Annals of Burns and Fire Disasters - vol. XII - n° 4 - December 1999

BURNS IN A SUICIDE ATTEMPT RELATED TO PSYCHIATRIC SIDE EFFECTS OF INTERFERON
Burns are sometimes a result of suicide attempts, and here such a case is described in which interferon treatment, to which the patient had been subjected, appears to have had a contributory effect in the depression that provoked the attempted suicide. The patient, aged 50 yr, poured lamp oil over her body and set fire to herself. She had been receiving interferon-a treatment for chronic hepatitis. While following this treatment, she became anxious, irritable, insomniac, and depressed. The burns cure with topical cream and treatment, and subsequent grafting, were uneventful. The patient had no significant psychiatric history, and the depression is thought to have been brought on by the interferon treatment. Physicians treating burn patients must be aware of this possible development following interferon treatment.

Fukunishi K., Tanaka K, Maruyama L, Takahashi K, Kitagishi K, Ueshima U., Maruyarna K.
Burns, 24: 581-3, 1998

FUNCTIONAL ANALYSIS AND T LYMPHOCYTES INFILTRATING THE DERMIS AND EPIDERMIS OF POST-BURN HYPERTROPHIC SCAR TISSUES
This study determined the cytokine profile of T cell clones (TCC) obtained from the dermis and epidermis of burn patients presenting hypertrophic scars in active and remission phases. It was found that the tissues in active hypertrophic scars were heavily infiltrated by Type 0-Type 1 polarized CD3+ lymphocytes producing high IFN-7 and low IL-4 levels. An analysis of their surface marker phenotype indicated that the high IFN-y production was shared equally between the CD4+ TCRoc/P and CD8+ TCRoc/p clones. The profile of TCC from remission phase hypertrophic scars showed pronounced infiltration of Type 0-Type I polarized lymphocytes with an even more evident Type 1 profile. The levels of IFN-,y produced remission phase hypertrophic scar-derived TCC were however 4 to 6 times lower than those produced by active phase hypertrophic scar-derived TCC. These findings indicate that high levels of IFN-y produced by Type 0-Type I lymphocytes infiltrating hypertrophic scars are a feature of active hypertrophic scars, while a reduction of this ability to produce high levels of IFN-y (but with a shift towards a Type I-Type 2 phenotype through an increase in IL-4) is characteristic of remission phase hypertrophic scars.

Bernabei R, Rigamonti L., Ariotti S., Stella M., Castagnoli C.
Burns, 25: 43-8, 1999

The effectiveness of the airbag as safety device in decreasing fatalities and reducing morbidity is well documented: an airbag reduces fatal injuries by 45-55% if the driver is wearing a lap-and-shoulder seat belt and by 20-40% if the driver is unbelted. Some cases have however occurred of burns due to airbag deployment. Such injuries will occur more frequently as airbags are more widely used. The various types of burn that can occur following airbag deployment are reviewed. These include thermal burns, chemical burns, and friction burns.

Baruchin A.M., Jakini L, Rosenberg L., Nahlieli 0.
Burns, 25: 49-52, 1999

EFFICACY OF A RISE IN C-REACTIVE PROTEIN SERUM LEVELS AS AN EARLY INDICATOR OF SEPSIS IN BURNED CHILDREN
Any information that can help physicians to pronounce an early diagnosis of sepsis could potentially improve the treatment of burn patients. This paper shows how a defined rise in C-reactive protein serum levels can be useful in this way. C-reactive protein serum levels were measured in 57 patients with 3-92% T13SA burns. A rise in Creactive protein serum levels was defined as an increase of at least 3 mg/dL for two days or 10 ing for 1 day. Patients were defined as septic when they received systemic antibiotics and exhibited at least two of 16 specific clinical parameters. C-reactive protein serum levels accurately predicted sepsis in 82% of cases. Nonseptic patients generally did not manifest increased C-reactive protein serum levels. When sepsis occurred, it was always preceded by increased C-reactive protein, and increased C-reactive protein occurred 2.3 ± 0.5 days before the patient was clinically deemed to be septic.

Neely AX, Smith W.L., Warden G.D.
J. Burn Care Rehabil., 19: 102-5, 1998

TREATMENT OF THE SERIOUSLY BURNED INFANT
Recent experience with large burns (over 30% TI3SA) in infants (under lyr of age) has shown that results improve if certain treatment protocols are followed. These include precise fluid support, excision, and biological closure in full-thickness wounds within 5 days, limited exposure to high inflating pressures (over 40 cm H20), weekly replacement of central venous catheters, and intensive nutritional support via the enteral route when possible. Such treatment was applied in 12 burned infants. Two children had inhalation injury, one had aspirated hot liquid, and six required mechanical ventilation. Major infectious complications occurred in four children. Complications included pneumonia (two), catheter sepsis (two), peritonitis (one), and wound sepsis (two). Six children required parenteral nutritional support. All the children survived and returned home. It is concluded that infants with large burns can survive if appropriately treated according to the protocol indicated.

Sheridan R., Remensnyder J., Prelack K., Petras L., Lydon M.
L Burn Care Rehabil., 19: 115-8, 1998

CHILDREN WITH SENSORIMOTOR DEFICIT. A SPECIAL RISK GROUP
Certain categories of children are more susceptible than others to the risk of lethal burns. These include sufferers from spina bifida, cerebral palsy, mental retardation, developmental delays, and seizure states. The children affected may present sensorimotor deficit such as gait or co-ordination instability, temperature insensitivity, and mental simplicity. A review spanning 30 years of hospitalization in a paediatric burns centre in the USA was conducted in order to investigate the correlation between paediatric sensorimotor deficit and burn injury. It was found that out of 4874 acute burn admissions 66 related to children with previous sensorimotor defects. An analysis of these cases indicated that children with sensorimotor defects were more prone to burn injury because of their physical handicaps and badly supervised environments. The mortality risk was also higher. Such children require special supervision, lack of which was the responsible for some 80% of the cases reviewed. It is clear that the wellbeing of children with sensorimotor deficits requires health care providers to play a greater role in the education of parents and caregivers.

Ramirez R.J., Behrends L.G., Blakeney P., Herridon D.N.
J. Burn Care Rehabil., 19: 124-7, 1998

HOT-PRESS HAND BURN TREATMENT
The treatment is described of seventeen patients with hot-press hand burns. The following aspects were studied: type of injury; treatment methods; functional outcome; cosmetic appearance; and complications. Such injuries are particularly common among workers in the dry-cleaning industry. Three methods of treatment were followed: hydrotherapy, excision, and grafting. The methods of treatment are described and the results presented. The importance is emphasized of adequate training and accident prevention propaganda for workers exposed to such occupational hazards.

Celikoz B., Achauer B., VanderKam V.M.
J. Burn Care Rehabil., 19: 128-30, 1998

EXTRACORPOREAL MEMBRANE OXYGENATION IN THE TREATMENT OF RESPIRATORY FAILURE IN PAEDIATRIC PATIENTS
Extracorporeal membrane oxygenation (ECMO) can save the lives of many burned children estimated to have a more than 90% probability of dying because of pulmonary failure due to post-shock respiratory distress. Five such cases are presented of children who after developing severe respiratory failure that was resistant to medical management and maximal ventilatory support were subjected to ECMO treatment. ECMO appeared to be a viable therapy for children with acute respiratory failure when maximal conventional pulmonary support proved unsuccessful. The outcome in such cases is poor for burned children receiving ECMO therapy after prolonged ventilatory support for smoke inhalation injury. Nevertheless, children who suffer perfusion/reperfusion shock injury to the lungs following delayed resuscitation after scald burns appear to benefit from short courses of ECMO, whatever the extent of their burn. The main candidates for ECMO would therefore be children who suffer respiratory failure after scald injury and who have been subjected only to a brief period of mechanical ventilation. It is still not clear whether ECMO might benefit flarne-injured children in whom severe inhalation injury develops.

Pierre E.G., Zwischenberger J.13., Angel C., Upp J., Cortiella L, Sankar A., Herndon D.N.
J. Burn Care Rehabil., 19: 131-4, 1998

THE USE OF GROWTH HORMONE IN THE TREATMENT OF EXTENSIVE BURNS: A CASE REPORT
The beneficial effects of growth hormone in the treatment of severe burns, especially in children, has been known for some ten years. Growth hormone is an anabolic hormone that induces increased cell growth, positive nitrogen and calcium balance, lipolysis, and hyperglycaernia and promotes protein synthesis. The case is reported of a 12-yr-old child who had been burned after climbing on the roof of a railway carriage, where he suffered an electric arc burn from a 25000 V overhead cable. The patient presented 80% BSA burns (60% full thickness). Recombinant human growth hormone (Norditropin, Novo Nordisk) was administered in daily doses of 0.52 i.u./kg starting on day 19 post-burn for 15 consecutive days. The treatment was well tolerated except for mild insulin resistance, which was corrected by slightly increasing the insulin added to the glucose solution. After 56 days of intensive care and numerous excisions and graft procedures, the majority of the burns had healed.

Koller J., Marinov Z., Kvalteni K.
Acta Chirurgiae Plasticae, 40: 76-8, 1998

OUR EXPERIENCE WITH THE USE OF CERIUM SULPHADIAZINE IN THE TREATMENT OF EXTENSIVE BURNS
The onset of burn disease accompanied by infection as the major complication continues to be a problem in burn patients. Improved survival is now possible, especially in children, thanks to the early surgical excision of the eschar followed by immediate grafting. In adults, however, early massive excision has not greatly improved survival prospects. In such cases more or less sequential staged excisional procedures have been successfully tried. Topical therapy with a cerium nitrate/silver sulphadiazine cream combination has proved to be useful. Adding 2.2% of the rare earth element cerium salt to silver sulphadiazine causes the formation of a hard, yellow leather-like eschar that offers good resistance to infection as well as good long-tenii adherence to the burn wound. The surgeon is thus able to perform late tangential excision and immediate autografting. The open wound extent is thus reduced, with a consequent drop in the severe infection rate. This combined treatment was used in twenty patients with deep burns in over 20% T13SA, and compared with treatment only with silver sulphadiazine cream. The combined treatment with silver sulphadiazine cream was found to be safe and effective in the treatment of deep and extensive burns. The advantages of the method are the easy and painless application and removal, and the good resistance to infection. Staged, sequential excisions are therefore possible in cases where early massive excision is not feasible.

Koller J., Orsag M.
Acta Chirurgiae Plasticae, 40: 93-5, 1998