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P018 The impact of short term thermal cure therapy in pediatric burn patients
S21
B U R N S 3 7 S (2011) S1 –S2 5
P008.1
P035
Parent reports of psychological problems in children with burns: associations
Adipocyte derived stem cells favour healing in a new minipig model of
with family variables and burn severity
cutaneous radiation syndrome through reepithelialisation and
J. Sveen 1 , B. Sjoberg ∗,2 . 1 Uppsala University, Uppsala, Sweden; 2 Department of Hand, Plastic Surgery and Intensive Care, Linköping, Sweden
neoangiogenesis F. Forcheron ∗ ,1 , D. Agay 1 , H. Schertan 2 , D. Riccobono 1 , M. Vivier 1 , B. Ballester 1 , F. Herodin 1 , V. Meineke 2 , M. Drouet 1 . 1 IRBA, La Tronche, France; 2 Bundeswehr
Rationale: Burns may have a devastating effect on psychological health among
Institute of Radiology, Munich, Germany
children, however previous studies also emphasize family variables as important factors. The aim was to explore statistical predictors of psychological problems
Rationale: Cutaneous radiation syndrome (CRS) is the delayed consequence of
after burns in children as reported by parents using a standardised instrument.
localized skin exposure to high doses of ionizing radiation. Here we examined
Methods: Parents (n=89) of 56 boys and 33 girls aged 3–18 with burns 0.3–9.0
for the first time in a large animal model the therapeutic potential of autologous
years ago answered the Strengths and Difficulties Questionnaire (SDQ) cover-
adipose tissue-derived stroma cells (ASCs) to prevent/cure CRS. 60
ing Emotional, Conduct, Hyperactivity/Inattention, Peer relationship problems,
Methods: Göttingen minipigs were locally irradiated using a
Prosocial behaviour, and a Total Difficulties score. Also, questions regarding
dose of 50 Gy and grafted (n=5) or not (n=8). ASCs were cultured in MEMα with
Co-γ source at the
parent psychological health, education and family structure were included. Burn
10% fetal calf serum and basic fibroblast growth factor (2 ng mL−1 ) and then
severity was assessed with TBSA burned, TBSA fullthickness burns (TBSA-FT),
were intradermally injected four times from days 25 to 95 (50×106 ASCs each
Length of Stay in the intensive care unit for burns, and presence of visible scars
time).
at the time of the investigation.
Results: All controls exhibited a clinical evolution similar to human with final
Results: In regression analyses, 9–34% of the variance in the different SDQ
necrosis (day 91). In grafted pigs an ultimate wound healing was observed in
subscales was explained, mainly by family variables. Parents’ psychological
four out of five grafted animals (day 130±28, complete in two of them). Cleaning
symptoms had positive associations with all problem scores except for Peer
of the damaged epidermis appeared earlier than in non-grafted controls
problems, and a negative association with Prosocial behavior. A change in family
and immunohistological analysis of cytokeratin expression showed a final
structure after the burn was associated with more Peer problems, while living
strong hyperproliferative activity of the keratinocytes leading to surnumerous
with biological parents was associated with lower scores on Total Difficulties,
cell layers in the entry area. Q-dot labelling confirmed that grafted ASCs
Hyperactivity and Conduct. In addition, higher education of the fathers was
accumulated at the dermis/subcutis barrier in which they attracted numerous
associated with lower Total Difficulties score and less Peer problems. TBSA-FT
immune cells correlated with an earlier and increased CD3 and λ light chain
had a negative association with Prosocial behavior and visible scars had a
labelling and even an increased vasculature in one pig. Complementary in
positive association with the Total Difficulties score.
vitro study confirmed an increased of VEGF mRNA levels in 25 Gy γ-irradiated
Conclusion: Although burn severity was related to more problems and less
fibroblasts incubated with ASC-conditioned media.
prosocial behavior, the family variables exerted the most influence on parent
Conclusion: Globally this study strongly suggests that local injection of ASCs
reports of child psychological health after burns.
may represent a useful strategy to mitigate CRS.
P018 The impact of short term thermal cure therapy in pediatric burn patients K. Maertens ∗ ,1 , I. Ponjaert-Kristoffersen 2 . 1 Oscare NPO, Merksem, Belgium; 2 Vrije Universiteit Brussel (VUB), Brussels, Belgium
P045 Epidemiology of aspergillosis and mucormycosis in burn patients: a retrospective study J.V. Schaal ∗ , L. Bargues, M. Boutonnet, T. Leclerc, H. Le Bever. Military Hospital Percy, Clamart, France
Rationale: Although little demonstrated in literature, hydrotherapy or bathing is commonly considered to benefit the evolution of scar tissue, to facilitate
rationale: Fungal infections increase in burn patients [1]. Aspergillosis (ASP)
physical therapy and mobilization and to favour well-being and comfort in
and Mucormycosis (MMC) are accepted to cause severe diseases and wound
patients with burns. Evidence-based research concerning hydrotherapy is very
infections in patients with extensive burns [1]. However data are scarce in
scarce, certainly in children with burns. Hydrotherapy is supposed to reduce
literature about incidence and consequences. The aim of this work was to
itching, pain when contacting or touching the scar, redness of the skin and
collect demographics on ASP and MMC in burns.
irregularities of the burn surface area, to supple the skin, to gain functionality
Methods: This retrospective study reviews all patients admitted in our centre
of the movements and to provide the possibility to relax. This study investigates
with acute burn injuries (2000–2010) and positive wound culture for Aspergillus
the medical effects of hydrotherapy in burn-injured children.
or Mucorales. Patients were separated in three categories [2]: 1) fungal wound
Methods: Scars of 28 burned children, aged 5 to 16 years, were evaluated before
colonization (FWC) 2) Fungal wound infections (FWI) defined by a quantitative
the start of a two-week thermal cure, and at follow-up moments three and six
biopsy >10.5 pathogens/g tissue associated with SIRS or local signs of wound
months after the end of the cure. The Patient Observer Scar Assessment Scale
infection (including superficial and deep skin infections) 3) Disseminated
(POSAS) was used to assess pain, itching, color, elasticity, and thickness of the
Infection (DI) defined by FWI with a positive blood culture or a positive
scar. Besides, objective measures like scar colour, elasticity and transepidermal
antigenemia or severe sepsis or secondary organ localization(s). We collected
water loss (TEWL) were measured by a Minolta Chromameter CR-400 and Der-
demographic characteristics and outcome.
maLab elasticity- and TEWL-module (Cortex Technology, Denmark) respectively.
Results: 1575 patients were hospitalized. Mean TBSA (%) was 23.3±21.5. Mortality
Results: Significant improvement was found on the POSAS for pain, itching,
rate was 12.5%. Incidences of ASP and MMC were respectively 1.07% (17 cases)
color, and elasticity after time (p<0.05) and for color (p<0.05) as measured with
and 0.5% (8 cases) and the gender was 83% and 87.5% of male. Mean age was
the Chromameter.
41±14 years for both ASP and MMC. Respectively for FWC, FWI and DI, there
Conclusion: Thermal cures could have an additional value to the treatment of
were 4, 7, 6 patients with ASP and 3, 5, 0 with MMC. Mean TBSA was for ASP
burn scars in the active phase of recovery. However, more research is needed to
56±37, 75.5±16, 71±18.7, and for MMC 56±11, 51.6±29. The total length of stay
entangle the precise functioning of this type of treatment in order to enlighten
(in days) was for ASP 104±52, 150±101, 128±80 and for MMC 97±32, 79,4±35.
even further effects at long-term.
5 patients died of ASP (mortality 2.5%). Two of them presented both ASP and MMC. Conclusion: ASP and MMC occur in the most severe burns and are strongly associated with increased mortality and morbidity. References: [1] Ballard J. J Burn Care Res 2008. [2] Greenhalgh DG. J Burn Care Res 2007.
B U R N S 3 7 S (2011) S1 –S2 5
P008.1
P035
Parent reports of psychological problems in children with burns: associations
Adipocyte derived stem cells favour healing in a new minipig model of
with family variables and burn severity
cutaneous radiation syndrome through reepithelialisation and
J. Sveen 1 , B. Sjoberg ∗,2 . 1 Uppsala University, Uppsala, Sweden; 2 Department of Hand, Plastic Surgery and Intensive Care, Linköping, Sweden
neoangiogenesis F. Forcheron ∗ ,1 , D. Agay 1 , H. Schertan 2 , D. Riccobono 1 , M. Vivier 1 , B. Ballester 1 , F. Herodin 1 , V. Meineke 2 , M. Drouet 1 . 1 IRBA, La Tronche, France; 2 Bundeswehr
Rationale: Burns may have a devastating effect on psychological health among
Institute of Radiology, Munich, Germany
children, however previous studies also emphasize family variables as important factors. The aim was to explore statistical predictors of psychological problems
Rationale: Cutaneous radiation syndrome (CRS) is the delayed consequence of
after burns in children as reported by parents using a standardised instrument.
localized skin exposure to high doses of ionizing radiation. Here we examined
Methods: Parents (n=89) of 56 boys and 33 girls aged 3–18 with burns 0.3–9.0
for the first time in a large animal model the therapeutic potential of autologous
years ago answered the Strengths and Difficulties Questionnaire (SDQ) cover-
adipose tissue-derived stroma cells (ASCs) to prevent/cure CRS. 60
ing Emotional, Conduct, Hyperactivity/Inattention, Peer relationship problems,
Methods: Göttingen minipigs were locally irradiated using a
Prosocial behaviour, and a Total Difficulties score. Also, questions regarding
dose of 50 Gy and grafted (n=5) or not (n=8). ASCs were cultured in MEMα with
Co-γ source at the
parent psychological health, education and family structure were included. Burn
10% fetal calf serum and basic fibroblast growth factor (2 ng mL−1 ) and then
severity was assessed with TBSA burned, TBSA fullthickness burns (TBSA-FT),
were intradermally injected four times from days 25 to 95 (50×106 ASCs each
Length of Stay in the intensive care unit for burns, and presence of visible scars
time).
at the time of the investigation.
Results: All controls exhibited a clinical evolution similar to human with final
Results: In regression analyses, 9–34% of the variance in the different SDQ
necrosis (day 91). In grafted pigs an ultimate wound healing was observed in
subscales was explained, mainly by family variables. Parents’ psychological
four out of five grafted animals (day 130±28, complete in two of them). Cleaning
symptoms had positive associations with all problem scores except for Peer
of the damaged epidermis appeared earlier than in non-grafted controls
problems, and a negative association with Prosocial behavior. A change in family
and immunohistological analysis of cytokeratin expression showed a final
structure after the burn was associated with more Peer problems, while living
strong hyperproliferative activity of the keratinocytes leading to surnumerous
with biological parents was associated with lower scores on Total Difficulties,
cell layers in the entry area. Q-dot labelling confirmed that grafted ASCs
Hyperactivity and Conduct. In addition, higher education of the fathers was
accumulated at the dermis/subcutis barrier in which they attracted numerous
associated with lower Total Difficulties score and less Peer problems. TBSA-FT
immune cells correlated with an earlier and increased CD3 and λ light chain
had a negative association with Prosocial behavior and visible scars had a
labelling and even an increased vasculature in one pig. Complementary in
positive association with the Total Difficulties score.
vitro study confirmed an increased of VEGF mRNA levels in 25 Gy γ-irradiated
Conclusion: Although burn severity was related to more problems and less
fibroblasts incubated with ASC-conditioned media.
prosocial behavior, the family variables exerted the most influence on parent
Conclusion: Globally this study strongly suggests that local injection of ASCs
reports of child psychological health after burns.
may represent a useful strategy to mitigate CRS.
P018 The impact of short term thermal cure therapy in pediatric burn patients K. Maertens ∗ ,1 , I. Ponjaert-Kristoffersen 2 . 1 Oscare NPO, Merksem, Belgium; 2 Vrije Universiteit Brussel (VUB), Brussels, Belgium
P045 Epidemiology of aspergillosis and mucormycosis in burn patients: a retrospective study J.V. Schaal ∗ , L. Bargues, M. Boutonnet, T. Leclerc, H. Le Bever. Military Hospital Percy, Clamart, France
Rationale: Although little demonstrated in literature, hydrotherapy or bathing is commonly considered to benefit the evolution of scar tissue, to facilitate
rationale: Fungal infections increase in burn patients [1]. Aspergillosis (ASP)
physical therapy and mobilization and to favour well-being and comfort in
and Mucormycosis (MMC) are accepted to cause severe diseases and wound
patients with burns. Evidence-based research concerning hydrotherapy is very
infections in patients with extensive burns [1]. However data are scarce in
scarce, certainly in children with burns. Hydrotherapy is supposed to reduce
literature about incidence and consequences. The aim of this work was to
itching, pain when contacting or touching the scar, redness of the skin and
collect demographics on ASP and MMC in burns.
irregularities of the burn surface area, to supple the skin, to gain functionality
Methods: This retrospective study reviews all patients admitted in our centre
of the movements and to provide the possibility to relax. This study investigates
with acute burn injuries (2000–2010) and positive wound culture for Aspergillus
the medical effects of hydrotherapy in burn-injured children.
or Mucorales. Patients were separated in three categories [2]: 1) fungal wound
Methods: Scars of 28 burned children, aged 5 to 16 years, were evaluated before
colonization (FWC) 2) Fungal wound infections (FWI) defined by a quantitative
the start of a two-week thermal cure, and at follow-up moments three and six
biopsy >10.5 pathogens/g tissue associated with SIRS or local signs of wound
months after the end of the cure. The Patient Observer Scar Assessment Scale
infection (including superficial and deep skin infections) 3) Disseminated
(POSAS) was used to assess pain, itching, color, elasticity, and thickness of the
Infection (DI) defined by FWI with a positive blood culture or a positive
scar. Besides, objective measures like scar colour, elasticity and transepidermal
antigenemia or severe sepsis or secondary organ localization(s). We collected
water loss (TEWL) were measured by a Minolta Chromameter CR-400 and Der-
demographic characteristics and outcome.
maLab elasticity- and TEWL-module (Cortex Technology, Denmark) respectively.
Results: 1575 patients were hospitalized. Mean TBSA (%) was 23.3±21.5. Mortality
Results: Significant improvement was found on the POSAS for pain, itching,
rate was 12.5%. Incidences of ASP and MMC were respectively 1.07% (17 cases)
color, and elasticity after time (p<0.05) and for color (p<0.05) as measured with
and 0.5% (8 cases) and the gender was 83% and 87.5% of male. Mean age was
the Chromameter.
41±14 years for both ASP and MMC. Respectively for FWC, FWI and DI, there
Conclusion: Thermal cures could have an additional value to the treatment of
were 4, 7, 6 patients with ASP and 3, 5, 0 with MMC. Mean TBSA was for ASP
burn scars in the active phase of recovery. However, more research is needed to
56±37, 75.5±16, 71±18.7, and for MMC 56±11, 51.6±29. The total length of stay
entangle the precise functioning of this type of treatment in order to enlighten
(in days) was for ASP 104±52, 150±101, 128±80 and for MMC 97±32, 79,4±35.
even further effects at long-term.
5 patients died of ASP (mortality 2.5%). Two of them presented both ASP and MMC. Conclusion: ASP and MMC occur in the most severe burns and are strongly associated with increased mortality and morbidity. References: [1] Ballard J. J Burn Care Res 2008. [2] Greenhalgh DG. J Burn Care Res 2007.