Epidemiology and mortality of burns in a general hospital of Eastern Sri Lanka

This 2-year prospective study examined the epidemiology and mortality of 345 patients admitted with burn injuries. Sixty-four percent of all burns were accidental in nature and at least 25% were self-inflicted. The rest were due to assaults or had a doubtful cause. The median age was 22 years. Forty-one percent of the accidents were due to the fall of a homemade kerosene bottle lamp. The main cause was flames, followed by scalds. Females outnumbered males in all categories of burns except cases of assault, and suffered from a higher mortality. Most at risk of accidental burns were children between 1 and 4 years, who suffered primarily from scalds. Self-inflicted burns were most common among women aged 20–29 years. The overall median total body surface area (TBSA) burned was 16%. Self-inflicted and ‘doubtful’ burns were much more extensive and more often fatal than accidental ones. The overall mortality rate was 27%. Burns involving more than 50% of the body surface area were invariably fatal. Mortality was highest in the elderly and in the 20–29 years age group. Burns were the first single cause of mortality in the surgical wards. The case is made for the establishment of more Burns Units.     

Growth hormone therapy and lipid profile in children on chronic peritoneal dialysis

The aim of the study was to assess the effect of recombinant human growth hormone (rhGH) on serum lipids in children treated with chronic peritoneal dialysis. We studied 26 patients aged 5-18 years, including 13 patients treated with rhGH at a dose of 1-1.1 IU/kg per week for 6 months and a control group of 13 patients. Serum total cholesterol (TC), low-density lipoprotein-cholesterol (LDL-C), HDL-C, triglycerides (TG), apolipoproteins A-I and B-100 (apoA and apoB), lipoprotein (a) [Lp(a)], total protein, albumin, urea, and creatinine levels were measured in all children at baseline and at 1, 3, and 6 months of follow-up. We found a significant increase in the TG level after 1 month of administration of rhGH in the treatment group compared with both baseline (218.8+/-49.2 mg/dl vs. 175.9+/-71.9 mg/dl, respectively, P<0.05) and the control group at 1 month of follow-up (146.5+/-44.3 mg/dl, P<0.001). We found no change in TC, LDL-C, HDL-C, apoA, and Lp(a) levels during treatment with rhGH. These data suggest that administration of rhGH to children treated with peritoneal dialysis results in only a transient increase of serum TG level and has no effect on TC, LDL-C, HDL-C, apoA, and Lp(a) levels.     

The cost-effectiveness of the RSI QuickScan intervention programme for computer workers: Results of an economic evaluation alongside a randomised controlled trial

Background  

The costs of arm, shoulder and neck symptoms are high. In order to decrease these costs employers implement interventions aimed at reducing these symptoms. One frequently used intervention is the RSI QuickScan intervention programme. It establishes a risk profile of the target population and subsequently advises interventions following a decision tree based on that risk profile. The purpose of this study was to perform an economic evaluation, from both the societal and companies' perspective, of the RSI QuickScan intervention programme for computer workers. In this study, effectiveness was defined at three levels: exposure to risk factors, prevalence of arm, shoulder and neck symptoms, and days of sick leave.     

Shoulder arthroplasty: evolving techniques and indications

The development of modern shoulder replacement surgery started over half a century ago with the pioneering work done by CS Neer. Several designs for shoulder prostheses are now available, allowing surgeons to select the best design for each situation. When the rotator cuff is intact, unconstrained prostheses produce reliable and reproducible results, with prosthesis survival rates of 97% after 10 years and 84% after 20 years. In patients with three- or four-part fractures of the proximal humerus, the outcome of shoulder arthroplasty depends largely on healing of the greater tuberosity, which is therefore a major treatment objective. Factors crucial to greater tuberosity union include selection of the optimal prosthesis design, flawless fixation of the tuberosities, and appropriate postoperative immobilization. The reverse shoulder prosthesis developed by Grammont has been recognized since 1991 as a valid option for patients with glenohumeral osteoarthritis. Ten-year prosthesis survival rates are 91% overall (including trauma and revisions) and 94% for glenohumeral osteoarthritis with head migration. These good results are generating interest in the reverse shoulder prosthesis as a treatment option in situations where unconstrained prostheses are unsatisfactory (primary glenohumeral osteoarthritis with marked glenoid cavity erosion; comminuted fractures in patients older than 75 years; post-traumatic osteoarthritis with severe tuberosity malunion or nonunion; massive irreparable rotator cuff tears with pseudoparalysis; failed rotator cuff repair; and proximal humerus tumor requiring resection of the rotator cuff insertions).     

Faut-il reconstruire le rétinaculum des fléchisseurs (retinaculum flexorum) dans le canal carpien ?

Conflicting data in the literature justify this review about the flexor retinaculum (FR). Reconstruction of the FR following carpal tunnel open release has been recommended in order to limit the drawbacks of open carpal tunnel release; these drawbacks have been reported in wide series of results published between 1956 and 1988. This paper includes a review of the literature, a survey of the practice of the members of the French society for surgery of the hand (GEM), a self-evaluation of grip strength as well as a summary of indications.