Treating distal fingertip traumatic amputations with semi-occlusive foil dressings—preliminary results

Introduction: Traumatic amputations of the fingertip are a common injury, often encountered in the emergency department, resulting from work-related or domestic incidents, mainly blunt-force trauma or laceration with sharp objects. Many treatment strategies for such injuries exist without any one taking precedence.Aim: The aim of this study is to evaluate the effectiveness of a novel technique, which implements semi-occlusive foil dressings to treat such injuries.Materials and Methods: Fifteen patients with distal fingertip injuries were treated with foil dressings and were followed up for 4 months. Bandages were changed weekly and no antibiotic treatment was prescribed to any of them. After the tip of the finger granulated, patients were given instructions to treat the area of intact skin with epithelializing unguents.Results: The treatment regimen continued for 3–4 weeks, patients were able to get back to activity as early as 1–3 days after injury. Full use of the injured finger during treatment was advocated. After the treatment the pulp of the finger had normal shape, bulk, and size with full range of motion and regained sensitivity.Conclusion: Fingertip amputations are injuries associated with the professional occupation or following domestic incidents, commonly presented in the emergency departments. Historically many treatment methods have been proposed. Our work presents a fast, simple, cheap, and effective treatment method, which is a safe alternative to flap plastic reconstructions. The duration of treatment was 3–4 weeks on average, depending on the severity of the injury, and resulted in a nearly complete restoration of sensitivity and an excellent cosmetic outcome

Fingertip traumatic amputations in children. Treatment with semiocclusive foil dressings-preliminary results

Introduction: Traumatic fingertip amputations in childhood constitute 2% of all hand injuries in individuals under the age of 14. These injuries have a significant impact on the psychological and emotional well-being of both the children and their parents. The treatment is multifactorial, dependent on the severity and location of the injury, and can involve both conservative and surgical approaches. Materials and Methods: The study involved 6 patients between the ages of 8 and 15 with fingertip amputations of the hand. The average duration of treatment with semi-occlusive dressings was between 3-4 weeks. The dressing was changed once a week, and after the final dressing, the border between the wound surface and healthy skin was treated with epithelializing ointments. Results: The average duration of treatment was 20-30 days. On average, dressings were changed 3-5 times throughout the treatment period. After the completion of treatment, the pulp had a normal shape, and the cosmetic outcome was excellent. No contractures were observed in the adjacent joints, and the two-point discrimination test had an average value of 2.5 mm. Discussion: Fingertip amputations present challenging injuries with multiple available treatment strategies. The presented technique is relatively simple to apply, reduces pain and discomfort, and allows direct visualization of the wound surface without the need for frequent dressing changes. Treatment with semi-occlusive dressings is a minimally invasive method, particularly suitable for the pediatric age group. Conclusion: Treatment of fingertip amputations with semi-occlusive foil dressings offers several advantages in childhood. Regular patient follow-up and cooperation from both the child and the parents are essential prerequisites for successful treatment

Trauma system law in Bulgaria

The contemporary standard of emergency in the health care system (trauma system) has been voted in the USA in 1992, and after that (in a period of 2–4 years) in many other countries. It has been unknown in countries in Eastern Europe, but some have implemented it. In Bulgaria this system does not exist in its full capacity. It has never been voted as a law. In Bulgarian healthcare system we can see only a few elements from trauma system that work—ATLS, DCS, definitive treatment when it is possible, triage. But those components are not linked into a whole system, which makes them not as effective as they have to be. Contemporary standard of emergency (trauma system) in fact is around 70–80% of health care and that lack of such standard reflects on the quality of all procedures in our country

Integrating the military trauma system in civilian life—a key to lowering preventable death in polytraumatized patients

The goal of the current work is to pose the question of how to imply the new Trauma System protocol in Bulgaria. Historically the question of establishing a protocol, which would raise the overall survival of polytraumatized patients, is getting more and more recognition, especially after the wars in Korea and Vietnam. The war medics introduced organizational protocols, which are carried over in civilian life because of the unpreparedness and the lack of adequate and fast enough actions in polytrauma setting. The ATS (American Trauma Association) was created by war medics and helicopter pilots (who flew victims over in war settings)

HER-2/neu - Molecular Structure and Status. Antibody - Targeted Therapy with Pertuzumab, Trastuzumab and Docetaxel and the Impact on Overall Survival (OS) and Progression-Free Survival (PFS) in Patients with Metastatic Breast Cancer

Introduction: HER-2 positive breast cancer is one of the most aggressive and rapidly growing neoplasms, due to the amplification and overexpression of the HER-2/neu gene. The exceeding presence of the receptor on the cell`s membrane makes it a valuable treatment target.Materials and Methods:  HER-2 receptors are among the main factors controlling the cellular growth, division and self-repair. In approximately 25% of breast cancers, the HER-2 gene mutates, producing too many copies of itself. Several methods are possible for discovering the HER-2 status: immunohistochemistry (IHC) and in situ hybridization (ISH, FISH, CISH, Dual-ISH tests). Positive results on these tests qualify patients for specific antibody-targeted therapy with trastuzumab and pertuzumab. The therapy includes docetaxel combined with trastuzumab or with both trastuzumab and pertuzumab. Scientific studies analyze key aspects such as OS and PFS by conducting double-blind studies comparing pertuzumab+trastuzumab+docetaxel with placebo+trastuzumab+docetaxel. Poll among oncologists was also used to review the efficacy of both treatments.Results: The result of the study, used as reference, showed that the PFS was prolonged by 6.1 months - from 12.4 in the control group to 18.5 in the group, using pertuzumab, instead of placebo. The OS rates improved from 40.8 to 56.6 months - a 15.8 months increase. Distinct side effect of the treatment - left ventricular dysfunction also drops by 3.9% in the pertuzumab group (from 8.3% to 4.4%). Data, gathered from the study, is further validated by the oncologists polled. The results can be explained by delving into the action mechanism of pertuzumab, which blocks heterodimerization of the HER-2 receptor with other members of the ErbB family, thus complementing the effects of trastuzumab.Conclusion: The pertuzumab+trastuzumab+docetaxel treatment shows significantly better results in OS and PFS, as opposed to placebo+trastuzumab+docetaxel, when used as first line of therapy, simultaneously lowering cardiovascular side effects