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Biomedical subjects

Finn Gottrup

Publications and source records attributed to Finn Gottrup.

At least 19 recordsLinked to original sources
PubMed2006

[Nutrition and pressure ulcers among old people].

In 2004 a Cochrane review was published with the objective of evaluating the effectiveness of nutritional support in the prevention and treatment of pressure ulcers. It was not possible for the reviewers to draw any definitive conclusions. A recent meta-analysis of five randomised controlled trials (four included in the Cochrane review), however, found a significantly lower incidence of pressure ulcer development in at-risk patients compared with those in routine care (OR 0.74; 95% CI 0.62-0.88). These results are still a matter of discussion. Both articles concluded that further research is needed.

Aged↗
PubMed2006

Combination of pre-operative radiotherapy and surgery suppresses local accumulation of collagen and TGF-beta1 in rats.

BACKGROUND: The systemic and local tissue repair responses of radiation in combination with surgery are still unclear. We have studied the effect of fractionated pre-operative radiotherapy with or without subsequent laparotomy on collagen accumulation using a rodent model. MATERIALS AND METHODS: Thirty-two male Sprague-Dawley rats were divided into four groups (eight rats per group): 1) sham radiation and sham laparotomy (control); 2) sham radiation and laparotomy; 3) radiation and sham laparotomy; and 4) radiation followed by laparotomy. Expanded polytetrafluoroethylene (ePTFE) tubes were implanted subcutaneously in the abdominal wall in the radiotherapy field and on the back outside the radiotherapy field day 0. The abdomen (3 cm x 4 cm) was irradiated day 3 (10 Gy) and again day 7 (10 Gy). On day 10, implants were extirpated, laparotomy undertaken in groups 2 and 4 and new ePTFE tubes implanted subcutaneously. The second implants were extirpated on day 20. Implants were analyzed for hydroxyproline, total protein and transforming growth factor-beta1 (TGF-beta1) levels. RESULTS: On day 10, hydroxyproline (P < 0.05) and TGF-beta1 (P < 0.001) were lower in ePTFE tubes in irradiated compared with non-irradiated rats. On day 20, the abdominal ePTFE hydroxyproline remained low (P < 0.001) in animals subjected to laparotomy and pre-operative irradiation while hydroxyproline levels of rats subjected to irradiation only were similar to controls. The effects of radiation on hydroxyproline were confined to the irradiated abdominal area. There was a positive correlation between hydroxyproline and TGF-beta1 levels in the abdominal wall implant day 20 (r = 0.53, P < 0.005). CONCLUSION: A clinically relevant fractionated radiation scheme reduced subcutaneous collagen accumulation pre-operatively and profoundly within the radiation field post-operatively after laparotomy, possibly because of lowered TGF-beta1 levels.

Animals↗
PubMed2005

The effect of preoperative radiotherapy on systemic collagen deposition and postoperative infective complications in rectal cancer patients.

PURPOSE: Preoperative, high-dose radiotherapy for rectal cancer reduces local recurrence rates and improves overall survival. However, adverse effects in varying degrees include impaired wound healing and local infection. This study investigates the influence of preoperative, high-dose radiotherapy on subcutaneous accumulation of collagen in a primary rectal cancer group operated on with or without adjuvant radiotherapy. METHODS: Forty-two eligible patients who underwent total mesorectal excision surgery with or without radiotherapy were included in the study. Polytetrafluoroethylene tubings were implanted in the arm ten days before surgery (three days before the start of radiotherapy). Implants were extracted the day before surgery. New implants were inserted before surgery and were extracted ten days after surgery. The hydroxyproline and proline contents of the implants were measured and the hydroxyproline/proline ratio was calculated as a measure for deposited collagen relative to protein. Blood loss, postoperative complications, and blood levels of hemoglobin, leukocytes, and albumin were recorded. RESULTS: The two groups were similar in relation to Dukes stage, age, and body mass index. Infectious complications developed in 39 percent of patients after radiotherapy compared with 16 percent in the nonirradiated group. In the irradiated patients with infective complications we found a significant decrease in the hydroxyproline/proline ratio compared with that of irradiated patients without infections (P = 0.037). There was a significant decrease in the leukocyte count preoperatively and postoperatively in the irradiated group compared with surgery alone. CONCLUSIONS: High-dose, short-term radiotherapy does not have a systemic effect on collagen accumulation, but a significant reduction is manifested in infected patients. Radiotherapy also impairs leukocyte production and increases the postoperative infective complication rate.

Aged↗
PubMed2005

Standardised method of surgical treatment of chronic leg ulcers.

Healing and recurrence rates were compared in leg ulcers of different aetiology in 385 patients with 406 chronic leg ulcers. Standard treatment was excision of the ulcer followed by meshed split-skin grafting and correction of superficial venous insufficiency in the area. The median age of the patients was 75 years (range 16-95). After one year 345 patients with 357 leg ulcers were alive. Overall healing rate was 64% (227 in 357 legs) after one year. The best results were achieved in traumatic ulcers (31 in 36 ulcers) and worst for the arterial ulcers (4 in 20 ulcers). Recurrence rate in venous and venous/ischaemic ulcers was 14% (33 in 235 legs) and 8% (n=3) in the traumatic ulcers. Vasculitic ulcers tend to recur 59% (n=10), but the graft does relieve pain.

Adolescent↗
PubMed2005

The silver-releasing foam dressing, Contreet Foam, promotes faster healing of critically colonised venous leg ulcers: a randomised, controlled trial.

The study compared the effect of a sustained silver-release foam dressing (Contreet Foam) with a foam dressing (Allevyn Hydrocellular) without added silver in critically colonised venous leg ulcers with delayed healing. The study was a multicentre, open, randomised, controlled study lasting for 4 weeks. Ulcer area and healing were assessed weekly. Odour, maceration, absorption capacity and leakage were evaluated at dressing changes. All adverse events were recorded. One hundred and twenty-nine patients were included (Contreet Foam: 65, Allevyn Hydrocellular: 64). The two groups were comparable in all respects. After 4 weeks, there was a significantly greater reduction in ulcer area in the Contreet Foam group (45%) than in the Allevyn Hydrocellular group (25%). After 1 and 4 weeks, odour was present in significantly less of the ulcers in the Contreet Foam group (17% and 19%, respectively) compared with the Allevyn Hydrocellular group (47% and 39%, respectively) and at the final visit there were significantly fewer leakages in the Contreet Foam group (19%) compared with the Allevyn Hydrocellular group (49%). Also, less maceration was observed after 1 and 4 weeks in the Contreet Foam group (34% and 37%, respectively) compared with the Allevyn Hydrocellular group (55% and 48%, respectively). The occurrence and cause of adverse events were equally distributed between the study groups. The present study provides evidence of the superior performance of the silver-releasing dressing, Contreet Foam, compared with a traditional moist foam wound healing dressing in the treatment of critically colonised, chronic venous leg ulcers. The results of this randomised, controlled study suggest an important role of sustained silver-releasing dressings in the treatment of critically colonised chronic wounds.

Adult↗
PubMed2005

Clinical quality indicators of venous leg ulcers: development, feasibility, and reliability.

In the clinical setting, diagnosis and treatment of venous leg ulcers can vary considerably from patient to patient. The first step to reducing this variation is to document venous leg ulcer care through use of quantitative scientific documentation principles. This requires the development of valid and reliable evidence-based quality indicators of venous leg ulcer care. A Scandinavian multidisciplinary, cross-sectional panel of wound healing experts developed clinical quality indicators on the basis of scientific evidence from the literature and subsequent group nominal consensus of the panel; an independent medical doctor tested the feasibility and reliability of these clinical indicators, assessing the quality of medical technical care on 100 consecutive venous leg ulcer patients. Main outcome measures were healing, recurrence, pain, venous disease diagnosis, differential diagnosis and treatment, and inter- and intra-rater reliability. The indicators proved feasible and reliable to measure (inter-rater kappa = 0.79, P < 0.01 and intra-rater kappa = 0.89, P < 0.1). Within 3 months of initial examination, venous etiology was verified by duplex in 61 of the 98 participating patients (62%) and 31 (32%) were assessed for venous surgery. Distal arterial pressure was measured following initial examination in 33 of the patients (34%). All patients (100%) were prescribed compression therapy. Of the 98 patients, 11 (11%) had ulcers recur in 3 months and 72 (73%) healed in 12 months, which is in line with the literature. It is feasible to reliably measure the quality of medical technical venous leg ulcer care in the clinical setting using a few strategic clinically relevant indicators of quality.

Aged↗
PubMed2004

Oxygen in wound healing and infection.

It is a fundamental clinical observation that wounds do not heal in tissue that does not bleed, and they almost always heal in tissue that bleeds extensively. Continuous supply of oxygen to the tissue through microcirculation is vital for the healing process and for resistance to infection. Evaluation of tissue perfusion and oxygenation is important in all types of wound patients. Monitoring systems should measure the hemodynamic situation and the ability of the cardiovascular system to deliver an adequate volume of oxygen to meet the metabolic demands of the peripheral tissue. Oxygen therapy is important in relation to both healing and resistance to infections. External factors have been shown to significantly decrease the peripheral oxygen supply, and supplementary perioperative oxygen to reduce the surgical wound infection rate by one- half in patients undergoing colorectal resection. Hyperbaric oxygen therapy may be beneficial in situations where the nutritive flow and oxygen supply to the healing tissue are compromised by local injury, and particularly if anaerobic infection is present. However, the definitive proof for the effect and indications of this therapy in wound healing still has to be established. It can be concluded that adequate delivery of oxygen to the wound tissue is vital for optimal healing and resistance to infection. Assessment of perfusion and oxygenation is essential for the wound patient, as well as the treating personnel. The indication for hyperbaric oxygen treatment still needs to be defined. During wound healing the continuity and function of the damaged tissue are re-established. This is only possible through a restoration of the microcirculation and thereby the nutrition to the tissue. The main component of the nutrition is oxygen, which is critically important for healing a wound by production of granulation tissue and for ensuring resistance against infection. This has been shown experimentally, but recently a short period of supplementary oxygen has been shown to decrease wound complications in clinical practice as well.

Female↗
PubMed2004

Effect of smoking and abstention on oxidative burst and reactivity of neutrophils and monocytes.

BACKGROUND: Smoking is associated with surgical wound infections, impaired wound healing, and tissue-destructive disorders. The mechanisms are largely unknown, but changes in the function and activity of inflammatory cells may be involved. METHODS: Seventy healthy volunteers (54 smokers and 16 never smokers) were included. The smokers were studied while they smoked and after 20 days of abstinence. After the first 10 days of abstinence, they were randomized to double-blind treatment with transdermal nicotine patch 25 mg per day or placebo. Venous blood neutrophils and monocytes were sampled and isolated. In 22 randomly selected smokers and in all never smokers, the oxidative burst and chemotaxis were determined by a chemiluminescence response assay and a modified Boyden chamber technique, respectively. Stimulants were opsonized zymosan, formyl-Met-Leu-Phe, and zymosan-activated serum. RESULTS: The neutrophil and monocyte oxidative burst was 50% and 68% lower, respectively, in smokers compared to never smokers (P < .05). Neutrophil chemotaxis was 93% higher in smokers (P < .05). Monocyte chemotaxis was lower in smokers compared to never smokers (P < .05). After 20 days of abstinence, neutrophil oxidative burst increased to the level of never smokers (P < .05); monocyte oxidative burst increased by 50% (P < .05). Chemotaxis was only marginally affected. The changes induced by abstinence were less pronounced in the transdermal nicotine patch group compared to the placebo group. CONCLUSIONS: Smoking attenuates the oxidative burst of inflammatory cells and increases chemotaxis. Three weeks of abstinence normalize the oxidative burst, but affect chemotaxis only marginally.

Administration, Cutaneous↗
PubMed2004

Surgical treatment of pressure ulcers.

Although a pressure ulcer is a potentially serious condition that always calls for treatment, only a small percentage of patients with pressure ulcers are candidates for surgery. The choice between conservative treatment and surgery for a pressure ulcer depends on a thorough evaluation of the ulcer, as well as the patient's physical and mental states. In general, superficial pressure ulcers (stages I and II) are likely to benefit from conservative treatment. Deep pressure ulcers (stages III and IV, often resulting from spinal cord injury) often require surgical intervention. The surgical techniques described in this essay include direct closure (which is rarely indicated), local and sensate flaps, and skin grafting. Skin transplantation and cutaneous and other thin flaps have more limited indications in pressure ulcer surgery. Thorough debridement before reconstruction, patient compliance, control of concomitant disease, professional postoperative support, and sufficient pressure relief are imperative for treatment success.

Debridement↗
PubMed2004

A specialized wound-healing center concept: importance of a multidisciplinary department structure and surgical treatment facilities in the treatment of chronic wounds.

The optimal way to improve prophylaxis and treatment of patients with problem wounds is to create an independent multidisciplinary wound-healing center that focuses on all types of problem wounds and has an outpatient clinic, as well as an inpatient ward. An integrated wound-healing department concept should be a standard in wound healing. A department structure containing both an outpatient clinic and inpatient ward, employing full-time personnel, allows the development of all features vital for optimal wound treatment. These are standardized treatment plans, access to relevant objective investigative methods and surgical approaches, a higher degree of continuity in treatment, increased patient satisfaction, greater potential for education and training, and improved possibilities for basic and clinical research in healing and care. The Copenhagen Wound Healing Center, Copenhagen, Denmark, and the University Center of Wound Healing, Odense, Denmark, are examples of this type of department. Initial results have demonstrated that these concept centers have resulted in improved rates of healing in patients with leg ulcers and have decreased the necessity for major amputations. The structure of the centers also offers greater opportunities for both basic and clinical research and provides expert education for all types of health care personnel. The centers were created in an attempt to establish an expert function in wound healing that would be fully integrated into the Danish national health care system. This model may, with individual modifications, be applicable for both industrialized and developing countries. In case it is impossible to realize the model in its entirety, alternative center concepts should be considered.

Chronic Disease↗