摘要:

&NA;The growth of human keratinocytes on human acellular dermis in 4 different culture systems was compared. Epidermis was completely separated and removed from dermis after skin samples had been soaked in 0.1% trypsin at 4°C for 1 week. Forty pieces of salinewashed dermis, 1 cm2each, were randomized into 4 groups: in group A, human keratinocytes that had undergone 2 to 3 cell passages were seeded (30 × 104cell/cm2) onto the dermis and sprayed with a thin layer of fibrin glue and proliferative 3T3 feeder cells that had been growing separately on the culture dish; in group B, the dermis was only sprayed with fibrin glue; in group C, the dermis was treated with 3T3 cells only; and in group D, the dermis was not sprayed with anything. The dermis samples in all groups were raised on a grid to provide an air‐liquid culture system. Histology results of the composite grafts at 2 weeks were assessed as having either scanty colonies of keratinocytes (SCK), continuous stratified epithelium (CSE), or no observable keratinocyte growth. Eight out of the ten dermis samples (80%) in group A demonstrated CSE, and 30% of the samples in group B showed SCK. There were 10% SCK and 20% CSE in group C, and in group D, 30% SCK and 10% CSE were found. The good results in group A indicated that the fibrin glue facilitated the seeding efficiency of the keratinocytes on the dermis and that the vital factors released from the 3T3 feeder cells enhanced the growth and differentiation of the keratinocytes. This model provides an optimal system for the cultivation of keratinocytes on acellular dermis. (J Burn Care Rehabil 2000;21:1‐4)

ISSN:0273-8481    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

&NA;Meshed split‐thickness skin grafts, especially when required to be widely spread, do not obtain immediate biologic wound closure. In cases of patients with burns that cover a large percentage of the body surface area, this leaves the patient at risk for metabolic problems and life‐threatening infection. Several cytokines and growth factors could theoretically affect the rate of epithelialization and, therefore, the rate of meshed graft interstitial closure. With the use of human meshed skin grafts explanted onto athymic “nude” rats, the epithelialization kinetics of interleukin‐4 (IL‐4), macrophage colony‐stimulating factor (MCSF), keratinocyte growth factor‐1 (KGF‐1), keratinocyte growth factor‐2 (KGF‐2), basic fibroblast growth factor (bFGF), and transforming growth factor beta‐2 (TGFB2) were investigated; the results were compared with the rates of epithelialization of grafts treated with a vehicle control. On postoperative day 3, wounds treated with IL‐4, KGF‐2, bFGF, and TGFB2showed a significantly increased rate of interstitial closure (P< .05). On postoperative days 5 and 7, wounds treated with KGF‐2, bFGF, and TGFB2all exhibited a significantly higher rate of interstitial closure than the grafts in the control group (P< .05). These data suggest that epithelialization kinetics can be accelerated with the use of several topical growth factors, and they provide support for a future clinical trial. (J Burn Care Rehabil 2000;21:5‐9)

ISSN:0273-8481    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

&NA;The cellular mechanisms by which topical cyclosporine A (tCsA) induces site‐specific immunosuppression were investigated. Experiments were designed to elucidate how cyclosporine A (CsA) suppresses activated immunocytes in animals that are undergoing local alloactivation and concomitant tCsA immune suppression. Lewis rats received dual Lewis × Brown Norway rat skin allografts; the rats were treated with systemic CsA (sCsA) at 8 mg/kg/day for 10 days after grafting and then tCsA and vehicle thereafter. CsA added to mixed lymphocyte reactions 24 hours after culture initiation modeled the local effects of CsA on alloactivated immunocytes, and tCsA in conjunction with limited sCsA prolonged local skin allograft survival. CsA inhibited both antigen‐specific and nonspecific activated alloresponses of immunocytes from animals that had received allografts and that underwent limited sCsA treatment only in a dose‐dependent manner. When tCsA had been applied, immunocyte responses to a nonspecific antigen were extremely CsA‐resistant as compared with those induced by antigen‐specific suppression. However, this nonspecific alloresponse was fully suppressible with the use of elevated CsA doses (66 &mgr;g/mL); thus alloresponding immunocytes were significantly more sensitive to CsA if they were challenged with the donor antigen and preexposed to limited sCsA followed by tCsA in vivo. (J Burn Care Rehabil 2000;21:10‐9)

ISSN:0273-8481    

出版商:OVID    

年代:2000

数据来源: OVID

ISSN:0273-8481    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

&NA;We present a model used to describe the effects of systemic thermal injury in cerebral permeability with the use of an open, acute pial window technique. Sprague‐Dawley rats were anesthetized, and an open pial window was constructed. The area was then bathed with artificial cerebrospinal fluid with a pH adjusted to 7.4 that was heated to a constant temperature of 37°C, which was allowed to circulate into a reservoir at a rate of 2 cc/min. The fluid was infused with a gas mixture of 5% carbon dioxide and 95% nitrogen. A warming blanket was placed under the animal's ventral surface, and the animal's temperature was maintained at 37°C and monitored with a rectal thermal probe. Experimental animals were submerged to the xiphoid process in 100°C water bath for a total of 6 seconds, which produced a 70% total body surface area third degree burn. Control animals were submerged in 37°C water for 6 seconds. The animals were then injected with a constant infusion of bovine albumin coupled with fluorescein isothiocyanate. Recordings were taken every 15 minutes for 6 hours. The vascular albumin leakage was determined from the ratio of interstitium to vascular fluorescence and expressed as a percentage. The percent albumin leakage in the control group was found to be significantly different from that in the experimental group at all periods measured. The mean increase in permeability ranged from 20% at 15 minutes to 104% at 6 hours. These changes were found to be statistically significant with the use of unpairedttest at aPvalue of .0001. The model presented is the first to demonstrate changes in cerebral permeability after acute severe systemic thermal injury. (J Burn Care Rehabil 2000;21:20‐5)

ISSN:0273-8481    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

&NA;Many patients with minor burn wounds will initially be evaluated in an emergency department (ED) and incur unnecessary costs that could be avoided through a direct referral to a burn center. In June 1997, use of an ED burn triage protocol was begun at our hospital. Adults with uncomplicated burns that covered more than 1% and less than 15% of total body surface area (TBSA) and children with burns that covered more than 1% and less than 10% of TBSA were to be triaged directly to the outpatient clinic of the burn center without registering in the ED. From 1996 to 1997, 653 patients were seen in the ED for burn injuries. Approximately 500 patients fit the present criteria for direct triage to the burn center. Since the triage protocol began, the percentage of patients triaged to the burn center has increased from 27% in the first month of use (July 1997) to 73% in December 1997. At least 33% of ED patients were eligible by protocol but not triaged. The average ED visit time for these patients was 103 minutes versus 44 minutes for patients who were sent directly to the burn clinic. An estimated $125,000 per year decrease in charges would occur with use of the protocol. Implementation of an ED triage protocol leads to avoidance of emergency room visits for the majority of patients with minor burn injuries, which results in more efficient, less expensive, faster care. (J Burn Care Rehabil 2000;21:26‐8)

ISSN:0273-8481    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

&NA;To develop a standardized, practical, self‐administered questionnaire to monitor pediatric patients with burns and to evaluate the effectiveness of comprehensive pediatric burn management treatments, a group of experts generated a set of items to measure relevant burn outcomes. Children between the ages of 5 and 18 years were assessed in a cross‐sectional study. Both parent and adolescent responses were obtained from children 11 to 18 years old. The internal reliability of final scales ranged from 0.82 to 0.93 among parents and from 0.75 to 0.92 among adolescents. Mean differences between parent and adolescent were small; the greatest difference occurred in the appearance subscale. Parental scales showed evidence of validity and potential for sensitivity to change. In an effort to support the construct validity of the new scales, they were compared with the Child Health Questionnaire and related to each other in clinically sensible ways. These burn outcomes scales reliably and validly assess function in patients with burns, and the scales have been developed in such a way that they are likely to be sensitive to change over time. (J Burn Care Rehabil 2000;21:29‐39)

ISSN:0273-8481    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

&NA;Anhydrous ammonia, a caustic compound commonly used in industry, can cause severe burns, even with brief contact. As with other alkali burns, early irrigation to remove the ammonia from burned areas is crucial to limit tissue damage. Two cases of identical exposure to industrial strength ammonia are presented. Each patient was exposed to ammonia liquid and vapors simultaneously when a tank containing this compound exploded. One patient showered at the scene immediately after exposure, whereas the other deferred irrigation until he arrived at the hospital. The first patient suffered minor burns with a 2‐day, uncomplicated hospital stay. The second patient suffered 14% total body surface area burns and a significant inhalation injury. He required intubation, mechanical ventilation, and skin grafting during his 13‐day hospitalization. Although much is written about the management of chemical burns, few articles address ammonia burns. Aggressive initial management significantly reduces morbidity of ammonia burns. (J Burn Care Rehabil 2000;21:40‐2)

ISSN:0273-8481    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

&NA;Advances in medical management have dramatically decreased the mortality of children with massive burn injuries, which raises many questions about the expected quality of life for these young survivors. In this article, we address this issue by examining the functional and psychological adaptation of 41 young survivors with 88% mean total body surface area (TBSA) burns and 85% mean third degree TBSA burns. Patient scores were compared with normative data on standardized psychological measures of adjustment and on performance of age appropriate activities of daily living (ADL) skills. Thirty‐three of the 41 patients (80%) were independent in basic ADL skills. Eighty‐six percent of the patients who were aged 10 years and older were independent in advanced ADL skills. Patients with amputated fingers were significantly more dependent in ADL skills than those without amputations (P< .05). Mean psychosocial adjustment scores were within normal limits and were not significantly related to functional independence in ADL skills. (J Burn Care Rehabil 2000;21:43‐9)

ISSN:0273-8481    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

&NA;Hypopigmentation may be a significant problem after burn injury. It is often difficult to predicably repair with conventional surgical techniques. It has been our experience that epidermal cells cultured from patients with dark skin produce pigment within the epidermal cell sheets, which indicates the presence of melanocytes. The presence of melanocytes and melanin in these cell sheets was demonstrated with the use of histochemical techniques. The results indicate that repigmentation with cultured epithelial autograft is possible. We describe a novel technique of dermabrasion and a co‐culture of epidermal cells and melanocytes. (J Burn Care Rehabil 2000;21:50‐4)

ISSN:0273-8481    

出版商:OVID    

年代:2000

数据来源: OVID