orabase and Acute-Disease

Despite advances in treatment of burn injuries and their consequent pain, wound care is the main source of the pain associated with burn injury. This two-part article explores burn pain and its treatment from a nursing perspective. Last month, Part 1 provided an overview of burn injury and addressed the wound care-related causes of burn pain, as well as its assessment and treatment. Part 2, presented here, provides a more in-depth discussion of pain management; topical medications and the psychological aspects of burn pain are also discussed.

Topics: Acute Disease; Analgesia; Analgesics; Anti-Infective Agents, Local; Burns; Carboxymethylcellulose Sodium; Causality; Drug Monitoring; Drug Therapy, Combination; Humans; Mafenide; Nurse's Role; Pain; Polyesters; Polyethylenes; Practice Guidelines as Topic; Relaxation Therapy; Silver Sulfadiazine; Skin Care; Stress Disorders, Post-Traumatic

This study aimed to compare the performance of a hydrofibre (Aquacel) and an alginate (Sorbsan) dressing on acute surgical wounds left to heal by secondary intention. A total of 100 patients were prospectively randomised pre-operatively to receive either the hydrofibre or the alginate dressing. Dressing performance was measured at operation, at 24 hours and seven days. Parameters measured included ease of: application and removal of the first dressing; re-application on the first postoperative day; and removal and re-application one week postoperatively. The hydrofibre dressing received higher scores for all of these categories. Patients in this group also experienced less pain (mild or none) on removal of the first dressing and at one week. However, these results did not achieve statistical significance, and should be seen as a trend. Nevertheless, the authors recommend the use of hydrofibre dressings on open acute surgical wounds.

Topics: Acute Disease; Alginates; Bandages; Carboxymethylcellulose Sodium; Humans; Prospective Studies; Surgical Procedures, Operative; Wound Healing

Bullous diseases of the oral cavity cause painful erosion. They must be distinguished from aphthae and vesicles which may have a similar presentation. Acute, chronic and congenital conditions are recognized. Acute lesions may involve a polymorphous oral erhythema which has an polymorphous erythematous presentation or toxidermia (Stevens-Johnson syndrome, Lyell syndrome, fixed pigmented erythema). Examination of the skin and history taking are the keys to diagnosis. Patients with chronic bullous diseases may have a congenital condition (bullous epidermolysis or lymphangioma) suggested by the age at onset and the clinical presentation. Acquired chronic bullous diseases include lichen planus and autoimmune bullous diseases. Careful examination is essential to identify mucosal or cutaneous involvement and to obtain a biopsy for histological examination. Search for antibodies deposited in the perilesional mucosa is necessary. Chronic erosive gingivitis is a frequent presentation. Most of the patients have cicatricial pemphigoid, lichen planus, and more rarely pemphigus. The pinch sign is highly discriminative to differentiate the cause of this syndrome. Symptomatic treatment of bullous lesions of the oral cavity include adapted diet and correct and early use of antalgesics.

Topics: Acute Disease; Carboxymethylcellulose Sodium; Chronic Disease; Diagnosis, Differential; Erythema Multiforme; Glucocorticoids; Humans; Lichen Planus, Oral; Mouth Diseases; Mouth Mucosa; Pemphigoid, Benign Mucous Membrane; Pemphigus; Skin Diseases, Vesiculobullous

In a carboxymethyl cellulose (CMC) air pouch inflammation model, accumulation of exudate decreased at a relatively rapid rate and almost disappeared 3 days after a 2% CMC injection into the preformed air pouch. After a second injection of 2% CMC solution into the 1-day-old CMC pouch on the day following the first CMC injection, the decrease in rate of exudate was similar to the change seen after the first CMC injection. In another group of rats, 3 days after the first CMC injection when inflammation had subsided, a second injection of 2% CMC solution into the 3-day-old CMC pouch resulted in a marked increase of exudate accumulation, inflammatory cell infiltration and vascular permeability. Histologically, large numbers of macrophages accumulated in the 3-day-old CMC pouch and fibroblast proliferation and newly formed blood vessels were also visible. The enhanced exudative reaction was significantly inhibited by dexamethasone but not by indomethacin. These results indicate that the enhanced inflammatory reactions appear to be closely correlated with the increase of reactivity at the site of inflammation and the exudative reaction was not mediated by cyclo-oxygenase products.

Topics: Acute Disease; Air; Animals; Carboxymethylcellulose Sodium; Disease Models, Animal; Drug Administration Schedule; Exudates and Transudates; Inflammation; Male; Microscopy, Electron; Rats; Rats, Inbred Strains

Therapeutic efficacy and toxicity were evaluated in 28 children with acute lymphoblastic leukemia, in ten with acute nonlymphoblastic leukemia (ANLL), and in 13 with metastatic neuroblastoma. All were refractory to standard chemotherapeutic agents and 25 were refractory to an investigational drug. The initial dose was 12 mg/m2/day and was based on an established maximal dose tolerated in adults. This dose was found to be intolerable in 5 of 5 children with leukemia. Similarly an initial dose of 9 mg/m2/day was intolerable in 4 of 5 patients with leukemia. The starting dose in the next 28 children with leukemia or neuroblastoma was 3 mg/m2. This drug was gradually increased to the highest tolerated dose by 3-mg/m2 increments. Fifteen children with acute lymphoblastic leukemia, 3 children with ANLL, and 2 children with neuroblastoma received the drug daily. Seven patients with ANLL and 7 patients with neuroblastoma received the drug biweekly. Seventeen patients with acute lymphoblastic leukemia, 6 patients with ANLL, and 5 patients with neuroblastoma had an adequate trial of the drug. An adequate trial was defined as a minimum of 5 weeks of therapy unless progressive disease developed. Side effects of the drug were striking and included fever, hypotension, myalgia, bone pain, arthralgia, arthritis, abdominal pain, liver toxicity, thrombocytopenia, and neurotoxicity. No complete remission occurred although interferon levels above 100 units/ml were induced in nearly 50% of the patients.

Topics: Acute Disease; Adolescent; Carboxymethylcellulose Sodium; Child; Child, Preschool; Drug Evaluation; Humans; Interferon Inducers; Interferons; Leukemia; Methylcellulose; Neuroblastoma; Poly I-C; Polylysine

A Phase II study of poly(I,C)-LC was performed in 28 children and adolescents with acute lymphoblastic leukemia (ALL), 10 with acute nonlymphoblastic leukemia (ANLL), and 13 with metastatic neuroblastoma. All were refractory to standard chemotherapeutic agents and 25 to an investigational drug. Initial doses of 12 mg/m2 and 9 mg/m2 were intolerable. However, 9 mg/m2 was tolerable in the majority of patients when the drug was started at 3 mg/m2 and increased by 3 mg/m2 increments. Fifteen children with ALL, three with ANLL, and two with neuroblastoma received the drug daily. Seven patients with ANLL and seven children with neuroblastoma received the drug biweekly. Twenty-eight patients received an adequate trial, which was defined as a minimum of 5 weeks at the maximal tolerated dose, unless there was progressive disease at the maximal tolerated dose. Side effects of the drug were striking, and included fever, hypotension, myalgia, bone pain, arthralgia, arthritis, abdominal pain, liver toxicity, thrombocytopenia, and neurotoxicity. No complete remissions occurred in spite of interferon levels above 100 U in nearly 50% of patients.

Topics: Acute Disease; Carboxymethylcellulose Sodium; Child; Drug Evaluation; Female; Humans; Interferon Inducers; Interferons; Leukemia; Leukemia, Lymphoid; Male; Methylcellulose; Neuroblastoma; Poly I-C; Polylysine