Classification of chronic radiation-induced ulcers in the chest wall after surgery in breast cancers.

BACKGROUND AND PURPOSE: To explore the methods of clinical classification in chronic radiation-induced ulcers in the chest wall (CRUCWs). MATERIALS AND METHODS: A total of 64 patients with CRUCWs were treated. We divided the cases into 3 types (mild, moderate, or severe) according to their clinical manifestations. Conservative treatments, axial-pattern myocutaneous or local flaps, or filleted flaps were applied correspondingly. RESULTS: The cases were divided as follows: mild (n = 11), moderate (n = 45), and severe (n = 8). Eight cases were cured by conservative surgical therapy. One case had a recurrence 6 months after conservative therapy and was cured by a latissimus dorsi myocutaneous flap. The transferred flaps all survived, including 26 transverse rectus abdominis myocutaneous flaps, 8 longitudinal rectus abdominis myocutaneous flaps, 6 latissimus dorsi myocutaneous flaps, 3 contralateral breast flaps, 5 lateral thoracic rotation flaps, and 7 filleted flaps. In 2 transverse rectus abdominis myocutaneous flaps and 2 latissimus dorsi myocutaneous flaps, distal necrosis appeared in small areas. The resulting wounds were salvaged with skin graft and full healing was achieved. CONCLUSION: CRUCWs can be divided into three types. Surgical methods should vary with distinguished classifications. The effective classification of CRUCWs has definite instructive significance on the selection of surgical approaches.

Estudo da ação da romã (Punica granatum L. ) na cicatrização de úlceras induzidas por queimadura em dorso de língua de ratos Wistar (Rattus norvegicus) / Pomegranate action study (Punica granatum L. ) for the healing of ulcers induced by burns to the dorso-lingual mucosa in Wistar rats (Rattus norvegicus).

RESUMO O objetivo desse estudo foi observar a ação da romã (Punica granatum L.) em estomatites induzidas por queimaduras no dorso da língua de ratos Wistar. Foram utilizados 24 ratos Wistar machos adultos, provenientes do Biotério da UNIVASF. Foram formados quatro grupos (G1: Polpa da romã por gavagem; G2: Polpa da romã por gavagem + aplicação local do chá da casca do fruto; G3: aplicação local do chá da casca do fruto e G4: Controle negativo). As queimaduras foram confeccionadas com instrumental odontológico padrão. Os tratamentos foram realizados duas vezes ao dia, durante 14 dias. Metade dos animais de cada grupo (n=3) foi eutanasiada no sétimo dia de experimentação, enquanto o restante foi eutanasiado no 14º dia. As línguas foram removidas e fixadas com formaldeído a 10% tamponado, processadas com cortes de 5 µm e coradas em HE. Clinicamente, os animais do grupo G2 tiveram melhores resultados. Na análise histológica qualitativa foi avaliada a reepitelização e os graus de inflamação numa escala de 0 a 4. Na análise estatística, utilizou-se o teste Qui-quadrado de Pearson. Houve significância estatística (p=0,026 e p=0,023) quando se comparou o tratamento com os graus de reepitelização e inflamação nos quatro grupos estudados. O grupo G2 apresentou cicatrização completa com 14 dias. Os piores escores obtidos foram atribuídos ao Grupo G4 nos dois parâmetros de avaliação qualitativa. Diante dos resultados obtidos, observa-se que a romã (Punica granatum L.) possui ação cicatrizante na mucosa lingual de ratos Wistar.

ABSTRACT The objective of this study was to observe the action of pomegranate (Punica granatum L.) on stomatitis induced burns on the dorso-lingual musosa in Wistar rats. Twenty-four male, adult Wister albino rats were used, from the bioterium of UNIVASF. There were four groups (G1: Pomegranate juice by gavage; G2: Pomegranate juice by gavage + local application of fruit peel tea; G3: Local application of fruit peel tea only and G4: a negative control). The burns were made with standard dental instruments. The treatments were performed twice a day for 14 days. Half the animals in each group (n = 3) were euthanized on the seventh day of experimentation, while the remainder were euthanized on day 14. The tongues were removed and fixed with a 10% formaldehyde buffer, processed as 5µm sections and stained with HE. Clinically the animals treated with tea showed better healing. For statistical analysis the Pearson chi-squared test was used. There was a statistical significance (p = 0.026 and p = 0.023) when compared to treatment with the degree of re-epithelialization and inflammation of the four groups studied. The G2 group showed complete healing within 14 days. The worst scores were found in the G4 group in both qualitative assessment parameters. Based on these results, it was observed that pomegranate (Punica granatum L.) has a healing action on the lingual mucosa of Wistar rats.

A comparison of nasal trauma in preterm infants extubated to either heated humidified high-flow nasal cannulae or nasal continuous positive airway pressure.

UNLABELLED: The objectives of this study were (1) to devise a nasal trauma score for preterm infants receiving non-invasive respiratory support, (2) to compare the incidence of nasal trauma in preterm infants <32 weeks gestation randomised to either nasal continuous positive airway pressure (NCPAP) or heated humidified high-Flow nasal cannulae (HHHFNC), in the first 7 days post-extubation and (3) to assess the effect of two different nasal dressings in those assigned to NCPAP. We randomly assigned preterm ventilated infants to receive Vapotherm® HHHFNC or NCPAP post-extubation. Infants receiving HHHFNC were treated with Sticky Whiskers® and infants receiving NCPAP received either Sticky Whiskers® or Cannualaide® nasal dressings. Bedside nursing staff scored six sites on each infant's nose for erythema, bleeding or ulceration. Scores were recorded three times daily for the first 7 days post-extubation. The sum of these 21 scores was used as the summary measure of nasal trauma. The mean nasal trauma score for infants assigned HHHFNC was 2.8 (SD 5.7) compared to 11.7 for NCPAP (SD 10.4), p < 0.001. There was no difference in mean trauma score between infants on NCPAP assigned Sticky Whiskers® 14.4 (SD 12.5) or Cannualaide® 9.5 (SD 7.3), p = 0.06. CONCLUSION: HHHFNC resulted in significantly less nasal trauma in the first 7 days post-extubation than NCPAP and was most significant in infants <28 weeks of gestation. The use of protective dressings was not associated with decreased nasal trauma for infants on NCPAP.

Connective tissue ulcers.

Connective tissue disorders (CTD), which are often also termed collagen vascular diseases, include a number of related inflammatory conditions. Some of these diseases include rheumatoid arthritis, systemic lupus erythematosus, systemic sclerosis (scleroderma), localized scleroderma (morphea variants localized to the skin), Sjogren's syndrome, dermatomyositis, polymyositis, and mixed connective tissue disease. In addition to the systemic manifestations of these diseases, there are a number of cutaneous features that make these conditions recognizable on physical exam. Lower extremity ulcers and digital ulcers are an infrequent but disabling complication of long-standing connective tissue disease. The exact frequency with which these ulcers occur is not known, and the cause of the ulcerations is often multifactorial. Moreover, a challenging component of CTD ulcerations is that there are still no established guidelines for their diagnosis and treatment. The morbidity associated with these ulcerations and their underlying conditions is very substantial. Indeed, these less common but intractable ulcers represent a major medical and economic problem for patients, physicians and nurses, and even well organized multidisciplinary wound healing centers.

Prolonged ulcerative laryngitis: a new disease entity.

Over the last decade, a new disease entity, prolonged ulcerative laryngitis (PUL), with unique clinical presentation and prolonged disease course, has been recognized. Until now, very few studies dealing with this disease have been reported in the literature. From 1999 to 2008, we analyzed clinical data from a series of 39 PUL patients who were treated with an observational approach without implementing specific treatments. This disease affects adults, predominantly females. The age of patients in our series ranged from 26 to 76 years with a median of 49.5 years. This disease is characterized by ulcers and signs of acute inflammation on the membranous portion of the vocal folds with a prolonged clinical course. The recovery times of patients ranged from 4 to 20 weeks with an average of 9.4 weeks. The data in this study may reflect a natural history of this disease. PUL seems to be a self-limited disease, but the etiology of this disease is unknown. Specific infections or systemic inflammatory processes involving the larynx must be ruled out before diagnosis, and conservative treatments are suggested.

Avaliação dos efeitos clínicos da fototerapia em úlceras venosas / Evaluation of clinical effects of phototherapy in venous ulcers

As úlceras venosas são lesões do sistema tegumentar de difícil cicatrização. Essas lesões são freqüentes em pacientes portadores de insuficiência venosa crônica e representam cerca de 80 por cento das lesões ulcerativas em membros inferiores. O objetivo deste trabalho foi avaliar os efeitos da ledterapia sobre o processo de cicatrização de úlceras venosas crônicas em uma paciente do gênero feminino, portadora de insuficiência venosa. Os resultados mostraram que todas as lesões apresentaram sinais de cicatrização, com redução da área das feridas após a introdução da ledterapia, sugerindo que esse recurso foi eficaz em aprimorar o processo de cicatrização das úlceras venosas da participante deste caso.

The venous ulcers are lesions of cutaneous tissue very difficult to heal. These lesions are frequent in patients with chronic venous insufficiency and about 80 percent of ulcerated lesions are on lower limbs. The objective of this study was to evaluate the effects of LED therapy on healing process of chronic venous ulcers of a female patient with venous insufficiency. The results showed that all lesions showed signs of healing, with wounds area reduction after beginning LED therapy, suggesting that this action was effective in improving healing process of venous ulcers of the participant of this case study.

Tratamento de úlceras de decúbito com laser de baixa intensidade / Decubitus ulcers treatment with low level laser

Úlceras de pressão são lesões que podem interferir na qualidade de vida dos indivíduos. O objetivo deste estudo consistiu em avaliar o efeito clínico da aplicação do laser de baixa potência no processo de cicatrização de úlceras de decúbito. Foram realizadas 2 aplicações semanais, durante 6 semanas, do laser Ga-As (904 nm) com dosimetria de 4 J/cm2 em dois indivíduos com úlceras de pressão crônicas na região sacral. Os resultados, avaliados através de registros fotográficos e mensuração da área da ferida, indicaram um aprimoramento no processo de cicatrização das úlceras. Conclui-se, que o laser de baixa potência foi eficaz no tratamento das úlceras de decúbito crônicas.

Pressure ulcers are injuries that can interfere in the quality of life of individuals. The aim of this study was to evaluate the clinical effect of the application of low-level laser in the healing process for decubitus ulcers. The Ga-As (904 nm) laser was applied twice a week, 4 J/cm², during 6 weeks, in two subjects with chronic pressure ulcers in the sacral region. The results were assessed through photographic registers and area measurements of each ulcer. They had indicated an improvement in the healing process of ulcers. It can be concluded that low-level laser was efficient in the treatment of chronic decubitus ulcers.

Gastropatia hiperplasica glandular gigante (Enfermedad de Menetrier) / Menetrier´s diseases

La enfermedad de Ménétrier se caracteriza por un crecimiento glar dular con engrosamiento de pliegues en las paredes del estómago, constituyendo parte de un grupo de gastropatías hiperplásicas perdedoras de proteínas de etiología aún no precisada. Es una dolencia que ocurre usualmente en personas con edades entre 30 a 60 años, siendo muy rara en la edad pediátrica. Clinicamente se presenta con diarrea recurrente, vómitos, dolor abdominal y pérdida de peso. No existe un tratamiento específico, requiriendo solo un manejo sintomático de soporte. Los autores informan el caso de un niño de 7 años, con esta enfermedad, la cual se presentó con síntomas poco habituales (edemas, asciti derrame pleural); en los estudios de gabinete se confirmó PC trasonido, ascitis, derrame pleural y una hiperecogenecidad del estomago por la cual se procedió a realizar un tránsito gastrointestinal, cortando irregularidades en el llenado gástrico. El estadio endoscópico mostró un fundus gástrico de forma irregular, engrosando, con secreción espesa, viscosa y transparente en todo el estómago. El tratamiento intaurado consistió en la administración de albúmina, con la cual do obtener la desaparición de su sintomatología (edemas, ascitis ame pleural); posteriormente se continuó con la administració tomática de protectores gástricos y dieta hiperproteica. Fue dado d tres semanas despúes sin molestias significativas

Tratamiento oclusivo con alginato de calcio en heridas infectadas / Obstetricia treatment with calcium alginate in infected wounds

Las heridas infectadas representan un problema quirúrgico serio, con implicacionmes ocupacionales y económicas. El uso de Alginato de Calcio en su tratamiento puede ser de gran ayuda para su curación. En nuestro estudio, noventa y tres pacientes con heridas infectadas, que requerían debridación y curas compresivas, fueron tratados con cura de alginato de calcio el cual fue bien tolerado, su retiro fue fácil sin causar dolor ni daño, reduciendo el número de curas oclusivas realizadas y su frecuencia así como mejorando la curación y cicatrización con efectos adversos mínimos

[Interobserver variation in the Red-Yellow-Black wound classification system]. / Interobservatørvariation ved rødt-gult-sort-sårbeskrivelsessystemet.

Communicating wound descriptions between disciplines for treatment and wound care necessitates a simple and unequivocal classification system. The Red-Yellow-Black (RYB) system has been suggested to comply with these demands. The reliability of the RYB-system has, however only been investigated in small studies. The aim of this study was to determine interobserver homogeneity (group Kappa a.m. Schouten) of the RYB-system and further to examine whether interobserver homogeneity was dependent on educational level. One-hundred-and-twenty photo-slides of non-healing ulcers of various etiologies were shown to 21 observers who recorded their assessments in an entry form without discussing their assessments with the other observers. Eighty-nine percent of the possible assessments were completed. Observed agreement for all observers = 0.65; Kappa = 0.47. Kappa-coefficient in subgroup of nurses = 0.49, subgroup of physicians with less than three years of experience with wound treatment = 0.46 and for physicians with more than 10 years of experience with wound healing = 0.48. In conclusion, we demonstrated moderate interobserver agreement for using the RYB-characteristics. The RYB-system is useful for communication about wound care and treatment. However, continuous education and consensus meetings are advisable to increase agreement.

Fístulas biliodigestivas espontáneas en Venezuela 1945-1994 / Spontaneous biliodigestive fistulas in Venezuela 1945-1994

Hemos realizado una revisión de la cirugía de vesícula y vías biliares en Venezuela, que abarca un lapso de 48 años, entre 1945 y 1993; se han reportado 10363 intervenciones con 76 casos de fístulas biliodigestivas espontáneas para una incidencia de 0,73 por ciento de esta patología en nuestro país. En el Hospital Universitario de Caracas se han realizado varias revisiones del tema. Nuestros análisis evidencian que la etiología, incidencia, diagnóstico, tratamiento y complicaciones son similares a los reportes anteriores de nuestro centro, así como de otros autores nacionales

Rise in prevalence of genital ulcers among STD clinic attenders in Jamaica: significance for HIV transmission - abstract

Two cross-sectional surveys were undertaken to estimate the prevalence of genital ulcer disease (GUD) in all clients presenting at the Comprehensive Health Centre in Kingston, Jamaica with a new STD complaint. The first survey done in 1983 involved 23,050 clients (men 11,948; women 11,102). The second survey in 1990 involved 1,001 clients (men 517; women 484). All clients were screened for syphilis and in 1990 for HIV. Culture for herpes virus was done on a subsample of 103 persons seen in 1983, but in the main, diagnoses were clinical. In 1983, GUD was found in 1,571 clients, an overall prevalence of 6.8 percent (men 1,110, 9.3 percent; women 461, 4.2 percent). Of those with GUD, genital herpes was diagnosed in 267 (17 percent); syphilis in 203 (12.9 percent); chancroid in 195 (12.4 percent); viral warts in 89 (5.7 percent); lymphogranuloma venereum in 65 (4.1 percent) and granuloma inguinale in 55 (3.6 percent). A diagnosis could not be made in 697 (44.5 percent) cases. All conditions were significantly higher in men (p<0.001) except for syphilis which was higher in women (p<0.05) and viral warts, where there was no significant difference. In 1990, GUD was found in 128 clients, an overall prevalence of 12.8 percent (men 95, 18.2 percent; women 33, 6.8 percent). Of clients with GUD, syphilis was diagnosed in 24 (18.8 percent); chancroid in 17 (13.3 percent); genital herpes in 10 (7.8 percent); viral warts in 8 (6.3 percent); lymphogranuloma venereum in 5 (3.9 percent) and granuloma inguinale in 3 (2.3 percent). A diagnosis could not be made in 61/128, 47.6 percent of cases in 1990. The prevalence of HIV was 28/1,001 (3.2 percent). A significant association was found between GUD and HIV infection (men with current GUD: OR 7.3, CI1.4 - 72; women with history of "bad blood" (syphilis): OR 6.6, CI 1.3-30). Overall prevalence rates of GUD were significantly higher in 1990 than in 1983 for both sexes (p<0.001), as well as total rates for each sex (males p< 0.001, females p<0.004) (AU)