Blister fluid composition in a pediatric patient with toxic epidermal necrolysis.

Toxic epidermal necrolysis (TEN) is a rare life-threatening disease mostly related to drug ingestion. Apoptotic keratinocytes lead to separation of the epidermis from dermis and widespread blistering of the skin. This case is a pediatric patient with a seizure disorder who developed TEN after starting carbamezepine.

Hypercalcemia in patients in the burn intensive care unit.

Although patients with burns are known to develop hypocalcemia, the development of hypercalcemia has also been reported in a few patients in the burn intensive care unit. Here, the incidence of hypercalcemia in the burn unit of a single institution is reviewed. The records of all patients admitted to the burn intensive care unit over a period of 4 years of a single institution were reviewed.

Chemical scalp burns after hair highlights.

Hair highlighting using chemical solutions to alter the pigmentation of hair is a popular procedure. Given their chemical properties, these solutions also are potentially caustic to the scalp. However, the actual incidence and range of injuries is not well reported in the American literature.

Purpura fulminans in an adult patient with Haemophilus influenzae sepsis: case report and review of the literature.

Purpura fulminans is a rare complication of a coagulopathy or an infection. Haemophilus influenzae infection, which has decreased since the haemophilus influenzae type B vaccine was initiated, is an unusual initiating cause of purpura fulminans. This case is the first reported in the literature of an adult who developed purpura fulminans after Haemophilus influenzae sepsis.

Use of porcine acellular dermal matrix as a dermal substitute in rats.

Objective: To examine porcine acellular dermal matrix (ADM) as a xenogenic dermal substitute in a rat model.

Summary Background Data: Acellular dermal matrix has been used in the treatment of full-thickness skin injuries as an allogenic dermal substitute providing a stable wound base in human and animal studies.

Methods: Xenogenic and allogenic ADMs were produced by treating porcine or rat skin with Dispase and Triton X-100.

Long-term outcome of xenogenic dermal matrix implantation in immunocompetent rats.

Background: Acellular dermal matrix (ADM) has been used successfully in the treatment of full-thickness skin injuries as an allogenic dermal substitute. To assess the efficacy of xenogenic ADM in such wounds, we examined the long-term wound healing and immunological responses to porcine ADM in a rat model.

Materials And Methods: Xenogenic and allogenic ADMs were produced by treating porcine (fresh or cryopreserved) or rat skin with dispase and Triton X-100.

Xenogeneic acellular dermal matrix as a dermal substitute in rats.

Acellular dermal matrix (ADM) has been used as a dermal substitute for the treatment of deep burns, but the availability of cadaver skin for the production of ADM is limited. The usefulness of porcine ADM as a xenogeneic dermal substitute in rats was studied. With the use of Dispase II (Boehringer Mannheim, Indianapolis, Ind) and Triton X-100 (US Biochemicals, Cleveland, Ohio), xenogeneic ADM was prepared from commercially available, cryopreserved porcine skin, and allogeneic ADM from the rats was also prepared.

Silver sulfadiazine induced Clostridium difficile toxic megacolon in a burn patient: case report.

A 53 yr old diabetic male presented with a 34% total body surface area (TBSA) deep partial- and full-thickness burns. On post burn days 4 and 9, all of his burns were excised and grafted. Although he had only been treated with topical antibiotics, he developed Clostridium difficile colitis after his second surgery that progressed to Toxic Megacolon and perforation.

Characterization of acellular dermal matrices (ADMs) prepared by two different methods.

The efficacy of acellular dermal matrix (ADM) in the treatment of full-thickness skin injuries as a dermal substitute depends on its low antigenicity, capacity for rapid vascularization, and stability as a dermal template. These properties will be determined largely by the final composition of the ADM. We have treated human skin with either Dispase followed by Triton X-100 detergent or NaCl followed by SDS detergent, cryosectioned the resulting ADMs, and then characterized them immunohistochemically.

Reduced resuscitation fluid volume for second-degree burns with delayed initiation of ascorbic acid therapy.

Background: Oxygen radicals may play an important role in injury due to thermal burns. High-dose antioxidant ascorbic acid (vitamin C, Cenolete, Abbott Laboratory, Abbott Park, Ill) therapy reduces edema of burned and unburned tissue, lipid peroxidation, and subsequent resuscitation fluid volume requirement in experimental burn models.

Objective: To determine the hemodynamic effects of delayed initiation (2 hours after injury) of antioxidant therapy in patients with second-degree burns.

Dispase/detergent treated dermal matrix as a dermal substitute.

A method for preparing acellular allogeneic dermal matrix (ADM) and its effectiveness as a dermal substitute are described. Treatment of rat skin with Dispase followed by Triton X-100 completely removed cellular components from the dermis. Subcutaneously implanted ADM evoked no immunological reaction and 20 weeks after implantation, the size of the implanted ADM was reduced to about 60 per cent of its original area.

Hemodynamic effects of delayed initiation of antioxidant therapy (beginning two hours after burn) in extensive third-degree burns.

The hemodynamic effects of the delayed initiation of antioxidant therapy with high-dose vitamin C were studied in 12 guinea pigs with third-degree burns over 70% of their body surface area. All animals were resuscitated with Ringer's lactate solution (RL) according to the Parkland formula (4 ml/kg/% burn during the first 24 hours) from 1/2 to 2 hours after burn, and the infusion rate was reduced thereafter to 25% of that of the Parkland formula. The vitamin C group (n = 6) received RL with vitamin C (14 mg/kg/hr), and the control group (n = 6) received RL only.

Burn injuries in firefighters.

The authors cover the care of burn injuries from start to finish, beginning with a discussion of immediate intervention and concluding with a look at psychosocial aspects of burns. Topics in the middle include early management, evaluation of the patient and classification of the burn's severity, burn resuscitation, the pathophysiology of smoke inhalation, dressing of burn wounds, escharotomies and fasciotomies, surgical management, and rehabilitation.

Nosocomial infections in a burn intensive care unit.

Although many studies have reviewed burn wound infections (BWIs) in burn patients, few have prospectively surveyed other nosocomial infections. Seriously burned patients are clearly at increased risk for infection due to the nature of the burn injury itself, immunocompromising effects of burn injury, prolonged hospital stays, and invasive diagnostic and therapeutic procedures. Over 6 months, we prospectively reviewed all patients admitted to our burn intensive care unit (BICU) for nosocomial infections.

Antioxidant therapy using high dose vitamin C: reduction of postburn resuscitation fluid volume requirements.

Twenty-four guinea pigs with third degree burns over 70% of the body surface area were divided equally into four groups. At 0.5 hours postburn, all groups received Ringer's lactate solution (R/L) according to the Parkland formula.

The effects of high-dose vitamin C therapy on postburn lipid peroxidation.

The effects of vitamin C treatment (14 mg/kg/hr) on postburn lipid peroxidation were evaluated in 12 dogs. A lymph duct above the ankle was cannulated bilaterally. Hourly lymph flow rates, plasma and lymph total protein concentrations, and plasma and lymph malondialdehyde concentrations were measured before the burn injury and for 24 hours after the burn injury.

How long do we need to give antioxidant therapy during resuscitation when its administration is delayed for two hours?

Twenty-four guinea pigs with third-degree burns over 70% of the body surface area were divided equally into four groups. All animals received Ringer's lactate (R/L) beginning 30 minutes after burn injury. Group 1 received R/L without vitamin C beginning 2 hours after burn injury.

Effects of high-dose vitamin C administration on postburn microvascular fluid and protein flux.

The effects of vitamin C treatment (14 mg/kg/hr) on burn injury were evaluated in the hind paws of 12 mongrel dogs. A lymph duct above one hind paw of each dog was cannulated. Hourly lymph flow rates (QL) and plasma and lymph total protein concentrations were measured before the burn injury and for 6 hours after the burn injury.

High-dose vitamin C therapy for extensive deep dermal burns.

We studied the haemodynamic effects of antioxidant therapy with high-dose vitamin C administration (170 mg/kg/24 h) in guinea-pigs with 70 per cent body surface area deep dermal burns. The animals were divided into three groups of six animals each. Group 1 was resuscitated with Ringer's lactate solution according to the Parkland formula; group 2 with 25 per cent of the Parkland formula with vitamin C; and group 3 with 25 per cent of the Parkland formula without vitamin C.

Reduced fluid volume requirement for resuscitation of third-degree burns with high-dose vitamin C.

The effects of high-dose vitamin C therapy (170 mg, 340 mg, and 680 mg/kg/day) were evaluated in 70% body surface area third-degree burns in guinea pigs that were resuscitated with 1 ml/kg/%burn Ringer's lactate solution. The water content measurements of the burned skin at 24 hours after burn injury in the vitamin C-treated groups were significantly lower than those of the control group (1 ml/kg/%burn) and those of the standard resuscitation group (4 ml/kg/%burn). The cardiac outputs in the group that received 340 mg vitamin C were significantly higher than those of the control group but not significantly different than those of the standard therapy group at 2 hours after burn injury and thereafter.

Effects of cimetidine on fluid requirement during resuscitation of third-degree burns.

Seventy percent body surface area third-degree burns were produced in four groups of six guinea pigs each, after which all were resuscitated with Ringer's lactate solution. Group 1 received 4 ml/kg/%burn. Group 2 received 1 ml/kg/%burn with cimetidine, which was begun at 0.

The role of tissue expansion in the reconstruction of secondary burn defects.

Tissue expansion has become firmly established as an acceptable and useful modality in the treatment of various soft tissue defects. This article relates our experience with this technique for the reconstruction of secondary burn deformities in 26 patients. Details of expander placement and use are discussed, as well as the results and complications in this series.

Early coverage of deep hand burns with groin flaps.

Deep burns of the hands require skin flap coverage in order to protect the exposed vital structures. The groin flap is a safe and effective method of obtaining early closure of these defects. We have used groin flaps to cover deep hand burn defects in nine patients.

The effect of burn wound size on resting energy expenditure.

Numerous formulas have been used to estimate the calorie requirements of hypermetabolic burned patients. With the recent development of instrumentation for indirect calorimetric measurements, questions have been raised concerning the validity and accuracy of the early equations. Because metabolic rate decreases during the course of wound healing, we attempted to determine the magnitude of hypermetabolism and the accuracy of the Curreri formula in patients with various wound sizes.