Aquacel Ag dressing versus Acticoat™ dressing in partial thickness burns: A prospective,randomized, controlled study in 100 patients. Part 1: Burn wound healing

Introduction

Studies comparing contemporary silver dressings in burns are scarce.

Methods

In a prospective, randomized, controlled study, counting 50 patients/research group, we compared two frequently used silver dressings, Acticoat™ and Aquacel^® Ag, in the management of partial thickness burns with a predicted healing time between 7 and 21 days as assessed by laser Doppler imaging between 48 and 72 h after burn. Variables investigated were related to baseline research group characteristics, wound healing, bacteriology, economics, nurse, and patient experience.

Results

Both research groups were comparably composed taking into account gender, age and burn characteristics. Similar results were obtained as to healing time and bacterial control with both silver dressings. A statistically significant difference in favor of the Aquacel^® Ag dressing was found for average ease of use (p < 0.001), average ease of application (p = 0.001), patient pain (p < 0.001), patient comfort with the dressing (p = 0.017), silver staining (p < 0.001), and cost effectiveness (p < 0.001).

Conclusion

Both silver dressings resulted in comparable healing times and bacterial control but the Aquacel^® Ag dressing significantly increased comfort for patients as well as nurses and was significantly more cost-effective than the Acticoat™ dressing for the given indication.     

Gastrointestinal sutureless anastomosis in pigs using absorbable intraluminal stents, stent placement devices, and fibrin glue – a summary

Introduction and methodology: To develop a practical gastrointestinal sutureless anastomosis technique, 164 end-to-end and end-to-side anastomoses were performed on the small intestine (SI), large intestine (LI), rectum, esophagus and gallbladder in 109 female Landrace pigs weighing 25 kg and 35 kg. There were 116 fibrin glue (FG) and 48 sutured anastomoses. The end-to-end SI and LI anastomoses were divided into five groups: sliding absorbable intraluminal nontoxic stent (SAINT); SAINT placement device (SAINT-PD); nonsliding SAINT (nST); sutureless stapler (SS); and sutured controls. The SAINT had a sucrose base, with some having reinforcing fibers. Results: No deaths from dehiscence occurred in any group except one FG-cylinder attempt in the colon (technique abandoned). Statistical analysis of gross pathology indices showed no significant group differences. However, trends favored the SAINT in many indices, including grade-0 intraluminal tissue ridge formation (70.8% SI, 84.4% LI) and grade-0 adhesion rates (45.8% SI, 73.1% LI). Histologic examination showed fewer giant cells, less inflammation, less scar tissue formation and faster healing in the SAINT and nST anastomoses than controls. Follow-up of 300–540 days demonstrated no signs of necrosis or stenosis in the SAINT anastomoses. The nST had excellent results; however, it seems impractical in SI anastomoses and unsuitable for LI. Conclusions: The SAINT-PD has potential for all gastrointestinal sites, but needs larger experimental trials. The SS technique is impractical and had high tissue ridge formation and adhesion rates. These preliminary trials suggest the simplicity, versatility and safety of the SAINT technique; however, the small groups limit result interpretation. The results present a starting point for sutureless FG gastrointestinal anastomosis, and future experimental evaluation with more extensive statistical analyses in larger studies are needed. Received: 14 December 1998 In revised form: 31 March 1999 Accepted: 22 April 1999     

Diagnostic value of zinc protoporphyrin in a screening strategy for α-thalassemia

The definitive diagnosis of α-thalassemia involves detection of a deletion of one or more α-globin that encode the α-chains of Hb (hemoglobin). To determine whether DNA analysis is indicated, screening tests such as mean corpuscular volume (MCV) and Hb typing are employed. α-Thalassemia often correlates with normal or low HbA2 values. Zinc protoporphyrin (ZPP) is usually high in ferropenic anemia or lead-poisoning and is normal or slightly raised in ß-thalassemia. Therefore, ZPP is currently used as a marker to discriminate between ferropenic anemia and β-thalassemia. We investigated the diagnostic potential of ZPP < 150 μmol/mol heme in a screening strategy for α-thalassemia. We measured ZPP and performed DNA analysis for detecting the seven most prevalent α-thalassemia deletions, namely, α3.7, SEA, α20.5, α4.2, MED, FIL, and THAI, in the blood samples of 200 patients with MCV < 70 fL and HbA2 ≤ 3.5%. Deletions were detected in 9% subjects in the ZPP ≥ 150 group (n = 175) and 56% subjects in the ZPP < 150 group (n = 29); this difference was statistically significant (chi-square test, P < 0.001). We conclude that ZPP < 150 μmol/mol heme can be used in a new screening strategy for α-thalassemia.     

Enhancement by chlordiazepoxide of the anticholinergic-induced locomotor stimulation in mice

Spontaneous locomotor activity has been studied in mice treated with chlordiazepoxide, atropine, and scopolamine, given alone or in combination. Chlordiazepoxide alone increased activity for a short time, while the two anticholinergic drugs produced longer lasting stimulatory effects. Locomotor stimulation was stronger when chlordiazepoxide and anticholinergics were given in combination.     

Human epithelial growth factor receptor 2[Ile655Val] polymorphism and risk of breast fibroadenoma.

Studies on the association between the Ile to Val polymorphism at codon 655 of the human epithelial growth factor receptor 2 (HER-2) gene and susceptibility to breast cancer have been reported for almost all ethnic populations, with both positive or negative conclusions. No study, however, has yet been focused on the possible association between this gene and its predisposition to benign breast lesions, especially on risk for fibroadenoma. We aimed to study the association of the single nucleotide polymorphism V655 HER-2 gene polymorphism with histologically verified breast fibroadenoma risk. We conducted a molecular epidemiological case-control study of 70 breast fibroadenoma cases without cellular atypia and 172 healthy female controls. We found that the Val variant allele and genotype frequency of this polymorphism is higher in cases with fibroadenoma; however, this difference was not significant (allele Val 655: 27.86 and 22.67% in fibroadenoma and controls, respectively; genotype Ile/Val: 35.71 and 38.37% and Val/Val: 10.0 and 3.49% in fibroadenoma and controls, respectively). Applying logistic regression analysis, we found an increased risk of fibroadenoma formation in carriers of the Val allele (odds ratio = 1.17; 95% confidence interval = 0.67-2.05), in which the highest risk was associated with homozygous genotype (odds ratio = 3.07; 95% confidence interval = 0.97-9.72), but this risk was not significant. Stratification by age (cut-off 45 years) revealed the highest risk of fibroadenoma among young women homozygous for the Val allele (odds ratio = 3.30). The risk, however, was slightly increased (odds ratio = 1.24) among older carriers of the aberrant allele in their genotype as well, but it was not significant. In spite of insignificant differences, our results indicate that HER-2 Ile655Val polymorphism, especially in a homozygous form might play some role in the etiology of breast fibroadenoma formation. The significance of this susceptibility, however, will have to be verified by larger studies.     

Chronobiological aspects of adult-onset Crohn disease

PURPOSE: To study the time course of Crohn disease and its signs. To compare the results with the world literature and draw conclusions for practice. BASIC PROCEDURES: Fifty-six patients were studied retrospectively: 31 males aged 19-48 years with disease duration 1-8 years, and 25 females aged 21-65 with disease duration 1-13 years. The disease was active (Crohn disease activity index > 150) in 25 patients and inactive in 31. Plasma levels of interleukin-6 (normal upper value 8 pg/ml) were investigated with radioimmunoassay. Bone mineral density was measured as the T-score (normal range between -1 and 0 standard deviations) in the forearm using dual-energy X-ray absorptiometry. The seasonality of births of the patients in relation to the total Slovak population and seasonality of severity of three important disease signs were examined with Halberg cosinor regression. The dependence of the signs on age and duration of disease was evaluated using quadratic regression. Results are presented as 95% confidence intervals (for means) and 95% tolerance intervals (for individuals). The level of statistical significance was set at alpha = 0.05. MAIN FINDINGS: Significant seasonality in births was found: decreased frequency in May-June and increased frequency in September-January. Significant spring elevation of interleukin-6 levels, accompanied by significant spring rise of the disease activity index and by decrease of bone density, is described. Among patients with active disease, interleukin-6 levels significantly increased up to the age of 41 years, whereas linear increase of disease activity during aging was on the borderline level of significance in the same subgroup. No significant age trend was encountered in T-score for either subgroup. The same was true for interleukin-6 and disease activity versus duration. Significant decrease in T-score paralleled disease duration up to seven years in the subgroup with active disease. PRINCIPAL CONCLUSIONS: The course of Crohn disease is influenced by time, including the seasons of the year. However, this does not find full agreement in the world literature, probably because of geographic, socioeconomic and epidemiologic differences, as well as varying approaches in method. In practice, regular monitoring of the time course is necessary in provision of appropriately timed treatment.     

Endotracheal colonization at birth is associated with a pathogen-dependent pro- and antiinflammatory cytokine response in ventilated preterm infants: a prospective cohort study

The possible association between mediators of inflammation such as cytokines and perinatal colonization of the respiratory tract remains unclear. This prospective cohort study evaluated endotracheal colonization in 141 ventilated preterm infants at birth. The relation with cytokine response in the airways and C-reactive protein (CRP) in umbilical blood was investigated. Of the 141 preterm infants enrolled in this study, 37 (26%) were colonized. In addition to traditional pathogens (61%), commensal species (26%) and Mycoplasmataceae (13%) were isolated. Both the pro-inflammatory cytokines IL-1 beta, IL-6, IL-8, and tumor necrosis factor (TNF)-alpha as well as the antiinflammatory IL-10 are increased in colonized patients in a dose-dependent manner, with the strongest response in neonates colonized with Gram-negative organisms. There was no antimicrobial IL-12p70 response in colonized infants. Commensal flora is associated with the same inflammatory response as traditional pathogens. Although the umbilical cord blood CRP level was significantly higher in neonates with endotracheal colonization, it was highest in those colonized with Gram-negative organisms but still close to normal limits. Microorganisms in the endotracheal fluid of ventilated preterm infants are associated with a pathogen-specific and dose-dependent cytokine response in the airways and systemic CRP response.     

Flow calorimetry--a useful tool for determination of immobilized cis-epoxysuccinate hydrolase activity from Nocardia tartaricans

Bacterial cells Nocardia tartaricans with cis-epoxysuccinate hydrolase activity were entrapped in hardened calcium pectate gel by a commercial high performance encapsulator. This enzyme (in a single step reaction with no formation of side products) was used to hydrolyze disodium cis-epoxysuccinate to a pure enantiomer--disodium L-(+)-tartrate. Activities of this enzyme were determined using flow calorimetry. The validity of this method was corroborated by HPLC and isotachophoresis. The immobilized biocatalyst has activity (75.8 U/mgdry) able to convert disodium cis-epoxysuccinate to disodium tartrate at 94% yield in 5.5h. Immobilization of N. tartaricans in hardened calcium pectate gel beads had a positive effect on the activity of cis-epoxysuccinate hydrolase, storage stability, yield, and time of bioconversion.