An Introduction to Burn Care.

GENERAL PURPOSE: The purpose of this learning activity is to provide an overview about burns and current burn care. TARGET AUDIENCE: This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES: After completing this continuing education activity, you should be better able to:1. List factors affecting the types, size, and depth of burns.2. Propose first aid and treatment for various burns. ABSTRACT: Burns are a very specific type of injury and, particularly in the case of large and/or deep lesions, require highly specialized care. This article gives a basic overview of burns and burn care and is not intended to discuss overall burn care in detail.

How often is a positive faecal occult blood test the result of coeliac disease?

BACKGROUND AND AIMS: It has been reported that occult gastrointestinal bleeding as detected by faecal occult blood (FOB) testing can occur in coeliac disease. This study examines whether a positive FOB is a feature of coeliac disease and whether FOB-positive subjects need investigation for coeliac disease. METHODS: First, the records of patients on the Nottingham Register for Coeliac Disease were reviewed for positive FOB testing. Second, the Nottingham colorectal cancer screening trial database was also reviewed to examine how many coeliac patients on the Register had participated and to examine their FOB results. Finally, sera from 309 screening trial participants who were FOB-positive but had no colonic abnormality were screened for immunoglobulin A (IgA) gliadin and IgA endomysial and human tissue transglutaminase (tTG) IgA antibodies. RESULTS: Five of 590 patients on the Register had had FOB tests at the time of diagnosis; four had positive tests during investigation of diarrhoea and/or anaemia. Of 21 patients on the Register who had participated in the colorectal cancer screening trial, one had a positive FOB test and was found to have a rectal tubulo-villous adenoma. Of the 309 FOB-positive patients, 7% (22 subjects) were positive for IgA gliadin antibodies, but none had IgA endomysial antibodies detected and two subjects had positive human tTG antibody assays for coeliac disease. CONCLUSIONS: Occult gastrointestinal bleeding occurs in a small number of symptomatic coeliac disease patients before diagnosis, but is no more frequent in treated and undetected coeliac disease patients than in the general population. Unless there are other indications, coeliac disease does not need to be considered in the investigation of a positive FOB test.

Gastric bypass for morbid obesity: a medical--surgical assessment.

With the operative modifications and dietary guidelines described in this report, death and complications from gastric bypass were minimal, and weight loss was marked. Ninety per cent of a group of 69 patients lost more than half of their excess weight within the first two years after operation. Stringent preselection of patients for operation was crucial to the success of the operation, and marked alterations of eating behavior was necessary to achieve the weight loss. Mild electrolyte deficiencies and hypovitaminosis occurred in up to one-fourth of the patients. While none of these abnormalities was harmful to the patients, and all were easily corrected, their occurrence demonstrates the importance of long-term follow-up after the operation. We conclude that gastric bypass, with a 50-60 cc pouch and a small (1-1.2 cm) gastrojejunostomy, remains the operation of choice for morbid obesity.

Studies of the functional and morphologic status of islets maintained at 24 C for four weeks in vitro.

Isolated rat islets were maintained in vitro at 24 C for 1-4 weeks in tissue culture medium containing D-glucose (1.5 mg/ml). The rate of insulin release at 24 C remained stable for three weeks (2.2 muU/islet/hr) and decreased to 1.2 muU/islet/hr during the fourth week. Increasing the temperature from 24 C to 37 C at the end of 1, 2, 3, or 4 weeks produced a 5--7-fold increase in the rate of insulin release in the presence of glucose (1.5 mg/ml). This rate of secretion was comparable to control islets maintained at 37 C for 1--4 weeks. Light- and electron-microscopic studies revealed minimal central necrosis of large islets maintained at 24 C for 3 weeks. In contrast, extensive central necrosis was present in large islets maintained at 37 C for only 1 week. Degranulation of B cells occurred at 24 C with almost complete degranulation at 28 days. Regranulation occurred when the temperature was increased to 37 C. These findings indicate that isolated islets maintained at 24 C remain functionally and morphologically intact for 4 weeks. Initial studies have shown that maintenance of islets at 24 C for 1 week in conjunction with a single injection of antilymphocyte serum will produce marked prolongation of survival of islet allografts. The finding that isolated islets will survive for prolonged periods of time at 24 C should be of importance to future studies on islet transplatation, immune rejection, and investigations on hormonal release from islets maintained under these conditions.