Panminerva medica
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In cases of thermal injuries it is always difficult to predict the extent of necrosis to the peripheral ischemic zone. Practically, full-thickness skin burn also affects the underlying muscle, panniculus carnosus, which adheres tightly to the skin. In this proposed model, the muscle which was always partly damaged also covers the ischemic zone of full-thickness burn injury. To evaluate the deeper levels of injury, the status of the micro circulation of thermally affected muscle was evaluated by counting the accumulated radioactive agent, 99mTc methoxyisobutylisonitril (MIBI) in the muscle cells. ⋯ Muscle layer, where just below the burn area and tightly attached to the skin, could be assessed as a representative of the extension of the injury.
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Review Case Reports
Munchausen's syndrome. A case of factitious hemoptysis.
Factitious hemoptysis is the bleeding type of Munchausen's syndrome, rarely reported in the literature (only seventeen cases). After a careful and detailed literature review, the authors report the case of a 22-year-old working-woman, with a history of asthma, Mediterranean anaemia and recurrent hemoptysis, who was admitted several times to the cardiovascular and Respiratory Sciences Department in the Carlo Forlanini Hospital in 1994 for an asthmatic attack and wheeziness at rest. During the admissions the patient underwent laboratory tests (such as the examination of sputum specimens, urinalysis, tuberculin test, cold agglutinins and pneumotropic virus tests) and diagnostic studies (fiberoptic bronchoscopy with bronchoalveolar lavage, computerized tomography and radiography of the chest, bronchial arteriography, bronchography, perfusion and ventilation lung scan), because she continually presented with hemoptysis, in order to spot and discover the nature of the bleeding. Since such examinations failed (a few of them-namely fiberoptic bronchoscopies--were even performed when she was coughing up blood) and psychiatric consultations revealed the presence of psychologically traumatic events in the patient's history which could explain the psychopathic traits of her personality (in fact she was aggressive and unstable in interpersonal relations), a diagnosis of factitious hemoptysis in Munchausen's syndrome was made.
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Clinical Trial
Evaluation of effect and distribution of heparin administered in vascular reconstructive surgery.
The aim of this study was to find out whether intravenously administered heparin is distributed equally not only proximal but also distal to the arterial occlusion level in vascular reconstructive surgery. ⋯ In vascular reconstructive surgery which requires temporary arterial occlusion for as long as 80 minutes, the effect of heparin is excellent and equal throughout the body by collateral vessels, and the metabolic influence due to blockade of the blood flow is not so critical as to lead to cellular damage although anaerobic glycolysis is promoted distally due to hypoxia.