Cutis
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The initial therapy of thermal injuries is directed at removal of loose debris and necrotic epidermis, alleviation of pain, and prevention of infection. Following initial wound debridement, bacterial growth in the wound itself is controlled primarily through the use of tropical antibiotic agents and daily hydrotherapy to clean the wounds and remove any loose eschar. Effectiveness of topical therapy is monitored by quantitative burn wound biopsy cultures; growth of greater than 10(4) micro-organisms per gram of tissue indicates invasive burn wound sepsis. ⋯ Once eschar separation has exposed healthy granulation tissue, the burn wound must be covered with suitable biologic dressings prior to autografting. All open wounds may then be autografted with sheet grafts to the face, neck, and areas exposed to trauma or by expansion mesh grafts to cover large areas from limited donor sites. Upon completion of autografting, a vigorous physical therapy program is necessary to rehabilitate victims of massive thermal injury to a functional existence.
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Treatment of burned patients begins at the scene of the accident, continues in the emergency department, and terminates in the burn center. The "burn team" of specialists includes the paramedic at the scene of the accident, the physician and nurses in the emergency room, and the burn center staff. Since the early stages of treatment often predetermine the final outcome, every physician or nurse who may someday be involved with the initial assessment and management of a severely burned patient should review a plan of evaluation and treatment. Thus, patient salvage from devastating burn injuries will continue to improve.
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Telogen effluvium is the excessive loss of normal club hairs. It can be diagnosed simply by microscopic examination of the hairs that are being shed. These hairs have uniform shaft diameter and normally shaped bulbs that contain no pigment. ⋯ It is usually not accompanied by inflammatory changes and the prognosis is excellent provided the causative styling practices-braids, rollers, ponytails, etc-are discontinued. Telogen conversion may be caused by interference with papillary blood flow. Since traction alopecia would seem to be reproducible, it may serve as a model for the study of telogen conversion.
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Sire the basis for this study. All cases were clinically diagnosed as porokeratosis plantaris discreta (PPD). Biopsies were done in fifteen cases. ⋯ Porokeratosis plantaris dicreta is a localized plantar hyperkeratosis that is resistant to therapy. It is often mistaken for a wart. PPD should be considered in the differential diagnosis of keratotic lesions on the sole.
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"Black heel" (calcaneal petechiae) is a traumatic lesion affecting the back or posterolateral aspect of the heel. It is seen almost exclusively in adolescentes or young adults engaged in active sports, notably basketball, but also football, lacrosse, tennis, and so forth. The lesion is disposed horizontally at the upper dege of the calcaneal fat-pad and consists of grouped punctate hemorrhages, the nature of which is revealed by repeated paring of the lesion. ⋯ It is likely to be cuased by a shearing or pinching stress from abrupt contact of th foot with a floor or hard ground. As it si usually symptomless, it may be disregarded or only observed by chance. However, it has been confused clinically with a melaonoa, and as it is such a trivial self-healing process, it is important that it be recognized for what it is.