- Email: [email protected]
Icatibant improves microvascular leakage after thermal injury in sheep
S122
Burns 3 3 S ( 2 0 0 7 ) S1–S172
(2) A temperance substitute of the epidermis made of silicone that guarantees an immediate governing of the wound. The silicon’s layer, thanks to its micro porosity, allow us to control the leak of the fluids; it provides an antibacterial barrier with a permeability to the steam like the normal skin. The three-dimensional matrix is composed by reduced collagen and it acts like an extra cellular matrix, supporting the cellular increase and the collagen’s synthesis, minimizing the inflammatory answer. The three-dimensional matrix is degraded biologically and is replaced from a self-governing derma. ´ to: The use of Integra in Paediatrics is appliqued (1) (2) (3) (4)
The treatment of burns (2◦ deep and 3◦ ). The treatment of Burns’s complication (retractile scars or keloids). Rebuilding of a skin’s loss for a trauma. Exceptional pathologies (pimply epidermolysis).
The Integra is applied on the wound with silicon’s layer directed towards the auteur and it is leaved on the wound for 21 days. After the silicon’s layer is removed and it is possible to lay an audiologist graft very fine on the new derma (so we have a rapid recovery of the area of the drawing). The new skin is soft, flexible and durable it rises with the patient. We think that the best indication of the use Integra is the complication of healing. It is a consequence of a bad making of the derma in its structure and not aenelastic. The Integra works as a structure of a support where the fibroblasts prepare in regular way. This allows us to have a functional derma. Our experience is relevant to the treatment of Burns’s complication (retractile scars and keloids) in seven cases; rebuilding of skin’s loss for a trauma in six cases and two cases of treatment of a large nevus. The authors present some cases of their casuistry. doi:10.1016/j.burns.2006.10.282 Pseudomonas aeruginosa is diminished by KGF supplementation in experimental burn model using human cultured keratinocytes Sobral C.S. a , Ferreira L.M. a , Ipolito M.Z. b , Filho A.G. a a
˜ Paulo, Sao ˜ Paulo, Brazil Plastic Surgery Division, Federal University of Sao ˜ Paulo, Sao ˜ Paulo, Brazil Federal University of Sao E-mail address: [email protected] (C.S. Sobral).
b
Background: Experimental models have shown Pseudomonas aeruginosa ability to interact to epidermic keratinocytes, stimulating these cells to produce specific peptides that start an immunological chain reaction in epidermis. The immune reaction causes cytokines and growth factors release. We wished to test whether the presence of Keratinocyte Growth Factor (KGF) altered P. aeruginosa proliferation on experimental burn model. Method: Human keratinocytes from newborn foreskin were isolated and cultured following standard method. Keratinocytes were seeded on collagen matrices and cultured to form stratified epithelia. A thermal plate was used to produce burn defect. Each matrix was inoculated with luminescent P. aeruginosa strain. Experiments were made using keratinocyte medium without KGF and keratinocyte medium supplemented with different concentrations of KGF. Statistical analyses were made using Wilcoxon paired test and Friedman test for multiple samples. Results: When KGF was added to keratinocyte medium in the presence of Pseudomonas the bacterial proliferation decreased, however, when KGF was added to P. aeruginosa alone there was no effect on bacterial growth. More effective KGF concentration was 40 ng/ml. Conclusion: This method made possible real time evaluation, observing how long after bacterial growth occurred. The KGF was involved in reduction of bacterial viability. However, as KGF alone did not produce effect on P. aeruginosa proliferation, it seems to modulate the skin immune response. doi:10.1016/j.burns.2006.10.283 Icatibant improves microvascular leakage after thermal injury in sheep Jonkam C.C., Traber D.L., Esechie A., Wang J., Nakano Y., Traber L.D., Enkhbaatar P. University of Texas Medical Branch, USA E-mail address: [email protected] (C.C. Jonkam). Increased microvascular permeability observed after burn injury is mediated by numerous vasoactive substances, including bradykinin released after burn. In this study, we tested the effects of icatibant (a bradykinin B2 receptor antagonist) on microvascular permeability in sheep exposed to 40% total body surface area (TBSA), third degree burn.
Burns 3 3 S ( 2 0 0 7 ) S1–S172
S123
Methods: Female sheep were surgically prepared for study and randomised into the following groups: Sham (nY=Y6, non injured, non treated), control (nY=Y7, 40% TBSA third degree burn, non treated), icatibant 4 (nY(Y6, 40% TBSA third degree burn, treated with icatibant 4Y(g/kg/h), icatibant 20 (nY=Y8.40% TBSA third degree burn, treated with icatibant 20Y(g/kg/h). Fluid resuscitation was started immediately after burn or sham procedure according to the Parkland formula: 4YmlY(Y% burnY(Ykg body weight, for the first 24Yh and 2YmlY(Y% burnY(Ykg body weight, for the next 24Yh. Icatibant infusion started 1Yh after injury and was given continuously for the rest of the experimental period. Results: Prefemoral lymph flow did not increase in the sham animals but increased about eight-folds in the control group, about four-folds in the icatibant four group and about three-folds in icatibant 20 group at 48Yh. Total prefemoral protein leak was reduced in both treatment groups. However there was a dose dependent increase in heart rate in the treated animals.Conclusion: Icatibant moderates cutaneous microvascular permeability to fluid after 40% TBSA third degree burn in sheep. doi:10.1016/j.burns.2006.10.284 ˜ from 2001 to 2004 Physiotherapic procedures in the burnt unit of Hospital Infantil Joana de Gusmao ´ ˜ F.S.V. a,b , Martins M.A. a,b Tibola J. a,b , Pereima M.J.L. a,b , Honorio D.R. a,b , Kroeff M.S. a,b , Guimaraes a
Universidade do Estado de Santa Catarina, Brazil ˜ Brazil Hospital Infantil Joana de Gusmao, E-mail address: [email protected] (J. Tibola).
b
The thermal trauma constitutes a serious health problem that frequently reaches preschool children age. The survival tax increased in function of best treatment conditions and teams multidiscipline work, which include the physiotherapist. The ˜ in Florianopolis-SC ´ Hospital Infantil Joana de Gusmao, is a state reference for children burning attendance. The physiotherapic attendance in the burn unit (UQUE) is performed by professionals and students. A descriptive study was developed to analyze the number of physiotherapic burnt procedures with patients interned in UQUE, from 2001 to 2004. Data of 388 handbooks had been collected. In the analysis, we used descriptive statistics. It was analyzed that only 331, from those 388, presented the necessary data for this study. The internments numbers had been increasing in the first years, 26% average, until remain itself around 100 internments per year; conversely, the average of internment days in the period varied between 13 and 28. The physiotherapic procedures annual averages fell in about 70% and the average of procedures for patients remain falling around 79% in the same period, in such way, the patients who had not got some physiotherapic procedure reached to 40%. There were many factors that can justify the absence of physiotherapic procedures: (a) school vacations that moved away students from the hospital, (b) substitution of employees in the physiotherapic section, (c) break without professionals in the institution. It was proven that exist a deficit in the physiotherapic procedures. It has been known that precocity, and the physiotherapy continuity is important for rehabilitation success, being enough to the effective existence of operating physiotherapists in the UQUE. doi:10.1016/j.burns.2006.10.285 The Bradford burns chart part 1: Adults Asaad K. a,b,c,d , Khan A. a,b,c,d , Sillitoe A. a,b,c,d , Cox V. a,b,c,d , Rawlins J. a,b,c,d a
Bradford Plastic Surgery And Burns Research Unit, HG2 7AY, United Kingdom A and E Department, Bradford Royal Infirmary, BD9 6RJ, United Kingdom c Department of Plastic Surgery, Hull Royal Infirmary, HU3 2JZ, United Kingdom d Bradford Plastic Surgery and Burns Research Unit, BD9 6RJ, United Kingdom E-mail address: [email protected] (K. Asaad). b
Introduction: If the first doctor to assess a patient with major burns in an emergency department (ED) is not very experienced in their management, fluid resuscitation can be a source of confusion and error. To improve the initial management of major burns, we have devised a chart that clearly shows patients’ fluid requirements. Aims: We assessed the usefulness of a chart that showed the hourly fluid requirements for patients with burns of 15-80% TBSA and weights of 40-120Ykg. Materials and methods: Groups of ED doctors and plastic surgeons of all grades were given Lund and Browder charts with major burns marked on 10 patients. They were given the Parkland formula and asked to calculate the resuscitation requirements for half the patients. For the other half of patients, they were given the chart and asked to determine fluid requirements. Results: All doctors found that using the chart was easier than calculating the fluids. It resulted in 10% fewer errors. It was also 44% quicker. Comments were extremely favourable about the usefulness of the charts.
Burns 3 3 S ( 2 0 0 7 ) S1–S172
(2) A temperance substitute of the epidermis made of silicone that guarantees an immediate governing of the wound. The silicon’s layer, thanks to its micro porosity, allow us to control the leak of the fluids; it provides an antibacterial barrier with a permeability to the steam like the normal skin. The three-dimensional matrix is composed by reduced collagen and it acts like an extra cellular matrix, supporting the cellular increase and the collagen’s synthesis, minimizing the inflammatory answer. The three-dimensional matrix is degraded biologically and is replaced from a self-governing derma. ´ to: The use of Integra in Paediatrics is appliqued (1) (2) (3) (4)
The treatment of burns (2◦ deep and 3◦ ). The treatment of Burns’s complication (retractile scars or keloids). Rebuilding of a skin’s loss for a trauma. Exceptional pathologies (pimply epidermolysis).
The Integra is applied on the wound with silicon’s layer directed towards the auteur and it is leaved on the wound for 21 days. After the silicon’s layer is removed and it is possible to lay an audiologist graft very fine on the new derma (so we have a rapid recovery of the area of the drawing). The new skin is soft, flexible and durable it rises with the patient. We think that the best indication of the use Integra is the complication of healing. It is a consequence of a bad making of the derma in its structure and not aenelastic. The Integra works as a structure of a support where the fibroblasts prepare in regular way. This allows us to have a functional derma. Our experience is relevant to the treatment of Burns’s complication (retractile scars and keloids) in seven cases; rebuilding of skin’s loss for a trauma in six cases and two cases of treatment of a large nevus. The authors present some cases of their casuistry. doi:10.1016/j.burns.2006.10.282 Pseudomonas aeruginosa is diminished by KGF supplementation in experimental burn model using human cultured keratinocytes Sobral C.S. a , Ferreira L.M. a , Ipolito M.Z. b , Filho A.G. a a
˜ Paulo, Sao ˜ Paulo, Brazil Plastic Surgery Division, Federal University of Sao ˜ Paulo, Sao ˜ Paulo, Brazil Federal University of Sao E-mail address: [email protected] (C.S. Sobral).
b
Background: Experimental models have shown Pseudomonas aeruginosa ability to interact to epidermic keratinocytes, stimulating these cells to produce specific peptides that start an immunological chain reaction in epidermis. The immune reaction causes cytokines and growth factors release. We wished to test whether the presence of Keratinocyte Growth Factor (KGF) altered P. aeruginosa proliferation on experimental burn model. Method: Human keratinocytes from newborn foreskin were isolated and cultured following standard method. Keratinocytes were seeded on collagen matrices and cultured to form stratified epithelia. A thermal plate was used to produce burn defect. Each matrix was inoculated with luminescent P. aeruginosa strain. Experiments were made using keratinocyte medium without KGF and keratinocyte medium supplemented with different concentrations of KGF. Statistical analyses were made using Wilcoxon paired test and Friedman test for multiple samples. Results: When KGF was added to keratinocyte medium in the presence of Pseudomonas the bacterial proliferation decreased, however, when KGF was added to P. aeruginosa alone there was no effect on bacterial growth. More effective KGF concentration was 40 ng/ml. Conclusion: This method made possible real time evaluation, observing how long after bacterial growth occurred. The KGF was involved in reduction of bacterial viability. However, as KGF alone did not produce effect on P. aeruginosa proliferation, it seems to modulate the skin immune response. doi:10.1016/j.burns.2006.10.283 Icatibant improves microvascular leakage after thermal injury in sheep Jonkam C.C., Traber D.L., Esechie A., Wang J., Nakano Y., Traber L.D., Enkhbaatar P. University of Texas Medical Branch, USA E-mail address: [email protected] (C.C. Jonkam). Increased microvascular permeability observed after burn injury is mediated by numerous vasoactive substances, including bradykinin released after burn. In this study, we tested the effects of icatibant (a bradykinin B2 receptor antagonist) on microvascular permeability in sheep exposed to 40% total body surface area (TBSA), third degree burn.
Burns 3 3 S ( 2 0 0 7 ) S1–S172
S123
Methods: Female sheep were surgically prepared for study and randomised into the following groups: Sham (nY=Y6, non injured, non treated), control (nY=Y7, 40% TBSA third degree burn, non treated), icatibant 4 (nY(Y6, 40% TBSA third degree burn, treated with icatibant 4Y(g/kg/h), icatibant 20 (nY=Y8.40% TBSA third degree burn, treated with icatibant 20Y(g/kg/h). Fluid resuscitation was started immediately after burn or sham procedure according to the Parkland formula: 4YmlY(Y% burnY(Ykg body weight, for the first 24Yh and 2YmlY(Y% burnY(Ykg body weight, for the next 24Yh. Icatibant infusion started 1Yh after injury and was given continuously for the rest of the experimental period. Results: Prefemoral lymph flow did not increase in the sham animals but increased about eight-folds in the control group, about four-folds in the icatibant four group and about three-folds in icatibant 20 group at 48Yh. Total prefemoral protein leak was reduced in both treatment groups. However there was a dose dependent increase in heart rate in the treated animals.Conclusion: Icatibant moderates cutaneous microvascular permeability to fluid after 40% TBSA third degree burn in sheep. doi:10.1016/j.burns.2006.10.284 ˜ from 2001 to 2004 Physiotherapic procedures in the burnt unit of Hospital Infantil Joana de Gusmao ´ ˜ F.S.V. a,b , Martins M.A. a,b Tibola J. a,b , Pereima M.J.L. a,b , Honorio D.R. a,b , Kroeff M.S. a,b , Guimaraes a
Universidade do Estado de Santa Catarina, Brazil ˜ Brazil Hospital Infantil Joana de Gusmao, E-mail address: [email protected] (J. Tibola).
b
The thermal trauma constitutes a serious health problem that frequently reaches preschool children age. The survival tax increased in function of best treatment conditions and teams multidiscipline work, which include the physiotherapist. The ˜ in Florianopolis-SC ´ Hospital Infantil Joana de Gusmao, is a state reference for children burning attendance. The physiotherapic attendance in the burn unit (UQUE) is performed by professionals and students. A descriptive study was developed to analyze the number of physiotherapic burnt procedures with patients interned in UQUE, from 2001 to 2004. Data of 388 handbooks had been collected. In the analysis, we used descriptive statistics. It was analyzed that only 331, from those 388, presented the necessary data for this study. The internments numbers had been increasing in the first years, 26% average, until remain itself around 100 internments per year; conversely, the average of internment days in the period varied between 13 and 28. The physiotherapic procedures annual averages fell in about 70% and the average of procedures for patients remain falling around 79% in the same period, in such way, the patients who had not got some physiotherapic procedure reached to 40%. There were many factors that can justify the absence of physiotherapic procedures: (a) school vacations that moved away students from the hospital, (b) substitution of employees in the physiotherapic section, (c) break without professionals in the institution. It was proven that exist a deficit in the physiotherapic procedures. It has been known that precocity, and the physiotherapy continuity is important for rehabilitation success, being enough to the effective existence of operating physiotherapists in the UQUE. doi:10.1016/j.burns.2006.10.285 The Bradford burns chart part 1: Adults Asaad K. a,b,c,d , Khan A. a,b,c,d , Sillitoe A. a,b,c,d , Cox V. a,b,c,d , Rawlins J. a,b,c,d a
Bradford Plastic Surgery And Burns Research Unit, HG2 7AY, United Kingdom A and E Department, Bradford Royal Infirmary, BD9 6RJ, United Kingdom c Department of Plastic Surgery, Hull Royal Infirmary, HU3 2JZ, United Kingdom d Bradford Plastic Surgery and Burns Research Unit, BD9 6RJ, United Kingdom E-mail address: [email protected] (K. Asaad). b
Introduction: If the first doctor to assess a patient with major burns in an emergency department (ED) is not very experienced in their management, fluid resuscitation can be a source of confusion and error. To improve the initial management of major burns, we have devised a chart that clearly shows patients’ fluid requirements. Aims: We assessed the usefulness of a chart that showed the hourly fluid requirements for patients with burns of 15-80% TBSA and weights of 40-120Ykg. Materials and methods: Groups of ED doctors and plastic surgeons of all grades were given Lund and Browder charts with major burns marked on 10 patients. They were given the Parkland formula and asked to calculate the resuscitation requirements for half the patients. For the other half of patients, they were given the chart and asked to determine fluid requirements. Results: All doctors found that using the chart was easier than calculating the fluids. It resulted in 10% fewer errors. It was also 44% quicker. Comments were extremely favourable about the usefulness of the charts.