[Influence of escharectomy and skin grafting during early burn stage on acute-phase response in severely burned rats and its significance].

OBJECTIVE: To investigate the influence of escharectomy and skin-grafting during early burn stage on the production of acute-phase reactants by the liver in severely burned rats. METHODS: Ninety-six Wistar rats were randomly divided into three groups: normal control group (C), escharectomy on postburn day (PBD) 1 group (0) and escharectomy on PBD4 group (F). 30% III degrees (total body surface area full-thickness) burn injury was caused by immersing the back in boiling water for 10 seconds. Escharectomy and skin grafting with cryopreserved allogeneic skin were performed one day or 4 days after the burn injury. ON days 1, 2, 4, 5 and 7 after burn injury blood was withdrawn from the abdominal aorta of 8 rats for each experimental group. The serum contents al-antitrypsin (AT), al-acid glycoprotein (AGP), C-reactive protein (CRP), albumin (Alb), and transferrin (Trf) were measured by turbidimetry. RESULTS: Significant increase in concentrations of positive acute-phase reactant, CRP, AGP, and AT, was observed in group O and group F as compared with normal control, (P < 0.05), while the concentrations of negative acute-phase reactants, Alb and Trf, decreased markedly (P < 0.05). The serum concentrations of AT and AGP in group O began to decrease significantly on PBD 5 and PBD7 respectively in comparison with that of the group F (P < 0.05), however, they still maintained a rather higher levels on PBD7. The concentration of CRP in group O began to decrease on PBD4, and the values on PBD4, 5, and 7 were significantly lower than those of the group F (P < 0.05). The concentration of CRP in PBD1 group reached the normal level on PBD7, however, the concentration of CRP in group F kept increasing till PBD5, and remained significantly higher than that in group C (P < 0.05). The concentration of Alb in group O was significantly higher on PBD7 than that in group F (P < 0.05). The concentration of Trf in group O on PBD5 and PBD7 was significantly higher than those in group F (P < 0.05). CONCLUSION: Escharectomy and skin grafting during early burn stage attenuates acute-phase response after burn injury and are beneficial to the organism.

Resposta inflamatória causada pelas fraçöes do adesivo de gelatina-resorcina e formaldeído (Colagel) em camundongos / Inflammatory reaction caused by the fractions of the adhesive composed of gelatin resorcine and formaldehyde (Colagel) in mice

Diante de relatos de intensa reaçäo inflamatória após a aplicaçäo cirúrgica do adesivo biológico COLAGEL em tecidos orgânicos, realizou-se a aplicaçäo isolada das fraçöes do adesivo (gelatina-resorcina, formaldeído, cola polimerizada no local e cola polimerizada imediatamente antes da aplicaçäo) em grupos distintos de camundongos, com o objetivo de identificar a fraçäo responsável por tal processo. Através da avaliaçäo dos cortes histológicos, notou-se que os grupos que receberam apenas o formaldeído e a cola polimerizada in situ foram dotados de alto grau de infiltrado inflamatório, com dissociaçäo de fibras musculares e necrose tecidual. O grupo que recebeu apenas a gelatina-resorcina revelou discreta infiltraçäo polimorfonuclear, o mesmo ocorrendo com o uso da cola previamente polimerizada, o que permitiu concluir que a fraçäo do COLAGEL responsável pela grande reaçäo inflamatória foi o polimerizante formaldeído, e que o modo mais conveniente de utilizaçäo do produto seria sua prévia polimerizaçäo.

An acute phase reaction in diabetic patients with foot ulcers.

The acute phase reaction is a molecular response to noxious stimuli. Over 50 glycoproteins have been identified as reactants. While this is likely a protective response, some of the changes could be detrimental to body homeostasis. The objective of this study was to examine whether an acute phase reaction occurs in diabetic patients with foot ulcers. In age- and sex-matched populations, measurements of C-reactive protein, fibrinogen, albumin, hematocrit, whole blood viscosity and protein C were performed on: (i) 24 diabetic patients with a foot ulcer (group A); (ii) eight diabetic patients without foot ulcer (group B); and (iii) seven patients without diabetes (group C). Analysis of variance was used to compare means of each respective group (mean (s.d.)). Group A demonstrated an increase in C-reactive protein (5.6 (5.4) mg/dl) compared with group B (0.78 (0.46) mg/dl; P = 0.013) and group C (0.71 (0.26) mg/dl; P = 0.026). Fibrinogen was also increased in group A (619 (205) mg/dl) compared with group B (310 (58) mg/dl; P = 0.005) and group C (370 (88) mg/dl; P = 0.04). Hematocrit (37 (6)%) and albumin (3.5 (0.5) g/dl) were decreased in group A compared with group B (hematocrit 46 (4)%; P < 0.0001; albumin 4.3 (0.3) g/dl; P = 0.0005) and group C (hematocrit 45 (3)%; P = 0.005; albumin 4.6 (0.3) g/dl; P < 0.0001). No difference was found in whole blood viscosity and levels of protein C. There also was no significant difference demonstrated between any of the parameters studied when comparing groups B and C. In conclusion, these results indicate that diabetic patients with a foot ulcer undergo an acute phase reaction as evidenced by a rise in C-reactive protein and fibrinogen compared with diabetic patients without a foot ulcer and normal control patients. As more is learned about the acute phase reaction, this information may prove valuable in the management of the diabetic patient.

Modulation of C4b-binding protein isoforms during the acute phase response caused by orthopedic surgery.

Orthopedic surgery is described as an event with a high risk of thromboembolic diseases. This is probably a consequence of a synergistic combination of different risk factors in the patients subjected to this type of surgery, including age, immobilization, anesthesia and different hypercoagulable states. After surgery patients develop an acute-phase response that leads to changes in several plasma proteins. One of these proteins is the complement regulator C4b-binding protein (C4BP). We have recently shown that in some acute-phase patients C4BP is incorrectly controlled (with elevation of the C4BP beta-containing isoforms), leading to a potential hypercoagulable state by decreasing the plasma levels of free (active) protein S. Here we have studied whether patients subjected to orthopedic surgery have an appropriate modulation of the C4BP isoforms during their postoperative acute-phase responses. We have analyzed the evolution of the C4BP isoforms in serial samples from 11 patients who have undergone knee (or hip) prosthesis surgery (mean age 70 years), or scoliosis surgery (mean age 18 years). Our data suggest a similar evolution of C4BP isoforms in all these patients, with an almost exclusive increase of C4BP isoforms lacking C4BP beta polypeptides and steady levels of free protein S.

[The value of various ultrasound criteria in objective assessment of acute reactive cholecystitis. A prospective follow-up study of ventilated intensive care patients]. / Stellenwert verschiedener Ultraschallkriterien zur Objektivierung einer reaktiven akuten Cholezystitis. Eine prospektive Verlaufsstudie bei intensivtherapiepflichtigen Beatmungspatienten.

Ultrasound of the abdomen was performed in 30 artificially respirated patients under intensive care conditions for 7 days per patient over a time period of 6 months to elucidate the therapeutic value of different ultrasonographic findings with respect to the diagnosis "reactive acute cholecystitis". Our results show, that neither the detection of concrements or sludge within the gallbladder, nor the transient dilatation of the bile duct, nor a transient wall-thickening or the occurrence of a three-layered wall of the gallbladder can be interpreted as reliable sonographic criteria for the occurrence of an acute reactive cholecystitis. From this we conclude, that reactive acute cholecystitis leading to the indication for cholecystectomy can only be diagnosed from the combination of clinical and sonographic findings. However, reactive acute cholecystitis can almost certainly be excluded, even in obscure upper abdominal symptoms, when the sonogram of the gallbladder is normal.

[Operation planning of secondary interventions after polytrauma]. / Operationsplanung von sekundären Eingriffen nach Polytrauma.

A prospective study of 135 secondary operations (> 24 h after trauma) in patients with multiple injuries (ISS 40.6 pts) was performed to determine specific and unspecific indicators of the inflammatory response that may indicate the degree of risk of postoperative organ failure in these patients. On the morning of the operation each patients' data were recorded and blood samples were collected. Patients were divided in those in whom respiratory, renal and/or hepatic failure developed or preexisting organ failure worsened by more than 20% from baseline within 2 days after the operation and those who had no complications. In 29 patients who were operated upon between 24 and 72 h after trauma only the pO2/FiO2 ratio allowed discrimination between the two groups. The overall accuracy of this parameter as a predictor of postoperative organ failure was 83%, with a sensitivity of 78% and a specificity of 85%. In 106 patients with secondary operations later than 72 h after trauma, neutrophil elastase, C-reactive protein and platelet count revealed the highest predictive accuracy, with cut-off values of 250 ng/ml, 11 mg/dl and 180 x 10(6)/ml, respectively. The combined accuracy of these three parameters in prediction of postoperative organ failure was 79% (sensitivity 73%, specificity 83%). In this group of patients the pO2/FiO2 ratio was of less value and blood pressure, heart rate, renal function parameters, lactate and coagulation parameters were of no value.(ABSTRACT TRUNCATED AT 250 WORDS)