ABSTRACT
BACKGROUND: In Central Europe, cold-induced injuries are much less common than burns. In a burn center in western Germany, the mean ratio of these two types of injury over the past 10 years was 1 to 35. Because cold-induced injuries are so rare, physicians often do not know how to deal with them. METHODS: This article is based on a review of publications (up to December 2014) retrieved by a selective search in PubMed using the terms "freezing," "frostbite injury," "non-freezing cold injury," and "frostbite review," as well as on the authors' clinical experience. RESULTS: Freezing and cold-induced trauma are part of the treatment spectrum in burn centers. The treatment of cold-induced injuries is not standardized and is based largely on case reports and observations of use. distinction is drawn between non-freezing injuries, in which there is a slow temperature drop in tissue without freezing, and freezing injuries in which ice crystals form in tissue. In all cases of cold-induced injury, the patient should be slowly warmed to 22°-27°C to prevent reperfusion injury. Freezing injuries are treated with warming of the body's core temperature and with the bathing of the affected body parts in warm water with added antiseptic agents. Any large or open vesicles that are already apparent should be debrided. To inhibit prostaglandin-mediated thrombosis, ibuprofen is given (12 mg/kg body weight b.i.d.). CONCLUSION: The treatment of cold-induced injuries is based on their type, severity, and timing. The recommendations above are grade C recommendations. The current approach to reperfusion has yielded promising initial results and should be further investigated in prospective studies.
Subject(s)
Cold Injury/diagnosis , Cold Injury/therapy , Debridement/standards , Hyperthermia, Induced/standards , Reperfusion/standards , Triage/standards , Anti-Inflammatory Agents, Non-Steroidal/administration & dosage , Combined Modality Therapy/methods , Combined Modality Therapy/standards , Evidence-Based Medicine , Germany , Humans , Ibuprofen/administration & dosage , Practice Guidelines as Topic , Treatment OutcomeABSTRACT
OBJECTIVE: To investigate whether postischemic administration of minocycline attenuates hind-limb motor dysfunction and gray and white matter injuries after spinal cord ischemia. DESIGN: A prospective, randomized, laboratory investigation. SETTING: Laboratory in university, single institution. PARTICIPANTS: Male New Zealand White rabbits. INTERVENTION: Spinal cord ischemia was induced by an occlusion of the infrarenal aorta for 15 minutes. The groups were administered minocycline 1 hour after reperfusion (M-1; n = 8), minocycline 3 hours after reperfusion (M-3; n = 8), saline 1 hour after reperfusion (control [C]; n = 8), or saline and no occlusion (sham; n = 4). Minocycline was administered intravenously at 10 mg/kg 6 times at 12-hour intervals until 60 hours after the initial administration. MEASUREMENT AND MAIN RESULTS: Hind-limb motor function was assessed using the Tarlov score. For histologic assessments, gray and white matter injuries were evaluated 72 hours after reperfusion using the number of normal neurons and the percentage of areas of vacuolation, respectively. Motor function 72 hours after reperfusion was significantly better in group M-1 than in group C. The number of neurons in the anterior horn was significantly larger in group M-1 than in groups M-3 or C but did not differ significantly between groups M-3 and C. No significant difference was noted in the percentage of areas of vacuolation among the ischemia groups. CONCLUSIONS: Minocycline administration beginning at 1 hour after reperfusion improved hind-limb motor dysfunction and attenuated gray matter injury in a rabbit spinal cord ischemia model.
Subject(s)
Minocycline/administration & dosage , Neuroprotective Agents/administration & dosage , Spinal Cord Ischemia/prevention & control , Animals , Drug Evaluation, Preclinical/standards , Hindlimb/blood supply , Hindlimb/drug effects , Infusions, Intraventricular , Male , Minocycline/standards , Neuroprotective Agents/standards , Prospective Studies , Rabbits , Random Allocation , Reperfusion/methods , Reperfusion/standards , Spinal Cord Ischemia/pathologyABSTRACT
Optimal factors for small DC current electrical stimulation for nerve regeneration were studied. These studies are consistent with previous data and values expected for a return of function following Peripheral Nervous System (PNS) damage. This work represents the first detailed investigation of a dose response in the PNS using applied electric fields. As such, using the stimulator design described herein, we have found that a delivery of 1.4 microA DC (about 8mV/cm field strength) to a nerve cuff will result in a more rapid increase of axon numbers in the distal slump with no detectable adverse influence of chronic delivery of current. Since it appears as though the regenerative capacity in the PNS and CNS is related to increased blood flow brought upon by the electric field, then it is important to consider this result in the final analysis of the mechanism of electric field induced nerve regeneration. Studies aimed at describing the mechanisms by which such regeneration occurs are now underway.