Plasma fibronectin concentrations in patients with severe burn injury.

Plasma fibronectin concentrations were measured in 33 patients with major burn injury. Changes in plasma fibronectin concentration were related to the day of burn injury, surgery and to the development of sepsis. Within 24 hours of the burn injury and surgical treatment, a decrease of the plasma fibronectin concentration was observed, which returned to normal values within 72 hours. A decrease in the plasma fibronectin concentration was observed as sepsis developed, while recovery from septicaemia was associated with plasma fibronectin concentration returning to normal values.

Acute excision or exposure treatment? Final results of a three-year randomized controlled clinical trial.

Which treatment, acute excision or exposure, is the method of choice in the treatment of patients with small, medium-sized or large burns, and superficial or deep burns respectively? In an attempt to give an answer to this question a Randomized, Controlled, Clinical Trial was carried out by the Burns Unit in Copenhagen. The RCCT consisted of all patients (570) admitted primarily for burn injuries over the 3-year period 1976-79. Patients who would be too difficult to compare were sorted out (unsuited for trial--421 patients). The remaining patients were stratified into two groups: group A = patients treated with excision of all burned areas (superficial dermal plus deep dermal plus subdermal burns) and grafted as quickly as possible after the accident, and consequently in the shock-phase (73 patients), and group E = patients treated with exposure until day 14 post-burn, at which time all non-spontaneously healed areas were excised and grafted (76 patients). The stratification was successful, and it was revealed that the two groups were comparable with regard to the extent and depth of the burn and the age of the patients. The following parameters were used: the crude mortality rate and the time and causes of death. The morbidity estimated by the kind and number of complications; especially the number of infected patients and the severity of the infections. The resource expenditure expressed in number of bed-days, duration of operations and amount of blood transfusions. Late results are described elsewhere.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute excision or exposure treatment? Secondary reconstructions and functional results.

To evaluate late-result of burn treatment 102 patients (52 treated with acute excision and grafting and 50 with exposure treatment and grafting on the 14th day) were examined 3 years after the burn injury. The series included patients with small, medium-sized and large burns, 56 of whom had used pressure bandages for about one year. During the first 3 years post-burn, 17 patients with contractures required release operations amounting to a total of 60 reconstructive procedures. At the follow-up 86 contractures, most of them of hands, could be demonstrated in 25 patients, but only 5 needed further reconstructions. No difference in late-result could be demonstrated between the two groups of patients treated by acute excision and by exposure.

Clinical results of treatment of patients in the air-fluidized bed (Clinitron) during a one-year period.

Beside the nursing difficulties in using the Clinitron bed we have experienced further technical difficulties during the introduction period which are described. However, the beds have been most effective from a bacteriological point of view and have reduced the infection rate.

Prognosis of acute nonspecific abdominal pain. A prospective study.

In a prospective study of 230 patients followed up for 5 years after hospital admission for acute non-specific abdominal pain, 21 patients (9 patients) could not be traced, and 11 (5 percent) had died. Only one death was related to symptoms from the first admission. Of the remaining 198 patients, 77 percent were healthy and free of any symptoms during the observation period. Fourteen patients (7 percent) had been hospitalized once more due to acute abdominal pain; 5 had acute appendicitis. The others had diagnosed recurrences of nonspecific abdominal pain. Sixteen percent complained of continuing of intermittent abdominal symptoms, mainly of benign colonic or gynecologic origin, while malignant disease developed in 1 percent (or 4 percent of patients over 50 years of age). It is concluded that control of these patients is generally unnecessary, but when symptoms recur further examinations, especially for colonic or gynecologic disease, should be carried out. In patients over 50 years old, the possibility of malignant disease should be kept in mind.

Acute appendicitis. Prospective trial concerning diagnostic accuracy and complications.

In a prospective trial comprising 202 patients operated on because of suspicion of acute appendicitis, the diagnostic accuracy was 70 percent based on histologic examination of all removed appendices. The diagnostic accuracy was lowest in women less than 50 years old and in young patients (aged 20 years or less), being about 60 percent in both of these groups. The reasons were gynecologic disorders and uncharacteristic abdominal pains, respectively. Twenty-three of the 142 patients with acute appendicitis had perforation (16 percent). The frequency of perforation was significantly higher in patients more than 50 years old. Postoperative complications were seen in 11 percent of the patients. There was no significant difference in the frequency of complications in patients with a normal appendix and no other surgical abdominal disorder and patients with nonperforated appendicitis. However, there was a statistically significant difference between these two groups and the group with perforated appendicitis. In the latter group, postoperative complications occurred in 39 percent of the patients as opposed to 4 percent and 8 percent, respectively, in the former groups.

Inhibition of gastric acid secretion in man by exogenous and endogenous pancreatic glucagon.

The interaction of intravenously infused glucagon and pentagastrin on gastric acid secretion was studied in 5 healthy subjects. First a step dose-response study with pentagastrin in doses of 0.01, 0.1,1.0, and 10.0 mug per kg-hr was performed. The dose required for one-half maximal response (D50) was 130 ng per kg-hr. With this dose of pentagastrin as background stimulation a step dose-response study with glucagon in doses of 0.5, 2.0, 8.0, and 16.0 mug per kg-hr was performed. The dose of glucagon required for one-half maximal inhibition was 1.64 mug per kg-hr. In a third experiment the dose-response study with pentagastrin was repeated on a background infusion of glucagon in the dose found to be D50. A significant inhibition of acid secretion was found on all dose levels. The inhibition followed noncompetitive kinetics. Plasma concentrations of pancreatic glucagon in 4 of the 5 subjects in this experiment were comparable concentrations seen after a protein meal. Intravenous infusion of l-arginine on a background stimulation of acid secretion with synthetic human gastrin I in a dose of 250 ng per kg-hr was performed in 7 healthy subjects. Arginine increased serum glucagon concentration to levels seen after a meal and resulted in a significant inhibition of acid secretion. The results favor the hypothesis that pancreatic glucagon may participate in the physiological inhibition of gastric acid secretion.

Accidents and complications in selective and proximal gastric vagotomy.

In 3 years 266 consecutive patients were electively operated on for ulcer disease with either selective vagotomy (SV) with drainage (159) or proximal gastric vagotomy (PGV) without drainage (107). The total number of operative accidents was 15 (6 percent), similar to that of truncal vagotomy. Perforation of the stomach occurred in six SV and in one PGV. The perforation went unobserved in two patients, of whom one died. Esophageal perforations were not observed. Bleeding from the lesser omentum or from the spleen was seen in seven patients, requiring reoperation in one. Postoperative surgical complications were seen in 25 patients (9 percent): clinical gastric retention was observed in nine patients, five with SV and four with PGV, and 13 had wound abscesses or dehiscence. Fifty-nine patients had other complications, of which 52 were radiologically demonstrated atelectases, mostly without any clinical significance. The total mortality rate was 1.1 percent, similar to that of truncal vagotomy. The duration of the two operative procedures did not differ, and the greater care required for preservation of the nerve of Latarjet tended to diminish the number of operative accidents.