Comparative study of two antimicrobial dressings in infected leg ulcers: a pilot study.

OBJECTIVE: The aim of the study was to compare the efficacy of a microorganism-binding (MB) dressing with a silver-containing hydrofiber (SCH) dressing in controlling the bacterial loads of heavily colonised or locally infected chronic venous leg ulcers, before surgical management with homologous skin grafts. METHOD: A randomised comparative single centre study recruited patients presenting with hard-to-heal critically colonised or locally infected leg ulcers, who could be treated with skin grafting. Inclusion criteria included; ulcers of vascular aetiology, over 18 years old, a wound duration ≥6 months and ankle brachial index (ABPI) >0.6. Patients were randomly assigned to treatment with SCH dressings (Aquacel Ag) or MB dressing (Cutimed Sorbact). Dressings were changed daily over a four-day observation period, after which they were taken for a skin grafting procedure. Swab samples from ulcer beds were taken in order to quantify the bacterial load at inclusion (D0) and at the end of the observation period day 4 (D4). No antibiotics were administered before or during the evaluation period. RESULTS: Both groups (n=20 SCH, n=20 MB) were similar in gender, age, pathophysiology (both had 15 patients with venous leg ulcers and 5 with arterial leg ulcers), ulcer surface, ulcer duration, treatment-related pain and initial bacterial load. Analysing bacterial load variation showed a significant reduction of bacterial burden at D4 in both groups. In the SCH group, we found an average bacterial load reduction of 41.6%, with an average reduction of 73.1% in the MB group (p< 0.00001). No serious adverse events were reported. CONCLUSION: Our evaluation confirmed that MB and SCH dressings are effective in reducing the bacterial burden in critically colonised or locally infected chronic leg ulcers, without inducing adverse events, with MB dressings significantly more effective. DECLARATION OF INTEREST: There were no external sources of funding for this study. The authors have no conflicts of interest to declare.

17Beta-estradiol and estrone concentrations in plasma and milk during bovine pregnancy.

Estrone (E1) and 17beta-estradiol (E2) are present in milk, but the mechanism(s) that regulate their appearance in milk are not known. The objectives of this study were to determine the impact of stage of pregnancy on the concentrations of E1 and E2 in plasma and milk and to determine the correlations between plasma and milk E1 and E2 and with milk components throughout pregnancy. Blood and milk samples were collected from 13 cows every 28 d throughout pregnancy. The E1 and E2 were quantified in plasma and milk using RIA after organic solvent extractions and Sephadex LH-20 column chromatography. Plasma E1 concentrations averaged 0.8, 16.9, and 41.8 pg/mL in trimesters 1, 2, and 3, respectively. The respective E1 concentrations in milk averaged 0.6, 7.9, and 27.1 pg/mL. The E2 concentrations in plasma averaged 0.5, 0.9, and 2.0 pg/mL; milk E2 averaged 0.3, 0.9, and 5.0 pg/mL. Plasma and milk E2 concentrations were greater in trimester 3 compared with trimesters 1 and 2. The E1 concentrations in milk were significantly correlated with plasma E1 concentrations (r = 0.77), percentage of milk fat (r = 0.50), and milk yield (r = -0.43). The E2 concentrations in milk were significantly correlated with plasma E2 concentrations (r = 0.93), percentage of milk protein (r = 0.63), and milk yield (r = -0.57). The milk-to-plasma ratio of E2 increased from 0.4 during trimester 1 to 2.2 in trimester 3, which suggested that the mechanism(s) regulating the appearance of E2 in milk may change over the course of pregnancy.

Concentrations of 17beta-estradiol in Holstein whole milk.

Some individuals have expressed concern about estrogens in food because of their potential to promote growth of estrogen-sensitive human cancer cells. Researchers have reported concentrations of estrogen in milk but few whole milk samples have been analyzed. Because estrogen associates with the fat phase of milk, the analysis of whole milk is an important consideration. The objectives of this study, therefore, were to quantify 17beta-estradiol (E2) in whole milk from dairy cows and to determine whether E2 concentrations in milk from cows in the second half of pregnancy were greater than that in milk from cows in the first half of pregnancy or in nonpregnant cows. Milk samples and weights were collected during a single morning milking from 206 Holstein cows. Triplicate samples were collected and 2 samples were analyzed for fat, protein, lactose, and somatic cell counts (SCC); 1 sample was homogenized and analyzed for E2. The homogenized whole milk (3 mL) was extracted twice with ethyl acetate and once with methanol. The extract was reconstituted in benzene:methanol (9:1, vol/vol) and run over a Sephadex LH-20 column to separate E2 from cholesterol and estrone before quantification using radioimmunoassay. Cows were classified as not pregnant (NP, n = 138), early pregnant (EP, 1 to 140 d pregnant, n = 47), or midpregnant (MP, 141 to 210 d pregnant, n = 21) at the time of milk sampling based on herd health records. Mean E2 concentration in whole milk was 1.4 +/- 0.2 pg/mL and ranged from nondetectable to 22.9 pg/mL. Milk E2 concentrations averaged 1.3, 0.9, and 3.0 pg/mL for NP, EP, and MP cows, respectively. Milk E2 concentrations for MP cows were greater and differed from those of NP and EP cows. Milk composition was normal for a Holstein herd in that log SCC values and percentages of fat, protein, and lactose averaged 4.9, 3.5, 3.1, and 4.8, respectively. Estradiol concentration was significantly correlated (r = 0.20) with percentage fat in milk. Mean milk yield was 18.9 +/- 0.6 kg for the morning milking. The mean E2 mass accumulated in the morning milk was 23.2 +/- 3.4 ng/cow. Likewise, using the overall mean concentration for E2 in milk, the mean E2 mass in 237 mL (8 fluid ounces) of raw whole milk was 330 pg. The quantity of E2 in whole milk, therefore, is low and is unlikely to pose a health risk for humans.

Automatic cluster remover setting affects milk yield and machine-on time in dairy cows.

The primary objectives of this study were to examine effects of automatic cluster remover (ACR) settings on milk yield and machine-on time, and to describe variation in cow body weight (BW) associated with day of bovine somatotropin (bST) cycle. Automatic cluster removal settings of 0.48, 0.6, and 0.8 kg/min were used to regulate the end of milk removal. The setting was changed every 2 wk for 12 wk and followed the sequence 0.8, 0.6, 0.48, 0.48, 0.6, and 0.8 kg/min. Milk yield, machine-on time, and BW were measured for 60 Holstein cows at each milking. Milk yield averaged 19.7, 19.9, and 19.3 kg/cow per milking for ACR settings of 0.48, 0.6, and 0.8, respectively. There was a 2.5% reduction in milk yield at the high setting, but yields were similar for the others. Machine-on time was 6.3, 5.9, and 5.6 min for ACR settings of 0.48, 0.6, and 0.8, respectively. There was an 11.1% reduction in milking time between the 0.8- and 0.48-kg/min settings. The middle ACR setting yielded a shorter milking time than the low setting without reducing production. Milk yield and cow BW increased over the 14-d bST cycle, peaking by d 8, and then declining through d 14. Automated collection of milk yield, milking time, and BW at each milking can be used to establish normal patterns for individual animals, which could be useful in making management decisions.

Induced lactation in nonpregnant cows: profitability and response to bovine somatotropin.

Significant culling of high-producing cows with low fertility reduces profitability of dairy farms as those cows are replaced with heifers. Induced lactation of nonpregnant cows may be a management alternative to reduce culling and increase profits. The objectives of this study were to evaluate the efficacy of bovine somatotropin (bST) to increase milk production in cows induced into lactation with estrogen plus progesterone, and to determine the profitability of inducing cows into lactation vs. using replacement heifers entering the herd as first-lactation cows. Parity 1 or greater, nonpregnant, healthy Holstein cows (n = 28) were induced into lactation by administration of estradiol-17beta (0.075 mg/kg of body weight [BW] per d) and progesterone (0.25 mg/kg of BW per d) for 7 d. Milking began on d 18. Cows were randomly assigned to control or bST treatment groups on d 37 +/- 20 of milking, and milk production was compared for 70 d. After the 70-d comparison, all cows received bST for the duration of lactation. Cows receiving bST produced more milk (28.4 kg/d) than controls (24.1 kg/d), with variable yields among cows. For the economic analysis, induced cows were compared to first-lactation cows in the same herd using fair market value for costs and multiple component pricing for milk. Net present value for an induced cow (1966 dollars) was significantly greater than that for a first-lactation cow (1446 dollars). Our data suggest that bST use in induced cows is profitable. If a reliable method were developed and approved by the FDA, inducing nonpregnant cows into lactation could be used by dairy producers to increase profitability.

Hardness of plantar skin in diabetic neuropathic feet.

To evaluate if skin hardness in diabetic neuropathic feet was increased and if its eventual modifications could be correlated to the severity of neuropathy, we studied a group of diabetic outpatients with and without neuropathy. Patients, selected among those who were attending their routine screening for diabetic neuropathy at our diabetologic clinic, were divided into two groups according to the presence (ND+) or absence (ND-) of diabetic neuropathy with the criteria of the S. Antonio Consensus Conference on Diabetic Neuropathy. Patients then underwent an evaluation of vibration perception threshold (VPT) by means of a biotesiometer, measurement of skin hardness (DMT) by means of a durometer, and transcutaneous oxygen tension (TcPO2) determination. VPT was determined at allux (VPT-A) and external malleolus (VPT-M), DMT was measured at heel (DMT-H), at medial (DMT-M) and lateral (DMT-L) midfoot, and at posterior midcalf (DTM-C) as a control site; TcPO2 was evaluated at dorsum (TcPO2-D) and at medial midfoot (TcPO2-M), respectively. All measurements were performed on the nondominant side with the patients supine. Patients were compared with age and gender-matched healthy volunteers (Controls), who underwent the same evaluations in the same order. ND+ patients showed higher values of VPT than ND- and Controls, both at first toe and at malleolus analysis of variance (ANOVA) p<0.01), as well of DMT in all the three sites explored (ANOVA, p<0.01). Moreover, ND+ showed no difference in DMT among the sites, while both in ND- and in controls DMT-M was significantly (p<0.05) lower than DMT-H and DMT-L. No difference among the three groups were observed in TcPO2 measurements, and no difference in DMT-C was observed either. A significant correlation was observed between DMT-H and VPT-M (r2 = 0.516) and between DMT-M and VPT-A (r2 = 0.624) in ND+ patients. Skin hardness was diffusely increased in ND+ patients, and this increase strongly correlates with the severity of neuropathy. Simple, noninvasive determination of skin hardness could identify patient at potential risk to develop neuropathic foot ulcers.

Current uses of diagnostic high-frequency US in dermatology.

OBJECTIVE: The diagnosis of most skin diseases, both focal and diffuse, has long relied mainly on physical examination findings. The recent introduction of technologically advanced ultrasound equipment using 20 MHz probes has permitted the specific application of ultrasound to dermatology. Accordingly, we investigated whether the findings at very high frequencies can represent a valid adjunct to clinical assessment in many skin conditions, including neoplasms, inflammatory states and diseases of unknown origin. MATERIALS AND METHODS: Skin lesions are studied using high frequency probes, which very clearly detail the three layers (epidermis, dermis and subcutaneous tissues) forming the normal skin. The choice of the probes frequency should depend mainly on the lesion diameters and site. Electronic 7.5-13 MHz linear probes depict flat and regular surfaces effectively and provide a wider field of surface vision and, therefore, a wider view than sectorial probes. Water bath sectorial mechanical probes with 10-20 MHz frequency have very superficial focusing and are excellent to study irregular surfaces. RESULTS: High frequency ultrasound can be usefully correlated with clinical tests to study focal skin lesions. The diagnosis of most benign skin cancers is usually made on clinical bases. Ultrasound examinations are performed preoperatively in questionable cases. Malignant neoplasms appear at ultrasound as hypoechoic focal lesions, generally with no specific features in relation to the histologic type; nevertheless, preoperative ultrasound may play an important role in that it measures the thickness of cutaneous melanoma, which is a very important prognostic factor. In particular, 20 MHz probes permit to assess the depth of melanoma invasion. The sonographic evaluation of melanoma thickness is usually in agreement with histologic findings. 'Satellite' neoplastic lesions growing near the main tumor can also be revealed. Color and power Doppler studies may be combined with gray-scale imaging: the identification of abnormal intra- or peritumoral low-resistance pulsatile flow signals suggests the malignant nature of the cutaneous lesion. High frequency ultrasound can also be used to study diffuse cutaneous conditions. Among them, ultrasound can provide a valid morphologic representation of psoriatic skin lesions and it is also a noninvasive and accurate method for evaluating the therapeutic efficacy of antipsoriatic drugs. In scleroderma, sonographic findings vary depending on disease activity and the patterns vary; therefore, 20 MHz probes may also prove useful over the other instrumental tools to monitor the disease course and treatment efficacy in focal scleroderma. Other potential applications include allergic dermatitis, nodular erythema, dermatomyosis, sarcoidosis, lymphedema of the limbs and allergologic conditions. Ultrasound can also be used in monitoring the response to or complications of topic drugs administration, and in the follow-up of focal burns. CONCLUSION: High frequency ultrasound can provide a reliable morphologic representation of skin lesions but it is also an accurate noninvasive tool for monitoring the therapeutic efficacy of drugs administration in focal or diffuse diseases. The application of high frequency studies to dermatology is very challenging. Indeed, the very high frequency probes up to 20 MHz currently available are particularly useful for reliable studies. Contrast-enhanced color and power doppler are very promising techniques. Advancements in technology will improve the correlation of clinical with high frequency ultrasound findings in the assessment of several skin diseases.