Ligand and metal-centred reactivity in 2,6-bis(imino)-1,4-dihydropyridinate Zn(II) alkyls: the dual behaviour of an intriguing type of complex.

Dihydropyridines, either free or metal-coordinated, are organic hydride transfer reductants that perform on the same premises as the natural redox cofactor NAD(P)+/NAD(P)H. 1-Bn and 1-Me are alkylzinc complexes containing dihydropyridinate-based pincer ligands that have been synthesized through different routes involving the addition of ZnR2 (R = Bn, Me) to the 2,6-bis(imino)-pyridine and 2,6-bis(imino)-4-Bn-dihydropyridine (iPrBIP and 4-BniPrBIPH2) ligands, respectively. The alkyls complexes 1-R react with fluorinated alcohols RFOH (RF = C6F5 or t-C4F9) yielding isolable fluoroalkoxides 2-F5 and 2-F9, in which the reactive 1,4-dihydropyridinate ligand remains unchanged. The crystal structure of 2-F5 shows the shortest Zn⋯F-C interaction reported so far, involving one of the o-F atoms of the C6F5 group. However, the mechanism of the alcoholysis reactions is not straightforward, as NMR monitoring revealed that acidic RFOH first protonates the dihydropyridine nitrogen, releasing the dihydropyridine base 4-BniPrBIPH2 and a highly reactive Zn(R)(ORF) species that re-captures the dihydropyridine in a subsequent step, eliminating the corresponding alkane (R-H). Depending on the mixing conditions, the pincer dihydropyridinate ligand may undergo aromatization to produce the new Zn(II) dialkoxides 3-F5 and 3-F9 stabilised by a neutral iPrBIP ligand [(4R-iPrBIP)Zn(ORF)2]. These protonation and hydride transfer reactions illustrate the dual reactivity of the pincer 1,4-dihydropyridinate zinc entity.

Electrical burns in times of economic crisis: A new epidemiologic profile.

Electrical injuries and especially those of high voltage still remain a source of high morbidity. Over the past few years, a change in the epidemiologic profile of these lesions was noticed at the Vall d'Hebron University Hospital Burn Unit, corresponding to an increase in cases out of the legal framework. It is our aim to describe this particular subset, to determine the extent of their injuries and to understand the reason for their increased incidence. We think this was favoured by the rise in the unemployment rate, along with higher copper prices.

[Severe burns related to steam inhalation therapy]. / Quemaduras graves relacionadas con la terapia inhalatoria con vahos.

INTRODUCTION: Despite lack of proven effectiveness and its potential to cause severe burns, steam inhalation therapy (SIT) is still used as a treatment for benign respiratory conditions. OBJECTIVE: To characterize cases of burns related to steam inhalation therapy (BRSIT) in order to formulate appropriate preventive criteria. PATIENTS AND METHODS: A review was conducted on cases of BRSIT admitted to a Burns Unit between 2006 and 2012, analysing epidemiological data, clinical aspects, severity and course. RESULTS: A total of 530 patients were admitted; 375 (70%) with scalds, and 15 with BRSIT (2.8% of burns; 4% of scalds). SIT was indicated in most cases for mild upper airway infections. The median age of patients was 7 years (2.5m-14 y). The burned area (BA) was ≥10% in 60% of cases (max. BA 22%). Injuries involved trunk, genital area, and extremities; only in one case was the face affected. The mean hospital length-of-stay was 14 days (3-30 d). Five patients (33%) were admitted to the PICU, most of them (60%) younger than 3 years. Eight patients (53%) underwent surgical treatment (skin grafting). In a 12-year-old patient whooping cough was diagnosed in the Burns Unit, and a 2.5-year-old patient developed staphylococcal toxic shock syndrome. No patient died. The final course was satisfactory in all patients. CONCLUSIONS: BRSIT can be severe and cause significant use of health resources. Professionals caring for children, particularly paediatricians, should seriously consider their prevention, avoiding treatments with SIT, and educating parents in order not to use it on their own.

Analysis of intra-abdominal hypertension in severe burned patients: the Vall d'Hebron experience.

Although severely burned patients are at a high risk of developing intra-abdominal hypertension (IAH: IAP>12 mmHg) and Abdominal Compartment Syndrome (ACS) (IAP ≥ 20 mmHg), few data about its incidence and prevalence is available. Our aim was to determine the incidence and prevalence of IAH and ACS in patients with severe burns in our geographical setting. A pilot prospective, observational study was performed at the Burns Unit of the Plastic Surgery Department in Vall d'Hebron University Hospital (Barcelona), during a 12-month period. All patients with age ≥ 18 years old and burns >20% of the total body surface area (TBSA) were considered for inclusion. Patients who did not require urinary catheterization via the urethra were excluded. All patients included were followed during the first five days from their admission. Results are expressed as median (interquartile range) or frequency (percentage). During the study period, 303 patients were admitted to the Burns Unit. Twenty-five patients were included in the study (21 [84%] male, 4 [16%] female; age 42 [30-69 years]; TBSA burned 33 [25-58]%; all patients presented deep second-degree and/or third-degree burns). Eighteen (72%) patients met criteria for IAH, but only one (4%) developed ACS. The incidence of IAH and ACS was 0.56 and 0.04 cases/patient-day, respectively. Patients with IAH presented higher number of organs failure (2 [0-2.2] vs 0 [0-0]; p = 0.03). Patients with >20% TBSA burned presented a very high prevalence of IAH. Development of organ failure occurred even at moderately increased values of IAP. In this scenario, monitoring of IAP is the first step for establishing the importance of IAH/ACS in this patient population.

Full face transplantation organization, development, and results--the Barcelona experience: a case report.

The initial experience in facial composite tissue allotransplantation has demonstrated that it is surgically feasible, safe, and reproducible. A robust team approach is necessary to warrant successful outcomes. We designed a specific face organ donation that limits facial donation requests followed by synchronous in situ dissection with the internal organs that has proved to be efficient and safe for face and solid organ procurement and transplantation. The first human full face transplantation in our institution was performed on March 27, 2010. The holistic team approach of donation and procurement proved to be effective and reproducible; the recipient showed excellent outcomes at 12 months.

Logistics and strategy of multiorgan procurement involving total face allograft.

The face is the latest body structure to be added to the field of transplantation and the learning curve is ongoing. In the scenario of multiorgan recovery, the face is a nonvital 'organ' structure compared with other life-saving organs. To date, the face has been the first 'organ' to be procured in a multiorgan procurement. A technique for simultaneous recovery of the whole face, heart, lungs, liver, pancreas and kidneys is described. Thirty professionals participated in the procedure, of whom 13 were surgeons. No tracheotomy was performed. A mask of the donor's face was made from a mold impression. Duration of the procedure from skin incision to the end of surgery was 7.3 h. The face was perfused with Wisconsin solution through a cannula inserted into the aortic arch between the origin of the brachiocephalic arterial trunk and the left subclavian artery. Blood requirements consisted of 4 units of packed red blood cells. After the procedure, the mask was placed on the donor's face. All recovered grafts functioned immediately. In summary, simultaneous multiorgan procurement including the whole face is feasible, effective and saves time without jeopardizing life-saving organs and without the need for tracheotomy.

Chronic granulomatous disease of childhood. Report of two cases with unusual involvement of the gastric antrum and spleen.

Chronic granulomatous disease (CGD) of childhood is a rare entity. The disease is characterized by recurrent infections with granuloma and abscess formation caused by an inherited defective neutrophil leukocyte function. The most common sites of involvement are the lungs, lymph nodes, skin, liver, spleen and bones. Rarely are other organs affected. Two children with CGD are presented. The children were cousins, the older with bone, lung and splenic involvement. The younger had circumferential thickening of the gastric antrum. Some of the lesions were well delineated with ultrasonography. The unusual gastric antrum wall and focal splenic involvement in this disease are emphasized.