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Case 1.5
Published in Monica Fawzy, Plastic Surgery Vivas for the FRCS(Plast), 2023
You mentioned your estimation of the approximate surface area being 4–5%. How would you assess the surface area of burns in general?In patients with small burns, I use the template of the patient’s palm and fingers for small, patchy burns, where the surface of the patients’ hands with fingers adducted has been taken to represent approximately 1% of their TBSA, orIn those with larger and patchy burns, I use tools that provide a graphical record of the extent of the burn, such as:the Lund and Browder charts in children, orthe Wallace rule of nines in adults.In addition, I am aware of the development of specific apps to assist with this assessment.
Trauma and Poisoning
Published in Walter F. Stanaszek, Mary J. Stanaszek, Robert J. Holt, Steven Strauss, Understanding Medical Terms, 2020
Walter F. Stanaszek, Mary J. Stanaszek, Robert J. Holt, Steven Strauss
Estimation of the area of a burn is often performed using the "rule of nines," which divides the body into areas each corresponding to a multiple of 9% of the body surface area (BSA). Treatment of all burns involves strict asepsis (freedom from infection; a = without, sepsis = infection) and care of the wound, relief of pain, control of infection, correction of attendant anemia, maintenance of nutrition, and prevention or relief of shock. Treatment of shock always takes precedence since the fluid and protein loss through burned surfaces can be enormous. Local treatment of the wound may be open (exposed to the air) or closed (covered), depending on the type of wound and area burned.
Burns
Published in Alexander Trevatt, Richard Boulton, Daren Francis, Nishanthan Mahesan, Take Charge! General Surgery and Urology, 2020
Estimating body surface area of burn: Rule of Nines: In adults the body can be divided into anatomical regions that represent 9%, or multiples of 9%, of the total body surface area (TBSA). The head and each upper limb represent 9%, the front of the torso, back of the torso and each lower limb represent 18% and genitalia 1% (Figure 21.1).The palmar surface of the patient's hand is approximately 1% TBSA.In children TBSA differs considerably: The use of a Lund and Browder chart is the most accurate method to determine TBSA, taking into account changes with age and growth.
Reduction of proteinuria in patients with diabetes kidney disease and dysautonomia through measures aimed at controlling supine hypertension
Published in Chronobiology International, 2022
Guilherme Palhares Aversa Santos, Douglas Inomata Cardoso da Silva, Vanessa Burgugi Banin, Silméia Garcia Zanati Bazan, Pasqual Barretti, Roberto Jorge da Silva Franco, Luis Cuadrado Martin
To detect an 8 g decrease in 24 hours proteinuria, with a standard deviation of 5 g, statistical power of 0.9 and alpha error of 0.05, at least seven patients would be needed. For safety reasons, nine patients were included. Categorical data were described in absolute number and percentage. Numerical data of Gaussian distribution were described as mean ± standard deviation, and the numerical data of non-Gaussian distribution were described as median (25th percentile; 75th percentile). Normality was tested using the Shapiro-Wilk test. Statistical inferences in relation to baseline data, if categorical, were made using the χ2 test or Fisher’s exact test. Statistical inferences for data with parametric distribution were performed using the “t” test or the Mann-Whitney test for non-parametric distribution. The behavior of the variables was tested by comparing the differences between the pre-intervention and post-intervention data (comparison between the “deltas”) using the “t” or Mann-Whitney test. SigmaStat 4.0 software was used for statistical analysis. A multiple linear model was performed, including as variable of interest the occurrence of the studied intervention, as the outcome variable the reduction of proteinuria, and confounding variables those that differed between groups at the level of p <0 .05.
Enzymatic debridement: past, present, and future
Published in Acta Chirurgica Belgica, 2022
Ignace De Decker, Liesl De Graeve, Henk Hoeksema, Stan Monstrey, Jozef Verbelen, Petra De Coninck, Els Vanlerberghe, Karel E. Y. Claes
In 2017, based on the combined experience of applying enzymatic debridement in more than 500 adult and pediatric patients by the consensus panelists, Hirche et al. published a preliminary guideline including 68 consensus statements for the use of EDNX [19]. The degree of consensus was remarkably high, with a unanimous consensus in 88.2% of statements. In 2020, Hirche et al. published the updated consensus guidelines including 43 topics based on clinical experience and practice patterns of 1232 summarized patient cases treated by the panelists [18]. Also here, the degree of consensus was remarkably high (97.7%). In 2021, Ziegler et al. from nine German-speaking burn centers further discussed topics concerning indication, the definition of treatment pathways, practical issues, post-treatment, and handling of complications [20].
Clinical subsets of juvenile dermatomyositis classified by myositis-specific autoantibodies: Experience at a single center in Japan
Published in Modern Rheumatology, 2019
Naomi Iwata, Haruna Nakaseko, Toaki Kohagura, Ryuhei Yasuoka, Naoki Abe, Shinji Kawabe, Shiro Sugiura, Yoshinao Muro
Baseline clinical and laboratory data at diagnosis and during the study period were retrospectively obtained from medical records including fever, JDM-associated skin lesions, muscle weakness, and arthralgia or arthritis. Severe muscle weakness was defined as level 2 or lower on manual muscle testing or its equivalent. Rapidly progressive muscle weakness was defined as weakness that progressed to severe within 3 months after onset of any weakness. Muscle weakness during the disease course was evaluated by assessing dysphagia and history of wheelchair use. JDM-associated skin lesions at diagnosis included malar rash, Gottron’s sign, erythema on extensor of extremity, subcutaneous edema and skin ulcer. JDM-associated skin lesions during the clinical disease course included V-neck sign, shawl sign, poikiloderma, panniculitis, lipodystrophy, and subcutaneous calcification. The extent of skin lesions was evaluated using a method based on Lund–Browder Charts and the Rule of Nine, which is used to evaluate burns on body surface areas (Supplemental Table), with cutaneous lesions present on ≥15% of the body surface area defined as extensive eruptions. Initial laboratory data included whole blood counts, serum levels of muscle-derived enzymes [aspartate aminotransferase (AST), lactate dehydrogenase (LDH), creatine kinase (CK), aldolase and myoglobin), markers of vasculitis (D-dimer and von Willebrand factor (vWF)] and interstitial lung disease (ILD) (Krebs von den Lungen-6 (KL-6)) [10]. Chest computed tomography scan was performed in all patients at diagnosis of JDM. The development of malignancy during the course of disease was also evaluated.