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Volume XV |
Number 4 |
December 2002 |
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SUMMARIES
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EPIDEMIOLOGY OF BURN INJURIES DURING PREGNANCY IN TEHRAN, IRAN
(Mehdizadeh A.,Akbarian A.,Samareh Pahlavan P.,Tavajjohi S.,MacKay Rossignol A.,Alaghehbandan R.,Groohi B. - Iran - USA)
Objectives: The objectives of the study were to quantify the frequency of burn injuries in pregnant women, to identify risk and predisposing factors, to understand the health consequences of these burns in terms of maternal and foetal mortality, and to compare the results with findings from other published studies. Setting: The study was conducted at the Motahari Burn Centre in Tehran, Iran. Methods: A medical record review was conducted of the 103 pregnant burned women, aged 15-49 yr, admitted over the six-year period beginning 21 March 1994. Data were collected regarding the size and outcome of the burn, and demographic information. These data were supplemented by data from the 1996 population census. Results: The burn incidence rate for pregnant women was estimated as 9.4/100,000 person-years compared with a rate of 15.8 for similarly aged non-pregnant women. The burn rate was higher in women who were illiterate or had only primary school education than in women with a more formal education. Flame burns accounted for 93.2% of all burns. Maternal death occurred in 62.1% of cases; the corresponding percentage for foetuses was 72.8%. The percentage of cases of burns due to suicide attempts was 14.6%. Conclusions: Burn injuries during pregnancy appear to be a larger problem in economically developing countries like Iran where burns are more common in females than in males. As most burns in pregnant females were unintentional, there is clearly an opportunity for prevention, for example by educating pregnant women in the antenatal care clinic as to burn risk factors and prevention efforts.
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| 170 |
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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| 174 |
ELECTRICAL INJURIES CAUSED BY GRAPHITE FISHING ROD CONTACT WITH OVERHEAD ELECTRIC CABLES
(Yuan Z.Q., Peng Y.Z. - People's Republic of China)
Fishing rods are made of non-insulated graphite and carbon, which are highly conductive to electricity. This causes a potential hazard of electrical injury to fishermen. Eight cases of persons suffering from electrical injuries caused by their highly conductive fishing rods touching overhead electric cables are reported. The clinical characteristic of such injuries and suggestions for prevention are discussed.
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| 176 |
INITIAL MANAGEMENT OF THE BURN PATIENT - AN ALGORITHM APPROACH FOR SCENE CARE
(Domres B., Kay M.V., Manger A. - Germany)
An algorithm is presented for use in the primary treatment of burn injuries. The intention of its creators is to provide an understandable pathway for decision-making and to encourage clinical thinking. Burn injuries are classified according to a number of criteria, and clear recommendations are made with regard to matters such as fluid resuscitation.
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| 179 |
THE PATTERN AND OUTCOME OF SEPTICAEMIA IN A BURNS INTENSIVE CARE UNIT
(Zorgani A., Zaidi M., Franka R., Shahen A. - Lybia)
Over a three-year period, we analysed 77 patients admitted to the burns intensive care unit of the Burns and Plastic Surgery Hospital, Tripoli, Libya, who were clinically and microbiologically proven to be suffering from septicaemia, and their characteristics are presented. The seventy-seven patients altogether suffered 97 episodes of septicaemia: 62 patients had one episode only, while fifteen had multiple episodes. The organisms were detected in blood cultures as early as 48 h post-admission. Of the 97 episodes, 27 (28%) were due to Staphylococcus aureus, five (5%) to coagulase-negative staphylococci, 40 (41%) to Pseudomonas species, two (2%) to streptococci, six (6%) to coliforms, three (3%) to Candida, and 14 (14%) to more than one organism. Once septicaemia was diagnosed, appropriate therapy was instituted. The apparently high mortality rate of 35 patients (45%) was probably due to a combination of several factors: delayed referral to the Burn and Plastic Surgery Hospital, the occurrence of septicaemia quite early with a major degree of burns (3rd-4th degree), inhalation injury, high percentage total body surface area, and multiple episodes with multi-resistant organisms such as methicillin-resistant S. aureus in seven isolates (25%).
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| 183 |
ROLE OF HUMAN FOETAL MEMBRANES (AMNIOTIC MEMBRANE) IN THE MANAGEMENT OF BURN WOUNDS
(Bari M.S., Choudhury M.I.M.,Khan A.-A.-R., Nessa A. - Bangladesh)
This is a prospective study of 40 patients with deep and deep dermal burns in which human foetal membranes (FMs) - also known as amniotic membrane - were used. FMs were used in 25 patients unsuitable for early burn excision who presented some degree of infection. The results with respect to the formation of granulation tissue were excellent, and the control of infection was satisfactory. FMs were also used in 15 patients over widely meshed split-skin grafts where the formation of hypertrophic granulation tissue through the windows of the mesh-graft prevented coalescence of the epithelium and delayed healing. In five patients in this second group, FMs were used in the split-skin graft donor area. The patients complained of severe pain and dryness in the area, which was relieved by using a moistening ointment.
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| 187 |
CUTANEOUS BURNS OF VARIOUS DEGREES. OUR EXPERIENCE WITH BURNSHIELD®. PRELIMINARY DATA
(Osti E., Osti F. - Italy)
Cutaneous lesions due to burns constitute a major problem. When deep, even if they affect only a small percentage of the cutis, they are slow to heal, become infected, cause persistent pain, and lead to unaesthetic scarring and invalidity. When the burn is severe, it can cause death because of a variety of complications - septicaemia, acute renal insufficiency, respiratory distress syndrome, cardiocirculatory failure, etc. This preliminary study was carried out on burn patients with cutaneous lesions in a percentage of total body surface area that generally does not require hospitalization (> 10% for a child and > 20% for an adult). The analgesic efficiency of the anti-burn hydrogel product Burnshield® was tested and, after the follow-up, we intend to assess its aesthetic and cicatricial effects. Twenty patients received a local application of Burnshield®. Good results were found with regard to the analgesic efficiency of Burnshield®, which was effective almost immediately and persistent. However, with regard to the risk of infection, further research requires to be done. The complication most frequently observed was maceration of the cutis, even if this did not prevent continuation of treatment with the hydrogel.
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| 191 |
PROFIL SOCIOCULTUREL DES PATIENTS BRULES: ETUDE DESCRIPTIVE DE 150 CAS
(Alibou P., Diouri M., Mradmi W., Bahechar M., Boukind E.H. - Maroc)
Les Auteurs se penchent sur le profil socioculturel des patients brûlés. C'est une étude descriptive étalée sur quatre mois (mars-juillet 2001) intéressant 150 patients brûlés admis au Centre des Brûlés et de Chirurgie Plastique du CHU Ibn Rochd de Casablanca (Maroc). Nos patients sont soit hospitalisés soit suivis en ambulatoire et leur âge est > 15 ans. Nous avons analysé les données sociodémographiques, le niveau de vie (revenu, type de logement, profession), les indicateurs culturels et les données sur la santé (couverture médicale et les antécédents médicaux et toxiques). Les Auteurs retrouvent une prédominance de patients issus de milieux défavorisés avec un taux d'analphabétisme élevé. Il s'agit de patients qui vivent en famille nombreuse, en promiscuité, avec un taux de chômage élevé et des ressources financières sous le seuil de la pauvreté. Ces facteurs prédisposent à la brûlure accidentelle quand l'agent causal s'y prête. Les Auteurs soulignent l'intérêt de prendre en considération le profil socioculturel de cette population cible dans l'élaboration de campagnes de prévention adaptées, et d'intégrer dans la prise en charge des brûlés une assistance psychosociale qui s'avère indispensable pour la réhabilitation post-brûlure.
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| 195 |
ISOLATION AND SENSORY DEPRIVATION - CLINICAL OBSERVATIONS FOLLOWING EIGHT YEARS OF COLLABORATION
(Lasagna G., Germoglio M. - Italy)
For some years our burns unit has been working with our hospital psychologist on the prevention of the syndrome of post-traumatic sensory deprivation in burn patients. Isolated burned people are likely to suffer from mild disorientation, confusion, illusions, or hallucinations caused by the shock of extremely threatening events and sensory deprivation. This condition may be dangerous for the patients' mental health during hospitalization and after discharge.
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| 199 |
RESTRUCTURING AND REALIZATION OF THE NEW BURNS CENTRE AT THE CELIO MILITARY POLYCLINIC IN ROME, IN THE LIGHT OF NEW CRITERIA IN THE CONTROL OF INFECTION
(Inzani F., Tecnicaer Engineering - Italy)
This paper reports on the principles underlying the planning of the new Burns Centre at the Celio Military Polyclinic in Rome. The prevention and control of hospital infection were primary considerations. The organization of the spaces for burn patient care is described, and an analysis is made of some basic functional models. The criteria for climatization in the special wards are presented. The problem of hospital infection, which is the result of a series of interacting causes, must not be underestimated, and its reduction brings undoubted human and economic benefits.
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