摘要:

The acute-phase response that follows injury and sepsis is characterized by increased hepatic synthesis of specific secreted proteins while production of albumin is decreased. The effect of burn injury on specific synthesis rates of secreted hepatic proteins has not been reported. In this study, Sprague-Dawley rats received either a 30% flame burn (n= 12) or a sham burn (n= 12) and were allowed to recover for 11 days. Burned animals showed slower weight gains and a 25% to 30% higher resting energy expenditures compared with controls. On postburn day 11, synthesis of secreted hepatic proteins was measured by incorporation of leucine during a 2-hour isolated liver perfusion. Synthesis of total secreted proteins, the seromucoid fraction, and complement component C3 was significantly increased in burned animals, whereas synthesis of albumin was unaltered. In spite of unchanged albumin synthesis, plasma albumin concentrations were 50% lower in burned animals than in control animals throughout the postburn period. These findings suggest that decreased albumin synthesis is not the only mechanism responsible for persistent hypoalbuminemia that follows burn injury.

ISSN:0273-8481    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Viable bacteria in the gut of thermally injured patients may be translocated through the gut mucosa, causing widespread infection. Increased flora from optimization of bacterial growth by pH elevation, coupled with the decreased intestinal motility common among patients whose mucosal integrity has been compromised, may increase the incidence of translocation. Gastric pH in these patients is monitored and maintained around pH 6 by various agents to reduce susceptibility to stress ulceration. Whole milk, given as a nutrient source, also raises pH. An in vitro trial simulating gastric fluid under conditions found in patients with burns was conducted to evaluate the growth of commonly ingested bacteria. Bicarbonate buffer containing pepsin and adjusted to pH 2, 4, or 7 with HCl was dosed with magnesium and aluminum hydroxide antacid (Maalox) (10 ml), sucralfate (Carafate) (0.4 gm), or prostaglandin E2(PGE2) (10 ng) before inoculation withEscherichia coli(3 x 102organisms),Pseudomonas aeruginosa(3 x 102organisms), orStaphylococcus aureus(2 x 101organisms). Bacterial growth and pH were determined periodically over the 24-hour trial. Milk was added at intervals in half the samples to simulate patient feeding. Maalox increased pH in all samples containing milk (initially pH 2, 4, or 7) to over 7.0 in 2 hours, and increased pH more slowly without milk. Carafate had a moderating effect, increasing pH 2 and pH 4 and decreasing pH 7, with a narrower pH range found in the milk groups. PGE2treatments combined with milk also increased pH 2 and pH 4, but slightly elevated pH 7 within 24 hours. Without milk, PGE2did not alter pH from initial values. Bacterial growth did not occur during the first 4 hours. At 24 hours, Maalox and Carafate groups without milk still showed no response, whereas bacteria in PGE2-treated groups had multiplied except in pH 2. Overall, groups with milk were capable of supporting growth, likely a result of both higher pH values and presence of substrate. BothS. aureusandP. aerugiosctresponses were limited by Maalox and milk alone and enhanced by Carafate and PGE2.E. coli, however, grew in all treatments. This observation confirms that seen in cases of translocation, where most bacteria found systemically outside the gut areE. coli.

ISSN:0273-8481    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Wound bacterial colonization in 118 patients treated with chlorhexidine digluconate 0.2% in silver sulfadiazine 1% applied daily to the burn wounds was compared to that of 135 comparable patients similarly treated with silver sulfadiazine 1%. With chlorhexidine digluconate 0.2% in silver sulfadiazine 1%, colonization byStaphylococcus aureuswas less frequent (38%) than with silver sulfadiazine (54%, p = 0.016). No statistical difference was found for colonization byEnterococcus faecalis, Pseudomonas aeruginasa, orEnterobacter cloacae. Washing of the wounds of 65 patients with chlorhexidine gluconate 4% during daily dressing changes was associated with reduced wound colonization byS. aureus(35% versus 51%,p= 0.03) andP. aeruginosa(8% versus 16%,p= 0.08) when compared to the 188 washed with nonantibacterial soap. Chlorhexidine, whether added to the topical agent silver sulfadiazine (chlorhexidine digluconate 0.2%) or in the bath soap (chlorhexidine gluconate 4%), decreased colonization byS. aureus.

ISSN:0273-8481    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Thermal injury increases the rate of translocation ofCandida albicansin guinea pigs, but early enteral feeding can significantly decrease this rate. We studied the combined effects ofC. albicanstranslocation and early feeding on outcome of thermal injury in guinea pigs. Eighty guinea pigs were subjected to a flame burn covering 50% total body surface area. One hour before burn injury, half of the animals underwent gavage with 3 x 1010viableC. albicans, a dosage that in previous studies was associated with greater than 90% incidence of yeast translocation to the mesenteric lymph nodes. The other half underwent gavage with an equal volume of saline. After injury, half of each group were randomly selected to receive guinea pig feed ad libitum and the other half were starved for 72 hours. All were allowed access to water ad libitum. Mortality rate was recorded at 3 days. The group that underwent gavage withC. albicansand subsequent starvation after burn injury had a significantly higher mortality rate than had any of the other groups. We conclude that induced translocation ofC. albicansin guinea pigs increases mortality after burn injury. Moreover, early enteral feeding has a protective effect, presumably by decreasing translocation rates as has been shown in previous studies.

ISSN:0273-8481    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

The role of soluble inflammatory mediators in the wound healing process is under investigation. Interleukin 2 (IL2), an immune modulator produced by T lymphocytes, was tested in vitro for its effects on human diploid fibroblasts. Human diploid fibroblasts (1.0 x 104) were incubated for 24 hours in Alpha minimal essential media (Gibco Laboratories, Gaithersburg, Md.) at 37°C in 5% CO2in air with 500 U/ml of IL2 (Cetus Corp., Emeryville, Calif.). Cells were then pulsed with 3 μCi/ml of tritiated thymidine overnight. The meanincreasein the incorporation of tritiated thymidine of the cells treated with IL2 over control cells was 38% (pvalue < 0.05). Interleukin 2 has a significant effect on the metabolism of human dermal fibroblasts and may accelerate the wound healing process.

ISSN:0273-8481    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Wound management of the burned elbow is not always possible with a skin graft alone. Rather than resort to distant pedicle flaps or the complexity of microsurgical tissue transfers, local fasciocutaneous flaps may provide a better source for vascularized tissue. “Random” fasciocutaneous flaps do not require isolation of any discrete vessel, but must be designed to parallel the longitudinal axis of perifascial circulation in the upper extremity. Therefore no vessel in the major extremity need ever be violated, and muscle function is always preserved. Excision-to-fascia techniques for burn escharcctomy should probably be minimized in the elbow region, because if the fascia remains intact, the overlying skin-grafted subcutaneous fat will survive flap transposition as a fasciocutaneous flap. Local flaps allow for earlier rehabilitation, and the donor defect is restricted to the already deformed ipsilateral extremity.

ISSN:0273-8481    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Patients with burns of the lower extremity that require skin grafting were randomized into three groups to determine when postgraft ambulation could be safely resumed. Dangling protocol was initiated on postoperative day 6, 8, or 10, and ambulation was started on the next day. Grafts were evaluated at six stages on a five-point scale. In the 22 patients who completed the study, there was no significant difference in scores of the three groups. There was a significant difference in length of hospital stay when patients who dangled on postoperative day 6 were compared with patients who dangled on postoperative day 10.

ISSN:0273-8481    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Lipid peroxidation products (conjugated dienes) extracted from the plasma of scald-burned rats were injected intraperitoneally in mice before immunization of the mice with sheep erythrocytes. Five-day plaque-forming cell assays showed that mice receiving conjugated dienes isolated from the plasma of burned rats had enhanced specific immunoglobulin M antibody production compared to mice receiving dienes from normal rat plasma or sheep erythrocytes alone. These observations suggest that lipid peroxidation products in the plasma of burned animals may modulate the humoral immune response.

ISSN:0273-8481    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Previous studies have shown that vitamin E acetate given by gavage to mice before thermal injury can improve survival from subsequent infection. We tested the efficacy of aqueous vitamin E given parenterally after burn injury. Female BALB/c mice (n= 120) were given 15% total body surface area full-thickness flame burns. Three groups of mice were randomized to receive water-miscible vitamin E with the resuscitation fluid in doses of 0.5 mg per mouse, 0.167 mg per mouse, or 0.056 mg per mouse. These doses represented approximately nine, three, and one times the murine recommended daily allowance for vitamin E, respectively. Control mice were given saline only. The next day the mice were challenged with 2.5 x 105Pseudomonas aeruginosabeneath the eschar. Administration of vitamin E was continued on a daily basis for a total of three doses and ending the day after bacterial challenge. Mortality rates were observed for 1 week and were not statistically different among the four groups. We conclude that vitamin E supplementation started after thermal injury in mice does not improve outcome from subsequent challenge withPseudomonas aeruginosa.

ISSN:0273-8481    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Dietary lipids can influence the immune response, chiefly through modulation of eicosanoid synthesis. Previous studies showed that diets high in linoleic or oleic acid significantly improved survival rates, compared with diets high in either saturated fats or ω-3 fatty acids, when fed to mice for 2 to 3 weeks before burn injury. These experiments suggest that neutrophil function in rats is not altered by diets high in either fish or safflower oil before burn injury. Serum opsonization is marginally improved by safflower oil diets for 2 weeks before burn injury but not for 6 weeks before burn injury.

ISSN:0273-8481    

出版商:OVID    

年代:1991

数据来源: OVID