Preputial skin can be used in all boys with burns requiring grafting.

BACKGROUND: In patients with extensive burns, all unburned areas can be used as donor sites. In male patients with small burns, preputial skin graft may be a good choice in order to avoid donor site problems. METHODS: We retrospectively reviewed 12 patients treated in our burn center from January 1997 to August 2007 with preputial skin grafting. RESULTS: In three patients, preputial skin was the only graft source. In nine patients, other donor sites were also used for split-thickness graft harvesting. In two patients, preputial skin graft was used for periareolar grafting where hyperpigmented healing was preferred. In the rest of the patients, preputial skin graft was used on various parts of the body. Overall success rate for preputial skin graft was 100%. There was no early donor site morbidity. CONCLUSION: Preputial skin is a full-thickness, highly elastic and easy-to-harvest graft that should be considered in all burned male children in whom grafting is needed.

Is the Routine Use of Impedance Analysis for the Diagnosis of Gastro-Esophageal Reflux Disease More Expensive than Conventional pH Monitoring? Cost Analysis of Two Procedures.

Conventional 24-h pH monitoring is the gold standard for the diagnosis of non-erosive, non-acidic gastro-esophageal reflux disease. Multichannel Intraluminal Impedance (MII) analysis markedly improves diagnostic accuracy of non-erosive, non-acidic gastro-esophageal reflux disease. However, MII catheters are more expensive than standard catheters. This study aimed to determine the rates of acid or non-acid reflux and by making a retrospective projection, to predict the costs of two algorithms. We retrospectively reviewed the medical data of 102 patients who presented to our hospital with suspected non-erosive GERD and underwent 24 h impedance/pH-monitoring. Demographic characteristics, Demeester scores, number of reflux episodes, and results of impedance analysis were recorded. According to these data, cost was calculated either for the scenario in which impedance measurement was performed solely or following a negative conventional pH monitoring. Thirty-seven of all 102 patients (36.3 %) had a Demeester score greater than 14.7. These patients were assigned as group 1 (acid reflux). The impedance analysis of the remaining 65 patients detected 34 patients (33.3 %) to have more than 50 reflux episodes over a period of 24 h and assigned as Group 2, and 31 patients (30.4 %) had no reflux (group 3). The cost of the single- step algorithm using MII catheter was calculated as $15,300, while the total cost of two-step scenario would have been predicted as $16,890. Our study showed that an initial conventional pH monitoring can make the diagnosis of GERD in only one third of the patients with suspected non-erosive GERD. In nearly two-thirds of patients, however, repeated procedures and use of impedance catheters are needed. It is clear that this algorithm has certain drawbacks with regard to cost, patient comfort, and workforce loss.