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Biomedical subjects

C N McCollum

Publications and source records attributed to C N McCollum.

At least 91 records · Page 5Linked to original sources

Venous ulcer fibroblasts compared with normal fibroblasts show differences in collagen but not fibronectin production under both normal and hypoxic conditions.

Previous immunocytochemical analysis showed that the base of venous ulcers was deficient in fibronectin compared with surrounding "normal" dermis. Here, we investigate whether impaired synthetic ability of ulcer fibroblasts could underlie this observation. Ulcer fibroblasts, established in culture from biopsies of the edge of chronic venous leg ulcers, were compared with normal fibroblasts grown from biopsies of site-and age-matched normal skin for their ability to synthesize matrix molecules. Collagen and fibronectin synthesis were measured following metabolic labeling, as collagenase susceptible counts and counts with gelatin affinity, respectively. More collagen was produced by normal fibroblasts than ulcer fibroblasts, both when the cells were cultured on plastic and in collagen gels. In fibronectin synthesis, however, there was no major difference between the two cell types on either substratum. The hypoxic environment to which ulcer fibroblasts are exposed may have caused the intrinsic differences in collagen synthesis by the two fibroblast types. When we tested the effect of culturing cells under hypoxic conditions, both cell types produced less collagen, especially normal fibroblasts grown in a collagen gel, but there was no effect of hypoxia on fibronectin synthesis. We conclude that venous ulcer edge-derived fibroblasts have an impaired ability to synthesize collagen in vitro, but synthesize fibronectin normally. Therefore, the low level of fibronectin found in venous ulcers is not likely to be due to the inability of ulcer cells to produce it or to the response to hypoxic conditions but may be due to the degradation of synthesized fibronectin by proteases present in these ulcers.

Cells, Cultured↗

Approaches to venous leg ulcer care within the community: compression, pinch skin grafts and simple venous surgery.

The traditional approach to leg ulcer care is both expensive and achieves poor outcomes. The outcome of treatment for patients with venous ulceration has been improved using a more scientific and research-based approach to patient assessment, adequate compression bandaging, use of other procedures such as pinch skin grafting and simple venous surgery, and the delivery of these innovations in patient care to the community as a whole. Multi-layer compression bandaging is superior to standard (one-layer) bandaging because it can easily be adapted to a wide range of ankle circumferences and leg sizes to provide sustained, graduated compression. Pinch skin grafting is cost-effective, accelerates healing, and, following adequate training, may be performed by specialist nurses in the community. Simple venous surgery may be offered under local anaesthesia when only the superficial veins are incompetent; however, deep venous surgery has yet to prove itself in clinical practice. Implementation of dedicated community leg ulcer clinics using these research-based findings will result in a substantially reduced prevalence of venous leg ulceration.

Ambulatory Care↗

Soluble P selectin in peripheral vascular disease: relationship to the location and extent of atherosclerotic disease and its risk factors.

Circulating levels of the adhesion molecule P-selectin (CD62P) are increased in the plasma of patients with atherosclerosis, but its relationship to the anatomical location of symptomatic disease or extent of symptomatic disease is unknown. The influence of the risk factors for atherosclerosis on soluble P-selectin is also unclear. To clarify these questions we analysed plasma samples from 170 patients with symptomatic peripheral vascular disease and 119 asymptomatic controls who were, as a group, age- and sex-matched. Soluble P-selectin (ELISA) was increased in 83 patients with symptomatic disease of the iliac and/or femoral arteries alone (P < 0.05, ANOVA) but not in 37 patients with symptomatic carotid artery disease alone compared with controls. Soluble P-selectin was equally raised in 120 patients with disease at one arterial site and in 50 patients with disease at two or more arterial sites (both P < 0.05) compared with controls. Smoking and atherosclerosis were both independent predictors of raised soluble P-selectin. We conclude that increased soluble P-selectin may have value as a marker of peripheral vascular disease of the iliac and/or femoral arteries in group comparisons only, as the poor discrimination and wide variation of data make comparisons at the individual level difficult.

Aged↗

How do general practitioners manage patients at risk from stroke?

This study assessed by means of a postal questionnaire how general practitioners (GPs) manage patients at risk from stroke. Of the 640 GPs sent a questionnaire, 294 (46%) replied. In patients with a recent transient ischaemic attack or minor ischaemic stroke, 24% of responding GPs would not arrange any investigations. Sixty-one per cent refer under half of their patients for further investigation, although 99% of GPs would commence aspirin. Seventy-seven per cent of GPs were aware of the benefits of carotid surgery. For patients in atrial fibrillation, most GPs (77%) thought that warfarin reduced stroke rates, but only 20% would consider commencing warfarin, although 26% would commence aspirin. In hypertensive patients, the GPs' threshold for treatment ranged from 135 to 200mmHg systolic (median 160mmHg), and from 90 to 110mmHg diastolic (median 100mmHg). Most GPs (84%) would treat isolated systolic hypertension with a median threshold of 180mmHg (range 140-240mmHg). The results of this study suggest that some patients at risk from stroke may not receive optimal investigation and treatment in the community.

Aged↗

The influence of contralateral carotid stenosis and occlusion on cerebral oxygen saturation during carotid artery surgery.

OBJECTIVES: To study the effect of contralateral carotid stenosis on oxygen saturation (CsO2) of both cerebral hemispheres monitored by reflective near-infrared spectroscopy (NIRS) during carotid surgery. METHODS: NIRS was compared to ipsilateral transcranial Doppler ultrasonography (TCD) of the middle cerebral artery and jugular bulb venous oxygen saturation (JvSO2) in 54 patients undergoing carotid endarterectomy. RESULTS: Median operated side and contralateral CsO2 were 68(54-88)% and 69(55-85)% before carotid clamping falling to 63(44-80)% and 69(55-84)% respectively on clamping the carotid (p < 0.0001 and p = NS). JvSO2 fell from 78(38-98)% to 72(30-97)% on carotid clamping with a percentage fall in peak TCD of -28(0 to -100)% (p < 0.0001). Patients with a contralateral carotid artery occlusion experienced falls in ipsi and contralateral CsO2 of -8(-4 to -10)% and -3(2 to -7)% compared to -4(0 to -14)% and 0(-5 to 4)% in those with a lesser stenosis (p < 0.05). On declamping, median ipsilateral and contralateral CsO2 rose from 65(46-82)% and 67(52-87)% to 68(53-84)% respectively (p < 0.0001 and p = NS). JvSO2 increased from 75(33-95)% to 79(42-95)% (p < 0.0001) with an increase in median peak TCD of 35(-34 to 506)%. CONCLUSIONS: The greatest changes in CsO2 occurred in the operated side cerebral hemispheres in those with a contralateral carotid artery occlusion. However, a contralateral carotid artery occlusion does not reliably predict the need for a shunt and cerebral monitoring remains essential; although is only required on the operated side.

Brain↗

Factors associated with healing leg ulceration with high compression.

To investigate factors relevant to the healing of leg ulceration by high compression, patients were interviewed using a standard questionnaire prior to treatment with a four-layer bandage high-compression system in six community ulcer clinics. We explored the relation of size, ulcer duration and medical history to healing. Cumulative healing rates were high using this method, being 69% after 12 weeks and 83% after 24 weeks. Twelve-week healing rates varied slightly between clinics, ranging from 62% to 83%. Univariate analysis of the total group showed that male sex (RR = 0.77, p = 0.023), poor limb joint mobility (RR = 0.39, p < 0.001), poor general mobility (RR = 0.49, p = 0.015), treatment at home (RR = 0.52, p < 0.001), ulcer size > 10 cm2 (RR = 0.37, p < 0.001), history of deep vein thrombosis (RR = 0.67, p = 0.016) and ulcer duration >6 months (RR = 0.35, p < 0.001) were significantly inversely associated with healing, Ulcer size, duration, limb joint mobility and general mobility were significant independent factors in multivariate analysis.

Adult↗

Venous ulcer healing: effect of socioeconomic factors in London.

OBJECTIVE: To determine which social and clinical factors are associated with healing in patients with venous ulceration. DESIGN: Patients were questioned about social factors at their first visit to a community ulcer clinic. They were treated by high compression bandage system and were interviewed again after 12 weeks. SETTING: Community leg ulcer clinics held in health centres throughout Riverside Health Authority in London. PATIENTS: All patients referred to five community leg ulcer clinics with venous ulceration over a six month period. MAIN OUTCOME MEASURES: These were factors significantly associated with healing within 12 weeks of beginning treatment, measured by odds ratio (OR) given by logistic regression analysis. MAIN RESULTS: Of 168 patients with venous ulceration, 87 (52%) healed after 12 weeks of treatment. Univariate analysis showed that low social class (OR = 3.44, 95% CI 1.17, 10.14), lack of central heating (OR = 2.22, 95% CI 1.18, 4.18), and being single (OR = 2.77, 95% CI 1.15, 6.69) were all significantly associated with delayed healing. After adjustment for the known risk factors of ulcer size, ulcer duration, and general mobility only lack of central heating was still significant (OR = 2.27, 95% CI 1.11, 4.55). The remaining factors failing to achieve statistical significance because of their inter-relationship with the known risk factors. CONCLUSIONS: Clinical features of the ulcer seem to determine the progress of healing in patients with leg ulceration. Although there were associations between socio-economic factors and poor healing, adjustment for clinical risk factors generally led to lower non-significant associations. Only lack of central heating retained its association and may play a part in prolonging healing of venous ulceration.

Aged↗

Leg ulcer odour detection identifies beta-haemolytic streptococcal infection.

beta-Haemolytic streptococci were identified in bacteriological cultures from 14 of 24 chronic venous leg ulcers in 21 patients. Multi-element odour detection (MEOD) analysis demonstrated a significant difference in odour in those ulcers from which beta-haemolytic streptococci were isolated (p < 0.01). MEOD has potential to detect pathogenic organisms instantaneously in the clinical setting.

Chronic Disease↗

Atherosclerosis risk factors: variation in healthy hospital workers and members of local communities asymptomatic for vascular disease. Implications for normal controls.

The major risk factors for atherosclerosis were measured in 100 middle-aged members of the local community aged between 40 and 66 attending hospital for minor operations, hernia repair, varicose veins or endoscopy, and their healthy accompanying spouses. Levels in this group were compared with those measured in 75 age- and sex-matched hospital workers. Ten of the 12 risk factors measured were more unfavourable in the local population (P = 0.039). Levels of total cholesterol (P = 0.0013), low-density lipoprotein (LDL) cholesterol (P = 0.0002) and body mass index (P = 0.0074) were higher in members of the local community. There was no difference in levels of triglycerides, high-density lipoprotein cholesterol, von Willebrand factor (vWf, an index of damage to the endothelial cell), fibrinogen, glucose, systolic and diastolic blood pressure, waist-to-hip ratio or the proportion of smokers. We also found systolic blood pressure (P = 0.014) and vWf (P = 0.021) to be higher, while high-density lipoprotein (P = 0.022) was lower in the 35 smokers, but we could not identify any factor that correlated with age. However, systolic (P = 0.028) and diastolic (P = 0.0072) blood pressures, triglycerides (P = 0.029) and waist-to-hip ratio (P < 0.0001) were all lower, while high-density lipoprotein was higher (P < 0.0001) in the 80 women compared to the men. We conclude that precise definition of the identity of the control group is necessary in studies of risk factors for atherosclerosis, or in frank disease, if mis-interpretation is to be avoided.

Aged↗

von Willebrand factor, soluble P-selectin, tissue plasminogen activator and plasminogen activator inhibitor in atherosclerosis.

Tissue plasminogen activator antigen (tPA), plasminogen activator inhibitor antigen (PAI-1), soluble P-selectin and von Willebrand factor antigen (vWf) were measured by ELISA in 41 patients with peripheral vascular disease (PVD), 41 with ischaemic heart disease (HD) and in 46 age and sex matched asymptomatic controls. Increased vWf was found in patients with IHD (p = 0.0002) and in patients with PVD (p = 0.0011) relative to the controls but levels did not differ between the two patients groups. Raised tPA found in both PVD (p = 0.0006) and IHD (p = 0.0061) compared to the controls also failed to differentiate the two groups of patients. Soluble P-selectin was also raised in both groups (p = 0.003 in IHD and p = 0.0102 in PVD) with no difference between the groups. There were no differences in levels of PAI-1 between the groups. In the subjects taken as a whole, there were significant Spearman's correlations between tPA and vWf (r = 0.37, p < 0.001), tPA and triglycerides (r = 0.38, p < 0.001), tPA and P-selectin (r = 0.19, p = 0.032), vWf and age (r = 0.25, p = 0.005) and inversely between vWf and HDL (r = -0.25, p = 0.006). These data support the concept that increased levels of tPA may be important in atherosclerosis, and indicate that soluble P-selectin may be useful in further analysis of the role of platelets and the endothelial cell in this disease.

Aged↗

Pressure sores.

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Humans↗