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Page 1: Exercises and heterotopic ossification

80 Burns (1987) 13, (1). 8C-82 Printedin Great Britain

Abstracts CLINICAL STUDIES

T-Cell activity and immunoglobulin production In patients with hurns covering over 2X per cent of the body surface area pokeweed-induced secretion of IgG and IgM was elevated in the first 2-3 weeks after burning and then depressed at -3-4 weeks. Immunoglo- bulin production was then apparently restored to base- line or higher levels in surviving patients, whereas in patients whose antibody response continued to be sup- pressed fatal septicaemia developed. Spontaneous im- munoglobulin synthesis increased significantly over the normal range in lo/78 tests carried out.

The changes in induced immunoglobulin production correlated well with the changes in T-cell alloreactivity as mcasurcd by the mixed lymphocyte reaction.

Teodorczyk-lnjeyan J. A., Sparkes B. G.. Falk R. E. et al. (19X6) Polyclonal immunoglobulin production in burned patients-kinetics and correlations with T cell activity. J. Truumu 26, (9). X34-X39.

Electrical injuries Electrical burns accounted for 3.5 per cent (I 13/3265) of total acute burn admissions over a IO year period. Voltages less than lo00 accounted for 73 per cent of the I I3 injuries. Such injuries commonly occurred in chil- dren and were probably preventable. High voltages (over lobt) volts) caused the remaining injuries. over half wcrc not work-rclatcd. they tcndcd to occur out- side the- home in young adult males and many were preventable. None of the patients developed renal failure and all survived. however, tissue damage was extensive In IO patients and required major limb amputations. Aggressive Huid resuscitation, continuous haemodynamic and metabolic support and early aggressive surgical intervention was also required.

Hanumadass M. L.. Voora S. B.. Kagan R. J. et al.

administration eliminated S/U/I/~. ~urcus septicaemia in 10 patients with burns covering an average of 35 per cent of the body surface area. However, sepsis with Pr. ueruginosu and methicillin-resistant S@r. aureus was not treated effectively by Timentin. For a more effec- tive therapy Timentin can be combined with an amino- glycosidc or a ccphalosporin.

Diem E. and Graninger W. (1986) Timentin in the treatment of invasive burn wound infection with sepsis. J. Aniimicroh. Chemother. 17, (Suppl C). 123-126.

Chemical burns In a survey of 51 patients with chemical burns mainly caused by alkali or sulphuric acid. 79 per cent occurred in the 21-50 year age group. Sixty-nine per cent of the injuries were work-related in men and I7 per cent in women. Of the 20 patients who received prompt adequ- ate treatment involving aqueous dilution or chemical neutralization, only I9 per cent required skin grafting and the mortality rate was 9.5 per cent. In contrast, when early treatment of 31 patients was inadequate, inappropriate or delayed, 36 per cent of the patients required skin grafting and the mortality rate was 21 per cent.

Sykes R. A.. Mani M. M. and Hiebert J. M. (1986) Chemical burns. Retrospective review. J. Burn Cure Rehubil. 7. (4). 343-347.

Exercises and heterotopic ossification Heterotopic ossification was found in I2 of Iofr6 pa- tients (1.2%) admitted over a IO year period. Abnor- mal bone formation around the elbow joint developed fairly rapidly after injury (mean time of onset I2 weeks). This ossitication progressed to complete ankylosis in patients who persisted with passive and active assisted range of motion exercises beyond the range of pain-free movements. In contrast, patients who only carried out active exercises within the pain- free range ultimately gained excellent ranges of mo- tion.

(1986) Acute electrical burns: a IO yearclinical experi- cnce. &rrrt.s 12. (6). 427-431.

Crawford C. M.. Varghese G.. Mani M. M. et al. ( 1986) Heterotopic ossification: are range of motion exercises contraindicated’! J. Burn Cure Rehuhil. 7, (4). 32.3-327.

Treatment of sepsis with Timentin The addition of potassium clavulanatc to ticarcillin (as Renal elimination of vancomycin in Timentin) makes it possible to treat burn wound The clearance of vancomycin from serum and its sepsis with ticarcillin-resistant strains of various Gram- appearance in urine was determined in IO patients with positive and Gram-ncgativc organisms. Timcntin burns covering between 37 and hS per cent of the body

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