|Ann. Medit. Burns Club - voL VI - n. I - March 1993
METABOLIC AND IMMUNE EFFECTS OF ENTERAL ASCORBIC ACID AFTER BURN TRAUMA
Ascorbic acid (vitamin C) is known to be an essential nutrient for the maintenance of good health, playing a number of important roles, and significant decreases in plasma vitamin C concentration have been found in patients with large burns and in the adrenal cortex of animals following burn trauma. However, the commercially available enteral diets used for supplying all or part of a burn patient's nutrition normally provide little more than the recommended daily allowance of vitamins and micronutrients required by healthy persons. As the nutritional need of the burn patient would appear to be significantly increased, it was decided to evaluate the selective metabolic and immunological effects of enteral vitan-fin C, using an established guinea-pig burn model. On the basis of trials performed on 36 guinea-pigs, it was found that large amounts of vitamin C have beneficial effects on the maintenance of body weight and metabolic rate following burn trauma.
Nelson J.L., Alexander J.W., Jacobs P.A., Ing R.D., Ogle C.K. Burns, 18: 92-97, 1992.
SELECTIVE INTESTINAL DECONTAMINATION FOR PREVENTION OF WOUND COLONIZATION IN SEVERELY BURNED PATIENTS: A RETROSPECTIVE ANALYSIS
Bacterial infection is a frequent and serious problem in patients surviving the shock phase of ther mal injury, and is estimated to be the cause of at least 50% of all burn-related deaths. In this light a study was carried out on the effect of selective intestinal decontamination of the digestive tract (SDD) on wound colonization. The results are described of the results obtained from 91 patients with acute thermal injuries admitted to a hospital in the Netherlands between 1980 and 1990. All the patients received polymyxin, and in 63 patients oral co-trimoxazole and amphotericin B were added to the regimen. The addition of cotrimoxazole reduced the incidence of Enterobacteraciae wound colonization from 71% to 11% (P < 0.005). Colonization with Proteus was eliminated in patients treated with co-trimoxazole, compared to a 36% incidence in the group treated only with polymyxin (P < 0.001). The addition of amphotericin B reduced yeast colonization of the burn wound from 39% to 10% (P < 0.005). There was found to be a close relation between burn wound colonization and colonization of the GI tract. The results therefore suggest that SDI) is effective in the prevention of wound colonization.
Manson W.L., Klasen HT, Sauer E.W., Oliernan A. Burns, 18: 98-102, 1992.
SUN TANNING-RELATED BURNS -A 3-YEAR EXPERIENCE
The objective of this report was to analyse the epidemiology and treatment of burns caused by sunbathing, with a view to the definition of the population at risk, prevention campaigns and the improvement of results. The retrospective study covered 562 sunrelated burns in patients admitted to a hospital in Goiania (Central Brazil) over a 3-year period, in an area where sunbathing is widely practised and the local people use a number of homemade tanning solutions. Female patients were more numerous (60.8%). The main causes of injury were: sun only, 36.7%; sun plus fig leaf 'tea' tanning lotion, 17.7%, and plus lemon juice, 17.7%. Healing to normal skin appearance was achieved in 99. 1 % of cases, with scarring in 0.7%, and one fatality following massive sepsis. The effects of sunlight on the skin and the use of homemade plantderived suntan lotions are discussed. It is recommended that supervised conservative treatment is the choice for treatment of solar burn victims.
Sarto Piccolo-Lobo M., Sarto Piccolo N., Sarto Piccolo-Daher M.T., Cardoso V.M.
Burns, 18: 103-106, 1992.
EFFECT OF ACUTE AND CHRONIC LIPOPOLYSACCHARIDE (LPS) ADMINISTRATION ON RETICULCIENDOTHELIAL SYSTEM (RES) PHAGOCYTIC ACTIVITY IN VIVO
Septicaemia is the major cause of morbidity and mortality in burned patients, including multiple organ system failure, in which the lung is the organ most commonly involved. One reason why septicaemia develops could be the inability of the reticuloendothelial system (RES) to clear micro-organisms from the blood efficiently. It was decided to determine, in unanaesthetized rats, the effect of the injection or the chronic infusion of lipopolysaccharide (LPS) on the distribution of [99 Tern] SC. At a dose of 2.5 mg/kg, LPS injection caused a marked alteration in the distribution of the radiolabelled material, with more uptake in the lung and less in the spleen; liver and kidney uptake was also modified. Chronic infusion of LPS at a similar dose Q mg/kg in 24 h) caused a marked decrease in uptake of the radioactive material only in the lung. These findings are in line with the hypothesis that the alterations in RES phagocytic activity of the lung observed in rats subjected to burn trauma could be in part related to LPS, either coming in the form of a bolus or being continuously presented.
Trop M., Schiffrin E.J., Carter E.A. Burns, 18: 107-108, 1992.
COMPARISON OF PROGNOSTIC INDICES FOR BURNS AND ASSESSMENT OF THEIR ACCURACY
In this investigation, logistic regression was used to create four individual models of prognostic indices based on a population consisting of 461 consecutive adult burn patients admitted to a Burns Unit. The indices obtained were compared with five other indices: B aux's, Bull's, Shirani's, Roi's total burn and Roi's full skin thickness burn. It was found that the simplest index, using only the factors of age, extent of full thickness burn and inhalation injury, proved to be the best. Modifications in treatment methods and im~ provements in therapy will affect the accuracy of a survey. As conditions change, indices must be adapted in order to avoid false predictions of death.
Z6ch G., Schemper M., Kyral E, MeissI G. Burns, 18: 109-112, 1992.
BURNS IN PATIENTS OVER 60 YEARS OLD: EPIDEMIOLOGY AND MORTALITY
A retrospective study was made of epidemiology and mortality among burn patients aged over 60 years admitted in a 3-year period (1988-1990) to the La Fe Hospital Burn Centre in Spain. These 69 patients represented 7.8% of all patients presenting. There were 40 females (58%) and 29 males (42%) and the mean age was 72.2 years. The mean burn area was 21.6% of TI1SA. The most commonly affected area was the lower limbs (81 %). The commonest cause of burns was fire flames (65.2%), which also produced the most extensive lesions. The great majority (85%) of accidents occurred in the home, and more than a third in winter. Patient mortality was 33.3%, the commonest causes being hypovolaemic shock during the first 24 h and pneumonia in later stages. Four * important management points are stressed: the necessity of increasing awareness among the elderly to this problem; the close control of previous pathology; preventive measures against infection; and an intermediate approach to surgery, which should be postponed until around day 10.
TeJerina C., Reig A., Codina L, Safont 1, Mirabet V Burns, IS: 149-152, 1992.
COLD STRESS RESPONSE IN PATIENTS WITH SEVERE BURNS AFTER 13-BLOCKADE
Some studies in burn patients have shown that 8-adrenergic receptor blockade with therapeutic doses of propranolol has been useful in treating tachycardia and increased myocardial work during the hypermetabolic phase without decreasing metabolic rates, while others have found that propranolol and propranolol in combination with phentolarnine significantly reduces metabolic rates. The therapeutic use of B-blockers in burn patients has therefore been controversial because of the concern that the B-blockade may adversely influence the ability to respond to episodic stresses of sepsis and cold. This paper evaluates the response of children and adults with severe burns to cold stress after 13-blockade, by comparing resting energy expenditures (REEs) during cold exposure before and after administration of a therapeutic dose of propranolol with those of patients with similar burns kept in rooms with normal ambient temperatures. REEs were measured by indirect calorimetry; the test subjects were exposed to mean temperatures of 27.5 "C (room temperature) or 24.6 'C (cold). After extensive investigation it was concluded that 13-blockade with propranolol in therapeutic doses may be used in patients with burns without adversely affecting the cold stress response.
Honeycutt D., Barrow R., Herndon D.
J. Burn Care Rehabil., 13: 181-186, 1992
BURNS ARE DIFFERENT: THE CHILD PSYCHIATRIST ON THE PEDIATRIC BURNS WARD
This article, by a child psychiatrist who is a consultant to a burn team, considers the non-surgical implications of burn injuries in children, which give rise to problems not found in relation to other surgical conditions. The three stages of primary, secondary and tertiary consultation are described and exemplified through a series of case vignettes. It is stressed that the child patient's long-term adjustment to his condition is likely to depend on his personality and familial support, and the opinion is expressed that various aspects of the psychosocial management of the patient and his family will play a significant part in determining the long-term outcome, even though concrete evidence to support this claim is at present lacking. This highlights the need for evaluative studies in the field.
Jessee P.O., Strickland M.P., Leeper J.D., Wales P.
J. Burn Care Rehabil., 13: 33-38, 1992
BURNS AND SEXUALITY
The psychological problems of burn-damaged persons are considered in relation to sexuality. The scientific literature contains very little about this subject, but a survey is made of what there is. The psychological effects of burns to the genitals are described. A study is mentioned which found that the self-esteem of patients with burns does not depend on the degree of the burn, nor on the part of the body affected, but rather on the age of the patient when the burn occurred and the number of years since the burn. Patients burned between birth and 10 years of age and when adolescents had the lowest self-esteem, and this had marked effects on their capacity for sexuality. It is also stressed that burned children need frequent skin contact with their parents in order to restore their self-confidence, which is a necessary component of their subsequent successful sexuality.
Bogaerts E, Boechxs W.
J. Burn Care Rehabil., 13: 39-43, 1992
YOUNG WOMEN WITH BREAST BURNS: A SELF-HELP "GROUP BY MAW'
Burns to the breast carry special significance for women. The breasts are one of their most cherished physical attributes and a source of female identity, symbolizing motherhood and maternal feelings and also being associated with sensuality and sexual pleasure. Unlike burn scars in the hands or face, which cannot be covered up and which in time may be easier to live with, scarring of the breasts may leave more marked emotional trauma: breast-scarred women, especially if young, may suffer from low self-esteem and have fears about sexual relationships. It is difficult for them to be open and seek counsel on the subject. A burn unit therapist should therefore be creative in providing pschyotherapeutic intervention for the female patient with breast scars. A group therapy project is desribed in which women with these problems were contacted by mail and a correspondence group was set up. It was found to provide an excellent opportunity for self-help and mutual support and it reached a large number of persons. There may be an added benefit in the fact that face-to-face communication was avoided by this method.
Cahners S.S. J. Burn Care Rehabil., 13: 44-47, 1992.
LIFESTYLE ADJUSTMENTS IN ELDERLY PATIENTS AFTER BURN INJURY
The purpose of this study was to identify the impact of burn injury on the lifestyle of elderly patients. The records were examined of all patients over 45 years of age admitted to an American Burn Center over a 9-year period (this age was chosen because it marked the point after which, according to mortality reports from the institution, the survival of burn patients began to be affected). A mail survey was carried out among 168 former patients who could be traced, regarding living arrangements, personal care, family relations, social life, work status, and outlook on the future. The replies showed that with increased age there was an increased tendency towards dependence and the need for assistance in daily life. Most of the patients however remained independent and had a positive outlook on life. It would seem that a policy of aggressive treatment in elderly patients is justified by the results of the survey.
Larson C.M., Saffle J.R., Sullivan J. J. Burn Care Rehabil., 13: 48-52, 1992.
RETURN TO WORK AFTER BURN INJURY
Some of the factors influencing the time before return to work after a serious burn are examined, concentrating in particular on demographic, physical, and treatment factors thought to have a significant bearing. The following specific variables were taken into account: percentage body surface area burned, total percentage of partial- and full-thickness burn, duration of treatment, payment source of treatment, sex, race, type of burn, and age. The most significant predictor of time before return to work was percentage BSA burned, followed in order by percentage BSA with full-thickness burns, percentage BSA with partialthickness burns, and number of weeks of treatment. It was possible to develop a regressive equation to predict the time necessary before return to work, and this was useful in informing patients, families, employers and health-funding agencies as to the probable delay before return to work after serious burn injury.
J. Burn Care Rehabil., 13: 48-57, 1992,
SEVERE BURN INJURY: EFFECTS ON PSYCHOLOGIC AND IMMUNOLOGIC FUNCTION IN NON-INJURED CLOSE RELATIVES
In view of the crucial role played by close relatives in the rehabilitation of severely burned persons, it was decided to assess the effects of severe burn injury on the psychological and immunological functioning of close non-injured family members. It was hypothesized that the relatives of the severely burned would exhibit a heightened state of psychological distress in the acute post-injury phase and downward alterations in cell-mediated immune functions that correlate with depressive syndromes. Four standardized measures of depression, anxiety, and cell-mediated immunity were considered in relation to 14 spouses and parents of patients with more than 20% TBSA burns. Two time intervals were considered: less than 72 h after admission of the patient, and 2 to 5 weeks later. Depression and anxiety were high in the first period. There was a significant drop in depression at the second testing, but not in anxiety. Immune function was suppressed at the first test but improved at the second. 'Mere were significant negative correlations between immune reponse and psychological distress, suggesting that immune function declined as depressive symptoms increased. There would therefore seem to be a clear interaction between psychological stress and immunity, confirming the stressful nature of severe burn injury on close non-injured relatives.
Shelby J., Sullivan J., Groussmann M., Gray R., Saffle J. J. Burn Care Rehabil., 13: 58-63, 1992.
RECLAIMING BODY IMAGE: THE HIDDEN BURN
The writer, a registered nurse, recounts her personal experience as a severe burns victim. She was injured as a child, and was left with permanent scarring in 45% of her body. Most of the injuries could be covered by clothing, and the title of the article alludes to the way she eventually came to terms with her physical appearance, when she realized that she was concealing her burn scars not only from other people but also from herself. She describes her experience in a burn survivors' self-help group, and a body awareness workshop. She learned to talk about her body and gradually overcame her shyness about showing herself undressed in a swimming-pool - a particular difficulty was that her lack of normal breasts prevented her from feeling like a normal woman. Group exercise however helped her to feel less physically self-conscious. She was thus able to develop positive feelings about her unclothed body and to allow her femininity and the character of her body to emerge and become integrated.
Willis-Helmich J.J. J. Burn Care Rehabil., 13: 64-67, 1992.
BURN CAMPS AND COMMUNITY ASPECTS OF BURN CARE
Burn injuries in children are known to have a profound impact on their psychological development and emotional stability. The social and emotional problems of such children require acute and long-term psychosocial rehabilitatilon services, two of which are school re-entry programmes and specialized burn camps. These services facilitate the successful adaptation of the majority of burn-injured children. The specific ways in which the children are affected by the camp experience are currently being investigated, as also the particular merits of particular programme activities. Burn care professionals are encouraged to consider the possibility of setting up burn camps in their community or to refer patients to existing facilities. A list is included of children's burn camps in the USA, Canada, Australia, New Zealand and Belgium.
Doctor M.E. J. Burn Care Rehabil., 13: 68-76, 1992.