[Cement burns: a 10-year retrospective study in our burn unit. About 55 cases]. / Brûlures par ciment : étude rétrospective sur dix ans dans le centre des brûlés du CHRU de Tours. À propos de 55 cas.

SUBJECT: Although cement burns represents only a small percentage of admissions to burn centers, their diagnosis and treatment are specific. Our retrospective study concerns all patients treated for cement burns in our unit between 1999 and 2009. This is the largest series described. PATIENTS AND METHOD: Fifty-five patients, aged from 23 to 63, were treated in our burn unit from 1999 to 2009. A review of medical and socioeconomic data was made from computer data files. RESULTS: This population is predominantly male, young and active. These burns occurred mainly in a domestic accident situation (78.2%). Burns were limited but deep and concerned especially lower limbs. The average duration of treatment was 39days. Forty-four patients were treated medically. The mean duration of sick live for these patients was 63 days. It was only of 21 days for those treated surgically. Aesthetic and functional sequelae were present in 88% of medically treated patients and in 18% of patients treated surgically. CONCLUSION: This study demonstrates that early surgical diagnosis and the coverage (care) of these burns allows to limit the socioeconomic echo and to reduce the risk of after-effects for this population of patients mainly young and active. The necessity of strengthening the precautionary measures with these users who are informed enough about the risks incurred during the misuse of the cement is also a reality.

[Local treatment of burns]. / Traitement local des brûlures.

Local burn care is one among the components of the total burn care. However since local wounds initiate and maintain the systemic disorders and provoke the aesthetic and functional sequellae, its significance must be stressed. The quality of the results relies upon teams trained and organized to control infection hazards in centres specifically designed. Closure of the wounds, through spontaneous healing of superficial burns or surgical techniques in deep ones, represents the aim of local care which includes the cleaning and dressing of superficial wounds and deep ones before and after grafting, with topical antibacterial (or not) agents, and also excision and grafting procedures. Today skin autografts remain the basic technique for closing deep burns. However because of the inadequacy between donor and wound areas either they must be meshed or other methods are added especially skin allografts, keratinocytes cultures or artificial skin. Local care does not come to an end when wound closure is achieved because of the lengthy rehabilitation cares such as massages, wearing of custom-fitted pressure garments, cures at specialized spas and some patients also need secondary surgery. Burn injuries remain one of the most devastating ordeal that a human being can sustain, because most of them provoke permanent and severe after-effects, whatever their extend and areas, that initial local care must aim at minimizing.

[Eyelid burns. An 11-year retrospective evaluation]. / Les brûlures des paupières. Bilan rétrospectif de onze ans.

This retrospective study has concerned 1115 adults burns patients hospitalized between January 1, 1984 and December 31, 1994 in the CHU Trousseau Burns Centre in Tours. 448 patients who suffered from facial burns were treated in the centre. The rate of facial burns and association with hand burns were observed as usually described, as well as the severity of chemical injuries and prolonged exposure to a heat source. 87 patients underwent grafting of the face and 33 of these patients, were grafted on the eyelids with or without grafts on other areas of the face. Grafting procedures on the eyelids were performed an average of 23.4 days after the injury although the medical staff of the centre had always emphasized the importance of early excision followed by grafting during the same procedure. However, the data showed that grafting was performed significantly earlier when good results (no functional disorders, no chronic conjunctivitis, no ectropion, good mobility) were obtained: 21.6 days versus 34.3, p < 0.05. The causes of the surgical delays observed and the various surgical methods are discussed.

[Surgery for sequelae of burns]. / Chirurgie des séquelles de brûlures.

Burn injury remains one of the most devastating ordeal that a human being can sustain because of the function of the skin on vital and psychological levels. After-effects are mainly observed at cutaneous level as functional and aesthetically deformity contractures and may be linked with deeper lesions too. In most cases secondary surgical procedures are undertaken after stabilization of the inflammatory process but earlier surgery is needed in some cases because of problems encountered at ocular, mouth and neck levels mainly. All the possibilities of plastic surgery can be utilized. However in our practice Z plasties and skin grafts represent the basis of the burn reconstructive surgery while the more recent technique of tissue expansion has extended the part of local and regional flaps (but one should not use it as a routine method).

[Ceftazidime in severe infections in burnt patients]. / La ceftazidime dans les infections sévères chez le brûlé.

Infections being common and severe in burnt patients, their control is of paramount importance. In 49 burnt patients treated with ceftazidime 60 treatments (43 curative and 17 preventive) were prescribed. Ceftazidime was used as first-line therapy, usually combined with an aminoglycoside (amikacin as a rule). The overall success rate was 81 per cent, and only 5 cases (8.6 per cent) could be regarded as true failures. These results, comparable to those found in the literature, are discussed in detail. No significant change occurred in the bacterial population of our hospital unit during the period of the study (more than 3 years). Our experience confirms that ceftazidime should play a predominant role in the treatment of severe infections affecting burnt patients.

Burns and the toxic effects of a derivative of hydrazine.

Comments are presented on a case history of extensive burns associated with 1,1-dimethylhydrazine (UDMH) toxicity in a 31-year-old man. Neurological symptoms dominated early developments. Specific treatment with pyridoxine, while begun late, effected a quite rapid resolution and the subsequent progression of treatment was straightforward. In reviewing previous reported findings, the authors have clarified the distinctive characteristics of UDMH toxicity, the methods for its detection and modes of treatment. They draw conclusions, based on problems encountered, linked to the exceptional character of acute UDMH toxicity especially in its association with extensive burns.

[Role of Pseudomonas aeruginosa in infection in burn patients]. / Place du pyocyanique dans l'infection des brûlés.

The regular finding of Pseudomonas aeruginosa in Burns Units has always been a source of worries. Following a brief review of the natural history of this micro-organism, the authors examine all possible therapeutic measures. They underline the importance of measures aimed at controlling environmental and epidemiological factors and at improving surveillance. These measures, together with baths, topical applications of antibacterial agents and prophylactic vaccination and serotherapy tend to circumscribe the infection. When therapeutic measures are not as effective as expected and natural defences collapse, sepsis develops with clinical features that male diagnosis uneasy. The conditions in which antibiotics are given are peculiar in burned patients, and the therapeutic approach to Pseudomonas infections is particularly difficult in such cases.

[Hemostasis in burn patients and treatment with heparin. Relation to prognosis and infection. Pattern of blood levels of prekallikrein, alpha-2-macroglobulin, antithrombin III, plasminogen and alpha-2-antiplasmin]. / Hémostase des brûlés et traitement par l'héparine. Rapport avec le pronostic et l'infection. Evolution du taux de prékallicréine plasmatique, de l'alpha-2-macroglobuline, de l'antithrombine III, du plasminogène et de l'alpha-2-antiplasmine.

In burnt patients with a fatal prognosis, the level of prekallikrein is initially low and further diminished. In burnt patients who survive, the initial decrease of the prekallikrein level is less pronounced and is progressively overcome, significantly by the sixth day. Moreover the decrease of the prekallikrein level occurs before and during clinical infection. In good prognosis patients, the level of alpha-2-macroglobulin remains low until day 20 and then increases in the noninfected patients while in fatal prognosis patients the level decreases. The level of antithrombin III and plasminogen is lower in fatal prognosis patients. These is no correlation between the level of antiplasmin and the outcome of burn injuries.

[Use of the intravisceral graft technic for the study of histologic changes in the skin after freezing]. / Utilisation de la technique des greffes intraviscérales pour létude de l'évolution histologique de la peau après congelation.

The authors present their technique for freezing thin skin samples which may be used for intravisceral grafts in the testis, the liver and the kidney to test developing potentials for grafts conserved in this manner. In comparison with fresh grafts, they show that frozen samples not only retained their vitality, but the ability to multiply, differentiate and mature. They eliminate any ambiguities in the interpretation of the results. At the same time, they note that the period spent in liquid nitrogen does not prevent graft rejection in the case of allografts.