Toxic epidermal necrolysis is a rare condition involving the skin at the dermoepidermal junction, with possible inclusion of mucous membranes. The condition is associated with systemic toxicity and high mortality rates. Successful treatment requires optimization of local as well as systemic therapy. We report the case of a young woman who developed toxic epidermal necrolysis, possibly resulting from lamotrigine therapy. Local therapy included a combination of a biological cover and alginate together with a synthetic cover (Aquacel Ag®).
- Publikační typ
- časopisecké články MeSH
The aim of our study was to retrospectively evaluate the epidemiological characteristics of patients with high voltage electrical injury from 1999 to 2009. The Clinic of Burns and Reconstructive Surgery, Faculty Hospital Brno is located in a region of 2,505,000 inhabitants. In total 13,911 patients (including both children and adults, and outpatients as well as hospitalized patients) were treated at our burn center during the period of study. Of these patients, 1,030 were hospitalized for burns treatment. For the purposes of this study, we have included only patients with high voltage electrical trauma, of which there were 58, 2 of whom were female. Basic epidemiological indicators were gathered on these patients, including age, gender, place of accident, extent of trauma, mortality and whether the injury was occupational or non-occupational. Electrical burns (caused by both low-voltage and high-voltage electric current) made up 1.10% of all burns treated in our burn center and high voltage electrical injuries represented 0.42% of all burn injuries. The average incidence of high voltage electrical trauma was 0.21 cases/100,000 inhabitants. The average age of the patients was 28.59 years. Nine patients died and the mortality was fixed at 15.52%. The average length of hospitalization was 53.43 days. The average extent of burnt area was 35.01% TBSA. In our study, we were able to define the basic epidemiological parameters in 58 patients with high voltage electrical trauma. We also have to highlight the still disappointingly high number of non-occupational electrical injuries affecting those in the lower age groups, especially children. However, preventive programmes for educating specific risk groups have shown positive results.
- Publikační typ
- časopisecké články MeSH
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.
- MeSH
- délka pobytu MeSH
- dítě MeSH
- jednotky intenzivní péče pediatrické statistika a číselné údaje MeSH
- kojenec MeSH
- lidé MeSH
- mladiství MeSH
- popálení epidemiologie etiologie MeSH
- popáleninové jednotky statistika a číselné údaje MeSH
- předškolní dítě MeSH
- rizikové faktory MeSH
- rozložení podle pohlaví MeSH
- úrazy v domácnosti statistika a číselné údaje MeSH
- věkové rozložení MeSH
- Check Tag
- dítě MeSH
- kojenec MeSH
- lidé MeSH
- mladiství MeSH
- mužské pohlaví MeSH
- předškolní dítě MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Česká republika MeSH
Aim. The aim of this work is to determine the incidence of ventilator-associated tracheobronchitis (VAT) and ventilator-associated pneumonia (VAP) and to define the define the most important respiratory pathogens in patients with inhalation injury. Introduction. Infectious complications in severely burned patients present serious problems. Patients with inhalation injuries are exposed to greater risk owing to the possible development of infectious complications in the lower respiratory tract. VAP is the predominant cause of death in these patients. This is due to the increasing resistance of strains of Gram-negative bacteria such as Pseudomonas aeruginosa, Acinetobacter baumannii, and Klebsiella pneumoniae. Design. Retrospective, monocentric. Setting. A five-bed burn intensive care unit. Material and methods. Between 2004 and 2009, 348 adult patients were hospitalized in the intensive care unit of the Department of Burns and Reconstructive Surgery, Brno University Hospital, Czech Republic. Of these, 127 (36.49%) were diagnosed by bronchoscopy as having inhalation injury. The prerequisite for inclusion in the cohort was an inhalation injury requiring artificial ventilation for at least 48 h. The lower airway microbiological condition was monitored regularly by sampling biological material for cultures (sputum, tracheobronchial aspirates, etc.). For the diagnosis of VAP and VAT we used the Centers for Disease Control and Prevention criteria and the Clinical Pulmonary Infection Score. Results. The average age of the 127 patients (31 women/96 men) included in the study was 38.4 yr (range, 21-69 yr) and the average total body surface area (TBSA) burned was 29.3% (range, 2-75%). The average length of hospital stay was 49.4 days (range, 4-150 days) and the duration of mechanical ventilation 8.7 days; 18 patients (14.2%) died. In patients with inhalation injury, 309 strains of bacteria were cultivated from the lower respiratory tract, of which 234 were Gram-negative. All of these bacterial strains were isolated in significant quantities for lower respiratory tract infection. The most common bacteria isolated from the lower respiratory tract was Klebsiella pneumoniae (78 times), followed by Pseudomonas aeruginosa (49x), and Acinetobacter baumannii (28x). VAT was diagnosed in 109 patients (85.8%) in the cohort. The incidence of VAT was calculated to be 98.8 per 1000 days of mechanical ventilation. VAP was diagnosed in 34 patients in the cohort (26.8%). The incidence of VAP was calculated as being 30.8 cases per 1,000 days of mechanical ventilation. In eight patients (23.5%), VAP was diagnosed within 5 days of initiation of mechanical ventilation (early onset) and in 26 patients (76.5%) after a longer period (late onset). The most common aetiological agent of VAT and VAP was Klebsiella pneumoniae (respectively 41.3% and 35.3%). Conclusion. In this study we were able to determine the incidence of VAP and VAT in patients with inhalation injury. In spite of the advances in diagnostics and therapy, inhalation injury is still burdened with disappointingly high morbidity and mortality rates. For this reason, the treatment of VAP remains a major challenge for all physicians caring for patients with inhalation injury.
- Publikační typ
- časopisecké články MeSH
- MeSH
- dítě MeSH
- kvalita života MeSH
- lidé MeSH
- popálení komplikace psychologie MeSH
- sociální izolace psychologie MeSH
- životní styl MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- Publikační typ
- kongresy MeSH
V letech 1999–2005 bylo na pracovišti Kliniky popálenin a rekonstrukční chirurgie Fakultní nemocnice v Brně hospitalizováno pro úraz elektrickým proudem o vysokém napětí celkem 41 pacientů, což činilo 6,06 % počtu všech pacientů léčených na popáleninové JIP pro rozsáhlé popáleninové trauma. Průměrný věk pacientů s těžkým elektrotraumatem byl 27,29 let. Nejmladší pacient byl ve věku 9 let, nejstarší ve věku 64 let. V letech 2001–2005 bylo na brněnském popáleninovém pracovišti ošetřeno celkem 8 695 popálených pacientů (dětí i dospělých). Pacientů s úrazem elektrickým proudem bylo léčeno celkem 46 , což činí 0,53 % všech léčených pacientů s popáleninovým traumatem. Úrazů elektrickým proudem o vysokém napětí bylo léčeno 27, což činí 0,31 % pacientů léčených v letech 2001–2005 na brněnském popáleninovém pracovišti. Zůstává otázkou, zda část poraněných elektrickým proudem o nízkém napětí není ošetřena na jiných pracovištích našeho regionu. Příspěvek jasně ukazuje hrozivý počet případů nepracovních úrazů elektrickým proudem o vysokém napětí v prostředí železnice, postihující především nejmladší věkové skupiny – mladistvé a děti.
Between 1999 and 2005, a total of 41 patients were hospitalized at the Burn Centre of Brno University Hospital with high voltage electrical injuries, representing 6.06% of the total number of patients treated at the Burn Intensive Care Unit (ICU) for extensive burn trauma. The average age of patients with serious electrotraumas was 27.29 years. The youngest patient was 9 years old, the oldest 64 years. Lethality amounted to 17.07% of the total number of patients. The article clearly shows the sinister dimension (a frighteningly high number of cases) of high voltage electrical injuries suffered outside work context in the vicinity of railway tracks and affecting in particular the youngest age groups – children.
