No abstract

Alcohol and drug use have been associated with increased mortality and morbidity from thermal injury. To determine whether substance users (SUs) differed from controls, 398 burn patients were studied, of whom, 161 had a positive drug screen for either ethanol, cannabinoids, cocaine metabolites, amphetamines, phencyclidine, or benzodiazepines. SUs versus controls showed no difference in age, but had a significantly greater percentage of total burn surface area (TBSA) (25 vs. 17%), inhalation injury (29 vs. 7%), and mortality (14 vs. 3%). The alcohol users (AUs) and drug users (DUs) were similar in relation to sex, age, inhalation injury, percentage of TBSA, and type of burn. DU patients experienced the same increase in inhalation injury as the AU group compared to controls. The mortality of AU patients was twice that of DU patients and six times that of controls. The best independent predictors of death were age, inhalation injury, percentage of TBSA (p < 0.001), and ethanol use (p < 0.02).

Abdominal Compartment Syndrome (ACS) has multiple causes, and decompressive laparotomy has been the most frequent modality to prevent worsening cardiovascular, respiratory, and renal function. This pilot study evaluated the utility of percutaneous drainage (PD) of peritoneal fluid compared with decompressive laparotomy in burn patients. A 26-month review was conducted. Nine of 13 (69%) study patients developed intra-abdominal hypertension (IAH) that progressed to abdominal compartment syndrome in 4 (31%). All were treated with PD using a diagnostic peritoneal lavage catheter. Peritoneal fluid analysis revealed a sterile plasma ultrafiltrate with electrolyte and other chemistries reflecting patient serum levels. Five patients underwent PD successfully, and their IAH did not progress to ACS. Four patients with greater than 80% TBSA and severe inhalation injury did not respond to PD and required decompressive laparotomy. There was no evidence of bowel edema, ischemia, or necrosis. All patients requiring decompressive laparotomies died either from sepsis or respiratory failure. Percutaneous decompression is a safe and effective method of decreasing IAH and preventing ACS in patients with less than 80% TBSA thermal injury.

No abstract

OBJECTIVE -Diabetic burn patients comprise a significant population in burn centers. The purpose of the study was to determine the demographic characteristics of diabetic burn patients and their rate of community-acquired and nosocomial infections.RESEARCH DESIGN AND METHODS -This was a 46-month retrospective chart and patient registry review comparing diabetic with nondiabetic burn patients. Statistical analysis consisted of means Ϯ SD, descriptive statistics, one-way ANOVA, and 2 tests. , P ϭ 0.001). Adult diabetic burns had a significant increase in sepsis (P Ͻ 0.002) and community-acquired burn wound cellulitis (P Ͻ 0.001) compared with adult nondiabetic patients; and senior diabetic patients had a significantly increased frequency of urinary tract infections compared with senior nondiabetic burn patients (P Ͻ 0.04).The most common organisms in diabetic burn infections were Streptococcus, Proteus, Pseudomonas, Candida species, and MRSA (methicillin-resistant Staphylococcus aureus). Forty-two percent of the diabetic patients were admitted during the winter months and 25% in the spring. Only 49 of 130 (38%) diabetic burn patients presented for treatment within 48 h after injury compared with 669 of 1,126 (62%) nondiabetic patients (P ϭ 0.001).CONCLUSIONS -Peripheral neuropathy may have precipitated and delayed medical treatment in lower-extremity burns of diabetic patients. Hospitalized diabetic burn patients were also at an increased risk for nosocomial infections, which prolonged hospitalization. Diabetic patient education must include not only caution about potential burn mishaps but also educate concerning the complications from burns that may ensue. Diabetes Care 27:229 -233, 2004A pproximately 17 million (6.2%) of the U.S. population are diabetic; this disease is the seventh leading cause of death in the U.S. (1). The American Diabetes Association lists the hazards of treating diabetic feet with hot water bottles, heating pads, and hot water soaks but does not alert the readers to the actual severity and consequences of injuries that can ensue (1). There have been numerous anecdotal literature reports about diabetic foot burns from electric heating pads, foot spas, and water baths (2-9). Diabetic patients are known to experience more inf e c t i o n s i n c l e a n w o u n d s t h a n nondiabetic patients and to heal more slowly, especially in the extremities (10 -11). The purpose of this study was to determine the demographic characteristics of diabetic burn patients at a large urban hospital and compare their propensity for nosocomial infections with that of the general burn population. RESEARCH DESIGN AND METHODS Burn careResuscitative fluids were administered dependent on requirements for all injuries using modified Parkland formula guidelines. All patients were treated with closed silver sulfadiazine-embedded gauze dressings or Collagenase Santyl (Advance Biofactures, Lynbrook, NY), an enzymatic debriding product, until either the wound healed or surgical intervention was initiated. Arterial blood ...

A b s t r a c t We evaluated 48 archival cases of acute erythroleukemia and divided them into 3 groups: M6a

Erythroleukemia is a heterogeneous disorder that can have an excess of myeloblasts or proerythroblasts in the setting of dyserythropoiesis. The French-American-British classification, established in 1976 and subsequently revised, allows only for the diagnosis of erythroleukemias whose immature elements are predominated by myeloid blasts, previously described as DiGuglielmo's syndrome. However, there is another form of erythroleukemia, in which the predominant immature elements are proerythroblasts, called DiGuglielmo's disease. To clarify this issue, 23 cases of erythroleukemia were reviewed and classified: 10 with a myeloblast predominance and 13 with a proerythroblastic predominance. These two forms of erythroleukemia can be distinguished on the basis of quantitative and qualitative morphologic features. When there were 30% or more proerythroblasts, calculated by dividing the total erythroid component into the proerythroblasts, there were few to no myeloblasts, no Auer rods, and increased cytoplasmic vacuoles; and myeloperoxidase staining was negative. The malignant proerythroblasts had increased block and blush periodic acid-Schiff positivity. The most frequent chromosomal abnormalities involved chromosomes 5 and 7. The patients with DiGuglielmo's disease had a median survival time of 2 months (range, 0.06 to 9 months), compared to a median of 16 months (range, 2 to 48 months), in patients with DiGuglielmo's syndrome. The erythroleukemia with the preponderance of proerythroblasts had a worse prognosis because many of the individuals did not survive long enough to respond to the therapy initiated. Erythroleukemia with 30% or more proerythroblasts should be included in the French-American-British classification because it behaves clinically and appears morphologically as an acute leukemia rather than a myelodysplastic syndrome.

No abstract