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Hypogonadism following burns
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 clttributed 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.
Hydrocortisone
31,
362-369.
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 pcrcentagcs 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 normal 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 chemilumincsccncc ;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 chcmilumincscence Wits higher th;ln control V;I~UCSwhen 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 chcmiluminescence 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(7-59s.
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 Association 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 amputations, loss of range of motion and nerve damage.
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 clttributed 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.
Hydrocortisone
31,
362-369.
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 pcrcentagcs 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 normal 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 chemilumincsccncc ;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 chcmilumincscence Wits higher th;ln control V;I~UCSwhen 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 chcmiluminescence 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(7-59s.
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 Association 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 amputations, loss of range of motion and nerve damage.