Autologous bilayered self-assembled skin substitutes (SASSs) as permanent grafts: a case series of 14 severely burned patients indicating clinical effectiveness.

Split-thickness skin autografts (AGs) are the standard surgical treatment for severe burn injuries. However, the treatment of patients with substantial skin loss is limited by the availability of donor sites for skin harvesting. As an alternative to skin autografts, our research group developed autologous self-assembled skin substitutes (SASSs), allowing the replacement of both dermis and epidermis in a single surgical procedure. The aim of the study was to assess the clinical outcome of the SASSs as a permanent coverage for full-thickness burn wounds. Patients were recruited through the Health Canada's Special Access Program. SASSs were grafted on debrided full-thickness wounds according to similar protocols used for AGs. The graft-take and the persistence of the SASS epithelium over time were evaluated. 14 patients received surgical care with SASSs. The mean percentage of the SASS graft-take was 98 % (standard deviation = 5) at 5 to 7 d after surgery. SASS integrity persisted over time (average follow-up time: 3.2 years), without noticeable deficiency in epidermal regeneration. Assessment of scar quality (skin elasticity, erythema, thickness) was performed on a subset of patients. Non-homogeneous pigmentation was noticed in several patients. These results indicated that the SASS allowed the successful coverage of full-thickness burns given its high graft-take, aesthetic outcome equivalent to autografting and the promotion of long-term tissue regeneration. When skin donor sites are in short supply, SASSs could be a valuable alternative to treat patients with full-thickness burns covering more than 50 % of their total body surface area.

[Choroidal metastases in lung cancer]. / Métastases choroïdiennes des cancers broncho-pulmonaires.

INTRODUCTION: Ocular metastases are rare and their diagnosis can be difficult, being dependent on a combination of clinical examination of the eye, ultrasound, angiography and magnetic resonance imaging. CLINICAL CASE: We describe two cases of cases of choroidal metastases in patients with a bronchogenic carcinoma. In both cases the metastases presented at a late stage in the disease and occurred in association with cerebral metastases. One patient had an epidermoid tumour the other a small cell carcinoma. Loss of visual acuity, which was slowly progressive in the first case and abrupt in the second, led to the diagnosis of choroidal metastases. Following radiotherapy in a dose of 30 Gray delivered to the posterior segment of the eye, both patients' visual acuity recovered to near normal within a few weeks. CONCLUSION: If patients with lung cancer develop visual disturbance the possibility of choroidal metastases should be considered. Ocular radiotherapy can often ameliorate disabling visual disturbance, significantly improving quality of life.

Adoption and race: implementing the Multiethnic Placement Act and the Interethnic Adoption Provisions.

Passage of the Multiethnic Placement Act of 1994 (MEPA) and the 1996 provisions on Removal of Barriers to Interethnic Adoption (Interethnic Adoption Provisions) provides an ideal opportunity to examine what can be done to increase adoptions of foster children, particularly children of color. To assist states and child welfare professionals in serving children better and meeting legal obligations, this article discusses racial matching, MEPA, and the Interethnic Adoption Provisions. Implications for practice and challenges in implementing the law also are discussed. The article suggests principles for adoption practice, recruitment, and placement that provide a framework for simultaneously meeting the requirements of the law and serving the best interests of children. Recommendations for practice, policy, and research are offered.