A new technique is described for inflicting a controlled ventral scald burn in rodents whose back is inaccessible because of pre-burn preparation. Boiling water is applied across a polyethylene membrane which partially envelops the subject. This simple, economical, and reproducible technique makes it possible to carry out intravital microscopic study of the microcirculation in a remote muscular bed before and after bum injury.
Korompai F.L., Yuan S.Y.
Burns, 28: 321-7, 2002
As burn patients are highly susceptible to infection, the prevention and treatment of infectious conditions is basic to the successful management of severe burns. In view of the finding that multi-resistant Acinetobacter baumannii (MR-AB) strains are becoming increasingly important in nosocomial infection, we conducted a retrospective study of all adult admissions to the Singapore General Hospital National Burns Centre over an 18-month period. The only independent risk factors for the acquisition of MR-AB were found to be the APACHE II score on admission and the number of intravascular lines placed. The only independent predictor of infection with MR-AB was the number of intravascular lines placed. The only independent predictors of longer length of stay were the total number of operations required and infection with MR-AB. The only independent predictor of mortality was the APACHE II score. These results contrast with other studies that have suggested that the acquisition of MR-AB is an independent risk factor for mortality.
Ting Hway Wong, Ban Hock Tan, Moi Lin Ling, Colin Song
Burns, 28: 349-57, 2002
The use of biological dressings is well established in contemporary burns care, but the type and source of such biological materials can give rise to both legal and ethical issues. This paper considers the issues in relation to allogenic skin. It is argued, from a medical perspective, that non-viable allogenic skin cannot be transplanted and should therefore be classified both medically and legally as a dressing.
Burd A., Lam P.K., Lau H.
Burns, 28: 358-66, 2002
The purpose of this paper is to document and describe motorbike exhaust burns in children. The findings came from a departmental database and case note review of all children with motorbike exhaust burns seen at the Stuart Pegg Paediatric Bums Centre (Brisbane, Australia) between January 1996 and October 2001. The findings reviewed included the number and the age of the children burned, the circumstances of their injury, the burns sustained, the treatment required, and long-term sequelae. It was found that twenty-four children (median age, 8 yr) sustained thermal burns, most frequently in the right lower leg. Thirteen children required surgery, and seventeen required chronic scar management. It is concluded that motorbike exhausts were a frequent a cause of burns in children. The injuries received resulted in significant morbidity to these children, and this warrants a campaign aimed at reducing the incidence of such injuries.
Roberts R., Kelson E., Goodall-Wilson D., Kimble R.
Burns, 28: 367-9, 2002
The objective was to report on the effects of campfire burns on children, in order to identify the sources of danger that contribute to such injuries and thus to devise a prevention strategy. The data came from a departmental database and a case note review of all children with campfire burns seen at a Burns Unit in a tertiary referral children’s hospital between January 1999 and June 2001 in Brisbane, Australia. The number and the age of the children burned were recorded, together with risk factors contributing to the accidents, the injuries sustained, the treatment required, and long-term sequelae. It was found that 33 children (median age, 2.5 yr), sustained burns, usually in the hands and feet. Eight required surgery, and the majority needed some form of scar therapy. Seventy-four percent of the children were burned by hot ashes and coals, usually from the previous night’s campfire, rather than by open flames. It is concluded that campfires cause serious injuries to children. Hot ashes and coals from inadequately extinguished campfires pose the greatest danger. It is intended to initiate a public education campaign in order to increase awareness of this easily preventable problem among campers.
Choo K.L., Fraser J.F., Kimble R.M.
Burns, 28: 374-8, 2002
Activation of a pro-inflammatory cascade after a burn injury is important in the development of later immune dysfunction, susceptibility to sepsis, and multiple organ failure. Macrophages are important producers of pro-inflammatory mediators and their productive capacity for such mediators increases considerably after thermal injury. Macrophage hyperactivity (i.e. increased productive capacity for pro-inflammatory mediators) would seem to be critically important in the development of post-burn immune dysfunction. This review article considers the state of the art as regards the role of macrophages in the development of post-burn immune dysfunction. In particular, the following aspects are discussed: nitric oxide synthase and cyclo-oxygenase enzyme systems, macrophages and the T-helper-1/T-helper-2 cytokine responses, alterations in macrophage signal transduction, and a potential role for Á/‰ T-cells in the development of macrophage hyperactivity after thermal injury. It is hoped that a more comprehensive understanding of the relationship between macrophage activity and post-burn immune dysfunction will constitute the basis for improved therapeutic regimes in the treatment of burn patients.
Schwacha M.G.
Burns, 29: 1-14, 2003
Numerous factors are involved in the development of infection in burn patients, and a description is given of various wound management procedures, infection-associated risk factors, typical bacterial pathogens and associated exotoxins, current problems with antibiotic resistance, wound sampling, and rare complications. New treatments currently being developed, such as cell-signalling molecules and the increasing use of natural antimicrobial agents, e.g. honey, papaya fruit, and tea-tree oil, are discussed, and an account is given of the impact of new methods for earlier detection of infectious agents that could change future practices in burn care.
Edwards-Jones V., Greenwood J.E.
Burns, 29: 15-24, 2003
This study presents follow-up data on social competence and behavioural problems in a sample of burned Swedish children and compares the results with normative data from a reference group of children of comparable age, socio-economic status, and gender. The parents of 44 children aged 7-12 yr were invited to complete a questionnaire that included the Children’s Behaviour Questionnaire (CBQ) and the Social Competence Inventory (SCI). Data were also collected from the teachers of 20 of the children using the same booklet. Data on TBSA, localization of injury, and other background factors were also collected. It was found that the burned children were rated by their parents as showing a lower degree of social initiative and a greater number of externalising and concentration problems than the control group. Teachers rated the burned children as having less pro-social orientation, more externalizing problems, and more concentration problems. Gender and the characteristics of the burn injury were not found to have any clear effects. The results of the SCI were associated with scores in the CBQ. These findings are consistent with previous research, as the differences observed were relatively small. They draw attention to the possible negative effects of growing up with a burn injury and to the possible pre-morbid characteristics that may be related to the injury.
Andersson G., Sandberg S., Rydell A.-M., Gerdin B.
Burns, 29: 25-30, 2003
In India, ritual self-immolation has long been practised. In the past this custom was related to suttee, while today it is more often associated with dowry disputes. In India, dowries are a continuing series of gifts endowed before and after the marriage. If dowry undertakings are not respected, the bride may be killed or forced to commit suicide, most frequently by burning. In a cohort of 152 burned wives, 32 (21%) were immolation suicides, and these cases are analysed from both the epidemiological and the medicolegal aspects. Suicide by burning among women is a major source of concern in India and has become pervasive in all social strata and geographical areas. In this series, most of the women came from joint families (i.e. multigenerational groups of related individuals living under a single roof) and the suicides occurred 2-5 yr after marriage. The majority (69%) of the affected wives were aged 21-25 yr at the time of the suicide, sustaining burn injuries in more than 50% TBSA after dousing themselves with kerosene. Most of the women died at the time of the incident or within the subsequent 24 h, usually from shock.
Kumar V.
Burns, 29: 31-5, 2003
IL-12 induces type 1 T-cell responses, which are necessary in host defence against herpes simplex virus type 1 (HSV-l) infection. However, type 1 T-cell responses are not elicited by IL-12 in thermally injured mice (TI-mice), which routinely have a predominance of burn-associated type 2 T-cell responses. In previous studies that we performed, benzoylmesaconine (BEN, an aconitine derivative extracted from heated Aconiti tuber) provoked the generation of CD4+ T-cells antagonistic to type 2 T-cells (BEN-CD4+ T-cells). The present study investigates the effects of a combination therapy using IL-12 and BEN to treat severe HSV-1 infection in TI-mice. When TI-mice were treated with either IL-12 (500 U per mouse) or BEN (1 Ìg/kg) alone, they did not resist HSV-1 infection. However, 60-80% of TI-mice exposed to HSV-1 survived after they received IL-12 and BEN or BEN-CD4+ T-cells in combination. After stimulation with anti-CD3 mAb in vitro, IFN-Á was not produced in cultures of splenic T-cells from TI-mice exposed to HSV-1 and treated with either IL-12, BEN, or BEN-CD4+ T-cells alone. However, IFN-Á production was induced by mAb stimulation in cultures of T-cells from infected mice treated with IL-12 and BEN or BEN-CD4+ T-cells in combination. These findings suggest that a combination therapy of IL-12 (which induces type 1 T-cell responses) and BEN (which inhibits type 2 T-cell responses) may protect TI-mice from severe HSV-1 infection.
Kobayashi M., Takahashi H., Herndon D.N., Pollard R.B., Suzuki F.
Burns, 29: 37-42, 2003