Acute renal failure and infectious mononucleosis

Renal failure is a rare complication of infectious mononucleosis, and is usually due to acute interstitial nephritis. Outcome has been variable with spontaneous recovery, death, and chronic renal failure being described. Only two patients have been reported as requiring dialysis. In some cases the aetiology of the interstitial nephritis has been open to doubt and may have been drug-induced. The case of a patient with acute renal failure associated with infectious mononucleosis and in whom interstitial nephritis appears to have been totally related to the underlying disease is described. There was an excellent response to treatment with high doses of methyl prednisolone given intravenously.     

Gastrointestinal bleeding in patients with acute spinal injuries

Twenty out of 365 patients (5.5 per cent) with acute spinal cord injuries referred to a spinal ward over a $\text{9}\text{1}\text{2}$-year period bled from the gastrointestinal tract.A cause of the haemorrhage was found in 15 patients. Six patients were endoscoped. Most patients had gastroduodenal ulceration but we could not be certain whether this was due to stress or peptic ulceration. We did not confirm that cervical cord lesions were associated with a higher incidence of gastrointestinal bleeding.The 4 patients who died probably represent an ‘inevitable’ mortality in severely ill patients.The role of endoscopy is outlined, the pathogenesis of gastrointestinal ulceration discussed and future management of these patients is suggested.     

Extensive deep neck burns

A total of 1402 patients were treated in the Nuffield Burns Unit between 1960 and 1970. There were 51 deaths (3·3 per cent); 40 were anticipated from mortal burns (Bull, 1954), 5 from pulmonary embolism and 1 each from airway burn, diffuse adrenal haemorrhage, septicaemia, coincidental rupture of an aortic aneurysm, toxic nephritis and hepatitis.Of the 1402, 218 (15·8 per cent) had burns involving the neck and adjacent areas; 29 of these 218 had extensive whole skin loss of the neck and adjacent skin.     

Associated injuries in patients with spinal injury

The associated injuries found in 100 consecutive spinal injuries are described. Fifty-one of the patients had injuries of the cervical cord, 31 per cent complete. A total of 75 per cent of the patients had associated injuries, the commonest being a head injury. Chest injuries were the next most frequent. The management of these injuries in the presence of a severe spinal injury is described. The importance of early tracheostomy and prophylactic anticoagulant therapy is stressed in reducing the mortality to the order of 2 per cent. The value of spinal injury units is emphasized.     

An unusual penetrating injury of the cheek: a case report

The immediate management of an unusual penetrating injury of the cheek is described. The early problems that arose following operation and their management are discussed. There is very little residual disturbance of function and surgical revision of the facial scars is being deferred for the time being.     

An approach to the treatment of hand burns

Burns of the dorsum of the hand may occur in isolation or as part of a more extensive burn. In planning treatment we are guided by the general condition of the patient as well as the local condition of the hand. The depth of these burns is often in doubt and a conservative policy is often indicated.

If infection is avoided many deep burns heal spontaneously. Intensive physiotherapy from the outset reduces oedema and rapidly restores mobility. A Bunyan bag technique using sulphamylon as the antibacterial agent has minimized infection and allowed free movement of the hands.

Using this method the large majority of dorsal burns of the hands heal in 4–5 weeks and show almost normal mobility.