PubMed Health⌕ Search

Biomedical subjects

S M Milner

Publications and source records attributed to S M Milner.

At least 19 recordsLinked to original sources

Inducibility of HBD-2 in acute burns and chronic conditions of the lung.

The respiratory tract produces a number of molecules that act in the first line of host defense to protect against pathogenic colonization and tissue invasion. Most of the innate antimicrobial activity can be attributed to airway fluid proteins, such as lysozyme, lactoferrin, and secretory leukoproteinase inhibitor, and peptides, such as defensins. Human beta-defensins are cationic antimicrobial peptides with broad and potent microbicidal activity that have been shown to play a role in protecting the healthy lung from infection. To determine the effect of thermal injury on the production of the inducible beta-defensin, human beta-defensin-2 (HBD-2), we measured the concentration of HBD-2 by Western blot analysis in bronchoalveolar lavage samples from the lungs of burned patients with and without inhalation injury. Our data demonstrates an increased amount of HBD-2 in the pulmonary airways with thermal injury compared to normal lung. A further substantial increase in levels was noted in chronic lung conditions.

Acute Disease↗

The Burn Wheel.

Explore the source record for details and available documents.

Adolescent↗

Human beta defensin is absent in burn blister fluid.

Defensins are a family of cationic antimicrobial peptides that participate in innate host defence. Human beta defensin-2 (HBD-2) is produced by human keratinocytes, and has a potent bactericidal activity against a wide spectrum of microorganisms. We have recently shown that expression of HBD-2 is present in normal skin and lost in the full-thickness burn wound. Defensins have been found in the blister fluid of chronic wounds. Our study was designed to examine blister fluid from partial-thickness burns for defensin content. Fluid from five patients was collected from partial-thickness burn blisters, and then analysed by sandwich Enzyme-Linked Immunosorbent Assay (ELISA) with a monoclonal antibody and rabbit polyclonal antibody to HBD-2. The assay was validated against a Western blot assay for HBD-2 in samples of bronchoalveolar lavage fluid from patients with inflammatory lung disease. No HBD-2 was detectable in any of the burn blister fluids analysed. HBD-2 is lost in the full-thickness burn wound, and we have now demonstrated its absence in burn blister fluid. This finding represents evidence of a host defence defect within the burn wound and suggests a possible therapeutic role for antimicrobial peptides in the management of burn wounds.

Adolescent↗

The "stegosaurus" dressing: a simple and effective method of securing skin grafts in the burn patient.

Skin grafts are vulnerable to shear stress, infection, and hematoma formation during the postoperative period, all of which reduce graft survival. Various methods of dressing application and materials have been described in the literature to try and prevent graft loss. The authors report the use of the "stegosaurus dressing" (Eggcrate Pad) in 6 patients to secure skin grafts. Patients chosen were those who were either noncompliant or who sustained burns in unfavorable anatomic sites. All grafts demonstrated complete take without infection and hematoma formation. This foam dressing provides an even pressure to the recipient bed, absorbs drainage, and protects the graft from shearing. It also demonstrates the versatility to be used in difficult nonburn skin graft areas. The stegosaurus dressing is easy to apply, inexpensive, and provides a very secure dressing over the skin graft.

Burns↗

Resuscitation of severe thermal injury with hypertonic saline dextran: effects on peripheral and visceral edema in sheep.

BACKGROUND: Edema of tissue not directly injured by heat is a common complication after resuscitation of burn shock. Hypertonic 7.5% NaCl 6% dextran (HSD) infusion reduces early fluid requirements in burn shock, but the effects of HSD on peripheral and visceral tissue edema are not well-defined. METHODS: We measured the microcirculatory absorptive pressures of burned and nonburned skin and tissue water content of skin and other tissues in anesthetized sheep after 70% to 85% total body surface area scald and resuscitation. Fluid infusion was initiated 30 minutes after injury using 10 mL/kg HSD (n = 11) or lactated Ringer's (LR) (n = 12), with infusion rates titrated to restore and maintain preburn oxygen delivery (DO2). Thereafter, both groups received LR infusions as needed to maintain DO2 until the study's end at 8 hours. Colloid osmotic pressure was measured in plasma, and combined interstitial colloid osmotic and hydrostatic pressures were measured in skin. RESULTS: Both treatments successfully restored DO2, but fluid requirements were less with the HSD group than with the LR group (43+/-19 mL/kg vs. 194+/-38 mL/kg, respectively, p < 0.05). The peripheral and visceral tissue water contents at 8 hours postinjury until the end of the study in both burn groups were significantly higher than in nonburn controls. However, HSD-treated sheep had significantly less water content in the colon (less 28%), liver (less 9%), pancreas (less 55%), skeletal muscle (less 21%), and nonburned skin (less 12%) compared with LR-treated sheep (p < 0.05 for each). HSD-treated sheep maintained significantly higher (3 to 5 mm Hg) plasma colloid osmotic pressure than LR-treated sheep. CONCLUSION: There were no observed differences in edema in burn skin between the two treatment groups. The early volume-sparing effect of HSD and reduction in tissue edema are likely attributed to an increased extracellular osmolarity and a better maintenance of the plasma oncotic pressure.

Animals↗

Reduced antimicrobial peptide expression in human burn wounds.

Severely burned skin ceases to perform its natural protective role and surrenders itself as a nidus and portal for bacterial invasion. Antimicrobial peptides are part of a non-specific chemical defence system, separate from cellular and humoral immunity. Two of these peptides, human beta-defensins 1 and 2 have been recently found in skin and are produced by keratinocytes. Beta defensins have potent bactericidal activity against a wide spectrum of bacterial and fungal organisms commonly responsible for burn wound infections. To date, expression of beta defensins has not been examined in the human burn wound. Our findings demonstrate that expression of hBD-2 is greatly decreased in the burn wound whereas hBD-1 appears to be preserved. These results may have important implications in the pathogenesis and treatment of invasive burn sepsis.

Burns↗

The use of a modified Dakin's solution (sodium hypochlorite) in the treatment of Vibrio vulnificus infection.

We report the first clinical use of a modified Dakin's solution (0.025% sodium hypochlorite [NaOCl]) to halt the progress of severe cutaneous Vibrio vulnificus infection in a critically ill patient. The regimen used arose from an initial in vitro study designed to examine the sensitivity of Vibrio species to topical antimicrobial agents. Twenty-eight wound isolates were tested against the following eight topical preparations: silver sulfadiazine (Silvadene), nitrofurazone, mupirocin ointment (Bactroban), polymyxin B/bacitracin, mafenide acetate (Sulfamylon), nystatin/Silvadene, nystatin/polymyxin B/bacitracin, and 0.025% NaOCl solution. The results showed that V vulnificus, along with the other 18 Vibrio species tested, was most sensitive to the modified NaOCl solution.

Administration, Cutaneous↗

Calcitonin gene-related peptide improves skin flap survival and tissue inflammation.

The effects of systemic administration of calcitonin gene-related peptide (CGRP) on survival and inflammation of experimental skin flaps subjected to prolonged arterial ischemia were studied. An island groin flap was elevated in the rat. The femoral artery was occluded for 8, 10, 12 or 14 h in four groups of 10 rats. In a group of 10 sham-operated control animals, the femoral artery was not occluded. After ischemia, blood flow was restored and flap survival evaluated at day 7. Following 12 h of ischemia, three flaps (30%) survived, compared with 100% survival of the control group. In the second part of the study the effects of CGRP on flap survival were assessed. Eighty flaps were rendered ischemic for 12 h, and received systemic CGRP (10(-7), 10(-8), 10(-9), 10(-10) M) or saline (control) at the end of the ischemia period. Administration of CGRP (10(-7) M) significantly increased the number of flaps surviving compared with the control. The effect of systemic pretreatment of the animals with the CGRP receptor antagonist CGRP8(-37), followed by CGRP (10(-7) M) treatment was also evaluated in 10 flaps. Flap survival in this group was 10%. In the third part of the study the anti-inflammatory effects of CGRP were evaluated. Forty rats were subjected to arterial ischemia for 12 h, and received systemic CGRP (10(-7) M), or saline at the end of the period of ischemia. The animals were sacrificed at 24 h and flap tissue samples were obtained. Myeloperoxidase (MPO) analysis was used as marker of neutrophil accumulation. CGRP (10(-7) M) significantly reduced the 24 h MPO accumulation in the flap, compared with saline treatment. A group of animals was pretreated with CGRP8(-37), followed by CGRP (10(-7) M), and a significant increase of MPO accumulation was seen, compared with the group treated only with CGRP. This study suggests that CGRP has a beneficial effect on survival of the rat ischemic groin flap, and diminishes the inflammatory response to the ischemic insult.

Animals↗

Venous ulcers: improved healing by iontophoretic administration of calcitonin gene-related peptide and vasoactive intestinal polypeptide.

A study on the effects of iontophoretic administration of calcitonin gene-related peptide and vasoactive intestinal polypeptide on the healing of venous stasis ulcers of the extremities was carried out on 66 patients. Two randomized groups of patients were compared, one receiving standard treatment plus iontophoresis of calcitonin gene-related peptide and vasoactive intestinal polypeptide, and the other receiving standard treatment plus placebo iontophoresis. Calcitonin gene-related peptide and vasoactive intestinal polypeptide were administered locally by iontophoresis for 20 min three times weekly for 12 weeks. To determine the effects of the two treatments, the percentage surface area of ulcer healed and the number of healed ulcers were compared after 2, 4, 6, 8, and 12 weeks of treatment. The results demonstrate that there were significant improvements of the healing process in the group treated with calcitonin gene-related peptide and vasoactive intestinal polypeptide when compared with placebo iontophoresis, and support the use of iontophoresis administration of calcitonin gene-related peptide and vasoactive intestinal polypeptide in the treatment of venous ulcers.

Aged↗

The histological interpretation of high frequency cutaneous ultrasound imaging.

BACKGROUND: High frequency, high resolution B-scan ultrasound imaging (US) has been used to assess skin. The use of US is limited because of difficulty interpreting the various echoes. OBJECTIVES: To correlate the appearance of constant US echoes with histology in normal human skin. METHODS: Normal skin from eight volunteers was scanned with US at a frequency of 20-25 MHz, prior to excision for clinical reasons. The echogenic bands of the skin and histological measurements of various layers were related statistically. RESULTS: Three constant echogenic bands were identified, which correlated with skin surface, dermis, and subcutaneous fascia. CONCLUSION: The correct interpretation of echogenic bands in normal skin allows for the US to be more reliably used for assessment of skin disorders.

Adult↗

A personal digital assistant for determination of fluid needs for burn patients.

In most instances, the treatment of major burn victims begins in the emergency room of the hospital closest to the accident site. It can be assumed that the emergency room personnel in most hospitals rarely see patients with major burns. Thus, their experience with burn fluid resuscitation is often limited. Yet it is critical that primary early treatment of burn injury with fluid resuscitation begin before the patient is admitted locally or transferred to a burn unit. To assist these individuals a fluid resuscitation calculation application has been developed to run on a hand-held personal digital assistant (Palm Pilot). This hand-held application is meant to assist in emergency situations where time is short, thoughtful computation is not possible, and a quick determination of fluid replacement therapy is important for the survival of the patient.

Adult↗

Comparison of vascular effects of calcitonin gene-related peptide and lidocaine on human veins.

Arterial and venous constriction during microsurgery are among the leading causes of flap failure. So far, pharmacologic tools have been proposed only for arterial constriction, and local anesthetics are commonly used to counteract the vascular spasm. The purpose of this study was to investigate the vascular effects of two known arterial vasodilators on human veins, in order to evaluate the possibility of their potential use during microsurgery. In vitro experiments were performed on 31 greater saphenous vein (SV) rings obtained from 20 patients and on 12 cephalic vein (CV) rings from 7 patients. The rings were mounted in organ baths and their isometric contractile activity was measured. Experiments were conducted by cumulatively adding calcitonin gene-related peptide (CGRP) or lidocaine to the organ baths. The endothelium was mechanically removed in 18 SV rings and in 6 CV rings. Results demonstrated that in vitro CGRP produced vasodilation only; no constrictive effects were seen. Lidocaine produced a biphasic response with contraction at low concentrations (1.5 x 10(-5) M, 1.5 x 10(-3) M) and release of the maximal contraction at higher concentrations, similar to that observed in arteries. Removal of the endothelium did not significantly affect contractile activity in either CGRP- or lidocaine-treated vessels. The data supported the conclusion that CGRP could be used to relieve venous constriction, and it is suggested that further studies on the clinical use of CGRP in microsurgery is warranted.

Calcitonin Gene-Related Peptide↗

Calcitonin gene-related peptide in experimental ischemia. Implication of an endogenous anti-ischemic effect.

Ischemia resulting from flap harvesting and vascular manipulation during microsurgery may be responsible for flap ischemic sufferance and, ultimately, necrosis. Recently, the regulatory role of the sensory nervous system in ischemia has attracted much interest. Calcitonin gene-related peptide (CGRP), a neuropeptide, is a naturally occurring vasodilator with no constrictive effects. In the present study, we developed a model of partial, chronic ischemia in the rat epigastric flap and investigated the effects of ischemia on concentrations of CGRP-like immunoreactivity (-LI) in ischemic skin and in different regions of the rat brain (striatum, hippocampus, pituitary, hypothalamus, and frontal and occipital cortex). A neurovascular island flap based on the superficial epigastric vessels was raised in 10 animals. Ischemia of the flap was obtained by ligating the feeding artery so that the blood flow was reduced to 25% of the normal circulation. An electromagnetic Doppler positioned on the artery was used to monitor the blood flow reduction. Ten nonoperated animals were used as controls. Ten days after the operation, CGRP-LI was significantly increased in five of six brain regions analyzed (striatum excepted). Significantly decreased concentrations of CGRP-LI were found in seven ischemic flaps, as opposed to the control group. In the remaining three flaps, no significant changes in CGRP concentration were observed. The highest blood flux values (detected using a laser Doppler) in the flaps correlated positively with the highest concentrations of CGRP-LI in the flap tissue. The results of the present study suggest that endogenous CGRP may be involved in the adaptive response to ischemia.

Animals↗

The Burn Wheel: a practical guide to fluid resuscitation.

During preparation for mass casualties of burn victims in the Gulf War (1990-91), a 'Battlefield Burns Table' was devised to allow rapid calculation of fluid replacement. By standardizing weights and using only Hartmann's Solution BP, a regimen could be prescribed by the non-specialist without resort to mathematical calculations. By means of a revolving disc, this has now been refined for use in a civilian setting where expert burn advice may not be immediately available.

Burns↗

The Burns Calculator: a simple proposed guide for fluid resuscitation.

Most burn casualties will receive their primary care in an emergency department. These departments are staffed by doctors with a varying degree of supervision, and their experience of the treatment of burns is often very modest. Evidently there is a need for a simple method to calculate the fluid requirements of these patients. The Burns Calculator is designed for use during the first eight hours post-injury and is based upon the Parkland resuscitation formula, using only Hartmann's solution BP. It is expected that the patient will have received expert aid by the end of this time. Values for children have been predetermined using body surface area nomograms. The calculator will assist the non-specialist to determine the correct amount of fluid needed to resuscitate a burned patient, and perhaps decrease morbidity and mortality associated with this injury.

Aging↗

Acetic acid used for the elimination of Pseudomonas aeruginosa from burn and soft tissue wounds.

Acetic acid was used topically at concentrations of between 0.5% and 5% to eliminate Pseudomonas aeruginosa from the burn wounds or soft tissue wounds of 16 patients. In-vitro studies indicated the susceptibility of P. aeruginosa to acetic acid; all strains exhibited a minimum inhibitory concentration of 2 per cent. P. aeruginosa was eliminated from the wounds of 14 of the 16 patients within two weeks of treatment. Acetic acid was shown to be an inexpensive and efficient agent for the elimination of P. aeruginosa from burn and soft tissue wounds.

Acetates↗