Snip conjunctivoplasty associated with methylene blue staining for treatment of postoperative conjunctival chemosis.

Conjunctival chemosis usually undergoes spontaneous resolution; sometimes, it requires treatment. We present the case of a 43 years-old female patient who developed bilateral conjunctival chemosis following upper and lower blepharoplasty. Two months after the operation, patient underwent bilateral snip conjunctivoplasty with methylene blue demarcation of the chemotic conjunctiva.

The prevention of obesity starting from the kindergarten by means of peer educator mothers and WhatsApp messages.

BACKGROUND: Early-life diet plays a crucial role in the development of body weight issues. We therefore investigated the effectiveness of a peer-education intervention, aiming at encouraging the intake of fruits and vegetables and of a healthy mid-morning snack, targeting the mothers of 3-8 years old children attending kindergarten and primary school. STUDY DESIGN: Experimental approach. METHODS: The study involved 924 children (intervention group) and 450 children (control group). The intervention was carried out by organizing three meetings at school with the participation of healthcare professionals, mothers and teachers in a maieutic way. The meetings focused on i) discussing the issues that mothers face with their children's nutrition; ii) possible solutions; iii) identification of "leading mothers" playing as peer-educators. As control a similar intervention targeting only the teachers, without involving the mothers, was also carried out. The effectiveness of such interventions was evaluated by external evaluators, before, the interventions and 3 and 9 months after the interventions. RESULTS: The check, carried out 3 months after the intervention, showed a significant improvement with respect to the mid-morning snack, and the consumption of the main dishes as well as fruits; the check carried out 9 months after the intervention, showed that such improvements were maintained in the case of the mid-morning snack and the fruit intake. No improvement was observed in relation to the control group. CONCLUSIONS: This is the first example of an intervention promoting a healthy diet involving mothers of children attending kindergarten and primary school as peer educators and it actually improved the dietary habits.

The entity of thermal-crush-avulsion hand injury (hot-press roller burns) treated with fast acting debriding enzymes (nexobrid): literature review and report of first case.

Hand burns are present in >60% of all burn cases and in fire mass casualty incidents even up to 100%. Most trauma and especially burns may be detrimental to the complex and delicate structures of the hand by direct injury, indirect BICS (Burn Induced Compartment Syndrome and interstitial high pressure) or by delayed or faulty treatment. BICS represents a special threat as the increasing swelling and oedema of the small diameter hand and forearm will exert pressure on the capillary/venous system, eventually ending in irreversible damage to the skin, nerves, muscle and vascular bed. Immediate release of constricting skin by incisional escharotomy and sometimes fasciotomy may arrest this vicious cycle: escharotomy is simple for experienced hand or burn surgeons, but they are not always present at the primary treatment site. The diagnosis of BICS is not simple either, as the direct measurement of interstitial/compartment pressure is rarely done. Burns caused by hot rollers such as industrial linen ironing machines are especially traumatic as besides the "simple" thermal burn, the hot rollers exert immense crushing pressure to the hand caught between the rollers. Over the last few years, several publications have described the role of a newly approved Bromelain derived enzymatic debriding agent (NexoBrid) for burns in general and hand burns in particular, and its ability to resolve or prevent BICS. We present a rare severe thermal/crush hand injury case where we were able to successfully treat the patient with NexoBrid enzymatic debridement-escharotomy.

Une atteinte des mains est observée dans plus de 60% des brûlures, et dans quasiment tous les cas de catastrophes. La plupart des traumaitismes, en particulier les brûlures, peuvent être délétères pour les structures complexes et délicates de la main. Ceci peut être dû à la brûlure elle même, à un syndrome compartimental (SC), à un traitement tardif ou mal conduit. Le SC est particulièrement dangereux dans les espaces ténus de l'avant bras et de la main. L'augmentation de pression consécutive à l'oedème obère la microcirculation, entraînant au bout du compte des lésions cutanées, nerveuses, vasculaires et musculaires irréversibles. La libération immédiate des tissus ainsi comprimés par incision de décharge cutanée voire aponévrotomie peut interrompre le cercle vicieux. Il s'agit d'un geste simple pour des chirurgiens spécialisés, malheureusement pas toujours disponibles sur le site du traitement initial. Le diagnostic de SC n'est pas toujours aisé si la mesure directe des pressions tissulaires n'est pas réalisée. Les brûlures dues à des rouleaux chauffés comme ceux des presses à repasser industrielles car, outre le dégagement de chaleur, les rouleaux exercent une pression intense sur la main coincée entre eux. Depuis quelques années, plusieurs articles on décrit le rôle d'un nouvel agent de débridement enzymatique à base de bromélaïne (Nexobrid) pour le traitement des brûlures dont celles des mains ainsi que ses capacité à prévenir et traiter les SC. Nous présentons ici un cas de main de presse avec utilisation, couronnée de succès, de Nexobrid.