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Impaired neutrophil bactericidal activities
Burns (1988) 14, (6), 511-513
511
Printed in Great Britain
Abstracts CLINICAL STUDIES Lorazepam metabolism Although the hepatic metabolism of diazepam by the cytochrome P-450 oxidases (a phase I reaction) is impaired after burning injury, this seems not to be true for lorazepam which undergoes metabolism by conjugation (a phase II reaction). Studies in 10 burned children and 10 age-, weight- and sex-matched normal children given a bolus dose of lorazepam showed that compared with the control results there was a significantly increased rate of clearance of lorazepam from the plasma, an increased total volume of distribution and a significantly reduced biological half-life of the drug. These results all suggest that the elimination kinetics of lorazepam are not impaired and in fact may be enhanced in burned patients. Martyn J. and Greenblatt D. J. (1988) Lorazepam conjugation is unimpaired in burn trauma. Clin. PharmacoL Ther. 43, (3), 250-255.
Impaired neutrophil bactericidal activities The intracellular killing power of neutrophils from 16 burned patients was tested against organisms derived from themselves and against other laboratory organisms. Neutrophils from patients who survived had diminished intracellular killing capacity for their own organisms but normal capacity for killing laboratory organisms either matched or unmatched with the patients own isolates' species. In these patients the chemotactic index, the lymphocyte helper/suppressor ratio and the serum IgG concentrations remained within normal limits. In contrast, the neutrophils from patients who died failed to kill their own as well as laboratory organisms and their chemotactic index, lymphocyte helper/suppressor ratio and IgG concentrations were significantly diminished. Moran K. T., Allo M. M., O'Reilly T. J. et al. (1988) Neutrophol intracellular kill following thermal injury. Different bactericidal capability for patients' organisms and laboratory organisms. Arch. Surg. 123, (6), 686-688.
Anchorage of cultured epidermis The degree of adhesion of cultured epidermal autografts as late as 7 months after application and 'take' was compared with that of normal epidermis in one patient, after © 1988 Butterworth & Co (Publishers) Ltd 0305-4179/88/06051 I~)3 $03.00
all four patients who had been grafted with cultured epidermis showed evidence of limited adhesion (spontan.eous blister formation). A suction blistering technique showed that blisters formed from below the lamina dense of the basement membrane in cultured epidermal allo-. grafts after only 17rain, whereas normal epidermis did not blister until 65 min and then at a superficial plane of cleavage above the basal lamina. It was found that the reconstituted basement membrane zone beneath the cultured autograft was incomplete and lacked type IV basement membrane collagen 7-S sites and anchoring fibrils. Woodley D. T., Peterson H. D., Herzog S. R. et al. (1988) Burn wounds resurfaced by cultured epidermal autografts show abnormal reconstitution of anchoring fibrils. JAMA 259, (17), 2566-2571.
Lipid clearance factors in major burns The reasons for the impaired clearance of chylomicra from the plasma of some patients with very extensive burns was studied in 25 patients with burns covering an average of 52+ 6 per cent of the body surface area. Measurements of the plasma levels of lipids and apolipoproteins CII, CIII, E and A-I were measured prior to the administration of fat emulsions. The levels of plasma cholesterol and apolipoproteins CII, CIII and A-I were low, whereas the triglyceride levels were not abnormally elevated and the apolipoprotein E levels were normal. The reduced levels of apolipoproteins necessary for triglyceride metabolism may induce intolerance of exogenous triglycerides when they are given at high rates of administration. Vega G. L., Alaupovic P., Zhang Z. J. et al. (1988) Levels of co-factors for lipoprotein lipase and lecithincholesterol-acyltransferase in plasma from patients with severe thermal injury. J. Burn Care Rehabil. 9, (l), 18-21.
Chylomicra clearance from plasma The rate of clearance of chylomicrons from plasma was measured in 12 patients with burns covering between 28 and 84 per cent of the body surface area. Five of the patients with relatively small burns (38 + 9 per cent of the body surface area) had normal triglyceride levels both before and after the infusion of the fat emulsion and the biological half-life of the chylomicra was very short. In contrast, seven of the patients with an average burn size of
511
Printed in Great Britain
Abstracts CLINICAL STUDIES Lorazepam metabolism Although the hepatic metabolism of diazepam by the cytochrome P-450 oxidases (a phase I reaction) is impaired after burning injury, this seems not to be true for lorazepam which undergoes metabolism by conjugation (a phase II reaction). Studies in 10 burned children and 10 age-, weight- and sex-matched normal children given a bolus dose of lorazepam showed that compared with the control results there was a significantly increased rate of clearance of lorazepam from the plasma, an increased total volume of distribution and a significantly reduced biological half-life of the drug. These results all suggest that the elimination kinetics of lorazepam are not impaired and in fact may be enhanced in burned patients. Martyn J. and Greenblatt D. J. (1988) Lorazepam conjugation is unimpaired in burn trauma. Clin. PharmacoL Ther. 43, (3), 250-255.
Impaired neutrophil bactericidal activities The intracellular killing power of neutrophils from 16 burned patients was tested against organisms derived from themselves and against other laboratory organisms. Neutrophils from patients who survived had diminished intracellular killing capacity for their own organisms but normal capacity for killing laboratory organisms either matched or unmatched with the patients own isolates' species. In these patients the chemotactic index, the lymphocyte helper/suppressor ratio and the serum IgG concentrations remained within normal limits. In contrast, the neutrophils from patients who died failed to kill their own as well as laboratory organisms and their chemotactic index, lymphocyte helper/suppressor ratio and IgG concentrations were significantly diminished. Moran K. T., Allo M. M., O'Reilly T. J. et al. (1988) Neutrophol intracellular kill following thermal injury. Different bactericidal capability for patients' organisms and laboratory organisms. Arch. Surg. 123, (6), 686-688.
Anchorage of cultured epidermis The degree of adhesion of cultured epidermal autografts as late as 7 months after application and 'take' was compared with that of normal epidermis in one patient, after © 1988 Butterworth & Co (Publishers) Ltd 0305-4179/88/06051 I~)3 $03.00
all four patients who had been grafted with cultured epidermis showed evidence of limited adhesion (spontan.eous blister formation). A suction blistering technique showed that blisters formed from below the lamina dense of the basement membrane in cultured epidermal allo-. grafts after only 17rain, whereas normal epidermis did not blister until 65 min and then at a superficial plane of cleavage above the basal lamina. It was found that the reconstituted basement membrane zone beneath the cultured autograft was incomplete and lacked type IV basement membrane collagen 7-S sites and anchoring fibrils. Woodley D. T., Peterson H. D., Herzog S. R. et al. (1988) Burn wounds resurfaced by cultured epidermal autografts show abnormal reconstitution of anchoring fibrils. JAMA 259, (17), 2566-2571.
Lipid clearance factors in major burns The reasons for the impaired clearance of chylomicra from the plasma of some patients with very extensive burns was studied in 25 patients with burns covering an average of 52+ 6 per cent of the body surface area. Measurements of the plasma levels of lipids and apolipoproteins CII, CIII, E and A-I were measured prior to the administration of fat emulsions. The levels of plasma cholesterol and apolipoproteins CII, CIII and A-I were low, whereas the triglyceride levels were not abnormally elevated and the apolipoprotein E levels were normal. The reduced levels of apolipoproteins necessary for triglyceride metabolism may induce intolerance of exogenous triglycerides when they are given at high rates of administration. Vega G. L., Alaupovic P., Zhang Z. J. et al. (1988) Levels of co-factors for lipoprotein lipase and lecithincholesterol-acyltransferase in plasma from patients with severe thermal injury. J. Burn Care Rehabil. 9, (l), 18-21.
Chylomicra clearance from plasma The rate of clearance of chylomicrons from plasma was measured in 12 patients with burns covering between 28 and 84 per cent of the body surface area. Five of the patients with relatively small burns (38 + 9 per cent of the body surface area) had normal triglyceride levels both before and after the infusion of the fat emulsion and the biological half-life of the chylomicra was very short. In contrast, seven of the patients with an average burn size of