Toxic shock syndrome toxin-1 (TSST-1) antibody levels in burned children.

Young children with burns are at risk of developing a toxic shock-like illness during the first 2-3 days after the injury. The staphylococcal exotoxin, toxic-shock syndrome toxin-1 (TSST-1) is implicated in development of this illness. Low levels or absence of anti-TSST-1 antibodies may indicate susceptibility to this illness. Anti-TSST-1 antibody levels were measured in consecutive cases admitted to the children's burns unit. Results of antibody levels in 38 of the youngest children, aged 0.04-4.0 years are reported. At the time of admission to the unit 50% of the children had IgG antibodies to TSST-1. A higher number of young burned children had antibodies to TSST-1 than expected.

The acute febrile response to burn injury in children may be modified by the type of intravenous fluid used during resuscitation--observations using fresh frozen plasma (FFP) or Hartmann's solution.

Fever is a common clinical problem in burned children. The purpose of this study was to compare rectal temperature (T(r)) in two groups of children with burns, > or =10% of the total body surface area (tbsa) who received fresh frozen plasma (FFP) or a crystalloid solution (Hartmann's) for restoration of blood volume. Twelve to 16 h after the burn T(r) reached a peak. The children who had received FFP for restoration of blood volume had significantly higher fever than those children who received crystalloid solutions only.

Dietary intake and changes in body weight in burned children.

Two groups of children were studied. In the first group serial measurements of body weight were made during the child's stay in hospital. In 11 patients, aged 7 months to 13 years, admitted with 10-58 per cent burns, the maximum weight loss was between 6 and 13 per cent of admission weight. Patients had not regained their admission weight at discharge (8-77 days after injury). In the youngest patients, the discharge weight corresponded with the maximum recorded weight loss. In five of the 11 patients dietary intake was calculated by weighing the foods in meals. This was done on average twice per week. Energy and protein intake was below that recommended for children with burns and often lower than that recommended for healthy children. In the second group of 10 patients, 6 months to 7 years had elapsed since the burn. These children were outpatients attending the Burns Aftercare Clinic. Six of the children were at a lower weight centile position when compared to the position at the time of the accident. The children had not 'caught up' to their original centile position.

Experience with severe extensive blistering skin disease in a paediatric burns unit.

Vesiculobullous disorders are thankfully uncommon. A brief overview of the literature is presented together with our experience of managing these cases on a paediatric burns unit in the six years 1992 1998. The advantages of management on such a unit are outlined and include a facility for major dressings and frequent changes and a familiarity with fluid resuscitation in the child with major skin loss. The financial cost of treatment and rehabilitation of these children is high.

Patterns of Staphylococcus aureus colonization, toxin production, immunity and illness in burned children.

Toxic shock syndrome toxin-one (TSST-1) produced from some but not all strains of Staphylococcus aureus is considered to be responsible for the development of the serious illness, toxic shock syndrome (TSS). The aim of this study was to establish the importance of S. aureus in the aetiology of suspected cases of TSS in acutely burned children. The pattern of colonization of S. aureus, and in particular toxic shock syndrome toxin-one (TSST-1) producing isolates, was studied in 53 burned children admitted as consecutive cases. S. aureus was not normally present on admission. Although it was the most common wound pathogen, it was acquired during the first few days after admission. Antibody status to TSST-1 on admission and at discharge was determined. Only half (49 per cent) of the children had antibodies to TSST-1. When it was possible to obtain paired admission and discharge samples in patients who had been given blood products, an assessment of seroconversion could be made. Two of the four patients given blood products during the resuscitation and postoperative period were antibody negative on admission (the other two were TSST-1 antibody positive). By discharge they had antibodies to TSST-1. Whilst the majority of donated blood products had antibodies to TSST-1 (76 per cent), some (24 per cent) did not. Seven of 53 children (13 per cent) developed a toxic shock-like illness which caused clinical concern.(ABSTRACT TRUNCATED AT 250 WORDS)

Making the best use of consultant orthodontic services. Part 1: Determining which patients require referral.

General dental practitioners and community dental officers may need to consider several factors when referring patients to the consultant orthodontic service. In Birmingham, a local professional group incorporating representatives from both primary care and secondary care (consultant) services have drawn up a set of formal referral guidelines. The purpose of the exercise was to encourage the most appropriate use of the consultant service so that its resources could be directed towards those in greatest need. In this paper, the factors which determine the patients requiring referral are discussed; a second article will deal with the actual process of referral.

Making the best use of consultant orthodontic services, Part 2: How to undertake the referral.

The previous article in this series dealt with the selection of patients who would benefit from referral to a consultant orthodontist. It is equally important to access consultant services in a manner which allows the referral to be processed efficiently. This paper discusses factors related to the actual mechanism of referral.

Heterotopic nasopharyngeal brain tissue associated with cleft palate.

Heterotopic brain tissue in a cleft palate is a very rare developmental anomaly. We present the eighth case reported worldwide with a review of the literature and suggestions on the management of this unusual condition.

Recurrent pleomorphic adenoma of the palate in a child.

A rare case of recurrent pleomorphic adenoma of the palate in a 9-year-old boy is presented. Pleomorphic adenoma is relatively rare in children compared with its incidence in adults. However, it is the most common benign epithelial tumour of the salivary glands. The majority of pleomorphic adenomata in children occur in the major salivary glands, mainly the parotid gland. Pleomorphic adenomata of the minor salivary glands are rare in children and mainly occur in the palatal glands. Of the few cases of pleomorphic adenoma of the palate reported in children, only one case showed recurrence of the tumour after primary excision. We present the second case of recurrent pleomorphic adenoma of the palate in a child.

A comparison of some thermoregulatory responses in healthy children and in children with burn injury.

1. Changes in body heat content in five normal adults, in 30 healthy children and in 24 children who had suffered burn injury 1-5 h previously, have been studied in cool (20 degrees C) and warm (30 degrees C) environments. 2. On moving from a cool to a warm environment, the heat content rose in both normal adults and healthy children, but the increase was significantly larger in the children. 3. Much larger changes occurred in the burned children in whom the heat content rose to a new plateau within about 8 h of the accident. 4. The changes after burn injury were unrelated to the bandaging of the burn and were little affected by the environmental temperature.

Subcutaneous adrenaline infiltration in paediatric burn surgery.

Paediatric burn surgery may be associated with significant blood loss and postoperative pain. To investigate methods of reducing these symptoms, we studied a prospective series of 29 children with small to medium sized burns. Presurgically both the burn wound and split skin graft donor sites were injected with a 1:500,000 adrenaline solution, to which bupivicaine had been added. No patient required blood transfusion and no patient developed systemic side effects from the injected solution. Four patients required parenteral analgesia, two in the immediate postoperative period and two at first dressing change. In all other patients pain was controlled with oral analgesia alone. Mean graft take in our series was 95%, indicating that this technique does not compromise burn depth assessment, nor impair graft survival.

Incomplete excision of basal cell carcinoma: a prospective multicentre audit.

The audit of incomplete excision of basal cell carcinoma can be used as a parameter for clinical governance in plastic surgery units. However, there are no national standards, and all the previous reports from the UK have been retrospective and from regional units only. This 1 year prospective audit was undertaken simultaneously in the plastic surgery units of three different categories of hospital: a regional plastic surgery unit (University Hospital of South Manchester), a supraregional cancer hospital (Christie Hospital) and a district general hospital (Royal Bolton Hospital). A total of 757 lesions were excised from 600 patients, with 34 lesions (4.5%) being incompletely excised. The incidences of incomplete excision were similar in the regional unit (3.2%) and the district general hospital (3.1%), but higher in the supraregional cancer hospital (7.5%). The commonest site for incomplete excision was the eyebrow, followed by the postauricular area, the nose and the temple. There were no statistically significant differences in the distributions of the age and sex of the patients, the site and size of the lesions or the methods of repair between the three hospitals. However, there were significant differences in the distribution of syndromal, multiple and recurrent lesions, the grade of surgeon, and the clinical and histological subtypes. When the various confounding factors were adjusted by logistic regression, the variables most likely to have affected the incidence of incomplete excision were found to be grade of surgeon, minimal excision margin and histological subtype.