RESUMO
OBJECTIVES: Scalds involving toddlers commonly involve the torso and are frequently mid-dermal in depth. Initial management of a mid-dermal burn is conservative, progressing to grafting if healing has not been achieved in 10-14 days. Historically BiobraneTM (UDL Laboratories, Inc., Sugar Land, TX) is thought to have more favourable clinical outcomes compared to Acticoat TM (Smith and Nephew, St. Petersburg, Fl, USA). The Burns Unit at The Children's Hospital at Westmead (CHW) uses both dressings on a regular basis, providing the opportunity to compare the results of the dressings in a cohort of patients with mid-dermal torso burns. METHOD: A retrospective review was undertaken of all paediatric mid-dermal torso burns admitted to CHW between 2015 and 2017. The primary outcomes analysed were: time to complete healing and the need for grafting. Secondary outcomes included: operating theatre time, clinic visits, length of stay in hospital and positive wound swab colonisation. RESULTS: 78 children met the study criteria, 64 (82%) in the Acticoat group and 14 (18%) in the Biobrane group. 36 out of 78 children (56%) in the Acticoat group had their burns spontaneously healed without the need of skin graft surgery, compared with 10 out of 14 children (71%) in the Biobrane group. The days to complete healing were quicker in the Acticoat group (13 days) compared to the Biobrane group (17 days), although this was not statistically significant (P = 0.3). Overall patients managed with the Biobrane dressing required more operative sessions under general anaesthesia, a longer hospital stay, more clinic visits and a higher number of positive wound swab colonisation with heavy growth compared to the Acticoat group. CONCLUSION: This study suggests that the use of the Biobrane dressing does not significantly improve the clinical outcomes of mid-dermal torso burns in children compared to the Acticoat dressing. Acticoat reduced healing time, decreased the requirements for a general anaesthesia, reduced inpatient hospital stay and risk of infection.
RESUMO
PURPOSE: Fifty years ago, Bolande described Congenital Mesoblastic Nephroma (CMN) as a benign lesion. Unexpected aggressive clinical behaviors prompted a sub-classification based on histology. Recent molecular genetic evidence has identified the aggressive cellular variant to be the renal manifestation of congenital infantile fibrosarcoma. We submit a reappraisal and analysis of the available literature on recurrent and metastatic CMN. METHODS: An electronic search of PubMed, MEDLINE, EMBASE, and Scopus yielded 38 children with local recurrence and/or metastases. RESULTS: Of the 38 children with local recurrence and/or metastasis, 59% were girls. Median time to recurrence was 6 months (range 1-12 months). The commonest sites of metastases were the lung (39%) and liver (29%). Fifty percent of these children died of disease. The outcome of additional chemotherapy (p = 0.5) did not differ from that of surgery alone. The choice of chemotherapy did not influence the outcome (p = 0.6). CONCLUSIONS: Recurrence and metastasis in cellular CMN are much more common than described earlier and carry a high mortality. Children with cellular and mixed CMN require close clinical and radiological follow-up for a minimum of 12 months after primary surgery. Surgery is the mainstay of the treatment of recurrent and metastatic lesions. Neoadjuvant chemotherapy is recommended only if the lesion is inoperable. Targeted therapy may be an option in treatment of refractory cases.
