ISSN:0273-8481    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

Serum of patients with severe burns has the ability to suppress mitogen-induced lymphocyte proliferation. Edema fluid collected from the site of injury during resuscitation and at the time of fascial excision has also been shown to suppress this response. An animal model was designed to identify the onset time of the formation of suppressive factors, their potential site(s) of origin, and their route of entry into the systemic circulation. Femoral artery, saphenous vein, and lateral saphenous lymphatic vessels were cannulated in an anesthetized dog. Baseline samples were collected, the hind paw was subjected to scald injury, and samples were collected serially for up to 6 hours after burn injury. Tissue fluid beneath the scald injury was harvested at the end of the experiments. In the absence of significant serologic evidence for inhibition, lymph and tissue fluid exhibited early and prolonged suppression of mitogen-induced lymphocyte proliferation. We concluded that edema fluid capable of cell-mediated immune suppression forms early after thermal injury and that lymph generated from the site of burn injury is immunosuppressive.

ISSN:0273-8481    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

Prostaglandin E2(PGE2) is a very important immunosuppressive substance that is synthesized and released by all macrophages including KupfFer cells (KCs). In this study the changes of PGE2released by KCs were evaluated in a burned guinea pig model. Prostaglandin E2was releaesd by KCs from burned guinea pigs at a consistently and significantly high level when stimulated with endotoxin. On postburn day 82KCs that were cocultured with hepatocytes released significantly less PGE2. There was also a significant decrease in antibody-dependent cell-mediated cytotoxicity on postburn day 1. Kupffer cells can mediate immune suppression in burn injury by a prolonged increased production of PGE2that has immunosuppressive effects on other cells and by a decreased cytotoxic effect soon after burn injury.

ISSN:0273-8481    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

Polymorphonuclear leukocytes (PMNs) comprise the majority of early nonspecific inflammatory responses to infection or trauma and, as such, must be of sufficient number and qualitative function to properly limit and combat inflammation. Peripheral PMNs isolated from rats that received 10% or 30% body surface area full-thickness thermal injuries were quantitated and examined for functional alterations in membrane potential and cytosolic hydrogen peroxide production for 35 days after thermal injury. With 10% thermal injury, leukocytes increased quantitatively to experimental maximums that were 70% above normal on day 7 before a return to normal by day 28. Platelet levels showed a nonsignificant decrease for 2 days after thermal injury before increasing to levels 20% to 40% above normal through day 28. Phorbol myristate acetate-induced PMN membrane depolarization was inhibited as much as 30% for 21 days after 10% thermal injury. No changes in oxidative activity were apparent except for day 14, when hydrogen peroxide production was 40% above normal. With 30% thermal injury, leukocyte quantities were three to five times normal, with increased relative numbers of PMNs and decreased lymphocytes through day 28. Platelet levels decreased for 4 days before increasing to levels 30% to 47% above normal through day 21. Compared with 10% thermal injury, 30% thermal injury further reduced the ability of PMN membranes to depolarize through day 35. In addition, PMN hydrogen peroxide production was 30% lower on day 1 and increased thereafter to levels that were 40% above normal on day 21.

ISSN:0273-8481    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

Various antimicrobial solutions for topical use on burn wounds tested, in vitro with a newly described wet disc assay, for their activity against bacterial isolates from patients with burns. The antimicrobial activity of triple antibiotic solution was shown to reside in the neomycin component. The activity of 2.5% mafenide hydrochloride solution was equal to that of 4% mafenide HCl and could be used clinically with significant savings and perhaps, fewer side effects. Chlorhexidine gluconate had broad antimicrobial activity in an 0.05% solution in water; however, dissolving the active ingredient in saline nullified its activity significantly. The wet disc assay appears to be a useful means by which to assess the efficacy of solutions for topical use.

ISSN:0273-8481    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

Cardiac disease has many manifestations that may complicate burn care. A review of 2477 consecutive acute burn admissions was conducted to determine the types and incidence of cardiac complications in this patient population. Nearly one half of patients with a prior cardiac history manifested some form of cardiac dysfunction, most frequently arrhythmias. Eight percent had an in-hospital myocardial infarction. Only 6% of patients without a prior cardiac history manifested cardiac dysfunction. The in-hospital mortality rate after myocardial infarction for both groups was 3.5 to 4 times that of patients without burns. Except for patients with prosthetic valves, for whom anticoagulation and infection prophylaxis are required, burn care of the cardiac patient is expectant with selective use of invasive monitoring and therapy as determined by the patient's clinical course.

ISSN:0273-8481    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

Between 1966 and 1986, fifty-seven pediatric patients with partial and/or full-thickness perineal and genital burns with a minimum of 1-year follow-up were identified. Fifty percent of the patients with genital burns and 20% of the patients with perineal and/or buttock burns required skin grafting in the acute stage. No patient required suprapubic cystostomies, diverting colostomies, or local flap coverage of exposed testicles. Burn scar contractures were the most frequent complications. Thirty-two patients (56%) required contracture release of the perineum and coverage with either skin grafts or local skin flaps. In three patients (6%) contracture required release of the penis and scrotum. One patient lost a testicle. Three patients developed rectal prolapse and were treated without surgery. Four patients developed rectal stenosis with fecal incontinence because of burn scar contracture and were treated by anal dilatation, local transposition flaps, and/or excision of the scar and primary closure. Acute management of pediatric patients with such injuries can be conservative. Delayed complications of contractures of the perineum and genitals can be easily corrected with scar excisions, skin grafts, or the use of local skin flaps.

ISSN:0273-8481    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

An electronic device capable of measuring finger joint stiffness has been developed and used to evaluate the effects of dynamic flexion splinting on the recovery of joint motion in patients with burned hands. The device locates an angle of primary (greatest) resistance and the reactive torque at that angle for a selected joint. Using the device, four subjects with stiff hands were measured before and after dynamic splinting treatments. During the 3-day treatment period, there were statistically significant differences in the angle of primary resistance (p< 0.0001) and reactive torque (p< 0.001). This initial trial suggests that: (1) finger stiffness can be quantified in terms of reactive torque as well as joint exclusion, (2) dynamic rubber-band flexion splinting does alter joint condition and allow increased motion, (3) the amount of initial joint stiffness may be an indicator of treatment outcome, and (4) increasing treatment time may not enhance outcome.

ISSN:0273-8481    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

It has been previously suggested that the surgical removal of areas of heterotopic ossification in patients with burns should be delayed until bone scans return to normal. The present study describes a patient who underwent surgical removal of heterotopic ossification from both elbows, 1 year after burn injury, with strongly positive bone scans, because of progressive ulnar nerve compression. Subsequently, 7 years after burn injury and 6 years after this surgery, the patient maintained an excellent range of motion in both elbows. At this time, his bone scans continue to be strongly positive. Didronel (Norwich Eaton, Norwich, N.Y.), a diphosphonate, may have played a role in this patient's recovery by decreasing bony deposition following surgery.

ISSN:0273-8481    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

This study was designed to test the hypothesis that auricular acupuncture-like transcutaneous electrical nerve stimulation would significantly reduce the pain experienced by patients with burns immediately after wound debridement, other wound care, and dressing changes. Subjects were 11 inpatients at the University of Alabama Hospital Burn Unit. A two-period crossover design was used, and each patient received one experimental treatment consisting of bilateral acupuncture-like transcutaneous electrical nerve stimulation to six ear points and one control treatment consisting of a placebo pill. The Visual Analogue Scale was used as a measure of pain and was completed immediately before and after treatments and at 15, 30, and 60 minutes after treatment. A two-factor repeated measures ANOVA indicated significant effects of measurement time (p< 0.001) and treatment by time (p= 0.002). Post hoc analysis revealed significant differences (p< 0.05) between experimental and control conditions at all times after treatment but not at pretreatment baseline. These results indicate that auricular acupuncture-like transcutaneous electrical nerve stimulation may be an effective pain management technique in patients with burns.

ISSN:0273-8481    

出版商:OVID    

年代:1990

数据来源: OVID