Novel insights into patient's thoughts about their body image in abdominal wall hernia.

BACKGROUND: Abdominal wall hernias (AWH) are frequently large and deforming. Despite this, little is known about how AWH impact upon body image. This study is the first study to qualitatively examine patients' subjective lived experiences of how AWH affects their body image. METHODS: Fifteen patients were interviewed from a purposive sample of AWH patients awaiting surgery until no new narrative themes emerged. Interviews explored patient thoughts and experiences of AWH and body image. Data were examined using interpretative phenomenological analysis (IPA). RESULTS: Two key themes pertaining to body image were identified: "Changes to perceptions of self" and "Fears concerning other's perceptions of them". Both themes were often interrelated and displayed detrimental effects AWH had on patients' body image. CONCLUSIONS: Our findings illustrate that AWH detrimentally affected patients' body image. This aspect of patient care can be treated and managed through better pre-operative information, including on body image as part of a holistic needs assessment (HNA), and ensuring the results are addressed in a patient care package. These development suggestions may positively affect the AWH patient's experience and outcomes in terms of Quality of Life (QoL) by preparing patients better for realistic results regarding what can be achieved in terms of form, function thus making a more holistic recovery from surgery.

Bath PUVA--an investigation of the distribution of trioxsalen (TMP) and 8-methoxypsoralen (8-MOP) in bathwater.

Trioxsalen (TMP) bath PUVA avoids the side effects of nausea and headache associated with oral 8-methoxypsoralen (8-MOP) treatment and allows shorter irradiation times that can be advantageous in some patients. However we noted that a number of patients developed unusual patterns of phototoxic burning. We thought that this was related to an uneven distribution of the TMP in the bathwater and for this reason, a study of bath water TMP concentrations achieved using different TMP preparations was undertaken. The distribution of 8-MOP in an 8-MOP bath was also measured for comparison. Our results confirm that an uneven distribution of TMP is achieved using TMP capsules or suspension and would explain our observed patterns of burning. With an ethanolic solution of TMP, or the commercial equivalent Tripsor, or with Puvasoralen-8 (an 8-MOP preparation), a homogeneous psoralen distribution is achieved, and they are therefore preferable for use in bath PUVA.

Radiation from ultraviolet phototherapy sources results in photodegradation of 12(R) and 12(S)-hydroxy-eicosatetraenoic acid: high-performance liquid chromatography and polymorph migration studies.

The effect of irradiation from Sylvania PUVA lamps (emitting predominantly in the ultraviolet (UVA) region) and broadband Philips TL-12 lamps (peaking in the UVB region) on two inflammatory mediators, 12(R)- and 12(S)-hydroxy-eicosatetraenoic acid (HETE) was studied. A high-performance liquid chromatography study showed significant photodegradation of both enantiomers at a concentration of 5 micrograms/ml in phosphate-buffered saline following irradiation with 10 J.cm-2 UVA or 0.375 J.cm-2 UVB. The in vitro chemokinetic microdroplet migration response of human peripheral polymorphonuclear leukocytes from normal and psoriatic subjects was significantly reduced following irradiation of 12(R)-HETE at a concentration of 1 micrograms/ml in medium with 40 J.cm-2 UVA and 1.5 J.cm-2 UVB respectively. No such effect was seen with 12(S)-HETE. The effect of ultraviolet on skin physiology, and in particular in the successful phototherapy of a range of inflammatory skin disorders, is not fully understood. The photodegradation of inflammatory mediators such as 12-HETE, as shown in this study, provides another factor of possible therapeutic significance.

A study of the photodegradation of leukotriene B4 by ultraviolet irradiation (UVB, UVA).

In view of the presence of the polymorphonuclear leukocyte (PMN) chemoattractant Leukotriene B4 (LTB4) in the surface scale of the psoriatic lesion and the known therapeutic effect of phototherapy in psoriasis, the photostability of LTB4 was investigated. LTB4 was irradiated with dosages of UVB (290-320 nm) ranging from 100-1500 mJ cm-2 and with dosages of UVA (320-400 nm) ranging from 5-40 J cm-2. Topical application of UVB irradiated LTB4 to the forearm skin of normal volunteers showed a marked reduction in cutaneous erythema, paralleled histologically by reduced transepidermal PMN migration when compared with sites of application of unirradiated and UVA irradiated LTB4. High performance liquid chromatography (HPLC) demonstrated a dose-dependent photodegradation of LTB4 by UVB irradiation. UVA irradiation produced no such effect. The wavelengths responsible lie within the absorption spectrum of LTB4. In vitro chemotaxis studies, using an under agarose technique, showed a statistically significant reduction in the migration of PMN from both psoriatic and non-psoriatic subjects to the UVB irradiated LTB4 compared with the unirradiated LTB4, whilst UVA irradiated LTB4 produced a normal PMN chemotactic response.

Polymorphonuclear leucocyte chemotaxis in response to leukotriene B4 in treated and untreated psoriatics.

Various chemoattractants have been implicated in the aetiology of the polymorphonuclear leucocyte (PMN) migration into the epidermis seen in early lesions of psoriasis. Using an under-agarose technique, the in vitro chemotactic responses of PMN to the arachidonic acid lipoxygenase product leukotriene B4 (LTB4) were assayed in five groups of subjects: normal healthy volunteers (n = 12), untreated psoriatics (n = 11) and psoriatics treated with topical tar (n = 12), PUVA (n = 11) and UVB phototherapy (n = 10). No significant difference was observed between the responses of control subjects and of untreated psoriatics, nor between the untreated psoriatic group and the PUVA- and UVB-treated groups, respectively. However, comparison of the tar-treated and untreated groups revealed a significantly increased chemotactic response to LTB4 in the tar-treated group (p less than 0.01).