This study concerns the long-term psychosocial problems of severely burned persons. The patients considered were 25 of the 28 survivors (three could not be contacted) out of the 46 severely burned patients admitted to the Department of Plastic Surgery, Odense, Denmark, in the period 1968-1980. The observation time ranged between 7 and 21 years. The entry criterion for the study was bums in more than 30% BSA (either deep dermal or full skin thickness). All the patients were interviewed in semistandardized fashion, adjusted according to age at the time of the burn trauma; they were also assessed psychiatrically and physically in order to establish their psychological condition and functional capacity. It was found that there was no correlation between the degree of disfiguration/functional loss and longterm psychosocial adaptation. The determining factor appeared to be the patients' prernorbid psychological integration and to some extent support from relatives and the staff group. It is therefore important that potentially poor adapters should be identified as early as possible so that they can be supported as much as possible.

Riis A., Andersen M., Pedersen M.B., Hall K.W. Bums, 18: 121-6, 1992.

The haemodynamic effects of antioxidant therapy using high-dose vitamin C administration (170 rng/kg/24 h) in 18 guinea-pigs with 70% BSA deep dermal bums divided into three groups. The animals in the first group were resuscitated with Ringer's lactate solution according to the Parkland formula without vitamin C. Heart rate and blood pressure did not vary significantly between the three groups in the 24-1t study period. The third group had significantly higher haematocrit values than the second group at 3h post-burn and thereafter. In the second group cardiac output values were significantly higher than in the third group and equal to those of the first group. The burned skin water content in the second group was significantly lower than in the other two groups, which indicated that increased post-burn capillary permeability was minimized when vitamin C was administered. Adjuvant vitamin C administration reduced the 24-h resuscitation fluid volume from 4 to I ml/kg/% burn, cardiac output remaining adequate.

Matsuda T., Tanaka H., Shimazaki S., Matsuda H., Abcarian H., Reyes H., Hanumadass M.
Bums, 18: 127-31,1992.

In order to discover the exact role of macrophages and their PGE-2 production in postbum immunosuppression, it was decided to investigate the phenomenon of immunosuppression, the function of the macrophages and the amount of macrophage PGE-2 production simultaneously. Experiments were performed on inbred mice with full skin thickness thermal injury. Splenic cell proliferative response to ConA was used for detection of T-cell reactivities. The spontaneous activity of the lymphocytes was also tested. The experimental results confirmed that activation of suppressor macrophages could have an aetiological role in the induction of cell-mediated immunosuppression after burn injury. Activated macrophages may produce this effect by increasing their synthesis and release of PGE-2. This mechanism is particularly important during the early period of post-bum immunosuppression.

Yang L., Hsu B.-X. Bums, 18: 132-6,1992.

The report considers the optimal location and specific requirements of a Burns Unit, including dressing, operating and isolation rooms, intensive care and ancillary facilities. Ideally, the unit should be part of a teaching or district general hospital, and it should also be part of a trauma centre with intensive care facilities, as bum patients often have multiple injuries. The burns unit may be adjacent to other units, such as plastic surgery, provided that there is physical separation, no direct airflow between the unit and other areas, and no uncontrolled exchange of staff. The various specific requirements are given in detail, and various ventilation systems are considered. The overall design will naturally depend on the required size and available finance.

Ayliffe G.A.J., Lawrence J.C., Cooke E.M., Judkins K.C., Settle J.A.D., Wilkinson P.J.
Bums, 18: 137-8, 1992.

The aim of this retrospective study was to determine whether patients with petrol (gasoline) burns needing resuscitation constitute a clinically distinct group in terms of fluid resuscitation requirements. The study was prompted by the clinical impression that such patients, especially if suffering from full skin thickness injury, require a significantly higher amount of fluid resuscitation than that predicted by the modified Muir an Barclay formula, which is widely used in the United Kingdom. A total of 450 admissions to the St Andrews Hospital Regional Burn Unit (Essex, England) from 1982 to 1988 were considered, of whom 44 met the requirements for inclusion within the study (patients with pre-existing cardiovascular disease, respiratory diease or inhalation injury were excluded, as well as fatalities within the first 72 h). The 44 patients fell into two groups, 15 with petrol burns and 29 with non-petrol burns, all of whom were treated with the modified Muir and Barclay formula, with adjustments made on the basis of clinical and laboratory monitoring. A comparison by the Wilcoxon Sum Test of the results in the two groups showed that the petrol burns groups had a significantly greater fluid resuscitation requirement. This is probably due to the lipid solubility of the petrol prior to ignition, resulting in destabilization of cell membranes. This would result in greater membrane permeability, increased fluid loss and the consequent increased fluid resuscitation requirement.

Hankins C.L., Hacket M.E., Varma S.
Bums, 18: 141-4,1992.

In this controlled prospective study of 20 patients, a comparison was made between the efficacy of calcium sodium alginate (KALTOSTAT) and silver-impregnated porcine xenograft (E-Z DERM) in the treatment of split-skin graft donor sites, with each material. The healing time was 8.1 days with KALTOSTAT and was constantly good, and better than with E-Z DERM in 95% of patients. Hypertrophic scarring was not found with KALTOSTAT but occurred in 25% of patients treated with E-Z DERM. Some allergic reactions were found to E-Z DERM. KALTOSTAT was preferred by 75% of patients, the other 25% expressing no preference. On these findings it was concluded that KALTOSTAT is superior to E-Z DERM as a dressing for split-thickness skin donor sites.

Vanstraelen P.
Bums, 18: 143-8, 1992.

In this retrosp&ctive study of the mortality rate in aged burn patients (over 65 years of age) admitted to a burns unit in Vienna (Austria), two time periods (1980-86 and 1987-1990) with different regimes of general and topical treatment are compared. There was a significant drop in the mortality rate of patients in the second period, when there was an increased number of nurses and better documentation of wound status, general conditions and nutritional aid.

Z6ch G., MeissI G, Bayer S., Kyral E. Bums, 18: 153-6, 1992.

In the Valencia area of Spain the misuse of gunpowder is a frequent cause of burns - 10.7% of the patients admitted to the local Burn Centre between 1983 and 1990 had sustained bums from gunpowder explosions, due to fireworks used at local festivities, weddings, public celebrations, etc. Most of the injuries are minor, but some require surgical treatment. The serious burns are usually deep dermal or full-skin thickness. A common combination of burns is in the groin, genitalia, hypogastrium and hands, caused when fireworks ignite in the pocket. The genera management of such burns does not differ from that of burns caused by other agents, except that special attention must be paid to any associated lesions, mainly in the ears, eyes and hands.

Navarro-Monzonis A., Benito-Ruiz L, Baena-Montilla R, Mena-Yago A., de la Cruz-Ferrer L.I.
Bums, 18: 159-61, 1992

This article describes available psychometric assessment instruments for the evaluation of psychosocial factors that can influence patient rehabilitation. Assessment of these factors offers important information to help the bum team design interventions that can maximize successful patient rehabilitation. Psychological assessment instruments are described that assist in the identification of psychological problems that contribute to the patient's failure to attain the fullest quality of life. Clinical interviews are not enough: structured psychometric screening must be integrated into the assessments. The three most critical variables to assess in this domain are described: alcohol/drug a~use, depression, and post-traumatic stress disorder. Reference is made to the widely used Psychological Adjustment to Illness Scale. The Baltimore Regional Burn Center has developed its own 80-itern Bum Specific Health Scale, which is also described.

Pruzinsky T., Rice L.D., Himel H.N., Morgan R.F., Edlich R.F.
J. Bum Care Rehabil., 13: 79-88, 1992.

This article is a report by a study group set up at the 1989 Nursing Special Interest Group Meeting of the American Burn Association. The purpose of the investigation was to identify nursing research priorities in burn care. The Delphi method of sequential questionnaires formed the foundation of the study design. In all, 94 participants completed four rounds of questionnaires. Of the 101 research questions identified, 21 concerned psychosocial issues. The top five ranked psychosocial questions, as regard impact on patient welfare, were: (1) stress reduction techniques, (2) social re-entry strategies, (3) management of psychosis and post-traumatic stress disorder, (4) strat~gies to assist patients with impaired communication capabilities, and (5) the role of recovered burn survivors in encouraging patient compliance with treatment. In relation to the impact on the profession of burn nursing, the top five ranked issues were: (1) stress reduction techniques, (2) coping techniques for bum survivors, (3) management of psychosis and posttraumatic stress disorder, (4) nursing's supportive role in regard to "do not resuscitate" orders, and (5) coping strategies to be used with patients who express a desire to die. It is hoped that nurses at all staff, management, education - will use the findings to guide them in the development of future research projects.

Knighton J., Carrougher G.J., Marvin J.A., Bayley E.W., Rutan R.L., Weber B.
J. Bum Care Rehabil., 13: 97-104, 1992.

The Prognostic Inflammatory and Nutritional Index (Pini = [(x,-acid glycoprotein x C-reactive protein] ~ [albumin x prealbumin]), used to predict morbidity or mortality in burn patients, was considered in this study in relation to its efficacy versus its individual determinants as potential prognostic indicators of infection or death. The study took into consideration 60 patients with a mean TSBA bum of 44.7% (range, 10 to 81%) and a mean age of 18.9 years (range, 0.5 to 71 years). On the basis of the findings, a new index is proposed, incorporating only two of the four PINI indices (Creactive protein and prealbumin). This was found to be of greater prognostic value than PINI and than either acid glycoprotein, C-reactive protein, albumin, or prealbumin alone. Albumin and acid glycoprotein do not appear to contribute significantly to the sensitivity and specificity of such a model and the simplified formula proposed may be less costly and more accurate in terms of predicting the clinical outcome of bum patients.

Gottschlich M.M., Baunier T., Jenkins M., Khoury J., Warden G.D. J. Bum Care Rehabil., 13: 105-13, 1992.

Firefighters work in varied and dangerous environments where they have to face a series of health hazards that increase their risk of death or injury in the line of duty. They are exposed to high noise levels, changing thermal conditions, and hazardous breathing atmospheres. The protective equipment that they necessarily have to wear may impose limitations on their efficiency and performance. This article relates these conditions to specific physical performance requirements for firefighters, with a view to reducing line-of-duty injury, disability and mortality. Physical fitness and health maintenance programmes will reduce the risk of cardiovascular disease and musculoskeletal injury for firefighters. The article also includes an exhaustive bibliography on the subject.

Matticks C.A., Westwater J.J., Himel N., Morgan R.F., Edlich R.F.
J. Bum Care Rehabil., 13: 223-35, 1992.

As little is known about the long-term exercise tolerance of the bum patient, a study was undertaken to document this feature in paediatric patients who had recovered from burns. The data were intended to represent a baseline for assessment of recovery and to assist in prescription of individual exercise programmes. Stress testing was undertaken as a means of simultaneously measuring the effect of diminished cardiopulmonary reserve and altered energy metabolism in these patients. A treadmill test was devised in which the former patients (59 children aged 11.4 ± 3.9 years; average time since burn injury 2.9 ± 1.9 years; mean bum surface area 46%, 33% consisting of full-thickness burns) were tested in eight 3-minute stages. No differences in exercise tolerance were observed among the children, regardless of the presence of inhalation injury, method of excision or burn size. The study suggest that in the paediatric patient even massive massive injuries are compatible with normal levels of activity. The longterm prognosis for the burned child is therefore encouraging.

McElroy K., Alvarado I., Hayward P.G., Desai M.H., Hemdon D.N., Robson M.C.
J. Bum Care Rehabil., 13: 223-35, 1992.

It is important,that pressure garments used in the treatment of the maturing burn wound should fit properly, because otherwise poor cosmesis and functional limitations may occur. This study was therefore designed to determine the pressure volumetric characteristics of compliance in three commonly used brands of pressure garment (Jobst, Barton-Carey and Tubigrip). Compliance is defined as the displacement of a linear mechanical system under a unit of force or, as it is more commonly known, elasticity. Garment sleeves (37 cm in length of each brand were repeatedly (20 times) saturated with lubricating substances and then washed and dried. Measurements were taken initially and after every fifth washing/drying cycle. The overall results showed that there was little change in the Jobst and Barton-Carey garments, whereas the Tubigrip garments displayed an inconsistent pattern.

Gallagher J.M., Kaplan S., Hills Maguire G., Leman C.J., Johnson P., Elbaurn P.T.
J. Bum Care Rehabil., 13: 239-43, 1992.

Many different classifications have been made in the course of time to describe burns (Fabricius 1-fildanus, 1607; Dupuytren, 1832; Boyer, 1893; Derganc, 1960; Converse and Robb Smith, 1944; Benaim, 1950, 1952; Fossati, 1966). These classifications are compared and their advantages and disadvantages considered. The author is of the opinion that it would be useful to unify criteria for the formulation of an accurate diagnosis that permits better prognosis of survival and burn sequelae, and a method is proposed for doing so. The joint evaluation of bum extent and depth, together with the patient's age and state of health prior to the bum, are sufficient elements for prognosis of survival. Bum depth and localization are the criteria necessary for prognosis of sequelae. The method is illustrated by the use of special tables. The convenience of a unified system of clinical classification is emphasized, as it would permit easier comparison of case descriptions derived from different sources.

Benaim F. Revista Argentina de Quemaduras, 6: 22-26, 1991.