ISSN:0273-8481    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

Burn-induced immunosuppression is thought to be partially mediated by suppressor lymphocytes. Endotoxin induces activation of suppressor T cells, an action blocked at the receptor level by small doses of polymyxin B (PB). Since patients with large burns are often endotoxemic early following burn, a series of burned mice and a pilot group of patients were treated with PB. Antibody formation improved 20% in treated mice, this improvement being proportional to the severity of burninduced suppression.Six patients with burns exceeding 30% body surface area (BSA) were studied: three controls and three patients receiving polymyxin. The PB was given immediately after admission at a dosage of 1,500 units/kg increasing to 5,000 units/kg over seven days (subtherapeutic dose). All controls had one positive blood culture; in two clinical sepsis developed and death followed. There was a single episode of sepsis in the PB group but no deaths.Immunologic improvement in treated patients ranged from moderate to dramatic. The prevention of suppressor T cell activation with lipopolysaccharide-blocking agents has apparent therapeutic potential.

ISSN:0273-8481    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

Heat absorbed during burns damages endothelium and blood components. Fibrinogen is denatured and blocks capillaries. Erythrocytes become spherical and are unable to traverse capillaries. Damaged erythrocytes and endothelial cells release tissue thromboplastin from their membranes; this particulate material, plus exposure of foreign surfaces, initiates the extrinsic and intrinsic sequences of the clotting process. Intravascular fibrin formation is promoted. The proenzyme of the fibrinolytic enzyme is denatured by heat. Reduction in fibrinolytic activity, and the fact that denatured fibrinogen is resistant to proteolysis, causes both fibrin and denatured fibrinogen to persist within vessels. The sum total of these alterations results in a compromised microcirculation. As a consequence of the impaired circulation, cells in the skin that were still viable immediately after the bum are unable to survive. In addition, particulate materials, including denatured fibrinogen, tissue thromboplastin, and erythrocyte fragments, overload and block the reticuloendothelial system, thereby reducing defenses against infection.

ISSN:0273-8481    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

It is generally believed that viable allografts are preferable to nonviable counterparts to prepare a wound for grafting. Most interest has centered on properties of the graft material, with less emphasis on the response of the underlying wound tissue to the dressing. The purpose of the present investigation was to quantitate and compare the effects of viable and nonviable dressings on the biochemistry of underlying wound tissue. Initially, viable autograft was compared with viable allograft during the first week posttrauma. No significant differences were observed; therefore, viable allograft was tested in concert with nonviable allograft. DNA and protein synthesis—in particular, collagen synthesis—was quantitated in wound tissues underlying the dressing types.On Day 0, 180-gm, male Sprague- Dawley rats received either single or dual, 4-sq cm, full-thickness wounds in the dorsal skin. The rats, divided into four groups, received (1) 4-sq cm graft of live, allogeneic skin; (2) similar grafts using nonviable skin that had been repeatedly frozen and thawed (5 x ), then stored at -70 C; (31 both viable and nonviable grafts; or (4) 20% full-thickness burns and viable and nonviable grafts. On Days 3 and 6 postgraft, samples were taken from the wound tissue beneath the grafts. Analysis of DNA and protein synthesis in these samples indicated that there are no statistically significant differences in synthesis from samples in wound tissue underlying viable or nonviable grafts. However, wound tissue DNA and protein synthesis was increased in animals that received dual grafts compared with single graft counterparts. The latter results suggest that, as total wound area increases in an animal, the overall wound healing response may also increase.In other experiments, the total amount, as well as synthesis, of collagen and noncollagen protein was not significantly different in wound tissue beneath viable or nonviable dressings for Day 3. For Day 5 tissue, total collagen content was not changed, but a decrease in total noncollagen protein content was observed with the nonviable dressing group. By Day 5, relative collagen synthesis was slightly lower in wound tissue beneath viable dressings than beneath nonviable dressings.These results suggest that under laboratory conditions the biochemical responses of wound tissue to viable or nonviable biologic dressings on Days 3, 5, and 6 post coverage are similar. Thus, viability may not be a critical issue in selecting a biologic dressing as a temporary cover for a wound bed.

ISSN:0273-8481    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

Toxic epidermal necrolysis, a disease that produces skin loss, was encountered in 18 patients in a burn center. Drugs were associated in all cases, but six patients had symptoms of fever or cough before drug exposure. Liver function abnormalities were noted in all 18 patients. Corticosteroids were ineffective in preventing skin loss, and sepsis caused death in 11 patients. The unacceptably high incidence of septic deaths led to the current protocol of debridement, rapid steroid taper, topical chemotherapy, and cover age with homograft or synthetic skin substitute. Gastrointestinal ulcerations may have been a part of the disease process or a complication of high-dose corticosteroids.

ISSN:0273-8481    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

Two cases of burn homicides are presented. In both instances, the victims were doused with gasoline and deliberately set on fire. Through evidence collected at the scene and from physician's testimony and hospital records, both assailants were convicted of first-degree murder. The type of medical evidence needed to assist the police investigation and the kind of testimony an attending physician will be asked to give in court are reviewed. Child abuse as a factor in burn homicide is also discussed.

ISSN:0273-8481    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

Wound closure remains the key to survival in patients with large bums. When sufficient unburned skin is not available for initial autografting, temporary wound closure becomes necessary. Wound stability and closure can be achieved with temporary skin substitutes if they remain adherent and can prevent bacterial proliferation and sepsis. In 21 burned patients, quantitative bacterial biopsy cultures were used to compare the effectiveness of fresh human cadaver allograft, porcine xenografts, and the semisynthetic temporary wound dressing Biobrane. When applied to an eschar-free wound with fewer than 100,000 organisms per gram of tissue, the three test dressings were equally effective. For longer-term wound stability, Biobrane and allograft are superior to porcine xenograft.

ISSN:0273-8481    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

The case history of a patient in whom cerebellar ataxia developed after an electric injury is presented. The pathophysiology and clinical spectrum of electrically induced neurologic injuries are reviewed. Based on this review, it appears that neurologic injuries that develop immediately or shortly after the accident and are not in proximity to the entrance or exit wounds have a good prognosis. In contrast, neurologic deficits that develop after the acute injury period, or neurologic deficits involving nerves in the region of the cutaneous injury, have a worse prognosis.

ISSN:0273-8481    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

Transaminase testing in 33 hospitalized burn patients showed a high incidence of hepatitis (59%). These cases were not due to any virus known to cause hepatitis and were classified by exclusion as non-A, non- B hepatitis. Two types were distinguished: those of short and those of long incubation. In the latter cases, the infection often resulted in chronic hepatitis.

ISSN:0273-8481    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

A major complication of thermal injury is the development of hypertrophic scars, keloids, or contractures. Ace wraps and Jobst garments have been used to prevent or reduce the incidence of these complications. However, these methods have limitations: ace wraps are cumbersome to use and often result in inconsistent pressure; Jobst garments are expensive and rapidly outgrown. Thus, we studied the clinical use of a tubular compression bandage, Tubigrip, in 23 pediatric burn patients. Twelve of the children (52%) were under age three years, and the mean TBSA burn was 23% (range 3% to 70%). In 16 children, Tubigrip was applied immediately, ie, during the acute bum period to either localized healed or grafted areas, prior to healing of the burns at other anatomical sites. Tubigrip application in the remaining 7 children was delayed until several months postburn. Sixty-five anatomical sites were treated. Thirteen children (57%) were treated successfully with Tubigrip alone or in conjunction with special devices such as splints, silicone elastomere, or foam inserts. The remaining children (10) ultimately required Jobst garments. The areas most effectively treated were flat circumferential areas, including the upper extremity, lower extremity, and trunk. In contrast, Tubigrip was not effective in treating burns of the head, neck, axilla, groin, or digits. Although Tubigrip has not completely replaced Jobst garments in our patient population, it has added a new therapeutic dimension to traditional compression methods in selected pediatric burn patients.

ISSN:0273-8481    

出版商:OVID    

年代:1983

数据来源: OVID