Cost and mortality data of a regional limb salvage and hyperbaric medicine program for Wagner Grade 3 or 4 diabetic foot ulcers.

We obtained costs and mortality data in two retrospective cohorts totaling 159 patients who have diabetes mellitus and onset of a diabetic foot ulcer (DFU). Data were collected from 2005 to 2013, with a follow-up period through September 30, 2014. A total of 106 patients entered an evidence-based limb salvage protocol (LSP) for Wagner Grade 3 or 4 (WG3/4) DFU and intention-to-treat adjunctive hyperbaric oxygen (HBO2) therapy. A second cohort of 53 patients had a primary lower extremity amputation (LEA), either below the knee (BKA) or above the knee (AKA) and were not part of the LSP. Ninety-six of 106 patients completed the LSP/HBO2with an average cost of USD $33,100. Eighty-eight of 96 patients (91.7%) who completed the LSP/HBO2had intact lower extremities at one year. Thirty-four of the 96 patients (35.4%) died during the follow-up period. Costs for a historical cohort of 53 patients having a primary major LEA range from USD $66,300 to USD $73,000. Twenty-five of the 53 patients (47.2%) died. The difference in cost of care and mortality between an LSP with adjunctive HBO2therapy vs. primary LEA is staggering. We conclude that an aggressive limb salvage program that includes HBO2 therapy is cost-effective.

Diagnostic indices of zinc deficiency in children with renal diseases.

Abnormal taste acuity and zinc depletion have been reported with endstage renal disease. In order to determine when altered taste and zinc deficiency begin in the course of chronic progressive renal disease and to assess the various indices of zinc depletion, 14 pediatric patients were studied who were in various degrees of renal failure. They were not yet on dialysis or in need of transplantation. Taste acuity was abnormal in all patients. The mean plasma zinc levels were less than normal, but the differences were not statistically significant. The hair and RBC zinc concentrations, however, were significantly depressed. Analysis of the data indicate that zinc deficiency begins early in the course of chronic renal failure, that hair and RBC zinc measurements are the most reliable indicators of zinc status, and that poor intake of zinc containing foods is the major cause of the zinc depletion.

Zinc supplementation in chronic renal failure.

Zinc deficiency, abnormal taste acuity and decreased caloric intake begin early in children and adolescents with chronic progressive renal disease. This may contribute to their poor growth. We studied the effect of zinc supplementation, using a double blind crossover design, on 14 pediatric patients in chronic renal failure, but not yet on dialysis or in need of a transplant. Zinc supplementation increased red blood cell zinc concentrations and taste acuity. In those with less advanced renal failure (serum creatinine less than 5.0 mg/dl) it also improved caloric intake. No changes in growth velocity were seen, however, during the six months of zinc supplementation.

A simplified method of obtaining umbilical cord blood for pH using a heparinized vacutainer versus heparinized syringe.

Two experimental methods for collecting cord blood for acid-base analysis using green top vacutainer tubes were compared with a standard method using heparinized syringes. Paired samples from 30 newborn infants were collected using one of the vacutainer methods and the standard heparinized syringe method. No significant differences in pH, pCO2, base deficit, or pO2 were noted when comparing the two vacutainer methods with the standard syringe method. Both vacutainer methods were substantially easier to use than the heparinized syringe method. A green top vacutainer may be used to obtain an accurate cord blood sample for assessment of an infant's acid-base status at birth, and to aid the neonatologist as an indicator of intrapartum asphyxia.