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Volume X |
Number 4 |
December 1997 |
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SUMMARIES
| 197 |
BURNS IN THE ELDERLY. EPIDEMIOLOGY AND MORTALITY. ANALYSIS OF 53 CASES
(A. Bortolani, D. Barisoni - Italy)
Over a four-year period (May 1991-May 1995) 53 patients aged over 60 years and with total burned surface area >20% or full-thickness burn >10% were admitted to the Verona Burn Centre, Italy. Flame burns were most commonest cause of injury, and hot liquids, especially bath-water, and gas explosions were also aetiologically significant. Using hypertonic solutions, we achieved satisfactory urine output and the reduction of post-resuscitation complications. In order to reduce patient morbidity and mortality in patients with preexisting cardiopulmonary diseases we used continuous positive airway pressure and early respiratory physiotherapy. Systemic antibiotic prophylaxis was used in many cases. In our experience early excision and grafting, in haemodynamically stable patients, reduces mortality. Our policy for the elderly burned patient is based on use of hypertorric sodium solution, early excision and grafting, nutritional support, and the prevention of pulmonary complications. Mortality remains high, but is lower than in other reports.
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| 200 |
BURNS IN GROUPS OF PEOPLE DURING THE LAST TWENTY YEARS IN ALBANIA
(G.J. Belba, I. Dauti, K. Zhilika, G. Pepi, A. Andrea - Albania)
This paper presents data on burns that have occurred in Albania in groups of people during the last twenty years. Referring to the different groups of patients who suffered injuries, the Authors consider the type of burning agent, the extent and depth of the burn, and the final results of medical treatment. The treatment of the most recently injured group of patients, after an explosion during the processing of waste materials in Korce in October 1995, is described in greater detail. The importance is emphasized of resuscitation therapy with complementary fluid regimens that exceed the amounts recommended by standard formulas. This increased need is primarily related to the location of the burn in critical areas of the body, but also to delay in the initiation of fluid therapy. The total mortality in these groups of patients provides obvious evidence about the hazards that such traumas present to each individual in the group. Organized measures aimed at preventing such hazards and managing the traumas with the close collaboration of different disciplines are necessary to minimize human losses.
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| 204 |
SEVERE COMPLICATIONS IN BURN TRAUMA - A CASE REPORT
(J. Hruba, R. Konigova - Czech Republic)
A 52-year-old patient suffered burns in 69% T13SA. The cause of the accident was a flare-up of his clothing, which was soaked in diluent fluid. Prior to the trauma the patient had been suffering from a duodenal ulcer. Prophylaxis of stress bleeding was performed by H2 blockers. In spite of this treatment, there was massive bleeding from the stomach, and by day 16 post-burn surgical treatment became indispensable. The bleeding continued and the patient had to be treated with terlipresin and subsequently with somatostatin. The side-effect of this treatment was a hypertensive reaction and the onset of severe, haemodynamically significant arrhythmia. The patient was treated with intravenous nitroglycerin and a variety of antiarrhythmics for 46 days. The burned areas were treated by necrectomies and transplants. A further complication was osteomyelitis of the right hip bone. The cause of the thromboeytosis remains unclear. Rehabilitation of the patient still continues.
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| 207 |
FACTEURS PREDICTIFS DUNE INSUFFISANCE RENALE AIGUE CHEZ LES BRULES
(A. Gharsallah, D. Wassermann, T Atallah, G. Sarfati, F. Lebreton, M. Schlotterer, L. Souffiane, F. Hemou - Tunisie, France)
L'objectif de cette étude était de considérer les cas des brûlés admis dans l'unité de soins intensifs des Auteurs pour identifier les facteurs prédictifs de la survenue d'une insuffisance rénale aiguë sur la base des éléments cliniques et biologiques rélévés à l'admission. Ils ont trouvé que l'âge avancé, l'étendue, et la profondeur de la brûlure sont des facteurs de mauvais pronostic et prédictifs d'une évolution vers l'insuffisance rénale aiguë. Cette dernière pouvait être détectée des les premières heures après l'admission.
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| 210 |
RADIOLOGICAL DIAGNOSTICS OF PULMONARY COMPLICATIONS IN BURN REANIMATION: POSSIBILITIES AND PROBLEMS
(O.D. Dmitrienko, Ta. Goilimbievskaya, T.N. Trofimova, A.L. Kossovoy - Russia)
This paper considers minimal burns with a potentially favourable prognosis, the effects of which were much aggravated by the presence of inhalation trauma. In the group of patients considered, 17 fatalities were expected, against an actual number of 27. Radiological investigations provided a considerable amount of interesting information, as the pulmonary complications could be predicted by evaluation of the dynamics of the radiological changes. This facilitated early intensive therapy.
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| 215 |
TRANSFER OF AUTOLOGOUS KERATINOCYTES GROWN ON A POLYMER REDUCES TIME TAKEN FROM BIOPSY TO GRAFT
(A.M. Burt, I.A. Clarke - Great Britain)
A method has been developed to transfer autologous keratinocytes to a wound bed within 5-7 days of receipt of biopsy. With the development by Smith and Nephew of a polymer that supports cell growth it has been found that actively dividing (undifferentiated) keratinocytes will invert and grow on a suitable wound bed. Keratinocytes were grown in flasks in serum containing medium for 48 h, fed with serum-free medium, and when actively growing were transferred to the polymer. This was then incubated for 2-3 days to produce a subconfluent cell layer (70-90% confluent) which was easily inverted on to the wound bed in theatre or at the bedside. When placed on a suitable wound bed, healing was evident as a translucent film after 5-7 days.
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| 219 |
USE OF SOLCOSERYL IN MINOR BURNS
(I.G. Ghoneimi, R.L. Bang - Kuwait)
A study was made in Kuwait of forty minor burn patients treated as out-patients from February 1994 to April 1995 (27 males/13 females; mean age 19 yr ; age range 1-47 yr). Twenty-six patients sustained scalds, five flame burns, five contact burns, and four had electric flash burns, The extent of burn ranged from I to 12% total body surface, mainly involving the lower limbs. Thirty-eight patients sustained dermal burns and two had minimal full-thickness burns. The burn wounds were treated with topical Solcoseryl'.* Solcoseryl dressing was easy to use, comfortable, and well tolerated by the patients. The spontaneous wound heating in 7 to 29 days (mean 18 days) conformed to initially assessed burn depth in the majority of patients. The favourable healing showed that no post-injury deepening of the burn wound had occurred. The incidence of hypertrophic scarring was comparatively less in Solcoseryl-treated patients. Solcoseryl is therefore is a good topical agent for the management of minor burn wounds.
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| 223 |
REPARATION DES SEQUELLES DE BRULURES CERVICALES
(H. Khochtali, A. Turki, N. Mansouri, A. Bakir - Tunisi)
Les s?quelles de br?lures cervicales peuvent poser des probl?mes de r?paration selon leur gravit?. La plupart des techniques de chirurgie r?paratrice peuvent ?tre appliqu?es. Notre ?tude porte sur 32 patients trait?s entre 1987 et 1995. La femme jeune est la plus atteinte, dans la majorit? des cas ? la suite d'un accident domestique. Soixante pour cent des s?quelles cervicales sont associ?es ? des s?quelles faciales et thoraciques. La plupart de ces s?quelles correspondent ? des brides r?tractiles, et de ce fait cinquante pour cent des patients ont b?n?fici? d'une plastie en Z dans un but essemellement fonctionnel. Nous avons obtenu des r?sultats satisfaisants dans 68% des cas sur le plan fonctionnel et dans 37% des cas sur le plan esth?tique.
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| 228 |
CHARACTERISTICS AND DYNAMICS OF THE PSYCHOLOGICAL CONSEQUENCES IN CHILDREN SUFFERING THERMAL INJURY
(D. Andreeva, A. Atanasov - Bulgaria)
A description is given of the regular connection between thermal injury and its consequences (disability, functional and cosmetic defects) and its reflections on child psychology - a high degree of anxiety, an inferiority complex, neuropathic tendencies, negative self-acceptance, and aggressive behaviour. The investigation concerned 217 cases of burn consequences among children aged 3 to 18 years. The psychological methods used were: the "Draw-a-person" and the "Bewitched Family" tests; the SCSA scale (classical and sociosituational anxiety and agitation of mind); Dernbo-Ruben stain's self-evaluation test; Eysenck questions; IQ test; test for degree of pretensions; and the polyphase personal questionnaire.
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| 233 |
FIRE DISASTER IN A MOTORWAY TUNNEL
(M. Masellis, A. Iaia, G. Sferrazza, E. Pirillo, N. D'arpa, P Cucchiara, M. Sucameli, B. Napoli, G. Alessandro, S. Giaimi - Italy)
On 18 March 1996, in a tunnel along the Palermo-Punta Raisi motorway (Italy), a tank-truck carrying 2500 litres of liquid petroleurn gas (LPG) was involved in an accident. The truck was hit by a coach, which ripped off the top of the coach, provoking the escape of gas, which caught fire within seconds. The flames heated the LPG still in the tank, causing a BLEVE(boiling liquid expanding vapour explosion). At the moment of the accident there were 22 cars and a minibus in the tunnel, besides the coach, with a total of 50 persons. The delay between the ignition of the gas and the explosion enabled numerous passengers to escape. However, five people were burned to death and twenty were severely injured. Ten people presented minor burns or other traumas. The following aspects are analysed: the dynamic of the accident, the dynamic of the rescue operations, the management of the severely injured patients treated at the Palermo Burns Centre, the psychological reaction of the population, relatives and injured persons, the evolution of the pathologies, and the medical and surgical treatment. The Palermo tunnel disaster, with its terrible dynamic, confirms the thesis that the only way to counteract the impossibility of predicting this type of accident is through the coordinated response of rescue aid at all levels, from the general population to physicians, nurses, volunteer groups, Civil Defence, police, etc., who must all be adequately trained in appropriate education campaigns to prevent fire disasters. This accident, the first case described of a BLEVE in a closed and restricted environment, can provide material for indications and suggestions for the formulation of research hypotheses, operative proposals and teaching possibilities, with a view to realizing an ever higher level of disaster preparedness.
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| 241 |
THE RISK OF TRANSPORTATION OF DANGEROUS GOODS: BLEVE IN A TUNNEL
(P. Ciambelli, A. Bucciero, M. Maremonti, E. Salzano, M. Masellis - Italy)
Boiling liquid expanding vapour explosion (BLEVE) is regarded as a major risk in the storage and transportation of hazardous materials. Nearly all the cases reported in the literature refer to open environments while BLEVEs in confined or congested areas are very uncommon. This paper presents the case history of a BLEVE of a tank truck transporting LPG that occurred in a highway tunnel near Palermo (Italy). The truck was involved in a car crash that gave rise to the release of propane gas through a crack that formed on the top of the vessel. The ignition of the gas cloud that was created caused critical burns in 25 persons. The subsequent tank truck BLEVE caused five deaths. The accident was described by modelling separately the deflagration of the gas cloud and the BLEVE. The evolution in time and space of the deflagration was modelled with a computational fluid dynamics technique, using a commercial code, while a beat transfer model was specifically developed in order to simulate the pressure increase inside the vessel until the tank collapsed and the BLEVE occurred.
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