At the end of January 2020, SARS-CoV-2 started escalating worldwide. COVID-19 can exert its effects on immunity, inflammation, and multi-organ system disease, common denominators with the burn injury. The pandemic required major efforts to Burn centres in order to preserve burn patients’ care and contribute to the health care response. In our Burn Unit we autonomously developed a protocol for patients acceptance and surveillance of the hospitalized ones and the personnel. We briefly describe our experience with six cases of burn patients infected by SARS-CoV-2 highlighting the overlap between medical treatment of burn patients and COVID-19 patients. To avoid viral spreading epidemiologic control is essential, especially preventive measures such as isolation of infected patients and identification of the source of infection. In our surgical practice, we increased the use of enzymatic debridement avoiding procedures with a high risk of viral particles spreading. Personnel protection and dedicated pathways have been planned, optimizing air circulation and disinfection. Vaccines represent the best hope for the global population to stop the viral spread, despite new variants outbreaks.
Part of the book: Trauma and Emergency Surgery
Neurofibromatosis (NF1) is a rare genetic disease that predisposes to tumors in the peripheral and central nervous systems and other neoplasms. Neurofibromas are complex benign tumors involving various cell types. Among them, plexiform neurofibromas are locally invasive peripheral nerve sheath tumors (PNs) that can cause disfigurement and functional limitations. Based on histopathological and magnetic resonance imaging (MRI) data, PNs display variable morphology and behavior. The appearance of distinct nodular lesions (DNLs) in PNs raises concerns about an increased risk of transformation into malignant peripheral nerve sheath tumors (MPNSTs). Surgery represents the primary treatment option for NF1-related PN, although recently, specific targeted agents, that is, MEK inhibitors, have been shown to be partially effective. Several surgical techniques have been proposed for PNs to decrease intraoperative bleeding and facilitate tumor excision of either diffuse PNs or rapidly growing nodular PN. However, despite improving surgical methods, complete tumor excision can be achieved in only a few cases. In this frame, it emerges evident that searching for appropriate surgical and pharmacological treatments for neurofibromas is a priority challenge. In this chapter, we will review current treatments approved by the scientific/clinical community, emphasizing the most recent progress in this field.
Part of the book: Neurofibromatosis