Burns : journal of the International Society for Burn Injuries
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Randomized Controlled Trial
Enteral resuscitation and early enteral feeding in children with major burns--effect on McFarlane response to stress.
Early enteral feeding has become standard practice for burned patients. The aim of this study was to determine whether early enteral feeding could be used as an avenue for resuscitation and feeding and the effect it would have on the induction/amelioration of the hormonal stress response. ⋯ Enteral resuscitation and early enteral feeding is a safe and effective method and particularly suited for children in developing countries. It resulted in the amelioration of the hormonal stress response and improved outcome. Enteral resuscitation should not be introduced in a patient in shock or with existing gastrointestinal disease. Complications were minimal.
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Methods for handling burn wounds have changed in recent decades and increasingly aggressive surgical approach with early tangential excision and wound closure is being applied. Split-thickness skin (STSG) autografts are the "gold standard" for burn wound closure and remain the mainstay of treatment to provide permanent wound coverage and achieve healing. ⋯ Questions related to optimal cell type for culture, culture techniques, transplantation of confluent sheets or non-confluent cells, immediate and late final take, carrier and transfer modality, as well as final outcome, ability to generate an epithelium after transplantation, and scar quality are still not fully answered. Progress accomplished since Reinwald and Green first described their keratinocyte culture technique is reviewed.
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Amniotic membranes collected from the placentae of screened donors were processed and sterilized by gamma irradiation at 25 kGy. The sterility assurance level (SAL) of gamma irradiated amniotic membranes and clinical efficacy in second-degree burn wound healing were evaluated. Processed air-dried amniotic tissue from 159 batches of processing was checked for the bioburden level before sterilization. ⋯ The bacteriology of fluid showed Pseudomonas aeruginosa in four cases, Staphylococcus aureus in two cases, Escherichia coli in two cases and Acinetobacter in one case. The application of radiation sterilized amniotic membranes on the burn wound favoured epithelialization. In all the patients, membranes dessicated and separated in 10-14 days time leaving behind an epithelialized surface.
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Toxic epidermal necrolysis (TEN) and Stevens-Johnson syndrome (SJS) are rare, drug-induced, severe acute exfoliative skin and mucosal disorders. Several treatments previously proposed have produced contradictory results in small series; in 1998 the use of intravenous immunoglobulins (IVIG) was introduced with excellent clinical findings. Our experience (1999-2005) using IVIG in the therapy of TEN/SJS, together with a local conservative approach, is reported and related to our previous treatments (1993-1998). ⋯ Concerning the local approach, a conservative wound management in IVIG series replaced an extensive epidermal debridment and coverage with artificial skin substitutes of the pre-IVIG series. Overall mortality in patients treated before IVIG was 75% (6/8), in the IVIG group it decreased to 26% (6/23) with a cessation of further epidermal detachment after an average of 5 days (3-10 days) from the onset of the therapy. The SMR showed a trend to lower actual mortality (not significative) with IVIG treatment than the predicted mortality (SMR=0.728; 95% CI: 0.327-1.620).