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Background: When combustion and ambustion induce a superficial injury, they are summarized as superficial burns, regardless of the underlying cause. Reflectance-confocal microscopy (RCM) allows noninvasive imaging of the human skin on morphological features. We hypothesized that combustion and ambustion have different histomorphological effects on the human skin. Methods: Superficial burns caused by combustion (CO-group, five females, three males; aged 26.8 ± 14.2 years) and caused by ambustion (AM-group, four females, four males; aged 28.1 ± 13.8 years) were evaluated 24 h after injury. The following parameters were obtained using RCM on injured and noninjured (control) site: horny layer thickness, epidermal thickness, granular cell size, basal layer thickness. Results: Compared with the controls (12.8 ± 2.5 μm), horny layer thickness decreased significantly to 10.6 ± 2.1 μm in the CO-group, whereas it increased significantly to 17.8 ± 2.8 μm in the AM-group. The epidermal thickness did not differ significantly in CO-group (47.9 ± 2.1 μm) and AM-group (49.0 ± 3.1 μm), however, both increased significantly compared with the controls (42.7 ± 1.6 μm). The basal layer thickness increased more in AM-group (17.0 ± 1.2 μm) compared to CO-group (15.4 ± 1.1 μm). Both differed significantly compared with their controls (13.9 ± 0.9 μm). The granular cell size increased significantly in both groups ompared to the controls (721 ± 42 μm), however, a significantly higher increase was observed in CO-group compared to AM-group (871 ± 55 μm vs. 831 ± 51 μm). Conclusions: RCM evaluates significant histomorphological differences in superficial burns caused by combustion and ambustion. The term 'superficial burn' should consider the underlying cause and thus supplemented by the term 'combustion' or 'ambustion.' Microsc. Res. Tech., 2010. © 2009 Wiley-Liss, Inc. [ABSTRACT FROM AUTHOR]

Background: Mortality in burn patients has several contributing factors as sex, age, degree of burns, or inhalation injuries. Usefulness of Candida antigen (CAG) titer is still being under debate to predict mortality. This study assessed correlation between CAG titer and mortality in burn patients., Methods: From 1988 to 2011, 877 burn intensive care patients were evaluated for age, sex, total burn surface area (TBSA), multi organ failure (MOF), burn depth, escharotomy, fasciotomy, antibiotic use, co-morbidities, CAG titer and intubation., Results: From 870 admitted patients, 190 patients were not enrolled. Increasing age was correlated with a higher mortality. The abbreviated burn severity index (ABSI) score of the deceased was 4 points and the TBSA was 20% higher than the survivors. The correlation for age, intubation, TBSA, inhalation injury, MOF, CAG titer, antibiotic use and escharotomy was significant. An increasing mortality was noted with antibiotic use and a CAG titer of 1:8 and higher. CAG titer of 1:8 and higher had a sensitivity of 51.1% and specificity of 86.3% for mortality. Multivariate analysis confirmed high influence of older age, MOF, comorbidities, antibiotic use and CAG titer of 1:8 and higher on mortality. There was a significant correlation for sex, younger age and CAG titer., Conclusion: CAG titers of 1:8 and higher might warrant beginning of antimycotic treatment in elderly patients with high TBSA to avoid increase in mortality., Competing Interests: The authors declare no conflict of interest.

Self-immolation constitutes a rare form of suicide in developed countries, though it accounts for unique injury characteristics in the burn intensive care unit. The aim of this study was to present the epidemiological and clinical features of patients burned during a suicidal attempt seen in a North Rhine-Westphalia burn intensive care unit (BICU). To address this aim, we undertook a 21-year retrospective study involving patients with thermal injuries admitted to the largest burn unit in Germany. A total of 125 suicide-related burn victims were identified in the study period (9.4%). Comparing the self-immolation group with the rest burn patient cohort, suicide victims were more likely to be single and to act under the influence of alcohol. The suicidal group had a larger extent of burns, higher incidence of inhalation injury, required more surgical procedures, catecholamines, blood transfusions, and a longer BICU stay. Their clinical course was complicated by prolonged intubation period, higher rate of multiple drug-resistant bacteria acquisition and sepsis, leading to a higher mortality rate. Although the proportion of self-immolation victims among all burned patients is not high, the markedly higher severity of their burns and their poorer quality of outcomes makes them an important clinical subgroup for further study.