摘要:

Ninety-four electrical burn patients were treated in a 5-year period at our center. The majority of these patients were males, in both children and adults, with the cause of injury mainly due to misuse, inattentiveness, lack of knowledge, and lack of parental supervision.Two major complications were encountered: musculoskeletal (37.3%), which required major amputations in 71.42%; and acute renal failure in 18.08%. Despite treatment with peritoneal and/or hemodialysis, the mortality rate in these series was quite high (58.82%). In order to decrease these complications, a closer monitoring of the patient and early surgical decompression must be applied.Therefore, to prevent this life-threatening event, measures should be taken by health-care officials and physicians to help educate the public in electrical burn prevention through every available means of communication.

ISSN:0022-5282    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

Carbon monoxide (CO) poisoning occurs frequently in victims of enclosed space fires, resulting in the formation of carboxyhemoglobin (COHb). Based on in vitro studies it has been suggested that CO poisoning causes a left shift of the oxyhemoglobin dissociation curve, decreasing peripheral oxygen extraction and exacerbating hypoxic injury. Formation of carboxycytochrome oxidase has also been postulated to act as a toxin by blocking cellular oxygen utilization. The effects of in vitro CO poisoning were evaluated in studies of 12 anesthetized, paralyzed dogs ventilated at 150 cc/kg/min. Six were subjected to CO poisoning by ventilation with a 0.5% CO in air inspirate. Six were ventilated with a mixture of air and nitrogen (N2) to produce a similar decrement of arterial oxyhemoglobin (aO2Hb) saturation. Arterial and mixed venous blood gases, thermal dilution cardiac output, and spectrophotometric arterial and mixed venous O2Hb and COHb saturation were measured. Oxygen consumption (VO2) and extraction (EXT) were calculated from these measurements and the CO and N2groups were compared by ANOVA and Wilcoxon sign rank test as oxyhemoglobin was progressively decreased. There were no significant differences in VO2or O2EXT in these two sets of animals subjected to equivalent reductions of arterial oxyhemoglobin despite the fact that CO poisoning was the mode of desaturation in one group. These findings suggest that CO poisoning is primarily a hypoxic lesion caused by replacement of O2Hb by COHb. Effects predicted from in vitro studies may not be manifest in vivo due to physiologic responses active in the whole organism. This may have implications for the resuscitation of CO-injured patients.

ISSN:0022-5282    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

Flagella preparations of the two antigenic types that make up all the flagella antigens inPseudomonas aeruginosawere used, individually, to immunize mice. Mice thus immunized were protected when burned and infected withP. aeruginosa. Protection was specific for the flagella antigen of the challenge strain but independent of its somatic antigen. When both antigens were used, together, for immunization, protection was independent of both the flagella and somatic antigen of the challenge strain. These results suggest that a divalentP. aeruginosa‘vaccine’ would be of considerable value for immunoprophylaxis in burn patients.

ISSN:0022-5282    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

Speed of closure of the burn wound has been shown to influence survival in several large series, yet is difficult to quantitate. A computerized wound mapping system is described which records and computes the extent of the burn wound and its rate of closure. The program stores, displays, and modifies a series of Lund and Browder charts for each patient. The percentage of the wound which is open is computed. Linear regression analysis is used to compute a Wound Closure Index (WCI). The hospital courses of 40 consecutive patients treated for major burns were analyzed using this system. Patients with <20% BSA burned, or with burns requiring less than 2 weeks' hospitalization, were excluded from the study. There were 31 survivors and nine who died. Mean WCI for survivors was 1.40, contrasted with 0.44 for nonsurvivors (p<0.001). To minimize the effects of age, patients over 60 years old were considered separately. Discriminant analysis applied to this subgroup confirmed that WCI was an accurate predictor of mortality. The system provides an accurate record of changes in the burn wound. The WCI gives an objective measure of wound closure which correlates with survival.

ISSN:0022-5282    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

Six cases are presented demonstrating uncomplicated primary healing following early microvascular reconstruction for complex electrical and deep thermal injuries. We advocate early preservation of eschar and the prevention of infection with the use of penetrating topical antibacterial agents, removal of the soft-tissue eschar when clinically indicated, and immediate coverage of the undebrided bone through the provision of well-vascularized tissue. Microvascular free tissue transfer should be considered as a primary method of reconstruction for complex electrical or thermal injury whenever clinically feasible. These reconstructive techniques offer an early, reliable means of definitive reconstruction, preserving function, providing uncomplicated healing, and promoting early rehabilitation.

ISSN:0022-5282    

出版商:OVID    

年代:1986

数据来源: OVID

ISSN:0022-5282    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

This study was done to determine whether early massive excision and grafting would decrease the hypermetabolic response that characterizes burn injury. Thirteen consecutively admitted adult males with burns over more than 45% of the total body surface area (TBSA) were randomly assigned to one of two treatment groups. One group was treated by excising the burn within 72 hours of injury and grafting with autograft overlaid with cadaveric allograft or cadaveric allograft alone depending on available donor sites and size of recipient areas. The second group was treated conservatively with daily hydrotherapy and twice daily applications of topical antimicrobial agents until granulating beds could receive autografts.Resting energy expenditure (REE) was calculated from measurement of vO2and vCO2at the patient's bedside. The responses of the two groups were comparable: the REE was approximately 20—30% above the predicted basal metabolic rate (BMR). Excisional therapy did not markedly decrease the hypermetabolic response to burn injury.

ISSN:0022-5282    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

This study examined the relationship between chemotaxis and susceptibility to infection. Rats were subjected to a 30% BSA burn to the dorsum of the back and resuscitated. Rats with burns from 1 to 11 days old were injected with varying inocula ofS. aureusinto nonburned skin. Animals with burns more than 6 days old had significantly decreased PMN chemotaxis into the inoculation site but had no increase in susceptibility to infection. This lack of correlation between PMN chemotaxis and susceptibility to infection suggests that PMN motility is not the dependent factor in resistance to infection fromS. aureusin this burn model.

ISSN:0022-5282    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

Thirty-two children admitted from 1977 through 1981 were treated by serial debridement of their burn wounds with 1:1.5 to 3:1 meshed autografting of granulating tissue as it became available. Thirty-two burned children treated from 1981 to 1984 were treated by early total excision to fascia with application of 4:1 expanded autograft and cadaver skin for complete closure. The ages (6.8 ± 0.6 years), sex distribution, and mean per cent third-degree burn (64 ± 1%) were the same in both groups. There were seven deaths in each group. Overall operating time (10.3 ± 0.8 hours) and units of blood loss (28.3 ± 3.5) were indistinguishable in the survivors of both groups. The survivors of the early excision group underwent fewer operative procedures, (5.8 ± 0.5 vs. 7.6 ± 0.5) and had a greatly decreased length of hospital stay (57 ± 5 vs. 97 ± 8). The ultimate functional and aesthetic consequences of the two techniques must be compared.

ISSN:0022-5282    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

The purpose of this project was the development of a small animal model and the use of external gamma imaging for the study of acute post-inhalation permeability changes. New Zealand white rabbits were anesthetized with ketamine and acepromazine IM, intubated, and a catheter placed in an ear artery. Smoke was produced by burning absorbent cotton in a combustion chamber supplied with 10 liters/min of air. Smoke was delivered to a holding chamber, allowed to cool to room temperature, and immediately delivered to the animals via endotracheal tube. Animals were allowed to inhale smoke for 3 sessions of 2 to 3 minutes. Blood samples were collected for the measurement of PO2, PCO2, and COHb. Lungs were removed at 3 to 4 days postinjury and subjected to microscopic histologic analysis.The results of six animal experiments showed a significant inhalation injury. The mean COHb level was 48% (range, 36%-58%). The change in the pre- and post-injury PO2and PCO2values were not significant (mean PO2, 66 mm Hg; mean PCO2, 32 mm Hg). Histologic evaluation of the lungs of three animals at 24 hrs postinjury revealed extensive loss of tracheal epithelium extended to many terminal bronchi. Inflammation of surrounding tissue, including edema and increased migration of polymorphonuclear cells, was also present. Analysis of tissue obtained at 10 to 14 days showed reparative re-epithelialization of trachea and major bronchi but acute inflammation and loss of intralobar bronchi. Inflammatory exudate extended to adjacent alveoli.In conjunction with the above model we have developed a method for the noninvasive measurement of lung permeability changes. This method is based on a dual tracer technique modified for external detection using a scintillation camera and digital computer. Tc-99m RBC and Tc-99m dextran (87,000 MW) are the reference and test tracers, respectively. Increased vascular permeability of test tracer is indicated by increased pulmonary extraction compared to the reference tracer.

ISSN:0022-5282    

出版商:OVID    

年代:1986

数据来源: OVID