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Volume XI |
Number 4 |
December 1998 |
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SUMMARIES
| 197 |
THE TREATMENT OF BURNS DISEASE IN THE HIPPOCRATIC ERA
(Ioannovic J.D. - GREECE)
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| 198 |
BURN INJURIES IN BENGHAZI: EIGHT YEARS' STUDY
(El-Gallal A.R.S., Yousef S.M., Toweir A.A. - LIBYA)
This study evaluates thermal injuries in the region of Benghazi, Libya. From January 1990 to December 1997, 6797 patients were treated in the Burn Unit at A1jala Hospital, Benghazi. The frequency of burns increased every year, being more frequent in the cold season. All serious burned patients from hospitals outside Benghazi (25.7%) were referred to our unit. Young adults (48.9%) were the most commonly involved, followed by infants and children (35.9%), while elderly patients with burns were infrequent (1.5%). Overall, scald accidents were the commonest cause of thermal injuries (47.2%), followed by flame burns (34.9%). Scalding was the also the main cause of burns in infants and children, while among adults burns were mostly caused by flame. The male to female ratio was 1: 1. 1. Home accidents accounted for 68.3 % of our patients, of whom 69.8 % were females. Work accidents were responsible for only 21.2% of the injuries. Suicide attempts were generally infrequent (0.6%) but were relatively more frequent among females. The mean BSA was 23.8% (12.7%) and the overall mortality was 19%. Non-Libyan patients (mostly adult males) accounted for 9.6% of the cases. Diabetes was the commonest associated medical condition found in our patients (10.7%). The data obtained in our study are discussed and compared those of similar studies carried out elsewhere.
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| 203 |
SEVERE BURNS IN CHILDREN IN THE LAST FIVE YEARS IN ALBANIA
(Belba G., Pema L., Belba M., Isaraj S., Mingomataj L. - ALBANIA)
This is an epidemiological and statistical survey of the occurrence of severe burns among children in Albania in the last five years. The patients taken into consideration were burned children from all parts of the country as well as from the capital of Albania, admitted to and treated in the intensive care unit of the Clinic of Burns and Plastic Surgery in the University Hospital Centre of Tirana, Albania. Special attention is paid to the body area where the burns occurred, as compared with other burned patients admitted to our ICU, the age groups most subject to severe burn injury, sex distribution, and the site of the accident. In the five-year period there was a prevalence of 10-20% and 20-30% BSA burns. The causative agents (flame, hot water and liquids, electric current, chemicals) were studied in relation to the percentages of the burns and their location in particular body areas. The treatment protocol is described, and in particular the resuscitation phase, local treatment, general therapy, and the possible complications due to burn shock or sepsis. Total mortality figures are presented, with the main causes of death. In addition to cases in which epithelialization was spontaneous, the plastic surgery approaches adopted to treat severely burned children are described. The application and combination of different surgical stages, i.e., eschar excision and meshed skin grafting at the appropriate time, are% introduced as a possible successful management option. The data obtained underline the importance of propaganda campaigns for the prevention of severe burns in children.
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| 209 |
ELECTRICAL BURNS IN THE BENGHAZI URBAN AREA
(El-Gallal A.R.S., Yousef S.M. - LIBYA)
Between January 1988 and December 1997, a total number of 389 patients aged between 2 and 58 years with true electrical burns were treated in the Burn Unit of Aljala Hospital in Benghazi, Libya. Benghazi is a growing city that has upcoming industrial units in the suburbs, and the hospital serves not only the city but also the surrounding villages and receives all referral cases from the eastern part of Libya. Thirty-eight patients sustained high-voltage electrical injuries while in the other 351 the burns were low-voltage. Initial resuscitation was employed in most of the patients; we also carried out appropriate urgent surgery whenever required. Despite the medical and surgical management, nine patients with high-voltage and seven with low-voltage injury succumbed to their injuries. Our study showed that electrical injury remains a formidable problem with significant morbidity. It is therefore advocated that an appropriate preventive plan should be drawn up and applied.
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| 214 |
SUICIDE ATTEMPTED BY BURNING: A THREE-YEAR STUDY
(Haddad S.Y., Haddadin K.J., Abu-Samen M., Wreikat M.W., Haddad A.I - JORDAN)
This is a prospective study of 20 patients with documented self-inflicted burns out of a total of 564 admissions treated at the Burn Unit of Farah Royal Jordanian Rehabilitation Center, King Hussein Medical Center, Jordan over a three-year period from 1 January 1993 to 31 December 1995. The commonest method used by these suicidal patients was to pour kerosene over themselves and to set light to it (18 patients out of 20). A high proportion of females (16/20) was found in this series. Eight patients had previous psychiatric illness and five, all females, were involved in recent family or marital feuds. The average total body surface area burned was 48% and the overall mortality rate 70%.
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| 217 |
LYELL'S SYNDROME MANAGEMENT IN A BURN UNIT. COVERAGE WITH CRYOPRESERVED ALLOGRAFT
(Garcia Bernal F.J., Torrero V., Regalado J., Ferdinandez Samaniego F., Gabilondo F J. - SPAIN)
Eight cases of Lyell's syndrome or toxic epidermal necrolysis are described that have been managed in the Cruces Hospital Burn Centre in the last five years. The therapeutic approach to the patients is presented, describing the methodology of the systemic treatment and the disease's cutaneous manifestations. Along with the general treatment scheme, the topical care of the cutaneous manifestations is presented. Cryopreserved allografts obtained from our skin bank were used as a skin coverage tool.
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| 222 |
TRACKING DYSPROTEINAEMIA IN THERMAL INJURIES USING SERUM PROTEIN ELECTROPHORESIS
(Wedler V., Prokop S., Konzi W., Meyer V.E., Stocker R., Borgi U. - SWITZERLAND)
Serum protein electrophoresis is a routine method for diagnostics of dyslipoproteinaemia. The last 25 years' literature gives an extensive survey of the technical possibilities of separating total plasma protein qualitatively and quantitatively in its fractions. Although there are specific descriptions of dysproteinaemia for a multitude of acute and chronic diseases, its course in thermal injuries has been little described. From February to October 1997 serum protein electrophoresis was performed prospectively in 24 patients suffering from burn injuries, with total body surface ranging from 15 to 72% (mean: 30%). They were followed from the acute phase until discharge from the intensive care unit. The individual fractions were analysed and compared with each other. A typical curve with a compensatory shift to the alpha-1 and alpha-2 fractions was demonstrated in serum protein electrophoresis of the investigated burn patients. It is not sufficient to analyse only total serum protein and alburnin concentration to control hepatic protein synthesis. Analysis of the other protein fractions and different serum proteins (alpha-1 acid glycoprotein, C-reactive-protein, high-density lipoproteins, low-density lipoproteins, caeroluplasmin and transferrin) warrants consideration to prevent insufficient substitution of alburnin with the possible risk of decreasing endogenous protein synthesis.
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| 227 |
CERIUM NITRATE BATHING PREVENTS TNF-a ELEVATION FOLLOWING BURN. INJURY (EXPERIMENTAL STUDY)
(Sengezer M., Deveci M., Eski M. - TURKEY)
The physiopathological changes in the burn wound are not only characterized by the effects of heat but are also closely related to pronounced acute inflammatory processes. Following thermal injury, induction of a number of cytokines rapidly occurs. TN17-ot may be considered to be the most important cytokine related to systemic inflammation and multiple organ failure after a major trauma. Using cerium nitrate, the improvement in survival has been reported to be equal to that observed following prompt excision of the burn eschar. The aim of this experimental study was to investigate the effectiveness of cerium nitrate bathing with respect to serum levels of TNF-a in burned rats. It was observed that treatment with cerium nitrate prevented the elevation of TNF-a levels in the early stages of thermal injury. This would appear to prevent toxic materials originating in the burn wound from entering the blood stream and thus to improve survival.
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| 230 |
BURN SCARS COMPLICATED BY VERRUCOUS CARCINOMA. OUR EXPERIENCE
(Brienza E., Albanese V., Armeneise G., Miro A. - ITALY)
A report is presented on the surgical treatment of post-burn sequelae complicated by a histologically defined verrucous carcinoma. After destructive plastic surgery, reconstruction proved to be partially unsuccessful in all the patients treated, owing to recidivation. The lesions were healed by the use of simple topical treatment with creams enriched with proteolytic enzymes, without any further histological evidence of neoplasia. The methods of treatment and application are described.
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| 233 |
METHODOLOGY OF RECORDING THE CAUSES OF FIRE DISASTERS
(Saini K.N. - GREECE)
This paper considers the main theories, definitions and approaches in the methodology of recording the causes of fire disasters. Fire risk is analysed and fire prevention factors are listed. Methods of estimating and calculating fire risk are also considered. The question of acceptable risk and unavoidable risk is discussed. Fire prevention depends on accurate definitions of the risks involved and on the intentions of the fire prevention design plan.
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