Burns : journal of the International Society for Burn Injuries
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The first 12 months of a new consultation-liaison service to a burns unit is described. Management of contact between the psychiatrist and the burns team is discussed and diagnostic categories are given for referrals seen. Diagnostic criteria are not achieved for many patients assessed, and yet the burns team still requires help managing patients who are psychologically disturbed. Education and a forum for team discussion are used as a way for the burns team to integrate psychological work in the management of their patients.
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A woman with very extensive burns (of over 75 per cent TBSA and 45 per cent full skin thickness) received cyclosporin to extend the survival of skin allografts obtained from several unmatched donors. The patients' wounds appeared completely healed after 3 months when the cyclosporin was discontinued. ⋯ The burns were then successfully covered with autografts during two operations. The late functional results were excellent.
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Haemodynamic monitoring is important in severely burned patients and repeated catheterization of the arteries of these victims seems to be inevitable. We present a 46-year-old female with 54 per cent TBSA burns who suffered from bilateral femoral mycotic aneurysms due to repeated arterial punctures.
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Postburn metabolic and immunological alterations may in part be due to translocation of gut exotoxin and endotoxin, which can result in tumour necrosis factor (TNF) and prostaglandin E (PGE) production by macrophages. We evaluated the effect of burn injury, plus exotoxin and endotoxin on TNF-alpha and PGE production by Kupffer cells, and peritoneal macrophages. Adult Wistar rats underwent 30 per cent TBSA burn or sham burn. ⋯ The increased TNF-alpha production was inversely related to PGE levels. In conclusion, both burn injury and Exo-A potentiate the responsiveness of Kupffer cells and peritoneal macrophages to endotoxin as measured by the rate of production of TNF-alpha and PGE. PGE may locally downregulate the immune response by limiting Kupffer cells' and peritoneal macrophages' TNF-alpha production.
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A prospective study was performed that allowed a quantitative estimation of blood loss in excision and grafting of adult burn injuries. The average value for blood loss was 9.2 per cent of the patient's estimated blood volume or 387 ml per 1 per cent burn excised and grafted. ⋯ These values do not apply to the very young, the very old and those patients who have bleeding disorders, and when using various methods to limit blood loss. This figure allows adequate cross-matched whole blood to be available preoperatively.