Influence of severe burn injury on the expression of RM 3/1 and HLA-DR antigens in human blood monocytes.

The effect of severe burns on the expression of the glucocorticoid-inducible RM 3/1 and HLA-DR antigens in blood monocytes was studied in patients with less than or more than 50% total body surface area (TBSA) burned. All patients showed a strong increase in the portion of RM 3/1+ monocytes within 1 day after injury. In patients with more than 50% TBSA, RM 3/1+ cells decreased after 2 days; in those with less than 50% TBSA, cells decreased after 3 days HLA-DR+ monocytes decreased within 4 days in both groups. In patients with less than 50% TBSA, HLA-DR+ monocytes slowly increased thereafter to basic levels. In patients with more than 50% TBSA, HLA-DR+ monocytes further decreased, then slowly increased, however, did not reach basic levels. This long-lasting decrease was evidence in the nonsurvivors. These results show that severe burns differently affect monocyte antigens. The induction of the anti-inflammatory subtype RM 3/1 and the decrease of the immunoregulatory HLA-DR antigens may contribute to the immunosuppression observed after burn injury.

[Clinical importance of hypocaloric parenteral feeding]. / Klinische Bedeutung der hypokalorischen parenteralen Ernährung.

Hypocaloric parenteral nutrition (HPN) is mainly and frequently used in surgical medicine since it allows a reliable and standardized supply of nutrients. Ready-mix solutions which are suitable for peripheral venous nutrition generally contain about 50 g carbohydrates (glucose and/or xylitol), 25 g amino acids and electrolytes per liter. The osmolarity of the solutions averages between 600 and 800 mosmol/l. HPN has two distinct advantages: firstly the minimal effects on carbohydrate metabolism and secondly the good improvement in nitrogen balance. If 2 g/kg and day glucose are administered, even postoperatively, the mean blood sugar levels are only just above the normal range and an amino acid dosage of 1 g/kg and day, compared with liquid substitution alone or the administration of small amounts of carbohydrates, leads to an approximately 60% improvement in postoperative N-balance. Experience gained with HPN in surgical medicine to date permits the following recommendation: 1. HPN should not be used after small and moderate interventions with short nutritional abstinence; it is not necessary to administer nutrients in such cases. 2. HPN may be used after moderate to serious surgical interventions; e.g. after gastrointestinal resections in the case of elective surgery on patients with a normal nutritional status. However, studies have yet to prove the clinical efficacy of HPN, e.g. as evidenced by shorter hospitalization or a reduced perioperative morbidity or mortality, although this reservation equally applies to the routinely administered complete parenteral or enteral nutrition.(ABSTRACT TRUNCATED AT 250 WORDS)

[Comparative studies on collagen expression of chondrocytes in monolayer and spheroid culture]. / Vergleichende Untersuchungen über die Kollagenexpression von Chondrozyten in Monolayer- und Sphäroidkultur.

Dedifferentiation of cells is well known in cell culture biology. This phenomenon is examined in comparative studies on collagen expression of chondrocytes in monolayer and spheroid culture. Immunohistochemical studies were carried out by the indirect peroxidase technique. In the differentiated state a positive reaction for collagen type II was found. This was lost as dedifferentiation took place, in which case positivity for collagen types I, III, and V increased.

Use of Pseudomonas hyperimmunoglobulin to treat septic shock in burn cases.

The progress of 18 episodes of septic shock in nine patients with burn injuries after administration of a Pseudomonas immunoglobulin is presented. In nine instances the septic shock was treated successfully. The mean burn index of these nine patients was 96. In six of the nine patients the septic shock was accompanied by simultaneous inhalation trauma and in six by acute kidney failure. In four cases the sepsis was caused by P. aeruginosa and in five by staphylococci. Despite the different causative agents, successful treatment was possible in these cases. The mean burn index for the four patients who eventually died was 119; all patients in this group were suffering from an inhalation trauma and acute kidney failure requiring dialysis. In these cases even the use of Pseudomonas immunoglobulin had no decisive effect.

Distribution of lymphocytes in intermingled skin grafts.

Chinese intermingled skin grafts of allogenic material interspersed with small autogenic islets heal permanently with no signs of a rejection reaction. A study of the T-helper and T-suppressor cells in the region of the autogenic islets and the remaining allodermis revealed a distinctly greater frequency of these cells in the islets, with marked massing of the cells between the autoepithelium and the autodermis. Histologically it could be shown, that the Langerhans' cells grow over the allodermis together with the epithelium, although compared with the autogenic islets their number in the newly formed epidermis remained reduced.