Contact palm burns in toddlers from glass enclosed fireplaces.

We have seen an alarming increase in the incidence of pediatric palm burns associated with gas fireplaces. The increasing popularity of these units places more children at risk. Medical records of patients under the age of 5 years who sustained hand burns from contact with the glass enclosure of gas fireplaces from 1996 through 2002 were reviewed. Thirty-nine patients were identified, with a mean age of 12.8 months. A 15-fold increase in incidence was observed. Thirty-three patients suffered superficial second-degree burns that were treated conservatively. Twenty-one percent of children developed significant wound complications requiring intensive therapy including extension splinting or surgery. Pediatric burns resulting from palmar contact with the glass enclosures of gas fireplaces have emerged as an avoidable new danger within the home. Although most of these injuries heal with conservative treatment alone, many require surgery or other intensive management to regain acceptable function.

Prognostic value of cortical magnetic stimulation in spinal cord injury.

Cortical magnetic stimulation was performed in a consecutive series of 10 patients presenting within 15 days of traumatic spinal cord injury. In those patients with complete paraplegia or quadriplegia, motor evoked potentials at presentation were absent below the level of the lesion. Six months after the injury, potentials had returned in the biceps brachii and abductor pollicis brevis muscles in some quadriplegic cases, but remained absent from the tibialis anterior in all of this group. None of those with a complete lesion made a significant functional recovery. Of the three patients with incomplete quadriplegia, two showed a significant recovery after 6 months. Motor evoked potentials were recordable below the level of the lesion at presentation in these cases, although the latencies were prolonged. In the remaining patient who failed to improve, potentials were unrecordable throughout the study. This small pilot study suggests that cortical magnetic stimulation may be useful in refining the prognosis in patients with an incomplete spinal cord injury.

Neuropathy in chronic obstructive pulmonary disease: a multicentre electrophysiological and clinical study.

The incidence and type of neuropathy in patients with chronic obstructive pulmonary disease (COPD) were assessed. In a selected group of 89 patients, abnormal nerve conduction studies were found in 44%. Electrophysiological signs of a generalized peripheral neuropathy were found in 5-18%, depending on diagnostic criteria. Lesions which were thought to be due to compression or other forms of trauma were present in a further 24%. In the patients with peripheral neuropathy, the changes were distally predominant, affected mainly sensory fibres, and were consistent with an axonal type of neuropathy. There was a significant correlation between age and the incidence of peripheral neuropathy. Electrophysiological evidence of neuropathy was three times as common as clinical evidence. Much of the variation in the reported incidence of neuropathy in COPD is probably due to imprecise diagnostic criteria.

Management of the difficult split-thickness donor site.

Split-thickness skin graft donor sites are often areas of significant morbidity in the elderly, in immunocompromised patients, and in steroid-dependent patients. We found that managing these donor sites with split-thickness skin and transparent dressings greatly increases the rate of healing and diminishes morbidity.

Status epilepticus complicating migraine.

We describe 2 patients who developed status epilepticus in association with migraine attacks. One patient died and at the autopsy had ischaemic changes confined to the occipital lobes. The second patient made an uneventful recovery.

Controlled air suspension: an advantage in burn care.

The clinical uses of the air-fluidized Clinitron therapy system and the air suspension KinAir bed are discussed based on a review of 31 patients. The risks of infection and high evaporative water loss on the air-fluidized bed are problems not associated with the air suspension bed. The clinical use of the air suspension bed is much simpler and safer for nursing personnel. The air suspension bed is indicated for patients with massive burn injuries, patients with deep burns of the back, obese burn patients, heavily infected burn patients, and debilitated patients.

Causes of polyneuropathy in the elderly.

Seventy-four patients over 65 years with electrophysiologically confirmed polyneuropathies were reviewed. Common causes were diabetes (27%), neoplasms (13%) and the Guillain-Barré syndrome (11%). In only 28% was no cause identified.

The Guillain-Barré syndrome in the elderly: clinical and electrophysiological features of five cases.

The Guillain-Barré syndrome is an important cause of polyneuropathy in the elderly. The clinical and electrophysiological features of five cases are presented. Electrophysiological investigation has a valuable role in the diagnosis of this condition in the elderly.

Spontaneous injury caused by a muscle exerciser.

Two patients with spontaneous injuries occurring while using a 'Bullworker' exerciser are described. An explanation for their injuries is suggested.

Paroxysmal symptoms as the first manifestations of multiple sclerosis.

Paroxysmal symptoms are described in 14 patients with undoubted or suspected multiple sclerosis (MS). In seven of the patients the paroxysms were the first symptom of the disease, although only one has developed definite MS so far. The clinical features have been compared with 153 patients previously reported in the literature which has been reviewed, with special reference to 36 in whom paroxysmal symptoms were the initial manifestations of MS. Attention has been focused on paroxysmal symptoms of brain stem and spinal cord origin of the following types: paroxysmal dysarthria and ataxia, diplopia, tonic seizures, paroxysmal akinesia, paroxysmal sensory disturbances and pains. Examples of each type have been reported as the first symptoms of MS with remissions ranging from less than one to 21 years before other manifestations of MS have developed.

Oxpentifylline in Parkinson's disease.

The effects of oxpentifylline were assessed in a double-blind trial in 11 patients with Parkinson's disease already under treatment. No significant improvement was noted. Eight patients developed involuntary movements or a worsening of movements if already present. The significance of this unexpected finding is discussed.

Olfactory mucosa in herpes simplex encephalitis.

The olfactory mucosa was examined in three patients dying from herpes simplex encephalitis. It showed changes attributed to infection by the herpes simplex virus. It is suggested that in some patients encephalitis may be a complication of infection of the olfactory mucosa.

A preliminary report on the spray application of topical silver sulfadiazine to burn wounds.

A simple, flexible system for spray application of topical antimicrobials has been developed in the Burn Unit at Hennepin County Medical Center. In contrast to previous attempts, this method allows spray application of silver sulfadiazine without dilution. Because of the viscosity of the micronized cream, aerosol spread is minimal. Inexpensive commercially available components are used without modification. This system can be readily adapted to most hospital situations and provides rapid topical antimicrobial application. Time required for dressing changes has been reduced in our Burn Unit by 75% and fewer nursing personnel are required. Spray application avoids direct physical contact with burn wounds, eliminating potential contamination and greatly reducing pain associated with dressing changes. Patient acceptance is high.

Endocrine function following the treatment of acute leukemia in childhood.

Pituitary function has been studied in 25 children after treatment of acute leukemia. Impaired growth hormone responses both to hypoglycemia and to Bovril were found in 11 subjects. Elevated basal thyroid-stimulating hormone levels were seen in five children, three of whom had an augmented TSH response to thyrotrophin-releasing hormone. Radiation-induced damage to the hypothalamic-pituitary region is thought to be the cause of these abnormalities in growth hormone and in secretion of TSH. The peak cortisol response to hypoglycaemia is significantly decreased in the group of subjects who received the higher dose of cranial radiation therapy, but no individual child is hypothyroid or shows impaired adrenal function, clinically or biochemically. Three prepubertal girls studied have biochemical evidence of ovarian failure following the use of combination chemotherapy.