benefits of mixtures of topical antimicrobials

1
Burns (1990), 16,(3)233-234Printedin GreatBtitain 233 Abstracts CLINICAL STUDIES Alveolar macrophages and smoke injury Bronchoalveolar lavage (BAL) was performed on 32 fire victims with smoke inhalation injury, with or without skin burns, and 26 control subjects. Compared with controls smoke inhalation injury induced a raised yield of lavage cells, mainly neutrophils, and the number was significantly high on repeat lavage in 12 patients. Among the lavage cells various subgroups of macrophage were identified using various markers. There was an increase in UCHM- and RFD,-positive cells in each subgroup. The increase in RFD,- positive cells was confined to patients with only smoke inhalation injury, whereas the UCHM-positive cells were found following burns as well as smoke inhalation injury. Riyami B.M.S., Tree R., Kinsella J. et al. (1990) Changes in alveolar macrophage, monocyte and neutrophil cell profiles after smoke inhalation injury. 1. Clin. P&d. 43, (I), 43-45. Tumour necrosis factor, infection and mortality Serum samples from 43 severely burned patients with or without sepsis were analysed for tumour necrosis factor (TNF) levels. TNF was detectable in 69 per cent of patients with sepsis, in only 33 per cent of patients without sepsis, in 71 per cent of the patients who died and in only 3 1 per cent of the survivors. The frequency of the appearance of TNF correlated with both infection and mortality rate. The three patients with the highest TNF levels all died. There was no correlation between TNF levels and the extent of burn or presence of smoke inhalation injury. Sequential studies showed that serum TNF appeared transiently but repetitively in the circulation. Higher serum cortisol levels were correlated with the absence of TNF during sepsis and just before death. Marano M. A., Fong Y., Moldawer L. L. et al. (1990) Serum cachectin/tumor necrosis factor in critically ill patients with burns correlates with infection and mortality. Swrg. Gyneco\. Obstet. 170, (I), 32-38. Bum blister fluid limits fibrinolysis There is a substance in burn blister fluid that limits plasmin- induced fibrinolysis. The activity of this substance can be inhibited by ibuprofen and can be diminished by treatment with indometha- tin, imidazole and tolmetin. The blister fluid-induced reduction in fibrinolysis by plasmin may contribute to vascular occlusion fol- lowing burns which leads to secondary dermal ischaemia and the development of necrosis. Rockwell W. B. and Ehrlich H. P. (1990) Fibrinolysis inhibition in human bum blister fluid. J. Bum Cure Rehabil. 11, (I), l-6. Caloric needs of burned adolescents Adolescent patients with very large bums were found to require 1500 Kcal per mz total body surface area per day plus 1500 Kcal per mt of burned area per day to maintain body weight. These energy requirements were about 1.6 times their resting energy expenditure. Hildreth M. A., Hemdon D. N., Desai M. H. et al. (1989) Caloric needs of adolescent patients with bums. J. Bum Care Rehabil. 10, (6), 523-526. 0 1990 Butterworth-Heinemann Ltd 0305-4179/90/03023342 A better plastic bag for hand bums In treating hand burns in plastic bags it was found that if the bag was made of expanded polytetrafluoroethylene (PTFE), which is semipermeable to water vapour, rather than from polyethylene there was much less maceration of the tissues, which allowed easier assessment of the extent and depth of injury. The reduced tissue fluid accumulations meant that only one daily dressing change was usually needed. Martin D. L., French G. W. G. and Theakstone J. (1990) The use of semipermeable membranes for wound management. Br. 1. Plusf. surg. 43, (I), 55-60. Aged patients benefit from early wound surgery Two large (n= over 100) comparable groups of elderly patients (over 64 years old; one group treated recently and one group treated over 10 years ago) were compared with respect to the effect of early aggressive surgical treatment of the wound on morbidity and mortality. The survival rates of the recent and ear- lier groups were 52 per cent and 37 per cent respectively. The length of stay in hospital of the survivors was 42 days (earlier group) and 22 days (recent group). Ten years ago only 62 per cent of the survivors were operated upon whereas recently this figure was 90 per cent. Slater A. L., Slater H. and Goldfarb I. W. (1989) Effect of aggres- sive surgical treatment in older patients with burns. J. Bum Cure Rehdd. 10, (6), 527-530. Bene&s of mixtures of topical antimicrobials Equal parts mixtures of nystatin and furacin, and nystatin and silver sulphadiazine were equally effective in vitro against Cundidu &cans, Staph. aurew, Ps. ueruginoa and E. coli. Ninety-three patients with burns covering more than 29 per cent of the body surface area were treated with either these pairs of mixtures of antimicrobial agents or all three combined. Of the 93 patients 90 had neither a major systemic bacterial nor candidal sepsis and none of the patients had associated localized burn wound sepsis during their stay in hospital. The 90 patients were discharged from hospi- tal without any documented signs of infection. Thus the mixture of antimicrobial agents appears to have eliminated significant burn wound infection. Heggers J. P., Robson M. C., Hemdon D. N. et al. (1989) The efficacy of nystatin combined with topical microbial agents in the treatment of bum wound sepsis. J. Bum Care Rehabil. 10, (6), 508-511. Tumor necrosis factor and prostaglandin levels Patients with burns showed significantly great tumour necrosis (factor alpha (TNF,) levels in serum 3 days before septic episodes as compared with normal controls. Increases in patients’ total mono- cyte TNF, levels correlated with septic episodes and these levels were increased despite a concomitant increase in the prostaglandin E, levels. Takayama T. K., Miller C. and Szabo G. (IWO) Elevated tumor necrosis factor alpha production concomitant to elevated prosta- gkmdin E, levels. Arch. Surg. 125, (I), 29-35.

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Page 1: Benefits of mixtures of topical antimicrobials

Burns (1990), 16,(3)233-234 Printedin Great Btitain 233

Abstracts

CLINICAL STUDIES

Alveolar macrophages and smoke injury Bronchoalveolar lavage (BAL) was performed on 32 fire victims with smoke inhalation injury, with or without skin burns, and 26 control subjects. Compared with controls smoke inhalation injury induced a raised yield of lavage cells, mainly neutrophils, and the number was significantly high on repeat lavage in 12 patients. Among the lavage cells various subgroups of macrophage were identified using various markers. There was an increase in UCHM- and RFD,-positive cells in each subgroup. The increase in RFD,- positive cells was confined to patients with only smoke inhalation injury, whereas the UCHM-positive cells were found following burns as well as smoke inhalation injury.

Riyami B.M.S., Tree R., Kinsella J. et al. (1990) Changes in alveolar macrophage, monocyte and neutrophil cell profiles after smoke inhalation injury. 1. Clin. P&d. 43, (I), 43-45.

Tumour necrosis factor, infection and mortality Serum samples from 43 severely burned patients with or without sepsis were analysed for tumour necrosis factor (TNF) levels. TNF was detectable in 69 per cent of patients with sepsis, in only 33 per cent of patients without sepsis, in 71 per cent of the patients who died and in only 3 1 per cent of the survivors. The frequency of the appearance of TNF correlated with both infection and mortality rate. The three patients with the highest TNF levels all died. There was no correlation between TNF levels and the extent of burn or presence of smoke inhalation injury.

Sequential studies showed that serum TNF appeared transiently but repetitively in the circulation. Higher serum cortisol levels were correlated with the absence of TNF during sepsis and just before death.

Marano M. A., Fong Y., Moldawer L. L. et al. (1990) Serum cachectin/tumor necrosis factor in critically ill patients with burns correlates with infection and mortality. Swrg. Gyneco\. Obstet. 170, (I), 32-38.

Bum blister fluid limits fibrinolysis There is a substance in burn blister fluid that limits plasmin- induced fibrinolysis. The activity of this substance can be inhibited by ibuprofen and can be diminished by treatment with indometha- tin, imidazole and tolmetin. The blister fluid-induced reduction in fibrinolysis by plasmin may contribute to vascular occlusion fol- lowing burns which leads to secondary dermal ischaemia and the development of necrosis.

Rockwell W. B. and Ehrlich H. P. (1990) Fibrinolysis inhibition in human bum blister fluid. J. Bum Cure Rehabil. 11, (I), l-6.

Caloric needs of burned adolescents Adolescent patients with very large bums were found to require 1500 Kcal per mz total body surface area per day plus 1500 Kcal per mt of burned area per day to maintain body weight. These energy requirements were about 1.6 times their resting energy expenditure.

Hildreth M. A., Hemdon D. N., Desai M. H. et al. (1989) Caloric needs of adolescent patients with bums. J. Bum Care Rehabil. 10, (6), 523-526.

0 1990 Butterworth-Heinemann Ltd 0305-4179/90/03023342

A better plastic bag for hand bums In treating hand burns in plastic bags it was found that if the bag was made of expanded polytetrafluoroethylene (PTFE), which is semipermeable to water vapour, rather than from polyethylene there was much less maceration of the tissues, which allowed easier assessment of the extent and depth of injury. The reduced tissue fluid accumulations meant that only one daily dressing change was usually needed.

Martin D. L., French G. W. G. and Theakstone J. (1990) The use of semipermeable membranes for wound management. Br. 1. Plusf. surg. 43, (I), 55-60.

Aged patients benefit from early wound surgery Two large (n= over 100) comparable groups of elderly patients (over 64 years old; one group treated recently and one group treated over 10 years ago) were compared with respect to the effect of early aggressive surgical treatment of the wound on morbidity and mortality. The survival rates of the recent and ear- lier groups were 52 per cent and 37 per cent respectively. The length of stay in hospital of the survivors was 42 days (earlier group) and 22 days (recent group). Ten years ago only 62 per cent of the survivors were operated upon whereas recently this figure was 90 per cent.

Slater A. L., Slater H. and Goldfarb I. W. (1989) Effect of aggres- sive surgical treatment in older patients with burns. J. Bum Cure Rehdd. 10, (6), 527-530.

Bene&s of mixtures of topical antimicrobials Equal parts mixtures of nystatin and furacin, and nystatin and silver sulphadiazine were equally effective in vitro against Cundidu &cans, Staph. aurew, Ps. ueruginoa and E. coli. Ninety-three patients with burns covering more than 29 per cent of the body surface area were treated with either these pairs of mixtures of antimicrobial agents or all three combined. Of the 93 patients 90 had neither a major systemic bacterial nor candidal sepsis and none of the patients had associated localized burn wound sepsis during their stay in hospital. The 90 patients were discharged from hospi- tal without any documented signs of infection. Thus the mixture of antimicrobial agents appears to have eliminated significant burn wound infection.

Heggers J. P., Robson M. C., Hemdon D. N. et al. (1989) The efficacy of nystatin combined with topical microbial agents in the treatment of bum wound sepsis. J. Bum Care Rehabil. 10, (6), 508-511.

Tumor necrosis factor and prostaglandin levels Patients with burns showed significantly great tumour necrosis (factor alpha (TNF,) levels in serum 3 days before septic episodes as compared with normal controls. Increases in patients’ total mono- cyte TNF, levels correlated with septic episodes and these levels were increased despite a concomitant increase in the prostaglandin E, levels.

Takayama T. K., Miller C. and Szabo G. (IWO) Elevated tumor necrosis factor alpha production concomitant to elevated prosta- gkmdin E, levels. Arch. Surg. 125, (I), 29-35.