Neurological complications of extracorporeal membrane oxygenation in children.

OBJECT: Extracorporeal membrane oxygenation (ECMO) is a potentially life-saving treatment for patients in refractory cardiorespiratory failure. Neurological complications that result from ECMO treatment are known to significantly impact patient survival and quality of life. The purpose of this study was to review the incidence of neurological complications of ECMO in the pediatric population and the role of neurosurgery in the treatment of these patients. METHODS: Data were obtained from the national Extracorporeal Life Support Organization (ELSO) Registry for the years 1990 to 2009. The neurological complications recorded by the registry include CNS hemorrhage, CNS infarction, and seizure. The ECMO Registry at the authors' institution was then searched, and 3 pediatric patients who had undergone craniotomy during ECMO treatment were identified. RESULTS: Children in the ELSO Registry who were treated with ECMO survived to hospital discharge in 65% of cases. Intracranial hemorrhage occurred in 7.4% of the ECMO-treated patients, with 36% of those surviving to hospital discharge. Hemorrhage was more likely in patients younger than 30 days old and in those requiring ECMO for cardiac indications. Cerebral infarction occurred in 5.7% of all ECMO-treated patients. Clinically diagnosed seizures occurred in 8.4% of all ECMO-treated patients. The ECMO Registry at the authors' institution revealed that 1898 patients were treated there. Intracranial hemorrhage was diagnosed in 81 patients (5.8%), and 3 of these patients were treated with craniotomy. Two of the patients were alive with minimal neurological impairment and normal school performance at 10 and 16 years of follow-up. CONCLUSIONS: Intracranial hemorrhage is a serious complication of ECMO treatment. While the surgical risk is substantial, there may be a role for surgical evacuation of hemorrhage in well-selected patients.

Burn injury and wound healing in X-linked ichthyosis.

X-linked ichthyosis is a skin condition of decreased keratin degradation and hyperkeratosis resulting from a deficiency of steroid sulfatase causing scaly skin. Burns in these patients may require skin grafting and harvesting from diseased donor sites. No descriptions of the outcomes of attempted grafting, donor site healing, and burn recovery in patients with X-linked ichthyosis exist. The authors describe split-thickness skin grafting in one patient with X-linked ichthyosis who sustained a burn with crush injury to his bilateral lower extremities. Although he developed cellulitis, there is no evidence that patients with ichthyosis have higher rates of infection. The patient exhibited rapid healing at postgrafting clinic visits with a much flatter texture than expected early after meshed skin grafting. This could be a benefit of the excess keratin state. Wound healing was not impaired by the ichthyosis. Concerns over skin harvest were alleviated by aggressive topical emollients, which did not negatively impact harvest of donor skin or primary burn site healing.

A multidisciplinary approach to improving women's health in semi-urban Ecuador.

OBJECTIVE: To examine women's reasons for seeking care at The Quito Project (TQP), a student-led organization that aims to improve the health, education, and well-being of a semi-urban community in Quito, Ecuador, and to explore the need for additional preventative interventions. METHODS: An oral survey was administered to 86 adult patients in 2008. We also completed a chart review to evaluate patient demographics and medical conditions. RESULTS: Sixty-three (73.3%) survey respondents were female. Nearly three-quarters of the women reported an income below the minimum wage; 60% reported that the cost of medical care posed a burden. Fifty-two percent sought care at TQP because the services were free. Additionally, 77% of women reported going to the doctor only when ill and did not access preventative services. CONCLUSIONS: By offering medical, dental, and tutoring services, along with preventative health workshops, TQP addresses established barriers to achieving adequate women's health. Survey results have reinforced TQP's focus on prevention.

Fatalities associated with the termination of electrical services.

The worldwide dependence on electricity to support the needs of today's society is often taken for granted and, as such, the hazards associated with the termination of electrical services are often neglected. Whether electrical services are unintentionally terminated as the result of severe weather or intentionally terminated as the result of nonpayment of utility bills, the ensuing conditions may lead to injury or death in affected individuals. We performed a retrospective review of all deaths investigated by the Onondaga County Medical Examiner's Office between 1999 and 2004. Our case database was searched for causes of death that included hypothermia, hyperthermia, carbon monoxide, fire, electrocution, and/or electricity. Further review of these cases was undertaken to determine the potential relationship between the death and the termination of electrical services. Seven fatalities were found to be associated with the termination of electrical services. Four fatalities resulted from its unintentional termination and 3 were a consequence of intentional termination. In reporting these deaths, we hope to emphasize the potential dangers associated with the termination of electrical services and explore the informational programs and public health laws that are in place to limit the associated potential negative outcomes.