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Biomedical subjects

F Gottrup

Publications and source records attributed to F Gottrup.

At least 55 records · Page 3Linked to original sources
PubMed1996

Reduced collagen accumulation after major surgery.

The preoperative and postoperative wound-healing capacity of 23 patients undergoing elective major abdominal, thoracic or urological surgery was tested objectively by the subcutaneous accumulation of hydroxyproline and proline in an expanded polytetrafluoroethylene (ePTFE) tube. Before scheduled surgery two ePTFE tubes were implanted for removal after 5 and 10 days. This was repeated for each patient immediately after surgery. After 10 days a higher amount of hydroxyproline was measured before than after operation (median 2.91 (range 0.37-14.45) versus 1.45 (range 0.26-6.94) micrograms/cm, P = 0.01)). This decline was significantly higher in the six patients who had a postoperative infection (median 3.02 (range -0.06 to 6.14) versus 0.36 (range -1.56 to 12.60) micrograms/cm, P = 0.02). This study shows that major surgery is associated with impairment of subcutaneous collagen accumulation in a test wound, suggesting diminished systemic wound-healing capacity in such patients.

Aged↗
PubMed1996

Gentamicin concentrations in human subcutaneous tissue.

Wound infections frequently originate from the subcutaneous tissue. The effect of gentamicin in subcutaneous tissue has, however, normally been evaluated from concentrations in blood or wound fluid. The aim of the present study was to investigate the pharmacokinetic properties of gentamicin in human subcutaneous adipose tissue by a microdialysis technique. Seven healthy young volunteers each had four microdialysis probes placed in the fat (subcutaneous) layer of the abdominal skin. After the administration of a 240-mg gentamicin intravenous bolus, consecutive measurements of the drug concentrations in serum and subcutaneous interstitial fluid were obtained simultaneously for 6 h. The tissue gentamicin concentration peaked after 10 to 30 min. The peak concentration in the tissue was 6.7 +/- 2.0 mg.liter-1 (standard deviation), equivalent to 39.1% of the peak concentration in serum. The area under the concentration-versus-time curve for the first 6 h in the tissue was 1,281 +/- 390.0) mg.min liter-1, equivalent to 59.7% of the area under the concentration-versus-time curve in serum. It is concluded that the microdialysis technique can be used to make dynamic and quantitative measurements of the gentamicin concentration in human subcutaneous tissue. In this adipose tissue, the peak concentrations of gentamicin were approximately seven times the MIC for Pseudomonas aeruginosa and 33 times the MIC for Staphylococcus aureus after the administration of an intravenous bolus of 240 mg, indicating the presence of sufficient concentrations in the adipose tissue to be effective against common bacteria.

Adipose Tissue↗
PubMed1996

Failure of buflomedil to improve wound healing in ischaemic skin flaps.

The effect of buflomedil and isoxsuprine on the healing of ischaemic wounds was investigated using an ischaemic flap model previously evaluated on rats. The drugs were given twice daily intraperitoneally for a total of nine days starting on the day before operation. The wounds were tested biomechanically after 10 and 20 days of healing, respectively, and the length of surface necrosis on the flaps was measured after 10 days. The study showed no differences in any of the biomechanical (functional) parameters of the ischaemic wounds compared with the control groups, either after 10 or 20 days of healing. There were no differences in the length of surface necrosis on the flaps. Neither of these drugs has so far convincingly proved to be effective in the treatment of ischaemic wounds or flaps.

Adrenergic alpha-Antagonists↗
PubMed1996

[Current ulcer treatment].

Patients with wounds and cutaneous ulcers have been a costly but low priority group. During recent years, greater attention has been focused on wound problems, partly as the result of the formation of interest groups and the establishment of wound treatment centres, e.g. in Britain and the USA. In June this year, the first wound treatment centre in Scandinavia is to open in Copenhagen. Research and education in this field give promise of modernised treatment for patients with chronic non-healing wounds and ulcers.

Algorithms↗
PubMed1995

Randomized comparison of polyglycolic acid and polyglyconate sutures for abdominal fascial closure after laparotomy in patients with suspected impaired wound healing.

A randomized study of abdominal fascial closure using interrupted polyglyconate and polyglycolic acid sutures after laparotomy was carried out in 204 consecutive patients with suspected impaired wound healing. There were no statistically significant differences between the two sutures with regard to the development of fascial disruption and incisional hernia. Wound infection demanding surgical intervention was found in 7 per cent of patients with polyglyconate sutures and in 16 per cent of those with polyglycolic acid sutures (P = 0.04). Monofilament polyglyconate suture does not reduce the incidence of fascial disruption and incisional hernia after laparotomy in patients with suspected impaired wound healing but the incidence of wound infection may be reduced compared with that of multifilament polyglycolic acid suture.

Abdominal Muscles↗
PubMed1995

Immunohistochemical characterization of the cutaneous cellular infiltrate in different areas of chronic leg ulcers.

Current understanding of the immunological mechanisms involved in the pathogenesis of venous leg ulcers is insufficient. In this study the cellular composition of skin biopsies taken from the center, the edge, and 2 cm distant from the edge of venous leg ulcers was characterized quantitatively by immunohistochemical staining. In the epidermis the mean numbers of Langerhans cells (CD1a+) were four times lower at the edge of the ulcer compared to clinically intact epidermis 2 cm distant from the edge. In the dermis a statistically significant increase in the mean numbers of macrophages (CD68+) and neutrophils (NP57+) from the distant area towards the center of the ulcer was observed. No significant differences were observed in the distribution of T cells nor in the ratio of CD4+/CD8+ T-cell subsets between the different regions of the ulcer. About 30% of T lymphocytes were CD8+ in all microenvironments. The center and the edge of the ulcer were dominated by macrophages comprising 63% and 53% of the cells respectively, while T lymphocytes dominated the distant area. The area 2 cm distant from the edge was also heavily infiltrated by macrophages and neutrophils. B cells (CD22+) and NK cells (CD56+) were relatively rare in all areas, comprising less than 3% of the dermal infiltrate. In conclusion, local microenvironments each with a different cellular composition can be defined within venous leg ulcers.

Adult↗
PubMed1995

Measurements of tissue oxygen tension in vascularised jejunal autografts in pigs.

Tissue oxygen measurements were evaluated as a monitor of the jejunal flap in seven female landrace pigs. A small polarographic sensor (diameter 0.55 mm) was used in which interstitial tissue oxygen tension was measured continuously in a jejunal flap and a muscle flap (rectus abdominis) during arterial and venous occlusion. Mean (SEM) tissue oxygen tension in the two types of flap were 44(9) mmHg (jejunal flap) and 47(8) mmHg (rectus flap). After arterial occlusion for 30 minutes the values dropped to 17(4) mmHg for the jejunal flap and 12(2) mmHg for the muscle flap. The decline became significant after five minutes. During venous occlusion (30 minutes) the values fell to 20(4) mmHg and 14(1) mmHg. The arterial occlusion was undetectable by the naked eye, but the enteric tissue after venous occlusion became severely congested and blue-black in colour. The condition returned to normal after release of the clamp. We conclude that direct measurement of tissue oxygen tension in a jejunal flap is a reliable method of detecting impaired perfusion. This method may in the future be used to monitor vascularised jejunal autografts.

Animals↗
PubMed1995

Dose response profiles of human growth hormone in subcutaneous wound chambers in rats.

OBJECTIVE: To investigate dose response profiles of human growth hormone in soft connective tissue healing when it is given locally in subcutaneous wound chambers. DESIGN: Placebo controlled parallel study. SETTING: Institute of Medical Anatomy, Denmark. MATERIAL: 36 male Sprague Dawley rats, in three group of 12. INTERVENTIONS: Stainless steel wire mesh cylinders 7 mm in diameter and 20 mm long were implanted subcutaneously in pairs in the upper and lower back on either side of the midline in three groups of male Sprague Dawley rats. Two groups were each given two different doses of growth hormone (group 1, 0.2 and 0.7 IU; and group 2, 0.02 and 2 IU) in two cylinders and vehicle alone in the two cylinders on the opposite side. Group 3 were given vehicle alone in two cylinders and needle puncture (sham) on the opposite side. Injections of growth hormone or vehicle (placebo) were given every three days for 16 days. MAIN OUTCOME MEASURES: Body weight, weight of granulation tissue, and concentrations of hydroxyproline and aminoterminal propeptide of procollagen type III. RESULTS: The dose response curves for weight of granulation tissue and deposition of collagen were upward convex (ANOVA p < 0.001 and 0.001, respectively). Growth hormone in doses of 0.2 and 0.7 IU stimulated formation of granulation tissue to means of 180% (95% confidence interval (Cl) 149% to 210%) and 174% (95% Cl 148% to 200%) more than in the placebo treated cylinders (group 3) (p < 0.05 and < 0.01, respectively). Doses of 0.2 and 2 IU, however, had less effect. The placebo cylinders in animals in groups 1 and 2 contained a mean of 157% (95% Cl 137% to 177%) more granulation tissue than the cylinders in group 3, indicating that locally applied growth hormone also had a systemic effect. CONCLUSION: The clinical use of topical growth hormone in wound healing may be complicated by the relatively narrow therapeutic interval.

Animals↗
PubMed1994

[Methods for measurement of wound extent].

Healing is a biologically complicated process, which is difficult to measure objectively. Several products and pharmaceuticals have been applied to the treatment of both acute and chronic wounds. There are, however, only few well-documented studies of the effect and many recommendations are based on casuistries, undocumented studies or in vitro studies. One of the most prominent problems has been the lack of exact measurements. This article describes the available clinical measurement parameters and discusses their strengths and weaknesses. The following methods of measurement are described: Wound surface area (WSA), wound area (WA), and volume (VOL). A stratification of wounds before measuring is suggested depending on aetiology and form (volume or surface wounds). The most sensitive measure for assessment of wound healing is recommended. From a clinical point of view the transition from a volume to surface wound is not distinct, and therefore WA is recommended as the most relevant measurement during wound healing.

Body Surface Area↗
PubMed1994

Evaluation of the wound healing potential in human beings from the subcutaneous insertion of expanded polytetrafluoroethylene tubes.

Subcutaneous insertion of expanded polytetrafluoroethylene tubes with local anesthesia constitutes a minimally invasive model permitting quantitative and qualitative studies of the wound healing potential in human beings. Light and electron microscopic examination of these implants in rats showed a normally appearing granulation tissue. The amount of hydroxyproline accumulated in the expanded polytetrafluoroethylene tubes may be assayed and converted to collagen content. In 28 surgical patients, the collagen content increased from 6.6 microg/cm (interquartile range: 5.1 to 9.9) after 5 days to 12.4 microg/cm (7.1 to 16.8) after 10 days (p < 0.05). The median ratio between the higher and lower collagen amount measured in two expanded polytetrafluoroethylene tubes inserted for an identical period within the same patient was 1.25 (1.10 to 1.81). This variability ratio was not related to the amount of collagen accumulated or the duration of implantation. There was a tendency for higher collagen amounts in the middle section than in the ends of the expanded polytetrafluoroethylene tubes, with a median ratio between the two sections equaling 1.12 (0.96 to 1.58); (p > 0.05). No infectious or hemorrhagic complications from the insertion occurred in any of the patients. Increments of collagen deposition with time may be easily assessed by this expanded polytetrafluoroethylene tube model, which is inexpensive and has high patient acceptance. Measurement variability was encountered, which has to be taken into account when designing clinical trials.

Journal Article↗
PubMed1994

Influence of human growth hormone on granulation tissue formation, collagen deposition, and the aminoterminal propeptide of collagen type III in wound chambers in rats.

The influence of growth hormone on granulation tissue formation was investigated in wire mesh cylinders implanted subcutaneously in rats. Two groups of 10 rats (study 1) and 1 group of 12 rats (study 2) were used for the investigation. Growth hormone, 0.02 and 0.2 IU (study 1), 0.05 and 0.2 IU (study 2), or vehicle only, was injected into the cylinders every third day for 16 days. In study 2, wound fluid was aspirated before injection of growth hormone and saved for later analysis of the aminoterminal propeptide of collagen type III. In both studies, growth hormone significantly increased the formation of granulation tissue and of total collagen content dose-dependently, whereas the relative amount of collagen was unaffected by growth hormone treatment. Wound fluid aminopropeptide increased significantly after implantation of the cylinders until day 7, before declining slightly, with no difference between the groups. We conclude that growth hormone stimulated granulation tissue formation and collagen deposition dose-dependently in the wound cylinders when injected every third day. The results suggest that growth hormone treatment does not cause excessive collagen deposition in newly formed granulation tissue.

Journal Article↗
PubMed1994

Conjunctival oxygen tension measurements for assessment of tissue oxygen tension during pulmonary surgery.

Conjunctival oxygen tension (PcjO2) and routine cardiorespiratory parameters were measured in 8 patients during pulmonary surgery. In each patient we found a close relationship between PcjO and arterial blood oxygen tension (PaO2), and for all patients the correlation coefficient was 0.962. The mean values of the ratio between PcjO2 and PaO2 in each patient were ranging between 0.46 and 0.55. We conclude that PcjO2 measurements represent a useful and reliable method for evaluation of peripheral oxygenation and perfusion during pulmonary surgery. Furthermore, the method has been found useful for estimation of arterial blood oxygen tension in hemodynamically stable patients during anesthesia.

Adult↗
PubMed1994

Physiology and measurement of tissue perfusion.

Sufficient tissue perfusion and oxygenation are vital for all metabolic processes in cells and the major influencing factor of tissue repair and resistance to infectious organisms. The concept of tissue perfusion has been aliked with blood flow, oxygen delivery or a combination of flow and nutritional supply including that of oxygen. A concept covering both oxygen delivery, tissue oxygen transport and oxygen consumption of the cells could be named tissue oxygen perfusion. This concept could be useful for clinicians describing tissue perfusion and oxygenation of the patient. Tissue perfusion must be evaluated on local tissue level. A single tissue that would represent the situation in all tissues of the body and be easily available for measurements, would be ideal. Subcutis and mucosa of the gastrointestinal tract are such types of tissue. Many monitoring systems are available for measuring tissue perfusion and oxygenation. However, only measurement of tissue oxygen tension and pH the gastrointestinal mucosa fulfil the criteria of tissue oxygen perfusion. Future evaluation of tissue perfusion will be of fundamental importance for the outcome of medical treatment. Presently measurements of tissue oxygen tension, and in intensive care units also gastrointestinal mucosal pH, seem to be the best monitoring systems clinically available for this purpose.

Blood Circulation↗
PubMed1993

Outcome at three to five years of primary closure of perianal and pilonidal abscess. A randomised, double-blind clinical trial with a complete three-year followup of one compared with four days' treatment with ampicillin and metronidazole.

OBJECTIVE: To evaluate the long term results after primary closure of perianal abscess and pilonidal sinus. DESIGN: Follow up by questionnaire and study of casenotes. SETTING: University hospital and district hospital. SUBJECTS: 88 Patients who had previously been in a prospective random control trial of two regimens of antibiotic treatment (ampicillin and metronidazole for one compared with four days) before incision, curettage, and primary closure of perianal abscess or pilonidal sinus. MAIN OUTCOME MEASURES: Recurrence rate and outcome. RESULTS: 32 Patients had perianal abscesses of which 31 (97%) healed primarily (95% confidence interval [CI] 84 to 100%) with 4 recurrences (13%, 95% CI 2 to 24%). 56 Patients had pilonidal sinuses or abscesses of which 46 (82%) healed primarily (95% CI 70 to 91%) with 14 recurrences (30%, 95% CI 16 to 40%). There were no significant differences between the two antibiotic regimens. The mean followup was 53 months. Two patients had died, both had had perianal abscesses. Pilonidal sinuses tended to recur during the first year, whereas pilonidal abscesses recurred after a lapse of two years or more. Half the patients who had had previous operations for the same complications, compared with a third who were being operated on for the first time. CONCLUSIONS: A one day course of ampicillin and metronidazole is not associated with any more complications than a four day course. Perianal abscesses respond well to primary closure, but management of pilonidal abscesses and sinuses is more difficult.

Abscess↗
PubMed1992

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.

Abdomen↗