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[Modes of occurrence of accidental scalds and burns in infancy and childhood (author's transl)].

The modes of occurrence of scalds and burns of varying severity in infancy and childhood were statistically compiled from the case notes of 790 patients admitted to the Department of Paediatrics, University of Graz during the years 1968 to 1973. The most frequent mode of injury was pulling down pots containing hot fluids from stoves and other elevated places (37% cases); 26% of the children were scalded by tripping over pots placed on the floor by adults and falling into the spilt liquid, 11% received burns by touching hot objects or by direct contact with fire and 9% were burned accidentally in a "passive" manner by their siblings or parents. In 18% of cases the accidents happened in a variety of more unusual ways. The age of the injured child and the time of day of the event both appear to play an important role in the genesis of the accident, whereas the season of the year and social status seem to be of minor importance in this connexion. The most important preventive measure is the adequate instruction of parents and others in charge of young children in respect to the common domestic hazards in everyday life which may lead to scalds and burns.

Accidents↗

Scalded skin syndrome: Diagnosis, differential diagnosis, and management of 42 children.

The bacteriologic, epidemiologic, clinical, and diagnostic findings and management of the scalded skin syndrome (SSS) in 42 children are reported SSS may present in one of three ways: (1) Ritter's disease in infants, characterized by an acute, generalized bullous dermatitis simulating the appearance of scalded skin, followed by exfoliation; (2) Lyell's disease, or toxic epidermal necrolysis (TEN), in children or adults, with scalded skin and bullae followed by extensive exfoliation; or (3) a nonstreptococcal scarlatiniform eruption, or staphylococcal scarlet fever, manifested by a generalized scarlatiniform erythema ans subsequent minimal to moderate fine desquamation. Staphylococcus aureus was isolated and implicated as the causative agent in 32 of the 42 children; nine of the other ten children had received a drug or vaccine preceding their rash. SSS in children has increased in frequency recently, is usually due to S aureus infection with potential epidemic aspects, can be recognized easily by its unusual clinical features, and has an excellent prognosis with appropriate management.

Child↗

[Changes of the mRNA expression and the intestinal mucosal cyclooxygenase activity in scalded rats].

OBJECTIVE: To investigate the changes of the mRNA expression and the intestinal mucosal cyclooxygenase (COXs) activity in scalded rats. METHODS: Wistar rats inflicted with 30% TBSA III degree scalding were employed as the model. The changes of COX-1, COX-2 activities were determined by substrate fluorescence analysis and the mRNA expressions of COX-1 and COX-2 by RT-PCR. RESULTS: The mRNA expressions and the activities of COX-2 in rat intestinal mucosa increased obviously after injury. But those of COX-1 exhibited lower range of change. CONCLUSION: The pathological mechanism of rat intestinal mucosa injury after scalding might be closely related to the COXs participation by different styles between the two enzymes.

Animals↗

[An observation of the effects of Tiopronin on the oxygen free radicals in severely scalded rats receiving delayed fluid resuscitation].

OBJECTIVE: To observe the harmful effects of oxygen free radicals and the protective roles of Tiopronin in severely scalded rats after delayed fluid resuscitation. METHODS: Rats inflicted with 30% III degree scald on the back were employed as the model. They were divided into delayed resuscitation (D) and Tiopronin treatment (T) groups. The changes in superoxide dismutase (SOD) and malonyldialdehyde (MDA) in plasma and subeschar fluid were determined at 24 to 48 postburn hours (PBHs) by means of electron spin resonance (ESR) technique and other routine methods. And the pathomorphological changes in the heart, liver, kidneys and small intestine, and changes in the blood biochemical indices were simultaneously determined. Normal rats were taken as control group (N). RESULTS: The plasma SOD level was was lower than that in N group, while the MDA content in plasma and subeschar fluid in D group was much higher than that in N group. Changes in all the blood biochemical and internal organ pathomorphology were more obvious in the D group. on the other hand, the rat plasma SOD level in T group increased obviously (P < 0.01) while the MDA contents was decreased in T group (P < 0.05) when compared with those rats of D group. In addition, the internal organ pathomorphology and blood biochemical indices were improved evidently in T group. CONCLUSION: Oxidative stress injury was evoked in severely scalded rats after delayed fluid resuscitation, and it could be protected to some extent by Tiopronin.

Animals↗

[Translocation of intestinal endotoxin and bacteria induced by the apoptosis of enterocytes in scald rats after delayed resuscitation].

OBJECTIVE: To investigate the role of enterocyte apoptosis in translocation of intestinal endotoxin and bacteria after delayed resuscitation in scalded rats. METHODS: One hundred and ten male Wistar rats were divided randomly into two groups: group A, early resuscitation, n=60; group B, delayed resuscitation, n=50. All animals were subjected to 30% total body surface area (TBSA) full-thickness scald. In group A, saline resuscitation was begun immediately after the injury. Saline resuscitation later than 6 hours after scalding was referred as delayed resuscitation. Apoptosis of enterocytes was identified by DNA fragmentation (ap%), DNA agarose gel electrophoresis, TdT-mediated dUTP nick end labeling (TUNEL) method and electron microscope (EM). The levels of endotoxin in portal vein and systemic circulation were determined by limulus amebocyte lysate technique. The amount of bacteria in mesenteric lymph nodes (MLN) was detected by a quantitative bacteria culture of biopsy. RESULTS: The ap% of enterocytes was increased significantly in groups A and B, peaking at 12 hours postburn. The increased ap% in the group B occurred much earlier and higher than in group A from 3 hours to 48 hours postburn (P<0.05 or P<0.01). This was corroborated by the results observed in electrophoresis, TUNEL method and EM. The portal endotoxin was much higher in group B than in group A at the same postburn timepoints. So were the endotoxin levels in systemic circulation. A significant positive relationship existed between the portal endotoxin levels and the ap% of intestinal epithelial cells in groups A and B (group A: r=0.936, P<0.01; group B: r=0.899, P<0.05). The frequency of bacteria translocation of MLN in group B was higher than that in group A. CONCLUSION: Significant pathologic apoptosis of enterocytes is induced by delayed resuscitation after thermal injury in rats. This may lead to a compromise of intestinal barrier. It may be one of the major causes of translocation of endotoxin and bacteria postburn.

Animals↗

[Effects of escharectomy during shock stage on the plasma lipid and serum free fatty acid levels in scalded rats].

OBJECTIVE: To investigate the influence of escharectomy during shock stage on plasma lipid and free fatty acid levels in scalded rats. METHODS: Thirty-two adult Wistar rats inflicted with 30% TBSA III degree scalding were employed as the model and were divided into normal control (NC), scalding control (SC) and treatment groups (T), and the latter was further divided into three sub groups according to the time of escharectomy, i.e. 8 postburn hour (PBHs) (T8), 24 PBHs (T24) and 96 PBHs (T96) groups. The rats were sacrificed at 168 PBHs. The postburn changes in the rat plasma lipid and free fatty acid levels were determined. RESULTS: 1) There was significant increase in serum triglyceride (TG), cholesterol (CHO), high density lipoprotein (HDL), low density lipoprotein (LDL), very low density lipoprotein (VLDL), apolipoprotein A (ApoA), apolipoprotein B (ApoB) and all the free fatty acids (FFAs) in the total serum FFAs excluding myristic acid (P < 0.05) at 168 PBHs in rats of all the T groups. 2) The serum levels of TG, CHO, ApoB, total FFA, lauric acid, palmitic acid, zoomaric acid, oleic acid and linoleic acid in T8 and T24 groups were evidently lower than those in SC group (P < 0.05). The plasma levels of VLDL, stearic acid and arachidonic acid in T8 were obviously lower than those in SC group (P < 0.05); 3) In T96 group, the serum levels of ApoB and lauric acid were significantly lower than those in SC group (P < 0.05), but all the other indices remained higher than those before injury. CONCLUSION: There was enhanced fat mobilization after severe burn injury. Escharectomy during shock stage might decrease fat mobilization, which was beneficial to the restoration of normal lipid metabolism.

Animals↗

[Change of the erythrocyte chemokine receptor binding activity in scalded rats with Pseudomonas aeruginosa infection].

OBJECTIVE: To explore the influence of infection on the erythrocyte chemokine receptor (ECKR) binding activity in severely scalded rats. METHODS: The Sprague-Dawley (SD) rats were randomly divided into three group: sham scald group (A), burn and infection group (B) and infection group (C). The B group rats were scalded with 30% total body surface area (TBSA) of III degree, and the rats ECKR binding activity with interleukin-8 (IL-8) as ligand were detected by enzyme-linked immunosorbent assay (ELISA) at 1, 2, 4, 6 and 8 hours after infection. RESULTS: Compared to that in A group, ECKR binding activities declined significantly (both P<0.01) after infection in both of B and C groups, but they increased at 8 hours (P<0.01). ECKR binding activity in B group was significantly less at 2, 8 hours than that in C group after infection (both P<0.05). The declining range of ECKR binding activity was more in B group, in which the decline of ECKR binding activity appeared earlier (2 hours) than that in C (6 hours) group. CONCLUSION: The infection lead to the decline of ECKR binding activity in burned rats, and the erythrocytes might participate in the chemokine regulation and play a novel role in the infection.

Animals↗

[Changes in the expression of apoptotic genes in the intestinal tissue of scalded rats before and after resuscitation].

OBJECTIVE: To explore the dynamic changes in the expression of c-fos, proliferation cell nuclear antigen (PCNA) and Bax in the intestinal tissue of scalded rats before and after resuscitation. METHODS: Wistar rats inflicted with 30% TBSA full thickness scald were employed as the model and randomly divided into four groups with 8 in each group, i.e. 2.0, 2.5, 4.0, 6.0 postscald hour (PSH) groups. Rats in each group received routine fluid infusion at 2 PSH, and were sacrificed at 2, 2.5, 4, 6 PSH, respectively. Then the intestinal tissue of the rats was harvested for the detection of the expression of c-fos, PCNA and Bax. RESULTS: The expression of c-fos, PCNA and Bax at 2.0 PSH group (65.8 +/- 4.2%, 74.5 +/- 2.4%, 26.3 +/- 5.7%, respectively) significantly increased when compared with those in 2.5 PSH group (92.4 +/- 5.7%, 85.6 +/- 4.5%, 67.1 +/- 6.6%, respectively) (P < 0.01). The expression of 3 genes increased dramatically at 2.5 and 4.0 PSH, and reached the peak at 2.5 PSH. There was no obvious difference in the gene expression between 4 PSH and 2 PSH groups. CONCLUSION: The expression of apoptotic genes in the intestinal tissue of scalded rats increased significantly during early resuscitation stage after burn injury.

Animals↗

[Anti-inflammatory activity and healing-promoting effects of topical application of emu oil on wound in scalded rats].

OBJECTIVE: To investigate the effects of topical application of emu oil on wound healing in scalded rats. METHODS: In 144 male Wistar rats with 10%; total body surface superficial II degree scald treated on a random basis with physiological saline, povidone iodine and emu oil, respectively, the changes of the wound were observed and the wound tissue and blood samples harvested at different times after injury for evaluation of histopathological changes, total tissue water content (measured by wet:dry weight ratios), and tumor necrosis factor (TNF)-alpha levels in the wound tissue and plasma by enzyme-linked immunosorbent assay (ELISA). The general condition of the wound healing was also observed. RESULTS: After application of emu oil, the swelling and effusion of the burn wound were alleviated and evidences of wound infection or adverse effects were not observed. Pathological examination showed that emu oil could alleviate topical inflammation, which was particularly obvious on days 1 and 3 after injury as compared with the other two groups. On day 3 after injury, water content and TNF-alpha level in the tissues was markedly decreased with the application of emu oil (P<0.05), with a significant correlation between their changes (P<0.001) and shortened wound healing time (P<0.05). Pathological examination showed that emu oil could promote epithelialization and differentiation of various epidermal layers. CONCLUSION: Emu oil has topical anti-inflammatory activity in rats with superficial II degree scald, possibly in association with decreased levels of the proinflammatory cytokines in the tissues and can promote wound healing by inhibiting local secondary inflammation.

Administration, Topical↗

[Study on the mechanism of protective effect of oral L-arginine on intestine after scald injury in rats].

OBJECTIVE: To explore the mechanism of protective effect of oral L-arginine (L-Arg) on the intestine after scald injury in rats. METHODS: Sixty-six Sprague-Dawley (SD) rats were randomly divided into three groups: i.e. normal control (N, n = 6, without treatment), oral L-arginine group (A, n = 30, with 1 ml 70 g/L of L-Arg per os 2 times a day from 2 post scald hour (PSH)) on with normal enteral feeding and group B (n = 30, with oral feeding of cold boiled water after scald). The changes in the content of superoxide dismutase (SOD), malondialdehyde (MDA), nitric oxide (NO), endothelin (ET), ET/NO ratio in the intestine and the level of plasma endotoxin (LPS) in portal vein were assessed at 6, 12, 24, 48, 72 PSH. Ileum tissue samples were harvested for pathological examination. RESULTS: The ET content in the intestinal tissue in A group at 6, 12 and 24 PSH (0.80 +/- 0.26 ng/g, 0.75 +/- 0.30 ng/g, 0.63 +/- 0.22 ng/g) was obviously lower than that in B group (1.26 +/- 0.38 ng/g, 1.34 +/- 0.37 ng/g, 0.97 +/- 0.19 ng/g, P < 0.05), but the NO contents in the intestine in A group at the same time points were significantly higher than that in B group (P < 0.01). The ET/NO ratio and the level of plasma endotoxin in A group were significantly lower than those in B group at each time point (P < 0.05 or 0.01). Pathological examination showed that the intestinal mucosal injury in the A group was obviously milder than that in the B group. CONCLUSION: Oral L-arginine was shown to have the effects to ameliorate ischemia reperfusion injury of the intestine and to protect the barrier function of the intestinal mucosa. This might be related to an increase in the NO level in intestinal mucosa resulting in maintenance of a stable ET/NO ratio.

Animals↗

[Experiment study of enteral immuno-nutrition combined with recombinant human growth hormone in treatment of severe scald in rats].

OBJECTIVE: To investigate the effects of enteral immuno-nutrition (EIN) combined with recombinant human growth hormone (rhGH) on nutrition metabolism, immunological function and inflammatory response in rats with severe scald. METHODS: Sixty-four SD rats subjected to 30% total body surface area (TBSA) III degree scalds were randomly divided into EIN and EIN combined with recombinant human growth hormone (EIN+rhGH) groups. Animals of both groups were fed isocaloric enteral nutrition. Nutrition metabolism, T lymphocyte subsets, serum levels of immunoglobulins and inflammatory mediators were determined on the 1, 4, 7 and 10 postinjury day (n=8). Another 8 rats served as controls, and the above-mentioned parameters were also determined. RESULTS: Total protein (TP), albumin (Alb), transferrin protein (TFP), CD3(+), CD4(+), CD4(+)/CD8(+), IgG, IgM and IgA in group EIN+rhGH were slightly higher than those of group EIN (all P>0.05) at all time points after the injury, while CD8(+) slightly lowered (P>0.05). Serum levels of lipopolysaccharide (LPS), interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-alpha) plummeted significantly (P<0.05 or P<0.01)on 4th, 7th and 10th postinjury day compared with group EIN. CONCLUSION: Our findings indicate that EIN combined with rhGH is superior to EIN alone in the early stage of severe scald in rats, not only ameliorate the disturbance in metabolism and immunological function, but also reduce inflammatory response.

Animals↗

[Prevention of scald injury due to intraperitoneal hyperthermic perfusion for far-advanced gastric cancer].

In an attempt to prevent scald injury on the peritoneo-serosal surface due to intraperitoneal hyperthermic perfusion (IPHP) for far-advanced gastric cancer patients, a histamine H2-receptor antagonist, cimetidine, was prescribed for 9 patients. The IPHP treatment was carried out with a closed circuit using a heated perfusate, and intra-abdominal temperature was kept over 44 degrees C throughout IPHP, for 120 minutes. Of 18 patients given IPHP, 9 were administered intravenously cimetidine at a dose of 50 mg/kg just before IPHP (cimetidine group) and the remaining 9 were prescribed IPHP and not given cimetidine (control group). Amounts of exudate and protein from peritoneal cavity and serum histamine were compared between the two groups. The amount of intra-abdominal exudate was 768 +/- 95 ml for 24 hours in the control group, against 408 +/- 75 ml in the cimetidine group. The protein amounts in exudate throughout IPHP were 62.5 +/- 23.5 g in the control group, against 15.9 +/- 5.4 g in teh cimetidine group. Both the exudate and protein amounts were significantly decreased in the cimetidine group, compared with the controls (p = 1.416 x 10(-7), p = 5.358 x 10(-5)). Serum histamine levels in the cimetidine group increased 2.5 to 6.5 fold for over 12 hours after IPHP, compared to those in the control group. These findings suggest that cimetidine suppresses scald injury on the peritoneo-serosal surface by competitive inhibition with histamine. Consequently, histamine originated from the scald region was released into the circulating blood. Thus, cimetidine helped to prevent thermal injury due to the IPHP.

Body Temperature↗

Brown adipose tissue activity and oxygen consumption after scald injury in the rat.

Scald injury (30% surface scald) in the rat caused rapid (1-3 h) and transient decreases in oxygen consumption (VO2 20%), colonic temperature (1.1 degree C), and brown adipose tissue (BAT) thermogenic activity (22%). Three days after injury, VO2 was slightly increased in injured rats, and sympathetically mediated heat production (assessed from the inhibitory effect of a beta-adrenergic antagonist on VO2) was significantly greater than than for controls. At this time, BAT activity (in vitro mitochondrial GDP binding) was 35% higher in injured than control rats. Food intake was inhibited for only 24 h in injured animals, but weight gain was suppressed for at least 3 days. The data indicate that sympathetic modification of BAT thermogenesis may contribute to the changes in metabolic rate and body weight gain after scald injury in the rat.

Adipose Tissue, Brown↗

[The combined modulating effects of cerium nitrate with certain Chinese traditional drugs on altered cell-mediated immunities in scald mice].

Altered cell-mediated immunities (CMI) is one of the important causes of increased susceptibility to infection and, high mortality of burned patients. This paper presents the experimental work on mice with scald injury to restore their altered CMI by local application of cerium nitrate (CE) or systemic administration of Astragalus membranaceus (AM) or Lonicera japonica Thunb (LJT), as well as combination use of these drugs. The proliferative response to Con A and the ability of IL-2 production of murine spleen cells and the delayed hypersensitivity test using DNFB as sensitizer were chosen as the parameters of CMI. Results showed that CMI of untreated scald mice was suppressed to 50-60% of normal control 11 days following scald injury. While either CE used locally or AM or LJT given by oral with different dosages might bring up the depressed CMI to various degrees, near the normal level and some even above normal. When CE was used accompanied with AM or LJT, their effects on restoration of CMI were significantly better than that when any single drug was administered alone.

Animals↗

Acute-phase response to scalding: changes in serum properties and acute-phase protein concentrations.

The time course of changes in the concentrations of individual acute-phase proteins (APRs) in the plasma was examined in the model of rats exposed to a single (sublethal) and repeated (fatal) scalding. These data were interrelated with the rate of survival, plasma volume, corticosterone level, and immunosuppressive potency of the serum. The infliction of a sublethal scalding composing 20% body surface area resulted in an initial 50% reduction of the plasma volume and a severalfold increase of the corticosterone level and immunosuppressive activity of the serum. A subsequent normalisation of these deviations proceeded in parallel with an increased rate of APR synthesis. An early infliction of a second scald was fatal. It led to a 60% reduction of the plasma volume, a lack of plasma APRs, and an additional enhancement of the immunosuppressive activity of serum.

Acute-Phase Proteins↗

A study of the glucocorticoid receptor of the cytosol and nuclei in nonlethally and lethally scalded rats.

The glucocorticoid receptor (GCR) of the cytosol of liver and brain was studied by radioligand binding assay, using [3H] dexamethasone (Dex) as the ligand in lethally and nonlethally scalded rats. As compared with controls, the binding capacity (R0) was decreased and the apparent Kd of [3H] Dex specific binding was increased in both scalded groups. In the lethal group, the R0 is much lower than that in the nonlethal group. In order to determine whether the decrease of R0 was due to the translocation of [3H] Dex-GCR complex into the cell nuclei, the [3H] corticosterone (B) specific binding of the hepatic nuclei was measured by the exchange assay. There was no significant difference between the control and scalded groups. The possible mechanisms and the clinical significance of these changes were discussed.

Animals↗

Tap water scald burns in children.

Tap water scald burns account for 7% to 17% of all childhood scald burns that require hospitalization. Often the burns are severe and disabling. Toddlers and preschool children are the most frequent victims. In 45% of the injuries, the unsupervised victim or peer turned on the tap water; in 28% the cause was abuse. Eighty percent of the homes tested had unsafe bathtub water temperatures of 54 C (130 F) or greater, exposing the occupants to the risk of full-thickness scald with 30-second exposure to hot water. Such burns may be prevented passively by limiting household water temperatures to less than 52 C (125 F). New water heaters could be preset at this temperature and families could be taught to turn down the temperature on existing units.

Accidents, Home↗

Use of cultured human epidermal allografts for the treatment of extensive partial thickness scald burn in children.

In spite of recent progress in burn treatment, the early surgical therapy of partial thickness scald burns in children is still controversial. Early tangential excisions is not easily applicable for these patients because of difficulties in determination of the burn depth and probable physiological derangement after surgery. Hypertrophic scar formation and wound contraction after meshed autografts are other limitations. For these reasons, conservative treatment, not early excision therapy, has been chosen initially for these injuries. We used cultured epidermal allografts for extensive, partial thickness scald burns, during the early post-burn period without escharectomy. Fifty to 100% of the engrafted superficial dermal burns were epithelialized within 7 days. In contrast, untreated identical wounds remained open. Repeated grafting of cultured allografts on unexcised wound granulations of dermal burns also enhanced epithelialization. Long term results showed that hypertrophic scar formation in the mixed superficial and deep dermal burns was reduced when cultured allografts were used. Allografting of the cultured epidermis without surgical excision apparently promoted the rapid regeneration of the partial thickness burns. Procedural complications did not occur. Cultured allografts should be used as an effective and safe biological dressing for partial thickness scald burns in children.

Burns↗