The nitric acid burn trauma of the skin.

Nitric acid burn traumata often occur in the chemical industry. A few publications addressing this topic can be found in the medical database, and there are no reports about these traumata in children. A total of 24 patients, average 16.6 years of age, suffering from nitric acid traumata were treated. Wound with I degrees burns received open therapy with panthenol-containing creams. Wound of II degrees and higher were initially treated by irrigation with sterile isotonic saline solution and then by covering with silver-sulphadiazine dressing. Treatment was changed on the second day to fluid-absorbent foam bandages for superficial wounds (up to IIa degrees depth) and occlusive, antiseptic moist bandages in combination with enzymatic substances for IIb degrees -III degrees burns. After the delayed demarcation, necrectomy and mesh-graft transplantation were performed. All wounds healed adequately. Chemical burn traumata with nitric acid lead to specific yellow- to brown-stained wounds with slower accumulation of eschar and slower demarcation compared with thermal burns. Remaining wound eschar induced no systemic inflammation reaction. After demarcation, skin transplantation can be performed on the wounds, as is commonly done. The distinguishing feature of nitric-acid-induced chemical burns is the difficulty in differentiation and classification of burn depth. An immediate lavage should be followed by silver sulphadiazine treatment. Thereafter, fluid-absorbent foam bandages or occlusive, antiseptic moist bandages should be used according to the burn depth. Slow demarcation caused a delay in performing surgical treatments.

[Ultrasonic assessment of the ankle joint in supination trauma]. / Die sonographische Beurteilbarkeit des oberen Sprunggelenkes bei Supinationstraumen.

Comparing 20 healthy subjects to 31 injured patients in this study it is demonstrated that ultrasound examination appears to be a reliable tool in the diagnosis of ligamentous inversion force injuries of the ankle. The ultrasound diagnosis was confirmed by conventional standard and on the tension X-Rays. When lateral collateral ligaments were ruptured mean differences of 2.3 mm for the anterior talofibular ligament and 5.5 mm for the calcaneofibular ligament, respectively were obtained between X-Rays in standard and on the tension position. In comparison, the values in the control group (no ankle injury) were 1.4 mm and 2.2 mm respectively. The results shown in this study are mainly in keeping with the present literature.

[Diagnostic imaging and treatment of an invasive thymoma together with myasthenia gravis]. / Bildgebende Diagnostik und Therapie eines invasiven Thymoms mit Myasthenia gravis.

A 40-year old woman with an invasive thymoma and myasthenia gravis is described in this article. Chest-x-ray, CT and MRI of the mediastinum could not offer definite results on tumour malignancy. Radical surgical removal was the consequence. This revealed a tumour infiltration of the pleura and pericardium; hence an adjuvant irradiation must have been performed. Mestinon--treatment was afterwards gradually reduced.

Postmortem findings after epidural anaesthesia.

Postmortem specimens of 10 patients who had received continuous epidural anaesthesia postoperatively (ranging from 2-21 days) were examined. Slight epidural haemorrhage was observed in six patients and a macroscopically visible haematoma in a thrombocytopenic patient. Nonspecific epidural inflammatory reactions were observed microscopically in all patients. Specimens from seven patients with systemic infection showed signs of epidural infection. No similar pathology was found in a control group without epidural catheters. The aetiology and risk factors of the above findings are discussed, and recommendations given to prevent such sequelae after epidural anaesthesia.

[Epidural hematoma following epidural catheter anesthesia in thrombocytopenia]. / Epidurales Hämatom nach Katheterperidualanaesthesie bei Thrombozytopenie.

We report a 21-year-old male patient suffering from acute myeloid leukemia and concomitant thrombocytopenia. Following a diagnostic thoracotomy-which revealed Aspergillus pneumonia-he developed respiratory insufficiency and dyspnea. A thoracic epidural catheter was inserted and epidural morphine treatment led to improved ventilation. No clinical signs of pathological epidural processes were noticed during the treatment. The patient died of Aspergillus sepsis 26 days after catheter insertion. Autopsy revealed bacterial growth in the epidural space with slight infectious tissue reactions as well as an epidural hematoma. No evidence of spinal cord compression was found at autopsy. The development of epidural infection or hematoma seems to be a possible complication of epidural analgesia in patients suffering from impaired defense mechanisms or thrombocytopenia. These risk factors should be taken into account when epidural analgesia is considered. We suggest that the platelet count should be determined beforehand in patients suspected of having thrombocytopenia (e.g. cancer, pre-eclampsia).