Southern medical journal
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Southern medical journal · Jun 1996
Comparative StudyDecreasing length of hospital stay by early excision and grafting of burns.
All acutely burned patients admitted to one surgeon's practice during a 1-year period were considered for burn excision and grafting. A total of 222 patients were enrolled; 57 did not have surgery. In all, 130 patients having surgery within 24 hours after admission were compared with 48 patients having excision later than this. ⋯ The proportion of acute readmissions was not significantly different. The patients in the early excision group had a significantly shorter hospital stay for the first admission and for total length of stay for acute care, since if the length of stay for the first acute admission was added to the duration of hospitalization at any second acute admission, the early excision group again had a significantly shorter total length of stay. It appears that early burn excision (defined as within 24 hours of admission in this series) results in a reduced length of hospital stay without adverse effects on clinical outcome.
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Southern medical journal · Jun 1996
Case ReportsPersistent paralysis after prolonged use of atracurium in the absence of corticosteroids.
Neuromuscular blocking agents (NMBAs) are often used for patients requiring prolonged mechanical ventilation. Reports of persistent paralysis after the discontinuance of these drugs have most often involved aminosteroid-based NMBAs such as vecuronium bromide, especially when used in conjunction with corticosteroids. Atracurium besylate, a short-acting benzylisoquinolinium NMBA that is eliminated independently of renal or hepatic function, has also been associated with persistent paralysis, but only when used with corticosteroids. We report a case of atracurium-related paralysis persisting for approximately 50 hours in a patient who was not treated with corticosteroids.
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Southern medical journal · Jun 1996
Case ReportsPersistent cutaneous larva migrans due to Ancylostoma species.
Cutaneous larva migrans is considered to be a self-limited parasitic infection of about 2 to 8 weeks' duration, though it has been reported to persist for as long as 55 weeks. In this case, a healthy 47-year-old white man had multiple serpiginous lesions typical of cutaneous larva migrans for 18 months. A biopsy taken 2 months before presentation showed a parasite consistent with Ancylostoma species deep in a hair follicle. ⋯ Cutaneous larva migrans may sometimes be long-standing, here almost 2 years, even in a healthy patient. Organisms may reside deep in the hair follicles. Topical thiabendazole may not penetrate to this depth, necessitating oral thiabendazole therapy.
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Tripe palms is a cutaneous paraneoplastic syndrome. We report a case of tripe palms in a 71-year-old man with non-small cell lung cancer. Approximately 90% of patients with tripe palms have an associated cancer, most commonly involving the lung or the stomach. Any patient with tripe palms must have a complete cancer workup, especially for lung and stomach cancer.
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Chest trauma in children is a marker of injury severity and is associated with a high mortality rate. This retrospective study of 1,356 trauma patients from a private pediatric hospital over a 2.5-year period identified 82 patients with chest injuries and a mortality rate of 22%. Results of Injury Severity Score, Glasgow Coma Scale, and Revised Trauma Score all indicated that children with chest injuries sustained more severe injuries. ⋯ Specific chest injuries, such as rib fractures and pulmonary contusions, were not related to increased mortality unless there was an associated extrathoracic injury. Many reports have shown a high mortality associated with chest trauma. This study suggests that it is the associated extrathoracic injury, rather than the chest injury itself, that is the real cause of the high mortality.