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da Costa Ferreira SA, Serna González CV, Thum M, da Costa Faresin AA, Woo K, de Gouveia Santos VLC. Topical therapy for pain management in malignant fungating wounds: A scoping review. J Clin Nurs 2022. [PMID: 36055976 DOI: 10.1111/jocn.16508] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 07/04/2022] [Accepted: 08/05/2022] [Indexed: 10/14/2022]
Abstract
AIMS AND OBJECTIVES To map and synthesise the existing literature on topical therapies for malignant fungating wounds pain management and the gaps involved. BACKGROUND Most cancer patients with malignant fungating wounds suffer from wound-related pain, affecting their quality of life. Unfortunately, even though pain is a relevant symptom in cancer and palliative care, little is currently known about topical treatments' availability and impact on pain management. DESIGN A scoping review following JBI® methodology METHODS: Searches were performed in CINAHL, LILACS, Embase, Web of Science, PubMed, Cochrane, NICE, Scopus, JBISRIR and grey literature, in English, Portuguese and Spanish, with no time limit. Two authors independently reviewed all citations and a third was called in case of divergence, and studies in adults with malignant fungal wounds reporting topical pain interventions were included. In addition, a data extraction tool for synthesis and thematic analysis was developed. This study followed the PRISMA-ScR Checklist. RESULTS Seventy publications were selected from 796 records retrieved from databases. The studies mainly included non-systematic reviews and case studies with only six clinical trials. According to the narrative synthesis, twenty therapies were identified, including the use of wound dressings (58.6%), analgesic drugs (55.7%), topical antimicrobials (25.7%), skin barriers (15.7%), cryotherapy (5.7%) and negative pressure wound therapy (4.3%). Therapies were recommended to be applied to the wound bed or the periwound skin. In 68.5% of the studies, a standardised assessment for pain was not described. CONCLUSIONS Topical therapies applied to malignant fungating wounds or periwound areas had been examined for pain management. However, their effectiveness was analysed in a few interventional studies, indicating the need for further primary studies to inform evidence-based practice. IMPLICATION FOR PRACTICE Highlighted topical therapies for clinical practice consideration are opioids, anaesthetics and antimicrobials, with positive results described in randomised clinical trials. This study did not include patients.
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Affiliation(s)
| | - Carol Viviana Serna González
- School of Nursing-EEUSP, University of São Paulo - Adult Health Nursing Graduate Program-PROESA, Sao Paulo, Brazil
| | - Magali Thum
- School of Nursing-EEUSP, University of São Paulo - Adult Health Nursing Graduate Program-PROESA, Sao Paulo, Brazil
| | | | - Kevin Woo
- Faculty of Health Sciences, School of Nursing, Queen's University, Kingston, Ontario, Canada
| | - Vera Lúcia Conceição de Gouveia Santos
- Medical-Surgical Nursing Department Research Group of Enterostomal Therapy Nursing Stomatherapy-GPET, Sao Paulo, University of São Paulo, School of Nursing-EEUSP, Sao Paulo, Brazil
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Starace M, Carpanese MA, Pampaloni F, Dika E, Pileri A, Rubino D, Alessandrini A, Zamagni C, Baraldi C, Misciali C, Patrizi A, Bianchi T, Apalla Z, Piraccini BM. Management of malignant cutaneous wounds in oncologic patients. Support Care Cancer 2022; 30:7615-7623. [PMID: 35672478 PMCID: PMC9385755 DOI: 10.1007/s00520-022-07194-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 05/30/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE Neoplastic wounds may develop as a result of primary tumor growth in the skin, due to metastasis, or due to skin invasion by tumors emerging from deeper levels. Malignant wounds may present as a crater-like ulcer, or as raised nodules with a cauliflower-like appearance. They are associated with malodor, necrosis, pain, bleeding, and secondary infection. The aim of our study is to better characterize fungating wounds and their management. METHODS We retrospectively reviewed the database of the Wound Care Unit of the University of Bologna in order to identify individuals affected by neoplastic wound, between January 2019 and February 2021. RESULTS We identified 9 females and 2 males with a mean age of 63 years; all were referred by the Oncology Unit. Management differed depending on the characteristics of the patients and the ulcers. Complete healing of the wound, following the parallel complete remission of the lymphoproliferative neoplasia, was observed in one individual. Among the others, one died because of breast cancer, while cutaneous lesions in 2 individuals deteriorated after 1 year of follow-up. Remission/relapse of the ulcer following the treatment course administered for the lymphoma were observed in one patient. CONCLUSIONS Treatment of malignant fungating wounds is challenging. Considering the neoplastic nature of the wounds, complete healing or improvement cannot be expected with the application of classically prescribed dressing for wounds. A mostly palliative treatment, focusing on maintaining the patient's quality of life, is a reasonable choice.
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Affiliation(s)
- Michela Starace
- Dermatology - IRCCS Policlinico Di Sant'Orsola - Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Miriam Anna Carpanese
- Dermatology - IRCCS Policlinico Di Sant'Orsola - Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Francesca Pampaloni
- Dermatology Unit, Department of Medicine, University of Padova, Via Gallucci 4, 35121, Padua, Italy.
| | - Emi Dika
- Dermatology - IRCCS Policlinico Di Sant'Orsola - Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Alessandro Pileri
- Dermatology - IRCCS Policlinico Di Sant'Orsola - Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Daniela Rubino
- Addarii Medical Oncology Unit, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Via Albertoni 15, Bologna, Italy
| | - Aurora Alessandrini
- Dermatology - IRCCS Policlinico Di Sant'Orsola - Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Claudio Zamagni
- Addarii Medical Oncology Unit, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Via Albertoni 15, Bologna, Italy
| | - Carlotta Baraldi
- Dermatology - IRCCS Policlinico Di Sant'Orsola - Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Cosimo Misciali
- Dermatology - IRCCS Policlinico Di Sant'Orsola - Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Annalisa Patrizi
- Dermatology - IRCCS Policlinico Di Sant'Orsola - Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Tommaso Bianchi
- Dermatology - IRCCS Policlinico Di Sant'Orsola - Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Zoe Apalla
- Second Dermatology Department, Papageorgiou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Bianca Maria Piraccini
- Dermatology - IRCCS Policlinico Di Sant'Orsola - Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum University of Bologna, Bologna, Italy
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3
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Batista JVC, Uecker A, Holandino C, Boylan F, Maier J, Huwyler J, Baumgartner S. A Scoping Review on the Therapeutic Potential of Resin From the Species Larix decidua Mill. [Pinaceae] to Treat Ulcerating Wounds. Front Pharmacol 2022; 13:895838. [PMID: 35721139 PMCID: PMC9204203 DOI: 10.3389/fphar.2022.895838] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 05/17/2022] [Indexed: 11/29/2022] Open
Abstract
Malignant ulcerating wounds or neoplastic lesions are a considerable burden for patients suffering from advanced cancer. These wounds have no effective treatment and are very difficult to manage. The present review summarizes evidence in support of a hypothesis put forward in anthroposophic medicine, which suggests a beneficial role of resin from the species Larix decidua Mill. [Pinaceae] for treating such wounds. A systematic search strategy was performed using the databases PubMed, EMBASE and SciFinder. The included publications described the chemical composition of this species, as well as in vitro, in vivo, and ex vivo experiments using plant extracts and isolated compounds. The results show that among the phytochemical classes, terpenoids were the major components of this species, especially in the resin. The summarized biological experiments revealed antimicrobial, antioxidant and anti-inflammatory effects, with promising potential for the extracts and isolated compounds. However, the molecular mechanisms and toxicological effects are as of yet not conclusively evaluated. From the data of our study, we can conclude that L. decidua might indeed have a promising potential for the treatment of malignant wounds, but definitive information that can prove its effectiveness is still lacking. We therefore suggest that future efforts should be dedicated to the evaluation of L. decidua resin's therapeutic use considering its antiseptic action and proposed wound healing properties.
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Affiliation(s)
- João V. C. Batista
- Hiscia Institute, Society for Cancer Research, Arlesheim, Switzerland
- Department of Pharmaceutical Sciences, Division of Pharmaceutical Technology, University of Basel, Basel, Switzerland
| | - Annekathrin Uecker
- Institute of Integrative Medicine, University of Witten/Herdecke, Witten, Germany
| | - Carla Holandino
- Departamento de Fármacos e Medicamentos, Faculdade de Farmácia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Fabio Boylan
- School of Pharmacy and Pharmaceutical Sciences, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | - Jakob Maier
- Hiscia Institute, Society for Cancer Research, Arlesheim, Switzerland
| | - Jörg Huwyler
- Department of Pharmaceutical Sciences, Division of Pharmaceutical Technology, University of Basel, Basel, Switzerland
| | - Stephan Baumgartner
- Hiscia Institute, Society for Cancer Research, Arlesheim, Switzerland
- Institute of Integrative Medicine, University of Witten/Herdecke, Witten, Germany
- Institute of Complementary and Integrative Medicine, University of Bern, Bern, Switzerland
- *Correspondence: Stephan Baumgartner,
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Furka A, Simkó C, Kostyál L, Szabó I, Valikovics A, Fekete G, Tornyi I, Oross E, Révész J. Treatment Algorithm for Cancerous Wounds: A Systematic Review. Cancers (Basel) 2022; 14:cancers14051203. [PMID: 35267512 PMCID: PMC8909326 DOI: 10.3390/cancers14051203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 02/14/2022] [Accepted: 02/24/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND In advanced cancer stage the incidence of cancerous wounds is about 5%, and the estimated life expectancy is not more than 6 to 12 months. Without interdisciplinary and individualized treatment strategy, symptoms progress, and adversely influence quality of life. METHODS Authors collected different treatment algorithms for cancerous wound published by wide scale of medical expertise, and summarized surgical, oncological, radiation oncological, nursing and palliative care aspects based on radiological information. RESULTS Interdisciplinary approach with continuous consultation between various specialists can solve or ease the hopeless cases. CONCLUSIONS This distressing condition needs a comprehensive treatment solution to alleviate severe symptoms. Non-healing fungating wounds without effective therapy are severe socio-economic burden for all participants, including patients, caregivers, and health services. In this paper authors collected recommendations for further guideline that is essential in the near future.
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Affiliation(s)
- Andrea Furka
- Centre of Clinical Oncology and Radiotherapy, Borsod-Abaúj-Zemplén County Hospital and University Teaching Hospital, 3526 Miskolc, Hungary; (I.S.); (A.V.); (G.F.); (E.O.); (J.R.)
- Department of Clinical Radiology, Faculty of Health Care, Institute of Practical Methodology and Diagnostics, University of Miskolc, 3526 Miskolc, Hungary;
- Correspondence: ; Tel.: +36-309988499
| | - Csaba Simkó
- Erzsébet Hospice, Borsod-Abaúj-Zemplén County Hospital and University Teaching Hospital Miskolc, 3526 Miskolc, Hungary;
| | - László Kostyál
- Department of Clinical Radiology, Faculty of Health Care, Institute of Practical Methodology and Diagnostics, University of Miskolc, 3526 Miskolc, Hungary;
- Department of Diagnostic Imaging, Borsod-Abaúj-Zemplén County Hospital and University Teaching Hospital Miskolc, 3526 Miskolc, Hungary
| | - Imre Szabó
- Centre of Clinical Oncology and Radiotherapy, Borsod-Abaúj-Zemplén County Hospital and University Teaching Hospital, 3526 Miskolc, Hungary; (I.S.); (A.V.); (G.F.); (E.O.); (J.R.)
| | - Anikó Valikovics
- Centre of Clinical Oncology and Radiotherapy, Borsod-Abaúj-Zemplén County Hospital and University Teaching Hospital, 3526 Miskolc, Hungary; (I.S.); (A.V.); (G.F.); (E.O.); (J.R.)
| | - Gábor Fekete
- Centre of Clinical Oncology and Radiotherapy, Borsod-Abaúj-Zemplén County Hospital and University Teaching Hospital, 3526 Miskolc, Hungary; (I.S.); (A.V.); (G.F.); (E.O.); (J.R.)
| | - Ilona Tornyi
- Department of Human Genetics, University of Debrecen, 4032 Debrecen, Hungary;
- Biosystems Immunolab Zrt., 4032 Debrecen, Hungary
| | - Endre Oross
- Centre of Clinical Oncology and Radiotherapy, Borsod-Abaúj-Zemplén County Hospital and University Teaching Hospital, 3526 Miskolc, Hungary; (I.S.); (A.V.); (G.F.); (E.O.); (J.R.)
| | - János Révész
- Centre of Clinical Oncology and Radiotherapy, Borsod-Abaúj-Zemplén County Hospital and University Teaching Hospital, 3526 Miskolc, Hungary; (I.S.); (A.V.); (G.F.); (E.O.); (J.R.)
- Department of Clinical Radiology, Faculty of Health Care, Institute of Practical Methodology and Diagnostics, University of Miskolc, 3526 Miskolc, Hungary;
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Uebach B, Krull E, Simon ST, Bausewein C, Voltz R, Doll A. [Guideline-based Care for patients with malignant lesions : The new S3 guideline for patients with incurable cancer]. HNO 2022; 70:167-178. [PMID: 35171305 DOI: 10.1007/s00106-022-01145-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The German Association of Palliative Care developed an evidence-based guideline about the management of malignant wounds in adult patients with incurable cancer. There is a lack of evidence-based guidelines about fungating wounds and a confusing wide range of available wound dressings. The goal of the guideline is to reduce the suffering of patients with malignant wounds and stabilize or improve their quality of life. The guideline is constructed following the German Instrument for Methodological Guideline Appraisal (DELBI): A systematic review was carried out for guidelines and reviews. A wound expert group discussed these research findings and suggested recommendations which were adapted and consented by representatives of 62 medical and health professionals associations.The guideline has 34 recommendations, thereof nine (26%) are evidence based with an evidence level from 2+ to 4 (according to SIGN). The assessment chapter comprises specific assessment tools for malignant wounds, odor and wound-related quality of life. Three recommendations address the psychosocial support of patients and their family caregivers and aim to reduce the impact of the wound on their emotional wellbeing, caregiver burden and social participation. The pain recommendations focus on a preventive atraumatic dressing change, positioning, systemic pain medication (anticipated, rescue and baseline) and local application of morphine or local anesthetics. The guideline gives recommendations on odor management (metronidazole, active coal and antiseptic dressings) and management of exudate (super absorber). The recommendations on prevention and management of bleeding (antifibrinolytica, haemostyptica) are vital for patients and caregivers. This guideline is one of the first evidence-based and consented guideline on malignant wound care and has the potential to improve the palliation of patients who suffer from there malignant wounds.
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Affiliation(s)
- Barbara Uebach
- Zentrum für Palliativmedizin, Helios Klinikum Bonn/Rhein-Sieg, Von-Hompesch-Straße 1, 53123, Bonn, Deutschland.
| | - Elisabeth Krull
- Zentrum für Ambulante Hospiz- und Palliativversorgung München Land und Stadtrand Caritas-Zentrum Taufkirchen, Deutschland, Oberhaching
| | - Steffen T Simon
- Zentrum für Palliativmedizin, Universitätsklinikum Köln, Köln, Deutschland
| | | | - Raymond Voltz
- Zentrum für Palliativmedizin, Universitätsklinikum Köln, Köln, Deutschland
| | - Axel Doll
- Zentrum für Palliativmedizin, Universitätsklinikum Köln, Köln, Deutschland
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6
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Nicodème M, Dureau S, Chéron M, Kriegel I, Trenchand M, Bauër P, Fromantin I. Frequency and Management of Hemorrhagic Malignant Wounds: A Retrospective, Single-Center, Observational Study. J Pain Symptom Manage 2021; 62:134-140. [PMID: 33259905 DOI: 10.1016/j.jpainsymman.2020.11.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 11/06/2020] [Accepted: 11/21/2020] [Indexed: 10/22/2022]
Abstract
CONTEXT The prevalence of bleeding episodes in malignant wounds (MW) is poorly documented, with no distinction between minor and potentially severe bleedings. This affects the quality of care. OBJECTIVES Assessing the frequency and management of hemorrhagic malignant wounds at Institut Curie hospital, an anti cancer center. METHODS Retrospective study conducted from the medical records of patients followed up by the Research and Wound Care Unit from Curie Institute (Paris, France), between 2017 and 2018. Patients >18 years of age, seen at least once by the Unit, and with an MW > 10 cm2 were included. RESULTS Ninety patients were included, 74.4% female and 25.6% male, with a median age of 64 years (32-92). The most frequent etiologies were breast cancer (52.2%), sarcomas (12.2%), squamous cell carcinoma ear, nose and throat (11%), and pelvic cancer (8.9%). The median survival of patients after their first consultation was 5.6 months (95% CI: 4.6-8.4). Minor bleedings were observed in 38.9% of situations. Bleedings were significantly higher in malignant fungating wounds (P < 0.01). They were treated by the application of alginate or nonadherent dressings. The presence of at least one minor bleeding significantly increased the risk of more severe bleedings (P < 0.001). Hemorrhagic episodes were reported in 18.9% of patients, and 2.2% of patients died as a result of these bleeding episodes. Hemorrhages were fully controlled by hemostatic dressings in 70.6% of cases. The appearance of bleeding (minor or hemorrhagic) was significantly associated with survival (P < 0.001). CONCLUSION MWs with bleedings appear to be associated with a poor prognosis and could be a reason for early palliative care even if the patient's general condition is preserved. Palliative care must incorporate wound care skills to provide the most appropriate solutions to this anxiety-provoking symptom.
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Affiliation(s)
| | | | - Maxime Chéron
- Research and Wound Care Unit, Institut Curie, Paris, France
| | - Irène Kriegel
- Research and Wound Care Unit, Institut Curie, Paris, France
| | | | - Pierre Bauër
- Research and Wound Care Unit, Institut Curie, Paris, France; Univ. Paris Est Créteil, INSERM, IMRB, CEpiA, France.
| | - Isabelle Fromantin
- Research and Wound Care Unit, Institut Curie, Paris, France; Univ. Paris Est Créteil, INSERM, IMRB, CEpiA, France
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7
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Bhat KRS, Raghunath SK, Srivatsa N, Tejus C, Vishruth K, Kumar RA. Outcomes of Minimally Invasive Radical Prostatectomy-a Contemporary Review. Indian J Surg Oncol 2020; 11:580-588. [PMID: 33299276 PMCID: PMC7714884 DOI: 10.1007/s13193-020-01125-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 06/02/2020] [Indexed: 10/24/2022] Open
Abstract
Prostatectomy has been widely accepted as a treatment option for prostate cancer and can be performed via an open, laparoscopic, and robotic approach. The outcomes following prostatectomy are primarily sub-grouped into oncological and functional outcomes. Oncological outcomes have been comparable in the above three surgical modalities. However, the robotic platform seems to have a better functional outcome compared to open prostatectomy. The data on the outcome of the laparoscopic approach is scarce and is not widely performed due to technical difficulty. With experience continence outcomes have reached a plateau in many robotic series, however, the potency outcome is the real Achilles tendon of this procedure. Many factors influence potency outcomes but the amount and quality of nerve-sparing is one factor that is under a surgeon's control and it improves with experience.
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Affiliation(s)
| | - S. K. Raghunath
- Trustwell Hospital, No 5, J C Road, Bangalore, 560002 India
- HCG Hospital, Bengaluru, Karnataka India
| | | | - C. Tejus
- HCG Hospital, Bengaluru, Karnataka India
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8
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Sabir AU, Sabir S, Abbas S. Bloody Aggressive: A Case Report on a Fungating Breast Mass in a Paraplegic Requiring Emergency Mastectomy. Cureus 2020; 12:e10952. [PMID: 33209515 PMCID: PMC7667621 DOI: 10.7759/cureus.10952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Fungating malignant lesions pose a huge deal of agony to the patients. Their management is also deemed as difficult by most physicians. This report describes a case of a 45-year-old paraplegic female with delayed presentation of a very aggressive fungating left breast mass, which was diagnosed as invasive ductal carcinoma. The uncontrollable hemorrhage had the surgeons succumb to the option of emergency mastectomy as a palliative treatment to save the life of the patient. Hence, we infer that the emergency mastectomy in a hemorrhagic fungating breast lesion can be life-saving and can be performed with little to no risk to the patient. Such a procedure, surprisingly, has never been documented in the surgical literature before.
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Virgen CA, Barker CA, Lacouture ME. The microbial flora of clinically infected cutaneous metastases: a retrospective study. Clin Exp Dermatol 2020; 45:722-726. [PMID: 32304588 DOI: 10.1111/ced.14241] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2020] [Indexed: 01/20/2023]
Abstract
Symptomatic cutaneous metastases are associated with discharge, malodour, pruritus and pain, all of which may negatively impact quality of life and cutaneous health. We conducted a retrospective chart review of patients referred to the Dermatology Service at Memorial Sloan Kettering Cancer Center between August 2006 and June 2015, and characterized the microbial flora and antimicrobial management of cutaneous metastases in 64 patients. We detected pathogenic and/or opportunistic bacteria in 50% of skin lesions. The most commonly isolated organisms were Staphylococcus aureus and Pseudomonas aeruginosa. Patients treated with oral antibiotics, alone or in combination with topical agents, had a statistically significant better improvement in infectious symptoms than those treated without oral antibiotics. Our findings suggest that the normal skin microbial flora is disrupted in patients with symptomatic skin metastases. Oral antibiotics may provide benefit when used as first-line therapy for infected skin lesions in patients with symptomatic cutaneous metastases.
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Affiliation(s)
- C A Virgen
- Department of Dermatology, University of California Irvine, Irvine, USA
| | - C A Barker
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, USA
| | - M E Lacouture
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA
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10
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Hu JK, Ligtenberg KG, Leventhal J, Bunick CG. Successful management of malodor from fungating tumors using crushed metronidazole tablets. JAAD Case Rep 2019; 6:26-29. [PMID: 31909133 PMCID: PMC6938872 DOI: 10.1016/j.jdcr.2019.10.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- Jamie Katy Hu
- School of Medicine, Yale University, New Haven, Connecticut
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11
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Janowska A, Dini V, Oranges T, Iannone M, Loggini B, Romanelli M. Atypical Ulcers: Diagnosis and Management. Clin Interv Aging 2019; 14:2137-2143. [PMID: 31849457 PMCID: PMC6911347 DOI: 10.2147/cia.s231896] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Accepted: 11/16/2019] [Indexed: 01/22/2023] Open
Abstract
Atypical ulcers show atypical clinical features, histology, localization, and resistance to standard therapies. The persistence of a chronic ulcer despite treatment with standard therapies requires a more specific diagnostic investigation. Diagnosis involves obtaining the history and performing clinical examination and additional tests. A skin biopsy is frequently used to confirm unclear diagnosis. In difficult cases, microbiological and immunohistochemical examinations, laboratory blood tests, or instrumental tests should be evaluated. The treatment of atypical wounds is characterized by local systemic therapy and pain control. Our results highlight the need for early diagnosis, and standardized and targeted management by a multidisciplinary wound healing center.
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Affiliation(s)
- Agata Janowska
- Department of Dermatology, University of Pisa, Pisa, Italy
| | - Valentina Dini
- Department of Dermatology, University of Pisa, Pisa, Italy
| | - Teresa Oranges
- Department of Dermatology, University of Pisa, Pisa, Italy.,Department of Health Sciences, Anna Meyer Children University Hospital, University of Florence, Florence, Italy
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Affiliation(s)
- Katie Spencer
- Leeds Institute of Cancer and Pathology, University of Leeds, Leeds LS2 9NL, UK
| | - Rhona Parrish
- Garforth Medical Centre, Garforth, Leeds LS25 1HB, UK
| | - Rachael Barton
- Queen's Centre for Oncology and Haematology, Castle Hill Hospital, Cottingham HU16 5JQ, UK
| | - Ann Henry
- Leeds Institute of Cancer and Pathology, University of Leeds, Leeds LS2 9NL, UK
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13
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McCaughan D, Sheard L, Cullum N, Dumville J, Chetter I. Patients' perceptions and experiences of living with a surgical wound healing by secondary intention: A qualitative study. Int J Nurs Stud 2018; 77:29-38. [PMID: 29031127 PMCID: PMC5744862 DOI: 10.1016/j.ijnurstu.2017.09.015] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 08/14/2017] [Accepted: 09/23/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND Most surgical wounds heal by primary intention, that is to say, the edges of the wound are brought together with sutures, staples, adhesive glue or clips. However, some wounds may be left open to heal (if there is a risk of infection, or if there has been significant tissue loss), and are known as 'surgical wounds healing by secondary intention'. They are estimated to comprise approximately 28% of all surgical wounds and are frequently complex to manage. However, they are under researched and little is known of their impact on patients' lives. OBJECTIVES To explore patients' views and experiences of living with a surgical wound healing by secondary intention. DESIGN A qualitative, descriptive approach. SETTINGS Participants were recruited from acute and community nursing services in two locations in the North of England characterised by high levels of deprivation and diverse populations. PARTICIPANTS Participants were aged 18 years or older and had at least one surgical wound healing by secondary intention, which was slow to heal. Purposeful sampling was used to include patients of different gender, age, wound duration and type of surgery (general, vascular and orthopaedic). Twenty people were interviewed between January and July 2012. METHODS Semi-structured interviews were conducted, guided by use of a topic guide developed with input from patient advisors. Data were thematically analysed using steps integral to the 'Framework' approach to analysis, including familiarisation with data; development of a coding scheme; coding, charting and cross comparison of data; interpretation of identified themes. FINDINGS Alarm, shock and disbelief were frequently expressed initial reactions, particularly to "unexpected" surgical wounds healing by secondary intention. Wound associated factors almost universally had a profound negative impact on daily life, physical and psychosocial functioning, and wellbeing. Feelings of frustration, powerlessness and guilt were common and debilitating. Patients' hopes for healing were often unrealistic, posing challenges for the clinicians caring for them. Participants expressed dissatisfaction with a perceived lack of continuity and consistency of care in relation to wound management. CONCLUSIONS Surgical wounds healing by secondary intention can have a devastating effect on patients, both physical and psychosocial. Repercussions for patients' family members can also be extremely detrimental, including financial pressures. Health care professionals involved in the care of patients with these wounds face multiple, complex challenges, compounded by the limited evidence base regarding cost-effectiveness of different treatment regimens for these types of wounds.
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Affiliation(s)
- Dorothy McCaughan
- University of York, Department of Health Sciences, University of York, York, YO10 5DD, UK.
| | - Laura Sheard
- Bradford Institute for Health Research, Bradford, BD9 6RJ, UK
| | - Nicky Cullum
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, UK; Research and Innovation Division, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre; Jean McFarlane Building, Manchester M13 9PL, UK
| | - Jo Dumville
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, UK
| | - Ian Chetter
- Academic Vascular Surgical Unit, Hull York Medical School, University of Hull, Hull and East Yorkshire NHS trust, Hull, HU3 2JZ, UK
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Freitas de Castro MC, Santos WAD, Fuly PDSC, Caldeira dos Santos MLS, Ribeiro Garcia T. Intervenções de enfermagem para pacientes oncológicos com odor fétido em ferida tumoral. AQUICHAN 2017. [DOI: 10.5294/aqui.2017.17.3.2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objetivo: identificar intervenciones de enfermería para el diagnóstico de olor fétido en herida tumoral. Métodos: revisión integradora de la literatura a partir de las bases de datos MEDLINE, CINAHL, LILACS e Cochrane, que resultó en la selección de 48 artículos científicos acerca de la temática investigada. Resultados: con base en las evidencias empíricas identificadas en los artículos incluidos en el estudio, se elaboraron 24 intervenciones de enfermería para el control y la reducción del olor fétido en heridas tumorales. Conclusiones: las intervenciones de enfermería presentadas en el estudio posibilitan la promoción de la calidad de vida al paciente con herida tumoral en cuidado paliativo. Como sugerencia posterior al Consejo Internacional de Enfermeros, se deben validar clínicamente para que su inserción se realice en el subconjunto terminológico cuidados paliativos para una muerte digna, de la Clasificación Internacional para la Práctica de Enfermería (CIPE®).
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15
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Illsley MJ, Akhmetova A, Bowyer C, Nurgozhin T, Mikhalovsky SV, Farrer J, Dubruel P, Allan IU. Activated carbon-plasticised agarose composite films for the adsorption of thiol as a model of wound malodour. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2017; 28:154. [PMID: 28864980 DOI: 10.1007/s10856-017-5964-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 08/16/2017] [Indexed: 06/07/2023]
Abstract
Conditions such as diabetes, cardiovascular disease and long-term immobilisation can precipitate the development of chronic dermal ulcers. Such wounds are associated with inflammation and bacterial contamination which in turn can lead to the liberation of offensive odours that cause patient embarrassment and, in some instances, social isolation. Activated carbon-containing dressings have been used to manage the odours from such wounds. However, these can be bulky and can become fouled by wound exudate. Agarose is a natural polysaccharide derived from seaweed that forms brittle free-standing films that can be made pliable by addition of a plasticiser. In this study, activated carbon-containing plasticised agarose films were evaluated for their ability to sequester thiol-containing molecules from solution and the gaseous phase. The water vapour transmission rate was also evaluated to determine the potential breathability of these films should they be considered for application to the skin. It was found that the adsorption of thiols was directly proportional to the activated carbon content of the films. Water vapour was found to pass relatively freely through the films indicating that sweat-induced tissue maceration would be unlikely to occur if applied clinically. In conclusion, activated carbon-containing plasticised agarose films have some potential in the sequestration of malodourous molecules such as those liberated from chronic dermal wounds.
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Affiliation(s)
- M J Illsley
- School of Pharmacy and Biomolecular Sciences, University of Brighton, Brighton, BN2 4GJ, UK
| | - A Akhmetova
- Laboratory of Experimental and Clinical Pharmacology and Pharmacy, National Laboratory Astana, Nazarbayev University, Astana, Kazakhstan
| | - C Bowyer
- Enterprise & Innovation, Faculty of Creative and Cultural Industries, University of Portsmouth, Winston Churchill Avenue, Portsmouth, PO1 2UP, UK
| | - T Nurgozhin
- Laboratory of Experimental and Clinical Pharmacology and Pharmacy, National Laboratory Astana, Nazarbayev University, Astana, Kazakhstan
| | - S V Mikhalovsky
- School of Pharmacy and Biomolecular Sciences, University of Brighton, Brighton, BN2 4GJ, UK
| | - J Farrer
- Enterprise & Innovation, Faculty of Creative and Cultural Industries, University of Portsmouth, Winston Churchill Avenue, Portsmouth, PO1 2UP, UK
| | - P Dubruel
- Polymer Chemistry & Biomaterials Group, Ghent University, Krijgslaan 281 (S4-bis), 9000, Ghent, Belgium
| | - I U Allan
- School of Pharmacy and Biomolecular Sciences, University of Brighton, Brighton, BN2 4GJ, UK.
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Abstract
BACKGROUND Malignant wounds are a devastating complication of cancer. They usually develop in the last six months of life, in the breast, chest wall or head and neck regions. They are very difficult to treat successfully, and the commonly associated symptoms of pain, exudate, malodour, and the risk of haemorrhage are extremely distressing for those with advanced cancer. Treatment and care of malignant wounds is primarily palliative, and focuses on alleviating pain, controlling infection and odour from the wound, managing exudate and protecting the surrounding skin from further deterioration. In malignant wounds, with tissue degradation and death, there is proliferation of both anaerobic and aerobic bacteria. The aim of antibiotic therapy is to successfully eliminate these bacteria, reduce associated symptoms, such as odour, and promote wound healing. OBJECTIVES To assess the effects of systemic antibiotics for treating malignant wounds. SEARCH METHODS We searched the following electronic databases on 8 March 2017: the Cochrane Wounds Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL; the Cochrane Library, 2017, Issue 3), Ovid MEDLINE, Ovid Embase and EBSCO CINAHL Plus. We also searched the clinical trial registries of the World Health Organization (WHO) International Clinical Trials Registry Platform (apps.who.int/trialsearch) and ClinicalTrials.gov on 20 March 2017; and OpenSIGLE (to identify grey literature) and ProQuest Dissertations & Theses Global (to retrieve dissertation theses related to our topic of interest) on 13 March 2017. SELECTION CRITERIA Randomised controlled trials that assessed the effects of any systemic antibiotics on malignant wounds were eligible for inclusion. DATA COLLECTION AND ANALYSIS Two review authors independently screened and selected trials for inclusion, assessed risk of bias and extracted study data. A third reviewer checked extracted data for accuracy prior to analysis. MAIN RESULTS We identified only one study for inclusion in this review. This study was a prospective, double-blind cross-over trial that compared the effect of systemic metronidazole with a placebo on odour in malignant wounds. Nine participants with a fungating wound and for whom the smell was troublesome were recruited and six of these completed both the intervention and control (placebo) stages of the trial. Each stage lasted fourteen days, with a fourteen day gap (washout period) between administration of the metronidazole and the placebo.The study, in comparing metronidazole and placebo, reported on two of this review's pre-specified primary outcomes (malodour and adverse effects of the treatment) and on none of the review's pre-specified secondary outcomes.MalodourThe mean malodour (smell) scores for the metronidazole group was 1.17 (standard deviation (SD) 1.60) and the mean for the placebo group was 3.33 (SD 0.82). It is unclear if systemic antibiotics were associated with a difference in malodour (1 study with 6 participants; MD -2.16, 95% CI -3.6 to -0.72) as the quality of the evidence (GRADE) was very low for this outcome. The study was downgraded due to high risk of attrition bias (33% loss to follow-up) and very serious imprecision due to the small sample size.Adverse effectsNo adverse effects of the treatment were reported in either the intervention or control group by the trial authors. AUTHORS' CONCLUSIONS It is uncertain whether systemic metronidazole leads to a reduction in malodour in patients with malignant wounds. This is because we were only able to include a single study at high risk of bias with a very small sample size, which focused only on patients with breast cancer. More research is needed to substantiate these findings and to investigate the effects of systemic metronidazole and other antibiotics on quality of life, pain relief, exudate and tumour containment in patients with malignant wounds.
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Affiliation(s)
| | - Valerie Smith
- Trinity College DublinSchool of Nursing and Midwifery24 D'Olier StreetDublinIreland2
| | - Fiona Hayden
- Lloyd’s PharmacyCommunity PharmacySupervalu Shopping CentreLucanDublinIreland
| | - Patricia Cronin
- Trinity College DublinSchool of Nursing and Midwifery24 D'Olier StreetDublinIreland2
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17
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Affiliation(s)
- Suzanne Tandler
- Tissue Viability Nurse. Worcestershire Health & Care NHS Trust
| | - Jackie Stephen-Haynes
- Professor in Tissue Viability, Professional Development Unit, Birmingham City University and Consultant Nurse, Worcestershire Health and Care NHS
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Emineke S, Cooper AJ, Fouch S, Birch BR, Lwaleed BA. Diluted honey inhibits biofilm formation: potential application in urinary catheter management? J Clin Pathol 2016; 70:140-144. [DOI: 10.1136/jclinpath-2015-203546] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 06/21/2016] [Accepted: 06/26/2016] [Indexed: 11/04/2022]
Abstract
AimsBiofilms are ubiquitous and when mature have a complex structure of microcolonies in an extracellular polysaccharide and extracellular DNA matrix. Indwelling medical devices harbour biofilms which have been shown to cause infections and act as reservoirs for pathogens. Urinary catheters are often in place for considerable periods of time and are susceptible to both encrustation and biofilm formation. Strategies for minimising biofilm occurrence underpin an active research area in biomedicine. Manuka honey has, inter alia, well-established antibacterial properties. This study aims to assess the influence of honey on early biofilm formation in an established in vitro model.MethodsAn established model of early biofilm formation using static bacterial cultures in vinyl 96-well plates was used to grow Escherichia coli, strain ATC 25922 and Proteus mirabilis, strain 7002. Planktonic cells were removed and the residual biofilm was stained with crystal violet, which were subsequently eluted and quantified spectrophotometrically. Manuka honey (Unique Manuka Factor 15+) was added either with the bacteria or up to 72 hours after.ResultsBiofilms in this model was developed over 3 days, after which growth stalled. Mixed (1:1) cultures of E. coli and P. mirabilis grew slower than monocultures. In mixed cultures, honey gave a dose-dependent reduction in biofilm formation (between 3.3 and 16.7%w/v). At 72 hours, all concentrations inhibited maximally (p<0.001). Application of honey to cultures after 24 and 48 hours also reduced the adherent bacterial biomass (p<0.05–p<0.01).ConclusionManuka honey at dilutions as low as 3.3% w/v in some protocols and at 10% or above in all protocols tested significantly inhibits bacterial attachment to a vinyl substrate and reduces further early biofilm development. No augmentation of growth over untreated controls was observed in any experiment.
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Ramasubbu DA, Smith V, Hayden F, Cronin P. Systemic antibiotics for treating malignant wounds. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2015. [DOI: 10.1002/14651858.cd011609] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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