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PubMed1997

Studies on the metabolism and disposition of the new retinoid 4-[(5,6,7,8-tetrahydro-5,5,8,8-tetramethyl-2-naphthyl)carbamoyl]benzoic acid. 5th communication: factors affecting percutaneous absorption in rats.

4-[(5,6,7,8-Tetrahydro-5,5,8,8-tetramethyl-2-naphthyl)carbamoyl] benzoic acid (CAS 94497-51-5, Am-80) is a new synthetic retinoid which has been shown to have a potent topical antipsoriatic activity. Factors affecting the percutaneous absorption of Am-80 were studied with the intention of obtaining information for toxicity and clinical investigations. The percutaneous absorption of radioactivity was compared after topical application of 0.1% 14C-Am-80 ointment to female rats by simple application (SA), occlusive dressing technique (ODT), and application using lint (AUL). After single topical application to normal skin female rats, the percutaneous absorption of radioactivity was very low with no significant differences in the extent of absorption among the three application methods. In the stripped skin female rats, a distinct increase of the percutaneous absorption was observed indicating that it was markedly affected by the lack of the stratum corneum. Compared with the single dosing, a considerable increase of percutaneous absorption was observed following repetitive topical application once daily for 4 or 7 days to the normal skin female rats. The extent of increase was highest in ODT rats followed by SA rats, but was relatively low in AUL rats. The effects of concentration, dose and application area of 14C-Am-80 ointment on the percutaneous absorption of radioactivity were studied following topical application of 0.002%-0.008% 14C-Am-80 ointment to normal skin male rats by ODT to areas of 72 cm2/kg-360 cm2/kg (5%-25% of the body surface area) at ointment doses of 2g/kg-8 g/kg. When the application area and the amount of ointment applied were fixed at 144 cm2/kg (10% of the body surface area) and 2 g/kg, respectively, the amount of radioactivity absorbed increased in proportion to the 14C-Am-80 concentration in the ointment, whereas the rate of percutaneous absorption, expressed as the percent of dose, was nearly constant. When the 14C-Am-80 concentration in the ointment and the amount of ointment applied were fixed at 0.08% and 2 g/kg, respectively, both the amount of radioactivity absorbed and the rate of percutaneous absorption markedly increased with an increase in the application area. When the concentration of 14C-Am-80 in the ointment was set at 0.008% and the application area at 72 cm2/kg, 144 cm2/kg or 288 cm2/kg (5%, 10% or 20% of the body surface area), the amount of radioactivity absorbed increased as the amount of ointment applied increased for areas of the same, though the rate of percutaneous absorption remained almost constant. When the 14C-Am-80 concentration in the ointment was fixed at 0.008%, the amount of radioactivity absorbed increased markedly about 20-fold with 4-fold simultaneous increases in both the application area (from 72 cm2/kg to 288 cm2/kg) and the amount of ointment applied (from 2 g/kg to 8 g/kg).

Animals↗
PubMed1997

[Malingering in vascular disease].

Pathomimicry occurs in all fields of medicine. Although difficult to recognize, all physicians should be aware of the underlying mechanisms in order to avoid excessive ordering of complementary examinations and therapeutic propositions which may be dangerous. Pathomimesis is to be distinguished from Munchhausen's syndrome which involves simulation of severe disease and extravagant lies with false history reporting leading to successive hospitalizations in different hospitals. Pathomimesis is also distinguished by the goal of the simulation which is to obtain a precise material benefit. In vascular pathology, pathomimesis can take on several aspects:hemorrhagic syndrome by self-prescribed anticoagulants, self-induced limb edema (tourniquet), or self-inflicted skin wounds. Diagnosis is suggested by the absence of a cause, identification of the stricture groove in case of edema, imprivement with occlusive dressings for skin ulcers and by the general presentation. Pathomimesis is usually encountered in young intelligent women with some medical knowledge. This behavior has a psychopathological significance, the provoked symptoms demonstrating difficult emotional events in the past. The patient attempts to overcome an earlier tragic situation. Pathomimicry is thus expressed during acute episodes of fear and/or anxiety. For the practitioner, it is important to avoid accusing the patient or attempting to get the patient to avow as there is an important risk of exaggerated or self-destructive response. The patient should be led to realize that the physician knows what is happening. This unstated interchange allows the patient to establish a confident relationship with the physician, a relationship which should lead to an accepted psychotherapy.

Attitude of Health Personnel↗
PubMed1997

[The value of total contact casting in treatment of neuropathic foot ulcers in diabetic patients].

Neuropathic foot ulcers in diabetic patients pose great difficulties in treatment. Total contact casting is one of the available methods. It is thought to distribute the pressure evenly over the entire surface of the foot. The purpose of the study was the evaluation of the total contact casting as a method of treatment of neuropathic foot ulcers in diabetic patients. Ten diabetic patients with neuropathic foot ulcers were treated with total contact casting. The inclusion criteria were good arterial blood supply and the absence of bone, joints or surrounding soft tissue infection. The mean area of the ulcers was 1.9 cm2 (1.3-3.6 cm2). The average duration of the ulcer prior to commencement of the treatment was 10 months. Total contact cast was applied after thorough surgical debridement and covering of the ulcer with occlusive dressing. The casts were changed every six to ten days. The ulcers healed in 9 out of 10 treated patients. The healing time averaged two months. In one patient development of soft tissue infection necessitated discontinuation of the treatment and performing open ray amputation. In four patients superficial ulcerations of the skin of the dorsal aspect of the toes developed. They resulted in prolonged duration of the treatment. Total contact casting in adequately qualified and reliable patients is safe and effective method of treatment of neuropathic foot ulcers in diabetes.

Casts, Surgical↗
PubMed1998

Acute compartment syndrome of the forearm.

The forearm is the most common site for compartment syndrome in the upper extremity. The three compartments of the forearm include the volar (anterior or flexor), the dorsal (posterior or extensor), and the mobile wad. Both-bone forearm fractures and distal radius fractures are common initial injuries in adults that lead to acute forearm compartment syndrome. Supracondylar fractures, especially those with associated vascular injuries, are frequent causes of compartment syndrome in children. The flexor digitorum profundus and flexor pollicis longus are among the most severely affected muscles because of their deep location, adjacent to bone. Initial treatment consists of removal of occlusive dressings or splitting or removal of casts. If symptoms do not resolve rapidly, fasciotomy is indicated. Decompression fasciotomy of the forearm is performed through volar or dorsal approaches. The medial nerve is decompressed throughout its course, including high-risk areas deep to the lacertus fibrosus; between the humeral and ulnar heads of the pronator teres, the proximal arch, and deep fascial surface of the flexor digitorum superficialis; and the carpal tunnel.

Acute Disease↗
PubMedDate not supplied

[Cutaneous side effects of ketoprofen gels: results of a study based on 337 cases].

Ketoprofen gels, since their introduction on the French market (1989), have been responsible for various cutaneous side-effects (essentially photosensitization and contact eczemas). A study conducted by the French drug surveillance system detected 337 cases. Analysis showed that the frequency of cutaneous adverse events was from 0.008/1000 to 0.023/1000 according to the commercial gel. The sex ratio was well distributed, and the population was young (30-40 years) and athletic. Treatment lasted about 7 days, and the appearance of the side-effect was sometimes quite delayed relative to discontinuance of treatment. Reactions were severe in 40 per cent of cases. The factors favourable to side-effects were essentially exposure to the sun (one-third of cases) and occlusive dressing. No particular predisposing conditions were noted, although 2.6 per cent and 8.5 per cent of cases respectively involved earlier sensitization by a topical NSAID. The side-effect lasted about 16 days. The course was usually favourable but hospitalization was required in about 10 per cent of cases. Photoallergological testing indicated photosensitization to ketoprofen. These results led the National Commission of the French drug surveillance system to request a modification in the indications for the prescription of the ketoprofen gels.

Administration, Topical↗
PubMed1976

[Systemic side effects of external corticoids: results of dermatologic studies in children with neurodermititis].

Of 111 children with atopic dermatitis who were admitted as in-patients in a German aero-biological childrens clinic, 83 patients (74.8%) had been prescribed a prolonged corticosteroid therapy from their family doctor. For 60 children (54.1%) the corticosteroid application was topital, partly with occlusive dressing or with fluorinated preparations. The remaining 23 children (20.7%) were treated topically and systemically with corticosteroids. Of the 60 children whose atopic dermatitis was treated exclusively with topical corticosteroids, 59 patients (98.3%) showed undesirable side effects. Moreover, irreversible body changes developed through the transcutaneous absorptive processes, which were more evident and appeared more often in girls than in boys.

Administration, Topical↗
PubMed1976

[Estimation of the activity of an antiseptic agent on skin microbial flora under various conditions].

The bacterial flora of the skin of the fore-arm was studied in fifteen normal subjects by a modified Williamson and Kligman technique. The quantitative results were in agreement with those found in other laboratories which indicates the reproducibility of the method. The action of an antiseptic containing 0.5 p. cent of benzalkonium chloride was studied under three conditions or single application of the antiseptic for five consecutive days and for 24 hours after the application of an occlusive dressing. The bacterial flora of the skin showed marked quantitative variations from one subject to another and, in the same subject, from one time to another. Evaluation of the activity of an antiseptic should take into consideration these physiological variations and also various conditions of use in practice. Are discussed also the factors leading to standardisation of the methods and the criteria of evaluation of the activity of antiseptics on the skin.

Bacteria↗
PubMed1998

Effects of occlusive and conventional gauze dressings on incisional healing after abdominal operations.

OBJECTIVE: To compare the effect of occlusive (Comfeel) and conventional (Mepore) dressings on the healing of incisional wounds after abdominal operations. DESIGN: Prospective randomised study. SETTING: Laboratory and teaching hospital, Denmark. SUBJECTS: 73 patients who underwent clean operations requiring incisions longer than 5 cm between August 1993 and August 1995 were randomised to have their wounds dressed with either Comfeel or Mepore. INTERVENTIONS: Comfeel was left on until the sutures were removed, and Mepore was removed 2 days postoperatively. MAIN OUTCOME MEASURES: Infection, adherence, leakage, and cosmetic appearance three months later. RESULTS: 36 patients were randomised to have Comfeel and 37 to have Mepore. 29 patients were withdrawn from the study (20 having Mepore and 9 having Comfeel) leaving 26, and 17 for analysis, respectively. Wound infections developed in 1 patient in the Comfeel group and 5 in the Mepores group (p = 0.2). There were no differences between the groups regarding the need for dressings to be changed, the incidence of leakage, or loosening of the dressing from the skin. Comfeel adhered securely to the skin and remained more or less transparent until sutures were removed. It remained totally transparent in 23 (64%), and no dressing became totally opaque. There were no differences in cosmetic appearance after three months. We had the impression that patients who had Comfeel were more comfortable and found it easier to mobilise and carry out their daily activities. CONCLUSION: Occlusive dressings stay in place and stay transparent, and do not increase the risk of wound infection. They may even be more comfortable. they are a reasonable alternative to conventional dressings.

Abdomen↗
PubMed1990

[Occlusive therapy of psoriasis--comparison of clinical effectiveness of short-term and prolonged use].

In an open clinical trial on stationary psoriatic plaques, we compared the effects of shortime occlusive (SO) dressing (24h) and prolonged occlusion (PO: 5-28 days). IN SO, Weinstein's index decreased from 7.3 +/- 1.7 to 3.3 +/- 1.8 (n = 21), in PO from 6.5 +/- 1.1 to 3.7 +/- 1.7 (n = 15). The results were even better in cases with optimal PO dressing (decrease from 6.8 +/- 1.4 to 2.5 +/- 0.9). The most important side effects were itching and exsudation with ensuing smell. In only one of the cases did the side effects cause a drop-out after 5 days. Regarding stationary psoriatic plaques on the extensor sides of the lower legs and forearms. We recommend continuous occlusive dressing for 8-10 days--either as an alternative mode of therapy, or as an intermediate regimen.

Adolescent↗
PubMed1991

Hydrocolloid dressing versus tulle gauze in the treatment of abrasions in cyclists.

Abrasions in cyclists were either treated with an occlusive hydrocolloid dressing or with tulle gauze. The main object of the study was to investigate practical questions, e.g: Could the cyclists go on racing without their injuries impeding their progress? Medical aspects evaluated in the study were: the healing time and the infection rate of the wounds. Twenty-three racing cyclists with 38 abrasions were treated with a hydrocolloid dressing and 41 abrasions in 24 cyclists with tulle gauze. The results of the study show that the occlusive dressing produces a shorter healing time (5.6 days) than the tulle gauze (8.9 days), with smaller risks of infection (0% and 10%, respectively) and a longer wearing period per dressing. The hydrocolloid dressing also gives more pain relief than the tulle gauze (91% no pain during racing with the hydrocolloid dressing, 30% with the tulle gauze) and a higher overall comfort (very comfortable to comfortable versus uncomfortable to moderately uncomfortable, respectively).

Adolescent↗
PubMed1993

Surgical wound dressing in outpatient paediatric surgery. A randomised study.

A comparison of two different wound dressings was carried out in a series of 88 paediatric patients. The patients were randomised to either Steristrip plus Cutiplast, a conventional absorbent wound dressing, or to DuoDERM, an occlusive adhesive dressing. The study, set up to show which was the most convenient dressing for minor outpatient surgery, focused on the psychological aspects of operative treatment of infants and children. The results showed that the DuoDERM group had fewer bandage changes than the Steristrip & Cutiplast group, although this was not significant. Significantly less pain was experienced on removal of the wound dressing in the DuoDERM group. When dressed with DuoDERM, children could be bathed in the immediate postoperative period without complication. In conclusion, an occlusive wound dressing (DuoDERM) seems to minimize the physical and psychological trauma to the infant or child and reduce the disruption to the child's and the parents' daily routines.

Adolescent↗
PubMed2003

Short-term growth and bone turnover in children undergoing occlusive steroid ('Wet-Wrap') dressings for treatment of atopic eczema.

To assess the effects of steroid wet-wrap therapy on short-term growth and bone turnover, eight prepubertal (M:F,5:3) children with a median age of 5.1years (range 3.3-8.8) were studied over a 2-week period prior to therapy and at 2-week intervals during therapy. Short-term growth was assessed by measuring lower leg length velocity (LLLV) by knemometry and bone and collagen turnover was assessed by urinary deoxypyridinoline crosslink excretion corrected for creatinine excretion (DPD). Median duration of study during occlusive dressings was 12 weeks (range 2-18). Topical beclomethasone dipropionate diluted 1:10 or 1:4 in white soft paraffin was applied under tubular (Tubifast) bandages in 7/8 children. Median LLLV before and during therapy were 0.43 mm/week (10(th),90(th) centile; 0.0,0.7) and 0.42 mm/week (10(th),90(th) centile; -0.35,1.01), respectively (not significant). Median DPD before and during therapy were 25.9 nmol/l/creatinine (10(th),90(th) centile; 20.8, 33.0) and 26.3 nmol/l/creatinine (10(th),90(th) centile; 21.7, 34.1) respectively (not significant). Non-invasive assessment of the effects of steroid wet-wrap therapy can be performed in children with eczema. These preliminary results show no substantial growth promoting or adverse effects of therapy.

Bone Remodeling↗
PubMed1996

Eutectic lidocaine/prilocaine 5% cream and patch may provide satisfactory analgesia for excisional biopsy or curettage with electrosurgery of cutaneous lesions. A randomized, controlled, parallel group study.

BACKGROUND: Needle puncture and infiltrational anesthesia is generally required for minor cutaneous surgical procedures and may be associated with anxiety, fear, discomfort, and pain. The use of topical anesthetics such as eutectic lidocaine/prilocaine 5% cream may provide an alternative means of delivering anesthesia. OBJECTIVE: Our purpose was to evaluate the effectiveness of eutectic lidocaine/prilocaine 5% cream applied under either occlusive adhesive dressing (Tegaderm) or patch formulation in providing analgesia for removal of lesions 40 mm long or shorter on the trunk or extremities; removal was effected by excisional biopsy or curettage with electrosurgery. METHODS: One hundred six patients (58 men, 48 women), 22 to 90 years of age, participated in this open-labeled, randomized, controlled, parallel group study. Patients were randomly assigned to receive either 2.5 to 5 gm of cream applied under an occlusive dressing or a 1.0 gm single-dose-unit patch. The topical anesthetic was removed 2 to 3 hours after application and just before surgery. This area was then tested for analgesia to pinprick. If analgesia was insufficient to the pinprick or during the surgical procedure, lidocaine infiltration was given. Patients rated the pain of the surgical procedure on a 100 mm visual analog scale. RESULTS: After application times of 110 to 180 minutes, effective anesthesia was achieved in 87% of subjects. Treatment with the patch was equal to the cream/Tegaderm dressing in reducing pain experienced during surgery. No significant difference was found between the adhesiveness of the two dressings; however, the patch was easier to apply than the cream/ Tegaderm. No unexpected adverse events were observed. CONCLUSION: For minor skin surgical procedures involving excisional biopsy or curettage with electrosurgery, eutectic lidocaine/prilocaine 5% cream/Tegaderm and patch formulations were equally effective and provided effective anesthesia in 87% of subjects. The patch formulation may be more convenient for self-application.

Adhesiveness↗
PubMed2003

Human neutrophil elastase inhibition with a novel cotton-alginate wound dressing formulation.

Occlusion and elasticity were combined in a novel cotton-based alginate dressing containing a nontoxic elastase inhibitor. Cotton gauzes were modified with a textile finishing process for incorporating alginate to yield a dressing material that retains elasticity while enhancing absorption. The algino-cellulose conjugates were formed through citric acid crosslinking of cellulose and alginate. The alginate-citrate finishes were applied to cotton gauzes in various formulations containing citric acid, sodium hypophosphite, and polyethylene glycol. The modified gauzes contain a citrate conjugate of alginate and cellulose that gels upon hydration. The alginate-citrate finishes were combined with the neutrophil elastase inhibitor, oleic acid, to demonstrate the ability of the algino-cellulose fibers to release the inhibitor and neutralize destructively high levels of neutrophil elastase found in nonhealing and burn wounds. Four types of gauzes were examined for the effect of the algino-cellulose finish on cotton gauze absorbency and elasticity. Fourier transform infrared (FTIR) spectroscopy of the film and alginate-citrate finished cotton showed formation of the alginate and citrate cellulose esters. Scanning electron microscopy analysis revealed large areas of the yarn surface covered by the alginate film with a smooth surface on the original fibers. Wetting of the gauze surface resulted in formation of a hydrated gel on the yarns with apparent swelling of the film and the fiber-coated alginate.

Alginates↗
PubMed1997

Aerobic, anaerobic and fungal burn wound infections.

One hundred and twenty-seven patients were studied prospectively for aerobic, anaerobic and fungal burn wound infections. All cases yielded organisms on culture. A total of 377 isolates were recovered (239 aerobes, 116 anaerobes and 22 fungi). Aerobic bacteria alone were present in 49 patients (38.6%). Anaerobic bacteria alone were present in four patients (3.2%). Candida sp. alone was present in one patient (0.8%). Mixed aerobic and/or anaerobic bacteria and/or fungi were present in 73 patients (57.5%). Fungi were isolated from 21 patients (23.9%) of 88 patients having fungal cultures. The predominant isolates recovered in descending order of frequency were: Pseudomonas aeruginosa, Staphylococcus aureus, Bacteroides sp., Klebsiella sp. and Peptostreptococcus sp. There were 70 patients (55.1%) infected with anaerobic bacteria. The rate of recovery of anaerobes was higher in patients with open wound dressing (72.7%) than in patients with occlusive wound dressings (41.7%), (P < 0.01). Seventeen patients presented with septic shock, 15 of them (88.2%) yielding positive anaerobic cultures. Bacteroides sp. were isolated from 14 patients with septic shock, and were recovered from the four patients who had anaerobic infection alone. These results indicate a significant role of Bacteroides sp. in burn wound sepsis.

Adolescent↗
PubMed1994

Influence of occlusive and impregnated gauze dressings on incisional healing: a prospective, randomized, controlled study.

After elective surgery, 28 patients with 40 wounds were enrolled in a controlled clinical study to assess the effects of two different dressings on incisional healing. Patients served as their own control with one-half of each incision covered with an impregnated gauze (Xeroform) and the other half of the incision covered with a thin occlusive hydrocolloid dressing (DuoDerm Extra Thin CGF). All wounds were evaluated 2 to 3 days, 7 to 10 days, 4 weeks, and 7 months postoperatively. None of the incisions segments showed any evidence of infection. At the time of suture removal, the hydrocolloid dressing's ability to contain exudate, protect the wound, and facilitate mobility and personal hygiene were rated higher compared with the gauze-type dressing (p < 0.001, for all variables). At the 4-week visit, both the patient and the surgeon rated the scar segments covered with the hydrocolloid dressing better with respect to color, evenness, and suppleness (p < or = 0.04, for all variables). These differences were no longer apparent 7 months after surgery.

Adolescent↗