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Treatment options for liver metastases (primarily colorectal cancer) are limited by high recurrence rates and persistent tumor progression. Surgical approaches to management of these metastases typically use heat energy including electrocautery, argon beam coagulation, thermal ablation of surgical margins for hemostasis, and preemptive thermal ablation to prevent bleeding or to effect tumor destruction. Based on high rates of local recurrence, these studies assess whether local effects of hepatic thermal injury (HTI) might contribute to poor outcomes by promoting a hepatic microenvironment favorable for tumor engraftment or progression due to induction of procancer cytokines and deleterious immune infiltrates at the site of thermal injury. To test this hypothesis, an immunocompetent mouse model was developed wherein HTI was combined with concomitant intrasplenic injection of cells from a well-characterized MC38 colon carcinoma cell line. In this model, HTI resulted in a significant increase in engraftment and progression of MC38 tumors at the site of thermal injury. Furthermore, there were local increases in expression of messenger ribonucleic acid (mRNA) for hypoxia-inducible factor-1α (HIF1α), arginase-1, and vascular endothelial growth factor α and activation changes in recruited macrophages at the HTI site but not in untreated liver tissue. Inhibition of HIF1α following HTI significantly reduced discreet hepatic tumor development ( P = 0.03). Taken together, these findings demonstrate that HTI creates a favorable local environment that is associated with protumorigenic activation of macrophages and implantation of circulating tumors. Discrete targeting of HIF1α signaling or inhibiting macrophages offers potential strategies for improving the outcome of surgical management of hepatic metastases where HTI is used.

Background: The mechanism of esophageal thermal injury (ETI; esophageal mucosal injury and periesophageal nerve injury leading to gastric hypomotility) remains unknown when using a high-power short-duration (HP-SD) setting. This study sought to evaluate the characteristics of esophageal injuries in atrial fibrillation ablation using a HP-SD setting., Methods: After exclusion of 5 patients with their esophagus at the right portion of left atrium and 21 patients with additional ablations such as box isolation and low voltage area ablation in left atrium posterior wall, 271 consecutive patients (62±10 years, 56 women) who underwent pulmonary vein isolation by radiofrequency catheter ablation were analyzed. In the 101 patients, a HP-SD setting at 45 to 50 W with an Ablation Index module was used (HP-SD group). In the remaining 170 patients before introduction of the HP-SD setting, a conventional power setting of 20 to 30 W with contact force monitoring was used (conventional group). We performed esophagogastroduodenoscopy after pulmonary vein isolation in all patients and investigated the incidence and characteristics of ETI., Results: Although the incidence of ETI was significantly higher in the HP-SD group compared with the conventional group (37% versus 22%, P =0.011), the prevalence of esophageal lesions did not differ between the groups (7% versus 8%). Multivariate logistic regression analysis revealed that the use of the HP-SD setting (odds ratio, 6.09, P <0.001), and the parameters that suggest anatomic proximity surrounding the esophagus, were independent predictors of ETI. However, the majority of ETI in the HP-SD group was gastric hypomotility, and the thermal injury was limited to the shallow layer of the periesophageal wall using the HP-SD setting., Conclusions: Although the use of the HP-SD setting was a strong predictor of ETI, it could avoid deeper thermal injuries that reach the esophageal mucosal layer.

Severe burn injury results in systemic disruption of metabolic regulations and impaired cardiac function. Restoration of hemodynamic homeostasis utilizing intravenous (IV) fluids is critical for acute care of the burn victim. However, the effects of burns and resuscitation on cardiomyocyte mitochondria are currently unknown. The purpose of this study is to determine cardiac mitochondrial function in a swine burn model with subsequent resuscitation using either crystalloids or colloids. Anesthetized Yorkshire swine ( n = 23) sustained 40% total body surface area burns and received IV crystalloids ( n = 11) or colloids ( n = 12) after recovery from anesthesia. Non-burned swine served as controls ( n = 9). After euthanasia at 48 h, heart tissues were harvested, permeabilized, and analyzed by high-resolution respirometry. Citrate synthase (CS) activity was measured, and Western blots were performed to quantify proteins associated with mitochondrial fusion (OPA1), fission (FIS1), and mitophagy (PINK1). There were no differences in state 2 respiration or maximal oxidative phosphorylation. Coupled complex 1 respiration decreased, while uncoupled state 4 O and complex II increased significantly due to burn injury, particularly in animals receiving colloids ( P < 0.05). CS activity and electron transfer coupling efficiency were significantly lower in burned animals, particularly with colloid treatment ( P < 0.05). Protein analysis revealed increased FIS1 but no differences in mitophagy in cardiac tissue from colloid-treated compared with crystalloid-treated swine. Taken together, severe burns alter mitochondrial respiration in heart tissue, which may be exacerbated by early IV resuscitation with colloids. Early IV burn resuscitation with colloids may require close hemodynamic observation. Mitochondrial stabilizing agents incorporated into resuscitation fluids may help the hemodynamic response to burn injury.

Background: Increased smartphone use among minors makes our population more prone to electrical injury. Despite regulations on electrical home safety standards, smartphones and chargers still pose a risk for severe injury among users., Case Presentation: We present a case of a patient with low-voltage electrical burns due to smartphone use in a bathtub. The 13-year-old Caucasian patient was using a smartphone plugged into the electrical grid while taking a bath. We report the burns and their treatment. We discuss the likely burn mechanism., Conclusions: Burn wounds after electrical injury due to smartphone use are rare. The presented case shows the danger of smartphone use in bathtubs.

Rapid repair of vascular injury is an important prognostic factor for electrical burns. This repair is achieved mainly via stromal cell-derived factor (SDF)-1α promoting the mobilization, chemotaxis, homing, and targeted differentiation of bone marrow mesenchymal stem cells (BMSCs) into endothelial cells. Forming a concentration gradient from the site of local damage in the circulation is essential to the role of SDF-1α. In a previous study, we developed reactive oxygen species (ROS)-sensitive PPADT nanoparticles containing SDF-1α that could degrade in response to high concentration of ROS in tissue lesions, achieving the goal of targeted SDF-1α release. In the current study, a rat vascular injury model of electrical burns was used to evaluate the effects of targeted release of SDF-1α using PPADT nanoparticles on the chemotaxis of BMSCs and the repair of vascular injury. Continuous exposure to 220 V for 6 s could damage rat vascular endothelial cells, strip off the inner layer, significantly elevate the local level of ROS, and decrease the level of SDF-1α. After injection of Cy5-labeled SDF-1α-PPADT nanoparticles, the distribution of Cy5 fluorescence suggested that SDF-1α was distributed primarily at the injury site, and the local SDF-1α levels increased significantly. Seven days after injury with nanoparticles injection, aggregation of exogenous green fluorescent protein-labeled BMSCs at the injury site was observed. Ten days after injury, the endothelial cell arrangement was better organized and continuous, with relatively intact vascular morphology and more blood vessels. These results showed that SDF-1α-PPADT nanoparticles targeted the SDF-1α release at the site of injury, directing BMSC chemotaxis and homing, thereby promoting vascular repair in response to electrical burns.

The impact of Pseudomonas aeruginosa biofilm infections in chronic wounds and clinical implication for healing is receiving increased attention. However, the pathophysiology of host/pathogen interplay is not fully understood. By further revealing the mechanisms, necessary new treatment strategies may be identified. Since the background for chronic wounds is diverse, representative animal models are important. We assessed host response and spontaneous wound closure in the relatively resistant C3H/HeN and the susceptible BALB/c mouse strain. Full-thickness burn wounds were inflicted in 108 mice. Pseudomonas aeruginosa biofilm (106 colony forming units) was injected subcutaneously in 72 mice, euthanised day 4, 7 or 10 days post-infection. Wounds were analysed for neutrophil host response markers: S100A8/A9, keratinocyte-derived chemokine and granulocyte-colony stimulating factor. Total peripheral blood leucocyte and polymorphonuclear count were assessed in parallel. Histopathology evaluated wound inflammatory burden. Photoplanimetry described macroscopical wound closure. Stable chronic wound infection was established in all challenged mice. Pseudomonas aeruginosa biofilm suppressed neutrophil host response in wounds. C3H/HeN mice achieved earlier systemic inflammatory control and healed faster than BALB/c mice. Pseudomonas aeruginosa biofilms perturb host defence thereby inducing a steady state of chronic infection which may impair wound healing. These results indicate therapeutic options for immune modulation of biofilm-infected wounds., (© FEMS 2017. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Aims: Longer procedural time is associated with complications in radiofrequency atrial fibrillation ablation. We sought to reduce ablation time and thereby potentially reduce complications. The aim was to compare the dimensions and complications of 40 W/30 s setting to that of high-power ablations (50-80 W) for 5 s in the in vitro and in vivo models., Methods and Results: In vitro ablations-40 W/30 s were compared with 40-80 W powers for 5 s. In vivo ablations-40 W/30 s were compared with 50-80 W powers for 5 s. All in vivo ablations were performed with 10 g contact force and 30 mL/min irrigation rate. Steam pops and depth of lung lesions identified post-mortem were noted as complications. A total of 72 lesions on the non-trabeculated part of right atrium were performed in 10 Ovine. All in vitro ablations except for the 40 W/5 s setting achieved the critical lesion depth of 2 mm. For in vivo ablations, all lesions were transmural, and the lesion depths for the settings of 40 W/30 s, 50 W/5 s, 60 W/5 s, 70 W/5 s, and 80 W/5 s were 2.2 ± 0.5, 2.3 ± 0.5, 2.1 ± 0.4, 2.0 ± 0.3, and 2.3 ± 0.7 mm, respectively. The lesion depths of short-duration ablations were similar to that of the conventional ablation. Steam pops occurred in the ablation settings of 40 W/30 s and 80 W/5 s in 8 and 11% of ablations, respectively. Complications were absent in short-duration ablations of 50 and 60 W., Conclusion: High-power, short-duration atrial ablation was as safe and effective as the conventional ablation. Compared with the conventional 40 W/30 s setting, 50 and 60 W ablation for 5 s achieved transmurality and had fewer complications., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2016. For permissions please email: journals.permissions@oup.com.)

In forensic practice, determination of electrocution as a cause of death usually depends on the conventional histological examination of electrical mark in the body skin, but the limitation of this method includes subjective bias by different forensic pathologists, especially for identifying suspicious electrical mark. The aim of our work is to introduce Fourier transform infrared (FTIR) spectroscopy in combination with chemometrics as a complementary tool for providing an relatively objective diagnosis. The results of principle component analysis (PCA) showed that there were significant differences of protein structural profile between electrical mark and normal skin in terms of α-helix, antiparallel β-sheet and β-sheet content. Then a partial least square (PLS) model was established based on this spectral dataset and used to discriminate electrical mark from normal skin areas in independent tissue sections as revealed by color-coded digital maps, making the visualization of electrical injury more intuitively. Our pilot study demonstrates the potential of FTIR spectroscopy as a complementary tool for diagnosis of electrical mark., Competing Interests: The authors have declared that no competing interests exist.

Endothelial-to-mesenchymal transition (EndMT) has been implicated in a variety of aberrant wound healing conditions. However, unambiguous evidence of EndMT has been elusive due to limitations of in vitro experimental designs and animal models. In vitro experiments cannot account for the myriad ligands and cells which regulate differentiation, and in vivo tissue injury models may induce lineage-independent endothelial marker expression in mesenchymal cells. By using an inducible Cre model to mark mesenchymal cells (Scx-creERT/tdTomato + ) prior to injury, we demonstrate that musculoskeletal injury induces expression of CD31, VeCadherin, or Tie2 in mesenchymal cells. VeCadherin and Tie2 were expressed in non-endothelial cells (CD31-) present in marrow from uninjured adult mice, thereby limiting the specificity of these markers in inducible models (e.g. VeCadherin- or Tie2-creERT). However, cell transplantation assays confirmed that endothelial cells (ΔVeCadherin/CD31+/CD45-) isolated from uninjured hindlimb muscle tissue undergo in vivo EndMT when transplanted directly into the wound without intervening cell culture using PDGFRα, Osterix (OSX), SOX9, and Aggrecan (ACAN) as mesenchymal markers. These in vivo findings support EndMT in the presence of myriad ligands and cell types, using cell transplantation assays which can be applied for other pathologies implicated in EndMT including tissue fibrosis and atherosclerosis. Additionally, endothelial cell recruitment and trafficking are potential therapeutic targets to prevent EndMT.

Decades after the problem was first identified, power line electrocution continues to be a cause of avian mortality. Currently, several federal laws protect eagles and other migratory birds, meaning that utility companies may be liable for electrocution-related deaths. Veterinarians and veterinary pathologists called upon to diagnose and treat electrocuted birds should keep this in mind when conducting clinical and postmortem examinations. This review details necropsy findings and methods used to diagnose electrocution. A combination of gross, subgross, and radiographic examinations can aid in identification of subtle injury. Diagnosis is made based on the presence of skin and/or feather burns. Other necropsy findings may include skin lacerations, subcutaneous burns, bruising, limb avulsion, hemopericardium, and vascular rupture. At the US Fish and Wildlife Service's National Forensics Laboratory, from 2000 to 2015, 417 raptor deaths were determined to have been caused by electrocution. Bald eagles and golden eagles were the most commonly submitted species. In a retrospective review of 377 cases, for which whole bodies were submitted, 18% of the electrocuted birds had only a single, small (less than 3 cm in diameter) external burn. Small, isolated burns tended to occur on the undersides of the wings at and distal to the elbow and on the lower legs and feet. These areas should be most carefully examined in cases where electrocution injury is not immediately apparent., (© The Author(s) 2016.)

Electrical injuries in animals occur most often accidentally. They comprise contact to various forms of currents, including alternating, rotary, or direct currents. Depending on various parameters of the current (including the type of circuit, voltage, current and duration of exposure) and conditions of the animal (such as wet or dry hair coat and pathway of current through the body), lesions may be absent or may include early or localized development of rigor mortis, signs of acute circulatory failure, or severe thermoelectrical burns. Such burns may present as external current marks, singed hair or feathers, metallization of the skin, or occasionally internal electroporation injury resulting in muscle necrosis, hemolysis, vascular damage with thrombosis, injury to brain and spinal cord, or skeletal fractures. Furthermore, lightning strikes occur regularly in grazing animals, which have greater risk of death from step potentials (ground current) in addition to direct strike and contact injury. Such cases may have no lesions, external signs of linear or punctate burns, keraunographic markings, or exit burns on the soles of the hooves or the coronary bands. Besides detailed information about the circumstances at the location where the animal was found, electrical injuries in animals require a thorough morphological workup, including additional investigations in conjunction with certain knowledge about the possible lesion spectrum., (© The Author(s) 2016.)

Successful reconstruction of extensive anterior chest wall defect following major electrical burn represents a very challenging surgery. Herein we report the first case using pedicled full-thickness abdominal flap combined with skin grafting to treat this injury with severe infection and exposure of pericardium and ribs in a Chinese patient. Following the performance of chest debridement to remove necrotic and infected tissues and the injection of broad-spectrum antibiotics to reduce infection, a pedicled full-thickness abdominal flap was used to cover the exposed pericardium and ribs, and skin grafting from the right leg of the patient was done to cover the exposed vital tissues. The patient was followed up for a total of 3·5 years, and satisfactory cosmetic and functional outcomes were obtained without complications. This report provides an effective method for the surgeons who encounter similar cases where reconstruction of extensive anterior chest wall is required., (© 2013 The Authors. International Wound Journal © 2013 Medicalhelplines.com Inc and John Wiley & Sons Ltd.)

The aim of the present study was to investigate the thermal injury in the liver after a minimally invasive electrosurgery technique with a copper-doped diamond-like carbon (DLC-Cu) surface coating. To effectively utilize electrosurgery in a clinical caner setting, it is necessary to suppress the thermal injury to adjacent tissues. The surface morphologies of DLC-Cu thin films were characterized using scanning electron microscopy and transmission electron microscopy. Three-dimensional liver models were reconstructed using magnetic resonance imaging to simulate the electrosurgical procedure. Our results indicated that the temperature decreased significantly when minimally electrosurgery with nanostructured DLC-Cu thin films was used, and that it continued to decrease with increasing film thickness. In an animal model, thermography revealed that the surgical temperature was significantly lower in the minimally invasive electrosurgery with DLC-Cu thin film (DLC-Cu-SS) compared to untreated electrosurgery. In addition, DLC-Cu-SS created a relatively small thermal injury area and lateral thermal effect. These results indicated that the biomedical nanostructure coating reduced excessive thermal injury, and uniformly distributed temperature in the liver.

The burn effects in high-voltage electrocutions are manifold ranging from inconspicuous marks to deep charring. Apart from lesions caused by direct contact with a live conductor, the victim's body may suffer flash burns from arcing resulting in extensive scattered or confluent heat damage of the skin. In such cases, the nail plates of fingers and toes may undergo thermal changes which up to now have not been mentioned in the pertinent literature. Macroscopically, the nail shows a yellowish discoloration with tiny and closely arranged verruciform elevations. Histologically, the uppermost layer of the nail plate is interspersed with small vacuoles resembling micro-blisters as seen in the corneal layer of common electric marks. The surface of the nail is coated with a thin film of carbonaceous material. Based on an accidental high-voltage electrocution recently observed by the authors, attention is also drawn to the possible occurrence of contact burns from metal objects heated by the current as this finding is usually described only in victims of lightning strikes and not in the context of high-voltage discharges of technical electricity., (Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.)

Composite facial allotransplantation is emerging as a treatment option for severe facial disfigurements. The technical feasibility of facial transplantation has been demonstrated, and the initial clinical outcomes have been encouraging. We report an excellent functional and anatomical restoration 1 year after face transplantation. A 59-year-old male with severe disfigurement from electrical burn injury was treated with a facial allograft composed of bone and soft tissues to restore midfacial form and function. An initial potent antirejection treatment was tapered to minimal dose of immunosuppression. There were no surgical complications. The patient demonstrated facial redness during the initial postoperative months. One acute rejection episode was reversed with a brief methylprednisolone bolus treatment. Pathological analysis and the donor's medical history suggested that rosacea transferred from the donor caused the erythema, successfully treated with topical metronidazol. Significant restoration of nasal breathing, speech, feeding, sensation and animation was achieved. The patient was highly satisfied with the esthetic result, and regained much of his capacity for normal social life. Composite facial allotransplantation, along with minimal and well-tolerated immunosuppression, was successfully utilized to restore facial form and function in a patient with severe disfigurement of the midface., (©2011 The Authors Journal compilation©2011 The American Society of Transplantation and the American Society of Transplant Surgeons.)

Steam pop and intramural charring have been reported during cooled-tip radiofrequency catheter ablation (RFCA). We studied the feasibility of temperature-controlled cooled-tip RFCA in the canine heart.An internally cooled ablation catheter was inserted into the left ventricle. A custom-made radiofrequency (RF) generator capable of controlling the tip-temperature at the preset level by slow increases in the power was used. Temperature-controlled cooled-tip RF applications were performed at a target temperature of 40 degrees C for 90 seconds. Acute study: Intramyocardial temperature was measured at the ablation site in 10 dogs by inserting a fluoroptic probe. Chronic study: Lesion depth and volume were measured in 5 dogs after 3 weeks of survival. In the acute study, no pop or abrupt impedance rise was observed. Maximum intramyocardial temperature was 72.4 + or - 14.4 degrees C at 2-4 mm above the endocardium. No coagulum formation, craters, or intramural charring were observed. Maximum lesion depth was 6.7 + or - 1.5 mm, and lesion volume was 404 + or - 219 mm3. In the chronic study, maximum lesion depth was 5.9 + or - 1.1 mm, and lesion volume was 281 + or - 210 mm(3).Temperature controlled RFCA is feasible with a cooled-tip catheter and an RF generator that slowly increases the RF power until the preset catheter-tip temperature is reached.

The morphology of burn injuries in 120 consecutive patients from the Department of Plastic and Reconstructive Surgery, CHR, Hospital B in Lille was correlated to the etiology and type of heat. Analysis identified five typical patterns of cutaneous burn injuries. Jet of flame-pattern from methylated spirits and gasoline detonations: superficial burn injuries; sparing of skin wrinkles and the submental region; absence or small amounts of soot; preference of exposed body regions, esp. the face and hands. Explosion-pattern from explosions and electrothermal injuries: superficial burn injuries; sparing of skin wrinkles but not of the submental region; soot; preference of exposed body regions. Alveolar soot arrangement and metallisation in electrothermal injuries. Considerable third-degree burns in dust explosions. Flame-pattern from direct flame effects due to burning gasoline or oil, open fires or ignited clothing: nonuniform depth including large third-degree burns; no sparing of the submental region; soot; preference of body regions covered by clothing. Immersion-pattern: superficial (bullous) injuries; blurred junction between scalded and unscalded areas; extremities, buttocks, and back are favourite sites; cave child abuse: waterlines and zebra-burns. Spilling-pattern: superficial injuries; sharp junction between scalded and unscalded areas; head, anterior trunk, and upper extremities are favourite sites; running off and splashing stains. Consideration of these patterns can assist the reconstruction in fire investigations or unclear scaldings. In cases of suspected arson, a typical burn injury pattern or a single finding not compatible with the rest of the pattern can disprove a suspect or raise the level of suspicion.

Background: Left atrioesophageal fistula is a rare but devastating complication that may occur after catheter ablation of atrial fibrillation. We used capsule endoscopy to assess esophageal injury after catheter ablation for atrial fibrillation in a population randomized to undergo general anesthesia or conscious sedation., Methods and Results: Fifty patients undergoing atrial fibrillation ablation for paroxysmal symptomatic atrial fibrillation refractory to antiarrhythmic drugs were enrolled and randomized, including those undergoing the procedure under general anesthesia (25 patients, group 1) and those receiving conscious sedation with fentanyl or midazolam (25 patients, group 2). All patients underwent esophageal temperature monitoring during the procedure. The day after ablation, all patients had capsule endoscopy to assess the presence of endoluminal tissue damage of the esophagus. We observed esophageal tissue damage in 12 (48%) patients of group 1 and 1 esophageal tissue damage in a single patient (4%) of group 2 (P<0.001). The maximal esophageal temperature was significantly higher in patients undergoing general anesthesia (group 1) versus patients undergoing conscious sedation (group 2) (40.6+/-1 degrees C versus 39.6+/-0.8 degrees C; P< 0.003). The time to peak temperature was 9+/-7 seconds in group 1 and 21+/-9 seconds in group 2, and this difference was statistically significant (P<0.001). No complication occurred during or after the administration of the pill cam or during the procedures. All esophageal lesions normalized at the 2-month repeat endoscopic examination., Conclusions: The use of general anesthesia increases the risk of esophageal damage detected by capsule endoscopy.

The aim of this study was to reveal histopathological features for differential diagnosis of skin lesions caused by electrocution, flames and abrasions. Based on the causes of the lesions, cases were assigned into three groups. Group 1 included 30 deaths from electric shock. Group 2 included 30 individuals with flame burns who died in the fires. Group 3 included 30 deaths from traffic accidents, from which the individuals had abrasions. Data from the crime scene investigations and macroscopic and microscopic findings from the autopsies allowed determination of the cause of death in all cases. The features of the lesions examined under the light microscope were intraepidermal separation, subepidermal (dermoepidermal) separation, coagulation necrosis in the epidermis, nuclear elongation in the epidermis, dark-staining epidermal nucleus, depth of homogenization in the dermis, and nuclear elongation in the epithelium of hair follicles. A significantly high rate of electrical lesions had intraepidermal separation. The rate of subepidermal separation was slightly more significant in flame burns. A significantly higher rate of electrical lesions had both intraepidermal and subepidermal separation. The rate of coagulation necrosis in the epidermis was significantly the highest in electrical lesions. Although the severity of nuclear elongation was the most significant in electrical lesions, varying degrees of nuclear elongation in the epidermis were present in all three groups. Dark staining of the epidermal nuclei was present in all lesions except for one electrical lesion, though the severity of staining was significant in the abrasion group. The depth of homogenization was slightly more significant in the abrasion group. The rate of nuclear elongation in the epithelium of the hair follicles was significantly lower in the abrasion group. The results of this study revealed that certain morphological changes determined under a light microscope could help the differential diagnoses of electrical lesions, flame burns and abrasions.

Background: Leptin is a potent direct angiogenic factor that stimulates endothelial cell migration and activation in vitro and angiogenesis in vivo. In addition, leptin has been discussed to play an important role in angiogenesis, as it promotes the formation of new blood vessels., Purpose: The effect of exogenously administered leptin on the healing process of a full tissue burn wound model., Methods: Sixty-three Sprague-Dawley male rats were used. Full tissue burn wound was created by electrocautery. The width of the pin was 0.3 cm; its length was 2 cm and was used at the "cut" modulation. Rats were divided into seven groups of nine animals each. Burn wounds were injected with murine recombinant leptin and the rats were sacrificed 3, 7 and 9 days after surgery. Every group had obtained three animals for the three different days of sacrifice. Three different leptin doses of 250 pg/ml, 500 pg/ml and 1000 pg/ml were used in different animal groups (A, B and C). For every one of the three leptin doses used, another animal group was evaluated by using the combined injection of leptin and antileptin (A1, B1, and C1), in order to study the inhibitory effect to the leptin factor. Nine rats were served as controls. These were injected with 0.3 ml water for injection solution and sacrificed at the same time intervals. After sacrifice of the animals, the skin was grossly determined by its appearance, colour and texture. Full thickness burn wounds were dissected for histological examination. A qualitative analysis of angiogenesis in the burn wound was conducted following a standard hematoxylin and eosin stain. The wound tissue samples from each experimental group underwent immunohistochemical evaluation of microvessel density by endothelial cell staining with mouse anti-rat CD 34 monoclonal antibody., Results: The most impressive growth of new blood vessels appeared seven and nine days after treatment with the highest leptin doses. There were no significant differences in microvessel density between the seventh and the ninth postoperative day among different groups treated with leptin. All wounds from the control group, as well as those from animal groups treated with the combined injection of leptin and antileptin did not develop any new vessels., Conclusion: Exogenous administration of recombinant leptin increases early tissue angiogenesis in the burn wound level of an experimental animal model.

The pathological and histopathological examination of two female roe deer found dead after a severe thunderstorm is described. One of the two roe deer was killed by a direct hit of atmospheric flash, while the other animal, lying 1.5 m from the first one, died as a consequence of ground current strike. The major part of the coat and skin of the animal that was killed by a direct hit was covered with scorched streaks. The trachea and bronchi of both animals contained a considerable amount of aspirated light-red foam. Necropsy revealed diffuse haemorrhages over the epicardium of the right atrium with a diameter of 1 millimetre. The liver and the kidney exhibited severe congestion.

A case of burn injury to lips and cheek mucosa is reported who developed severe contracture of cheek mucosa leading to inability to open mouth. Patient was misdiagnosed as a case of temporomandibular ankylosis and was managed on those lines to no relief. When the contracture was released and soft tissue defect repaired with nasolabial flap, patient gained near normal mouth opening.

Previously, electrical injuries have been suggested caused only by the concomitant heat developed during the passage of an electrical current. Recent experimental studies on fully anesthetized pigs and the study of one human case have, however, shown typical electrical alterations. The purpose of the present study was further to evaluate the histology of electrically induced changes in the skin in humans. In addition, supplementary in vivo methods for evaluation of skin changes as high-frequency ultrasound and Raman spectroscopy were used. The skin of 11 patients treated with a defibrillation of the heart was examined for macroscopic changes, the skin of eight of them also for histologic changes and for changes observable via supplementary methods. Immediately and 7 days after the defibrillation, fractions of a narrow red ring were observed along the periphery of the tin-foil electrode. Epidermis showed signs previously observed following electrical influence: segmental alterations often related to the openings of sweat ducts, darkstaining or "empty" nuclei and homogeneous cytoplasm, eosinophilic or pale. Dermis did not show the specific sign of electrical influence: deposits of calcium salts on dermal fibres, neither via histologic examination nor via high-frequency ultrasonography and Raman spectroscopy. Fractions of a narrow red ring along the periphery of the electrode showing histological signs of electric influence in epidermis thus appear to be characteristic of high voltage electrical injury.

Fatalities caused by electrocution (n = 37) were re-examined on the basis of the autopsy records, the police reports and the technical expertise. Accidents including two lightning deaths caused 2/3rd and suicides 1/4th of the fatalities and there were two homicides. Carelessness or ignorance were a major reason for accidental deaths while technical defects could be verified in five cases only. Low-voltage ac and male victims predominated. Electrical burns or current marks were detected in 81% including all high voltage electrocutions. The seven victims lacking burns were electrocuted in a wet environment including six cases of suicide in the bathtub with a hair drier. Petechial haemorrhages were present in 74% of the cases and the favourite sites were the skin of the eyelids, conjunctivae, visceral pleura, and the epicard. The presence of petechiae did not depend on the voltage or the current pathway relative to the heart. It is, therefore, suggested that the petechiae are not caused by asphyxia but by a combination of venous congestion due to cardiac arrest and a sudden rise in blood pressure induced by muscle contractions. Consequently, "electrical petechiae" represent a non-specific but typical finding in electrocution irrespective of the mechanism leading to death. Unlike electrical burns, petechiae also indicate the vital origin of the events. The relevance of this typical morphological sign in the examination of possible electrocution fatalities is therefore emphasised., (Copyright 2002 Elsevier Science Ireland Ltd.)

A case of electrically induced cataract in both eyes in a 12-year-old boy, after a high-voltage electric shock, is reported. He sustained skin burns on the neck, chest, abdomen, and inner left arm. The cataract developed first in the left eye and later on in the right eye. The child regained normal vision in both eyes after cataract extraction and aphakic correction with spectacles. The need for awareness of the possibility of this complication and screening of all cases of electrical injuries is stressed. The majority of cases respond well to surgery, but final visual acuity will depend on the other ocular damage due to electrical current. The clinical features and pathogenesis of this condition are briefly reviewed.

The combined scapular parascapular flap was used for coverage of six high voltage electrical burn defects of upper extremity. The flaps resurfaced the exposed tendon, nerve, bone or blood vessels on the volar and dorsal side of the distal forearm and the hand. In all cases successful soft tissue coverage and wound healing was achieved. After the stabilisation of the wounds, secondary reconstructive procedures, such as nerve grafting, tendon grafting, tendon transfers were performed. Nerve healing and tendon gliding was found to be successful under the flap.

The pathogenesis and pathophysiologic features of electrical injury are more complex than once thought. The relative contributions of thermal and pure electrical damage depend on the duration of electric current passage, the orientation of the cells in the current path, their location, and other factors. If the contact time is brief, nonthermal mechanisms of cell damage will be most important and the damage is relatively restricted to the cell membrane. When contact time is much longer, however, heat damage predominates and the whole cell is affected directly. These parameters also determine the anatomic tissue distribution of injury. Damage by Joule heating is not known to be dependent on cell size, whereas larger cells are more vulnerable to membrane breakdown by electroporation. Cells do survive transient plasma membrane rupture under appropriate circumstances or if therapy is instituted quickly. If membrane permeabilization is the primary cellular pathologic condition, then injured tissue may be salvageable and the challenge for the future is to identify a technique to reseal the damaged membranes promptly. Present standards of care for electrical injury require a fully staffed and well-equipped intensive care unit, available operating suites, and the availability of the full range of medical specialists. Major teaching hospitals with burn centers may be the ideal setting for the treatment of an electrical trauma victim. After the initial resuscitation, efforts are directed primarily towards preventing additional tissue loss mediated through the compartment syndrome, compressive neuropathies, or the presence of necrotic tissue. Renal and cardiac failure caused by the release of intracellular muscle contents into the circulation must be prevented. Attention can then be directed towards maximizing tissue salvage and preventing late skeletal and neuromuscular complications. Reconstructive procedures that transfer healthy tissue from a distance are necessary to optimize the functional value of the remaining tissue. Finally, unless the patient is rehabilitated psychologically, the real benefit from other sophisticated care will not be fully realized. These goals are important throughout the acute care of the patient. In the future, new guidelines for treating electrical trauma will be based on a clearer understanding of the relevant pathophysiologic features. These strategies will rely on improved diagnostic imaging and on reversing the fundamental problem of cell membrane damage. Moreover, complex biochemical and organ system pathophysiologic interactions will require careful management. If successful, research efforts presently underway should improve the prognosis of victims after electrical trauma.

It is not uncommon for sympathetically maintained pain (SMP) to follow electric burns at the site of current entry. The occurrence of SMP at the exit point has not been reported. This report describes a patient who was exposed transiently to a 220W electrical current. After a delay of 3 months, the typical manifestations of SMP appeared on the right hand (entry point); symptoms appeared on the left foot (exit point) after 11 months. Ultrasonography was helpful in identifying the bony and soft tissue changes that occurred with SMP. Serial sympathetic blocks, oral phenytoin, and an intensive physical rehabilitation program were useful in treating this electrically induced SMP.

In two patients undergoing open heart operations, electrochemical burns developed at the sites of connection to an external pacing system. Investigation revealed that failure of the pacing generator caused a small, continuous, direct current to pass through the patients, resulting in electrolysis at the sites of contact with the pacing and grounding wires. This electrolytic reaction was recreated in a mock pacing system and resulted in tissue injury and disintegration of the pacing wire. Guidelines to help recognize and prevent this complication are presented.

The morphology of pig skin after electrical (el) and thermal exposure was studied in order to find methods applicable for disclosing electrical torture. Biopsies from pig skin exposed 24 hours earlier to either heat or electrical current under general anesthesia were studied by light microscopy. The amount of energy used of either type ranged from about 6 to about 100 joule deposited on two circular areas of the skin measuring 12 mm in diameter. In sections stained with hematoxylin and eosin alterations were found in heat-influenced specimens following the administration of moderate and large doses of energy. Changes were observed in el-influenced specimens also after the administration of low amounts of energy, which did not lead to macroscopical changes in the skin. The two types of energy induced different patterns of alterations inside the epidermis. The most characteristic change following heat exposure was the presence of a granular or fibrillar eosinophilic cytoplasm and subepidermal clefts, while el-expoure often produced white homogeneous cytoplasm and shadowy nuclei ("white necrosis") in the attached epidermis. The individual changes could be produced by both types of injury, but to a highly different degree. However, the alteration classified as "vesicular nuclei" was only observed observed in el-damaged skin. The dermis from the more severely injured skin of both groups showed a homogeneous appearance ("necrosis"). While the changes of epidermis and dermis in response to heat were diffusely distributed, the changes created by electrical injury were often present in segments. By electrical damage homogeneous areas with loss of stainability and shadowy nuclei were occasionally observed in sweat glands, hair sheaths and in vessel walls, structures which are suggested to serve as conductors for the electrical current. "Vesicular nuclei" were observed in similar structures. Some of the findings may be associated with differences in intensity of energy during exposure to heat and electricity. Furthermore, the existence of different biological patterns following the two types of exposure should be considered. The studies are being continued to elucidate these basic questions, and to study further the medical diagnostic potential of examining skin biopsies from tortured individuals.

Deposition of calcium salts on collagen fibres has been shown to occur in cathode areas from 2 days to 2 months after exposure to direct current (d.c.) via contact knobs measuring 12 mm in diameter using energy level from 0.5 to 96 J and on day 7 after exposure to alternating current (a.c.) via pointed electrodes using energy level from 30 to 50 J. In order to determine the statistical relation of this histological observation to the type of energy applied 1095 biopsies from 49 pigs including biopsies from skin areas exposed to heat, 50 Hz a.c., 100 kHz a.c. and d.c. as well as from unexposed skin were examined. The specificity was 1.0 using calcium deposition as the test criterium. The sensitivity for cathode areas was found to vary from 0.52 to 1.0 depending on the biopsy technique and the number of days after exposure. Calcium salts on collagen fibres seem uniformly to be present in the cathode area from day 4 to 7, the positive test answer being depending on the biopsy technique. For 50 Hz a.c. the sensitivity using a pointed electrode was found to vary from 0.08 to 0.27 dependent on the number of days after exposure. For all other types of energy the sensitivity was 0.

In order to find methods applicable for disclosing electrical torture, pig skin was exposed to heat and electricity under controlled circumstances. Biopsies were obtained immediately after exposure and the morphology of the heat lesions was compared to that of electrical lesions. The cytoplasm of epidermal cells in heat lesions appeared granular or fibrillar, while the nuclei were rather unaffected. In electrical lesions the cytoplasm appeared homogeneous often with a peculiar white colour in hematoxylin-eosin stained sections. The nuclei were either dark and shadowy or enlarged and vesicular. The keratin in electrical lesions often showed a bright yellow colour. Small defects in the epidermis were seen in some electrical lesions. Thus the morphology of electrical lesions differed markedly from that of heat lesions. Although some of these differences may be due to differences in distribution and intensity of energy, it is probable that pH shifts in the cells due to electrolysis is the main cause of the specific morphology of electrical lesions.

Two cases of fatal accidental electrocution involving high-tension cables are reported in which autopsy revealed the presence of flash burns and, more significantly, multiple circumscribed and cavitated lesions associated with arcing. Attention is drawn to the danger of 'near-contact' with high-tension cables. The autopsy findings of severe internal injuries, which may be associated with the blast of the electrical discharge or occur secondary to a fall are discussed. In the absence of an adequate history, the autopsy findings may help to elucidate more accurately the circumstances of death and the type of electrical injury involved in fatal electrocution.

In order to find methods applicable for disclosing electrical torture, pig skin was exposed to heat and electricity under controlled circumstances. Biopsies for electron microscopy were obtained immediately after exposure. In heat lesions the nuclei were slightly distorted, sometimes with broken nuclear membranes. The tonofilaments were clumped, intracellular oedema was present and cell membranes were ruptured between desmosomes. In electrical lesions the nuclei were usually enlarged with strongly condensed chromatin. Some nuclei were composed of fine, evenly dispersed granular material. The cytoplasm appeared homogeneous, in large magnification finely granular. Cell borders could sometimes be identified located in situ. In the stratum corneum, which appeared normal in heat lesions, single or several cells or large areas had an electron-dense appearance. The difference in ultrastructure of heat and electrical lesions makes it probable that electricity has a specific action on epidermal cells.