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Volume XXIV |
Number 3 |
September 2011 |
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Summaries
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EPIDEMIOLOGICAL ANALYSIS OF BURN PATIENTS IN THE MILITARY HOSPITAL, RABAT, MOROCCO
(ELKAFSSAOUI S., TOURABI K., BOUAITI E., ABABOU K., MOUSSAOUI A., ENNOUHI M.A., BOULMAAROUF A., MRABET M., QUYOU A., SOULAYMANI A., IHRAI H. - MOROCCO)
A retrospective study was conducted of burn patients admitted to the military hospital in Rabat, Morocco, in the 6-yr period from 2004 to 2009. This is the first multivariate study to be performed in Morocco. The epidemiological data from the 291 patients hospitalized were collected and studied. The type of burn was indicated in 284 of the patients: 94% of the injuries were thermal burns, 4% were electrical burns, and 1.5% chemical burns. In 261 cases the exact aetiology was noted: 56% of accidents were caused by flames, 38% by hot liquids, 4% by electric current, and 2% by chemicals. The distribution of the Moroccan population is as follows: 0-4 yr, 7%; 5-l4 yr, 8%; 15-19 yr, 8%; 20-59 yr, 70%; over 60 yr, 7%. The male/female sex ratio was 1.63. The mean duration of hospitalization stay was 42 ± 62 days. The mean body surface area burned was 21 ± 18%. Total mortality was 5%; 57% of deaths were due to septic shock. Our results were similar to data from other studies in the literature, with certain characteristics in our series, especially the age bracket most affected, the body surface area burned, and the mechanisms of injury. |
| 120 |
EPIDEMIOLOGY OF VENTILATOR-ASSOCIATED TRACHEOBRONCHITIS AND VENTILATOR-ASSOCIATED PNEUMONIA IN PATIENTS WITH INHALATION INJURY AT THE BURN CENTRE IN BRNO (CZECH REPUBLIC)
(LIPOVY B., RIHOVÁ H., GREGOROVA N., HANSLIANOVA M., ZALOUDIKOVA Z., KALOUDOVA Y., BRYCHTA P. - CZECH REPUBLIC)
Aim. The aim of this work is to determine the incidence of ventilator-associated tracheobronchitis (VAT) and ventilator- associated pneumonia (VAP) and to define the define the most important respiratory pathogens in patients with inhalation injury. Introduction. Infectious complications in severely burned patients present serious problems. Patients with inhalation injuries are exposed to greater risk owing to the possible development of infectious complications in the lower respiratory tract. VAP is the predominant cause of death in these patients. This is due to the increasing resistance of strains of Gram-negative bacteria such as Pseudomonas aeruginosa, Acinetobacter baumannii, and Klebsiella pneumoniae. Design. Retrospective, monocentric. Setting. A five-bed burn intensive care unit. Material and methods. Between 2004 and 2009, 348 adult patients were hospitalized in the intensive care unit of the Department of Burns and Reconstructive Surgery, Brno University Hospital, Czech Republic. Of these, 127 (36.49%) were diagnosed by bronchoscopy as having inhalation injury. The prerequisite for inclusion in the cohort was an inhalation injury requiring artificial ventilation for at least 48 h. The lower airway microbiological condition was monitored regularly by sampling biological material for cultures (sputum, tracheobronchial aspirates, etc.). For the diagnosis of VAP and VAT we used the Centers for Disease Control and Prevention criteria and the Clinical Pulmonary Infection Score. Results. The average age of the 127 patients (31 women/96 men) included in the study was 38.4 yr (range, 21-69 yr) and the average total body surface area (TBSA) burned was 29.3% (range, 2-75%). The average length of hospital stay was 49.4 days (range, 4-150 days) and the duration of mechanical ventilation 8.7 days; 18 patients (14.2%) died. In patients with inhalation injury, 309 strains of bacteria were cultivated from the lower respiratory tract, of which 234 were Gram-negative. All of these bacterial strains were isolated in significant quantities for lower respiratory tract infection. The most common bacteria isolated from the lower respiratory tract was Klebsiella pneumoniae (78 times), followed by Pseudomonas aeruginosa (49x), and Acinetobacter baumannii (28x). VAT was diagnosed in 109 patients (85.8%) in the cohort. The incidence of VAT was calculated to be 98.8 per 1000 days of mechanical ventilation. VAP was diagnosed in 34 patients in the cohort (26.8%). The incidence of VAP was calculated as being 30.8 cases per 1,000 days of mechanical ventilation. In eight patients (23.5%), VAP was diagnosed within 5 days of initiation of mechanical ventilation (early onset) and in 26 patients (76.5%) after a longer period (late onset). The most common aetiological agent of VAT and VAP was Klebsiella pneumoniae (respectively 41.3% and 35.3%). Conclusion. In this study we were able to determine the incidence of VAP and VAT in patients with inhalation injury. In spite of the advances in diagnostics and therapy, inhalation injury is still burdened with disappointingly high morbidity and mortality rates. For this reason, the treatment of VAP remains a major challenge for all physicians caring for patients with inhalation injury. |
| 126 |
ANALYSE PHARMACEUTIQUE DE LA PRESCRIPTION DES ANTIBIOTIQUES AU SERVICE DES BRÛLÉS ET CHIRURGIE PLASTIQUE DE L'HÔPITAL MILITAIRE D'INSTRUCTION MOHAMMED V, MAROC
(BENZIANE H., KARFO R., SIAH S., TAOUFIK J. - MAROC)
L'infection est longtemps restée la principale cause de mortalité chez le brûlé grave. Ce travail a pour but d'évaluer la prescription des antibiotiques dans notre Service des Brûlés et Chirurgie Plastique, au regard du dossier d'autorisation de mise sur le marché (Résumé des caractéristiques du produit). Tous les patients sous antibiothérapie, au Service des Brûlés et Chirurgie Plastique de l'Hôpital Militaire d'Instruction Mohammed V de Rabat, Maroc, durant la période janvier 2008/mai 2009, ont été inclus. Il s'agit d'une étude rétrospective qui a analysé 41 dossiers de patients. Les antibiotiques utilisés par le service appartiennent à différentes familles. Les plus utilisés sont les bêta-lactamines (65%), glycopeptides (10,5%), aminosides (9%), quinolones (7%) et colistine (4,3%), avec 4,2% pour les autres classes d'antibiotiques (métronidazole 500 mg en perfusion, fluconazole injectable 100 mg/50 ml, rifampicine 600 mg en perfusion, sulfadiazine argentique crème, acide fusidique 2% crème, etc.); 70% des prescriptions sont non documentées. La voie injectable est prépondérante (89%). En tout, 227 ordonnances nominatives d'antibiothérapie ont été analysées: la posologie et les contre-indications ont été respectées par rapport à l'autorisation de mise sur le marché. Trois cas d'interactions médicamenteuses ont été relevés (fluconazole-rifampicine, fluconazole-Saccharomyces boulardii, amikacine-vancomycine). Ce constat montre l'importance de l'analyse pharmaceutique des prescriptions des antibiotiques dans un service utilisant des antibiotiques de la réserve hospitalière, donc actifs mais très toxiques. |
| 132 |
COMPARISON BETWEEN TOPICAL HONEY AND MAFENIDE ACETATE IN TREATMENT OF BURN WOUNDS
(MAGHSOUDI H., SALEHI F., KHOSROWSHAHI M.K., BAGHAEI M., NASIRZADEH M., SHAMS R. - IRAN)
Histological and clinical studies of wound healing were performed in comparable cases of fresh partial-thickness burns treated with honey dressing or mafenide acetate in two groups of 50 randomly allocated patients. Of the patients with honey- treated wounds, 84% showed satisfactory epithelialization by day 7 and 100% by day 21. In wounds treated with mafenide acetate, epithelialization occurred by day 7 in 72% of cases and in 84% by day 21. Histological evidence of reparative activity was observed in 80% of wounds treated with honey dressing by day 7 with minimal inflammation. Fifty-two per cent of the mafenide acetate treated wounds showed reparative activity with inflammatory changes by day 7. Reparative activity reached 100% by day 21 with the honey dressing and 84% with mafenide acetate. Thus, in honey-dressed wounds, early subsidence of acute inflammatory changes, better control of infection, and quicker wound healing were observed, while in mafenide acetate treated wounds a sustained inflammatory reaction was noted even on epithelialization. |
| 138 |
ACID BURN VIOLENCE IN IRAN
(HAFEZI F., NAGHIBZADEH B., AMIR HOSSEIN NOUHI, HAMID ELMI RAD - IRAN)
Background. Acid assault is one of the most brutal of crimes. This crime is not meant to kill but to punish the victim or to destroy the victim's social life. This violent act usually occurs in third-world countries. The aim of this paper is to assess the epidemiological factors that steer a person toward such a violent act. Method. From May 2004 to October 2010, the charts of victims of acid violence referred to the Motahari Burn Center in Iran were reviewed. During this 6-yr period, 59 patients were included in this retrospective study. We identified the aetiology and the extent of the damage that was produced as a result of throwing corrosive chemicals onto the victim's body for the purpose of revenge. Results. The cases reviewed concerned 51% male patients and 49% female. The face and upper body were the most commonly injured areas, and the most common assailant was a close family member. Conclusion. The authors believe that lack of information about the catastrophic outcome of this action, plus the widespread availability of strong, destructive chemicals, are the main reasons for the rising incidence of this crime. |
| 141 |
AN UNUSUAL BURN CAUSED BY HOT ARGY WORMWOOD LEAF WATER
(LIANG X., CHEN X.-L., WANG F., GUO F. - PEOPLE'S REPUBLIC OF CHINA)
An unusual burn case caused by hot wormwood leaf water is discussed. A 29-yr-old woman sustained a 7% seconddegree burn on both buttocks and the left thigh. This case report highlights a rare cause of chemical burn that may become more common with increasing use of this method of traditional Chinese medicine. Measures for preventing this type of burn injury are also presented. |
| 144 |
TUMESCENT INFILTRATION OF LIDOCAINE AND ADRENALINE FOR BURN SURGERY
(GÜMܸS N. - TURKEY)
Tumescent infiltration is a widely used type of regional anaesthesia for cutaneous surgery. This technique makes it possible to administer high doses of lidocaine and adrenaline within the safety limits, leading to reduction in pain and bleeding during the operation. In this study, tumescent infiltration of lidocaine and adrenaline was used in routine procedures of burn surgery such as escharectomy, debridement, tangential excision, and skin grafting. In 17 patients with scald and flame burns, tumescent infiltration was performed prior to surgical procedures under either general anaesthesia or intravenous sedation. After 15 minutes, escharectomy, debridement of necrotic tissues, tangential excision of the burned skin, removal of the granulation tissue, and harvesting of the skin graft were performed. No complications occurred. All vital signs remained within safety limits during the operations. Haemorrhage was minimal and the operations were thus performed easily and rapidly. During removal of granulation tissue, very little blood loss occurred so that both the excision of granulation tissue and skin grafting were accomplished rapidly because of the minimal need of severe haemostasis. The duration of surgery was considerably reduced. No haematoma or bruising developed after surgery. No blood transfusions were required as the decline in haematocrit levels was not more than 3%. Postoperative analgesia was excellent for the first 8 h, eliminating the need of additional measures. Tumescent infiltration of adrenaline and lidocaine is a simple, effective and safe technique which facilitates anaesthesia in large areas of the burned body surface and leads to less bleeding and easy surgical dissection and hydrodissection, allowing fast, easy and painless burn surgery. |
| 149 |
LES RÉTRACTIONS CERVICALES POST-BRÛLURE - À PROPOS DE 49 CAS ET REVUE DE LA LITTÈRATURE
(ELAMRANI D., ZAHID A., ABOUJAAFR N., DIOURI M., BAHECHAR N., BOUKIND E.H. - MAROC)
Les brides cervicales post-brûlure sont la conséquence de brûlures profondes, souvent négligées ou mal prises en charge. Elles affectent la fonction, l'esthétique et l'état psychologique des patients et peuvent être de traitement difficile. A partir d'une étude rétrospective étalée sur une période de six ans (janvier 2002-janvier 2008), nous avons analysé les caractéristiques épidémiologiques et cliniques ainsi que les indications et les résultats thérapeutiques chez 49 patients présentant des brides cervicales post-brûlure, suivis au Centre National des Brûlés et de Chirurgie Plastique de Casablanca. L'enfant et l'adulte jeune sont les plus touchés, avec une légère prédominance féminine (59,2%). Les brûlures domestiques sont les plus fréquentes (93,9%) et l'étiologie de l'accident est dominée par la brûlure thermique (98,0%). Les brides cervicales modérées et sévères (selon la classification d'Achauer) sont les plus fréquentes et représentent respectivement 30,6% et 38,8% des cas. Le traitement chirurgical a fait appel aux greffes cutanées dans 67,3% des cas, aux plasties locales dans 24,5% des cas et aux lambeaux dans 8,2% des cas. Chez les 47 patients suivis à long terme, les résultats fonctionnels et esthétiques sont jugés bons dans 83,0% des cas et moyens dans 8,5% des cas, tandis que les cas restants (8,5%) ont nécessité une reprise chirurgicale. Sur le plan épidémiologique (âge, sexe, caractéristiques de la brûlure) et clinique (localisation des séquelles, formes cliniques), les résultats de notre série sont comparables aux données de la littérature. Le rôle de la prise en charge initiale (excision-greffe précoce, pressothérapie et immobilisation par minerve) dans la réduction de l'incidence et de la sévérité des séquelles de brûlures cervicales est prouvé. Lorsqu'un traitement chirurgical est indiqué, le choix du procédé de réparation dépend essentiellement de l'étendue des séquelles. Les plasties (Z, IC, Y-V.) et les lambeaux locaux, avec ou sans expansion, sont d'indication classique dans le cas des brides mineures. Dans le cas des brides sévères et majeures les auteurs sont divisés quant au choix entre greffes cutanées et lambeaux. Cependant, quel que soit le traitement chirurgical établi, la rééducation demeure nécessaire pour avoir un résultat final satisfaisant. |
| 157 |
CASE HISTORY: LE SYNDROME D'OGILVIE CHEZ LE BRÛLÉ GRAVE
(SIAH S., SEDDIK H., ABABOU K., IHRAI H., DRISSI KAMILI N. - MAROC)
La pseudo-occlusion colique aiguë ou syndrome d'Ogilvie est une dilatation aiguë du colon antérieurement sain, survenant en l'absence de lésion obstructive. Des circonstances pathologiques comme les brûlures ou une médication neuroleptique ont été reconnues comme prédisposantes. En réanimation des brûlés, l'incidence de cette complication digestive varie de 0,5 à 1%. Le but de notre travail est de rappeler, à travers un cas de pseudo-obstruction aiguë du côlon chez un patient atteint de brûlures étendues, les données cliniques et paracliniques de ce syndrome et ses bases physiopathologiques, ainsi que sa prise en charge thérapeutique. Le tableau clinique était caractéristique chez notre patient: météorisme abdominal important. Le scanner abdominal a montré une énorme dilatation colique sans obstacles mécaniques. L'évolution a été favorable après une exsufflation colonoscopique. Le syndrome d'Ogilvie est une éventualité rare qui peut conduire, sans traitement efficace, à la perforation cæcale au pronostic péjoratif. Il est donc nécessaire d'établir le diagnostic précocement et surtout de réaliser une surveillance radiologique stricte après la mise en place d'un traitement médical, dans lequel la coloscopie constitue un apport précieux. |
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