Less collagen production in smokers.

BACKGROUND: An association between smoking and impaired wound healing has been reported in retrospective studies. The smoking status of a surgical patient may be confounded by social and medical parameters. We have evaluated the effect of smoking in a test wound in volunteers, with special reference to a reliable scientific match between smokers and nonsmokers. METHODS: In a prospective open study with blinded assessment, 19 smoking (20 cigarettes/day) and 18 nonsmoking healthy volunteers were matched with respect to baseline characteristics. The deposition of total protein and mature collagen (expressed as hydroxyproline) was assessed in an expanded polytetrafluoroethylene wound healing model implanted subcutaneously for 10 days. RESULTS: The nonsmokers had a 1.8 times higher median amount of hydroxyproline than the smokers (p < 0.01). The deposition of hydroxyproline was negatively correlated with the consumption of tobacco both before (r = -0.44; p < 0.01) and during the study (r = -0.48; p < 0.005). The impairment was specific for the production of collagenous proteins and not other proteins. CONCLUSIONS: The synthesis of subcutaneous collagen in smokers is specifically impeded, indicating an impaired wound-healing process. Because mature collagen is the main determinator of strength of an operative wound, the results support the view that patients should be advised to stop smoking before an operation.

Comparison of self reported and observed length, width, and colour of scar tissue.

To evaluate the reliability of self assessment as a substitute for follow up, 30 self reported assessments of length, width, and colour of abdominal scars were compared with those of clinicians. The degree of disagreement between patients and medical observers was not significant. We conclude that as long as instructions to patients are unambiguous, reliable information may be obtained by postal inquiry. Self reported measurements may thus replace time-consuming follow up visits in studies on the influence of various factors on scar tissue.

The effect of smoking on tissue function.

A review of current thinking on the influence of nicotine and carbon monoxide on peripheral tissue and wound healing.

Intra-arterial injection of dextropropoxyphene into hand arteries.

We report a case of deliberate intra-arterial injection of dextropropoxyphene into the palms, leading to chronic oedema of both hands. The aetiology is discussed. This cause must be borne in mind in the diagnosis of chronic oedema of the hands.

The effect of cigarette smoking on wound healing.

To see if there was any difference in the skin healing of smokers as opposed to non-smokers we studied 120 women admitted consecutively for laparotomy sterilisation. The method of skin suture was standardised. We compared width, length, and colour of the scars, and assessed the overall cosmetic result using a scoring system in 69 smokers and 51 non-smokers. When the incision was in the midline the scars in the smokers measured 7.4 mm averagely as compared with 2.7 mm in non-smokers (p less than 0.02). There was a corresponding tendency in transverse incisions. When the colour was compared, 26% of smokers had light coloured scars compared with 12% of non-smokers (p less than 0.05). There were no differences between the groups when dark coloured scars were assessed. Overall, using the scoring system, smokers had significantly worse cosmetic results than non-smokers.

[Male sterilization. Historic review and current methods in Denmark]. / Sterilisation af maend. Historisk tilbageblik og metoder i Danmark i dag.

PIP: In a survey of 75 departments in Danish hospitals carrying out male sterilization, 48 reported that they had prescribed procedures pertaining to the incision, resection and occlusion of the vas as well as placement of the vas ends. In the consensus method the testicular ends of the ducts should be buried under the membranes in order to avoid formation of fistulae and the ends should be buried each at its level in order to avoid recanalization. Scar tissue has been shown to be minimal around the ends of the duct when occluded by means of metal clips and bipolar electrocoagulation. In Denmark 4000-5000 men are officially sterilized each year and in all the Ministry of Health has recorded more than 71,000 cases of voluntary sterilization since 1973. Medical sterilization was 1st carried out in Indiana in 1899 and spread in the USA until 22 states had sterilization laws in 1929. In the same year, Switzerland was the 1st country in Europe with a sterilization law; Denmark introduced a test law which became final in 1935. Both were based on genetic indications. Between 1933 and 1945 the totalitarian regimes used forced sterilization for genetic diseases and on undesired races. In the 1950s family planning was introduced as a basis for male sterilization, 1st in Asiatic countries. The operative methods that are in use today were essentially developed by the early 1970s with the introduction of nonirritating hemoclips and techniques for electrocoagulation of the vas ends.^ieng

[Sterilization of women using laparoscopy. A 3-year cohort]. / Sterilisation af kvinder ved laparoskopi. Et 3 års materiale.

PIP: Retrospective review of 294 women who were sterilized by laparoscopy employing the falope ring during a 3-year period revealed complications in 2.7% of the cases. 2.5% became pregnant after the intervention. In more than 1/2 of the cases, this was due to incorrect placement of the ring. 21% experienced low abdominal pain postoperatively and 58% experienced menstrual changes. On the average, the patients felt well after 12 days; work was re-commenced after 3. Sexual activity was resumed after 14 days. Dyspareunia occurred in 6.5% of the cases and persisted, on an average, for 18 weeks. 14% experienced increased libido and 16% said they found greater sexual satisfaction. Nearly every 10th women (8.6%) regretted the procedure and 7% were dissatisfied with the cosmetic results. The frequency and predictability of complications, postoperative lower abdominal pain, and menstrual disturbances were similar in both a department of general surgery and a specialized gynecological unit. The duration of hospitalization, time spent convalescing, and duration of sick leave were considerably shorter than following sterilization by laparotomy and, in addition, sexual activity was resumed earlier. On the basis of this investigation, laparoscopic sterilization is recommended as a means of sterilization for women in departments of general surgery. (author's modified)^ieng

[Sterilization of women. A historical review with review of the literature and description of the methods employed in Denmark at present]. / Sterilisation af kvinder. Historisk tilbageblik ved gennemgang af litteraturen-metoder i Danmark i dag.

PIP: Voluntary sterilization was 1st introduced in Singapore and in the state of Virginia in 1969 and since then has spread in popularity across the western world. In 1973, voluntary sterilization was introduced in Denmark. The numbers of sterilizations performed has tripled in Europe and quadrupled in the US. In Denmark, the numbers have risen from approximately 1600 to 7410 annually between 1973-82. The increasing number has resulted in increasing interest in methods which are freer from complications, are rapid, effective, and cosmetically acceptable. Although Osathanondu described a minilaparotomy method in 1973 by which sterilization was carried out via an incision in the skin of 2.5 cm and with an average operating time of 20 minutes, this method is seldom used in Denmark. In 1986, a questionnaire was sent to 79 departments in Denmark which carried out sterilizations on women. 31 departments were specialized gynecological departments and 48 were surgical departments. Of the surgical departments, 24 used laparotomy and 20 laparoscopy while 3 used both and 1 used minilaparotomy. Of the gyncological departments, 27 used laparoscopy, 1 laparotomy, 1 used both, 1 both laparoscopy and minilaparotomy, and 1 used endocoagulation. Since 1978, the laparoscopic sterilizations have increased from 12.5% to 47.9% in surgical departments and from 69.9% to 93.5% in gynecological departments. (author's modified)^ieng

Peripartum cardiomyopathy.

Peripartum cardiomyopathy is a rare form of heart disease with a high mortality rate. We report a case, refractory to intensive medical treatment, with a fatal issue 5 months post partum. In recent years the literature has provided examples of the beneficial effect of immunosuppressive therapy, either Azathioprine combined with prednisone, or prednisone alone.

Injuries in taekwondo.

During the 6th Taekwondo World Championship more than 4 per cent of the competitors were admitted to hospital. The majoirity of the severe injuries were to the head and neck. More padding and a change of rules are recommended.