Burns, 4. 291-293 Printed in Great Britain 291

Abstracts CLINICAL STUDIES Burn scar carcinoma A retrospective study of 46 patients with burn scar carcinoma showed that the average time between burning and the diagnosis of cancer was 42 years (range 1.5-75 years). Almost two-thirds of the patients were male. Of 16 patients (35 per cent) who showed or developed metastases, 15 died from the malignancy. The presence or absence of metastases therefore proved to be the most important prognostic indicator. Five patients (11 per cent) developed recurrences after treatment, and of these 3 died from recurrent disease. The 5-year survival figures ranged from 57 per cent for face and neck lesions to 31 per cent for lower extremity lesions. A significant correla- tion was observed between specific treatment and mortality. Although prophylactic node dissections have not generally been recommended, the high percentage of metastases from lower extremity lesions (54 per cent), the poor prognosis associated with such metastases and the low salvage rate with regional node dissection for positive nodes strongly suggest that prophylactic node dissection be considered, especially for lower extremity burn scar carcinoma.

Novick M., Card D. A., Hardy S. B. et al. (1977) Burn scar carcinoma: a review and analysis of 46 cases. J. Trauma 17, 809.

Night clothing burns A review of the records of 678 children with acute Six children who had been exposed to smoke in a burns referred to the Shriners Burns Unit in Boston confined space or had soot or burns on the face were during an 8-year period indicated that flame burns studied in detail because respiratory distress was from a single ignition source (50 per cent) outranked present or anticipated. Those of the patients who scalds (27 per cent) or house fires (12 per cent) as showed a deteriorating respiratory activity were causes of burning. There was no temporal trend in curarized, intubated and mechanically ventilated for the rank pattern. The majority of these single-source at least 48 h. To limit the possibility of the reoccur- flame injuries were severe and involved ignition of rence of stridor or pulmonary oedema extubation clothing. Between 1969 and 1973 night clothes were was delayed until at least 24 h after the cessation of involved in 32 per cent of the accidents. Since 1973, mechanical ventilation, during which period spon- and coincident with formulation of strict federal and taneous respiration occurred against a positive airway state standards for flammability of children’s night pressure. An endotracheal tube small enough to clothing, a dramatic decline in the number of children allow a leak between it and the oedematous mucosa referred with injuries of this type has taken place. It is must be passed to prevent laryngeal damage and probable that the single factor most important to this subsequent subglottic stenosis. The inspired gases decline is lower fabric flammability, but because the should have a high humidity to maintain secretions Boston data may not be representative, corroboration in a fluid form and to keep the endotracheal tube is needed before factors such as altered garment patent. High concentrations of oxygen in the inspired design, fire safety practices at home or changing air were used to compensate for deficient oxygen

patterns of hospital referral can be excluded. McLaughlin E., Clarke N., Stahl K. et al. (1977)

One pediatric burn unit’s experience with sleepwear- related injuries. Pediatrics 60, 405.

Patterns of burn injuries Criteria have been developed to identify the source of an injury with respect to whether a unique causative mechanism is clear or not using both a retrospective review of 1061 charts and a prospective analysis of all accidental injuries to children over a 5-year period. These criteria were then used to diagnose 712 cases of child abuse, of which 43 were burns. There were four specific burn patterns: readily evident were contacts with hot objects, the others were caused by various applications of hot liquids. In these latter cases the position of the body at the time of burning could be precisely detected by analysis of the depth, configuration, distribution of the burns and the reciprocal relation to flexion creases and joints of the spared areas.

This information is a powerful tool for assessing the truth of the history presented by the child’s guardian when considering a diagnosis of child battering.

Lenoski E. F. and Hunter K. A. (1977) Specific patterns of inflicted burn injuries. J. Traltma 17,842.

Respiratory tract injuries