PubMed Health⌕ Search

Biomedical subjects

Robert H Demling

Publications and source records attributed to Robert H Demling.

7 recordsLinked to original sources
PubMed2005

The role of anabolic hormones for wound healing in catabolic states.

OBJECTIVE: The purpose of this paper is to present an overview of the interrelationship between hormones, nutrition, and wound healing. METHODS: The data on various hormones and their effects on specific elements of nutrition and wound healing are reviewed. RESULTS: The key anabolic hormones are human growth hormone, insulin-like growth factor-1, insulin, and testosterone and its analogs. Although each has specific metabolic actions, there is also a very important hormone-hormone interaction. A deficiency of these hormones occurs in acute and chronic catabolic states, resulting in lean mass loss and impairing the healing process. CONCLUSION: There is a well-recognized interrelationship between hormones, nutrition, and wound healing. The anabolic process of protein synthesis, with new tissue formation, requires the action of anabolic hormones. Exogenous administration of these agents has been shown to maintain or increase lean body mass as well as directly stimulate the healing process through their anabolic and anticatabolic actions.

Journal Article↗
PubMed2003

Oxandrolone induced lean mass gain during recovery from severe burns is maintained after discontinuation of the anabolic steroid.

Weight loss and lean mass loss from burn induced catabolism can be more rapidly restored when the anabolic steroid oxandrolone is added to optimum nutrition compared to nutrition alone. Our purpose in this study was to determine whether the regained lean body mass (LBM) is retained 6 months after stopping oxandrolone. Forty-five severe burn patients, entering the recovery phase were randomized into a nutrition group alone or with the addition of oxandrolone, 20mg per day upon admission to the acute burn rehabilitation (RH) unit. Oxandrolone was discontinued after at least 80% of the involuntary weight loss occurring in the acute burn period, was restored. Body composition was measured using bioelectric impedence analysis (BIA). We found that patients receiving oxandrolone, in the rehabilitation unit, regained weight and lean mass two to three times faster than with nutrition alone. The difference was statistically significant (P<0.05). All patients were discharged from RH on a nutrition and exercise program and monitored in the outpatient burn center. After 6 months, body weight and body composition were again measured. We found that the body weight and lean mass which was restored during RH, was maintained 6 months after discontinuation of oxandrolone. Lost lean mass was not yet restored in the nutrition alone group. We can conclude that body weight and lean mass which is lost, due to burn induced catabolism, can be effectively restored in the post-burn recovery period with oxandrolone. The body weight and lost lean mass which is regained, is maintained 6 months after stopping the drug.

Adult↗
PubMed2002

The rate of re-epithelialization across meshed skin grafts is increased with exposure to silver.

UNLABELLED: The objective in this study was to determine whether exposure to pure silver increases the rate of re-epithelialization across a partial thickness wound. A meshed skin graft, placed on an excised burn wound was used as a healing model. METHODS: The rate of meshed skin graft epithelial closure on an exposed burn using a moist healing environment was shown. A moistened silver delivery system (Acticoat) was compared with a standard xeroform and eight ply gauze dressing continually moistened with a 0.01% neomycin and polymyxin solution (NP). Twenty burn patients with deep burns of over 15% of TBS were excised and grafted with 2:1 meshed grafts. One graft area was treated with the antibiotic solution and another with the silver delivery. The meshed graft was performed within 3 days of injury. RESULTS: No infections were noted and quantitative swab cultures gave less than 10(2) bacteria in all cases at wound closure. At day 7, re-epithelialization was complete with silver and 55% closed with NP solution. Wound closure was complete in the NP solution group at day 10. Silver increased re-epithelialization rate by over 40%, a significant increase. Graft take was over 95% in both groups. CONCLUSION: Silver released in a moist wound surface environment significantly increases the rate of re-epithelialization compared to a standard antibiotic solution.

Adult↗
PubMedDate not supplied

The incidence and impact of pre-existing protein energy malnutrition on outcome in the elderly burn patient population.

Protein energy malnutrition (PEM) and involuntary weight loss is a common problem in the elderly population. Our purpose was to determine the incidence and the effect on outcome of PEM in the elderly burn patient population. A chart review and review of the burn data registry was undertaken to determine the incidence and effect of PEM in patients older than 65 years of age with major burns from 1% to 30% TBSA. PEM was diagnosed using standard physiological and biochemical markers. Data were compared with those from a well-nourished elderly burn group to assess the impact. Of the 123 patients studied, we found that PEM was present in 61%. There was a significant increase in infection rate, decrease in the rate of healing of a standard skin graft donor site, and an increase in length of stay in the PEM group compared with the nourished elderly burn group. Mortality with PEM was 17% compared with 9% without PEM, a significant increase. We conclude that PEM is a common comorbid factor in the elderly burn population that increases morbidity and mortality.

Age Factors↗
PubMedDate not supplied

Fourth-degree burns to the lower extremity with exposed tendon and bone: a ten-year experience.

Fourth-degree extremity burns involve muscle, tendon, and bone, often leading to amputation or significant functional impairment. We report our 10-year experience (1995-2004) at an urban burn center with fourth-degree burns to the lower extremity to characterize treatments and outcomes. Twenty-one patients (40 limbs), mean age of 45 years, were treated for fourth-degree lower-extremity burns with the average extremity burn size of 24% TBSA (range, 2-36%) and a mean fourth-degree burn size of 9% TBSA (range, 2-18%). A mean of eight operations were required for limb salvage. Six free-tissue transfers, 2 fillet flaps, 14 local flaps, and multiple skin grafts were performed. Five patients underwent tibial burring for granulation tissue stimulation, and the subatmospheric pressure device was used in eight patients. Seven limb amputations (18%) were required in four patients, and 76% of patients were ambulatory on follow-up. The mean hospital stay was 76 days with high rates of cellulitis, deep vein thrombosis, and bacteremia. Patients treated with flap closure had a significant decrease in the number of operations required for limb salvage. Fourth-degree lower-extremity burns require multistage reconstructive procedures using multiple levels of the reconstructive ladder but limb salvage is possible in a majority of cases.

Adolescent↗
PubMedDate not supplied

The burn edema process: current concepts.

Massive tissue edema after thermal injury is a well-recognized entity. Although this process is responsible for the patient's large fluid needs during resuscitation and also for local problems, such as a compartment syndrome, there have been no effective treatment modalities introduced into clinical care to control the degree of edema. A review of what is now known about the edema process is presented here, including attempted prevention and treatment modalities. The pathogenesis involves changes in most of the physical forces controlling fluid flux across the capillary and also how fluid accumulates in the interstitium. Increased capillary permeability to protein is but one of these changes. The presence of an initial profound negative interstitial pressure "sucking" fluid into the tissues and a marked increase in interstitial space compliance are equally important components. A host of mediators, especially oxidants, have been reported to cause these physical changes, and some mediator inhibitors appear to be of benefit, especially antioxidants. However, few clinical trials, aimed at decreasing edema, have been performed. With these new insights into the edema process, future prevention and treatment modalities can be developed.

Burns↗