Stigmata in the history: between faith, mysticism and science.

Stigmata are one of the most ancient and fascinating mysteries of the Christian religion. The word "stigmata" derives by the Greek "stigma", that means sign, mark. Classically, stigmata are the sores inflicted on Jesus Christ during his passion and crucifixion. Today, the term stigmatized has been extended to designate several cases of individuals, who show skin sores similar to those of Christ. The Authors report a brief history of stigmata, trying to give an explanation to such a fascinating phenomenon.

History of venous leg ulcers.

To retrieve the history of venous ulcers and of skin lesions in general, we must go back to the appearance of human beings on earth. It is interesting to note that cutaneous injuries evolved parallel to human society. An essential first step in the pathogenesis of ulcers was represented by the transition of the quadruped man to Homo Erectus. This condition was characterized by a greater gravitational pressure on the lower limbs, with consequences on the peripheral venous system. Furthermore, human evolution was characterized by an increased risk of traumatic injuries, secondary to his natural need to create fire and hunt (e.g. stones, iron, fire, animal fighting). Humans then began to fight one another until they came to real wars, with increased frequency of wounds and infectious complications. The situation degraded with the introduction of horse riding, introduced by the Scites, who first tamed animals in the 7th century BC. This condition exhibited iliac veins at compression phenomena, favouring the venous stasis. With time, man continued to evolve until the modern age, which is characterized by increased risk factors for venous wounds such as poor physical activity and dietary errors (1, 2).

Increased burn patient survival with once-a-day high dose teicoplanin and netilmicin. An Italian multicenter study.

This is the final report of a large, controlled, multicenter Italian study on immuno- and chemotherapy in adult patients with burns affecting 20 to 95% of total body surface area (mean 35%). The antibiotic treatment of burn patients consisted of topical silver sulfadiazine, short-term antimicrobial chemoprophylaxis with pefloxacin (800 mg i.v. qd) for the first 4 days and polychemotherapy with teicoplanin (800 mg i.v. qd) together with netilmicin (300 mg i.m. qd) in one or more cycles of 5-12 days. At random, half of the patients received thymostimulin, 70 mg i.m. qd for the first month and every other day thereafter. The analysis at completion of 634 valid cases showed that when the results are stratified by means of the Roi risk index, 396 of the 530 patients who contracted wound infection (84%) after chemoprophylaxis were in the first three categories and a mean of 95% survived. Of the remaining 134 patients (Roi index 4-5) only 50% survived. There was no difference in survival of the immunotherapy group in comparison with the parallel group without thymostimulin. The short-term antimicrobial prophylaxis prevented wound infection in only 104 of 634 patients (16%) and they were at low risk (84% Roi index 1). Of the bacterial pathogens involved in septic complications Staphylococcus aureus and Pseudomonas aeruginosa were prevalent (86%): eradication was achieved in 43% of patients and clinical cure or improvement were seen with combination chemotherapy in 64% of all patients, mainly with only one treatment cycle. This value increased to 79% for the 395 protocol-complying patients and went down to 20% in the 135 non-compliers. The total survival of complier and non-complier patients was 447 of the 530 valid patients (84%). The overall mortality of the 634 evaluable patients was 13.1%, ranging from less than 2% to 68%. Burn mortality was directly proportional to the percentage of burned body surface area, to increasing age and other variables of the Roi index, a 50% mortality being associated with a 72.5% total body surface area burned. Normoergic burn patients had a mortality rate of 9.1% versus 35.7% in anergic patients.

[The use of intravenous immunoglobulins in patients with severe burns]. / Uso endovenoso delle immunoglobuline nell'ustionato grave.

The parenteral use of whole molecule immunoglobulins is an important instrument for immunotherapy which can be employed in a variety of morbid conditions characterized by immunodeficiency, and therefore also in the management of severe burns. In order to confirm this assumption, the effect of i.v. administration of immunoglobulins has been studied in a group of burn patients and has been compared with the results obtained in the same number of clinically homologous patients not submitted to this treatment. In view of the results obtained, i.v. immunoglobulins can be usefully employed for the control of inflammatory and septic phenomena with reduction of abnormal parameters and a positive influence on the recovery curve.

Topical treatment of burn wounds with chloroxidating solution and silver sulfadiazine: a comparative study.

The present paper reports the results of clinical and laboratory tests carried out on two homogeneous groups of ten burn patients subjected to local therapy, either with isotonic chloroxidating solution Amuchina* or with 1% silver sulfadiazine cream at the Burns Centre of the Pisa University Dermatological Clinic. The local systemic behaviour of the patients examined was evaluated for the containment of septic complications at the burn site. In the group subjected to treatment with chloroxidating solution, sepsis appeared to have a lower incidence in the evolution of dermatitis in the phase of escharolysis, in the formation of granulation tissue, and in the attachment of cutaneous grafts. The systemic involvement (temperature curve, etc.) appeared to be more marked for some patients treated with silver sulfadiazine in response to septic aggression of the burn wounds. On the basis of data referring to the development of the wound granulation and the temperature curve, as well as the microbial presence and the subjective tolerance of the medication, the comparison was favourable, making all necessary allowances, to topical treatment with electrolytic chloroxidating solution; other comparative data were at the limit of significance.