Prevention and management of contractures in patients with burns of the neck

Two hundred patients with neck burns were analyzed to determine the incidence of contractures. It was found that only 8 per cent of patients with second degree burns had contractures, all of which were mild. Both the overall incidence of cervical contractures in patients with third degree neck burns and their severity can be decreased by the use of a custom-formed isoprene splint. Splinting should begin as soon as possible after the burn and continue until scar maturation is complete.     

Effect of Preoperative Antibiotic Regimen on Development of Infection after Intestinal Surgery: Prospective, Randomized, Double-Blind Study

A prospective, randomized, double-blind study was performed to compare preoperative antibiotic preparation with neomycin (group 1), neomycin and tetracycline (group 2), and placebo (group 3) in patients undergoing elective intestinal surgery. The 196 patients were approximately equally distributed among the three study groups, which proved similar to each other in terms of age, sex, diagnosis, site of lesion, and operative procedure. There were significantly (P < 0.01) fewer patients with postoperative wound sepsis in the neomycin-tetracycline group (group 2) than in either of the two other groups. Postoperative wound infection rates in groups 1 and 3 were nearly identical. Most infections contained both aerobic and anaerobic bacteria. Eight of nine episodes of septicemia due to Bacteroides fragilis occurred in patients in groups 1 and 3.     

Disposable Plastic Centrifuge Bowls for Separation of Red Blood Cells and Plasma in the Processing of Frozen Blood

A simplified method for automated red blood cell processing is described. The method uses sterile, disposable plastic centrifuge bowls with attached tubing and reagent solutions. It can be used for the separation of red blood cells and plasma and the glycerolization and deglycerolization of red blood cells for storage in the frozen state. Data is presented on operational performance of the equipment and on red blood cell yields and post-thaw transfusion survival.     

Exclusive characteristics of graft survival and risk factors in recipients with immunoglobulin A nephropathy: a retrospective analysis of registry data

BACKGROUND: Some studies have claimed that patients with immunoglobulin A (IgA) nephropathy have better graft survival than other renal graft recipients, whereas others have rejected this statement. We have addressed this paradox in the present study. METHODS: In all, 1,207 patients with IgA nephropathy who received a primary cadaveric renal graft from 1990 to 2002 were identified in the Eurotransplant database. For comparison, we analyzed 7,935 patients with nonglomerular diseases. Death-censored graft survival was calculated using Kaplan Meier estimates and a multivariable Cox regression analysis was used for risk calculations. RESULTS: Death-censored graft survival was superior in patients with IgA nephropathy in the first period after transplantation. After 3 years posttransplant, however, there was an accelerated decline in graft survival in recipients with IgA nephropathy. The fully adjusted risk of graft loss in the first year was increased by 40% in the control group compared to IgA nephropathy (hazard ratio [HR] 1.40, 95% CI 1.12-1.75), whereas the risk was significantly lower in the control group after the first year posttransplant (HR 0.75, 95% CI 0.63-0.88). Cold ischemia time, immunization and HLA-DR mismatch were risk factors for graft loss in the control group but not for IgA nephropathy, whereas HLA-AB mismatch was an independent risk factor, exclusively for the IgA nephropathy group. CONCLUSIONS: Recipients with IgA nephropathy have better 1-year graft survival, presumably due to favorable immunological behavior. This benefit was however abolished in the long-term by increased graft loss with time. Studies are needed to explain the difference in graft survival and the reason why different risk factors are involved in graft failure.     

Tibial Angioplasty as an Alternative Strategy in Patients with Limb-Threatening Ischemia

The purpose of this study was to assess the technical feasibility and early outcome of tibial angioplasty for a subset of patients with limb-threatening ischemia who were not candidates for bypass grafting. A retrospective analysis was conducted of 19 patients (7 male, 12 female) who underwent crural angioplasty for limb-threatening ischemia using 0.018- or 0.014 inch-based systems. Contraindications to bypass were insufficient conduit in 7 patients and severe comorbid illness in 12. Concurrent treatment of inflow lesions was performed in 12 of 20 limbs via either angioplasty alone (5) or combined with stenting (12). Outcome measures were anklebrachial indices (ABI), relief of rest pain, and healing or healed wounds. Twenty-three vessels were treated, including 14 tibial occlusions and 9 stenoses. The average length of diseased segment was 11 cm (range, 3-25 cm). Thirteen of 14 occlusions were treated with subintimal recanalization, the remainder with laser recanalization. Technical success was achieved in 22 of 23 treated vessels. Mean preoperative ABI was 0.53 and mean postoperative ABI was 0.85. Palpable pulses were present in 11 of 20 limbs (55%). There was one perioperative mortality (5.2%). Mean follow-up was 3 months. Three failures occurred requiring amputation (15.8%). The remaining 16 patients were improved with healing (8) or healed (4) wounds and relief of rest pain (4). These results indicate that technical success may be achieved with outflow lesion angioplasty in the majority of patients encountered. The durability of this method of therapy is unknown, and our length of follow-up is not sufficient to answer this question. However, an attempt at angioplasty appears justified before primary amputation and before surgical bypass in those patients at high risk for intervention.Presented at the 17th Annual Meeting of the Eastern Vascular Society, New York, NY, May 1-5, 2003.     

Developing a decision instrument to guide computed tomographic imaging of blunt head injury patients

BACKGROUND: Computed tomographic (CT) head scanning of blunt trauma patients is expensive, delays care, and necessitates radiation exposure, while detecting intracranial injuries in a minority of patients. Clinical characteristics may be able reliably identify patients who do not have intracranial injuries and consequently, do no require imaging. METHODS: Physicians assessed blunt trauma patients undergoing imaging for the presence or absence of specific criteria. Recursive partitioning was used to identify criteria that predict intracranial injuries with high sensitivity. RESULTS: Intracranial injuries were found in 917 of 13,728 enrolled patients (6.7%). Injuries were rare among patients under age 65 who had no evidence of skull fracture, scalp hematoma, neurologic deficit, abnormal alertness, abnormal behavior, coagulopathy, or persistent vomiting. These characteristics would have identified 901 injury cases (sensitivity 98.3% [CI: 97.2-99.0]), while classifying 1,752 patients (12.8%) as "low risk." CONCLUSIONS: Clinical characteristics can reliably identify patients who are unlikely to have intracranial injuries and who do not require CT imaging.     

Systemic artery-to-pulmonary vein fistula in osteogenic sarcoma of the chest wall

An arteriovenous fistula between the systemic and pulmonary circulations may be congenital, as in bronchopulmonary sequestration, or the communication may be acquired. Inflammatory disease, trauma, and, rarely, neoplasm have been implicated as possible causes of acquired communications. We describe a patient who had a systemic artery-to-pulmonary vein fistula that was secondary to a recurrent sarcoma of the chest wall. Review of the literature failed to reveal a previous report of a similar case.