Treatment of Superficial Surgical Wounds after Removal of Seborrheic Keratoses: A Single-Blinded Randomized-Controlled Clinical Study

BACKGROUND: For the treatment of superficial surgical wounds, there are a number of options, including topical antibiotic ointments, dressings, and specialized wound care materials, such as hydrocolloid dressings. OBJECTIVE: To evaluate the wound-healing activity of a commercially available hydrocolloid wound dressing (Avery H2460, Avery Dennison, Turnhout, Belgium) in comparison with a control treatment (Fucidine cream with Cutiplast sterile dressing) in superficial wounds after surgical removal of seborrheic keratoses. METHODS: In a single-blinded, randomized, controlled trial, the hydrocolloid wound dressing (Avery H2460) was compared with healing by secondary intention as a control. Sixteen patients between 18 and 80 years of age with seborrheic keratoses were enrolled. Wound healing was evaluated after 7 and 10 days and then daily until complete closure of the wound area. In 7 of 16 patients, biopsies were taken after 14 days of reepithelization. RESULTS: The hydrocolloid wound dressing (Avery H2460) induced a significantly (p<.05) faster healing (median: 8.5 days) in comparison with the control treatment (median: 10 days). The histologic investigations showed no significant differences for the investigated parameters in both groups. CONCLUSION: The faster healing in comparison with the control treatment supports the use of the hydrocolloid wound dressing (Avery H2460) for the treatment of superficial surgical wounds.     

The determination of spontaneous megakaryocyte colony formation is an unequivocal test for discrimination between essential thrombocythaemia and reactive thrombocytosis

Summary. Spontaneous colony formation from bone marrow megakaryocyte progenitors (BMsCFU-Mk) was studied in 24 patients with essential thrombocythaemia (ET), 20 patients with reactive thrombocytosis (RT), 20 patients with polycthaemia rubra vera with thrombocytosis (PRVtr), 16 patients with chronic myeloid leukaemia with thrombocytosis (CMLtr) and 18 normal control subjects (C).
The culture medium which was used in the methylcellu-lose assay in vitro contained 30% of plasma from a single patient with hereditary haemochromatosis. Remarkable BMsCFU-Mk growth was recorded in all patients with ET but in none with RT or in C. BMs-CFU-Mk were present in 11/20 patients with PRVtr and 7/16 patients with CMLtr.
Spontaneous bone marrow erythroid progenitors (BMsBFU-E) were also determined in these patients. BMsBFU-E were found in 21/24 patients with ET and none in the patients with RT and C. All patients with PRVtr and one patient with CMLtr showed BMsBFU-E.
We conclude that our implementation of the in vitro methylcellulose assay allows the BMsCFU-Mk to be used as an unequivocal test for discrimination between ET and RT which has not been shown in previously published studies.
In addition, we present evidence that in 10 patients BMsCFU-Mk and/or BMsBFU-E growth in the test persisted after long-lasting haematological remission.     

A retrospective analysis of anesthesiologic complications in pediatric neurosurgery

Background and objective:  Different clinical and surgical factors can influence the occurrence of anesthesiologic complications in pediatric neurosurgery. Preoperative knowledge of these factors is of great importance in the application of safe anesthetics and a favorable surgical outcome. The objective was to establish the importance of clinical and surgical risk factors on the frequency of anesthesia complications in pediatric neurosurgery.
Data and method:  The research, from 1996 to 2000, involved 705 children, aged from <1 year to 15 years, who underwent surgery for elective neurosurgical pathology and severe head injuries. We analysed the influence that: age, the preoperative neurologic diagnosis, the urgency of the operation, additional disorders, the surgical position, and the duration of anesthesia had on the frequency of anesthesia complications. To test the statistical relevance and to confirm the hypothesis, the Pearson's chi-square test, Mann–Whitney U -test, and univariate and multivariate logistic regressions were used.
Results:  Anesthesia complications (cardiovascular, respiratory, air embolism, allergic reactions) were present in 68/705 (9.6%) patients. Their frequency was statistically greater in children for whom the surgery was >240 min, who were in the sitting position and when comorbidity was evident. Neither age nor the urgency of the operation or reoperation had any significant influence on the occurrence of anesthetic complications.
Conclusion:  The duration of anesthesia, the sitting position of the patient, and the presence of comorbidities significantly increase the risk of anesthesia complications in pediatric neurosurgery.     

Absorbable Suture Technique: Solution to the Growth Problem in Pediatric Pacing with Endocardial Leads

Endocardial pacing system implantation has been performed in 15 children of mean age 37 months (ranging from 1 day to 89 months), Endocardial lead fixation was performed by means of slowly resorbable suture (Dexon) to allow spontaneous lead migration as the child grows. During a mean follow-up period of 61 months (range 17–108 months), none of the patients needed reintervention for correcting the lead length to allow growth.     

Autoantibodies to Mitotic Apparatus: Association with Other Autoantibodies and Their Clinical Significance

The most important mitotic apparatus (MA) antigens are centrosome (CE), nuclear mitotic apparatus (NuMA-1, NuMA-2), midbody, and centromere F (CENP-F). We studied associations of anti-MA antibodies with other autoantibodies and their clinical significance. A total of 6270 patients were studied for the presence of anti-MA antibodies on HEp-2 cells. Sera positive for anti-MA were tested for anti-extractable nuclear antigens (ENA) antibodies. Anti-MA antibodies were detected in 56 (45 females and 11 males) of 6270 sera (0.9%). Of these 56, NuMA-1 was found in 23, NuMA-2 in 7, CE in 20, CENP-F in 5, and CENP-F/centrosome in 1 case. Anti-NuMA-1 were associated with anti-ENA antibodies (p < 0.001). Diagnoses were established in 43/56 patients: 22 connective tissue diseases, 7 infections, 6 autoimmune hepatitis, 3 vasculitis, 3 primary antiphospholipid syndrome, 1 malignancy, and 1 fever of unknown origin. The differential diagnosis of anti-NuMA-1-positive patients must include Sj?gren's syndrome, while patients with anti-CE antibodies must be observed for HCV infection.     

Breast feeding: Overview and breast milk immunology

The transfer of host defence capacity to the human offspring provides a remarkable model of passive transfer of immunity. In fact it may also provide an example of active immunization. The transfer of mucosal protection via breast feeding offers many additional advantages for the mother and infant. Through its contraceptive effects it increases the spacing between births, thus diminishing the infant mortality and the burden on the mother. It also enhances bonding between mother and child, it seems to increase the IQ and school result of the infant and might decrease the risk of certain malignancies and perhaps of juvenile diabetes. A fully breast-fed infant receives as much as 0.5-1 g of secretory immunoglobulin A (SIgA) antibodies daily, the predominant antibody of human milk. This can be compared to the production of some 2.5 g of SIgA per day for a 60 kg adult. These SIgA antibodies have been shown to protect against Vibrio cholerae, ETEC, Campylobacter, Shigella and Giardia. Furthermore, milk is rich in receptor analogues for certain epithelial structures which microbes need for attachment to host tissues as an initial step in infections. Thus the adherence of Haemophilus influenzae and pneumococci for example to retropharyngeal cells is efficiently inhibited by human milk. This may be one explanation for the fact that breast-fed babies have less otitis media than the non-breast-fed. Other milk factors like lysozyme and lactoferin may contribute to the host defence, but this has not yet been well defined. However, human milk also supports the well-being of the infant by being anti-inflammatory. The predominant SIgA antibodies and the receptor analogues prevent microbes from getting into contact with host tissues causing tissue inflammation via inflammatogenic immunoglobulin G and immunoglobulin M antibodies and activated T lymphocytes. Rather, milk proteins like lactoferrin can inhibit the production of inflammatogenic cytokines like interleukin-6 from intestinal epithelium and monocytes/macrophages. Breast feeding enhances vaccine responses in the infant. This may occur via immunostimulation effects via anti-antibodies present in the milk. Human milk truly provides an unequalled mixture of factors supportive of the health of the infants. Many factors may still remain to be discovered.     

Evaluation techniques for the Healthy School project in Yugoslavia

In preparation for the implementation of the Healthy Schoolproject in Yugoslavia, great attention was paid to evaluationprocedures and instruments. One of them was the ‘Drawand Write Investigation Technique’ suitable for monitoringchanges in pupils' knowledge during first four grades of elementaryschooL The pupils (n=473) in first four grades were tested inthree cities: Belgrade, Novi Sad and Zajecar. The results werecompared and tested by age, sex, residence, and type of health-promotingmeasures mentioned. The results proved that the technique issensitive enough to reveal expected differences in knowledgeacquired in school. The technique was accepted by teachers,health workers, and pupils as very attractive and interesting.With some adaptations and modifications ‘Draw and WriteInvesti gation Technique’ will be used as a knowledge-changeevaluation instrument in the Healthy School project in Yugoslavia