Efficacy of glutathione mesotherapy in burns: an experimental study.

BACKGROUND: Thermal burns are the leading cause of trauma worldwide. Currently, no consensus on optimal treatment of deep partial-thickness (second-degree) burns has emerged, as reflected by the wide variability in available wound-care materials. The relative efficacies of products used for treatment of partial-thickness thermal burns remain unclear. Mesotherapy features intradermal administration of various agents, depending on burn location. In the present experimental study, we explored the efficacy of mesotherapy used to treat partial-thickness thermal burns in 50 male Wistar rats divided into five groups of equal number. No procedure was performed after infliction of thermal burns in control group (Group 1). Mesotherapy was applied with physiological saline in sham group (Group 2), glutathione, taurine, and L-carnitine were separately applied in Group 3, Group 4, and Group 5, respectively. MATERIALS AND METHODS: Mesotherapeutic agents were injected intradermally into the reticular layer of the dermis using the point technique. The first course of mesotherapy was given within the first 2 h after infliction of thermal burns, and therapy was continued to day 10. On day 22, unhealed thermal burn areas were measured prior to sacrifice, and biopsies covering the total areas of burns were performed to allow of pathological evaluation. RESULTS: Group 3 (the glutathione group) showed the best extent of healing, followed by Group 4 (the taurine group) and Group 5 (the L-carnitine group). The healed thermal burn areas in these groups were significantly greater than those in the control and sham groups (P = 0.001). All of healing, acute and chronic inflammation, the amount of granulation tissue, the level of fibroblast maturation, the amount of collagen, the extent of re-epithelization and neovascularization, and ulcer depth were scored upon pathological examination of tissue cross-sections. The best outcomes were evident in the glutathione group, with statistical significance. Although wound healing in the L-carnitine and taurine groups was better than in the control and sham groups, the differences were not statistically significant. CONCLUSION: Thus, glutathione mesotherapy was effective when used to treat partial-thickness thermal burns and may be a useful treatment option for various human burns.

The analgesic effect of dexketoprofen when added to lidocaine for intravenous regional anaesthesia: a prospective, randomized, placebo-controlled study.

This prospective, randomized, placebo-controlled study evaluated the effects of dexketoprofen as an adjunct to lidocaine in intravenous regional anaesthesia (IVRA) or as a supplemental intravenous (i.v.) analgesic. Patients scheduled for elective hand or forearm soft-tissue surgery were randomly divided into three groups. All 45 patients received 0.5% lidocaine as IVRA. Dexketoprofen was given either i.v. or added into the IVRA solution and the control group received an equal volume of saline both i.v. and as part of the IVRA. The times of sensory and motor block onset, recovery time and postoperative analgesic consumption were recorded. Compared with controls, the addition of dexketoprofen to the IVRA solution resulted in more rapid onset of sensory and motor block, longer recovery time, decreased intra- and postoperative pain scores and decreased paracetamol use. It is concluded that coadministration of dexketoprofen with lidocaine in IVRA improves anaesthetic block and decreases postoperative analgesic requirements.

Tramadol as a local anaesthetic in tendon repair surgery of the hand.

This double-blind pilot study compared the local anaesthetic effects of tramadol plus adrenaline with lidocaine plus adrenaline during surgery to repair hand tendons. Twenty patients were randomly allocated to receive either 5% tramadol plus adrenaline (n = 10) or 2% lidocaine plus adrenaline (n = 10). Injection site pain and local skin reactions were recorded. At 1-min intervals after injection of the anaesthetic agent, the degree of sensory blockade was assessed by the patient reporting the extent to which they felt a pinprick, light touch and a cold sensation. Pain felt during surgical incision was also recorded. There was no difference in the quality of sensory blockade or the incidence of side effects between the two groups. Only patients treated with tramadol did not require additional post-operative analgesia. A combination of tramadol plus adrenaline provided a local anaesthetic effect similar to that of lidocaine plus adrenaline.

Cross-sectional internal diameters of radial, thoracodorsal, and dorsalis pedis arteries in children: relationship to subject sex, age, and body size.

The purpose of this study was to determine the average diameter of the radial, thoracodorsal, and dorsalis pedis arteries in a pediatric population and to evaluate the relationship of these measurements to the subject's age, sex, height, weight, and body mass index (BMI). The internal diameters of the radial, thoracodorsal, and dorsalis pedis arteries were non-invasively studied in 45 normotensive, presumed normal children of various ages (4 to 14 years) with the use of a Doppler system. The average diameters of the radial, thoracodorsal, and dorsalis pedis arteries in females and males were as follows: radial artery 1.39 (SD +/- 0.18) mm and 1.57 (SD +/- 0.18) mm; thoracodorsal artery 1.27 (SD +/- 0.11) mm and 1.36 (SD +/- 0.2) mm; and dorsalis pedis artery 1.22 (SD +/- 0.08) mm and 1.34 (SD +/- 0.12) mm. These were correlated with the age, height, weight, and BMI. Gender had a strong influence on the diameter of these arteries. In a linear regression model, weight was found to be statistically the best independent variable for predicting radial and dorsalis pedis diameters, whereas age was the best predictor for the diameter of the thoracodorsal artery. The diameters of these three arteries in an age group of 4 to 14 years ranged between 1 to 2 mm. The age and weight of the children predicted the diameters of the peripheral arteries.

Spotting the signs: a case of late diagnosed painful calciphylaxis.

Although the number of cases of calciphylaxis is increasing, it is often not diagnosed until a late stage, increasing the risk of mortality. A characteristic is purple, mottled and painful lesions, which have a tendency to become necrotic.

Caffeic acid phenethyl ester improves oxidative organ damage in rat model of thermal trauma.

Severe burn injuries cause functional impairment in distant internal organs. Although this mechanism is not clear, it is possible that free radical toxicity plays an important role. Research in animals and clinical studies have shown that there is a close relationship between a lipid peroxidative reaction and secondary pathological changes following thermal injury. It has been demonstrated that antioxidant treatment prevents oxidative tissue damage associated with thermal trauma. This study was designed to determine the possible protective effect of caffeic acid phenethyl ester (CAPE) treatment against oxidative damage in the kidney and lung induced by thermal injury. Rats were decapitated either 1, 3 or 7 days after burn injury. CAPE was administered intraperitoneally immediately after thermal injury. Kidney and lung tissues were taken for the determination of malondialdehyde (MDA) level, myeloperoxidase (MPO), catalase (CAT), superoxide dismutase (SOD) and xanthine oxidase (XO) activities. Severe skin thermal injury caused a significant decrease in SOD and CAT activities, as well as significant increases in MDA level, XO and MPO activities in tissues during the postburn period. Treatment of rats with CAPE (10 micromol/kg) significantly elevated the decreased SOD and CAT activities, while it decreased MDA levels and MPO as well as XO activity.

Comparison of local anaesthetic effects of tramadol with prilocaine for minor surgical procedures.

BACKGROUND: Recent studies have shown that a local anaesthetic action of tramadol 5% was able to induce a sensory block to pinprick, touch, and cold similar to that of lidocaine 1%. The aim of this study was to compare the local anaesthetic effects of tramadol hydrochloride with prilocaine. METHODS: Sixty ASA I or II patients, undergoing excision of the cutaneous lesions under local anaesthesia, were included in the study. Patients were randomly assigned to receive either 1 ml of tramadol 5% (Group T, n=30) or 1 ml of prilocaine 2% (Group P, n=30) intradermally, in a double-blinded fashion. The degree of the burning sensation and pain at the injection site was documented. Sensory block was assessed 1 min after injection. The patient was asked to report the degree of sensation and to grade touch and pinprick sensation. Two minutes after drug administration, incision was performed and intensity of pain, felt by the patient was evaluated on a four-point scale (0-3). Any local adverse effects were recorded. RESULTS: There was no difference in the quality of block between the two groups. Side effects were noted in both groups with a significant increase in the incidence of local reaction (rash) in Group T (seven patients) when compared with Group P (one patient) (P<0.05). Seven patients in Group T vs four patients in Group P complained of burning at the injection site (P>0.05). CONCLUSIONS: Intradermal tramadol 5% can provide a local anaesthesia similar to the prilocaine but the incidence of local adverse effects is higher.

Modified mandibulotomy approach to tumors of the oropharynx.

The surgical approach to tumors in the deep oral cavity, oropharynx, and parapharyngeal space has always been a problem. Midline mandibulotomy for exposure and resection of tumors in these areas is usually essential. However, postoperatively accurate and stable reconstruction of the symphysis is difficult. The authors present a modified notch mandibulotomy in a trapezoidal shape to stabilize the symphysis with only a four-hole miniplate. This shape of the osteotomy reduces the time to return to an unrestricted diet and permits more accurate occlusion.

The use of iliac bone flap as a penile stiffener in a diabetic patient with erectile dysfunction.

A diabetic man with erectile dysfunction in whom two previous attempts at penile prosthesis implantation had failed was treated by using an iliac bone flap as a penile stiffener. The patient had satisfactory sexual function with his penis; it retained its size and stiffness during the 1-year follow-up period. We recommend this method for use in patients in whom multiple earlier attempts at penile prosthesis implantation were unsuccessful.

Silicone gel sheeting for stabilization of skin grafts.

BACKGROUND: Success of skin grafts depends on sufficient immobilization and early intervention for hematoma, seroma, or infection. OBJECTIVE: To stabilize and cover skin grafts with a tie-over technique using translucent silicone gel sheet. METHODS: Twenty-seven skin defects were resurfaced with skin grafts. A sterile silicone gel sheet was placed over the skin graft. Gel was fixed to the wound edges with skin staplers. RESULTS: All grafts healed without any complication. CONCLUSION: Using silicone gel sheeting on 27 skin grafts, we found that it is an effective method for stabilization and allows direct visualization of the graft in order to inspect hematoma-like complications.

Penile reconstruction in children using a double vascular pedicle composite groin flap.

The purpose of this report is to describe the use of a double vascular pedicle composite groin flap for penile reconstruction in children. The flap was composed of skin, soft tissue and iliac crest bone. Both deep and superficial circumflex iliac vessels were included in the pedicle to ensure a well-vascularized extended skin and bone in the flap. The procedure was carried out in two stages to allow for the prefabrication of a neourethra which was reconstructed in the flap using a full-thickness skin graft, prior to the transfer of the flap. The large skin island and bone with a dual blood supply enabled reconstruction of the penis of appropriate size and stiffness without vascular compromise. Two boys, aged 8 and 10 years, were treated successfully with this method and followed clinically for 4-12 months.