RESUMEN
A review of the periodical literature relating to burn topical antibacterial agents as listed in the Cumulated Index Medicus from January 1, 1965, through November 30, 1992, as well as bound volumes and unpublished material reveals that the optimal dose and mode of deployment of 1% silver sulfadiazine cream in burn wound therapy have not been fully defined. Defining these should provide better control of sepsis in burn facilities. The effectiveness of a burn topical antibacterial agent depends in part upon the extent to which it is absorbed. The process of absorption of a burn topical antibacterial agent may be likened to that of an in vitro model in which the absorption of a test solute through an isolated preparation of the stratum corneum is determined in a diffusion cell. Some of the determinants are the concentration of the solute, the volume of the solvent, the duration of contact with the membrane, the binding tendency of the solute to the membrane, the integrity and wetness of the membrane, intrinsic factors of the solute/membrane interaction (distribution and diffusion coefficients), and the adjuvant formulation. Three of these (solvent volume, duration of solute contact, and membrane wetness) are readily adjusted. As a possible preliminary to the more effective clinical use of 1% silver sulfadiazine, a ranging of these three factors and of the silver sulfadiazine concentration, should be carried out in a rat model with septic burns. Though control of burn wound bacteria remains of overriding importance, the absorption of silver through the burn wound treated with silver sulfadiazine, binding to normal tissues, is a source of rising concern and requires further investigation.
Asunto(s)
Quemaduras/tratamiento farmacológico , Sulfadiazina de Plata/administración & dosificación , Administración Tópica , Vendajes , Difusión , Humanos , Sulfadiazina de Plata/efectos adversos , Sulfadiazina de Plata/farmacocinética , Absorción CutáneaRESUMEN
The cause of early postburn leukopenia (EPBL) is unknown. The evidence suggests that treating burn wounds with 1% silver sulfadiazine cream (SSD) is contributory, but that other factors exist, possibly including burn stress. Differences of opinion exist as to whether SSD applications to the wounds of non-septic burn patients should be discontinued if EPBL develops. A survey of opinion in 101 North American burn treatment facilities and a review of the literature show a strengthening of the perception that EPBL, whether caused by SSD or not, holds little risk for the burn patient. The majority of burn patients are now being assigned to treatment strategies in which the onset of EPBL requires discontinuance of SSD only at WBC counts lower than 2,000/cu mm or not at all. This is significantly lower (p less than .02) than the mean of the values recorded in the literature. There is now substantial experience with continuing the SSD therapy in this setting regardless of the WBC count. No complications are reported therefrom.
Asunto(s)
Quemaduras/tratamiento farmacológico , Leucopenia/inducido químicamente , Sulfadiazina de Plata/efectos adversos , Sulfadiazina/efectos adversos , Infección de Heridas/prevención & control , Administración Tópica , Unidades de Quemados , Recolección de Datos , Humanos , Recuento de Leucocitos , Factores de Riesgo , Sulfadiazina de Plata/administración & dosificación , Estados UnidosRESUMEN
A patient has been observed with a distinct form of disseminated porokeratosis. During the course of his disease, he developed changes in the porokeratosis lesions that included cellular atypia, dysplasia, and invasive squamous cell carcinoma. One of the squamous cell carcinomas produced regional and disseminated metastases, resulting in the death of the patient. Although malignancy has been previously described in the various types of porokeratosis, this is the first report of disseminated metastases and death in any form of this disease.