|
 |
Volume IX |
Number 2 |
June 1996 |
|
|
SUMMARIES
| 67 |
BRULURE ET EPILEPSIE - ETUDE SUR UNE DECENNIE 1984-1994
(Jowdar S., Kismoune R, Boudjemia F, Bacha R, Abchiche M. - Algerie)
L'?pilepsie et la br?lure sont deux affections connues depuis l'antiquit?: elles ont toutes les deux un caract?re sacr? et surnaturel enfoui dans l'inconscient des gens. Bien qu'ayant b?n?fici? des progr?s techniques de la m?decine et de la chirurgie, ces deux pathologies, quand elles se rencontrent, s'associent pour handicaper s?rieusement le malade qui en est atteint. A travers l'?tude de plus d'une centaine de cas, les auteurs tentent une approche du m?canisme de la br?lure chez l'?pileptique. La non observance m?dicamenteuse, la p?nurie des m?dicaments, la honte d'aller consulter et le recours ? la m?decine traditionnelle sont autant de facteurs qui rendent l'?pileptique plus vulnerable ? la br?lure. La profondeur des l?sions, l'atteinte des extr?mit?s, la faible surface br?l?e et les br?lures it?ratives sont les caract?ristiques des br?lures chez les ?pileptiques. Apr?s avoir pass? en revue les m?thodes th?rapeutiques m?dico-chirurgicales, des axes de pr?vention sont soulign?s pour rendre l'?pilepsie plus acceptable.
|
| 73 |
ADMISSION AND PATTERN OF BURN INJURIES AT A NEW BURN UNIT AT UNAYZAH, QASSIM, SAUDI ARABIA
(Fadaak R, Fawzy S., EI-Fayomy S., AI-Kurashi N, Esawi 0., Nada V. - Saudi Arabia)
Over a 3-year period ((1991-94) 116 patients were admitted to the 5-bed bum unit at King Saud Hospital, Unayzah, Qassirn (Saudi Arabia). Eighty-seven (75.0%) were males, the majority of them non-Saudi workers in the age group 18 to 60 yr. Forty (34.5%) were children under the age of 5 yr, and eight patients (6.9%) were aged 5-18 yr. The mean age was 13 yr (range 2 months-75 yr); only one patient over the age of 60 was admitted. Flame burns were present in 55 patients (47.4%), scalds in 48 (41.4%), electrical burns in 15 (12.9%) and chemical burns in two (1.7%). Saudi patients were involved more in domestic fires (57.8%), while fire at work was more common (36.2%) in the non-Saudi group. No significant seasonal variation was found. Burned TBSA ranged from 2 to 80%, the majority of patients (74 = 63.8%) presenting less than 10%. Hospital stay ranged from one to 338 days, with a mean of 31 days. Twenty-five patients were discharged against medical advice. There were 29 different complications in 22 patients due to burn injuries, with wound infection in 6 patients. Three patients (2.6%) died. This survey stresses the importance of prevention programmes. Also stressed is the need to establish bum clinics and to train staff in the management of minor burns, in order to reduce hospital admissions with added cost burdens. The need for bum units and their better utilization is also discussed.
|
| 79 |
PREVALENCE DE VINFECTION DANS LE SERVICE DES BRULES DU C.H.U IBN ROCHD
(Boukind ER, Chlihi A, Alibou F, Chafiqui N, Terrab S, Bouchta A, Bahechar N, Zerouali N.O. - Maroc)
Les auteurs rapportent les résultats d'une étude rétrospective portant sur 178 brûlés colligés au Service des Brûlés de Casablanca (Maroc) de janvier 1993 à juin 1994, afin d'évaluer la prévalence de l'infection. Il s'agit de 92 hommes et 86 femmes d'âge moyen de 26 ans, la surface corporelle brûlée est en moyenne de 40%. La flamme est en cause dans 80% des cas. Sur 162 hémocultures réalisées chez 41 patients, 62 sont positives (soit 38,2%) avec isolement du Pseudomonas aeruginosa dans 37% des cas, du Staphylococcus dans 12,9% ainsi que l'Acinetobacter dans 12,9% des cas. Sur 122 prélèvements cutanés, 98,3% sont positifs avec isolement, par ordre de fréquence, du Pseudomonas aeruginosa (47,5%), du Proteus (18,3%) et de l'Acinetobacter (15%). Seul le tiers des hémocultures positives est associé à un prélèvement local positif au même germe. Il a été noté une proportion élevée de résistance aux antibiotiques testés du Pseudomonas aeruginosa, du Staphylococcus et de l'Acinetobacter. Par ailleurs un décès sur deux survenu pendant la période d'étude est secondaire à l'infection. Enfin les auteurs se proposent d'insister sur l'intérêt des mesures préventives à tous les niveaux de prise en charge des brûlés tant sur le plan technique que sur l'information et l'éducation du personnel soignant impliqué dans la transmission de germes en perpétuelle mutation.
|
| 83 |
QUELQUES CONSIDERATIONS SUR LES BRULURES DU LARYNX PAR INHALATION
(Pardo Mateu L., Lorda Barraguer E., Rodes Perez A., Tafalla Peha M. - Espagne)
Les brûlures du larynx sont peu fréquentes. Elles revêtent un potentiel de gravité non seulement en raison du risque obstructif laryngé immédiat ou du risque sténogène ultérieur, mais également à cause de la possibilité de lésions associées et/ou (le la toxicité propre de certains produits. Ces brûlures relèvent de deux mécanismes: brûlures par inhalation et brûlures par déglutition de substances catistiques, irritantes et/ou brûlantes. Nous présentons douze cas de lésions causées par des inhalations pendant lit période 1990-1991 et analysons quelques variables d'intérêt épidémiologique et clinique.
|
| 88 |
AMNIOTIC MEMBRANES FOR TEMPORARY BURN COVERAGE
(Hadjiiski 0., Anatassov N. - Burgarie)
A survey is made of the use of amniotic membrane as a temporary coverage for burn wounds. Amniotic membrane can be used for superficial bums, deep burns, after necrectomy, on extensive granulating wound surfaces, on autografts, in donor regions, and after dermoabrasion. Amniotic membrane is readily available and does not present immunological problems. It does not cause allergic responses and reduces water loss. The risk of the transmission of some viral infections has to be taken into account. Bacterial examinations performed in 20 patients with burn wounds covered with amniotic membrane showed low or no bacterial colonization of the burn surface. It is concluded that amniotic membrane should be more widely used in this particular aspect of burn treatment.
|
| 93 |
ADDITION OF ANTIOXIDANTS AND POLYETHYLENE GLYCOL 4000 ENHANCES THE HEALING PROPERTY OF HONEY IN BURNS
(Subrahmanyam N. - India)
A prospective study was carried out in two groups of 42 randomly allocated patients with partial-thickness burns to compare the effect of honey alone with that of honey fortified with antioxidants (vitamin C and vitamin E) and polyethylene glycol (PEG) 4000. Bums treated with honey plus antioxidants and PEG healed earlier than those treated with honey alone (mean 6.4 (lays versus 8.3). In this study the addition of antioxidants and PEG 4000 accelerated the healing properties of honey in burns.
|
| 96 |
EXPERIMENTAL BURN MODELS
(Santos Heredero FX, Hamann C., Obispo Martin J.M., Rodriguez Arias C., Coca Menchero S. - Spain)
The experimental study of burns requires the use of different animal models in order to reproduce physiopathological conditions. The basic animal models and their manipulation are presented based on the experience of our Experimental Unit. The most frequently used animal is the Wistar rat due to its availability, low cost, resistance to infections, and the feasibility ofreproducing different types of burns. Scalding is the easiest mechanism of provoking a dermal experimental burn. The possibility of varying water temperature, time of exposure and the burned area makes this method ideal for reproducing almost every kind of thermal aggression. Electrical burns usually require superior animals to achieve lesions comparable to those observed in humans. To evaluate the depth of the experimental burn, the Suzuki scale is used, which gives objective histological parameters of the lesion. With this scale, the scalding burn model most frequently used in our Unit provokes superficial or deep dermal lesions depending on exposure time and temperature. Catheterization of the common femoral vein has proved to be the most viable way of obtaining blood samples, providing a long-term route for blood drawing or drug administration. If the experimental burn models described are to be homologated and considered comparable, they inusi be reproducible by other researchers, consistent in results, simple in performance, and, if possible, low in cost. This last condition is easily achieved with the models described, and makes it possible to extend animal experimentation in the field of burns to units and centres which are not specialized and have only limited resources.
|
| 101 |
EFFECTS OF HYPERTONIC SODIUM LACTATE DEXTRAN 70 RESUSCITATION IN SEVERELY BURNED DOGS
(Ge S.D., Xhu S.H., Liu S.K., Chen Y.L. - People's Republic of China)
The present comparative study was performed to evaluate the effects of resuscitation with hypertonic sodium lactate dextran (HLD) 70 solution (HLD, Na+ 250 mmol/l, 6% dextran 70) and with lactated Ringer s (LR) solution on the volune OfIltlid illfused, Seruill Na+ and alburnin, crystalloid osmolarity, plasma lipid peroxide, and SOD activity. Twelve adult dogs were dividcd randomly into two equal groups. A 35% TBSA third-degree burn was created on the back. One hour post-burn the six animals in the HLD group received HLD (19.6 mI/kg/3 hours) intravenously in bolus injection, followed by LR solution (6 ml/kg/% TBSA). The six aninials in the LR group received only LR solution for resuscitation (8 ml/kg/% TBSA). Infusion of LR solution in both groups was adjusted by maintaining urinary output at 0.5-1 ml/kg/h. The volume of fluid infused in the HLD group (5.05 ± 1.11 ml/kg/% TBSA) was much les, than lhat ill the IR group (10.03 ± 1.30 ml/kg/% TBSA) (p<0.01). There was no significant difference between the two group serumNa+ andalburnin, and plasma crystalloid. Theplasmalevel of NIDA decreased after resuscitation with HI,I), which was nitich lowor (0.81 ± 0.20 mmol/g Hb) than that in the LIZ group (1.39 ± 0.44 inmol/g Hb) four hours post-burn (p<0.05). Plas nia Sol) activity (722) t 0.68 p/g Hb) in the HLD group was much higher than that in the LIZ group (4.86 ± 0.53 p/g Hb) four hours pos(-bnrn (1)<0.05), It is concill ded that HLD resuscitation could significantly reduce the required amount of fluid infused during resuscitation coinpared with LR ,olulion, and attenuate post-burn damage to tissue induced by lipid peroxide by elevating plasma SOD activity. Hypertonic solutions have been reported to restore systemic haemodynamics during resuscitation after circulatory shock more effectively and more rapidly than isotonic solutions. , , . In particular, hypertonic saline dextran (7.5% NaCI/6% dextran 70) (HSD) has been used as a rapid expander of intravascular volume in hypovolaemic shock` and burn injury, , although the improvement seems to be transient and the total fluid requirements and oedema formation remain unchanged in burns. There are however some controversial issues in HSD resuscitation .7 The volume of fluid infused in burn shock resuscitation varies. , In the present study, hypertonic sodium lactate dextran 70 (Na+ 250 mmol/1, 6% dextran 70) (HLD) was used in burn resuscitation. We compared the effects of HLD and lactated Ringer s (LR) solution on the volume of fluid infused, serum Na+ alburnin and crystalloid osmolarity. We also investigated the level of NIDA and SOD activity in plasma 24 hours post-burn. This presented lipid peroxidation indirectly, which plays an important role in the post-burn phase.
|
| 105 |
RESULTS OF COMPLETE REHABILITATION OF BURN PATIENTS
(Petrova M. - Bulgaria)
The results are presented of 10 years' experience in the treatment of 3500 patients with important All individual rella bilitation programme is prepared immediately after the admission of each patient. The patient performs daily baths and under water exercises, massage, and physiotherapy. Particular attention is paid to pressure garments, masks, and elastic bandages lewd illtion with applications of Dorcil.
|
| 107 |
BRULURES INDUSTRIELLES
(Escarduca Dias J.M. - Portugal)
L'auteur traite le sujet des br?lures industrielles, avec un int?r?t particulier pour le Portugal. Cette forme de l?sion a augment? ,i (~ause de la forte industrialisation des ann?es r?centes. Il d?crit son exp?rience avec environ mille patients atteints de br?lures chimiques Pi ovenant des industries transformatrices chimiques. L'auteur conclut en soulignant l'importance de la pr?vention et de l'?ducation pour surer la s?ret? au travail.
|
| 110 |
HISTORY OF THE PRAGUE BURN CENTRE
(KonigovA R.)
An interesting account is given of the development of burn care and plastic surgery in ex-Czechoslovakia. Much of the credit for the progress achieved is due to Francis Burian, who in 1938 won the first Chair of Plastic Surgery to be established at Charles University. He understood that mortality and morbidity were related to absence of asepsis and to non-use of grafting. Wartime experience led to his creation of a specialized bum unit, providing total, continual burn care in a separate building, not just in existing plastic surgery facilities. The staffing of the present-day Prague Burn Centre is described, along with current trends in treatment. The psychological aspect is also given its due importance.
|
|