Multiple primary cancers: With reference to atomic bomb survivors in Hiroshima

We treated 44 patients with multiple primary cancers, at the Second Department of Surgery, Hiroshima University, during the 14 year period from 1968–1981. The total number of malignant tumors was 1,934 during this period, thus the incidence of multiple primary cancers was 2.3 per cent. Nine of the 44 were atomic bomb survivors in Hiroshima and were characterized by the frequent incidence of the second tumor about 30 years after exposure to the atomic bomb. In addition, the second tumor tended to develop later in patients prescribed radiotherapy for the first tumor. As for the site of tumor, there was no tendency of more frequent development of tumors in organs highly sensitive to radiation other than the thyroid.     

Treatment of axillary burn scars by a scapular island flap with a vascular pedicle]

Type 3 axillary burn retractions, involving the neck, the axilla, the upper arm and the lateral aspect of the chest, can cause difficult static and dynamic deficits altering the aesthetic appearance and the function of the shoulder. The posterior scapular area can provide an autonomized skin flap, based on the circumflex scapular vessels. This scapular flap, used as an island vascular flap, easily covers the anterior and posterior aspects of the axilla, obtaining a smooth skin surface, with a good underlying subcutaneous fatty tissue. Its elastic properties are well adapted to the dynamic requirements of the separate movements of the shoulder joint. Performed on 25 axillary burn retractions in 20 patients, this flap provided a convincing improvement in the shoulder range of movement and a return to a normal activity.     

Effects of silicone gel on burn scars

Aim

To study the efficacy of silicone gel applied to hypertrophic burn scars, in reducing scar interference with normal function and improving cosmesis.

Methods

A randomised, double-blind, placebo-controlled trial involving 38 people with hypertrophic burn scars. Each scar was divided into two segments; silicone gel sheet was applied randomly to one of the two and placebo to the other. Participants were seen again after 1 and 4 months. Their data and wound characteristics were collected using the Vancouver scar scale.

Results

The median age of participants was 22 years (1.5–60 years) and 16 were male; 4 did not attend follow-up and were excluded from the study. There were no significant differences in baseline characteristics. Although after 1 month all scar scale measures were lower in treated areas, only the vascularity scale was significantly different between the two areas. After 4 months, all scale measures were significantly lower in the silicone gel group than in the control group, except for the pain score.

Conclusion

Silicone gel is an effective treatment for hypertrophic burn scars.     

Psychosocial adjustment of burn survivors

The purpose of this study was to assess the magnitude and predictors of psychosocial adjustment in burn victims. It was postulated that once individuals sustain a burn, their long-term psychosocial adjustment is a function of their present coping responses, social resources, burn severity and time since burn. It was expected that these variables could also be used to identify individuals at risk for psychosocial maladjustment. A historical cohort analytical survey of 340 randomly selected adults and the mothers of 145 children who had sustained either major or minor burns during the past 12 years were administered the Coping Scale, Participation in Social and Recreational Activities Index, Social Support and the Psychosocial Adjustment to Illness Scale. The children's mothers also completed the Family Environment Scale and the Child Behaviour Checklist. In summary, the variance in psychosocial adjustment among adults was related to unemployment, loss of occupational status, avoidance coping, and little involvement in recreational activities. Together, these variables explained 40 per cent of the variance in psychosocial adjustment. Severity of the burn and time since the burn were not related to psychosocial adjustment. The prevalence of psychosocial maladjustment among the adults was 10 per cent and 15.7 per cent among children. Psychosocial adjustment among children was not related to the severity of the burn. The less adjusted children could be distinguished from adjusted children on the basis of their mothers' adjustment and methods of coping. The findings tended to refute the commonly held view that post-burn adjustment is associated with burn severity and suggests psychosocial adjustment is a function of both coping responses and social resources.     

Living with burn scars caused by self-immolation among women in Iraqi Kurdistan: A qualitative study

Patients with burns have to live with a variety of long-term physical and psychosocial consequences. Burns lead to prolonged hospital stay, disfiguring scars, disability, and even death. Since self-immolation is common in women of Iraqi Kurdistan, the present study sought to explore the experiences of women living with scars caused by self-immolation. This paper was part of a qualitative research study. A purposive sample of 18 female self-immolation survivors from Iraqi Kurdistan was selected, and 21 individual interviews were conducted and analyzed using conventional content analysis. Four categories emerged during the data analysis: (1) feelings of disbelief, regret, and anger caused by post-burn scars; (2) desperately seeking solutions; (3) grief due to disappointment and surrender to despair; and (4) rejection and isolation. In conclusion, individuals with scars and disfigurements sometimes adopted inappropriate measures to deal with the psychological problems caused by others’ behaviors and wrong perceptions. Educational and support programs are hence indicated to promote awareness levels of self-immolation survivors, their families, and the whole society.     

Effect of intense pulsed light on immature burn scars: A clinical study

Introduction:

As intense pulsed light (IPL) is widely used to treat cutaneous vascular malformations and also used as non-ablative skin rejunuvation to remodel the skin collagen. A study has been undertaken to gauze the effect of IPL on immature burn scars with regard to vascularity, pliability and height.

Materials and Methods:

This study was conducted between June 2013 and May 2014, among patients with immature burn scars that healed conservatively within 2 months. Photographic evidence of appearance of scars and grading and rating was done with Vancouver Scar Scale parameters. Ratings were done for both case and control scar after the completion of four IPL treatment sessions and were compared.

Results:

Out of the 19 cases, vascularity, pliability and height improved significantly (P < 0.05) in 13, 14 and 11 scars respectively following IPL treatment.

Conclusions:

Intense pulsed light was well-tolerated by patients, caused good improvement in terms of vascularity, pliability, and height of immature burn scar.KEY WORDS: Burn scar, intense pulse light, vancouver scar scale     

The evaluation of a clinical scar scale for porcine burn scars

This study describes the evaluation of a clinical scar scale for our porcine burn scars, which includes scar cosmetic outcome, colour, height and hair, supplemented with reference porcine scar photographs representing each scar outcome and scar colour scores. A total of 72 porcine burn scars at week 6 after burn were rated in vivo and/or on photographs. Good agreements were achieved for both intra-rater reliability (correlation is 0.86–0.98) and inter-rater reliability (ICC = 80–85%). The results showed statistically significant correlations for each pair in this clinical scar scale (p < 0.01), with the best correlation found between scar cosmetic outcome and scar colour. A multivariate principle components analysis revealed that this clinical scar assessment was highly correlated with scar histology, wound size, and re-epithelialisation data (p < 0.001). More severe scars are clinically characterised by darker purple colouration, more elevation, no presence of hair, histologically by thicker scar tissue, thinner remaining normal dermis, are more likely to have worse contraction, and slower re-epithelialisation. This study demonstrates that our clinical scar scale is a reliable, independent and valuable tool for assessing porcine burn outcome and truthfully reflects scar appearance and function. To our knowledge, this is the first study demonstrating a high correlation between clinical scar assessment and scar histology, wound contraction and re-epithelialisation data on porcine burn scars. We believe that the successful use of porcine scar scales is invaluable for assessing potential human burn treatments.     

Laser in the treatment of hypertrophic burn scars

This prospective study looked at the outcome of laser (light amplification by stimulated emission of radiation) treatment for hypertrophic scarring. Dermatrade mark K laser (a set of combined lasers erbium:yttrium aluminium garnet/carbon dioxide, qualified as a class IV laser) was used. Between 21 June 2000 and 19 November 2002, at the Siemianowice Burn Center, Poland, 592 interventions, using laser, were performed on N= 327 patients (220 women and 107 men, aged between 3 and 80 years). The majority of cases [N= 223 (68.9%)] were patients with post-burn hypertrophic scars, and 104 cases (31.8%) had various types of hypertrophic scars. Evaluation took place using an adapted Vancouver Scar Scale and digital photographs as well as the patient's opinion. It was noted that after laser treatment, satisfactory results were achieved in 72% of cases. The scars had become less red (192/327 scored no redness at the end of the study versus 92/327 upon initial), less raised (272/327 scored a flat scar versus 72/327 upon initial) and demonstrated an improved viscoelasticity (192/327 scored a soft skin versus 62/327 upon initial). Laser treatment did not improve contractures in post-burn hypertrophic scars. Results were not confirmed using objective measurement tools, as these were not available to us.     

Silicone gel: a new treatment for burn scars and contractures

A new method of treatment for burn scar management is outlined using silicone gel sheets (Spenco Corporation MD-3071). The method has been applied to 42 patients with burns of varying degree and maturity. The results have been successful in all cases. The mode of action of the gel is unknown, but it does not rely on pressure. The method can easily be tailored to the individual needs of the scar and the patient. Individual initiative and a flexible approach to its use are advocated.     

细菌胶原酶对瘢痕降解的实验研究及临床观察

目的探讨细菌胶原酶治疗增生性瘢痕及瘢痕疙瘩的作用机理;观测评价其临床疗效。方法通过动物实验对细菌胶原酶降解增生性瘢痕的作用进行验证,并通过10个病例对其临床疗效进行初步观察。结果动物实验显示,两次注药后,两周内瘢痕块体积平均缩小86%,较对照组差异有非常显著意义(P<0.001)。临床观察显示,经过两次病灶内细菌胶原酶的注射(剂量200～2000U),瘢痕体积两周内平均缩小46.92%,其中有4例缩小50%以上,占病例总数的30%。经过对5名病人3～16个月随访,除1例瘢痕疙瘩于治疗后第2个月复发外,余均无复发迹象。胶原酶作用后的瘢痕组织,光镜及电镜下可以清楚地看到处于溶解状态的胶原结构。结论细菌胶原酶可以直接降解瘢痕组织内的胶原纤维,可望成为一种快速有效的治疗增生性瘢痕和瘢痕疙瘩的新方法。     

Attention deficit hyperactivity disorder & pediatric burn injury: a preliminary retrospective study

Attention deficit hyperactivity disorder (ADHD) has been described as a preexisting psychiatric disorder for patients with burns that may have contributed significantly to their injury. The authors are not aware of any studies that have specifically looked at ADHD in burn patients and its role in the injury. A retrospective chart review of all youth that were admitted to a burn care unit over the past 20 years and diagnosed with ADHD on admission was conducted to describe the occurrence and features of their injury. In the 39 patients identified as having ADHD, impulsive behavior contributed to burn injury in 21 cases (54%) and possibly four additional cases. In addition, nine of the 21 cases were not on prescribed stimulant medication on the day of burn injury. The presence of ADHD is important to consider with respect to risk and potential prevention of pediatric burn injury.     

Stigma and illness uncertainty among patients with visible burn scars: A cross-sectional study

The purpose of this research was to understand the current status of stigma and illness uncertainty in patients with visible burns and explore the correlation between them. Measures to help patients alleviate shame and uncertainty in illness are also discussed. A cross-sectional study was conducted in a tertiary hospital from November 2020 to March 2021 for patients with burns on exposed parts of the face, neck, or limbs. The scales used in this study include demographic data questionnaires, the Social Impact Scale (SIS), and the Mishel Uncertainty in Illness Scale for Adults (MUIS-A). A two-tailed independent t-test was used to evaluate the differences in the respondents’ sociodemographic characteristics, stigma, and illness uncertainty. The total stigma and illness uncertainty scores of 146 patients were 57.03 ± 6.762 and 68.59 ± 12.901, respectively. Spearman correlation analysis showed that stigma was positively correlated with illness uncertainty (r = 0.398, p < 0.01). Multiple regression analysis showed a relationship between stigma and uncertainty of illness (B = 0.215, p = 0.000), itching (B = 2.555, p = 0.01), residence (B = 2.545, p = 0.029), and age (B = 0.074, p = 0.037). The stigma level of patients with visible burns increased with increasing uncertainty regarding illness. Therefore, reducing the patients’ uncertainty in illness is a way to intervene in stigma.     

Decreased neuroplasticity in minor burn injury survivors compared to non-injured adults: A pilot study in burn injury survivors aged 45 years and older

ObjectiveNeuroplasticity is the capacity of the brain to change or adapt with experience: brain changes occur with use, disuse, and injury. Repetitive transcranial magnetic stimulation (rTMS) can be used to induce neuroplasticity in the human brain. Here, we examined rTMS-induced neuroplasticity in the primary motor cortex in burns survivors and controls without injury, and whether neuroplasticity is associated with functional recovery in burns survivors.MethodsSixteen burn injury survivors (total body surface area of burn injury <15%) and 13 non-injured control participants were tested. Repetitive TMS (specifically, spaced continuous theta-burst stimulation[cTBS]) was applied to induce neuroplasticity 6 and 12 weeks after injury in burn survivors and in two sessions separated by 6 weeks in controls. Motor evoked potentials (MEPs) elicited by single-pulse TMS were measured before and after rTMS to measure neuroplasticity. Burns survivors completed a functional assessment 12 weeks after injury.ResultsNon-injured controls showed decreased MEP amplitude 15?30 min after spaced cTBS in both experimental sessions. Burn survivors showed a smaller change in MEP amplitude after spaced cTBS compared to controls 6 weeks after burn injury but no difference compared to controls 12 weeks after burn injury. In burn survivors, there was a significant positive association between general health outcome (Short-Form Health Survey) and the change in MEP amplitude after spaced cTBS 12 weeks after injury (r=.73, p = .01).ConclusionsThe current findings suggest that burn survivors have a reduced capacity for neuroplasticity early in the recovery period (6 weeks after injury), which normalizes later in the recovery period (12 weeks after injury). Furthermore, the results provide preliminary evidence to suggest that burn survivors with normalized neuroplasticity 12 weeks after injury recover faster after burn injury.