Health Utility, Social Interactivity, and Peristomal Skin Status: A Cross-Sectional Study.

PURPOSE: The objective of this study was to examine relationships among social interaction, health utility, and peristomal skin status in adults with ostomies. DESIGN: Cross-sectional, descriptive. SUBJECTS AND SETTING: 15,591 persons residing in the United States were randomly selected from 3 multinational proprietary databases of individuals who had undergone surgery. METHODS: The study was a cross-sectional assessment utilizing the SF36v2 survey instrument. Potential subjects were sent an e-mail letter of invitation that included instructions for completing the questionnaire, an informed consent form, and nontransferable link to an electronic survey. Health utility was derived from the SF6D, and the Hawthorne Friendship Scale was used to measure social connectivity. Social functioning was derived from the SF36v2. A minimally important social value of health (MISVH) is reported as the minimum quality-adjusted life-days to be of benefit (influence) within indices of social connectivity and function. A self-reported determinant of peristomal skin health was included. RESULTS: Increased social interactivity, defined as social functioning and social connectivity, was associated with increased health utility. In addition, health utility decreased as peristomal skin integrity worsened. A MISVH can be demonstrated. CONCLUSION: Findings indicate that peristomal skin complications are more than dermatologic issues. They negatively affect the well-being of those who must cope and adapt to their impact and the community at large. Social interaction is also negatively influenced.

Recent advances in the research of lymphatic stomata.

Lymphatic stomata are small openings of lymphatic capillaries on the free surface of the mesothelium. The peritoneal cavity, pleural cavity, and pericardial cavity are connected with lymphatic system via these small openings, which have the function of active absorption. The ultrastructure of the lymphatic stomata and their absorption from the body cavities are important clinically, such as ascites elimination, neoplasm metastasis, and inflammatory reaction. The lymphatic stomata play an important role in the physiological and pathological conditions. Our previous study indicated for the first time that nitric oxide (NO) could regulate the opening and absorption of the lymphatic stomata. It could decrease the level of free intracellular calcium [Ca(2+)] through increasing the cyclic guanosine monophosphate (cGMP) level in the rat peritoneal mesothelial cells, thus regulating the lymphatic stomata. This process is related with the NO-cGMP-[Ca(2+)] signal pathway. In this review, we summarize the recent advances in understanding the development and the function of the lymphatic stomata. The ultrastructure and regulations of the lymphatic stomata are also discussed in this review.

[Effects of nitric oxide on peritoneal lymphatic stomata and lymph drainage via NO-cGMP-Ca2+ pathway].

To study the cell signal transduction mechanism of nitric oxide (NO) on the peritoneal lymphatic stomata and lymph drainage in the rat, cGMP content were measured by a commercially available radioimmunoassay kit, and the [Ca(2+)](i) were observed by a confocal laser scanning microscope in the cultured peritoneal mesothelial cell. Animal experiment was practiced to study the effect of NO-cGMP-Ca(2+) pathway on the lymphatic stomata and lymph absorption. The results showed that: (1) Sper/NO increased cGMP of the rat peritoneal mesothelial cell (RPMC) in a dose-dependent manner (P<0.01) compared to the control group. This effect was blocked by 1H-[1,2,4] oxadiazolo [4,3-a] quinoxalin-1-one (ODQ) (P<0.05), a specific inhibitor of soluble guanylyl cyclase (sGC). The level of [Ca(2+)](i) in single RPMC decreased by adding Sper/NO (P<0.05). Pretreatment with ODQ for 10 min blocked the Sper/NO-induced decrease in [Ca(2+)](i). L-typed calcium channel blocker nifedipine induced an immediate and marked decrease in [Ca(2+)](i) (P<0.05).. After [Ca(2+)](i) reached a balance again, adding Sper/NO could not change [Ca(2+)](i) (P>0.05). (2) Sper/NO increased the area of the stomata (P<0.01) and the quantity of the tracer in a dose-dependent manner (P<0.05) compared to the control group. Pretreatment with ODQ significantly inhibited Sper/NO-induced change of lymphatic stomata and lymph drainage (P<0.01). Nifedipine increased the opening area of the lymphatic stomata (P< 0.01) and the concentration of absorbed trypan blue of the diaphragm (P<0.05). Sper/NO could not make a further change in the samples pretreated by nifedipine (P> 0.05). The results indicate that NO can decrease [Ca(2+)](i) in the RPMC through the NO-cGMP pathway. This procession is related with the L- type voltage-gated Ca(2+) channel. NO enlarges the opening area of the lymphatic stomata and enhances the lymph drainage of tracer by NO-cGMP-[Ca(2+)](i) pathway.

Contribution of lymphatic drainage through stomata to albumin removal from pleural space.

The contribution of lymphatic drainage through the stomata of parietal mesothelium to the overall removal of labeled albumin from the pleural space was found 89% in sheep with very large hydrothoraces (10 ml/kg), a condition involving a approximately 20 times increase in lymphatic drainage [Broaddus et al., J. Appl. Physiol. 64 (1988) 384]. We determined this contribution in anesthetized rabbits with small (0.12 ml/kg) and large (2.4 ml/kg) hydrothoraces of Ringer-albumin with labeled albumin and labeled dextran-2000 kDa. This dextran was used as marker of liquid removal through the stomata because it should essentially leave the pleural space through the stomata only, owing to its size. The removal of labeled albumin by lymphatic drainage through the stomata was 39% of the overall removal in the small hydrothoraces, and 64% in the large ones. Hence, lymphatic drainage through the stomata does not contribute most of protein and liquid removal from the pleural space under physiological conditions, as it has been maintained. It markedly increases with the increase in pleural liquid volume.

Postinflammatory changes of the diaphragmatic stomata.

Numerous investigations concerning the fine morphology of diaphragmatic stomata have been performed, but its ultrastructural changes in experimental conditions remain unclear. The present study demonstrates the peritoneal side of the diaphragm in adult Wistar rats by transmission electron microscopy. Ten experimental animals were observed 5 and 8 days after Pseudomonas aeuriginosa instillation (PI) into the peritoneal cavity. A control group of 6 rats showed flat mesothelial covering on basal lamina (BL) and connective tissue layer, as well as cubic mesothelial cells, single stomata over underlying lymphatic lacunae (LL). Five days after PI the mesothelial cells had more numerous microvilli, microvesicles, vacuoles, lysosomes and a lesser number of specialized contacts. The multiplication of the extravasal cells and larger intercellular spaces lead to thickenings of the connective tissue around LL. LL were larger and located in close proximity of the mesothelium. Intercellular spaces in the mesothelial layer and different types of contacts between mesothelial cells and endothelial protrusions of LL (with common BL or without BL) were encountered. Eight days after PI the mesothelium, endothelium of LL, their BL and surrounding connective tissue were interrupted and structurally modified to form typical new channels--stomata. The larger portion of the channels were formed of mesothelial cells, while the endothelial cells participated in the submesothelial part. LL were more numerous than in the previous period, and were arranged in groups. LL increased their vertical (50.59 microm) and horizontal (155.57 microm) diameter, as compared with control animals (respectively 12.37 microm and 74.08 microm). Neighbouring LL were separated by thin or thick septae. Peristomatal mesothelial cells or more rarely endothelium formed valve- or bridge-like structures. Valves on the opposite side of LL were observed. Groups of electron-dense bodies characterized some tall endothelial cells of LL. Cubic mesothelium, endothelium of the LL, both BL, the cell connections that formed new stomata, LL and surrounding connective tissue underwent rapid and parallel changes after PI. Among these elements of the lymphatic regions mentioned above, the mesothelium and endothelium of LL had a main role in experimental conditions.