A case of deep burns, while diving The Lusitania.

We present the first documented case of severe burns, sustained by a diver as a result of auto-ignition of air-activated heat packs at high partial pressure of oxygen and high ambient pressure. Our patient was diving the shipwreck of The Lusitania off the south coast of Ireland. This is a significant wreck, lying 90 metres down on the seabed. Torpedoed by a German U-boat in 1915, its loss prompted American involvement in WW1. Several unlikely events combined in this case to bring about serious and life threatening injuries. Herein we discuss the case and explore some of the physical and chemical processes that lead to these injuries.

Biological fate and clinical implications of arginine metabolism in tissue healing.

Since its discovery in 1987, many biological roles (including wound healing) have been identified for nitric oxide (NO). The gas is produced by NO synthase using the dibasic amino acid L-arginine as a substrate. It has been established that a lack of dietary L-arginine delays experimental wound healing. Arginine can also be metabolized to urea and ornithine by arginase-1, a pathway that generates L-proline, a substrate for collagen synthesis, and polyamines, which stimulate cellular proliferation. Herein, we review subjects of interest in arginine metabolism, with emphasis on the biochemistry of wound NO production, relative NO synthase isoform activity in healing wounds, cellular contributions to NO production, and NO effects and mechanisms of action in wound healing.

Vitamin E: patterns of understanding, use, and prescription by health professionals and students at a university teaching hospital.

BACKGROUND: Vitamin E is a generic term used to describe the many derivatives of tocol and tocotrienol. It is the major lipid-soluble antioxidant in the skin and has been used as treatment for many skin conditions, including scarring. Studies have shown that vitamin E provides no benefit to the cosmetic outcome of scars. METHODS: The authors constructed and distributed a questionnaire among staff and students at their institution. Their aim was to determine patterns of use and prescription of vitamin E among staff and students and to determine the understanding of the properties and biological functions of vitamin E. RESULTS: Questionnaires were completed by 208 staff and students, including 110 nonconsultant hospital doctors (52.89 percent), 61 nurses (29.33 percent), and 27 medical students (12.98 percent). Nearly 68 percent thought that vitamin E could be of use in improving the cosmetic appearance of scars, while 25 percent actually recommended vitamin E to patients to improve the cosmetic outcome of scars. Just under 40 percent were aware of the biological function of vitamin E, while 16.35 percent thought vitamin E had absolutely no effect on scarring. Of respondents, 21.64 percent had used vitamin E for their own scars; 31.11 percent of these said it was suggested by a doctor, while 6.67 percent said a pharmacist suggested it. CONCLUSIONS: Without scientific basis, health professionals continue to recommend vitamin E for use on scars. Such recommendations should not be made in the absence of evidence-based medicine.