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1.
Khirurgiia (Mosk) ; (8): 17-22, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32869610

RESUMO

OBJECTIVE: To evaluate the effectiveness of surgical treatment of post-burn defects of face and cranial vault. MATERIAL AND METHODS: There were 65 patients with post-burn defects of face and cranial vault. Mean age of patients was 38.5 years (min 17 years, max 67 years). Soft tissue reconstruction was performed by using of local tissues, combined plasty, balloon dermotension aand free flaps on microvascular anastomoses. Osteoectomy and sequestrectomy were carried out if it was necessary. Implants were used to eliminate through skull defects. RESULTS: Balloon dermotension with expanders and plasty with local tissues ensure skull reconstruction in the vast majority of patients. Through bone defects required reconstruction of the cranial vault with various implants. CONCLUSION: The proposed surgical approach ensures correction of severe functional and cosmetic disorders caused by post-burn skull defects, elimination of bone damage, restoration of normal skin of the face and cranial vault.


Assuntos
Queimaduras/cirurgia , Traumatismos Craniocerebrais/cirurgia , Face/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Crânio/cirurgia , Adolescente , Adulto , Idoso , Queimaduras/complicações , Traumatismos Craniocerebrais/etiologia , Traumatismos Faciais/etiologia , Traumatismos Faciais/cirurgia , Retalhos de Tecido Biológico , Humanos , Microcirurgia , Pessoa de Meia-Idade , Implantação de Prótese , Estudos Retrospectivos , Crânio/lesões , Lesões dos Tecidos Moles/etiologia , Lesões dos Tecidos Moles/cirurgia , Expansão de Tecido , Ferimentos e Lesões/etiologia , Ferimentos e Lesões/cirurgia , Adulto Jovem
2.
Plast Reconstr Surg ; 146(3): 331e-338e, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32842115

RESUMO

BACKGROUND: Each year, millions of individuals develop scars secondary to surgery, trauma, and/or burns. Scar-specific patient-reported outcome measures to evaluate outcomes are needed. To address the gap in available measures, the SCAR-Q was developed following international guidelines for patient-reported outcome measure development. This study field tested the SCAR-Q and examined its psychometric properties. METHODS: Patients aged 8 years and older with a surgical, traumatic, and/or burn scar anywhere on their face or body were recruited between March of 2017 and April of 2018 at seven hospitals in four countries. Participants answered demographic and scar questions, the Fitzpatrick Skin Typing Questionnaire, the Patient and Observer Scar Assessment Scale (POSAS), and the SCAR-Q. Rasch measurement theory was used for the psychometric analysis. Cronbach's alpha, test-retest reliability, and concurrent validity were also examined. RESULTS: Consent was obtained from 773 patients, and 731 completed the study. Participants were aged 8 to 88 years, and 354 had surgical, 184 had burn, and 199 had traumatic scars. Analysis led to refinement of the SCAR-Q Appearance, Symptoms, and Psychosocial Impact scales. Reliability was high, with person separation index values of 0.91, 0.81, and 0.79; Cronbach alpha values of 0.96, 0.91, and 0.95; and intraclass correlation coefficient values of 0.92, 0.94, and 0.88, respectively. As predicted, correlations between POSAS scores and the Appearance and Symptom scales were higher than those between POSAS and Psychosocial Impact scale scores. CONCLUSIONS: With increasing scar revisions, a scar-specific patient-reported outcome measure is needed to measure outcomes that matter to patients from their perspective. The SCAR-Q represents a rigorously developed, internationally applicable patient-reported outcome measure that can be used to evaluate scars in research, clinical care, and quality improvement initiatives.


Assuntos
Cicatriz , Medidas de Resultados Relatados pelo Paciente , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Queimaduras/complicações , Canadá , Criança , Chile , Cicatriz/diagnóstico , Cicatriz/etiologia , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nova Zelândia , Complicações Pós-Operatórias/diagnóstico , Psicometria , Autorrelato , Pele/lesões , Estados Unidos , Adulto Jovem
3.
Zhonghua Shao Shang Za Zhi ; 36(7): 615-619, 2020 Jul 20.
Artigo em Chinês | MEDLINE | ID: mdl-32842415

RESUMO

Hyperpigmentation and hypopigmentation are complications commonly seen in burn patients after wound healing, which may have seriously adverse impact on the appearances of the patients. The change of skin color in the exposed areas such as the face and hands may cause great psychological burden on the patients. While the occurrence and development mechanisms of hyperpigmentation and hypopigmentation post burns are unclear, it is generally believed to be associated with excess or deficiency of melanin content in the epidermis. Therefore, the therapeutic strategies of hyperpigmentation or hypopigmentation are as follows: the former focuses on inhibiting the synthesis of melanin and reducing the content of melanin in the skin, while the latter can restore the normal skin color by improving the function of melanocytes to promote the synthesis of melanin. In recent years, the therapeutic technologies for abnormal melanin metabolism after burns have developed rapidly. In this paper, treatment strategies commonly used in clinical practice are summarized in terms of photoelectric therapies, drugs, and operations, aiming to provide references for the treatment of patients who suffer abnormal pigmentation after burns.


Assuntos
Queimaduras/complicações , Hiperpigmentação , Hipopigmentação , Humanos , Hiperpigmentação/etiologia , Hipopigmentação/etiologia , Melanócitos , Pele , Pigmentação da Pele
4.
Saudi Med J ; 41(7): 726-732, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32601641

RESUMO

OBJECTIVES: To first describe the epidemiological data of burns, including burn types and burn-related infections, in adult and pediatric patients. Second, to determine the effect of Methicillin-Resistant Staphylococcus aureus (MRSA) on length of hospital stay and, third, to determine if the microbiological profile differs in patients with severe and non-severe burns. Methods: This is a retrospective chart review in which medical records of all burn patients admitted to Al-Noor Specialist Hospital, Makkah, Kingdom of Saudi Arabia between January 2016 and January 2017 were reviewed for demographic, microbiological, and burn data using a data-collection sheet. No randomization was necessary as all patients were included. Descriptive and inferential statistics were performed on the collected data. Results: Of 250 patients, 53.6% were pediatric patients and 68.4% were male patients. The most common organism in blood and wound cultures of minor burns was Staphylococcus aureus. Methicillin-resistant Staphylococcus aureus (MRSA) frequency was 82.5%. Length of stay increased in patients with infected burn injuries. Conclusion: The pediatric population had a high frequency of burn injuries, representing an incentive for more focused educational prevention programs in that group. Additionally, burn infections carry significant morbidity, and are associated with longer hospital stay. These data can help implement various prevention programs.


Assuntos
Unidades de Queimados/estatística & dados numéricos , Queimaduras/epidemiologia , Infecção dos Ferimentos/epidemiologia , Infecção dos Ferimentos/etiologia , Adolescente , Queimaduras/complicações , Queimaduras/prevenção & controle , Feminino , Humanos , Tempo de Internação , Masculino , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Morbidade , Educação de Pacientes como Assunto , Estudos Retrospectivos , Arábia Saudita/epidemiologia , Staphylococcus aureus/isolamento & purificação , Infecção dos Ferimentos/microbiologia , Adulto Jovem
5.
Zhonghua Shao Shang Za Zhi ; 36(6): 503-505, 2020 Jun 20.
Artigo em Chinês | MEDLINE | ID: mdl-32594713

RESUMO

In February 2018, one 54-year-old male patient with severe scald complicated with pneumonia and sepsis was transferred to Qingdao Municipal Hospital from other hospital. Drugs including cephalosporin, vancomycin, and imipenem/cilastatin combined with ciprofloxacin were used successively for anti-infective treatment, with no obvious effect. Multiple bacterial culture results of sputum, blood, and wound exudate showed infection of extensively drug resistant Pseudomonas aeruginosa. On the 4th day of admission, the anti-infective treatment plan was adjusted, and plasma, red blood cell, and albumin were supplemented and nutritional support and symptomatic treatment were performed. At the same time, medication and drug-related adverse reaction were monitored. After treatment for more than 10 days, infection of the patient was effectively controlled and the condition gradually improved. The case suggests that severely burned patients are prone to have serious and fatal systemic infection, irregular use of antibiotics increases the risk of infection of extensively drug resistant bacteria, clear anti-infection idea and effective application of antibacterial drug can help to improve the success rate of infection treatment and are of important value in improving the prognosis of patients with severe burn.


Assuntos
Queimaduras , Pneumonia , Sepse , Antibacterianos , Queimaduras/complicações , Combinação Imipenem e Cilastatina , Humanos , Masculino , Pessoa de Meia-Idade , Pneumonia/etiologia , Pseudomonas aeruginosa , Sepse/etiologia
6.
PLoS One ; 15(6): e0233711, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32492026

RESUMO

Animals that experience painful procedures as neonates are more sensitive to pain later in life. We evaluated whether disbudding with a heated iron at 3 (n = 12), 35 (n = 9), or 56 (n = 20) d of age affected heifers' pain responses to vaccine injections at 11 mo of age. Heifers responded to the injection procedure with struggling and changes in eye temperature and heart rate variability compared to a sham procedure the day before, and still had a heightened response 6 d later, regardless of disbudding age. However, some heart rate variability indices suggested increased sympathetic dominance in heifers disbudded at 35 d, compared to the other 2 age groups, independent of the injection procedure. We also found that heifers disbudded at 3 or 35 d had a higher mean heart rate after the injection procedure compared to those disbudded at 56 d. We conclude that: (1) heifers find injections aversive; and (2) there is some evidence that disbudding age influences autonomic nervous system activity later in life.


Assuntos
Comportamento Animal , Queimaduras/complicações , Dor/etiologia , Dor/prevenção & controle , Analgésicos/farmacologia , Criação de Animais Domésticos/métodos , Animais , Animais Recém-Nascidos , Bovinos , Estudos de Coortes , Feminino , Frequência Cardíaca , Cornos/crescimento & desenvolvimento , Injeções , Meloxicam/farmacologia , Vacinação , Vacinas/administração & dosagem
7.
Zhonghua Shao Shang Za Zhi ; 36(5): 357-362, 2020 May 20.
Artigo em Chinês | MEDLINE | ID: mdl-32456372

RESUMO

Objective: To explore the effect of combined application of pulsed dye laser (PDL) and ultra-pulsed fractional carbon dioxide laser (UFCL) in the treatment of pediatric large burn scars at early stage. Methods: One hundred and twenty pediatric patients with large burn scars at early stage conforming to the study criteria were admitted to the People's Hospital of Hunan Province from January 2016 to December 2019. Their data were retrospectively analyzed by the method of single case-control study. There were 78 males and 42 females with age of (4.2±0.8) years and scar area of (100.3±0.7) cm(2). PDL combined with UFCL was used for the first time. The treatment interval of PDL was a month and the treatment interval of UFCL was 3 months. The total treatment cycle was 6 months, with 2 PDL treatments alone and two combined treatments. Before the first combined treatment and 6 months after two combined treatments, the curative effect was assessed using Patient and Observer Scar Assessment Scale (POSAS) by doctors and family members of pediatric patients. Satisfaction degrees of the family members of pediatric patients were recorded, and the overall satisfaction rate was calculated 6 months after two combined treatments. The adverse effects during the whole treatment course were recorded. Data were statistically analyzed with paired t test. Results: (1) Six months after two combined treatments, the scores of pediatric patients' scar vascularity, pigment, thickness, relief, pliability, surface area, and overall valuation in POSAS by doctors and the scores of pain, itch, color, stiffness, thickness, irregularity, and overall valuation in POSAS by family members of pediatric patients were all significantly lower than those before the first combined treatment (t=16.6, 16.0, 16.9, 14.9, 20.8, 29.3, 30.7, 20.4, 29.3, 18.1, 27.9, 25.8, 20.8, 45.3, P<0.01). The overall evaluation scores by doctors were (8.1±0.8) and (2.7±0.6) points, and the overall evaluation scores by family members of pediatric patients were (8.2±0.8) and (2.4±0.5) points respectively before the first combined treatment and six months after two combined treatments. (2) Six months after two combined treatments, 110 (92%) family members of pediatric patients were very satisfied with the curative effect, 6 (5%) family members of pediatric patients were satisfied, and 4 (3%) family members of pediatric patients were relatively satisfied with no unsatisfied reported. The overall satisfaction rate was 97% (116/120). (3) During the treatment, pruritus and rash appeared in 5 pediatric patients 3 to 4 days after the first treatment; pigmentation appeared in 3 pediatric patients 3 weeks after the first treatment; pruritus and vesicle appeared in 1 patient 1 week after the third treatment. No adverse effects such as aggravated scar or infection were observed on the wounds. Conclusions: In treating pediatric large burn scars at early stage, PDL combined with UFCL has demonstrated significant effect with short treatment cycle, few adverse effects. The combined treatment can alleviate symptoms and improve the quality of pediatric patients' life, and is worthy to be popularized and applied in clinic.


Assuntos
Queimaduras/complicações , Cicatriz/terapia , Lasers de Corante , Lasers de Gás , Queimaduras/terapia , Estudos de Casos e Controles , Pré-Escolar , Cicatriz/etiologia , Feminino , Humanos , Masculino , Estudos Retrospectivos , Resultado do Tratamento
8.
Health Qual Life Outcomes ; 18(1): 144, 2020 May 19.
Artigo em Inglês | MEDLINE | ID: mdl-32429975

RESUMO

BACKGROUND: The EQ-5D domain pain/discomfort (PD) uses one item to capture pain and other aspects of discomfort, like itching. This study explored how pain, itching and the EQ-5D-5L PD domain relate to each other in a sample of burn patients. METHODS: Adult burn patients completed the EQ-5D-5L and the Patient and Observer Scar Assessment Scale (POSAS) 5-7 years after sustaining their injury. The POSAS includes a separate pain and an itching item. Spearman's correlation coefficient established the association between the EQ-5D-5L PD and the POSAS pain and itching item. With multivariable regression analysis the linear association between the POSAS pain and itching item and EQ-5D-5L PD domain was tested. RESULTS: Data from 245 patients were included. Mean EQ-5D-5L index value was 0.87 and 39.2% reported at least slight problems on the EQ-5D-5L PD domain. Most patients gave corresponding answers on the EQ-5D-5L PD domain and on the POSAS pain (73%) and itching (70%) item. Spearman correlation coefficients of the EQ-5D-5L PD domain with the POSAS pain and itching were 0.468 (p < 0.001) and 0.473 (p < 0.001), respectively. Among respondents with pain and without itching and respondents with itching and without pain, Spearman correlation coefficients were 0.585 (p = 0.076) and 0.408 (p = 0.001), respectively. POSAS pain (unstandardized Beta = 0.14) and POSAS itching (unstandardized Beta = 0.08) were significantly associated with EQ-5D-5L PD domain (p < 0.001). CONCLUSIONS: Our findings indicate that, in a sample of burn patients, pain and itching are captured by the broader EQ-5D-5L PD domain. The EQ-5D-5L PD domain can thus be used to assess pain and itching in relation to HRQL, but the POSAS pain and itching items are more sensitive. The EQ-5D-5L is, however, no replacement of the POSAS when the POSAS is used for its primary aim; assessment of scar quality. TRIAL REGISTRATION: Netherlands Trial Register (NTR6407).


Assuntos
Queimaduras/complicações , Dor/psicologia , Prurido/psicologia , Qualidade de Vida , Inquéritos e Questionários/normas , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos , Dor/etiologia , Prurido/etiologia , Psicometria
9.
Acta Chir Plast ; 60(2-4): 62-67, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32370520

RESUMO

Serious burn trauma is associated with changes of the immune system, and immunosuppression induced by burn trauma can lead to reactivation of latent infections. Herpetic viruses are known for their lifelong persistence after primary infection and ability to reactivate. Their reactivation in the setting of burn trauma or primary infection can cause serious complications for a weakened burn patient. Presented is a case of a toddler who sustained second-degree scald burns over 20% of his body surface area. The injury was complicated by a multi-resistant bacterial infection in addition to reactivation of a latent HHV-6 infection concurrently with a primary HSV-1 infection. Described further are basic diagnostics, local and systemic treatment strategies, and other complications due to disseminated herpetic infections. To date, HHV-6 reactivation has not been described in conjunction with burn injury.


Assuntos
Infecções Bacterianas/microbiologia , Queimaduras/fisiopatologia , Infecções por Herpesviridae/virologia , Herpesvirus Humano 1/isolamento & purificação , Herpesvirus Humano 6/isolamento & purificação , Infecções Bacterianas/etiologia , Queimaduras/complicações , Pré-Escolar , Farmacorresistência Bacteriana Múltipla/fisiologia , Infecções por Herpesviridae/etiologia , Humanos , Ativação Viral/fisiologia
10.
Acta Chir Plast ; 61(1-4): 32-35, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32380841

RESUMO

Third degree burn trauma of the head and neck requires an interdisciplinary approach. After emergency care and hemodynamic stabilization of the patient the focus lies on the reconstruction of the damaged tissue. The options of reconstruction are influenced by the general condition of the patient and by the condition of the surrounding tissues. The deep defects of the head are dangerous for a high risk of wound infection and possible fatal complications. In particular cases the first methods of choice for closure of the defect may be ineffective and a free flap transfer should be considered. We present a case report of a 62-year-old woman who suffered third degree burn trauma of the head and neck leading to a deep defect of the forehead reaching behind the hairline. On the bottom there was an exposed bone with no healing tendency. Due to surrounding fragile scarred tissue we chose a free flap transfer using serratus anterior muscle as a method of closure. The flap was fully healed and provided good aesthetic and functional outcome.


Assuntos
Queimaduras/cirurgia , Traumatismos Faciais/cirurgia , Retalhos de Tecido Biológico , Lesões do Pescoço/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Queimaduras/complicações , Traumatismos Faciais/etiologia , Feminino , Testa/lesões , Testa/cirurgia , Humanos , Pessoa de Meia-Idade , Lesões do Pescoço/etiologia , Resultado do Tratamento
11.
Ned Tijdschr Geneeskd ; 1642020 05 13.
Artigo em Holandês | MEDLINE | ID: mdl-32406635

RESUMO

This case concerns a girl with geometrically round blisters, mainly on the left arm since 1 month. Histopathologic examination of a skin biopsy showed a necrotic epidermis with subepidermalclefting suggesting thermal damage. Recently, similar thermal burns have been observed more often in adolescents following a so-called 'deo challenge'.


Assuntos
Vesícula/etiologia , Queimaduras/complicações , Queimaduras/diagnóstico , Braço , Biópsia , Vesícula/patologia , Queimaduras/patologia , Criança , Feminino , Humanos , Pele/patologia
12.
Zhonghua Shao Shang Za Zhi ; 36(3): 210-218, 2020 Mar 20.
Artigo em Chinês | MEDLINE | ID: mdl-32241047

RESUMO

Objective: To explore the clinical effects of concentrated growth factor (CGF) combined with plasma albumin gel (PAG) in treating facial depressed scar. Methods: From January 2018 to June 2019, 14 patients in the First Affiliated Hospital of Zhengzhou University and 10 patients in Henan NO.3 Provincial People's Hospital with facial depressed scar who met the inclusion criteria were admitted, and their clinical data were retrospectively analyzed by the method of case-control study. Based on the method of treatment, 8 patients (4 males and 4 females) aged 28.50 (25.50, 31.50) years were enrolled in CGF alone group, 8 patients (3 males and 5 females) aged 32.00 (28.50, 35.00) years were enrolled in PAG alone group, and 8 patients (5 males and 3 females) aged 33.50 (29.00, 35.75) years were enrolled in CGF+ PAG group. Suitable amount of CGF, PAG, and CGF+ PAG (mixed at a ratio of 1.0∶1.0-1.0∶1.5) prepared from autologous blood were injected subcutaneously via a single or multiple entrance (s) into the depressed scar of patients in CGF alone, PAG alone, and CGF+ PAG groups respectively to fill up the concavity, once every 4 weeks for a total of 3 times. Before the first treatment (hereinafter referred to as before treatment) and 3 months after the last treatment (hereinafter referred to as after treatment), the Goodman & Baron Acne Scar Grading System was used for scar grading, and the difference was calculated; the Anxiety Self-Rating Scale was used to score anxiety, and the difference was calculated. The Visual Analogue Score was used to score pain immediately after the first treatment. By one, two, and three months after treatment, the patients' satisfaction to scar treatment was scored, and the Global Aesthetic Improvement Scale was used to score the scar improvement. Adverse reaction of patients after treatment was monitored. Data were statistically analyzed with Fisher's exact probability test, Kruskal-Wallis H test, Mann-Whitney U test, Bonferroni correction, and Wilcoxon signed rank sum test. Results: (1) The scars of patients in the three groups were all graded 4.00 (4.00, 4.00) before treatment (χ(2)<0.001, P>0.05). By three months after treatment, compared with 2.00 (1.25, 2.00) of CGF alone group, the scar grades of patients in PAG alone group and CGF+ PAG group (3.00 (2.00, 3.00) and 1.00 (1.00, 1.00), respectively) had no significant change (Z=2.199, 2.003, P>0.05). The scar grade of patients in CGF+ PAG group was significantly lower than that in PAG alone group (Z=3.229, P<0.01). Compared with those before treatment, the scar grades of patients in CGF alone group, PAG alone group, and CGF+ PAG group were significantly reduced three months after treatment (Z=2.588, 2.598, 2.640, P<0.05 or P<0.01). The difference in scar grade before and after the treatment was significantly higher in CGF+ PAG group than in PAG alone group (Z=3.229, P<0.01). (2) The anxiety scores of patients in the three groups were similar before treatment and 3 months after (χ(2)=2.551, 2.768, P>0.05). Compared with those before treatment, the anxiety scores of patients in CGF alone group, PAG alone group, and CGF+ PAG group were significantly reduced three months after treatment (Z=2.395, 2.527, 2.533, P<0.05). The differences in anxiety score before and after the treatment were similar among the three groups (χ(2)=1.796, P>0.05). (3) The pain scores of patients in the three groups were similar immediately after the first treatment (χ(2)=0.400, P>0.05). (4) By one and two month (s) after treatment, the patients' satisfaction scores to scar treatment in the three groups were similar (χ(2)=2.688, 5.989, P>0.05). By three months after treatment, the patients' satisfaction score to scar treatment in CGF+ PAG group was significantly higher than that in PAG alone group (Z=2.922, P<0.01). Compared with those one month after treatment within the same group, the patients' satisfaction scores to scar treatment in CGF alone group, PAG alone group, and CGF+ PAG group were significantly increased two and three months after treatment (Z=1.121, 2.392, 2.000, 2.828, 2.449, 2.598, P<0.05 or P<0.01). Compared with those two months after treatment within the same group, the patients' satisfaction scores to scar treatment in CGF alone group, PAG alone group, and CGF+ PAG group were significantly increased three months after treatment (Z=2.271, 2.000, 2.646, P<0.05 or P<0.01). (5) One month after treatment, the scar improvement scores of patients in the three groups were similar (χ(2)=4.438, P>0.05). Two months after treatment, the scar improvement scores of patients in CGF alone group and CGF+ PAG group were 2.00 (2.00, 2.75) and 2.00 (2.00, 2.00) points, respectively, which were significantly higher than 1.00 (1.00, 1.00) point of PAG alone group (Z=3.303, 3.771, P<0.01). Three months after treatment, the scar improvement score of patients in CGF+ PAG group was 3.00 (3.00, 3.00) points, which was significantly higher than 2.00 (2.00, 2.75) points of CGF alone group and 1.00 (1.00, 2.00) points of PAG alone group (Z=2.450, 3.427, P<0.05 or P<0.01). Compared with those one month after treatment within the same group, the scar improvement scores of patients were significantly higher in CGF alone group and CGF+ PAG group two and three months after treatment and in PAG alone group three months after treatment (Z=2.828, 2.828, 2.530, 2.640, 2.121, P<0.05 or P<0.01). Compared with that two months after treatment within the same group, the scar improvement score of patients in CGF+ PAG group was significantly higher three months after treatment (Z=2.449, P<0.05). (6) After injection, all patients in the three groups had slight redness and swelling at the needle prick point and no other adverse reactions. Conclusions: CGF combined with PAG can reduce the scar grading, anxiety of patients, and enhance patients' satisfaction and scar improvement in the treatment of patients with facial depressed scar. The combined CGF+ PAG injection, without significant adverse reactions, is better than single component injection and is worthy of clinical application.


Assuntos
Queimaduras/complicações , Cicatriz/terapia , Géis/uso terapêutico , Albumina Sérica/uso terapêutico , Adulto , Queimaduras/terapia , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Satisfação do Paciente , Estudos Retrospectivos , Resultado do Tratamento
14.
Cir. plást. ibero-latinoam ; 46(supl.1): S97-S106, abr. 2020. tab, ilus, graf
Artigo em Português | IBECS | ID: ibc-193499

RESUMO

INTRODUÇÃO E OBJECTIVO: Definimos sequela de queimaduras como qualquer condição corporal anormal relacionada ou decorrente de uma queimadura, funcional as que levam a qualquer limitação da função e não-funcional quando ainda existe a sequela, porém não existe limitação da função, antigamente chamada de sequela estética. O presente estudo propõe uma sistematização de raciocínio no tratamento de sequelas de queimaduras de maneira para facilitar e estabelecer uma padronização do atendimento e da programação cirúrgica dos pacientes. MATERIAL E MÉTODOS: Estudo realizado no ambulatório de se¬quelas de queimaduras do hospital das clínicas da Faculdade de Medicina da Universidade de São Paulo (Brasil). Foram tratados 640 pacientes e geraram esta sistematização do atendimento de pacientes com sequelas de queimaduras. RESULTADOS: Em razão da dificuldade no tratamento das sequelas de queimaduras desenvolvemos um algoritmo onde se tornasse fácil o ensino dos conceitos e do raciocínio lógico. A padronização dos procedimentos e das condutas tornou o atendimento de sequelas de queimaduras reprodutível, de fácil compreensão por parte dos cirurgiões plásticos e ainda melhoraram os resultados. Desta maneira, acreditamos que a formação acadêmica se torna mais fácil e efetiva. CONCLUSÕES: O raciocínio médico padronizado é os algoritmos são uma arma poderosa e métodos auxiliares simples e eficazes na obtenção de resultados consistentes na prática diária da medicina


BACKGROUND AND OBJECTIVE: We define burn sequelae as any abnormal body condition related to or resulting from a burn, functional when lead to any limitation of function and non-functional when the sequel still exists but there is no limitation of function, formerly called aesthetic sequelae. The present study proposes a systematization of reasoning in the treatment of burn sequelae in order to facilitate and establish a standardization of care and of the surgical schedule of patients. METHODS: We conduct a study in the burn sequelae outpatient clinic of the Hospital das Clinicas at the Faculty of Medicine of the University of São Paulo (Brazil), treating 640 patients and generating a systematization of care for patients with burn sequelae. RESULTS: Due to the difficulty in treating burn sequelae, we developed an algorithm where the teaching of concepts and logical reasoning became easy. The standardization of procedures made the treatment of burn sequelae reproducible, easy to understand by plastic surgeons and even improving the results. In this way, we believe that academic training becomes easier and more effective. CONCLUSIONS: Standardized medical reasoning and algorithms are a powerful weapon and simple and effective auxiliary methods to obtain consistent results in the daily practice of medicine


Assuntos
Humanos , Queimaduras/cirurgia , Queimaduras/complicações , Cicatriz/cirurgia , Estatísticas de Sequelas e Incapacidade , Corticosteroides/uso terapêutico , Tatuagem , Expansão de Tecido
15.
Cir. plást. ibero-latinoam ; 46(supl.1): S107-S114, abr. 2020. ilus
Artigo em Espanhol | IBECS | ID: ibc-193500

RESUMO

El presente artículo comprende una amplia y descriptiva revisión de la radiación desde su concepción básica, características, clasificación, fuentes, equipos, elementos radioactivos y los efectos biológicos en el ser humano. La diferencia entre radiación ionizante y no ionizante radica en la cantidad de energía del fotón individual y no en la cantidad de energía total. La radiación no ionizante se caracteriza por no contar con energía suficiente para convertir átomos o moléculas a iones, sin embargo es capaz de producir calor, útil en tratamientos fisiátricos y estéticos, pero con la posibilidad de producir quemaduras y otras lesiones que aún siguen en estudio. Entre las fuentes de radiación no ionizante tenemos la luz visible, el laser, la luz infrarroja, el microondas, y el teléfono móvil. Los diversos equipos de diagnóstico y tratamiento empleados en Medicina como rayos X, radioterapia, medicina nuclear, o en el caso de accidentes nucleares y guerras radiactivas, pueden generar radiaciones del tipo ionizante que rompen enlaces químicos, con el consecuente desarrollo de lesiones biológicas, en ocasiones graves


This article includes a broad and descriptive review of radiation from its basic conception, characteristics, classification, sources, equipment, radioactive elements and the biological effects on humans. The difference between ionizing and non-ionizing radiation lies in the amount of energy of the individual photon and not in the amount of total energy. Non-ionizing radiation is characterized by not having enough energy to convert atoms or molecules to ions; however they are capable of producing heat, useful in physiological and aesthetic treatments, with the possibility of producing burns and other injuries that are still under study. Among the non-ionizing radiation sources, we have visible light, laser, infrared light, microwave and mobile phone. The various diagnostic and treatment equipment used in Medicine such as X-rays, radiotherapy, nuclear medicine, or in the case of nuclear accidents and radioactive wars, can generate ionizing type radiation that breaks chemical bonds, with the consequent development of biological lesions that may be severe


Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Idoso , Queimaduras/complicações , Radiação/classificação , Radioterapia/efeitos adversos , Lesões por Radiação/diagnóstico , Lesões por Radiação/etiologia , Pele/lesões , Radiação Ionizante , Radiação não Ionizante/efeitos adversos , Lesões por Radiação/complicações
16.
Artigo em Alemão | MEDLINE | ID: mdl-32191972

RESUMO

First aid and treatment of burn patients pose a challenge to responsible physicians. Primary assessment should include an evaluation of the degree and extent of the burn injuries as well as a physical examination for other trauma injuries and trauma caused by the inhalation of toxic agents. One should focus on removal of the burning source, preservation of body temperature, sterile coverage of the burnt areas, pain management and sufficient hemodynamic stabilization. Grade IIb and more severe burns are most likely subject to surgical intervention to assure sufficient healing. Our case report illustrates a burn patient's initial treatment and clinical course, which includes the development of an acute pulmonary embolism with severe hemodynamic instability. As other critically ill patients, burn patients are at particular risk for complications like infections or other causes for hemodynamic instability. Every cardiovascular event is possibly suspicious for acute pulmonary arterial embolism (PAE). A high or increasing gap between expiratory and arterial CO2 tension accompanied by typical symptoms like tachycardia and hypotension or respiratory distress may be caused by PAE. An echocardiogram can provide information about possible pathophysiological changes typical for PAE, nevertheless, CT-angiography is today's clinical gold standard for the diagnosis of PAE. As therapeutic measures, heparin should be administered, and thrombolysis should be considered in case of persisting hemodynamic instability, attentively taking possible contraindications into account.


Assuntos
Queimaduras , Estado Terminal , Hemodinâmica , Doença Aguda , Queimaduras/complicações , Humanos
17.
Complement Ther Med ; 49: 102341, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32147030

RESUMO

AIM: Present review aimed to conduct a comprehensive review of the effectiveness of non-pharmacological interventions (NPIs) on reducing anxiety in adult burn patients. METHOD: We searched PubMed, Web of Science, Scopus, Cochrane Library, and Google Scholar databases through September 2019 for randomized clinical trials comparing NPIs to a control group. The primary outcomes were general anxiety and pain anxiety. The Cochrane Risk of Bias Tool was used to assess the risk of bias. All data was pooled with Revman 5.3. RESULTS: 20 studies were eligible for quantitative synthesis. Compared to routine care, Music (4 Randomized Clinical Trials (RCTs), Standardized Mean Difference (SMD) = -2.00, 95 % Confidence Interval (CI) = -3.21 to -0.79), massage (4 RCTs, SMD= -1.84, 95 % CI= -2.77 to -0.91), hypnosis (2 RCTs, SMD= -1.06, 95 % CI= -2.90 to 0.78), relaxation (2 RCTs, SMD= -0.77, 95 %CI= -1.52 to -0.02), transcranial direct current stimulation (1 RCT, SMD= -1.92, 95 %CI= -2.54 to -1.30), and therapeutic touch practices (1 RCT, SMD=-0.45 95 %CI= -0.86 to -0.04), were associated with a significant effect on the anxiety of burn patients. Aromatherapy interventions and virtual reality showed no evidence of a reduction in the anxiety. A large amount of heterogeneity exist among trials. Risk of bias varied across studies. Only one study reported on safety issues. CONCLUSION: Due to weak evidence, we are unable to make strong recommendations in favor of NPIs for burn anxiety. Further well-designed large sample size randomized clinical trials are warranted.


Assuntos
Ansiedade/etiologia , Ansiedade/terapia , Queimaduras/complicações , Queimaduras/psicologia , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto
18.
Cir. plást. ibero-latinoam ; 46(1): 79-84, ene.-mar. 2020. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-190866

RESUMO

El pioderma gangrenoso es una rara dermatosis idiopática, crónica, caracterizada por pústulas y úlceras coalescentes que aparece por lo general sobre la piel previamente traumatizada, con preferencia en extremidades inferiores y tronco. Se asocia a enfermedades sistémicas y los tratamientos quirúrgicos tienden a empeorar el cuadro clínico por el fenómeno de patergia. No hay un tratamiento de elección, pero se acepta el tratamiento inmunosupresor. Presentamos 2 casos de pioderma gangrenoso asociado a quemaduras, una entidad escasamente recogida en la literatura, con abordaje y evolución diferente


Pyoderma gangrenosum is a rare, chronic, and idiopathic dermatosis, characterized by pustules and coalescent ulcers. It usually develops on previously traumatized skin, especially on the lower extremities and trunk. It is associated with systemic diseases, and surgical treatments tend to worsen clinical signs and symptoms as a result of pathergy. There is no treatment of choice, but immunosuppressive therapy is accepted. Two cases of pyoderma gangrenosum associated with burns, an entity rarely collected in the literature, are presented, with different approaches and courses


Assuntos
Humanos , Masculino , Adulto , Pessoa de Meia-Idade , Pioderma Gangrenoso/etiologia , Pioderma Gangrenoso/tratamento farmacológico , Queimaduras/complicações , Adalimumab/uso terapêutico , Ácido Micofenólico/uso terapêutico , Prednisolona/uso terapêutico , Ciclofosfamida/uso terapêutico , Doença Crônica
19.
Khirurgiia (Mosk) ; (2): 95-99, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32105263

RESUMO

A 51-year-old severely burned woman had hospitalized at the Clinic of Thermal Injuries of the S.M. Kirov Military Medical Academy with a diagnosis: flame burn in a surface area of 40% (11%)/II-III b degrees of head, neck, trunk, limbs. Inhalation injury of moderate severity. The infusion drug of the combined action reamberin, which has a volemic and antihypoxic effect, had added to the complex antishock therapy. The presented clinical observation demonstrates the favorable course of burn shock: stopping of burn shock 28 hours after injury.


Assuntos
Queimaduras , Meglumina/análogos & derivados , Militares , Choque , Succinatos , Queimaduras/complicações , Feminino , Hidratação , Humanos , Meglumina/uso terapêutico , Pessoa de Meia-Idade , Choque/etiologia , Choque/terapia , Succinatos/uso terapêutico
20.
BMC Infect Dis ; 20(1): 142, 2020 Feb 14.
Artigo em Inglês | MEDLINE | ID: mdl-32059701

RESUMO

BACKGROUND: Obligate anaerobes usually account for less than 10% of bacteria recovered from blood cultures (BC). The relevance of routine use of the anaerobic bottle is under debate. The aim of this study was to evaluate the utility of anaerobic bottles for the diagnosis of bloodstream infections (BSI). METHODS: We conducted a 6-month, retrospective, monocentric study in a tertiary hospital. All positive BC were grouped into a single episode of bacteremia when drawn within 7 consecutive days. Bacteremia were classified into contaminants and BSI. Charts of patients with BSI due to obligate anaerobes were studied. RESULTS: A total of 19,739 blood cultures were collected, 2341 of which (11.9%) were positive. Anaerobic bottles were positive in 1528 (65.3%) of all positive BC but were positive alone (aerobic bottles negative) in 369 (15.8%). Overall 1081 episodes of bacteremia were identified, of which 209 (19.3%) had positive anaerobic bottles alone. The majority 126/209 (60.3%) were contaminants and 83 (39.7%) were BSI. BSI due to facultative anaerobes, obligate aerobes and obligate anaerobes were identified in 67 (80.7%), 3 (3.6%) and 13 (15.7%) of these 83 episodes, respectively. BSI due to obligate anaerobic bacteria were reported in 9 patients with gastro-intestinal disease, in 3 with febrile neutropenia and in 1 burned patient. CONCLUSIONS: Anaerobic bottles contributed to the diagnosis of a significant number of episodes of bacteremia. Isolated bacteria were mostly contaminants and non-obligate anaerobic pathogens. Rare BSI due to obligate anaerobes were reported mainly in patients with gastro-intestinal disorders and during febrile neutropenia.


Assuntos
Bacteriemia/microbiologia , Bactérias Aeróbias/isolamento & purificação , Bactérias Anaeróbias/isolamento & purificação , Hemocultura/instrumentação , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Bacteriemia/tratamento farmacológico , Bacteriemia/etiologia , Bactérias Aeróbias/patogenicidade , Bactérias Anaeróbias/patogenicidade , Hemocultura/métodos , Queimaduras/complicações , Queimaduras/microbiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neutropenia/microbiologia , Estudos Retrospectivos , Centros de Atenção Terciária
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