Early surgical management in patients with burns.

Burns can be life threatening injuries with a significant risk of lifelong consequences. Severity of thermal injury is assessed using the combination of six essential factors (mechanism of injury, presence of inhalation trauma, extent of the burn area, depth of the burn, its location, patients age and co-morbidities) which also represent the determinants of referral to one of the three specialized burn centers in the Czech Republic. Early management consists of ABC Trauma Life Support (adequate oxygenation and ventilation, a venous access, parenteral fluid administration), pain relief, and sterile covering of the burn areas.

[Hypocholesterolemia after multiple injuries is not caused by simple hemodilution]. / Hypocholesterolemie po polytraumatu není zpusobena prostou hemodilucí.

The authors examined in 45 patients with multiple injuries total serum cholesterol levels and the packed cell volume on admission, 24 hours and 48 hours after injury. The cholesterol level in these patients declined as compared with a control group to 0.61 on admission of the patient (on average 102 min. after injury) and to 0.51 and 0.53 24 and 48 hours after injury, while the packed cell volume declined to 0.76 on admission and to 0.64 24 and 48 hours after the injury. The lose correlation between cholesterol and the packed cell volume (r2 = 0.27) suggests the part played by another mechanism of development of hypocholesterolaemia in patients with multiple injuries than mere haemodilution. In eight patients who died no correlation with hypocholesterolaemia was found.

[The role of cholesterol and intermediary metabolites of its synthesis in intensive care and parenteral nutrition]. / Uloha cholesterolu a intermediárních metabolitu jeho syntézy v intenzivní péci a umelé výzive.

Hypocholesterolaemia is a frequent and typical phenomenon of many acute situations such as injury, severe infection associated with sepsis and septic shock, catabolic situations after serious operations, in myocardial infarction and neoplastic diseases. This phenomenon cannot be explained only by malnutrition or energy deficiency although they may participate in the development of hypocholesterolaemia. In the development of the mentioned acute conditions participates according to our opinion also impaired synthesis of cholesterol as well as of intermediary metabolites of its biosynthesis (isoprene, squalene, lanosterol, and lathosterol). Evidence was provided that deprivation of these metabolites is frequent, very marked and statistically significant. Some precursors of cholesterol biosynthesis are extremely important for normal processes in the cell and as mediators (isoprene, farnesyl diphosphate, squalene). Their deficiency is a serious disorder which must be diagnosed in time. It is important to define the patients and conditions where a serious deficiency of these metabolites develops regularly and to seek ways how to treat deprivation of the mentioned metabolites.

[Osteochondritis ischiopubica--van Neck-Odelberg disease in the differential diagnosis of coxalgia]. / Osteochondrosis ischiopubica--morbus van Neck-Odelberg v diferenciálnej diagnostike koxalgií.

The authors describe five cases from out-patient practice, whose pains were localized into lumbar joint due to the damage of ischiopubic joint in children at the age of five to twelve years. Aseptic necrosis of ischiopubic localization has been described in available literature as morbus van Neck-Odelberg. A description of clinical and X-ray picture is described, in the first case being typical in all stages of X-ray symptoms. Some symptoms described in literature were or were not identical. It proved to be impossible to demonstrate the influence of an injury as a trigger factor, but limitation in the homolateral lumbar joint (abduction or adduction component) as well as spontaneous tension of adductors were regularly observed. Flexion and extension were not limited with the exception of the fifth patient. A general picture of the described disease may be established on the basis of clinical and, particularly, X-ray picture.