The literature describes numerous successful applications using dermal regeneration templates such as IntegraⓇ. Despite widespread use for burns, trauma, and chronic wounds among others, Integra has associated complications which need continued investigation. Large multi-center studies designed to investigate its safety have shown that infections are the most common complications. In this case report, we share our experience with a patient who developed toxic shock syndrome (TSS) following abdominal scar revision with Integra. The literature reviewed identified one report of TSS in association with Integra use, which was fatal. In our case, the patient recovered uneventfully as a result of early recognition, expedient debridement, and appropriate antibiotic administration. Acknowledging that TSS is a rare but potential complication associated with the use of Integra is crucial for early recognition which will improve patient outcomes and reduces mortality.

Staphylococcal toxic shock syndrome (TSS) is most frequently produced by TSS toxin-1 (TSST-1) and Staphylococcal enterotoxin B (SEB), and only rarely by enterotoxins A, C, D, E, and H. Various clinical pictures can occur depending on severity, patient age and immune status of the host. Severe forms, complicated by sepsis, are associated with a death rate of 50-60%. The case of a Caucasian female infant, aged seven weeks, hospitalized with a diffuse skin rash, characterized as allergodermia, who initially developed TSS with axillary intertrigo, is reported. TSS was confirmed according to 2011 CDC criteria, and blood cultures positive for Methicillin-sensitive Staphylococcus aureus (MSSA). Severe development occurred initial, including acidosis, consumption coagulopathy, multiple organ failures (MOF), including impaired liver and kidney function. Central nervous system damage was manifest by seizures. Clinical management included medical supervision by a multidisciplinary team of infectious diseases specialist and intensive care specialist, as well as the initiation of a complex treatment plan to correct hydro electrolytic imbalances and acidosis. This treatment included antibiotic and antifungal therapy, diuretic therapy, immunoglobulins, and local treatment similar to a patient with burns to prevent superinfection of skin and mucous membranes lesions. There was a favourable response to the treatment with resolution of the illness.

A 57-year-old woman was diagnosed as a Rathke cleft cyst (RCC). Endoscopic transsphenoidal surgery (TSS) was performed uneventfully. She developed subarachnoid haemorrhage on postoperative day 3. The vessels adhered the cyst had been pulled into the pituitary fossa, causing an aneurysm.

This study investigated the potential effect of climate changes on stormwater pollution runoff characteristics and the treatment efficiency of a stormwater retention pond in a 95 ha catchment in Denmark. An integrated dynamic stormwater runoff quality and treatment model was used to simulate two scenarios: one representing the current climate and another representing a future climate scenario with increased intensity of extreme rainfall events and longer dry weather periods. 100-year long high-resolution rainfall time series downscaled from regional climate model projections were used as input. The collected data showed that total suspended solids (TSS) and total copper (Cu) concentrations in stormwater runoff were related to flow, rainfall intensity and antecedent dry period. Extreme peak intensities resulted in high particulate concentrations and high loads but did not affect dissolved Cu concentrations. The future climate simulations showed an increased frequency of higher flows and increased total concentrations discharged from the catchment. The effect on the outlet from the pond was an increase in the total concentrations (TSS and Cu), whereas no major effect was observed on dissolved Cu concentrations. Similar results are expected for other particle bound pollutants including metals and slowly biodegradable organic substances such as PAH. Acute toxicity impacts to downstream surface waters seem to be only slightly affected. A minor increase in yearly loads of sediments and particle-bound pollutants is expected, mainly caused by large events disrupting the settling process. This may be important to consider for the many stormwater retention ponds existing in Denmark and across the world.

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