[A case of multiple difficult illnesses in a patient with extremely severe burn complicated with type 2 diabetes]

On December 20, 2018, a 40-year-old male patient with extremely severe flame burn was admitted to Guangzhou First People's Hospital. A variety of difficult illnesses occurred simultaneously (refractory hyperglycemia, refractory hypernatremia, and progressive wound deepening) and successively (repeatedly postoperative hypotension, nervous system diseases, and secondary diabetes insipidus). The patient underwent treatments such as anti-shock, reducing blood sugar and blood sodium, scab removing, and gradual skin grafting after admission. Although the hyperglycemia and hypernatremia were basically corrected and the wounds were basically repaired, the patient ultimately died of nervous system diseases and secondary diabetes insipidus 5 months later. Although the cause of the above illnesses can not be fully determined, the targeted treatments to improve clinical symptoms, maintain stable internal environment and physiological function, and accelerate the process of wound repair conducted by the team may provide some experience for the treatment of such severe patients.

An experimental study on systemic inflammatory response syndrome induced by subeschar tissue fluid

OBJECTIVE

To investigate the biological activity of subeschar tissue fluid (STF) and its probable mechanism in the genesis of systemic inflammatory response syndrome(SIRS).

METHODS

The changes of heart rate (HR), respiratory rate (RR), white blood cell count (WBCC) as well as the major organ function were observed in the animals injected with STF. The inflammatory mediators TNF-alpha and IL-1 in the supernatants of macrophages cultured with STF were assayed.

RESULTS

The HR, RR and WBCC were elevated in animals after injection with STF. STF showed a deleterious effect on function and structure of the major visceral organs. Macrophages were activated to produce excessive TNF-alpha and IL-1.

CONCLUSION

The findings suggest that STF may be one of the inducing factors involved in the genesis of SIRS and the development of MODS in the early postburn stage.

Successful recovery of 14 patients afflicted with full-thickness burns for more than 70 per cent body surface area

Fourteen cases suffering full-thickness burns of more than 70 per cent total body surface area (TBSA) have been successfully treated during the last 8 years (1988-1995). Among these patients, 10 cases suffered from burns of more than 90 per cent TBSA. Five cases had full-thickness burns of 80-90 per cent TBSA. Escharectomy, followed by coverage of wounds with a homograft to the lower surface of which, adjacent to the wound bed, microautoskin grafts had been attached was employed to close wounds in the early stages after burn. The remaining non-surgically treated wound was treated by exposure and topical silver sulfadiazine. The temperature and humidity of the ward was controlled by air conditioning and dehumidification. Aggressive excision of eschar and auto-skingrafting was carried out 3 weeks post-injury. Strictly limiting the uncovered wound to less than 5 per cent appeared to be the major effective measure in preventing burn infection.

[Experimental study of pulmonary infection and its systemic dissemination in the early stage of severe burn]

A total of 138 rabbits were used for the study of pulmonic infection and systemic dissemination in early stage of severe burns. One group of animals was inflicted with third degree burns on the back covering 20% of total body surface area; coincidently an intratracheal introduction of sero-type IX pseudomonas aeruginosa (IXPA) were performed. Above group of animals were compared with the simple body surface burns, simple intratracheal colonization and amikacin treatment groups. For observation, a series of blood samples, swabs of throat were taken at regular times for bacterial culture and IXPA identification. Endotoxin levels of blood plasma were measured too. Animals were killed at 8, 16, 24, 72 hours post-injury, tissue specimens of lung, liver, spleen and kidney were taken for quantitative bacterial cultures, and lung tissues for histological examination. The results showed that the predominant colonization of IXPA in the throats in burned animals are more difficult to be eliminated than that of in non-burned ones. The susceptibility of drugs to IXPA in burned group is higher than that of in control groups, with more severe tissue damages under microscopic examination. The pathogen of pulmonary infection began to invade into the blood stream at four hours post-injuries, and multiple organs dissemination occurred, in which the livers and kidneys were primarily affected. Coincidently a process of endotoxemia was proved. The systemic use of sensitive antibiotics immediately after burns showed benefit to decrease the rate of bacteremia and dissemination of other organs, as well as the rate of death.