Cases reported "Burns"

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1/9. Neutral phosphate-induced renal tubular metabolic alkalosis.

    A severely burned patient receiving neutral phosphate supplement developed renal tubular alkalosis. This phenomenon is compared with the results of experimental observations on animals, reported in the literature. The physiologic mechanism, including the possible role of parathyroid hormone, is illustrated.
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2/9. Proposal of leukotoxin, 9,10-epoxy-12-octadecenoate, as a burn toxin.

    It is postulated that toxic substances (burn toxin) synthesized in burned skin are transferred into general circulation and cause multiple organ failure. We found a highly cytotoxic substance, leukotoxin, a linoleate epoxide, exists in burned skin. Leukotoxin, as the name indicates, was synthesized by leukocytes from linoleate as a substrate. The aim of this study is to evaluate the possibility of leukotoxin as a burn toxin. We studied plasma leukotoxin level of four patients with extensive burns (over 50% of body surface area) and examined coagulation studies in these patients. We detected considerable amounts of leukotoxin (11.4 nmol/ml-37.0 nmol/ml) in all patients. Leukotoxin was not detected in the control subjects. pulmonary edema, cardiac failure, and coagulation abnormalities were found in these patients. Exogeneously administered leukotoxin induced similar pathological conditions in experimental animals to those observed in patients with extensive burns. Hence, it is concluded that leukotoxin is a responsible substance as a burn toxin.
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3/9. 'The fire coral' (Millepora dichotoma) as a cause of burns: a case report.

    A case of a full skin thickness burn after contact with a hydrozoa, Millepora dichotoma, is described. The poison secreted by specialized cells on the spines of this marine animal is a strong local irritant. Deep burns due to this agent do not appear to have been described before.
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4/9. Psychological regression and marital status: determinants in psychiatric management of burn victims.

    Major burn trauma is ordinarily associated with psychological regression, which regularly assumes either an immature, dependent (childlike), or primitive (animal-like) form. Also, the severely burned patient is exquisitely responsive, both constructively and destructively, to behavioral nuances in his or her "significant other," typically, the spouse. Two variables, type of regression and marital status, provide an empirically derived rationale for the psychiatric treatment of behavioral problems affecting patient management, including especially (1) pain-related behavior, (2) intrusive reexperiencing of the trauma, (3) depletion/despair phenomena, and (4) problems related to scarring. Results are more favorable when regression is of the dependent type rather than primitive type. Treatment is enhanced when the partner in a committed relationship is included in the treatment program.
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5/9. The syndrome of milker's nodules in burn injury: evidence for indirect viral transmission.

    Four patients with first- to second-degree burns developed multiple unusual nodular lesions confined to the burned areas 2 to 3 weeks after the accident. Electron microscopy disclosed viral particles within epidermal cells. These were identified as subgroup II poxvirus. Viral culture established the diagnosis of paravaccinia (milker's nodule) infection. Since none of the patients had had direct contact with infected animals, but had been in contact with contaminated objects, an indirect viral transmission, previously not reported for milker's nodules, appears the most likely mode of infection.
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6/9. Actual problems of immunoprophylactic and immunotherapy of burn infection.

    Staphylococcal anatoxin which has a systemic therapeutic effect, improving burn wound condition and increasing humoral and cellular immunity was used for the prevention of staphylococcal infection among patients with deep burns of up to 15 per cent of body surface area as a component of their therapy. The patients with burns of over 15 per cent of their body surface were treated with hyperimmune antistaphylococcal plasma which had a clinical effect and decreased mortality in the group of severely burned patients by more than two fold. On our model of general wound infection from 5 most frequently observed serotypes of pseudomonas aeruginosa we have got multicomponent cellfree vaccine pyoimmunogen with marked protective effect in experiments. This vaccine protected 80-85 per cent of animals in comparison with 90-95 per cent mortality in experiment. Preliminary clinical data speak for the high preventive and medical effect of pyoimmunogen and anti-Ps. aeruginosa hyperimmune plasma.
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7/9. High-frequency electromagnetic radiation injury to the upper extremity: local and systemic effects.

    Industrial use of radiofrequency and microwave energy sources (nonionizing, high-frequency electromagnetic radiation) is a growing and widespread phenomenon, with projected risks of exposure to more than 20 million workers in the united states. A description of the nature of this form of electromagnetic energy is given, with emphasis on the variability of energy absorption by humans. The current state of biological research is reviewed, and a summary of the known effects of radiofrequency and microwave radiation exposure on animals and humans provided. These known effects appear to be principally thermal, similar to conventional electrical burn injuries, but with some unique systemic expression. Derangements of cardiovascular, gastrointestinal, endocrine, hematological, ophthalmological, and behavioral functions are well described in animal experimentation. Two patients are presented--one a young woman exposed to a high-density radiofrequency field in an industrial setting, leading to necrosis of the entire hand and wrist as well as to a constellation of systemic effects, and one an older woman exposed to excessive microwave radiation from a malfunctioning microwave oven, leading to chronic hand pain and paresthesias resembling median nerve entrapment at the carpus. The prevalence of potential exposure in certain industries is noted and recommendations for follow-up care of workers exposed to this form of trauma are delineated.
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8/9. hexachlorophene storage in a burn patient associated with encephalopathy.

    hexachlorophene (HCP), a chlorinated phenolic hydrocarbon with bacteriostatic properties against staphylococcus, is used in a number of topical products. absorption through normal and damaged human skin has been appreciated and neurologic changes have been described in experimental animals, but instances of human toxicity have been reported infrequently. A 10-year-old boy who sustained a 25% burn did well initially but died in the second week of convalescence with hyperthermia, lower-extremity weakness, and cerebral edema. His treatment had included frequent applications of HCP. Analysis of post-mortem tissue revealed the presence of toxic levels of HCP in the blood (2.2 mug/gm) and brain (2.2 mug/gm), with storage in skin (25 mug/gm), liver (4.4 mug/gm), and fat (6.0 mug/gm). This case suggests that topical applications of HCP in man may result in an extensive absorption with fat storage and may cause fatal encephalopathy.
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9/9. Laparoscopically harvested omental free flap to cover a large soft tissue defect.

    OBJECTIVE: The omentum has been a very important tool in the armamentarium of the reconstructive surgeon. It has lost much of its value because of the morbidity associated with laparotomy. Laparoscopic surgery has become a popular technique and allows operations to be performed with minimal morbidity. The possibility of harvesting the omental free flap with the laparoscope and its use in reconstructive surgery has been demonstrated. SUMMARY BACKGROUND DATA: Since the first laparoscopic cholecystectomy was performed, many surgeons have learned the procedure. Other surgical specialties have also benefited from this technique. The omentum provides a large amount of vascularized tissue and excellent wound coverage. It can be transferred as a pedicle flap, or as a free flap, using microvascular technique. methods: The procedure was developed and refined in an animal model. One team harvested the omentum with laparoscopic assistance, while the other team prepared the recipient vessels. After completion of the microvascular transfer, the dogs were observed for 14 days. At that time, the omental tissue was examined for gross and histologic changes. A clinical case is also presented. RESULTS: Gross and microscopic studies documented the viability of this approach. The patient tolerated the procedure well and had an unremarkable postoperative course. CONCLUSIONS: Experimental and clinical evidence shows that the omentum can be successfully harvested as a free flap using laparoscopic assistance. This technique may prove to be of clinical significance and very useful for reconstructive surgery with less morbidity.
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