A case of corrosive digestive tract and lung injury caused by ingestion of pipeline dredging agent / 中华劳动卫生职业病杂志

Ingestion of corrosive substances can severely burn the upper digestive tract leading to bleeding or perforation, and may even be life-threatening. Less commonly, damage to the trachea and bronchi is involved. In this paper, a case of corrosive digestive tract injury and lung injury after oral administration of pipeline dredging agent (the main components are hydroxide, sodium carbonate, sodium hypochlorite, etc.) was analyzed. After active rescue treatment, the patient died of massive hemoptysis. It is suggested that serious complications may occur after ingestion of corrosive substances. Timely diagnosis and reasonable medical management are needed to improve the level of recognition and treatment of such diseases.

Perfil clínico-epidemiológico de queimaduras químicas em uma Unidade de Terapia de Queimados no Brasil / Clinical-epidemiological profile of chemical burns in a Burn Therapy Unit (BTU) in Brazil

Introdução: Substâncias químicas apresentam uma prevalência relativamente baixa dentre as causas de queimaduras. Porém, têm importância, pois a maioria dos acidentes ocorrem no âmbito do trabalho e em população economicamente ativa. O objetivo é realizar uma análise do perfil dos pacientes internados por queimaduras químicas em uma Unidade de Queimados. Métodos: Análise retrospectiva de pacientes internados na Unidade de Queimados do Hospital Estadual de Bauru, Bauru, SP, Brasil, entre os anos de 2008 e 2018. Múltiplas variáveis foram analisadas, como idade, sexo, agente químico, local onde ocorreu o acidente, necessidade de internação em UTI e dias de hospitalização. Resultados: No total, 40 (1,7%) pacientes foram internados devido a queimadura química. A média de idade foi de 35 anos, com predominância do sexo masculino, com 30 (75%) indivíduos. O principal local do trauma foi no ambiente de trabalho, em 20 casos (50%). Acidentes com base foram responsáveis por 20 (50%) internações. A superfície corporal queimada média foi de 7,5%. Queimadura ocular ocorreu em 11 (27,5%) pacientes. Leito de terapia intensiva foi necessário para 10 (25%) casos. Quando comparados os acidentes entre substâncias ácidas e bases, evidenciamos diferença no número de pacientes internados em UTI, com oito pacientes em lesões envolvendo bases e dois com ácidos (p=0,04). Conclusão: A casuística e resultados apresentados neste artigo são semelhantes à literatura mundial sobre o assunto. Evidenciamos a importância dessa queimadura no ambiente de trabalho e o acometimento de indivíduos em idade ativa, assim como a maior gravidade de acidentes com substância química.

Introduction: Chemicals have a relatively low prevalence among the causes of burns. However, they are important because most accidents occur in the scope of work and in an economically active population. The objective is to perform an analysis of the profile of patients hospitalized for chemical burns in a Burn Unit. Methods: Retrospective analysis of patients hospitalized in the Burn Unit of the State Hospital of Bauru, Bauru, SP, Brazil, between 2008 and 2018. Multiple variables were analyzed, such as age, gender, chemical agent, place where the accident occurred, need for ICU stay and days of hospitalization. Results: In total, 40 (1.7%) patients were hospitalized due to chemical burn. The mean age was 35 years, with predominance of males, with 30 (75%) individuals. The main site of trauma was in the workplace, in 20 cases (50%). Based accidents were responsible for 20 (50%) admissions. The mean burned body surface was 7.5%. Eye burn occurred in 11 (27.5%) patients. Intensive care bed was required for 10 (25%) cases. When comparing accidents between acid iced substances and bases, we noted a difference in the number of ICU patients, with eight patients in lesions involving bases and two with acids (p=0.04). Conclusion: The sample and results presented in this article are similar to the world literature on the subject. We evidenced the importance of this burn in the work environment and the involvement of individuals of active age, as well as the greater severity of accidents with chemical substance.

Characteristic analysis and efficacy evaluation of bougie dilation and bougie dilation combined with stent implantation for pediatric caustic esophageal stenosis / 中华消化内镜杂志

To investigate the efficacy and safety of endoscopic bougie dilation and stent implantation for pediatric caustic esophageal stenosis. Clinical characteristics, diagnosis and treatment of children with pediatric caustic esophageal stenosis from October 2009 to December 2019 at Department of Gastroenterology, the Seventh Medical Center of PLA General Hospital were retrospectively analyzed. A total of 50 caustic esophageal stenosis cases were enrolled, among whom, 94.0% (47/50) received conservative treatment before sending to our hospital. Thirty-six (72.0%) of them accidently ingested caustic substance of alkali and 22.0% (11/50) of them accidently ingested caustic substance of acid. Forty-six children (92.0%) who ingested caustic agents were younger than 7 years old. The stenosis was more common in the upper esophagus, accounting for 64.0% (32/50). Twenty-seven cases (54.0%) underwent simple bougie dilation and 16 cases (32.0%) underwent bougie dilation combined with stent treatment. All 50 children underwent a total of 1 260 expansions. The numbers of simple dilations and dilations combined with stent implantation were 37.8±26.2, 20.9±12.6 respectively with significant difference ( t=2.453, P=0.021). Among them, 2 cases (4.0%) underwent surgery, 5 cases (10.0%) underwent surgery combined with dilatation and stent implantation. The stenosis diameter widened significantly after treatment (1.1±0.2 cm VS 0.2±0.1 cm, t=23.004, P<0.001), and the Stooler grade of dysphagia improved significantly (grade 3.5±0.5 VS 1.2±0.7, t=19.925, P<0.001). Perforation occurred in only 1 patient, who was cured by conservative treatment with stent implantation. The total effective rate was 100.0% (50/50) and the satisfaction rate was 98.0% (49/50). Endoscopic bougie dilation and bougie dilation combined with stent implantation is safe and effective for pediatric caustic esophageal stenosis. Combination with stent implantation can reduce the number of dilation times.

Queimadura por asfalto: relato de caso e revisão terapêutica / Hot asphalt burns: case report and therapeutic review

As queimaduras por asfalto quente representam uma ameaça para a saúde devido ao risco de morte e adesão aos tecidos. Paciente do sexo masculino, 40 anos, vítima de queimadura de 1° e 2° graus por asfalto quente em 20% da superfície corporal. O asfalto aderido na pele foi removido no 4º dia de UTI com vaselina líquida, e as queimaduras, tratadas com cicatrizante tópico. As queimaduras por asfalto quente são graves e representam 1,4% dos casos hospitalizados. Acometem jovens nas regiões da pele e vias aéreas por inalação dos vapores. Remover o asfalto da pele caracteriza-se em grande desafio terapêutico.

Hot asphalt burns are a health threat due to the risk of death and adhesion to tissues. A 40-year-old man suffered first and second-degree burns by hot asphalt on 20% of the body surface area. The asphalt adhered to the skin was removed on the 4th day of the ICU stay with liquid petroleum jelly, and the burns were treated with healing gel. Burns caused by hot asphalt are serious and represent 1.4% of hospitalized cases. They affect young people in the skin and airways by inhaling the vapors. Removing asphalt from the skin is a major therapeutic challenge.

Severe corneal burn due to the accidental application of salicylic acid packed in a plastic dropper bottle / Quemadura corneal grave debida a la aplicación accidental de ácido salicílico envasado en un frasco gotero plástico

Eye burns due to the accidental application of pharmacological or nonpharmacological substances packaged in plastic dropper bottles have been described for more than three decades and continue to occur. These burns can cause potentially serious corneal injuries. We report the case of a patient who mistakenly applied salicylic acid to the right eye after confusing it with an eye lubricant, which caused him a severe corneal burn. Fortunately, after aggressive medical and surgical management (including oxygen therapy and amniotic membrane grafting), the visual results were good. We suggest conducting educational campaigns and taking legislative measures in our country to avoid packaging corrosive substances in this type of dropper bottle to reduce the risk of accidental burns.

Las quemaduras oculares por aplicación accidental de sustancias farmacológicas o no farmacológicas envasadas en frascos goteros plásticos, se han descrito desde hace más de tres décadas y siguen ocurriendo. Estas quemaduras pueden causar lesiones potencialmente graves de la córnea. Se presenta el caso de un paciente que se aplicó ácido salicílico en el ojo derecho al confundir el envase con el de un lubricante ocular, lo que le causó una grave quemadura corneal. Afortunadamente, tras un manejo médico y quirúrgico agresivo (incluida oxigenoterapia e injerto de membrana amniótica) los resultados visuales fueron buenos. Se sugiere hacer campañas educativas y adoptar normas en el país para evitar el envase de sustancias corrosivas en este tipo de frascos goteros, con el fin de disminuir el riesgo de quemaduras accidentales.

Closure of a full-thickness scalp burn that occurred during hair coloring using a simple skin-stretching method: A case report and review of the literature

Full-thickness scalp burns secondary to hair coloring are rare; however, such defects can be large and complex reconstruction of hair-bearing tissue may be necessary. Many skin-stretching devices that use gradual traction have been applied to take advantage of the viscoelastic properties of the skin. A 21-year-old female patient was seen with a burn defect on her occipital scalp leading to exposed subcutaneous tissue after chemical application of hair coloring in a salon. The dimensions of the wound were 10 cm×5 cm, and a skin graft or flap would have been necessary to close the defect. Two long transfixing K-wires (1.4 mm) and paired 3-wire threads (23 gauge), which are readily available in most hospitals, were applied over a period of 12 days for trichophytic closure of the defect. The remaining scalp scars after primary trichophytic closure with this skin-stretching method were refined with hair follicle transplantation. This skin-stretching method is simple to apply and valuable for helping to close problematic areas of skin shortage that would otherwise require more complicated procedures. This case shows a relatively unknown complication of hair coloring and its treatment.

Long-term outcomes with Boston type 1 keratoprosthesis in ocular burns / Resultados a longo prazo com o implante da ceratoprótese de Boston tipo 1 em queimaduras oculares

ABSTRACT Purpose: To evaluate the long-term outcomes of Boston type I keratoprosthesis (B-Kpro) in the management of patients with ocular burn injuries. Methods: This prospective study included all patients with ocular burns who underwent B-Kpro implantation at a tertiary eye care center between February 2008 and November 2015. Twelve patients (12 eyes) were enrolled. The procedures performed for managing ocular injury were identified, and information on ocular history, surgical procedures performed, and postoperative outcomes was collected. The main outcome measures were visual acuity, prosthesis retention, postoperative complications, and required surgical procedures. Results: Twelve eyes from 12 patients met the inclusion criteria for B-Kpro implantation, including nine eyes with alkali burns and three eyes with thermal burns. A total of 13 B-Kpro devices were implanted in the 12 eyes. The mean follow-up period was 60.8 months (range, 13-91 months). Preoperative best-corrected visual acuity ranged from counting fingers to light perception. Postoperative best-corrected visual acuity was better than 20/200 in 83.3%, 66.6%, and 57.1% of patients at 12, 48, and 60 months, respectively. The initial keratoprosthesis was retained in 10 (83.3%) eyes and was successfully replaced in one eye. The major cause of worsening of initial visual acuity was advanced glaucoma (four of 12 eyes). Conclusion: The anatomical and functional results support the use of B-Kpro for managing bilateral limbal stem cell deficiency secondary to ocular burns. However, glaucoma should be carefully evaluated, as it is a continuous threat that may result in irreversible visual loss in this population.

RESUMO Objetivo: Avaliar os resultados em longo prazo do implante da ceratoprótese de Boston tipo 1 (B-Kpro) no tratamento de pacientes vítima de queimadura ocular. Métodos: Trata-se de um estudo prospectivo envolvendo todos os casos de implante de B-Kpro 1 para queimadura ocular em um centro de oftalmologia terciário durante o período de fevereiro/2008 e novembro/2015. Doze pacientes (doze olhos) foram incluídos no estudo. Os procedimentos realizados para o manejo da queimadura ocular foram identificados, e os dados foram coletados com relação à história oftalmológica do paciente, procedimentos cirúrgicos realizados, e resultados pós-operatórios. Os principais parâmetros avaliados foram acuidade visual, retenção da prótese, complicações pós-ope ratórias e intervenções cirúrgicas necessárias. Resultados: Doze pacientes preencheram os critérios de inclusão para implante da B-Kpro, incluindo 09 olhos vítimas de queimadura por álcali e 03 olhos pós queimadura térmica. Um total de 13 B-Kpro tipo 1 foram implantadas em 12 olhos de 12 pacientes. O tempo de seguimento médio foi de 60,8 meses (variando, 13-91 meses). Melhor acuidade visual corrigida pré-operatória variou de conta dedos à percepção luminosa. Melhor acuidade visual corrigida pós-operatória foi melhor que 20/200 em 83,3%, 66,6% e 57,1% dos pacientes em 12 meses, 48 meses e 60 meses, respectivamente. A ceratoprótese inicialmente implantada permaneceu retida em 10 (83,3%) dos olhos e foi re-implantada com sucesso em um olho. A principal causa de piora da acuidade visual inicialmente atingida foi glaucoma avançado (4 de 12 olhos). Conclusão: Os resultados anatômicos e funcionais reportados neste estudo dão suporte ao uso da B-Kpro para o tratamento da deficiência límbica bilateral secundária a queimadura ocular. Glaucoma é o principal fator limitante e pode causar perda visual irreversível nesses pacientes.

Analysis on effects of modified dosage of calcium gluconate on patients with hydrofluoric acid burns not in hands or feet / 中华烧伤杂志

Objective@#To retrospectively explore the effects of modified dosage of calcium gluconate (CG) on the patients with hydrofluoric acid burns not in hands or feet.@*Methods@#One hundred and sixty patients with hydrofluoric acid burns not in hands or feet were hospitalized in our burn ward from January 2004 to December 2017. Based on the dosage of CG at different admission time, 76 patients hospitalized from January 2004 to December 2012 were included in traditional group, and 84 patients hospitalized from January 2013 to December 2017 were included in modified group. For patients in the two groups, subcutaneous injection of CG solution at one time was immediately conducted on admission in topical treatment. In traditional group, the injection was CG solution with mass concentration of 100 g/L. For wounds of superficial partial-thickness and above degree, CG solution was prescribed at the dosage of 50 mg/cm2. Wounds of superficial-thickness or mass fraction of hydrofluoric acid less than 20.0% did not receive injection. In modified group, the mass concentration of CG solution for injection was diluted with normal saline to 25 g/L. For wounds of deep partial-thickness and above degree, CG solution was prescribed at the dosage of (50×mass fraction of hydrofluoric acid) mg/cm2. For wounds of superficial partial-thickness, CG solution was prescribed at the dosage of (25×mass fraction of hydrofluoric acid) mg/cm2. For wounds of superficial-thickness, CG solution was prescribed at the dosage of 2.5 mg/cm2. For systemic treatment, the injection velocity of CG solution via venous access was adjusted according to the level of serum calcium namely total serum calcium of patients in traditional group. In modified group, serum ionized calcium was additionally detected through automatic blood gas analyzer by the bed to regulate the injection velocity of CG via venous access. The incidence rate of hypercalcemia and mortality of patients after treatment in the two groups, and the situation about treatment of survivors in the two groups were analyzed. Data were processed with chi-square test, Fisher′s exact probability test, t test, and Mann-Whitney U test.@*Results@#(1) After treatment, 9 patients (11.8%) had hypercalcemia, while the other 67 patients (88.2%) did not have hypercalcemia in traditional group. Two patients (2.4%) had hypercalcemia, while the other 82 patients (97.6%) did not have hypercalcemia in modified group. The incidence rate of hypercalcemia of patients in traditional group was significantly higher than that in modified group (χ2=5.579, P=0.02). (2) There were two deaths (2.6%) and 74 survivors (97.4%) in traditional group, while there were two deaths (2.4%) and 82 survivors (97.6%) in modified group. The mortalities of patients in the two groups were close (P>0.05). (3) The ratios of eschar excision and skin grafting and hyperplastic scar formation, wound healing time, and ratio of esophageal scar stenosis of survivors in the two groups were close (χ2=0.002, 0.054, Z=0.66, P>0.05).@*Conclusions@#Hydrofluoric acid is highly dangerous. The early management of patients with hydrofluoric acid burns emphasizing specialized dosage of CG for treatment can be helpful to reduce incidence of complications and improve the safety of treatment.

Analysis on clinical characteristics of 316 patients with hydrofluoric acid burns / 中华烧伤杂志

Objective@#To investigate the clinical characteristics of patients with hydrofluoric acid (HF) burns.@*Methods@#Clinical data of 316 patients with HF burns admitted to Zhejiang Quhua Hospital from January 2004 to December 2016 were retrospectively analyzed. Patients were divided into non and mild poisoning group (NMP, n=157), moderate poisoning group (MP, n=120), and severe and fatal poisoning group (SFP, n=39) based on the severity of poisoning. Occurrences of hypocalcemia, hypomagnesemia, hypokalemia, and hyperkalemia of patients within 24 hours after admission were recorded. Values of emergency urinary fluoride of patients on admission were recorded. Values of urinary fluoride of patients admitted to hospital in 4 hours post injury in groups MP and SFP at post injury hour 4, 12, and 24 and on post injury day 2, 3, 4, 5, 6, and 7 were also recorded. Electrocardiographic abnormalities of patients within 24 hours after admission were recorded. Data were processed with chi-square test, Kruskal-Wallis H test, and Mann-Whitney U test.@*Results@#(1) Hypocalcemia, hypomagnesemia, and hypokalemia occurred in some patients in each of the three groups, but no patient had hyperkalemia. Taking serum calcium namely total serum calcium as reference, the incidence rate of hypocalcemia of patients in group NMP was close to that in group MP (χ2=0.05, P>0.05). The incidence rate of hypocalcemia of patients in group SFP was significantly higher than that in group NMP or group MP (χ2=10.53, 7.92, P<0.01). The incidence rates of hypokalemia in the three groups were close (χ2=0.63, P>0.05). Taking serum ionized calcium as reference, the incidence ratio of hypocalcemia of patients in group NMP was close to that in group MP (χ2=0.01, P>0.05), while there were statistically significant differences in incidence ratio of hypocalcemia of patients between group SFP and each of group NMP and group MP (χ2=4.66, 4.47, P<0.05). Taking serum calcium as reference, the incidence rate of hypocalcemia of patients was 7.3% (23/316). Taking serum ionized calcium as reference, the incidence rate of hypocalcemia of patients was 60.0% (42/70), which was significantly higher than that of taking serum calcium as reference (χ2=113.74, P<0.01). The incidence rates of hypomagnesemia of patients in groups MP and NMP were close (χ2=0.02, P>0.05). The incidence rate of hypomagnesemia of patients in group SFP was significantly higher than that in group NMP or group MP (χ2=14.69, 9.94, P<0.01). (2) The urinary fluoride levels were tested in 288 patients, with the value of emergency urinary fluoride of patients on admission 0.2-590.0 mg/L. The values of urinary fluoride of 202 patients were above the normal value. The values of emergency urinary fluoride of patients in groups NMP, MP, and SFP were 2.15 (1.11, 4.30), 5.89 (1.72, 14.25), and 36.0 (13.2, 103.2) mg/L, respectively. The values of emergency urinary fluoride of patients in groups MP and SFP were significantly higher than the value in group NMP (χ2=23.28, 66.03, P<0.01). The value of emergency urinary fluoride of patients in group SFP was significantly higher than that in group MP (χ2=39.23, P<0.01). The value of urinary fluoride of 33 patients admitted to hospital within 4 hours post injury in groups MP and SFP reached the top at 4 hours post injury and then gradually declined, which returned to normal on about 5 days post injury. The values of urinary fluoride of patients in group SFP at 4, 12, and 24 hours post injury and on 2, 3, 4, 5, 6, and 7 days post injury were significantly higher than those in group MP (Z=-4.28, -4.15, -3.81, -4.21, -2.48, -2.06, -2.31, -2.68, -3.03, P<0.05 or P<0.01). (3) Twenty-seven patients had electrocardiographic abnormality. There were 12 patients with T wave changes (the most common), 8 patients with ST-T changes, 6 patients with ventricular arrhythmias, 6 patients with conduction block, and 1 patient with broadened QRS waveform. There was no patient with prolonged Q-T interval. The ratios of patients with the above electrocardiographic abnormalities in group SFP were higher than those in group NMP and group MP.@*Conclusions@#Clinical manifestations of patients with HF burn are hypocalcemia, hypomagnesemia, hypokalemia, and electrocardiographic abnormality. In addition to routine serum electrolyte and electrocardiogram monitoring, the levels of serum ionized calcium and urinary fluoride can be helpful to evaluate the severity of illness of the patients.

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.

Acute Kidney Injury Following Chemical Burns Caused by Hexavalent Chromium / 대한내과학회지

The metal chromium is widely used in industry. Hexavalent chromium is a strong oxidizing agent, and exposure to some hexavalent compounds can cause serious problems, such as skin ulcers, acute gastroenteritis, acute tubular necrosis with renal failure, and hepatic necrosis. We report a case of acute kidney injury following skin exposure to hexavalent chromium, which burned a relatively small percentage of the total body surface area (TBSA). A 49-year-old man developed oliguria and acute kidney injury 3 days after burning about 5% of his TBSA with chromic acid solution, causing second-to third-degree chemical burns. His creatinine level increased to 12.5 mg/dL. The patient underwent hemodialysis with supportive care. His renal function improved and the dialysis was discontinued. The serum and urine chromium concentrations also decreased.

Protective effects of citric acid-disodium hydrogen phosphate rinsing solution on ocular surface of mice with acute chemically induced corneal burns / 中华实验眼科杂志

Background Immediately ocular rinsing is a key step for the prevention of eye tissue damage after acute chemical bums.A good ophthalmic rinsing solution can neutralize chemical substance and improve the prognosis of patients.Objective This study attempted to evaluate the therapeutic effect of self-made citric aciddisodium hydrogen phosphate buffer and citric acid-disodium hydrogen phosphate-potassium chloride buffer on corneal chemical burns in mice.Methods Citric acid-disodium hydrogen phosphate buffer solution (solution 1) and citric acid-disodium hydrogen phosphate-potassium chloride buffer solution (solution2) with the pH 7.4 were prepared.One hundred and twenty clean male C57 mice aged 6-8 weeks were randomized to two groups,and filter papers containing 1 mol/L H2SO4 or 0.15 mol/L NaOH were attached to the central corneas of the right eyes to create the acid or alkali burning models.Then the eyes were immediately rinsed by 40 ml solution 1,tap water or solution 2 according to the grouping and the model eyes without rinsing served as the control group.The corneal opacity was examined by slit lamp microscope and scored in 3,7 and 14 days after modeling.The percentages of corneal fluorescein staining,corneal neovascularization and corneal ulcer were analyzed.The study protocol was approved by Experimental Animal Ethic Commission of Second Military Medical University.Results In the corneal acid burning models,the number of eye with corneal opacity scored 1 in the solution 1 group,tap water group and solution 2 group was significantly more than that in the non-rinsing group in 3,7 and 14 days after modeling (all at P＜0.01);In 3 days after modeling,the numbers of eye scored 1 were more in the solution 1 group than those in the tap water group and solution 2 group (x2 =11.000,P =0.001;x2 =4.000,P =0.046).There were no differences in the eye number of different corneal opacity scores in 14 days after acid burning (all at P＞0.05).In 3,7 and 14 days after corneal alkali burning,the number of eyes with corneal opacity scored 1-2 was significantly increased in the solution 1 group,tap water group and solution 2 group compared with non-rinsing group (all at P＜0.01).The percentage of corneal ulcer in the solution 1 group,tap water group and solution 2 group was 7％,27％ and 13％,respectively,which was significantly lower than 73％ in the non-rinsing group (P =0.000,0.027,0.003),and no significant differences were seen in various time points after corneal alkali burning (all at P＞O.05).Corneal neovascularization occurred in 50％ mice in non-rinsing group in 14 days after acid burning.However,no neovascularization was seen in the mice of the solution 1 group,tap water group and solution 2 group in both acid and alkali burning mice.Conclusions Citric aciddisodium hydrogen phosphate buffer (pH 7.4) appears to be an effective emergency rinsing solution for corneal chemical burns and the rinsing solution with or without potassium chloride is not obviously affected to the prognosis of corneal chemical burns in the mice.

Comparação dos efeitos do ácido hialurônico 0, 2% e ácidos graxos essenciais em paciente com queimadura por fertilizante: relato de caso / Comparison of the effects of hyaluronic acid 0. 2% and essential fatty acids in burn victim due to fertilizer exposure: case report / Comparación de los efectos del ácido hialurónico 0, 2% y los ácidos grasos esenciales en víctima de quemaduras debido a la exposición a fertilizante: relato de caso

Objetivo: Relatar a experiência no tratamento de queimadura decorrente de exposição a fertilizante, comparando o uso de creme de ácido hialurônico (AH) e ácidos graxos essenciais (AGE), em paciente atendido pelo programa Estratégia Saúde da Família (ESF) de Jaguariúna, SP. Relato de caso: P.C.M., sexo masculino, 46 anos, com queimaduras de 2o grau superficial e pequenas áreas de 2o grau profundo nas duas mãos, decorrentes do uso de fertilizante, sem sinais de infecção ou demais complicações. Foi atendido em Unidade de ESF, onde foi iniciado protocolo de limpeza diária das lesões com soro fisiológico 0,9%. Na mão direita, foi aplicada fina camada de AH 0,2% e, na mão esquerda, AGE, na mesma frequência de uso do AH. Os curativos foram feitos pela enfermeira e técnica da ESF. A evolução da reparação da lesão foi acompanhada e avaliada diariamente por esses profissionais. Resultados: Após 60 dias de uso tópico de creme contendo AH 0,2%, ocorreu a completa cicatrização da mão direita. Na mesma data de avaliação, a mão esquerda ainda apresentava fissuras e descamação, não demonstrando total cicatrização. Com a piora do quadro da mão esquerda, optou-se por suspender o uso do AGE e iniciar o uso de AH uma vez ao dia. Após 39 dias, foi verificado que a lesão estava completamente cicatrizada. Conclusão: Os resultados demonstraram que o uso de AH proporcionou cicatrização de forma mais rápida e efetiva para queimadura decorrente da exposição a fertilizante, em comparação ao AGE.

Objective: To report the experience in treating a burn victim due to fertilizer exposure comparing hyaluronic acid (HA) cream and essential fatty acids (EFA), who was treated by Health Family Strategy (HFS) of Jaguariuna, SP. Case report: P.C.M., male, 46 years old, with superficial second-degree burn injuries and small areas with deep second degree burn on both hands, caused by fertilizer exposure. There were no signs of infection or other complications. He was treated at HFS Unit where a protocol to clean the wound with saline solution 0.9% was initialized. On his right hand was applied HA 0.2% and on his left hand was applied EFA following the same routine in both hands. A nurse and a technical nurse of the HFS Unit did all the dressings and evaluated the wounds daily. Results: The complete reparation of the injury on the right hand was achieved after 60 days applying HA 0.2%. In the same period, the left hand was still not fully recovered and presented fissure and peeling, with this result the nurses decided to suspend the EFA and start using HA on the left hand once a day. After 39 days, the left hand was entirely recovered. Conclusion: These results demonstrate that the use of HA provided healing more quickly and effectively to burn due to exposure to fertilizer, as compared to the EFA.

Objetivo: Presentar la experiencia en el tratamiento de quemaduras debido a la exposición a fertilizante, comparando el uso de la crema de ácido hialurónico(AH) y ácidos grasos esenciales(AGE),en pacientes atendidos por el Estratégia Saúde da Família(ESF) en la ciudad de Jaguariúna, São Paulo. Relato de caso: P.C.M., varón, de 46 años, con quemaduras de segundo grado superficiales y pequeñas áreas de segundo grado profundo en ambas manos, como resultado del uso de fertilizantes, sin signos de infección u otras complicaciones. El paciente fue tratado en la Unidad ESF, donde se inició el protocolo de limpieza diaria de las lesiones con solución salina al 0,9%. En su mano derecha se aplicó una capa fina de AH 0,2% y en la mano izquierda, AGE, en la misma frecuencia del uso de AH. Las curaciones fueron realizadas por la enfermera y la técnica de enfermería de ESF. La evolución del reparo de la lesión fue acompañada y evaluada diariamente por esos profesionales. Resultados: Después de 60 días de utilización de AH 0,2% em crema, se observó completa cicatrización de la mano derecha. En la misma data, la mano izquierda aún presentaba grietas y descamación, no siendo observado cicatrización completa. Con la imagen de la izquierda empeoramiento, se decidió suspender el uso del AGE y comenzar a usar AH una vez al día. Después de 39 días, se encontró que la lesión se curó completamente. Conclusión: Estos resultados demuestran que el uso de HA proporciona una curación más rápida y efectiva para quemaduras debido a la exposición a fertilizantes en comparación con la AGE.

Molten metal-related ocular thermal burn: report on two cases / Queimadura térmica ocular por metal derretido: relato de dois casos

ABSTRACT We report two cases of severe thermal burns on the ocular surface and its adnexal appendages that developed secondary to exposure to molten heavy metal with a melting temperature of near-thousand degree Celsius. Despite aggressive intervention and strict monitoring, the profound inflammation caused significant damage to the ocular surface, ending up in an intractable infection with an unfavorable outcome. The heat of the molten metal at impact, the heat-retaining capacity of the heavy metal, the total area of the ocular surface exposed to the molten metal, and the duration of exposure determined the severity of the injury. The unfavorable outcome, despite an intensive treatment, in terms of visual acuity and cosmetic appearance, should be explicitly explained to the patient, and a psychiatrist consultation should be considered if necessary.

RESUMO Relatamos dois casos de queimaduras graves da superfície ocular e seus anexos causadas por exposição à metais pesados derretidos com temperatura de fusão de quase mil graus Celsius. Embora rigorosamente acompanhados, a inflamação intensa causou danos significativos para a superfície ocular, que acabou em uma infecção intratável com um resultado desfavorável. O calor do metal fundido no momento do impacto, a capacidade de retenção de calor do metal pesado, a área total da superfície ocular exposta ao metal fundido e a duração da exposição determinaram a gravidade da lesão que vai ocorrer. O resultado desfavorável, apesar do tratamento intensivo, em relação à acuidade visual e à aparência estética, devem ser claramente explicados ao paciente e uma consulta ao psiquiatra deve ser considerada, se necessário.

Limbal transplantation at a tertiary hospital in Brazil: a retrospective study / Transplante de limbo em hospital terciário no Brasil: estudo retrospectivo

ABSTRACTPurpose:Epidemiological analysis of limbal transplantation surgeries performed in the Ophthalmologic Hospital of Sorocaba.Methods:Retrospective medical records review of 30 patients who underwent limbal stem cell transplants between January 2003 and March 2008. Cases involving conjunctival limbal autograft were classified as group I, and those involving conjunctival limbal allograft as group II.Results:Two patients were excluded due to incomplete data during postoperative follow-up. Of the total sample of 28 patients, 53.6% constituted group I, whereas 46.4% were included in group II. Males were predominant (67.9%), and right eyes were the most prevalent (67.9%). The mean age was 40.3 years. Unilateral cases accounted for 60.7%. The most frequent pathology causing limbal system failure was chemical burns (53%). The mean length of time from diagnosis to surgery was 11.18 years. The limbal graft and amniotic membrane were associated in 75% of all cases, and tarsorrhaphy in 57.1%. The average follow-up period was 24.84 months. The uncorrected visual acuity improved in 38% of the cases, was unchanged in 28.5%, and deteriorated in 33.3%. There was no persistent epithelial defect in 75% of the patients. The conjunctivalization rate was similar between the groups (53.3% and 58.3%, respectively). The transparency improved in only 38.4% of the cases, and 28.5% of the surgeries performed were successful. The most prevalent complication was persistent epithelial defect, which occurred in 25% of the patients, followed by corneal melting in 14.2%. Other complications observed included infectious ulcers, limbal graft necrosis or ischemia, perforation, and descemetocele.Conclusion:Chemical burns remain the main cause of limbal stem cell deficiency. In these cases, limbal transplantation is the standard procedure to restore the ocular surface even though the success rate is low.

RESUMOObjetivo:Análise epidemiológica dos transplantes de limbo realizados no Hospital Oftalmológico de Sorocaba.Método:Foi realizada uma análise retrospectiva através de revisão de prontuário de trinta casos de transplante de limbo realizados no período de janeiro de 2003 a março de 2008. Casos de transplante de limbo autólogo foram classificados como grupo I e alogênicos como grupo II.Resultados:Dois pacientes foram excluídos da análise por insuficiência de dados nos registros. Da amostra completa de 28 pacientes, 53,6% constituíram o grupo I enquanto 46,4% o grupo II. O olho direito (68%) e o sexo masculino (68%) foram mais acometidos, com uma média de idade de 40,3 anos. Casos unilaterais contabilizaram 60,7%. A patologia de base causadora da deficiência límbica mais prevalente foi a queimadura química (53%). A média do tempo de doença até a cirurgia foi de 11,18 anos. Na maioria dos casos o transplante foi associado a membrana amniótica (75%) e tarsorrafia (57%). O tempo médio de seguimento foi de 24,84 meses. Foi observado melhora da acuidade visual não corrigida em 38% dos casos enquanto 28,5% permaneceram inalteradas e 33,3% pioraram. Evolução sem defeito epitelial persistente ocorreu em 75% dos pacientes. A taxa de conjuntivalização foi semelhante nos 2 grupos (53,3% e 58,3%). Em apenas 38% dos casos houve melhora da transparência. A taxa de sucesso foi de cerca de 28%. A complicação mais prevalente foi defeito epitelial persistente (25%) seguida de melting (14,2%). Outras complicações observadas foram úlceras infecciosas, necrose ou isquemia do enxerto, perfuração e descemetocele.Conclusões:A queimadura química permanece como principal patologia causadora de deficiência límbica. Nestes casos o transplante de limbo é atualmente a técnica de eleição para restauração da superfície ocular, porém com baixa taxa de sucesso.

Evaluation of Stem Cell Components in Retrocorneal Membranes

The purpose of this study was to elucidate the origin and cellular composition of retrocorneal membranes (RCMs) associated with chemical burns using immunohistochemical staining for primitive cell markers. Six cases of RCMs were collected during penetrating keratoplasty. We examined RCMs with hematoxylin and eosin (H&E), periodic acid-Schiff (PAS) staining and immunohistochemical analysis using monoclonal antibodies against hematopoietic stem cells (CD34, CD133, c-kit), mesenchymal stem cells (beta-1-integrin, TGF-beta, vimentin, hSTRO-1), fibroblasts (FGF-beta, alpha-smooth muscle actin), and corneal endothelial cells (type IV collagen, CD133, VEGF, VEGFR1). Histologic analysis of RCMs revealed an organized assembly of spindle-shaped cells, pigment-laden cells, and thin collagenous matrix structures. RCMs were positive for markers of mesenchymal stem cells including beta-1-integrin, TGF-beta, vimentin, and hSTRO-1. Fibroblast markers were also positive, including FGF-beta and alpha-smooth muscle actin (SMA). In contrast, immunohistochemical staining was negative for hematopoietic stem cell markers including CD34, CD133 and c-kit as well as corneal endothelial cell markers such as type IV collagen, CD133 except VEGF and VEGFR1. Pigment-laden cells did not stain with any antibodies. The results of this study suggest that RCMs consist of a thin collagen matrix and fibroblast-like cells and may be a possible neogenetic structure produced from a lineage of bone marrow-derived mesenchymal stem cells.

The expression and significance of connective tissue growth factor after rat corneal alkali burn / 中国医师杂志

Objective To evaluate the effects of connective tissue growth factor (CTGF) on corneal neovascularization.Methods Twenty-five Wistar rats were divided into control and experimental groups.Corneal neovascularization (CNV) was induced by alkaline burn of the cornea with 1 mmol/L NaOH.On the 1st,4th,7th,and 14th day,CNV was observed,and the expression of CTGF was investigated with immunohistochemical method in rat cornea at the different time point.Results On the 4th day,7th day and 14th day after alkaline burn,the areas of CNV were (12.740 ±2.536) mm2,(26.068 ± 10.028) mm2,and (37.588 ± 8.066) mm2,respectively.CTGF was rarely expressed in the cornea of normal rats,and then CTFG expression was quickly increased after alkaline burn,reached the highest level on the 4th day (1.714 ± 0.185),and then declined remarkably on the 7th day (1.334 ± 0.198).Conclusions CTGF might be involved in the formation process of corneal neovascularization after corneal alkali burn.

A importância do atendimento pré-hospitalar nas queimaduras químicas no Brasil / The importance of pre hospital care in chemical burns in Brazil

O autor apresenta dois relatos de casos que demonstram o aumento da eficáciae eficiência envolvendo os serviços de atendimentos pré-hospitalares de urgências relacionados às queimaduras químicas. A relação tempo x qualidade de prognóstico decorre de uma otimização dos recursos tecnológicosexistentes e disponíveis, agregando valores e resultados. A utilização de um descontaminante químico do tipo quelante, como o Diphoterine, pode modificar a história evolutiva de uma agressão por produtos químicos, minimizando ou eliminando as sequelas advindas dos mesmos.

The author presents two case reports that demonstrate the increased effectiveness and efficiency, involving the pre hospital care services emergency related to chemical burns. The relationship time x quality of prognosis stems from an optimization of existing technological resources and available, aggregating values and results. The use of a chemical decontaminant to the remnants of chelation type, such as Diphoterine can modify the evolutionary history of an aggression by chemical products, minimizing or eliminating the consequences arising thereof.

Ação do bevacizumabe subconjuntival na neovascularização e re-epitelização corneana 25 dias após queimadura química / Effect of subconjunctival bevacizumab on corneal neovascularization and reepithelization 25 days after chemical burn

OBJETIVOS: Avaliar a ação do bevacizumabe subconjuntival em modelo experimental de neovascularização em córnea de coelho. Analisar se o modelo de avaliação empregado é adequado e comparar entre os grupos a extensão dos vasos, inflamação e re-epitelização da córnea. MÉTODOS: Estudo experimental, prospectivo em 20 coelhos submetidos a trauma químico com hidróxido de sódio a 1 N divididos em dois grupos, Imediatamente após a queimadura, o grupo tratado recebeu injeção subconjuntival de 0,15 ml (3,75 mg) de bevacizumabe e o grupo controle, injeção subconjuntival de 0,15 ml de soro fisiológico a 0,9 por cento. Após 25 dias, foi realizada análise fotográfica digital para avaliar a extensão e inflamação/calibre dos vasos segundo critério pré-estabelecido e estudo histopatológico da córnea, no qual foi avaliado o estado do epitélio e o número de polimorfonucleares. RESULTADOS: A extensão dos neovasos corneanos foi menor no grupo estudo em relação ao controle (p<0,001). Não houve diferença significativa entre os grupos na inflamação/calibre dos vasos. A análise histopatológica mostrou que não ocorreu diferença entre os grupos nas variáveis estado do epitélio e número de polimorfonucleares. A análise de concordância para a variável extensão dos vasos e para a variável inflamação/calibre dos vasos teve uma estimativa do coeficiente de Kappa respectivamente de 0,705 e 0,500 indicando bom grau de concordância nas diferentes avaliações cegadas, validando o método empregado. CONCLUSÕES: O modelo de avaliação foi adequado e pode ser reproduzido para avaliar outras drogas na córnea. O bevacizumabe inibiu a neovascularização corneana, porém não foi eficaz em reduzir o processo inflamatório. A droga não atrasou a re-epitelização da córnea.

PURPOSES: To evaluate the effect of subconjunctival bevacizumab in an experimental model of neovascularization in rabbit cornea. Determine its effect on vessels extension, inflammation, epithelialization of the cornea and whether the evaluation method used is appropriate to compare neovascular models. METHODS: Experimental, prospective, randomized, blinded study in twenty rabbits subjected to chemical trauma with sodium hydroxide at 1N divided into two groups. The study group received subconjunctival injection of 0.15 ml (3.75 mg) of bevacizumab and was compared with the control group that received subconjunctival injection of 0.15 ml saline solution. After 25 days, digital photographic analysis was performed to assess the vessel's extension and inflammation/diameter according to pre-established criteria. Histopathology of the cornea, which evaluated the state of the epithelium and the number of polymorphonuclear cells was also studied. RESULTS: The length of the neovessels was greater in the control group compared to the study group (P=<0.001). There was no difference in inflammation/vessel diameter between groups. Histopathology analysis showed that there was no difference between groups for the variables state of the epithelium and number of polymorphonuclear cells. The concordance analysis for the variable extension of the vessels and the variable inflammation/vessel diameter was estimated with Kappa coefficients of 0.705 and 0.500 respectively, indicating a good level of agreement in different evaluations and validating the method. CONCLUSIONS: The experimental model is adequate and can be reproduced to evaluate other drugs in the cornea. Bevacizumab inhibit the neovessels' growth but was not effective in preventing the inflammatory response. The drug did not delay the reepithelialization of the cornea.

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.