1/3. Hand infections caused by delayed inoculation of vibrio vulnificus: does human skin serve as a potential reservoir of vibrios?vibrio vulnificus may cause severe soft tissue infections of the upper extremity. This pathogen usually gains access to soft tissues either by direct inoculation through a penetrating injury by an infected marine animal or by exposing abraded skin to contaminated water. We report five patients with vibrio vulnificus hand infections following superficial hand injuries incurred within 24 hours after uneventful handling of fish. This clinical observation, together with the fact that the physiologic characteristics of human sweat simulate the natural environment of the vibrio vulnificus, support the assumption that human skin may serve as a reservoir for Vibrios. The anamnesis in patients presenting with hand infection should essentially include an inquiry regarding recent, albeit uneventful, fish handling.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
2/3. The broken wire suture.The body is a hostile environment for wire sutures. Although the problems of electrochemical corrosion, direct chemical attack on the suture, and inflammation produced in reaction to the suture have been largley eliminated by the use of austenitic stainless steel wires, failure of the wires may still occur due to mechano-chemical cracking -- the combined effect of insignificant stresses, usually from cold working, and insignificant chemical potentials produced by body fluids. Although stainless steel wire remains a satisfactory material for sternotomy closure or for reattaching costal cartilages, the two spectacular complications of a broken wire point out the need for care in using wire sutures. Bending, twisting, kinking and knotting must be avoided as much as possible.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
3/3. Successful roadside resuscitative thoracotomy: case report and literature review.patients with injuries severe enough to require cardiopulmonary resuscitation (CPR) have a dismal prognosis. time to surgical intervention is a major determinant of outcome in moribund trauma patients who have a potential for survival. With the exception of endotracheal intubation during evacuation to surgical intervention, no other usual prehospital procedures have been validated to affect outcome in such cases of extremis. This is a report of a case in which resuscitative surgical techniques were extended successfully to the prehospital environment. The patient was a 30-year-old man in extremis after a stab wound to the left chest. Estimating a transport time of 15 minutes, a physician riding with the emergency medical service (EMS) crews elected to perform a resuscitative thoracotomy. Following digital aortic compression, the patient regained both blood pressure and consciousness by the time of arrival at the trauma center. A left lower lobectomy was then performed in the operating room. The patient recovered fully and was discharged home in 21 days, neurologically intact. Four years later, the patient was alive, healthy, and working. This report demonstrates the feasibility of prehospital thoracotomy and raises provocative issues regarding future intense surgical involvement in prehospital care.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |