Burns : journal of the International Society for Burn Injuries
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Two non-invasive methods (the bioimpedance technique, BIA, and the impression method, IM) were studied, to find out whether they are sensitive enough to detect and chronicle the development of the oedema and fluid resuscitation effects (Parkland formula) that occur secondary to a major burn. Ten patients with a total burned body surface area (TBSA) of more than 10% were included in this prospective study. Total body water (TBW), as measured by the resistance (BIA) or F(0) variable (IM), reached a maximum on day 2. ⋯ The phase angle (BIA) indicative of cellular membrane effects of burn and sepsis had its lowest values at day 1.5, and stayed significantly low until day 4. Interestingly, the phase angle was lowest in the two cases that died subsequently. The different time course of the INT value (IM), which reflected the translocatable interstitial fluid volume in skin, may be the result of resuscitation fluid remaining in this compartment, due to the excess sodium content together with a possible change in tissue compliance secondary to the early total water peak on day 2.
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Comparative Study
A longitudinal study of C3, C3d and factor Ba in burn patients in Hong Kong Chinese.
A longitudinal study of serum C3, C3d and fragment Ba was carried out in 53 burn patients of Chinese origin whose total burn surface area ranged from I to 45%. Complement C3 was found to be activated on or before day 7 post-burn. ⋯ In addition factor Ba was increased in these patients, suggesting that the alternative pathway was also activated following thermal injuries. The fluctuations of C3, C3d and Factor Ba observed about 1 year after injury suggested chronic inflammation associated with long term of outcome of healing in the burn sites.
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This paper provides an overview of thermal injury resulting in death or hospitalization in New Zealand adults, defined as age 15 years and over. For the 10-year period 1978-1987, there were 493 adult thermal injury deaths resulting in an overall rate of 2.1 per 100000 person-years (95%CI: 1.9-2.3). For the year 1988, there were 644 hospitalizations resulting in a rate of 25.1 per 100000 (95%CI: 23.2-27.1). ⋯ Typical scenarios involved burns from hot water expelled from automobile radiators, from hot water use in the workplace, from hot beverages, and from household hot tap-water. The epidemiology of the adult thermal injuries in New Zealand is similar to that reported in other developed countries. Opportunities and strategies for the prevention of these injuries are discussed.
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Comparative Study
Clinical experience of postage stamp autograft with porcine skin onlay dressing in extensive burns.
Fifteen patients with extensive burns (deep second-degree burn > 50%, or third-degree burn > 30% of total body surface area) were treated with postage stamp autograft and meshed porcine skin onlay dressing from 1992 to 1996. All patients received the procedure within 10 days of sustaining the burn, with an average of 6.3 days. The areas chosen for postage stamp autograft were the anterior chest, abdomen, back, buttocks and the proximal part of the extremities. ⋯ The success rate of the skin grafts was nearly 100% in 14 patients. One patient had a 40% loss due to contamination from adjacent wounds. In conclusion, the postage stamp autograft with porcine skin overlay is an effective way to treat extensive burn wounds in the early stages.
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Case Reports Comparative Study
Intrabronchial surfactant application in cases of inhalation injury: first results from patients with severe burns and ARDS.
Damage to the respiratory tract caused by inhalation of toxic products of combustion with subsequent development of an acute respiratory distress syndrome (ARDS) is one of the main causes of death in burn patients. Treatment with an exogenous surfactant is a therapeutic option for which there has previously been no empirical data. We report on four severely burned patients with deep partial thickness and full thickness burns of between 40 and 70 per cent body surface area (BSA), and with inhalation injury complicated by ARDS. ⋯ After the limits of mechanical ventilation had been reached, bronchoscopic intrabronchial administration of surfactant was followed by temporarily improved gas exchange with an increase in arterial O2 partial pressure (PaO2), accompanied by a reduction in inspiratory O2 concentration (FiO2), and also improved lung compliance. All the patients survived in spite of an initially unfavourable prognosis. Replacement of exogenous surfactant in the treatment of inhalation traumatized severe burn patients with ARDS appears to show considerable promise as an approach to improving the survival chances of these high-risk patients.