Annals of the MBC - vol. 4 - n' 4 - December 1991

A novel Israeli method used for elevating burned limbs is described. A plastic bag is used, provided with a spigot that serves for inflating by mouth (or for deflating, if necessary). The bag itself costs nothing, as its original use is as a container for fruit juice. When suitably washed it can thus be used as an economic means of limb support.

Van Straten 0. . Burn Care Rehabil., 14: 170-171, 1991.

The article describes the use of Hexcelite for burn splints. This is a lightweight low-temperature self-adhering plastic material that is easily moulded. The splints are easy to make and they provide good aeration for the wound. The mesh configuration is ideal for use on newly grafted areas and drainage from the wounds is not hindered. Patient discomfort is minimal.

Van Straten 0., Shemesh Y., Rosenberg L. J. Burn Care Rehabil., 14: 172-173, 1991.

Little attention has been given in the literature to the problem of the loss of opening of the mouth after facial burns. Here a dynamic exercise splint is described that can help to prevent contractures of the facial muscles and softening of scar tissue. The splint contains a spring and the patient is encouraged to bite on the splint in order to exercise the jaw muscles. The results of using the splint with two patients are described. It is suggested that this new dynamic splint should be an integral part of the therapy programme for the rehabilitation of the patient with facial burns.

Van Straten 0. J. Burn Care Rehabil., 14: 174-176, 1991.

The finite-element method was used to solve for the transient temperature field that develops within the skin during a burn protocol, as defined by a spec ic combination of surface temperature and duration of exposure. Five different burn injury models were employed to compute injury as a function of position and time in the tissue on the basis of calculated thermal histories caused by the injury. The five models are compared over a broad spectrum of temperatures and exposure times, providing a general guide for the estimation of thermal injury. The data indicate that the limitations of individual models must be considered when one designs a predictive simulation and interprets numerical results.

Diller K.R., Hayes L.J., Blake G.K. J. Burn Care Rehabil., 14: 177-189, 1991.

A brief summary is given of the results of a Delphi study to develop priorities for burn nursing research. The Delphi method uses a multiple, sequential survey technique to reach consensus among groups of experts. It was found on the basis of the survey that the highest priority concerned pain management. Infection control/wound healing was another high priority. Rehabilitation and aftercare were also well represented. Other priorities were psychosocial issues and nutritional support. The detailed results of the survey are given.

Marvin J.A., Carrougher C., Bayley B., Weber B., Knighton J., Rutan R.

J. Burn Care Rehabil., 14: 190-197, 1991.

The importance of intensive nutritional support IS well established. The article reviews some of the nutrients that are usually found as components of parenteral or enteral solutions: proteins (glutamine, arginine, branch-chain aminoacids, nucleotides, peptides); lipids (medium-chain triglycerides, structured lipids, polyunsaturated fatty acids, 6) -6 fatty acids, w -3 fatty acids); and fibre (insoluble, soluble, soy polysaccharide).

Paxton J., Williamson J. J. Burn Care Rehabil., 14: 198-202, 1991.

Grease burns are a significant problem for adolescent employees in fast-food restaurants, as teenagers are usually unaware of the dangers involved. Burn wounds in this work environment can be caused by adding, -filtering or removing hot grease, slipping on the greasy floor, cleaning the grill or fryer, and splashing hot grease during serving. The young age of the victims presents particular psychosocial problems. A number of recommendations are made in order to reduce the risks involved in employment at such restaurants.

Hayes-Lundy C., Ward R.S., Saffle J.R., Reddy R., Warden G.D., Scnebly W.A.

J. Burn Care Rehabil., 14: 202-208, 1991.

Omiderm (Jobskin; Jobst Institute Inc.), a new polyurethane membrane applied dry to wounds of various types, was found to be a valuable addition to the available range of dressings. It is easy to use, can be cut to any shape or contour, and immediately relieves pain in burn wounds, donor sites, and excised wounds. Omiderm is labour-saving because, apart from being easy to apply and remove, it eliminates the need for dressing changes over a period of many days, and this allows cost savings by making early discharge possible.

Staso M.A., Raschbaum M., Slater H., Goldfarb I.W. J. Burn Care Rehabil., 14: 209-210, 1991.

According to the literature, children in whom the toxic shock syndrome (TSS) is diagnosed have a very low white cell count (WCC) at the time of the onset of the symptoms, which usually occurs around day 3 post-burn. The objective of this study was to investigate whether this finding could be a useful predictive factor in the diagnosis of TSS. A study was therefore made of the normal pattern of leucocyte response to thermal injury in children, in order to make a comparison between those who did and those who did not develop TSS. It is recommended on the basis of the results of the investigation that a daily differential WCC with particular attention to the lymphocyte count should be done in all children with a thermal injury large enough to warrant hospital admission. This additional factor may help with the diagnosis of TSS so that prompt resuscitative measures can be initiated.

Brain A.N., Frame J.D., Eve M.D. J. Burn Care Rehabil., 14: 211-212, 1991.

A system of logistic regression was used to calculate the death probability on admission of all the burn patients treated in the Critical Area of the "La Paz" Hospital Burns Unit during a 3-year period (1984-1987). The following parameters were considered: age, BSA, depth of burn, site and mechanism of burn in relation to the patients' death. A very simple model was obtained in which only age and BSA are significant. These two parameters were used to construct a table in which the parameters are distributed in subgroups of 10 (10, 20, 30... years and 10,20,30%... BSA). The table is easy to use and very practical.

Herruzo Cabrera R., Garcia Torres V., Gil de Miguel A., Rey-Calero J.

Cirugia Pldstica lbero-Latinoamericana, 17: 225-228, 1991.

Prompt surgical excision of the eschar and immediate skin grafting are generally advocated as the best way of preventing the bacterial proliferation that may occur if moist eschar remains in position following a burn wound * The early removal of the eschar may be facilitated by use of the debriding agents to be found n pineapple stem. This in vivo study in 12 rats was designed to evaluate the efficacy of two newly discovered proteolytic components from pineapple stem, known as ananam and comosain. Although it is not exactly known how these components function, the results showed that rats treated 24 hours post-burn with ananain and comosain could be subjected to debridement within 4 hours. These two enzyme fractions from pineapple stem would therefore appear to be potentially useful non-surgical debriding agents.

Rowan A.D., Christopher CW., Kelley S.F., Buttle D.J., Eholich H. P.

Burns, 16: 243-246, 1990.

An investigation was made of the changes of thromboxane and prostacyclin, together with a number of other variables (circulatory platelet aggregate rations, creatinine phosphokinase, lactic dehydrogenase, glutarnic-oxaloacetic transaminase, platelet counts, blood viscosity, cortisol and urine epinephrine contents), in burned patients. The aim was to define the roles of thromboxane prostacyclin imbalance in burn shock and the therapeutic effects of the thromboxane synthesis inhibitor, anisodamine, in antishock treatment. The findings showed that the changes of thromboxane and the thromboxane prostacyclin ratios played an important role in the haemodynamics and haernorrheology in burn shock. Anisodamine restored the haemodynamic and rheological disturbances towards normal. The findings also suggested that anisodamine could accelerate the restoration of the neuroendocrine disturbances initiated by burn shock.

Huang Yuesheng, Li Ao (Ngao), Yang Zongcheng Burns, 16: 249-253, 1990.

A prospective study was carried out of all domestic burn accidents during a I-year period. Out of 338 cases recorded 134 involved children under the age of 16 years. The highest incidence was in the 0-2 years age group. The commonest cause was contact, followed by scalds. Boys outnumber girls 1.6 to 1. Hands, heads and fingers were most often affected. The kitchen and cooking activities were most frequently related to the causes of the burns.

Lindblad B.E., Terkelsen CT Burns, 16: 254-256, 1990.

A retrospective examination was made of the records of all burn patients admitted to a Burn Unit over a 22-year period (1965-86) to investigate the incidence of self-inflicted burns. It was found that 22 out of 5934 patients (0.37%) had attempted suicide, 17 of them (77%) dying. More than three-quarters were women. 91% used petrol which they set alight. 50% of the patients had a history of mental disorders.

Ben Meir P., Sagi A., Ben Yakar Y., Rosenberg L. Burns, 16: 257-258, 1990.

EFFECTS OF BETA-BLOCKADE ON ENERGY METABOLISM FOLLOWING BURNS

The two aims of this study were to assess the effect of beta-blockade on energy expenditure In burn patients and to compare the effects of i.v. acute propranolol infusion vs. prolonged oral administration (4 days). Ten non-infected burn patients were considered in the study. The resting metabolic rate (RMR) was determined four times consecutively by indirect calorimetry following: (1) i.v. physiological saline; (2) Lv. propranolol infusion (2 ~i g/kg/min following a bolus of 80 4 g/kg); (3) oral propranolol (40 l_L g a.l.d. during 4 +/- days); and (4) in control patients. Large increases in both RMR and in urinary catecholamine excretion were observed in all patients. Propranolol infusion induced a significant decrease in RMR to 135 +/- 2% and oral propranolol to 129 +/3% of reference values. There was a decrease in lipid oxidation but no change in carbohydrate and protein oxidation during propranolol administration. The decrease in RMR induced by propranolol did not appear to be influenced by the route of administration. The extent of the decrease in energy expenditure suggests that beta-adrenergic hyperactivity represents only one of the mediators of the hypermetabolic response to burn injury.

Breitenstein E., Chiol6ro R.L., Mquier E., Dayer P., Krupp S. Schutz Y.

Burns, 16: 259-264, 1990.

The effects of dietary vitamin A were studied by means of a burned guinea-pig model (30% BSA). The 65 guinea-pigs were infused enterally via gastrostomy feeding tubes with identical formulae (175 kcal/kg/day, 20% of calories as protein) containing various amounts of vitamin A (0, 10,000 iti, 50,000 iti, and 250,000 lu of vitamin A). The animals were killed after 14 days of tube feeding. The animals which had received no vitamin A showed vitamin A deficiency with low haemoglobin levels, lower red blood cell counts and lower caecal mucosal weight. Hypervitaminosis was observed only in animals receiving the highest dose of vitamin A (elevated serum alkaline phosphatase and complement C3 levels, and enlarged adrenal glands). These animals also showed defective cell-mediated immunity. A second experiment was performed, with doses of 0, 10,000 1u, 50,000 iu, and 100,000 in of vitamin A per litre, again for 14 days. On post-burn days 12, 13 and 14 the animals received subcutaneously 3 x 108 of Staphylococcus aureus once daily. After sacrifice on day 15 the numbers of viable bacteria at each injection site were counted. No significant variations were found between the various groups. Serum vitamin A concentration was significantly lower in the guinea-pigs that had not received vitamin A; no group showed signs of hypervitaminosis. These findings suggest that vitamin A is required following burn injury at doses from 10,000 to 100,000 iu (equivalent to I to 10 RDA). Overdosage (250,000 1u) may however be harmful.

Kuroiwa K., Trocki 0., Wesley Alexander J., Tchervenkov J., troue S., Nelson J. Burns, 16: 265-272, 1990.