Can the wound healing process be improved by vitamin supplementation? Experimental study on humans.

UNLABELLED: The improvement of the wound healing process in humans by vitamin supplements is still controversial because of the lack of a clearly demonstrated correlation with the mechanical properties of scars. OBJECTIVE: The aim of this work was to study the effects of high doses of ascorbic acid (AA) and pantothenic acid (PA) on the wound healing process of human skin. METHOD: Two groups of patients undergoing surgery for tattoo removal by the successive resection procedure received AA (1 or 3 g/day) and PA (0.2 or 0.9 g/day). More than 80 mechanical, biological and histological parameters were investigated in both preoperated skin and the scars. RESULTS: The breaking energy of scars was higher in group 2, and energy and treatment were directly correlated (p = 0.006). Mg and Mn significantly rose in group 2 whereas Fe decreased in a dose-dependent manner. Intragroup comparison showed patient and treatment effects for Mg, a time.treatment effect for Cu and a treatment effect for Fe. CONCLUSION: The degree and rapidity of variations rather than the variations of the absolute values themselves of fibroblasts, hydroxyproline, Fe, Cu and Mg are significantly related to the enhancement of the mechanical properties of scars. From this study, it may be assumed that in order to obtain 'better', more solid and resistant scars, the decrease of Fe must be quick and acute in order to avoid the harmful effects of toxic radicals; the increase of Cu, Mg and Mn must be early and high in order to have more stable and solid collagen.

Small bowel biopsy by remote control: experimental study on dogs.

Telemetry has been used for 30 years in medicine because it requires no link between patients and apparatus. To take advantage of this, we have developed a multipurpose intestinal capsule for the small bowel, with interchangeable tips triggered by remote control. A new tip, performing small bowel mucosal biopsy by remote control is presented. The location of the capsule is radiotransmitted by means of a cogwheel, which is rotated by contact with the intestinal wall. At the chosen site (ie, a number of centimeters from the pylorus), the remote control is activated and the mucosal biopsy is performed through a suction port and kept inside the tip. The capsule then passes throughout the bowel and is recovered in the stool to allow examination of the biopsies. The results of 24 studies on a dog (crossing of the pylorus, length, transit time, velocity) are analyzed to validate the method. Biopsies were accomplished in the stomach, the small bowel (ileum), and the colon. The device failed two times, but no complications occurred. Biopsies, with average surfaces were 6mm2, never penetrated the longitudinal muscular layer. The system is precise to within 3 cm, efficient, reliable, noninvasive, and causes minimal discomfort during investigation.

[The intestinal capsule: a new way of investigating the small intestine]. / La navette intestinale: une nouvelle façon d'explorer l'intestin grêle.

The small bowel is difficult to explore because of its location far away from the natural orifices. The aim of this study is to describe a telemetric, autonomous and multifunctional capsule (39 mm in length and 11 mm in diameter) designed according to a modular system to explore the small bowel. It consists of a central cylinder containing a location detector which allows permanent data collection concerning its position in the small bowel, the length of the small bowel and the transit velocity; secondly, several interchangeable tips allow either aspiration of a sample of intestinal juice, or release of a substance previously placed in the capsule, or to perform a mucosal biopsy. After having been swallowed by the patient, the capsule passes through the whole gut and is then recovered in the stools between 24 and 48 hours later. The preliminary study consisted of comparing, in patients undergoing a surgical procedure, the small bowel length measured by telemetry (542.3 +/- 113.8 cm) to that measured intraoperatively by the arithmetical mean of the mesenteric and antimesenteric edges (515 +/- 112.7 cm), p = 0.28. These different interchangeable working tips have already been used to determine the level of absorption of various substances, the discovery of absorption sites and the performance of mucosal biopsies without any material link between patient and the measuring or recording equipment. The main advantages of this intestinal capsule are the possibility to continuously transmit its location, its total autonomy and remote control of the desired action.

Does fibrin glue improve drainage after axillary lymph node dissection? Prospective and randomized study in humans.

The aim of this prospective and randomized study was to establish whether the use of fibrin glue was beneficial after axillary lymph node dissection. From January 1990 to January 1991, 40 women were randomized before surgery for breast cancer: 20 patients (group A) underwent vaporization of fibrin glue (Tissucol, 5 ml of 500 IU thrombin) only in the area of axillary dissection; another 20 patients (group B) served as controls. The two groups were compared for age, number of nodes removed and involved, volume and duration of fluid drainage and complications. Student's t test, Mann-Whitney nonparametric test and the chi 2 test were used when appropriate for statistical analysis. The two groups were well balanced for age, number of nodes removed and involved, staging and histologic findings. The average volume of lymphorrhea in the lymph node dissection area was greater after use of fibrin glue (410.4 ml) than in controls (275.5 ml, p = 0.016). No difference was noted between the two groups for the volume of drainage fluid of the site of mastectomy or lumpectomy, or for the total volume of drainage fluid. Drainage duration as well as duration of hospital stay were similar. Six complications occurred in group A, and one in group B (p = 0.037).(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of pantothenic acid and ascorbic acid supplementation on human skin wound healing process. A double-blind, prospective and randomized trial.

This study aimed at testing human skin wound healing improvement by a 21-day supplementation of 1.0 g ascorbic acid (AA) and 0.2 g pantothenic acid (PA). 49 patients undergoing surgery for tattoos, by the successive resections procedure, entered a double-blind, prospective and randomized study. Tests performed on both skin and scars determined: hydroxyproline concentrations, number of fibroblasts, trace element contents and mechanical properties. In the 18 supplemented patients, it was shown that in skin (day 8) Fe increased (p < 0.05) and Mn decreased (p < 0.05); in scars (day 21), Cu (p = 0.07) and Mn (p < 0.01) decreased, and Mg (p < 0.05) increased; the mechanical properties of scars in group A were significantly correlated to their contents in Fe, Cu and Zn, whereas no correlation was shown in group B. In blood, AA increased after surgery with supplementation, whereas it decreased in controls. Although no major improvement of the would healing process could be documented in this study, our results suggest that the benefit of AA and PA supplementation could be due to the variations of the trace elements, as they are correlated to mechanical properties of the scars.

[Biological glue does not reduce lymphorrhoea after lymph node excision. Randomized prospective study on 40 patients]. / La colle biologique ne réduit pas la lymphorrhée après curage axillaire. Etude prospective randomisée sur 40 patientes.

The aim of this prospective and randomized study, was to demonstrate the benefit by using fibrin glue after axillary lymph node dissection. From January 1990 to January 1991, forty females were randomized before surgery for breast cancer: 20 patients of the group A underwent additional application of fibrin glue (5 ml containing 500 IU of thrombin) by spray only in the area of axillary dissection, while the 20 patients of group B acted as the control group. The two groups were compared for age, number of nodes removed and involved, drainage volume and duration and complications. Student's t test, Mann and Whitney non parametric test and chi 2 were used when appropriate for statistical analysis. The two groups were well balanced for age, number of nodes removed and involved, staging and histologic findings. The average volume of lymphorrhoea in the lymph node dissection area was greater after use of fibrin glue (410.4 ml) than in controls (275.5 ml, p = 0.016). No difference was noted between the two groups for the volume of drainage of the mastectomy or lumpectomy site or, for the total volume of drainage. Drainage durations as well as hospital stay were similar. Six complications occurred in group A, and one in group B (p = 0.037).(ABSTRACT TRUNCATED AT 250 WORDS)

[Conservative radiosurgical treatment in in situ ductal cancer of the breast. Analysis of 86 cases]. / Traitement conservateur radiochirurgical dans le cancer canalaire in situ du sein. Analyse de 86 observations.

OBJECTIVES: With effective screening programmes, the global incidence of in situ ductal carcinoma of the breast has risen to 15%, representing 20 to 30% of the mammographically detected T0 tumours. Prognosis is generally good in these tumours, but treatment has in the past, paradoxically, relied on extensive surgery. We report our experience with conservative radiosurgery performed in such cases from 1980 to 1990. METHODS: There were 86 patients with a mean age of 52 years. Initial TNM classification was T0 = 57, T1 = 17, T2 = 9 and Tx = 3. All underwent limited surgery (quadrantectomy: 17; lumpectomy: 69) and 49 had axillary dissection. All received breast irradiation with scar boost (46-50 Gy + 10-14 Gy with classical fractionation). Thirty one postmenopausal women received adjuvant tamoxifen. The quality of the resection was good in 77 cases, doubtful or incomplete in 9. In one case axillary nodal involvement was found. The histological subtype was clearly identified in 63 cases. With a median follow-up of 58 months, 3 local relapses occurred (3.4%), at 27, 48 and 52 months respectively. One was in situ and two invasive. All were clinical lesions (2 T1 and 1 T2); two had incomplete or doubtful excision and all received less than 60 Gy on the tumour bed. All had mastectomy. Two are alive and well but one developed multiple metastasis. Five other women had subsequent surgery for suspicion of local relapse but all had benign disease. One developed contralateral disease 20 months later. Two women died subsequently due to a second cancer. CONCLUSION: These results confirm the importance of the excision quality and suggests a possible dose-effect in the control of in situ ductal carcinoma by radiotherapy. The recent results of the B-17 NSBAP trial also conclude that the radiosurgical conservative treatment, for limited in situ ductal carcinoma, is a reasonable alternative to mastectomy.

The unopened colostomy: a procedure to protect colonic anastomosis.

The results of an alternative to the classic diverting lateral colostomy when used to protect a high risk anastomosis are reported. Fourteen out of 122 patients undergoing colonic or colorectal resection had a restoration of intestinal continuity with a proximal closed loop colostomy--of these 11 did not require opening in the immediate post-operative period. These had an uneventful early post-operative course, and the return of the colostomy to the abdominal cavity was performed within 10 days post-operatively, without having been opened. In three cases where local or general complications occurred, the opening of the colonic loop led to the creation of a conventional temporary protective colostomy. This procedure allowed a reduction of the originally planned number of colostomies by 50%.

Variations of magnesium, iron, copper and zinc during the colonic wound healing process: experimental study on rabbits.

The role of trace elements in the wound-healing process is still controversial. Their variations within a normal colonic wound healing have never been studied. An experimental study on rabbits was designed to study magnesium, iron, copper and zinc variations in blood, normal colonic walls and colonic anastomoses on each of the first 7 postoperative days. No major variations of Mg could be observed. Fe decreased in blood as well as in colonic walls and anastomoses. Cu increased in blood, whereas it decreased in colonic walls and anastomoses. Zn decreased in blood, whereas it increased in colonic walls without significant changes in anastomoses. The role of Fe seemed to be rather difficult to understand. Plasma mobilization seems to explain the local use of Zn, while early tissue release with further return in blood occurred for Cu. The importance of a well-balanced nutritional status is underlined to prevent and correct the variations of trace elements in the postoperative course.

Autonomous telemetric capsule to explore the small bowel.

An intestinal telemetric capsule has been developed to study the small bowel in man. It consists of a cylinder (11 mm in diameter and 39 mm in length) containing a location detector, a radiotransmitter, a lithium battery and an interchangeable tip. After having been swallowed by the patient, the capsule passes through the whole gut and is recovered in the stools. During the transit through the small bowel, the information provided by the radiotransmitter allows continuous monitoring of the distance covered from the pylorus, the direction and the velocity of progression. Moreover, according to the type of interchangeable tip, it is possible, by remote control, to sample 0.5 ml of intraluminal fluid for subsequent analysis or to release 1 ml of any liquid substance in a precisely determined place for pharmacological studies. The main originality of the capsule is its ability to transmit its precise location inside the small bowel.

[Intestinal absorption of insulin with a new telemetric shuttle in dogs]. / Etude de l'absorption intestinale de l'insuline chez le chien grâce à une nouvelle capsule de largage télémétrique.

Telemetric shuttles for the in vivo investigation of the gastrointestinal tract have been available for sometime. We describe herein the use of a new shuttle model whose original features include: a) continuous, real time transmission of its location in the small bowel and accurate measurement of the gut length, b) controlled release of 1 ml of a given substance at any chosen site, allowing detailed investigation of intestinal absorption at different levels of the small bowel under physiological conditions. Small bowel length was measured in dogs using the shuttle and was later compared to the actual small gut length measured in the same animals at laparotomy. The telemetric measurements appeared to closely match the direct operative measurements. Insulin absorption from the canine small bowel was then investigated releasing different dosages of insulin together with the pancreatic enzyme inhibitors Soybean and Aprotinine and a surfactant (5-methoxysalicylate). By adjusting the dose of insulin released, the type of adjuvant substance delivered with it and the site of release in the small bowel, we have been able to precisely define the conditions of insulin absorption. Insulin as such is exclusively absorbed in the ileum when released in doses of 500 IU or higher and mixed with aprotinine. For absorption to take place the solution delivered by the shuttle needs to have the correct pH and natremic concentration.

[Improvement in the healing of colonic anastomoses by vitamin B5 and C supplements. Experimental study in the rabbit]. / Amélioration de la cicatrisation des anastomoses coliques par une supplémentation en vitamines B5 et C: Etude expérimentale chez le lapin.

To study the effects of vitamins B5 and C on the healing process of colonic anastomoses, 3 groups of 20 rabbits were given daily either placebo (group A), or vitamin B5 (100 mg/kg: group B) or vitamin C (100 mg/kg: group C). After 8 days of supplementation, via a midline incision and under general anaesthesia, 2 colonic segments were removed, and the continuity was restored. On the 3rd post-operative day, the rabbits were killed and the anastomoses were removed. Mechanical properties of both normal colon and anastomoses were determined by using bursting pressure tests, number of burst anastomoses, fibroblast count, hydroxyproline concentration and determination by microanalysis of trace element content: Mg, P, S, Ca, Fe, Cu, Zn and Mn. Vitamin B5 (p = 0.03) and vitamin C (p less than 0.01) both decreased the number of burst anastomoses. Furthermore the required bursting pressure values were higher with vitamin C (p = 0.01) than in controls. Both vitamins restored normal Zn levels at the anastomotic site, whereas these levels decreased on the 3rd post-operative day during the normal healing process of colonic anastomosis. Moreover, vitamins B5 and C increased Fe, Cu and Mn levels, which are intimately all involved in collagen synthesis. Vitamins B5 and C enhance the colonic wound healing process in the rabbit, acting together in synergy in vivo as well as in vitro, as previously demonstrated.

[Difference in the action of prostaglandin E2 (PGE2) on longitudinal circular muscle contractions of the colon. Experimental study in dogs]. / Différence d'action de la prostaglandine E2 (PgE2) sur les contractions musculaires coliques longitudinales et circulaires: Etude expérimentale chez le chien.

The effect of prostaglandin E2 (PgE2) on the circular and longitudinal contractions of the canine colon was studied in chronic conditions. A mechanical transducer developed in our laboratory and implanted on the canine colon collected simultaneously and separately the variations of length in two perpendicular directions. The recordings started at the 6 postoperative day. The colonic motility was recorded two hours before (as control period) and two hours after the intravenous injection of PgE2 at three different doses: 0.1-1.0 and 10 micrograms/kg. PgE2, at the three doses, induced, progressively over time, a significant decrease in duration and amplitude of the circular contractions, while the amplitude of longitudinal contractions remained unchanged. 10 micrograms/kg of PgE2 immediately induced a significant increase in the duration of longitudinal contractions followed by a decrease in this value during the 2nd hour after PgE2 administration. Each dose of PgE2 shortened the period of recurrence of longitudinal contractions, inducing rapid or immediate bursts of contractions. This effect was moderate or absent for the circular contractions. It is concluded, that PgE2 has different actions on circular and longitudinal contractions of the colon. According to the dose used, it induces hypokinesia (relaxation) in the circular muscle and premature strong contractions in the longitudinal motor activity.

[Limy bile syndrome. Study of a case with double localization in the gallbladder and common bile duct]. / Le syndrome de la bile calcique. Etude d'un cas à double localisation vésiculaire et cholédocienne.

We report the case of a patient with limy bile located in both the gallbladder and common bile duct, and disappearing spontaneously. Since the first description of this syndrome in 1911, approximately 300 cases have been reported in the literature, including 20 cases with double localization. The male/female ratio was 1/3. All patients were more than 40 year old. Conventional radiogram was sufficient to establish diagnosis. Spontaneous disappearance of limy bile is rare. The etiopathogenesis remains unclear; cholecystectomy is appropriate.

[Rectocolic tuberculosis. Radiological aspects apropos of 14 cases]. / La tuberculose recto-colique. Aspects radiologiques à propos de 14 observations.

During 11 years, 14 cases of tuberculosis of the colon are radiographied. The clinical findings are not specific and the association with evolutive pulmonary tuberculosis is infrequent (28%). The radiological features are described: ulcerations (4 cases), ulcerations and hypertrophic features (3 cases) and hypertrophic features (7 cases). The involving sites are caecum and ileocecum in 6 cases, ascending colon in 3 cases, transverse colon in 2 cases, descending colon in 2 cases and recto-sigmoid in 2 cases. The differential diagnosis are segmental Crohn colitis and colonic carcinoma. Endoscopic examination with biopsy is a help to the diagnosis, but in 5 cases, it will be deficient. The diagnosis of colonic tuberculosis is setting only by surgical resections in 6 cases (43%) and 4 patients have been treated by medical treatment with success. No relapse appears in operated patients.

[Value of Deloyers' method. Apropos of a case of ruptured aneurysm of the splenic artery requiring colectomy]. / Intérêt de l'artifice de Deloyers. A propos d'un cas d'anévrysme rompu de l'artére splénique ayant nécessité une colectomie.

The authors report a new case of splenic artery congenital aneurysm. With regards to the surgical procedure, they insist on the necessity of a massive resection and remind a particular surgical procedure which allows to restore the colonic continuity with fittest conditions.

[Value of small intestine transit by enteroclysis in obstructive syndromes of the small intestine. Apropos of 212 examinations]. / Intérêt du transit du grêle par entéroclyse dans les syndromes obstructifs de l'intestin grêle. A propos de 212 examens.

During seven years, 212 small bowel examinations are made on patients with suspected small bowel obstruction by barium infusion. We find all the main small bowel pathology: Crohn's disease (16.5%), carcinomatosis (14.6%), neoplasia (10.3%), vascular disease (17.8%), actinic enteritis (9.5%) and miscellanous (18%). The small bowel infusion is normal in 15%. Surgery is avoided in 51% of the cases. There is non complications associated with the examination but in 12% of the cases, the examination is unsuccessful.

[A rare complication of vaginal hysterectomy: vaginal evisceration. Apropos of a case of recurrent evisceration]. / Une complication rare de l'hystérectomie par voie basse: l'éviscération vaginale. A propos d'un cas d'éviscération itérative.

A patient developed repeated vaginal eviscerations after vaginal hysterectomy. This is a rare complication, only 21 cases having been reported in the literature. The present case was a 61 year old woman with post-vaginal hysterectomy eviscerations 8 and 21 months after the operation. Reduction of the herniated loop and suturing of the ununited vaginal stump is generally a simple procedure, but the perineal reconstruction necessary to prevent recurrence raises problems that are discussed in detail.