2Cinderella
Вы не могли бы подсказать,как по интернету найти инф. о физиотерапии ожогов III ст.,желательно на англ яз.,применяются ли фоно-,электрофорез,квантовая,биорезонансная терапия.
У нас самый глубокий ожог на суставах пальчиков ноги,хотелось бы узнать возможно ли как-то предотвратить формирование рубцов,чтобы избежать деформаций.У врачей мнения разные от - ничего,кроме компресс.одежды - до лазера.Если Вам не сложно,то я была бы благодарна за любую информацию.
Конференция "Детская медицина""Детская медицина"
Раздел: -- посиделки
Отвечать в конференциях и заводить новые темы может любой участник, независимо от наличия регистрации на сайте 7я.ру.
2Cinderella Вы не могли бы подсказать,ка
08.04.2002 23:12:36, MamaE15 комментариев
Third-degree burns
Acupuncture
Electrical Stimulation
Transcutaneous electrical nerve stimulation (TENS) is a method of applying controlled, low-voltage electrical stimulation to the skin for the purpose of relieving pain. Recent studies have suggested that TENS applied to acupuncture points (called═electroacupuncture) on the ear (auricular acupuncture) may provide pain relief for people with burns. In one study, 11 burn patients received two forms of treatment prior to wound care: auricular TENS and a placebo pill. Seven patients reported at least a 70% reduction in pain during the TENS acupuncture treatments and only two patients reported that degree of relief when receiving the placebo pill. This preliminary study suggests that further investigation into the use of auricular electroacupuncture for the relief of pain in burn patients is warranted.
Massage and Physical Therapy
Massage Therapy
People with burns suffer pain, itching, and anxiety both from the burn itself and during the healing of the wound. Some studies suggest that massage may help ease these symptoms in both the emergency-care and recovery phases. In one study, 28 burn patients were randomly assigned to receive massage therapy or standard treatment while in the hospital. Patients in the massage therapy group received a 20-minute general body massage prior to wound cleaning once a day for 1 week. Reported effects included:
Decreased anxiety
Decreased pulse rate (a potential sign of improved relaxation and/or diminished pain)
Decreased levels of cortisol (a hormone that indicates stress in the body)
Decreased pain
Improved mood, including diminished depression and anger
In another small study, 20 burn victims were randomly assigned to receive massage and standard therapy or standard therapy only during the recovery phase of their injury (between 80 to 165 days after the injury). The massage group received a 30-minute massage twice a week for 5 weeks in addition to standard therapy (consisting of physical and occupational therapy, regular check ups by the physician, medication for symptoms of pain and itching, and application of cocoa butter to the closed wound). People who received massages reported significantly less itching, pain, anxiety, and depressed mood compared to those who received standard care only.
Physical Therapy
Occupational and physical therapy begin very early for patients who are hospitalized for burns. The techniques used by occupational and physical therapists improve movement and function and reduce scar formation. Rehabilitation with the guidance of occupational and physical therapists may include the practices listed below:
Body and limb positioning
Splinting
Assistance with activities of daily living until normal function and ability are recovered
Passive (physical therapist moves the patient's limbs) and active exercises
Assistance with walking
Homeopathy
Although very few studies have examined the effectiveness of specific homeopathic therapies in the treatment of burns, professional homeopaths may consider the following measures to treat first and second degree burns and to aid recovery from any burn. Before prescribing a remedy, homeopaths take into account a person's constitutional type. A constitutional type is defined as a person's physical, emotional, and psychological makeup. An experienced homeopath assesses all of these factors when determining the most appropriate treatment for each individual.
Immersing the burned area in cold water until the pain subsides (this generally takes at least a few minutes)
Arnica Montana -- taken orally immediately following a burn
Calendula -- applied to the skin for first-degree burns and sunburns; this remedy is sometimes considered the treatment of choice for children; calendula may also be used in the healing stages of second- and third-degree burns to stimulate regrowth of skin and to diminish scar formation
Cantharis -- for persistent pain, restlessness, and anxiety especially as a result of severe burns; oral and/or topical forms may be recommended; requires a homeopathic doctor's prescription; may be used in children
Hypericum perforatum -- used topically if there are sharp, shooting pains with the burn
Urtica urens -- taken orally for stinging pains, itching, and swelling of first-degree burns; a cream or gel may also be applied to the skin for first-degree burns and sunburns; this remedy may be used for children
Causticum -- taken orally for burning pains with great rawness (as from an open wound) or when there are long-term physical or emotional symptoms after a burn; may be used in children under the direction of a licensed homeopath, often in the case of more severe burns
Phosphorus -- taken orally for electrical burns, especially if the individual is easily startled and excitable
Mind/Body Medicine
Hypnosis
Several studies suggest that hypnosis may reduce pain and anxiety and enhance relaxation in burn patients. In one study, 30 hospitalized burn patients received either standard wound care (including pain medications) or standard wound care plus hypnosis with a technique called rapid induction analgesia (RIA). RIA sessions were administered prior to wound care over four burn care sessions during a 48-hour period. Patients who received RIA treatment had less anxiety and pain as well as reduced consumption of pain medication over the course of the burn care sessions. Relaxation ratings also increased in the RIA group during this time. These findings suggest that RIA may be a helpful addition to standard wound care in burn patients; further research of hypnosis is certainly warranted.
Therapeutic Touch
Therapeutic touch (TT) is based on the theory that the body, mind, and emotions form a complex energy field. Therapists seek to correct the body's imbalances by moving their hands just over the body in a practice they call "the laying on of hands." This practice has been used for a variety of ailments including the relief of pain and anxiety, but studies have shown conflicting results. A recent trial of patients hospitalized for severe burns suggests that TT may reduce pain and anxiety associated with burns. Ninety-nine patients received either TT treatments or sham TT treatments (therapists moved their hands over the body but did not attempt to alter the energy field) once a day for 5 days. Patients who received TT treatments reported a significant reduction in pain and anxiety compared with the sham group, but there was no difference between groups in amount of medication used, stress relief, or satisfaction with therapy.
11.04.2002 00:35:35, Лисенок
This clinical study was undertaken to test the efficacy of topical Sucralfate Cream in second and third degree burns. Topical Sucralfate Cream has been used on a wide variety of lesions from radiation proctitis and dermatitis to keratoconjunctivitis with remarkable results. The study was carried out in two phases. The first phase comprised 60 patients, 30 of whom were treated with Sucralfate Cream while the other 30 were treated with other topical antimicrobial agents. Twenty-one of the patients in the study group had second-degree burns and nine patients' third degree burns. In the second phase, a double blind study was carried out on 25 patients where one area of burns was treated with Sucralfate Cream while another control area of the same patient was treated with a placebo ointment, containing the excipients used during preparation of the Sucralfate Cream, without Sucralfate. In the first phase, it was seen that the period of epithelialisation of second degree burns in the study group treated with Sucralfate Cream was 18.8 days compared with 24.6 days with other topical agents. This difference is statistically significant with a P value of <0.00001. In the double blind study, also healing in the areas treated with Sucralfate was more rapid than those treated with bland placebo ointment. The difference in the two rates of healing was statistically significant with a P value of 0.00067. Histopathological studies were also carried out in 10 patients of phase I of the trial. Sucralfate Cream promotes rapid epithelialisation of second degree burns with minimal said effects and offers another topical agent in the burn care specialist's armamentarium.
11.04.2002 00:36:35, Лисенок
Burn scar hypertrophy typically develops in deeper partial-thickness injuries and third-degree burns that are allowed to heal primarily. Hypertrophy of grafted areas of excised burn wound occur less frequently and is dependent, in part, on the time from injury to excision, on the involved anatomic part, and on the particular surgical technique employed. Tangential excision of the burn wound was introduced to obtain a better cosmetic and functional result. With tangential excision, necrotic tissue of a partial-thickness burn is removed in successive layers until a base of partially viable dermis is reached; in most circumstances, the wound is then immediately grafted. With deep burns, sequential excision may extend through all levels of the skin and into subcutaneous tissue until all nonviable tissue is removed. Delayed tangential excision is more likely to result in residual scar hypertrophy in grafted burn wound unless the bleeding granulation tissue below the nonviable portion of the burn also is excised.
Because only a few epithelial elements, sweat glands, and hair follicles remain viable in deep partial-thickness burns, healing takes place from these remnants over a period of 3 to 6 weeks. The resulting scar epithelium is of poor quality and is prone to form hypertrophic scar. Although both exhibit excessive collagen production, hypertrophic scar should be distinguished from a keloid. [23] A keloid overgrows the original dimensions of the initial injury. Hypertrophic scar develops in the bed of the injured tissue and is confined to its original anatomic boundaries. Hypertrophic scars frequently will flatten with time and pressure, whereas keloids often do not respond. As described above, burn scar hypertrophy is most commonly treated with a constant application of pressure on healed wounds by elastic garments. Although long-term controlled trials have not clearly demonstrated permanent beneficial effects from compression therapy, compression garments quickly reduce the mass of hypertrophic immature scars and provide patients with tangible evidence of the benefits of conscientious follow-up after injury. The mechanism by which constant compression application reduces scar mass is not well defined. Electron microscopy has demonstrated that fibroblasts in pressure-treated wounds are more linearly organized and collagen is manufactured in a
more organized fashion. Other forms of therapy for hypertrophic scarring include radiotherapy, cryotherapy, reexcision and wound closure, and intralesional steroid injections. Radiation probably produces an inhibitory effect on both fibroplasia and capillary budding. Cryotherapy is now rarely used. It is associated with depigmentation and increased sensitivity to subsequent cold exposure. The most successful approach to residual hypertrophic burn scars is initial pressure therapy until the wound matures, followed by subsequent excision and application of grafts. Tissue expansion has been used to expand normal skin and replace the excised hypertrophic scar or keloid. Complication rates with tissue expansion are as high as 40% and include infection, implant extrusion, and device rupture. Such complications usually require removal of the original implant, treatment of any infection, and replacement.
Because of their marked propensity to recur, keloids are much more difficult to treat. Therapy has included excision of the keloid and primary closure, which is effective for linearly oriented keloids with a narrow base; however, excessive wound tension leads to recurrence. Broad-based keloids may be removed flush with the surrounding skin and a split-thickness skin graft placed over the base of the keloid to prevent it from recurring. [2] Unfortunately, excision alone has a recurrence rate of greater than 50%. Intralesional injection of corticosteroids has been advocated as a means to reduce the bulk of keloid and hypertrophic scar mass. This therapeutic modality may be used in combination with excision or split-thickness skin grafting. Triamcinolone is the most commonly used steroid and is believed to act by decreasing collagen synthesis and increasing collagen degradation through its effect on the collagen inhibitors, alpha-2 macroglobulin and alpha-1 antitrypsin. When steroid injection is used in conjunction with surgery, keloids should be injected for at least 1 month prior to the operation. Some surgeons inject triamcinolone in the base of the wound and along its edges during the surgical procedure. Postoperatively, the patient receives injections monthly until the wound matures. Major side effects of intralesional injection of steroids are hypopigmentation and atrophy of the skin surrounding the keloid.
Many burns heal with loss of pigmentation, and burn scar hypopigmentation and surface irregularity can be improved by dermabrasion and thin split-thickness grafting. Adequate pigmentation and flat surfaces are obtained in most patients. Tissue expanders are particularly effective for treating burn scar alopecia. Approximately 20% of patients treated in burn facilities are readmitted for reconstructive procedures. The most common areas of reconstruction involve the hand and wrist (most common), arm and forearm, face, and neck. Improved inpatient burn treatment and early scar management have reduced the need for subsequent reconstructive surgery.
11.04.2002 00:37:08, Лисенок
вы знаете , тема ваша настолько специфична , что мне надо очень сильно углуюляться в поиск , чтоб найти
вы попробуйте зарегистрироваться в нижеперечисленный адресах и поискать... 10.04.2002 16:17:03, Cinderella
вы попробуйте зарегистрироваться в нижеперечисленный адресах и поискать... 10.04.2002 16:17:03, Cinderella
Cinderella,в любом случае огромное спасибо за поиски!
10.04.2002 21:24:23, MamaE
мед поиск не работает
пока из других источников
здесь
здесь
еще здесь 09.04.2002 22:36:30, Cinderella
пока из других источников
здесь
здесь
еще здесь 09.04.2002 22:36:30, Cinderella
Спасибо большое,я уже это находила,но это слишком общее,меня скорее интересует инф. для специалистов.
А что такое мед. поиск 09.04.2002 23:10:05, MamaE
А что такое мед. поиск 09.04.2002 23:10:05, MamaE
это поиск в medline, medscape , md consult
про ожоги получаб очень узкую информацию , про реабилитацию нахожу мало , физиотерапия+ожоги тоже нет
посмотрим , лисенок ищет с другого сервера , может , она что найдет 09.04.2002 23:30:55, Cinderella
про ожоги получаб очень узкую информацию , про реабилитацию нахожу мало , физиотерапия+ожоги тоже нет
посмотрим , лисенок ищет с другого сервера , может , она что найдет 09.04.2002 23:30:55, Cinderella
пойду искать , сейчас еще других к поиску подключу
08.04.2002 23:14:57, Cinderella
Mama E, попробую поискать для Вас. Постараюсь опубликовать в течение пары часов.
PS Cinderella, а чем дело с HEV закончилось? 09.04.2002 21:41:02, Лисенок
Очень жаль,надеюсь он не нас испугался:)).Будем ждать.
09.04.2002 21:36:13, MamaE
PS Cinderella, а чем дело с HEV закончилось? 09.04.2002 21:41:02, Лисенок
Лисенок,спасибо!
09.04.2002 22:22:47, MamaE
будем ждать родов и сдавать анализы , делать ультразвук итд
муж придет в чеиверг на анализы сам- если помнишь , то у нее еще и активный гепатит в 09.04.2002 21:56:42, Cinderella
муж придет в чеиверг на анализы сам- если помнишь , то у нее еще и активный гепатит в 09.04.2002 21:56:42, Cinderella
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