This investigation was conducted in order to determine whether 21-aminosteroids could limit burn-induced alterations in microvascular permeability in a well-defined animal model. The 21-aminosteroids, also known as lazaroids, are a group of compounds initially designed to localize within cell membranes in order to inhibit lipid peroxidation reactions in the central nervous system. The effects were evaluated of two lazaroid compounds (U734389F and U75412E) on alterations in microvascular permeability caused by burn injuries. A canine model was used for the purpose. The results showed that the administration of one or the other lazaroid compound did not produce any significant effect on burn-induced changes in capillary permeability. It is concluded that the two lazaroids do not prevent burn-related changes in impermeability at the injury site when administered after an injury. U75412E administered before the injury effectively limited the alterations in microvascular permeability.
Dyess D.L., Collins J.N., Ardell J.L., Townsley M.I., Tayler A.E., Ferrara J.J.
J. Burn Care Rehabil., 21: 406-13, 2000
Interleukin-10 (IL-10) is an anti-inflammatory cytokine that alters HLA expression in certain haemopoietic cells. The aim of this experiment was to establish if IL-10 treatment of allogeneic keratinocytes would have a protective effect on in vitro transplantation. It was shown that IL-10 increased the HLA-DR expression of keratinocytes in the presence of interferon Á. The increase in HLA-DR expression augmented the stimulation and proliferation of allogeneic peripheral blood mononuclear cells, and this intern augmented in vitro rejection of allogeneic keratinocytes. It was thus shown that the exogenous application of IL-10 to cultured keratinocytes increased the rejection by allogeneic peripheral blood mononuclear cells in in vitro conditions rather than having the expected protective effect.
Ho-Asjoe M., Frame J.D., Leigh I.M.
J. Burn Care Rehabil., 21: 417-22, 2000
When a patient suffers massive burn injury, the ethical considerations involved in decisions whether to resuscitate and continue treatment are complex. Now that survival prospects have appreciably improved, the parameters normally used are no longer so clear. It is often difficult to know when further treatment is futile and the choice whether to withhold or withdraw treatment is a source of great anxiety for all concerned, both family and physicians. It is therefore useful to identify operative ethical principles that can clarify the issues involved. There is no simple algorithm for such decision making with its ethical dilemmas, but the systematic application of the model presented here may be useful. This model consists of four prioritized questions addressing medical indications, patient preferences, quality-of-life issues, and contextual factors. Early consultation with a hospital bioethics committee is recommended to overcome conflict and provide a forum for discussion
Miller P.L.
J. Burn Care Rehabil., 21: 433-8, 2000
Torchiere-style halogen lamps have become widely used since they were first introduced in 1983. However, it must never be forgotten that they constitute a significant fire hazard, sometimes causing fatal accidents. The 500-W halogen bulb generates a temperature of up to 1200 °F. In the USA, the Consumer Products Safety Commission has issued many warnings related to these lamps, as well as numerous recalls. Surveys have shown that many lamp users were not aware of the risks of injury, the extreme bulb temperatures, or the safety measures recommended in their use. It is therefore important to increase community awareness and education in order to reduce the fire hazards related to the use of these halogen lamps.
Bridges P.E., Calmieri T., Greenhalgh D.G.
J. Burn Care Rehabil., 21: 447-9, 2000
After thermal injury, the complication of increased intra-abdominal pressure is often observed during burn shock or sepsis. If intra-abdominal pressure is severely elevated, surgical treatment by laparotomy is necessary in order to avert cardiac, respiratory and renal damage. The aim of this retrospective study was to examine manipulations of the nutrition programme and outcomes in response to such a procedure. Open laparotomy for increased intra-abdominal pressure was necessary in six patients admitted to a paediatric burns facility in Ohio between March 1993 and April 1999. One patient was excluded from the review because the child died two days after the burn injury (one day after laparotomy) and nutrition intervention was not initiated. Four of the five remaining patients were given parenteral nutrition within 48 h of surgery. One patient did not receive parenteral nutrition because the enteral regimen reached its goal within five days after laparotomy. Trophic enteral feeding was initiated in all five patients within 48 h of the operations. Tube feedings were gradually increased and the parenteral nutrition rate was decreased in relation to gastrointestinal tolerance (abdominal girth, bowel motility). Enteral nutrition was initiated before abdomen closure in all the patients. There was no occurrence of mechanical, infectious, or mortality-related complications related to the initiation of enteral nutrition after open laparotomies. Surgical intervention by open laparotomy thus interrupts the post-burn nutrition regimen but does not preclude safe post-operative recovery and the advancement of enteral feeding.
Mayes T., Gottschlich M.M., Warden G.D.
J. Burn Care Rehabil., 21: 451-6, 2000
This study concerns 25 consecutive patients in Saudi Arabia treated for hypertrophic scars using Cica-care silicone gel sheets. All the scars were caused by burns or traumatic friction. The patients were instructed how to apply and wash the gel, and regular attendance at a review clinic was required. At each visit an occupational therapist assessed the scars using the Vancouver scale. The problems associated with gel sheeting included persistent pruritis (80%), skin breakdown (8%), skin rash (28%), skin maceration (16%), foul smell from the gel (4%), poor durability of the sheet (8%), failure of the sheet to improve hydration of dry scars (50%), poor patient compliance (12%), and poor response of the scar to treatment (24%). The majority of the problems were solved by temporary interruption of treatment, more frequent washing of the gel sheet, better skin hygiene, and changes in the brand of gel sheet used. Silicone gel’s action mechanism in the treatment of hypertrophic scars is discussed.
Nikkonen M.M., Pitkanen J.M., Al-Qattan M.M.
Burns, 27: 498-501, 2001
This paper describes an exceptional case in which a 28-year-old man received high-tension electrical injures while receiving a telephone call. The current entered the telephone circuit owing to contact with a high-tension live wire running close to the telephone wire. The injury was due to arcing of the current from a high-tension overhead electric cable (13000 W) located six inches away from unguarded telephone cables two km from the site of the accident. The patient sustained 15% deep burns in the chest wall, neck, thighs, and scapular region, as well as a totally charred left thumb, which was eventually amputated. The solution to this type of electrical problem could be to cover telephone wires with non-conductive material in areas where they cross electric cables. Alternatively, the isolated electric cable system or telephone cable system could be placed underground in selected accident-prone areas.
Thomas P.C., Kumar P.
Burns, 27: 502-3, 2001
It is always necessary to manage even minor burns in children with great caution as life-threatening complications may develop, especially in the presence of staphylococcal infection. The case is described of an 18-month-old boy with minor burns (12% TBSA) who developed pneumatocoeles and pneumomediastinum following Staphylococcus aureus pneumonia, which caused severe respiratory distress. Most of the pneumatocoeles were spontaneously absorbed within ten days while surgery was being contemplated. The conservative approach prevents unnecessary surgery. A survey of the literature (since 1966) in Britain did not reveal any report of pneumatocoeles in association with burns, and this appears to be a unique report.
George A., Bang R.L., Gupta R., Khalaf E.M.
Burns, 27: 504-8, 2001
The case is described of an 82-year-old man who after suffering a cerebrovascular accident sustained deep dermal burns due to contact with gastric contents when his percutaneous endoscopic gastrostomy tube became accidentally disconnected. The patient was found on the day of the incident on his bed, lying in a pool of stomach contents. He sustained 1% deep dermal burns in the right arm and right leg. It is recommended that manufacturers of percutaneous endoscopic gastrostomy tubes should provide a secure method of outlet control in order to prevent the accidental spillage of gastric contents onto skin.
Alvi R., Walmsley P., James M.I.
Burns, 27: 509-11, 2001
A case is reported in which a 23-year-old Chinese woman suffered deep contact burns when she attempted suicide using alcohol, benzodiazepine, and burning charcoal in her sealed bedroom. While only half conscious she sustained 1% full-thickness leg burns and burns in the left tibialis anterior and extensor digitorum longus. After resuscitation with 100% oxygen and gastric lavage, the patient was treated in the burns unit for wound care, surgical debridement of the burn, and skin graft; she also received psychological support. Suicide by burn is uncommon among the Chinese population in Hong Kong, but there is an emerging local trend in suicide attempts in which charcoal is burned in a closed space.
Ying S.Y., Ho W.S.
Burns, 27: 512-4, 2001