Treatment of non-healing leg ulcers with honeydew honey.

BACKGROUND: Honey is used as a traditional medicine for centuries by different cultures for the treatment of various disorders. However, not all honeys exhibit equal antimicrobial potency and only a few meet the criteria for clinical usage. AIM: The aim of the study was to determine clinical efficacy of sterilised honeydew honey in the treatment of the lower leg ulcers in 25 patients. Furthermore, we evaluated honey acceptability of patients in terms of pain and overall satisfaction. METHODOLOGY: A total of 25 patients with chronic venous leg ulcers were recruited into this study. The 100% γ-irradiated sterile honeydew honey was applied onto the cleaned wounds and each wound was assessed at the least two times in for a period of 6 weeks. RESULTS: During the course of treatment, the average wound area of all patients decreased significantly from 51 (3-150) to 22 (0-91) cm(2). Eighteen patients (72%) experienced a decrease in reported pain levels while five patients (20%) experienced the same level of pain throughout the study. The overall satisfaction with honey treatment was positive in 80% of patients. Only two patients experienced poor tolerance due to problems at ulcer site related to pain. CONCLUSION: Based on these findings, honeydew honey has the potential to be one of the medical-grade honeys.

Subcutaneous adipose tissue zinc-α2-glycoprotein is associated with adipose tissue and whole-body insulin sensitivity.

OBJECTIVE: To examine the regulatory aspects of zinc-α2-glycoprotein (ZAG) association with obesity-related insulin resistance. METHODS: ZAG mRNA and protein were analyzed in subcutaneous adipose tissue (AT) and circulation of lean, obese, prediabetic, and type 2 diabetic men; both subcutaneous and visceral AT were explored in lean and extremely obese. Clinical and ex vivo findings were corroborated by results of in vitro ZAG silencing experiment. RESULTS: Subcutaneous AT ZAG was reduced in obesity, with a trend to further decrease with prediabetes and type 2 diabetes. ZAG was 3.3-fold higher in subcutaneous than in visceral AT of lean individuals. All differences were lost in extreme obesity. Obesity-associated changes in AT were not paralleled by alterations of circulating ZAG. Subcutaneous AT ZAG correlated with adiposity, adipocyte hypertrophy, whole-body and AT insulin sensitivity, mitochondrial content, expression of GLUT4, PGC1α, and adiponectin. Subcutaneous AT ZAG and adipocyte size were the only predictors of insulin sensitivity, independent on age and BMI. Silencing ZAG resulted in reduced adiponectin, IRS1, GLUT4, and PGC1α gene expression in primary human adipocytes. CONCLUSIONS: ZAG in subcutaneous, but not in visceral AT, was markedly reduced in obesity. Clinical, cellular, and molecular evidence indicate that ZAG plays an important role in modulating whole-body and AT insulin sensitivity.

Acute mesenteric ischemia.

BACKGROUND/AIMS: Acute mesenteric ischemia (AMI) is a serious disease in old age with low incidence but with a very high mortality rate (60-70%). The etiology is either primary (embolism or thrombosis of mesenteric arteries or veins, non-occlusive mesenteric ischemia) or secondary (mechanical obstruction such as intestinal volvulus, intussusception, tumor-caused compression). Independent of the origin of the illness, the clinical-pathological picture is the same: intestinal ischemia with subsequent necrosis. The aim of this study was to ascertain which underlying conditions lead to increased probability of development of acute mesenteric ischemia. METHODS: Two hundred and fifteen patients with a primary form of AMI were treated in the years 1991-2007, in the 1st Clinic of Surgery in Brno, Czech Republic and in the Department of General Surgery, Derer's University Hospital in Bratislava, Slovak Republic; the results of the treatment have been statistically evaluated. CONCLUSION: The probability of arterial mesenteric ischemia development rises significantly (p < 0.05) in patients with a history of atrial fibrillation and/or myocardial infarction. This probability is also significantly higher in smokers with symptoms of hypertension and clinical signs of abdominal angina (p < 0.05).

Acute necrotizing pancreatitis: intra-abdominal vacuum sealing after necrosectomy.

BACKGROUND: Cases of acute pancreatitis with infected pancreatic necrosis warrant consideration of surgical interventions designed to achieve the goal of pancreatic debridement and drainage. Notable experience with the use of vacuum assisted closure for abdominal wall defects was an assumption for its peripancreatic application after debridement in septic patients with infected pancreatic necrosis confirmed by radiological evidence of gas or results of fine needle aspiration. The goal of this study was to evaluate our own experience with this new therapeutic technique. METHODS: This study is a multi-center retrospective analysis and comparison of 2 groups of patients with severe sepsis and a proven pancreatic source of infection. Group A consisted of 67 patients, 42 men and 25 women with ages ranging from 19-90 years (mean 48.0), who were treated surgically between 2002 and 2006 using a combination of laparostomy, multiple irrigations and abdominal drainage. Group B consisted of 39 patients, 28 men and 11 women aged from 18-87 years (mean 51.8), who were treated between 2002 and 2006 using the former techniques with the addition of an intra-abdominal vacuum assisted negative pressure therapy system. RESULTS: The number of repeat laparotomies with debridement of the open abdominal wound in general anesthesia in group A ranged from 5-18 over 10-33 days (median 21) of surgical treatment period. The number of repeat laparotomies in group B decreased to 3-9 and the surgical treatment period decreased to 9-29 days (median 16). Seventeen patients (25.4%) in group A died because of severe sepsis and multiple organ failure, compared to 7 patients (17.9%) in group B. CONCLUSION: Authors confirmed significant reduction of morbidity and mortality with the use of the intra-abdominal vacuum assisted system in the treatment of localized pancreatic source of sepsis.

Haemorrhoidectomy in outpatient practice.

OBJECTIVE: To evaluate our results of haemorrhoidectomy done as an outpatient procedure. DESIGN: Retrospective study. SETTING: University hospital Bratislava, Slovak Republic. SUBJECT: 256 patients who required haemorrhoidectomy in 1996-2001. INTERVENTIONS: Milligan-Morgan haemorrhoidectomy under local (0.5% lignocaine with adrenaline 1:200,000, 100 ml) or epidural (0.5 bupivacaine, marcain, 20 ml; or 1% lignocaine, 20 ml). MAIN OUTCOME MEASURES: Mortality, morbidity, need for admission to hospital, and acceptability to patients. RESULTS: No patient died. All patients were observed in the recovery room for 0.5-8 hours (mean 5 hours). 23 of the 256 patients (9%) developed minor complications including bleeding (n = 6), pain (n = 15), anal discharge (n = 1), and retention of urine (n = 1). 5 patients (2%) were admitted for pain or retention of urine. During the first 3 days after operation 29 patients required increased analgesia for discomfort. 223 patients (87%) were satisfied with outpatient treatment, while the remaining would have preferred to be admitted to hospital. CONCLUSION: Day case haemorrhoidectomy is a safe and effective way of reducing costs without increasing morbidity, mortality, and is acceptable to most patients.