MACROPHAGE-MEDIATED SUPPRESSION OF GRANULOCYTE AND MACROPHAGE GROWTH AFTER BURN WOUND INFECTION REVERSAL BY MEANS OF ANTI-PGE2

Production and release of the granulocytes and macrophages that are so crucial for the host defence system are significantly impaired after burn injury and sepsis, and prostaglandin E2 (PGE2) is known to be myelosuppressive. The Authors of this paper hypothesized that macrophages contribute to myelopoietic suppression by increased production of PGE2, induced by burn injury and sepsis. Peritoneal macrophages were elicited at day 3 from normal mice and from mice that underwent a 15% TBSA dorsal scald burn with or without Pseudomonas aeruginosa burn wound infection. The macrophages were incubated without endotoxin and with or without PGE2 polyclonal antiserum (anti-PGE2) for 18 h. Macrophage supernatants were then used in co-cultures of bone marrow calls in a clonogenic assay of granulocyte-macrophage colony-forming cells (GM-CFCs) to determine the effect of burn wound infection on the alteration of the proliferative state of the GM-CFCs. Burn wound infection and endotoxin caused a considerable reduction in GM-CFC growth in culture. This inhibition was significantly reversed by the addition of anti-PGE2 to the cultures. These results suggest that PGE2 is a key mediator in the gram-negative sepsis-induced macrophage suppression of granulocyte and macrophage production. This capacity of PGE2 could be useful to reduce the myeloid depression that occurs after post-burn sepsis.

Gamelli R.L., He L.-K., Liu L.H.

J. Burn Care Rehabil., 21: 64-9, 2000

“SUPERSPLINT”: A NEW DYNAMIC COMBINATION SPLINT FOR THE BURNED HAND

Dynamic splinting is an integral part of burned hand occupational therapy programmes. The “supersplint” described in this article developed from the need to reduce the time necessary to manufacture splints for such home therapy programmes. The supersplint gives active-resistive movements of the fingers and thumb. With increasing range of motion, resistance can be increased to strengthen muscles and tendons. The supersplint also helps to keep oedema under control, prevents muscle disuse and skin and capsular contraction, reduces complications, and helps to prevent deformities.

Van Straten O., Sagi A.

J. Burn Care Rehabil., 21: 71-3, 2000

THE EPIDEMIOLOGY OF FIRE-RELATED DEATHS IN ALABAMA, 1992-1997

This study presents the epidemiology of fire-related deaths in the state of Alabama (USA) in the period 1992-1997. Fatality rates were higher among black people, men, children, and older people. Approximately half the deaths occurred between October and March. Residential fires caused the highest proportion of deaths. Fatality rates were higher in mobile home residents. The most frequent cause of fatal fires was the misuse of cigarettes. More than half the victims aged 18 yr and over had been drinking alcoholic beverages. Fire prevention efforts concentrate on smoke detectors, fire-safe cigarettes, and the dangers of alcohol.

McGwin G., Chapman V., Rousculp M., Robison J., Fine P.

J. Burn Care Rehabil., 21: 75-83, 2000

PSYCHIATRIC STATUS, PREVENTION, AND OUTCOME IN PATIENTS WITH BURNS

This retrospective study reviews 100 consecutive patients admitted to the Tampa Bay Regional Burn Center (USA), assessing cause of injury, pre-burn psychiatric status, and outcome (survival, duration of hospitalization, occurrence of new psychiatric or psychological disorders). It was found that patients with psychiatric disorders were more likely to have preventable injuries; there was also a trend for these patients to have more emergent psychiatric disorders and longer periods of hospitalization. It is suggested that the Burn Severity Index could be revised to include the presence of pre-burn psychiatric disorders.

Powers P.S., Cruse C.W., Boyd F.

J. Burn Care Rehabil., 21: 85-8, 2000

BURNS SUSTAINED BY HOT BATH AND SHOWER WATER

This 8-year retrospective study reviews patients admitted to an English hospital suffering from burns due to hot bath and shower water. The patients were divided into adults (>16 yr) and children. Altogether 57 patients were included in the study, of whom nine died. The main characteristics of the burns, aetiology, and outcomes are analysed. The paediatric patients, mainly under 3 yr of age (83%), sustained most frequently superficial burns (49%), with areas of less than 10% TBSA (72%). Parental supervision was inadequate in 85% of cases. Among the adults, 83% were aged over 60 yr. Two-thirds of the adults suffered from some form of psychomotor disorder that represented a risk factor. There was an encouraging decline in the number of admissions, which underlines the importance of preventative measures.

Cerovac S., Roberts A.H.N.

Burns, 26: 251-9, 2000

MATERNAL AND CHILD PSYCHOLOGICAL SEQUELAE IN PAEDIATRIC BURN INJURIES

A six-month controlled, prospective following study was carried out in order to consider psychological sequelae in children and their mothers following paediatric burns. Forty children and their mothers were included in the study. The selected children were all of the same race (Caucasian) in order to minimize potential ethnic-difference confounders. Three control groups were also considered (acutely ill children, a fracture group, and a non-ill non-injured group). The Child Behaviour Checklist and the Hospital Anxiety Depression Scale were used. Higher initial maternity anxiety scores were found in the burn group than in the fracture and burn injury group. Children who sustained burn injuries did not appear to develop significant psychological sequelae, whereas the mothers of such children appeared to be at higher risk for the development of psychological sequelae.

Kent L., King H., Cochrane R.

Burns, 26: 317-22, 2000

A SURVEY INTO TOXIC SHOCK SYNDROME (TSS) IN UK BURNS UNITS

The toxic shock syndrome (TSS) was first reported in 1985, since when many other reports have appeared. TSS is a rare complication of Staphylococcus aureus infection and is primarily seen in children with small burns. With a view to establishing the syndrome’s incidence, a survey was undertaken to establish whether the incidence of TSS in burned children could be related to the type of wound dressing used. A questionnaire was prepared and circulated to burns units in the United Kingdom, 33 of which responded. Of these, 23 units treated children, and of this number eight had either not encountered TSS previously or not within the two previous years. Approximately 2.5% of the children admitted presented symptoms of TSS. Wound management procedures differed to a slight extent, but there were many similarities, including wound cleaning with normal saline, use of 1% silver sulphadiazine or 10% povidone iodine, and dressing with a paraffin tulle, gauze and crepe bandages. It is concluded that it was impossible to establish an association between methods of burn wound management and the subsequent development of TSS.

Edwards-Jones V., Dawson M.M., Childs C.

Burns, 26: 323-33, 2000

THE CONTINUING RISK OF DOMESTIC HOT WATER SCALDS TO THE ELDERLY

With the increasing average age of the population, the number of burns in the home is also increasing, as the elderly are particularly exposed to this type of accident. Many such burns are due to hot water. This paper considers the temperature of water in the private homes of elderly people and in residential care homes. Altogether 39 homes (25 private and 14 residential care) were included in the survey. The hot water temperature was below 45 °C in only two homes (one private, one residential home), while it is generally recommended that this temperature should not exceed 45 °C. This study therefore shows that in the great majority of cases considered, the storage temperature of water was dangerously hot - in some cases exceeding 70 °C. However, one must not neglect the danger of infection with Legionella pneumophila, which may occur at temperatures below 60 °C. The solution is to install “fail safe” thermostatic devices.

Stone M., Ahmed J., Evans J.

Burns, 26: 347-50, 2000

STAPHYLOCOCCAL SEPTICAEMIA IN BURNS

The aim of this study was to survey cases of staphylococcal septicaemia in burn patients. The study, lasting 6.5 yr, was conducted in a burns centre in Kuwait. The following factors were evaluated: percentage and cause of burns, time of onset of staphylococcal septicaemia, intubation, use of prophylactic antibiotics, surgical intervention, and the outcome of treatment. Out of 1516 burn patients, 109 (7.2%) developed septicaemia, of whom 80 (73.4%) showed one or other type of Staphylococcus in their blood. A detailed breakdown of the results is provided. No significant difference was observed with regard to mortality among the septicaemic patients, whether they were on prophylactic antibiotics or not. The mortality rate was low, probably owing to early detection of the organism, correct antibiotic therapy, care for nutrition, and early wound coverage. The most likely source of entry into the blood stream was a surface wound. It was possible to detect Staphylococcus in the blood as early as 48 h post-burn, and in burns as little as 1% (in this burn unit methicillin-resistant Staphylococcus aureus was endemic). Inhalation injury in major burns associated with staphylococcal septicaemia was fatal.

Gang R.K., Sanyal S.C., Bang R.L., Mokaddas E., Lari A.R.

Burns, 26: 359-66, 2000

CULTURED EPITHELIAL AUTOGRAFTS IN EXTENSIVE BURN COVERAGE OF SEVERELY TRAUMATIZED PATIENTS: A FIVE-YEAR SINGLE-CENTRE EXPERIENCE WITH 30 PATIENTS

The purpose of this study is to describe a five-year experience in a large, single-centre series where severely burned and otherwise injured patients received cultured epithelial autografts (CEA) from a commercial laboratory (Epicel). CEA were applied between 1991 and 1996 to patients with a mean 37 ± 17% total body surface area (TBSA) burn extent, 65 ± 16% average third-degree burn size, 90% prevalence of inhalation injury (confirmed by endoscopy), and 37% prevalence of other serious conditions. CEA gave a permanent mean coverage of 26 ± 15% TBSA, corresponding to a larger area than that covered by conventional autografts. The survival rate was 90%. Final CEA take was a mean 69 ± 23%. Epicel CEA provided good, extensive, permanent coverage, contributing to the high survival rate.

Carsin H., Ainaud P., Le Bever H., Rives R.M., Lakhel A., Stephanazzi J., Lambert F.

Burns, 26: 379-87, 2000