348 Bums (1991) 17, (4), 000-000 Printed in Great Britain

Abstracts

CLINICAL STUDIES

Beneficial use of chlorhexidine The admixture of 0.2 per cent chlorhexidine digluconate with silver sulphadiazine (AgSD) for the topical treatment of burn wounds reduced the incidence of colonization with Staph. aureus from 54 per cent with AgSD alone to 38 per cent. No beneficial effect of this mixture was found for colonization with E. fuecalis, E. cloacae and Ps. aeru@wsa.

Washing the burn wounds of other patients with 4 per cent chlorhexidine digluconate in bath soap reduced wound colo- nization by Staph. aurew from 51 per cent in controls to 35 per cent, and by Ps. mginosa from 16 per cent to 8 per cent.

Snelling C. F. T., Inman R. J., Germann E. et al. (1991) Comparison of silver sulfadiazine 1% with chlorhexidine diglu- conate 0.2% to silver sulfadizine 1% alone in the prophylactic topical antibacterial treatment of bums.J. Berm Care Reha&il. 12, (I), 13-18.

Benefit of a BCAA-enriched oral diet Studies in 14 severely burned patients given nasogastric feeds of differing composition with respect to branched chain amino acid content showed that, when compared to a standard whole protein feed (16 per cent leucine), a diet containing a high leucine content (31 per cent) significantly reduced the urinary 3-methyl histidine content and serum urea levels. Substitution of most of the leucine in the high leucine content diet with alpha keto isocaproate had no such beneficial effect.

King P. and Power D. M. (1990) Branched chain amino/keto acid supplementation following severe bum injury: a preliminary report. Clin. Ncrh: 9, (4), 226-230.

Parenteral nutrition with or without BCAA enrichment A randomized well-controlled study was carried out in 20 patients with severe bums who received parenteral nutrition containing either modified amino acids (high BCAA content) or standard amino acids. Sequential measurements of nitrogen balance and the serum levels of fibronectin, somatomedin-C/insulin-like growth factor I, prealbumin and retinol-binding protein were made for 4 weeks. It was found that the parenteral nutrition significantly improved the nitrogen balance and increased visceral protein concentrations compared with the findings in comparable bum patients not receiving parenteral nutrition, but that the differing alternative amino acid compositions had no discernible beneficial effect.

Brown R. O., Buonpane E. A., Vehe K. L. et al. (1990) Comparison of modified amino acids and standard amino acids in parenteral nutrition support of thermally injured patients. Crif. Care Med. IS, (lo), 1096-1101.

Early enteral feeding is safe and effective One hundred and six consecutive patients with a mean bum size of 40 & 21 per cent of the body surface area received enteral feeding starting within 6 h of injury and were followed for the first 7 days

0 1991 Butterworth-Heinemann Ltd 0305-4179/91/040000-00

after injury. The incidence of complications related to enteral feeding was low. Aspiration pneumonia did not occur. Vomiting was the major complication observed but only occurred 21 times in 16 patients during 745 days of study (2.8 per cent daily incidence). The mean number of calories absorbed enterally increased daily and met the patients’ calculated resting energy expenditure on the third day after burning.

McDonald W. S., Sharp C. W. and Deitch E. A. (1991) Immediate enteral feeding in bum patients is safe and effective. Ann. Strrg. 213, (2), 177-183.

Oedema and depressed cell-mediated immunity Tissue oedema or subeschar tissue fluid obtained from seven patients with burns covering between 30 and 100 per cent of the body surface area between 9 and 139 h after injury was found to induce complete inhibition of mitogen-induced lymphocyte pro- liferation. Serum collected from the patients concomitantly was also capable of inducing this inhibition. Both the tissue fluid and the serum were bacteriologically sterile. The suppressive material was stable for at least 4 h at room temperature and indefinitely at - 70°C.

Dyess D. L., Ferrara J. J., Luterman A. et al. (1991) Subeschar tissue fluid: a source of cell mediated immune suppression in victims of severe thermal injury. J. Burn Cure Rehabil. 12, (2), 101-105.

ANIMAL STUDIES

Lipid peroxidation products and humoral immunity Conjugated dienes isolated from the plasma from scalded rats were injected intraperitoneally into mice before the mice were immunized with sheep erythrocytes. Plaque forming cell assays 5 days later showed that the mice receiving the dienes from burned animals showed increased production of IgM compared with controls receiving dienes from normal rat plasma or sheep erythrocytes alone. Thus the humoral immune response may be modulated by these lipid peroxidation products.

Thomson P. D., Till G. O., Prasad J. K. et al. (1991) Enhancement of humoral immunity by heterologous lipid peroxidation products resulting from burn injury. 1. Bum Care Rehabil. 12, (I), 38-40.

Hepatic synthesis of proteins postbum The synthesis of secreted hepatic proteins was measured on day 11 after injury in rats recovering from deep flame bums covering 30 per cent of the body surface area. At this time the rats showed a diminished rate of weight gain and resting energy expenditures that were 25-30 per cent above normal. The rate of incorporation of leucine during a 2-h isolated liver perfusion indicated increased rates of synthesis of total secreted proteins, the seromucoid fraction and C3. The rate of synthesis of albumin was not increased above normal although its plasma concentration had fallen to only 50 per cent of normal.

Hiyama D. T., von Allmen D., Rosenblum L. et al. (1991) Synthesis of albumin and acute phase proteins in perfused liver after bum injury in rats. J. Burn Cure Rehbil. 12, (I), 1-6.