Burn wound sepsis in 156 extensively burned patients was studied bacteriologically. The variation in the pattern of antibiotic sensitivity to each single microorganism was also studied. The bacteria most frequently isolated were Staphylococcus aureus, Pseudomonas aeruginosa, Proteus mirabilis and Escherichia coli. Staphylococcus aureus, the commonest bacteria observed, usually appeared in the first week post-bum; Pseudomonas acruginosa often appeared secondarily in an advanced stage as a superinfecting agent and was in most cases fatal. As to antibiotic sensitivity, all the bacterial strains isolated, with the exception of Pseudomonas aeruginosa, evolved in time and provided useful information for preventive antibiotic therapy. Pseudomonas aeruginosa was constant in its response to two antibiotics, namely Colymycin and Tobramycin.

Bocciarelli G, Migliori F, Rava C., Gari M., Biggini C. Riv. Ital. Chir. Plastica 18: 81-89, 1986.

Brienza E, Bufo R, Lograno M.D., Vollono E, Giudice G., Aquila R.

Riv. ltal. Chir. Plastica 18: 91-97, 1986.

An interdisciplinary comprehensive model of fluid, electrolyte, and colloid control for acute bum resuscitation. The methods of systems dynamics were used as an initial step in a longer-term project to clarify the roles of various mechanisms that induce fluid shifts, the effects of crystalloid v. colloid therapy, and the assessment of ditlerent mixtures and guidelines for fluid resuscitation. The model provides reasonable responses to external inputs, including ditTerent body sizes, difTerent-size burns, different loss factors for water from the burn wound, and different levels and

times of treatment. With appropriate extensions - the addition of other compartments such as bum and nonbum interstitial and intracellular spaces and their constituents, water, albumin and potassium - the model ofTers a potentially powerful tool for investigating hypothesized pathophysiological mechanisms, evaluating alternative treatments, adapting therapy to individual patient needs, and supplementing on-line control.

Bush J.W., Schneider A.M., Wachtel T.L., Brimm J.E. J. Bum Care Rehabil., 7: 86-94, 1986.

BIOLOGIC, BIOSYNTHETIC, AND SYNTHETIC DRESSINGS AS TEMPORARY WOUND COVERS: A BIOCHEMICAL COMPARISON

A comparison was made of the effects of biological, biosynthetic and synthetic dressings on the biochemical responses of cells in underlying full-thickness wounds in rats. Total collagen and noncollagen (NCP), together with the DNA content of wound tissues, were also determined, as well as the rates of synthesis of these macromolecules. It was found that the wound tissue generated beneath biosynthetic and synthetic dressings had reduced collagen and increased NCP content compared to control wounds covered with biological dressing. On day 3 post-trauma, collagen and NCI? synthesis was also decreased for the Biobrane and hydrogel groups but not for the other two (OP-Site and fine-mesh gauze). The trends were similar on day 5. There were evident signs of alterations in the rates of protein degradation among the groups. The results indicate that cells in wound beds created by full-thickness skin removal react biochemically in different ways to biological, synthetic and biosynthetic wound dressings. This may affect how well the autograft survives during subsequent grafting, and the biological future of the graft bed.

Banes A.J., Compton D.W., Bomhoeft J., Hicks H., Link G.W., Bevin A.G., Lawrence W.T., Peterson H.D.

J. Bum Care Rehabil., 7: 9& 104, 1986.

A pilot study was carried out to test the ~yp thesis that burn patients are sleep-deprived. NUres reports on the quality of patients' sleep are ofte'n in confct with the patients' own reports. It is concluded that a better sleep environment should be provided and that nursing staff should be provided with information that may improve bum unit protocols.

Dotson C.H., Kibee E., Eland LM. J. Bum Care Rehabil., 7: 105-108, 1986.

Dazinegrel is a highly effective and selective thromboxane synthetase inhibitor. An investigation was made of its effects on the immune system in a bilateral 5 per cent BSA area deep partial thickness scald in a guinea-pig model. The animals were randomly divided into two groups, one receiving daily 3.4 mg/kg Dazinegrel by i.m. injection, the other the same volume of saline. Cell-mediated immunity was evaluated by the response to the hapten dinitrofluorobenzene, as measured by ear swelling in response to cutaneous application. Ear swelling in the Dazinegrel-treated group was 52.8 +/- 3.8 per cent, against 41.4 +/- 2.4 per cent in the control group. The treated animals had a significantly improved neutrophil bactericidal index. Dazinegrel exerted a positive effect on the immune system in this bum model, improving neutrophil antibacterial function and cell-mediated immunity.

Wang S., Waymack J.P., Alexander JW. Bums, 12: 307-311, 1986.

THE EFFECT OF THE THROMBOXANE SYNTHETASE INHIBITOR DAZMEGREL (UK-38,485) ON WOUND HEALING, DERMAL INK PERFUSION AND SKIN BLOOD FLOW MEASUREMENTS IN DEEP PARTIAL THICKNESS BURNS

Dazinegrel, a new highly selective inhibitor of thromboxane synthetase, was used in a guinea-pig model in order to assess its effect on burn wound healing. At a dosage i.m. of 3.4 mg/kg per day the effect was beneficial - higher doses had no effect. There was no change in dermal perfusion measured by India ink injection or by 133Xe injection in animals receiving parenteral Dazinegrel. Topical application of Dazinegrel inhibited wound healing. The findings confirm that prostaglandin inhibitors improve bum wound healing when given parenterally but impair it when applied topically.

Wang S., Silberstein E.B., Lukes S., Robb E., Zou W., Bruno L., Heyd T.J., Waymack J.P., Alexander J.W.

Bums, 12: 312-317, 1986.

A study was made of cellular immune response during a 1 -month period in 51 patients with 20-55 per cent BSA bums. The results showed lymphocytopenia and significant depression in the total T cells in all the patients. There were significant increases in the levels of T cells in patients who showed clinical improvement. The loss of expression of 'E' receptor correlated with the reduction of the protein-synthesizing capacity of the mononuclear cells. The functional integrity of the lymphocytes also showed an incapacity to recognize and stimulate normal alloantigens in a mixed lymphocyte reaction. An investigation of the mechanisms responsible for immunosuppression revealed the generation of T suppressor activity.

Mistry S., Mistry N.P., Arora S., Antia N.H. Burns, 12: 318-324, 1986.

In experiments carried out on rats, -it was found that after severe thermal injury intestinal microbes were capable of passing very rapidly through the intestinal mucosa defence barrier. Generalized dissemination of intestinal microbes occurred well before the onset of burn-wound infection. It is therefore recommended that in the treatment of burn patients great attention should be paid during the first post-burn stages to infection from microbes of the intestinal tract.

Li Nt., Guang-Xia X., De Wang W., Ngao L. Bums, 12: 325-329, 1986.

Pulmonary surfactant is a phospholipid material secreted by type 11 pulmonary epithelial cells. It is important, for the maintenance of stability of lung alveoli, regulation of compliance, and prevention of, fluid exudation from pulmonary capillaries into alveoli. In this research in rabbits, lung water content, PaO, surface tension (in terms of hysteresis) and lecithin content of both bronchial irrigation fluid and lung homogenates were determined after severe steam inhalation injury. When Pa02 increased and lung water content increased there was a moderate fall in pulmonary surfactant activity, shown by a progressive. decrease in the area of the hysteresis loop and a, decrease of the lecithin content in both bronchial irrigation fluid and lung homogenate. This fall in pulmonary surfactant activity would appear to play an important role in the pathogenesis of pulmonary oedema after inhalation injury. Successive determinations of lecithin content and/or surface tension of bronchial irrigation fluid are therefore recommended as early diagnostic and prognostic aids in severe burn injury.

Thermal injury induces alterations of the capillary dynamics that are mainly characterized by an increase in the fluid and protein shifts from the vascular to the interstitial space. An algorithm is presented for the qualitative and quantitative study of these variations, using measurements commonly made in bum patients, i.e. the values of the haematocrit, plasma protein concentration, fluid replacements and diuresis. The net protein and liquid shifts indicate the state of the capillary dynamics of the burned patient. The presented algorithm allows an on-line evaluation of the capillary dynamic state, as well as the individual response of the patient to fluid replacement therapy during the shock phase after the thermal injury. The reliability of the algorithm was, assessed by a retrospective comparison of the results with the clinical progress of 39 patients and by the agreement with the experimental and clinical result obtained by other authors.