Marjolin's Ulcer: A Preventable Complication of Burns?
ABSTRACT LEARNING OBJECTIVES: After studying this article, the participant should be able to: 1. Discuss the clinical features of Marjolin's ulcer. 2. Identify the risk factors for the development of Marjolin's ulcer. 3. Develop a surgical management plan for the treatment of Marjolin's ulcer. SUMMARY: Marjolin's ulcer is a rare and aggressive cutaneous malignancy that arises on previously traumatized and chronically inflamed skin, especially after burns. This clinical condition was first described by Marjolin in 1828. The term "Marjolin's ulcer" has been generally accepted to refer to a long-term malignant complication of the scars resulting from burns. However, vaccination, snake bites, osteomyelitis, pilonidal abscesses, pressure sores, and venous stasis may also induce this tumor. Clinically, reports suggest that atrophic and unstable scars tend to develop into cancer. Various etiological factors have been implicated in the condition, including toxins released from damaged tissues, immunologic factors, cocarcinogens, and miscellaneous factors such as irritation, poor lymphatic regeneration, antibodies, mutations, and local toxins. The incidence of burn scars undergoing malignant transformation has been reported to be 0.77 to 2 percent. All parts of the body can be affected, but the extremities and the scalp are most frequently affected. There are two variants: acute and chronic. In the former, the carcinoma occurs within 1 year of the injury. The chronic form is more frequent and malignancy tends to develop slowly, with an average time to malignant transformation of 35 years. Although many different cell types can be seen in these lesions, the major histological type is squamous cell carcinoma. Marjolin's ulcers are generally considered as very aggressive tumors with a higher rate of regional metastases; radical excision is the treatment of choice, but there is no consensus on lymph node dissection. Marjolin's ulcer can be insidious and often leads to a poor prognosis, and deaths from Marjolin's ulcer are not uncommon. Meticulous wound care is a crucial step in prevention of these lesions.
- European Journal of Plastic Surgery 01/2012; 36(1). DOI:10.1007/s00238-012-0745-8
Conference Paper: The link between Life Cycle Design and innovation[Show abstract] [Hide abstract]
ABSTRACT: Forthcoming products of engineering must not only be of sound quality and cost effective; they must also be optimized ecologically. Therefore, the question if optimizing the environmental performance of a product hinders or supports innovation is a commonly asked one. This paper addresses this issue and shows how Life Cycle Design reveals new challenges in product design, initiating new ways for innovative solutions. Definitions and models of innovation and Life Cycle Design are reviewed. These findings are combined to develop a suitable approach for carrying out LCD while increasing the likelihood of ending up with an innovative product. A vacuum cleaner is used as an example to verify the model and to show that environmental constraints have in fact a high potential to trigger innovations. The main goal of the paper is to convey that working towards environmentally conscious solutions fosters innovation, because it forces product development teams to think in new ways.Environmentally Conscious Design and Inverse Manufacturing, 2003. EcoDesign '03. 2003 3rd International Symposium on; 01/2004
Conference Paper: Real-time diagnosis and prognosis with sensors of uncertain quality[Show abstract] [Hide abstract]
ABSTRACT: This work presents a real-time approach to the detection, isolation, and prediction of component failures in large-scale systems through the combination of two modules. The modules themselves are then used in conjunction with an inference engine, TEAMS-RT, which is part of Qualtech Systems integrated diagnostic toolset, to provide the end user with accurate diagnostic and prognostic information about the state of the system. The first module is a filter used to "clean" observed test results from multiple sensors from system noise. The sensors have false alarm and missed detection probabilities that are not known a-priori, and must be estimated - ideally along with the accuracies of these estimates - online, within the inference engine. Further, recognizing a practical concern in most real systems, a sparsely instantiated observation vector must not be problematic. Multiple hypothesis tracking (MHT) is at the heart of the filtering algorithm and beta prior distributions are applied to the sensor errors. The second module is a prognostic engine that uses an interacting multiple model (IMM) approach to track the "trajectory" of degrading sensors. Kalman filters estimate the movement in each dimension of the sensors. The current state and trajectory of each sensor is then used to predict the time to failure value, i.e., when the component corresponding to the sensor is no longer usable. The modules are integrated together and as part of the TEAMS-RT suite; logic is presented for the cases that they disagree.Aerospace Conference, 2004. Proceedings. 2004 IEEE; 04/2004