Irén Erdei

Evaluation of mortality following severe burns injury in Hungary: external validation of a prediction model developed on Belgian burn data.

PURPOSE To evaluate mortality in a group of Hungarian burn patients and, as such, to perform an external validation of a prediction model developed on Belgian burn data by which the mortality appraisal was executed. BASIC PROCEDURES In a historical cohort we analysed all burn patients admitted between 1998 and 2006 to the Debrecen University Hospital (n=2326). The prediction model, based on three criteria (age, burned surface area (BSA) and inhalation injury) was also used to evaluate several subpopulations based on gender and age. MAIN FINDINGS Mean age was 35.3 years, mean BSA was 10.7%, 54% of the population was male, inhalation injury was rare (n=7; 0.3%) and overall mortality was 1.4% (1.6% male, 1.1% female). The men were younger and more severely burned, which was significant in every age group above 2 years. The model gave an accurate prediction of mortality, with a small overestimation in the lower risk categories. The receiver operating characteristic analysis demonstrated an area under the curve of 0.94 (95% confidence interval: 0.89-0.98). CONCLUSION Overall burn mortality in Hungary was low. The mortality prediction model demonstrated a high discriminative value. As such, this model is a helpful tool for outcome prediction and risk stratification for research purposes in burn patients.

Role of acellular dermal matrix allograft in minimal invasive coverage of deep burn wound with bone exposed--case report and histological evaluation.

A sandwich graft was applied to the debrided cortical bone layer of the tibia in the case of a 72‐year‐old male patient with full‐thickness necrotic burn injury. The combined graft consisted of a dermal template material and autologous split thickness skin graft. After application, the graft was found totally accepted and provided good functionality with acceptable appearance. Histopathologic evaluation revealed a complete take with revascularisation of the implant. Supporting lamellar bony trabecules were also seen in the deep dermal dermis representing a connection to the underlying bone. The use of the dermal matrix in deep burn exposing the bone provides a satisfactory functional result and good cosmetic appearance.

Phagocytosis and intracellular killing of heterogeneous vancomycin-intermediate Staphylococcus aureus strains.

Risk factors for invasive infections by heterogeneous vancomycin-intermediate Staphylococcus aureus (hVISA) may involve resistance to opsonophagocytosis and bacterial killing. hVISA strains typically have a thickened cell wall with altered peptidoglycan cross-linking. To determine whether hVISA may be endowed with an increased resistance to phagocytosis, this study assessed the characteristics of uptake and killing by granulocytes of three hVISA strains. All isolates were analysed by multilocus sequence typing and staphylococcal chromosome cassette mec typing. One of the strains belonged to the Hungarian meticillin-resistant S. aureus (MRSA) clone ST239-MRSA-III and the other two to the New York/Japan MRSA clone ST5-MRSA-II. In the presence of 10 % normal serum, the extent of phagocytosis and killing by blood granulocytes was equivalent for hVISA, MRSA and meticillin-sensitive S. aureus (MSSA) strains. Using granulocytes and serum from one patient who survived hVISA infection, the rate of phagocytosis and killing was also found to be comparable to that by control cells in the presence of 10 % serum. However, phagocytosis and killing of hVISA and MRSA (ATCC 25923) strains by normal granulocytes was markedly decreased in the presence of low concentrations (1 and 2.5 %) of serum from the patient who survived hVISA infection compared with that found with normal human serum. These data suggest that hVISA and MRSA isolates may be more resistant to opsonophagocytosis and bacterial killing than MSSA isolates, at least in some cases.

Long-Term Followup of Dermal Substitution with Acellular Dermal Implant in Burns and Postburn Scar Corrections

Full-thickness burn and other types of deep skin loss will result in scar formation. For at least partial replacement of the lost dermal layer, there are several options to use biotechnologically derived extracellular matrix components or tissue scaffolds of cadaver skin origin. In a survey, we have collected data on 18 pts who have previously received acellular dermal implant Alloderm. The age of these patients at the injury varied between 16 months and 84 years. The average area of the implants was 185 cm2. Among those, 15 implant sites of 14 patients were assessed at an average of 50 months after surgery. The scar function was assessed by using the modified Vancouver Scar Scale. We have found that the overall scar quality and function was significantly better over the implanted areas than over the surrounding skin. Also these areas received a better score for scar height and pliability. Our findings suggest that acellular dermal implants are especially useful tools in the treatment of full-thickness burns as well as postburn scar contractures.

Sporotrichoid Cutaneous Mycobacterium Tuberculosis Infection in a Child

Eva Remenyik, Bela Nagy, Maria Kiss, Imre Veres, Monika Sapy, Iren Horkay, Iren Erdei and Janos Hunyadi Departments of Dermatology and, Pediatrics, University of Debrecen, Medical and Health Science Center, University of Debrecen, Nagyerdei korut 98, HU-4012 Debrecen, Hungary and Department of Dermatology and Allergology, University of Szeged, Szeged, Hungary. E-mail: remenyik@jaguar.dote.hu Accepted December 22, 2004.

Diagnostic accuracy of 18F-FDG-PET/CT in early and late stages of high-risk cutaneous malignant melanoma

The precise role of total body 18F‐fluorodeoxyglucose‐positron emission tomography/computed tomography (PET/CT) in the clinical management of patients with cutaneous malignant melanoma (CMM) is not well established.

Cell therapy for burns – Our experiences in Debrecen

NAGY ENDRE DR.1,2, ERDEI IRÉN DR.1,2,3, FARKAS MÁTÉ DR.1,2, PÉTER ZOLTÁN DR.1,2, VÁRVÖLGYI TÜNDE DR.1, KIRÁLY GÁBOR DR.1,4, JUHÁSZ ISTVÁN DR.1,2,4 Debreceni Egyetem Általános Orvostudományi Kar, Bőrgyógyászati Tanszék, Debrecen1 Debreceni Egyetem Klinikai Központ, Bőrgyógyászati Klinika Égésiés Bőrsebészeti Osztály2 Debreceni Egyetem Általános Orvostudományi Kar, Aneszteziológiai és Intenzív Terápiás Tanszék3 Debreceni Egyetem Fogorvostudományi Kar, Fogorvosi Műtéttani Koordináló Tanszék4