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Baartmans M.G.A.,Burn Center | Dokter J.,Burn Center | Den Hollander J.C.,Erasmus MC | Oranje A.P.,Sophia Childrens Hospital
Neonatology | Year: 2011

Background: Staphylococcal scalded skin syndrome (SSSS) is a rare toxin-mediated skin disease caused by Staphylococcus aureus and seen in infants and children younger than 5 years. Objectives: The supportive role of skin substitutes in SSSS is stressed as a new and relatively unknown method. Methods: Retrospective observational case-series study, in neonates and young infants diagnosed with SSSS. Results: Seven infants with SSSS, treatment with antibiotics, skin substitutes, strict pain relief strategy and prognosis were described. One of them was severely affected and deceased. Conclusion: This study describes 7 infants with SSSS and stresses the important role of skin substitutes as Omiderm® and Suprathel® as valuable adjuvant treatment modality. Copyright © 2010 S. Karger AG, Basel.

Van Hattem S.,University of Groningen | Beerthuizen G.I.,Burn Center | Kardaun S.H.,University of Groningen
British Journal of Dermatology | Year: 2014

Acute generalized exanthematous pustulosis (AGEP) and Stevens-Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN) are rare but severe cutaneous adverse drug reactions. Especially in TEN, large areas of the skin and mucosae may become detached. Although AGEP and SJS/TEN are distinct entities with a different clinical picture, pathogenesis, prognosis and treatment, they may share some features, raising the hypothesis of overlap between both entities. We present a severe case of AGEP, caused by flucloxacillin, clinically presenting with TEN-like features and pronounced systemic symptoms with haemodynamic and respiratory instability. Furthermore, we present a review of the literature on cases of AGEP with features resembling SJS/TEN or a supposed overlap with SJS/TEN. What's already known about this topic? Acute generalized exanthematous pustulosis (AGEP) can be accompanied by mild systemic involvement. Coalescence of pustules in AGEP can result in clinically toxic epidermal necrolysis (TEN)-like cutaneous features. Histopathology can assist in the differential diagnosis between AGEP and Stevens-Johnson syndrome or TEN. What does this study add? Flucloxacillin may cause AGEP. Severe neutrophilia in AGEP can contribute to the severity of systemic involvement. A literature review could not substantiate the existence of an AGEP-TEN overlap. © 2014 British Association of Dermatologists.

News Article | December 20, 2016

DALLAS - Dec. 20, 2016 - A new way to fight multidrug-resistant bacteria by blinding them rather than killing them proved highly effective in a model of burn injuries, UT Southwestern Medical Center research shows. "In the United States, there are more than 1 million burn injuries and 100,000 hospitalizations annually. Up to 75 percent of the mortality in burn patients is associated with infections, which are particularly common in patients who suffer extensive burns -- those that cover 40 percent or more of the body," said Dr. Steven Wolf, Section Chief for Burns and Professor of Surgery at UT Southwestern Medical Center. Dr. Wolf, one of three senior authors of the study published today in Scientific Reports, is also a former Director of the Burn Center at the U.S. Army Institute of Surgical Research in San Antonio, Texas. "Rather than killing the bacteria, we blinded them so they could not find the places where they normally stick to the host (body's) cells. If bacteria cannot bind, they cannot grow," said Dr. Wolf, who is also Surgery's Vice Chair for Research and holder of the Golden Charity Guild Charles R. Baxter, M.D. Chair. The study done in rats targeted one of the most lethal pathogens: multidrug-resistant Pseudomonas aeruginosa, which is found in approximately 33 percent of all burn cases and in 59 percent of extensive burns. The researchers showed that topical application of an engineered adhesion inhibitor molecule - Multivalent Adhesion Molecule 7, or MAM7 - substantially decreased the bacterial levels in wounds in the first 24 hours after administration and prevented the spread of the infection to adjacent tissue for three more days. In addition, the experimental molecule aided wound healing and maintained normal inflammatory responses to the burn, the researchers report. "Antibiotic-resistant bacteria are an increasingly prevalent problem in the clinic and hospital, so new ways to prevent and treat infections are direly needed. Antibiotics work by killing bacteria, which places microbes under extreme pressure to develop antibiotic resistance," said co-senior author Dr. Kim Orth, Professor of Molecular Biology and Biochemistry at UT Southwestern. "Our approach doesn't target bacterial survival; rather it targets the microbes' ability to damage the host - its virulence. There is no reason for the bacteria to become resistant to this approach. Being unable to bind to wounded tissue is an inconvenience, and the bacteria move on," Dr. Orth said. She compared the situation to the search for parking at a shopping mall. "If all the parking spaces are filled, then the bacteria have no place to park," said Dr. Orth, a Howard Hughes Medical Institute Investigator who also holds the Earl A. Forsythe Chair in Biomedical Science and is a W.W. Caruth, Jr. Scholar in Biomedical Research at UT Southwestern. The experimental molecule was developed in the Orth laboratory and grew out of the postdoctoral research project of the study's third senior author, Dr. Anne-Marie Krachler, now with the McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth). When working at UT Southwestern, Dr. Krachler studied a group of adhesion molecules called adhesins that are created by bacteria to bind, or stick to cells in an early and crucial step in causing infection. Although most adhesins are specific to various pathogens, members of the adhesion family she identified - Multivalent Adhesion Molecules, including MAM7 - are used by most gram-negative bacteria, including the type used in this burn study. In one UTSW experiment, Dr. Krachler detached MAM7 from the bacteria that produce it and showed that the lack of MAM7 made the bacteria much less able to cause infection. In 2013, Dr. Orth gave a UT Southwestern President's Lecture describing the molecular activity of MAM7. Dr. Wolf was in attendance, and approached Dr. Orth about a collaboration to test the efficacy of MAM7 using a fluorescent strain of antibiotic-resistant bacteria in a live animal model. That led to the multiyear effort to develop the recombinant MAM7 inhibitor attached to a scaffold made of bacteria-sized polymer microbeads that was used in this study. UT Southwestern has an international patent application filed on the molecule. "We attached lots of copies of MAM7 to the microbeads. In this study, we found that topically applied MAM7-coupled microbeads reach the cells' binding sites first and - for at least four days in this experiment - stay there, without hindering wound healing. The MAM7 adhesion inhibitors remain on the wounds and prevent the bacteria from binding to the tissue," Dr. Orth said. In addition to burns, Dr. Krachler said, this strategy could work against diabetic ulcers and surgical wounds that can become infected. "What's exciting about MAM7 is that the agent is so broad-spectrum. Most bacteria have their own specific type of adhesion molecules. For instance Vibrio uses one kind and Salmonella uses a different one and multidrug-resistant bacteria another, but almost all of them want to park in the same place. "Antibiotics are amazing drugs, and they have saved countless lives since their discovery more than 80 years ago. But there is a challenge - the challenge of antibiotic resistance that has made many antibiotics ineffective. A material that targets virulence instead of killing bacteria could be a way to treat infections that are resistant to antibiotics," she said. "This is a trial in rats. A future goal is to use this strategy in patients." Following the success of this proof-of-concept study, additional steps include testing whether the anti-adhesion strategy might also block infection of bacteria that can cause lethal infections during surgery, Dr. Orth said. UT Southwestern co-authors include: lead author Dr. Ryan Huebinger, Assistant Professor of Surgery; Dr. Marcela de Souza Santos, a postdoctoral researcher in Molecular Biology; Dr. Deborah Carlson, Assistant Professor of Surgery and Pediatrics; and Dr. Juquan Song, Assistant Professor of Surgery. Researchers at the University of Birmingham, United Kingdom, also participated. The research received support from the Biotechnology and Biological Sciences Research Council in the United Kingdom; the National Institutes of Health; Once Upon a Time...; the Welch Foundation; the Howard Hughes Medical Institute; the Golden Charity Guild Charles R. Baxter Chair in Burn Surgery, which provided additional research funding; and the Burroughs Welcome Fund. The U.S. Army Institute for Surgical Research provided the bioluminescent strain of P. aeruginosa used in this study. UT Southwestern, one of the premier academic medical centers in the nation, integrates pioneering biomedical research with exceptional clinical care and education. The institution's faculty includes many distinguished members, including six who have been awarded Nobel Prizes since 1985. The faculty of almost 2,800 is responsible for groundbreaking medical advances and is committed to translating science-driven research quickly to new clinical treatments. UT Southwestern physicians provide medical care in about 80 specialties to more than 100,000 hospitalized patients and oversee approximately 2.2 million outpatient visits a year. This news release is available on our website at http://www. To automatically receive news releases from UT Southwestern via email, subscribe at http://www.

Daigeler A.,University Hospital Bergmannsheil | Daigeler A.,Burn Center | Simidjiiska-Belyaeva M.,University Hospital Bergmannsheil | Drucke D.,University of Kiel | And 5 more authors.
Langenbeck's Archives of Surgery | Year: 2011

Purpose: The vertical rectus abdominis muscle (VRAM) flap is considered a safe and simple option to cover defects of the trunk and proximal thigh. Detailed long-time follow-up studies in oncologic patients including complications and donor site morbidity are rare. In this study, complications and donor site morbidity were analysed. Methods: Data of 78 consecutive patients with oncologic disease, having received VRAM flaps, were analysed retrospectively. Patients with soft tissue sarcomas (n∈=∈38), radiation ulcers (n∈=∈18), carcinoma (n∈=∈10), wound-healing difficulties after tumour resection (n∈=∈8), breast reconstruction after ablation (n∈=∈3) and malignant melanoma (n∈=∈1) were included. Statistics concerning patients' satisfaction, the occurrence of wound-healing difficulties, incisional herniation, loss of abdominal wall strength in correlation to operative and (neo)adjuvant treatment and patients' history were performed. The mean follow-up time was 5.5 years. Results: No complete flap loss was observed. A body mass index over 30 was positively correlated with wound-healing difficulties; radiation had no negative effect. A contralateral cutaneous pedicle could reduce the risk of lymphoedema in groin defect patients. Incisional hernia was present in 13%. Strength endurance of the abdominal wall was reduced compared to an age-matched control. Most patients were satisfied with the postoperative result. Conclusions: VRAM flaps are reliable tools for defect coverage in the oncologic patient to prevent chronic ulceration, lymphangitis or more severe complications like septic rupture of femoral vessels and hip disarticulation. Donor site morbidity is tolerable, and patients' satisfaction is high. © 2011 Springer-Verlag.

News Article | October 29, 2015

Troy Patchin practices getting in and out of a car as part of his physical therapy at The Ohio State University Wexner Medical Center. Patchin was burned over nearly half his body in a work accident, and as part of his treatment at Ohio State's More Dr. Larry Jones, director of the< a href="">Comprehensive Burn Center at The Ohio State University Wexner Medical Center, contributed this column to Live Science's Expert Voices: Op-Ed & Insights. Patients with severe burns, understandably, suffer from substantially diminished appetites because they're in a considerable amount of pain and are often sedated, as a result. So it may seem counterintuitive to ask severely burned patients to consume considerably more calories than they're used to while in the hospital. Despite these challenges, when burn patients are admitted to the Comprehensive Burn Center at The Ohio State University Wexner Medical Center, we make nutrition a priority, often beginning a feeding tube within 6 hours. It's an aggressive approach that helps burn patients heal faster and recently earned international recognition. When someone experiences a severe burn, defined as a second- or third-degree burn that covers at least 20 percent of the body, the hypermetabolic response is extreme. Second- and third-degree burns occur when damage extends beyond the top layer of the skin. With a second-degree burn, the skin blisters and can become extremely red and sore. Third-degree burns are the worst type, extending through every layer of the skin. The damage can even seep into the bloodstream, bones and major organs. After the body's initial shock response to the injury wears off, metabolism rates can increase up to 180 percent, heart rates can jump by up to 150 percent and the liver can increase in size by up to 200 percent. In short, the body goes into hyperdrive to heal wounds, and it looks for nutrients wherever it can find them. Unless the patient receives large amounts of supplemental nutrients, the body will rob itself of core nutrients. Essentially, if patients aren't able to meet the high calorie and protein requirements it takes to heal, their body will start consuming its own muscle mass in order to deliver nutrition. Muscle wasting is most obvious in the arms, legs and abdomen. Once patients lose that muscle mass, their ability to exercise, undergo rehabilitation and fight infection are severely compromised. Doctors need to intervene early in this process to prevent muscle loss and give the patient's body the nutrients it desperately needs to heal. Upon admission to the burn center, patients are evaluated by a dietitian to determine their energy and protein needs. Many are given a feeding tube almost immediately, through which we provide them with up to three to four times the amount of protein they normally receive in a day and 140 percent more calories. Each case is different, of course, so nurses monitor a patient's weight and caloric intake daily and dietitians adjust nutrients as needed. As a patient's burns heal, they are transitioned to oral meals during the day, with supplemental feedings overnight through the tube. Among other ingredients, the feeding solution contains proteins, which are used by the body to repair and close wounds caused by the burn; glucose, which fuels the healing efforts; vitamin D, which helps modulate cell grown and, along with omega-3 fatty acids, helps control inflammation. Ingesting such a high volume of calories and supplements can be a challenge. Severe pain is associated with a marked loss of appetite and excessive intake can lead to nausea. When necessary, we may also prescribe patients medication to allow them to tolerate the additional feedings. The healing process continues long after discharge. At a microscopic level, severe burns can take anywhere from a year to 18 months to heal — in some cases, even longer. My colleagues and I at the burn center are currently studying whether nutritional support should continue after discharge. As patients prepare to leave the burn center, dietitians help develop personalized meal plans for use at home that are high in protein and carbohydrates to stimulate continued healing. When patients return to the burn center for follow-up care for their wounds, we re-evaluate their nutritional status as well.

News Article | February 16, 2017

When we think about safety net hospitals, the narrative often turns into one of facilities struggling to make use of limited resources to serve some of the most complex and challenging patient populations. Rarely do we align safety net hospitals with leading edge cognitive technology. But that is exactly what is happening at Grady Health System in Atlanta. Grady Health System (Grady) comprises a network of providers, clinics, and inpatient services that combine to deliver care for metro Atlanta. The system has served the community since 1892 and acted as a healthcare safety net for a diverse and growing population. As of last year, Grady treated almost 41,000 adult and newborn patients admitted to the main hospital and conducted close to 500,000 outpatient visits. Caring for such a large population requires innovation and focus. In 2016, system leadership wanted to find a way to better target resources and identify patients at risk of returning to the hospital within 30 days of discharge. These readmissions pose a real threat to patient health and provider viability. Government mandates focused on reducing preventable readmissions impose hefty fines for performance that doesn’t meet established thresholds. “We landed on Jvion’s Cognitive Clinical Success Machine,” explained Ben McKeeby, Grady’s Chief Information Officer. Cognitive Clinical Success Machine Technology leverages the same power as well know and established search engines and cognitive technologies that understand, reason, and learn. What makes Jvion’s Cognitive Clinical Success Machine unique is its ability to drive patient-specific prioritizations, predictions, recommendations, and interventions that are precise, integrated directly into the clinical workflow, and delivered in a matter of weeks. “The Cognitive Clinical Success Machine that Grady is using leverages self-learning Eigen sphere technology to deliver an ultra-high definition view into the future state of the patient. This view accounts for the tens of thousands of exogenous factors that impact a patient’s risk along with the clinical context provided during the episode of care,” explained Todd Schlesinger, Vice President at Jvion. The machine is making a significant impact on a hard to reach and treat population. In addition to targeting readmissions broadly, the Grady team is using the cognitive science solution to specifically identify those patients with Congestive Heart Failure. Teams across the facility—from inpatient nursing staff to case managers and EMTs—use recommendations from Jvion’s Cognitive Clinical Success Machine to most effectively lower a patient’s risk. “With Jvion’s solution we have a remarkable cognitive appliance that works as seamlessly as any diagnostic test to deliver the most precise and actionable interventions for our patient population,” said McKeeby. “This kind of technology is the future. And with Jvion, cognitive power is finally within reach for healthcare providers.” About Grady Health System Grady Health System is one of the largest safety net health systems in the United States. Grady consists of the 953-bed Grady Memorial Hospital, six neighborhood health centers, Crestview Health & Rehabilitation Center, and Children's Healthcare of Atlanta at Hughes Spalding, which is operated as a Children's affiliate. With its nationally acclaimed emergency medical services, Grady has the premier level I trauma center in the Metro Atlanta region and serves as the 911 ambulance provider for the city of Atlanta. Grady’s American Burn Association/American College of Surgeons verified Burn Center is one of only two in the state. And the Marcus Stroke and Neuroscience Center is a Joint Commission designated Advanced Comprehensive Stroke Center. Other key services include Grady’s Regional Perinatal Center with its Neonatal Intensive Care Unit, Georgia’s first Cancer Center for Excellence, The Avon Comprehensive Breast Center, the Georgia Comprehensive Sickle Cell Center, and the Ponce de Leon Center - one of the top three HIV/AIDS outpatient clinics in the country. About Jvion Jvion delivers a Cognitive Clinical Success Machine that serves as a high-performance appliance for providers and the healthcare community. It activates recommendations that help healthcare providers who need ultra-definition patient-level predictions, prioritizations, interventions, and suggestions produced with unmatched speed, clinical applicability, and verity. The machine delivers the action-level recommendations that will best reduce the likelihood of an adverse event. This capability is enabled by a cognitive engine driven by horsepower that is based on more than a quadrillion clinical and non-clinical considerations and thousands of data elements. The machine’s thousands of self-learning Eigen spheres are applied to this data for each patient in real time to help hundreds of hospitals across the nation reduce target illnesses and diseases. Jvion’s Cognitive Clinical Success Machine includes broad clinical application vectors that, when applied to specific patients, deliver individualized prioritizations, interventions, and suggestions within two weeks. One of the reasons Jvion’s solution is independently ranked number one in clinical predictive science is because the machine is more than accurate, it is effective. Our approach mitigates the “accuracy fallacy” perpetuated within the industry by delivering a true picture of individual patient risk along with the actions that will lead to better health outcomes. Because Jvion’s machine works as a cognitive appliance, it plugs in directly to the existing Electronic Medical Record/clinical systems to deliver recommendations seamlessly into the organic workflow. Clinician and caregiver adoption of Jvion’s recommendations is accelerated because of the “on-demand” nature of the information. The machine outperforms and outsmarts even the highest performing predictive solutions/approaches available. And this performance hasn’t gone unnoticed; Jvion’s solution has won numerous external awards including designation as the #1 Predictive Provider in Healthcare by Black Book Market Research. ###

Jaminet P.,Burn Center | Rahmanian-Schwarz A.,Burn Center | Pfau M.,Burn Center | Nusche A.,Burn Center | And 2 more authors.
Microsurgery | Year: 2012

Background: Giant-cell tumors of the distal radius are rare. They have a high-risk of local recurrence and a risk of pulmonary metastasis. Curettage alone or combined with adjunctive agents is often associated with local recurrence. Methods: Three patients with giant-cell tumor of the distal radius are presented. All patients showed Campanacci grade 3 lesions. All patients underwent complete distal radius resection and reconstruction with a vascularized fibular graft distally fused with the scaphoid and the lunate, allowing midcarpal motion. Results: The follow-up period ranged from 6 to 60 months. For all three patients, emotional acceptance was excellent. The postoperative motion of the wrist was good, with a range of motion of 30-0-30°, 40-0-0°, and 30-0-10° (extension-flexion). There was neither tumor recurrence nor pulmonary metastasis. Conclusion: Fibulo-scapho-lunate fusion is an elegant method of distal radius reconstruction with good functional outcome and low risk of pulmonary metastasis. © 2012 Wiley Periodicals, Inc. Microsurgery, 2012. Copyright © 2012 Wiley Periodicals, Inc.

Warner P.M.,University of Cincinnati | Coffee T.L.,Burn Center | Yowler C.J.,Burn Center | Yowler C.J.,Case Western Reserve University
Surgical Clinics of North America | Year: 2014

Most burn patients have injuries that may be treated on an outpatient basis. Newer silver-based dressings and improved medications for the treatment of pain and pruritus have led to further growth of outpatient care. The final barrier of distance from the burn center will decrease with the growth of telemedicine. It is incumbent for burn centers to develop outpatient guidelines to facilitate this growth of outpatient care. © 2014 Elsevier Inc.

Larsen M.,Mayo Medical School | Pelzer M.,Burn Center | Friedrich P.F.,Mayo Medical School | Wood C.M.,Mayo Medical School | Bishop A.T.,Mayo Medical School
Journal of Bone and Joint Surgery - Series A | Year: 2011

Background: Segmental bone defects pose reconstructive challenges. Composite tissue allotransplantation offers a potential solution but requires long-term immunosuppression with attendant health risks. This study demonstrates a novel method of composite-tissue allotransplantation, permitting long-term drug-free survival, with use of therapeutic angiogenesis of autogenous vessels to maintain circulation. Methods: Ninety-three rats underwent femoral allotransplantation, isotransplantation, or allografting. Group-1 femora were transplanted across a major histocompatibility complex barrier, with microsurgical pedicle anastomoses. The contralateral saphenous artery and vein (termed the AV bundle) of the recipient animal were implanted within the medullary canal to allow development of an autogenous circulation. In Group 2, allotransplantation was also performed, but with AV bundle ligation. Group 3 bones were frozen allografts rather than composite-tissue allotransplantation femora, and Group 4 bones were isotransplants. Paired comparison allowed evaluation of AV bundle effect, bone allogenicity (isogeneic or allogeneic), and initial circulation and viability (allotransplant versus allograft). Two weeks of immunosuppression therapy maintained blood flow initially, during development of a neoangiogenic autogenous blood supply from the AV bundle in patent groups. At eighteen weeks, skin grafts from donor, recipient, and third-party rats were tested for immunocompetence and donor-specific tolerance. At twenty-one weeks, bone circulation was quantified and new bone formation was measured. Results: Final circulatory status depended on both the initial viability of the graft and the successful development of neoangiogenic circulation. Median cortical blood flow was highest in Group 1 (4.6 mL/min/100 g), intermediate in Group 4 isotransplants (0.4 mL/min/100 g), and absent in others. Capillary proliferation and new bone formation were generally highest in allotransplants (15.0%, 6.4 μm3/μm2/yr) and isotransplants with patent AV bundles (16.6%, 50.3 μm3/μm2/yr) and less in allotransplants with ligated AV bundles (4.4%, 0.0 μm3/μm 2/yr) or allografts (8.1%, 24.1 μm3/μm 2/yr). Donor and third-party-type skin grafts were rejected, indicating immunocompetence without donor-specific tolerance. Conclusions: In the rat model, microvascular allogeneic bone transplantation in combination with short-term immunosuppression and AV bundle implantation creates an autogenous neoangiogenic circulation, permitting long-term allotransplant survival with measurable blood flow. Clinical Relevance: These methods may allow future composite-tissue allotransplantation of bone without the appreciable health risks that are associated with long-term immunosuppression or immune tolerance induction. Copyright © 2011 by The Journal of Bone and Joint Surgery, Incorporated.

News Article | November 17, 2016

Attorney Bert Louthian says that the e-cigarette industry faces the potential of a consumer protection crisis if devices aren't made safer COLUMBIA, SC--(Marketwired - November 17, 2016) - In the face of growing concerns about e-cigarette safety and a number of medical facilities reporting injuries due to exploding e-cigarette batteries, one South Carolina attorney is calling for greater consumer protection for users of these devices. "Exploding e-cigarettes have caused users serious burns, disfigurement and other costly injuries," said Bert Louthian of Louthian Law Firm P.A. "The Centers for Disease Control and Prevention said that nearly four percent of adults regularly use e-cigarettes. With an increase in the popularity of these devices, comes the responsibility to ensure the safety of e-cig users." At least 134 reports of explosions, overheating and fires related to e-cigarettes have been made since 2009, according to the Wall Street Journal. E-cigarette review and news site eCig One has discovered reports of over 180 e-cig explosions. Louthian said that this issue should be of great concern to both users and e-cigarette business owners. While many in the industry feel under siege by the regulatory uncertainty hovering over the e-cigarette industry, everyone can agree that users should be as safe as possible, he said. "Nobody wants to see people injured by these devices," Louthian said. "It's bad for stores that sell e-cigarettes. It's bad for the industry as a whole. Most importantly, it's bad for consumers. We have to make sure that these products are safe before they hit the market. The fact that this isn't being done has put us in a situation that should be considered a consumer protection crisis." According to NBC News, facilities like the University of Colorado Hospital Burn Center and the Harborview Medical Center in Seattle have noted an increase in the number of injuries caused by exploding e-cigarette batteries. North Carolina Jaycee Burn Center at UNC Hospitals have reported treating 10 patients with injuries caused by exploding e-cigarettes since the beginning of 2016. Many of the explosions come from the use of lithium-ion batteries, which have also caused issues in cell-phones, laptops and hover boards. There are many questions about why these batteries are exploding, Louthian said. He asks if it is a case of consumers not being told by manufacturers the importance of using the appropriate charger, or if they are defective in other ways. "The truth is we don't even know the depths of this problem because there is inadequate oversight, but it's clear that it is incredibly serious," Louthian said. "Medical facilities that treat injured e-cigarette users are sounding the alarm. It's time we heed their calls." Bert Louthian practices law in Columbia, South Carolina. Along with his father, Herb, they provide representation to those who have been injured due to someone else's negligence. Learn more about Louthian Law Firm P.A. by visiting

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