Contemporary reconstruction of a severe neuropathic foot burn injury

The neuropathic foot in diabetic patients constitutes a special clinical entity that needs particular care and ministration. A burn on such a foot requires special care and attention in order to avoid amputation, especially when the burn is a deep partial or a full-thickness burn. The indication for early excision and coverage of a diabetic foot is taken under consideration in clinical practice. An 80-year-old male diabetic patient with deep partial and full-thickness burns on both his feet after a long hot footbath is presented. Even though feet appearance indicated the need for amputation of both feet, we performed gradual surgical debridement and primary coverage with human skin allografts. Both feet were finally covered with partial thickness skin grafts. Considering age, general condition and severity of the burn injuries, the final results were very satisfactory. We believe that the gamma-radiated allograft is another useful adjunct to the reconstructive armamentarium of the surgeon.

Abdominal compartment syndrome (ACS) in a severely burned patient

Abdominal compartment syndrome (ACS) occurs when increasing intra abdominal-pressure (IAP) reduces blood flow to abdominal organs. This results in impairment of pulmonary, cardiovascular, renal, hepatic, central nervous system and gastro-intestinal (gi) function, causing multiple organ dysfunction syndrome and death. The significant prognostic value of elevated intra-abdominal pressure has prompted many intensive care units to adopt measurement of this physiologic parameter as a routine vital sign in patients at risk. ACS generally occurs in patients who are critically ill due to any of a wide variety of medical and surgical conditions. it has been recently described as a rare complication of burn injury. it is fundamental to: 1) recognize IAP and ACS; 2) resuscitate effectively; and 3) prevent the development IAP-induced end-organ dysfunction and failure. We present our recent experience with one patient suffering from ACS secondary to burn injury and the physiologic results of abdominal wall escharotomy.

Outcomes of patients who commit suicide by burning

Cases in which people use fire when attempting or committing suicide are not common but nevertheless constitute a cause of admission to burns units worldwide. Usually these people are suffering from stress and have been diagnosed as mentally ill. Schizophrenia, depression, and personality disorders are the most frequently diagnosed conditions. The psychological problems appear to have been overlooked by the family or not to have been presented to them. The aim of this study is to present the clinical features, characteristics, and outcomes of patients burned during a suicide attempt. The role of the psychiatrist is important, starting in the emergency room. The incidence of patients committing self-injury by burning appears to be higher in women burn patients. Deceased patients usually have a larger extent of burns and a higher incidence of other injuries and require more surgical procedures and longer hospitalization times. The problems for burn unit staff and qualified psychiatric care are discussed.

Burns during Easter festivities in Greece

Easter is the most important holiday for the Greek Church. It is rich in traditions and rituals but during the Greek Easter festivities, especially at midnight Mass on Easter Saturday night, it is customary to throw fireworks around. These fireworks are not part of the true Easter tradition and they are potentially fatal. Unfortunately, in the past few years, the custom has become more and more popular in Greece. There are some local variations, mainly in the Aegean islands, where homemade rockets are used to have a "rocket war". The rockets consist of wooden sticks loaded with an explosive mixture containing gunpowder and launched from special platforms. Many severe injuries involving loss of sight and limbs as well as major burns are also caused by the use of illegal fireworks at Easter. Every year numerous burn victims are hospitalized. The most affected areas are the face, the upper extremities, and the chest, often in association with slight or severe wounds and injuries. This study presents our department's experience with incidents due to the use of fireworks during Easter festivities.

Stevens-johnson syndrome: a case report

The Stevens-Johnson syndrome has the appearance of a partial-thickness burn that may lead to a 100% loss of epidermis, requiring the same resuscitation as a severe burn. A 38-yr-old male patient was admitted to the neurosurgery department of the Evangelismos General Hospital in Athens, where immediately after administration of an antiepileptic drug he developed sloughing of total epidermis, high fever, and the clinical picture of a severe burn patient. He was treated as a burn patient with massive cutaneous injuries and the concomitant systemic effects. Fluid resuscitation was important and the Parkland formula was used, as in a burn patient. Steroid medications were initially administered. Systemic antibiotics were discontinued after signs of sepsis and documented infection had been overcome. Improved treatment techniques and critical burn care have decreased mortality and morbidity in cases of the Stevens-Johnson syndrome. Prompt recognition of the disease and cure of the patient by the appropriate staff of the burns centre contribute to the successful treatment of such patients.

Emergency percutaneous tracheostomy in a severely burned patient with upper airway obstruction and circulatory failure

Airway inaccessibility is one of the most dreaded situations in emergency medicine. Surgical tracheostomy is not indicated in emergency situations because it takes a long time and can result in death if respiratory support cannot be provided during the procedure. Emergency percutaneous tracheostomy (PCT) was widely regarded as absolutely counterindicated. Recently, however, a number of studies have appeared on the safety and feasibility of PCT in situations regarded as presenting relative contraindications. We describe the life-saving action of Griggs' PCT in a patient with upper airway obstruction resulting from burns, smoke injuries, and unsuccessful tracheal intubation attempts. Emergency PCT using the Griggs technique was immediately performed without aseptic care, and a 9-mm internal diameter tracheostomy tube was successfully inserted in less than one minute. Griggs' PCT is a quick technique that secures an airway when tracheal intubation fails. The feasibility - in selected cases - of using an emergency Griggs' PCT, in experienced hands, rather than cricothyroidotomy or surgical tracheostomy, is recommended.

Hypophosphataemia in burns

Hypophosphataemia is defined as a phosphate level of less than 2.5 mg/dl (0.8 mmol/l). Many of the pathophysiological changes and therapeutic interventions in the first week post-burn affect serum phosphorus concentration. A retrospective study reviewed the medical records of nine severely burned patients, and a special reference of decreased phosphate serum level was noted. Serum phosphorus levels declined, with a nadir between days 2 and 6 post-burn. The severe hypophosphataemia that often follows major burns returns to normal phosphorus levels on days 18 to 20 post-burn. Weight-based phosphorus dosing is safe to use in critically burned patients receiving nutritional support. Moderate doses effectively increase serum phosphorus concentrations.

Pain response and pain control in burn patients

Burn injury is totally correlated to pain, which depends on burn depth and extent, cause, age and the patient's general condition, and on the local therapy of the burn wound. In hospitalized patients adjectival and numerical scales have been used to measure pain. The management of pain is challenging to the therapist and extremely important for the patient.

Traumatic injuries with deep abrasion: "a burn"

This epidemiological study deals with 34 patients with friction burns sustained between January 2007 and January 2008. The age group most affected was that between 21 and 30 yr, with a male predominance. Road traffic accidents were the commonest cause of friction burns (31 patients) and the lower limb was body part most commonly affected. The therapy was mostly conservative (no. 18): 14 patients were treated with a split-thickness skin graft, and just two with flap cover. Friction burns are overlooked in the emergency department because of their association with more critical mechanical injuries. They can be prevented by observing standard safety measures such as special clothing or appropriate equipment, especially as regards motorcycle riders.

Acute acalculous cholecystitis - a rare complication of burn injury

The aim of this study is to draw attention to acute acalculous cholecystitis, a rare complication that may occur during the post-burn period (usually within 20-30 days). A 42-yr-old male patient, the victim of 35% TBSA high-voltage electrical burns that caused the amputation of both upper extremities by day 45 post-burn, was brought to our operating theatre suffering from acute acalculous cholecystitis. Mild epigastric pain followed by reflex nausea, vomiting, and pain that shifts to the upper quadrant and considerably increases during the post-burn period should make the therapist think of acalculous cholecystitis and react immediately with an urgent operation. Diagnosis of acute acalculous cholecystitis in a burn patient depends on recognizing a combination of signs and symptoms which are often attributed to other problems. Once diagnosed, the best choice of treatment for acalculous cholecystitis is cholecystectomy in an otherwise clinically stable patient.

Epidemiological Survey of Burn Victims Treated as Emergency Cases in our Hospital in the Last Five Years

We present a retrospective epidemiological study based on 1061 patients admitted to our burns centre in Greece over the 5-yr period from January 2002 to January 2007. Their average age was 25 yr, and 61% were female. The two main causes of burns were scalding and flames. Other significant causes were chemicals and friction. Electricity, frostbite, and contact burns were less frequent. The upper extremity and face were most commonly affected, followed by the lower limbs. All the patients had minor burns (less than 20% total body surface) and were treated on an out-patient basis as there was no need for hospitalization.

Burns and ulcerative colitis

The co-existence of an extensive burn with a systemic disease negatively affects the outcome of the burn as well as the progress of the disease. A case report is presented regarding a 70-yr-old female patient with 45% total body surface area burns and ulcerative colitis under treatment. The outcome of the burns is described and it is pointed out that the healing process of the burns and the remission of the ulcerative colitis were related.

Fluctuation of psychological status in burn patients during hospitalization

This paper considers the fluctuations in psychological status that occur in burn patients in the acute phase, during hospitalization, and in the post-hospitalization period. The various disorders are reported. Psychiatric consultation is mandatory, along with psychological support, and appropriate medication should be prescribed.

Diseases mimicking a burn - outcome and treatment

Burn care is not reserved uniquely to burns. Several diseases have the symptomatology, clinical presentation, complications, treatment requirements, and outcome of burns. Such diseases are: 1. Stevens-Johnson disease; 2. Lyell's syndrome; 3. bacterial fasciitis; 4. skin necrosis combined with coagulation disturbances; 5. pemphigoid; and 6. subacute cutaneous lupus erythematosus.

Burns and fire disasters

A fire disaster took place on New Year's Eve 2003 in a small closed environment as the result of a Molotov cocktail bomb attack. Seven persons suffered burns, two of whom died and five were hospitalized. The aim of this paper is to focus on the consequences of such explosions, which are numerous and cause extensive burns with fewer though more severe injuries when they occur in a closed environment than fire disasters in an open environment.

Vinorelbine in Combination with Interleukin-2 as Second-Line Treatment in Patients with Metastatic Melanoma. A Phase II Study of the Hellenic Cooperative Oncology Group

OBJECTIVES

To evaluate the efficacy and toxicity of the combination of vinorelbine and interleukin (IL)-2 in patients with metastatic melanoma as second-line chemotherapy.

PATIENTS AND METHODS

Twenty-two patients with histologically confirmed stage IV melanoma previously treated with temozolomide-based chemotherapy--only one regimen of chemotherapy for disseminated disease was allowed--were treated with vinorelbine 30 mg/m2 on days 1 and 15 and IL-2 subcutaneous 9 x 10(6) once daily on days 2-6 and 16-19 every 4 weeks for maximum of six cycles.

RESULTS

From January 2000 to July 2001, 22 patients entered the study; the median age was 56 years. Among 20 evaluable patients there were 2 (9.1%) objective responses including 1 complete response and 1 partial response. Five (22.7%) had stabilization of their disease, and 13 (59.1%) progressed. The median time to progression (TTP) was 2.9 months and the median overall survival was 9.1 months. There was a significant difference in TTP in patients who responded or remained stable (median TTP 10.75 months) and those who progressed (median TTP 2.1 months) (p<0.05). There was also a difference in survival in the two groups (p<0.05 (28 vs. 8 months). The most common side effects were flulike symptoms, such as fever, chills, fatigue, and injection site reaction. Grade 3 hematological toxicity rarely occurred. One patient discontinued therapy because of fatigue and anorexia. There were no treatment-related deaths.

CONCLUSIONS

The combination of vinorelbine and IL-2 provides clinical benefit in patients recurring or progressing on first-line chemotherapy for metastatic melanoma, with manageable toxicity.