Clinical observations on the use of honcrivine in the chemical debridement of wounds.

BACKGROUND: Chronic and non healing wounds, necrotic wounds and contused and devitalized wounds require debridement to rid the wounds of all these impediments that encourage bacterial growth and multiplications with consequent impairment of wound healing. Whereas there are several methods of wound debridement with their peculiar indications, merits and demerits, the ideal method of debridement is yet to be discovered. AIM: The aim of this study is to investigate clinically the ability of honcrivine (honey plus acriflavine 0.1%) to chemically debride various wounds in routine clinical practice. PATIENTS AND METHOD: One hundred and eighty nine consecutive patients managed by the author between June 1995 and June 2005 were included in this study. They were 125 males and 64 females and their ages ranged between 6 and 78 years. Initially swab was taken for bacterial culture from each wound before being cleaned with normal saline, then dressed daily with gauze soaked in honcrivine. Bacterial culture was repeated fortnightly. Antibiotics were administered as dictated by culture and sensitivity report. RESULTS: Wound debridement progressed rapidly and impressively with necrotic and devitalized tissues as well as tenacious pus and fibrin deposits being replaced with healthy granulation tissue. Patients age, sex and bacterial burden did not influence the rate of debridement, rather wound age and necrotic burden were inversely proportional to the debridement rate. Honcrivine did not provoke any inflammatory response nor was any allergic reaction observed. CONCLUSION: It is one of the oldest remedies known to mankind and is still useful and versatile today as it was 2000 years ago. It is a very effective chemical wound debridant.

Breast abscesses in Nigeria: lactational versus non-lactational.

This review of 299 cases of breast abscesses seen over a 10-year period (1981-1990) at the University of Calabar Teaching Hospital in Nigeria seeks to establish the current status of breast abscesses in the tropics. Lactational breast abscess constitutes 95% of breast abscesses while non-lactational breast abscess constitutes only 5% in this review. The commonest pathogen cultured from lactational breast abscess is Staphylococcus aureus and the disease responds to incision and drainage and systemic antibiotics, while non-lactational breast abscess is caused mostly by anaerobic organisms, usually with underlying mammary duct ectasia. The low incidence of non-lactational breast abscess corresponds to the low incidence of cigarette smoking and mammary duct ectasia in Nigerian women. While the high incidence of lactational breast abscess corresponds to the high rate of breast feeding and low level of personal hygiene in the low income group Nigerian women in which the disease is commonest. Economic recession has also reduced patronage of artificial feeds thus intensifying breast feeding and consequent lactational breast abscess.

PIP: A consultant surgeon analyzed data on 299 women aged 18-56 treated for breast abscess during 1981-1990 at the University of Calabar Teaching Hospital in Nigeria to examine the differences and similarities in the etiology, presentation, management, and prognosis of lactational and nonlactational breast abscess. This hospital treats an average of 30 cases annually. Only 14 women (5%) were not lactating at the time of presentation. The lactating group comprised younger women than the nonlactating group (median age, 25 vs. 42). 85% of all lactational breast abscesses submitted for culture grew Staphylococcus aureus. 5% grew coliforms and 10% grew no organisms. 9 nonlactational breast abscesses were submitted for culture: 4 grew anaerobic organisms (3 Bacteroides sp. and 1 Streptococcus), 1 grew coliforms, and 2 grew nothing. All the women with lactational breast abscess improved with treatment: incision and drainage followed by daily packing with gauze soaked in magnesium sulfate solution (135 cases), Eusol (100 cases), and honey (50 cases) and systemic antibiotic with erythromycin, ampiclox, or amoxicillin/clavulanic acid. Only 4 of the women with nonlactational breast abscess improved with this treatment. The other 10 women experienced recurrence of breast abscess. Excision biopsy was required to treat them. They had acute or chronic inflammation with duct ectasia. All the women in the lactational breast abscess group were poor, while 6 of the 14 women with nonlactational breast abscess were from the high income group. No one from either group smoked cigarettes, probably explaining the low incidence of nonlactational breast abscess in Nigeria. The continual high incidence of lactational breast abscess coincides with the high incidence of breast feeding and with poor personal hygiene in the low income group in Nigeria.

The features and aetiology of Fournier's gangrene.

This paper reports a clinical study of 20 cases of gangrenous ulcers of the scrotum and/or of the penis (Fournier's gangrene) and a review of previous publications. Even though found mostly in elderly male patients, the disease spares no age group and can involve the external genitalia in neonates and women as well. The disease is a necrotising fasciitis of infective origin and always has a portal of entry of the infecting organisms even though it may be so trivial as to be undetected. The commonest portals of entry of infection are periurethral sepsis, groin wound sepsis, anorectal sepsis, prostatic sepsis and trauma. The infecting organisms comprise both aerobic and anaerobic organisms such as Escherichia coli, Streptococcus pyogenes, Pseudomonas aeruginosa, Klebsiella pneumonia, Proteus mirabilis, enterococci, Bacteroides fragilis and anaerobic streptococcus. Fournier's gangrene is probably the same disease as necrotizing fasciitis occurring in other parts of the body, but modified by the peculiar anatomy of the genitoperineum.

Clinicopathological features of untreated fibrous hamartoma of infancy.

AIM: To study the clinicopathological features of fibrous hamartoma of infancy in Nigerian children. METHODS: Six children aged between 6 months and 10 years were studied. All specimens were stained with haemotoxylin and eosin and examined routinely. The children were followed up for between one and three years. RESULTS: In four of the children lesions were present at birth; in the other two they appeared by the age of 1 year. Some of the children had had the lesion for between three and 10 years. All lesions were located in the subcutis. They were solitary and varied in size and shape. They had grown rapidly up to the age of 5, after which growth decelerated, but did not stop or regress. The younger the child the less clearly demarcated was the tumour on the deep surface. In the older children the capsule was more developed. CONCLUSIONS: Fibrous hamartoma of infancy is rare, but it is important for clinicians to know that it is benign and readily amenable to treatment.

Recent advances in the management of Fournier's gangrene: preliminary observations.

Twenty consecutive cases of Fournier's gangrene managed conservatively with systemic antibiotics and topical application of unprocessed honey (group A) were compared with 21 similar cases of Fournier's gangrene managed by the orthodox method (group B) during the same period. Group A received oral amoxicillin/clavulanic acid and metronidazole in addition to daily topical application of honey to the gangrenous scrotum, whereas group B underwent wound debridement, wound excision, secondary suturing, and in some cases scrotal plastic reconstruction in addition to receiving a mixture of systemic antibiotics dictated by culture and sensitivity results. The organisms cultured in both groups were similar. Even though the average duration of hospitalization was slightly longer in group A (4.5 weeks) as opposed to group B (4 weeks), topical application of honey showed distinct advantages over the orthodox method. Three deaths occurred in group B, whereas no deaths occurred in group A. The need for anesthesia and expensive surgical operation was obviated. Response to treatment and alleviation of morbidity were faster in group A. Honey may revolutionize the treatment of this dreadful disease by reducing morbidity and mortality.

The antimicrobial spectrum of honey and its clinical significance.

The antimicrobial spectrum of honey was investigated by placing two drops into each of the wells made on culture media on which pure cultures of various organisms obtained from surgical specimens were grown. The organisms were grown under both aerobic and anaerobic environments. Fungal cultures of common fungi causing surgical infections or wound contaminations were mixed with 100%, 50% and 20% unprocessed honey. Growth inhibition was complete in the media containing 100%, partial in media containing 50% and no inhibition was produced by 20% honey. Unprocessed honey inhibited most of the fungi and bacteria causing wound infection and surgical infection except Pseudomonas aeruginosa and Clostridium oedematiens. Apart from Streptococcus pyogenes which is only moderately inhibited, golden syrup, a sugar syrup with similar physical properties as honey, did not inhibit any of the bacteria or fungi tested, demonstrating that honey is superior to any hypertonic sugar solution in antimicrobial activity. Honey is thus an ideal topical wound dressing agent in surgical infections, burns and wound infections.

Clinical and bacteriological study on childhood empyema in south eastern Nigeria.

Forty-eight children with empyema thoracis were seen over a seven-year period (December, 1982 to November 1989) in the University of Calabar Teaching Hospital, Calabar, Nigeria. This number accounted for 0.2% of all paediatric admissions during the period. The peak age incidence was 2 years and under. Pneumonia was the antecedent illness in about all cases, but surprisingly, measles played an insignificant role. Late consultation and severe morbidity were constant feature with anaemia and cardiac failure as frequent complications of the disease. Staphylococcus aureus, the predominant causative organism was resistant to penicillin and ampicillin but sensitive to gentamicin, cloxacillin and erythromycin. The initial use of the parenteral gentamicin or cloxacillin in treating children with empyema is therefore recommended. This study demonstrates the rarity and low fatality (6%) of childhood empyema in Calabar, but protracted hospitalisation and exorbitant medication involved make it an important disease. Perhaps, it can be completely eliminated if parents are educated enough to avoid late reporting of childhood respiratory disease.

PIP: Physicians analyzed December 1982-November 1989 data on 48 2-60 month old children with empyema thoracis at the University of Calabar Teaching Hospital in southeastern Nigeria to determine the incidence and etiology of empyema thoracis in this region. The incidence rate stood at 2/1000 pediatric admissions. 3 children died (6.3%), all of heart failure. 47 children suffered from fever, cough, and breathlessness, the symptoms for pneumonia. Even though bronchopneumonia is a common complication of measles which occurs frequently in Calabar, only 3 children (6.25%) also had measles. The most frequent complication of this accumulation of pus in the thoracic cavity was congestive heart failure (16 cases). 47 patients suffered from anemia (hemoglobin levels 11 gm/dl). Hemoglobin levels of 54% of all patients decreased over time to 8 gm/dl. In fact, 2 children had hemoglobin levels of 4.4 gm/dl and they experienced cardiac failure. Laboratory personnel were only able to examine pleural aspirates from 37 patients. They did not detect any organisms in 27% of these aspirates. This may have been due to parent's widespread practice of giving medication to all the children before coming to the hospital. 45.9% of the aspirates only grew Staphylococcus aureus while another 8.1% grew it and other pathogens. About 90% of the pathogens were resistant to ampicillin and penicillin and almost 90% were sensitive to cloxacillin, gentamicin, and erythromycin. Cloxacillin was very expensive and parenteral erythromycin was unavailable. Nevertheless the pediatricians used parenteral gentamicin and cloxacillin. The parents were responsible for buying the antibiotics which tended to be costly. All the patients required emergency closed tube thoracostomy drainage within 24 hours of admission. 83.3% remained in the hospital for 2 weeks and 33.3% for 1 month. Despite the rarity of empyema, long hospitalization and expensive drugs make it an important disease in Calabar.

The effects of fresh palm wine on human gastric acid secretion.

The effect of fresh palm wine on gastric acid secretion was studied using human volunteers. Basal acid output for seven subjects used for the study with palm wine was 1.05 +/- 0.14 mMol/hr (mean and SEM). Peak acid output following the administration of 200 ml of the palm wine was 1.21 +/- 0.20 mMol/hr, and was not statistically different from the basal. Basal acid output for six subjects used for the study with ethanol (a constituent of palm wine) was 0.95 +/- 0.13 mMol/hr and following the administration of 200 ml of 5% ethanol the peak acid output was 5.85 +/- 0.32 mMol/hr. This peak acid output was higher in the ethanol group than the palm wine group (p less than 0.001). Fresh palm wine is not ulcerogenic as might be thought despite its content of ethyl alcohol (5%).

Clinical observations on the wound healing properties of honey.

Fifty-nine patients with wounds and ulcers most of which (80 per cent) had failed to heal with conventional treatment were treated with unprocessed honey. Fifty-eight cases showed remarkable improvement following topical application of honey. One case, later diagnosed as Buruli ulcer, failed to respond. Wounds that were sterile at the outset, remained sterile until healed, while infected wounds and ulcer became sterile within 1 week of topical application of honey. Honey debrided wounds rapidly, replacing sloughs with granulation tissue. It also promoted rapid epithelialization, and absorption of oedema from around the ulcer margins.