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Biomedical subjects

N Pallua

Publications and source records attributed to N Pallua.

At least 19 recordsLinked to original sources
PubMed2006

A recombinant anti-ICAM-1 Fab fragment is as effective as the complete IgG antibody in treatment of burns in rabbits.

The purpose of this study was to examine the efficiency of an Anti-ICAM-1-Fab fragment in the treatment of burns. Blocking ICAM-1 using murine IgG with the purpose to prevent further damage to the zone of stasis has proven its effectiveness in animal models as well as in humans. The use of murine Antibodies has some disadvantages including allergic reactions and complement activation. For the first time we examined an industry produced Fab-fragment blocking ICAM-1 and compared it to the corresponding IgG antibody. We showed in a standardised rabbit burn model that an Fab-fragment is capable of blocking ICAM-1 and therefore improving the reaction of the skin to trauma in the zone of stasis.

Animals↗
PubMed2006

[Methods of burn treatment. Part I: general aspects].

Burns and scalds are common injuries that present with a wide range of severity. Correct evaluation of a burn's depth and extent is essential for adequate treatment, not only initially but also for late results. The depth of a burn is classified as first-to-third degree, and its extent can be deducted from specific tables. As a generalised haemodynamic reaction, a capillary leak allows fluid and colloidal substances to leave the intravasal system. This can lead to hypovolemic shock. In the first 24 h, only cristalloid fluid according to Baxter's formula should be administered. Transfer to a burn centre is indicated in accordance with well-defined guidelines. Concomitant injuries, especially inhalation traumata, need to be diagnosed and treated early. By activation of the immune response, a sepsis-like immune response syndrome can occur,resulting in bacterial translocation and colonisation with high mortality rates.

Burns↗
PubMed2006

[Methods of burn treatment. Part II: Technical aspects].

The best treatment for burns and scalds depends on the depth of the skin necrosis. Epidermal and superficial dermal burn injuries (IIa) can heal spontaneously with conservative treatment without scar development, but deep dermal or full-thickness burns constitute an absolute indication for surgery. Full-thickness or split-thickness skin grafts are used for wound closure. In the case of extensive burn injuries allografts are used for temporary wound closure. In certain licensed laboratories autologous keratinocytes can be cultured for transplantation. In circumferential burn injuries affecting the extremities or the trunk the rigid eschar has to be incised to relieve the pressure behind it. Following a debridement conservative treatment of superficial dermal burns involving wound coverage with biosynthetic dressings or nanocristalline silver gauze dressings or use of special disinfecting ointments can be implemented.

Administration, Cutaneous↗
PubMed2006

[Heated car seats--a potential burn risk for paraplegics].

The comfort of heated car seats has gained popularity worldwide. We present a rare case of severe second- and third-degree burn in the lower back and sacral region of a 42-year-old post-traumatic paraplegic patient while using a heated car seat. The patient was admitted to our burn unit and required several reconstructive surgery procedures. Inadvertent thermal injury is a constant potential hazard for individuals with impaired sensibility such as paraplegics and other neurologically impaired patients. Early education of patients, manufacturers, and health care personnel is of eminent importance to prevent severe burn injuries in this risk population.

Adult↗
PubMed2006

Long-term nipple shrinkage following augmentation by an autologous rib cartilage transplant in free DIEP-flaps.

Aesthetically pleasing nipple-areola reconstruction is a satisfying part of a two-stage breast reconstruction. The up to 50% [Banducci DR, Le TK, Hughes KC. Long-term follow-up of a modified Anton-Hartrampf nipple reconstruction. Ann Plast Surg 1999;43(5):467-9; discussion 469-70] postoperative shrinkage following a conventional nipple reconstruction is a well-known problem. Augmentation of the nipple with autologous banked cartilage seems to be a promising solution. From 2000-2003, 17 patients underwent a nipple-areola-complex reconstruction following secondary breast reconstruction using free perforator flaps. The rib cartilage harvested during the preparation of the internal thoracic vessels was banked subcutaneously and six months later replanted under the 'arrow flap' after contouring it in a 'mushroom' shape. One year later the shrinkage of the nipple in comparison to the intraoperative status was measured. In addition, patients were asked about their personal palpation impression and the aesthetic outcome. The average height decreased one year postoperatively about 25%. Thirteen of 17 patients judged the aesthetic outcome as very good, 16 nipples healed without cartilage protrusion and no patient felt discomfortable stiffness of the nipple. Our concept of a nipple augmentation with rib cartilage improves the projection and allows a more correct judgement of the later nipple shrinkage. We consider this technique to be an aesthetically satisfying and safe method, which could be used with any kind of breast reconstruction.

Cartilage↗
PubMed2006

[Chiparray-based identification of gene expression in HUVECs treated with low frequency electric fields].

PURPOSE: After high-voltage electric injury, patients often show progressive tissue necrosis and thrombosis of blood vessels even remote from the entry and exit sites of electrical current. Recently, we were able to demonstrate IN VIVO and VITRO the release of several prothrombotic factors. In this study, we report on IN VITRO studies performed to characterize gene expression profiles using a DNA-microarray in HUVECs (human umbilical vein endothelial cells) exposed to low frequency electrical current. METHODS: HUVECs were plated and grown to confluence in a culture chamber. They were exposed to 25 periods of 50 Hz sinusoidal waves. The periods had field strength of 60 V/cm and duration of 100 ms. Periods were interrupted by 10-second intervals to prevent significant joule heating. Control HUVECs were treated identically except that no electric field was applied. Samples from control and treated cells were taken after six and 24 hours. A PIQOR Immunology Array (Milteny Biotech) containing 1076 cDNAs was used for gene expression analysis. Hybridization of Cy3- and Cy5-labelled samples, image capture, and signal quantification of hybridized arrays were performed. Local background was subtracted from the signal to obtain the net signal intensity and the ratio of Cy5/Cy3. The ratios were normalized to the median of all ratios and the mean of the ratios of four corresponding spots was computed. More than two-fold increases or decreases of the gene expression were regarded as relevant. RESULTS: A total of 413 genes (1s + s) respectively 345 genes (2s + s) could be detected. The results obtained display a distinct expression pattern of up-regulated genes known to be important for hemostasis (e.g. UPA, UPAR, ECE1, PAFAH1B1, PGT, INOS, ENOS, TPA, ICAM1, VCAM1, PAI1, PAI2, VWF, PTGDR, F3, THBD), which was most evident after 24 hours. This expression profile might lead to a hypercoagulated state. Furthermore, the expression of genes involved in angiogenesis was reduced whereas the expression of those involved in platelet formation was increased. CONCLUSION: Our results indicate that low frequency electrical fields induce a distinct signature of differential gene expression in exposed HUVECs. This might explain the clinical observation of thrombosis and progressive tissue necrosis after electrical injury.

Blood Coagulation↗
PubMed2006

[Anatomic considerations to improve vasculature of the nipple-areola complex in vertical mammaplasty].

AIM: This anatomic study is intended to point out the most regular and reproducible vessels supplying the nipple-areola complex (NAC) for use in vertical mammaplasty. BACKGROUND: The superior pedicle technique routinely performed within the context of vertical mammaplasty procedures bears some risk for vascular dependent complications of the NAC especially in large breasts. Concerning vasculature, the supposedly most eligible pedicle to use should meet equally the best vascular requirements and technical demands necessary for maintaining both viability of the NAC and plasticity of the entire breast tissue. METHODS: Based on an anatomic microdissection study of the thoracic vessel system of seven female corpses, a modification of the superior pedicle approach to carry the NAC was anatomically evaluated and tailored to vertical mammaplasty performed in the L-technique. RESULTS: Out of six vascular sources responsible for the blood supply to the breast the branches originating from the lateral thoracic artery and concomitant veins appeared to reflect the major source of blood supply to the NAC due to their regularity and reproducibility. Especially the full-thickness glandular-dermal superolaterally-based pedicle should safely enclose these dominant branches, as well as supplementary vessels deriving from minor important sources in this region, while keeping plasticity of the vertically reduced breast. CONCLUSION: The superolaterally-based full-thickness glandular-dermal pedicle mobilized epipectorally to carry the NAC proves to be anatomically a safe and reliable procedure eligible as an integral part of vertical mammaplasty.

Breast↗
PubMed2006

The impact of vacuum freeze-drying on collagen sponges after gas plasma sterilization.

The sterilization of porous collagen sponges remains a challenging procedure. Gamma irradiation denatures collagen, resulting in dramatic changes to its structure. Ethylene oxide leaves toxic residues requiring weeks to evaporate. This study investigated the impact on cell behavior of gas plasma treatment when combined with vacuum freeze-drying. The goal of this procedure is to eliminate the molecules of hydrogen peroxide remaining after the sterilization process, together with their decomposition products, from the scaffolds. These molecules hinder the immediate use of the porous designs. Collagen and EDC/NHS-heparinized collagen scaffolds were sterilized with gas plasma. H2O2 released by the collagen specimens was measured by peroxidase test both immediately and also 1 week after the plasma treatment. Further measurements were done 24, 36, 48 and 72 h after vacuum freeze-drying. The activity of these scaffolds was further evaluated in relation to the proliferation, migration and differentiation of human umbilical vein endothelial cells (HUVECs). Both immediately after exposure to gas plasma and also 1 week later, the collagen designs contained significantly higher concentrations of H2O2 than scaffolds having also undergone vacuum freeze-drying. This procedure achieved faster decontamination of the remaining H2O2. Following vacuum freeze-drying, sponges already allowed HUVEC proliferation after 48 h, but in non-lyophilized specimens after gas plasma treatment alone, cell death occurred as early as only 1 week later. These data highlight the advantages of carrying out vacuum freeze-drying following gas plasma sterilization. The results show the substantial impact of sterilization of porous materials made for tissue engineering.

Animals↗
PubMed2006

Enhanced dermal regeneration using modified collagen scaffolds: experimental porcine study.

Ongoing research has achieved much progress towards the development of new artificial skin substitute products. However, effective implant material for correcting full-thickness defects (such as those arising from extensive burns, tumor resection, hereditary or congenital defects and chronic wounds) has not yet become available. Following split-thickness skin grafting, contraction and scar formation are unavoidable. These phenomena are believed to be due to poor dermis regeneration. Collagen dermis substitute has been developed for the treatment of deep, poorly vascularized tissue defects. However, their application is problematic, because scaffolds of this kind fail to adequately induce the neoangiogenesis needed for regeneration. To overcome these shortcomings a number of matrices have been chemically modified. Furthermore, these matrices first require implantation and follow-up by skin grafting 3 to 5 weeks later. In this article we describe new materials made of modified collagen which enhance dermal regeneration and neoangiogenesis. The procedure was applied in successfully dealing with full-thickness defects in pigs, with subsequent split-thickness skin grafting being performed immediately afterwards. Histological findings revealed that the neodermis obtained resembles a normal dermis structure. These scaffolds have the potential of serving as an off-the-shelf skin replacement in the reconstruction of deep wounds, thus supporting wound-healing processes.

Animals↗
PubMed2005

[Severe burn as a consequence of an epileptic seizure while showering].

We report a case of a 17-year-old patient who experienced an epileptic seizure while showering. The patient suffered full-thickness scald injuries involving thorax, abdomen and both arms and legs. The burn, which included 35% of the patient's body surface area, will cause life-long secondary functional and aesthetic deformities. By installing adjustable shower equipment with a maximal temperature limit, this devastating accident could have been prevented.

Accidents, Home↗
PubMed2005

[Necrotizing fasciitis following therapeutic injection in a shoulder joint].

Necrotizing fasciitis is an inflammatory, rapidly progressive soft tissue infection usually caused by Streptococcus pyogenes or by a combination of aerobic and anaerobic microorganisms. Here we report the case of a patient who developed necrotizing fasciitis near the site of therapeutic injections. An orthopaedic surgeon in private practice had given the 74-year-old patient, who suffered from left shoulder pain, cortisone injections in his left shoulder joint. During the course of this therapy, the patient developed necrotizing fasciitis. Despite radical surgical debridement of the patient's back, left thorax and amputation of his left arm, the patient expired 15 h after arriving at our department. In cases such as these, patient survival depends upon an early diagnosis followed by immediate radical surgical intervention including complete opening of fascial compartments and excision of necrotic tissues.

Aged↗
PubMed2005

The use of Integra in an upper extremity avulsion injury.

We present the case of a 22-year-old man who suffered an avulsion injury of the left upper extremity including the elbow region in an industrial accident. After debridement of the skin flap, the defect was primarily closed with Integra. On day 22 split thickness skin graft was performed. Functional and aesthetic outcome and skin quality are excellent.

Accidents, Occupational↗
PubMed2005

Endothelial thrombomodulin (CD 141) in a rabbit burn model.

UNLABELLED: Thrombomodulin (CD 141) is an endothelial surface transmembrane glycoprotein. It is involved in the activation of protein C in the inactivation of thrombin. In severe sepsis CD 141 is shed from the endothelial surface. This leads to disseminated intravascular coagulation (DIC), disturbed organ functions and multi organ failure (MOF). In this study, we investigated if endothelial bound thrombomodulin is shed in thermal injuries. MATERIAL AND METHODS: In 10 New Zealand white rabbits full thickness and superficial partial thickness burns were produced. Dermal blood flow was analyzed by measuring the fluorescence of intravenously injected indocyanine green. Skin-biopsies were taken from the burn wounds from the zones of stasis between full thickness burns and from unburned skin 72 h post burn. Specimens were processed for immunoperoxidase staining using a specific monoclonal antibody against CD 141. RESULTS: Dermal blood flow was reduced in burned skin areas and in the zones of stasis. Thrombomodulin was only detectable on the surface of capillary endothelial cells in specimens taken from unburned skin areas. No thrombomodulin was detectable in specimens taken from burn wounds or from the zones of stasis. Thus, shedding of thrombomodulin was detectable in areas with reduced dermal blood flow. CONCLUSION: Thermal injuries affect the dermal endothelial surfaces resulting in a shedding of thrombomodulin. This mechanism might be involved in the development of progressive skin damage in the zone of stasis. Disseminated intravascular coagulation following inactivation of thrombomodulin might lead to multiple organ dysfunctions in severe burn injuries.

Animals↗
PubMed2005

[Reconstructive surgery using an artificial dermis (Integra): results with 19 grafts].

BACKGROUND: Integra was initially developed for covering of acute burn wounds. The artificial dermis is a bilayered dermal substitute, the upper layer is a thin silicone layer, which acts as temporary epidermis, the under layer is a collagen network, which functions as the dermis. In the meantime, Integra is applicated in reconstructive surgery. PATIENTS AND METHODS: We present a series of 12 patients who underwent reconstructive surgery with Integra grafting for a total of 19 operational sites. The average area grafted per procedure was 210 cm(2) (15-1 200 cm(2)). The operation sites were located at the extremities, trunk and head-neck. The split thickness skin graft was performed, on average, after 20 days (16-29 days). The patients were admitted for 41 days on average (24 days-3 months). The follow-up was after 17 months (9-30 months). RESULTS: Early complications included seroma, loss of Intregra, and infection. Late complications were instable scars. In five cases, we found slight hypertrophe scars in borderline between healthy skin and covering with Integra. CONCLUSION: The advantages of using Integra in reconstructive surgery are its immediate availability and the availability in large quantities. Disadvantages are the necessity of two operations, risks of infection, the high price and time-consuming dressing changes. Defect covering with Integra should be used in special cases.

Adult↗