||IONTOPHORESIS IN THE TREATMENT OF BURN EAR CHONDRITIS
(Peled 1.j., Zagher U., Rotem M. - Israel)
Burn chondritis of the ear is quite a common complication with difficult treatment and poor aesthetic results. We report the use of preventive and therapeutic iontophoresis with gentamicin and using a custom-made acrilic resin stent. This modality of treatment has rendered gratifying results and lessened the need for surgical procedures.
||TRAITEMENT ORTHETIOUE DE LA MAIN BRULEE
(Gavroy JA, Ster F. & J., Rouge D., Teot L., De Godebout J., Dossa J. - France)
Dès la première phase du traitement primitif des mains brûlées, le programme de réhabilitation comporte obligatoirement l'adaptation d'orthèses travaillant dans deux axes bien distincts mais souvent associés: le positionnement et la compression.
||THE PSYCHOLOGICAL RECOVERY OF THE BURN PATIENT: AN INTEGRATED REHABILITATION WORK PROGRAMME
(Amico W., Colaianni E., Mosca K., Masellis M. - Italy)
A programme is proposed to of the various professional figures involved. the psychological rehabilitation of the burn patient that takes into consideration the group-work The psychologist is the essential link between patient, physician, paramedical staff, physiotherapist, social worker and family. The programme was prepared on the basis of a suitably long period of observation by these professional figures of the events and the emotional climates in a Burns Centre.
||LA REEDLICATI-ON DES GRANDS BRULES - FILM VHS
(Gavroy J.L., Ster F. et J., De Godebout J. - France)
Comme conséquence de l'importante amélioration du pronostic vital, le problème des séquelles des brûlures se posera avec d'autant plus acuité et de fréquence. Le prélude à la rééducation, c'est le nursing. Il faut effectuer une prévention orthopédique dès l'installation au lit fluidisé, et la prévention des raideurs dès les premiers bains. Dés l'abord va se poser l'equation du traitement spécifique de la brûlure, c'est-à-dire des cicatrices qui vont se constituer; il faut donc éviter l'hypertrophie, la chéloïde, la rétraction, et l'induration. La solution, toujours imparfaite, c'est la compression. Outre les vêtements compressifs, des orthèses compressives préventives et correctives seront également confectionnées. On doit réaliser aussi, plusieurs fois par jour, de courts massages suivant une technique extrêmement précise. Naturellement les autres séquelles traumatiques seront abordées en même temps et la chirurgie secondaire, orthopédique ou plastique doit être insérée à la domande. Dès que l'aspect extérieur du patient le permet, les exercices collectifs sont indiqués.
||THE APPEARANCE OF AUTOIMMUNE PHENOMENA DURING POST-BURN THERAPY
(D'Arpa W., Masellis M., Lio R., Pipitone G. - Italy)
The literature offers numerous data indicating that the bum trauma causes a serious immune deficiency which profoundly affects the natural progress of the lesion. It is not however so well known if the imbalance of the immune system in such patients provokes the disappearance of autoimmune phenomena. This work assesses the appearance of organ specific and non-specific autoantibodies at different times after the bum lesion. It was found that anti-epithelial cell antibodies appeared rather late in 60% of the patients. This finding may account for some of the late complications of the -bum syndrome".
||CALORIMETRIC EVALUATION OF ENERGY EXPENDITURE IN BURNED PATIENTS
(Casadei k Enzi W, Chiarelli k Zurio F., Martini G., Campagna C. - Italy)
The human organism responds to diflerent types of stress (traumas, burns, infections) with an increase of energy expenditure and caloric requirement. In burned patients the resting metabolic rate (RMR) increases in relation to the burned surface area showing a weight loss due to increased catabolism, protein loss from burned surfaces and immobilization. Therefore, it is very important to evaluate energy expenditure of burned patients to ensure good nutritional administration both quantitatively and qualitatively. For this purpose, 6 burned patients (2 males and 4 females) (burned surface area 20-40% and average age 35.4 years +/- 5.2) were studied for 40 days at the Padua Burn Centre. During this period, the following nutrients were administered IN.: glucose 10%, amino acids (Freamine 111) and lipids (Intralipid 10%); others were given by naso-gastric tube: ready to use semi-liquid nutrients (Nutrisond Nutricia; 1 Keal/mL) and whenever needed: polysaline solutions, plasma, blood and albumin units. Energy expenditure was measured with open circuit indirect calorimetry (MMC Horizon Beckman Sensor Medies). Two types of measurements were carried out: 1) Basal Metabolic Rate (BMR), or energy expenditure of a patient at rest (on a patient, in the morning, fasted at least 12 hours at a constant temperature); and 2) Resting Metabolic Rate (RMR), or energy expenditure of a subject at rest who is continuously fed for at least 8 hours through a naso-gastric tube. During calorimetric tests, heart rate (HR) and axillary body temperature ('C) were monitored. The patients' BMR was 2090 +/- 148.5 Kcal. The BMR pattern was two-phase, with higher values at the end of the second week following the injury and a progressive decrease during the subsequent weeks.
||EPIDERMALIZATION OF AN ARTIFICIAL DERMIS MADE OF COLLAGEN
(Vescovali C., Damour 0., Shahabedin L., David M.F., Dantzer E., Marichy J., Collombel C., Echinard C. - France)
Since 1987 we have been developing a cultured epidermis, using H. Green's technique. This epithelium was intended to cover skin losses such as extensive burns or excisions of giant naevi. Skin was harvested from the patient when he was admitted; 1.5 X 106 keratinocytes were cultured with 2 x 106 3T3 fibroblasts. After 10 days, a subculture was performed. On day 21, the sheets of cells were grafted onto patients or animals. Results with this single technique were not very satisfactory: the quality of the skin was poor and contractures often appeared within 2 months. A fibrotic scar was formed under the epithelium. For this reason we also developed an artificial dermis made of human collagen, chitosan and glycosaminoglycans. The epidermal ization of this dermis was then undertaken. This was first performed in vivo in rats and nude mice. These works are still in progress. In vitro epithelialization was also done using Green's or Boyee's technique on artificial dermis prior to grafting. Recent data about these experimental studies will be reported.
||THE LOW AIR LOSS BED SYSTEM IN TREATMENT OF BURN PATIENTS
(Landi, 0., Catrani S., Mengozzi E, Greco 1, Erbazzi A., Arcangeli F., Feletti S. - Italy)
In the new Mediscus Mark 5A-M low air loss bed the patient lies on a mattress formed by five groups of air sacs, adjustable in each section to different air pressure and made of material permeable to water-vapour. This prevents the formation of pressure sores and ensures that the patient's skin is kept dry in a comfortable and controlled warm air atmosphere. In cases of severe burns the patient can be nursed supine for long periods without being turned and there is no friction against painful burn wounds. When skin grafts are applied, the patient may be placed on the bed resting on the grafts without significant damage. The bed can be easily positioned in order to achieve maximum patient comfort and it can be adapted to accommodate any medical emergency. The recent experiences with two low air loss beds in the care of burn patients over a period of six months are described.
||EMERGENCIES: REGIONAL APPROACHES TO GLOBAL PROBLEMS
(Gunn S.W.A. - Italy)
Generalized global planning in the field of disasters may be remote from regional realities. Two examples of organizations responsible for successful regional endeavours are the European Centre for Disaster Medicine, and the Mediterranean Burns Club, both of which emphasize training and believe in three main principles: a) efTective disaster management requires technical training; b) such training must be interdisciplinary; c) results are better when there is maximum common interest. An analysis is made of various principles concerning the scientific and technical basis of disaster management. It is pointed out that each disaster has its own epidemiological and pathological profile. Rescue studies show that immediate rescue is paramount - external help often arrives too late. This emphasizes the need to educate the general public. Training is necessary, as promoted by the European Centre for Disaster Medicine, in order to promote the prevention and mitigation of the effects of disasters through research, training courses, publishing and international cooperation. The Mediterranean Burns Club offers a specific surgical approach to the problem. The international community must have mechanisms for planning, mobilization and co~ordination in order to achieve maximum results. It has however been found that the action of the various international organizations is more efficient and etTective when organized and applied on a regional basis.
||A PROPOSAL FOR THE STRATEGIC PLANNING OF MEDICAL SERVICES IN THE CASE OF MAJOR FIRE DISASTERS IN THE CITY OF BARI
(Dioguardi R., Brienza E., Portincasa A., Di Lonardo A., Matarrese V. - Italy)
In view of the high level of industrialization in the City of Bari and the consequently large work-force, we considered it imperative to define a health strategy to be followed in the event of a fire disaster. The contents of this paper are part of a planning proposal presented to the different authorities in charge of managing the city and surrounding territory (Prefecture, Military Authorities, Town Council, Fire Brigade). As said, our objective was to identify, in the light of experience gained in other cities, potentially critical areas in the city, and in particular:
1) the industrial zone (the site of a thermoelectric power plant and oil refineries);
2) the railway stations;
3) the port area (with crude oil stocks).
We have also identified the main routes into and out of the city, transit routes for rescue vehicles, and prepared a thorough organizational plan. This strategy, which we are sure can only be successful with the intervention and control of the Armed Forces, proposes the following four phases of development:
* Alarm phase: by appropriate means of communication;
* Organizational phase: selection of a coordination centre;
. Activation phase: selection of three distinct operative areas plus field hospital;
. Specialist health treatment phase: Plastic surgery, burns surgery.
||STUDY OF AN EMERGENCY PLAN IN THE EVENT OF A VIOLENT FIRE IN A HIGH-RISE BUILDING
(Cannata E., Masellis M. - Italy)
An emergency fire plan should be prepared as early as the planning stages of a building so that due account may be taken of all safety factors, also with regard to the position of the building and its future use (hotel, hospital, offices, school, residential etc.). It often happens however that it is necessary to prepare the emergency plan when the building is already completed, and this paper deals with such a situation. Priority must be given to an examination of the architectural plans of the building and of accompanying reports in order to know all parameters regarding evacuation of persons in the event of a fire: the stairs (whether smokeproof, protected etc.), lifts, corridors and passageways, safe areas in the building, the number of floors, the density of persons per floor, the surface area and the cubic capacity of each floor and any activities of specific risk. Other factors considered concern the fire-resistance of the structures, the reaction to fire of the materials used, fire loads and any division into fireproof compartments. On the basin of hypotheses of where in the building fire may break out, it is possible to study how the flames may spread and how therefore persons and structures will be involved.