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Volume XX |
Number 2 |
June 2007 |
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SUMMARIES
| 59 |
BURN INJURIES IN A YOUNG NIGERIAN TEACHING HOSPITAL
(Olaitan P.B., Fadiora S.O., Agodirin O.S. - Nigeria)
A total of 36 patients were seen and managed at the Ladoke Akintola University of Technology Teaching Hospital, Osogbo, Osun State, Nigeria, over a period of five years (2000 to 2004). There were 28 males and 8 females (male to female ratio, 3.5:1). The ages ranged from 1 to 46 yr (mean, 14.5 yr). The burn surface area percentage ranged between 2.5 and 70% (mean, 22.9%). Flame constituted the commonest source of injury (66.7%). Other agents were scalding (9 patients = 25%) and electrical burns (3 patients = 8.3%). The sources of flame burns were kerosene lantern/stove explosion (7 patients = 29.2%); petrol explosion (7 patients = 29.2%); road accidents followed by an explosion (3 patients = 12.5%); one case each (4.2%%) involving ethanol explosion, gun powder explosion, firewood, a lighted candle that ignited furniture and then a whole house; and other unexplained sources (3 patients = 12.5%). Mortality in this study was 7 cases (19.4%). Death was due to acute respiratory distress syndrome in one patient, sepsis in five, and tetanus infection in one. We conclude that most of the injuries were preventable. Education regarding refuelling a lighted lantern/stove, discouraging the storing of petrol in the house, and driving with care will reduce the number of accidents and subsequent possible burn injuries. Children should be monitored carefully to prevent scalding from hot water and food. |
| 62 |
SEPTICAEMIA IN SCALD AND FLAME BURNS: APPRAISAL OF SIGNIFICANT DIFFERENCES
(Bang R.L., Sharma P.N., Bang S., Mokaddas E.M., Ebrahim M.K., Ghoneim I.E. - Kuwait)
One hundred and sixty burn patients suffering from septicaemia, hospitalized in the Al-Babtain Centre burns unit, Kuwait, between June 1992 and May 2001, were studied. Thirty-two patients (20%) had scalds and 128 (80%) flame burns, thus representing a ratio of 1:4 among septicaemic patients. There were 20 males (62.5%) in the scald group, compared to 73 (57%) with flame burns. Flame burns were significantly higher (p < 0.01) among non-Kuwaiti patients. The mean ages of the scald and flame burn patients were respectively 6.2 and 31.5 yr. The mean total body surface area burn in scalds was 20% and in flame burns 49%, which was significantly higher (p < 0.001). The 34 septicaemic episodes in 32 scald patients and 212 such episodes in 128 flame burn patients showed a significantly higher incidence in the latter group. The majority of septicaemic episodes, in scalds (82.4%) and flame burns (57.6%), were due to gram-positive organisms, mainly methicillin-resistant Staphylococcus aureus and methicillin-resistant Staphylococcus epidermidis. A significantly increased number of episodes were due to S. aureus (p < 0.001) and Enterococcus (p < 0.05) in scald patients. More surgical operations were performed in flame burn patients and survival increased significantly with an increasing number of grafting sessions (p < 0.001). The mean hospital stay in flame burn patients (56 days) was significantly higher than in scald patients (23 days) (p < 0.001). It is significant to record that all the 38 deaths (29.7%) were in flame burn septicaemic patients (p < 0.001). The scald and flame burn patients were quite distinct in their demographic and clinical characteristics. The flame burn patients were more vulnerable to septicaemia, with a high risk of mortality. |
| 69 |
BRULURES PROFONDES DES MEMBRES APRES INTOXICATION AU CO PAR USAGE DU BARBECUE TRADITIONNEL EN SALLE DE BAIN
(Chraïbi R., Moussaoui A., Tourabi K., Ennouhi A., Ihrai H., Hassam B. - Maroc)
En l'absence des moyens de chauffage moderne à domicile chez une proportion non négligeable des Marocains, le recours au moyen traditionnel est fréquent. A travers six observations de brûlures profondes des membres, particulières par leur mode de survenue et par leur gravité, les Auteurs attirent l'attention sur le danger de l'utilisation du barbecue traditionnel «majmer» pour réchauffement en milieu clos. |
| 72 |
CLINICAL EXPERIENCE IN USING THE WATER JET IN BURN WOUND DEBRIDEMENT
(Yang J.-Y., Hwuang J.-Y., Chuang S.-S. - Taiwan)
Water jets have been used in many areas of surgery. Recently a new surgical debridement device was launched onto the market - VersajetTM. VersajetTM is a unique hydrosurgical device that uses a precise jet of water to simultaneously hold, cut, and remove devitalized or necrotic tissue. This paper describes our experience with ten patients comparing Weck knives with the newly designed hydrosurgical device when debriding burn wounds. The patients' age ranged from 27 to 60 yr (average, 37.8 yr) and the burn wounds treated were between 3 and 7% total body surface area, involving the face, abdomen, and limbs. The hydrosurgical system is a very useful tool for irregular and complex burn wound debridement. This paper represents the first written clinical experience utilizing hydrosurgery in the burn wound management in an Eastern country. |
| 78 |
ALDEHYDE-TREATED PORCINE SKIN VERSUS BIOBRANE AS BIOSYNTHETIC SKIN SUBSTITUTES FOR EXCISED BURN WOUNDS: CASE SERIES AND REVIEW OF THE LITERATURE
(El-Khatib H.A., Hammouda A., Al-Ghol A., Habib B. Al-Basti. - Qatar)
Background. The use of skin substitutes as temporary or permanent coverings has been a subject of research and study since 1500 BC. Temporary coverage of the burn wound can decrease the metabolic rate, fluid loss, pain, and colonization. The aim of this study is to review clinical experience with Biobrane and aldehyde-treated porcine skin (E.Z. Derm) as biosynthetic skin substitutes for the treatment of excised burn wounds. Methods. Fifty-two patients (42 males and 10 females) with deep dermal and full-thickness burns were selected for this retrospective study. Half of these patients were treated with Biobrane (this part of the study covered the period Jan. 1995/Dec. 1999) and the other half were treated with E.Z. Derm (Jan. 2000/Dec. 2005). The mean total body surface area (TBSA) burned was 30%. The excisional therapy was carried out in stages, each procedure being limited to 7-15% TBSA. All the patients underwent either tangential excision or excision down to the muscle fascia. The male/female ratio was 3:1 and the patients' ages ranged between 5 and 67 yr (mean, 35 yr). Data collection included: initial observation (age, sex extent of burn, depth of burn, photograph), skin substitute observation (adherence, presence of fluid collection, rejection, infection, photograph), and follow-up wound evaluation. Results. Both Biobrane and E.Z. Derm reduced pain, decreased evaporative water and heat loss, and limited bacterial growth. Both decreased exudative protein loss, protected the underlying vessels and nerves, and enhanced the healing of partial-thickness wounds. Both promoted the development of granulation tissues to be ready for autografting, and neither presented antigenicity or transmitted diseases. Porcine skin showed limited wound adhesion and limited control of infection compared to Biobrane. Conclusion. Biobrane and E.Z. Derm protected excised burn wounds from bacterial contamination and dehydration. It can be concluded that Biobrane has the potential for long-term adherence (10 days). Aldehyde-treated porcine skin (E.Z. Derm) is a reliable tool for short-term use and should not remain on the wound more than 3-4 days. |
| 83 |
ANTIMICROBIAL EFFECT OF BEE HONEY IN COMPARISON TO ANTIBIOTICS ON ORGANISMS ISOLATED FROM INFECTED BURNS
(Abd-El Aal A.M., El-Hadidy M.R., El-Mashad N.B., El-Sebaie A.H. - Egypt)
Despite recent advances in antimicrobial chemotherapy and burn wound management, infection continues to be an important problem in burns. Honey is the most famous rediscovered remedy that is used to treat infected wounds and promote healing. The present study aims to evaluate the antimicrobial effect of bee honey on organisms isolated from infected burns in comparison to the antibiotics used in treatment of burn infection, and to evaluate the effects produced when bee honey is added to antibiotic discs. Thirty patients with burn infection were selected for this study. The collected specimens were cultured on blood agar plates. The isolated colonies were identified by different methods. The isolated organisms were inoculated onto Müller-Hinton agar. Each agar plate was divided by a marker pen into two halves - in one half the antibiotic discs were plated while on the opposite side each antibiotic disc, immersed in honey, was plated opposite to the same antibiotic disc. At the centre of the agar, a sterile filter paper disc immersed in honey was applied. The most frequently isolated organism was Pseudomonas aeruginosa, representing 53.3% of the isolates. The mean inhibition zones (in mm) produced by honey (18.2 ± 2.5 mm) when applied to isolated gram-negative bacteria were significantly higher than amoxicillin/clavulinic acid, sulbactam/ampicillin, and ceftriaxone (p1 = 0.005 for each). When honey was added to the antibiotic discs there was highly significant increased sensitivity of isolated gram-negative bacteria compared with each of the antibiotic discs alone and with honey alone. The susceptibility of isolated staphylococci revealed the synergistic effect of added honey to the antibiotic discs tested. The antimicrobial effect of honey (18.7 ± 2.2 mm) was significantly higher than antibiotics - ciprofloxacin, sulbactam/ampicillin, ceftriaxone, and vancomycin (p1 ? 0.05 for each). After the addition of honey to the tested antibiotic discs there were highly significant increased inhibition zones of antibiotic mixed with honey compared with antibiotic alone - ciprofloxacin, vancomycin, and methicillin (p3 ? 0.001 for each). Also, the increase was significant compared with antibiotics alone - imipenem, amoxicillin/clavulinic acid, and ceftriaxone (p3 ? 0.05). In conclusion, honey had more inhibitory effect (85.7%) on isolated gram-negative bacteria (Pseudomonas aeruginosa, Enterobacter spp., Klebsiella) than commonly used antibiotics, while it had an inhibitory effect on all methicillin-resistant Staphylococcus aureus (100%) compared with antibiotics used. A synergistic effect of honey was observed when it was added to antibiotics for gram-negative bacteria and also for coagulase-positive staphylococci. |
| 89 |
A STUDY ON BIOMARKERS, CYTOKINES, AND GROWTH FACTORS IN CHILDREN WITH BURN INJURIES
(Abdel-Hafez N.M.1, Saleh Hassan Y.2, El-Metwally T.H. - Egypt)
Background. Burns are a unique injury which not only is devastating for the patients but also puts a great burden on society by consuming enormous health care resources. Despite improvements in burn wound care and treatment, understanding the role of pro-inflammatory and anti-inflammatory cytokines as well as the mechanisms responsible for the healing process remains to be clarified. Although leptin is regarded as a circulating hormone, it can exert a direct effect on T cells and monocytes, causing the release of cytokines. It may induce angiogenesis or influence angiogenic factors. The aim of the present work is to determine serum levels of leptin, tumour necrosis factor a (TNFa), interleukin-6 (IL-6), basic fibroblast growth factor (bFGF), procalcitonin (PCT), and C-reactive protein (CRP) in a group of children with thermal burns and to determine the changes in these parameters in relation to the duration of hospital stay, the presence of infection, and the total body surface area (TBSA) burned. Patients and methods. The study included 42 children with burns (22 males and 20 females; age range, 2 months to 7 years). The study also included 26 age-matched controls. Besides full clinical assessment, including assessment of TBSA burned and the presence or absence of sepsis, all the patients and controls had the following investigations performed: complete blood count, CRP, IL-6, TNFa, PCT, serum leptin, bFGF, and transforming growth factor a (TGFa). Results. The fatality rate in this study was 28.6%. Burn cases as a whole showed significantly higher values of white blood cells (WBC), CRP, PCT, TNFa, IL-6, leptin, bFGF, and TGFa than controls. Cases with sepsis showed significantly higher values of WBC, CRP, PCT, TNFa, and IL-6 than cases without sepsis. They showed significantly lower values of TGFa than cases without sepsis. Patients with larger TBSA (>30%) showed significantly higher levels of WBC, CRP, PCT, TNFa, IL-6, and leptin than cases with smaller TBSA. They showed significantly lower levels of bFGF and TGFa than patients with smaller TBSA. Non-survivors showed significantly higher levels of WBC, CRP, PCT, TNFa, and IL-6 than survivors. They showed significantly lower levels of leptin, bFGF, and TGFa than survivors. Correlation studies showed a significant positive correlation between TBSA and each of IL-6, TNFa, and leptin. Conclusions. Cytokines and leptin increased in severely burned patients, cases associated with sepsis, and in fatal cases, while bFGF and TGFa levels were lower in severe cases. This may point to impaired healing in such cases and to their poorer prognosis. Recommendations. It is highly recommended to monitor immunological parameters such as PCT and/or IL-6 for early detection of infectious complications following thermal injury. Leptin can be regarded as a novel treatment modality to diminish burn-induced inflammation, reduce post-burn immune dysfunction, and enhance burn healing. |
| 101 |
FIRE DISASTERS IN THE TWENTIETH CENTURY
(Cavallini M., Papagni M.F., Baruffaldi Preis F.W. - Italy)
In the field of natural and man-made disasters, fire has played a predominant role. A report is presented of fire disasters in the twentieth century, with a chronological analysis of different worldwide typologies. |
| 104 |
Case report: DEEP BURNS CAUSED BY FAR-INFRARED RAYS IN A CHIROPRACTIC SALES CENTRE
(Habib M.E., Punnoose T., Thomas C. - Sultanate of Oman)
We report the case of a patient who sustained a deep burn in the right ankle as a result of using far-infrared rays for the management of chronic pain in that site. The burn was sustained in a chiropractic sales centre. We recommend medical supervision in such centres and strict adherence to safety precautions. |
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