Journal of burn care & research : official publication of the American Burn Association
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Randomized Controlled Trial
Efficacy of propranolol in wound healing for hospitalized burn patients.
Burn patients have the highest metabolic rate among critically ill or injured patients. Because propranolol decreases energy expenditure and muscle protein catabolism, in this study, we hypothesized that propranolol would improve healing process and decrease wound-healing time. This study was a double-blind randomized clinical trial; a total of 79 burn patients who referred to this center from January 2006 to January 2007 fulfilled the inclusion criteria. ⋯ Patients in the propranolol group had a shorter hospital stay period than the control group (30.95+/-8.44 days vs 24.41+/-8.11 days; P=.05). Administration of propranolol, improved burn wound healing, and decreased healing time and hospital stay period. The use of propranolol decreased the surface area of wounds that needed to be skin grafted.
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The long-term effects of burn injuries can be devastating and last a lifetime. The aims of this study were to: (1) identify what factors adult burn survivors report as important during their burn recovery, (2) identify the frequency and reported benefits of peer support for burn survivors, (3) determine the difference in the level of reported hope among burn survivors who received peer support compared with survivors who did not receive peer support. ⋯ The t test scores for the two groups reflected the following: the group who received peer support (N=87) and the group who did not (N=28) showed a statistical significance for the Pathway Subscale [t=-2.197 (P=.030)] and the Total Hope Score [t=-1.971 and (P=<.050)]. The results of this survey suggest that there are perceived benefits of peer support and imply that peer support may have a positive impact on hope for burn survivors.
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Burn injury is associated with a significant leak of intravascular fluid into the interstitial space, requiring large amounts of volume resuscitation. Activation of the intrinsic (mitochondrial) apoptotic pathway has been associated with vascular hyperpermeability. We hypothesized that vascular hyperpermeability following burns is also mediated via this pathway. ⋯ Burn serum increased mitochondrial reactive oxygen species levels and reduced mitochondrial membrane potential; these effects were markedly reduced by (-)-deprenyl. Cytochrome c release was increased by treatment with burn serum (P<.05), and this effect was significantly inhibited by (-)-deprenyl (P<.05). Burn serum induces hyperpemeability and activates intrinsic apoptotic signaling in microvascular endothelial cells. (-)-Deprenyl, an antioxidant and antiapoptotic drug, modulates intrinsic apoptotic signaling and attenuates burn-induced hyperpermeability.
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Burns to the upper extremity and axilla frequently result in the formation of contractures that can impede shoulder range of motion. The purpose of this study was to determine the long-term effects of upper extremity burn scar contracture release on motion during activities of daily living in the first year postrelease. Upper extremity motion analysis was conducted on children aged 4 to 17 years before and 1, 3, 6, and 12 months after axillary contracture release surgery. ⋯ Improvements were maintained for 1 year after surgery with majority of the improvement involving shoulder flexion. Axillary contracture release surgery improves functional shoulder mobility and decreases compensatory motions used during activities of daily living in the first year postrelease. Additional follow-up is needed to evaluate the impact of growth on scar development.
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Randomized Controlled Trial
Effects of fluid resuscitation methods on burn trauma-induced oxidative stress.
The aim of the study was to analyze the oxidative stress response after severe burn injury. We studied the effect of two methods of fluid resuscitation regimes on the oxidative stress reaction. Sixteen patients were involved in the study. ⋯ Plasma malondialdehyde level (P<.05 vs control population), reactive oxygen species production in whole blood (P<.05 vs control population), and catalase activity were elevated, whereas glutathione, plasma sulfhydryl groups level (P<.05 vs control population), and superoxide dismutase enzyme activity lowered in both groups. Our results confirmed that burn injury induces pronounced oxidative stress. The main finding is that fluid resuscitation regimes have different impact on prooxidant status, mainly on the granulocyte function but not on the changes in endogenous antioxidants in burned patients.