S-nitrosoglutathione-containing hydrogel accelerates rat cutaneous wound repair

BACKGROUND: Nitric oxide (NO) plays a key role in wound repair and S-nitrosothiols like S-nitrosoglutathione (GSNO) are well known NO donors. METHODS: Animals were separated in two groups and submitted to excisional wounds on the dorsal surface at the first day. GSNO (100 microm)-containing hydrogels were topically applied on the wound bed in the GSNO group, daily, during the first 4 days. Control group was topically treated with hydrogel without GSNO for the same period. Wound contraction and re-epithelialization were measured. Animals were sacrificed 21 days after wounding. Samples of lesion and normal tissue were formalin-fixed, paraffin embedded for histological analysis. RESULTS: Wound contraction, measured 14 and 21 days after wounding, was greater in the GSNO group than in the control group (P<0.05 for both). The re-epithelialized wound area, measured 14 days after wounding, was higher in the GSNO group than in the control group (P<0.05). A higher amount of inflammatory cells was observed in superficial and deep areas of the granulation tissue of the control group compared to the GSNO group. Twenty-one days after wounding, thin red-yellow collagen fibers arranged perpendicularly to the surface were found in the granulation tissue of the control group, whereas in the GSNO-treated group collagen fibers were thicker and arranged parallel to the surface. Increased number of mast cells was observed in the GSNO group compared with that in the control group. Vascularization and myofibroblast distribution were similar in both groups. CONCLUSION: Topical application of GSNO-containing hydrogel during the early phases of rat cutaneous wound repair accelerates wound closure and re-epithelialization and affects granulation tissue organization.     

Toxic shock syndrome in scalded children

Five patients showing clinical signs resembling the 'toxic shock syndrome' presented over a 4-month period at the Wessex Regional Burns Centre. Toxin-producing isolates of Staphylococcus aureus were made from wound swabs in four of the five patients. Four different phage types producing four different toxins were observed. Seven other patients yielded staphylococci from wound swabs but did not develop the toxic shock syndrome. In three of these latter patients the staphylococcus isolated was toxin producing. Since the syndrome carries a significant mortality risk it is desirable that it is recognized and treated without delay. To this end a simplified set of criteria for the identification of probable toxic shock syndrome cases is proposed. The observations suggest that toxic shock syndrome is more common than previously supposed. The syndrome may show a broad spectrum in its clinical presentation, and involve a wide range of staphylococcal phage types with possible involvement of several different enterotoxins.     

Difficulties using the Franco-Italian Glossary in assessing toxicity of cervical cancer treatment

Shakespeare TP, Ferrier AJ, Holecek MJ, Jagavkar RS, Stevens MJ. Difficulties using the Franco-Italian Glossary in assessing toxicity of cervical cancer treatment. Int J Gynecol Cancer 1998; 8: 51–55
We assessed the toxicities of patients treated for cervical cancer using the revised Franco-Italian Glossary (FIG). A total of 69 separate complications were appraised in 47 patients; however, only 43.5% of these side-effects could be accurately graded. In all, 56.5% of toxicities could not be scored for a variety of reasons: (1) the FIG does not account for all possible complications of cervical cancer treatment; (2) some important toxicities are regarded as too minor to be graded; (3) subjective assessment of some side-effects did not allow consensus to be reached when assigning a grade; (4) we could not accurately score toxicities using the FIG in a retrospective manner. Previous studies utilizing the FIG retrospectively have noted few problems with its use, with no indication of the number of toxicities unable to be graded. In view of the inability to grade the majority of complications in the present study in an accurate manner, we conclude that the revised FIG requires detailed data that are best collected prospectively and that several minor modifications of the glossary should be considered. Results of studies using the glossary retrospectively should be viewed with caution.     

Reflex inhibition of the quadriceps after meniscectomy: lack of association with pain

We have examined the severity and duration of reflex inhibition of quadriceps activation after arthrotomy and meniscectomy, its relationship with pain, and the effect of local anaesthesia on this relationship. Fourteen men, on completion of medial meniscectomy by arthrotomy, received either 10 ml (B10 group) or 15 ml (B15 group) of 0.5% bupivacaine hydrochloride ('Marcaine Plain') into the knee, or no injection (control group). Reflex inhibition of quadriceps was measured as the percentage reduction, from the ipsilateral preoperative value, in the integrated surface electromyogram recorded during maximal voluntary isometric contractions with the knee in extension. Pain during each contraction was recorded on a linear analogue scale. Unoperated limbs showed no evidence of quadriceps inhibition. In the operated limbs, at 1-2 h post-operatively, controls had both severe inhibition (median = 62%) and severe pain on attempting a maximal quadriceps contraction. The B10 group had similar inhibition but less pain (P less than or equal to 0.005, Wilcoxon 2-sample, 1-tailed test). In the B15 group both inhibition (P less than or equal to 0.05) and pain (P less than or equal to 0.01) were less than in the controls. These effects of bupivacaine had been lost by 4-5 h post-operatively. At 3-4 days, inhibition was still severe (median = 75%) in all three groups of patients but pain was only mild or absent. At 10-15 days, median inhibition was still 35%, but there was little or no pain. We conclude that postmeniscectomy inhibition is not simply due to perceived pain but is due, at least in part, to stimuli from the knee.     

Normal erythrocyte sedimentation rate in the elderly

Two hundred subjects aged 60-89 were selected for a study aimed at defining a reference range for the erythrocyte sedimentation rate in the elderly. The study extended a previous survey in subjects aged 20-65. The results confirmed that the sedimentation rate increases with age and that women have higher values than men but suggested that over half of elderly patients with disease would have rates within the previously defined "normal" range. It is therefore suggested that an erythrocyte sedimentation rate exceeding 19 mm in the first hour in elderly men and 22 mm in the first hour in elderly women warrants investigation.     

双能量X线骨质密度测量仪监测小儿下肢骨延长骨矿物质的变化

目的　在儿童骨延长的患儿中 ,为了能够有效地控制骨延长的速率 ,达到骨延长的目的 ,采用双能量X线骨质密度测量仪 (dualenergyX Rayabsorptiometry ,DEXA)监测延长断端骨矿含量 (bonemineralcontent,BMC)的变化。方法　 30例患儿中有 5 0处下肢作了骨延长术 ,平均年龄10 .9岁 (5～ 17岁 ) ,引起短肢的病因不同。术后 7～ 10d开始行骨延长 ,每次延长 0 .2 5mm ,每天 4次。牵引延长期间每周扫描一次 ,拆除外固定器后每 2周扫描一次到术后 2年。DEXA扫描的分辨率是 1mm× 1mm ,扫描速度 30mm/s。比较不同延长时期中骨矿含量的变化。分析不同病因和不同外固定器之间骨矿含量变化的差别。结果　不同固定器之间骨矿含量的差别无著性意义。根据骨延长区BMC增加速率 ,将患儿分为快速组、一般组和慢速组。快速组每日BMC增加速率为 0 .3%～ 0 .6 % ,新骨生长快速 ;一般组每日BMC增加 0 .1%～ 0 .3% ,新骨中速生长 ;慢速组每日增加 <0 .1% ,新骨生成缓慢。骨矿化速率与原发病因相关。结论　DEXA能动态监测骨延长中新生骨的骨矿含量的变化 ,根据骨矿含量变化的程度 ,能够调整骨延长的速率 ,从而达到预期骨延长的目的。     

Longitudinal neurological follow-up of a group of HIV-seropositive and HIV-seronegative hemophiliacs: results from the hemophilia growth and development study

BACKGROUND: Boys and young men with hemophilia treated with factor infusions before 1985 had a substantial risk of acquiring the human immunodeficiency virus (HIV) and the acquired immunodeficiency syndrome. This study was designed to assess the effects of HIV and hemophilia per se on neurological function in a large cohort of subjects with hemophilia, and to investigate the relationships between neurological disease and death during follow-up. METHODS: Three hundred thirty-three boys and young men (207 HIV seropositive and 126 HIV seronegative) were evaluated longitudinally in a multicenter, multidisciplinary study. Neurological history and examination were conducted at baseline and annually for 4 years. The relationship between neurological variables, HIV serostatus, CD4+ cell counts, and vital status at the conclusion of the study was examined using logistic regression models. RESULTS: The risks of nonhemophilia-associated muscle atrophy, behavior change, and gait disturbance increased with time in immune compromised HIV-seropositive subjects compared with HIV seronegative or immunologically stable HIV-seropositive subjects. The risk of behavior change in immune compromised HIV-seropositive hemophiliacs, for example, rose to 60% by year 4 versus 10% to 17% for the other study groups. Forty-five subjects (13.5%), all of whom were HIV seropositive, died by year 4. Subjects who died had had increased risks of hyperreflexia, nonhemophilia-associated muscle atrophy, and behavior change. CONCLUSIONS: These results indicate that immune compromised, HIV-seropositive hemophiliacs have high rates of neurological abnormalities over time and that neurological abnormalities were common among subjects who later died. By contrast, immunologically stable HIV-seropositive subjects did not differ from the HIV-seronegative participants. Hemophilia per se was associated with progressive abnormalities of gait, coordination, and motor function.