John A. Schilling

THE GLYCOPROTEINS AND THEIR RELATIONSHIP TO THE HEALING OF WOUNDS

“Mucosaccharides” are widely distributed in tissues and fluids of the body.’ In plasma there are a number of distinctly different glycoproteins found associated with the globulin fractiom2 In connective tissues both acid mucopolysaccharides and soluble glycoproteins are found in the semifluid ground substance between the collagen fibers? Ordinarily under physiological conditions, the constituents of connective tissues have a rather low turnover and remain relatively constant. But when abnormal conditions arise, such as an injury, alterations occur. Locally this involves variable damage to tissues and vessels while a systemic response is usually indicated by blood plasma ~hanges.~J’ Variations, particularly in the glycoprotein components of plasma, have been observed after wounding and inflammation. During wound healing, changes occur in concentrations of polysaccharide material of the wound area. An early accumulation of bound hexosamine has been reported in repair tissue’ as well as in tissue surrounding the wound? Increased amounts of acid mucopolysaccharides have been found in proliferating tissue both by chemical analysisQ and with tracer studies.1° The influence of vitamin C on the acid mucopolysaccharide content of the wound has been a subject of wide interest.” Granulomas produced by carageenin injections in scorbutic animals contain mucopolysaccharides of the hyaluronate type while chondroitin sulfate is depressed.1°J2 -la Evidence seems to indicate that glycoproteins are involved in the complex processes of growth and repair of connective tissue and that, as such, they are intimately related to wound healing. The significance of glycoproteins in wound healing has been confused by discrepancies in their nomenclature and classification as well as by variable wounding, tissue sampling, and fractionating methods. Nor has the presence of extracellular fluid been adequately studied. It seems pertinent for the evaluation of our data, therefore, to describe briefly the methods employed in each section of this study.

Gastric pH monitoring as a prognostic indicator for the prophylaxis of stress ulceration in the critically III.

Previous studies have documented the efficacy of prophylaxis in the prevention of stress ulceration and bleeding in critically ill patients. In an effort to determine whether all critically ill patients require prophylaxis, 144 patients admitted to an intensive care unit were monitored by continuous indwelling nasogastric or gastrostomy tubes. Any patient with a measured gastric pH of less than 4 was treated with prophylactic cimetidine or antacids to maintain a pH of 4 or greater. One hundred twenty-three (85 percent) met this criterion. The gastric pH of 21 patients (15 percent) never fell below 4 during continuous monitoring for 26+/- 4.2 hours. There was a significantly lower incidence of hypotension and respiratory failure in this group ( pl < 0.05). Mortality was higher in the patients who required prophylaxis (15 percent) than in those who did not (0 percent). No bleeding was encountered in any patient in either group. These data suggest that patients who do not require prophylaxis may be determined by continuous monitoring of intragastric pH. If, within 24 hours, intragastric pH does not fall below 4, minimal indications for prophylaxis exist. Intragastric pH monitoring is a simple, effective tool in the care and management of critically ill or traumatized patients.

Modifications of George Wright canine tracheal divider.

Summary Two modifications of the “George Wright” canine tracheal divider have been made. They are: 1) substitution of polyethylene for brass tubing, and 2) addition of prongs to the divider head. Inadvertent pulmonary artery obstruction is prevented, and the divider does not slip past the carina.

Wound Healing Investigation of Proteins, Glycoproteins, and Lipids of Experimental Wound Fluid in the Dog

Summary Surgical implants of stainless steel mesh cylinders were made into subcutaneous tissue of dogs back. These were removed at intervals of 1 to 4 weeks. Wound fluid was aspirated from inside these cylinders encapsulated with fibrous tissue. When compared with animals serum, this fluid was lower in protein, glycoprotein, and lipid; and these components decreased with time during post-wound period. As studied by paper electrophoresis, wound fluid had a higher per cent of albumin and lower alpha-2 and beta-1 globulin. An elevation of protein-bound hexose was found in beta and gamma globulin fractions at 3 to 4 weeks. Seromucoid was present at same level in wound fluid and serum. The lipid partition revealed especially low phosphatides but similar cholesterol:protein ratios. It appears that time-related changes occur in large molecular constituents of fluid found in wound area which may be significant in wound healing phenomenon.

Fractional analysis of experimental wound fluid.

Summary Wound fluid, contained in subcutaneously implanted wire mesh cylinders, was harvested. Its crystalloidal and colloidal components were compared with those of the blood plasma of the wounded animals and their pair-fed controls. Significant differences were observed in the protein and lipoprotein fractions.

Advances in knowledge related to wounding, repair, and healing: 1885-1984.

The purpose of this paper is to record objectively the contribution of Annals of Surgery to the development of the science of surgery and its application to patient care in commemoration of its Centennial. Though many other subjects could have been chosen, the literature relating to wounding, repair, and healing is pertinent to all of surgery and uniquely comprises a significant portion of its history and science. By reviewing the articles and content of the 200 volumes, a personal perspective was gained and hopefully captured in the body of the manuscript. By departing from the usual format of a bibliography, names of authors appear rather than impersonal numbers. The editorial eras are apparent, punctuated by the beginnings, the World Wars, the Wars of Korea, Vietnam, and North Africa, the development of biomedical research, and the technologies in other fields. Annals also reflects the logarithmic increase in higly competent surgeons through the burgeoning educational programs of university health centers, major hospitals, and clinics in the United States and in other parts of the world. Societal needs and problems are reflected by the scope and breadth of the surgical articles in response to the medical needs of its constituents during war and peace. The evolution of specialization is apparent from the beginning. Declining morbidity and mortality rates reflect the application of research, technology, and experience to the science of surgery and the biology of wounds through their dissemination.

Ruptured pericostal steel wire retention sutures: A post-thoracotomy complication

Abstract Pericostal stainless steel retention sutures employed in the closure of thoracotomies in dogs showed a high incidence of breakage. This led to various postoperative complications, three of which were fatal. The stress-corrosion phenomenon, i.e., the combination of tensile strain and biochemical corrosion, is considered responsible for the early rupture of the stainless steel sutures. The use of this material in thoracic surgery seems contraindicated.