Annals of surgery
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Hypermetabolism characterizes the metabolic response to thermal injury and the extent of energy production is positively related to the rate of urinary catecholamine excretion. Alpha and beta adrenergic blockade decreased metabolism from 69.6 +/- 5.3 Kcal/m(2)/hr to 57.4 +/- 5.2 (p < 0.01), and infusion of 6 microgm epinephrine/minute in normal man significantly increased metabolic rate. Twenty noninfected burned adults with a mean burn size of 45% total body surface (range 7-84%) and four normal controls were studied in an environmental chamber at two or more temperatures between 19 and 33 C with vapor pressure constant at 11.88 mm Hg. ⋯ Burned patients are internally warm, not externally cold, and catecholamines appear to mediate their increased heat production. Hypermetabolism may be modified by ambient temperature, infection, and pharmacologic means. Alterations in hypothalamic function due to injury, resulting in increased catecholamine elaboration, would explain the metabolic response to thermal injury.
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The development of effective, non-toxic (local and systemic) methods for the rapid chemical (enzymatic and non-enzymatic) debridement of third degree burns would dramatically reduce the morbidity and mortality of severely burned patients. Sepsis is still the major cause of death of patients with extensive deep burns. The removal of the devitalized tissue, without damage to unburned skin or skin only partially injured by burning, and in ways which would permit immediate (or very prompt) skin grafting, would lessen substantially the problems of sepsis, speed convalescence and the return of these individuals to society as effective human beings, and would decrease deaths. ⋯ The authors' work with the chemical debridement of burns, in particular the use of Bromelain, indicates that this approach will likely achieve clinical usefulness. The experimental studies indicate that rapid controlled debridement, with minimal local and systemic toxicity, is possible, and that effective chemotherapeutic agents may be combined with the Bromelain without either interfering with the actions of the other. The authors believe that rapid (hours) debridement accomplished by the combined use of chemical debriding and chemotherapeutic agents will obviate the possibility of any increase in infection, caused by the use of chemical agents for debridement, as reported for Paraenzyme(21) and Travase.(39,48) It is possible that the short term use of systemic antibiotics begun just before and continued during, and for a short time after, the rapid chemical debridement may prove useful for the prevention of infection, as appears to be the case for abdominal operations of the clean-contaminated and contaminated types.
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Comparative Study
Reversal of capillary stasis and prevention of necrosis in burns.
It has been suggested that the ultimate depth of burn necrosis might be minimized by prevention or reversal of the progressive capillary stasis which occurs in the early postburn hours. To study the role of wound dehydration in determining burn depth, 5% body surface area, 75 C, 10 second burns (in which the zone of stasis included the full thickness of skin) were inflicted on the backs of guinea pigs and subsequent mechanical trauma was prevented. At various times postburn, water content, (and after India ink perfusion) depth of capillary stasis and histological structure of burn were studied in the following groups: 1) blister intact; 2) blister removed; and 3) blister replaced by several different types of dressing. ⋯ Other dressings were associated with deep necrosis or gross infection. These and other data suggest that in the zone of stasis, capillary stasis may be reversed and necrosis avoided by appropriate prevention of wound dehydration. Clinical correlations are suggested.
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A case of a patient with burn scar carcinoma of an extremity associated with hypercalcemia and without bone metastasis is presented. From the data presented, it seems reasonable to assume that this squamous cell carcinoma of a burn scar secreted some type of parathyroid hormone-like substance or substances which posessed calcium-increasing biological activity resulting in hypercalcemia.