Serum Prealbumin Affected More by Serum CRP Than by Residual Burned Surface Area

PURPOSE: Prealbumin is known as a biochemical marker for assessing nutritional status, and it is influenced by a systemic inflammatory condition. This study aims to find any correlation between patients' low serum prealbumin in electrical burn and unhealed burn surface area and insufficient nutritional support. METHODS: Data were collected by a review of the medical charts of patients admitted to Hanil General Hospital for electrical burn. Laboratory results such as prealbumin, albumin, total lymphocyte count (TLC), and C-reactive protein (CRP) were collected and tested every week. Residual burn surface area (residual BSA) during a specific period was calculated from the surgery record. Statistical analysis was conducted using Pearson's correlation and multiple regression analysis. RESULTS: A total of 30 subjects were selected, all male. Average total burn surface area was 20.9±14.9%, and patients were operated on about three times after admission. There was statistical significance among all variables in Pearson's correlation test, but in multiple regression analysis, albumin and CRP were significant compared with prealbumin. CONCLUSION: The results could indicate that burn causes a systemic inflammatory reaction, which could affect the serum prealbumin level. Further study concerning the biological plausibility of each variable is needed.

Difference in Bacteriology and Antibiotics Resistance with the Change of Burn Wound Dressing

PURPOSE: This study aims to analyse the difference in bacteriology and antibiotics resistance on colonization of burn wound by the change of burn wound dressing. METHODS: A retrospective review of all medical records of patients admitted with burns to the burn center of the Hanil General Hospital in 2002 when the conservative wound dressing was managed and in 2009 when the advanced wound dressing was carried out. Patient demographics, extent and type of burn, mortality rates were reviewed. Isolation and identification of microorganisms was done using the standard procedure. Disc diffusion tests were performed for all the isolates for antimicrobial susceptibility. RESULTS: A total of 456 patients in 2002 and a total of 208 patients in 2009 were admitted. Of them, 27 patients in 2002 (Group A) and 35 patients in 2009 (Group B) have the result of colonization on burn wound by surface swab culture after post admission day 7. Mean age was 43.59+/-3.64 (Group A), 49.46+/-2.79 (Group B). The sex ratio of the patients was 1:0.4 with 20 men and 7 women (Group A), 1:0.5 with 24 men and 11 women (Group B). The mean admission day was 61.46+/-12.02 (Group A), 61.62+/-7.55 (Group B). The average value of total body area burned was 32.30+/-4.43 (Group A), 10.40+/-1.73 (Group B). A total of 3 patients (Group A) has inhalation burn. Three patients (Group A) and one patient (Group B) died. The most common cause of burn was flame burn (59.3%) (Group A), scald burn (48.6%) (Group B). The frequency of resistant microorganisms causing colonization on burn wound was 44.44% (Group A), 22.86% (Group B). CONCLUSION: In group managed with the conservative burn dressing, the resistant microorganisms and pathogens are more frequent than in the advanced burn dressing group. However there was no statistically significant. Ongoing data collection and reanalysis is required.

A Retrospective Epidemiologic Analysis of Elderly Burn Patients at Hanil General Hospital

PURPOSE: This study aims to analyse the epidemiologic characteristics of burn in the elderly and to discusses a possible prevention program for this population. METHODS: A retrospective review of all medical records of elderly patients (above 60 years old) admitted with burns to the burn center of the Hanil General Hospital from January 1996 to December 2007 was carried out. Patient demographics, etiology, extent, and type of burn, seasonal variation, and mortality rates were reviewed. RESULTS: A total of 537 elderly patients (mean age of 69.8 years, median age of 68 years, range 60~97 years) was admitted. The gender ratio of the patients was 1:.5 with 217 men and 320 women. The most common causes were scald burn (44.9%) and flame burn (35.4%). The average total body area burned was 13.5% (range 0~95%). Twenty six patients (4.8%) died. CONCLUSION: In elderly patients, scald burns are more common in women but flame burns are more common in men. The mortality rate is higher in flame burns and men

A Retrospective Epidemiologic Analysis of Burn Patients at Hanil Hospital

PURPOSE: Burn injuries still produce a significant morbidity and mortality. The collection and analysis of burn epidemiology data would provide insights into new prevention management strategies in terms of nationwide profile. We reviewed and compared the data from other countries. METHODS: This study was carried out to analyze the epidemiology, current etiological factors (circumstances), treatment methods and mortality of 4,321 acute burn patients, excluding electrical burn, who were admitted to Hanil Hospital Burn Center during 12 years (1996~2007). RESULTS: 1) The male to female ratio was 1.3:1. The mean age of admission was 30.0 years. The children below 18 years made up 38.9%, and adult over 60 years 10.2%. 2) The scald was the most common cause making up 53.8% followed by flame (30.8%), contact (9.3%), steam (3.6%) and chemical (2.1%) burn. The mean extent was 9.8%, 19.1%, 3.8%, 7.2%, 8.7% respectively. 3) The etiologies of scald burn were boiled water (32.9%), hot food soup (28.1%), boiling water (13.8%), instant food (10.3%) at home (87.4%). The 13.7% of victims underwent surgery of STSG (12.9%), FTSG (0.6%), local flap (1.2%) and advanced flap (0.1%). 4) The majority of flame burn occurred at home (43.7%) and work place factory (23.5%). Leading causes were inflammables (29.3%), fire (14.0%), explosion of butane can (12.8%), gas range (10.1%) and LPG (8.7%). The 31.4% of victims underwent STSG (26.2%), FTSG (0.8%), local flap (0.2%) and major amputation (0.1%). 5) The major victims (50.6%) of steam were children below 2years by exposing to steam of rice cooker (70.0%) at home. The 28.9% of victims underwent STSG (14.7%), FTSG (16.0%) and local flap (5.1%). 6) The contact burns occurred at various places (home; 56.5%, work place; 16.9%, vehicles; 9.0%, sauna; 4.5%) by various causes (Ondol; 11.9%, hot pack; 11.2%, oriental herb medicine; 6.7%). The 45.8% of victims underwent STSG (36.3%), FTSG (6.7%), local flap (5.2%), advanced flap (2.0%) and minor amputation (1.2%). 7) The chemical burn occurred at various place (home; 39.3%, work place; 49.4%) by acids (43.8%), alkalies (11.2%), vinegar (15.7%) and herb moxa (16.9%). The 28.1% of victims underwent STSG (22.5%), FTSG (9.0%), local flap (7.9%) and minor amputation (6.7%). 8) Children<18 years old were burnt mainly by scald (79.0%) while for adults below 50 years old was flame, over 50 years was scald. Children below 2 years old had higher frequency of steam (9.2%) and contact (7.9%) burn. The contact burn had relatively higher frequency among 7th (17.6%) and over 8th (20.4%), while chemical among 6th (3.9%) decade. 9) Inhalation injury was accompanied in 13.8% of flame burn (4.3% of total). The inhalation injury only was 4.9% of flame (1.5% of total). 10) The overall mortality rate was 1.8%. The mean age of death was 47.3 years old and burn extent was 74.5%TBSA. There was a strong correlation between flame burn (96.2% of total death), TBSA (50~60%; 9.3% vs 70~80%; 65.2%, 80~90%; 71.4%, over 90%; 87.9%) and mortality. The prognosis was poor for those over 70 year old (7.7% vs 30~50 yo; 2.8%, 7 th decade; 3.7%), flame burn (5.6% vs scald; 0.04%) and combined inhalation injury (22.3%). The patients died at mean 17.3 PBD by ARDS (51.3%), sepsis (44.9%), burn shock (20.5%) and ARF (5.1%) 11) The severity and sequelae of scald by prepackaged instant food, steams of rice cooker, flame by used butane can, contact by Ondol, sauna and chemical by vinegar should be added to preventive programs. CONCLUSION: Further study for implications of changes in management protocols and policies on treatment outcomes would improve the provision of appropriate care for the patients.

Apoptosis Gene Expression Pattern Analysis of Jurkat Cells Treated with FK506

PURPOSE: FK506 (tacrolimus) is a widely used immunosuppressive agent in the treatment of various medical conditions, including autoimmune disease, bone marrow and organ transplantations. Previously FK506 was known to cause apoptotic death of human Jurkat T cells. METHODS: The current study was designed to analyze the gene expression pattern of Jurkat T cells after FK506 application by using cDNA microarray. Treatment of Jurkat T cells with FK506 resulted in a decrease of cell viability in a time- and dose-dependent manner. Next, total RNA of Jurkat T cells was extracted by using TRIzol reagent and used to carry out a confirmation test for the purity and integrity of total RNA. RESULTS: Gene expression levels related to apoptosis and cell cycle process were mainly focused to analyze in FK506-treated Jurkat T cells. According to the inhibition of calcineurin activity, MARCKS in PKC substrates and Sp3 transcription factor was markedly increased in FK506-treated cells. Also, cell cycle control gene Id1 and Id3 were induced in expression from FK506-treated Jurkat T cells. However, FK506 decreased the expression of Src homology 2, G protein, and MEK 2 genes in bioactive peptide induced signaling pathway. It also reduced the expression level of the insulin receptor, DRPLA and Bai1-associated protein 2 genes, which are involved in the regulation of cell motility and morphology control. CONCLUSION: The author will continue to pursue the exact functional roles of genes that are markedly changed in expression by FK506 in human Jurkat T cells in vitro and in vivo experimental models.

The Case Report of Burn Wound Healing in the Patient with Arteriovenous Fistula

PURPOSE: Arteriovenous fistula (AV fistula) and immune suppressive drug have a different effect on wound healing. AV fistula supposed to have a positive role of wound healing by the increased blood flow around the wound. But immunosuppressive drug has a well known effect of delayed wound healing. METHODS: We experienced 55 years old female patient who suffered from 9% burn of TBSA, 2nd to 3rd degree burn of arm and chest wall with arteriovenous fistula in the burned arm. She also take immunosuppressive drugs for 13 years due to kidney transplantation. RESULTS: She takes two consecutive skin graft operations on post admission day 14 and 42. Bleeding from the surface of eschar excised arm was profuse so it makes us unable to finish in the first operation. But graft skins were well taken except partial take-off in chest wall area. Episode of shock make 2nd skin graft postponed for a month but the skin uptake of arm was very successful. CONCLUSION: The arteriovenous fistula has the positive effect in the case of burn wound healing including the skin graft, exceed the negative role of immunosuppressive drugs in the wound healing.

Biologic Wet Dressing with Amnion in Muscle Necrosis of Lower Extremity Caused by Acute Limb Ischemia

Early treatment to facilitate the muscular blood flow can avert myonephropathic metabolic syndrome (MNMS) and major amputation for patients suffering with acute limb ischemia. Delayed reperfusion or microemboli in the small vessels can aggreviate: ischemic changes and lead to irreversible muscle necrosis. Amnion is an excellent biological dressing, and we tried using it to treat anterior compartment muscle necrosis (ACMN). The amnions were aseptically collected from caesarean sections. Additional betadine (1 : 3 solution) and vaseline-soaked gauzes were applied over the amnion as a daily biologic wet dressing. The amnion was replaced every three days. Finally, split skin grafting was performed on the healthy granulation tissue. We treated two patients who happened to have shin muscle necrosis. A 65-year-old man with a femoro-femoral arterial bypass showed graft thrombosis. Thirteen days after performing balloon angioplasty with stent insertion in the right femoral artery, new emboli were found in the stent and in the left popliteal artery. There was an attack of myocardial infarction the next day after embolectomy. The severe MNMS and ACMN at the right shin occurred after cardiopulmonary resuscitation. The dry gangrene was excised 3 months later, and this was followed by a skin graft 4 months later. An 81-year-old woman with atrial fibrillation showed left common femoral arterial obstruction and ACMN on the left shin during the management of congestive heart failure. The dry gangrene was excised 2 months later, and this was followed by a skin graft 3 months later. The amnion dressing shows promises for providing healthy granulation tissue for split skin grafts when treating muscle necrosis of the leg. Biologic dressing with using amnion is an option for limb salvage in the case of muscle necrosis that is caused by acute limb ischemia, although the treatment takes a long time.