Administration of Tumescence in Pediatric Burn Patients Causes Significant Hypertension

2019 ◽  
Vol 40 (6) ◽  
pp. 752-756 ◽  
Author(s):  
Holly B Weis ◽  
Kyle E Meinhardt ◽  
Abu Minhajuddin ◽  
Hannah Viroslav ◽  
Meaghan Colletti ◽  
...  
Keyword(s):  
Nonparametric Tests ◽  
Burn Patients ◽  
Univariate Logistic Regression Analysis ◽  
Predominately White ◽  
Estimated Blood Loss ◽  
High Incidence ◽  
Male Patients ◽  
Clinically Significant ◽  
Duration Of Operation ◽  
Intraoperative Hypertension

AbstractThe effects of injecting tumescence containing phenylephrine in pediatric burn patients are unknown, but anecdotally our clinicians note a high incidence of hypertension requiring treatment. This study sought to determine whether tumescence with phenylephrine was associated with hypertension requiring treatment in our pediatric burn patients. This was a retrospective cohort study of pediatric burn patients who underwent tangential excision with split-thickness autografting, excision alone, or autografting alone from 2013 to 2017. Records were reviewed for hypertensive episodes, defined as ≥2 consecutive blood pressure readings that were >2 SD above normal. Published intraoperative age- and sex-adjusted standards were used to define reference values. Parametric and nonparametric tests were used when appropriate. In total, 258 operations were evaluated. Mean patient age was 7.6 ± 5.2 years, and 64.7% were male. Patients were predominately white (69.8%). Overall, there was a 62.8% incidence of hypertension. On univariate logistic regression analysis, duration of operation, estimated blood loss, treated TBSA, and weight-adjusted volume of tumescence were significant predictors of intraoperative hypertension (P < .01). On multivariate analysis, weight-adjusted volume of tumescence alone was significantly associated with the presence of hypertension with an odds ratio of 2.0 (95% confidence interval: 1.33–3.04). Of the 162 operations which exhibited at least one episode of significant hypertension, 128 cases (79%) were treated. Intraoperative administration of phenylephrine-containing tumescence in pediatric burn patients is associated with clinically significant hypertension requiring treatment. This practice should be conducted with caution in pediatric burn operations until its clinical implications are defined.

The Frequency of Random Findings on Abdominal / Pelvis Computed Tomography in Pediatric Trauma Patients

2020 ◽  
Vol 16 ◽  
Author(s):  
Betül Tiryaki Baştuğ
Keyword(s):  
Computed Tomography ◽  
Incidental Findings ◽  
Pediatric Population ◽  
Pediatric Trauma ◽  
Trauma Patients ◽  
Injured Child ◽  
Level 3 ◽  
Male Patients ◽  
Clinically Significant ◽  
Discharge Summaries

Aims: In this study, we aimed to find the percentage of random pathologies and abdominopelvic region anomalies that are not related to trauma in pediatric patients. Background: An abdominal assessment of an injured child usually involves computed tomography imaging of the abdomen and pelvis (CTAP) to determine the presence and size of injuries. Imaging may accidentally reveal irrelevant findings. Objectives: Although the literature in adults has reviewed the frequency of discovering these random findings, few studies have been identified in the pediatric population. Methods: Data on 142( 38 female, 104 male) patients who underwent CTAP during their trauma evaluation between January 2019 and January 2020 dates were obtained from our level 3 pediatric trauma center trauma records. The records and CTAP images were examined retrospectively for extra traumatic pathologies and anomalies. Results: 67 patients (47%) had 81 incidental findings. There were 17 clinically significant random findings. No potential tumors were found in this population. Conclusion: Pediatric trauma CTAP reveals random findings. For further evaluation, incidental findings should be indicated in the discharge summaries.

scholarly journals A Nationwide Survey on Danon Disease in Japan

2018 ◽  
Vol 19 (11) ◽  
pp. 3507 ◽  
Author(s):  
Kazuma Sugie ◽  
Hirofumi Komaki ◽  
Nobuyuki Eura ◽  
Tomo Shiota ◽  
Kenji Onoue ◽  
...  
Keyword(s):  
De Novo ◽  
Sudden Cardiac Arrest ◽  
Nationwide Survey ◽  
Clinicopathological Features ◽  
Significant Prognostic Factor ◽  
De Novo Mutations ◽  
Present Survey ◽  
Danon Disease ◽  
High Incidence ◽  
Male Patients

Danon disease, an X-linked dominant cardioskeletal myopathy, is caused by primary deficiency of lysosome-associated membrane protein-2 (LAMP-2). To clarify the clinicopathological features and management, we performed the first nationwide, questionnaire-based survey on Danon disease in Japan. A total of 39 patients (17 males, 22 females) from 20 families were identified in the analysis. All patients had cardiomyopathy. Of the 21 patients who died, 20 (95%) died of cardiac failure or sudden cardiac arrest. Most patients had hypertrophic cardiomyopathy. Wolf–Parkinson–White syndrome was present at a comparatively high incidence (54% in males, 22% in females). Only one female patient received a heart transplant, which is the most effective therapy. Histopathologically, all male patients showed autophagic vacuoles with sarcolemmal features in muscle. Half of the probands showed de novo mutations. Male patients showed completely absent LAMP-2 expression in muscle. In contrast, female patients showed decreased LAMP-2 expression, which is suggested to reflect LAMP-2 haploinsufficiency due to a heterozygous null mutation. In conclusion, Danon disease is an extremely rare muscular disorder in Japan. Cardiomyopathy is the most significant prognostic factor and the main cause of death. Our findings suggest that the present survey can extend our understanding of the clinical features of this rare disease.

scholarly journals A 3-Years Pneumonia Incidence in Burn Cases with Inhalation Injury at the Burn Center of Dr. Soetomo General Hospital Surabaya in 2015-2018

2022 ◽  
Vol 13 (1) ◽  
pp. 27
Author(s):  
Salsabilla Gina Rania ◽  
Lynda Hariani ◽  
Helmia Hasan ◽  
Iswinarno Doso Saputro
Keyword(s):  
General Hospital ◽  
Early Adulthood ◽  
Secondary Data ◽  
Inhalation Injury ◽  
Burn Patients ◽  
Risk Of Death ◽  
Burn Center ◽  
Specific Term ◽  
Male Patients

Introduction: Inhalation injury is one of burns impact. Airway burns due to inhalation injury is a non-specific term which refer to all respiratory tract injuries occurred due to irritative chemicals, including heat and smoke during inspiration. Inhalation injury increases the risk of death in burns. Pneumonia is one of burns-related inhalation injury complications.Methods: This was a descriptive retrospective study aiming to determine the incidence of pneumonia in burn patients with inhalation injury using secondary data at Burn Center Dr. Soetomo General Hospital Surabaya in the period of January 2015 - December 2018.Results: There were 5 cases of pneumonia in 14 burn cases with inhalation injury (35.71%). Respectively, 2 and 3 cases were found in 2017 and 2018. There were 2 female (40%) and 3 male (60%) patients, with age varied within 28-73 years old. The burn area of burn patients with inhalation injury and pneumonia were found by 15%, 20%, 24%, 32% and 71%, or within the classification of 11-20% burn area, and most complication found was hypoalbuminemia, as much as 3 cases (60%).\Conclusion: Most pneumonia in burn cases with inhalation injury was occurred in 2018, dominated by male patients. The age of the patient were ranging from early adulthood to elderly. Most burns were in the range of 11-20% burn area with the most complication found was hypoalbuminemia.

scholarly journals Isolation of bacterial flora from post burn infection: influence of socio-demographic background on the occurrence of burn injury

2020 ◽  
Vol 5 (4) ◽  
pp. 336-342
Author(s):  
Amatun Nasir Tama ◽  
Aleya Begum ◽  
Mandira Mukutmoni ◽  
Mohammad Rabiul Karim Khan
Keyword(s):  
Staphylococcus Aureus ◽  
Burn Injury ◽  
Bacterial Flora ◽  
Occupational Status ◽  
Burn Patients ◽  
Bacteriological Profile ◽  
Degree Burn ◽  
Male Patients ◽  
Susceptibility Tests ◽  
Demographic Background

The objective of this work was to find out the bacteriological profile and risk factor for burn patients. Sixty burn patients were investigated during July 2014 to May 2015. Specimens were collected in the form of wound swabs. The prospective study showed that one third of the patients below 10 years old belong the highest burn infections. The rate of burn infections was higher (61.67%) in female compared to male patients. Respondents under primary level were the major victims (28.33%). On the basis of occupational status, student showed the highest (30%) infection. Maximum (48.33%) patients were injured by first degree burn. Hot liquids (scald) was found as one of the main causes of burn which was 50% prevalent. Forensic background explained maximum burn injuries were accidental (88.34%). Most of the children were the main victims during playing (36.67%) followed by working persons (25%). Pseudomonas spp (73%) was found to be the most common isolated microorganisms followed by Klebsiella spp (6.67%), Staphylococcus aureus (6.67%), Escherichia coli (6.67%), Proteus spp (5%) and Enterobacter (1. 6%). Some medical devices like floor, bed, water etc. were detected as positive sources of organisms. By antibiotic susceptibility tests it was found that Pseudomonas are resistant to ceftriaxone (100%) followed by ceftazidime (93%) and sensitive to colistin (90%). In the case of Staphylococcus aureus, 100% are resistant to amoxyclave and 100% are sensitive to ciprofloxacin. Asian J. Med. Biol. Res. June 2019, 5(4): 336-342

Mechanisms of action of second generation antipsychotic drugs in schizophrenia: insights from brain imaging studies

2005 ◽  
Vol 20 (1) ◽  
pp. 15-27 ◽  
Author(s):  
Anissa Abi-Dargham ◽  
Marc Laruelle
Keyword(s):  
First Generation ◽  
Antipsychotic Drugs ◽  
Second Generation ◽  
Dopaminergic System ◽  
Therapeutic Strategies ◽  
Therapeutic Action ◽  
Imaging Studies ◽  
High Incidence ◽  
Second Generation Antipsychotic ◽  
Clinically Significant

AbstractMultiple lines of evidence including recent imaging studies suggest that schizophrenia is associated with an imbalance of the dopaminergic system, entailing hyperstimulation of striatal dopamine (DA) D2 receptors and understimulation of cortical DA D1 receptors. This DA endophenotype presumably emerges from the background of a more general synaptic dysconnectivity, involving alterations in N-methyl-d-aspartate (NMDA) and glutamatergic (GLU) functions. Equally important is the fact that this DA dysregulation might further impair NMDA transmission. The first generation antipsychotic (FGA) drugs are characterized by high affinity to and generally high occupancy of D2 receptors. The efficacy of FGAs is limited by a high incidence of extrapyramidal side-effects (EPS). Second generation antipsychotic (SGA) drugs display reduced EPS liability and modest but clinically significant enhanced therapeutic efficacy. Compared to FGAs, the improved therapeutic action of SGAs probably derives from a more moderate D2 receptor blockade. We will review the effects of SGAs on other neurotransmitter systems and conclude by highlighting the importance of therapeutic strategies aimed at directly increasing prefrontal DA, D1 receptor transmission or NMDA transmission to enhance the therapeutic effect of moderate D2 receptor antagonism.

scholarly journals Tourniquet Use in Wide-Awake Carpal Tunnel Release

Hand ◽  
2018 ◽  
Vol 15 (1) ◽  
pp. 59-63 ◽  
Author(s):  
Sarah E. Sasor ◽  
Julia A. Cook ◽  
Stephen P. Duquette ◽  
Elizabeth A. Lucich ◽  
Adam C. Cohen ◽  
...  
Keyword(s):  
Blood Loss ◽  
Carpal Tunnel ◽  
Local Anesthetic ◽  
Operative Time ◽  
Carpal Tunnel Release ◽  
Estimated Blood Loss ◽  
Tunnel Syndrome ◽  
Clinically Significant ◽  
Without Tourniquet ◽  
Wide Awake

Background: Carpal tunnel syndrome is a common cause of upper extremity discomfort. Surgical release of the median nerve can be performed under general or local anesthetic, with or without a tourniquet. Wide-awake carpal tunnel release (CTR) (local anesthesia, no sedation) is gaining popularity. Tourniquet discomfort is a reported downside. This study reviews outcomes in wide-awake CTR and compares tourniquet versus no tourniquet use. Methods: Wide-awake, open CTRs performed from February 2013 to April 2016 were retrospectively reviewed. Patients were divided into 2 cohorts: with and without tourniquet. Demographics, comorbidities, tobacco use, operative time, estimated blood loss, complications and outcomes were compared. Results: A total of 304 CTRs were performed on 246 patients. The majority of patients were male (88.5%), and the mean age was 59.9 years. One hundred patients (32.9%) were diabetic, and 92 patients (30.2%) were taking antithrombotics. Seventy-five patients (24.7%) were smokers. A forearm tourniquet was used for 90 CTRs (29.6%). Mean operative time was 24.97 minutes with a tourniquet and 21.69 minutes without. Estimated blood loss was 3.16 mL with a tourniquet and 4.25 mL without. All other analyzed outcomes were not statistically significant. Conclusion: Operative time was statistically longer and estimated blood loss was statistically less with tourniquet use, but these findings are not clinically significant. This suggests that local anesthetic with epinephrine is a safe and effective alternative to tourniquet use in CTR. The overall rate of complications was low, and there were no major differences in postoperative outcomes between groups.

602 Managing Hypothermia in the Surgical Burn Patient

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S144-S144
Author(s):  
Patricia Regojo ◽  
Molly Mohan
Keyword(s):  
Quality Assurance ◽  
Operating Room ◽  
Core Body Temperature ◽  
Temperature Management ◽  
Evidence Based ◽  
Burn Patients ◽  
Estimated Blood Loss ◽  
Increased Risk ◽  
Burn Unit ◽  
Burn Patient

Abstract Introduction It is known, hypothermia, core body temperature at or below 36oC/96.8oF, can lead to dangerous complications for burn patients. Due to loss of their protective thermoregulation, burn patients are at an increased risk of hypothermia during surgery. Findings from a Quality Assurance audit revealed burn patients were returning from surgery hypothermic and hemodynamically unstable. There was little evidence of intra-operative temperature management in the electronic medical record (EMR) or reported to the nurse upon the patients’ return from the operating room (OR). Only 73% of patients had temperatures recorded during their surgery and of those, 40% had a drop of temperature &gt;2 degrees from their baseline. The purpose of this collaborative evidence-based quality assurance project was to improve temperature management in the operating room and prevent hypothermia in the intra and post operative periods. Our aim was to develop warming methods pre-operatively that would establish a goal for keeping the patients’s temperature within 2 degrees of their baseline preoperative temperature during surgery. Methods A literature search obtained from CINAHL, Cochrane, EMBASE, and MEDLINE from 2010–2018, provided current surgical guidelines and evidence-based practices for managing surgical hypothermia in burn patients (levels of evidence I, III, V, & VI). Recommendations from the burn unit staff for preoperative warming initiatives were listed and shared with the OR staff. Hemodynamic documentation, including core temperature, estimated blood loss, and intra-operative warming methods were monitored for twelve months after the Burn Unit Warming Protocol was implemented. Progress was reported quarterly in our Burn and Trauma Quality Committees. Results After implementing the Burn Unit Warming Protocol, temperature management of the burn patient improved. Intra-operative warming methods were initiated. Patients began returning from surgery warmer with improved hemodynamics. 96% of the patients had their temperatures recorded and managed intra-operatively. Of those patients, only 2.6% had a drop in temperature &gt; 2 degrees from their pre-operative baseline. Conclusions Implementing a nurse-driven warming protocol from the pre-operative stage through surgery can aid in reducing post-operative hypothermia in burn patients. Applicability of Research to Practice Managing hypothermia will help reduce complications that can lead to increase morbidity and mortality in burn patients.

scholarly journals A Study of Early post-operative wound complications of spina bifida aperta repair “Incidence and Risk Factors”

2018 ◽  
Vol 60 (2) ◽  
pp. 89-92
Author(s):  
Ali K. AL-Shalchy ◽  
Wameedh Q. Abdul-hussein
Keyword(s):  
Risk Factors ◽  
Wound Complications ◽  
Spina Bifida Aperta ◽  
Csf Leakage ◽  
High Incidence ◽  
Operation Duration ◽  
The Third World ◽  
Duration Of Operation ◽  
Type Of Delivery ◽  
Early Wound

Background: Myelomeningocele is the single most common congenital anomaly that affects the CNSand vertebral column. The third world countries having a higher incidence. The management is usuallysurgical with relative high incidence of complications.Objectives: to evaluate the possible risk factors that may predispose to early wound complications ofmyelomeningocele.Methods: This prospective study was carried out in the Surgical Specialization Hospital in Medical CityComplex - Baghdad from 2009-2012. 147 cases were included in the study. Requested data weregestational age, type of delivery, gender, age at operation, type of suturing of the wound, tension ofsuturing, duration of operation, site of the lesion, ruptured vs non ruptured myelomeningocele, associatedshunting, peri-operative stay in hospital and associated jaundice.Result: Forty four (44 %) of the total developed complications. All premature infants developedcomplications. Hydrocephalic cases was associated with higher rate of complication (86%). Type ofdelivery, age at operation, duration of operation, ruptured cases and site of the lesion were not associatedwith complications.Conclusion: Myelomeningocele was predominantly affecting female. Most of the complications werewound infection with or without dehiscence, CSF leakage or seroma.

scholarly journals The Shortest Distance from the Skin to Pancreas and the Lower Sternum Angle can Influence Short-Term Surgical Outcomes of Laparoscopy-Assisted Distal Gastrectomy for Gastric Cancer

2020 ◽  
Author(s):  
Dong Peng ◽  
Wei Tao ◽  
Yuxi Cheng ◽  
Ying-Ying Zou ◽  
Kun Qian ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Surgical Outcomes ◽  
Distal Gastrectomy ◽  
Subcutaneous Fat ◽  
Short Term ◽  
Xiphoid Process ◽  
Female Patients ◽  
Shortest Distance ◽  
Estimated Blood Loss ◽  
Male Patients

Abstract Background The surgery of laparoscopic distal gastrectomy + D2 lymph node dissection (LADG) is widely used in patients with gastric cancer, the purpose of the study is to explore the effect of abdominal shape on short-term surgical outcomes.Methods This was a retrospective study which included 316 patients undergoing LADG from January 2013 to June 2019 at a single clinical center. The abdominal parameters including the shortest distance of the pancreas from the anterior abdominal skin (PAAD), the lower sternum angle (LSA), the thickness of subcutaneous fat at the navel level (SFT), the anteroposterior diameters (APD) and left-right diameters(LRD) at the navel level, the distance from xiphoid process to the navel (XND), and the distance from xiphoid process to the pubis (XBD) were calculated by preoperative abdominal computed tomography (CT) image. The parameters and short-term surgical outcomes were analyzed.Results In males, the number of retrieved lymph nodes was significantly higher in patients with BMI <25kg/m2 (p=0.023) and APD <176.2mm (p=0.004). The time of operation was significantly shorter in male patients with BMI <25kg/m2(p=0.001), PAAD <64.6mm(p=0.000), SFT <14.9mm(p=0.017), APD <176.2mm(p=0.002) and LRD <290.0mm(p=0.036), and in female patients with XBD >370.0mm(p=0.042). The estimated blood loss was significantly lower in male patients with LSA <83.8° (p=0.009), PAAD <64.6mm(p=0.001), SFT <14.9mm(p=0.001), APD <176.2mm(p=0.009) and LRD <290.0mm(p=0.011). The complications were fewer in male patients with PAAD <64.6mm(p=0.045) and APD <176.2mm(p=0.011), and in female patients with LRD <288.5mm(p=0.047).Conclusion Various abdominal shapes can influence the difficulty of LADG. Lower LSA and PAAD can reduce the difficulty of LADG in male patients.

scholarly journals Should isolated morbid obesity influence the decision to operate in hip and knee arthroplasty?

2021 ◽  
Vol 2 (7) ◽  
pp. 515-521
Author(s):  
Peter F. Crookes ◽  
Roslyn S. Cassidy ◽  
Aleksander Machowicz ◽  
Janet C. Hill ◽  
John McCaffrey ◽  
...  
Keyword(s):  
Morbid Obesity ◽  
Venous Thromboembolism ◽  
Wound Infection ◽  
Knee Arthroplasty ◽  
High Volume ◽  
Morbidly Obese ◽  
Hip And Knee Arthroplasty ◽  
Clinically Significant ◽  
One Year ◽  
Duration Of Operation

Aims We studied the outcomes of hip and knee arthroplasties in a high-volume arthroplasty centre to determine if patients with morbid obesity (BMI ≥ 40 kg/m2) had unacceptably worse outcomes as compared to those with BMI < 40 kg/m2. Methods In a two-year period, 4,711 patients had either total hip arthroplasty (THA; n = 2,370), total knee arthroplasty (TKA; n = 2,109), or unicompartmental knee arthroplasty (UKA; n = 232). Of these patients, 392 (8.3%) had morbid obesity. We compared duration of operation, anaesthetic time, length of stay (LOS), LOS > three days, out of hours attendance, emergency department attendance, readmission to hospital, return to theatre, and venous thromboembolism up to 90 days. Readmission for wound infection was recorded to one year. Oxford scores were recorded preoperatively and at one year postoperatively. Results On average, the morbidly obese had longer operating times (63 vs 58 minutes), longer anaesthetic times (31 vs 28 minutes), increased LOS (3.7 vs 3.5 days), and significantly more readmissions for wound infection (1.0% vs 0.3%). There were no statistically significant differences in either suspected or confirmed venous thromboembolism. Improvement in Oxford scores were equivalent. Conclusion Although morbidly obese patients had less favourable outcomes, we do not feel that the magnitude of difference is clinically significant when applied to an individual, particularly when improvement in Oxford scores were unrelated to BMI. Cite this article: Bone Jt Open 2021;2(7):515–521.

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