State of the art in topical wound-healing products

Chronic wounds represent a significant medical burden. Such wounds fail to normally progress through the stages of healing, often complicated by a proinflammatory milieu caused by increased proteinases, hypoxia, and bacterial burden. As a result, several modalities, such as dressings, antimicrobials, growth factors, and human skin substitutes, have been devised in an attempt to correct the chronic wound environment. This review addresses these modalities with a focus on evidence and randomized controlled trials

THE SERUM PROTEINS IN PORTAL CIRRHOSIS UNDER MEDICAL MANAGEMENT. ELECTROPHORETIC STUDIES

Alterations in the composition of the serum proteins in hepatic disease have been studied by numerous workers using the electrophoretic method (1-11). The present investigation was undertaken to determine the changes in the serum proteins in portal cirrhosis by serial electropho-retic analyses during the course of prolonged medical management. METHODS Electrophoretic runs were performed with standard apparatus and technique, the experimental details having been given in an earlier report (11). The tests of he-patic function were performed by the usual methods as previously described (11), alkaline phosphatase being reported in Bodansky units. CASE MATERIAL The ten cases of the present study were all chronic alcoholics considered to have proven portal cirrhosis. The diagnosis was confirmed histologically by Vim-Silverman needle biopsy of the liver in seven of the ten cases, and in one patient (R. M. S.) also by autopsy. In one case (P. F.) the cirrhotic liver was visualized by peritoneoscopy and subsequently during an umbilical herniorrhaphy, but tissue for biopsy was not obtained. In two clinically typical cases (J. H. and C. R.), needle biopsy was attempted, yielding minute amounts of fibrous tissue considered insufficient for histologic diagnosis. The ten cases were divided into two groups. Group I. Five patients with hepatic insufficiency and ascites were studied with serial electrophoretic analyses of the serum proteins and various tests of hepatic func-tion during the course of medical management for periods ranging up to ten months. The initial electrophoretic analysis designated as "Day 04 " was carried out before or very early in the course of medical management. Although a few patients had re