Judy Evans

U.K. guidelines for the management of cutaneous melanoma

Summary  These guidelines for management of cutaneous melanoma present evidence‐based guidance for treatment, with identification of the strength of evidence available at the time of preparation of the guidelines, and a brief overview of epidemiological aspects, diagnosis and investigation. To reflect the collaborative process for the U.K., they are subject to dual publication in the British Journal of Dermatology and the British Journal of Plastic Surgery.1

Does glutamine contribute to immunosuppression after major burns

The effects of glutamine concentration on the rates of lymphocyte proliferation after mitogenic stimulation and of phagocytosis by macrophages were investigated in vitro. A decrease in the glutamine concentration in culture medium from 0.6 to 0.05 mmol/l greatly decreased the rate of proliferation of human lymphocytes and of phagocytosis by mouse macrophages. In patients with major burn injury plasma glutamine concentration was 58% lower than that in normal controls and it remained low for at least 21 days after the injury. The findings indicate that the decrease in plasma glutamine concentration may contribute to the injury-induced impairment of immune function occurring after major burn injury.

Biochemical markers for post-operative fatigue after major surgery.

OBJECTIVE To establish a link between tryptophan (a precursor for 5-hydroxytryptamine (5-HT) or serotonin, involved in sleep and fatigue) and post-operative fatigue after major surgery. BACKGROUND There is a link between tryptophan (the precursor for the neurotransmitter 5-hydroxytryptamine), and its competitive binding with non-esterified fatty acids (NEFA) to albumin in the blood. An increase in the plasma concentration of free tryptophan can lead to an increased rate of synthesis of 5-HT in the brain. Free tryptophan competes with the branched chain amino acids (BCAA) for the same port of entry across the blood-brain barrier. It is suggested that the plasma concentration of these amino acids could be a marker of post-operative fatigue. In a previous study undertaken in this laboratory on patients undergoing two different types of major surgery, similar post-operative increases were observed in the plasma concentration of free tryptophan and the plasma concentration ratio of free tryptophan to branched chain amino acids. However, the study was retrospective and no measure of fatigue had been made. METHODS In the present study, this deficiency has been addressed by administering a modified Profile of Mood States questionnaire to patients undergoing reconstructive or colorectal surgery. In addition, blood samples were measured for plasma free tryptophan, albumin, NEFA and branched chain amino acids before and on 2 days after surgery. RESULTS There was a significant correlation between fatigue scores and plasma free tryptophan (P<0.000), and the plasma concentration ratio of free tryptophan/BCAA (P<0.016) after surgery in all the patients studied (n=34). This correlation was more marked in the colorectal-surgery patients, in whom surgery was more severe. In the three categories of patients receiving elective reconstructive surgery (n=24), those having breast reductions (n=6) had a lower plasma concentration of NEFA and appeared to recover from fatigue more quickly than those with pre-tibial lacerations or malignant melanoma. CONCLUSIONS These data provide further evidence of a possible biochemical mechanism for central fatigue which involves a precursor of 5-HT. The provision of branched chain amino acids may help to combat the surge in free tryptophan that occurs during stress such as major surgery.

A case of septicaemia due toAeromonas hydrophila

A case of Aeromonas hydrophila septicaemia is reported, arising from the use of leeches in an attempt to salvage a replanted arm. It is believed that this is the first report of this complication.

Site-specific properties of human adipose depots homologous to those of other mammals

1. Mean adipocyte volume, collagen content and the maximum activities of hexokinase and phosphofructokinase were measure in 15 depots of 8 men who were in good health until their sudden death. The data were used to establish homologies between depots in humans and other mammals. 2. The basic organization of adipose tissue in humans is similar to that of other mammals, although additional depots that are minimal or absent in rodents may be massive in humans. 3. Known site-specific properties relevant to manipulation of adipose tissue are reviewed.

DERMATOFIBROMAS AND ARTHROPOD BITES: IS THERE ANY EVIDENCE TO LINK THE TWO?

30 patients with dermatofibromas were questioned closely about contacts with stinging or blood-sucking arthropods before the development of their lesions. Their responses were not significantly different from those of a matched control group. 100 dermatofibromas were examined by dissection, histology, and after acid digestion of the collagenous material; no traces of arthropod skeletal tissues were found. These data are not consistent with the theory that the mechanical presence of arthropod tissues is necessarily, or even usually, a cause of dermatofibromas.