Copyright 2006 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2006
Cutaneous Burns Treated With Hydrogel (Burnshield) and a Semipermeable Adhesive Film
Hypothesis: A transparent adhesive film possessing selective permeability combined with a hydrogel (Burnshield) may be effective in burn patients to reduce skin maceration, improve medication, control pain more effectively, and reduce the incidence of late complications (hypertrophic scars).
Design: This is a prospective study; the mean follow-up in all patients was 28.4 months (range, 14-35 months). The external part of the film is impermeable to fluid and microorganisms, but allows transpiration of water vapor from the cutis. The permeability to water vapor of a semipermeable film in contact with liquids is measured in grams per meters squared every 24 hours at 37°C, and is defined as the moisture vapor transmission rate. In this study, a film with a moisture vapor transmission rate of 1600 g/m2 every 24 hours at 37°C was used.
Patients: For about 2 years, this type of therapy was used in the first aid treatment of 48 burn patients, 4 of whom were lost during therapy and 4 of whom were unavailable for follow-up.
Interventions: The patients were treated with hydrogel and a semipermeable film at first medication, and some were treated in this way during subsequent medications.
Main Outcome Measures: The mean reepithelialization time of all patients was 17 days (range, 4-60 days); 8 (20%) of 40 patients with complications were treated with a gel (Same Plast Gel). Late complications were observed: hypertrophic scars in 2 patients (5%) and dyschromic lesions in 6 (15%).
Results: The most frequent complication, which occurred at various stages during medication, was skin maceration (15 [34%] of 44 patients). Other complications recorded during therapy were infections in 2 patients (5%), vertigo in 1 patient (2%), and abundant fibrin production in 1 patient (2%). In some of the patients, associated diseases and/or conditions were found: hepatic cirrhosis, diabetes mellitus, epilepsy, and pregnancy (33rd week) (each found in 1 patient each). Four patients were sent to the burn unit, 3 with second-degree burns of the hand and 1 with first-degree burns of the abdomen and thigh, with 12% of the total body surface area burned.
Conclusions: In the reepithelialization phase, complications were recorded in 8 of the 40 patients: 7 (18%) had residual inflammation and 1 (2%) had a hypertrophic scar. During the follow-up, late complications were recorded in 2 (5%) of the 40 patients. A gel was used in 8 patients: in 6 of the 7 patients with residual inflammation, the complication resolved, while in 1, despite therapy, the residual inflammation evolved into hypertrophic scarring. Treatment with the gel in the 2 patients with late lesions reduced the thickness and extent of the lesions, with minimal aesthetic and functional damage.
Health-Related Quality of Life and Psychosocial Characteristics of Patients With Benign Essential Blepharospasm
Objective: To examine vision-targeted health-related quality of life and psychosocial characteristics in patients with benign essential blepharospasm (BEB) compared with patients with hemifacial spasm (HFS).
Methods: Persons with BEB (n = 159) or HFS (n = 91) were identified based on International Classification of Diseases, Ninth Revision, Clinical Modifications codes with subsequent verification by record abstraction. Information regarding demographics, health characteristics, disease characteristics, and vision-targeted health-related quality of life was obtained through a telephone interview.
Results: For patients with BEB and HFS, the composite scores and subscale scores on the 25-item National Eye Institute Visual Function Questionnaire (NEI-VFQ-25) were low. Compared with patients with HFS, patients with BEB reported more depressive symptoms (P = .03), met the criteria for generalized anxiety disorder (P = .007), had lower NEI-VFQ-25 composite scores (P<.001), and had lower NEI-VFQ-25 subscale scores regarding general vision (P = .03), ocular pain (P<.001), distance activities (P = .001), driving (P<.001), and all of the vision-specific subscales addressing psychosocial issues.
Conclusions: Compared with patients with HFS, those with BEB experience a greater reduction in vision-targeted health-related quality of life and are more prone to symptoms of depression and anxiety. This underscores the inadequacy of current treatment options for BEB in light of the fact that these patients had been undergoing standard-of-care treatments for some time.
Hall TA, McGwin G Jr, Searcey K, Xie A, Hupp SL, Owsley C, Kline LB
Minimally Invasive Orbital Decompression: Local Anesthesia and Hand-Carved Bone
Objective: To investigate the safety and efficacy of a conservative orbital decompression using sharp-curette bony decompression and intraconal fat debulking through a transconjunctival incision in patients with thyroid-related orbitopathy and mild to moderate proptosis.
Design: Retrospective, noncomparative, interventional case series.
Participants and Methods: Data from all patients undergoing minimal orbital decompression at the Jules Stein Eye Institute, Los Angeles, Calif, over a period of 4¼ years were collected and analyzed. Data included visual acuity, exophthalmometry measurements, intraocular pressure, complete slitlamp examination results, ocular ductions, new-onset primary or downgaze diplopia, and patient satisfaction. Conservative decompression was performed through a transconjunctival incision using a manual curette and by removing cortical bone from the zygomatic marrow space on the anterior rim of the inferior orbital fissure; intraconal fat was bluntly dissected and excised or suctioned with a Frasier tip aspirator.
Main Outcome Measures: Patient perception of pressure pain and ocular discomfort, proptosis, visual acuity, intraocular pressure, postoperative complications, and new-onset primary or downgaze diplopia.
Results: Eighty minimally invasive orbital decompression surgeries were performed in 48 patients (6 male, 42 female). Six surgeries (4 patients) were performed for prominent globes with relative proptosis and no thyroid-related orbitopathy (non-Graves proptosis). All patients had improvement in congestive orbitopathy and pressure pain associated with thyroid-related orbitopathy. Exophthalmos decreased by a mean ± SD of 2.4 ± 2.6 mm from 22.7 ± 2.5 mm (range, 17-29 mm) to 20.3 ± 2.3 mm (range, 14-25 mm) (P<.001 [95% confidence interval, 1.8-3.0]). Mean visual acuity improved after surgery (P = .02). One patient (2.1%) developed postoperative primary or downgaze diplopia; he underwent successful eye muscle surgery at a later stage. No complications were associated with orbital decompression.
Conclusions: Minimally invasive orbital decompression surgery with intraconal fat debulking in this group of patients was effective in proptosis reduction; improvement in subjective pressure pain and high patient satisfaction were noticed. Surgery was associated with a low rate (2.1%) of new-onset primary or downgaze diplopia. Proptosis reduction using a graded approach accounting for 4 mm of retrodisplacement was achieved.
Ben Simon GJ, Schwarcz RM, Mansury AM, Wang L, McCann JD, Goldberg RA
Confocal Examination of Untreated Fresh Specimens From Basal Cell Carcinoma: Implications for Microscopically Guided Surgery
Objective: To evaluate the diagnostic accuracy of confocal examination of basal cell carcinoma (BCC) in microscopy-guided surgery.
Design: Four independent observers with no previous experience in confocal laser scanning (CLS) microscopy received standardized instruction about diagnostic CLS microscopic features. Subsequently, 120 confocal images of fresh excisions from BCCs or normal skin were evaluated by each observer, imaged using a commercially available, near-infrared, reflectance CLS microscope. Logistic regression analysis was performed on a combination of all morphologic features using the forward-stepwise (Wald) method. Reliability (interobserver agreement) data were evaluated by κ statistic.
Setting: Department of Dermatology, Medical University of Graz.
Patients: Twenty patients with histologically verified BCC.
Interventions: Evaluation of fresh BCC excisions by CLS microscopy.
Main Outcome Measures: Diagnostic accuracy of the method was evaluated by χ2 test. Diagnostic impact and reliability of each morphologic feature were evaluated by logistic regression analysis and κ statistic, respectively.
Results: Overall, high diagnostic accuracy was achieved by the 4 observers. Logistic regression analysis revealed that mainly tumor cell nuclei and tumor nests should be taken into account for diagnostic decisions, whereas disintegration of tumor cells, peripheral palisading, and retraction of stroma were rarely useful. However, most of the features were highly reliable.
Conclusions: This diagnostic validation study of CLS microscopy in microscopy-guided surgery yielded promising results and opens avenues for further studies. In the future, CLS microscopy may guide microsurgery of any skin cancer.
Gerger A, Horn M, Koller S, Weger W, Massone C, Leinweber B, Kerl H, Smolle J
Abstracts: In Other Archives Journals. Arch Facial Plast Surg. 2006;8(3):224-225. doi: