Annals of the MBC - vol. 4 - n' 3 - September 1991

INTERNATIONAL ABSTRACTS

BICIBRANE WOUND DRESSING USED IN THE TREATMENT OF TOXIC EPIDERMAL NECROLYSIS: A CASE REPORT

The case is described of a 10-year-old boy with toxic epidermal necrolysis (TEN), a severe and often fatal forni of epidermal sloughing thought to be caused by a ra-e reaction to a wide variety of medications. Anat ically, TEN lesions resemble a superficial 7to the head, developed the condition after partial hickness burn. The boy, who had a gunshot wound treatment with a number of antibiotics. It is important to protect the exposed dermis from infection and desiccation, and regeneration can occur from the skin appendages. In this case the skin lesions were dressed with Biobrane temporary wound dressing. Infection was pre ented, wound pain decreased, and subsequent healing was uncomplicated.

BILATE AL FEMORAL NECK FRACTURES AFTER ELECTR CAL INJURY: A CASE REPORT AND LITERA URE REVIEW

Simultaneous bilateral fractures of the femoral necks are rare, especially when unaccompanied by an underly ng pathological condition. The literature contains only 10 cases in which this type of injury was causes y a trauma (with electricity as the cause in only o e case). A second such case is described, in which healthy truck-driver indirectly contacted a 40,000 ~ V high-tension wire while unloading his vehicle.~! The patient complained of medial thigh pain, but fernDral damage was not initially suspected. It was only on day 3 post-burn that roentgenograms showed bilatera femoral neck fractures of the Garden IV type. It is im injury increasi of the fi portant to be aware of the possibility of this ind to diagnose it early, in order to avoid ng the risks of subsequent avascular necrosis -moral head, non-union and severe arthritis.

Slater R Jr, Peterson H.D. J. Bum ~are Rehabil., 11: 240-243, 1990.

If orally or nasally placed endotracheal and gastric tubes are not positioned securely they may cause compression on the car, leading to necrosis and infection. A simple technique is described that avoids this complication, which in burn patients in particular can be troublesome.

Wade E.J., Purdue G.F., Hunt J.L. J. Burn Care Rehabil., 11: 244-245, 1990.

A burn scar assessment is proposed based on physical parameters, related to healing and maturation of wounds, cosmetic appearance, and the function of the healed skin. An independent assessment is made of pigmentation, vasciflarity pliability and scar height, an increasing score being assigned to greater pathological condition (normal skin = 0). The validity of the scale is described in relation to 73 scarred patients.

Sullivan T., Smith J., Kermode J.. McIver E., Cotirlemanchc D.J. J. Burn Care Rehabil., H: 256-260, 1990.

Burn safety campaigns can be boring, especially for children. Here a stimulating edticational programme is described, as administered to 66 fourth-grade elementary school children, who learned burn safety techniques by playing games ("ciawling on their bellies" like the GI Joe TV character) iather than passively listening to lectures. In a testing session, also based on games, a high learning rate was found.

Wade J., Purdue G,F., Hunt J.L., Childers L

J. Burn Care Rehabil., 11: 261-263, 1990,

This study describes the developinctil of an animal model in which full-thickness dernial necrosis was achieved without hot burn injury. 1,1quid nitrogen was used to produce full-thickness necrosis in the dorsal dermis of rats. The in vivo effect of(his trauma on the uptake of technetium 99m-labelled sulphur colloid (99m-Tc-Sc) by the lung and spleen was measured to further elucidate the role of dermal necrosis in burn-induced alteration in reticuloendothelial system phagocytic function. There was a marked reduction in the amount of 99m-Tc-Sc taken up by the spleen, whereas lung uptake was definitely increased.

Trop M., Schiffrin E.J., Jung W., Ehrlich, H.P., Carter E.A. J. Burn Care Rehabil., 12: 97-100, 1991.

SURESCHAR TISSUE FLUID: A SOURCE OF CELL-MEDIATED IMMUNE SUPPRESSION INVICTIMS OF SEVERE THERMAL INJURY

Thermal injury causes physiological alterations in the microcirculation of the damaged site which lead to an increase in microvascular permeability and the consequent accumulation of tissue oedema, or subeschar tissue fluid (STF). Oedema has the adverse capacity in vitro of inhibiting cell-mediated immune function, The purpose of this study was to determine the time frame during which STF demonstrates its immune suppressive action. Seven patients were included in the study (burns from 30 to 100% TBSA). STF added to cultures of lymphocytes obtained from healthy donors caused complete inhibition of mitogen-induced lymphocyte proliferation (MILP). Serum collected from the burned patients also inhibited MILP. STF possesses the ability to inhibit MILP, from its first inception. The gradual absorption of STF probably contributes to the serological evidence of cell-mediated immune suppression in severe burn victims.

Dyess D.L,. Ferrara J.J., Lutennan A., Curreri P.W. J. Burn Care Rehabil., 12: 101-105, 1991.

A new type of silver sulphadiazine-impregnated poly-L-leucine wound dressing was evaluated for its antibacterial capacity against Pseudomonas aeruginosa and its cytotoxicity to human fibroblasts and human epidermal keratinocytes. In experiments using mice, the dressing showed effective bacterial control. Its cytotoxicity, examined on a monolayer of cells formed in culture dishes, was much lower than that of 1% silver sulphadiazine cream.

Kuroyanagi Y., Kitn E., Shioya N. J. Burn Care Rehabil., ll: 106-115, 1990.

THE EFFICACY OF POLYSPORIN FIRST AID ANTIBIOTIC SPRAY (POLYMYXIN B SULPHATE AND BACITRACIN ZINC) AGAINST CLINICAL BURN WOUND ISOLATES

The purpose of this study was to evaluate the effectiveness of Polysporin First Aid Antibiotic Spray (~ijrroughs Wellcome Co.) against organisms isolated from burn wounds in hospitalized patients. Altogether 353 clinical isolates were treated with Polysporin Spray (202 gram-positive and 151 gram-negative). The growth of all the gram-positive organisms (including methicillin -resistant strains of Staphylococcus) was inhibited by the spray. The gram-negative organisms were also sensitive to the spray, except for Serratia marcescens, Morganella morganii and Proteus mirabilis. These qualities suggest that Polysporin First Aid Antibiotic Spray may be useful in the treatment Qf minor burns and other minor injuries susceptible to infection.

Walton M.A., Carino E., Hemdon D.N., Heggers J.P. J. Bum Care Rehabil., 11: 116-119, 1990.

Thc-re is still no satisfactory explatiation for the unusual susceptibility of burn patients to bacteria] infections. The main difficulty is that the mechanisms of resistance are numerous and interdependent and that they operate in a controlled physiological environment which is not easy to reproduce. The examination of individual immune systems may not therefore be sufficient to account for the overall failure of resistance. Experiments with whole blood are therefore useful because they reflect the workings of all the immune systems in one fluid compartment of the body. Experiments are described in which known numbers of Klebsiella pneumoniae or Staphylococcus aureus were added to fresh heparinized blood, which was clotted immediately with thrombin, and incubated under conditions closely resembling those in vitro. Simultaneous tests were made with heparinized plasma. Whole blood and plasma from normal persons and patients with bums had the same antibacterial power against both organisms. This suggests that the failure of resistance to bacterial infection in burn patients cannot be attributed to a failure of immune mechanisms in the blood. The explanation must thus be searched for elsewhere.

Ward C.G., Spalding P.B., Marcial E., Bullen J.J. J. Bum Care Rehabil., 11: 120-126, 1990.

Accurate assessment of nutritional needs following burn injury is important for the establishment of a dietary therapy designed to minimize the detrimental effects of hypermetabolism and subsequent catabolism. The inadequacies of traditional anthropomorphic measurements for assessing nutritional status in burned patients are pointed out. Energy expenditure can be estimated adequately by direct calorimetry (very expensive and rather complicated), indirect calorimetry, or by the use of a formula (inexpensive and simple to use). Formula estimations need readjustment every week or two. Generally speaking, enteral feeding is superior to parenteral feeding for the delivery of nutrients. Four tables are provided to assist in the assessment of the nutritional needs of burned patients.

Curreri PM. Suppl. J. Trauma, 30, 12: S20-S23, 1990.

ANTIBIOTICS AND THE POST-BURN HYPER METABOLIC RESPONSE

Burn injury results in multiple metabolic and physiological alterations, of which one of the most prominent is the hypermetabolic response, which increases rapidly following resuscitation and peaks in the second week. This increase would appear to be correlated with the degree of burn wound colonization and infection with bacteria. When colonization and infection are prevented by typical microbial agents there is a decrease in the metabolic alteration resulting from burn injury. It has also been hypothesized that bum-induced translocation of intestinal bacteria could contribute to the post-bum hypermetabolic response. Attempts to prevent this entity in a burned guinea pig model through the use of selective decontamination of the digestive tract by the administration of enteral antibiotics have failed to demonstrate any measurable effect.

Waymack LP. Suppl. J. Trauma, 30, 12: S30-S35, 1990.

A review is made of the remarkable progress made in the treatment of burn injury in the last 30 years. Data relative to a Bums Centre in Massachussetts, which are typical of those in the USA, show a drop in mortality from just below 30% in the early 1970s to about 5% today. The reasons for this improvement are discussed and suggestions are made regarding future research in the field of burn therapy.

Burke H.F. Suppl. J. Trauma, 30, 12: S36-S40, 1990.

PULMONARY CIRCULATION AND BURNS AND TRAUMA

The lung is a critical organ for patients suffering a trauma or thermal injury. As blood returning from the injured organs must eventually pass through the lungs, cellular debris and toxic mediators released by the bum wound and/or the injured organs are first exposed to the pulmonary microcirculation. The lung may also contribute to the injury of systemic organs, as the result of reduced delivery of oxygenated blood or the direct release of cytotoxins into the systemic circulation. Injury to the lung may be to the pulmonary microvasculature or to the airway. The bronchial circulation reacts to injury by a considerable increase in its blood flow and microvascular impermeability. These effects could be important in mediating the changes that occur in the lung parenchyma.

Hemdon D.H., Traber D.L. Suppl. J. Trauma, 30, 12: S41-S44, 1990.

IDENTIFICATION AND MODIFICATIONS OF THE PULMONARY AND SYSTEMIC INFLAMMATORY AND BIOCHEMICAL CHANGES CAUSED BY A SKIN BURN

Bum patients are particularly prone to the development of a sepsis syndrome and multiple organ failure, especially lung failure, in the later post-bum period. The purpose of this study was firstly to determine the relationship between a relatively small skin burn and early pulmonary and systemic physiological, histological and biochemical changes, and the effect of pre-burn inhibitors and the bum wound on the process; and secondly to determine the time course of the initial burn-induced changes and to attempt to block this response with post-burn mediator inhibition. The model used was a chronically instrumented sheep in which continuous physiological and -metabolic measurements could be obtained. The animal was subjected to full-thickness body burns of 15 or 30%. Several manipulations, both surgical and pharmacological, were found to modify the injury. The methods used have the potential of being used also in humans.

Demling R.H., Lalonde C. Suppl. J. Trauma, 30, 12: S57-S62, 1990.

A clinically lethal strain of Pseudomonas acruginosa obtained from the wounds of an infected patient was tested and its growth patterns in normal plasma and in normal whole blood clotted with thrombin were compared. The original isolate of P. acruginosa was divided into two subcultures; one was preserved in liquid nitrogen while the other was passed through 24 successive room-temperature cultures on blood agar plates. It was found that plasma alone and whole blood controlled the growth of a clinically pathogenic strain of P. aeruginosa consistently and uniquely for each donor, dependent on size of inoculum, length of incubation, and the means by which the culture was maintained. The changing virulence of an organism and its unique growth pattern in the plasma and whole blood of different individuals could explain why patients exposed to the same organisms within the same environment vary infection.

Ward C.G., Bullen J.J., Spalding P.B. J. Burn Care Rehabil., 11: 127-131, 1990.