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[PMID]:29275616
[Au] Autor:Li SJ; Wang ZL; Zhu WP; Xiang Y; Lin J; Yu YJ; Li P
[Ad] Endereço:Department of Radiology, Shanghai Electric Power Hospital, Shanghai 200050, China.
[Ti] Título:[Clinical research of features of magnetic resonance imaging of high-voltage electrical burns in limbs at early stage].
[So] Source:Zhonghua Shao Shang Za Zhi;33(12):750-756, 2017 Dec 20.
[Is] ISSN:1009-2587
[Cp] País de publicação:China
[La] Idioma:chi
[Ab] Resumo:To analyze the features of magnetic resonance imaging (MRI) of patients with high-voltage electrical burns in limbs at early stage. Thirty-eight patients with high-voltage electrical burns, conforming to the study criteria, were hospitalized in our unit from March 2013 to August 2016. T(1) weighted imaging (T(1)WI), T(2)WI, fat-suppression T(2)WI plain scan, and fat-suppression T(1)WI enhanced scan of MRI were performed in 78 limbs, including 56 upper limbs and 22 lower limbs at post injury hour 72. The MRI signal characteristics of electrical burns in skin and subcutaneous tissue, skeletal muscle, tendon, joint ligament, and skeleton of limbs were analyzed. " Sandwich-like" necrosis and injury in skeletal muscle, injuries of tendon, joint ligament, and skeleton were observed. MRI signal characteristics of amputated upper limbs and salvaged limbs were also analyzed. All patients underwent surgery within 24 h after MRI examination, and the muscle vitality was judged during operation. Muscle tissue without reaction to electrical stimulation which was completely necrotic as shown by MRI, muscle tissue with weak reaction to electrical stimulation which was injured with blood supply as shown by MRI, and muscle tissue with edema as shown by MRI were collected, and then the pathological characteristics of muscle tissue were observed with HE staining. (1) The defect area of patients at entrance of current was bigger than that at exit. The skin and subcutaneous tissue extensively unevenly thickened. T(2)WI manifested hyperintensity, and T(1)WI manifested isointensity, while fat-suppression enhanced T(1)WI manifested uneven enhancement. Zonal effusion was seen in the region of serious subcutaneous edema. (2) For complete necrosis of skeletal muscle, T(2)WI manifested hypointense, isointensity, or slight hyperintensity, and T(1)WI manifested isointensity, slight hyperintensity, or mixed signal of isointensity and slight hyperintensity, while fat-suppression enhanced T(1)WI manifested most no enhancement area with clear boundary. The MRI signals of injured skeletal muscle could be divided into two types. Type â…  signal was for partial necrotic muscle adjacent to the completely necrotic zone. T(2)WI manifested uneven hyperintensity or slight hyperintensity, with unclear boundary. T(1)WI manifested isointensity or slight hyperintensity. Fat-suppression enhanced T(1)WI manifested significant banding or laciness enhancement. Type â…¡ signal was for deep muscle tissue far from the complete necrotic zone. T(2)WI manifested hyperintensity, and T(1)WI manifested isointensity or main isointensity mixed with hyperintensity, while fat-suppression enhanced T(1)WI manifested uneven moderate or slight enhancement. Normal muscle signal, type â…  signal, and type â…¡ signal were all mixed with necrotic signal, showing " sandwich-like" change. For skeletal muscle edema, T(2)WI manifested slight hyperintensity and unclear boundary, and T(1)WI manifested hypointense, while fat-suppression enhanced T(1)WI manifested no obvious enhancement. (3) For complete necrosis of tendon, T(2)WI manifested isointensity or slight hyperintensity, and T(1)WI manifested isointensity, while fat-suppression enhanced T(1)WI manifested no enhancement. For tendon injury, T(2)WI manifested isointensity, and T(1)WI manifested isointensity or hypointense, while fat-suppression enhanced T(1)WI manifested slight enhancement. (4) Severe injury of wrist joint were manifested as complete necrosis of soft tissue around joint. T(2)WI manifested slight hyperintensity or isointensity, and T(1)WI manifested isointensity, while fat-suppression enhanced T(1)WI manifested no enhancement or slightly uneven enhancement. For completely destroyed wrist joints, the structures were not clear from outside to inside. T(2)WI manifested slight hyperintensity or isointensity, and T(1)WI manifested hypointense or isointensity, while fat-suppression enhanced T(1)WI manifested no enhancement. For elbow injury, T(2)WI manifested hyperintensity, and T(1)WI manifested isointensity or hypointense, while fat-suppression enhanced T(1)WI manifested uneven enhancement. For knee injury, T(2)WI manifested hyperintensity, and T(1)WI manifested hypointense, while fat-suppression enhanced T(1)WI manifested slight enhancement. (5) For bone edema, T(2)WI manifested isointensity, while fat-suppression T(2)WI manifested slight hyperintensity. T(1)WI manifested isointensity, and fat-suppression enhanced T(1)WI manifested patchy enhancement. (6) MRI of amputated upper limbs showed necrosis signals, type â…  signals, type â…¡ signals, and mixed signals of type â…  and type â…¡ in skeletal muscle. The necrosis signal and type â…  signal area of the distal end were more than 50% greater than those of the lesion. The scope of the ecological tissue was large and the boundary was not clear. There were diffuse injuries in both anterior and posterior muscles, and the ulnar and radial artery pulsation disappeared in the upper limbs. The MRI of salvaged limbs were type â…  signal, type â…¡ signal, mixed signals of type â…  and type â…¡, and local necrosis signals of skeletal muscle. The type â…  signal was the main type, and the distal end showed type â…¡ signal. (7) For completely necrotic skeletal muscle as shown by MRI, surgical exploration showed loss of muscle viability, and pathological examination showed complete necrosis of striated muscle tissue. For injury area of skeletal muscle as shown by MRI, surgical exploration showed interecological muscle with activity worse than mormal muscle, and pathological examination showed normal muscle cells and muscle fiber mixed with necrotic striated muscle cells having karyopyknosis, with different degree of injury. For edema area of skeletal muscle as shown by MRI, surgical exploration showed swelling skeletal muscle and normal muscle vitality, and pathological examination showed striated muscle interstitial edema with a large number of inflammatory cells infiltration. The manifestions of MRI were consistent with the results of surgical exploration and pathological examination. Skeletal muscle complete necrosis, injury, and edema could be preferably differentiated by MRI, and the definite scope and depth of electrical injury, the injury of skin, tendon, joint ligament, and bone could also be displayed well on MRI. It can provide objective imaging basis for the diagnosis of high-voltage electrical burns in limbs at early stage, the establishment of clinical operation plan, and the judgment of intraoperative tissue vitality.
[Mh] Termos MeSH primário: Queimaduras por Corrente Elétrica/diagnóstico por imagem
Extremidades/diagnóstico por imagem
Imagem por Ressonância Magnética
[Mh] Termos MeSH secundário: Edema
Eletricidade
Feminino
Seres Humanos
Masculino
Músculo Esquelético
Necrose
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180105
[Lr] Data última revisão:
180105
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171226
[St] Status:MEDLINE
[do] DOI:10.3760/cma.j.issn.1009-2587.2017.12.006


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[PMID]:29275615
[Au] Autor:Zhang QF; Li Y; Feng JK; Xu YF; Tu LL
[Ad] Endereço:Department of Burns and Plastic Surgery, the First Hospital of Hebei Medical University, Burns Treatment Project Technology Research Center of Hebei Province, Shijiazhuang 050031, China.
[Ti] Título:[Changes of platelet rheological behavior and the interventional effects of ulinastatin in rats with high-voltage electrical burns].
[So] Source:Zhonghua Shao Shang Za Zhi;33(12):744-749, 2017 Dec 20.
[Is] ISSN:1009-2587
[Cp] País de publicação:China
[La] Idioma:chi
[Ab] Resumo:To explore the influence of high-voltage electrical burns on the number of platelet aggregation, ß-thromboglobulin (ß-TG) and platelet factor 4 (PF-4) and the interventional effects of ulinastatin in rats with high-voltage electrical burns. A total of 240 Sprague-Dawley rats were divided into sham injury (SI) group, simple electrical burn (SEB) group, normal saline (NS) group, and ulinastatin (UTI) group according to the random number table, with 60 rats in each group. The electrical current was applied to the outside proximal part of left forelimb of rats and exited from the outside proximal part of right hind limb of rats. Rats in groups SEB, NS, and UTI were inflicted with high-voltage electrical burn wounds of 1 cm×1 cm at current entrances and exits, with the voltage regulator and experimental transformer. Rats in group SI were sham injured through connecting the same equipments without electricity. At 2 min post injury, rats in group NS were intraperitoneally injected with 2 mL/kg NS, and rats in group UTI were intraperitoneally injected with 2×10(4) U/kg UTI of 10 g/L. At 15 min before injury and 5 min, 1 h, 2 h, 4 h, 8 h post injury, 10 rats in each group were selected to collect 5-7 mL blood of heart respectively. Blood of 0.05 mL were collected to make fresh blood smear for observing the number of platelet aggregation, and serum were separated from the remaining blood to determine content of ß-TG and PF-4 with enzyme-linked immunosorbent assay. Data were processed with analysis of factorial design of variance, student-Newman-Keuls test, Kruskal-Wallis test, Wilcoxon rank sum test, and Bonferroni correction. (1) At 15 min before injury, the numbers of platelet aggregation of rats were close among groups SI, SEB, NS and UTI (5.9±1.2, 5.8±1.2, 5.9±1.3, 5.9±1.1, respectively, with values above 0.05). At 5 min, 1 h, 2 h, 4 h, 8 h post injury, the numbers of platelet aggregation of rats in group SEB were 57.2±16.3, 59.1±16.9, 60.8±20.6, 83.6±24.9, and 83.4±30.3, respectively, obviously more than those in group SI (6.0±1.3, 6.0±1.4, 5.9±1.4, 5.7±1.1, and 5.8±1.3, respectively, with values below 0.001); the numbers of platelet aggregation of rats in group UTI were 29.6±7.4, 31.9±10.1, 35.0±14.2, 43.0±13.6, and 35.2±11.1, respectively, obviously more than those in group NS (58.3±16.1, 63.9±18.0, 60.8±17.7, 74.2±23.0, and 82.3±21.9, respectively, with values below 0.001). There was no significantly statistical difference in the number of platelet aggregation of rats in group SI between each two time points within the same group (with values above 0.05), but the number of platelet aggregation of rats in the other 3 groups at each time point post injury was significantly more than that of the same group at 15 min before injury (with values below 0.001). (2) At 2, 4, and 8 h post injury, ß-TG content of serum of rats in group SEB was significantly higher than that in group SI (with values from -3.780 to -3.477, values below 0.05). At 5 min and 4 h post injury, ß-TG content of serum of rats in group UTI was significantly lower than that in group NS (with values respectively -3.477 and -3.780, values below 0.05). There was no significantly statistical difference in ß-TG content of serum of rats in group SI at all time points of the same group ( (2)=0.130, >0.05). At 2, 4, and 8 h post injury, ß-TG content of serum of rats in group SEB was significantly higher than that of the same group at 15 min before injury (with values from -3.780 to -3.553, values below 0.05). At 5 min, 1 h, and 4 h post injury, ß-TG content of serum of rats in group NS was significantly higher than that of the same group at 15 min before injury (with values from -3.780 to -3.477, values below 0.05). At 1 and 4 h post injury, ß-TG content of serum of rats in group UTI was significantly higher than that of the same group at 15 min before injury (with values respectively -3.250 and -3.780, values below 0.05). (3) At 2 and 8 h post injury, PF-4 content of serum of rats in group SEB was significantly higher than that in group SI (with values below 0.05). At 2 h post injury, PF-4 content of serum of rats in group UTI was significantly higher than that in group NS ( <0.05), and at 4 and 8 h post injury, PF-4 content of serum of rats in group UTI was significantly lower than that in group NS (with values below 0.05). At all time points, PF-4 content of serum of rats in group SI was close (with values above 0.05). At 2 and 8 h post injury, PF-4 content of serum of rats in group SEB was significantly higher than that of the same group at 15 min before injury (with values below 0.05). At 1, 4, and 8 h post injury, PF-4 content of serum of rats in group NS was significantly higher than that of the same group at 15 min before injury (with values below 0.05). There were significantly statistical differences in PF-4 content of serum of rats between all time points except for 5 min post injury and 15 min before injury (with values below 0.05). Increasing number of platelet aggregation and abnormal secretion of ß-TG and PF-4 of rats with high-voltage electrical burns can lead to microcirculation disturbance. UTI can alleviate microcirculation disturbance caused by high-voltage electrical burns by reducing the number of platelet aggregation and inhibiting secretion of ß-TG and PF-4.
[Mh] Termos MeSH primário: Plaquetas/efeitos dos fármacos
Queimaduras por Corrente Elétrica/fisiopatologia
Glicoproteínas/farmacologia
Agregação Plaquetária/efeitos dos fármacos
Inibidores da Tripsina/farmacologia
[Mh] Termos MeSH secundário: Animais
Queimaduras
Queimaduras por Corrente Elétrica/sangue
Ensaio de Imunoadsorção Enzimática
Microcirculação
Ratos
Ratos Sprague-Dawley
Soro
beta-Tromboglobulina
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Glycoproteins); 0 (PPBP protein, human); 0 (Trypsin Inhibitors); 0 (beta-Thromboglobulin); OR3S9IF86U (urinastatin)
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180105
[Lr] Data última revisão:
180105
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171226
[St] Status:MEDLINE
[do] DOI:10.3760/cma.j.issn.1009-2587.2017.12.005


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[PMID]:29275614
[Au] Autor:Shen YM; Ma CX; Qin FJ; Zhang C; Wang C; Hu XH
[Ad] Endereço:Department of Burns, Beijing Jishuitan Hospital, Beijing 100035, China.
[Ti] Título:[Wound repair and functional reconstruction of high-voltage electrical burns in wrists].
[So] Source:Zhonghua Shao Shang Za Zhi;33(12):738-743, 2017 Dec 20.
[Is] ISSN:1009-2587
[Cp] País de publicação:China
[La] Idioma:chi
[Ab] Resumo:To explore the methods and effects of wound repair and functional reconstruction of high-voltage electrical burns in wrists. From January 2009 to June 2016, 71 patients with high-voltage electrical burns in wrists were hospitalized, with 118 wrist wounds including 21 of type â… , 69 of type â…¡, 9 of type â…¢, and 19 of type â…£. According to the wrist injuries, different surgical operations were performed. Forearm amputation was conducted in 20 wrists with necrosis in the distal end. On the basis of fasciotomy for decompression, early debridement was performed on the other 98 wrist wounds. After debridement, wounds with area ranging from 10 cm×7 cm to 30 cm×18 cm were repaired with tissue flaps with abundant blood supply. Thirty-two wounds were repaired with pedicled groin flaps, 11 wounds with pedicled paraumbilical flaps, 3 wounds with pedicled anterolateral thigh island flaps, 9 wounds with combined abdominal axial pattern flaps, 37 wounds with free skin flaps or myocutaneous flaps, and 6 wounds with flow-through descending branch of lateral femoral circumflex artery flaps, with tissue flap area ranging from 12 cm×8 cm to 34 cm×20 cm. Ulnar artery or radial artery vascular reconstruction was performed in 20 wrist wounds. Forty-one donor sites were sutured directly, while 14 were closed by thin split-thickness skin grafts from same-side thighs, and 43 were closed by thin split-thickness skin grafts from opposite-side thighs. Fifty-three wrist wounds were performed with tendon and nerve repair surgery, of which 20 were performed with simple tendon and nerve release surgery. Flexor digitorum profundus tendons and (or) flexor pollicis longus tendons were reconstructed with autologous or allogeneic tendon transplantation in 33 wrist wounds, and the median nerve was repaired with sural nerve graft in 21 wrist wounds. In 6 to 24 months after the last operation, tendon function of 53 wrist wounds which had tendon repair was evaluated with finger total active motion (TAM) method, while median nerve function of 21 wrist wounds which had median nerve repair was evaluated with integrate estimation method. (1) After forearm amputation, the incisions of 20 wrists with necrosis in the distal end were healed. (2) Among the 98 tissue flaps, 90 had good blood flow, while 8 had distal necrosis, of which 6 were healed after necrotic tissue removal and skin grafting, and two were sutured directly after debridement. Infection occurred under 7 flaps, of which 3 were healed by dressing change, and 4 were healed after second debridement. Twenty wrist wounds which had radial artery or ulnar artery repair had good blood supply of hand and amputation was avoided. During follow-up of 1 to 3 years, the incisions and flaps of patients who had tissue flap repair surgery healed well. (3) The excellent and good rate of TAM in each finger of the corresponding affected limbs of 53 wrist wounds which had tendon and nerve repair surgery was 51%. (4) Twenty wrists which had simple tendon and nerve release surgery were followed up for 1 to 2 years. The strength of muscle dominated by the median nerve was restored to grade â…¤ in 1 wrist, grade â…£ in 3 wrists, and grade â…¢ in 2 wrists. The strength of muscle dominated by the ulnar nerve was restored to grade â…£ in 3 wrists, with no recovery in other wrists. Sensory function examination showed grade S0 in 4 wrists, grade S1 in 2 wrists, grade S2 in 3 wrists, grade S3 in 8 wrists, and grade S4 in 3 wrists. Twenty-one wrists which had median nerve repair were followed up for 1 to 2 years. There was no recovery in muscle strength dominated by the median nerve. Sensory function examination showed grade S0 in 3 wrists, grade S1 in 5 wrists, grade S2 in 8 wrists, and grade S3 in 5 wrists. It is a good method to sequentially conduct early fasciotomy for decompression, early debridement, vascular reconstruction, transplant of tissue flap with abundant blood supply, tendon and nerve repair in repairing electrical burn wounds of wrists, avoiding amputation, and reconstructing hand function according to the condition of electrical burns of wrists.
[Mh] Termos MeSH primário: Queimaduras por Corrente Elétrica/cirurgia
Procedimentos Cirúrgicos Reconstrutivos/métodos
Cicatrização
Traumatismos do Punho/cirurgia
[Mh] Termos MeSH secundário: Adulto
Desbridamento
Feminino
Seres Humanos
Masculino
Meia-Idade
Retalho Miocutâneo
Higiene da Pele
Transplante de Pele
Lesões dos Tecidos Moles/terapia
Retalhos Cirúrgicos
Traumatismos do Punho/etiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180105
[Lr] Data última revisão:
180105
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171226
[St] Status:MEDLINE
[do] DOI:10.3760/cma.j.issn.1009-2587.2017.12.004


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[PMID]:29275613
[Au] Autor:Jiang MJ; Li Z; Xie WG
[Ad] Endereço:Department of General Surgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, China.
[Ti] Título:[Epidemiological investigation on 2 133 hospitalized patients with electrical burns].
[So] Source:Zhonghua Shao Shang Za Zhi;33(12):732-737, 2017 Dec 20.
[Is] ISSN:1009-2587
[Cp] País de publicação:China
[La] Idioma:chi
[Ab] Resumo:To analyze the epidemiological characteristics of the hospitalized patients with electrical burns in Institute of Burns of Tongren Hospital of Wuhan University & Wuhan Third Hospital (hereinafter referred to as Institute of Burns of Wuhan Third Hospital), so as to provide reference for the prevention and treatment of electrical burns. Medical records of all hospitalized burn patients in Institute of Burns of Wuhan Third Hospital from January 2004 to December 2016 were collected. Genders, ages, social categories, seasons of injury, total burn areas, depths of wounds, electrical voltages of injury, sites of wound, treatment methods, amputation rates, lengths of hospital stay, operation costs, hospitalization costs, and treatment outcomes of the electrical burn patients were collected. Treatment methods, lengths of hospital stay, operation costs, and hospitalization costs of the thermal burn patients were collected and compared with those of the electrical burn patients. Electrical voltages of injury, amputation rates, operation costs, hospitalization costs, and treatment outcomes were compared and analyzed between the electrical contact burn patients and the electrical arc burn patients. Data were processed with Chi-square test and Wilcoxon rank-sum test. During the 13 years, 23 534 burn patients were admitted to Institute of Burns of Wuhan Third Hospital, among whom 2 133 (9.1%) were with electrical burns, without obvious variation in admission number of electrical burn patients every year. There were 1 418 patients (66.5%) with electrical contact burns and 715 patients (33.5%) with electrical arc burns. The ratio of male to female was 11.2∶1.0 among the electrical burn patients with known genders. The proportions of three age groups of more than 20 years old and less than or equal to 30 years old, more than 30 years old and less than or equal to 40 years old, and more than 40 years old and less than or equal to 50 years old were relatively higher, which were 18.3% (391/2 133), 22.1% (471/2 133), and 24.6% (525/2 133), respectively. The first three social category groups in proportions were workers, peasants, and preschool children, which were 57.9% (1 235/2 133), 14.6% (311/2 133), and 6.0% (128/2 133), respectively. Among the electrical burn patients with known seasons of injury, most cases were injured in summer (659 cases, accounting for 34.1%), obviously more than the proportions in autumn (537 cases, accounting for 27.8%), spring (455 cases, accounting for 23.5%), and winter (283 cases, accounting for 14.6%), with (2) values from 8.414 to 149.573, values below 0.01. The group of patients with total burn areas less than 10% total body surface area (TBSA) occupied the highest proportion (1 603 cases, accounting for 75.15%), among whom 229 (10.74%) were with scattered small wounds which were less than 1% TBSA. The percentage of electrical contact burn patients with deep wounds was 79.1% (1 122/1 418), which was obviously higher than 2.5% (18/715) of the electrical arc burn patients ( (2)=381.741, <0.001). Among the patients with known electrical voltages of injury, patients injured by high voltage among the electrical contact burn patients accounted for 78.4% (469/598), which was obviously higher than 8.7% (11/127) of the electrical arc burn patients ( (2)=227.893, <0.001). The most common wound site of the electrical burn patients was upper limbs (1 650 cases, accounting for 63.2%), followed by lower limbs (382 cases, accounting for 14.6%), head and neck (292 cases, accounting for 11.2%), trunk (247 cases, accounting for 9.5%), and hip and perineum (40 cases, accounting for 1.5%). The operation rate of electrical burn patients was 32.4% (691/2 133), obviously higher than 19.1% (3 860/20 209)of the thermal burn patients during the same period ( (2)=210.255, <0.001). Wounds of 116 electrical contact burn patients were repaired with free flap by vascular anastomosis, of which 9 (7.8%) failed. The length of hospital stay, the operation cost, and the hospitalization cost of electrical burn patients were (28±29) d, (9 534±16 935) and (44 258±93 012) Yuan, respectively, obviously longer or higher than those of the thermal burn patients during the same period [(17±19) d, (2 990±8 916) and (23 291±88 340) Yuan, respectively, with values from -21.323 to -10.996, values below 0.001]. The amputation rate and the death rate of electrical burn patients were 3.8% (82/2 133) and 0.8% (16/2 133) respectively. Compared with those of electrical arc burn patients, the amputation rate and the operation cost of electrical contact burn patients were obviously higher ( (2)=36.970, =-11.351, values below 0.001), and the length of hospital stay of electrical contact burn patients was obviously longer ( =-5.181, <0.001). There were no significant differences in hospitalization cost and treatment outcome between the electrical contact burn patients and the electrical arc burn patients ( =-1.461, (2)=1.673, values above 0.05). The number and the proportion of hospitalized electrical burn patients in Institute of Burns of Wuhan Third Hospital were relatively high, indicating a hard task of prevention for electrical burns in Wuhan area. Working-age workers and farmers, and preschool children were the key groups in prevention from electrical burns. The length of hospital stay, the operation cost, and the hospitalization cost of electrical burn patients were obviously higher than those of thermal burn patients. The amputation rate and the operation cost of electrical contact burn patients were obviously higher than those of electrical arc burn patients, but there were no obvious differences in hospitalization cost or treatment outcome between them. Actively using tissue flaps including free flap to repair of wounds may be helpful to reduce the amputation rate, improve the results, and shorten the time of treatment.
[Mh] Termos MeSH primário: Queimaduras por Corrente Elétrica/epidemiologia
Tempo de Internação
[Mh] Termos MeSH secundário: Amputação
Queimaduras por Corrente Elétrica/terapia
Pré-Escolar
Feminino
Retalhos de Tecido Biológico
Hospitalização
Seres Humanos
Extremidade Inferior
Masculino
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180105
[Lr] Data última revisão:
180105
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171226
[St] Status:MEDLINE
[do] DOI:10.3760/cma.j.issn.1009-2587.2017.12.003


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[PMID]:29275612
[Au] Autor:Xie WG
[Ad] Endereço:Institute of Burns, Tongren Hospital of Wuhan University & Wuhan Third Hospital, Wuhan 430060, China.
[Ti] Título:[Prevention and treatment of electrical burn injury: much progresses achieved yet further efforts still needed].
[So] Source:Zhonghua Shao Shang Za Zhi;33(12):728-731, 2017 Dec 20.
[Is] ISSN:1009-2587
[Cp] País de publicação:China
[La] Idioma:chi
[Ab] Resumo:Electrical burn injury is very common, including electrical contact burn, electrical arc burn, and lightning burn, etc. Electrical burn patients account for 0.04 to 5 percent of all burn victims in the developed countries, while it hit up to 27 percent in the developing countries, much more than the global average of 4.5 percent. Historical and recent data have shown that the electrical burn injuries in China, either for the case number, the proportion of burn patients in hospital, or the population incidence per year, are much higher than those of the developed countries and the global average. Before the 1960s, conservative treatment or skin grafts after repeated debridements were used for electrical burns, resulting in high rates of amputation and severe deformity. In the 1960s, transplantation of flaps after debridement in early stage were used for repairing wrist electrical burn wounds, breaking through the traditional conservative methods. In the 1980s, local, distant and island pedicled skin or myocutaneous flaps were widely used for early stage repair of electrical burn wounds. In recent years, along with the increasing experience of evaluating the blood vessel injuries and the development of microsurgical techniques, free flaps have been more and more used to cover the deep wounds of electrical burns in early stage, leading to much better effects and shorter length of hospital stay. With the persistent efforts of the burn specialists in the last decades, great improvements have been made for the treatment of electrical burn injuries in China. Future study on decoding the full mechanism of electrical burn injury, exploring new methods to save the injured but not yet necrotic tissue, are still needed to improve the treatment and reduce amputation and deformity of electrical burn injury.
[Mh] Termos MeSH primário: Queimaduras por Corrente Elétrica/prevenção & controle
Queimaduras por Corrente Elétrica/terapia
Desbridamento
Transplante de Pele
Retalhos Cirúrgicos
[Mh] Termos MeSH secundário: Adulto
Amputação
China
Feminino
Retalhos de Tecido Biológico
Seres Humanos
Masculino
Retalho Miocutâneo
Necrose
Lesões do Sistema Vascular
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180105
[Lr] Data última revisão:
180105
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171226
[St] Status:MEDLINE
[do] DOI:10.3760/cma.j.issn.1009-2587.2017.12.002


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[PMID]:29078867
[Au] Autor:Overbey DM; Hilton SA; Chapman BC; Townsend NT; Barnett CC; Robinson TN; Jones EL
[Ad] Endereço:Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado; Department of Surgery, Denver Veterans Affairs Medical Center, Denver, Colorado.
[Ti] Título:Hand-to-hand coupling and strategies to minimize unintentional energy transfer during laparoscopic surgery.
[So] Source:J Surg Res;219:103-107, 2017 Nov.
[Is] ISSN:1095-8673
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Energy-based devices are used in nearly every laparoscopic operation. Radiofrequency energy can transfer to nearby instruments via antenna and capacitive coupling without direct contact. Previous studies have described inadvertent energy transfer through bundled cords and nonelectrically active wires. The purpose of this study was to describe a new mechanism of stray energy transfer from the monopolar instrument through the operating surgeon to the laparoscopic telescope and propose practical measures to decrease the risk of injury. METHODS: Radiofrequency energy was delivered to a laparoscopic L-hook (monopolar "bovie"), an advanced bipolar device, and an ultrasonic device in a laparoscopic simulator. The tip of a 10-mm telescope was placed adjacent but not touching bovine liver in a standard four-port laparoscopic cholecystectomy setup. Temperature increase was measured as tissue temperature from baseline nearest the tip of the telescope which was never in contact with the energy-based device after a 5-s open-air activation. RESULTS: The monopolar L-hook increased tissue temperature adjacent to the camera/telescope tip by 47 ± 8°C from baseline (P < 0.001). By having an assistant surgeon hold the camera/telescope (rather than one surgeon holding both the active electrode and the camera/telescope), temperature change was reduced to 26 ± 7°C (P < 0.001). Alternative energy devices significantly reduced temperature change in comparison to the monopolar instrument (47 ± 8°C) for both the advanced bipolar (1.2 ± 0.5°C; P < 0.001) and ultrasonic (0.6 ± 0.3°C; P < 0.001) devices. CONCLUSIONS: Stray energy transfers from the monopolar "bovie" instrument through the operating surgeon to standard electrically inactive laparoscopic instruments. Hand-to-hand coupling describes a new form of capacitive coupling where the surgeon's body acts as an electrical conductor to transmit energy. Strategies to reduce stray energy transfer include avoiding the same surgeon holding the active electrode and laparoscopic camera or using alternative energy devices.
[Mh] Termos MeSH primário: Queimaduras por Corrente Elétrica/prevenção & controle
Eletrocirurgia/métodos
Transferência de Energia
Laparoscopia/métodos
Traumatismos Ocupacionais/prevenção & controle
Cirurgiões
[Mh] Termos MeSH secundário: Animais
Queimaduras por Corrente Elétrica/etiologia
Bovinos
Eletrocirurgia/instrumentação
Mãos
Seres Humanos
Laparoscopia/instrumentação
Fígado/cirurgia
Traumatismos Ocupacionais/etiologia
[Pt] Tipo de publicação:CLINICAL TRIAL; JOURNAL ARTICLE
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171109
[Lr] Data última revisão:
171109
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171029
[St] Status:MEDLINE


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[PMID]:28763908
[Au] Autor:Shen YM; Chen X; Zhang C; Wang C; Qin FJ; Ma CX; Hu XH
[Ad] Endereço:Department of Burns, Beijing Jishuitan Hospital, Beijing 100035, China.
[Ti] Título:[Effects of flow-through descending branch of lateral circumflex femoral artery flap on repairing high-voltage electrical burn wounds of wrist of patients].
[So] Source:Zhonghua Shao Shang Za Zhi;33(7):422-425, 2017 Jul 20.
[Is] ISSN:1009-2587
[Cp] País de publicação:China
[La] Idioma:chi
[Ab] Resumo:To investigate the effects of flow-through descending branch of lateral circumflex femoral artery flap on repairing high-voltage electrical burn wounds of wrist of patients. From January 2014 to June 2016, 5 patients with high-voltage electrical burn of unilateral wrist were hospitalized in our burn ward, with extensive necrosis of skin soft tissue of burn wrist. Five patients were transferred to our burn ward 6 to 12 days post injury after undergoing emergency dermotomy of wrist to reduce tension in other hospitals. In 2 to 3 days after admission, operation was performed by two surgeon group at the same time, when patients' general condition were stable. One group underwent debridement and the other group designed and dissected flap according to the range of skin soft tissue defect of wrist. Wrist wounds after debridement ranged from 15 cm×10 cm to 24 cm×15 cm. Three patients were treated with flow-through descending branch of lateral circumflex femoral artery flap and great saphenous vein for repairing wounds of wrist and reconstruction of ulnar and radial artery. Two patients were treated with flow-through descending branch of lateral circumflex femoral artery flap for repairing wounds of wrist and reconstruction of ulnar artery. The dissected flaps ranged from 16 cm×12 cm to 26 cm×16 cm and the length of bridging vessel ranged from 15 to 21 cm. The flow-through descending branch of lateral circumflex femoral artery flaps of five patients survived well. Wounds of 4 patients healed and wounds of 1 patient with infection under the flap on 3 days after operation healed after changing wound dressing and undergoing debridement for 2 weeks. After the operation, wrists and hands of 5 patients had adequate blood supply and ulnar and radial artery recovered patency. Follow-up of patients for 6 months to 1 year showed good flap appearance and adequate blood supply of burn hands. The flow-through descending branch of lateral circumflex femoral artery flap can repair wrist wounds and recover blood supply of hands and it is a good method for repairing high-voltage electrical burns of wrist.
[Mh] Termos MeSH primário: Queimaduras por Corrente Elétrica/terapia
Artéria Femoral/cirurgia
Transplante de Pele
Lesões dos Tecidos Moles/cirurgia
Coxa da Perna
Traumatismos do Punho/cirurgia
[Mh] Termos MeSH secundário: Adulto
Queimaduras por Corrente Elétrica/complicações
Desbridamento
Feminino
Artéria Femoral/fisiopatologia
Mãos/irrigação sanguínea
Seres Humanos
Masculino
Meia-Idade
Retalhos Cirúrgicos/irrigação sanguínea
Coxa da Perna/irrigação sanguínea
Artéria Ulnar
Cicatrização
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170904
[Lr] Data última revisão:
170904
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170802
[St] Status:MEDLINE
[do] DOI:10.3760/cma.j.issn.1009-2587.2017.07.006


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[PMID]:28763907
[Au] Autor:Bian X; Zhu ZJ; Wang Y
[Ad] Endereço:Department of Burns and Plastic Surgery, Qingdao Municipal Hospital, Qingdao 266011, China.
[Ti] Título:[Epidemiological investigation of hospitalized children with burn injury in a hospital of Qingdao].
[So] Source:Zhonghua Shao Shang Za Zhi;33(7):415-418, 2017 Jul 20.
[Is] ISSN:1009-2587
[Cp] País de publicação:China
[La] Idioma:chi
[Ab] Resumo:To investigate epidemiological characteristics of hospitalized children with burn injury in the author's affiliation, so as to provide theoretical basis for developing prevention strategies of children with burn injury. Medical records of 384 and 596 hospitalized children with burn injury, aged 0 to 12-year-old, were collected respectively from January 2001 to December 2005 and January 2011 to December 2015. Percentage of children with burn injury to total hospitalized patients with burn injury in the same period of time, age, causes of injury, gender, injury month, residence, condition of first aid measures conforming to medical standard, time of admission post injury, burn degree, and operation condition of children with burn injury were analyzed. Data were processed with Mann-Whitney test and Chi-square test. From January 2001 to December 2005 and January 2011 to December 2015, percentages of children with burn injury to total hospitalized patients with burn injury in the same period of time were respectively 23.6% (384/1 626) and 25.4% (596/2 346) , with no statistically significant difference ( (2)=1.653, >0.05). Age of all children with burn injury was 1.0 (1.0, 2.0) year old from January 2011 to December 2015, obviously lower than that from January 2001 to December 2005[1.0 (1.0, 3.0) year old, =-3.257, <0.01]. Ages of children with burn caused by hot liquid and electrical burn from January 2011 to December 2015 were obviously lower than those from January 2001 to December 2005 (with values respectively -4.248 and -2.040, <0.05 or <0.01). Compared with that from January 2001 to December 2005, age of children with burn caused by flame from January 2011 to December 2015 increased, with no statistically significant difference ( =1.852, >0.05). There was no statistically significant difference in gender of children with burn injury between the two periods of time ( (2)=1.374, >0.05). Burn injury of children in the two periods of time mainly occurred in Spring, and season of burn injury between the two periods of time was similar ( (2)=1.177, >0.05). There was statistically significant difference in residence of children with burn injury between the two periods of time ( (2)=15.513, <0.01). The number of children with burn injury of first aid measures conforming to medical standard and admission within 6 h post injury from January 2011 to December 2015 was obviously more than that from January 2001 to December 2005 (with (2) values respectively 7.434 and 43.961, values below 0.01). Burn degrees of children with burn injury mainly were moderate in the two periods of time, and there was no statistically significant difference in burn degree and condition of operation between the two periods of time (with (2) values respectively 5.731 and 1.583, values above 0.05). Burn of children is a social problem. We should make great efforts on popularization of prevention and treatment about burn of children, especially children with younger age in rural areas. We should publicize standard first aid measures of burn of children and advocate admission of burn of children within 6 h post burn injury for treatment.
[Mh] Termos MeSH primário: Queimaduras/epidemiologia
Criança Hospitalizada/estatística & dados numéricos
[Mh] Termos MeSH secundário: Queimaduras/terapia
Queimaduras por Corrente Elétrica
Criança
Pré-Escolar
China/epidemiologia
Feminino
Hospitalização
Seres Humanos
Lactente
Recém-Nascido
Masculino
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170904
[Lr] Data última revisão:
170904
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170802
[St] Status:MEDLINE
[do] DOI:10.3760/cma.j.issn.1009-2587.2017.07.004


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[PMID]:28709880
[Au] Autor:Antal A; Alekseichuk I; Bikson M; Brockmöller J; Brunoni AR; Chen R; Cohen LG; Dowthwaite G; Ellrich J; Flöel A; Fregni F; George MS; Hamilton R; Haueisen J; Herrmann CS; Hummel FC; Lefaucheur JP; Liebetanz D; Loo CK; McCaig CD; Miniussi C; Miranda PC; Moliadze V; Nitsche MA; Nowak R; Padberg F; Pascual-Leone A; Poppendieck W; Priori A; Rossi S; Rossini PM; Rothwell J; Rueger MA; Ruffini G; Schellhorn K; Siebner HR; Ugawa Y; Wexler A; Ziemann U; Hallett M; Paulus W
[Ad] Endereço:Department of Clinical Neurophysiology, University Medical Center Göttingen, Georg August University, Göttingen, Germany. Electronic address: AAntal@gwdg.de.
[Ti] Título:Low intensity transcranial electric stimulation: Safety, ethical, legal regulatory and application guidelines.
[So] Source:Clin Neurophysiol;128(9):1774-1809, 2017 Sep.
[Is] ISSN:1872-8952
[Cp] País de publicação:Netherlands
[La] Idioma:eng
[Ab] Resumo:Low intensity transcranial electrical stimulation (TES) in humans, encompassing transcranial direct current (tDCS), transcutaneous spinal Direct Current Stimulation (tsDCS), transcranial alternating current (tACS), and transcranial random noise (tRNS) stimulation or their combinations, appears to be safe. No serious adverse events (SAEs) have been reported so far in over 18,000 sessions administered to healthy subjects, neurological and psychiatric patients, as summarized here. Moderate adverse events (AEs), as defined by the necessity to intervene, are rare, and include skin burns with tDCS due to suboptimal electrode-skin contact. Very rarely mania or hypomania was induced in patients with depression (11 documented cases), yet a causal relationship is difficult to prove because of the low incidence rate and limited numbers of subjects in controlled trials. Mild AEs (MAEs) include headache and fatigue following stimulation as well as prickling and burning sensations occurring during tDCS at peak-to-baseline intensities of 1-2mA and during tACS at higher peak-to-peak intensities above 2mA. The prevalence of published AEs is different in studies specifically assessing AEs vs. those not assessing them, being higher in the former. AEs are frequently reported by individuals receiving placebo stimulation. The profile of AEs in terms of frequency, magnitude and type is comparable in healthy and clinical populations, and this is also the case for more vulnerable populations, such as children, elderly persons, or pregnant women. Combined interventions (e.g., co-application of drugs, electrophysiological measurements, neuroimaging) were not associated with further safety issues. Safety is established for low-intensity 'conventional' TES defined as <4mA, up to 60min duration per day. Animal studies and modeling evidence indicate that brain injury could occur at predicted current densities in the brain of 6.3-13A/m that are over an order of magnitude above those produced by tDCS in humans. Using AC stimulation fewer AEs were reported compared to DC. In specific paradigms with amplitudes of up to 10mA, frequencies in the kHz range appear to be safe. In this paper we provide structured interviews and recommend their use in future controlled studies, in particular when trying to extend the parameters applied. We also discuss recent regulatory issues, reporting practices and ethical issues. These recommendations achieved consensus in a meeting, which took place in Göttingen, Germany, on September 6-7, 2016 and were refined thereafter by email correspondence.
[Mh] Termos MeSH primário: Encéfalo/fisiologia
Guias de Prática Clínica como Assunto/normas
Estimulação Transcraniana por Corrente Contínua/ética
Estimulação Transcraniana por Corrente Contínua/normas
[Mh] Termos MeSH secundário: Animais
Queimaduras por Corrente Elétrica/etiologia
Queimaduras por Corrente Elétrica/prevenção & controle
Seres Humanos
Estimulação Transcraniana por Corrente Contínua/efeitos adversos
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170831
[Lr] Data última revisão:
170831
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170716
[St] Status:MEDLINE


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[PMID]:28624042
[Au] Autor:Li H; Tan J; Zhou J; Yuan Z; Zhang J; Peng Y; Wu J; Luo G
[Ad] Endereço:State Key Laboratory of Trauma, Burn and Combined Injury, Institute of Burn Research, Southwest Hospital, Third Military Medical University, Chongqing, China.
[Ti] Título:Wound management and outcome of 595 electrical burns in a major burn center.
[So] Source:J Surg Res;214:182-189, 2017 Jun 15.
[Is] ISSN:1095-8673
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Electrical burns are important causes of trauma worldwide. This study aims to analyze the clinical characteristics, wound management, and outcome of electric burns. METHODS: This retrospective study was performed at the Institute of Burn Research of the Third Military Medical University during 2013-2015. Data including the demographics, injury patterns, wound treatment, and outcomes were collected and analyzed. RESULTS: A total of 595 electrical burn patients (93.8% males) were included. The average age was 37.3 ± 14.6 y, and most patients (73.5%) were aged 19∼50 years. Most patients (67.2%) were injured in work-related circumstances. The mean total body surface area was 8.8 ± 11.8% and most wounds (63.5%) were full-thickness burns. Operation times of high-voltage burns and current burns were higher than those of low-voltage burns and arc burns, respectively. Of the 375 operated patients, 83.2% (n = 312) underwent skin autografting and 49.3% (n = 185) required skin flap coverage. Common types of skin flaps were adjacent (50.3%), random (42.2%), and pedicle (35.7%). Amputation was performed in 107 cases (18.0%) and concentrated on the hands (43.9%) and upper limbs (39.3%). The mean length of stay was 42.9 ± 46.3 d and only one death occurred (0.2%). Current burns and higher numbers of operations were major risk factors for amputation and length of stay, respectively. CONCLUSIONS: Electrical burns mainly affected adult males with occupational exposures in China. Skin autografts and various skin flaps were commonly used for electric burn wound management. More standardized and effective strategies of treatment and prevention are still needed to decrease amputation rates.
[Mh] Termos MeSH primário: Queimaduras por Corrente Elétrica/terapia
[Mh] Termos MeSH secundário: Adulto
Unidades de Queimados
Queimaduras por Corrente Elétrica/diagnóstico
Queimaduras por Corrente Elétrica/epidemiologia
Queimaduras por Corrente Elétrica/etiologia
China/epidemiologia
Terapia Combinada
Feminino
Seres Humanos
Modelos Lineares
Masculino
Meia-Idade
Traumatismos Ocupacionais/diagnóstico
Traumatismos Ocupacionais/epidemiologia
Traumatismos Ocupacionais/etiologia
Traumatismos Ocupacionais/terapia
Estudos Retrospectivos
Fatores de Risco
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170919
[Lr] Data última revisão:
170919
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170619
[St] Status:MEDLINE



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