RESUMEN
Prescription drug abuse ranks as the second most common class of illicit drug use in the United States, and one mechanism of opiate abuse involves intravenous injection of enteral narcotics such as oxycodone or hydrocodone. The authors describe a patient who sustained significant soft tissue necrosis after intravenously injecting a solution made from crushed enteral narcotics, with a focus on the operative course that resulted due to a delay in initial definitive treatment. The patient's wounds encompassed 8% total body surface area and covered 247 cm2. A 55-year-old female was admitted to the burn unit (West Penn Burn Center, Western Pennsylvania Hospital, Pittsburgh, PA) after she initially presented with infection and cellulitis to her bilateral upper extremities 3 weeks after intravenously injecting herself with crushed oxycodone/acetaminophen. She underwent numerous sequential operative repairs including initial debridement, placement of dermal replacement templates, and several split-thickness autografts and xenografts. Her total length of stay was 59 days, broken into an initial 47-day stay, and a subsequent 12-day readmission due to graft failure secondary to poor follow-up. As the number of prescription drug abusers rises, it is possible that an increase in attempts to intravenously abuse enteral narcotics may also rise. As such, burn centers should be prepared for the extent of potential limb necrosis and the operative treatment that may ensue.
Asunto(s)
Acetaminofén/efectos adversos , Analgésicos no Narcóticos/efectos adversos , Narcóticos/efectos adversos , Oxicodona/efectos adversos , Mal Uso de Medicamentos de Venta con Receta/efectos adversos , Infecciones de los Tejidos Blandos/inducido químicamente , Celulitis (Flemón)/inducido químicamente , Celulitis (Flemón)/patología , Desbridamiento/métodos , Combinación de Medicamentos , Erupciones por Medicamentos/etiología , Erupciones por Medicamentos/patología , Erupciones por Medicamentos/cirugía , Femenino , Rechazo de Injerto , Humanos , Persona de Mediana Edad , Necrosis/inducido químicamente , Necrosis/patología , Necrosis/cirugía , Trasplante de Piel/métodos , Infecciones de los Tejidos Blandos/patología , Infecciones de los Tejidos Blandos/cirugía , Traumatismos de los Tejidos Blandos/inducido químicamente , Traumatismos de los Tejidos Blandos/patología , Traumatismos de los Tejidos Blandos/cirugía , Abuso de Sustancias por Vía Intravenosa/complicaciones , Abuso de Sustancias por Vía Intravenosa/patologíaRESUMEN
OBJECTIVES: As CAD/CAM technologies improve we question whether adhesive lamination of ceramic materials could offer mechanical advantages over monolithic structures and improve clinical outcomes. The aim was to identify whether an adhesive interface (a chemically cured resin-cement) would influence the biaxial flexure strength (BFS) and slow-crack growth in a machinable dental ceramic. METHODS: Monolithic and adhesively laminated (with a chemically cured dimethacrylate resin-cement) feldspathic ceramic discs of identical dimensions were fabricated. BFS testing was performed on the Group A monolithic specimens (n = 20), on Group B laminated specimens with the adhesive interface positioned below the neutral bending axis (n = 20) and Group C laminated specimens with the adhesive interface positioned above the neutral bending axis (n = 20). To study subcritical crack growth additional laminated specimens received controlled indentations and were exposed to thermo-mechanical fatigue. BFS data was analysed using parametric statistics (α = 0.05). Fractographic analyses were qualitatively assessed. RESULTS: No significant differences between the mean BFS data of Groups A and B were observed (p = 0.92) but the mean BFS of Group C was slightly reduced (p < 0.01). Lamination reduced the stiffness of the structure and fractographic analysis demonstrated that energy consuming crack deflection occurred. Thermo-mechanical fatigue caused subcritical extension of radial cracks associated with indentations adjacent to the adhesive interface. Crack growth was limited to parallel to the interface and was arrested or deflected in a direction normal to the interface. CONCLUSIONS: Ceramic lamination increased the damage tolerance of the structure and could limit or arrest subcritical crack growth at regions near the 'interlayer'. CLINICAL SIGNIFICANCE: Lamination of a dental ceramic with a polymeric 'interlayer' could offer toughening effects which could potentially delay or arrest sub-critical crack growth at regions near the interface and thereby improve restoration longevity.
Asunto(s)
Porcelana Dental , Coronas con Frente Estético , Adhesividad , Fenómenos Biomecánicos , Porcelana Dental/química , Ensayo de Materiales , Resinas SintéticasRESUMEN
OBJECTIVE: To determine whether pulmonary function decreases as a function of severity of pectus excavatum, and whether reduced function is restrictive or obstructive in nature in a large multicenter study. STUDY DESIGN: We evaluated preoperative spirometry data in 310 patients and lung volumes in 218 patients aged 6 to 21 years at 11 North American centers. We modeled the impact of the severity of deformity (based on the Haller index) on pulmonary function. RESULTS: The percentages of patients with abnormal forced vital capacity (FVC), forced expiratory volume in 1 second (FEV(1)), forced expiratory flow from 25% exhalation to 75% exhalation, and total lung capacity findings increased with increasing Haller index score. Less than 2% of patients demonstrated an obstructive pattern (FEV(1)/FVC <67%), and 14.5% demonstrated a restrictive pattern (FVC and FEV(1) <80% predicted; FEV(1)/FVC >80%). Patients with a Haller index of 7 are >4 times more likely to have an FVC of ≤80% than those with a Haller index of 4, and are also 4 times more likely to exhibit a restrictive pulmonary pattern. CONCLUSIONS: Among patients presenting for surgical repair of pectus excavatum, those with more severe deformities have a much higher likelihood of decreased pulmonary function with a restrictive pulmonary pattern.
Asunto(s)
Flujo Espiratorio Forzado/fisiología , Tórax en Embudo/diagnóstico , Insuficiencia Respiratoria/etiología , Capacidad Vital/fisiología , Adolescente , Niño , Progresión de la Enfermedad , Femenino , Estudios de Seguimiento , Tórax en Embudo/complicaciones , Tórax en Embudo/fisiopatología , Humanos , Masculino , Pronóstico , Estudios Prospectivos , Radiografía Torácica , Insuficiencia Respiratoria/diagnóstico , Insuficiencia Respiratoria/fisiopatología , Índice de Severidad de la Enfermedad , Espirometría , Tomografía Computarizada por Rayos X , Adulto JovenRESUMEN
Left ventricular systolic dysfunction (LVSD) is both common and treatable. These patients ought to be identified. A cost effective way to detect LVSD patients who would normally be missed might be to screen patients who present to hospital with their first noncardiac vascular event i.e. their first stroke, their first transient ischemic attack (TIA) or new onset of peripheral vascular disease (PVD). A consecutive series of 255 stroke, TIA and PVD patients aged between 45 and 86 years were identified at their first noncardiac vascular presentation to hospital. Age and gender matched controls (202) were recruited from family practice. Each patient underwent a history, physical examination, echocardiography and a 12 lead ECG. LVSD was defined as LVEF ≤ 40%. LV dysfunction was found in 28% of vascular patients compared with 5.5% of age and gender-matched controls. Almost two thirds of LVSD patients were asymptomatic. LVSD is more common in stroke, TIA and PVD patients than in the general population. Our findings would suggest that there is enough LVSD in such patients to warrant routine screening.Future studies should consider whether screening for LVSD in these patients would reduce high rate of cardiac death.
La disfunción sistólica del ventrículo izquierdo (DSVI) es tan frecuente como tratable. Entonces, deberíamos identificar estos pacientes. Una manera rentable de detectar los enfermos con DSVI que habitualmente se pasarían por alto podría ser la pesquisa de los pacientes que se presentan en el hospital por un primer episodio vascular no cardíaco, por ejemplo, su primer accidente cerebro vascular (ACV), accidente isquémico transitorio (AIT) o un nuevo episodio de enfermedad vascular periférica (EVP). Pacientes pertenecientes a una serie consecutiva de 255 enfermos con ACV, AIT y EVP, de entre 45 y 86 años, fueron identificados en su primer ingreso en el hospital por patología vascular no cardíaca. Además, se convocaron 202 controles equiparables por edad y sexo provenientes del servicio de medicina familiar. A cada paciente se le realizó historia clínica, examen físico, ecocardiografía y a 12 se les efectuó ECG. La DSVI fue definida como una fracción de eyección del ventrículo izquierdo (FEVI) igual o menor del 40%. Se encontró disfunción del ventrículo izquierdo (VI) en 28% de los pacientes vasculares, en comparación con 5.5% de los controles equiparados por edad y sexo. Casi dos tercios de los pacientes con DSVI eran asintomáticos. La DSVI es más común en los pacientes con antecedentes de ACV, AIT y EVP que en la población general. Nuestros hallazgos sugieren que la incidencia de DSVI en este tipo de pacientes justifica efectuar una pesquisa de rutina. Futuros estudios deben considerar si la pesquisa de DSVI en estos pacientes podrá reducir el alto índice de fallecimiento por causas cardíacas.