Dorsal pentagonal island flap to reconstruct post-burn interdigital web.

INTRODUCTION: This study reports the use of a dorsal pentagonal island flap for post-burn webbing contracture, in which the islanded flap is harvested from the burn scar tissue. METHODS: Fourteen dorsal pentagonal island flaps were harvested in seven patients with post-burn webbing. Each flap was selected by examining the scar tissue donor using a modified Vancouver scar scale. Modification from the basic design was made according to the density of the donor scar tissue and the metacarpophalangeal joint movement. RESULTS: All the flaps survived with normal abduction of the affected fingers. Modification of the flap design needed adjustment by assessing it through flexion and extension of the metacarpophalangeal joints. There was no incidence of web creep after two months to one year of follow-up. CONCLUSION: Dorsal pentagonal island flap shows promising results as an alternative for reconstructing post-burn webbing.

Perinatal transmission of HIV-2 infection in malnourished children in Guinea Bissau.

Since there have been a few reports of pediatric HIV-2 infection. We therefore investigated the perinatal transmission of HIV-2 in 147 malnourished and 164 well-nourished children attending a health center in the northern part of Guinea Bissau. Specific HIV-2 antibodies were detected in 17 mothers and in 2 malnourished children, one of them with pediatric AIDS. This study demonstrates that mother to child transmission of HIV-2 infection occurs in Guinea Bissau and suggests that there is an increased likelihood of detecting HIV-2 infection in malnourished children. The high seroprevalence of HIV-2 in a rural population without known risk factors may represent a hidden threat to mother/child health.

PIP: The authors tested blood samples of 147 malnourished children, 164 well-nourished children, and their 205 mothers with the goal of exploring the extent to which HIV-1 and HIV-2 were being transmitted perinatally in Guinea-Bissau. The children were attending a health center in the northern part of Guinea-Bissau and had been breast fed from birth to 20 months of age or longer. Analysis found antibodies to HIV-2 in 17 mothers and 2 malnourished children, one with pediatric AIDS. These findings demonstrate the occurrence of mother-to-child transmission of HIV-2 in the country and suggest a possible increased likelihood of detecting HIV-2 infection in malnourished children. The high seroprevalence of HIV-2 infection in a rural population without known risk factors may represent a hidden threat to the health of mothers and children.

Posttransfusion hemoglobinuria and myoglobinuria in neonates.

Posttransfusion positive dipsticks for occult blood do not differentiate hemoglobinuria from myoglobinuria, relatively common events in infants admitted to the neonatal intensive care unit. We studied posttransfusion plasma and urine hemoglobin and myoglobin in relation to occult blood positivity in the urine dipsticks, in 48 consecutive transfusions with packed RBC (28 neonates, birth weight 850-3,700 g, postnatal age 3-167 days). Urine dipsticks show a low sensitivity for detecting hemoglobin and also undervalue myoglobin, both possible in different amounts in the plasma and urine of ill neonates. However, posttransfusion occult blood positive urine dipsticks due to myoglobinuria are present in 10% of transfused neonates.

[Levels of myoglobin in umbilical cord blood of infants born by spontaneous labor and cesarean section]. / Livelli di mioglobina nel sangue funicolare dei nati da parto spontaneo e cesareo.

The levels of myoglobin in the umbilical cord blood of 20 full-term infants were studied in relation to spontaneous vaginal delivery and elective cesarean section, using the Rapitex Myoglobin (Behring Institute, Marburg, FRG). The content of myoglobin in umbilical cord blood was similar and within normal limits (less than 50 micrograms/l). We conclude that semiquantitative methods are not useful at birth to detect rhabdomyolysis and myoglobinuria secondary to the stress of vaginal delivery.

Analbuminaemia: a natural model of metabolic compensatory systems.

Important clinical signs are usually not present in analbuminaemia, a congenital condition inherited as an autosomal recessive trait, but several biochemical alterations in proteins, cholesterol, phospholipids and plasma beta lipoproteins have been observed. We studied two sibs, R.U. and R.R., with this disease and observed a striking increase in the variables mentioned above as well as a high LDL fraction with concomitant increase in apo B; increases in HDL3 and apo A-I and A-II levels were also observed. The lipoproteins, however, were not altered in morphology but showed a slight increase in lipid/protein ratio. Post-heparin lipolytic activity was normal in the male patient and reduced in the female while LCAT enzyme activity instead was increased in both. Fatty acids bound to phospholipids and serum cholesterol were mostly monounsaturated. Free fatty acid concentration was normal and they appeared mostly bound to the LDL and HDL3 fractions, which are increased in this disease and appear to replace albumin in one of its main carrier functions.

Lactoferrin serum levels in burned patients.

Twenty burned patients were studied (with mean body surface area burned 46.5%, mean age 25.4 years, and mean survival probability 78%), and lactoferrin, white-cells count and blood cultures were determined. Lactoferrin was detected more frequently (P less than 0.01) in the samples of patients with positive blood cultures. The role of lactoferrin in host defense mechanism and its possible function in sepsis is considered.