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Monocyte chemotaxis in burns
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was 4-7 times better than the loose coverall or gown in preventing the soiling of clothes worn underneath it, but appeared to permit substantially more transfer from garments underneath it to a mock 'patient' and to the air than did the looser garments. A cotton gown reduced the soiling of clothes underneath it by more than 10 times and the contamination of a mock patient by more than 30 times as compared with no barrier garment. The close coverall further diminished the contamination of clothes but not the transfer to the patient. The possible mechanisms for the discrepancy between particle transmission tests and experimental procedures have still to be determined. Hambraeus A. and Ransj6 U. (1977) Attempts to control clothes-borne infection in a burn unit. I. Experimental investigations of some clothes for barrier nursing, or. Hyg. (Camb.) 79, 193.
T lymphocytes after major burns The ability of lymphocytes to form rosettes with sheep erythrocytes was studied in the acute burn period to estimate the number of T lymphocytes. Seventeen adult patients with burns of greater than 15 per cent of the body surface were studied serially and compared with normal controls. The absolute number of total rosette-forming cells averaged 1229.4.93 per mm 3 in control individuals. In the burned patients a conspicuous decrease in the absolute number of total rosette-forming cells occurred at 3-5 days after burning (578 -4-144 per m m 8; P < 0-001) and during the 6-10-day period (800-4-106 per mm3; P<0.01). Similarly, the percentage of total rosetteforming cells in patients at days 6-10 (49-4-3 per cent) was significantly lower than in the controls (74-4-0"7 per cent; P<0.01). The decrease in total rosetteforming cells did not correlate with the total lymphocyte count or the cortisol level. The findings suggest that the numbers of T lymphocytes are decreased or have altered rosette-forming ability in the early post-burn period, agreeing with other reports of impaired cellular immunity following burns. Neilan B. A., Taddeini L. and Strate R. G. (1977) T lymphocyte rosette formation after major burns. J A M A 238, 493.
Monocyte chemotaxis in burns Sepsis is the leading cause of morbidity and mortality in severely burned patients. Since normal monocyte function is essential to host defence, the chemotactic responses of monocytes from 25 burned patients were measured in vitro. Patients with burns covering Jess than 20 per cent of the body surface had normal monocyte chemotaxis, while monocytes from patients with burns of greater than 20 per cent had depressed chemotaxis. This defect was most marked in patients
Burns Vol. 4/No. 3
with burns exceeding 40 per cent of the body surface. Analysis of the data showed that monocyte chemotaxis in patients with the burns which exceeded 40 per cent was initially near normal, showed a maximum depression during the sixth week after burning and then gradually returned to normal. These studies indicate that the degree of depression of monocyte chemotaxis is proportional to the extent of the burn. Altman L. C., Klebanoff S. J. and Curreri P. W. (1977) Abnormalities of monocyte chemotaxis following thermal injury. J. Surg. Res. 22, 616.
T and B lymphocyte changes Lymphocytes have been counted by E rosette assay for T lymphocytes and by EA and EAC rosette assay for B lymphocytes in 49 burned patients sequentially for 30 days following injury. The patients were separated into different groups according to the severity of the burn and whether pseudomonas sepsis was present or not. Significant depressions in T lymphocyte percentages and counts per m m 3 were seen in the early post-burn period, the magnitude of which increased with increasing burn severity. There was a trend towards elevated levels of EAC rosetting cells in mild to moderate injury, but there was an absolute depression in severe injury. Extreme depressions of T lymphocytes have been seen consistently in patients who coincidentally developed clinical evidence of pseudomonas sepsis. Volonec F. J., Man± M. M., Clark G. M. et al. (1977) Peripheral blood T and B lymphocytes in patients with burns. II. Sequential rosette analyses considering burn severity and pseudomonas sepsis. Burns 4, 7.
SURGICAL TECHNIQUES Dermabrasion ddbridement Dermabrasion d~bridement is presented as another method of tangential excision of 'deep dermal' burns, with immediate or early skin grafting. The advantages in selected patients appear to be (a) more rapid healing, (b) a more stable end result because of the presence of dermis, (c) the prevention of spontaneous healing with unstable epithelium, hypertrophic scarring and contractures and (d) a better final appearance. The operation is technically easy with minimum blood loss. Krant S. M. and Arons M. S. (1977) Dermabrasion d6bridement of the deep dermal burn. Plast. Reconstr. Surg. 60, 68. Abstracts compiled by J. W. L. Davies, DSc, M R C Burns Research Unit, Birmingham Accident Hospital, Bath Row, Birmingham, B15 1NA.
was 4-7 times better than the loose coverall or gown in preventing the soiling of clothes worn underneath it, but appeared to permit substantially more transfer from garments underneath it to a mock 'patient' and to the air than did the looser garments. A cotton gown reduced the soiling of clothes underneath it by more than 10 times and the contamination of a mock patient by more than 30 times as compared with no barrier garment. The close coverall further diminished the contamination of clothes but not the transfer to the patient. The possible mechanisms for the discrepancy between particle transmission tests and experimental procedures have still to be determined. Hambraeus A. and Ransj6 U. (1977) Attempts to control clothes-borne infection in a burn unit. I. Experimental investigations of some clothes for barrier nursing, or. Hyg. (Camb.) 79, 193.
T lymphocytes after major burns The ability of lymphocytes to form rosettes with sheep erythrocytes was studied in the acute burn period to estimate the number of T lymphocytes. Seventeen adult patients with burns of greater than 15 per cent of the body surface were studied serially and compared with normal controls. The absolute number of total rosette-forming cells averaged 1229.4.93 per mm 3 in control individuals. In the burned patients a conspicuous decrease in the absolute number of total rosette-forming cells occurred at 3-5 days after burning (578 -4-144 per m m 8; P < 0-001) and during the 6-10-day period (800-4-106 per mm3; P<0.01). Similarly, the percentage of total rosetteforming cells in patients at days 6-10 (49-4-3 per cent) was significantly lower than in the controls (74-4-0"7 per cent; P<0.01). The decrease in total rosetteforming cells did not correlate with the total lymphocyte count or the cortisol level. The findings suggest that the numbers of T lymphocytes are decreased or have altered rosette-forming ability in the early post-burn period, agreeing with other reports of impaired cellular immunity following burns. Neilan B. A., Taddeini L. and Strate R. G. (1977) T lymphocyte rosette formation after major burns. J A M A 238, 493.
Monocyte chemotaxis in burns Sepsis is the leading cause of morbidity and mortality in severely burned patients. Since normal monocyte function is essential to host defence, the chemotactic responses of monocytes from 25 burned patients were measured in vitro. Patients with burns covering Jess than 20 per cent of the body surface had normal monocyte chemotaxis, while monocytes from patients with burns of greater than 20 per cent had depressed chemotaxis. This defect was most marked in patients
Burns Vol. 4/No. 3
with burns exceeding 40 per cent of the body surface. Analysis of the data showed that monocyte chemotaxis in patients with the burns which exceeded 40 per cent was initially near normal, showed a maximum depression during the sixth week after burning and then gradually returned to normal. These studies indicate that the degree of depression of monocyte chemotaxis is proportional to the extent of the burn. Altman L. C., Klebanoff S. J. and Curreri P. W. (1977) Abnormalities of monocyte chemotaxis following thermal injury. J. Surg. Res. 22, 616.
T and B lymphocyte changes Lymphocytes have been counted by E rosette assay for T lymphocytes and by EA and EAC rosette assay for B lymphocytes in 49 burned patients sequentially for 30 days following injury. The patients were separated into different groups according to the severity of the burn and whether pseudomonas sepsis was present or not. Significant depressions in T lymphocyte percentages and counts per m m 3 were seen in the early post-burn period, the magnitude of which increased with increasing burn severity. There was a trend towards elevated levels of EAC rosetting cells in mild to moderate injury, but there was an absolute depression in severe injury. Extreme depressions of T lymphocytes have been seen consistently in patients who coincidentally developed clinical evidence of pseudomonas sepsis. Volonec F. J., Man± M. M., Clark G. M. et al. (1977) Peripheral blood T and B lymphocytes in patients with burns. II. Sequential rosette analyses considering burn severity and pseudomonas sepsis. Burns 4, 7.
SURGICAL TECHNIQUES Dermabrasion ddbridement Dermabrasion d~bridement is presented as another method of tangential excision of 'deep dermal' burns, with immediate or early skin grafting. The advantages in selected patients appear to be (a) more rapid healing, (b) a more stable end result because of the presence of dermis, (c) the prevention of spontaneous healing with unstable epithelium, hypertrophic scarring and contractures and (d) a better final appearance. The operation is technically easy with minimum blood loss. Krant S. M. and Arons M. S. (1977) Dermabrasion d6bridement of the deep dermal burn. Plast. Reconstr. Surg. 60, 68. Abstracts compiled by J. W. L. Davies, DSc, M R C Burns Research Unit, Birmingham Accident Hospital, Bath Row, Birmingham, B15 1NA.