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Volume XXIV |
Number 1 |
March 2011 |
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Summaries
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PROFIL ÉPIDÉMIOLOGIQUE DES BRÛLÉS À MARRAKECH: À PROPOS DE 152 CAS
(IBNOUZAHIR M., ETTALBI S., OUAHBI S., DROUSSI H., SOUSOU M., CHLIHI A., BAHAICHAR N., BOUKIND H. - MAROC)
Cet article concerne une étude épidémiologique rétrospective portant sur 152 patients brûlés hospitalisés entre 2006 et 2008. Les brûlés avaient moins de 20 ans dans 65% des cas. Le sex ratio (m/f) était de 1,18/1. L'origine thermique est incriminée dans 84% des cas. L'atteinte par flammes représente 56% des cas. La surface corporelle brûlée moyenne chez nos patients était de 28%, et les brûlures de deuxième degré étaient de loin les plus fréquentes. Dans notre série, le visage et le cou étaient le siège le plus fréquemment touché. La prévention reste la meilleure arme pour lutter contre ce fléau, et pour cela plusieurs mesures sont proposées pour améliorer l'état actuel des choses.
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BURN CARE IN SOUTH AFRICA
(RODE H., BERG A.M., ROGERS A. - SOUTH AFRICA)
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COST ANALYSIS OF ACUTE BURN PATIENTS TREATED IN A BURN CENTRE: THE GULHANE EXPERIENCE
(SAHIN I., OZTURK S., ALHAN D., AÇIKEL C., ISIK S. - TURKEY)
Even if calculating the exact cost of burn treatment is a very hard task, the study of cost analysis provides financial perspective. We performed a cost analysis study in our burn centre to respond to questions about total patient treatment cost and the length of hospital stay. We reviewed all patients admitted to the Gulhane Military Medical Academy Burn Centre in Ankara, Turkey, between March 2005 and August 2008. Forty-three patients with major burns were identified on the basis of the study criteria. The data regarding total treatment cost and the length of hospital stay for each type of burn (flame, scald, electric) were collected at the end of the study. The average total body surface area burned was 36 ± 7%.. The average duration of hospital stay was 73 ± 33 days. Patients with electrical burns stayed longer in hospital than patients with other types of burn injuries. Each one per cent of burn corresponded to a mean hospital stay of two days. The overall mean total cost was $US 15,250. The mean total cost of electrical burns was the highest, with $US 22,501 ± 24,039. Even if the costs associated with burn injury are higher than some other well-known health-related problems, they have not been much studied. Reports have produced different results, but it should be kept in mind that although the results of cost analysis studies may vary they must be performed in all newly established burn centres in order to form a financial overview.
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MONITORING CAUSTIC INJURIES FROM EMERGENCY DEPARTMENT DATABASES USING AUTOMATIC KEYWORD RECOGNITION SOFTWARE
(VIGNALLY P., FONDI G., TAGGI F., PITIDIS A., NATIONAL INJURY DATABASE, NATIONAL INFORMATION SYSTEM ON ACCIDENTS IN THE HOME, NATIONAL TOXIC EXPOSURE SURVEILLANCE GROUPS - ITALY)
In Italy the European Union Injury Database reports the involvement of chemical products in 0.9% of home and leisure accidents. The Emergency Department registry on domestic accidents in Italy and the Poison Control Centres record that 90% of cases of exposure to toxic substances occur in the home. It is not rare for the effects of chemical agents to be observed in hospitals, with a high potential risk of damage - the rate of this cause of hospital admission is double the domestic injury average. The aim of this study was to monitor the effects of injuries caused by caustic agents in Italy using automatic free-text recognition in Emergency Department medical databases. We created a Stata software program to automatically identify caustic or corrosive injury cases using an agent-specific list of keywords. We focused attention on the procedure's sensitivity and specificity. Ten hospitals in six regions of Italy participated in the study. The program identified 112 cases of injury by caustic or corrosive agents. Checking the cases by quality controls (based on manual reading of ED reports), we assessed 99 cases as true positive, i.e. 88.4% of the patients were automatically recognized by the software as being affected by caustic substances (99% CI: 80.6%- 96.2%), that is to say 0.59% (99% CI: 0.45%-0.76%) of the whole sample of home injuries, a value almost three times as high as that expected (p < 0.0001) from European codified information. False positives were 11.6% of the recognized cases (99% CI: 5.1%- 21.5%). Our automatic procedure for caustic agent identification proved to have excellent product recognition capacity with an acceptable level of excess sensitivity. Contrary to our a priori hypothesis, the automatic recognition system provided a level of identification of agents possessing caustic effects that was significantly much greater than was predictable on the basis of the values from current codifications reported in the European Database.
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BURN RESUSCITATION: IS IT STRAIGHTFORWARD OR A CHALLENGE?
(HAYEK S., IBRAHIM A., ABU SITTAH G., ATIYEH B. - LEBANON)
Burn shock resuscitation has been extensively studied over the past four decades. Many formulas exist and many parameters have been suggested to assess the adequacy of resuscitation. The most commonly used formula is the Parkland formula, the most commonly used fluids are crystalloids, and the most commonly used parameter is urine output. However, until now, no conclusive evidence has suggested that one formula is superior to another or that one parameter is a better predictor than another. In this article we will review the updated information about the subject and we will look into new advancements in this field. We will pose some questions at the end that will help researchers concentrate their future efforts to solve this important challenge in burn care.
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LE FACTEUR XII DE LA COAGULATION: BIEN PLUS QU'UN STABILISANT DE LA FIBRINE
(MESSAOUDI N., LAMAALMI F., CHAKOUR M., BELMEKKI A., NAJI M. - MAROC)
Les Auteurs considèrent le rôle du facteur XIII de la coagulation dans la cicatrisation. Identifié depuis 1923, le rôle du facteur XIII ou le facteur stabilisant de la fibrine dans la coagulation a été bien élucidé. Son rôle dans la cicatrisation suggéré dès 1960 est méconnu par les hématologistes et les médecins prenant en charge les brûlés. Les Auteurs se proposent de mettre la lumière sur ce rôle, qui reste encore mystérieux et mérite d'être élucidé.
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LOW MOLECULAR WEIGHT HEPARIN MEDIATED REGULATION OF NITRIC OXIDE SYNTHASE DURING BURN WOUND HEALING
(LAKSHMI R.T.S., PRIYANKA T., MEENAKSHI J.,MATHANGI K.R., JEYARAMAN V., BABU M. - INDIA)
Nitric oxide (NO) is an important signal molecule in many types of cells and tissues. Efficiently balanced NO production was noted to play an important role in the healing of burns. Inducible nitric oxygen synthase (iNOS) is responsible for the discontinuous synthesis of high amounts of NO. Dysregulation of nitric oxygen synthase (NOS) activity has been associated with multiple organ failure in burn patients and may therefore represent a novel therapeutic target in such circumstances. Heparin and low molecular weight heparin (LMWH) derivatives may offer therapeutic benefit for inflammatory diseases, whereas NO plays a protagonist role. Burn injury in humans has been associated with a significant increase in NO2/NO3 (nitrite/nitrate) plasma levels. In this prospective study burn patients were treated with and without LMWH to provide evidence that LMWH has NOS-reducing activity. This was proved by colorimetric and immunohistological studies. There was a significantly different NOS activity between the treated and the control group and our results suggest that LMWH was more effective in the treatment of burn patients through iNOS inhibition. Treatment with LMWH was initiated within 6 h post-burn.
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ARRÊT CARDIOCIRCULATOIRE PAR ACCIDENTS D'ÉLECTRISATIONS: INTÉRÊT DU DÉFIBRILLATEUR SEMI-AUTOMATIQUE
(SIAH S., FOUADI F.E., ABABOU K., IHRAI I., DRISSI N.K. - MAROC)
Les brûlures par accidents électriques sont graves car elles peuvent entraîner le décès par arrêt cardiocirculatoire. Les arrêts cardiocirculatoires induits par le courant de basse tension sont en règle générale dûs à une fibrillation ventriculaire, plutôt de bon pronostic si la chaîne des secours est efficace. Il faut donner la priorité à la défibrillation systématique d'emblée en utilisant un défibrillateur semi-automatique. La défibrillation électrique est susceptible de procurer immédiatement une restauration de l'activité circulatoire spontanée.
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LES SÉQUELLES DE BRÛLURES CERVICOCÉPHALIQUES CHEZ L'ENFANT
(SANKALE A-A., NDIAYE A., NDOYE A., NDIAYE L., NDOYE M. - SÉNÉGAL)
La peau, barrière protectrice de l'organisme, est très exposée aux agressions et donc aux brûlures. Le but de ce travail est d'apprécier les particularités des séquelles de brûlure cervicofaciales chez l'enfant en milieu sub-saharien et d'évaluer leur prise en charge. Il s'agit d'une étude rétrospective réalisée dans le service de Chirurgie Pédiatrique du Centre Hospitalo-universitaire Aristide Le Dantec de Dakar (Sénégal). Vingt-sept dossiers de patients ont été colligés entre mai 2001 et avril 2008. L'âge moyen lors de la consultation était de 6,7 ans et le sex ratio m:f de 1,7:1. La topographie des séquelles se répartit ainsi: la face (66,7%), le cou (29,6%) et le cuir chevelu (11,1%). Concernant le type de séquelles, les brides prédominaient (33,3%), suivies des cicatrices chéloïdiennes ou hypertrophiques (25,9%), des ectropions de paupières (18,5%), des alopécies du cuir chevelu (11,1%), des ulcérations chroniques (7,4%) et de dyschromie (3,7%). Le traitement a été chirurgical dans 55,7% des cas: plasties en Z suivies ou non d'une greffe de peau pour les brides et libération de bride suivie d'une greffe pour les ectropions de paupières. Pour ce qui concerne les patients opérés, la morbidité opératoire a été de 20% et la mortalité opératoire nulle. Les cicatrices chéloïdiennes ont fait l'objet d'un traitement médical par infiltrations de dermocorticoïdes. Au-delà de l'urgence, les brûlures cervicofaciales de l'enfant entraînent un préjudice esthétique et fonctionnel important. L'amélioration de leur pronostic passe par la qualité des premiers soins et par la sensibilisation des parents aux risques d'accidents domestiques.
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LA PLASTIE EN RAIL DANS LE TRAITEMENT DES BRIDES RÉTRACTILES DU CREUX POPLITE
(ACHBOUK A., KHALES A., BOURRA K., TOURABI K., ABABOU K., IHRAI H. - MAROC)
Les Auteurs décrivent le cas d'un patient âgé de 45 ans atteint de brûlures thermiques par flammes suite à la déflagration d'une bonbonne de gaz. Les lésions initiales intéressaient les quatre membres (en particulier, le genou) et le tronc. La prise en charge initiale a consisté en une excision-greffe précoce des membres. L'évolution a été marquée par la survenue de cicatrices hypertrophiques au niveau des zones non greffées et à la bordure de la greffe ainsi que la survenue de brides rétractiles. Devant l'handicap fonctionnel engendré par la bride à cause de la limitation importante de l'extension, le patient a été admis pour cure chirurgicale. Grâce à la technique en rail décrite, le patient a pu récupérer une fonction normale du genou. Les suites ont été simples avec une durée d'hospitalisation d'un mois. Le résultat esthétique est relativement satisfaisant. La technique en rail est un moyen parmi l'arsenal thérapeutique qui permet de traiter la bride du creux poplité. Sa simplicité, sa facilité technique et son résultat satisfaisant ainsi que ses suites simples permettent de la rendre une technique très prisée dans le traitement de ce type de bride.
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POST-BURN BREAST DEFORMITY: VARIOUS CORRECTIVE TECHNIQUES
(EL-OTIEFY M.A.E., DARWISH A.M.A. - EGYPT)
Burns of the front of the chest and abdomen and sometimes the front of the neck and axilla, mostly caused by flame in domestic accidents, are very common in Egypt. If deep, these burns can produce breast deformity in females either in childhood or in adolescence. This work considers 74 female breasts in 55 patients who had post-burn breast deformities due to accidents in childhood or early adulthood. The patients' median age was 21 years (range, 13 to 42 years). The cause was scalding in 18 patients and flame in 37. The following conditions were found: upward contracture in 26 breasts (35%), 21 patients; downward contracture in 32 breasts (43%), 25 patients; and loss or distortion of the nipple/areola complex in 16 breasts (22%), 9 patients. Surgical correction included: Z-plasty, scar revision, scar excision and reconstruction by local flap or skin graft, and use of tissue expanders. Adequate projection of the reconstructed breast with the creation of a normal-looking inframammary fold was obtained. There were no major complications. Two patients had partial skin loss of the split-thickness graft, and partial loss of edges of the areola occurred in three cases. The burns thus caused various degrees of breast deformity and the corrective surgery varied accordingly. It is concluded that in such cases the general rules of scar revision have to be applied, correcting the contracture by Z-plasty or else by a local flap, if available, or by a split-thickness graft if the surrounding area is affected by post-burn scarring or if a large defect appears after complete release. Tissue expanders play a role in some if the scar area is surrounded by normal healthy tissue.
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