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Biomedical subjects

H Carsin

Publications and source records attributed to H Carsin.

At least 37 records · Page 2Linked to original sources
PubMed1997

[Objectives, results and future prospects of burn treatment in 1997].

When burn injuries to the skin are extensive, delays in wound closure contribute to multiple organ failure because the availability of donor sites does not allow early and permanent coverage of excised wounds. From 1991 to 1996, 30 patients with a mean burn size of 78% total body surface area (65% full-thickness) underwent skin grafting with autologous cultured epidermis (AEC) performed in the labs of Genzyme Tissue Repair Company. Twenty three were adults and seven children under 15 (mean age 29, range 2.5 to 70); 27 suffered inhalation injury; 3 presented with multiple trauma and 2 with blast injury. As soon as possible wound beds were excised and temporarily covered with allografts or with sandwich or meshed autografts; the mean surface covered with autografts was 28 +/- 12%. Keratinocytes grafts were applied to a mean of 37 +/- 16.5%, an average of 210 grafts of 25 to 30 cm2. Three patients died respectively at day 67, 81 and 90. At time of gaze backing removal, the mean percentage of culture engraftment was 69% (range 25 to 95); this engraftment was higher for children (74%) and very bad above 60 (25%). The mean length of hospitalisation was 114 +/- 30 days. The definitive coverage by AEC was evaluated through the percentage of secondary autografted area: 10 +/- 9.5% (range 0 to 46). The average cost by patient was 98,500$ or 16$ by cm2 of culture. The weakness of epithelialisation makes essential a dermal support to the keratinocytes cultures, allodermis is now currently used, perhaps the new skin substitutes will give the ideal missing piece.

Adolescent↗
PubMed1997

[Inhalation burns: apropos of 198 cases. Incidence of laryngotracheal involvement].

Inhalation burns and laryngotracheal involvement were studied in a retrospective series of 635 patients hospitalized for skin burns at the Center for Burn Treatment from January 1993 to January 1997. Inhalation burns were observed in 31.1% of the cases. Exclusive laryngeal involvement occurred in 19.6% of the inhalation burns. Both tracheobronchial and laryngeal burns were observed in 27.2%. Patients with inhalation burns also had facial burns (90.9%) and extensive (> 50%) or severe (UBS > 200) skin burns in 39.8% and 29.7% of the cases respectively. Mortality of skin burns was increased six-fold to 19.1% in patients who also had inhalation burns. Intubation was used alone in 60.1% and was followed by tracheotomy in 27.2%. The decision for tracheotomy was essentially based on the probable duration of ventilatory assistance. Tracheotomy was required in case of severe inhalation burns and the predictable duration of intubation was over 8 days. Laryngotracheal stenosis occurring after inhalation burns is complex and extensive, with great variability over time. Laryngotracheal calibration is indicated as first intention therapy.

Burns, Inhalation↗
PubMed1996

[Nosocomial infections in a burns unit. Results of a prospective study over a year].

OBJECTIVES: To assess nosocomial infections in a burn care centre, to identify patients' infection risk factors at the time of admission and factors of monthly variations of infection incidence. STUDY DESIGN: Prospective survey, from October 1992 to September 1993. PATIENTS AND METHOD: The study included 140 patients staying for more than two days in a 22-bed burn unit. Nosocomial infection criteria were derived from the 1988 CDC criteria. Incidence rates of infection were calculated. Infected and noninfected patients were compared. Each monthly infection incidence was compared with six unit activity indicators. RESULTS: Fifty-six patients developed 132 infections. The overall incidence was 94%. Incidence density was 25 infections per 1,000 days of care. The distribution of infected sites was: skin (30%), intravascular catheters (25%), blood (22%), urinary tract (18%), respiratory tract (5%). The most frequent pathogens were Pseudomonas sp (49%), Staphylococcus sp (18%), Escherichia coli (18%), and Streptococcus faecalis (10%). They were characterized by a good antibiotic sensitivity. Each common burn severity index was predictive of nosocomial infections. Facial, perineal and respiratory lesions were also linked to infection. There was a positive correlation between the peak of nosocomial infections in the unit during a month and the peak of activity during the foregoing one. CONCLUSION: Incidence rates of infection were high, as 40% of the population was concerned. Choosing reliable infection criteria was the most difficult problem to solve.

Adult↗
PubMed1996

Clinical pharmacokinetics of piperacillin-tazobactam combination in patients with major burns and signs of infection.

The pathophysiology associated with major burns is complex and subject to a state of flux. The combination of beta-lactamase inhibitors with powerful penicillins is an interesting and an attractive potential solution to the emergence of bacterial resistance. The kinetics in serum and urine and the clinical safety of a fixed combination of 4 g of piperacillin (PPR) and 0.5 g of tazobactam (TZB) were studied in 10 patients (22 to 50 years old and weighing 45 to 105 kg) with major burns who were infected with Pseudomonas aeruginosa and various entero-bacteria. All of them received additional antimicrobial drugs. Treatment involved one dose every 6 h. The mean body surface area affected by third-degree burns was 30.0% +/- 4.0%. The study took place in accordance with current ethical guidelines. Two series of blood samples were drawn after the first (day 1) and ninth (day 3 at steady state) doses; urine was collected during the same periods. Levels of PPR and TZB in serum and urine were measured by high-pressure liquid chromatography. A noncompartmental method was used for kinetic and graphic analysis of concentration-time pairs. The safety of the treatment was excellent. There was no systemic accumulation of the beta-lactam combination. Residual concentrations measured on days 1 and 3 [mean (standard error of the mean)] were above the MIC for the organism responsible for infection; i.e., C(min)day1 = 26.3 (8.5) and C(min)day3 = 21.0 (9.1) for PPR and C(min)day1 = 1.9 (0.6) and C(min)day3 = 1.4 (0.3) for TZB. There was no statistically significant difference between pharmacokinetic parameters determined for day 1 and day 3. Evidence was found in burn patients, in contrast to healthy subjects, of a marked increase in apparent volumes of distribution, in such a way that the apparent elimination half-lives of the combination were notably prolonged, i.e., 1.8 (0.3) versus 1.5 (0.3) h for PPR in patients and healthy subjects, respectively, and 1.7 (0.3) versus 1.4 (0.3) h for TZB. These findings indicate the possibility of nonrenal translesional diffusion of PPR-TZB in burn patients. The polarity of the association would further support this hypothesis. It has been shown here that the recommended dosage regimen for administration of PPR-TZB must be high in major-burn patients, i.e., 4 g/0.5 g every 6 h. The data obtained provide valuable information, which is suitable for immediate application in everyday clinical practice.

Adult↗
PubMed1995

Clinical interest of cutaneous models reproduced in vitro for severe burn treatment: histopathological and ultrastructural study.

The healing of minimal skin lesions is usually obtained by epidermal migration and proliferation from peripheral wound margins. However, cutaneous grafts or reconstituted skin are necessary for severe injuries. Various models have recently been reproduced for this purpose. The aim of this work is to report the histopathologic evolution of burn lesions treated two years ago by autologous epidermis (Genzyme Tissue Repair, Boston, USA). Fifteen patients with severe burns (more than 80% of surface) have been treated. These observations have been based exclusively on biopsies of grafted wounds. Cultured epidermis is rapidly fully differentiated after grafting with temporary hyperplasia and normal strata. At 18 months, rete ridges formation is present only in young patients. Melanocytes and Langerhans' cells repopulated grafts rapidly. The use of cultured epidermis nowadays represents an important improvement in burn treatment.

Burns↗
PubMed1995

[Role of autografts of cultured epidermis in the treatment of deep burns of the face. Preliminary results].

Deep burns of the face raise the problem of skin cover after surgical detersion to limit the serious functional and aesthetic sequelae which they can induce. Autologous cultured epidermal grafts currently occupy an important place in the surgical treatment of the early phases of facial burns. The authors present their preliminary results of the use of this graft technique in patients with burns of more than 60% of the body surface, including the face. The surgical protocol is described, consisting of surgical detersion with benzoic acid, grafting and specific dressings. Three patients treated by this technique are then presented before concluding on the very interesting prospects of autologous culture epidermal grafts on a fibrin substrate. A clinical case of facial burns treated by this new type of graft is presented to conclude the discussion.

Burns↗
PubMed1995

[Multiple trauma and burns].

In peace time, burn injury combined with traumatic, chemical or radioactive casualties is rarely encountered and often unrecognized; during disasters, burn injury is unlikely the only trauma. The authors try to bring out the main pathophysiological, diagnostic and therapeutic characteristics of changes induced by combined lesions on burn injury and vice-versa.

Burns↗
PubMed1994

[Use of Diprivan in burn patients].

The use of propofol should be avoided in the first 48 hours after a burn injury, as a major haemodynamic instability characterizes this period. For excision and/or grafting, propofol is mainly used as an induction agent. Maintenance of anaesthesia requires higher doses, often in the range of 15 mg.kg-1.h-1, and varying with each patient and the stage of the burn. Propofol is most appropriate in anaesthesia for dressing changes, considering the repetition of the procedures, interfering least with enteral nutrition and the quality of recovery, considered as essential. Combined with alfentanil or fentanyl, the dose of propofol is titrated to obtain the desired effect, from a simple sedation with patient co-operation to total anaesthesia.

Anesthesia, Intravenous↗
PubMed1994

[Polytraumatized burnt patients].

In peace time, burn injury combined with traumatic, chemical or radioactive casualties, is rarely encountered and often unrecognised; during disasters, burn injury is unlikely the only trauma. The authors try to bring out the great physiopathologic, diagnostic and therapeutic principles of changes due to combined lesions on burn injury and vice-versa.

Burns↗
PubMed1993

High serum procalcitonin concentrations in patients with sepsis and infection.

High concentrations of calcitonin-like immunoreactivity have been found in the blood of patients with various extrathyroid diseases. By means of a monoclonal immunoradiometric assay for calcitonin precursors, we have measured serum concentrations of procalcitonin in patients with various bacterial and viral infections. 79 children (newborn to age 12 years) in hospital with suspected infections were investigated prospectively. 19 patients with severe bacterial infections had very high serum concentrations of procalcitonin at diagnosis (range 6-53 ng/mL) in comparison with 21 children found to have no signs of infection (baseline concentrations < 0.1 ng/mL). Serum procalcitonin values decreased rapidly during antibiotic therapy. 11 patients with peripheral bacterial colonisation or local infections without invasive sepsis and 18 (86%) of 21 patients with viral infections had concentrations within or slightly above the normal range (0.1-1.5 ng/mL). Among 9 severely burned patients studied in an intensive care unit, the post-traumatic course of procalcitonin concentrations (range 0.1-120 ng/mL) was closely related to infectious complications and acute septic episodes. Concentrations of mature calcitonin were normal in all subjects, whatever procalcitonin concentrations were found. Concentrations of a substance immunologically identical to procalcitonin are raised during septic conditions. Serum concentrations seem to be correlated with the severity of microbial invasion.

Bacterial Infections↗
PubMed1992

Bronchopulmonary distress associated with toxic epidermal necrolysis.

We describe here a patient with severe TEN and respiratory distress and we review the subject of bronchopulmonary symptoms in TEN. Even if pseudostratified ciliated involvement is uncommon, bronchial lesions in the absence of other known causes, should be specifically related to TEN. The mechanisms of pulmonary involvement and ARDS associated with TEN are discussed.

Bronchial Diseases↗
PubMed1990

[Fatal Lyell's syndrome caused by griseofulvin].

A case of toxic epidermolysis (TE) with a fatal outcome is reported. It occurred after administration of 500 mg griseofulvin twice daily in a 19-year-old female patient. She developed the first skin lesions on the sixth day of treatment. All the body surface was involved, except for the scalp. Several complications arose in the course of the disease, thrombocytopaenia, lymphocytopaenia, rhabdomyolysis, and non cardiogenic pulmonary oedema. Death occurred as a result of multiple organ failure following septic shock associated with adult respiratory distress syndrome. The pathogenesis of these complications and the major therapeutic difficulties encountered are discussed. The involvement of griseofulvin in TE has only been reported once before. The arguments in favour of its involvement in the present case are discussed.

Adult↗
PubMed1989

[Burns and pregnancy. A case of severe burn occurring at the beginning of pregnancy. Maternal and fetal survival].

The authors report a case of a severe thermal burn (70% of the surface of the body) in a pregnant woman who had 15 weeks amenorrhoea. The survival of the mother and the continuation of the pregnancy to term allowed a normal live baby to be born. As far as the authors know this is the fourth case history of a severe (more than 60% of the body) burn published occurring in the first trimester of pregnancy and carried through successfully to term. A study of the literature has shown that the physiopathological results of severe burns do explain the usually poor prognosis for mother and fetus. Large quantities of prostaglandins are released into the circulation of the mother because of the thermal insult to tissues and because of the infection that usually accompanies such burns. These prostaglandins can stimulate the myometrium, which gives rise to fatal obstetric complications. The urgent acute treatment for a severe burn in a pregnant woman, which should preferably be carried out in a special centre, consists in water and electrolyte resuscitation, assisted respiration and prevention of bacterial contamination. These measures are just as important for the fetus. At the same time obstetric care should be started. Good collaboration between the obstetricians and those who carry out the resuscitation all bring about the measures that are needed to allow the mother and fetus to survive.

Adult↗