Spontaneous healing and scar control following enzymatic debridement of deep second-degree burns.

Scarring after a burn injury remains the greatest unmet challenge in the treatment of functional and psychosocial sequelae of burns. The hypertrophic scar represents the most common type of cicatrix after burns, and it has a prevalence of up to 70%. We present a case of upper and lower extremity partial-thickness burns in a female patient treated in two different modalities. Superficial seconddegree burns on the upper extremities were treated with conservative dressing with fairly early wound closure but they developed hypertrophic scars. Deeper, lower extremity burns were debrided with a new bromelain-based debriding agent, resulting in scar-free healing. The pathophysiology of hypertrophic scar formation is based on the perturbation of collagen production or degradation or both. The duration and magnitude of the inflammatory phase of wound healing also appears to play a role in hypertrophic scarring. Bromelain has demonstrated an anti-angiogenic effect in various cancer cell lines and it has been shown to regulate a variety of pro-angiogenic growth factors. This case raises the classical question of the relationship between time to healing and formation of hypertrophic scars after burn injury, pointing to other potential factors that may play an important role in burn healing.

La cicatrisation après une brûlure reste le plus grand défi du traitement des séquelles à la fois sur le plan fonctionnel et sur le plan psychologique. La cicatrisation hypertrophique représente l'évolution la plus fréquente après brûlure et sa prévalence est supérieure à 70 %. Nous présentons une observation de brûlures du 2e degré au niveau du membre supérieur et du membre inférieur chez une patiente traitée suivant deux modalités différentes. Les brûlures du second degré superficiel du membre supérieur furent traitées par un pansement classique avec une cicatrisation précoce, mais suivie de cicatrices hypertrophiques. Les brûlures plus profondes du membre inférieur furent détergées avec le nouvel agent à base de bromelaïne, et permirent une guérison sans cicatrice. La physiopathologie de la cicatrisation hypertrophique est basée sur les troubles de production des fibres de collagène, ou de leur dégradation, ou des deux. La durée et l'amplitude de la phase inflammatoire de la cicatrisation paraît aussi jouer un rôle dans l'hypertrophie cicatricielle. La bromelaïne a démontré son effet anti-angiogénique dans plusieurs lignées cellulaires cancéreuses ; elle a montré aussi son aptitude à réguler les divers facteurs de croissance pro-angiogéniques. Cette observation soulève la question classique de la relation entre le temps de cicatrisation et l'apparition de cicatrices hypertrophiques après brûlure, en soulignant les autres facteurs potentiels jouant un rôle important dans la cicatrisation des brûlures.

[HFR-AEQUILIBRIUM and intradialytic cardiovascular stability: results of the first multicenter study in Lazio]. / HFR-AEQUILIBRIUM e stabilità cardiovascolare intradialitica: risultati del primo studio multi-centrico laziale.

Intradialytic hypotension (IDH) is a still-frequent and poorly-understood complication of haemodialysis. Haemofiltration has recently been shown to reduce the phenomenon of IDH. HFR-Aequilibrium adds to traditional HFR and is, in practice, a variant comprising endogenous re-infusion of haemodiafiltration with dialysate sodium concentration and ultrafiltration rate profiles elaborated by the 'Profiler' plasma sodium biofeedback system, and measurement of plasma sodium via the on-line Natrium sodium sensor.

New chitin complexes and their anti-aging activity from inside out.

BACKGROUND: Nutritional and topical antioxidants and immuno-modulant compounds play a key role in maintaining healthy skin. However, little is known about the combined effects antioxidant cosmeceuticals and nutricosmetics can have on the appearance of aging skin. OBJECTIVE: The clinical trial was designed to study the combined effects on skin hydration, superficial lipids, elasticity, peroxidation and global clinical appearance, of melatonin, Vit. E and Betaglucan (MEB) complexed with chitin nano-crystals administered both topically and orally. Clinical examinations were conducted by dermatologists. DESIGN: By a randomized placebo-controlled, 12 week multicenter study on 70 healthy subjects, affected with skin photo-aging, the anti-aging efficacy and tolerability of the combined activity of topical emulsion and oral hard capsules, containing MEB complexed with chitin nano-crystals (CN) was evaluated clinically and by biophysical non-invasive measurements at week 4,8 and 12. RESULTS: The effects of MEB intake resulted significantly higher (p<0.005) than placebo for all the parameters evaluated by biophysical and clinical measurements. The values resulted higher when the active ingredients MEB were complexed with CN, whether used topically, orally or a combination of both (p<0.05). The positive results, observed since week 4, were accompanied by no side-effects throughout the entire study. CONCLUSION: The combined topical and oral use of MEB was associated with reduced wrinkling, better skin appearance and general overall wellness. When MEB were complexed with CN, the obtained results were statistically more positive (p<0.05) for all the biophysical and clinical parameters considered.

Topical clindamycin 1% vs. linoleic acid-rich phosphatidylcholine and nicotinamide 4% in the treatment of acne: a multicentre-randomized trial.

It has been shown that topical linoleic acid rich-phosphatidylcholine seems to be effective in normalization of follicular hyperkeratinization, whereas nicotinamide has an interesting anti-inflammatory effect. However, little is known about their combined effect on acne. A multicentre, double-blind, 12-week randomized vehicle and parallel-active control study was conducted by clinical and biophysical non-invasive measurements to evaluate the efficacy, tolerability and safety of a 4% nicotinamide-phospholipidic (N-PHCL) emulsion vs. 1% topical clindamycin phosphate applied once daily. Four percentage N-PHCL cosmetic treatment resulted slightly superior to topical clindamycin with all the parameters studied for its better compliance and the global clinical improvement.

Ischiatic pressure sores: our experience in coupling a split-muscle flap and a fasciocutaneous flap in a 'criss-cross' way.

STUDY DESIGN: Description of a technique and prospective follow-up study. OBJECTIVES: The aim of this study was to present our experience in the surgical treatment of ischial pressure sores, especially recurrence. SETTING: The Department of Plastic and Reconstructive Surgery and Spinal Injuries Unit, CTO Hospital, Rome, Italy. METHODS: From 1995 to 1997, the authors used in 12 consecutive paraplegic patients, who had a grade III or IV decubitus ulcer in the ischial area only, two different and independent flaps coupled together in a 'criss-cross' musculocutaneous flap: a split-muscle gluteus maximus flap and a rhomboid fasciocutaneous local flap. The average follow-up period was 3 years and 9 months. Details of the operative procedure are presented to prove that this criss-cross closure of the ischial pressure sore beneficial for patients with spinal cord injury. RESULTS: All flaps survived; recurrence of the decubitus ulcer occurred in one patient (8%). Pressure-sore-free survival after surgery was 20 months in the patient with recurrence and an average of 26 months in patients without recurrence. CONCLUSION: The results obtained confirm this procedure to be safe and useful. We believe this technique to be a valuable alternative for the reconstruction of primary or recurrent ischial pressure ulcers.

Beneficial long-term effects of combined oral/topical antioxidant treatment with the carotenoids lutein and zeaxanthin on human skin: a double-blind, placebo-controlled study.

BACKGROUND: The skin is exposed to numerous environmental assaults that can lead to premature aging. Of these agents, perhaps none is more ubiquitous than the ultraviolet (UV) wavelengths of sunlight. The primary immediate defense against environmental skin damage is the antioxidant capacity of the skin. However, this defense system can be compromised by moderate exposure to UV light. Therefore, bolstering the antioxidant defense system of the skin is a potentially important strategy for reducing environmentally induced skin damage. AIM OF THE STUDY: This clinical trial was designed to study the efficacy of lutein and zeaxanthin, two potentially important antioxidants found naturally in the skin, upon five skin physiology parameters (surface lipids, hydration, photoprotective activity, skin elasticity and skin lipid peroxidation - malondialdehyde) of human subjects. These xanthophyllic carotenoids were administered either orally, topically, or in combination (both oral and topical routes). RESULTS: The results obtained indicate that the combined oral and topical administration of lutein and zeaxanthin provides the highest degree of antioxidant protection. However, oral and topical administration of these antioxidants individually also provides significant activity in the skin. In addition, oral administration of lutein may provide better protection than that afforded by topical application of this antioxidant when measured by changes in lipid peroxidation and photoprotective activity in the skin following UV light irradiation.

[The Campodimele study: 24-hour blood pressure in rural life style subjects]. / Studio di Campodimele: la pressione arteriosa di 24 ore in soggetti con stile di vita rurale.

The present paper is aimed at investigating the daily blood pressure in subjects with a rural style of life with the purpose of detecting whether or not the blood pressure regimen is influenced as expected because of the stress less prominent in the non-urban areas. Control data were obtained by the study of age- and sex-matching subjects with a metropolitan style of life. The results indicate the blood pressure has a lower daily level in rural subjects as compared to urban subjects. The daily baric impact is also lower, suggesting that the blood pressure regimen is really less pronounced in those who live according to a rural style of life. Such a lower magnitude allows us to experimentally suggest that the rural life is concrete in protecting the hemodynamic system from the higher level of blood pressure which are observable in subjects who live according to a metropolitan style of life. Interestingly, the expected phase anticipation in blood pressure circadian rhythm of rural subjects was not detected, as the wake up time was not so anticipated to act as a synchronizer.

Spontaneous pseudocystogastrostomy as a cause of gastrointestinal bleeding. Management by selective embolization.

A case of pancreatic bleeding pseudocyst communicating with the stomach, developing after post-operative acute pancreatitis is reported. The successful treatment by selective embolization is described and alternative methods of management are reviewed.