Unsuccessful therapy of combined mycotic infection in a severely burned patient: a case study.

Patients with burn trauma are always in danger of contracting an infection. Although invasive mycotic infections are not as frequent as bacterial infections, high mortality and in many cases difficult diagnostics pose a serious threat not only for neutropenic patients. In more extensive burns the status is further complicated by specifically compromised immunity. The most frequent species of micromycetes isolated in burn patients are Candida spp. and Aspergillus spp. Zygomycetes represents a relatively uncommon isolation worldwide (up to 2% of all fungi. We present a case study of a young patient with 82% TBSA (total body surface area) burns, where we isolated simultaneously 3 different types of micromycetes (Aspergillus fumigatus, Fusarium sp., Absidia sp.). Mycotic infection is understood primarily as a complication in neutropenic patients and, after prophylactic antibiotic and antimycotic administration, in extensive burn trauma patients. The case ended with the death of the patient due to severe sepsis caused by the multiresistant strain Pseudomonas aeruginosa.

Mutilating electrotrauma--case report.

The passage of electric current through a human body causes polarization changes in cell membranes, which can possibly lead to the death of these cells. At the same time, electric energy is transformed to thermal energy, primarily in high resistance tissues. We present a case report of a 22-year-old male who was hit by an electric current with a voltage of 22 kV when he was working on a high-voltage overhead line tower. Primary treatment which included fasciotomies was completed two hours after the injury. Fasciotomies and revisions of all muscle groups were completed on the left upper extremity and right shank. On the right upper extremity fasciotomies were completed on the forearm. Retinaculum flexorum was cut in the area of both wrists. Despite the complex therapy including higher doses of a low-molecular-weight heparin, ischemization of the whole left upper extremity and distal part of right shank and foot occurred. On the sixth day after the injury it was necessary to amputate the right lower extremity in shank and on the eighth day after injury to amputate the left upper extremity below the shoulder, and on the fourteenth day, due to progressive ischemic necrosis, it was necessary to complete exarticulation of the left shoulder. The 45th day after the injury our team of micro-surgeons closed the defect of soft tissues in the distal part of right forearm and radial part of right hand by transferred parascapular fasciocutaneous flap. The right median nerve appeared to be necrotic in the distal part of forearm even at the day of injury. Four months after the injury the 12 cm long defect of the right median nerve was bypassed by a graft from the suralis nerve. Outpatient care followed as well as physical and psychological rehabilitation. The support of the family was admirable. One and a half years after the injury reconstruction of the right thumb flexor tendon was completed. Two years after the injury function of the right hand in terms of grip function was satisfactory (patient was able to complete pinch grip and sign). Gait with the prosthesis was very good.

The epidemiology of pediatric burns undergoing intensive care in Burn Centre Brno, Czech Republic, 1997-2009.

UNLABELLED: The aim of this study was to determine the basic epidemiological characteristics of severely burned children who were admitted to the intensive care unit (ICU), Department of Burns and Reconstructive Surgery Faculty Hospital Brno, Czech Republic in the years 1997-2009. METHODS: We collected and evaluated epidemiological data such as age, sex, burn etiology, length of hospitalization, duration of the ICU stay, surgical or conservative therapeutic strategies, the use of mechanical ventilation and its duration, day and month of injury and the extent of burned area. RESULTS: In total 383 children (253 boys, 130 girls) aged 0-14 years, underwent intensive care for at least 48h. Male to female ratio was 1.95:1. The average range of burn area in the group was 16.43±12.86% TBSA (total body surface area). During the reporting period, 16 children were admitted with burns over 50% TBSA. 328 children suffered burns indoors, with 55 children being burned outdoors. Indoor/outdoor ratio was set at 5.96:1. The most frequent etiological agent was scalding (hot water, soup, coffee, oil, tea). The total number of scalded children in this group was 312 (81.46%). Mechanical ventilation was used in 96 cases (25.07% of all the admitted patients). The duration of mechanical ventilation in these patients was 8.03±5.67 days in average. The average length of stay in ICU was 10.71±10.92 days and total length of hospital stay was an average of 21.55±14.55 days. A total of 184 patients (48.04%) were treated surgically and therefore required necrectomy and skin grafting. The other 199 (51.96%) patients were treated conservatively. During the reporting period 3 children died (0.78%). CONCLUSION: In our report we identify basic epidemiological data defined in the aim of this study for burned children requiring intensive care.