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Volume IX |
Number 1 |
March 1996 |
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SUMMARIES
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MANAGEMENT OF SEVERELY BURNED PATIENTS A STUDY OF 684 SEVERELY BURNED PATIENTS ADMITTED IN THE LAST SIX YEARS TO THE BURN AND PLASTIC SURGERY CENTRE, TRIPOLI, LIBYA
(Zaidi M.M., Abussetta A.A., Franka MR, Shahata G, Traikov E, Uyang L. - Libya)
Between 1 January 1989 and 31 December 1994 684 severely burned patients were admitted to the Intensive Care Unit (ICU) in the Burn and Plastic Surgery Centre in Tripoli (Libya). The ICU is an isolated department with nine beds (three single isolated beds, plus six others), with separate operating theatres and five air-fluidized beds. The Unit is staffed by four anaesthesiologists from the Anaesthesia Department together with three burn surgeons working exclusively in the Unit, as well as specially trained nurses. All facilities for non-invasive monitoring are available for the nine beds. As in the central control unit, dialysis is available in the ICU if required.
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PRISE EN CHARGE EXTRA HOSPITALIERE ET ACCUEIL DU BRULE HORS CENTRE SPECIALISE
(Bertin-Maghit M, Gueugniaud RY, Bouchard C, Fonrouge J.M., Petit P. - France)
Les auteurs consid?rent les divers aspects de la prise en charge extra hospitali?re et de l'accueil du br?l? hors centre sp?cialis?. Ils indiquent les crit?res g?n?raux qu'il faut suivre et les premiers secours qu'il faut effectuer. Apr?s avoir d?fini les cas o? l'hospitalisation s'av?re obligatoire, ils d?crivent certaines ?tiologies qui posent des probl?mes sp?cifiques. La mise en condition pr?-hospitali?re du br?l? est identique ? celle de tout patient et cons?quemment il faut consid?rer les aspects suivants: l'abord veineux, J'?quipement, l'intubation naso-trach?ale, le remplissage vasculaire, la protection thermique, et l'analg?sie/anesth?sie. La prise en charge m?dicale pr?-hospitali?re doit d?buter les soins de r?animation, pr?venir les incidents li?s au transport et orienter le patient dans les meilleurs d?lais vers un centre sp?cialis?.
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OUR EXPERIENCE IN THE TREATMENT OF PATIENTS WITH SELF-INFLICTED BURNS
(Bocchi A., Toschi S., Caleff i E., Papadia F. - Italy)
Self-inflicted burns represent a great problem because they are often deep and extensive, and the patients generally have a history of mental illness and difficult family relations. The authors describe the benefits of appropriate psychological and psychiatric support for these patients.
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OBSERVATION CLINIQUE DES BRULURES A HAUT VOLTAGE
(Hadjiiski O., Argirova M. - Bulgarie)
Au Centre des Brûlés et de Chirurgie Plastique à l'Institut des Urgences Pirogov à Sofia (Bulgarie), sur une période de cinq ans (1989-1993) ont été traité 2704 malades dont 239 (8,33%) avec des brûlures électriques. Les victimes de brûlures électriques à haut voltage ont été 151 personnes (63,18%), âgées de 3 à 68 ans. L'étendue de la brûlure variait de 1 à 62% de la surface corporelle. Dans notre étude nous analysons les caractéristiques épidémiologiques et cliniques des brûlures électriques à haut voltage, ainsi que les différentes techniques de traitement. La cause la plus fréquente a été le contact avec un conducteur non-isolé (dans 31,80% des cas), en deuxième position avec un poteau électrique (dans 24,50% des cas), en troisième avec les distributeurs d'électricité communaux (19,20% des cas), etc. Ont été opérés 63,6% des brûlés. Les techniques opératoires ont été comme suit: greffe précoce ou lambeaux chez 71,71%, amputations chez 21,05111o, trépanations chez 7,24% des opérés. Sont discutées les atteintes associées à la brûlure. Le taux d'invalidisation est de 26,5% et de la mortalité de 5,29%.
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SERUM CYTOKINES FOLLOWING THERMAL INJURY
(Shehab El-Din S.A., Aref S., Salama O.S., Shouman O.M. - Egypt)
Serum levels of interleukin- 16 (IL- 1ß), interleukin-6 (IL-6) and tumour necrosis factor-a (TNF-a) were assayed in 31 bum patients and 12 controls. A study was made of the correlation between cytokine levels and time post-burn, burn area, and mortality. The early IL-1ß, IL-6 and TNF-a systemic responses following thermal injury decreased with time post-burn but did not reach control levels. With increased burn area a significant elevation of IL-6 and TNF-a, but not of IL-1ß, was detected in the systemic circulation. All non-surviving burn patients had detectable levels of IL-1ß, IL-6 and TNF-oc; these were significantly higher than those of surviving patients. The results suggest that IL-1ß, IL-6 and TNF-a may play a role in the pathogenesis of septic shock or multiple organ failure and are therefore to be considered bad clinical omens.
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DYNAMIC ANALYSIS OF EXTRACELLULAR FLUID EXCHANGES IN THE BURN PATIENT DURING CONTINUOUS ARTERIOVENOUS HAEMOFILTRATION
(Gòmez-Cia T., Ortega-Martinez J.I., Roa L. - Spain)
An algorithm is presented for the analysis of effects of continuous arteriovenous haernofiltration (CAVH) on critical burn patients. The objective of CAVH is the controlled elimination of vascular fluids and low molecular weight solutes. Th s method requires rigorous control of fluid intake and elimination. The algorithm, calculated on the basis of easily available daily varia venous haemotocrit and plasma protein concentration), can show us the behaviour in time of variables such as blood volume and fluid shifts between plasmatic and interstitial compartments. These variables are indicative of the real state work also presents the results obtained using the algorithm in a series of burn patients subjected to CAV1-1.
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CONSIDERATIONS ON NUTRITIONAL THERAPY IN THE BURN PATIENT
(Cucchiara R, Masellis M, Sucameli M. - Italy)
A description is given of the nutritional therapy protocol used in the Palermo Burns Centre. This protocol recommends the enteral approach, but also uses parenteral support in the treatment of patients with burns in more than 25% body surface area. Enteral nutrition is without any doubt an effective therapeutic approach which prevents complications, in particular of the gastroenteric tract.
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HONEY DRESSING FOR BURNS - AN APPRAISAL
(Subrahmanyam M. - India)
In a prospective randomized study, honey was used as a dressing for partial-thickness burns (<40% TBSI period in 450 patients and the results were compared to those obtained in the same number of patients treated by c,,ven the same period. The wounds treated with honey healed earlier than those treated with conventional methods (8.8 da S Residual scars were noted in 28 patients (6.2%) in patients treated with honey and in 89 patients (19.7%) treatc methods.
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THE HISTORY AND FUNCTION OF THE EURO SKIN BANK
(Hermans RP, Hoekstra MJ, Kropman GM, Koenderink JA - The Netherlands)
This article describes the creation of the Euro Skin bank in the Netherlands in 1992. The Euro Skin Bank is a non-profit making organization which developed out of the Dutch National Skin Bank. This was founded in 1976, at which time cryopreservation was the technique used for preserving skin.
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EXTENSIVE BURN SCAR CARCINOMA IN THE SCALP AND ITS TREATMENT WITH FREE FLAPS: THREE CASE
(AcartOrk S., Dalay C., Yavuz M, Irik G, Kesiktas E. - Turkey)
The malignant potential of an unstable burn scar is ever present. It may develop in the scalp regio body, such as the lower and upper extremities and the prestemal region. This paper presents three cases of extensi oping in an unstable burn scar. Deep extensive excision is necessary for this kind of expansive turnoral invasion, and are not sufficient to reconstruct the complex scalp defect. After extensive excision of the tumour, free latissimus do (two cases) and free radial artery forearm flap (one case) were carried out to reconstruct the excisional defect. It is sue transfer is a good choice in the reconstruction of deep extensive scalp defects.
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ÊTUDE DE VECOLOGIE BACTERIENNE SUR SIX ANS DANS UN SERVICE DE BRULES: RELATION AVEC LES INFECTIONS NOSOCOMIALES ET LES THERAPEUTIQUES ANTI-INFECTIEUSES
(Perro G., Bourdarias B., Cutillas M., Castède J.C., Sanchez R. - France)
Les auteurs ont étudié 4500 prélèvements bactériologiques chez 1600 patients hospitalisés entre 1989 et 1994. Les germes 1s('~iès, sont les Staphylocoques dorés (25%), les Streptocoques (16%), les autres bactéries à Gram positif (14%), les Pseudomonas (26%), les i'i(iii-es bactéries à Gram négatif (13%) et les levures (6%); il existe des variations significatives en fonction du temps. Staphylocoque et Pseudonionas représentent 27% de la flore isolée à partir des lésions cutanées avant le 8ème jour d'évolution et 60% après le jour. Huit pour cent des patients ont présenté une bactériémie, 8% un syndrome septique avec au moins une défaillance viscérale, 1~c ont développé une infection urinaire (surtout Pseudomonas et Candida), 7% une pneumopathie nosocomiale (Pseudomonas 45%). ~ih'gi pour cent des cathéters centraux sont contaminés (51% de Staphylocoques) entraînant 4% de bactériémies. Les auteurs présentent 1 C, ~i 1- l5ilse cri charge anti-infectieuse topique et systémique. Il existe une relation significative négative entre le nombre de Staphylocoques isoie~s, et l'administration d'antistaphylococciques d'une part, et une relation significative positive d'autre part entre l'administration de cer(ain"s antibiotiques et l'apparition de souches multi-résistantes (synergistines et Staphylocoques dorés, fluoro-quinolones et Pseudomonas).
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THE RELATIONSHIP BETWEEN STERILIZATION AND MAJOR INFECTION IN BURN PATIENTS: THE SITUATION AT THE BURNS CENTRE IN PARMA, ITALY
(Toschi S., Caleffi E., Bocchi A., Papadia F. - Italy)
The sterilization of the environments is one of the most important clinical factors for the prevention of major infection in burn patients. The authors describe the situation at the Burns Centre in Parma before and after the use of sterilization and conclude that periodic sterilization decreases the incidence of sepsis and mortality in bum patients.
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