Dynamic variations in platelet counts may reflect the severity and prognosis of stingray injuries in the early phase.

There is often a delay in offering quality and prompt treatment after a stingray sting. We present 3 cases of stings and discuss the Poisoning Severity Score (PSS) and a simple tool to assess the severity of such injuries. A 34-year-old man, who worked as an aquarium keeper, presented a wound on the left fifth digit caused by a stingray. Acute myocardial injury and rhabdomyolysis were detected. After 6weeks, the wound had almost healed. A 27-year-old man who experienced a stingray injury on the left second digit recovered without sequelae after 5weeks. A 45-year-old man with a history of diabetes, who was accidentally stung in the right palm by a stingray, experienced rhabdomyolysis and returned to work after 2months. We performed debridement, administered the tetanus toxoid and antibiotics, and immersed the wounded hand in warm water (about 43°C) for all three cases. Meanwhile, patients with rhabdomyolysis were administered intravenous hydration. Upon presentation at the emergency department, we recorded the severity of the injury by using PSS. We found that relatively high PSSs were associated with lower platelet counts that happen due to various adverse events. We suggest that dynamic changes in platelet counts may be associated with the severity of the injury. Furthermore, lower platelet counts in the normal or abnormal range may indicate poor prognoses.

Inflammatory biomarkers in combat wound healing.

BACKGROUND: Modern war ballistics and blast injuries inflict devastating extremity injuries, violating soft tissue, bone, and neurovascular structures. Despite advances in complex wound management, appropriate timing of war wound closure remains subjective. In addition, the pathophysiology of acute wound failure is poorly defined. METHODS: Patients with penetrating extremity wounds sustained during combat were prospectively studied and followed for 30 days after definitive wound closure. The primary outcome was wound healing. Wound dehiscence was defined as spontaneous partial or complete wound disruption after closure. Serum, wound effluent, and wound bed tissue biopsy were collected at each surgical wound debridement. Serum and wound effluent were analyzed with a multiplex array of 22 cytokines and chemokines, and wound tissue for corresponding gene transcript expression. RESULTS: Fifty-two penetrating extremity war wounds in 33 male patients were investigated. Nine (17%) wounds dehisced. Concomitant vascular injury, increased wound size, and higher injury severity score correlated with wound dehiscence. Both serum and wound effluent cytokine and chemokine protein profiles were statistically associated with healing outcome at various time points. Wound biopsy gene transcript expression demonstrated increased tissue inflammation associated with wound failure. Multiple protein and gene transcript biomarkers predictive of wound healing were identified. CONCLUSIONS: The cytokine and chemokine protein and gene transcript expression patterns demonstrate a condition of inflammatory dysregulation associated with war wound failure. A molecular biomarker panel may predict combat wound healing outcome and warrants prospective validation.

[Dynamic monitoring of sIL-2R, IL-2 and IL-6 levels of serum after double-hand transplantation].

OBJECTIVE: To investigate the value of monitoring cytokines in serum after human double-hand allotransplantation. METHODS: We detected solube interleukin-2 receptor(sIL-2R), interleukin-2(IL-2) and interleukin-6(IL-6) levels of the serum in the patient who were performed double-hand transplantation with immunosuppressive from September 2000 to November 2000, and in 15 healthy volunteers by using enzyme linked immunosorbent assays. RESULTS: The IL-2 and IL-6 levels decreased quickly during inducing period (P < 0.05), and then increased gradually. While the sIL-2R level increased. The IL-2 level was lower(P < 0.05), the IL-6 and sIL-2R levels were slightly higher when compared with those before transplantation. There was significant difference in the IL-2 level between the patient and healthy volunteers both before and after transplantation, in the IL-6 level between the patient and healthy volunteers during inducing period. CONCLUSION: IL-2, IL-6 and sIL-2R levels of serum may be useful in diagnosis of rejection, prevention of opportunistic infection, tumor and graft versus host disease.

[Preoperative prevention of infection with cefuroxime in hand surgery emergencies. Efficacy, control of concentration, follow-up]. / Pröperative Infektionsprophylaxe mit Cefuroxim beim handchirurgischen Notfall. Effizienz, Konzentrationskontrolle, Verlaufskontrolle.

Clinical efficacy and drug safety of Cefuroxime for preoperative prophylaxis of wound infection was investigated in 20 cases of acute open hand injuries. Ten minutes before filling of the tourniquet, Cefuroxime was given. Tissue and serum levels of ten patients were determined 10 and 70 minutes later. Levels far above the minimum inhibitory concentrations of possible pathogenic bacteria were obtained. No serious infection occurred. Wound complications not related to infection occurred in 15%.