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Volume VII |
Number 3 |
September 1995 |
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SUMMARIES
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A MULTIMEDIA COMPUTERIZED TEACHING SYSTEM IN THE FIELD OF BURNS THE COMETT PROJECT OF THE EUROPEAN UNION
(Masellis M., Costagliola M., Garcia Torres V., loannovich J., Magliacani G. - Italy, France, Spain, Greece)
COMETT (Community Programme for Education and Training in Technology) is an instrument proposed by the European Union to improve cooperation between universities, research institutes ang1the world of business. One of COMETT's objectives is to use this cooperation to accelerate the process of technological transfer from higher education institutions to industrial applications by promoting training courses using new technologies. In the spirit of the COME`IT project, in 1990 the Mediterranean Bums Club presented a proposal entitled "European network for the establishment of textual and iconographic documentation relative to bums in the Mediterranean area", with the objective of producing a training plan common to all the partners by the use of innovative technologies and in particular interactive multimedia applications. The main purposes of the project are to improve and make more uniform the level of professional specialization, to promote activities in the field of prevention, therapy and rehabilitation of the bum patient, and to improve care and rescue work in fire disasters. Five academic partners and one technical partner were involved in the preparation of the project. The system is a genuine teaching instrument that can be used both for training in the general field of bums and for in-depth study of specific issues. The technological solutions adopted in the project are described. The results obtained by the project can be summarized as follows: training of all the academic partners in the potentials of image processing systems; training in systems and methodologies for developing multimedia applications; production of a multimedia application on CD-ROM for use as a training instrument in Bums Centres for medical and paramedical personnel and as a teaching aid in university medical degree courses with particular reference to bums.
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| 128 |
BURNS IN PAEDIATRICS: LONG-TERM EFFECTS OF A PREVENTION CAMPAIGN IN THE CESENA AREA (ITALY)
(Arcangeli F, Calisti D, Landi G. - Italy)
To verify the long-term results of a campaign for the prevention of bum injuries in paediatric age, initiated in 1977 throughout the Cesena area (central Italy), a retrospective review was made of paediatric admissions to the Cesena Bums Centre from 1972 to 1992. The number of burned children resident in the Cesena area dropped sharply after 1977, reaching a 98% decrease by 1992. The number of non-resident burned children, taken as a reference control group, showed a more gradual reduction, showing a smaller decrease of 64% by 1992. These data reinforce the conviction of the effectiveness of prevention campaigns and educational programmes involving children, school teachers and social operators.
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| 131 |
ALTERED NEUTROPHIL FUNCTION IN PATIENTS WITH MAJOR BURN TRAUMA
(Pralat U., Lips U., Pallua N., Stangel W. - Germany)
After severe burn injury, large amounts of tissue debris, endotoxins and micro-organisms have to be eliminated. Growing exhaustion of the non-specific immune system leads to the secondary immunodeficiency syndrome with polymorphonuclear leucocytes (PMN) profoundly suppressed. Twenty-seven burn patients were studied with a total of 221 measurements. The results showed that chemotaxis in the surviving patients was significantly higher than in the non-surviving group. Superoxideanion and hydrogen peroxide play a suspected role in the pathogenesis of the adult respiratory distress syndrome (ARDS). However, hydrogen peroxide production after stimulation with formyl-methionyl-leucyl-phenylalanin (FMLP) was nearly three times higher in non-surviving patients than in survivors. Patients with a regular clinical course show lower superoxideanion generation than non-survivors after stimulation with FMLP. These results indicate that non-surviving patients displayed reduced chernotaxis, while the generation of possibly damaging oxygen radicals was significantly enhanced in comparison with patients with a regular clinical course.
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| 136 |
INDICATIONS FOR APPLICATIONS OF GLUCOCORTICOIDS IN BURN MEDICINE
(Hruba L., Kénigova R., Drabek T. - Czech Republic)
This paper discusses various indications for glucocorticoids in bum medicine: first aid to burn victims, inhalation trauma, prevention and treatment of burn shock, and administration before initiation of antibiotic therapy when there is a threat of endotoxin shock. All these indications require short-term treatment with large doses of glucocorticoids. In the decision-making process regarding the adn-dnistration of glueocorticoids, it is necessary to consider the expected therapeutic contribution in relation to possible undesirable effects. The danger of multiple organ failure generally leads to the decision to give the patient glueocorticoids. An analysis is made of records of cases in which glucocorticoids were administered to bum patients in first aid. The causes of respiratory insufficiency in bum patients are also considered. The onset and development of bum shock, with release of vasoactive mediators, can be favourably influenced by glucocorticoids. When administered before bactericidal antibiotic therapy, glucocorticoids can prevent irreversible endotoxin shock.
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| 139 |
TRACHEO-OESOPHAGEAL FISTULA AS A COMPLICATION IN EXTENSIVE BURNS WITH INHALATION INJURY
(Padera L., Kenigova R., Hdjek M. - Czech Republic)
Two patients with extensive bums and inhalation injury were treated in our Intensive Care Unit in 1992-93. The patients were artificially ventilated for three and two months respectively by means of tracheostomy. The long-term ventilation led to the developmerit of perforation of the trachea, complicated by a communication with the oesophagus.
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| 141 |
PREGNANCY AND BURNS: EXPERIENCE FROM FIVE CASES
(loannovich J., Kastana D., Alexakis D., Tsoutsos D., Panayotou P. - Greece)
The bums disease influences the course of pregnancy and has specific effects on both mother and fetus. The already hypermetabolic pregnant woman has to overcome the metabolic and septic complications of the bums disease. The alterations in the metabolic, hydrostatic, electrolytic and hormonal environment of the mother have direct consequences on the fetus's growth, metabolism, nutrition and the general status. Spontaneous abortion is often due to heat-induced degradation of albumins and to the circulation of various tissue hormones. The septic complications of the burns disease may also induce premature labour. This study presents five cases of pregnant women with burns and discusses the consequences of the burns disease in pregnancy.
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| 143 |
HEALING EFFECT OF RECOMBINED HUMAN/PIG SKIN ON DERMAL DEFECTS
(Matou~kovd E, Ndmcovd D., Dvofdnkovd D., VogtovA D., KénigovA R. - Czech Republic)
The healing effect of recombined human/pig skin (R11PS), composed of human keratinocytes growing on cell-free xenodermis, was studied. When R11PS was applied with the keratinocyte layer facing the wound, stimulation of healing of leg ulcers and deep-dermal wounds was observed. The structure of RHPS makes manipulation easier and more effective compared to cultured epidermal sheets.
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| 147 |
COMPARISON OF VARIOUS DRESSING MATERIALS USED FOR OUT- PATIENT BURN TREATMENT AT OUR CENTRE
(Ugar N, Haberal M. - Turkey)
In the present prospective study a comparison was made between various dressing materials commonly used for ambulatory bum treatment at our Centre. Fifty-two out-patients were included in the study, divided into groups of 11-14 individuals. 'Me patients in each group were treated by application of one of the following dressing materials: nitrafurazone embedded gauze (NEG), silver nitrate incorporated amniotic membrane (SNIAM), WaterJel and Orniderm. Healing time in days was 14.7 ± 1.4, 12.5 ± 1.5, 12.1 ± 2.2 and 14.3 ± 1.3 for NEG, SNIAM, WaterJel and 0miderm respectively. The clinical wound infection rate was observed to be lowest in the SNIAM group. The 0miderm group showed a slightly lower infection rate than the NEG and Water-Jel groups. Two patients in each group deve-loped major complications such as hypertrophic scar or contracture. Water-Jel was found to be the most effective dressing material for pain relief in emergency situations. No patients needed grafting. In the present study the dressing materials provided almost identical end-results with approximately the same complication rates. Although each dressing material had its advantages and disadvantages, the bum wounds healed in about the same length of time, with the same results, if a relatively sterile and moist environment was maintained for the wounds and if epitbelial regeneration was not disturbed either during dressing changes or by topical agents.
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| 150 |
NATURAL SKIN GRAFT EXPANSION: OUR EXPERIENCE WITH A FOUR-MONTHS PREGNANT BURNED PATIENT
(Caleffi E., Bocchi A., Toschi S., Papadia F. - Italy)
Skin has the property of stretchability in natural phenomena such as obesity and pregnancy but it can also be contracted by wound healing or cutaneous grafts. On the basis of these considerations, the case is reported of a four-months pregnant patient with abdominal bums. It is concluded that natural expansion overcomes wound and graft contraction and produces better final results in comparison to unexpanded cutaneous surfaces in the same patient or in another patient in whom natural expansion does not occur.
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| 153 |
REEDUCATION DE LA MAIN BRULEE
(Tromel M.F., Leclerc J. - France)
Les auteurs considèrent le rééducation dans le cas de brûlures intermédiaires ou profondes susceptibles de laisser des séquelles, à l'exclusion du petit enfant et des brûlures électriques. La rééducation doit être introduite dès les premiers jours de la brûlure et les auteurs décrivent les buts, les principes et les moyens dans la main non cicatrisée, la main greffée et la main cicatrisée. Ils indiquent les méthodes de la kinésithérapie (massage, mobilisation, rééducation générale), de l'ergothérapie et en outre ils décrivent l'appareillage qu'il faut employer (orthèses de maintien rigide, orthèses compressives continues, compressions sélectives). Les douches filiformes sont un complément indispensable de ces traitements. La rééducation ne peut éviter toutes les séquelles de la main brûlée, mais permet cependant de mieux les maîtriser.
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