Successful management of the open abdomen with hydrocolloid dressing in a resource-constrained setting.

PURPOSE: To evaluate and detail the management of a difficult, long-term, open abdomen in a resource constraint setting with the use of Hydrocolloid dressing. METHOD: An observational retrospective study was conducted at a single level-1 trauma center. Over a 5-year period, all the open abdomen patients were evaluated and the cohorts who were treated with Hydrocolloid dressings were described in detail from their admission to their discharge. RESULTS: During this period, there were 147 open abdomens. 7.5% (11) patients required long-term open abdomen management, in which Hydrocolloid dressing was utilized. Of this group, there were no entero/colonic-atmospheric fistulas, and there was either de-novo complete skin coverage, successful skin graft placement, or definitive abdominal wall repair in all the patients. De-novo complete skin coverage took an average of 7.4 months. All the patients were discharged home after an average of 107 days hospitalized. CONCLUSION: Despite not being an optimal management of an open abdomen, there are always a small group of these patients who lose abdominal domain, are critically ill or injured, and have prolonged hospitalization with an open abdomen. In this cohort, and especially in resource constraint settings, Hydrocolloid dressing is a cost-efficient, simple, and effective method to treat the 'long-term' open abdomens.

Femoral venous access is safe in burned children: an analysis of 224 catheters.

OBJECTIVE: To document the incidence of septic and mechanical complications associated with femoral venous catheters in a subgroup of patients thought to be at particularly high risk of both: young children with large burns. DESIGN: An analysis of data collected prospectively on all femoral venous catheters placed during a 4-year period at a regional pediatric burn facility. RESULTS: There were 224 femoral catheters placed in 86 children with an average age of 5.3 +/- 5.1 years and an average burn size of 38% +/- 23%. Catheters were left in place for a mean duration of 5.7 days. Catheter-related sepsis occurred with 4.9% of the catheters, and mechanical complications occurred in 3.5% of the patients. There was no statistically significant association between the risk of catheter sepsis and the placement of catheters through burned versus unburned skin. Similarly, the risk of sepsis was equivalent between lines placed over a guide wire and those placed of a new site. CONCLUSION: Femoral venous catheters are safe in burned children and are associated with a low incidence of infectious and mechanical complications.

Increased urinary nitrite excretion in children with minimal change nephrotic syndrome.

OBJECTIVE: We tested the hypothesis that nitric oxide synthesis by the kidney is increased in children with primary nephrotic syndrome. METHODS: We examined the urinary excretion of nitrite, a stable metabolite of nitric oxide, using the Griess reaction, in children with nephrotic syndrome. RESULTS: In comparison with healthy children, patients with minimal change nephrotic syndrome had increased urinary nitrite excretion regardless of whether the disease was in relapse or remission (p < 0.025). In contrast, urinary nitrite excretion was similar in control subjects and patients with focal segmental glomerulosclerosis or IgA nephropathy. CONCLUSION: These findings indicate that measurement of urinary nitrite excretion may be a useful test to help discriminate between minimal change nephrotic syndrome and focal segmental glomerulosclerosis in children with idiopathic nephrotic syndrome.

Long term follow-up of descending thoracic aorto-iliac/femoral bypass.

A prospective study of 26 patients undergoing descending thoracic aorto-iliac/femoral (DTAI/F) bypass was conducted over a 13-year period with an average follow up of 53 months. Reasons for selecting the procedure were occluded aortic bifurcation grafts (9 patients), hostile abdomen (6), infected aortic graft (1), microaorta (10, and surgeons preference in 8 patients who had juxtarenal aortic occlusion. The operative mortality was 3.8% (1 patient). A late mortality of 36% was due to myocardial infarction (1), lung carcinoma (2), renal failure (4), stroke (1) and pulmonary insufficiency (1). Graft failure occurred in 4 patients at 23, 26, 54 and 109 months respectively. Primary cumulative patency was 86% statistically valid at 42 months. DTAI/F bypass is recommended in selected patients when conventional approaches to the aorta are considered unduly hazardous.

Thymosin alpha 1 in milk specimens from Guatemalan women.

Thymosin alpha 1 was determined in milk samples obtained from 67 Guatemalan women 5 days, and 1-3 and 6-18 months postpartum. All the specimens collected 5 days after delivery contained measurable levels (583 +/- 304 pg/ml) of thymosin alpha 1 but only 33% of those obtained 1-3 months postpartum and none collected thereafter did. Since thymosin alpha 1 has been shown to increase T-cell mediated immunity, and to enhance host resistance to infection, it may play an important role in the maturation of mucosal immunity and host resistance in general in the neonate. This study is the first to document the presence of a thymic hormone in early postpartum milk.

Acceptability of antenatal diagnosis for sicke-cell disease among jamaican mothers and female patients

A questionnaire on the need and acceptability of antenatal diagnosis (AND) for sickle-cell disease was given to 112 women with homozygous sickle-cell (SS) disease and 117 AS mothers for patients with SS disease, all aged 15-45 years. AND was favoured by 58% of patients and 76% of mothers, the option for termination of an affected pregnancy being the reason in 43% of patients and in 51% of mothers among this group. Fear of the procedure was the commonest reason for not selecting AND. Of the two common methods, chorionic villus samplis (first trimester) and amniocentesis (second trimester), 74% of all women selected the first trimester method, and 93% considered these tests should be available in Jamaica. Faced with the diagnosis of a foetus with SS disease, 30% of patients and 46% of mothers stated they would request termination

Relationship between high school student smoking and recognition of cigarette advertisements.

We report the results of a study examining the level of advertisement recognition and tobacco experimentation in a group of U.S. high school students. Students who smoked as few as one cigarette per week were found to identify a preferred cigarette brand. One brand of cigarettes accounted for 76% of all preferred brands. A dose-response relationship was found between smoking level and cigarette advertisement recognition, with regular smokers recognizing 61.6% of advertisements, compared with only 33.2% for nonsmokers. These data have potential implications for youth smoking prevention programs. Future research is needed to explain this association and to establish whether cigarette advertising and adolescent smoking are causally related.

Immature circulating lymphocytes in severely malnourished Guatemalan children.

The percentage of peripheral blood lymphocytes forming rosettes with sheep erythrocytes (E-rosettes) was determined in 33 severely malnourished Guatemalan children, and in two groups of clinically well but mildly growth retarded children from the same environment. Mean E-rosettes in the acutely ill patients was lower than the value observed in the mildly malnourished children, although there was considerable overlap between groups. These data differ from previously published studies of severely malnourished children from other parts of the world in that not all patients had decreased values for E-rosettes, in contrast to the uniform depression reported by others. As all patients were clinically similar, the results suggest that there may be specific nutrient defects associated with protein-energy malnutrition that particularly affect immune function. In addition, in vitro incubation of lymphocytes from the acutely malnourished children with the thymic factor, thymosin fraction 5, increased the percentage of E-rosettes in a dose-dependent fashion. These data suggest that immature, thymosin-responsive T cells are present in circulation. It is possible that in vivo thymosin administration may be beneficial for malnourished individuals.

Circulating thymulin and thymosin-alpha 1 activity in pediatric acquired immune deficiency syndrome: in vivo and in vitro studies.

Twenty-five children with acquired immune deficiency syndrome (AIDS) or AIDS-related complex had a characteristic pattern of T cell deficiency. Abnormally low plasma thymulin levels preceded the development of peripheral blood T cell abnormalities. In contrast to patients with congenital T cell deficiencies, our patients had elevated serum levels of thymosin-alpha 1. Treatment with thymosin fraction 5 in three children with AIDS resulted in only transient clinical and immunologic improvement.

Elevated thymosin alpha I levels in Brazilian pemphigus foliaceus.

Levels of thymosin alpha I in the sera of 37 patients with Brazilian pemphigus foliaceus (BPF) were measured using a competitive binding radioimmunoassay. The values were compared with 19 patients with other forms of pemphigus, 13 relatives of patients with BPF, 18 patients with other dermatological diseases, and 265 normal controls. We found that 27 (73%) of the patients with BPF had thymosin alpha I serum levels that were at least two standard deviations above the mean for normal individuals. The mean value for patients with BPF was significantly greater than any other groups studied. The thymosin elevation is similar to alterations seen in certain viral diseases and suggests that BPF is aetiopathogenically distinct from the forms of pemphigus.

Peripleuritis tuberculosa. / Tuberculous peripleuritis

Presentamos un caso de peripleuritis tuberculosa consecutiva a una tuberculosis gangliopleuropulmonar, en una de 10 anos de edad que consulto por una ulceracion cutanea en region medioesternal, adenitis supraclaviculares y axilares.El diagnostico de tuberculosis se confirmo por medio del examen bacteriologico de las lesiones, todas ellas con bacilos acido-alcohol resistentes al examen directo. Fue tratada con isoniacida: 15 mg/kg/dia; rifampicina: 10 mg/kg/dia y etambutol: 20 mg/kg/dia con buena evolucion clinicorradiologica: cierre de las fistulas y ulceraciones.Si bien se trato de una forma clinica de rara observacion en la infancia, considerada grave y de evolucion fisica, que se presenta con mayor frecuencia en pacientes procedentes de nuestro norte argentino, a todo esto se agrego una historia alimentaria muy carenciada, lo que determino una evolucion torpida en los primeros meses, propia de dicha forma lesional. La aparicion de nuevas fistulas y abscesos en pleno tratamiento la llevaron a una nueva internacion para supervisar la medicacion e impedir un riesgo mayor. Su posterior evolucion fue muy buena, con cierre total de las fistulas anteriores y dorsal

Peripleuritis tuberculosa. / Tuberculous peripleuritis

Presentamos un caso de peripleuritis tuberculosa consecutiva a una tuberculosis gangliopleuropulmonar, en una de 10 anos de edad que consulto por una ulceracion cutanea en region medioesternal, adenitis supraclaviculares y axilares.El diagnostico de tuberculosis se confirmo por medio del examen bacteriologico de las lesiones, todas ellas con bacilos acido-alcohol resistentes al examen directo. Fue tratada con isoniacida: 15 mg/kg/dia; rifampicina: 10 mg/kg/dia y etambutol: 20 mg/kg/dia con buena evolucion clinicorradiologica: cierre de las fistulas y ulceraciones.Si bien se trato de una forma clinica de rara observacion en la infancia, considerada grave y de evolucion fisica, que se presenta con mayor frecuencia en pacientes procedentes de nuestro norte argentino, a todo esto se agrego una historia alimentaria muy carenciada, lo que determino una evolucion torpida en los primeros meses, propia de dicha forma lesional. La aparicion de nuevas fistulas y abscesos en pleno tratamiento la llevaron a una nueva internacion para supervisar la medicacion e impedir un riesgo mayor. Su posterior evolucion fue muy buena, con cierre total de las fistulas anteriores y dorsal