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A randomized, prospective study comparing the use of Biobrane (group 1) with the use of 1% silver sulfadiazine (group 2) in treating 56 partial-thickness burn wounds was carried out in 52 outpatients with burns that comprised less than 10% of their total body surface area. The two groups were similar in age, gender, race, and extent of burn. Wounds of patients in group 1 (30) were compared with those of group 2 (26) for healing time, pain, compliance with scheduled visits, and costs. Infected and skin-grafted wounds were excluded from healing time analysis. Infection rates of the two groups were similar (three of 30 vs two of 26). One patient in each group underwent skin grafting. Healing times of group 1 wounds were significantly less than those of group 2 (10.6 +/- 0.8 vs 15.0 +/- 1.2 days, P less than .01). Using a pain scale of 1 to 5, Biobrane-treated patients averaged lower pain scores at 24 hours after the burn (1.6 +/- 0.8 vs 3.6 +/- 1.3 P less than .001) and used less pain medication. Compliance with scheduled outpatient visits was also improved in the Biobrane-treated group (88.6% vs 63.2% attendance, P less than .001). Idealized total treatment costs averaged $434 for patients in group 1 compared with $504 for patients in group 2. We conclude that when used on properly selected wounds, Biobrane therapy can significantly decrease pain and total healing time without increasing the cost of outpatient burn care. Improved patient compliance may be an added benefit.

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Branhamella catarrhalis, a common inhabitant of the upper respiratory tract, has been identified recently as a cause of lower airway infection. In this report we present a case of B. catarrhalis pneumonia and bacteremia in a child with smoke inhalation as the first description of invasive disease involving this organism in a traumatized airway. In addition, other pediatric cases of B. catarrhalis bacteremia are reviewed, suggesting immunocompromise as a risk factor.

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A computer-based system was developed to handle information and images in a clinical setting. The system is based on an 80286 AT computer, the topology of which includes a 16-bit color image capture/display graphics adapter and a 256 gray scale 8-bit digital image analysis processor. Using its color capabilities, we have created a picture database of patients' injuries, radiographs, and other relevant clinical data. The computer-based imaging system allows instant access to this information and minimizes subjective evaluation, making comparison of and follow-up of treatments more objective. The image analysis components permit digital characterization of the burn wound, enhancing our ability to quantitatively evaluate wound size, contracture, graft take, and re-epithelialization. This is a cost-effective method of handling information and images in the clinical setting as well as an effective research and teaching tool that facilitates management and follow-up care of the patient with burns.

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A prospective, controlled study of 101 intravascular catheter sites was undertaken to determine the importance of tubing manipulation and skin contamination in the etiology of catheter infection in burned patients. Catheters in place for 3 days were randomized to have the tubing changed every 24 or 48 hours. Catheters were removed at 72 hours and the tips cultured by the semi-quantitative technique of Maki. Hubs were cultured (by swab culture) at times of tubing change and at the time of catheter removal. Skin cultures of the area surrounding the catheter were done at the time of insertion and removal. Catheter tip infection was defined as 15 or more colony forming units. Positive cultures were found in 25.7% of the cases, and were most often due to Pseudomonas species (33%) and coagulase-negative Staphylococcus (29%). Infections occurred in 35% of arterial catheters, 27% of central, and 12% of peripheral venous catheters. No benefit was observed from changing the administration tubing at 24 hours vs. 48 hours. Hub cultures were positive 30% of the time at 24 hours, 39% at 48 hours and 41% at 72 hours. Although the isolated organisms correlated with tip cultures, false positive rates varied from 8 to 62%. Discriminant analysis showed no relationship between catheter infection and burn size or day postburn; however, the incidence of catheter infection correlated inversely with the distance of the catheter insertion site from the burn wound (p = 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

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When used appropriately on superficial or moderate-depth partial-thickness burns, Biobrane significantly decreased total healing time to complete reepithelialization, reduced pain, and was associated with decreased nursing time and costs when compared to 1% silver sulfadiazine cream. Care must be used in selecting wounds for Biobrane therapy. They must be fresh, noninfected, and free of eschar and debris with a moist, sensate surface that demonstrates capillary blanching and refill. Wounds must be inspected regularly for nonadherence and signs of infection. Early fluid accumulation requires prompt aspiration. Biobrane should be removed if fluid reaccumulates or the Biobrane becomes nonadherent at any time after 48 hours. When used appropriately, Biobrane offers significant advantages over conventional therapy of acute partial-thickness burns.

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We examined neutrophil substrate adherence in 19 subjects with burns involving 1%-83% of their body surface area. Within 24 h of injury, neutrophils from burn patients demonstrated a 50% reduction in adhesion to both gelatin and plastic substrates when stimulated with N-formyl-L-methionyl-L-leucyl-L-phenylalanine (FMLP), phorbol myristate acetate, and calcium ionophore A23187. Neutrophil substrate adherence examined as long as two weeks after burn injury remained abnormal. Neutrophils, from burn patients, stimulated with FMLP, phorbol myristate acetate, and calcium ionophore A23187 demonstrated a 51%, 37%, and 45% decrease, respectively, in release of immunoreactive fibronectin compared with control neutrophils. In neutrophils from burn patients there was a 31% reduction in total neutrophil-associated fibronectin compared with controls. The decrement in release and total cellular content of fibronectin in neutrophils from burn patients did not change when reexamined on day 7 after injury. The magnitude and time course of alterations in the cellular content and release of fibronectin correlate with adhesive dysfunction after burn injury.

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A modification of past percutaneous methods for peritoneal lavage is described which combines the safety of the Veress Needle with the utility of a readily available introducer-dilator catheter. The technique has been used in 30 patients seen for blunt abdominal trauma and has been found to be a reliable and accurate method for peritoneal lavage.

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