Attempted suicide by means of burns.

A study was made of the results of treatment of 57 patients who made 68 suicide attempts by means of burns in the period between 1979 and 1987. They formed 14 per cent of the total patient population older than 16 years of age. Attempted suicide was observed most frequently in patients between 20 and 39 years of age. The sex incidence was equal. Most patients were in contact with or had been in contact with mental health care institutions at the time of their attempt, half of the attempts took place in a psychiatric hospital. Twelve patients died, in nine the prognosis was considered to be so poor that in view of the seriousness of the burns or the accompanying injuries no treatment was initiated. Follow-up took place after an average 3.8 years (1-8.25 years). Information was obtained on all 45 surviving patients. Eight patients had died, six of natural causes and two had committed suicide. Eighteen patients were living at home, 13 were residents at a psychiatric hospital, three were living in a protective commune, two were being detained during Her Majesty's pleasure and one was in prison. It appeared to be difficult to incorporate these patients in a closed follow-up regimen.

Paradoxical embolism through a patent foramen ovale.

The high prevalence of clinically silent venous thrombosis and the presence of a patent foramen ovale in up to 35% of the general population suggests that paradoxical embolism (PDE) may be the cause of an ischaemic stroke or a peripheral thrombo-embolic occlusion more often than is presently considered. We report an ante-mortem diagnosed case of PDE and a review of the literature. Contrast echocardiography with provocative manoeuvres is suggested as the key investigation for diagnosis and anticoagulation is the mainstay of therapy.

Fasciitis necroticans.

Fasciitis necroticans (F.N.) is a rapidly progressing necrotizing process of subcutaneous tissue and fascia which results in large soft tissue defects and severe systemic toxicity. During the last five years nine patients with F.N. were admitted at our department of surgery. Antibiotic prophylaxis immediately after the eliciting trauma was associated with a significant delay in treatment. Early recognition and surgical treatment are the most important factors influencing survival.

Changes in the serum concentration and the glycosylation of human alpha 1-acid glycoprotein and alpha 1-protease inhibitor in severely burned persons: relation to interleukin-6 levels.

The relation between interleukin-6 (IL-6) levels and changes in serum concentrations and glycosylation (concanavalin A affinity) of two human acute-phase glycoproteins, alpha 1-acid glycoprotein (AGP) and alpha 1-protease inhibitor (PI), was studied in sequential serum samples of burn patients. The level of IL-6 was already increased at the first day following injury, and after a dip at day 2 or 3 rapidly reached a second maximal value at day 4 or 5. The serum concentrations of AGP and PI reached their maximal values after day 5 and remained at a high level throughout the total period studied (7 weeks). The concanavalin A reactivities of both acute-phase glycoproteins were found to be elevated only during the first 2-2.5 weeks. Maximal values were observed on day 2 and from day 7 to 16, following closely the rise and fall of the IL-6 serum level. After day 16, the concanavalin A affinity rapidly declined long before a decrease was observed in the serum concentrations of AGP and PI. Our previous in vitro studies have indicated an involvement of IL-6 in the induction of both secretion and increased concanavalin A affinity. This study indicates that IL-6 could play a causal role in the induction of both phenomena in vivo.