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Article ; Online: Coronary Vasospasm After Burn Injury: First Described Case Series of a Lethal Lesion.

Culnan, Derek M / Sood, Rajiv

Journal of burn care & research : official publication of the American Burn Association

2018 Volume 39, Issue 6, Page(s) 1053–1057

Abstract: Burn injuries generate multisystem physiological derangements. The authors present a case series of three patients developing acute coronary syndrome (ACS) stemming from coronary vasospasm (CVS) over a course of 5 months. This etiology of ACS is ... ...

Abstract	Burn injuries generate multisystem physiological derangements. The authors present a case series of three patients developing acute coronary syndrome (ACS) stemming from coronary vasospasm (CVS) over a course of 5 months. This etiology of ACS is significant as it has previously not been described in burn patients and requires a different management algorithm than vaso-occlusive disease.All patients were admitted to a single accredited burn unit. Burn mechanisms were flash burn, chemical fire, and house fire. TBSA were 20%, 72%, and 31%, respectively. Ages were 67-, 41-, and 52-year-old men. All smoked tobacco, and one had diabetes and coronary artery disease. CVS presented with acute onset ST elevations, severe bradycardia, and cardiac arrest in all. Diagnosis was made via EKG and angiography. Treatment was undertaken with nitrates and calcium channel blockers. One of the patients died of refractory disease.The authors identified CVS in burn patients with an incidence of 2% of admissions and accounting for 17% of our burn mortality during this period. To date, there is no linkage between CVS and burns described in humans; however, there is a well-described animal model in rats. The risk factors for CVS are common among burn patients, particularly smoking and endothelial dysfunction. CVS may be a significant cause of ACS in burn patients, and it should be considered in the setting of ACS especially with a negative angiography. Knowledge of this disease state can change burn management to mitigate risk and accommodate specific cardiac treatments.
MeSH term(s)	Adult ; Aged ; Burns/complications ; Burns/surgery ; Coronary Angiography ; Coronary Vasospasm/diagnosis ; Coronary Vasospasm/drug therapy ; Coronary Vasospasm/etiology ; Electrocardiography ; Fatal Outcome ; Humans ; Male ; Middle Aged ; Obesity/complications ; Smoking/adverse effects
Language	English
Publishing date	2018-06-21
Publishing country	England
Document type	Case Reports ; Journal Article
ZDB-ID	2224246-6
ISSN	1559-0488 ; 1559-047X
ISSN (online)	1559-0488
ISSN	1559-047X
DOI	10.1093/jbcr/irx032
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Article: Roux-en-Y gastric bypass alters intestinal glucose transport in the obese Zucker rat.

Meng, Qinghe / Culnan, Derek M / Ahmed, Tamer / Sun, Mingjie / Cooney, Robert N

Frontiers in endocrinology

2022 Volume 13, Page(s) 901984

Abstract: Introduction: The gastrointestinal tract plays a major role in regulating glucose homeostasis and gut endocrine function. The current study examines the effects of Roux-en-Y gastric bypass (RYGB) on intestinal GLP-1, glucose transporter expression and ... ...

Abstract	Introduction: The gastrointestinal tract plays a major role in regulating glucose homeostasis and gut endocrine function. The current study examines the effects of Roux-en-Y gastric bypass (RYGB) on intestinal GLP-1, glucose transporter expression and function in the obese Zucker rat (ZR). Methods: Two groups of ZRs were studied: RYGB and sham surgery pair-fed (PF) fed rats. Body weight and food intake were measured daily. On post-operative day (POD) 21, an oral glucose test (OGT) was performed, basal and 30-minute plasma, portal venous glucose and glucagon-like peptide-1 (GLP-1) levels were measured. In separate ZRs, the biliopancreatic, Roux limb (Roux) and common channel (CC) intestinal segments were harvested on POD 21. Results: Body weight was decreased in the RYGB group. Basal and 30-minute OGT plasma and portal glucose levels were decreased after RYGB. Basal plasma GLP-1 levels were similar, while a 4.5-fold increase in GLP-1 level was observed in 30-minute after RYGB (vs. PF). The increase in basal and 30-minute portal venous GLP-1 levels after RYGB were accompanied by increased mRNA expressions of proglucagon and PC 1/3, GPR119 protein in the Roux and CC segments. mRNA and protein levels of FFAR2/3 were increased in Roux segment. RYGB decreased brush border glucose transport, transporter proteins (SGLT1 and GLUT2) and mRNA levels of Tas1R1/Tas1R3 and α-gustducin in the Roux and CC segments. Conclusions: Reductions in intestinal glucose transport and enhanced post-prandial GLP-1 release were associated with increases in GRP119 and FFAR2/3 after RYGB in the ZR model. Post-RYGB reductions in the regulation of intestinal glucose transport and L cell receptors regulating GLP-1 secretion represent potential mechanisms for improved glycemic control.
MeSH term(s)	Animals ; Body Weight ; Gastric Bypass ; Glucagon-Like Peptide 1 ; Glucose ; Obesity ; RNA, Messenger ; Rats ; Rats, Zucker
Chemical Substances	RNA, Messenger ; Glucagon-Like Peptide 1 (89750-14-1) ; Glucose (IY9XDZ35W2)
Language	English
Publishing date	2022-08-11
Publishing country	Switzerland
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	2592084-4
ISSN	1664-2392
ISSN	1664-2392
DOI	10.3389/fendo.2022.901984
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Article ; Online: Evolving Antibiotic Resistance of

Mokhtar, Khalid / Culnan, Derek M / Lineaweaver, William C

Surgical infections

2019 Volume 21, Issue 2, Page(s) 158–160

Abstract: Background: ...

Abstract	Background:
MeSH term(s)	Aeromonas/drug effects ; Anti-Bacterial Agents/pharmacology ; Anti-Bacterial Agents/therapeutic use ; Cefepime/pharmacology ; Cefepime/therapeutic use ; Ciprofloxacin/pharmacology ; Ciprofloxacin/therapeutic use ; Drug Resistance, Microbial/drug effects ; Humans ; Leeching/adverse effects ; Leeching/methods ; Microbial Sensitivity Tests ; Replantation/adverse effects ; Replantation/methods
Chemical Substances	Anti-Bacterial Agents ; Ciprofloxacin (5E8K9I0O4U) ; Cefepime (807PW4VQE3)
Language	English
Publishing date	2019-09-26
Publishing country	United States
Document type	Journal Article
ZDB-ID	1440120-4
ISSN	1557-8674 ; 1096-2964
ISSN (online)	1557-8674
ISSN	1096-2964
DOI	10.1089/sur.2019.067
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Article ; Online: The 11th Annual Joseph M. Still Burn Symposium.

Hills, Jocelyn / Culnan, Derek M / Lineaweaver, William C / Mullins, Fred

Annals of plastic surgery

2019 Volume 82, Issue 3 Suppl 2, Page(s) S145

MeSH term(s)	Burn Units/history ; Burn Units/organization & administration ; Burns/diagnosis ; Burns/therapy ; Congresses as Topic/history ; History, 21st Century ; Humans ; United States
Language	English
Publishing date	2019-02-06
Publishing country	United States
Document type	Biography ; Historical Article ; Introductory Journal Article
ZDB-ID	423835-7
ISSN	1536-3708 ; 0148-7043
ISSN (online)	1536-3708
ISSN	0148-7043
DOI	10.1097/SAP.0000000000001824
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Article ; Online: Fifty Years of Burn Care at Shriners Hospitals for Children, Galveston.

Čapek, Karel D / Culnan, Derek M / Desai, Manubhai H / Herndon, David N

Annals of plastic surgery

2018 Volume 80, Issue 3 Suppl 2, Page(s) S90–S94

Abstract: More than 50 years ago, Shriners Hospitals for Children expanded their philanthropy to include care for burned children. In so doing, the effects of their work weightily expanded from rehabilitation and quality of life outcomes to include survival proper. ...

Abstract	More than 50 years ago, Shriners Hospitals for Children expanded their philanthropy to include care for burned children. In so doing, the effects of their work weightily expanded from rehabilitation and quality of life outcomes to include survival proper. As the first facility dedicated to the care of burned children, originally designated the Shriners Burn Institute, the Galveston hospital remains the cornerstone of this endeavor. Shriners maintains charitable pediatric hospitals, provide care irrespective of the patient's or the family's ability to pay, and promote research. The sole criterion for admission at Shriners Hospitals for Children is the determination by a surgeon at a Shriners hospital that "the child's trouble may be corrected or improved." This philanthropic effort to provide medical care for children is one expression of the human commonality recognized by Shriners. In this article, we provide some background information on how this hospital came into existence as well as a global summary of its interventions toward greater survival and more complete rehabilitation of burned children. Based on the findings presented herein, we assert that there is less suffering and less loss of life due to childhood burns today than in previous years. We attribute much of this improvement to the simple voluntary collective decision by Shriners to provide alms for burned children.
MeSH term(s)	Benchmarking/organization & administration ; Burn Units/organization & administration ; Child ; Child Welfare ; Disease Management ; Hospitals, Pediatric/organization & administration ; Humans ; Outcome Assessment, Health Care ; Quality of Life ; Rehabilitation Centers/organization & administration ; United States
Language	English
Publishing date	2018-02-20
Publishing country	United States
Document type	Journal Article
ZDB-ID	423835-7
ISSN	1536-3708 ; 0148-7043
ISSN (online)	1536-3708
ISSN	0148-7043
DOI	10.1097/SAP.0000000000001376
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Article ; Online: Rapid Communication: Solution for the MEEK Glue Transfer Problem.

Culnan, Derek M / Craft-Coffman, Beretta / Bitz, Genevieve / Mullins, Robert F

Journal of burn care & research : official publication of the American Burn Association

2017 Volume 39, Issue 2, Page(s) 274–277

Abstract: Meek micrografting permits wide expansion of skin grafts in true ratios from 3:1 to 9:1, as well as the utilization of poor donor sites. The proprietary glue critical to successful skin transference is unavailable in the United States. While the ... ...

Abstract	Meek micrografting permits wide expansion of skin grafts in true ratios from 3:1 to 9:1, as well as the utilization of poor donor sites. The proprietary glue critical to successful skin transference is unavailable in the United States. While the technique is widely employed worldwide, alternative glues resulted in poor skin transfer and frustrated use in American burn centers. The authors present their protocol resulting in effective MEEK skin transfer using Mastisol® adhesive: "The Rule of Sevens." 1) Soak the corks in normal saline for 7 minutes. 2) Then spread the grafts on the corks and mince with the MEEK machine. 3) Spray the epidermal surface of the micrograft-covered corks thoroughly with 7 pumps of Mastisol® from a distance of 7 inches (17.7 cm). 4) Allow the Mastisol® to dry for 7 minutes on the micrografts. 5) Apply the corks with the Mastisol®-imbued skin to the gauzes. Press firmly for 7 seconds. 6) Allow the skin to transfer from cork to gauze undisturbed for 7 minutes. Next, carefully remove the corks and expand the gauzes. Apply the micrograft-covered gauzes to excised and prepared wound beds and staple into position. 7) After 7 days, remove the gauzes, though the authors have left them in place for up to 21 days. This novel protocol provides reliable skin transfer and permits the modified MEEK technique to be a consistent part of our practice. The authors present this rapid communication to allow others to utilize this technique without the frustration of adhesive failure resulting in lost grafts.
MeSH term(s)	Adhesives/therapeutic use ; Bandages ; Burns/therapy ; Humans ; Mastic Resin/therapeutic use ; Skin Transplantation/methods
Chemical Substances	Adhesives ; Mastic Resin
Language	English
Publishing date	2017-05-29
Publishing country	England
Document type	Journal Article
ZDB-ID	2224246-6
ISSN	1559-0488 ; 1559-047X
ISSN (online)	1559-0488
ISSN	1559-047X
DOI	10.1097/BCR.0000000000000587
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Article ; Online: Temporary ectopic implantation for salvaging amputated parts: A systematic review.

Tu, Yiji / Lineaweaver, William C / Culnan, Derek M / Bitz, Genevieve H / Jones, Kyler J / Zhang, Feng

The journal of trauma and acute care surgery

2018 Volume 84, Issue 6, Page(s) 985–993

Abstract: Background: Temporary ectopic implantation is an option when handling severe crushing injuries to the distal extremities or other body parts. The surgical techniques applied in those cases, and the patient outcomes have not been previously analyzed.: ... ...

Abstract	Background: Temporary ectopic implantation is an option when handling severe crushing injuries to the distal extremities or other body parts. The surgical techniques applied in those cases, and the patient outcomes have not been previously analyzed. Methods: Extensive literature search was performed using PubMed, EMBASE, and Google Scholar to collect articles reporting outcomes of temporary ectopic implantation for salvaging amputated extremities or other body parts. Age and sex of patients, injured part, amputation level, surgical details, and clinical outcomes were recorded. Results: Twenty-two articles encompassing 38 amputated cases met the inclusion criteria. The publication dates ranged from 1986 to 2016. Of the 38 cases, temporary ectopic implantation procedures were performed in 16 digit cases, 10 hand cases, 3 forearm cases, 5 foot cases, 1 penis case, 1 testes case, and 2 scalp cases. The ectopic implantation duration varied from 6 to 319 days. The ectopic implantation and following replantation of the amputated parts resulted in a survival rate of 81.6% and 100%, respectively. With different follow-up durations, most patients were found to have sensation restore in the tips of reconstructed extremities, and those reconstructed extremities were functionally useful in daily lives. The function of other replanted parts was also satisfactory. Conclusion: Temporary ectopic implantation is a valuable technique for salvaging amputation cases resulted from severe crushing injuries. There is yet no consensus on the indications of this surgical technique. In future practices, both success and failure cases should be recorded and analyzed to help us to optimize the surgical strategies and improve the patient outcomes. Level of evidence: Systematic review, level IV.
MeSH term(s)	Amputation, Traumatic/surgery ; Crush Injuries/surgery ; Humans ; Microsurgery/methods ; Reconstructive Surgical Procedures/methods ; Replantation/methods ; Salvage Therapy/methods ; Transplantation, Autologous ; Transplantation, Heterotopic/methods
Language	English
Publishing date	2018-04-10
Publishing country	United States
Document type	Journal Article ; Systematic Review
ZDB-ID	2651070-4
ISSN	2163-0763 ; 2163-0755
ISSN (online)	2163-0763
ISSN	2163-0755
DOI	10.1097/TA.0000000000001817
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Article ; Online: The First Year of Global Cleft Surgery Education Through Digital Simulation: A Proof of Concept.

Plana, Natalie M / Diaz-Siso, J Rodrigo / Culnan, Derek M / Cutting, Court B / Flores, Roberto L

The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association

2018 Volume 55, Issue 4, Page(s) 626–629

Abstract: Introduction: Parallel to worldwide disparities in patient access to health care, the operative opportunities of surgical trainees are increasingly restricted across the globe. Efforts have been directed toward enhancing surgical education outside the ... ...

Abstract	Introduction: Parallel to worldwide disparities in patient access to health care, the operative opportunities of surgical trainees are increasingly restricted across the globe. Efforts have been directed toward enhancing surgical education outside the operating room and reducing the wide variability in global trainee operative experience. However, high costs and other logistical concerns may limit the reproducibility and sustainability of nonoperative surgical education resources. Methods: A partnership between the academic, nonprofit, and industry sectors resulted in the development of an online virtual surgical simulator for cleft repair. First year global access patterns were observed. Results: The simulator is freely accessible online and includes 5 normal and pathologic anatomy modules, 5 modules demonstrating surgical markings, and 7 step-by-step procedural modules. Procedural modules include high-definition intraoperative footage to supplement the virtual animation in addition to include multiple-choice test questions. In its first year, the simulator was accessed by 849 novel users from 78 countries; 70% of users accessed the simulator from a developing nation. Conclusion: The Internet shows promise as a platform for surgical education and may help address restrictions and reduce disparities in surgical training. The virtual surgical simulator presented may serve as the foundation for the development of a global curriculum in cleft repair.
MeSH term(s)	Cleft Lip/surgery ; Cleft Palate/surgery ; Clinical Competence ; Computer-Assisted Instruction/methods ; Global Health ; Humans ; Internet ; Orthognathic Surgical Procedures/education ; Simulation Training/methods
Language	English
Publishing date	2018-02-06
Publishing country	United States
Document type	Journal Article
ZDB-ID	1069409-2
ISSN	1545-1569 ; 0009-8701 ; 1055-6656
ISSN (online)	1545-1569
ISSN	0009-8701 ; 1055-6656
DOI	10.1177/1055665617726544
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Article ; Online: Carbon Monoxide and Cyanide Poisoning in the Burned Pregnant Patient: An Indication for Hyperbaric Oxygen Therapy.

Culnan, Derek M / Craft-Coffman, Beretta / Bitz, Genevieve H / Capek, Karel D / Tu, Yiji / Lineaweaver, William C / Kuhlmann-Capek, Maggie J

Annals of plastic surgery

2018 Volume 80, Issue 3 Suppl 2, Page(s) S106–S112

Abstract: Carbon monoxide (CO) is a small molecule poison released as a product of incomplete combustion. Carbon monoxide binds hemoglobin, reducing oxygen delivery. This effect is exacerbated in the burned pregnant patient by fetal hemoglobin that binds CO 2.5- ... ...

Abstract	Carbon monoxide (CO) is a small molecule poison released as a product of incomplete combustion. Carbon monoxide binds hemoglobin, reducing oxygen delivery. This effect is exacerbated in the burned pregnant patient by fetal hemoglobin that binds CO 2.5- to 3-fold stronger than maternal hemoglobin. With no signature clinical symptom, diagnosis depends on patient injury history, elevated carboxyhemoglobin levels, and alterations in mental status. The standard of care for treatment of CO intoxication is 100% normobaric oxygen, which decreases the half-life of CO in the bloodstream from 5 hours to 1 hour. Hyperbaric oxygen (HBO2) is a useful adjunct to rapidly reduce the half-life of CO to 20 minutes and the incidence of delayed neurologic sequelae. Because of the slow disassociation of CO from hemoglobin in the fetus, there is a far stronger indication for HBO2 in the burned pregnant patient than in other burn patient populations.Cyanide intoxication is often a comorbid disease with CO in inhalation injury from an enclosed fire, but may be the predominant toxin. It acts synergistically with CO to effectively lower the lethal doses of both cyanide and CO. Diagnosis is best made in the presence of high lactate levels, carboxyhemoglobin concentrations greater than 10%, injury history of smoke inhalation from an enclosed fire, and alterations in consciousness. While treatment with hydroxocobalamin is the standard of care and has the effect of reducing concomitant CO toxicity, data indicate cyanide may also be displaced by HBO2.Carbon monoxide and cyanide poisoning presents potential complications impacting care. This review addresses the mechanism of action, presentation, diagnosis, and treatment of CO and cyanide poisonings in the burned pregnant patient and the use of HBO2 therapy.
MeSH term(s)	Burn Units ; Carbon Monoxide Poisoning/complications ; Carbon Monoxide Poisoning/therapy ; Cyanides/poisoning ; Emergency Medical Services ; Female ; Humans ; Hyperbaric Oxygenation/methods ; Pregnancy ; Pregnancy Complications/therapy ; Smoke Inhalation Injury/therapy
Chemical Substances	Cyanides
Language	English
Publishing date	2018-02-19
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	423835-7
ISSN	1536-3708 ; 0148-7043
ISSN (online)	1536-3708
ISSN	0148-7043
DOI	10.1097/SAP.0000000000001351
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Article ; Online: Volume Resuscitation in Patients With High-Voltage Electrical Injuries.

Culnan, Derek M / Farner, Kelley / Bitz, Genevieve H / Capek, Karel D / Tu, Yiji / Jimenez, Carlos / Lineaweaver, William C

Annals of plastic surgery

2018 Volume 80, Issue 3 Suppl 2, Page(s) S113–S118

Abstract: Volume resuscitation of patients with high-voltage electrical injuries (>1000 V) is a more complex challenge than standard burn resuscitation. High voltages penetrate deep tissues. These deep injuries are not accounted for in resuscitation formulae ... ...

Abstract	Volume resuscitation of patients with high-voltage electrical injuries (>1000 V) is a more complex challenge than standard burn resuscitation. High voltages penetrate deep tissues. These deep injuries are not accounted for in resuscitation formulae dependent on percentage of cutaneous burn. Myonecrosis occurring from direct electrical injury and secondary compartment syndromes can result in rhabdomyolysis, compromising renal function and urine output. Urine output is the primary end point, with a goal of 1 mL/kg/h for adult patients with high-voltage electrical injuries. As such, secondary resuscitation end points of laboratory values, such as lactate, base deficit, hemoglobin, and creatinine, as well as hemodynamic monitoring, such as mean arterial pressure and thermodilution techniques, can become crucial in guiding optimum administration of resuscitation fluids. Mannitol and bicarbonates are available but have limited support in the literature. High-voltage electrical injury patients often develop acute kidney injury requiring dialysis and have increased risks of chronic kidney disease and mortality. Continuous venovenous hemofiltration is a well-supported adjunct to clear the myoglobin load that hemodialysis cannot from circulation.
MeSH term(s)	Acute Kidney Injury/chemically induced ; Acute Kidney Injury/therapy ; Adult ; Burns, Electric/complications ; Burns, Electric/metabolism ; Burns, Electric/therapy ; Critical Care/methods ; Hemodynamics ; Humans ; Lactic Acid/metabolism ; Male ; Resuscitation/methods
Chemical Substances	Lactic Acid (33X04XA5AT)
Language	English
Publishing date	2018-02-19
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	423835-7
ISSN	1536-3708 ; 0148-7043
ISSN (online)	1536-3708
ISSN	0148-7043
DOI	10.1097/SAP.0000000000001374
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