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Patients with epilepsy: a high-risk population prone to severe burns as a consequence of seizures while showering.

We document the severe burns sustained by three patients with epilepsy who suffered seizures while showering. On the basis of the circumstances of these accidents, we suggest preventative measures to help other patients with epilepsy avoid similar burn injuries. Patient data collected from January 1987 to May 2004 by the Burn Unit of the Department of Plastic Surgery, University of Aachen, Germany, were reviewed. Three patients with epileptic disorders were found who suffered severe burn injuries caused by seizures that occurred while showering. Scald location and depth was assessed. Three patients (two women, one man) sustained extensive scald injuries after epileptic seizures while showering. Burn extent ranged from 20% to 35% TBSA. Scalds primarily affected the trunk, legs, arms, and buttocks. Two of the three patients used showers with levers for controlling water temperature. Safety devices for limiting water temperature were absent. All patients used shower cubicles. Patients with epilepsy may sustain serious burns, typically affecting the trunk, legs, arms, and buttocks, when a seizure occurs while showering. We suggest that individuals with epilepsy use showers designed with pirouetting taps, rather than levers, to regulate water temperature. Pirouetting taps are less likely to be shifted out of position during a seizure. We also recommend that epileptic patients have safety devices installed in their water heaters that limit maximum water temperature. Such safety devices prevent scald injury. And, finally, we suggest that people with comparable disorders generally avoid using shower cubicles. Instead, showers with curtains should be used, which may allow occupants to escape from dangerously hot shower water more easily.

Accident Prevention↗

Deep dermal burn injury results in scarless wound healing in the ovine fetus.

Early to mid-term fetuses heal cutaneous incisional wounds without scars; however, fetal response to burn injury has not been ascertained. We present a fetal model of thermal injury and subsequent analysis of fetal and lamb response to burn injury. A reproducible deep dermal burn injury was created in the fetus by application of water at 66 degrees C for 7 seconds, and at 82 degrees C for 10 seconds to the lamb. Macroscopically, the area of fetal scald was undetectable from day 7 post injury, while all lamb scalds were readily identified and eventually healed with scarring. Using a five-point histopathology scoring system for alteration in tissue morphology, differences were detected between control and scalded skin at all stages in lamb postburn, but no difference was detected in the fetal model after day 7. There were also large differences in content of alpha-smooth muscle actin and transforming growth factor-beta1 between control and scalded lamb and these differences were statistically significant at day 14 (P < 0.01). This novel model of fetal and lamb response to deep dermal injury indicates that the fetus heals a deep burn injury in a scarless fashion. Further elucidation of this specific fetal process of burn injury repair may lead to improved outcome for patients with burn injury.

Actins↗

Anabolic action of insulin on skin wound protein is augmented by exogenous amino acids.

To investigate the metabolic basis of skin wound healing, we measured in anesthetized rabbits the responses of protein kinetics in scalded skin to insulin and amino acids. L-[ring-(13)C(6)]Phe was infused on the 7th day after the ear was scalded, and the scalded ear was used as an arteriovenous unit to reflect protein kinetics in skin wound. The ipsilateral carotid artery was clamped to control the wound blood flow within four- to fivefold the normal skin rate to measure the enrichment difference in the scalded ear during hyperaminoacidemia. Neither insulin (2.5 mU x kg(-1) x min(-1)) nor amino acid (2.5 mg x kg(-1) x min(-1)) infusion alone improved net protein balance in the skin wound. In contrast, combined infusion of insulin and amino acids increased the net protein balance in skin wound from -6.5 +/- 4.5 to 1.4 +/- 5.2 micromol x 100 g(-1) x h(-1) (P < 0.01, control vs. insulin plus amino acids). We conclude that there is an interactive effect of insulin and sufficient amino acid supply on protein metabolism in skin wound, meaning that their combined anabolic effect is greater than the sum of their individual effects.

Amino Acids↗

Effects of hypertonic saline and dextran 70 resuscitation on microvascular permeability after burn.

Administration of hyperosmolar fluids to burn patients has been proposed as a means of decreasing resuscitative fluid volume and, subsequently, wound edema accumulation. To test this hypothesis, canine hindpaw lymph flow (QL) and lymph (CL) and plasma (CP) total protein concentrations were measured, and capillary filtration coefficient (Kf) was calculated before and for 6 h after a 5-s 100 degrees C footpaw scald. Scald was followed 30 min later by bolus infusion (4 ml/kg) of 7% saline or 6% Dextran 70 or the two in combination. Before scald, venous pressure was elevated until a minimal CL/CP was reached. The reflection coefficient (sigma d) was calculated by the formula: 1-minimal CL/CP. Scald increased QL, CL/CP, and Kf, but sigma d was decreased (P less than 0.05). Compared with burn alone, 7% saline exacerbated burn-induced increases in QL and Kf. In contrast, infusion of Dextran 70 did not exacerbate these changes in QL or Kf. Perhaps more importantly, Dextran 70 may have attenuated the increase in CL/CP and reduced edema formation in the burned hindpaw. However, the addition of 7% saline to the dextran eliminated these beneficial effects.

Animals↗

Plasma cell-free DNA as an indicator of severity of injury in burn patients.

BACKGROUND: Raised levels of plasma cell-free DNA have been detected in various patient groups, including trauma patients. We hypothesized that plasma DNA is increased in burn patients and may represent an objective indicator of burn severity and have predictive as well as prognostic significance. METHODS: This was a prospective clinical study with full ethical approval. With informed consent, blood samples were collected from 28 burn patients within 24 h of injury and from 12 control subjects. Plasma cell-free DNA was measured by real-time quantitative polymerase chain reaction (PCR) assay for the beta-globin gene. Descriptive analysis, non-parametric data comparison tests (Mann-Whitney) and correlation tests (Spearman rank) were performed on the data. RESULTS: Samples were taken at a mean time of 5.7 h after injury from 13 patients with flame/flash burns and 15 patients with scalds. Median plasma DNA levels in the control, scald and flame/flash burn patient groups were 287, 648 and 2685 kilogenome-equivalents/L, respectively. Plasma DNA levels correlated with the length of hospital stay, but not with admission to the intensive care unit (ICU) nor the length of ICU stay. DNA levels correlated with the burn surface area (Spearman rank r = 0.54, p = 0.04) and the number of operations needed (Spearman rank r = 0.55, p = 0.03) for scalds, but not for flame/flash burns. CONCLUSIONS: Plasma DNA is increased after burn injury and is significantly correlated with some outcome measures, including the length of hospital stay. DNA levels are higher in flame/flash patients than in scald patients; the difference may provide an objective indication of burn depth and inhalation injury.

Body Surface Area↗

Coliform, Escherichia coli, and salmonellae concentrations in a multiple-tank, counterflow poultry scalder.

Scald water samples from a commercial broiler processing plant were tested for coliforms, Escherichia coli, and salmonellae to evaluate the numbers of suspended bacteria in a multiple-tank, counterflow scalder. Water samples were taken from each of three tanks on 8 different days after 6-week-old broilers had been processed for 8 h. Coliforms and E. coli were counted using Petrifilm, and the most probable number (MPN) of salmonellae was determined both in water samples and in rinses of defeathered carcasses that were removed from the processing line immediately after taking the water samples. Mean coliform concentrations in tanks 1, 2, and 3 (the last tank that carcasses pass through before being defeathered) were 3.4, 2.0, and 1.2 log10(CFU/ml), respectively. E. coli concentrations followed the same pattern with means of 3.2, 1.5, and 0.8 in tanks 1, 2, and 3, respectively, with significant differences (P < 0.02) in the concentrations of both coliforms and E. coli between the tanks. Sixteen of 24 scald-water samples were positive for salmonellae with a geometric mean of 10.9 MPN/100 ml in the positive samples. Salmonellae were isolated from seven of eight water samples from both tanks 1 and 2, but in only two of eight water samples from tank 3, the last tank that carcasses pass through. It appears that most bacteria removed from carcasses during scalding are washed off during the early part of scalding.

Animals↗

Hot water and organic acid interventions to control microbiological contamination on hog carcasses during processing.

Pork skin and muscle tissue were washed with water at temperatures from 25 to 80 degrees C. Water temperatures of 65 and 80 degrees C resulted in greater population reductions of Enterobacteriaceae on pork muscle tissue than lower water temperatures. There was no observable effect of water temperature on population reductions of Enterobacteriaceae on pork skin. Water temperatures of 55, 65, and 80 degrees C reduced the populations of Enterobacteriaceae on inoculated scalded carcasses processed in a university abattoir by 1 to 1.5 log/cm2. Following the water wash with an organic acid rinse resulted in further numerical reductions in populations, although these were not statistically different from the water wash alone. The jowls of both scalded and skinned carcasses processed in a commercial establishment were directly inoculated with a fecal material slurry and then processed with organic acid rinsing only, hot water washing only, or a combination of hot water washing followed by organic acid rinsing. The hot water and acid treatment reduced the populations of mesophilic aerobic bacteria and Escherichia coli by approximately 2 log cycles on both scalded and skinned hog carcasses. The combined treatment resulted in 60% of the scalded carcasses and 40% of the skinned carcasses with undetectable levels of E. coli after direct fecal inoculation of the carcasses. Hot water washing followed by organic acid rinsing can significantly improve the microbiological quality of pork carcasses.

Acids↗

Application of distilled white vinegar in the cloaca to counter the increase in Campylobacter numbers on broiler skin during feather removal.

Because of the escape of highly contaminated gut contents from the cloaca of positive carcasses, Campylobacter numbers recovered from broiler carcass skin samples increase during automated feather removal. Vinegar is known to have antimicrobial action. The objective of this study was to determine the effect of vinegar placed in the cloaca prior to feather removal on the numbers of Campylobacter recovered from broiler breast skin. Broilers were stunned, killed, and bled in a pilot processing plant. Vinegar was placed in the colons of the chickens prior to scalding. Carcasses were scalded, and Campylobacter numbers were determined on breast skin before and after passage through a commercial-style feather-picking machine. Campylobacter numbers recovered from the breast skin of untreated control carcasses increased during feather removal from 1.3 log CFU per sample prior to defeathering to 4.2 log afterward. Placement of water in the colon before scalding had no effect on Campylobacter numbers. Campylobacter numbers recovered from the breast skin of carcasses treated with vinegar also increased during defeathering but to a significantly lesser extent. Treated carcasses experienced only a 1-log increase from 1.6 log CFU per sample before feather removal to 2.6 log CFU per sample afterward. Application of an effective food-grade antimicrobial in the colon prior to scald can limit the increase in Campylobacter contamination of broiler carcasses during defeathering.

Acetic Acid↗

[The clinical and experimental study on postburn metabolic characteristics of zinc and its influence on copper, iron and calcium].

OBJECTIVE: To observe postburn metabolic characteristics of zinc and its influence on copper, iron, calcium. METHODS: (1) To analyze the levels of Zn, Cu, Fe, Ca in the serum and urine of burn patient on different postburn days. (2) To replicate a rat model of zinc deficiency and to observe the symptoms and the effects of zinc supplementation in different dosage after scalding in rats with zinc deficiency. (3) To assay the levels of Zn, Cu, Fe, Ca in rat wound tissues following supplementation of zinc in diet and to wounds in rats after scald. RESULTS: (1) The levels of serum Zn and Cu decreased markedly on 1 similar 3 days in major burn patients, whereas the urine Zn and Cu increased obviously, reaching the peak value on the 14th day. The serum and urine Fe increased rapidly on PBD2 and then descended steeply. The serum and urine Ca kept lower levels all along. (2) In zinc deficient rats growth retardation appeared first and other symptoms emerged subsequently. Serum Zn decreased and serum Cu, Fe, Ca increased. (3) The levels of Zn, Cu, Fe, Ca in wound tissue of scalded rats showed a continuous postburn increase. The Ca contents in wound tissue increased about 50 -- fold. Zn content in wound was more obviously increased than Cu, Fe and Ca when Zn was supplemented through wound compared with that with diet supplementation. CONCLUSION: Serum Zn level was lowered after scald and it could be elevated after supplementing zinc by diet or through wound, Changes in serum Cu, Fe, Ca occurred corresponding to the change in serum Zn.

Animals↗

[Vitamin biosynthesis by germinating seeds at low temperature and in overmoistened soil].

The distribution of farnesene and farnesene hydroperoxide in apples of different varieties was studied. The relationship between the content of these compounds and the pathological browning of the apple surface, scald was followed. It was shown that 1) farnesene and farnesene hydroperoxide were concentrated in the cuticle; 2) there was no distinct correlation between farnesene concentration and scald, 3) there was a direct correlation between the concentration of farnese hydroperoxide and scald development; 4) the factors that inhibited farnesene oxidation (antioxidants, low oxygen concentration, mineral oils--farnesene absorbers) slowed down the scald development during apple storage.

Biotin↗

[The influence of L-arginine on the angiogenesis in burn wounds in diabetic rats].

OBJECTIVE: To investigate the possible mechanism of L-arginine supplementation on the angiogenesis of burn wounds in diabetic rats. METHODS: One hundred male Sprague-Dawley (SD) rats were used in the study and were randomly divided into A (scalding control, n = 25), B (scalding of the rats with diabetes, n = 25), C (L-glycine control, n = 25) and D (L-arginine supplementation, n = 25) groups. Diabetes was produced by intra-peritoneal injection of streptozotocin (STZ) in B, C and D groups. The rats in C and D groups were gavaged with L-glycine and L-arginine in dose of 200 mg.kg(-1).d(-1), respectively. The glucose content of the back skin tissue was determined for five rats in each group eight weeks after STZ administration. Deep partial thickness scalding of 20% TBSA was engendered on the back in the other 80 rats. The wound area, wound healing rate, and microvascular density with CD34 immunohistochemistry staining were determined on 3rd, 7th, 14th, and 21st post scalding days (PSDs), In addition, the amount of nitric oxide (NO) released from the wound tissue and the tissue contents of vascular endothelial growth factor (VEGF) and transforming growth factor beta1 (TGF-beta1) from wound were determined at the above time points. RESULTS: Compared to those in group B, the wound healing rate in group D increased significantly since the 7th PSD [(44.10 +/- 3.50)%, P < 0.05], and the wound MVD value was increased significantly at all postburn time points. Furthermore, the levels of VEGF, NO and TGF-beta1 in the wound tissue was also increased significantly, while the glucose content in the cutaneous tissue was decreased to (1.380 +/- 0.120) mg/g. CONCLUSION: L-arginine supplementation could be beneficial to the angiogenesis in the burn wound of the rats with diabetes, as well as to wound healing by increasing the synthesis and the release of VEGF, NO and TGF-beta1 from burn wound and by decreasing the glucose content in the cutaneous tissue of diabetic rats.

Animals↗

[An assessment of patients hospitalized for burn injuries].

To study the causes of burn injuries and the nature of their medical treatment, we investigated the medical histories of hospitalized patients admitted to the burn center of Taipei City Ho-Ping Hospital from June 6, 1983 to June 6, 1987. Additionally, a phone interview follow-up on recovery conditions was made. Among the 300 patients admitted, the majority (53.7%) were burned by scalding water, while fire was the second most common cause of burns. The rate of incidence was highest for those aged 0-4 years, and 90% of this age group were victims of scalding. For all age groups, 78.9% of the burns resulted from negligence, with most accidents occurring in a kitchen, factory or workplace, or a bathroom. Men's burns were more severe than women's burns on average. Severe fire burns constituted half of the cases. The majority of the burns affected the front of the limbs, torso, head and neck. The degree of the burns was mixed, but second degree burns were most prominent (36%). Sixty percent of the patients were burned over less than 10% of their body surface. Seasonality was not evident, but most cases occurred between noon and eight o'clock in the evening. Patients with electric burns had the longest hospital stays, averaging 30.5 days, while those burned by scalding had the shortest (16 days). Those with severe burns average 26.5 days. Half (50.7%) of the patients recovered by the time they left the hospital. Examining the death rate by type of burn, we found that the death rate for chemical burns was the highest (10.34%), while the rate was lowest for scalding.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

Stress-induced regulation of glucocorticoid receptor gene expression in the rat.

To investigate the mechanism of the changes in glucocorticoid receptor (GR) under various stress conditions, experiments were carried out on normal and partial adrenalectomized rats by utilizing radioligand binding assay and molecular hybridization. It was found that hepatic GR binding capacity and GR mRNA in intact rats decreased significantly after the scalding stress, but the changes in GR binding capacity is mainly owing to the decrease in GR mRNA levels, and other mechanisms at protein level are also involved. In partial adrenalectomized rats, hepatic GR binding capacity and GR mRNA were increased instead of decreased, whereas serum corticosterone did not rise in response to the scalding stress. Therefore, it may be concluded that the decrease in GR binding capacity and GR mRNA in intact rats after the scalding stress is mainly the result of the increased concentration of serum corticosterone. Our further studies did demonstrate that there exists downregulation of GR mRNA in rats by exogenous administration of hydrocortisone. It is also suggested that there might be factors that can upregulate GR and GR mRNA in intact rats after the scalding stress.

Adrenal Glands↗

Accidents, poisoning and violence as a cause of hospital admissions in children.

A study has been carried out to assess the pattern of child admissions to Tayside Hospitals as a result of accidents, poisoning and violence (hereafter referred to simply as 'accidents') during 1989, and to determine if any major changes have taken place since 1980. The length of stay resulting from each class of accident was used as an approximate indicator of severity and the consumption of Health Service resources. In 1989, 1,388 of Tayside's 70,609 children were admitted to hospital as a result of accidents. With a total of 4,140 days spent in hospital, an average of 11.3 beds are constantly occupied by child accident victims (not including the long-term disabled). Falls resulted in the largest number of admissions to hospital, with poisoning, and having been accidentally struck by persons or objects, in second and third place. Analysis of bed usage, however, revealed a different pattern. While falls remained the biggest consumer of bed days, these were now followed by motor vehicle traffic accidents (MVTAs) and scalds. The average length of stay for MVTAs and scalds was 9.1 and 9.0 days respectively compared with an average of 2.8 days for all types of accident. Poisoning and scalds showed a remarkable age dependence with 81% of children admitted for poisoning or suspected poisoning being in the 1-3 year age group, and 63% admitted for scalds under the age of two.

Accidental Falls↗

Interleukin-1 in vivo modulates trauma-induced immunosuppression.

To elucidate the mechanisms underlying trauma-induced immunosuppression and decreased IL-2 production we evaluated: 1) the effect of trauma on IL-1 production at different time intervals and 2) the effect of IL-1 in vivo administration on immune functions (IL-1 production, IL2 production, NK cell cytotoxicity) in normal and traumatized mice. Experiments were performed on CBA/H mice a) subjected to scald injury (sacrificed 3 h and 6 h later) b) treated with IL-1 in vivo (human recombinant IL-1 beta 100 ng/mouse, sacrificed 21 h and 24 h later) and c) subjected to both IL-1 in vivo treatment and scald (IL-1 was given 18 h before scald, animals were sacrificed 3 h and 6 h after scald i.e. 21 h and 24 h after IL-1 administration). Our results demonstrate that trauma alone increases IL-1 production from 1 h to 24 h after trauma infliction. Recombinant IL-1 given in vivo also induces a significant rise in IL-1 production. When mice were subjected to both trauma and IL-1 in vivo treatment, the rise in IL-1 production was not additive. Trauma induced severe depression of IL-2 production which could not be overcome by in vitro addition of IL-1 to IL-2 producing splenocytes from traumatized mice. In contrast, IL-1 administered in vivo stimulated IL-2 production in normal mice, and when given prior to trauma infliction, it completely abrogated trauma-induced suppression of IL-2 production. The same effect was seen on NK cell cytotoxicity (an IL-2 dependent function).(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

[The relationship between opportune administration of antibiotics and infection after burn injury: an experimental study].

45 male rabbits with 15% III degree burn were infected with Pseudomonas aeruginosa. They were divided into three groups: the prevention group, in which cpz (cefoperazone) was immediately administered after the scald at the dose of 25 mg/kg with an interval of 1/12 h for a total of 4 doses; the treatment group, in which cpz was administered 48 th after the scald with the dosage same as above; control group in which cpz was not administered. The findings were as follows: In the prevention group, gross observation showed dessication and crustation of the surface of the wound within 1 week after the scald. By employing immunofluorescent antibody it was found that P. A existed only in the superficial layer. However, ulceration and exudation were found in the control and treatment group within 3 or 4 days after the scald, and P. A was shown to have invaded the deep muscular tissue to cause intermuscular septal abscess. The positive rate of blood culture of bacteria in the prevention group (10/81) was significantly lower than that of the treatment (15/57) and the control groups (21/76, P < 0.05). The death rate of the prevention group (2/15) was significantly lower than that of the treatment (10/15) and the control groups (9/15, P < 0.05). The above finding showed that antibiotics specific to the infectious organism of the wound in extensive burn patients should be given in the early exudation stage in order to ward off invasive infection.

Animals↗

[Effects of processing on special toxicity and pharmacodynamics in semen Armeniacae amarum].

The ethereal extract and decoction from raw Semen Armeniacae Amarum were found to induce EBV-EA activation in Raji cells cultured in vitro. Experiments show that both the extract and decoction have tumor-promoting activities, but the EBV-EA activation can be decreased by three kinds of processing-parching, scalding or parching after scalding, of which parching and parching after scalding are better. Moreover, parching after scalding is the best to enhance the relaxing of bowels, inactivate the amygdalase and increase the decoction rate of amygdalin.

Amygdalin↗

Modifying the environment: a community-based injury-reduction program for elderly residents.

The Department of Public Health, City and County of San Francisco, established the Community and Home Injury Prevention Program for Seniors (CHIPPS) to reduce the rate of unintentional injuries among elderly residents. Through a collaboration between the CHIPPS program, the University of California at Berkeley School of Public Health and the University of California at San Francisco School of Medicine, we tested the hypothesis that providing minor home safety modifications would reduce rates of falls, scalds, and burns. A one-group, pretest-posttest design was used to compare self-reported falls, scalds, and burns for six-month periods before and after the intervention. The intervention used 10 person-hours of unskilled labor and $93 worth of materials on average and included home safety assessments and modifications such as removing clutter; installing hand rails, grab bars, nonskid strips; and securing rugs and electrical cords. Reported falls were reduced by 60% after the intervention, from 0.81 to 0.33 falls per person year (p < .01). Scalds were reduced from 9 to 0 (P < .01) and burns from 7 to 0 (P < .02) during the six-month periods before and after the intervention. Some of the apparent effect may be due to differential reporting. This community-based program to reduce hazards in the home environments of senior citizens was feasible, well accepted, and probably effective in preventing falls, burns, and scalds. Medical Subject Headings (MeSH): accidental falls/prevention and control, aged, safety.

Accident Prevention↗