Chronic radiation proctitis treated with hyperbaric oxygen.

Chronic proctitis is a well-known complication of therapeutic irradiation. The results of hyperbaric oxygen therapy (HBO2) used in the treatment of chronic radiation proctitis are reported. From 1992 to 1995, 14 patients with chronic radiation-induced proctitis were treated with HBO2. Nine patients were treated in a monoplace chamber at 2.0 atm abs (203 kPa O2), and five patients were treated at 2.36 atm abs (239 kPa O2). Eight patients experienced complete resolution of symptoms and one patient had substantial improvement for a total response rate of 64%. Follow-up ranged from 5 to 35 mo. (mean 17 mo.). Five patients (36%) were classified as non-responders. Three experienced significant improvement during treatment but relapsed soon after therapy was discontinued, whereas two had no symptomatic improvement. Responders who had sigmoidoscopy after therapy showed documented improvement whereas no non-responders showed improvement. The authors conclude that HBO2 therapy should be considered in patients with chronic radiation proctitis.

Transcutaneous oxygen measurements predict healing of leg wounds with hyperbaric therapy.

Twenty-six patients with chronic leg wounds had transcutaneous oxygen measurements taken from the peri-wound area and a chest reference site before undergoing hyperbaric oxygen therapy in order to evaluate the utility of transcutaneous oxygen measurements in predicting the response of wounds to hyperbaric therapy. Wound scores and wound areas were determined before treatment and after 10 hyperbaric exposures. Patients whose wounds averaged a 5% or greater reduction in wound score per treatment were designated "responders." Nine patients' wounds exhibited at least a 5% reduction in wound score per treatment. There were no differences observed between responders and the 17 nonresponders in age, duration of the wound, initial wound area, initial wound score, or in wound or reference transcutaneous oxygen measurements. Responders required significantly fewer treatments to achieve wound closure than did nonresponders. Peri-wound transcutaneous oxygen pressure when the patient was exposed to 2.4 atmospheres absolute correlated directly with the improvement in wound score per treatment (r = 0.64, p = 0.03). An inverse correlation was noted between surface peri-wound transcutaneous oxygen pressure and improvement in wound score per treatment (r = -0.74, p = 0.006). Elevated peri-wound transcutaneous oxygen measurements at 2.4 atmospheres absolute and reduced peri-wound oxygen measurements at 1 atmosphere absolute were associated with a more rapid response to hyperbaric oxygen treatments in patients with chronic leg wounds. The use of these measurements should allow this expensive and time-consuming therapy to be limited to those patients most likely to benefit.

The effect of selenium supplementation on selenium status of patients receiving chronic total parenteral nutrition.

Patients receiving long-term total parenteral nutrition (TPN) are at risk for selenium deficiency. The purpose of this study was to determine the effect of parenteral selenium as selenious acid on the selenium status of seven long-term TPN patients. Patients received a dosage of zero, 80, or 160 micrograms Se/day for 1 month each. The measures of selenium status used were selenium levels in plasma and glutathione-peroxidase activities in erythrocytes and platelets. Urinary selenium excretion was measured. Control subjects were selected to match the sex, age, and weight of the patients. With increasing levels of parenteral selenium, there was increasing plasma selenium concentration as well as erythrocyte and platelet glutathione-peroxidase activity. There was no statistical difference between the patients during the time they received the 160 micrograms parenteral selenium treatment and the control subjects for platelet glutathione-peroxidase activity. At the 160 micrograms Se/day level, patient plasma selenium concentrations increased from 28% to 58% of the control levels. Four patients were studied after they returned to the 80 micrograms parenteral selenium/day from the 160-micrograms Se/day treatment. With decreasing parenteral selenium, three patients had decreasing platelet glutathione-peroxidase activity, while plasma selenium concentration decreased in two patients. These data suggest that some patients receiving long-term parenteral nutrition should receive parenteral selenium.

Blood selenium and glutathione peroxidase levels and dietary selenium of free-living and institutionalized elderly subjects.

The purpose of this study was to evaluate the selenium status of healthy free-living and institutionalized elderly people. For the 36 free-living elderly dietary selenium intake averaged 94 +/- 44 micrograms Se/day and a positive correlation coefficient was found between dietary selenium and dietary calories (r = 0.46; P less than 0.05), dietary protein (r = 0.60; P less than 0.01), and dietary fat (r = 0.43; P less than 0.05). Diet histories from the institutionalized subjects revealed a strong correlation coefficient between selenium and carbohydrate (r = 0.51; P less than 0.005) and selenium and calories (r = 0.44; P less than 0.05). Mean erythrocyte and plasma selenium levels for the free-living subjects were 0.20 +/- 0.06 micrograms/ml and 0.10 +/- 0.03 micrograms/ml, respectively, while mean erythrocyte glutathione peroxidase (GSH-Px) activity was 27.5 +/- 5.0 units/g protein. For the free-living subjects positive correlation was found between dietary selenium and erythrocyte selenium levels (r = 0.38; P less than 0.05) but no correlation existed between dietary selenium and plasma selenium (r = 0.13; P greater than 0.05) and RBC GSH-Px (r = -0.15; P greater than 0.05). The dietary selenium levels and blood selenium and GSH-Px levels were above the levels found in populations proposed to be at risk for selenium deficiency. Thus, these elderly appear to have adequate selenium status.

Zinc concentrations in hair, plasma, and saliva and changes in taste acuity of adults supplemented with zinc.

The effect of zinc supplementation as zinc acetate (15 mg Zn/day for 5 weeks) was determined on stimulated parotid salivary zinc levels and taste acuity. In addition, zinc and copper levels of hair and plasma in 10 healthy subjects (five male and five female) between the ages of 17 and 37 years were studied. Presupplementation and 5 weeks postsupplementation levels were evaluated as well. Taste acuity for sweet improved with zinc supplementation and returned to presupplementation levels after supplementation ceased. No changes in plasma copper or salivary zinc levels were found with zinc supplementation although stimulated parotid saliva flow rate increased. Plasma zinc levels increased significantly while hair copper increased slightly with supplementation. All indices returned to presupplementation levels by 5 weeks after cessation of supplementation.

Variability of zinc concentrations in human stimulated parotid saliva.

The objective of this study was to determine the effect of sample collection conditions on the zinc concentrations in stimulated parotid (SP) saliva. The variability of zinc levels in SP saliva was determined on the basis of different times within a single day, from day-to-day, from one month to the next month, and between subjects. Ten healthy subjects, half of each sex, consumed 15-22 mg Zn/day in their diet. No significant difference in the mean zinc concentration of SP saliva on a day-to-day or month-to-month basis was demonstrated. Three subjects had significantly different SP saliva zinc levels than the other seven subjects. A significant diurnal variation in the mean SP salivary zinc levels was found. Changes of SP saliva flow rates suggested a training effect.

Epidemic hepatitis B: a sustained outbreak in a large military population.

A sustained outbreak of viral hepatitis occurred at an Army base in Texas between January 1971 and June 1973. Seven hundred ninety-two admissions but no deaths were recorded in a military population of 35,000. Cases were sporadic, with highest attack rates in low-ranking soldiers with disciplinary problems. Twenty-nine per cent of patients had histories of intravenous drug use within six months prior to hospitalization; most of the rest had close personal contact with jaundiced persons. Of 505 patients tested, 31% were seropositive for hepatitis B antigen (HBSAg) by counterelectrophoresis. Comparison of 38 hepatitis patients (cases) to 34 orthopedic patients (controls) revealed marked differences in rates of exposure to jaundiced persons are shared needles. Sixteen (94%) of 17 antigenemic cases tested were of subtype ayw. Seven (78%) of nine NBSAg-negative cases tested were antibody (anti-HBS) positive three months later.