The management of paediatric burns with Burns and Wounds ointment and burdock leaves: a case series.

OBJECTIVE: In the Amish community, natural therapies, such as Burns and Wounds (B&W) ointment and burdock leaves, are preferred over modern medicine when treating burn wounds. The primary aim of this case series is to highlight the use and clinical outcomes of this treatment for paediatric Amish patients. METHOD: At the a paediatric burn centre, two patients were treated with B&W ointment and burdock leaves. The first patient was 11 months old with 17% total body surface area (TBSA) partial and full-thickness scald burns to her lower extremities. The second patient was 24 months old with 20% TBSA partial-thickness scald burns to the torso, bilateral upper extremities, neck and chin. RESULTS: Soon after presentation to the hospital, both patients developed positive wound cultures and required cessation of ointment and burdock leaf therapy. Both patients ultimately underwent surgical interventions. CONCLUSION: Managing burn wounds with B&W ointment and burdock leaves should be considered as an additional option for wound care in select cases. However, the efficacy of this therapy is limited and standard-of-care modern medical burn treatments should remain an option for these patients. It is critically important to build a mutually respectful relationship with Amish patients' community leaders, as this allows open communication and collaboration in patient care and increases the likelihood that Amish guardians will bring their children to a hospital when necessary.

Experience in Using Fetal Membranes: The Present and New Perspectives.

INTRODUCTION: The placenta is an accessible source of tissues for transplantation. Placental transplants have been used in wound treatment because of the basic function of the placenta and its nutritious properties and structure. PATIENTS AND METHODS: The aim of this work is to present the clinical usage of fetal membranes, including human amnion, on the basis of the burn treatment center's experience. The clinical use of amnion and different types of placental transplants are described. The initial results of research work within the MEDPIG project are presented regarding the application of placenta from transgenic pigs as a source of tissues for transplantation. RESULTS: From August 2011 to March 2017, 252,592 cm2 of biostatic human amnion transplants were prepared in our tissue bank. During this period they were transplanted to 528 patients, including 10 patients with Lyell syndrome. Initial studies were conducted in which placentas were collected from 5 transgenic pigs and 27,426 cm2 of amniotic grafts were prepared from them. DISCUSSION: The authors' own experience as well as the literature confirm the extraordinary efficiency of transplants prepared from placental tissues, especially from the amniotic membrane. CONCLUSIONS: The clinical effects confirm the effectiveness of using human amnion in wound treatment. Amniotic transplant is a new treatment standard in toxic epidermal necrolysis TEN (Lyell's syndrome), which has found confirmation in very good clinical outcomes. The collected placentas from transgenic animals enabled the preparation of significantly more grafts than in the case of human material, which is a great advantage of this source of placenta over human tissues.

Fetal membrane patch and biomimetic adhesive coacervates as a sealant for fetoscopic defects.

Iatrogenic preterm premature rupture of membranes after fetoscopic procedures affects 10-47% of patients, secondary to the non-healing nature of membranes and the separation of layers during the entry. In this study we developed an in vitro model to mimic the uterine wall-fetal membrane interface using a water column with one end sealed with human fetal membranes and poultry breast, and a defect was created with an 11 French trocar. Further, a fetal membrane patch in conjunction with multiphase adhesive coacervates modeled after the sandcastle worm bioadhesive was tested for sealing of an iatrogenic defect. The sealant withstood an additional traction of 12 g for 30-60 min and turbulence of the water column without leakage of fluid or slippage. The adhesive is non-toxic when in direct contact with human fetal membranes in an organ culture setting. A fetal membrane patch with multiphase adhesive complex coacervates may help to seal the defect and prevent iatrogenic preterm premature rupture of the membranes.

Cells of extraembryonic mesodermal origin confer human dystrophin in the mdx model of Duchenne muscular dystrophy.

Duchenne muscular dystrophy is an X-linked recessive genetic disease characterized by severe skeletal muscular degeneration. The placenta is considered to be a promising candidate cell source for cellular therapeutics because it contains a large number of cells and heterogenous cell populations with myogenic potentials. We analyzed the myogenic potential of cells obtained from six parts of the placenta, that is, umbilical cord, amniotic epithelium, amniotic mesoderm, chorionic plate, villous chorion, and decidua basalis. In vitro cells derived from amniotic mesoderm, chorionic plate, and villous chorion efficiently transdifferentiate into myotubes. In addition, in vivo implantation of placenta-derived cells into dystrophic muscles of immunodeficient mdx mice restored sarcolemmal expression of human dystrophin. Differential contribution to myogenesis in this study may be attributed to placental portion-dependent default cell state. Molecular taxonomic characterization of placenta-derived maternal and fetal cells in vitro will help determine the feasibility of cell-based therapy.

Early steps in neural development.

We studied early neurulation events in vitro by transplanting quail Hensen's node, central prenodal regions (before the nodus as such develops), or upper layer parts of it on the not yet definitively committed upper layer of chicken anti-sickle regions (of unincubated blastoderms), eventually associated with central blastoderm fragments. We could demonstrate by this quail-chicken chimera technique that after the appearance of a pronounced thickening of the chicken upper layer by the early inductive effect of neighboring endophyll, a floor plate forms by insertion of Hensen's node-derived quail cells into the median part of the groove. This favors, at an early stage, the floor plate "allocation" model that postulates a common origin for notochord and median floor plate cells from the vertebrate's secondary major organizer (Hensen's node in this case). A comparison is made with results obtained after transplantation of similar Hensen's nodes in isolated chicken endophyll walls or with previously obtained results after the use of the grafting procedure in the endophyll walls of whole chicken blastoderms.

Multilayer vs. monolayer amniotic membrane transplantation for deep corneal ulcer treatment.

The purpose of the study was to evaluate the efficacy of multilayer amniotic transplantation (AMT) for reconstruction of corneal stroma and epithelium. Corneal ulcer (28) was a consequence of a previous infectious or neurotrophic keratitis. In the first group (17) ulcer was covered with monolayer AM, while in the other group (11) there were two or more layers of AM situated in the ulcer and the whole cornea was covered with AM sheet. Monolayer AMT was successful in 64% while the multilayer AMT success rate was 72%. AM gradually dissolved within 3-6 postoperative weeks. AM transplantation facilitates rapid healing of corneal epithelium, reduces inflammation and stimulates epithelial cell regrowth. In eyes with deep corneal ulcer multilayer technique proved to be better then monolayer procedure.

Vaginoplasty with amniotic membrane graft

Introducción. Las opciones para reconstrucción de agenesia vaginal están limitadas por la disponibilidad de tejido local, las malformaciones asociadas, la necesidad de usar conformadores y las dificultades técnicas. Las complicaciones a largo plazo como serían las estenosis de vaginas injertadas, el defecto de sitios donadores y la durabilidad de la reconstrucción afectan la elección del tipo de cirugía. Se presenta una paciente con agenesia total de vagina, reconstruida con una técnica simple, efectiva y relativamente poco invasiva utilizando injertos de membrana amniótica colocados en un túnel disecado en el espacio vésico-rectal. Esta técnica permite reepitelización vigorosa de la neovagina que tendrá resultados permanentes funcionales y estéticos. Caso clínico. Paciente fenotípicamente femenina de 17 años de edad con ausencia de útero y vagina. El plan incluía reconstrucción vaginal con injerto de membranas amnióticas. El seguimiento a largo plazo de la paciente expresó satisfacción con la reconstrucción. Ella reportó relaciones sexuales normales, negó problemas en el área quirúrgica o estenosis, y se describe la reconstrucción como estéticamente equivalente a una vagina normal.Conclusión. Esta técnica ofrece numerosas ventajas sobre técnicas convencionales; un factor que limita su utilidad es la posibilidad de transmisión de enfermedades infecciosas. Para medios en los que los recursos son limitados, representa un beneficio significativo cuando se compara con otros métodos reconstructivos. Malformaciones congénitas; vaginoplastia; injerto de amnios.

The preparation of lyophylised of fetal membrane for biological dressing.

The preparation of lyophylised fetal membrane was performed between November 1982 and May 1984, and the membrane was applied to a variety of wounds. The result of the study was impressive, the biologic dressing property did fairly well, and the utilization of this fetal membrane was convenient in time and place.

[An experimental induction of teratomatous tumor in rats].

Extrauterine implantation of the fetal membrane was performed in Wistar King A strain rats by the technique of fetectomy at the time of the twentieth gestational day. Thirty-five rats received fetectomy alone, and in nineteen rats the fetectomy was combined with 7,12-dimethylbenz (a) anthracene (DMBA) application. The results obtained were as follows: In the fetectomy group, 23(65.7%) tumors 17(73.9%) mature teratomas and 6(26.1%) yolk sac tumors occurred. In the group which also received the application of DMBA, the tumors were found in seven of 19 rats (36.8%). The incidence of yolk sac tumor was 28.6% in this group and the remaining five tumors were mature teratomas. The direct application of the carcinogen did not affect the incidence or histology of the induced tumor. To identify the exact histogenesis of these teratomatous tumors from the fetal membrane, further research is necessary.

Amnion graft for treatment of congenital absence of the vagina.

The successful application of an amniotic membrane graft in the treatment of congenital absence of the vagina is described. Follow up with vaginal smears and vaginal biopsies revealed that amnion when used alone with mesenchyme applied to the host gives protection to the underlying granulation tissue and facilitates epithelialization.

In search of an ideal skin substitute.

A review of skin substitutes currently in use is presented. These include allografts, xenografts, embryonic membranes, tissue derivatives and synthetic skin substitutes. Clinical results from Langerhans cell depressed cadaver allografts on burned patients and crural ulcers are presented.

Management of the pelvic floor after pelvic exenteration.

At the Mayo Clinic, 198 exenterative operations were performed from 1950 through 1971. Although the 5-year survival rate of all patients was 33%, bowel obstruction occurred in 11.6% of patients and intestinal fistula formation in 12.6%. The majority of patients with these complications had had previous pelvic irradiation. The difficulty in dealing with the large raw area in the pelvis is discussed with a review of the various methods that have been tried to date to reperitonealize the pelvis and thereby, it is hoped, prevent adhesions or fistula formation.

[Repair of prenatally ruptured omphalocele and the paraumbilical abdominal wall defect with the infant's own fetal membranes (author's transl)]. / Versorgung der pränatal rupturierten Omphalozele und des paraumbilikalen Bauchwanddefektes mit geburtseigenen Eihäuten

Since 1971, 35 children with prenatally ruptured omphalocele and paraumbilical abdominal wall defects were operated on in the surgical clinic of the Cologne Children's Hospital. 45.7% of them survived compared with 29.2% in earlier years. This improved chance of survival is attributed the use of the child's own fetal membranes.

[Use of amniotic membranes as biological dressings. Preliminary report]. / Utilización de membranas amnióticas como apósitos biológicos. Comunicación preliminar

The authors compared the results obtained with the use of amniotic membranes as biological dressings in the treatment of 15 patients with skin loose of different etiology and that obtained with the conventional therapy. The associated benefits obtained with this treatment were lessen of the pain, low incidence of infections, early cicatrization of the wounds and shortening of the hospital time. The primary observations permit a wide investigation about the therapeutic usefulness of this kind of biological dressings.