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Volume IX |
Number 4 |
December 1996 |
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SUMMARIES
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PSEUDOMONAS FOLLICULITIS ACQUIRED FROM HOT TUBS AND WHIRLPOOLS: AN OVERVIEW
(Baruchin AN., Shapira A., Scharf S., Rosenberg L. - Israel)
Pseudomonas aeruginosa folliculitis occurs in persons who bathe in contaminated water. Most cases are associated with recreational and therapeutic activity involving the use of public hot baths, whirlpools, swimming-pools or saunas. The rash consists of erythernato-papulopustular lesions on the trunk and extremities. The eruptions usually resolve spontaneously within a week or little more. Awareness of this condition and its benign course is essential to diagnosis and treatment in order to avoid unnecessary diagnostic testing and therapeutic measures.
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| 206 |
HAEMATOLOGICAL CHANG IN SEVERELY BURNED PATIENTS
(EI-Sonbaty M.A., EI-0tiefy M.A. - Egypt)
A prospective study was undertaken to determine the haematological changes occurring in severely burned patients. The study included 30 patients (18 females and 12 males), all with flame burns (range, 30/65% TBSA). Daily estimation of routine haematological laboratory values was carried out. The individual mean of each of these values in patients who survived (21 patients) was statistically compared with that of patients who died (9 patients). It was found that laboratory manifestations of anaemia were evidenced six days postburn and two days earlier in the non-survivors. Leucocytosis was manifested soon after the bum and was steady in the survivors. The platelet count showed decreased levels in both groups, with significantly increased levels in the survivors by the end of the first week.
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| 216 |
EXPRESSION OF FUNCTIONAL INTERLEUKIN 2 RECEPTOR IN POST-BURN HYPERTROPHIC SCARS
(Castagnoli C, Trombotto C., Stella M., Magliacani G., Teich Alasia S. - Italy)
Immunoperoxidase staining of skin sections obtained from 14 hypertrophic scars, 8 normotrophic scars and 6 samples of normal skin was performed using monoclonal antibodies (MoAbs) against p55 and p75 chains of the interleukin 2 receptor (IL-2R), An anomalous expression of keratinocytes of IL-2 high affinity receptors was clearly detected in all tested hypertrophic scar specimens. Human leukocyte antigen class 11 (HLA-DR) and intercellular adhesion molecule type I (ICAM-1) were ectopically expressed on the same cells. In contrast, CD36 antigen was detected only in the stratum granulosum of epithelium and was absent in the basal layers of the epidermis. A correlation was found between IL-2R, ICAM-1 and HLA-DR molecule expression and the presence of abundant infiltrates of activated T lymphocytes and macrophages, suggesting that this anomalous distribution was induced by cytokines produced by infiltrating cells. In the dermis of hypertrophic scar samples a positive staining with anti-IL-2R p55 (a chain) and p75 (P chain), ICAM-1, and HLADR MoAbs was detected on fibroblasts and endothelia. The production of IL-2R has not been previously reported for keratinocytes and fibroblasts. These results emphasize the role played by immune mechanisms in hypertrophic scarring and suggest the involvement of cellmediated immune phenomena.
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| 222 |
FACTORS AFFECTING RESULTS IN THERMAL HAND BURNS
(Gokalan L, Ozgor F., Gursu G., Kecik A. - Turkey, Ankara)
One hundred and seven burned hand deformities reconstructed since 1978 in the clinic of Hacettepe University Department of Plastic and Reconstructive Surgery (Ankara, Turkey) were analysed retrospectively and the results evaluated statistically in relation to various factors (patient's age at time of burn, cause of burn, place of early therapy, degree of deformity, time of reconstruction, and methods of reconstruction). In the group of mild hand bum deforn-dties (95), 18 hands were reconstructed with Z-plasties, 65 with Z-plasties and skin grafts, and 12 with skin grafts. In the group of severe hand burn deformities (12), five hands were reconstructed with abdominal and groin flaps, four with forearm flaps, and three with distant flap transfers. The results obtained after ~he reconstruction of scald burns, domestic accidents, and bums during childhood showed a better range of motion. Early reconstruction, without any delay pending scar maturation, was also found to give better results, with greater improvement in range of motion. Hand deformities as a result of industrial accidents such as chemical burns could not be satisfactorily reconstructed as these were difficult cases with deep injuries in the hand's functional units.
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| 229 |
WHICH PERSONALITY SHOULD LEAD THE BURN TEAM?
(Bucek S, Hruba J, Svobodova K, Blaha J, Singerova H. - Czech Republic)
This paper seeks the answer to a question often discussed in medical literature: "Which personality should lead a burn care team?" Attention is drawn to the fact that the personal, professional and social qualities of the applicants for the post of Head of a bum care team should not only be subjected to very detailed examination during the oral competition tests (which may be influenced by pressure groups) but also be objectively evaluated by computerized scoring of the applicants' personality. The target is to find the optimum Head of the burn care team (i.e. a medical personality in the best sense of the word, compatible in his discipline at world level). The Head of the burn care team must be able to accept and also creatively develop all aspects of modern medical science, university teaching and scientific activity at the end of the 20th and the beginning of the 21st century.
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| 232 |
BEHAVIOUR DURING A MASS INDUSTRIAL BURN DISASTER
(Hadjiiski O. - Bulgaria)
A severe industrial accident is described in which a tank containing 2000 m' of hot water (90 'C) exploded, causing a wave 4-5 m high to cascade over 25 workers. All suffered tbird-degree burns (30-100% total body surface area [TBSA]) and steam inhalation. Six persons, with 100% TBSA burns, steam inhalation and multiple traumatic injuries, died immediately. The others were transferred first to a small regional hospital and some hours later to the nearest district hospital, where three patients with 100% TBSA burns and steam inhalation died within three days. Six hours post-bum four patients were transported 100 km by helicopter to a small burn care unit, where two with minor burns survived and two with 50% TBSA burns died respectively on days 3 and 7 post-bum. Between 7 and 10 hours postburn the remaining twelve patients (one with 30% TBSA burns and eleven with 70-100% TBSA burns) were transferred by air 200 km to the largest burn care centre in Bulgaria. Of this group of twelve patients, the eleven with over 70% TBSA burns died between days 1 and 19 post-burn (total number of days of hospitalization, 8 1), while the patient with only 30% TBSA burns survived. A description is given of fluid resuscitation during burn shock, local and surgical treatment, and the medical supplies used. Despite the poor prognosis of such patients, the importance is emphasized of the necessity of treating them in specialized burns centres.
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| 235 |
PROBLEMS OF EMERGENCY MEDICAL CARE AT THE TIME OF THE GREAT HANSHIN-AWAJI EARTHQUAKE
(Ukai T. - Japan)
The distinguishing characteristic of the Great Hanshin-Awaji earthquake which hit Kobe and its vicinity in the early morning of 17 January 1995 was that the tremor directly affected a highly urbanized city and revealed the fragility of human life in a sophisticated modem metropolis. The scope of the damage included damage to medical facilities. The difficulties encountered in the early relief activities are also reported.
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| 240 |
EVALUATION OF DISASTER MEDICAL RESPONSE: A PROPOSAL FOR A RESEARCH TEMPLATE
(Gunn S.W.A., Masellis M. - Italy)
The three main objectives of medical response to a disaster are to mitigate mortality and morbidity, restore the health status to pre-disaster levels, and establish a recovery process that will promote health and a preparedness level to even beyond the pre-disaster condition. ln order to achieve these objectives, a template or standardized protocol is proposed which could be used by all disaster workers in a harmonized manner for the design, conduct, assessment and reporting of medical action in disasters. The template is a staged 13-step ladder, starting from an assessment of the pre-disaster situation and progressing through various levels to the final steps of evaluating the findings and making recommendations for future responses. The template, modelled on the Utstein Style, is based on criteria used in the social sciences, epidemiological studies, managerial decision trees, and medical and public health assessment methodologies.
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