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Herpesvirus infection in burned patients
ABSTRACTS
INSEGUMENT
AND CONNECTIVE TISSUE
THE TOPICAL THERAPY OF BURNS IN CHILDREN. E. 1. Smith and M. S. DeWeese.
Arch. Surg. 98:462-468
(April),
1969.
All patients were treated without dressings except where these were necessary to obtain restraint. Topical agents in the form of Mafenide (Sulfamylon) acetate and Furazolium Chloride (Novofur) were applied after admission following minimal debridement and cleansing, and the drugs were applied thereafter two to three times daily with more frequent applications if necessary to maintain a thin coat over the burned areas. Daily hydrotherapy was begun early after injury. Operative debridement was frequently employed in large burns. Autografting with split-thickness grafts was performed under general anesthesia. Saline packs were applied to grafted areas within 24 hours postoperatively, and the topical medication continued throughout the period of grafting. Early hydrotherapy apparently resulted in a greater percentage of successful split-thickness grafts than a delay in hydrotherapy with consequent loss of graft to infection. With the use of topical therapy, deaths from sepsis were less than in a previous period when topical therapy was used less extensively. The authors emphasized that topical antibacterial therapy, although very helpful in children, is but one vital factor in the shifting equilibrium between the patient and efforts at recovery and the burn injury and its complications. Penicillin was used almost routinely in all but minor burns during the first 5 days following the injury in patients receiving topical agents.--A. M. Salzberg.
ABSOLUTE BARRIER ISOLATION AND ANTIBIOTICS IN THE TREATMENT OF EXPERIMENTAL BURN WOUND SEPSIS. Francis C. Name, Victor Lewis and George H. Bornside. J. of Surg. Res. 10:33-39 (Jan-
uary),
1970.
Sepsis remains the most important cause of death following major burns. The authors designed this study to determine the effect of absolute barrier isolation, combined with intensive local and systemic antibiotic ther-
apy, upon the mortality and morbidity from experimental bum wound sepsis. On the second postburn day, the burns were contaminated by smearing each rat with feces and a strain of Pseudomonas which was originally isolated aeruginosa, from a burn patient. The animals were separated in groups of 18 each and treated with various antibiotics. The animals with uncontaminated burns had a very low mortality (11.1 per cent). Bacterial contamination increased the mortality to 72.2 per cent. Topical mafenide with or without systemic Polymyxin markedly improved survival. The mortality of animals treated with systemic and oral Polymyxin, topical mafenide, and absolute barrier (germ free) isolation was the same as the mortality of similarily treated animals without isolation. In this model, absolute barrier isolation was of no value in the treatment of experimentally contaminated burn wounds.-G. Holcomb, Jr. HERPESVIRUS INFECTION IN BURNED PATIENTS. F. D. Foley, K. A. Greerlwald. G. Nash and B. A. Pruitt, Jr. New Eng.
J. Med. 282: 652-656
(March
19). 1970.
Six patients are described who developed herpesvirus hominis infection in healing partial-thickness burns. Two died, including a 5-year-old girl who had sustained flame burns over 4.5 per cent of her body surface. The burns were left exposed and treated with topical mafenide. On the 27th postburn day the wound appeared to deteriorate and was demonstrated to contain staphyloccocci, gram-negative bacilli, and epithelial cells with eosinophilic intranuclear structures resembling viral inclusions. A few days later small hemorrhagic, vesicular lesions developed in the nonburned skin, which on a biopsy were typical of herpetic infection. A serum sample drawn on the 34th postburn day demonstrated a neutralizing antibody titer to herpesvirus antigen of 1:2 and absence of complement-fixing antibodies. There were repeated blood cultures yielding Staphylococcus aureus, Candida species and Pseudomonas. The patient died on the 47th postburn day. At autopsy, systemic candidiasis with metastatic lesions in kidneys, liver, heart, and thyroid were demonstrated. No residual viral infection was identified in the cutaneous lesions. Two others died and were
480
ABSTRACTS
found to have necrotizing hepatic and adrenal lesions similar to those seen in neonates without neutralizing antibody. Each of the patients who died had a low predicted mortality based on the extent of the burn, suggesting that this infection was a fatal complication in those patients. It is possible that this represents failure of immune response, due to thermal injury, and that fatal Pseudo~monas burn sepsis arose in herpetic lesions.-B. M. Henderson. A CONTRIBUTION TO WOUND INFECTION IN PEDIATRIC SURGERY. P. Wurnig. Wien. Med. Wschr. 120:171 (March), 1970. Referring to the current literature it seems very difficult to lower the rate of wound infection below 5-10 per cent. Analyzing a series of 1096 of his own surgical cases, the author found local wound infection in 14.9 per cent of 608 operations without local use of an antibiotic, and in 13 per cent of 488 cases where an antibiotic spray was used. Thus it seems that there is no significant difference whether an antibiotic spray is used or not. The only striking difference was seen in cases of acute appendicitis, where in 59 cases without local spray infection occurred in 62.6 per cent, whereas in 48 cases treated with local antibiotics wound infection occurred only in 35.4 per cent. In a second series of 24 myelomeningoceles, the occurrence of wound infection and development of pyocephalus could be lowered by repeated use of an antibiotic spray containing neomycin and bacitracin as well as colistin.-G. Brandesky.
HEAD AND NECK PITUITARY GROWTH HORMONE INSUFFICIENCY ASSOCIATEDWITH CLEFT LIP AND PALATE. Z. Laron, E. Taube and I. Kaplan. Helv. Paediat. Acta 24:576-581,
1969. Of 33 children with cleft lip and palate, found to have growth retardation and lag in skeletal maturation. In 2, further revealed a disturbance in examination growth-hormone secretion. The authors explain this anomaly by a developmental defect of the anterior pituitary during the early embryologic development of the facial structures-M. Beftex. 3 were
PROBLEMS IN CLEFT PALATE SURGERY. R. Morger. Helv. Chirurg. Acta 37:40-43,
1970. The author describes his personal technique for operative correction of cleft palate. He uses a method derived from the operation of Axhausen-M. Bet&x. HETEROTOPIC ESOPHAGEAL CYST IN THE TONGUE. A. Moragas, M.-T. Vidal and L. Tresserra. Helv. Paediat. Acta 25:95-
98, 1970. Gastro-enteric cystic duplications located in the tongue are very rare. The authors found only 8 cases in the literature, all but one in males. They report a ninth case observed in a female infant 2 days of age. The epithelial lining of the cyst was partly ciliated, partly stratified with nests of mucous cells. It is suggested it could be of fetal esophageal origin--M. Bettex. CARCINOMA OF THYROGLOSSALDUCT CYST: CASE REPORTS AND REVIEW OF THE LITERATURE. B. S. Bhagavan, D. R. Govinda Rao and T. Weinberg. Surgery
67:281-291
(February),
1970.
Three instances of carcinoma of a thyroglossal duct cyst (in a 66-year-old, 38. year-old, and 26-year-old man) are reported in detail together with a review of the 40 previously reported cases from the literature. The tumor was papillary adenocarcinoma in 34, adenocarcinoma in 2, epidermoid carcinoma in 3, malignant struma in 1, follicular carcinoma in 1, and mixed follicular and papillary adenocarcinoma in I. There were regional nodal metastases in 6 patients, but remote metastases to lung and liver appeared in only one patient (a 7 year old boy). While many believe these tumors represent metastases from small primary thyroid tumors, their status as primary tumors of the thyroglossal duct is defended by the absence of primary carcinoma in thyroid glands removed in some of these patientsW. K. Sieber. CONGENITAL STRIDOR. R.
Clin. Pediat.
9:94
S.
(February),
Zllingworth.
1970
Congenital stridor usually starts at birth, then tends to get worse for 3-6 months,
INSEGUMENT
AND CONNECTIVE TISSUE
THE TOPICAL THERAPY OF BURNS IN CHILDREN. E. 1. Smith and M. S. DeWeese.
Arch. Surg. 98:462-468
(April),
1969.
All patients were treated without dressings except where these were necessary to obtain restraint. Topical agents in the form of Mafenide (Sulfamylon) acetate and Furazolium Chloride (Novofur) were applied after admission following minimal debridement and cleansing, and the drugs were applied thereafter two to three times daily with more frequent applications if necessary to maintain a thin coat over the burned areas. Daily hydrotherapy was begun early after injury. Operative debridement was frequently employed in large burns. Autografting with split-thickness grafts was performed under general anesthesia. Saline packs were applied to grafted areas within 24 hours postoperatively, and the topical medication continued throughout the period of grafting. Early hydrotherapy apparently resulted in a greater percentage of successful split-thickness grafts than a delay in hydrotherapy with consequent loss of graft to infection. With the use of topical therapy, deaths from sepsis were less than in a previous period when topical therapy was used less extensively. The authors emphasized that topical antibacterial therapy, although very helpful in children, is but one vital factor in the shifting equilibrium between the patient and efforts at recovery and the burn injury and its complications. Penicillin was used almost routinely in all but minor burns during the first 5 days following the injury in patients receiving topical agents.--A. M. Salzberg.
ABSOLUTE BARRIER ISOLATION AND ANTIBIOTICS IN THE TREATMENT OF EXPERIMENTAL BURN WOUND SEPSIS. Francis C. Name, Victor Lewis and George H. Bornside. J. of Surg. Res. 10:33-39 (Jan-
uary),
1970.
Sepsis remains the most important cause of death following major burns. The authors designed this study to determine the effect of absolute barrier isolation, combined with intensive local and systemic antibiotic ther-
apy, upon the mortality and morbidity from experimental bum wound sepsis. On the second postburn day, the burns were contaminated by smearing each rat with feces and a strain of Pseudomonas which was originally isolated aeruginosa, from a burn patient. The animals were separated in groups of 18 each and treated with various antibiotics. The animals with uncontaminated burns had a very low mortality (11.1 per cent). Bacterial contamination increased the mortality to 72.2 per cent. Topical mafenide with or without systemic Polymyxin markedly improved survival. The mortality of animals treated with systemic and oral Polymyxin, topical mafenide, and absolute barrier (germ free) isolation was the same as the mortality of similarily treated animals without isolation. In this model, absolute barrier isolation was of no value in the treatment of experimentally contaminated burn wounds.-G. Holcomb, Jr. HERPESVIRUS INFECTION IN BURNED PATIENTS. F. D. Foley, K. A. Greerlwald. G. Nash and B. A. Pruitt, Jr. New Eng.
J. Med. 282: 652-656
(March
19). 1970.
Six patients are described who developed herpesvirus hominis infection in healing partial-thickness burns. Two died, including a 5-year-old girl who had sustained flame burns over 4.5 per cent of her body surface. The burns were left exposed and treated with topical mafenide. On the 27th postburn day the wound appeared to deteriorate and was demonstrated to contain staphyloccocci, gram-negative bacilli, and epithelial cells with eosinophilic intranuclear structures resembling viral inclusions. A few days later small hemorrhagic, vesicular lesions developed in the nonburned skin, which on a biopsy were typical of herpetic infection. A serum sample drawn on the 34th postburn day demonstrated a neutralizing antibody titer to herpesvirus antigen of 1:2 and absence of complement-fixing antibodies. There were repeated blood cultures yielding Staphylococcus aureus, Candida species and Pseudomonas. The patient died on the 47th postburn day. At autopsy, systemic candidiasis with metastatic lesions in kidneys, liver, heart, and thyroid were demonstrated. No residual viral infection was identified in the cutaneous lesions. Two others died and were
480
ABSTRACTS
found to have necrotizing hepatic and adrenal lesions similar to those seen in neonates without neutralizing antibody. Each of the patients who died had a low predicted mortality based on the extent of the burn, suggesting that this infection was a fatal complication in those patients. It is possible that this represents failure of immune response, due to thermal injury, and that fatal Pseudo~monas burn sepsis arose in herpetic lesions.-B. M. Henderson. A CONTRIBUTION TO WOUND INFECTION IN PEDIATRIC SURGERY. P. Wurnig. Wien. Med. Wschr. 120:171 (March), 1970. Referring to the current literature it seems very difficult to lower the rate of wound infection below 5-10 per cent. Analyzing a series of 1096 of his own surgical cases, the author found local wound infection in 14.9 per cent of 608 operations without local use of an antibiotic, and in 13 per cent of 488 cases where an antibiotic spray was used. Thus it seems that there is no significant difference whether an antibiotic spray is used or not. The only striking difference was seen in cases of acute appendicitis, where in 59 cases without local spray infection occurred in 62.6 per cent, whereas in 48 cases treated with local antibiotics wound infection occurred only in 35.4 per cent. In a second series of 24 myelomeningoceles, the occurrence of wound infection and development of pyocephalus could be lowered by repeated use of an antibiotic spray containing neomycin and bacitracin as well as colistin.-G. Brandesky.
HEAD AND NECK PITUITARY GROWTH HORMONE INSUFFICIENCY ASSOCIATEDWITH CLEFT LIP AND PALATE. Z. Laron, E. Taube and I. Kaplan. Helv. Paediat. Acta 24:576-581,
1969. Of 33 children with cleft lip and palate, found to have growth retardation and lag in skeletal maturation. In 2, further revealed a disturbance in examination growth-hormone secretion. The authors explain this anomaly by a developmental defect of the anterior pituitary during the early embryologic development of the facial structures-M. Beftex. 3 were
PROBLEMS IN CLEFT PALATE SURGERY. R. Morger. Helv. Chirurg. Acta 37:40-43,
1970. The author describes his personal technique for operative correction of cleft palate. He uses a method derived from the operation of Axhausen-M. Bet&x. HETEROTOPIC ESOPHAGEAL CYST IN THE TONGUE. A. Moragas, M.-T. Vidal and L. Tresserra. Helv. Paediat. Acta 25:95-
98, 1970. Gastro-enteric cystic duplications located in the tongue are very rare. The authors found only 8 cases in the literature, all but one in males. They report a ninth case observed in a female infant 2 days of age. The epithelial lining of the cyst was partly ciliated, partly stratified with nests of mucous cells. It is suggested it could be of fetal esophageal origin--M. Bettex. CARCINOMA OF THYROGLOSSALDUCT CYST: CASE REPORTS AND REVIEW OF THE LITERATURE. B. S. Bhagavan, D. R. Govinda Rao and T. Weinberg. Surgery
67:281-291
(February),
1970.
Three instances of carcinoma of a thyroglossal duct cyst (in a 66-year-old, 38. year-old, and 26-year-old man) are reported in detail together with a review of the 40 previously reported cases from the literature. The tumor was papillary adenocarcinoma in 34, adenocarcinoma in 2, epidermoid carcinoma in 3, malignant struma in 1, follicular carcinoma in 1, and mixed follicular and papillary adenocarcinoma in I. There were regional nodal metastases in 6 patients, but remote metastases to lung and liver appeared in only one patient (a 7 year old boy). While many believe these tumors represent metastases from small primary thyroid tumors, their status as primary tumors of the thyroglossal duct is defended by the absence of primary carcinoma in thyroid glands removed in some of these patientsW. K. Sieber. CONGENITAL STRIDOR. R.
Clin. Pediat.
9:94
S.
(February),
Zllingworth.
1970
Congenital stridor usually starts at birth, then tends to get worse for 3-6 months,