The Clinical Investigation of Necrotizing Fasciitis in Burn Center

Intravenous Colistin Therapy for Multidrug-Resistant Gram-Negative Bacterial Infections in Major Burn Injuries

PURPOSE: The aim of this study was to investigate the characteristics of Acute Kidney Injury Network (AKIN)-defined nephrotoxicity in patients undergoing intravenous colistimethate sodium (CMS) therapy for major burns. METHODS: This retrospective study included burn patients who received more than 48 h of intravenous CMS between September 2009 and December 2015. Data collection was performed using the institution's electronic medical record system. Patients assigned to the developed nephrotoxic group experienced aggravation of current AKIN stage during CMS treatment; those assigned to the non-nephrotoxic group experienced no change in current or exhibited improved AKIN stage during CMS therapy. RESULTS: A total of 306 patients were included in this study. All patients were grouped according to AKIN stage: AKIN 0 (n=152); AKIN 1 (n=6); AKIN 2 (n=9); AKIN 3 (n=139). The baseline creatinine (Cr) level was 0.73 mg/dL. The incidence of nephrotoxicity was 50.3% according to AKIN stage; overall mortality was 45.8%. The non-nephrotoxic group consisted of 127 (74.7%) patients and 43 (25.3%) were in the developed nephrotoxic group. In patients requiring continuous renal replacement therapy (CRRT), baseline Cr level was 0.83 mg/dL, pre-CMS Cr level was 1.17 mg/dL, and post-CMS Cr level was 1.34 mg/dL. CONCLUSION: CMS can be administered without signs of nephrotoxicity for a certain period (approximately 1 week), it can be used relatively safely for 2 weeks. Application of CMS is a reasonable option for treating infections caused by multi-drug resistant gram-negative bacteria in patients with major burns. The caution should be exercised nevertheless.

The Clinical Investigation Study of Pancreatitis Developed in Burn Patients

PURPOSE: To find progression and prognosis of pancreatitis developed in massive burn patients through retrospective analysis. METHODS: A retrospective study was conducted on 32 patients with abnormal increase of serum lipase level among 2523 acute burn patients admitted to our burn center from January 1, 2017 to June 30, 2018. Pancreatitis in this study was defined as a serum lipase concentration level that is higher than 180 IU/L which is three times more than the normal level (less than 60 IU/L). In this study, a retrospective analysis was performed on patients with serum lipase level higher than 300 IU/L to better understand causality of burns and pancreatitis. RESULTS: 32 patients (1.27%) had serum lipase level higher than 180 IU/L among 2523 acute burn subjects. And 13 patients (0.52%) of these 32 patients had serum lipase level elevated more than 300 IU/L. The study indicated serum lipase level was increased around 7 days after the injury. It returned to normal level early as after 1 to 2 weeks and late as after 4 to 6 weeks of injury. The serum amylase level was increased as similar modality as to the serum lipase level increase. The serum bilirubin, AST, ALT, LD, and GGT were also observed to be elevated when serum lipase was more than 1000 IU/L. CONCLUSION: The pancreatitis developed in burn patients are mostly as mild symptom. It could due to the ischemic injury and can easily be treated by a temporary fasting, TPN, and Gabexate intravenous injection.

Spinal Canal Remodelling after Stabilization of Thoracolumbar Burst Fractures / 대한정형외과학회잡지

About half of all burst fractures at the thoracolumbar junction lead to neurological impairment and several clinical series have demonstrated a statistically significant correlation between canal encroachment and neurologic impairment, but not directly related. Spontaneous canal remodelling over time due to bone resorption has been observed in conservatively treated burst fractures. The aim of this study was to measure spinal canal remodelling after stabilization of burst fractures. So, we evaluated 22 cases of surgically stabilized burst fractures of thoracolumbar junction about pre and postoperative spinal canal stenotic ratio and canal remodelling by bone resorption over time. The results were as follows; l. Pedicle splaying increases the spinal canal area and necessitates correction. 2. Patients with neurological deficits had average 53% encroachment and the neurological normal patient had a canal compromise of 33.9%. 3. Postoperatively canal encroachment had decreased to a mean of 17.4% and further reduced by resorption of bony fragment to a mean of 8.3% within 14 months. In conclusions, remodelling of the spinal canal by resorption of encroaching bone fragments is a consistent feature in surgically stabilized thoracolumbar burst fractures and most patients regain their prefracture canal demensions within 14 months.

Hydrogen Peroxide Production in Neutrophils after Tourniquet Release / 대한정형외과학회잡지

The use of lower extremity tourniquets for procedures of the lower leg is considered routine in orthopedic surgery, but, lower extremity tourniquets do harm occasionally. While the tourniquet is inflated, metabolic changes such as increased PaCO2 , lactic acid, and serum potassium and decreased level of PaO2 and pH occur in the ischemic limb. Deflation of tourniquet results in release of anaerobic metabolic products during ischemia into systemic circulation. In this ischemia/reperfusion situation, oxygen free radicals could potentially be produced during the reperfusion period by several mechanisms. One of these mechanisms is release of intracellular superoxide or hydrogen peroxide by activated neutrophils in the area. These reactive oxygen species(ROS) could be a causative factor for the postreperfusion no-flow, lung injury, induction of tourniquet shock, etc. The purpose of this clinical study was to investigate the effect of tourniquet deflation on the hemodynamic changes, changes of blood gas analysis, and hydrogen peroxide production using flow cytometric analysis of fluorescent DCF(Dichlorofluorescein). Quantitative analysis of fluorescent DCF was performed in resting and fMLP(N-formyl-methyonyl-leucyl-phenylalanine) or PMA(phorbol myristate acetate) stimulated neutrophils. Also differences of these factors between two groups of tourniquet time, one is less than one hour and the other more than one to two hours, were analysed. The hemodynamics(blood pressure, pulse rate), arterial PO2, bicarbonate, base excess, and hydrogen peroxide production showed no significant change before and after tourniquet release(p>0.05). Arterial pH and PaCO2 decreased significantly until 10 and 5 minutes after tourniquet release, respectively(p>0.05). Tourniquet time didn’t reveal any significances differences. These results indicate that tourniquet application with400mmHg pressure and less than 2 hours does not release significant hydrogen peroxide into systemic circulation during reperfusion period after tourniquet release.

Hydrogen Peroxide Production in Neutrophil after Tourniquet Release / 대한마취과학회지

The use of lower extremity tourniquets for procedures of the lower leg is considered routine in orthopedic surgery, yet, lower extremity tourniquets are not benign. While the tourniquet is inflated, metabolic changes such as increased PaCO2, lactic acid, and serum potassium and decreased level of PaO2. and pH occur in the ischemic limb. Deflation of tourniquet results in release of anaerobic metabolic products during ischemia into systemic circulation. In this ischemia/reperfusion situation, oxygen free radicals could potentially be produced during the reperfusion period by several mechanisms. One of these mechanisms is release of intracellular superoxide or hydrogen peroxide by activated neutrophils in the area. These reactive oxygen species(ROS) could be a causative factor for the postreperfusion no-flow, lung injury, induction of tourniquet shock, etc, The purpose of this clinical study was to investigate the effect of tourniquet deflation on the hemodynamic changes, changes of blood gas analysis, and hydrogen peroxide production using flow cytometric analysis of fluorescent DCF(Dichlorofluorescein). Quantitative Analysis of fluorescent DCF was performed in resting and fMLP(N-formyl-methyonyl-leucyl-phenylalanine) or PMA(phorbol myristate acetate) stimuliated neutrophils. The results were as follows: 1)The hemodynamic changes (systolic and diastolic BP, pulse rate) did not show any significant difference before and after tourniquet release(P>0.05). 2)Arterial pH deceased significantly until 10min and PaC was increased significantly until Smin after toumiquet release(P0.05). 4) Hydrogen peroxide production which was estimated by fluorescent DCF in neutrophils did not show any significant change before and after tourniquet release(P>0.05). These results indicate that tourniquet application(400mmHg, less than 2hours) could not release significant hydrogen peroxide during reperfusion period after tourniquet release.