Annals of
Burns and Fire Disasters - vol. XIII - n° 1 - March 2000
INTERNATIONAL ABSTRACTS
SKIN
SUBSTITUTES IN BURNS
A survey is presented of the development
of skin substitutes until the present day. The current reality is that skin substitutes
are designed to be either temporary or permanent. The uses and formulations of
temporary and permanent substitutes now available are reviewed and future directions in
skirt substitute research are speculated upon. Current temporary substitutes include
porcine xerrograft, synthetic membranes, and allogenic l~,.iiii)~)iai.y,siibstitutes which
are described. Current epidermal and dermal substitutes are also presented, as well as
composite substances. Future developments point to the creation of temporary dressings
containing growth factor secreting allogenic tissues that stimulate native wound healing
and to the realization of a permanent composite skin replacement. Progress may also be
expected in the field of temporary skin substitutes and improvements in skin banking
techniques.
Sheridan R.L., Tompkins
R.G.
Burns, 25: 97-103, 1999
CHANGES IN CIRCULATING
LEVELS OF INTERLEUKIN 6 IN BURNED PATIENTS
Changes in serum interleukin 6
(IL-6) levels were determined by using serial serum levels in 10 burned patients (burn
injury 30-85% TBSA). Five patients recovered and the other five, all septic, died. The
results obtained were compared with changes in body temperature and serum TNF-ot and IL-8
determined previously. There was a good correlation between the dynamic changes of
circulating levels of the three cytokines TNF-ec, IL-8, and IL-6 in the ten patients.
Serum levels of these cytokines were significantly higher in the septic patients. It is
concluded that all three cytokines studied may play a significant role in the
pathophysiology of sepsis in burned patients.
Yeh F.L., Lin W.L., Shen H.D.,
Fang R.H.
Bums, 25: 131-6, 1999
CORRELATION BETWEEN
FUNGI ISOLATED FROM BURN WOUNDS AND BURN CARE UNITS
A prospective study was made of fungal
isolates from burned patients and from burn care units. It was found that the most
frequent isolate both in the burn patients and in the burn units was Aspergillus niger.
Ulocladium was the commonest isolate in the control group (other areas in the
hospital). Aspergillus terreus, Penicillium and Zygomyeetes, all of which were
recovered from burn patients, were also found more often in burn care units than in the
control group. The findings suggest that there is a potential risk of fungal infection
that can be acquired from the immediate surroundings of patients in burn care units. It is
therefore recommended that periodical decontamination should be carried out in burn care
wards.
Mousa H.A., Al-Bader S.M.,
Hassan D.A.
Bums, 25: 145-7, 1999
CARE OF BURNS
VICTIMS IN EUROPE
A survey is presented of the care of
burns victims in European countries. The opinion is expressed that there is a need for a
central information point where data and facts relating to all aspects of burn patient
care could be collected, creating a central iniormation resource. A European-wide service
could thus be called on in the event of a severe fire disaster. Figures are given
regarding licspital capacities in all European countries, the number of burn centres, the
number of adult/child beds and ventilators, and overall nurnher of admissions. Various
disasters (San Juanico, Bashkiri. Los AVaclues, Rarnstein, and others) are referred to,
and the lessons learned should be widel) circulated. The international exchange of
inforruation is important, as for example by the Arbeitsgemeinschaft flir
Verbrefinungsbehandlung, the European Burns Association, and the Mediterranean Club for
Burn and Fire Disasters. The Ramstem disaster in particular showed that in certain
circumstances (disaster in a well-populated area, pre-existing disaster plans) such
disasters can be dealt with efficiently and to the general benefit of all concerned.
Wedler V., Kiffizi W., BUrgi.
U., Meyer V.E.
Bums, 25: 152-7, 1999
ACUTE RENAL
FAILURE IN SEVERELY BURNED PATIENTS
Acute renal failure (ARF) has been reported to be
found as a complication in between 0.5 and 30% of admissions to burn hospitals, depending
on the severity of the bums and on the definition of ARF. With a view to analysing
possible pathogenic and prognostic factors associated with ARF in burn patients, a
retrospective survey was made of the files of 328 patients with burns in over 10% body
surface area in a bums centre in Munich over a 4-month period (January-April 1998). The
rate of ARF was found to be 14.0%. The patients with ARF were treated by continuous
arteriovenous haernofiltration (CAVH) for a mean period of 10.5 days (range 1-47). CAVH
had a complication rate of 10%. Most of the complications were associated with the
vascular access in the femoral artery. The mortality rate in patients suffering from ARF
was 85%, death being due to multiple organ failure in 83% of the cases. Only burned BSA
and inhalation injury were significantly correlated with the onset of ARF. The factors of
age, burn surface area, day of onset of ARF, and the duration of renal replacement therapy
were not significant for comparing survivors with non-survivors and were thus not
predictive for survival rate.
Holm C., Hdrbrand E, Henckel
von Donnersmarck G., Miffilbauer W.
Bums, 25: 171-8, 1999
SELF-INFLICTED
BURN INJURIES
Self-inflicted bums are uncommon in
western culture, with a range of 1-9% of total burn admissions reported in different
studies. A 9-yr retrospective review of admissions to a bums centre in Pittsburgh, USA,
found that 11 out of 1135 burn admissions (0.97%) were due to self-inflicted bums. Of
these 11, ten had a previous psychiatric diagnosis (major depression in six cases,
schizophrenia in three, and a personality disorder in one case). The eleventh patient was
diagnosed during hospitalization as suffering from major depression. Two of the patients
were attempting to commit suicide. It is recommended in the light of this review that
patients with an abnormal psychological profile (including suicidal orientation) should be
adequately monitored and followed by trained mental health professionals. Greater
awareness of the potential dangers may help to reduce such self-inflicted injuries in the
future.
Erzurum V.Z., Varcelotti J.
J. Burn Care Rehabil., 20: 22-4, 1999
COST REDUCTION
STUDIES IN BURN NUTRITION SERVICES: ADJUSTMENTS IN DIETARY TREATMENT OF PATIENTS WITH
HYPONATRAEMEA AND HYPO. PHOSPHATAEMIA
This paper describes two simple cost-saving
strategies that could be adopted by bums centres. They relate to two projects that were
carried out with a view to trimming costs due to two phenomena frequently observed in burn
patients: hyponatraemia in children and hypophosphataemia in severely burned adults. The
use of adult enteral formulae for paediatric patients reduced the incidence of
hyponatraemia and the need for expensive sodium supplements. The prophylactic
administration of oral phosphate in the first days of hospitalization was found to lessen
the decline in serum phosphate, thus reducing the cost of treating hypophosphataemia in
severely burned patients. Both the strategies described were successful in cutting costs
in the two categories of patients considered.
Mathews J.J., Aleem R.F.,
Gamelli R.L.
J..Burn Care Rehabil., 20: 80-4, 1999
IMMUNOHISTOCHEMICAL ANALYSIS OF BURN DEPTH
The techniques normally used for the
assessment of burn depth (visual examination; ultrasound and circulatory monitors,
including laser Doppler; and thermography) require either very expensive equipment or
considerable technological expertise. Clinical judgement may be adequate in very shallow
bums and full-thickness bums, but problems of differentiation arise between superficial
and deep dermal bums. Employing an in vitro model it has been found that by using
cryosections and an immunofluorescent staining method, it is possible to achieve quicker
and more clear-cut results than those offered by standard light microscopy techniques. The
proposed method helps to define burns that will benefit from early excision and grafting.
This experimental model, if further investigated, could become standard practice in
routine clinical use.
Ho-Asjoe M., Chronnell C.M.,
Frame J.D., Leigh I.M., Carver N.J.
Burn Care Rehabil., 20: 207-11, 1999
MORTALITY IN PAEDIATRIC BURNS IN THE PRAGUE BURNS CENTRE
(1994-1997)
A survey is presented of the mortality of
severely burned children who were hospitalized in the Intensive Care Unit, Prague Bums
Centre between 1994 and 1997. Overall 345 children were treated (age range, 3 months-15
yr; bums in 1-88% TBSA, mixed superficial and deep bums). There were no fatalities due to
burn shock in the early postbum period. Five children who died after suffering deep bums
in more than 50% TBSA presented at necropsy signs of infection-related multiple organ
system failure. It is concluded that meticulous clinical care and an interdisciplinary
approach are necessary to prevent sepsis and multiple organ failure. This means:
stabilization of whole-body haemodynamics with adequate tissue perfusion; support of the
gut barrier (early enteral feeding, proper management of burn wounds (early excision +
early closure); regular infection control of all possible sources of infection in
patients, staff, and ICU equipment.
Kriptier L, Broz L., Kiinigovd
R., Bouska 1. Acta Chirurgiae Plasticae, 40: 79-82, 1998
BACTERIOLOGICAL MONITORING IN THE PRAGUE BURNS CENTRE
The Prague Burn Centre regularly monitors
microbial flora. The microbiological aspect of the prevention of nosocomial infections in
the Centre consists primarily of the surveillance of bacterial flora and its antibiotic
resistance. The patients are examined by conventional methods (swab taking in burn sites)
and also by the printing method. This permits a semi-quantitative assessment of the
colonization of burn areas. An investigation of the bacterial contamination in the
external environment of the Department is also carried out, as also colonization in the
nursing staff. Sensitivity to antibiotics is examined in all the strains isolated; the
knowledge thus gained is important for deciding therapeutic possibilities and for the
Centre's antibiotic policy. The typing of bacterial strains makes it possible to determine
their epidemiological markers, and consequently to estimate their presence in the Centre.
The most frequent isolate has been found to be S. aureus and the prevalence of MRSA is
relatively high. With regard to gram-negative rods the strains of P. aeruginosa, K.
pneumoniae, and E. cloacae are isolated most frequently isolated. A number of
typing methods revealed endemic spread of some strains of rarely isolated species (E. agglomerans,
S. marcescens, A. bauniannii, etc.).
Vrankova L, Bendova E., Konigova R., Broz L.
Acta Chirurgiae Plasticae, 40: 105-8, 1998
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