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Ääriolosuhteissa saunavammoja voi aiheutua kontaktin ja kuuman ilman lisäksi myös vesihöyryn syrjäyttäessä hapen. Saunomisen MM-kisoissa vuonna 2010 oletettavasti nimenomaan hapenpuute esti vaarallisten merkkien havaitsemisen ja saunojat jäivät saunaan kriittisiksi viimeisiksi minuuteiksi

Plasma NGAL predicts early acute kidney injury no earlier than s-creatinine or cystatin C in severely burned patients

Introduction: Neutrophil gelatinase-associated lipocalin (NGAL) is a novel biomarker used in acute kidney injury (AKI) diagnostics. Studies on burn patients have highlighted it as a promising biomarker for early detection of AKI. This study was designed to discover whether plasma NGAL is as a biomarker superior to serum creatinine and cystatin C in detecting AKI in severely burned patients. Methods: Nineteen subjects were enrolled from March 2013 to September 2014 in the Helsinki Burn Centre. Serum creatinine, cystatin C, and plasma NGAL were collected from the patients at admission and every 12 h during the first 48 h and thereafter daily until seven days following admission. AKI was defined by acute kidney injury network criteria. Results: Nine (47%) developed AKI during their intensive care unit stay and two (11%) underwent renal replacement therapy. All biomarkers were significantly higher in the AKI group but serum creatinine-and cystatin C values reacted more rapidly to changes in kidney function than did plasma NGAL. Plasma NGAL tended to rise on average 72 h perpendicular to 29 h (95% CI) later in patients with early AKI than did serum creatinine. Area-under-the-curve values calculated for each biomarker were 0.92 for serum creatinine, 0.87 for cystatin C, and 0.62 for plasma NGAL predicting AKI by the receiver-operating-characteristic method. Conclusion: This study demonstrated serum creatinine and cystatin C as faster and more reliable biomarkers than plasma NGAL in detecting early AKI within one week of injury in patients with severe burns. (C) 2015 Elsevier Ltd and ISBI. All rights reserved.Peer reviewe

Resuscitated unconscious male : Lichtenberg's sign lighting the way

Non peer reviewe

Hospitalized burns in Finland : 36305 cases from 1980-2010

To analyse the epidemiology of burns in Finland, a comprehensive study was conducted among all hospitalized burn patients between 1980 and 2010. All patients with burn injury as the main diagnosis, 36305 cases in total, treated in the public and private sectors, were included. Patient data were obtained from the Finnish Hospital Discharge Register (FHDR). The incidence of hospitalized injuries declined from over 30 to 17 per 100000 persons. Men were at higher risk than women in all age groups. Children aged under ten years were overrepresented throughout the period and the highest incidence was found among one year old boys. The median total length of stay shortened from seven days in 1980-1995 to five days in 1996-2010. The annual number of hospitalized patients is recently under 1000 cases (17/100000). The male predominance (70%) did not change but the age group with the most injuries shifted from 20-39 years to 40-59 years. Injuries were most common during the summer months. This study of all hospitalized burn injuries of one entire country shows similar tendency of diminishing numbers and rising age of burn victims as in other western countries. The FHDR is a reliable source of data in epidemiological studies but precise recording of E- and N-codes in the registry would enable the accurate analysis of types and extent of injury. (C) 2017 Elsevier Ltd and ISBI. All rights reserved.Peer reviewe

Occupational burn injuries in Finland 2011-2015

Background This study comprises all hospitalized work-related burn injuries in one country during 2011-2015. The purpose was to describe demographics, causes and risk factors of occupational burn injuries with special focus on the outcome of return to work. Material and methods This is a retrospective study on two data sources of which Finnish Workers' Compensation Center's (FWCC) register includes all work-related burn cases at a given time. Additional data have been obtained from those patients, who were referred to the National Burn Centre (NBC) during the same time according to the Emergency Management of Severe Burns (EMSB) criteria. We compare demographics, injury mechanisms and general burn data of these two patient groups. Results Based on FWCC register, in 2011-2015 occurred 11,623 work-related burn cases of whom 54% were men. During the study period, NBC admitted 26 patients fulfilling EMSB criteria. The most severe patients treated in NBC had injuries affecting multiple body parts. In FWCC data, hand was most injured body part. Kitchen/bakery work was the most common profession in FWCC register but in NBC material industrial and transport professions dominated. In FWCC register, patients had lower mean age (37 years vs. 43 years). Most severe injuries occurred among older patients: In NBC data, those with total body surface area 40% or over had mean age 53 years. Majority of patients returned to work. Conclusion Safety at work in Finland has improved during last decades, and the vast majority of work-related burn injuries are minor. Minor burn injuries are common in young adults working in kitchen and bakery work, whereas elderly men working in transports and industry sustain the most severe burn accidents. Retirement after work-related injury becomes very expensive for all parties, and this data can be used in preventing those cases as well as the minor accidents.Peer reviewe

Long-Term Outcome After Renal Replacement Therapy in Severe Burns

Acute kidney injury is a common sequela after major burn injury, but only a small proportion of patients need renal replacement therapy. In the majority of patients, need for renal replacement therapy subsides before discharge from the burn center but limited literature exists on long-term outcomes. A few studies report an increased risk for chronic renal failure after burn injury. We investigated the long-term outcome of severely burned patients receiving renal replacement therapy during acute burn injury treatment. Data on 68 severely burned patients who received renal replacement therapy in Helsinki Burn Centre between November 1988 and December 2015 were collected retrospectively. Thirty-two patients survived and remained for follow-up after the primary hospital stay until December 31, 2016. About 56.3% of discharged patients were alive at the end of follow-up. In 81.3% of discharged patients, need for renal replacement therapy subsided before discharge. Two patients received renal replacement therapy for longer than 3 months; however, need for renal replacement therapy subsided in both patients. One patient required dialysis several years later on after the need for renal replacement therapy had subsided. This study showed that long-term need for renal replacement therapy is rare after severe burn injury. In the vast majority of patients, need for renal replacement therapy subsided before discharge from primary care. Acute kidney injury in association with burns is a potential but small risk factor for later worsening of kidney function in fragile individuals.Peer reviewe

Silmäluomien korjaava kirurgia

Vertaisarvioitu. Näin hoidan.Silmäluomien useiden toiminnallisesti tärkeiden rakenteiden moitteeton toiminta on terävän näön edellytys. Monet sairaudet, vammat ja ikääntyminen muuttavat silmäluomien anatomiaa ja toimintaa, joita voidaan usein parantaa korjaavalla kirurgialla. Tämä edellyttää alueen anatomian ja eri rekonstruktiotekniikoiden hyvää tuntemusta. Kasvainleikkausten jälkeen silmäluomien eri kerrokset voidaan korjata siirteiden ja kielekkeiden avulla. Luomien virheasennot ja raskaat luomet voidaan korjata kiristämällä löystyneitä rakenteita. Silmän sulkeutumista ja luomien vetäytymistä voidaan korjata kirurgisesti. Julkisen terveydenhuollon piiriin kuuluvat vain toiminnallista haittaa aiheuttavat muutokset

N-Terminal Brain Natriuretic Peptide First Week After Burn Injury

B-type natriuretic peptide has shown promising results as a biomarker for acute kidney injury in general intensive care patients. It may also indirectly reflect fluid balance of the circulation. Among burn patients, it has been observed to indicate excessive fluid resuscitation and organ dysfunction, although its clinical use to indicate acute kidney injury or guide fluid resuscitation has not been validated. The aim of this study was to evaluate whether the N-terminal pro-brain natriuretic peptide values are related to the amount of fluids given after severe burn injury and whether it can act as a novel biomarker for acute kidney injury in these patients. Nineteen consecutive burn patients were included. Plasma N-terminal pro-brain natriuretic peptide was measured daily during 1 week from admission. Other variables such as laboratory values and intravenous infusions were also recorded. The association between acute kidney injury and N-terminal pro-brain natriuretic peptide values was analyzed with a multivariable panel regression model, adjusted for burned total body surface area, age, body mass index, and laboratory values. N-terminal pro-brain natriuretic peptide values varied between single patients, and even more between the patients who developed acute kidney injury. Older age, lower body mass index, and cumulative infusions were independently associated with higher N-terminal pro-brain natriuretic peptide values, whereas acute kidney injury was not. N-terminal pro-brain natriuretic peptide values correlated with cumulative infusions given during the first week. The authors could not validate the role of N-terminal probrain natriuretic peptide as a biomarker for acute kidney injury in burns.Peer reviewe

Impulsiveness and burn patients

Objective: Impulsiveness is a tendency to act quickly based on a whim without reflection or consideration of consequences. We studied its correlations with burn variables and mental disorders among burn patients. Methods: Consecutive acute burn patients (N=107) admitted to the Helsinki Burn Center were assessed with the Structured Clinical Interview for DSM-IV mental disorders (SCID) at baseline and at 6 months. All patients filled out the 30-item Barratt Impulsiveness Scale (BIS-11), the most commonly administered self-report measure and a standard point of reference in research on impulsiveness. Results: The mean total score of BIS-11 was 64.5 (range 41.0-87.8, SD +/- 6.9). There was not a significant correlation between impulsiveness and a range of characteristics of burn injury (all p-values >0.05). We found a significant correlation between some pre-burn mental disorders and impulsiveness, alcohol dependence and attentional impulsiveness (OR=1.22, p=0.022), any personality disorder and non-planning impulsiveness (OR=1.21, p=0.005), and antisocial personality disorder and motor impulsiveness (OR=1.35, p=0.043). Patients with high impulsiveness (total score >65) more often than those with low impulsiveness ( Conclusion: Impulsiveness had a significant correlation with mental disorders but not with burn-related variables. Therefore the role of impulsiveness in burn injuries should not be investigated independently without first accounting for the role of mental disorders. (C) 2018 Elsevier Ltd and ISBI. All rights reserved.Peer reviewe