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Biomedical subjects

G W Cherry

Publications and source records attributed to G W Cherry.

At least 37 records · Page 2Linked to original sources

The veno-arteriolar reflex in venous leg ulcer patients studied by laser Doppler imaging.

Posture-induced microcirculatory changes in the lower leg were studied in venous leg ulcer patients and in control subjects by means of laser Doppler imaging (LDI), a technique which allows almost real-time mapping of the perfusion from a distance, each perfusion value constituting the mean of a number of measurements at separate sites. LDI values for intact skin with the subject supine were 0.39 (0.32, 0.47) V [geometric mean (gm -SD, gm +SD)] and 0.32 (0.15, 0.70) V in two age groups of controls and 0.91 (0.66, 1.24) V in patients (NS). Values were 2.04 (1.25, 3.35) V for skin at the ulcer margin, and 1.44 (0.72, 2.88) V in the ulcer proper. With the lower leg passively dependent, lower LDI values were obtained at all sites in all groups, the reduction in intact skin value being 62 +/- 11% (arithmetic mean +/- SD) (p < 0.01) in the younger controls, 43 +/- 24% (p < 0.01) in the older controls and 62 +/- 19% (p < 0.001) in the patient group, and the reduction in ulcer values being 45 +/- 27% (p < 0.05) for the margin and 52 +/- 23% (p < 0.001) for the ulcer proper. Thus, a high degree of postural vasoconstriction was present overall, even in the ulcer itself. Vasomotor tone in the skin of the lower leg was assessed by topical application of methyl nicotinate, a vasodilator. The skin perfusion value (supine position, no stimulus) was 71 +/- 31% (p < 0.01) of the drug-induced (assumed peak) hyperaemia value [0.60 (0.30, 1.10) V] in patients and 24 +/- 25% (p < 0.001) of the hyperaemia value (1.30 (0.64, 2.62) V] in the controls. It would appear that in ulcer patients the veno-arteriolar reflex, despite being comparable in magnitude to that in controls, may nonetheless be insufficient to reduce tone during dependency to a level similar to that in healthy controls.

Adult↗

Enhanced proliferation of fibroblasts and endothelial cells treated with an extract of the leaves of Chromolaena odorata (Eupolin), an herbal remedy for treating wounds.

Burns are a major problem in many developing countries. Eupolin ointment is a topical agent used in the treatment of soft-tissue wounds and burns in Vietnam and is made from an aqueous extract of the leaves of Chromolaena odorata (formerly Eupatorium odoratum). Clinical studies using this extract have shown antimicrobial and anticoagulation effects as well as the promotion of tissue remodeling in the wound healing process. However, the mechanism by which this agent affects cells involved in the wound healing process is unknown. In our research, fibroblasts and endothelial cells, two cell types that play a crucial role in wound healing, were used to investigate some of the effects of Eupolin extract in vitro. Cell growth was estimated by a colorimetric assay at different time intervals. Enhanced growth of fibroblasts and endothelial cells was found at concentrations of 10 microg/ml and 100 microg/ml of Eupolin extract. This was particularly evident in medium supplemented with only 0.5% fetal calf serum where the cells were quiescent. Toxicity of the extract to fibroblasts was observed at 250 microg/ml in Dulbecco's modified Eagle's medium/0.5% fetal calf serum, but there was no significant damage at this dose to the endothelial cells. The results of the study demonstrated that Eupolin extract increased fibroblast and endothelial cell growth, and this could explain in part the beneficial clinical effects that have been observed.

Anti-Infective Agents↗

Postural vasoregulation and mediators of reperfusion injury in venous ulceration.

PURPOSE: To test the hypothesis that ischemia and reperfusion injury may contribute to the cause or nonhealing of venous ulcers, the effects of postural change on the microcirculation of ulcers and on levels of known mediators of reperfusion injury in their venous effluent were studied. METHODS: A standard protocol of stabilization (20 minutes), limb dependency (1 hour), and reelevation (2 hours) was used in 10 patients with venous leg ulcers as proven by clinical history, examination, ankle-brachial pressure index, and light reflective rheography. Superficial blood flow in and around ulcers was repeatedly examined with a new laser-Doppler scanning technique. Blood samples from the saphenous vein or a tributary adjacent to the ulcer before dependency and at 0, 10, 30, 60, and 120 minutes after reelevation were analyzed for tumor necrosis factor-alpha, interleukin (IL)-1RA, IL-1 beta, IL-6, platelet-activating factor, thromboxane B2, leukotriene B4, and P-selectin. RESULTS: Scans showed a consistent pattern of high ulcer blood flow, which decreased on dependency (p < 0.05) and then returned to baseline levels on reelevation and (in 7 of 10) eventually exceeded initial values. Mediator assays showed that levels of platelet-activating factor, IL-1RA, and IL-6 were significantly higher in resting ulcer venous effluent than in systemic venous samples; the reverse was true for P-selectin. There was no statistically significant change in effluent concentration of any mediator as a function of posture, ulcer size, or healing. CONCLUSIONS: Postural vasoregulation causes relative ischemia and reperfusion in venous leg ulcers. However, this is not associated with changes in release of mediators known to be related to reperfusion injury in internal organs.

Aged↗

Cadexomer iodine in ulcers colonised by Pseudomonas aeruginosa.

The clinical and bacteriological efficacy of topical cadexomer iodine on venous leg ulcers colonised with Pseudomonas aeruginosa was evaluated in an open, uncontrolled, multicentre pilot study. Nineteen patients with venous leg ulcers (median ulcer area 15.5 cm2) were treated with cadexomer iodine paste and short-stretch bandaging for 12 weeks or until the ulcer was healed within that period. Bacteriological cultures for growth of Pseudomonas aeruginosa and ulcer area measurements were regularly performed during the study period. Seven patients were withdrawn during the study period for the following reasons: pain in the ulcer (n = 2), ulcer enlargement (n = 2), treatment of cellulitis in non-study ulcer with a systemic antibiotic that is effective against Pseudomonas aeruginosa (n = 1), increased thyroid-stimulating hormone level (n = 1) and poor compliance (n = 1). In addition, one patient was erroneously withdrawn. After one week's treatment, 11 out of 17 patients (65%) had a negative culture of Pseudomonas aeruginosa. At 12 weeks, six out of eight patients (75%) had a negative culture and complete healing was achieved in three patients (16%). The median ulcer area reduction obtained at 12 weeks was 32.9%. The results indicate that cadexomer iodine paste might be the treatment of choice for venous leg ulcers colonised with Pseudomonas aeruginosa. However, a larger controlled clinical study is needed for final evaluation.

Adult↗

Pain in venous leg ulcers.

A prospective study was conducted to assess the prevalence, severity and diagnostic utility of pain in patients with venous leg ulcers. A semi-structured questionnaire was completed by 140 consecutive patients in two specialist centres caring for patients with leg ulcers. A high proportion (64%) of the 94 patients with ulcers of purely venous aetiology reported severe pain; 50% of these patients were taking either mild analgesia or none at all. In 10 of 72 cases, leg elevation made the pain worse. Venous ulcers are painful. Pain in three distinct locations was reported by patients-within ulcers, around ulcers and elsewhere in the leg. The presence of severe pain does not necessarily indicate arterial disease or infection. Pain is, in general, inadequately controlled in these patients.

Adult↗

An aqueous extract of the leaves of Chromolaena odorata (formerly Eupatorium odoratum) (Eupolin) inhibits hydrated collagen lattice contraction by normal human dermal fibroblasts.

Chromolaena odorata (formerly Eupatorium odoratum) is used as a traditional medicine in Vietnam (Nghiem, 1992), where its Vietnamese common name is "co hoi." While it has been widely considered a weed by agriculturalists (Holm et al., 1991), the aqueous extract and the decoction from the leaves of this plant have been used throughout Vietnam for the treatment of soft tissue wounds, burn wounds, and skin infections. A number of clinical studies done by Vietnamese as well as foreign medical workers has demonstrated the efficacy of this extract on the wound-healing process. In this article, the effect of the Eupolin extract on hydrated collagen lattice contraction by human dermal fibroblasts, an in vitro model of wound contraction, is described. The significant inhibition of collagen gel contraction by Eupolin extract at 50 to 200 micrograms/ml is demonstrated in various concentrations of collagen. When the extract at 50 to 150 micrograms/ml was washed out of the lattices and replaced by fresh medium without Eupolin, the contraction of collagen by cells was resumed. The visualization of cells in the lattices by incubation in a tetrazolium salt for 2 h showed live cells at 50 to 150 micrograms/ml of extract. In contrast, all cells were killed in the higher extract doses of 300 or 400 micrograms/ml. These preliminary results showing the inhibitory effect of Eupolin extract on collagen contraction suggest that a clinical evaluation of its effect on wound contraction and scar quality should be made. This work illustrates that traditional remedies that are used by folk practitioners to improve healing can be examined in a scientific manner using in vitro wound-healing models. It could be that the synergistic properties of components of the natural extract contribute to the positive effects demonstrated on various wound-healing mechanisms.

Cells, Cultured↗

Perfusion imaging of skin island flap blood flow by a scanning laser-Doppler technique.

Conventional laser-Doppler perfusion measurements can only obtain information from a single site. Since superficial blood flow is heterogeneous, this is a serious limitation, particularly in studies of methods to improve skin flap survival. A scanning laser-Doppler instrument has been developed which provides both an image and quantitative information about perfusion of the superficial tissue. We have evaluated this instrument in a circumflex iliac artery island flap model in the pig. The validity of the model was demonstrated by fluorescein dye injection and histology. Elevation of flaps was found to increase proximal flap blood flow but to decrease it in the distal portion. In flaps subjected to arterial ischaemia (9 h) and reperfusion we found an early increase in proximal flow, which gradually extended distally over the first 40 to 60 min. 16 h later, flow had declined, compatible with reperfusion damage to the vasculature. We suggest that perfusion imaging may be a valuable technique for investigating the mechanisms and extent of reperfusion injury.

Animals↗

The effect of minoxidil analogues and metabolites on the contraction of collagen lattices by human skin fibroblasts.

Minoxidil, in addition to its effect on hypertension and hair growth, has been proposed as a potential antifibrotic agent. Minoxidil inhibits the contraction of collagen lattices by human fibroblasts in vitro. However, the mechanism of inhibition is unknown. As minoxidil is metabolised in the body to minoxidil glucuronide and minoxidil sulphate, we investigated the potencies of these metabolites to inhibit collagen lattice contraction. We also studied selected analogues of minoxidil to assess the influence of certain functional groups in the inhibition. The major metabolite, minoxidil glucuronide, proved to be inactive, whereas minoxidil sulphate was considerably more active than minoxidil. In terms of the structural analogues, the substitution of one amino group by a methyl group resulted in loss of the inhibitory activity; removal of the nitroxide oxygen led to stronger inhibition than with minoxidil. Further studies are planned to learn more about a possible role for minoxidil in wound contraction.

Animals↗

Regional differences in capillary density of the normal human dermis.

Quantitative study of the capillary density of normal dermis of 113 biopsy specimens taken from 20 body sites from 6 cadavers was carried out. Histologic quantification of dermal capillaries using the alkaline phosphatase method to delineate vascular endothelium and automated image analysis demonstrates statistically significantly greater capillary density in the head-face/neck region both in the papillary and reticular dermis than in the lower parts of the body. The smallest numbers of the dermal capillary density were noted in the calf and shin areas. These data support the hypothesis that random-pattern skin flaps can be safely raised longer in the face and neck than in other parts of the body.

Aged↗

Flexible approach to amperometric oxygen determination.

In vitro and in vivo results obtained from a novel flexible amperometric oxygen sensor are reported. The sensor is fabricated using thin film deposition techniques and is operated by the application of a pulsed waveform. Development of the sensor was undertaken in order to produce a device that is capable of being sited at the interface of a wound and an overlying wound dressing. Oxygen determinations in such an environment would aid in gaining an understanding of the role of oxygen in wound healing and the type of wound dressing that would provide an environment conducive towards wound healing. In vitro data indicate that linearity of response is good although other performance characteristics are irreproducible. In vivo response to oxygen has been observed 50 h after insertion into a porcine sham wound. Expected trends were followed when changes to the oxygen regime of the wound space were effected, but absolute values of oxygen tension are difficult to state with certainty. This may be due to poor calibration stability and inadequate sealing of the sensor from the surrounding environment.

Animals↗

Endothelial cell crystalloids in newborn human foreskin.

This study describes the presence of crystalline inclusions in the endothelial cells of foreskins. They were found in 9 normal full-term newborn infants, without maternal medication or complication during pregnancy and delivery. These cytoplasmic crystalloids occurred in 10% of endothelial cells of small blood vessels. The diameter of the inclusions ranged from 0.3 to 1.5 micron and they appeared as round, oval, hexagonal or irregular polygonal in shape. These inclusions were surrounded by a triple membrane and their contents demonstrated granular, homogeneous and crystalloid-like material with a regular periodicity of dense and less dense layers measuring about 20-25 nm. Similar crystalloids in the endothelial cells were observed in the normal upper lip skin of a 6-week-old girl, although they were present in much smaller numbers than in foreskin. No endothelial inclusions were found in normal skin taken from 11 body areas in 29 patients aged 2.5 to 56 years. The nature and function of these cytoplasmic crystalloids are unknown.

Adolescent↗

The treatment of cutaneous vascular lesions with the infra-red coagulator: a preliminary report.

The treatment of vascular naevi with lasers is widely practised. The concept of specific vascular damage was an early ideal but it is much harder to attain than had been anticipated. The favourable results achieved by coagulation necrosis of the epidermis and upper dermis with the argon and CO2 lasers prompted us to try to produce the same changes with non-laser radiation. We have used an infra-red coagulator to treat flat vascular naevi and ectatic blood vessels. The handpiece which looks like a gun has a light guide capped by a 6 mm diameter sapphire. This size combined with a pulse duration of less than 1.0 second enables large areas of skin to be treated quickly. Preliminary results are presented.

Humans↗

Precise dermal damage with an infrared coagulator.

Using an infrared coagulator, we have shown, in pigskin, a direct relationship between depth of injury and the duration of infra-red pulses, which was highly reproducible at a particular site. This has been related to the clinical results achieved in one patient whose three tattoos were treated with different pulse times.

Adult↗

Tattoo removal using infra-red coagulation.

Using a radiation source from which the output is maximal in the near infra-red range, we have successfully treated thirty-six tattoos in twenty-one patients. This technique is described and its place in practice is discussed.

Arm↗

Intracellular collagen fibers in the capsule around silicone expanders in guinea pigs.

Ultrastructural studies of fibrous capsules surrounding silicone tissue expanders in guinea pigs revealed a number of fibroblasts containing collagen fibers inside cytoplasm with typical periodicity. These fibers were single or multiple, appeared straight, coiled, or bent, and lay in narrow, undulating membrane spaces. These intracellular collagen fibers were found in as many as 15% of the cells in capsules between 7 and 12 weeks of expansion. These observations suggest that during capsule development there is some imbalance between the synthesis of collagen fibers and their degradation. It is possible that increased synthesis of collagen fibers as well as their phagocytosis by fibroblasts may exist simultaneously.

Animals↗

Quantitative evaluation of mast cells in cellularly dynamic and adynamic vascular malformations.

Mast cells were counted in 78 histologic specimens from 70 patients with various vascular malformations showing cellularly dynamic and cellularly adynamic lesions. In growing stages of strawberry hemangiomas, there was an increased number of mast cells (mean 11.0 cells per high-power field in stage III and 23.7 in stage IV), as well as a high number of mast cells in the initial involution of strawberry hemangiomas (stage V, mean 21.0 cells per high-power field). In later involuting stages (stages VI and VII), the number of mast cells decreased (mean 9.3 in stage VI; mean 4.7 in stage VII). In cellularly adynamic lesions, i.e., port wine stains, the mean number of mast cells was 4.8, and in congenital arteriovenous malformations, it was 3.6. In normal skin, the mean number of mast cells was 3.2. In cellular hemangiomas that showed active growth (stages III to IV), the number of mast cells was strikingly low (mean 1.3). It seems that the mast cells are not responsible for the proliferation of the endothelium or for growth of the hemangioma. The markedly increased number of mast cells in the growing stages and initial involuting stage of strawberry hemangiomas parallels the gradual growth of fibrous connective tissue inside the tumor. Mast cells may thus be a precursor of the beginning of the involution of a strawberry hemangioma.

Adolescent↗