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Volume XIV |
Number 3 |
September 2001 |
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SUMMARIES
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CHEMICAL BURNS - A CLINICAL REPORT ON 30 CASES
(Da Silva J.C., Bento C., Coelho M.J., Almeida M.A. - Portugal)
A study was made of thirty patients who sustained chemical burns between May 1998 and May 1999. The criteria considered were sex, age, origin of accident, chemical agent, immediate washing with water, localization, extent and depth of burn, need for hospitalization, and average healing time. Young males suffering work-related accidents were the most frequent victims. Acid was the most frequent agent involved and the hands were the most frequent site of injury. Most burns were small and of second degree, did not require hospitalisation, and healed within two weeks. In certain cases wound healing was delayed for unknown reasons, requiring repeated surgical interventions. Chemical burns accounted for 1.9% of all admissions to the Burns Unit of the São José Hospital.
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| 115 |
ACID BURNS IN BANGLADESH
(Bari Md. Shahidul, Choudhury Md. Iqbal Mahmud - Dhaka)
The distribution is documented of burn injuries treated during the period December 1996/July 2000 in the burn unit of Dhaka Medical College Hospital and City Hospital (Bangladesh). Acid burns constituted 8.76% of all the burn cases treated. In Bangladesh most such cases were of intentional origin (attempts to disfigure the face, eyes, nose, genital organ). Young girls were common victims. The incidence was greater in rural than in urban areas.
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| 119 |
ENDOGENOUS INTOXICATION AS THE LEADING CAUSE OF ACUTE GASTRODUODENAL HAEMORRHAGES IN BURN PATIENTS
(Ermolov A.S., Smirnov S.V., Spiridonova T.G., Golikov P.P., Khvatov V.B., Volkov S.V., Matveyev S.B., Kalashnikov A.Yu., Fiodorova N.V., Syromyatnikova E.D., Bitkova E.E., Marchenko V.V., Merculova E.A. - Russia)
Acute erosive-ulcerous gastroduodenal haemorrhages are among the severest complications of burn injury. The pathogenesis of acute ulceration is complicated and diverse. This study was conducted to assess endogenous intoxication level using data on middle molecular weight peptides, lipid peroxidation processes, biogenic amines, and circulating immune complexes in the blood of 32 burn patients admitted to the Burn Centre of the N.V. Sklifosovsky Institute for Emergency Medicine (Moscow). The study measurements were performed at 1, 3, 7, 14, and 21 days post-burn. At the same time points, all the patients were examined by oesophagogastroduodenoscopy, and in accordance with the results the patients were divided into two groups: group 1 was comprised of 18 patients with gastrointestinal mucosa lesions, without evidence of haemorrhage, while group 2 contained 14 patients with mucosa lesions accompanied by gastroduodenal haemorrhage (the differences between the groups by age and burn area were statistically insignificant). The comparative analysis of the data obtained revealed that patients in group 2 had significantly higher levels of endogenous intoxication than patients in group 1, which was the main cause of gastrointestinal mucosa lesions, resulting in the development of erosive-ulcerous haemorrhages.
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| 126 |
EXTENSIVE BURN INJURY COMPLICATED BY MUCORMYCOSIS: A CASE REPORT
(Tsoutsos D., Tsati E., Metaxotos N., Keramidas E., Rodopoulou S., Ioannovich J. - Greece)
Mucor fungus infection is an opportunistic infection that can occur in immunocompromised patients. The case is presented of a burn patient with mucormycosis. A previously healthy 38-yr-old male was admitted to a non-urban hospital having sustained a burn injury (50% TBSA) combined with inhalation injury. Uneventful healing was achieved in 35% TBSA. On day 28 post-burn day, a groin flap was raised to cover a full-thickness burn on the right forearm and wrist. Signs of infection in both the hand and the flap area appeared on day 5 post-operation. Consequently, the flap was completely detached. The infection persisted and led to multiple organ failure, and in the end a forearm amputation was performed. The patient was then admitted to our burn unit. Immediate swab culture detected Mucor fungus. Despite appropriate treatment (amphotericin B and repeated debridement), the patient succumbed. This case serves to emphasize the possibility of rare but serious infections due to fungi other than Candida albicans in burn patients. Early diagnosis and treatment of these mycoses can be lifesaving, as the mortality is reported to be very high.
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| 129 |
EXPERIENCE WITH CULTURED EPITHELIAL AUTOGRAFTS IN THE TREATMENT OF PATIENTS WITH EXTENSIVE FULL-THICKNESS THERMAL INJURIES
(JanezSicS T. - Slovenia)
This paper presents a single-centre experience with cultured epithelial autografts (CEAs). Six patients with critical thermal injuries (mean burn area, 73% TBSA; mean full-thickness burns, 64% TBSA) were treated in the period 1993-1999. The full-thickness burn wounds were closed by early and sequential excisions, split-thickness skin autografts, and CEAs. CEAs were applied to a mean area of 18% TBSA. Three patients died in the course of treatment. The mean CEA take 30 days post-transplantation was 45% (min., 10%; max., 80%) and the mean area closed by CEAs was 7% TBSA (min., 2% TBSA; max.: 11% TBSA). CEAs were found to be a very important part of the life-saving treatment of critically injured thermal patients with extensive full-thickness burn wounds.
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| 134 |
SKIN BANK LEGAL REQUIREMENTS. OPERATION AND CLINICAL APPLICATIONS
(Torrero J.V., Bejar J.M., Llop M., Sancho M., García Gutierrez J.J., Gabilondo F.J. - Spain)
The authors describe the methodology used in their department for obtaining skin and storing it in a skin bank and the use of cryopreserved skin. They indicate the legal requirements for the creation of a live tissue bank specifically for frozen skin, and they present the results of five years' work.
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| 138 |
PSYCHOLOGICAL ASSESSMENT OF THE BURN IN-PATIENT
(Travado L., Ventura C., Martins C., Veloso I. - Portugal)
The psychotherapy team at São José Hospital has been collaborating with the Burns Unit since 1985, and the type of co-operation is presented. A study was designed to assess in-patients' emotional reactions and the subjective meanings of their illness, treatment, and coping process while in the burns unit. We used a methodology based on a qualitative assessment provided by a semi-structured interview designed for the purpose and a quantitative assessment provided by two self-rating scales that assessed anxiety and depression. Twenty-four in-patients were assessed. We present the results and discuss their implications to our clinical practice with burn in-patients and to our role within the burn unit health team.
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| 143 |
EFFECTS OF TOPICAL APPLICATION OF HONEY ON BURN WOUND HEALING
(Subrahmanyam M., Sahapure A.G., Nagane N.S., Bhagwat V.R., Ganu J.V. - Portugal)
In this prospective trial 100 burn patients were randomized in two equal groups to be treated either with honey dressing or with silver sulphadiazine gauze dressing. In the honey-treated group, wounds healed earlier (mean, 15.4 days versus 17.2 days). Serum lipid peroxide levels were raised in the immediate post-burn period in both groups. However, by days 7 and 14 there was a significant reduction in malon dialdehyde values that was more significant in the honey-treated group. Bacterial cultures revealed that 90% were rendered sterile in the honey-treated group, whereas in the silver-sulphadiazine-treated group there was persistent infection. Honey, by its anti-oxidant effect, presumably helped to limit lipid peroxidation and contributed to the rapid healing of the wounds, apart from its other known beneficial effects.
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| 146 |
PATIENTS SUFFERING FROM EPIDERMOLYSIS BULLOSA HEREDITARIA TREATED IN THE SIEM PIROGOV BURNS AND PLASTIC SURGERY CLINIC
(Dyakov R., Hadjiiski O. - Bulgaria)
Hereditary dermatoses of the epidermolysis bullosa (EB) group are the result of improper connection of the epidermis to the basal membrane and the dermis. According to Gedde-Dahl's classification, the group consists of three major types divided into 23 subtypes. We discuss two clinical cases of EB treated in 1999 and 2000. The first case is that of a boy aged 10 months with EB-generalisata multilans (Hallopeau-Simens) (R-EBD-GM) who was treated conservatively and after the skin lesions closed. He was dismissed for further observation in a regional hospital. The second case is that of a 2-month-old boy showing signs of EB dystrophica (Type Cocayne Touraine (D-EBD-L) who died of pneumonia. EB treatment is difficult because there is no definite, specific treatment. This is limited to care for the patient in terms of personal hygiene, careful nutrition, and prevention of traumas and infections; this should be the main task of the hospital staff. Such patients have high protein and calorie needs owing to the large skin lesion surfaces. Local treatment should not involve pulling or tangential forces. In EB the skin can cope with compressive forces. The wound should be treated with careful water procedures and, after drying, standard medications containing 1% silver sulphadiazine lotion should be used. Dressings are changed every 1-3 days. The new methods of gene therapy are not yet available to patients. The skin lesions look like a IIA-degree burn and EB can be treated effectively in a burns unit.
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| 151 |
AN AUTOMATIC EARLY WARNING SYSTEM FOR FOREST FIRES
(Kührt E., Knollenberg J., Mertens V. - Germany)
Forest fires cause significant economic damage to the environment all over the world. Early warning and the fast extinction of fires are, apart from preventive measures, the only way to avoid major casualties and damage to nature, especially in densely populated regions. Different methods for early detection of fires have been developed in relation to local conditions and financial aspects. A common method is for trained staff to observe the endangered areas. In Germany, several hundred observation towers have been erected in the forests. The staff work up to 12 hours a day, usually under difficult circumstances. In countries with large forest areas aeroplanes are used to watch the forest areas. Satellite data can be applied only to keep large fires under control. Various technical systems for forest fire detection have been tested in recent years and these are described. The Automatic Early Warning System for Forest Fires (AWFS), a system developed and tested in Germany, is described. AWFS was installed on three observation towers in Brandenburg, Germany, and it was tested during the last two forest fire seasons. The testing forest authority confirmed that the system is mature for service and easy to use. AWFS also saves on costs. Further systems are about to be installed in Germany.
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