Early versus late excision and grafting in the treatment of second and third degree burns

One hundred seventy eight patients with second or third degree burns who attended the emergency department in Suez Canal University Hospital in whom the total body burned surface area [TBSA] ranged between 10- 50% were included in our study. They were allocated randomly into two equal groups using simple randomization technique. [n= 89 patients]. Patients of the first group were treated by early excision of eschars and auto grafting [EEG], after a mean period of 5.39 +/- 1.47 days while patients of the second group were treated by repeated eschar excision, wound dressing and late grafting [LEG] after a mean period of 39.12 +/- 18.26 days [P<0.0001]. The mean graft take was 95.38% +/- 7.70 in the EEG group while it was 94.37% +/- 6.81 in the EEG group. The difference was statistically insignificant. Hypertrophic scars were common among patients of EEG group [41.57%] compared to [26.96%] in LEG group. It declined to 35% in EEG group compared to 30% in LEG group when burned surface area was equal or below 20% of [TBSA]. Late contracture was less common among patients of EEG group [6.74%] compared to [24.71%] in LEG group [P<0.001]. It declined to 0% in EEG group compared to 25% in LEG group when burned surface area was equal or below 20% of [TBSA]. The overall mortality was 5.06% [9 patients]. All mortalities had a burned surface area of 40-50%, it was due to septicaemia in 6 patients [3.37%], acute renal failure in 2 patients [1.12%] and DIC in one patient [0.56%]. Five of them [5.62%] were in EEG group and 4 [4.49%] were in the LEG group [NS]. The mean hospital stay was shorter in the EEG group [22.75 +/- 22.58 days] compared to [61.43 +/- 22.01 days] in the LEG group [p=0.0002]. We recommend the use of EEG in the management of second and third degree burn

Upper gastrointestinal bleeding in Ismailia: agreement between clinical and endoscopic diagnosis

Thorough detailed history and clinical examinations were obtained, and early upper gastrointestinal endoscopy was performed to 632 patients presenting with upper gastrointestinal bleeding to determine the bleeding source. The Chi-square test, the student t test and Mannwitney test were used where appropriate. A "p" value less than 0.05 was considered to be significant. The statistic Kappa was computed to quantify the extent of agreement beyond chance between the clinical and endoscopic diagnosis of the bleeding source. Esophageal varices was found to be the most common source of bleeding. Duodenal ulcer and gastric ulcer occurred with decreasing frequencies. 32% of patients had more than one potential bleeding site, emphasizing the need to anticipate more than one lesion at endoscopy in patients with upper gastrointestinal bleeding and the importance of early endoscopy to identify the bleeding source. No source of bleeding was apparent in 6.7% of cases. Kappa was only 0.58 emphasising that clinical system is not able to discriminate well between the disease categories. Patients with bleeding esophageal varices were significantly younger than non variceal bleeders [36.8 +/- 12 years and 51.8 +/- 18 years, respectively]. About 86% of patients with bleeding varices and 39% of those with non-variceal source of bleeding were rural [p < 0.05]. There was a tendency for upper gastrointestinal bleeding to occur more often in the winter months regardless of the cause. The overall mortality rate was 21.4%. It was higher [29.4%] in patients with varices compared with non variceal bleeders [6.4%]. Liver status, mode of presentation and severity and activity of bleeding at presentation were fount to be predictors to the hospital outcome