Electrocardiographic abnormalities in patients with acute burn injuries.

OBJECTIVE: To determine the incidence and types of electrocardiographic (ECG) abnormalities in patients admitted with acute burn injuries and correlate them with the degree and the extent of burn injuries. METHODS: Retrospective analysis of 192 patients admitted to the burn unit was performed. Thirty-four patients met the inclusion criteria of having a 12-lead ECG performed on admission and at least one more time during their stay. RESULTS: There were 26 men and 8 women. The average age of patients was 53.4 +/- 17.5 years. The average degree of burn was 2.4 +/- 0.6 and the average body surface area (BSA) involved was 12.8 +/- 11.8%. There were 18 patients (53%) with ECG abnormalities. Five patients had sinus tachycardia, including two with premature atrial complexes (PACs) and one with ST-T abnormality. Three patients had premature ventricular complexes (PVCs), including one with a paced atrial rhythm and one with a prolonged QT interval. Right bundle branch block was present in two patients, and low voltage QRS was present in one. Atrial fibrillation was present in two patients, including one with ST-T abnormality due to digitalis effect. Four patients had a prolonged QT interval as the sole abnormality. One patient had left ventricular hypertrophy, an old inferior myocardial infarct, PACs, and non-specific ST-T wave abnormality. CONCLUSIONS: In patients with acute burn injuries sinus tachycardia and a prolonged QT interval were the most common ECG abnormalities. There was no correlation between the extent of burn injuries and observed ECG abnormalities. No patient had a life threatening arrhythmia, and all patients had a good outcome.

Treatment of posttransplantation recurrence of hepatitis C with interferon and ribavirin: lessons on tolerability and efficacy.

Recurrence of hepatitis C virus (HCV) infection after orthotopic liver transplantation is a major cause of graft failure. The aim of our study was to determine the safety, efficacy, and tolerability of combination therapy with interferon and ribavirin in the treatment of recurrent hepatitis after liver transplantation. Twenty-six patients (18 men) with histologically established HCV recurrence after liver transplantation for cirrhosis secondary to chronic HCV infection were treated with a combination of interferon alfa-2b (3 million units three times weekly) and ribavirin (800 to 1,000 mg/d). Dosage modifications were according to a standard protocol incorporating laboratory values and clinical side effects. Fifty percent of patients completed 1 year or more of therapy. On an intention-to-treat basis, nine patients (35%) showed an end-of-treatment virological response. Six of these nine patients completed greater than 6 additional months of follow-up, and all have had sustained virological responses. A histological response (decrease in histological activity index > or = 2) was seen in 75% of virological responders and 67% of nonresponders. Adverse events requiring dose modification or cessation of therapy occurred in 66% of patients. Adjuvant therapies used to support hemoglobin levels included erythropoietin and red blood cell transfusions. There were no independent pretreatment predictors of a virological response, perhaps because of the small sample size. Combination therapy with interferon and ribavirin may be beneficial in patients with recurrent HCV after liver transplantation. The majority of patients require dose modifications because of side effects. Histological response is common in virological nonresponders.