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Recurrence of psoriasis 30 weeks after initiation of ustekinumab (PASI, 9.8). B, Patient 1. PASI 75 after combining 17 sessions of narrowband UV-B therapy (12.9<span class="elsevierStyleHsp" style=""></span>J/cm<span class="elsevierStyleSup">2</span>) with ustekinumab (PASI, 2.1). PASI indicates Psoriasis Area and Severity Index.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "P. Soro Martínez, I. Belinchón Romero, M.P. Arribas Granados" "autores" => array:3 [ 0 => array:2 [ "nombre" => "P." "apellidos" => "Soro Martínez" ] 1 => array:2 [ "nombre" => "I." "apellidos" => "Belinchón Romero" ] 2 => array:2 [ "nombre" => "M.P." "apellidos" => "Arribas Granados" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S000173101300207X" "doi" => "10.1016/j.ad.2013.03.007" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S000173101300207X?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219014000328?idApp=UINPBA000044" "url" => "/15782190/0000010500000002/v1_201403090058/S1578219014000328/v1_201403090058/en/main.assets" ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letter</span>" "titulo" => "Sevoflurane: A Valid Alternative for the Treatment of Vascular Ulcers?" "tieneTextoCompleto" => true "saludo" => "<span class="elsevierStyleItalic">To the Editor:</span>" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "202" "paginaFinal" => "203" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "R.F. Lafuente-Urrez, Y. Gilaberte" "autores" => array:2 [ 0 => array:4 [ "nombre" => "R.F." "apellidos" => "Lafuente-Urrez" "email" => array:2 [ 0 => "fati1997@gmail.com" 1 => "rfz97@yahoo.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Y." "apellidos" => "Gilaberte" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital Reina Sofía, Tudela, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital San Jorge, Huesca, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Sevoflurano, ¿una alternativa en el tratamiento de las úlceras vasculares?" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Vascular ulcers are a major health problem because of their frequency, chronic nature, and high recurrence rate. The standard treatment, which consists of cleansing, debridement, and application of dressings, achieves cure rates of 65% to 85%.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The approaches used to accelerate scarring of these ulcers include dressings (biologic, synthetic, or biosynthetic), human amniotic membrane transplantation,<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> and autologous platelet-rich plasma.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Options for analgesia to control the pain associated with vascular ulcers include topical anesthetics such as the creams Emla (lidocaine and prilocaine) and Lambdalina (lidocaine), oral analgesics, and even opiates. These products aid in the healing process and in pain control, although they can produce undesirable effects.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Sevoflurane is an inhaled general anesthetic from the halogenated ether family that is indicated for induction and maintenance of general anesthesia during hospital or outpatient surgery.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Its analgesic effect is both central<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> and peripheral,<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5-7</span></a> although it has traditionally been thought that halogenated anesthetics lack a peripheral analgesic effect.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Topical sevoflurane has been reported to be effective in the treatment of long-standing venous ulcers<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> and ischemic ulcers<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> that are refractory to standard treatment; when irrigated topically over the painful ulcer bed, it produces a rapid, intense, and lasting analgesic effect, with a suitable safety profile that is well accepted by patients. In addition, it significantly reduces the size of the ulcer and the time necessary for epithelialization.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5-7</span></a> Its effect can be so intense that it is even possible to perform surgical debridement without the need for further analgesia.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Similarly, it has been suggested that direct application of sevoflurane has an antimicrobial effect on ulcers that are superinfected by multiresistant <span class="elsevierStyleItalic">Pseudomonas aeruginosa</span>,<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> and a bactericidal effect has been reported in vitro against <span class="elsevierStyleItalic">Staphylococcus aureus</span>, <span class="elsevierStyleItalic">P. aeruginosa</span>, and <span class="elsevierStyleItalic">Escherichia coli</span>.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Sevoflurane (Sevorane) is marketed as a colorless volatile liquid with no additives or preservatives in a 250-mL amber-colored polyethylene naphthalate bottle with a safety cap and a filling adapter. Each milliliter of liquid contains 1<span class="elsevierStyleHsp" style=""></span>mL of sevoflurane (INN). It should be kept at room temperature and protected from sunlight.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Once the ulcer has been cleansed with saline solution, sevoflurane is applied directly on the ulcer bed, ensuring that the liquid is distributed throughout the tissue and taking care that it does not come into contact with the surrounding healthy skin. It is necessary to wait 2<span class="elsevierStyleHsp" style=""></span>minutes before applying standard wound care<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6,7</span></a> and placing the dressing. A compression bandage should also be applied when necessary.</p><p id="par0045" class="elsevierStylePara elsevierViewall">To date, 12 patients have been treated with topical sevoflurane, and 2 of these cases have been published.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5,6</span></a> The case of an immunodepressed patient with a postsurgical wound superinfected by multiresistant <span class="elsevierStyleItalic">P. aeruginosa</span> who was cured after several applications of sevoflurane is pending publication.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> At the 17<span class="elsevierStyleSup">th</span> Annual Meeting of the European Society of Regional Anesthesia in Barcelona in October 2011, a series of 9 patients was presented (6 women and 3 men with diabetes). The patients had painful venous ulcers on the lower limbs that were refractory to regular analgesics and were treated with sevoflurane on an outpatient basis to control the pain.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> In all cases, the reduction in pain at rest was rapid (less than 2 minutes), intense (7.4<span class="elsevierStyleHsp" style=""></span>[0.5] to 2.1<span class="elsevierStyleHsp" style=""></span>[0.6] points with the first application and 7.2<span class="elsevierStyleHsp" style=""></span>[1.3] to 1.1<span class="elsevierStyleHsp" style=""></span>[0.6] points with all of the remaining 67 applications), and lasting (from 7 to 16<span class="elsevierStyleHsp" style=""></span>hours). The ulcers were cured in 4 cases.</p><p id="par0050" class="elsevierStylePara elsevierViewall">The risk-benefit ratio of sevoflurane has proven very favorable to date.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6,7</span></a> The only undesirable effects of topical application are pruritus at the borders of the wound and irritation of the surrounding skin with repeated applications.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Sevoflurane has not been reported to have sensitizing potential. Similarly, local irrigation with sevoflurane was well tolerated in patients with heart disease.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5-7</span></a> Systemic absorption of sevoflurane applied to an ulcer involving circulatory compromise is thought to be slow and incomplete,<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> although blood levels have not been measured in patients treated with this procedure.</p><p id="par0055" class="elsevierStylePara elsevierViewall">The mechanism underlying the analgesic, epithelializing, and antimicrobial effects of sevoflurane remains unknown. Inhaled sevoflurane has no peripheral analgesic effect<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a>; however, topical or subcutaneous administration does produce a peripheral effect.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> When a halogenated agent is inhaled, the partial pressure reached in the peripheral nociceptors may not be sufficient to block transmission of a painful stimulus; however, with direct application, the nociceptors are exposed to sufficient partial pressure to block transmission of painful stimuli.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">In conclusion, topical sevoflurane could prove to be a promising strategy for analgesia and epithelialization in the treatment of vascular ulcers.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Lafuente-Urrez RF, Gilaberte Y. 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Year/Month | Html | Total | |
---|---|---|---|
2024 November | 8 | 9 | 17 |
2024 October | 72 | 49 | 121 |
2024 September | 66 | 27 | 93 |
2024 August | 89 | 63 | 152 |
2024 July | 84 | 31 | 115 |
2024 June | 77 | 35 | 112 |
2024 May | 77 | 51 | 128 |
2024 April | 77 | 24 | 101 |
2024 March | 68 | 20 | 88 |
2024 February | 64 | 27 | 91 |
2024 January | 58 | 34 | 92 |
2023 December | 60 | 14 | 74 |
2023 November | 78 | 34 | 112 |
2023 October | 79 | 21 | 100 |
2023 September | 84 | 27 | 111 |
2023 August | 53 | 18 | 71 |
2023 July | 50 | 32 | 82 |
2023 June | 52 | 23 | 75 |
2023 May | 54 | 27 | 81 |
2023 April | 52 | 26 | 78 |
2023 March | 54 | 21 | 75 |
2023 February | 47 | 24 | 71 |
2023 January | 52 | 32 | 84 |
2022 December | 53 | 69 | 122 |
2022 November | 28 | 32 | 60 |
2022 October | 38 | 29 | 67 |
2022 September | 45 | 42 | 87 |
2022 August | 88 | 34 | 122 |
2022 July | 35 | 45 | 80 |
2022 June | 33 | 38 | 71 |
2022 May | 72 | 39 | 111 |
2022 April | 63 | 36 | 99 |
2022 March | 53 | 46 | 99 |
2022 February | 40 | 35 | 75 |
2022 January | 72 | 34 | 106 |
2021 December | 37 | 39 | 76 |
2021 November | 46 | 42 | 88 |
2021 October | 49 | 66 | 115 |
2021 September | 41 | 44 | 85 |
2021 August | 38 | 40 | 78 |
2021 July | 35 | 32 | 67 |
2021 June | 39 | 36 | 75 |
2021 May | 33 | 34 | 67 |
2021 April | 93 | 42 | 135 |
2021 March | 95 | 30 | 125 |
2021 February | 81 | 31 | 112 |
2021 January | 56 | 27 | 83 |
2020 December | 65 | 11 | 76 |
2020 November | 35 | 20 | 55 |
2020 October | 49 | 16 | 65 |
2020 September | 50 | 18 | 68 |
2020 August | 44 | 19 | 63 |
2020 July | 38 | 18 | 56 |
2020 June | 60 | 42 | 102 |
2020 May | 52 | 18 | 70 |
2020 April | 40 | 17 | 57 |
2020 March | 50 | 16 | 66 |
2020 February | 10 | 0 | 10 |
2019 December | 8 | 8 | 16 |
2019 November | 4 | 7 | 11 |
2019 October | 0 | 7 | 7 |
2019 September | 4 | 13 | 17 |
2019 August | 4 | 11 | 15 |
2019 July | 8 | 11 | 19 |
2019 June | 2 | 17 | 19 |
2019 May | 6 | 27 | 33 |
2019 April | 2 | 17 | 19 |
2019 March | 0 | 10 | 10 |
2019 February | 4 | 9 | 13 |
2019 January | 0 | 1 | 1 |
2018 December | 1 | 3 | 4 |
2018 November | 3 | 8 | 11 |
2018 October | 2 | 0 | 2 |
2018 March | 0 | 1 | 1 |
2018 February | 36 | 7 | 43 |
2018 January | 35 | 6 | 41 |
2017 December | 40 | 7 | 47 |
2017 November | 26 | 10 | 36 |
2017 October | 38 | 10 | 48 |
2017 September | 35 | 26 | 61 |
2017 August | 28 | 14 | 42 |
2017 July | 21 | 12 | 33 |
2017 June | 47 | 17 | 64 |
2017 May | 30 | 20 | 50 |
2017 April | 26 | 28 | 54 |
2017 March | 27 | 28 | 55 |
2017 February | 20 | 13 | 33 |
2017 January | 22 | 15 | 37 |
2016 December | 31 | 16 | 47 |
2016 November | 53 | 16 | 69 |
2016 October | 59 | 21 | 80 |
2016 September | 49 | 18 | 67 |
2016 August | 50 | 10 | 60 |
2016 July | 48 | 12 | 60 |
2016 June | 16 | 8 | 24 |
2016 May | 8 | 11 | 19 |
2016 April | 2 | 14 | 16 |
2016 March | 3 | 1 | 4 |
2016 February | 14 | 1 | 15 |
2016 January | 11 | 3 | 14 |
2015 December | 12 | 1 | 13 |
2015 November | 7 | 4 | 11 |
2015 October | 11 | 12 | 23 |
2015 September | 8 | 7 | 15 |
2015 August | 10 | 4 | 14 |
2015 July | 30 | 7 | 37 |
2015 June | 33 | 12 | 45 |
2015 May | 51 | 18 | 69 |
2015 April | 28 | 7 | 35 |
2015 March | 33 | 4 | 37 |
2015 February | 28 | 4 | 32 |
2015 January | 40 | 4 | 44 |
2014 December | 30 | 6 | 36 |
2014 November | 20 | 4 | 24 |
2014 October | 41 | 4 | 45 |
2014 September | 31 | 2 | 33 |
2014 August | 20 | 6 | 26 |
2014 July | 20 | 4 | 24 |
2014 June | 26 | 6 | 32 |
2014 May | 37 | 12 | 49 |
2014 April | 76 | 8 | 84 |
2014 March | 8 | 8 | 16 |