ISSN:0273-8481    

出版商:OVID    

年代:1987

数据来源: OVID

ISSN:0273-8481    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Patients with thermal injury suffer a high incidenceof infectious complications secondary to impairedhost resistance. Nonspecific immunostimulatoryagents are being tested increasingly for their abilityto correct the postburn immunosuppression. Bymeans of a burned guinea pig model, three suchdrugs—indomethacin, cyclophosphamide, andcimetidine—were tested for their ability to correctimmunosuppression and prevent lethal infec-tious complications. The burned animals were chal-lenged with Pseuclomonas aeruginosa 1244 onthe third postburn day. Neither indomethacin norcimetidine altered the animals' clinical course.However cyclophosphamide, at a dosage of 2 mg/kgbody weight/day, improved survival from 30%to 57% and prolonged mean survival time from 5.72to 7.77 days. Cyclophosphamide, at a dosage of15 mg/kg body weight/day, decreased mean sur-vival to 3.63 days and percent survival to 0. Thesedata show that treatment with cyclophosphamidecould be beneficial in severe burn injury patients,but further work is necessary due to the dose-dependent nature of the drug.

ISSN:0273-8481    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

The degree of accuracy of existing formulas forcalculating energy expenditure can be determinedby comparing them to the measured energyexpenditure via indirect calorimetry. As a result,one can modify traditional predicted recom-mendations for nutrition alimentation of the burnpatient with real-time data. In this study, 21 se-quential adult admissions with second- and third-degree total body surface area (TBSA) burnwounds (range 21%-81% TBSA) underwent serialassessments of energy expenditure by indirectcalorimetry. On admission, maximum, and dis-charge, measured energy expenditure (MEE) wascompared with the calculations for predictedenergy expenditure by the Curreri (CEE) andmodified Harris-Benedict (MBEE) equations. Themean energy expenditure calculated from theCurreri equation on admission (CEEA) over-estimated the mean MEE on admission (MEEA)by 25% (P < 0.001) and on discharge (MEED) by36% (P<s0.0005). The mean modified Harris-Benedict equation overestimated the mean MEEAby 32% (P<0.0005) and the mean MEED by 39%(P<0.0005). No significant difference was notedbetween the mean MEE at maximum (MEEM) andthe mean CEEA or the mean MBEEA. This indi-cates excessive overfeeding of the burn patientfrom admission to discharge by both standardformulas. Actual measured data provide a betterindicator of varying nutritional needs throughoutthe hospital course than the standard formulas,and their use would result in significant savings inthe expenses of enteral/parenteral nutritionalsupplements.

ISSN:0273-8481    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Hypertrophic scar formation remains the majorproblem for severely burned patients who survivetheir injuries. This scarring can result in bothcosmetic and functional deformities. One of themajor problems in dealing with this complicationis the lack of an adequate animal model with whichto test various possible therapeutic modalities.We describe an animal model that uses human skinapplied to the backs of nude mice to investigatethe problem. Immunosuppression is not necessaryin this model since the nude mouse lacks athymus gland and is therefore not able to reject theskin. With this model we have been able to achievecontracture of meshed normal human skin graftsand hypertrophic scar formation in normal humanskin that was burned a month after grafting tothe mouse. We have also had success in graftinghuman hypertrophic scars, obtained from burnpatients, to the mice. This model oilers uniqueopportunities for investigation of the cause andtreatment of burn scars in humans.

ISSN:0273-8481    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Twenty patients with extensive thermal injurywere entered into a prospective randomizeddouble-blind trial of prophylactic intravenousimmunoglobulin administration. Ten patientsreceived intravenous immunoglobulin and ten,albumin controls. No statistically significantdifference was found between mortality rates,mortality rates from sepsis, the incidence ofpositive blood cultures, the positive quantitativewound biopsies, urine cultures, or positive intra-venous line cultures. No significant improve-ment was noted in assays of neutrophil chemotacticindex or intracellular kill, assays of lymphocytefunction, or helper/suppressor ratio. We did,however, note significant improvement in theincidence of polymicrobial blood cultures, cyto-megalovirus titers, and blood endotoxin con-centration in treated patients. While the highincidence of inhalation injury (16 out of 20 pa-tients) and, therefore, the disproportionatelyhigh mortality rate (40% overall) in the study groupdo not permit extension of these observationsto the burn patient population at large, certaincautious recommendations may be made withregard to the use of intravenous immunoglobulin Gin the management of burn patients.

ISSN:0273-8481    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

A controversy exists with regard to the relativeefficacy of two preparations of silver sulfadiazine(AgSD), Silvadene and Flint's Silver SulfadiazineCream. We compared the susceptibility of Stapby-lococcus aureus and clinical Gram-positive cocci,Gram-negative rods, and mixed floral isolates by theNathan's agar well diffusion method and foundno differences. However, when 5 aureus-inkctedrat burn wounds were treated with these anti-microbial creams over a period of ten days, Silva-dene significantly lowered bacterial counts,whereas results after treatment with Flint's SilverSulfadiazine Cream were no different from thoseof the control group, which received no treat-ment. These data imply that Silvadene controlsS aureus-genevated burn wound infections betterthan the Flint product.

ISSN:0273-8481    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

A prospective trial of Biobrane versus scarlet redas a skin graft donor site dressing was done in21 burn patients with mean total body surface areaburns of 31.9%. Corresponding body areas wererandomly selected on each patient to receive oneof the dressings. Daily evaluations were madeof subjective expression of pain, exuclate formationand infection, and time of separation of thedressing from the wound. Biobrane was found tobe superior in reducing donor site pain. How-ever, with Biobrane there was a higher incidenceof infection (57% i> 9.5%) and a significant delayin separation from the wound. Scarlet red wasfound to be more cost-effective. Occlusive dressingshave previously been shown to have a high in-cidence of complications (30%). In extensive burns,isolating the donor site from the wound is dif-ficult and may lead to increased complications.Scarlet red appears to be superior to Biobrane forskin graft donor sites in this patient population.

ISSN:0273-8481    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Major disturbances of shoulder function secondaryto axillary burn contracture require some formof surgical release if conservative therapy has beenunsuccessful. Any area large enough to needextensive skin grafts should be considered for re-construction using a parascapular fasciocutaneousflap. This flap, which may be elevated easily,provides an option for single-stage correction ofthe deformity without the need for long-termrehabilitation or splinting.

ISSN:0273-8481    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Early vascular grafting has been used to reestablishcirculation to the hand in the treatment of elec-tric injuries of the wrist with arterial damage. Since1972 this therapy has yielded good results bypreventing necrosis of the injured hand and byhelping to maintain function. However, theindications and timing for performing this opera-tion still are poorly defined. The surgeon isfaced with the difficult task of determining whetherthe injury is severe enough to affect distal cir-culation and thereby lead to necrosis. The lack ofreliable clinical signs is chiefly responsiblefor this difficulty; however, the potential for delayedthrombosis of vessels complicates the problem.In this article, indications for early vasculargrafting in an electrically injured wrist are dis-cussed based on recent clinical experience,with emphasis on the use (if arteriography. A casehistory involving electric burns of both upperextremities is presented as an illustration.

ISSN:0273-8481    

出版商:OVID    

年代:1987

数据来源: OVID