A case of coarctation of the aorta with repeated intrapericardial haemorrhage consequent on rupture of a dissection of the aorta is descriptionbed. The associated abnormalities are discussed. The lack of evidence of a collateral circulation is emphasized. The condition of coarctation may be completely symptom-free until a terminal complication arises.
The essential corner-stones of burn treatment are:- I. Efficient first aid, which is crucial to subsequent successful management. II. Effective compression of the burnt area. III. Early grafting for repair and avoidance of deformity. IV. Clinical and biochemical assessment of fluid volume and composition requirements for restoration of circulation and relief of tissue anoxia. V. Blood transfusion in the earliest stage after any burn. VI. Oral nutrition and fluids, which should be employed to the greatest extent possible. VII. Intravenous ACTH, Cortisone and Heparin, whichhave proved beneficial in the burn shock phase of some cases. VIII. Urine output as a guide to volume requirements. IX. Varied, high calorie, high protein diet throughout the hospital period. X. Possible causes of delayed healing, e.g. anaemia, hypoproteinaemia and electrolyte imbalance, should be kept in mind. The handling of burns is not a one-man job. It should be in the hands of a team: -the intern who appreciates the severity of the shock and how best to deal with it: sisters and nurses in the operating theatre and wards ready with the necessary equipment at any time; the surgeon and his assistants who know how to handle bum cases, to carry on the post-burn phases and the value of early grafting of full-thickness bums; and finally, but not least in importance, the biochemist who will report daily, and even possibly hourly, on changes in the blood and urinary chemistry 50 that fluid balance and electrolyte control can be conducted scientifically, and assist the clinician to avert many a ï¿½chemical death' and 'parenteral drowning'.