Management of burn wounds of the head and neck region.

Management of burn wounds of the head and neck region. Management of the severely burned patient is ery often a challenge, not only due to major disturbances in anatomy and physiological processes, but also because the relatively low incidence of this pathology in both civilian and military practice results in care providers'lack of experience. The purpose of this educational document is to provide doctors confronted with these formidable trauma patients with basic management guidelines as well as some practical tips. In summary, and most importantly, these patients should be reated as any other multitrauma patient. First aid is essential and can be provided by non-medical staff. Initial medical nanagement should focus on the usual, familiar trauma algorithms of ABCDEF from the emergency management of evere burns (EMSB) manual' or the ABCDEs of the manual of advanced trauma life support (ATLS)2 or advanced burn life support (ABLS). Medical care should proceed through the following steps - Step one: establish a reliable intravenous nfusion; step two: protect the airway; step three: establish and maintain a haemodynamic state compatible with sufficient organ perfusion in order to reduce aggravation of the burn wounds and increase overall survival likelihood; step four: provide analgesia with adequate sedation and provide anaesthesia for escharotomy, fasciotomy or other surgical injuries; step five: maintain normothermia; step six: feed the patient by starting enteral nutrition as early as possible; step seven: prevent infection using antiseptic wound management, systemic antibiotics and tetanus prophylaxis. All of these intricate steps require continuous reassessment and adjustment, but the existence of other wounds (blast injuries, penetrating and blunt trauma) even further complicates the management of burn casualties.

Impact of an external electron acceptor on phosphorus mobility between water and sediments.

The present work assessed the impact of an external electron acceptor on phosphorus fluxes between water and sediment interface. Microcosm experiments simulating a sediment microbial fuel cell (SMFC) were carried out and phosphorus was extracted by an optimized combination of three methods. Despite the low voltage recorded, ~96 mV (SMFC with carbon paper anode) and ~146 mV (SMFC with stainless steel scourer anode), corresponding to a power density of 1.15 and 0.13 mW/m(2), it was enough to produce an increase in the amounts of metal bound phosphorus (14% vs 11%), Ca-bound phosphorus (26% vs 23%), and refractory phosphorus (33% vs 28%). These results indicate an important role of electroactive bacteria in the phosphorus cycling and open a new perspective for preventing metal bound phosphorus dissolution from sediments.

A longitudinal study, for 15 years, of the myocardial infarction, in a population of middle aged men.

The long-term evolution of the patients with incident myocardial infarction (MI) was studied in a group of 5,000 men ranging in age from 40 to 60 years, included in an action of primary prevention of arterial hypertension (AHT) and coronary heart disease, in comparison with a second group of 5,000 other men with similar age and occupation, selected at random, who received medical assistance without primary prevention. The incidence of MI was of 2.34% (111 cases) in the group of intervention, with a cardiovascular mortality of 46.84%, while in the control group it amounted to 2.88%, with an overall mortality by cardiovascular diseases of 52.7%. The highest mortality rate was recorded in the patients with recurrent infarctions (72.6% and 60% of deaths, respectively). During a follow-up period of 15 years, the presence of AHT before the occurrence of MI proved to be an aggravation factor for the cardiovascular mortality which, in the group of intervention, was two times more frequent in such patients than in those with pre-existent angina. The pathologic association angina--AHT as well as the AHT alone, preceding the MI occurrence, have significantly increased the risk of cardiovascular mortality. The action of primary prevention has evidently reduced the immediate mortality, as well as that of the patients with angina before the MI.

Evolution of ischemic heart disease risk factors in "The Bucharest Multifactorial Preventive Trial of Coronary Heart Disease" after 15-year follow-up.

The paper presents the evolution of the levels of smoking, hypercholesterolemia, essential hypertension and obesity in the course of a prophylactic action carried out for 15 years (1971-1986) in a group of 5000 males aged 40-60 years. In the group still available after 15 years of follow up consisting of 2000 subjects, a decrease was obtained in the number of smokers, from 22.3% to 5.6% of hypercholesterolemia from 31.3% to 23.7%. The cumulated incidence of essential hypertension has increased from 15.5% to 36.7% and of obesity from 12.6% to 14.4%. At the same time the incidence of angina pectoris and myocardial infarction increased from 1.1% to 5.3%. For comparison are presented data obtained in a similar control group.

The Bucharest multifactorial prevention trial. The changes of morbidity and of general and specific mortality.

The paper presents the results of the Bucharest multifactorial prevention trial of coronary heart disease, concerning changes in cardiovascular morbidity and mortality during the first 5-year-period of follow-up. The age adjusted 5-year-rates disclose important reductions in the intervention group in comparison with the control one: for hard events (myocardial infarction, stroke, acute coronary insufficiency)--by 41%; for myocardial infarction--by 35%; for coronary mortality--by 38%; for stroke--by 39%; for cardiovascular mortality--by 30%. The decrease of hard events, myocardial infarction and stroke incidences are statistical significant. The evolution curves of cardiovascular morbidity and mortality show that both groups (the intervention as well as the control one) began with near the same values, but on the way and especially after 5 years they are differently located, those of the control group being higher than those of the intervention group.

The Bucharest multifactorial prevention trial of coronary heart disease. General methodology and risk factor correction after five year follow-up (1971-1977).

Both the intervention and the control group included each 5000 men aged 40-60 years, randomly selected by their home address in five districts of the city of Bucharest. The intervention group underwent an "at entry" examination for risk factor detection (high serum cholesterol, high blood pressure, overweight, diabetes, minor ECG abnormalities, family history) and subsequently a five-year multifactorial intervention aimed to reduce the risk factors. Both groups were followed up in this lapse of time for major end-points: myocardial infarction, stroke, sudden death. The qualitative analysis of the results used ten evolution indices based on a quantal counting and lead to a classification of risk factors which allowed the setting up of a strategy for their correction. The quantitative analysis showed the following decreases between the first and the last examination in the intervention group: for serum cholesterol greater than or equal to 250 mg/dl -17%; for cigarettes/day greater than or equal to 15-53%; for overweight greater than or equal to 30% - 13.57%; for high blood pressure -8%; for the overall risk computed by multiple regression -33.8%.