Burns and Fire Disasters - vol. XIII - n. 3 - September 2000
BUT DOES NOT ELIMINATE THE INCREASE IN BODY TEMPERATURE FOLLOWING BURN INJURY IN RATSburn 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.
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
Burns, 25: 299-305, 1999
ETHICAL ISSUES IN BURN
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
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
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.,
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
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.
Revista argentina de quemaduras, 13: 54-60, 1998