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Volume XIX |
Number 4 |
December 2006 |
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SUMMARIES
| 171 |
BURNS IN MALAWI
(Virich G., Lavy C.B.D. - Malawi)
Objective: To describe burns seen at the largest hospital in Malawi. Methods: In a prospective study conducted at Queen Elizabeth Central Hospital, Blantyre, Malawi, a series of twelve accidental burns was analysed over a four-week period. Results: Hot water was the commonest source of burns (6 out of 12). Open-fire and petroleum lamp accidents were the commonest cause of burns among epileptic patients. Males were affected more than females (male:female ratio = 8:4). Most burns were superficial (11 out of 12). One patient had deep burns requiring grafting. All patients were treated with topical silver sulphadiazine and a combination antibiotic regime. Children aged six yr or under were a major subgroup at risk of suffering burns (7 out of 12) and only one patient was aged over 30 yr. Lack of anti-epileptic medication resulted in potentially avoidable burns in four epileptic patients. Conclusions: There is a need for cheap preventive health promotion measures as well as the provision of simple resources as most burns encountered can be managed effectively by simple measures. |
| 174 |
MATERNAL AND FOETAL OUTCOME OF BURNS DURING PREGNANCY IN KERMANSHAH, IRAN
(Rezavand N., Seyedzadeh A. - Iran)
Burn injury is rare during pregnancy. However, severe burn injury during pregnancy is very dangerous for both mother and foetus. Maternal and foetal outcome depends on the mother's total body surface area (TBSA) burned. In women with more than 50% TBSA burned, foetal and maternal complications are considerable. Our study on pregnant women over a period of 12 years in Kermanshah, Iran, found 59.5% maternal mortality in the age range 21-40 yr. This study shows a positive correlation between foetal and maternal mortality, morbidity, and TBSA burned, with the highest rate in women with more than 50% TBSA. |
| 177 |
BURNS DURING PREGNANCY - EFFECT ON MATERNAL AND FOETAL OUTCOMES
(Subrahmanyam M. - India)
During a 5-yr period (1999-2004), of the 529 women of reproductive age admitted with burns, 44 (7.4%) were pregnant. Of these 44, 37 (84%) were in the age group 15-25 yr and 22 (50%) were in the second trimester; 33 burns (75%) were accidental and 11 (25%) the result of suicide attempts. Flame burns accounted for 42 out of the 44 cases (95.5%); two cases were due to scalds (4.5%). Maternal death occurred in 28 of the cases (63.6%) and foetal death in 29 (65.9%). The maternal complications that led to mortality were shock in 15 cases (53.6%), respiratory distress in 8 (28.6%) and sepsis in 14 (50.0%); one patient had corneal perforation. |
| 180 |
SEVERE BULLOUS SKIN DISEASES: ANALYSIS OF SEVEN CHILDREN MANAGED IN A BURNS UNIT
(Elkharaz S., Abdel-Razek E.M., Eldin A., Abdel-Razek A.M. - Kingdom of Saudi Arabia)
Patients suffering from considerable cutaneous loss must be treated under strict aseptic conditions and with positive pressure ventilation, which is available in burns units. The differentiation of severe bullous skin diseases remains a challenge for the clinician. We report seven cases of severe bullous skin diseases in a paediatric age group treated in a burns unit with the co-operation of a paediatric intensive care unit (King Saud Hospital, Unizah, Kingdom of Saudia Arabia) between 2001 and 2005. Toxic epidermal necrolysis (Lyell's syndrome) was encountered in five cases, staphylococcal scalded-skin syndrome in one, and generalized drug eruption in one. The mortality rate was 14% (one of the seven patients). Most of the children presented with about 35% desquamation and 45% intact bullous formation (70-80% total body surface area involvement). The majority presented after the sudden onset of high fever, signs of systemic toxicity, and intense mucocutaneous exfoliation. The diagnosis was confirmed by skin biopsy and culture swabs. All the patients were managed as for mixed second-degree burns with regard to fluid calculation and hydrotherapy. We used the closed technique for dressing. The results are presented, and the literature was searched for similar cases reported in other parts of the world. The importance of diagnosis and appropriate treatment of the condition is emphasized. |
| 188 |
STAPHYLOCOCCAL SCALDED SKIN SYNDROME: CRITERIA FOR DIFFERENTIAL DIAGNOSIS FROM LYELL'S SYNDROME. TWO CASES IN ADULT PATIENTS
(Napoli B., D'Arpa N., D'Amelio L., Chimenti S., Pileri D., Accardo-Palumbo A., Conte F. - Italy)
A review of the relative international literature of the last few years is followed by a description of two cases of staphylococcal scalded skin syndrome in adults. As in both cases the initial diagnosis was that of Lyell's syndrome, the main criteria for the differential diagnosis of the two pathologies are considered in order to permit specific and effective treatment. |
| 192 |
THE ROLE OF PORES IN ACELLULAR DERMAL MATRIX SUBSTITUTE
(Xiao S.-C., Xia Z.-F., Ben D.-F., Tang H.-T., Wang G.-Q., Zhu S.-H., Yu W.-R. - People's Republic of China)
To promote the engraftment rate of autologous skin combined with acellular dermal matrix (ADM), ADM was punched to produce regular pores from 500 to 800 µm in diameter, separated by a distance of 3 to 5 mm. The porous ADM was then implanted beneath the flap and transplanted onto an open full-thickness defect wound combined with autografts about 0.2 mm thick in a rat model. The change in diameter of pores in ADM and the neovascularization of ADM matrix were evaluated, and the take rate of porous ADM combined with overlying autologous skin was compared with that of non-porous ADM. The results showed that when porous ADM was grafted onto the full-thickness skin excised wound, plasma penetrated from the wound bed to the surface of ADM through these pores, i.e. the pores punched on ADM were responsible for the imbibition function. Subdermal implantation of ADM indicated that one week post-operation the pores in ADM were still detectable, and some of them contained red blood cells. Two to three weeks after grafting the pores became smaller, partly because of newly synthesized collagen matrix deposition. In Sprague-Dawley rats the engraftment rate of autologous sheet skin graft placed over ADM with pores was 89.5%, which was significantly higher than ADM without pores (63.2%). It is concluded that porous ADM could serve as a good dermal substitute. |
| 196 |
ANTITHROMBIN III PREVENTS EARLY BACTERIAL TRANSLOCATION IN BURN INJURY
(Herek Ö.1, Y¦lmaz M., Kaleli I., Cevahir N., Demirkan N. - Turkey)
We experimentally studied the effects of antithrombin III (AT III) on bacterial translocation (BT) and intestinal morphology in the early period of burn injury. For this aim, 30 male albino rats were used. A sham burn group (group 1, no. 10) was exposed to 21 °C water. A burn group (group 2, no. 10) and a burn + AT III group (group 3, no. 10) were exposed to 95 °C water for 10 sec, producing full-thickness burn in 30% of the total body surface area. In group 3 the rats received 250 U/kg AT III via the right jugular vein, 15 min before burn injury. One ml 0.9% NaCl was given as a placebo in group 1 and in two rats by the same route. All group 3 rats were sacrificed on day 2 post-burn using an overdose anaesthetic. Cultures of the mesenteric lymph nodes, liver, spleen, blood, and caecal contents were performed. Histopathological examinations, including polymorph nuclear leukocyte (PNL) infiltration and villus morphologies, were qualitatively evaluated on the resected distal ileal segment. The incidence of BT was 1/10 (10%) in group 1, 7/10 (70%) in group 2, and 1/10 (10%) in group 3. A significant increase in BT incidence was observed in group 2 compared with groups 1 and 3 (p = 0.02), while a significant decrease in BT incidence was found in group 3 rats with AT III treatment. Although the PNL infiltration rate was reduced by AT III treatment, a significant decrease was not found compared with group 2 (50% and 90%, respectively). On the other hand, the villus degeneration rate was significantly reduced by AT III treatment compared with group 2 (30% and 90%, respectively). These results suggest that the incidence of BT was enhanced by the burn injury. AT III decreased the incidence of BT in the early period of burn injury. We conclude that AT III can be effectively used to protect from intestinal mucosal injury and to prevent bacterial translocation, especially in early post-burn period. |
| 201 |
COMPARATIVE ANTIBACTERIAL ACTIVITY OF HONEY AND GENTAMICIN AGAINST ESCHERICHIA COLI AND PSEUDOMONAS AERUGINOSA
(Adeleke O.E., Olaitan J.O., Okpekpe E.I. - Nigeria)
The clinical significance of Pseudomonas aeruginosa and Escherichia coli is a strong factor for regular monitoring of their sensitivity to both established and novel antimicrobial compounds. Human isolates of these organisms were collected from different pathological sources and tested for their sensitivity to gentamicin - an established aminoglycoside antibiotic - and to honey, a natural product that is generating renewed interest for its therapeutic application. In an agar-cup diffusion method, three undiluted different samples of honey and their 1:2 to 1:6 aq. dilutions showed activity on 100% and 96.4% respectively of Pseudomonas aeruginosa isolates compared with 95.4% of Escherichia coli using either of the undiluted or 1:2 aq. dilutions of the honey samples. Gentamicin used in concentrations of 8.0 and 4.0 µg/ml varied in its activity against both organisms but was generally lower than the antibacterial activity of each undiluted honey and its 1:2 aq. dilution. In the event of therapeutic failure with genta-micin or any other related antibiotics, honey offers a suitable and better alternative in managing infected burn wounds and other forms of infected wounds as well as prophylaxis in trauma wounds. |
| 205 |
LES LESIONS OCULAIRES PAR JEU DE FEU AU COURS DE ACHOURA
(El Ketani A., Amir F., Ali T.B., Hamdani M., Zaghloul K. - Maroc)
Les enfants célèbrent la fête de Achoura au Maroc par des jeux de feu, ce qui occasionne des blessures oculaires plus au moins graves. Nous rapportons 15 observations de malades traités au Service d'Ophtalmologie Pédiatrique de l'Hôpital 20 Août 1953 de Casablanca. L'âge moyen des patients était de 12 ans et demi, avec des extrêmes de 3 et 25 ans. Les pétards, la première cause des accidents (50%), ont occasionné des contusions oculaires avec parfois un odème de Berlin (deux cas). L'atteinte oculaire par fusée a occasionné un éclatement de globe et une plaie de paupière. Les bombes de carbone ont été responsables de brûlures de deuxième degré palpébrales et conjonctivo-cornéennes avec de multiples corps étrangers cornéens profonds. Les «étoiles» et la limaille de fer ont provoqué des brûlures cornéennes moins graves avec des corps étrangers superficiels. Les pistolets à bille ont été responsables de contusions oculaires. La réglementation de vente des jeux de feu et la sensibilisation du grand public par les moyens audiovisuels permettraient de prévenir ces blessures oculaires. |
| 208 |
PLANNING AND TECHNICAL DETAILS WHEN TREATING A POST-BURN HAND CONTRACTURE
(Kola N., Isaraj S., Belba G.J. - Albania)
Hand contractures are still a problem in everyday plastic surgery practice. We decided to review the hand contractures we had treated over a 5-yr period (2000-2004) and to present some guidelines for their prevention. In the 5-yr period we operated on 206 patients with hand contractures. The number of patients demonstrates that not infrequently our plastic surgeons still have to treat this condition. The age group most liable to this form of burns sequelae is that of children up to five years old, because of the deeper burns they suffer in the hands. The surgical approach to post-burn contractures of the hand is discussed from three aspects: the skin aspect, the osteotendinous aspect, and the wound closure procedure. The discussion puts special stress on the risk of impairing blood supply to the distal phalanges, which is related not only to the involvement of the arteries in the scar tissue but also to spasms or accidental damage in the digital arteries. Special attention must be paid when the fifth finger is interested. |
| 212 |
CASE REPORT:ETIOLOGIE RARE DE SINUSITES NOSOCOMIALES EN MILIEU DE REANIMATION - A PROPOS D'UNE OBSERVATION
(Messadi A.A., Oueslati S., Thabet L., Bousselmi K., Menif E. - Tunisie)
Les sinusites nosocomiales ne sont pas rares en réanimation. Elles surviennent en général dans les suites d'une intubation nasotrachéale voire même orotrachéale. Le tubage gastrique peut être à lui seul à l'origine d'une sinusite nosocomiale. Nous rapportons le cas d'une patiente hospitalisée qui a été victime de brûlures étendues chez qui la sonde nasogastrique a été à l'origine d'une pansinusite dont l'issue a été fatale. |
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