Injury, 8, 74-76
Detection of Pseudomonas
The authors describe an immunofluorescent method for the detection of Pseudonlonas aeruginosa in sputum which may have advantages over cultural methods. Sands R. L. and Green 1. D. (1975) A note on the use of immunofluorescent methods for the detection of Pseudomonas aeruginosu in bronchitic sputum. J. C/in. Pathol. 28, 997. Tetanus antitoxin
The number of people who developed tetanus in the United States fell from 206 in 1965 to 95 in 1971. The case papers of these patients were analysed to determine the effectiveness of antitoxin in treatment. There was a case fatality rate of 78 per cent without serotherapy and 62 per cent with antitoxin. This reduction with the use of antitoxin is statistically significant, although not enough to put serum into the category of a major therapeutic agent. There was no difference in the effectiveness of equine antitoxin and human tetanus immune globulin. There was some evidence that 500 units of TIG was just as effective as the recommended dose (3OOC-10000 units). In the treatment of tetanus, therefore, it is much more important to rely on skilful sedation, maintenance of respiration, control of spasms and prevention of pneumonia. Blake P. A. et al. (1976) Serologic therapy of tetanus in the United States 196551971. JAMA 235, 42. Burns Plasma biotin levels The concentration of biotin in the plasma was measured in 9 children, aged between 13 months and 9 years. who had suffered burns or scalds involving 12150 per cent of the body surface. The concentration of biotin in 20 control samples of plasma was 1.261_ 0.38 nM/l (mean*s.d.). Lower concentrations were found in 8 of the 9 injured children and the mean level was significantly below the control value. The reason for the difference is not known. Barlow G. B., Dickerson J. A. and Wilkinson A. W. (1976) Plasma biotin levels in chidren with burns and scalds. J. Clin. Pathol. 29, 58.
Fluid balance in burns
Estimations of the physiological spaces of red cells, sodium and albumin after experimental burning in animals. Leape L. L. (I 972) Kinetics of burn oedema formation in primates. Ann. Surg. 176, 223. Epidemiology
Environment has long been accepted as a major factor in the cause of burns, and the role of the open fireplace, boiling liquids in the kitchen, inflammable nightdresses and certain industrial situations have been well documented. It is not so commonly appreciated that there is a type of patient that is often prone to burns. More than half of the I55 patients admitted to the burns unit of the Peter Bent Bingham Hospital in Boston, USA showed a clear predispostion to injury by burning. Not only were these people more prone to this type of injury, they were more likely to suffer extensive burns and to succumb to the injury. The authors identified several predisposing factors. The taking of drugs, of which alcohol was by far the most frequent, was most common. Degenerative vascular disease, including cerebrovascular accidents and acute coronary occlusion, was next in frequency, followed closelv by senility. chronic neurological disease (mainly- epilepsy with absent warning aura) and chronic mental illness. Women showed a greater predisposition to injury than men, especially in the group with major burns. Recognition of this predisposition should lead to preventive measures, particularly in institutions for handicapped people. MacArthur J. D. and Moore F. D. (1975) Epidemiology of burns: the burn-prone patient. JAM.4 231, 259. Organization prevention
Donation of kidneys
A review of the results now obtainable from the various types of kidney transplant using live donors or cadavers. For those concerned in the care of the injured, the important lesson is that in the UK about 2000 patients a year need transplants but only 500 receive them. Leading Article: British Medical Journal (1975) Donation of kidneys. Br. Med. J. 3, 556.