464 Burns (1667) 13. (61.494-495 Printedin Great Brir~in

Abstracts

CLINICAL STUDIES

Hypogonadism following burns Serum testosterone levels were measured in 19 men with burned areas covering between 4 and 70 per cent of the body surface area. The profound and persistent depression of this sex hormone could not be explained by changes in sex hormone binding globulin capacity. hyperprolactinaemia. classical primary testicular failure or a hyp,g~~nadotrophic state.

These burned patients also showed reduced levels of luteinizing hormone which also appeilred to have a

reduced biological activity. Such effects may bc clttri- buted to hypothalamic dysfunction.

Semplc C. G.. Robertson W. R.. Mitchell R. et al. (1987) Mechanisms Icading to hypogonadism in I~C'II

with burns injuries. Rr. Md. 1. 295. 40.3407.

Epidermal oxygen barrier Stripping of the epidermis while heated to 43°C with multiple applications of udhcsivc tape did not chimge the cutaneous blood Ilow. whcrcas it reduced the oxy pen consumption and increased the mean skin 1%):. This stripping eliminated XZ per cent of the oxygen gradient bctwcen the capillaries and the measuring oxygen electrode while reducing the computed oxygen consumption by Z-30 per cent. The study concluded that the spidcrmal membrane is a signiliclnt barrier to oxygen diffusion. but also that the transcutancous oxygen-measuring electrode had ;I significant effect on skin Po2 owing to its own low oxygen consumption.

Jaszczlk P. and Sejrscn P. (19X7) Oxygen tension and consumption measured by 3 tc-/%a2 electrode on hcatcd skin before and after epidsrmal stripping. Acru A trursrht-sioi. Scutd. 31, 362-369.

Hydrocortisone and lymphocyte changes To test the hypothesis that elevated hydrocortironc levels in burned patients decrease the production of T, lymphocytes, normal human volunteers were given constant hydrocortisons infusions and the numhcrs and types of lymphocytes and other white cells were counted. The infused volunteers showed signilicant lymphopcnia. monocytopenia and granulocytosis. In addition. there were signilicant decreases in the pcrcen- tagcs of T,, T, and T,, lymphocytes. no signilicant chilnges in the percentages of T, cells and an increase in the pcrcentegc of Leu+cells. These changes in lympho-

cyte subsets mimicked those found in burned patients who had ;I mean burn size of 42 per cent of the body surface urea

Calvano S. E.. Albert J. D.. Legospi A. et al. (19X7) Comparison of numerical and phenotypic leukocyte changes during constant hydrocortisone infusion in nor- mal humans with those in thermally injured patients. SW&? G,vrWcol. Ohs&f. 164, (6). SW-5%.

PMN chemiluminescence f%ctericid;tl activity and neutrophil chemiluminescence are closely correlated suggesting that the microbicidal action of ncutrophils depends on the generation of oxygenating npnts. Measurements of neutrophil che- milumincsccncc ;tnd opsonic index in 36 patients with burns covering more thnn one-third of the body sttrfilcc are;1 showed th;lt both wcrc subst;mtially lower th;tn in healthy control subjects. In contrast. the chcmilu- mincscence Wits higher th;ln control V;I~UCS when the burn4 ;Irci( was smdlcr. II rcmaincd high in thcsc patients during persistent infections hut dccrcitsed to norm;4 when appropriate antibiotic therilpy was

st;rrtcd. Sepsis in the more scvercly burned pilticnts was

associated with a very marked reduction in both chcmi- luminescence nnd the opsonic index. The reductions were gre;lter with /?s. rwu~itwsu infections than with Sru/~/r. ui1fu4.~ infections.

Chcmilumincsccncc w;Is rehtively ~loscly correlated with hoth the opsonic index and the serum transferrin levels.

Sheng C. Y. and Tung Y. L. (19X7) Ncutrophil chcmilumincsccncc in burned pnticnts. J. Trttutttu 27. (6), 51(7-595.

Burn-induced physical impairment The degree of physical impairment was objectively ussessed in 325 burned patients who survived for at least I YCilr after injury. The mean burned area was I I.6 per cent of the hody surface urea, the mean age was 2X.2 years. Using the American Medical Associa- tion Guide to Evaluiltion of Pcrmancnt Impiiirment. the mean whole man impairment was 7-7 per cent. For adults the mean time off work was 12.7 weeks and for the children the mean time off school was X.5 weeks. The critical factors in the impairment were amputa- tions, loss of range of motion and nerve damage.

Abstracts 495

Engav L. H.. Covey M. H.. Dutcher K. D. et al. (lYX7) Impairment. time out of school and time off from work after hurns. Phsf. R~m.sw. Surg. 7Y. (h). Y27-92-t.

Trial of thienamycin A novel thienamycin antibiotic (Imipenem cilastatin) was tested for safety and eflicacy in 20 severely burned and infected patients. The mean burned area covered more than half the body surface area. Fourteen of the patients also showed evidence of inhalation injury. Treatment was clinically successful in 13 patients and not successful in five patients. The response could nclt he determined in two patients with multisystem organ failure. All the clinical failures were in patients with pulmonary infections. No serious toxicity or side- effects were noted. Resistant organisms developed in eight patients. of whom live were in the clinicid failure group. Psc~tclon~onu.~ ucru~~inosu resistant to this new antibiotic was isl>l;ltcd from seven patients.

Cuber&on G. R.. McM;mus A. T.. Conarro P. A. et al. (19X7) Clinical triid of lmipencm cililstiltin in severc- ly burned ;mtl infected patients. Sq. G~~~cco/. Ohsrcr. 165. (I ). 25-28.

ANIMAL STUDIES

Benefits of arginine supplementation Four groups of guinea-pigs with hums covering 30 per cent of the holy surhce urea received :I continuous isonitrogencnts, iscraloric. isoVol;~cmic intragnstric Iced. The groups, however. rcccivcd zero. I per cent, 2 per cent or 4 per cent of the total energy intake us ;qinins. The ;tvcr;lgs hc~Iy weight post.hurn decre;lrctl equally in all groups. t lowcvcr. the rating metabolic cxpenditurc on day 6 post-burn was higher in the groups of animals receiving I and 2 per cent argininc. ‘I’hcse anim;ds also showed the lowest mortality rittes. The response to dinitrotluorohcnzenc chellsnpc on day I2 po\t-hurn as measured hy c’;lr thickness was greatest in the animals receiving 2 per cent argininc.

S;lito II.. ‘I’rocki 0.. Wang S. L. et al. (10X7) Mct;l- holic imd immune cffccts of distilry urginine supplc- mcntation after hurn. Arc/f. Surg. 122. (7). 7X4-7X0.

A model of smoke inhalation injury Inhakltion injury was produced in 5X sheep exposed to graded doses of smoke derived from the combustion of ;I mixture of polyethylene, wood pulp ond cellulose. In terms of units of exposure, I2 units of smoke containing IO-I4 per cent oxygen. .%X per cent carbon dioxide and 0.7-2.2 per cent c&on monoxide and other comhus- tion products hut no cyanide. caused death within 72 h ol exposure. Death occurred within 24 h with IX units of smoke.

The hat corrcl;ltion hctwccn smoke dose and rc- sponse was ohserved in irrteri;d oxygen tension 24 h alter cxpo5urc. Compared with control studies in *non- smoked’ animals. at 2-t h most of the cardiopulmonary indices showed significant changes only after a l2-unit

exposure. The dose-response relationship appeared to h-either sipmoid or cu&linear in shape:

Shimazu T.. Yukioka T.. Huhhard G. B. et al. (19X7) A dose resyxJnsive m&e1 of smoke inhalation injury. Ann. Surg. 206. (I). XY-9X.

immunological effects of transfusions Determinations whether blood transfusions increased the susceptibility to infection were carried out in ruts with burns covering 25 per cent of the body surface area. The effects of blood transfusions with autologous or homologous blood were compared with infusions of Ringer’s lactate. given 9.73 and I day hefore the burn. The burned areas were infected with Ps. orncginosu 0.1 or 2 days after burning.

Homologous blood increased mortality unless given I day before Pseudomonas challenge. when it dimi- nished mortality. Transfusion with syngeneic blood had no effect. suggesting that transfusions may advervly affect survival when given before bacterial chellenge. possibly due to immunmupression from exposure to non-self histocompatihility antigens.

W;lym;lck J. P., R&h E. and Alexander J. W. (lYX7) Effect of transfusion on immune function in ;I trilUm;b tized ;mimal model. II. Effect on mortality rate follow- ing septic challenge. Arch. Surf. 122, (X). YZ.SY3Y.

LABORATORY STUDIES

Changes in dermal vascularity A hixt&@el study explored the hcnclit to hc derived from meshing skin grafts. The meshing process in- cre;Isc’s the iIre: of exposed dermis which cont;Gns the cut ends of hlcxd vessels derived from the suhp;lpill;~ry plexus. Microscopic examination of the dermis showed that each of the skin bridges within the mesh changed shape so that the blood vessels came to open on to the undcrsurfacc of the graft. These vessel ends arc advan- tageously placed to help the formation of u vascular network with the @t.

Knight S. L. imd Mcwqhcn M. (19X7) Conligura- tional changes within the dermis of meshed split skin grafts: a hi~tologic;tl study. Rr. /. P/US/. Sq. 10, (4). 420-422.

Inhibitors of red cell formation Gel filtration of sera from hurned patients showed a region with a molecular size between l4t~tMltt and 2YtttMtt) daltons which inhibited erythrucyte colony formation in vitro. Treatment of the seru with proteo- lytic enzymes caused P loss of this inhibitory activity, suggssting that the inhibitory substance(s) was u pro- tein. Ion-&change chromatography showed that the inhihitor was an acidic protein. It seems likely that this acidic protein induced the anucmir of hurns hy rcduc- ing the rate of erythrtcytc production.

Wallncr S., Vautrin R.. Katz J. et al. (IYX7) The anemia of thermal injury: partial characterization of an erythroid inhibitory substance. 1. Trucrmu 27. (6). 63Y- MS.