Comparison Between Numeric Parameters From Acute and Chronic Venous Leg Ulcers: Identification of Potential Objective Nonhealing Parameters.

BACKGROUND: Some authors claim that the clinical methods often employed to assess chronic venous leg ulcers (CVLU) are based on subjective interpretation. The treatments based on a subjective characterization could become a trial-and-error therapy, resulting in longer evolutions and high recurrence rates. PURPOSE: The aim of this work was to compare numeric parameters from acute and chronic venous leg ulcers to identify potential objective nonhealing parameters. METHODS: The study was performed with hospital outpatients from 2016 to 2019. Cohorts were established according to the ulcer evolution time. Data collected related to ulcer characteristics included exudate pH, lactate and glucose concentrations, temperatures, microbiology findings, and imaging study results. RESULTS: Approximately 83% of the examined ulcers were chronic. Seventy-one percent of CVLUs and 59% of the acute ulcers had a pH ≥8. A high variability was found for the concentration of glucose and lactate in exudates of both acute and chronic ulcers. Variations of temperatures of normal skin (ΔT1) and periulcer zone (ΔT2) in reference to the wound bed temperature with values above 1 could indicate the presence of an inflammatory process and be used as a new potential marker of inflammation. All the acute ulcers and 88% of CVLUs showed <80% of granulation tissue in the imaging study. Finally, more than 105 organisms per gram of tissuewere found in 100% of the analyzed samples. CONCLUSIONS: Whereas there were not significant differences among the clinical measured parameters between acute and chronic ulcers, further research on the use of objective measurable parameters is needed to establish cutoff points to differentiate the "chronic state" of an ulcer as a "nonhealing state" regardless of the evolution time. Also, the use of these easily obtainable and low-cost nonhealing parameters would be a new approach to accurately monitor this pathology.

How much myocardial revascularization can we do without extracorporeal circulation?

OBJECTIVE: The main goal of this study is to present a technical alternative that allows myocardial revascularization to be performed on the marginal branches of the circumflex coronary artery without the use of extracorporeal circulation (ECC). METHODS: The technique for exposing the coronary vessels is performed by placing a stitch in the posterior pericardium. The surgeon lifts the heart using his or her left hand with the aim of exposing the posterior pericardium. A single polypropylene "O" stitch on a #4 needle is threaded into a cardiac ribbon folded back on itself and run twice through the region between the inferior pulmonary vein and the inferior vena cava. The suture thread is run along a tourniquet-type rubber tube and the latter is then directed down to the pericardium, bringing the cardiac ribbon with it. Handling the thread by means of such a tourniquet and the two parts of the ribbon makes it possible to maneuver the heart into different positions in order to expose the coronary arteries: anterior interventricular, diagonal, circumflex, and right coronary. In the present study, the position exposing the coronary arteries was adopted. The circumflex artery was exposed by separating the two legs of the ribbon and pulling one of them +/- 90 degrees to the right and the other +/- 90 degrees to the left of the patient's main axis, with the polypropylene thread being pulled in the direction of the patient's main axis and fixed in the inferior angle of the surgical wound. RESULTS: From August 1981 to June 1999, 609 patients had their arteries revascularized without the use of ECC. Among this group, 147 patients (24.14%) had the circumflex artery revascularized. Of the 609 patients, 48 (7.88%) presented serious complications and 21 (3.44%) died. CONCLUSIONS: It was possible to modify the anatomical position of the heart by exposing the circumflex artery with its marginal obtuse branches and performing anastomosis in a simple manner with no loss of quality or hemodynamic involvement, permitting a complete revascularization without the aid of extracorporeal circulation.

Correlaçäo cirúrgica da coarctaçäo da aorta através da " istmoplastia sem enxerto "- experiência inicial / Surgical correlaction of coarctation of the aorta by an \" isthmusplatic operation without graft \" early results

O presente trabalho tem como objetivo apresentar nossa experiência com a "istmoplastia sem enxerto". No período compreendido entre 01.08.91 e 13.07.92, seis pacientes portadores de coarctaçäo de aorta foram operados por esta técnica. A idade variou de três meses a seis anos (média= 24 meses) e o peso de 2.800grs a 19.600grs (média = 9.000grs.)Quatro pacientes possuíam uma coarctaçäo anular e os outros dois segmentar. A aorta bem liberada, e a regiäo coarctada incisada longitudinalmente sendo entÝo suturada transversalmente sem a utilizaçäo de material protético. Näo evidenciamos gradientes e a anastomose apresentou um excelente aspecto cirúrgico. Um paciente foi a óbito e os demais apresentaram boa evoluçäo pós-operatória, com a normalizaçäo dos pulsos nos membros inferiores. O ecocardiograma foi realizado em todos pacientes e apenas um tinha um gradiente de 10mm/Hg. Os autores discutem a técnica, suas indicaçöes, compara com as demais técnicas e considera este procedimento a operaçäo de escolha para tratamento da coarctaçäo levando-se em consideraçäo o completo alívio da área coarctada sem a utilizaçäo de enxerto e a näo mobilizaçäo ou ligadura da artéria subclávia