Annals of Burns and Fire Disasters - vol. XIII - n. 3 - September 2000

INTERNATIONAL ABSTRACTS

VAGOTOMY MODIFIES BUT DOES NOT ELIMINATE THE INCREASE IN BODY TEMPERATURE FOLLOWING BURN INJURY IN RATS
In the light of the observation that rats with burn injury to 50% BSA manifest a significant increase in body temperature (TB) during the hours of light, and a decrease of circadian variation in TB, research was performed to investigate the hypothesis that part or all of the signal for increased TB in burned rats is transmitted to the central nervous system by afferent vasal fibres. Experimental animals were divided into four groups: burn-sham vagotomy, control-sham vagotomy, burn vagotomy, and control vagotomy. The animals received scalp bums equal to 50.3 ± 2.5% BSA. The main effect of vagotomy (bilateral subdiapbragmatic) on TB was a small but significant reduction in TB during hours of darkness. At least 87% of this decrease was also present in the control vagotomy group. Vagotomy had no effect on the increase in TB in the burn groups during light hours. During dark hours vagotomy significantly reduced TB in bums and controls, and burn injury reduced activity. It is concluded that it is reasonable to speculate that afferent vagal signals may be partly responsible for maintenance of TB, with or without burn injury, and that the main signal for the increase in TB in burned animals is not a neural one via afferent vagal pathways.

Caldwell F.T., jr, Graves D.B., Wallace B.H.
Burns, 25: 299-305, 1999

ETHICAL ISSUES IN BURN CARE
A survey is presented of current issues related to the ethics involved in burn care. The question is posed: "What are ethics?", and a consideration is made of medical ethics, medical law, and intuitive ethics. Ethical theories may be defined by rights, by duties, and by consequences, and they are always subject to deliberation. Some specific aspects of burn care are addressed: the patient/carer relationship; models of patient/physician interaction; consent to treatment; informed consent; consent in the incompetent adult; consent in minors; refusal of treatment; medical futility; withholding and withdrawing treatment; assisted suicide; research; rationing and distributive justice. It is stressed in conclusion that the professionals involved should have no fear or reluctance to examine the moral basis of their decisions.

Grant I.
Bums, 25: 307-15, 1999

MORTALITY ACCORDING TO AGE AND BURNED BODY SURFACE IN THE VIRGIN DEL ROCIO UNIVERSITY HOSPITAL
This study analyses the comparability of the results of burns treatment in the Virgin del Rocfo University Hospital in Seville (Spain) with internationally accepted reference data. Updated clinical protocols are used and it is important to assess their degree of success. The probability of survival in 1000 consecutive patients admitted between July 1993 and August 1997 is compared by graphic analysis with the mortality curves of other centres, with similar results. It is concluded that the quality of the medical care provided to the patients was in line with that of the other centres used as references.

Gómez-CIa T., Mallén J., Mârquez T., Portela C., Lopez I.
Burns, 25: 317-23, 1999

EPIDEMIOLOGY AND MORTALITY OF ADULT BURNS IN CATALONIA
The aim of this study was to describe the impact of bums in Catalonia, Spain, to analyse their mortality in the population, and to determine the risk factors in the local society. The incidence of burns in Catalonia is similar to that in other countries (31.2 per 100,000 persons per year). The population in the area is approximately 6 million, with an average annual rate (January 1989-December 1995) of 1824 ± 89 patients admitted to hospital. The overall mortality rate was 3.49%. There was a low incidence of inhalation injury and ARDS, but these conditions had high mortality. The factors increasing mortality were contact bums, inhalation injury, age, and burn size. Survival was not affected by pre-existing conditions. Seventy-five per cent of deaths occurred in the first week post-burn. Patients received early serial debridement and cerium nitrate sulphadiazine, with results comparable with those reported in the literature. Comparing mortality rates with the Abbreviated Burn Severity Index, a disparity in results was observed, suggesting the importance of finding a better and more applicable prognostic test for the outcome of burn injuries.

Barret J.P., Gomez P., Solano L, Gonzalez-Dorrego M., Crisol F.J.
Burns, 25: 325-9, 1999

OULTURED AUTOLOGOUS KERATINOCYTES ON A CELL-FREE DERMIS IN THE TREATMENT OF FULLTHICKNESS WOUNDS
The possibilities were investigated of combining cultured autologous keratinocytes with cell-free allodermis and thereby simplifying and shortening the culture process as well as achieving better functional and cosmetic results. Two full-thickness grafts (1 x 1 cm) were taken from four healthy volunteers. The epidermis was separated enzymatically from the dermis and the cells of the dermal part were removed by incubation in Triton X-100. Keratinocytes were seeded on a cell-free dermis and the combined graft was transplanted back to one of the wounds of the donors of the keratinocyte donor. The other wound was covered with cell-free dermis without keratinocytes. The grafted wounds were removed after 2, 3, 4, and 6 weeks, respectively, and investigated histologically and immunohistochemically as regards re-epithelialization, fibroblast ingrowth, and angiogenesis. It was found that wounds covered with cell-free dermis and keratinocytes had complete epidermal coverage two weeks after transplantation, while wounds covered with unseeded dermis showed epidermal coverage only at the wound edges. Fibroblast ingrowth and angiogenesis also showed a marked difference. This study thus demonstrates that autologous keratinocytes can be seeded on a cell-free demlls and transplanted as a kerato-dermal graft which stimulates re-epithelialization as well as fibroblast ingrowth and angiogenesis in the wound.

Gustafson C.-J., Kratz G.
Burns, 25: 331-5, 1999

PHYSICAL THERAPY ACUTE BURN EVALUATION TOOL
A new evaluation tool is described for the assessment of bums. This provides a concise evaluation of the burn patient in accordance with physiotherapy department protocol, using a check-off and circle design in order to decrease documentation time and ensure completeness of the assessment. Additional space is left for individualization of the assessment. The assessment form is presented and explained. The form was found to be useful for outlining a thorough physical assessment and treatment plan, and that it decreased documentation time. It also proved to be a useful educational tool for medical students. The checkoff format with areas for comment is easily adaptable to a computer format.

Keck T.L., HollingerJones J.L., Yowler C.J., Yurko L., Fratianne R.B. J. Burn Care Rehabil., 20: 321-4, 1999

MEASURED TOTAL ENERGY REQUIREMENTS OF ADULT PATIENTS WITH BURNS
The energy requirements of burn patients are traditionally estimated using multifactorial equations taking into account anthropometric variables and burn severity. The recent availability of portable metabolic carts has however reduced the need for dieticians to rely on predicted requirements. The use of metabolic carts may however lead to underestimation of energy requirements, as the carts do not always accurately measure the effects of surgery, dressing changes, and other treatment. The aim of this study was to calculate the difference between resting energy expenditure and total energy expenditure. Seven adult burn patients (burn range, 18-80% TBSA) were used in the study. It was found that total daily energy expenditure averaged 106 ± 11% of average resting energy requirements. This research refers to a limited number of patients, but it would appear justifiable to assume that energy requirements can be measured using the resting metabolic rate by allowing for an increase of 5-15% for non-rest activities and treatment.

Wall-Alonso E., Schoeller D.E., Schechter L., Gottlieb LT
J. Burn Care Rehabil., 20: 329-37, 1999

PERSONALITY TRAITS AND PSYCHOSOCIAL ADJUSTMENT OF PATIENTS WITH BURNS
This paper considers the relationship between the personality traits of burn patients and their ability to cope with their burn condition, as found in series of 61 Israeli patients. A satisfaction-with-life scale was used. Adjustment to the traumatic experience was found to be strongly related to specific personality traits, such as extroversion, optimism, self-mastery, and hope, rather than to just the physical features of the burn injury. Neuroticism and social anxiety figured as negative aspects. The importance of a patient's ability to elicit social support as a mean of coping is also considered in this paper.

Gilboa D., Bisk L._ Montag I., Tsur H.
J. Burn Care Rehabil. 20: 340-46, 1999

THERAPEUTICAL ASPECTS OF USING CITALOPRAM
This study considers the use of Citalopram (Seropram inf-tbl Lundbeck, Denmark). Preliminary results indicate a significant decrease in the duration of oedema in burn patients, probably as a result of the inhibition of vascular hyperpermeability. Patients under Citalopram therapy can therefore undergo surgical procedures such as necrectomy or autograft sooner because their stabilization is more rapid. Patients with bums in the face and deep dermal burns have a better cosmetic prognosis. Citalopram was also found to have a beneficial effect on the emotional disturbances of the severely burned patients. With regard to scarring, Citalopram applied as a 40 mg bolus i.v. immediately after admission of the patients to the intensive care unit improved the scarring process, and hypertrophic scars were not seen. Citalopram applied as a continuous infusion yielded results that compared favourably with those of the control group.

Blâha J., Svobadovà S., Kapounkovâ Z.
Acta Chirurgiae Plasticae, 41: 25-32, 1999

EVALUATION AND GUIDELINES FOR THE TRANSPORT OF CHILDREN WITH SEVERE BURNS
This paper (in Spanish) from Argentina assesses transfer conditions in severely burned children and proposes guidelines for lower morbidity and mortality in this age group. A prospective analysis was made of severe burn patients referred to the Paediatric Burn Unit at the Juan P. Garrahan Paediatric Hospital in Buenos Aires between August 1991 and August 1994. During this period 100 such patients were admitted, with a 25% incidence of inhalation injury. Inadequate transfer conditions were assessed in 54% of referrals, i.e. presenting preventable complications related to errors during transfer. The mean referral delay was 3.78 days, with 30% of patients being referred after day 2 post-burn. Out of the 100 patients, 26 died, and the mortality risk was significantly higher in patients who had suffered inadequate transfer conditions. An analysis is also made of common complications associated with the transfer of such patients. In conclusion some general guidelines are proposed that can reduce mortality and improve prognosis.

Demirdjian G.
Revista argentina de quemaduras, 13: 54-60, 1998