ABSTRACT
Background To maintain corneal transparency is important for good visual function.A new treatment concept and the selection of surgical techniques and timing of surgery are critical for stopping the infringement of cornea tissue after alkali burning and other chemical warfare agents.Objective This study was to investigative the ultrastructure and histopathological status following the femtosecond laser-assisted deep lamellar keratoplasty (DLK) for acute alkali burn of cornea.Methods Acute corneal alkali burn models were established in 12 New Zealand rabbits by putting the 6 mm filter paper with 1 mol/L NaOH at the central cornea for 30 seconds.The rabbits were randomly allocated to femtosecond laser-assisted DLK group and model control group according to the randomized number table method.Femtosecond laser-assisted DLK was performed to transplant the corneal grafts of domestic rabbits to the model rabbits 24 hours after burning.The rabbits were sacrificed 1 week,2 weeks and 4 weeks after modeling,and the corneas were extracted for the preparation of corneal section.The cornea were performed with hematoxylin and eosin staining to assess the histopathological status under the optical microscope,and the ultrastructure of grafts and corneas was examined under the transmission electron microscope (TEM).Results Acute corneal alkali bourn models were successfully eatablished.In the fourth week after surgery,corneal graft was clear in the femtosecond laser-assisted DLK group.However,corneal swelling,conjunctival congestion and neovascularization were found in the model control group.Histopathological examination revealed the defect of corneal epithelium,edema of stroma,loose arrangement of collagen fibers,much vacuoles,few neovascularization and infiltration of a large number of inflammatory cells in the model control group,but in the femtosecond laser-assisted DLK group,the inflammatory response was slight.More desmosomes among the endothelial cells were seen,and the nuclei were intact in the grafts.In the fourth week after surgery,the transplanted corneas were transparent with the regular arrangement of collagen fibers and entire fibroblasts in the femtosecond laser-assisted DLK group under the TEM.However,flat surface corneal epithelial cells and shedding of some epithelial cells were exhibited in the modelcontrol group.Conclusions Femtosecond laser-assisted DLK can effectively alleviate the inflammatory response,promote epithelial healing and enhance intercellular tight junction in the cornea with acute alkali burn.
ABSTRACT
Las quemaduras son una causa importante de mor-bimortalidad a nivel mundial y en nuestro país. Según la Asociación de Ginebra en el 2006 el país con mayor mortalidad por incendios fue Estados Unidos con 3550 fallecidos, seguido de Japón, Francia y Polonia. En el año 2007 en Venezuela causaron 323 defunciones. En el año 2008 en el Estado Lara hubo 10 defunciones por quemaduras y en el Municipio Andrés Eloy Blanco, donde pertenece Sanare no hubo ningún fallecido. El objetivo del trabajo es evaluar el comportamiento epidemiológico durante una década para poder contribuir al manejo del paciente quemado en un futuro. Se analizaron 60 historias médicas de pacientes con diagnóstico de ingreso y egreso de quemadura en el Hospital José María Bengoa, durante el período 2000-2009. Se recolectaron datos como: sexo, edad, grado de la quemadura, porcentaje de la superficie corporal comprometida según Lund y Browder y grado de severidad según la American Burn Association. El 52% de la muestra fue de sexo masculino y 48% del sexo femenino. El rango de edades estuvo comprendido entre 0,5 años y 70 años, con un promedio de 14, 16 años; el lugar de ocurrencia más frecuente fue la cocina. El 98% de las quemaduras fue por agente físico, dentro de las cuales el más frecuente fue el agua caliente. El 90% de las quemaduras fueron de segundo grado. El 61% de los pacientes presentaron quemaduras de grado severo por ABA. El 71,6% de los pacientes recibió penicilina cristalina profiláctica. El estudio epidemiológico de las quemaduras en un período prolongado aporta datos oportunos para el mejor manejo del paciente quemado a futuro.
Burn injuries are an important cause of morbidity and mortality worldwide and in our country. Accoording to the General Association, in 2006 the country with the biggest number of fire related deaths was United State with 3550 deaths, fallow by Japan, France and Poland. In 2007 there were 323 fire related deaths in Venezuela. In 2008 at the Lara State there were 10 deceases and in the Andrés Eloy Blanco Municipality where Sanare belong there were no fire or burn deaths related. The objective of this paper is to evaluate the epidemiological behavior for over a decade to hopefully contribute to the management of the burn patient un the future. We analyzed 60 medical charts from patients with burn diagnosis at the moment of the admission and dischange in the J.M. Bengoa Hospital between 2000-2009. We collected information such as: sex, age, burn depth, percentage of total body surface compromise according to Lund and Browder and the degree of severity by the American Burn Association. 52% of the sample was male, and 48% female. The average age was 14,16 years ald with a range between 0,5 years and 70 years. The most common place of occurrence was the kitchen. 98% of the burn injuries were by a physical agent, among which the most frequent one was hot water. 90% of the lesions were second-degree burns. 61% of the patients had a severe degree by ABA. 71,6% of the patients received prophylactic crystalline penicillin. The epidemiological study of burn injuries for a long period of the time contributes with opportune data for the improved management of the burn patient in the future.
Subject(s)
Adolescent , Adult , Child , Middle Aged , Oxacillin/administration & dosage , Penicillins/administration & dosage , Skin/injuries , Burns/epidemiology , Burns/etiology , Thoracic Injuries , Leg Injuries , Accidents, Home , Chemical Compounds , Medical RecordsABSTRACT
PURPOSE: In the partial thickness burn management, despite of several advantages, the use of human amniotic membrane has been limited. The authors applied dried bovine amniotic membrane(DBAM) to overcome disadvantages of amniotic membrane for partial thickness burn and to compare the effectiveness of cultured allogenic keratinocytes(CAK) that have been recently used for the management of burn. METHODS: From August 2007 to May 2008, 16 patients with partial thickness burn were assigned to this study. The ages ranged from 12 to 59, with the average of 38. Either DBAM or CAK were applied, and the secondary dressing was removed on the following day. To compare treatment effect, time for epithelization, Vancouver scar scale and chromameteric results were evaluated. RESULTS: The time for epithelization was 10.1 days and 9.1 days in DBAM and CAK, respectively, which are shorter than the previous 2-3 weeks. At the follow up Vancouver scar scale was 2.8 in DBAM and 3.0 points in CAK, both of which showed good results. The results of chromameter showed that the L*, a*, and b* values of the area applied DBAM were 60.1, 13.6, and 13.3, respectively, and the values of the area applied CAK were 60.1, 12.4, and 12.4, respectively. It was found that the skin color of the healed area after burn was darker, the redness was higher, and the yellowness was lower. After dressing, no significant side effects were observed, and in the cases of applying CAK, it was inconvenient as the moving area had to be fixed. CONCLUSION: As CAK, DBAM has several advantages such as the shortening of the epithelization period, reduction of scar and pigmentation, and convenient application, etc., it is an effective method for the partial thickness burn management.
Subject(s)
Humans , Amnion , Bandages , Burns , Cicatrix , Follow-Up Studies , Keratinocytes , Pigmentation , SkinABSTRACT
INTRODUCCIÓN: la evaluación de la superficie corporal quemada tiene gran importancia para el tratamiento inicial y el pronóstico del paciente quemado. Se revisan los diferentes métodos para evaluar la superficie corporal quemada y algunos conceptos básicos de reanimación.MATERIALES Y MÉTODOS: se realizó un estudio descriptivo, retrospectivo y transversal a partir de las historias clínicas de los pacientes quemados hospitalizadosen el Hospital Universitario San Vicente de Paúl (HUSVP) de Medellín durante el año 2004. Se compararon los diagnósticos de extensión quemada emitidos porel médico remitente, el médico del servicio de urgencias pediátricas o de adultos del HUSVP en el momento del ingreso del paciente a esta institución, y el cirujanoplástico de la unidad de quemados. Los datos obtenidos fueron procesados con el paquete EpiInfo 6,04 y se consideró como estadísticamente significativo un valor de p<0,05. Las variables se presentan como valores absolutos y sus respectivos porcentajes.RESULTADOS: fueron atendidos 329 pacientes. El 60 por ciento de los diagnósticos de remisión eran incompletos o errados, comparado con 39,2 por ciento de incompletos o incorrectos en el momento del ingreso a los servicios de urgencias del HUSVP; fueron más frecuentes los errores por exceso en la evaluación de la extensión de la superficie quemada, que por defecto. En la mayoría de los casos la magnitud del error fue suficiente para modificar la categoría de la quemadura (leve, moderada o severa). CONCLUSIONES: es necesario reforzar el conocimiento básico sobre la evaluación y tratamiento de las quemaduras en los médicos generales o especialistas que atienden servicios de urgencias.
Subject(s)
Burns/therapy , Burn UnitsABSTRACT
Artificial skin Integra - a biological membrane that could restore derma, is new material in treating burn wound and in many other specialties such as plastic surgery, orthopedics, and pediatrics. Integra was commonly used in cases deep burn on head and neck, hands. It speeds up formation new derma layers at implanted areas and the successful rate was high (95%), gives good results in functional and aesthetic aspects
Subject(s)
Skin, Artificial , Surgery, Plastic , Burns , TherapeuticsABSTRACT
The treatment process of serious burn patients has the characteristics of overwork,dirt, weariness……. Patient has nocompany, can not take care oneself. In addition, patients andrelatives can not supervies treatment work. Therefore doctors and nurses should have high sense of responsibility, sympathetic heart. And also the paper advances the moral request in the course of treatment.