Burns : journal of the International Society for Burn Injuries
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Epidemiology and mortality among burn patients over age 60 years who were admitted to the Burn Centre of La Fé Hospital (Valencia, Spain) between 1 January 1988 and 1 January 1991 have been studied. A total of 443 patients (7.8 per cent of all presenting patients) were hospitalized during this 3-year period; of these, 69 (15.5 per cent) were over 60 years old. There were 40 females and 29 males (mean age, 72.2 years). ⋯ Fire flames were the most common cause of burns (65.2 per cent) and produced the most extensive lesions. Eight-five per cent of the accidents occurred at home, and winter was the season of highest incidence. Patient mortality was 33.3 per cent, the most common causes of which were hypovolaemic shock during the first 24 h and pneumonia in the later stages.
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Serum neopterin levels have been determined retrospectively in 22 patients with burn injuries. Neopterin, which is produced by monocytes/macrophages following stimulation by interferons, is regarded as a marker for the activation of the cellular immune response. In most patients neopterin levels were initially in the normal range. ⋯ No correlation of neopterin levels with the burned body surface area was observed. However, mean serum neopterin levels were higher in the group of non-survivors (five patients) compared to survivors during the first 2 weeks after the trauma; rising neopterin levels were observed during the last 5 days before death. Although elevated neopterin levels could not be attributed either to the burn itself or to later events, the cellular immune system of burned patients was shown to be highly activated.
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Burn patients often complain of restricted mobility following application of elasticized nylon anti-burn-scar supports. This study was designed to analyse the influence of this type of pressure garment on joint range of motion (ROM). Data were compiled from 80 burn-affected joints of 17 burn patients placed in a support for the first time. ⋯ Patients were also asked if movement felt any different after the support was applied. Their varied comments, such as movement felt easier or more difficult, were consistent with the actual ROM data. It appears that there is no predictably detrimental change in joint ROM due to the application of pressure garments.
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Case Reports
Clinical studies on postburn multiple organ failure: its aetiological factors and monitoring.
This study demonstrated that multiple organ failure (MOF) developed in 16 of 57 severely burned patients (28.1 per cent). When expressed as a percentage of the 590 patients admitted during the same period, the incidence became 2.7 per cent. Fifteen of the 16 MOF cases died, with a mortality of 93.8 per cent. ⋯ However the values of the myocardial enzyme spectrum (MES) remained at significantly higher levels, indicating significant and continuous increases of microaggregate formation and the continuous existence of visceral and tissue ischaemia and cellular destruction. Changes of CPAR and MES in MOF patients were directly related to the development of MOF. It is advisable to use CPAR and MES to monitor the possible development of postburn MOF.
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Clinical Trial
A prospective clinical study on the pathogenesis of multiple organ failure in severely burned patients.
This study has shown that multiple organ failure (MOF) is one of the major causes of death in patients with severe burns. Both the plasma and visceral levels of TXB2 and the TXB2/6-keto-PGF1 alpha ratio were significantly increased. The changed plasma levels of TXB2 and the TXB2/6-keto-PGF1 alpha ratio paralleled the deterioration of the general condition in MOF patients. ⋯ Degeneration, destruction, oedema, haemorrhage and thrombosis were observed in tissues from patients who died due to heart, lung, renal and hepatic failure. Clinically, 13 of the 16 MOF cases developed organ failure and 11 died between 3 and 7 days postburn. These findings confirmed that the increases of TXA2 and the TXA2/PGI2 ratio in plasma and visceral tissues can be an important factor in the genesis and development of postburn MOF.