Wound botulism associated with black tar heroin and lower extremity cellulitis

Wound botulism is a rare and potentially fatal disease. The use of black tar heroin has spawned an increase in the incidence of the disease, with the majority of cases occurring in California. The use of botulism antitoxin and surgical debridement are recommended to decrease hospital stay. For this to be effective, the diagnosis of wound botulism first must be considered, followed by an aggressive search for any area of infection that may be debrided. This case report demonstrates several factors to consider in patients presenting with symptoms of botulism poisoning: occurrence away from the Mexico border, no obvious abscess, and the need for prolonged ventilatory support. This case report documents a prolonged hospital stay, possibly caused by delay in administration of antitoxin in a patient with cellulitis that was not considered appropriate for debridement.     

Brugada-Type Pattern on Electrocardiogram Associated with High-Dose Loperamide Abuse

Background

Loperamide has been increasing in popularity recently for its effects separate from treatment of diarrhea. In large doses or in combination with other agents, it can lead to desirable effects in the central nervous system. However, cardiotoxicity has been reported with its abuse.

负压治疗联合滴注冲洗对感染性伤口治疗效果的Meta分析

目的 系统评价负压治疗联合滴注冲洗对感染性伤口的治疗效果。方法 检索国内外各数据库2022年5月前发表的有关负压治疗联合滴注冲洗对感染性伤口治疗效果的研究，使用RevMan 5.4以及R Studio 4.2.1软件对纳入文献进行系统评价。结果 最终纳入15篇文献，共涉及996例研究对象。与传统负压伤口治疗相比，负压治疗联合滴注冲洗能有效降低引流管的堵管率[OR=0.11,95%CI(0.05,0.28),P<0.001]，提高伤口闭合率[OR=1.99,95%CI(1.38,2.87),P<0.001]和细菌清除率[OR=18.04,95%CI(16.77,19.31),P<0.001]，缩短感染性伤口的闭合时间[MD=-3.15,95%CI(-3.15,-2.34),P<0.001]。而对于滴注冲洗液的选择，生理盐水与抗菌溶液两个亚组的伤口闭合率和伤口闭合时间的合并效应量差异均无统计学意义（P=0.226,P=0.568）。结论 负压治疗联合滴注冲洗能促进感染性伤口的闭合，抑制局部感染与细菌繁殖，提高感染性伤口负压治疗的效果，且负压吸引联合生理盐水滴注冲洗与...     

Topical Lyophilized Targeted Lipid Nanoparticles in the Restoration of Skin Barrier Function following Burn Wound

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Wound Irrigation with Tap Water

Abstract. Objective: The study hypothesis was that irrigation with tap water is as efficacious as irrigation with sterile saline in removing bacteria from simple lacerations in preparation for wound closure.
Methods: The study was conducted in a laboratory rat model previously described in the literature for evaluating wound irrigation techniques. The study used a randomized, blinded crossover design using 10 animals. Two full-thickness skin lacerations were made on each animal and each wound was inoculated with standardized concentrations of a Staphylococcus aureus broth. Wounds were irrigated for 4 minutes with normal saline from a syringe or 4 minutes with tap water from a faucet. Tissue specimens were sampled from each laceration prior to and following irrigation. Bacterial counts per gram of tissue were determined for each specimen and compared pre- and postirrigation.
Results: Preirrigation bacterial counts were not significantly different for saline vs tap water specimens. The wounds irrigated with saline had a mean reduction in bacterial count of 54.7% (SD =±28%), while the wounds irrigated with tap water had a mean reduction in bacterial count of 80.6% (SD =±20%) (p < 0.05, 2-tailed, paired t-test).
Conclusions: In this animal model, bacterial decontamination of simple lacerations was not compromised, and was actually improved using tap water irrigation. This is most likely due to the mechanical differences in the types of irrigation. In certain instances, such as with upper-extremity lacerations, tap water irrigation would likely be cheaper and less labor-intensive than irrigation with normal saline from a syringe.     

负压伤口治疗时两种填充敷料对伤口床温度和渗液酸碱度的影响

目的比较实施负压治疗时纱布和泡沫填充敷料对伤口床温度(伤口温度和伤口周围皮肤温度)和渗液酸碱度的影响,以筛选更合理有效的填充敷料。方法便利抽样法选择2009年10月至2011年3月在南京军区南京总医院门诊伤口护理中心治疗的20例患者为研究对象,按入院时间的先后将其分为A、B两组,每组10例。A组患者采用泡沫敷料,B组患者采用纱布作为填充敷料实施负压治疗,两组患者均给予智能化吸引装置,其压力值和吸引模式均相同。两组在治疗前及治疗后7、14、21d使用相同方法测量伤口床温度及渗液pH,并比较两组患者治疗3周后的平均伤口缩小率、治愈率及愈合时间。结果敷料干预主效应、敷料干预与治疗时间交互效应,两种填充敷料实施负压治疗前和后21d内渗液pH变化、伤口温度和周围皮肤温度差异均无统计学意义(均P>0.05);治疗时间主效应、负压治疗前和后21d内渗液pH差异均无统计学意义(均P>0.05),但伤口温度随治疗时间延长有明显升高(P<0.05)。结论纱布和泡沫敷料作为填充敷料实施负压伤口治疗对伤口床温度及渗液pH作用相当,均可以作为负压治疗的有效敷料。     

氧化锌油加地塞米松治疗糜烂创面临床观察

采用氧化锌油加地塞米松对５６例不同伤口进行治疗，治疗２次～１２次后，伤口痊愈。     

Meningismus Associated with Malpositioned Intraspinal Catheter for Drug Delivery

Background: Implanted delivery systems for intrathecal drug administration have become more common in the management of nonmalignant pain. Many postprocedural complications have been described in the literature including infection and headache provoked by position changes. Determining the etiology of a postimplant headache is important particularly when considering the possibility of a life‐threatening infection. Case Report: We present a patient who underwent placement of an implantable drug delivery system (IDDS) for intractable abdominal pain that developed positional headaches, and significant neck and back pain. Attempted cerebrospinal fluid aspiration reproduced her symptoms and imaging revealed a malpositioned intraspinal catheter tip approximated to the meninges. Revision of the system completely relieved her symptoms. Conclusion: Meningismus from malpositioned catheters is a rare complication that can mimic meningitis but should be considered in the differential for postimplant headaches. Given the increased use of IDDS, it is important to recognize and evaluate postimplant complication and treat it appropriately. We discuss this case report and appropriate work‐up and differential diagnosis for meningismus following implant.     

Comparison of Patient Satisfaction and Practitioner Satisfaction with Wound Appearance after Traumatic Wound Repair

Introduction : Existing cosmetic scales for wounds are based only on practitioners' evaluations. They have not been validated using the patient's assessment.
Objective : To validate a previously developed wound cosmesis scale by determining the relationship between patient and practitioner assessments of cosmetic outcome following traumatic wound repair. Methods : A convenience sample of patients with lacerations repaired in an ED were evaluated at the time of suture removal. Practitioners assigned 0 or 1 point each for the presence or absence of a step-off of borders; contour irregularities; margin separation; edge inversion; excessive distortion; and overall appearance. A total cosmetic score was calculated by adding the categories above. As previously defined, a score of 6 was considered optimal; < s6 was considered "suboptimal." Patients, blinded to the physician score, assessed their degrees of satisfaction with the cosmetic outcome of the wounds using a 100-mm visual analog scale (VAS). Because VAS scores were not normally distributed, practitioner scores were compared with patient satisfaction scores using a Mann-Whitney U test.
Results : 125 patients were enrolled, of whom 64% were male; the median age was 19.5 years (interquartile range = 8–33 years). Wounds were located predominantly on the face, scalp, or neck (47%) and upper extremity (35%), and had a median length of 2 cm. The 86 lacerations given optimal practitioner scores had a median patient satisfaction score of 97 mm; the 39 "suboptimal" lacerations had a median patient satisfaction score of 87 mm (p = 0.0006).
Conclusion : Lacerations that practitioners ponsidered to have optimal cosmetic appearances at the time of suture removal received higher patient satisfaction scores than did lacerations considered to be suboptimal. This provides a measure of validity to this 6-item categorical cosmetic scale.     

A Descriptive Study of an Epidemic of Poisoning Caused by Heroin Adulterated with Scopolamine

Objective: Adulterants, contaminants, and diluents are all examples of additives to street drugs. Some of these additives may be pharmacologically active; however, it is unusual for them to cause toxic side effects. In the spring of 1995, a new form of heroin appeared in New York City, spreading to other East Coast cities, that was adulterated with scopolamine. It caused severe anticholinergic toxicity in heroin users with patients often presenting to emergency departments in great numbers. This is a report of the demographics and clinical characteristics of the epidemic. Methods: A combination of prospective and retrospective data collection from the New York City, New Jersey, Delaware Valley, and Maryland Poison Centers. The primary measurements were age, sex, route of drug use, vital signs, signs and symptoms, disposition, and treatment. Results: Of the 370 cases reported to the participating poison centers, 129 were excluded from the final analysis because of insufficient data. Of the patients who used this product, 55% presented with signs and symptoms of heroin toxicity but then became severely agitated with anticholinergic symptoms when naloxone was used to reverse respiratory depression. Nasal insufflation was the route of administration in 34% of the cases. Seizures were rare (3%). Ninety percent required admission, and half were admitted to a critical care unit. Conclusions: Adulteration of street drugs can lead to toxic epidemics. Poison centers are essential for identification of these trends and are the primary source of information on diagnosis and treatment.     

A Retrospective Review of Leg Wound Complications After Coronary Artery Bypass Surgery

Little research or attention has been paid to finding out whether wound closure with sutures or staples attains the best outcomes after saphenous vein harvest for coronary artery bypass grafting. We undertook a quality improvement project to compare the prevalence of leg wound complications (eg, infection, seroma, hematoma, dehiscence) between two types of skin closure (ie, staples, subcuticular sutures) after conventional open surgery with bridging between incisions and vein harvesting during coronary revascularization to determine the need for practice changes. We found no significant differences between patients with wound complications and those without. However, in this project, the risk for infections was greater for patients with diabetes whose wounds were closed by using subcuticular sutures. These findings have led to practice changes for reducing leg wound complications within our institution: clinicians now assess patients for increased risk of leg wound complications preoperatively and opt to close wounds with staples for patients who have diabetes.     

综合护理干预对美沙酮维持治疗者海洛因渴求反应的影响

目的探讨综合护理干预措施对美沙酮维持治疗者海洛因渴求反应的影响。方法把门诊在治的美沙酮维持治疗者79人按治疗卡号单双数随机分为干预组39人与对照组40人。干预组进行心理干预、家庭干预、奖惩激励、美沙酮剂量干预等综合干预措施;对照组进行单纯美沙酮维持治疗。两组研究对象在专人监督下进行每周1次的吗啡尿样检测,在第1、第6、第12个月进行海洛因渴求问卷调查。结果干预组第12个月海洛’因渴求总分、用药意向因子分明显低于对照组（P〈O．01或P〈0．05）;组内比较,干预组第12个月海洛因渴求总分及用药意向、用药渴望、期待效果、用药渴望各因子分均明显低于第1个月（P（O．05）。干预组尿检总阳性次数明显低于对照组（P〈O．01）,干预组与对照组平均治疗剂量比较差异无统计学意义（P〉0．05）。结论综合护理干预可以明显降低美沙酮维持治疗者对海洛因的渴求反应。     

多孔敷料负压封闭治疗创面的观察和护理

目的 :观察负压封闭治疗创面的效果。方法 :采用多孔敷料负压封闭疗法 ,对不同深度及大小的急、慢性创面进行处理。结果 :经该方法处理创面后创面愈合时间 ,急性创面 1～ 3周 ,平均 2周 ;慢性创面 2～ 8周 ,平均 4周。结论 :多孔敷料负压封闭处理创面与传统方法相比较 ,具有操作简单、密闭好、创面愈合速度加快、降低交叉感染等优点     

大面积烧伤合并创面脓毒症40例临床分析

目的:总结烧伤合并创面脓毒症的临床特点和防治措施。方法:回顾性分析我科2007年1月至2012年12月收治的烧伤合并创面脓毒症40例的临床资料。结果:治愈32例,死亡8例。结论:烧伤早期休克渡过不平稳及创面早期处理不当易致创面脓毒症,预防强调积极有效的液体复苏、早期肠道营养、加强代谢与免疫调理、尽早封闭创面及加强多器官功能保护与支持,治疗强调以创面处理为核心的综合治疗策略,尽早手术覆盖封闭深度创面是救治成功的关键。     

Intracranial Hemorrhage Associated with Tangential Gunshot Wounds to the Head

Abstract. Tangential gunshot wounds (TGSWs) to the head are gunshot wounds in which the bullet or bullet fragments do not penetrate the inner table of the skull. Objectives: To determine the occurrence of intracranial hemorrhage (ICH) associated with TGSW to the head and to assess the ability of selected clinical criteria to predict ICH in this patient population. Methods : A retrospective chart review of patients diagnosed as having TGSWs to the head presenting to the ED of Los Angeles County + University of Southern California Medical Center from October 1, 1993, to May 31, 1996. Results : Four hundred twenty patients with gunshot wounds to the head presented to the ED. CT confirmed the diagnosis of TGSWs in 154 patients (36.7%). Head CT of patients with TGSWs revealed 25 (16.2%) skull fractures and 37 (24.0%) ICHs. Fourteen (56.0%) skull fractures were depressed. Of patients with a CT-doc-umented TGSW to the head, 23 (16.1%) had a history of a loss of consciousness (LOC), 129 (84.3%) had a normal neurologic examination in the ED, 17 (11.1%) had a Glasgow Coma Scale score (GCS) < 15, and 75 (48.7%) had retained extracranial bullets or bullet fragments. Of all patients with TGSWs to the head, 113 had a GCS of 15 with no LOC and a normal neurologic examination, with 17 of these 113 patients (15.0%) having ICH. One patient died while hospitalized. Fifty-six (36.6%) patients were released home directly from the ED. Five clinical criteria (history of LOC, GCS < 15 on ED presentation, skull fracture, location of TGSW on the skull, and presence of extra-cranial bullet fragments) were examined to determine their ability to predict ICH. None of these criteria either alone or in combination were adequately predictive of ICH. Conclusion : In this series, 1 in 4 patients with a TGSW to the head had an ICH. All patients with TGSWs to the head should undergo head CT to rule out depressed skull fractures and ICH.     

高强度超声损伤兔肝肿瘤的病理转归

目的观察高强度超声（HIU）破坏兔肝肿瘤病理转归情况。 方法 建立兔VX2肝肿瘤模型，5d后应用术中HIU和手术切除治疗肿瘤组织，从大体形态、组织病理及术后肿瘤复发和转移发生率观察愈后情况。 结果 HIU治疗后即刻肿瘤组织发生凝固性坏死，坏死组织逐渐为纤维结缔组织取代并液化吸收，未发现引起肿瘤复发和转移。 结论 HIU可以彻底杀灭肿瘤组织，不增加肿瘤复发和转移机会，从而使肿瘤这一“不能愈合伤口”痊愈。