Burns : journal of the International Society for Burn Injuries
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The key decision in the treatment of thermal injuries is the determination of the depth of the burn wound and the resultant decision on treatment options. The trend in the treatment of deep dermal and full thickness burns is toward very early excision and grafting to reduce the risk of infection, decrease scar formation, shorten hospital stay, and thereby reducing costs. Traditionally, this has involved serial clinical examinations, which involves primarily subjective judgment. ⋯ In conclusion, ICG video angiography seems to be a practical method to describe vascular patency in a burn wound. The results indicate that ICG fluorescence angiography is a practical, accurate, and effective adjunct to clinical methods for estimating burn wound depth and thereby to assist in the rational assessment of treatment options. Furthermore, it allows an objective, qualitative and quantitative observation of the dynamic changes in burn wound depth, which are observed during the acute post-burn period, thereby indicating optimal timing of the first operation.
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This study was designed to assess intestinal drug transport via transcellular absorption and intestinal P-glycoprotein content following thermal injury in rats using propranolol as a marker substrate. Male, Sprague Dawley rats (n=30) underwent either a 30% total body surface area full thickness burn or sham treatment. Twenty-four hours later, animals were anesthetized, underwent laparotomy and the proximal jejunum was cannulated. ⋯ P-glycoprotein and villin content in the jejunum were significantly decreased in burn animals. The transcellular transport of propranolol is unaffected 24h following thermal injury in rats, despite alterations in intestinal P-glycoprotein content. The decrease in P-glycoprotein and villin content in thermally injured animals may reflect loss of mature enterocytes at the villus tips.
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To evaluate the roles of ischemia and hypoxia in the development of post-burn cardiac shock and its molecular pathogenesis. ⋯ The findings of the present study suggest severe myocardial damage due to ischemia and hypoxia following burns; promotion of myocardial NF-kappaB activity and TNFalpha mRNA expression in myocardium may be an important factor in the development of post-burn cardiac shock.
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Despite histamine being a potent endogenous vasoactive agent released in increasing amounts postburn, its role in postburn oedema formation has been controversial and its effect on burn circulation poorly investigated. The present study investigated the involvement of H(1), H(2) and H(3) receptors in postburn edema in rats exposed to skin and muscle burns and their influence on skin circulation postburn. We used the selective antagonists clemastine (H(1)), ranitidine (H(2)), thioperamide (H(3)) and the selective H(3) receptor agonist, imetit. ⋯ Moreover, imetit significantly (P<0.01) increased mean arterial pressure while thioperamide significantly (P<0.01) reduced systemic pressure. In conclusion, H(1), H(2) and H(3) receptors are not important actors in the regulation of vascular patency permeability, whereas H(3) receptors play an important role by increasing skin circulation postburn, presumably by relaxation of vascular smooth muscle and/or by interacting with other inflammatory neurotransmitters. Data also suggest that H(2) receptor blockers may not be best choice for stress ulcer prophylaxis in burn patients.
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Randomized Controlled Trial Comparative Study Clinical Trial
Oxandrolone induced lean mass gain during recovery from severe burns is maintained after discontinuation of the anabolic steroid.
Weight loss and lean mass loss from burn induced catabolism can be more rapidly restored when the anabolic steroid oxandrolone is added to optimum nutrition compared to nutrition alone. Our purpose in this study was to determine whether the regained lean body mass (LBM) is retained 6 months after stopping oxandrolone. Forty-five severe burn patients, entering the recovery phase were randomized into a nutrition group alone or with the addition of oxandrolone, 20mg per day upon admission to the acute burn rehabilitation (RH) unit. ⋯ Lost lean mass was not yet restored in the nutrition alone group. We can conclude that body weight and lean mass which is lost, due to burn induced catabolism, can be effectively restored in the post-burn recovery period with oxandrolone. The body weight and lost lean mass which is regained, is maintained 6 months after stopping the drug.