Characterization of the nasal, sublingual, and oropharyngeal mucosa microbiota in cleft lip and palate individuals before and after surgical repair.

Objective: To delineate inherent differences in the microbial milieu in cleft palate patients compared with cleft lip patients and to document changes in microbial flora before and after cleft lip and palate repair.

Design: A prospective study of preoperative and postoperative culture results from the nasal, sublingual, and oropharyngeal surfaces of patients undergoing primary cleft lip repair and palate closure.

Setting: Shriners Hospitals for Children, Galveston, Texas, and University of Texas Medical Branch, Galveston, Texas.

Empiric antibiotic therapy for seawater injuries: a four-seasonal analysis.

Background: Previous seawater studies found Vibrio species associated with morbidity, suggesting that seawater-contaminated wounds should be treated early. The purpose of this study was to identify common seawater pathogens and antibiotic sensitivities to provide empiric antibiotic therapy until patient-specific culture results are available.

Methods: Seasonal samples were collected from 25 Galveston beach locations and cultured.

The potential benefit of 5% Sulfamylon Solution in the treatment of Acinetobacter baumannii-contaminated traumatic war wounds.

Background: The recent report of high numbers of Acinetobacter baumannii bloodstream infections among service members injured in Iraq and Afghanistan during the period January 2002 through August 2004 has prompted an investigation into their etiology. A review of the current guidelines for open combat casualty wounds as part of this broad investigation was not mentioned in the report.

Objective: The objective of this study was 2-fold: to ascertain the susceptibility of A.

Topical Sulfamylon cream inhibits DNA and protein synthesis in the skin donor site wound.

Background: Whereas Sulfamylon is effective in treatment of burn wound infection, controversy exists regarding its effect on the healing process.

Methods: A partial thickness skin donor site wound was created on the back and indwelling catheters were placed in the carotid artery and jugular vein in rabbits under general anesthesia. Sulfamylon cream (8.

Gentamicin improves hemodynamics in ovine septic shock after smoke inhalation injury.

Previously, our group developed an ovine model of hyperdynamic sepsis associated with acute lung injury. In this study, we sought to modify this sepsis model by the administration of gentamicin to more closely simulate the symptoms observed in human sepsis in the intensive care unit. In a prospective, controlled, randomized laboratory experiment, 18 female sheep were surgically prepared for chronic study.

Comparison of in vitro disc diffusion and time kill-kinetic assays for the evaluation of antimicrobial wound dressing efficacy.

There is a plethora of new silver-containing dressings on the market today. Various manufacturers attempt to show that their dressings are the most efficacious and therefore should be preferentially employed by health care workers based on the results of their in vitro tests. However, there have been no studies that clearly identify which tests are appropriate for comparison purposes.

Therapeutic efficacy of three silver dressings in an infected animal model.

The organic salt AgNO3 has been available as a topical armamentarium to the medical arena for centuries and for burns for the past 60 years. Thirty-five (1968) years later, Charles Fox introduced and popularized a new topical agent known as silver sulfadiazine. More recently, several new slow-release silver dressings came to the forefront.

Retardation of wound healing by silver sulfadiazine is reversed by Aloe vera and nystatin.

Inhibition of wound contraction by topical anti microbial agents has been described. The purpose of this study was to further investigate that phenomenon and to explore the effect that other agents such as Aloe vera might have on this process. Full-thickness excised wounds were created on the dorsum of Sprague-Dawley rats under anaesthesia.

Correlation of bronchoalveolar lavage with radiographic evidence of pneumonia in thermally injured children.

The diagnosis of pneumonia in the critically ill patient is very difficult because the usual signs and symptoms are unreliable in the intensive care setting. Bronchoalveolar lavage (BAL) is a diagnostic tool with a reported sensitivity of 70%. The purpose of this study was to determine the efficacy and specificity of BAL in severely burned pediatric patients.

Effects of early excision and aggressive enteral feeding on hypermetabolism, catabolism, and sepsis after severe burn.

Background: Severe burn induces a systemic hypermetabolic response, which includes increased energy expenditure, protein catabolism, and diminished immunity. We hypothesized that early burn excision and aggressive enteral feeding diminish hypermetabolism.

Methods: Forty-six burned children were enrolled into a cohort analytic study.

Assessing and controlling wound infection.

Quantitatively, wounds harboring bacteria that exceed 105 colony-forming units per gram are considered infected wounds. There are acute wounds and chronic wounds, and the approach to controlling the infection is similar. Although the granulating bed may be avascular, systemic anti-infectives are employed adjunctively to circumvent systemic infection.

Effects of interleukin-1alpha administration on intestinal ischemia and reperfusion injury, mucosal permeability, and bacterial translocation in burn and sepsis.

Objective: To evaluate the effect of interleukin-1alpha (IL-1alpha) on the mesenteric circulation, intestinal mucosal integrity, and bacterial translocation in a burn/endotoxemia chronic porcine model.

Summary Background Data: Major burn and sepsis are associated with a high mortality, ischemia/reperfusion injury to the intestine, and an increased rate of bacterial translocation. Pathologic alterations of IL-1 synthesis, degradation, and binding to receptors have been reported.

The effectiveness of processed grapefruit-seed extract as an antibacterial agent: II. Mechanism of action and in vitro toxicity.

Objectives: Recent testimonials report grapefruit-seed extract, or GSE (Citricidal) to be effective against more than 800 bacterial and viral strains, 100 strains of fungus, and a large number of single and multicelled parasites. This study investigated GSE for antibacterial activity at varying time intervals and concentration levels and tissue toxicity at varying concentrations in an effort to determine if a concentration existed that was both microbicidal and nontoxic and in what period of time.

Design: Gram-negative and gram-positive isolates were introduced into graduated dilutions of GSE (twofold concentrations ranging from 1:1, through 1:512) for determination of bacterial activity.

The effectiveness of processed grapefruit-seed extract as an antibacterial agent: I. An in vitro agar assay.

Objectives: Grapefruit-seed extract (GSE) Citricidal has, in recent reports, been reported to be successful in combating a variety of common infectious agents. In our study, drops of concentrated grapefruit-seed extract were tested for antibacterial properties against a number of gram-positive and gram-negative organisms.

Design: Sixty-seven (67) distinct biotypes were tested for their susceptibilities to the GSE as well as to 5 other topical antibacterials (Silvadene, Sulfamylon, Bactroban, Nitrofurazone, and Silvadene, Nystatin).

Comparison of propolis skin cream to silver sulfadiazine: a naturopathic alternative to antibiotics in treatment of minor burns.

Background: Propolis, a naturopathic substance derived from bees wax extract, has recently been praised for its antimicrobial, anti-inflammatory, and cicatrization-enhancing properties.

Objective: In our study, we compare these properties in a high-grade Brazilian propolis skin cream directly with silver sulfadiazene (SSD) in the treatment of minor burns (superficial second degree) in the ambulatory care setting (less than 20% total body surface area burned).

Settings/location: The study was conducted at the burn clinic in Pronto Socorro para Queimaduras, Gioania, Brazil.

Association of hyperglycemia with increased mortality after severe burn injury.

Background: Hyperglycemia is commonly associated with the hypermetabolic stress response. However, persistent hyperglycemia may adversely affect wound healing and immunity. The purpose of this study was to assess any relationship between hyperglycemia and clinical outcome after severe burn injury.

Cadaveric allograft discards as a result of positive skin cultures.

Introduction: The availability of cadaveric allograft is often limited by potentially pathogenic microbial organisms. Little data exists on cadaveric allograft discard rates related to positive microbiology. The purpose of this retrospective review was to determine the cadaveric allograft discard rates related positive microbiology and the subsequent breakdown of those organisms involved.

Cadaver donor discards secondary to serology.

The use of cadaveric skin has made a major impact in the survival of patients experiencing major thermal injury. However, the availability of cadaveric skin is often limited by potentially pathogenic organisms. Very little data exists as to why cadaveric skin from donors who have been previously screened was discarded.

The effects of hyperglycemia on skin graft survival in the burn patient.

The authors elected to determine the relative effects of hyperglycemia and/or elevated wound Gram-positive bacterial counts on success of skin graft survival in 74 burn patients. Results of serum glucose and quantitative wound biopsies on the day of admission and on postoperative day 4 were charted. Cases were separated into the following groups for analysis: normoglycemia plus normal bacterial counts, elevated bacterial counts only, hyperglycemia only, and hyperglycemia plus elevated bacterial counts.

Biobrane improves wound healing in burned children without increased risk of infection.

A synthetic bilaminar membrane used as a skin substitute (Biobrane) has been shown to decrease pain and hospitalization in superficial second-degree burns. Despite these benefits, it has not been utilized universally, particularly in young children, due to a perceived increase in related infections. We propose that when this synthetic membrane is applied to superficial scald burns <25% of the total body surface area (TBSA), decreased healing times are expected without increased risk of infection.

Angiotensin II inhibitor DuP753 attenuates burn- and endotoxin-induced gut ischemia, lipid peroxidation, mucosal permeability, and bacterial translocation.

Objective: To investigate the role of angiotensin II as a mediator of burn- and sepsis-induced gut ischemia and reperfusion injury and to determine whether treatment with the angiotensin II inhibitor DuP753 can attenuate mucosal injury and bacterial translocation in a burn/endotoxemia porcine model.

Summary Background Data: Thermal injuries and endotoxemia have been shown to induce ischemia and reperfusion injury to the intestine, leading to increased mucosal permeability and bacterial translocation. Angiotensin II, the production of which has been reported to increase after burn, is thought to be one of the primary mediators of postburn mesenteric vasoconstriction.

Infestations and chronic infections in foreign pediatric patients with burns: is there a role for specific protocols?

Infestations by parasites such as Mycobacterium tuberculosis and other viral infections are common in third world countries. Consequently, the admission of a significant number of foreign patients to burn centers in the United States may pose new problems, not only for inpatients but also for health care workers. To document infestations in patients from third world countries and to determine the need for specific protocols, we studied 62 consecutive foreign patients admitted to our pediatric burn reconstruction service between July 1997 and December 1998.

The effect of denervation on leukocyte function in soft tissue infection.

Background: The present study was undertaken to investigate the effect of denervation on leukocyte function in soft-tissue infection in an isolated in vivo ovine flap model.

Methods: Fifteen adult ewes were divided into three groups. An island pedicle flap was raised on the right buttock.

Modified Dakin's solution for cutaneous vibrio infections.

Vibrio species, specifically Vibrio vulnificus, are known to be endemic to warm saltwater environments. As a human pathogen they are capable of causing severe, progressive, necrotizing infections. The lesions are bullous in nature and often require wide surgical debridement due to the aggressiveness of this organism.

Topical nystatin powder in severe burns: a new treatment for angioinvasive fungal infections refractory to other topical and systemic agents.

Angioinvasive fungal infections have a significant morbidity and mortality in the immunocompromised host. Massive burns produce a profound derangement in cellular immunity along with a loss of cutaneous barrier function. Treatment of fungal burn wound infections poses a difficult therapeutic challenge.