Semi-permanent skin staining associated with silver-coated wound dressing Acticoat.

A 17-year-old male with burns to 8% of his total body surface area was treated for 10 days with Acticoat(®), a nanocrystalline silver dressing. The burns, which were on his back and shoulder, healed without infection. However, a skin discoloration in the wound area and the adjacent uninjured skin appeared in the first days of treatment. The staining remained visible even after the treatment had ended and disappeared approximately three years later. Despite the outstanding antimicrobial properties, possible side effects of silver nanocrystalline dressings should be kept in mind.

Un garçon de 17 ans avec des brûlures sur 8% de la surface corporelle totale a été traité avec Acticoat®, un pansement d'argent nanocristallin, pendant 10 jours. Les brûlures, qui étaient sur son dos et une épaule, ont guéri sans infections. Cependant, une décoloration de la peau dans la zone de la plaie et la peau indemne adjacente est apparue dans les premiers jours de traitement. La coloration est restée visible même après le fin du traitement et elle a disparu environ trois ans plus tard. Malgré ses propriétés antimicrobiennes importantes, il faut considérer les effets secondaires possibles de pansements d'argent nanocristallins.

The properties of the "ideal" donor site dressing: results of a worldwide online survey.

Split skin grafting is a widely used technique for reconstructing skin defects. Although a vast number of different coverage options for donor sites have become available in daily clinical practice, no optimum dressing material has been found to date. For this reason, we conducted a globally-distributed online survey to poll for the properties of such an "ideal" donor site dressing, possibly leading to an improved clinically-driven direction of future wound dressing developments. A total of 69 respondents from 34 countries took part in the questionnaire, resulting in a response rate of 13.8% (69/500) over a 1-month period. The majority of respondents rated the characteristics of an "ideal" donor site dressing to be either "essential" or "desirable" as follows: lack of adhesion to the wound bed ("essential": 31/69, 44.9%; "desirable": 30/69, 43.5%); pain-free dressing changes ("essential": 38/69, 55.1%; "desirable": 30/69, 43.5%); absorbency ("essential": 27/69, 39.1%; "desirable": 33/69, 47.8%); ease of removal ("essential": 37/69, 53.6%; "desirable": 27/69, 39.13%). With regard to the desired frequency of dressing changes, respondents preferred "no dressing change until the donor site has healed" (51/69, 73.9%) in the majority of cases, followed by "twice weekly" (10/69, 14.5%), "alternate days" (5/69, 7.2%) and "daily" (3/69, 4.3%). With regard to the design of the dressing material, the majority of participants preferred a one-piece (composite) dressing product (44/69, 63.8%). The majority of respondents also denied the current availability of an "ideal" donor site dressing (49/69, 71%). The strength of this study was the remarkable geographic distribution of responses; all parts of the world were included and participated. We believe that this globally conducted online survey has polled for the properties of the "ideal" donor site dressing and possibly will lead to an improved clinically-driven direction of future wound dressing development.

Les greffes de peau mince sont largement utilisées pour reconstruire les défauts de la peau. Même si un grand nombre de différentes options de couverture des sites donneurs sont devenus disponibles dans la pratique clinique quotidienne, à ce jour, aucun matériel de pansement optimum n'a été trouvé. Pour cette raison, nous avons mené un sondage en ligne mondialement distribué à scrutin pour les propriétés d'un tel pansement de site donneur «idéal¼, qui peut conduire à une meilleure direction en ce qui concerne des futurs développements de pansement. Un total de 69 répondants de 34 pays ont été inclus dans le questionnaire, soit un taux de réponse de 13,8% (69/500) sur une période de 1 mois. La majorité des répondants ont évalué les caractéristiques d'un pansement «idéal¼ pour les sites donneurs d'être «essentiel¼ ou «souhaitable¼ comme suit: le manque d'adhérence au lit de la plaie («essentiel¼: 31/69, 44,9%; «souhaitable¼ : 30/69, 43,5%), le changement de pansement sans douleur («essentiel¼: 38/69, 55,1%; «souhaitable¼: 30/69, 43,5%); l'absorption («essentiel¼: 27/69, 39,1% ; «souhaitable¼: 33/69, 47,8%), la facilité de retrait («essentiel¼: 37/69, 53,6%; «souhaitable¼: 27/69, 39.13%), par rapport à la fréquence souhaitée des changements de pansements, les répondants préféraient «aucun changement de pansement jusqu'à ce que le site donneur est guéri¼ (51/69, 73,9%) dans la majorité des cas, suivi par «deux fois par semaine¼ (10/69, 14,5%), «deux jours¼ (5/69 , 7,2%) et «quotidienne¼ (3/69, 4,3%). En ce qui concerne la conception du matériel de pansement, la majorité des participants ont préféré une seule pièce (composite) (44/69, 63,8%). La majorité des répondants a également nié l'existence actuelle d'un pansement au site donneur «idéal¼ (49/69, 71%). La force de cette étude est la répartition géographique remarquable de réponses ; toutes les parties du monde ont été inclus et ont participé. Nous croyons que cette enquête en ligne, menée au niveau mondial, concernant les propriétés du pansement «idéal¼ pour les sites donneurs se traduira, éventuellement, par une amélioration future dans le développement des pansements.

Hair bleaching and skin burning.

Hairdressing-related burns are preventable and therefore each case is one too many. We report a unique case of a 16-yr-old girl who suffered full-thickness chemical and thermal burns to the nape of her neck and superficial burns to the occiput after her hair had been dyed blond and placed under a dryer to accelerate the highlighting procedure. The wound on the nape of the neck required surgical debridement and skin grafting. The grafted area resulted in subsequent scar formation.

Les brûlures causées par les coiffures sont évitables et donc chaque cas constitue un cas de trop. Nous présentons le cas unique d'une jeune fille de 16 ans atteinte de brûlures chimiques et thermiques à toute épaisseur à la nuque et de brûlures superficielles à l'occiput après un traitement pour rendre les cheveux blond patinés suivi par séchage sous un séchoir pour accélérer l'application des mèches. Pour les lésions à la nuque la patiente a eu besoin d'une opération de débridement chirurgical et d'une greffe cutanée. La greffe, avec le temps, a causé la formation de zones cicatricielles.

An innovative local treatment for staphylococcal scalded skin syndrome.

Staphylococcal scalded skin syndrome (SSSS) is the clinical term used to describe a range of blistering skin disorders induced by the exfoliative toxins of Staphylococcus aureus and prevalently affects neonates, infants and toddlers who lack antibodies to S. aureus toxins. SSSS is a highly contagious disease and is characterised by erythema and fever, followed by the formation of large fragile superficial blisters, which rupture only to leave extensive areas of denuded skin. A diagnosis of SSSS relies on the clinical picture, as well as on histological and microbiological findings. Neonates and young infants are particularly susceptible to a lack of the protective skin barrier, which may cause excessive protein and fluid losses, hypothermia and secondary infection. Due to a complete denudation of skin, the patients also suffer from almost unbearable pain. In our communication, we present an innovative temporary coverage of the denuded skin with Suprathel (PolyMedics Innovations GmbH, Denkendorf, Germany). Suprathel relieves pain, prevents heat loss and secondary infection, accelerates wound healing, does not need to be changed and makes daily care easy for the nurses and is well tolerable for the patient.

Unhealed wounds, hypoalbuminaemia and cachexia in a burned child - where is the limit ?

In our case report we attempt to reconstruct the case of a 10-yr-old boy in Iraq with severe burns who survived almost six months without any adequate treatment, i.e. adequate treatment according to our therapeutic standards. We also highlight the patient's predominant symptoms, such as open wounds, hypoalbuminaemia, and cachexia.

[Congenital malaria due to Plasmodium falciparum and Plasmodium malariae]. / Konnatale Malaria durch Plasmodium falciparum und Plasmodium malariae.

Increasing tourism and growing numbers of immigrants from malaria-endemic countries are leading to a higher importation rate of rare tropical disorders in European countries. We describe, to the best of our knowledge, the first case of connatal malaria in Austria. The patient is the first child of a 24 year old mother who was born in Ghana and immigrated to Austria one and a half years before delivery. She did not stay in an endemic region during this period and did not show fever or any other signs of malaria. The boy was healthy for the first six weeks of his life. In the 8th week of life he was admitted to our hospital due to persistent fever of unknown origin. On physical examination he showed only mild splenomegaly. Routine laboratory testing revealed mild hemolytic anemia with a hemoglobin value of 8.3 g/l. In the blood smear Plasmodium falciparum and Plasmodium malariae were detected. Oral therapy with quinine hydrochloride was successful and blood smears became negative for Plasmodia within 6 days. This case shows that congenital malaria can occur in children of clinically healthy women who were born in malaria-endemic areas even one and a half year after they have immigrated to non-endemic regions.

Controlled mechanical hypoventilation in a paediatric burn patient as treatment of acute respiratory distress syndrome.

The paediatric patient we are describing suffered a scald injury covering 83 per cent of the total body surface area (TBSA). This injury was complicated by Klebsiella pneumoniae septicaemia resulting in multiorgan failure (MOF). Acute respiratory distress syndrome (ARDS), gastrointestinal insufficiency, hepathopathy and wound conversion to full thickness posed the main problems. The boy was ventilated with pressure-controlled mechanical ventilation. The concept of permissive hypercapnia (PHC) resulted in a complete resolution of ARDS within 4 weeks. From our experience, further lung injury among infants and children suffering from severe ARDS can be avoided by using controlled mechanical hypoventilation. It is a simple and safe technique that allows adequate oxygenation.

Congenital central hypoventilation syndrome (Ondine's curse syndrome) in two siblings: delayed diagnosis and successful noninvasive treatment.

UNLABELLED: Congenital central hypoventilation syndrome (CCHS, Ondine's curse syndrome) is a rare respiratory disorder; less than 100 cases have been reported. Familiality of the disease has been discussed, but only few familial cases have been reported so far. In this report we describe the occurrence of CCHS in two male siblings. Diagnosis was established only at the age of 4 years in the first case, although the patient had disease related symptoms since early infancy. The second patient was one of dizygotic twins, he was diagnosed with CCHS at the age of 8 months. Up to that age only moderate desaturations had been observed. The other twin was unaffected by the disease. Both patients were successfully treated by nocturnal positive-pressure ventilation via a specially adapted face mask. They show satisfactory physical and neurologic development. CONCLUSION: Our cases support the assumption of familiality in CCHS although the mode of inheritance remains to be clarified. Polygraphic recordings including capnography should be performed in siblings of CCHS patients early in life in order to avoid secondary complications. Noninvasive treatment by ventilation via special face masks is feasible.

Procel burn cover used as a total body dressing in burns.

A 26-month-old boy sustained a scald injury covering 83 per cent of his total body surface area (TBSA). He also developed sepsis and multiorgan failure (MOF). Locally he was treated with Procel burn cover and silver sulphadiazine cream (SSD) for 23 days. By using Procel, the dressing-change time was shortened significantly. Procel burn cover controlled core and skin temperature more effectively compared to conventional dressing, and the staff acceptance increased because of its easy and fast use. Based on our observation, this material can be used successfully as a total body dressing with children with extensive partial thickness burns or temporarily in full thickness burns until wound excision can be performed.

[Extracorporeal membrane oxygenation in newborn infants and children]. / Die extrakorporale Membranoxygenierung bei Neugeborenen und Kindern.

The purpose of this report is to describe our experience with veno-arterial (VA) and veno-venous extracorporeal membrane oxygenation (VV-ECMO) for neonates and children with severe acute respiratory or cardiocirculatory failure. From 1990 to 1994 20 neonates and 12 children were treated at the ECMO center in Graz. Indications for ECMO were acute respiratory failure in 27 patients and cardiocirculatory failure in 5 patients. Mean duration of ECMO was 228 +/- 30 hours. Fifteen neonates were weaned from ECMO and were subsequently extubated. Of the 12 children 7 had severe acute respiratory failure and underwent VV-ECMO. Five of these 7 children were weaned from ECMO and subsequently extubated. Only two of 5 patients with cardiac ECMO support could be weaned from bypass; one patient subsequently died, but the other patient is a long-term survivor. All patients with cardiac ECMO support after open heart surgery had severe mediastinal bleeding. The survival rate in neonates and pediatric patients with respiratory failure treated by ECMO was 75% and 71%, respectively, whereas it was only 20% in children with cardiocirculatory failure. Major complications on ECMO were local and intracerebral bleeding. ECMO is an effective therapy for neonates and children with acute respiratory failure. It is less effective for cardiac support in children after open heart surgery, but the use of heparin-layered ECMO systems might increase the safety of the procedure.

Arterial blood pressure immediately after thermal injury: the role of anesthesia.

Mean arterial blood pressure was measured in anesthetized rats. The duration that the rats were under anesthesia with ether or methohexital was brief, and the animals were allowed to awaken early after injury. Three hemodynamic measurements were compared: (1) lowest mean arterial blood pressure, (2) duration at lowest mean arterial blood pressure, and (3) time to recover initial mean arterial blood pressure. In these studies the anesthetic agents reduced mean arterial blood pressure by 36%, recovering to normal pressures within 24 to 39 minutes. During the hemodynamic observation period, no significant additional hemodynamic effects as a result of the thermal injury were seen. Administration of resuscitation fluid did not significantly affect hemodynamics during the observation period in this study. These studies demonstrate that anesthesia dominates the short-term cardiovascular effects of thermal injury, and therefore caution is required in the interpretation of acute cardiovascular effects immediately after thermal injuries with patients under general anesthesia.

Effect of heta-starch colloidal solutions on reticuloendothelial phagocytic system (RES) function in burned and infected rats.

The biodistribution of the plasma expander colloidal solution, heta-starch (HES), has been examined in rats, subjected to thermal injury or sepsis. The ability of these solutions to alter RES phagocytic function of [99mTc]-sulphur colloid ([99mTc]SC) uptake in vivo has been examined. The biodistribution of radiolabelled HES has been determined in normal rats. The HES colloidal solution has no deleterious effect upon RES function in vivo in the thermally injured animals or the septic animals as compared to sham controls. In addition, the HES colloidal solution seemed to be distributed primarily within the liver, spleen and kidney, with a small amount residing in the lung. Thermal injury did not increase the uptake of this material by the lung. These results suggest that the use of HES in thermally injured and septic individuals has no deleterious effects on RES function, nor does it accumulate in the lungs, and hence, should be advocated for use in these situations.

Core body temperature responses immediately after cutaneous thermal injury in rats.

Internal temperatures were continuously measured in rats that received 20% or 40% body surface area cutaneous scald injuries in 25 degrees C and 38.5 degrees C environments. In animals that received thermal injuries in the 25 degrees C environment, intraperitoneal, intraesophageal, and intrarectal temperatures rapidly rose to 40 degrees C within 5 minutes but returned to normal values within 15 minutes after injury. When 20% body surface area injuries were induced in a 25 degrees C environment, all of the animals survived. In the 25 degrees C environment, neither acute core body temperature elevations nor use of fluid resuscitation predicted survival. In contrast, in a 38.5 degrees C environment core body temperatures rapidly exceeded 41 degrees C with the 20% injury, and all of the animals died within minutes in spite of fluid resuscitation. These studies suggest that the ambient environmental temperature may significantly influence a thermally injured animal's ability to rapidly eliminate absorbed heat of injury and result in an elevated core body temperature, which may contribute to the immediate lethality of the injury.

Effect of chronic interleukin-2 treatment on RES phagocytic activity in the rat.

The effect of chronic interleukin-2 (IL-2) injection upon reticuloendothelial system (RES) function in the rat has been determined. Seven-day treatments with two doses of human recombinant IL-2 resulted in a dramatic reduction in the phagocytic uptake of the liver and spleen, while increasing the weight of both organs. There were dramatic histological changes in the intestine, liver and spleen as well. These results suggest that the chronic use of IL-2 can result in hepatic dysfunction, which is associated with altered RES phagocytic function.

Tick-borne encephalitis in a 3-month-old child.

Tick-borne encephalitis has not been reported in infants younger than 12 months of age. We report a 3.5-month-old child with a serologically proven tick-borne encephalitis. The infant had a history of a tick bite 3.5 weeks before the first symptoms of encephalitis appeared. The family lives in an endemic area of the disease. There were no prodromal signs and the course of the disease was monophasic. In an endemic area, prophylactic treatment with hyperimmunoglobulin after a tick bite should be considered even in very young infants, but in most children active immunization is probably not necessary because of infrequent exposure. Active immunization is still recommended after the 1st year of life.

Effect of acute and chronic lipopolysaccharide (LPS) administration on reticuloendothelial system (RES) phagocytic activity in vivo.

The effect of injection or chronic infusion of lipopolysaccharide (LPS) into unanaesthetized rats on the distribution of [99Tcm-]SC has been determined. At a dose of 2.5 mg/kg, LPS injection caused a marked alteration in the distribution of the radiolabelled material, with more uptake being achieved in the lung while less was taken up by the spleen. Kidney and liver uptake were also changed. Chronic infusion of LPS at a similar dose (3 mg/kg in 24 h) caused a marked increase in the uptake of the radioactive material by the lung only. These data are consistent with a working hypothesis that the alterations in RES phagocytic activity of the lung observed in rats subjected to burn trauma could be related in part to LPS, either coming as a bolus, or being continuously presented.

Platelet-activating factor induces intestinal necrosis, but not septic shock, in germ-free and specific-pathogen-free rodents.

Platelet-activating factor (PAF) was injected into conventional mice, endotoxin-resistant mice (C3H/HEJ), conventional rats, germ-free rats and specific-pathogen-free (SPF) mice. The PAF resulted in significant necrosis and damage to the small intestines of all the animals tested. In general, the frequency and severity of the lesions were similar in all groups. All the conventional rats and mice, as well as the endotoxin-resistant HEJ mice, were dead 18 h after the injection of the PAF, while all the germ-free rats and the SPF mice survived. These data demonstrate that development of massive intestinal lesions, in the absence of aerobic bacteria, is not sufficient to cause the death of the host from septic shock and endotoxaemia.