INTERNATIONAL ABSTRACTS

ACUTE PHASE PROTEINS AND PROGNOSTIC INFLAMMATORY AND NUTRITIONAL INDEX (PIND IN MODERATELY BURNED CHILDREN UP TO 3 YEARS

The plasma levels of albumin, prealbumin, orosomucoid and C-reactive protein (CRP) were determined in 27 burned children (aged 3 months to 3 years) classified in two groups - minor bums, up to 10% BSA, and more extensive burns, between I I and 20% BSA. The lesions were either dermal burns (Class 1113) or full skin-thickness bums (Class 111). The results of the measurements were used to calculate the prognostic inflammatory and nutritional index (PINI). The findings in the two groups are compared. It is concluded that there are no pronounced changes in plasma protein leves in the group with only minor bums. The patients in the more extensively burned group show significant reductions in albumin and prealburnin levels and an increase in CRP. The PINI proves to be a useful instrument which reflects the consequences of thermal trauma in the metabolism of plasma proteins in children under the age of 3 years.

Kudlácková M., Andel M., Hájková, Nováková J. Bums, 16: 53-56, 1990.

The major role of the reticuloendothelial system (RES) is to clear micro-organisms from the blood and it is possible that the development of septicaemia in patients suffering from acute burn trauma could be partially explained by a reduction in this activity. This hypothesis was tested in a series of experiments on rats. The techniques used are described. It was found that acute bum trauma caused a marked reduction in colloid uptake by the spleen and a marked increase of colloid uptake by the lung. The colloid uptake of the liver and kidney appeared to be unchanged. When burn eschar was implanted into normal control rats colloid uptake was not significantly affected. The results suggest that alterations in RES phagocytic activity of the spleen and lung occur rapidly after burn injury, within a few minutes, and that they may not be related to the presence of burn eschars.

Trop M., SchitTrin EL, Carter E.A. Bums, 16: 57-59, 1990.

The technique of early excision and grafting in the treatment of deep bum injuries underlines the need for accurate and reliable assessment of the depth of the burn injury. This study shows the advantage of the use of thermography in the selection of patients who might benefit from early surgery. Twenty-three patients with 36 bums in 32 hands were examined thermographically within 48 h of injury. Superficial and deep partial-thickness bums were treated conservatively, with excision and grafting in those cases which had not healed within 2 to 3 weeks after injury. This group of delayed surgical cases was compared with the healed group to determine the predictive value of the initial clinical and thermographic assessments of bum depth. Full skin-thickness burns were excluded from the study. It was found that initial thermographic assessment correctly predicted the outcome in 33 out of the 36 bums (whether healed or excised and grafted), whereas initial clinical assessment of depth had no significant relationship with the time taken to heal.

Cole R.P., Jones S.G., Shakespeare P.G. Bums, 16: 60-63, 1990.

TOPICAL ANTIMICROBIAL TESTING OF BURN WOUND MICRO-ORGANISMS: EVALUATION OF A NEW TECHNIOUE

A prospective trial was designed to determine the usefulness of a new system of determining the susceptibility of burn wound micro-organisms to topical microbial therapy. The new method, known as TOPITEST, employs a methacrylate polymer delivery system for the release of topical antimicrobial agents into agar. Test plates can be inoculated either by a direct swab culture of the wound or with micro-organisms isolated by other methods. TOPITEST was compared to an agar well diffusion (AWD) test that uses commercially compounded antimicrobials and biopsy-recovered organisms. TOPITEST had comparable results to those of AWD when using biopsy-recovered organisms, while with the swab culture technique, it had a high failure rate in the recovery of sufficient organisms from the burn wound for testing. TOPITEST provided results more rapidly than the AWD test, but, may not be so cost effective.

Taddonio T.E., Thomson P.D., Smith D.J. Jr, Prasad J.K. Bums, 16: 64-66, 1990.

A simple method is described for the protection of exposed skin grafts. The equipment is cheap, easy to construct and use, and adaptable to most sites of the body. The graft has circulation of air, fulfilling the criteria of exposed grafting, and it can be viewed easily through the netting cover.

Zoltie N., Rayner R. Burns, 16: 67-68, 1990.

A case is described in which a car electrician sustained a deep circumferential burn of the ring finger, on which he was wearing a stainless-steel ring. The bum was caused by the short-circuiting of the car battery by a metal spanner and the ring, but it was found that it was a contact and not an electric burn.

Attalla M.F., EL-Ekiabi S., Al-Baker A. Bums, 16: 69-70, 1990.

SILDIMAC: A NEW DELIVERY SYSTEM FOR SILVER SULFADIAZINE IN THE TREATMENT OF FULL-THICKNESS BURN INJURIES

Routine wound care for the purposes of the removal of exudates and debris and the limitation of infection causes the patient discomfort and is time and energy consuming for staff. In an attempt to improve patient care and comfort and to make better use of nursing time a multicentre research project using Sildimac (Dimac with silver sulfadiazine, Marion Laboratories, Kansas City, Mo., USA) was carried out, in order to test its safety and efficiency in the treatment of full-thickness burn wounds. Sildimac, when left in place for up to 4 days, appeared to be as effective as twice daily wound cleansing and application of Silvadene cream 1% (Marion Laboratories, Kansas City, Mo., USA) in the treatment of full-thickness burns.

Miller L., Hansbrough J., Slater H., Goldfarb I.W., Kealey P., Saffle J., Kravitz M., Silverstein P.

J. Burn Care Rehabil., 11: 35-41, 1990.

In the light of the effects of two recent major nuclear accidents, a study was carried out to evaluate the usefulness of the rat as a model of combined radiation and thermal injury and to establish the efficacy of early burn wound excision in a setting of combined radiation and thermal injury. Whole-body irradiation (WBI) in various doses caused a predictable mortality rate, with an LD50 30 of 783 rad with 95% confidence limits of 737 and 823 rad. 10% BSA full-thickness burns did not cause any deaths in 30 control animals. When combined with a non-lethal 10% thermal injury, varying doses of whole-body irradiation led to widely varying LD50 30 values in 3 separate groups of rats. Survival prospects were not improved by excision and closure of a 10% burn 24 h after exposure to 200 rads. This study did not prove the superiority of early excision in a com-bined-injury model, but the magnitude of immune suppression associated with a thermal injury and WBI and the probability of wound sepsis justify the development of models in which surgical (excision and closure), medical or combined' qherapeutic protocols are evaluated.

Hirsch E.F., Vezina R., Corbett S., LaMorte W., Feldman M. J. Burn Care Rehabil., 11: 42-45, 1990.

A review is made of the literature describing cases of cancers arising from old burn scars. This is combined with a study of 21 patients followed up at a Burns Centre. The lag period in these patients for the appearance of cancer ranged from 8 months to 60 years. The extremities were most frequently affected. Such cases of cancer, when confirmed by biopsy specimen, can be treated by wide excision and skin graft or local flap coverage.

Bartle E.J., Sun J.H., Wang X., Schneider B.K. J. Burn Care Rehabil., 11: 46749, 1990.

Burns of the oral commissure are the commonest type of electrical injury in children, usually being caused by sucking or biting the end of a live wire or the junction between a charged extension cord and an appliance. With a view to reducing post-operative wound contracture in late reconstructive surgery, a method of functional reconstruction has been developed in which excision of the burn scar is combined with lateral advancement of the orbicularis orbis muscle, re-creation of the modiolus labii, and re-establishment of vermilion continuity. This technique was used in 5 children with mouth burns and appeared to significantly reduce the amount of post-operative wound contracture (p< 0.025).

Pensler J.M., Rosenthal A. J. Burn Care Rehabil., 11: 50-53, 1990.

During the years 1981 to 1986 a review was carried out of 1987 patients in order to answer the following questions: (1) Are Foley catheters or suprapubic catheters necessary for all patients with perineal burns? (2) Is there any advantage to early excision of perineal burn wounds? (3) What are the unique complications of perineal burn wounds? Of the 103 patients with perineal burns (mean burn size 36% TBSA) 29 died, but not for reasons related to the perineal bums. Of the 74 survivors 36 (49%) needed Foley catheters, which were however in position only during the period of resuscitation. Catheterization did not cause any urethral complications and only three patients required surgery (urethral meatotomy and split-thickness grafts). No genitourinary complications associated with perineal bums were observed. Nearly all the perineal and genital burns were managed without indwelling catheters. It was found that early excision of the perineal burn wound was not necessary, and that most of the wounds healed satisfactorily without grafting.

Peck M.D., Boileau M.A., Grube B.J., Heimbach D.M. J. Burn Care Rehabil., 11: 54-56, 1990.

It is recognized by all psychologists that play is of such critical importance in a child's life that any significant decline in a child's ability to-play is worthy of examination and treatment. This aspect of child development is investigated in relation to a 3-year-old child who suffered full-thickness burns on his face, arms, hands, chest and back. Two members of his family died and his mother was so badly injured that she could not visit him for some time. The child was initially fearful and timid when meeting the hospital psychologist and he did not verbalize responses. It was found that his main anxiety was not the disfigurement of his burns but rather the fear of separation and of the loss of newly acquired autonomy and initiative. The play therapy adopted is described. The restoration of the child's play not only offered the vehicle for understanding his stresses but also made available his cognitive, affective and social resources, which in turn enhanced adaptation.

Mahaney N.B. J. Bum Care Rehabil., 11: 57-63, 1990.

An unusual case is described of a C02 laser fire in the laryngotracheobronchial tree which occurred -because of an increase in the fraction of inspired oxygen to greater than 40%. This caused ignition of an endotracheal tube, resulting in severe burns of the respiratory mucosa. The patient concerned was a 45-year-old diabetic woman suffering from juvenile laryngeal papillomatosis. After treatment in a burn intensive care unit, the patient made a fairly uncomplicated recovery and was discharged from hospital 25 days after the burn.

Bingham H.G., Gallagher T.J., Singleton G.T., Gravenstein J.S., Pashayan A.G., Bjoraken D.G.

J. Burn Care Rehabil., 11: 64-66, 1990.

DELAY11D AUTOGRAFT LOSS IN HIV-POSITIVE PATIEATS: TWO CASES

Two case histories are described of delayed autograft loss secondary to late polymicrobial infection in HIV-positive patients who had suffered bums. A review is made of mechanisms of HIV-deficiency in such patients and it is considered whether polymorphonuclear or some other immune dysfunction could contribute to the graft failure. As the number of HIV-positive patients increases, HIV-positivity is becoming a more frequent element in prognosis. The need for special surgical considerations in these patients is also considered. The question of HIV transmissibility in a burn unit is discussed, together with problems of infection control.

DeLaney A.R., Damato R.A., Ikeda C.J. J. Bum Care Rehabil., 11: 67-70, 1990.

Branhamella catarrhalis, although part of the normal flora of the upper respiratory tract, has recently been implicated as a lower airway pathogen. A case is described of a healthy 2 1/2-year-old child who after recovering from respiratory arrest due to smoke inhalation in a house fire later developed B. catarrhalis pneumonia and bacteremia. This is the first description of invasive disease involving this organism in a traumatized airway. Other pediatric cases of B. catarrhalis bicteremia are reviewed, and it is suggested that immunopompromise is a risk factor.

Dietrich M.C., Gerding R.L., Kumar M.L. J. Bum Care Rehabil., 11: 71-73, 1990.