摘要:

The purpose of the present studies was to investigate the effect of glucocorticoids on catabolism and lymphocyte numbers in a rat model of thermal injury or thermal injury plus burn wound infection. Thermal injury alone caused only an acute increase in plasma corticosterone concentrations. Furthermore, body weight declined moderately (5%), and lymphocyte numbers in lymph nodes draining the burn wound and blood increased markedly, whereas splenic lymphocyte numbers declined by about 60%. By contrast uninjured rats subjected to chronic elevation of corticosterone by corticosterone pellet implantation showed large decreases in body weight and lymphocyte numbers in all tissues examined. The combination of injury and chronic corticosterone elevation resulted in body weight and lymphocyte changes intermediate between injury alone and corticosterone treatment alone. Chronic elevation of corticosterone for 4 days before burn wound infection significantly decreased survival time and survival. Burn wound infection immediately after injury caused chronic elevation of endogenous plasma corticosterone and body weight and numeric lymphocyte changes that were remarkably similar to those of uninjured rats treated with corticosterone. Finally, the glucocorticoid receptor antagonist RU 486 significantly increased survival time in thermally injured, burn wound—infected rats. These results lend support to a hypothesis that chronic elevation of plasma cortisol concentrations as observed in patients with burns may be deleterious.

ISSN:0273-8481    

出版商:OVID    

年代:1995

数据来源: OVID

ISSN:0273-8481    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

A significant decline in plasma concentrations of copper and iron were observed in sheep exposed to preferential smoke inhalation of the left lung. The decline was evident 30 minutes after smoke inhalation, and die levels of both trace metals persisted at quite low levels for up to the 18-hour time interval after injury. From that time a gradual recover for copper but not for iron levels was observed so that by 24 hours die levels of copper were in die same range of those at baseline. Copper and iron levels showed an inverse correlation to airway peak and plateau pressures and left lung vascular resistance index and a direct correlation to left lung blood flow. Administration of BM 13.177 (Solutroban), a thromboxane antagonist, before exposure to smoke inhalation protected the sheep from die decline of copper and iron levels in plasma. In these animals airway peak and plateau pressure, left lung vascular resistance, and blood flow were also unmodified. Lipid peroxidation of the lung tissue by oxygen free radicals were lower than in those animals that did not receive BM 13.177. There was likewise a tendency of a decreased wet-to-dry weight ratios in die animals treated with BM 13.177. BM 13.177 treatment in an inhalation injury model might partly protect lung damage and parallels unchanged plasma copper and iron levels. The plasma copper and iron may therefore be an indicator of acute lung damage.

ISSN:0273-8481    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Endothelin is a peptide with 21 amino acids that is produced by ischcmic or injured endothelial cells. As indicated by in vitro and animal studies, endothelin is also a potent constrictor for renal mesangial and coronary vessels, a bronchoconstrictor, and an endocrine regulator. Our laboratory has shown that endothelin is an agonist for monocyte production of interleukins-1, -6, and -8, prostaglandin E2, and substances that trigger superoxide production. Systemic endothelin levels increase in patients with hypoperfusion and sepsis, indicating that endothelin may be yet another important cytokine in critical illness. Though endothelin has been shown to be a potent vasoconstrictor in healthy dogs, systemic vascular resistance does not increase in critically ill patients with high endothelin levels. (We hypothesize that this might be due to prostaglandin E220%). Ten hemodynamically stable patients resuscitated by a modified Parkland formula to a urine output greater than 30 ml/hr had endothelin levels drawn on admission and at 1, 6, 12, 24, and 48 hours after admission. Endothelin levels were measured by radioimmunoassay. Mean endothelin levels were elevated at 205 ± 28 fmol/ml at all time points in contrast to levels of 39 ± 9 fmol/ml in the healthy control group. In summary, systemic endothelin levels increase significantly in patients with major burns. Endothelin may be yet another cytokine playing a significant role in the immune, inflammatory, and multiorgan dysfunction observed with major burns.

ISSN:0273-8481    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Dermagrafts (Advanced Tissue Science, La Jolla, Calif.) is a possible dermal substitute currently in early stages of clinical trials. It consists of polyglycolic acid mesh impregnated with viable, human, neonatal fibroblasts. The randomized prospective study with the mouse model was undertaken to determine the effect of Dermagraft on skin graft viability in the presence of wound contamination with controlled concentrations of commonly encountered burn wound pathogens. Appropriate controlled series were run concurrently. Placement of Dermagraft, or polyglycolic acid mesh, had no significant effect on skin graft viability when compared with simple skin grafts. Controlled bacterial contamination of skin grafts with Dermagraft did not significantly change the occurrence of graft viability when compared with control groups of skin grafts with controlled bacterial contamination. These studies suggest that Dermagraft does not increase the occurrence of graft loss in the face of wound bed contamination.

ISSN:0273-8481    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

This study was undertaken to evaluate 25:1, 50:1, and 100:1 expansions of micronized skin grafts in a porcine model. Two full-thickness skin excisions (graft and control) were performed on each of 30 immature pigs (20 pounds). The pigs were divided into three groups of 10 animals each: group A, 25 cm2; group B, 50 cm2; and group C, 100 cm2. One square centimeter of the excised skin was thinned to produce a thick split-thickness skin graft. Four 90-degree passes were made through a skin mesher with the smooth side of the plastic mesh carrier to produce uniform pieces of skin. These pieces were applied to one area on each pig. Both the graft and control sites were covered with film. The film was removed on postoperative day 7, and excision sites were photographed on postoperative days 7, 10, 14, and 21. Healing was evaluated with a 12 x 12 inch digitizing pad to estimate the percent area healed. Healing was compared via analysis of variance, with percent area healed used as the dependent variable and treatment (control or graft) and postoperative day and expansion size used as the independent variables. No difference was found on postoperative day 7. On postoperative day 10, 25:1 grafts healed better than the 50:1 grafts, which were healed more than the 100:1 grafts. No difference was seen between 25:1 and 50:1 grafts on postoperative day 14; however, they were healed better than the 100:1 expansion grafts. No difference was seen between the graft sites on postoperative day 21. Except for the 100:1 graft on postoperative day 10, the graft sites were significantly better healed than the control sites for all expansion sizes on postoperative days 10, 14, and 21. The optimum graft size appears to be between 25:1 and 50:1. This study suggests the possible use of these grafts in the clinical setting. These grafts provide an immediately available autograft with a large expansion ratio.

ISSN:0273-8481    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Fourth-degree hand burns are rare but devastating injuries. They cannot be grafted readily but often require flaps and amputation, and impairment is significant. We report our 10-year experience (1981 to 1990) with deep hand burns to characterize our treatment and outcome. A total of 25 patients (35 hands) were treated. Eight local flaps, nine distant flaps, and two free-tissue transfers were performed. Eleven hands were treated with K-wire immobilization and grafting. Thirty-three amputations were done. Postburn function was evaluated in 25 salvaged hands. Eleven hands had good outcomes, whereas seven had moderate sequelae and seven were severely affected. Patients who were treated with flap coverage of exposed tendons and joints had better functonal outcomes than those treated with delayed closure with immobilization and grafting. The excellent outcomes in the flap coverage group justifies the added commitment of technical and therapeutic resources that this treatment requires.

ISSN:0273-8481    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

One hundred eighty-six patients with electrical burns were treated within an 11-year period at The Hacettepe University Burn Unit. Both children and adults were treated in this burn unit. The main causes of injury were misuse of electrical appliances, inattentiveness, lack of education in safety precautions, and lack of parental supervision. Treatment consisted of first, normal resuscitation in which Ringer's lactate solution was administered (according to the Parkland formula). Fluid resuscitation was followed by debridement, fasciotomy, and escharatomy. Two major complications were encountered: musculoskeletal involvement in 44% of patients, which required major amputation in 79%, and acute renal failure in 14.51% of patients. In spite of treatment with peritoneal dialysis or hemodialysis, the mortality rate for patients with renal failure was quite high (59%). To decrease the number of complications, closer monitoring of patients and early surgical decompression were applied. The results of this survey demonstrate the need for burn prevention programs in Turkey. Physicians and health care officials have an obligation to educate the public about the prevention of electrical burns. The results of this study and other studies on electrical burns should be communicated to the public through every available means.

ISSN:0273-8481    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

White phosphorus is used in many types of military munitions, in fireworks, and in industrial and agricultural products. It ignites spontaneously and causes deep thermal injuries. It may also cause multiorgan failure because of its toxic effects on erythrocytes, liver, kidneys, and heart. Our previous studies demonstrated deleterious effects of copper sulfate. Only copious water irrigation was effective. This study examined other modalities of treatment and a free oxygen radical scavenger. One of the treatments seemed to have some beneficial effects, but simple water irrigation was much more effective. Superoxide dismutase, a free radical scavenger, reduced hepatic damage and adjacent skin flap destruction but did not prevent death of the animal receiving the high dose of white phosphorus used in the present setup.

ISSN:0273-8481    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

One hundred twenty-three patients who were admitted to the University of Florida burn intensive care unit during a 1-year period were included in this retrospective study. The average age of the patients was 28 years (range 3 months to 90 years), and the average size of die total body surface area burned was 18%, with 7% full-thickness burns. The average hospital stay of each patient was 17.46 days. One hundred twelve operations were carried out in the burn unit's operating room with a circulating nurse from the registered nursing staff of the burn intensive care unit. No major complications occurred during the procedures. There were 1689 hydrotherapies and 2496 splint days. No significant loss of function of the patients' extremities developed while the patients were in the burn intensive care unit after the 112 debridement and skin grafting procedures were done. During the year, 365 follow-up examinations were done on previously discharged patients in the outpatient clinic area of the burn intensive care unit, which gave the doctors, registered nurses, and therapists an opportunity to determine their patients' progress. During the past year 537 separate pieces of compression garments were fitted.

ISSN:0273-8481    

出版商:OVID    

年代:1995

数据来源: OVID