Epidemiological characteristics and treatment outcome analysis of 229 patients with hydrofluoric acid burns in hands / 中华烧伤杂志

Objective: To explore the epidemiological characteristics and treatment outcomes of patients with hydrofluoric acid burns in hands. Methods: A retrospective observational study was conducted. The medical records of 229 patients with hydrofluoric acid burns in hands who were admitted to Zhejiang Quhua Hospital from January 2008 to December 2020 and met the inclusion criteria were collected. The following statistical data of patients were collected, including gender, age, type of affiliated enterprise, hydrofluoric acid mass fraction, injury site, total burn area, prehospital time, length of hospital stay, length of wound healing, whether hypocalcemia and hypomagnesemia occurred or not on admission, whether surgery intervention was performed or not, and whether scar sequelae occurred or not. Single factor and multivariate logistic regression analysis were used to screen out the risk factors impacting surgery intervention and scar sequelae of all the patients and patients whose hydrofluoric acid mass fraction was known. Single factor and multivariate linear regression analysis were used to screen out the risk factors impacting the length of wound healing of all the patients and patients whose hydrofluoric acid mass fraction was known. Results: The 229 patients included 206 males and 23 females, with the majority aged 30 to 50 years (139 patients). The type of affiliated enterprise of majority patients was non-fluorine chemical enterprise. The hydrofluoric acid mass fraction was known in only 91 patients, mainly medium. The majority injury site was in the middle and end of finger. The total burn area was below or equal to 1% total body surface area. The prehospital time was 19 (9, 29) h. The length of hospital stay was 2 (1, 7) d. The length of wound healing was 12 (8, 18) d. The proportions of hypocalcemia and hypomagnesemia were 0.9% (2/229) and 1.3% (3/229) on admission, respectively. Thirty-six patients had surgeries and 83 patients had scar sequelae. In 229 patients, single factor logistic regression analysis showed that both type of affiliated enterprise and prehospital time were the factors impacting surgery intervention (with odds ratio values of 7.86 and 51.35, respectively, 95% confidence intervals of 1.83-33.76 and 11.89-221.78, respectively, P<0.01) and scar sequelae of patients (with odds ratio values of 3.62 and 27.40, respectively, 95% confidence intervals of 1.76-7.43 and 13.25-56.68, respectively, P<0.01); multivariate logistic regression analysis showed that prehospital time was the independent risks factor impacting surgery intervention and scar sequelae of patients (with odds ratio values of 43.00 and 24.55, respectively, 95% confidence intervals of 9.89-187.03 and 11.78-51.16, respectively, P<0.01); single factor linear regression analysis showed that both type of affiliated enterprise and prehospital time were the factors impacting the length of wound healing of patients (with β values of 6.16 and 12.83, respectively, 95% confidence intervals of 3.38-8.93 and 10.72-14.93, respectively, P<0.01); multivariate linear regression analysis showed that both type of affiliated enterprise and prehospital time were the independent risk factors impacting the length of wound healing of patients (with β values of 2.81 and 12.16, respectively, 95% confidence intervals of 0.50-5.13 and 10.00-14.31, respectively, P<0.05 or P<0.01). In 91 patients whose hydrofluoric acid mass fraction was known, single factor logistic regression analysis showed that type of affiliated enterprise, hydrofluoric acid mass fraction (low and high), and prehospital time were all the factors impacting surgery intervention of patients (with odds ratio values of 9.10, 11.25, 10.69, and 0.04, respectively, 95% confidence intervals of 1.15-72.25, 1.39-90.93, 1.32-86.59, and 0.01-0.19, respectively, P<0.05 or P<0.01), type of affiliated enterprise, hydrofluoric acid mass fraction, and prehospital time were all the factors impacting scar sequelae of patients (with odds ratio values of 0.32, 0.21, and 36.80, respectively, 95% confidence intervals of 0.11-0.92, 0.06-0.73, and 11.03-122.79, respectively, P<0.05 or P<0.01); multivariate logistic regression analysis showed that both hydrofluoric acid mass fraction and prehospital time were the independent risk factors impacting surgery intervention of patients (with odds ratio values of 11.51 and 0.04, respectively, 95% confidence intervals of 1.22-108.26 and 0.01-0.25, respectively, P<0.05 or P<0.01), prehospital time was the independent risk factor impacting scar sequelae of patients (odds ratio=37.71, with 95% confidence interval of 9.97-142.69, P<0.01); single factor linear regression analysis showed that type of affiliated enterprise, hydrofluoric acid mass fraction (low and high), and prehospital time were all the factors impacting the length of wound healing of patients (with β values of 7.12, -5.63, -9.74, and 13.50, respectively, 95% confidence intervals of 2.43-11.81, -10.59--0.68, -14.78--4.70, and 10.14-16.86, respectively, P<0.05 or P<0.01); multivariate linear regression analysis showed that both hydrofluoric acid mass fraction and prehospital time were the independent risk factors impacting the length of wound healing of patients (with β values of -5.84 and 0.09, respectively, 95% confidence intervals of -10.59--1.08 and 0.05-0.12, respectively, P<0.05 or P<0.01). Conclusions: The majority of patients with hydrofluoric acid burns in hands are young and middle-aged males. Type of affiliated enterprise, hydrofluoric acid mass fraction and prehospital time are the risk factors that affect the treatment outcomes of patients with hydrofluoric acid burns in hands.

Toxicidad por ácido fluorhídrico: reporte de casos / HYdrofluoric acid toxicity

Los accidentes con ácido fluorhídrico en Argentina son un motivo de consulta infrecuente, a pesar de ser utilizado en varias actividades laborales. Es uno de los pocos cáusticos con tratamiento específico que se debe tener en cuenta. Reportamos el caso de un paciente de 35 años que estuvo en contacto con esta sustancia con posterior compromiso de miembro superior, presentando placa eritematosa en región palmar derecha y lesión ampollar con descamación posterior y sangrado en lecho ungueal. Recibió tratamiento local con gluconato de calcio al 20% en toda la extensión de la zona afectada durante 48 hs con recuperación completa a los quince días. La sospecha clínica temprana y la administración adecuada de gluconato de calcio evitan lesiones de mayor grado y extensión

In Argentina, hydrofluoric acid accidents are a rare reason for consultation, despite being a commonly used substance in laboral activities. It is one of the few caustics with a specific treatment that must be taken into account. We report the case of a 35 year old patient affected by said substance, in which we observe an impairment of the upper limb, presenting on the right palmar region, an erythematous plaque with a blister lesion with posterior scaling and bleeding of the nail bed. The importance of the early clinical suspicion and the proper administration of calcium gluconate would avoid bigger and more extensive lesions

Alternativas de tratamientos de superficie para adhesión de cerámica de disilicado de litio / Alternatives of surface treatments for adhesion of lithium disilicate ceramics

Introduction: the clinical success of a restoration is strongly associated with the quality and durability of the ceramic-cement resin interface. In order to obtain an adequate union between these materials of different nature surface treatments are used and achieve mechanical retention or chemical interaction. Objectives: to check if any method promotes a true chemical bond between lithium disilicate ceramics and resin cement. As well as determineif there is any treatment that reports bonding values comparable to hydrofluoric acid and silane (gold standard). Methods: a systematic literature review was developed based on the PRISMA strategy, where the databases were searched: Science Direct, Pubmed (MEDLINE), EMBASE, Springer Journal, SciELO with MeSH and free terms from 2005 to November 2016 for articles in English and Spanish on surface treatments for lithium disilicate. Results: from 58 publications selected a sample of 21 articles. Two articles reported high risk of bias. Conclusions: hydrofluoric acid and silane continue to be the method with the highest and most reliable adhesion values in the literature. Universal adhesives are an alternative to promote chemical adhesion additional to the silane. Diamond burs, Nd: YAG and Er: YAG laser are not recommended as surface treatments(AU)

Introducción: el éxito clínico de una restauración se asocia fuertemente a la calidad y duración de la interface cerámica-cemento resinoso. Para que exista una adecuada unión entre estos materiales de distinta naturaleza se emplean tratamientos de superficie para lograr una buena retención mecánica o interacción química. Objetivos: revisar si algún método promueve una verdadera adhesión química entre la cerámica de disilicato de litio y el cemento resinoso, así como determinar si existe algún tratamiento que reporte valores de unión comparables al ácido fluorhídrico y silano (patrón de oro). Métodos: se desarrolló una revisión sistemática de literatura basada en la estrategia PRISMA, donde se buscó en las bases de datos: Science Direct, Pubmed (MEDLINE), EMBASE, Springer Journal, SciELO con términos MeSH y libres desde el 2005 a noviembre de 2016 para artículos en inglés y español sobre tratamientos de superficie para disilicato de litio. Resultados: de 58 publicaciones, se seleccionó una muestra de 21 artículos. Dos artículos reportaron riesgo de sesgo alto. Conclusiones: el ácido fluorhídrico y silano continúan siendo el método con los valores de adhesión más altos y confiables de la literatura. Los adhesivos universales son una alternativa para promover adhesión química adicional al silano. Fresas diamantadas, laser Nd: YAG y Er:YAG no se recomienda como tratamientos de superficie(AU)

Efeito da temperatura de secagem de dois tipos de silano e da supressão ou redução do tempo de condicionamento com ácido hidrofluorídrico na resistência de união entre uma cerâmica de dissilicato de lítio e um cimento resinoso / Effect of drying temperature of two silan types and elimination or reduction of conditioning hydrofluoridric acid time with the bond strenght between a lithium disilicate ceramic and a resin cement

Este estudo avaliou o efeito de diferentes métodos de silanização e aplicação do ácido hidrofluorídrico (HF) sobre a resistência à microtração de uma cerâmica de dissilicato de lítio a um cimento resinoso. Quarenta blocos de IPS e.max Press /Ivoclar Vivadent (5x5x6mm) foram cimentados a blocos de resina Z250/3M ESPE (5x5x6mm) usando o cimento resinoso RelyX ARC/3M ESPE de acordo com os seguintes métodos de tratamento superficial: G1: 20s de ácido fluorídrico (HF) + silano não hidrolisado Primer-Activactor/Dentsply (SNH) seco à temperatura ambiente; G2: 20s HF + silano pré-hidrolisado RelyX Ceramic-Primer/3M ESPE (SPH) seco à temperatura ambiente; G3: 10s HF + SNH seco com ar quente (50oC-2min); G4: 10sHF + SPH seco com ar quente (50oC-2min); G5: sem ácido, SNH seco com ar quente (50oC-2min); G6: sem ácido, SPH seco com ar quente (50oC-2min); G7: sem ácido, SNH seco à temperatura ambiente; G8: sem ácido, SPH seco à temperatura ambiente. Antes de cada método de silanização, os blocos cerâmicos receberam acabamento com lixas de carbeto de silício (220-600) e limpeza com ácido fosfórico 37% (1min). A cimentação foi realizada com carga vertical de 1kg por 10min. Os conjuntos de cerâmica/cimento/resina foram armazenados em água destilada (37ºC) por 24 horas e depois seccionados em máquina de corte Isomet 1000 a fim de obter palitos (n = 40) de ± 1mm2 de área da seção transversal, que foram submetidos ao teste de microtração em máquina de ensaio universal Emic (v = 0,5mm/min). O modo de fratura foi avaliado em microscópio eletrônico de varredura. A análise estatística foi realizada utilizando ANOVA / Dunnett (p-valor = 0,000). As médias MPa e desvio padrão foram: G1-21,5 (8,9) BC; G2-30,5 (7,2) A; G3-19.4 (9.1) BC; G4-24,0 (9,0) B; G5-8.1 (3.2) D; G6 -18,0 (6,2) C; G7-7.8 (2,6) D; G8-6.3 (2,5) D. Grupos 2, 3, 4 e 6 não tiveram falhas prematuras...

This study devaluated the effect of different types of silanization and hydrofluoric acid on the microtensile bond strength of a lithium dissilicate ceramic system. Forty IPS e.max Press /Ivoclar Vivadent blocks (5x5x6mm) were cemented to Z250/3M ESPE resin blocks (5x5x6mm) using RelyX ARC/3M ESPE resin-cement according to the following silanization methods: G1: 20s hydrofluoric acid (HF) + non-hydrolyzed silane Primer-Activactor/Dentsply (NHS) dried at room temperature; G2: 20sHF + pre-hydrolyzed silane RelyX Ceramic-Primer/3M ESPE (PHS) dried at room temperature; G3: 10sHF + NHS dried with hot air (50oC-2min); G4: 10sHF + PHS + hot air; G5: NHS + hot air; G6: PHS + hot air; G7: NHS dried at room temperature; G8: PHS dried at room temperature. Before each silanization method, all ceramic blocks were abraded with SiC grit papers (220-600) and cleaned with 37% phosphoric acid (1min). The cementation was made with vertical load of 01 kg for 10 min. After cementation procedure, all ceramic/ciment/resin blocks were stored in distilled water (37oC) for 24h before being cut to obtain stick-shapped specimens (n=45) of approximately 1mm2 cross-sectional area for microtensile test (v=0.5mm/min). Statistical analysis was performed using ANOVA/Dunnett (p-value = 0,000). The mean MPa(SD) values were: G1-21.5(8.9)BC; G2-30.5(7.2)A; G3-19.4(9.1)BC; G4-24.0(9.0)B; G5-8.1(3.2)D; G6-18.0(6.2)C; G7-7.8(2.6)D; G8-6.3(2.5)D. Groups 2, 3, 4 and 6 had no sticks premature fail against groups 1, 5, 7 and 8, that had 2.2, 44.4, 75.6 and 33.3% of sticks premature fails, respectively. As the correlation coefficient was statistically significant, -0.736 (p-value = 0.000), it could be argued that as the percentage of premature...

Efeito da temperatura de secagem de dois tipos de silano e da supressão ou redução do tempo de condicionamento com ácido hidrofluorídrico na resistência de união entre uma cerâmica de dissilicato de lítio e um cimento resinoso / Effect of drying temperature of two silan types and elimination or reduction of conditioning hydrofluoridric acid time with the bond strenght between a lithium disilicate ceramic and a resin cement

Este estudo avaliou o efeito de diferentes métodos de silanização e aplicação do ácido hidrofluorídrico (HF) sobre a resistência à microtração de uma cerâmica de dissilicato de lítio a um cimento resinoso. Quarenta blocos de IPS e.max Press /Ivoclar Vivadent (5x5x6mm) foram cimentados a blocos de resina Z250/3M ESPE (5x5x6mm) usando o cimento resinoso RelyX ARC/3M ESPE de acordo com os seguintes métodos de tratamento superficial: G1: 20s de ácido fluorídrico (HF) + silano não hidrolisado Primer-Activactor/Dentsply (SNH) seco à temperatura ambiente; G2: 20s HF + silano pré-hidrolisado RelyX Ceramic-Primer/3M ESPE (SPH) seco à temperatura ambiente; G3: 10s HF + SNH seco com ar quente (50oC-2min); G4: 10sHF + SPH seco com ar quente (50oC-2min); G5: sem ácido, SNH seco com ar quente (50oC-2min); G6: sem ácido, SPH seco com ar quente (50oC-2min); G7: sem ácido, SNH seco à temperatura ambiente; G8: sem ácido, SPH seco à temperatura ambiente. Antes de cada método de silanização, os blocos cerâmicos receberam acabamento com lixas de carbeto de silício (220-600) e limpeza com ácido fosfórico 37% (1min). A cimentação foi realizada com carga vertical de 1kg por 10min. Os conjuntos de cerâmica/cimento/resina foram armazenados em água destilada (37ºC) por 24 horas e depois seccionados em máquina de corte Isomet 1000 a fim de obter palitos (n = 40) de ± 1mm2 de área da seção transversal, que foram submetidos ao teste de microtração em máquina de ensaio universal Emic (v = 0,5mm/min). O modo de fratura foi avaliado em microscópio eletrônico de varredura. A análise estatística foi realizada utilizando ANOVA / Dunnett (p-valor = 0,000). As médias MPa e desvio padrão foram: G1-21,5 (8,9) BC; G2-30,5 (7,2) A; G3-19.4 (9.1) BC; G4-24,0 (9,0) B; G5-8.1 (3.2) D; G6 -18,0 (6,2) C; G7-7.8 (2,6) D; G8-6.3 (2,5) D. Grupos 2, 3, 4 e 6 não tiveram falhas prematuras...

This study devaluated the effect of different types of silanization and hydrofluoric acid on the microtensile bond strength of a lithium dissilicate ceramic system. Forty IPS e.max Press /Ivoclar Vivadent blocks (5x5x6mm) were cemented to Z250/3M ESPE resin blocks (5x5x6mm) using RelyX ARC/3M ESPE resin-cement according to the following silanization methods: G1: 20s hydrofluoric acid (HF) + non-hydrolyzed silane Primer-Activactor/Dentsply (NHS) dried at room temperature; G2: 20sHF + pre-hydrolyzed silane RelyX Ceramic-Primer/3M ESPE (PHS) dried at room temperature; G3: 10sHF + NHS dried with hot air (50oC-2min); G4: 10sHF + PHS + hot air; G5: NHS + hot air; G6: PHS + hot air; G7: NHS dried at room temperature; G8: PHS dried at room temperature. Before each silanization method, all ceramic blocks were abraded with SiC grit papers (220-600) and cleaned with 37% phosphoric acid (1min). The cementation was made with vertical load of 01 kg for 10 min. After cementation procedure, all ceramic/ciment/resin blocks were stored in distilled water (37oC) for 24h before being cut to obtain stick-shapped specimens (n=45) of approximately 1mm2 cross-sectional area for microtensile test (v=0.5mm/min). Statistical analysis was performed using ANOVA/Dunnett (p-value = 0,000). The mean MPa(SD) values were: G1-21.5(8.9)BC; G2-30.5(7.2)A; G3-19.4(9.1)BC; G4-24.0(9.0)B; G5-8.1(3.2)D; G6-18.0(6.2)C; G7-7.8(2.6)D; G8-6.3(2.5)D. Groups 2, 3, 4 and 6 had no sticks premature fail against groups 1, 5, 7 and 8, that had 2.2, 44.4, 75.6 and 33.3% of sticks premature fails, respectively. As the correlation coefficient was statistically significant, -0.736 (p-value = 0.000), it could be argued that as the percentage of premature...

Queimadura por ácido hidrofluorídrico e descontaminação com quelante anfótero e gluconato de cálcio: relato de caso / Hydrofluoric acid burn and decontamination with amphoteric chelator and calcium gluconate: case report

Um trabalhador sofreu projeção de ácido hidrofluorídrico a 70% de concentração em aproximadamente 10% de superfície corpórea (SC), causando queimaduras químicas de 1º, 2º e 3º graus em face, tronco e membro inferior esquerdo. A descontaminação inicial envolveu enxágue com água, remoção da vestimenta, e enxágue adicional com mais água, bem como aplicação tópica de solução de óxido de magnésio e analgésico intravenoso para controle da dor. Após retardo de aproximadamente 3 horas, realizou-se descontaminação ativa com 5 litros de solução ativa de um quelante anfótero, Hexafluoriner, seguida de aplicação intravenosa, intradérmica perilesional e tópica de gluconato de cálcio. Alívio da dor e sensação refrescante foram relatados após aplicação do quelante. Não ocorreu intoxicação sistêmica significante, embora isto tenha ocorrido em casos previamente relatados de exposição ao ácido hidrofluorídrico concentrado. Apesar das queimaduras, o paciente foi liberado da Unidade de Terapia Intensiva após 2 dias, e os tratamentos cirúrgicos posteriores, enxertia, tiveram bons resultados.

A worker was splashed with 70% hydrofluoric acid (HF), sustaining approximately 10% total body surface area (TBSA) 1st-3rd degree chemical skin burns on the face, trunk and left leg. Initial decontamination involved water rinsing, removal of clothing, and more water rinsing, as well as topical application of a magnesium oxide solution and administration of intravenous narcotics for management of severe pain. After a delay of approximately 3 hours, the active skin decontamination solution Hexafluoriner, 5 liters, was used followed by intravenous, intradermal perilesional and topical application of calcium gluconate. Pain relief and a cooling sensation were quite prompt. No significant systemic toxicity occurred, although this has occurred in previously reported concentrated HF exposure cases. While burns did develop, the patient was released from the intensive care service after 2 days and after skin grafting had a good outcome.

Quemaduras por agentes químicos / Chemical burns

Se realiza una revisión de la literatura nacional e internacional sobre quemaduras químicas. En primer término se describen las causas, la fisiopatología de las quemaduras y se presenta una clasificación de los compuestos químicos corrosivos que al ponerse en contacto con la piel general quemaduras químicas. Se destacan los ácidos inorgánicos, ácidos orgánicos, compuestos alcalinos y compuestos específicos que, por la naturaleza y gravedad de las lesiones que producen, requieren de una presentación individual, tales como el fósforo y el tetracloruro de titanio. A continuación se describen las medidas generales iniciales de tratamiento para toda quemadura química y algunas medidas especiales para corrosivos específicos de alta peligrosidad. Luego se definen las medidas de tratamiento local secundario. Por último, se incluye un párrafo especial para el manejo de las quemaduras oculares por agentes corrosivos. Al cierre, se destaca la necesidad de desarrollar una política educativa de prevención en el manejo de productos corrosivos como el mejor método par reducir la incidencia de lesiones graves