ISSN:0273-8481    

出版商:OVID    

年代:1994

数据来源: OVID

ISSN:0273-8481    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Increasing evidence shows that cells other than immune cells have the potential for producing cytokines and arachidonate metabolites. It was the purpose of this study to determine whether isolated enterocytes could prdouce tumor necrosis factor, interleukin-1, interleukin-6, and prostaglandin E2, to compare the production with that of isolated gut macrophages, and to determine whether a difference existed in the production of these mediators after thermal injury. Guinea pigs received a 30% total body surface area burn and were killed 24 hours after injury. Isolated enterocytes and related intestinal macrophages (5 x 105cells/ml) were cultured for 24 hours in the presence and absence of endotoxin, and the supernatants were assayed for the mediators. An increase was seen in production of interleukin-6 by enterocytes and by macrophages after thermal injury. In general enterocytes and gut macrophages produced about the same amounts of the different mediators. In contrast to macrophages from other tissues, enterocytes did not produce more prostaglandin E2after stimulation with lipopolysaccharide, and with one exception gut macrophages did not produce larger amounts of mediators after stimulation with lipopolysaccharide. Enterocytes may be a significant source of immunomediator production and could contribute to the inflammatory response.

ISSN:0273-8481    

出版商:OVID    

年代:1994

数据来源: OVID

ISSN:0273-8481    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Although subjective evidence suggests that patients with burns are deprived of sleep, previous clinical studies have been limited to observational data and have not to date included electroencephalographic or polysomnographic recordings. The purpose of this study was to characterize the sleep pattern of patients suffering from thermal injury. Biweekly 24-hour polysomnographic measurements (electromyography, electrooculography, and electroencephalography) were performed with 12 leads. This measuring permitted continuous recording of intrinsic electrical activity in skeletal muscles via chin electrodes, eye movement via outer canthal electrodes, and brain wave activity with the other bipolar electrodes. Determinations were obtained on 11 patients with thermal injuries for a total of 43 24-hour periods. The patients had a mean age of 8.31 ± 1.5 years (range 1.4 to 16 years), a mean total body surface area burn of 55.1% ± 16.5% (range 17.5% to 90.5%), and a mean full-thickness burn of 48.5% ± 8.1% (range 10.5% to 90.5%). Although mean total sleep time was seemingly adequate (625.1 ± 31.6 min/patient/24 hrs), large aberrations in sleep stage distribution were noted. Significant decreases in stage 3 + 4 and in rapid eye movement (deep sleep) and increases in stages 1 and 2 (light sleep) were noted, suggesting a cycling back to stages 1 or 2 after disruption of sleep. Overall, in 43 runs 40% of the subjects were completely lacking stage 3 + 4, and 19% were missing rapid eye movement during an entire 24-hour run. All patients demonstrated some stage 1 and 2 sleep; however, an absence of stage 3 + 4 and rapid eye movement sleep occurred in 41% and 17% of the 37 evaluation periods, respectively. Stage 3 + 4 and rapid eye movement percent of total sleep time increased during the course of hospital stay concomitant with a decrease in stages 1 and 2. This increase suggested an association between time after burn and normalization of sleep stage. Multiple regression analysis of individual sleep stages compared with that of standardized normal stages showed a relation with time after burn. In conclusion, although the mean total sleep time of 10.5 hours appears to be a sufficient amount of time spent in sleep, a marked reduction of stage 3 + 4 and rapid eye movement sleep occurred after burn injury. Future studies are needed to determine whether sleep deprivation influences the physiological and psychologic disturbances observed after burn.

ISSN:0273-8481    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Systemic activation of inflammatory cascades has been implicated in the pathogenesis of the multiple organ dysfunction syndrome. To begin to determine whether dysregulation of macrophage cytokine expression after burn plays a role in organ failure, we examined tumor necrosis factor a bioactivity of liver and lung macrophages under two conditions: (1) at 1, 3, 5, and 7 days after 40% scald burn, and (2) after sequential insult consisting of 40% scald burn followed by in vitro incubation with endotoxin. Burn alone did not significantly alter alveolar macrophage or Kupffer cell tumor necrosis factor a bioactivity at any of the timepoints examined. Sequential insult did not result in significant changes in Kupffer cell tumor necrosis factor a, but tumor necrosis factor a was increased 11.1 times in alveolar macrophages harvested on postburn day 3. Therefore macrophage cytokine responses to thermal injury are apparently both tissue-specific and time-dependent.

ISSN:0273-8481    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

This prospective randomized study was performed to evaluate the metabolic and thermal responsiveness of patients with burns to thermal stress with three protocols of wound care: group I (n=7) treated with dressings and variable ambient temperature selected for patient subjective comfort; group II (n=7) treated without dressings and variable ambient temperature for patient comfort; group III (n=6) treated without dressings and ambient temperature of 25° C, electromagnetic heaters were set to achieve patient subjective comfort; and group IV (n=6) healthy volunteers. After baseline partitional calorimetry was performed, individual patients were cold-challenged while subjectively comfortable by sequentially lowering either the ambient temperature or the output from the electromagnetic heaters. Heat balance and temperatures were obtained after each perturbation in external energy support. For patients in groups I and II, subjective perception of thermal comfort (warm, neutral, neutral and fed, cool, or cold) was more strongly correlated (p< 0.02) with the changes in the rate of heat production than the actual ambient temperature. For patients treated with electromagnetic heaters, changes in heat production were most strongly correlated with the energy output from the electromagnetic heaters. Even though the environmental conditions required to achieve a particular level of comfort are quite different between treatment groups, the difference in temperature between the patient's surface and ambient is approximately the same for groups I, II, and IV for each subjective state. Changes in metabolic rate were more strongly correlated with the patient's actual perception of thermal comfort than with ambient temperature. Patients with burns who are subjectively cold will have a higher metabolic rate than when subjectively comfortable. To minimize the metabolic rate interview the patient with burns to determine the subjective level of thermal comfort and maintain their environmental temperature at the upper level of their established zone of thermal preference.

ISSN:0273-8481    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Dehydroepiandrosterone has been proposed as a means of restoring immune function after injury. In this study we examined the effect of dehydroepiandrosterone on the impaired immunoglobulin M synthesis and depressed lymphocyte mitogenic responses observed after burn injury. We divided BALB/c mice (n=28) into four equal groups that received either a 25% total body surface area dorsal steam burn or a sham procedure. One hour later we injected mice subcutaneously either with 100 fig dehydroepiandrosterone or vehicle alone. Five days later we isolated splenocytes for assessment of immune function. We stimulated splenocytes with lipopolysaccharide and 5 days later measured immunoglobulin M synthesis specific for peptidoglycan polysaccharide, a ubiquitous bacterial antigen. We stimulated additional cultures with lipopolysaccharide or concanavalin A to measure B- or T-lymphocyte mitogenic response. Burn injury impaired peptidoglycan polysaccharide— specific immunoglobulin M synthesis compared with sham (p< 0.05), and this impairment was not restored by the administration of dehydroepiandrosterone (p< 0.05). Furthermore dehydroepiandrosterone did not correct the burn-induced impairments of B- and T-cell mitogenic responses (p< 0.05). Our study demonstrates that in this model the administration of dehydroepiandrosterone in vivo does not correct the impairments of humoral or cellular immunity induced by burn injury.

ISSN:0273-8481    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Adequate sedation is an integral component of mechanical ventilation. To document the safety and efficacy of midazolam infusion in pediatric patients with burns who were undergoing mechanical ventilation, a retrospective review was done of all patients requiring mechanical ventilation over a 22-month period. Twenty-four acutely burned pediatric patients required mechanical ventilation. The average age was 6.4 years (range 7 months to 12 years), and the average burn size was 50% of the body surface (range 40% to 95%). Midazolam infusion was initiated at an average dose of 0.045 mg/g/hr (range 0.04 to 0.35 mg/kg/hr). The duration of infusion averaged 16.5 days (range 4 to 56 days). All patients received simultaneous infusions of morphine sulfate. Midazolam infusion was titrated to achieve a diminished narcotic requirement, decreased anxiety, and better tolerance of dressing changes. No hypotension or problems weaning from mechanical ventilation were seen. Two (8.3%) children experienced reversible neurologic abnormalities attributed to midazolam infusion but made full neurologic recoveries. In conclusion, our experience with midazolam infusion in pediatric patients with burns who were undergoing mechanical ventilation is favorable and supports its continued use.

ISSN:0273-8481    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

The efficacy of an oil-in-water emulsion of a traditional Kenyan medicine, Compound R, on thermal burn wounds in fuzzy rats is reported. The burn wounds were inflicted on the depilated skin of rats with a 2 cm diameter aluminum template heated at 65° C. Mean ± SD days to healing (complete closure) were 9.9 ± 2.2 (range 7 to 14 days) and 13.3 ± 2.4 (range 10 to 16 days) for the treated and control (untreated) wounds, respectively (paired Student's t test, t value − 5.667,p=0.0003). Preliminary microbiologic results showed no activity of Compound R against some of the commonly encountered pathogens in burn wounds. Compound R appears to decrease the days to burn wound healing in fuzzy rats. This study provides preliminary data for further investigations of Compound R in managing burn wounds.

ISSN:0273-8481    

出版商:OVID    

年代:1994

数据来源: OVID