Period Of Burn Disease Research Articles

Near-Field Microwave Tomography of Biological Tissues: Future Perspectives.

This overview shows the mapping of specific visualization techniques, depth assessment of the structure of the underlying tissues and used wavelengths of radiation. Medical imaging is currently one of the most dynamically developing areas of medical science. The main aim of the review is a systematization of information on the current status of the microwave imaging of biological objects, primarily of body tissues. The main options of microwave sensing of biological objects are analyzed. Two basic techniques for sensing differing evaluation parameters are characterized. They are microwave thermometry (passive) and near-field resonance imaging. The physical principles of microwave sensing application are discussed. It is shown that the resonant near-field microwave tomography allows visualization of the structure of biological tissues on the basis of the spatial distribution of their electrodynamic characteristics - permittivity and conductivity. Potential areas for this method in dermatology, including dermatooncology, are shown. The known results of applying the method to patients with dermatoses are given. The informativeness of the technology in the early diagnosis of melanoma is shown. The prospects of microwave diagnostics in combustiology, reconstructive and plastic surgery are demonstrated. Thus, microwave sensing is a modern, dynamically developing method of biophysical assessment of body tissues. There is a strong indication of the feasibility of application of microwave sensing in combustiology (in different periods of burn disease), as well as in reconstructive surgery. Further research in this and other areas of biomedicine will significantly expand the range of possibilities of modern technologies of visualization.

Нарушения функции почек в остром периоде ожоговой болезни и их прогностическое значение

Цель исследования: определить влияние тяжелой термической травмы на изменение уровня показателей функции почек в острый период ожоговой болезни. Материалы и методы. Проведен ретроспективный анализ 132 пациентов с тяжелой ожоговой травмой, которые были распределены на две группы в зависимости от исхода ожоговой болезни. Результаты. Были исследованы 132 истории болезни пациентов с тяжелой ожоговой болезнью. У 5,4 % (n = 3) пациентов I группы и 85,5 % (n = 65) пациентов II группы наблюдалось развитие острого поражения почек. Также у 10,5 % (n = 8) пациентов II группы в анамнезе отмечалось хроническое заболевание почек. В первые сутки острого течения ожоговой болезни отмечалось повышение уровня креатинина во II группе — 84,8 ± 4,2 мкмоль/л, что превышало показатели I группы, которые были ниже нормы — 67,9 ± 2,1 мкмоль/л. Показатели уровня мочевины сыворотки крови были повышены с первых суток ожоговой болезни в I и II группах и достигали максимума на 14-е сутки острой фазы ожоговой болезни (р = 0,304 и р = 0,694) соответственно. Протеинурия в исследуемых группах наблюдалась с первых суток ожоговой болезни и достигла максимума на 7-е сутки в І группе (0,22 ± 0,1 г/л, p = 0,115) и на 14-е сутки — во II группе (0,2 ± 0,1 г/л, p = 0,069). Темп суточного диуреза в течение всего периода ожоговой болезни существенно не менялся в обеих группах. Выводы. Течение тяжелой ожоговой болезни у больных сопровождается развитием почечного поражения, что в совокупности с возрастом, степенью поражения и наличием сопутствующей патологии обусловливает высокую летальность.

Витамин D и ожоговая травма

Дефицит витамина D является характерным для общей популяции населения. Он также отмечается у 40–70 % пациентов отделений реанимации и интенсивной терапии. Витамин D обладает широким спектром плейотропных эффектов на различные процессы и системы, включая иммунную воспалительную реакцию. Низкие уровни витамина D у критических больных ассоциируются с более частым развитием сепсиса, респираторного дистресс-синдрома, полиорганной недостаточности, повышенной летальностью. Клиническое понимание гиповитаминоза D остается не совсем оцененным, и поэтому он часто игнорируется в острых клинических ситуациях, включая ожоговую травму, при которой существует ряд факторов, способствующих развитию и длительному сохранению дефицита витамина D. Хотя исследования по изучению уровня витамина D у пациентов с ожогами ограниченны, было показано, что содержание витамина D снижается после термической травмы. Цель данного обзора — выяснение текущего понимания роли витамина D у больных с термической травмой, влияния уровня витамина D на результаты лечения в разные периоды ожоговой болезни, возможности и необходимости коррекции гиповитаминоза D у данной категории больных. В работе проанализирована возможность улучшения результатов лечения ожоговой травмы, предотвращения ряда осложнений ожоговой болезни путем коррекции уровня витамина D.

Структура фізичної реабілітації в гострому періоді у хворих комбустіологічного профіля

У опікових хворих, внаслідок неминучого збереження косметичного дефекту післятравми, хоча і за наявності позитивних функціональних результатів лікування, реабілітації від-водиться першочергове значення. Фізична реабілітація пацієнтів з опіками послідовно прово-диться в усі періоди опікової хвороби. Превентивна реабілітація (перший етап) проводитьсяв гострий період травми в процесі відновлення втраченого шкірного покрову. На другомуетапі – ранньої консервативноїреабілітації, коли після закриття ран відбувається інтенсивнеформування рубцевої тканини, консервативні заходи спрямовані на обмеження, розм’якшеннярубців і профілактику деформацій і контрактур.

AGGREGATION AND SIZE OF PLATELETS IN CHILDREN WITH BURN DISEASE

Introduction. One of the main factors involved in the pathogenesis of burn disease consists in the disturbance of microcirculation and haemostasis, caused by increased platelet aggregation. Mechanisms underlying the enhancement of platelet aggregation are poorly understood. Main results were obtained for adult patients at the onset of the burn disease, with no similar data on paediatric patients being available. There is evidence of a relationship between the size of platelets (MPV) and their functionality.Aim. To undertake a study of spontaneous and ADP-induced platelet aggregation and their size in children with burn disease.Materials and methods. We studied the aggregation and size of platelets in children aged 3–17 years, in whom burn areas covered 10–70 % of the body surface at the onset of the disease and before discharge. Spontaneous platelet aggregation was analysed under conditions of induced shear flow, whereas ADP-induced aggregation was studied employing a turbidimetric method. The study of platelet sizes was carried out using a conductometric method.Results. Spontaneous platelet aggregation increases significantly in children with burn disease. The integrated optical density of the formed aggregates, their area and perimeter were estimated for the first time. These indicators remained elevated even after burn wounds had been completely closed. In burn disease, changes in ADP-induced platelet aggregation were multidirectional in nature. Mean platelet volume (MPV) was increased during the acute period of burn disease, decreased during the period of toxaemia, and normalised by the time of patients’ discharge. Changes in MPV did not affect the aggregation properties of platelets. There was no correlation between the degree of aggregation and the severity of hyperfibrinogenemia. The blood of burn patients contained a large number of activated platelets, which was the reason for the increase in their spontaneous aggregation, not requiring the participation of exogenous inducers.Conclusion. An increase in spontaneous platelet aggregation was observed in children after a thermal injury, which remained elevated until the burn wounds were completely closed. A significant increase in the number of activated platelets constituted the reason for the increase in spontaneous platelet aggregation.Conflict of interest: the authors declare no confl ict of interest.Financial disclosure: the study had no sponsorship.

Peculiarities of the wound healing process in the acute period of burn disease depending on the antiseptic used

Background. Burn injury, as one of the most common types of trauma, requires a comprehensive approach to treatment, including surgical and conservative treatment with effective post-burn wound protection. One of the main obstacles to wound healing is purulent-infectious complications, for prevention of which antiseptics are widely used.
 The aim is to study the microbiological, histological features of the wound healing course in the acute period of burn disease with the use of various antiseptics.
 Materials and methods. In the research there were involved 44 patients with burns (burn area 10–20 % of the body surface), treated in the Clinical Center for Thermal Injury and Plastic Surgery of Communal Non-Commercial Enterprise “Vinnytsia Regional Clinical Hospital named after M. I. Pirogov” (2018–2019). Depending on the antiseptic therapy, these patients were divided into three observation groups. Patients in the 1st study group (n = 15; mean age 48.07 ± 12.05 years) were treated with 2.0 % povidone-iodine during dressing. In the 2nd group (n = 15; mean age – 48.53 ± 14.76 years) antiseptic based on 0.02 % decamethoxin was used. In patients of the comparison group (n = 14; mean age – 47.71 ± 12.39 years) a solution of 10.0 % NaCl was administrated for topical wound management. Microbiological assessment of the condition of the wound surface (on 3, 7, 14, 21 days) and histological examination of tissue samples from the bottom of the wound (on 3, 7, 14 days) were carried out by means of standard methods.
 Results. Under the use of antiseptic agents based on 2.0 % povidone-iodine and 0.02 % decamethoxin during the treatment period in patients with burns up to 14 days, an effective reduction in the number of conditionally pathogenic microorganisms on the wound surface to lg (4.8 ± 0.4) and lg (3.06 ± 0.5) CFU/ml, respectively, was registered and it was significantly 1.5 times lower than that based on 10 % sodium chloride solution (p < 0.05). When applying decamethoxin for 14 days at the same time as the eradication of conditionally pathogenic microorganisms, moderate colonization of wounds was registered by representatives of normal skin microbiota (Corynebacterium spp., S. epidermidis). Histologically, there was found that with the use of 2.0 % povidone-iodine, the wound healing course was accompanied by a marked decrease in inflammation signs, as well as a pronounced inhibition of the formation of granulation tissue (10–14 days). The use of 0.02 % decamethoxin was accompanied by the formation of granulation tissue of sufficient maturity for atodermoplasty, in the presence of signs of inflammatory cellular reaction with the presence in the superficial parts of the bottom of the post-burn wounds of the fibrinoid layer, with signs of permanent formation of new hemocapillaries in it, surrounded by a thin argyrophilic mesh. When using a hypertonic sodium chloride solution before autodermoplasty, the granulation tissue had signs of uneven inflammatory cell infiltration. Signs of leukocyte-necrotic tissue changes, fibrinoid-leukocyte layers with fragments of tissue detritus, signs of resuscularization of granulation tissue were recorded.
 Conclusion. Microbiological data strongly suggest the efficacy of 0.02 % decamethoxin and 2.0 % povidone-iodine in reducing microbial wound colonization infection compared to 10.0 % NaCl. The use of antiseptics and hypertonic sodium chloride solution in the acute period of burn disease provides a marked reduction in histological signs of inflammation in the wound with a noticeable positive effect of decamethoxin and 10.0 % NaCl on the formation of granulations and their revascularization compared with povidone-iodine (p < 0.001).

The Results of Gastric pH-metry in Patients with Extensive Burns

Aim of studyTo study of the role of hydrochloric acid in the genesis of stress-induced gastric ulceration in patients with extensive burns.Material and methodsThe results of gastroscopy and endoscopic pH-metry of 30 young patients with extensive burns (19 male patients and 11 female patients). The acidity of the gastric contents was measured on day 1,7 and 14 after the trauma.ResultsIt was found that the early period of burn disease was followed by the pH growth in the acid-producing area of the stomach to 3.8–4.2 (p=0.002–0.020). This indicated that extensive burns provoked a significant decrease of hydrochloric acid production by parietal cells of the stomach. The restoration of the acid production occurred only 14 days after thermal injury and was not followed by the development of a hyperacid state. The frequency of erosive-ulcerative lesions detection in the gastric mucosa by the end of the first day after receiving burns was 83%, 87% on day 7, and 96% on day 14. In total, stress-induced lesions of the gastrointestinal mucosa were diagnosed in 26 of 30 patients with a shock-induced thermal injury. Consequently, in patients with burn shock the protective factors of the gastric mucosa were depressed so that a minimum amount of hydrochloric acid was sufficient to damage it.ConclusionInhibition of acidogenic function is typical for patients with burn disease. Hydrochloric acid does not play a leading role in the genesis of stressinduced ulceration in patients with severe thermal trauma.

A comparative description of dynamics of metabolic response indexes in the phases of burn disease course depending on terms of the onset of surgical intervention.

A question of possibilities of influence on decline of progressing systemic response on the burn trauma remains open, despite actuality and active study of this problem. The aim of this work was carrying out a comparative description of dynamics of metabolic response indexes in the phases of burn disease (BD) course depending on terms of the beginning of the surgical intervention. Рatients with a thermal trauma were inspected and analyzed in this work. All the patients were estimated for the index of the thermal defeat severity, the percentage of the area of deep burn, a general area of burn, the age of a patient and the presence of respiration system burn. According to these, all the patients were divided into separate groups of research. The 1st group included 46 injured with the index of thermal defeat severity (TDS) from 61 to 90 units. The 2 group included 29 patients with the TDS index over 91 units. According to the terms of surgical intervention, patients of these groups were divided into sub-groups: 1.1 and 2.1, where the first surgical intervention was conducted five days before burn disease; 1.2 and 2.2, where the first surgical intervention was conducted five days after of burn disease. The level of cortisol and glycaemia of blood serum of injured people on different stages of inspection were taken into consideration. The diagnostically-curative program was conducted according to the clinical protocol of medical care to injured with thermal trauma. Estimating the dynamics of cortisol level, there was a considerable increase of it over the first twenty-four hours in both groups, which preserved during an acute period of burn disease. In the patients of the sub-group 2.1, with the TDS index over 91 units, who underwent early surgical tactics, the further activating of a sympathic adrenal system on the 7th day after the burn (an increase in cortisol by 82% compared with the previous indicator) was noted. From the first twenty-four hours after the burn, injured people suffered from a stress-induced hyperglycaemia which developed in all research groups, the latter did not depend on the severity of the burn trauma and did not correlate with the cortisol level of blood serum. With the early surgical treatment of burns, a more rapid normalization of blood glucose level in patients of 1.1 and 2.1 sub-groups on the 5th and 7th day of burn disease accordingly occurred.

SOLUBLE CD25 AND CD95 MOLECULES LEVEL AT BURNS

Background: Burn injury is accompanied by modulation of the many components of immunity, including the system regulation, which includes soluble forms of leukocyte differentiation molecules. Earlier in burn patients, we detected changes in serum levels of soluble differentiation molecules CD25 (sCD25) and CD95 (sCD25). Despite the existence of data on change of serum level of the soluble molecules CD25 and CD95 in the blood of patients with a burn trauma, there are no data on particular cell producers.Aims: To conduct the analysis of serum level of the molecules sCD25 and sCD95 in the blood of patients with acute burn trauma in comparison with peripheral blood cells composition to obtain data on the types of cells that produce the molecules sCD25 and sCD95.Materials and methods: Blood samples from 24 heavily burnt patients aged 16 to 77 years were studied. Determination of sCD25 and sCD95 molecules serum levels was performed by ELISA. Number of CD45+CD25+ lymphocytes, CD45+CD95+ cells, CD14+CD95+ monocytes, CD16b+CD95+ neutrophils, and RFMI (relative mean fluorescence intensity) was evaluated by flow cytometry.Results: In the first five days of the date of burn sCD25 and sCD95 serum levels tended to increase. sCD25 molecules contents in the blood of surviving and dead patients did not depend on the relative content of CD45+CD25+ lymphocytes, RFMI index, but correlated with the absolute level of lymphocytes and leukocytes. Serum levels of sCD95 molecules showed the dependence on the absolute neutrophil count and leukocytes in the survivors and on the absolute content of lymphocytes, neutrophils, and leukocytes in patients who died.Conclusions: The findings suggest that the lymphocytes in the early period of burn disease are the main cells-producers of sCD25 and affect the increase of its content in the blood serum not due to changes in the density of CD25 molecules expression on their membrane followed by increased shedding but by increasing the number of CD25 positive cells. The main cells-producers of sCD95 molecules for survivors in the early period of burn disease are likely to be the neutrophils and lymphocytes; in the dead patients, the main producers are neutrophils.

Liver dysfunction in pathogenesis of burn disease and its correction with succinate-containing drugs

Current information on the effects of extensive and deep burns upon the liver functions as well as some novel methods of its correction with succinic acid derivates are reviewed. The liver is the main target organ for extensive burn injuries. Manifestations of cytolytic and cholestatic syndrome were observed already on the first days of the disease. To correct these conditions a comprehensive layout of the infusion of intensive therapy is needed. In burn disease it is impossible to restore the circulating blood volume only by infusion of plasma-substituting solutions. Thus, these cocktails must contain drugs, stabilizing metabolic disorders and reducing the concentration of proinflammatory cytokines. Complex intensive therapy in case of burns should also include correction of energy production within the cells without increasing oxygen transport. Substrate antihypoxic drugs are used in order to reduce the need of tissues for oxygen, stabilization of cell membranes and reduction of lipid peroxidation. Succinic acid is a substrate antihypoxic drug capable of detoxification, antihypoxic, antioxidant and hepatoprotective effects. Its derivates modify cellular respiration, compensate for metabolic acidosis, reducing lactate, pyruvate and citrate concentration, normalize histamine and serotonin concentration, improve microcirculation without affecting systemic hemodynamics. All of these effects are pathogenetically substantiated in the treatment of patients with burns. Data regarding the use of drugs on the basis of succinic acid in the treatment of patients with extensive deep burns, critical and supercritical burns during various periods of burn disease, their influence on the severity of multiple organ dysfunction in these patients, the presence of hepatoprotective effect are reported in a few of publications and their conclusions are so far ambiguous enough.

Burn encephalopathy and syndrome of hypermetabolism-hypercatabolism: is there an interrelation?

Aim : To define an influence of hypermetabolism-hypercatabolism syndrome on the burn encephalopathy development on the base of study of metabolic changes on the background of an acute period of burn disease. Materials and methods : there were examined 104 patients separated in 2 groups depending on heaviness of injury. There were defined the levels of cortisol, neurospecific enolase (NSE), glucose and blood protein. There were assessed memory, thinking and psychological state of patients. Results : At admission to hospital the cortisol level in patients of 1 and 2 groups was 270,5±29,2 ng/ml and 330,3±17,4 ng/ml, glucose level - 6,0±0,4 mmol/l and 7,7±0,5 mmol/l in 1 and 2 groups respectively. The protein level of blood maximally decreased at 3 day and was 53,6±1,1 g/l in patients of the 1 group and 48,9±1,1 g/l in patients of the 2 group. An increase of cortisol level depended on heaviness of thermal trauma. There was defined correlation between the levels of cortisol and neuron specific enolase in patients of the 1 group at 3 day (R=0.638, p=0.006), in patients of the 2 group at 7 day (R=0.488, p=0.002). In patients of the 1 group sleep disorder and delirium development did not depended on the level of metabolic changes. At the 7 day there was defined correlative connection between cortisol level and memory (R=-0,681, p=0,071) and thinking (R=-0,520, p=0,038). In patients of the 2 group cortisol level at 1 day determined the memory and thinking disorders to the septic-toxemia stage. Sleep disorder correlated with expressed hypoproteinomia at 3 day (R=-0,483, p=0,001). The delirium development was caused with an increase of blood serum cortisol at 1 day after thermal trauma (R=0,467, p=0,058). Conclusion : The one of mechanisms of nerve tissue injury was the development of metabolic changes caused by stress on the background of heavy thermal trauma. The dynamics of cortisol level to the burn shock stage corresponded with the changes of neurospecific enolase level of blood serum as a marker of the nerve tissue injury

SYSTEM ANALYSIS OF METABOLIC PROFILE OF BLOOD IN PATIENTS WITH THERMAL TRAUMA

Aim: to make multiparametric analysis of blood metabolic profile in early period of burn disease. Materials and methods: we tested blood samples of 15 healthy adults (control group) and 60 patients with thermal trauma (main group — II–IIIA, B degree of burn, more then 15 bsp). Parameters of lipid metabolism, level of glucose, lactate, malonic dialdehyde and some enzymes in blood plasma and erythrocytes were estimated. Results: in early period of burn disease we fixed the clear metabolic disorders, including tissues hypoxia, activation of plasma transaminases and oxidoreductases, inhibition of detoxication system, induction of oxidative stress. Connection of metabolic changes, associated with burn disease, was registered. It supported by numerous correlations between studied parameters, formed from first day after trauma. Conclusions: our data expand the knowledge about mating metabolic changes of catalytic activity of blood enzymes, forming in early period of burn disease (system metabolic disadaptation), and diagnostic value of some blood biochemical parameters in estimation of burned patient metabolism.

Intravenous Laser Therapy in Young Children with Thermal Injuries

Objective : to evaluate the laboratory and clinical effects of combined intravenous laser therapy in young children with thermal injuries in the acute period of burn disease. Subjects and methods. Forty children whose mean age was 2.67±0.35 years were examined; thermal injuries accounted for 25.05±1.01% of the total body surface area; of them degrees IIIaIIIb was 19.04±0.85%. A comparison group (n=15) received conventional therapy without taking into account and correcting baseline and current hemostasiological disorders. On day 1, a study group (n=25) had programmed anticoagulant therapy and intravenous laser therapy at different radiation frequencies with a Mustang 20002+ laser therapy apparatus (patent for invention No. 2482894) in addition to the conventional therapy. The laser therapy cycle was 6 to 16 sessions. The investigators estimated and compared the following examined parameters: white blood cell count; leukocytic index of intoxication; plasma average mass molecules at a wavelength of 254 nm; toxogenic granularity of neutrophils; wound exudate discharge time; surgical plasty area; and hospitalization time. Results. The positive laboratory and clinical effects of the performed combined intravenous laser therapy in the combined therapy of burn disease in young children were comparatively shown in the study group patients. The significant decrease in the level of an inflammatory response and endogenous intoxication led to a rapider burn wound cleansing, active epithelization, and reduced surgical plasty volumes. Conclusion. Combined intravenous laser therapy signif icantly exerts antiinflammatory and detoxifying effects in young children with 40% thermal injuries in the acute period of burn disease. Abolishing a systemic inflammatory response by combined intravenous laser therapy initiated early regenerative processes in the burn wound and caused reductions in surgical plasty volumes and hospitalization time, which optimizes ther apy for burn disease.

Hemostasis system condition in infectious complication development in severe burned patients

Over the period of the history of combustiology one of the main problems for treatment of patients with burns is infection, both local - bacterial pneumonia - and generalized - sepsis - characterized by extremely severe course, complex diagnostics and high lethality rate. However, the role of hemostasis disorders in infectious complication development in severe burned patients is taken into consideration insufficiently. The aim of the study is to reveal the most relevant hemostasis system changes in sepsis and pneumonia in patients with serious heat injury in an acute period of burn disease.

Pathomorphology of the superior cervical sympathetic ganglia in burns

Structural changes of upper cervical sympathetic ganglions of 75 patients who died in different stages of burn disease at the age of 19-85, were studied by neurohistological and neurohistochemical methods. It was determined that neurones change at earlier stages of burn disease begins with their reactivity increase. Later hypertrophy, atrophy and decay of neurones body take place. Sharp cateholamine exhaustion in the structures of upper cervical sympathetic ganglions is also determined during the first days of burn trauma (burn shock stage). Some restoring of mediator stock takes place in subsequent periods of burn disease.

Correction of protein metabolism in burns

Abstract The inhibitors of a trypsin-kallikrein system and high calorie parenteral feeding were successfully used for correcting protein metabolism in 267 patients, both in acute and later periods of burn disease. With deficiency of the insulin apparatus the effective treatment was insulin therapy with consideration of the insulin tolerance test. Complex treatment of burn disease may include either of these methods or both.

Changes in the excitability of the heart during the acute period of burn disease

Changes in the excitability of the heart during the acute period of burn disease