Terence J. Ryan

Blood vessels and lymphatics

We may not be able to make you love reading, but blood vessels and lymphatics will lead you to love reading starting from now. Book is the window to open the new world. The world that you want is in the better stage and level. World will always guide you to even the prestige stage of the life. You know, this is some of how reading will give you the kindness. In this case, more books you read more knowledge you know, but it can mean also the bore is full.

Glucose tolerance in lichen planus

Glucose tolerance has been investigated in twenty‐one patients with lichen planus. 62% of these patients have shown abnormal results, suggesting impaired tolerance.

PROTEOLYTIC ENZYMES IN WOUND HEALING: THE ROLE OF ENZYMATIC DEBRIDEMENT

Proteolytic enzymes are a family of proteins that serve to degrade necrotic debris derived from cell breakdown. They are produced endogenously often as precursor proteins whose activation is precisely regulated. These activated enzymes serve many functions in normal as well as pathological situations. In particular they are involved in the regulation of cell maturation and multiplication; collagen synthesis and turnover; the development and removal of the perivascular fibrin cuffs found in venous insufficiency and leg ulceration as well as the removal of dead tissues following inflammation. As a limited number of enzymes perform all these functions, it is difficult to predict the effects of applying synthetic proteolytic enzymes to a wound. Many such enzymes are currently commercially available and being promoted as alternatives to surgical wound debridement. It is important for their use to be considered in the context of their interaction with endogenous proteases, their physiological role in tissue, their ability to reach a desired target and the stage of wound healing at the time they are applied.

Lymphedema and wound healing

Abstract The lymphatic system is a widespread vascular network that plays a vital role in homeostasis of the extracellular space. The role of the lymphatics is often neglected and the aim of this article is to emphasize the important contribution the lymphatics make to maintenance of cell equilibrium and normal wound healing. The most important role of the lymphatics is the control of the interstitial microcirculation. The lymphatic vessels remove from the extravascular space macromolecules and particulate matter too large to reenter the blood capillaries. If these materials are not removed, the osmotic and hydrostatic forces within the tissues change and disease results. Failure of the lymphatics leads to pollution of the tissues because of the excesses of protein, other macromolecules, and fluid around the cells. The lymphatics are the pathway for exit of T lymphocytes and Langerhans cells. The immunologic processes that occur in the skin need the lymphatic system to function. Macrophages and Langerhans cells leaving the skin travel in the lymphatics to lymph nodes where they are recognized and induce an immunologic response. Contact dermatitis cannot develop without the lymphatics, as cellular immunity cannot develop without lymphatics directing antigen from the skin to the lymph node. Patients with lymphedema are prone to develop secondary infection as the lymphatics are the normal pathway for clearance of bacteria from the interstitium.

Community level morbidity control of lymphoedema using self care and integrative treatment in two lymphatic filariasis endemic districts of South India: a non randomized interventional study

BACKGROUND Currently there is no global program to manage lymphoedema as a result of lymphatic filariasis (LF). The primary aim of this study was to determine the efficacy of a previously proposed integrative treatment protocol, using locally available resources to address the morbidity, in a community village setting. METHODS Two LF endemic districts of south India, Gulbarga in Karnataka (GK) and Alleppey in Kerala (AK), were selected for the study. All known patients were invited to an LF camp. Patients with grade two late or three lymphoedema were enrolled. All patients were given training in the integrative procedure which involved patient education and the domiciliary protocol. RESULTS A total of 730 patients (851 limbs) completed the three and half month follow up. There was a statistically significant (1%) reduction up to mid thigh level volume measurement for both small (0.7-1.1 liters) and large (1.8-5.0 liters) limbs, p < 0.000. In AK inflammatory episodes at the three months interval reduced from 37.5% (127 patients) to 28.3% (96 patients) and in GK from 37.6% (147 patients) to 10.2% (40 patients), p < 0.000. All patients had reduced bacterial entry points. There was an overall improvement in quality of life in all domains of LF specific quality of life questionnaire p < 0.000. CONCLUSIONS Self care and integrative treatment is possible in resource poor Indian village settings. Further work is needed to explore factors leading to better compliance by randomizing the interventions such as washing and emollient compression vs Ayurvedic and yoga interventions before integrative treatment is considered for national health programmes in developing countries.

Dermatology and HIV/AIDS in Africa

Human immunodeficiency virus and the acquired immunodeficiency syndrome (HIV/AIDS) have greatly complicated dermatologic disease and the required care in most regions of Africa. Opportunistic infections, ectoparasites, Kaposi sarcoma, and skin manifestations of systemic infections are exceedingly common in patients with HIV/AIDS. Dermatologists have contributed significantly to our knowledge base about HIV/AIDS and have played an important educational role regarding the clinical manifestations historically. Because of the increased burden of skin disease in Africa due to the HIV/AIDS epidemic we must redouble our efforts to provide dermatology education to care providers in Africa. We review the burden of skin disease in Africa, how it relates to HIV/AIDS and global infectious disease, current educational strategies in Africa to address this need, and suggest potential solutions to move these efforts forward.

Plasma proteins in a standardised skin mini-erosion (I): permeability changes as a function of time

BackgroundA standardised technique using a suction-induced mini-erosion that allows serial sampling of dermal interstitial fluid (IF) for 5 to 6 days has been described. In the present study, we studied permeability changes as a function of time.MethodsWe examined IF concentrations of total protein concentration and the concentration of insulin (6.6 kDa), prealbumin (55 kDa), albumin (66 kDa), transferrin (80 kDa), IgG (150 kDa) and alpha-2-macroglobulin (720 kDa) as a function of time, using an extraction pressure of 200 mmHg below atmospheric.ResultsAt 0 h after forming the erosion, mean total IF protein content (relative to plasma) was 26 ± 13% (SD). For the individual proteins, the relative mean concentrations were 65 ± 36% for insulin, 48 ± 12% for albumin, 30 ± 19% for transferrin, 31 ± 15%for IgG and 19.5 ± 10% for alpha-2-macroglobulin. At 24 h, the total IF protein content was higher than at 0 h (56 ± 26% vs 26 ± 13%; p < 0.05, diff: 115%), as were some of the individual protein concentrations: prealbumin (50 ± 24 vs 25 ± 13%; p < 0.05), albumin (68 ± 21 vs 48 ± 12%; p < 0.05) and IgG (55 ± 30 vs 31 ± 15%; p = 0.05). ln the interval 24 h to 96 h the concentrations were relatively unchanged.ConclusionsThe results indicate that fluid sampled at 0 h after forming the erosion represents dermal IF before the full onset of inflammation. From 24 h onward, the sampled fluid reflects a steady state of increased permeability induced by inflammation. This technique is promising as a tool for clinically sampling substances that are freely distributed in the body and as a model for studying inflammation and vascular permeability.

Human papillomavirus type 6‐induced condylomata: an unusual complication of intertrigo

A 79‐year‐old virgo intacta presented with a 20‐year‐history of intertrigo. and a 3‐month history of superimposed warty masses beneath both breasts and in the groin and perianal areas. There was no evidence of immunosuppression. Histology of the warty lesions showed squamous papillomata. with evidence of wart virus infection. Human papillomavirus (HPV) type 6 was identified by in situ DNA hybridization, in the submammary lesions. This is an unusual manifestation of both intertrigo and wart virus infection. HPV‐6 is classically found in anogenital warts. We assume that these warts were acquired by a non‐venereal route and/or by congenital infection some 78 years ago. We suggest that it is the warm, moist environment, rather than the specific site, which encourages HPV‐6 to flourish.

Wound healing and current dermatologic dressings

Abstract Dressings should not be relied upon to heal ulcers. They are ancillary when conditions are otherwise optimal for healing. Thus, before relying on a dressing, wherever possible, causes of ulcers should be eliminated. Arterial, venous, and lymphatic flow should be encouraged and edema controlled. Dressings may, however, modify the etiologic factors contributing to ulceration by protecting against further trauma and counteracting infection. There are now a number of agents which can be applied to ulcers that can modify the capillary bed, either by encouraging the angiogenesis of granulation tissue or promoting capillary flow by discouraging blood cell aggregation, promoting fibrinolysis, or simply by means of support and compression, allowing the venous and lymphatic system to respond to underlying muscle and joint movement. It should be remembered that dressings cannot restore to normal congenital defects such as the absence of valves, nor repair damaged veins, nor provide the necessary agents in diseases of malnutrition, such as scurvy and diabetes mellitus, or in biochemical defects, such as prolidase deficiency. They are unlikely to modify the consequence of circulating immune complexes or neoplasia.

Exchange and the mechanical properties of the skin: oncotic and hydrostatic forces control by blood supply and lymphatic drainage.

Unwounded healthy skin can survive several hours without oxygen. The rich blood supply of the skin is important for thermoregulation, mostly only above the waist. Why then, does the skin of even the big toe have a rich blood supply? That exchange requirements are more for fluid in support of turgor and that this process is essential for the mechanical properties of the skin is suggested. It is argued that the supposed richness of blood supply is not sufficient for wound healing, and thus a new organ, granulation tissue, has to be grown. However, granulation tissue is mechanically inappropriate for the protective mechanical function of the skin and must be completely removed before healing is complete.