80 Burns (1987) 13, (1). 8C-82 Printedin Great Britain

Abstracts CLINICAL STUDIES

T-Cell activity and immunoglobulin production In patients with hurns covering over 2X per cent of the body surface area pokeweed-induced secretion of IgG and IgM was elevated in the first 2-3 weeks after burning and then depressed at -3-4 weeks. Immunoglo- bulin production was then apparently restored to base- line or higher levels in surviving patients, whereas in patients whose antibody response continued to be sup- pressed fatal septicaemia developed. Spontaneous im- munoglobulin synthesis increased significantly over the normal range in lo/78 tests carried out.

The changes in induced immunoglobulin production correlated well with the changes in T-cell alloreactivity as mcasurcd by the mixed lymphocyte reaction.

Teodorczyk-lnjeyan J. A., Sparkes B. G.. Falk R. E. et al. (19X6) Polyclonal immunoglobulin production in burned patients-kinetics and correlations with T cell activity. J. Truumu 26, (9). X34-X39.

Electrical injuries Electrical burns accounted for 3.5 per cent (I 13/3265) of total acute burn admissions over a IO year period. Voltages less than lo00 accounted for 73 per cent of the I I3 injuries. Such injuries commonly occurred in chil- dren and were probably preventable. High voltages (over lobt) volts) caused the remaining injuries. over half wcrc not work-rclatcd. they tcndcd to occur out- side the- home in young adult males and many were preventable. None of the patients developed renal failure and all survived. however, tissue damage was extensive In IO patients and required major limb amputations. Aggressive Huid resuscitation, continuous haemodynamic and metabolic support and early aggressive surgical intervention was also required.

Hanumadass M. L.. Voora S. B.. Kagan R. J. et al.

administration eliminated S/U/I/~. ~urcus septicaemia in 10 patients with burns covering an average of 35 per cent of the body surface area. However, sepsis with Pr. ueruginosu and methicillin-resistant S@r. aureus was not treated effectively by Timentin. For a more effec- tive therapy Timentin can be combined with an amino- glycosidc or a ccphalosporin.

Diem E. and Graninger W. (1986) Timentin in the treatment of invasive burn wound infection with sepsis. J. Aniimicroh. Chemother. 17, (Suppl C). 123-126.

Chemical burns In a survey of 51 patients with chemical burns mainly caused by alkali or sulphuric acid. 79 per cent occurred in the 21-50 year age group. Sixty-nine per cent of the injuries were work-related in men and I7 per cent in women. Of the 20 patients who received prompt adequ- ate treatment involving aqueous dilution or chemical neutralization, only I9 per cent required skin grafting and the mortality rate was 9.5 per cent. In contrast, when early treatment of 31 patients was inadequate, inappropriate or delayed, 36 per cent of the patients required skin grafting and the mortality rate was 21 per cent.

Sykes R. A.. Mani M. M. and Hiebert J. M. (1986) Chemical burns. Retrospective review. J. Burn Cure Rehubil. 7. (4). 343-347.

Exercises and heterotopic ossification Heterotopic ossification was found in I2 of Iofr6 pa- tients (1.2%) admitted over a IO year period. Abnor- mal bone formation around the elbow joint developed fairly rapidly after injury (mean time of onset I2 weeks). This ossitication progressed to complete ankylosis in patients who persisted with passive and active assisted range of motion exercises beyond the range of pain-free movements. In contrast, patients who only carried out active exercises within the pain- free range ultimately gained excellent ranges of mo- tion.

(1986) Acute electrical burns: a IO yearclinical experi- cnce. &rrrt.s 12. (6). 427-431.

Crawford C. M.. Varghese G.. Mani M. M. et al. ( 1986) Heterotopic ossification: are range of motion exercises contraindicated’! J. Burn Cure Rehuhil. 7, (4). 32.3-327.

Treatment of sepsis with Timentin The addition of potassium clavulanatc to ticarcillin (as Renal elimination of vancomycin in Timentin) makes it possible to treat burn wound The clearance of vancomycin from serum and its sepsis with ticarcillin-resistant strains of various Gram- appearance in urine was determined in IO patients with positive and Gram-ncgativc organisms. Timcntin burns covering between 37 and hS per cent of the body

Abstracts 81

surface. A highly significant correlation was found be- in the smoke. In contrast, 14Oml/h/m~ body surface tween the clearance of vancomycin and creatinine and area of fluid resuscitation resulted in lower lung lymph with a slope that was very similar to that found in Rows and lymph to plasma protein concentration ratios patients not suffering from burns. Since patients with and a nearer normal cardiac output. These results are burns clear vancomycin in a manner similar to that of not signiticantly different from those found in sheep other patients at all levels of renal function, the rate of that had not suffered smoke inhalation. renal elimination of the antibacterial agent can be used Herndon D. N.. Traber D. L. and Traber L. D. to select a rate of administration which will give optimal (IYX6) The effect of resuscitation on inhalation injury. therapeutic levels in serum. .%rger_v 100. (2). 24t+25 I.

Brater D. C., Bawdon R. E., Anderson S. A. et al. (1986) Vancomycin elimination in patients with burn injury. C/in. fharmacol. Ther. 39, (6). 631-634. Vasopressin and peripheral resistance

Adequacy and cost of fluid resuscitation In dogs with deep Rame burns covering IS per cent of the body surface there were prompt increases in plasma

Patients with burns covering more than 2Y per cent of vasopressin levels and peripheral resistance soon after the body surface area and aged between S months and injury. thcsc remained elevated for a further 6 h. Admin- 21 years were randomly resuscitated with either hyper- &ration of a vasopressin-blocking agent before hurn- tonic lactated saline (HLS) or Ringer’s lactate colloid ing significantly reduced the increase in peripheral re- (RLC). The 24 and 4Xh Ruid inputs with RLC were sistance and limited the fall in cardiac output seen in silrniticantlv treater than with HLS. The urine outouts non-blocked animals. The mean arterial blood press-

ures did not differ however. bgtween theywo groups did not differ and the hae’ma- tocrits were equally maintained. Although RLC treat- ment resulted in greater gains in body weight, the sodium inputs and balances were not significantly diffe- rent. Colloid oncotic pressures, serum albumin and albumin/globulin ratios were similar for the first 4X h.

The essentially similar effectivenessof the two types of fluid therapy led the authors to recommend the use of HLS. since its cost is only about one-eighth of the regimen which included colloid.

Bowser-Wallace B. H. and Caldwell F. T. (19X6) A prospective analysis of hypertonic lactated saline V. Ringer’s lactate-colloid for the resuscitation of severely burned children. Burns 12. (6). 402-409.

Neutrophil subpopulation changes Measurements of the following neutrophil activities, random migration, chemotaxis, phagocytosis and the rate of killing of Sluph. uureus were carried out to determine if the known neutrophil dysfunctions in pa- tients with extensive burns (mean area 40 per cent) could be attributed to a depletion of Fc-positive cells. Although a significant fall in the percentage of Fc+ cells was found in these patients. there were no correla- tions between the numhers of rosette-forming cells and random migration, chemotaxis or bactericidal activity. Thus the acquired defect in ncutrophil functions could not be explained by changes in the Fc+ to Fc- cell

Hilton J. G., McPherson M. B. and Marullo D. S. (1986) The relationship between post-hurn increases in peripheral resistance and vasopressin. Burns 12. (6). 410-4414.

LABORATORY STUDIES

lmmunodepressive compound Many aspects of burn-induced depressed immuno- competence appear to be due to a low molecular weight glycopeptide-lipid complex. Further analysis of this compound and its effects suggests that the collagen-like peptide portion of the mole&le alone is respo&ible for its haemolytic activity, whereas the presence of the lipid-probably a prostanoid derivative-is required for neutrophil inhibition and suppression of lympho- cyte hlastogenesis. The activity of the glycopeptide- lipid complex appears to be calcium dependent and can be greatly reduced by the addition of anti-collagen. anti-Clq or anti-burn toxin globulin. or by treatment with cerium nitrate.

Ozkan A. N.. Ninnemann J. L. and Sullivan J. J. (1986) Progress in the characterization of an immuno- suppressive glycopeptide (SAP) from patients with ma- jor thermal injuries. J. Bum Cure Rehuhil. 7, (5). 3x8-397.

ratio. Deitch E. A. and Landry K. N. (1986) Neutrophil

subpopulations change after thermal iniurv. J. Truumu lnterleukin 1 in blister fluid 26. ‘(6j S34-S37. -

. , Fluid taken from some blisters on burned or scalded skin contains substantial amounts of lnterleukin I. In other samples of blister fluid the orobahle nresence 01

ANIMAL STUDIES inhibitors of lymphocyte proliferaiion gave the impress- ion that less lnterleukin 1 was present. Gel filtration

Resuscitation and smoke inhalation injury and high-performance liquid chromatography show

A study of the effects of smoke inhalation injury in that the lntcrleukin 1 activity has a molecular weight ot

sheep showed that inadequate.tluid resuscitation (7Oml/ 15-20008 doltons and can hc blocked with an antihody

h/m’ body surface area) worsened the lung microvascu- to lntcrlcukin I The source of the lnterleukin I activity

Iar permeability changes induced by toxic compounds may hc the injured kcratinocytc. Since epidermal Inter- lcukin I is a potent T-cell chcmoattractant. it may