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In the present study, persistent organic pollutants (POPs) were determined in 14 livers from specimens of the Brazilian sharpnose shark (Rhizoprionodon lalandii), which is an important economic resource for small-scale fisheries on the southeastern coast of Brazil. The following concentrations (lipid weight) of POPs were found: ∑PCBs: 1019±267 ng g(-1); ∑DDTs: 111±40 ng g(-1) and ∑PBDEs: 10.4±4.78. PCB 153 made the greatest contribution to ∑PCB (21.4%), followed by PCB 138 (14.6%) and PCB 180 (9.94%). Among chlorinated pesticides, only the p,p'-DDE and p,p'-DDD isomers had concentrations above the detection limit. Moreover, levels above the detection limit were found only for PBDE congeners 47 and 100 (BDEs 47>99). On average, BDE 47 accounted for 88% of the total PBDE load. The feeding habits of the Brazilian sharpnose shark close to the Brazilian coastline are likely the most important difference regarding the accumulation of POPs in comparison to oceanic species that feed in deeper waters. Thus, this species may be used to evaluate the pollution of coastal areas as well as human exposure to contaminants, as the Brazilian sharpnose shark is a frequently used for human consumption. Further studies in other areas of Brazil and involving other species are needed to clarify the mechanisms and potential impact of POPs, which can affect the biology of different organisms and cause population declines.

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This paper presents the results of the analysis of clinical data from a series of 132 thermally injured patients with 214 burned hands. The objective was to identify the factors affecting the pathogenesis of postburn hand deformities. The study indicates that deep burns have the worst prognosis and that circumferential burns are always followed by secondary sequelae. The incidence of secondary hand deformity rises sharply when the burn affects more than 25 per cent of the total body surface area (TBSA). Given the same physical therapy programme, early tangential excision and immediate grafting yield better results than conservative treatment. The results underline the role of patient motivation in maximal hand rehabilitation.

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Hetastarch is a synthetic polysaccharide colloid that has been used clinically in the management of multiple trauma, hypovolemic shock, and postoperative cardiac patients. Our objective was to determine whether hetastarch is a safe alternative to blood products in burn shock resuscitation. Twenty-six patients received hetastarch during the colloid phase of resuscitation and were compared to matched historical controls who received either albumin or fresh frozen plasma. Clinical and laboratory parameters were measured on admission and for 4 days after the burn. There was no significant difference in hemodynamics, respiratory status, incidence of bleeding, or renal or liver function among the three colloid groups. The advantages of hetastarch include immediate availability, no dependence on human blood donor population, no risk of serum-transmitted diseases, and lower cost. It can be safely recommended for those patients who object to blood products for resuscitation, in those situations where human donors are few, and when cost is a consideration.

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The understanding of and care for burn trauma have become increasingly sophisticated. A review of important clinical and laboratory conditions over the past five years highlights current thought and future trends in burn management.

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Full-thickness dorsal hand and digit burns result in serious acute and chronic functional disability. Early wound closure is paramount to minimize functional impairment and improve ultimate cosmetic appearance. Fifty patients were followed for 2 to 6 years after excision and immediate autografting of full-thickness hand and digit burns. Based on the depth of injury distal to the metacarpal phalangeal joints, two groups of hand burns emerged in this series. Group I: Patients had uninjured and intact extensor mechanisms. Near normal range of motion was obtained by the end of the second postoperative week. Local wound sepsis and/or inadequate depth of excision resulted in autograft loss and additional surgical procedures in 10% of the hands. Group II: Patients with thermal damage to some portion of the extensor mechanism of the digit. Seventy-five per cent of these hands had thermal damage to bone. An average of three operative procedures was required on each hand for ultimate wound closure. Prolonged immobilization, persistent edema, and local wound sepsis were common to all Group II hands. Reconstructive surgery was necessary within 1 year in 43% of all hands. Hands in Groups I and II required surgery 12% and 75% of cases, respectively. Early surgical excision coupled with aggressive physical and occupational therapy has decreased but not eliminated many of the acute and chronic sequelae of full-thickness hand and digit burns.

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A review of 102 cases of high-voltage electric injuries was performed. The average total body surface area was 15.2%. The average age was 32 years. The mortality was 2.1%. Advances in fluid therapy have virtually eliminated renal failure. Devitalized muscle was accurately identified preoperatively with the use of the technetium Tc 99m pyrophosphate muscle scan. Septic complications were reduced substantially by using the following therapeutic modalities: early excision of the burn eschar and necrotic muscle; quantitative wound biopsies to monitor the bacterial flora; allograft as a temporary coverage of open wounds; and early creation of local and distant flaps. Early institution of physical and occupational therapy are mandatory if the patient is to be restored to his or her maximum postinjury potential.

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We present our experience with a method of phalloplasty which can be applied by reconstructive surgeons to cases of penile loss from diverse etiologies. The complications with this method have been frequent, but not life-threatening. Achievement of the stated objectives is obtained in a sufficiently high proportion of cases to make this a method whorthwhile to use until a clearly superior method can be demonstrated.

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