Too hot to handle? Hot water bottle injuries in Sydney, Australia.

OBJECTIVE: Hot water bottles are frequently used in the community as a source of warmth, and to alleviate a number of medical symptoms. In Australia it is believed that over 500,000 water bottles are sold annually (Whittam et al., 2010). This simple treatment is known to result in significant burns and has led to mandatory labeling requirements on hot water bottles in Australia. Despite this, few published studies have documented the incidence and nature of burns sustained through their use. This study aimed to assess the incidence, causation and outcome of hot water bottle burns presenting to a major burn trauma unit in Sydney (Australia). METHODS: The New South Wales Agency for Clinical Innovation Statewide Burn Injury database and admission data to the Concord Hospital Burns Injury Unit (major treatment unit) provided information on hot water bottle burns occurring between 2005 and 2013. Demographic details, cause of burn, burn depth, total burn surface area (%TBSA), and outcome of burn were ascertained. In order to assess the burn potential of hot water bottles, a separate study examined the thermic properties of hot water bottles in 'real life' scenarios. FINDINGS: There were 155 hot water bottle burn presentations resulting in 41 admissions and 24 grafts. The majority of patients were female, and most burns resulted from appliance rupture when used for local pain relief. Patients had an average TBSA of 2.4%. Burns patients were slightly more likely to reside in areas with greater socio-economic disadvantage. In real life scenarios, hot water bottles were shown to retain heat over 50°C for at least 3 hours (h). CONCLUSIONS: Hot water bottles are a source of common and preventable burns in the community, with women being more at risk than men. Hot water bottles may retain harmful levels of heat over an extended period of time. Additional labeling requirements pertaining to the longevity of hot water bottles and their use among people especially at risk of burns (i.e. children, the elderly, patients who have undergone recent surgery and/or those with conditions associated with sensory impairment) may further reduce the incidence and severity of hot water bottle burns in the community.

Radiofrequency ablation as an adjunct to systemic chemotherapy for colorectal pulmonary metastases.

BACKGROUND: Radiofrequency ablation (RFA) is an alternative to local treatment for pulmonary metastases in patients who are nonsurgical candidates. Based on previously documented efficacy of this treatment, the authors retrospectively studied the prognostic factors for long-term survival. METHODS: One hundred patients with unresectable colorectal pulmonary metastases underwent percutaneous RFA. Clinical and treatment variables were collected and evaluated using univariate and multivariate analyses with overall survival as the primary endpoint. RESULTS: At a median follow-up period of 23 (range, 1 to 96) months from the time of RFA treatment, 49 patients have died. The median overall survival after RFA treatment was 36 months and 5-year overall survival rates of 30%. Univariate analyses demonstrated that histopathological grade (p < .001), time to RFA treatment (p = .017), response to treatment (p < .001), repeat RFA treatments (p = .001), presence of extrapulmonary metastases (p < .001), presence of mediastinal lymphadenopathy (p = .007), and adjunct systemic chemotherapy (p < .001) were associated with overall survival. Multivariate analyses demonstrated that response to RFA treatment (p < .001), repeat RFA treatment (p = .002), presence of extrapulmonary metastases (p = .008), and use of adjunct systemic chemotherapy (p = .05) were independent predictors for survival. CONCLUSIONS: Radiofrequency ablation for colorectal pulmonary metastases represents a step forward towards a nonsurgical option of combining systemic and local treatment for metastatic disease and is a safe treatment with a low risk profile.