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Complications of ear piercing: treatment and prevention.

Ear piercing and wearing earrings have been associated with many medical problems including local infection, sepsis, superficial cervical lymphadenopathy, localized argyria, contact dermatitis, lymphoplasia, edema and hematoma formation, exuberant granulation tissue, keloids, lipomas, embedded earrings, epidermal cyst formation, sarcoidal granulomas, earlobe deformities, cutaneous injury resembling frostbite, pressure sores or bruising of the postauricular area, syncope, aspiration, and ingestion. Proper precautions should help to prevent many of these common complications.

Adult↗

A field study of cold effects among cold store workers in China.

A field study was carried out among cold store workers in China. A self administrative questionnaire and health check-up were taken among 463 male workers from two different types of cold stores, all during their whole daily work. 296 men from Lower Temperature Stores (LTS), where the air temperature was between -10 to -25 degrees C, and 167 men from Ice Stores (IS), where the air temperature was between -5 and +5 degrees C participated. Another group of 152 men working in normal stores and exposed to an air temperature between 20 and 30 degrees C served as a control group. The study did not indicate any special disease attributable to the cold environment. The number of complaints of lower back pain and knee pain in the cold exposed group were significantly higher than that of the control group (in LTS: 42.3%, 46.6%; IS: 52.7%, 50.8%; control group: 9.2%, 14.5%; low back and knee pain, respectively). After 5 years of cold exposure work, the lower back and knee symptoms were very frequent. The point press pain on the knees of the cooler group (LTS) was higher than in the moderate cold group (IS). We suppose that the cold factor contributed to lower back and knee pain. 12.2% of 463 cold exposed workers had frostbite on the body extremities viz: hand, foot and ear. Self estimation of health indicated more problems among cold exposed workers (28.0%) than control group (2.7%).

Adult↗

Wrist and hand skeletal injuries in children.

When accidents occur, the hand is the part of the body most often thrust out to lessen the consequences, resulting in a wide array of combinations of soft-tissue and chondro-osseous injuries. Pediatric wrist and hand skeletal injuries discussed in this article include growth mechanism injury, fractures and dislocations, nailbed injuries, fingertip injuries, burns, and frostbite.

Child↗

[Prevention of stress ulcers with sulpiride (author's transl)].

Stress ulcers or hemorrhagic lesions of the digestive tract may arise after multiple or cranial trauma, burns, frostbite, severe operations or intensive care treatment, respiratory of renal failure, or any other severe disorder affecting the body. The risk of a stress ulcer accurring varies from 10 to 50% according to the severity and number of factors involved. Sulpiride was studied to assess its preventive value, in 50 high-risk patients being treated in an intensive care unit for medical or surgical conditions. The dosage was 3 injectable ampoules daily during the whole period of intensive care treatment. Control investigations (endoscopy, gastric aspiration, autopsy in case of death) were carried out in all patients. No gastro-intestinal erosions or ulcers developed in any of the 50 patients, and no signs of intolerance were reported.

Female↗

[Value of tele-thermographic studies in the diagnosis of head and neck diseases].

The tele-thermographic examinations are of non-invasive character, they can be repeated any time and may be applied also for check-up examinations. The fact that they are evaluated together with other completing clinical examinations (X-ray, scintigraphy, ultrasonography, biopsy etc.) gives the objective significance and value of the examination. According to the author's observation the tele-thermography provides important help in the diagnostics of cervico-facial tumors, in the demonstration of metastases before the operation and detection of postoperative recurrences, in the follow-up of the patient's condition at the period of irradiation- or cytostatic therapy gives exact information in dermatology on the biological activity and extent of malignant melanoma. The treatment of persons with burn- or frostbite injuries requires it equally and good information may be obtained by its use on the condition of blood circulation in cases of vascular obstruction and vascular anomalies.

Biopsy↗

Surveillance of work-related cold injuries using workers' compensation claims.

The usefulness of workers' compensation claims for the surveillance of occupational injuries was evaluated by analyzing claims for cold injury. Five hundred ten claims filed in 1983 from 23 states participating in the Bureau of Labor Statistics Supplementary Data System and an additional 147 claims filed with the Division of Safety and Hygiene of the Industrial Commission of Ohio from Jan 1, 1984, to June 30, 1985, were examined. As expected, the number of injuries per winter day increased as temperature decreased and wind speed increased. The rate of injury began to increase when temperatures fell below 10 degrees F and wind speeds exceeded 10 mph. These weather conditions were milder than previously published cold hazard charts suggest. Frostbite injuries of the lower extremities occurred at milder temperatures, required more lost workdays, and were more costly than cold injuries to the head and face or to the upper extremities. Industries with the highest rates of injury included agriculture, oil and gas extraction, trucking and warehousing, protective services, and interurban transportation. Injuries during nonwinter months involved the processing, distribution, and preparation of food. Vehicle breakdown or contact with water, gasoline, alcohol, or cold water were noted as contributing factors on many of the compensation claims. This probe suggests that claims for workers' compensation adequately reflect the expected association of environmental factors and the occurrence of cold injury.

Absenteeism↗

[Photoplethysmography and laser Doppler velocimetry in the study of cutaneous vasomotility at high altitudes].

During the second French scientific medical expedition to the Himalaya (ARPE, Annapurna IV, 1985), modifications of cutaneous circulation in hypoxia were studied. Two techniques were used for the first time to evaluate cutaneous vasoactivity under such conditions: laser Doppler velocimetry and photoplethysmography. Measurements were performed on the pulp of the third and fourth fingers of the right hand in 6 subjects native of sea-level countries: first at sea level, then in hypoxia after 15 days at 4,800 m before and after ingestion of a vasodilator drug (nicardipine 20 mg). Cutaneous circulation was explored under three thermal conditions: baseline (ambient temperature); after vasodilation obtained by immersion of the hand in hot water (40 degrees C), and after immersion of the hand in cold water (12 degrees C). In prolonged hypoxia a reduction in vasoconstriction at 12 degrees C was observed with both techniques. No significant change was observed at 40 degrees C. After dosing with nicardipine, the results differed according to the exploratory technique: a slight increase of the laser Doppler signal (NS) and a decrease of the photoplethysmographic signal were recorded. Acclimatization to cold and to hypoxia may concur to determine this response of cutaneous circulation. The action of vasodilating agents on cutaneous microcirculation in prolonged hypoxia is not clear and deserves further investigation. These drugs must be used with caution in the prevention and treatment of frostbite.

Adult↗

[Autodermoplasty in the treatment of wound emaciation].

Different types of dermoplasty aimed at the closure of reactive wounds were applied in the treatment of 26 cases with protracted non-healing wounds (up to 30 years) following burns, frostbites, open fractures, outcomes of acute suppurative diseases with sepsis phenomena. The treatment failed only in one patient. The transplantation of free stamp-like skin grafts proved to be the most effective one. Biostimulating effect of the single grafts which fuse has been noted.

Acute Disease↗

[Skin problems in joggers].

Reports on skin problems in joggers are rare in medical literature. Jogger dermatoses are caused by repeated trauma, mechanic overuse, thermic effects, allergic-toxic reactions and infectious processes. Most common are bullosis mechanica, piezogenic papules, hyperkeratosis haemorrhagica and subungual haematomas. Contact allergies and infections such as athlete's foot, pitted keratolysis and pyoderma are well-known complications in joggers. Frostbite and actinic damage, abrasions of the nipples, collisions with vehicles and injuries by buzzards are further possible incidents to be reckoned with occasionally. In most cases, prophylaxis is possible by training adaptation and use of adequate footwear. Jogger dermatoses usually clear after a suitable jogging-free interval.

Athletic Injuries↗

[Determination of the amputation level by transcutaneous PO2 measurement and distal arterial systolic pressure].

Transcutaneous oxygen partial pressure measurement (TcPO2) using a polarographic probe heating the skin at 44 degrees C provides informations about the capacity of blood to supply skin with oxygen. As oxygen is necessary for tissue survival, TcPO2 could constitute an adequate parameter for the determination of an amputation level. Among 67 amputations performed between 1983 and, 1984, we included in this study 34 patients (35 amputations), in whom TcPO2 was preoperatively measured (24 males, 10 females, mean age 67 years, range 19-86 years). Twenty two were diabetics. Twenty patients suffered from severe ischemia (stage Fontaine 4); 13 patients suffered from chronic diabetic lesions or/and osteomyelitis and two patients suffered from frostbite. The follow-up period lasted until operative wound was healed or a more proximal amputation was undertaken (mean 2.5 months, range 15 days to 10 months). Five operative wounds did not heal, so that a more proximal amputation was undertaken. TcPO2 was below 20 mm Hg in 3 of these 5 patients. TcPO2 was above 20 mm Hg in 24 among 30 patients in whom operative wound healed. When TcPO2 is above 20 mm Hg, the probability of operative wound healing is 92%. When TcPO2 is below 20 mm Hg, the risk of a more proximal amputation is 33%. Distal systolic blood pressure has no predictive value. It is concluded than when TcPO2 is above 20 mm Hg, the probability of healing of operative wound is clinically acceptable. When TcPO2 is below 20 mm Hg, 1 of 3 patients will be reamputated at a more proximal level, but healing does occur in 66% of patients.

Adult↗

The petrified auricle: comments on ossification, calcification and exostoses of the external ear.

The petrified auricle is a clinical entity in which the auricle, in part or total, has become stone-hard and moves as a rigid unit. This uncommon condition is most often due to ectopic calcification of the auricular cartilage. It may occur as a result of local trauma, in association with various systemic diseases such as Addison's disease, hypopituitarism, thyroid or parathyroid disorders, or following radiation therapy. Auricular ossificans (ectopic ossification) is a rare phenomenon in which the rigidity of the petrified ear is due to replacement of the elastic cartilage by bone. In the literature there are presently nine cases documented histologically. Two more cases are reported here. In most cases, the auricular changes are preceded by acute, severe hypothermia (frostbite). Exostoses of the external auditory canal is another disease of the external ear in which the proliferation of bone follows chronic mild hypothermia of the external auditory canal caused by exposure to cold water while surfing. It is postulated that if surfers who have developed exostoses of the external auditory canal from the cold water continue to enjoy such littoral activities, ossification of the auricle may also occur.

Adult↗

[The ossification of the ear cartilage in Addison's disease].

Stiffening and tenderness of the helix of the ear, with radiologically demonstrable calcific deposits, has been reported in various conditions such as frostbite, and also in Addison's disease. To a total of 14 clinical observations with only 4 well documented cases, a first autopsy report of the disorder in a case of tuberculosus Addison's disease is added. It is shown that the elastic cartilage of the pinna, of the epiglottis and of the trachea undergoes ossification without preceding dystrophic or metastatic calcification. The ossification has been observed only in males with longstanding Addison's disease treated exclusively with mineralocorticoids over a long period. The possible pathogenetic mechanisms are discussed. An important factor seems to be the long-standing glucocorticoid deficiency.

Addison Disease↗

Fatal accidental hypothermia and alcohol.

A series of 51 fatal cases of accidental hypothermia in northern Sweden has been reviewed. The cases conform well to previous investigations with respect to the mean age of the victims (48 years) and a predominance of males. The cases occurred mainly during the winter months and on Saturdays. Most cases succumbed at temperatures below -10 degrees C. The most frequent necropsy findings were areas of frostbite with purple discoloration of the skin, reddish lividity and superficial erosions of the gastric mucosa. Paradoxical undressing was present in more than half of the cases. About two thirds of the cases were under the influence of alcohol with a mean blood alcohol concentration of 1.6 g/l. Furthermore, at least half of the cases could be considered habitual drunkards. In conclusion, the present series shows two main groups of fatal hypothermia victims: one group of elderly persons, mostly chronic abusers and under the influence of alcohol (approximately two-thirds of the series), and another of younger and sober persons, performing recognised sporting activities (approximately one-fourth of the series).

Adolescent↗

Death on Denali.

Between 1903 and 1975 about 1 percent of climbers on Mount McKinley (Denali) and Mount Foraker in Alaska died. In 1976 a total of ten (1.7 percent) of 587 mountaineers died, but this rate of death was not significantly higher than previously. Nineteen percent of climbers in 1976 suffered major or minor injuries, illness or death. Acute mountain sickness (AMS), frostbite and fractures were common. Thirty-three rescues or retrievals of bodies were mounted at a cost of more than $82,000. Inexperience (particularly with arctic mountaineering), poor leadership, faulty equipment and undue reliance on rescue by helicopter contributed to the alarming incidence of accident, illness and death on big peaks in Mount McKinley National Park in 1976.

Adolescent↗

Physicians on Mount Everest. A clinical account of the 1981 American Medical Research Expedition to Everest.

The American Medical Research Expedition to Everest had a wide variety of medical problems, ranging from leech bites to high-altitude pulmonary edema. Preventive measures, however, such as careful attention to ingesting only pure water and food at the lower elevations and adequate personal hydration, nutrition and rest at extremely high altitude minimized the morbidity suffered by the group. Prophylactic administration of doxycycline was effective in reducing the severity of diarrheal illness in the group. Every member of the expedition suffered upper respiratory tract infections and many other infections, some of which were resistant to all therapy until the patient moved down from high altitude. Despite careful acclimatization, several cases of acute mountain sickness occurred and required descent to a lower altitude for treatment. Frostbite was avoided entirely.

Altitude Sickness↗

Transaxillary sympathectomy (T2 to T4) for relief of vasospastic/sympathetic pain of upper extremities.

Experience with 22 consecutive thoracic sympathectomies is presented. Diagnoses included minor causalgia (12), mixed vasospastic and occlusive disease (4), Raynaud's disease (4), and frostbite with ulceration (2). The operation was a transaxillary resection of ganglia T2, T3, and T4. Both objective and subjective results indicate that this type of sympathectomy is as good as more extensive resections without the risk of a Horner's syndrome. Morbidity was minor but frequent and included dysesthesia, pneumothorax, and compensatory sweating. The success rate of 77%.

Adult↗

Accidental hypothermia treated without mortality.

Accidental hypothermia, a core temperature below 34 degrees C., is frequently fatal, particularly in the ill and elderly. Traditional treatment methods result in reported mortalities of between 45 and 100 per cent. Despite these terrible statistics, advocates of slow rewarming persist. They cite the shock and vascular collapse which can occur with peripheral dilation as reasons to avoid rapid external rewarming. Isolated successes using internal core rewarming, such as hemodialysis or cardiopulmonary bypass, are spectacular but not practical in the usual clinical situation. By combining methods used for the resuscitation of burn injury with the treatment principles for frostbite, a highly effective treatment protocol results. Agressive fluid resuscitation, rapid immersion rewarming and careful systematic monitoring have been used to treat ten consecutive patients without a single death. Concomitant problems of alcoholism, stroke, myxedema, tuberculosis and paraplegia were also treated. Rapid external rewarming by immersion can result in a low mortality in patients with severe hypothermia.

Acidosis↗

Alternative methods for below-knee amputation: reappraisal of the Kendrick procedure.

BACKGROUND: In 1956, Kendrick described a technique for below-knee amputation (BKA) using anterior and posterior flaps in a length ratio of 1:2. There has been no review of the utility and safety of this technique over the past four decades. STUDY DESIGN: The Kendrick method was studied in 96 consecutive patients who underwent 100 BKAs from 1982 to 1995. Follow-up examination was continued through the period of rehabilitation and included all revisional surgery. RESULTS: Eighty-one patients had diabetes mellitus, 15 patients were nondiabetic, and the mean age was 67 years (range, 12 to 94 years). Fifty-seven patients underwent BKA for diabetic foot sepsis with healing failure after debridement or nonreconstructable vascular disease, 19 patients underwent BKAs for progressive necrosis despite a patent arterial reconstruction, and 24 patients underwent BKAs for other causes, including microembolism, calciphylaxis-related gangrene, bypass failure, trauma, frostbite, and calf-wound healing failure after coronary revascularization. Preliminary guillotine amputations were performed on three limbs. There was an incision in the calf from previous vascular surgery in 25 limbs. The 30-day mortality rate was 6 percent. Healing of the stump and knee salvage occurred in 93 limbs (93 percent). Four patients had local wound complications develop in the stump, yet they eventually healed. During the follow-up period, conversion to an above-knee amputation was necessary in seven patients, five within 30 days. Only one of these was in a limb with a previous arterial reconstruction in the calf. CONCLUSIONS: The Kendrick procedure for BKA with anterior and posterior flaps is efficacious and safe. This procedure is advantageous for its anatomic basis, the ease with which the flaps can be designed despite leg edema or overall size, and the ability of the surgeon to distance the posterior flap margin from sepsis in the lower one-third of the calf.

Adolescent↗