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Volume XI |
Number 1 |
March 1998 |
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SUMMARIES
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THE WORLD HEALTH ORGANIZATION CENTRE FOR PREVENTION AND TREATMENT OF BURN AND FIRE DISASTERS: THE MEDITERRANEAN CLUB FOR BURNS AND FIRE DISASTERS
(Gunn S.W.A., Masellis M. - ITALY)
The Mediterranean Club for Burns and Fire Disasters (MBQ has recently been appointed a Collaborating Centre by the World Health Organization (WHO), the supreme intergovernmental authority on all health matters. A WHO Collaborating Centre is part of an international collaborative network carrying out activities in support of the organization's programmes at all levels. Only institutions showing a proven capacity to fulfil functions related to WHO's mission, as well as an elevated international scientific and technical standing, can qualify for this prestigious designation. This new WHO Collaborating Centre is located at the headquarters of the MBC, at the Department of Plastic Surgery and Burns Centre, Civic Hospital, Palermo, Italy - the headquarters of our Club. The MBC will attend to its duties in this prestigious organization with pride, dignity and effectiveness.
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CONTRIBUTION A VETUDE DES ASPECTS EPIDEMIOLOGIQUES DES BRULURES SUICIDAIRES EN TUNISIE: A PROPOS DE 94 CAS
(Messadi A., Mahjoub E., Asairi M., Nouira R., Hedhili A., Mahbouli S., Braham F. - TUNISIE)
Les Auteurs s'occupent du suicide par le feu et d?crivent le profil ?pid?miologique de ces suicidants hospitalis?s durant une p?riode de quatre ans dans l'unit? des br?les d'un h?pital tunisien entre 1992 et 1995. L'analyse porte sur tous les br?l?s admis. La plupart des victimes ont tent? le suicide sur le mode impulsif. La mortalit? des victimes de br?lure volontaire par le feu est particuli?rement ?lev?e et pr?coce. Les tentatives de suicide par le feu sont en passe de devenir un probl?me de sant? publique s?rieux par ses dimensions et ses cons?quences sociales et ?conomiques lourdes.
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ASH BURNS - A NEW ADDITION TO THE AETIOLOGY OF BURNS
(Bhat F.A., Bhagwat Swaroop Mathur, Hussain M.T., Fawaz Khailil Beidas, Bunyan A.R. - SAUDI ARABIA)
We present nineteen patients with ash burns. The patients had sustained burns by walking on charcoal ash that was the result of the ignition of burning charcoal left covered with sand. A description is given of the unusual mode and typical distribution of the burns in relation to the footwear used by the patients.
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LETHAL CAUSES IN BURN PATIENTS OVER THE AGE OF SIXTY YEARS IN BULGARIA
(Yonov Y, Serdev N, Vassilev V. - BULGARIA)
An analysis was made of the causes of death in 610 burn patients over the age of 60 yr treated at the Centre for Burns and Plastic Surgery, Pirogov Medical Institute, Sofia, Bulgaria, over a period of 11 years (1980-90). Of these patients, 144 died. Attention is directed mainly at septic complications, which were lethal in 38 patients (57.6%). The conclusions drawn could serve as a starting-point for correcting treatment methods in elderly burn patients in order to improve cure protocols and achieve better recovery.
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MICROBIOLOGY OF SEPTICAEMIA IN BURN PATIENTS
(Sanyal S.C., Mokaddas E.M., Gang R.K., Bang R.L. - KUWAIT)
A prospective study was conducted over a period of four years (July 1992-June 1996) in a burn unit to establish the actiologics of septicaemia and the number of episodes per patient and to perform antimicrobial susceptibility tests for selection of the (litig/s of choice for empiric therapy. Out of 943 patients admitted during the period, 79 (8%) suffered from 118 septicaemic episodes and Wood culture yielded 145 isolates. Seventy-two (61%) of the episodes were due to gram-positive cocci, 31 (26%) to gram-negative bacilli, one to Candida albicans and 14 to mixed infections. Of the 72 gram-positive episodes methicillin-resistant staphylococei accounted for 66 (92%). Sixty (76%) patients had a single episode, while the remainder each had 2-10 episodes. Most of the gramposilive organisms (76%) were methicillin-resistant staphylococci that were resistant to most drugs, but not glycopeptides. The gramnegalive organisms included Pseudomonas (38%), Acinetobacter (35%), and coliforms (25%). Most of the isolates of Pseudomonas were susceptible only to imipenem while those of Acinetobacter and Enterobacteriaceae were susceptible also to piperacillin/tazobactam.
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SELECTIVE GASTROINTESTINAL DECONTAMINATION AND BURN WOUND SEPSIS
(Shalaby H.A., Higazi M, El Far N. - EGYPT)
Many experimental studies have assessed the role of gastrointestinal decontamination, among other factors, on bacterial and endotoxin translocation in burn patients. In this study, 256 burned patients were allocated randomly into three groups. Patients in group 1, in whom there was no gastrointestinal decontamination, were used as control; group 11 patients were subjected to treatment with colistine sulphate, co-trimoxazole, and nystatin; and group III patients received selective gastrointestinal decontamination (SGD) plus xanthine oxidase inhibitors. Systemic antibiotics were given to any patient if indicated by clinical or laboratory signs only. Early feeding with a fibre-rich diet was given to all patients. The results indicated that SGD markedly reduced the chance of bactaeraerma and wound colonization, especially by gram-negative enteric rods. The addition of xanthine oxidase inhibitors to SGI) had no significant effect on the results.
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ASSESSMENT OF CERTAIN NEUTROPHIL RECEPTORS, OPSONOPHAGOCYTOSIS AND SOLUBLE INTERCELLULAR ADHESION MOLECULEA (ICAM-1) FOLLOWING THERMAL INJURY
(Shehab El-Din S.A., Aref S.E., Salama O.S. - EGYPT)
Polymorphnuclear leukocytes (PMLs) play a key role in host defence, and phagocyte dysfunction has been associated with increased susceptibility to infections in patients with thermal injury. Intercellular adhesion molecule-1 (ICAM-1) plays a role in leukocyte accumulation and extravasation. Flow cytometric analysis (FCM) was used to study PML expression of IgG Fc-receptor III (Fey R111) as well as the complement receptors CRI (receptor for C3b) and CR3 (receptor for Obi) in 23 patients with large burns. Analysis of PML complement- and immunoglobulin-mediated phagocytosis of Candida albicans was performed in parallel using the phagocytic index. Plasma ICAM-1 was determined using ELISA. This study revealed a significant increase, with variable degrees, in CRI- and CR3-dependent fluorescence, complement-mediated phagocytosis of Candida albicans, and plasma ICAM- 1, starting on day 2 and continuing for about 20 days until normalization. In contrast Fcy RIII-dependent fluorescence and Ig-mediated phagocytosis were significantly decreased versus control values. These results demonstrate a significant change in PML opsonin receptor expression and opsonophagocytosis, documenting systemic activation of PMLs after large burns. In addition, elevation of plasma ICAM-1 may enhance the harmful effect of neutrophil activation due to leukocyte accumulation and extravasation following enclothelial damage in the skin and lung.
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COMPLICATIONS OF BURNS IN CHILDREN - A STUDY OF 266 SEVERELY BURNED CHILDREN ADMITTED TO A BURNS CENTRE
(Shahin A, Shadata G, Franka M.R., Abusetta A, Brogouski A, Ezzaidi M.M. - LIBYA)
This study covers 113 children aged 0-14 yr divided into four age groups: 0-1 yr, 2-3 yr, 4-6 yr and 7-14 yr admitted to a burn ICU in Libya in the period 1995-97. The criteria for admission to the ICU were extensive burns, inhalation injury, burns with complications, and burns with other systemic problems. For extensive burns, antacids and H2 receptor blocking agents were administered. Tangential excision is our method of choice, but we perform fascial excision in deep third-degree flame burns. Scalding was the main cause of burns, followed by flame. Out of the 113 children admitted, sixteen (14%) died. The main cause of mortality was septicaernia, prevalently due to Pseudomonas.
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KERATINOCYTES AS BIOLOGICAL DRESSING IN THE TREATMENT OF PARTIAL- THICKNESS BURNS IN CHIlILDREN
(Koupilovia I., Suchanek I. - CZECH REPUBLIC)
In order to evaluate the treatment of deep dermal burns with keratinocytes and to establish the possibility of reducing hospitalization and the frequency of painful wound rebandaging, a survey is presented of 109 children with deep dermal burns treated with cultured epidermal allografts. The decline in the mean duration of hospitalization was statistically significant compared with that of children treated without the use of keratinocytes. The healing of deep dermal burns treated with keratinocytes was successful in all patients, in accordance with our expectations. The application of these biological allografts had to be repeated - twice at most - in only in 24.7% of cases.
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SEQUELLES DE BRULURE DU CUIR CHEVELU - PREPARATION PAR LE TECHNICIEN DE L'EXPANSION CUTANEE (ILLUSTRE PAR UN CAS)
(Bouiladas, M, EL Gbouri H, Nassih M., Ammar M, Rzin A, Ihrai H., Jidal B. - MAROC)
Il existe de multiples proc?d?s de r?paration pour corriger les grandes pertes de substance du cuir chevelu. Parmi les moyens les plus utilis?s on retrouve les lambeaux locaux, mais tr?s souvent les sites donneurs sont greff?s, ce qui aggrave les s?quelles , La technique de l'expansion cutan?e a boulevers? cette chirurgie. Elle a permis de r?parer de larges pertes de substance avec un minimum de pr?judice. N?anmoins, elle ob?it ? certaines r?gles qu'il faut peser avant son indication.
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ORGANIZATION AND TRANSPORT IN MASS BURNS DISASTERS
(Hadjiiski O., Dimitrov D. - BULGARIA)
Il existe de multiples proc?d?s de r?paration pour corriger les grandes pertes de substance du cuir chevelu. Parmi les moyens les plus utilis?s on retrouve les lambeaux locaux, mais tr?s souvent les sites donneurs sont greff?s, ce qui aggrave les s?quelles , La technique de l'expansion cutan?e a boulevers? cette chirurgie. Elle a permis de r?parer de larges pertes de substance avec un minimum de pr?judice. N?anmoins, elle ob?it ? certaines r?gles qu'il faut peser avant son indication.
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PERTES DE SUBSTANCE CUTANEE POSTRAUMATIQUES DES MEMBRES INFERIEURS CHEZ LES ENFANTS
(Mitiche B. - ALGERIE)
Il s'agit d'une ?tude r?trospective concernant 67 cas de pertes de substance cutan?e posttraumatiques des membres inf?rieurs survenues toutes chez des enfants ?g?s de 2 ? 13 ans au cours d'une p?riode de cinq ans (janvier 1990 ? d?cembre 1994) trait?s au Service des Enfants Br?l?s et de Chirurgie Plastique P?diatrique de Bab El Oued (Alger). Plusieurs param?tres ont ?t? ?tudi?s, et ils ont r?v?l? la fr?quence de ces accidents chez l'enfant entre 6 et 8 ans, la fr?quence des localisations au niveau de la jambe, ainsi que la fr?quence des accidents de la voie publique qui constituent la principale cause de cette pathologie. Enfin, les diff?rente m?thodes th?rapeutiques utilis?es sont expos?es en soulignant la place importante de la greffe en filet, qui arrive ? r?soudre la majorit? des probl?mes. Les r?sultats et une discussion terminent le travail.
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