ascorbic-acid and Contracture

Topics: Aging; Agranulocytosis; Anemia; Animals; Ascorbic Acid; Cicatrix; Collagen; Contracture; Drainage; Endothelium; Fibroblasts; Foreign Bodies; Granulation Tissue; Hematoma; Humans; Neutrophils; Protein Deficiency; Recurrence; Skin; Steroids; Stress, Mechanical; Surgical Procedures, Operative; Wound Healing; Wound Infection

Frozen shoulder is a common, painful, and movement-restricting condition. Although primary frozen shoulder is idiopathic, secondary frozen shoulder can occur after trauma or surgery. Prophylactic and therapeutic options are often unsatisfactory. Vitamin C (ascorbic acid) is a potent physiological antioxidant and likely inhibits the activation of nuclear factor κB, which plays a decisive role in inflammatory reactions.. Because of its anti-inflammatory effects, vitamin C may be valuable in the prevention of secondary frozen shoulder.. Controlled laboratory study.. An in vivo shoulder contracture model was conducted by fixation of the right proximal limb of Sprague-Dawley rats. A treatment group (n = 8) receiving vitamin C orally was compared with a control group (n = 9) without vitamin C. The primary outcome was capsular thickness at the shoulder joint measured on magnetic resonance imaging (MRI) examination. Further histological examination was performed but was not statistically analyzed because of variability of the cutting plane through the glenoid.. Vitamin C treatment resulted in less thickening of the axillary fold of the operated shoulder at 2 of the 3 locations measured on MRI compared with untreated controls (insertion to the glenoid,. Prophylactic vitamin C seemed to reduce the thickening of the axillary recess in secondary frozen shoulder in this preclinical study.. Vitamin C may be helpful as a noninvasive therapeutic measure to prevent secondary frozen shoulder (eg, within the context of surgery in the shoulder region or immobilization) or to treat primary frozen shoulder at an early stage. Further studies are required to evaluate the effect of this treatment in humans and the necessary dosage in humans.

Topics: Animals; Ascorbic Acid; Bursitis; Contracture; Humans; Models, Animal; Rats; Rats, Sprague-Dawley; Shoulder; Shoulder Joint

Dear Editor, Scurvy is a nutritional disorder which can develop after prolonged (>1-3 months) severe vitamin C deficiency. Vitamin C is a cofactor in several enzyme reactions involved in collagen synthesis. The defect in collagen causes blood vessel fragility, poor wound healing, mucocutaneous bleedings, hair abnormalities, bone pains, and joint contractures due to periosteal and intraarticular bleeding (1,2). Risk factors for scurvy development are undernutrition, low socioeconomic status, older age, male sex, alcoholism, tobacco smoking, and severe psychiatric illnesses (1-3). The required daily intake for vitamin C is ~60 mg, and this amount of vitamin C can be found in only one medium-sized orange. For this reason, the disease is rarely encountered in developed countries and is often underrecognized by healthcare personnel. Herein, we present an illustrative case of scurvy in order to raise the awareness of this disorder. A 61-year-old Caucasian man was admitted to hospital due to fatigue, hypotension (80/50 mmHg), severe normocytic anemia (hemoglobin 76 g/L), kidney failure (estimated glomerular filtration rate of 6 mL/min/1.73m2) and mild elevation in C-reactive protein (30.9 mg/L). Prior medical history included radical cystoprostatectomy with an ileal conduit performed eight years ago due to a bladder tumor and moderate chronic kidney disease with recurrent urinary tract infections. The patient was also an alcoholic and tobacco smoker, with a very low-income and a poor diet. He did not use any medications. Heteroanamnestically, the current clinical state had developed slowly over several weeks. At admission, the patient was afebrile, lethargic, malnourished, and immobile due to generalized weakness, bone pains, and hip and knee contractures. He had generalized edema, mostly related to kidney failure, as well as severe hypoalbuminemia (serum albumin 19 g/L). There were multiple ecchymoses (Figure 1, a) and perifollicular bleedings (Figure 1, b) in the skin. The teeth were defective, and the patient's facial hair had a "corkscrew" appearance (Figure 1, c). The platelet count was normal, as was the serum fibrinogen level and the prothrombin- and activated partial thromboplastin times. Vancomycin-resistant Enterococcus faecium and multi-drug-resistant Acinetobacter baumanii were isolated from the urine. Therefore, hemodialysis, linezolid, and colistin were started. However, the patient continued to be lethargic, immobile, and with prominent skin bleed

Topics: Anemia; Anticoagulants; Ascorbic Acid; Ascorbic Acid Deficiency; C-Reactive Protein; Colistin; Contracture; Fatigue; Fibrinogen; Humans; Linezolid; Male; Middle Aged; Prothrombin; Renal Insufficiency; Scurvy; Serum Albumin; Thromboplastin; Vancomycin; Vitamins

Wound contraction and scar contracture were studied in guinea pigs deficient (stage I) and nondeficient in vitamin C (stage II). Some vitamin C-deficient and some nondeficient animals were subjected to excision of an ellipse of skin measuring 40 X 20 mm in an area not containing panniculus carnosus. The wounds were approximated without undermining. In other animals, the same type of excision was carried out; however, the wounds were left unapproximated. Wound contraction was studied in the unapproximated group and scar contracture was studied in both groups for six months postoperatively. Scar contracture was found to be more significant in animals with unapproximated wounds who were on regular diets, implying a role for vitamin C in this process. Wound contraction was noted to take place in scorbutic and non-scorbutic groups at the same rate. These findings are in line with previous studies done in areas containing panniculus carnosus, implying that the role of this cutaneous muscle in contraction and contracture is not essential in either deficient or nondeficient states. Two animals also developed a remarkably thicker scar than their counterparts while in a deficient state. The relationship between vitamin C deficiency and the formation of hypertrophic scar in guinea pigs is postulated.

Topics: Animals; Ascorbic Acid; Ascorbic Acid Deficiency; Cicatrix; Contracture; Female; Guinea Pigs; Skin; Time Factors; Wound Healing

Topics: Adolescent; Ascorbic Acid; Bandages; Baths; Blood Transfusion; Burns; Child; Classification; Contracture; Debridement; Drug Therapy; Gluconates; Humans; Infant; Mortality; Penicillins; Potassium; Psychotherapy; Regeneration; Shock; Silver Nitrate; Skin; Skin Transplantation; Sodium Chloride; Streptomycin; Toxicology; Wound Infection