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The American Burn Association, only 5 years old, is a unique organization in that it includes the entire team of personnel interested in the problems of burns.

During the latter part of the Korean conflict a survey of patients who had abdominal injuries and were admitted to the 46th Mobile Army Surgical Hospital showed a mortality of 8.85 per cent. The average evacuation time was 3.1 hours and the time from injury until operation was 6.3 hours. In a comparable group during World War II the case fatality rate was 20.51 per cent. The fatality rate among patients who had thoracoabdominal injuries was 13.1 per cent as compared with 27 per cent in World War II. Several factors were responsible for this reduction in mortality. The surgical technics employed were essentially the same as those used in World War II but the stable tactical situation in Korea permitted better organization for surgical care and a longer period of postoperative observation. The availability of an adequate number of trained anesthesiologists and anesthestists, together with modern antibiotic therapy, was undoubtedly of assistance in decreasing the mortality. Two of the most effective factors in decreased mortality, however, seemed to be early restoration of blood volume and utilization of larger quantities of whole blood.

CHRONIC renal failure so severe that maximum medical management fails to accomplish renal compensation continues to be a common and discouraging clinical problem. The search for effective means of augmenting renal function has been directed largely toward renal homotransplantation and chronic extracorporeal hemodialysis.1 To date, chronic intermittent extracorporeal hemodialysis has proved to be the more successful method of management of these patients.1 2 3 Attempts to improve the effectiveness and lessen the expense of a program of chronic dialysis have prompted an investigation of extracorporeal lymph dialysis. During the last two months the daily collection, dialysis and reinfusion of the lymph of . . .

Most authorities agree that there is a basic association between benign breast lesions and malignant disease. Therefore, early differential diagnosis by careful palpation, roentgenography, transillumination, exfoliative cytology and biopsy is extremely important.Cystic disease of the breast is the most common pathologic condition encountered, accounting for 45 per cent of all breast diseases. Plasma cell mastitis and comedomastitis tend to occur in older women and to imitate carcinoma. Prompt biopsy is the safest mode of action.

Use of the Stryker frame in the care of the severely burned patient greatly facilitates nursing care, permits frequent change of position and increases the comfort of the patient. The use of a new burn dressing, semielastic gauze bandage, irrigating hand table and plastic intravenous needle, are worth while practical technics in the care of the burn patient.

Es wird uber tierexperimentelle Versuche zur Beeinflussung der Wasser- und Natriumretention nach Verbrennungen berichtet. 25 Hunden wurde eine drittgradige Verbrennung von 30% der Korperoberflache zugefugt. Vor und nach der Verletzung wurden Aufnahme und Ausscheidung von Wasser und Natrium gemessen und aus zweitagigen Durchschnittswerten Veranderungen des Flussigkeits- und Elektrolythaushalts errechnet. 1. Bei den Kontronlltieren wurde eine betrachtliche Zunahme der Retention von Wasser und Natrium nach der Verbrennung festgestellt. 2. Nur wenig geringer war die Wasser- und Natriumretention nach Behandlung mit einer 5%igen Mannitollosung. 3. Die Wasserretention bei den mit einer 4%igen Harnstofflosung behandelten Hunden lag nach der Verbrennung nur wenig uber dem Ausgangswert. 4. Rheomacrodex (niedrigmolekulares Dextran) in 10%iger Losung bewirkte eine deutliche Verminderung der Natriumretention. Hinsichtlich einer Beeinflussung der Wasserretention war ihm Harnstoff uberlegen.

The care and maintenance of catheters as well as problems which effect flow determine the effectiveness and life of the cannulation. The one-way flow design and Hepacone plating of the venous catheter has substantially reduced the problems of clotting and bacterial growth. The irrigatable tip has reduced the incidence of clotting in the thoracic duct cannula. A large increase in erythroctye levels in the lymph resulting from febrile periods or minor surgical procedures may still cause clotting. Increasing the anticoagulant concentrations via the irrigating catheter can control this problem. Loss of flow caused by the development of collateral channels can be corrected by location of the collateral with a retrograde lymphangiogram and a minor surgical procedure. Stabilization of the catheters with a skin exit button which provides a bacterial seal at the point of exit and careful attention to sterile technics in handling of the catheters will substantially decrease problems of infection and increase the life of the equipment and cannulation.

A series of 100 consecutive victims of cardiopulmonary arrest were evaluated for treatment in the field by paramedic teams and for the patients' subsequent course. Analysis of the data correlated success rates with specific factors, including response, treatment and transportation times, proximity to the emergency center, establishment of an intravenous line and administration of drugs, pulmonary aspiration of gastric contents, cardiopulmonary resuscitation by a bystander, cardiopulmonary arrest in the presence of the team, and other factors. Successful resuscitation was accomplished in 24% of cases, and 7% of the victims ultimately returned to their previous lifestyles. Therapeutic maneuvers which prolonged time at the scene worsened prognosis. These results were compared to recent reports from other institutions with specific reference to differences in technique regarding success rates. Although the basic policy of "rush the patient to the hospital" of past years has shifted to one of evaluation, emergency treatment and stabilization at the scene before transportation, the data suggest that specific guidelines consistent with the urgency of the situation are necessary to maximize the patient salvage rate.

Summary If the patient with an electrical injury survives the initial shock, he will usually have more tissue damage than is generally expected. Too frequently he is treated for burn injury, although his injury is more like a crush injury and should be treated accordingly.

During the past 10 years significant advances have been made in the treatment of burns. Modern concepts of therapy are based on a more thorough understanding of the physiological derangements that occur after burning. APPRAISAL OF THE BURNED PATIENT The magnitude of injury is based upon two principal factors, extent of injury and depth of burn. The extent of burn is usually expressed as the percentage of the total body surface area. For many years, Berkow's table was used as a guide for estimating the percentage of body surface burned. A modification of this table by Tennison and Pulaski into the "rule of nines" has been employed recently (see figure).1 For children, the extent of burn should be increased for the head and trunk and decreased for the extremities. Burns are usually divided into three categories based on depth: first degree, second degree, and third degree. A first degree burn

• Evidence of gastrointestinal (usually duodenal) ulceration was seen in 20 out of 1,000 patients hospitalized for burns over a period of 78 months. The ulceration was found at autopsy in 17 of the 80 patients who died; it was accepted as the immediate cause of death in 4. The concentration of uropepsin in the urine was higher in the patients with the more severe burns, and this was associated with high concentrations of pepsin and hydrochloric acid in the gastric juice.

THE ACTIVATION of large quantities of trypsin is considered to be of major importance in the pathogenesis of acute pancreatitis. 1 In animals, 2-5 as well as in patients, 4,6-11 the course of inflammatory disorders of the pancreas has been favorably influenced by an antitryptic agent (Trasylol). It appears that this drug inhibits the formation of trypsin and other proteolytic enzymes. 6 Since in previous investigations use of this compound was followed by a decrease of the mortality in experimentally produced pancreatitis in animals, it could be anticipated to have a prophylactic action as well. 4,12 This study was designed to evaluate the prophylactic effect of its antitryptic activity in dogs which were submitted to experimental pancreatitis. Materials and Methods Adult mongrel fasting dogs weighing approximately 15 kg (33 lb ) were used. In a control series, acute hemorrhagic pancreatitis was produced in 20 dogs by a modified Elliott technique. 13

Because protein for rebuilding tissue cannot be given intravenously, it must be fed orally. After a serious burn, patients require 20 gm of nitrogen per square meter of body surface. Giving high-protein powder between meals or by tube feeding can help make up deficits.

IN a study of victims of the Coconut Grove fire, Cobb and Lindemann1 recorded a high incidence of emotional disturbances soon after burning and concluded that both the psychiatrist and the social w...

One of the prime requisites of adequate initial surgery in war wounds is the removal of all devitalized tissue. When this is accomplished, delayed primary closure can be carried out in four to six days. On the other hand, if devitalized tissue and, especially, dead muscle are allowed to remain, bacterial growth is fostered and local infection, clostridial myositis, septicemia, and even death may ensue. Although adequate debridement of a wound depends to a great extent on the operator's ability to distinguish viable from dead muscle, experienced surgeons differ as to the criteria of greatest reliance. Their criteria are based more on personal impressions of how wounds behave postoperatively than on any direct studies of the muscle tissue itself. Thus, although a surgeon may acquire great skill in debridement by dint of personal experience, it may be difficult for him to explain to the uninitiated the precise reasons why he

It is generally accepted that creatinine produced by endogenous metabolism is derived from muscle creatine and phosphocreatine. The conversion is apparently the result of an irreversible process of normal metabolism which takes place at a constant rate, proportional to muscle mass and independent of muscular exercise.* The daily urinary excretion of creatinine is constant for the individual, ranging from 1.5 to 2.0 gm. for men and from 0.8 to 1.5 gm. for women. This corresponds to approximately 2% of the total body creatine, from which it is derived. This excretion rate is apparently independent of protein ingestion and is considered an index of muscle metabolism. It is not influenced by exercise or urine volume. Decreased creatinine excretion, with concurrent elevation in plasma level, is generally indicative of impaired renal function, since creatinine is freely filterable at the glomerulus. Decreased excretion in the absence of elevated plasma concentration is usually due