Saturday night burns: an increasing problem?

In Italy the economic crisis has caused changes in behavior in daily as well as leisure activities. For instance, night clubs have changed both their scenography and what they can offer. From simply providing a place to dance, they can now offer more complex scenography with spectacular fireworks and lit cocktails. While this can be amazing for all of us it can also be another cause of burn injuries. We conducted a retrospective study of all burns patients admitted to the Accident and Emergency Department at CTO Hospital in Turin from 2009 to 2013, after a night clubbing. A total of five patients were identified with an average age of 20 years old: four were burned by flaming cocktails and one was burned by a firework. Two received outpatient treatment, while orotracheal intubation and admission were needed for three, and two required surgical debridement and resurfacing with split skin graft. All patients had permanent sequelae caused by pathologic scarring and/or dyschromia. Our findings show that the risk of burn injuries is higher at weekends, mainly in summer, if all correct safety procedures are not followed. Meanwhile it is important to highlight that the promotion of inappropriate behavior at night clubs during firework displays and the passing of flaming cocktails should be avoided.

En Italie la crise économique a entraîné des changements dans le comportement de tous les jours ainsi que des activités de loisirs. Par exemple, les boîtes de nuit ont changé à la fois leur scénographie et ce qu'ils peuvent offrir. D'abord ils fournissaient simplement un endroit pour danser, mais ils peuvent désormais offrir une scénographie plus complexe avec des feux d'artifice spectaculaires et des cocktails éclairés. Même si cela peut être amusant pour nous tous, il peut aussi être une autre cause de brûlures. Nous avons mené une étude rétrospective de tous les patients brûlés admis à l'hôpital CTO de Turin de 2009 à 2013, après une nuit dans une boîte. Les patients identifiés étaient cinq jeunes avec un âge moyen de 20 ans: quatre ont été brûlés par des cocktails enflammés et un a été brûlé par un feu d'artifice. Deux ont reçu un traitement ambulatoire, trois ont reçu l'intubation orotrachéale et l'admission de prévention, et deux ont reçu un débridement chirurgical et avec les greffes de peau. Tous les patients avaient des séquelles permanentes causées par la cicatrisation et / ou dyschromie pathologique. Nos résultats montrent que le risque de brûlure est plus élevé le week-end, surtout en été, si toutes les procédures de sécurité appropriées ne sont pas suivies. Il est important de souligner que la promotion d'un comportement inapproprié dans les boîtes de nuit pendant les feux d'artifice et le passage de cocktails flambés doit être évitée.

Contrast-enhanced ultrasonography evaluation after autologous fat grafting in scar revision.

AIM: Fat transfer is commonly used to fill loss of volume in depressed scars caused by trauma, deep burns or surgery. The aim of the study is to investigate the degree of fat graft take through evaluation of the microcirculation of grafted autologous adipose tissue using contrast-enhanced ultrasonography. PATIENTS AND METHOD: From 2010 to 2012 at the Department of Plastic and Reconstructive Surgery of the Traumatological Center in Turin, a study population was selected from patients with surgical indications for autologous fat transfer for scar correction. For each surgical procedure patients underwent a clinical and sonographic evaluation before and after intervention (at 1 month and 3 months). RESULTS: Out of a total of 28 interventions, 24 showed a good result; defined as improvement of the scar, and confirmed by the presence of vascularization in the transplanted tissue. In 4 cases, there was a lack of blood supply at the first evaluation but an initial good clinical scar correction. The absence of blood vessels was confirmed at 3 months accompanied by complete resorption of the transferred fat with a failure of good clinical outcome. CONCLUSION: Contrast-enhanced ultrasonography was able to evaluate the microvasculature of adipose tissue after fat transfer. Due to this characteristic, it allows to monitor and predict the take of adipose tissue and provide realistic and early information on the clinical outcome of fat transfer.

Purpura fulminans in meningococcal septicaemia in an adult: a case report.

Purpura fulminans is a rare and severe complication of meningococcal septicaemia. It presents as a petechial rash spreading rapidly in extent and depth, evolving into full-thickness skin necrosis. The condition is extremely uncommon in the adult population. We report the case of a 28-yr-old man with extensive meningococcal-related skin necrosis. The initial diagnosis was made and first treatment given in the emergency department of a local hospital, from where after 12 days he was transferred to our hospital. Our approach was based on the continuation of intensive treatment and on staged aggressive debridement. Temporary alloplastic skin grafts were used to prepare the wound bed and the wounds were closed with autologous skin grafts. The patient survived but subsequently, owing to chronic skin ulceration and scar instability, he underwent late bilateral below-the-knee amputation.The patient returned to normal deambulation with an orthopaedic prosthesis 18 months after the onset of meningococcal septicaemia.

Activity of GH/IGF-1 axis in burn patients: comparison with normal subjects and patients with GH deficiency.

The aim of this study was to clarify the activity of GH/IGF-1 axis as well as the variations of nutritional parameters following a thermal injury in man. To this goal, in 22 patients with burn [BURN, age (mean+/-SE): 46.5+/-3.4 yr, BMI: 25.0+/-0.8 kg/m2, % burn surface area: 26.0+/-3.0%, ROI score: 0.22+/-0.1] we evaluated IGF-1, IGF binding protein (IGFBP-3), GH, GH binding protein (GHBP), pre-albumin (pre-A), albumin (A) and transferrin (TRA) levels on days 1, 3, 7, 14 and 28 after intensive care unit (ICU) admission. IGF-1, IGFBP-3, GH and GHBP levels were also assayed basally in 29 normal subjects (Ns) (Ns, age: 47.5+/-2.8 yr, BMI: 22.0+/-1.4 kg/m2) and in 34 panhypopituitary patients with severe GH deficiency (GHD, age: 42.7+/-2.5 yr, BMI: 25.6+/-0.8 kg/m2). On ICU day 1, IGF-1 and IGFBP-3 in BURN were higher than those in GHD (p<0.05 for both, respectively) and lower than those in Ns (p<0.05) while GH levels in BURN did not differ from those in Ns and higher than GHD (p<0.01). In BURN, IGF-I and IGFBP-3 levels showed a progressive decline (p<0.05) with nadir on day 14, when they overlapped those in GHD, and then an increase on day 28, though persisting lower than in Ns, while GH levels did not vary during ICU stay. IGF-I levels were associated neither to burn extension nor to ROI score. On ICU day 1 pre-A, A and TRA levels were similar to those in Ns, but underwent a progressive decrease with nadir on day 7 (p<0.001) for pre-A and TRA, and later, on day 14 (p<0.05) for A; pre-A and TRA but not A showed a rebound increase (p<0.01) on day 14, though persistingly lower than in Ns. In conclusion, our present data firstly show the time course variation of IGF-I levels in burn patients as function of nutritional and hormonal variables. It has to be emphasized that in the most critical phase after burn injuries, IGF-1 levels are as low as in hypopituitary patients with severe GHD. The physiological basis which leads to the impairment of this endogenous anabolic drive in this phase is, however, not clear yet.

Fig leaf tanning lotion and sun-related burns: case reports.

A sun tan is considered a symbol of well-being in our society, but incorrect methods of sun exposure can create serious problems. We present two cases of severe sun-related burns caused by fig leaf decoction used as home-made tanning lotion. Twenty four-thirty six hours after application and sun exposure, patients developed a phytophotodermatitis characterised by erythema, and blister formation involving all the photoexposed areas (45-70% BSA). Their general conditions became rapidly critical and they were admitted to our Burn Centre. The patients were discharged after 11 and 26 days, respectively. Haemolytic anaemia and retinal haemorrhages presented as systemic complications due to the furocoumarins present in the fig leaf decoction.

Toxic epidermal necrolysis treated with intravenous high-dose immunoglobulins: our experience.

BACKGROUND: Toxic epidermal necrolysis (TEN) is a rare severe acute exfoliative drug-induced skin disorder which has recently been ascribed to alterations in the control of keratinocyte apoptosis, mediated by an interaction between the cell surface death receptor Fas and its respective ligand. A therapeutic approach with intravenous immunoglobulins (IVIG) associated with pulse methylprednisolone, based on the inhibition of Fas-mediated keratinocyte death by naturally occurring Fas-blocking antibodies included in human immunoglobulin preparations, has produced good preliminary results. OBJECTIVE: To analyse the efficacy of IVIG in the treatment of TEN. PATIENTS: Nine patients with erythematous body surface area ranging from 38 to 85% and dermo-epidermal detachment from 4 to 37% were treated. RESULTS: Eight patients were healed and 1 died of septic shock and multiple organ failure. Interruption of further epidermal detachment occurred after an average of 4.8 days from the onset of IVIG therapy. Complete wound healing occurred after an average of 12 days. Concerning complications, 3 out of 8 surviving patients had acute respiratory failure requiring mechanical ventilation and 1 acute renal failure was treated with dialysis. Late sequelae were limited to dyschromia and nail dystrophies. No hypertrophic scars were observed. CONCLUSION: IVIG therapy represents a safe and valid approach for TEN.