Antiseptic-impregnated central venous catheters: their evaluation in burn patients.

Central venous catheter-related infections are an important source of morbidity and mortality in burn patients. Antiseptic impregnated catheters have been recommended to prevent infections related to central venous lines in high-risk patients who require short-term catheters. This prospective, randomized, and controlled study compared the efficacy of standard and antiseptic devices in reducing catheter-related infections in burn patients. Twenty-two patients were included in the study with an average age of 47.6 yr and an average burned total body surface area of 38.7%. Thirty-eight silver-sulphadiazine, chlorhexidine catheters were compared with 40 non-antiseptic catheters. No differences in bacteraemia or colonization rates were observed between standard and antiseptic-coated catheters. Antiseptic catheters were more effective in reducing S. epidermidiscolonization than standard catheters (4% vs 31%, p < 0.01). However, Gram-negative bacilli were responsible more often than Gram-positive cocci for catheter tip colonization (53% vs 46%) and they were responsible for all the bacteraemias (5.1%) related to catheters in the present study. We conclude that antiseptic-impregnated catheters could be more effective for Gram-positive cocci and could therefore be less effective in patients with high Gram-negative bacilli bloodstream infection prevalence, as burn patients are.

Peri-Operative Bacteraemia in Burn Patients. What Does it Mean?

Bacteraemias during burn wound manipulation are frequent, especially following burn wound excision. However, these bacteraemias seem not to have any clinical consequences, and their treatment is therefore controversial. Over a 20-month period 35 surgical debridement procedures were recorded prospectively in 18 burn patients. Blood culture samples were drawn before, during, and after surgical excision. Bacteraemias were found in ten out of the 35 patients (28%), and 16 of the 105 blood samples (15%) were positive. All three blood samples were positive in one case ("primary bacteraemia"), while others were "transient bacteraemia". Six positive blood cultures were considered to be "bacteraemias induced by wound manipulation" and seven "bacteraemias of unknown source". Bacteraemias of unknown source were not recorded at any time while "bacteraemias induced by wound manipulation" were recorded after day 5 post-burn. Patients with more than 40% TBSA had 4.3 times more bacteraemic risk than patients with less extensive TBSA. Blood pressure and white blood cell variations were observed in bacteraemic patients but without any clinical relevance. We conclude that bacteraemic rates were high and that there were two different patterns of bacteraemia- both transient and with no clinical relevance.

Development in the treatment of burns in South America during the last decades.

The scientific approach toward the problems of burn treatment in South America started in the 1930's and was emphasized in the 1940's as a result of the positive influence of the Latin American Congresses of Plastic Surgery initiated in 1941. During the 1950's, as an appropriate answer to the problem, specialized burns facilities started to spread over the Latin American countries. Consequently, there was a progressive incorporation of very important advances such as a more adequate fluid replacement, early excision and grafting, enteral feeding, new topical antibacterial agents, a more appropriate approach for the prevention and treatment of infections, a better understanding of the smoke inhalation injury and better management of physical and psychological rehabilitation. Thus, during the past 25 years, burn care has dramatically evolved toward excellence. The Latin American Committee for Prevention and Care of Burns, created in 1964 was one important land-mark in the development of burn treatment in South America. The creation of Burn Associations in many South American countries was initiated in 1990, and culminated in 1991 when the Latin American Federation of Burn Associations was founded. These developments illustrate how the specialists in the South American countries have followed the tune of international progress. They constitute at this time, an important group of committed workers, not only to the treatment of burned patients but also to the scientific and academic side of this specialty.

Massage in hypertrophic scars.

Various attempts have been made to intervene with the formation of hypertrophic scarring (HTS) or to ameliorate it once it has developed, but none have yet proved effective. Massage therapy is routinely used by therapists for the treatment of various conditions, and there have been reports of increased scar pliability and decreased scar banding with the use of massage. This study examines the use of friction massage over a 3-month period in a group of 30 pediatric patients with HTS. The patients were randomly assigned to receive either therapeutic massage sessions of 10 minutes per day in combination with treatment with pressure garments or they were treated with pressure garments alone. A modified Vancouver Burn Scar Assessment Scale was used to measure the characteristics of the identified scars (10 cm by 10 cm) before and after the implementation of massage therapy. The study failed to demonstrate any appreciable effects of massage therapy on the vascularity, pliability, and height of the HTS studied, although there were reports of a decrease in pruritus in some patients. Further studies, with prolonged treatment intervals, are necessary to conclusively demonstrate the ineffectiveness of this therapy for HTS.

Pulsed electromagnetic fields in experimental cutaneous wound healing in rats.

Electromagnetic fields are now being used in many diseases such as osseous, ligamental, cartilaginous, or nervous reparation, diabetes, and myocardial or cerebral ischemia. Although many publications show the usefulness of magneto-therapy, discrepancies exist about the utility of electromagnetic fields in skin wound healing. The objective of this work was to study the effect of pulsed electromagnetic fields on wound healing in rats. Twenty-two male Wistar rats were used; a circular lesion was made in the back of each animal. They were divided into three groups: group C (control) with sham treatment (n = 8), group NF, treated with topical nitrofurazone solution (n = 7), and group PEMF, treated with pulsed electromagnetic fields of 20 mT (n = 7). The treatments were 35 minutes twice a day. The absolute and relative values of the area and perimeter of the wounds showed significantly lower values in the PEMF group at days 7, 14, and 21 compared with those in group C (p < 0.01, analysis of variance), whereas the PEMF group showed significantly lower values at day 21 only compared with the NF group (p < 0.01, analysis of variance). The results suggest a significant beneficial stimulation in the wound healing process in rats treated with PEMF, which could lead to the development of a practical tool for research and clinical use.

The use of the modified Thomas splint for a patient with cultured epidermal autografts.

UNLABELLED: Because of the difficulty in handling a patient with cultured epidermal autografts in pressure areas of the limbs, we have adopted a splint that is easy to apply, allows an easy access to the wound, and is well tolerated by the patient. HYPOTHESIS: Avoiding pressure in areas with autografts is recommended. This is the reason we have used a splint that avoids the pressure and the secretion buildup. This technique helps a better "take of the grafts." METHODS: We have modified the original Thomas splint in two ways: (1) the use of a distant and upper appliance that allows to correct the foot's flexion; and (2) the use of an appliance that can be regulated, is inflatable, and can be removed, allowing the change of pressure in different areas. We have used this method with one patient with a deep degree of circumferential burn in both lower limbs. The splint has been maintained and the elevation changed every day for 15 days. Traction has been made with the use of the Kirschner stirrup. RESULTS: The dressing was changed easily and without patient pain. Good mobility was possible, with genital hygiene and grafts that were taken in 70% of the cultured epidermal autografts. CONCLUSION: This method allows maintenance of the legs in functional position during dressing changes and avoids pressure and chafing. It decreases the loss of the autograft for mechanical effects.

Sensibility assay for topical agents. A new method.

We present a new laboratory method to test the sensibility of clinically isolated strains to topical agents. It is a method of dilution of the whole cream in a solid medium. The cream is weighted, suspended in sterile water, and maintained at 45 degrees C. Then a volume of that suspension is added to the agar, maintained at 45 degrees C also. The mixture is agitated and plated. Afterwards 25 strains are inoculated by a Multinoculator (Cetin, Bs. As., Argentina). After incubation (18 hours at 37 degrees C), the results are obtained by observing the presence or absence of bacterial development. The minimal inhibitory concentration is calculated as the lowest concentration that inhibited growth. It is a simple, economical, and reproducible method.

Plan de regionalizacion para la atencion del quemado en la Argentina. / Regionalization plan for the care of the burned patient in Argentina

La Argentina cuenta en la actualidad con un sistema de atencion al quemado, basado en el concepto de regionalizacion.Aprobado por el COFESA (Consejo Federal de Salud) en su reunion de abril de 1983 es el resultado de un Programa iniciado desde el Hospital de Quemados de la Ciudad de Buenos Aires en 1958 para formar nuevo recurso humano y estimular a las autoridades para la creacion de nuevos centros. Estan en funcionamiento Unidades de Alta Complejidad en La Plata, Cordoba, Mendoza, Salta y Rosario, que actuan como Centros de Referencia y se completa la red con otros 8 de Complejidad Mediana y 10 de Complejidad Minima, distribuidas en Capital, Conurbano e interior que sumados al Hospital de la Ciudad de Buenos Aires de Maxima Complejidad, totalizan 24 Centros en actividad.Estos Centros son coordinados por una Comision central con representacion regional que actualiza anualmente las normas. En Plan se complementa con Programas de Educacion Continua y Campanas de Prevencion y Recoleccion de datos estadisticos

Plan de regionalizacion para la atencion del quemado en la Argentina. / Regionalization plan for the care of the burned patient in Argentina

La Argentina cuenta en la actualidad con un sistema de atencion al quemado, basado en el concepto de regionalizacion.Aprobado por el COFESA (Consejo Federal de Salud) en su reunion de abril de 1983 es el resultado de un Programa iniciado desde el Hospital de Quemados de la Ciudad de Buenos Aires en 1958 para formar nuevo recurso humano y estimular a las autoridades para la creacion de nuevos centros. Estan en funcionamiento Unidades de Alta Complejidad en La Plata, Cordoba, Mendoza, Salta y Rosario, que actuan como Centros de Referencia y se completa la red con otros 8 de Complejidad Mediana y 10 de Complejidad Minima, distribuidas en Capital, Conurbano e interior que sumados al Hospital de la Ciudad de Buenos Aires de Maxima Complejidad, totalizan 24 Centros en actividad.Estos Centros son coordinados por una Comision central con representacion regional que actualiza anualmente las normas. En Plan se complementa con Programas de Educacion Continua y Campanas de Prevencion y Recoleccion de datos estadisticos