Operating room fire: Should we mistrust alcoholic antiseptics?

Surgical site infections are a challenge for public health. One of the keystones of prevention is the skin preparation of the patient. Alcoholic antiseptics are presented as the best solution. But the adverse effects attributed to them must not be overshadowed by the exclusive benefit of their microbiological performance. The authors report four cases of severe burn having occurred in the operating room after skin antisepsis performed with an alcoholic antiseptic. The mechanisms of these accidents and preventive measures are reviewed. It concerns the restriction of ignition factors during use and the strict conformity to drying time. These potentially dramatic complications can and should be avoided. Probably underestimated, burns due to ignition of alcoholic antiseptics should appear more clearly in the evaluation of the risk-benefit balance.

Necrotizing soft tissue infections following a scald burn of the lower limb: a case report.

Necrotizing soft tissue infection (NSTI) is a rare but potentially fatal infection. It usually complicates skin traumas, such as lacerations, scratches, insect bites, burns and recent surgeries. Rapid diagnosis is crucial for a favourable prognosis. NSTI is an emergency surgical condition and every delay in the operative treatment has a proven negative effect. Recently, a rare case presented to us with a late diagnosis of NSTI complicating a scald burn of the lower limb. The patient's injury was initially treated as a burn case but unfortunately ended in an above knee amputation. We report our management experience in this case, with a review of the literature.

L'infection nécrosante des tissus mous (INTM) est une infection rare mais potentiellement mortelle. Elle complique habituellement les traumatismes de la peau, comme des lacérations, des éraflures, des piqûres d'insectes, des brûlures et des chirurgies récentes. Un diagnostic rapide est essentiel pour un pronostic favorable. L'INTM necessite un traitement chirurgical urgent et tout retard dans le traitement chirurgical a un effet négatif éprouvé. Récemment, un cas rare a été présenté à nous avec un diagnostic tardif de l'INTM, compliquant une brûlure du membre inférieur. La blessure du patient a été initialement traitée comme un cas de brûlure causé par l'eau chaude, mais malheureusement est terminé à une amputation au-dessus du genou. Nous rapportons notre expérience de gestion dans ce cas, avec une revue de la littérature.

Interest of exhaled biomarkers in occupational asthma to latex: a case report.

New methods for exploring pulmonary inflammation might be useful: measurements of exhaled nitric oxide (NO) and hydrogen peroxide (H(2)O(2)) in exhaled breath condensate (EBC). The authors describe the application and utility of these methods in a case report of pediatric nurse presenting an occupational asthma to latex. Despite compliance with avoidance measures, respiratory discomfort had worsened during work. Classical tests (spirometry, monitoring of peak expiratory flow) were not contributing to objectify the discomfort. Exhaled NO and H(2)O(2) in EBC increased immediately after work periods, compared with rest periods. Application of these new methods, at the same time, in workplace appears useful in the objective demonstration of a temporal relation between work and respiratory problems. The results allowed the occupational physician to transfer the patient to a new work station more appropriate for her respiratory health status.

[Treatment of sequelae of burns in children]. / Le traitement des séquelles de brûlure de l'enfant.

Burn sequelae in children are conveyed in the form of retraction, deformity and growth problems together with dyschromia and trophic disorders. All the plastic surgical procedures can be used to correct them: full thickness or split thickness skin grafts, Z plasty and its derivatives (trident plasty, IC flaps), expansion, flaps, artificial skin, and dermabrasion. In most cases, these procedures will be combined. The aim of surgical treatment coordinated with rehabilitation is to restore the function, correct the deformities induced, improve the morphological aspect and permit normal growth. Good knowledge of the paediatric environment is, however, required to cope with the specificities of the child: treat the severe local inflammation, get the family to participate in the projects of rehabilitation, sometimes with the help of social services, maintain normal schooling, accompany the disorders in body schema, and, finally, prolong follow-up until growth is complete, a challenge in these patients who are often very young at the time of the accident.

[Facial burns in children. 197 patients]. / Les brûlures de la face chez l'enfant. A propos de 197 patients.

Facial burns frequently occur in child. A total of 197 burned patients with facial localisation were seen during the time period (1991-1996) covered by this retrospective study. One hundred and sixteen patients were less than three years old. A quarter of the child were issued from poor social classes with nine cases of child abuse by burning. One hundred and thirteen injuries were performed by hot water or drinks. The total burn area was less than 10% in 63% of the cases. The average facial burned area was 4%. The cheek, the front and the chin were often concerned. Low limbs and trunk were unjured in all cases. 130 patients needed hospitalisation, and stayed in average 17.31 days at hospital. Four patients died from respiratory complications, all after flame injuries. Fifty two child needed skin split grafts. Complete cicatrisation was observed after 21 days of treatment in child without grafts, and after 35.65 days in child with skin grafts. Twenty eight patients needed physiotherapy in center. The scars had a correct cosmetic appearance, without retraction and inflammatory signs in 158 child after two years. Eleven patients needed other surgical treatment. The authors analyse the results and insist on prevention.

[Spontaneous rupture of the spleen during the development of chronic pancreatitis. One case]. / Rupture spontanée de rate au cours de l'évolution d'une pancréatite chronique. Un cas.

Spontaneous rupture of the spleen is a relatively rare occurrence during the course of chronic pancreatitis. The physiopathology remains imprecise and mechanical factors are associated with pancreatic enzyme diffusion and vascular changes in explaining its aetiology. The diagnosis is difficult since it often mimics an acute exacerbation of pancreatitis or even actual acute pancreatitis when the existence of the pancreatic condition is not previously known. Abdominal echotomography or peritoneal puncture-lavage and, now, CAT scanning are the key factors in reaching the diagnosis.