|Annals of Burns and Fire Disasters - vol. VIII - n.
4 - December 1995
ANALYSES OF BACTERIURIA IN PATIENTS WITH BURNS
The purpose of this prospective study of bacteriuria in bum patients was to investigate a number of problems that arise in such patients - the incidence of uroinfections, their sources and causes, and the impact on clinical condition and outcome. The patients included in the study met the following criteria: a case history with pre-existing renal or other concomitant disease; clinical findings of uroffifection; use of transurethral catheters. One hundred and forty-eight patients treated over a two-year period (1991-92) were included in the study. Urine infection was found in 46 (7.6%) patients (39.1% community-acquired and 60.9% hospital-acquired). Eight patients presented bacteriuria secondary to a generalized bacterial infection and 11 patients had candiduria associated with massive antibacterial therapy. The communityacquired infections were mainly due to E. coli, Citrobacter and Proteus sp., and hospital-acquired infections to Pseudomonas aeruginosa, Klebsiella sp., Acinetobacter sp. and Serratia sp. The study confirmed that transurethral catbeterization is related to the development or exacerbation of chronic uroinfections, which increased the probability of mortality, especially in elderly persons with concomitant urological, nephrological or other diseases. It is emphasized that strict monitoring of burn patients at risk for uroinfection is essential. Preventive measures are also of great importance.
Lesseva M.l., Hadjiski O.G. Burns, 21: 3-6, 1995.
EFFECT OF EGF DOSAGE FORMS ON ALKALI-BURNED CORNEAL WOUND HEALING OF MICE
Epidermal growth factor (EGF) is a polypeptide present in biological fluids such as plasma, milk, urine and saliva. This study identifies the effect of topical EGF delivered in solution or contained in the bioadhesive gel system on alkali-bumed comeal wound healing in ntice. Corneal wounds were induced by 0.5 M NaOH solution on the comeal surfaces of the mice. Local EGF solutions (100 ng/ml) and gel form in 0.2% w/w carbopol 940 (100 ng/ml) were dropped in 5 p I aliquots into the eye twice a day. The comeal wounds were measured after one and two weeks and examined histologically at the end of the fifteenth day of the experimental period. The results showed that topical EGF treatment in solution improved the healing of alkali-bumed comeal wounds when compared with EGF delivered in a polymer system.
G6mil B., Erdogan D., Ozogul C., Koz M., BabUl A., ~-'elebi N. Burns, 21: 7-10, 1995.
AN INVESTIGATION INTO THE MECHANISMS BY WHICH HUMAN DERMIS DOES NOT SIGNIFICANTLY CONTRI. BUTE TO THE REJECTION OF ALLOSKIN GRAFTS
The aim of this work was to throw more light on the mechanisms underlying the inert role of the allodermis in the inumme rejection of skin grafts, considering that the reasons why dermis does not significantly induce the immune rejection reaction in vivo are still unknown. A new in vitro model was therefore employed to assess the distribution of the host lymphocyte cells in the alloskin. Various other parameters were considered, e.g. mixed lymphocyte reactions and immunohistochemistry, in order to understand the possible mechanisms of the interactions between the peripheral blood mononuclear cells and the dermis or epidermis. The results of this investigation indicate that the apparent immunological inertia of the dermis is not the consequence of an immunostimulatory incapacity on the part of the dermal cells but may on the contrary be due to factors impeding contact between the peripheral blood mononuclear cells and the allodermal cells. The peripheral blood mononuclear cell/skin co-culture model presented here is also a useful tool for investigations of the migrating and homing patterns of lymphocytes.
Wu J., Barisoni D., Armato U. Bums, 21: 11-16, 1995.
EVALUATION OF EARLY ENTERAL FEEDING IN CHEL. DREN LESS THAN 3 THREE YEARS OLD WITH SMALLER BURNS (8-25 PER CENT TOSA)
The purpose of this study was to evaluate the safety and efficacy of early enteral nasogastric feeding of high protein content in children under 3 years old with burns of 8-25% T13SA. An attempt was also made to validate existing mathematical formulae for estimating energy requirements in young children with smaller burns. It was found that the ten children studied who received such feeding were able to tolerate high protein intake without detrimental effects. The incidence of gastrointestinal complications related to nasogastric feeding was low. The children required about two weeks of supplemental nasogastric feeding, which provided two-thirds of total energy intake and three-quarters of protein intake. Although the burns were comparatively small, the mean measured resting energy expenditure was 1.3 times that predicted. The mean energy intake of 92% of recommended daily allowances for energy or 1.7 times predicted resting energy expenditure was able to maintain body weight. The mean protein intake was 4.3 gmlkg/day with a non-protein calorie ratio of 114: 1. The high protein intake raised the visceral proteins, which were low in the first week post-burn, to normal ranges. It is concluded that early nasogastric feeding is safe and efficacious for achieving increased energy intake and improved protein in very young burned children.
Trocki 0., Michelini J.A., Robbins S.T., Eichelberger MR. Burns, 21: 17-23, 1995.
A PROSPECTIVE STUDY OF BURN SCAR MATURATION IN PEDIATRICS. DOES AGE MATTER?
A prospective study was conducted in order to examine variance in burn scar maturation among different paediatric burn groups, with a view to investigating the hypothesis that burn scars in younger children peak (i.e. reach their maximum amount of erythema, firmness, and thickness) and mature more rapidly than in older children. Sixty-three paediatric bum patients were divided into three age groups: up to 3 years, 4 to 11 years, and 12 to 18 years. The scarring of sheet grafts on an extremity was assessed during the maturation process in three areas: vascularity, pliability, and height. A one-inch square was selected on the graft edge adjacent to unburned skin. The test areas were independently evaluated by two experienced therapists and the scores were averaged. The initial hypothesis was disproved as it was found that there were no significant differences in the rate of scar maturation between the various groups. Burn scar maturation of sheet skin grafts in children demonstrated a rapid peak of scarring (1 to 2 months) and scar maturation (9 to 13 months).
Schwanholt C.A., Ridgway
C.L., Greenhalgh D.G., Staley M.J., Gaboury T.J., Morress C.S., Walling S.J., Warden G.D.
PSYCHOLOGICAL DISTRESS AMONG SURVIVORS OF BURN INJURY: THE ROLE OF OUTCOME EXPECTA. TIONS AND PERCEPTIONS OF IMPORTANCE
A survey is made of factors associated with psychological distress among burn injury survivors. Hypotheses derived from Scheier and Carver's model of behavioural self-regulation were tested. Two primary predictor variables were considered: expectations as to rehabilitative outcome and the importance attached to the outcome. A cross-sectional research design was used. Data were collected via mailed questionnaire and chart review from 216 persons who had sustained major or moderate thermal burn injuries within the two previous years. It was found, confirming the hypotheses of the study, that participants who attached great importance to further improvement without however entertaining great expectations exhibited the most psychological distress. The study results therefore confirm Scheler and Carver's model and suggest that application of the model within the context of bum rehabilitation might help to increase our understanding of the rehabilitation process. Directions for future theory-based research are also considered.
Blalock SJ., Bunker B.J., DeVellis R.F. J. Bum Care Rehabil., 15: 421-7, 1994
CURRENT TRENDS IN THE USE OF ALLOGRAFT SKIN FOR PATIENTS WITH BURNS AND REFLECTIONS ON THE FUTURE OF SKIN BANKING IN THE UNITED STATES
Cadaver skin can play a critical role in the treatment of patients with massive bum injuries. There is today a heightened sense of awareness of the potential for disease or infection transmission, particularly viral, via transplantation of cadaver skin. This method can function as an ideal wound covering for deep partial-thickness burns and for excised burn wounds, but the perceived "risk-benefit" ratio has probably dampened enthusiasm for the use of cadaver skin in lesser injuries. The purpose of this study was to evaluate the current use of cadaver skin in hospitals in the USA. Detailed questionnaires were sent to 140 medical directors of American bums centres and to 40 skin banks, of whom respectively 38% and 45% replied. According to the replies to the questionnaire, 12% of admitted patients were treated with cadaver skin at the responding bums centres. Sixty-nine per cent of burns centre directors were in a position to provide fresh cadaver skin. Although respondents referred to cadaver allograft skin as the "gold standard" for biological dressings, the majority indicated that successful development of skin replacements is not only inevitable but also desirable. These developments may eventually eliminate the need for skin banks as we know them today.
Greenleaf G., Hansbrough J.F. J. Bum Care Rehabil., 15: 428-31, 1994.
MODIFIED STRYKER FRAME FOR INTRAOPERATIVE POSITIONING OF THE PATIENT WITH BURNS
It can prove to be very difficult to position particularly large bum patients in the prone position, requiring operating room personnel to use a gang-lift technique. This paper describes the use of of the upper portion of a Stryker frame mounted to a standard operating theatre table-base in over 200 bum operations in which adult burn patients were transfer-red from the supine to the prone position, and vice versa, without any complications.
Sheridan R.L., Hurley J.,
Lynch L., Balmer J., Ryan C.M., Bondoc C.C., Quinby W.C., Tompkins R.G., Burke J.F.
ADAPTIVE AIR TRAVEL TRANSPORTATION SYSTEMS FOR PERSONS WITH DISABILITIES
The American Air Carrier Access Act forbids any air carrier to discriminate against persons with disabilities. This law establishes rules and regulations that remove architectural barriers impeding persons with disabilities. A comprehensive adaptive air transport system for persons with disabilities includes a special aircraft boarding environment, boarding chairs, collapsible aircraft wheelchairs, stowage procedures for battery-powered wheelchairs, and aircraft shuttle bus or van services. Such systems ensure that persons with disabilities have the same level of service as those without disabilities.
Nabidazeh S.A., Van Meter B.H., Ferris
B.L., Thacker LG., Edlich
BURNS IN MEN SECONDARY TO SPOUSE ABUSE
Over a 5-year period 61 men admitted to a burns centre in Detroit (USA) claimed to have suffered their bum injuries as a result of abuse by their wife. The commonest cause was hot water. Seventy per cent of the patients were aged less than 40 years. This study, the aim of which was to identify the incidence and social problems involved in the phenomenon of male patients admitted with burns secondary to spouse abuse, indicates that there is need of increased awareness in order to identify such patients, who may require psychosocial rehabiltation, and to prevent a second injury.
Balakrishnan C., Imel L., Prasad J.K. J. Bum Care Rehabil., 15: 449-51, 1994.