Increases in anaphylaxis fatalities in Australia from 1997 to 2013.

BACKGROUND: Recent epidemiological studies indicate increases in Australian, UK and US hospital anaphylaxis admission rates. OBJECTIVES: The aim of this study was to determine whether Australian anaphylaxis fatalities are increasing in parallel and to examine the characteristics of fatalities recorded in the National Coronial Information System (NCIS). METHODS: Time trends in Australian anaphylaxis fatalities were examined using data derived from the Australian Bureau of Statistics (ABS) 1997-2013 and the NCIS 2000-2013, the latter providing additional information to verify cause and identify risk factors. RESULTS: The ABS recorded 324 anaphylaxis fatalities by cause: unspecified (n = 205); medication (n = 52); insect stings/tick bites (n = 41); food (n = 23); and blood products (n = 3). From 1997 to 2013, all-cause fatal anaphylaxis rates increased by 6.2%/year (95% CI: 3.8-8.6%, P < 0.0001) or from 0.054% to 0.099/10(5) population. Fatal food anaphylaxis increased by 9.7%/year (95% CI: 0.25-20%, P = 0.04) and unspecified anaphylaxis deaths by 7.8% (95% CI: 4.6-11.0, P < 0.0001). There was an insignificant change in medication-related fatalities (5.6% increase/year; 95% CI: 0.3% decrease to 11.8% increase, P = 0.06), and sting/bite fatalities remained unchanged. Hospital anaphylaxis admission rates for all-cause, food, unspecified and medication anaphylaxis increased at rates of 8%, 10%, 4.4% and 6.8%/year, respectively. A total of 147 verified NCIS deaths were examined in detail: medication- and sting/bite-related fatalities occurred predominantly in older individuals with multiple comorbidities. Upright posture after anaphylaxis was associated with risk of sudden death (all causes). Seafood (not nuts) was the most common trigger for food-related anaphylaxis deaths. CONCLUSIONS: Australian anaphylaxis fatality rates (most causes) have increased over the last 16 years, contrasting with UK- and US-based studies that describe overall lower and static overall anaphylaxis fatality rates (0.047-0.069/10(5) population).

The national incidence and clinical picture of SLE in children in Australia - a report from the Australian Paediatric Surveillance Unit.

OBJECTIVES: The objectives of this paper are to prospectively determine the incidence of paediatric systemic lupus erythematosus (pSLE) in Australia as well as describe the demographics, clinical presentation and one-year outcome. STUDY DESIGN: Newly diagnosed cases of pSLE were ascertained prospectively from October 2009 to October 2011 through the Australian Paediatric Surveillance Unit (a national monthly surveillance scheme for notification of childhood rare diseases) as well as national subspecialty groups. Questionnaires were sent to notifying physicians at presentation and at one year. RESULTS: The annual incidence rate was 0.32 per 10(5) children aged less than 16 years. The incidence was significantly higher in children of Asian or Australian Aboriginal and Torres Strait Islander parents. Approximately one-third of children underwent a renal biopsy at presentation and 7% required dialysis initially although only one child had end-stage kidney disease (ESKD) at one-year follow-up. CONCLUSION: The incidence of pSLE in Australia is comparable to that worldwide with a significantly higher incidence seen in children of Asian and Australian Aboriginal and Torres Strait Islander backgrounds. Renal involvement is common but progression to ESKD, at least in the short term, is rare.

Frequency and significance of immediate contact reactions to peanut in peanut-sensitive children.

BACKGROUND: Parents of atopic children frequently report, and are alarmed by, contact reactions to foods. Some schools restrict foods due to concerns regarding possible systemic reactions following contact in allergic children. OBJECTIVE: We aimed to determine the frequency with which peanut-sensitive children exhibited contact sensitivity to peanut butter and to assess the significance of such reactions. METHODS: One gram of peanut butter was applied directly to the skin of 281 children who were skin prick test (SPT) positive to peanut (immediate skin application food test; I-SAFT). The test was considered positive if one or more weals were present when the patch was removed after 15 min. A subset of children then underwent an open-label oral challenge with graded amounts of peanut protein. RESULTS: During 3515 clinic visits, 330 I-SAFT tests for peanut contact sensitivity were performed; 136 (41%) were positive. The mean SPT diameter was 10 mm in the I-SAFT-positive children and 8.5 mm in the I-SAFT-negative children (t-test, P<0.0001). No child had a systemic reaction following topical application of peanut butter. Eighty-four children had 85 oral challenges after blinded, placebo-controlled I-SAFT testing. Challenge was positive in 26/32 of those with a positive I-SAFT and negative in only 6/32. Challenge was also positive in 26/53 but negative in 27/53 of those with a negative I-SAFT (sensitivity 50%, specificity 82%, chi2, P=0.003). CONCLUSION: A minority of children sensitized to peanut (positive SPT) develop localized urticaria from prolonged skin contact with peanut butter. No tested subjects, including ones with systemic reactions upon oral challenge, developed a systemic reaction to prolonged skin exposure to peanut. Therefore, systemic reactions resulting from this mode of contact with peanut butter appear highly unlikely.

Colgajo subcutáneo muscular de isquiotibial en úlcera isquiática / Subcutaneous muscular flap for ischial sore

El cierre de la úlcera isquiática con pequeño orificio cutáneo mediante un colgajo subcutáneo muscular-isquiotibial basado en el bíceps crural, permite un considerable ahorro de tejido tanto en la excisión como en el colgajo mismo. Este colgajo es útil cuando la úlcera cutánea es pequeña, debe cubrirse el muñón óseo y rellenar la cavidad subcutánea con tejidos con excelente circulación y suficiente espesor, y así evitar una gran movilización de tejidos, así como cicatrices innecesarias en áreas potencialmente recidivantes

Colgajo subcutáneo muscular de isquiotibial en úlcera isquiática / Subcutaneous muscular flap for ischial sore

El cierre de la úlcera isquiática con pequeño orificio cutáneo mediante un colgajo subcutáneo muscular-isquiotibial basado en el bíceps crural, permite un considerable ahorro de tejido tanto en la excisión como en el colgajo mismo. Este colgajo es útil cuando la úlcera cutánea es pequeña, debe cubrirse el muñón óseo y rellenar la cavidad subcutánea con tejidos con excelente circulación y suficiente espesor, y así evitar una gran movilización de tejidos, así como cicatrices innecesarias en áreas potencialmente recidivantes

Resultados de la colecistectomía por laparoscopia / Results of laparoscopic cholecistectomy

Se comunica los resultados de la colecistectomía por laparoscopia en 245 pacientes. El procedimiento se completó en 223. La conversión a colecistectomía abierta fue necesaria en 22 pacientes (8,9%) debido a dificultades anatómicas y principalmente coledocolitiasis. Diez pacientes presentaron complicaciones quirúrgicas, 4 de ellas de importancia (1,8%). Hay un fallecido a los 18 días postoperatorios por embolia pulmonar. La incidencia de lesión de la vía biliar fue de 1 en 223 casos (0,4%). El promedio de días de estada intrahospitalaria fue de 2,4 días y el retorno a la actividad laboral fue de 10,2 días

Cáncer de mama oculto: revisión de 21 casos / Hidden breast cancer: 21 cases review

La mamografía es un excelente método de diagnóstico en los cánceres ocultos de la mama. En 20 cánceres de mama de un total de 21 que presentaron 17 pacientes, el diagnóstico fue realizado por esta técnica, lo que permitió su tratamiento quirúrgico oportuno, no mutilante y efectivo, con un promedio libre de enfermedad a 4 años promedio de la totalidad de los pacientes

Colecistectomía laparoscópica: experiencia colectiva de los cirujanos del hospital militar / Laparoscopic cholecystectomy: experience at militar hospital

Se presenta la experiencia de las primeras 350 colecistectomías laparoscópicas realizadas en el Hospital Militar desde agosto 1990 a junio 1991. Los resultados en cuanto a calidad del postoperatorio y baja incidencia de complicaciones médicas (7,1%) y quirúrgicas (4%), hacen recomendable esta técnica para el tratamiento de la litiasis biliar

Preparación anterógrada y profilaxis antibiótica con dosis única en cirugía colorrectal electiva / Anterograde preparation and antibiotic prophylaxis with a single dose in elective colorectal surgery

Cincuenta y nueve pacientes sometidos a cirugía colorrectal electiva recibieron preparación de colon por vía anterógrada y profilaxis antibiótica en dosis única con ceftriaxona y ornidazol. La preparación utilizada fue bien tolerada, obteniendo una adecuada limpieza del lumen intestinal y minimizando las alteraciones hidroelectrolíticas y del equilibrio ácido-base. No hubo sepsis ni complicaciones sépticas graves intraabdominales.