Burns and Fire Disasters - vol. XIII - n. 4 - December 2000
SUICIDE BY BURNS: A TRAGIC END
Suicide figures are sometimes underestimated
because of religious and social considerations. Also, suicide attempts are often denied by
survivors, who claim accidental reasons. The aim of this study was to attempt to evaluate
the extent of the problem and to suggest a prophylactic programme aimed at the target
population. The study covers a 20-month period during which túne 23 patients presented to
the burn unit of Ain Shams University in Cairo after attempting suicide by
self-immolation. Only two patients were male. The total body surface area burn ranged from
15 to 95% (mean, 45%) and the mortality rate was 73%. All the patients used kerosene to
carry out their intent. Most of the victims had had previous psychiatric problems, and it
is thus suggested that this vulnerable population group should if possible be identified
and given special help.
Mabrouk A.R., Omar A.N.M., Massoud K.,
Sherif M.M., El Sayed N
Burns, 25: 337-9, 1999
EXPLOSIVE BURNS DURING ABUSIVE INHALATION
OF BUTANE GAS
In Korea, some juvenile drug abusers use
adhesive chemicals and butane gas in addition to alcohol and tobacco. The Hallym Medical
Centre reports a 1.6% rate of admissions due to flame burns from this cause. This
retrospective review of a 5-year period identified 48 patients in this category. The
male/female ratio was 3:1. The mean age was 16 yr 8 months. The accidents occurred mostly
in bedrooms or motel rooms. The average burn extent was 28.5% TBSA. All patients had face,
arm, and hand burns. Twenty-two patients (mean hospital stay, 51.6 days) needed skin
grafts and 12 patients (mean hospital stay, 22.3 days) were treated conservatively. The
mortality rate was 10.4%. Explosion burns during the abusive inhalation of butane gas are
potentially fatal accidents and are the cause of major injuries.
Oh S.-J., Lee S.-E., Chung
C.-H., Lee J.-W., Chang Y.-C., Kim D.-C.
Burns, 25: 341-4, 1999
ACCURACY OF BURN SIZE
ESTIMATION AND SUBSEQUENT FLUID RESUSCITATION PRIOR TO ARRIVAL AT THE YORKSHIRE REGIONAL
BURNS UNIT. A THREE-YEAR RETROSPECTIVE STUDY
The assessment of burn extent in an Accident
and Emergency Department is one of the most important aspects of the initial care of burn
victims, and inaccurate assessment has important implications for resource management and
patient welfare. In this study, covering a 3year period, a retrospective assessment was
made of the accuracy of burn size estimation and subsequent fluid administration by
referring hospitals prior to hospitalization in the Yorkshire Regional Burns Unit (Great
Britain). Burns of about 20%o BSA were most accurately assessed, with smaller burns
tending to be overestimated and larger burns underestimated. The inaccuracies in fluid
resuscitation meant on average that patients received twice the appropriate volume of
fluid for the burn size. The paper concludes with a discussion of the possible causes,
implications, and solutions
Collis N., Smith G.,
Burns. 25: 345-51, 1998
A 15-YEAR EXPERIENCE WITH
VARICELLA INFECTIONS IN A PAEDIATRIC BURN UNIT
Varicella infection is potentially very
dangerous for burned children because of their immunocompromised condition. It is of great
importance to prevent cross-infections in a paediatric burns unit. A 15-year experience
with varicella is described, focusing on morbidity in a paediatric burn unit associated
with the infection and on measures that have effectively prevented cross-infection.
Varicella infection in acutely burned children was found to be associated with
pneumonitis, but with little wound-related morbidity. Although the incubation period is
deceptively long, rapid identification and isolation of index cases were associated with
an extremely low incidence of cross-infection. So long as varicella continues to be
widespread, the disease will remain a threat to hospitalized children. This underlines the
importance of a properly conducted index case isolation strategy.
Sheridan R.L., Weber J.M.,
Pasternak M.M., Mulligan J.M., Tompkins R.G.
Burns, 25: 353-6, 1999
ELECTRIC BURNS: HIGH- AND LOW-TENSION
A survey is presented of 179 patients
suffering from electrical injuries suffered in the 5-year period 1993-97. Of these, 55
were hightension injuries and 124 Low-tension. There was a high incidence of amputation
(42%) among the victims of high-tension injury, although no patients in this group died.
The treatment protocols are described. Early and serial debridement of necrotic tissue was
the standard treatment. Extensive rehabilitation and psychological treatment were often
Gomez Morell P.
Burns, 25: 357-60, 1999
EXPERIENCING POSTOPERATIVE NAUSEA AND VOMITING AFTER BURN RECONSTRUCTION: AN ANALYSIS
Nausea and vomiting after surgery have an
important impact on the burn patient's hospital course. Post-operative nausea and vomiting
(PONV) in paediatric patients undergoing reconstructive scalp surgery were considered in
order to assess its incidence. Thirty-eight children aged between 5 and 12 years old were
selected for the study. Altogether 46 surgical procedures were involved. as 8 patients
were evaluated for both insertion and removal of scalp expanders. No differences were
identified between the groups for previous history of PONV. length of anaesthesia, or
position during surgery. The retrospective data indicated that the paediatric patients
with reconstructive procedures in the scalp experienced PONV at a rate of 10qc I 2T
procedures i. while only -l5rc (10 procedures) of patients whose surgery did not involve
the. scalp experienced PON`'. Episodes of PON`r~and the time to oral intake increased in
patients whose operation involved the scalp. A prospective study has therefore been
initiated in order to determine whether changes in the perm-operative protocol could
improve patient outcome and reduce the incidence of PONV.
Stubbs T.K.. Saylors S..
Jenkins 12.. McCall J.. Fisher C.. Warden G.J.
Burn Care Rehabil.. 20: 2 36-8. 1999
THE USE OF THE
BRACHIORADIALIS MUSCLE FLAP FOR THE COVERAGE OF BURNS OF THE ACUTE ELBOW JOINT
A case is reported of early coverage of deep
bums in the elbow by use of the brachioradialis muscle flap in the posterior elbosy joint.
including the olecranon. The functional importance of the elbow is such that a one-stage
procedure is preferable to facilitate a rapid return to movement. The surgical procedures
are described. Primary coverage was thus obtained and a good cosmetic and functional
result was achieved.
Balakrishnan C.. _Mendoza
R.L. Nvitrav J.J.
Burn Care Rehabil.. 265-6.1999
SAFETY AND EFFICIENCY OF
TRANSCYTE FOR THE TREATMENT OF PARTIAL-THICKNESS BURNS
In many parts of the world the standard
treatment for extensive partial-thickness burns involves the application of topical
antimicrobial agents and repetitive wound debridements and dressing changes. A new
biological wound covering is described here. TransCyte (Advanced Tissue Sciences, La
Jolla, California. formerly marketed as Dermagrafr Transitional Covering) is composed of
human newborn fibroblasts which are cultured on the nylon mesh of Biobrane ( Dove B.
Hickam. Inc. Sugarland. Texas); the thin silicone membrane bonded to the mesh provides a
moisture vapour barrier for the wound. A prospective. randomized comparison study of
silver sulphadiazine and TransCyte was performed using paired wound sites in 1-1 patients.
It vvas found that TransCyte healed ~counds more quickly (mean. 11.1-4 days to 90rc
epithelialization compared with 18.14 days. p = 0.00?). There was no infection in the
TransCyte-treated patients. NWund sites treated with TransCyte healed with less
hypertrophic scarring than sites treated with silver sulphadiazine.
Nordenbo, J.. Dorč C.,
Burn Care Rehabil.. 20: 275-81, 1999
CUTANEOUS BURN INJURY
ALTERS RELATIVE TRICARBOXYLIC ACID CYCLE FLUXES IN RAT LIVER
This study report; for the first time on the
effect of a major burn injury on the tricarbotylic acid ITCAi cycle fluxes in the liver.
using a rat cutaneous burn model. It was found that the burn injury caused an increase in
the fiovv of pyruvate to oxaloacetate at the expense of non-TCA cycle sources and a
considerable increase in the -C-labelling of glucose. This suggests an upresulation in the
pathways involved in gluconeogenesis from lactate. thus providing evidence for an increase
in intrahepatic glucose cycling after a burn injury.
Yannush D.M., MacDonald
.A., Fov B.D., Berthiaume F., Tompkins, R.G., Yarmush M.I.
J. Burn Care Rehabil.. 210: 292-302, 1999
IN PATIENTS WITH BURN: CASE REPORT AND REVIEW OF LITERATURE
Stern L.E.. Kagan R.J.J.
Muconn; osis is an opportunistic fungal
infection commonly found in patients sufferim from impaired host defences or diabetes
mellitus. The rhinocerebral form is rare in burn patients, and muconnvotic infections more
often involve cutaneous burn wounds. As both forms maN- have a high mortality rate and
interfere with treatment, initial mortality management is very important, %a ith vigorous
glucose control. correction of acidosis. and administration of systemic antifungal agents
such as amphotericin B. A case report is presented. The rhinocerebral form can be very
virulent and interstitial and intraventricular antifuneal therapy mad be necessary. In
both forms of muconnyosis. extensive surgical debridement of all infected and necrotic
tissue is the mainstay of treatment
Burn Care Rehabil.. 30: 303-6, 20