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1.
Zhonghua Shao Shang Za Zhi ; 36(7): 534-539, 2020 Jul 20.
Artigo em Chinês | MEDLINE | ID: mdl-32842399

RESUMO

Objective: To preliminarily observe the clinical effects of vacuum sealing drainage (VSD) in the treatment of alkali burn wounds. Methods: From June 2016 to March 2020, 60 male patients with alkali burns who met the inclusion criteria and hospitalized in the Affiliated Hospital of Jiangnan University were recruited in this prospectively randomized control study. According to the random number table, silver sulfadiazine group and VSD group were both allocated with 30 patients, aged (36±8) and (35±10) years respectively; with total burn area of (7.2±2.0) % and (8.5±3.0) % total body surface area respectively. After admission, patients in silver sulfadiazine group were treated with conventional silver sulfadiazine dressing change once a day after debridement; patients in VSD group were given continuous VSD treatment after debridement, with the negative pressure setting at -10.67 kPa, and the negative pressure materials were replaced every 6 to 8 days. On treatment day 1, 4, and 7, the exudate from the wounds of patients in silver sulfadiazine group and the wound drainage fluid of patients in VSD group were collected, the pH value was measured by a portable pH meter, and the volume of exudate/drainage fluid was measured. After 7, 14, and 21 days of treatment, the wound healing rates of patients were calculated in the two groups. Before treatment and 7 days after treatment, venous blood was collected from the patients in the two groups to detect the serum level of tumor necrosis factor α (TNF-α) and interleukin 8 (IL-8). Within treatment day 14, Visual Analogue Scale was used to assess the pain score of patients in the two groups during each time of dressing change. The medical costs and discharge satisfaction scores of patients in the two groups were recorded. Data were statistically analyzed with analysis of variance for repeated measurement, t test, and Bonferroni correction. Results: (1) On treatment day 1, 4, and 7, the pH values of the drainage fluid of patients in VSD group were 9.75±0.59, 9.01±0.46, and 8.13±0.28, respectively, which were significantly higher than 9.35±0.62, 8.18±0.18, and 7.58±0.09 of exudate of patients in silver sulfadiazine group (t=2.03, 6.80, 7.56, P<0.05 or P<0.01). On treatment day 1 and 4, the volumes of drainage fluid of patients in VSD group were (553±83) and (239±65) mL respectively, which were significantly higher than (440±77) and (175±49) mL of exudate of patients in silver sulfadiazine group (t=3.44, 2.24, P<0.05). On treatment day 7, the volume of drainage fluid of patients in VSD group was (21±8) mL, which was significantly lower than (149±44) mL of exudate of patients in silver sulfadiazine group (t=-12.61, P<0.01). (2) After 7, 14, and 21 days of treatment, the wound healing rates of patients in VSD group were (39±6) %, (74±10) %, and (92±3) %, respectively, which were significantly higher than (25±3) %, (59±6) %, and (77±6) % in silver sulfadiazine group (t=7.07, 5.59, 7.09, P<0.01). (3) Before treatment, the serum levels of TNF-α and IL-8 of patients in the two groups were similar. After 7 days of treatment, the serum levels of TNF-α and IL-8 of patients in VSD group were significantly lower than those in silver sulfadiazine group (t=-8.75, -8.04, P<0.01). (4) The pain score during dressing change and medical cost of patients in VSD group were significantly lower than those in silver sulfadiazine group (t=-4.28, -7.56, P<0.01), while the discharge satisfaction score of patients in VSD group was significantly higher than that in silver sulfadiazine group (t=10.91, P<0.05). Conclusions: The application of VSD technology in clinical alkali burn wounds can effectively promote the removal of residual lye, alleviate the further damage of lye to skin tissue, shorten the wound healing time, effectively remove inflammatory mediators, reduce the pain of dressing change, decrease the total cost of treatment, and enhance satisfaction of patient.


Assuntos
Queimaduras Químicas , Tratamento de Ferimentos com Pressão Negativa , Adulto , Álcalis , Queimaduras Químicas/terapia , Drenagem , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
3.
Toxicol Lett ; 320: 73-79, 2020 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-31811912

RESUMO

INTRODUCTION: Choking agent exposure, among them chlorine gas, occurs in household or industrial accidents, chemical warfare and terrorist attacks. AIMS: Review of published animal and human data regarding the history, pathophysiology, clinical effects and management of chlorine exposure. PATHOPHYSIOLOGY: Highly soluble agents cause quick upper respiratory tract symptoms. Chlorine gas has a medium solubility, also causing delayed lower airway symptoms, mainly due to its oxidizing potential by releasing hypochlorous and hydrochloric acid, but also by interacting with Transient Receptor Potential channels. SYMPTOMS: Eyes may show conjunctival injection, abrasions and corrosions. Burns of the oronasal mucosa and trachea can occur. Dyspnea, bronchospasm and possible retrosternal pain occur frequently. Glottis edema or laryngospasm are acute life-threatening emergencies. Chlorine gas can cause toxic pneumonitis, lung edema and acute respiratory distress syndrome (ARDS). MANAGEMENT: General management includes physical examination, pulse oximetry and arterial blood gases. Eyes should be irrigated, humidified oxygen and inhalative bronchodilators administered. An EKG, cardiac enzymes and complete-blood-count should be obtained if there is retrosternal pain. Routine chest x-ray is not recommended - except if pulmonary edema is suspected. Laryngoscopy should be performed if glottis edema is suspected. Sodium bicarbonate inhalation after chlorine gas inhalation is discussed controversially. Mechanical ventilation with continuous-positive-airway-pressure or intubation/tracheotomy with high positive-end-expiratory-pressure may be necessary. Glucocorticoids for prevention of pulmonary edema should be applied restrictively. Prophylactic antibiotics are not recommended. In severe ARDS, extracorporeal membrane oxygenation (ECMO) can be considered. CONCLUSION: Treatment is mainly symptom oriented. New and promising therapies are in development.


Assuntos
Acidentes Domésticos , Acidentes de Trabalho , Queimaduras Químicas/terapia , Substâncias para a Guerra Química/envenenamento , Cloro/envenenamento , Queimaduras Oculares/terapia , Doenças Respiratórias/terapia , Animais , Queimaduras Químicas/etiologia , Queimaduras Químicas/história , Queimaduras Químicas/fisiopatologia , Substâncias para a Guerra Química/história , Cloro/história , Queimaduras Oculares/induzido quimicamente , Queimaduras Oculares/história , Queimaduras Oculares/fisiopatologia , História do Século XX , História do Século XXI , Humanos , Exposição por Inalação/efeitos adversos , Exposição Ocupacional/efeitos adversos , Prognóstico , Doenças Respiratórias/induzido quimicamente , Doenças Respiratórias/história , Doenças Respiratórias/fisiopatologia , Medição de Risco
4.
Anesth Analg ; 130(3): 665-672, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-30829672

RESUMO

Button battery ingestions result in significant morbidity and mortality in children-before, during, and even after removal. The injuries created by a button battery lodged in the esophagus develop rapidly and can be severe. The current of the button battery, conducted through saliva and the tissue drives a highly alkaline caustic injury, leading to liquefactive tissue necrosis. In June 2018, new guidelines were released from the National Capital Poison Center, which include the use of preoperative protective, pH-neutralizing and viscous barrier interventions with honey and/or sucralfate administered within 12 h of ingestion. In addition, the use of postremoval irrigation of the esophagus with 50-150 mL 0.25% acetic acid is done in the operating room to help neutralize the site of tissue injury. Given that anesthesiologists play an important role in the management of esophageal foreign body removal, the entire specialty needs to be aware of the supporting data behind this and general perioperative considerations for management and potential complications of button battery ingestion.


Assuntos
Anestesiologia/normas , Queimaduras Químicas/terapia , Fontes de Energia Elétrica , Esôfago/lesões , Corpos Estranhos/terapia , Guias de Prática Clínica como Assunto/normas , Ácido Acético/administração & dosagem , Adolescente , Fatores Etários , Queimaduras Químicas/etiologia , Queimaduras Químicas/patologia , Criança , Pré-Escolar , Consenso , Procedimentos Clínicos , Técnicas de Apoio para a Decisão , Esôfago/patologia , Corpos Estranhos/complicações , Corpos Estranhos/patologia , Mel , Humanos , Lactente , Necrose , Fatores de Risco , Sucralfato/administração & dosagem , Irrigação Terapêutica , Resultado do Tratamento
5.
Emerg Nurse ; 27(4): 17-19, 2019 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-31468846

RESUMO

This article describes the case of a 33-year-old man with cerebral palsy who sustained a full-thickness burn to his thorax as a result of lying in gastric acid that had leaked from a damaged percutaneous endoscopic gastrostomy feeding tube. The patient required referral to a tertiary burns centre for specialist management. The article highlights the potential harm caused by gastric acid and why some patients may be particularly vulnerable to such injuries.


Assuntos
Queimaduras Químicas/etiologia , Gastrostomia/efeitos adversos , Traumatismos Torácicos/induzido quimicamente , Adulto , Queimaduras Químicas/terapia , Paralisia Cerebral , Falha de Equipamento , Humanos , Masculino , Traumatismos Torácicos/terapia
6.
Cutis ; 103(6): 346-350, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31348449

RESUMO

Chemical burns to the eyes are one of the few ocular emergencies that dermatologists may encounter in their everyday clinic. As such, dermatologists should be confident in their ability to urgently manage ocular chemical injuries should accidental exposure occur during a procedure. We report a case of accidental ocular exposure to aluminum chloride hexahydrate during skin biopsy of the cheek and subsequent transient ocular injury that resolved with early appropriate management. This article provides background information on acute chemical ocular injuries, offers practical step-by-step guidance for the dermatologist, and highlights immediate copious irrigation as perhaps the most critical step in determining the clinical course of the injury.


Assuntos
Cloreto de Alumínio/efeitos adversos , Queimaduras Químicas/terapia , Queimaduras Oculares/terapia , Irrigação Terapêutica/métodos , Cloreto de Alumínio/administração & dosagem , Queimaduras Químicas/etiologia , Dermatologia/métodos , Emergências , Queimaduras Oculares/induzido quimicamente , Feminino , Humanos , Pessoa de Meia-Idade
8.
Graefes Arch Clin Exp Ophthalmol ; 257(8): 1795-1803, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31147840

RESUMO

PURPOSE: There is currently uncertainty about the most efficacious decontamination solution for corrosive chemical eye burns. This 30-year longitudinal study evaluated the relative efficacy of two different decontamination methods. Passive decontamination consists of rinsing with tap water, 0.9% normal saline, isotonic buffered phosphate solution, or Ringer's lactate. Active decontamination adds an amphoteric, polyvalent, and chelating component with Previn® (Diphoterine®) solution (Laboratoire Prevor, Valmondois, France). METHODS: A prospective evaluation of patients treated in two specialized eye clinics for eye burns was begun in 1988. Recorded data included exposure circumstances, type of corrosive, different types of first therapy, and clinical treatment and outcome. Patients were treated from clinic admission and up to 24 h after the corrosive chemical burn with rinsing for 15 min using two different protocols. From 1988 to 2005, sterile 0.9% normal saline or Ringer's lactate was used. Since 2006, sterile, hypertonic, amphoteric Previn® solution was used. Comparative statistical analysis was done with the Fisher contingency tables and Wilcoxon tests. RESULTS: There were a total of 1495 patients with 2194 chemically burned eyes. In 1988-2005, the annual incidence was 66.1/year; in 2006-2017, it was 65.5/year. Similar incidences were noted when initial rinsing was with tap water or isotonic buffered phosphate solutions. There was a significantly more severe outcome of corrosive chemical eye burns with any first aid rinsing solutions other than Previn® solution or tap water was used (p < 0.001). Previn® solution or tap water rinsing in the pre-hospital setting and secondary rinsing with Previn® solution in the hospital decreased lesion severity in comparison with all other rinsing solutions (p < 0.001). CONCLUSION: The frequency of corrosive chemical eye burns was comparatively high despite tightening of occupational health and safety regulations over the past 30 years. The severity of corrosive chemical eye burns has been dramatically decreased since the introduction of Previn® solution for initial and secondary rinsing. A new protocol for immediate Previn® solution use by the Cologne Fire Brigade and secondary Previn® solution rinsing in hospital has reduced the frequency of severe corrosive chemical eye burns to less than 60% as compared to the period of 1988-2005 when other rinsing solutions were utilized.


Assuntos
Queimaduras Químicas/terapia , Descontaminação/métodos , Queimaduras Oculares/terapia , Primeiros Socorros/métodos , Previsões , Acuidade Visual , Adolescente , Adulto , Idoso , Queimaduras Químicas/diagnóstico , Queimaduras Químicas/epidemiologia , Criança , Pré-Escolar , Queimaduras Oculares/diagnóstico , Queimaduras Oculares/epidemiologia , Feminino , Seguimentos , Alemanha/epidemiologia , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Índices de Gravidade do Trauma , Resultado do Tratamento , Adulto Jovem
9.
Rev Gastroenterol Peru ; 39(1): 7-11, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31042231

RESUMO

BACKGROUND: Esophageal stricture is one of the most important complication of the caustic ingestion. OBJECTIVE: The aim of this study was to evaluate complications of balloon dilatation among children with esophageal stenosis. MATERIAL AND METHODS: In this retrospective study 82 children were included. Children who underwent balloon dilatation for esophageal stenosis were included in our study. Duration of study was 14 year starting from 2001. Mean age of the cases was 3.95±0.4 year (Min: 15 days, Max: 14 year). Chart review and telephone calling were the methods of data collection. Data was analyzed using SPSS. RESULTS: In this study, 47% of the patients were male and 53% of the cases were female. Caustic ingestion (33.7%) was the most common etiology for the esophageal stricture. Vomiting (87.8%) was the most common presenting symptom. Among our cases, 76.8% had no compliant after esophageal dilatation. Chest pain was the most common compliant after esophageal dilatation. Response rate was similar among boys and girls. Toddler age had the best treatment response after esophageal dilatation. CONCLUSION: Among our cases, 76.8% had no post procedural compliant after esophageal dilatation. Esophageal perforation was seen in 4.9% of the cases. Chest pain was the most common post dilatation complication.


Assuntos
Dor no Peito/etiologia , Dilatação/efeitos adversos , Perfuração Esofágica/etiologia , Estenose Esofágica/terapia , Esofagoscopia/efeitos adversos , Queimaduras Químicas/terapia , Criança , Pré-Escolar , Acalasia Esofágica/complicações , Estenose Esofágica/induzido quimicamente , Estenose Esofágica/congênito , Feminino , Humanos , Lactente , Recém-Nascido , Irã (Geográfico) , Masculino , Estudos Retrospectivos , Centros de Atenção Terciária/estatística & dados numéricos , Vômito/etiologia
12.
Laryngoscope ; 129(8): 1772-1776, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30835848

RESUMO

OBJECTIVES/HYPOTHESIS: Pediatric esophageal button battery (BB) injuries can progress even after removal and continue to be a significant source of morbidity and mortality. The objective in this case series is to present initial safety data for the human application of intraoperative tissue pH neutralization using 0.25% acetic acid irrigation after BB removal. STUDY DESIGN: Retrospective case series. METHODS: Pediatric patients who underwent rigid esophagoscopy for BB removal between October 2016 and December 2017 and who had the injury site irrigated with 120 to 150 mL sterile 0.25% acetic acid (pH = 3) were included in the study. Outcome measures included visual tissue appearance after irrigation, immediate or delayed esophageal perforation, and evidence of eventual esophageal stricture formation. RESULTS: Six pediatric patients (aged 19 months-10 years) had a 3 V lithium BB lodged in the esophagus for 2 to 18 hours and had irrigation of the esophageal injury site with sterile 0.25% acetic acid in the operating room after BB removal. None of the patients showed any evidence of thermal tissue injury. By surgeon assessment, all cases had improved visual esophageal tissue appearance. Neither immediate post-operative or delayed onset esophageal perforation nor eventual stricture development were seen. CONCLUSIONS: Esophageal irrigation in the operating room with sterile 0.25% acetic acid after BB removal, to neutralize the highly alkaline tissue microenvironment (pH 10-13) was safe and resulted in improved visual mucosal appearance. This immediate tissue pH neutralization may help halt the progression of liquefactive necrosis by immediately bringing tissue pH to physiologic range. This post-removal irrigation technique is recommended by current National Capital Poison Center BB guidelines. LEVEL OF EVIDENCE: 4 Laryngoscope, 129:1772-1776, 2019.


Assuntos
Queimaduras Químicas/terapia , Fontes de Energia Elétrica/efeitos adversos , Esôfago/lesões , Corpos Estranhos/terapia , Irrigação Terapêutica/métodos , Queimaduras Químicas/etiologia , Criança , Pré-Escolar , Perfuração Esofágica/etiologia , Perfuração Esofágica/terapia , Estenose Esofágica/etiologia , Estenose Esofágica/terapia , Esofagoscopia , Esôfago/cirurgia , Feminino , Corpos Estranhos/complicações , Humanos , Concentração de Íons de Hidrogênio , Lactente , Lítio , Masculino , Radioisótopos , Estudos Retrospectivos , Resultado do Tratamento
13.
Exp Eye Res ; 184: 64-71, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30898556

RESUMO

Neovascularization during ocular tissue repair can cause severe visual loss in the optical axis and is therefore an issue of considerable concern to ophthalmologists. Here, we introduced a cholesterol-modified siRNA delivery system targeting stromal cell-derived factor 1 (SDF-1) to treat ocular angiogenesis in vivo. SDF-1 expression was analyzed in rat endothelial progenitor cells (EPCs) and bone marrow mesenchymal stem cells (BMSCs) using quantitative PCR (qPCR). Migration ability of BMSC and HUVEC were assessed through transwell assay. The proliferation effect of chol-siSDF1 on HUVEC was measured by colony formation assay. In vivo anti-angiogenic effects of chol-siSDF1 were tested in a cornea alkali burn model and the area of cornea neovascularization was measured using computer-imaging analysis system. Then phosphorylated Akt and total Akt protein levels were measured through western blot. Results turned out that rat EPCs and BMSCs showed high SDF-1 mRNA expression, which can be down-regulated by using chol-siSDF-1. Chol-siSDF-1 could significantly inhibit migration of BMSC and HUVEC. In addition, chol-siSDF1 also could inhibit HUVEC proliferation and exert a significant anti-angiogenic effect in corneal alkali burn model. As for the mechanism, chol-siSDF1 may inhibit the neovascularization, proliferation and metastasis through inhibiting the Akt signaling pathway. Thus, cholesterol modification of siRNA targeting SDF-1 displays an effective inhibition of migration and angiogenesis, with a much longer duration of inhibition effect.


Assuntos
Queimaduras Químicas/terapia , Quimiocina CXCL12/genética , Colesterol/química , Neovascularização da Córnea/terapia , Queimaduras Oculares/induzido quimicamente , Proteínas Proto-Oncogênicas c-akt/antagonistas & inibidores , RNA Interferente Pequeno/uso terapêutico , Inibidores da Angiogênese , Animais , Western Blotting , Movimento Celular/fisiologia , Células Cultivadas , Neovascularização da Córnea/metabolismo , Células Progenitoras Endoteliais/metabolismo , Ensaio de Imunoadsorção Enzimática , Técnicas de Silenciamento de Genes , Células Endoteliais da Veia Umbilical Humana/citologia , Humanos , Masculino , Células-Tronco Mesenquimais/metabolismo , Fosforilação , Ratos , Ratos Sprague-Dawley , Reação em Cadeia da Polimerase em Tempo Real , Hidróxido de Sódio
14.
Cutan Ocul Toxicol ; 38(4): 315-321, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30741024

RESUMO

Purpose: To compare the therapeutic effects of human derivatives in a mouse alkali burn model. Methods: The right eyes of mice were injured using NaOH. After alkali injury, one of the following agents was topically administered for 7 d: human amniotic membrane (hAM) suspension, human umbilical cord serum (hUCS), and human peripheral blood serum (hPBS), or saline. The epithelial defect areas on days 1, 2, and 3 degrees of opacity on days 2, 3, and 7, and corneal neovascularization (NV) areas on day 7 were evaluated. Histologic examination and mRNA expression levels of tumour necrosis factor (TNF)-α, interleukin (IL)-6, vascular endothelial growth factor (VEGF), matrix metalloproteinase (MMP)-2, MMP-8, and MMP-9 were also evaluated on day 7. Results: The epithelial defect areas in the hUCS group were smaller than those in the control and hPBS groups on day 3 (p < .05, respectively). The epithelial defect areas in the hAM suspension group showed smaller than those in the control and hPBS groups on days 1 and 2 (p < .05, respectively). The degrees of opacity were lower in all treatment groups than that of the saline control group on day 7 (p < .05, respectively). Corneal NV areas were not different among groups on day 7 (p = 0.20). The expression levels of TNF-α, IL-6, MMP-8, and MMP-9 mRNA and the infiltration of the inflammatory cells in all treatment groups were lesser than those in the control group on day 7 (p< .05, respectively). Conclusions: All treatments reduced inflammatory reactions and corneal opacity development. Corneal reepithelialization was faster in the hUCS group.


Assuntos
Âmnio , Queimaduras Químicas/terapia , Neovascularização da Córnea/terapia , Opacidade da Córnea/terapia , Queimaduras Oculares/terapia , Soro , Hidróxido de Sódio/toxicidade , Animais , Queimaduras Químicas/patologia , Córnea/efeitos dos fármacos , Córnea/patologia , Neovascularização da Córnea/patologia , Opacidade da Córnea/patologia , Queimaduras Oculares/induzido quimicamente , Queimaduras Oculares/patologia , Humanos , Masculino , Camundongos Endogâmicos BALB C
15.
Invest Ophthalmol Vis Sci ; 60(1): 245-254, 2019 01 02.
Artigo em Inglês | MEDLINE | ID: mdl-30646013

RESUMO

Purpose: Pathologic corneal neovascularization is a major cause of blindness worldwide, and treatment options are currently limited. VEGF is one of the critical mediators of corneal neovascularization but current anti-VEGF therapies have produced limited results in the cornea. Thus, additional therapeutic agents are needed to enhance the antiangiogenic arsenal. Our group previously demonstrated epithelial membrane protein-2 (EMP2) involvement in pathologic angiogenesis in multiple cancer models including breast cancer and glioblastoma. In this paper, we investigate the efficacy of anti-EMP2 immunotherapy in the prevention of corneal neovascularization. Methods: An in vivo murine cornea alkali burn model was used to study pathologic neovascularization. A unilateral corneal burn was induced using NaOH, and subconjunctival injection of either anti-EMP2 antibody, control antibody, or sterile saline was performed after corneal burn. Neovascularization was clinically scored at 7 days postalkali burn, and eyes were enucleated for histologic analysis and immunostaining including VEGF, CD31, and CD34 expression. Results: Anti-EMP2 antibody, compared to control antibody or vehicle, significantly reduced neovascularization as measured by clinical score and central cornea thickness, as well as by histologic reduction of neovascularization, decreased CD34 staining, and decreased CD31 staining. Incubation of corneal limbal cells in vitro with anti-EMP2 blocking antibody significantly decreased EMP2 expression, VEGF expression and secretion, and cell migration. Conclusions: This work demonstrates the effectiveness of EMP2 as a novel target in pathologic corneal neovascularization in an animal model and supports additional investigation into EMP2 antibody blockade as a potential new therapeutic option.


Assuntos
Anticorpos Bloqueadores/uso terapêutico , Neovascularização da Córnea/terapia , Modelos Animais de Doenças , Imunoterapia , Glicoproteínas de Membrana/imunologia , Animais , Antígenos CD34/metabolismo , Western Blotting , Queimaduras Químicas/etiologia , Queimaduras Químicas/metabolismo , Queimaduras Químicas/terapia , Movimento Celular , Células Cultivadas , Neovascularização da Córnea/etiologia , Neovascularização da Córnea/metabolismo , Ensaio de Imunoadsorção Enzimática , Células Epiteliais/metabolismo , Queimaduras Oculares/induzido quimicamente , Feminino , Células Endoteliais da Veia Umbilical Humana , Humanos , Limbo da Córnea/citologia , Glicoproteínas de Membrana/metabolismo , Camundongos , Camundongos Endogâmicos BALB C , Molécula-1 de Adesão Celular Endotelial a Plaquetas/metabolismo , Hidróxido de Sódio , Fator A de Crescimento do Endotélio Vascular/metabolismo
16.
Burns ; 45(4): 763-771, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30442380

RESUMO

INTRODUCTION: Electronic cigarettes (EC) have been reported to be associated with burns secondary to explosions of the device or battery, or contact from overheating, resulting in flame, contact or chemical burns. In addition to this, there have also been reported cases of soft tissue and bony trauma with or without associated burns. Using collective evidence, this review aims to summarise all reported burns associated with ECs, and its implications on immediate management with a particular focus on surgical treatment. METHODS: A search was conducted on PubMed, EMBASE and Medline for all case reports, case series and letters to editors published since 2014, using terms "electronic cigarette", "e-cigarette", "vaping" and "burn". The search was repeated by the co-author to avoid bias and a review of the bibliographies of each paper was conducted to ensure all relevant cases were included. The mechanisms, type and severity of burn injury, and management and treatment outcomes of the patients were recorded. Exclusion criteria included non-English articles, explosions with no associated burn and publications with insufficient information. RESULTS: 90 patients from 19 case series or case reports were included. With the exception of one study, gender was recorded with a male predominance (95.6%). Mean age is 30.1years (range 18-59). The most common type of burn was flame. However, there were reports of chemical burns associated with ECs. The mean total body surface area (TBSA) affected was 4.9% (range 1-27.25%) with the majority of burns being mixed partial and full thickness. 22 patients underwent excision and autologous skin grafting within range of three to 21days. One patient had a full thickness contact burn excised and closed, one patient received a xenograft following debridement and one had biosynthetic skin dressing. 42 patients were managed conservatively with dressings or ointments. DISCUSSION: In this review over a three-year period (2015-2017), 90 cases of EC related burn injuries were reported, however, this is likely an underestimation of the problem. The suggested mechanism for EC related injuries is battery malfunction. ECs are powered by Lithium ion batteries which are susceptible to "thermal runaway" reactions, which result in device overheating with potential for subsequent explosion. We explain hypothesized triggers for these reactions and mechanisms of other injuries associated with ECs such as chemical burns and blast injury. CONCLUSION: EC-associated burn injury results in combined thermal and chemical burns, which should be managed in tandem. Explosion injuries sustained whilst using the device may result in both facial trauma or inhalation injury and therefore should be reviewed with a high index of clinical suspicion. It is noted that there is no agreed standard for management for such burns by specialist bodies in the UK. We suggested a treatment algorithm to provide guidance for the burn injuries associated with ECs.


Assuntos
Queimaduras/terapia , Fontes de Energia Elétrica/efeitos adversos , Sistemas Eletrônicos de Liberação de Nicotina , Traumatismos Faciais/terapia , Guias de Prática Clínica como Assunto , Algoritmos , Traumatismos por Explosões/etiologia , Traumatismos por Explosões/terapia , Queimaduras/etiologia , Queimaduras Químicas/etiologia , Queimaduras Químicas/terapia , Queimaduras por Inalação/etiologia , Queimaduras por Inalação/terapia , Gerenciamento Clínico , Traumatismos Faciais/etiologia , Humanos , Concentração de Íons de Hidrogênio
18.
J Burn Care Res ; 40(1): 133-135, 2019 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-29931078

RESUMO

Over the years, many cultures have used herbs for serious health problems. Garlic (Allium sativum) pose hypocholesterolemic, fibrinolytic, antidiabetic, and antibiotic actions. However, it has unusual adverse effects such as chemical burns and contact dermatitis when used topically. In this case report, the authors present two cases of topical garlic burn caused after the use of crushed garlic with a bandage for pain relief due to arthritis.


Assuntos
Lesões nas Costas/induzido quimicamente , Queimaduras Químicas/etiologia , Alho/efeitos adversos , Traumatismos do Joelho/induzido quimicamente , Medicina Tradicional/efeitos adversos , Manejo da Dor/efeitos adversos , Lesões nas Costas/terapia , Queimaduras Químicas/terapia , Feminino , Humanos , Traumatismos do Joelho/terapia , Masculino , Pessoa de Meia-Idade
19.
Laryngoscope ; 129(1): 49-57, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-29889306

RESUMO

OBJECTIVES/HYPOTHESIS: Ingestion of button batteries (BB) can rapidly lead to caustic esophageal injury in infants and children, resulting in significant morbidity and mortality. To identify novel mitigation strategies, we tested common weakly acidic household beverages, viscous liquids, and Carafate® for their ability to act as protective esophageal irrigations until endoscopic removal of the BB. STUDY DESIGN: Cadaveric and live animal model. METHODS: Apple juice, orange juice, Gatorade®, POWERADE®, pure honey, pure maple syrup, and Carafate® were screened using a 3 V lithium (3 V-CR2032) BB on cadaveric porcine esophagus. The most promising in vitro options were tested against a saline control in live American Yorkshire piglets with anode-facing placement of the BB on the posterior wall of the proximal esophagus for 60 minutes. BB voltage and tissue pH were measured before battery placement and after removal. The 10 mL irrigations occurred every 10 minutes from t = 5 minutes. Gross and histologic assessment was performed on the esophagus of piglets euthanized 7 ± 0.5 days following BB exposure. RESULTS: Honey and Carafate® demonstrated to a significant degree the most protective effects in vitro and in vivo. Both neutralized the tissue pH increase and created more localized and superficial injuries; observed in vivo was a decrease in both full-thickness injury (i.e., shallower depths of necrotic and granulation tissue) and outward extension of injury in the deep muscle beyond surface ulcer margins (P < .05). CONCLUSIONS: In the crucial period between BB ingestion and endoscopic removal, early and frequent ingestion of honey in the household setting and Carafate® in the clinical setting has the potential to reduce injury severity and improve patient outcomes. LEVEL OF EVIDENCE: NA Laryngoscope, 129:49-57, 2019.


Assuntos
Queimaduras Químicas/terapia , Fontes de Energia Elétrica/efeitos adversos , Esôfago/lesões , Corpos Estranhos/terapia , Irrigação Terapêutica/métodos , Animais , Queimaduras Químicas/etiologia , Cadáver , Modelos Animais de Doenças , Esôfago/química , Corpos Estranhos/etiologia , Humanos , Concentração de Íons de Hidrogênio , Suínos
20.
Am J Ophthalmol ; 199: 209-215, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30419194

RESUMO

PURPOSE: To compare the outcomes of conventional medical treatment vs combined medical treatment and amniotic membrane transplantation (AMT) in the management of patients with Roper-Hall grade IV ocular chemical injury. DESIGN: Randomized, parallel-controlled clinical trial. METHODS: Setting: Single tertiary referral hospital. PATIENTS: Sixty eyes of 60 patients with Roper-Hall grade IV ocular chemical injury with a minimum follow-up of 12 months were enrolled in the study. INTERVENTION: Patients were randomly assigned to 2 groups: Group 1 (30 eyes) received topical preservative-free lubricating gel and drops, chloramphenicol, betamethasone, homatropine, oral vitamin C, and doxycycline; Group 2 (30 eyes) received amniotic membrane transplant (AMT) on the entire ocular surface in addition to the medical treatment provided in Group 1. OUTCOME MEASURES: The main outcome measure was time to complete corneal epithelialization. Secondary outcome measures were best-corrected visual acuity (BCVA) and neovascularization in the central 5 mm of the cornea. RESULTS: Mean follow-up time was 20.3 ± 2.5 months (range 13-24 months). Corneal epithelial defects healed within 72.6 ± 30.4 (21-180) days in Group 1 vs 75.8 ± 29.8 (46-170) days in Group 2 (P = .610). Mean BCVA was 2.06 ± 0.67 (0.4-2.6) logMAR vs 2.06 ± 0.57 (1-2.9) logMAR in Groups 1 and 2, respectively (P = .85). Group 1 developed more central corneal neovascularization (22 eyes; 73.3%) compared to Group 2 (16 eyes; 53.3%); however, it was not statistically significant (P = .108). CONCLUSIONS: In comparison to conventional medical therapy, combined amniotic membrane transplantation and medical therapy does not accelerate corneal epithelialization or affect final visual acuity in severe chemical injuries.


Assuntos
Âmnio/transplante , Queimaduras Químicas/terapia , Doenças da Córnea/terapia , Queimaduras Oculares/induzido quimicamente , Administração Oftálmica , Adolescente , Adulto , Antibacterianos/uso terapêutico , Ácido Ascórbico/administração & dosagem , Queimaduras Químicas/tratamento farmacológico , Queimaduras Químicas/fisiopatologia , Queimaduras Químicas/cirurgia , Criança , Doenças da Córnea/tratamento farmacológico , Doenças da Córnea/fisiopatologia , Doenças da Córnea/cirurgia , Epitélio Anterior/fisiologia , Queimaduras Oculares/fisiopatologia , Queimaduras Oculares/terapia , Feminino , Glucocorticoides/uso terapêutico , Humanos , Lubrificantes Oftálmicos/administração & dosagem , Masculino , Pessoa de Meia-Idade , Soluções Oftálmicas , Estudos Prospectivos , Reepitelização/fisiologia , Acuidade Visual/fisiologia , Cicatrização/fisiologia , Adulto Jovem
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