Fish skin grafts compared to human amnion/chorion membrane allografts: A double-blind, prospective, randomized clinical trial of acute wound healing.

Chronic, nonhealing wounds consume a great deal of healthcare resources and are a major public health problem, associated with high morbidity and significant economic costs. Skin grafts are commonly used to facilitate wound closure. The grafts can come from the patient's own skin (autograft), a human donor (allograft), or from a different species (xenograft). A fish skin xenograft from cold-water fish (Atlantic cod, Gadus morhua) is a relatively recent option that shows promising preclinical and clinical results in wound healing. Chronic wounds vary greatly in etiology and nature, requiring large cohorts for effective comparison between therapeutic alternatives. In this study, we attempted to imitate the status of a freshly debrided chronic wound by creating acute full-thickness wounds, 4 mm in diameter, on healthy volunteers to compare two materials frequently used to treat chronic wounds: fish skin and dHACM. The purpose is to give an indication of the efficacy of the two therapeutic alternatives in the treatment of chronic wounds in a simple, standardized, randomized, controlled, double-blind study. All volunteers were given two identical punch biopsy wounds, one of which was treated with a fish skin graft and the other with dehydrated human amnion/chorion membrane allograft (dHACM). In the study, 170 wounds were treated (85 wounds per group). The primary endpoint was defined as time to heal (full epithelialization) by blinded assessment at days 14, 18, 21, 25, and 28. The superiority hypothesis was that the fish skin grafts would heal the wounds faster than the dHACM. To evaluate the superiority hypothesis, a mixed Cox proportional hazard model was used. Wounds treated with fish skin healed significantly faster (hazard ratio 2.37; 95% confidence interval: (1.75-3.22; p = 0.0014) compared with wounds treated with dHACM. The results show that acute biopsy wounds treated with fish skin grafts heal faster than wounds treated with dHACM.

[Intussusception in children in Iceland]. / Garnasmokkun hjá börnum á Íslandi.

INTRODUCTION: Intussusception occurs when a proximal portion of the bowel invaginates into the distal bowel. It is the most common cause of intestinal obstruction in children between 3 months and 3 years. This study aimed to assess patient profile, clinical presentation, diagnostic methods, treatment and outcome in children diagnosed with intussusception in Iceland. MATERIAL AND METHODS: We conducted a retrospective chart review of all children diagnosed with intussusception in Iceland during a 25 year period (1986-2010). Patients were identified from a medical record database in Iceland's two main hospitals, Landspítali and Akureyri Hospital. RESULTS: A total of 67 children aged 3 months to 11 years (median age 8 months) were diagnosed with intussusception. Male to female ratio was 3:2. The mean incidence of intussusception was 0.4 cases per 1000 children <1 year old. Intussusception was idiopathic in 70% of patients and occurred in the ileocolic region in 94%. Barium contrast enema was the most common diagnostic test. Barium enema reduction was attempted in 82% of patients and successful reduction rate was 62%. Surgical treatment was required in 49% of patients and involved resection of bowel in 9%. Three children had recurrent intussusception. CONCLUSION: The results of treatment for intussusception in Iceland are good. The decline of enemas performed and the rise in surgical treatment observed over the study period is a reason for concern. In this regard there is room for improvement.