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Volume XIX |
Number 2 |
June 2006 |
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SUMMARIES
| 59 |
ANALYSIS OF BURN MORTALITY IN A BURNS CENTRE
(Olaitan P.B., Jiburum B.C. - Libya)
We present an analysis of burn mortality in our burns centre in Nigeria. A total number of 285 patients sustained burns during the study period (1996-2000). Fifty-seven of the patients (20%) died, of whom 38 were male (66.7%) and 19 female (33.3%). Flame burn was responsible for 92.9% of the deaths, followed by 5.3% of deaths due to chemical burns and 1.8% to scalding. The highest mortality was found in the 71-80 yr age group, and survival decreased with increasing percentage burn surface areas. Mortality in males (20.8%) was higher than in females (18.6%), with flame burns causing produced more deaths than other aetiologies. The causes of deaths were acute renal failure (24 cases, 42.1%), septicaemia (18 cases, 31.6%), acute respiratory syndrome (5 cases, 8.7%), shock (4 cases, 7.0%), and upper gastrointestinal bleeding due to peptic ulcer and severe anaemia (1 case each, 1.8%). We conclude that improved facilities and better trained personnel will lead to a reduction in the current high mortality rate among burn patients in our environment. |
| 63 |
ANTISEPTIC-IMPREGNATED CENTRAL VENOUS CATHETERS: THEIR EVALUATION IN BURN PATIENTSANTISEPTIC-IMPREGNATED CENTRAL VENOUS CATHETERS: THEIR EVALUATION IN BURN PATIENTS
(Ramos G., Bolgiani A., Patiño O., Prezzavento G., Guastavino P., Durlach R., Fernandez Caniggia L., Benaim F. - Argentina)
Central venous catheter-related infections are an important source of morbidity and mortality in burn patients. Antiseptic-impregnated catheters have been recommended to prevent infections related to central venous lines in high-risk patients who require short-term catheters. This prospective, randomized, and controlled study compared the efficacy of standard and antiseptic devices in reducing catheter-related infections in burn patients. Twenty-two patients were included in the study with an average age of 47.6 yr and an average burned total body surface area of 38.7%. Thirty-eight silver-sulphadiazine, chlorhexidine catheters were compared with 40 non-antiseptic catheters. No differences in bacteraemia or colonization rates were observed between standard and antiseptic-coated catheters. Antiseptic catheters were more effective in reducing S. epidermidis colonization than standard catheters (4% vs 31%, p < 0.01). However, Gram-negative bacilli were responsible more often than Gram-positive cocci for catheter tip colonization (53% vs 46%) and they were responsible for all the bacteraemias (5.1%) related to catheters in the present study. We conclude that antiseptic-impregnated catheters could be more effective for Gram-positive cocci and could therefore be less effective in patients with high Gram-negative bacilli bloodstream infection prevalence, as burn patients are. |
| 68 |
PRELIMINARY ESTIMATION OF THE PROGNOSTIC VALUE OF THE HAEMODYNAMIC RESULTS OF DOPPLER EXAMINATION IN SEVERELY BURNED PATIENTS
(Bujok G. - Poland)
It is difficult to define all cardiac risk factors in the course of burn treatment. The adequate function of the circulatory system is the main factor in successful therapy. The aim of this study was to define, using a transoesophageal Doppler system, the cardiac circulatory risk factors of death in burn patients. One hundred and forty-seven burn patients were divided into two groups defined as survivors and non-survivors. In both groups the following haemodynamic parameters were analysed: 1. cardiac output; 2. stroke volume (SV); 3. heart rate (HR); 4. flow time (FT); 5. peak velocity; 6. average acceleration. The differential statistical significance was evidenced by analysis of SV, FT, and HR, using the ANOVA test. All the results showed that the best predictor factors for survival were SV and HR. |
| 71 |
PYODERMA GANGRENOSUM AND FULL-THICKNESS BURNS: IS THERE A PROBLEM OF DIFFERENTIAL DIAGNOSIS?
(Napoli B., D'Arpa N., Conte F. - Italy)
A case is presented of pyoderma gangrenosum, describing its characteristic features with particular reference to the phenomenon of pathergy, which considerably limits the surgical approach to the disease. After an account of the numerous skin ulcerations that have to be taken into consideration in order to make a differential diagnosis, it is noted that pyoderma gangrenosum can only on rare occasions be confused with a full-thickness granulating burn . |
| 74 |
INTUBATION DIFFICILE CHEZ LE BRULE DE LA FACE ET DU COU A LA PHASE DE SEQUELLES
(Siah S., El Wali A., Ababou K., Nassim Sabah T., Drissi N.K., Ihrai I. - Maroc)
L'intubation trachéale chez le brûlé de la face et du cou au stade de séquelles peut être difficile voire impossible chez certains patients. La technique de ventilation à l'aide d'un masque laryngé ou d'intubation avec un fibroscope bronchique permet de résoudre la plupart des problèmes d'intubation difficile. Les Auteurs rapportent deux observations chez deux patientes porteuses de séquelles de brûlures de la face et du cou. |
| 78 |
EARLY SEQUENTIAL EXCISION OF CHEMICAL BURNS - OUR EXPERIENCE IN RIYADH BURNS UNIT
(Bhat F.A. - Kingdom of Saudi Arabia
This paper reports on the treatment of chemical burns in a burns unit in Saudi Arabia in the 10-yr period 1993 to 2003. In 1993, in line with new approaches, the protocol for treating deep chemical burns in the first 48 h was modified to employ sequential excision followed by a second-look approach after 24 h, at which stage autografts/homografts were effected, depending upon the extent of the burn and having ascertained that the wound was bleeding and that there was no necrotic tissue. Results have much improved with this new approach. Three hundred cases of chemical burns are reviewed. Early sequential excision is recommended, followed by immediate grafting within 24 h post-excision. |
| 80 |
NON-OPERATIVE TREATMENT OF HYPERTROPHIC SCARS AND KELOIDS AFTER BURNS IN CHILDREN
(Argirova M., Hadjiski O., Victorova A. - Bulgaria)
Scars are a consequence of the natural way of wound healing and replacement of the damaged part of the skin. Hypertrophic scars and keloids are formed as a result of the process of abnormal wound healing, causing aesthetic and functional deformities, discomfort, and disturbance of children's normal growth. The prophylaxis and treatment of these scars, i.e. burns sequelae, are a significant moment in the treatment of children with burns. The objectives of the present study are methods for the prophylaxis and non-operative treatment of hypertrophic scars and keloids in children with burns. Altogether, 547 children with 485 burns sequelae - fresh scars in the period of healing and old hypertrophic scars (377) and keloids (108) - were treated in our Clinic of Children's Burns for a period of five years. The age of the patients varied between 0 and 18 years. Non-operative treatment was applied in 276 children. The patients were divided into two groups according to the treatment applied. Compression, intralesional application of triamcinolone acetonide, and silicone sheets were employed in the first group (84.06%), while only silicone sheets were applied to children in the second group (15.94%). Unaffected areas and areas adjacent to the scar were used as control areas. The sequelae monitored in both groups were assessed using the Vancouver Scar Scale. The children were monitored in an out-patient department. The results obtained are regardless of age, anatomical location, and scar aetiology. In old scars, and especially in keloids, the treatment proved to have variable results, according to the assessment parameters. We were satisfied with the improvement of the parameters during the course of treatment and with the good final results, which we consider a therapeutic success. Analysis of the results shows that the parameters improved slowly during the course of treatment, the process being most active during the first few weeks. The use of compressive therapy, the intralesional application of triamcinolone acetonide, and silicone sheets may prevent and minimize the formation of hypertrophic scars and keloids. The methods of non-operative treatment of these abnormal scars continue to be discussed and developed. |
| 88 |
EFFECTS OF HIGH-FREQUENCY OSCILLATORY VENTILATION AND PARTIAL LIQUID VENTILATION ON ACUTE LUNG INJURY INDUCED BY STEAM INHALATION IN NEW ZEALAND RABBITS
(Wang S.-G., Guo G.-H., Fu Z.-H., Zhou S.-F. - People's Republic of China)
Objective: to investigate the beneficial effects of high-frequency oscillatory ventilation (HFOV) and partial liquid ventilation (PLV) in treating acute lung injury induced by steam inhalation. Design: a prospective, randomized, controlled, multiple-group study. Setting: an animal research centre laboratory in a university burns centre. Subjects: New Zealand rabbits (n = 30; 2.25 ± 0.25 kg) of either sex. Interventions: the animals were ventilated by HFOV with a mean airway pressure of 10 cm H2O, a frequency of 10 Hz, an amplitude of 20 cm H2O, an I:E ratio of 1:1, and an FiO2 of 1.0. After the induction of acute lung injury by steam inhalation, the animals were randomly assigned to receive either HFOV alone or a combined therapy of HFOV + PLV. The animals were grouped as HFOV, HFOV + PLV, and control group (without ventilation after recovery from muscular relaxation). Measurements and main results: arterial blood gases, cardiovascular haemodynamics, dynamic lung compliance, and total lung injury scores were measured. After steam inhalation, all three groups displayed low PaO2 and low dynamic lung compliance. In the control group all the animals died within 3 h. In the HFOV and HFOV + PLV groups, all the animals displayed significant improvements in dynamic lung compliance, oxygenation, and histological outcomes; HFOV + PLV showed the best results. Conclusion: in a New Zealand rabbit model of steam inhalation injury, HFOV improved oxygenation, increased dynamic lung compliance, and alleviated lung histological injury. Combined therapy with HFOV + PLV was clearly superior to that with HFOV alone during the observation period |
| 95 |
CATASTROPHE IN ASUNCIÓN, PARAGUAY
(Balmelli B., Aquino O., Insaurralde M., Romero F. - Paraguay)
On Sunday 1 August 2004, at noon, in a well-known supermarket (Ycua Bolaños) on the outskirts of Asunción, the capital of Paraguay, there was a violent explosion in the fast-food section. This was caused by a build-up of gases in the chimneys of the kitchen. The flames spread rapidly through the air ducts, causing a huge fire throughout the supermarket. When the fire broke out, there were about 1000 people present. According to official records, 424 people died in the disaster and 30 were reported missing. Various medical institutions admitted a total number of 360 patients with third-degree burns and/or damage to the airways. One hundred and eighteen patients were treated in the Reconstructive Plastic Surgery and Burns Department of the Institute of Social Welfare Hospital, the centre of reference for the capital of Paraguay. |
| 99 |
CASE REPORT: HOME OXYGEN THERAPY AND CIGARETTE SMOKING: A DANGEROUS PRACTICE
(Lindford A.J., Tehrani H., Sassoon E.M., O'Neill T.J. - United Kingdom)
Oxygen as a therapeutic agent is an important form of home therapy for hypoxic chronic obstructive pulmonary disease (COPD) and improved survival has been demonstrated in hypoxic COPD patients receiving continuous oxygen. However, some patients, despite dissuasion, continue to smoke and we describe the case of a patient on home oxygen who sustained a partial-thickness facial flash burn whilst engaged in this habit. A review is made of the literature, as also a comparison of all discovered cases of burns in home oxygen users, followed by a discussion of the implications of this potentially hazardous form of therapy. |
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