Volume XV

Number 1

March 2002

BURN PREVENTION AND BURN PREVENTION PROGRAMMES
(Koulermou G. - Cyprus)
After considering the general psycho-emotional and physical changes in the life of a burned person, and the importance of effective prevention programmes, the Author of this article examines the specific situation in Cyprus, with reference to educational campaigns. A particular reference is made to local traditions in Cyprus that may be hazardous. Emphasis is laid on the importance of safety in the home.

CHEMICAL BURNS BY CALCIUM HYDROXIDE IN SOCCER PLAYERS
(Pedro B., Teles L., Cabral L, Cruzeiro C. - Portugal)
A brief review is made of the physiopathology of burns caused by calcium hydroxide and a clinical case is presented of a soccer player with first- and second-degree burns in the thighs, buttocks, and genitals.

HOME HEATING INJURIES IN AN URBAN BURN CENTRE
(Ugolini K.R., Hughes W.B. - USA)
This is a retrospective analysis of nine burn patients admitted to the Temple University Hospital Burn Center for home-heating radiator injuries between January 2000 and January 2001. There was a prevalence of elderly men in this population and an average TBSA burned of 4.6%. Two case reports are presented.

COMPLICATIONS IN SEVERELY BURNED PATIENTS AND THEIR DEVELOPMENT ACCORDING TO THE PERIODS OF THE DISEASE
(Belba M. - Albania)
The Author describes the experience of the medical staff at the hospital where she works as regards the treatment of post-burn complications. After presenting the statistics of the previous year, she indicates the incidence of complications in the phase of shock and in sepsis. The criteria for admission to the Intensive Care Unit in question on the basis of the percentage of burn area are indicated, together with the more frequent complications in survivors and in deceased patients. The mortality rate was 13%. The Author’s main intention was the introduction of new concepts in the evaluation of the clinical situation, especially during the septic period of the illness. A definition is given of SIRS (Systemic Inflammatory Response Syndrome) and a description is made of how this gradually proceeds, according to the severity of the illness, up to septic shock.

TREATMENT OF TOXIC EPIDERMAL NECROLYSIS (TEN)
(Brambilla G., Brucato F., Angrisano A., Palmieri G. - Italy)
Toxic epidermal necrolysis (ten) is a common and potentially dangerous mucocutaneous disease characterized by rash, bullae, and diffuse exfoliation of wide cutaneous surface areas. A description is given of the disease, also known as Lyell’s syndrome, and it is distinguished from similar conditions. Information is provided regarding the epidemiology, aetiology, and pathogenesis of TEN, as well as its clinical features. Diagnosis and therapy are also considered. Pharmacological therapy is required, particularly with cyclosporin.

ACTIVETEX® WOUND DRESSINGS IN BURN TREATMENT
(Alekseev A.A., Krutikov M.G., Bobrovnikov A.E., Vasilyeva T.S., Grishina I.A., Paltsyn A.A. - Russia)
An analysis was performed of the topical treatment of 40 patients suffering from various burns using Activetex® dressings. Activetex® provides a prolonged therapeutic effect due to its content of various medicines (antibacterial, anaesthetic, wound-healing) in combination with a biocompatible polymer. A control group of patients with analogous burn injuries was treated with ointments on a polyethylene glycol base with antibacterial preparations. It was shown that the efficiency of Activetex® dressings is in many cases superior to that of water-soluble ointments and in other cases is generally equal to such ointments in burn wound treatment. Activetex-ChL is effective in the treatment of limited non-infected II-IIIA burns, Activetex-ChF can be successfully used in the treatment of limited infected II-IIIA burns and to prepare IIIB burns for autografting, and Activetex-ChHap is effective in the treatment of residual non-healing burn wounds. Activetex® dressings can be successfully used as an alternative to traditional methods at all stages of topical burn treatment in clinics, out-patient departments, and emergency services.

ADVANCES IN THE USE OF MEBO (A NEW APPROACH IN THE METHOD OF APPLICATION)
(Ait-Aissa M. - Kingdom of Saudi Arabia)
The new product presented must be understood as an advance in the use of MEBO (moist exposed burn ointment) and a new presentation that allows an extension of the field of applications and indications. Clinicians engaged in wound care today face a challenge that is growing in both magnitude and complexity. An estimated 25 million patients require costly therapeutic management for acute or chronic wounds every year in the USA. In the year 2030, more than 20% (60 million) of all Americans will be over the age of 65, and many of these will be institutionalized, immobile, and therefore prone to difficult-to-treat decubitus or pressure ulcers. The concept of gauze impregnated with ‚-sitosterol used as a semi-permeable dressing offers a new approach in wound management.

AN EXPERIMENTAL STUDY OF THE ROLE OF CELLULAR APOPTOSIS AND ITS MECHANISM IN PULMONARY INJURY IN SCALDED RATS
(Fusheng Shi, Liu Xusheng, Di Guiping, Yang Zhengguo, Luo Xiangdong, Yang Zongcheng. - People’s Republic of China)
Our aim in this study is to explore the role and mechanism of gene modulation of cell apoptosis in pulmonary injury in scalded rats. Apoptosis of pulmonary parenchymal cells in scalded rats was observed with the TUNEL method. The gene expressions of Fas/FasL, NF- k B/I k B, and BcL-2 and the expression of VE-calcium adhesion molecules in pulmonary tissue and post-burn pulmonary permeability were observed by the immunohistochemistry technique. It was found that apoptosis occurred in the pulmonary tissue cells of scalded Wistar rats. In particular, apoptosis was more obvious in alveolar epithelia and pulmonary vascular endothelia than in other cells. Pulmonary permeability in scalded rats was evidently increased when measured by 99Tm labelled albumin. Simultaneously, the expression of VE-calcium adhesion molecules of pulmonary vascular endothelia decreased, and this was well correlated with pulmonary cellular apoptosis. In the pulmonary tissue of scalded rats, the expression of Fas/FasL was markedly up-regulated and that of Bcl-2 was down-regulated. Also, the increased expression of Fas/FasL was correlated with the increase of pulmonary tissue cellular apoptosis. The expression of NF- k B/I k B was in accordance with that of Fas/FasL. We conclude that apoptosis occurred in the alveolar epithelia and pulmonary vascular endothelia of scalded rats, which might be related to the pathogenesis of pulmonary injury and increased pulmonary microvascular permeability and inter-endothelial conjunction injury in scalded rats. The activation of pulmonary tissue Fas/FasL, NF- k B/I k B, and Bcl-2 systems in scalded rats might participate in post-burn pulmonary injury and the signal transduction of pulmonary tissue cell apoptosis.

EFFICACY OF MICRONIZED FLAVONOID FRACTION ON HEALING IN THERMALLY INJURED RATS
(Acar T., Taçyildiz R., Vahapog×lu H., Karakayali S., Aydin R. - Turkey)
This study was designed to evaluate the efficacy of micronized flavonoid fraction (Daflon) in an experimental burn injury model. Thirty Wistar-Maller rats underwent burn injury by the standard Walker-Mason method. The rats were randomly divided into three groups. The first group received no treatment (control), the second group received Daflon 60 mg/kg/day orally, and the third group received Daflon 60 mg/kg/day two times topically. The surface area measurements and histopathological evaluations on days 4 and 12 of the locally and systemically treated groups were compared with each other and with the control group. The study showed that both systemic and local use of Daflon improved burn healing.

THE HOUSE NURSING CARE DURING THE POST-BURN PERIOD: THE GREEK REALITY
(Siamanga H. - Greece)
The purpose of this study is to provide information about the development of house nursing care (HNC) in Greece and its contribution during the post-burn period. In 1979 the Metaxas Hospital in Piraeus developed a pilot HNC programme aimed at local cancer patients. In 1986 a similar pilot programme was pursued by the Saints Anargiri Hospital of Oncology. In 1990 the Greek Red Cross organized an HNC unit for the entire population. According to Greek Red Cross data concerning HNC, 2,721 patients were given such nursing care within seven years, with 32,113 visits. It is clear that the cost of hospital nursing care is higher. It is concluded that most burns can be treated successfully with HNC. Patients suffering from burns can be discharged from hospital sooner. The number of malformations caused by scars is reduced, and the cost of HNC is much lower.