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Volume VI |
Number 3 |
September 1993 |
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SUMMARIES
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EPIDEMIOLOGICAL STUDY OF SCALDING IN CHILDREN
(Reig A., Tejerina C., Baena R, Mirabet V. - Spain)
A retrospective epidemiological study is made of scald bums in patients under age 16 admitted to our Bum Centre during 1988 and 1989. A total of 3711 patients were treated, of whom 302 (8.1%) were hospitalized. Of the latter, 92 (30.4%) were under age 16. In these cases scalding was the cause of lesion in 54 patients (58.7%), corresponding to 26 girls and 28 boys (mean age, 3.6 years); 72.2% were under 6 years of age. The mean burn extent was 13.2% BSA, and the most commonly affected region was the upper limbs (51.8%). Over 90% of the accidents occurred at home. Surgery was performed at least once in 59% of cases. The mean hospital stay was 14.9 days.
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| 161 |
USE OF POLYMYXIN B IMMOBILIZED FABRIC (PMX-D) FOR BURN WOUND DRESSING
(Yamamoto Y., Takahashi S., Kawai M., Ninomiya N., Matsui K., Tsujii A., Kurokawa A., Otsuka T, Shoji H. - Japan)
A description is given of the preparation and use of an elastic fabric (PMX-D) made of polymyxin B fixed fibre employed as a dressing material in burn wound care. It was found that PNIX-D showed excellent antimicrobial activity to gram-negative bacteria and endotoxin neutralizing activity. The majority of patients treated with PNIX-13 showed good epithelialization and the preparation is therefore considered to be useful as a burn wound dressing.
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| 165 |
THE BURNED HAND: ITS CONSEQUENCES FOR THE PATIENTS' PSYCHOLOGICAL STATUS AND SOCIAL READJUSTMENT
(Striglis C., Tsutsos D., Panayotou R, Papagelis M., loannovich J. - Greece)
This study considers the psychological effects of burns to the hands. It is based on the results of the treatment of 74 patients with hand burns, seen over a 2-year period. A number of parameters of social readjustment were considered, including work productivity and self-care ability. It was found that long periods of hospitalization were related to the subsequent development of a psychological disorder. Surgeons must consider not only the aspect of correct initial treatment but also that of long-term consequences.
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| 168 |
THE REGENERATION OF SKIN SENSITIVITY AFTER EXTENSIVE BURNS
(Stella M., Magliacani G., Calcagni M., Panzica G.C., Ramieri G. - Italy)
This work provides histological confirmation of superficial sensitive structures following scarring, and highlights the presence, in grafts, of fibres and superficial receptors. Fifteen patients were selected for the study, in which standard aesthesiological tests were used, integrated with the Weber and the Dellon test. The anti-protein gene product 9.5 was used to evidence the presence of nerve structures in normal skin, dermo-epidermic grafts and scars. The relative distribution of the structures regenerated in various anatomical regions is almost equal to normal, quantitatively speaking, even if the absolute number may be less.
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| 171 |
THE EXTENDED DEEP INFERIOR EPIGASTRIC FLAP: A SPEARHEAD TO CHARGE INTO THE MOST RESISTANT SITES
(Kadry M., Noureldin A.A., Khalifa I.G. - Egypt)
The authors present their experience of the extended deep inferior epigastric flap (EDIEF) for the coverage of over 30 cases of extensive compound defects of the groin, lower abdomen, perineum and trochanteric areas, and the thigh, as well as distant areas such as the hand where this flap can be used both as a distant or as a free flap. The EDIEF, though described since 1983 by Taylor et al., has not been given enough trials for extensive clinical application. The indications for its use, its limitations, and the technical difficulties and hazards during use, as well as its application in different ages and sex, are demonstrated and discussed. The EDIEF seems to be one of the most robust and the most consistently vascularised flaps. Its length and width, the arc of rotation, the presence of both muscular and fascial portions, the ability to include other musculocutaneous and random territories of the epigastric system, its rich vascularity, plus the size of the flap and of the deep inferior epigastric artery make it one of the most versatile and reliable flaps for the coverage of large defects.
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| 176 |
PROBLEMS CREATED BY THE USE OF CULTURED EPITHELIA
(Guilbaud J. - France)
When burns are extensive the area available for donor sites is much reduced, and a point is reached when donor sites are inadequate. For this reason the cultured epidermal autograft (CEA) is very useful, although it also creates some problems, which are the subject of this paper. The problems are either technical or organizational. The technical problems include the method of debridement and the materials used for temporary wound closure. The strategies for reducing wound-bed colonization and infection are also considered. The organizational problems are related to the difficulties created by the supply of CEA. Other wound coverage techniques are also considered (Chinese autografting technique, etc.). In conclusion, it is stated that although the CEA is expensive to use and requires great care in its application, it is an irreplaceable technique that can save many lives.
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| 179 |
FIRE BEHAVIOUR AND FIRELINE SAFETY
(Viegas DX - Portugal)
The main physical aspects of forest fire propagation are described with the intention of illustrating its complexity and the risks associated with fire-fighting activities. The various modes of fire propagation and corresponding heat transfer mechanisms are described in relation to their effects on personnel working on the fireline. Some study cases of fatal accidents caused by forest fires are presented in order to emphasize the importance of having an adequate assessment of fire behaviour, together with training and adequate protective equipment, in order to prevent this type of accident.
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| 187 |
THE PROBLEM OF FIRE DISASTERS IN RUSSIA, INCLUDING FIRES AT CHERNOBYL-TYPE NUCLEAR PLANTS
(Shoigu S. - Russia)
A comprehensive survey is made of the problem of fire disasters in Russia in recent years and of the measures to prevent them, particular reference being made to disasters in nuclear plants. Various statistics are given in relation to industrial, domestic and forest fires. The need of effective legislation is emphasized. A description is given of the IL-76 TP fire-fighting aircraft. The organization of immediate medical aid is considered, particularly with regard to the pipeline explosion at Ufa, which also involved two passing trains. The problems presented by nuclear plants are considered and the latest security precautions are described.
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| 190 |
ETHICAL PROBLEMS IN MASS DISASTERS
(Kbnigovd R. - Czechoslovakia)
A survey is made of current thinking on the matter of ethical problems in mass disasters. One basic question is the selection of patients to be treated and patients for whom treatment is either unnecessary or useless. The psychological problems of mass burn victims are also considered. Predictive models have their advantages but they are not the absolute answer to all practical problems in individual cases. Euthanasia is another consideration that brings in ethical and moral problems. However, certain principles are clear: the timehonoured tradition of medicine is to provide disaster victims with considerate management of their pain and their fears. Outcome prediction, cost efficiency and quality of life assessment are important tools for the solution of these problems.
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| 193 |
THE ROLE OF TOXIC OXYGEN METABOLITES OF NEUTROPHIL IN CANINE SMOKE INHALATION INJURY
(Liu Xu-sheng, Li Ao (Ngao), Yang Zong-cheng, Jiang Kun-yuan - China)
Canine models inflicted with smoke inhalation injury were used in this experiment. The NAD(P)H oxidase activity and superoxide anion (02) production of neutrophil were studied in vitro with zymozan as stimulant. The concomitant changes of blood gas, lung water volume, chest X-ray, and pulmonary pathornorphology were also observed, in order to demonstrate the relationship between toxic oxygen metabolites and acute lung injury. The results showed that: 1) CO poisoning, hypoxaemia, metabolic acidosis, respiratory alkalosis and lung injury developed rapidly in the early stage after smoke inhalation; 2) the WBC count decreased rapidly at an early stage after smoke inhalation; 3) the activity of neutrophil NAD(P)H oxidase increased gradually from 30 min to 6 h and then decreased, reaching its pre-injury level at 12 h post-injury. In contrast, the 0-2 production of polymorphonuclear neutrophils (PMN) in vitro decreased progressively from 30 min to 6 h and returned to its pre-injury level at 12 h post-injury. We explain these follows: 1) neutrophils produced a large amount of superoxide anion in vivo within 6 h post-injury, accompanied by a huge consumption of NAD(P)H; 2) six hours postinjury, newborn granulocytes with less activity were released from the bone marrow into the blood stream, and the activity of inflammatory factors such as C5a etc. gradually decreased. It is thus proposed that neutrophils accumulate in pulmonary tissue after smoke inhalation and experience a "respiratory burst" characterized by the activation of cytoplasmic NAD(P)H oxidase and the production of a large amount Of 0-2 as well as other toxic oxygen radicals, which participate in the pathogenesis of acute lung injury in the early stage after smoke inhalation injury.
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