A 14-month-old female suffered a 95% TBSA flame burn from a water heater malfunction and explosion. Her head, face, and perineum were largely spared. All other areas had full-thickness burns. She did not suffer an inhalation injury. The patient was transported to a regional burn center and standard thermal injury protocols were instituted, including endotracheal intubation and ventilator support, aggressive intravenous fluid resuscitation with crystalloid and colloid, wound management with topical antimicrobials 5% sulfamylon solution, and enteral nutrition. Our standard of care included no venous thromboembolic prophylaxis and change of all arterial and central venous catheters every 7 days. The patient required early escharotomies of all four extremities, hands, and feet. The patient underwent early burn excision with fascial excision and allograft placement to all thermal wounds on post injury days (PID) three, four, and five. These excisions were all performed at the bedside because the patient's tenuous cardiopulmonary status precluded transporting her to the operating room.
Objectives To develop a rapid and sensitive method for identification of patients at risk for organ system failure and death due to acute meningococcal infection, and to evaluate the reliability of the Pediatric Risk of Mortality score in predicting mortality rates from acute meningococcal infection. Design A prospective study which followed a retrospective analysis. Setting The Emergency Department and pediatric intensive care unit (ICU) of a university-affiliated children's hospital. Patients The hospital records of 86 pediatric patients with acute meningococcal infection during a 5-yr period (group 1) were reviewed. Twenty-two ICU patients (group 2) were then prospectively evaluated, and the occurrence rate of organ system failure was compared with that rate predicted by the model developed from the analysis of group 1. Interventions The occurrence of prognostic factors was compared with the development of organ system failure and death by Fisher's exact test and logistic regression analysis for patients in group 1. The mortality rates for groups 1 and 2 were compared with those rates that were predicted by the use of the Pediatric Risk of Mortality score. Main Results Eighteen of 86 patients in group 1 developed organ system failure, and seven (8.1%) patients died. Logistic regression analysis found that the combination of circulatory insufficiency, peripheral WBC counts of <10,000 cells/mm3, and coagulopathy best predicted organ system failure. Ten of 22 patients in group 2 developed organ system failure, and two died. All patients with organ system failure exhibited ≥1 of three identified prognostic factors. The probability of organ system failure occurring was ≥.5 for nine of ten patients with organ system failure. A total of nine patients in groups 1 and 2 developed multiple organ system failure, and all nine patients died. Based on Pediatric Risk of Mortality scoring, the mortality risk for nonsurvivors ranged from 27% to 94%, compared with 1% to 48% for survivors. The overall mortality rate was consistent with that rate predicted by the Pediatric Risk of Mortality scoring system. Conclusions Patients with acute meningococcal infection who exhibit signs of circulatory insufficiency, a peripheral WBC count of <10,000 cells/mm3, or a coagulopathy have a high probability of developing organ system failure. Death is highly probable when multiple organ system failure develops, and the overall mortality rate is accurately predicted by the Pediatric Risk of Mortality score. (Crit Care Med 1993; 21:447–452)
Phosphaturic mesenchymal tumor (mixed connective tissue variant) (PMT-MCT) are tumors that may cause tumor-induced osteomalacia and rarely appear intracranially. The authors describe the case of an 8-year-old girl who was found to have PMT-MCT with involvement of the cerebellar hemisphere and a small tumor pedicle breaching the dura mater and involving the skull. This was removed surgically in gross-total fashion without further complication. Histologically the tumor was confirmed to be a PMT-MCT. There was no evidence of tumor-induced osteomalacia. At the 42-month follow-up, the patient is doing well, has no abnormalities, and is free of recurrence. PMT-MCTs are rare tumors that may involve the brain parenchyma. A gross-total resection may be effective to cure these lesions.
Buffalo pox virus (strain BP 4) has been studied by electron microscopy of sections of infected chorioallantoic membrane cells. The ultrastructure of the virus has been described and compared with the ultrastructure of vaccinia virus. No differences between the two viruses were found. In relation to the ways of release two forms of mature virions have been described. These are probably analogous to the previously described C- and M-form of vaccinia.
