Burns in adults in Zaria, Nigeria

From 1971 to 1981, 245 adults with burn injuries were admitted to the Ahmadu Bello University Hospital, Zaria. The burns were major in 197 patients, moderate in 28 and minor in 20. Socioeconomic factors contributing to the injuries included the use of wood fires for cooking, for warming the body and the dwelling during the cool harmattan season, loose indigenous garments, thatch-roofed huts, petrol hoarding and epileptic seizures. Flame burns exceeded scalds with a high seasonal frequency in both men and women during the harmattan. Scalds occurred predominantly among the women, puerperal hot baths being a major cause. The overall mortality rate of 22 per cent is excessive. General economic development, architectural improvements, proper handling of petrol and kerosene, modification or abandonment of the puerperal ritual of hot baths, the maintenance of chronic epileptics on anticonvulsants and a programme of universal active immunization against tetanus would contribute to the prevention of burns and complications in adults and decrease the mortality rate.     

Primary hyperparathyroidism in children,adolescents, and young adults

Primary hyperparathyroidism (HPT) is considered a rare disease in children and an uncommon one in adolescents and young adults. Until 1975, only 60 children under the age of 16 years had been reported with proven HPT. Most had symptoms of weakness, irritability, anorexia, and weight loss. Severe hypercalcemia (serum calcium>15 mg/ 100 ml) and radiologic evidence of bone changes were common findings, and suggested delayed diagnoses. This report is based on the clinical and laboratory findings in 53 young patients with proven primary HPT (range: 1–30 years of age) from 1971 to 1980, treated in one hospital. There were 29 male and 24 female patients, 26 of whom developed symptoms before age 18. Common symptoms included hematuria and renal colic (50%), renal calculi (50%), and hypertension with (6%) and without (3%) severe headaches. Although 64.2% of patients had adenomas, only 54% of patients under 18, and as many as 77.8% over 18, had them. The incidence of hyperplasia was markedly increased in the patients under 18 (38%) as compared to the patients over 18 (18.5%) or the group taken as a whole (30.2%). The following associated diseases were identified: MEA I syndrome (4); MEA II syndrome (4); von Recklinghausen's neurofibromatosis; papillary carcinoma of thyroid; craniopharyngioma; and multiple metaphyseal chondromatosis. One child had hereditary neonatal parathyroid hyperplasia. Primary hyperparathyroidism is more common than previously suspected in young people. Symptoms of renal stones, hypertension, persistent headaches, unexplained anorexia, and weight loss should prompt evaluation for primary HPT. If hyperplasia is found, the patient and family should be investigated for associated endocrinopathies.

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Résumé L'hyperparathyroïdie est considérée une maladie extraordinaire des infants et bien rare des adolescents et des jeunes adultes. Jusqu'à 1975, seulement 60 enfants qui avaient moins de 16 ans étaient rapportés avec l'hyperparathyroïdie verifiée. La majorité avaient les symptômes de faiblesse, irritabilité, anorexie et perdu des poids. L'hypercalcémie severe (calcémies > 15 mg/100 ml) et l'évidence radiologique d'abnormalitiés osseux sont les conclusions ordinaires, et cela donne l'idée que le diagnostic était tard.Ce rapport présente les données cliniques et du laboratoire de 53 malades jeunes avec l'hyperparathyroïdie vérifiée (1–30 ans) pendant dix ans entre 1971 à 1980 qui ont reçu les traitements dans le même hôpital.Vingt-neuf étaient mâle; 24 étaient female. Vingtsix ont developés les symptômes avant qui avaient 18 ans. Les symptômes assez répandue englobait hematurie avec la colique des reins (50%), des calculs renais (50%), et hypertension artérielle avec (6) et sans (3) mal à tête sévère.64.2% des malades avaient l'adenômes compris seulement 54% des malades qui avaient moins de 18 ans et jusqu'à 77.8% qui avaient 18 ans et davantage. L'incidence d'hyperplasie était augmentée des malades qui avaient moins de 18 ans (38%) en comparaison de ceux qui avaient 18 ans et davantage (18.5%) ou toutes les malades (30.2%). L'hyperparathyroïdie était associée avec: MEA I (4); MEA II (4); neurofibromatose de von Recklinghausen; carcinomie papillaire de thyróidie; craniopharyngioma et multiple metaphyseal chondramotosis. Un enfant avait hyperplasie neonatal, héréditaire de parathyroïdie.L'hyperparathyroïdie des jeunes malades est plus ordinaire qu'on pense bien auparavant. Les symptômes de calculs renais, hypertension artérielle, mals à tête persistants, anorexie inexpliqué et perdu des poids demandent l'evaluation prompt d'hyperparathyroïdie. Si l'hyperplasie de parathyroïdie est trouvée, on doit étudier le malade et sa famille pour chercher des autres endocrinopathies associées.

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Presented before the annual meeting of the International Association of Endocrine Surgeons, Montreux, Switzerland, September, 1981.     

Osteomyelitis,a cause of prolonged fever in adults

A 35 years old male patient with an unexplained prolonged fever, after serial unsuccessful investigations in 3 different services, suffers a fracture of the lower third of the right femur produced by a minor trauma. This raises the suspicion of a pathological fracture. The surgical intervention and the microbiological exam confirms the existence of an osseous infection with Gram-negative germs, and the clinical course is uneventful after stabilization with an external fixator and appropriate antibiotic therapy. Osteomyelitis, although rare in adults, should be included in the differential diagnosis of any prolonged fever of unknown origin in adults.     

Risk factors, prevention, and treatment of corticosteroid-induced osteoporosis in adults

An orthopedist can play a critical role in corticosteroid induced osteoporosis management by identifying at-risk patients and selecting appropriate prophylactic measures. This article is part two in a two-part series on osteoporosis. Part one appeared in the July 2008 issue of ORTHOPEDICS.     

Prolactin, corticotropin, and gonadotropin concentrations following thermal injury in adults

The concentration of serum prolactin (PRL), plasma corticotropin (ACTH), serum follicle stimulating (FSH), and luteinizing (LH) hormones were measured in 28 adult burned patients (25 males and three females). Morning and night determinations were performed for each hormone. Serum PRL was elevated in males up to the fourth week after the thermal injury. Plasma ACTH increased significantly on the second day postburn and returned gradually to normal on the fifth; serum FSH and LH increased on day 1, then decreased significantly on day 2 and remained low for about 2 weeks. In females, while PRL increased significantly, the gonadotropins were slightly elevated and the ACTH remained within normal limits for the 3 days during which it was possible to study these patients. In all subjects the circadian rhythm of the four measured hormones showed significant variations from the normal pattern.     

Stereoselective pharmacokinetics of ketorolac in children, adolescents and adults

BACKGROUND: Previous pharmacokinetic studies on racemic ketorolac using nonstereoselective analytical methods have indicated that the plasma clearance of ketorolac is higher and the volume of distribution greater in children than in adults. The aim of this study was to study the stereoselective pharmacokinetics of racemic ketorolac in children, adolescents and adults. METHODS: 18 children (6-11 yrs), 18 adolescents (12-17 yrs) and 18 adults (18-44 yrs) participated in the study. At the end of eye surgery they were given intravenous racemic ketorolac tromethamine 0.5 mg/kg. Plasma samples were assayed for (R)- and (S)-ketorolac with high-pressure liquid chromatography. Clearance (CL), volume of distribution at steady state (Vss) and elimination (Vz) and elimination half-life (t1/2,z) were calculated with standard methods. Incidence of side-effects were recorded. RESULTS: CL, Vss, Vz and t1/2,z were higher (P<0.05) for (S)-ketorolac than for the (R)-enantiomer. Vss of the active (S)-enantiomer was higher in children than in adolescents (P<0.05) and adults (P<0.001) but the values for CL were similar. Due to the higher volume of distribution, t1/2,z was also higher in children than in adults. The pharmacokinetics of the (R)-enantiomer were essentially unaffected by age. CONCLUSION: On a pharmacokinetic basis, the maintenance dose requirements of ketorolac are similar in children, adolescents and adults.     

Rocuronium in infants, children and adults during balanced anaesthesia

We studied 20 infants, 20 children and 20 adults during balanced anaesthesia to compare the neuromuscular blocking effects of rocuronium in these age groups. Neuromuscular function was recorded by adductor pollicis emg and a cumulative log-probit dose-response curve of rocuronium was established. Thereafter, full spontaneous recovery of the neuromuscular function was recorded. Onset time of the first dose of rocuronium was shorter in children than in infants or adults. The potency of rocuronium was greatest in infants and least in children; the ED₅₀ doses (mean ± SD) being 149 ± 36 μg˙kg^?1 in infants, 205 ± 52 μg˙kg^?1 in children and 169 ± 47 μg˙kg^?1 in adults (P<0.05 between infants and children) and the ED₉₅ doses being 251 ± 73 μg˙kg^?1, 409 ± 71 μg˙kg^?1 and 350 ± 77 μg˙kg^?1, respectively (P<0.05 between all groups). The emg recovery following an average 94.5 ± 4.8% neuromuscular blockade established by rocuronium was roughly similar in all study groups. Thus, one ED₉₅ dose of rocuronium, unlike vecuronium, acts as an intermediate-acting agent in all age groups.     

成人脊髓纵裂

目的: 分析成人脊髓纵裂患者的手术治疗效果。方法: 对 13例行手术治疗的成人脊髓纵裂患者进行回顾性分析。结果: 通过手术后观察和 6个月 ~5年的随访发现, 手术的总有效率可达 87%, 尤其是疼痛为主诉的患者恢复最为明显, 术后恢复似乎与术前病程无关。结论: 双管型脊髓纵裂患者一旦确诊, 无手术禁忌证就应尽早手术。只要手术操作细致, 大多患者症状可缓解, 不会出现明显的神经并发症。     

Plasma concentrations of fentanyl in infants,children and adults

To evaluate whether there are age-related differences in the plasma concentration-vs-time course of fentanyl, the authors administered fentanyl to seven infants (3-10 months), seven children (1-9 years) and seven adults (18-41 years). Anaesthesia was induced with thiopentone, nitrous oxide, and pancuronium; following tracheal intubation, fentanyl (approximately 30 micrograms X kg-1 for infants and children, 20 micrograms X kg-1 for adults) was administered as a 2-min IV infusion. Anaesthesia was maintained with nitrous oxide, pancuronium, and morphine sulphate as clinically indicated. Plasma samples were obtained for 4 h and fentanyl concentrations determined by radioimmunoassay. Plasma concentrations per microgram X kg-1 fentanyl administered were lowest in infants 4-10 and 60-240 min after the start of the 2-min infusion; values for children were lower than those for adults 4, 180 and 210 min after the start of the 2-min infusion. These findings are consistent with the authors' clinical observation that infants tolerate larger doses of fentanyl than do adults.