Nutrition, anabolism, and the wound healing process: an overview.

Objective: To develop a clear, concise, and up-to-date treatise on the role of anabolism from nutrition in wound healing. Special emphasis was to be placed on the effect of the stress response to wounding and its effect.

Methods: A compilation of both the most important and most recent reports in the literature was used to also develop the review.

Burns: what are the pharmacological treatment options?

Background: Many advances have been made in the understanding and management of burn injury, dramatically increasing pharmacological decision options for burn care professionals. Since burn injury is so multi-faceted, these advances cross many injury processes, both acute and chronic.

Objective: The purpose of this review was to highlight the advances and decision options across the entire scope of the burn injury process.

Smoke inhalation lung injury: an update.

Objectives: The purpose of this study is to present a multifaceted, definitive review of the past and current status of smoke inhalation injury. History along with current understanding of anatomical, physiology, and biologic components will be discussed.

Methods: The literature has been reviewed from the early onset of the concept of smoke inhalation in the 1920s to our current understanding as of 2007.

The increasing problem of wound bacterial burden and infection in acute and chronic soft-tissue wounds caused by methicillin-resistant Staphylococcus aureus.

Unlabelled: Methicillin-resistant Staphylococcus aureus (MRSA) has become a leading cause of colonization and infection in both acute and chronic soft-tissue wounds.

Objective: Our objective is to define this current epidemic problem caused by both community-acquired MRSA (CA-MRSA) and hospital-acquired MRSA (HA-MRSA), focusing on the similarities and differences between these 2 isolates as well as the impact on wound management decisions.

Methods: Methods used include a literature review on the growth of the current MRSA problem and its International scope.

The use of anabolic agents in catabolic states.

Objective: We plan to review the current problem of lean mass erosion in catabolic states, caused by injury and critical illness. This protein loss is driven by the hormonal imbalance and excess inflammation referred to as the "stress response to injury." We then plan to provide the current concepts on the use of available anabolic agents to attenuate the excess catabolism.

The role of anabolic hormones for wound healing in catabolic states.

Objective: The purpose of this paper is to present an overview of the interrelationship between hormones, nutrition, and wound healing.

Methods: The data on various hormones and their effects on specific elements of nutrition and wound healing are reviewed.

Results: The key anabolic hormones are human growth hormone, insulin-like growth factor-1, insulin, and testosterone and its analogs.

Predictors of survival and length of stay in burn patients older than 80 years of age: does age really matter?

Predictors of survival and length of stay (LOS) in the advanced elderly with burn injuries is not well studied. Because of progress in burn wound and critical care, we hypothesized that a contemporary analysis would show improved outcomes. Clinical data were collected on 45 consecutive patients older than 80 years of age that were treated for burn injury at our institution during the past 10 years.

Fourth-degree burns to the lower extremity with exposed tendon and bone: a ten-year experience.

Fourth-degree extremity burns involve muscle, tendon, and bone, often leading to amputation or significant functional impairment. We report our 10-year experience (1995-2004) at an urban burn center with fourth-degree burns to the lower extremity to characterize treatments and outcomes. Twenty-one patients (40 limbs), mean age of 45 years, were treated for fourth-degree lower-extremity burns with the average extremity burn size of 24% TBSA (range, 2-36%) and a mean fourth-degree burn size of 9% TBSA (range, 2-18%).

The burn edema process: current concepts.

Massive tissue edema after thermal injury is a well-recognized entity. Although this process is responsible for the patient's large fluid needs during resuscitation and also for local problems, such as a compartment syndrome, there have been no effective treatment modalities introduced into clinical care to control the degree of edema. A review of what is now known about the edema process is presented here, including attempted prevention and treatment modalities.

The incidence and impact of pre-existing protein energy malnutrition on outcome in the elderly burn patient population.

Protein energy malnutrition (PEM) and involuntary weight loss is a common problem in the elderly population. Our purpose was to determine the incidence and the effect on outcome of PEM in the elderly burn patient population. A chart review and review of the burn data registry was undertaken to determine the incidence and effect of PEM in patients older than 65 years of age with major burns from 1% to 30% TBSA.

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.

The development of an educational web site for burn care: burnsurgery.org.

Advances in burn care are well documented in the literature but often do not reach health care professionals who treat burn patients. The World Wide Web provides instant access to a wide variety of information globally. We describe the development of www.

The rate of re-epithelialization across meshed skin grafts is increased with exposure to silver.

Unlabelled: The objective in this study was to determine whether exposure to pure silver increases the rate of re-epithelialization across a partial thickness wound. A meshed skin graft, placed on an excised burn wound was used as a healing model.

Methods: The rate of meshed skin graft epithelial closure on an exposed burn using a moist healing environment was shown.

The rate of restoration of body weight after burn injury, using the anabolic agent oxandrolone, is not age dependent.

We determined the effect of age on the restoration of lost body weight and lean mass after burn injury, using the anabolic steroid oxandrolone. Patients with deep burns of 30-55% of body surface were studied when entering the recovery phase of injury, defined as resolution of the hypermetabolic, catabolic state. Patients were provided optimum nutrition and exercise alone or with the addition of oxandrolone.

Enteral glutamine administration prevents the decrease in cell energy charge potential produced in ileum after a skin burn in the rat.

A skin burn produces a decrease in cell energy charge potential (ECP), a marker of cell function, in the liver and other organs. The process appears to be oxidant induced because reduced glutathione (GSH) appears to be protective. The gut mucosal barrier is also known to be altered after burns and appears to be improved by glutamine, which is a source of energy and GSH production.

Effect of a hypocaloric diet, increased protein intake and resistance training on lean mass gains and fat mass loss in overweight police officers.

We compare the effects of a moderate hypocaloric, high-protein diet and resistance training, using two different protein supplements, versus hypocaloric diet alone on body compositional changes in overweight police officers. A randomized, prospective 12-week study was performed comparing the changes in body composition produced by three different treatment modalities in three study groups. One group (n = 10) was placed on a nonlipogenic, hypocaloric diet alone (80% of predicted needs).

Pulmonary artery catheterization and clinical outcomes: National Heart, Lung, and Blood Institute and Food and Drug Administration Workshop Report. Consensus Statement.

Objective: The efficacy and safety of the pulmonary artery catheter are under scrutiny because of its association with increased morbidity and mortality in observational studies. In response, the National Heart, Lung, and Blood Institute (NHLBI) and the US Food and Drug Administration (FDA) conducted the Pulmonary Artery Catheterization and Clinical Outcomes workshop in Alexandria, Va, on August 25 and 26, 1997, to develop recommendations regarding actions to improve pulmonary artery catheter utility and safety.

Participants: The NHLBI and FDA planning task force selected a workshop chairperson, subcommittee chairs, and participants.

Oxandrolone, an anabolic steroid, enhances the healing of a cutaneous wound in the rat.

The effect of the anabolic steroid oxandrolone on the healing rate of a standardized full thickness linear wound on the back of the rat was studied. Oxandrolone was given orally by gavage in peanut oil at a dose of 0.1 mg/kg/day.

Metabolic management of patients with severe burns.

Burn injury results in profound metabolic abnormalities perpetuated by an exaggerated stress response to injury. Hypermetabolism and marked catabolism, with rapid erosion of lean body mass, becomes evident shortly after injury. Much of the morbidity and mortality of a major burn can be attributed to this process, which increases infection risks, decreases the healing rate, and alters cell function.

The anticatabolic and wound healing effects of the testosterone analog oxandrolone after severe burn injury.

Purpose: Severe burn injury leads to marked catabolism and decreased lean mass, which can impair healing. Anabolic agents can attenuate net catabolism. Our purpose was to determine whether the testosterone analog, oxandrolone, given during the acute post burn period decreased the degree of nitrogen loss and loss of body weight while also increasing the healing rate of a skin donor site.