Tissue Oxygenation, Venous Ulcers and Fibrin Cuffs

Skin oxygen tension (TcPo2) was measured at 43°C on patients (n=27) with venous ulcers. Measurements were made at ulcer edge and, proximally on the same limb for control. Similar measurements were also made on healthy volunteers (n=14) in the medial aspects of the distal third of the legs. TcPo2 at ulcer edge was significantly lower (P=0.001) than control values which in turn were lower than that measured on healthy volunteers. TcPo2 reflects skin nutrition. While low TcPo2 at ulcer edges might be the result of pericapillary barriers to oxygen transport, the control values measured on apparently normal skin suggest the need for further studies.

Changes in Skin Microcirculation at Periulcerous Sites in Patients with Chronic Venous Ulcers during Leg Elevation

Objective:

To investigate the effect of limb elevation on the microcirculation of the skin in patients with venous ulceration of the leg.

Design:

Prospective study in patients receiving in patient treatment for venous ulceration.

Setting:

Health Service teaching hospital.

Patients:

Thirteen patients with venous ulceration of the lower limb for more than two years were investigated.

Interventions:

Patients were admitted to hospital and treated by bedrest with elevation of the lower limbs by 10° above the horizontal.

Main outcome measures:

Laser Doppler fluximetry and transcutaneous oximetry of the skin surrounding the venous ulcers was undertaken.

Results:

The laser Doppler fluximetry in the periculcerous region increased by 10.8 A.U. (95% CI 17 to 4.54). However, the transcutaneous oxygen measurements did not change during the period of treatment.

Conclusions:

Admission to hospital with elevation of the limb for patients with venous ulceration results in ***microcirculatory changes which are probably attributable to reduction in lower limb oedema.

How to Measure Changes in Oedema in Patients with Chronic Venous Ulcers?

objective:

To assess changes in limb volume and oedema in Patients admitted to hospital for treatment of venous ulceration.

Design:

Prospective study in thirteen patients.

Setting:

Health Service teaching hospital.

Patients:

Thirteen patients with venous ulceration for 2 years.

Interventions:

Patients were admitted to hospital for bed-rest and lower limb elevation for a period of 24 hours

Main outcome measures:

Limb volume was measured by water displacement and impedance plethysmography.

Results:

During limb elevation there was a mean reduction limb volume of 524 mls (95% CI 377–671 mls) after 24 hours of bedrest. This corresponded with a reduction in impedance measured by the impedance plethysmograph of 19–0 ohms (95% CI 24.3 to 15.6 ohms).

Conclusion:

Measurement of the lower limb volume by water displacement and by impedance plethysmography are likely to be useful methods in the investigation of Patients with chronic venous insufficiency.

Homozygous variegate porphyria: a compound heterozygote with novel mutations in the protoporphyrinogen oxidase gene

Homozygous variegate porphyria results from mutations in both alleles of the protoporphyrinogen oxidase (PPOX) gene. Our patient, a 36-year-old woman, has severe cutaneous manifestations. Her clinical and biochemical features are similar to the few other reported cases, including onset before 18 months of age, photosensitivity, absence of acute porphyric attacks, and elevated erythrocyte protoporphyrin. Mutation analysis of the PPOX gene revealed an in-frame 12 bp insert (c. 657-658 ins AAGGCCAGCGCC) encoding lysine-alanine-serine-alanine (KASA), and a G to A transition at the splice donor site of exon 11 (IVS 11-1 G-->A). Neither of these mutations has been reported previously. Our patient's mother has the splice site mutation and has had acute porphyric episodes. A maternal first cousin has the same mutation but no clinical manifestations. The medical and family history of our patient's father is uncertain.

Methylprednisolone pulses and urine electrolyte excretion

The mineralocorticoid activity of methylprednisolone pulses was assessed by measurement of urine electrolyte excretion prior to and during alternate day pulsing in patients with skin or joint disease. Two groups were studied: the first receiving pulses, but no other steroid; the second having taken oral prednisolone prior to and during pulsing. Urine sodium excretion in 24 hr urine specimens from both groups was suppressed, with no rebound between pulses, but a gradual "escape" occurred from the effects of continued pulsing. Four hour urine collections demonstrated suppression of urinary sodium excretion for up to 32 hr after pulsing with gradual recovery. The peak recovery in sodium excretion coincided with the subsequent pulse and was insufficient to compensate for the preceding sodium retention. Alternate day pulsing does not, therefore, reduce the risk of sodium retention from large doses of methylprednisolone.

Severe atypical molluscum contagiosum infection in an immunocompromised host

A case of severe molluscum contagiosum in a patient with treated thymoma is described. This unusual complication of immunosuppression is discussed and the literature on the subject reviewed.

Homozygous variegate porphyria: two similar cases in unrelated families

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