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Volume VI |
Number 1 |
March 1993 |
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SUMMARIES
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EPIDEMIOLOGY OF BURNS ACCORDING TO SEX STUDY IN A SPANISH REGIMAL BURN UNIT
(Pardo L. - Spain)
Ever since man discovered fire, the treatment of burns has been die object of concern not only because of the high mortality but also because of the severe sequelae. Burns can be prevented only when the risk factors are fully known. Twenty-nine features were studied in the 265 patients hospitalized in the Alicante (Spain) Bums Unit in 1990-91, and the results were compared with those of other studies. The male/female ratio was 67.55% to 32.45%, a finding similar to that found in other countries (except Algeria, Kashmir and Jordan). No significant differences were found between the sexes except as regards marital status, causative agent, localization and occupation.
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ACUTE AND CHRONIC PAIN RESULTING FROM BURN INJURIES
(Tsirigotou S. - Greece)
After a description of the physiology of burn pain, and the development of pain in the successive phases of the bum disease, suggestions are given for appropriate treatment, which may be local or systemic. Medical and nursing staff frequently underestimate pain and are unnecessarily worried about undesirable secondary effects, such as addiction, that it is feared may follow opioid administration. With individualized drug treatment, all bum patients can benefit from pain relief.
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THE INFLUENCE OF A VARIETY OF PARAMETERS ON THE OUTCOME OF THE BURN DISEASE IN ELDERLY PATIENTS
(D'Arpa N., Napoli B., Masellis M. - Italy)
A number of parameters (age, percentage burn, time interval between bum and initiation of resuscitatory therapy, bum phase, previous pathology, type of treatment) are analysed in relation to the outcome of the bum disease in patients aged 65 years or more. The analysis shows that deaths are generally due to the reciprocal influence of all the parameters considered.
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INTRAVENOUS IMMUNOOLOBULAN IN SEVERELY BURNED PATIENTS FIVE YEARS OF SUCCESSFUL EXPERIENCE
(Oliva R.G., Sica I. - Argentina)
Tlis report is a retrospective study of the therapeutic benefit of parenteral administration of an intravenous immunoglobulin (IVIG) preparation for reducing infectious complications in 202 thermally injured patients. All the patients received a complex therapy that included in 67 patients high doses of IVIG. The efficacy of the treatment was evaluated according to the frequency and localization of the infections, clinical response to anti-infectious therapy, duration of the infectious process, overall time of hospitalization and mortality rate. The results demonstrate that patients treated with IVIG in addition to antibiotic therapy had a significant reduction in mortality due to infections. The patients recovered faster (50% reduction in hospitalization time) from the thermal injury.
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THE THERAPEUTIC ACTION OF ALKANIA ROOT EXTRACT IN THE CONSERVATIVE TREATMENT OF PARTIAL-THICKNESS BURN INJURIES
(Michaelides C, Striglis C, Panayiotou R, loannovich J. - Greece)
Alkanin and its esters have been known to medical science since ancient times and their healing properties are used in many folk remedies. Helixdenn, an alkania root ointment, was used in order to test its efficiency in the care of partial-thickness burn injuries. A scoring system was established based on the criteria of pain, redness, oedema, bullae, traumatic sepsis and reinfection, and the results were compared to conventional treatment. It was found that in partial-thickness burns Helixderm offered quicker and more comfortable healing and that the surface tissue was smooth and not fragile.
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GASTROINTESTINAL AND RENAL COMPLICATIONS IN BURN PATIENTS
(Haberal M., Ozdemir A., Bayraktar U, Oner Z, Bilgin N. - Turkey)
In a period of eleven years, from January 1 1979 to December 31 1989, 915 burn injury patients were admitted to our centre. The ParklaDd formula was used for fluid resuscitation in all patients. In 24 (2.6%) patients gastrointestinal (GI) complications were encountered, 22 with upper GI complications. In 4 patients with massively bleeding ulcer, vagotomy + pyloroplasty or vagotomy + gastrojejunost6my was performed together with suturing of the ulcer. Of the 22 patients with upper GI bleeding, 18 died. The causes of death were massive bleeding in four patients, and septic complications in the others. 19 (2%) of the 915 burn patients required dialysis treatment because of acute renal failure. The reasons for acute tubular necrosis were either multiple organ failure or sepsis. The mortality rate in acute renal failure patients requiring dialysis was 78.9% (100% in flame bum patients and 60% in electrical burn patients).
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CHONDRECTOMIE EN PHASE AIGUE DANS LES BRULURES PROFONDES DU PAVILLON DE L'OREILLE
(Rougé D., Grolleau J.L., Micheau Ph., Laguerre J., Conil J.M., Chavoin J.P., Costagliola M. - France)
La chondrite fermée est une complication redoutable des brûlures du pavillon de l'oreille. Le traitement de ses séquelles est difficile et aléatoire. La chondrectomie en phase aiguë est proposée comme traitement préventif de la chondrite dans les brûlures profondes du pavillon de l'oreille. Cette exérèse du cartilage peut être partielle au niveau de l'anthélix quand la peau postérieure du pavillon est intacte. Les résultats de 32 chondrectomies pour 53 brûlures profondes sont intéressants avec peu de déformation du pavillon même si l'oreille est souvent un peu plus petite.
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LA REPARATION ESTNETIQUE DES SEQUELLES DE BRULURES SEVERES DU COU
(Joucdar S., Kismoune K., laouamri T. - Algérie)
A travers l'étude d'une quarantaine de cas de séquelles de brûlures sévères du cou les auteurs tentent une approche de traitement esthétique de ces lésions. Ces séquelles, classées comme "cou majeur global" selon la classification lilloise, sont en majeure partie des synéchies stemomentonnières sévères ayant un retentissement fonctionnel grave et un impact esthétique important sur la face et le thorax. La cure chirurgicale, largement inspirée de l'intervention de Texier, a pour but la restauration de l'angle cervico-mentonnier par un large débridement du magma cicatriciel, excision des peauciers, bourgeonnement par un pansement proinflammatoire puissant et greffe dermo-épidermique demi-épaisse une semaine après. La pérennité des résultats fonctionnels et esthétiques est réalisée par la confection d'un collier cervical en mousse de polyéthylène (Plastazote), d'une épaisseur de 1 cm, thérmomalléable, moulé fortement sur le cou, dès la prise de greffe. Ce collier très léger maintient le cou en extension et comprime le greffon et les régions cicatricielles adjacentes; poreux, il évite la macération. Il sera porté pendant une durée de neuf mois en moyenne, jour et nuit. Il est nettoyé à l'eau savonneuse une fois par semaine et changé dès que son pouvoir d'extension et de compression auront diminué. Cette association chirurgie/appareillage donne des résultats esthétiques et fonctionnels stables et acceptables en utilisant des techniques simples et peu onéreuses. Il est sûr cependant qu'un traitemente initial correct des brûlures cervicales permettra de diminuer les préjudices techniques, esthétiques et fonctionnels.
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FINGER INJURY FROM A PULSE OXIMETER SENSOR DURING ORTHOONATHIC SURGERY
(Baruchin A.M., Nahlieli 0., Neder A., Shapira Y. - Israel)
llis paper describes a case of finger injury caused by an oxygen saturation monitor probe. A review of the literature is also provided. The patient was subjected to a 7-hour procedure to correct maxillofacial and.nasal deformities, during which oxygen saturation was monitored by means of a nondisposable oximeter sensor placed on the third finger of the right hand. When the probe was removed, a 1.5 x 2 cm blister and a deep circular burn, coinciding with the photo-transmitter side of the probe, were found. The injury was treated conservatively with silver sulphadiazine and healed in 3 weeks. It is recommended that probes should be moved to a different finger every 3 to 4 hours and not be placed too tightly.
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THE BIJLMERMEER PLANE DISASTER: AN ACCOUNT OF THE RESCUE OPERATION WITH SPECIAL REFERENCE TO BURN CASUALTIES
(Mackie D.P., Hoekstra MJ. - The Netherlands)
On 4th October 1992, a Boeing 747 cargo plane crashed into a block of flats in the BijImermeer, on the outskirts of Amsterdam. Approximately 50 people died at the site of the disaster. 37 patients were treated in local hospitals, of whom 16 were admitted. 3 patients suffered severe burn injury. Although the numbers injured were limited, a full-scale disaster response was evoked, providing an opportunity to study the effectiveness of existing plans. lle rapid response of the ambulance service and the hospitals involved indicates that rehearsed disaster planning is effective. The dispersal of the injured to several nearby hospitals prevented the overloading of casualty departments. Secondary transfer of severely burned patients to the burn centre was well ordered and followed existing guidelines. In retrospect, communication between the various services might be subject to minor criticism, but no problems were encountered which seriously threatened a well-executed rescue operation. No patient who survived the immediate impact subsequently died.
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