Morbidity in pediatric burns, toxic shock syndrome, and antibiotic prophylaxis: a retrospective comparative study.

The prophylactic use of antibiotic for pediatric burns has been suggested as a possible means of reduction of toxic shock syndrome. In our study, we review 1250 burn cases during a 16-year period (1983-1999). There was a change in protocol during this period (after 1991, all pediatric burn received prophylactic antibiotics irrespective of presentation), thus creating 2 groups: our control who received antibiotics when clinically necessary and our cases who received antibiotics as routine prophylaxis. Our results show no statistical difference between the 2 groups both in signs of morbidity and signs of potential toxic shock syndrome. We conclude that prophylactic antibiotic use is unnecessary and the use of antibiotics should be guided on a case by case basis according to symptoms.

The relationship between the intercostal distance, patient height and outcome in microsurgical breast reconstruction using the second interspace rib-sparing internal mammary vessel exposure.

PURPOSE OF THE STUDY: Rib-sparing internal mammary vessel (IMV) exposure in breast reconstruction is becoming common, with a smaller space in which to perform the microanastomoses. The objectives were to determine whether patient height could be used as a proxy measurement for intercostal distance (ICD), assess whether the complication rate or the flap ischemia time are affected in such surgery, and provide anatomical data about ICDs. METHODS: Data were collected from 95 consecutive patients (109 breasts) undergoing free flap breast reconstruction using rib-sparing vessel exposure over a 3-year period by one surgeon. Pearson's product moment correlation coefficient was used to assess the relation between height and ICD, body mass index (BMI), operative times, and flap outcomes. RESULTS: There was no correlation between patient height and ICD (r = 0.087), age, BMI, recipient vessel preparation time, and flap ischemia time. CONCLUSION: Being able to predict patients with a small ICD in whom microsurgery may be more challenging can influence surgical planning. The anatomy of the intercostal spaces is variable and was not predictable in relation to height, BMI, or age. Height was not a reliable proxy for ICD and where there is a concern about the available ICD it is suggested that it is measured directly through preoperative imaging. This study found no increase in the complication rate and flap ischemia time using the rib-sparing IMV exposure technique.

Cold finger: urban frostbite in the UK.

A 24-year-old man, presented to the accident and emergency (A&E) department 48 h after a social evening where excess alcohol had been consumed. He had fallen asleep outside then made a visit to the A&E department once his finger became painful. His diagnosis was frostbite.

Surprise met in minor ops.

The case of a woman who was initially diagnosed as having a sebaceous cyst but who died from metastatic lung carcinoma 2 weeks after her initial 'minor op' procedure. Minor surgical procedures are increasingly being performed by specialist nurses and by general practitioners in primary care. However, such non-experts may lack the resources to cope with surprises such as was found in this case. It is, therefore, imperative that adequate training and support is provided as the model of care changes.