Effect of CD4(+) and CD8(+) cell depletion on wound healing.

BACKGROUND: Depression of the immune system can result in poor or delayed wound healing. METHODS: Thymectomized rats were depleted of CD4(+) and CD8(+) lymphocytes by intraperitoneal injection of Medical Research Council Oxford (MRC OX)38 antibodies and MRC OX8. Significant depletion was demonstrated throughout the wound healing process by immunofluorescence studies of peripheral blood. Following depletion the rats underwent laparotomy incisions which were allowed to heal for 10 weeks. Differences in healing were demonstrated by analysing the wounds biomechanically by tensiometry to obtain values of ultimate strength, resilience, toughness, maximum extension and elastic constant. RESULTS: Wounds of animals depleted of CD4+ lymphocytes showed a significant decrease in ultimate strength, resilience and toughness. Wounds of animals depleted of CD8(+) lymphocytes showed a significant increase in ultimate strength, resilience and toughness. CONCLUSION: Wounds healed in the absence of T lymphocytes. However, the subsets have an opposing regulatory role, with CD4(+) lymphocytes upregulating and CD8(+) lymphocytes downregulating wound healing. Presented to the Surgical Research Society in Nottingham, UK, 11 July 1997 and published in abstract form as Br J Surg 1997; 84: 1618

A comparison of biomechanical properties of excised mature scars from HIV patients and non-HIV controls.

BACKGROUND: Patients with human immunodeficiency virus (HIV) infection have been found to have impaired wound healing. This study aimed to determine whether the healed wounds from these patients have an impaired intrinsic strength. METHODS: The healed wounds of patients with HIV infection who were undergoing a subsequent surgical procedure were excised and examined immediately by tensionometry. A non-HIV group with wounds of the same range of maturity were used as controls. RESULTS: The wounds of 11 patients with HIV were compared with those of 11 controls. There was no significant difference between the groups' preoperative hemoglobin or albumin; however, the white cell count was lower in the HIV group (P = 0.005). When examined biomechanically, wounds of the HIV group had a lower resilience (P = 0.0138), toughness (P = 0.0138), and maximum extension (P = 0.0235) compared with the control group. CONCLUSIONS: The wounds of patients with HIV infection when measured biomechanically are weaker than those of normal non-HIV controls.

Defensive focus and the Defense Style Questionnaire.

The classification of defenses into affect and content focused is examined in the light of modern theorizing about defensive processes. The results of two studies into the factor structure of the Defense Style Questionnaire (DSQ) are reported. The results indicate that the classification into levels by Vaillant is both empirically robust and theoretically meaningful. The two studies are presented as complimentary due to the predominance of female gender in study 1 and male gender in study 2. Implications for future research and clinical practice are explored, particularly in relation to personality and anxiety disorders.

Increased risk of wound complications and poor healing following laparotomy in HIV-seropositive and AIDS patients.

The number of individuals in the UK who are HIV seropositive is increasing as is their presentation with abdominal complications. Poor wound healing following anorectal surgery in HIV-positive patients has been well reported. This study reviews the incidence of wound complications following laparotomy. The hospital records of all HIV-positive patients who underwent laparotomy at a London teaching hospital over a 10-year period were reviewed and compared to an equal number of matched non-HIV patients. Between April 1986 and April 1996, 64 laparotomies were carried out on 53 patients. There was a significantly greater incidence of wound complications (chi2 = 12.75, 1 d.f., p = 0.0003) and wound breakdown (chi2 = 10.45, 1 d.f., p = 0.012) in the HIV group following laparotomy than in the non-HIV control group.

Glove powder--a risk factor for the development of latex allergy?

Studies are described which compare the prevalence of sensitisation against latex proteins in medical personnel in different hospitals. The objective of these studies was to find out whether the use of powdered or unpowdered gloves could be related to the prevalence of latex allergy. Employees of one of the investigated hospitals (Germany) were using only powdered latex gloves, and in the other two hospitals (Great Britain) low protein powder-free latex gloves were used. Methods by which latex allergy can be avoided are suggested.

Surgery and human immunodeficiency virus-1 infection.

BACKGROUND: HIV and AIDS continues to be a significant health problem with many patients requiring the attention of a general surgeon. METHOD: A retrospective case note review over a two-year period was undertaken. RESULTS: 237 patients underwent invasive procedures. The majority 100 patients (145 procedures) were for venous access. Anorectal problems in 69 patients presents a particular problem in this group and major surgery in 26 patients (30 procedures) has a definite role in selected patients. CONCLUSION: The surgical management of patients with AIDS is discussed with reference to safety. Recognition of specific disease patterns in this group is important and best managed by a dedicated team.

Are Japanese and European gastric cancer the same biological entity? An immunohistochemical study.

To examine the suggested biological difference between Japanese and British gastric cancers, immunohistochemistry was used to demonstrate eight markers of biological activity in a matched series of 40 Japanese and 33 British cases. There were no differences in the proportions of Japanese and British tumours positive to epidermal growth factor, epidermal growth factor receptor, transforming growth factor alpha, cripto or p53. A significantly greater proportion of British tumours were positive to c-erbB-2 whilst a significantly greater proportion of Japanese tumours were positive to nm23. British tumours had a significantly greater mean proliferating cell nuclear antigen proliferation index than Japanese tumours. These differences could be clinically significant.

A survey of glove preferences of general and orthopaedic surgeons in North West Thames Regional Health Authority.

The glove preferences of all the consultant surgeons and consultant orthopaedic surgeons in North West Thames were surveyed by questionnaire. Responses were received from 59 of 78 general surgeons and 47 of 55 orthopaedic surgeons. Twenty-two percent of general surgeons never double gloved compared with 4% of orthopaedic surgeons (P < 0.01). Seventy-three percent of general surgeons double gloved for 'high risk' patients compared with 17% of orthopaedic surgeons (P < 0.001). When double gloving the majority of surgeons (67%) used their normal sized glove inside and half a size larger on the outside.

Effect of starch-containing glove powder on wound healing in the rat.

The effect of the starch-containing powder BioSorb on wound healing was examined in an immunocompetent and a T cell-deficient animal model. Wounds were tested by tensionometry to give values of resilience, ultimate strength, toughness and extension. Starch significantly decreased the resilience (P < 0.03), ultimate strength (P < 0.004), and toughness (P < 0.006) of wounds in the immunocompetent model but was not shown to affect the healing of wounds in T cell-depleted animals. When the uncontaminated wounds of the two groups were compared, those from T cell-depleted animals were tougher (P < 0.04) and less extensile (P < 0.0002). These results suggest that starch impairs wound healing by its effect on the T cell-mediated immune system, and that this system may also be involved in regulation of the reparative process because its absence leads to tougher wounds.

The expression of mmp-7 messenger-RNA in primary and metastatic human colorectal adenocarcinoma.

MMP-7 mRNA expression was examined by RT-PCR and Southern blot hybridisation following cDNA synthesis of extracted tissue RNA in a total of 33 colorectal cancer patients. Expression was studied in tumour tissues and compared to adjacent non-neoplastic tissues. MMP-7 mRNA was detected in all tumour samples, with no qualitative difference between primary and metastatic tumours and there was no relation to Dukes' clinical stage. Adjacent nonneoplastic colon and rectum (65%) and liver (100%) also expressed MMP-7, although the signal intensity was weaker. In contrast, only 31% of adjacent non-neoplastic lymph nodes expressed MMP-7. The results suggest that MMP-7 is probably expressed early in the neoplastic transformation in patients with colorectal adenocarcinoma.

Duodenal plasmacytoma: a rare extramedullary localization simulating carcinoma of the head of the pancreas.

Plasmacytomas occurring in extramedullary sites are rare tumours, particularly so when located in the gastrointestinal tract. We report the case of a solitary extramedullary plasmacytoma arising in the duodenum and simulating a carcinoma of the head of the pancreas. Diagnostic and treatment options are discussed.

Expression of transforming growth factor alpha in experimental gastric carcinogenesis.

The induction of adenocarcinomas in the glandular stomach of the adult male Wistar rat by N-methyl-N'-nitro-N-nitrosoguanidine (MNNG) was used as a model to study the expression of the growth promoting peptide, transforming growth factor alpha (TGF alpha), during experimental gastric carcinogenesis. TGF alpha was identified using the monoclonal antibody Ab-2 and standard immunohistochemistry, together with a semiquantitative assessment of the intensity of expression. Immunoreactivity was confined to the differentiated compartment of the mucosa while the carcinogen MNNG caused a significant increase in the intensity of TGF alpha expression (p < 0.01), after as little as 16 weeks' exposure. In experimental adenocarcinomas, a change to a previously undescribed pattern of perinuclear TGF alpha expression was found, which may represent the site of intense TGF alpha production in the Golgi apparatus after malignant transformation.

A case of Churg-Strauss vasculitis complicated by small bowel necrosis.

A case of Churg-Strauss syndrome causing mesenteric intestinal ischaemia and small bowel necrosis is described in a 29-year-old man. Despite conservative management, the patient's condition deteriorated and he underwent five laparotomies. Small and medium-sized arteries within the mesentery and lymph nodes showed necrotizing vasculitis. Currently he is doing well on oral nutrition and medical management.

Role of pre-admission clinics in a general surgical unit: a 6-month audit.

We report a 6-month audit of the running of a pre-admission assessment clinic for routine general surgical admissions. An attendance rate of 91.4% of fit patients ready for surgery on the day of admission was achieved. Of all patients attending the pre-admission clinics, 79.5% underwent surgery as planned. Pre-admission clinics are recommended as a method of improving the efficiency of elective surgical admissions.

Laparoscopic varicocele repair.

Varicocele is a common condition for which currently accepted methods of treatment are less than satisfactory. Reported herein is a successful laparoscopic technique of repair.

Effect of anoreceptive intercourse on anorectal function.

This study is the first published assessment of the effect of anoreceptive intercourse (ARI) on anal sphincter tone and function. Forty anoreceptive (AR) male homosexuals were compared with 18 age matched non-anoreceptive (non-AR) heterosexual males. Subjects were questioned about ARI, defaecation and faecal incontinence. Anal resting pressure, maximum voluntary squeeze pressure, anal mucosal electrosensitivity, perineal descent and rectal sensation were measured in all subjects. Fourteen of the AR subjects but only one of the non-AR subjects had symptoms of frequent anal incontinence (P < 0.05). There was a significant reduction in both maximum anal resting pressure (P < 0.01) and anal mucosal electrosensitivity (P < 0.05) and a significant difference in the anal resting pressure profile (P = 0.02) in the AR subjects compared with the non-AR subjects. There was a significant reduction in maximum squeeze pressure in AR subjects with anal incontinence compared with either AR subjects without anal incontinence (P < 0.01) or non-AR subjects (P < 0.01). There were no significant differences in stoll consistency, frequency of defaecation, perineal descent or rectal sensation between the groups. ARI is associated with reduced resting pressure in the anal canal and an increased risk of anal incontinence. The risk of incontinence is greatest amongst AR subjects with reduced maximum squeeze pressure.