This document summarizes a study on the effectiveness of homeomesotherapy using Made® and Guna®-Collagen injections to treat pathological scars. A basic group of 30 patients received injections of these preparations alone, while a control group of 15 patients received standard scar treatment. Results showed the basic group had softer, less discolored scars with reduced treatment time compared to the control group. Biochemical analysis and histological examination provided further evidence that homeomesotherapy helped regulate scar tissue metabolism and structure.
COMPARISON BETWEEN SUTURING AND STAPLE APPROXIMATION OF SKIN IN ABDOMINAL INC...KETAN VAGHOLKAR
Background: Skin approximation is a very important step in a surgical operation. The quality of skin
approximation affects the quality of the scar. Traditional skin suturing is associated with quite a few wound complications.
Staple approximation is an innovative alternative with good results. Aim: The aim of the study is to compare
traditional suturing of skin edges versus staple approximation and to evaluate the impact of these techniques on wound
complications such as pain, surgical site infections, scarring and patient satisfaction. Materials and methods: 150 patients
are included in the study and divided into two groups. Group A (skin suturing) and group B (staple approximation).
The effect of the technique on wound healing is evaluated. Results: Patients belonging to group B (staple approximation)
had less pain, shorter skin closure duration, no wound complications, fine scarring and greater patient satisfaction.
Conclusion: Staple approximation of skin edges during the closure of laparotomy incisions is recommended.
This document summarizes a study on using maggot debridement therapy (MDT) to treat necrotizing fasciitis. 15 patients with necrotizing fasciitis were treated with surgical debridement, antibiotics, and MDT. MDT involved applying sterile maggots to wounds to remove dead tissue. Patients who started MDT within 9 days of diagnosis needed fewer surgical debridements than those treated later. The study concludes that early use of MDT may reduce surgical interventions and help wounds heal for patients with necrotizing fasciitis.
This study compared outcomes of 120 burn patients who underwent either early excision and grafting (E&G) within 4-7 days, or delayed excision and grafting (D&G) within 1-4 weeks. Significant differences favored the E&G group: fewer culture-positive wounds, better graft take, shorter post-graft hospital stay, and no mortality. While early excision improves outcomes, the optimal timing requires further study. However, this study supports performing excision as early as possible when stabilization has occurred.
EFFICACY OF FIXED VERSUS REMOVAL RETAINER POST ORTHODONTIC TREATMENT: A COMP...DrHeena tiwari
This study compared the efficacy of fixed versus removable retainers for maintaining orthodontic treatment outcomes over 4 years. 48 participants from an original randomized controlled trial were evaluated. Those with fixed retainers had lower irregularity scores on average (0.85mm increase) compared to removable retainers (1.47mm increase). After adjusting for confounding factors, the difference in irregularity between groups was statistically significant, with removable retainers having 1.64mm more irregularity on average. No other significant differences were found between groups for other metrics like inter-canine width. Compliance with removable retainers decreased over time. Fixed retainers maintained their position better, though some required repair. In conclusion, fixed retainers appeared to
Effectiveness of Nurses in Assessing Managing Postop PainRhonda Herring
The six studies critically reviewed all aimed to evaluate the effectiveness of nurses in managing postoperative pain in adult patients undergoing general surgery. Key findings across the studies were:
1) Nurses consistently underassessed patients' pain levels and documentation of pain was often inaccurate or incomplete.
2) Barriers to effective pain management included poor nurse-patient communication, a lack of patient education, and nurses' own attitudes and misconceptions about pain.
3) Time constraints and high nurse workload negatively impacted pain assessments and administration of analgesics.
The review suggests that while guidelines for postoperative pain management have been established, nurses continue to face challenges in implementing comprehensive pain assessments and providing optimal pain relief for postoperative patients. Improving nurses' knowledge
Austin Tissue Engineering is an open access, peer reviewed, scholarly journal dedicated to publish articles covering all areas of Tissue Engineering.
The journal aims to promote research communications and provide a forum for doctors, researchers, physicians and healthcare professionals to find most recent advances in all areas of Tissue Engineering. Austin Tissue Engineering accepts original research articles, reviews, mini reviews, case reports and rapid communication covering all aspects of Tissue Engineering.
Austin Tissue Engineering strongly supports the scientific up gradation and fortification in related scientific research community by enhancing access to peer reviewed scientific literary works. Austin Publishing Group brings universally peer reviewed journals under one roof thereby promoting knowledge sharing, mutual promotion of multidisciplinary science.
COMPARISON BETWEEN SUTURING AND STAPLE APPROXIMATION OF SKIN IN ABDOMINAL INC...KETAN VAGHOLKAR
Background: Skin approximation is a very important step in a surgical operation. The quality of skin
approximation affects the quality of the scar. Traditional skin suturing is associated with quite a few wound complications.
Staple approximation is an innovative alternative with good results. Aim: The aim of the study is to compare
traditional suturing of skin edges versus staple approximation and to evaluate the impact of these techniques on wound
complications such as pain, surgical site infections, scarring and patient satisfaction. Materials and methods: 150 patients
are included in the study and divided into two groups. Group A (skin suturing) and group B (staple approximation).
The effect of the technique on wound healing is evaluated. Results: Patients belonging to group B (staple approximation)
had less pain, shorter skin closure duration, no wound complications, fine scarring and greater patient satisfaction.
Conclusion: Staple approximation of skin edges during the closure of laparotomy incisions is recommended.
This document summarizes a study on using maggot debridement therapy (MDT) to treat necrotizing fasciitis. 15 patients with necrotizing fasciitis were treated with surgical debridement, antibiotics, and MDT. MDT involved applying sterile maggots to wounds to remove dead tissue. Patients who started MDT within 9 days of diagnosis needed fewer surgical debridements than those treated later. The study concludes that early use of MDT may reduce surgical interventions and help wounds heal for patients with necrotizing fasciitis.
This study compared outcomes of 120 burn patients who underwent either early excision and grafting (E&G) within 4-7 days, or delayed excision and grafting (D&G) within 1-4 weeks. Significant differences favored the E&G group: fewer culture-positive wounds, better graft take, shorter post-graft hospital stay, and no mortality. While early excision improves outcomes, the optimal timing requires further study. However, this study supports performing excision as early as possible when stabilization has occurred.
EFFICACY OF FIXED VERSUS REMOVAL RETAINER POST ORTHODONTIC TREATMENT: A COMP...DrHeena tiwari
This study compared the efficacy of fixed versus removable retainers for maintaining orthodontic treatment outcomes over 4 years. 48 participants from an original randomized controlled trial were evaluated. Those with fixed retainers had lower irregularity scores on average (0.85mm increase) compared to removable retainers (1.47mm increase). After adjusting for confounding factors, the difference in irregularity between groups was statistically significant, with removable retainers having 1.64mm more irregularity on average. No other significant differences were found between groups for other metrics like inter-canine width. Compliance with removable retainers decreased over time. Fixed retainers maintained their position better, though some required repair. In conclusion, fixed retainers appeared to
Effectiveness of Nurses in Assessing Managing Postop PainRhonda Herring
The six studies critically reviewed all aimed to evaluate the effectiveness of nurses in managing postoperative pain in adult patients undergoing general surgery. Key findings across the studies were:
1) Nurses consistently underassessed patients' pain levels and documentation of pain was often inaccurate or incomplete.
2) Barriers to effective pain management included poor nurse-patient communication, a lack of patient education, and nurses' own attitudes and misconceptions about pain.
3) Time constraints and high nurse workload negatively impacted pain assessments and administration of analgesics.
The review suggests that while guidelines for postoperative pain management have been established, nurses continue to face challenges in implementing comprehensive pain assessments and providing optimal pain relief for postoperative patients. Improving nurses' knowledge
Austin Tissue Engineering is an open access, peer reviewed, scholarly journal dedicated to publish articles covering all areas of Tissue Engineering.
The journal aims to promote research communications and provide a forum for doctors, researchers, physicians and healthcare professionals to find most recent advances in all areas of Tissue Engineering. Austin Tissue Engineering accepts original research articles, reviews, mini reviews, case reports and rapid communication covering all aspects of Tissue Engineering.
Austin Tissue Engineering strongly supports the scientific up gradation and fortification in related scientific research community by enhancing access to peer reviewed scientific literary works. Austin Publishing Group brings universally peer reviewed journals under one roof thereby promoting knowledge sharing, mutual promotion of multidisciplinary science.
This study evaluated outcomes of the ReMeEx adjustable sling system for treating female stress urinary incontinence (SUI) over 15 years in 55 patients. The ReMeEx system allows postoperative readjustment of sling tension to improve continence without reoperation. At long-term follow-up, 50 patients were cured with 10 requiring readjustment. Complications like temporary retention were minor. The ReMeEx system achieved high cure rates and improved quality of life for SUI patients, including those with prior incontinence surgery or worse prognosis, by enabling durable sling tension adjustment without reoperation.
Mandibular Degree II Furcation Defects Treatment With Platelet-Rich Fibrin an...Dr Ripunjay Tripathi
journal club Mandibular Degree II Furcation Defects Treatment With Platelet-Rich Fibrin and 1% Alendronate Gel Combination: A Randomized Controlled Clinical Trial
This document discusses advanced concepts in wound coverage by Dr. Suresh Koneru. It outlines factors to consider when a wound is ready for coverage, including a low bacterial count and adequate patient nutrition status. It then reviews the reconstructive ladder of options from primary closure to skin grafts to local flaps to microvascular tissue transfer and composite tissue allotransplantation. Postoperative care considerations are provided for skin grafts.
1) The document describes a study on the effects of low level laser therapy (LLLT) on human appendicular bone fracture healing.
2) A total of 40 patients with fractures were divided into a laser group (20 patients) who received LLLT, and a control group (20 patients) who did not.
3) Results showed the laser group had better clinical outcomes like less pain and earlier movement, and radiological outcomes like faster/greater callus formation and bone density increases.
4) The study concluded LLLT can accelerate bone union and enhance healing when used as an adjunct to standard fracture treatment.
VAC therapy has emerged as a novel adjunct to wound management over the last decade. It works by removing edema and inhibitory factors from wounds, reducing bacterial counts, and improving healing through increased blood flow, granulation tissue formation, and angiogenesis. VAC therapy finds applicability in many wound types by preparing wounds for reconstruction and securing skin grafts. It provides an economical alternative to other treatments and can help expedite healing and reduce hospital stays. However, VAC therapy is an adjunct and not a substitute for thorough debridement and other established wound care measures.
This document proposes revisions to the original SACS Classification for Peristomal Skin Disorders. The authors conducted a multi-center study observing lesions that could not be classified by the original SACS method. They defined a new L5 lesion involving loss of substance beyond the fascial plane. The study aimed to include this new lesion in the classification and classify all lesions present rather than just the most serious lesion. Based on the study findings, the authors propose a revised classification called SACS 2.0 that retains the original classification's objectivity while integrating the new L5 lesion and allowing for classification of multiple concurrent lesions.
Sacs 2.0 a review of the original sacs scale WUWHS Florence 29.09.2016Mario Antonini
About eight years have passed since the publication of the SACS Classification, the use of which has proved to be essential in Italy, not only on account of the particular characteristics of this instrument but also and above all as it is a point of reference for debate and discussion and aims to facilitate an objective awareness of peristomal skin lesions.
This document discusses the evaluation and management of open fractures. The key points are:
1. Open fractures involve both bone and soft tissue injuries and managing them aims to prevent infection, achieve fracture union and restore function.
2. Open fractures are classified based on the type of fracture, soft tissue injury and bacterial contamination. This helps determine treatment and prognosis.
3. Immediate antibiotics and tetanus prophylaxis should be given. Wound irrigation and debridement are also important to prevent infection.
4. Controversies exist regarding wound closure timing and irrigation techniques. Extensive soft tissue damage may require muscle flaps. Fracture stabilization depends on location and injury characteristics.
This randomized controlled trial compared the efficacy of 2% lignocaine with epinephrine (Group A) to a mixture of 2% lignocaine with epinephrine and 4 mg dexamethasone (twin mix, Group B) for third molar surgery. The study found that the twin mix provided a faster onset of anesthesia, longer duration of soft tissue anesthesia, and less postoperative pain, swelling and trismus compared to lignocaine alone. Specifically, the twin mix group had onset of anesthesia in 51 seconds compared to 81 seconds, duration of anesthesia of 251 minutes compared to 142 minutes, and lower pain scores on the first, third and seventh postoperative days. The twin mix also resulted in less facial swelling and reduced mouth opening after
This document summarizes a study comparing the healing of partial-thickness skin graft donor sites treated with two different moist dressings: Tegaderm, a semipermeable membrane dressing, and MEBO, a burn ointment that provides a moist environment without an occlusive dressing. The study found that donor sites treated with MEBO healed anatomically faster than those treated with Tegaderm. Physiologic barrier recovery, as measured by transepidermal water loss, also occurred significantly earlier with MEBO. Finally, MEBO treatment resulted in better scar quality compared to Tegaderm. The findings suggest that MEBO is an effective alternative to conventional occlusive dressings for treating partial-thickness wounds.
EWMA 2013 - Ep518 - A NOVEL EGF-CONTAINING WOUND DRESSING FOR THE TREATMENT O...EWMAConference
Doerler Martin1), Eming Sabine2), Dissemond Joachim3), Stücker Markus1)
1) Department of Dermatology, Venereology and Allergology. Vein Centre of the Departments of Dermatology and Vascular Surgery, Ruhr-University Bochum, Bochum, GERMANY
2) Department of Dermatology, Venereology and Allergology, University of Cologne, Cologne, GERMANY
3) Department of Dermatology, Venereology and Allergology, University of Essen, Essen, GERMANY
jc scar and laser.pptx journal club scar treatmentMalaM67
This study assessed the efficacy and safety of combined CO2-IPL and single light IPL in treating hypertrophic scars. 138 patients with hypertrophic scars were randomized to receive either 3 sessions of combined CO2-IPL or single IPL treatment over 10-14 week intervals. Clinical assessment using the POSAS scale found that the combined CO2-IPL treatment resulted in significantly lower POSAS scores compared to single IPL, indicating greater improvement in scar characteristics. 100% of patients treated with CO2-IPL expressed satisfaction with results compared to 84% for single IPL. The combination of CO2-IPL was found to be a safe and effective alternative for treatment of hypertrophic sc
journal club - scar revision with laser and narrowband intensed pulsed lightMalaM67
The document summarizes a study assessing the efficacy and safety of combined CO2-IPL and single light IPL in treating hypertrophic scars. 138 patients with hypertrophic scars were randomized to receive either 3 sessions of combined CO2-IPL or single light IPL treatment with a 3 month follow up. Results showed that the combined CO2-IPL treatment was more effective at improving scar characteristics according to POSAS scores. 100% of patients treated with CO2-IPL expressed satisfaction with outcomes compared to 84% for single light IPL. The study concludes that combined CO2-IPL therapy provides significant improvement in scar assessment and is a safe alternative for multi-photoelectric scar treatment.
Extracorporeal shockwave therapy (ESWT) has analgesic and anti-inflammatory effects. With the evolu- tion and comprehension of its biological and physical mechanisms, the application of ESWT on other pathologies has also been studied, especially in musculoskeletal diseases. Recently, studies on animal models have shown its angiogenic capacity and a higher rate of local re-epithelization. These small stud- ies led to few trials using low-energy, radial ESWT to treat problematic chronic skin ulcers. Skin ulcers have diverse etiologies, ranging from pressure ulcers, burns, venous or arterial ulcers, and even diabetic ulcers. Their treatment is usually a challenge, due to the long-term treatment and high costs.
Effectiveness of Low-Level Lasers in the Management of Recurrent Aphthous Sto...DrHeena tiwari
This study assessed the effectiveness of low-level lasers in treating recurrent aphthous stomatitis. 30 subjects with minor, major, or herpetiform aphthae were treated with lasers and their pain was evaluated using VAS scores. For all groups, pain was significantly less after 24 hours and further reduced at 72 hours compared to pre-treatment levels. At 1 week, pain scores were minimal or zero. The results demonstrated that low-level lasers provide effective pain relief and accelerated healing for recurrent aphthous stomatitis lesions.
Content server (10)A randomized, controlled, double-blind prospective trial w...Missing Man
A randomized, controlled, double-blind prospective trial
with a Lipido-Colloid Technology-Nano-OligoSaccharide
Factor wound dressing in the local management of
venous leg ulcers
Dr. kushagra case study, supported by TRIAGE MEDITECH NPWT INDIASiddharth Mandal
This study compared the effectiveness of vacuum assisted wound therapy (VAC) to standard wound therapy for treating open musculoskeletal injuries. 30 patients were randomly assigned to receive either VAC or standard saline dressings after surgical debridement. Wound size reductions were measured after 8 days of treatment. VAC resulted in greater wound size reductions of over 5 mm compared to less than 5 mm for standard therapy. VAC facilitated more rapid formation of healthy granulation tissue, potentially shortening healing time and reducing needs for further soft tissue procedures. The study concluded that VAC therapy is effective for open musculoskeletal wounds and produces better outcomes than standard wound care.
Light-Emitting Diode Irradiation Promotes Donor Site Wound Healing of the F...Shilpa Shiv
This document summarizes a study that investigated the effects of LED light irradiation on wound healing of free gingival grafts in rats. The study found that LED light irradiation at 10-20 J/cm2 promoted fibroblast viability and wound closure in vitro, and accelerated wound healing in vivo by promoting re-epithelialization, reducing inflammation and sequestrum formation, and increasing collagen deposition. LED light facilitated healing, likely by reducing reactive oxygen species and promoting angiogenesis and tissue remodeling, though additional research is still needed to validate the optimal LED conditions for clinical use.
Vacuum compression therapy (VCT) uses cycles of negative and positive pressure to enhance wound healing. The document summarizes two studies on VCT:
1) A randomized controlled trial found that adding VCT to conventional therapy for diabetic foot ulcers significantly reduced ulcer surface area compared to conventional therapy alone. VCT improved blood flow and oxygenation to accelerate wound healing.
2) A case report described using VCT to treat a non-healing ischemic ulcer. After adding VCT, the ulcer decreased in size by 25% within 2 weeks and healed completely within 8 weeks, suggesting VCT facilitated healing in this case by improving capillary filling.
CALVREV 2.pptxhdhhdjdsnAll aboveIs true and goodCrajRaj
1) The study compared abdominal skin incision closure with non-absorbable sutures versus staples in 147 patients undergoing elective abdominal surgery.
2) Results showed that staples significantly reduced surgical site infections compared to sutures, especially in incisions 5-10cm and clean wounds. Staples also significantly reduced postoperative pain levels.
3) Staples yielded better cosmetic results, with superior scar appearance rated by patients and observers, especially in incisions under 5cm and over 10cm.
This study evaluated outcomes of the ReMeEx adjustable sling system for treating female stress urinary incontinence (SUI) over 15 years in 55 patients. The ReMeEx system allows postoperative readjustment of sling tension to improve continence without reoperation. At long-term follow-up, 50 patients were cured with 10 requiring readjustment. Complications like temporary retention were minor. The ReMeEx system achieved high cure rates and improved quality of life for SUI patients, including those with prior incontinence surgery or worse prognosis, by enabling durable sling tension adjustment without reoperation.
Mandibular Degree II Furcation Defects Treatment With Platelet-Rich Fibrin an...Dr Ripunjay Tripathi
journal club Mandibular Degree II Furcation Defects Treatment With Platelet-Rich Fibrin and 1% Alendronate Gel Combination: A Randomized Controlled Clinical Trial
This document discusses advanced concepts in wound coverage by Dr. Suresh Koneru. It outlines factors to consider when a wound is ready for coverage, including a low bacterial count and adequate patient nutrition status. It then reviews the reconstructive ladder of options from primary closure to skin grafts to local flaps to microvascular tissue transfer and composite tissue allotransplantation. Postoperative care considerations are provided for skin grafts.
1) The document describes a study on the effects of low level laser therapy (LLLT) on human appendicular bone fracture healing.
2) A total of 40 patients with fractures were divided into a laser group (20 patients) who received LLLT, and a control group (20 patients) who did not.
3) Results showed the laser group had better clinical outcomes like less pain and earlier movement, and radiological outcomes like faster/greater callus formation and bone density increases.
4) The study concluded LLLT can accelerate bone union and enhance healing when used as an adjunct to standard fracture treatment.
VAC therapy has emerged as a novel adjunct to wound management over the last decade. It works by removing edema and inhibitory factors from wounds, reducing bacterial counts, and improving healing through increased blood flow, granulation tissue formation, and angiogenesis. VAC therapy finds applicability in many wound types by preparing wounds for reconstruction and securing skin grafts. It provides an economical alternative to other treatments and can help expedite healing and reduce hospital stays. However, VAC therapy is an adjunct and not a substitute for thorough debridement and other established wound care measures.
This document proposes revisions to the original SACS Classification for Peristomal Skin Disorders. The authors conducted a multi-center study observing lesions that could not be classified by the original SACS method. They defined a new L5 lesion involving loss of substance beyond the fascial plane. The study aimed to include this new lesion in the classification and classify all lesions present rather than just the most serious lesion. Based on the study findings, the authors propose a revised classification called SACS 2.0 that retains the original classification's objectivity while integrating the new L5 lesion and allowing for classification of multiple concurrent lesions.
Sacs 2.0 a review of the original sacs scale WUWHS Florence 29.09.2016Mario Antonini
About eight years have passed since the publication of the SACS Classification, the use of which has proved to be essential in Italy, not only on account of the particular characteristics of this instrument but also and above all as it is a point of reference for debate and discussion and aims to facilitate an objective awareness of peristomal skin lesions.
This document discusses the evaluation and management of open fractures. The key points are:
1. Open fractures involve both bone and soft tissue injuries and managing them aims to prevent infection, achieve fracture union and restore function.
2. Open fractures are classified based on the type of fracture, soft tissue injury and bacterial contamination. This helps determine treatment and prognosis.
3. Immediate antibiotics and tetanus prophylaxis should be given. Wound irrigation and debridement are also important to prevent infection.
4. Controversies exist regarding wound closure timing and irrigation techniques. Extensive soft tissue damage may require muscle flaps. Fracture stabilization depends on location and injury characteristics.
This randomized controlled trial compared the efficacy of 2% lignocaine with epinephrine (Group A) to a mixture of 2% lignocaine with epinephrine and 4 mg dexamethasone (twin mix, Group B) for third molar surgery. The study found that the twin mix provided a faster onset of anesthesia, longer duration of soft tissue anesthesia, and less postoperative pain, swelling and trismus compared to lignocaine alone. Specifically, the twin mix group had onset of anesthesia in 51 seconds compared to 81 seconds, duration of anesthesia of 251 minutes compared to 142 minutes, and lower pain scores on the first, third and seventh postoperative days. The twin mix also resulted in less facial swelling and reduced mouth opening after
This document summarizes a study comparing the healing of partial-thickness skin graft donor sites treated with two different moist dressings: Tegaderm, a semipermeable membrane dressing, and MEBO, a burn ointment that provides a moist environment without an occlusive dressing. The study found that donor sites treated with MEBO healed anatomically faster than those treated with Tegaderm. Physiologic barrier recovery, as measured by transepidermal water loss, also occurred significantly earlier with MEBO. Finally, MEBO treatment resulted in better scar quality compared to Tegaderm. The findings suggest that MEBO is an effective alternative to conventional occlusive dressings for treating partial-thickness wounds.
EWMA 2013 - Ep518 - A NOVEL EGF-CONTAINING WOUND DRESSING FOR THE TREATMENT O...EWMAConference
Doerler Martin1), Eming Sabine2), Dissemond Joachim3), Stücker Markus1)
1) Department of Dermatology, Venereology and Allergology. Vein Centre of the Departments of Dermatology and Vascular Surgery, Ruhr-University Bochum, Bochum, GERMANY
2) Department of Dermatology, Venereology and Allergology, University of Cologne, Cologne, GERMANY
3) Department of Dermatology, Venereology and Allergology, University of Essen, Essen, GERMANY
jc scar and laser.pptx journal club scar treatmentMalaM67
This study assessed the efficacy and safety of combined CO2-IPL and single light IPL in treating hypertrophic scars. 138 patients with hypertrophic scars were randomized to receive either 3 sessions of combined CO2-IPL or single IPL treatment over 10-14 week intervals. Clinical assessment using the POSAS scale found that the combined CO2-IPL treatment resulted in significantly lower POSAS scores compared to single IPL, indicating greater improvement in scar characteristics. 100% of patients treated with CO2-IPL expressed satisfaction with results compared to 84% for single IPL. The combination of CO2-IPL was found to be a safe and effective alternative for treatment of hypertrophic sc
journal club - scar revision with laser and narrowband intensed pulsed lightMalaM67
The document summarizes a study assessing the efficacy and safety of combined CO2-IPL and single light IPL in treating hypertrophic scars. 138 patients with hypertrophic scars were randomized to receive either 3 sessions of combined CO2-IPL or single light IPL treatment with a 3 month follow up. Results showed that the combined CO2-IPL treatment was more effective at improving scar characteristics according to POSAS scores. 100% of patients treated with CO2-IPL expressed satisfaction with outcomes compared to 84% for single light IPL. The study concludes that combined CO2-IPL therapy provides significant improvement in scar assessment and is a safe alternative for multi-photoelectric scar treatment.
Extracorporeal shockwave therapy (ESWT) has analgesic and anti-inflammatory effects. With the evolu- tion and comprehension of its biological and physical mechanisms, the application of ESWT on other pathologies has also been studied, especially in musculoskeletal diseases. Recently, studies on animal models have shown its angiogenic capacity and a higher rate of local re-epithelization. These small stud- ies led to few trials using low-energy, radial ESWT to treat problematic chronic skin ulcers. Skin ulcers have diverse etiologies, ranging from pressure ulcers, burns, venous or arterial ulcers, and even diabetic ulcers. Their treatment is usually a challenge, due to the long-term treatment and high costs.
Effectiveness of Low-Level Lasers in the Management of Recurrent Aphthous Sto...DrHeena tiwari
This study assessed the effectiveness of low-level lasers in treating recurrent aphthous stomatitis. 30 subjects with minor, major, or herpetiform aphthae were treated with lasers and their pain was evaluated using VAS scores. For all groups, pain was significantly less after 24 hours and further reduced at 72 hours compared to pre-treatment levels. At 1 week, pain scores were minimal or zero. The results demonstrated that low-level lasers provide effective pain relief and accelerated healing for recurrent aphthous stomatitis lesions.
Content server (10)A randomized, controlled, double-blind prospective trial w...Missing Man
A randomized, controlled, double-blind prospective trial
with a Lipido-Colloid Technology-Nano-OligoSaccharide
Factor wound dressing in the local management of
venous leg ulcers
Dr. kushagra case study, supported by TRIAGE MEDITECH NPWT INDIASiddharth Mandal
This study compared the effectiveness of vacuum assisted wound therapy (VAC) to standard wound therapy for treating open musculoskeletal injuries. 30 patients were randomly assigned to receive either VAC or standard saline dressings after surgical debridement. Wound size reductions were measured after 8 days of treatment. VAC resulted in greater wound size reductions of over 5 mm compared to less than 5 mm for standard therapy. VAC facilitated more rapid formation of healthy granulation tissue, potentially shortening healing time and reducing needs for further soft tissue procedures. The study concluded that VAC therapy is effective for open musculoskeletal wounds and produces better outcomes than standard wound care.
Light-Emitting Diode Irradiation Promotes Donor Site Wound Healing of the F...Shilpa Shiv
This document summarizes a study that investigated the effects of LED light irradiation on wound healing of free gingival grafts in rats. The study found that LED light irradiation at 10-20 J/cm2 promoted fibroblast viability and wound closure in vitro, and accelerated wound healing in vivo by promoting re-epithelialization, reducing inflammation and sequestrum formation, and increasing collagen deposition. LED light facilitated healing, likely by reducing reactive oxygen species and promoting angiogenesis and tissue remodeling, though additional research is still needed to validate the optimal LED conditions for clinical use.
Vacuum compression therapy (VCT) uses cycles of negative and positive pressure to enhance wound healing. The document summarizes two studies on VCT:
1) A randomized controlled trial found that adding VCT to conventional therapy for diabetic foot ulcers significantly reduced ulcer surface area compared to conventional therapy alone. VCT improved blood flow and oxygenation to accelerate wound healing.
2) A case report described using VCT to treat a non-healing ischemic ulcer. After adding VCT, the ulcer decreased in size by 25% within 2 weeks and healed completely within 8 weeks, suggesting VCT facilitated healing in this case by improving capillary filling.
CALVREV 2.pptxhdhhdjdsnAll aboveIs true and goodCrajRaj
1) The study compared abdominal skin incision closure with non-absorbable sutures versus staples in 147 patients undergoing elective abdominal surgery.
2) Results showed that staples significantly reduced surgical site infections compared to sutures, especially in incisions 5-10cm and clean wounds. Staples also significantly reduced postoperative pain levels.
3) Staples yielded better cosmetic results, with superior scar appearance rated by patients and observers, especially in incisions under 5cm and over 10cm.
This study compared the efficacy of the antifungal agents sertaconazole and clotrimazole in treating tinea corporis. Sixty patients were divided into two groups, with one group using sertaconazole cream and the other clotrimazole cream, applied twice daily for three weeks. Parameters like erythema, scaling, itching, lesion size and KOH mount were assessed before and after treatment. There was a significant reduction in symptoms for both groups, but sertaconazole showed significantly greater improvement in erythema, scaling, itching and lesion margins compared to clotrimazole based on statistical analysis. The mean reduction in total symptom scores was also significantly higher for
This study evaluated a rutin-allicin gel (RAG) for treating diabetic foot ulcers and compared it to tetrachlorodecaoxide (TCDO). 60 patients were divided into two groups, with one group treated with TCDO and the other with RAG. RAG treated wounds started epithelializing by day 6 and fully healed by day 21, significantly faster than the TCDO group. RAG dressing was also significantly cheaper than TCDO. Both treatments showed bactericidal effects with no infections. The authors concluded RAG had a quicker and more effective wound healing response due to the synergistic antioxidant effects of rutin and allicin.
This study investigated the effects of topical and systemic atorvastatin on skin flap survival in mice. Mice underwent skin flap surgery and were divided into groups receiving various doses of atorvastatin or saline by injection or topically. After 2 weeks, systemic atorvastatin significantly reduced necrosis compared to controls. While promising, further research is needed to confirm effects in humans and determine optimal dosing to maximize benefits and minimize risks.
Fractional laser resurfacing modalities can be used to treat various signs of aging skin and acne scarring. Ablative fractional CO2 lasers work by creating microscopic thermal zones that stimulate collagen remodeling but cause more downtime. Non-ablative fractional lasers like Er:glass cause less injury and faster healing but may require more treatments. Both can improve acne scarring and wrinkles but ablative lasers carry higher risks of post-inflammatory hyperpigmentation which commonly occurs in Asian skin. Precise patient selection and education on risks and post-care are important when using lasers for skin rejuvenation.
This study evaluated surgical treatment of spinal tuberculosis in 25 patients over a period of 15 months on average. Microbiological testing confirmed tuberculosis in all cases. Patients underwent anterior, posterior, or combined surgical procedures along with 12 months of antitubercular drug therapy. Neurological function improved in all patients. Bony fusion was achieved within 6 months on average. For dorsolumbar lesions, the average kyphosis angle improved from 36 to 17 degrees. The authors concluded that early surgical intervention along with chemotherapy can effectively treat spinal tuberculosis by stabilizing the spine and preventing kyphosis progression.
To Follow Dermatological Treatment Regimens – Patients' and Providers' Vi...ricklock78
Adherence to long-term therapy for chronic illness is on average 50%. However, regarding adherence to derma- tological treatment the existing literature is limited. The aim of the study was to acquire an understanding of issues associated with adherence to dermatological therapy. Focus group interviews were used in two types of fora: patients with chronic dermatological diseases and health care providers, including doctors, nurses and pharmacists working in dermatological care. Results reveal the providers' view of a suboptimal rate of adherence.
A comparative study of intralesional injection of triamcinolone acetonide alo...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Case study: A non healing wound treated with hyperbaric oxygen therapyApollo Hospitals
Problem wounds represent a significant and growing challenge to our healthcare system. The incidence and prevalence of these wounds are increasing in the population resulting in growing utilization of healthcare resources. These problem wounds may arise from excessive pressure, trauma, venous insufficiency, diabetes mellitus, vascular disease, or prolonged immobilization leading to its difficult management with significant increases in cost, disability, and liability. Healing of such wounds is a dynamic pathway requiring the presence of oxygen for optimal restoration of tissue integrity and function needs good building blocks for repair and a good transport system to get the building blocks to the site of action. Hyperbaric oxygen therapy (HBOT) is used as a therapeutic modality which leads to an increase in tissue oxygen pressures at the wound site and hence allowing the reversal of a hypoxic state by increasing the oxygen diffusion within the plasma, consequently promoting angiogenesis, encouraging fibroblastic activity and supporting the tissues to resist against bacteria. It is used as an adjunctive treatment to enhance best-practice wound care and employing HBOT in a directed and appropriate way can significantly enhance wound healing efforts. We review a case of 17 year old girl with Grade I pressure ulcer over her right heel since 6 years and role of hyperbaric oxygen therapy as an adjunctive for its management.
EWMA 2014 - EP454 EXPERIENCES WITH USING A COLLAGEN WOUND MATRIX* ON RECALCIT...EWMA
The document describes a case series that evaluated the use of a collagen wound matrix on various recalcitrant complex chronic wounds. The study found that 4 patients experienced a decrease in wound size and increase in healthy tissue, with one patient healing completely and another almost healing. In 3 patients, infection developed and treatment was stopped to resolve the infection. The collagen wound matrix showed potential to increase tissue formation and encourage wound closure in patients without infection.
1. The study investigated the effectiveness of antihomotoxic preparations Traumeel S and Osteobios in combination treatment of degenerative spinal diseases. Patients receiving these preparations in addition to traditional therapy saw greater improvements in pain, mobility, and bone healing markers than the control group receiving only traditional therapy.
2. Specifically, those receiving Traumeel S injections and ointment experienced greater reductions in pain levels and muscle spasms after 4 days compared to the control group. They also had faster wound healing after surgery.
3. The group also receiving Osteobios showed higher blood alkaline phosphatase levels upon discharge, indicating increased bone formation compared to the control group. This supported Osteobios' role
ABSTRACT- The treatment of carbuncle is early administration of antibiotics and surgery. The commonest surgical approach is Saucerization and Incision & Drainage (I&D). Two cases are presented here, one underwent Saucerization and then primary split thickness skin grafting. Another un-derwent I&D for her carbuncle. They were followed up for 8 weeks to assess their outcome. Saucerization produced the shortest length of hospital stay while I&D resulted in shortest wound healing. As a new modality of treatment now-a-days two new modalities gaining popularity for better cosmetic purpose: primary split thickness skin grafting & transposition of local skin/musculocutaneous flap.
Keywords: carbuncle, surgery, good glycemic control
Similar to Tratamiento de homeomesoterapia en cicatrices con Guna (20)
El documento describe la composición de CELLFOOD, un suplemento nutricional. Contiene una amplia variedad de minerales, aminoácidos, enzimas y electrolitos que proporcionan nutrientes esenciales para el cuerpo. Al tomar CELLFOOD, algunas personas pueden experimentar una "crisis de curación" en la que el cuerpo elimina toxinas acumuladas, lo que puede causar síntomas temporales de desintoxicación. Esto es un signo positivo de que el cuerpo se está limpiando a profundidad. Siguiendo las
I. Un estudio prospectivo evaluó el efecto de Rowatinex® en 50 pacientes tratados con litotripsia para cálculos renales o ureterales.
II. A los 14 días, el 60% de pacientes estaban libres de cálculos y el 82% a los 28 días.
III. Los resultados para el alivio de dolor también fueron excelentes, con un 82% libres de dolor a los 14 días y un 94% a los 28 días.
La dispepsia o indigestión se define como un síntoma que incluye náuseas, ardor de estómago y dolor abdominal superior. Rowachol contiene seis terpenos purificados que mejoran la bilis, son coleréticos, antiespasmódicos, estimulan la secreción pancreática y tienen efectos carminativos, lo que alivia los síntomas de la dispepsia. Varios estudios con animales y humanos han demostrado que Rowachol mejora la función del sistema digestivo y la composición de la bilis.
This document is a medication guide for non-steroidal anti-inflammatory drugs (NSAIDs) that outlines important safety information. It states that NSAIDs can increase the risk of heart attack, stroke, ulcers and bleeding in the stomach and intestines. It lists common side effects like stomach pain and serious side effects like kidney problems. The guide provides information on who should not take NSAIDs and cautions to stop use and seek medical help if concerning symptoms arise. It also lists examples of prescription NSAID medicines.
Este documento describe un estudio clínico sobre el tratamiento de la celulitis mediante mesoterapia homeopática y fitoterapia. El estudio incluyó 1,564 pacientes tratados entre 1991 y 1994 con una mezcla homeopática llamada Lipodistrofin inyectada mediante mesoterapia, complementada con tratamientos dietéticos, de ejercicio y aplicaciones tópicas. Los resultados mostraron mejoras en la pérdida de peso, disminución del diámetro de la cintura y síntomas relacionados con la celulitis, sin efectos
This study evaluated the effectiveness of Osteobios and Guna-Fem supplements for treating early postmenopausal osteoporosis compared to calcium and vitamin D supplements. 70 postmenopausal women with osteoporosis were divided into two groups. The group treated with Osteobios and Guna-Fem showed greater reductions in pain levels, improvements in quality of life, and decreases in bone resorption markers compared to the calcium/vitamin D group. The results suggest Osteobios and Guna-Fem may be effective treatments for reducing symptoms of early postmenopausal osteoporosis.
This document discusses using cytokines and homeopathic dilutions therapeutically. It argues that cytokines, which are protein molecules that regulate the immune system, can be used in homeopathic form to help defend the body against illness. The document states that homeopathy uses extremely diluted stimuli that are able to precisely target ultrafine body structures. It asserts that this approach can help restore balance to the complex fractal dynamics of various biological systems interacting in the body. Overall, the document proposes that cytokines can be applied homeopathically to provide a balanced, non-toxic stimulation that supports the body's natural healing responses.
The document summarizes a study on the use of Osteobios to treat calcium metabolism disorders in patients with chronic kidney disease stages II-III. 20 patients received Osteobios drops daily for a month in addition to other treatments, while a control group of 20 similar patients received no such treatment. Testing showed improvements in calcium, phosphorus, parathyroid hormone, and pain levels in the treatment group compared to baseline and the control group. The study concluded that Osteobios safely improves calcium metabolism in patients with chronic kidney disease without the need for additional medications.
Physiological Regulating Medicine (PRM) is the latest integration between Conventional Medicine and Homeopathic Medicine. PRM integrates classic Homeopathy with a new therapeutic concept - the restoration of physiological conditions through molecules such as hormones, neuropeptides, interleukins and growth factors in homeopathic dilutions corresponding to physiological concentrations. The method includes current knowledge on Homeopathy, Homotoxicology, the Psycho-Neuro-Endocrine-Immune axis, and nutrition. PRM offers injectable formulations for the control of nociceptive, neuropathic and mixed pain that can be injected into acupuncture points with excellent therapeutic results and no side effects.
Este documento presenta los resultados de un estudio multicéntrico sobre el uso de la mesoterapia homeopática con Condrotrofín R para tratar la patología articular. El estudio evaluó 200 pacientes durante 5 semanas y encontró una mejoría significativa de los síntomas en el 40% de los pacientes después de la primera semana de tratamiento. El tratamiento con Condrotrofín R redujo la necesidad de medicamentos convencionales y fue bien aceptado por los pacientes.
1. The extracellular matrix (ECM) represents the basic system of living organisms, where nourishment, control, and management of cells takes place through mutual information exchange.
2. The ECM is composed of proteoglycans and glycosaminoglycans which help maintain homeostasis. It also contains collagen, elastin, and other glycoproteins.
3. Over a lifetime, catabolites can accumulate in the ECM, making energy exchange between cells more difficult and contributing to the aging process. Physiological Regulating Medicine aims to cleanse and restore the ECM, such as through the product GUNA-MATRIX.
This study aimed to determine the safety and efficacy of three popular mesotherapy cocktails in treating localized fat deposits in Filipino women. Sixty subjects received injections of one of three cocktails - phosphatidylcholine and organic silicium (PC-OS), phaphatidylcholine, tiratricol and L-carnitine (PC+L), or the homeopathic formula Omeoformula 1. Measurements and blood tests showed PC-OS and Omeoformula 1 were comparable in reducing arm circumference and had fewer adverse effects than PC+L. Overall, mesotherapy was deemed safe and effective for reducing localized fat deposits with some benefit to HDL and LDL cholesterol levels.
Este estudio experimental evaluó los efectos de un preparado homeopático llamado Musclebig en parámetros antropométricos y dinamométricos de 32 culturistas masculinos. Los participantes fueron asignados aleatoriamente a un grupo tratado con inyecciones de Musclebig o a un grupo control. Tras 12 semanas, el grupo tratado mostró aumentos estadísticamente significativos en su índice de masa corporal, masa magra y fuerza de resistencia, así como una disminución en la grasa corporal, en comparación con el
The document describes a clinical study on 681 patients that evaluated the efficacy of the homeopathic remedy MADE® in treating wrinkles and skin slackening. The study found MADE® to be an effective alternative to conventional pharmacological treatments, showing good results in preventing and treating wrinkles and skin slackening, especially in patients aged 30-40 and 40-50.
This document discusses inflammation and cytokines. It notes that cytokines are proteins secreted by immune cells in response to antigens that induce inflammation. Cytokines influence each other in cascades and have pleiotropic, redundant, synergistic and antagonistic effects. Their secretion is brief and self-limiting, requiring multiple cytokines in relay to achieve a targeted biological response. Physiological regulating medicine uses homeopathic cytokines and other remedies to reset and coordinate the immune system.
The document discusses the transition from homeopathy to physiological regulating medicine (PRM). While homeopathy is based on the principle of treating "like with like" using highly diluted substances, PRM was developed by an Italian research group inspired by homeopathy but aiming to have a more scientifically valid treatment approach based on the latest immunology and neuroendocrinology discoveries. Key aspects of homeopathy discussed include the principle of similarity in symptom matching, and the use of potentized dilutions, which some research has found can induce physical changes in water and potentially have physiological effects.
The document discusses the transition from homeopathy to physiological regulating medicine (PRM). While homeopathy is based on the principle of treating "like with like" using highly diluted substances, PRM was developed by an Italian research group inspired by homeopathy but aiming to have a more scientifically valid treatment approach based on the latest immunology and neuroendocrinology discoveries. Key aspects of homeopathy discussed include the principle of similarity in symptom matching, and the use of potentized dilutions, which some research has found can induce physical changes in water and potentially have physiological effects.
1) The study evaluated the effectiveness of endoscopic biliary stenting combined with ursodeoxycholic acid (UDCA) and a terpene preparation for treating difficult common bile duct (CBD) stones in elderly patients.
2) 28 elderly patients with difficult CBD stones underwent biliary stenting and were given UDCA and terpene preparation daily for 6 months on average.
3) After treatment, CBD stone size and CBD diameter decreased significantly. Complete stone removal was achieved in 26 of 28 patients (92.8%) with an average of 1.7 additional ERCP sessions.
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
Our backs are like superheroes, holding us up and helping us move around. But sometimes, even superheroes can get hurt. That’s where slip discs come in.
TEST BANK For Community and Public Health Nursing: Evidence for Practice, 3rd...Donc Test
TEST BANK For Community and Public Health Nursing: Evidence for Practice, 3rd Edition by DeMarco, Walsh, Verified Chapters 1 - 25, Complete Newest Version TEST BANK For Community and Public Health Nursing: Evidence for Practice, 3rd Edition by DeMarco, Walsh, Verified Chapters 1 - 25, Complete Newest Version TEST BANK For Community and Public Health Nursing: Evidence for Practice, 3rd Edition by DeMarco, Walsh, Verified Chapters 1 - 25, Complete Newest Version Test Bank For Community and Public Health Nursing: Evidence for Practice 3rd Edition Pdf Chapters Download Test Bank For Community and Public Health Nursing: Evidence for Practice 3rd Edition Pdf Download Stuvia Test Bank For Community and Public Health Nursing: Evidence for Practice 3rd Edition Study Guide Test Bank For Community and Public Health Nursing: Evidence for Practice 3rd Edition Ebook Download Stuvia Test Bank For Community and Public Health Nursing: Evidence for Practice 3rd Edition Questions and Answers Quizlet Test Bank For Community and Public Health Nursing: Evidence for Practice 3rd Edition Studocu Test Bank For Community and Public Health Nursing: Evidence for Practice 3rd Edition Quizlet Test Bank For Community and Public Health Nursing: Evidence for Practice 3rd Edition Stuvia Community and Public Health Nursing: Evidence for Practice 3rd Edition Pdf Chapters Download Community and Public Health Nursing: Evidence for Practice 3rd Edition Pdf Download Course Hero Community and Public Health Nursing: Evidence for Practice 3rd Edition Answers Quizlet Community and Public Health Nursing: Evidence for Practice 3rd Edition Ebook Download Course hero Community and Public Health Nursing: Evidence for Practice 3rd Edition Questions and Answers Community and Public Health Nursing: Evidence for Practice 3rd Edition Studocu Community and Public Health Nursing: Evidence for Practice 3rd Edition Quizlet Community and Public Health Nursing: Evidence for Practice 3rd Edition Stuvia Community and Public Health Nursing: Evidence for Practice 3rd Edition Test Bank Pdf Chapters Download Community and Public Health Nursing: Evidence for Practice 3rd Edition Test Bank Pdf Download Stuvia Community and Public Health Nursing: Evidence for Practice 3rd Edition Test Bank Study Guide Questions and Answers Community and Public Health Nursing: Evidence for Practice 3rd Edition Test Bank Ebook Download Stuvia Community and Public Health Nursing: Evidence for Practice 3rd Edition Test Bank Questions Quizlet Community and Public Health Nursing: Evidence for Practice 3rd Edition Test Bank Studocu Community and Public Health Nursing: Evidence for Practice 3rd Edition Test Bank Quizlet Community and Public Health Nursing: Evidence for Practice 3rd Edition Test Bank Stuvia
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by...Donc Test
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by Stamler, Verified Chapters 1 - 33, Complete Newest Version Community Health Nursing A Canadian Perspective, 5th Edition by Stamler, Verified Chapters 1 - 33, Complete Newest Version Community Health Nursing A Canadian Perspective, 5th Edition by Stamler Community Health Nursing A Canadian Perspective, 5th Edition TEST BANK by Stamler Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Pdf Chapters Download Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Pdf Download Stuvia Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Study Guide Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Ebook Download Stuvia Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Questions and Answers Quizlet Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Studocu Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Quizlet Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Pdf Chapters Download Community Health Nursing A Canadian Perspective, 5th Edition Pdf Download Course Hero Community Health Nursing A Canadian Perspective, 5th Edition Answers Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Ebook Download Course hero Community Health Nursing A Canadian Perspective, 5th Edition Questions and Answers Community Health Nursing A Canadian Perspective, 5th Edition Studocu Community Health Nursing A Canadian Perspective, 5th Edition Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Pdf Chapters Download Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Pdf Download Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Study Guide Questions and Answers Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Ebook Download Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Questions Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Studocu Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Stuvia
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Tratamiento de homeomesoterapia en cicatrices con Guna
1. PHYSIOLOGICAL REGULATING MEDICINE 2011
HOMEOMESOTHERAPY OF THE
PATHOLOGICAL SCARS
SUMMARY
S. Korkunda
RESEARCH AIMS
The aim of this research is to detect indi-
cations and efficiency, using the low
dose preparations Made®
and Guna®
-
Collagen (Guna Laboratories, Milan -
Italy) in mesotherapy on the pathologi-
cal scars of different origin and age in
comparison with traditional methods.
MATERIALS AND METHODS
Patients with pathological scars –
keloids, hypertrophic, and atrophic
scars (KS, HS, AS) – who were treated
at the Kharkiv Burn Center (Kharkiv-
Ukraine) from November 2009 to July
2011, were taken under clinical obser-
vations.
To the first (basic) group belonged
patients with pathological scars of dif-
ferent age which embrace different
areas; these only got mesotherapeutic
treatment with Made®
and Guna®
-
Collagen.
The second group was a control one.
Similar patients received a standard
treatment regimen. The efficiency of
treatment was estimated in accordance
with clinical characteristics of scar tis-
sue, patients’ subjective estimation,
laboratory blood analysis, and histo-
logical study of scar tissue before and
at the end of the treatment.
FINDINGS AND DISCUSSION
᭤ The basic group (30 patients aged be-
tween 10 and 62 years) was treated on-
ly with an intralesional injections
course of the preparations Made®
and
Guna®
-Collagen, 0.5-4 ml/week.
None of the patients was treated with
the compression therapy because of
scars location. The conservative thera-
py of joints desmogenic contracture was
not conducted. The medium term of
treatment was 115 days.
After 2 weeks of treatment the soften-
ing and flattening of HS and KS, the
minimization of vegetative reaction
were noticed; lightening of scar tissue,
disappearance of the scar tissues flab-
biness in patient with AS and color
changes from depigmentation to skin
color were noticed after 4 weeks.
After 2 weeks of treatment all the pa-
tients noticed pain and itch relief sub-
jectively. At the end of the treatment, the
scar tissue is soft, elastic, without any
pathological vegetative reaction and it
can be easily taken into a fold.
In patients with HS and KS the color of
the skin is from flesh to intensive pink
(in case of old KS); in patients with AS
the skin has a flesh color.
The most evident transformation of scar
tissue ensued in patients with fresh scars
(the beginning of treatment not later
than 1-2 months from the start of scar
tissue growth) in a period of 80 days, in
patients with old scars (the first visit took
place 8-12 months from the beginning
The results of this study concerning
homeomesotherapy of the pathological
scars demonstrate the high clinical ef-
ficacy compared to the traditional treat-
ment, such as:
1) Reducing treatment time at the average
by 93-146 days.
2) Reducing the costs of rehabilitation.
3) Achieving the best possible treatment
outcome in the basic group with early
start of treatment.
4) Getting clinically more full-fledged re-
sult, when working with biologically safe
medicines.
5) Determination of laboratory diagnostic
indicators, which make it possible to
control the treatment and make projec-
tions.
6) Identification of new trends in the treat-
ment of patients with pathological scars.
7) Reduction of indication for the further
conservative and surgical rehabilitation.
8) Improving the patients’ quality of life,
and optimization of social rehabilitation.
Mesotherapy of pathological scars with
Made®
and Guna®
-Collagen can achieve
significant functional and aesthetic
results in a shorter period of treatment;
it doesn’t have any complication or neg-
ative side effect, nor any special
requirements for equipment is needed.
The treatment course is not problemat-
ic fot the patients’ life and work activi-
ties, and the treatment helps to improve
their quality of life.
PATHOLOGICAL
SCARS, HOMEOMESOTHERAPY,
COLLAGEN, OXYPROLINE, GAGs,
MADE®
, GUNA®
COLLAGEN
KEY WORDS
23
THERAPEUTICS
From: http://www.scars1.com/gallery/images/3wk_
pre.jpg
Korkunda-A:Art. Del Giudice 15/12/11 09.22 Pagina 23
2. 24
PHYSIOLOGICAL REGULATING MEDICINE 2011
of the scar tissue growth) in a period of
125 days.
Complications and side effects were not
found out; during the treatment proce-
dures the painfulness was moderate.
Clinically the scar tissue, which takes
up a small area, becomes hardly no-
ticeable, similar to the surrounding skin.
The extensive scar tissues slightly differ
in color from the not injured skin, but
functionally they are identical to it; which
shows itself by gaining of motion in the
joints with desmogenic contractures.
᭤ In the control group (15 patients aged
between 14 and 45 years) a standard
anti-scars therapy was performed: com-
pression therapy (elastic pressure band-
ages), ointment Contractubex, physio-
therapy courses, a course of Longidaza
N° 20 intramuscularly, gymnastics, in-
tralesional injections of steroid hor-
mones, sanatorium-and-spa treatment.
The medium term of treatment lasted
218 days.
Clinically, at end of the treatment, the
scar tissue is soft, with low-grade vege-
tative reaction, cannot be taken into a
fold on all the areas of the skin, color
varies from hyperpigmented to intensive
pink. Patients with AS present the fol-
lowing changes: increased flabbiness of
scar tissue, and persistent depigmenta-
tion remains in scars.
In the basic group, according to the
ultrasound scan results before the treat-
ment, the height of hypertrophic and
keloid scars averaged 4.31 mm; the depth
of the atrophic scars was 3.03 mm.
The presence of not uniform irregular-
shaped inclusions with reduced
echogenicity in the scar tissue was di-
agnosed in all the patients; there was
strong flattening or absence of a dermo-
epidermal junction line.
At the end of the treatment the scar
height (HS, KS) averaged 3.43 mm, the
depth of AS averaged 4.2 mm; the or-
der of fibers and the evident dermo-epi-
dermal junction line are observed in the
scars structure. Thereby the height re-
ducing of hypertrophic and keloid scars
averaged 0,872 mm (d < 0,05), and the
depth increase of AS averaged 1,15 mm
(d < 0,05).
Similar results have been observed in
the control group, treatment performed
at the same time, they maintain unim-
portant small difference in indexes
in patients with HS and KS, but they
differ significantly in patients with AS
(TAB. 1).
Thus, when using both the treatments,
the height reducing of HS and KS oc-
curs with a significant small difference;
when treating AS in the basic group of
treatment the volume filling of lost tis-
sue occurs, which is physiologically
positive.
– On the contrary, when treating with
standard methods, the atrophy of the
tissue gets worse.
Morphological examination of biopsy
materials of the old scar tissue in the ba-
sic group before the treatment (100,
200 and 400, hematoxylin eosin stain
and Van Gieson's stain): papillary layer
of dermis became thin, not full-blown,
a tough fibrous connective tissue with
occurrence of hyalinosis in the reticu-
lar dermis; almost complete absence of
vascular component attracts attention –
single large thick-walled vessels with
sclerosis and hyalinosis of their wall.
Reticular layer has a zonal structure
with the presence of beams of tough fi-
brous sclerosed fibers that are random-
ly woven and complete lack of cellular
elements (fibroblasts and fibrocytes);
these bundles are surrounded by a quite
dense and cellular connective tissue
and with a relatively large number of fi-
broblasts and a small amount of thin-
walled vessels. After the treatment the
reticular dermis is presented with a fi-
brous, soft, well vascularized connec-
tive tissue with a small amount of
coarse-fibered collagen.
The basis of well-defined, interlacing
collagen fibers is a large quantity of fi-
broblasts and fibrocytes.
Rather more of them can be observed
around small, thin-walled vessels. In this
case, the morphology of the dermis con-
nective tissue approximates to the struc-
ture of the skin with normal structure.
Morphological research in the control
group was carried out only at the end
of the treatment: hyperkeratosic lami-
nated pavement epithelium, flattening
of dermo-epidermal line, growth of the
coarse sclerosed fibers in the reticular
dermis, poor leucocytic infiltration, iso-
lated vessels, and fibroblasts.
– Histopathologic finding of biopsy in
the control group have expressed dif-
ferences from that in the basic group.
The purpose of the laboratory blood
analysis before and after treatment was
to study the metabolism of the connec-
tive tissue in the process of anti-scars
therapy, by the identification of poten-
Research
Groups
Basic group
Control group
* The differences are significant d < 0,05; ** The differences are significant between the groups.
Before
treatment, mm
After
treatment, mm
Changes in mm %
HS, KS
4,31
4,28
AS
3,03
2,89
HS, KS
3,43*
3,58*
AS
4,2**
2,32*
HS, KS
-0,872**
-20,42%
-0,70*
-16,36%
AS
+1,15**
+38,61%
-0,57*
-19,73%
Pathological scars before and after the treatment. Ultrasound scan results.
TAB. 1
Korkunda-A:Art. Del Giudice 15/12/11 09.22 Pagina 24
3. 25
PHYSIOLOGICAL REGULATING MEDICINE 2011
tial diagnostic indicators of pathologi-
cal process cicatrization activity.
We studied the free and bound
oxyproline, total collagen, gly-
cosaminoglycans (GAGs), vitamin C,
flavin adenine dinucleotide, L-trypto-
phan, core-protein in both groups of
patients, who were receiving treat-
ment of pathological scars (TAB. 2).
Comparison was carried out with infor-
mation about laboratory norms of con-
ventionally healthy people.
One of the main indicators of collagen
metabolism is the content of oxyproline
in the blood.
– Oxyproline (proline derivative) is
one of the collagen basic amino acids;
this allows to consider it as a marker,
which reflects the catabolism of this
protein. About 20% of the peptides,
which contain oxyproline released
from the collagen molecules, are
excreted with the urine.
Only 1% of urine oxyproline is in free
form; the remaining 99% are the pep-
tides’ components.
In case of violation of collagen synthe-
sis the amount of cross-links in collagen
fibrils decreases, which leads to an in-
creased content of easily soluble colla-
gen.Therefore, in patients with impaired
metabolism of the connective tissue, the
excretion of oxyproline increases in
urine, the content of its free fraction in
the blood increases, and the content of
its bound fraction decreases.
– GAGs play an important role in the
transport and exchange of water, salts,
nutrients, and metabolites in tissues.
The study of the structural and meta-
bolic state of the connective tissue
demonstreted high activity of GAGs:
the amount was largely increased in the
blood plasma of patients in the 1st and
in the 2nd group respectively (57,5 ±
2,4 and 49,2 ± 1,3 micromole/l) after
our treatment, 1,5 and 1,2 times higher
- respectively - than the indexes of the
comparison group (conventionally
healthy patients).
– Collagenolytic activity (CLA) had sim-
ilar dynamics and didn’t depend on the
choice of therapeutic method.
The highest CLA values were recorded
in patients with the standard therapy
method (46,8 ± 2,3 micromole of
oxyproline l/h). Levels of plasma CLA
in this group exceeded the data of con-
ventionally healthy patients 7-8 times,
and in the main group of 4-5 times.
Thus this figure can be viewed as one,
which has an important diagnostic and
prognostic value in determining predis-
position to a pathological cicatrization
and, of course, to choose the method of
therapy.
The average of free oxyproline in both
groups before the treatment was 2,17
0,65 micromole/l, while in 12 persons
(41,5%), its concentration was in-
creased, in 8 patients (35,6%) it was re-
duced and in the rest of patients oxypro-
line level was 1,55±0.27 micromole/l,
which fitted the indicators of conven-
tionally healthy people.
Also in the 1st and 2nd group there was
a significant increase of bound oxypro-
line in serum compared to the indica-
tors of control individuals (27,3% and
46,6%), respectively (d < 0,001).
If we take into account that the level of
free oxyproline in the blood serum re-
flects the intensity of the collagen decay,
and the level of a protein-bind oxypro-
line reflects the activity of proliferative
Group
and method
of treatment
1st
Group
(basic) n = 27
2nd
Group
(control) n = 13
Conventionally
healthy people
n = 18
Indexes, M±m
* The differences are significant d < 0,05; ** The differences are significant between the groups.
free oxyproline
millimole/l
bind oxyproline
mole/l
GAGs
micromole/l
CLA (micromole of
oxyproline/l·h)
Before the
treatment
1,32±0,8
2,21±0,5
After the
treatment
1,57±0,3**
2,1±0,2*
Before the
treatment
7,35±1,4
9,5±1,0
After the
treatment
7,7±1,3**
9,2±1,3*
Before the
treatment
52,7±4,3*
41,5±1,9
After the
treatment
57,5±2,4*
49,2±1,3**
Before the
treatment
31,7±3,5
46,8±2,3
After the
treatment
39,6±4,2**
47,4±2,5*
1,49±0,12 6,28±0,19 38,2±1,2 male – 7,3±0,56
female – 7,6±0,43
Dynamic of biochemical parameters in patients with pathological scars, depending on the treatment method.
TAB. 2
Korkunda-A:Art. Del Giudice 15/12/11 09.22 Pagina 25
4. 26
PHYSIOLOGICAL REGULATING MEDICINE 2011
processes in the connective stroma of
the organs (Kaminskaya G., Puryaeva
N.L., 1990; Sodikova N.B, 2002), the
indexes of the above mentioned mark-
ers in the pathogenesis of the patholog-
ical scars formation becomes clear.
The analysis of the research results of
these parameters allows us to get to
the following conclusions: the for-
mation of pathological scars is ac-
companied by profound metabolic
disorders of the connective tissue
and it is confirmed by a significant
increase of collagenolytic activity of
blood serum and glycosaminogly-
cans content in it.
Evaluative studies of oxyproline showed
the most pronounced changes of bind
oxyproline after the treatment, where-
as the rates of free oxyproline were mul-
tidirectional. Almost half of the patients
in the two groups showed an increase
of this index, which indicates an in-
creased level of connective tissue re-
modeling.
In other patients, against the back-
ground of basic therapy, the free
oxyproline levels were low, which - on
the contrary - reflects the reduction in
the intensity of collagen metabolism,
perhaps as a result of the therapy we
carried out.
The GAGs index may be a predictive
criterion for the selection of the thera-
peutic measures. The high correlation
between the dynamics of collagenolyt-
ic activity and the level of bind oxypro-
line of blood plasma allow us to use
them as monitoring criteria for the ef-
fectiveness of the conducted therapy.
Catabolism of the connective tissue is
carried out in the intercellular substance
under the influence of specific en-
zymes: collagenase, elastase, proteas-
es, glycosidases.
Peptide chains of collagen are formed
on polyribosomes, associated with the
membranes of the endoplasmic reticu-
lum (EPR). Simultaneously with the
translation of DNA, hydroxylation of
proline and lysine residues takes place
in peptide chains.
Ascorbic acid acts as a reducing agent,
which contributes to the hydroxylated
iron in the ferrous state.
Hydroxylation of proline is necessary
for the formation of a stable triple helix
structure of collagen. Hydroxylation of
lysine is necessary for the formation of
covalent bonds between molecules of
collagen in the formation of collagen
structures. Hydroxylysine residues are
sites of glycosylation.
– In case of vitamin C deficiency, the
collagen synthesis breaks down at the
stage of hydroxylation. Less strong and
less stable collagen fibers emerge.
As a result of our investigation, we es-
tablished that patients who were in the
basic treatment group had a signifi-
cantly important increase in the level of
vitamin C during the therapy, more than
the control group, and in both groups
without additional treatment (FIG. 1).
Proteins-proteoglycans are called core-
proteins. The protein part of proteogly-
cans, as well as of other secretory pro-
teins, is synthesized on the poliribo-
some EPR.
Peptide chain penetrates the membrane
and grows into the cavity of the EPR.
Here begins the synthesis of gly-
cosaminoglycans and proteoglycans
part. As a result of our study of core-pro-
tein before the treatment, we found out
that there is a qualitative positive reac-
tion in the two studied groups (posi-
tive/positive), whereas in the group of
conventionally healthy people, this re-
action was negative (negative/negative).
On the background of our therapy in
the 1st group submitted to the basic
treatment we saw reaction changes for
negative/positive.
In the 2nd group of patients reaction on
the core-protein remained unchanged
(positive/positive).
Our data indicate the impact of the
treatment on the first reactions of gen-
eration of the carbohydrate component
of proteoglycans, which occurs in the
EPR.
Most of the subsequent stages of gli-
cosamin chains synthesis and their
modifications occur in the Golgi appa-
ratus, where it is much harder to influ-
ence biochemical processes.
In the synthesis of GAGs participate cor-
responding nucleotide derivatives of
monosaccharides and highly specific
glycosyltransferase.To study their effect
we measured levels of FAD+ / FADH2
and copper content in the serum of pa-
tients before and after therapy.
As a result of our study we found out a
violation of metabolism oxidative stage
of connective tissue at the level of
FAD/FADH as mandatory participants
of redox reactions and regulators of tis-
sue respiration in the pentose-phos-
phate pathway, which runs at the mo-
ment of the pathological scars forma-
tion.
In the patients of both groups before the
treatment, an oxidized form increase of
coenzymes of flavin-dependent form.
At a deeper study of bioenergetic
processes in the cell, we analyzed the
ratio of FAD+ and FADH2, as regulators
of the mitochondrial respiratory chain.
In all the groups the reduction of FADH2
(0,0294±0.001 micromole/l) by the
0,45
0,4
0,35
0,3
0,25
0,2
0,15
0,1
0,05
0
Before
treatment
Considered
as healthy
1st
Group 2nd
Group
After
treatment
Vitamin C levels in patients with pathological
scars, depending on the treatment method.
FIG. 1
Korkunda-A:Art. Del Giudice 15/12/11 09.22 Pagina 26
5. 27
PHYSIOLOGICAL REGULATING MEDICINE 2011
control values (0,054±0,005 micro-
mole/l) was observed.
The concentration of FAD+ (0,234±0,13
micromole/l) in both groups was signifi-
cantly higher (d <0,05) than in the group
of healthy patients (TAB. 3; FIGG. 2, 3).
– The correlation grows of FAD+/FADH2
lowers the activity of FADH2 depend-
ent enzymes in the cytosol and mito-
chondria. During the study of these
data before and after our treatment, we
found out that in the first group with
the basic treatment the rates of FAD+
and FADH2 tended to improve, while
in the second group they remained at
the same level.
All this may indicate a reduction of di-
hydroxyacetone phosphate, an inter-
mediate metabolite of glycolysis and
gluconeogenesis, which leads to a rate
reduction of gluconeogenesis and the
starting of the pentose phosphate path-
way, and consequently, to an increased
formation of pathological scars in the
second group of patients.
The growth of FADH2 concentration, in
comparison with FAD+, slows down the
oxidation in the pentose-phosphate
pathway, thereby the ratio of
lactate/pyruvate is increasing, which
further reduces the rate of gluconeoge-
nesis, and increases the lactate con-
centration in blood.
Oxidative decarboxylation of pyruvate is
accompanied by the formation of FADH2
and the kynurenic pathway and its end
products are directly dependened on the
concentration of FAD+, which is involved
in the mitochondrial respiratory chain
and provides the ATP cell.
It is known that the ratio of FAD+/FADH2
in the cell is a relatively stable rate and
that the reduction of FADH2 reduces the
speed of decarboxylation of pyruvate.
Thus, the rate of change in the ratio of
FAD+/FADH2 is an important factor,
which represents the energy needed by
cells to regulate the rate of oxidation in
the mitochondria and being responsible
for the mechanism of the pentose phos-
phate pathway regulation.
Tryptophan is a source of nicotinamide
coenzyme forms (NAD+
and NADP) of
vitamin B5; the tryptophan metabolism
is also associated with the formation of
biogenic monoamine serotonin, hor-
mone melatonin, inducer of cell differ-
entiation and proliferation – 5-hydrox-
yindoleacetic, 5-HIAA (5-hydroxy in-
dolic acid), which are able to influence
considerably the metabolism of various
organs and tissues.
– Analysis of scientific data shows that
the studies of the tryptophan metabo-
lism and pathogenic role of its meta-
bolic products in the mechanisms of
pathological scarring development
have not found the proper reflection in
the scientific literature now available.
This issue is of great scientific interest
to study the pathogenic mechanisms of
pathological scars formation, diagnos-
tic optimization of difficulty degree of
the process of cicatrization and devel-
opment of the appropriate treatment.
It is known that L-tryptophan is the sta-
bilizer of the enzymeTDO (tryptophan-
2, 3-dioxygenase).
It contributes to the formation of a sta-
ble conformational state, the TDO has
an absolute substrate specificity towards
the L-tryptophan and catalyzes the irre-
versible key reaction of amino acid ca-
tabolism in kynurenic pathway of its
metabolism with the formation of N-
formyl-L-kynurenine, and later one of
the key end-metabolites – NAD+
.
– This enzyme accelerates the incorpo-
Before
treatment
Considered
as healthy
1st
Group 2nd
Group
After
treatment
0
0,2
0,1
0,3
0,4
0,5
FAD+ levels in patients with pathological
scarring before and after the treatment.
FIG. 2
Before
treatment
Considered
as healthy
1st
Group 2nd
Group
After
treatment
0
0,02
0,01
0,03
0,04
0,05
0,06
FADH2 levels in patients with pathological
scarring before and after the treatment.
FIG. 3
* The difference is reliable by comparison
with the standard;
* * The difference is reliable between the groups.
Indexes
FAD+
FADH2
FAD+/ FADH2
Standard
0,243±0,13
0,054±0,005
0,09±0,02
1st Group
0,365±0,08*
0,0294±0,001*
0,12±0,035
2 nd Group
0,43±0,2*
0,0267±0,004*
0,15±0,028
The concentration of FAD+ and FADH2 in the serum of patients with pathological scars
(micromole/l) before the treatment.
TAB. 3
Korkunda-A:Art. Del Giudice 15/12/11 09.22 Pagina 27
6. 28
PHYSIOLOGICAL REGULATING MEDICINE 2011
ration of molecular oxygen directly
into the molecule of L-tryptophan and
its catalyzed reaction is a factor which
limites the speed of reaction of the
conversion of the substrate.
The examination has found out the activ-
ity growth of the TDO and the L-trypto-
phan content in the serum in both groups
before the treatment (TAB. 4).
In these metabolic conditions the way of
increased synthesis of NAD+
and NADP+
coenzyme opens, needed to strengthen
the reducing syntheses of tissue differen-
tiation and proliferation.
The regulation of TDO is put into effect
by the feedback of kynurenic pathway fi-
nal products of L-tryptophan NAD+
and
NADP+
metabolism, whereas the en-
zyme activation is associated with an in-
crease of the substrate oxidation content
L-tryptophan.
Positive activators of theTDO enzyme are
Cu2+
ions, hematin, ferriheme and σ-
aminolevulinic acid (σ-ALA). Hemin is a
TDO. A significant increase in the TDO
activity allows to evaluate the reduction
of the protein synthesis function of con-
nective tissue in patients with pathologi-
cal scarring, and particularly about the
disturbance of hemoglobin synthesis,
which caused heme to oxidize by oxy-
gen in hemin, which is a coenzyme acti-
vator of this enzyme, and on the other
hand – the oxidized form of heme
(hemin) inhibits the activity of the mito-
chondrial enzyme σ-aminolevulinic,
which catalyzes the first reaction of heme
synthesis from succinyl-CoA and glycine,
σ- aminolevulinic acid.
The main suppliers of reduced substrates
are the central metabolic pathways – ox-
idative decarboxylation of pyruvic acid
and citric acid cycle.
Both of them are realized in the mito-
chondria matrix.
In the course of this processes reactions
of decarboxylation occur (the most part
of all the carbon dioxide produced in the
cells is produced here). In addition, as al-
ready mentioned, during these process-
es the reactions of substrate dehydro-
genation takes place, the reduced coen-
zyme forms NADP∙H+
and FADH2 are
generated, their hydrogen comes into the
respiratory chain of the internal mito-
chondria membrane, where its oxidation
by oxygen to water and synthesis of ATP
occurs. The growth of NAD+
/NADP,
FAD+
/FADH2 correlation indicates ener-
gy deficit, and it is a signal for the oxida-
tion acceleration in the Krebs cycle.
The main effect of the regulators is di-
rected on the activity of three key en-
zymes: citrate synthase, isocitrate dehy-
drogenase and α-ketoglutarate dehydro-
genase.
During the examination of L-tryptophan
metabolism in both groups before the
treatment, any statistically significant
changes in the dynamics of L-trypto-
phan content in serum and theTDO en-
zyme activity (d <0.05) were not found
out, although the stable dynamics in in-
creasing of L-tryptophan and TDO.
However, against the background of the
conducted therapy the parameters of L-
tryptophan and the enzyme TDO activ-
ity differed significantly in the patients
of the 1st group: they were 55,12 ± 2,3
micromole/l and 38,5 ± 2,1 nanomole
kynurenine/mg of protein∙1 hour for
the L-tryptophan and enzyme TDO ac-
tivity respectively, and in the 2nd group
59,192 ± 2,5 micromole/l and 40,1 ±
2,1 nanomole kynurenine/mg of protein
1 hour.
Analysis of the metabolic rates dynam-
ics of amino acid L-tryptophan metabo-
lism indicates (FIG. 4) that the availabili-
ty of L-tryptophan in serum is a signif-
icant diagnostic indicator of the possi-
ble pathological scarring.
These data confirm clearly the impor-
tant role of neuroendocrinal regulation
in the pathogenesis of pathological
scarring formation. However, the eval-
uation of metabolites of L-tryptophan
metabolism allows to make a predictive
conclusion about the level of activity
or probability of pathological cica-
trization.
Thus, the study of amino acid L-trypto-
* The differences are significant d < 0,05.
Indexes
Patients n = 32
69,18±3,6*
41,6±4,1*
L-tryptophan
(micromole/l)
TDO (nanomole
kynurenine/mg of
protein·1 hour)
Conventionally healthy peopleGroup of
observation, sex
Male
(n = 23)
51,8±2,3
37,5±2,3
Female
(n = 20)
50,5±3,0
35,8±3,4
Indexes of L-tryptophan metabolism in patients of the both groups with pathological scars before
the treatment (M ± m).
TAB. 4
Before
treatment
Considered
as healthy
1st
Group 2nd
Group
After
treatment
0
10
20
30
40
50
60
70
80
L-tryptophan levels in patients with
pathological scars before and after treatment,
according to the treatment groups.
FIG. 4
Korkunda-A:Art. Del Giudice 15/12/11 09.22 Pagina 28
7. 29
PHYSIOLOGICAL REGULATING MEDICINE 2011
phan metabolism makes it possible to
confirm objectively the stage of patho-
logical scar development and monitor
the treatment process.
The monitoring indicators are: the test-
ing of L-tryptophan content in serum
and theTDO enzyme activity, which re-
flects one of the important links in the
structural and metabolic disorders dur-
ing the development of pathological ci-
catrization.
The laboratory study of the indexes of
connective tissue metabolism makes it
possible to optimize the pathogenetic
therapy of pathological scars, namely:
the inclusion of therapeutic and health
promotion programs, which are aimed
at normalization of the neuroendocrine
regulation of L-tryptophan metabolism,
organism detoxification, correction of
metabolic acidosis, increasing the lev-
el of antioxidant protection and inhibi-
tion of oxidative stress, increasing of the
immunological resistance in conjunction
with local impact. The efficiency control
of remedial measures can be realized by
studying the metabolites dynamics of the
amino acid L-tryptophan metabolism,
which has a great prognostic value of the
cicatrization process result.
CONCLUSIONS
The results of ths study demonstrate the
high clinical efficacy of the presented
mesotherapeutic treatment of patholog-
ical scars compared to the traditional
treatment, such as:
1) Reducing treatment time at the average
by 93-146 days.
2) Reducing the costs of rehabilitation.
3) Achieving the best possible treatment
outcome in the basic group with early
start of treatment.
4) Getting clinically more full-fledged re-
sult when working with biologically
safe medicines.
5) Determination of laboratory diagnostic
indicators, which make it possible to
control the treatment and make projec-
tions.
6) Identification of new trends in the treat-
ment of patients with pathological scars.
7) Reduction of indication for the further
conservative and surgical rehabilitation.
8) Improving the patients’ quality of life,
and optimization of social rehabilita-
tion.
Mesotherapy of pathological scars
with Made®
and Guna®
-Collagen can
achieve significant functional and aes-
thetic results in a shorter period of
treatment; it doesn’t have any compli-
cations or negative side effect, nor any
special requirements for equipment is
needed.
The treatment course is not problem-
atic for the patients’ life and work ac-
tivities, and treatment results to im-
prove the quality of life. í
author’s address
Dr. Svetlana Korkunda, PhD.
– Docent in the Department of Com-
bustiology, Reconstructive, and
Plastic Surgery of KhMAPE.
Kharkiv City Hospital Emergency
Medical Care.
Kharkiv - Ukraine
Korkunda-A:Art. Del Giudice 15/12/11 09.22 Pagina 29