Multiple surgical procedures necessitated by thermal trauma traditionally require withholding nutritional support during the perioperative period. Significant caloric deficits develop with subsequent catabolism of body tissues to provide energy and amino acids for the synthesis of protein. Eighty patients, matched for age and total body surface area burn, were enrolled in a study to evaluate the safety and efficacy of providing enteral support throughout operative procedures. All patients had duodenal feeding tubes placed under fluoroscopy and were provided with isonitrogenous nutritional support calculated to meet measured energy needs (indirect calorimetry). Forty patients received enteral support throughout 161 surgical procedures, and 40 had enteral support withheld during 129 procedures. Age, incidence of inhalation injury, percentage of total body surface area, and postburn day of admission were similar in both groups. Nutritional parameters, calorie counts, and infectious complications were recorded during the first 4 weeks after burn. No patient in either group experienced aspiration. The unfed group demonstrated a significant caloric deficit (p < 0.006) and increased incidence of wound infection (p < 0.02) and required more albumin supplementation to maintain serum levels at a minimum of 2.5 gm/dl (p < 0.04). Enteral nutrition can be provided safely during the perioperative period and provides the additional benefits of reducing caloric deficits, wound infections, and exogenous albumin supplementation.

Burns↗

PubMedDate not supplied

A prospective analysis of serum vitamin K in severely burned pediatric patients.

Patients with burn injuries exhibit multiple risk factors for the development of vitamin K deficiency, including malabsorption, limited enteral intake, antibiotic therapy, and multiple surgical procedures. A prospective evaluation of 48 children was conducted to evaluate serum vitamin K values during the first 4 postburn weeks. Serum levels were analyzed in relation to clinical course. Days of antibiotic (p < 0.02) and albumin therapy (p < 0.003), percentage body surface area excised (p < 0.006), and the administration of blood products (p < 0.05) were significantly correlated with serum vitamin K levels, and days of diarrhea approached statistical significance (p < 0.06). No relationship was found between serum values and prothrombin time, activated partial thromboplastin time, or serum albumin. Ninety-one percent of the children demonstrated serum values below expected norms. These data suggest a relationship between coagulopathy and an intact functioning gastrointestinal tract. However, the relative importance of dietary versus endogenous vitamin K produced by intestinal bacteria remains to be elucidated.

Adolescent↗

PubMedDate not supplied

Breast implants: facts, controversy, and speculations for future research.

The breast implant crisis has been widely publicized. Beyond its immediate problems for the patients, the crisis has also discredited the use of silicone rubber as one of the most widely used biomaterials. Silicone elastomer or gel, the primary material in mammary prostheses, may be exposed to the body's tissues via envelope rupture, gel bleed, or elastomer fragmentation. Local responses to silicone include granulomatous inflammation, capsular contraction, and infection, all in varying degrees depending on ill-defined factors, which may include patient condition, peri- and postoperative complications, and hereditary predisposition, as well as material properties such as surface texture. The theory that silicone breast implants cause immunological disorders has not been proven. However, further study is necessary because some patients report autoimmune-like disorders (human adjuvant disease) following implant placement. Like autoimmune disease, human adjuvant disease is characterized by abnormalities of the immune response, autoantibody formation, and chronic inflammation. Silicone has been shown to play the role of an adjuvant, providing constant nonspecific stimulation of the immune system. Some researchers have hypothesized the role of silicone in specific immune reactions, including immunoglobulin formation and T-cell activation. This report examines the role of silicone as an agent of disease, focusing on material surface-tissue interactions.

Breast Implants↗

PubMedDate not supplied

The 1994 Clinical Research Award. A prospective clinical study of the polysomnographic stages of sleep after burn injury.

Although subjective evidence suggests that patients with burns are deprived of sleep, previous clinical studies have been limited to observational data and have not to date included electroencephalographic or polysomnographic recordings. The purpose of this study was to characterize the sleep pattern of patients suffering from thermal injury. Biweekly 24-hour polysomnographic measurements (electromyography, electrooculography, and electroencephalography) were performed with 12 leads. This measuring permitted continuous recording of intrinsic electrical activity in skeletal muscles via chin electrodes, eye movement via outer canthal electrodes, and brain wave activity with the other bipolar electrodes. Determinations were obtained on 11 patients with thermal injuries for a total of 43 24-hour periods. The patients had a mean age of 8.31 +/- 1.5 years (range 1.4 to 16 years), a mean total body surface area burn of 55.1% +/- 16.5% (range 17.5% to 90.5%), and a mean full-thickness burn of 48.5% +/- 8.1% (range 10.5% to 90.5%). Although mean total sleep time was seemingly adequate (625.1 +/- 31.6 min/patient/24 hrs), large aberrations in sleep stage distribution were noted. Significant decreases in stage 3 + 4 and in rapid eye movement (deep sleep) and increases in stages 1 and 2 (light sleep) were noted, suggesting a cycling back to stages 1 or 2 after disruption of sleep. Overall, in 43 runs 40% of the subjects were completely lacking stage 3 + 4, and 19% were missing rapid eye movement during an entire 24-hour run.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗