Self-inflicted burns in Athens, Greece: a six-year retrospective study.

Self-inflicted burns represent a major social and medical problem. The aim of this study was to record the epidemiology, mortality and etiology of suicide attempts by burning, in Athens, Greece. Over a 6-year period from April 1997 to April 2003, all the medical charts of the patients who were admitted to the Burn Center of the General State Hospital of Athens, Greece, with self-inflicted burns were retrospectively studied. Of the 1435 burn patients, 53 (3.69%) had attempted suicide by self-inflicted burn. Their ages ranged from 18 to 90 years old (mean 53.5 years). Females (57%) outnumbered males (43%). The mean total body surface area (TBSA) burned was 41.6% (range: 15-100%). The overall mortality rate was very high (75.4%). A preexisting psychiatric disorder was present in 43.3% of the patients. In conclusion, the extent and the depth of the burn injuries could explain the high mortality rate seen in these patients, in correlation with their negativism to the treatment. Burn care professionals should be familiar with self-inflicted burn patients who constitute a considerable proportion of major burns and require constant psychiatric support in addition to burn care.

Microvascular repair following crush-avulsion type injury with vein grafts: effect of direct inhibitors of thrombin on patency rate.

The aim of this study was to develop a standardized effective thrombogenic arterial anastomosis model, as usually encountered in clinical practice, and to offer a detailed evaluation of the antithrombotic effect of thrombin's direct inhibitors, antithrombin III and hirudin, as locally applied. Wistar rats were divided into four groups of 12 animals each. The carotid artery sustained a standardized crush-avulsion-type injury (groups B-D). A segment of the afflicted area was removed and replaced by a microvenous graft. Group A had no crush-avulsion injury inflicted; a microvenous graft replaced a simple resection from the center of the carotid artery. During microvascular anastomoses, normal saline (groups A and B), recombinant hirudin (group C), or antithrombin III (group D) were locally applied. Bleeding times were recorded, and patency tests were performed 20 min, 48 h, and 1 week after blood flow reestablishment. All grafts were harvested and examined histologically. Patency tests, 1 week postrevascularization, demonstrated that this experimental crush-avulsion injury model ensured low patency in group B (25%), whereas group A, which had no injury inflicted, achieved a 100% patency rate. The local application of hirudin and antithrombin III significantly increased bleeding times as well as the patency rate (92% and 75%, respectively) compared to group B. These findings indicate the efficiency of the experimental model and the potential use of thrombin's direct inhibitors in microvascular surgery.