Abdominal compartment syndrome in burns patients: Introduction of an evidence-based management guideline and algorithm.

ABSTRACT: Abdominal compartment syndrome is a serious potential complication of burn injury, and carries high morbidity and mortality. Although there are generalised published guidelines on managing the condition, to date no management algorithm has yet been published tailored specifically to the burn injury patient. We set out to examine the literature on the subject in order to produce an evidence based management guideline, with the aim of improving outcomes for these patients. The guideline covers early detection and assessment of the condition as well as optimum medical, surgical and postoperative management. We believe that this guideline provides a much needed benchmark for managing burns patients with raised intra-abdominal pressure, as well as providing a template for further research and improvements in care.

The Uppingham typhoid outbreaks of 1875-1877: a rural case-study in public health reform.

Uppingham, a small market town in the East Midlands, suffered repeated typhoid outbreaks in 1875-6, centred on its famous boarding school. A fierce battle developed between the school doctor and the local medical officer of health (MoH), with the Local Government Board (LGB) struggling to satisfy the various parties, many of which had a vested interest in controlling rate increases. Faced with ruin if nothing were done, the headmaster, Edward Thring, removed the school to the Welsh coast for an entire year. The town's shopkeepers, heavily dependent on the school, forced the Rural Sanitary Authority (RSA) to implement better drainage, while Thring and others set up a private company to supply water to the town. Writers such as Hamlin, Hennock and Wohl have already pointed to the formidable obstacles to public health reform facing authorities in urban areas. Uppingham's experience, unusually well documented for a small community, suggests that in rural areas these difficulties were equally great, and that local leaders were hopelessly ill-equipped for the task they faced.

Perianal abscess: a pilot study comparing packing with nonpacking of the abscess cavity.

PURPOSE: Perianal sepsis is traditionally treated by incision and drainage, with packing of the residual cavity until healing. This study was designed to show that perianal abscess may be safely treated by incision and drainage alone. METHODS: Healing times, analgesic requirements, pain scores, abscess recurrence, and fistula rates were compared between two randomized groups treated with and without packing of perianal abscess cavities. RESULTS: Fifty patients were recruited (7 lost to follow-up): 20 in the packing and 23 in the nonpacking arm. The groups were comparable in terms of age and gender distribution, type and size of abscess, and the presence of a fistula at operation. Mean healing times were similar ( P = 0.214). The rate of abscess recurrence was similar ( P = 0.61). Postoperative fistula rates were similar ( P = 0.38). Pain scores at the first dressing change were similar ( P = 0.296). Although pain scores appeared much reduced in the nonpacking arm, this did not attain statistical significance. CONCLUSIONS: Our pilot study indicates that perianal abscesses can be managed safely without continued packing of the cavity without any obvious complications.