[Verapamil in conjunction with pressure therapy in the treatment of pathologic scar due burn injury]. / Verapamilo en conjunto con prendas de compresión en el tratamiento de cicatriz patológica causada por quemadura.

BACKGROUND: Keloids and hypertrophic scars are dermal fibro-proliferative disorders unique to humans. Their treatment is a true challenge with multiple options, but not all the time with good results. Unfortunately this problem is not uncommon in patients with history of burn injury. The aim of this article is to evaluate the use of verapamil and pressure garments in patients with hypertrophic or keloid scar caused by burn injury. METHODS: We included patients with a hypertrophic or keloid scar caused by burn injury candidate to treatment with pressure garment. The pathologic scars were evaluated by serial photographic records, Vancouver and Posas scales. The scales of Vancouver and Posas were compared with t Student. RESULTS: We included 13 scars in 11 patients. Four scars were located in the legs, 4 in the arms, 4 in the face-neck and 1 in the abdomen. The dose of verapamil was calculated .03mg per kg. Injections were scheduled every 7 to 10 days until complete 6 sessions. Taking in count Posas scale, patients referred improvement in pigmentation (.01), thickness (.005), pliability (.01) and surface area (.004). In the Vancouver scale the observers mentioned improvement in elevation (.008), pigmentation (.014), vascularity (.022), flexibility (.014) and pruritus (.003). No adverse effects were found in verapamil injection. CONCLUSIONS: Verapamil was useful in conjunction with pressure garment to improve the condition of the keloid and hypertrophic scar caused by burn.

Introducción: la cicatriz queloide y la hipertrófica son desordenes fibro-proliferativos únicos de los humanos, su tratamiento representa un reto en con pocas opciones. El uso de prendas de compresión resulta útil, sin embargo el proceso de maduración no es tan rápido; decidimos usar verapamilo para facilitar este proceso y poder mejorar la calidad de vida de nuestros pacientes. El objetivo de este estudio es evaluar el uso del verapamilo y las prendas de compresión en pacientes con cicatrización patológica como consecuencia de quemadura. Métodos: incluimos pacientes con cicatrización patológica, ya sea queloide o hipertrófica, causada por quemadura. La cicatriz fue evaluada con fotografías seriadas, escala de Vancouver y Posas. Los resultados fueron comparados con la prueba de t de Student. Resultados: incluimos 13 cicatrices en 11 pacientes. La localización de las cicatrices fue en: brazos 4, piernas 4, cara y cuello 1, y abdomen 1. La dosis de verapamilo se calculó a .03 mg por kg de peso. Las inyecciones se aplicaron de manera intralesional y se administraron cada 7 a 10 días, hasta completar 6 sesiones. Encontramos mejoría en los siguientes parámetros de la escala de Posas: pigmentación, pliabilidad, endurecimiento y superficie. En la escala de Vancouver: elevación, pigmentación, vascularidad, flexibilidad y prurito. No encontramos efectos adversos con la administración de verapamilo. Conclusiones: el verapamilo fue útil en conjunto con las prendas de compresión para mejorar las condiciones de la cicatriz queloide e hipertrófica causadas por lesiones por quemadura.

Relapsing massive metal bezoar: a case report.

INTRODUCTION: Bezoars are uncommon findings in the gastrointestinal tract and are composed of a wide variety of materials. We report a case of a relapsing metal bezoar in a man with schizophrenia. CASE PRESENTATION: A 34-year-old man presented with a history of sub-acute onset of mild diffuse abdominal pain and abdominal distention. Physical examination revealed dullness to percussion in the upper and lower left quadrants. Past medical history was remarkable for epilepsy, schizophrenia and previous abdominal surgery for intestinal occlusion. Plain radiographs revealed objects of metal density contained within a dilated stomach. Celiotomy was performed revealing more than 350 metal objects inside the stomach. The patient was discharged and referred to a psychiatric facility. CONCLUSION: Intestinal occlusion in patients with psychiatric disorders can result from rare causes such as bezoars. This report alerts surgeons to rule out bezoars in the differential diagnosis of intestinal occlusion in people with mental health problems.