Volume XIV

Number 4

December 2001

ON BURN DISEASE
(Ecker D. - Germany)
More than 9000 cases of burn injury are treated in the Federal Republic of Germany every year - and effective therapy needs extensive knowledge of "burn diseases" and their particular potential of danger. The development of thermal damage within the organism is described in detail, as also disturbances of vital organic systems (brain, kidney, liver, etc.). The determination of burn dimension is related to knowledge of certain rules. These are very important for establishing appropriate therapy, which is fundamental especially in first-aid treatment. This phase affects the patient’s future outcome. After extensive first aid and secondary in-patient treatment, surviving persons with serious burns need specialized care for their rehabilitation..

SELF-INFLICTED BURNS INITIATED AS A SOCIO-ECONOMIC OR POLITICAL PROTEST
(AçIkel c., Peker F., Ebrinç S., Ülkür E., Çeliköz B. - Turkey)
Between May 1997 and February 2001, 956 burn patients were treated at the Gülhane Military Medical Academy Haydarpas¸a Training Hospital Burn Unit, of whom 36 (3.8%) presented deliberately self-inflicted burns. Seven of these 36 patients (19.4%) had attempted suicide; 27 (75%) were male. The average age was 31.4 yr, and the average total burn surface area was 37% (range, 12-95%). The method most commonly used was flame with the addition of a flammable liquid. Psychiatric disorders were diagnosed in 83% of the cases. The overall mortality rate was 19.4%. Socio-economic and political conflicts constituted the majority of the precipitating factors, and most of the patients burned themselves in front of other people as a protest..

IRON BURNS IN CHILDREN UNDER SIX
(Berlin D.A., Hughes W.B. - USA)
Contact burns are a very common cause of injury in children. We have reviewed the medical records of 119 children under six years of age seen at Temple Burn Center over a 15-month period. Twenty-seven children (23%) had contact burns from curling or clothes irons. The aetiology of the burns is presented. Only one case was investigated by the Department of Human Services. An awareness programme was also started..

THE PATHOLOGIES OF CHILDHOOD TREATED IN OUR CENTRE AND SOME SPECIFIC FEATURES OF ANAESTHESIA
(Belba M. - Albania)
A panoramic view is given of the surgical pathologies of childhood treated in the Clinic of Burns and Plastic Surgery in Tirana, Albania. Three main groups of surgical pathologies are evident: consequences of burns and trauma, surgical treatment of burns, and surgery of avulsion trauma. The children were divided into groups according to age. The observations indicate that more than half of the interventions concerned the age group 5-14 yr. The article pays particular attention to the types of anaesthetic techniques used. Emphasis is laid on the selection of medicaments for pre-medication, induction, and maintenance of anaesthesia.

THE TREATMENT OF FACE BURNS WITH JALOSKIN
(Merone A., Severino G., Capone C., Saggiomo G. - Italy)
The Authors present their experience in the treatment of face burns using the advanced medication Jaloskin. This medication is entirely composed of a new class of biomaterials: Hyaff membranes from esterification of hyularonic acid, a naturally occurring extracellular matrix molecular. This treatment was used in 40 children with good aesthetic results. Some significant cases are presented..

MULTIRESISTANT ACINETOBACTER INFECTION IN A BURNS UNIT
(Pedro B., Teles L., Cabral L., Cruzeiro C. - Portugal)
Acinetobacter is a gram-negative bacteria of the Neisseriaceae family. A very rare strain of multiresistant Acinetobacter baumanii was identified in the Burns Unit of Coimbra University Hospitals (Portugal) in January and February 1999. This infectious episode involved 11 patients and made it necessary to take strong hygiene and isolation measures.

BURNS TREATED WITH AND WITHOUT HEPARIN: CONTROLLED USE IN A THERMAL DISASTER
(Reyes A.E., Astiazaran J.A., Chavez C.C., Jaramillo F., Saliba M.J. - Mexico)
Eight men and one woman, subjected to a propane gas explosion-fire, sustained 2nd- and 3rd-degree burns of 30-90% BSA size. In Hospital One (H1), four men with burns (40, 45, 83, and 90%; 65% av.) were treated promptly with large doses of heparin, administered topically and parenterally. The five patients with burns (30, 32, 35, 40, and 65%; 41% av.) treated at Hospital Two (H2) were not treated with heparin the first five days. The burn pain in patients at H1 was relieved by heparin; but, as a routine, four doses of pain medication were given on day 1. Without the use of heparin in the first five days, each H2 patient needed a significantly larger number of doses of pain medicine (av. 24 vs 4, p < 0.00001). Resuscitation fluids infused into H1 patients on days 1-3 were a significant 39-48% less than at H2 (p < 0.02). With heparin use, H1 patients had less swelling, no fasciectomies, earlier burn revascularization, and no bleeding. Without heparin, H2 patients had swelling, eight fasciectomies, and relatively avascular burns. Starting day 5, six 25,000 IU doses of heparin were topically applied, within 48 h, on the burns of each H2 patient. Their pains were relieved, pain medications were stopped, and revascularization resulted in minor surface bleeding by day 8, when topical use was discontinued and pain medications were restarted. Patients were given antibiotics. No skin grafts were performed. The skin was smooth without scars or contractures. Heparin shortened hospital stay: at H1 to 23 days (56% size av.); to 21 days at H2 (33%). A 5-day delay in using heparin increased hospital stay two weeks in comparable 40% patients. Burn treatment procedures and costs using heparin were much less.

THE EFFECTIVENESS OF EARLY ENTERAL NUTRITION IN BURN PATIENTS
(Marvaki C., Joannovich J., Kiritsi E., Iordanou P., Iconomou T. - Greece)
This study was performed in order to investigate the effectiveness of early enteral nutrition (EEN) in burn patients, in association with their post-burn nutritional state and immunological response. Patients with burns in more than 25% of the total body surface area (TBSA) admitted to the Department of Plastic Surgery and Burn Unit of the General State Hospital of Athens over a three-year period were included in our study. A nutritional support protocol was followed that included EEN in the first 6 h via a nasogastric tube and administration of nutritional formulas of different nutritional value, according to each patient’s needs and tolerance. We administered to our patients: 1) low kcal value, 0.5 kcal/ml with 2 g/%; 2) standard value, 1 kcal/ml with 4 g/%; 3) high kcal value, 1.5 kcal/ml with 6 g/%. The following markers were used to assess the effectiveness of EEN: total serum proteins, serum albumin, serum globulin, absolute number of lymphocytes, immunoglobulin IgA, IgM, IgG, serum iron, and total iron binding capacity (TIBC). Blood samples were collected from each patient on days 1, 8, and 15 after admission for the measurement of the nutritional markers. Data were collected on a specially designed assessment chart. This was followed by statistical analysis for evaluation of the results. Thirty-one patients (age range 17-95 yr, mean 43.7 ± 12.2 yr; TBSA burn range, 25-85%, mean 43.4 ± 18.67%) were studied. All mean protein values increased significantly between the first and third measurements: total proteins increased from 5.06 to 6.33 mg/dl (p < 0.001); serum albumin from 2.97 to 3.40 mg/dl (p < 0.005); serum globulin from 2.06 to 2.91 mg/dl (p < 0.001); iron from 34.56 to 48.44 mg/l (p < 0.008); and TIBC from 84.80 to 120.60 mg/l (p < 0.001). There were no significant changes in the absolute number of lymphocytes or in immunoglobulin IgA, IgM, IgG. Our results demonstrated that early enteral nutrition provided optimal preservation of the patients’ nutritional state and maintained nutritional markers at normal values.

FIRE DISASTERS: THE WHO-UNEP-WMO HEALTH GUIDELINES FOR VEGETATION FIRE EVENTS
(Schwela D. - Switzerland)
The causes of vegetarian fires are reviewed and their potential risk is documented. Strategies for reducing the risks are listed. The specific health risks of vegetation fires are also analysed. High concentrations of inhalable particulate matter are found in smoke from vegetation fires, constituting a health risk. Suspended particulate matter has been associated with increased mortality, and morbidity. Asthmatics are particularly at risk. A series of health guidelines for vegetation fire events is presented.

FIRE DISASTERS IN CYPRUS IN THE LAST DECADE - MANAGEMENT AND CONSEQUENCES
(Mantas N. - Cyprus)
This article reports on the incidence and severity of fire disasters in Cyprus, the third largest island in the Mediterranean, in the last decade. Various aspects are considered: the location of forest fires, their frequency, fire-fighting facilities, burn centres, etc. The medical service in Cyprus is equipped to handle all burn victims, even in cases of mass burns.