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Measurements of intestinal permeability
Bums (1992) 18, (4), 349-350
Printed in Greuf Britain
349
Abstracts CLINICAL STUDIES Nystatin effectively treats Candida infections In two groups of patients of comparable ages, mean burn sizes and mean areas of full thickness skin burns, the administration of nystatin orally and topically to the bum wound reduced the incidence of Candida cdonimfion from 26.7 per cent to 15.6 per cent, reduced the incidence of Candida infection from 21.3 per cent to 10.0 per cent, and reduced the incidence of Candida sepsis from 12.2 per cent to zero. Desai M. H., Rutan R. L., Heggers J. P. et al. (1992) Candida infection with and without nystatin prophylaxis. An 11 year experience with patients with bum injury. Arch. Swg. 127, (2), 159-162.
Jndocyanine green estimates of burn depth Partial and full skin depth thermal injuries have been differentiated using the infrared (840-850~1) fluorescence emission from intravenously given indocyanine green following excitation of the dye with infrared (780~1) and ultraviolet (369nm) radiations. The infrared and UV-induced fluorescence intensity ratios relative to normal unburned skin immediately after the burn and on postbum days 1, 3 and 7 distinguished between full and partial thickness skin injuries, Green H. A., Bua D., Anderson R. R. et al. (1992) Burn depth estimation using indocyanine green fluorescence. Arch. Dermzfol. 128, (1X 43-49.
Measurements of intestinal permeability Lactulose and mannitol were used to determine the degree of intestinal permeability in 10 normal individuals and in 15 patients during the first 2 weeks after thermal injuries covering about half the body surface area. The lactulose to mannitol excretion ratio was 0.159 f 0.017 for the patients and 0.017 f 0.003 for the controls. The increased ratio did not correlate with the size of the bums or the time after injury. Patients who developed significant clinical infections during the period of study had lactulose to mannitol ratios on the second day after burning, which were significantly higher than those of the controls and those observed in the patients who did not develop infections. LeVoyer T., Cioffi W. G., Pratt L. et al. (1992) Alterations in intestinal permeability after thermal injury. Arch. Surg. 127, (I), 26-30.
Long-term smoke inhalation-induced defects Clinical assessments made at 6 months after the smoke inhalation injury occurring during the Rings Cross underground station fire showed the persistence of hoarseness, cough, breathlessness and exacerbated asthma. Eighteen months later ventilatory studies in 10 victims showed peak expiratory flows, spirometric indices and carbon monoxide transfer factors which were within the predicted normal ranges. However, the mean residual volume was supranormal and the mean maximal expiratory flow at 25 per cent of vital capacity was subnormal, with no significant differences 0 1992 Butterworth-Heinemann 0305-4179/92/040349-02
Ltd
between the tobacco smokers and non-smokers. At least one of these ventilator-y defects, suggesting obstruction of the small airways, was present in 11 survivors at 6 months and they persisted in the 7 patients who were reassessed at 2 years. Fogarty P.W ,, George P. J. M., Solomon M. et al. (1991) Long term effects of smoke inhalation in survivors of the Rings Cross underground station fire. Z%horu.r 46, (12) 914-918.
Zinc metabolism following burns Patients with severe bums have markedly elevated urinary zinc excretions, although with burns covering more than 20 per cent TBSA the severity did not correlate with the urine zinc content. Serum zinc concentrations were depressed early after injury and then gradually increased during the subsequent weeks, whereas the peak urinary zinc excretion occurred between 2 and 5 weeks postbum. These serum and urine zinc levels were not temporally related. The urine zinc contents were not temporally related to the urine contents of cysteine, histidine and J-methyl histidine, whereas they were related to the urine amylase contents. An increased oral intake of zinc increased the urinary zinc content. Patients receiving total parenteral nutrition did not have significantly increased urinary zinc excretions compared with people receiving their total nutritional intakes by mouth. Boosalis M. G., Solem L. D., Cerra F. B. et al. (1991) Increased urinary zinc excretion after thermal injury. 1. Lab. Clin. Med. 118, (6), 538-545.
ANIMAL STUDIES Repair of bum-induced gut mucosal injury Rats with either 20 per cent or 60 per cent TBSA bums or no bums were studied at 0, 3, 12, 24 and 48 h for proximal and distal small bowel mucosal weight, DNA content, protein content and omithine decarboxylase (ODC) activity. Gut mucosal ODC messenger ribonucleic acid (mRNA) levels were also measured. Bum injury caused significant atrophy of the gut mucosa by 12 h postbum, with restoration evident by 48 h postbum. ODC activity was increased in the proximal small bowel at 12 hand 24 h postbum in the rats in both the 20 and 60 per cent TBSA groups. In contrast, only rats in the 60 per cent group had raised ODC activity in the distal small bowel. ODC mRNA levels increased in the proximal gut mucosa as early as 3 h postbum and returned to control values after 24 h. Chung D. H., Evers B. M., Townsend C. M. et al. (1992) Burn-induced transcriptional regulation of small intestinal omithine decarboxylase. Am. 1. Strrg, 163, (I), 157-163.
Immunological effects of interleukin 6 Mice were given interleukin 6 to produce the levels found in the serum of burned patients. At these dose levels the interleukin 6 inhibited T-cell proliferation. The inhibitory effect was dose and time dependent, it was specific for T cells, was not due to impairment of interleukin 2 production or interleukin 2 receptor
Printed in Greuf Britain
349
Abstracts CLINICAL STUDIES Nystatin effectively treats Candida infections In two groups of patients of comparable ages, mean burn sizes and mean areas of full thickness skin burns, the administration of nystatin orally and topically to the bum wound reduced the incidence of Candida cdonimfion from 26.7 per cent to 15.6 per cent, reduced the incidence of Candida infection from 21.3 per cent to 10.0 per cent, and reduced the incidence of Candida sepsis from 12.2 per cent to zero. Desai M. H., Rutan R. L., Heggers J. P. et al. (1992) Candida infection with and without nystatin prophylaxis. An 11 year experience with patients with bum injury. Arch. Swg. 127, (2), 159-162.
Jndocyanine green estimates of burn depth Partial and full skin depth thermal injuries have been differentiated using the infrared (840-850~1) fluorescence emission from intravenously given indocyanine green following excitation of the dye with infrared (780~1) and ultraviolet (369nm) radiations. The infrared and UV-induced fluorescence intensity ratios relative to normal unburned skin immediately after the burn and on postbum days 1, 3 and 7 distinguished between full and partial thickness skin injuries, Green H. A., Bua D., Anderson R. R. et al. (1992) Burn depth estimation using indocyanine green fluorescence. Arch. Dermzfol. 128, (1X 43-49.
Measurements of intestinal permeability Lactulose and mannitol were used to determine the degree of intestinal permeability in 10 normal individuals and in 15 patients during the first 2 weeks after thermal injuries covering about half the body surface area. The lactulose to mannitol excretion ratio was 0.159 f 0.017 for the patients and 0.017 f 0.003 for the controls. The increased ratio did not correlate with the size of the bums or the time after injury. Patients who developed significant clinical infections during the period of study had lactulose to mannitol ratios on the second day after burning, which were significantly higher than those of the controls and those observed in the patients who did not develop infections. LeVoyer T., Cioffi W. G., Pratt L. et al. (1992) Alterations in intestinal permeability after thermal injury. Arch. Surg. 127, (I), 26-30.
Long-term smoke inhalation-induced defects Clinical assessments made at 6 months after the smoke inhalation injury occurring during the Rings Cross underground station fire showed the persistence of hoarseness, cough, breathlessness and exacerbated asthma. Eighteen months later ventilatory studies in 10 victims showed peak expiratory flows, spirometric indices and carbon monoxide transfer factors which were within the predicted normal ranges. However, the mean residual volume was supranormal and the mean maximal expiratory flow at 25 per cent of vital capacity was subnormal, with no significant differences 0 1992 Butterworth-Heinemann 0305-4179/92/040349-02
Ltd
between the tobacco smokers and non-smokers. At least one of these ventilator-y defects, suggesting obstruction of the small airways, was present in 11 survivors at 6 months and they persisted in the 7 patients who were reassessed at 2 years. Fogarty P.W ,, George P. J. M., Solomon M. et al. (1991) Long term effects of smoke inhalation in survivors of the Rings Cross underground station fire. Z%horu.r 46, (12) 914-918.
Zinc metabolism following burns Patients with severe bums have markedly elevated urinary zinc excretions, although with burns covering more than 20 per cent TBSA the severity did not correlate with the urine zinc content. Serum zinc concentrations were depressed early after injury and then gradually increased during the subsequent weeks, whereas the peak urinary zinc excretion occurred between 2 and 5 weeks postbum. These serum and urine zinc levels were not temporally related. The urine zinc contents were not temporally related to the urine contents of cysteine, histidine and J-methyl histidine, whereas they were related to the urine amylase contents. An increased oral intake of zinc increased the urinary zinc content. Patients receiving total parenteral nutrition did not have significantly increased urinary zinc excretions compared with people receiving their total nutritional intakes by mouth. Boosalis M. G., Solem L. D., Cerra F. B. et al. (1991) Increased urinary zinc excretion after thermal injury. 1. Lab. Clin. Med. 118, (6), 538-545.
ANIMAL STUDIES Repair of bum-induced gut mucosal injury Rats with either 20 per cent or 60 per cent TBSA bums or no bums were studied at 0, 3, 12, 24 and 48 h for proximal and distal small bowel mucosal weight, DNA content, protein content and omithine decarboxylase (ODC) activity. Gut mucosal ODC messenger ribonucleic acid (mRNA) levels were also measured. Bum injury caused significant atrophy of the gut mucosa by 12 h postbum, with restoration evident by 48 h postbum. ODC activity was increased in the proximal small bowel at 12 hand 24 h postbum in the rats in both the 20 and 60 per cent TBSA groups. In contrast, only rats in the 60 per cent group had raised ODC activity in the distal small bowel. ODC mRNA levels increased in the proximal gut mucosa as early as 3 h postbum and returned to control values after 24 h. Chung D. H., Evers B. M., Townsend C. M. et al. (1992) Burn-induced transcriptional regulation of small intestinal omithine decarboxylase. Am. 1. Strrg, 163, (I), 157-163.
Immunological effects of interleukin 6 Mice were given interleukin 6 to produce the levels found in the serum of burned patients. At these dose levels the interleukin 6 inhibited T-cell proliferation. The inhibitory effect was dose and time dependent, it was specific for T cells, was not due to impairment of interleukin 2 production or interleukin 2 receptor