Prolonged Wound Healing Research Articles

202 IORT in primary rectal cancer: Experimental and clinical results

For IORT we use a flexible flab which is placed into the sacral cavity. The flab contains plastic tubes. A 370 GBq-192-Ir-source is inserted in one tube after the other and stepwise retracted. IORT was experimentally performed in the pelvis ofa female dead body. The measured doses were identical with the 3 D-calculated dose distribution in the target volume and region of critical organs (e.g. ureter). In a phase II trial 40 patients with locally advanced primary rectal cancer were treated with pre- orpostoperative radiochemotherapy (pre: 2×21.1Gy/day, 40Gy; post: 1×21.8Gy, 50.4Gy; Cht: 5 FU, continuous infusion or bolus). Overall survival data suggest a benefit of IORT combined with preop RT. Major side effect is a prolonged wound healing and local infection.

Guidelines for pulse oximetry use in pediatrics

I N A STUDY OF the use of pulse oximetry in a medical-surgical pediatric unit (Kozlowski, DiMarcello, Stashinko, & Phifer, 1994), Kozlowski et al. recommend the development of standards for the use of pulse oximetry in the pediatric population. This review will discuss guidelines for the use of the pulse oximetry equipment in pediatrics. Pulse oximetry and transcutaneous Po2 readings to assess oxygenation status were both developed in the 1970s. Because transcutaneous Po2 closely estimated Pao2 in hemodynamically stable infants, it was rapidly integrated into clinical use to reduce the dangers of hyperoxia in premature infants. The technology of pulse oximetry underwent further development before it became widely used in the early 1980s. When technology advanced to make pulse oximetry easy and reliable, its use increased in pediatric short-term care settings. Initially, pulse oximetry use was confined to patients undergoing anesthesia or those in intensive care units. Pulse oximetry is now recommended for the general pediatric population for postoperative transport, during diagnostic procedures, for patients with oxygen requirements, and for patients undergoing opioids therapy for pain management (Agency on Health Care Policy and Research, 1992). Pulse oximetry provides a noninvasive, painless, and reliable method to measure arterial hemoglobin oxygen saturation. It can identify both constant and transient/episodic hypoxemic events alone or those that coexist with constant hypoxemia. Prolonged tissue hypoxia can lead to ischemia of the heart and brain and can prolong wound healing. Therefore, early detection of hypoxic events may

Rôle des oligo-éléments et des vitamines en nutrition périopératoire

The micronutriment requirements, whether trace elements (inorganic) or vitamins (organic), are tightly linked to the carbohydrate, lipid and protein metabolism, since they are involved in all metabolic pathways as cofactors. The micronutriments also have major immunological, endocrinological and antioxydant functions. Especially in the surgical patient, individual requirements may vary considerably and will be particularly increased in case of prior deficiency, anabolic states, or increased losses (burns, diarrhoea, gastric aspiration, intestinal fistulae, alcoholism, use of renal replacement techniques). In some of these settings, the micronutriment requirements will be independent from the macronutriments : this has been demonstrated for burns and intestinal fistulae. In the case of depletion prior to surgery, an isolated supplementation may be required without starting a proper nutrition.In general, micronutriment supplements will have to be started upon initiation of any artificial nutrition. After elective surgery and in absence of specific losses, the micronutriment requirements will be linked to the metabolic state of the patient and to the energy-protein intakes. This is most striking for the vitamin B group, where the requirements are indicated in mg per 1000 kcal. Vitamins A and E are also at risk in the surgical patient. Recommended micronutriment supplements have been revised in 1994. Some trace element deficiencies (Se, Cr, Mo) can initiate very serious complications and will require special caution in the perioperative period. Other deficiencies (Cu, Zn) result in more slowly evolving clinical pictures, with lesser life-threatening potential, resulting in infections and prolonged wound healing. In such cases, multi-elementary supplements are inadequate, and single element solutions supplements are required. All the micronutriments are characterized by a dose-response curve. The quantity avoiding biochemical dysfunctioning in human pathological situations has not yet been established, and it is unsatisfactory to merely compensate for the losses. This notion of biochemical dysfunctionning phase preceeding the clinical deficiency syndrome is in investigation for many nutriments, especially as the importance of some micronutriments, such as Se and vitamin E, in maintaining antioxidant defences is clearly established. The potential for preventing free radical induced overproduction of cytokines by means of nutritional strategy and enhanced antioxidant defences clearly exists, and is only at an early phase of investigation in patients. The future will be marked by the development of nutritional pharmacology based on pathology-specific micronutriment supplements.

Rôle des oligo-éléments et des vitamines en nutrition périopératoire

The micronutriment requirements, whether trace elements (inorganic) or vitamins (organic), are tightly linked to the carbohydrate, lipid and protein metabolism, since they are involved in all metabolic pathways as cofactors. The micronutriments also have major immunological, endocrinological and antioxydant functions. Especially in the surgical patient, individual requirements may vary considerably and will be particularly increased in case of prior deficiency, anabolic states, or increased losses (burns, diarrhoea, gastric aspiration, intestinal fistulae, alcoholism, use of renal replacement techniques). In some of these settings, the micronutriment requirements will be independent from the macronutriments: this has been demonstrated for burns and intestinal fistulae. In the case of depletion prior to surgery, an isolated supplementation may be required without starting a proper nutrition. In general, micronutriment supplements will have to be started upon initiation of any artificial nutrition. After elective surgery and in absence of specific losses, the micronutriment requirements will be linked to the metabolic state of the patient and to the energy-protein intakes. This is most striking for the vitamin B group, where the requirements are indicated in mg per 1000 kcal. Vitamins A and E are also at risk in the surgical patient. Recommended micronutriment supplements have been revised in 1994. Some trace element deficiencies (Se, Cr, Mo) can initiate very serious complications and will require special caution in the perioperative period. Other deficiencies (Cu, Zn) result in more slowly evolving clinical pictures, with lesser life-threatening potential, resulting in infections and prolonged wound healing. In such cases, multi-elementary supplements are inadequate, and single element solutions supplements are required. All the micronutriments are characterized by a dose-response curve. The quantity avoiding biochemical dysfunctioning in human pathological situations has not yet been established, and it is unsatisfactory to merely compensate for the losses. This notion of biochemical dysfunctionning phase preceeding the clinical deficiency syndrome is in investigation for many nutriments, especially as the importance of some micronutriments, such as Se and vitamin E, in maintaining antioxidant defences is clearly established. The potential for preventing free radical induced overproduction of cytokines by means of nutritional strategy and enhanced antioxidant defences clearly exists, and is only at an early phase of investigation in patients. The future will be marked by the development of nutritional pharmacology based on pathology-specific micronutriment supplements.

Pigmentation dependent, short time skin reactions to copper vapour laser and argon laser treatment

Thirteen human volunteers selected to have a varying degree of epidermal skin pigmentation were laser treated on the inside of the brachium in six hexagonal areas; three areas with an argon laser (AL, 488, 514.5 nm) and three corresponding areas with a copper vapour laser (CVL, 578 nm). The lasers were connected to a Hexascan device and the physical settings were identical for the two laser types, except for the wavelengths. Beam diameter was 1 mm, pulse duration 200 ms, intensities 0.7, 1.0 and 1.3 W/spot, corresponding to 14.1, 20.2 and 26.2 J/cm 2 per treated skin area. The skin pigmentation was objectified by skin reflectance. A correlation was demonstrated between skin pigmentation and wound healing time, maximum wound area, and the acute clinical response at days 0, 1, 4, 7, 11 and 17 after laser treatment. An increased skin pigmentation resulted in increased acute and subacute skin reactions. Comparison of the AL and the CVL demonstrated that the CVL on day 0 (0.7 and 1.0 Wlspot) and on day 1 (0.7 W/spot) induced a significantly higher degree of skin reactions as compared with the AL. At 0.7 W/spot the CVL induced a significantly higher maximum wound area and a significantly prolonged wound healing time as compared with the AL. An inverse reaction existed between pigmentation and the threshold intensity required to induce wound formation.

Effects of noise in hospitals.

Excessive noise in health care settings can induce headaches, cause irritability, prolong wound healing and increase sensitivity to pain. Simple measures, such as wearing soft-soled shoes, closing doors to areas with excessive noise (the television or sluice rooms) and choosing equipment with quieter alarms, can improve patient outcomes and result in a better working environment for hospital staff.

Progressive Hyperopia After Radial Keratotomy - An Explanation?

OBJECTIVE: To study the corneal stability after radial keratotomy. STUDY DESIGN: Measurement of corneal topography after intraocular pressure (IOP) increase up to 40 mmHg to demonstrate the instability of corneas after radial keratotomy. SETTING: Department of Ophthalmology, University of Hamburg, Germany. PATIENTS: Thirty patients after radial keratotomy, ten emmetropic, ten myopic and ten hyperopic subjects as control group. MAIN OUTCOME MEASURES: A 180° tilting table was used to increase intraocular pressure (IOP). A TMS photokeratoscope was used to measure corneal topography before and after pressure increase. RESULTS: Owing to the rapid IOP increase, each image of normal subjects showed a peripheral and central steepening of the corneal curvature during tilting. A peripheral steepening and a central flattening of the corneal curvature could be demonstrated in each patient after radial keratotomy. CONCLUSION: A weakened cornea after radial keratotomy is exposed to a permanent stretching stress. This stress in a tissue with weak stability and prolonged wound healing causes a permanent progressive hyperopia.

Effect of salivary gland hypofunction on the healing of extraction wounds: A histomorphometric study in rats

The effect of salivary gland hypofunction (SGH) on oral wound healing is not well established. The present study evaluates the healing of extraction wounds in a SGH rat model. Experimental rats underwent removal of the submandibular and sublingual glands and ligation of the parotid ducts. Maxillary left first molars were extracted and healing was determined at 0, 1, 3, 5, 7, 10, 14, and 21 days after extraction. Salivary gland hypofunction caused a significant delay in socket healing. The inflammatory process was more intense and of longer duration. The formation of fibrous connective tissue and bone was relatively slow among the experimental rats. The results suggest that SGH patients undergoing oral surgery may have prolonged wound healing.

Infections at the Site of a Hip Implant

Thirty-four patients developed the complication of deep infection at the site of a hip implant (n = 35). Multiple factors in existence at the time of implant placement and the time of presentation with infection as well as the therapeutic regimen were retrospectively analyzed. Patients with successful outcomes (n = 15) were relatively younger (mean, 52 years) compared to those that had an unsuccessful outcome (n = 19; mean, 65 years; p less than 0.01). No other factors were predictive of the outcome of treatment. Implant extirpation, expedient wound closure, and, when necessary, muscle transposition favored a successful outcome. Implant retention and open wound packing resulted in prolonged wound healing and, sometimes, hip disarticulation or death.

The role of lasers in hemorrhoidectomy

Eighty-eight patients who received treatment for hemorrhoids were randomized into two groups. Group A received the Nd-YAG laser phototherapy for internal hemorrhoid combined with the CO2 laser for external hemorrhoid. Group B was treated with closed Ferguson hemorrhoidectomy. The need of narcotic injections for pain relief was 11 percent in group A vs. 56 percent in group B (P less than 0.001). The incidence of postoperative urinary retention was 7 percent in group A, vs. 39 percent in group B (P less than 0.05). No enema was required postoperatively in group A, vs. 9 percent in group B; 84 percent of the patients in group A were discharged on the second postoperative day, vs. 83 percent of the patients in group B discharged on the fifth postoperative day. The cost was 20 percent less in the former group. The overall complications in both groups were insignificant in difference, except prolonged wound healing in group A was noted. One year follow-up showed satisfactory results. Laser treatment is considered one of the alternatives to conventional treatment, but the surgeon needs to be aware of laser hazards.

Chromic acid burns; beware, be aggressive, be watchful

Two cases involving the development of systemic toxicity and prolonged wound healing in small percentage area burns due to chromic acid are reported. The treatment of chromic acid burns is reviewed and a protocol of management suggested.

Complications of Cutaneous Laser Surgery

We surveyed a selected group of 139 dermatologists and plastic surgeons about their experience with the complications of cutaneous laser surgery. Reported complication rates varied from 0% to 35%, with means of 3.2% for dermatologists and 6.2% for plastic surgeons using the argon laser, and 4.2% for dermatologists and 2.8% for plastic surgeons using the carbon dioxide laser. Hypertrophic scarring was the complication noted most frequently; 69% of physicians using the argon laser and 64% of physicians using the carbon dioxide laser have seen at least one case of hypertrophic scarring. Complications noted less frequently include infection, pain, atrophic scarring, intraoperative or postoperative hemorrhage, and prolonged wound healing. Environmental accidents were few. No procedure-related deaths, ocular damage, or secondary cutaneous malignant neoplasms were reported. We conclude that cutaneous laser surgery has an acceptable risk profile but that complications are not uncommon.

Complications of cutaneous laser surgery. A survey

• We surveyed a selected group of 139 dermatologists and plastic surgeons about their experience with the complications of cutaneous laser surgery. Reported complication rates varied from 0% to 35%, with means of 3.2% for dermatologists and 6.2% for plastic surgeons using the argon laser, and 4.2% for dermatologists and 2.8% for plastic surgeons using the carbon dioxide laser. Hypertrophic scarring was the complication noted most frequently; 69% of physicians using the argon laser and 64% of physicians using the carbon dioxide laser have seen at least one case of hypertrophic scarring. Complications noted less frequently include infection, pain, atrophic scarring, intraoperative or postoperative hemorrhage, and prolonged wound healing. Environmental accidents were few. No procedure-related deaths, ocular damage, or secondary cutaneous malignant neoplasms were reported. We conclude that cutaneous laser surgery has an acceptable risk profile but that complications are not uncommon. (<i>Arch Dermatol</i>1987;123:345-349)

Carbon dioxide laser vaporization and curettage in the treatment of large or multiple superficial basal cell carcinomas.

Many of the standard forms of therapy for large or multiple superficial basal cell carcinomas are limited by significant postoperative pain, excessive scarring, and prolonged wound healing time. Combining traditional curettage with carbon dioxide laser vaporization creates a procedure that allows excellent visualization, due to the bloodless surgical field produced by the laser, minimal nonspecific thermal damage, rapid healing, and diminished postoperative pain. In addition, the speed and ease with which this procedure can be performed allow successful treatment of many lesions in a single outpatient session. We wish to report our results using this technique for the treatment of 52 patients with 370 superficial basal cell carcinomas.

The Effect of Non‐therapeutic Ophthalmic Preparations on the Cornea and Tear Film

The effects of non-therapeutic ophthalmic preparations such as preservatives, vehicles, surface anaesthetics and irrigating solutions, on the cornea and tear film are summarised and reviewed. Critical concentrations and tonicities of various commonly used agents can be identified, which prolong wound healing and affect contact lens wear.

Observations on epidermal papillomata in wild and cultured Atlantic salmon Salmo salar L. in Finland

Epidermal papillomata are frequently observed neoplasms in several fish species. The condition recognized as salmon wart disease is a benign, neoplastic lesion of the epidermis mainly observecl in juvenile Atlantic salmon Salmo salar L. Recently, the disease was recorded also in marine cultured rainbow trout Salmo gairdneri Richardson in Scotland (Roberts & Bullock 1979). The pathological changes in typical papillomatosis of salmon include only epidermal elements. The affectecl areas show extensive hyperplastic growth of the middle cell layers of the epidermis resulting in the whitish plaques characteristic of the disease. Detailed information on the appearance, histopathology and ultrastructure of this condition has been presented in reports by Chronwall (1976), Carlisle & Roberts (1977) and Carlisle (1977). The papillomata usually appear in late summer; they are self-limiting and in most cases are shed during late autumn and winter. In uncomplicatecl cases the resolution of the plaques is immediately accompanied by re-epithelialization and healing of the lesions. Apparently, the lesions do not cause immecliate death of the fish but seconclary infections with prolonged wound-healing may prove fatal for affected fish. Epizootic outbreaks with unusually high mortality in a freshwater hatchery in northern Finland focusecl our attention on the disease. Investigations of parr and smolt in the northernmost parts of Lapland also revealecl cases of papillomatosis in populations of wild salmon. At the Montta fish farm at the River Oulujoki occurrences of papillomatosis have been regularly observed since 1968 with varying frequency from year to year. The most serious epizootics occurred during 1978-79 when as many as 80-90% of the fish in some culture tanks were affected. The fish affected were salmon of age classes 1 + and 2 + . Of 12 specimens examined for sexual maturity, six were males at the IVstage of maturity (Orton, Jones & King 1938) and six were females at the II-stage. In addition to the common sea-migrating salmon a population of landlocked salmon—a relic form living in freshwater—was also affected. The disease was never observecl in other salmonid species (Salmo trutta L., Salvelinus alpinus (L.) and Coregonus lavaretus L.) reared in the hatchery. The first signs of disease appear at the end of July and from October the plaques spontaneously begin to slough. Although starting as small transparent patches at an

2. Causes of Prolonged Healing of Anorectal Open Wound

Prolonged healing of anorectal open wound results mainly from 4 kind of causes being described below.1) Neglecting cardinal principle of anorectal surgery2) Inadequate control of post operative bowel movement3) Inproper after care Further there exist in fact a few cases of prolonged wound healing, which cause is quite unknown.

Prolonged catheter drainage of anorectal abscesses as a preliminary to elective anal fistulotomy.

The conventional surgical treatment of the common perianal and Ischiorectal varieties of anorectal abscess necessitates the patient's urgent admission to hospital, the Induction of general anæsthesia, and postoperative hospital convalescence. In addition, there is a period of prolonged wound healing. The result Is considerable Inconvenience to the patient from a minor surgical condition. An alternative method of prolonged catheter drainage of the abscess, combined with elective anal fistulotomy, if Indicated, Is suggested. The catheter employed Is the self-retaining de Pezzer type made of soft latex rubber. It Is introduced under local anæsthesia and can be used In the doctor's surgery, casualty, or In the out-patient department of a hospital. It Is not necessary for the patient to be admitted to hospital.