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Volume VIII |
Number 1 |
March 1995 |
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SUMMARIES
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BURN INJURY ADMISSIONS TO A NEW BURNS UNIT IN BURAIDAH, QASSIM, SAUDI ARABIA - A STUDY OF 218 CASES
(Fadaak R., AI-Kurashi N., Mahaluxmivala S., Mathur A., Borkar K., Ibrahim E. - Saudi Arabia)
A 10-bed "state of the arC burns unit was commissioned at King Fahd Hospital, Buraidah Ad-Qassim, Saudi Arabia, and the first 218 cases admitted to the Unit over a 42-month period were analysed. The mean age (ISD) of the patients was 8.2 years (range 6 months - 75 years); 56.9% were males and 43. 1 % females; 60.6% were children under 12 years, of whom 78.8% were qnder five years of age. Only four patients were aged over 60 years. Scalds and flames accounted for 75.2% of-the aetiological factors. Domestic bums constituted the majority of the cases (160/218; 73.4%), and the majority of patients were admitted within the first 24 hours (79.4%). Admission was either direct or through a general hospital or a health centre. The mean (± SE) total body surface area (TBSA) burned was 26% (± 2.4), with a range of 1-98%. The mean hospital stay of the entire group was 19.2 days. The in-hospital mortality rate was 15 patients (6.9%). The TBSA burned was found to be the main factor influencing mortality. The study highlights the important factors that affect the outcome in this Unit and others in Saudi Arabia. Factors that can improve the morbidity and mortality rates are identified. The study reveals certain patterns and aetiological patterns in the Qassim, region. Education for prevention through a national campaign remains the keystone for the reduction of the incidence of burns, particularly in children, and for the maximization of resources.
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CLINICAL EXPERIENCES WITH THE APPLICATION OF REDITAC FLUID THERAPY
(Pint& L. - Czech Republic)
A description is given of the treatment of burn patients based on Reditac fluid therapy, which presents a number of advantages. This method can also be used in cases of polytrauma, d6collement and in reconstructive surgery. Two clinical cases are described. Reditac fluid therapy can be effectively combined with pulse therapy, which reduces the risk of contractures.
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A CASE OF TOXIC EPIDERMAL NECROLYSES ASSOCIATED WITH MYCOSIS FUNGOIDES AND COMPLICATED BY CONSUMPTION COAGULOPATHY
(Napoli B., D'Arpa N., Sferrazza-Papa G, Masellis M. - Italy)
A case of drug-related toxic epidermal necrolysis (TEN) is described in an adult patient suffering from mycosis fungoides. The course of the disease, which affected 50% of the body surface and ended fatally following cerebral haemorrhage, was characterized by the onset of a serious hepatopathy, thrornbocytopenia and consumption coagulopathy. These alterations were considered to be TEN-specific and not secondary to the sepsis subsequently observed. Stress is laid on the complexity of this disease, which is not only cutaneous or cutaneoushnucoseal, and on the importance of immediate hospitalization in a specialized centre in order to guarantee continuity of therapeutic treatment.
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INFECTION IN BURNS: EXPERIENCE OF A TEACHING HOSPITAL IN SYRIA
(Dayoub A, Zeidan F, Radidy S. - Syria)
Infection continues to be the major cause of death in bum patients. In a retrospective survey covering a 15-year period (1978-1993) we found that 71 % of our hospitalized bum patients' deaths were due to wound sepsis, septicaemia and complications of septicaemia. Staphylococcus aureus and other gram-positive cocci isolated from infected sites were the dominant organisms causing infection in the first week of hospitalization. In the second week and subsequently, Pseudomonas organisms dominated the picture and were responsible for most of the complications of septicaemia. The aim of this paper is to describe this long period of experience in a large teaching hospital in Syria, with regard to epidemiology, methods of diagnosis, management, and infective complications in bums.
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EXTENSIVE GRANULOMA PYOGENICUM COMPLICATING SEVERE BURNS
(Shlash S., AI-Jalsi L, Somorin A. - Saudi Arabia)
A six-year-old girl, admitted over a seven-montb period with 70% tbird-degree bums to the Burns Unit of a tertiary Saudi Arabian medical centre, developed an unusual form of histologically confirmed, multiple, rubbery, widespread, vascular, giant-sized granuloma pyogenicum. Despite the corporeal severity of the flame bums accident and the benign cutaneous neoplasm, the patient made an uneventful recovery after multiple sessions of cryotherapy, meshed partial-thickness skin grafting, multiple intravenous antibiotics, albumin, blood and other fluids.
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THE ROLE OF TNF ALPHA AND BETA CYTOKINES IN SCAR HYPERTROPHY IN BURN PATIENTS: AN IMMUNOHISTOCHEMICAL STUDY
(Castagnoli W., Stella W., Magliacani W., Richiardi R. - Italy)
The pathogenetic factors involved in the development of hypertrophic scarring are still to some extent unknown. It has recently been found that biopsies of hypertrophic scars reveal an anomalous behaviour of molecules activating the immune system. A significant association has also been observed be , tween class 11 histocompatibility leucocyte antigens (HLA) and the formation of hyper trophic scars. This paper analyses the percentagebf cells that produce the tumoral necrosis factor (TNF) alpha and beta in hypertrophic scars, using normal scar biopsies and healthy skin biopsies as controls and following the three-stage immunoperoxidase method and specific monoclonal antibodies. The samples were initially studied in order to characterize cell infiltrates. The biopsies of hypertrophic scars showed a massive presence of infiltrating activated cells capable of producing TNF beta and IL- I beta. The percentage of cells producing TNF alpha (8~vo) was significantly smaller than that in normal scars (35.4%). The production of TNF beta was found to be substantially similar in hypertrophic and normal scars.
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INTERET DU "TEST DE VITROPRESSION" DANS LE SUIVI DES CICATRICES DE BRULURES A PARTIR DE 50 OBSERVATIONS
(Gavroy JR, Poveda K., Oversteyns B., Plantier W., Roug6 D., Griffe Cl., Teot L., Costagliola W., Ster F. - France)
Les auteurs sont partisans de la méthode du test inflammatoire classique de vitropression pour éviter certaines conséquences fonctionelles des brûlures. Ce test permet de chiffrer l'inflammation en chronométrant le temps que met la peau déprimée à se recolorer: cette durée est inversement proportionnelle à la quantité d'inflammation. Après avoir décrit une étude qui porte sur 58 patients, les auteurs discutent les résultats et concluent que le test de vitropression permet de quantifier précisément l'inflammation, d'avoir un contrôle sur l'efficacité des techniques de rééducation et de sensibiliser les patients.
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SILICONE TUBULAIRE: UN COMPROMIS ENTRE COMPRESSION ET REHYDRATATION DE LA PEAU?
(Gavroy JR, Poveda K., Oversteyns B., Plantier W., Roug6 D., Griffe Cl., Teot L., Costagliola W., Ster F. - France)
Les auteurs décrivent leur longue expérience avec l'emploi de la compression dans le traitement des séquelles de brûlures. En particulier ils ont utilisé les silicones tubulaires à haut pouvoir élastique et compressif. Les zones les plus fréquemment traitées sont les creux poplites, les régions malléolaires, les mains et les coudes. L'utilisation des mousses imprégnées de produits antiseptiques ou antibiotiques a permis de constater plusieurs effets (anti-inflammation, anti-friction, compression et hydratation). Après avoir considéré quelques avantages et inconvénients, les auteurs concluent que la gamme de plus en plus riche des produits utilisables permet de traiter toutes les zones sans aucune exception, et ils posent la question: "Quand les vêtements compressifs entièrement siliconés seront-ils commerciabsés?"
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PATHOLOGICAL SCAR FORMATION IN BURNS: NEW BIOCHEMICAL AND MOLECULAR FACTORS IN THE HEALING PROCESS
(Bocchi A., Caleffi E., Toschi S., Stabile M. - Italy)
A review is made of the principal biochemical and molecular factors that have most recently come to light in research into the processes involved in pathological scar formation due to bums. A better understanding of the biochemical events leading to pathological scar formation will help to improve prevention and therapy. The various vascular changes following tissue injury are considered, as well as the question of tissue repair. As shown by the most up-to-date research, it is now possible to accomplish the pharmacological and non-surgical therapy of burn scars by means of both chemical and physical agents. These various agents are systematically reviewed. Among the chemical agents, corticosteroids and zinc are considered to be the first-choice drugs; while among the physical agents, pressure would appear to be the most effective.
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ROLE DE L'AIDE MEDICALE HUMANITAIRE FACE A LA NOTION DE RESPONSABILITE DANS LA GENESE DES CATASTROPHES TECHNOLOGIQUES (INCENDIES, EXPLOSION, ETC.)
(Fonrouge J.W., Fonrouge G., Belanger M. - France)
Les auteurs considèrent les effets particuliers d'une catastrophe technologique, qui provoque une situation de crise sociale, parfois économique voire politique, et conduit à la recherche d'un responsable. La mise en cause de personnes, de grandes sociétés, de l'Etat même fausse la gestion des secours, et on assiste à un phénomène de négation de la gravité de la catastrophe qui peut conduire à un refus de l'aide internationale. Il faut absolument que l'organisation de l'aide humanitaire ne réunisse que des médecins qui respectent le principe de neutralité observé par la Croix Rouge et se fasse sous l'égide d'organismes reconnus (ONU, OMS) capables de garantir l'éthique de toutes les structures intervenantes.
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