Work-related burns in South Wales 1995-96.

The aim of this work was to evaluate the epidemiology of occupational burns referred to the Welsh Regional Burns Unit from 1st January 1995 to 31st December 1996. Three hundred and twenty-four patients were identified as having sustained occupational burns and the case notes of 319 were available for review. Data on age, sex, occupation, aetiology, percentage and site of burn, treatment, complications and length of hospital stay were recorded. Twenty percent of all burns referred to our unit occurred in the workplace, the majority of whom were male (male:female 11:1), with a mean age of 34 years. Patients presented late to our unit in 35% of cases, with an average delay of 5 days. Chemical burns predominated (23%), followed by flame (14%) and scald (14%). Small burns (< or =1% TBSA) were seen in 70% of all patients. Five patients had burns involving >15% TBSA. One hundred and seventy-five patients were admitted, of whom 79 required surgery. The length of stay ranged from 1-110 days (mean 8.5), with an average follow-up for all patients of 3.5 months. One patient died as a result of his burn injury. In conclusion, occupational burn injuries continue to account for a significant proportion of all burn injuries, affecting mainly young males in physical occupations. Despite Health and Safety guidance, chemical burns are the predominant cause and more needs to be done to educate those working with chemicals to prevent injury.

The use of the latissimus dorsi musculocutaneous flap for immediate correction of the deformity resulting from breast conservation surgery.

Breast conservation surgery is now widely accepted as the treatment of choice in early breast cancer. Randomised controlled trials have shown comparable recurrence and survival rates following breast conservation when compared to mastectomy, with the perceived advantage that it should leave a cosmetically acceptable result without reconstruction. It is our experience that an adequate local excision may result in a poor cosmetic result with distortion of the nipple position, especially in women with small breasts. Between January 1994 and July 1996, we have performed 30 procedures, combining a wide local excision and axillary lymph node clearance for breast cancer with immediate reconstruction of the defect with a latissimus dorsi musculocutaneous flap. All patients had postoperative radiotherapy to the residual breast and, where appropriate, to the axilla. Adjuvant hormonal therapy or chemotherapy was prescribed where indicated. Patient's ages ranged from 36 to 72 years. All tumours were in the lateral, superior or inferior quadrants. The mean combined operating time was 120 min. Two patients required postoperative blood transfusion. Mean hospital stay was 8 days. Histology confirmed tumour clearance in all cases and six patients had axillary lymph node metastases. There were two cases of minor wound infection and six cases of seroma at the donor site. We conclude that breast cancers are ideally treated by a multidisciplinary team and that an immediate latissimus dorsi musculocutaneous flap may correct the deformities often seen after breast conservation surgery.

Coraçöes com dupla via de entrada ventricular: aspectos morfológicos em 20 casos / Morphological aspects of 20 heartswith double inlet ventricle

Verificar as apresentaçöes mais freqüentes da dupla via de entrada ventricular (DVEV) e das lesöes associadas, visando aplicaçäo no diagnóstico e no tratamento cirúrgico. Vinte coraçöes provenientes de coleçöes anátomo-patológicas, todos com DVEV. A análise foi feita de forma segmentar e em seqüência. O "situs" atrial era "solitus" em 14 casos e ambígüo em seis (quatro com isomerismo direito e dois com esquerdo). Com "situs solitus" havia duas valvas atrioventriculares (AV), enquanto que nos casos de isomerismo havia uma valva AV comum. O ventrículo principal era morfologicamente esquerdo em 13 casos, direito em um e indeterminado nos remanescentes. A conexäo ventrículo-arterial foi discordante em 10 casos, concordante em dois, dupla via de saída em oito (seis de ventrículo indeterminado, um da câmara principal e um da rudimentar). Obstruçöes ao fluxo pulmonar foram mais freqüentes no grupo dos isomerismos attriais (67%). Estenose de valva AV esteve presente em 4 casos, em dois esquerda e em dois direita. "Straddling" de uma das valvas AV foi observado em cinco casos e coarctaçäo de aorta em três. A comunicaçäo interventricular era restritiva em dois casos, ambos com DVEV para ventrículo principal esquerdo e concordância ventrículo-arterial ("coraçäo de Holmes"). Nos pacientes com isomerismos atriais, as lesöes de estenose pulmonar dominam o quadro e merecem atençäo preliminar. Nos demais, as derivaçöes átrio-pulmonares deveräo levar em conta também as peculiaridades morfológicas ...

Câncer oculto como forma especial dos carcinomas mamários / Occult cancer as a special type of breast neoplasms

O câncer oculto de mama, caracterizado como um quadro no qual o diagnóstico da metástase axilar precede a identificaçäo da lesäo primária, deve ser distinguido do câncer subclínico, quando um exame radiológico indica a existência de uma lesäo neoplásica mamária, näo perceptível no exame clínico. Dois casos säo relatados. O primeiro em 1975, com a execuçäo de mastectomia radical após rápida identificaçäo da neoplasia primária, e o segundo em 1985, com o diagnóstico de tumor metastático axilar e localizaçäo tardia da lesäo primitiva após 40 meses de controles periódicos, quando foi executada uma quadrantectomia mamária. Ambas as pacientes encontram-se assintomáticas. Tais casos, assim como outros citados na literatura internacional, permitem encarar o câncer oculto de mama como um tipo especial dentro do grupo genérico de tumores primários desconhecidos, com condiçöes biológicas e prognósticas que permitem um tratamento menos agressivo que o usualmente preconizado para estes tipos de lesäo