- Email: [email protected]
Unexplained resistance to non-depolarizing muscle relaxants
Burns (1989) Vol. Is/No.
344
PO, saturation of greater than 90 per cent on an FIo,of 60 per cent or less in five patients with severe inhalation injury, a prospective study of another 10 patients was carried out. Two of the patients could not be ventilated effectively and were removed from the study. The remaining eight patients with severe inhalation injury and a mean bum area of 38 per cent of the body surface area all survived after being ventilated at between 200 and 600 breaths per minute with the FIo, and PEEP being adjusted to maintain an oxygen saturation of greater than 90 per cent. Cioffi W. G., Graves T. A, McManus W. F. et al. (1989) High frequency percussive ventilation in patients with inhalation injury. J Trauma 29, (3) 350-354.
Granulocyte binding of kukotriene B, The specific binding of leukotriene B, was measured in polymorphonuclear granulocytes obtained from four patients with burns covering between 25 and 75 per cent of the body surface area. Compared with the response of normal polymorphonuclear granulocytes the cells from burned patients showed a decreased receptor expression, probably as a consequence of cellular preactivation. It was also found that leukotriene B, synthesis was reduced and differential counts showed a shift from segmented neutrophils to immature cells. In survivors the leukotriene B, binding returned to normal, whereas in non-survivors it always remained subnormal. Brom J., Keller M., Schoenfeld W. et al. (1989) Decreased expression of leukotriene B, receptor sites on polymorphonuclear granulocytes of severely burned patients. Prostugkrtrdins Lo&t. &sent. FaHy AL+%34, (3), 153-159.
Prediction of calorie requirements
Repeated measurements of measured energy expenditure were made in 122 patients with a wide range of burned areas using indirect calorimetry over the entire period of stay in hospital. These measurements were compared with various predictions derived from body size and extent of burns. It was found that for major burns exceeding 30 per cent of the body surface area twice the predicted resting metabolic energy expenditure in health was consistently dosest to the measured energy expenditure. When a nutritional energy input was given equal to twice the predicted resting metabolic requirement this minimized the risk of over feeding yet provided an adequate energy input. Cunningham J. J., Hegarty M. T., Meara P. A. et al. (1989) Measured and predicted calorie requirements of adults during recovery from severe bum trauma. Am. J. C/in. Nutr. 49, (31, 404408.
B lymphocytes, corticosteroids and the immune response The temporal relationships between serum and urine corticosteroid levels, the number of circulating B cells, the serum immunoglobulm levels and delayed hypersensitivity reactions were measured in 15 patients with extensive burns (mean= 50 per cent of body surface area). During the early postbum period there was an increased percentage of B lymphocytes compared with controls; this inaeased percentage gradually declined over the following 4 weeks irrespective of the clinical outcome. These B-cell changes were paralleled by changes in the urine content of I 7 hydroxy steroids. Serum IgG concentrations were low during the early postbum period in both survivors and non-survivors and returned to normal and then supranormal levels during the ensuing weeks. The delayed hypersensitivity skin test reactions were also
5
depressed in the early postburn period but returned to normal only in the survivors by the end of week 2 postburn. Kagan R. J., Bratescu A., Jonasson 0. et al. (1989) The relationship between the percentage of circulating B cells, corticosteroid levels and other immunologic parameters in thermally injured patients.]. Trauma 29, (2), 208-213.
New carbohydrate plasma expander Patients with burns covering between 25 and 85 per cent (mean = 39 per cent) of the body surface area received crysdloid solution plus 500 ml of 5 per cent albumin or 500 ml of 10 per cent pentastarch for early fluid resuscitation. This new hydroxyethyl starch was an effective plasma volume expander which resulted in increases of pre load, cardiac output, oxygen delivery and oxygen consumption. The haemodynamic effects of pentastarch infusions were equal or superior to those of albumin. Both pentastarch and albumin caused increased bleeding and clotting times, responses which were likely to be the result of dilution. Waxman K., Holness R., Tominaga G. et al (1989) Hemodynamic and oxygen transport effects of pentastarch in burn resuscitation. Ann. Surg 209, (3), 341-346.
ANIMAL
STUDIES
Oxidative metabolism of PMN leucocytes
The direct effect of burns and the indirect effect of burn serum on murine polymorphonuclear @MN) leucocyte oxidative metabolism was measured, after cell stim&tion, I,5 and 10 days after a bum covering 25 per cent of the body surface area. Chemiluminescence and H,O, production were measured and showed that oxidative metabolism of PMN leucocytes was clearly depressed on days 5 and IO after burn injury. Control PMN leucocytes in the presence of day 5 bum serum produced decreased levels of H,O,, which returned to normal by day 10. Gadd M. A. and Hansbrough J. F. (1989) The effect of thermal injury on murine neutrophil oxidative metabolism. J. Bum Care Rehubi~.10,(2) 125-130.
Allogeneic epidermis and graft rejection
Whereas skin equivalents containing allogeneic fibroblasts in a collagen matrix and overlaid with isologous epidennal cells have been grafted successfully in rodents, skin equivalents containing isologous fibroblasts and allogeneic epidermal cells provoked a strong rejection reaction. The rejection response was characterized by the infiltration of mononuclear cells after 1 week and occlusion of the miaovasculature and destruction of the epidermis by 2 weeks after grafting. Lemer-Tung M. 8. and Hull B. E. (1989) The role of allogeneic epidermis in murine graft rejection. J. Bum Cure Rddd. 10,(2), 151-155.
Unexplained resistance to non-depolarizing
muscle relaxants
The density of acetylcholine receptors and the activity of acetylcholinesterase were measured in rats with deep bums covering 30 per cent of the body surface area about 40 days after burning. The density and junctional to extrajunctional ratio of acetylcholine receptors in gastrocnemius and diaphragm was unchanged by burn injury. The total acetyfchofinesterase was unchanged in burned rats compared with controls. Separation of the molecular forms of acetylcholinesterase by suaose gradient centrifugation also showed no change in the relative proportions
34s
Abstracts
of these species. The resistance to non-depolarizing muscle relaxants after burns is still unexplained. Marathe P. H., Haschke R. H., Slattery J. T. et al. (1989) Acetylchohne receptor density and acetylcholinesterase activity in skeletal muscle of rats following thermal injury. Anesthesiology 70, (4) 654-659.
Metabolic response and wound bacteria Rats with deep burns covering 30 per cent of the body surface were studied with respect to resting oxygen consumption, colonic
temperature and the degree of bacterial wound colonization. When the wounds were seeded with non-virulent pseudomonas organisms (10~ cells) this treatment accelerated the metabolic and thermoregulatory responses; there was a significant correlation between wound bacterial counts and the increasing VO, in 44 non-bacteraemic animals. Changes in colonic temperature were unrelated to wound bacterial count but were correlated with changes in VO,. A&k L. H., Wroczyski F. A., Coil J. A. et al. (1989) Metabolic and thermoregulatory responses to burn wound colonization. J. Trauma 29, (4), 478-483.
Tanner-Vandeput Prize for Burn Research 1990 Award The 1990 Tanner-Vandeput Prize for Burn Research, consisting of a cash payment, will be awarded at the 8th International Congress on Burn Injuries of the ISBI, to be held November 11-16, 1990 in New Delhi, India. The Prize will go to a person or person who, in the opinion of the Prize Committee, has made a substantial and outstanding contribution to any aspect of the burn field in their lifetime (i.e.‘, a ‘senior investigator’s’ award). The recipient does not have to be a member of the ISBI or a physician, but be responsible for a major advancement in the treatment of burns. Nominations for the 1990 Prize may be made by colleagues of those who have made such a contribution to burn care in their lifetime. A candidate may also make an application on his own behalf. Anyone interested in applying for the 1990 Tanner-Vandeput Prize for Burn Research should send the following information to the ISBI Secretary-General at the address below.
Information required to apply for the Tanner-Vandeput
Prize for 1990:
?? Letter
of nomination (can be sent by candidate or by someone else) of work including samples and documentation 0 Current Curriculum Vitae 0 Letters of support from colleagues ?? Description
Send five copies of this information to: Dr. John A. Boswick, International Society for Bum Injuries, 2005 Franklin St. #660, Denver, Colorado 80205, USA. Tel (303) 839-1694. Deadline for receipt of applications: July 31, 1990
Information regarding the Tanner-Vandeput prize for burn research The Prize was established in 1984 by Dr J. C. Tanner of Atlanta, Georgia, co-inventor with Dr. Jacques Vandeput of the TannerVandeput Mesh Dermatome. This Prize was conceived and established to promote the aims of the International Society for Burn Injuries and to motivate individual investigators to do research, study, undertake patient care and treatment and other aspects of the burns problem, and will be awarded to one who has made a substantial contribution to burn care in their lifetime (a ‘senior investigator’s’ award). The Prize consists of a cash payment. A foundation was created for the sole purpose of awarding the Prize every four years and has separate funds invested to produce income used for the Prize. A trust fund is owned by the ‘International Burn Foundation of the United States,’ an organization entirely separate from
the ISBI. The funds do not overlap or mingle in any way with those of the ISBI. The only role the ISBI plays in the Tanner-Vandeput Prize is to coordinate and award the Prize for each Quadrennial Congress. The International Burn Foundation has a Board of Directors and a Prize Committee which reviews applications and makes recommendations for award of each Prize. The Prize Committee voted to award the first Tanner-Vandeput Prize, presented at the 7th International Congress held February 1986 in Melbourne, Australia to Dr Ian Alan Holder of the Shriners Burns Institute in Cincinnati, Ohio for his work on ‘Infection by Pseudomonas Aeruginosa.’ He was presented with a cash payment and a gold and diamond lapel pin signifying his achievement.
344
PO, saturation of greater than 90 per cent on an FIo,of 60 per cent or less in five patients with severe inhalation injury, a prospective study of another 10 patients was carried out. Two of the patients could not be ventilated effectively and were removed from the study. The remaining eight patients with severe inhalation injury and a mean bum area of 38 per cent of the body surface area all survived after being ventilated at between 200 and 600 breaths per minute with the FIo, and PEEP being adjusted to maintain an oxygen saturation of greater than 90 per cent. Cioffi W. G., Graves T. A, McManus W. F. et al. (1989) High frequency percussive ventilation in patients with inhalation injury. J Trauma 29, (3) 350-354.
Granulocyte binding of kukotriene B, The specific binding of leukotriene B, was measured in polymorphonuclear granulocytes obtained from four patients with burns covering between 25 and 75 per cent of the body surface area. Compared with the response of normal polymorphonuclear granulocytes the cells from burned patients showed a decreased receptor expression, probably as a consequence of cellular preactivation. It was also found that leukotriene B, synthesis was reduced and differential counts showed a shift from segmented neutrophils to immature cells. In survivors the leukotriene B, binding returned to normal, whereas in non-survivors it always remained subnormal. Brom J., Keller M., Schoenfeld W. et al. (1989) Decreased expression of leukotriene B, receptor sites on polymorphonuclear granulocytes of severely burned patients. Prostugkrtrdins Lo&t. &sent. FaHy AL+%34, (3), 153-159.
Prediction of calorie requirements
Repeated measurements of measured energy expenditure were made in 122 patients with a wide range of burned areas using indirect calorimetry over the entire period of stay in hospital. These measurements were compared with various predictions derived from body size and extent of burns. It was found that for major burns exceeding 30 per cent of the body surface area twice the predicted resting metabolic energy expenditure in health was consistently dosest to the measured energy expenditure. When a nutritional energy input was given equal to twice the predicted resting metabolic requirement this minimized the risk of over feeding yet provided an adequate energy input. Cunningham J. J., Hegarty M. T., Meara P. A. et al. (1989) Measured and predicted calorie requirements of adults during recovery from severe bum trauma. Am. J. C/in. Nutr. 49, (31, 404408.
B lymphocytes, corticosteroids and the immune response The temporal relationships between serum and urine corticosteroid levels, the number of circulating B cells, the serum immunoglobulm levels and delayed hypersensitivity reactions were measured in 15 patients with extensive burns (mean= 50 per cent of body surface area). During the early postbum period there was an increased percentage of B lymphocytes compared with controls; this inaeased percentage gradually declined over the following 4 weeks irrespective of the clinical outcome. These B-cell changes were paralleled by changes in the urine content of I 7 hydroxy steroids. Serum IgG concentrations were low during the early postbum period in both survivors and non-survivors and returned to normal and then supranormal levels during the ensuing weeks. The delayed hypersensitivity skin test reactions were also
5
depressed in the early postburn period but returned to normal only in the survivors by the end of week 2 postburn. Kagan R. J., Bratescu A., Jonasson 0. et al. (1989) The relationship between the percentage of circulating B cells, corticosteroid levels and other immunologic parameters in thermally injured patients.]. Trauma 29, (2), 208-213.
New carbohydrate plasma expander Patients with burns covering between 25 and 85 per cent (mean = 39 per cent) of the body surface area received crysdloid solution plus 500 ml of 5 per cent albumin or 500 ml of 10 per cent pentastarch for early fluid resuscitation. This new hydroxyethyl starch was an effective plasma volume expander which resulted in increases of pre load, cardiac output, oxygen delivery and oxygen consumption. The haemodynamic effects of pentastarch infusions were equal or superior to those of albumin. Both pentastarch and albumin caused increased bleeding and clotting times, responses which were likely to be the result of dilution. Waxman K., Holness R., Tominaga G. et al (1989) Hemodynamic and oxygen transport effects of pentastarch in burn resuscitation. Ann. Surg 209, (3), 341-346.
ANIMAL
STUDIES
Oxidative metabolism of PMN leucocytes
The direct effect of burns and the indirect effect of burn serum on murine polymorphonuclear @MN) leucocyte oxidative metabolism was measured, after cell stim&tion, I,5 and 10 days after a bum covering 25 per cent of the body surface area. Chemiluminescence and H,O, production were measured and showed that oxidative metabolism of PMN leucocytes was clearly depressed on days 5 and IO after burn injury. Control PMN leucocytes in the presence of day 5 bum serum produced decreased levels of H,O,, which returned to normal by day 10. Gadd M. A. and Hansbrough J. F. (1989) The effect of thermal injury on murine neutrophil oxidative metabolism. J. Bum Care Rehubi~.10,(2) 125-130.
Allogeneic epidermis and graft rejection
Whereas skin equivalents containing allogeneic fibroblasts in a collagen matrix and overlaid with isologous epidennal cells have been grafted successfully in rodents, skin equivalents containing isologous fibroblasts and allogeneic epidermal cells provoked a strong rejection reaction. The rejection response was characterized by the infiltration of mononuclear cells after 1 week and occlusion of the miaovasculature and destruction of the epidermis by 2 weeks after grafting. Lemer-Tung M. 8. and Hull B. E. (1989) The role of allogeneic epidermis in murine graft rejection. J. Bum Cure Rddd. 10,(2), 151-155.
Unexplained resistance to non-depolarizing
muscle relaxants
The density of acetylcholine receptors and the activity of acetylcholinesterase were measured in rats with deep bums covering 30 per cent of the body surface area about 40 days after burning. The density and junctional to extrajunctional ratio of acetylcholine receptors in gastrocnemius and diaphragm was unchanged by burn injury. The total acetyfchofinesterase was unchanged in burned rats compared with controls. Separation of the molecular forms of acetylcholinesterase by suaose gradient centrifugation also showed no change in the relative proportions
34s
Abstracts
of these species. The resistance to non-depolarizing muscle relaxants after burns is still unexplained. Marathe P. H., Haschke R. H., Slattery J. T. et al. (1989) Acetylchohne receptor density and acetylcholinesterase activity in skeletal muscle of rats following thermal injury. Anesthesiology 70, (4) 654-659.
Metabolic response and wound bacteria Rats with deep burns covering 30 per cent of the body surface were studied with respect to resting oxygen consumption, colonic
temperature and the degree of bacterial wound colonization. When the wounds were seeded with non-virulent pseudomonas organisms (10~ cells) this treatment accelerated the metabolic and thermoregulatory responses; there was a significant correlation between wound bacterial counts and the increasing VO, in 44 non-bacteraemic animals. Changes in colonic temperature were unrelated to wound bacterial count but were correlated with changes in VO,. A&k L. H., Wroczyski F. A., Coil J. A. et al. (1989) Metabolic and thermoregulatory responses to burn wound colonization. J. Trauma 29, (4), 478-483.
Tanner-Vandeput Prize for Burn Research 1990 Award The 1990 Tanner-Vandeput Prize for Burn Research, consisting of a cash payment, will be awarded at the 8th International Congress on Burn Injuries of the ISBI, to be held November 11-16, 1990 in New Delhi, India. The Prize will go to a person or person who, in the opinion of the Prize Committee, has made a substantial and outstanding contribution to any aspect of the burn field in their lifetime (i.e.‘, a ‘senior investigator’s’ award). The recipient does not have to be a member of the ISBI or a physician, but be responsible for a major advancement in the treatment of burns. Nominations for the 1990 Prize may be made by colleagues of those who have made such a contribution to burn care in their lifetime. A candidate may also make an application on his own behalf. Anyone interested in applying for the 1990 Tanner-Vandeput Prize for Burn Research should send the following information to the ISBI Secretary-General at the address below.
Information required to apply for the Tanner-Vandeput
Prize for 1990:
?? Letter
of nomination (can be sent by candidate or by someone else) of work including samples and documentation 0 Current Curriculum Vitae 0 Letters of support from colleagues ?? Description
Send five copies of this information to: Dr. John A. Boswick, International Society for Bum Injuries, 2005 Franklin St. #660, Denver, Colorado 80205, USA. Tel (303) 839-1694. Deadline for receipt of applications: July 31, 1990
Information regarding the Tanner-Vandeput prize for burn research The Prize was established in 1984 by Dr J. C. Tanner of Atlanta, Georgia, co-inventor with Dr. Jacques Vandeput of the TannerVandeput Mesh Dermatome. This Prize was conceived and established to promote the aims of the International Society for Burn Injuries and to motivate individual investigators to do research, study, undertake patient care and treatment and other aspects of the burns problem, and will be awarded to one who has made a substantial contribution to burn care in their lifetime (a ‘senior investigator’s’ award). The Prize consists of a cash payment. A foundation was created for the sole purpose of awarding the Prize every four years and has separate funds invested to produce income used for the Prize. A trust fund is owned by the ‘International Burn Foundation of the United States,’ an organization entirely separate from
the ISBI. The funds do not overlap or mingle in any way with those of the ISBI. The only role the ISBI plays in the Tanner-Vandeput Prize is to coordinate and award the Prize for each Quadrennial Congress. The International Burn Foundation has a Board of Directors and a Prize Committee which reviews applications and makes recommendations for award of each Prize. The Prize Committee voted to award the first Tanner-Vandeput Prize, presented at the 7th International Congress held February 1986 in Melbourne, Australia to Dr Ian Alan Holder of the Shriners Burns Institute in Cincinnati, Ohio for his work on ‘Infection by Pseudomonas Aeruginosa.’ He was presented with a cash payment and a gold and diamond lapel pin signifying his achievement.