Cases Of Severe Burns Research Articles

Nursing care for cases of severe alkali burns of eyes after amniotic membrane transplantation

目的 探讨新鲜羊膜移植治疗眼表急性重度碱烧伤的护理方法.方法术前采取有效的护理措施和针对性心理护理,术后严密观察植片生长和角膜创面愈合情况,保护眼部,加强点眼护理,去除引起泪膜异常的因素,做好出院指导等措施.结果采取以上护理措施,35例38眼均保全了眼球,眼表损伤迅速稳定,角膜不再继续融解,无穿孔发生,无新生血管长入,无睑球粘连并发症发生.结论系统的术前、术后护理以及针对性心理护理是提高手术成功率和减少术后并发症的重要保证。

High throughput high intensity focused ultrasound (HIFU) treatment for tissue necrosis

To increase HIFU throughput, a HIFU transducer (diameter of 7 cm, focal length of 6 cm, operating frequency of 3.4 MHz), coupled to an imaging probe (ICT 7-4, Sonosite), was driven by 100 W driving unit with 500 W amplifier. A water pillow connected to a circulation pump with degassed water provided transducer coupling and cooling. Input electrical power was 400 W, corresponding to focal intensity of 51<th>300 W/cm2 (in water). HIFU was applied transcutaneously in porcine thigh muscle in vivo, and intraoperatively in liver hilum, for 30–60 s. After 30 s of treatment, muscle lesions had diameter of 2.1±0.4 cm and length of 2.0±0.4 cm. After 60 s of treatment, muscle lesions had diameter of 3.1±0.9 cm and length of 3.1±1.0 cm. In few cases of severe skin burns, the lesions were formed immediately under the skin and were shallow (∼1 cm). Liver lesions had diameter of 2.1±0.3 cm and length of 2.3±0.6 cm. In comparison, after the 30 s treatment with our standard HIFU device (focal intensity of 27<th>000 W/cm2, in water) the muscle lesions had diameter of 1.3±0.6 cm and length of 1.1±0.6 cm. High power HIFU device can quickly coagulate large tissue volumes.

Macular burn after transpupillary thermotherapy for occult choroidal neovascularization

PurposeTo report a case of severe macular burn as a complication of transpupillary thermotherapy treatment for occult choroidal neovascularization. DesignInterventional case report. MethodsA 65-year-old man developed a severe macular burn following transpupillary thermotherapy treatment. ResultsBefore treatment, fluorescein angiography and indocyanine green angiography showed a progressive, ill-defined leakage corresponding to the presence of occult choroidal neovascularization. One month after treatment, fundus examination disclosed macular atrophy. The early phases of fluorescein angiography and indocyanine green angiography showed that the macular choroidal filling time had worsened dramatically. At the late phase of indocyanine green angiography, the initial hyperfluorescence of choroidal neovascularization was replaced by a persistent, markedly hypofluorescent area. ConclusionProlonged choroidal filling may be a risk factor for macular burn and choroidal occlusion after transpupillary thermotherapy. In such cases, we suggest that transpupillary thermotherapy should be considered with caution and, when applied, that its intensity should be reduced.

Active form of gelatinases in tear fluidin patients with corneal ulcer or ocular burn

Purpose: To investigate the expression of the active form of gelatinases (gelatinase A: matrix metalloproteinase-2 [MMP-2] and gelatinase B: matrix metalloproteinase-9 [MMP-9]) in ocular surface disorders, we determined the presence of the active form of these gelatinases in the tear fluid of patients with corneal ulcer or ocular burn. Methods: The subjects consisted of the ulcer group comprising 13 eyes, the burn group comprising 6 eyes, and the normal group comprising 10 eyes. Tear samples were taken by the method of the Schirmer test I. The tears were eluted using extraction buffer containing 0.01 M phosphate buffer solution (pH 7.2), 1% Tween 20 and 1 M NaCl, and analyzed by gelatin zymography. Results: Only the proforms of MMP-2, and MMP-9 were detected in the normal group and in uncomplicated herpetic keratitis or herpetic keratitis cases complicated by mixed infection in the ulcer group. Active MMP-9 was detected in mild corneal ulcer cases and mild ocular burn cases. Both active MMP-2 and active MMP-9 were detected in endogenous corneal ulcer cases and severe burn cases, including perforation cases. Conclusions: Both active gelatinases were detected in tears of severe corneal ulcer or severe ocular burn cases. The active form of gelatinase expression may be related to the severity of ulceration.

Treatment of bilateral severe eyelid burns with skin grafts: an odyssey

Eyelid burns occur in about 10% of thermal injuries and pose a considerable challenge for the reconstructive surgeon. A consensus on a treatment regime has not been reached and plastic surgeons are divided on the subject. A case of severe bilateral eyelid burns was treated with full- and split-thickness skin grafts. The patient was first operated at 2 years post-injury, and a total of 5 operations in 5 years were necessary to address recurrent ectropion of both upper and lower eyelids.

Severe burn injury in pregnancy in Northern Nigeria

A total of 21 cases of severe burns in pregnancy managed at the University of Maiduguri Teaching Hospital, Maiduguri, over a 10-year period, spanning January 1991-December 2000 inclusively were reviewed. The pregnancy loss was 92·9%, with the pregnancies spontaneously terminated within 10 days of sustaining the injury. Maternal mortality was 47·6% with sepsis as the most common cause of death. It is advocated that viable pregnancies should be terminated as soon as the mother is resuscitated following severe burn injury. Prophylactic systemic antibiotics should be given to minimise the development of sepsis. Patients are best managed in the obstetrics ward during the first 2 weeks of injury. A multidisplinary approach is encouraged in managing cases of severe burns in pregnancy.

Acute cerebral infarction caused by congenital hypoplasty of cerebral artery in a severe burn case

An 81-year-old man who had been healthy died 1 week after suffering severe burns. The autopsy revealed a fresh unilateral cerebral infarction with hemorrhagic transformation within the territory of the anterior cerebral artery (ACA) and hypoplasty of the A1 portion of the ACA. Since no other cause which could have resulted in this infarction was detected and since the victim had been healthy before the fire broke out, we concluded that this infarction occurred because of congenital hypoplasty of the left ACA and hypovolemic shock suffered after the burn injuries. Since cerebral infarction itself can lead to burn injuries or other accidents due to acute motor disturbance or syncope, detailed macroscopic and histological examinations of the brain of severe burn victims is important for evaluating the correlation between the infarction and a fire or other accidents.

Fig leaf tanning lotion and sun-related burns: case reports

A sun tan is considered a symbol of well-being in our society, but incorrect methods of sun exposure can create serious problems. We present two cases of severe sun-related burns caused by fig leaf decoction used as home-made tanning lotion. Twenty four–thirty six hours after application and sun exposure, patients developed a phytophotodermatitis characterised by erythema, and blister formation involving all the photoexposed areas (45–70% BSA). Their general conditions became rapidly critical and they were admitted to our Burn Centre. The patients were discharged after 11 and 26 days, respectively. Haemolytic anaemia and retinal haemorrhages presented as systemic complications due to the furocoumarins present in the fig leaf decoction.

Citric acid treatment of severe electric burns complicated by multiple antibiotic resistant Pseudomonas aeruginosa

A case of severe electric burns complicated by multiple antibiotic resistant Pseudomonas aeruginosa not responding to various antibiotics administered systemically is presented. Citric acid (3%) was used successfully to eliminate Pseudomonas aeruginosa from burn wounds and infection was completely controlled in 14 days. Citric acid treatment is evidently of value in the clinical control of burn wound colonization caused by difficult strains of Pseudomonas aeruginosa.

Oro-maxillofacial skeletal deformities resulting from burn scar contractures of the face and neck

The deforming forces of the scar contracture associated with burns of the head and neck region involve primarily the skin and secondarily the facial musculoskeletal structures. A case of severe face and neck burn accompanied by extreme facial skeletal deformity is reported. Best results are obtained in patients treated properly and promptly by a team including plastic and maxillofacial surgeons as well as orthodontists.

High pressure industrial steam washer injury resulting in digital amputation

High pressure washers are increasingly used to clean industrial machinery. We report a case of severe full skin thickness burn resulting from momentary exposure to the jet of steam.

Control of Growth and Differentiation In Vitro of Human Keratinocytes Cultured in Serum-free Medium

Normal human proliferative keratinocytes can be serially cultured in serum-free medium. The medium and culture conditions that have been developed support the growth of these cells in the absence of a feeder layer and in the absence of contaminating fibroblasts. Using this system, the nutritional and hormonal factors that affect the growth and differentiation of these cells have been studied in the absence of undefined supplements. The data suggest that the control of proliferation and differentiation in keratinocytes may take place by unique mechanisms. The defined serum-free conditions that have been developed provide an excellent system for the study of nutritional disorders that affect human epidermal cells. In addition, the culture system can be used to propagate large numbers of cells for use in autografts for cases of severe burns.

Formic acid burn—local and systemic effects report of a case

Formic acid is an organic acid which has mainly been used in industry, but in recent years its use in agriculture has greatly increased in the Scandinavian countries. Formic acid is more caustic to the skin than acetic acid. However, reports on formic acid burns are scarce in the medical literature, and no serious burn has previously been described. A few reports on formic acid ingestion have been published. It is of great interest that formic acid has been shown to play the major role in the methanol poisoning syndrome. A case of severe burn with undiluted formic acid is reported. In the beginning, the dermal injury seemed to be of minor degree, but then the patient, a 15-year-old girl, developed signs of systemic formic acid intoxication, including metabolic acidosis, intravascular hemolysis and hemoglobinuria. These signs were similar to those described as a result of formic acid ingestion. The systemic effects were successfully treated without late sequele, but the burn turned out mainly to be full-thickness, resulting in major scarring, as commonly seen after various chemical burns.

Treatment of severe burn cases in the air-fluidized bed

Abstract During a half-year period, the air-fluidized bed was used in the treatment of severely burned patients. In most cases good results were obtained. However, in the treatment of a 31-year-old patient with second and third degree burns of 40 per cent of the total body surface area, there occurred severe hypernatraemia, hyperosmolarity of the serum, mental disorientation and decubitus ulcers. The positive and negative results of the treatment are presented. Reasons for the poor results experienced in our series and in other burn centres will be discussed.

Pseudomonas aeruginosa infections in burns

Observations were carried out on 32 patients with burns. In 20 cases of extensive and severe burns Pseudomonas aeruginosa infections were found. Twenty-eight strains of Ps. aeruginosa were isolated from burn wounds and blood of the burn patients. These strains were typed by pyocine method. Among investigated strains of Ps. aeruginosa, the pyocine type A (39·2 per cent) dominated. When Ps. aeruginosa type A was present in burn wounds, the level of antibodies in blood sera of patients was distinctly increased. In 3 cases of septicaemia, low level of antibodies in blood sera of patients was found. Two patients died. All isolated strains of Ps. aeruginosa were sensitive to gentamycin and colimycin.

Survival of Burned Patients

ABSTRACT To the Editor:— The recent article by McCoy et al, Discriminant Function Probability Model for Predicting Survival in Burned Patients. (203:644, 1968), purports to enable one to determine prognosis in severe burn cases, but does not take into account improvements in burn survival that are made possible by the control of sepsis with large doses of antibiotics (200:939, 1967).Assuming that the statistical methods of McCoy et al are valid, the accompanying Table shows the difference in survival as predicted by their discriminant function model and the survival achieved at St. Mary's Burn Center, Milwaukee, with a prophylactic regimen of the highest tolerated doses of antibiotics and complete exposure.We point this out to avoid undue anxiety or pessimism that may discourage maximum treatment, especially in the case of older persons, who, as the comparison Table shows, have a much better chance of survival than McCoy et al

The burns unit in Copenhagen. II. Material and results, 1962-1966.

A 5–year material comprising 1326 in-patients from the Burns Unit, Kommunehospitalet. Copenhagen, is presented. This Unit admits all patients with burns from the municipality of Copenhagen (1136) as well as severe burn cases from other parts of Denmark (190). In addition, the Unit includes an out-patient clinic. The total annual number of patients has been fairly constant, while the proportion of patients from other parts of Denmark has increased considerably through the 5 years. The composition of the material in respect to sex, age, cause of burn, and place of accident is compared with the authors' previous paper on the “Total number of burn injuries in a Scandinavian population”. The marked differences between a material composed exclusively of in-patients and a material comprising also out-patients are discussed. Tables V and VI list the material by age, sex, extent of burn, and mortality in the various groups. Only 209 patients (one-sixth) had burns exceeding 10% of the body surface (Fig. 3). The dep...

The urinary excretion of “free” and “peptide” amino acids by a patient with thermal burns

The “free” amino acids and those liberated by acid hydrolysis in consecutive 24-h urine specimens from a case of severe thermal burns have been examined by quantitative ion exchange chromatography. There was a progressive increase in the excretion of both forms of amino acids. The proportions of glycine, proline and hydroxyproline and the presence of hydroxylysine in the “combined” amino acid fraction lead to the conclusion that the largest part of the urinary peptides originate from collagen.

COLLAGEN AS TEMPORARY DRESSING AND BLOOD VESSEL REPLACEMENT.

Carelessness in the handling of fire is the greatest cause for the large number of deaths as well as extensive property loss. Unfortunately the next cause for a large number of severe burn cases is a direct result of modern warfare. This was demonstrated in World War II and in Korea. The overwhelming mortality of these massive third degree burns and the paucity of definitive treatment induced us to investigate body fluids as a temporary dressing. The most obvious and the most readily available material was collagen. Collagen deposits can be created by placing an irritant foreign substance in the subcutaneous tissue. This was apparent in the use of plastics or skin in hernia repairs.1-4,8It has been known for some time that collagen deposits on casts of foreign materials. We decided to investigate the possibilities of its use in the treatment of third degree burns and as a

Value of Dermo-epidermic Grafts in Covering Amputation Stumps in Severe Burn Cases

Value of Dermo-epidermic Grafts in Covering Amputation Stumps in Severe Burn Cases