Serum sodium imbalance in the bedridden elderly. Part One: Realities and problem of management

This study assessed the topical effects of bitumen on burn wounds and their surrounding skin in guinea-pigs. It consisted of three different experiments. The bitumen used in this experiment was a soft tar produced by Daye Steel Plant. The first experiment showed that the skin of the bitumen group marked pathological changes under both light and electron microscopes. The second experiment suggested that healing of the burn wounds of bitumen group was delayed, and less hair follicle counts and a lower intradermal thickness were found as compared with the other groups. The third experiment indicated that the wound edges had been seriously destroyed by bitumen, leading to enlargement of the size of the ulcers, and hypertrophy of scar occurred after healing. It is concluded that bitumen, especially the soft coal tar, has more errosive, irritating and destructive effects, therefore in bitumen burns the bitumen must be immediately and entirely removed from burn wounds.     

Treatment of eyelid burns and results

Eyelid burns may cause irreversible damage to the eyelids and eye globe. We review 45 patients with eyelid burns, in 8 of whom skin grafting was required due to the deepness of the burn. The results were satisfactory in all except 1, in whom 9 surgical procedures were required to give complete coverage of the cornea. During 1 procedure skin was grafted directly onto the conjunctiva. The other 36 patients were treated conservatively.     

Usefulness of platelet-derived growth factor as a prognostic factor in pulmonary adenocarcinoma

The effects of 6-methyluracil given in single intraperitoneal doses of 50 and 2.7 mg/kg on the healing of burn wounds and some physicochemical parameters of lipid peroxidation regulation were studied in the liver and erythrocytes of noninbred albino rats with thermal burns. 6-Methyluracil was shown to alter the time course of a wound process and to accelerate the healing of burn wounds. The drug doses under study were found to exert a great effect on the level of lipid antioxidative activity and the composition of phospholipids of the liver and erythrocytes, which remained for a long time after burn. The findings suggest the hypothesis that the capacity of 6-methyluracil to be involved in the regulation of lipid peroxidation processes underlies its therapeutic effect.     

Evaluation of therapeutic effects of moist burn ointment and betadine ointment in treatment of severe burn

In order to compare the therapeutic value of moist burn ointment (MBO) and betadine ointment in severe burns, the authors divided 30 patients with burn over 30% TBSA into two groups. In one group MBO was used, and in another group betadine was used. The result showed; 1. The difference between two groups was not great in superficial II degree burn wound. 2. MBO was less effective than betadine in deep burn wound. MBO had little antibacterial effect, wound healing was delayed, and incidences of infection, complication and mortality were higher. At the same time, MBO did not have noticeable effect in inhibiting scar hypertrophy. The authors suggest that MBO must be used with caution in severe burn patients, especially in the southern provinces where the climate is hot and humid.     

Cryopreserved cadaveric allografts for treatment of unexcised partial thickness flame burns: clinical experience with 12 patients

Partial thickness burns (PTB) usually heal within 3 weeks. Prevention of infection and desiccation of the wounds are crucial for optimal healing. Early tangential excision of the burn eschar and allografting prevent deepening of the burns, and are therefore advocated for treatment with the best functional and aesthetic results. For superficial partial thickness burns (SPTB) conservative use of topical antimicrobial agents with frequent dressing changes are implemented. We compared the conservative treatment for PTBs and SPTBs to grafting cryopreserved cadaveric allografts with no prior excision. Twelve patients with flame PTB areas were allografted after mechanical debridement without excision of the burn wounds. The allografts were cadaveric skin cryopreserved by programmed freezing and stored at -180 degrees C for 30-48 months. Matching burns for depth and area were treated with silver sulfadiazine (SSD) one to two times daily until healing or debridement and grafting were required. It was found that 80 per cent of the cryopreserved allografts adhered well and 76 per cent of the treated areas healed within 21 days, whereas only 40 per cent of the SSD-treated burns healed within 21 days. Partial thickness burns can be treated successfully with viable human allografts (cryopreserved cadaveric skin) with no prior surgical excision. The burn wounds heal well within 3 weeks. For deep partial thickness burns (DPTB) treatment with allografts has no advantage if they have not been previously excised.     

Our experience with the use of cerium sulphadiazine in the treatment of extensive burns

The development of the burn disease with infection as the most important complication represents still a major problem in burn patients. With the introduction of the method of early surgical excision of the Af1p4r with immediate grafting in major burns, improved survival has been achieved, particularly in children. However, especially in adults, early massive excisions did not prove to be of much benefit for survival. In these cases, more-or-less sequential staged excisional procedures have been introduced by many renown burn surgeons. In 1976 Monafo et al. presented the cerium nitrate-silver sulphadiazine cream (CSD) combination for topical therapy. The addition of 2.2% of the rare earth metal cerium salt to silversulphadiazine causes the formation of a relatively hard, yellow, leather-like eschar with excellent resistance to infection and good long-term adherence to the burn wound. This allows the surgeon to perform late tangential excision and immediate autografting thus decreasing the open wound size and the rate of severe infections originating in the burn wound itself. We report our experience with the treatment of 20 patients with deep burns exceeding 20% of the BSA with cerium nitrate-silver sulphadiazine cream compared with a similar group of burn patients treated by silver sulphadiazine cream alone. CSD proved to be safe and effective in the treatment of deep and extensive burns. Its advantages include easy and painless application and removal, turning the necrotic skin to yellow, and a leathery crust with good resistance to infection, thus enabling later, or staged, sequential excisions in cases where early massive excisions are not possible.     

Environmental health implications of heavy metal pollution from car tires

OBJECTIVE: To determine the effect of retinoic acid on wound healing of laser burns to explants of porcine retinal pigment epithelium (RPE). DESIGN: With the help of a mirrored attachment to a Coherent argon laser, laser burns (spot size 100 mu, power 500 mW, duration 0.2 seconds) were performed in 12 explants. The explants were then cultured in the presence (six explants) or absence (six explants) of 1 microM retinoic acid. Two explants in either group were recovered 4, 8 and 12 days after treatment for histologic study and scanning electron microscopy. OUTCOME MEASURE: Mean burn area remaining after culture. RESULTS: The area of wound remaining unhealed in the presence of retinoic acid was significantly larger than the area of wound remaining unhealed in the absence of retinoic acid at each time point. CONCLUSIONS: Retinoic acid inhibited wound healing of laser burns to porcine RPE. This effect may illustrate a role for retinoic acid in the pharmacotherapy of proliferative disorders.     

Risperidone in the treatment of schizophrenia: results of a study of patients from Germany, Austria, and Switzerland

Wound healing is a complex series of highly interdependent and overlapping stages involving a number of cellular processes. Macrophages are pivotal to the healing process, as director cells, but also functioning as phagocytes and debridement agents in addition to producing chemoattractants and growth factors which attract cells necessary for repair and control of wound healing processes. A number of other factors influence wound healing, such as oxygen, the immune system, and corticosteroids.     

Total gluteal pouching with pseudoanus caused by burn injury: report of a case

PURPOSE: We report the case of a 69-year-old man who had suffered a third-degree burn injury of the buttocks close to the perianal region at the age of 2 years. Although initial attempts for conservative treatments failed, wound healing was achieved after numerous skin grafts. However, after prolonged healing, the patient developed scar contracture, resulting in total effacement of the gluteal folds and natal crease, and formation of a gluteal pseudoampulla and a pseudoanus. As a result of misinterpretation of the local anatomy, for the next 50 years the patient had to defecate into the gluteal pouch and empty this pseudoampulla by manually compressing the buttocks and irrigating with chamomile tea. METHOD: After a thorough examination revealed the presence of a normal, uninjured anus hidden by the scarred pouch, we excised this burn scar to expose the unburned perianal tissue and covered the resulting defect with a meshed, split-thickness skin graft. RESULT: Anorectal function was preserved, the anatomic contour was restored, and primary wound healing was achieved after one single-stage operation. CONCLUSION: To prevent such deformities, we recommend early excision and skin grafts as initial treatment, as opposed to conservative treatment, and thorough follow-up examinations to avoid misinterpretation of such a complex, altered local anatomy.     

Fasciola hepatica: the effect of challenge by the subcutaneous or intraperitoneal route with living adult flukes in sensitized rats

Primary burn excision with immediate wound closure by skin grafting was used as the initial definitive treatment for deep burns of the hand in 30 consecutive children. The results are compared with an additional group of 30 children whose burns were treated with AgNO3 alone. There is a significant difference in all categories examined between the excised and the nonexcised group. Hand deformities, secondary reconstructive procedures, and morbidity were significantly reduced in the excised group. Excision provided improved functional and cosmetic results.     

Molten metal burns: early treatment improves outcome

Molten metal burns have received relatively little attention in the surgical literature. We performed a retrospective chart review of 150 patients who sustained molten metal burns between 1972 and 1997. The injuries all occurred in male foundry workers, most commonly from molten aluminum (60%). The typical accident was that of a splatter spill, creating a full-thickness burn. The mean burn size was 2.3 per cent of the body surface area (range, 0.25-25%). The lower extremities were the most commonly injured areas (85%), yet 37 per cent of patients had multiple sites burned. Patients were often initially treated nonoperatively and then referred to a surgeon when the wound failed to heal. Hospitalization was necessary in 89 patients at a mean of 16 days after the injury, and 92 patients required an operation, most commonly excision of the wound with skin grafting. The mean length of hospital stay was 11.2 days, and mean absence from work was 72.6 days. Fifty-one patients treated by the burn surgeon within 2 weeks of injury had a mean length of disability significantly shorter than those referred late (53.5 vs. 83.4 days; P < 0.05). We believe that an underestimation of the severity of these burns often leads to a delay in correct therapy and extends disability.     

Influence of age of the recipient on 85Sr uptake of tibia transplants in mice (author''s transl)

The treatment of burnt hands is not simple. By emphasizing problems that are frequently encountered, I have attempted to stress certain methods of treatment based on sound principles of burn wound care and skin grafting. Great responsibility rests on the person who does the initial skin grafting in the full-thickness loss burn of the hand, just as there is on the person who is treating the burnt hand prior to grafting. Such responsibility demands the maintenance of adequate range of motion during the preparatory wound care, after the important initial grafting, and during the rehabilitation period, so that maximum final function can be attained. If one does not recognize the importance of these principles of treatment, a stiff, malpositioned, contracted hand will result that is impossible to adequately correct, leading to significant permanent disability and loss of earning power. All who treat burned patients should realize that the major permanent disability of burns is in the hands. Proper treatment based on sound principles can greatly reduce or eliminate that disability.     

Endothelial F-actin changes in the alkali burned rabbit cornea

The healing mechanism of corneal endothelium after alkali burn was not completely understood. Rabbit cornea was burned with 1N sodium hydxoside for 1 minute. Endothelial F-actin was stained with NBD-phallacidin in regular sequence to find out the details of endothelial healing after alkali burn. F-actin was completely destroyed leaving a sharp margin against the unaffected area 1 hour after the burn. In the 3, 5 and 7 day specimens, highly active F-actin reactions were noted at the wound margin. New multiple F-actin layers, arising from the intact endothelium near the wound margin, were noted in the 9 day specimen. In the 8 1/2 month specimen, the endothelial defected area was covered by large primitive cells, each of which showed F-actin fiber bundles in the cytoplasm with a large nuclear shadow. Nearly all of the large primitive cells showed F-actin fibers arranged in shapes of cell junctions. Twelve months after the burn, endothelial defects were not found. Nearly all of the endothelial cells were normal in size and shape except for some mushroom-like projections toward the anterior chamber in some areas. Nineteen months after the burn, the endothelial cells were normal. Endothelial wound healing process can be continued even 1 year after the alkali burn in rabbit cornea.     

Randomised placebo-controlled trial of use of topical recombinant bovine basic fibroblast growth factor for second-degree burns

BACKGROUND: Wound healing is a dynamic process that could be accelerated by growth factors. We investigated the effect of recombinant bovine basic fibroblast growth factor (rbFGF) on burn healing in a randomised placebo-controlled trial. METHODS: We recruited 600 patients with superficial or deep second-degree burns. Patients received 150 AU/cm2 daily topical rbFGF (n=300) or placebo (n=300) plus vehicle. We assessed healing by photography, punch-biopsy, and clinical examination. FINDINGS: All patients treated with rbFGF had faster granulation tissue formation and epidermal regeneration than those in the placebo group. Superficial and deep second-degree burns treated with rbFGF healed in a mean of 9.9 (SD 2.5) days and 17.0 (4.6) days, respectively, compared with 12.4 (2.7) and 21.2 (4.9) days (p=0.0008 and p=0.0003, respectively). No adverse effects were seen locally or systemically with rbFGF. INTERPRETATION: rbFGF effectively decreased healing time and improved healing quality. Clinical benefits would be shorter hospital stays and the patient's skin quickly becoming available for harvesting and grafting.     

Efficacy of lomefloxacin and ofloxacin in complex therapy of infections in patients with burns]

The experience with lomefloxacin and ofloxacin respectively in the complex therapy of 26 and 40 patients with burns is described. The drugs were shown to be highly active in the treatment of burn wound infections and infectious complications of burn disease. The clinical efficacy of lomefloxacin and ofloxacin amounted to 88 and 77.5 per cent and the bacteriological efficacy amounted to 81 and 80 per cent respectively.     

Percutaneous electrical nerve stimulation (PENS): a complementary therapy for the management of pain secondary to bony metastasis

BACKGROUND: Metal skin clips are used in surgery. They may contain metals that might cause allergic reactions and delayed wound healing. METHODS: The metal composition of 18 different surgical clamps was examined. The allergy status of 184 patients was determined by patch tests and was correlated with the clinical outcome of wound healing after application of skin clips. RESULTS: Skin clips contained chromium, nickel, molybdenum, cobalt, and titanium in concentrations high enough to cause allergic reactions. Eighteen percent of the men and 23% of the women were sensitive to nickel and 16% of the men to chromium. We found a positive correlation between the grade of nickel allergy and the reaction to the skin clips. CONCLUSIONS: Our study suggests that allergic reactions and delayed wound healing can be caused by the use of surgical skin clips. Therefore skin clips are not recommended for patients with a history of contact dermatitis to metals and/or atopy.     

3D fast FLAIR: a CSF-nulled 3D fast spin-echo pulse sequence

OBJECTIVE: To examine the effects of peptidyl membrane interactive molecule D4B in a murine model of lethal burn wound infection. EXPERIMENTAL DESIGN: Four experiments were performed: (1) growth inhibition assays of Pseudomonas aeruginosa treated with D4B, 0 to 100 micromol/L; (2) in vitro coculture of bone marrow cells with D4B, 0 to 100 micromol/L; (3) D4B treatment survival studies after burn injury only or burn wound infection in mice; and (4) peripheral white blood cell count, burn wound tissue bacterial culture, and burn wound morphological analysis at days 1, 2, and 3 after injury. SETTING: University medical center laboratory. SUBJECTS: Groups of B6D2F1 male mice (20 each) were studied. INTERVENTIONS: Full-thickness scald burn, 15% of total body surface area, with P aeruginosa topical infection, and subeschar injections of D4B at 200 microg or 0.25 mL of placebo per mouse at 2 and 24 hours after injury. MAIN OUTCOME MEASURES: Animal survival after thermal burn wound bacterial infection, circulating leukocyte numbers, in vitro clonal cell culture of granulocyte-macrophage progenitor cells, and wound histopathological analysis. RESULTS: The survival rate in the D4B-treated group was nearly 2-fold greater than that in controls (P<.01) during 14 days of study. Bacterial quantitative wound cultures disclosed significant reductions in bacterial numbers at days 1, 2, and 3 in D4B-treated animals as compared with controls (P<.05 to <.01). D4B induced a dose-dependent inhibition of bacterial cell growth when added to in vitro P aeruginosa cultures (P<.01). Granulocyte-macrophage progenitor cell growth in culture was not altered by D4B treatment. D4B-treated animals displayed no signs of toxic effects or impairment in wound healing. CONCLUSIONS: The peptidyl membrane interactive molecule D4B had the ability to improve survival after gram-negative burn wound sepsis via direct antimicrobial effects. Peptidyl membrane interactive molecules may offer the potential of alternative treatments to standard topical agents or in patients with drug-resistant microbes.     

Analysis of collagen in burned skin with SDS-polyacrylamide gel electrophoresis

Type III collagen was determined by SDS-polyacrylamide gel electrophoresis in normal rabbit skin, skin with deep II degrees burn 72h after injury, skin one month after burn, and healed burn 1.5 month after injury. Results showed that there was a reduction of type III collagen in the process of healing of burn wounds.     

Use of laser Doppler flowmetry for estimation of the depth of burns

The trend for treatment of deep second degree burns and third degree burns is toward early excision and skin grafting. The ability to predict burn depth accurately as early as possible is important for early excision and skin grafting. This study, prospectively evaluated the ability of laser Doppler flow measurements, obtained within 72 hours after burn injury, to predict the depth of burn wounds. A Periflux system 4001 laser Doppler flowmeter was used to measure the cutaneous microflow circulation of 100 selected points of burn wounds on 44 inpatients and of 1680 selected points on 120 volunteers from March of 1993 to February of 1994. The mean value of superficial second degree burns checked by laser Doppler was 194.6 perfusion units (PU). The value of deep second degree burns was 59.7 PU, and the value of third degree burns was 5.1 PU. The mean normal cutaneous blood flow of 120 volunteers (control group) was between 4 and 9 PU, except on the head, neck, hand, and foot. Blood flow of more than 100 PU correctly predicted (90.2 percent of cases) a superficial second degree burn. Blood flow between 100 and 10 PU correctly predicted (96.2 percent of cases) a deep second degree dermal burn. That of less than 10 PU correctly predicted (100 percent of cases) a third degree burn. There was also a significant correlation between initial flow measurements and the depth of burn wounds. We conclude that laser Doppler flow measurements performed early after burn injury are useful in predicting the depth of burn wounds. Laser Doppler flowmetry has the advantage of being easy to use and noninvasive and of providing immediate results for early determination of burn depth. Laser Doppler flowmetry is useful in selecting patients for early excision and grafting of burn wounds.     

A silicone-coated nylon dressing reduces healing time in burned paediatric patients in comparison with standard sulfadiazine treatment: a prospective randomized trial

Mepitel is a new grid like silicone coated nylon dressing containing no additional biological compounds. We describe a prospective randomized pilot study comparing Mepitel to the standard silver sulfadiazine cream (Flamazine) dressing for the topical treatment of paediatric burns. Seventy-six children presenting within 24 h of injury with a non previously treated burn were randomly assigned to Mepitel treatment (group M) or Flamazine treatment (group F). Age, sex, surface area of burn and causal agent were noted at admission. The depth of the burn, cumulative number of dressings, presence or absence of a complete epithelial cover, infection, bleeding and allergy were noted at each dressing change. There were 41 children in group M and 35 children in group F. Five children were subsequently withdrawn from each group because they required skin grafting. Analysis of the above mentioned criteria showed no statistical difference between the two groups except for the healing time (group M: 7.58+/-3.12, group F: 11.26+/-6.02, p < 0.01) and the number of dressings (group M: 3.64+/-1.5, group F: 5.13+/-2.9, p < 0.05). Mepitel has proved to be an easy-to-remove dressing, adhering only to intact skin. The faster healing time found in the Mepitel group may be related to a direct effect of silicone on epithelial growth or to a decrease in surface-cell damage compared to the silver sulfadiazine group. This attractive product will be further assessed on a larger scale trial to confirm our observations.