- Email: [email protected]
Polyvalent pseudomonas vaccine
274
required in all critically ill patients with unexplained bilious vomiting. Gastric decompression coupled with agressive use of intravenous hyperalimentation has reduced the need for operative treatment from 42 per cent to 11 per cent. Lescher T. J., Sirinek K. R. and Pruitt B. A. (1979) Superior mesenteric artery syndrome in thermally injured patients. Z Trauma 19, 567.
Glucose infusions and lipid metabolism Lipolysis was studied by measuring glycerol turnover in injured and infected patients. Glycerol turnover was elevated two to three times the normal values in 5 injured and 4 infected patients during infusions of 5 per cent dextrose in water. No correlation was found between glycerol turnover and plasma glycerol concentration in both groups of patients. Glycerol turnover showed similar rates when measured during total parenteral nutrition in 5 injured and 3 infected patients. During total parenteral nutrition plasma-free fatty acid levels remained unchanged in the injured patients but decreased by 48 per cent in the septic patients. Beta-hydroxybutyrate concentrations were high during the glucose infusions and droppedin both groups during parenteral nutrition. The urine content of noradrenaline was high in both groups of patients during both glucose infusions and total parenteral nutrition; and the insulin response to total parenteral nutrition did not inhibit the catabolism oftriglycerides but did increase plasma ketone body concentrations. Carpentier Y. A., Askanazi J., Elwyn D. H. et al. (1979) Effects of hypercaloric glucose infusion on lipid metabolism in injury and sepsis. J. Trauma 19, 649.
Polyvalent pseudomonas vaccine A polyvalent pseudomonas vaccine has been tested in controlled clinical trials at two burns units, in Birmingham and New Delhi, in children and adults with full-thickness skin loss burns covering more than 15 per cent of the body surface. None of the vaccinated patients in either trial showed blood cultures containing Pseudomonas aeruginosa, and vaccinees showed raised titres of protective antibody and increased phagocytic activity against P. aeruginosa. In the New Delhi unit, where death with P. aeruginosa infection is common, the mortality in adults was reduced from 40"6 per cent (13/32) in the unvaccinated group to 6"6 per cent (2/30) in the vaccinated group. The mortality of children was reduced from 20-8 per cent (5/24) in the unvaccinated group to 4"8 per cent (1/21) in the vaccinated group. Jones R. J., Roe E. A. and Gupta J. L. (1979) Controlled trials ofa polyvalent pseudomonas vaccine in burns. Lancet 2,977.
Prediction of burn mortality Data from 3285 patients with varying severity burns are used to compare the accuracy of four different statistical methods of predicting mortality.
Burns Vol. 6/No. 4
1. Baux's rule, which adds the patient's age in years to the percentage of his body surface area burned; the original assertion was that values over 75 meant a very poor prognosis. 2. Probit analysis. 3. Discriminant analysis. 4. Logistic risk function analysis. Of the four methods, probit analysis is the most accurate in classifying actual survivors, while discriminant analysis is the most accurate in classifying acutal deaths. Stern M. and Waisbren B. A. (1979) Comparison of methods of predicting burn mortality. Burnsr, 119.
A N I M A L STUDIES Pulmonary fluid exchanges A study was made of the reliability of the currently used measures of pulmonary vascular hydrostatic and oncotic pressures in monitoring pulmonary water content after a major burn. The flow of pulmonary lymph, a reliable indicator of the rate of filtration of pulmonary transvascular fluid (Of) was measured before and for 72 h after a full-thickness skin loss burn covering 40-.55 per cent of the body surface of sheep. Changes in Qfwere correlated with measured changes in pulmonary microvasular pressure (Pmv), plasma colloid osmotic pressure (np) and interstitial colloid oncotic pressure (hi) as measured in the pulmonary lymph. The periods from 0 to 24 h (resuscitation), from 24 to 48 h (early mobilization of fluid) and from 48 to 72 h (early recovery) were compared with baseline values. Regression equa.tions and correlation coefficients for Qf versus Pmv, Qf versus Pmv minus 7~p and ~)f versus Pmv minus (np- hi), the oncotic gradient, were calculated. There were significant differences in slopes between the periods of time, with all three comparisons indicating that the responses of the microcirculation to the same changes in pressure were different in each time period. The correlation between (~f and the comparisons of pressures was clearly best in the period from 48 to 72 h. The comparison of Pmv minus np was not better than Pmv alone, while the comparison of Pmv minus the oncotic gradient (np- hi) was significantly better than either of the other comparisons in predicting Qf. Demling R. H., Manohar M. and Will J. A. (1979) Relation between pulmonary transvascular fluid filtration rate and measured Starling's forces after major burns. Chest 76, 448.
Macrophage dysfunction The phagocytic and microbicidal activities of alveolar and peritoneal macrophages were measured 4 and 24 h after a full-thickness skin loss burn covering about 27 per cent of the body surface of rats. The contribution of serum factors to the macrophage functions were studied concurrently. The phagocytic activity of alveolar macrophages obtained 4 or 24 h after burning
required in all critically ill patients with unexplained bilious vomiting. Gastric decompression coupled with agressive use of intravenous hyperalimentation has reduced the need for operative treatment from 42 per cent to 11 per cent. Lescher T. J., Sirinek K. R. and Pruitt B. A. (1979) Superior mesenteric artery syndrome in thermally injured patients. Z Trauma 19, 567.
Glucose infusions and lipid metabolism Lipolysis was studied by measuring glycerol turnover in injured and infected patients. Glycerol turnover was elevated two to three times the normal values in 5 injured and 4 infected patients during infusions of 5 per cent dextrose in water. No correlation was found between glycerol turnover and plasma glycerol concentration in both groups of patients. Glycerol turnover showed similar rates when measured during total parenteral nutrition in 5 injured and 3 infected patients. During total parenteral nutrition plasma-free fatty acid levels remained unchanged in the injured patients but decreased by 48 per cent in the septic patients. Beta-hydroxybutyrate concentrations were high during the glucose infusions and droppedin both groups during parenteral nutrition. The urine content of noradrenaline was high in both groups of patients during both glucose infusions and total parenteral nutrition; and the insulin response to total parenteral nutrition did not inhibit the catabolism oftriglycerides but did increase plasma ketone body concentrations. Carpentier Y. A., Askanazi J., Elwyn D. H. et al. (1979) Effects of hypercaloric glucose infusion on lipid metabolism in injury and sepsis. J. Trauma 19, 649.
Polyvalent pseudomonas vaccine A polyvalent pseudomonas vaccine has been tested in controlled clinical trials at two burns units, in Birmingham and New Delhi, in children and adults with full-thickness skin loss burns covering more than 15 per cent of the body surface. None of the vaccinated patients in either trial showed blood cultures containing Pseudomonas aeruginosa, and vaccinees showed raised titres of protective antibody and increased phagocytic activity against P. aeruginosa. In the New Delhi unit, where death with P. aeruginosa infection is common, the mortality in adults was reduced from 40"6 per cent (13/32) in the unvaccinated group to 6"6 per cent (2/30) in the vaccinated group. The mortality of children was reduced from 20-8 per cent (5/24) in the unvaccinated group to 4"8 per cent (1/21) in the vaccinated group. Jones R. J., Roe E. A. and Gupta J. L. (1979) Controlled trials ofa polyvalent pseudomonas vaccine in burns. Lancet 2,977.
Prediction of burn mortality Data from 3285 patients with varying severity burns are used to compare the accuracy of four different statistical methods of predicting mortality.
Burns Vol. 6/No. 4
1. Baux's rule, which adds the patient's age in years to the percentage of his body surface area burned; the original assertion was that values over 75 meant a very poor prognosis. 2. Probit analysis. 3. Discriminant analysis. 4. Logistic risk function analysis. Of the four methods, probit analysis is the most accurate in classifying actual survivors, while discriminant analysis is the most accurate in classifying acutal deaths. Stern M. and Waisbren B. A. (1979) Comparison of methods of predicting burn mortality. Burnsr, 119.
A N I M A L STUDIES Pulmonary fluid exchanges A study was made of the reliability of the currently used measures of pulmonary vascular hydrostatic and oncotic pressures in monitoring pulmonary water content after a major burn. The flow of pulmonary lymph, a reliable indicator of the rate of filtration of pulmonary transvascular fluid (Of) was measured before and for 72 h after a full-thickness skin loss burn covering 40-.55 per cent of the body surface of sheep. Changes in Qfwere correlated with measured changes in pulmonary microvasular pressure (Pmv), plasma colloid osmotic pressure (np) and interstitial colloid oncotic pressure (hi) as measured in the pulmonary lymph. The periods from 0 to 24 h (resuscitation), from 24 to 48 h (early mobilization of fluid) and from 48 to 72 h (early recovery) were compared with baseline values. Regression equa.tions and correlation coefficients for Qf versus Pmv, Qf versus Pmv minus 7~p and ~)f versus Pmv minus (np- hi), the oncotic gradient, were calculated. There were significant differences in slopes between the periods of time, with all three comparisons indicating that the responses of the microcirculation to the same changes in pressure were different in each time period. The correlation between (~f and the comparisons of pressures was clearly best in the period from 48 to 72 h. The comparison of Pmv minus np was not better than Pmv alone, while the comparison of Pmv minus the oncotic gradient (np- hi) was significantly better than either of the other comparisons in predicting Qf. Demling R. H., Manohar M. and Will J. A. (1979) Relation between pulmonary transvascular fluid filtration rate and measured Starling's forces after major burns. Chest 76, 448.
Macrophage dysfunction The phagocytic and microbicidal activities of alveolar and peritoneal macrophages were measured 4 and 24 h after a full-thickness skin loss burn covering about 27 per cent of the body surface of rats. The contribution of serum factors to the macrophage functions were studied concurrently. The phagocytic activity of alveolar macrophages obtained 4 or 24 h after burning