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Razavi MS, Fathi M, Vahednia E, Ardani AR, Honari S, Akbarzadeh F, Talaei A. Cognitive rehabilitation in bipolar spectrum disorder: A systematic review. IBRO Neurosci Rep 2024; 16:509-517. [PMID: 38645887 PMCID: PMC11033165 DOI: 10.1016/j.ibneur.2024.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 04/07/2024] [Accepted: 04/08/2024] [Indexed: 04/23/2024] Open
Abstract
Background and objectives Neurocognitive deficits in bipolar disorder (BD) have a negative impact on the quality of life, even during the euthymic phase. And many studies conducted to improve cognitive deficits in bipolar disorder. This systematic review aims to summarize studies on cognitive rehabilitation (CR) conducted in bipolar patients and evaluate its impact on neurocognitive deficits. The primary objective is to explore how CR interventions can enhance cognitive functioning, treatment outcomes, and overall quality of life in this population. Methods A comprehensive search was conducted on PubMed, Google Scholar, Scopus, Embase, and PsycINFO databases from 1950 to 2023, following the 2015 PRISMA-P guidelines, using search terms related to BD and CR. Results The initial search yielded 371 titles across the five databases. After applying inclusion and exclusion criteria through screening, a total of 23 articles were included in the study. The selected articles evaluated verbal memory, attention, executive functions, and social cognition. Conclusion The findings suggest that CR can be an effective treatment approach for bipolar patients, aimed at enhancing their cognitive abilities, treatment outcomes, and overall quality of life. The primary finding of this study indicates that cognitive-behavioral therapy (CBT) protocols, skill training, and homework exercises, which offer a daily structure, social support, and opportunities for exchanging coping strategies, are more effective in enhancing cognitive functions. However, it is important to acknowledge the notable limitations of this review. Firstly, we did not assess the methodological rigor of the included studies. Additionally, there was a lack of detailed analysis regarding specific cognitive rehabilitation approaches that adhere to core CR principles, resulting in increased heterogeneity within the reviewed studies.
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Affiliation(s)
| | | | - Elham Vahednia
- Psychiatry and Behavioral Sciences Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Amir Rezaei Ardani
- Psychiatry and Behavioral Sciences Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Sara Honari
- Psychiatry and Behavioral Sciences Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Farzad Akbarzadeh
- Psychiatry and Behavioral Sciences Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ali Talaei
- Psychiatry and Behavioral Sciences Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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Honari S, Soltani D, Mirimoghaddam MM, Kheiri N, Rouhbakhsh Zahmatkesh MR, Saghebdoust S. Post-Traumatic Stress Disorder and Post-Traumatic Growth in Patients with Breast Cancer: A Retrospective Cross-Sectional Study in a Developing Country. Indian J Gynecol Oncolog 2022. [DOI: 10.1007/s40944-022-00654-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Asadi Anar M, Foroughi E, Sohrabi E, Peiravi S, Tavakoli Y, Kameli Khouzani M, Behshood P, Shamshiri M, Faridzadeh A, Keylani K, Langari SF, Ansari A, Khalaji A, Garousi S, Mottahedi M, Honari S, Deravi N. Selective serotonin reuptake inhibitors: New hope in the fight against COVID-19. Front Pharmacol 2022; 13:1036093. [PMID: 36532776 PMCID: PMC9748354 DOI: 10.3389/fphar.2022.1036093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 11/17/2022] [Indexed: 12/05/2022] Open
Abstract
The emerging COVID-19 pandemic led to a dramatic increase in global mortality and morbidity rates. As in most infections, fatal complications of coronavirus affliction are triggered by an untrammeled host inflammatory response. Cytokine storms created by high levels of interleukin and other cytokines elucidate the pathology of severe COVID-19. In this respect, repurposing drugs that are already available and might exhibit anti-inflammatory effects have received significant attention. With the in vitro and clinical investigation of several studies on the effect of antidepressants on COVID-19 prognosis, previous data suggest that selective serotonin reuptake inhibitors (SSRIs) might be the new hope for the early treatment of severely afflicted patients. SSRIs' low cost and availability make them potentially eligible for COVID-19 repurposing. This review summarizes current achievements and literature about the connection between SSRIs administration and COVID-19 prognosis.
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Affiliation(s)
- Mahsa Asadi Anar
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Elaheh Foroughi
- School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Elika Sohrabi
- Department of Medicine, Islamic Azad University of Medical Sciences, Tehran, Iran
| | - Samira Peiravi
- Department of Emergency Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Yasaman Tavakoli
- Department of Medicine, Mazandaran University of Medical Sciences, Sari, Mazandaran, Iran
| | | | - Parisa Behshood
- Department of Microbiology, Young Researchers and Elite Club, Islamic Azad University, Shahrekord, Iran
| | - Melika Shamshiri
- School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Arezoo Faridzadeh
- Department of Immunology and Allergy, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
- Immunology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Kimia Keylani
- School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyedeh Faride Langari
- Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Akram Ansari
- Shantou University Medical College, Shantou, Guangdong, China
| | | | - Setareh Garousi
- Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mehran Mottahedi
- Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Sara Honari
- Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Niloofar Deravi
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Emami Kazemabad MJ, Asgari Toni S, Tizro N, Dadkhah PA, Amani H, Akhavan Rezayat S, Sheikh Z, Mohammadi M, Alijanzadeh D, Alimohammadi F, Shahrokhi M, Erabi G, Noroozi M, Karimi MA, Honari S, Deravi N. Pharmacotherapeutic potential of pomegranate in age-related neurological disorders. Front Aging Neurosci 2022; 14:955735. [PMID: 36118710 PMCID: PMC9476556 DOI: 10.3389/fnagi.2022.955735] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 07/13/2022] [Indexed: 11/24/2022] Open
Abstract
Age-related neurological disorders [AND] include neurodegenerative diseases [NDDs] such as Alzheimer's disease [AD] and Parkinson's disease [PD], which are the most prevalent types of dementia in the elderly. It also includes other illnesses such as migraine and epilepsy. ANDs are multifactorial, but aging is their major risk factor. The most frequent and vital pathological features of AND are oxidative stress, inflammation, and accumulation of misfolded proteins. As AND brain damage is a significant public health burden and its incidence is increasing, much has been done to overcome it. Pomegranate (Punica granatum L.) is one of the polyphenol-rich fruits that is widely mentioned in medical folklore. Pomegranate is commonly used to treat common disorders such as diarrhea, abdominal pain, wound healing, bleeding, dysentery, acidosis, microbial infections, infectious and noninfectious respiratory diseases, and neurological disorders. In the current review article, we aimed to summarize the data on the pharmacotherapeutic potentials of pomegranate in ANDs.
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Affiliation(s)
| | - Sara Asgari Toni
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Neda Tizro
- School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Parisa Alsadat Dadkhah
- Student Research Committee, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hanieh Amani
- Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Shima Akhavan Rezayat
- Student Research Committee, Faculty of Medicine, Islamic Azad University of Mashhad, Mashhad, Iran
| | - Zahra Sheikh
- Student Research Committee, School of Medicine, Babol University of Medical Sciences, Babol, Iran
| | - Mohammad Mohammadi
- Student Research Committee, School of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Dorsa Alijanzadeh
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farnoosh Alimohammadi
- Student Research Committee, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Gisou Erabi
- Student Research Committee, Urmia University of Medical Sciences, Urmia, Iran
| | - Masoud Noroozi
- Department of Biomedical Engineering, Faculty of Engineering, University of Isfahan, Isfahan, Iran
| | - Mohammad Amin Karimi
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sara Honari
- Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Niloofar Deravi
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Gholami K, Norouzkhani N, Kargar M, Ghasemirad H, Ashtiani AJ, Kiani S, Sajedi Far M, Dianati M, Salimi Y, Khalaji A, Honari S, Deravi N. Impact of Educational Interventions on Knowledge About Hypertensive Disorders of Pregnancy Among Pregnant Women: A Systematic Review. Front Cardiovasc Med 2022; 9:886679. [PMID: 35795374 PMCID: PMC9252511 DOI: 10.3389/fcvm.2022.886679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 05/19/2022] [Indexed: 11/13/2022] Open
Abstract
Background Hypertensive disorders of pregnancy (HDP), including chronic hypertension, preeclampsia and gestational hypertension, is the cause of about 50,000 deaths out of 400,000 perinatal deaths. HDP is an effective risk factor in stroke, type 2 diabetes, and cardiovascular diseases like ischemic heart disease. There is a significant relation between HDP, lifestyle, and knowledge. Unfortunately, many studies showed that pregnant women have lack of knowledge about HDP. Therefore, the importance of educational interventions is, today, more acknowledged than before. Aim The goal of this systematic review was to investigate the effect of interventional educations on the knowledge of pregnant women about HDP. Methods A systematic review of the related articles was conducted. We included English randomized controlled trials published up to December 2021, including pregnant women as population, HDP as the outcome, and educational interventions as the intervention. Results After the process of study selection, six articles containing 819 pregnant women were included in this study. Educational pamphlets, mobile-based application, a mixture of pamphlets, pictographic magnet and videos, and a combination of PowerPoint and data show projectors and conversation were the educational interventions in these studies. Conclusions The positive effects of educational interventions on the knowledge of women with HTP were observed in all studies. The higher knowledge leads to HDP-related complications. Systematic Review Registration https://archive.org/details/osf-registrations-gcs5r-v1, identifier: doi: 10.17605/OSF.IO/GCS5R.
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Affiliation(s)
- Kosar Gholami
- Student Research Committee, Semnan University of Medical Sciences, Semnan, Iran
| | - Narges Norouzkhani
- Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Meraj Kargar
- Student Research Committee, Afzalipour Faculty of Medicine Kerman University of Medical Sciences, Kerman, Iran
| | - Hamidreza Ghasemirad
- Student Research Committee, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | | | - Shamim Kiani
- Student Research Committee, Department of Midwifery, Faculty of Nursing and Midwifery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | | | - Maryam Dianati
- Student Research Committee, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Yasaman Salimi
- Student Research Committee, School of Dentistry, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | | | - Sara Honari
- Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Niloofar Deravi
- Students Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Rhee R, Oderich G, Hertault A, Tenorio E, Shih M, Honari S, Jacob T, Haulon S. Multicenter experience in translumbar type II endoleak treatment in the hybrid room with needle trajectory planning and fusion guidance. J Vasc Surg 2019; 72:1043-1049. [PMID: 31882316 DOI: 10.1016/j.jvs.2019.10.076] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 10/14/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate the efficacy of treating type II endoleaks (T2Ls) after aortic endovascular repair with image guidance translumbar puncture using intraoperative cone beam computed tomography with preprocedure computed tomography angiography fusion in hybrid operating rooms. METHODS Twenty-six consecutive T2L patients in three different institutions were treated between March 2015 and September 2017 by direct translumbar puncture of the abdominal aortic aneurysm (AAA) sac after previous endovascular aortic repair. All patients were treated at a single setting in a cardiovascular hybrid operating room with a workstation featuring needle trajectory planning and guidance software. Aneurysm sac size change from the index treatment, freedom from recurrent endoleak after treatment, demographics, risk factors, and procedure factors were analyzed with univariate analysis. RESULTS All patients (N = 26; 19 male, 7 female; age range, 59-95 years; mean body mass index, 27.44 ± 3.06 kg/m2) underwent treatment for AAA sac expansion or symptoms. Four patients had failed to respond to previous catheter-directed T2L treatment. The most common risk factors included hypertension, hypercholesterolemia, coronary artery disease, tobacco use, and diabetes. Time to initial endoleak diagnosis ranged from 2 to 1914 days (average, 404 days). Aneurysm size after initial repair was 60.3 ± 7.5 mm; sac size had increased 10.1 ± 6.5 mm at the time of treatment. Onyx (Medtronic, Irvine, Calif) or glue (n-butyl cyanoacrylate) and coil embolization was used in 20 cases, and 6 patients were treated with coiling alone. There was no difference between the patients treated with coils alone and those treated with coils or glue (P > .05) in terms of freedom from failure. Total procedure time was 75.9 ± 40.7 minutes; contrast material volume, 19.9 ± 29 mL; fluoroscopy time, 13.74 ± 12.2 minutes; and radiation dose, 121.16 ± 167.7 mGy. After embolization, the mean sac diameter decreased by 2.2 mm to 67.5 ± 9.8 mm. Average follow-up period was 214 days. In 19 patients, the sac reduced in size between 0.2 and 19.1 mm per 100 days; in 2 patients, there was continued AAA expansion (3.4-4.3 mm per 100 days); there was no change in the sac size in 5 patients after the procedure. There were no AAA ruptures during the study period. Once T2L was treated, the recurrence rate was low at 11.5%. CONCLUSIONS This initial multicenter evaluation of the effectiveness of fusion image-guided translumbar obliteration of T2L demonstrated that the technique was effective at all three study centers and showed excellent efficacy to reduce AAA sac size. This may become a more effective and efficient method of treating T2L compared with transarterial or transcaval embolization because of its high success rate and technical ease.
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Affiliation(s)
- Robert Rhee
- Division of Vascular and Endovascular Surgery, Maimonides Medical Center, Brooklyn, NY.
| | - Gustavo Oderich
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minn
| | - Adriene Hertault
- Department of Vascular Surgery, University Hospital of Lille, Lille, France
| | - Emmanuel Tenorio
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minn
| | - Michael Shih
- Division of Vascular and Endovascular Surgery, Maimonides Medical Center, Brooklyn, NY
| | - Sara Honari
- Division of Vascular and Endovascular Surgery, Maimonides Medical Center, Brooklyn, NY
| | - Theresa Jacob
- Division of Vascular and Endovascular Surgery, Maimonides Medical Center, Brooklyn, NY
| | - Stephan Haulon
- Aortic Center, Hôpital Marie Lannelongue, Université Paris Sud, Le Plessis-Robinson, France
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Qaja E, Honari S, Rhee R. Arterial thoracic outlet syndrome secondary to hypertrophy of the anterior scalene muscle. J Surg Case Rep 2017; 2017:rjx158. [PMID: 28928918 PMCID: PMC5597902 DOI: 10.1093/jscr/rjx158] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Accepted: 07/24/2017] [Indexed: 11/12/2022] Open
Abstract
Thoracic outlet syndrome (TOS) was first introduced in literature by Peet et al. in 1956. Since then is has been studied extensively and subcategorized into at least four closely related syndrome. Neurogenic TOS due to the compression of brachial plexus, arterial TOS in cases of compression of the subclavian artery, venous TOS in cases of compression of the subclavian vein, and non-specific type of TOS. Neurogenic TOS is by far the most common consisting of 95% of the cases, followed by venous and lastly arterial. Arterial TOS comprises ~1% of all TOS cases, they are caused largely by presence of cervical rib and/or anomalies of first rib. Here we describe arterial TOS caused by hypertrophy of the anterior scalene muscle in a 65-year-old male. Patient underwent successful open surgical repair with Dacron interposition graft. Postoperative course was unremarkable. Patient was discharged home on POD 2.
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Affiliation(s)
- Erion Qaja
- Department of General Surgery, Wyckoff Heights Medical Center, Brooklyn, NY 11237, USA
| | - Sara Honari
- Department of Vascular Surgery, Maimonides Medical Center, Brooklyn, NY 11219, USA
| | - Robert Rhee
- Department of Vascular Surgery, Maimonides Medical Center, Brooklyn, NY 11219, USA
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Honari S. IP007. Simplified Translumbar Treatment of a Type II Endoleak Using CT Fusion in Hybrid Room. J Vasc Surg 2017. [DOI: 10.1016/j.jvs.2017.03.106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Patterson DR, Ptacek JT, Carrougher G, Heimbach DM, Sharar SR, Honari S. The 2002 Lindberg Award. PRN vs regularly scheduled opioid analgesics in pediatric burn patients. J Burn Care Rehabil 2002; 23:424-30. [PMID: 12432319 DOI: 10.1097/01.bcr.0000036585.31018.55] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Very little has been published on treating acute pain in children younger than the age of 3 for burns or any other trauma etiology. This study prospectively monitored the pain behavior and opioid analgesic intake of 31 pediatric burn patients (mean age = 23.71 months; SD = 15.75). Twelve of those children were randomized to conditions in which they either received opioid analgesics pro re nata (ie, as needed, pain contingent) or on a regular basis. The two groups did not show differences in demonstrable pain but, interestingly, they received equivalent does of opioid analgesics. As such, the pro re nata group was likely medicated largely on a regularly scheduled basis. For most of the remaining (nonrandomized) subjects, physicians ordered regularly scheduled opioid analgesics, suggesting that this practice has become largely institutionalized in the study setting. Information on pediatric opioid analgesic dosing and pain measurement strategies for nonverbal subjects can be derived from the findings.
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Affiliation(s)
- D R Patterson
- University of Washington School of Medicine, Seattle, Washington, USA
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Fang P, Engrav LH, Gibran NS, Honari S, Kiriluk DB, Cole JK, Fleckman P, Heimbach DM, Bauer GJ, Matsumura H, Warner P. Dermatome setting for autografts to cover INTEGRA. J Burn Care Rehabil 2002; 23:327-32. [PMID: 12352134 DOI: 10.1097/00004630-200209000-00005] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Using the INTEGRA Dermal Regeneration Template requires the outer silastic layer to be replaced with an autograft. We followed the manufacturer's directions for epidermal autografting and frequently obtained shredded, useless grafts, therefore, it seemed important to determine the proper dermatome setting. We evaluated dermatome settings from 0.002 to 0.012 inches. First, with feeler gauges, we verified the dermatome settings. Second, we harvested skin at various dermatome settings and measured the thickness histologically. We found that 1) the dermatome settings are reasonably accurate; 2) harvesting useful sheets at 0.002 and 0.004 inches is virtually impossible; 3) the variability of histologic graft thickness is enormous; and 4) a dermatome setting of 0.006 inches yields useful grafts. We no longer use the term epidermal autografting but rather ultrathin split-thickness grafting. To harvest these grafts, we now merely set the dermatome to 0.006 inches and make whatever midcourse corrections are necessary to obtain translucent grafts.
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Affiliation(s)
- P Fang
- University of Washington Burn Center at Harborview, Harborview Medical Center, 325 Ninth Avenue, Seattle, WA 98104, USA
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Fang P, Engrav LH, Gibran NS, Honari S, Kiriluk DB, Cole JK, Fleckman P, Heimbach DM, Bauer GJ, Matsumura H, Warner P. Dermatome setting for autografts to cover INTEGRA. J Burn Care Rehabil 2002. [PMID: 12352134 DOI: 10.1097/01.bcr.0000028567.45444.df] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Abstract
Using the INTEGRA Dermal Regeneration Template requires the outer silastic layer to be replaced with an autograft. We followed the manufacturer's directions for epidermal autografting and frequently obtained shredded, useless grafts, therefore, it seemed important to determine the proper dermatome setting. We evaluated dermatome settings from 0.002 to 0.012 inches. First, with feeler gauges, we verified the dermatome settings. Second, we harvested skin at various dermatome settings and measured the thickness histologically. We found that 1) the dermatome settings are reasonably accurate; 2) harvesting useful sheets at 0.002 and 0.004 inches is virtually impossible; 3) the variability of histologic graft thickness is enormous; and 4) a dermatome setting of 0.006 inches yields useful grafts. We no longer use the term epidermal autografting but rather ultrathin split-thickness grafting. To harvest these grafts, we now merely set the dermatome to 0.006 inches and make whatever midcourse corrections are necessary to obtain translucent grafts.
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Affiliation(s)
- P Fang
- University of Washington Burn Center at Harborview, Harborview Medical Center, 325 Ninth Avenue, Seattle, WA 98104, USA
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Mann R, Gibran NS, Engrav LH, Foster KN, Meyer NA, Honari S, Costa BA, Heimbach DM. Prospective trial of thick vs standard split-thickness skin grafts in burns of the hand. J Burn Care Rehabil 2001; 22:390-2. [PMID: 11761389 DOI: 10.1097/00004630-200111000-00007] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
For best function and appearance, thick skin grafts for hands are generally preferred to thinner grafts. But how thick is thick enough? This prospective randomized trial was designed to compare 0.015-inch skin grafts for burned hands to hand grafts that are 0.025 inches thick. Consecutive patients receiving skin grafts to hands were randomized to have sheet grafts using donor sites of 0.015-inch or 0.025-inch thickness. To prevent delayed healing and potential hypertrophic scarring, the thick graft donor sites were grafted with 0.008-inch grafts. There were no significant differences in range of motion, final appearance, or patient satisfaction between the two groups at 1 year. There were problems with donor site healing in both groups. We recommend that hand grafts for adults be at least 0.015 inches thick but do not see an advantage to the use of very thick (0.025-inch) grafts, even with thin split-thickness skin grafts to the donor site.
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Affiliation(s)
- R Mann
- Torrance Memorial Burn Center, Torrance Memorial Medical Center, CA 90505, USA
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Abstract
Toxic epidermal necrolysis (TEN) is a severe exfoliative disease of the skin and mucous membranes that results in high mortality. As the elderly population increases, the number of elderly patients with TEN can also be expected to increase. Elderly patients with comparably sized burn wounds usually have a poor prognosis. Our purpose was to determine whether elderly TEN patients exhibit similarly high mortality. A retrospective review was conducted of 52 patients treated for TEN from October 1991 through September 1998. Eleven patients were older than 65 years. All patients were treated according to our TEN protocol. Eight of 11 patients recovered, and 3 died. The mean total body surface area (TBSA) involvement for the patients who recovered was 24%, compared with 66% for the nonsurvivors. The survival rate for elderly patients (73%) compares well with that for those younger than 65 years (89%). Therefore, we propose that we should be aggressive in treating elderly patients with TEN.
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Affiliation(s)
- S Honari
- Department of Surgery, University of Washington Burn Center, Harborview Medical Center, Seattle 98104, USA
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Honari S, Patterson DR, Gibbons J, Martin-Herz SP, Mann R, Gibran NS, Heimbach DM. Comparison of pain control medication in three age groups of elderly patients. J Burn Care Rehabil 1997; 18:500-4. [PMID: 9404983 DOI: 10.1097/00004630-199711000-00006] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
There are no published reports of burn pain management in the elderly population. To assess the range of requirement and use of opioids among elderly patients with burns of different age categories, a retrospective review of 89 consecutive admissions of patients over 55 years of age (January 1995 through July 1996) was conducted. Complete data were available on 44 patients with a burn mean total body surface area of 17.2%. Patient ages ranged from 55 to 92 years. Individuals were divided into three age categories: Group I (55 to 65) n = 20; Group II (66 to 75) n = 14; and Group III (76 to 92) n = 10. Use of commonly prescribed opioids for procedural pain and breakthrough pain were evaluated. We compared the opioid equivalents of medications prescribed versus the actual amount administered. Paired t tests comparing minimum amount of medication ordered with that given revealed Group I patients received significantly more procedural medication than the minimum prescribed (t = 3.88, p = 0.001), and that Group III patients were given significantly less as needed medication than the minimum prescribed (t = 2.58, p < 0.05).
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Affiliation(s)
- S Honari
- Department of Surgery, University of Washington School of Medicine, Seattle, USA
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