Safety and effect of transforming growth factor-β2 for treatment of venous stasis ulcers

Transforming growth factor-beta(2) promotes healing in a variety of animal models and exhibits clinical effects thought to be mediated by connective tissue formation. Two clinical trials were conducted to evaluate the safety and effect of transforming growth factor-beta(2) purified from bovine bone and delivered topically to venous stasis ulcers three times per week for up to 6 weeks by means of a lyophilized collagen vehicle. The first was an open-label trial comparing transforming growth factor-beta(2) purified from bovine bone (0.5 microg/cm(2)) with a placebo consisting of lyophilized collagen vehicle-without active drug. After no safety issues arose in that trial, a prospectively randomized, closed-label, observer-blinded, three-armed trial was conducted to compare bovine transforming growth factor-beta(2) (2.5 microg/cm(2)) with the collagen matrix placebo vehicle and with a standard dressing. Standardized elastic compression was applied to all test extremities. The rate of reduction of ulcer area as measured by planimetry was the primary measure of effect. No serious safety-related events occurred in either trial. Clinical evaluation suggested that improvement in the quality and quantity of granulation tissue appeared to precede epithelialization of ulcers treated with bovine transforming growth factor-beta(2). In both studies, treatment with bovine transforming growth factor-beta(2) appeared to have a positive effect on the rate of ulcer closure, whereas ulcers in the control groups continued to exhibit impaired healing. In the open-label study, the mean rate of closure of ulcers treated with bovine transforming growth factor-beta(2) was significantly greater than that of ulcers treated with placebo. There was likewise enhanced reduction in ulcer area in the ulcers treated with bovine transforming growth factor-beta(2) in the second trial. However, because of a higher variability in patient response and a greater placebo effect, the difference was not significant. The placebo was not worse than the standard care arm, thereby showing that the vehicle is not injurious to healing. The combined results of the two trials suggest that, at doses of 0.5 to 2.5 microg/cm(2), bovine transforming growth factor-beta(2) is safe as a topically applied agent in a collagen matrix vehicle and can have a positive effect on closure of venous stasis ulcers. Large multicenter trials appear to be indicated to evaluate fully the potential utility of transforming growth factor-beta(2) in accelerating closure of chronic dermal ulcers.     

The HIV-Positive Physician and Disability Insurance

Occupational exposure to HIV is becoming a daily hazard in many emergency departments. Emergency physicians who are protected by disability insurance policies are likely to believe that if they are unable to continue working because of HIV-positive status, their disability policies will provide them with a source of income. Unfortunately, analysis of case law regarding claims under disability policies shows that the law is unlikely to consider an asymptomatic, HIV-positive physician disabled for purposes of payments under disability policies. Therefore, it is necessary for emergency physicians to make sure this issue is resolved before buying and relying on a disability policy so that an anticipated safety net will be operative over the full range of hazards that emergency physicians face.[Lavely R: The HIV-positive physician and disability insurance. Ann Emerg Med June 1994;23:1355-1362.]     

The emergency physician and patient confidentiality: A review

Confidentiality is a promise rooted in tradition, law andmedical ethics. Emergency physicians treat a variety of patients to whom confidentiality is of vital importance: employees, celebrities, victims of violence or disaster, minors, students, criminals, drug abusers, and patients with STDs. EDs should develop methods of ensuring confidentiality for all patients.³⁴Although confidentiality is an important principle thatshould be respected and guarded, it is not absolute. Various laws mandate disclosure of certain patient information; in addition, an overriding moral duty may occasionally require, a breach of confidentiality. As Beauchamp and Childress noted, “the therapeutic role may sometimes have to yield to ones role as citizen and as protector of the interests of others”.¹⁹ In general, however, circumstances requiring a breach of confidentiality are rare.     

Maxillary and mandibular occlusal photographs

Taking occlusal photographs can be challenging; they are by far the most difficult images to obtain. Achieving an ideal photograph of every arch may not always be possible. In patients with limited range of motion of the mandible, an oversized or hyperactive tongue, an excessive gag reflex, or reduced flexibility of lips and checks, the goal of an ideal occlusal photograph may not be achieved. Nevertheless, patience, practice, and attention to detail can often provide a satisfactory result.     

How Long Can Hair Follicle Units Be Preserved at 0 and 4°C for Delayed Transplant?

BACKGROUND: Preservation of hair follicle units for the purpose of delayed transplant will help us graft thousands of hair grafts at one session, even in a clinic with fewer assistants and less equipment. OBJECTIVE: This study was undertaken to evaluate and compare the viability of hair follicle units preserved at 0 and 4 degrees C for various periods. MATERIALS AND METHODS: Cell cultures and transplant of hair follicle units into athymic mice were performed. RESULTS: Outer root sheath cells could be cultivated in 96% (0 degrees C group) and 92% (4 degrees C group) of the hair follicles after 24 hours of preservation, whereas 85% (0 degrees C group) and 79% (4 degrees C group) of the follicles implanted into the mice regrew well after the same period of preservation. Then, in both the 0 degrees C and the 4 degrees C group, these rates decreased significantly with length of preservation in cell cultures and mice transplant; however, 0 degrees C seems better than 4 degrees C for preservation of grafts (p<.05). CONCLUSION: Grafts are better preserved at 0 degrees C instead of 4 degrees C. When delayed transplant is an option, it should be completed within 24 hours and no later than 48 hours.     

Severe adolescent head injury: Implications for transition into adult life

This report describes the outcomes of 28 children who had severe head injuries between 13–18 years of age. All were unconscious at least 24 hours and have been followed at least 2 years after injury. At present, their ages range from 18 to 27 years. Their educational achievements, social activities, marital status, functional independence, and employment at follow-up are described.     

Nursing: Caring or Codependent?

Can nurses practice caring within a healthcare system that promotes codependency? Caring promotes mutual empowerment of all participants while codependent caring disempowers. Nurses are expected to practice caring with clients, The authors contend, however, that nursing, as historically and currently practiced within bureaucratic/patriarchal organizations, is founded on a vlue system that fosters codependency. Until nursing is practiced within the context of caring organizations and a caring healthcare system, nurses will continue to be powerless to shape their own practice as carers and burnout will continue to be a problem.