Venous ulceration contaminated by multi-resistant organisms: larval therapy and debridement.

A 72-year-old female with venous insufficiency presented to a hospital-based multidisciplinary wound clinic after 20 years of recurrent episodes of venous leg ulcers. Examination showed bilateral leg ulcers with no evidence of arterial insufficiency, but complicated by considerable devitalised tissue, abnormally high bacterial load and the presence of multi-resistant organisms. The ulcers were initially treated with larvae to aid debridement and reduce the bacterial load, prior to skin grafting. Although ulcer free for a period of 4 months, further debridement was required when the skin condition deteriorated. Surgical intervention was chosen as the preferred method by the surgeons for a second acute care admission using hydrosugery, along with supplementary skin grafts and compression. Ongoing management, consisting of regular debridement, skin care and compression therapy, continues.

Private enterprise occupational health.

A private company in Palmerston North is providing occupational health services to the Manawatu. From an initial concept in mid-1987, the business commenced operations in early 1988. The concept has changed, the shareholding has changed but the business has survived and, by means of plenty of hard work, grew rapidly in 89 and 90, looks likely to achieve a 20% increase in gross turnover in 91/92 and has budgeted for an 11% increase in turnover for 92/93. A.C.C. legislative changes have provided a new opportunity and this is being explored. The new Health and Safety legislation should provide increased opportunities but so far there is little evidence of this occurring. However hope springs eternal and we are confident that we can see through the current hard times and that eventually an improved economy and a settled down health system will allow us to provide increased services for the benefit of the local community.

Adrenergic inhibition of cell proliferation in the buccal epithelium of rat.

Mitotic rates in the basal layer of cells in the buccal epithelium of rat were measured using a stathmokinetic technique. Adrenaline was found to inhibit cell proliferation in this tissue and the effect of adrenaline could be blocked by the beta-adrenergic antagonist propranolol but not by the alpha-adrenergic antagonist phentolamine nor by the specific beta2-adrenergic antagonist butoxamine. Cell proliferation in the buccal mucosa was also inhibited by terbutaline, a synthetic beta2-adrenergic agonist. The effect of terbutaline was not blocked by either butoxamine or by the specific beta1-adrenergic antagonist practolol.