The Experts below are selected from a list of 132 Experts worldwide ranked by ideXlab platform

Eric Bercoff - One of the best experts on this subject based on the ideXlab platform.

  • clinical presentation of hypernatremia in elderly patients a case control study
    Journal of the American Geriatrics Society, 2006
    Co-Authors: Philippe Chassagne, L Druesne, C Capet, Jean Francois Menard, Eric Bercoff
    Abstract:

    OBJECTIVES: To assess early clinical signs and their prognostic value in elderly patients with hypernatremia. DESIGN: Prospective, case control study of 150 patients with hypernatremia matched to 300 controls. SETTING: Multicenter study including seven short- and long-term geriatric care facilities. MEASUREMENTS: Clinical assessment of hydration status at bedside, such as abnormal Skin Turgor or dry oral mucosa. Secondary outcome measures: 30-day mortality rate and clinical indicators (assessed at the peak of natremia) associated with mortality. RESULTS: Patients and controls were comparable in terms of drugs and underlying diseases, except for history of dementia, which was more frequent in patients than in controls. Patients were significantly more likely than controls to have low blood pressure, tachycardia, dry oral mucosa, abnormal Skin Turgor, and recent change of consciousness. Only three clinical findings were found in at least 60% of patients with hypernatremia: orthostatic blood pressure and abnormal subclavicular and forearm Skin Turgor. The latter two signs were significantly more frequent in patients with hypernatremia. Four other signs (tachycardia, abnormal subclavicular Skin Turgor, dry oral mucosa, and recent change of consciousness) had a specificity of greater than 79%. Using logistic regression, four signs were significantly and independently associated with hypernatremia: abnormal subclavicular and thigh Skin Turgor, dry oral mucosa, and recent change of consciousness. The mortality rate was 41.5% and was significantly higher in patients with hypernatremia. The status of consciousness when hypernatremia was diagnosed was the single prognostic indicator associated with mortality (odds ratio=2.3, 95% confidence interval=1.01–5.2). CONCLUSION: Most of the classical signs of dehydration are irregularly present in patients with hypernatremia. Caregivers should carefully screen any variations in consciousness, because they may reveal severe hypernatremia.

Hsianjenn Wang - One of the best experts on this subject based on the ideXlab platform.

  • reconstruction of burn scar of the upper extremities with artificial Skin
    Plastic and Reconstructive Surgery, 2001
    Co-Authors: Trongduo Chou, Shaoliang Chen, Shyigen Chen, Tianyeu Cheng, Timmo Chen, Hsianjenn Wang
    Abstract:

    The management of upper-extremity burn contractures is a major challenge for plastic surgeons. After approval by the Food and Drug Administration, artificial Skin (Integra) has been available in Taiwan since 1997. From January of 1997 to July of 1999, the authors applied artificial Skin to 13 severely burned patients for the reconstruction of their upper extremities, resulting in an increased range of motion in the upper-extremity joints and improved Skin quality. An additional benefit was the rapid reepithelialization of the donor sites. There were no complications of infection throughout the therapeutic course, and the overall results were satisfactory. During the 2-year study, scar condition was monitored between 8 and 24 months, and a good appearance and pliable skirt were obtained according to the Vancouver Scar Scale. According to this evaluation of Oriental Skin Turgor, normal pigmentation was restored about 6 months after the resurfacing procedure. For patients with severe burns in whom there is insufficient available Skin for a full-thickness Skin graft or another appropriate flap for scar revision, Integra is an alternative. The two major concerns in dealing with artificial Skin are (1) a 10- to 14-day waiting period for maturation of the neo-dermis, necessitating a two-stage operation, and (2) prevention of infection with antibiotics and meticulous wound care.

Philippe Chassagne - One of the best experts on this subject based on the ideXlab platform.

  • clinical presentation of hypernatremia in elderly patients a case control study
    Journal of the American Geriatrics Society, 2006
    Co-Authors: Philippe Chassagne, L Druesne, C Capet, Jean Francois Menard, Eric Bercoff
    Abstract:

    OBJECTIVES: To assess early clinical signs and their prognostic value in elderly patients with hypernatremia. DESIGN: Prospective, case control study of 150 patients with hypernatremia matched to 300 controls. SETTING: Multicenter study including seven short- and long-term geriatric care facilities. MEASUREMENTS: Clinical assessment of hydration status at bedside, such as abnormal Skin Turgor or dry oral mucosa. Secondary outcome measures: 30-day mortality rate and clinical indicators (assessed at the peak of natremia) associated with mortality. RESULTS: Patients and controls were comparable in terms of drugs and underlying diseases, except for history of dementia, which was more frequent in patients than in controls. Patients were significantly more likely than controls to have low blood pressure, tachycardia, dry oral mucosa, abnormal Skin Turgor, and recent change of consciousness. Only three clinical findings were found in at least 60% of patients with hypernatremia: orthostatic blood pressure and abnormal subclavicular and forearm Skin Turgor. The latter two signs were significantly more frequent in patients with hypernatremia. Four other signs (tachycardia, abnormal subclavicular Skin Turgor, dry oral mucosa, and recent change of consciousness) had a specificity of greater than 79%. Using logistic regression, four signs were significantly and independently associated with hypernatremia: abnormal subclavicular and thigh Skin Turgor, dry oral mucosa, and recent change of consciousness. The mortality rate was 41.5% and was significantly higher in patients with hypernatremia. The status of consciousness when hypernatremia was diagnosed was the single prognostic indicator associated with mortality (odds ratio=2.3, 95% confidence interval=1.01–5.2). CONCLUSION: Most of the classical signs of dehydration are irregularly present in patients with hypernatremia. Caregivers should carefully screen any variations in consciousness, because they may reveal severe hypernatremia.

Laurence Finberg - One of the best experts on this subject based on the ideXlab platform.

  • capillary refilling Skin Turgor in the assessment of dehydration
    JAMA Pediatrics, 1991
    Co-Authors: Jose M Saavedra, Glenn D Harris, Laurence Finberg
    Abstract:

    • This study was undertaken to evaluate the usefulness of Skin Turgor or capillary refilling in estimating the degree of dehydration in infants with diarrhea. After initial standardization of the technique, capillary filling time was found to be more reproducible when measured in the fingernail bed after applying just the amount of pressure necessary to blanch the nail bed. Capillary refilling time in 30 normal infants 2 to 24 months of age was 0.81± 0.31 seconds. Capillary filling time was then measured in 32 infants with diarrhea admitted to the hospital and correlated to the degree of dehydration as estimated from the difference in weight from the time of hospital admission to the weight after rehydration. A Turgor time of 1.5 seconds or less was found to be indicative of a less than 50-mL/kg deficit or of a normal infant; 1.5 to 3.0 seconds suggests a deficit between 50 and 100 mL/kg, and more than 3 seconds suggests a deficit of more than 100 mL/kg. ( AJDC . 1991;145:296-298)

Trongduo Chou - One of the best experts on this subject based on the ideXlab platform.

  • reconstruction of burn scar of the upper extremities with artificial Skin
    Plastic and Reconstructive Surgery, 2001
    Co-Authors: Trongduo Chou, Shaoliang Chen, Shyigen Chen, Tianyeu Cheng, Timmo Chen, Hsianjenn Wang
    Abstract:

    The management of upper-extremity burn contractures is a major challenge for plastic surgeons. After approval by the Food and Drug Administration, artificial Skin (Integra) has been available in Taiwan since 1997. From January of 1997 to July of 1999, the authors applied artificial Skin to 13 severely burned patients for the reconstruction of their upper extremities, resulting in an increased range of motion in the upper-extremity joints and improved Skin quality. An additional benefit was the rapid reepithelialization of the donor sites. There were no complications of infection throughout the therapeutic course, and the overall results were satisfactory. During the 2-year study, scar condition was monitored between 8 and 24 months, and a good appearance and pliable skirt were obtained according to the Vancouver Scar Scale. According to this evaluation of Oriental Skin Turgor, normal pigmentation was restored about 6 months after the resurfacing procedure. For patients with severe burns in whom there is insufficient available Skin for a full-thickness Skin graft or another appropriate flap for scar revision, Integra is an alternative. The two major concerns in dealing with artificial Skin are (1) a 10- to 14-day waiting period for maturation of the neo-dermis, necessitating a two-stage operation, and (2) prevention of infection with antibiotics and meticulous wound care.