Volume XVI

Number 1

March 2003

RECEPTOR ALTERATIONS IN BURN PATIENTS
(Sabato A.F., Santoro G., Gatti A., Serafini G - Cyprus)
Burn victims present considerable biochemical and receptor alterations. Recent improvements in instrumental research techniques have clarified some of the mechanisms involved. One of the problems is resistance to curarizing drugs (which is probably not related only to receptor upregulation); also involved are metabolic alterations, immunodepression, hyperalgesia and pain “memory” phenomena, and, in particular, problems of skin tissue regeneration. .

THE REHABILITATIVE MANAGEMENT OF BURN PATIENTS IN THE POST-ACUTE PHASE
(Civaia A., Fedele C., Gallino A., Oliva R. - Italy )
The greatest commitment in rehabilitation after a serious burn trauma is the achievement by the patient of maximum autonomy and functionality in order to guarantee the best possible quality of life in the social, family, and working environments. Three phases can be distinguished: the acute phase, the post-acute phase, and the chronic phase. This paper examines the post-acute phase, and in particular contraindications to kinesitherapy, bandaging and compression therapy, manual lymphatic drainage, and physical therapy .

A COMPARATIVE STUDY OF THREE MODALITIES OF PAIN RELIEF DURING WOUND DRESSING OF BURN PATIENTS
(Kamel A.H., Abd El-Latif Z., El-Rahim J.A., Abd El-Sayed S.A. - Egypt)
Pain in burn patients has many causes, both functional and organic. Peak pain comes during wound dressing and/or physiotherapy. This is a comparative study of four groups of patients (15 per group). Three groups received a particular modality of pain control, and the results were compared with those of a fourth group, the control group, that did not receive any pain relief. We used the pain-rating scale described by Chambers and Price to assess the patients’ physiological and behavioural pain response.

THE USE OF FIBROBLAST AND KERATINOCYTE CULTURES IN BURNS TREATMENT
(Travia G., Palmisano P.A., Cervelli V., Esposito G., Casciani C.U. - Italy)
This experimental study examined the use of semisynthetic, autologous, engineered and biocompatible skin substitutes in burn patients. These biomaterials are used as dermal and epidermal grafts in extensive or deep burns in order to improve healing by means of a repair process that is as physiological as possible. The latest techniques of bioengineering help to improve therapy, long-term prognosis, and the quality of life of seriously burned patients.

SOUTIEN PSYCHOLOGIQUE CHEZ LES SAPEURS POMPIERS FRANÇAIS
(Flaujat A., Soldin M. - France)
Les sapeurs pompiers et les différents intervenant des services de secours ont besoin d’un soutien psychologique, au moins dans deux circonstances: lorsqu’ils ont frôlé leur propre mort et lorsque, soumis à des stress intenses ou répétés par leur profession, ils risquent de présenter ultérieurement des troubles psychiatriques sévères ou de décompenser un équilibre psychologique antérieur précaire. Il existe des techniques psychologiques de soins immédiats sur les lieux et post-immédiats dans la semaine qui suit, dérivées des thérapeutiques cognitivo-comportementales et mises au point par J.T. Mitchell pour les pompiers de New York. Cependant l’utilisation de ces techniques ne doit pas être systématique mais répondre à des situations d’exception pour garder leur efficacité. Il est nécessaire que l’ensemble des sapeurs pompiers français se dote de personnel compétent apte à les mettre en œuvre.

THE TREATMENT OF BURNS CAUSED BY GUNPOWDER EXPLOSION IN FIREWORKS FACTORIES
(Chen X.L., Wang Y.J., Wang C.R., Hu D.L., Fang L.S., Li S.S. - People’s Republic of China)
Patients with burns caused by gunpowder explosion in fireworks factories often have inhalation injury and associated injuries that lead to high mortality. The aim of this study was to analyse the management of these burn patients and to decrease their morbidity and mortality. The 339 patients considered were divided into two groups: patients admitted between 1987 and 1993 (group 1) and patients admitted between 1994 and 1999 (group 2). Data on age, sex, size and depth of burn, inhalation injury and associated injury, management, incidence of sepsis and the multiple organ dysfunction syndrome, mortality rate, and length of hospital stay were collected and compared. No significant difference was found between the patients in the two groups as regards male-to-female ratio, total body surface area and full-thickness burn, inhalation injury, or associated injury. Forty-seven patients in group 1 received inadequate fluid resuscitation and developed severe shock, whereas only 11 patients in group 2 presented severe shock. In the early period post-burn (within 1 week of injury), high-dose vitamin C was administered to 18 patients in group 1 and to 97 patients in group 2. No patients in group 1 received vitamin E, while 45 patients in group 2 received it the early period post-burn. Prophylactic tracheotomy was performed in one patient in group 1 and in 14 patients in group 2. The incidence of the acute respiratory distress syndrome in groups 1 and 2 was respectively 13.1% and 6.4% (p < 0.01). Forty-six patients in group 1 and 83 patients in group 2 underwent early excision and grafting. All associated injuries were well managed and no death was related to associated injuries or their direct complications in either group. The incidence of sepsis and the mortality rate of patients were significantly higher in group 1 than in group 2 (14.2% vs 5.1%, p < 0.01; 19.1% vs 5.8%, p < 0.01). The mean hospitalization period of survivors in group 2 was significantly shorter than that in group 1 (29.1 ± 11.3 days vs 36.3 ± 10.2 days, p = 0.041). In patients who sustain burns due to gunpowder explosions in fireworks factories, the following methods of treatment are crucial: 1. prompt, rapid, and adequate fluid resuscitation; 2. prophylactic tracheotomy with mechanical ventilation in patients presenting upper airways oedema or in whom airways patency is threatened; 3. early excision and grafting of larger deep wounds and coverage using allograft with a 1:10 micro-autograft; 4. vitamin E and high-dose vitamin C; 5. determination and immediate management of life-threatening associated injuries.

FROSTBITE - EXCEPTIONAL CASES
(Iliopoulou E., Lochaitis A. - Greece)
Frostbite or cold injury is produced by prolonged exposure to subfreezing temperatures (below -6 øC) for at least 1 h. Localized cold injury is categorized by its pathogenesis as frostbite, and generalized injury is discussed as systemic hypothermia. Although Greece is a small country in the Mediterranean area with weather that rarely causes frostbite, in the last 12 years we have treated 11 such patients (two Greeks, one Pakistani, and eight Kurds). Two cases were the result of industrial accidents and the other nine were due to inappropriate use of sandals in very cold weather. The localization (hands in the Greeks and feet and digits in the others) and the different social and financial backgrounds suggest that it is difficult to recognize any social aetiology. Better prevention and the control of infection, together with effective nutritional and metabolic support, will minimize the extent of necrosis and future invalidity. Our conclusions are as follows: frostbite is closely related to social and financial status; it is not associated with death, although in the event of septicaemia or renal failure due to muscle necrosis or gas gangrene the prognosis may be poor, with inevitable transient or permanent invalidity; general therapy is related to hypothermia (with or without coma), shock treatment, septicaemia, and anticoagulant drugs; local therapy, starting after demarcation of necrosis, consists of partial or total amputation of fingers or limbs; and, above all, the most effective therapy is prevention.

CASE REPORT: SEVERE BURN COMPLICATED BY THE ACUTE RESPIRATORY DISTRESS SYNDROME AND DISSEMINATED CANDIDIASIS
(Koulermou G., Yiallouros C. - Cyprus)
This report describes the successful treatment of a severely burned female patient suffering from the acute respiratory distress syndrome and disseminated candidiasis. The various phases are presented, as well as the antibiotic therapy administered. Careful treatment prevented the occurrence of the frequently dangerous complications in such cases.