[Anterior uveitis caused by electrical discharge in whole body injuries (fifteen years study)]. / Prední uveitida vyvolaná elektrickým výbojem u celotelového poranení (patnáctiletá studie).

AIM: To inform about clinical analysis of early ophthalmologic complication (uveitis) in patients sustained electric discharge injury. STUDY GROUP: The authors refer about fifteen years follow-up of pediatric patients at the Department of Burns Medicine, 3rd Medical Faculty, Charles University in Prague, Czech Republic, E.U., with electric discharge injury, in which the anterior uveitis was detected. Out of 43 patients after electric discharge injury, the always-unilateral iritis (iridocyclitis) was diagnosed in four (9 %) patients according to thorough going follow-up after first accidental diagnosis in the year 1998. Out of four boys aged 12 - 15 years, the first two were injured during the "play" - due to the contact with electrical trolley wire while running on railroad wagons roofs, and the two others were stuck by lighting under a tree by secondary electrical discharge. More serious skin burns were noticed in high-voltage current injury - 69 % or 55 % of body surface respectively, with the necessity of skin transplantation. The same was necessary in one boy injured by lighting with burns of 25 % of body surface, while the last one had on the skin the lighting signs only. In most of the patients, the resuscitation care due to unconsciousness and posttraumatic shock was necessary. The anterior uveitis was diagnosed subsequently, after initial preliminary diagnoses as conjunctivitis, episcleritis, or ophthalmia electrical. The iritis without visual function decrease was discovered in few days after the injury in three patients. Treatment and results: The inflammation was in these cases treated with short-term application of mydriatic and corticosteroid eye drops. Once only, the uveitis appeared after two months during the patients hospitalization and then the signs of iridocyclitis in the anterior chamber worsened and caused visual acuity decrease to hand movement in front of the eye. The condition was successfully treated by means of parabulbar betamethasone injection and long-term application of mydriatic and corticosteroid drops. CONCLUSION: Uveitis in electrical discharge injury of different origin is a rare early complication, which may be determined solely by regular ophthalmologic follow-up examinations of the patients.

Nutrition in patients with burn injuries in the intensive care unit.

Authors discuss the choices of nutritional support in patient after severe burn injury during the last three decades. Severe burn injury presents one of the most critical states of starvation under a severe stress to the organism. Timely and appropriate metabolic intervention can positively influence the hypermetabolism, which is a common reaction after an injury. Burn injury causes a long-term reaction with a great risk of multiple organ dysfunction (requirement to perform repeated dressing changes under general anesthesia, repeated surgeries, and infections). Incorporation of a nutritional support is based on the knowledge of pathophysiology and metabolic response to injury, and is influenced by choice of nutrition substrates and by possibility of its administration.

Care for children after burn injury.

Authors are summing up basic approach in the treatment of severe burn injury in children. Thorough evaluation of severity of the injury is essential and determines further therapy. In this phase connection between care prior to hospitalization and in hospital is important. During the course of therapy in hospital, interdisciplinary teamwork is essential for the solution of various complications after burn injury. Important part of the care is cooperation with family of the child.

Non-thermic skin affections.

The Centre for Burns can help by its means (material, technical and personal) in the treatment of burns with extensive and deep losses of the skin cover and other tissue structures and in some affections with a different etiology (non-thermic affections). Indicated for admission are, in particular, extensive exfoliative affections--Stevens-Johnson's syndrome (SJS), Lyell's syndrome--toxic epidermal necrolysis (TEN) and staphylococcal scalded skin syndrome (SSSS), deep skin and tissue affections associated with fulminant purpura (PF), possibly other affections (epidermolysis bullosa, posttraumatic avulsions etc.). The similarity with burn injuries with loss of the skin cover grade II is typical, in particular in exfoliative affections with a need for adequate fluid replacement in the acute stage and aseptic surgical treatment of the affected area from the onset of the disease. In conditions leading to full thickness skin loss, in addition to general treatment rapid plastic surgical interventions dominate.

Mortality in pediatric burns in the Prague Burns Centre (1994-1997).

The authors evaluate the mortality of severely burned children hospitalized in the Intensive Care Unit, Prague Burns Centre from 1994 till 1997. There were hospitalized 345 children (aged 3 months-15 years, 1%-88% TBSA, mixed superficial and deep burns). No child died from burn shock during the early postburn period. Five children who died suffered deep burns greater than 50% of TBSA and at necropsy there were identified signs of multiple organ system failure which was related to infection.

Emergency care of severe burn children (an experience of Prague Burn Centre).

The control of a shock associated with burns has marked effects on the further course of burn injuries. In spite of the steadily increasing improvement of intensive care of severe burn children sometimes are not applied essential recommended procedures which are necessary during the first aid and the transport of burn cases to a burn centre. These procedures are determined by the assessment of a lot factors. A misinterpretation of these factors can lead to an insufficient or to an excessively aggressive therapy with their sequelae. This holds true both for a local and for a systemic therapy of severe burn children. The most important problems are documented by 2 case reports.

Unexpected gastrointestinal complications in severely burned children.

The authors refer to the frequently difficult diagnosis of gastrointestinal complications of major burns, particularly in childhood, to weight the factors co-responsible for the development of those complications and to stress the importance of the patient's history. They report on the case of three and a half year-old child to demonstrate the fatal course of a late diagnosed complications -- perforating cholecystitis. Autopsy showed the chronic nature of the disease with acute exacerbation in the course of treatment. No case similar to this one has yet been seen at the Prague Burns Centre in any age category.