A PROSPECTIVE TRIAL OF PROPHYLACTIC INTRAVENOUS IMMUNE GLOBULIN FOR THE PREVENTION OF INFECTIONS IN SEVERELY BURNED PATIENTS

This report is a prospective randomized double-blind study of the potential therapeutic benefit of parenteral administration of an i.v. immune globulin (IGIV) preparation for reducing infectious complications in severely burned patients. The study was carried out on 50 adults and children with 20% or more TBSA, treated twice weekly with IVIG (500 mg per kg) or placebo, either for 5 weeks or until their wounds were covered. The IGIV treated patients immediately showed a correction of their depressed serum IgC levels, but there was no change in their infection or mortality rates. IGIV treatment had no adverse effects. The results of the study on this limited number of patients may not be completely reliable as the IGIV treated adult patients had a higher burn surface area and a higher incidence of inhalation injury than the control patients.

Waymack J.P., Jenkins M.E., Alexander JW., Warden G.D., Miller A.C., Carey M., Ogle C.K., Kopcha R.G.

Bums, 15: 71-76, 1989.

NEUTROPHIL DYSFUNCTION AFTER THERMAL INJURY: ALTERATION OF PHAGOLYSOSOMAL ACIDIFICATION IN PATIENTS WITH LARGE BURNS

Six patients with large bums were observed in order to examine whether the kinetics or degree of neutrophil phagolysosomal acidification were altered during phagocytosis of Staphylococcus aureus. Longitudinal examinations were performed using a flow cytometric technique that allowed the simultaneous measurement of phagocytosis and phagolysosomal pH. The kinetics of neutrophil phagolysosomal acidification were altered during the first 20 days post-bum and became normal only at discharge and follow-up. Measurements of neutrophil maximal phagolysosomal acidification showed reduced pH compared to controls during the first 5 days of hospitalization. It is concluded that the alterations in the pattern of neutrophil phagolysosomal acidification are significant and that there are alterations of an oxygen-dependent microbicidal mechanism in neutrophils from bum patients which may infection.

Bjerknes R., Vindenes H. Burns, 15: 77-81, 1989.

CYTOGENETIC INVESTIGATIONS OF THE ALLODERMIS AFTER INTERMINGLED SKIN GRAFTING

Intermingled skin transplants performed according to the methods developed In the People's Republ c of China are not usually subject to generalized rejection, the allodermis being integrated during the healing process and eventually covered over by outgrowing auto-epidermal cells. In this study, intermingled ~skin grafts were performed using male Wistar rats as recipients and female DA-rats as donors, in order to investigate the fate of the allogenic cells. Karyotype analysis of cells growing out from intermingled skin biopsies showed the presence of viable allogenic cells on days 53 and 111 post-transplantation. The intermingled skin appears to form a cellular mosaic with different portions of autogenic and allogenic cells.

Kistler D., Hafernann B., Flettich R. Burns, 15: 82-84, 1989.

In view of the non-rejection of intermingled grafts of allogenic skin interspersed with small autogenic islets, as performed according to the techniques developed in the People's Republic of China, a study was made of the T-helper and T-suppressor cells in the region of the autogenic islets and the remaining allodermis. This research showed a greater frequency of these particular cells in the islets, with marked massing between the autoepithelium and the autodermis. Histological tests indicated that the Langerhans cells grow over the allodermis together with the epithelium. However their number in the newly formed epidermis was reduced, compared to those in the autogenic islets.

Kistler D., Kauhl W., Hafernann B., Hofstddter, Hettich R. Bums, 15: 85-87, 1989.

A study was made of the follow-up of 57 patients who had attempted suicide by burning. The age group with the highest incidence was from 20 to 39 years. The sex ratio was about equal. Most of the patients were, or had been, under psychiatric care, half of the attempts actually taking place in a psychiatric hospital. Twelve of the patients died, and the follow-up (1-8.25 years, average 3.8) therefore concerned the 45 survivors. In this period, 6 patients died of natural causes and 2 committed suicide. Eighteen patients were at home, 13 in a psychiatric institution, 3 in a protective commune and 3 in custody. It would appear to be useful, though difficult, to follow these patients under a closed follow-up regimen.

Klasen H.J., van der Tempel G.L., Hekert J., San& E.W. Burns, 15: 88-92, 1989.

An unusual case is described of a patient with an 87% T13SA bum who developed a faecal fistula through the burned abdominal wall, following a car accident. The course and management of the disease are described. The patient, a 23-year-old male, made a complete recovery.

Prasad J.K., Thomson P.D., East M.K, Bums, 15: 112-114, 1989.

(This article constituted the Everett Idris Evans Memorial lecture - 1986.) In February 1981 58 people were killed in the Stardust Disco fire disaster in Dublin (Eire). In order to discover why the fire spread so rapidly, the United Kingdom Fire Research Station reconstructed the section of the night club where the fire started, using identical structural and furnishing materials. The development of the fire was then re-enacted, using a variety of recording instruments and telecameras. Numerous data are presented, followed by forensic, physiological and psychological studies, with references both to the persons who either died in the fire or survived and to cynomolgus monkeys, which inhaled non-lethal quantities of air containing the toxic chemicals present in the actual disaster. High concentrations were found of CO, HCN and HQ and these give a plausible reason for the location of the fatalities in the night club, death being so rapid that the victims were unable to find an exit. Knowledge of the chemicals that patients have inhaled into their lungs must be of interest to the staff of emergency rooms.

Davies J.W.L. J. Burn Care & Rehabil., 7: 213-222.

(This article constituted the 1986 Presidential Address to the American Burn Association.) The American Burn Association has four objectives in its chosen field: care, prevention, teaching, and research. It is essential that quality should be maintained and the various goals are considered in relation to a number of current problems. It is stressed that the preservation of the quality of interpersonal relationships depends on keeping these pressures in perspective.

Robson M.C. J. Burn Care & Rehabil., 7: 223-229.

A primary determinant factor in the mortality of patients with extensive thermal injury is the failure to respond to adequate fluid resuscitation during the immediate post-burn period. A protocol was therefore designed to evaluate the response to plasma exchange in burn patients who failed to respond as expected to conventional fluid resuscitation, for patients aged 15 to 70 years with over 30% TI1SA burns. Plasma exchange showed itself to be a means of sustaining patients during the immediate post-burn period when they failed to respond appropriately to conventional fluid resuscitation.

Schnarrs R.H., Cline C.W., Goldfarb I.W., Hanrahan J.B., Jacob H.E., Slater H., Gaisford J.C.

J. Burn Care & Rehabil., 7: 230-233.