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1.
J Burn Care Res ; 37(5): 273-7, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27171844

RESUMO

Pulmonary dysfunction is a significant contributor to morbidity and mortality in the pediatric burned population. We have previously reported that the administration of a synthetic testosterone derivative, oxandrolone, significantly reduced hypermetabolism, and significantly increased height percentile, bone mineral content, lean body mass, and strength in pediatric burned patients. We hypothesize that the administration of oxandrolone will improve pulmonary function in burned pediatric subjects. A subset of severely burned pediatric subjects from a prospective clinical trial (n = 222) were included in our study (n = 54, 7-18 years, ≥30% TBSA burn). The subjects were previously randomized to either the control arm (n = 35) or the oxandrolone arm (0.1 mg/kg twice/day for 12 months, n = 19). Maximum voluntary ventilation, the ratio between forced expiratory volume and forced vital capacity, and diffusion capacity were measured 6 months following burn injury, and results were compared between burned subjects with and without oxandrolone administration. Maximum expired ventilation (VEmax) was also measured in a subset of burned subjects. Subjects treated with oxandrolone had a significantly higher maximum voluntary ventilation (98 ± 53 L/min vs 115 ± 56 with treatment, P = .03). During maximal exercise, subjects treated with oxandrolone had a significantly higher VEmax compared with untreated subjects (32.0 ± 8.7 L/min vs 43.7 ± 13.6 with treatment, P = .02). The administration of oxandrolone was associated with improved lung function in pediatric burned patients.


Assuntos
Queimaduras/terapia , Proteínas de Neoplasias/efeitos dos fármacos , Proteínas Nucleares/efeitos dos fármacos , Oxandrolona/administração & dosagem , Ubiquitina-Proteína Ligases/efeitos dos fármacos , Adolescente , Criança , Feminino , Humanos , Masculino , Ventilação Voluntária Máxima , Oxandrolona/uso terapêutico , Estudos Prospectivos
2.
Burns ; 41(3): 519-27, 2015 May.
Artigo em Inglês | MEDLINE | ID: mdl-25445004

RESUMO

UNLABELLED: Pulmonary abnormalities occur in 30-80% of fatalities after burn. The objective of our study is to investigate lung pathology in autopsy tissues of pediatric burn patients. METHODS: Three scientists with pathology training in pediatric burn care reviewed masked autopsy slides of burned children who died after admission to a burn center from 2002 to 2012 (n=43). Autopsy lung tissue was assigned scores for histologic abnormalities in 9 categories, including alveolar and interstitial fibrosis, hyaline membranes, and type II epithelial cell proliferation. Scores were then tested for correlation with age, TBSA burn, number of days between burn and death, time between burn and admission, and the presence of inhalation injury using analyses with linear models. RESULTS: Type II epithelial cell proliferation was significantly more common in cases with a longer time between burn and admission (p<0.02). Interstitial fibrosis was significantly more severe in cases with longer survival after burn (p<0.01). The scores for protein were significantly higher in cases with longer survival after burn (p<0.03). Enlarged air spaces were significantly more prominent in cases with longer survival after burn (p<0.01), and in cases with the presence of inhalation injury (p<0.01). CONCLUSIONS: Histological findings associated with diffuse alveolar damage (DAD), which is the pathological correlate of the acute respiratory distress syndrome (ARDS), were seen in approximately 42% of autopsies studied. Protein-rich alveolar edema, which is the abnormality that leads to ARDS, may occur from multiple causes, including inhalation injury.


Assuntos
Lesão Pulmonar Aguda/patologia , Queimaduras/complicações , Pulmão/patologia , Síndrome do Desconforto Respiratório/patologia , Lesão por Inalação de Fumaça/patologia , Lesão Pulmonar Aguda/complicações , Adolescente , Autopsia , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Fibrose/complicações , Fibrose/patologia , Hemorragia/complicações , Hemorragia/patologia , Humanos , Hialina , Lactente , Recém-Nascido , Masculino , Edema Pulmonar/complicações , Edema Pulmonar/patologia , Síndrome do Desconforto Respiratório/complicações , Estudos Retrospectivos , Lesão por Inalação de Fumaça/complicações , Fatores de Tempo
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