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Burns from car cigarette lighters
Abstracts
213
used to close the plastic wrappings of sliced bread and suffered intestinal complications. Bundred N. J., Blackie R. A. S., Kingsworth A. N. and Eremin 0. (1984) Hidden dangers of sliced bread. Br. Med. J. 288, 1723. Laparotomies
As well as discussing practical matters such as the indications for exploring the belly, to the choice of incision and closure, the author deals carefully with the causes and prevention of the burst abdomen and incisional hernia. Ellis H. (1984) How to do a laparotomy. Br. J. Hosp. Med. 31, 437. Diagnosis of inhaled foreign bodies
Inhaled foreign bodies may escape detection on an X-ray tilm taken in inspiration but they are shown up by blockage of a bronchus and a consequent failure of the lung to empty during expiration. Griffiths D. M. and Freeman N. V. (1984) Expiratory chest X-ray examination in the diagnosis of inhaled foreign bodies. Br. Med. J. 288, 1074. Disembowelment
per rectum
A 22-year-old mentally defective male was found with 4.5 m of gut hanging out through a tear in his rectum following sexual assualt. The gut had been torn across at the duodenojejunum junction. When first seen his pulse, blood pressure and the condition of his abdomen were surprisingly normal. Anastomosis of duodenum to colon did not save his life. Mortensen N. J. McC. and Irvin T. T. (1984) Disembowelment per rectum. Br. J. Surg. 71, 289
FRACTURES
AND
DISLOCATIONS
preferred method of treatment since it resulted in an average shorter stay in hospital, lower costs and less time away from work than if the burned area was treated conservatively (no operation) and with the topical application of silver suphadiazine. While early excision and grafting resulted in the increased use of blood products and operating facilities, this did not induce increased patient morbidity. Long-term followup showed no difference in the need for reconstruction, incidence of blisters or loss of motion or contour irregularities although there was more mesh graft irregularity. The patients treated non-operatively required more late grafts for wound closure and showed more hypertrophic scarring. Engrav L. H., Heimbach D. M., Reus J. L. et al. (1983) Early excision and grafting vs. nonoperative treatment of bums of indeterminant depth: a randomized prospective study. J. Trauma 23, 1001. Burns from car cigarette lighters
Fourteen cases are reported of children burned while alone in motor cars with the ignition switched off. In some cases matches might have been responsible, in others cigarette lighters; some of the latter can be worked even though the ignition is switched off. Gill D. G. (1984) Conflagration of children in cars. Br. Med. J. 288, 973.
Early management of burns and scalds
A comprehensive review of the early management of both mild and severe burns and scalds. Brown J. and Ward D. J. (1984) Immediate management of burns in casualty. Br. J. Hosp. Med. 31, 360.
PATHOLOGY
AND
EXPERIMENTAL
WORK
Electrical stimulation for tibia1 non-union
Varying hormone levels
All fractures had been ununited for at least 52 weeks and were treated in long plasters for 24 weeks with protection from weight bearing. Five fractures of the nine patients with working machines united and five fractures of the seven patients with dummy machines also united. Further trials are required but the value of electrical stimulation is far from established. Barke A. T., Dixon R. A., Sharrad W. J. W. and Sutcliffe M. L. (1984) Pulsed magnetic field therapy for tibia1 non-unioninterim results of a double-blind trial. Lancet i, 994.
Morning and evening measurements of the serum concentrations of prolactin (PRL), corticotropin (ACTH), follicle stimulating and luteinizing hormones (FSH and LH) were measured in 25 male and 3 female burned patients. PRL was elevated in males up to the fourth week after injury. ACTH increased significantly during the second day after injury and then returned to normal by the fifth day. FSH and LH increased on the first day then decreased significantly on day 2 and remained low for about 2 weeks. In females while PRL increased significantly, the gonadotropins were only slightly elevated and ACTH remained within normal limits for at least 3 days. In all patients the circadian rhythm of the 4 hormones showed significant variations from the normal pattern. Brizio-Molteni L., Molteni A., Warpeha R. L. et al. (1984) Prolactin, corticotropin and gonadotropin concentrations following thermal injury in adults. J. Trauma 24, 1.
BURNS Incidence of hypertrophic scars
The factors associated with the development of hypertrophic scars were assessed in 100 patients during the 18 months following bums covering up to 20 per cent of the body surface area. Hypertrophic scars developed in 26 per cent of the 245 burned areas. There was no correlation between the development of wound problems and the age of the patient. Blackskinned patients had more wound problems if the wound took more than 14 days to heal. In all patients hypertrophic scarring was most common in slowly healing wounds and least common when the wound was healed within 21 days of injury. Deitch E. A., Wheelahan T. M., Rose M. P. et al. (1983) Hypertrophic bum scars: analysis of variables. J. Trauma ?3, 895. Healing of mixed depth burns
Early excision and grafting of bums of indeterminant depth covering less than 20 per cent of the body surface is the
Energy to nitrogen ratio and nitrogen balance
Nitrogen balance was measure4 in 36 burned patients receiving diets containing calorie to nitrogen inputs of either 150 : 1 or 100 : 1. With the higher energy to nitrogen inputs the nitrogen balances were + 2.33, +0.13 and - 3.38 g/day when the wound sizes were respectively l-10, 11-30 and 31-60 per cent of the body surface area. With the lower energy to nitrogen inputs the nitrogen balances were + 5.54, + 3.49 and + 3.38 g/day for the same wound areas. Thus the traditional 150 : 1 ratio may be adequate for patients with open wounds of less than 10 per cent of the body surface but is clearly inadequate when the burned area is more extensive. In the latter patients positive nitrogen balance can only be maintained with either a lower energy to nitrogen ratio or a higher nitrogen input.
213
used to close the plastic wrappings of sliced bread and suffered intestinal complications. Bundred N. J., Blackie R. A. S., Kingsworth A. N. and Eremin 0. (1984) Hidden dangers of sliced bread. Br. Med. J. 288, 1723. Laparotomies
As well as discussing practical matters such as the indications for exploring the belly, to the choice of incision and closure, the author deals carefully with the causes and prevention of the burst abdomen and incisional hernia. Ellis H. (1984) How to do a laparotomy. Br. J. Hosp. Med. 31, 437. Diagnosis of inhaled foreign bodies
Inhaled foreign bodies may escape detection on an X-ray tilm taken in inspiration but they are shown up by blockage of a bronchus and a consequent failure of the lung to empty during expiration. Griffiths D. M. and Freeman N. V. (1984) Expiratory chest X-ray examination in the diagnosis of inhaled foreign bodies. Br. Med. J. 288, 1074. Disembowelment
per rectum
A 22-year-old mentally defective male was found with 4.5 m of gut hanging out through a tear in his rectum following sexual assualt. The gut had been torn across at the duodenojejunum junction. When first seen his pulse, blood pressure and the condition of his abdomen were surprisingly normal. Anastomosis of duodenum to colon did not save his life. Mortensen N. J. McC. and Irvin T. T. (1984) Disembowelment per rectum. Br. J. Surg. 71, 289
FRACTURES
AND
DISLOCATIONS
preferred method of treatment since it resulted in an average shorter stay in hospital, lower costs and less time away from work than if the burned area was treated conservatively (no operation) and with the topical application of silver suphadiazine. While early excision and grafting resulted in the increased use of blood products and operating facilities, this did not induce increased patient morbidity. Long-term followup showed no difference in the need for reconstruction, incidence of blisters or loss of motion or contour irregularities although there was more mesh graft irregularity. The patients treated non-operatively required more late grafts for wound closure and showed more hypertrophic scarring. Engrav L. H., Heimbach D. M., Reus J. L. et al. (1983) Early excision and grafting vs. nonoperative treatment of bums of indeterminant depth: a randomized prospective study. J. Trauma 23, 1001. Burns from car cigarette lighters
Fourteen cases are reported of children burned while alone in motor cars with the ignition switched off. In some cases matches might have been responsible, in others cigarette lighters; some of the latter can be worked even though the ignition is switched off. Gill D. G. (1984) Conflagration of children in cars. Br. Med. J. 288, 973.
Early management of burns and scalds
A comprehensive review of the early management of both mild and severe burns and scalds. Brown J. and Ward D. J. (1984) Immediate management of burns in casualty. Br. J. Hosp. Med. 31, 360.
PATHOLOGY
AND
EXPERIMENTAL
WORK
Electrical stimulation for tibia1 non-union
Varying hormone levels
All fractures had been ununited for at least 52 weeks and were treated in long plasters for 24 weeks with protection from weight bearing. Five fractures of the nine patients with working machines united and five fractures of the seven patients with dummy machines also united. Further trials are required but the value of electrical stimulation is far from established. Barke A. T., Dixon R. A., Sharrad W. J. W. and Sutcliffe M. L. (1984) Pulsed magnetic field therapy for tibia1 non-unioninterim results of a double-blind trial. Lancet i, 994.
Morning and evening measurements of the serum concentrations of prolactin (PRL), corticotropin (ACTH), follicle stimulating and luteinizing hormones (FSH and LH) were measured in 25 male and 3 female burned patients. PRL was elevated in males up to the fourth week after injury. ACTH increased significantly during the second day after injury and then returned to normal by the fifth day. FSH and LH increased on the first day then decreased significantly on day 2 and remained low for about 2 weeks. In females while PRL increased significantly, the gonadotropins were only slightly elevated and ACTH remained within normal limits for at least 3 days. In all patients the circadian rhythm of the 4 hormones showed significant variations from the normal pattern. Brizio-Molteni L., Molteni A., Warpeha R. L. et al. (1984) Prolactin, corticotropin and gonadotropin concentrations following thermal injury in adults. J. Trauma 24, 1.
BURNS Incidence of hypertrophic scars
The factors associated with the development of hypertrophic scars were assessed in 100 patients during the 18 months following bums covering up to 20 per cent of the body surface area. Hypertrophic scars developed in 26 per cent of the 245 burned areas. There was no correlation between the development of wound problems and the age of the patient. Blackskinned patients had more wound problems if the wound took more than 14 days to heal. In all patients hypertrophic scarring was most common in slowly healing wounds and least common when the wound was healed within 21 days of injury. Deitch E. A., Wheelahan T. M., Rose M. P. et al. (1983) Hypertrophic bum scars: analysis of variables. J. Trauma ?3, 895. Healing of mixed depth burns
Early excision and grafting of bums of indeterminant depth covering less than 20 per cent of the body surface is the
Energy to nitrogen ratio and nitrogen balance
Nitrogen balance was measure4 in 36 burned patients receiving diets containing calorie to nitrogen inputs of either 150 : 1 or 100 : 1. With the higher energy to nitrogen inputs the nitrogen balances were + 2.33, +0.13 and - 3.38 g/day when the wound sizes were respectively l-10, 11-30 and 31-60 per cent of the body surface area. With the lower energy to nitrogen inputs the nitrogen balances were + 5.54, + 3.49 and + 3.38 g/day for the same wound areas. Thus the traditional 150 : 1 ratio may be adequate for patients with open wounds of less than 10 per cent of the body surface but is clearly inadequate when the burned area is more extensive. In the latter patients positive nitrogen balance can only be maintained with either a lower energy to nitrogen ratio or a higher nitrogen input.