Flammable liquid burns in children

Objectives: To document and describe the effects of flammable liquid burns in children. To identify the at risk population in order to tailor a burns prevention programme. Design, patients and setting: Retrospective study with information obtained from the departmental database of children treated at the burns centre at The Royal Children's Hospital, Brisbane between August 1997 and October 2002. Main outcome measures: Number and ages of children burned, risk factors contributing to the accident, injuries sustained, treatment required and long-term sequelae. Results: Fifty-nine children sustained flammable liquid burns (median age 10.5 years), with a clear preponderance of males (95%). The median total body surface area burned was 8% (range 0.5-70%). Twenty-seven (46%) of the patients required debridement and grafting. Hypertrophic scars occurred in 56% of the children and contractures in 14%, of which all of the latter required surgical release. Petrol was the causative liquid in the majority (83%) of cases. Conclusions: The study identified the population most at risk of sustaining flammable liquid burns were young adolescent males. In the majority of cases these injuries were deemed preventable. (C) 2003 Elsevier Science Ltd and ISBI. All rights reserved.

Gastroschisis: determinants of neonatal outcome

This retrospective study elicits information regarding the dependence of neonatal outcome in gastroschisis upon: (1) the mode of delivery, (2) place of birth, (3) time for birth to surgery, (4) method of closure, (5) time from operation to commencement of first enteral feeds. The neonatal intensive care database from five major tertiary centres was used to identify 181 neonates with gastroschisis from 1990 to 2000. There were 8 deaths. There were no significant differences in outcome for infants delivered vaginally (102) versus Caesarean section (79), those born near the tertiary centre (133) as compared to infants born away (48), ones operated within 7 hours (125) compared with those operated after 7 hours (56), with delayed closure (30) versus primary closure (151). Neonates fed within 10 days of operation (85) had significantly lower incidence of sepsis, duration of TPN and hospital stay when compared to those fed after 10 days (96). Early commencement of feeds decreases the incidence of sepsis, duration of total parenteral nutrition (TPN) and hospital stay. Place of delivery, mode of delivery, time to surgery and type of closure do not influence neonatal outcome.

Protocols for listing threatened species can forecast extinction

Risk-ranking protocols are used widely to classify the conservation status of the world's species. Here we report on the first empirical assessment of their reliability by using a retrospective study of 18 pairs of bird and mammal species (one species extinct and the other extant) with eight different assessors. The performance of individual assessors varied substantially, but performance was improved by incorporating uncertainty in parameter estimates and consensus among the assessors. When this was done, the ranks from the protocols were consistent with the extinction outcome in 70-80% of pairs and there were mismatches in only 10-20% of cases. This performance was similar to the subjective judgements of the assessors after they had estimated the range and population parameters required by the protocols, and better than any single parameter. When used to inform subjective judgement, the protocols therefore offer a means of reducing unpredictable biases that may be associated with expert input and have the advantage of making the logic behind assessments explicit. We conclude that the protocols are useful for forecasting extinctions, although they are prone to some errors that have implications for conservation. Some level of error is to be expected, however, given the influence of chance on extinction. The performance of risk assessment protocols may be improved by providing training in the application of the protocols, incorporating uncertainty in parameter estimates and using consensus among multiple assessors, including some who are experts in the application of the protocols. Continued testing and refinement of the protocols may help to provide better absolute estimates of risk, particularly by re-evaluating how the protocols accommodate missing data.

Carotid endarterectomy relieves pulsatile tinnitus associated with severe ipsilateral carotid stenosis

Objectives. Pulsatile tinnitus is a rare and often disabling condition. Pulsatile tinnitus sometimes occurs in patients with severe atherosclerotic carotid stenosis. It is uncertain whether carotid endarterectomy (CEA) relieves pulsatile tinnitus in patients with severe carotid stenosis. Design, Materials and Methods. This is a retrospective study of 14 patients with pulsatile tinnitus who underwent CEA. Demographic and clinical features and pre-operative duplex results were recorded. Operative results in this group were assessed. Results. CEA relieved symptoms of pulsatile tinnitus in 10 out of 14 cases (70%). Of 10 patients that had lateralisable tinnitus and ipsilateral surgery, 9 (90%) reported symptomatic improvement. Conclusions. CEA is effective in improving pulsatile tinnitus in patients with unilateral symptoms and severe ipsilateral carotid stenosis.

Epidemiology of open- and closed-globe trauma presenting to Cairns Base Hospital, Queensland

Purpose: To review the epidemiology of serious ocular trauma presenting to Cairns Base Hospital, from the far north Queensland health districts. Methods: A retrospective study of cases from January 1995 to November 2002 inclusive. Cases were analysed with respect to demographics, cause and nature of injury, method of transport and time to and type of ophthalmic treatment, and visual outcomes. Results: There were 226 cases identified, including 71 open-globe and 155 closed-globe injuries. The annual rate of injury was 3.7 per 100 000 for open-globe and 11.8 per 100 000 in total. The Aboriginal and Torres Strait Islander population from the far north Queensland districts showed a disproportionate incidence, with 38% of the total number of injuries, despite representing only 12.3% of the population. Assault in the Aboriginal and Torres Strait Islander population resulted in 69.6% of injuries in men and 75.8% of injuries in women. Of all assaults 76.2% were alcohol-related. The majority (71.5%) of injuries in the Caucasian population were due to accidental blunt and sharp trauma. In total, 77.4% of injuries occurred in men, with an average age of 31 years. Of all open and closed injuries in the study, a final visual acuity of 6/12 or better was achieved in 47.8% of eyes and a final visual acuity of 6/60 or less occurred in 17.7% of patients, 20.8% patients were lost to follow up. In total, 14.1% of open injuries required enucleation/evisceration. Conclusions: The incidence of ocular trauma in far north Queensland is equal to other Australian populations. However, there is a disproportionately high incidence in the Aboriginal and Torres Strait Islander population. Alcohol-related assault is a significant cause of visual loss in the Aboriginal and Torres Strait Islander population. Closed-globe injuries are more common than open globe; however, the latter have poorer visual prognosis. Initial visual acuity of all injuries correlated with final visual acuity.

The use of recombinant activated factor VII for refractory bleeding post complex cardiothoracic surgery

We reviewed the outcome following use of recombinant activated factor VII (rVIIa) in patients with major bleeding post cardiothoracic surgery in our unit between January 2002 and July 2004. The unit consists of 16 cardiothoracic intensive care beds in a public metropolitan teaching hospital which serves as a referral centre for heart and lung transplant surgery Patients with refactory bleeding following cardiothoracic surgical procedures who were treated with rVIIa were identified. A total of 12 episodes of rVIIa use were recorded in ten patients, including three episodes with ventricular assist devices, and 5 heart and/or lung transplants. The median dose used was 85 mu g/kg. Chest tube drainage decreased in all patients following administration of rVIIa; median chest tube drainage decreased front 445 ml/h to 171 ml/h (P=0.03). Despite cessation of bleeding, mortality was high, when rVIIa was used after more than 24 hours. In six episodes, despite early rVIIa use (within six hours), continued bleeding necessitated return to theatre, where a surgical source of bleeding was found. In this small retrospective study, rVIIa significantly reduced bleeding that was refractory to standard blood product transfusion. In this series of patients., those that did not respond to rVIla early in the postoperative phase were found to have a surgical source of bleeding.

Prevalence of drug-resistance mutations and non-subtype B strains among HIV-infected infants from New York State

Summary: Prevalence studies indicate that transmission of drug-resistant HIV has been rising in the adult population, but data from the perinatally infected pediatric population are limited. In this retrospective study, we sequenced the pol region of HIV from perinatally infected infants diagnosed in New York State in 2001-2002. Analyses of drug resistance, subtype diversity, and perinatal antiretroviral exposure were conducted, and the results were compared with those from a previous study of HIV-infected infants identified in 1998-1999. Eight of 42 infants (19.1%) had provirus carrying at least 1 drug-resistance mutation, an increase of 58% over the 1998-1999 results. Mutations conferring resistance to nucleoside reverse transcriptase inhibitors, nonnucleoside reverse transcriptase inhibitors, and protease inhibitors were detected in 7.1%, 11.9%, and 2.4% of specimens, respectively. Consistent with previous results, perinatal antiretroviral exposure was not associated with drug resistance (P = 0.70). Phylogenetic analysis indicated that 16.7% of infants were infected with a non-subtype B strain of HIV. It seems that drug-resistant and non-subtype B strains of HIV are becoming increasingly common in the perinatally infected population. Our results highlight the value of resistance testing for all HIV-infected infants upon diagnosis and the need to consider subtype diversity in diagnostic and treatment strategies.