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Volume VI |
Number 2 |
June 1993 |
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SUMMARIES
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ANALYSIS OF 1005 BURN PATIENTS TREATED IN OUR CENTRE
(Haberal M., Ugar N., Bayraktar U., Ener Z. - Turkey)
Over a period of 12 years 1005 patients were admitted to the bum unit at the Hacettepe University Hospital, Ankara. Of these patients, 66.3% were male and 42.4% were under the age of 14 years. Flame injuries and scalds accounted respectively for 52.5% and 44.3% of the injuries caused by thermal agents excluding electricity. Electrical bums affected a relatively high number of the patients, with a rate of 20. 1 %. The majority of the burns occurred at home. The overall mortality rate was 34.4%.
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| 76 |
A NEW PROGNOSTIC BURN INDEX
(Stavropoulou V., Daskalakis J., loannovich J. - Greece)
342 burned patients have been treated at the bums centre of our hospital during the last three years. An effort was made to examine the reliability of the usual bum indices and the Apache 11 severity score index, comparing their predicted mortality with the actual mortality in our sample. We concluded by forming a new prognostic index, which is more accurate in the prediction of mortality, because it considers objectively and in detail the patient's,general condition on admission.
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| 84 |
COMPARATIVE STUDY OF SEPSIS IN BURN DURING THREE PERIODS OF TIME
(Herruzo-Cabrera R., Calle-Puffin E., Garcia-Torres V., Luengo-Matos W, Lenguas-Portero F, Rey-Calero J. - Spain)
A comparative study was performed to investigate the variations in the septicaemia rate occuring in the Critical Area of the Burn Unit in La Paz Hospital. Three time periods were compared: 1980-84, 1985-86 and 1987-90, coinciding with major modifications in preventive measures in bum patients. The analysis was made by direct standardization and multiple logistic regression. Our results show that during the most recent time period the incidence of septicaemia decreased significantly and that the decrease coincided with the introduction of intensive decontamination treatment.
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| 90 |
HISTOLOGICAL ASSESSMENT OF THE LEVEL OF BURN WOUND INFECTION: DIAGNOSTIC AND THERAPEUTIC STRATEGIES
(Di Lonardo A., Ferrante M., Maggio G., Bucaria V., Del Zotti M., Brienza E. - Italy)
In the context of recent developments reported in the literature regarding methods for the histological assessment of burn wound infection, in addition to traditional microbiological techniques, the results are presented of a study of 40 patients admitted to the Bari Bums Centre in the period 1990-91. The histological analysis of the biopsies provided useful information which made it possible to have a better understanding of the parameters supplied by traditional microbiological tests and therefore to adopt a more personalized therapeutic approach in individual patients.
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| 94 |
AZTHREONAM IN THE TREATMENT OF PNEUMONIA IN MAJOR BURN PATIENTS: A PRELIMINARY STUDY
(Mariscal-Sistiaga F, Lenguas-Portero F, Galvan-Guijo B., Ahon-Elizaide J.M., Gomez-Tello V., Herruz-Cabrera R.*, Garcia Torres V. - Spain)
During 1990, 20 cases of nosocomial pneumonia in critical bum patients were treated in the Critical Bum Unit of the La Paz Hospital in Madrid. Fourteen of these patients were cured while four of them experienced a clinical improvement. The pathogen microorganism was eliminated in ten cases, and five controls were always negative, coinciding with clinical improvements and cures. No adverse effects were perceived. We conclude that azthreonam, in association with vancomycin and teichoplanin, is a very effective drug for treatment of nosocomial pneumonia in severe bum patiens, for which tolerance, both local and systemic, is excellent.
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| 98 |
SCREENING-TESTS POUR LA DIAGNOSE DU TRAUMA INHALATEUR POUR LES BRULES
(Malakhova M., Dmitrienko 0., Obolensky S. - Russia)
Les auteurs ont mis au point trois tests biochimiques pour l'analyse des personnes atteintes de brûlures: la détermination du degré d'intoxication, du fait du trauma inhalateur et de l'état septique. Les tests proposés permettent d'apprécier ces conditions d'après une seule analyse biochimique et ils consituent une méthode pour la diagnose rapide et précoce dans les hôpitaux pour le triage des patients brûlés.
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| 100 |
INTERET DES PONCTIONS BIOPSIES DES FIBRES MUSCULAIRES STRIEES SQUELETTIQUES CHEZ LE GRAND BRULE: ETUDE PRELIMINAIRE
(Wassermann D., Duvallet K., Lebreton F., Schlotterer R., Thieuiart L., Rieu W. - France)
Cette étude préliminaire rapporte les résultats de dosages effectués chez des brûlés hospitalisés, réalisés sur des prélèvements de muscle strié squelettique obtenus par ponction biopsie au niveau du muscle vaste externe. La mise au point de micro-méthodes de dosage a rendu possible l'utilisation d'aiguille à biopsie hépatique, peu traumatisante en comparaison des classiques aiguilles de Bergstrôm. Les premiers résultats obtenus chez cinq patients montrent un effondrement de la concentration musculaire du glycogène et une diminution importante de la proportion des fibres de type 1 (fibres lentes). Ces résultats, qui devront être confinnés par une étude plus large, permettent de penser que l'analyse de la typologie musculaire et de la concentration des substrats énergétiques dans le muscle pourrait représenter une méthode fine et peu traumatisante pour surveiller l'état nutritionnel des brûlés, état nutritionnel dont on conneit les difficultés d'appréciation.
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| 105 |
SYNTHETIC SKIN SUBSTITUTE FOR SUPERFICIAL PAEDIATRIC BURNS
(Weiss J., Herman 0., Wertheym E., Shafir R. - Israel)
Most paediatric bums are small-sized and superficial. Conventional treatment consists of once or twice daily change of dressings, the application and removal of which is painful. To avoid the pain, emotional trauma and hospitalization (which is sometimes indicated to facilitate the treatment), new materials have been tried. Orniderm is a synthetic-polyurethane membrane. Its application and removal are easy and painless. The bum heals under this transparent sheet. There is no need for any further treatment, hospitalization is unnecessary and the child returns to its daily activities unrestricted.
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| 109 |
SHOULDER DISARTICULATION AFTER HIGH-TENSION ELECTRICAL BURNS: TECHNICAL PROBLEMS
(Belba G., Zhuka K, Osmani X., Gedeshi L. - Albania)
In our daily practice we have come across massive acute haemorrhage from the axillary artery or vein during the late postoperative period, in the proximity of the ligature, after shoulder disarticulation in high-tension electrical burns. In these cases the stabilization of haemorrhage is imperative. The ligation is performed at a distance from the subclavian artery and vein. In order to avoid both haemorrhage and a second operation (which in most cases is carried out as an emergency), during the same operation stage we first ligate the subelavian artery and vein with a subclavian separate incision, and then we perform shoulder disarticulation.
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| 112 |
REHABILITATION OF ELDERLY BURNED PATIENTS: POSSIBILITIES AND LIMITS
(Amico M., Geraci V., Mingoia S., Masellis M. - Italy)
The rehabilitation of the elderly burned patient presents a series of problems, which are considered in this paper. These problems are both physical and psychological and any rehabilitation programme must take them into account. The Palermo Bums Centre has a two-phase protocol, for the hospitalization period and for the long post-discharge period. The first of these prescribes appropriate posture training, early mobilization and intensive occupational therapy. In the second phase, on discharge, patients are assigned to one of three distinct groups according to their age and condition. The ultimate objective is the maintenance of muscular strength, the prevention of articular stiffness and postural vices, and the strengthening of motor function. The various phases are described, always bearing in mind the particular physical and psychological limitations of the elderly.
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| 116 |
ORGANISATION DES SECOURS D'URGENCE
(Flaujat A., Maille P. - France)
Les auteurs décrivent l'organisation des secours d'urgence en France, en considérant les implications pour le corps médical et pour le grand publie. En particulier, ils décrivent la création du Centre 15, une structure administrative de contrôle et de gestion et un organisme d'évaluation d'une détresse et de répartition des moyens d'intervention. Il comprend essentiellement un centre de réception et de régulation des appels, qui peuvent provenir directement du publie on d'un professionnel de la santé. Les moyens et les buts du Centre 15 sont décrits, comme aussi le Service de l'Aide Médicale Urgente.
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