Volume XVII

Number 1

March 2004

HBURNS AND SCALDS: FIRST-AID HOME TREATMENT AND IMPLICATIONS AT ENUGU, NIGERIA
(Olaitan P.B., Iyidobi E.C., Olaitan J.O., Ogbonnaya I.S. - Nigeria)
Burn management has yet to be fully understood by everyone in our environment in Nigeria. That is why many of our patients who sustain burns still apply to their wounds any substance available. An analysis of the 147 patients studied in this work shows that 51% of the patients applied one substance or another. Various substances were used, including raw eggs, gentian violet, cassava, engine oil, kerosene, etc. The risk of infection with most of these substances is obvious. Intensive campaigns and education of the people are urgently needed. This will reduce the current spate of morbidity and mortality following burn injuries in our communities.

BURNCASE 3D: A RESEARCH PRODUCT FOR EFFECTIVE AND TIME-SAVING DOCUMENTATION OF BURN INJURIES
(Giretzlehner M., Dirnberger J., Luckeneder T., Haller H.L., Rodemund C. - Austria)
Research, science, and costing in burns are based on accurate assessment and documentation of burn injuries. This kind of documentation is time-consuming and labour-intensive. In order to reduce the work load for documentation and coding, a research project was started between Upper Austrian Research, a research department of the federal state of Upper Austria, the University of Applied Sciences Hagenberg, and Dr Herbert Haller and Dr Christian Rodemund. The basic idea is to paint the burn injury as well as surgical procedures on a three-dimensional model. This input generates automatically clear text as well as graphic reports concerning the extent and degree of burns, together with all necessary codes such as ICD 9 or 10, OPS, MEL codes, probability of survival, ABSI and others. Input can be performed as a description of the local burn wound situation (diagnosis), operative procedure, dressing procedure, and advice for nursing. The chronological sequence of such inputs can be visualized and printed together with the corresponding codes. Additionally, photos can be stored and visualized when needed. The graphic system is linked to a database, which keeps all details necessary for documentation of burns concerning the accident, emergency aid, admission to hospital, anaesthesiological data, outcome, complication register, and so on. This database is based on ABA-WHO Standards and has to be adjusted to the needs of EBA or national multi-centre studies. This system is parameterized flexibly so that users can decide which data they want to register.

EFFECT OF BURNS ON MATERNAL AND FOETAL OUTCOME IN PREGNANCY
(Still J.M., Law E.J., Gooding J., Colón-Santini J., Chudgar B. - USA)
Burns sustained during pregnancy have been reported as having an adverse effect on maternal and foetal survival. More recently, results have improved. We report 16 cases with generally satisfactory results. We also provide the long-term follow up in ten of the children. The study was carried out by retrospective chart review over a 19-yr period. The 16 cases ranged in age from 13 to 34 yr (mean, 22 yr). Burn size ranged from 2 to 94% (mean, 25.3%). Gestational age at admission ranged from 3 to 38 weeks (mean, 17.5 weeks). Seven patients had inhalation injuries. No treatment-related complications were identified. Two patients (12%) died, one of whom was first delivered of a viable infant. Three surviving patients underwent spontaneous abortions, two in the hospital and one post-discharge. Twelve patients were discharged doing well with pregnancies undisturbed. After discharge, eight patients delivered viable infants: the outcome in three cases is unknown. Ten surviving children whose families could be contacted were functioning normally at one to 15 years of age. The mortality and morbidity of pregnant patients who required hospitalization for the treatment of acute burns were felt be satisfactory. No long-term abnormalities were noted in the ten surviving children available for follow-up. <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.

ANALYSIS OF EFFICACY AND SAFETY OF GLUTAMINE GRANULES IN SEVERELY BURNED PATIENTS
(Peng X., Yan H., You Z., Wang P., Zhao Y., Wang S. - People’s Republic of China)
S In order to evaluate the clinical therapeutic effect and safety of glutamine granules on severe burn patients, 48 severely burned patients were randomly divided into two groups: a burns control group (B group, 23 patients) and a glutamine granules treatment group (GLN group, 25 patients). The GLN group patients were given glutamine granules 0.5 g/kg daily for 14 days and the B group received the same dosage of placebo for 14 days. The plasma glutamine concentration, the degree of intestinal mucosa damage, blood biochemistry, and complications were observed. The results show that after 14 days of oral administration of glutamine granules, the plasma glutamine concentration in the GLN group was significantly higher than in the B group (p < 0.01). The degree of intestinal damage and intestinal mucosa permeability in the GLN group was lower than that in the B group. This indicates that orally supplemented glutamine could reduce the degree of intestinal injury and lessen intestinal mucosal permeability. There was no evidence of any side effects.

L’INFECTION DANS UN SERVICE DE BRULES
(Ezzoubi M., Ettalbi S., Elmounjid S., Mradmi W., Bahechar N., Boukind E. - Maroc)
Les Auteurs rapportent les résultats d’une étude rétrospective portant sur 35 brûlés colligés au Service des Brûlés de Casablanca, Maroc, de juin 2002 à janvier 2003, afin d’évaluer la prévalence de l’infection. Il s’agit de 21 hommes et 14 femmes (âge moyen, 26 ans). La surface corporelle brûlée est en moyenne de 40%. La flamme est en cause dans 70% des cas. Sur 56 hémocultures réalisées chez 15 patients, 30 sont positives (soit 53%), avec isolement du Pseudomonas aeruginosa dans 13% des cas et du Staphylococcus dans 37,5%. Sur 140 prélèvements cutanés, 100% sont positifs avec isolement, par ordre de fréquence, du Pseudomonas aeruginosa (45%), du Proteus (25%) et de l’Acinetobacter (10%). Seul le tiers des hémocultures positives est associé à un prélèvement local positif au même germe. Il a été noté une proportion élevée de résistance aux antibiotiques testés du Pseudomonas aeruginosa, du Staphylococcus et de l’Acinetobacter. Par ailleurs un décès sur deux survenu pendant la période d’étude est secondaire à l’infection. Enfin les Auteurs se proposent d’insister sur l’intérêt des mesures préventives à tous les niveaux de prise en charge des brûlés tant sur le plan technique que sur l’information et l’éducation du personnel soignant impliqué dans la transmission de germes en perpétuelle mutation.

SERUM PRO-INFLAMMATORY CYTOKINES AND CHEMICAL ACID BURNS IN RATS
(Cavallini M., de Boccard F., Corsi M.M., Fassati L.R., Baruffaldi Preis F.W. - Italy)
This experimental study measures the evolution of the concentration of interleukin-6 and the tumour necrosis factor · in rats, after a chemical burn with hydrochloric acid (0.5 ml, 52% for 15 sec), comparing the results between saline solution, calcium gluconate, and an amphoteric solution called Diphoterine®.

PSYCHIATRIC AND PSYCHOLOGICAL ACTION IN BURN PATIENTS
(Gigantino M. - Italy)
This paper considers the importance of the presence in burn hospital wards of specialists in the psychological care of burn patients, whose apparently devastating physical sequelae may ultimately be less traumatic than their psychological sequelae. Various aspects are considered, including that of post-traumatic stress disturbance, which is described in detail. Suggestions are provided as to the assessment of the psychological condition of burn patients.

TOXIC EPIDERMAL NECROLYSIS - LYELL’S SYNDROME
(Cabral L., Riobom F., Diogo C., Teles L., Cruzeiro C. - Portugal)
Toxic epidermal necrolysis (Lyell’s syndrome) is a rare but very serious dermatological lesion characterized by the sudden onset of high fever, signs of systemic toxicity, and intense mucocutaneous exfoliation. Its pathophysiology is not yet well determined, although the presence of an immunological basis is almost consensual. It usually appears as a response to the taking of a drug and, in spite of being self-limited in the absence of complications, it is associated if not well managed with high morbidity and high mortality due in most cases to the development of sepsis. The main treatment is the immediate suspension of the inducing drug and early admission of the patient to a hospital facility which is capable of providing intensive support care and minimizing the risk of infection and which also offers conditions for the performance of surgical debridement and the covering of the affected areas, i.e. a burns unit. Several therapeutic measures designed to lower the morbidity and mortality of this syndrome are in the course of study, including the use of plasmapheresis, the administration of high doses of N-acetylcysteine, immunosuppression, and hyperbaric oxygen. The treatment protocol in use at the Coimbra Burns Unit in Portugal is presented and illustrated with three clinical cases from the Unit.

POST-BURN SCARS IN CHILDREN: A COMMON PROBLEM. THERAPEUTIC ASSESSMENT IN GENERAL
(Koulermou G., Yiallouros C. - Cyprus)
This short paper outlines aspects of the therapeutic aspects of burn scar treatment in children. The patients and their families have to be made to realize that plastic surgery is not the only answer to their problems, and other approaches are considered.

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