摘要:

A prospective study of growth hormone, insulin-like growth factor (IGF-1), and cortisol secretion was undertaken in six adults with burn injury. Serum concentrations of growth hormone and IGF-1 were low in all patients during the first 2 weeks of hospitalization. The mean growth hormone level was 4.35 ± 0.83 μg/L on day 1 and 1.70 ± 0.50 μg/L on day 13. The mean serum concentration of IGF-1, which reflects overall growth hormone secretion, was 0.43 ± 0.09 U/ml on day 1 and 0.61 ± 0.11 U/ml on day 13; these values are distinctly low. After 3 to 4 weeks, IGF-1 concentrations increased to the mid-normal range, whereas growth hormone values did not change. Morning plasma cortisol concentrations were modestly elevated; however, urine free cortisol concentrations, which reflect total cortisol secretion, were elevated 2 to 28 times above normal values at the time of admission (mean, 443.5 ± 323.7 nmol/L). Urinary free cortisol concentrations remained elevated after 2 weeks (mean, 230.5 ± 94.5 nmol/L). Patients with burn injury have inappropriately low growth hormone secretion and IGF-1 production in spite of the stress of the injury and more than adequate nutritional therapy. (J BURN CARE REHABIL, 1992;13:391–5)

ISSN:0273-8481    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Fluctuations in the diameter of selected arterioles in the cutaneous microcirculation of Syrian golden hamster dorsal skin flap chambers, which ranged in size from 10 to 70 μm at different branching order sites, were measured before burn, at the same sites after burn and after injection of the drug. Three different drugs epinephrine (administered intravenously), ibuprofen (administered intravenously), and tetrachlorodecaoxide (administered intravenously and topically) were evaluated. Results show that the response to thermal injury in the control group involved extensive vasodilation in the arterioles, prolonged flow irregularities including flow obstructions and stasis, and a decrease in the level of vasoactivity of the microvessels. In two treatment groups, the ibuprofen and tetrachlorodecaoxide groups, significant improvement as indicated by reduced vasodilation and edema and improved microcirculatory blood flow after injury were observed. Further testing of tetrachlorodecaoxide as a topically applied wound dressing is indicated. (J BURN CARE REHABIL 1992;13:396–402)

ISSN:0273-8481    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Treatment of the patient with burns has advanced dramatically during the last several decades. Patients with burns that cover a greater percentage of the body surface area are now surviving. Cardiac, pulmonary, and vascular insults are better understood and more adequately treated. Nutritional requirements of the patient with burns can be fulfilled, and physical therapy is providing improved quality of life. In spite of these advances, care of burned tissue has progressed only moderately. The introduction of silver nitrate and other topical antibiotics and early excision significantly improved burn care. Other advances are not in widespread use in spite of research data that detail beneficial alternatives or additions to current therapies. Specifically, reversal of burn injury is possible. The reseach in this field had progressed considerably to the present. Reversal of dermal vascular occlusion in burned tissue seems to preserve that tissue. (J BURN CARE REHABIL 1992;13:403–6)

ISSN:0273-8481    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Severe deformities of the ears are a distressing problem after burn injury. Successful management of chondritis has been elusive. Antibiotic iontophoresis has been used in the management of burned ears in patients who have been admitted to the St. Vincent Medical Center Burn Unit since 1983. There were 145 ear burns in 92 consecutive patients who received prophylactic penicillin or gentamicin iontophoresis and who were admitted from 1983 through 1990. A retrospective analysis of all patients who were admitted to the burn unit from 1967 to 1983 was done to review the outcome for patients with burned ears when conventional treatment was used. The incidence of infection, need for chondrectomy, and ear infection were virtually eliminated by management with antibiotic iontophoresis. In addition, no complications were noted when antibiotic iontophoresis was used. Antibiotic iontophoresis provides a safe, simple, and effective way to manage burned ears and thereby limits postburn ear deformities. (J BURN CARE REHABIL 1992;13:407–9)

ISSN:0273-8481    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Purpura fulminans is a rare disease, which may have devastating cutaneous manifestations. It usually follows an infectious illness, and although it most commonly occurs in children, it can occur in adults. The pathogenesis may be related to a relative deficiency of protein C and/or protein S. A case of an adult male is presented to illustrate the management of the severe full-thickness skin loss and the use of surgical excision and allograft in this disease. (J BURN CARE REHABIL 1992;13:410–3)

ISSN:0273-8481    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Seventy-nine persons who had sustained automobile engine carburetor- and radiator-related burns were admitted to Grady Memorial Hospital Burn Unit between June 1, 1984 and September 30, 1990. Forty patients with carburetor-priming flame burns had a mean age of 31.5 years, a mean burn size of 13.4% total body surface area, and a mean length of stay of 13.8 days. There were 37 male patients. Four patients had an inhalation injury. Twenty-two surgical procedures were performed on 13 patients. One patient was an innocent bystander, and one patient died. The clothing of 16 patients had ignited, which resulted in larger, deeper burns and in one death. Burns predominantly involved the right sides of the face, head, and torso; the right upper extremity; and the right hand. Thirty-nine patients had scald burns that were associated with uncapping a radiator. These patients had a mean age of 29.6 years, a mean burn size of 8.9% total body surface area, and a mean length of stay of 6.4 days. There were 36 male patients and three innocent bystanders. One autografting procedure was performed, and there were no deaths in this group of patients. The burn-prone person is the young adult male. The circumstances that result in such dangerous behavior are predictable, and resultant burn injuries are preventable. (J BURN CARE REHABIL 1992;13:414–21)

ISSN:0273-8481    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

In spite of the fact that injury warning labels have been placed on radiator caps for the last 15 years, automobile radiator scald burns continue to be a burn prevention problem. The temperature of radiator fluid may be as high as 100± F to 250± F in a properly functioning car and higher in an overheated vehicle. From 1974 to 1990, 100 patients with burns that were caused by automobile radiators have been admitted to the Parkland Memorial Hospital Burn Unit (1.5% of acute admissions). Eighty-two percent of the injuries occurred in the summer months, and 93% of the patients were male. Mean age was 31 ± 17 years (range, 8 months to 79 years), and mean burn size was 11.3% total body surface area (TBSA) (range, 1% to 32%) with a mean full-thickness burn size of 0.6% TBSA. Length of stay was 7 ± 7.4 days (range, 1 to 38 days). Burns to the face, neck, and trunk necessitated most admissions. Although there were no deaths, five patients required intensive care for airway monitoring; mean length of stay was 6 days. One patient required endotracheal intubation for a total of 11 days. Ten patients required one or more skin grafting procedures, and three patients required burn resuscitation. Four patients sustained minor ocular injuries. A subgroup of patients demands special review: 10 children younger than 10 years of age (mean age, 4.1 years) of which 70% were boys. Mean burn size was 15.5% TBSA; mean full-thickness burn size was 2.4% (four times larger than the mean burn size for the adult population). Also, mean length of stay was 11.1 days (1.7 times longer than that for adults). The majority of adults were burned as the result of self-initiated action; all of the young children were innocent bystanders. Certainly all of the burns in children and nearly all of the burns in adults could have been prevented. Heightened public awareness alone would markedly decrease the number of radiator burns in children. In regard to adult injuries, the solution is more problematic. Although radiator caps are clearly marked with warnings regarding their removal, these are frequently unheeded. One alternative is installation of closed radiator systems in automobiles. The noticeable lack of on-the-job injuries among radiator mechanics is striking; further investigation into this area will hopefully provide assistance in preventing radiator scald burns that are not job-related. (J BURN CARE REHABIL 1992;13:422–5)

ISSN:0273-8481    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Between February 20, 1987 and July 13, 1990, 844 patients were admitted to the Grady Memorial Hospital Burn Unit. Mean age was 25.5 years, mean burn size 16.5% total body surface area, mean survivor hospital length of stay 15.9 days, and an overall survival 90.5%. Seventy-three percent were male. One half of the burns were less than 10% total body surface area. Almost half (48.5%) of the patients had flame burns, which accounted for 88.8% of the 80 deaths. The peak burn incidence occurred in infants and children as a result of scalds. If those with toxic epidermal necrolysis (n= 5), those without skin injury (n= 13), and those who were allowed to die (n= 16) are excluded, survival was 92.2%. Survival in 62 patients with inhalation injury (55.23%) was significantly less than that in 474 patients without inhalation injury (98.10%) (p< 0.0001). The three variables—age, burn size, and inhalation injury—each influenced survival significantly but appeared to be dependent on each other; all three tended to increase or decrease together. Logistic regression equations to predict survival were developed. (J BURN CARE REHABIL 1992;13:426–36)

ISSN:0273-8481    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

A case is presented with emphasis on creatinine clearance and burn wound closure. It suggests that the burn wound acts as an extrarenal site for creatinine loss. As a result, renal creatinine clearance may be falsely elevated while the burn wound is open, and closure of the burn wound may affect creatinine clearance. (J BURN CARE REHABIL 1992;13:437–42)

ISSN:0273-8481    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

A 72-year-old woman sustained a 30% full-thickness total body surface area burn as a result of a malfunction in a heating blanket during coronary artery bypass surgery. Early burn wound excision and wound closure with skin grafts were performed. The patient experienced wide swings in systolic blood pressure. She was treated with antibiotics and received maximal mechanical support. However, cardiac collapse occurred, and the patient died on the tenth day after burn injury. Previous case reports have discussed only minor burns that resulted from heating blanket use. The magnitude of this injury and the death that resulted from it highlight the importance of preoperative and intraoperative equipment checks and careful intraoperative core temperature monitoring. (J BURN CARE REHABIL 1992;13:443–5)

ISSN:0273-8481    

出版商:OVID    

年代:1992

数据来源: OVID