One case of refractory gout with high fever / 中华烧伤杂志

On 17th June 2017, a 50 years old man with refractory gout was admitted in our hospital. During the treatment, he was accompanied by intermittent fever (39 to 40 ℃) of unknown origin for 60 days and gastrointestinal bleeding, with difficult wound repair. After comprehensive treatment of thorough debridement, vacuum sealing drainage, skin graft, skin flap repair, and drug administration, the patient was discharged fully recovered on post hospitalization day 104.

Wet cement skin burns / 中华烧伤杂志

Under certain condition, wet cement can cause skin chemical burns, which belongs to alkaline burns. As the symptoms are insidious in onset, the patients may be initially unaware of the injury until several hours later. It often causes full-thickness burns especially in knees, the lower limbs, and ankles. The prevalence of wet cement burns may be hugely underestimated. This article reviews the definition, occurrence, progress of injury and pathogenesis, clinical characteristics and diagnosis, and treatment and prevention of wet cement skin burns, in order to promote its prevention.

Analysis of diagnosis and management of 21 patients with Marjolin's ulcers / 中华烧伤杂志

<p><b>OBJECTIVE</b>To investigate the clinical manifestation, diagnosis, and treatment of patients with Marjolin's ulcers.</p><p><b>METHODS</b>The clinical materials of 21 patients with Marjolin's ulcers hospitalized from January 2007 to January 2013 were retrospectively analyzed, including age, gender, injury causes, duration time of primary disease in developing Marjolin's ulcer, duration of ulcer, lesion site, ulcer area, symptoms and signs of ulcer region, bacterial culture results before operation, histopathological type, grade of carcinoma cell differentiation, depth of invasion, treatment, and outcome.</p><p><b>RESULTS</b>(1) The age of 21 patients at the time of diagnosis of Marjolin's ulcers was 19-74 (47 ± 13) years, and the ratio of male to female was nearly 0.9:1.0. (2) The main primary lesions were flame burns and high temperature liquid scald, respectively occurred in 12 cases (57.1%) and 7 cases (33.3%). The time for development of Marjolin's ulcers from primary injury was 10-56 (40 ± 14) years. (3) Ulceration on top of scar lasted for longer than one year in 12 patients (57.1%). (4) Lesion site was mainly located in the limbs in 13 patients (61.9%), and on head and face in 6 patients (28.6%), respectively. (5) Ulcer area ranged 0.25-74.25 (39 ± 25) cm(2). Foul excretion, bleeding, intensified pain, and gradual enlargement of ulceration were observed in the lesion of most patients. (6) Bacterial culture of wound excretion before operation showed positive results in 16 patients (76.2%).</p><p><b>RESULTS</b>of bacterial culture of blood were negative in all patients. (7) Pathological examination revealed squamous cell carcinoma in 20 cases and basal cell carcinoma in 1 case, and mostly of high or medium differentiation. Cancer cells in nearly 40% patients had invaded the subcutaneous tissue or deeper area. (8) All patients were treated by surgery, among them autologous skin grafting was done after excision of lesion in 11 patients, and in 5 patients the defects were closed with skin flaps after excision of lesion, and in 5 patients limbs harboring the lesion were amputated. Twelve patients (57.1%) received postoperative rehabilitation treatment. Two patients with pulmonary metastasis received chemotherapy. (9) Most of the flaps and skin grafts survived well after surgery, and a few cases with failure of skin grafting or transplantation of flaps underwent skin grafts again. Patients were followed up for 6 months to 5 years, in 4 patients recurrence occurred after surgery, and 2 of them died. The other patients survived without recurrence.</p><p><b>CONCLUSIONS</b>Squamous cell carcinoma was the most common pathological type of Marjolin's ulcer admitted to our unit. A recurrent ulcer with long course should be considered as Marjolin's ulcer, and it should be scrutinized pathologically. Currently, surgery remains the optimal treatment for Marjolin's ulcer. Regular follow-up should be carried out after resection of the lesion to detect carcinoma recurrence and metastasis.</p>

Advances in the research of Marjolin's ulcer / 中华烧伤杂志

Marjolin's ulcer is a rare malignancy arising from various forms of scars, mainly an old scar resulted from burn. The second most common origin is malignant degeneration arising from tissue within osteomyelitis fistulae. Not uncommonly, the lesions may arise secondary to ulcers due to venous insufficiency or pressure sores. The pathology of the majority of Marjolin's ulcer is a well-differentiated squamous cell carcinoma. The exact reason for an ulcer which undergoes a malignant transformation is unknown. The pathologic diagnosis is the gold standard. Surgery remains the preferred treatment after diagnosis is reached. Wide surgical excision with margins up to 2-3 cm has been suggested. The necessity of whether lymphatic dissection should be executed, or radiotherapy and chemotherapy following surgery is still in dispute. This article deals with the etiology of Marjolin's ulcer and its pathological grading, diagnosis, treatment, prognosis, and prevention, with a hope to provide some useful clinical information.