Paediatric burns in the acute phase: specific aspects.

This paper deals with specific aspects of paediatric burns in the acute phase and considers how the treatment of burned children differs from that of burned adults. The epidemiology of paediatric burns is reviewed. Particular aspects of the treatment of burned children are presented, with regard to treatment at the site of the accident, first aid, resuscitation, and local treatment. The importance of the accurate assessment of paediatric burns is stressed.

[A multicenter epidemiological study of burns of the head in childhood in the period of 1986-1990]. / Studio epidemiologico multicentrico delle ustioni nell'estremo cefalico in età pediatrica nel periodo 1986-1990.

A retrospective study was performed over the children admitted to three regional pediatric burn units, over a 5-year period (1986-1990). Out of 695 pediatric patients, 270 (38.8%) were admitted with burns of the head and neck. This whole childhood age group (up to 14 years of age) was examined epidemiologically. The age group presenting the highest incidence was within 0-3 years (71%); scalds were involved in high percentage (68%) and many injuries occurred at home (93%). Epidemiological aspects of the report are discussed with particular consideration of preventive programs.

Skin substitutes in the treatment of deep partial skin thickness burns in children: clinical experience and long-term results.

This report describes the use of skin substitutes in the treatment of deep partial skin thickness burns in childhood. These are lesions that, if treated inadequately, can result in severe scarring. However, if treated appropriately, they can heal without any sequelae, which is obviously crucial for aesthetic and psychological reasons. This review contains children admitted to the authors' Burn Unit over a 5-year period (1984-88) with deep partial skin thickness lesions which were treated with synthetic and/or biosynthetic skin substitutes and without surgical procedures. This group of children has been compared with another group hospitalized for burns of the same depth and treated with conventional closed wound management. First, short-term results are presented, highlighting healing time, followed by the long-term results from an aesthetic and functional viewpoint.

[Isolated burns of the hand: the experience of a pediatric burn center]. / Le ustioni isolate della mano: esperienza di un Centro ustioni pediatrico.

Localized burns to hands are very frequent in the paediatric group age. Toddlers are particularly vulnerable. These burns have a favourable prognosis "quoad vitam" but often cause contracting scar deformity leading to loss of hand function. The authors report own experience in the last five years and emphasize the need for more severe prevention especially within the home environment to decrease the frequency of these simple but dangerous burns.

Spermatic and peripheral venous plasma concentrations of testosterone, 17-hydroxyprogesterone, androstenedione, dehydroepiandrosterone, delta 5-androstene-3 beta,17 beta-diol, dihydrotestosterone, 5 alpha-androstane-3 alpha,17 beta-diol, 5 alpha-androstane-3 beta,17 beta-diol, and estradiol in boys with idiopathic varicocele in different stages of puberty.

Serum testosterone (T), 17-hydroxyprogesterone (17P), androstenedione (delta 4-dione), dehydroepiandrosterone (DHA), delta 5-androstene-3 beta, 17 beta-diol (delta 5-diol), estradiol (E2), dihydrotestosterone (DHT),5 alpha-androstane-3 alpha,17 beta-diol (3 alpha diol), and 5 alpha-androstane-3 beta,17 beta-diol (3 beta diol) were measured in the peripheral and spermatic venous blood of 21 boys undergoing surgery for idiopathic left varicocele. The boys were divided into 3 groups according to their pubertal development: prepubertal (group 1 or P1; n = 8), pubertal stage 2 (group II or P2; n = 6), and pubertal stages 3-4 (group III or P3-4; n = 7). The testes of the prepubertal boys secreted T, 17P, DHA, delta 5-diol, DHT, and 3 alpha diol, but not delta 4-dione, E2, and 3 beta diol. In pubertal stage P2, the mean spermatic-peripheral secretory gradients of T, 17P, DHA, delta 5-diol, DHT, and 3 alpha diol were significantly higher than those in the prepubertal stage, and there was testicular secretion of delta 4-dione, E2, and 3 beta diol. In pubertal stage P3-4, the mean spermatic-peripheral secretory gradients of most of these steroids, even if increased, were not significantly different from those in stage P2 (with the exception of 17P, delta 5-diol, and DHA). We suggest that after the important modifications of testicular secretion occurring in pubertal stage P2, the testicular secretory pattern of the pubertal testis is similar to the pattern of the adult testis. We suggest also that these results, obtained in boys with idiopathic varicocele, can probably be extended to the secretory activity of the testes of normal pubertal boys.

[Opportunistic infections in burned children]. / Infezioni opportunistiche in bambini ustionati.

The burn injury is a typical pathology in which there is a possibility of opportunistic infections because the patients have a severe derangement in their defense. The authors examine etiology, pathogenesis, simptomatology, diagnosis, prophylaxis and therapy of these infections. The authors also report their own experience about these infections based on study of a group of burned children hospitalized in the pediatric surgery unit of A. Meyer hospital in Florence.

Injection therapy with triamcinolone hexacetonide in the treatment of burn scars in infancy: results of 44 cases.

In many cases deep second degree and third degree burns cause severe scarring. The authors have reported here their experience of the treatment of hypertrophic scarring from burns carried out on 44 children with intralesional injections of a long-acting cortico-steroid (Triamcinolone hexacetonide) using the jet spray technique.

Steroid secretion by the prepubertal human testis.

It has been demonstrated that the human testis secretes testosterone and, to a smaller extent and less constantly, also androstenedione. Testosterone, progesterone, 17 alpha-hydroxyprogesterone and 20 alpha-dihydroprogesterone have been measured in the spermatic and peripheral venous blood of prepubertal boys undergoing surgery for undescended testis or inguinal hernia repair. The spermatic plasma levels of testosterone and progesterone were significantly higher than peripheral levels. A significant spermatic-peripheral gradient was not found for 17 alpha-hydroxyprogesterone and 20 alpha-dihydroprogesterone. These studies demonstrate that the secretory pattern of the human prepubertal testis is different from that of the adults.

Spermatic and peripheral venous plasma concentrations of progesterone, 17 alpha-hydroxyprogesterone, and 20 alpha-dihydroprogesterone in prepubertal boys.

Testosterone, progesterone, 17 alpha-hydroxyprogesterone, and 20 alpha-dihydroprogesterone have been measured in the spermatic and peripheral venous blood of 17 prepubertal boys undergoing surgery for undescended testis or inguinal hernia repair. Mean (+/-SE) spermatic testosterone and progesterone (538 +/- 212 and 704 +/- 110 pg/ml, respectively) were significantly higher (P less than 0.005) than peripheral levels (91 +/- 11 and 419 +/- 71 pg/ml, respectively). No significant spermatic-peripheral gradient was found for 17 alpha-hydroxyprogesterone and 20 alpha-dihydroprogesterone. These in vivo studies demonstrate that the secretory pattern of the prepubertal testis is different from the adult testis.

Spermatic and peripheral venous plasma concentrations of dehydroepiandrosterone sulfate in prepubertal and pubertal boys.

Dehydroepiandrosterone sulfate (DEAS), a major adrenal product, is quantitatively one of the most important steroids found in human testicular tissue. However, conflicting data have been reported about the testicular production of DEAS 'in vivo'. We have measured the spermatic and peripheral concentrations of testosterone (T) and DEAS in two groups of prepubertal (Group I, N = 18) and pubertal (Group II; N = 11) boys undergoing surgery for undescended testis, inguinal hernia or varicocele. Mean (+/- SE) spermatic concentrations of DEAS (77 +/- 16 and 113 +/- 19 micrograms/dl in Group I and II respectively) were not significantly different from peripheral concentrations (70 +/- 13 and 130 +/- 16 micrograms/dl in Group I and II respectively). Mean spermatic concentrations of T (153 +/- 101 and 7515 +/- 4314 ng/dl in Group I and II respectively) were significantly different from peripheral concentrations (9 +/- 1 and 149 +/- 53 ng/dl; P less than 0.001 in both groups). Spermatic and peripheral levels of T and DEAS found in prepubertal boys were significantly lower than those found in pubertal boys. Spermatic levels of DEAS were not significantly related with spermatic levels of T in both groups. Our data show that, as in adult subjects, no significant spermatic-peripheral DEAS gradient is present in prepubertal and pubertal boys.

Spermatic and peripheral plasma concentrations of testosterone and androstenedione in prepubertal boys.

Spermatic and peripheral plasma concentrations of testosterone (T) and androstenedione (A) have been measured in prepubertal boys affected by inguinal hernia (group I; n = 7) and unilateral undescended testis (group II; n = 18). Mean (+/- SE) spermatic T concentrations (47.7 +/- 14.8 ng/dl in group I; 36.3 +/- 3.4 ng/dl in group II) were significantly different from mean peripheral T concentrations (9.8 +/- 2.1 ng/dl in group I; 9.3 +/- 0.9 ng/dl in group II) in both groups (P less than 0.05 and P less than 0.0005, respectively). Mean spermatic A concentration (59.7 +/- 4.9 ng/dl) was significantly higher than mean peripheral A concentration (49.8 +/- 4.9 ng/dl) in group II (P less than 0.05) but not in group I. Mean spermatic and peripheral T and A values found in boys of group I were not significantly different from those found in group II. The mean spermatic/peripheral T ratio was higher (5.01 in group I; 4.42 in group II) than the corresponding mean spermatic/peripheral A ratio (1.27 in group I; 1.32 in group II) in both groups. Our data suggest that 1) although testicular T secretion is present in all prepubertal boys, A secretion is not constant and often negligible; 2) the contribution of testicular secretion to the circulating T is much more important than the contribution to the circulating A; 3) no significant differences were found between the testicular secretory pattern of prepubertal boys with inguinal hernia and unselected boys with unilateral undescended testis.

Testosterone concentrations in spermatic venous blood plasma of prepubertal boys.

Testosterone concentration has been measured in spermatic and peripheral venous plasma obtained during surgery from a total of 25 prepubertal boys affected either by inguinal hernia (Group I; N = 6; age range 2-8 years) or unilateral undescended testis (Group II; N = 19; age range 5-11 years). Median spermatic venous testosterone level was 58.7 ng/dl) (range 14.0--120.8 ng/dl) in Group I and 43.2 ng/dl (range 12..2-267.5 ng/dl) in Group II; median peripheral testosterone level was 4.9 ng/dl (range 2.3-15.4 ng/dl) and 5.6 ng/dl (range 1.1-89.3 ng/dl) in Group I and II, respectively. The difference between the spermatic and peripheral level was statistically significant in both groups (P less than 0.01 in Group I and P less than 0.001 in Group II). These results indicate that the prepubertal human testis secretes testosterone, even if in a very low amount. It is also suggested that this secretion can be responsible for LH inhibition in prepubertal boys.