•A substantial drop of pediatric burns in the major paediatric burn centre in Croatia.•Improvement in the standard of living is most likely to be related to this drop.•Housing standard, employment ...rate and level of education were crucial.
In the “Children’s Hospital Zagreb Referral Centre for Paediatric Trauma of the Ministry of Health Republic of Croatia (MHC)” we observed a significant decline in the number of both hospitalised and ambulatory treated paediatric patients with burn injuries in the period from 2011 to 2018. Our hypothesis is that this decline could be either due to the decline of the paediatric population of Croatia or due to the economic growth and the improvement in the standard of living that Croatians have enjoyed in the past decade.
In this observational study, we analysed data on the numbers of patients treated due to burn injuries from January 2011 to December 2018 in the Children’s Hospital Zagreb Hospital. Indicators of standard of living and population size estimates were obtained from Eurostat and the Croatian Bureau of Statistics. Associations between the proportion of people with poor standard of living and the number of treated patients were analysed with logistic regression models.
Percentage of the population with low housing standards, percentage of Croatians with low level of education, percentage of children that live in jobless households, and percentage of children at risk of poverty and social exclusion were predictors of the rate of hospital admissions, ambulatory treated patients and total number of treatments. The slight decrease in the rate of treated patients was interrupted with notable decline in 2014 followed by the slight increase in 2015. Over following years, the rate did not change remarkably.
Apart from the decline of the paediatric population of Croatia, it is reasonable to assume that the improvement in the standard of housing, level of education and employment rate as well as the reduction in the risk of poverty and social exclusion in children had a notable contribution to the decline in the rate of paediatric burns in the observed period.
A one-year-old boy was referred to our Department of Pediatric Surgery with extensive scalp injury. He was bitten by a neighbour's mixed-breed dog. The wound of the forehead is primary closed while ...scalp is reimplanted. Due to non-acceptance on the eighth day a necrectomy of devitalized tissue was done. Before applying Integra®, for 2 days, the wound was treated with a V.A.C.® system. After 14 days, Integra® was accepted and split-thickness skin graft (STSG) was transplanted from left upper leg. After 3 months the local status is satisfactory. A hair transplant is planned in the future.
The purpose of this study was to create a fibrin-based human skin substitute in vitro with epidermal and dermal component and to assess its healing potential in deep partial and full thickness burns. ...Fibrin scaffolds were prepared from commercial fibrin glue kits. Human fibroblasts were cultured in fibrin gel. Human keratinocytes were seeded on the top of the gel. Viability of cells was determined fluorimetrically. Scanning electron microscope and immunocytochemistry analysis of cultured cells were performed. After hydrosurgical preparation of deep burn necrotic tissue, wound bed was prepared for skin substitutes. Progress of healing was documented using visual estimation and photos. Scanning electron microscope images showed good cell attachment and colony spreading of
keratinocytes and fibroblasts on fibrin scaff old. Immunofluorescent staining of cell cultures on fibrin scaffold showed expression of vimentin, a marker of fibroblast cells, cytokeratin 19, a marker of epithelial stem cells, as well as involucrin, a marker of differentiated keratinocytes. Clinical results clearly showed that appearance of the skin did not differ significantly from the areas of transplanted skin using split-thickness skin graft techniques. In conclusion, using these fibrin-cultured autografts on massive full-thickness burn resulted in good healing.
Aplasia cutis congenita (ACC) is a rare, heterogeneous group of congenital disorders characterized by the focal or widespread absence of the skin. ACC can occur anywhere on the body; however, the ...vast majority of cases occur on the scalp midline. At birth, the lesions may have already healed with scarring or may remain superficially eroded to deeply ulcerated while in approximately 15%–30% of cases, the scalp defect is associated with a defect in the underlying bone and dura mater, with exposure of the brain and sagittal sinus. There is no consensus for early management and treatment modalities for large ACC cases. We present a case of a female infant at the age of 2 days (birth 40 + 3 weeks, vaginal, birth weight 3530 g, birth length 52 cm, and Apgar score 10/10) which has been moved from a maternity hospital to our institution due to aplasia cutis congenita of the scalp. She was born of the first regular pregnancy of a 29–year–old mother. At birth, in the parietal skin area above the wide–open fontanel, a 6 cm × 8 cm defect was observed without associated malformations on the rest of the body. Ultrasound of the brain and heart was neat. On the craniogram, partially parietal bone mutually was undeveloped.Neurological status of the newborn was neat. Magnetic resonance brain made using standard techniques and T1 HIRES, and Blackbone technique was neat with sustained continuity of dura without signs of cerebral herniation.Initially, Staphylococcus aureus was isolated, and Garamycin therapy with vaseline gas was initiated twice a day. Daily tracking of local findings was improving. One month after receipt, the eschar was gradually demarcated while the smaller nonepithelialized granulation zone treated merbromin with the baths. A protective helmet was created for the child to temporarily protect the brain and the soft tissue. Successive treatments from week to week have seen the reduction of the eschar with the closure of the bony segments. After 6 months, on the skin, a well–developed subcutaneous with the presence of capillary bleeding was observed. Within 1 month, Suprasorb A + Ag® and Suprasorb H® (Lohmann and Rauscher) wound dressings were introduced in the therapy. The iodine cream and the Mepitel® (Mölnlycke Health Care) were introduced into the therapy by removing the Suprasorb® wound dressing. Ten months since the onset of conservative treatment, the aplastic area was almost completely cured.
A five year-old girl came to the tourist ambulance because of the dysuria, sore throat and tingling of external genitalia. A local physician prescribed amoxicillin/clavulanic acid suspension. She ...took her first dose in the afternoon. During the night, parents noticed the rash and redness of the entire body. During the night, another dose of antibiotic was given, after which the rash and redness continued to spread rapidly.Immediately methylprednisolone and chloropyramine are administered intramuscularly. Upon arrival to the hospital, the girl was a normal state of consciousness with dyspnea, breathing frequency 25/min, SpO2 97%, dehydrated, febrile 38.1 °C, tachycardic (135/min) and normotensive (RR 103/66 mmHg). On the skin of the face and on the larger surface of the body (TBSA = 80%) were visible bullae and vesicles which ruptured and it came to skin peeling. Due to the progression of respiratory insufficiency, tracheotomy was performed. Also due to the increase in inflammatory parameters for the first ten days, ceftriaxone and amikacin were ordered, with all supportive therapy. On the second day of admission, cyclosporine is ordered. All the swabs were negative. Lyell’s syndrome, or toxic epidermal necrolysis, is a rare, potentially life-threatening mucocutaneous disease, usually provoked by the administration of a drug and characterized by acute necrosis of the epidermis. The drugs most frequently incriminated are nonsteroidal antiinflammatory drugs, chemotherapeutics, antibiotics, and anticonvulsants. Although the cases where amoxicillin/clavulanic acid suspension caused this condition were described, in our case, amoxicillin/clavulanic acid suspension was probably not the cause, given that the girl had been treated twice in the past with this drug without side effects.
Opekline šake u djece su relativno česte, uzrokovane pri dodiru s vrelim površinama, vrućom vodom, pirotehnikom i plamenom. Pravilnim konzervativnim ili operacijskim pristupom njihovom liječenju uz ...fizikalnu terapiju mogu se izbjeći ili smanjiti funkcijske i estetske posljedice. Neurovaskularna ugroza jedna je od najtežih komplikacija cirkumferentnih i dubokih opeklina šake i zahtijeva hitnu dekompresiju. Površne opeklinske ozljede i veći dio opeklina djelomične debljine kože dobro zacjeljuju uz pomoć različitih obloga za epitelizaciju. Dio opeklina djelomične i sve opekline pune debljine kože, zbog opsežnosti gubitka tkiva, zahtijevaju kirurški pristup i primjenu autolognih kožnih transplantata, kožnih režnjeva ili dermalnih regeneracijskih predložaka. Ekscizija u blijedoj stazi nožem ili hidrokirurškim sustavom, dobra hemostaza, transplantati djelomične debljine kože s vlasišta ili bedra, uz potporu kondicionirane plazme obogaćene trombocitima i uređaja za cijeljenje rana negativnim tlakom pristup su koji u pravilu daje dobre rezultate liječenja u djece. Dostupni dermalni regeneracijski predlošci svojom građom i potporom cijeljenju kvalitetnije nadomještaju dermalni sloj uz jednake ili bolje konačne funkcijske i estetske rezultate. U nedostatku periosta ili tetivnih ovojnica nakon debridmana opeklinske rane šake izbor je primjena kožnih režnjeva. Unutar prva 24 sata nakon opeklinske ozljede treba započeti s fizikalnom terapijom aktivnim i pasivnim vježbama. Ožiljci i kontrakture nakon liječenja opeklina šake mogu dovesti do djelomičnog gubitka funkcije šake. Osim kirurškog, multimodalni pristup uključuje primjenu masaže, silikonskih preparata, kompresivnih rukavica i laserske tretmane PDL i CO2 frakcijskim ablacijskim laserom. Najčešće tehnike plastične kirurgije kod operacijskih korekcija opeklinskih ožiljaka na dječjoj šaci su lokalni transpozicijski i klizni režnjevi te transplantati pune debljine kože.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
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