1,720,963 research outputs found
Treatment with vacuum-assisted closure and cryo-preserved homologous de-epidermalised dermis of complex traumas to the lower limbs with loss of substance, and bones and tendons exposure
No full textJ Plast Reconstr Aesthet Surg. 2008 Dec;61(12):1507-11. Epub 2007 Nov 13.
Treatment with vacuum-assisted closure and cryo-preserved homologous de-epidermalised dermis of complex traumas to the lower limbs with loss of substance, and bones and tendons exposure.
Brandi C, Grimaldi L, Nisi G, Silvestri A, Brafa A, Calabrò M, D'Aniello C.
Source
Department of General and Specialist Surgery, Plastic Surgery Unit, University of Siena, Polyclinic S Maria alle Scotte, Viale Bracci, Sienna, Italy. [email protected]
Abstract
SUMMARY: Lower-limb injuries with loss of tissue and exposure of bones and tendons are an increasing problem. The condition of the wound locally and the patient in general does not always allow immediate and adequate coverage of the structures exposed by the trauma. Therefore, new therapeutic solutions are needed. A reduction in the time that bones and tendons are exposed is essential to achieve complete healing of bone fractures, with reduced risks of infection and less disabling outcomes. The effectiveness of vacuum-assisted closure (VAC) therapy in supporting wound healing and of cryopreserved homologous de-epidermalised dermis (DED) in providing an effective template for re-epithelialisation has been previously reported. We carried out a study to evaluate the effectiveness of the synergistic and combined use of the two methodologies. Eighteen patients with traumatic loss of tissue in the lower limbs, involving exposure of bone and tendon structures, were enrolled in the study. All participants had local, general contraindications to first-instance reconstructions, or both. All patients received a combination of VAC therapy and DED implants. Granulation tissue was obtained in all wounds, with complete coverage of exposed structures. No infections were detected in the cohort, and all patients were prepared for further necessary reconstructive treatments. In our experience, the combination of VAC therapy and DED could, in selected cases, constitute an effective treatment for complex lower limb traumatic injuries with bone and tendon exposure
Management of a rare ulcerated erythema nodosum in a patient affected by Crohn's disease and tuberculosis
No full textWe reported a rare case of Erythema Nodosum secondary to Crohn's disease in which nodes localized to lower limbs became ulcerated even if usually they spontaneously involves in few weeks. After the patient contracted tuberculosis, that is another factor favouring secondary EN, immunomodulating therapy had been reduced to avoid the spreading of the infection: in this way panniculitides had became quiet untreatable. Skin ulcers underlying lower limbs nodularities had appeared and different strategies of treatment failed being no longer sufficient to reach adequate healing. We emphasize the use of cycles of VAC therapy alternated to Promogran© as valid approach providing a means of achieving a good healing
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
The role of carbon dioxide therapy in the treatment of chronic wounds
No full textA wound is defined as chronic when it does not heal according to the normal repair times and mechanisms. This particular condition may be principally due to local hypoxia. Carbon dioxide (CO2) therapy refers to the transcutaneous or subcutaneous administration of CO2 for therapeutical effects on both microcirculation and tissue oxygenation. In this study, we report the clinical and instrumental results of the application of CO2 in the therapy of chronic wounds. The study included 70 patients affected by chronic ulcers. The patients were selected by aetiology and wound extension and equally divided into two homogeneous groups. In group A, CO2 therapy was used in addition to the routine methods of treatment for such lesions (surgical and/or chemical debridement, advanced dressings according to the features of each lesion). In group B, patients were treated using routine methods alone. Both groups underwent to instrumental (laser doppler flow, measurement of TcPO2), clinical and photographic evaluation. In the group that underwent subcutaneous treatment with CO2 therapy, the results highlighted a significant increase in tissue oxygenation values, which was confirmed by greater progress of the lesions in terms of both healing and reduction of the injured area. Considering the safety, efficacy and reliability of this method, even if further studies are necessary, we believe that it is useful to include subcutaneous carbon dioxide therapy in the treatment of wounds involving hypoxia-related damage
Digital epiluminescence dermoscopy for pigmented cutaneous lesions, primary care physicians, and telediagnosis: a useful tool?
No full textBACKGROUND: Digital epiluminescence dermoscopy is a relatively recent tool, based on the acquisition of high-definition digital images, for the diagnosis of pigmented cutaneous lesions.
PURPOSE: To verify the usefulness of digital dermoscopy in detecting pigmented lesions with features which may lead to suspicion of malignancy, when the examination is carried out by primary care physicians (PCP), not expert in that kind of diagnosis. Another target was an appraisal of the effectiveness and safety of telediagnosis based on epiluminescence digital dermoscopy on pigmented lesions.
METHODS: Digital images from some peripheral centres (235 lesions) have been forwarded in real time to the reference centre (Unit of Plastic Surgery, University of Siena, Italy), with a double judgement by each primary care physician ('benign' or 'suspicious of malignancy') on the basis of anamnesis and clinical examination at first step, and dermoscopy as second step. The image analysis carried out from the reference centre identified every lesion examined as 'to be controlled' (219 lesions) or 'to be removed' (16 lesions).
RESULTS: Regarding the patients with dermoscopic examination (197 subjects, 235 lesions), the investigation reduced the number of lesions suspected of malignancy from 68 to 29 after the first dermoscopy, and from 29 to 16 after the re-examination of the image by the central unit researchers. Fourteen lesions suspected of malignancy when examined in the peripheral centres were then evaluated as benign by the central unit researchers, while one lesion, judged as benign at first (always labelled as 'benign' by the PCP), was then revealed as a dysplastic naevus.
CONCLUSION: Digital dermoscopy can be enhanced by telediagnosis, which provides a better control of cutaneous pigmented lesions in the peripheral areas, thus reducing the number of consultations in specialised centres
Cutaneous metastasis of the superior lip from adenocarcinoma of the gastro-oesophageal junction. A case report
No full textThe Authors report a rare case of cutaneous upper lip metastasis from an adenocarcinoma of the gastro-oesophageal junction, in a 72-year-old white man, which was excised and the defect repaired with a transposition flap from the cheek. From a review of the literature, the skin is generally an uncommon site of metastasis particularly for this kind of cancer, with very few reports. The prognosis of such lesions is poor, and the incidence of other synchronous secondary localisations is high in these cases, but prompt treatment preserves the functionality and aesthetic appearance of the region, ensuring a good quality of life
Surgical site infections in plastic surgery: an italian multicenter study
No full textBACKGROUND:Plastic surgery interventions have increased in terms of frequency, complexity of surgical procedures, and postoperative complications, particularly surgical site infections (SSIs). The aim of the present study was to assess the SSI frequency in plastic and reconstructive surgery settings in Italy and to evaluate the associated risk factors.
METHODS:From June 2004 to June 2005, a prospective multicenter study including 2806 consecutive patients was conducted in 23 Italian plastic and reconstructive units. To assess potential risk factors for surgical site infection, a conditional logistic regression model was used and results were exposed in terms of odds ratio (OR) with their respective 95% confidence interval (CI).
RESULTS:SSIs occurred in 85/2806 (3%) patients. Sixty (70.6%), 24 (28.2%), and 1 (1.2%) SSIs were classified as superficial, deep, and organ/space, respectively. Sixty-six percent of the SSIs were diagnosed during postdischarge surveillance. At multivariate analysis, diabetes mellitus, chronic obstructive pulmonary disease, preoperative radiotherapy, and use of surgical drains were significantly associated with the occurrence of SSI.
CONCLUSIONS:Our findings, based on a large population including all types of plastic and reconstructive interventions, provided consistent information on potential risk factors for SSI in this surgical setting. Moreover, the high rate of SSI found during the postdischarge surveillance underlines the need for improving active surveillance methodologies in this surgical setting
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Association of nevus of Jadassohn, sebaceoma and trichoblastoma in a scalp lesion
No full textAssociation of nevus of Jadassohn, sebaceoma and trichoblastoma in a scalp lesion
- …
