The Evaluation of a Golden Period of Fasciotomy for High Voltage Electrical Burn Injury Patients With Compartment Syndrome.

Electrical burn injuries can cause various acute manifestations that require surgeons to make an early decision, such as fasciotomy for compartment syndromes. Early decompression can become a 'golden period'for limb salvation. This study evaluates the duration of burn to fasciotomy (B-F time) and amputation. A cross-sectional study was performed on medical records. Inclusion criteria were patients with high voltage electrical injuries and compartment syndrome. Exclusion criteria were patients whose extremities were already non-vital on admission and those lost to follow up. Demographic information, burn surface area and B-F time for patients amputated above the elbow (group A amputation), below the elbow (group B amputation), and no amputation (non-amputated) were investigated. More than 50% patients underwent amputation and 60% had less than 18 hours B-F time. Mean B-F time for non-amputated patients was 18 hours and for amputated patients 20.38 hours. Mean burn to amputation (B-A) time and fasciotomy to amputation (F-A) time in group B was about double compared to group A. The B-A time range of group Awas 4.2-7.3 days. Our study showed 18 hours maximum to be the golden period of burn to fasciotomy. The window period of muscle injury evaluation is maximum 7 days to permit limb salvation at the lowest level possible.

Les brûlures électriques peuvent entraîner des situations cliniques nécessitant une chirurgie urgente, en particulier une aponévrotomie pour syndrome de loge. Cette étude se penche sur l'évaluation de la corrélation entre le délai de réalisation d'une aponévrotomie après brûlure (délai B-A) et une amputation. Il s'agit d'une étude comparative rétrospective sur dossiers. Le critère d'inclusion était l'apparition d'un syndrome de loge après électrisation. Les critères d'exclusion étaient l'existence de nécrose distale d'emblée et les perdus de vue. Nous avons relevé les données démographiques, la surface brûlée, le délai B-A et comparé 3 groupes : amputation au bras (amp. A), amputation à l'avant- bras (amp. B) et sans amputation (amp. 0). Plus de la moitié des patients ont été amputés, et le délai B-A était de moins de 18 h pour 60% d'entre eux. Le délai B-F moyen de amp. 0 était de 18 h, et de 20,38 h pour les amputés. Les délais moyens entre brûlure et amputation (B-amp.) et entre aponévrotomie et amputation (A-Amp.) était presque le double chez amp. B que chez amp. A (de 4,2 à 7,3 jours dans ce groupe). Le délai maximal entre électrisation et aponévrotomie semble être de 18 h et le délai avant de décider du niveau d'amputation de 7 j.

Characteristics Of Liquefied Petroleum Gas (Lpg) Related Burn Injuries In Hasan Sadikin Bandung General Hospital.

The number of liquefied petroleum gas (LPG) related burn injuries has increased over recent years in Indonesia, since the conversion of kerosene to LPG in 2007 (government policy). Based on studies in India and China, LPG-related burn injuries have become a serious public health issue. A 5-year retrospective study was conducted from medical records of patients with LPG-related burn injuries. The data included age, gender, place, occupation, LPG tank size, mechanism, burn classification, burn site and concurrent injury. A total of 169 patients with LPG-related burn were admitted. The yearly incidence was in the range of 24-46% of all burn injury cases. They mostly occurred in males (66.2%) aged 36-55 years (43.1%). The most common place was the home (83.4%) and the most common occupation was merchant (32%). LPG leakage (94.7%) was the main cause of burn, followed by LPG explosion (5.3%). A 3-kilogram LPG tank (96.4%) was the most common cause. Patient burn classification was mostly major burns (62.1%), with the most common site being the head and neck (73%), and concurrent with inhalational injury (16%). Our study showed that the increasing number of LPG-related burn injuries is alarming. The majority of the patients were males in the productive age and they suffered major burns. Some of them suffered inhalation injury that increases the risk of mortality. Since LPG leakage was the main cause and the most common place was the home, there must be regulation with government related prevention strategies.

Le nombre de brûlures par GPL a augmenté ces dernières années en Indonésie, suivant la loi sur la conversion kérosène/GPL de 2007. Les études indiennes et chinoises en font un problème de santé publique. Nous avons revu les dossiers des 169 patients admis pour de telles brûlures pendant 5 ans. Les données étudiées comprenaient l'âge, le sexe, le lieu, l'activité, la taille du réservoir de GPL, le mécanisme, la surface, la profondeur, les zones brûlées et les lésions associées. Ces brûlures représentaient 22 à 46% de l'ensemble. Elles touchaient préférentiellement des hommes (66,2%) de 36 à 55 ans (43,1%). Bien que survenant le plus souvent au domicile (83,4%), elles étaient liées à des activités commerciales dans 32% des cas. La fuite de GPL était la cause très largement majoritaire (94,7%), les explosions ne représentant que 5,3% des mécanismes, la bonbonne de 3kg étant impliquée dans 96,4% des accidents. Les brûlures étaient considérées comme graves dans 62,1% des cas ; la zone cervico- faciale était atteinte 3 fois sur 4 (73%). Une inhalation était observée dans 16% des cas. Notre étude montre l'augmentation préoccupante des brûlures graves par GPL, survenant chez des hommes actifs, certains d'entre eux souffrant en plus d'une inhalation, qui accroît le risque létal. La fuite de GPL en étant l'origine prédominante, une législation de prévention primaire doit être mise en place.

[How to evaluate and improve the effectiveness of intensive care]. / Kako prosuditi i poboljsati ucinkovitost intenzivne skrbi.

Organizational problems regarding intensive care units (ICU) have become more and more significant. It is necessary to question the factors which can influence their effectiveness, and in this way ensure the high quality of intensive care. A grading of intensive care units through a quantitative method is necessary, and then a comparison of intensive care units with the same care level. In making a judgement of efficacy we need to follow the whole intensive care process, even after medical treatment. The time has come for establishing a national data base concerning the organization of ICU size, structure, technological capacity, staff, type and number of patients, mortality, length of stay, bed occupation, criteria for admission and discharge, interventions and procedures, etc. Future multidisciplinary units must employ educated and closely-specialized professionals. From the means of estimating the severity of sickness, the relationship between expected and real mortality should be used in judging efficacy. Measuring the burden of work, by using the TISS model, modified according to the conditions of our ICUs, will show the type and quality of the work done, and, in addition, can also determine cost. It points to a rational use of tests, the use of guidelines and recommendations and further recommends the making of our own protocols. Close professional links between ICUs are also necessary.

One line decreases the visibility of a simultaneous identical distant second line.

A top line decreased the visibility of a simultaneous, identical, distant bottom line. This context-produced decrease in visibility (DV) occurred when the bottom line was masked by flanking lines and hence was less visible than the top line. It continued when the top line was three times as far from the bottom line. It disappeared without the mask. There was a hint of an opposing context-produced increase in visibility (IV) when the lines were close together. The DV is not accounted for by numerous extant phenomena and theories. It means that the top line decreased the similarity in visibility between it and the bottom line, a contrast effect for visibility, rather than for a typical attribute. Contrast does not occur between two attributes that are perceptually equal. Therefore, the reason why two distant equally visible objects fail to result in a DV may be that their equal visibility precludes the occurrence of contrast. This DV-as-contrast theory is consistent with evidence that two groups (phenomenal wholes) are associated with both contrast and DVs, and thus also with evidence that one group is associated with both assimilation and IVs.

The association of assimilation and an increase in visibility in perceptual grouping.

Subjects performed a series of forced-choice discriminations to determine whether both group-assimilation and group-visibility associations could be obtained from nearly identical strong and weak group patterns. The discrimination between the context+target square and the context [symbol: see text] was better than between the target- and background, as was the case for --, whose context and target components were its left and right halves, but not for [symbol: see text]. Square and -- produced a better performance when their lines (halves) were the same in color, and a poorer performance when their lines were different in color, but [symbol: see text] produced the reverse. Likewise, only square and -- produced a better performance when closed, and a poorer performance when open. These context+target etc., same-different, and closure results argue that square and -- produced a greater increase in visibility of their component --, more assimilation among their parts, and a stronger group than did [symbol: see text]. This evidence of a group-assimilation-visibility association cannot be attributed to the fortuitous occurrence of an increase in visibility with one object, assimilation with a second, and closure with a third, unlike previous evidence. This association cannot be explained by feature-based theories. Therefore, a superordinate unit is the cause of this association.

Prevalence of antibodies to Borrelia burgdorferi flagellin in Styrian blood donors.

Lyme borreliosis and tick-borne encephalitis (TBE) are the most common diseases in Austria caused by tick bites. TBE endemic areas are well defined. It seemed to be of interest to compare prevalence data of antibodies against Borrelia burgdorferi (B.b.) to TBE endemic and non endemic areas. Blood samples (n = 1162) were obtained from healthy blood donors in combination with a standardized questionnaire during 21 excursions to 7 selected regions of Styria, Austria. Serum samples were screened for IgG antibodies against B.b. by a commercial flagellum ELISA. None of the tested persons showed symptoms of active Lyme borreliosis. A higher prevalence of antibodies against B.b. could be found in TBE endemic areas (7.7%) compared to TBE nonendemic areas (3.8%). There was a significant increase in positive antibodies against B.b. with age, exposure and number of tick bites remembered by test persons. The antibody prevalence to B.b. flagellin antigen is significantly higher in TBE endemic areas than in non-endemic comparative regions.

A clinical trial of hydroxyethylrutosides in the treatment of haemorrhoids of pregnancy.

The safety and efficacy of 500 mg O-(beta-hydroxyethyl)rutosides given orally twice daily in the treatment of 97 patients with first-, second-, or third-degree haemorrhoids were investigated in a double-blind, randomized placebo-controlled trial. The rutosides produced a significant (P less than 0.001) improvement in patient-assessed subjective symptoms (pain, bleeding, exudation and pruritus) compared with placebo. There was also a significant (P less than 0.001) improvement in clinician-assessed subjective and objective signs (bleeding, inflammation and dilatation of the haemorrhoidal plexus) after 2 and 4 weeks' treatment compared with placebo. There were three mild, transient side-effects reported in the active treatment group and no drug-related problems in the pregnancy or delivery were observed. The results suggest that O-(beta-hydroxyethyl)rutosides provide a safe and effective treatment for women with haemorrhoids of pregnancy.

AIDS and Austrian physicians.

Physicians have key roles both in treating disease and educating their patients about health and disease-related issues. To assess which factors correlate with Austrian physician's willingness to treat and educate patients about HIV-related risk behaviors and deal with AIDS issues, we conducted a survey of general practitioners, internists, and dermatologists in Graz, Austria. We report on some aspects of the knowledge, attitudes, and practices of these physicians. Factor analysis revealed two attitudinal components significantly associated with HIV-related practices of the respondents. We labeled these components Reluctance and Infection. "Reluctance" reflected discomfort with sex-related matters and was associated with less HIV counseling and less interest in HIV-related continuing medical education. "Infection" reflected a fear of contracting HIV disease and was positively associated with an increased assessment of different risk factors and a tendency to refer HIV-infected patients for all further treatment. Results suggest that physicians need further training in their ability to deal with HIV issues. Fortunately they seem willing to improve and take further training to do so. Patients, physicians, and the public would all benefit from acknowledging and dealing with the attitudes and needs of physicians toward HIV-related issues.

Cancer mortality from 1978 to 1987 in smaller regions of Styria, Austria, with different environmental conditions.

In 1984 we have shown in a study, that regions with high air pollution have a higher respiratory cancer rate than regions without substantial air pollution. In this study 45 small regions of Styria, which can be considered homogenous from an environmental viewpoint, have been studied with respect to age standardized respiratory cancer mortality. These small regions have been classified into regions without substantial air pollution, with substantial air and substantial water pollution. Between 1978 and 1987 we have found that small regions with substantial air or water pollution show an increased age standardized respiratory cancer mortality than small regions with "good" environmental conditions. In some regions the rate was twice as high compared to regions without substantial environmental problems. The main difference was found for the age group between 60 and 75 years. Generally between 1978 and 1987 no trend has been observed, only within age groups a shift can be seen.

[The HELLP syndrome--a case report]. / HELLP sindrom--uz prikaz bolesnice.

A 31-year-old secundipara with eclampsia developed the HELLP syndrome after delivery. Clinically, along with very high blood pressure values (29.3/17.3 kPa) and eclamptic attacks, an intense pain in the upper abdomen and nausea were dominant. The patient also had severe thrombocytopenia (18 x 10(9)/L), hemolysis, and increased liver enzymes (SGOT up to 220 U/L and SGPT up to 100 U/L). An intensive therapy, including--together with usual interventions in serious EPH gestoses--also plasmapheresis, antithrombin III substitution, freshly frozen plasma, and transfusion of blood and thrombocytes, proved successful in achieving the normalization of the blood pressure, blood count and liver enzymes, as well as a clinical improvement, so that 18 days after delivery it was possible for the patient to go home, provided with necessary instructions.

Hygienic investigation of coastal waters of the upper Adriatic Sea.

In the course of the bathing season of 1989, investigations of bathing waters were carried out in two-week intervals. From the point of view of public health, the chemical-physical and microbiological results do not suggest objections against bathing at the beach areas investigated (Grado, Lignano). However, these favorable results do not imply intact ecological conditions. National and international standards are designed for humans and allow only very limited conclusions about the living conditions of the marine ecosystem. This also means that ecological investigations are not sufficient to permit conclusions about hygienic conditions. In spite of this seeming contradiction, hygienic and ecological concerns are clearly identical. Hygienic measures must not be limited to local "cosmetic" corrections but must target foremost unfavorable basic conditions.

[Pulmonary silicosis complicated by systemic vasculitis]. / Silikoza pluca komplicirana sistemskim vaskulitisom.

A patient is described who had been--as a cutter of crystal--for 40 yrs exposed to the silica dust. At regular medical examinations at out-patients' department for pulmonary diseases first stage of pulmonary silicosis had been found and confirmed at the Institute for Occupational Health. Nine years after the retirement the clinical symptoms of febrility, cough, joint and muscular pains appeared together with the difficulties in swallowing and dyspnea even at minor physical activities. During the treatment the systemic vasculitis, probably visceral erythematodes, was established with satisfactory response to the corticosteroid therapy.

[Air pollution emissions and changes in lung function]. / Luftschadstoff-Immissionen und die Veränderung der Lungenfunktion.

Among the environmental hazards in a modern industrial society, air pollutants are of major significance. They can directly affect the cells of the bronchopulmonary system and lead to an irritation of the epithelial and immunocompetent cells. This results in a decreased secretion of immunoglobulin A, and, consequently, a decreased resistance against infections. Thereby pathogens, especially bacteria, may lead to an inflammation of the respiratory tract. Apart from the direct toxic effect of their pollutants, recurrent inflammations eventually lead to small airway obstruction. The spirometric parameters FVC, FEV1 and MEF50 were reduced. IgA concentration in the saliva was determined by means of immunodiffusion and was found to be reduced when compared to a less exposed group. A series of pathogenic germs were isolated from various mucous membranes (conjunctiva, nose/throat). The median immissions for the children examined were 1.345 mg/m3 SO2 and 0.189 mg/m3 HCl.

[Ultrasound in the diagnosis of pulmonary and pleural diseases]. / Ultrazvuk u dijagnostici bolesti pluca i pleure.

Ultrasound as a method in evaluation of pleural diseases, peripheral pulmonary infiltrates and tumors has already been accepted throughout the world. However we haven't yet been applying it widely. In this work the possibilities of ultrasound as a method in pleural and lung diseases diagnostics have been described, together with the typical findings and examination technique. Indications of thoracic ultrasound which along with unavoidable X-ray examinations represent a new increase of quality in the diagnostics of pleural and lung diseases are specified.