Silver-sulfadiazine eschar pigmentation mimics invasive wound infection: a case report.

A 3-year-old girl with 52% TBSA scalds, mostly partial thickness, was treated topically with 5% mafenide acetate solution and 1% silver sulfadiazine cream. All blood cultures and wound swabs were negative for the first 5 days. On day 6 gram-negative bacteria and yeast forms were isolated from her wounds. High fever and leukocytosis were present and the child was treated with intravenous ampicillin and gentamicin according to sensitivity bacteriogram. The bacteria were identified as Pseudomonas aeruginosa and the yeast was Candida tropicalis. On day 7, Escherichia coli was identified in blood cultures and intravenous cefixime was added. Amphotericin B was added on day 9 when blood cultures grew Candida tropicalis and Burkholderia cepacia. On day 13 dark pigmentation foci developed on some areas of partial-thickness burns in the back, resembling invasive wound infection. White blood cell count was 14,300 cells/mm3, and her body temperature reached 39.7 degrees C. Cultures from the pigmented areas were negative, and biopsies revealed deposits of silver. Most of the areas healed uneventfully, and only about 8% TBSA needed grafting, including some of the pigmented areas. No residual pigmentation remained on discharge.

Repair of bilateral complete cleft lip: intraoperative nasolabial anthropometry.

Synchronous repair of bilateral complete cleft lip and nasal deformity requires conception of three-dimensional form and fourth-dimensional changes with growth, as distorted by the malformation. The aim is to obviate typical postoperative nasolabial stigmata. The strategy is to construct fast-growing features on a smaller scale and slow-growing features on a normal or slightly larger scale. In this study, intraoperative alterations in nasolabial dimensions were documented by anthropometry in 46 consecutive infants with bilateral complete cleft lip. These values were averaged and compared with measures from normal Caucasian infants at ages 0 to 5 months and 6 to 12 months. Nasal height (n-sn) and nasal width (al-al), both fast-growing features, were set smaller (88 percent and 96 percent, respectively) than those of age-matched normal infants. In contrast, the slow-growing features, nasal protrusion (sn-prn) and columellar length, were constructed longer than normal (130 percent and 167 percent, respectively). Because all labial features grow rapidly, they were made diminutive in this study, with the exception of central vermilion-mucosal height (median tubercle), which was purposively made full. These maneuvers resulted in a normal, average overall upper-lip height (sn-sto). Two technical refinements also are described: (1) construction of deepithelialized bands flanking the philtral flap to improve surface contour; and (2) positioning and fixation of the dislocated alar cartilages, performed entirely through superiomedial nostril rim incisions.

Double-vein jugular/inferior vena cava clamp technique for long-term in vivo studies in rats.

We present a step-by-step manual for chronic cannulation of rats using a simple technique. This concept facilitates repeated clamping of the same rat over a 6-10-week period, providing a completely separate infusion route from blood sampling access which is placed into mixed venous blood in the inferior vena cava. Permanent catheters implanted into the left external jugular vein and the inferior vena cava were used for miniature blood sampling and recycling. The design and running of clamp experiments and other physiological research models are detailed. Long-term reliable venous access, simple installation, and easy after-care of the rats' cannulas are the principal advantages of the procedure described.

The effect of acute insulin-like growth factor-II administration on glucose metabolism in the rat.

The in vivo effects of the insulin-like growth factor-II (IGF-II) on glucose metabolism is not yet well defined. To assess the acute effect of IGF-II administration on whole body glucose utilization and hepatic glucose production, we used the well-established euglycemic clamp technique and compared the effects in awake cannulated rats with those of insulin. Each animal underwent several 90-min euglycemic studies, alternating between IGF-II and insulin. Following IGF-II infusion, tissue glucose uptake was increased to 9.8 +/- 0.6 mg/kg/min (mean +/- SEM), which represented only 14% of the effect of insulin, despite the molar plasma concentration ratio of insulin: IGF-2 being 1:460. IGF-II and insulin infusion reduced hepatic glucose output by 49 and 75%, respectively. Thus, IGF-II, administered acutely, affects glucose homeostasis in a manner very similar to insulin, probably via the insulin receptors, although with significantly lower potency.

Female breast burns: conservative treatment with a reconstructive aim.

We retrospectively reviewed 421 burn patients treated in our burn unit in the past 3 years, focusing on breast burns in female patients. The aim of our study was to review the epidemiology, establish the mechanism of breast burn occurrence, and review the treatment plan. We evaluated 138 female burn patients, 38 (9%) of whom had non-isolated breast burns. In this group 25 burns (66%) were caused by scalds and 13 (34%) by fire. Scalds were responsible for first- to second-degree burns (50%), and cooking oil and fire for second- to third-degree burns (50%). A statistically significant difference was noted in the incidence of breast burns, which occurred mainly in late summer and fall (P = 0.03). There was a direct correlation between burn depth and duration of hospitalization, with average hospitalization time of 1.45 days for each percent of burn. Most breast burns were domestic, with children constituting the majority of the victims. Most breast burn patients were treated conservatively. Breast deformity on recovery varied in severity from minor deformity correctable with simple breast reduction surgery in older patients to severe deformity requiring further reconstructive surgery in infants.

Elevation of eyeglasses from the nasal bridge--a simple solution.

Wearing eyeglasses following nose surgery is a problem faced by many patients who require glasses for clear vision. The solutions offered for this seemingly minor problem are unsatisfactory and usually mandate special spectacle frames. We developed a simple apparatus, using a baseball cap and a tie clip, that enables suspension of eyeglasses with no pressure on the nasal bridge. This solution utilizes readily available components and maintains clear vision with possible frequent readjustment of the glasses. It also avoids contact of the glasses with any part of the face, namely the operative site, dressing, and wound discharge. We find this technique a simple and useful solution for a disturbing problem in plastic surgery.

Modulation of the activity of glucose transporters (GLUT) in the aged/obese rat adipocyte: suppressed function, but enhanced intrinsic activity of GLUT.

To study the contribution of glucose transporters (GLUT) to insulin resistance in aging, GLUT intrinsic activity was assessed in a cell-free system. Adipocytes were isolated from 18-month-old rats and young controls and incubated either with or without 7 nM insulin. Plasma membrane (PM) and low density microsomal fractions were prepared from the cells, and GLUT levels were assessed in these fractions before and after reconstitution into liposomes. Glucose transport rates were measured in intact cells and liposomes. Functional and intrinsic activities of GLUT were assessed from the ratio between these transport rates and GLUT levels in the respective fractions. Basal 3-O-methylglucose transport rates were unaffected by aging, which is consistent with unchanged levels of GLUT in PM. Insulin-stimulated glucose transport was 60% lower in aging, as was the extent of GLUT recruitment to PM. The effect of insulin stimulation of GLUT functional activity by 6-fold at PM was attenuated by 40% in aging. Conversely, the basal intrinsic activity of GLUT was significantly enhanced in aging (by 280% and 230% in PM and density microsomal liposomes, respectively) and was further stimulated by insulin by about 160% in PM, compared to only about 117% stimulation in controls. In conclusion, our data show that insulin stimulates the intrinsic activity of GLUT in rat adipocytes, and this activity is further enhanced in aging. Impaired glucose uptake in aging can be attributed to depleted GLUT4 levels and impaired function of GLUT at the cell surface. The discrepancy observed between impaired function and enhanced intrinsic activity of GLUT suggests the presence of additional factors that modulate the full functional expression of GLUT at the cell surface.

In vivo insulin action in normal and streptozotocin-induced diabetic rats.

Models studying in vivo insulin animal action usually employ single-use anesthetized animals, mainly for technical reasons. We developed a modification of the euglycemic insulin clamp technique and used it to repeatedly assess in vivo insulin effects in awake streptozotocin-induced diabetic rats, and in weight- and/or age-matched controls. Permanent catheters implanted into the left carotid artery and the right jugular vein were used for miniature blood sampling (20 microliters) and recycling. Insulin was infused at 1, 2, 3, 15, and 30 mU/kg.min. Plasma insulin and C-peptide levels and glucose utilization rate were measured at blood glucose levels of 100 mg/dl. Diabetes was associated with diminished elevation of plasma C-peptide and insulin levels after ad lib feeding, 50% decreased (p < 0.005) insulin sensitivity, 31% decreased (p < 0.001) insulin responsiveness, and unchanged insulin clearance rates. Thus, using repeated clamps of the same rat over a prolonged period of time, we demonstrate that diabetes is associated with unchanged clearance but decreased sensitivity and responsiveness to insulin.

Epidemiology of burns in the Tel Aviv area.

Between 1 August 1988 and 31 January 1992, 421 burn patients were admitted to the Burn Unit at Beilinson Medical Center. Name, age, sex, month of the year, cause of burn, area and degree of burn and duration of stay in hospital were recorded. Of these patients, 37 per cent were treated surgically and the remainder were treated conservatively. The male to female ratio was 2:1. Burns occurred most frequently in July and January; the peak average age was the first decade of life. The most frequent cause in children was scalding (domestic burns), and in adults open fires (work accidents). Patients treated by early tangential excision and skin grafting (204 operations on 157 patients) had a shorter stay in hospital than conservatively treated patients. In accordance with others, we suggest that early surgery of burn injuries decreases morbidity and mortality and leads to better aesthetic results and improved motor function. Secondly, burn injury can be prevented in children and the elderly by increasing safety measures at home, and in adults by enforcing strict safety measures at work.