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Biomedical subjects

D E Boyce

Publications and source records attributed to D E Boyce.

At least 19 recordsLinked to original sources
PubMed2004

Dorsal Dupuytren's disease causing a swan-neck deformity.

A previously undescribed lesion of Dupuytren's disease is presented. An oblique cord coursed parallel to the oblique retinacular ligament of Landsmeer, but inserted proximal to the proximal interphalangeal joint, tethering the central slip and radial lateral band across the intervening transverse retinacular ligament. Contraction of this cord caused a rigid swan-neck deformity. Excision of the cord resulted in complete resolution of the deformity and a full range of motion in the affected digit.

Dupuytren Contracture↗
PubMed2001

Inflammatory-cell subpopulations in keloid scars.

The aim of this study was to investigate the contribution of lymphocytes and macrophages to keloid scarring by morphologically characterising inflammatory cell subpopulations in keloid scars in comparison with normal skin. We took 3mm punch biopsies from the anterior forearms of eight normal healthy volunteers. Eight keloid scars were excised using an intralesional technique. All tissue was snap frozen in liquid nitrogen and serial sections were stained with a panel of anti-inflammatory cell monoclonal antibodies. The numbers of macrophages and lymphocytes and the proportions of the subpopulations were compared. Higher numbers of both macrophages and lymphocytes were found in keloid dermis (P=0.01 and P=0.02, respectively (Mann-Whitney U -test)). There was no significant increase in the expression of the lymphocyte-activation markers, CD25 and CD27. However, there was a significantly higher CD4(+):CD8(+)(Th:Ts) ratio (P= 0.046) in keloid tissue. This suggests that an imbalance in these inflammatory cell subpopulations may contribute to keloid scarring in man.

Adolescent↗
PubMed2000

The role of lymphocytes in human dermal wound healing.

BACKGROUND: Animal experimental data indicate a requirement for functionally active T lymphocytes to allow optimal healing of dermal wounds. Little evidence exists to confirm that this is the case in humans. Lymphocyte involvement in regulation of healing is probably mediated by release of secreted cytokines/growth factors, and we hypothesize that the cytokine profile requirement will be modulated as healing progresses. OBJECTIVES: As this is likely to be reflected in lymphocyte subset changes over the course of normal healing, we investigated the immunophenotype of lymphocyte subpopulations during wound healing. METHODS: Sequential biopsies were taken over 42 days from the margin of 12 wounds healing by secondary intention after pilonidal sinus excision. Serial biopsy sections were analysed by immunohistochemistry using lymphocyte-specific monoclonal antibodies, and lymphocytes were counted microscopically. RESULTS: Within 42 days, the mean decrease in wound volume was 87.5%. This was accompanied by significant changes in the wound margin lymphocyte population. Total numbers (mean +/- SEM) of T lymphocytes decreased from 36.8 +/- 9.8 cells per field at inclusion in the study to 25.9 +/- 3.0 immediately prior to wound closure, with a concomitant increase in B lymphocytes from 1 +/- 0.4 to 9.5 +/- 3.6 cells per field. The CD4/CD8 T-lymphocyte ratio fell from an initial level of 3.6 +/- 0.3 to 2.1 +/- 0.3 (mean +/- SEM) prior to closure. CONCLUSIONS: These data indicate that human wound-associated lymphocyte populations are modulated during healing; the increase in numbers of CD8+ T-suppressor lymphocytes is in accordance with previous animal data, indicating a role for these cells in downregulating healing as the wound closes. This study also documents an associated increase in B lymphocytes and healing of human wounds, with an as yet undefined role.

Antibodies, Monoclonal↗
PubMed2000

The use of ADCON-T/N glycosaminoglycan gel in the revision of tethered scars.

Recurrent subdermal scar tethering is a difficult management problem in areas of high tissue mobility. We describe a novel solution to this clinical problem, which involves instilling the anti-fibrotic gel ADCON-T/N in the plane between the skin and the underlying structures. We present our results in three difficult clinical situations where excellent results have been achieved using this method.

Adult↗
PubMed1998

Adult hernia surgery in Wales revisited: impact of the guidelines of The Royal College of Surgeons of England.

This study investigated the impact of the guidelines of The Royal College of Surgeons of England on the practice of hernia surgery in Wales. This was assessed by means of a postal survey to all consultant general surgeons in Wales in 1996-1997. The areas covered were: awareness of the guidelines of The Royal College of Surgeons of England and the impact of such guidelines on their practice, attendance at hernia courses, operative technique, materials used for repair and skin suture, proportion of day case hernias, length of inpatient stay, thromboembolic (TE) prophylaxis and postoperative advice to patients with regard to light work, heavy work and sport. In all, 79 replies were received (85%). Almost all the surgeons had read the guidelines; this changed the practice of 20% of respondents but did not in 32%. A further 48% did not answer the question. In contrast with our 1993 survey results, in Wales there is now a uniform surgical management of adult inguinal hernias: the most common operation is the Liechtenstein, with monofilament non-absorbable suture to secure the mesh, followed by the Shouldice repair. The Bassini and inguinal darn operations are becoming much less common and none now uses braided or absorbable sutures for the repair. Skin closure is still rather variable, with only 58% of respondents adhering to the recommended absorbable subcuticular suture. Postoperative advice is now uniform and in accordance with the guidelines. A trend towards more TE prophylaxis and more day case hernia surgery is also seen.

England↗
PubMed1997

Hyaluronic acid induces tumour necrosis factor-alpha production by human macrophages in vitro.

Foetal wounds heal with minimal or no scar formation. High levels of hyaluronic acid (HA) have been implicated as a contributory factor. Macrophages are essential for normal wound healing, a role facilitated by secretion of an array of cytokines. Of these, tumour necrosis factor alpha (TNF-alpha) has been shown to reduce wound collagen levels and thus scarring. This study examines the ability of HA to stimulate TNF-alpha production by human macrophages. The human U937 myelomonocytic cell line was differentiated into DU937 adherent macrophages. DU937 monolayers were exposed to HA at concentrations of 0.1, 1, 10 and 100 micrograms/ml. Conditioned media from HA-exposed monolayers were assayed for TNF-alpha activity using a standard L929 fibroblast bioassay. TNF-alpha activities of HA-exposed DU937 culture supernatants were compared to those of controls and expressed as % cytotoxicity. Exposure of macrophages to HA at concentrations of 10 micrograms/ml and 100 micrograms/ml significantly stimulated TNF-alpha production, as demonstrated by % cytotoxicities expressed as median (interquartile range) of 33.5 (29-34.5)% (P = 0.03) and 77.5 (67-85)% (P = 0.029) respectively (Mann-Whitney U test). This effect was specifically associated with TNF-alpha generated during HA exposure, as these cytotoxic effects could be abolished by addition of anti-TNF-alpha antibody, reducing cytotoxicity to 9 (6.5-13.5)% and 8.5 (6-12)% respectively. These observations indicate that HA stimulates TNF-alpha production by human macrophages. TNF-alpha is known to downregulate fibroblastic collagen synthesis within experimental wounds. We suggest that the high levels of HA within foetal wounds may play a part in limiting fibroplasia, and thereby limit scarring, via an upregulation of TNF-alpha production from wound macrophages.

Animals↗
PubMed1995

Aspects of hernia surgery in Wales.

The management of elective inguinal herniorrhaphy in Wales was assessed by means of a postal survey of consultant general surgeons. This included technique of repair, length of inpatient stay, follow-up, use of heparin thromboprophylaxis and advice regarding driving, strenuous activities and work. In all, 54 replies (77%) were received. The views of patients on their surgery was assessed by a questionnaire sent to 80 patients treated on a single surgical unit; 60 replies (75%) were received. Waiting times were relatively short among this group, 67.5% of patients being treated within 6 months of seeking medical advice; 16.25% suffered a complication. All wound infections occurred after discharge and 15% of patients had some groin discomfort 6 months after operation. Accuracy of clinical examination of 50 inguinal hernias by different grades of surgeon was assessed. Consultants were significantly more accurate when compared with house officers (P < 0.001). There is a wide range of repair techniques and postoperative advice practised by consultant general surgeons in Wales. Patients' main complaint was that of a sparsity of postoperative advice, although there also appears to be an appreciable postoperative morbidity. Clinical experience plays a significant role in assessment of the suitability of hernias for surgery.

Elective Surgical Procedures↗
PubMed1993

Wet cement: a poorly recognized cause of full-thickness skin burns.

Cement is a rare cause of full-thickness burns. We have examined the aetiology, frequency and severity of these burns, and assessed public awareness of the potential of cement as a caustic agent. Of patients, 95 per cent were unaware of the potential of cement to cause burns, and none had seen precautionary warnings on cement bags or delivery dockets. Factors important in burn production appear to be alkalinity, duration of contact and the abrasive nature of the cement particles. It is concluded that doctors, especially casualty officers, should know of the potential of progressive full-thickness burns from wet cement. General public awareness should be increased. The cement manufacturers were asked to comment on the content of this paper.

Adult↗