Current expectations for survival in pediatric burns.

Background: Conventional wisdom and published reports suggest that children, particularly those younger than 48 months, have higher mortality rates after burns than young adults. However, coincident with refinements in resuscitation, operative techniques, and critical care, survival rates for children with burns seem to have improved. To document this change and to define current expectations, a review of deaths during two 7-year intervals separated by a decade was done.

Treatment of the seriously burned infant.

Infants (younger than 12 months) with large (more than 30%) burns are reported to have poorer chances for survival than older children with similar injuries. However, recent experience with such infants has been positive, prompting a 5-year review of management techniques. The injuries were approached in an organized fashion that included precise fluid support, excision, and biologic closure of full-thickness wounds within 5 days, limited exposure to high inflating pressures (more than 40 cm H2O), weekly replacement of central venous catheters, and intensive nutritional support via the enteral route whenever possible.

Management strategy in purpura fulminans with multiple organ failure in children.

Purpura fulminans (PF), which describes the necrosis of soft tissue secondary to diffuse microvascular thrombosis induced by transient protein C deficiency associated with meningococcal sepsis, is unusual despite the approximately 15000 cases of bacterial meningitis which occur annually in the USA. PF has a reported mortality of 50 per cent secondary to multiple organ failure which commonly accompanies the syndrome and is associated with major long-term morbidity in those who survive. Children who develop multiple organ failure in association with purpura fulminans are difficult management problems and benefit from the unique surgical and critical care resources available in burn centres.

Progress in a Moscow children's burn unit: a joint Russian-American collaboration.

A joint Russian-American paediatric burn programme involving Childrens Hospital No. 9 in Moscow and Project HOPE in Millwood, Virginia emerged from the efforts of burn professionals from both countries in caring for a group of children seriously burned as a result of the train-pipeline catastrophe that occurred in June 1989 in the Ural Mountains. This paper describes the burn unit and its activities during the years 1985-93 and includes: (1) a general description of the physical and administrative structure of the unit; (2) the demography of burn admissions; (3) clinical activities; (4) a comparison of the clinical results of the years before the institution of the combined programme (1985-89) with those achieved during the first 4 years of the combined collaboration (1990-93).

The burn unit as a resource for the management of acute nonburn conditions in children.

Burn units bring together resources to manage large complex wounds, organ failures, and the hypermetabolic response to injury. These resources can also facilitate management of other problems such as purpura fulminans, toxic epidermal necrolysis, staphylococcal scalded skin syndrome, and major mechanical soft-tissue injuries. During a recent 10-year interval 2.

Comparison of the effects of interleukin-1 beta on proteoglycan synthesis by human skin and post-burn normal scar explant cultures.

The effect of interleukin (IL)-1 beta on proteoglycan (PG) synthesis and secretion, into culture medium by normal human skin and post-burn human normal scar using tissue explants in culture, was investigated. Following exposure of different tissues to labeling with Na2[35SO4] in the presence and absence of IL-1 beta, the extractable [35SO4]PG (isolated from 0.15 M NaCl and 4 M Gdm.

Initial experiences with surgical treatment of deep burns at a USSR children's burn unit.

Thirty-eight consecutive children with deep burns who underwent early burn wound excision and grafting are reported from the 6th Surgical Department and the All-Union Pediatric Burn Center, Children's Hospital no.9, Moscow, USSR. Early excision represents a radical departure from previously employed expectant treatment.

Proteoglycan synthesis in human skin and burn scar explant cultures.

The synthesis of proteoglycans (PG) by normal human skin, and normal and hypertrophic scars were compared using tissue explants in culture. Newly synthesized PG were labelled with [35S]Na2SO4. Significant differences were found in the proportion of [35S]-radio-labelled incorporation of PG in the tissue and accumulation of [35S]PG in culture medium in the different tissues.

Burned children from the Bashkir train-gas pipeline disaster. II. Follow-up experience at Children's Hospital 9, Moscow.

A group of US surgeons and nurses was invited by the Soviet surgeons and nurses of the Burn Unit of Childrens Hospital 9 to return to Moscow to participate in the evaluation and treatment of a group of 25 children burned in the Bashkir train-gas pipeline accident of 4 June 1989. The US group had participated in the acute care of the children 7 months before. Major sequelae observed were hepatitis, cardiomyopathy and severe emotional disorders.

Burned children from the Bashkir train-gas pipeline disaster. I. Acute management at Children's Hospital 9, Moscow.

Following the Bashkir train-gas pipeline disaster of 4 June 1989, US surgeons and nurses had an opportunity to join their Soviet counterparts at the Burn Unit at Children's Hospital 9 in Moscow in caring for the children. As a result of the joint effort, both the Soviet and US professionals came to understand the strengths and limits of each system of burn care. Joining strengths through mutual willingness to listen and cooperate left an elevated level of burn care at Children's Hospital 9.

Cultured epithelial autografts for giant congenital nevi.

Eight pediatric patients with giant congenital nevi confluent over 21 to 51 percent body surface area were treated by excision and grafting. The nevus was excised to the muscle fascia, and the open wound was grafted with cultured epithelial autografts and split-thickness skin grafts. The patients have been followed from 17 to 56 months.

A multivariate analysis of determinants of survival for patients with squamous cell carcinoma of the head and neck.

The prognosis for patients with squamous cell carcinoma of the head and neck remains poor, despite refinements in conventional therapy and experimental protocols using alternative treatment modalities. Clinical characteristics reported to influence survival have included age and sex of the patient, the therapy used, location of the primary tumor, and stage at initial presentation. However, such variables are highly correlated, and previous reports have lacked sufficient statistical analysis to assess the independent influence of these competing variables on survival.

Significant reductions in mortality for children with burn injuries through the use of prompt eschar excision.

During the past 19 years, mortality due to burn injuries has markedly declined for children at the Boston Unit of the Shriners Burns Institute (SBI), dropping from an average of 9% of SBI admissions during 1968-1970 to an average of 1% during 1981-1986. Detailed statistical analysis using logistic regression was necessary for determining whether this decline in mortality was explained by changes in patient characteristics, such as age or burn size, which are known to strongly influence the outcome of burn injuries. This dramatic decline in mortality during the past 19 years was not the result of change in the age of the patients or their burn sizes; rather, it may be attributed to improvements in burn care.

Squamous cell carcinoma of the head and neck at the Massachusetts General Hospital: a comparison of biologic characteristics in men and women.

Little is known about the biologic behavior of squamous cell carcinoma of the head and neck in women. A few recent reports for selected sites have suggested that these tumors may be becoming more common in women. To evaluate potential differences between males and females with squamous cell carcinoma of the oral cavity, oropharynx, and hypopharynx and to assess whether the proportion of females with this disease is increasing, the authors have undertaken a retrospective review of 542 consecutive patients treated at our institution from 1962 through 1976.

Management of toxic epidermal necrolysis in a pediatric burn center.

Toxic epidermal necrolysis (TEN) is an acute severe exfoliative skin and mucosal membrane disorder with a clinical picture similar to a total-body scald injury. Toxic epidermal necrolysis shares features with severe erythema multiforme seen in Stevens-Johnson syndrome, and is thought by some to be a maximal expression of this syndrome. Drug-related TEN is uncommon in children.

Clinical behavior and results of current therapeutic modalities for squamous cell carcinoma of the buccal mucosa.

A retrospective analysis of 28 patients who received therapy for squamous cell carcinoma of the buccal mucosa at the Massachusetts General Hospital from January 1962 through December 1976 is presented. The patients ranged in age from 42 to 78 years; the majority of patients presented with disease at 50 years or more. The proportion of females in this series (43 per cent) represented a dramatic increase compared with previous reports from other large centers.

Squamous cell carcinoma of the alveolar ridge and palate. A 15-year survey.

A retrospective review of 82 patients treated at the Massachusetts General Hospital from 1962 through 1976 for squamous cell carcinoma of the maxillary and mandibular alveolar ridge and soft and hard palates is presented. Stage at first presentation, clinical features of the disease, analysis of current therapeutic modalities, survival statistics, and prevalence of second primary malignancies are analyzed and compared with reports from other large centers.

Squamous cell carcinoma of the tongue: a comparison of the anterior two thirds of the tongue with its base.

A retrospective analysis of 176 patients with squamous cell carcinoma of the tongue has been reported. The tongue base and mobile tongue, believed to behave as two clinically distinct anatomic areas, have been compared and contrasted. Women comprised 25 percent of the patients with tumors of the base of the tongue and 45 percent of those with mobile tongue lesions, an increase over previous reports for both locations.

Squamous cell carcinoma of the mobile tongue. Clinical behavior and results of current therapeutic modalities.

A retrospective review of 122 patients who received therapy at the Massachusetts General Hospital for squamous cell carcinoma of the mobile tongue from January 1962 through December 1976 was analyzed for clinical patterns of behavior and results of current therapeutic modalities. The results were compared with a previously reported series from our surgical service. Our series showed a dramatic increase in the proportion of women with carcinoma of the tongue from the 10 to 30 percent distribution reported 20 to 30 years ago to the 45 percent female to male ratio we observed.

Intra-oral cancer at the Massachusetts General Hospital. Squamous cell carcinoma of the floor of the mouth.

A retrospective review of 163 consecutive patients with biopsy-proven, invasive squamous cell carcinoma of the floor of the mouth who underwent inpatient treatment at the Massachusetts General Hospital during the 15-year period from January 1962 through December 1976 is presented. The stage at first presentation, clinical features of the disease, incidence of second primary tumors, analysis of therapeutic modalities, and survival statistics are compared with reports from other large centers. Floor of mouth tumors comprised 28%, (163/592) of oral squamous cell carcinomas seen at the Massachusetts General Hospital during that time period.

Justinian II and Carmagnola: a Byzantine rhinoplasty?

The Carmagnola statue, although undoubtedly a Byzantine Emperor, still holds its secret as to who it actually represents, and how his nose got that way. Our tentative conclusions concerning the possibility of Justinian's Indian nasal reconstruction only raise other questions. If Justinian Rhinometos did have a nasal reconstruction, how was the knowledge of the technique transmitted from northern India to the Byzantine Empire by the end of the 7th century? And if Justinian did have his "rhinokopia" surgically corrected, would this represent the first case of nasal reconstruction in the western world, 900 years before the triumphs of Tagliacozzi?

External fixation of endotracheal tubes while skin grafting severe burns of the face.

The use of an external cranial device for endotracheal tube fixation can prevent mechanical dislodgement of skin grafts and permit easy access while one is operating on extensive burns of the face.

Forehead flap for reconstruction after ablative surgery for oral and oropharyngeal malignancy.

The forehead flap is a reliable means of bringing viable lining to the oral and oropharyngeal cavities after composite resections for cancer in locally radiated areas. We discuss the complications and results of such reconstructions.