Abstract
Modern intensive care combined with current improvements in the specific, systemic and local therapy of burns has delayed the mortal effects of severe burns. Nor has there been any significant improvement in this mortality during the last decade.
The occurrence of uncontrollable infection and sepsis due to gram-negative bacteria or fungi as the basic cause of death was not a satisfactory explanation. So, progress should only be expected from a new concept in burn treatment. This new concept should be to view the burn disease as being caused by toxic factors induced by thermal injury to the skin. Electron-microscope studies in mice and rats have revealed similar mitochondrial alterations in hepatocytes after either a sublethal controlled burn injury or an intraperiotoneal application of an equivalent dose, of a cutaneous burn toxin. The intraperitoneal injection of different amounts of the burn toxin indicated, that the extent of the mitochondrial changes correlated directly with the dose of toxin. Investigations of liver metabolism suggested an inhibition of the oxygenation chain. The incubation of isolated liver cells together with the burn toxin demonstrated by scanning electron microscopy a direct cytotoxic effect of the burn toxin. In animal tests the pathogenic effect of the burn toxin could be prevented by treatment with an antitoxic IgG generated in sheep.
The fatal sepsis of severely burned patients is the consequence of a decreased host defence against infections, which is caused by a primary and general toxic alteration of the whole organism. One important aspect of treatment should therefore be the elimination of burn toxins. To achieve this management should include primary excision of the burns, local application of nonabsorbable protein-complex-binding substances and specific passive immuno-therapy with an antitoxic IgG.
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References
Allgöwer M, Burri C, Cueni L, Engley M, Gruber UF, Harder F, russel RGG (1968) Study of burn toxins. Ann NY Acad Sci 150:807
Asko-Seljavaara S (1975) Altered cell proliferation in different organs in burned mice. Scand J Plast Reconstr Surg (Suppl.) 13
Asko-Seljavaara S, Sundell B, Rytömaa T (1976) The effect of early excision on bone-marrow cell growth in burned mice. Burns 3:140
Advakoff V (1876) Pathological modification of tissue by burns. St. Petersburg Med vestnik 16:4
Bardeen CR (1898) A review of the pathology of superifical burns. John Hopkins Hosp Rep 7:137
Baxter CR, Moncrief JA, Prager MD, Cohen LS (1971) A circulating myocardial depressant factor in burn shock. In: Matter P, Barclay TL, Konickova Z (eds), p. 499. Research in burns. Bern, Hans-Huber-Verlag
Baxter CR (1974) The current status of burn research. J Trauma 14:1
Bojar H, Balzer K, Reiners K, Basler M, Reipen W, Staib W (1975) Isolierung intakter Leberparenchymzellen durch eine modifizierte enzymatische Methode. Z Klin Chem Klin Biochem 13:25
Clark WR, Lerner D (1978) Regional burn survey: Two years of hospitalized burned patients in central New York. J Trauma 7:524
Feller I, Crane KH (1970) National burn information exchange. Surg Clin N Am 6:1425
Feller L, Flora LD, Baeol R (1976) Baseline results of therapy for burned patients. JAMA 17:1943
Feodorov N, Skurkovich VS (1960) The treatment of burns with the serum of patient convalescent from burns. Acta Hämatol 21:163
Feodorov NA, Movshev BE, Nedoshivina RV, Petrov VN, Averchenko VI (1974) Isolation and study of toxic fractions from burned skin. Vop Med Khim 20:371
Hamit HF (1978) Factors associated with deaths of burned patients in a community hospital. J Trauma 6:405
Kremer B, Allgöwer M, Scheidegger A-M, Schmidt KH, Schölmerich J, Wüst B, Schoenenberger GA (1979) Toxin-specific ultrastructural alterations of the mouse liver after burn injuries and the possibility of a specific antitoxic therapy. Scand J Plast Reconstr Surg 13:217–222
Kremer B, Frenzel H, Schölmerisch J, Allgöwer M, Schweitzer A, Schönenberger GA (1977) Vergleichende transmissions-und rasterelektronenmikroskopische Untersuchungen über Leberveränderungen bei Mäusen nach subletaler Hautverbrennung und intraperitonealer Injektion eines spezifischen cutanen Verbrennungstoxins. Langenbecks Arch Chir Suppl Chir Forum 145
Monafo WW, Robinson HN, Yosioka T, Ayrazian VH (1978) Lethal burns. Arch Surg 113:397
Monati F, Moczar E, Miskulin C, Sepulchre C, Robert AM, Monteil R, Guilbaud J (1977) Mise en évidence et charactérisation partielle de substances cardio-toxiques et neuro-toxiques dans le sérum brulés. Path biol 25:225
Moshev BE, Nedoshivina RV (1973) Comparative study of the biological activity of toxin, isolated from burned skin by physicochemical and immunoabsorption methods. Vop Med Khim 23:685
Phillips AW (1968) Disaster mangement — to treat or not to treat? Ann Surg 168:986
Schoelmerich J, Kremer B, Richter JE, Schmidt K, Setyadharma H, Schoenenberger GA (1979) Effect of cutaneous human or mouse burn toxin on the metabolic function of isolated liver cells. Scand J Plast Surg 13:223
Schoenenberger GA (1975) Burn toxins isolated from mouse and human skin. Monogr Allergy 9:72
Schoenenberger GA, Cueni LB, Bauer U, Eppenberger U, Allgöwer M (1972) Isolation and characterisation of a toxic lipid protein complex formed in mouse skin by controlled thermal energy. Biochem Biophys Acta 263:149
Schoenenberger GA, Bauer U, Eppenberger U, Cueni LB, Städtler K, Allgöwer M (1972) Physical, chemical and biological properties of a specific toxic lipid-protein complex formed Biochem biophys Acta 263:164
Städtler K, Allgöwer M, Cueni LB, Schoenenberger GA (1972) Pathophysiologische Untersuchungen an einem Verbrennungs-modell der Maus. Res Exp Med 158:23
Städtler K, Allgöwer M, Cueni LB, Schoenenberger GA (1972) Immuntherapeutische Untersuchungen mit Verbrennungstoxin am Modell der Maus. Rex Exp Med 158:34
Wertheim G (1968) Über Veränderungen des Blutes bei Verbrennungen und Verbrühungen. Wien Med Presse 9:309
Wüst B (1977) Isolierung, physikalisch-chemische Charakterisierung, Immunologie und biologische Eigenschaften eines spezifischen cutanen Verbrennungstoxins und dessen Vorstufe beim Menschen. Dissertation, GTP-Verlag, Basel
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Kremer, B., Allgöwer, M., Graf, M. et al. The present status of research in burn toxins. Intensive Care Med 7, 77–87 (1981). https://doi.org/10.1007/BF01687264
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DOI: https://doi.org/10.1007/BF01687264