Appearance of the sheep red blood cell receptor on burn T-lymphocytes after cold incubation in fetal calf serum—a possible prognostic test

In patients sustaining thermal injury, a longitudinal study was designed to evaluate total T-cells and a subpopulation of active T-cells (T₁hr). Additionally, the in vitro effect of overnight incubation at 4°C on the active T₁-cells was studied.The preliminary observations were: (1)Within 10 days of thermal injury, a marked depression of total T-cell number occurred which was paralleled with depression in T₁-cell number; (2) on follow up, although the total T-cell number showed an increase, it did not reveal any significant alteration in survivors and non survivors. In survivors, there was a gradual return of T₁-lymphocyte number to the normal range. Overnight incubation of T₁-cells in 10 per cent fetal calf serum at 4°C demonstrated a remarkable increase in survivors only. This observation suggests that incubation of cells at 4°C for 24 hours may help to modify the cell membrane resulting in an increased receptor affinity for sheep red blood cells. Though the exact mechanism remains obscure the above observation might contain some prognostic significance.     

An approach to cataloguing a burns slide library

A detailed index of burns care, suitable for cataloguing a large collection of burns slides is described together with the mechanics of operating the indexing system and of converting any existing system to it. Its benefits are enumerated.     

Deep vein thrombosis in burns

A prospective study of consecutive burn patients was carried out to determine the incidence of deep vein thrombosis, using the ¹²⁵I-fibrinogen uptake test, to evaluate the appropriateness of this test as a routine investigation in the burned patient, and to assess the feasibility of the treatment of deep vein thrombosis with anticoagulants.

Deep vein thrombosis was found to be at least as common in burns as in other conditions which necessitate prolonged bed rest and the ¹²⁵I-fibrinogen uptake test was found to be a valid method of detection. The treatment regime of intravenous heparin followed by oral warfarin proved to be feasible despite the risk of haemorrhage after subsequent surgery.     

Bacillus cereus infection in burns

Two patients are reported in whom severe toxicity developed about 4 days after relatively minor burn injuries and in whom the burn areas then appeared to enlarge. In both patients, B. cereus and Staph. aureus were isolated and the affected burn areas had subcutaneous thrombosis and necrosis. The management is outlined and the dramatic rapidity of onset of toxicity emphasized, with special reference to increasing pain, lividity and extension of the burns.     

Depressed gastrin secretion in burns

In 5 burned subjects we investigated basal serum gastrin concentration and serum gastrin responses to a meal in the acute phase and after the healing ofburns. We found serum gastrin responses during the acute phase to be 62 per cent of the values observed after healing. This difference is significant (P < 0?025), whereas there was no difference in basal concentrations of gastrin in serum. The findings do not support the theory that stress ulcers are related to hypergastrinaemia.     

Enzymatic debridement of burns: a review

The search for an effective method of enzymatic debridement of burns has been characterized by numerous compounds which, although initially promising, failed to produce acceptable clinical results. Nevertheless, the theoretical potential of such a method is considerable and could significantly change both the management and the prognosis of patients with extensive burns. This paper reviews the basis for enzymatic debridement and with reference to Travase (sutilains), illustrates the widely conflicting clinical experience with such an agent.     

Fc and complement receptor integrity of polymorphonuclear (PMN) cells following thermal injury

In patients sustaining thermal injury, a sequential study was formulated to evaluate Fc and complement receptor expression of polymorphonuclear cells (PMN). Additionally, the role of factors in burn sera and maturity of PMN cells in the circulation were studied. The salient features of the study were:

1. 1. Marked reduction in Fc receptor expression by the 5th day of injury in both survivors and non-survivors. Thereafter levels gradually increased in survivors, though they were still below the normal range. In non-survivors, the depression was severe and persistent.

2. 2. In contrast to Fc receptor expression, complement receptor integrity was not grossly affected in both survivors and non-survivors.

3. 3. Burn sera collected from survivors on the 5th and 13th post-burn day showed reduction in Fc receptor expression of normal PMN cells, whereas sera obtained a month after the injury exhibited no inhibitory effect. Non-survivors sera inhibited Fc receptor expression of normal PMN cells on 5th, 13th and 21st post-burn days.

4. 4. The appearance, increase and disappearance of immature PMN cells in the circulation was correlated with the clinical progress of the patient. Mechanisms involved in the aberrations and its implications are discussed.

     

Fractures in previously abnormal parts

This paper discussed fractures in defective or deformed bones, in stiff, wasted or anaesthetic limbs and at the ends of metal implants. Suggestions are made as to how treatment should be modified in these situations.     

Are expensive and elaborate burns units always necessary? a review of the bangour burns unit over the first 10 years of use

The Bangour Burns Unit was opened in 1968. It was built on a limited budget and great care was taken in the design and discipline. The unit was not airconditioned and strict isolation of the patients was only necessary on occasions.In an attempt to see whether or not the design and system was satisfactory, bacteriological analyses of the patients and staff were made in 1969, 1974 and 1978, which were the years before the unit was electively closed for painting. During these periods, the burn population remained similar and no major change in policy was made. The results confirm that there were no more infections in 1974 or in 1978 compared with 1969.It is suggested that, while the management of burns is generally best done in a burns unit, expensive, elaborate designs and complicated equipment may not be essential in every area. Possibly of greater importance is the application of a code of discipline as suggested by MacMillan (1975) in the Shriners Institute, particularly if the burn population contains a high percentage of severe burns.     

Burns of the female breast: a long term study

Burns to the nipple area in female children were examined a minimum of 14 years after injury. Breast mound development had occurred in all the cases studied, confirming that the conservative management practised in this group of patients was a safe technique. The factors resulting in breast distortion are analysed and the management of this problem is discussed. Mistakes resulting from poorly planned surgery to the anterior axillary fold are reported.     

Neutropenia and thrombocytopenia in burns

Two patients are presented who developed a potentially lethal blood dyscrasia after a burn injury. The first developed a neutropenia and the second a thrombocytopenia. The possible causes are discussed. These cases stress the importance of regular monitoring of the complete blood picture in the management of burns patients.     

False aneurysm of the profunda femoris artery following internal fixation of an intertrochanteric femoral fracture

A case is presented of traumatic aneurysm of the profunda femoris artery following spontaneous unscrewing of the nut at the nail--plate junction of a two-piece nail plate which was used for internal fixation of an intertrochanteric femoral fracture. Methods of avoiding this complication during hip operations are described, together with a short review of the literature.     

Lyophilized pigskin in the treatment of superficial and deep dermal burns

Two consecutive groups of patients with superficial or deep dermal burns have been treated by the application of two different preparations of lyophilized pigskin.

Armour lyophilized pigskin (Armour Pharmaceutical Co., Phoenix, Arizona) reconstituted reliably and was pliable and easy to spread. Corethium I (Epidermis) (Ethicon Ltd. Edinburgh) lyophilized pigskin sometimes reconstituted patchily and handled less well.* Both preparations were conveniently packaged with a long shelf life and reconstituted within 30 min in normal saline.

Both gave dramatic pain relief and adhered to the wound well. The time taken to achieve healing was closely comparable in the two groups. The quality of healing was excellent in both groups when the burn was entirely superficial, but in those burns initially assessed as being deep dermal, hypertrophic scarring occurred in approximately half of the cases. We had hoped that under this type of biological dressing the quality of healing in deep dermal burns would show some significant improvement, but this expectation was not fulfilled.     

The management of complex forearm fractures

This paper describes the management, complications and results of 6 complex forearm injuries sustained in high velocity accidents. The value of combining established concepts with modern advances in the treatment of such injuries is discussed.     

Treatment for hydrofluoric acid burns

Various approaches to HF burn have been studied. This presentation offers a somewhat different approach which centres around the use of benzethonium chloride solution and betamethasone. A review of 10 case records confirms the effectiveness of this treatment when compared to that in prior use, especially in the treatment of an emergency.     

Fracture of an ossified Achilles tendon.

A case of rupture of an ossified Achilles tendon is described. It is suggested that the management of this condition is surgical. Previously undescribed histological appearances demonstrate osteogenic potential. The significance of subcutaneous Achilles tenotomy is discussed.