Annals of surgery
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Both suppressor lymphocytes and serum immunosuppressive factors have been found in patients who have had major thermal burns, and may inhibit host resistance to the bacteria invariably present in burn wounds. However, the relationship and clinical importance of these two manifestations of impaired immune reactivity are poorly understood. Eighteen patients (aged 20-84 years) with full thickness burns of varying severity have been studied, and the clinical course related to the presence of nonspecific immunosuppressive serum and circulating suppressor lymphocytes. ⋯ Depression of the PHA response of peripheral blood lymphocytes was much less common and was associated with this finding died. No patients who did not have severe depression of the lymphocyte response to PHA died. Nonadherent leukocyte (NA leukocyte) populations exhibiting a depressed PHA response were capable of suppressing the PHA response of normal human lymphocytes and, therefore, contained suppressor cells.
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Available evidence indicates that about one third of all patients presenting with localized finger gangrene developed the condition due to intrinsic occlusions of the small arteries of the hand and fingers caused by one of a variety of systemic diseases. We have treated 35 such patients in the past seven years. A variety of diagnostic tests allowed the establishment of the diagnosis of connective tissue disease in 14 patients, hypersensitivity angiitis in 13 patients, arteriosclerosis in five patients, and myeloid metaplasia, calciphylaxis, and carcinoma in one patient each. ⋯ Five patients required partial phalangeal amputation. These results suggest that appropriate diagnostic tests will allow an accurate diagnosis in all patients, and that the natural history is that of spontaneous improvement without major tissue loss. In our experience, surgical sympathectomy plays no role in the treatment of these patients.