Wounds

Burns

It is customary for all major burns to be managed by general or plastic surgeons in regional burn units with access to intensive care facilities. A scald is a burn caused by moist heat. First-degree burns involve only the epidermis and papillary dermal blood vessels and produce pain, redness and swelling. In second-degree or partial skin thickness burns, the epidermis blisters and becomes necrotic. In third-degree or full thickness burns, the necrosis is deeper and pain may be absent if nerve endings are destroyed. If the wound is anaesthetic, it is likely that the skin appendages will also have been destroyed and this has important implications for healing.

Varicella Zoster Virus Infections

Richard J. Whitley

DEFINITION

Varicella-zoster virus (VZV) causes two distinct clinical entities: varicella (chickenpox) and herpes zoster (shingles). Chickenpox, a ubiquitous and extremely contagious infection, is usually a benign illness of childhood characterized by an exanthematous vesicular rash. With reactivation of latent VZV (which is most common after the sixth decade of life), herpes zoster presents as a dermatomal vesicular rash, usually associated with severe pain.

Urticaria and angioedema

Urticaria

Urticaria: introduction and pathogenesis

Urticaria is a term describing erythematous or oedematous swellings of the dermis or subcutaneous tissues. The defining characteristic of urticaria is the transient nature of the lesions, which persist only for minutes up to 24 hours.

Superficial swellings tend to be itchy, whereas deeper swellings are painful and are often described as angioedema.

Lesions are frequently more irregular or bizarre in outline in children than in adults, but diagnosis is rarely possible based on the appearance of the lesion alone.

In a minority of instances, the clinical phenomenon of urticaria is associated with identifiable physical causes, and these are often termed physical urticarias

Urinary tract infections

A high fluid intake and complete bladder emptying assist antimicrobial therapy of urinary tract infections (UTI).

Acute cystitis

A high fluid intake and complete bladder emptying assist antimicrobial therapy of urinary tract infections (UTI).

Escherichia coli and Staphylococcus saprophyticus are the commonest causative organisms, although other members of the Enterobacteriaceae may be responsible. Some patients require investigation to exclude an underlying abnormality when cystitis is confirmed by a positive urine culture. These patients are males of any age, females under 5 years and premenarcheal females with recurrent UTI.

Ulcers

Leg ulcers

Leg ulcers: background

Skin heals more slowly below the knee. If the arterial circulation, the venous circulation or the natural aversion to trauma that is associated with normal sensation is impaired, then the skin may not heal at all. This results in the development of a chronic ulcer at sites of trauma.

The Ezetimibe/Simvastatin Single Pill in the Management of Hypercholesterolaemia

Akira Yik-Tian Wu, MBBS (Monash), FRACP, FAMS

oduction

Therapy with 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors or statins has been shown to be effective in lowering low-density lipoprotein cholesterol (LDL-C) levels, which are linked to cardiovascular morbidity and mortality. Previous pivotal trials with simvastatin have demonstrated that reductions in LDL-C resulted in a decrease in acute coronary events and improved survival.^1,2 However, a significant number of patients still fail to achieve LDL-C goals.³ There is evidence to suggest that greater reductions in LDL-C can further protect patients from cardiovascular events.^2,4 The strategy of increasing the doses of statins is effective but is complicated by an increase in the incidence of adverse reactions.⁵ To limit toxicity and maintain anti-atherosclerotic benefits, one approach is to combine a moderate dose of a statin and another lipid-lowering drug, such as ezetimibe. This review will focus on simvastatin and ezetimibe in a single pill.

Systemic infections

Australian spotted fevers (tick typhus: Rickettsia australis, R. honei), scrub typhus (Orientia tsutsugamushi)

In severe disease or children less than 8 years old, consultation with an infectious diseases physician or clinical microbiologist is recommended.

Sweating disorders

Hyperhidrosis

Hyperhidrosis or excess sweating most commonly affects the palms, soles and axilla and is usually idiopathic, prolonged and symmetrical. It is exacerbated by stress but is relatively independent of temperature and occurs in both warm and cold climates, although it is usually more severe with warmth. Onset is most common in childhood or around puberty, and it may spontaneously improve after the age of 25. It is estimated that 1% of the population is affected, and there may be a positive family history.

Streptococcal and Enterococcal Infections

Michael R. Wessels

Many varieties of streptococci are found as part of the normal human flora colonizing the respiratory, gastrointestinal, and genitourinary tracts. Several species are important causes of human disease. Group A Streptococcus, or S. pyogenes, is responsible for streptococcal pharyngitis, one of the most common bacterial infections of school-age children, and for the postinfectious syndromes of acute rheumatic fever and poststreptococcal glomerulonephritis. Group B Streptococcus, or S. agalactiae, is the leading cause of bacterial sepsis and meningitis in newborns and a major cause of endometritis and fever in parturient women. Enterococci are important causes of urinary tract infection, nosocomial bacteremia, and endocarditis. Viridans streptococci are the most common cause of bacterial endocarditis.