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Neutrophil activation and complement receptors
530
Burns (1986)12, (71,530-532
Printed in Great Britain
Abstracts CLINICAL STUDIES Egg-enriched
nutrition
The nutrition of 12 young adults with a mean burned area of 54+ 12 per cent of the body surface area was based upon a daily intake of 5 eggs per 10 kg body weight incorporated into milkshakes. Each 250-ml bottle of enriched milkshake given enterally or by nasogastric tube contained 2318 kJ, 29g protein, 51 g carbohydrate and 28.6g fat. In terms of energy provision, protein provided 21 per cent, fat 42 per cent and carbohydrate 37 per cent. The patients received a mean daily intake of 5kl.5 g/kg protein, 8kO.75 g/kg carbohydrate, 5+ 1.O g/kg fat and between 378 and 420 kJ/kg. During 40 days administration of this diet, the plasma lipids remained within normal limits and the serum protein levels returned to normal within the first 3 weeks. Kaufman T., Hirshowitz B., Moscona R. et al. (1986) Early enteral nutrition for mass burn injury: the revised egg-rich diet. Burns 12, (4), 260-263.
New test for PMN function Polymorphonuclear cell function was assessed in five patients with burns covering over 25 per cent of the body surface area using the new acridine orange fluorochrome microassay technique. This reliable, simple and reproducible technique showed a significant decrease in bacterial killing and phagocytosis at some point during the clinical course of each patient. Carpenter A. B., Boykin J. V., Crute S. L. et al. (1986) The acridine orange fluorochrome microassay: a new technique for quantitation of neutrophil function in burned patients. J. Trauma 26, (4). 389-392.
Neutrophil ceptors
activation
and complement
re-
Neutrophil activation was measured in adults with burns of differing severities using serial immunofluorescence measurements indicative of complement opsonin receptors. The level of these receptors was elevated during the first 5 days after burning and then gradually returned to normal. Neutrophil chemotaxis was depressed by zymosan-activated serum, a source of C5a, for most of the first 3 weeks after burning and inversely correlated with the levels of the complement opsonin receptors. Plasma C3a des-arg levels were supranormal throughout the period of study.
It is suggested that C5a is responsible for the increased susceptibility of burned patients to infection by virtue of its ability to inhibit neutrophil chemotaxis. Moore F. D., Davis C., Rodrick M. et al. (1986) Neutrophil activation in thermal injury as assessed by increased expression of complement receptors. New Engl. J. Med. 314, 948-952.
Benefits of phosphate
supplementation
Sixteen patients with burns covering between 20 and over 60 per cent of the body surface area received phosphate supplements-up to 75mmol per day. Measurements of serum phosphate and 2,3-DPG were made in these patients and also in comparable burned patients not receiving phosphate supplements. In the patients receiving phosphate supplements the serum phosphate levels were still subnormal for the first four post-burn days whereas the 2,3-DPG levels remained normal. Thus post-burn disturbances in red cell phosphate metabolism characteristically found in severely burned patients may be prevented by giving phosphate supplements. Loven L., Larsson L., Nordstrom H. et al. (1986) Serum phosphate and 2,3 diphosphoglycerate in severely burned patients after phosphate supplementation. J. Trauma 26, (4), 348-352.
Hazards of enterococcal
sepsis
Enterococcal burn wound infections were found in 38 patients over a 26-month period. The incidence was sporadic without any evidence of an epidemic. Twenty of these 38 patients developed positive blood cultures for enterococci. Ten patients died within 10 days of the bacteraemia, while 9 others eventually died from other complications. Prior antibiotic therapy did not appear to increase the risk for enterococcal infection. Specific therapy against the enterococcus after the bacteraemia was identified appeared to have no effect on mortality. Bacteraemic patients had a greater mortality than patients with only enterococcal wound infections or without enterococcal infections. Aggressive therapy is reauired to nrevent the development of enterococcal sepsis with its high mortality rate. Jones W. G.. Barie P. S.. Yurt R. W. et al. (1986) Enterococcal burn sepsis. A’highly lethal complication in severely burned patients. Arch. Surg. 121, 649-6.53.
Treatment
of axillary contractures
The authors’
experience
of treating
post-burn
axillary
Burns (1986)12, (71,530-532
Printed in Great Britain
Abstracts CLINICAL STUDIES Egg-enriched
nutrition
The nutrition of 12 young adults with a mean burned area of 54+ 12 per cent of the body surface area was based upon a daily intake of 5 eggs per 10 kg body weight incorporated into milkshakes. Each 250-ml bottle of enriched milkshake given enterally or by nasogastric tube contained 2318 kJ, 29g protein, 51 g carbohydrate and 28.6g fat. In terms of energy provision, protein provided 21 per cent, fat 42 per cent and carbohydrate 37 per cent. The patients received a mean daily intake of 5kl.5 g/kg protein, 8kO.75 g/kg carbohydrate, 5+ 1.O g/kg fat and between 378 and 420 kJ/kg. During 40 days administration of this diet, the plasma lipids remained within normal limits and the serum protein levels returned to normal within the first 3 weeks. Kaufman T., Hirshowitz B., Moscona R. et al. (1986) Early enteral nutrition for mass burn injury: the revised egg-rich diet. Burns 12, (4), 260-263.
New test for PMN function Polymorphonuclear cell function was assessed in five patients with burns covering over 25 per cent of the body surface area using the new acridine orange fluorochrome microassay technique. This reliable, simple and reproducible technique showed a significant decrease in bacterial killing and phagocytosis at some point during the clinical course of each patient. Carpenter A. B., Boykin J. V., Crute S. L. et al. (1986) The acridine orange fluorochrome microassay: a new technique for quantitation of neutrophil function in burned patients. J. Trauma 26, (4). 389-392.
Neutrophil ceptors
activation
and complement
re-
Neutrophil activation was measured in adults with burns of differing severities using serial immunofluorescence measurements indicative of complement opsonin receptors. The level of these receptors was elevated during the first 5 days after burning and then gradually returned to normal. Neutrophil chemotaxis was depressed by zymosan-activated serum, a source of C5a, for most of the first 3 weeks after burning and inversely correlated with the levels of the complement opsonin receptors. Plasma C3a des-arg levels were supranormal throughout the period of study.
It is suggested that C5a is responsible for the increased susceptibility of burned patients to infection by virtue of its ability to inhibit neutrophil chemotaxis. Moore F. D., Davis C., Rodrick M. et al. (1986) Neutrophil activation in thermal injury as assessed by increased expression of complement receptors. New Engl. J. Med. 314, 948-952.
Benefits of phosphate
supplementation
Sixteen patients with burns covering between 20 and over 60 per cent of the body surface area received phosphate supplements-up to 75mmol per day. Measurements of serum phosphate and 2,3-DPG were made in these patients and also in comparable burned patients not receiving phosphate supplements. In the patients receiving phosphate supplements the serum phosphate levels were still subnormal for the first four post-burn days whereas the 2,3-DPG levels remained normal. Thus post-burn disturbances in red cell phosphate metabolism characteristically found in severely burned patients may be prevented by giving phosphate supplements. Loven L., Larsson L., Nordstrom H. et al. (1986) Serum phosphate and 2,3 diphosphoglycerate in severely burned patients after phosphate supplementation. J. Trauma 26, (4), 348-352.
Hazards of enterococcal
sepsis
Enterococcal burn wound infections were found in 38 patients over a 26-month period. The incidence was sporadic without any evidence of an epidemic. Twenty of these 38 patients developed positive blood cultures for enterococci. Ten patients died within 10 days of the bacteraemia, while 9 others eventually died from other complications. Prior antibiotic therapy did not appear to increase the risk for enterococcal infection. Specific therapy against the enterococcus after the bacteraemia was identified appeared to have no effect on mortality. Bacteraemic patients had a greater mortality than patients with only enterococcal wound infections or without enterococcal infections. Aggressive therapy is reauired to nrevent the development of enterococcal sepsis with its high mortality rate. Jones W. G.. Barie P. S.. Yurt R. W. et al. (1986) Enterococcal burn sepsis. A’highly lethal complication in severely burned patients. Arch. Surg. 121, 649-6.53.
Treatment
of axillary contractures
The authors’
experience
of treating
post-burn
axillary