ISSN:0273-8481    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Heparin-binding EGF-like growth factor has been identified in human burn-wound fluid and in the epithelial cells of excised human partial-thickness burns. In the present study, the effect of heparin-binding EGF-like growth factor on burn-wound healing was evaluated by incorporating purified, recombinant heparin-binding EGF-like growth factor into slow-release cholesterol-lecithin pellets that were applied topically to partial-thickness burns in mice. Both experimental (heparin-binding EGF-like growth factor-treated) and control (untreated) mice were sacrificed on days 3, 5, and 10 after burn. Total burn-wound area, histology, keratinocyte proliferation, and in situ hybridization analysis for transforming growth factor-α were determined for each wound. The mean wound area of the experimental group on day 5 after burn was 1.07 cm2, compared with 2.20 cm2for controls (p= 0.04). Cellular proliferation (as measured by immunohistochemical detection of 5-Bromo-2-deoxyuridine) on day 5 after burn in marginal keratinocytes and follicular epithelial cells was greater in the experimental group than in the control group. In situ hybridization showed up-regulation of transforming growth factor-α mRNA levels in experimental animals by day 5 after burn. Topical application of heparin-binding EGF-like growth factor significantly accelerates the reepithelialization of murine partial-thickness burns, increases keratinocyte proliferative activity, and enhances production of endogenous transforming growth factor-α mRNA. (J Burn Care Rehabil 1998;19:95–101)

ISSN:0273-8481    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

C-Reactive protein serum levels were measured in 57 pediatric patients with 3% to 92% total body surface area burns to determine whether a defined rise in C-reactive protein serum levels could indicate sepsis earlier in burn patients. A rise in C-reactive protein serum levels was defined as an increase of at least 3 mg/dL for 2 days or 10 mg for 1 day. Increases the first 2 days after the burn or the day after surgery were excluded, since these injuries increase C-reactive protein serum levels. Patients were defined as septic when they were on systemic antibiotics and exhibited at least two of 16 specific clinical parameters. C-Reactive protein serum levels correctly predicted sepsis 82% of the time (efficiency = 82%). Nonseptic patients generally did not show increased C-reactive protein serum levels (specificity = 69%). When sepsis did occur, it always was preceded by increased C-reactive protein (sensitivity = 100%), and the increased C-reactive protein occurred 2.3 ± 0.5 days before the patient was deemed septic clinically. Hence, a defined rise in C-reactive protein serum levels can predict sepsis sooner in burned children. (J Burn Care Rehabil 1998;19:102–5)

ISSN:0273-8481    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

In previous studies, we established that circulating epinephrine (E) is not essential for a normal hypermetabolic response to burn injury in the rat, within the zone of thermal neutrality. In other studies, burned rats with adrenal medullectomy (AdxB) studied at 22° C were unable to maintain rectal temperature (TR) after α-adrenergic blockage. These data suggest that norepinephrine (NE) is calorigenic in such animals without formal cold acclimation. These studies investigate the hypothesis that, contrary to the usual belief, norepinephrine might be calorigenic in rats without formal cold acclimation. Burned (B) and control (C) rats with adrenal medullectomies (Adx) and Sham (S) Adx (AdxB, SAdxB, AdxC, and SAdxC) were housed at either 22° C or 28° C. Calorimetry was performed during the eighth to eleventh days after the burn. For groups housed at 22° C and studied at 28° C, NE given intravenously (iv) produced an average 16.5% ± 3.3% increment in heat production (HP) for the four groups, which was significant for AdxB, SAdxB, and SAdxC. Intravenous administration of E produced an average increment in HPof 4.44% ± 4.1%, which was not significant. HPwas significantly higher after NE than E in three cases. Studies with animals housed at 28° C and studied at 28° C produced intermediate but similar results. For groups housed at 28° C and studied at 22° C, iv administration of E and NE produced average decreases in HPof 18% ± 6.7% for E and 10.75% ± 4.7% for NE. Except for the AdxC group, these differences were significant. These data suggest that chronic exposure to an ambient temperature of 22° C produces an enhanced calorigenic response to NE in burn and control rats. Based on the data presented here, combined with earlier studies, NE must be considered as a facilitator for hypermetabolic response to burn injury in the rat. It is interesting to speculate whether NE is calorigenic for patients with large burn wounds, which are managed without dressings at ambient temperatures below thermal neutrality. (J Burn Care Rehabil 1998;19:106–14)

ISSN:0273-8481    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Infants (younger than 12 months) with large (more than 30%) burns are reported to have poorer chances for survival than older children with similar injuries. However, recent experience with such infants has been positive, prompting a 5-year review of management techniques. The injuries were approached in an organized fashion that included precise fluid support, excision, and biologic closure of full-thickness wounds within 5 days, limited exposure to high inflating pressures (more than 40 cm H2O), weekly replacement of central venous catheters, and intensive nutritional support via the enteral route whenever possible. Twelve such infants were treated during the 5-year interval. Their average age was 7.8 months (range, 1 to 12 month[s]), average weight was 8.8 kg (range, 4.3 to 13 kg), and average burn size was 42% (range, 30% to 90%). Inhalation injury was present in two of the children, and one child aspirated hot liquid. Six (50%) of the infants required the support of a mechanical ventilator for an average of 11.6 days (range, 4 to 18 days). Eight children required an average of 5.7 operations (range, 1 to 18 operation[s]), seven required central venous catheters, and five required arterial cannulae. Major infectious complications were seen in four children. Complications included pneumonia (two), catheter sepsis (two), peritonitis from a perforated ulcer (one), and wound sepsis (two). Six children required parenteral nutritional support for an average of 15 days (range, 5 to 36 days), and six children required enteral tube feedings for an average of 23 days (range, 9 to 55 days). Anabolic agents were not used. Discharge weights averaged 8.6 kg (range, 4.9 to 10.5 kg). The average ratio of the children's discharge to admission weight was 101% (range, 73% to 120%). All children survived and were discharged home. We conclude that these difficult injuries can be approached successfully with a strategy that emphasizes precise fluid repletion; early excision and biologic closure of wounds; avoidance of ventilator-induced lung injury; and intensive nutritional support. (J Burn Care Rehabil 1998;19:115–8)

ISSN:0273-8481    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Victims of purpura fulminans are overcome by a rapidly progressive and sometimes fatal course involving large amounts of tissue loss and multiple organ system failure. From 1986 to 1995, seven children ranging in age from 10 months to 19 years (mean, 6.2 years) were referred to the Shriners Burns Institute in Cincinnati with purpura fulminans.Neisseria meningitidiswas identified as the precipitating pathogen in most of the patients. The mean TBSA full-thickness skin loss was 33%. Fourteen extremities were amputated in the seven patients, including three patients with amputations of all four extremities. Transfer to our institution occurred after a mean delay of 20 days, usually after the demarcation of viable tissue. In one patient, however, fasciotomies obviated multiple impending amputations. Monitoring for elevated compartment pressures, early fasciotomies, and expedient transfer to a burn center for a multidiciplinary approach to care should improve the outcome in patients with purpura fulminans. (J Burn Care Rehabil 1998;19:119–23)

ISSN:0273-8481    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Children with spina bifida, cerebral palsy, mental retardation, developmental delays, and seizure states are handicapped with sensorimotor deficits, including gait or coordination instability, temperature insensitivity, and mental simplicity. These handicaps make this distinct and unpretentious population more susceptible to lethal burns. A 30-year review was conducted in a pediatric burn center to examine the relationships between pediatric sensorimotor deficit and burn injury. Of the 4874 acute burn admissions, 66 children were identified with preexisting sensorimotor deficits. Data indicate that children with sensorimotor deficit are more prone to burn injury from both their physical impairment and poorly supervised environments. In addition to extended hospitalizations, these children bear significantly higher mortality risks. Had the special supervisions and protection required by such handicapped children been provided, 80% of the burn injuries could have been prevented. Results emphasize that the future of these special children with sensorimotor deficits relies on health care providers playing a greater role in educating parents and caregivers. (J Burn Care Rehabil 1998;19:124–7)

ISSN:0273-8481    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Hand injuries are common in the workplace. Modern industrial machines cause complex occupational hand injuries. Hot-press contact hand burns generally are encountered by workers in the dry-cleaning industry. Seventeen patients with hot-press hand burns were treated at the University of California-Irvine Medical Center Burn Center. Eight patients (47%) required skin grafting, seven (41%) were treated with hydrotherapy only, and two (12%) needed flaps. These results were not what we expected. (J Burn Care Rehabil 1998;19:128–30)

ISSN:0273-8481    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Extracorporeal membrane oxygenation (ECMO) as a treatment for pulmonary failure from postshock respiratory distress in burned children recently has been shown to salvage patients who were thought to have more than a 90% chance of dying. We describe five burned children in whom severe respiratory failure—not responsive to medical management and maximal ventilatory support—developed, and who underwent ECMO treatment. Three (60%) cases involved flame burns, with significant inhalation injury as diagnosed after a bronchoscopy; mean age was 3 years (2 to 4 years), with a mean total body surface area (TBSA) burn of 32% (15% to 53%), mean third-degree burns of 25% (5% to 53%). two (40%) cases involved scald burns; mean age was 6 years (7 months to 11 years), with a mean TBSA burn of 56.5% (43% to 70%), mean third-degree burns of 40% (10.5% to 70%). Outcome was poor for those burned children who received ECMO therapy after prolonged ventilatory support for smoke inhalation injury. Children who experience perfusion/reperfusion shock injury to the lungs as a result of delayed resuscitation of scald burns may have an improved chance of survival with short courses of ECMO regardless of the burn size. (J Burn Care Rehabil 1998;19:131–4)

ISSN:0273-8481    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

We report the first case of hemolytic uremic syndrome in a patient with burns. An unusual case of the syndrome developed in a 1-year-old black girl hospitalized after second-degree burns to 33% of her total body surface area. Acute abdominal distention, hemolytic anemia, hematuria, and oliguric renal failure developed 1 week after admission to the burn unit. Blood cultures grewEscherichia coli0157:H7. She received supportive care and antibiotics, in addition to low-dose dopamine, which promptly reversed the oliguria. Dialysis was not required, and the child made a complete recovery. (J Burn Care Rehabil 1998;19:135–7)

ISSN:0273-8481    

出版商:OVID    

年代:1998

数据来源: OVID