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Caustic ingestion injuries
422 Burns (1987) 13, (5), 422424
Printedin
Great Britain
Abstracts CLINICAL STUDIES Silver in serum and urine Topical application of silver sulphadiazine to the burn wounds of 23 patients was followed by assays of the silver content of serum and urine. The burned area ranged between I2 and 90 per cent of the body surface area (BSA) and involved both partial and full thickness skin loss injuries. The mean serum silver levels were modestly elevated throughout the patients' stay in hospital. The urinary excretion of silver was markedly elevated and was highest in the patients with the most extensive injuries. peaking at I ltH)ug/24 h when the burn exceeded 60 per cent BSA compared with a normal value of less than 1ug/24 h. Boosalis M. G., McCall J. Y.. Ahrenholz D. H. et al. (19X7) Serum and urinary silver levels in thermal injury patients. Surgery 101, (I). 4043.
Pain relief during debridement In 24 patients receiving topical Travase for enzymic debridement of burn eschar. transcutaneous electric nerve stimulation (TENS) was used as an alternative to morphine for pain relief. Over a 4 h period of study pain levels scored on a visual analogue scale and a verbal categorical scale showed that TENS was as effective as morphine for relief of pain. Kimball K. L.. Drews J. E.. Walker S. et al. (1987) Use of TENS for pain reduction in burn patients receiving Travase. J. Bunt Cure Rchuhil. 8, (I), 28-31.
Drug-loaded
synthetic dressing
Deep dermal burns with a mean area of 25 per cent of the body surface in 27 patients were treated with either Hydron dressing incorporating silver sulphadiazine or silver sulphadiazine alone. Both forms of dressing were tested on discrete sites on the same patient. The mean total time of synthetic dressing application per patient was about 9 days and each dressing remained in place for nearly 4 days. During this time interval the control sites required four changes of dressing. In I7 tests for infection the control areas were contaminated but no bacteria were found under the synthetic dressing. In three tests the controls had no bacteria whereas the synthetic dressing did. Healing of burns was similar under both types of dressing. Benefits of Hydron treatment included increased patient comfort because of the
reduced number of dressing changes and in some patients greater freedom from contaminating bacteria. Fang C., Nathan P., Robb E. C. et al. (1987) Prospective clinical study of Hydron, a synthetic dressing, in delivery of an antimicrobial drug to second degree burns. J. Burn Cure Rehuhil. 8. (3), 206209.
Caustic ingestion injuries Burns following ingestion of caustics require prompt fibreoptic endoscopy. A survey of 4X4 patients injured by caustics showed that all the 250 patients who only developed superficial lesions of the oesophageus, stomach or duodenum showed healing without adverse sequelae. Of 44 patients who required emergency surgery 24 died, the remainder required oesophagectomy without thoracotomy. The remaining 190 patients suffered gastric or oesophageal ulceration without necrosis: 92 recovered without complications. three succumbed to aorto-oesophageal fistulas, I2 survived following delayed surgery for complications and three developed oesophageal and/or gastric stenosis which subsequently required endoscopic or surgical treatment. Sarfati E.. Gossot D., Assens P. et al. (1987) Management of caustic ingestion in adults. Br. J. Surg. 74. (2). 146-148.
Thymopentin
and immunological
changes
Attempts were made to correct the immunological abnormalities found in 24 patients with burns covering about half the body surface area using a controlled trial of thymopentin or placebo. Immunological tests undertaken included white blood cell counts, 0KT4 to OKT8 ratios, lymphocyte blastogenesis and neutrophil bactericidal index. The results showed that although there were no differences in patient mortality, infective complications or antibiotic use in the two groups of patients. there was a decreased lymphocyte blastogenic response in the treated group at 2 weeks after burning without a difference in T4 to TX ratios and there was less leukopenia during the first week after injury in the treated group. Waymack J. P.. Jenkins M.. Warden G. D. et al. (1987) A prospective study of thymopentin in severely burned patients. Surg. Gynecol. Obsm. 164. (5). 42.7 430.
Printedin
Great Britain
Abstracts CLINICAL STUDIES Silver in serum and urine Topical application of silver sulphadiazine to the burn wounds of 23 patients was followed by assays of the silver content of serum and urine. The burned area ranged between I2 and 90 per cent of the body surface area (BSA) and involved both partial and full thickness skin loss injuries. The mean serum silver levels were modestly elevated throughout the patients' stay in hospital. The urinary excretion of silver was markedly elevated and was highest in the patients with the most extensive injuries. peaking at I ltH)ug/24 h when the burn exceeded 60 per cent BSA compared with a normal value of less than 1ug/24 h. Boosalis M. G., McCall J. Y.. Ahrenholz D. H. et al. (19X7) Serum and urinary silver levels in thermal injury patients. Surgery 101, (I). 4043.
Pain relief during debridement In 24 patients receiving topical Travase for enzymic debridement of burn eschar. transcutaneous electric nerve stimulation (TENS) was used as an alternative to morphine for pain relief. Over a 4 h period of study pain levels scored on a visual analogue scale and a verbal categorical scale showed that TENS was as effective as morphine for relief of pain. Kimball K. L.. Drews J. E.. Walker S. et al. (1987) Use of TENS for pain reduction in burn patients receiving Travase. J. Bunt Cure Rchuhil. 8, (I), 28-31.
Drug-loaded
synthetic dressing
Deep dermal burns with a mean area of 25 per cent of the body surface in 27 patients were treated with either Hydron dressing incorporating silver sulphadiazine or silver sulphadiazine alone. Both forms of dressing were tested on discrete sites on the same patient. The mean total time of synthetic dressing application per patient was about 9 days and each dressing remained in place for nearly 4 days. During this time interval the control sites required four changes of dressing. In I7 tests for infection the control areas were contaminated but no bacteria were found under the synthetic dressing. In three tests the controls had no bacteria whereas the synthetic dressing did. Healing of burns was similar under both types of dressing. Benefits of Hydron treatment included increased patient comfort because of the
reduced number of dressing changes and in some patients greater freedom from contaminating bacteria. Fang C., Nathan P., Robb E. C. et al. (1987) Prospective clinical study of Hydron, a synthetic dressing, in delivery of an antimicrobial drug to second degree burns. J. Burn Cure Rehuhil. 8. (3), 206209.
Caustic ingestion injuries Burns following ingestion of caustics require prompt fibreoptic endoscopy. A survey of 4X4 patients injured by caustics showed that all the 250 patients who only developed superficial lesions of the oesophageus, stomach or duodenum showed healing without adverse sequelae. Of 44 patients who required emergency surgery 24 died, the remainder required oesophagectomy without thoracotomy. The remaining 190 patients suffered gastric or oesophageal ulceration without necrosis: 92 recovered without complications. three succumbed to aorto-oesophageal fistulas, I2 survived following delayed surgery for complications and three developed oesophageal and/or gastric stenosis which subsequently required endoscopic or surgical treatment. Sarfati E.. Gossot D., Assens P. et al. (1987) Management of caustic ingestion in adults. Br. J. Surg. 74. (2). 146-148.
Thymopentin
and immunological
changes
Attempts were made to correct the immunological abnormalities found in 24 patients with burns covering about half the body surface area using a controlled trial of thymopentin or placebo. Immunological tests undertaken included white blood cell counts, 0KT4 to OKT8 ratios, lymphocyte blastogenesis and neutrophil bactericidal index. The results showed that although there were no differences in patient mortality, infective complications or antibiotic use in the two groups of patients. there was a decreased lymphocyte blastogenic response in the treated group at 2 weeks after burning without a difference in T4 to TX ratios and there was less leukopenia during the first week after injury in the treated group. Waymack J. P.. Jenkins M.. Warden G. D. et al. (1987) A prospective study of thymopentin in severely burned patients. Surg. Gynecol. Obsm. 164. (5). 42.7 430.