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Burn injuries produce a hypermetabolic state in the body, which is characterized by increased flow of glucose, protein and fat wasting, increased use of oxygen, and a negative nitrogen balance. Severely burned children may show this response by decrease in physical growth and development. The effect of treatment with recombinant human growth hormone (rHGH) on wound healing in 40 severely burned children was studied. The children ranged in age from 2 to 18, and had sustained burns from fire or scalding. All children had burns covering at least 40 percent of their total body surface area; 20 percent of the burns required a skin graft. In a two-phase, double blind study design, the patients were given either rHGH or a placebo. Those receiving rHGH were given either 0.1 mg or 0.2 mg dose per kilogram per day. There was no difference in the rate of wound healing of the donor graft site between the placebo and 0.l mg dose group. Patients receiving the higher 0.2 mg dose had significantly higher blood levels of IGF-1 antibody than the children receiving the placebo, and also had a significant decrease in wound healing time. There was a significant decrease in hospital stay for the group treated with 0.2 mg rHGH compared with the placebo group. For the average patient with 60 percent total body surface area burns, the hospital length of stay was 46 days in the placebo group compared with 32 days in the 0.2 mg treatment group. It is concluded that administration of rHGH decreases wound healing time and length of hospitalization. (Consumer Summary produced by Reliance Medical Information, Inc.)

With the introduction of tangential excision, burn wound excision (removal) has been performed on wounds ranging in size from 15 to 30 percent of total body surface area (TBSA). Tangential excision, while removing dead tissue, preserves much of the surrounding viable tissue, and decreases the change in body contour that often occurs when the fascial layer of tissue is excised. Tangential excision, however, has been associated with greater blood loss than other excision techniques. It has been suggested that decreased blood loss may occur if tangential excision is performed in the first few days after injury. This may be due to the effects of vasoactive mediators and swelling, which reach maximum levels of blood vessel constriction within the first 24 hours after injury. A study was undertaken of 594 acutely burned patients who each underwent near total excision of burns in a single surgical procedure. There were no operative deaths. The blood loss in large burns (30 percent TBSA) was found to be significantly less when the surgery was performed within the first 24 hours after injury, or after the sixteenth day, compared with between the second and sixteenth day. There was no increase in mortality in the patients who were operated on in the first 24 hours compared with those operated on later. It is suggested that near-total excision of large burns, performed within 24 hours of injury, can reduce blood loss and morbidity without increasing mortality or disturbing hemodynamic stability. (Consumer Summary produced by Reliance Medical Information, Inc.)

After a severe trauma, such as a cutaneous thermal injury, an increase in hepatocyte apoptosis has been associated with hepatocyte damage and impairment in hepatic function. Insulinlike growth factorI IGFI exerts antiapoptotic effects in several organs, thus improving organ homeostasis. The purpose of the present study was to determine whether IGFI in combination with its principle binding protein3 BP3 attenuates liver damage after a burn and whether this attenuation is through signals of the apoptoticproliferative axis of hepatocytes. SpragueDawley rats 56 males received a 60 total body surface area thirddegree scald burn and were randomly divided to receive either rhIGFIBP3 10 mgkgday sc. or saline control. Serum aspartate transaminase AST and nitric oxide NO, and hepatocyte proliferation and apoptosis, were measured on postburn days 1, 2, 5, and 7. Hepatic interleukin1 IL1 and tumor necrosis factor TNF mRNA and hepatic nuclearfactor B NFB were determined at 1 and 2 days postburn. IGFIBP3 decreased serum AST and increased serum NO at 1, 2, and 5 days after burn when compared with controls P< 0.05. IGFIBP3 increased hepatocyte proliferation on the first day after burn and decreased hepatocyte apoptosis at day 7 postburn when compared with controls P< 0.05. IGFIBP3 decreased hepatic IL1 and TNF mRNA 1 day after burn P< 0.05. IGFIBP3 further increased hepatic NFB concentration 1 and 2 days postburn when compared with controls P< 0.05. Recombinant hIGFI in combination with its principle binding protein conserves hepatic homeostasis, which is associated with a transient increase in hepatocyte proliferation and decrease in hepatocyte apoptosis possibly through NO and hepatic NFB.

Lung functions were measured on 13-day-old conjoined thora-copagus twins. Mean values for tidal volume and minute ventilation were 14.8 ml and 1102 ml/min for twin A and 12.8 ml and 963 ml/ min for twin B. Functional residual capacities (FRC) were 35 ml/ kg and 39 ml/kg for twins A and B, respectively. Pulmonary compliance and flow resistance for twin A were 2.8 ml/cm H2O and 75 cm H2O/liter sec−1with 45 of the total work used to overcome elastic resistance. Although values for resistance and work of breathing are within the normal range for studies reported elsewhere, these results tend to be elevated and probably reflect an abnormal state.

A severe thermal injury is commonly associated with immune suppression and increased susceptibility to sepsis, frequently leading to multiple organ failure. Transforming growth factorbeta TGF is a potent immunosuppressive cytokine involved in complications associated with major trauma. Interleukin 4 IL4 is thought to synergize the immunosuppressive activity of TGF by promoting naive lymphocytes to differentiate and generate TGF secreting cells. This study examines the alterations in serum levels of TGF and IL4 after a thermal injury. Male SpragueDawley rats 300400 g were anesthetized and received a 50 total body surface area fullthickness scald burn followed by fluid resuscitation and analgesia. Control rats were given the same treatment, but were immersed in water at room temperature. Rats were sacrificed from 1 h to 8 days after injury. Blood samples were collected aseptically from the inferior caval vein. Serum levels of TGF and IL4 were measured by enzyme linked immunosorbent assay. Rats in the control and thermal injury groups showed similar increases in serum TGF 1 h after injury. A progressive increase in serum TGF was observed in burned animals compared to control animals starting on day 3 and continued through day 8 P< 0.01. Serum IL4 levels in control and thermally injured animals remained undetectable <15.6 pgmL throughout the experiment. Thermal injury induces a significant increase in serum TGF, which may contribute to postburn immunosuppression with an increased susceptibility to sepsis.