Gene Expression of Neurotrophins and Their Receptors in Keloids.

The aim of this study was to assess gene expression of neurotrophins and their receptors in keloids. Skin samples of normal skin and keloids were obtained from patients in the control (n = 12) and keloid (n = 12) groups, respectively. Ribonucleic acid was extracted from the skin specimens, purified, evaluated by spectrophotometry, and used to synthesize complementary DNA. Real-time quantitative polymerase chain reaction analysis of 84 human neurotrophin genes and their receptors was performed. Twelve genes, including heat shock 27-kDa protein 1, gastrin-releasing peptide receptor, corticotropin-releasing hormone receptor 2, neuropeptide Y Y2 receptor, interleukin 6 signal transducer, nerve growth factor, metallothionein 3, B-cell chronic lymphocytic leukemia/lymphoma 2, cholecystokinin A receptor, persephin, galanin receptor 2, and fibroblast growth factor receptor 3, were down-regulated in keloid tissue compared with normal skin. The genes 27-kDa heat shock protein 1, gastrin-releasing peptide receptor, corticotropin-releasing hormone receptor 2, nerve growth factor, metallothionein 3, B-cell chronic lymphocytic leukemia/lymphoma 2, and persephin protein were considered priority genes associated with keloid formation.

Developing an instrument to assess physician knowledge of initial care for burn patients.

INTRODUCTION: Burns are associated with high rates of morbidity and mortality, especially in low- and middle-income countries, such as Brazil, because there are no routine prevention programs, a lack of adequate legislation and supervision, and care quality in the acute phase is precarious. In most cases, initial care for burn patients is provided by emergency services without specialized personnel, which leaves the majority of cases to general practitioners who have no specific training in initial burn care, which can lead to worse prognoses and outcomes. OBJECTIVE: To develop an instrument to assess physician knowledge of initial care for burn patients. METHODS: This primary quantitative study used the Delphi technique, which involves consensus from a panel of expert panel, as a methodological reference. The instrument was based on information provided in the Ministry of Health's booklet on emergency burn treatment, and an agreement index of 80% was required for item inclusion. RESULTS: After 3 Delphi phases, the instrument was approved by the panel with an agreement index of 100%. CONCLUSION: Although the instrument was finalized, other psychometric properties must still be assessed to further determine its validity and reliability.

Preparing for a burn disaster in Brazil: Geospatial modelling to inform a coordinated response.

INTRODUCTION: To optimize the early care of burned patients, protocols were developed that guide pre-hospital care and the need to transfer to a specialized burn treatment unit. Burn disasters are an important public health concern in developed and developing nations. Among the early steps in disaster preparedness is the understanding of geographic locations and capacity of burn care facilities. We aimed to map and classify medical facilities that provide burn care in Brazil and to undertake a location-allocation analysis to identify which could be targeted to increase capacity. METHODS: A review of burn hospitalizations was conducted using Brazilian Ministry of Health data. Capacity was defined by number of burn patients admitted each year and bed type. Spatial population data per one-square kilometer were obtained from World Pop as a raster dataset. A road network dataset using Open Street Map data was created to conduct the drive time analysis. Location/allocation analysis was conducted to identify the proportion of Brazil's population living within 2- and 6-hours' drive time of a burn care capable hospital, stratified by the level of hospital capacity. Hospitals were ranked according to number of additional people served. RESULTS: We found 26.471 burn admissions. Of these, 3.508(13,2 %) were ICU admissions. A total of 735(2,7 %) hospital deaths occurred under the selected burn codes. In all, 1.273 facilities admitted burn patients, and 263(20,7 %) reported ICU admissions of burn patients. Seventeen hospitals were classified as maximum capacity facilities. Additional 23 hospitals were identified as potential targets for capacity building. Most maximum capacity hospitals are clustered in the Southeast of Brazil. Currently, 40.8 % of the Brazilian population live within 2 h of a maximum capacity facility. A large part of the population lives farther than 6 h away from a maximum capacity hospital. Most of the potential targets for capacity building are located near the coast of Brazil. DISCUSSION: We mapped and classified facilities that provide public burn care in Brazil. We identified public facilities that could be targeted to increase capacity to improve access for patients in the event of a burn disaster. Mapping, planning, and coordinating response is key for optimal outcomes in Mass Casualties Incidents. Cataloging and understanding local resources is a crucial first step in disaster management. Inequality in profiles can determine specific regional needs. Specialized burn centers are rare in regions other than the southeast. Health equity should be considered when planning disaster preparedness initiatives. Location-allocation modelling may assist in universal and equitable burn care service offerings. CONCLUSION: This study proposes an initial step in the classification and mapping of available burn treatment centers and population coverage in Brazil.

National multicentric study on the incidence of alcohol burns during the COVID-19 pandemic.

BACKGROUND: Burns are traumatic wounds that occur when skin is exposed to an amount of energy greater than its maximum dissipation capacity. Alcohol, because it fuels flames and its vapor can cause an explosion, is one of the most common causal agents of burns in Brazil. In late 2019, the COVID-19 pandemic caused a sudden and substantial increase in the use of 70% alcohol (w/v) for antisepsis. OBJECTIVES: To analyze the epidemiological characteristics of alcohol burns during the COVID-19 pandemic in participating Burn Treatment Centers, as well as the severity and treatment of these burns. METHOD: Descriptive, cross-sectional, quantitative and retrospective study based on data obtained from medical records of patients treated in participating Burn Treatment Centers. Data collection included origin, gender, education level, occupation, circumstance of the accident, wound depth and type of treatment. RESULTS: Of eight participating centers, theHospital da Restauraç ão Gov. Paulo Guerra Burn Treatment Center experienced the highest number of alcohol burn patients (38.4%) and male gender accounted for 53.6% of all cases. Predominant occupations were those that involve domestic activities (29%) and 48.6% of patients had not completed elementary school. The most common cause was an accident during cooking (35.5%) followed by suicide attempt (18.3%). More than half (58.6%) of the patients had concomitant second and third degree burns and wound treatment of choice was surgical (43.1%). CONCLUSIONS: The predominant population in this study was male, had a lower level of education, resided in the northeast region and had an occupation carried out in a domestic environment. The latter may reflect the population's longer stay at home due to social constraints caused by the COVID-19 pandemic. There were a large number of second and third degree burns and, as a consequence, a high number of cases in which surgical treatment was required.

Surviving Sepsis After Burn Campaign.

INTRODUCTION: The Surviving Sepsis Campaign was developed to improve outcomes for all patients with sepsis. Despite sepsis being the primary cause of death after thermal injury, burns have always been excluded from the Surviving Sepsis efforts. To improve sepsis outcomes in burn patients, an international group of burn experts developed the Surviving Sepsis After Burn Campaign (SSABC) as a testable guideline to improve burn sepsis outcomes. METHODS: The International Society for Burn Injuries (ISBI) reached out to regional or national burn organizations to recommend members to participate in the program. Two members of the ISBI developed specific "patient/population, intervention, comparison and outcome" (PICO) questions that paralleled the 2021 Surviving Sepsis Campaign [1]. SSABC participants were asked to search the current literature and rate its quality for each topic. At the Congress of the ISBI, in Guadalajara, Mexico, August 28, 2022, a majority of the participants met to create "statements" based on the literature. The "summary statements" were then sent to all members for comment with the hope of developing an 80% consensus. After four reviews, a consensus statement for each topic was created or "no consensus" was reported. RESULTS: The committee developed sixty statements within fourteen topics that provide guidance for the early treatment of sepsis in burn patients. These statements should be used to improve the care of sepsis in burn patients. The statements should not be considered as "static" comments but should rather be used as guidelines for future testing of the best treatments for sepsis in burn patients. They should be updated on a regular basis. CONCLUSION: Members of the burn community from the around the world have developed the Surviving Sepsis After Burn Campaign guidelines with the goal of improving the outcome of sepsis in burn patients.

Tap Water has No Influence on Microbial Colonization of Skin Wounds in Rats.

UNLABELLED:  The aim of this study was to investigate the influence of tap water on microbial colonization of skin wounds in rats. METHODS: A cir- cular wound 2.4 cm in diameter was created on the back of 40 Wistar rats, which were randomly assigned to the control (n = 20) or study (n = 20) group. The wounds were cleansed daily using a sterile 0.9% sodium chloride solution (control group) or tap water (study group) for 6 days, following a standardized protocol. Sequential samples were collected for microbiological analysis every other day. RESULTS: Microbial growth occurred in 49% of the samples from the control group and in 47% of the samples from the study group (P = 0.39). There was no significant difference in microbial growth between groups for the different culture media: thioglycolate (P = 0.20), mannitol salt agar (P = 0.53), blood agar (P = 0.61), eosin methylene blue agar (P = 0.51), and Sabouraud agar (P = 0.34). The following microorganisms were identified: Bacil- lus subtilis, Staphylococcus sp, Aureobasidium sp, Penicillium sp, and Cladosporium sp. CONCLUSION: The use of tap water for cleansing skin wounds in rats had no effect on microbial colonization compared with the use of a sterile saline solution. .

Predicting mortality for critically ill burns patients, using the Abbreviated Burn Severity Index and Simplified Acute Physiology Score 3.

INTRODUCTION: Reviewing the profile of patients admitted at the Burns Intensive Care Unit at São Paulo Hospital - UNIFESP, as well as the available literature, it becomes evident the need for tools able to predict those patients' outcomes. Distinct score models are used in different health centers, not only as prognostic models, but also as research and quality control tools. Amongst these prognostic scores, there are two strands, the burns specific scores - which consider the injury's characteristics - and the general critical patient's scores. OBJECTIVE: This study aims to analyze the differences and tendencies in mortality prediction of two broadly used scores when applied to São Paulo Hospital's Burns Intensive Care Unit patients, ABSI - burns specific score - and SAPS 3 - general score for critical patients. METHODS: This is an individual, observational, retrospective and comparative study, developed with medical records review. Both scores were applied to every patient admitted at São Paulo Hospital's Burns Intensive Care Unit from 2011 to 2016. Statistical analyses used the non-parametric test of Kolmogorov-Smirnov, a p-value <0.05 was considered significant. RESULTS: 122 patients were included, the average age was 34,4 years old. 70,5% of patients were male and 49% had a total body surface area burned of 20%. 27% of the patients died. Statistical analyses do not show significant differences between ABSI and SAPS3 mortality predictions for burns patients at this health center. CONCLUSION: The study evidences that SAPS 3 score, frequently used at general Intensive Care Units, has a similar performance to ABSI score, which is specific for burns populations. ABSI score is easier to implement, as it is simpler and able to show instant results.

Burn Specific Health Scale - Brief - Brazil and International Classification of Functioning, Disability and Health in Burn Patients.

With better burn trauma survival rates, quality of life and functionality have become important outcomes in the evaluation of burn patients. The objective of this study was to evaluate the quality of life of burn survivors using the Burn Specific Health Scale-Brief-Br and their function and health using the International Classification of Functioning Disability and Health (ICF) in order to assess whether there is a correlation in the results obtained between the two instruments. A cross-sectional study with 80 burn patients who underwent outpatient follow-up was completed. Quality of life was assessed using the BSHS-B-Br, an instrument translated and validated in Brazilian Portuguese. Based on ICF category concepts, a data collection tool was used with "yes" and "no" answers. A "yes" answer represented the "8" qualifier, indicating a problem without a specific order of magnitude. Both instruments were self-applied in standardized conditions without complications during the process. Results were analyzed through Spearman's rank correlation coefficients. The BSHS-B-Br had an average score of 127.12 (SD ± 23.03). The correlation was moderate between the total BSHS-B-Br score and the answers of ICF for body functions (r = -.53; P < .001) and environmental factors (r = -.50; P < .001). It was weak for body structures (r = -.47; P < .001) and for activities and participation (r = -.43; P < .001). This study found a moderate correlation between the results of the Burn Specific Health Scale - Brief - Brazil and the International Classification of Functioning, Disability and Health for burn patients showing that both instruments provide complementary information about burned patients.

Control of the skin scarring response.

There comes a time when the understanding of the cutaneous healing process becomes essential due to the need for a precocious tissue repair to reduce the physical, social, and psychological morbidity. Advances in the knowledge on the control of interaction among cells, matrix and growth factors will provide more information on the Regenerative Medicine, an emerging area of research in medical bioengineering. However, considering the dynamism and complexity of the cutaneous healing response, it is fundamental to understand the control mechanism exerted by the interaction and synergism of both systems, cutaneous nervous and central nervous, via hypothalamus hypophysis-adrenal axis, a relevant subject, but hardly ever explored. The present study reviews the neuro-immune-endocrine physiology of the skin responsible for its multiple functions and the extreme disturbances of the healing process, like the excess and deficiency of the extracellular matrix deposition.

Hemicellulose dressing versus rayon dressing in the re-epithelialization of split-thickness skin graft donor sites: a multicenter study.

The aim of this study was to compare the effectiveness of a hemicellulose dressing with that of rayon dressing in the healing of split-thickness skin graft donor sites. Twenty-eight patients were selected from five different hospitals and randomized into two groups: hemicellulose dressing group and rayon dressing group. All patients underwent split-thickness skin grafting for various reasons, and the skin graft donor site wounds were covered with hemicellulose dressing (n=14) or rayon dressing (n=14). The donor site was assessed on postoperative days 1, 7, 14, 21, and 28 for hyperemia, pruritus, pain, exudate level, and adherence of the wound dressing. At the 60-day follow-up visit, the donor site was assessed again for pruritus and pain. Touch-pressure, thermal, and pain sensibility tests were performed preoperatively and on postoperative day 60 together with the assessment of color and texture of the re-epithelialized area. In all patients, re-epithelialization was completed between 14 and 21 days after surgery. There were no significant differences between the two groups with regard to pain, hyperemia, pruritus, exudate, and final appearance (color and texture) of the skin graft donor site. The rayon dressing provided significantly better adherence than the hemicellulose dressing, and both dressings showed similar results with regard to the parameters evaluated when used in the treatment of split-thickness skin graft donor sites.

Microarray as a new tool to study hypertrophic and keloid scarring.

UNLABELLED:  Background. Normal wound healing results from a complex set of reactions between blood cells, skin cells, and biochemical mediators including pro- and anti-inflammatory molecules, growth factors, cytokines, hormones, and vitamins. As this cascade of reactions is ultimately regulated by the coordinated expression and silencing of numerous genes, the gene expression analysis of hypertrophic and keloid scarring (HS and KS, respectively) should provide important information and improve our understanding of HS and KS pathophysiology. Microarray is a new tool that can shed light on the complex genetic background that regulates pathologic scarring. This review will describe basic principles of microarray technique for wound care professionals and explain how this technology is contributing to a better understanding of HS and KS biology. METHODS: A brief review of the literature on microarray in HS and KS over the last 7 years was conducted. RESULTS: The inter-experiment comparisons are somewhat difficult because of differences in the probes used, diverse source of samples, different time points of wound healing, and in-vivo or ex-vivo analysis. Wound healing gene expression must be studied in an environment where all cells and mediators could show how the regulatory network functions. CONCLUSION: All results confirmed previous findings about HS and KS related to over-expression of collagen or extracellular matrix (ECM) genes. One conclusion after this initial approach is that a standardized animal model, probe, and software for data analyses to compare results would increase the understanding of HS and KS pathophysiology.

Cellulose Dressing Versus Rayon Dressing in Skin Graft Donor Sites: Aspects of Patients' Health-related Quality of Life and Self-esteem .

UNLABELLED:  Objective. The aim of this study was to compare the health-related quality of life (HRQoL) and self-esteem of patients who underwent split-thickness skin grafting, when either cellulose dressings or rayon dressings were applied to the donor sites. METHODS: A total of 25 patients, who were enrolled at five participant hospitals and required split-thickness skin grafting for various clinical reasons, were randomized into two treatment groups, the rayon dressing group (n = 13), or the cellulose dressing group (n = 12). All patients were assessed preoperatively and 60 days postoperatively. The HRQoL was assessed with the Short Form-36 (SF-36) health survey questionnaire, and self-esteem was evaluated using the Rosenberg Self-Esteem Scale (RSE)/UNIFESP-EPM (Brazilian versions). There were no surgery-related complications during the study period. RESULTS: In both treatment groups, SF-36 scores for emotional role, mental health, vitality, and general health decreased from baseline. RSE scores increased from baseline in both treatment groups, showing a reduction in self-esteem after treatment. There was a statistical difference (P = 0.024) in the SF-36 bodily pain domain for the rayon group. CONCLUSION: There were no significant differences in HRQoL and self-esteem between treatment groups. In the rayon-dressing group, there was a significant decrease in bodily pain from baseline .

The role of vitamin C in the gene expression of oxidative stress markers in fibroblasts from burn patients.

PURPOSE: To assess the action of vitamin C on the expression of 84 oxidative stress related-genes in cultured skin fibroblasts from burn patients. METHODS: Skin samples were obtained from ten burn patients. Human primary fibroblasts were isolated and cultured to be distributed into 2 groups: TF (n = 10, fibroblasts treated with vitamin C) and UF (n = 10, untreated fibroblasts). Gene expression analysis using quantitative polymerase chain reaction array was performed for comparisons between groups. RESULTS: The comparison revealed 10 upregulated genes as follows: arachidonate 12-lipoxygenase (ALOX12), 24-dehydrocholesterol reductase (DHCR24), dual oxidase 1 (DUOX1), glutathione peroxidase 2 (GPX2), glutathione peroxidase 5 (GPX5), microsomal glutathione S-transferase 3 (MGST3), peroxiredoxin 4 (PRDX4), phosphatidylinositol-3,4,5-trisphosphate dependent Rac exchange factor 1 (P-REX1), prostaglandin-endoperoxide synthase 1 (PTGS1), and ring finger protein 7 (RNF7). CONCLUSION: Cultured fibroblasts obtained from burn patients and treated with vitamin C resulted in 10 differentially expressed genes, all overexpressed, with DUOX1, GPX5, GPX2 and PTGS1 being of most interest.

Risk Factors for Pressure Ulcers in Hospitalized Elderly without Significant Cognitive Impairment.

PURPOSE: To evaluate risk factors for pressure ulcers (PU) in hospitalized elderly without significant cognitive impairment. METHODS: From July 2005 to February 2006, 40 hospitalized elderly patients without cognitive deficit were evaluated in a university hospital in Pouso Alegre, Brazil. Twenty patients with a PU formed the study group and 20 without a PU formed the control group. The Mini Mental State Examination (MMSE) was used to assess cognitive status. Pressure ulcers were classified using the National Pressure Ulcer Advisory Panel (NPUAP) guidelines, followed by evaluation of risk factors for PU using the Braden scale. The chi-squared test was applied and for the Braden scale the Mann-Whitney test was used. RESULTS: In the study group, 14 (70%) of the subjects were women and 6 (30%) were men. The average age was 71.5 years. The average score for the MMSE was 19.7. The average time of hospitalization was 23.1 days for the study group and 13 days for the control. In the Braden scale, the risk factors such as humidity, activity, mobility, friction, and shear force were significant (P < 0.05). CONCLUSION: The data from the present study demonstrate that hospitalized elderly patients have an increased risk for the development of PU. Humidity, activity, mobility, friction, and shear are important risk factors during the hospitalization period.

Response and legislative changes after the Kiss nightclub tragedy in Santa Maria/RS/Brazil: Learning from a large-scale burn disaster.

PURPOSE: A major fire occurred on January 27, 2013, at 02:30 at Kiss nightclub in the city of Santa Maria, State of Rio Grande do Sul, in Southern Brazil. In this retrospective report, we aimed to describe the nightclub fire event, its immediate consequences, and evaluated its impact on legislation. Our objective was to disseminate the lessons we learned from this large-scale nightclub fire disaster. METHODS: We conducted a literature review in PubMed and Lilacs database from 2013 to 2015 related to the nightclub Kiss, Santa Maria, fire, burns, and similar events worldwide over the past 15 years. We searched in the general press and online media information sites, and seeking legislation about this topic at the federal level in Brazil. We reported on the legislation changes that resulted from this nightclub fire. RESULTS: Current federal legislation on fire prevention and the scope of public safety, including night clubs and discos, states is the duty of the state and everyone's responsibility, pursuant to Article 144 of the Federal Constitution of Brazil. Thus, the federal union, individual states and municipalities have the power to legislate on fire prevention, and especially to ensure the security of the population. A state law called "Law Kiss", was passed in 2014, establishing standards on safety, prevention and protection against fire in buildings and areas of fire risk in the state of Rio Grande do Sul. On a national level, a law of prevention and fire fighting in Brazil was also drafted after the Santa Maria disaster (Law project no. 4923, 2013). Currently, this bill is still awaiting sanction before it can take effect. CONCLUSION: As we push for enactment of the national law of prevention and fire fighting in Brazil, we will continue emphasizing fire prevention, fire protection, fire fighting, means of escape and proper management. All similar events in this and other countries remind us that similar tragedies may occur anywhere, and that the analysis of facts, previous mistakes, during and after the incident are crucial to our understanding, and will help us lessen the chance of future occurrences.

Aldefluor protocol to sort keratinocytes stem cells from skin.

PURPOSE: To investigate the use Aldefluor® and N, N - Dimethylaminobenzaldehyde (DEAB) to design a protocol to sort keratinocyte stem cells from cultured keratinocytes from burned patients. METHODS: Activated Aldefluor® aliquots were prepared and maintained at temperature between 2 to 8°C, or stored at -20°C. Next, the cells were collected following the standard protocol of sample preparation. RESULTS: Best results were obtained with Aldefluor® 1.5µl and DEAB 15 µl for 1 x 106 cells, incubated at 37°C for 15 minutes. Flow cytometer range for keratinocyte stem cells separation was evaluated. There were 14.8% of stem cells separated in one sample of keratinocyte culture used to pattern the protocol. After being defined the ideal concentration, the same test pattern was performed in other keratinocyte samples. We observed a final mean of 10.8%. CONCLUSION: Aldefluor® has been shown as a favorable marking of epidermal keratinocyte stem cells for subsequent separation on a flow cytometer, with detection of 10.8% of epidermal keratinocyte stem cells, in this protocol.

Upregulation of TGF-beta1 expression may be necessary but is not sufficient for excessive scarring.

Transforming growth factor beta 1 (TGF-beta1) upregulation has been implicated in hypertrophic scars and keloids, but it is unclear if it is the cause or an effect of excessive scar formation. In this study, we overexpressed TGF-beta1 in fibroblasts and characterized its role. Normal human dermal fibroblasts were genetically modified to overexpress TGF-beta1 as the wild-type latent molecule or as a mutant constitutively active molecule. TGF-beta1 secretion was measured, as were the effects of TGF-beta1 upregulation on cell proliferation, expression of smooth muscle cell alpha actin (SMC alpha-actin) and ability to contract collagen lattices. Fibroblasts were implanted intradermally into athymic mice and tissue formation was analyzed over time by histology and immunostaining. Gene-modified fibroblasts secreted approximately 20 times the TGF-beta1 released by control cells, but only cells expressing mutant TGF-beta1 secreted it in the active form. Fibroblasts expressing the active TGF-beta1 gene had increased levels of SMC alpha-actin and enhanced ability to contract a collagen lattice. After intradermal injection into athymic mice, only fibroblasts expressing active TGF-beta1 formed "keloid-like" nodules containing collagen, which persisted longer than implants of the other cell types. We conclude that upregulation of TGF-beta1 by fibroblasts may be necessary, but is not sufficient for excessive scarring. Needed are other signals to activate TGF-beta1 and prolong cell persistence.

Keratinocyte growth factor and the expression of wound-healing-related genes in primary human keratinocytes from burn patients.

PURPOSE: To evaluate the effect of keratinocyte growth factor (KGF) treatment on the expression of wound-healing-related genes in cultured keratinocytes from burn patients. METHODS: Keratinocytes were cultured and divided into 4 groups (n=4 in each group): TKB (KGF-treated keratinocytes from burn patients), UKB (untreated keratinocytes from burn patients), TKC (KGF-treated keratinocytes from controls), and UKC (untreated keratinocytes from controls). Gene expression analysis using quantitative polymerase chain reaction (qPCR) array was performed to compare (1) TKC versus UKC, (2) UKB versus UKC, (3) TKB versus UKC, (4) TKB versus UKB, (5) TKB versus TKC, and (6) UKB versus TKC. RESULTS: Comparison 1 showed one down-regulated and one up-regulated gene; comparisons 2 and 3 resulted in the same five down-regulated genes; comparison 4 had no significant difference in relative gene expression; comparison 5 showed 26 down-regulated and 7 up-regulated genes; and comparison 6 showed 25 down-regulated and 11 up-regulated genes. CONCLUSION: There was no differential expression of wound-healing-related genes in cultured primary keratinocytes from burn patients treated with keratinocyte growth factor.

[Experimental model of primary cultured metastatic melanoma by fine needle aspiration]. / Modelo experimental de cultura primária de melanoma metastático por punção aspirativa de agulha fina.

PURPOSE: Establish an experimental model of metastatic melanoma primary culture cells from fine-needle aspiration biopsies (FNAB). METHODS: Two metastatic melanoma primary culture cells from (FNAB) have been developed from patients who had been submitted to excision of metastatic lesions and they were identified by immunohistochemical analyses using S-100 and MB-45 melanoma markers. RESULTS: The culture diagnostic was confirmed by immunohistochemical. The technique of FNAB offers the advantage of providing a sequential analysis of the same tumor nodules throughout treatment, and is a minimally invasive procedure with almost no associated morbidity. CONCLUSION: The establishment of metastatic melanoma primary culture from FNAB samples showed a viable technique.

Burns and epilepsy--review and case report.

Decompensation of epilepsy in burned patients may be caused by several factors. Burn is a classic etiology of systemic inflammatory response syndrome, and evolves into two physiological phases. The first 48h after injury corresponds to the first phase involving severe hypovolemic shock. The second phase corresponds to the hypermetabolic response to burns. Altered pharmacokinetics of anticonvulsant drugs is observed. Albumin and other plasma proteins are reduced, leading to increased free fraction of phenytoin, resulting in greater clearance and a lower total drug concentration. Associated with metabolic changes of burned patient, this fact predisposes to seizures in epileptic burned patients. The authors present the case of an epileptic 36-year-old-woman who developed recurrent seizures after a thermal injury, despite using the same medications and doses of anticonvulsant drugs of last 12 years, with controlled epilepsy.