|
 |
Volume XVII |
Number 1 |
March 2004 |
|
|
SUMMARIES
| 5 |
HOT-WATER BOTTLE BURNS: A REVIEW OF 294 CASES TREATED IN CHANGHAI HOSPITAL BURN CENTRE IN THE PERIOD 1991-2001
(Ben D.F., Chen Xu L., Xia Z.F., Huan J.N., Chen X.L., Huang J.R, Ge S.D. - People's Republic of China)
The aim of this study was to evaluate the epidemiology of burns due to the use of hot-water bottles. We performed a 10-yr survey of all hot-water bottle burns treated in our burns centre. Two hundred and ninety-four patients were identified with hot-water bottle burns between 1 January 1991 and 31 December 2001. Records were kept of age, sex, size, depth and site of burn, time period before first reporting of burn, incidence by month, type and rate of operations, time before hospitalization, length of hospital stay, morbidity, mortality, types of bacteria in wounds, and aetiology. The majority of the patients were female, and the mean age was 21.4 yr. The mean time period before reporting the burn injury was 8 h, with a range of 0.5-78 h. Patients presented late to our unit in 41% of cases, with an average delay of 6 days. Patients were hospitalized on average within the first 13.5 days, with a range of 2-113 days. Usually the burn surface area was less than 0.1% off the total body surface area and consisted mainly of full-thickness burns. The body area most commonly burned was the leg. One hundred and eighty-six patients (63.2%) were injured in the months of November, December, and January. Two hundred and eighty-two patients (95.9%) required surgery. Eschar excision and skin-grafting (75.8% of cases) and the creation of local flaps (24.2%) were performed within the first 6 days in full-thickness burns. The mean period of hospital stay in hospital was 13.4 days, with a range of 1-47 days. Two patients died in this series, giving a mortality rate of 0.68%. Fifty-six patients presented 63 registered burn wound infections. The micro-organisms most commonly observed in the burn wounds were Staphylococcus aureus and Pseudomonas aeruginosa. |
| 9 |
ELECTRICAL BURN INJURIES
(Subrahmanyam M. - India)
Between January 1999 and December 2000, a total number of 40 patients with electrical burns treated at General Hospital, Sangli, India, were studied. Electrical burns were responsible for 2% of all burn admissions; 67.5% of the burns were due to low voltage and 32.5% to high voltage. The extremities were involved in 52.5% of the patients, and 55% underwent surgery. Debridement was the commonest procedure, followed by escharotomy. The mortality rate was 25%. The commonest cause of death was cardiac arrest, followed by septicaemia and renal failure. Congestion of the brain and oedematous lungs were frequent findings post mortem. |
| 12 |
PATTERN OF BACTERIAL PATHOGENS IN BURN WOUND INFECTIONS IN IBADAN, NIGERIA
(Kehinde A.O., Ademola S.A., Okesola A.O., Oluwatosin O.M., Bakare R.A. - Nigeria)
A retrospective study of 85 patients with burn wound infections was carried out in University College Hospital, Ibadan, Nigeria, between April 1998 and March 2001. A total number of 85 specimens consisting of 35 wound swabs (41.2%) and 50 wound biopsies (58.8%) were processed during the period. Burn wound infections were significantly more frequent in children and adolescents (5-20 yr) than in adults (p < 0.05). Klebsiella species was the pathogen most commonly isolated, constituting 34.4%. This was closely followed by Pseudomonas aeruginosa (29.0%) and Staphylococcus aureus (26.8%). The rate of isolation of Gram-negative organisms was more than twice that of Gram-positive organisms. More than 75% of the Gram-negative isolates were resistant to gentamicin, a commonly used antibiotic for Gram-negative infections, but sensitive to ceftazidime and pefloxacin. Gram-positive isolates were predominantly Staphylococcus aureus sensitive to azithromycin and pefloxacin. This study highlights the predominant bacterial pathogens and their antimicrobial profile among infected burn wounds in our centre. |
| 16 |
EARLY AND LATE COMPLICATIONS OF INHALATION INJURY
(Valová M., Königová R., BrozS L., Vajtr D. - Czech Republic)
Severe inhalation injury causes a substantial deterioration in the prognosis and increases the general mortality of patients with extensive burns. Recently, in particular because of the development of the invasive monitoring of patients and the effective treatment of acute burn shock, we encounter with increasing frequency patients who survive the acute stage, including complications such as acute respiratory distress syndrome, and reach the stage of late complications. The latter include tracheo-oesophageal fistulas that develop on the basis of pressure ulcers and chondromalacia, usually at the site of the balloon of the tracheostomic cannula, and the overproduction of fibrous tissue in the area of the airways that leads to the development of stenosis, pulmonary fibrosis, and bronchiectasis. Frequently, different early and late complications combine. |
| 20 |
INTERET DE L'ETUDE DE LA CINETIQUE DE LA PROTEINE C-REACTIVE POUR LE DIAGNOSTIC DU SEPSIS ET SON EVOLUTION CHEZ LES BRULES
(Messaadi A., Bousselmi K., Haddad N., Khorbi A. - Tunisie)
Ce travail prospectif est entrepris en aveugle pour évaluer l'intérêt de l'étude de la cinétique de la C réactive protéine (CRP) pour le diagnostic et le suivi de sepsis chez les brûlés. Durant la période du 1er janvier 2000 au 31 décembre 2001, 407 malades ont été hospitalisés pour brûlures. Seuls 139 patients consécutifs ont été inclus. Deux groupes ont été distingués: groupe S - malades septiques (N = 104); groupe NS - malades non septiques (N = 35). L'étude de la cinétique de la CRP chez ces malades a permis de dégager les résultats suivants. Les brûlés présentent une CRP de départ évaluée à 51,49 ± 53 mg/l; l'intensité de la réaction inflammatoire induite par la brûlure explique ce taux élevé par rapport au sujet normal. Chez les brûlés, la CRP va augmenter progressivement chez les malades non septiques sans dépasser 100 mg/l puis va baisser pour se rapprocher des valeurs initiales. Chez les malades septiques, la CRP va atteindre des taux significativement plus élevés (121 ± 28 mg/l). Un seuil de la CRP > à 112 mg/l a une valeur prédictive positive de sepsis de 92%, avec une spécificité de 69,2 %. Ce résultat est d'autant plus intéressant que cette valeur seuil est généralement atteinte avant la valeur maximale observée le jour du diagnostic de sepsis. Une baisse de la CRP à j4 de traitement > à 20% est fortement associée à la guérison. La CRP constitue un paramètre utile aussi bien pour le diagnostic de sepsis chez le brûlé que pour suivre son évolution sous traitement. |
| 25 |
CONDUITE PRATIQUE DE L'ANTIBIOTHERAPIE CHEZ LES BRULES
(Ezzoubi M., Benbrahim A., Elmounjid S., Fassi Fihri J., Bahechar N., Boukind E.H. - Maroc)
L'infection est la principale cause de mortalité chez le brûlé. Outre les mesures de prévention de celle-ci par l'observance d'une asepsie rigoureuse, l'antibiothérapie est restée pour longtemps discutée. A travers cet article, nous avons essayé de cerner l'indication de l'antibiothérapie chez le grand brûlé en répondant à des questions sans suggérer pour autant une attitude ou une autre, ouvrant ainsi la voie à la discussion de ce problème. |
| 34 |
METHOD OF SURGICAL TREATMENT OF AN EXTENSIVE POST-BURN DEFORMITY OF THE ABDOMINAL WALL AND THE LUMBOSACRAL REGION
(Moroz V., Adamskaya N., Sarygin P., Yudenich A.A. - Russia)
Thermal injury to the abdominal wall and the lumbosacral region may cause severe disfigurement of the trunk. The proposed method of surgical treatment of patients with scar deformations and defects of soft tissues of the anterior abdominal wall and the lumbosacral region was used in 53 patients. The method is based on large mobilization and acute distension of undamaged fasciocutaneous flaps in neighbouring zones with scar defects. Acute dermotension makes it possible to remove large scar defects and restore the natural integument in patients with burn trauma. |
| 40 |
REGARDING A CASE OF SÉZARY SYNDROME TREATED WITH PUVA THERAPY AND COMPLICATED BY A SERIOUS PHOTOALLERGIC REACTION SIMULATING LYELL'S SYNDROME
(Napoli B., D'Arpa N., Alessandro G., Iaia A., Masellis M. - Italy)
The case is described of a 62-yr-old male patient suffering from leukemized mycosis fungoides (Sézary syndrome) who was subjected to PUVA (psoralen and ultraviolet A radiation) therapy, and complicated by a serious condition of cutaneous photosensitivity. After a discussion of cutaneous T cell lymphomas, of which mycosis fungoides and the Sézary syndrome are the most frequent forms, an analysis is made of the hepatotoxic, phototoxic, and photoallergic effects of psoralen, a drug used to sensitize the skin to high-level ultraviolet rays. The criteria are described for a differential diagnosis between Lyell's syndrome and the vesiculobullous reactions provoked by photoallergic mechanisms. |
| 44 |
BURN DAMAGE AND LAWS REGARDING INDUSTRIAL INJURIES: CLINICAL AND MEDICO-LEGAL ISSUES
(Cortellini M., Iorio M., Magliacani G., Bollero D. - Italy)
This paper focuses on data regarding burn accidents for which compensation was awarded by INAIL (Istituto nazionale per l'assicurazione contro gli infortuni sul lavoro, i.e. National Institute for Insurance against Industrial Accidents). This is the public agency in Italy that deals with compulsory insurance against industrial accidents and occupational diseases in industry, trade, and craft trades. The data refer to the period 1994-2000. It is important to stress that the cases mentioned are those for which compensation was actually paid - they do not represent the total number of accidents in the work environment. New regulations recently came into effect in Italy in the year 2000: the new system provides for three compensation procedures. These consist of a disability chart (385 entries, arranged by number and in relation to the functional systems involved); a biological damage compensation chart (regarding factors such as the gravity of the damage, chronological age, and sex; and a coefficient chart (to compensate for the financial loss caused by disabilities of at least 16%). However, this method for the overall evaluation of burn-related injuries, from scar sequelae to other outcomes of the burn disease, is inadequate in the light of what is now known about thermal trauma. We may say this because, if strictly applied, the procedure would mean that the highest percentage degree of disability acceptable for compensation would be only 30%. This score (equivalent to one-third of psychological and physical integrity) is not a fair assessment of the damage represented by face disfigurement due to third-degree burns or by injuries in 80% of the body surface area. Our suggestion is to reform the charting system by introducing, alongside scar entries, various other separate factors allowing an assessment of burn sequelae and calculating the total disability percentage by means of a proportional formula based on single damage factors. To this end, it might be useful to formulate a weighted estimate by analysing Italian and other national evaluation standards and by comparing international manuals and the current INAIL chart. |
|