|
 |
Volume XXII |
Number 1 |
March 2009 |
|
|
Summaries
| 3 |
SERUM LEVELS OF CORTISOL, IMMUNOGLOBULIN, AND C-REACTIVE PROTEIN IN BURN PATIENTS
(PILERI D., ACCARDO-PALUMBO A., D'AMELIO L., D'ARPA N., ARNONE G., GRISAFFI C., AMICO M., BRANCATO R., LOMBARDO C., CONTE F. - Italy)
Thermal injury is known to induce alterations in the immune system, but the precise mechanisms have yet to be elucidated. It has been shown that thermal injury in more than 20% of the total body surface area (TBSA) leads to disturbances in the cortisol metabolism and the equilibrium of the hypothalamic-pituitary-adrenal axis. We investigated the temporal relationship between serum cortisol levels, C-reactive protein, and immunoglobulin levels in the post-burn period. Twenty-one adult burn patients (mean age, 52 ± 17 yrs) were included in the study (TBSA, 10-80%); nine developed sepsis and five died. The nonseptic group consisted of twelve patients. Thirty healthy blood donors served as controls. Our results suggest that increased cortisol and decreased immunoglobulin levels could be related to severe sepsis and clinical outcome. |
| 6 |
BURNS, ENDOTHELIAL DYSFUNCTION, AND OXIDATIVE STRESS: THE ROLE OF ANTIOXIDANTS
(SAHIB A.S., AL-JAWAD F.H., AL-KAISY A.A. - Iraq)
Background. Burns cause a systemic inflammatory response, endothelial dysfunction, and increased microvascular permeability which results in oedema being formed; these effects are probably the result of a complex interplay between the direct effects of heat on the microcirculation and the action of chemical mediators, including reactive oxygen species. The use of antioxidants can reduce these changes, which are considered a promised step in burns management. Patients and methods. Forty-eight burn patients of either sex and with varying burns percentages were involved in the study. They were each allocated to one of four groups: A, B, C, and D, each group composed of 12 patients. Groups B, C, and D were treated with antioxidants: allopurinol, melatonin, and N-acetylcysteine respectively, while group A was treated according to normal hospital policy, without antioxidants; 12 healthy subjects (group E) served as a control group for comparison. In each group, serum malondialdehyde and serum glutathione levels were measured and liver and kidney function tests were performed, as well as microalbuminuria tests, using standard methods. Results. The administration of antioxidants to burns patients produced significant improvements in the parameters studied compared to group A parameters (no antioxidant given). Conclusion. This study clearly demonstrates the role of reactive oxygen species in endothelial dysfunction occurring in burn patients and the beneficial effect of antioxidants in reducing it, as shown by the reduced microalbuminuria and reduced resuscitation fluid in antioxidant-treated burn patients; the study also supports newly emerging evidence regarding the use of microalbuminuria as an indicator for endothelial dysfunction in burn patients. |
| 12 |
INVESTIGATION OF THE EFFECT OF A DISPOSAL ENDOTRACHEAL CATHETER AND METAL CATHETER COMBINATION APPLICATION IN INHALATION INJURY PATIENTS
(ZHANG Y., ZENG Y.,XIN G. - PEOPLE'S REPUBLIC OF CHINA)
Objective. The aim of this paper was to make an objective evaluation of the scientific nature and effectiveness of a combination application of two catheters by investigating and comparing the effects and the occurrence of complications using a single metal catheter application, a single disposal endotracheal catheter application, and a combination application of these two catheters separately in tracheotomy patients. Method. A study was carried out on 85 patients with a metal catheter from 1990 to 1997, 62 patients with a disposal endotracheal catheter from 1998 to 2002, and 56 patients with an on-vent disposal endotracheal catheter and an off-vent metal catheter from 2003 to November 2008, defined respectively as groups A, B, and C, in order to observe catheter balloon rupture and catheter olisthe during intubation, as also sputum adhesion to the endotracheal catheter wall after application, and to assess the number of cases of patients with airway bleeding, the number of patients with endotracheal catheter blockage, and the time lapse between ventilator withdrawal and extubation. Results. Patients in groups B and C were observed to have balloon rupture; the number of patients with catheter olisthe and airway bleeding was in both cases less than in group A (p < 0.05); and in groups A and C the number of patients with catheter blockage was in both cases less than in group B (p < 0.05) - extubation time was also shorter than in group B, but without statistical significance (p > 0.05). Macroscopic observation found that there was a large amount of sputum adhering to the lumen of the open disposal endotracheal catheter and that the lumen became significantly narrow, while the metal catheter became non-significantly narrow. Conclusion. In inhalation injury patients we found that the effect of the combination application of the disposal endotracheal catheter and the metal catheter was better than that of the single application. |
| 16 |
NET FLUID ACCUMULATION AND OUTCOME. A RANDOMIZED CLINICAL TRIAL
(BELBA M., ALEKSI A.,NEZHA I., TAFAJ S., SHTYLLA M., BELBA G. - Albania)
Outcome measures are the first step in determining the consequences of health care. These include mortality, morbidity, and quality of life. As major burns are life-threatening conditions, the main priority in discussing outcome measures is mortality as a problem-specific measure. A number of studies have shown that mortality is predominantly determined by many variables obtained as "admission" predictors" as also by numerous variables obtained during the hospital course. Net fluid accumulation (NFA) is one of the many important factors that correlate with clinical outcome. The purpose of this paper is thus to evaluate NFA during resuscitation with Ringer's lactate (RL) and its relationship with mortality. We hypothesized that rigorous monitoring of fluid replacement therapy might result in lower fluid retention, which could be effective in the prognosis of severely burned patients. In this prospective randomized study, the patients were divided into two groups of 55 cases each. In RL group 1, the patients were resuscitated using the Parkland formula in adults and the Galveston Shriner formula in children, without modifications, while in RL group 2 the formula was utilized as a starting-point only and the amount of fluid was modified in each case on the basis of the clinical situation and urine output. It was found that there was a statistically significant difference in NFA between the two groups (p = 0.001), as also a statistically significant difference between the amount of fluids given and the complications (p = 0.08). The majority of patients who died (70%) presented higher NFA values in the period of resuscitation. There was a statistically significant difference between mortality and total body surface area burned (p = 0.036), comorbidities (p = 0.015), cause of burn (p = 0.004), inhalation injury (p = 0.027). The degree of NFA correlated, with a linear positive relationship, with morbidity (Kendall's tau_br = 0.143, p = 0.019) and, with a negative relationship, with mortality (Kendall's tau_br = 0.234, p = 0.001). Mortality as the primary endpoint was 16% in group 1 and 9% in group 2. Giving the smallest amount of fluids necessary for adequate resuscitation can be effective in creating a successful and specific therapy for all burn patients. With regard to morbidity and mortality, predictor factors, as also the method of resuscitation, have an influence in maintaining constant NFA values. |
| 22 |
ELECTRISATION
(CHAIBDRAA A., MEDJELLEKH M.S., BENTAKOUK M.C. - Algerie)
La qualité de la prise en charge en urgence des patients atteints d'accidents d'électrisation dépend du degré de compréhension des données physiopathologiques à l'origine des nombreuses manifestations cliniques, dominées par la mort subite. La connaissance des rôles respectifs des différentes caractéristiques de l'électricité (les ampères tuent, les volts brûlent, le risque potentiellement élevé de traumatisme associé), de l'électrothermie et des mécanismes à l'échelon cellulaire a permis de mieux appréhender son extrême gravité. Les conséquences fonctionnelles, esthétiques et psychologiques, avec de lourdes séquelles, expliquent le caractère multidisciplinaire de la prise en charge au long cours. Face à une morbidité importante, la prévention est fondamentale, en particulier pour les professions exposées et pour ce qui concerne les accidents domestiques chez l'enfant. |
| 33 |
LA PRISE EN CHARGE DES BRULURES ELECTRIQUES: A PROPOS DE 30 CAS
(BAKKALI H., ABABOU K., BELLAMARI H., ENNOUHI A., NASSIM SABAH T., ACHBOUK A., MOUSSAOUI A., FOUADI F.Z., SIAH S.,IHRAI H. - Maroc)
Les brûlures électriques sont rares mais graves nécessitant une prise en charge urgente et adéquate car l'évolution peut être émaillée de complications graves, notamment cardiaques, neurologiques et rénales, et les séquelles sont importantes. A travers une étude analytique et rétrospective de janvier 2000 à novembre 2007 ayant inclus 30 patients admis au Service des Brûlés de l'Hôpital Militaire d'Instruction Mohamed V de Rabat, Maroc, pour prise en charge de brûlures électriques, il a été relaté les mécanismes des brûlures électriques, comme aussi les complications, la morbidité et la mortalité, dues aux brûlures électriques, tout en insistant sur les modalités de prise en charge initiale chez ces patients. La prévention reste le point capital pour réduire l'incidence de ces accidents. Cette prévention se base sur la surveillance des enfants et l'élimination de facteurs de risque à la maison, par la maintenance des installations électriques et par l'information et l'éducation du public. |
| 37 |
BRULURES PAR BOUILLOTTES CHEZ LES DIABETIQUES
(ACHBOUK A., KHALES A., OUFKIR A.,BELMIR R., ARROB A., RIBAG Y., NASSIMSABAH T., ENNOUHI M.A., TOURABI K., ABABOU K.,MOUSSAOUI A., OULEGHZAL H., IHRAI H. - Maroc)
La neuropathie diabétique est une complication fréquente du diabète. La forme clinique la plus fréquente est la polynévrite «en chaussette» avec perte de la sensibilité des pieds à la douleur. Les brûlures par les bouillottes sont l'apanage des patients diabétiques atteints d'une polyneuropathie sensitive, et elles sont profondes. Leur prise en charge thérapeutique est difficile et doit être multidisciplinaire. Nous soulignons à travers ce travail l'intérêt de l'éducation des patients diabétiques et leur sensibilisation en ce qui concerne l'usage des bouillottes. |
| 40 |
BURN INJURIES IN ENUGU, NIGERIA - AETIOLOGY AND PREVENTION. A SIX-YEAR RETROSPECTIVE REVIEW (JANUARY 2000 - DECEMBER 2005)
(NNABUKO R.E.E., OGBONNAYA I.S, OTENE C.I., OGBONNA U., AMANARI O.C., OPARA K.O. - Nigeria)
Background. Burn injuries frequently occur in our homes and workplaces and during travels. They are a common presentation at the National Orthopaedic Hospital, Enugu, Nigeria, which is a regional centre for burns care and for plastic surgery, orthopaedic surgery, and trauma patients. Most burn injuries are preventable, and campaigns to arouse greater awareness are necessary to reduce the number of occurrences. Objectives. The objectives of this study are to highlight the causes of burn injuries and to characterize age and sex incidences, as also the severity of burn injuries. It is hoped that formidable preventive measures will be suggested to aid public enlightenment campaigns in fighting the scourge of burn injuries. Materials and method. A retrospective review of patient's folders from Jan. 2000 to Dec. 2005 showed that 414 cases of burn-injured patients were treated at the emergency unit of the National Orthopaedic Hospital, Enugu. Results. Flame burns accounted for 48.3% of burn injuries followed by scalds with 40.6%; chemical burns accounted for 6.3%, while electrical and friction burns accounted for 4.6% and 1.0% respectively. Males made up 60.4% of the cases and females 39.6% (ratio, 1.5:1). The age group most commonly affected was that of children aged between 0 and 10 yr, accounting for 37.2% of cases, followed by the 21-30 yr age group with 22.7%. Altogether, 95.0% of the patients were aged less than 50 yr. With regard to flame burns, 51.5% were due to petrol flames (premium motor spirit), while 33.0% were due to kerosene. Cooking gas explosions accounted for 7.5% of the cases and diesel (automotive gas oil) 1.0%. Of the scalds, hot water accounted for 89.3% and hot oil 7.7%. As to chemical burns, 84.6% were due to acids, with alkalis, corrosive creams, and others making up the rest. With regard to electrical injury, current passage accounted for 63.2% of cases and flash burns for 36.8%. |
| 44 |
TRAUMATIC INJURIES WITH DEEP ABRASION: "A BURN"
(CASTANA O., DAGDELENIS J., REMPELOS G., PANERIS P., ANAGIOTOS G., DIPLAS D., ALEXAKIS D. - Greece)
This epidemiological study deals with 34 patients with friction burns sustained between January 2007 and January 2008. The age group most affected was that between 21 and 30 yr, with a male predominance. Road traffic accidents were the commonest cause of friction burns (31 patients) and the lower limb was body part most commonly affected. The therapy was mostly conservative (no. 18): 14 patients were treated with a split-thickness skin graft, and just two with flap cover. Friction burns are overlooked in the emergency department because of their association with more critical mechanical injuries. They can be prevented by observing standard safety measures such as special clothing or appropriate equipment, especially as regards motorcycle riders. |
| 48 |
CASE REPORT: ACUTE ACALCULOUS CHOLECYSTITIS - A RARE COMPLICATION OF BURN INJURY
(CASTANA O., REMPELOS G., ANAGIOTOS G., FONIA E., KISKIRA O., ALEXAKIS D. - Greece)
The aim of this study is to draw attention to acute acalculous cholecystitis, a rare complication that may occur during the post-burn period (usually within 20-30 days). A 42-yr-old male patient, the victim of 35% TBSA high-voltage electrical burns that caused the amputation of both upper extremities by day 45 post-burn, was brought to our operating theatre suffering from acute acalculous cholecystitis. Mild epigastric pain followed by reflex nausea, vomiting, and pain that shifts to the upper quadrant and considerably increases during the post-burn period should make the therapist think of acalculous cholecystitis and react immediately with an urgent operation. Diagnosis of acute acalculous cholecystitis in a burn patient depends on recognizing a combination of signs and symptoms which are often attributed to other problems. Once diagnosed, the best choice of treatment for acalculous cholecystitis is cholecystectomy in an otherwise clinically stable patient. |
|
