A body packer swallowed 39 condoms containing a total of 518 g hashish oil. He was arrested on entry into Canada. Two days later, a urine sample was obtained. Total cannabinoid concentrations by TDx and Emit II were 10,200 ng/mL and 11,400 ng/mL, respectively. The concentration of 11-nor-delta 9-tetrahydrocannabinol-9-carboxylic acid by gas chromatography/mass spectrometry was 1140 ng/mL.

Cannabinoids↗

PubMedDate not supplied

Heterotopic bone formation in the patient with burn injuries. A retrospective assessment of contributing factors and methods of investigation.

The incidence of heterotopic bone formation in seven of 25 patients with burn injuries who required endotracheal intubation and ventilation for smoke inhalation injury was believed to be unacceptably high. Factors in the affected patients distinguishing them from those unaffected were sought. Total protein levels were found to be higher in the affected group. This may correlate with the calciuretic response to protein loading reported previously. Of the affected patients, four demonstrated extreme agitation and resisted physiotherapy. Only one of the 18 nonaffected patients was equally agitated and resistant (p less than 0.05). The additional joint trauma sustained by the affected patients may contribute to the development of heterotopic bone. In bone scans in 18 consecutive patients deemed to be at risk, all showed increased radioactivity at multiple joints. Only seven patients developed heterotopic bone. Bone scans are not sufficiently specific to be used as a diagnostic tool in detecting heterotopic bone.

Adolescent↗

PubMedDate not supplied

Major burns managed without blood or blood products.

Four major burns (two flame, one scald, one electrical) were managed without administration of blood or plasma. Serial changes in hemoglobin, and serum albumin and total protein measurements were compared with those of controlled patients matched in age and total body surface area burned who were treated by standard methods. Hemoglobin values were lower but within one standard deviation, although serum protein and albumin measurements fell more than one standard deviation below mean values observed in control patients at comparable times after burn injury. Important treatment principles that were instrumental to recovery include a high-calorie, high-protein diet, iron supplementation, use of pediatric blood sampling techniques, and monitoring for and prophylaxis against infection while allowing eschar to separate spontaneously rather than performing early debridement. Amputation of mummified electrically burned limbs at more proximal levels, including marginally viable muscle, is recommended to minimize infection and decrease blood loss associated with customary conservative serial debridements.

Adult↗

PubMedDate not supplied

Comparison of silver sulfadiazine 1% with chlorhexidine digluconate 0.2% to silver sulfadiazine 1% alone in the prophylactic topical antibacterial treatment of burns.

Wound bacterial colonization in 118 patients treated with chlorhexidine digluconate 0.2% in silver sulfadiazine 1% applied daily to the burn wounds was compared to that of 135 comparable patients similarly treated with silver sulfadiazine 1%. With chlorhexidine digluconate 0.2% in silver sulfadiazine 1%, colonization by Staphylococcus aureus was less frequent (38%) than with silver sulfadiazine (54%, p = 0.016). No statistical difference was found for colonization by Enterococcus faecalis, Pseudomonas aeruginosa, or Enterobacter cloacae. Washing of the wounds of 65 patients with chlorhexidine gluconate 4% during daily dressing changes was associated with reduced wound colonization by S. aureus (35% versus 51%, p = 0.03) and P. aeruginosa (8% versus 16%, p = 0.08) when compared to the 188 washed with nonantibacterial soap. Chlorhexidine, whether added to the topical agent silver sulfadiazine (chlorhexidine digluconate 0.2%) or in the bath soap (chlorhexidine gluconate 4%), decreased colonization by S. aureus.

Administration, Topical↗