RESUMEN
Cultured epithelial autograft (CEA) has been used as an adjunct in burn wound coverage at the Vancouver Hospital and Health Sciences Centre since 1988, and has been available to all patients admitted with significant burn injuries. During the 5-year period from 1988 to 1992 inclusive, 28 patients treated with CEA survived long enough for assessment. The mean age was 35.3 years with a mean total body surface area burn of 52.2% and a mean total full thickness injury of 42.4%. CEA was applied to wounds covering between 2% and 35% body surface area (BSA; mean 10.4%) after excision to fat or fascia. Most wounds had interim homograft coverage. Preservation of homograft dermis was attempted in three patients at the time of removal without effect. The mean CEA "take" was 26.9% of the grafted area. Eight patients had 50% or greater take and were discharged with between 1 and 19% BSA covered with CEA. Thirteen patients had no take on wounds between 2 and 16% BSA. Overall mortality in burn patients treated at the Vancouver Hospital and Health Sciences Centre from 1988 to 1992 was not significantly different from 1983 to 1987 with the populations being similar in terms of total BSA burns, age, inhalation injury, and homograft availability. When compared to a matched control population from the preceding 5 years, when CEA was not available, there was no significant difference in duration of hospital stay or number of autograft harvests. However, approximately one more debridement without autograft harvest per CEA patient occurred. Timing and depth of wound excision, interim coverage, type of dressing, and wound microbiology were not found to influence good versus poor take. The anterior trunk and thighs were the best recipient sites. Subjective differences between CEA and meshed autograft were noted. The results show that after 5 years of use, CEA engraftment continues to be unpredictable and inconsistent, and hence, it should be used as only a biologic dressing and experimental adjunct to conventional burn wound coverage with split thickness autograft.
Asunto(s)
Quemaduras/terapia , Trasplante de Piel/métodos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Apósitos Biológicos , Células Cultivadas , Células Epiteliales , Epitelio/trasplante , Femenino , Supervivencia de Injerto , Humanos , Masculino , Persona de Mediana Edad , Trasplante Autólogo/métodos , Resultado del TratamientoRESUMEN
Eighteen patients with major burns (mean total body surface area burned was 49% and mean total body surface area with full-thickness burns was 38%) had cultured epithelial autografts applied to 2% to 35% of the body surface area. In six patients successful "take" of greater than 65% occurred, and in 12 patients less than 40% "take" occurred. Most wounds underwent early excision to subcutaneous fat or fascia, and the wounds of 16 patients had been treated previously with homograft. Cultured epithelial autografts were covered with either single or multilayered dressings. Perioperative wound cultures showed that all patients had microorganisms, and appropriate perioperative antibiotic coverage of Staphylococcus epidermidis and Pseudomonas aeruginosa was noted less frequently in the poor take group, which may have influenced subsequent cultured epithelial allograft take. Adherence and stability of cultured epithelial allografts lag behind adherence and stability of meshed split-thickness autograft. The anterior trunk and thighs are the best recipient sites. The number of autograft harvests that were required to close wounds and the length of hospital stay were not significantly decreased by the use of cultured epithelial allografts as compared with comparable full-thickness burns that were treated previously without cultured epithelial allografts. Presently, grafting with cultured epithelial allografts is an adjunct but not an alternative to conventional burn-wound coverage with split-thickness autograft, because engraftment is inconsistent.
Asunto(s)
Quemaduras/cirugía , Trasplante de Piel/métodos , Adolescente , Adulto , Antibacterianos/uso terapéutico , Quemaduras/epidemiología , Células Epiteliales , Femenino , Estudios de Seguimiento , Supervivencia de Injerto , Humanos , Masculino , Trasplante de Piel/fisiología , Trasplante Autólogo , Infección de Heridas/tratamiento farmacológico , Infección de Heridas/epidemiologíaRESUMEN
The putative involvement of alpha 2-macroglobulin (alpha 2M) in the pathogenesis of cystic fibrosis has long been a subject of controversy. Previous reports have indicated that there are alterations in the carbohydrate moieties of alpha 2M in the disease. In the present study the carbohydrate composition of alpha 2M isolated from the plasma of six patients with CF was compared to that of alpha 2M from six age- and sex-matched normal controls. The carbohydrate composition of CF alpha 2M expressed as mean mumol carbohydrate +/- SD per 100 mg protein was: fucose 0.70 +/- 0.12; mannose 14.07 +/- 1.31; galactose 6.72 +/- 0.65; glucosamine 15.38 +/- 1.59; sialic acid 5.52 +/- 0.33 while that of normal control alpha 2M was: fucose 0.69 +/- 0.11; mannose 14.42 +/- 1.21; galactose 6.91 +/- 0.52; glucosamine 16.13 +/- 1.77; sialic acid 5.58 +/- 0.31. Therefore, contrary to previous reports, this paper demonstrates that there is no difference in the carbohydrate composition of alpha 2M in cystic fibrosis.
Asunto(s)
Carbohidratos/análisis , Fibrosis Quística/sangre , alfa-Macroglobulinas/análisis , Adolescente , Niño , Femenino , Glucosamina/análisis , Hexosas/análisis , Humanos , Masculino , Ácidos Siálicos/análisisRESUMEN
Both excess dietary vitamin E and vitamin E deficiency in rats can significantly depress the activity of GSH peroxidase in liver and plasma of rats. Of all the six levels of vitamin E tested in this study, the dietary level of vitamin E found to maintain the maximum activity of GSH peroxidase in tissues of rats was somewhere between 25 and 250 IU/kg diet. This study conclusively indicates that the excess dietary vitamin E represses GSH peroxidase activity.