Methods of Investigation of Functional Disturbances After Burn Injury of the Foot.

BACKGROUND: Foot burns involve a specialized area of function, and although they involve a small total body surface area (3.5%), they can cause a significant degree of morbidity. METHODS: This study included 104 patients with burn trauma of the foot treated at the burn department of Republican Scientific Centre of Urgent Medical Aid and Inter-Regional Burn Center, Samarkand, Uzbekistan. A study of support-motor function of the foot after a burn by means of simultaneous registration of mechanograms of ankle join mobility in various terms made it possible to reveal considerable walking disturbances manifested in short-term support ability of various foot parts compared with normal. RESULTS: Deviations in podagrams were clearly marked during the first weeks after elimination of burn wounds, especially the duration of support ability of the plantar surface in those who experienced burns. CONCLUSIONS: The study in separate terms after elimination of burn injury showed that the function of feet begins to regenerate in 3 to 4 months in deep foot burns.

Frostbite in hot climates of Central Asia: retrospective analysis of the microflora of wound and antibiotic therapy.

The problem of deep frostbites belongs to one of the most complex in surgery. Treatment of such victims is very prolonged, expensive, requiring crippling operations resulting in disability. The purpose of this present study is of etiological structure of the wound microflora and its tolerance to antibacterial preparations in patients with cold injury in the regions with warm climate of severe degree. 57 microbiological investigations of wound secretions in 38 patients with severe cold injury treated in our Burn Department of RSCUMA, Samarkand, Uzbekistan had been carried out. Microflora of wounds in patients who suffered from cold injury is characterized by polyetiology and is presented by gramnegative (49.5%) and grampositive (50.5%) microorganisms. There are Pseudomonas aeruginosa (17.9%). Among gramnegative microorganisms. In this context sensitivity to preparations owing activity to Pseudomonas aeruginosa-Ceftazidim, Ceferin and Amycacin makes 48.8%, 54.5% and 81.3% accordingly. Prevailing flora of grampositive is Staphylococcus aureus (26.3% of agents), of which 60% makes MRSA. High resistance to Ciprofloxacin (66.6%), Erythromycin (52.5%) and Lincomycin (44.4%) is noted. The investigations give evidence that ABT in patient with severe frostbites is a serious problem and needs well-ground approach in prescribing antibacterial preparations.

Comparison of the effectiveness of novel intervention on restricted range of motion of shoulder in young healthy subjects.

OBJECTIVE: To evaluate the effectiveness of four novel and pragmatic interventions on the restricted range of motion (ROM) of shoulder joint in healthy subjects. METHODS: The study was conducted at Helping Hand Institute of Rehabilitation Sciences, Mansehra, in 6-months duration. This quasi-experimental study recruited 120 young subjects with an equal proportion of males and females for four novel intervention groups (n=30 each group) including pragmatic posterior capsular stretch, Serratus anterior stretch, rotator cuff facilitation and acromioclavicular joint mobilization. Study variables included measurement of Reaching up behind the back (RUBTB), Reaching down behind the neck (RDBTN), and shoulder range of motion (flexion, abduction, external rotation, internal rotation). The paired t-test was used for the change in pretest and posttest variables and the Kruskal Wallis test was used to compare the change in each group of interventions. RESULTS: All the variables improved significantly (p< 0.05) from their baseline scores for the interventions. The mean difference among the intervention groups for the variables was statistically significant (p<0.001) on the Kruskal Wallis test. Pragmatic posterior capsular stretch (PPCS) and serratus anterior stretch (SAS) improved the RUBTB and RDBTN more than the other interventions. Rotator cuff facilitation (RFC) improved shoulder rotation more than the rest of the intervention. Acromioclavicular joint mobilization (ACJM) was effective in improving the abduction and flexion ROM. CONCLUSION: Pragmatic interventions are effective in improving shoulder ROM in young healthy adults and recommended for the trials on prevention and rehabilitation of shoulder pathologies.

Frostbite injuries and our experience treatment in the Samarkand area Uzbekistan.

Cold injury remains one of the most complex and actual problems of emergency medicine. Frosting injuries are also observed in the regions with warm climate particularly in Uzbekistan able - bodies men suffer most often, 85-90% of them are admitted in the condition of alcohol intoxication. A retrospective review was performed of patients admitted to the Burn Department of the Centre of Emergency Medical Care with frostbite injury 92 individuals of 19 to 63 years of age. The data on each patient were collected including age, sex, period of injury, injuries of extremities, bacteriological investigations, along with general warming of victims, all patients were given intravenous injection of infusion spasm and to improve microcircula determination of the injury area and different general and local treatment. Treatment of these patients is very prolonged, expensive, frequently requiring crippling operations, resulting in disability.

A new method for the high-precision assessment of tumor changes in response to treatment.

Motivation: Imaging demonstrates that preclinical and human tumors are heterogeneous, i.e. a single tumor can exhibit multiple regions that behave differently during both development and also in response to treatment. The large variations observed in control group, tumors can obscure detection of significant therapeutic effects due to the ambiguity in attributing causes of change. This can hinder development of effective therapies due to limitations in experimental design rather than due to therapeutic failure. An improved method to model biological variation and heterogeneity in imaging signals is described. Specifically, linear Poisson modeling (LPM) evaluates changes in apparent diffusion co-efficient between baseline and 72 h after radiotherapy, in two xenograft models of colorectal cancer. The statistical significance of measured changes is compared to those attainable using a conventional t-test analysis on basic apparent diffusion co-efficient distribution parameters. Results: When LPMs were applied to treated tumors, the LPMs detected highly significant changes. The analyses were significant for all tumors, equating to a gain in power of 4-fold (i.e. equivalent to having a sample size 16 times larger), compared with the conventional approach. In contrast, highly significant changes are only detected at a cohort level using t-tests, restricting their potential use within personalized medicine and increasing the number of animals required during testing. Furthermore, LPM enabled the relative volumes of responding and non-responding tissue to be estimated for each xenograft model. Leave-one-out analysis of the treated xenografts provided quality control and identified potential outliers, raising confidence in LPM data at clinically relevant sample sizes. Availability and implementation: TINA Vision open source software is available from www.tina-vision.net. Supplementary information: Supplementary data are available at Bioinformatics online.

Some different treatment of sandal burns of the hand in children.

The hands account for less than 5% of total body surface area, but loss of the hand constitutes a 57% loss of function for the whole person. In Central Asia, and particularly in Uzbekistan, many episodes of burns take place at homes because of using sandal heaters. During a 16-year period (1992-2007), 61 patients with severe sandal burns of the hand were treated at the Burn department of RSCUMA and Samarkand Inter-Regional Burn Center, Uzbekistan. The main goal of this work was to present the most complete information about sandal burns of the hand and discuss the most effective methods of treatment for sandal burns. As a result of using this method of treatment for burned children in our practice, the percentage of post burn consequences, such as the impact on mobility and growth of the extremities, was greatly reduced.

Laparoscopic management of hydatid cyst of the liver.

BACKGROUND: Hydatid liver disease management has evolved from traditional operative approaches to the increasing application of laparoscopic treatments. We aimed to prospectively assess the early outcomes of laparoscopic treatment at our institution. PATIENTS AND METHODS: Forty-four patients with hydatid disease of liver were screened with ultrasonography and computed tomography of the abdomen to exclude Gharbi type V cysts. The distribution of cyst sizes was: 1-4 cm, 10; 5-10 cm, 24; 10-15 cm, 8; > 15 cm, 2 patients. The following laparoscopy therapies were performed: 30 patients had cystectomy alone, 14 patients had partial pericystectomy. Pericystectomy was performed using a hook and harmonic tissue sealers with the resection made through normal liver tissue. RESULTS: Three patients were converted to open surgery. Seven patients had biliary leakage through their cystic cavity drains. Five stopped spontaneously by the 7th postoperative day and 2 responded to ERCP sphincterotomy. There were no deaths and no recurrence of disease noted by 6 months. CONCLUSION: In selected patients with hepatic hydatid disease, a laparoscopic treatment is feasible and safe with low conversion rate and short term recurrences.

Treatment of sandal burns of the feet in children in a moist environment.

Burns to children's feet are often due to scalds, from hot tap water, as an infant's skin is thinner and hence more susceptible to a full-thickness injury. In Central Asia, and particularly in Uzbekistan, many episodes of burns take place at homes because of using sandal heaters. In the case of sandal burns of the foot, it usually is not only skin that is injured but also underlying tissues: subcutaneous fat, fasciae, muscles and even bones. Many controlled studies have confirmed that wounds heal more readily in a moist, physiological environment. After performing the toilet of burn wounds of the foot, we applied Dermazin cream on the affected areas and then the foot was placed onto a polyethylene packet of large size and fixed by a bandage. Measurement of wound water evaporation was performed every day post-burn. Surgery was usually performed 15-17 days after burn by applying a perforated skin graft or a 0.2-0.3-mm-thick non-perforated skin graft. The procedures helped to improve the general condition of patients, shortened their stay in hospital and also reduced expenses and lessened joint deformities and contracture deformities.

Neuroendocrine and epithelial phenotypes in small-cell lung cancer: implications for metastasis and survival in patients.

BACKGROUND: Small-cell lung cancer (SCLC) has a very aggressive clinical course with early metastasis. This study investigated how the distinctive neuroendocrine characteristics contribute to disease progression and invasion in human SCLC. METHODS: The neuroendocrine phenotype (pro-opiomelanocortin (POMC)) was quantified by ELISA in blood samples from 43 SCLC patients. The neuroendocrine (POMC, chromogranin A, neuron-specific enolase, NCAM) and epithelial (cytokeratin and E-cadherin) phenotypes were investigated, using ELISA and immunocytochemistry/immunohistochemistry. RESULTS: In SCLC patients, 16% had elevated circulating POMC, which was associated with significantly worse survival (P=0.02) and liver metastases (P=0.004). In addition, POMC correlated with epithelial-positive circulating tumour cells (P=0.0002). In a panel of SCLC cell lines, all POMC-secreting cell lines expressed cytokeratin (40% of total). Even after cloning, DMS 79 cells expressed both neuroendocrine and epithelial markers. DMS 79 xenografts secreted POMC into the blood, which mirrored the tumour volume. These xenografts expressed both neuroendocrine and epithelial phenotypes in all tumours, with both phenotypes prevalent in cells invading the surrounding tissue. CONCLUSION: Both neuroendocrine and epithelial phenotypes coexist in human SCLC tumours in vitro and in vivo and this persists in invading tumour cells. In patients, POMC secretion predicts poor survival and liver metastases, suggesting a crucial role of the neuroendocrine phenotype.

Different surgical treatment of post-burn trophic ulcers of the plantar surface in foot burns.

Burns of the plantar surface of the foot with the subsequent formation of scar is often complicated by unhealing trophic ulcers. Trophic ulcers increase due to constant local irritation, reaching various depth and area, penetrating to the bone and the tendons and covering the area of several centimetres in diameter up to the whole heel area. A total of 21 patients (12 men and nine women) have been under our observation at Samarkand Inter-Regional Burn Center, Uzbekistan, for prolonged trophic ulcers of soft tissues of the plantar surface of the foot. Ulcers sizes were from 1.0-2.5 to 3-5 cm in diameter. All patients had undergone earlier unsuccessful operation (3-5 times). The method of closure should be chosen according to both severity and localisation of the injury, using local uninjured tissues and soft scars to make bilobed skin-flap plasty, one-lobed skin-flat flap, tube graft and other shaped flaps and free grafts placed on the area of the excised scars. In 18 observations, a good result was achieved and no complications were noted. The grafts were viable, sensibility was preserved and no marginal necrosis was noticed. Patients can take up their work by 1.5-2.0 months after surgery.

Deep foot burns: effects of early excision and grafting.

Few on the problem of foot burns can be found in the available scientific literature. It is necessary to mention that often deep foot burns occur in Central Asia since many natives still use the ancient means of heating called 'Sandal' during the winter months. Eighty-four patients with severe foot burns were treated in the Burn department of RCSUMA and the Inter-regional Burn Center, Uzbekistan. The patients were subdivided into two groups, depending upon the terms of performing operative intervention. There was no special allocation of patients to groups. Criteria for selection were isolated deep burns of the foot. As for the character of the injury, area of deep burn and the severity of injury, patients of the control and basic groups were not different. The first group included 34 patients on whom early excision was done using skin graft 4-5 days after resuscitation, and the second group consisted of 50 patients who were treated in the traditional way. Methods used on the first group, described in this article, helped to improve the general condition of patients, contributed to the restoration of their foot function, lessened joint deformities and post-burn contracture deformities, shortened their stay in hospital and also reduced expenses.

The hypoxia-selective cytotoxin NLCQ-1 (NSC 709257) controls metastatic disease when used as an adjuvant to radiotherapy.

BACKGROUND: Metastases cause most cancer-related deaths. We investigated the use of hypoxia-selective cytotoxins as adjuvants to radiotherapy in the control of metastatic tumour growth. METHODS: The NLCQ-1, RB6145 and tirapazamine were assessed against the spontaneously metastasising KHT model. Subcutaneous KHT tumours (250 mm(3)) were irradiated with 25 Gy (single fraction) to control primary growth. Equitoxic drug treatments (NLCQ-1 (10 mg kg(-1)) once daily; RB6145 (75 mg kg(-1)) and tirapazamine (13 mg kg(-1)) twice daily) were administered 3-6 days post-radiotherapy when hypoxic cells were evident in lung micrometastases. Mice were culled when 50% of controls exhibited detrimental signs of lung metastases. RESULTS: In total, 95% of control mice presented with lung disease. This was significantly reduced by NLCQ-1 (33%; P=0.0002) and RB6145 (60%; P=0.02). Semi-quantitative grading of lung disease revealed a significant improvement with all treatments, with NLCQ-1 proving most efficacious (median grades: control, 4; NLCQ, 0 (P<0.0001); RB6145, 1 (P<0.001), tirapazamine, 3 (P=0.007)). Positron emission tomography (PET) was evaluated as a non-invasive means of assessing metastatic development. Primary and metastatic KHT tumours showed robust uptake of [(18)F]fluorodeoxyglucose ([(18)F]FDG). Metastatic burden discernable by [(18)F]FDG PET correlated well with macroscopic and histological lung analysis. CONCLUSION: The hypoxia-selective cytotoxin NLCQ-1 controls metastatic disease and may be a successful adjuvant to radiotherapy in the clinical setting.

L-form plastics in the treatment of post-burn trophic ulcers and cicatrices of the foot calcaneal area.

The burn trauma of the posterior surface of calcaneus region and ankle joint followed by cicatrix formation in the Achilles tendon zone is often complicated by unhealing trophic ulcers. Eleven patients (seven men and four women, aged 9-54 years) have been operated on under our observation for prolonged unhealing ulcers and cicatrices located in the Achilles tendon zone. After cicatrices dissection, L-form plastic surgery was performed. The postoperative period was smooth; a skin graft was appropriately fixed to the proper tissues and the wound margins. Good results were achieved in 10 cases, and no complications were noted. However, in only one patient a marginal necrosis of the external talus part adjoining the ulcer due to tissue changes has been noted, but that had no influence on the good results of the operation.

Inhibition of vascular endothelial growth factor signalling using cediranib (RECENTIN; AZD2171) enhances radiation response and causes substantial physiological changes in lung tumour xenografts.

A number of pre-clinical studies have suggested that blocking vascular endothelial growth factor (VEGF) signalling can be beneficial in combination with radiotherapy. This study investigated the effects of cediranib, a highly potent orally available inhibitor of VEGF receptor tyrosine kinase activity in combination with radiation in Calu-6 lung xenografts. In nude mice, Calu-6 tumours were established and treatments initiated at a volume of 250 mm(3). Tumour-localized radiotherapy was given as three or five daily fractions of 2 Gy. Cediranib (3 mg kg(-1)) was administered 2 h prior to each fraction and continued post radiotherapy (concomitant regimen) or was initiated immediately after the completion of radiotherapy (sequential regimen). The endpoint was the time taken for tumour volume to quadruple (RTV4). Combined treatments resulted in a significantly enhanced growth delay compared with either modality alone. The therapeutic benefit was the same irrespective of the scheduling regimen. Tumour regression was observed post radiotherapy, which was associated with high levels of apoptosis and necrosis, and pronounced antivascular effects in histological samples. The amplified antivascular effect of cediranib when given after radiation suggests that pre-irradiated endothelium is sensitized to cediranib. Concomitant 5-day treatment with both cediranib and radiation reduced vessel density, perfusion and increased in tumour hypoxia. This was not associated with an acquired radioresistance suggesting that the maintenance of cediranib treatment post radiotherapy prevents the contribution of hypoxic cells to tumour regrowth. Collectively, these data support the contention that VEGFR inhibition can enhance radiation response in pre-clinical models and provide a rationale to develop cediranib in combination with radiotherapy in the clinical setting.

Treatment of severe foot burns in children.

Only a few papers on the problem of foot burns can be found in the easily accessible scientific literature. In Central Asia foot burns are widespread, because many people, especially children, walk barefoot in summer, and because the heated sandal is still used for keeping warm in winter. In the Samarkand Inter-Regional Burn Center in Uzbekistan, the following method of treatment was developed: initial surgical debridement of the wound, necrectomy with application of chemotherapeutic medications and early necrectomy, the removal of necrotic tissues and preparation the wound for early autodermoplasty. This effective treatment method contributed to the restoration of foot function in patients, lessened their joint deformities and post-burn contractures/deformities, and also shortened their hospital stay.

Sandal burns and their treatment in children.

Sandal is an ancient, primitive heating device that is still in use by both poor and rich people in mountain areas of Middle Asia. Sandal burn injuries are a serious health problem. Characteristics of sandal burns include not only skin injuries of various depths but also injuries to underlying tissues: subcutaneous fat, fasciae, muscles, and even bones. Sandal burns are characterized by such severe deep injuries because of a close contact of the body with live coals or woods. The main goal of this work was to present the most complete information about sandal burns and discuss the most effective methods of treatment for sandal burns. This treatment is used to accelerate the rejection of necrotic tissue, to prepare the wound for early autodermoplastic surgery, to decrease the postburn contractures/deformities, and also to shorten hospital stay for the patients.