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Volume XI |
Number 3 |
September 1998 |
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SUMMARIES
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DIABETES AND BURNS - PROBLEMS OF DIAGNOSIS AND THERAPY
(Napoli B., D'arpa N., Masellis M. - ITALY)
The gradual average aging of the population has led to an increasing number of middle-aged and elderly persons suffering burns as a result of the alterations in glucose metabolism typical at this age which the burn highlights or aggravates. There is bound to be an increasing need to deal with cases of hyperglycaemia that were undetected or kept under control prior to the burn trauma. In view of the scarce amount of literature available, this article considers differential diagnoses between the various conditions of hyperglycaemia and the reasons for administering insulin therapy, with its immediate and long-term risks. Certain parameters are also considered (diuresis, natraemia, urea creatininaemia, plasma osmolarity, glycosuria and glycaemia). The accurate monitoring and interpretation of these parameters is basic to the management of the burned diabetic patient.
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| 135 |
CRITERIA FOR PATIENTS AT RISK IN RELATION TO MULTIORGANIC DEFICIENCY DUE TO BURN INJURIES
(Yonov Y., Petkov P., Serdev N. - BULGARIA)
The gradual average aging of the population has led to an increasing number of middle-aged and elderly persons suffering burns as a result of the alterations in glucose metabolism typical at this age which the burn highlights or aggravates. There is bound to be an increasing need to deal with cases of hyperglycaemia that were undetected or kept under control prior to the burn trauma. In view of the scarce amount of literature available, this article considers differential diagnoses between the various conditions of hyperglycaemia and the reasons for administering insulin therapy, with its immediate and long-term risks. Certain parameters are also considered (diuresis, natraemia, urea creatininaemia, plasma osmolarity, glycosuria and glycaemia). The accurate monitoring and interpretation of these parameters is basic to the management of the burned diabetic patient.
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| 138 |
COMPRENDRE ET RECONNAITRE LES MANIFESTATIONS DOULOUREUSES POUR MIEUX LES SOIGNER
(Fonrouge J.M., Branche P., Lakdja F. - FRANCE)
Cet article considère la douleur, ou "les douleurs", comme disent les auteurs, pour mieux les soigner. Après avoir défini la douleur ils expliquent l'importance du critère des différentes douleurs. Ils considèrent aussi la perception de la douleur, qui est vécue de façon différente en fonction de plusieurs paramètres. Il y a deux priorités pratiques face à un syndrome douloureux aigu: la sédation de l'anxiété et la sédation de la douleur et il faut choisir l'anxiolytique et l'antalgique les plus appropriés. Après avoir décrit l'hierarchie de prescription les antalgiques en fonction du niveau de douleur, les Auteurs illustrent les protocoles de traitements des différents types de douleurs. En conclusion, ils indiquent des règles et des manières de prévention des effets secondaires et de sécurité.
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| 149 |
STRESS ANALGESIA ASSOCIATED WITH EXPERIMENTAL BURN SHOCK
(Sinitsin L. N. - RUSSIA)
This paper considers excitation transmission changes in the afferent and visceral efferent cerebral systems, the threshold of pain sensitivity, the endogenous opiate synthesis level, and the character of the antishock agent activity due to burn shock.
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| 153 |
ELECTRICAL BURN INJURIES
(Babikin J., Sandor, Sopko - SLOVAKIA)
The distribution of burn injuries treated in the Saca Burns Centre in Kosice (Slovakia) is documented. During the period considered (1971 -present day), electrical burns constituted 2.7% of all burn cases treated. With regard to the period between 1987 and 1994, a more detailed study describes 96 patients treated for burns caused by electricity. The causes of the burns and typology are described. The methods of treatment are also considered.
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| 156 |
ASPECTS OF RECONSTRUCTION IN ELECTRICAL INJURY
(Konigova R. - CZECH REPUBLIC)
Between January 1984 and January 1998 an annual average number of 550 patients were admitted to the Prague Burn Centre, with an annual average of 700 in the last three years. Electrical injuries accounted for 4.6% of these cases. Apart from casualties with devastation of the upper extremities that necessitated amputation above or below the elbow, there were manifold other locations with extensive electrical injuries requiring an interdisciplinary approach in the Intensive Care Unit. Regarding reconstructive surgery, strictly individual decision-taking was indispensable. Decompressive surgery was accomplished immediately, simultaneously with resuscitation, followed by necrectomy every second day using xenografts as a temporary cover. For the permanent closure of exposed bones, tendons, joints or nerves various types of flaps were used. A special problem was encountered in cases with facial defects. The tubed flap technique, pioneered by our late Professor Francis Burian in 1912 and later recommended by Fitatov and Gillies, is still advantageous in some cases. This method can be performed under local anaesthesia using simple instruments at all stages. Patients with extensive burns and electrical injuries are severely compromised, and the use of free flaps (involving prolonged surgery under lengthy general anaesthesia) has to be a carefully taken decision.
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| 162 |
HIGH-TENSION ELECTRICAL BURNS
(Faggiano G., De Donno G., Verrienti P., Savoia A. - ITALY)
Electrical burns have traditionally been considered as distinct from thermal burns. The management of high-voltage electrical burns, in particular, poses certain therapeutic challenges for the surgeon. We present our experiences with a series of such patients admitted to the Burn Unit of Brindisi Hospital (Italy).
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| 165 |
BURNS SEQUELAE AND THEIR PLACE IN THE ACTIVITY OF OUR CLINIC
(Belba G., Isara J S., Xhepa G., Belba M., Lila N. - ALBANIA)
The clinic of Burns and Plastic Surgery at the University Hospital Centre, Tirana, deals with a broad spectrum of surgical diseases. A considerable part of this activity consists of burns sequelae. This paper gives a general view of this activity during 1996, and then concentrates on the surgical treatment of burns sequelae. We compare the different groups of pathologies treated surgically, present a surgical image of our clinic, and discuss medical concepts in a clinic of this type. Statistical data make it clear that medical propaganda, research, and the long-term follow-up of burn patients are the most efficient means of preventing burns and their sequelae.
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| 168 |
INTERDENTAL WIRE FIXATION OF ENDOTRACHEAL TUBE FOR SURGERY OF SEVERE FACIAL BURNS
(Botts J., Srivastava K.A., Matsuda T., Hanumadass M.L.- USA)
Complex facial burns requiring complete exposure of the face for initial skin grafting and secondary reconstructive surgery prompted our improvising a wire fixation method of securing the oral endotracheal tube. Utilizing this method, we have experienced no accidental extubations or trauma to the patient's dentition. A small amount of gingival bleeding is possible both during and after insertion and removal of the wire. Alternative methods must be utilized for both edentulous patients and those with prosthetic dental devices located in the anterior portion of the mouth. We have found this method to be superior to the external cranial fixation device of Hansen, the lip fixation method, and various taping techniques when diffuse severe facial burns require reconstructive surgery. Not only does the wire fixation method appear applicable to a wider range of facial surgery such as diffuse burns or severe trauma but the fact that the tube can be safely secured in 5-10 minutes gives an advantage over other previously described methods.
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| 171 |
TEMPORARY WOUND DRESSING OF BURNS WITH FRESH, STERILE, FROZEN PORCINE SKIN
(Becker D. - GERMANY)
In 1964 Kohnlein described seven severely burned patients who received a primary wound dressing of fresh porcine skin, with reasonable success. When fresh, frozen, sterile porcine skin became readily available as a dressing, our hospital in Bad Hersfeld (Germany) adopted this primary wound dressing as a regular part of its planning of burns treatment. Today, the use of cadaver skin as a better biological dressing has been discontinued because of the danger of HIV infection, and the expectations raised by the culture of epithelial cells have not been fully realized: the culturing is very expensive and the sheets transplanted become necrotic in most patients after six months. It is thus necessary to revive the use of porcine skin wound dressing. Porcine skin is available as a collagenate (Mediskin), which can be stored without any problems. And pigs are to be found all over the world.
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