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Results for “OCCLUSIVE DRESSINGS”

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At least 469 records · Page 26Linked to original sources

PubMed2002

Acute methyl salicylate toxicity complicating herbal skin treatment for psoriasis.

We present an interesting case of salicylism arising from the use of methyl salicylate as part of a herbal skin cream for the treatment of psoriasis. A 40-year-old man became quite suddenly and acutely unwell after receiving treatment from an unregistered naturopath. Methyl salicylate (Oil of Wintergreen) is widely available in many over the counter topical analgesic preparations and Chinese medicated oils. Transcutaneous absorption of the methyl salicylate was enhanced in this case due to the abnormal areas of skin and use of an occlusive dressing. The presence of tinnitus, vomiting, tachypnoea and typical acid/base disturbance allowed a diagnosis of salicylate toxicity to be made. Our patient had decontaminated his skin prior to presentation, limiting the extent of toxicity and was successfully treated with rehydration and establishment of good urine flow.

Adult↗

PubMed1998

Photomechanical transcutaneous delivery of macromolecules.

Transcutaneous drug delivery has been the subject of intensive research. In certain situations, rapid transcutaneous delivery is very desirable. A mechanical (stress) pulse generated by a single laser pulse was shown to transiently increase the permeability of the stratum corneum in vivo. The barrier function of the stratum corneum recovers within minutes. The increased permeability during these few minutes allows macromolecules to diffuse through the stratum corneum into the viable epidermis and dermis. Macromolecules (40 kDa dextran and 20 nm latex particles) were deposited into the skin using a photomechanical pulse generated by a single 23 ns laser pulse. This treatment can potentially be utilized in therapies that currently require occlusive dressings for hours or day(s).

Animals↗

PubMed1999

Resurfacing the acne-scarred face.

BACKGROUND: : Dermabrasion has been a useful method for the improvement of acne scars since 1953. However, the improvement is often limited. Adjuvant procedures are often necessary to improve results. OBJECTIVE: : To improve the results of resurfacing the acne scarred face. By combining the techniques of subcutaneous filling, laser shrinkage of collagen, dermabrasion, and excision, we hope to achieve better results. METHODS: A Jessner/TCA peel is performed on the neck and décolleté area after the skin has been preconditioned with vitamin A conditioning lotions. The acne scars are subcised with a semi-blunt needle, and the developed pockets are filled with adipose tissue. Following this, the surface skin is vaporized with three passes of the CO2 laser, and the deeper acne scars in the mid-face region are sanded with a diamond fraise. Residual scars are excised and sutured. A semi-occlusive dressing is used for 5 days, then replaced with an ointment-based moisturizer. After 10 days, a moisturizer-sunscreen is used, followed with a bleaching cream at 15 days. Make-up may be applied after 14 days. CONCLUSION: : By combining these multiple modalities it is possible to produce a dramatic improvement of the acne-scarred complexion.

Acne Vulgaris↗

PubMedDate not supplied

Dynamics of the matrix metalloproteinases MMP-1 and MMP-8 in acute open human dermal wounds.

Extracellular matrix degradation during dermal wound healing involves multiple levels of regulation by several enzymes of the matrix metalloproteinase family, their activators, and their inhibitors. This study tested the hypothesis that a temporal pattern of interstitial collagenase appearance occurs during normal dermal wound healing, with matrix metalloproteinase-8 originating from neutrophils appearing earlier than the fibroblast-derived matrix metalloproteinase-1. Open (6 mm) full-thickness dermal wounds, which were covered by transparent occlusive dressings, were made in healthy human volunteers (n = 20). Wound fluids from under the dressings were collected daily through day 8, and wound tissue biopsies were obtained on days 0, 2, 4, 14, and 28. Collagenases were extracted from homogenized tissue biopsies for analysis. Samples were analyzed for the presence of matrix metalloproteinase-1 and matrix metalloproteinase-8 by enzyme-linked immunosorbent assays and by collagenase activity assays using purified types I and III collagen as substrates. In addition, tissue inhibitor of metalloproteinases-1 and matrix metalloproteinase-1/tissue inhibitor of metalloproteinases-1 complexes in wound fluids were measured. Results showed a differential temporal pattern of matrix metalloproteinase-1 and matrix metalloproteinase-8 in wound exudates with peak levels of matrix metalloproteinase-8 occurring on day 4 and matrix metalloproteinase-1 peak levels on day 7. Maximal levels in tissue for both enzymes occurred on day 2. At all time points examined, levels of matrix metalloproteinase-8 were statistically higher than matrix metalloproteinase-1 (100-fold to 200-fold). Tissue inhibitor of metalloproteinases-1 levels declined over time, whereas levels of matrix metalloproteinase-1/tissue inhibitor of metalloproteinase-1 complexes increased to a plateau on day 7. This study provides new evidence implicating matrix metalloproteinase-8 as a major collagenase in healing human dermal wounds. It also shows a temporal pattern in the appearance of the matrix metalloproteinases, tissue inhibitor of metalloproteinase-1, and matrix metalloproteinase-1/tissue inhibitor of metalloproteinases-1 complexes, suggesting that a tightly regulated pattern of expression of matrix metalloproteinases and their inhibitors is essential for normal wound healing in humans.

Adult↗

PubMedDate not supplied

Acceleration of wound contraction and healing with a photocrosslinkable chitosan hydrogel.

Application of ultraviolet light irradiation to a photocrosslinkable chitosan aqueous solution resulted in an insoluble, flexible hydrogel like soft rubber within 60 seconds. In order to evaluate its accelerating effect on wound healing, full-thickness skin incisions were made on the backs of mice and subsequently a photocrosslinkable chitosan aqueous solution was added into the wound and irradiated with UV light for 90 seconds. Application of the chitosan hydrogel significantly induced wound contraction and accelerated wound closure and healing compared with the untreated controls. Histological examination also showed an advanced contraction rate on the first 2 days and tissue fill rate on days 2 to 4 in the chitosan hydrogel-treated wounds. Furthermore, in cell culture studies, chitosan hydrogel culture medium supplemented with 5% fetal-bovine serum was found to be chemoattractant for human dermal fibroblasts in an invasion chamber assay using filters coated with Matrigel and in a cell migration assay. Due to its ability to accelerate wound contraction and healing, chitosan hydrogel may become accepted as an occlusive dressing for wound management.

Animals↗

PubMedDate not supplied

A double-blind, randomized, placebo-controlled trial of eutectic lidocaine/prilocaine cream 5% (EMLA) for analgesia prior to cryotherapy of warts in children and adults.

Liquid nitrogen cryotherapy is an effective treatment modality for verrucae in children. However, sometimes the pain of the procedure is too much for the young child. In such instances the availability of an effective topical anesthetic would be of tremendous benefit. Warts are usually present on hardened skin, that is, the palms, periungual areas, and soles. In a double-blind, randomized, placebo-controlled, single-center, parallel-group trial with one visit, children (6-18 years old) and adults (>18 years old) had 2.5 g of lidocaine/prilocaine cream 5% applied under an occlusive dressing to the wart and a 1 to 2 mm area surrounding it 1 hour prior to liquid nitrogen cryotherapy. In both age groups the warts were subdivided by location-hardened skin areas versus nonhardened skin sites. The topical anesthetic was then removed and cryotherapy applied for 5 to 10 seconds. The pain of cryotherapy was assessed by the patient on a visual analogue scale (VAS) immediately after the cryotherapy and 4 and 8 hours later. There was no statistically significant difference in the pain of cryotherapy experienced following the application of active cream (n = 64) and placebo (n = 64). Exploratory subgroup analysis by wart location showed promising results for lidocaine/prilocaine cream 5% over placebo in children with warts on hardened skin sites (palms and soles). The topical anesthetic was safe and generally well-tolerated. Lidocaine/prilocaine cream 5% may provide some anesthesia in children receiving cryotherapy when the wart is on the palms or soles. Further studies are needed to better understand the site and age specificity of the anesthetic properties of lidocaine/prilocaine cream 5% when used to reduce the pain experienced during cryotherapy of warts.

Administration, Topical↗

PubMed2005

Bubbles in the brain veins as a complication of daily management of a scalp vein catheter.

Recently, it has been suspected that venous dural sinus air embolisms could occur as a result of scalp vein infusion. The possible mechanism for this complication has not been documented to date, and procedures to avoid venous dural sinus air embolism have not been presented. We report a preterm neonate who demonstrated venous dural sinus air embolism following daily management of a scalp vein catheter. The air embolism disappeared in a few days without complications. Clinicians should avoid injecting air into a scalp vein catheter and leaving it open to air. Following careful examination and review of the infant's case, we were able to conclude that positioning the infant in either supine or Trendelenburg position during daily management of scalp venous infusions and using an air-occlusive dressing once the catheter is removed could limit the risk of venous dural sinus air embolisms caused by scalp vein infusions.

Anti-Bacterial Agents↗

PubMed1997

Efficacy and safety of lidocaine-prilocaine cream for pain during circumcision.

BACKGROUND: Neonatal circumcision is a painful surgical procedure often performed without analgesia. We assessed the efficacy and safety of 5 percent lidocaine-prilocaine cream (Emla) in neonates undergoing circumcision. METHODS: We carried out a double-blind, randomized, controlled trial in 68 full-term male neonates: 38 were assigned to receive lidocaine-prilocaine cream, and 30 to receive placebo. One gram of lidocaine-prilocaine or placebo cream was applied to the penis under an occlusive dressing for 60 to 80 minutes before circumcision. Behavioral (facial activity and time spent crying) and physiologic (heart rate and blood pressure) responses were recorded during the procedure. Blood samples were obtained at various times after drug application for measurements of methemoglobin and plasma lidocaine, prilocaine, and o-toluidine (a metabolite of prilocaine). RESULTS: A total of 68 and 59 neonates were included in the safety and efficacy analyses, respectively. Demographic characteristics such as gestational age and birth weight did not differ between the lidocaine-prilocaine and placebo groups. During circumcision, the neonates in the lidocaine-prilocaine group had less facial activity (P= 0.01), spent less time crying (P<0.001), and had smaller increases in heart rate (P=0.007) than the neonates in the placebo group. Facial-activity scores were 12 to 49 percent lower during various steps of the procedure in the lidocaine-prilocaine group. As compared with neonates in the placebo group, infants in the lidocaine-prilocaine group cried less than half as much and had heart-rate increases of 10 beats per minute less. Blood methemoglobin concentrations (expressed as a percentage of the hemoglobin concentration) were similar (1.3 percent) in both groups. Lidocaine and prilocaine were detected in plasma in 23 (61 percent) and 21 (55 percent) of the infants treated with lidocaine-prilocaine cream, respectively. CONCLUSIONS: Lidocaine-prilocaine cream is efficacious and safe for the prevention of pain from circumcision in neonates.

Anesthesia, Local↗

PubMed1998

Alleviation of the pain of venepuncture in neonates.

UNLABELLED: A recent study has shown venepuncture to be more effective and less painful than heel-lancing when a single blood test is performed in neonates [Larsson, Pediatrics (in press)]. The aim of the present study was to investigate the value of EMLA applied on the dorsum of the hand when sampling blood in neonates. METHODS: This was a controlled randomized and double-blinded study. One hundred and twenty neonates were randomly allocated to two groups, EMLA or placebo. Five hundred milligrams (0.5 ml) of EMLA or placebo was placed on the dorsum of the hand, covered with an occlusive dressing, and left in place for 60 minutes. For venepuncture, a needle measuring 0.9 x 40 mm was used. The two groups were also compared as regards the total time needed to complete the PKU test and the number of skin punctures required. The facial reaction was videotaped and later analysed by two blinded observers using the Neonatal Facial Coding System (NFCS). RESULTS: No side effects occurred, except for a temporary blanching or redness of the skin, which disappeared within minutes. Nociceptive response: After skin puncture, the NFCS scores were significantly lower in the EMLA group than in the placebo group (median 287 and 374, respectively). After the first skin puncture, a cry was recorded in 35/55 cases (64%) in the EMLA group and in 38/56 cases (68%) in the placebo group, this difference was not significant. The duration of the first cry was significantly shorter in the EMLA than in the placebo group (median 12 and 31 s, respectively). CONCLUSION: In comparison with a placebo, EMLA significantly reduces the pain caused by venepuncture on the dorsum of the hand and does not complicate puncture of the vein.

Anesthetics, Local↗

PubMed2003

Lack of effect of long-term octreotide therapy in severe thyroid-associated dermopathy.

Severe thyroid associated dermopathy (TAD), a rare complication of Graves' disease, currently lacks effective treatment. Mediators of growth and inflammation, including insulin-like growth factor-1 (IGF-1) and somatostatin (SST) have been implicated in its pathogenesis. Octreotide, a potent SST analogue, has been used in TAD with anecdotal success. Therefore, we evaluated the efficacy of long-term octreotide therapy in moderate to severe TAD. Three obese women with TAD were studied. Baseline treatment included levothyroxine, methimazole, fluocinonide ointment under occlusive dressing, and physiotherapy for lymphedema. After establishing baseline clinical status, octreotide was started (300 microg subcutaneously daily) for 10 to 28 months. Studies obtained at baseline and every 3 months included: leg circumference, skin examination, clinical photography, self-reported clinical status, body mass index (BMI), serum thyrotropin (TSH) and free thyroxine, titers of antithyroidal and anti-TSH receptor antibodies. Minimal changes in the edema, erythema, skin texture and size of nodules were observed. The minor changes seen followed significant decreases in the patients' BMI, and hence, cannot be specifically attributed to octreotide administration. No clinically significant benefit from long-term octreotide therapy was demonstrated in three patients with moderate to severe TAD. Weight loss and measures such as compression bandaging and topical corticosteroid application still remain the most cost effective treatment modalities for TAD.

Adult↗

PubMed1998

Topical anaesthesia of intact skin: liposome-encapsulated tetracaine vs EMLA.

In this randomized, double-blind study, we have compared the ability of 5% liposome-encapsulated tetracaine (amethocaine) (LET) vs 5% eutectic mixture of local anaesthetics (EMLA) to produce local anaesthesia of intact skin in 40 healthy volunteers. Volunteers had both preparations applied to their forearms under an occlusive dressing for 1 h. Superficial anaesthesia was measured by a total of nine 1-mm pinpricks on each arm. Deeper anaesthesia was assessed by single insertion of a sterile 22-gauge needle to a depth of 3 mm and pain was reported on a visual analogue scale (VAS). If the volunteer perceived greater than four of the 1-mm pinpricks, the 3-mm insertion was not performed. Results showed that the number of pinpricks perceived was significantly less (P < 0.01) for LET (median 1.0; range 0-9) vs EMLA (1.5; 0-9). In volunteers who had deeper anaesthesia assessed, there was no significant difference (P = 0.065) in VAS scores for LET (mean 1.5 (SD 1.4); n = 34) vs EMLA (2.4 (2.1); n = 28). Overall anaesthetic effect, as ranked by all of the subjects, was significantly better for LET compared with EMLA (P = 0.024). We have demonstrated that when applied in equal volumes, 5% LET produced better superficial local anaesthesia than EMLA.

Administration, Cutaneous↗

PubMed1991

Salvage of distal flap necrosis by topical superoxide dismutase.

Significance of the reactive oxygen species in distal flap necrosis and the efficacy of superoxide dismutase (SOD) in salvaging necrosis have become indicated in recent studies. To enhance the therapeutic effect of SOD, topical application was designed. Water-soluble ointment containing 1% SOD was prepared, and three experiments were made to study the effect of topical SOD in improving flap survival. Simple application of SOD ointment to the upper surface of the flap had no effect, whereas its application to the under surface or occlusive dressing was effective. These effects were corroborated by assay of tissue SOD activity.

Administration, Topical↗

PubMed1992

A comparison of two techniques of care for indwelling arterial introducers after coronary angioplasty.

To determine whether indwelling arterial introducers can be maintained for 24 hours without risk of infection and/or hemorrhage in the post-coronary angioplasty patient, 96 patients were assigned to one of two groups. Introducers of the subjects in group I were flushed with 500 U of heparin, capped, and covered with a sterile occlusive dressing. Introducers of subjects in group II were connected to a heparinized (500 U in 500 mL normal saline) and pressurized (200 to 300 mm Hg) flush device. All introducers were removed 24 hours after coronary angioplasty. Results of t tests showed no significant difference between the two groups in incidence of infection or hemorrhage when hemoglobin, hematocrit, partial thromboplastin time, and white blood cell count were compared. Signs of inflammation at the introducer site (redness and swelling) and temperature elevation > or = 37.8 degrees C were not significantly different between the two groups. The incidence of hematoma formation at the introducer site was 40% in both groups. The two methods were found to be equally effective in maintaining a patent arterial introducer without risking infection and/or hemorrhage in the post-coronary angioplasty patient whose introducer remains indwelling for 24 hours.

Academic Medical Centers↗

PubMed2004

The efficacy of LMX versus EMLA for pain relief in boys undergoing office meatotomy.

PURPOSE: We determined if a difference in pain management occurred when topical anesthetics LMX (formerly ELA-Max, lidocaine 4%) and EMLA (lidocaine 2.5% and prilocaine 2.5%) were compared in boys undergoing office meatotomy for symptomatic meatal stenosis. MATERIALS AND METHODS: A prospective randomized study was performed on 52 boys who underwent office meatotomy by a single pediatric urologist. Of the boys 26, 2 to 9 years old (mean age 4.4) underwent meatotomy 45 minutes after topical anesthetic application (LMX 13, EMLA 13) between February and December 2001, 26, ages 1 to 10 years old (4.6) underwent meatotomy 30 minutes after topical anesthetic application (LMX 13, EMLA 13) between April 2002 and January 2003. A single pediatric urological nurse performed pain assessment using the Wong-Baker Faces scale before applying the anesthetic ointment and immediately following the procedure. Each child had either LMX or EMLA applied and covered with an occlusive dressing for either 45 or 30 minutes before the procedure. Oral acetaminophen (10 mg/kg) was given at the time of anesthetic application. A meatotomy was then performed using a straight crushing hemostat for 1 to 2 minutes followed by incision. Mann-Whitney rank sum test was implemented to determine statistical significance. RESULTS: Excellent procedure outcomes were experienced by all patients without recurrent meatal stenosis. CONCLUSIONS: There was no significant difference between LMX and EMLA when applied 45 minutes before meatotomy. When applied 30 minutes before meatotomy LMX provided significantly superior pain management than EMLA.

Anesthetics, Local↗

PubMed2004

Prospective evaluation of vacuum-assisted fascial closure after open abdomen: planned ventral hernia rate is substantially reduced.

OBJECTIVE: The goal of this report is to examine the success of vacuum-assisted fascial closure (VAFC) under a carefully applied protocol in abdominal closure after open abdomen. SUMMARY BACKGROUND DATA: With the development of damage control techniques and the understanding of abdominal compartment syndrome, the open abdomen has become commonplace in trauma patients. If the abdomen is not closed in the early postoperative period, the combination of adhesions and fascial retraction frequently make primary fascial closure impossible and creation of a planned ventral hernia is required. We have previously reported our experience with the development of a technique for VAFC that allowed for closure of the fascia in many such patients long after initial operation. During this previous study, during which the technique was being developed, VAFC was successful in 69% of patients in whom it was applied, and 22 patients were successfully closed at > or = 9 days after initial surgery (range, 9 to 49 days). A protocol for the use of VAFC in patients with open abdomen was developed on the basis of these data and has been employed since October 2001. The outcome of this protocol's use is examined. METHODS: This is a prospective evaluation of all trauma patients admitted to Wake Forest University Baptist Medical Center over a 19-month period who required management with an open abdomen. VAFC employs suction applied to a large polyurethane sponge under an occlusive dressing in the wound and allows for constant medial traction of the abdominal fascia. It is attempted in all patients in whom the rectus muscles and fascia are intact. Studied variables include fascial closure rate, time to closure, incidence of wound dehiscence, and hernia development after closure. RESULTS: From November 1, 2001, through May 31, 2003, 212 laparotomies were performed in injured patients; 53 (25%) of these patients required open abdomen management. Mean injury severity score for the group was 34, with an average abdominal abbreviated injury score of 2.9. Forty-five (78%) survived until abdominal closure. Vacuum dressings were used in all 45 but VAFC was not attempted in 2 patients (1 due to development of enterocutaneous fistula, 1 because a rectus flap was used for another wound). Closure rate in those undergoing VAFC was 88% (38), with mean time to closure being 9.5 days. This is significantly higher than the 69% rate of fascial closure during the time in which the technique was developed (P = 0.03). Twenty-one patients (48%) were closed at > or =9 days (range, 9 to 21 days). Two patients (4.6%) developed wound dehiscence and underwent successful reclosure. One patient (2.3%) developed a ventral hernia on follow-up, which has since been repaired CONCLUSIONS: The use of VAFC under a carefully defined protocol has resulted in significantly higher fascial closure rates, obviating the need for subsequent hernia repair in most patients. The utility of this technique is not limited to the early postoperative period, but it can be successful as much as 3 to 4 weeks after initial operation.

Abdominal Injuries↗

PubMed1978

Identification of topical photosensitizing agents in humans.

A method is described for the detection of topical photosensitizers in humans. Test agents were applied to the untanned midback under an occlusive dressing for 6 hr and then exposed to broad-spectrum radiation containing UV-A and visible wavelengths from a Xenon arc source. Well-known topical photosensitizers were readily identified. It was found that with certain poorly-penetrating substances, such as water-soluble dyes, applications to scarified skin were necessary to reveal phototoxic activity. In addition, these dyes were activated by wavelengths in the visible region of the spectrum.

Administration, Topical↗

PubMed1986

Eye-derived growth factor isolated from bovine retina and used for epidermal wound healing in vivo.

Eye-derived growth factor (EDGF) has been found in several ocular tissues and shown to be able to stimulate the in vitro proliferation of cells from various tissues and organisms. It had already been shown that EDGF differs biochemically and biologically from other growth factors such as epidermal growth factor (EGF) and fibroblast growth factor in that it is the only one that can stimulate the in vitro growth of human adult keratinocytes. Moreover EDGF stimulates reepithelialization and neovascularization. In this paper we report data concerning the effect on the rate of epidermal wound healing in guinea pigs of different extracts obtained from adult bovine retina. Our results show that EDGF can significantly increase the rate of reepithelialization when epidermis is detached from dermis and removed after induction of a blister. The doses used were comparable to the ones used to obtain maximal increase of cell proliferation in vitro. However no attempt was made to further investigate the mechanism accounting for the observed wound healing. At 24 h, control wounds maintained under occlusive dressing had only about 50% of their surface covered with cells as opposed to EDGF-treated wounds which were covered up to about 80% (p = 0.05). On the other hand, EGF does not increase the rate of wound healing in this model even at 1000-fold higher doses than those used in in vitro bioassays. Although EDGF is still not purified to homogeneity and another 10- to 100-fold purification might be necessary to achieve homogeneity, our results suggest that EDGF may find therapeutic applications as a potent in vivo epidermal wound healing agent.

Animals↗

PubMed1979

Experimental inoculation of dermatophytes on psoriatic skin.

Two dermatophytic agents, Trichophyton rubrum and Trichophyton mentagrophytes were used in the experimental inoculation of psoriatic lesions in 27 volunteer patients (13 males and 14 females with an age range from 17 to 72 yr). T. rubrum was inoculated in 14 patients and T. mentagrophytes (varietas granulare) in 13. For purposes of control in each patient the same agent was also inoculated on healthy skin. Results were noted once a week for a period of 1 mo. A positive response was found in 12 of the 14 patients inoculated with T. rubrum but only in 4 of the 13 inoculated with T. mentagrophytes. Healthy skin was found to have a positive response in only 5 cases, in 4 with T. rubrum, and in 1 with T. mentagrophytes. These results confirm the possibility of invasion of psoriatic lesions by dermatophytes and suggest that the coexistance of psoriasis and dermatophytic infection may be not always purely coincidental. The importance of the awareness of the presence of mycotic lesions and their possible spread with the application of steroid ointments under occlusive dressings in a psoriatic patient is stressed.

Adolescent↗