Squamous Cell Carcinoma at Split Thickness Skin Graft Donor Site: A Case Report and Review of the Literature.

Squamous cell carcinoma (SCC) or keratoacanthoma (KA) development at split thickness skin graft donor sites is a documented but very rare entity. We describe a case in which a patient develops a lesion at his graft site seven weeks postoperatively. Upon pathological review, it was found to be SCC and was excised expediently thereafter. Notably, in reviewing the literature, these lesions tend to develop soon after the trauma of skin graft harvest with over half diagnosed within 3 months and a vast majority within 1 year of the operation. This is in contrast to Marjolin ulcers which take years to develop after the initial burn insult. Given the diversity of autograft indications in the reviewed literature, it seems unlikely that the burns themselves contribute to the development of SCC at the donor site. Our case highlights the need for routine surveillance of graft donor sites postoperatively with an emphasis on catching malignant sequelae.

Burn Prevention in the Elderly: Identifying Age and Gender Differences in Consumer Products Associated With Burn Injuries.

Elderly suffer worse outcomes from burns; thus, it is important to identify the causes of burns in the elderly to develop burn prevention campaigns. We performed a 10-year review of burns that were registered in the NEISS database. We included patients at least 65 years old and analyzed the top five products that caused burn injury. In adults 65 to 74 years old, hot water was the most common cause of burns. Women suffered more burns by candles and cookware. Heaters/heating systems and gasoline were among the top five causes of burns in only men. For the age group 75 to 84 years old, the most common burn was from hot water in women and gasoline in men. For women, the top five included candles, nightwear, and cookware. Only men suffered gasoline burns. The majority of daywear, home/room fire, and ranges/ovens caused burns occurred in men. The majority of burns from hot water, ranges/ovens, electric heating pads, and bathtubs/showers occurred in women. For men, burns from gasoline, structural fires, and heaters are more prevalent. This data can be used to develop age- and gender-specific prevention campaigns to reduce the risk of burn injury.

Volatile anesthetic action in a computational model of the thalamic reticular nucleus.

BACKGROUND: Although volatile anesthetics (VAs) modulate the activity of multiple ion channels, the process whereby one or more of these effects are integrated to produce components of the general anesthetic state remains enigmatic. Computer models offer the opportunity to examine systems level effects of VA action at one or more sites. Motivated by the role of the thalamus in consciousness and sensory processing, a computational model of the thalamic reticular nucleus was used to determine the collective impact on model behavior of VA action at multiple sites. METHODS: A computational model of the thalamic reticular nucleus was modified to permit VA modulation of its ion channels. Isobolographic analysis was used to determine how multiple sites interact. RESULTS: VA modulation of either T-type Ca(2+) channels or gamma-aminobutyric acid type A receptors led to increased network synchrony. VA modulation of both further increased network synchronization. VA-induced decrements in Ca(2+) current permitted greater impact of inhibitory currents on membrane potential, but at higher VA concentrations the decrease in Ca(2+) current led to a decreased number of spikes in the burst generating the inhibitory signal. MAC-awake (the minimum alveolar concentration at which 50% of subjects will recover consciousness) concentrations of both isoflurane and halothane led to similar levels of network synchrony in the model. CONCLUSIONS: Relatively modest VA effects at both T-type Ca(2+) channels and gamma-aminobutyric acid type A receptors can substantially alter network behavior in a computational model of a thalamic nucleus. The similarity of network behavior at MAC-awake concentrations of different VAs is consistent with a contribution of the thalamus to VA-induced unconsciousness through action at these channels.