Amputation of the right big toe in child bicycle passengers.
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Biomedical subjects
Publications and source records attributed to M Subrahmanyam.
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In a study conducted over a four year period, 99 developed thrombophlebitis of the total of 560 intravenous infusions under similar infusion conditions. In all the patients who developed phlebitis, fluid from the bottle, first 5 ml. of fluid from the infusion set after removing the drip and the needle itself were subjected to bacteriological study. Only in two cases the culture was positive, indicating it was a non-bacterial inflammation. The vein was subjected for histopathology after obtaining a small segment. Histopathology showed thrombus in the lumen of the vein in the majority of the cases, destruction of endothelial lining with pyknosis of nuclei and leucocyte infiltration in the media.
The incidence of thrombophlebitis in the present study was 18.3%. It was of mild grade in all the cases. The incidence of thrombophlebitis was more (24%) when short teflon canula was used as intravenous placement device. Under similar infusion conditions with stainless steel needle, scalp vein needle and long teflon canula, the incidence was 16.6%, 13.3% and 16.6% respectively. Thrombophlebitis bears a direct relationship to the duration of infusion. The incidence was negligible at the end of 8 hours, whereas 14 patients developed thrombophlebitis by the end of 24 hours (63.7%).
205 children treated with bicycle injuries during the four year period 1979-1982 at General Hospital, Sangli, in rural Western Maharashtra were reviewed. Amputation of the right toe was the most common injury comprising 74% of all the injuries. This occurred in children carried as passengers on the rear carrier of the bicycle, who hang their legs on either side of the spoke wheel. The right big toe of the passenger is then trapped by the chain above, the spokes at the extreme inner end, horizontal fork below and the free wheel posteriorly. Peddling of the bicycle in a reverse direction followed by forward propulsion results in amputation of the toe by the rotating teeth of the free wheel. In 122 cases amputation was through the proximal phalanx, in 28 cases through the distal phalanx and in 2 cases at the level of the metatarso phalangeal joint. A disarticulation through the proximal joint was performed in these cases. A four year follow up showed no residual disability.
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Rats were subjected to common bile duct ligation, after which intermittent peritoneal dialysis with a buffered solution containing rat plasma proteins was carried out in an attempt to reduce plasma bilirubin levels. Plasma bilirubin increased significantly (P less than 0.01) on the seventh day and was still rising 12 days after ligation of the common bile duct. Dialysis was performed during the second postoperative week. Provided that rat plasma protein was present in the dialysing fluid, dialysis significantly reduced (P less than 0.01) the levels of total plasma bilirubin, conjugated bilirubin and serum GPT in the experimental animals.
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In a study conducted on 110 patients intravenous heparin and cortisone were studied as regards their role in prevention of infusion thrombophlebitis. Intravenous heparin (500 I.U.) was given 6 hourly during the 24 hr period of saline infusion. Hydrocortisone (1 mg/100 ml) was added to the infusion itself. Of the 30 patients in the control group 3 patients developed thrombophlebitis (10%). In the group treated with intravenous heparin 3 out of the 40 patients (7.5%) developed thrombophlebitis. With hydrocortisone, only 1 out of 40 patients had thrombophlebitis, (2.5%). In the group in which hydrocortisone was used, the onset of phlebitis was also delayed.
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