||THE USE OF A "CIRCULAR DIAGRAW' IN THE EVALUATION OF THE BURN PATIENT'S OXYGENATION STATE
(Benigno - Italy)
A circular diagram (Lanza 1984) was used to study the oxygenation state of I I patients with extensive bums (18% to 90% BSA, UBS from 42 to 270) admitted to the Edouard Herriot Hospital Burns Centre in Lyons. The patients were divided into three groups and three blood samples were taken from each patient in the first three weeks. Three circular diagrams were obtained, for each group, by tabulating the mean values of the parameters monitored, which were: PO.5, S25, SVO2, PVO2, SaO2, PaO2, T, PHv, PHa, PvCO2, Hb, CaO2, CaO2 (S25).
Examination of the diagrams revealed the repetition, in the three groups, of a single model, regardless of the varying gravity of the patients (the only exception is represented in the graph based on the parameters of sample A in Group 3).
Characteristic features are:
1) leftward shift of Hb curve
2) venous phase of O2 metabolism more or less tending to scarce peripheral utilization
3) increase in T.
It may thus be concluded that the bum patient presents impairment of O2 metabolism at tissue and pulmonary level which, though not severe enough to cause the patient's death, plays a negative role in a more general picture of organic pathology.
||LEUKERGY IN MAJOR BURNS
(Tuchman - Israel)
Leukergy, which consists of the appearance in the peripheral circulation of aggregates of leukocytes, was detected within a few hours in the case of major bums (at least 50% BSA). Leukergy leukocytes have greater mobility than normal leukocytes, their phagocytic activity is several times greater, and their adhesiveness is such that they cause agglomerates. The number of aggregates and the number of leukocytes present in each aggregate were directly proportional to the severity of the bum. In severe burn victims leukergy was often followed by ARDS. A lab model was performed with guinea pigs.
||PRELIMINARY CONSIDERATIONS ON HAEMOCOAGULATIVE PROBLEMS FOLLOWING SERIOUS BURNS
(Argano - Italy)
Haemocoagulative complications after serious bums are a constant feature, and very often represent a considerable clinical problem. Our preliminary observations of 15 patients sent to us by the U.S.L. 58 Bums Centre indicate that the burn lesion gives rise to a series of haematological modifications, beginning with a phase of hypercoagulability immediately after the burn injury, followed by activation of fibrinolysis and finally a coagulative rebound. In some cases the appearance of shock, sepsis or the liberation into the bloodstream of tissue activators can precipitate an acute condition of intravascular coagulation, whose diagnostic predictability using the tests currently available for haemocoagulative studies is in any case uncertain, and possibly even controversial.
Among traditional tests an important place is occupied by the study of thromboeytosis and platelet function. Our efYorts are therefore now directed at the search for valid parameters which through simple and straightforward investigations will make it possible to make a more precise assessment of haemostatic disorders, with a view to preventing any subsequent more serious haemocoagulative imbalances. We therefore believe that the inclusion of tests for Protein C evaluation, 17PA and antifibrinolysins in standard laboratory protocol, together with the study of the bone marrow and RES clearance, when possible, will provide us with more useful and more complete data for better clinical surveillance and a more rational therapy.
||PREVENTION AND THERAPY OF ACUTE RENAL FAILURE IN SEVERELY BURNED PATIENTS
(Manni - Italy)
In burn casualties, renal function is severely affected. In the treatment of these cases prevention of renal failure is fundamental in preventing complications and death.
Maintenance of the efficiency of renal function is based on water and salts administration, control of cardiac, vascular and respiratory functions and prevention of infections.
In the treatment of impending or actual renal failure the following points must be considered:
- Evaluation of kidney function by assessing the variations of different parameters of renal performance.
- Conduct of proper therapeutic intervention to substitute the efFects of renal failure (dialysis), to minimize their damage to the total organism, and to facilitate clinical recovery (nutrition).
||OUR EXPERIENCE IN TREATMENT OF BURNED PATIENTS
(Visentini - Italy)
A rapid account is given of the changing in treatment ofextensively burned patients in the last twenty years.
A systematic control of blood composition seems of fundamental importance, with particular regard to protein composition.
Equally important is the appropriate use of antibiotics, an early operation and possibly remedies which increase immunitary defences. Results obtained with 845 patients are reported.
||PRIORITIES AND PITFALLS IN TREATMENT OF BURNS
(Zdravic - Yugoslavia)
An analysis of burn work done in I-jubIjana during the last 30 years showed that the most important lesson we learned is to plan an individual strategy of treatment for each severely burned patient. It is an advantage to organize the bum service in the country in erder to have the severely burned patient sent for treatment without delay. If this is done, then we do not miss the best time to perform releasing incisions or excisions of the burn eschar in circumferential bums which compromise the blood circulation causing severe late invalidity.
The early delayed excision of deep dermal burns is the treatment of choice; however it may produce very bad results if not performed properly. A series of patients is shown to illustrate these points.
||IS EARLY SURGICAL TREATMENT STILL THE BEST SOLUTION FOR DEEP BURNS?
(Mahler - Israel)
Early surgical excision with immediate autografting has long become an alternative treatment to the more conventional procedure of autografting after spontaneous separation and bedside debridement of deep bum eschars. In the Soroka Medical Center the year 1975 was a crossroad date, for prior to that year all bums were treated by the conservative method while since then early tangential excision and early skin grafting has been applied as the treatment of choice. Between the years 1964-1974 1100 bum patients were hospitalized in our Dept. 255 of them suffered from deep bums and were treated conservatively by bathing with various solutions and dressings with occlusive bandages with various antibiotic powder or ointment. After a good granulation tissue was obtained a sj~in grafting was performed. Between the years 1975-1985, 4734 bum patients were admitted to the same Dept. 934 of them suffered from deep bums and were treated by early tangential excision and early skin grafting in the first instance and with Jobst pressure garment, occupational therapy and physiotherapy afterwards. This early surgical treatment by comparison with the conservative treatment shortened morbidity, reduced the hospital stay, minimized the need for secondary operations, lowered the mortality from 33% to 2.71% and led to good functional and cosmetic results, enabling the affected patients to quickly return to normal routine life and activity.
||PRELIMINARY CONSIDERATIONS ON THE USE OF AN AIRBED (CLINITRON MK 11) IN A THERAPY CENTRE FOR SEVERE BURN PATIENTS
(Maviglio - Italy)
The authors describe their experience using the CLINITRON airbed at the Bums Centre in Brindisi.
The bed has been in use only for a few months and the number of patients treated in it not very high. However, despite the limits of this experience, the CLINITRON has proved to be very useful particularly with regard to the patient's comfort, the length of hospitalization and nursing.
||SEVERE ELECTRICAL INJURY AND REHABILITATION
(Haberal - Turkey)
Between January 1979 and January 1987, 125 patients were treated in our centre as a result of electrical injuries.
Of these, 85 patients were over 15 years old (89.4% males and 10.6% females) and 40 patients were under 15 years old (92.5% males and 7.5% females).
The occupation of the over 15 years old group was mainly that of electrician, and of student in the under 15 years old group. Besides systemic and surgical treatment, 5 of our 6 multiple trauma patients were rehabilitated through physical therapy and prothesis and have returned to their occupation in society.
||BILAN D'ACTIVITE DU SERVICE DE REEDUCATION FONCTIONELLE DES BROLES DU CENTRE MEDICAL DE SAINTE-FOY L'ARGENTIERE
(Marduel - France)
La finalit? du traitement des br?l?s est d'assurer au mieux leur r?int?gration socio-professionnelle. Ceci n'est possible que dans le cadre d'une prise en charge globale donc multidisciplinaire de ces patients. De 1980 ? 1986, 455 br?l?s ont ?t? trait?s pr?cocement au Centre m?dical de Sainte-Foy l'Argenti?re. Les complications infectieuses ont ?t? rares en particulier chez les patients en phase pr?cicatricielle, seuls trois patients ont eu une septic?mie apr?s leur hospitalisation en centre de r??ducation. L'acquisition des techniques de cicatrisation dirig?e par l'?quipe de r??ducation a permis de r?duire la dur?e d'hospitalisation en centre de br?l?s en particulier pour les patients greff?s. La pr?vention des s?quelles est confirm?e par un taux faible de reprises chirurgicales secondaires. Le port de v?tements compressifs est bien tol?r? dans la majorit? des cas.
||PROGRAMMATION D'UN CENTRE DE BROGS DANS UN PAYS EN VOIE D'INDUSTRIALISATION
(Amamou - France)
La n?cessit? de soigner les br?l?s dans une Unit? sp?cifique de soins s'est impos?e progressivement dans nos pays industrialis?s du fait de la sp?cificit? de ce traumatisme et des traitements locaux et g?n?raux qui en d?coulent. Le premier Centre de Br?l?s fran?ais a ?t? cr?e en 1953, ? l'H?pital Saint Luc ? Lyon sous l'impulsion du Docteur P. Colson et des milieux industriels lyonnais. Un deuxi?me Centre ouvrait ses portes ? l'H?pital Edouard Ilerriot en 1954, dirig? par le Professeur Creyssel.
L'exp?rience lyonnaise et. celle des autres villes fran?aises o? s'est b?ti un Centre de Br?l?s fait ressortir que celui-ci ne peut ?tre qu'un service sp?cialis? au sein d'un CAI.U. En effet, les soins aux br?l?s n?cessitent la mise en oeuvre de nombreux moyens pour contr?ler les iisques vitaux du patient et assurer ? celui-ci le maximum de chances de survie avec le minimum d'handicap et de s?quelles.
Du Centre de Br?l?s et de ses besoins m?dico-techniques, sa programmation dans un pays en voie de d?veloppement doit ?tre conduite en conjuguant les cinq axes de r?flexion suivants:
1 - La connaissance du site, des dimensions d?mographiques et ?pid?miologiques locales qui caract?risent l'?tat de la population
2 - U?tablissement d'un plan directeur ? partir de l'ensemble des sp?cialit?s cliniques et m?dico-techniques existant ou non sur le site pr?vu d'implantation
3 - Le maintien d'un ?quilibre entre les besoins ressentis, le savoir-faire m?dical et technique, les techniques disponibles et possibles, les moyens financiers
4 - Le d?veloppement d'?changes en termes techniques, m?dicaux et ?conomiques qui doit avoir pour but de renforcer la collaboration entre les deux pays sur le plan sanitaire et social
5 - La d?finition d'un calendrier afin de faire co?ncider au mieux les diff?rentes phases du projet et d'?viter tout d?calage entre la r?alisation de l' "outil" et son utilisation.
A partir de ces cinq points une strat?gie de d?marrage du Centre doit ?tre discut?e de fa?on ? ?viter tout d?rapage ou essouflement de la part des ?quipes charg?es de s'en occuper.
||THE ORGANIZATION OF BURN CENTRES IN THE EVENT OF NATURAL CALAMITIES AND DISASTERS
(Donati - Italy)
The socio-economie structure of the modern world generates ever more complex situations and consequently greater numbers of people are involved in calamitous events: life is lived in ever larger "blocks of population" and at the same time man's relationship with Naltire has never been riskier (Chernobyl docel).
It is well known that the care ofextensive burns requires special teams that must be sophisticated in terms of both qualified personnel and equipment. No Burn Centre can be structured to cope with the demands arising from a disaster or a natural calamity without enormous overrating of the problem.
The solution can only lie in considering the problem not from a local viewpoint but from a more general viewpoint, in the framework ofa process of global coordination for the more intelligent use of all available resources, through the rapid transfer of equipment, personnel and information, all of which is possible using a telematic service.