Donati L

Updated evaluation of the activity of antibiotics in a burn centre

The results of microbiological tests performed in a burns unit between January 1989 and December 1990 have been analysed. Burn wound swabs and biopsies, blood cultures, central venous and urinary catheters, bronchial aspirates, pharyngeal swabs and faecal cultures for a total of 7950 examinations were considered. Staph. aureus was the most frequently isolated bacterium, followed by Staph. epidermidis, Pseud. aeruginosa and E. coli. The antibiograms have shown a low efficacy rate of cephalosporins, even of the latest generation, while with Gram-positive isolates the highest rates of activity were recorded by vancomycin and teicoplanin (100 per cent sensitivity). The situation seems better with Gram-negative organisms since they appear to be sensitive to a larger number of antimicrobial agents.

Congenital infiltrating lipomatosis of the face related to cytomegalovirus infection

A case of congenital infiltrating lipomatosis of the face is presented, associated with a congenital cytomegalovirus infection.

Preliminary clinical experiences with the use of immunomodulators in burns

The remarkable progress achieved in control of infections in burned patients has significantly increased survival rates. Nevertheless, septic complications are still the leading cause of death in these patients. The immunologic disturbances present after severe burns certainly play a key role in susceptibility to infection, and in particular the impairments of the phagocytic system warrant major investigative efforts in order to increase host defenses. Determination of phagocytic and microbicidal capacity of neutrophils from burned patients evidenced a marked functional impairment of these cells. The alterations recorded were partly due to intrinsic (cellular) defects, and partly to extrinsic (serum) defects. Indeed, opsonic factors are known to be reduced in these patients, but also phagocytosis-inhibiting factors such as immunocomplexes have been detected in the patients we have studied. Administration of the immunomodulating agents methysoprinol and timostimoline were found to be effective in partially restoring neutrophil function. Rational immunotherapy in burned patients will consist of replacement of humoral mediators, clearance of inhibitory factors and stimulation of the cellular effectors of immunity.

Combined Embolization and Surgery for Craniofacial Angiomas???Report of a Complex Case

A patient with a huge osteoangiofibroma of the right orbitozygomatic-maxillary region is described. The tumor bled repeatedly to a life-threatening degree. In an interdisciplinary approach, the tumor was first embolized through selective arterial catheterization. This reduced the pathological vascularization, allowing a safer surgical procedure with minimal blood loss.

Latissimus myocutaneous free flap in the reconstruction of lower limb defects--three clinical cases.

The authors present three case histories of patients undergoing reconstruction of traumatic lower limb defects: one with a third-degree burn of the popliteal fold with joint capsule damage and exposure of the femoral condyles, one with severe scarring of the popliteal fold following soft tissue deglovement, and one with a soft tissue defect of the middle third of the leg caused by a motorcycle accident. Reconstruction was carried out with the free transfer of a latissimus dorsi myocutaneous flap and microvascular anastomosis. The procedure was successful in 2 patients; 1 sustained late superficial necrosis of the flap.