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Volume XXI |
Number 4 |
December 2008 |
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SUMMARIES
| 171 |
EPIDEMIOLOGICAL SURVEY OF BURN VICTIMS TREATED AS EMERGENCY CASES IN OUR HOSPITAL IN THE LAST FIVE YEARS
(Castana O., Anagiotos G., Dagdelenis J., Tsagoulis N., Giannakidou M., Roidi D., Alexakis D. - Greece)
We present a retrospective epidemiological study based on 1061 patients admitted to our burns centre in Greece over the 5-yr period from January 2002 to January 2007. Their average age was 25 yr, and 61% were female. The two main causes of burns were scalding and flames. Other significant causes were chemicals and friction. Electricity, frostbite, and contact burns were less frequent. The upper extremity and face were most commonly affected, followed by the lower limbs. All the patients had minor burns (less than 20% total body surface) and were treated on an out-patient basis as there was no need for hospitalization. |
| 175 |
NUTRITIONAL AND PHARMACOLOGICAL MODULATION OF THE METABOLIC RESPONSE OF SEVERELY BURNED PATIENTS: REVIEW OF THE LITERATURE (PART III)
(Atiyeh B.S., Gunn S.W.A., Dibo S.A. - Lebanon)
Severe burn patients are some of the most challenging critically ill patients, with an extreme state of physiological stress and an overwhelming systemic metabolic response. Increased energy expenditure to cope with this insult necessitates mobilization of large amounts of substrate from fat stores and active muscle for repair and fuel, leading to catabolism. The hypermetabolic response can last for as long as nine months to one year after injury and is associated with impaired wound healing, increased infection risks, erosion of lean body mass, hampered rehabilitation, and delayed reintegration of burn survivors into society. Reversal of the hypermetabolic response by manipulating the patient's physiological and biochemical environment through the administration of specific nutrients, growth factors, or other agents, often in pharmacological doses, is emerging as an essential component of the state of the art in severe burn management. Early enteral nutritional support, control of hyperglycaemia, blockade of catecholamine response, and use of anabolic steroids have all been proposed to attenuate hypermetabolism or to blunt catabolism associated with severe burn injury. The present study is a literature review of the proposed nutritional and metabolic therapeutic measures in order to determine evidence-based best practice. Unfortunately, the present state of our knowledge does not allow the formulation of clear-cut guidelines. Only general trends can be outlined which will certainly have some practical applications but above all will dictate future research in the field. |
| 182 |
CONCENTRATIONS OF CYTOKINES IL-6 AND IL-10 IN PLASMA OF BURN PATIENTS: THEIR RELATIONSHIP TO SEPSIS AND OUTCOME
(Pileri D., Accardo Palombo A., D'Amelio L., D'Arpa N., Amato G., Masellis A.,Cataldo V., Mogavero R., Napoli B., Lombardo C., Conte C. - Italy)
Burn injury induces a suppression of the Th1 response, which is associated with an increased susceptibility to conditions of infection, morbidity, and mortality. It is well established that cytokines modulate the pathogenesis of burn injury. In this study, plasma levels of interleukin-6 (IL-6) and interleukin-10 (IL-10) were determined in burn patients and correlated with the severity of sepsis. Sixty adult burn patients (total body surface area burned, 8-80%) were included in the study, of whom 34 developed sepsis and 14 died. The nonseptic group consisted of 26 patients. Thirty-one healthy blood donors served as controls. Patients were not treated with antibiotics until sepsis occurred. Plasma samples were collected immediately post-burn and after several days, and cytokine concentrations were determined by ELISA. Within three days, all the patients presented high levels of circulating IL-6, which were significantly higher in septic patients than in nonseptic patients (349 ± 278 vs 63 ± 56 pg/ml, p < 0.001). IL-10 levels were higher in septic patients than in nonseptic patients at all times in our study. The value of 60 pg/ml shows a sensitivity of 92% and a specificity of 93% in the differentiation of survivor from nonsurvivor septic patients. In this study the high value of circulating IL-10 on day 3 suggests that cytokine may discriminate between nonsurvivor septic and survivor septic patients. |
| 186 |
ROLE OF ANTIOXIDANTS IN THE TREATMENT OF BURN LESIONS
(Al-Jawad F.H., Sahib A.S., Al-Kaisy A.A. - Iraq)
Burns are a major health problem worldwide, with high mortality and morbidity in addition to causing changes in the quality of life of burn patients. Utilizing antioxidant therapeutic strategies depending on new mechanisms involved in the pathogenesis of burns-related "oxidative stress" may be considered a promising step in burns management. This study involved 180 burn patients of varying age and either sex and with varying burns percentages. The patients were subdivided into six groups (A, B, C, D, E, and F); each group thus included 30 patients. Patients in groups B, C, D, E, and F were treated with antioxidants (vitamin E with vitamin C, zinc sulphate, allopurinol, melatonin, and N-acetylcysteine respectively) while group A was treated according to hospital policy, without any antioxidant; also, healthy subjects (group G) were involved in the study as a control group for comparison. In each group we examined serum malondialdehyde and serum glutathione levels, serum zinc and copper levels, liver function, renal function, mortality rate, and healing time, using standard methods. It was found that the administration of antioxidants to burn patients produced significant improvement in the parameters studied compared with group A (no antioxidant given). This study clearly shows the importance of the therapeutic targeting of oxidative stress in the treatment of burns. It is important to consider antioxidant a most effective weapon that must be added to the arsenal available in the combating of burn complications. |
| 192 |
BLOOD GASES AS AN INDICATOR OF INHALATION INJURY AND PROGNOSIS IN BURN PATIENTS
(Megahed M.A., Ghareeb F., Kishk T., El-Barah A., Abou-Gereda H., El-Fol H., El-Sisy A., Omran A.M. - Egypt)
Inhalation injury greatly increases the incidence of respiratory failure and the acute respiratory distress syndrome. It is also the cause of most early deaths in burn victims. The aim of our research was to study the incidence, early diagnosis, complications, and management of inhalation injury and to discuss the relation between inhalation injury and death in burn patients. This study included 130 burn patients with inhalation injury admitted to Menoufiya University Hospital Burn Center, Egypt, from January 2004 to April 2008 (61 males and 69 females). We found that the presence of inhalation injury, increasing burn size, and advancing age were all associated with increased mortality (p < 0.01). The incidence of inhalation injury in our study was 46.3% (130 patients were identified as having inhalation injury out of 281). The overall mortality for patients with inhalation injury was 41.5% (54 patients out of 130) compared with 7.2% (11 patients out of 151) for patients without inhalation injury. These statistical data make it clear that inhalation injury is an important factor for the prediction of mortality in burn patients. Approximately 80% of fire-related deaths are due not to the burn injury to the airway but to the inhalation of toxic products, especially carbon monoxide and hydrogen cyanide gases. Inhalation injury is generally caused by thermal burns, mostly confined to the upper airways. Major airway, pulmonary, and systemic complications may occur in cases of inhalation injury and thus increase the incidence of burn patient mortality. |
| 199 |
LES HEMORRAGIES GASTRODUODENALES DE STRESS CHEZ LE BRULE GRAVE
(Siah S., Fouadi F.E., Ababou K., Nassim Sabah T., Ihrai I. - Maroc)
Les Auteurs rapportent trois observations d'hémorragies gastroduodénales de stress chez le brûlé grave. Ils rappellent l'importance des mesures thérapeutiques qui doivent être prises chez le brûlé grave, comme le traitement du choc, du sepsis, des plaies et de la douleur, la nutrition entérale précoce et l'oxygénothérapie. Tout cela permet de réduire les facteurs de risque de survenue d'une hémorragie gastroduodénale de stress. |
| 203 |
HEAD AND NECK BURNS: ACUTE AND LATE RECONSTRUCTION. DATA OF BURN INJURY MANAGEMENT IN 2007
(Belba G., Gedeshi I., Isaraj S., Filaj V., Kola N., Belba M. - Albania)
Modern burn care is based on operative wound management. The evidence is clear that prompt excision and closure can be lifesaving for patients even with large burns. Facial burns that are full-thickness need grafting. Deep dermal facial burns need surgery in the third week post-burn. Deep burns to the eyelids should be excised and grafted early in order to prevent cicatricial ectropion and corneal exposure. Following healing from burns, the reconstruction of severe deformities and scars of the face, head, and neck confronts the surgeon with some of the most challenging problems in reconstructive surgery. Our purpose is to provide some retrospective data on acute and late reconstruction of head and neck burns in 2007. Eighty-one patients are considered who were operated on in the Burns and Plastic Surgery Service of the University Hospital Centre in Tirana, Albania, suffering from burns and also from burn deformities in the head and neck regions. A description is given of the different types of operative techniques used for head and neck reconstruction as also of developmental aspects of burned face deformities (physical and psychological) and of their correction. In all, 246 patients with burns and burn deformities were subjected to surgery in 2007. Of these we have extracted 81 cases in which the pathology concerned the head and the neck, including 13 cases of full-thickness facial burns needing excising and grafting. The other 68 cases were burn deformities. This last group of patients included 19 with facial deformities, 14 with perioral deformities, 12 with burn alopecia, ten with upper and lower eyelid deformities, nine with ear deformities, and four with cervical deformities. The operative techniques used were skin grafts (split-thickness or full-thickness), composite grafts, pedicle flaps, and tissue replacement. In burn alopecia cases, we used tissue expansion for the correction. Head and neck burns constitute some of the most challenging problems in acute wound care and in the subsequent rehabilitation and reconstruction. With knowledge of the reconstruction techniques available, plus an accurate diagnosis of tissue deficiency and secondary distortion, a carefully performed surgical plan is the first step for achieving improvements in a burn-deformed face. |
| 206 |
UNUSUAL DONOR SITES FOR HARVESTING OF ISLAND SKIN GRAFTS
(Gümüs N. - Turkey)
This study reports on the use of two unusual donor sites for the harvesting of island skin grafts used in the coverage of large skin wounds. Island grafts were taken not only from intact skin but also from itself and from newly generated epithelium, so that it could be transferred to another defect area. The study included 23 patients with skin wounds of different sizes due to burn injury (17 patients) and traffic accidents (6 cases). After granulation tissue had taken on the wound surface, island grafts (area 1 to 2 cm2) were harvested from three donor sites and placed over the wound 1 to 3 cm apart. The granulation tissue around the grafts was covered by the epithelium spreading from the island grafts, with the wounds closing in two to seven weeks, depending on their size. Donor areas healed spontaneously, with epithelialization in one to three weeks. Utilizing the new donor sites as a source of epithelium, island grafts may become a new alternative to other skin graft techniques in patients who have limited donor sites or who do not want any more donor site scars. |
| 210 |
LE PSEUDOMONAS: EXPERIENCE DU CENTRE DES BRULES D'ANNABA ET REVUE DE LA LITTERATURE
(Chaibdraa A., Medjellekh M.S., Saouli A., Bentakouk M.C., Algérie)
Le Pseudomonas est un agent pathogène à l'origine d'infections nosocomiales graves dans les centres des brûlés. Son opportunisme et sa virulence en font une préoccupation majeure. Ce travail se propose d'évaluer la place de cette bactérie dans l'écologie bactérienne locale et d'en apprécier la sensibilité aux antibiotiques. Cette étude rétrospective préliminaire porte sur la période de juin 2003 à décembre 2005. Elle intéresse l'ensemble des prélèvements bactériologiques ayant pu être réalisés au centre des brûlés d'Annaba. L'effectif est de 633 micro-organismes isolés dont 128 Pseudomonas (20,2%): 127 aeruginosa (99,2%), 1 fluorescens (0,8%); distribution selon le site de prélèvement: écouvillon (87,5%), prélèvement trachéobronchique (4,6%), hémoculture (3,1%), cathéters (1,6%), urine (1,6%) et sonde urinaire (1,6%). Le pyocyanique se situe après le staphylocoque pour les prélèvements précoces et repasse en tête après un séjour supérieur à une semaine, où 89% des pyocyaniques sont identifiés. Il est en première position dans les pneumopathies sous ventilation assistée invasive. Il se classe troisième dans les hémocultures et les cultures de cathéters. Dans les infections urinaires il est devancé par Candida et la flore périnéale. Les 128 antibiogrammes regroupent 314 réponses sensibles. La sensibilité à plus de deux antibiotiques est de 68%, à deux antibiotiques 24% et à un antibiotique 8%. Seules quatre molécules restent actives: ciprofloxacine > péfloxacine > pipéracilline > ceftazidime. Une résistance absolue est retrouvée pour trois Pseudomonas (2,4%). Le pronostic sévère des infections nosocomiales à pyocyanique et les risques d'options thérapeutiques très limitées font toute leur gravité, d'où l'intérêt de respecter des règles strictes de prescription des antibiotiques et des mesures de prévention. |
| 219 |
CASE REPORT: FATAL DOMESTIC ACCIDENT FROM A 1.5 VOLT DRY-CELL BATTERY EXPLOSION AS SEEN IN LAGOS STATE UNIVERSITY TEACHING HOSPITAL, IKEJA, LAGOS, NIGERIA
(Fadeyibi I.O., Izegbu M.C., Benebo A.S. - Lagos)
Objective: To illustrate the danger of wrong disposal of used dry-cell batteries in Lagos, Nigeria. Method: Information was extracted from the case notes of a patient who died following the explosion of a 1.5 volt dry-cell battery. No post-mortem was performed because the death certificate was inadvertently issued and the body was buried hurriedly according to Islamic rites. Results: A 53% burn involving the face, upper arm, trunk, and thigh was found on examination, in addition to inhalation injuries. Conclusion: Dry-cell batteries are highly explosive when heated. There is a need to educate the populace about their explosive nature and to keep batteries away from children. |
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