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Tryptophan and albumin synthesis
Burns, 5, 353-355
353
Printed in Great Britain
Abstracts CLINICAL STUDIES Tryptophan and albumin synthesis Studies in 10 patients with moderate to severe burns indicated that during the acute phase, and when they were receiving an average diet containing 1-2 g of tryptophan, there was a direct relationship between the plasma levels of albumin and tryptophan. The concentrations of both compounds were subnormal during weeks 1 and 2 post burn, i.e. during the phase of hypercatabolism; the concentrations of both compounds returned to normal during weeks 3 to 5 post burn when healing of the burned area was occurring at an optimal rate. When 10 other patients with comparable burned areas received tryptophan supplements of 10 g per day given orally, the plasma albumin concentrations increase to levels greater than those seen in the patients not receiving the tryptophan supplements. In addition the patients receiving extra tryptophan were in a better nutritional state, their tranquillity was enhanced and their apprehension was reduced. Pennisi V. R., Pennisi V. M., Wyatt J. et al. (1978) The relationship of tryptophan and albumin in the acute burn patients: preliminary observations. Burns 5, 174.
Natural anticoagulant activity Heparin cofactor, the major natural anticoagulant in human plasma, was measured in the plasma from 20 patients with burns covering between 7 and 95 per cent of the body surface and in rats with full-thickness burns covering 30 per cent of the body surface. Heparin cofactor behaved like an acute-phase reactant protein following burning, with an early increase in concentration followed by a slower return to normal in the relatively minor burns. In the more extensive burns the activity decreased to markedly subnormal values during the weeks post burn, associated with gross infection with Gram-negative bacteria, coagulation changes suggestive of intravascular coagulation and a mortality rate of 70 per cent. A similar pattern of results was observed in the burned rats. Braunstein K. M., Dodds K. A., Stewart G. et al. (1978) Heparin cofactor activity following thermal injury. Am. J. Clin. Pathol. 70, 632.
Amikacin therapy Extended periods (6-9 h) of subtherapeutic serum amikacin levels were observed in 5 burned patients receiving the recommended intravenous dose of 7.5 mg/kg body weight every 12 h. Kinetic studies revealed an unusually short half-life, especially in younger patients. This more rapid elimination required administration of amikacin every 6 h, resulting in an increased daily dose of 30 mg/kg per day. In a study of 10 patients with normal renal function, 7"5 mg/kg every 6 h caused peak therapeutic concentrations and shortened periods of subtherapeutic serum concentrations. A transient episode of tinnitus without cochlear damage occurred in one patient after the first dose. Neither ototoxicity nor nephrotoxicity occurred in any of the patients. Because of variability between patients in elimination of amikacin frequent monitoring of serum levels is required to maintain an optimal therapeutic level. Zaske D. E., Sawchuk R. J. and Strate R. G. (1978) The necessity of increased doses of amikacin in burn patients. Surgery 84, 603.
Neutrophil bactericidal function The bactericidal capacity of polymorphonuclear leucocytes was studied in 30 patients (age range 1-70 yr) with burned areas covering between 7 and 95 per cent of the body surface, and receiving either 0.5 per cent silver nitrate solution or silver sulphadiazine. Tests against Staphylococcus aureus (coagulase positive) and Pseudomonas aeruginosa before and after applying the silver compounds to the burn wound showed that bactericidal capacity was decreased by the burn injury and that this dysfunction was enhanced by both the silver compounds used for topical treatment. Yetgin S., Haberal M. and Bilgin N. (1978) Bactericidal function of neutrophils in burned patients. Burns 5, 188.
Pulmonary catheters and endocarditis The post-mortem finding of acute right sided bacterial endocarditis in a burn patient monitored with an indwelling pulmonary artery (Swan-Ganz) catheter for 14 days prompted a review of burn autopsies in which the catheter had been used. Autopsies of 6 consecutive burn patients monitored with a pulmonary
353
Printed in Great Britain
Abstracts CLINICAL STUDIES Tryptophan and albumin synthesis Studies in 10 patients with moderate to severe burns indicated that during the acute phase, and when they were receiving an average diet containing 1-2 g of tryptophan, there was a direct relationship between the plasma levels of albumin and tryptophan. The concentrations of both compounds were subnormal during weeks 1 and 2 post burn, i.e. during the phase of hypercatabolism; the concentrations of both compounds returned to normal during weeks 3 to 5 post burn when healing of the burned area was occurring at an optimal rate. When 10 other patients with comparable burned areas received tryptophan supplements of 10 g per day given orally, the plasma albumin concentrations increase to levels greater than those seen in the patients not receiving the tryptophan supplements. In addition the patients receiving extra tryptophan were in a better nutritional state, their tranquillity was enhanced and their apprehension was reduced. Pennisi V. R., Pennisi V. M., Wyatt J. et al. (1978) The relationship of tryptophan and albumin in the acute burn patients: preliminary observations. Burns 5, 174.
Natural anticoagulant activity Heparin cofactor, the major natural anticoagulant in human plasma, was measured in the plasma from 20 patients with burns covering between 7 and 95 per cent of the body surface and in rats with full-thickness burns covering 30 per cent of the body surface. Heparin cofactor behaved like an acute-phase reactant protein following burning, with an early increase in concentration followed by a slower return to normal in the relatively minor burns. In the more extensive burns the activity decreased to markedly subnormal values during the weeks post burn, associated with gross infection with Gram-negative bacteria, coagulation changes suggestive of intravascular coagulation and a mortality rate of 70 per cent. A similar pattern of results was observed in the burned rats. Braunstein K. M., Dodds K. A., Stewart G. et al. (1978) Heparin cofactor activity following thermal injury. Am. J. Clin. Pathol. 70, 632.
Amikacin therapy Extended periods (6-9 h) of subtherapeutic serum amikacin levels were observed in 5 burned patients receiving the recommended intravenous dose of 7.5 mg/kg body weight every 12 h. Kinetic studies revealed an unusually short half-life, especially in younger patients. This more rapid elimination required administration of amikacin every 6 h, resulting in an increased daily dose of 30 mg/kg per day. In a study of 10 patients with normal renal function, 7"5 mg/kg every 6 h caused peak therapeutic concentrations and shortened periods of subtherapeutic serum concentrations. A transient episode of tinnitus without cochlear damage occurred in one patient after the first dose. Neither ototoxicity nor nephrotoxicity occurred in any of the patients. Because of variability between patients in elimination of amikacin frequent monitoring of serum levels is required to maintain an optimal therapeutic level. Zaske D. E., Sawchuk R. J. and Strate R. G. (1978) The necessity of increased doses of amikacin in burn patients. Surgery 84, 603.
Neutrophil bactericidal function The bactericidal capacity of polymorphonuclear leucocytes was studied in 30 patients (age range 1-70 yr) with burned areas covering between 7 and 95 per cent of the body surface, and receiving either 0.5 per cent silver nitrate solution or silver sulphadiazine. Tests against Staphylococcus aureus (coagulase positive) and Pseudomonas aeruginosa before and after applying the silver compounds to the burn wound showed that bactericidal capacity was decreased by the burn injury and that this dysfunction was enhanced by both the silver compounds used for topical treatment. Yetgin S., Haberal M. and Bilgin N. (1978) Bactericidal function of neutrophils in burned patients. Burns 5, 188.
Pulmonary catheters and endocarditis The post-mortem finding of acute right sided bacterial endocarditis in a burn patient monitored with an indwelling pulmonary artery (Swan-Ganz) catheter for 14 days prompted a review of burn autopsies in which the catheter had been used. Autopsies of 6 consecutive burn patients monitored with a pulmonary