RESUMEN
Background: Gangrenous cholecystitis (GC) must be promptly treated for its high morbimortality. The object of our study is to identify clinical, laboratory or ultrasound factors that might us diagnose GC. Method: A Retrospective cohort study is devised including all patients admitted to Hospital de Laredo (Cantabria, Spain) between 2015 and 2017 with the diagnose of acute cholecystitis and having been operated. Patients were classified in two groups according to pathology: GC and non-GC. We compared their demographics characteristics, comorbidities, laboratory parameters and ultrasound findings. Results: A total of 115 patients were operated, of whom 32 had CG and 83 CNG. Neutrophil-to-lymphocyte ratio and C-reactive protein (CRP) showed significantly increased levels in GC group (p = 0.042) and CRP (p < 0.0001). To CRP showed an area under the ROC curve of 0.872 (95% confidence interval: 0.797-0.946). Acalculous cholecystitis was significantly associated to GC (24.1 vs. 7%; p < 0.005). In the multivariate analysis only the CPR showed as a predictive factor. A cutting point of CRP at 15.25 mg/dl, that had high sensibility (90.6%) and high negative predictive value (95%). Conclusion: CRP helped identify patients with CG to indicate early surgical intervention.
Antecedentes: La colecistitis aguda gangrenosa (CG) debe tratarse precozmente por su alto riesgo de morbimortalidad. Objetivo: Identificar factores clínicos, analíticos o ecográficos que permitan diagnosticar CG preoperatoriamente. Método: Estudio de cohorte retrospectiva en el Hospital de Laredo (Cantabria, España), entre 2015 y 2017, de pacientes con diagnóstico de colecistitis aguda que hayan sido intervenidos. Se clasificó a los pacientes en dos grupos según el diagnóstico anatomopatológico: CG y colecistitis no gangrenosa (CNG). Se compararon las características demográficas, la comorbilidad, los datos analíticos y los datos ecográficos. Resultados: Fueron operados 115 pacientes, de los cuales 32 tenían CG y 83 tenían CNG. Los pacientes con CG muestran unos valores más altos de índice de neutrófilos/linfocitos (p = 0.042) y de proteína C reactiva (PCR) (p < 0.0001). La colecistitis alitiásica se asoció con mas frecuencia a la CG (24.1 vs. 7.0%; p < 0.005). En el estudio multivariable, solo la PCR se muestra significativa. La PCR mostró un área bajo la curva ROC de 0.872, (intervalo de confianza del 95%: 0.797-0.946). Un punto de corte de PCR de 15.25 mg/dl tuvo una alta sensibilidad (90.6%) y un alto valor predictivo negativo (95%). Conclusión: La PCR ayuda a identificar a los pacientes con CG para indicar una intervención quirúrgica precoz.
Asunto(s)
Proteína C-Reactiva/análisis , Colecistitis Aguda/diagnóstico , Vesícula Biliar/patología , Colecistitis Alitiásica/complicaciones , Anciano , Área Bajo la Curva , Biomarcadores/análisis , Colecistitis Aguda/sangre , Colecistitis Aguda/patología , Colecistitis Aguda/cirugía , Intervalos de Confianza , Femenino , Gangrena/sangre , Gangrena/diagnóstico , Gangrena/cirugía , Humanos , Recuento de Leucocitos , Masculino , Análisis Multivariante , Estudios Retrospectivos , Sensibilidad y Especificidad , UltrasonografíaRESUMEN
The cytokine blood profile in patients with complicated erysipelas was investigated. It was found that in patients with complications of erysipelas (gangrene, phlegmon, abscess, thrombophlebitis of the subcutaneous veins of the shin) levels of pro-inflammatory cytokines IL-1ß, TNF-α, IL-2, IL-6 in serum significantly increase and level of anti-inflammatory cytokine IL-4 increases slightly, as well as was found a significant increase in coefficients reflecting the ratio of pro-inflammatory and anti-inflammatory cytokines, which indicates the prevalence in the blood of examined patients with complications of erysipelas an anti-inflammatory properties. A more significant increase in pro-inflammatory cytokines serum levels is typical for patients with destructive forms of erysipelas - phlegmonous and gangrenous, a slight increase - for patients without purulent-necrotic component of complication (thrombophlebitis of the subcutaneous veins of the shin). In the future we plan to study pharmacological correction of shifts in cytokine blood profile with drugs with immunomodulating properties in patients with complicated erysipelas.
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Absceso/sangre , Celulitis (Flemón)/sangre , Erisipela/sangre , Gangrena/sangre , Tromboflebitis/sangre , Absceso/complicaciones , Absceso/tratamiento farmacológico , Absceso/inmunología , Adulto , Antibacterianos/uso terapéutico , Antiinflamatorios/uso terapéutico , Biomarcadores/sangre , Celulitis (Flemón)/complicaciones , Celulitis (Flemón)/tratamiento farmacológico , Celulitis (Flemón)/inmunología , Erisipela/complicaciones , Erisipela/tratamiento farmacológico , Erisipela/inmunología , Femenino , Gangrena/complicaciones , Gangrena/tratamiento farmacológico , Gangrena/inmunología , Humanos , Interleucina-1beta/sangre , Interleucina-1beta/inmunología , Interleucina-2/sangre , Interleucina-2/inmunología , Interleucina-4/sangre , Interleucina-4/inmunología , Interleucina-6/sangre , Interleucina-6/inmunología , Masculino , Persona de Mediana Edad , Tromboflebitis/complicaciones , Tromboflebitis/tratamiento farmacológico , Tromboflebitis/inmunología , Factor de Necrosis Tumoral alfa/sangre , Factor de Necrosis Tumoral alfa/inmunologíaRESUMEN
No disponible
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Humanos , Diabetes Mellitus/sangre , Pie Diabético/metabolismo , Salud Pública/legislación & jurisprudencia , Amputación Quirúrgica/métodos , Necrosis/enzimología , Gangrena/sangre , Angiopatías Diabéticas/patología , Pie Diabético/patología , Diabetes Mellitus/metabolismo , Salud Pública/métodos , Amputación Quirúrgica/clasificación , Necrosis/patología , Gangrena/metabolismo , Angiopatías Diabéticas/metabolismoRESUMEN
PURPOSE: Our aim was to establish the role of hyperbilirubinemia as a predictive parameter for the prediction of either acute, or gangrenous/perforated appendicitis as well as to compare other parameters in a similar role. METHODS: Medical files of the patients who underwent appendectomies between September 2013 and September 2014 were evaluated. Age, gender, preoperative white blood cell count (WBC), neutrophil count (NEU), neutrophil percentage (NEU%), C-reactive protein (CRP), total/direct/indirect bilirubin levels, and the postoperative histopathological findings were recorded. The Fisher's exact, Pearson's χ (2), ANOVA, and Kruskal-Wallis tests while logistic regression for multivariate analysis was performed. p < 0.05 was accepted as statistically significant. RESULTS: The study group of 162 patients consisted of 97 (60 %) men and 65 (40 %) women with a median age of 36 (18-90). Histopathological examinations revealed normal appendix in 21 (13 %) patients, non-complicated acute appendicitis in 100 (62 %), and appendiceal gangrene/perforation in 41 (25 %) patients. WBC, NEU, NEU%, and CRP levels were significantly higher in cases of acute and gangrenous/perforated appendicitis (p < 0.01). Total and direct bilirubin levels were also significantly elevated in patients with acute and gangrenous/perforated appendicitis (p < 0.01). According to multivariate analysis, elevated CRP levels were associated with 14 times, elevated total bilirubin levels were associated with five times, and elevated direct bilirubin levels were associated with 36 times greater risk for appendiceal gangrene/perforation (p < 0.01, p < 0.05, p < 0.01, respectively). CONCLUSIONS: Hyperbilirubinemia, especially with elevated direct bilirubin levels, may be considered as an important marker for the prediction of appendiceal gangrene/perforation.
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Apendicitis/complicaciones , Apendicitis/diagnóstico , Bilirrubina/sangre , Hiperbilirrubinemia/complicaciones , Hiperbilirrubinemia/diagnóstico , Enfermedad Aguda , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Apendicectomía , Apendicitis/sangre , Apéndice/lesiones , Apéndice/metabolismo , Biomarcadores/sangre , Proteína C-Reactiva/metabolismo , Femenino , Gangrena/sangre , Gangrena/complicaciones , Gangrena/diagnóstico , Humanos , Hiperbilirrubinemia/sangre , Recuento de Leucocitos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Estudios Retrospectivos , Adulto JovenRESUMEN
INTRODUCTION: Acute gangrenous appendicitis (AGA) is a common medical condition; however, the grade of appendicitis usually cannot be established preoperatively. We have attempted to identify some indicators, such as the mean platelet volume (MPV) and the platelet distribution width (PDW), to diagnose AGA. Aims. To evaluate whether or not the MPV and PDW are suitable markers to diagnose AGA. METHODS: A retrospective study of 160 patients with AGA and 160 healthy patients was undertaken. Disease diagnosis was confirmed based on the pathologic examination of surgical specimens. Patient white blood cell (WBC) count, neutrophil ratio (NR), platelet (PLT) count, MPV, PDW, and hematocrit (HCT) were analyzed. Receiver operating characteristic (ROC) curves were used to evaluate the sensitivity and specificity of these indices in AGA. Results. There were no significant differences between the AGA and control groups in age and gender. Compared to the control group, the WBC count, NR, and PDW were significantly higher (P < 0.001, resp.) and the MPV and HCT were significantly lower (P < 0.001, resp.) in the AGA group. The diagnostic specificities of the WBC count, NR, PLT count, MPV, PDW, and HCT were 86.3%, 92.5%, 58.1%, 81.7%, 83.9%, and 66.3%, respectively. Therefore, the NR had the highest diagnostic specificity for the diagnosis of AGA. CONCLUSIONS: This is the first study to assess the MPV and PDW in patients with AGA. Our present study showed that the MPV is reduced and the PDW is increased in patients with AGA; the sensitivity of PDW was superior to the MPV. A decreased MPV value and an increased PDW could serve as two markers to diagnose AGA. The NR had the highest specificity for the diagnosis of AGA.
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Apendicitis/sangre , Volúmen Plaquetario Medio , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Apendicitis/patología , Biomarcadores/sangre , Estudios de Casos y Controles , Femenino , Gangrena/sangre , Hematócrito , Humanos , Recuento de Leucocitos , Masculino , Persona de Mediana EdadRESUMEN
No disponible
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Adulto , Humanos , Masculino , Síndromes Paraneoplásicos/metabolismo , Síndromes Paraneoplásicos/patología , Gangrena/sangre , Gangrena/patología , Angiografía/métodos , Biopsia con Aguja Fina/instrumentación , Síndromes Paraneoplásicos/complicaciones , Síndromes Paraneoplásicos/diagnóstico , Gangrena/complicaciones , Gangrena/genética , Angiografía/normas , Biopsia con Aguja Fina/métodos , Informes de CasosRESUMEN
No disponible
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Humanos , Masculino , Divertículo Ileal/mortalidad , Divertículo Ileal/patología , Anomalía Torsional/complicaciones , Anomalía Torsional/metabolismo , Gangrena/sangre , Gangrena/metabolismo , Leucocitos/citología , Leucocitos/patología , Tomografía/instrumentación , Divertículo Ileal/complicaciones , Divertículo Ileal/genética , Anomalía Torsional/genética , Anomalía Torsional/terapia , Gangrena/patología , Gangrena/psicología , Leucocitos/metabolismo , Leucocitos , TomografíaRESUMEN
A total of 50 does were used to determine selected hematological and biochemical parameters with special references to oxidative stress markers, acute phase protein profiles, and proinflammatory cytokines in healthy and gangrenous mastitis affected does. Animals were divided into two equal groups represented as clinically healthy (control) and diseased groups, respectively. The bacteriological examination of milk samples from diseased does revealed many types of bacterial infection. The isolated bacteria were Staphylococcus aureus (N=23/25), Escherichia coli (N=11/25), and Clostridium perfringens (N=4/25). There was a significant increase in the levels of ß-hydroxybutyrate, non-esterified free fatty acids, triglyceride, low density lipoprotein cholesterol (LDL-C), aspartate aminotransferase, and alanine aminotransferase and a significant reduction in the levels of glucose, cholesterol, and high density lipoprotein cholesterol (HDL-C) in does with gangrenous mastitis compared to healthy does. Moreover, there was a significant increase in the levels of malondialdehyde and uric acid with a significant decrease in the levels of reduced glutathione, super oxide dismutase, and catalase in does with gangrenous mastitis compared to healthy does. In addition, there was a significant increase in the haptoglobin, serum amyloid A, fibrinogen, interleukin 6 (IL-6), IL-1ß, and tumor necrosis factor-α (TNF-α) in does with gangrenous mastitis compared to healthy ones. Conclusively, oxidative stress biomarkers, acute phase proteins, and proinflammatory cytokines play an essential task as biomarkers for gangrenous mastitis in does. Mastitis may be considered as one of the ketotic stressors in does after parturition.
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Gangrena/veterinaria , Enfermedades de las Cabras/inmunología , Mastitis/veterinaria , Estrés Oxidativo/fisiología , Ácido 3-Hidroxibutírico/sangre , Proteínas de Fase Aguda/metabolismo , Animales , Estudios de Casos y Controles , Catalasa/sangre , Citocinas/sangre , Ácidos Grasos no Esterificados/sangre , Femenino , Gangrena/sangre , Gangrena/inmunología , Gangrena/microbiología , Glutatión/sangre , Enfermedades de las Cabras/sangre , Enfermedades de las Cabras/microbiología , Cabras , Malondialdehído/sangre , Mastitis/sangre , Mastitis/inmunología , Mastitis/microbiología , Estrés Oxidativo/inmunología , Superóxido Dismutasa/sangre , Ácido Úrico/sangreRESUMEN
OBJECTIVE: The purpose of our study was to determine, first, if gallbladder wall striations in patients with sonographic findings suspicious for acute cholecystitis are associated with gangrenous changes and certain histologic features; and, second, if WBC count or other sonographic findings are associated with gangrenous cholecystitis. MATERIALS AND METHODS: Sixty-eight patients who underwent cholecystectomies within 48 hours of sonography comprised the study group. Sonograms and reports were reviewed for wall thickness, striations, Murphy sign, pericholecystic fluid, wall irregularity, intraluminal membranes, and luminal short-axis diameter. Medical records were reviewed for WBC count and pathology reports for the diagnosis. Histologic specimens were reviewed for pathologic changes. Statistical analyses tested for associations between nongangrenous and gangrenous cholecystitis and sonographic findings and for associations between wall striations and histologic features. RESULTS: Ten patients had gangrenous cholecystitis and 57, nongangrenous cholecystitis. One had cholesterolosis. Thirty patients had wall striations: 60% had gangrenous and 42% nongangrenous cholecystitis. There was no association with the pathology diagnosis (p = 0.32). There was no association between any histologic feature and wall striations (p ≥ 0.19). A Murphy sign was reported in 70% of patients with gangrenous cholecystitis and in 82% with nongangrenous cholecystitis; there was no association with the pathology diagnosis (p = 0.39). Wall thickness and WBC count were greater in patients with gangrenous cholecystitis than in those with nongangrenous cholecystitis (p ≤ 0.04). CONCLUSION: Gallbladder wall thickening and increased WBC counts were associated with gangrenous cholecystitis; however, there was considerable overlap between the two groups. Wall striations and a negative Murphy sign were not associated with gangrenous cholecystitis.
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Colecistitis Aguda/sangre , Colecistitis Aguda/diagnóstico por imagen , Gangrena/sangre , Gangrena/diagnóstico por imagen , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Colecistectomía , Colecistitis Aguda/cirugía , Femenino , Gangrena/cirugía , Humanos , Recuento de Leucocitos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Estudios Prospectivos , Estadísticas no Paramétricas , UltrasonografíaRESUMEN
The purpose of this study was to clarify the clinical features most closely associated with gangrenous appendicitis. From among 314 patients who had undergone open appendectomy in our collected database, 222 for whom sufficient data were evaluable were enrolled. The results of univariate analysis revealed that age (≤40/>40 years), sex (female/male), fever (≤37°/>37°C), the serum levels of C-reactive protein and albumin, the Glasgow prognostic score (0, 1/2), and the neutrophil-to-lymphocyte ratio (NLR) (≤8/>8) were associated with gangrenous appendicitis. Among these 7 clinical features, multivariate analysis disclosed that age (≤40/>40 years) (odds ratio, 3.435; 95% confidence interval 1.744-6.766; P < 0.001) and NLR (≤8/>8) (odds ratio, 3.016; 95% confidence interval 1.535-5.926; P = 0.001) were associated with gangrenous appendicitis. The sensitivity and specificity of these two clinical features were 65% and 27%, and 73% and 39%, respectively. NLR (>8) shows a significant association with gangrenous appendicitis in patients undergoing appendectomy.
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Apendicectomía , Apendicitis/patología , Linfocitos/metabolismo , Neutrófilos/metabolismo , Enfermedad Aguda , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Apendicitis/sangre , Apendicitis/cirugía , Biomarcadores/sangre , Niño , Femenino , Gangrena/sangre , Humanos , Modelos Logísticos , Recuento de Linfocitos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Estudios Retrospectivos , Sensibilidad y Especificidad , Índice de Severidad de la Enfermedad , Adulto JovenRESUMEN
Peripheral gangrene is rare in children. Protein C, protein S, and antithrombin deficiency, positivity for anticardiolipin antibodies or lupus anticoagulant and factor V Leiden mutation are important causes of thrombosis in the venous system. There is paucity of literature on the contribution of these factors in children with peripheral gangrene. We evaluated the role of aforementioned factors in children with peripheral gangrene. Protein S deficiency was seen in one case and another was transiently positive for lupus anticoagulant. None of the 11 age- and sex-matched normal controls had protein C, protein S, or antithrombin deficiency. Our results indicate that deficiency of protein C, protein S, and antithrombin, and positivity for anticardiolipin antibodies, lupus anticoagulant, and factor V Leiden are uncommon causes of peripheral gangrene in children in north-western India. Fibrinolytic and antiplatelet parameters were not tested. Testing for these may yield further clues to the etiology of this condition.
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Gangrena/sangre , Deficiencia de Proteína S/sangre , Adolescente , Anticuerpos Anticardiolipina/sangre , Deficiencia de Antitrombina III/sangre , Deficiencia de Antitrombina III/genética , Niño , Preescolar , Factor V/genética , Factor V/metabolismo , Femenino , Gangrena/genética , Humanos , Lactante , Inhibidor de Coagulación del Lupus/sangre , Masculino , Mutación , Proteína C/genética , Proteína C/metabolismo , Proteína S/genética , Proteína S/metabolismo , Deficiencia de Proteína S/genética , Estudios RetrospectivosRESUMEN
BACKGROUND: Increasing circumstantial evidence suggests that not all patients with appendicitis will progress to perforation and that appendicitis that resolves may be a common event. Based on this theory and on indications of aberrant regulation of inflammation in gangrenous appendicitis, we hypothesized that phlegmonous and gangrenous appendicitis are different entities with divergent immunoregulation. METHODS: Blood samples were collected from patients with gangrenous appendicitis (n = 16), phlegmonous appendicitis (n = 21), and nonspecific abdominal pain (n = 42). Using multiplex bead arrays, we analyzed a range of inflammatory markers, such as interleukin (IL)-1ra, IL-1rbeta, IL-2, IL-6, IL-10, IL-12p70, IL-15, and IL-17; interferon-gamma; tumor necrosis factor; CXCL8; CCL2; CCL3; and matrix metalloproteinase (MMP)-1 MMP-2, MMP-3, MMP-7, MMP-8, MMP-9, MMP-12, and MMP-13 in blood. RESULTS: Compared with patients with phlegmonous appendicitis and nonspecific abdominal pain, the patients with gangrenous appendicitis had increased levels of the proinflammatory markers IL-6, CCL2, IL-17, MMP-8, and MMP-9 (P < or = .04 each) accompanied by increased levels of the anti-inflammatory cytokines IL-1ra and IL-10 (P < or = .02). Patients with phlegmonous appendicitis had increased levels of IL-10 only. CONCLUSION: The finding of a pattern of inflammatory markers compatible with the highly inflammatory Th17 subset in sera from patients with gangrenous appendicitis, but not in phlegmonous appendicitis, supports the hypothesis that gangrenous and phlegmonous appendicitis are different entities with divergent immune regulation. Additional studies of the differential immunopathogenesis of phlegmonous and gangrenous appendicitis are warranted, as this may have important implications in the diagnosis and management of patients with suspicion of appendicitis.
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Apendicitis/sangre , Apendicitis/patología , Interleucina-17/sangre , Dolor Abdominal/sangre , Dolor Abdominal/etiología , Dolor Abdominal/patología , Adolescente , Adulto , Apendicitis/inmunología , Estudios de Casos y Controles , Quimiocinas/sangre , Femenino , Gangrena/sangre , Gangrena/inmunología , Gangrena/patología , Humanos , Interferón gamma/sangre , Masculino , Metaloproteinasas de la Matriz/sangre , Persona de Mediana Edad , Supuración/sangre , Supuración/inmunología , Supuración/patología , Factor de Necrosis Tumoral alfa/sangre , Adulto JovenRESUMEN
The treatment of diabetic patients with pyonecrotic lesions in the lower extremities requires prolonged reflexo-segmental balneophysiotherapy to normalize functions of the nerve centres. Curative volcanic mud solutions (15-24 g/l) enriched with organic and nonorganic biologically active compounds from volcanic deposits in Azerbaijan were used for the first time to treat such patients. Peloids were applied to the lumbar region (location of sympathetic nerve nodes) and the lower legs above and beneath the affected sites. The patients were subjected to 12-15 seances of peloidotherapy (at 40-41 degrees Celsius) each lasting 20-30 minutes. The treatment was preceded by wound sanation using the standard procedure and a course of antibiotic therapy based on individual antibiotocograms. A total of 86 daibetic patients with leg gangrene underwent rheovasographic thermovision examination that revealed enhanced blood supply to the affected extremities under the action of the applied peloids. Peloidotherapy resulted in the normalization of blood and urine glucose levels in 53 (63%) of the patients. Simultaneously, the doses of medicamentous therapy could be lowered. Wound and ulcer healing was completed in the majority of the patients (86%) by the end of balneophysiotherapy when fresh granulation tissue began to develop and signs of oedema to disappear. These patients no longer needed amputation.
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Glucemia/análisis , Complicaciones de la Diabetes , Gangrena , Glucosuria/orina , Peloterapia , Antibacterianos/administración & dosificación , Glucemia/metabolismo , Complicaciones de la Diabetes/sangre , Complicaciones de la Diabetes/patología , Complicaciones de la Diabetes/terapia , Complicaciones de la Diabetes/orina , Femenino , Gangrena/sangre , Gangrena/patología , Gangrena/terapia , Gangrena/orina , Glucosa/metabolismo , Glucosuria/sangre , Glucosuria/patología , Glucosuria/terapia , Calor , Humanos , Extremidad Inferior/patología , Masculino , Cicatrización de HeridasRESUMEN
Today a high degree of "false" appendicitis diagnoses are occurring. In this study, a screening experiment of biomarkers of two different kinds of appendicitis, gangrenous and phlegmonous, were conducted with CE and CEC coupled to MS. Plasma samples were obtained from patients pre- and post-surgery. A large amount of data was generated to be able to compare them, and chemometrics tools were utilized to visualize the differences. Indicative patterns were found for both pre- and post-surgery of the two types of inflammation as well as between them. The divergences were traced back to the MS peaks obtained in the CE- and CEC-MS setups as possible biomarkers for the two forms of appendicitis.
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Apendicitis/sangre , Apendicitis/clasificación , Electrocromatografía Capilar/métodos , Celulitis (Flemón)/sangre , Electroforesis Capilar/métodos , Gangrena/sangre , Adulto , Anciano , Anciano de 80 o más Años , Apendicectomía , Apendicitis/complicaciones , Apendicitis/cirugía , Biomarcadores/sangre , Electrocromatografía Capilar/instrumentación , Celulitis (Flemón)/complicaciones , Electroforesis Capilar/instrumentación , Femenino , Gangrena/complicaciones , Humanos , Masculino , Espectrometría de Masas/métodos , Persona de Mediana Edad , Plasma/químicaRESUMEN
The aim of the present study was to evaluate blood rheological disorders, in particular RBC enhanced aggregation, and compare changes in these parameters in patients with type 1 and 2 diabetes mellitus. For evaluation of RBC aggregability in the present study we applied the "Georgian technique", which was developed and applied for several years in our laboratory. Its advantage is that it is a direct and quantitative method. In all the investigated patients, diabetes mellitus was complicated with the foot gangrenes. The patients were divided into two groups: (a) with type 1 and (b) with type 2 diabetes mellitus. We matched the RBC aggregability indices in both groups of diabetic patients and compared the obtained results with those in the healthy control group. We found that rheological disorders were considerably pronounced. The RBC aggregability index increased by 62 percent (p < 0.001) in type 1 and by 57 percent (p < 0.001) in type 2 diabetic patients as compared to the control group. However, there were insignificant differences of the RBC aggregability changes between the two groups of patients. Therefore we conclude that blood rheological disorders are similar in both types of diabetes mellitus. The disturbed blood fluidity related to the increased RBC aggregability in the microcirculation promotes, in particular, the development of legs gangrene in both types of diabetes mellitus.
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Complicaciones de la Diabetes/sangre , Agregación Eritrocitaria/fisiología , Gangrena/sangre , Adulto , Trastornos de la Coagulación Sanguínea/sangre , Viscosidad Sanguínea , Diabetes Mellitus Tipo 1/complicaciones , Diabetes Mellitus Tipo 2/complicaciones , Hemorreología , Humanos , Hiperglucemia/sangre , Microcirculación/patología , Persona de Mediana EdadRESUMEN
AIM: The aim of this study was to study the inflammatory response to open revascularization of an ischemic leg in terms of activation of white blood cells (WBC), platelets and endothelial cells. DESIGN: prospective study. METHODS: Venous samples from 21 patients suffering critical limb ischemia (CLI) were drawn before, and 4 weeks after (20 patients) revascularization. Total WBC, differentiated WBC, and platelets were counted. Expression of CD11b/CD18 on granulocytes and monocytes and CD41 on platelets was measured by flow cytometry. Soluble endothelial markers (sICAM-1, sVCAM-1, sE-selectin and sP-selectin) were analysed with ELISA. RESULTS: WBC and granulocyte count decreased in the subgroup of patients with ulcer and gangrene but no change in activation of WBC was recorded. The endothelial marker sICAM-1 decreased while VCAM-1 increased following surgery, most evident in the subgroup with ulcers and gangrene. CONCLUSIONS: This study shows that revascularization of CLI does not significantly influence the inflammatory response in patients with rest pain only, but a limited response of down regulation was found in the ulcer/gangrene patients probably as an effect of healing ulcers.
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Células Endoteliales , Isquemia/cirugía , Pierna/irrigación sanguínea , Leucocitos , Procedimientos Quirúrgicos Vasculares , Anciano , Anciano de 80 o más Años , Biomarcadores/sangre , Plaquetas/metabolismo , Antígenos CD11/biosíntesis , Antígenos CD18/biosíntesis , Selectina E/sangre , Células Endoteliales/metabolismo , Ensayo de Inmunoadsorción Enzimática , Femenino , Citometría de Flujo , Estudios de Seguimiento , Gangrena/sangre , Gangrena/cirugía , Humanos , Molécula 1 de Adhesión Intercelular/sangre , Isquemia/sangre , Pierna/patología , Recuento de Leucocitos , Leucocitos/metabolismo , Masculino , Persona de Mediana Edad , Selectina-P/sangre , Dolor/sangre , Dolor/cirugía , Activación Plaquetaria , Glicoproteína IIb de Membrana Plaquetaria/biosíntesis , Descanso , Úlcera Cutánea/sangre , Úlcera Cutánea/cirugía , Resultado del Tratamiento , Molécula 1 de Adhesión Celular Vascular/sangreRESUMEN
Heparin use, both prophylactically and therapeutically, is prevalent among hospitalized patients. Patients on heparin may develop a thrombocytopenia that is self-limited. Fewer patients develop a heparin-induced thrombocytopenia that can cause severe bleeding and thrombosis owing to intravascular platelet aggregation. The authors present a case report of heparin-induced thrombocytopenia in a patient who underwent aortic arch and aortic valve replacement that resulted in bilateral above-knee amputations. The patient developed limb ischemia related to heparin-associated thrombosis, but had a delay in antibody seroconversion. Early and accurate diagnosis of heparin-induced thrombocytopenia requires a high clinical suspicion and may be present despite the absence of serum antibodies.
Asunto(s)
Amputación Quirúrgica , Anticoagulantes/efectos adversos , Gangrena/etiología , Heparina/efectos adversos , Isquemia/etiología , Extremidad Inferior/irrigación sanguínea , Trombocitopenia/etiología , Trombosis/etiología , Anciano , Anticuerpos/sangre , Gangrena/sangre , Gangrena/cirugía , Heparina/inmunología , Humanos , Isquemia/sangre , Isquemia/cirugía , Rodilla/cirugía , Extremidad Inferior/cirugía , Masculino , Trombocitopenia/sangre , Trombosis/sangre , Trombosis/cirugíaRESUMEN
Our aim was to see the levels of lipoprotein (a) (Lp (a)) in patients with gangrenous or non-gangrenous diabetic foot lesions. Twenty-two patients with gangrenous foot lesions, 11 with non-gangrenous foot lesions and 10 healthy subjects were included in the study. All the patients had similar glycemic control and duration of diabetes. The main outcome measure was serum Lp (a) levels in both group of patients with diabetes and healthy subjects. Diabetic patients with gangrenous foot lesions had significantly higher Lp (a) levels (83.8+/-8.3 mg/dl) than the patients with non-gangrenous foot lesions (38.3+/-5.8 mg/dl) and healthy subjects (35.6+/-4.2 mg/dl). Lp (a) levels were not significantly different in healthy subjects and in patients with non-gangrenous foot lesions. Lp (a) levels may have a pathogenetic role in the development of gangrenous foot lesions in patients with diabetes mellitus.