Surgical rehabilitation following ocular chemical injury.

PURPOSE: The purpose of this study is to evaluate the management of limbal stem cell deficiency (LSCD) secondary to chemical ocular burns. MATERIALS AND METHODS: The charts of 48 eyes of 40 patients with grade 2 or higher chemical injury were evaluated retrospectively. Subjects with follow-up longer than 1 year were included. Medical treatment, surgical correction of abnormalities of ocular adnexial structures, limbal stem cell transplantation from patient's fellow eye, from living relatives or from cadaveric donor, amniotic membrane transplantation, conjunctival epitheliectomy, chelation with ethylenediaminetetraacetic acid and penetrating keratoplasty were the treatment modalities. Outcome measures were ocular surface stability and corrected distance visual acuity (CDVA). Failure was defined as the appearance of persistent epithelial defect (nonhealing epithelial defect for more than 2 weeks) with progressive corneal conjunctivalization/vascularization and thinning, and also progression of conjunctivalization to the central 6 mm of the cornea in eyes with subsequent keratoplasty. RESULTS: The mean age of 31 male and 9 female patients were 32.32 ± 12.6 years. LSCD was bilateral in 8 cases. The mean follow-up was 77.2 ± 35.1 months. The presentations were in acute phase in 37.5%, in subacute phase in 32.5% and in chronic phase in 30% of the patients. Only 13 of 48 (27.1%) eyes obtained sufficient ocular surface stability through medical treatment; however, only 5 of these eyes achieved CDVA of less than 0.7 logMAR. Limbal stem cell transplantation was performed in 26 eyes as conjunctival limbal autograft, living-related conjunctival limbal allograft and keratolimbal allograft or as a combination of these transplantations. At the last visit, 30 eyes (62.5%) had an intact and stable ocular surface. Clear cornea was achieved in 11 (78.6%) of 14 eyes with grade 2 injury, in 9 (60%) of 15 eyes with grade 3 injury, in 5 (50%) of 10 eyes with grade 4 injury, in 1 (16.6%) of 6 eyes with grade 5 injury and in 1 (33.3%) of 3 eyes with grade 6 injury. The CDVA that was 1.66 ± 0.99 logMAR initially improved to 0.87 ± 0.85 logMAR at the last visit (p < 0.001). CONCLUSION: While patients with low-grade chemical injury seem to benefit quite well from the medical treatment, amniotic membrane transplantation, limbal graft transplantation and subsequent keratoplasty; patients with severe injuries seem to be more prone to failure after all of the available treatment modalities.

[Homeostasis changes during rehabilitation period after acute chemical poisoning].

The article deals with review of 78 patients of rehabilitation toxicological unit. The patients received resuscitation and detoxification. All patients were divided into three groups; 1st group--patients after poisoning with psychopharmaceuticals, 2nd group--patients after poisoning with cauterizing liquids and 3rd group--patients with encephalopathy after poisoning with neurotoxin (psychopharmaceuticals, narcotics and ethanol). Disorders of rheology, haemostasis and endotoxicosis accrued in all groups. These disorders were a signs of the erythrocytes and platelets aggregation developing and viscoelasticity disorder. Homeostasis changes during rehabilitation period need an accurate diagnostics for purposeful treatment of the defined disorders.

Definitive magnetic nasal prosthesis for partial nasal defect.

Maxillofacial trauma refers to any injury to the face or jaw caused by physical force, trauma, the presence of foreign objects, animal or human bites, and burns. Facial defects can be devastating in their impact on physical structure and function of the affected individual, leading to potential compromises in quality of life. Restoration of facial defects, especially nasal defects, is a difficult challenge for both the surgeon and the prosthodontist. Here is a case report of partial nasal defect caused by trauma, rehabilitated with a magnetic nasal prosthesis made with silicone elastomers using mechanical and anatomical retentive aids.

Oral chemical burns caused by self-medication in a child: case report.

There are few published reports that discuss oral burns in children. Electrical, chemical, and thermal agents are the main causative agents of these burns. Some chemicals can cause burning in the mucosa of cheeks, lips, tongue, and palate. Because of the clinical state of acute pain associated with lack of or inadequate care to relieve the symptoms, some patients use self-medication. The purpose of this work is to report the case of oral chemical burns caused by topical self-medication for tooth pain relief, and also to discuss the clinical presentation and the treatment performed.

Surgical rehabilitation following severe ocular burns.

Chemical and thermal burns can cause devastating injuries to the anterior segment. The consequences of alkali injuries are notoriously severe due to the rapid penetration of these agents into the ocular tissues. Denaturation of tissue, inflammation, and scarring leads to loss of function. An understanding of the pathogenesis of tissue damage has lead to a rational approach to treatment. Emergency irrigation of the eye is essential and there is a 'window of opportunity' during the first 7-10 days after injury when medical treatment can significantly limit the potentially blinding consequences. The acute injury is followed by early and late reparative phases during which the prognosis can be further improved by surgical intervention. Early surgical intervention is targeted at protecting the ocular surface and encouraging re-epithelisation. Later, surgical treatments are directed at ocular surface reconstruction and restoration of vision. However, before any attempt is made at surface reconstruction, the ocular surface environment must be optimised by division of symblepharon, and correction of lid deformity and trichiasis. If there is conjunctivalisation of the corneal surface, limbal stem cell transplantation can restore a corneal epithelial cell phenotype, and transplantation of in vitroamplified corneal epithelial stem cells has been developed as an alternative to keratolimbal transfer techniques. Keratoplasty and cataract surgery may then be necessary to clear the visual axis. Finally, keratoprosthesis is an option for the most severely damaged eyes.

Sternocleidomastoid muscle myocutaneous flap for corrosive pharyngoesophageal strictures.

BACKGROUND: Strictures at the pharyngoesophageal junction represent a subgroup of corrosive esophageal strictures requiring a specialized management approach. Non-dilatable cricopharyngeal strictures need surgical intervention. We report the use of the sternocleidomastoid muscle myocutaneous inlay flap (SCMMIF) for reconstruction of the cervical esophagus in patients with corrosive strictures. METHODS: A SCMMIF was used in four patients with cricopharyngeal strictures. The surgical technique is described. All patients had complete dilatation of the stenosed cricopharyngeal segment as seen on postoperative endoscopy and contrast studies. One patient was managed successfully for a short midesophageal stricture by serial endoscopic dilatations. Another patient underwent an esophagocoloplasty subsequently for bypass of the long distal esophageal stricture The last two patients await esophagocoloplasty. CONCLUSIONS: This is the first report on the use of sternocleidomastoid muscle myocutaneous inlay flap for corrosive cricopharyngeal strictures. The flap is simple to construct, is effective and can be performed in a short time, and yields good cosmetic results.

[Limbal transplantation in the treatment of and optic rehabilitation of the patients with severe chemical burns of the eyes]. / Limbal'naia transplantatsiia v lechenii i zritel'noi reabilitatsii patsientov s tiazhelymi khimicheskimi ozhogami glaz.

Described in the paper are the results of observations of the autogenous and allogenic limb transplantation (LT) made in 4 patients at exacerbation of severe and extra severe burns of the eyes and made in 8 patients in the remote period after severe chemical burns (4 months and more after trauma). A total vascularized corneal leukoma shaped up in 3 patients with LT made at exacerbation; an intense corneal opacification was observed in 1 more such patient. As for the patients, who were operated on in the remote period, better corneal properties and significantly improved visual acuity were registered in them. Relapsing corneal conjunctivalization were observed only in 3 cases of allogenic LT. Thus, LT was proven to be an effective tool in the remote visual rehabilitation of patients with severe eye burns, whereas, the procedure made at exacerbation and in cases of acute and extra acute burns with extensive lesions in the conjunctiva is low effective or a failure.

Visual rehabilitation after severe alkali injury with piggyback hyper O2 contact lenses.

PURPOSE: To report successful visual rehabilitation following severe bilateral alkali injury using piggyback hyperoxygen-transmissible (hyper O2) contact lenses. METHODS: Case report and literature review. RESULTS: More than 15 years after a severe bilateral alkali injury, multiple surgical procedures including repeat bilateral penetrating keratoplasty, severe tear deficiency, and chronic ocular surface disruption, the patient achieved 20/30 best-corrected vision through the simultaneous use of a hyper O2 rigid gas permeable contact lens over a hyper O2 soft contact lens in his right eye. The patient has tolerated this piggyback combination without any adverse reactions or complications, and his corneal graft remains clear and healthy. CONCLUSION: Visual rehabilitation for conditions that compromise the ocular surface can be accomplished by utilizing newer soft and rigid contact lens materials that facilitate oxygen transmission, thereby promoting epithelial healing and improving safety in extended wear situations. These newer materials may potentially reduce complications previously associated with extended wear therapeutic lenses.

Speech and swallowing rehabilitation following devastating caustic ingestion: techniques and indicators for success.

Caustic material ingestion, either accidental or intentional, may result in tissue and organ destruction leading to a wide range of complications, including loss of speech and the ability to eat. The esophagus can be reconstructed successfully, but reopening the larynx and upper airway poses a significant therapeutic dilemma. External reconstruction may put the neoesophagus at risk. Loss of the normal swallowing mechanism and the protective supraglottic structures often results in fatal aspiration. The authors present three cases of successful endoscopic laser recannulation of the larynx with esophageal replacement. The discussion includes surgical technique and the tools used to determine the success of the reconstruction, including computed tomographic scanning, modified barium swallow, placement of an upper esophageal anastomosis, psychologic support, and speech and swallowing therapy.

Fisioterapia respiratória em queimados / Respiratory physical therapy in burnt patients

Em uma enfermaria de queimados, freqüentemente se depara com pacientes que, além de uma queimadura cutânea, apresentam alteraçöes no aparelho respiratório. Feller e Hendrix em 1964, fizeram uma revisäo clínica e anátomo-patológica de sessenta pacientes que morreram após queimaduras, encontrando-se em 53% dos casos problemas respiratórios como causa primária. As complicaçöes pulmonares mais freqüentes, segundo Pruitt, em ordem decrescente säo: pneumonia, edema pulmonar, atelectasia, pneumotórax, embolia pulmonar e aspiraçäo

Burns of the hand. Thermal, chemical, and electrical.

The principles of emergency management of the burned hand include early estimate of the depth of injury; prevention of unnecessary post-burn sequelae, such as edema formation and joint stiffness; and measures to ensure prompt healing of the wound. A successful outcome requires correct splinting interspersed with early active motion, control of infection with frequent dressing changes, and early referral to a hand surgeon if the wound cannot be expected to heal by two weeks.

Long-term functional results of selective treatment of hand burns.

Four hundred seventy-eight patients with hand burns (786 hands) were treated at the burn service of the Massachusetts General Hospital. Long-term evaluation showed that early incision and immediate autografting of deep second degree, mixed second and third degree, and third degree full-thickness hand burns resulted in 93 percent, 95 percent, and 93 percent, respectively, excellent to good functional results. There was no significant differences in results in patients with superficial second degree burns treated nonsurgically with silver nitrate dressings and early physical therapy compared with results in patients with deep second degree, mixed second and third degree, and third degree hand burns treated with early excision and grafting. No patient with fourth degree burns had excellent to good results. Permanent damage was related to extent of original injury to the extensor tendons and joint capsules. On the basis of this broad experience, it is believed that all burned hands judged unlikely to heal within 3 weeks will benefit from early excision and grafting by experienced surgical personnel.

Chemical injuries of the eye.

This overview of the biochemical and pathophysiologic events after chemical burns of the eye is intended to act as a guide for appropriate therapy. Effective emergency measures must be instituted immediately followed by careful clinical evaluation to recognize and then treat problems at their inception. When and how to use the variety of drugs and devices is detailed. When these new methods and technology are applied successfully the clinical course may be improved and visual rehabilitation secured. The early results of conjunctival transplantation and hormonal therapy offer promise from experimental procedures. Exciting new treatments employing the foodstuffs ascorbate or citrate (orthomolecular therapy) are currently under investigation. The National Eye Institute sponsors our ongoing randomized clinical trial of these compounds in the treatment of the alkali burned eye. The outcome may change our thinking and our expectations after chemical burns of the eye.

Use of a multiple family group for crisis intervention.

This paper describes the ultilization of a multiple family group as a novel crisis intervention technique for the families of hospitalized burn patients following a tank car explosion. The technique combined a multiple family group with an information group model using a multidisciplinary team of liaison psychiatrist, chaplain, social worker, and psychiatric nurse consultant. A brief dicussion of the theoretical model and literature is included, as well as an assessment of the group process, the perspective of the different disciplines involved, and a follow-up report.

[Relationship between the epithelium and connective tissue at different stages of healing of chemical burns of the esophagus]. / O vzaimosviazi epiteliia i soedinitel'noi tkani na raznykh etapakh zazhivleniia khimicheskikh ozhogov pishchevoda

The interaction between the epithelial and connective-tissue structures was studied on 70 scarry changes in the oesophagus at various times (from 1 year to 45 years) following chemical burns. As sclerotic alterations progressed, proliferation of the layers of the stratified squamous epithelium decreased, which was particularly evident in the zones of strictures of the lumen of the damaged oesophagus. Exacerbation of inflammation due to repeated traumatization of the oesophagus wall was accompanied by proliferation of the epithelial layers. Only 25-30 years after the burns in the proliferative layers of the epithelium there were noted signs of atypia. The chronic inflammation was accompanied by marked lympho-plasmocytic infiltrations. This may indicate to concomitance of chronic oesophagitis with manifestations of autoimmune reactions.