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Volume IV |
Number 1 |
March 1991 |
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SUMMARIES
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DEATH PROBABILITY DETERMINATION IN BURN PATIENTS AS THEY ARE ADMITTED TO HOSPITAL. MATHEMATICAL MODEL OF LOGISTIC REGRESSION
(Herruzo Cabrera R., García Torres V., Fernández Arjona M., Rey Calero J. - Spain)
With the intention of improving death probability determination in bum patients, a sophisticated technique is proposed based on a logistic regression model. The method was used over a 3-year period, taking into account I I variables Presented by all the bum patients admitted to a Bums Unit. A Logress computer program was used to calculate the coefficient of independent variables. Tables are given for the simple calulation of death probability in these patients.
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DEATH PROBABILITY EVALUATION IN CRITICALLY BURNED PATIENTS WITH A MULTIVARIANT ADJUSTMENT
(Herruzo Cabrera R., Gil Miguel A., Garcia Torres J., Rey Calero J., Mayer Fournaraki R.F. - Spain)
193 critically burned patients (over 25% damaged body surface or affected by electric mechanisms) under treatment in the Burned Patients Unit of La Paz Hospital from 1985 to 1987 were examined and their death probability was calculated through a logistic regression model, which included their clinical characteristics (age, burned body surface, inhalation syndrome, delayed eschar debridement, previous pathology, etc.). All variables were included in the Logress program, which establishes a model with the principal predictive value of death. The model was evaluated through a Characteristics Operating Curve, where the optimum cut point was located at a 55% theoretical probability of death, with a sensitivity of 82%, a specificity of 82%, and Positive Predictive Value of 60.6%. The Negative Predictive Value was 93%, and the Likelihood Ratio 4.5.
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DISSEMINATED INTRAVASCULAR COAGULATION AS THE UNDERLYING CAUSE OF MULTIPLE ORGAN FAILURE IN BURNED PATIENTS: PRELIMINARY OBSERVATIONS
(Borgognone A., Gherardini G., Marinelli F. - Italy)
The multiple aspects which constitute the bum syndrome indicate a possible single mechanism activated by disseminated intravascular coagulation. This coagulation dysfunction could give rise to a process that causes frequent organ failure in burned patients. It was determined that multiple unrelated syndromes could be ascribed to massive clogging of the principal organs which work as strainers. It was observed that typical dysfunctions present in burned patients were caused by fibrinogen degradation products, clogs of platelets, and fibrin debris, which impair lung, kidney and liver filtration. If this mechanism of action is confirmed by further studies, a useful application in the field of therapy will be available for the care of burned patients.
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MODIFICATIONS OF COAGULATION IN THE BURN PATIENT
(Garcia Torres V., Jimenez M.C., Garcia Salvatierra B., Rivera M.J., Guemes Gordo F. - Spain)
The multiple aspects which constitute the bum syndrome indicate a possible single mechanism activated by disseminated intravascular coagulation. This coagulation dysfunction could give rise to a process that causes frequent organ failure in burned patients. It was determined that multiple unrelated syndromes could be ascribed to massive clogging of the principal organs which work as strainers. It was observed that typical dysfunctions present in burned patients were caused by fibrinogen degradation products, clogs of platelets, and fibrin debris, which impair lung, kidney and liver filtration. If this mechanism of action is confirmed by further studies, a useful application in the field of therapy will be available for the care of burned patients.
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EPIDEMIOLOGY OF BURNS IN ASSIUT PROVINCE, EGYPT, DURING THE LAST TWO YEARS
(EI-Sonbaty M.A., El-Oteify M. - Egypt)
Between January 1988 and January 1990, 559 bum patients were admitted to the Burn Units of Assiut El-Shamla General Hospital and Assiut University Hospital. A retrospective study was carried out to analyse the age, sex distribution, bum aetiological factors, modality of treatment, hospital stay and mortality rate. It was found that males and females were equally affected by bum accidents. Children were involved in 50.9% of the cases. The burn was due to flame (67.9%), hot liquids (29.9%), electricity (1.2%) and chemicals (1%). The number of deaths was 201 (33.5%). The causes of this high mortality are discussed.
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PERMANENT SKIN HOMOGRAFTING BETWEEN MONOZYGOTIC TWINS
(Bejar J.M., Jul C., Alonso F., Garcia Masclevall M.D., Gabilondo F.J. - Spain)
The problem of permanent skin coverage in patients with bums has still not been solved. There are two principal lines of research regarding this. One of these is the use of hom6grafts from cadavers in the coverage, using immunosuppressive drugs to prevent rejection. The other is the development of techniques for tissue culture, which has opened new possibilities. This paper shows the results obtained by performing homografts of skin on a severely burned patient, taken from a monozygotic twin. The results obtained indicate what could be achieved after the problems which both lines of investigation still present have been overcome.
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ORAL REHYDRATION THERAPY IN MODERATELY BURNED CHILDREN
(EI-Sonbaty M.A. - Egypt)
The resuscitation of children with more than 10% 13SA bum requires the administration of fluids containing salts and water during the first 48 h. The magic effect of the oral rehydration salt known as "Rehydran-n" in the treatment of children suffering from diarrhoea suggested the idea of trying it in the resuscitation of moderately burned children. Children with burns from 10% to 20% 13SA were chosen for the study. Twenty cases received oral rehydration solution according to a special protocol and 20 cases were resuscitated by the intravenous route using the Parkland formula as a control group. Haematocrit, Hb%, serum Na and K were measured, in addition to the assessment of the clinical picture and determination of the urine vol/h to evaluate the efficiency of oral rehydration therapy in resuscitation. The results were highly encouraging.
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EARLY EXCISION AND GRAFTING FOR BURNS OF THE HAND
(Kadry M.K.M., Bemelmans D., Cate A. - France)
The technique of early excision and grafting for 2nd- and 3rd-degree bums of the hand was attempted on 15 patients with 26 burned hands. The functional results were very good in 9 cases, good in 10cases, average in 4 patients and bad in 3 cases. This represents a 91.5% functional recovery.
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A RARE CAUSE OF BURN INJURY
(Navarro Monzonis A., Benito Ruiz J., Baena Montilla P., Mena Yago A., De la Cruz Ferrera L.I. - Spain)
This paper reports a unique cause of burns due to a very old tradition consisting of freeing a bull with a special device tied around its horns and set alight. Bums by this cause do not cause death but they provoke an important morbidity especially with regard to the site of the injury, which most commonly. affects the axilla, the inner aspect of the arms and the chest. Associated injuries, such as cuts, bone fractures and even cranioencephalic traumas, are not rare.
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PREVENTION DES BRULURES ELECTRIOUES
(Cabanes J. - France)
Bien que les accidents électriques soient rélativement rares dans les domaines professionnel et domestique, ils sont toujours tr&s graves. L'Auteur décrit des méthodes pratiques pour réduire le risque de ces accidents en milieu domestique et propose deux méthodes pour éviter les risques pour ce qui concerne les protessionnels de 1'é1ectricité. 11 conclut avec la considération que la prévention des accidents et des brfilures électriques doit passer par une formation et une éducation, la majorité des accidents étant due A une erreur humaine et non a une défaillance technique.
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LES BIOMATERIAUX CHEZ LES BRULES GRAVES
(Echinard C., Damour 0., Courbier R., Sahabecídin L., Vescovali C., Dantzer E. - France)
Les Auteurs consi&rent les divers biomatériaux utilisables aprés 1'excision précoce pour la couverture des brfflures étendues. Ils décrivent les avantages et les inconvénients de Putilisation de peau autologue, des homogreffes, des hétérogreffes et des divers types de substitut cutané (les membranes amniotiques, Foraiderm R, la Beschitin R, le PA 295 R, le Biobrane R). Une autre solution pour recouvrir les grands brOlés est l'utilisation de cultures de kératinocytes. Les Auteurs décrivent en outre leur expérience avec un derme artificiel, A base de collagéne humain, de glycoaminoglycane et de chitosan, qu'ils ont étudié chez le rat. En considération des résultats positifs chez I'animal, pour ce qui concerne 1'épidermisation, ces études devraient se poursuivre chez I'homme tr&s prochainement.
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L'IMMUNITE DU GRAND BRULE
(Echinard C., Vescovali C. - France)
Dans le traitement des troubles de l'immunit& qui se présentent chez les grands brfilés il est tr&s important de connaitre les signes cliniques et biologiques et de comprendre la cause et les mécanismes de ces troubles. Sans cette connaissance on ne peut pas affronter les problémes de la septicémie qui découle de la situation de dépression immunitaire. Les Auteurs décrivent ces signes et proposent des traitements appropries.
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