ISSN:0273-8481    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

Important characteristics of procured allograft skin (microbiologic contamination level, viability, amount of skin obtained per donor) were generally unrelated to commonly used donor selection criteria: age, sex, cause of death, and elapsed time postmortem. Statistically significant relationships included (1) a decrease in skin viability with elapsed time postmortem, (2) an 8% decrease in microbiologic contamination level per decade of donor age, and (3) a 15% larger amount of skin obtained from male donors than from female donors. Most dermal allografts were placed on legs and arms, allowing more important areas of function and cosmesis (head, hands, feet) to be quickly covered by the limited autograft available. Burns larger than 40% (TBSA) were covered with cadaver skin in proportion to their area over 40%. Patients whose ages and percentages of burn gave them some probability of nonsurvival received 82% of the allograft skin used. Estimates of the amount of cadaveric allograft skin needed by a particular burn center may be calculated from its burn patient population parameters.

ISSN:0273-8481    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

We have previously demonstrated that sera from thermally injured patients profoundly suppress the mitogen and mixed lymphocyte culture (MLC) responses of normal human peripheral blood lymphocytes. In related studies, others too have demonstrated the failure of burn patient lymphocytes to respond in a normal fashion to mitogens.Two studies were designed to confirm the immunologic depression of burn patient lymphocyte response and to observe the temporal relationship between the onset of immune dysfunction of burn patient lymphocytes and the presence of immunosuppressive substances in their serum. In addition, we set out to determine if lymphocyte reactivity could be altered by removing the cells from the burn environment and incubating cells for 48 hours in tissue culture.Our results indicate that the presence of immunosuppressive factors in burn patient sera appears to precede immune dysfunction of patient lymphocytes. We have also demonstrated that 48 hours in tissue culture dramatically increases the response of burn patient lymphocytes to both phytohemagglutinin and Concanavalin A. We offer the hypothesis that the reactivation of cultured lymphocytes is not due to the elution of suppressive substances from lymphocyte cell membranes. Instead it is more likely that restoration of cultured lymphocyte function is due either to (1) a decreased production of a suppressive lymphokine, or to (2) the selective elimination of a suppressor T cell subpopulation.

ISSN:0273-8481    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

Quantitative bacteriology of tissue biopsies measures the total number of hacteria in the involved wound tissue. The accuracy of this technique is considerably influenced by the method used to separate the bacteria from the tissue. Evaluation of several reported techniques demonstrated wide variability in their bacterial removal efficiency. Mechanical homogenization with a Polytron tissue grinder proved to be a simple, efficient, and accurate procedure.

ISSN:0273-8481    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

Photoplethysmographic (PPG) monitoring has been used on 41 extremities of 26 patients with circumferential burns and on three limbs of three patients with electric burns; average burn size was 47% total body surface area. At admission, 29 limbs (19 patients) had good pulsatile flow by PPG monitoring, though clinical signs at that time led to strong consideration of performing escharotomy in six extremities. No escharotomies were performed in this group and no morbidity was present. Six limbs (three patients) had very poor pulsatile flow but received no immediate escharotomy because of poor physical status: all three patients died shortly after admission without further therapy. Six limbs (four patients) had escharotomies done prior to placement of the PPG; all of these extremities postoperatively showed good pulsatile flow, which remained stable throughout the entire monitoring period. The PPG in three limbs (three patients) showed moderate pulsatile flow, which significantly diminished during 12 to 24 hours even though Doppler flow signals remained strong; good pulsatile flow was restored following early escharotomy. The PPG has been very easy to use and has been more sensitive to circulatory changes than have other available techniques. These clinical results suggest that photoplethysmography is a valuable continuous monitor of the vascular status of burned extremities and provides objective information regarding the need for, or adequacy of, early surgical decompression.

ISSN:0273-8481    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

To reflect the in vivo condition in an in vitro assay system, a whole blood assay technique (modified CO-micromethod) (Nakamura et al) was used for detection of oxygen consumption in peripheral blood that had been diluted with autologous plasma to bring the final concentration of leukocytes to 2.5 × 105/0.25 ml. Dextran-separated leukocytes in plasma and serum (1.600 × g. 30 minutes) were also used for analytical purposes.Burn patients' leukocytes showed an impaired rate of oxygen consumption during phagocytosis of opsonified zymosan in whole blood between 7 and 15 days postburn (n = 70; 19 cases). The separated burn leukocytes showed the lowest rate in autologous serum and gave the highest rate of activity in Hepessaline buffer. On the contrary, normal leukocytes constantly showed lowest activity in buffer. Preincubation (30 minutes, 37 C) of normal leukocytes in burn serum (cross-matched) resulted in an impaired rate of oxygen consumption. This decrease was not found on similar incubations in matched, normal homologous serum. These results indicate that burn serum (obtained during the 7− to 15-day postburn interval) contains phagocyte-inhibitory factor(s).These results suggest strongly that the burn serum or plasma may contain substance(s) responsible for a major portion of the observed inhibition of the rate of oxygen consumption.

ISSN:0273-8481    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

The increased use of cadaveric homograft skin, made possible through the development of skin banking techniques, has emphasized the necessity of bacteriologic control of transplant tissue. Since the inoculation of burn wounds with pathogenic organisms is known to be potentially lethal, the lack of adequate quality assurance programs for controlling donor graft flora could represent a significant hazard. This potential hazard was evaluated by studying bacterial flora isolates from 362 continuous cadaver donors harvested during an 18-month period.Positive cultures were found in 169 (46.6%) donor skins. Fifty-one (14%) of the samples grew a variety of potentially pathogenic organisms. Included in the potential pathogenic isolates were 36 aerobic gram-negative rods, three gram-positive cocci, and eight anaerobic organisms, six Clostridial species, and two Bacteroides species. All 51 of these donations were rejected for transplant. The remaining 118 cases grew indigenous skin flora and were accepted for transplant.These results emphasize the importance of routine culture assessment of all donor homografts before transplant. Additionally, the unexpected finding of anaerobic organisms (unpredicted by preculture donor screening) in the donor population indicates a need for a system of isolation and identification of uncommon or unexpected skin flora.

ISSN:0273-8481    

出版商:OVID    

年代:1981

数据来源: OVID

ISSN:0273-8481    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

Complications resulting from endotracheal suctioning in critically ill patients are well recognized in the literature. The potential life-threatening nature of these complications is not always totally appreciated by those caring for the patient with respiratory failure. We have reviewed our recent experience and that of others with suctioning-induced hypoxia in order to focus more attention on this problem. We also present a new suctioning technique that appears to substantially decrease this complication.

ISSN:0273-8481    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

Nurses, as part of the team treating burn patients, should be able to effectively help patients maintain range of motion. This study evaluated our nurses' knowledge and interest in maintaining joint function.

ISSN:0273-8481    

出版商:OVID    

年代:1981

数据来源: OVID