|Annals of Burns and Fire Disasters - vol. XI - n. 1
- March 1998
THE BURN WOUND AND PHARMACOLOGICAL TREATMENT. THE RUDI HER. MANS LECTURE, 1995
TOXIC EPIDERMAL NECROLYSIS IN A BURNS CENTRE: A 6-YEAR REVIEW
Toxic epidermal necrolysis (TEN) is a severe mucocutaneous reaction pattern characterized by severe systemic toxicity, tenderness and widespread exfoliation. The condition was described by many researchers in the first half of the 20th century, but the term "toxic epidermal necrolysis" was proposed by Lyell only in 1956. TEN, the severest form of the Stevens-Johnson syndrome-toxic epidermal necrolysis (SJS-TEN), leads to an average mortality of 25%. In the six-year study described, conducted in Singapore, it was found that commonest causative agents were anticonvulsants and traditional medication. The condition was most commonly associated with ocular complications and sepsis. Using our treatment protocol in a burns centre, we were able to achieve a mean time to complete healing of 20.2 days (range 7-53 days) and a mean duration of hospitalization of 34.1 days (range 7-134 days). The length of hospital stay was prolonged when there were also non-ocular complications. The overall mortality in the series was 10%. It is concluded that the best results in the treatment of the SJSTEN patient are obtained in a burns centre with an intemist, a dermatologist and an infectious disease specialist in the management team.
Khoo A.K.M., Foo C.L.
STAPHYLOCOCCAL INFECTIONS IN THE SOFIA BURN CENTRE, BULGARIA
The purpose of this study was to analyse staphylococcal infections in the Sofia Burns Centre in order to assess their frequency, main characteristics and role in burns. Over the eight-year period 1987-94, a study was made of the bacterial aetiology of wound infection and bacteraemia in burn patients. The prevalence of staphylococci in both wound exudation (31.4%) and blood cultures (60.7%) was established. In the final year of the study there was a significant increase in the incidence of methicillin-resistant Staphylococcus aureus (MRSA), from 19.4% to 28.0% (p = < 0.001). This raised serious therapeutic problems. MRSA was found more frequently in the intensive care unit than in the wards and in wounds and blood cultures compared with other species/strains. MRSA caused infections in 18.8% of the patients. Over 70% of the MRSA strains were resistant to gentamicin, erythromycin and tetracycline and about one-third were resistant to lincomycin, co-trimoxazole, chloramphenicol and ciprofloxacin. All the MRSA strains were sensitive to vancomycin and 71.1% were resistant to rifampicin. These findings show the need for urgent measures to restrict the further spread of MRSA infeefions in our burns centre.
Lesseva M. I.,
EFFECTIVE CONTROL OF METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS IN A BURN UNIT
This paper conforms that control of methicillin-resistant Staphylococcus aureus (MRSA) in burn patients is effective if the colonized patients are isolated, if gowns, gloves, masks and caps are worn, if hands are frequently washed, and if the correct antibiotics are used. It is also found that early incision and grafting are important because of the early closure of the wound, which otherwise becomes infected very easily. The results are based on experience with 231 burn patients treated between 1986 and 1984 in a hospital in Japan.
Yoshizawa N., Narumi A., Harunari N., Sugamata A., Watanabe K.
REFLEX SYMPATHY DYSTROPHY AFTER A BURN INJURY
Minor traumas and operations on an extremity are sometimes followed by reflex sympathetic dystrophy (RSD). The injuries range from simple contusions to fractures. A retrospective study was made of the prevalence of burns as a cause of RSD in a population of 829 patients with this condition, while a prospective study was made of the medical history, signs and symptoms of all patients with RSD seen in a burns department in a year-long period. Four of the patients had developed RSD after a burn injury, equivalent to a prevalence of 0.5%. The clinical signs of early RSD are similar to those of burns and it is necessary to be alert to recognize inflammatory signs, together with an increase in complaints after exercise, in order to be able to proceed to an early diagnosis and treatment of the complications induced by RDS.
van der Laan, Goris
EFFECTS OF ENDOTOXIN ON THI/TH2 RESPONSE IN HUMANS
In the systemic response to infection a critical role is played by monocyte/T-cell interactions. Two different types of T-helper cells (Th) produce distinct patterns of cytokines. Thl cells secrete interleukin-2 (IL-2) and interferon-y (IFN-y), while Th2 cells produce IL-4, IL-5, IL-6, ILI 0 and IL- 13. Systemic endotoxin administration initiates many features of gram-negative sepsis, including cytokine release, but the patterns - the Thl/Th2 patterns - have not been studied. This research investigated the effect of an intravenous bolus of endotoxin from Escherichia coli on the Thl/Th2 response in eight volunteers. All the participants presented tachycardia, decreased mean arterial pressure, fever and leukocytosis. IL-10 was significantly elevated 3 h after entotoxin administration, and IL-2 levels were decreased. IL-4 and IFN-,y were not detectable in plasma. The plasma levels of IL-12 showed no changes. The systemic responses were not correlated to changes in cytokine levels. The cytokine patterns found in this study would suggest that low-dose endotoxin administration is followed by a shift in the T-cell immune response towards the Th2 cell type response, a shift to which may contribute to the depressed cell-mediated immune response associated with sepsis.
Zimmer S., Pollard
V., Marshall G.D., Garofalo R.P., Traber D., Prough D., Herridon D.N.
USE OF A PNEUMATONOMETER
IN BURN SCAR ASSESSMENT
Spann K., Mileski
W.J., Atiles A., Purdue G., Hunt J.
ALCOHOL, DRUG INTOXICATION, OR BOTH AT THE TIME OF BURN INJURY AS A PREDICTOR OF COMPLICATIONS AND MORTALITY IN HOSPITALIZED PATIENTS WITH BURNS
This paper examines the association between drug and alcohol intoxication at the time of injury and subsequent complications. The data were analysed using a computerized database in relation to 3047 consecutive adult patients (age 21-75 yr), admitted between January 1982 and August 1994. A comparison was made of data for intoxicated patients (on the basis of history, blood alcohol content, or positive drug test) and nonintoxicated patients. The same analysis was performed with 429 consecutive adolescent patients (age 14-20 yr) who had suffered burns admitted in the same period. The incidence of intoxication at the time of the burn injury was 6.9%. Age, sex, race and burn site presented no significant differences, but there was a higher incidence of associated injuries in intoxicated patients who more frequently presented skin graft loss, cellulitis, donor site conversion, hypotension and pneumonia. They also had a higher number of admissions to intensive care, ventilator days, operations, transfusions, and total hospital days. Intoxicated patients presented lower mortality than patients in the control group (7.1% compared with 10.9%). The conclusion of the study is that intoxication at the time of burn injury is an important predictor of complications in adult burn patients.
Maniscalco S.P., Purdue G.R, Hunt J.L. J. Burn Care Reliabil., 17: 532-9, 1996.
COMPETENCE AND PHYSICAL IMPAIRMENT OF PEDIATRIC SURVIVORS OF BURN OF MORE THAN 809/6 TOTAL BODY SURFACE AREA
Paediatric patients now survive massive burn injuries that would have been fatal a decade ago, and a growing number of surviving children are challenged by the physical sequelae of their injuries. The aim of this study was to evaluate the impact of their physical impairment on the competence of such children in their daily lives. The hypothesis was formulated that children surviving burn injuries affecting more than 80% total body surface area would be less competent than their unburned peers, and that competence would decrease as physical impairment increased. The competence of nineteen patients was assessed by parental reporting using Achenbach's Child Behavior Checklist and the patient's self-report on the Youth Self-Report (same author). Physical impairment scores were calculated from the range of motion measurements of upper and lower extremities according to American Medical Association guidelines. Competence scores for the sample showed normal values. Physical impairment was significantly related to competence only in the area of activity on both the Child Behavior Checklist and the Youth Self-Report.
Moore P., Moore M.,
Blakeney P., Meyer W., Murphy L., Hem
EARLY DEBRIDEMENT OF SECOND-DEGREE BURN WOUNDS ENHANCES THE RATE OF EPITHELIALIZATION - AN ANIMAL MODEL TO EVAL. UATE BURN WOUND THERAPIES
This study considers the epithelialization rate of second-degree burns on the basis of the use of two debridement times (early and late). Burn wounds were randomly assigned to the following debridement groups: control, no debridement; early debridement 24 h post-burn; and late debridement 96 h post-burn. Wounds from each debridement group were harvested, incubated to permit separation of dermis and epidermis, and examined macroscopically for complete epithelialization. On day 7 post-burn, the percentages of completely epithelialized wounds were 41% (nondebrided), 75% (24 h early debridement), and 22% (96 h late debridement). Burn wounds excised 24 h post-burn therefore showed an enhanced healing rate compared with nondebrided wounds and wounds debrided 96 h post-burn.
Davis S.C., Mertz P.M.,
Bilevich E.D., Cazzaniga A.L., Eaglstein W.H.
AWARD OF THE G. WHITAKER INTERNATIONAL BURNS PRIZE PALERMO, ITALY FOR 1998
In the course of a
meeting held on March 28th 1998 at the seat of the G. Whitaker Foundation, Palermo, after
examining the scientific activity in the field of research, teaching, clinical examining
the scientific activity in the field of research, teaching, clinical organization,
prevention and cooperation among the nations presented by various candidates, in the light
of the consideration guiding the analysis of the high level of the candidates the
Adjudicating Committee unanimously decided to award the prize for 1998 to: Prof. Dr.
Friedrich E. Miiller, former Head of Department of Plastic Surgery and Burns in the
Berufsgenossenschaftlichen Krankenanstalten Bergmannsheil at the University Hospital in
"He began his professional activity showing specific interest in the sector of burns. In 1967 he organized the first centre for the treatment of burns in Germany, at Bochum, which he directed. He contributed to the opening of other centres in other cities in Germany. He organized a network linking the various burns centres in Germany, with a view to the management of beds in the event of disasters. His studies have concerned all the aspects of the burn disease. He has taken a particular interest in burns shock and immunological and infective aspects, supporting the trend towards the use of early surgery in burns treatment. The results of his studies have been collected in numerous publications that have appeared in various specialized journals and three volumes."
The official prize-giving of the prestigious award will be held on September 24th 1998 in Palermo at the seat of the G. Whitaker Foundation in the presence of the authorities and of representative of the academic, scientific and cultural world.
G. WHITAKER INTERNATIONAL BURNS PRIZEPALERMO, ITALY
Under the patronage of the Authorities of the Sicilian Region for 1999
By law n. 57 of June 14th 1983 the Sicilian Regional Assembly authorized the President of the Region to grant the Giuseppe Whitaker Foundation, a non-profit-making organization under the patronage of the Accademia dei Lincei with seat in Palermo, an annual contribution for the establishment of the G. Whitaker International Burns Prize aimed at recognizing the activity of the most qualified experts from all countries in the field of burns pathology and treatment.
The amount of the prize is fixed at twenty million Italian lire. The prize will be awarded every year by the month of June in Palermo at the seat of the G. Whitaker Foundation.
The Adjudicating Committee is composed of the President of the Foundation, the President of the Sicilian Region, the Representative of the Accademia dei Lincei within the G. Whitaker Foundation, the Dean of the Faculty of Medicine and Surgery of Palermo University, the President of the Italian Society of Plastic Surgery, three experts in the field of prevention, pathology, therapy and functional recovery of burns, the winner of the prize awarded in the previous year, and a legal expert nominated in agreement with the President of the Region as a guarantee of the respect for the scientific purpose which the legislators intended to achieve when establishing the prize.
Anyone who considers himself/herself to be qualified to compete for the award may send by January 3 1 st 1999 a detailed curriculum vitae to: Michele Masellis M.D., Secretary-Member of the Scientific Committee G. Whitaker Foundation, Via Dante 167, 90141 Palermo, Italy.