Thermal injuries in three children caused by an electrical warming mattress

Peroperative hypothermia is recognized to increase mortality and morbidity, and the paediatric anaesthetist faces specific challenges resulting from the increased body surface to volume ratio, particularly in smaller children. We describe three children who were consecutive patients on one operating list and sustained severe thermal injuries. These were due to a malfunctioning electrical heating mat, despite appropriate use and monitoring by the attending anaesthetist. It is rare for thermal warming devices to cause injury. We review the use of heating mats, and suggest modifications in their manufacture which may minimize the risks associated with heating devices.

The Quaternary pyroclastic succession of southeast Tenerife, Canary Islands: Explosive eruptions, related caldera subsidence, and sector collapse

A much-revised Quaternary stratigraphy is presented for ignimbrites and pumice fall deposits of the Bandas del Sur, in southern Tenerife. New Ar-41/Ar-39 data obtained for the Arico, Granadilla, Fasnia, Poris, La Caleta and Abrigo formations are presented, allowing correlation with previously dated offshore marine ashfall layers and volcaniclastic sediments. We also provide a minimum age of 287 +/- 7 ka for a major sector collapse event at the Gaimar valley. The Bandas del Sur succession includes more than seven widespread ignimbrite sheets that have similar characteristics, including widespread basal Plinian layers, predominantly phonolite composition, ignimbrites with similar extensive geographic distributions, thin condensed veneers with abundant diffuse bedding and complex lateral and vertical grading patterns, lateral gradations into localized massive facies within palaeo-wadis, and widespread lithic breccia layers that probably record caldera-forming eruptions. Each ignimbrite sheet records substantial bypassing of pyroclastic material into the ocean. The succession indicates that Las Canadas volcano underwent a series of major explosive eruptions, each starting with a Plinian phase followed by emplacement of ignimbrites and thin ash layers, some of coignimbrite origin. Several of the ignimbrite sheets are compositionally zoned and contain subordinate mafic pumices and banded pumices indicative of magma mingling immediately prior to eruption. Because passage of each pyroclastic density current was characterized by phases of non-deposition and erosion, the entire course of each eruption is incompletely recorded at any one location, accounting for some previously perceived differences between the units. Because each current passed into the ocean, estimating eruption volumes is virtually impossible. Nevertheless, the consistent widespread distributions and the presence of lithic breccias within most of the ignimbrite sheets suggest that at least seven caldera collapse eruptions are recorded in the Bandas del Sur succession and probably formed a complex, nested collapse structure. Detailed field relationships show that extensive ignimbrite sheets (e.g. the Arico, Poris and La Caleta formations) relate to previously unrecognized caldera collapse events. We envisage that the evolution of the nested Las Cahadas caldera is more complex than previously thought and involved a protracted history of successive ignimbrite-related caldera collapse events, and large sector collapse events, interspersed with edifice-building phases.

Longitudinal excursion and strain in the median nerve during novel nerve gliding exercises for carpal tunnel syndrome

Nerve and tendon gliding exercises are advocated in the conservative and postoperative management of carpal tunnel syndrome (CTS). However, traditionally advocated exercises elongate the nerve bedding substantially, which may induce a potentially deleterious strain in the median nerve with the risk of symptom exacerbation in some patients and reduced benefits from nerve gliding. This study aimed to evaluate various nerve gliding exercises, including novel techniques that aim to slide the nerve through the carpal tunnel while minimizing strain (sliding techniques). With these sliding techniques, it is assumed that an increase in nerve strain due to nerve bed elongation at one joint (e.g., wrist extension) is simultaneously counterbalanced by a decrease in nerve bed length at an adjacent joint (e.g., elbow flexion). Excursion and strain in the median nerve at the wrist were measured with a digital calliper and miniature strain gauge in six human cadavers during six mobilization techniques. The sliding technique resulted in an excursion of 12.4 mm, which was 30% larger than any other technique (p 0.0002). Strain also differed between techniques (p 0.00001), with minimal peak values for the sliding technique. Nerve gliding associated with wrist movements can be considerably increased and nerve strain substantially reduced by simultaneously moving neighboring joints. These novel nerve sliding techniques are biologically plausible exercises for CTS that deserve further clinical evaluation. © 2007 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 25:972-980, 2007

Sedimentologic, petrographic, and sulfur isotope constraints on fine-grained pyrite formation at Mount Isa Mine and environs, Northwest Queensland, Australia

Fine-grained pyrite is the earliest generation of pyrite and the most abundant sulfide within the Urquhart Shale at Mount Isa, northwest Queensland. The pyrite is intimately interbanded with ore-grade Pb-Zn miner alization at the Mount Isa mine but is also abundant north and south of the mine at several stratigraphic horizons within the Urquhart Shale. Detailed sedimentologic, petrographic, and sulfur isotope studies of the Urquhart Shale, mostly north of the mine, reveal that the fine-grained pyrite (delta(34)S = -3.3 to +26.3 parts per thousand) formed by thermochemical sulfate reduction during diagenesis. The sulfate source was local sulfate evaporites, pseudo morphs of which are present throughout the Urquhart Shale (i.e., gypsum, anhydrite, and barite). Deep-burial diagenetic replacement of these evaporites resulted in sulfate-bearing ground waters which migrated parallel to bedding. Fine-grained pyrite formed where these fluids infiltrated and then interacted with carbon-rich laminated siltstones. Comparison of the sulfur isotope systematics of fine-grained pyrite and spatially associated base metal sulfides from the Mount Isa Pb-Zn and Cu orebodies indicates a common sulfur source of ultimately marine origin for all sulfide types. Different sulfur isotope ratio distributions for the various sulfides are the result of contrasting formation mechanisms and/or depositional conditions rather than differing sulfur sources. The sulfur isotope systematics of the base metal and associated iron sulfide generations are consistent with mineralization by reduced hydrothermal fluids, perhaps generated by bulk reduction of evaporite-sourced sulfate-bearing waters generated deeper in the Mount Isa Group, the sedimentary sequence which contains the Urquhart Shale. The available sulfur isotope data from the Mount Isa orebodies are consistent with either a chemically and thermally zoned, evolving Cu-Pb-Zn system, or discrete Cu and Pb-Zn mineralizing events linked by a common sulfur source.