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PubMed2001

A study of burn injuries in the elderly in a regional burn centre.

We evaluated the epidemiology and outcome of 94 elderly burn patients of age 60 years or older treated in a local burn centre over a period of 6 years. There were 44 males and 50 females with a male to female ratio of 0.88 and an average age of 73.8+/-9 years. The mean extent of burn was 13.3+/-18.4% total body surface area (TBSA) with 14 patients (15%) suffering from a burn size >20% TBSA. The vast majority of injuries (90%) occurred at home. Scalds resulted in 62 admissions (66%) and flame burns accounted for another 29 admissions (31%). The burns predominantly involved the extremities and the trunk. Four patients had inhalation injuries and required admission to the Intensive Care Unit for ventilatory support. The majority of patients (60%) did not require any operations. The mean hospital stay of the survivors was 30.1+/-34.1 days and 35% of them stayed less than 2 weeks. Fifty-five patients (59%) had at least one pre-existing medical problem requiring long-term medication and 41 patients (44%) were living alone. Sixty-three patients (67%) presented more than 8 h after the burn injuries and 34 patients (36.2%) had no first aid treatment of their burn wounds. In addition, 40 patients (42.5%) had their wounds treated inappropriately. Seven patients died in this series which yielded a mortality rate of 7.4%. The outcomes of early versus late excision and grafting were also analyzed.

Aged↗
PubMed2001

Epidemiology and man-days loss in burn injuries amongst workers in an oil industry.

This retrospective study, conducted at the Indian Oil Corporation Ltd. (Assam Oil Division) Hospital, Digboi, in a period of 5 yr amongst workers of IOC Ltd. (AOD) describes work-associated injuries. Out of 2320 cases of different types of injuries involving workers over this period, 820 (35.3%) occurred at the workplace. 1430 (61.6%) at home or other places and 70 (3.1%) occurred on way to the workplace. Burn injuries were found in 132 cases (5.8% of the total injuries), but constituted 12.6% of the accidents at the workplace. The majority of the other injuries were soft tissue injuries, including sprains 1288 (55.5%) and hand injuries 688 (29.5%). Major burns (above 20% BSB) were found only in 5 cases. The most common sites of involvement in minor burns were the hands (45 cases), the legs (35 cases) and face (20 cases) with the remaining involving the chest and abdomen. Scald injury was observed in 66/132 (50%) cases, contact burns in 13/132 (10%) cases, flame burns in 33/132 (25%) cases, chemical burns in 11/132 (8.3%), and electrical burns in 9/132 (7%) cases. Mortality was 1.5%. Working days lost (man-days loss) in burn injuries was found to be higher in comparison to other injuries of similar severity. Causation of industrial burns is discussed and importance of prevention of burns in industries has been emphasised.

Absenteeism↗
PubMed2001

Cryopreserved cultured epidermal allografts achieved early closure of wounds and reduced scar formation in deep partial-thickness burn wounds (DDB) and split-thickness skin donor sites of pediatric patients.

Burn treatment in children is associated with several difficulties, e.g. available skin replacement is small, donor area could expand, and subsequent hypertrophic scar and contracture could become larger along with their physical growth. In order to have better clinical results, the authors prepared cryopreserved cultured epidermal allografts from excess epidermal cells of other patients, and applied the epidermal allografts to 55 children, i.e. 43 cases of deep partial-thickness burn wounds (DDB) due to scald burn and 12 cases with split-thickness skin donor sites. In the 43 DDB patients, epithelialization was confirmed 9.1+/-3.6 days (mean+/-S.D.) after treatment. In 10 of the 43 patients, epithelialization was comparable between the area which received the epidermal allografts (grafted area) and the area which did not receive the epidermal allografts but was covered with usual wound dressing (non-grafted area). As a result, epithelialization day was 7.9+/-1.7 in grafted areas and 20.5+/-2.3 in non-grafted areas. In the 12 patients with split-thickness skin donor sites, epithelialization was confirmed 6.3+/-0.9 days after treatment. Epithelialization of the grafted and non-grafted areas was comparable in 8 of the 12 patients, and it was 6.5+/-1.1 days and 14.1+/-1.6 days, respectively. In these 10 DDB patients and 8 split-thickness skin donor site patients, redness and scar formation were also milder in the grafted area. The 55 patients have been followed up for 1-8 years (mean, 4.75 years), and scar formation was suppressed in both DDB and split-thickness skin donor sites. These findings showed that cryopreserved cultured epidermal allografts achieve early closure of the wounds and good functional outcomes.

Adolescent↗
PubMed2001

Partial liquid ventilation with perfluorocarbons for treatment of ARDS in burns.

Pulmonary failure remains the major determinant of mortality and morbidity following burn injury. We hypothesized that intratracheal instillation of perfluorocarbon liquids could be a therapeutic measure in combination with conventional mechanical ventilation to improve pulmonary gas exchange in acute respiratory distress syndrome with thermal injury. Forty-five New Zealand rabbits were used for this prospective and randomized experimental study. The animals were burned by scald to reach full-thickness 40% burn surface area. After inducing respiratory distress by repeated lung lavage with saline, animals were divided randomly into three groups of 15 rabbits each. First group (control group) received conventional treatment (continuous positive-pressure ventilation) using a FiO(2) of 1.0, tidal volume of 12 ml/kg, respiratory frequency of 30 cycles/min and PEEP of 6 cm H(2)O. Second group was treated with 9 ml/kg of intratracheal perfluorocarbon. Third group was treated with 15 ml/kg of intratracheal perfluorocarbon. All groups were ventilated for 6 h. In the perfluorocarbon groups, PaO(2) increased significantly (P<0.05) from 46+/-4 to 439+/-10 mmHg compared to the control group in a dose-related manner. In pulmonary parameters we observed significant (P<0.05) decrease in mean airway pressures from the pre-treatment value of 11.44+/-0.15 cm H(2)O to the post treatment 10.22+/-0.12 cm H(2)O and increase (P<0.05) in respiratory system compliance from 1.8+/-0.02 to 2.46+/-0.07 ml/cm H(2)O with the perfluorocarbon. Perfluorocarbon instillation did not result in statistically significant changes in arterial pressure, heart rate and central venous pressure. In conclusion, partial liquid ventilation with perfluorocarbon is a new technique leading to a marked and sustained improvement in oxygenation and pulmonary function in an experimental model of ARDS in burns.

Animals↗
PubMed2002

Calcium induced the damage of myocardial mitochondrial respiratory function in the early stage after severe burns.

OBJECTIVE: To explore the role of Ca(2+) in the damage to myocardial mitochondrial respiratory function in the early stage after severe burns. METHODS: An experimental model of 30%TBSA full-thickness skin scalding was reproduced in rats. Myocardial mitochondria were isolated from control and burned rats in the 1st, 3rd, 6th, 12th and 24th hour post-burn. The mitochondrial respiratory function, contents of mitochondrial calcium ([Ca(2+)](m)), activities of mtPLA(2), mtNOS, F(0)F(1)-ATPase and cytochrome c oxidase were determined. RESULTS: (1) At the 1st hour post-burn, [Ca(2+)](m) was increased significantly and the myocardial mitochondrial respiratory function was significantly reinforced. At the same time, mitochondrial respiratory control rate (RCR) was elevated and positively correlated with [Ca(2+)](m) (r=0.8415, P<0.01). At the 3rd, 6th, 12th and 24th hour post-burn, [Ca(2+)](m) increased further to a higher level, however, the mitochondrial respiratory function was decreased from the peak value at 6h, and RCR was negatively correlated with [Ca(2+)](m). (2) The activities of mtNOS and mtPLA(2) were higher significantly at the 3rd, 6th, 12th and 24th hour post-burn than that of the control. After severe burns, mtNOS and mtPLA(2) activities were both positively correlated with [Ca(2+)](m) (r=0.8945, P<0.05; r=0.9271, P<0.01, respectively). (3) The F(0)F(1)-ATPase synthetic activity increased at the 1st hour post-burn, but it decreased to 51.4, 44.9, 77.6 and 87.4% of that of the control at the 3rd, 6th, 12th and 24th hour post-burn respectively. The F(0)F(1)-ATPase hydrolytic activity decreased at the 1st hour post-burn and increased at the 3rd, however, it decreased again at the 6th, 12th and 24th hour post-burn. The activity of cytochrome c oxidase at the 3rd, 6th, 12th and 24th hour was low compared to the control. CONCLUSIONS: The changes of [Ca(2+)](m) were involved in damage to or regulation of mitochondrial respiratory function after severe burns. Appropriate increase of [Ca(2+)](m) reinforced the mitochondrial respiration at 1st hour after of burn injury, but Ca(2+) severe overload impairing F(0)F(1)-ATPase and cytochrome c oxidase directly, or, indirectly by activation of mtPLA(2) and mtNOS, might play an important role in damage to myocardial mitochondrial respiratory function at later stages after severe burns.

Animals↗
PubMed2002

A retrospective analysis of 1083 Turkish patients with serious burns.

A total of 1083 burn cases hospitalised at a burn center between August 1988 and the end of 1997 were studied retrospectively to determine the factors and demographic features associated with burn injury in Turkey. The means for patient age and percent total body surface area (TBSA) burned were 18.1 years and 31.2%, respectively (medians were 14.0 years and 25.0%, respectively). Burn injuries were more common in winter and spring, and most occurred in the home. The majority of patients were city dwellers, and had been referred from public hospitals. There was a predominance of male patients (71.9%) in the study population, but the proportions of children and adults were equal. Almost half of the males and the majority of the females were children/students. The vast majority of female adults were housewives, and most of the men were employed outside the home. More than half of the patients suffered second-degree burns, and the others all had deeper burn injuries. The most frequent cause of burn in the study population was flame. Children mainly suffered from scalding, and adults from flame and electrical burns. There were no differences between the sexes regarding depth of burn; whereas percentage total burned surface area was higher in females. Children had a lower mean TBSA and lower rate of third-degree burns. Mortality rate of the study population was 33.5%. The study results identified various risk factors and the groups at high risk for serious burns and indicated some ways that prevention programmes can be improved.

Adolescent↗
PubMed2002

Ventral burn in rats: an experimental model for intravital microscopic study of microcirculation.

A novel technique of application of controlled ventral scald burn to rodent, whose back is inaccessible because of preburn preparation, is described. Boiling water is applied across a polyethylene membrane that partially envelops the subject. The technique is simple, economical, reproducible and allows intravital microscopic study of microcirculation in a remote muscular bed before and after burn injury.

Abdominal Injuries↗
PubMed2002

Attenuation of internal organ damages by exogenously administered epidermal growth factor (EGF) in burned rodents.

Major burns are associated with multiple internal organ damages, including necrosis of the gastrointestinal mucosa. Failure of the intestinal barrier is a serious complication in burned patients. Epidermal growth factor (EGF) is a mitogenic polypeptide that stimulates wound repair and affords protection to the gastric mucosa. We examined whether a single systemic intervention with EGF prevents organ systems damages, following full-thickness scalds (25-30%) in rodents. Animals were randomly assigned to receive an intraperitoneal injection of EGF (30 microg/kg in mice, 10 microg/kg in rats) or saline solution, 30 min prior thermal injury in mice or after the cutaneous injury in rats. General clinical condition and mortality during 24h were recorded. Animals were autopsied and histopathological and histomorphometric studies were conducted. Mice treated with EGF exhibited a milder clinical evolution and acute lethality was significantly reduced as compared to saline counterparts (P<0.01). Histopathological and morphometric analysis showed that EGF significantly reduced intestinal necrosis and contributed to preserve jejunoileal architecture in mice (P<0.05) and rats (P<0.01). The onset of renal hemorrhagic foci was significantly reduced in EGF-treated groups (P<0.01). Lung damages appeared attenuated in EGF-treated animals. These data indicate the salutary effects of EGF by attenuating internal complications associated to thermal injuries. Further studies are warranted to fully elucidate the usefulness of this therapy.

Animals↗
PubMed2002

Changes of myocardial mitochondrial Ca(2+) transport and mechanism in the early stage after severe burns.

OBJECTIVE: To investigate the change of myocardial mitochondrial Ca(2+) transport and its mechanism in the early stage after burns. METHODS: Forty-eight Wistar rats were randomized into a normal control group (n=8) and a burns group (n=40). The rats of the burns group were given a 30%TBSA full-thickness. Myocardial mitochondria were isolated from normal and scalded rats which were sacrificed at the 1st, 3rd, 6th, 12th and 24th hour post-burn. Mitochondrial Ca(2+) transport velocity, membrane potential (MP), ATP content and cytosolic Ca(2+) concentration [Ca(2+)](c) were determined. The effects of exogenous ATP on mitochondrial Ca(2+) transport velocity were also investigated. RESULTS: Mitochondrial Ca(2+) uptake velocity of the 1st hour post-burn was higher than that of the control, and Ca(2+) release velocity did not change significantly, but mitochondrial Ca(2+) transport velocity, MP and ATP content were all decreased at the 3rd, 6th, 12th and 24th hour post-burn. Mitochondrial Ca(2+) uptake velocity was positively correlated with MP after burn, and Ca(2+) release velocity with mitochondrial ATP content. [Ca(2+)](c) was increased at the 3rd, 6th, 12th and 24th hour post-burn. Exogenous ATP increased myocardial mitochondrial Ca(2+) uptake velocity of rats at the 3rd and 6th hour post-burn and Ca(2+) release velocity at the 3rd, 6th and 12th hour post-burn. CONCLUSIONS: Increase of [Ca(2+)](c) led to reinforcement of mitochondrial Ca(2+) uptake at the beginning of the post-burns period. ATP depletion and MP collapse cause myocardial mitochondrial Ca(2+) transport disorder in the following stages.

Adenosine Triphosphate↗
PubMed2002

Melatonin improves oxidative organ damage in a rat model of thermal injury.

Animal models of burn injury indicate oxygen radicals as causative agents in the local wound response, as well as in the development of burn shock and distant organ injury. This study was designed to determine the possible protective effect of melatonin treatment against oxidative damage in the liver, lung and intestine induced by burn injury. Under ether anaesthesia, the shaved dorsum of rats was exposed to a 90 degrees C bath for 10s to induce burn injury. Rats were decapitated either 3 or 24h after burn injury. Melatonin was administered i.p. immediately after burn injury. In the 24h burn group, melatonin injections were repeated for two more occasions. In the sham group the same protocol was applied except that the dorsum was dipped in a 25 degrees C water bath for 10s. Liver, lung and intestine tissues were taken for the determination of malondialdehyde (MDA) and glutathione (GSH) levels, myeloperoxidase (MPO) activity and protein oxidation (PO). Severe skin scald injury (30% of total body surface area) caused a significant decrease in GSH level, significant increases in MDA and PO levels, and MPO activity at postburn 3 and 24h. Treatment of rats with melatonin (10mg/kg) significantly elevated the reduced GSH levels while it decreased MDA and PO levels as well as MPO activity.

Animals↗
PubMed2002

Four years of burn injuries in a Red Cross hospital in Afghanistan.

This study examines the epidemiology and mortality of patients admitted with burns to a Red Cross hospital in Afghanistan between 1996 and 2000. Three hundred and eighty-eight cases were reviewed retrospectively (57% male, 43% female) with a median age of 8 years. Sixty-three percent were children. Scalds (44%) were the commonest injury followed by fire (37%). The median total body surface area burned (TBSA) was 15%. Forty-six percent of the patients required surgical debridement and 11% underwent delayed skin grafting. Overall, median duration of stay was 7 days. The mortality rate was 16% (M:F, 1.1:1) and fire was the commonest cause of fatal burns. The median TBSA of fatal burn was 40%. There were no survivors with burns greater than 45% TBSA. Multiple organ failure and sepsis were the cause for most of the deaths.

Adolescent↗
PubMed2003

Radiological manifestation of pulmonary complications in deceased intensive care burn patients.

The chest radiographs of 46 burn patients who died in the burn intensive care unit (BICU) were retrospectively analyzed to study the spectrum of pulmonary complications and their contribution to patient's mortality. There were 25 male and 21 female patients and their mean ages were 34 and 30 years, respectively. Forty-three patients had flame burns, two chemical, and one scald with a mean total burn surface area (TBSA) of 71%. Thirty-six of them had inhalation injury and of these 25 patients developed septicaemia. Out of these 46 patients, 39 had a total of 60 pulmonary complications on various postburn days. The commonest complications were consolidation (28.3%) and adult respiratory distress syndrome (ARDS) (26.7%) mainly due to inhalation injury and/or following septicaemia. The majority of these complications (46.7%) occurred in the late phase (postburn day 5 onwards). Forty-one (89.2%) patients died due to multi-organ failure (MOF) and a good number of them had secondary respiratory failure. The flame burn patients with large TBSA, presence of inhalation injury, and occurrence of septicaemia, are at risk for pulmonary complications that equally affect adult males and females. Pulmonary complications irrespective of the cause significantly contribute to the mortality. This study suggests that serial chest X-rays done in BICU form an important diagnostic tool for pulmonary complications from postburn day 1 onwards, and is useful for subsequent monitoring of the treatment. All burn intensive care units may not be privileged to have a full time radiologist, and intensivist. Therefore, the burn surgeon needs to metamorphose into an intensivist and double as a burn radiologist for early detection and quick treatment if his surgical skills are to be adequately rewarded.

Adolescent↗
PubMed2003

Shabbes burn, a burn that occurs solely among Jewish orthodox children; due to accidental shower from overhead water heaters.

From January 1990 to January 2000, 35 children were treated in our department for Shabbes burn, a unique scald burn that occurred mainly among orthodox Jews during the Sabbath. A retrospective review was conducted to determine the extent of the problem, to understand the burn mechanism and to suggest a prevention program. A shower of hot water from the Sabbath heater is the cause of this burn. Among the Shabbes burn cases, 27 patients were female (77%) and 17 children (48%) were between 3 and 6 years old. It is suggested that this is a common burn that occurs among orthodox Jewish families and affects mainly females. Education programs using the media directed to the Jewish orthodox population have been conducted, this combined with redesigned of the heater, have reduced significantly the incidence of the burn as seen in our institute. However, even though efforts have been supported widely, there remains a need for educational and governmental regulations on a national level. This could aid orthodox Jews not only in Israel but globally, as well.

Accidents, Home↗
PubMed2002

Recombinant human growth hormone modulates the hepatic acute-phase response and P-selectin in burned rats.

The purpose of this study was to determine the effect of recombinant human growth hormone (rhGH) on serum constitutive proteins, cytokines, P-selectin, and insulin-like growth factor (IGF-1) in the thermally injured rats.Sprague-Dawley rats (64 males) were given 30% total body surface area full thickness scald burn. They were randomly divided to receive either 2.5mg/kg per day im rhGH or saline (control). Rats were sacrified on postburn days 1, 2, 5, and 7, and serum constitutive proteins, cytokines, P-selectin, and IGF-1 levels were measured.Serum IGF-1 levels were increased on days 2, 5, or 7 after burn in rhGH-treated rats compared with controls (P<0.001, <0.01 and <0.001, respectively). Serum transferrin and albumin levels were increased on days 7 after burn in rhGH-treated rats compared with controls (P<0.05). The cytokines increased after thermal injury. The rhGH decreased serum levels of tumor necrosis factor-alpha on postburn days 1 compared with controls (P<0.001). Serum levels of interleukin-1 were decreased on days 1 and 2 after burn in rhGH treated rats compared with controls (P<0.001, <0.01, respectively). Rats receiving rhGH showed significantly increased P-selectin levels at 5 and 7 postburn days compared with controls (P<0.001). Our data indicate that rhGH, given after thermal injury, increased albumin, transferrin, IGF-1, and P-selectin levels and decreased serum tumor necrosis factor-alpha and interleukin-1 levels.

Acute-Phase Reaction↗
PubMed2003

Skin toxicity induced by wet heat.

Pieces of human skin from the skin bank were heated in an autoclave for 1 or 5 min at temperatures 80, 90, 100, 110 and 135 degrees C. The pieces were then homogenized and the homogenates were injected intraperitoneally into groups of mice. The amount injected was either a quantity equivalent to 50 or 75% of the mouse body surface area. Fourteen separate experiments were carried out, each one with a variety of temperatures. Mortality in the groups of mice was recorded by the 8th day. Control mice received homogenates of skin heated to no more that 38 degrees C and out of a total of 104 control mice there were only 4 deaths. In contrast homogenates of skin heated to 135 degrees C killed from 80 to 100% of the mice in different groups, averaging 92%. Skin heated to 110 degrees C killed from 33 to 90% of the mice in different groups, averaging 63%. Skin heated to 100 degrees C killed from 0 to 80% of the mice in different groups, averaging 33%. Temperatures of 80 and 90 degrees C killed no more than 10% of the mice in any group, averaging less than 3%. One minute of heating seemed to be sufficient to induce the toxic effect in the skin. These findings indicated that wet heat application to skin was capable of inducing toxicity in a fashion similar to that demonstrated many years ago with hotter dry temperatures applied to skin for 15s. That application was shown to induce polymerization of skin cell membrane lipid proteins rendering them toxic. In this study, increasing toxicity appeared similarly to depend on the quantity of wet heat input as illustrated by the range of increasing temperatures. The relatively lower temperatures of scalding versus flame burns can accomplish similar dangerous effects; it is simply a quantitative matter of heat input.

Animals↗
PubMed2003

Delayed dilated cardiomyopathy for major burn injuries.

PURPOSE: The early impact on the heart of severe burns has all been well documented previously. Here, we report on the late effects of burns upon the heart, and dilated cardiomyopathy, such aspects having been little reported previously in the literature. METHODS: Over the past 8 years (June 1991 to December 1998), 55 scalded or flame-burnt patients for whom the total burnt body surface area (TBSA) exceeded 50% were treated. Seventeen patients survived and were followed up. The mean age was 44 years. The mean follow-up period was 47.3 months; four patients displayed a previous history of heart disease. We used several parameters to evaluate and follow cardiac status to see the late effect of burns upon the heart. RESULTS: Of 17 patients, 3 patients (17.7%) were found to exhibit dilated cardiomyopathies after a mean time of 6 months post-injury. A dramatic recovery from symptoms and roentgenographic findings were observed for all patients following symptomatic treatment. CONCLUSION: Here we report three cases of delayed dilated cardiomyopathy, a condition that has been little reported in the past. There may be many causating factors. Several recommendations are described.

Adolescent↗
PubMed2003

What influences the functional outcome of children at 6 months post-burn?

The contribution of demographic, injury, pre-morbid, and parent factors to a child's functional outcome at 6 months post-burn injury was examined. Sixty-eight children, aged 5-14 years with percent total body surface area (%TBSA) burns ranging from <1 to 35%, and their primary caregivers participated in the study. It was expected that pre-morbid and parent factors but not injury factors would have a significant impact on the functional outcome of children at 6 months post-burn. Injury factors included the percent of total body surface area burned, number of operative procedures, and source of the burn (i.e. flame burn, scald burn). Pre-morbid child factors included the presence or absence of behaviour problems, psychological or psychiatric problems, learning difficulty or developmental delay. Parent factors included anxiety, depression, coping processes, and social support. Whilst investigating the contribution of these factors to functional outcome, the effect of demographic factors (i.e. age, gender, family socioeconomic status, and the number of previous hospitalizations) was controlled for and investigated. Analyses included two hierarchical multiple regression analyses that supported the expected results. R was significantly different from zero at the end of each step in both hierarchical regression analyses, indicating that each group of factors added significantly to the fit of the model. After step 4 in the final regression model with all independent variables in the equation, R=0.85, F(18,49)=6.89, P<0.001.

Adaptation, Psychological↗
PubMed2003

Work-related burn injuries in Ontario, Canada: has anything changed in the last 10 years?

BACKGROUND: Many burn injuries occur in the workplace. Previous research from this institution 10 years ago analyzed the incidence and nature of occupation-related burns admitted to our facility. PURPOSE: To compare the current incidence and patterns of work-related burn injuries treated at our adult regional burn center (Current group) with the findings of a similar study 10 years ago (Early group). METHODS: Retrospective study of all burn center admissions between 5 December 1998 and 31 December 2000 was completed. The data from the Early and Current groups was analyzed using the Chi-square test of homogeneity. RESULTS: During the study period, 355 patients were hospitalized. After exclusions, 100 occupational burn cases were identified (28%). The mean age of patients was 39+/-12 years, 90% were male. The mean total body surface area (TBSA) burn was 11+/-13.7%. The most common mechanism of burn was electrical (32%), followed by flame (22%), scald (17%), tar (14%), contact (8%), and chemical (7%). Four patients (4%) died of their injuries. There were no significant differences between the Current group and the Early group in terms of incidence, age, gender, occupation, mechanism of burn, or mortality. CONCLUSION: In the past 10 years no change was found in the incidence or pattern of work-related burn injuries treated at this institution. This suggests that existing prevention strategies have not been effective.

Accidents, Occupational↗