Abstracts 263

Erythropoietin response to anaemia The excretion of erythropoietin was persistently increased in 4 patients with burns covering between 15 and 58 per cent of the body surface. A patient with more extensive burns (65 per cent of the body surface) did not show an increased rate of excretion of erythro- poietin. In the group of 4 patients a good correlation was found between the rate of erythropoietin excre- tion and red cell volume but not between the erythro- poietin excretion and the venous haematocrit. In spite of an increased rate of formation of erythro- poietin, red cell formation in these 4 patients was insufficient to compensate for red cell losses as judged by bone marrow morphology, reticulocyte counts and transfusion requirements.

Andes W. A., Rogers P. W., Beason J. W. et al. (I 976) The erythropoietin response to the anaemia of thermal injury. J. Lab. C/in. Med. 88, 584.

Acute gastroduodenal disease after burns Studies were carried out in 48 patients with burns covering more than 35 per cent of the body surface to determine the efficacy of antacid in preventing clinical complications (haemorrhage and perforation) of gastrointestinal disease. In a prospective randomized study started within 72 h of burning, a lithium flex technique was utilized to determine the integrity of the gastric mucosal barrier in a group of 24 patients treated with sufficient antacid to maintain the pH of the gastric aspirate at 7 or more, and a group of 24 patients treated without antacid.

Only one of the 24 patients receiving antacid developed significant upper gastrointestinal bleeding, whereas 7 of the 24 patients receiving no antacid suffered harmorrhage and gastric ulcer perforation. None of the 7 patients with gastric mucosal barrier disruption who received antacid developed a clinical complication, whereas 6 of the 15 patients with gastric mucosal barrier disruption receiving no antacid showed various clinical complications. It was con- cluded that neutralization of gastric acid offered protection against the development of clinically signifi- cant ulcer complications in the burned patient.

McAlhany J. C., Czaja A. J. and Pruitt B. A. (1976) Antacid control of complications from acute gastro- duodenal disease after burns. J. Trauma 16, 645.

Baseline results of therapy Data collected by the National Burn Information exchange from 21 000 burned patients treated in 90 different American burn units have been subjected to probit analysis to determine the influence on survival of the size and depth of the burn, the age and sex of the patients, which topical antibacterial agents were used and which burn unit gave the treatment.

The results are clearly shown in various line drawings:

1. The sigmoid relationship between per cent survival and total area burned for the age groups O-I yr, 2-4 yr, 5-34 yr, 35-49 yr, 50-59 yr, 60-74 yr

and 75-100yr is shown; and the total burned areas associated with a 50 per cent mortality rate.

2. The similar relationship between per cent survival and area of full-thickness skin loss burn for the same age group is shown. The 50 per cent mor- tality rate was associated with smaller areas of full- thickness skin loss than with the total area of the burn.

3. It is shown that males appear to have a greater chance of survival than females over all ranges of severity.

4. It is shown that persons within the 5-34 yr age group have the best chance of surviving a burn of any severity. The chances of survival decrease in the following order of age groups, 2-4 and 3549 yr, O-1 and 50-59 yr, 60-74 and 75-100 yr.

5. It is shown that the topical antibacterial agents used in the various burn units did not appear to significantly influence the survival when compared with patients treated without the topical application of any antibacterial agent.

6. It is shown that there is a significant difference in the area of burn associated with a 50 per cent chance of survival depending upon which of the 10 major burn units in the United States controlled treatment.

Feller I., Flora J. D. and Bawol R. (1976) Baseline results of therapy for burned patients. JAMA 236, 1943.

Topical chemoprophylaxis A series of controlled trials gave the following results:

I. One per cent silver sulphadiazine cream applied daily (or at intervals of 2 or 3 days) to patients with burns had greater prophylactic value against Pseudo- monas aeruginosa than a cream containing 0.4 per cent silver phosphate with 0.2 per cent chlorhexidine gluconate.

2. One per cent silver sulphadiazine cream had greater prophylactic value against Staphylococcus aureus, P. aeruginosa, proteus species and miscel- laneous coliform bacilli than a 10 per cent povidone- iodine cream.

3. Silver nitrate chlorhexidine cream is more effective than silver phosphate/chlorhexidine gluco- nate cream as a prophylactic agent against P. aerugin- osa, apparently because of the greater solubility of silver nitrate. For this reason silver nitrate/chlorhexi- dine cream is judged to be an appropriate substitute for silver sulphadiazine cream when sulphonamide- resistant Gram-negative bacteria are predominant in the burns unit.

4. Ten per cent povidone-iodine and 0.5 per cent silver nitrate solutions applied 6-hourly to exposed burns of the face, compared with no topical applica- tion, showed that both solutions reduced bacterial colonization of the burns, but there was no significant reduction in colonization by individual pathogens.

Babb J. R., Bridges K., Jackson D. M. et al. (1977) Topical chemoprophylaxis: trials in silver phosphate chlorhexidine, silver sulphadiazine and povidone- iodine preparations. Burns 3, 65.