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Biomedical subjects

A M Munster

Publications and source records attributed to A M Munster.

At least 19 recordsLinked to original sources
PubMed1992

Inhibitory effects of interleukin 6 on immunity. Possible implications in burn patients.

Certain disease states are associated with abnormal increases in the monokine interleukin 6. Increased levels of interleukin 6 have been demonstrated in serum from patients with burns and are associated with systemic increases in endotoxin levels. Using a murine in vitro experimental model, we have studied the effects of interleukin 6 on various measures of immunity. Our data indicate that levels equivalent to the concentrations found in serum of burn victims inhibit T-cell proliferation. The inhibitory effect is dose and time dependent, is specific for T cells, is not due to impairment of interleukin 2 production or of interleukin 2 receptor expression, and is dependent on macrophages. These data suggest that extraordinary increases in interleukin 6 levels may be related to impaired T-cell responses and to an increased susceptibility to infection in the patient with burns.

Animals↗
PubMed1992

Posttraumatic adaptation and distress among adult burn survivors.

OBJECTIVE: The purpose of this study was to examine the prevalence, natural history, and psychosocial impact of posttraumatic symptoms in adult burn survivors. METHOD: Forty-three adult inpatients at a regional burn center were assessed at discharge with standardized instruments to determine the presence of psychiatric disorder, assess personality, and quantify depression. Thirty-one patients were evaluated 4 months after discharge. RESULTS: Posttraumatic stress disorder was diagnosed in 7% of patients at discharge and in over 22% of patients at follow-up. Symptoms of avoidance and emotional numbing (DSM-III-R criterion C symptoms) tended to emerge after discharge from the hospital. While posttraumatic symptoms were associated with symptoms of depression, they were not strongly associated with psychosocial adjustment to illness; psychosocial adjustment was more strongly related to aspects of personality, the injury itself, and its treatment. CONCLUSIONS: Since adult burn survivors often develop new symptoms of posttraumatic distress after leaving the hospital, longitudinal surveillance is required to detect new cases and provide appropriate treatment. Survivors at risk for poor psychosocial adjustment after discharge may be identifiable during hospitalization, and preventive treatment strategies should be developed and tested for this population.

Adaptation, Psychological↗
PubMed1979

Prophylactic antibiotics in surgery. Practices within surgical services of the Veterans Administration.

A survey of prophylactic antibiotic-prescribing habits among chiefs of surgical services of the Veterans Administration yielded a 99% response. These responses have been compared with guidelines set by an expert committee on antimicrobial use for the VA central office. Assuming that 100% concordance with the standards of the committee is a desired state, the average hospital is approximately one third away from this goal (average score, 62.4%). The majority of errors were those of overuse rather than underuse. The size of the service and the existence of a university affiliation had no influence on the results. Feedback to the chiefs of service regarding the use of antibiotics was informal and tended to be carried out on rounds rather than as a result of formal audits. Most senior surgeons indicated that they would be willing to be influenced by audit guidelines.

Anti-Bacterial Agents↗
PubMed1979

Netilmicin. A new aminoglycoside in the treatment of septic burn patients.

Netilmicin sulfate, a new aminoglycoside antibiotic, was administered to ten patients with thermal burns who were suffering from septic complications, usually burn wound sepsis. There were seven survivors. Eighty-three percent of all clinical isolates recovered showed sensitivity to the drug. No renal or auditory side effects were noted in any of the patients.

Adolescent↗
PubMed1979

Quality of life after major burns.

The only presently available method of measuring the outcome of major burns is the mortality rate. We have developed a scale, administered by interview and physical examination, with which the quality of life in survivors may be measured. In an initial group of 32 patients, we took each patient's own preinjury level of performance as a baseline. The size of the burn had no significant effect on the postburn score achieved. Substantial numbers of patients achieved levels superior to their preburn score. Improvement in scores did not begin until 12 months had elapsed from the time of injury. We feel that scales such as this will help determine what happens to patients after their injury, pinpoint areas of weaknesses in the burn program, and enable better comparison of performance between clinical facilities.

Burns↗
PubMed1979

Cerium nitrate-silver sulfadiazine cream in the treatment of burns: a prospective, randomized study.

In a prospective, randomized study of 34 patients with thermal burns, treatment with the topical agent Cerium nitrate-silver sulfadiazine was compared with therapy with silver sulfadiazine alone. Despite randomization, there was a significant difference in mean burn size, being larger in the silver sulfadiazine group. There was no significant difference between the two groups in clinical course, mortality, septic deaths, or quantitative microbiology of the burn wound. It is concluded that from these preliminary data no clearcut superiority for one cream over the other can be demonstrated at this time.

Adult↗
PubMed1977

Cell-mediated immune responses to Pseudomonas aeruginosa.

Of six healthy laboratory workers with no history of illness caused by Pseudomonas aeruginosa, four exhibited positive skin responses at 24 hours, strong inhibition of leukocyte migration, and marked stimulation of blastogenesis of peripheral lymphocytes when exposed to a "cocktail" of three phenol-killed strains of P aeruginosa. There was no correlation between the extent of these responses with serum hemagglutinin titers. It is postulated that cell-mediated immunity against P aeruginosa may have a biologic role in host defense.

Antigens, Bacterial↗
PubMed1977

Accelerated tumor growth following experimental burns.

When mice are given a 30% scald burn, the growth of subsequently inoculated Ehrlich ascites tumor is markedly accelerated. This effect, which parallels the well documented suppression of cell-mediated immunity occurring postburn, disappears 10 days postinjury. Possible clinical implications are discussed and an illustrative case report is presented.

Animals↗
PubMed1977

The effect of antibiotics on cell-mediated immunity.

Normal human lymphocytes in culture were stimulated by the addition of phytohemagglutinin, and deoxyribonucleic acid (DNA) synthesis was measured by the incorporation of tritiated thymidine. The effect of 11 commonly used antibiotics on DNA synthesis then was measured by adding each antibiotic to the culture in concentrations ranging from 2 to 64 microng/ml, a range which covers the plasma levels obtained during customary clinical therapy. Severe dose-dependent suppression of DNA synthesis was found in the presence of two preparations of minocycline, oxytetracycline, and the ascorbic acid salt of tetracycline. Less severe but stil significant suppression was found in the presence of chloramphenicol, clindamycin, tetracycline, and ascorbic acid alone. No effect was noted when penicillin, carbenicillin, or cephalothin was added, and slight stimulation was found in the presence of gentamicin. It is postulated that these findings may help to explain fungal and viral superinfection following antibiotic therapy and that they may play a role in the failure of antibiotic therapy to eliminate some infections.

Anti-Bacterial Agents↗
PubMed1976

Post-traumatic immunosuppression is due to activation of suppressor T cells.

Severe immunosuppression occurs after major thermal burns, accidental injuries, and extensive surgical operations, and probably contributes substantially to patient morbidity and mortality. The mechanism of immunosuppression is unknown and attempts to explain it are contradictory. The contradictions can be resolved by assuming the activation by injury of the suppressor T-cell system, which is involved in normal immunoregulation. If this is true, then generalised, non-specific attempts to bolster the immune response in these patients may be inappropriate.

Humans↗