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Purpura fulminans is a rare complication of a coagulopathy or an infection. Haemophilus influenzae infection, which has decreased since the haemophilus influenzae type B vaccine was initiated, is an unusual initiating cause of purpura fulminans. This case is the first reported in the literature of an adult who developed purpura fulminans after Haemophilus influenzae sepsis. Her elevated beta2 glycoprotein 1 ratio may have contributed to the severity of her disease. Although rare, Haemophilus influenzae may precipitate purpura fulminans. Current therapy is directed at control of precipitating factors, removal of nonviable tissue, treatment of secondary infections, and physiologic support. There also is evidence that patients respond well to hyperbaric oxygen therapy, with decreasing limb and tissue loss.

Objectives: The U.L.I.S.S.E. study is aimed at describing older patients who are cared for in hospitals, home care or nursing homes in Italy. Design: The U.L.I.S.S.E. study is an observational multicenter prospective 1-year study. Setting: Overall, 23 acute geriatric or internal medicine hospital units, 11 home care services and 31 nursing homes participated in the study. Measurements: The patient’s evaluation was performed using comprehensive geriatric assessment instruments, i.e. the interRAI Minimum Data Set, while data on service characteristics were recorded using ad-hoc designed questionnaires. Results: The older subjects who are in need of acute and long term care in Italy have similar characteristics: their mean age is higher than 80 years, they have a high level of disability in ADL, an important multimorbidity, and are treated with several drugs. The prevalence of cognitive impairment is particularly high in nursing homes, where almost 70% of residents suffer from it and 40% have severe cognitive impairment. On the other hand, there is a shortage of health care services, which are heterogeneous and fragmented. Conclusions: Health care services for older people in Italy are currently inadequate to manage the complexity of the older patients. An important effort should be undertaken to create a more integrated health care system.

Hair highlighting using chemical solutions to alter the pigmentation of hair is a popular procedure. Given their chemical properties, these solutions also are potentially caustic to the scalp. However, the actual incidence and range of injuries is not well reported in the American literature. We report a representative case from the severe end of the injury spectrum, that of a full-thickness chemical burn as a result of direct contact from hair-lightening solution. We review the composition and potential side effects of the chemicals used. Meticulous attention to the instructions of use is recommended to prevent these injuries. To our knowledge, this is the first case report of a full-thickness chemical scalp burn as a result of highlighting in the American literature, and we hope that it will serve as an educational resource with respect to the potential risks of this very common procedure.

Toxic epidermal necrolysis (TEN) is a rare life-threatening disease mostly related to drug ingestion. Apoptotic keratinocytes lead to separation of the epidermis from dermis and widespread blistering of the skin. This case is a pediatric patient with a seizure disorder who developed TEN after starting carbamezepine. Blister fluid was analyzed for protein, chemical, and mineral content. The TEN blister fluid composition was similar to burn blister, except that the burn blister fluid has a 3-fold increase in albumin and protein. There was a substantial increase in lactate dehydrogenase, calcium, and magnesium in both blister fluid specimens compared with serum levels. To our knowledge, this report is the first in the literature to analyze TEN blister fluid composition and compare it to burn blister fluid.

Although patients with burns are known to develop hypocalcemia, the development of hypercalcemia has also been reported in a few patients in the burn intensive care unit. Here, the incidence of hypercalcemia in the burn unit of a single institution is reviewed. The records of all patients admitted to the burn intensive care unit over a period of 4 years of a single institution were reviewed. When looking at a select group of burn patients who have been hospitalized for more than 4 weeks, an unusually high incidence of hypercalcemia was found, especially in patients with renal failure (because of decreased renal clearance, patients with renal failure are prone to hypercalcemia if another inciting factor is present). As previously reported, the hypercalcemia in our patients was consistent with hypercalcemia caused by immobilization. We also observed that mortality correlated with higher calcium levels.

The term radiological hyperthermia is used to describe the exposure of biological tissues to temperatures just above physiological ones, namely between 42 and 45 degrees C. A machine for hyperthermia (SAPIC SV03 produced by Aeritalia, Caselle, Turin) is been experimentally used at the authors' institute. The present study aims to analyse the technical and qualitative aspects of temperature control using invasive and previsional thermometry. The term invasive thermometry is used to describe the insertion of small teflon catheters into the biological body through which thermometric probes are introduced to control deep temperature. Previsional thermometry is the phrase used to describe the computer simulation of hyperthermic treatment, starting from knowledge of the tissue to be heated and the type of applicator used. The simulated treatment and the real temperature measured are then compared in order to optimize the treatment used.

During the past 2 years a multicenter study was performed comparing Biobrane (Woodroof) and frozen cadaver allograft as temporary dressings on freshly excised full-thickness burns before the application of autograft. Each biologic dressing was evaluated with respect to the other on the same patient. Seventy-one patients were evaluated. The mean burn size was 35 +/- 20% with a mean full-thickness burn of 28 +/- 20%. Mean patient age was 34 +/- 21 years. Overall survival was 82%. The mean time of wound coverage was 10.2 +/- 6.7 days. There was no significant difference in the number of dressing changes, area changed, purulence, autograft take, and final results between allograft- and Biobrane-covered sites. There were no complications following use of either Biobrane or allograft. We conclude that Biobrane is as effective as frozen human cadaver allograft for the temporary coverage of freshly excised full-thickness burn wounds before autografting.