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Volume VII |
Number 2 |
June 1994 |
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SUMMARIES
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LES BRULES: PROFIL EPIDEMOLOGIQUE ET ELEMENTS DE PREVENTION A PROPOS DE 1499 PATIENTS HOSPITALISES A L'UNITE DES BRULES DE CASABLANCA, MAROC
(Boukind E.A., Chafiki N., Bahecar N., Alibou F., Terrab S., Boumzebra C.L., Zerouali O.X. - Maroc)
Il s'agit d'une étude épidemiologique rétrospective portant sur 1499 patients atteints de brûlures sévères hospitalisés dans notre unité durant une periode de 9 ans (1985-1993). Les deux tiers des patients étaient âgés de moins de 20 ans. Le rapport numérique entre les deux sexes (m/f) était de 1,2/1. La flamme a été le chef de file des agents causaux, incriminée dans 51,5% des cas. Les brûlures par ébouillanternent ont été les plus fréquentes chez l'enfant de moins de 15 ans (69,1%). La surface corporelle brûlée moyenne était de 25%. La durée de séjour a été de 15 jours en moyenne. Le taux de mortalité était de 27,3%, essentiellement en rapport avec une septicémie (61,1%). La prévention reste le meilleur moyen de lutte, elle doit être inspirée des traditions et des conditions socio-économiques locales.
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| 63 |
BRULURES CHEZ LES PERSONNES AGEES
(Hadjiiski 0. - Bulgarie)
Pour une période de trois ans (1990-1992) au Centre des brûlés et de chirurgie plastique de l'hôpital des urgences Pirogov à Sofia ont été traités 203 malades âgés de plus de 60 ans. Ils représentent 22,89% de tous les 877 malades âgés de plus de 14 ans et traités au Centre. La plupart des patients âgés se sont accidentés à domicile et l'agent le plus fréquent de la brûlure était un liquide bouillant (116 cas). Les brûlures de 183 malades étaient inférieures et égales à 20% de la surface du corps. La moitié des patients (102) ont été opérés -des excisions précoces et des nécrectomies chimiques leur ont été faites, ainsi que des homogreffes et différentes types d'autogreffes. Des maladies préexistantes avaient 110 malades dont certains en avaient plus d'une. 161 patients sont guéris (79.31%) et 42 sont décédés (20.69%). La cause la plus fréquente de la mort chez les patients dont les brûlures étaient inférieures à 40% de la surface du corps étaient les complications des maladies préexistantes et chez les patients dont les brûlures étaient supérieures à 40% le déséquilibre mal maîtrisé de la hémodynamique.
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| 68 |
IMMUNOLOGICAL PROFILE IN MAJOR BURN CASES COMPARED WITH SURGICAL AND CLINICAL EVALUATION PARAMETERS
(Cavallini M., Tesauro P., Campiglio G.L., Grappolini S. - Italy)
Infective complications are the most feared in the prognosis of major burn cases. They can be reduced by appropriate antibiotic and nutritional therapy. The onset of sepsis can also be affected by early or late escharectomy. This study, carried out at the Plastic Surgery Institute and Bum Centre of Niguarda Ca' Granda Hospital in Milan (Italy), reviewed a group of bum patients. The group was monitored with regard to the immunological profile in order to make a comparison between our data and those in the literature. Our aim was to establish if it was possible to associate the changes in some immunological parameters with the appearance of septic phenomena.
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| 73 |
MICROBIOLOGICAL MONITORING OF SEVERELY BURNED PATIENTS ADMITTED TO THE BURNS CENTRE IN BARI (ITALY) IN THE PERIOD 1989-92
(Calvario A., Di Lonardo A., Larocca A.M.V., Parisi D., Montagna M.T., Ressa M., Silvestri A., Maggio G. - Italy)
An infection-prevention programme conducted in severely burned patients admitted over a four-year period to the Bums Centre in the Bari Polyclinic (Italy) indicated that the aetiopathogenesis of infection was mainly due to Pseudomonas aeruginosa and Staphylococcus aureus. These species - sometimes multiresistant to various topical and systemic treatments - often aggravated prognosis in the patients and complicated any reconstructive treatment already in progress. The importance is underlined of a systematic programme of microbiological surveillance covering patients, staff and the environment in order to monitor the circulation of the various microbic species and thus to ensure more successful results in the various types of reconstructive treatment, including skin flaps.
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BACTERIOLOGICAL MONITORING IN A BURNS CENTRE
(Cucchiara P., Sucameli M., Masellis M., Torregrossa M.V., Valentino L., Carmeni A. - Italy)
On the basis of the observation of multiresistant strains of Staphylococcus aureus in patients admitted to the Palermo Bums Centre, it was decided to consider the role played by the environment as a "reservoir" of pathogens. A microbiological monitoring programme was undertaken regarding all elements contributing to the circulation of germs around the patient such as the medical, paramedical and auxiliary staff and everything that can serve as a vehicle of infection (air, water, surgical in , struments, disinfectants and the rooms in the Centre). The microbial monitoring protocol that was thus prepared for the personnel and the environment was judged to be effective
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| 84 |
ANTIMICROBIAL THERAPY PROBLEMS IN BURN SEPSIS
(Magliacani G, Stella M, Calcagni M. - Italy)
This study concerns the difficulties of antimicrobial therapy, and analyses certain recently observed aspects in the treatment of sepsis, i.e. the utility of classifying bum patients in homogeneous classes, some particularities of pathogens, and effective methods for fighting them. The authors recommend use of Roi's Burn Severity Index, which makes it possible to classify patients in order to create comparable homogeneous groups. Regarding therapy, neither presumptive antibiotic therapy nor antibiotic prophylaxis seems useful, while single dose prophylaxis is indicated in some clinical situations. The authors recommend the use of vancomyein and teicoplanin against methicillin-resistant Staphylococcus, and of aminoglycosides, together with penicillin, against Pseudomonas aeruginosa.
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| 88 |
SELECTIVE INTESTINAL DECONTAMINATION OF THE DIGESTIVE TRACT: A TOOL FOR INFECTION PROPHYLAXIS IN BURNS?
(Manson W.L., Sauer E.W. - The Netherlands)
In the last few years much attention has been paid to the role of the gastrointestinal tract (GIT) in the pathogenesis of infectious complications in severely burned patients. There is considerable evidence that micro-organisms originating from the GIT play a role in the colonization of burn wounds. There may also be a direct dissemination of microbes from the GIT by means of bacterial translocation. Promising results have been obtained from recent studies in which selective decontamination of the digestive tract was used to prevent infections in burns.
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| 91 |
ELECTRICAL INJURIES CAUSED BY RAILWAY OVERHEAD CABLES - A REVIEW OF 24 CASES
(Koller J., OrsAg M., GrOinger L., KvaMni K., Ondrias'ovA E. - Slovakia)
Twenty-one patients with electrical burns due to railway overhead cables were treated at the Bratislava Bums Department over a period of three years. All the injuries occurred with the same mechanism - climbing on top of railway carriages and approaching the 25,000 V a.c. overhead cables. The cutaneous bums, ranging from 18 to 79% BSA, were mostly deep partial- to full-thickness injuries. Exceptionally, deep structures were involved in small areas of electrocution. The age range of the patients was from 9 to 41 years. Six of' the patients were adults and the remaining 18 were under 18 years of age. Two patients, a 14-year-old boy and an 18-year-old man, died respectively on days 5 and 9 post-burn. No amputations were necessary. ne pathophysiology and possible preventive measures are discussed. It must be stressed that arcing can be induced by an earthed moving object simply by approaching, and not necessarily touching, a cable carrying high voltage.
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| 95 |
DYNAMIC CHANGES OF FIBRE CONTENT IN RABBIT LUNG AFTER SMOKE INHALATION INJURY
(Er-fan X., Zong-cheng Y., Li Ao - China)
On the basis of the autofluoreseence characteristics of elastic and collagenous fibres, microspectrofluorometry was used in this study to measure the dynamic changes of the fluorescent intensity of alveolar walls in rabbit lung after smoke inhalation injury. Such changes would indicate the alteration of amounts of fibre content in the lung. The concomitant changes of arterial blood gas levels, lung water volumes and pathomorphology of lung tissue were also observed. It was found that after injury the fluorescent intensity of alveolar walls decreased progressively denoting a substantial loss of elastin and collagen in the lung. Serious lung damage and pulmonary oedema were also found. The results indicated that the disrupting effects of proteolytic enzymes on lung tissue structures may contribute importantly to lung injury after smoke inhalation. A new method, rnicrospectrofluorometry, is thus provided for the study of fibre content in the lung.
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| 98 |
ROLE D'UNE INFIRMIERE DANS LA GESTION LOGISTIQUE DES MOYENS DE SECOURS AUX BRULES
(Bernard C., Fonrouge J.M., Chavagnac B. - France)
Les auteurs, après avoir souligné l'importance de la préparation pour faire face à tous les types de catastrophes qui peuvent se produire, décrivent les moyens et le matériel nécessaires pour un SAMU. Pour organiser efficacement les secours il faut la présence d'une infirmière logisticienne qui doit régulièrement contrôler que le matériel se trouve bien dans les caisses, qu'il est en état et que les pérempfions soient bien à jour. Le rôle du logisticien est aussi de faire progresser la structure.
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