Comparing oil based ointment versus standard practice for the treatment of moderate burns in Greece: a trial based cost effectiveness evaluation

<p>Abstract</p> <p>Background</p> <p>The local treatment of burn wounds has long been a subject of debate. The objective of this study was to compare the cost and the effectiveness of Moist Exposed Burn Ointment -MEBO versus a combination of <it>povidone iodine </it>plus <it>bepanthenol </it>cream for partial thickness burns.</p> <p>Methods</p> <p>The study was carried out in the Burn Center of a state hospital in Athens, Greece. 211 patients needing conservative therapy were prospectively selected according to the depth of the burn wound. The treatment was allocated according to the Stratified Randomization Design. The outcomes measured were mean cost of in-hospital stay, rate of complications, time of 50% wound healing, pain scores, in hospital stay diminution. We have adopted a societal perspective.</p> <p>Results</p> <p>In the total groups MEBO presented lower cost, (although not significantly different: p = 0.10) and better effectiveness. The data suggest that MEBO is the dominant therapy for superficial partial burn wound with significantly lower costs and significantly higher effectiveness due to a lesser time of recovery and consequently lower time of hospitalization and follow-up. MEBO presented similar percentages of complications with the comparator, lower pain levels and smaller time of no healthy appearance of the burn limits for superficial partial thickness burns.</p> <p>Conclusions</p> <p>The data suggested that topical application of MEBO may be considered for further investigation as a potential first-line treatment modality for superficial partial thickness burns.</p> <p>Trial registration</p> <p>The trial has been registered on the International Standard Randomised Controlled Trial Number Register (ISRCTN) and given the registration number <a href="http://www.controlled-trials.com/ISRCTN74058791">ISRCTN74058791</a>.</p

Psychiatric disorders in burn patients: A follow-up study

Background: We report on a prospective study of 45 patients with burn injuries admitted to a major burn unit in the greater Athens area. The study aimed to explore the prevalence of psychological and psychiatric disorders among burn survivors. Methods: The sample comprised all consecutive cases of adult burn patients in a 6-month period. Personal interviews were conducted by the administration of the Langner scale and the DSM-III-R Structured Clinical Interview. Twelve months later, 30 patients of the baseline sample were reexamined. Results: Psychological impairment was found to be 45.5 and 40% at the baseline and follow-up assessments, respectively. The extent of burns was found to be associated with psychological impairment. The prevalence of psychiatric disorders (any DSM-III nosological entity) reached 46.6% at both baseline and follow-up examinations. Posttraumatic stress disorder was diagnosed in 17.8 and 20.0% of burn survivors at the baseline and the 12-month follow-up assessments, respectively. Logistic regression analysis revealed that face disfigurement was the only burn characteristic significantly associated with the presence of psychiatric morbidity. Conclusions: The results of the study suggest that the extent of burns is not so important when compared to the possibility of disfigurement from the point of risk of developing a psychiatric disorder. Copyright © 2001 S. Karger AG, Basel

MEGALOMASTIA - HISTOLOGICAL, HISTOCHEMICAL AND IMMUNOHISTOCHEMICAL STUDY

Megalomastia is a rare entity characterized by an uncommon enlargement of both breasts. Unilateral megalomastia is extremely rare. The purpose of this study was to collect information concerning the history of patients with this condition and to investigate its histology in order to outline the profile of this peculiar entity. Fifty cases of megalomastia were studied. In 41 data concerning the history of the patients was complete; there were 32 juvenile, 7 gravid and 2 adult type cases. All three unilateral megalomastias were in the juvenile group. A family history of megalomastia was frequently present: gravid megalomastia was more closely connected with a maternal familial history. A case of simultaneous megalomastia in monozygotic twins is included. The final size achieved by the breasts was independent of the type of megalomastia, the rapidity of breast development and the body weight of the patients. It was greater in breasts containing abundant adipose tissue and less in fibrous breasts. In all cases of megalomastia associated with pregnancy the breasts had lost the ability to produce milk. The main histological feature in all cases was severe damage and destruction of the lobular units associated with extensive fibrosis. In some breasts of all three types of megalomastia ramified new ducts named “juvenile units” had developed and had proceeded to atrophy. Immunohistochemistry revealed that the epithelium of these units was negative for oestrogen and positive to progesterone receptors. A biphasic pathological appearance, consisting of atrophic lobular units and “juvenile units”, is diagnostic of megalomastia

The efficacy of moisture retentive ointment in the mangement of cutaneous wounds and ulcers: A multicenter clinical trial

Local management of chronic wounds and ulcers remains one of the most costly unsolved problems in health care today. With proper clinical management, most chronic wound healing problems can be resolved and healing expected, though recurrence may be common. The recent logarithmic growth in our knowledge about wound healing and the appreciation of the importance of a moist environment in optimal wound healing has led to the introduction of new and exciting therapeutic modalities. In view of the many practical disadvantages as well as the serious complications of currently available moisture retentive dressings when applied to chronic contaminated wounds, a prospective multicenter clinical trial was conducted from December 1999 to November 2000 to evaluate the safety and efficacy of a newly introduced moisture retentive ointment (MEBO: Moist Exposed Burn Ointment) (Julphar - Gulf Pharmaceutical Industries, UAE) in the local wound care of problematic non-healing wounds. The active component of the ointment is &#x03B2;-sitosterol in a base of beeswax, sesame oil and other components. Though it was not a comparative study, the ointment was found to induce rapid reduction in ulcer size even after a prolonged stagnant state with other therapeutic modalities without complications such as skin maceration, unmanageable excessive exudation, and wound infection. As expected with such chronic wounds, the healing potential of local ointment application is limited by the mere size of the original defect and the underlying pathologies and associated diseases. however, the safety and practicality of simple ointment application was found to be a valid alternative treatment for local management of chronic wounds

Lymphocyte subpopulations and interleukin levels in high-risk melanoma patients treated with high-dose interferon A-2B

Immunologic effects of high-dose interferon are still unclear. We have evaluated changes in blood lymphocyte subpopulations, immunoglobulins, and multiple interleukin in patients with high-risk cutaneous melanoma on adjuvant treatment with high-dose interferon and compared pretreatment values with normal controls. Samples were obtained before treatment, I month after induction treatment and at 3, 6, and 12 months of maintenance treatment from 24 patients with high-risk melanoma. Lymphocyte subpopulations were measured by flow cytometry and interleukin and immunoglobulin levels by radioimmunoassay. A statistically significant reduction in Blymphocytes (p &lt; 0.001), natural killer (NK) cells (p = 0.0004), and monocytes (p = 0.04), and an elevation in CD4/ CD8 ratio (p &lt; 0.0001) was observed after I month of intravenous interferon. No changes were seen in CD3, CD4, and CD8 lymphocytes. No changes in interleukin (IL)-2, -4, or -5 were observed during 1 year of treatment. IL-2 pretreatment levels were significantly lower than healthy blood donors (P = 0.001), and IL-5 pretreatment levels were significantly higher (p = 0.0056). IL-10 levels significantly dropped after 6 months of treatment (p = 0.01). Immunoglobulins (IgG, IgA, IgM) remained within normal ranges. Three patients had elevated pretreatment levels of IgE. There is a time- and dose-dependent impact of interferon on numbers of circulating B lymphocytes, NK cells, monocytes, and CD4/CD8 ratio. Defects in cellular and humoral immunity are suggested by the low IL-2 and high IL-5 levels, measured in patients with melanoma as compared with healthy controls

Prognostic significance of the sequential detection of circulating melanoma cells by RT-PCR in high-risk melanoma patients receiving adjuvant interferon

The purpose of this study was to address the prognostic significance of circulating melanoma cells by reverse transcriptase-polymerase chain reaction in the peripheral blood of stage 1113 and III melanoma patients on high-dose adjuvant interferon at multiple sequential time points from initiation of treatment. Tyrosinase mRNA in peripheral blood from these patients was assayed by reverse transcriptase polymerase chain reaction prior to initiation of adjuvant interferon, at completion of I month of intravenous interferon and at 3 monthly intervals until progression, Four hundred and eighteen blood samples from 60 melanoma patients were analysed. The median follow-up time calculated from the time of inclusion in the study was 23 months (range 2-38 months). Tyrosinase mRNA in blood was detected in 42 (70%) of 60 patients: 16 (76%) of 2 1 stage IIB patients and 26 (66%) of 39 stage III patients, The presence of tyrosinase mRNA in blood was correlated with a shorter disease-free survival (P: 0.03) and in multivariante analysis was an indepent prognostic factor for relapse, Patients who seroconverted to a negative reverse-transcriptase-polymerase chain reaction after induction treatment had a significantly lower probability of recurrence, The presence of circulating melanoma cells is a marker of a high relapse risk and shorter disease-free survival whether detected postoperatively or during follow-up, Tyrosinase mRNA amplification by reverse-transcriptase-polymerase chain reaction may be a useful tool for monitoring the efficacy of adjuvant treatment in stage IIB and III melanoma patients, (C) 2002 Cancer Research UK