["Burns" caused by local application of garlic]. / "Brandsår" forårsaget af lokalbehandling med hvidløg.

A forty-two-year-old woman was admitted to the department of burns in Copenhagen, two days after application of 15 freshly sliced cloves of garlic fixed to the left knee with film for three hours. This was done to relieve chronic intra-articular pain. Examination showed a 2% blistering erythematous rash mimicking second degree burns. At 14 days 0.33% had not healed spontaneously. On the 24th day necrectomy and split skin transplantation had to be performed.

A new amorphous hydrocolloid for the treatment of pressure sores: a randomised controlled study.

A randomised controlled study was carried out to compare the effect of a new amorphous hydrocolloid (hydrogel, Coloplast) with that of conventional treatment on the healing time of pressure sores. After initial debridement in the outpatient clinic of pressure sores located in the sacral (n = 21) or trochanteric (n = 11) area the patients were randomised to be treated with either hydrogel (n = 17) or wet saline compresses (n = 15). Once a week the healing was estimated by the same investigator. The relative volumes (from the initial 100%) of hydrogel-treated wounds were significantly less (26 +/- 20%, p < 0.02) than those of saline treated wounds (64 +/- 16%) in the last week of the study. The saline treated wounds needed more frequent weekly debridement than the hydrogel-treated wounds (21% compared with 7% of all weekly dressings, p < 0.03). We conclude that amorphous hydrocolloid increases current healing of pressure sores compared with conventional treatment. It is therefore a better choice for treating patients with pressure sores in their homes.

Prestorage leukocyte filtration may reduce leukocyte-derived bioactive substance accumulation in patients operated for burn trauma.

Adverse effects of perioperative blood transfusion appear to be storage-time-dependent and may be related to extracellular accumulation of bioactive substances in blood products. In this study the clinical effects of leukofiltered and non-filtered blood products in patients undergoing surgery for burn trauma are investigated. 24 consecutive patients were randomly selected to receive transfusion with non-filtered blood components (group A, n = 12) or similar products, which were prestorage leukofiltered (group B, n = 12). The burn injury was scored using the Bull and Fischer index of age and burn surface area. Histamine, interleukin-6 (IL-6), plasminogen activator inhibitor-1 (PAI-1), eosinophil cationic protein (ECP) and myeloperoxidase (MPO) were analysed in plasma or serum collected from all patients 30 min before skin incision, at skin incision and 5, 10 and 30 min and thereafter every 30 min after skin incision until the grafts were secured by wrapping. Samples were also taken 8 h after skin incision and in the morning of postoperative days 1-5. The amount of blood products transfused from admission until day 5 postoperatively was recorded. All patients were followed until discharge or death. The Bull and Fischer index was comparable in the two groups. Prestorage leukofiltration reduced the amount of blood products required for transfusion significantly (p < 0.05) compared with non-filtered products. The levels of the various bioactive substances changed during and after the operation. In particular, ECP and MPO levels increased significantly (p < 0.05) in group A patients compared with unchanged (ECP) or decreased (MPO) levels in group B patients. IL-6 analyses showed, that the trauma had more severe impact on group B patients than on group A patients. Nevertheless, 4 patients died in group A and 2 in group B; all with a Bull and Fischer index between 1.0 and 2.0. Prestorage leukocyte filtration may reduce transfusion related accumulation of various bioactive substances and the requirement for blood in burn trauma patients.

Effect of heating on extracellular bioactive substances in stored human blood: in vitro study.

BACKGROUND: We have previously shown extracellular accumulation of various leukocyte and platelet-derived bioactive substances in human blood during storage. Release of bioactive substances may be temperature-dependent, and we studied the effect of heating during in vitro transfusion on bioactive substance accumulation in stored human blood. METHODS: Eight units of whole blood and eight units of prestorage leukofiltered whole blood were stored at 4 degrees C for 7 days. Subsequently, the blood from all 16 units was transfused via a blood-heating device, which increased the blood temperature to 37 degrees C at outlet. Samples for enzyme-linked immunosorbent assay or radioimmunoassay analyses of histamine, myeloperoxidase (MPO), eosinophil cationic protein (ECP), and plasminogen activator inhibitor-1 (PAI-1) were drawn from the units at donation, after 7 days of storage just before transfusion, and during the in vitro transfusion. RESULTS: Extracellular concentrations of histamine, MPO, ECP, and PAI-1 were significantly (p < 0.05) increased in nonfiltered whole blood stored for 7 days compared with concentrations in fresh donated blood and in prestorage leukofiltered whole blood stored for 7 days. Heating reduced histamine, MPO, and ECP concentrations significantly (p < 0.05) in nonfiltered whole blood, whereas PAI-1 concentrations increased significantly (p < 0.05). Finally, there was no difference in concentrations of histamine, MPO, ECP, and PAI-1 in samples collected before and after heating of leukofiltered whole blood. CONCLUSIONS: Heating reduces accumulation of extracellular leukocyte-derived bioactive substances in whole blood, whereas it increases platelet-derived substances. Prestorage leukofiltration, however, reduces the obligatory extracellular accumulation of leukocyte and platelet-derived bioactive substances, which in addition is unchanged by heating.

[Burn wounds after resuscitation of a newborn girl]. / Brandsår efter genoplivning af en nyfødt pige.

In resuscitation of an asphyctic newborn baby, a chemical hot pack was used for maintaining sufficient body temperature. The child lay for 45 min on the covered hot pack, which had a peak temperature of 54 degrees C. This led to a third degree burn (5% of BSA). The child needed split skin grafting. Control at four months of age showed a well-taken skingraft and the child was developing normally. We conclude that chemical hot packs should not be used for newborn babies unless the peak temperature in the packs is less than 44 degrees C.

Leucocyte-derived bioactive substances in fresh frozen plasma.

Bioactive substances in fresh frozen plasma (FFP) are considered to be related to adverse reactions after transfusion, particularly in septic or traumatized patients. Therefore, we analysed the concentration of various bioactive substances (histamine, eosinophil cationic protein, eosinophil protein X, myeloperoxidase and interleukin-6) in 25 u. of thawed FFP from healthy donors. These were compared with donor plasma concentrations of 24 healthy controls. In addition, we analysed the concentration of the bioactive substances, except interleukin-6, in 25 u. of thawed FFP, which were subjected to leucocyte filtration before freezing and storage. Finally, we analysed the substances in 10 leucocyte non-filtered plasma units before freezing and storage, and after thawing, respectively. Before analyses, which were performed by ELISA and RIA methods, these latter samples were sterile filtered through a 0.20-micron filter. Histamine, eosinophil cationic protein, eosinophil protein X and myeloperoxidase concentrations were significantly greater (P < 0.05) in the 25 u. of FFP compared with normal donor plasma. Pre-storage leucocyte filtration reduced concentrations of the bioactive substances in FFP to concentrations comparable with normal donor plasma concentrations. Interleukin-6 was undetectable in all FFP units and in 21 of the 24 control donors. Histamine, eosinophil cationic protein and myeloperoxidase concentrations were significantly higher (P < 0.05) in samples collected from the 10 u. of FFP after freezing and thawing compared with samples collected before freezing. We conclude that fresh frozen plasma prepared by a conventional separation method contains various leucocyte-derived bioactive substances, which may be reduced by pre-storage leucocyte filtration.

Bioactive substance accumulation and septic complications in a burn trauma patient: effect of perioperative blood transfusion?

Evidence has emerged that suggests adverse effects to perioperative homologous blood transfusion are related to the age of the blood products. Recently, time-dependent accumulation of bioactive substances in red cell suspensions, standard platelet concentrates and fresh frozen plasma during storage have been shown. The potential adverse effects of these bioactive substances were analysed in a burn trauma patient. A patient with 40 per cent second and third degree burn trauma without other injuries underwent a two-step transplantation operation. Samples for analyses of histamine, eosinophil cationic protein (ECP), eosinophil protein X (EPX), neutrophil myeloperoxidase (MPO) and interleukin 6 (IL-6) were drawn frequently from the patient before, during and after the operations, and from all transfused red cell, platelet and fresh frozen plasma units. Urine was sampled every hour during the first operation for analyses of ECP and EPX excretion. All analyses were performed by ELISA and RIA methods, and results compared to patient outcome. The patient received a total of 48 and 8 SAGM blood, 6 and 0 platelet and 12 and 4 fresh frozen plasma units at the two operations, respectively. Transfused products contained a total of 64.54 nmol and 17.50 nmol histamine, 115518 ng and 25764 ng ECP, 174457 ng and 38770 ng EPX, 6950915 ng and 1505125 ng MPO, and 14740 pg and 5600 pg IL-6 at the two operations, respectively. The accumulation of the substances in patient plasma correlated to postoperative septic reactions, without any disclosure of bacteraemia after the first operation, while the accumulation at the second operation correlated to the septic reaction and Pseudomonas aeruginosa infection. Time-dependent accumulation of bioactive substances in blood products during storage may be related to the development of post-transfusion adverse effects.

[Pressure sores. Background and therapeutic strategy]. / Tryksår. Baggrund og behandlingsstrategi.

A pressure ulcer is based on local tissue pressure and other pathological conditions in the patient. Pressure-reducing devices can reduce the incidence of pressure sores. The staff must be familiar with the strategies for prevention and treatment of pressure sores. Conservative treatment is used for pressure sores with the potential for spontaneous healing in regions where unphysiological pressure can be avoided. Split skin transplantation is only useful in superficial, granulating pressure sores in regions where pressure and shear will be limited after healing and where a short healing time is desirable. Musculocutaneous flaps are indicated in regions suffering pressure or other mechanical strain or in certain risk patients. Pressure-reducing devices should be administered according to guidelines and used from the beginning of the period where they are needed.

[Electric injuries--cardiac monitoring?]. / Elektriske skader--kardial monitorering?

During the years 1980-1990, 49 patients (38 men and 11 women) were treated in the department for various electrical injuries. The average age was 27 years (2-78 years). Thirty-nine had suffered low voltage (less than 1000 volts) accidents and ten had suffered high voltage (more than 1000 volts) accidents. The incidence and type of cardiac arrest/loss of consciousness on the scene of the accident, myoglobinuria, acute fasciotomies, surgical interventions, amputations, cardiovascular complications and outcome is reported. The most important finding was that no cardiac abnormalities were seen even with the patients with a clinical primary cardiac arrest. In spite of this finding 18 of the patients were initially brought to a medical department for electrocardiographic monitoring. This could clearly delay surgical intervention, though it did not seem to affect the final outcome (with some reservations). It was concluded that only abnormal ECGs should indicate electrocardiographic monitoring. Otherwise an electrical injury is a surgical matter.

Split skin grafting of defects from fasciotomy after compartment syndrome.

Proper treatment of compartment syndrome is fasciotomy. Secondary skin defects often complicate the course and require skin-grafting procedures. The present investigation is a retrospective study based on 17 fasciotomies. Their courses are reported, and the possibility of primary skin excision with the purpose of delayed grafting is demonstrated. This procedure would probably reduce the number of hospital days and the number of surgical procedures.

Biologic wound coverings in burn treatment.

A review of biologic wound coverings currently in use is presented. These include homografts, xenografts, embryonic membranes, and tissue derivatives. The indications, advantages, and disadvantages of such materials are discussed. Finally, future research directions are suggested.

Multiple symmetric lipomatosis: combined surgical treatment and liposuction. Case report.

A 47 year old man with a history of alcoholism presented with symmetrical lipomas on the shoulders, neck, and chest. He also had lipomatous areas on the trunk and thighs. He was treated with a combination of surgery and liposuction, and made an uneventful recovery. Histological examination confirmed the diagnosis of multiple symmetric lipomatosis, a rare disorder only about 200 cases of which have been reported. The aetiology is unknown, but is often seen in patients with a history of alcoholism.

[Burns caused by electric surgical instruments]. / Forbraendinger ved anvendelse af el-kirurgi.

Employment of electric surgical instruments involves a potential risk of burning at the neutral electrode. These are frequently third degree burns. Skin grafting may shorten the course of the illness. The importance of good contact over the entire neutral electrode plate is emphasized.

Surgical relocation of retracted eponychion.

Burn wound contracture of the dorsal side of fingers often leads to retraction of the nailfold with exposure of the growth zone of the nail. Disfigured nails, extremely annoying to the patients, are the results. A surgical procedure and clinical results of 50 cases (fingers) are reported and commented on.

Multiple symmetric lipomatosis.

Multiple symmetric lipomatosis (MSL) is a rare disorder only mentioned in about 200 cases in the medical literature. It manifests as massive lipomatous deposits in specific areas of the body. The cause is unknown, although there frequently is a history of alcoholism. Surgical lipectomy has so far been the choice of treatment. We present a review of the disease and report one case successfully treated with liposuction.

Clinical results of grafting burns with epidermal Langerhans' cell depleted allograft overlay.

Twenty-one severely burned patients have received widely meshed and expanded autografts and allografts of epidermis depleted of Langerhans' cells. In 18 patients 80% or more of the grafts took successfully. Six patients (29%) died, three of inhalation injuries. Using allografts of epidermis depleted of Langerhans' cells means that larger burned areas can safely be grafted during one procedure.