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582 Burns (1986) 12, (8), 592-594 Printedin Great Brifain Abstracts CLINICAL STUDIES Quality of life after major burns Twelve out of 21 burned children, with ages ranging from 0.8 to 12.4 years, who survived burns covering at least 80 per cent of the total body surface (with over 70 per cent full thickness injury) were studied with respect to the quality of their subsequent life. All the patients underwent total excision and grafting of all their wounds within 72 h of injury. Their average stay in hospital was 77_+10 days, they had a mean of 7.8kO.X operations and a total blood loss of 12F2 blood volumes. Three patients had septic episodes, four pa- tients required amputations. Physical impairment was approximately 60 per cent, however half of the children old enough to be tested were completely independent in activities of daily living. One-third of the children had excessive fear, regression and neurotic and somatic complaints. However, as all of them showed rcmark- able energy in adapting to their disabilities the final outcome can only be assessed later in adolescence and young adulthood. Herndon D. N., LeMaster J., Beard S. et al. (1986) The quality of life after major thermal injury in chil- dren: an analysis of 12 survivors with X%l% total body, 70% third degree burns. J. Truumu 26, (7), 609-619. Bacteraemia and burn mortality The relationship between burn mortality and bacter- aemia was studied in 5877 patients. Of these patients only 1481 had one or more positive blood cultures. In the remaining 4396 patients comparisons were made between observed and predicted mortality in subsets of patients with bacteraemia due to: (1) enteric organ- isms; (2) Pseudomonas species; (3) Gram-positive organisms or (4) yeast-like organisms, or (5) those without bacteraemia. The results showed that Gram- negative bacteraemia induced significantly increased mortality, there was an equivocal increase in mortality with yeast-like organism infections and no increase in mortality attributable to Gram-positive organisms. volume or myocardial performance. In some patients adequate resuscitation with fluids during the first 24 to 48 h after severe thermal injury may require measure- ments of ventricular volume and ejection fraction using either the thermodilution technique or ventriculogra- phy using technetium-99m. Martyn J. A. J., McKusick K.. Strauss H. W. et al. (1986) Ventricular volume and ejection fraction in the diagnosis of the aetiology of low cardiac output in burned patients. Anaesthesia 41, (5), 511-515. Myoglobin and CK in serum Serum levels of myoglobin and creatine kinase (CK) were measured frequently in 22 patients with burns covering between 7 and 81 per cent of the body surface area. There was a strong correlation between the myo- glohin and CK levels. Since CK levels were easier to determine than myoglobin levels, the former provided a prompt assessment of the degree of muscle damage. Both measurements were useful in assessing the likeli- hood of renal damage. Guechot J.. Lioret N., Cynoher L. et al. (1986) Myoglohinaemia after burn injury: relationship to creatine kinase activity in serum. Clin. Chem. 32. (S), 857-859. Aspects of drug metabolism An extensive review of the pharmacological aspects of drug therapy in burned patients has emphasized the role of cardiovascular behaviour and plasma protein binding effects on drug concentration. Specifically such changes arc known to affect the therapeutic levels of systemic antibiotics, topically applied antimicrobial agents, antacids, sedatives, analgesics, anaesthetics, adrenergic agonists and acetylcholine receptor agonists and antagonists. The level of knowledge is limited in many respects and clinical research studies are urgently required. Martyn J. A. J. (1986) Clinical pharmacology and drug therapy in the burned patient. Anesthesiology 65, (I), 67-75. Mason A. D.. McManus A: T. and F%uitt B. A. (1986) Association of burn mortality and bacteraemia: ANIMAL STUDIES a 25 year review. Arch. Surg. 121, (9). 1027-1031. Metabolic effects of infection Assessments of cardiac function Oxygen consumption and core temperature were mea- Routine measurements of atrial filling pressures and sured in rats with deep burns covering 30 per cent of the cardiac output do not always reflect adequacy of blood body surface. Some wounds were then seeded with P.Y.

Myoglobin and CK in serum

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582 Burns (1986) 12, (8), 592-594 Printedin Great Brifain

Abstracts

CLINICAL STUDIES

Quality of life after major burns Twelve out of 21 burned children, with ages ranging from 0.8 to 12.4 years, who survived burns covering at least 80 per cent of the total body surface (with over 70 per cent full thickness injury) were studied with respect to the quality of their subsequent life. All the patients underwent total excision and grafting of all their wounds within 72 h of injury. Their average stay in hospital was 77_+10 days, they had a mean of 7.8kO.X operations and a total blood loss of 12F2 blood volumes. Three patients had septic episodes, four pa- tients required amputations. Physical impairment was approximately 60 per cent, however half of the children old enough to be tested were completely independent in activities of daily living. One-third of the children had excessive fear, regression and neurotic and somatic complaints. However, as all of them showed rcmark- able energy in adapting to their disabilities the final outcome can only be assessed later in adolescence and young adulthood.

Herndon D. N., LeMaster J., Beard S. et al. (1986) The quality of life after major thermal injury in chil- dren: an analysis of 12 survivors with X%l% total body, 70% third degree burns. J. Truumu 26, (7), 609-619.

Bacteraemia and burn mortality The relationship between burn mortality and bacter- aemia was studied in 5877 patients. Of these patients only 1481 had one or more positive blood cultures. In the remaining 4396 patients comparisons were made between observed and predicted mortality in subsets of patients with bacteraemia due to: (1) enteric organ- isms; (2) Pseudomonas species; (3) Gram-positive organisms or (4) yeast-like organisms, or (5) those without bacteraemia. The results showed that Gram- negative bacteraemia induced significantly increased mortality, there was an equivocal increase in mortality with yeast-like organism infections and no increase in mortality attributable to Gram-positive organisms.

volume or myocardial performance. In some patients adequate resuscitation with fluids during the first 24 to 48 h after severe thermal injury may require measure- ments of ventricular volume and ejection fraction using either the thermodilution technique or ventriculogra- phy using technetium-99m.

Martyn J. A. J., McKusick K.. Strauss H. W. et al. (1986) Ventricular volume and ejection fraction in the diagnosis of the aetiology of low cardiac output in burned patients. Anaesthesia 41, (5), 511-515.

Myoglobin and CK in serum Serum levels of myoglobin and creatine kinase (CK) were measured frequently in 22 patients with burns covering between 7 and 81 per cent of the body surface area. There was a strong correlation between the myo- glohin and CK levels. Since CK levels were easier to determine than myoglobin levels, the former provided a prompt assessment of the degree of muscle damage. Both measurements were useful in assessing the likeli- hood of renal damage.

Guechot J.. Lioret N., Cynoher L. et al. (1986) Myoglohinaemia after burn injury: relationship to creatine kinase activity in serum. Clin. Chem. 32. (S), 857-859.

Aspects of drug metabolism An extensive review of the pharmacological aspects of drug therapy in burned patients has emphasized the role of cardiovascular behaviour and plasma protein binding effects on drug concentration. Specifically such changes arc known to affect the therapeutic levels of systemic antibiotics, topically applied antimicrobial agents, antacids, sedatives, analgesics, anaesthetics, adrenergic agonists and acetylcholine receptor agonists and antagonists. The level of knowledge is limited in many respects and clinical research studies are urgently required.

Martyn J. A. J. (1986) Clinical pharmacology and drug therapy in the burned patient. Anesthesiology 65, (I), 67-75.

Mason A. D.. McManus A: T. and F%uitt B. A. (1986) Association of burn mortality and bacteraemia: ANIMAL STUDIES a 25 year review. Arch. Surg. 121, (9). 1027-1031.

Metabolic effects of infection Assessments of cardiac function Oxygen consumption and core temperature were mea- Routine measurements of atrial filling pressures and sured in rats with deep burns covering 30 per cent of the cardiac output do not always reflect adequacy of blood body surface. Some wounds were then seeded with P.Y.