Asunto(s)
Gastrostomía/métodos , Laparoscopía/métodos , Preescolar , Femenino , Fundoplicación , Gastrostomía/instrumentación , HumanosRESUMEN
AIM: Bacille Calmette-Guérin (BCG) immunisation is well established as part of the South African national expanded programme for immunisation (EPI). The World Health Organization (WHO) currently recommends that BCG be given to all asymptomatic infants irrespective of HIV exposure at birth but does not recommend BCG vaccination for children with symptomatic HIV infection. This approach, however, has led to HIV-infected neonates who are asymptomatic at birth, developing severe vaccine-related complications. We present a surgical case series, representative of a minority of the cases in circulation, in support of a change to the timing of BCG administration to HIV-exposed neonates. METHODS: A case series of 17 HIV-infected patients with surgical complications of BCG vaccination. RESULTS: Seventeen patients are presented. The first two illustrate disseminated systemic BCG infection, resulting in BCG infection of the lymph nodes, liver, spleen and tibia, and the second with gastrointestinal involvement causing bowel obstruction. The other 15 patients represent a series of severe ulcerating lymphadenitis secondary to BCG. CONCLUSION: The risks of BCG in HIV-infected infants are significant. Current recommendations are not satisfactory, and a change in policy is required to prevent the harmful effects of this vaccine in a high-risk group of patients. We believe that there is sufficient need to adequately stratify patients and vaccinate them according to a protocol that takes impaired immunity into consideration.
Asunto(s)
Vacuna BCG/efectos adversos , Infecciones por VIH/diagnóstico , Mycobacterium bovis , Tuberculosis/inducido químicamente , Tuberculosis/diagnóstico , Preescolar , Estudios de Cohortes , Contraindicaciones , Infecciones por VIH/complicaciones , Infecciones por VIH/terapia , Humanos , Programas de Inmunización , Lactante , Recién Nacido , Masculino , Tamizaje Neonatal , Estudios Retrospectivos , Sudáfrica , Tuberculosis/terapiaRESUMEN
BACKGROUND: The beneficial effects of cooling a fresh burn wound were well demonstrated. However, there are still conflicting reports as to the optimum temperature of coolant, duration of application and effects in limiting tissue damage. A study was undertaken to investigate this, the importance of the temperature of, and the time period of application of the coolant. MATERIALS AND METHODS: Four identical deep dermal wounds were created on the back of 10 anaesthetised pigs. Each animal served as an independent experimental model. The effectiveness of cooling was monitored by measuring intradermal temperatures. The animals were divided into two groups; using ice water and tap water as the coolants. In each pig one wound was not cooled (wound 1). Three were cooled; one immediately for 30 min in group 1 and for 4 h in group 2 (wound 2). The other two wounds were cooled after 30 min for 30 min and 3 h (wounds 3 and 4, respectively). RESULTS: It was found that the temperature of the coolant was crucial. When ice water of 1-8 degrees C (group 1) was used more necrosis than in the wounds that were not cooled was seen. When tap water was used at 12-18 degrees C (group 2) it was demonstrated clinically and histologically that the cooled wounds had less necrosis than the uncooled wounds and thus healed faster. In group 2 the beneficial effects of cooling were still present when delayed for half an hour. CONCLUSION: First aid cooling of a burn wound with tap water is an effective method of minimising the damage sustained during a burn, and is universally and immediately available. Ice water cooling is associated with an increase in tissue damage.
Asunto(s)
Quemaduras/terapia , Hipotermia Inducida/métodos , Cicatrización de Heridas/fisiología , Animales , Quemaduras/fisiopatología , Frío , Hielo , Dolor/prevención & control , Porcinos , Factores de TiempoRESUMEN
BACKGROUND: Percutaneous and open liver biopsies are routine procedures for diagnosing liver pathology. However, the procedure can carry significant morbidity and even mortality, especially in the event of an uncorrectable coagulopathy or a highly vascular tumor. METHODS: A technique described for use in such circumstances involves laparoscopy for identification of the lesion to be biopsied, enables placement of a gelatin hemostatic plug in the core biopsy tract, and confirms hemostasis after percutaneous plugging of the biopsy site. RESULTS: The technique was successfully used for seven patients: six patients with hepatic coagulopathy and one with a highly vascular liver tumor. There were no complications during either the intra- or postoperative period. The patients experienced minimal postoperative discomfort and returned to baseline activity on the first postoperative day. CONCLUSION: The authors believe that the described technique of biopsy site plugging offers a safe alternative for liver biopsy among patients with an uncorrectable coagulopathy and those requiring a biopsy before correction of the bleeding disorder.