We collected event-related potential data from 22 veterans meeting Haley criteria for Gulf War (GW) Syndromes 1-3 and from 8 matched GW veteran controls, who were deployed but not symptomatic, while they performed a visual three-condition oddball task where images authenticated to be associated with the 1991 Persian Gulf War were the distractor stimuli. Hyperarousal reported by ill veterans was significantly greater than that by control veterans, but this was not paralleled by higher amplitude P3a in their ERP responses to GW-related distractor stimuli. Whereas previous studies of PTSD patients have shown higher amplitude P3b responses to target stimuli that are placed amid trauma-related nontarget stimuli, ill veterans in this study showed P3b amplitudes to target stimuli—placed amid GW-related nontarget stimuli—that were significantly lower than those of the control group. Hyperarousal scores reliably predicted P3b, but not P3a, amplitudes. Although many factors may contribute to P3b amplitude differences—most notably depression and poor sleep quality, symptoms that are prevalent in the GW syndrome groups—our findings in context of previous studies on this population are consistent with the contention that dysfunction in cholinergic and dopaminergic neurotransmitter systems, and in white matter and basal ganglia may be contributing to impairments in GW veterans. PMID:23149040

Gas gangrene without wound: both lower extremities affected simultaneously.

PubMed

Lu, Jun; Wu, Xiao-Tao; Kong, Xiang-Fei; Tang, Wen-Hao; Cheng, Jian-Ming; Wang, Hai-Liang

2008-10-01

Gas gangrene is a necrotizing soft tissue infection characterized by muscular necrosis and gas formation. It develops quickly and can cause septic shock and death. In adults, gas gangrene used to be a well-known complication of war wounds. Recently, cases of spontaneous or nontraumatic gas gangrene have been reported in both adults and children. We report a case of nontraumatic gas gangrene involving both the lower extremities simultaneously. Pathogenesis of this fatal soft tissue infection is discussed.We also review the diagnosis and treatment aspects of this entity.

Exposures to war-related traumatic events and post-traumatic stress disorder symptoms among displaced Darfuri female university students: an exploratory study

PubMed Central

2012-01-01

Background With the deaths of hundreds of thousands and the displacement of up to three million Darfuris, the increasingly complex and on-going war in Darfur has warranted the need to investigate war-related severity and current mental health levels amongst its civilian population. The purpose of this study is to explore the association between war-related exposures and assess post-traumatic stress disorder (PTSD) symptoms amongst a sample of Darfuri female university students at Ahfad University for Women (AUW) in Omdurman city. Methods An exploratory cross-sectional study among a representative sample of Darfuri female university students at AUW (N = 123) was conducted in February 2010. Using an adapted version of the Harvard Trauma Questionnaire (HTQ), war-related exposures and post-traumatic stress disorder (PTSD) symptoms were assessed. Means and standard deviations illustrated the experiential severity of war exposure dimensions and PTSD symptom sub-scales, while Pearson correlations tested for the strength of association between dimensions of war exposures and PTSD symptom sub-scales. Results Approximately 42 % of the Darfuri participants reported being displaced and 54 % have experienced war-related traumatic exposures either as victims or as witnesses (M = 28, SD = 14.24, range 0 – 40 events). Also, there was a strong association between the experiential dimension of war-related trauma exposures and the full symptom of PTSD. Moreover, the refugee-specific self-perception of functioning sub-scale within the PTSD measurement scored a mean of 3.2 (SD = .56), well above the 2.0 cut-off. Conclusions This study provides evidence for a relationship between traumatic war-related exposures and symptom rates of PTSD among AUW Darfuri female students. Findings are discussed in terms of AUW counseling service improvement. PMID:22863107

Wound healing.

PubMed

Harvey, Carol

2005-01-01

Wound healing in orthopaedic care is affected by the causes of the wound, as well as concomitant therapies used to repair musculoskeletal structures. Promoting the health of the host and creating an environment to foster natural healing processes is essential for helping to restore skin integrity. Normal wound healing physiologic processes, factors affecting wound healing, wound classification systems, unique characteristics of orthopaedic wounds, wound contamination and drainage characteristics, and potential complications are important to understand in anticipation of patient needs. Accurate wound assessment and knowledge of nursing implications with specific wound care measures (cleansing, debridement, and dressings) is important for quality care. New technologies are enhancing traditional wound care measures with goals of effective comfortable wound care to promote restoration of skin integrity.

The American Home Front: Revolutionary War, Civil War, World War I, World War II

DTIC Science & Technology

1983-01-01

ledgm ents ................................................... xvii WAR AND SOCIETY IN AMERICA: SOME QUESTIONS ..... I 1. THE AMERICAN REVOLUTION 5 The...Price of War ...................................... 6 A Revolutionary Society at War ............................ 8 The Revolutionary Economy...obilizing the Union for War .................................... 67 Civil War and American Society . ................................ 71 O rganizing the

The Syrian civil war: The experience of the Surgical Intensive Care Units

PubMed Central

Ozdogan, Hatice Kaya; Karateke, Faruk; Ozdogan, Mehmet; Cetinalp, Sibel; Ozyazici, Sefa; Gezercan, Yurdal; Okten, Ali Ihsan; Celik, Muge; Satar, Salim

2016-01-01

Objective: Since the civilian war in Syria began, thousands of seriously injured trauma patients from Syria were brought to Turkey for emergency operations and/or postoperative intensive care. The aim of this study was to present the demographics and clinical features of the wounded patients in Syrian civil war admitted to the surgical intensive care units in a tertiary care centre. Methods: The records of 80 trauma patients admitted to the Anaesthesia, General Surgery and Neurosurgery ICUs between June 1, 2012 and July 15, 2014 were included in the study. The data were reviewed regarding the demographics, time of presentation, place of reference, Acute Physiology and Chronic Health Evaluation II (APACHE II) score and Injury Severity Score (ISS), surgical procedures, complications, length of stay and mortality. Results: A total of 80 wounded patients (70 males and 10 females) with a mean age of 28.7 years were admitted to surgical ICUs. The most frequent cause of injury was gunshot injury. The mean time interval between the occurrence of injury and time of admission was 2.87 days. Mean ISS score on admission was 21, and mean APACHE II score was 15.7. APACHE II scores of non-survivors were significantly increased compared with those of survivors (P=0.001). No significant differences was found in the age, ISS, time interval before admission, length of stay in ICU, rate of surgery before or after admission. Conclusion: The most important factor affecting mortality in this particular trauma-ICU patient population from Syrian civil war was the physiological condition of patients on admission. Rapid transport and effective initial and on-road resuscitation are critical in decreasing the mortality rate in civil wars and military conflicts. PMID:27375683

Surgical advances during the First World War: the birth of modern orthopaedics.

PubMed

Ramasamy, Arul; Eardley, W G P; Edwards, D S; Clasper, J C; Stewart, M P M

2016-02-01

The First World War (1914-1918) was the first truly industrial conflict in human history. Never before had rifle fire and artillery barrage been employed on a global scale. It was a conflict that over 4 years would leave over 750,000 British troops dead with a further 1.6 million injured, the majority with orthopaedic injuries. Against this backdrop, the skills of the orthopaedic surgeon were brought to the fore. Many of those techniques and systems form the foundation of modern orthopaedic trauma management. On the centenary of 'the War to end all Wars', we review the significant advances in wound management, fracture treatment, nerve injury and rehabilitation that were developed during that conflict. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

TGF-beta antisense oligonucleotides reduce mRNA expression of matrix metalloproteinases in cultured wound-healing-related cells.

PubMed

Philipp, Katrin; Riedel, Frank; Germann, Günter; Hörmann, Karl; Sauerbier, Michael

2005-02-01

The pathology of chronic dermal ulcers is characterized by excessive proteolytic activity which degrades extracellular matrix. The transforming growth factor-beta (TGF-beta) has been identified as an important component of wound healing. Recent developments in molecular therapy offer exciting prospects for the modulation of wound healing, specifically those targeting TGF-beta. We investigated the effect of TGF-beta antisense oligonucleotides on the mRNA expression of matrix metalloproteinases in cultured human keratinocytes, fibroblasts and endothelial cells using multiplex RT-PCR. The treatment of keratinocytes and fibroblasts with TGF-beta antisense oligonucleotides resulted in a significant decrease of expression of mRNA of MMP-1 and MMP-9 compared to controls. Accordingly, a decreased expression of MMP-1 mRNA in endothelial cells was detectable. Other MMPs were not affected. Affecting all dermal wound-healing-related cell types, TGF-beta antisense oligonucleotide technology may be a potential therapeutic option for the inhibition of proteolytic tissue destruction in chronic wounds. Pharmaceutical intervention in this area ultimately may help clinicians to proactively intervene in an effort to prevent normal wounds from becoming chronic.

Nursing and en route care: history in time of war.

PubMed

Davis, R Scott; Connelly, Linda K

2011-01-01

The mission of the en route caregiver is to provide critical care in military helicopters for wounded Warriors. This care minimizes the effects of the wounds and injuries, and improves morbidity and mortality. This article will focus on the history of Army Nursing en route care. From World War II through Vietnam, and continuing through the War on Terrorism in Iraq and Afghanistan, Army nurses served in providing en route care in military airplanes and helicopters for patients being transported to higher echelons of care. From aid stations on the battlefield to forward surgical teams which provide life, limb, and eyesight saving care, to the next higher level of care in combat support hospitals, these missions require specialized nursing skills to safely care for the high acuity patients. Before the en route care concept existed, there was not a program to train nurses in these critical skills. There was also a void of information about patient outcomes associated with the nursing assessment and care provided during helicopter medical evacuation (MEDEVAC) of such unstable patients, and the consequent impact on the patient's condition after transport. The role of critical care nurses has proven to be essential and irreplaceable in providing full-spectrum care to casualties of war, in particular, the postsurgical patients transferred from one surgical facility to another in theatre. However, we have only recently developed the concepts over the required skill set, training, equipment, functionality, evidenced-based care, and sustainability of nursing in the en route care role. Much of the work to quantify and qualify nursing care has been done by individuals and individual units whose lessons-learned have only recently been captured.

Challenges in war-related thoracic injury faced by French military surgeons in Afghanistan (2009-2013).

PubMed

de Lesquen, Henri; Beranger, Fabien; Berbis, Julie; Boddaert, Guillaume; Poichotte, Antoine; Pons, Francois; Avaro, Jean-Philippe

2016-09-01

This study reports the challenges faced by French military surgeons in the management of thoracic injury during the latest Afghanistan war. From January 2009 to April 2013, all of the civilian, French and Coalition casualties admitted to French NATO Combat Support Hospital situated on Kabul were prospectively recorded in the French Military Health Service Registry (OPEX(®)). Only penetrating and blunt thoracic trauma patients were retrospectively included. Eighty-nine casualties were included who were mainly civilian (61%) and men (94%) with a mean age of 27.9 years old. Surgeons dealt with polytraumas (78%), severe injuries (mean Injury Severity Score=39.2) and penetrating wounds (96%) due to explosion in 37%, gunshot in 53% and stabbing in 9%. Most of casualties were first observed or drained (n=56). In this non-operative group more than 40% of casualties needed further actions. In the operative group, Damage Control Thoracotomy (n=22) was performed to stop ongoing bleeding and air leakage and Emergency Department Thoracotomy (n=11) for agonal patient. Casualties suffered from hemothorax (60%), pneumothorax (39%), diaphragmatic (37%), lung (35%), heart or great vessels (20%) injuries. The main actions were diaphragmatic sutures (n=25), lung resections (wedge n=6, lobectomy n=4) and haemostasis (intercostal artery ligation n=3, heart injury repairs n=5, great vessels injury repairs n=5). Overall mortality was 11%. The rate of subsequent surgery was 34%. The analysis of the OPEX(®) registry reflects the thoracic surgical challenges of general (visceral) surgeons serving in combat environment during the latest Afghanistan War. Copyright © 2016 Elsevier Ltd. All rights reserved.

Moral injury: a mechanism for war-related psychological trauma in military family members.

PubMed

Nash, William P; Litz, Brett T

2013-12-01

Recent research has provided compelling evidence of mental health problems in military spouses and children, including post-traumatic stress disorder (PTSD), related to the war-zone deployments, combat exposures, and post-deployment mental health symptoms experienced by military service members in the family. One obstacle to further research and federal programs targeting the psychological health of military family members has been the lack of a clear, compelling, and testable model to explain how war-zone events can result in psychological trauma in military spouses and children. In this article, we propose a possible mechanism for deployment-related psychological trauma in military spouses and children based on the concept of moral injury, a model that has been developed to better understand how service members and veterans may develop PTSD and other serious mental and behavioral problems in the wake of war-zone events that inflict damage to moral belief systems rather by threatening personal life and safety. After describing means of adapting the moral injury model to family systems, we discuss the clinical implications of moral injury, and describe a model for its psychological treatment.

[Neurological changes related to malnutrition during the spanish civil war (1936-1939)].

PubMed

Culebras, Jesús M

2014-04-01

In this lecture, given at the International Conferences on Neuroscience, in Quito, May 31st-June 1st of 2013, the topic of famine situations during the Spanish Civil War, 1936-1939, was approached. Madrid, the capital of Spain, was under food, water and milk rationing during that period. This situation led to conditions that showed the relationships between the nervous system and nutrition. The Madrilenian population was submitted to a real experiment of hyponutrition, similar to the one that may be reproduced at the laboratory. At the end of the war, the National Direction on Health and the Institute of Medical Investigations, with the collaboration of the Rockefeller Foundation, carried out a series of clinical and food consumption surveys among the Madrilenian population. There were three medical situations that were of particular relevance during the Civil War and after it: the pellagra epidemics, the onset of lathyrism, and the socalled Vallecas syndrome. The occurrence of pellagra cases was paramount because it allowed reconsidering all the unspecific symptoms observed from an already known vitamin deficiency. Pellagra became the most prevalent deficitrelated disease, and most clearly related to nutrition. Lathyrism is a chronic intoxication produced by the accumulation of neurotoxins. It is due to common intake of chickling peas (Lathyrus sativus). Chickling peas are toxic only if they represent more than 30% of the daily calories consumed for a prolonged period greater than two to three months. Lathyrism would reoccur in the Spanish population after the war, in 1941 and 1942, the so called "famine years", when due to the scarcity of foods chickling pea flour was again consumed in high amounts. Deficiency-related neuropathies observed in Madrid during the Civil War led to new and original clinical descriptions. In children from schools of the Vallecas neighborhood, a deficiency syndrome, likely related to vitamin B complex deficiency, was described, which

Cutaneous wound healing: Current concepts and advances in wound care

PubMed Central

Klein, Kenneth C; Guha, Somes Chandra

2014-01-01

A non-healing wound is defined as showing no measurable signs of healing for at least 30 consecutive treatments with standard wound care.[1] It is a snapshot of a patient's total health as well as the ongoing battle between noxious factors and the restoration of optimal macro and micro circulation, oxygenation and nutrition. In practice, standard therapies for non-healing cutaneous wounds include application of appropriate dressings, periodic debridement and eliminating causative factors.[2] The vast majority of wounds would heal by such approach with variable degrees of residual morbidity, disability and even mortality. Globally, beyond the above therapies, newer tools of healing are selectively accessible to caregivers, for various logistical or financial reasons. Our review will focus on the use of hyperbaric oxygen therapy (HBOT), as used at our institution (CAMC), and some other modalities that are relatively accessible to patients. HBOT is a relatively safe and technologically simpler way to deliver care worldwide. However, the expense for including HBOT as standard of care for recognized indications per UHMS(Undersea and Hyperbaric Medical Society) may vary widely from country to country and payment system.[3] In the USA, CMS (Centers for Medicare and Medicaid Services) approved indications for HBOT vary from that of the UHMS for logistical reasons.[1] We shall also briefly look into other newer therapies per current clinical usage and general acceptance by the medical community. Admittedly, there would be other novel tools with variable success in wound healing worldwide, but it would be difficult to include all in this treatise. PMID:25593414

Combat Wound Initiative program.

PubMed

Stojadinovic, Alexander; Elster, Eric; Potter, Benjamin K; Davis, Thomas A; Tadaki, Doug K; Brown, Trevor S; Ahlers, Stephen; Attinger, Christopher E; Andersen, Romney C; Burris, David; Centeno, Jose; Champion, Hunter; Crumbley, David R; Denobile, John; Duga, Michael; Dunne, James R; Eberhardt, John; Ennis, William J; Forsberg, Jonathan A; Hawksworth, Jason; Helling, Thomas S; Lazarus, Gerald S; Milner, Stephen M; Mullick, Florabel G; Owner, Christopher R; Pasquina, Paul F; Patel, Chirag R; Peoples, George E; Nissan, Aviram; Ring, Michael; Sandberg, Glenn D; Schaden, Wolfgang; Schultz, Gregory S; Scofield, Tom; Shawen, Scott B; Sheppard, Forest R; Stannard, James P; Weina, Peter J; Zenilman, Jonathan M

2010-07-01

The Combat Wound Initiative (CWI) program is a collaborative, multidisciplinary, and interservice public-private partnership that provides personalized, state-of-the-art, and complex wound care via targeted clinical and translational research. The CWI uses a bench-to-bedside approach to translational research, including the rapid development of a human extracorporeal shock wave therapy (ESWT) study in complex wounds after establishing the potential efficacy, biologic mechanisms, and safety of this treatment modality in a murine model. Additional clinical trials include the prospective use of clinical data, serum and wound biomarkers, and wound gene expression profiles to predict wound healing/failure and additional clinical patient outcomes following combat-related trauma. These clinical research data are analyzed using machine-based learning algorithms to develop predictive treatment models to guide clinical decision-making. Future CWI directions include additional clinical trials and study centers and the refinement and deployment of our genetically driven, personalized medicine initiative to provide patient-specific care across multiple medical disciplines, with an emphasis on combat casualty care.

Nelson's wound: treatment of spinal cord injury in 19th and early 20th century military conflicts.

PubMed

Hanigan, William C; Sloffer, Chris

2004-01-15

During the first half of the 19th century, warfare did not provide a background for a systematic analysis of spinal cord injury (SCI). Medical officers participating in the Peninsular and Crimean Wars emphasized the dismal prognosis of this injury, although authors of sketchy civil reports persuaded a few surgeons to operate on closed fractures. The American Medical and Surgical History of the War of the Rebellion was the first text to provide summary of results in 642 cases of gunshot wounds of the spine. The low incidence of this injury (0.26%) and the high mortality rate (55%) discouraged the use of surgery in these cases. Improvements in diagnoses and the introduction of x-ray studies in the latter half of the century enabled Sir G. H. Makins, during the Boer War, to recommend delayed intervention to remove bone or bullet fragments in incomplete injuries. The civil experiences of Elsberg and Frazier in the early 20th century promoted a meticulous approach to treatments, whereas efficient transport of injured soldiers during World War I increased the numbers of survivors. Open large wounds or cerebrospinal fluid leakage, signs of cord compression in recovering patients, delayed clinical deterioration, or intractable pain required surgical exploration. Wartime recommendations for urological and skin care prevented sepsis, and burgeoning pension systems provided specialized longterm rehabilitation. By the Armistice, the effective surgical treatment and postoperative care that had developed through decades of interaction between civil and military medicine helped reduce incidences of morbidity and dispel the hopelessness surrounding the combatant with an SCI.

Some aerodynamic discoveries and related NACA/NASA research programs following World War 2

NASA Technical Reports Server (NTRS)

Spearman, M. L.

1984-01-01

The World War 2 time period ushered in a new era in aeronautical research and development. The air conflict during the war highlighted the need of aircraft with agility, high speed, long range, large payload capability, and in addition, introduced a new concept in air warfare through the use of guided missiles. Following the war, the influx of foreign technology, primarily German, led to rapid advances in jet propulsion and speed, and a host of new problem areas associated with high-speed flight designs were revealed. The resolution of these problems led to a rash of new design concepts and many of the lessons learned, in principle, are still effective today. In addition to the technical lessons learned related to aircraft development programs, it might also be noted that some lessons involving the political and philosophical nature of aircraft development programs are worth attention.

Wound Healing Problems in the Mouth

PubMed Central

Politis, Constantinus; Schoenaers, Joseph; Jacobs, Reinhilde; Agbaje, Jimoh O.

2016-01-01

Wound healing is a primary survival mechanism that is largely taken for granted. The literature includes relatively little information about disturbed wound healing, and there is no acceptable classification describing wound healing process in the oral region. Wound healing comprises a sequence of complex biological processes. All tissues follow an essentially identical pattern to complete the healing process with minimal scar formation. The oral cavity is a remarkable environment in which wound healing occurs in warm oral fluid containing millions of microorganisms. The present review provides a basic overview of the wound healing process and with a discussion of the local and general factors that play roles in achieving efficient would healing. Results of oral cavity wound healing can vary from a clinically healed wound without scar formation and with histologically normal connective tissue under epithelial cells to extreme forms of trismus caused by fibrosis. Many local and general factors affect oral wound healing, and an improved understanding of these factors will help to address issues that lead to poor oral wound healing. PMID:27853435

Wound Healing in Patients With Impaired Kidney Function

PubMed Central

Maroz, Natallia; Simman, Richard

2014-01-01

Renal impairment has long been known to affect wound healing. However, information on differences in the spectrum of wound healing depending on the type of renal insufficiency is limited. Acute kidney injury (AKI) may be observed with different wound types. On one hand, it follows acute traumatic conditions such as crush injury, burns, and post-surgical wounds, and on the other hand, it arises as simultaneous targeting of skin and kidneys by autoimmune-mediated vasculitis. Chronic kidney disease (CKD) and end-stage renal disease (ESRD) often occur in older people, who have limited physical mobility and predisposition for developing pressure-related wounds. The common risk factors for poor wound healing, generally observed in patients with CKD and ESRD, include poorly controlled diabetes mellitus, neuropathy, peripheral vascular disease, chronic venous insufficiency, and aging. ESRD patients have a unique spectrum of wounds related to impaired calcium–phosphorus metabolism, including calciphylaxis, in addition to having the risk factors presented by CKD patients. Overall, there is a wide range of uremic toxins: they may affect local mechanisms of wound healing and also adversely affect the functioning of multiple systems. In the present literature review, we discuss the association between different types of renal impairments and their effects on wound healing and examine this association from different aspects related to the management of wounds in renal impairment patients. PMID:26199882

Peritraumatic dissociation predicts posttraumatic stress disorder symptoms via dysfunctional trauma-related memory among war-affected children.

PubMed

Peltonen, Kirsi; Kangaslampi, Samuli; Saranpää, Jenni; Qouta, Samir; Punamäki, Raija-Leena

2017-01-01

Background : Among adults there is strong evidence about peritraumatic dissociation (PD) predicting posttraumatic stress disorder (PTSD), yet evidence among children is very limited. It has been suggested that disturbances in memory functioning might explain the association between PD and PTSD, but this has not yet been empirically tested. Objective : We aimed to test the hypotheses that greater PD would be associated with more posttraumatic stress disorder (PTSD) symptoms, and that some of this association would be mediated by disorganized and non-verbal memories about the traumatic event. Method : The sample included 197 Palestinian children (10-12-years) living in the Gaza Strip, participating in the aftermath of the 2008/9 war. Self-report questionnaires were used to measure PD (Peritraumatic Dissociative Experiences Questionnaire) three months post-war, as well as trauma-related memory (Trauma Memory Quality Questionnaire) and PTSD symptoms (Children's Revised Impact of Event Scale) six months later. Exposure to war trauma was assessed by a checklist. Structural equation modelling was used to examine direct and indirect paths from PD to posttraumatic PTSS, controlling for number of traumatic war events. Results : Structural equation modelling results showed that greater self-reported PD predicted higher levels of PTSS nine months post-war, and that a significant part, but not all, of this relationship was mediated via the quality of trauma-related memories. Conclusions : This study provided empirical evidence that, among war-affected children, greater PD during traumatic events is linked with higher levels of PTSD symptoms several months later, even when accounting for their personal exposure to war trauma. Further, the study supported the idea that the detrimental effects of dissociation during a traumatic event may be due to dysfunctional memories characterized by disorganization and lack of access to verbal and coherence. Further tests of these

War Wounded and Victims of Traffic Accidents in a Surgical Hospital in Africa: An Observation on Injuries.

PubMed

Schneider, Martin

2015-12-01

Weapon injuries in armed conflict are likely to receive medical attention. Other types of injuries, like traffic accidents, continue to occur during armed conflict. Injuries caused by weapons and by traffic accidents require treatment, but reports and figures to help in prioritizing care are scarce. In a prospective observational study, all emergency patients admitted to the surgical ward in a public hospital of the Central African Republic were evaluated for the cause of their main injury. The proportion of patients injured by weapons and by traffic accidents was analyzed with respect to the level of violence. Seventy-eight patients were included in this study. Weapon injuries accounted for 50 (64%) admissions and traffic accidents for 28 (36%). These proportions varied significantly according to the weekly level of violence (χ(2)=46.8; P<.001). People injured in traffic accidents are an important, but overlooked, drain on surgical resources in low-income countries with armed conflict. Their proportion in relation to weapon wounded fluctuates with the level of violence. Humanitarian medical organizations might prepare themselves not only for weapon injuries, but also for wounds caused by traffic accidents.

War-related stressors are associated with asthma risk among older Kuwaitis following the 1990 Iraqi invasion and occupation.

PubMed

Wright, R J; Fay, M E; Suglia, S Franco; Clark, C J; Evans, J S; Dockery, D W; Behbehani, J

2010-07-01

Contemporary warfare involving civilian populations is a growing public health concern. In addition to the psychological impact, war-related trauma may result in physiological alterations and even broader health effects. Associations were examined between war-related stressors and incident asthma in elderly Kuwaiti civilians following the Iraqi invasion. A random sample of all Kuwaiti nationals aged 50-69 years on the day prior to the invasion were identified. Among the 7873 meeting eligibility criteria, 5567 (71%) agreed to participate and 5028 completed the questionnaire (91% of those eligible). Of these, 3759 were in Kuwait during the invasion, of whom 2294 were alive at follow-up. After exclusions for prevalent asthma or missingness on covariates, 2066 were available for analysis. War-related experiences were summarised into a continuous score using Rasch modelling. Relative Cox proportional hazard rates (HR) were calculated for asthma adjusting for covariates. Over 13 years of follow-up, physician-diagnosed asthma was reported by 66/996 (6.6%) men and 104/1070 (9.7%) women. In models adjusted for gender, socioeconomic status, smoking, BMI, and air pollution related to burning oil fires, those reporting highest stress exposure were more than twice as likely to report asthma (HR 2.3, 95% CI 1.3, 3.9) compared to civilians reporting no stressors. Experiences were more salient when anchored to fear for loss of life. War-related trauma is associated with increased asthma risk in these elderly civilians. Although prior research has documented the significant and persistent psychological toll of war, these findings implicate even broader health effects.

The Battle of Bentonville: Caring for Casualties of the Civil War. Teaching with Historic Places.

ERIC Educational Resources Information Center

Goode, John C.; Beck, Elaine

At the First Battle of Manassas (Virginia) in 1861 many Union doctors fled the battlefield in fear. Those who remained found themselves without adequate medical supplies or ambulances for their patients. As the U.S. Civil War progressed and casualties mounted, military surgeons became more adept at caring for the wounded. By the Battle of…

Surgical pathology to describe the clinical margin of debridement of chronic wounds using a wound electronic medical record.

PubMed

Golinko, Michael S; Joffe, Renata; de Vinck, David; Chandrasekaran, Eashwar; Stojadinovic, Olivera; Barrientos, Stephan; Vukelic, Sasa; Tomic-Canic, Marjana; Brem, Harold

2009-08-01

Chronic wounds, including diabetic foot ulcers (DFU), pressure ulcers (PU), and venous ulcers (VU) result from multiple physiologic impairments. Operative debridement is a mainstay of treatment to remove nonviable tissue and to stimulate wound healing. Unlike tumor resection, however, operative wound specimens are not routinely sent for pathology. The objective of this study was to describe the pathology present in chronic wounds. Pathology reports of the skin edge and wound base from 397 initial debridements in 336 consecutive patients with chronic wounds were retrospectively reviewed. All data were entered and stored in a Wound Electronic Medical Record. Pathology data were extracted from the Wound Electronic Medical Record, coded, and quantified. Up to 15 distinct histopathologic findings across 7 tissue types were observed after review of pathology reports from chronic wounds. Specifically, the pathology of epidermis revealed hyperkeratosis: 66% in DFUs, 31% in PUs, and 29% in VUs. Dermal pathology revealed fibrosis in 49% of DFUs, 30% of PUs, and 15% of VUs. Wound bed pathology revealed necrosis in the subcutaneous tissue in 67% of DFUs, 55% of PUs, and 19% of VUs. Fibrosis was reported in between 19% and 52% of all wound types. Acute osteomyelitis was present in 39% of DFUs, 33% of PUs, and 29% of VUs. This observational study of the histopathology of initial surgical debridement of chronic wounds revealed a wide range of findings across multiple tissue levels. Although certain findings such as osteomyelitis and gangrene have been shown to directly relate to impaired wound healing and amputation, other findings require additional investigation. To rigorously define a margin of debridement, a prospective study relating histopathology and clinical outcomes such as healing rates and amputation is needed.

[Organization and delivery of therapeutic care in modern local wars and armed conflicts].

PubMed

Khalimov, Iu Sh; Tkachuk, N A; Zhekalov, A N

2014-08-01

The system of providing therapeutic care within a united system of staged treatment of wounded and sick and evacuation was established during the Great Patriotic War of 1941-1945 and helped to return 90,6% of casualties to duty. In terms of local wars and armed conflicts the most important task of military field therapy is to improve the provision of therapeutic support through regional and territorial principles, echeloning of forces and facilities, optimization of allocation of medical institutions in accordance with their capabilities, evacuation routes, etc. The organization of therapeutic assistance should be guided primarily by the size and structure of sanitary losses. In modern local wars cannot exclude the occurrence of massive sanitary losses with limited use of weapons of mass destruction, as a result of failure (with a conventional weapon or as a result of sabotage) of nuclear power plants, chemical plants, and transport containers containing toxic chemicals.

Modeling of anisotropic wound healing

NASA Astrophysics Data System (ADS)

Valero, C.; Javierre, E.; García-Aznar, J. M.; Gómez-Benito, M. J.; Menzel, A.

2015-06-01

Biological soft tissues exhibit non-linear complex properties, the quantification of which presents a challenge. Nevertheless, these properties, such as skin anisotropy, highly influence different processes that occur in soft tissues, for instance wound healing, and thus its correct identification and quantification is crucial to understand them. Experimental and computational works are required in order to find the most precise model to replicate the tissues' properties. In this work, we present a wound healing model focused on the proliferative stage that includes angiogenesis and wound contraction in three dimensions and which relies on the accurate representation of the mechanical behavior of the skin. Thus, an anisotropic hyperelastic model has been considered to analyze the effect of collagen fibers on the healing evolution of an ellipsoidal wound. The implemented model accounts for the contribution of the ground matrix and two mechanically equivalent families of fibers. Simulation results show the evolution of the cellular and chemical species in the wound and the wound volume evolution. Moreover, the local strain directions depend on the relative wound orientation with respect to the fibers.

Wound ballistics 101: the mechanisms of soft tissue wounding by bullets.

PubMed

Stefanopoulos, P K; Pinialidis, D E; Hadjigeorgiou, G F; Filippakis, K N

2017-10-01

The mechanisms of soft tissue injury by bullets are reviewed, in the belief that the current incidence of firearm injuries in many urban areas necessitates an understanding of wound ballistics on the part of trauma surgeons who may not be familiar with the wounding factors involved. Review of the literature, with technical information obtained from appropriate non-medical texts. Despite numerous publications concerning the treatment of gunshot wounds, relatively few papers contain details on the mechanisms of ballistic trauma, with the main body of evidence derived from previous laboratory and animal studies which have only recently been systematically appraised. These studies have shown that in rifle injuries the main wound tract is surrounded by an area of damaged tissue as a result of the temporary cavitation induced once the bullet becomes destabilized or deformed. On the other hand, the more commonly encountered non-deforming handgun bullets cause damage limited to the bullet's path, mainly as a result of localized crush injury. The bullet's construction and ballistic behavior within tissue determine to what extent the previously overestimated velocity factor may influence wound severity. The damage produced from temporary cavitation depends on the tensile properties of the tissues involved, and in high-energy injuries may lead to progressive muscle tissue necrosis. Therefore, the term "high-energy" should be reserved for those injuries with substantial tissue damage extending beyond the visible wound tract.

Wound Documentation by Using 3G Mobile as Acquisition Terminal: An Appropriate Proposal for Community Wound Care.

PubMed

Ge, Kui; Wu, Minjie; Liu, Hu; Gong, Jiahong; Zhang, Yi; Hu, Qiang; Fang, Min; Tao, Yanping; Cai, Minqiang; Chen, Hua; Wang, Jianbo; Xie, Ting; Lu, Shuliang

2015-06-01

The increasing numbers of cases of wound disease are now posing a big challenge in China. For more convenience of wound patients, wound management in community health care centers under the supervision of a specialist at general hospitals is an ideal solution. To ensure an accurate diagnosis in community health clinics, it is important that "the same language" for wound description, which may be composed of unified format description, including wound image, must be achieved. We developed a wound information management system that was built up by acquisition terminal, wound description, data bank, and related software. In this system, a 3G mobile phone was applied as acquisition terminal, which could be used to access to the data bank. This documentation system was thought to be an appropriate proposal for community wound care because of its objectivity, uniformity, and facilitation. It also provides possibility for epidemiological study in the future. © The Author(s) 2014.

Nuclear War and Science Teaching.

ERIC Educational Resources Information Center

Hobson, Art

1983-01-01

Suggests that science-related material on nuclear war be included in introductory courses. Lists nuclear war topics for physics, psychology, sociology, biology/ecology, chemistry, geography, geology/meteorology, mathematics, and medical science. Also lists 11 lectures on nuclear physics which include nuclear war topics. (JN)

Wound management.

PubMed

Moreira, Maria E; Markovchick, Vincent J

2007-08-01

Wound management makes up an important part of the emergency physician's practice. Understanding the physiology of wound healing and the patient and wound factors affecting this process is essential for the proper treatment of wounds. There are many options available for wound closure. Each modality has its benefits and its drawbacks, and some are appropriate only for certain types of wounds. The goal is to achieve the best functional and cosmetically appealing scar while avoiding complications.

The national health-care agenda in relation to negative pressure wound therapy.

PubMed

Sinha, Surajit; Mudge, Elizabeth

2013-09-01

The NHS was founded upon the principle of providing health care for all, regardless of financial status. However, it has reached a point where patient demands are outgrowing NHS resources, causing conflict. Chronic wound management represents a considerable financial burden on health services in terms of manpower requirement, equipment, specialist opinion, and adjunct therapies, such as negative pressure wound therapy (NPWT). Although funding bodies often perceive NPWT to be expensive, there is evidence that if used appropriately it leads to faster healing, early discharge and better quality of life for patients with chronic wounds. However, it must be acknowledged that the type and quality of studies are mixed. Further evidence is required to justify the use of NPWT in chronic wounds in the primary and secondary health-care setting.

The incidence of wound complications related to negative pressure wound therapy power outage and interruption of treatment in orthopaedic trauma patients.

PubMed

Collinge, Cory; Reddix, Robert

2011-02-01

Negative pressure wound therapy (NPWT) using the Vacuum Assisted Closure system is an invaluable tool for use on patients with complex limb and soft tissue problems. Recently, the manufacturer (Kinetic Concepts, Inc, San Antonio, TX) made significant modifications to the NPWT platform, including computer software, battery, alarming systems, electric cord and plug apparatus, and others. Since these modifications, we have seen several cases in which the NPWT device has powered off resulting in an unrecognized interruption of therapy. We sought to evaluate the conditions and clinical effects, if any, to orthopaedic trauma patients who experienced an interruption of NPWT therapy when the device powers off. Retrospective study of consecutive patients. Two neighboring regional trauma centers. One hundred twenty-three consecutive orthopaedic trauma patients treated with NPWT by two orthopaedic trauma surgeons between May and November 2008. Patient/injury, treatment, and perioperative clinical outcomes data (with emphasis on wound complications such as infection, graft loss, and unscheduled surgery) were collected from medical records and wound care databases. Twelve patients (10%) had problems with the NPWT device powering off causing an unrecognized interruption of therapy. Eleven patients underwent early (less than 6 hours) wound débridement and reapplication of NPWT after detection, of which nine required unplanned surgery. Seven of the 12 patients recognized as having failed NPWT of this type ultimately experienced wound complications, including five deep infections and both patients being treated with an Integra graft (loss of graft). We have seen substantial problems in orthopaedic trauma patients treated with the NPWT, in which the device has powered off resulting in an unrecognized interruption of therapy. This has resulted in atypically unhealthy-appearing wounds, unplanned surgeries for débridement, and most importantly, an increased incidence of wound

Analysis of Orthopaedic Research Produced During the Wars in Iraq and Afghanistan.

PubMed

Balazs, George C; Dickens, Jonathan F; Brelin, Alaina M; Wolfe, Jared A; Rue, John-Paul H; Potter, Benjamin K

2015-09-01

Military orthopaedic surgeons have published a substantial amount of original research based on our care of combat-wounded service members and related studies during the wars in Iraq and Afghanistan. However, to our knowledge, the influence of this body of work has not been evaluated bibliometrically, and doing so is important to determine the modern impact of combat casualty research in the wider medical community. We sought to identify the 20 most commonly cited works from military surgeons published during the Iraq and Afghanistan conflicts and analyze them to answer the following questions: (1) What were the subject areas of these 20 articles and what was the 2013 Impact Factor of each journal that published them? (2) How many citations did they receive and what were the characteristics of the journals that cited them? (3) Do the citation analysis results obtained from Google Scholar mirror the results obtained from Thompson-Reuters' Web of Science? We searched the Web of Science Citation Index Expanded for relevant original research performed by US military orthopaedic surgeons related to Operation Iraqi Freedom and Operation Enduring Freedom between 2001 and 2014. Articles citing these studies were reviewed using both Web of Science and Google Scholar data. The 20 most cited articles meeting inclusion criteria were identified and analyzed by content domain, frequency of citation, and sources in which they were cited. Nine of these studies examined the epidemiology and outcome of combat injury. Six studies dealt with wound management, wound dehiscence, and formation of heterotopic ossification. Five studies examined infectious complications of combat trauma. The median number of citations garnered by these 20 articles was 41 (range, 28-264) in Web of Science. Other research citing these studies has appeared in 279 different journals, covering 26 different medical and surgical subspecialties, from authors in 31 different countries. Google Scholar contained 97

Situating wound management: technoscience, dressings and 'other' skins.

PubMed

Rudge, T

1999-09-01

This paper addresses the notion of wound care as a technology of skin and other skins imbued with the combined power of technology and science. It presents the discourses of wound care evident in the accounts of patients and nurses concerning this care, and discussions about wounds in wound care interest groups, journals, and advertising material about wound care products. The discussion focuses on wounds and wound dressings as effects immanent in the power relations of discourses of wound care. These effects colour and influence nurses' responses to wounds and wound care products. Moreover, the discourses that portray these practices are evidence of the complex articulation between technoscience and gender. Nurses and patients are fascinated by wound technoscience and lured towards it by its potential for mastery and control over wounds. Such seductions are evident in the texts of nurses, patients, and pharmaceutical advertisements for wound care products. Finally, the ways that these representations are used to talk about and market wound care products are shown as exemplifying the finer points of wound management as a nursing technoscience.

[Towards the problem of necessity to reduce the medical evacuation stages in conditions of local wars and armed conflicts].

PubMed

Gaĭdar, B V; Ivantsov, V A; Sidel'nikov, V O; Rusev, I T; Madaĭ, D Iu; Kokoev, V G; Zinov'ev, E V; Mutalibov, M M

2004-06-01

The article is devoted to the review of modern opinions concerning the experience of military operation medical support in conditions of local wars and military conflicts. On the base of analysis of medical assistance rendered to the wounded and casualties in Republic of Chechnya the advantages and defects of different approaches are discussed. The experience in rendering assistance to the casualties in the Armed Forces of NATO countries during the local wars for the last decades is discussed. It is shown that the optimal variant of organization of treatment-and-evacuation measures during the local armed conflicts and wars is the two-stage scheme of evacuation: the first medical aid--the qualified (specialized) medical aid.

Borrowed buildings: Canada's temporary hospitals during World War I.

PubMed

Adams, A

1999-01-01

This article explores the alterations and additions made to houses, colleges, and larger public buildings in their temporary use as convalescent homes for wounded Canadian soldiers during World War I. These ''borrowed buildings'' anticipated and emphasized three important characteristics of subsequent hospital architecture by suggesting that domestic environments enhanced healing, that hospitals should be accessible, and that patients should be segregated according to social status and disease. The broader implications of the study are that temporarily appropriated spaces contribute to the definition of many institutions and often act as arenas of resistance to established practices.

Acute spinal cord injuries in the Lebanon War, 1982.

PubMed

Ohry, A; Rozin, R

1984-04-01

Our experience with 17 patients with spinal cord injuries (SCI) acquired in the Lebanon War, 1982, is described. The SCI were due to gunshot wounds in 12 patients and to other causes in 5. Two laparotomies and one thoracotomy were performed. Corticosteroids were not seen to influence recovery, nor was laminectomy, which was performed in three cases. Complications such as pressure sores, hydronephrosis, ileus and deep vein thrombosis were rare or did not occur. Three high quadriplegics died. Based on our experience, we recommend conservative treatment and rehabilitation in acute SCI.

Principles and working mechanisms of water-filtered infrared-A (wIRA) in relation to wound healing

PubMed Central

Hoffmann, Gerd

2007-01-01

The experience of the pleasant heat of the sun in moderate climatic zones arises from the filtering of the heat radiation of the sun by water vapor in the atmosphere of the earth. The filter effect of water decreases those parts of infrared radiation (most parts of infrared-B and -C and the absorption bands of water within infrared-A), which would cause – by reacting with water molecules in the skin – only an undesired thermal load to the surface of the skin. Technically water-filtered infrared-A (wIRA) is produced in special radiators, whose full spectrum of radiation of a halogen bulb is passed through a cuvette, containing water, which absorbs or decreases the described undesired wavelengths of the infrared radiation. Within infrared the remaining wIRA (within 780-1400 nm) mainly consists of radiation with good penetration properties into tissue and therefore allows – compared to unfiltered heat radiation – a multiple energy transfer into tissue without irritating the skin, similar to the sun’s heat radiation in moderate climatic zones. Typical wIRA radiators emit no ultraviolet (UV) radiation and nearly no infrared-B and -C radiation and the amount of infrared-A radiation in relation to the amount of visible light (380-780 nm) is emphasized. Water-filtered infrared-A as a special form of heat radiation with a high tissue penetration and with a low thermal load to the skin surface acts both by thermal (related to heat energy transfer) and thermic (temperature depending, with a relevant change of temperature) as well as by non-thermal (without a relevant transfer of heat energy) and non-thermic (not depending on temperature, without a relevant change of temperature) effects. wIRA produces a therapeutically usable field of heat in the tissue and increases tissue temperature, tissue oxygen partial pressure, and tissue perfusion. These three factors are vital for a sufficient tissue supply with energy and oxygen. As wound healing and infection defense (e

Violation of International Conventions Relatively to the Treatment of Prisoners of War during the First World War

ERIC Educational Resources Information Center

Kokebayeva, Gulzhaukhar; Smagulov, Kadyrzhan; Mussabalina, Gulnara

2016-01-01

This article attempts to address the issue of prisoners of war through the prism of international law. The object of research is the work of the Commission to investigate the Entente's complaints of violation of Hague Convention on Treatment of Prisoners of War by German authorities. After the armistice, the governments of the Entente sent notes…

The Lauramann Howe Russell Papers: a Window into Critical Care Medicine during the American Civil War.

PubMed

Gorbaty, Benjamin

2017-10-01

The Civil War influenced all aspects of American society and culture, including the field of medicine and critical care. Union physician Lauramann Howe Russell's letter to his daughter, Ellen Howe, written on October 19, 1862, illustrates the changes in hospital construction, gender roles in healthcare and medical treatments which revolutionized healthcare during the Civil War. This letter offers a glimpse of the medical care of wounded soldiers during the early years of the Civil War. In describing his conversion hospital, he reveals the precursor to the new hospital construction which would greatly influence hospital design for decades to come. His description of women volunteers hints at the evolving role and growing importance of women in healthcare. Finally, the advancements in surgical and medical practice which developed during the Civil War are embodied in Russell's descriptions of his patients. His letter freezes a moment in medical history, bridging the gap between archaic medical practice and modern critical care. Copyright © 2017 Elsevier Inc. All rights reserved.

[Effects of arnebia root oil on wound healing of rats with full-thickness skin defect and the related mechanism].

PubMed

Shen, J Y; Ma, Q; Yang, Z B; Gong, J J; Wu, Y S

2017-09-20

Objective: To observe the effects of arnebia root oil on wound healing of rats with full-thickness skin defect, and to explore the related mechanism. Methods: Eighty SD rats were divided into arnebia root oil group and control group according to the random number table, with 40 rats in each group, then full-thickness skin wounds with area of 3 cm×3 cm were inflicted on the back of each rat. Wounds of rats in arnebia root oil group and control group were treated with sterile medical gauze and bandage package infiltrated with arnebia root oil gauze or Vaseline gauze, respectively, with dressing change of once every two days. On post injury day (PID) 3, 7, 14, and 21, 10 rats in each group were sacrificed respectively for general observation and calculation of wound healing rate. The tissue samples of unhealed wound were collected for observation of histomorphological change with HE staining, observation of expressions of vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (bFGF) with immunohistochemical staining, and determination of mRNA expressions of VEGF and bFGF with real time fluorescent quantitive reverse transcription polymerase chain reaction. Data were processed with analysis of variance of factorial design, t test, and Bonferroni correction. Results: (1) On PID 3, there were a few secretions in wounds of rats in the two groups. On PID 7, there were fewer secretions and more granulation tissue in wounds of rats in arnebia root oil group, while there were more secretions and less granulation tissue in wounds of rats in control group. On PID 14, most of the wounds of rats in arnebia root oil group were healed and there was much red granulation tissue in unhealed wounds, while part of wounds of rats in control group was healed and there were a few secretions and less granulation tissue in unhealed wounds. On PID 21, wounds of rats in arnebia root oil group were basically healed, while there were still some unhealed wounds of rats in

Negative-pressure wound therapy I: the paradox of negative-pressure wound therapy.

PubMed

Kairinos, Nicolas; Solomons, Michael; Hudson, Donald A

2009-02-01

Does negative-pressure wound therapy reduce or increase the pressure of wound tissues? This seemingly obvious question has never been addressed by a study on living tissues. The aim of this study was to evaluate the nature of tissue pressure changes in relation to negative-pressure wound therapy. Three negative-pressure wound therapy dressing configurations were evaluated-circumferential, noncircumferential, and those within a cavity-on 15 human wounds, with five wounds in each category. Tissue pressure changes were recorded (using a strain gauge sensor) for each 75-mmHg increment in suction, up to -450 mmHg. In the circumferential and noncircumferential groups, tissue pressure was also measured over a 48-hour period at a set suction pressure of -125 mmHg (n = 10). In all three groups, mean tissue pressure increased proportionately to the amount of suction applied (p < 0.0005). Mean tissue pressure increments resulting from the circumferential dressings were significantly higher than those resulting from the noncircumferential (p < 0.0005) or cavity group (p < 0.0005); however, there was no significant difference between the latter two groups (p = 0.269). Over the 48-hour period, there was a significant mean reduction in the (increased) tissue pressure (p < 0.04 for circumferential and p < 0.0005 for noncircumferential), but in only three of 10 cases did this reduce to pressures less than those before dressing application. Negative-pressure wound therapy increases tissue pressure proportionately to the amount of suction, although this becomes less pronounced over 48 hours. This suggests that negative-pressure wound therapy dressings should be used with caution on tissues with compromised perfusion, particularly when they are circumferential.

Russian nursing in the Crimean war.

PubMed

Sorokina, T S

1995-01-01

Although the practice of military medicine and surgery goes back to antiquity, the British date the proper care of the wounded from the arrival of Florence Nightingale at Scutari in Turkey on 4 November 1854. The 140th anniversary of her work in that winter of the Crimean war is being celebrated by an exhibition at the Florence Nightingale Museum, 2 Lambeth Palace Road SE1 7EW, from 1 December 1994 till 30 April 1995. For the first time in this country it will tell a little of the other side of the story--the exploits of Russian nurses in caring for the casualties from both sides in the conflict--which is the subject of this article.

The Burn Wound Exudate – an under-utilized resource

PubMed Central

Widgerow, Alan D; King, Kassandra; Tussardi, Ilaria Tocco; Banyard, Derek A.; Chiang, Ryan; Awad, Antony; Afzel, Hassan; Bhatnager, Shweta; Melkumyan, Satenik; Wirth, Garrett; Evans, Gregory R.D

2014-01-01

Introduction The burn wound exudate represents the burn tissue microenvironment. Extracting information from the exudate relating to cellular components, signaling mediators and protein content can provide much needed data relating to the local tissue damage, depth of the wound and probable systemic complications. This review examines the scientific data extracted from burn wound exudates over the years and proposes new investigations that will provide useful information from this underutilized resource. Method A literature review was conducted using the electronic database PubMed to search for literature pertaining to burn wound or blister fluid analysis. Key words included burn exudate, blister fluid, wound exudate, cytokine burn fluid, subeschar fluid, cytokine burns, serum cytokines. 32 relevant article were examined and 29 selected as relevant to the review. 3 papers were discarded due to questionable methodology or conclusions. The reports were assessed for their affect on management decisions and diagnostics. Furthermore, traditional blood level analysis of these mediators was made to compare the accuracy of blood versus exudate in burn wound management. Extrapolations are made for new possibilities of burn wound exudate analysis. Results Studies pertaining to burn wound exudate, subeschar fluid and blister fluid analyses may have contributed to burn wound management decisions particularly related to escharectomies and early burn wound excision. In addition, information from these studies have the potential to impact on areas such as healing, scarring, burn wound conversion and burn wound depth analysis. Conclusion Burn wound exudate analysis has proven useful in burn wound management decisions. It appears to offer a far more accurate reflection of the burn wound pathophysiology than the traditional blood/serum investigations undertaken in the past. New approaches to diagnostics and treatment efficacy assessment are possible utilizing data from this fluid

War-Related Stress: Addressing the Stress of War and Other Traumatic Events.

ERIC Educational Resources Information Center

Hobfoll, Stevan E.; And Others

1991-01-01

Reports the findings of a task force convened to develop strategies for prevention and treatment of psychological, psychosocial, and psychosomatic disorders associated with the Persian Gulf War. Discusses who is at risk, stress reactions to look for, and guidelines for successful coping. Recommends specific interventions at the institutional,…

Burn Wound Infections

PubMed Central

Church, Deirdre; Elsayed, Sameer; Reid, Owen; Winston, Brent; Lindsay, Robert

2006-01-01

Burns are one of the most common and devastating forms of trauma. Patients with serious thermal injury require immediate specialized care in order to minimize morbidity and mortality. Significant thermal injuries induce a state of immunosuppression that predisposes burn patients to infectious complications. A current summary of the classifications of burn wound infections, including their diagnosis, treatment, and prevention, is given. Early excision of the eschar has substantially decreased the incidence of invasive burn wound infection and secondary sepsis, but most deaths in severely burn-injured patients are still due to burn wound sepsis or complications due to inhalation injury. Burn patients are also at risk for developing sepsis secondary to pneumonia, catheter-related infections, and suppurative thrombophlebitis. The introduction of silver-impregnated devices (e.g., central lines and Foley urinary catheters) may reduce the incidence of nosocomial infections due to prolonged placement of these devices. Improved outcomes for severely burned patients have been attributed to medical advances in fluid resuscitation, nutritional support, pulmonary and burn wound care, and infection control practices. PMID:16614255

A field test of group based exposure therapy with 102 veterans with war-related posttraumatic stress disorder.

PubMed

Ready, David J; Thomas, Kaprice R; Worley, Virginia; Backscheider, Andrea G; Harvey, Leigh Anne C; Baltzell, David; Rothbaum, Barbara Olasov

2008-04-01

Group-based exposure therapy (GBET) was field-tested with 102 veterans with war-related posttraumatic stress disorder (PTSD). Nine to 11 patients attended 3 hours of group therapy per day twice weekly for 16-18 weeks. Stress management and a minimum of 60 hours of exposure was included (3 hours of within-group war-trauma presentations per patient, 30 hours of listening to recordings of patient's own war-trauma presentations and 27 hours of hearing other patients' war-trauma presentations). Analysis of assessments conducted by treating clinicians pre-, post- and 6-month posttreatment suggests that GBET produced clinically significant and lasting reductions in PTSD symptoms for most patients on both clinician symptoms ratings (6-month posttreatment effect size delta = 1.22) and self-report measures with only three dropouts.

Treatment of war injuries of the shoulder with external fixators.

PubMed

Davila, Slavko; Mikulić, Danko; Davila, Neda Jarza; Popović, Ljiljana; Zupancić, Bozidar

2005-05-01

In this retrospective study, 18 patients with war injuries of the shoulder were reviewed to evaluate the technical problems associated with external fixation and to analyze the incidence of infection and late functional results. The average patient age was 28.5 years. All patients were male. Thirteen patients had explosive wounds, whereas five wounds were caused by gunshot missiles. All injuries were extensive in terms of bone and soft tissue defects. Six patients presented with complex injuries involving neurovascular structures. Sixteen patients were treated with external fixation. Application of the proximal pins of the external fixator through the humeral head was possible in eight patients, the scapula served as the site of proximal fixation in four patients, only the clavicle was available for placement of pins in two patients, and both the scapula and the clavicle had to be pinned to achieve proximal stabilization in two patients. In two patients, fixation was not possible and early amputation was performed. Infection was eventually eradicated in all patients, allowing for adequate soft tissue coverage of the wounds. Analysis of functional results at an average of 6 years after the injury showed a considerable degree of functional deficit in most patients.

Wound Care Nursing: Professional Issues and Opportunities

PubMed Central

Corbett, Lisa Q.

2012-01-01

As the field of wound care advances and seeks validity as a distinctive healthcare specialty, it becomes imperative to define practice competencies for all related professionals in the arena. As such, the myriad nurses practicing wound care in settings across the continuum should be understood for their unique contribution to the wound care team. Furthermore, the hierarchy of wound care nursing with varying levels of licensure, certification, and scope of practice can be clarified to delineate leadership and reimbursement issues to meet current health care challenges. A review of the role of nursing in wound care from a historical and evolutionary perspective helps to characterize the trend towards advanced practice nursing in the wound care specialty. PMID:24527304

Wound Microbiology and Associated Approaches to Wound Management

PubMed Central

Bowler, P. G.; Duerden, B. I.; Armstrong, D. G.

2001-01-01

The majority of dermal wounds are colonized with aerobic and anaerobic microorganisms that originate predominantly from mucosal surfaces such as those of the oral cavity and gut. The role and significance of microorganisms in wound healing has been debated for many years. While some experts consider the microbial density to be critical in predicting wound healing and infection, others consider the types of microorganisms to be of greater importance. However, these and other factors such as microbial synergy, the host immune response, and the quality of tissue must be considered collectively in assessing the probability of infection. Debate also exists regarding the value of wound sampling, the types of wounds that should be sampled, and the sampling technique required to generate the most meaningful data. In the laboratory, consideration must be given to the relevance of culturing polymicrobial specimens, the value in identifying one or more microorganisms, and the microorganisms that should be assayed for antibiotic susceptibility. Although appropriate systemic antibiotics are essential for the treatment of deteriorating, clinically infected wounds, debate exists regarding the relevance and use of antibiotics (systemic or topical) and antiseptics (topical) in the treatment of nonhealing wounds that have no clinical signs of infection. In providing a detailed analysis of wound microbiology, together with current opinion and controversies regarding wound assessment and treatment, this review has attempted to capture and address microbiological aspects that are critical to the successful management of microorganisms in wounds. PMID:11292638

The molecular biology in wound healing & non-healing wound.

PubMed

Qing, Chun

2017-08-01

The development of molecular biology and other new biotechnologies helps us to recognize the wound healing and non-healing wound of skin in the past 30 years. This review mainly focuses on the molecular biology of many cytokines (including growth factors) and other molecular factors such as extracellular matrix (ECM) on wound healing. The molecular biology in cell movement such as epidermal cells in wound healing was also discussed. Moreover many common chronic wounds such as pressure ulcers, leg ulcers, diabetic foot wounds, venous stasis ulcers, etc. usually deteriorate into non-healing wounds. Therefore the molecular biology such as advanced glycation end products (AGEs) and other molecular factors in diabetes non-healing wounds were also reviewed. Copyright © 2017 Daping Hospital and the Research Institute of Surgery of the Third Military Medical University. Production and hosting by Elsevier B.V. All rights reserved.

Long-term effects of conflict-related sexual violence compared with non-sexual war trauma in female World War II survivors: a matched pairs study.

PubMed

Kuwert, Philipp; Glaesmer, Heide; Eichhorn, Svenja; Grundke, Elena; Pietrzak, Robert H; Freyberger, Harald J; Klauer, Thomas

2014-08-01

The aim of the study was to compare the long-term effects of conflict-related sexual violence experienced at the end of World War II (WWII) with non-sexual WWII trauma (e.g., being exposed to shell shock or physical violence). A total of 27 elderly wartime rape survivors were compared to age- and gender-matched control subjects who were drawn from a larger sample of subjects over 70 years of age who had experienced WWII-related trauma. A modified version of the Posttraumatic Diagnostic Scale was used to assess trauma characteristics and posttraumatic stress disorder (PTSD) symptoms and the Brief Symptom Inventory-18 was used to assess current psychopathology. Additionally, measures of posttraumatic growth (Posttraumatic Growth Inventory) and social acknowledgement as a trauma survivor (Social Acknowledgement Questionnaire) were used to assess two mediating variables in post-trauma conditions of rape victims. Women exposed to conflict-related sexual violence reported greater severity of PTSD-related avoidance and hyperarousal symptoms, as well as anxiety, compared with female long-term survivors of non-sexual WWII trauma. The vast majority (80.9 %) of these women also reported severe sexual problems during their lifetimes relative to 19.0 % of women who experienced non-sexual war trauma. Women exposed to conflict-related sexual violence also reported greater posttraumatic growth, but less social acknowledgement as trauma survivors, compared to survivors of non-sexual war trauma. The results were consistent with emerging neurobiological research, which suggests that different traumas may be differentially associated with long-term posttraumatic sequelae in sexual assault survivors than in other survivor groups and highlights the need to treat (or better prevent) deleterious effects of conflict-related sexual violence in current worldwide crisis zones.

Application of Three - dimensional Wound Analyzer in the Small Wound Area Measurement during the Process of Wound Healing.

PubMed

Sheng, Jiajun; Li, Haihang; Jin, Jian; Liu, Tong; Ma, Bing; Liu, Gongcheng; Zhu, Shihui

2018-02-20

The objective of this study was to determinate the reliability of 3-dimensional wound analyzer (3-DWMD) in the wound area measurement for animal small area in the process of wound healing. Seven Sprague-Dawley rats were used to establish the skin defect model. And the wound area and time consumption were measured on days 0, 5, 10, 15 using 3-DWMD, investigators, and planimetry method. The measurement results using 3-DWMD and investigators were analyzed comparative with that using planimetry method separately. A total 46 wounds, including 32 irregular wounds and regular 14 wounds, were measured. No matter calculating the irregular wounds or the regular wounds, there was no significant difference between 3-DWMD group and planimetry group in measuring wound area (P > 0.05). However, a statistically significant difference was found in time-consuming for measuring wound area between 3-DWMD group and planimetry group (P < 0.001). The same result was found between investigator group and planimetry group (P < 0.001). The 3-DWMD would quickly and accurately obtain the wound area, and its measurement results were consistent with planimetry method. Therefore, such measuring equipment has clinical reference value for measuring precision area of the wound in the process of wound healing.

Men, Women and War: Gender Differences in Attitudes towards War.

ERIC Educational Resources Information Center

Zur, O.; And Others

This study showed that war does have an appeal to both men and women, but that appeal is different and is related to the set of moral concerns that are unique to each gender. To assess the different aspects of men's and women's attitudes towards war, a 48-item Likert-type scale was constructed and administered to 148 students. Results showed that…

Observations of a pediatric surgeon in the Persian Gulf War.

PubMed

Reyna, T M

1993-02-01

In Third-World countries, infectious disease is the principal cause of childhood death and disability. During the Persian Gulf War trauma became the leading cause of death in children, prompting this review of experience with the delivery of pediatric trauma care to noncombatant children at a military hospital. Eight hundred seventy-seven patients were admitted to the 410th Evacuation Hospital from January to April 1991. Fifty of the patients (6%) were children, and 40 of the 50 were admitted for trauma. The mean age of the children was 9 years. Sixty-five percent of pediatric patients sustained penetrating injuries; mechanisms of injury included shrapnel wounds, gunshot wounds, burns, motor vehicle accidents, crush injuries, and falls. The overall mortality rate for children admitted to the hospital was 12%, but no injured child died as a result of trauma. Complications of dehydration or malnutrition in infants accounted for all the deaths.

[Epidemiology of war injuries, about two conflicts: Iraq and Afghanistan].

PubMed

Pasquier, P; de Rudnicki, S; Donat, N; Auroy, Y; Merat, S

2011-11-01

Since March 2003, military operations in Iraq "Operation Iraqi Freedom" (OIF) and in Afghanistan "Operation Enduring Freedom" (OEF), have made many wounded and killed in action (KIA). This article proposes to highlight the specific epidemiology of combat casualties, met in these both non-conventional and asymmetric conflicts. Personal protective equipments, Kevlar helmet and body armor, proved their efficiency in changing features of war injuries. Health Force Services organized trauma care system in different levels, with three main objectives: immediate basic medical care in battalion aid station, forward surgery and early aeromedical evacuation. The Joint Theater Trauma Registry (JTTR), a war injury registry, provides medical data, analyzed from the combat theater to the military hospital in United States. This analysis concluded that during modern conflicts, most injuries are caused by explosive devices; injuries are more severe and interestingly more specifically the head region and extremities than the trunk. Hemorrhage is the first cause of death, leading to the concept of avoidable death. Specific databases focused on mechanisms and severity of injuries, diagnostic and treatment difficulties, outcomes can guide research programs to improve war injuries prevention and treatment. Copyright © 2011 Elsevier Masson SAS. All rights reserved.

A current affair: electrotherapy in wound healing

PubMed Central

Hunckler, Jerome; de Mel, Achala

2017-01-01

New developments in accelerating wound healing can have immense beneficial socioeconomic impact. The wound healing process is a highly orchestrated series of mechanisms where a multitude of cells and biological cascades are involved. The skin battery and current of injury mechanisms have become topics of interest for their influence in chronic wounds. Electrostimulation therapy of wounds has shown to be a promising treatment option with no-device-related adverse effects. This review presents an overview of the understanding and use of applied electrical current in various aspects of wound healing. Rapid clinical translation of the evolving understanding of biomolecular mechanisms underlying the effects of electrical simulation on wound healing would positively impact upon enhancing patient’s quality of life. PMID:28461755

Practices in Wound Healing Studies of Plants

PubMed Central

Thakur, Rupesh; Jain, Nitika; Pathak, Raghvendra; Sandhu, Sardul Singh

2011-01-01

Wounds are the result of injuries to the skin that disrupt the other soft tissue. Healing of a wound is a complex and protracted process of tissue repair and remodeling in response to injury. Various plant products have been used in treatment of wounds over the years. Wound healing herbal extracts promote blood clotting, fight infection, and accelerate the healing of wounds. Phytoconstituents derived from plants need to be identified and screened for antimicrobial activity for management of wounds. The in vitro assays are useful, quick, and relatively inexpensive. Small animals provide a multitude of model choices for various human wound conditions. The study must be conducted after obtaining approval of the Ethics Committee and according to the guidelines for care and use of animals. The prepared formulations of herbal extract can be evaluated by various physicopharmaceutical parameters. The wound healing efficacies of various herbal extracts have been evaluated in excision, incision, dead space, and burn wound models. In vitro and in vivo assays are stepping stones to well-controlled clinical trials of herbal extracts. PMID:21716711

Choosing a Wound Dressing Based on Common Wound Characteristics

PubMed Central

Dabiri, Ganary; Damstetter, Elizabeth; Phillips, Tania

2016-01-01

Significance: Chronic wounds are a major healthcare burden.The practitioner should have an appropriate understanding of both the etiology of the wound as well as the optimal type of dressings to use. Fundamental wound characteristics may be used to guide the practitioner's choice of dressings. The identification of optimal dressings to use for a particular wound type is an important element in facilitating wound healing. Recent Advances: Researchers have sought to design wound dressings that aim to optimize each stage in the healing process. In addition, dressings have been designed to target and kill infection-causing bacteria, with the incorporation of antimicrobial agents. Critical Issues: Chronic wounds are frequently dynamic in presentation, and the numerous wound dressings available make dressing selection challenging for the practitioner. Choosing the correct dressing decreases time to healing, provides cost-effective care, and improves patient quality of life. Future Directions: Research into the mechanisms of wound healing has enhanced our ability to heal chronic wounds at a faster rate through the use of moisture-retentive dressings. Newer dressings are incorporating the use of nanotechnology by incorporating miniature electrical sensors into the dressing. These dressings are engineered to detect changes in a wound environment and alert the patient or practitioner by altering the color of the dressing or sending a message to a smartphone. Additional investigations are underway that incorporate biologic material such as stem cells into dressings. PMID:26858913

Identification of genes related to agarwood formation: transcriptome analysis of healthy and wounded tissues of Aquilaria sinensis

PubMed Central

2013-01-01

Background Agarwood is an expensive resinous heartwood derived from Aquilaria plants that is widely used in traditional medicines, incense and perfume. Only wounded trees can produce agarwood, and the huge demand for the agarwood products has led all Aquilaria spp. being endangered and listed in the Appendix II of the CITES (http://www.cites.org). The major components of agarwood are sesquiterpenes and phenylethyl chromones. Owing to a lack of genomic information, the molecular basis of wound-induced sesquiterpenes biosynthesis and agarwood formation remains unknown. Results To identify the primary genes that maybe related to agarwood formation, we sequenced 2 cDNA libraries generated from healthy and wounded A. sinensis (Lour.) Gilg. A total of 89,137 unigenes with an average length of 678.65 bp were obtained, and they were annotated in detail at bioinformatics levels. Of those associated with agarwood formation, 30 putatively encoded enzymes in the sesquiterpene biosynthesis pathway, and a handful of transcription factors and protein kinases were related to wound signal transduction. Three full-length cDNAs of sesquiterpene synthases (ASS1-3) were cloned and expressed in Escherichia coli, and enzyme assays revealed that they are active enzymes, with the major products being δ-guaiene. A methyl jasmonate (MJ) induction experiment revealed that the expression of ASS was significantly induced by MJ, and the production of sesquiterpenes was elevated accordingly. The expression of some transcription factors and protein kinases, especially MYB4, WRKY4, MPKK2 and MAPK2, was also induced by MJ and coordinated with ASS expression, suggesting they maybe positive regulators of ASS. Conclusions This study provides extensive transcriptome information for Aquilaria spp. and valuable clues for elucidating the mechanism of wound-induced agarwood sesquiterpenes biosynthesis and their regulation. PMID:23565705

How wounds heal

MedlinePlus

... wounds need care to prevent infection. Stages of Wound Healing Wounds heal in stages. The smaller the wound, ... How lacerations heal References Leong M, Phillips LG. Wound healing. In: Townsend CM, Beauchamp RD, Evers BM, Mattox ...

Post-combat syndromes from the Boer war to the Gulf war: a cluster analysis of their nature and attribution.

PubMed

Jones, Edgar; Hodgins-Vermaas, Robert; McCartney, Helen; Everitt, Brian; Beech, Charlotte; Poynter, Denise; Palmer, Ian; Hyams, Kenneth; Wessely, Simon

2002-02-09

To discover whether post-combat syndromes have existed after modern wars and what relation they bear to each other. Review of medical and military records of servicemen and cluster analysis of symptoms. Records for 1856 veterans randomly selected from war pension files awarded from 1872 and from the Medical Assessment Programme for Gulf war veterans. Characteristic patterns of symptom clusters and their relation to dependent variables including war, diagnosis, predisposing physical illness, and exposure to combat; and servicemen's changing attributions for post-combat disorders. Three varieties of post-combat disorder were identified-a debility syndrome (associated with the 19th and early 20th centuries), somatic syndrome (related primarily to the first world war), and a neuropsychiatric syndrome (associated with the second world war and the Gulf conflict). The era in which the war occurred was overwhelmingly the best predictor of cluster membership. All modern wars have been associated with a syndrome characterised by unexplained medical symptoms. The form that these assume, the terms used to describe them, and the explanations offered by servicemen and doctors seem to be influenced by advances in medical science, changes in the nature of warfare, and underlying cultural forces.

Prevention of combat-related infections: antimicrobial therapy in battlefield and barrier measures in French military medical treatment facilities.

PubMed

Mérens, Audrey; Rapp, Christophe; Delaune, Deborah; Danis, Julien; Berger, Franck; Michel, Remy

2014-01-01

Infection is a major complication associated with combat-related injuries. Beside immobilization, wound irrigation, surgical debridement and delayed coverage, post-injury antimicrobials contribute to reduce combat-related infections, particularly those caused by bacteria of the early contamination flora. In modern warfare, bacteria involved in combat-related infections are mainly Gram-negative bacteria belonging to the late contamination flora. These bacteria are frequently resistant or multiresistant to antibiotics and spread through the deployed chain of care. This article exposes the principles of war wounds antimicrobial prophylaxis recommended in the French Armed Forces and highlights the need for high compliance to hygiene standard precautions, adapted contact precautions and judicious use of antibiotics in French deployed military medical treatment facilities (MTF). Copyright © 2014 Elsevier Ltd. All rights reserved.

Long-term Disability Associated With War-related Experience Among Vietnam Veterans

PubMed Central

Gregory, Robert; Salomon, Joshua A.

2015-01-01

Background: Recent combat operations have involved large numbers of personnel. Long-term health effects of military deployment remain largely unknown. Objectives: To examine patterns and trends in long-term disability among combat veterans and to relate disability to aspects of wartime experience. Participants: A total of 60,228 Australian military personnel deployed between 1962 and 1975 during the Vietnam War, and 82,877 military personnel who were not deployed overseas. Outcome Measures: Accepted physician-assessed disability claims were evaluated over follow-up periods up to 50 years after deployment, and compared with age-matched controls. Multivariable analysis was used to examine differences by service branch, rank, age, and deployment duration. Results: The steepest rise in disability incidence was observed among Vietnam veterans starting in the 1990s, around 20–30 years after deployment for most veterans. After 1994, when Statements of Principles were introduced to guide evaluation of disability claims, the hazard ratio for disability incidence was 1.53 (95% confidence interval, 1.32–1.77) compared with the prior period. By January 2011, after an average follow-up of 42.5 years, 69.7% (95% confidence interval, 69.4%–70.1%) of veterans had at least 1 war-related disability. Many veterans had multiple disabilities, with leading causes being eye and ear disorders (48.0%), mental health conditions (47.9%), and musculoskeletal disorders (18.4%). For specific categories of disability, relative risks for accepted claims among veterans compared with controls were highest for mental health disorders, at 22.9 (21.9–24.0) and lowest for injuries, at 1.5 (1.4–1.6) with a relative risk for any disability of 3.7 (3.7–3.8). Veterans with service of >1 year were 2.5 (2.2–2.7) times more likely to have a mental health disability than those who served <100 days, and 2.3 (2.1–2.5) times more likely to have other disabilities. Conclusions: Long-term effects of

Science, ethics and war: a pacifist's perspective.

PubMed

Kovac, Jeffrey

2013-06-01

This article considers the ethical aspects of the question: should a scientist engage in war-related research, particularly use-inspired or applied research directed at the development of the means for the better waging of war? Because scientists are simultaneously professionals, citizens of a particular country, and human beings, they are subject to conflicting moral and practical demands. There are three major philosophical views concerning the morality of war that are relevant to this discussion: realism, just war theory and pacifism. In addition, the requirements of professional codes of ethics and common morality contribute to an ethical analysis of the involvement of scientists and engineers in war-related research and technology. Because modern total warfare, which is facilitated by the work of scientists and engineers, results in the inevitable killing of innocents, it follows that most, if not all, war-related research should be considered at least as morally suspect and probably as morally prohibited.

War experiences and psychotic symptoms among former child soldiers in Northern Uganda: the mediating role of post-war hardships – the WAYS Study

PubMed Central

Amone-P’Olak, Kennedy; Otim, Balaam Nyeko; Opio, George; Ovuga, Emilio; Meiser-Stedman, Richard

2014-01-01

Psychotic symptoms have been associated with post-traumatic stress disorder and war experiences. However, the relationships between types of war experiences, the onset and course of psychotic symptoms, and post-war hardships in child soldiers have not been investigated. This study assessed whether various types of war experiences contribute to psychotic symptoms differently and whether post-war hardships mediated the relationship between war experiences and later psychotic symptoms. In an ongoing longitudinal cohort study (the War-Affected Youths Survey), 539 (61% male) former child soldiers were assessed for psychotic symptoms, post-war hardships, and previous war experiences. Regression analyses were used to assess the contribution of different types of war experiences on psychotic symptoms and the mediating role of post-war hardships in the relations between previous war experiences and psychotic symptoms. The findings yielded ‘witnessing violence’, ‘deaths and bereavement’, ‘involvement in hostilities’, and ‘sexual abuse’ as types of war experiences that significantly and independently predict psychotic symptoms. Exposure to war experiences was related to psychotic symptoms through post-war hardships (β = .18, 95% confidence interval = [0.10, 0.25]) accounting for 50% of the variance in their relationship. The direct relation between previous war experiences and psychotic symptoms attenuated but remained significant (β = .18, 95% confidence interval = [0.12, 0.26]). Types of war experiences should be considered when evaluating risks for psychotic symptoms in the course of providing emergency humanitarian services in post-conflict settings. Interventions should consider post-war hardships as key determinants of psychotic symptoms among war-affected youths. PMID:24718435

Wound healing and treating wounds: Chronic wound care and management.

PubMed

Powers, Jennifer G; Higham, Catherine; Broussard, Karen; Phillips, Tania J

2016-04-01

In the United States, chronic ulcers--including decubitus, vascular, inflammatory, and rheumatologic subtypes--affect >6 million people, with increasing numbers anticipated in our growing elderly and diabetic populations. These wounds cause significant morbidity and mortality and lead to significant medical costs. Preventative and treatment measures include disease-specific approaches and the use of moisture retentive dressings and adjunctive topical therapies to promote healing. In this article, we discuss recent advances in wound care technology and current management guidelines for the treatment of wounds and ulcers. Copyright © 2015 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

Health-related quality of life among US military personnel injured in combat: findings from the Wounded Warrior Recovery Project.

PubMed

Woodruff, Susan I; Galarneau, Michael R; McCabe, Cameron T; Sack, Daniel I; Clouser, Mary C

2018-05-01

Little is known about the long-term, health-related quality of life (HRQOL) of those wounded in combat during Operations Enduring Freedom, Iraqi Freedom, and New Dawn. The present study described the overall HRQOL for a large group of US service members experiencing mild-to-severe combat-related injuries, and assessed the unique contribution of demographics, service- and injury-related characteristics, and mental health factors on long-term HRQOL. The Wounded Warrior Recovery Project examines patient-reported outcomes in a cohort of US military personnel wounded in combat. Participants were identified from the Expeditionary Medical Encounter Database, a US Navy-maintained deployment health database, and invited to complete a web-based survey. At the time of this study, 3245 service members consented and completed the survey. Hierarchical linear regression analyses were conducted to assess the unique contribution of each set of antecedents on HRQOL scores. HRQOL was uniquely associated with a number of demographics, and service- and injury-related characteristics. Nevertheless, screening positive for posttraumatic stress disorder (B = - .09; P < .001), depression (B = - .10; P < .001), or both as a set (B = - .19; P < .001) were the strongest predictors of lower long-term HRQOL. Postinjury HRQOL among service members wounded in combat was associated with service and injury experience, and demographic factors, but was most strongly linked with current mental health status. These findings underscore the significance of mental health issues long after injury. Further, findings reinforce that long-term mental health screening, services, and treatment are needed for those injured in combat.

A guide to wound managment in palliative care.

PubMed

Naylor, Wayne A

2005-11-01

Wound management in palliative patients is often a very challenging area of care. There are many unique issues that can combine to produce complicated wound management scenarios, including the types of wounds and wound symptoms most commonly affecting palliative care patients, as well as the presence of concurrent disease and associated treatment. Problems exist with the availability of suitable dressings and balancing life expectancy with the goals of wound care. A significant, and possibly under-recognized, issue is the emotional and social distress experienced by these patients, which can be directly attributed to their wound. These problems must all be recognized and addressed in order to manage wounds effectively in this patient population. This article aims to explore these issues and offer advice on the management of wound-related symptoms, with the ultimate goal of improving patients' quality of life.

[The war at home: "war amenorrhea" in the First World War].

PubMed

Stukenbrock, Karin

2008-01-01

In 1917, the Göttingen gynaecologist Dietrich published a short article about a phenomenon which he called "war amenorrhea" ("Kriegsamenorrhoe"). The article attracted the attention of his colleagues. While the affected women did not pay much attention to their amenorrhea, the physicians considered the phenomenon a new disease which was mainly caused by the war. This new disease gave the gynaecologists the opportunity to present their specialty as a discipline with high relevance for medicine in times of war. Nevertheless, there was no consensus about the importance, the incidence, the diagnostic criteria, the causes and the appropriate therapy of"war amenorrhea". Although the gynaecologists failed to define a uniform clinical syndrome, they maintained the construction of "war amenorrhea" after the war and subsumed it under well known types of amenorrhea. We can conclude that under the conditions of war a new disease emerged which was not sharply defined.

Application of low-pressure negative pressure wound therapy to ischaemic wounds.

PubMed

Kasai, Yoshiaki; Nemoto, Hitoshi; Kimura, Naohiro; Ito, Yoshinori; Sumiya, Noriyoshi

2012-03-01

Negative pressure wound therapy (NPWT) is a useful wound dressing that can be applied to a wide variety of wounds. Patients with ischaemic wounds, however, may experience further necrosis with NPWT at the commonly recommended pressure of -125 mm Hg. We hypothesized that with a suction pressure of -125 mm Hg, tissue pressure will likely occlude most of the capillaries adjacent to the wound edge. Therefore, we treated three patients with ischaemic wounds using low-pressure NPWT at -50 mm Hg. All wounds healed successfully without further necrosis at the wound edge. Crown Copyright © 2011. Published by Elsevier Ltd. All rights reserved.

Puncture Wounds

MedlinePlus

... into the wound during a puncture, along with dirt and debris from the object. All puncture wounds ... object, such as a rusty nail, the more dirt and debris are dragged into the wound, increasing ...

From Goya to Afghanistan--an essay on the ratio and ethics of medical war pictures.

PubMed

van Bergen, Leo; de Mare, Heidi; Meijman, Frans J

2010-01-01

For centuries pictures of the dead and wounded have been part and parcel of war communications. Often the intentions were clear, ranging from medical instructions to anti-war protests. The public's response could coincide with or diverge from the publisher's intention. Following the invention of photography in the nineteenth century, and the subsequent claim of realism, the veracity of medical war images became more complex. Analysing and understanding such photographs have become an ethical obligation with democratic implications. We performed a multidisciplinary analysis of War Surgery (2008), a book containing harsh, full-colour photographs of mutilated soldiers from the Iraq and Afghanistan wars. Our analysis shows that, within the medical context, this book is a major step forward in medical war communication and documentation. In the military context the book can be conceived as an attempt to put matters right given the enormous sacrifice some individuals have suffered. For the public, the relationship between the 'reality' and 'truth' of such photographs is ambiguous, because only looking at the photographs without reading the medical context is limiting. If the observer is not familiar with medical practice, it is difficult for him to fully assess, signify and acknowledge the value and relevance of this book. We therefore assert the importance of the role of professionals and those in the humanities in particular in educating the public and initiating debate.

The wound/burn guidelines - 1: Wounds in general.

PubMed

Inoue, Yuji; Hasegawa, Minoru; Maekawa, Takeo; Le Pavoux, Andres; Asano, Yoshihide; Abe, Masatoshi; Ishii, Takayuki; Ito, Takaaki; Isei, Taiki; Imafuku, Shinichi; Irisawa, Ryokichi; Ohtsuka, Masaki; Ohtsuka, Mikio; Ogawa, Fumihide; Kadono, Takafumi; Kodera, Masanari; Kawakami, Tamihiro; Kawaguchi, Masakazu; Kukino, Ryuichi; Kono, Takeshi; Sakai, Keisuke; Takahara, Masakazu; Tanioka, Miki; Nakanishi, Takeshi; Nakamura, Yasuhiro; Hashimoto, Akira; Hayashi, Masahiro; Fujimoto, Manabu; Fujiwara, Hiroshi; Matsuo, Koma; Madokoro, Naoki; Yamasaki, Osamu; Yoshino, Yuichiro; Tachibana, Takao; Ihn, Hironobu

2016-04-01

The Japanese Dermatological Association determined to prepare the Wound/Burn Guidelines focusing on treatments, catering to needs for the clinical practice of dermatology. Among these guidelines, "Wounds in General" was intended to explain knowledge necessary "to heal wounds" without specifying particular disorders. © 2016 Japanese Dermatological Association.

Dermal Wound Transcriptomic Responses to Infection with Pseudomonas aeruginosa versus Klebsiella pneumoniae in a Rabbit Ear Wound Model

DTIC Science & Technology

2014-05-02

harvested on POD4 for microarray and transcriptome analysis. Other wounds received topical antibiotic after infection for 24 hours to promote biofilm ...cell toxicity in response to a more damaging P.a. inflammatory milieu. The POD6 wounds were colonized with biofilm but expressed magnitudes fewer...infection for 24 hours to promote biofilm development, and were harvested on POD6 or POD12. Results: Wounds infected for 24 hours, relative to uninfected

Emerging topics in cutaneous wound repair.

PubMed

Valacchi, Giuseppe; Zanardi, Iacopo; Sticozzi, Claudia; Bocci, Velio; Travagli, Valter

2012-07-01

The intervention strategies in various types of skin wounds include several treatment programs that depend on the identified disease. Several factors such as aging, defective nutrition, traumatism, atherosclerosis, and diabetes may contribute to the formation of a wound that has no tendency to heal due to a defective and complicated repair process. The numerous advances in the understanding of the wound-healing process in both acute and chronic lesions have been recently described. The purpose of this paper is to describe relatively new approaches as viable alternatives to current wound-healing therapies. The future challenges for both the best targeting and optimization of these potential treatments are also described. © 2012 New York Academy of Sciences.

In Vivo Assessment of Protease Dynamics in Cutaneous Wound Healing by Degradomics Analysis of Porcine Wound Exudates*

PubMed Central

Sabino, Fabio; Hermes, Olivia; Egli, Fabian E.; Kockmann, Tobias; Schlage, Pascal; Croizat, Pierre; Kizhakkedathu, Jayachandran N.; Smola, Hans; auf dem Keller, Ulrich

2015-01-01

Proteases control complex tissue responses by modulating inflammation, cell proliferation and migration, and matrix remodeling. All these processes are orchestrated in cutaneous wound healing to restore the skin's barrier function upon injury. Altered protease activity has been implicated in the pathogenesis of healing impairments, and proteases are important targets in diagnosis and therapy of this pathology. Global assessment of proteolysis at critical turning points after injury will define crucial events in acute healing that might be disturbed in healing disorders. As optimal biospecimens, wound exudates contain an ideal proteome to detect extracellular proteolytic events, are noninvasively accessible, and can be collected at multiple time points along the healing process from the same wound in the clinics. In this study, we applied multiplexed Terminal Amine Isotopic Labeling of Substrates (TAILS) to globally assess proteolysis in early phases of cutaneous wound healing. By quantitative analysis of proteins and protein N termini in wound fluids from a clinically relevant pig wound model, we identified more than 650 proteins and discerned major healing phases through distinctive abundance clustering of markers of inflammation, granulation tissue formation, and re-epithelialization. TAILS revealed a high degree of proteolysis at all time points after injury by detecting almost 1300 N-terminal peptides in ∼450 proteins. Quantitative positional proteomics mapped pivotal interdependent processing events in the blood coagulation and complement cascades, temporally discerned clotting and fibrinolysis during the healing process, and detected processing of complement C3 at distinct time points after wounding and by different proteases. Exploiting data on primary cleavage specificities, we related candidate proteases to cleavage events and revealed processing of the integrin adapter protein kindlin-3 by caspase-3, generating new hypotheses for protease

War-related experiences of former child soldiers in northern Uganda: comparison with non-recruited youths.

PubMed

Vindevogel, Sofie; Schryver, Maarten de; Broekaert, Eric; Derluyn, Ilse

2013-11-01

Armed conflict imposes huge hardship on young people living in war zones. This study assessed former child soldiers' experience and perception of stress in common war events during the armed conflict in northern Uganda and compares it with their non-recruited counterparts. To investigate whether child soldiers experienced more severe exposure to war events, and explore how war might affect youths differently, depending on the co-occurrence of these events. The study was undertaken in four northern Ugandan districts in 22 secondary schools with a sample size of 981 youths, about half of whom had been child soldiers. The participants completed a questionnaire on socio-demographic characteristics and stressful war events which was analyzed using descriptive statistics, a probabilistic index and correlation network analysis. Former child soldiers had significantly greater experience of war events than their non-recruited counterparts. The violence of war is more central in their experience and perception of stress, whereas the scarcity of resources and poor living conditions are most central for non-recruited participants. The extent to which a war event, such as separation from the family, is perceived as stressful depends on the experience and perception of other stressful war events, such as confrontation with war violence for former child soldiers and life in an Internally Displaced Persons' camp for non-recruited participants. The network approach permitted demonstration of the many ways in which war-affected youths encounter and appraise stressful war events. War events might function as moderators or mediators of the effect that other war events exert on the lives and well-being of young people living in war zones. This demands comprehensive and individualized assessment.

Development of a wound healing index for patients with chronic wounds.

PubMed

Horn, Susan D; Fife, Caroline E; Smout, Randall J; Barrett, Ryan S; Thomson, Brett

2013-01-01

Randomized controlled trials in wound care generalize poorly because they exclude patients with significant comorbid conditions. Research using real-world wound care patients is hindered by lack of validated methods to stratify patients according to severity of underlying illnesses. We developed a comprehensive stratification system for patients with wounds that predicts healing likelihood. Complete medical record data on 50,967 wounds from the United States Wound Registry were assigned a clear outcome (healed, amputated, etc.). Factors known to be associated with healing were evaluated using logistic regression models. Significant variables (p < 0.05) were determined and subsequently tested on a holdout sample of data. A different model predicted healing for each wound type. Some variables predicted significantly in nearly all models: wound size, wound age, number of wounds, evidence of bioburden, tissue type exposed (Wagner grade or stage), being nonambulatory, and requiring hospitalization during the course of care. Variables significant in some models included renal failure, renal transplant, malnutrition, autoimmune disease, and cardiovascular disease. All models validated well when applied to the holdout sample. The "Wound Healing Index" can validly predict likelihood of wound healing among real-world patients and can facilitate comparative effectiveness research to identify patients needing advanced therapeutics. © 2013 by the Wound Healing Society.

Victimization and adversity among children experiencing war-related parental absence or deployment in a nationally representative US sample.

PubMed

Turner, Heather A; Finkelhor, David; Hamby, Sherry; Henly, Megan

2017-05-01

This study compares children and youth who have experienced lifetime war-related parental absence or deployment with those having no such history on a variety of victimization types, non-victimization adversity, trauma symptoms, and delinquency; and assesses whether cumulative adversity and victimization help to explain elevated emotional and behavioral problems among children of parents who have experienced war-related absence or deployment. The National Surveys of Children's Exposure to Violence (NatSCEV) are comprised of three cross-sectional telephone surveys conducted in 2008, 2011, and 2014. Data were collected on the experiences of children aged one month to seventeen years. In each survey, interviews were conducted with youth 10-17 years old and with caregivers of children 0-9 years old. The analyses use pooled data from all three U.S. nationally-representative samples (total sample size of 13,052). Lifetime parental war-related absence or deployment was a marker for elevated childhood exposure to a wide array of victimization and adversity types. Cumulative past year exposure to multiple forms of victimization and adversity fully explained elevated trauma symptoms and delinquency in this population of children. Given the breadth of victimization and adversity risk, children with histories of parental war-related absence or deployment, as well as their families, represent important target groups for broad-based prevention and interventions to reduce exposure and ameliorate consequences when it does occur. Copyright © 2017 Elsevier Ltd. All rights reserved.

Overcoming wound complications in head and neck salvage surgery.

PubMed

Kwon, Daniel; Genden, Eric M; de Bree, Remco; Rodrigo, Juan P; Rinaldo, Alessandra; Sanabria, Alvaro; Rapidis, Alexander D; Takes, Robert P; Ferlito, Alfio

2018-04-21

Loco-regional treatment failure after radiotherapy with or without chemotherapy and/or prior surgery represents a significant portion of head and neck cancer patients. Due to a wide array of biological interactions, these patients have a significantly increased risk of complications related to wound healing. Review of the current literature was performed for wound healing pathophysiology, head and neck salvage surgery, and wound therapy. The biology of altered wound healing in the face of previous surgery and chemoradiotherapy is well described in the literature. This is reflected in multiple clinical studies demonstrating increased rates of wound healing complications in salvage surgery, most commonly in the context of previous irradiation. Despite these disadvantages, multiple studies have described strategies to optimize healing outcomes. The literature supports preoperative optimization of known wound healing factors, adjunctive wound care modalities, and microvascular free tissue transfer for salvage surgery defects and wounds. Previously treated head and neck patients requiring salvage surgery have had a variety of disadvantages related to wound healing. Recognition and treatment of these factors can help to reverse adverse tissue conditions. A well-informed approach to salvage surgery with utilization of free vascularized or pedicled tissue transfer as well as optimizing wound healing factors is essential to obtaining favorable outcomes. Copyright © 2018 Elsevier B.V. All rights reserved.

Effect of war on the menstrual cycle.

PubMed

Hannoun, Antoine B; Nassar, Anwar H; Usta, Ihab M; Zreik, Tony G; Abu Musa, Antoine A

2007-04-01

To study the effect of a short period of war on the menstrual cycles of exposed women. Six months after a 16-day war, women in exposed villages aged 15-45 years were asked to complete a questionnaire relating to their menstrual history at the beginning, 3 months after, and 6 months after the war. A control group, not exposed to war, was also interviewed. The data collected were analyzed to estimate the effect of war on three groups of women: those who stayed in the war zone for 3-16 days (Group A), those who were displaced within 2 days to safer areas (Group B), and women not exposed to war or displacement (Group C-control). More than 35% of women in Group A and 10.5% in Group B had menstrual aberrations 3 months after the cessation of the war. These percentages were significantly different from each other and from that in Group C (2.6%). Six months after the war most women regained their regular menstrual cycles with the exception of 18.6% in Group A. We found a short period of war, acting like an acute stressful condition, resulted in menstrual abnormalities in 10-35% of women and is probably related to the duration of exposure to war. This might last beyond the war time and for more than one or two cycles. In most women the irregular cycles reversed without any medical intervention. II.

The Hanikoda Method: 3-layered Negative Pressure Wound Therapy in Wound Bed Preparation.

PubMed

Chik, Ian; Kelly, Enda G; Jarmin, Razman; Imran, Farrah-Hani

2016-10-01

Negative pressure wound therapy is a widely used method of wound dressing with various commercially available brands. The authors created the Hanikoda Method (HM) for effective wound bed preparation or definite wound closure. In this case series, the authors discuss 8 different wound cases that presented to their Plastics Unit from January 2014 to June 2015. Patients with traumatic or infected wounds were selected for treatment with the HM. Selected patients underwent multiple cycles of this method until their wounds were ready for definite wound closure or the wounds had closed by secondary closure. The purpose of any wound dressing is to encourage epithelization while ensuring no factors impede wound healing. An additional benefit is to reduce wound bed size so that it may close by secondary intention or require less skin graft coverage. Each layer of the dressing is described, along with its function in wound bed preparation or in closure. The HM facilitates reduction of wound size, wound bed preparation, and overall management.

Cost-effective wound management: a survey of 1717 nurses.

PubMed

Newton, Heather

2017-06-22

Delivering high-quality wound care requires a mix of knowledge and skills, which nurses aim to update by attending educational events such as conferences and study days. This article describes the data obtained from 30 educational study days, which took place across England, Scotland and Wales. It will explore nurses' knowledge in relation to the cost-effectiveness and clinical efficacy of current wound care practices, based on the answers of 1717 delegates that attended the events. It will also outline the results in relation to reducing expenditure on wound dressings and the importance of performing an accurate wound assessment.

Terrorism, civil war and related violence and substance use disorder morbidity and mortality: a global analysis.

PubMed

Kerridge, Bradley T; Khan, Maria R; Rehm, Jürgen; Sapkota, Amir

2014-03-01

The purpose of this study is to examine associations between deaths owing to terrorism, civil war, and one-sided violence from 1994-2000 and substance use disorder disability-adjusted life years (DALYs). The relationship between terrorism, and related violence and substance use disorder morbidity and mortality among World Health Organization Member States in 2002, controlling for adult per capita alcohol consumption, illicit drug use, and economic variables at baseline in 1994. Deaths as a result of terrorism and related violence were related to substance use disorder DALYs: a 1.0% increase in deaths as a result of terrorism, war and one-sided violence was associated with an increase of between 0.10% and 0.12% in alcohol and drug use disorder DALYs. Associations were greater among males and 15-44 year-old. Terrorism, war and one-sided violence may influence morbidity and mortality attributable to substance use disorders in the longer-term suggests that more attention to be given to rapid assessment and treatment of substance use disorders in conflict-affected populations with due consideration of gender and age differences that may impact treatment outcomes in these settings. Priorities should be established to rebuild substance abuse treatment infrastructures and treat the many physical and mental comorbid disorders. Copyright © 2014. Published by Elsevier Ltd.

Dual therapeutic functions of F-5 fragment in burn wounds: preventing wound progression and promoting wound healing in pigs

PubMed Central

Bhatia, Ayesha; O’Brien, Kathryn; Chen, Mei; Wong, Alex; Garner, Warren; Woodley, David T.; Li, Wei

2016-01-01

Burn injuries are a leading cause of morbidity including prolonged hospitalization, disfigurement, and disability. Currently there is no Food and Drug Administration-approved burn therapeutics. A clinical distinction of burn injuries from other acute wounds is the event of the so-called secondary burn wound progression within the first week of the injury, in which a burn expands horizontally and vertically from its initial boundary to a larger area. Therefore, an effective therapeutics for burns should show dual abilities to prevent the burn wound progression and thereafter promote burn wound healing. Herein we report that topically applied F-5 fragment of heat shock protein-90α is a dual functional agent to promote burn wound healing in pigs. First, F-5 prevents burn wound progression by protecting the surrounding cells from undergoing heat-induced caspase 3 activation and apoptosis with increased Akt activation. Accordingly, F-5–treated burn and excision wounds show a marked decline in inflammation. Thereafter, F-5 accelerates burn wound healing by stimulating the keratinocyte migration-led reepithelialization, leading to wound closure. This study addresses a topical agent that is capable of preventing burn wound progression and accelerating burn wound healing. PMID:27382602

Dual therapeutic functions of F-5 fragment in burn wounds: preventing wound progression and promoting wound healing in pigs.

PubMed

Bhatia, Ayesha; O'Brien, Kathryn; Chen, Mei; Wong, Alex; Garner, Warren; Woodley, David T; Li, Wei

2016-01-01

Burn injuries are a leading cause of morbidity including prolonged hospitalization, disfigurement, and disability. Currently there is no Food and Drug Administration-approved burn therapeutics. A clinical distinction of burn injuries from other acute wounds is the event of the so-called secondary burn wound progression within the first week of the injury, in which a burn expands horizontally and vertically from its initial boundary to a larger area. Therefore, an effective therapeutics for burns should show dual abilities to prevent the burn wound progression and thereafter promote burn wound healing. Herein we report that topically applied F-5 fragment of heat shock protein-90α is a dual functional agent to promote burn wound healing in pigs. First, F-5 prevents burn wound progression by protecting the surrounding cells from undergoing heat-induced caspase 3 activation and apoptosis with increased Akt activation. Accordingly, F-5-treated burn and excision wounds show a marked decline in inflammation. Thereafter, F-5 accelerates burn wound healing by stimulating the keratinocyte migration-led reepithelialization, leading to wound closure. This study addresses a topical agent that is capable of preventing burn wound progression and accelerating burn wound healing.

The impact of quercetin on wound healing relates to changes in αV and β1 integrin expression.

PubMed

Doersch, Karen M; Newell-Rogers, M Karen

2017-08-01

matrix through the regulation of integrin expression to promote a decrease in fibrosis. Furthermore, this work demonstrates that this naturally occurring and commercially available supplement could be used to improve wound healing by impacting integrin expression, leading to a lower extracellular matrix requirement to achieve healing. Impact statement Scar formation during wound healing can be problematic for patients but there are limited therapies available to treat or prevent excess fibrosis at wound sites. This work examines the impact of quercetin, a flavonoid that decreases fibrosis, on wound healing, and relates quercetin's effects to changes in integrin expression on the surface of fibroblast cells. To our knowledge, this is the first report that quercetin alters integrin expression or that this impact may be part of the mechanism by which quercetin prevents fibrosis. This work demonstrates that quercetin can be used to modulate integrin expression and that this effect may in turn reduce fibrosis during wound healing. Furthermore, this paper identifies the modulation of integrin expression as a possible therapeutic target in preventing scars. This information could be used to improve therapeutics to aid in the cosmetic and functional results following wound healing.

Wound Healing in PatientsWith Cancer

PubMed Central

Payne, Wyatt G.; Naidu, Deepak K.; Wheeler, Chad K.; Barkoe, David; Mentis, Marni; Salas, R. Emerick; Smith, David J.; Robson, Martin C.

2008-01-01

Objective: The treatment of patients with cancer has advanced into a complex, multimodal approach incorporating surgery, radiation, and chemotherapy. Managing wounds in this population is complicated by tumor biology, the patient's disease state, and additional comorbidities, some of which may be iatrogenic. Radiation therapy, frequently employed for local-regional control of disease following surgical resection, has quantifiable negative healing effects due to local tissue fibrosis and vascular effects. Chemotherapeutic agents, either administered alone or as combination therapy with surgery and radiation, may have detrimental effects on the rapidly dividing tissues of healing wounds. Overall nutritional status, often diminished in patients with cancer, is an important aspect to the ability of patients to heal after surgical procedures and/or treatment regimens. Methods: An extensive literature search was performed to gather pertinent information on the topic of wound healing in patients with cancer. The effects that surgical procedures, radiation therapy, chemotherapy, and nutritional deficits play in wound healing in these patients were reviewed and collated. Results: The current knowledge and treatment of these aspects of wound healing in cancer patients are discussed, and observations and recommendations for optimal wound healing results are considered. Conclusion: Although wound healing may proceed in a relatively unimpeded manner for many patients with cancer, there is a potential for wound failure due to the nature and effects of the oncologic disease process and its treatments. PMID:18264518

Wound treatment and pain management: a stressful time.

PubMed

Matsuzaki, Kyoichi; Upton, Dominic

2013-12-01

This review and case study report considers the evidence to indicate that the progress of wound healing is negatively affected by the presence of stressors and in circumstances where patients are in pain. It considers the relationship between perceptions of pain, stress and delayed wound healing with a specific focus on guidance for clinical practice. It is appreciated that although the literature has examined these issues in the management of acute wounds, demonstrating that psychological stress can have detrimental effects on the wound-healing process, the evidence to support this link in relation to chronic wounds is limited. The review considers evidence indicating that punch biopsy wounds heal more slowly in subjects under stress on account of caring for family members with long-term illnesses and also considers briefly the relationship between cortisol secretion in response to stress and the consequent influences on cytokine levels and the wound-healing process. © 2012 The Authors. International Wound Journal © 2012 John Wiley & Sons Ltd and Medicalhelplines.com Inc.

"War dysentery" and the limitations of German military hygiene during World War I.

PubMed

Linton, Derek S

2010-01-01

This article examines major epidemics of bacillary dysentery in the German army as well as among civilians in eastern Europe and in Germany during World War I. These epidemics were all the more surprising in light of prewar advances in understanding the disease and limiting dysentery outbreaks. Three major reasons are adduced for the incapacity of German military hygienists to prevent wartime epidemics. First was the difficulty of bacteriological testing at the front, especially early in the war, with negative consequences for diagnosis, therapy, and disease control. Second was inadequate hygiene including major shortcomings in latrine cleanliness and attempts to grapple with the "fly plague." Third was the lack of a Pasteur-type vaccine until late in the war. Susceptibility to dysentery was also heightened by war-related nutritional deficiencies. Taking off from an article by the English medical historian Roger Cooter, this article shows that the concept of "war dysentery" was socially constructed and served a variety of professional interests but at the same time takes issue with Cooter's arguments against linking "war" and "epidemics" pathogenetically.

Clinical approach to wounds: débridement and wound bed preparation including the use of dressings and wound-healing adjuvants.

PubMed

Attinger, Christopher E; Janis, Jeffrey E; Steinberg, John; Schwartz, Jaime; Al-Attar, Ali; Couch, Kara

2006-06-01

This is a clinical review of current techniques in wound bed preparation found to be effective in assisting the wound-healing process. The process begins with the identification of a correct diagnosis of the wound's etiology and continues with optimizing the patient's medical condition, including blood flow to the wound site. Débridement as the basis of most wound-healing strategies is then emphasized. Various débridement techniques, including surgery, topical agents, and biosurgery, are thoroughly discussed and illustrated. Wound dressings, including the use of negative pressure wound therapy, are then reviewed. To properly determine the timing of advance therapeutic intervention, the wound-healing progress needs to be monitored carefully with weekly measurements. A reduction in wound area of 10 to 15 percent per week represents normal healing and does not mandate a change in the current wound-healing strategy. However, if this level of wound area reduction is not met consistently on a weekly basis, then alternative healing interventions should be considered. There is a growing body of evidence that can provide guidance on the appropriate use of such adjuvants in the problem wound. Several adjuvants are discussed, including growth factor, bioengineered tissues, and hyperbaric medicine.

Psychological distress in young adults exposed to war-related trauma in childhood.

PubMed

Llabre, Maria M; Hadi, Fawzyiah; La Greca, Annette M; Lai, Betty S

2015-01-01

We tested a conceptual model of the effect of war-trauma exposure in childhood on psychological distress in young adulthood. Participants included 151 urban Kuwaiti children (51% female; M age = 10.62 years) exposed to the 1990-1991 Gulf crisis (assessed in 1993); participants also included 140 parents (81% female; M age mothers = 36.50 years; M age fathers = 41 years). In 2003, 120 participants were reassessed as young adults (50% female; M age = 21.19 years). The conceptual model was evaluated with structural equations. War-trauma exposure was associated with psychological distress in children and parents, but parents reported larger effects than children. Parents' psychological distress did not contribute to children's psychological distress. Children's psychological distress did not dissipate over time. Social support may function as a potential mediator of the effect of war-trauma exposure on psychological distress. Findings support the importance of early detection and treatment of children exposed to war trauma. Findings also implicate social support as a factor to consider in clinical interventions for children exposed to war trauma.

The permanent relation between biology, power and war: the dual use of the biotechnological development.

PubMed

de Almeida, Maria Eneida

2015-07-01

Throughout the twentieth century, the biological advance had a closer and closer relation with the strategies of power in search of high technology. From 1970, the manipulation of genetically recombined pathogenic agents was a high technological breakthrough that radically over passed traditional biology and reinforced the war relations of science. The biotechnological revolution started along with new perspectives for the political and military field of science. From this point of the biotechnological development a new paradigm for war, as well as for the sciences of life, was then created and new challenges for International Health in the twenty first century came into scene. Through a historical account related to power, this paper is meant to present the mechanism of articulation existent between science and power and to contribute for understanding how the military field is naturally inserted in the biotechnological development which, in its essence, produces biotechnologies for civil and military uses.

Best practice wound care.

PubMed

O'Brien, Melissa L; Lawton, Joanna E; Conn, Chris R; Ganley, Helen E

2011-04-01

This article describes the barriers, changes and achievements related to implementing one element of a wound care programme being best practice care. With the absence of a coordinated approach to wound care, clinical practice within our Area Health Service (AHS) was diverse, inconsistent and sometimes outdated. This was costly and harmful, leading to overuse of unhelpful care, underuse of effective care and errors in execution. The major aim was to improve the outcomes and quality of life for patients with wound care problems within our community. A collaborative across ten sites/services developed, implemented and evaluated policies and guidelines based on evidence-based bundles of care. Key barriers were local resistance and lack of experience in implementing structural and cultural changes. This was addressed by appointing a wound care programme manager, commissioning of a strategic oversight committee and local wound care committees. The techniques of spread and adoption were used, with early adopters making changes observable and allowing local adaption of guidelines, where appropriate. Deployment and improvement results varied across the sites, ranging from activity but no changes in practice to modest improvement in practice. Evaluating implementation of the leg ulcer guideline as an exemplar, it was demonstrated that there was a statistically significant improvement in overall compliance from 26% to 84%. However, only 7·7% of patients received all interventions to which they were entitled. Compliance with the eight individual interventions of the bundle ranged from 26% to 84%. Generic performance was evaluated against the wound assessment, treatment and evaluation plan with an average compliance of 70%. Early results identified that 20% of wounds were healed within the target of 10 days. As more standardised process are implemented, clinical outcomes should continue to improve and costs decrease. © 2011 The Authors. © 2011 Blackwell Publishing Ltd and

Irradiation at 660 nm modulates different genes central to wound healing in wounded and diabetic wounded cell models

NASA Astrophysics Data System (ADS)

Houreld, Nicolette N.

2014-02-01

Wound healing is a highly orchestrated process and involves a wide variety of cellular components, chemokines and growth factors. Laser irradiation has influenced gene expression and release of various growth factors, cytokines and extracellular matrix proteins involved in wound healing. This study aimed to determine the expression profile of genes involved in wound healing in wounded and diabetic wounded fibroblast cells in response to irradiation at a wavelength of 660 nm. Human skin fibroblast cells (WS1) were irradiated with a diode laser (wavelength 660 nm; fluence 5 J/cm2; power output 100 mW; power density 11 mW/cm2; spot size 9.1 cm2; exposure duration 7 min 35 s). Total RNA was isolated and 1 μg reverse transcribed into cDNA which was used as a template in real-time qualitative polymerase chain reaction (qPCR). Eighty four genes involved in wound healing (extracellular matrix and cell adhesion; inflammatory cytokines and chemokines; growth factors; and signal transduction) were evaluated in wounded and diabetic wounded cell models. Forty eight hours post-irradiation, 6 genes were significantly upregulated and 8 genes were down-regulated in irradiated wounded cells, whereas 1 gene was up-regulated and 33 genes down-regulated in irradiated diabetic wounded cells. Irradiation of stressed fibroblast cells to a wavelength of 660 nm and a fluence of 5 J/cm2 modulated the expression of different genes involved in wound healing in different cell models. Modulation of these genes leads to the effects of laser irradiation seen both in vivo and in vitro, and facilitates the wound healing process.

Portuguese War Veterans: Moral Injury and Factors Related to Recovery From PTSD.

PubMed

Ferrajão, Paulo Correia; Aragão Oliveira, Rui

2016-01-01

This study explored the factors to which a sample of Portuguese war veterans attributed their recovery from posttraumatic stress disorder (PTSD). Participants were a sample of veterans (N = 60) with mental sequelae of the Portuguese Colonial War: 30 suffered from chronic PTSD (unrecovered) and 30 veterans with remission from PTSD (recovered). Two semistructured interviews were conducted. Analysis of the interviews was conducted using the Thematic and Categorical Analysis. Results showed that unrecovered participants reported higher postwar betrayal, appraisal of hostile societal homecoming, social stigmatization, lack of personal resources (mental fatigue and restriction of coping strategies), and reduced perceived social support. Recovered participants verbalized some capability for self-awareness of their own mental states and/or awareness of others' mental states (mentalization ability), a wider repertoire of coping strategies, and higher perceived social support. The authors discussed that recovery from PTSD among veterans can be related to the assimilation of moral injury by developing higher mentalization abilities. © The Author(s) 2015.

Bromelain ameliorates the wound microenvironment and improves the healing of firearm wounds.

PubMed

Wu, Si-Yu; Hu, Wei; Zhang, Bo; Liu, Shuai; Wang, Jian-Min; Wang, Ai-Min

2012-08-01

In a previous study, we proposed a new therapy using topical bromelain as a supplement to simple wound-track incision for the debridement of firearm wounds. This enzymatic debridement greatly simplified the management of high-velocity gunshot wounds in a pig model, and bromelain was confirmed to improve wound healing. The purpose of the present study was to investigate the effect of bromelain on the microenvironment of firearm wounds. Sixteen Chinese landrace pigs wounded by high-velocity projectiles were divided randomly into four groups: wound incision (group I), incision + bromelain (group IB), wound excision (group E), and control. Blood perfusion, oxygen partial pressure (pO(2)), and the content of tumor necrosis factor (TNF)-α and transforming growth factor (TGF)-β in wound-track tissue were measured. Wound healing was also noted. The recovery of blood perfusion in tissue and pO(2) in wound tracks was significantly more rapid in group IB and group E than in group I and control. The tissue level of TNF-α was significantly lower in group IB than in group I and control 48 h and 72 h post-wounding, and was lower than in group E 48 h post-wounding. The tissue level of TGF-β in group IB was sustained at a significantly higher level than in the other three groups. Wound healing time was also shorter in group IB. Enzymatic debridement using topical bromelain in incised wound tracks accelerates the recovery of blood perfusion, pO(2) in wound tissue, controls the expression of TNF-α and raises the expression of TGF-β. Copyright © 2012 Elsevier Inc. All rights reserved.

Automatic wound infection interpretation for postoperative wound image

NASA Astrophysics Data System (ADS)

Hsu, Jui-Tse; Ho, Te-Wei; Shih, Hsueh-Fu; Chang, Chun-Che; Lai, Feipei; Wu, Jin-Ming

2017-02-01

With the growing demand for more efficient wound care after surgery, there is a necessity to develop a machine learning based image analysis approach to reduce the burden for health care professionals. The aim of this study was to propose a novel approach to recognize wound infection on the postsurgical site. Firstly, we proposed an optimal clustering method based on unimodal-rosin threshold algorithm to extract the feature points from a potential wound area into clusters for regions of interest (ROI). Each ROI was regarded as a suture site of the wound area. The automatic infection interpretation based on the support vector machine is available to assist physicians doing decision-making in clinical practice. According to clinical physicians' judgment criteria and the international guidelines for wound infection interpretation, we defined infection detector modules as the following: (1) Swelling Detector, (2) Blood Region Detector, (3) Infected Detector, and (4) Tissue Necrosis Detector. To validate the capability of the proposed system, a retrospective study using the confirmation wound pictures that were used for diagnosis by surgical physicians as the gold standard was conducted to verify the classification models. Currently, through cross validation of 42 wound images, our classifiers achieved 95.23% accuracy, 93.33% sensitivity, 100% specificity, and 100% positive predictive value. We believe this ability could help medical practitioners in decision making in clinical practice.

Missile war injuries of the face.

PubMed

Kummoona, Raja K

2011-11-01

In a society struggling to rebuild its country after 3 decades of years of dictatorships and wars, Iraqi maxillofacial and craniofacial surgeons play a critical role in treatment of many most serious terrorist missile injuries of the face by ongoing conflict in Iraq. This study reflects our surgical techniques of treating explosive missile injuries and other combat- and terrorism-related injuries and also evaluates the immediate and secondary phase managements of patients with missile injuries. This study includes 235 patients with missile war injuries of the face during a period of 4 years; all injured patients were treated in the Maxillofacial Unit of Surgical Specialties Hospital, Medical City, Baghdad. There were 195 men and 40 women; their ages ranged from 1 to 70 years (mean, 39.5 years). Posttraumatic missile facial deformities were classified as follows: 95 patients (40.43%) had bone loss; 72 patients (30.64%) had soft tissue loss; 33 patients (14.05%) had orbital injuries; and 35 patients (14.90%) had other deformities of scar contracture, fistula, and sinus formation. Two techniques were used for reconstruction of the bony defect, either by bone chips carried by osteomesh tray harvested from the iliac crest or by free block of corticocancellous bone graft from the iliac crest. Soft tissue reconstruction was done by local flaps and regional flaps such as lateral cervical and cervicofacial flaps, and the orbit was reconstructed by bone graft, lyophilized dura, and sialastic implant. Scar contracture was treated by scar revision and sinus tract excised at the same time of scar revision. In conclusion, the primary phase required an urgent airway management, controlling an active bleeding by surgical intervention; most entrance and exit wounds as well as retained missiles were located in the cheek, chin, and mandibular body, with few cases of mortality due to complications related to head injuries. The secondary phase management of deformities of the face as a

War Literature. [Lesson Plan].

ERIC Educational Resources Information Center

Soderquist, Alisa

Based on Stephen Crane's poems about war and his novel "The Red Badge of Courage," this lesson plan presents activities designed to help students understand that Crane examined war-related themes in prose and poetry; that close study of a poem for oral presentation helps readers see meaning or techniques not noted earlier; and that not all readers…

Sleeping under the threat of the Scud: war-related environmental insomnia.

PubMed

Lavie, P; Carmeli, A; Mevorach, L; Liberman, N

1991-01-01

The influence of the Scud missile attacks during the Persian Gulf war on the sleep of the Israeli population is described. Our study group comprised a random sample of 200 people (mean age 41.13 +/- 15.32) who were contacted by telephone during the third week of the war and interviewed about their sleep. Overall, 28% of the entire sample complained about sleep: 10% complained about mid-sleep awakenings, 4.5% on difficulties falling asleep, and 13.5% about the combination of the two. People living in the Tel Aviv and Haifa areas complained significantly more than those in the rest of the country. Women complained significantly more than men, and people with lower education complained significantly more than people with higher education. Only 3% of the sample reported using sleeping pills. During the war actigraphic sleep recordings in 19 adults living in the Tel Aviv and Haifa areas did not reveal any measurable decrease in sleep quality in comparison with pre-war recordings. Possible explanations for the discrepancy between the subjective and objective assessments are discussed.

Advances in Wound Healing: A Review of Current Wound Healing Products

PubMed Central

Murphy, Patrick S.; Evans, Gregory R. D.

2012-01-01

Successful wound care involves optimizing patient local and systemic conditions in conjunction with an ideal wound healing environment. Many different products have been developed to influence this wound environment to provide a pathogen-free, protected, and moist area for healing to occur. Newer products are currently being used to replace or augment various substrates in the wound healing cascade. This review of the current state of the art in wound-healing products looks at the latest applications of silver in microbial prophylaxis and treatment, including issues involving resistance and side effects, the latest uses of negative pressure wound devices, advanced dressings and skin substitutes, biologic wound products including growth factor applications, and hyperbaric oxygen as an adjunct in wound healing. With the abundance of available products, the goal is to find the most appropriate modality or combination of modalities to optimize healing. PMID:22567251

C. elegans epidermal wounding induces a mitochondrial ROS burst that promotes wound repair

PubMed Central

Xu, Suhong; Chisholm, Andrew D.

2014-01-01

SUMMARY Reactive oxygen species (ROS) such as hydrogen peroxide are generated at wound sites and act as long-range signals in wound healing. The roles of other ROS in wound repair are little explored. Here we reveal a cytoprotective role for mitochondrial ROS (mtROS) in C. elegans skin wound healing. We show that skin wounding causes local production of mtROS superoxide at the wound site. Inhibition of mtROS levels by mitochondrial superoxide-specific antioxidants blocks actin-based wound closure, whereas elevation of mtROS promotes wound closure and enhances survival of mutant animals defective in wound healing. mtROS act downstream of wound-triggered Ca2+ influx. We find that the Mitochondrial Calcium Uniporter MCU-1 is essential for rapid mitochondrial Ca2+ uptake and mtROS production after wounding. mtROS can promote wound closure by local inhibition of Rho GTPase activity via a redox-sensitive motif. These findings delineate a pathway acting via mtROS that promotes cytoskeletal responses in wound healing. PMID:25313960

Caring for our wounded warriors: A qualitative examination of health-related quality of life in caregivers of individuals with military-related traumatic brain injury

PubMed Central

Carlozzi, Noelle E.; Brickell, Tracey A.; Psych, D.; French, Louis M.; Sander, Angelle; Kratz, Anna L.; Tulsky, David S.; Chiaravalloti, Nancy D.; Hahn, Elizabeth A.; Kallen, Michael; Austin, Amy M.; Miner, Jennifer A.; Lange, Rael T.

2016-01-01

Objective To develop a conceptual framework that captures aspects of health-related quality of life (HRQOL) for caregivers of individuals with military-related traumatic brain injury (TBI). Design Qualitative data from nine focus groups composed of caregivers of wounded warriors with a medically documented TBI were analyzed. Setting Focus group participants were recruited through Walter Reed National Military Medical Center (WRNMMC), community outreach and support groups. Participants 45 caregivers of wounded warriors who had sustained a mild, moderate, severe, or penetrating TBI. Results Qualitative frequency analysis indicated that caregivers most frequently discussed social health (44% of comments), followed by emotional (40%) and physical health (12%). Areas of discussion that were specific to this population included: anger regarding barriers to health services (for caregivers and service members), emotional suppression (putting on a brave face for others, even when things are not going well), and hypervigilance (controlling one’s behavior/environment to prevent upsetting the service member). Conclusion Caring for wounded warriors with TBI is a complex experience that positively and negatively affects HRQOL. While some aspects of HRQOL can be evaluated with existing measures, evaluation of other important components does not exist. The development of military-specific measures would help facilitate better care for these individuals. PMID:27997672

Occurrence of Wounds in Nigerian Horses.

PubMed

Agina, Onyinyechukwu A; Ihedioha, John I

2017-01-01

This study investigated the occurrence of wounds in Nigerian horses. The study population was 1,621 horses sold at the Obollo Afor horse lairage in Enugu State, Nigeria, during a 6-month period: 3 months of dry season and 3 months of rainy season (February-April and June-August 2012). A total of 207 horses were systematically sampled and subjected to a comprehensive physical examination. Those with wounds were marked, recorded, and clinically examined. Of the 207 horses sampled, 21 (10.1%) had wounds. The body distribution of the wounds was 9.5% head, 9.5% forelimbs, 19.1% hind limbs, 4.8% tail, 14.3% flank, 9.5% loin, 19.1% hip, 9.5% barrel, and 4.8% croup. The occurrence of the wounds was not significantly associated with sex or season, but the occurrence in adults was significantly (p < .05) higher than that in the young and aged horses. It was concluded that the occurrence of wounds is relatively high (10.1%), and mainly the hind limbs, hip, and flank of adult horses are affected. It was recommended that horse guardians and handlers should be properly educated on the care of horses.

Anterior gradient 2 is induced in cutaneous wound and promotes wound healing through its adhesion domain.

PubMed

Zhu, Qi; Mangukiya, Hitesh Bhagavanbhai; Mashausi, Dhahiri Saidi; Guo, Hao; Negi, Hema; Merugu, Siva Bharath; Wu, Zhenghua; Li, Dawei

2017-09-01

Anterior gradient 2 (AGR2), a member of protein disulfide isomerase (PDI) family, is both located in cytoplasm and secreted into extracellular matrix. The orthologs of AGR2 have been linked to limb regeneration in newt and wound healing in zebrafish. In mammals, AGR2 influences multiple cell signaling pathways in tumor formation and in normal cell functions related to new tissue formation like angiogenesis. However, the function of AGR2 in mammalian wound healing remains unknown. This study aimed to investigate AGR2 expression and its function during skin wound healing and the possible application of external AGR2 in cutaneous wound to accelerate the healing process. Our results showed that AGR2 expression was induced in the migrating epidermal tongue and hyperplastic epidermis after skin excision. Topical application of recombinant AGR2 significantly accelerated wound-healing process by increasing the migration of keratinocytes (Kera.) and the recruitment of fibroblasts (Fibro.) near the wounded area. External AGR2 also promoted the migration of Kera. and Fibro. in vitro in a dose-dependent manner. The adhesion domain of AGR2 was required for the formation of focal adhesions in migrating Fibro., leading to the directional migration along AGR2 gradient. These results indicate that recombinant AGR2 accelerates skin wound healing through regulation of Kera. and Fibro. migration, thus demonstrating its potential utility as an alternative strategy of the therapeutics to accelerate the healing of acute or chronic skin wounds. © 2017 Federation of European Biochemical Societies.

A Novel Method for Verifying War Mortality while Estimating Iraqi Deaths for the Iran-Iraq War through Operation Desert Storm (1980-1993).

PubMed

Li, Shang-Ju; Flaxman, Abraham; Lafta, Riyadh; Galway, Lindsay; Takaro, Tim K; Burnham, Gilbert; Hagopian, Amy

2016-01-01

We estimated war-related Iraqi mortality for the period 1980 through 1993. To test our hypothesis that deaths reported by siblings (even dating back several decades) would correspond with war events, we compared sibling mortality reports with the frequency of independent news reports about violent historic events. We used data from a survey of 4,287 adults in 2000 Iraqi households conducted in 2011. Interviewees reported on the status of their 24,759 siblings. Death rates were applied to population estimates, 1980 to 1993. News report data came from the ProQuest New York Times database. About half of sibling-reported deaths across the study period were attributed to direct war-related injuries. The Iran-Iraq war led to nearly 200,000 adult deaths, and the 1990-1991 First Gulf War generated another approximately 40,000 deaths. Deaths during peace intervals before and after each war were significantly lower. We found a relationship between total sibling-reported deaths and the tally of war events across the period, p = 0.02. We report a novel method to verify the reliability of epidemiological (household survey) estimates of direct war-related injury mortality dating back several decades.

Post-combat syndromes from the Boer war to the Gulf war: a cluster analysis of their nature and attribution

PubMed Central

Jones, Edgar; Hodgins-Vermaas, Robert; McCartney, Helen; Everitt, Brian; Beech, Charlotte; Poynter, Denise; Palmer, Ian; Hyams, Kenneth; Wessely, Simon

2002-01-01

Objectives To discover whether post-combat syndromes have existed after modern wars and what relation they bear to each other. Design Review of medical and military records of servicemen and cluster analysis of symptoms. Data sources Records for 1856 veterans randomly selected from war pension files awarded from 1872 and from the Medical Assessment Programme for Gulf war veterans. Main outcome measures Characteristic patterns of symptom clusters and their relation to dependent variables including war, diagnosis, predisposing physical illness, and exposure to combat; and servicemen's changing attributions for post-combat disorders. Results Three varieties of post-combat disorder were identified—a debility syndrome (associated with the 19th and early 20th centuries), somatic syndrome (related primarily to the first world war), and a neuropsychiatric syndrome (associated with the second world war and the Gulf conflict). The era in which the war occurred was overwhelmingly the best predictor of cluster membership. Conclusions All modern wars have been associated with a syndrome characterised by unexplained medical symptoms. The form that these assume, the terms used to describe them, and the explanations offered by servicemen and doctors seem to be influenced by advances in medical science, changes in the nature of warfare, and underlying cultural forces. What is already known on this topicService in the Gulf war is associated with an increased rate of reported symptoms and worsening subjective healthPost-combat syndromes have been described after most modern conflicts from the US civil war onwardsWhat this study addsThere seems to be no single post-combat syndrome but a number of variations on a themeThe ever changing form of post-combat syndromes seems to be related to advances in medical understanding, the developing nature of warfare, and cultural undercurrentsBecause reported symptoms are subject to bias and changing emphasis related to advances in medical

Honey: A Potential Therapeutic Agent for Managing Diabetic Wounds

PubMed Central

Islam, Md. Asiful; Gan, Siew Hua; Khalil, Md. Ibrahim

2014-01-01

Diabetic wounds are unlike typical wounds in that they are slower to heal, making treatment with conventional topical medications an uphill process. Among several different alternative therapies, honey is an effective choice because it provides comparatively rapid wound healing. Although honey has been used as an alternative medicine for wound healing since ancient times, the application of honey to diabetic wounds has only recently been revived. Because honey has some unique natural features as a wound healer, it works even more effectively on diabetic wounds than on normal wounds. In addition, honey is known as an “all in one” remedy for diabetic wound healing because it can combat many microorganisms that are involved in the wound process and because it possesses antioxidant activity and controls inflammation. In this review, the potential role of honey's antibacterial activity on diabetic wound-related microorganisms and honey's clinical effectiveness in treating diabetic wounds based on the most recent studies is described. Additionally, ways in which honey can be used as a safer, faster, and effective healing agent for diabetic wounds in comparison with other synthetic medications in terms of microbial resistance and treatment costs are also described to support its traditional claims. PMID:25386217

The contribution of personal and exposure characteristics to the adjustment of adolescents following war.

PubMed

Lavi, T; Green, O; Dekel, R

2013-02-01

The study examined the unique contribution of both personal characteristics and several types of exposure variables to the adjustment of Israeli adolescents following the Second Lebanon War. Two thousand three hundred and fourteen adolescents, who lived in areas that were the target of multiple missile attacks, completed self-report questionnaires assessing personal characteristics of gender and early traumatic events, subjective exposure (i.e., measures of fear and shortage of basic necessities during the war), objective exposure (i.e., exposure to missile attacks, knowing someone who was wounded or killed) and media exposure. Fifteen percent of the adolescents reported moderate or severe post-traumatic symptoms. Girls and adolescents who experienced earlier traumatic events were at higher risk for distress. While the level of direct exposure contributed to greater distress, the contribution of subjective exposure was significantly stronger. The discussion deals with the unique contribution of both subjective and objective characteristics to post-war adjustment. Copyright © 2012 The Foundation for Professionals in Services for Adolescents. Published by Elsevier Ltd. All rights reserved.

Olfactory functioning in Gulf War-era veterans: relationships to war-zone duty, self-reported hazards exposures, and psychological distress.

PubMed

Vasterling, Jennifer J; Brailey, Kevin; Tomlin, Holly; Rice, Janet; Sutker, Patricia B

2003-03-01

To explore possible neurotoxic sequelae of Gulf War (GW) participation, olfactory identification performance, neurocognitive functioning, health perceptions, and emotional distress were assessed in 72 veterans deployed to the GW and 33 military personnel activated during the GW but not deployed to the war zone. Findings revealed that war-zone-exposed veterans reported more concerns about health, cognitive functioning, and depression than did their counterparts who did not see war-zone duty. There was no evidence that performances on olfactory or neurocognitive measures were related to war-zone duty or to self-reported exposure to GW toxicants. However, symptoms of emotional distress were positively correlated with self-report of health and cognitive complaints. Results do not provide support for the hypothesis that objectively-measured sensory (i.e., olfactory) or cognitive deficits are related to war-zone participation but do underscore the increasingly demonstrated association between self-reported health concerns and symptoms of emotional distress.

Impedance spectroscopy applied to the fast wounding dynamics of an electrical wound-healing assay in mammalian cells

NASA Astrophysics Data System (ADS)

Bellotti, Mariela I.; Giana, Fabián E.; Bonetto, Fabián J.

2015-08-01

Electrical wound-healing assays are often used as a means to study in vitro cell migration and proliferation. In such analysis, a cell monolayer that sits on a small electrode is electrically wounded and its spectral impedance is then continuously measured in order to monitor the healing process. The relatively slow dynamics of the cell healing have been extensively studied, while those of the much faster wounding phase have not yet been investigated. An analysis of the electrical properties of a particular cell type during this phase could give extra information about the changes in the cell membrane due to the application of the wounding current, and could also be useful to optimize the wounding regime for different cell types. The main issue when trying to register information about these dynamics is that the traditional measurement scheme employed in typical wound-healing assays doesn’t allow the simultaneous application of the wounding signal and measurement of the system’s impedance. In this paper, we overcome this limitation by implementing a measurement strategy consisting of cycles of fast alternating low- and high-voltage signals applied on electrodes covered with mammalian cells. This approach is capable of registering the fast impedance changes during the transient regime corresponding to the cell wounding process. Furthermore, these quasi-simultaneous high- and low-voltage measurements can be compared in order to obtain an empirical correlation between both quantities.

Leptospermum Honey for Wound Care in an Extremely Premature Infant.

PubMed

Esser, Media

2017-02-01

Neonatal wound care is challenging due to the fragility and vulnerable skin structure. Neonates are often left susceptible to the forces of their environment, leaving them open to infection when skin injury occurs. Leptospermum honey has been used successfully in adult patients, with evidence lacking in the neonatal population. This case demonstrates the management of a difficult-to-heal wound in a 23-week gestation infant. Selecting the proper treatment and products for wound healing is challenging, with little evidence-based research available for the treatment of neonatal wounds. Leptospermum honey and other adult-driven dressings have been used for neonatal wound care as well as other adult-driven dressings. This case demonstrates the benefits of Leptospermum honey as an option for neonatal wounds. This case presents the treatment and healing of an extensive wound of a 23-week gestation neonate using a hydrogel product initially and then transitioning to a Leptospermum honey dressing due to suboptimal healing. Results of this treatment included quick healing time, little to no scarring, and no loss of movement or function to the affected extremities. The incorporation of Leptospermum honey for wound care has the potential to promote faster wound healing, with less scarring in the neonatal population. Adult wound care principles have been applied in the face of a weak evidence base relating to neonatal-specific cases. There is a need for continued research related to moist wound healing in the neonatal population, with resulting product and practice recommendations.

Role of neuroinflammation and sex hormones in war-related PTSD.

PubMed

Mendoza, Cristhian; Barreto, George E; Ávila-Rodriguez, Marco; Echeverria, Valentina

2016-10-15

The susceptibility to develop posttraumatic stress disorder (PTSD) is greatly influenced by both innate and environmental risk factors. One of these factors is gender, with women showing higher incidence of trauma-related mental health disorders than their male counterparts. The evidence so far links these differences in susceptibility or resilience to trauma to the neuroprotective actions of sex hormones in reducing neuroinflammation after severe stress exposure. In this review, we discuss the impact of war-related trauma on the incidence of PTSD in civilian and military populations as well as differences associated to gender in the incidence and recovery from PTSD. In addition, the mutually influencing role of inflammation, genetic, and sex hormones in modulating the consequences derived from exposure to traumatic events are discussed in light of current evidence. Published by Elsevier Ireland Ltd.

Facial gunshot wound debridement: debridement of facial soft tissue gunshot wounds.

PubMed

Shvyrkov, Michael B

2013-01-01

Over the period 1981-1985 the author treated 1486 patients with facial gunshot wounds sustained in combat in Afghanistan. In the last quarter of 20th century, more powerful and destructive weapons such as M-16 rifles, AK-47 and Kalashnikov submachine guns, became available and a new approach to gunshot wound debridement is required. Modern surgeons have little experience in treatment of such wounds because of rare contact with similar pathology. This article is intended to explore modern wound debridement. The management of 502 isolated soft tissue injuries is presented. Existing principles recommend the sparing of damaged tissues. The author's experience was that tissue sparing lead to a high rate of complications (47.6%). Radical primary surgical debridement (RPSD) of wounds was then adopted with radical excision of necrotic non-viable wound margins containing infection to the point of active capillary bleeding and immediate primary wound closure. After radical debridement wound infection and breakdown decreased by a factor of 10. Plastic operations with local and remote soft tissue were made on 14, 7% of the wounded. Only 0.7% patients required discharge from the army due to facial muscle paralysis and/or facial skin impregnation with particles of gunpowder from mine explosions. Gunshot face wound; modern debridement. Copyright © 2012 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

The utility of routine histological examination of gunshot wounds.

PubMed

Perez, Danielo B; Molina, D Kimberley

2012-09-01

Determining the range of fire is a crucial part of a forensic examination of gunshot wound victims. Traditionally, this has been accomplished by noting the gross appearance of soot or powder around the wound. This study was undertaken to determine the utility of routine histological examination of gunshot wounds as related to range-of-fire determination. A prospective study was performed, and a total of 69 gunshot wounds were examined both macroscopically and microscopically. Of the 45 entrance wounds examined, there was 100% concordance between macroscopic and microscopic analysis for the close-range wounds and 67% concordance for the distant wounds, with 33% of these wounds showing no evidence of soot or powder grossly but where residue was seen microscopically. In addition, 21% of the exit wounds examined showed microscopic evidence of soot/powder residues when none were visible macroscopically. As described in previous studies, it can be assumed that the bullet itself can deposit small residues along the wound track (bullet wipe) that can be seen microscopically and is unrelated to the range of fire. Therefore, the authors conclude there is no utility in the routine histological examination of gunshot wounds for the determination of range of fire.

Wound botulism.

PubMed

Burningham, M D; Walter, F G; Mechem, C; Haber, J; Ekins, B R

1994-12-01

Wound botulism is a rare infectious and toxicologic complication of trauma and i.v. drug abuse. Only 39 cases have been reported in detail in the English literature. This case report describes a patient with wound botulism who presented to four medical facilities before receiving definitive diagnosis and treatment. Although his history and physical examination were consistent with wound botulism, diagnosis and therapy were delayed because this rare disease was not considered initially in the differential diagnosis. Wound botulism should be considered in trauma patients and i.v. drug abusers who present with cranial nerve palsies and descending paresis.

Biophysical Technologies for Management of Wound Bioburden

PubMed Central

Korzendorfer, Holly; Hettrick, Heather

2014-01-01

Significance: Chronic wounds commonly have high levels of bioburden and antibiotic-resistant pathogens. This review article focuses on findings from current literature related to four biophysical technologies (ultrasound, electrical stimulation, phototherapy, and negative pressure wound therapy) believed to be beneficial for managing wound bioburden and support healing. Recent Advances and Critical Issues: Recent advances for each modality are provided as a basic synopsis of the technology followed by brief overviews of the most recent literature addressing its effectiveness for managing wound bioburden, and critical issues for each modality are provided as conclusions. Future Directions: This review highlights the need for further clinically relevant studies examining bacterial levels in addition to healing progression for each technology. PMID:25493207

Wound Healing Angiogenesis: Innovations and Challenges in Acute and Chronic Wound Healing

PubMed Central

Demidova-Rice, Tatiana N.; Durham, Jennifer T.; Herman, Ira M.

2012-01-01

Background Formation of new blood vessels, by either angiogenesis or vasculogenesis, is critical for normal wound healing. Major processes in neovascularization include (i) growth-promoting or survival factors, (ii) proteolytic enzymes, (iii) activators of multiple differentiated and progenitor cell types, and (iv) permissible microenvironments. A central aim of wound healing research is to “convert” chronic, disease-impaired wounds into those that will heal. The problem Reduced ability to re-establish a blood supply to the injury site can ultimately lead to wound chronicity. Basic/Clinical Science Advances (1) Human fetal endothelial progenitor cells can stimulate wound revascularization and repair following injury, as demonstrated in a novel mouse model of diabetic ischemic healing. (2) Advances in bioengineering reveal exciting alternatives by which wound repair may be facilitated via the creation of vascularized microfluidic networks within organ constructs created ex vivo for wound implantation. (3) A “personalized” approach to regenerative medicine may be enabled by the identification of protein components present within individual wound beds, both chronic and acute. Clinical Care Relevance Despite the development of numerous therapies, impaired angiogenesis and wound chronicity remain significant healthcare problems. As such, innovations in enhancing wound revascularization would lead to significant advances in wound healing therapeutics and patient care. Conclusion Insights into endothelial progenitor cell biology together with developments in the field of tissue engineering and molecular diagnostics should not only further advance our understanding of the molecular mechanisms regulating wound repair but also offer innovative solutions to promote the healing of chronic and acute wounds in vivo. PMID:24527273

Wound healing and all-cause mortality in 958 wound patients treated in home care.

PubMed

Zarchi, Kian; Martinussen, Torben; Jemec, Gregor B E

2015-09-01

Skin wounds are associated with significant morbidity and mortality. Data are, however, not readily available for benchmarking, to allow prognostic evaluation, and to suggest when involvement of wound-healing experts is indicated. We, therefore, conducted an observational cohort study to investigate wound healing and all-cause mortality associated with different types of skin wounds. Consecutive skin wound patients who received wound care by home-care nurses from January 2010 to December 2011 in a district in Eastern Denmark were included in this study. Patients were followed until wound healing, death, or the end of follow-up on December 2012. In total, 958 consecutive patients received wound care by home-care nurses, corresponding to a 1-year prevalence of 1.2% of the total population in the district. During the study, wound healing was achieved in 511 (53.3%), whereas 90 (9.4%) died. During the first 3 weeks of therapy, healing was most likely to occur in surgical wounds (surgical vs. other wounds: adjusted hazard ratio [AHR] 2.21, 95% confidence interval 1.50-3.23), while from 3 weeks to 3 months of therapy, cancer wounds, and pressure ulcers were least likely to heal (cancer vs. other wounds: AHR 0.12, 0.03-0.50; pressure vs. other wounds: AHR 0.44, 0.27-0.74). Cancer wounds and pressure ulcers were further associated with a three times increased probability of mortality compared with other wounds (cancer vs. other wounds: AHR 3.19, 1.35-7.50; pressure vs. other wounds: AHR 2.91, 1.56-5.42). In summary, the wound type was found to be a significant predictor of healing and mortality with cancer wounds and pressure ulcers being associated with poor prognosis. © 2015 by the Wound Healing Society.

Muscle wound healing in rainbow trout (Oncorhynchus mykiss).

PubMed

Schmidt, J G; Andersen, E W; Ersbøll, B K; Nielsen, M E

2016-01-01

We followed the progression of healing of deep excisional biopsy punch wounds over the course of 365 days in rainbow trout (Oncorhynchus mykiss) by monitoring visual wound healing and gene expression in the healing muscle at regular intervals (1, 3, 7, 14, 38 and 100 days post-wounding). In addition, we performed muscle texture analysis one year after wound infliction. The selected genes have all previously been investigated in relation to vertebrate wound healing, but only few specifically in fish. The selected genes were interleukin (IL)-1β, IL-6, transforming growth factor (TGF)-β1 and -β3, matrix metalloproteinase (MMP) -9 and -13, inducible nitric oxide synthase (iNOS), fibronectin (FN), tenascin-C (TN-C), prolyl 4-hydroxylase α1-chain (P4Hα1), lysyl oxidase (LOX), collagen type I α1-chain (ColIα1), CD41 and CD163. Wound healing progressed slowly in the presented study, which is at least partially due to the low temperature of about 8.5 °C during the first 100 days. The inflammation phase lasted more than 14 days, and the genes relating to production and remodeling of new extracellular matrix (ECM) exhibited a delayed but prolonged upregulation starting 1-2 weeks post-wounding and lasting until at least 100 days post-wounding. The gene expression patterns and histology reveal limited capacity for muscle regeneration in rainbow trout, and muscle texture analyses one year after wound infliction confirm that wounds heal with fibrosis. At 100 dpw epidermis had fully regenerated, and dermis partially regenerated. Scales had not regenerated even after one year. CD163 is a marker of "wound healing"-type M2c macrophages in mammals. M2 macrophage markers are as yet poorly described in fish. The pattern of CD163 expression in the present study is consistent with the expected timing of presence of M2c macrophages in the wound. CD163 may thus potentially prove a valuable marker of M2 macrophages - or a subset hereof - in fish. We subjected a group of fish to

Silver nanoparticles enhance wound healing in zebrafish (Danio rerio).

PubMed

Seo, Seung Beom; Dananjaya, S H S; Nikapitiya, Chamilani; Park, Bae Keun; Gooneratne, Ravi; Kim, Tae-Yoon; Lee, Jehee; Kim, Cheol-Hee; De Zoysa, Mahanama

2017-09-01

Silver nanoparticles (AgNPs) were successfully synthesized by a chemical reduction method, physico-chemically characterized and their effect on wound-healing activity in zebrafish was investigated. The prepared AgNPs were circular-shaped, water soluble with average diameter and zeta potential of 72.66 nm and -0.45 mv, respectively. Following the creation of a laser skin wound on zebrafish, the effect of AgNPs on wound-healing activity was tested by two methods, direct skin application (2 μg/wound) and immersion in a solution of AgNPs and water (50 μg/L). The zebrafish were followed for 20 days post-wounding (dpw) by visual observation of wound size, calculating wound healing percentage (WHP), and histological examination. Visually, both direct skin application and immersion AgNPs treatments displayed clear and faster wound closure at 5, 10 and 20 dpw compared to the controls, which was confirmed by 5 dpw histology data. At 5 dpw, WHP was highest in the AgNPs immersion group (36.6%) > AgNPs direct application group (23.7%) > controls (18.2%), showing that WHP was most effective in fish immersed in AgNPs solution. In general, exposure to AgNPs induced gene expression of selected wound-healing-related genes, namely, transforming growth factor (TGF-β), matrix metalloproteinase (MMP) -9 and -13, pro-inflammatory cytokines (IL-1β and TNF-α) and antioxidant enzymes (superoxide dismutase and catalase), which observed differentiation at 12 and 24 h against the control; but the results were not consistently significant, and many either reached basal levels or were down regulated at 5 dpw in the wounded muscle. These results suggest that AgNPs are effective in acceleration of wound healing and altered the expression of some wound-healing-related genes. However, the detailed mechanism of enhanced wound healing remains to be investigated in fish. Copyright © 2017 Elsevier Ltd. All rights reserved.

[The medical assistance of Swedish Red Cross Field Hospital in Busan during and after the Korean war].

PubMed

Park, Jiwook

2010-06-30

After the outbreak of the Korean war, the Kingdom of Sweden, a permanent neutral nation, dispatched the Swedish Red Cross Field Hospital(SRCFH) instead of armed forces for humanitarian support to the allied forces in South Korea. The Hospital consisted of about 170 Swedes, all volunteers. From the early part of the Korean War, SRCFH took part in the medical assistance in Busan. When the frontline advanced to northern Korea, the number of inflowing casualties to this field hospital decreased. At that time, earnest medical aid for civilians commenced, and many Koreans were treated in available beds in SRCFH. After the armistice in July 1953, SRCFH became the Swedish Hospital in Busan, serving not only the military but also civilians, and continued its humanitarian mission until April 1957 for the Korean who were suffering from a collapsed medical system in the midst of war. When the Hospital returned to Sweden, it had treated over two million patients from twenty countries, including wounded UN allied force, Korean (south and north), Chinese prisoner of war and Korean civilian. Moreover, it left a transformative legacy, the National Medical Center in Seoul which was established in collaboration with other Scandinavian countries who dispatched medical assistance during the Korean War.

Three Generations, Three Wars: African American Veterans.

PubMed

Black, Helen K

2016-02-01

This article emerged from pilot research exploring experiences of war and suffering among African American veterans who served in World War II, Korean War, and Vietnam War. Men's experiences as soldiers reflected both racism and the social change that occurred in the Unites States while they served. We used techniques of narrative elicitation, conducting qualitative, ethnographic interviews with each of five veterans in his home. Interviews focused on unique and shared experiences as an African American man and a soldier. Three important themes emerged: (a) Expectations related to War--Although men viewed service to country as an expected part of life, they also expected equal treatment in war, which did not occur; (b) Suffering as an African American--Informants interpreted experiences of suffering in war as related to the lower status of African American servicemen; and (c) Perception of present identity--Each man was honed by the sum of his experiences, including those of combat, racism, and postwar opportunities and obstacles. From 40 to 70 years after the wars were fought, there are few scholarly narrative studies on African American veterans, despite the fact that Korean War Veterans are entering old-old age and few World War II Veterans are alive. The value of pilot research that offers narratives of unheard voices is significant; larger studies can interview more African American veterans to advance knowledge that might soon be lost. © The Author 2015. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

The effect of the plasma needle on the human keratinocytes related to the wound healing process

NASA Astrophysics Data System (ADS)

Korolov, Ihor; Fazekas, Barbara; Széll, Márta; Kemény, Lajos; Kutasi, Kinga

2016-01-01

In the present study we aim to verify the influence of a non-thermal atmospheric pressure plasma on the wound healing process. In this process the major contributors are the keratinocytes, which migrate to fill in the gap created by the wound. Therefore, we performed the direct treatment of HPV-immortalized human keratinocytes, protected by a layer of phosphate buffered saline (PBS) solution, with the glow discharge generated in flowing helium by a plasma needle. To mimick a wound, a 4 mm scratch was performed on the cell culture (scratch assay). We conducted two types of experiments: (i) cell proliferation and (ii) wound-healing model experiments. The plasma needle configuration, the plasma treatment conditions and the thickness of the protecting PBS layer were set based on viability experiments. The proliferation studies showed that short, 5-10 s, and low power treatments, such as 18 W and 20 W input power, could positively influence the cell proliferation when keratinocytes were protected by PBS. On the other hand, the plasma treatment of cell medium covered keratinocytes resulted in the decrease of proliferation. The wound-healing model (scratch assay) studies showed, that there was a maximum in the wound reduction as a function of the input power and treatment time, namely, at 18 W and 5 s. Furthermore, the wound reduction strongly depended on the treated cell—PBS interaction time. To mimic an infected wound, the scratch assay was covered with a 1× {{10}9} cfu ml-1 Propionibacterium acnes suspension. The plasma treatment of this infected assay resulted in closing of the scratch, while in the non-treated assay the wound did not close at all.

[Health Institutions of the Hungarian and Imperial-Royal Armed Forces in the First World War].

PubMed

Kiss, Gábor

2006-01-01

The Military Health Institutes established during the World War I. aimed maintenance and recovery of soldiers' fighting value. Establishing an effective sanitary control was rather important, since the Hungarian Royal Honvéd Army attempted to prevent epidemics and diseases, especially venereal diseases and tuberculosis. The sanitary establishments consisted of three parts: they belonged to the operational area, to the provisional zone and to the homeland territory. These institutions were divided into permanent and temporary ones. Permanent sanitary institutions were the garrison hospitals; troop and military ("honvéd") hospitals and houses for invalids, while temporary sanitary establishments worked only in case of mobilization. In their arrangement not the distance was taken into consideration, but the potential for transport of the wounded. The Hungarian sanitary institutions proved to be rather successful in World War I.

A wearable wound moisture sensor as an indicator for wound dressing change: an observational study of wound moisture and status.

PubMed

Milne, Stephen D; Seoudi, Ihab; Al Hamad, Hanadi; Talal, Talal K; Anoop, Anzila A; Allahverdi, Niloofar; Zakaria, Zain; Menzies, Robert; Connolly, Patricia

2016-12-01

Wound moisture is known to be a key parameter to ensure optimum healing conditions in wound care. This study tests the moisture content of wounds in normal practice in order to observe the moisture condition of the wound at the point of dressing change. This study is also the first large-scale observational study that investigates wound moisture status at dressing change. The WoundSense sensor is a commercially available moisture sensor which sits directly on the wound in order to find the moisture status of the wound without disturbing or removing the dressing. The results show that of the 588 dressing changes recorded, 44·9% were made when the moisture reading was in the optimum moisture zone. Of the 30 patients recruited for this study, 11 patients had an optimum moisture reading for at least 50% of the measurements before dressing change. These results suggest that a large number of unnecessary dressing changes are being made. This is a significant finding of the study as it suggests that the protocols currently followed can be modified to allow fewer dressing changes and less disturbance of the healing wound bed. © 2015 The Authors. International Wound Journal published by Medicalhelplines.com Inc and John Wiley & Sons Ltd.

Broad-Spectrum Inhibition of the CC-Chemokine Class Improves Wound Healing and Wound Angiogenesis.

PubMed

Ridiandries, Anisyah; Bursill, Christina; Tan, Joanne

2017-01-13

Angiogenesis is involved in the inflammation and proliferation stages of wound healing, to bring inflammatory cells to the wound and provide a microvascular network to maintain new tissue formation. An excess of inflammation, however, leads to prolonged wound healing and scar formation, often resulting in unfavourable outcomes such as amputation. CC-chemokines play key roles in the promotion of inflammation and inflammatory-driven angiogenesis. Therefore, inhibition of the CC-chemokine class may improve wound healing. We aimed to determine if the broad-spectrum CC-chemokine inhibitor "35K" could accelerate wound healing in vivo in mice. In a murine wound healing model, 35K protein or phosphate buffered saline (PBS, control) were added topically daily to wounds. Cohorts of mice were assessed in the early stages (four days post-wounding) and in the later stages of wound repair (10 and 21 days post-wounding). Topical application of the 35K protein inhibited CC-chemokine expression (CCL5, CCL2) in wounds and caused enhanced blood flow recovery and wound closure in early-mid stage wounds. In addition, 35K promoted neovascularisation in the early stages of wound repair. Furthermore, 35K treated wounds had significantly lower expression of the p65 subunit of NF-κB, a key inflammatory transcription factor, and augmented wound expression of the pro-angiogenic and pro-repair cytokine TGF-β. These findings show that broad-spectrum CC-chemokine inhibition may be beneficial for the promotion of wound healing.

Attachment-Focused Psychotherapy and the Wounded Self.

PubMed

Spiegel, Eric B

2016-07-01

The concept of the "wounded self" (Wolfe, 2005) offers an integrative theoretical framework for self-wounds and their developmental origins. Alladin (2013, 2014, 2016) integrated hypnotherapy into this model to comprehensively address the unconscious protective mechanisms and maladaptive conscious cognitive strategies of the wounded self. The purpose of this article is to propose how an attachment-focused psychotherapy could be utilized in working with the wounded self. With its emphasis on developmental maturation through the frame of the attachment relationship, attachment theory is well-positioned to offer conceptual and treatment insights in treating the wounded self. E. B. Spiegel's (2016) attunement, representation, and mentalization approach to attachment-focused psychotherapy described how hypnosis can be utilized across attachment processes of attunement, representation, and mentalization toward structural maturation and developmental repair of patients with histories of complex relational trauma. In this article, the attunement, representation, and mentalization attachment approach and associated interventions are further explicated in the treatment of self-wounds in the borderline and narcissistic spectrums of personality organization. These principles of conceptualization and treatment interventions are then applied in a case example.

A Novel Method for Verifying War Mortality while Estimating Iraqi Deaths for the Iran-Iraq War through Operation Desert Storm (1980-1993)

PubMed Central

Li, Shang-Ju; Flaxman, Abraham; Lafta, Riyadh; Galway, Lindsay; Takaro, Tim K.; Burnham, Gilbert; Hagopian, Amy

2016-01-01

Objectives We estimated war-related Iraqi mortality for the period 1980 through 1993. Method To test our hypothesis that deaths reported by siblings (even dating back several decades) would correspond with war events, we compared sibling mortality reports with the frequency of independent news reports about violent historic events. We used data from a survey of 4,287 adults in 2000 Iraqi households conducted in 2011. Interviewees reported on the status of their 24,759 siblings. Death rates were applied to population estimates, 1980 to 1993. News report data came from the ProQuest New York Times database. Results About half of sibling-reported deaths across the study period were attributed to direct war-related injuries. The Iran-Iraq war led to nearly 200,000 adult deaths, and the 1990–1991 First Gulf War generated another approximately 40,000 deaths. Deaths during peace intervals before and after each war were significantly lower. We found a relationship between total sibling-reported deaths and the tally of war events across the period, p = 0.02. Conclusions We report a novel method to verify the reliability of epidemiological (household survey) estimates of direct war-related injury mortality dating back several decades. PMID:27768730

Fighting the War on Academic Terrorism. Advocacy

ERIC Educational Resources Information Center

Kaplan, Sandra N.

2005-01-01

While the attention of the country is focused on the global and national war on terrorism, the war on academic terrorism is being waged in classrooms, infiltrating the gifted programs, and altering the outcomes derived for students participating in gifted programs. The war on academic terrorism is related to the broad areas of curriculum and…

Point-of-care wound visioning technology: Reproducibility and accuracy of a wound measurement app

PubMed Central

Anderson, John A. E.; Evans, Robyn; Woo, Kevin; Beland, Benjamin; Sasseville, Denis; Moreau, Linda

2017-01-01

Background Current wound assessment practices are lacking on several measures. For example, the most common method for measuring wound size is using a ruler, which has been demonstrated to be crude and inaccurate. An increase in periwound temperature is a classic sign of infection but skin temperature is not always measured during wound assessments. To address this, we have developed a smartphone application that enables non-contact wound surface area and temperature measurements. Here we evaluate the inter-rater reliability and accuracy of this novel point-of-care wound assessment tool. Methods and findings The wounds of 87 patients were measured using the Swift Wound app and a ruler. The skin surface temperature of 37 patients was also measured using an infrared FLIR™ camera integrated with the Swift Wound app and using the clinically accepted reference thermometer Exergen DermaTemp 1001. Accuracy measurements were determined by assessing differences in surface area measurements of 15 plastic wounds between a digital planimeter of known accuracy and the Swift Wound app. To evaluate the impact of training on the reproducibility of the Swift Wound app measurements, three novice raters with no wound care training, measured the length, width and area of 12 plastic model wounds using the app. High inter-rater reliabilities (ICC = 0.97–1.00) and high accuracies were obtained using the Swift Wound app across raters of different levels of training in wound care. The ruler method also yielded reliable wound measurements (ICC = 0.92–0.97), albeit lower than that of the Swift Wound app. Furthermore, there was no statistical difference between the temperature differences measured using the infrared camera and the clinically tested reference thermometer. Conclusions The Swift Wound app provides highly reliable and accurate wound measurements. The FLIR™ infrared camera integrated into the Swift Wound app provides skin temperature readings equivalent to the clinically

Human acellular dermal wound matrix: evidence and experience.

PubMed

Kirsner, Robert S; Bohn, Greg; Driver, Vickie R; Mills, Joseph L; Nanney, Lillian B; Williams, Marie L; Wu, Stephanie C

2015-12-01

A chronic wound fails to complete an orderly and timely reparative process and places patients at increased risk for wound complications that negatively impact quality of life and require greater health care expenditure. The role of extracellular matrix (ECM) is critical in normal and chronic wound repair. Not only is ECM the largest component of the dermal skin layer, but also ECM proteins provide structure and cell signalling that are necessary for successful tissue repair. Chronic wounds are characterised by their inflammatory and proteolytic environment, which degrades the ECM. Human acellular dermal matrices, which provide an ECM scaffold, therefore, are being used to treat chronic wounds. The ideal human acellular dermal wound matrix (HADWM) would support regenerative healing, providing a structure that could be repopulated by the body's cells. Experienced wound care investigators and clinicians discussed the function of ECM, the evidence related to a specific HADWM (Graftjacket(®) regenerative tissue matrix, Wright Medical Technology, Inc., licensed by KCI USA, Inc., San Antonio, TX), and their clinical experience with this scaffold. This article distills these discussions into an evidence-based and practical overview for treating chronic lower extremity wounds with this HADWM. © 2013 The Authors. International Wound Journal © 2013 Medicalhelplines.com Inc and John Wiley & Sons Ltd.

Life satisfaction and quality in Korean War veterans five decades after the war.

PubMed

Ikin, J F; Sim, M R; McKenzie, D P; Horsley, K W A; Wilson, E J; Harrex, W K; Moore, M R; Jelfs, P L; Henderson, S

2009-05-01

Military service is considered to be a hidden variable underlying current knowledge about well-being in the elderly. This study aimed to examine life satisfaction and quality of life in Australia's surviving male Korean War veterans and a community comparison group, and to investigate any association with war deployment-related factors. Participants completed a postal questionnaire which included the Life Satisfaction Scale, the brief World Health Organization Quality of Life (WHOQOL-Bref) questionnaire and the Combat Exposure Scale. Korean War veterans reported significantly lower Percentage Life Satisfaction (PLS) and quality of life scores on four WHOQOL-Bref domains, compared with similarly aged Australian men (each p value <0.001). These outcomes were most strongly associated with severity of combat exposure and low rank. Mean PLS was approximately 15% lower in veterans who reported heavy combat compared with those reporting no combat, and approximately 12% lower in enlisted ranked veterans compared with officers. Fifty years after the Korean War, life satisfaction and quality in Australian veterans is poor relative to other Australian men, and is associated with deployment-related factors including combat severity and low rank. In order to respond effectively to current and projected population health needs, nations with large veteran populations may need to consider the impact of military service on well-being in later life.

Diabetic foot wounds: the value of negative pressure wound therapy with instillation.

PubMed

Dalla Paola, Luca

2013-12-01

Chronic wounds such as diabetic foot wounds are a tremendous burden to the health care system and often require a multidisciplinary approach to prevent amputations. Advanced technologies such as negative pressure wound therapy (NPWT) and bioengineered tissues have been successfully used in the treatment of these types of complex wounds. However, the introduction of NPWT with instillation (NPWTi) has provided an alternative treatment for treating complex and difficult-to-heal wounds. This article provides an overview of NPWT and the new NPWTi system and describes preliminary experience using NPWTi on patients with complicated infected diabetic foot wounds after surgical debridement and in a multidisciplinary setting. © 2013 The Author. International Wound Journal © 2013 John Wiley & Sons Ltd and Medicalhelplines.com Inc.

[Red Cross hospital in Krapina, during the First world war from 1914 to 1918].

PubMed

Fures, Rajko; Habek, Dubravko; Kozina, Drago

2016-08-01

Red Cross Hospital in Krapina, during the First World War, was active from 1914 to 1918. Hospital led by Dr. Mirko Crkvenac, oriented humanist. The hospital is operated thanks to the help of municipalities and citizens. The hospital staff concern is for civilian and military victims of the First World War. Dr. Crkvenac, with the support of the City of Krapina and Mayor Vilibald Sluga, he succeeds to the organization and operation of the hospital to an enviable level. Across the Austro-Hungarian Empire and Croatian, Hospitals Red Cross, had a significant role in caring for the wounded, injured and sick soldiers and civilians. Red Cross Hospital in Krapina, is an example of a well-organized hospital in the toughest conditions. Such an organization was not simple in its implementation, and left the valuable lessons and experience.

War, what is it good for? Historical contribution of the military and war to occupational therapy and hand therapy.

PubMed

Yakobina, Sheila Catherine; Yakobina, Stephanie Robin; Harrison-Weaver, Sandra

2008-01-01

War has negative connotations; nevertheless, this article aims to highlight some of the positive outcomes that have occurred in the fields of occupational therapy (OT) and hand therapy due to war and war-related injuries. From the military background of one of OT's founders, Thomas Kidner, to the valiant efforts of the reconstruction aides, to the origin of hand therapy during the Vietnam War, the military influence has been a powerful force in furthering our profession. This article reviews the unique history of war, the establishment and development of OT and hand therapy, and the contributions from military service members.

Caring for our wounded warriors: A qualitative examination of health-related quality of life in caregivers of individuals with military-related traumatic brain injury.

PubMed

Carlozzi, Noelle E; Brickell, Tracey A; French, Louis M; Sander, Angelle; Kratz, Anna L; Tulsky, David S; Chiaravalloti, Nancy D; Hahn, Elizabeth A; Kallen, Michael; Austin, Amy M; Miner, Jennifer A; Lange, Rael T

2016-01-01

The purpose of this study was to develop a conceptual framework that captures aspects of health-related quality of life (HRQOL) for caregivers of individuals with military-related traumatic brain injury (TBI). We analyzed qualitative data from nine focus groups composed of caregivers of wounded warriors with a medically documented TBI. Focus group participants were recruited through hospital-based and/or community outreach efforts at the Walter Reed National Military Medical Center, the University of Michigan, and Hearts of Valor support groups (Tennessee and Washington). Participants were the caregivers (n = 45) of wounded warriors who had sustained a mild, moderate, severe, or penetrating TBI. Qualitative frequency analysis indicated that caregivers most frequently discussed social health (44% of comments), followed by emotional (40%) and physical health (12%). Areas of discussion that were specific to this population included anger regarding barriers to health services (for caregivers and servicemembers), emotional suppression (putting on a brave face for others even when things are not going well), and hypervigilance (controlling one's behavior/environment to prevent upsetting the servicemember). Caring for wounded warriors with TBI is a complex experience that positively and negatively affects HRQOL. While some aspects of HRQOL can be evaluated with existing measures, evaluation tools for other important components do not exist. The development of military-specific measures would help facilitate better care for these individuals.

The Effects of Japan’s Apology for World War II Atrocities on Regional Relations

DTIC Science & Technology

2008-12-01

textbooks and by government officials visiting Yasukuni Shrine, where Japan’s war dead are commemorated. The Japanese counter that they have offered... textbooks , Yasukuni War Shrine, Japan Apology, Article 9. 16. PRICE CODE 17. SECURITY CLASSIFICATION OF REPORT Unclassified 18. SECURITY...World War II. They assert that Japan feels no remorse, as evidenced by treatment of World War II in Japanese school textbooks and by government

Management of minor acute cutaneous wounds: importance of wound healing in a moist environment.

PubMed

Korting, H C; Schöllmann, C; White, R J

2011-02-01

Moist wound care has been established as standard therapy for chronic wounds with impaired healing. Healing in acute wounds, in particular in minor superficial acute wounds - which indeed are much more numerous than chronic wounds - is often taken for granted because it is assumed that in those wounds normal phases of wound healing should run per se without any problems. But minor wounds such as small cuts, scraps or abrasions also need proper care to prevent complications, in particular infections. Local wound care with minor wounds consists of thorough cleansing with potable tap water or normal saline followed by the application of an appropriate dressing corresponding to the principles of moist wound treatment. In the treatment of smaller superficial wounds, it appears advisable to limit the choice of dressing to just a few products that fulfil the principles of moist wound management and are easy to use. Hydroactive colloid gels combining the attributes of hydrocolloids and hydrogels thus being appropriate for dry and exuding wounds appear especially suitable for this purpose - although there is still a lack of data from systematic studies on the effectiveness of these preparations. © 2010 The Authors. Journal of the European Academy of Dermatology and Venereology © 2010 European Academy of Dermatology and Venereology.

A Clinicoepidemiological Profile of Chronic Wounds in Wound Healing Department in Shanghai.

PubMed

Sun, Xiaofang; Ni, Pengwen; Wu, Minjie; Huang, Yao; Ye, Junna; Xie, Ting

2017-03-01

The aim of the study was to update the clinical database of chronic wounds in order to derive an evidence based understanding of the condition and hence to guide future clinical management in China. A total of 241 patients from January 1, 2011 to April 30, 2016 with chronic wounds of more than 2 weeks' duration were studied in wound healing department in Shanghai. Results revealed that among all the patients the mean age was 52.5 ± 20.2 years (range 2-92 years). The mean initial area of wounds was 30.3 ± 63.0 cm 2 (range 0.25-468 cm 2 ). The mean duration of wounds was 68.5 ± 175.2 months (range 0.5-840 months). The previously reported causes of chronic wounds were traumatic or surgical wounds (n = 82, 34.0%), followed by pressure ulcers (n = 59, 24.5%). To study the effects of age, patients were divided into 2 groups: less than 60 years (<60), and 60 years or older (≥60). The proportion of wounds etiology between the 2 age groups was analyzed, and there was significant statistical difference ( P < .05, 95% confidence interval [CI] = 0.076-0.987). To study the associations between outcome and clinical characteristics in chronic wounds, chi-square test was used. There were significant differences in the factor of wound infection. ( P = .035, 95% CI = 0.031-0.038) Regarding therapies, 72.6% (n = 175) of the patients were treated with negative pressure wound therapy. Among all the patients, 29.9% (n = 72) of them were completely healed when discharged while 62.7% (n = 150) of them improved. The mean treatment cost was 12055.4 ± 9206.3 Chinese Yuan (range 891-63626 Chinese Yuan). In conclusion, traumatic or surgical wounds have recently become the leading cause of chronic wounds in Shanghai, China. Etiology of the 2 age groups was different. Infection could significantly influence the wound outcome.

Civil war, social integration and mental health in Croatia.

PubMed

Kunovich, R M; Hodson, R

1999-12-01

Research has shown that social relationships are generally beneficial for mental health (Thoits 1995). However, few scholars have examined this association after the occurrence of a significant shock to the social system as a whole. The purpose of this article is to examine the relationship between social integration and war-related distress in Croatia immediately following the recent civil war. Does social integration decrease war-related distress? Does social integration buffer the effect of traumatic events on war-related distress? We analyze these questions using nationally representative survey data collected in Croatia in 1996. Results suggest that social integration has both positive and negative direct effects on distress. Being a member of informal organizations, such as sports clubs, and participating in social activities are beneficial for mental health. On the other hand, being a member of some formal organizations, such as church organizations and unions, is detrimental to mental health. There is little support for the idea that social integration buffers the effect of traumatic events on distress. Only one of thirty-six possible interactions is significant and supports the buffer hypothesis. Frequent participation in social activities buffers the effect of experiencing violence on war-related distress. Also, some forms of social integration appear to aggravate the effect of traumatic events on war-related distress. In sum, social integration does affect war-related distress after a system shock, but in complex and sometimes unexpected ways.

The effect of early life experience, environment, and genetic factors on spontaneous home-cage aggression-related wounding in male C57BL/6 mice.

PubMed

Gaskill, Brianna N; Stottler, Aurora M; Garner, Joseph P; Winnicker, Christina W; Mulder, Guy B; Pritchett-Corning, Kathleen R

2017-03-22

Aggression is a major welfare issue in mice, particularly when mice unfamiliar to each other are first placed in cages, as happens on receipt from a vendor, and following cage cleaning. Injuries from aggression are the second leading cause of unplanned euthanasia in mice, following ulcerative dermatitis. Commonly employed strategies for reducing aggression-related injury are largely anecdotal, and may even be counterproductive. Here we report a series of experiments testing potential explanations and interventions for post-shipping aggression-related injuries in C57BL/6 mice. First, we examined the effects of weaning: testing whether manipulating weaning age reduced aggression-related injuries, and if repeated mixing of weaned mice before shipping increased these injuries. Contrary to our predictions, repeated mixing did not increase post-shipping injurious aggression, and early weaning reduced aggression-related injuries. Second, we examined potential post-shipping interventions: testing whether lavender essential oil applied to the cage reduced aggression-related injuries, and whether a variety of enrichments decreased injurious aggression. Again, contrary to predictions, lavender increased wounding, and none of the enrichments reduced it. However, consistent with the effects of weaning age in the first experiment, cages with higher mean body weight showed elevated levels of aggression-related wounding. Finally, we tested whether C57BL/6 substrains and identification methods affected levels of intra-cage wounding from aggression. We found no effect of strain, but cages where mice were ear-notched for identification showed higher levels of wounding than cages where mice were tail-tattooed. Overall, these results emphasize the multifactorial nature of home-cage injurious aggression, and the importance of testing received wisdom when it comes to managing complex behavioral and welfare problems. In terms of practical recommendations to reduce aggressive wounding in

Glu-Trp-ONa or its acylated analogue (R-Glu-Trp-ONa) administration enhances the wound healing in the model of chronic skin wounds in rabbits.

PubMed

Shevtsov, Maxim A; Smagina, Larisa V; Kudriavtceva, Tatiana A; Petlenko, Sergey V; Voronkina, Irina V

2015-01-01

The management of chronic skin wounds represents a major therapeutic challenge. The synthesized dipeptide (Glu-Trp-ONa) and its acylated analogue (R-Glu-Trp-ONa) were assessed in the model of nonhealing dermal wounds in rabbits in relation to their healing properties in wound closure. Following wound modeling, the rabbits received a course of intraperitoneal injections of Glu-Trp-ONa or R-Glu-Trp-ONa. Phosphate-buffered saline and Solcoseryl® were applied as negative and positive control agents, respectively. An injection of Glu-Trp-ONa and R-Glu-Trp-ONa decreased the period of wound healing in animals in comparison to the control and Solcoseryl-treated groups. Acylation of Glu-Trp-ONa proved to be beneficial as related to the healing properties of the dipeptide. Subsequent zymography analyses showed that the applied peptides decreased the proteolytic activity of matrix metalloproteinases MMP-9, MMP-8, and MMP-2 in the early inflammatory phase and reversely increased the activity of MMP-9, MMP-8, and MMP-1 in the remodeling phase. Histological analyses of the wound sections (hematoxylin-eosin, Mallory's staining) confirmed the enhanced formation of granulation tissue and re-epithelialization in the experimental groups. By administering the peptides, wound closures increased significantly through the modulation of the MMPs' activity, indicating their role in wound healing.

New York Chapter History of Military Medicine Award. U.S. Army medical helicopters in the Korean War.

PubMed

Driscoll, R S

2001-04-01

Medical evacuation helicopters are taken for granted in today's military. However, the first use of helicopters for this purpose in the Korean War was not done intentionally but as a result of the necessity of moving patients rapidly over difficult Korean terrain and of the early ebbing of the main battle line. The objective of this essay is to increase the historical awareness of military medical evacuation helicopters in the Korean War during this 50th anniversary year. By describing the many challenges and experiences encountered in implementing the use of helicopters for evacuation, the reader will appreciate how a technology developed for another use helped in the success of evacuating nearly 22,000 patients while contributing to establishing a mortality rate of wounded of 2.4%. The preparation to write this essay included archival research of historical reports, records, and oral histories from the archives of the U.S. Army Center for Military History. Additionally, a search of journal articles written during and after the Korean War was conducted. The result is a comprehensive description of the use of medical evacuation helicopters in the Korean War.

The Burn Wound Microenvironment

PubMed Central

Rose, Lloyd F.; Chan, Rodney K.

2016-01-01

Significance: While the survival rate of the severely burned patient has improved significantly, relatively little progress has been made in treatment or prevention of burn-induced long-term sequelae, such as contraction and fibrosis. Recent Advances: Our knowledge of the molecular pathways involved in burn wounds has increased dramatically, and technological advances now allow large-scale genomic studies, providing a global view of wound healing processes. Critical Issues: Translating findings from a large number of in vitro and preclinical animal studies into clinical practice represents a gap in our understanding, and the failures of a number of clinical trials suggest that targeting single pathways or cytokines may not be the best approach. Significant opportunities for improvement exist. Future Directions: Study of the underlying molecular influences of burn wound healing progression will undoubtedly continue as an active research focus. Increasing our knowledge of these processes will identify additional therapeutic targets, supporting informed clinical studies that translate into clinical relevance and practice. PMID:26989577

Bacteria and wound healing.

PubMed

Edwards, Ruth; Harding, Keith G

2004-04-01

Wound healing is a complex process with many potential factors that can delay healing. There is increasing interest in the effects of bacteria on the processes of wound healing. All chronic wounds are colonized by bacteria, with low levels of bacteria being beneficial to the wound healing process. Wound infection is detrimental to wound healing, but the diagnosis and management of wound infection is controversial, and varies between clinicians. There is increasing recognition of the concept of critical colonization or local infection, when wound healing may be delayed in the absence of the typical clinical features of infection. The progression from wound colonization to infection depends not only on the bacterial count or the species present, but also on the host immune response, the number of different species present, the virulence of the organisms and synergistic interactions between the different species. There is increasing evidence that bacteria within chronic wounds live within biofilm communities, in which the bacteria are protected from host defences and develop resistance to antibiotic treatment. An appreciation of the factors affecting the progression from colonization to infection can help clinicians with the interpretation of clinical findings and microbiological investigations in patients with chronic wounds. An understanding of the physiology and interactions within multi-species biofilms may aid the development of more effective methods of treating infected and poorly healing wounds. The emergence of consensus guidelines has helped to optimize clinical management.

Factors influencing wound dehiscence.

PubMed

Riou, J P; Cohen, J R; Johnson, H

1992-03-01

Thirty-one abdominal fascial wound dehiscences occurred in 2,761 patients undergoing major abdominal surgery during a 5-year period (1%). Twenty-two specific local and systemic risk factors were analyzed and compared with the risk factors of a control group of 38 patients undergoing similar procedures without dehiscence. Through multivariate analysis, each factor was assessed as an independent statistical variable. Significant factors (p less than 0.05) were found to include age over 65, wound infection, pulmonary disease, hemodynamic instability, and ostomies in the incision. Additional systemic risk factors that were found to be significant included hypoproteinemia, systemic infection, obesity, uremia, hyperalimentation, malignancy, ascites, steroid use, and hypertension. Risk factors not found to be important independent variables included sex, type of incision, type of closure, foreign body in the wound, anemia, jaundice, and diabetes. When dehiscence and control groups were combined, 30% of patients with at least five significant risk factors developed dehiscence, and all the patients with more than eight risk factors developed a wound dehiscence. There was an overall mortality of 29%, which was directly related to the number of significant risk factors. The co-existence of 9 risk factors portended death in one third of the patients, and all the patients with more than 10 risk factors died.

Investigating U.S. Links to Nazi War Criminals.

ERIC Educational Resources Information Center

Holtzman, Elizabeth

1984-01-01

The list of United States government connections with Nazi war criminals is a long one. We must ensure that Nazi war criminals living in America are brought to justice. And we must both explore and expunge the history of our government's relations with Nazi war criminals. (CS)

Optimizing the Moisture Management Tightrope with Wound Bed Preparation 2015©.

PubMed

Sibbald, R Gary; Elliott, James A; Ayello, Elizabeth A; Somayaji, Ranjani

2015-10-01

To provide an overview of moisture management and its importance in wound care. This continuing education activity is intended for physicians and nurses with an interest in skin and wound care. After participating in this educational activity, the participant should be better able to:1. Summarize causes and treatments for moisture balance issues of chronic wounds.2. Recognize the properties of dressings used for treatment for moisture management of chronic wounds and antiseptic agent cytotoxicity.3. Explain study findings of the effectiveness of dressing choices for treatment of chronic wounds. To provide an overview of moisture management and its importance in wound care. The authors evaluate the impact of moisture management for optimal wound care and assess current wound management strategies relating to antisepsis and moist wound healing utilizing the wound bed preparation paradigm 2015 update. The discussion distinguishes the form and function of wound care dressing classes available for optimal moisture management. Moisture management for chronic wounds is best achieved with modern moist interactive dressings if the wound has the ability to heal.

The effects of war on land-use/land-cover change: An analysis of Landsat imagery for northeast Bosnia

NASA Astrophysics Data System (ADS)

Witmer, Frank D. W.

The use of satellite technology by military planners has a relatively long history as a tool of warfare, but little research has used satellite technology to study the effects of war. This research addresses this gap by applying satellite remote sensing imagery to study the effects of war on land-use/land-cover change in northeast Bosnia. The war in Bosnia, 1992-1995, resulted in over 100,000 deaths, many more wounded, and the mass displacement of nearly half the population of 4.2 million. When combined with the destruction of much of the transportation infrastructure and housing stock, widespread mine placement, and loss of agricultural machinery, the impacts to both the people and land were dramatic. Though the most severe war impacts are visible at local scales (e.g. destroyed buildings), this study focuses on impacts to agricultural land, a larger scale visible to satellite sensors. Multispectral Landsat Thematic Mapper (TM) data (30m pixels) from before and during the war in addition to recent imagery from 2004/05 were used to detect abandoned agricultural land. The satellite images were co-registered to enable a perpixel analysis of changes based on the statistical properties of the pixels using multiple change detection methods. Ground reference data were collected in May of 2006 at survey sites selected using a stratified random sampling approach based on the derived map of abandoned agricultural land. Fine resolution (60cm) Quickbird imagery was also used to verify the accuracy of the classification. The remote sensing analysis results were then used to test two hypotheses related to war outcomes: (a) land abandonment is due to wartime minefields and (b) land abandonment is greater in pre-war Croat areas and areas where ethnic cleansing was heaviest. The effects of minefields on land abandonment was first tested in a geographic information system (GIS), and then by using multiple regression models that account for spatial autocorrelation among observations

Cost-effectiveness of negative pressure wound therapy in patients with many comorbidities and severe wounds of various etiology.

PubMed

Driver, Vickie R; Eckert, Kristen A; Carter, Marissa J; French, Michael A

2016-11-01

This study analyzed a cross-section of patients with severe chronic wounds and multiple comorbidities at an outpatient wound clinic, with regard to the cost-effectiveness and cost-benefit of negative pressure wound therapy (intervention) vs. no negative pressure wound therapy (control) at 1 and 2 years. Medicare reimbursement charges for wound care were used to calculate costs. Amputation charges were assessed using diagnosis-related groups. Cost-benefit analysis was based on ulcer-free months and cost-effectiveness on quality-adjusted life-years. Undiscounted costs, benefits, quality-adjusted life-years, undiscounted and discounted incremental net health benefits, and incremental cost-effectiveness ratios were calculated for unmatched and matched cohorts. There were 150 subjects in the intervention group and 154 controls before matching and 103 subjects in each of the matched cohorts. Time to heal for the intervention cohort was significantly shorter compared to the controls (270 vs. 635 days, p = 1.0 × 10 -7 , matched cohorts). The intervention cohort had higher benefits and quality-adjusted life-year gains compared to the control cohort at years 1 and 2; by year 2, the gains were 68-73% higher. In the unmatched cohorts, the incremental net health benefit was $9,933 per ulcer-free month at year 2 for the intervention; the incremental cost-effectiveness ratio was -825,271 per quality-adjusted life-year gained (undiscounted costs and benefits). For the matched cohorts, the incremental net health benefits was only $1,371 per ulcer-free month for the intervention, but the incremental cost-effectiveness ratio was $366,683 per quality-adjusted life-year gained for year 2 (discounted costs and benefits). In a patient population with severe chronic wounds and serious comorbidities, negative pressure wound therapy resulted in faster healing wounds and was more cost-effective with greater cost-benefits than not using negative pressure wound therapy. Regarding overall

Silk sericin ameliorates wound healing and its clinical efficacy in burn wounds.

PubMed

Aramwit, Pornanong; Palapinyo, Sirinoot; Srichana, Teerapol; Chottanapund, Suthat; Muangman, Pornprom

2013-09-01

The aim of this study was to evaluate the effect of silk sericin, a protein from silkworm cocoon, on scratch wound healing in vitro. For applicable result in clinical use, we also study the efficacy of sericin added to a standard antimicrobial cream, silver zinc sulfadiazine, for open wound care in the treatment of second-degree burn wounds. In vitro scratch assays show that sericin at concentration 100 μg/mL can promote the migration of fibroblast L929 cells similar to epidermal growth factor (positive control) at 100 μg/mL. After 1 day of treatment, the length of scratch in wounds treated with sericin was significantly shorter than the length of negative control wounds (culture medium without sericin). For clinical study, a total of 29 patients with 65 burn wounds which covered no less than 15 % of total body surface area were randomly assigned to either control (wounds treated with silver zinc sulfadiazine cream) or treatment (wounds treated with silver zinc sulfadiazine with added sericin cream) group in this randomized, double-blind, standard-controlled study. The results showed that the average time to reach 70 % re-epithelialization of the burned surface and complete healing in the treatment group was significantly shorter, approximately 5-7 days, than in the control group. Regarding time for complete healing, control wounds took approximately 29.28 ± 9.27 days, while wounds treated with silver zinc sulfadiazine with added sericin cream took approximately 22.42 ± 6.33 days, (p = 0.001). No infection or severe reaction was found in any wounds. This is the first clinical study to show that silk sericin is safe and beneficial for burn wound treatment when it is added to silver sulfadiazine cream.

Critical Advances in Wound Care

DTIC Science & Technology

2011-01-24

Wound Limb Salvage Program WRAMC/NNMC Inpatient Care Wound and Ostomy NNMC and WRAMC Outpatient Care 2 Clinics over 400 complex encounters NNMC and... Ostomy Wound care Skin Care Cleansers Research / EBP Pressure ulcer protocol CPG development Wound education research grant WRNMMC wound care formulary...Algorithm Sibbald, Orstead, Schultz, Coutts, Keast. Preparing the Wound Bed – Focus on Infection and Inflammation. Ostomy Wound Manag 49:24-51

Predictors of Postoperative Wound Necrosis Following Primary Wound Closure of Open Ankle Fractures.

PubMed

Ovaska, Mikko T; Madanat, Rami; Mäkinen, Tatu J

2016-04-01

Most open malleolar ankle fracture wounds can be closed primarily after meticulous debridement. However, the development of wound necrosis following operative treatment of open malleolar ankle fractures can have catastrophic consequences. The aim of this study was to identify risk factors predisposing to postoperative wound necrosis following primary wound closure of open malleolar ankle fractures. A total of 137 patients with open malleolar ankle fractures were identified. The open fracture wound was primarily closed in 110 of 137 (80%) patients, and postoperative wound necrosis occurred in 18 (16%) of these patients. These patients were compared to the open fracture patients without wound necrosis. Twenty possible risk factors for the development of wound necrosis were studied with logistic regression analysis. The variables that were independently associated with an increased risk for postoperative wound necrosis included ASA class ≥2, Gustilo grade III open injury, and the use of pulsatile lavage at index surgery. Our study showed that ASA class ≥2, Gustilo grade III open injury, and the use of pulsatile lavage at index surgery were the most important factors predisposing to postoperative wound necrosis following primary wound closure of open malleolar ankle fractures. The findings warrant a further study specifically comparing primary and delayed wound closure in patients with Gustilo grade III open malleolar ankle fractures and different ASA classes. Also, the role of pulsatile lavage should be re-evaluated. Level III, retrospective comparative series. © The Author(s) 2016.

Computational and Experimental Study of the Mechanics of Embryonic Wound Healing

PubMed Central

Varner, Victor D.; Taber, Larry A.

2013-01-01

Wounds in the embryo show a remarkable ability to heal quickly without leaving a scar. Previous studies have found that an actomyosin ring (“purse string”) forms around the wound perimeter and contracts to close the wound over the course of several dozens of minutes. Here, we report experiments that reveal an even faster mechanism which remarkably closes wounds by more than 50% within the first 30 seconds. Circular and elliptical wounds (~100 µm in size) were made in the blastoderm of early chick embryos and allowed to heal, with wound area and shape characterized as functions of time. The closure rate displayed a biphasic behavior, with rapid constriction lasting about a minute, followed by a period of more gradual closure to complete healing. Fluorescent staining suggests that both healing phases are driven by actomyosin contraction, with relatively rapid contraction of fibers at cell borders within a relatively thick ring of tissue (several cells wide) around the wound followed by slower contraction of a thin supracellular actomyosin ring along the margin, consistent with a purse string mechanism. Finite-element modeling showed that this idea is biophysically plausible, with relatively isotropic contraction within the thick ring giving way to tangential contraction in the thin ring. In addition, consistent with experimental results, simulated elliptical wounds heal with little change in aspect ratio, and decreased membrane tension can cause these wounds to open briefly before going on to heal. These results provide new insight into the healing mechanism in embryonic epithelia. PMID:23973771

Enhance wound healing monitoring through a thermal imaging based smartphone app

NASA Astrophysics Data System (ADS)

Yi, Steven; Lu, Minta; Yee, Adam; Harmon, John; Meng, Frank; Hinduja, Saurabh

2018-03-01

In this paper, we present a thermal imaging based app to augment traditional appearance based wound growth monitoring. Accurate diagnose and track of wound healing enables physicians to effectively assess, document, and individualize the treatment plan given to each wound patient. Currently, wounds are primarily examined by physicians through visual appearance and wound area. However, visual information alone cannot present a complete picture on a wound's condition. In this paper, we use a smartphone attached thermal imager and evaluate its effectiveness on augmenting visual appearance based wound diagnosis. Instead of only monitoring wound temperature changes on a wound, our app presents physicians a comprehensive measurements including relative temperature, wound healing thermal index, and wound blood flow. Through the rat wound experiments and by monitoring the integrated thermal measurements over 3 weeks of time frame, our app is able to show the underlying healing process through the blood flow. The implied significance of our app design and experiment includes: (a) It is possible to use a low cost smartphone attached thermal imager for added value on wound assessment, tracking, and treatment; and (b) Thermal mobile app can be used for remote wound healing assessment for mobile health based solution.

Assessing Lebanese Children's Reactions to War-Related Stress

ERIC Educational Resources Information Center

El Zein, Heyam Lutfi; Ammar, Diala F.

2011-01-01

This exploratory study investigates the psychological effect of the 2006 war on Lebanese children. A sample of 110 exposed and 105 nonexposed children (9-12 years) balanced for age and gender were assessed using Spielberger's State-Trait Anxiety Inventory. The analysis aimed at investigating the effect of proximity, exposure to combat, and family…

Exploratory Analysis of Factors Surrounding Aeromedical Evacuation (Patient Movement) from Operation Iraqi Freedom (OEF) Focusing on Placement of Wounded Warriors in US/CONUS-based Military Treatment Facilities (MTFs)

DTIC Science & Technology

2007-05-01

below), there were 281,881 casualties listed Table 1. Ametican War and Military Operations Casualties: Usts and Statistcs . Number Wounds not Battle...but the need for Solace was greater than ever. With the outbreak of yellow fever and malaria among the troops in Cuba, the situation was quite grave

Trajectories of posttraumatic stress symptoms (PTSS) after major war among Palestinian children: Trauma, family- and child-related predictors.

PubMed

Punamäki, Raija-Leena; Palosaari, Esa; Diab, Marwan; Peltonen, Kirsi; Qouta, Samir R

2015-02-01

Research shows great individual variation in changes in posttraumatic stress symptoms (PTSSs) after major traumas of terrorist attacks, military combat, and natural disasters. Earlier studies have identified specific mental health trajectories both in children and adults. This study aimed, first, to identify potential PTSS-related trajectories by using latent class growth analyses among children in a three-wave assessment after the 2008/2009 War on Gaza, Palestine. Second, it analyzed how family- and child related factors (e.g., attachment relations, posttraumatic cognitions (PTCs), guilt, and emotion regulation) associate with the trajectory class membership. The sample consisted of 240 Palestinian children (49.4% girls and 50.6% boys) of 10-13 years of age (M=11.29, SD=0.68), who completed PTSS (CRIES) assessments at 3 (T1), 5 (T2), and 11 (T3) months after the war. Children reported their personal exposure to war trauma, attachment style, cognitive trauma processing, and emotion regulation, and their parents reported family war trauma exposure and attachment style. Results revealed a three-trajectory solution, a majority of children belonging to the Recovery trajectory (n=183), and a minority belonged either to Resistant trajectory (n=29) or to Increasing symptoms trajectory (n=28). Low levels of negative posttraumatic cognitive appraisals, feelings of guilt and emotion regulation were characteristic of children in the Resistant trajectory as compared to Increasing symptoms trajectory. Father׳s attachment security was further associated with the Resistant trajectory membership. Children׳s attachment avoidance and high parental trauma were typical to children in Recovery trajectory (as compared to the Increasing symptoms trajectory). Copyright © 2014 Elsevier B.V. All rights reserved.

The utilization of an ocular wound chamber on corneal epithelial wounds

PubMed Central

McDaniel, Jennifer S; Holt, Andrew W; Por, Elaine D; Eriksson, Elof; Johnson, Anthony J; Griffith, Gina L

2018-01-01

Purpose Currently available ocular moisture chambers are not adequate to manage the treatment of periocular burns, corneal injuries, and infection. The purpose of these studies was to demonstrate that a flexible, semi-transparent ocular wound chamber device adapted from technology currently used on dermal wounds is safe for use on corneal epithelial injuries. Materials and methods A depilatory cream (Nair™, 30 seconds) was utilized to remove the excess hair surrounding the left eyes of anesthetized Institute Armand Frappier (IAF) hairless, female guinea pigs (Crl:HA-Hrhr). A 4 mm corneal epithelium defect was created using a corneal rust ring remover (Algerbrush®II). Epithelial defects were either left untreated or the eyes were fitted with an ocular wound chamber and 0.5 mL of hydroxypropyl methylcellulose (HPMC) gel (GenTeal®) or HPMC liquid (GenTeal®) was injected into each chamber (N=5 per group). At 0, 24, 48, and 72 hours fluorescein and optical coherence tomography imaging was collected and the intraocular pressure (IOP) was measured. H&E staining was performed on corneal and eyelid skin samples and evaluated by a veterinary pathologist. Results Corneal epithelial wounds demonstrated 100% closure rates when left untreated or treated with an ocular wound chamber containing HPMC gel at 72 hours while wounds treated with an ocular wound chamber containing HPMC liquid were 98% healed. No significant differences were found in corneal thickness and wound healing, IOP, or eyelid skin pathology in any treatment group when compared to controls. Conclusions This study indicates that adapted wound chamber technology can be safely used on sterile, corneal epithelial wounds without adverse effects on periocular or ocular tissue when filled with a liquid or gel. PMID:29785086

Mediators of the relation between war experiences and suicidal ideation among former child soldiers in Northern Uganda: the WAYS study.

PubMed

Amone-P'Olak, Kennedy; Lekhutlile, Tlholego Molemane; Meiser-Stedman, Richard; Ovuga, Emilio

2014-09-24

Globally, suicide is a public health burden especially in the aftermath of war. Understanding the processes that define the path from previous war experiences (WE) to current suicidal ideation (SI) is crucial for defining opportunities for interventions. We assessed the extent to which different types of previous WE predict current SI and whether post-war hardships and depression mediate the relations between WE and SI among former child soldiers (FCS) in Northern Uganda. We performed cross-sectional analyses with a sample of 539 FCS (61% male) participating in an on-going longitudinal study. The influence of various types of previous WE on current SI and mediation by post-war hardships and depression were assessed by regression analyses. The following types of war experiences: "witnessing violence", "direct personal harm", "deaths", "Involvement in hostilities", "sexual abuse" and "general war experiences" significantly predicted current SI in a univariable analyses whereas "direct personal harm", "involvement in hostilities", and "sexual abuse" independently predicted current SI in a multivariable analyses. General WE were linked to SI (β = 0.18 (95% CI 0.10 to 0.25)) through post-war hardships (accounting for 69% of the variance in their relationship) and through depression/anxiety (β = 0.17 (95% CI 0.12 to 0.22)) accounting for 65% of the variance in their relationship. The direct relationship between previous WE and current SI reduced but remained marginally significant (β = .08, CI: (.01, .17) for depression/anxiety but not for post-war hardships (β = .09, CI: (-.03, .20). Types of WE should be examined when assessing risks for SI. Interventions to reduce SI should aim to alleviate post-war hardships and treat depression/anxiety.

Family systems approach to attachment relations, war trauma, and mental health among Palestinian children and parents

PubMed Central

Punamäki, Raija-Leena; Qouta, Samir R.; Peltonen, Kirsi

2017-01-01

ABSTRACT Background: Trauma affects the family unit as a whole; however, most existing research uses individual or, at most, dyadic approaches to analyse families with histories of trauma. Objective: This study aims to identify potentially distinct family types according to attachment, parenting, and sibling relations, to analyse how these family types differ with respect to war trauma, and to explore how children’s mental health and cognitive processing differ across these family types. Method: Participants included Palestinian mothers and fathers (N = 325) and their children (one per family; 49.4% girls; 10–13 years old; mean ± SD age = 11.35 ± 0.57 years) after the Gaza War of 2008–2009. Both parents reported their exposure to war trauma, secure attachment availability, and parenting practices, as well as the target child’s internalizing and externalizing symptoms [Strengths and Difficulties Questionnaire (SDQ)]. Children reported their symptoms of post-traumatic stress disorder (on the Children’s Revised Impact Event Scale), depression (Birleson), and SDQ, as well as their post-traumatic cognitions (Children’s Post Traumatic Cognitions Inventory). Results: A cluster analysis identified four family types. The largest type reflected secure attachment and optimal relationships (security and positive family relationships, 36.2%, n = 102), and the smallest exhibited insecurity and problematic relationships (insecurity and negative family relationships, 15.6%; n = 44). Further, families with discrepant experiences (23.0%; n = 65) and moderate security and neutral relationships (25.2%; n = 71) emerged. The insecurity and negative relationships family type showed higher levels of war trauma; internalizing, externalizing, and depressive symptoms among children; and dysfunctional post-traumatic cognitions than other family types. Conclusion: The family systems approach to mental health is warranted in war conditions, and therapeutic

Family systems approach to attachment relations, war trauma, and mental health among Palestinian children and parents.

PubMed

Punamäki, Raija-Leena; Qouta, Samir R; Peltonen, Kirsi

2017-01-01

Background : Trauma affects the family unit as a whole; however, most existing research uses individual or, at most, dyadic approaches to analyse families with histories of trauma. Objective : This study aims to identify potentially distinct family types according to attachment, parenting, and sibling relations, to analyse how these family types differ with respect to war trauma, and to explore how children's mental health and cognitive processing differ across these family types. Method: Participants included Palestinian mothers and fathers ( N  = 325) and their children (one per family; 49.4% girls; 10-13 years old; mean ±  SD age = 11.35 ± 0.57 years) after the Gaza War of 2008-2009. Both parents reported their exposure to war trauma, secure attachment availability, and parenting practices, as well as the target child's internalizing and externalizing symptoms [Strengths and Difficulties Questionnaire (SDQ)]. Children reported their symptoms of post-traumatic stress disorder (on the Children's Revised Impact Event Scale), depression (Birleson), and SDQ, as well as their post-traumatic cognitions (Children's Post Traumatic Cognitions Inventory). Results: A cluster analysis identified four family types. The largest type reflected secure attachment and optimal relationships (security and positive family relationships, 36.2%, n  = 102), and the smallest exhibited insecurity and problematic relationships (insecurity and negative family relationships, 15.6%; n  = 44). Further, families with discrepant experiences (23.0%; n  = 65) and moderate security and neutral relationships (25.2%; n  = 71) emerged. The insecurity and negative relationships family type showed higher levels of war trauma; internalizing, externalizing, and depressive symptoms among children; and dysfunctional post-traumatic cognitions than other family types. Conclusion: The family systems approach to mental health is warranted in war conditions, and therapeutic interventions for

Survey of Wound-Healing Centers and Wound Care Units in China.

PubMed

Jiang, Yufeng; Xia, Lei; Jia, Lijing; Fu, Xiaobing

2016-09-01

The purpose of this study is to report the Chinese experience of establishing hospital-based wound care centers over 15 years. A total of 69 wound-healing centers (WHCs) and wound care units (WCUs) were involved. Questionnaires were diverged to the principal directors of these sites; data extracted for this study included origin, year of establishment, medical staff, degree of hospitals, wound etiology, wound-healing rate, hospital stay, and outcomes data. The period of data extraction was defined as before and after 1 year of the establishment of WHCs and WCUs. The earliest WHC was established in 1999, and from 2010 the speeds of establishing WHCs and WCUs rapidly increased. The majority of WHCs were divisions of burn departments, and all WHCs came from departments of outpatient dressing rooms. Full-time multidisciplinary employees of WHCs differed greatly to WCUs. Types of wound and outcomes vary with those of centers reported from Western countries and the United States. Improvement in wound healing caused by the establishment of WHCs and WCUs in China occurred without doubt. Some advices include the following: rearrange and reorganize the distribution of WHCs and WCUs; enact and generalize Chinese guidelines for chronic wounds; utilize medical resources reasonably; improve multidisciplinary medical staff team; draw up and change some medical and public policies and regulations. © The Author(s) 2015.

Astaxanthin protects against early burn-wound progression in rats by attenuating oxidative stress-induced inflammation and mitochondria-related apoptosis

PubMed Central

Fang, Quan; Guo, Songxue; Zhou, Hanlei; Han, Rui; Wu, Pan; Han, Chunmao

2017-01-01

Burn-wound progression can occur in the initial or peri-burn area after a deep burn injury. The stasis zone has a higher risk of deterioration mediated by multiple factors but is also considered salvageable. Astaxanthin (ATX), which is extracted from some marine organisms, is a natural compound with a strong antioxidant effect that has been reported to attenuate organ injuries caused by traumatic injuries. Hence, we investigated the potential effects of ATX on preventing early burn-wound progression. A classic “comb” burn rat model was established in this study for histological and biological assessments, which revealed that ATX, particularly higher doses, alleviated histological deterioration in the stasis zone. Additionally, we observed dose-dependent improvements in oxidative stress and the release of inflammatory mediators after ATX treatment. Furthermore, ATX dose-dependently attenuated burn-induced apoptosis in the wound areas, and this effect was accompanied by increases in Akt and Bad phosphorylation and a downregulation of cytochrome C and caspase expression. In addition, the administration of Ly 294002 further verified the effect of ATX. In summary, we demonstrated that ATX protected against early burn-wound progression in a rat deep-burn model. This protection might be mediated by the attenuation of oxidative stress-induced inflammation and mitochondria-related apoptosis. PMID:28128352

CICATRIZATION OF WOUNDS

PubMed Central

Du Noüy, P. Lecomte

1916-01-01

The cicatrization of sterile wounds may be studied in the same way as an ordinary physicochemical phenomenon. It is possible, therefore, to express the law of cicatrization by a mathematical equation as soon as an accurate measure of the wound can be obtained. By means of the equation, a curve is obtained which represents the theoretical evolution of the cicatrization of a wound. This curve, being an expression of what should happen on a normal wound, healing aseptically, on a normal man, is a daily point of comparison to what appears actually on the observed wound, and allows one to study accurately the fluctuations of cicatrization on a given individual, and the action of different dressings and antiseptic substances PMID:19868053

The American Home Front. Revolutionary War, Civil War, World War 1, World War 2

DTIC Science & Technology

1983-01-01

antimili- tarism and wish to avoid anything remotely related to the armed services or because they prefer to focus on either a war’s origins or its...RevoLtion’s opponents. to win reluctant support from many who preferred neutrality, and. with less justification, to settle old personal scores. On the...responsible for the American 0 farmers’ subsequent preference for inflation, seeing in easy money, according to John Schlebecker, the "route to agrarian

Physical and Mental Health Consequences of War-related Stressors Among Older Adults: An Analysis of Posttraumatic Stress Disorder and Arthritis in Northern Vietnamese War Survivors.

PubMed

Korinek, Kim; Loebach, Peter; Teerawichitchainan, Bussarawan

2017-10-01

We examine the impacts of trauma exposures and family stressors associated with the Vietnam War on musculoskeletal health and posttraumatic stress disorder (PTSD) outcomes in elderly Vietnamese who were widely impacted by the war as young adults. Noting that wars' impacts extend beyond male veterans in most survivor populations, we give attention to male and female war survivors placed in a variety of roles vis-a-vis the war. Utilizing data from the 2010 Vietnam Health and Aging Pilot Study (N = 405), we use logistic and Poisson regression models to estimate the effect of wartime trauma exposures and family stressors on disabling arthritis and PTSD symptoms in male and female northern Vietnamese adults aged 55 and older. The odds of experiencing recent PTSD symptoms are greater in respondents who report involvement in killing/causing severe injury and who observed war atrocities. In women, PTSD is positively correlated with war era child death and spousal separation. Arthritis also exhibits a significant, positive association with killing/causing severe injury. Our study provides insights into the burden of conflict upon health among populations of the global south that survived war and are now entering older adulthood. The pattern of results, indicating greatest suffering among those who inflicted or failed to prevent bodily harm or loss of life, is consistent with the concept of moral injury. © The Author 2016. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Chitosan preparations for wounds and burns: antimicrobial and wound-healing effects

PubMed Central

Dai, Tianhong; Tanaka, Masamitsu; Huang, Ying-Ying; Hamblin, Michael R

2011-01-01

Since its discovery approximately 200 years ago, chitosan, as a cationic natural polymer, has been widely used as a topical dressing in wound management owing to its hemostatic, stimulation of healing, antimicrobial, nontoxic, biocompatible and biodegradable properties. This article covers the antimicrobial and wound-healing effects of chitosan, as well as its derivatives and complexes, and its use as a vehicle to deliver biopharmaceuticals, antimicrobials and growth factors into tissue. Studies covering applications of chitosan in wounds and burns can be classified into in vitro, animal and clinical studies. Chitosan preparations are classified into native chitosan, chitosan formulations, complexes and derivatives with other substances. Chitosan can be used to prevent or treat wound and burn infections not only because of its intrinsic antimicrobial properties, but also by virtue of its ability to deliver extrinsic antimicrobial agents to wounds and burns. It can also be used as a slow-release drug-delivery vehicle for growth factors to improve wound healing. The large number of publications in this area suggests that chitosan will continue to be an important agent in the management of wounds and burns. PMID:21810057

Causes of death of prisoners of war during the Korean War (1950-1953).

PubMed

Lee, Myoung-Soon; Kang, Min-Jung; Huh, Sun

2013-03-01

This study aimed at analyzing the causes of death of prisoners of war (POWs) during the Korean War (1950-1953) who fought for the Communist side (North Korea and the People's Republic of China). In 1998, the United States Department of Defense released new information about the prisoners including, 7,614 deaths of the POW during the Korean War. The data on the causes of death of the POWs during the Korean War provides valuable information on the both the public health and history of the conflict. To analyze the causes of death of the POWs, we classified the clinical diagnosis and findings on 7,614 deaths into 22 chapters, as outlined in the International Statistical Classification of Diseases and Related Health Problems-10th Revision (ICD-10). Second, we traced changes in the monthly death totals of POWs as well as deaths caused by common infectious diseases and external causes of death including injury over time from August 1950 to September 1953. The most common category of causes of deaths of POWs was infectious disease, 5,013 (65.8%) out of 7,614 deaths, followed by external causes including injury, 817 (10.7%). Overall, tuberculosis and dysentery/diarrhea were the most common causes of death. Deaths caused by acute and chronic infection, or external causes showed different patterns of increases and decline over time during the Korean War. The information and data on POWs' deaths during the Korean War reflects the critical impact of the POWs' living conditions and the effect of public health measures implemented in POW camps during the war.

Saliva and wound healing.

PubMed

Brand, Henk S; Ligtenberg, Antoon J M; Veerman, Enno C I

2014-01-01

Oral wounds heal faster and with less scar formation than skin wounds. One of the key factors involved is saliva, which promotes wound healing in several ways. Saliva creates a humid environment, thus improving the survival and functioning of inflammatory cells that are crucial for wound healing. In addition, saliva contains several proteins which play a role in the different stages of wound healing. Saliva contains substantial amounts of tissue factor, which dramatically accelerates blood clotting. Subsequently, epidermal growth factor in saliva promotes the proliferation of epithelial cells. Secretory leucocyte protease inhibitor inhibits the tissue-degrading activity of enzymes like elastase and trypsin. Absence of this protease inhibitor delays oral wound healing. Salivary histatins in vitro promote wound closure by enhancing cell spreading and cell migration, but do not stimulate cell proliferation. A synthetic cyclic variant of histatin exhibits a 1,000-fold higher activity than linear histatin, which makes this cyclic variant a promising agent for the development of a new wound healing medication. Conclusively, recognition of the many roles salivary proteins play in wound healing makes saliva a promising source for the development of new drugs involved in tissue regeneration.

Economic comparison of methods of wound closure: wound closure strips vs. sutures and wound adhesives.

PubMed

Zempsky, William T; Zehrer, Cindy L; Lyle, Christopher T; Hedbloom, Edwin C

2005-09-01

Our objective was to review and assess the treatment of low-tension wounds and evaluate the cost-effectiveness of wound closure methods. We used a health economic model to estimate cost/closure of adhesive wound closure strips, tissue adhesives and sutures. The model incorporated cost-driving variables: application time, costs and the likelihood and costs of dehiscence and infection. The model was populated with variable estimates derived from the literature. Cost estimates and cosmetic results were compared. Parameter values were estimated using national healthcare and labour statistics. Sensitivity analyses were used to verify the results. Our analysis suggests that adhesive wound closure strips had the lowest average cost per laceration ($7.54), the lowest cost per infected laceration ($53.40) and the lowest cost per laceration with dehiscence ($25.40). The costs for sutures were $24.11, $69.91 and $41.91, respectively; the costs for tissue adhesives were $28.77, $74.68 and $46.68, respectively. The cosmetic outcome for all three treatments was equivalent. We conclude adhesive wound closure strips were both a cost-saving and a cost-effective alternative to sutures and tissue adhesives in the closure of low-tension lacerations.

Is wounding aggression in zoo-housed chimpanzees and ring-tailed lemurs related to zoo visitor numbers?

PubMed

Hosey, Geoff; Melfi, Vicky; Formella, Isabel; Ward, Samantha J; Tokarski, Marina; Brunger, Dave; Brice, Sara; Hill, Sonya P

2016-05-01

Chimpanzees in laboratory colonies experience more wounds on weekdays than on weekends, which has been attributed to the increased number of people present during the week; thus, the presence of more people was interpreted as stressful. If this were also true for primates in zoos, where high human presence is a regular feature, this would clearly be of concern. Here we examine wounding rates in two primate species (chimpanzees Pan troglodytes and ring-tailed lemurs Lemur catta) at three different zoos, to determine whether they correlate with mean number of visitors to the zoo. Wounding data were obtained from a zoo electronic record keeping system (ZIMS™). The pattern of wounds did not correlate with mean gate numbers for those days for either species in any group. We conclude that there is no evidence that high visitor numbers result in increased woundings in these two species when housed in zoos. Zoo Biol. 35:205-209, 2016. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

Wound Blush Obtainment Is the Most Important Angiographic Endpoint for Wound Healing.

PubMed

Utsunomiya, Makoto; Takahara, Mitsuyoshi; Iida, Osamu; Yamauchi, Yasutaka; Kawasaki, Daizo; Yokoi, Yoshiaki; Soga, Yoshimistu; Ohura, Norihiko; Nakamura, Masato

2017-01-23

This study aimed to assess the optimal angiographic endpoint of endovascular therapy (EVT) for wound healing. Several reports have demonstrated acceptable patency and limb salvage rates following infrapopliteal interventions for the treatment of critical limb ischemia (CLI). However, the optimal angiographic endpoint of EVT remains unclear. We conducted a subanalysis of the prospective multicenter OLIVE (Endovascular Treatment for Infrainguinal Vessels in Patients with Critical Limb Ischemia) registry investigation assessing patients who received infrainguinal EVT for CLI. We analyzed data from 185 limbs with ischemic ulcerations classified as Rutherford class 5 or 6, managed with EVT alone (i.e., not undergoing bypass surgery). The wound healing rate after EVT was estimated by the Kaplan-Meier method. The association between final angiographic data and wound healing was assessed employing a Cox proportional hazards model. The overall wound healing rate was 73.5%. The probabilities of wound healing in patients with wound blush obtainment was significantly higher than that of those without wound blush (79.6% vs. 46.5%; p = 0.01). In the multivariate analysis, wound blush obtainment was an independent predictor of wound healing. The presence of wound blush after EVT is significantly associated with wound healing. Wound blush as an angiographic endpoint for EVT may serve as a novel predictor of wound healing in patients with CLI. Copyright © 2017 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Enhanced wound contraction in fresh wounds dressed with honey in Wistar rats (Rattus Novergicus).

PubMed

Osuagwu, F C; Oladejo, O W; Imosemi, I O; Aiku, A; Ekpos, O E; Salami, A A; Oyedele, O O; Akang, E U

2004-01-01

Due to reports that honey accelerates wound healing, an investigation on its role in wound contraction in fresh wounds inflicted on wistar rats was carried out. Twenty adult male wistar rats had 2cm by 2cm square wound inflicted on their right dorsolateral trunk. They were divided into two groups. The experimental group had their wounds dressed with honey while the control group had normal saline dressing. Wound dressing was done every five days and measurements taken at each dressing. Wound morphology was also assessed. Dressing with honey significantly enhanced percentage wound contraction on day 10 with value of 79.20+/-2.94 compared to control value of 53.50+/-4.32. p=0.0. The mean wound measurement on day 10 reduced significantly in honey group, 1.15+/-0.18 compared to control group 2.38+/-0.28. p=0.002. However, there was no significant difference in fibroblast count per high power field in honey group 68.0+/-2.59 compared to control 90.2+/-17.40, p=0.242. Honey dressing increased mean blood vessel count per high power field, 18.8+/-3.77 albeit non significantly when compared to control value of 13.4+/-2.44, p=0.264. Also honey dressing caused increased granulation tissue formation in wounds dressed with honey compared to control group. Our study suggests that honey dressing enhances wound contraction in fresh wounds which is one of the key features of wound healing.

Atypical ulcers: wound biopsy results from a university wound pathology service .

PubMed

Tang, Jennifer C; Vivas, Alejandra; Rey, Andrea; Kirsner, Robert S; Romanelli, Paolo

2012-06-01

Chronic wounds are an increasing health burden across the continuum of care and encountered by a wide variety of healthcare providers and physicians of all specialties. The majority of chronic wounds are caused by vascular insufficiency, neuropathy, or prolonged pressure. Wounds caused by other underlying health conditions or external factors such as radiation or spider bites are usually referred to as atypical. Although a wound biopsy generally is recommended in the case of refractory, nonhealing ulcers or when wounds present with atypical signs and symptoms, little is known about the distribution of atypical ulcers. A retrospective, descriptive study was conducted to describe the proportion and differential diagnosis of atypical ulcer biopsies received during a 2-year period by the wound pathology division in the division of Dermatopathology at the University of Miami Department of Dermatology and Cutaneous Surgery. Of the 350 wound biopsies received for diagnostic purposes, 104 (29.7%) were due to atypical causes. The majority of specimens were neoplasms (n = 24). Pyoderma gangrenosum was the most common atypical diagnosis encountered (n = 14). Vasculitis, predominantly leukocytoclastic vasculitis, and external causes were diagnosed in 16 and 15 biopsies, respectively. This study represents the first published case series of atypical ulcer biopsy results from a wound pathology division. Although the prevalence results cannot be generalized and are likely lower in the general population of patients with nonhealing wounds, the results confirm the usefulness of obtaining wound biopsies to provide a definitive diagnosis and to guide care.

Wound Healing Effect of Slightly Acidic Electrolyzed Water on Cutaneous Wounds in Hairless Mice via Immune-Redox Modulation.

PubMed

You, Hae Sun; Fadriquela, Ailyn; Sajo, Ma Easter Joy; Bajgai, Johny; Ara, Jesmin; Kim, Cheol Su; Kim, Soo-Ki; Oh, Jin Rok; Shim, Kwang Yong; Lim, Hyun Kyo; Lee, Kyu-Jae

2017-01-01

Acidic electrolyzed water is an innovative sanitizer having a wide-spectrum of applications in food industry, and healthcare industry but little is known on its effect and mechanism in wound healing. The study was conducted to identify the effect and mechanism of slightly acidic electrolyzed water (SAEW) on cutaneous wounds in hairless mice. SAEW (pH: 5-6.5, oxidation reduction potential: 800 mV, chlorine concentration: 25 ppm) was prepared through electrolysis of water and was applied to the wounds of hairless mice three times a day for seven days. Wound size, immune response and oxidative stress were explored and compared to conventional agents such as Betadine and alcohol. We found that SAEW-treated group showed the highest wound reduction percentage (p<0.01). Antioxidant activities such as glutathione peroxidase, catalase and myeloperoxidase activities of SAEW group surpassed the total reactive oxygen species in skin. Nuclear factor erythroid-2-related-factor-2 and aryl hydrocarbon receptor were upregulated in SAEW group. Further, SAEW recruited the production of intracellular calcium and promoted its utilization for faster healing. In line, SAEW treatment decreased pro-inflammatory cytokines [interleukin (IL)-1β, IL-6, keratinocyte chemoattractant, and tumor necrosis factor-α] in serum. Other hallmarks of wound healing, matrixmetalloproteinases (MMP)1 and MMP9 were also upregulated. Collectively, our study indicates that SAEW is effective in wound healing of hairless mice via immune-redox modulation, and heals better/faster than conventional agents.

37 CFR 5.18 - Arms, ammunition, and implements of war.

Code of Federal Regulations, 2010 CFR

2010-07-01

... implements of war. 5.18 Section 5.18 Patents, Trademarks, and Copyrights UNITED STATES PATENT AND TRADEMARK... implements of war. (a) The exportation of technical data relating to arms, ammunition, and implements of war... parts 120 through 130); the articles designated as arms, ammunitions, and implements of war are...

Efficacy and Safety of a Novel Autologous Wound Matrix in the Management of Complicated, Chronic Wounds: A Pilot Study.

PubMed

Kushnir, Igal; Kushnir, Alon; Serena, Thomas E; Garfinkel, Doron

2016-09-01

The objective of this pilot study was to evaluate the efficacy and safety of a novel method using an autologous whole blood clot formed with the RedDress Wound Care System (RD1, RedDress Ltd, Israel), a provisional whole blood clot matrix used in the treatment of chronic wounds of various etiologies. Patients were treated at the bedside with the whole blood clot matrix. Blood was withdrawn from each patient using citrate, mixed with a calcium gluconate/kaolin suspension, and injected into an RD1 clotting tray. Within 10 minutes, a clot was formed, placed upon the wound, and fixed with primary and secondary dressings. Wounds were redressed weekly with a whole blood clot matrix. Treatment was terminated when complete healing was achieved, or when the clinician determined that the wound could not further improve without additional invasive procedures. Seven patients with multiple and serious comorbidities and 9 chronic wounds were treated with 35 clot matrices. Complete healing was achieved in 7 of 9 wounds (78%). In 1 venous ulcer with a nonhealing fistula, 77% healing was achieved. Treatment was terminated in 1 pressure ulcer at 82% closure, because an unexpected mechanical trauma resulted in deterioration; this was the only adverse event reported, unrelated to the product. No systemic adverse events occurred. This pilot study demonstrates the in vitro autologous whole blood clot matrix is effective and safe for treating patients with chronic wounds of different etiologies. A larger clinical trial is needed to assess the relative success rate of the matrix in different types of wounds in a diverse population with comorbidities.

Evidence review: the clinical benefits of Safetac technology in wound care.

PubMed

Davies, Phil; Rippon, Mark

2008-11-01

Common causes of trauma and wound pain include: the removal of dressings that become stuck to the wound bed; skin stripping of peri-wound skin, as a result of the repeated application and removal of adhesive dressings; and tissue excoriation and maceration of the peri-wound skin, due to inadequate management of wound exudate. This supplement outlines how dressings with Safetac adhesive technology can help clinicians to avoid these problems. A review of the clinical and scientific evidence relating to dressings with Safetac clearly demonstrates that they can be used to prevent trauma and minimise pain on a wide range of wound types and skin injuries.

Using wound care algorithms: a content validation study.

PubMed

Beitz, J M; van Rijswijk, L

1999-09-01

Valid and reliable heuristic devices facilitating optimal wound care are lacking. The objectives of this study were to establish content validation data for a set of wound care algorithms, to identify their associated strengths and weaknesses, and to gain insight into the wound care decision-making process. Forty-four registered nurse wound care experts were surveyed and interviewed at national and regional educational meetings. Using a cross-sectional study design and an 83-item, 4-point Likert-type scale, this purposive sample was asked to quantify the degree of validity of the algorithms' decisions and components. Participants' comments were tape-recorded, transcribed, and themes were derived. On a scale of 1 to 4, the mean score of the entire instrument was 3.47 (SD +/- 0.87), the instrument's Content Validity Index was 0.86, and the individual Content Validity Index of 34 of 44 participants was > 0.8. Item scores were lower for those related to packing deep wounds (P < .001). No other significant differences were observed. Qualitative data analysis revealed themes of difficulty associated with wound assessment and care issues, that is, the absence of valid and reliable definitions. The wound care algorithms studied proved valid. However, the lack of valid and reliable wound assessment and care definitions hinders optimal use of these instruments. Further research documenting their clinical use is warranted. Research-based practice recommendations should direct the development of future valid and reliable algorithms designed to help nurses provide optimal wound care.

PKM2 released by neutrophils at wound site facilitates early wound healing by promoting angiogenesis.

PubMed

Zhang, Yinwei; Li, Liangwei; Liu, Yuan; Liu, Zhi-Ren

2016-03-01

Neutrophils infiltration/activation following wound induction marks the early inflammatory response in wound repair. However, the role of the infiltrated/activated neutrophils in tissue regeneration/proliferation during wound repair is not well understood. Here, we report that infiltrated/activated neutrophils at wound site release pyruvate kinase M2 (PKM2) by its secretive mechanisms during early stages of wound repair. The released extracellular PKM2 facilitates early wound healing by promoting angiogenesis at wound site. Our studies reveal a new and important molecular linker between the early inflammatory response and proliferation phase in tissue repair process. © 2016 by the Wound Healing Society.

Keratinocyte growth factor and the expression of wound-healing-related genes in primary human keratinocytes from burn patients.

PubMed

Chomiski, Verônica; Gragnani, Alfredo; Bonucci, Jéssica; Correa, Silvana Aparecida Alves; Noronha, Samuel Marcos Ribeiro de; Ferreira, Lydia Masako

2016-08-01

To evaluate the effect of keratinocyte growth factor (KGF) treatment on the expression of wound-healing-related genes in cultured keratinocytes from burn patients. Keratinocytes were cultured and divided into 4 groups (n=4 in each group): TKB (KGF-treated keratinocytes from burn patients), UKB (untreated keratinocytes from burn patients), TKC (KGF-treated keratinocytes from controls), and UKC (untreated keratinocytes from controls). Gene expression analysis using quantitative polymerase chain reaction (qPCR) array was performed to compare (1) TKC versus UKC, (2) UKB versus UKC, (3) TKB versus UKC, (4) TKB versus UKB, (5) TKB versus TKC, and (6) UKB versus TKC. Comparison 1 showed one down-regulated and one up-regulated gene; comparisons 2 and 3 resulted in the same five down-regulated genes; comparison 4 had no significant difference in relative gene expression; comparison 5 showed 26 down-regulated and 7 up-regulated genes; and comparison 6 showed 25 down-regulated and 11 up-regulated genes. There was no differential expression of wound-healing-related genes in cultured primary keratinocytes from burn patients treated with keratinocyte growth factor.

A multi-centre clinical evaluation of reactive oxygen topical wound gel in 114 wounds.

PubMed

Dryden, M; Dickinson, A; Brooks, J; Hudgell, L; Saeed, K; Cutting, K F

2016-03-01

This article reports the outcomes of the use of Surgihoney RO (SHRO), topical wound dressing in a multi-centre, international setting. The aims were to explore the clinical effects of SHRO, including a reduction in bacterial load and biofilm and improvement in healing in a variety of challenging non-healing and clinically infected wounds. This was a non-comparative evaluation, where both acute and chronic wounds with established delayed healing were treated with the dressing. Clinicians prospectively recorded wound improvement or deterioration, level of wound exudate, presence of pain, and presence of slough and necrosis. Analysis of this data provided information on clinical performance of the dressing. Semi-quantitative culture to assess bacterial bioburden was performed where possible. We recruited 104 patients, mean age 61 years old, with 114 wounds. The mean duration of wounds before treatment was 3.7 months and the mean duration of treatment was 25.7 days. During treatment 24 wounds (21%) healed and the remaining 90 (79%) wounds improved following application of the dressing. No deterioration in any wound was observed. A reduction in patient pain, level of wound exudate and in devitalised tissue were consistently reported. These positive improvements in wound progress were reflected in the wound cultures that showed a reduction in bacterial load in 39 out of the 40 swabs taken. There were two adverse events recorded: a stinging sensation following application of the dressing was experienced by 2 patients, and 2 elderly patients died of causes unrelated to the dressing or to the chronic wound. These patients' wounds and their response to SHRO have been included in the analysis. SHRO was well tolerated and shows great promise as an effective potent topical antimicrobial in the healing of challenging wounds. Matthew Dryden has become a shareholder in Matoke Holdings, the manufacturer of Surgihoney RO, since the completion of this study. Keith Cutting is a

Gunshot wounds: epidemiology, wound ballistics, and soft-tissue treatment.

PubMed

Dougherty, Paul J; Najibi, Soheil; Silverton, Craig; Vaidya, Rahul

2009-01-01

The extremities are the most common anatomic location for gunshot wounds. Because of the prevalence of gunshot injuries, it is important that orthopaedic surgeons are knowledgeable about caring for them. The most common injuries seen with gunshot wounds are those of the soft tissues. Nonsurgical management of patients who have gunshot wounds with minimal soft-tissue disruption has been successfully accomplished in emergency departments for several years; this includes extremity wounds without nerve, intra-articular, or vascular injury. Stable, nonarticular fractures of an extremity have also been successfully treated with either minimal surgical or nonsurgical methods in the emergency department. Indications for surgical treatment include unstable fractures, intra-articular injuries, a significant soft-tissue injury (especially with skin loss), vascular injury, and/or a large or expanding hematoma.

Simple Skin-Stretching Device in Assisted Tension-Free Wound Closure.

PubMed

Cheng, Li-Fu; Lee, Jiunn-Tat; Hsu, Honda; Wu, Meng-Si

2017-03-01

Numerous conventional wound reconstruction methods, such as wound undermining with direct suture, skin graft, and flap surgery, can be used to treat large wounds. The adequate undermining of the skin flaps of a wound is a commonly used technique for achieving the closure of large tension wounds; however, the use of tension to approximate and suture the skin flaps can cause ischemic marginal necrosis. The purpose of this study is to use elastic rubber bands to relieve the tension of direct wound closure for simultaneously minimizing the risks of wound dehiscence and wound edge ischemia that lead to necrosis. This retrospective study was conducted to evaluate our clinical experiences with 22 large wounds, which involved performing primary closures under a considerable amount of tension by using elastic rubber bands in a skin-stretching technique after a wide undermining procedure. Assessment of the results entailed complete wound healing and related complications. All 22 wounds in our study showed fair to good results except for one. The mean success rate was approximately 95.45%. The simple skin-stretching design enabled tension-free skin closure, which pulled the bilateral undermining skin flaps as bilateral fasciocutaneous advancement flaps. The skin-stretching technique was generally successful.

Simple skin-stretching device in assisted tension-free wound closure

PubMed Central

Cheng, Li-Fu; Lee, Jiunn-Tat; Hsu, Honda; Wu, Meng-Si

2017-01-01

Background Numerous conventional wound reconstruction methods such as wound undermining with direct suture, skin graft, and flap surgery can be used to treat large wounds. The adequate undermining of the skin flaps of a wound is a commonly used technique for achieving the closure of large tension wounds; however, the use of tension to approximate and suture the skin flaps can cause ischemic marginal necrosis. The purpose of this study is to use elastic rubber bands to relieve the tension of direct wound closure for simultaneously minimizing the risks of wound dehiscence and wound edge ischemia that lead to necrosis. Materials and Methods This retrospective study was conducted to evaluate our clinical experiences with 22 large wounds, which involved performing primary closures under a considerable amount of tension by using elastic rubber bands in a skin-stretching technique following a wide undermining procedure. Assessment of the results entailed complete wound healing and related complications. Results All 22 wounds in our study showed fair to good results except for one. The mean success rate was approximately 95.45%. Conclusion The simple skin-stretching design enabled tension-free skin closure, which pulled the bilateral undermining skin flaps as bilateral fasciocutaneous advancement flaps. The skin-stretching technique was generally successful. PMID:28195891

Mild perioperative hypothermia and the risk of wound infection.

PubMed

Flores-Maldonado, A; Medina-Escobedo, C E; Ríos-Rodríguez, H M; Fernández-Domínguez, R

2001-01-01

Bacterial destruction caused by free radicals, which are synthesized by neutrophils in the presence of oxygen, depends on adequate tissue perfusion. Mild perioperative hypothermia causes vasoconstriction, reducing nutrient and oxygen supply to wounds and increasing frequency of surgical wound infection. However, the causal role of hypothermia in surgical wound infection is the subject of controversy. The present work proposes the hypothesis that mild perioperative hypothermia is associated with infection of the surgical wound. A prospective cohort of 290 surgical patients was studied in a second-level hospital; 261 (90%) of the patients concluded the follow-up. The relationship of hypothermia and of other confounding factors, such as diabetes mellitus, antibiotic treatment, and wound drains with infection outcome was evaluated. One physician, blinded to patient hypothermia, gathered the data. Surgical wound infection was defined as the surgeon's diagnosis with positive culture. Twenty subjects (7.6%) showed infection of surgical wound; 18 (11.5%) of 156 hypothermics and two (2%) 105 normothermics (p = 0.004). Hypothermia proved to be a significant independent risk of infection with relative risk of 6.3 (p = 0.01). Mild perioperative hypothermia is associated with infection of the surgical wound and its prevention is therefore justified.

Profiteering on the Iran-Iraq war

DOE Office of Scientific and Technical Information (OSTI.GOV)

Brzoska, M.

1987-06-01

The military gear delivered from the US in the Iran-contra affair represents only a minor portion of arms sales to the combatants in the Iraq-Iran war. That war has now lasted more than six years and has deeply influenced the international arms market. Occurring during a period when other demand for arms has been relatively low, the war has nourished new suppliers and has revived both the legal and illegal private arms market. The erratic behavior of the USSR and the US, until recently by far the most important arms suppliers to the Third World, has pushed Iran and Iraqmore » toward more commercially oriented sources, including many in the Third World. Both countries have had ample supplies of weapons during the war, and these weapons have served their purpose. Mainly because of its duration, the war already ranks third among post-World War II wars - after the Vietnam war and the Biafra war - in battlefield victims, with 300,000-500,000 casualties. The economic cost has risen to nearly $500 billion in weapons, destruction, and lost income. While it is hard to see anything but losers on the battlefield, the arms traffickers are profiting. Total Iranian arms imports since August 1980 have been higher than $10 billion, while Iraq has imported more than $30 billion worth. It is difficult to know whether making arms more difficult to obtain would have stopped the war, but judging from other recent wars, such as those between India and Pakistan, between Uganda and Tanzania, and in the Middle East, it seems likely that hostilities could have been stopped long ago. 12 references.« less

Psoriasis and wound healing outcomes: A retrospective cohort study examining wound complications and antibiotic use.

PubMed

Young, Paulina M; Parsi, Kory K; Schupp, Clayton W; Armstrong, April W

2017-11-15

Little is known about wound healing in psoriasis. We performed a cohort study examining differences in wound healing complications between patients with and without psoriasis. Psoriasis patients with traumatic wounds were matched 1:3 to non-psoriasis patients with traumatic wounds based on age, gender, and body mass index (BMI). We examined theincidence of wound complications including infection, necrosis, and hematoma as well as incident antibiotic use within three months following diagnosis of a traumatic wound. The study included 164 patients with traumatic wounds, comprised of 41 patients with psoriasis matched to 123 patients without psoriasis. No statistically significant differences were detected in the incidence of overall wound complications between wound patients with psoriasis and wound patients without psoriasis (14.6% versus. 13.0%, HR 1.18, CI 0.39-3.56). After adjustment for diabetes, peripheral vascular disease, and smoking, no statistically significant differences were detected in the incidence of overall wound complications between patients with and without psoriasis (HR 1.11, CI 0.34-3.58). Specifically, the adjusted rates of antibiotic use were not significantly different between those with and without psoriasis (HR 0.65, CI 0.29-1.46). The incidence of wound complications following traumatic wounds of the skin was found to be similar between patients with and without psoriasis.

Reactive oxygen species-dependent wound responses in animals and plants.

PubMed

Suzuki, Nobuhiro; Mittler, Ron

2012-12-15

Animals and plants evolved sophisticated mechanisms that regulate their responses to mechanical injury. Wound response in animals mainly promotes wound healing processes, nerve cell regeneration, and immune system responses at the vicinity of the wound site. In contrast, wound response in plants is primarily directed at sealing the wound site via deposition of various compounds and generating systemic signals that activate multiple defense mechanisms in remote tissues. Despite these differences between animals and plants, recent studies have shown that reactive oxygen species (ROS) play very common signaling and coordination roles in the wound responses of both systems. This review provides an update on recent findings related to ROS-regulated coordination of intercellular communications and signal transduction during wound response in plants and animals. In particular, differences and similarities in H2O2-dependent long-distance signaling between zebrafish and Arabidopsis thaliana are discussed. Published by Elsevier Inc.

The pattern of peripheral nerve injuries among Pakistani soldiers in the war against terror.

PubMed

Razaq, Sarah; Yasmeen, Rehana; Butt, Aamir Waheed; Akhtar, Noreen; Mansoor, Sahibzada Nasir

2015-05-01

To determine the pattern of peripheral nerve injuries in Pakistani soldiers in the War against terror. Case series. Department of Electrodiagnosis at Armed Forces Institute of Rehabilitation Medicine (AFIRM), Rawalpindi, Pakistan, from June 2008 to June 2011. All new cases of war wounded soldiers with peripheral nerve injuries were consecutively enrolled. Physical examination and electrodiagnostic study was carried out by experienced physiatrists. Data was entered in pretested especially designed questionnaire which was analysed using SPSS version 17.0. Seddon's classification system was used to assess the severity of injury. There were 418 cases of peripheral nerve injuries with 504 different nerve segments. Mean age was 29.41 ±8 years. Blast was the main cause of nerve injury in 244 (48.5%) cases followed by gunshot in 215 (42.7%) and 45 (8.9%) cases had nerve injuries secondary to fall, burial under debris and motor vehicle accidents. Eighty six (17%) cases had multiple nerve injuries. Most commonly injured nerve was ulnar (20.6%) followed by sciatic (16.7%), median (16.5%), radial (16.3%), peroneal (8.7%), brachial plexus (8.5%), axillary (4.8%), tibial (2%), femoral (1.8%), long thoracic (0.4%) and others (3.8%). Axonotmesis was seen in 459 (91.1%) cases, 44 (8.7%) cases revealed neurotmesis and 1 (0.2%) case had neuropraxia. Peripheral nerve injuries are a major component of war related injuries mainly involving the upper limbs. Electrodiagnostic studies help in assessing severity and determining prognosis. Precise documentation of severity of nerve injuries is important to estimate the burden on our resources and to extend rehabilitation services.

Analysis of morphological characteristics and expression levels of extracellular matrix proteins in skin wounds to determine wound age in living subjects in forensic medicine.

PubMed

Fronczek, Judith; Lulf, Ronald; Korkmaz, H Ibrahim; Witte, Birgit I; van de Goot, Franklin R W; Begieneman, Mark P V; Krijnen, Paul A J; Rozendaal, Lawrence; Niessen, Hans W M; Reijnders, Udo J L

2015-01-01

Wound age determination in living subjects is important in routine diagnostics in forensic medicine. Macroscopical description of a wound to determine wound age however is inadequate. The aim of this study was to assess whether it would be feasible to determine wound age via analysis of morphological characteristics and extracellular matrix proteins in skin biopsies of living subjects referred to a forensic outpatient clinic. Skin biopsies (n=101), representing the border area of the wound, were taken from skin injuries of known wound age (range: 4.5h-25 days) in living subjects. All biopsies were analyzed for 3 morphological features (ulceration, parakeratosis and hemorrhage) and 3 extracellular matrix markers (collagen III, collagen IV and α-SMA). For quantification, biopsies were subdivided in 4 different timeframes: 0.2-2 days, 2-4 days, 4-10 days and 10-25 days old wounds. Subsequently, a probability scoring system was developed. For hemorrhage, collagen III, collagen IV and α-SMA expression no relation with wound age was found. Ulceration was only found in wounds of 0.2-2, 2-4 and 4-10 days old, implying that the probability that a wound was more than 10 days old in case of ulceration is equal to 0%. Also parakeratosis was almost exclusively found in wounds of 0.2-2, 2-4 and 4-10 days old, except for one case with a wound age of 15 days old. The probability scoring system of all analyzed markers, as depicted above, however can be used to calculate individual wound age probabilities in biopsies of skin wounds of living subjects. We have developed a probability scoring system, analysing morphological characteristics and extracellular matrix proteins in superficial skin biopsies of wounds in living subjects that can be applied in forensic medicine for wound age determination. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Pleural drainage and its role in management of the isolated penetrating chest injuries during the war time in Sarajevo, 1992.-1995.

PubMed

Hadzismajlović, Ademir; Pilav, Alen

2007-05-01

Penetrating chest injuries are the most frequent causes of serious demage and death in wounded indivisuals. In reports from the last wars where wounds caused by high velocity projectiles predominated, thoracotomies were perfomed in about 15% of the wounded individuals, mostly encompassing injuries of the heart and great vessels, accomanied by massive bleeding that could not be resolved by chest tube insertion. This retrospective analysis was performed on the medical records of 477 patients tretaed for isolated penetrating chest injuries in Department of Thoracic Surgery Clinical Center of the University in Sarajevo between april 1992 - june 1995. We analised the ways of their menagement with special view on pleural drainage, indication for this method and results of treatment. 398 (83,4%) wounded individuals have been treated with pleural tube inserting as definitive mesaure and for the urgent thoracotomy there were 79 (16,6%) patients left. Average hospital treatment in wounded drained patients was 7,68 days. With shrapnels there were 357 (74,84%) wounded individuals, and with bullet 120 (25,16%) wounded individuals. The complications of plaural tube inserting were - empyema in 34 (7,13%) patients and there were no other complications. Chest tube inserting as definitive mesaure was used in 398 (83,44%) patients. Chest tube inserting as preoperative measure (urgent thoracotomy) was used in 79 (16,56%) patients. There were 460 (96,44%) healed patients. Death occurred in 17 (3,56%) patients.

Wound management in rodents.

PubMed

Langlois, Isabelle

2004-01-01

Successful wound management requires appropriate evaluation of the wound at the time of initial physical examination, an all throughout the healing process. Factors affecting wound healing need to be identified though a complete patient history and addressed to ensure proper healing. The clinician must have current knowledge of topical medications and bandages available and their clinical applications according to the stage of healing. It is essential to remember that wounds are painful; therefore, analgesics should be administered to render the animal pain-free during wound cleaning, debridement, bandaging, and surgical procedures.

Topical oxygen wound therapies for chronic wounds: a review.

PubMed

Dissemond, J; Kröger, K; Storck, M; Risse, A; Engels, P

2015-02-01

Chronic wounds are an increasing problem in our ageing population and can arise in many different ways. Over the past decades it has become evident that sufficient oxygen supply is an essential factor of appropriate wound healing. Sustained oxygen deficit has a detrimental impact on wound healing, especially for patients with chronic wounds. This has been proven for wounds associated with peripheral arterial occlusive disease (PAOD) and diabetic foot ulcers (particularly in combination with PAOD). However, this is still under debate for other primary diseases. In the past few years several different new therapeutic approaches for topical oxygen therapies have been developed to support wound healing. These tend to fall into one of four categories: (1) delivery of pure oxygen either under pressurised or (2) ambient condition, (3) chemical release of oxygen via an enzymatic reaction or (4) increase of oxygen by facilitated diffusion using oxygen binding and releasing molecules. In this review article, the available therapeutic topical oxygen-delivering approaches and their impact on wound healing are presented and critically discussed. A summary of clinical data, daily treatment recommendations and practicability is provided. J. Dissemond received an honorarium for lectures, advisory boards and/or clinical studies from the following companies: 3M, B. Braun, BSN, Coloplast, Convatec, Draco, Hartmann, KCI, Lohmann&Rauscher, Medoderm, Merz, Sastomed, Systagenix, UCB-Pharma, Urgo. K. Kröger received an honorarium for lectures, advisory boards and/or clinical studies from the following companies: Bayer, Sanofi, GSK, Hartmann, Sastomed, UCB-Pharma, Urgo. M. Storck received an honorarium for lectures for the following companies: KCI, Systagenix, and UCB-Pharma. A. Risse received an honorarium for lectures, advisory boards and/or clinical studies from the following companies: Bracco, Coloplast, Draco, Lilly Deutschland, NovoNordisk, Sastomed, Urgo. P. Engels received an

Diabetes and Wound Angiogenesis.

PubMed

Okonkwo, Uzoagu A; DiPietro, Luisa A

2017-07-03

Diabetes Mellitus Type II (DM2) is a growing international health concern with no end in sight. Complications of DM2 involve a myriad of comorbidities including the serious complications of poor wound healing, chronic ulceration, and resultant limb amputation. In skin wound healing, which has definite, orderly phases, diabetes leads to improper function at all stages. While the etiology of chronic, non-healing diabetic wounds is multi-faceted, the progression to a non-healing phenotype is closely linked to poor vascular networks. This review focuses on diabetic wound healing, paying special attention to the aberrations that have been described in the proliferative, remodeling, and maturation phases of wound angiogenesis. Additionally, this review considers therapeutics that may offer promise to better wound healing outcomes.

Diabetes and Wound Angiogenesis

PubMed Central

Okonkwo, Uzoagu A.; DiPietro, Luisa A.

2017-01-01

Diabetes Mellitus Type II (DM2) is a growing international health concern with no end in sight. Complications of DM2 involve a myriad of comorbidities including the serious complications of poor wound healing, chronic ulceration, and resultant limb amputation. In skin wound healing, which has definite, orderly phases, diabetes leads to improper function at all stages. While the etiology of chronic, non-healing diabetic wounds is multi-faceted, the progression to a non-healing phenotype is closely linked to poor vascular networks. This review focuses on diabetic wound healing, paying special attention to the aberrations that have been described in the proliferative, remodeling, and maturation phases of wound angiogenesis. Additionally, this review considers therapeutics that may offer promise to better wound healing outcomes. PMID:28671607

Generating and Reversing Chronic Wounds in Diabetic Mice by Manipulating Wound Redox Parameters

PubMed Central

Dhall, Sandeep; Do, Danh C.; Garcia, Monika; Kim, Jane; Mirebrahim, Seyed H.; Lyubovitsky, Julia; Lonardi, Stefano; Nothnagel, Eugene A.; Schiller, Neal; Martins-Green, Manuela

2014-01-01

By 2025, more than 500 M people worldwide will suffer from diabetes; 125 M will develop foot ulcer(s) and 20 M will undergo an amputation, creating a major health problem. Understanding how these wounds become chronic will provide insights to reverse chronicity. We hypothesized that oxidative stress (OS) in wounds is a critical component for generation of chronicity. We used the db/db mouse model of impaired healing and inhibited, at time of injury, two major antioxidant enzymes, catalase and glutathione peroxidase, creating high OS in the wounds. This was necessary and sufficient to trigger wounds to become chronic. The wounds initially contained a polymicrobial community that with time selected for specific biofilm-forming bacteria. To reverse chronicity we treated the wounds with the antioxidants α-tocopherol and N-acetylcysteine and found that OS was highly reduced, biofilms had increased sensitivity to antibiotics, and granulation tissue was formed with proper collagen deposition and remodeling. We show for the first time generation of chronic wounds in which biofilm develops spontaneously, illustrating importance of early and continued redox imbalance coupled with the presence of biofilm in development of wound chronicity. This model will help decipher additional mechanisms and potentially better diagnosis of chronicity and treatment of human chronic wounds. PMID:25587545

Causes of Death of Prisoners of War during the Korean War (1950-1953)

PubMed Central

Lee, Myoung-Soon; Kang, Min-Jung

2013-01-01

Purpose This study aimed at analyzing the causes of death of prisoners of war (POWs) during the Korean War (1950-1953) who fought for the Communist side (North Korea and the People's Republic of China). In 1998, the United States Department of Defense released new information about the prisoners including, 7,614 deaths of the POW during the Korean War. The data on the causes of death of the POWs during the Korean War provides valuable information on the both the public health and history of the conflict. Materials and Methods To analyze the causes of death of the POWs, we classified the clinical diagnosis and findings on 7,614 deaths into 22 chapters, as outlined in the International Statistical Classification of Diseases and Related Health Problems-10th Revision (ICD-10). Second, we traced changes in the monthly death totals of POWs as well as deaths caused by common infectious diseases and external causes of death including injury over time from August 1950 to September 1953. Results The most common category of causes of deaths of POWs was infectious disease, 5,013 (65.8%) out of 7,614 deaths, followed by external causes including injury, 817 (10.7%). Overall, tuberculosis and dysentery/diarrhea were the most common causes of death. Deaths caused by acute and chronic infection, or external causes showed different patterns of increases and decline over time during the Korean War. Conclusion The information and data on POWs' deaths during the Korean War reflects the critical impact of the POWs' living conditions and the effect of public health measures implemented in POW camps during the war. PMID:23364985

NeutroPhase® in chronic non-healing wounds

PubMed Central

Crew, John; Varilla, Randell; Rocas, Thomas Allandale; Debabov, Dmitri; Wang, Lu; Najafi, Azar; Rani, Suriani Abdul; Najafi, Ramin (Ron); Anderson, Mark

2012-01-01

Chronic non-healing wounds, such as venous stasis ulcers, diabetic ulcers, and pressure ulcers are serious unmet medical needs that affect a patient’s morbidity and mortality. Common pathogens observed in chronic non-healing wounds are Staphylococcus including MRSA, Pseudomonas, Enterobacter, Stenotrophomonas, and Serratia spp. Topical and systemically administered antibiotics do not adequately decrease the level of bacteria or the associated biofilm in chronic granulating wounds and the use of sub-lethal concentrations of antibiotics can lead to resistant phenotypes. Furthermore, topical antiseptics may not be fully effective and can actually impede wound healing. We show 5 representative examples from our more than 30 clinical case studies using NeutroPhase® as an irrigation solution with chronic non-healing wounds with and without the technique of negative pressure wound therapy (NPWT). NeutroPhase® is pure 0.01% hypochlorous acid (i.e. >97% relative molar distribution of active chlorine species as HOCl) in a 0.9% saline solution at pH 4-5 and is stored in glass containers. NovaBay has three FDA cleared 510(k)s. Patients showed a profound improvement and marked accelerated rates of wound healing using NeutroPhase® with and without NPWT. NeutroPhase® was non-toxic to living tissues. PMID:23272294

The wound-healing effects of a next-generation anti-biofilm silver Hydrofiber wound dressing on deep partial-thickness wounds using a porcine model.

PubMed

Davis, Stephen C; Li, Jie; Gil, Joel; Valdes, Jose; Solis, Michael; Higa, Alex; Bowler, Philip

2018-06-11

Topical antimicrobials are widely used to control wound bioburden and facilitate wound healing; however, the fine balance between antimicrobial efficacy and non-toxicity must be achieved. This study evaluated whether an anti-biofilm silver-containing wound dressing interfered with the normal healing process in non-contaminated deep partial thickness wounds. In an in-vivo porcine wound model using 2 pigs, 96 wounds were randomly assigned to 1 of 3 dressing groups: anti-biofilm silver Hydrofiber dressing (test), silver Hydrofiber dressing (control), or polyurethane film dressing (control). Wounds were investigated for 8 days, and wound biopsies (n = 4) were taken from each dressing group, per animal, on days 2, 4, 6, and 8 after wounding and evaluated using light microscopy. No statistically significant differences were observed in the rate of reepithelialisation, white blood cell infiltration, angiogenesis, or granulation tissue formation following application of the anti-biofilm silver Hydrofiber dressing versus the 2 control dressings. Overall, epithelial thickness was similar between groups. Some differences in infiltration of specific cell types were observed between groups. There were no signs of tissue necrosis, fibrosis, or fatty infiltration in any group. An anti-biofilm silver Hydrofiber wound dressing did not cause any notable interference with normal healing processes. © 2018 Medicalhelplines.com Inc and John Wiley & Sons Ltd.

Using Gene Transcription Patterns (Bar Coding Scans) to Guide Wound Debridement and Healing

PubMed Central

Tomic-Canic, Marjana; Ayello, Elizabeth A.; Stojadinovic, Olivera; Golinko, Michael S.; Brem, Harold

2010-01-01

PURPOSE To acquaint wound care practitioners with new information related to debridement of chronic wounds. TARGET AUDIENCE This continuing education activity is intended for physicians and nurses with an interest in wound care. OBJECTIVES After reading this article and taking this test, the reader should be able to: Explain the role of keratinocytes in wound healing. Discuss new research findings on the physiological differences between healing and nonhealing wounds. Identify implications of the new research for debridement of chronic wounds. PMID:18836328

The anthropology of war and peace

DOE Office of Scientific and Technical Information (OSTI.GOV)

Turner, P.R.; Pitt, D.

1989-01-01

Drawing parallels between tribal behavior and international relations to demonstrate that societies are not inherently aggressive but are led into conflict when pride or in-group pressures push people to fight, this profound look at the chilling reality of cold war and its arsenal of nuclear destruction offers valuable new insights into how prejudices and stereotypes contribute to what may seem like an inexorable drift to war. Yet the authors conclude that war is not inevitable, as they offer suggestions for an end to the arms race in, the nuclear age. Based on original research, this is a long overdue contributionmore » to the study of war and peace in our time and a text for newly emerging courses on the subject.« less

A systematic review of cost-effectiveness analyses of complex wound interventions reveals optimal treatments for specific wound types.

PubMed

Tricco, Andrea C; Cogo, Elise; Isaranuwatchai, Wanrudee; Khan, Paul A; Sanmugalingham, Geetha; Antony, Jesmin; Hoch, Jeffrey S; Straus, Sharon E

2015-04-22

Complex wounds present a substantial economic burden on healthcare systems, costing billions of dollars annually in North America alone. The prevalence of complex wounds is a significant patient and societal healthcare concern and cost-effective wound care management remains unclear. This article summarizes the cost-effectiveness of interventions for complex wound care through a systematic review of the evidence base. We searched multiple databases (MEDLINE, EMBASE, Cochrane Library) for cost-effectiveness studies that examined adults treated for complex wounds. Two reviewers independently screened the literature, abstracted data from full-text articles, and assessed methodological quality using the Drummond 10-item methodological quality tool. Incremental cost-effectiveness ratios were reported, or, if not reported, calculated and converted to United States Dollars for the year 2013. Overall, 59 cost-effectiveness analyses were included; 71% (42 out of 59) of the included studies scored 8 or more points on the Drummond 10-item checklist tool. Based on these, 22 interventions were found to be more effective and less costly (i.e., dominant) compared to the study comparators: 9 for diabetic ulcers, 8 for venous ulcers, 3 for pressure ulcers, 1 for mixed venous and venous/arterial ulcers, and 1 for mixed complex wound types. Our results can be used by decision-makers in maximizing the deployment of clinically effective and resource efficient wound care interventions. Our analysis also highlights specific treatments that are not cost-effective, thereby indicating areas of resource savings. Please see related article: http://dx.doi.org/10.1186/s12916-015-0288-5.

Comparing the Tolerability of a Novel Wound Closure Device Using a Porcine Wound Model

PubMed Central

Townsend, Katy L.; Akeroyd, Jen; Russell, Duncan S.; Kruzic, Jamie J.; Robertson, Bria L.; Lear, William

2018-01-01

Objective: To compare the tolerability and mechanical tensile strength of acute skin wounds closed with nylon suture plus a novel suture bridge device (SBD) with acute skin wounds closed with nylon suture in a porcine model. Approach: Four Yucatan pigs each received 12 4.5 cm full-thickness incisions that were closed with 1 of 4 options: Suture bridge with nylon, suture bridge with nylon and subdermal polyglactin, nylon simple interrupted, and nylon simple interrupted with subdermal polyglactin. Epithelial reaction, inflammation, and scarring were examined histologically at days 10 and 42. Wound strength was examined mechanically at days 10 and 42 on ex vivo wounds from euthanized pigs. Results: Histopathology in the suture entry/exit planes showed greater dermal inflammation with a simple interrupted nylon suture retained for 42 days compared with the SBD retained for 42 days (p < 0.03). While tensile wound strength in the device and suture groups were similar at day 10, wounds closed with the devices were nearly 8 times stronger at day 42 compared with day 10 (p < 0.001). Innovation: A novel SBD optimized for cutaneous wound closure that protects the skin surface from suture strands, forms a protective bridge over the healing wound edges, and knotlessly clamps sutures. Conclusion: This study suggests that the use of a SBD increases the tolerability of nylon sutures in porcine acute skin wound closures allowing for prolonged mechanical support of the wound. For slow healing wounds, this may prevent skin wound disruption, such as edge necrosis and dehiscence. PMID:29892494

Trauma and suicidality in war affected communities.

PubMed

Jankovic, J; Bremner, S; Bogic, M; Lecic-Tosevski, D; Ajdukovic, D; Franciskovic, T; Galeazzi, G M; Kucukalic, A; Morina, N; Popovski, M; Schützwohl, M; Priebe, S

2013-10-01

The aim was to assess whether experiences of war trauma remain directly associated with suicidality in war affected communities when other risk factors are considered. In the main sample 3313 participants from former Yugoslavia who experienced war trauma were recruited using a random sampling in five Balkan countries. In the second sample 854 refugees from former Yugoslavia recruited through registers and networking in three Western European countries. Sociodemographic and data on trauma exposure, psychiatric diagnoses and level of suicidality were assessed. In the main sample 113 participants (3.4%) had high suicidality, which was associated with number of potentially traumatic war experiences (odds ratio 1.1) and war related imprisonment (odds ratio 3) once all measured risk factors were considered. These associations were confirmed in the refugee sample with a higher suicidality rate (10.2%). Number of potentially traumatic war experiences, in particular imprisonment, may be considered as a relevant risk factor for suicidality in people affected by war. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

The Toronto Symptom Assessment System for Wounds: a new clinical and research tool.

PubMed

Maida, Vincent; Ennis, Marguerite; Kuziemsky, Craig

2009-10-01

To formulate a patient-rated assessment tool that facilitates the measurement of pain and polysymptom distress directly related to all classes of wounds. A prospective observational study derived from a sequential case series of patients with advanced illness was carried out to determine the most common symptoms associated with wounds from 9 distinct classes (malignant, pressure ulcers, iatrogenic, traumatic, diabetic foot ulcers, venous ulcers, arterial ulcers, infections/inflammatory lesions, and ostomies). Ten wound-related symptoms were identified and used to create a patient-scored assessment tool. The Toronto Symptom Assessment System for Wounds (TSAS-W) was then developed and used in a pilot trial during which patients completed TSAS-W at baseline and 7 days later. Five hundred thirty-one patients either presented with wounds at baseline or developed them during the 24-month follow-up period. Patients affected by any type of wound were asked to report on the top 3 symptoms directly attributable to their wounds. The pilot trial of TSAS-W involved 103 wounds afflicting 83 sequential patients. The most prevalent wound-related symptoms included pain, exudation, odor, itching, bleeding, aesthetic concern, swelling, and mass and bulk effects from the wound and associated dressings; 78.6% of the TSAS-W assessments were carried out by the patient alone, 14.6% were carried out by the patient assisted by a caregiver, and 6.8% were carried out entirely by a caregiver. The summation of all 10 TSAS-W parameters, the global wound symptom distress score (GWSDS), resulted in a mean for all wounds of 34.47 at baseline and decreased to a mean of 28.40 at 7 days later. Cosmetic or aesthetic concern and/or distress was associated with the highest mean scores of all symptoms. Malignant wounds and wounds involving the perineum and genitalia were associated with the highest GWSDSs. The TSAS-W is a new tool for systematically assessing the degree of pain and polysymptom distress

Factors Affecting Wound Healing

PubMed Central

Guo, S.; DiPietro, L.A.

2010-01-01

Wound healing, as a normal biological process in the human body, is achieved through four precisely and highly programmed phases: hemostasis, inflammation, proliferation, and remodeling. For a wound to heal successfully, all four phases must occur in the proper sequence and time frame. Many factors can interfere with one or more phases of this process, thus causing improper or impaired wound healing. This article reviews the recent literature on the most significant factors that affect cutaneous wound healing and the potential cellular and/or molecular mechanisms involved. The factors discussed include oxygenation, infection, age and sex hormones, stress, diabetes, obesity, medications, alcoholism, smoking, and nutrition. A better understanding of the influence of these factors on repair may lead to therapeutics that improve wound healing and resolve impaired wounds. PMID:20139336

Factors affecting wound healing.

PubMed

Guo, S; Dipietro, L A

2010-03-01

Wound healing, as a normal biological process in the human body, is achieved through four precisely and highly programmed phases: hemostasis, inflammation, proliferation, and remodeling. For a wound to heal successfully, all four phases must occur in the proper sequence and time frame. Many factors can interfere with one or more phases of this process, thus causing improper or impaired wound healing. This article reviews the recent literature on the most significant factors that affect cutaneous wound healing and the potential cellular and/or molecular mechanisms involved. The factors discussed include oxygenation, infection, age and sex hormones, stress, diabetes, obesity, medications, alcoholism, smoking, and nutrition. A better understanding of the influence of these factors on repair may lead to therapeutics that improve wound healing and resolve impaired wounds.

On the other side of the battle: Russian nurses in the Crimean War.

PubMed

Benson, E R

1992-01-01

One redeeming feature that emerged from the horrors of the Crimean War was the skilled and compassionate nursing care provided by women. The work of Florence Nightingale and her nurses with the British forces is a familiar story. What is less well-known is that the fighting forces on the other side of the battle lines also had their contingent of nurses who helped to alleviate the suffering of their sick and wounded. This paper discusses the events leading up to the organization of Russia's volunteer nurses who provided care on their side of the battle.

The bottom line on wound care standardization.

PubMed

McNees, Patrick; Kueven, John A

2011-03-01

North Mississippi Medical Center learned four important lessons in its effort to standardize wound care products and processes of care: Designate clinical champions. Limit the number of vendors that provide products for a specialty. Reduce the number of similar-function wound care products that are available for use, with decisions guided by clinicians. Provide transparent information related to cost, the intentions of the initiative, usage patterns, and the criteria for evaluation.

Adjuvant use of acoustic pressure wound therapy for treatment of chronic wounds: a retrospective analysis.

PubMed

Cole, Pamela S; Quisberg, Jennifer; Melin, M Mark

2009-01-01

Small studies have indicated that the addition of acoustic pressure wound therapy (APWT) to conventional wound care may hasten healing of chronic wounds. We evaluated our early clinical experience using APWT as an adjunct to conventional wound care. The study was a retrospective chart review of consecutive patients receiving APWT in addition to conventional wound care in a hospital-based, primarily outpatient setting. Medical records of all patients treated with APWT between August 2006 and October 2007 were reviewed. Analysis included the 41 patients with 52 wounds who received APWT at least 2 times per week during the study period. Statistical comparisons were made for wound dimensions, tissue characteristics, and pain at start versus end of APWT. Thirty-eight percent of wounds (N = 20) healed completely with a mean 6.8 weeks of APWT. Median wound area and volume decreased significantly (88% [P < .0001] and 100% [P < .0001], respectively) from start to end of APWT. The proportion of wounds with greater than 75% granulation tissue increased from 26% (n = 12) to 80% (n = 41) (P < .0001), and normal periwound skin increased from 25% (n = 13) to 54% (n = 28) (P = .0001). Presence of greater than 50% fibrin slough decreased from 50% (n = 24) to 9% (n = 4) of wounds (P = .006). This early experience supplementing conventional wound care with APWT suggests it may promote healing in chronic wounds, where the ordered cellular and molecular processes leading to healing have stalled.

Obesity and Surgical Wound Healing: A Current Review

PubMed Central

Pierpont, Yvonne N.; Dinh, Trish Phuong; Salas, R. Emerick; Johnson, Erika L.; Wright, Terry G.; Robson, Martin C.; Payne, Wyatt G.

2014-01-01

Objective. The correlation between obesity and deficient wound healing has long been established. This review examines the current literature on the mechanisms involved in obesity-related perioperative morbidity. Methods. A literature search was performed using Medline, PubMed, Cochrane Library, and Internet searches. Keywords used include obesity, wound healing, adipose healing, and bariatric and surgical complications. Results. Substantial evidence exists demonstrating that obesity is associated with a number of postoperative complications. Specifically in relation to wound healing, explanations include inherent anatomic features of adipose tissue, vascular insufficiencies, cellular and composition modifications, oxidative stress, alterations in immune mediators, and nutritional deficiencies. Most recently, advances made in the field of gene array have allowed researchers to determine a few plausible alterations and deficiencies in obese individuals that contribute to their increased risk of morbidity and mortality, especially wound complications. Conclusion. While the literature discusses how obesity may negatively affect health on various of medical fronts, there is yet to be a comprehensive study detailing all the mechanisms involved in obesity-related morbidities in their entirety. Improved knowledge and understanding of obesity-induced physiological, cellular, molecular, and chemical changes will facilitate better assessments of surgical risks and outcomes and create efficient treatment protocols for improved patient care of the obese patient population. PMID:24701367

Office management of minor wounds.

PubMed Central

Gouin, S.; Patel, H.

2001-01-01

OBJECTIVE: To review office interventions for minor wounds not requiring sutures, such as abrasions, bites, and lacerations. QUALITY OF EVIDENCE: Most information on minor wound management comes from descriptive studies. Few comparative studies examine the effectiveness of topical antisepsis for minor wounds. Several clinical trials have demonstrated that tissue adhesives produce short- and long-term cosmetic results equivalent to those achieved with suture materials. MAIN MESSAGE: Sterile saline is the least toxic solution for wound irrigation. Chlorhexidine (2%) and povidone iodine (10%) have been the most investigated antiseptic solutions. Systemic antibiotics are unnecessary for wounds unlikely to be infected. All bite wounds require special attention. Primary closure of bite wounds is indicated in certain circumstances: less than 12-hour-old nonpuncture wounds, uninfected wounds, and low-risk lesions (such as on the face). In spite of their many advantages, skin tapes should be used for low-tension wounds only. The popularity of tissue adhesives has greatly increased. Since the advent of newer products (with increased bonding strength and flexibility), adhesives are used to manage most lacerations except those in areas of high tension (e.g., joints) and on mucosal surfaces. CONCLUSION: Minor wounds not requiring sutures can be managed easily in the office. PMID:11340758