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PubMed1988

The toxic shock syndrome in a burn victim.

A case of toxic shock syndrome (TSS) in a 6-year-old boy with a 5 per cent body surface area partial thickness scald burn is reported. Biobrane was the wound dressing used initially. The clinical and laboratory characteristics of the syndrome are listed. The syndrome is caused by an exotoxin of Staph. aureus and can occur in the absence of invasive infection. The syndrome, first described in menstruating women who used tampons, has occurred in patients with a variety of wounds. Reports of the TSS syndrome in burn victims are limited to children whose wounds were covered. Children are most vulnerable to the development of TSS because of their limited prior exposure to the toxin.

Biocompatible Materials↗
PubMed1989

Burn injuries in the Jeddah area of Saudi Arabia: a study of 319 cases.

Three hundred and nineteen patients with different types of burns were studied at King Fahd Hospital, Jeddah, Saudi Arabia over a 2-year period (December, 1985 to December, 1987). Scalding was the most common cause (56.4 per cent) of burn injuries compared with 41.4 per cent of patients who sustained flame injury; 84.6 per cent of the thermal injuries occurred at home, with children (less than or equal to 18 years of age) being affected most frequently (61.8 per cent). The overall mortality was 9.4 per cent.

Adolescent↗
PubMed1989

Blood volume changes of the anaesthetized rat to a large burn or mock burn injury measured using a continuous measuring circuit.

A scald burn injury of 40-60 per cent body surface area was applied to the sodium pentobarbitone anaesthetized rat. The cardiac output of the burn injury rats fell from 39.5 +/- 2.1 to 27.7 +/- 1.5 ml/min (P less than 0.001) while heart rate, mean arterial blood pressure and central venous pressures were little changed but the total peripheral resistance rose significantly. Cardiovascular function was unchanged in control, mock-burned rats. The blood volume was measured continuously using an extracorporeal circuit and was observed to fall significantly by 0.78 +/- 0.36 ml in 5 min (P less than 0.05) and 1.65 +/- 0.38 ml in 60 min (P less than 0.001) after burn injury. The falls in blood volume and cardiac output were virtually simultaneous, and had occurred by 5 min. It is proposed however that this fall in blood volume is not sufficient to cause the observed changes in cardiac output and that additional factors such as cardiac impairment may be responsible for these changes postburn.

Animals↗
PubMed1989

The aetiology of burns in developed countries: review of the literature.

This article reviews the literature on the incidence and aetiology of burn injuries. Burn injuries are among the most serious injuries man can incur. Although prevention of burn injuries has been given a good deal of attention in the past, it has never been subjected to a systematic approach which could result in a thorough knowledge of the incidence and the major risk factors and risk groups. The methodological limitations of the studies carried out in this field are striking. For instance, none of the studies of risk factors has used a control population for comparison. No figures are available on the total number of burn injury patients in the Netherlands. Estimates are derived from the situation in other countries, which yields an incidence of four per 1000 per year. Scalds are relatively common in the 0-4-year category. This is usually assumed to be caused by the stage of development of motor and cognitive skills, coupled with incorrect assumptions about these skills by parents. Men are found to be more often the victims of burns than women. Coffee and tea are assumed to be risk factors. The supposed risk factors and risk groups need to be investigated in a controlled epidemiological study, in order to allow establishment of preventive measures.

Accidents, Home↗
PubMed1989

Car radiator burns: a report on 72 cases.

Seventy-two cases of car radiator burns (CRB) were treated in the Burns Unit, Hamad Medical Corporation, Doha, Qatar, over a 6-year period (1982-87). All the patients were males and most were between 20 and 40 years old. Chest wall, face and right upper limb were the commonest sites involved. Most of the patients suffered from relatively minor scalds. The scenario of the accidents as well as the topography of the burned areas were characteristic to this particular type of injury. The exceptionally high temperatures in the summer months were significantly related to the incidence of this type of burn.

Accidents↗
PubMed1989

Analysis of 100 patients with thermal injury treated in a new burn unit in Amman, Jordan.

This paper describes the treatment of patients with thermal injury in Jordan University Hospital. Between 1976 and 1980 inclusive 338 patients were treated in general surgical wards. More recently a new specialized burn unit has been built and between April 1985 and July 1986, 100 patients have been treated in this new unit. Compared with the earlier study there has been an increase in the number of patients admitted with more severe burns. Among these 100 patients scalds and fire-burn injury have a nearly equal incidence. Small children are especially vulnerable. The mortality rate, the incidence of disability and the duration of stay in hospital has decreased compared with the previous study.

Adolescent↗
PubMed1989

Cutaneous 10 MHz ultrasound B scan allows the quantitative assessment of burn depth.

Alterations in the epidermis and dermis after a scald burn (deep dermal wound) are sonographically displayed by different echo reflections. Histological slide preparations from various layers of healthy skin were studied to check the ultrasound analysis. Echo reflections of high and low density showed a close correlation to real anatomical structures in the histological slides. The 10-MHz B scan allows the differentiation of 0.1 mm. Heat causes an increase in dermal thickness of between 50 and 100 per cent for the period between 1 and 6 h after injury. Identifying the layers corresponding to the histological slides makes it is possible to measure the distance between the interfaces. This improves the quantitative assessment of both the depth and the area of thermal injury.

Animals↗
PubMed1989

Effect of allopurinol or superoxide dismutase plus catalase on cardiovascular function after burn injury in the anaesthetized rat.

A scald burn injury was applied to 22-23 per cent of the body surface area of anaesthetized rats. The cardiac output was 38-60 per cent lower in the burn injury group than in the control group; heart rate and mean arterial blood pressure were only slightly affected, but burn injury caused a significant increase in total peripheral resistance. The involvement of oxygen-free radicals in this immediate fall in cardiac output was investigated. Pretreatment with a blocker of free radical production, allopurinol or the infusion of the free radical scavengers superoxide dismutase plus catalase caused no cardiovascular improvement, suggesting that oxygen free radicals are not involved in the fall in cardiac output after burn injury. Allopurinol treatment, however, prevented the rise in total peripheral resistance seen after burn injury.

Allopurinol↗
PubMed1989

Burn injuries in Port Harcourt, Nigeria.

The pattern of burn injuries in Port Harcourt, Nigeria is presented for the first time. Ninety-two patients were studied and 43 (46.74 per cent) of them were children in the 0-5 years age range. Thirty-seven of the children in this group suffered from scalds and six from flame burns. Petrol fire was the commonest cause of flame burns. The overall mortality was 26.09 per cent and the majority of deaths occurred in burns covering over 50 per cent of the total body surface area. Improved parental supervision of children, in particular toddlers, a more reliable public power supply system, a ban on carrying petrol in open containers in the streets and public enlightenment campaigns are advocated by the authors as preventive measures.

Accidents↗
PubMed1990

Role of neutrophils in the intestinal alterations associated with thermal injury.

We have examined the role of neutrophils in the alterations observed in the intestines of rats subjected to 40 per cent surface area scald injury. Histologically, there was no evidence of neutrophilia in the intestinal tissue, and myeloperoxidase activity in mucosal scrapings was not elevated. The distribution of labelled human neutrophils injected into the burned rats showed no enhancement of uptake in the intestines, although there was increased uptake by the lung. The present data suggest that neutrophil migration may not play a role in the alterations in small intestinal function and morphology seen in burn trauma in the rat, but may be a factor in lung damage associated with thermal injury.

Acute Disease↗
PubMed1990

Alteration of wound colonization by selective intestinal decontamination in thermally injured mice.

The effects of selective intestinal decontamination on the bacterial colonization of burn wounds were investigated in experimentally burned mice. Prior to scalding pathogen-free mice were pretreated with bacitracin to induce intestinal overgrowth of Enterobacteriaceae. Mice treated for 20 days postburn with oral aztreonam had significantly reduced enterobacterial wound colonization compared to untreated controls. This study indicates that burn wound colonization is altered by selective decontamination of the intestinal tract.

Animals↗
PubMed1990

An analysis of 1704 burn injuries in Hong Kong children.

Over a 12-month period, 1704 children less than 15 years old with burn injuries seen in the accident and emergency departments of seven major regional hospitals in Hong Kong were analysed with respect to their epidemiological data. The age group with the highest risk for injury was 0-4 years (57 per cent) and with a maximum at 1-2 years of age. Boys showed a significantly higher incidence of burns than girls at any age. Ninety-three per cent of the accidents occurred at home and 92 per cent were scalds caused by hot water and other fluids. In the great majority of patients the total body area of burn did not exceed 5 per cent. Younger children had a higher incidence of burns involving the head, face and anterior trunk, 39 per cent of the 0-4 year age group required hospital admission. During the winter months, the children tended to suffer from deeper burns.

Accidents, Home↗
PubMed1990

Domestic burns among children.

Out of 338 domestic burn injuries 134 affected children below 16 years of age. The investigation was prospective over a 1-year period. The highest incidence occurred in the age-group 0-2 years and was most often caused by contact, secondly by scalds. The sex ratio girls/boys was 1/1.6. The most vulnerable areas were the hands, head and fingers. Activities related to cooking and in the kitchen caused most of the burns.

Accidents, Home↗
PubMed1990

Epidemiology of domestic burns related to products.

Of 4357 home accidents in a 1-year period related to products, a total of 338 burn injuries were prospectively studied with respect to age, sex, the time and cause of the burn accident and the product involved in the burn injury. The survey showed the highest incidence (26 per cent) in the age group 0-5 years and that most burns were caused by scalds or contact. The male to female ratio was 1:1. Activities related to cooking and making/drinking hot beverages constitute the majority of the domestic burns. A trend of more burns occurring during the weekends and the dark winter was found, but monthly or seasonal differences were not significant (0.10 less than P less than 0.20 and 0.20 less than P less than 0.30).

Accidents, Home↗
PubMed1990

Paediatric burn injuries in the Jeddah area of Saudi Arabia: a study of 197 patients.

A prospective study was conducted on paediatric thermal injury patients admitted to the Burns Unit at King Fahd Hospital, Jeddah, Saudi Arabia over a 2-year period (December 1985 to December 1987). A total of 197 patients (out of 319) were paediatric, aged up to 18 years. Infants and toddlers accounted for 59.4 per cent and adolescents for 14.2 per cent. Scalding and flame injuries accounted for 98 per cent with most injuries occurring at home (97.5 per cent) and the overall paediatric mortality rate was 4.4 per cent.

Accidents, Home↗
PubMed1990

Role of skin in the burn-induced reduction of reticuloendothelial phagocytic activity in rats.

Acute burn trauma has been demonstrated to depress reticuloendothelial system (RES) phagocytic activity, which could partially explain the development of septicaemia in burn patients. In the present study we have attempted to determine the role that skin plays in the depression of the RES. One group of Lewis rats was subjected to a 100 degrees C scald burn for 10 s. Eschar was then removed and implanted onto the backs of a second group of normal controls. A third group of Lewis rats were subjected to sham treatment; the eschar of these animals was removed and implanted onto the back of a fourth group of normal rats. The excision sites of the donor animals were immediately covered with Biobrane. Twenty-four hours later the technetium-99m sulphur colloid [( 99mTS]SC) method described earlier (Trop et al., 1989) was used to determine phagocytosis in these four groups of animals. Acute burn trauma produced a marked reduction in colloid uptake by the spleen and a marked increase in the uptake of colloid material by the lung, although no effect was observed on liver or kidney uptake. Implantation of the burn eschar into normal control rats had no statistically significant effect upon colloid uptake. These data suggest that alterations in phagocytic activity of the spleen and lung occur within minutes after burn injury and may be unrelated to the presence of the burn eschar itself.

Acute Disease↗
PubMed1991

Polyurethane film (Opsite) vs. impregnated gauze (Jelonet) in the treatment of outpatient burns: a prospective, randomized study.

As it has been shown that re-epithelialization of partial skin thickness wounds can be accelerated if the wound is kept moist, a prospective, randomized clinical study compared the water vapour-semipermeable polyurethane film, Opsite, with the conventional impregnated gauze dressing, Jelonet, in the treatment of outpatient partial skin thickness burns. Fifty-five patients were included: 30 were treated with the polyurethane film and 25 with the conventional dressing. The patients were followed at regular intervals until healing had occurred and were seen 3 months later for evaluation of residual scars and pigmentation. The burns treated with polyurethane films healed with a median of 10 days, while the conventionally treated burns healed with a median of 7 days (P greater than 0.05). Residual scars were noted in 21 per cent of the patients treated with polyurethane films and in 8 per cent treated conventionally (P greater than 0.05). Prophylactic methods should be publicly stressed since one-quarter of the patients were children of 3 years or less who were scalded by split hot liquids. Furthermore the patients' wounds were only briefly cooled before attending medical care. With small burns we advise that cooling should be prolonged until the pain fades then professional assistance should be sought.

Adolescent↗
PubMed1991

Analysis of 105 patients admitted over a 2-year period to a modern burns unit in Saudi Arabia.

This is an epidemiological survey of 105 burned patients treated between May 1986 and May 1988 in a modern Burns Unit in Saudi Arabia. Hospitalization time ranged from 1 to 100 days with a mean of 17 days. The mean age of the patients was 9 years. Sixty (57 per cent) of the patients were males and 45 (43 per cent) were females. The main causes of injury were hot liquids (57.7 per cent) and fire (33 per cent). The mean extent of injury was 19 per cent TBSA. Burns covered less than 40 per cent TBSA in 91 out of 105 patients (87 per cent). Deep burns did not exceed 100 units of burned skin in 48 out of 55 patients (87 per cent). Urgent escharotomy was done in 14 patients. Early excision and skin grafting was carried out in 34 patients. Complications included six cases (5.7 per cent) with septicaemia, one (0.9 per cent) with disseminated intravascular coagulopathy, three (2.9 per cent) with amputation and one (0.9 per cent) with stress gastric ulcer. Seven patients discharged themselves against medical advice. Five patients died. The favourable results in this series were attributed mainly to the low severity of burns and partially to the short delay between injury and admission, early surgery and remarkably good facilities. Childhood scalds in this region of the world could possibly be reduced by changing the family habit of having tea at floor level and recommending wide-based tea-pots.

Adolescent↗