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Volume XII |
Number 1 |
March 1999 |
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SUMMARIES
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A STUDY OF BURNS AMONG WORKERS IN ASSIUT CEMENT FACTORY, EGYPT, 1998
(El-Megeed H.S.A., El-Din S.M.A., Kotb S.A., El-Oteify M.A. - Egypt)
The cement industry is one of the most vital industries for the Egyptian economy, and occupational injuries constitute a major health problem for the working population. Burn injuries in the cement industry are among the main causes of economic loss to the country. This retrospective study of the period from 1991 to 1995 was conducted throughout the year 1995. The aims of the work were to determine the incidence and causes of burn accidents and the financial loss due to absence from work and to the cost of treatment and to define primary preventive measures against this type of burn. The mean annual number of factory workers in the 5-yr period period was 3200. The total number of burn accidents was 155. Most of the burn accidents occurred in the production department. The commonest cause of burn was contact with hot clinker or cement powder. The ankles and feet were the commonest parts of the body to be affected by burn, followed by the hands and wrists, and the head and neck. The total number of working days lost due to burns over the five years was 4776, with a mean of 31.0 ± 30.8 days per case. Despite the lack of specific training programmes and insufficient protective measures, the decreasing incidence of burn accidents towards the end of the period of study is a good sign that the factory authorities have become more aware of the importance of reducing the number of these catastrophic accidents.
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BRULURES GRAVES CHEZ VADULTE - A PROPOS DE 600 CAS
(Mitiche B., Behloul M, Hadjem K, Taibi S, Bouattou E, Oucherif H., Doukh A, Abchiche M.O. - Algerie)
Les Auteurs considèrent 600 cas de patients adultes brûlés étudiés pendant une période de trois ans (1995-98). Le travail porte sur les différents paramètres des patients traités, tels que l'âge, le sexe, l'agent causal de la brûlure, la surface cutanée brûlée et l'évolution vers la cicatrisation (spontanée ou après greffe), ainsi que le taux de mortalité de la série. Ils considèrent aussi le traitement général et local et les causes de la mort.
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THE EFFECT OF EARLY TUBE FEEDING ON SERUM COPPER AND ZINC LEVEL IN BURNED CHILDREN
(Gumus N, Dalay C, Arslan E, Uslular S, Kivanc K. - Turkey)
Copper (Cu) and zinc (Zn) play an important role in biological and metabolic processes. These elements are essential to man and have a beneficial effect on wound healing that is important in burn patients. This study was designed to investigate the effect of early tube nutrition on serum Zii and Cu levels after the administration of Zn- and Cu-containing nutrition solutions. The study included 11 paediatric patients admitted within the first 30 h post-burn. The burns were either deep partial- or full-thickness and the extent varied from 12 to 35%. A commercial feeding solution containing 1 ing Cu and 12 mg Zn per 1 was given at a rate of 10 ml/h via nasogastric or nasoenteral tube by a pump continuously at the beginning and adding 10 ml per h. The daily caloric intake was calculated with the Davies formula. Nutritional support was continued for 17 days post-burn. Samples of venous blood were taken and analysed. A statistical comparison (Anova test) between the control and therapy groups showed significant differences. The differences between the first samples and the others were analysed by the Anova test but no significant difference was observed. It was found that commercial nutritional solutions do not include sufficient amounts of Zn and Cii to satisfy the requirements of paediatric patients. Supplementary amounts must therefore be added.
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A NEW DELIVERY SYSTEM OF ANTIBIOTICS IN THE TREATMENT OF BURN WOUNDS
(Giannola L.L., De Caro V, Adragna E, Giandalia G, Giannola G, D'arpa N, Napoli B., D'amelio L.M., Genovese L.M., Lombardo C, Masellis M. - Italy)
The development of a new antibiotic delivery system suitable for application on burn wounds is described. The system was designed to be administered together with an implant of epidermal cultured keratinocyte stem cells. The antibiotic was entrapped in a reservoir compartment which was capable of releasing the drug at a controlled rate. The desired delivery profile was determined in vitro using a general two-compartment linear time-invariant model. The suitable rate for a release of the antibiotic in sufficient amounts for a therapy of 5-6 days was obtained using a combined mechanism based on diffusion through a membrane and decrease of drug movement properties in the vehicle. The topical release system that is proposed limited the indiscriminate use of broad-spectrum antibiotics, thus reducing the possible incidence of undesirable mulfiresistance. Interruption of the system in the area after five days of treatment was easy as it caused the patient no pain, no trauma to the zone, and no damage to the graft. Eight days after application it was observed that the treatment of patients with cultured keratinocytes had been successful and that the lesions had healed.
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A PRELIMINARY CLINICAL STUDY OF BIFIDOBACTERIA PREPARATION IN THE TREATMENT OF POST-BURN DIARRHOEA IN CHILDREN
(Jun Chen, Ya Ping Zhang, Guang Xia Xiao - China)
Certain strains of Bifidobacteria may promote recovery from acute diarrhoea. Bifidobacteria are of human origin and are natural colonizers of the gastrointestinal tract. We therefore investigated the possible role of Bifidobacteria preparation in the treatment of children with post-burn diarrhoea. Thirty-one severely burned children with diarrhoeal complications were studied. The children received 10' colony-forming units of Bificlobacteria preparation daily for six days. The clinical outcome of diarrhoea and stool microflora was evaluated. The results showed that the intestinal flora of all children with diarrhoea changed greatly before treatment and that the proportions of Bifidobacteria and bacteroid decreased significantly, whereas those of aerobes and Candida were relatively increased. The ratio of anaerobes to aerobes decreased. As a result, the children's intestinal flora was altered. After six days of treatment with Bifidobacteria preparation, the cultures of Bifidobacteria from stool samples demonstrated that administration of Bifidobacteria resulted in their colonization of the gastrointestinal tract. The diarrhoea in most of the children ceased and the intestinal microflora was restored. It is thus concluded that Bifidobacteria preparation is effective as a therapeutic reagent in post-burn diarrhoea in children.
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UTILISATION DES MEMBRANES AMNIOTIQUES CHEZ LES BRULES - A PROPOS DE 25 CAS
(Mitiche D., Larbi-Dahou B.M., Bouatou F, Abchiche M.O., Djeffal A, Mahlous M. - Algerie)
Les Auteurs d?crivent leur protocole pour la pr?paration et l'utilisation des membranes amniotiques humaines dans le traitement des patients br?l?s. Ces membranes r?pondent tr?s bien ? l'objectif du br?lologue d'utiliser un pansement qui r?duit les perturbations dues aux l?sions plus ou moins profondes de la barri?re cutan?e. Ils pr?sentent leurs r?sultats, obtenus dans une s?rie de 25 patients, et consid?rent l'aspect ?thique de la m?thode et ses nombreux avantages. L'emploi des membranes amniotiques humaines permet d'obtenir de bons r?sultats, avec des cicatrices de bonne qualit? et un co?t raisonnable.
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TOTAL BURN WOUND EXCISION OF MASSIVE PAEDIATRIC BURNS IN THE FIRST 24 HOURS POST-INJURY
(Barret J.P., Wolf S.E.,Desai M.H., Herndon D.N. - Texas)
Massive burns still present important morbidity and mortality. Early excision and coverage with skin substitutes have improved survival. The aims of our study were to study the safety and efficacy of total burn wound excision in the first 24 h postinjury and assess its impact on survival. Between July 1996 and December 1997 we studied a cohort of 30 consecutive paediatric burned patients affected with massive burns (TBSA burned > 60%) admitted within 24 h of their injury. All full-thickness burns were excised and auto- and/or homografted on admission. Data are depicted as mean ± SEM. Mean TBSA burned was 80% (± 2.2) and TBSA full-thickness burns were 72% (± 4.8). Five patients presented burns of over 95% and three of them were covered with cultured epidermal autografts. Incidence of smoke inhalation injury was 54%, and 47% of patients presented septic episodes. There were no intra-operative or post-operative complications. Mean circulating blood volume of the patients was 1694 ull (± 308), and 4133 rril (± 1692) of whole blood was transfused in the operation. Length of stay was 67 days (± 8.8) and mortality in this cohort of severely burned children was 10% (3 patients). Immediate total burn wound excision and grafting is a safe and effective technique in severe burn injuries.
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Barret J.P., Wolf S.E.,Desai M.H., Herndon D.N. - Texas
(Magliacani G, Stella M, Castagnoli C. - Italy)
Tissue repair is a complex phenomenon and various kinds of stimuli may alter the healing process, causing scar anomalies from hypertrophy to chronic ulcers. Owing to the lack of a rigorous clinical classification, a defective knowledge of actiopathogenesis and physiopathological mechanisms, and the difficulty of interpreting research findings, the inclusion of pathological scars in nosological groups remains an unresolved problem. Current diagnostic criteria, based on subjective assessment, do not make it possible to give anything more than an approximate evaluation of the precise evolution phase and clinicians are unable to predict the possible evolution, the timing, and the final outcome. The Authors, on the basis of their research and bibliographic reports, propose a clinical classification, justified by numerous observations that demonstrate the different biological status of scar tissue, providing the biological support on which to base the choice of therapy and the best timing of its initiation.
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TISSUE EXPANSION: A POSSIBLY VALID RECONSTRUCTIVE ALTERNATIVE IN ELECTRIC BURNS OF THE MOUTH
(Atiyeh B.S. - Lebanon)
Electric burns in general are relatively rare. In electric burn accidents, particularly in adults, hand injuries prevail. in children, however, the most common electric injuries are burns of the mouth, with 90% of such burns occurring in infants and toddlers less than four years of age. These burns are among the saddest, most devastating, and most difficult types of injury to correct. There is great confusion in the literature about the proper management of electric burns of the mouth in the acute phase. There is even greater confusion when it comes to secondary correction of the resultant deformity. Nearly all the surgical reconstructive techniques that have been described result in serious mutilation of the surrounding normal tissues and fail to simulate a normal oral sphincter. An attempt was made to expand remaining normal lip tissues in a child by simulating a technique that has been performed for many ages by populations throughout Africa, America, and the South Pacific. The expansion device has yet to be perfected, but in principle the idea is appealing since the condition of microstornia secondary to electric burns of the mouth can be corrected by expanding residual normal lip segments.
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RECONSTRUCTION OF VULVA IN A FEMALE PATIENT HAVING LONGSTANDING GENITAL BURN CONTRACTURE WITH SEVERE WEB AND MARJOLIN'S ULCER: A CASE REPORT
(Sonmez Ergun S, Iscen Cek D, Ulay M. - Turkey)
In this report, a 17-year-old female patient with a post-burn genital contracture that caused severe deformity and squarnous cell carcinoma and the results of the genital web release and vulva reconstruction with our flap design are presented.
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BURN-LIKE SYNDROMES
(Atiyeh B.S., Kayle D.L., Nasser A.A. - Lebanon)
Toxic epidermal necrolysis (TEN) defines a group of disease processes characterized by mucoepidermal lysis and necrosis. The condition is rare and may be associated with a wide range of aetiol.ogies, one of which is direct toxicity of a given agent on the epidermal keratinocytes. In its severe form, the outcome is usually dismal. Although many workers in the field have recommended managing patients presenting with this clinical picture in a similar manner to that adopted for burn patients, a comprehensive comparison between burn injury and TEN is still lacking in the literature. Moreover, the term "toxic epidermal necrolysis", coined by Lyell in 1956, is a confusing neologism that does not reflect the exact aetiology of the condition or hint at the way the clinical affliction should be managed. Since TEN shares with burn injuries several features, the most important of which is the treatment recommended during both the acute and the late stages, we propose the term "burn-like syndromes" to describe the wide range of diseases manifested by extensive epidermal blistering and sloughing, as well as cutaneous necrosis requiring hospitalization and special intensive care management.
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GUIDELINES FOR FIRE DISASTER MEDICAL MANAGEMENT IN THE MEDITERRANEAN COUNTRIES
(Magliacani G, Masellis M. - Italy)
Guidelines are suggested for fire disaster medical management in the Mediterranean countries. Three phases of management are distinguished: pre-hospital response (on the site of the disaster), first-level hospital response (continuation of medical response in the nearest hospital(s), and second-level hospital response (final stage of medical assistance, with definitive hospitalization). The three phases are described in detail. With proper planning it will be possible to improve overall rescue operations, to prevent overcrowding in specialized burns centres, and to transform a dramatic and chaotic circumstance into a situation that is as normal as possible, with the result that the emergency situation can be rationally resolved.
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