1/4. Occult brain tumour presenting with burns.An elderly male patient sustained mixed depth burns of 5% total body surface area. The incident was associated with inappropriate behaviour and subsequent clinical examination confirmed the presence of confusion and a hemiparesis. A CT scan revealed an intracranial tumour. Despite early suspicions that tumour excision would be delayed, wound healing was achieved quickly following tangential burn wound excision and skin grafting, and prompt transfer to a neurosurgical unit was expedited. Cases of burns and concomitant intracranial tumours with deteriorating neurological signs may present clinicians with a dilemma in deciding whether or not to await burn wound healing before carrying out tumour excision.- - - - - - - - - - ranking = 1keywords = behaviour (Clic here for more details about this article) |
2/4. pseudomonas infections in the thermally injured patient.pseudomonas aeruginosa, remains a serious cause of infection and septic mortality in burn patients, particularly when nosocomially acquired. A prototypic burn patient who developed serious nosocomially acquired Pseudomonas infection is described as an index case which initiated investigations and measures taken to identify the source of the infection. The effect of changes in wound care to avoid further nosocomial infections was measured to provide data on outcome and cost of care. The bacteriology of Pseudomonas is reviewed to increase the burn care providers understanding of the behaviour of this very common and serious pathogen in the burn care setting, before reviewing the approach to detection of the organism and treatment both medically and surgically. After controlling the nosocomial spread of Pseudomonas in our burn unit, we investigated the morbidity and mortality associated with nosocomial infection with an aminoglycoside resistant Pseudomonas and the associated costs compared to a group of case-matched control patients with similar severity of burn injury, that did not acquire resistant Pseudomonas during hospitalization at our institution. We found a significant increase in the mortality rate in the Pseudomonas group compared to controls. The morbidity in terms of length of stay, ventilator days, number of surgical procedures, and the amount of blood products used were all significantly higher in the Pseudomonas group compared to controls. Costs associated with antibiotic requirements were also significantly higher in the Pseudomonas group. Despite this increased resource consumption necessary to treat pseudomonas infections, these efforts did not prevent significantly higher mortality rates when compared to control patients who avoided infection with the resistant organism. Thus, in addition to the specific measures required to identify and treat nosocomial pseudomonas infections in burn patients, prevention of infection through modification of treatment protocols together with continuous infection control measures to afford early identification and eradication of nosocomial Pseudomonas infection are critical for cost-effective, successful burn care.- - - - - - - - - - ranking = 1keywords = behaviour (Clic here for more details about this article) |
3/4. The "second set" phenomenon as first shown in skin allografts. An historical case which shows also the behaviour of cell free collagen.A 2-year-old girl had granulating areas on her abdomen and thigh following burns. On these were placed two "sets" of homografts from her father at an interval of 13 days. The first set showed extensive growth in all directions, the second set showed little or none. Between dressings on the 23rd and 26th day after the first set was applied (10 and 13 days after applying the second set) all the epithelium of both sets disappeared. This strongly suggested that a reaction to the father's epithelium had reached an intensity where it destroyed all "homograft" epithelium on the body. The collagenous ghosts of the homografts remained, became grown over by host epithelium and remained visible below it until the end of the observation period of 2 months.- - - - - - - - - - ranking = 4keywords = behaviour (Clic here for more details about this article) |
4/4. Non-insulin-dependent diabetes mellitus: diagnostic and therapeutic challenges in the severely burned patient--a case report.The purpose of this paper is to describe the management of a previously undiagnosed non-insulin-dependent diabetic patient with a severe burn injury. The hyperglycaemia and glucose intolerance following burn injury was complicated by the hyperglycaemia of diabetes mellitus. Intravenous insulin infusion monitored by hourly glucose levels was required to manage this hyperglycaemia. During day 11 postburn injury, this patient required 2104 units of insulin to control his hyperglycaemia. Aggressive detection and management of infections complemented by early debridement and coverage of the burn wound were other important considerations in the management of this patient. The diagnosis of non-insulin-dependent diabetes mellitus (NIDDM) was made after the patient recovered from his burn injury. His rehabilitation programme has included primary prevention strategies for NIDDM that focus on health-improving behaviours such as improved diet, exercise, and weight control.- - - - - - - - - - ranking = 1keywords = behaviour (Clic here for more details about this article) |