Use of a semipermeable glove during treatment of hand dermatitis.

Forty-six subjects with hand dermatitis participated in a pilot study comparing a new semipermeable glove to a standard cotton glove. A variety of diagnoses were represented. Each subject received treatment with topical steroids and/or moisturizers and used one each of the experimental and cotton gloves for approximately one month. Physicians scored skin condition before and after treatment. Subjects evaluated skin comfort and practical aspects of using each type of glove. Thirty subjects completed the study protocol. The type of glove used had no impact on skin condition at follow up, with both groups of hands improving. Patients expressed a preference for the experimental gloves, noting improvements in skin and hand comfort, dexterity, cleanliness, and ease of use. Feedback suggested that the gloves will be well tolerated and patient compliance in using the gloves will be high. Evaluation of the gloves' value for prevention and chronic management of hand dermatitis is warranted.

A pregnancy complicated by mature abdominal burn scarring and its surgical solution: a case report.

Complications of pregnancy secondary to old abdominal burn scars are uncommon but have been reported. Common problems include failure of the scar to stretch (resulting in uterine displacement), maternal discomfort, and occasionally scar breakdown. We report the case of a 23-year-old patient who had a tight circumferential scar involving the majority of the abdomen. The uninvolved skin of the lower abdomen stretched remarkably, but the uterus was displaced inferiorly and anteriorly by the scar. The pregnancy progressed to term under careful supervision. After delivery, a flap created by the naturally expanded skin of the lower abdomen was used to replace a portion of the abdominal burn scar to prevent similar problems in future pregnancies. We know of no other reported case where the naturally expanded skin of pregnancy was used to reconstruct a mature burn scar.

Steam press burns of the hand.

Steam presses pose an occupational hazard to workers in the dry cleaning industry. Three patients with thermal burns to the hand from steam press accidents were recently treated at this institution. Each patient sustained deep second and third degree burns to the dorsum of the hand. Two patients required split-thickness skin grafts and have retained full range of motion and returned to full employment. One patient sustained destruction of extensor tendons and required a groin flap for coverage. Late tendon reconstruction will be necessary. Investigation revealed that older steam press models do not have an emergency release lever in case of accidental closure on a worker's hand. Although newer models are equipped with a thigh-activated emergency release lever, a contact burn remains likely if the press closes on the operator's hands. Some of the newest models have an attached safety bar that prevents the press from closing on the operator's hands. It is recommended that older models either be modified with the attachment of a safety bar or replaced entirely.

Hand infections secondary to catfish spines: case reports and literature review.

Catfish are one of the few freshwater fishes known to be venomous. Although "finning" of the hand is a frequent injury incurred by catfish anglers that results in intense pain, it rarely results in any long-term sequelae. We present three cases in which acute soft-tissue infections developed, necessitating ray amputations in two patients. The unique habitat and anatomy of the catfish are described and preventive and therapeutic measures are discussed.

Atypical mycobacterium soft-tissue infection of the dorsal radial wrist: a possible complication of steroid injection for de Quervain's disease.

Corticosteroid injection into the first dorsal compartment for acute de Quervain's tenosynovitis is an accepted form of therapy. Potential side effects include soft-tissue atrophy, tendon attrition, postinjection neuritis of the superficial radial nerve, systemic reactions, and infection. We present a patient with a Mycobacterium chelonei infection localized to the soft tissue overlying the first dorsal compartment, occurring 3 years after a triamcinolone injection into this area. Histological examination with the polarizing microscope revealed persistent steroid granules in the involved tissue. Successful treatment consisted of complete excision of the involved skin and subcutaneous tissue followed by delayed closure. Systemic antibiotics were not used.

Helicopter transport of the patient with acute burns.

Helicopter transportation of acutely injured or ill patients has become common practice at most major medical centers. However, its specific effectiveness in the transportation of acute-condition patients with burns has never been critically assessed. This study, for the period 1984 through 1988, evaluated the use of the helicopter for transportation of acute-condition patients with burns to a regional burn center for a rural area. It is concluded that helicopter transport within a 180-mile radius in a non-hospital-based system is not appreciably faster than is ambulance transport, and does not clinically benefit most burned patients. Consideration such as safety, cost, and working space are discussed. It is recommended that at least one of three criteria be met before helicopter transfer is considered for patients with burns: the surface area involved should be enough to require a formal fluid resuscitation, an inhalation injury should be present or suspected, or there should be a possible need for an escharotomy.

Chemotherapy-induced acral erythema.

Chemotherapy-induced acral erythema has been described in association with several different chemotherapy regimens. We review the literature on this topic and suggest that different mechanisms may be responsible for the clinically heterogeneous array of acral changes.

Splenosis. A report of subcutaneous involvement.

We report a case of subcutaneous splenosis in the abdominal wall of a 38-year-old woman who had suffered splenic trauma 30 years earlier. A review of the literature shows only five previous cases with subcutaneous involvement.

D-lactate production in erythrocytes infected with Plasmodium falciparum.

The production of D-lactate that accompanies the metabolism of glucose to L-lactate in Plasmodium falciparum was evaluated with erythrocytes that contained either young or mature parasites. Infected cells with ring-stage parasites release L-lactate and D-lactate at rates 1340 and 81 nmol h-1 (10(8) cells)-1, respectively. These rates increase to 2050 and 136 nmol h-1 (10(8) cells)-1, respectively, in infected cells with trophozoite/schizont-stage parasites. D-Lactate represents 6-7% of the total lactate. The formation of D-lactate is by way of a methylgloxal pathway in which methylglyoxal is formed nonenzymatically from dihydroxyacetone phosphate and is then converted into D-lactate by the sequential action of parasite glycoxalase I and glyoxalase II. The kinetic properties of parasite glyoxalase I and glyoxalase II allow these enzymes to be distinguished from those in the host cell. D-Lactate production by the parasite appears to be a defense mechanism to protect the parasite from the toxic effects of methylglyoxal.

Mauling by pit bull terriers: case report.

A child with extensive soft-tissue defects following an attack by four pit bull terriers is presented. Some future procedures are required and she will have a permanent gait disability. The multidisciplinary management of this patient is described. The escalating problem of dog attacks in the United States is discussed. It is hoped that increased physician and public awareness will expedite the enactment and enforcement of effective vicious-dog legislation.

Purification and characterization of an aminopeptidase from Plasmodium falciparum.

A soluble aminopeptidase from Plasmodium falciparum was purified by high performance liquid chromatography. The enzyme has a molecular weight of 100 000 and pI 6.8. Activity can be monitored conveniently with L-alanine-p-nitroanilide or L-leucine-p-nitroanilide at 405 nm or with L-leucine-7-amido-4-methylcoumarin in a fluorescence assay. The enzyme is inhibited by bestatin and phosphoramidone but not by leupeptin, chymostatin, antipain or pepstatin. pH-rate studies indicated the presence of a group on the free enzyme, pKa = 6.6, which must be in the conjugate base form for activity. The aminopeptidase has an essential sulfhydryl group at the active site which is rapidly modified by Hg2+ or Zn2+, is slowly modified by p-hydroxymercuribenzoate, but is not accessible to iodoacetamide or N-ethylmaleimide. The aminopeptidase is inhibited noncompetitively by chloroquine, mefloquine and quinacrine (Ki = 410, 280 and 20 microM, respectively) but is not inhibited by quinine or primaquine. Hemin does not inhibit. Complexation of hemin with quinacrine prevents inhibition by quinacrine.