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Volume XXII |
Number 3 |
September 2009 |
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Summaries
| 115 |
AETIOLOGY AND OUTCOME OF ELDERLY BURN PATIENTS IN TABRIZ, IRAN
(CMAGHSOUDI H., GHAFFARI A. - IRAN)
Background. Geriatric patients, usually defined as being 65 years of age or over, now make up about 10% of the major burn population. Main aim. To conduct a prospective study of elderly burn patients, analysing the predictive value of age, gender, total body surface area (TBSA) burned, inhalation trauma, pre-morbid conditions, and mortality. Methods. A 10-year prospec- tive study of burn victims hospitalized in a major burn centre in Iran was conducted to analyse the association between age, per- centage TBSA burn, inhalation injury, the causes of the burns, pre-existing co-morbid conditions and the risk of death, and the epi- demiology of the burns. Results. Three hundred and eighty patients aged 65 years and over were identified. The mean patient age was 71 years. There were 109 deaths overall (28.7%), the majority of which (74) were among patients with self-inflicted burns. Except for the incidence of the burns, there were no significant differences between males and females. The mean burn size (21.6%) was significantly larger in non-survivors than in survivors (49.5% vs 10.3%; p < 0.001). In these 380 elderly burn patients, when the TBSA burned exceeded 50% mortality reached 100%. Inhalation injuries were strongly associated with large burns and were present in the majority of flame-burn fatalities. There were no deaths related to scalds. Pre-morbid conditions had no statistically significant influence on mortality. Conclusion. Large burn size was the strongest predictor of mortality among elderly burn patients, followed by the presence of inhalation injury. This study showed that burn patients aged 65 years and over can achieve a good outcome. |
| 121 |
OPTIMIZING BURN TREATMENT IN DEVELOPING LOW- AND MIDDLE-INCOME COUNTRIES WITH LIMITED HEALTH CARE RESOURCES (PART 1)
(XATIYEH B., MASELLIS A., CONTE C. - LEBANON, ITALY)
In developing countries burn injuries are much more common than in the USA and Europe or other affluent devel- oped countries, due to poverty, overcrowding, and illiteracy, and are associated with higher mortality rates. The high incidence makes burns an endemic health hazard in these countries. Over 90% of burn-related fatalities occur in developing or low- and middle-income countries (LMICs), with south-east Asia alone accounting for over half of fire-related deaths. Management of burns and their sequelae even in the well-equipped, modern burn units of advanced affluent societies remains demanding despite advances in surgical techniques and development of tissue-engineered biomaterials available to these burn centres. Undoubtedly, in a devel- oping country with limited resources and inaccessibility to sophisticated skills and technologies, management of burns constitutes a major challenge. The present review of the literature analyses the challenges facing burn management in LMICs and explores probable modalities to optimize burn management in these countries. The review will be published in three parts. Part I will pres- ent the epidemiology of burn injuries and challenges for management in LMICs. Part II will be about management of burn injuries in LMICs and Part III will discuss strategies for proper prevention and burn care in LMICs. |
| 126 |
DISORDERS OF THE IMMUNE SYSTEM IN SEVERELY BURNED PATIENTS
(FAYAZOV A.D., SHUKUROV S.I., SHUKUROV B.I., SULTANOV B.C., NAMAZOV A.N., RUZIMURATOV D.A. - REPUBLIC OF UZBEKISTAN)
This paper analyses the results of immunological examinations of 124 patients with thermal injury. We examined in- dices of peripheral blood such us the size of the population of circulating T-lymphocytes (CD3), T-helpers (CD4), T-suppressors (CD8 and CD25), natural cell killers (CD16), transmembrane protein of apoptotic activity (CD16), B-lymphocytes, phagocyte ac- tivity of lymphocytes, and the level of serum antibody of the basic classes (Ig G, A, M). It was discovered that the burn disease was accompanied by deeply marked secondary immune deficiency primarily caused by all components of the active suppression of the cellular link of the immune system and reduction of phagocyte activity of neutrophils. |
| 131 |
COMPARATIVE STUDY BETWEEN SODIUM CARBOXYMETHYL-CELLULOSE SILVER, MOIST EXPOSED BURN OINTMENT, AND SALINE-SOAKED DRESSING FOR TREATMENT OF FACIAL BURNS
(HINDY A. - EGYPT)
Facial burns vary from relatively minor insults to severe debilitating injuries. Sustaining a burn injury is often a psy- chological trauma for the victim and is especially menacing when the face and neck are involved. This study was carried out on 60 patients with superficial dermal burns to the face admitted to the Burn Unit of Tanta University Hospital, Egypt, from Sep- tember 2007 to July 2008. The patients were allocated randomly to one of three groups, each of which was treated with one of the following: sodium carboxymethyl-cellulose silver (Aquacel Ag®), MEBO® (moist exposed burn ointment), or saline-soaked dressing. We found that patients managed with MEBO® had less pain and itching and easier movement than those managed with Aquacel Ag®, while the Aquacel Ag® group required a shorter duration of time for healing, without any bad odour, than the MEBO® group. Quality of healing and patient satisfaction were nearly equal as regards MEBO® and Aquacel Ag®. Saline-soaked dressings were least satisfactory - they caused the most pain and itching, limited the patients' movements the most, needed the longest time for healing, and gave patients the least satisfaction. It was concluded that MEBO® was an excellent choice for man- agement of facial burns owing to its soothing effect, ease of patient movement, easy handling, and good healing properties. Aqua- cel Ag® was found to be comparable to MEBO® and is specially recommended when frequent dressings cause difficulties for the patients or when they cannot accept a bad odour; saline-soaked dressings are not recommended for the management of facial burns because of the pain they cause, itching, limitation of patient movement, and delayed healing. |
| 138 |
SPERM QUALITY CHANGES IN SURVIVORS OF SEVERE BURNS
(JEWO P.I., FADEYIBI I.O., SAALU L.C., AKINOLA O.I., DURU F.I., ADEMILUYI S.A. - NIGERIA)
Severe thermal injury occurs frequently, especially in the low-income countries of the world, where they account for a substantial mortality and a wide range of devastating morbidity. Almost all systems of the body are affected, including the car- diovascular, immune, and reproductive systems. A number of studies have shown that people with severe burns may develop im- paired spermatogenesis and testicular damage. However, if we consider the many systems that are negatively affected by burns, the effects on the reproductive system are among the least investigated and are therefore poorly understood. We delineated sperm quality changes in 20 men recovering from severe burn injury. They submitted semen at monthly intervals for analysis over a four- month period. Our results show that these subjects had significantly lower total sperm counts than normal for their age range. Sperm counts were 20 million/ml or less in half of the study population with a mean of 26.58 ± 7.52 m/ml. Progressive motility was even more severely affected; the score was less than 20% in more than half of the patients, with a mean of 27.74 ± 7.64. Though abnormal sperm rates were within the normal range, in many of the patients 80% of abnormal cells had swollen, oblong and round heads. Cells with tail anomalies made up the rest. Our findings suggest that severe burns cause significant reduction of sperm density and motility. They also cause specific head abnormalities in the cells produced. Such sperm is now known to have very poor fertilization potential. |
| 142 |
PRISE EN CHARGE DU SYNDROME DE LYELL OU NECROLYSE EPIDERMIQUE TOXIQUE
(SIAH S., BAITE A., BAKKALI H., ATMANI M., ABABOU K., IHRAI H. - MAROC)
Le syndrome de Lyell ou nécrolyse épidermique toxique (NET) est une pathologie très grave des dermatoses bulleuses d'étiologie médicamenteuse. Il se caractérise par une nécrose aiguë de l'épiderme sur toute la hauteur du corps muqueux. L'aspect clinique de la NET est celui d'une brûlure étendue du deuxième degré profond. A ce tableau s'associent constamment des lésions muqueuses et une atteinte multiviscérale qui aggrave le pronostic. Nous rapportons deux cas de NET qui illustrent l'importance d'une prise en charge précoce et multidisciplinaire de ces patients atteints au sein d'un service de réanimation des brûlés, dont les fondements reposent sur l'asepsie rigoureuse, l'apport hydroélectrolytique et nutritionnel, la prévention de l'infection et son traite- ment par une antibiothérapie adaptée, et un nursing et des soins locaux. L'efficacité supposée des immunoglobulines intraveineuses ne repose que sur des cas isolés et il n'y a pas encore d'études randomisées. |
| 147 |
STEVENS-JOHNSON SYNDROME: A CASE REPORT
(CASTANA O., REMPELOS G., ANAGIOTOS G., APOSTOLOPOULOU C., DIMITROULI A., ALEXAKIS D. - GREECE)
The Stevens-Johnson syndrome has the appearance of a partial-thickness burn that may lead to a 100% loss of epi- dermis, requiring the same resuscitation as a severe burn. A 38-yr-old male patient was admitted to the neurosurgery department of the Evangelismos General Hospital in Athens, where immediately after administration of an antiepileptic drug he developed sloughing of total epidermis, high fever, and the clinical picture of a severe burn patient. He was treated as a burn patient with massive cutaneous injuries and the concomitant systemic effects. Fluid resuscitation was important and the Parkland formula was used, as in a burn patient. Steroid medications were initially administered. Systemic antibiotics were discontinued after signs of sepsis and documented infection had been overcome. Improved treatment techniques and critical burn care have decreased mortal- ity and morbidity in cases of the Stevens-Johnson syndrome. Prompt recognition of the disease and cure of the patient by the ap- propriate staff of the burns centre contribute to the successful treatment of such patients. |
| 152 |
EMERGENCY PERCUTANEOUS TRACHEOSTOMY IN A SEVERELY BURNED PATIENT WITH UPPER AIRWAY OBSTRUCTION AND CIRCULATORY FAILURE
(KOLIAS S., CASTANA O., KYRIAKOPOULOU M., REMPELOS G., ANAGIOTOS G., ALEXAKIS D., ROUSSOS C. - GREECE)
Airway inaccessibility is one of the most dreaded situations in emergency medicine. Surgical tracheostomy is not in- dicated in emergency situations because it takes a long time and can result in death if respiratory support cannot be provided dur- ing the procedure. Emergency percutaneous tracheostomy (PCT) was widely regarded as absolutely counterindicated. Recently, how- ever, a number of studies have appeared on the safety and feasibility of PCT in situations regarded as presenting relative con- traindications. We describe the life-saving action of Griggs' PCT in a patient with upper airway obstruction resulting from burns, smoke injuries, and unsuccessful tracheal intubation attempts. Emergency PCT using the Griggs technique was immediately per- formed without aseptic care, and a 9-mm internal diameter tracheostomy tube was successfully inserted in less than one minute. Griggs' PCT is a quick technique that secures an airway when tracheal intubation fails. The feasibility - in selected cases - of us- ing an emergency Griggs' PCT, in experienced hands, rather than cricothyroidotomy or surgical tracheostomy, is recommended. |
| 155 |
CHIRURGIE PLASTIQUE DES SEQUELLES DE BRULURES DE LA MAIN. EXPERIENCE DU CENTRE NATIONAL DES BRULES, CENTRE HOSPITALIER UNIVERSITAIRE DE CASABLANCA
(BENBRAHIM A., BENCHAMKHA Y., ELAMRANI D., ELMANSOURI N., DIOURI M., EZZOUBI M., CHLIHI A., BAHECHAR N., BOUKIND E.H.)
Les séquelles de brûlure de la main sont fréquentes et diverses, esthétiques et fonctionnelles, simples ou complexes. Nous rapportons notre expérience de cinq ans de traitement des séquelles de brûlure de la main dans le centre national des brûlés et de chirurgie plastique du CHU Ibn-Rochd de Casablanca. Notre étude a concerné 65 patients âgés de 2 à 70 ans dont 45 hommes et 20 femmes, chez qui nous avons réalisé 143 interventions chirurgicales sur 105 mains. Les séquelles siègent au niveau du dos de la main dans 57 cas, suivi des commissures dans 43 cas. Les différents moyens de reconstruction ont été utilisés avec notamment la greffe cutanée dans 58 cas et les lambeaux locaux dans 32 cas. Nous avons évalué le degré de satisfaction des patients des différents moyens utilisés. Concernant la greffe cutanée, 94% sont satisfaits des résultats obtenus au niveau de la face dorsale, 90% de l'utilisation des lambeaux locaux au niveau de la première commissure et 95% de l'utilisation des lambeaux à distance. Enfin, 100% des patients sont satisfaits des résultats de reconstruction du pouce par pollicisation d'un doigt et 75% par transfert du deuxième orteil. |
| 160 |
CASE REPORT: HIGH-TENSION ELECTRICAL BURNS: REPORT OF TWO CASES
(ABBAS A.D., DABKANA T.M., TAHIR C., NAAYA H.U. - NIGERIA)
High-tension electrical burns are a rare but devastating form of injury. The objective of this case report is to bring to the fore the severity of this rare form of injury and highlight the benefits of active surgical management of such a condition. We report the cases of two patients who were managed for high-tension electrical burns and highlight the main features of their presentation and management. Both patients needed urgent resuscitation and subsequent multiple amputations and disarticulations to save their lives. In high-tension electrical burns early resuscitation and wound exploration coupled with decisive action on the need for amputation would reduce the morbidity and mortality often associated with the ensuing overwhelming sepsis. |
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