Is ultrasound guidance necessary to avoid complications in the implantation of venous access ports?

BACKGROUND: The aim of this study was to present demographic information of patients undergoing totally implantable venous access port (TIVAP) implantation and to investigate the rates of early and late complications, assessing the benefits of performing the procedure underUS guidance. METHODS: From May 2018 to December 2023, the outcomes of a total of 537 TIVAP implantation procedures were analyzed retrospectively. Data of the surgeons' experiences for both puncture methods (anatomical landmarks and ultrasound guidance) are presented in the study. RESULTS: The average age of the patients was 53.1±11.9 years, and 261 (48.6%) were female. The right subclavian vein was the preferred insertion site. Fourteen patients developed early complications and 11 developed late complications. Arterial puncture was the most common early complication, while catheter-related infection was the most common late complication. The age, sex, and body mass index of the patients were not independent risk factors for developing complications. Early complications increased as the number of puncture attempts did (p=0.034) and developed significantly less when ultrasound guidance was used during insertion (p=0.011). CONCLUSION: The risk of developing complications was not affected by patient's age or sex. In addition, body mass index was not shown to be an independent risk factor for patients developing complications. It may be concluded from the study that early complications in particular can be reduced with ultrasound-guided implantation.

Endovascular and surgical management of splenic artery aneurysms.

BACKGROUND: Although true splenic artery aneurysms (SAA) are rare, due to advancements in imaging techniques, they are seen more frequently. The aim of this study is to present our strategy of managing patients with SAA. METHODS: Retrospectively, 13 patients who were treated in a tertiary university care center between 2012 and 2020 were included. Their demographic, clinical information, and post-operative complications were analyzed. RESULTS: Seven male and six female patients were evaluated between the ages of 27 and 73. The mean age was 49.8±13.2. The diameter of the aneurysm was between 17 and 80 mm with a mean range of 31.5±16 mm. Seven patients were treated with endovascular interventions (EV). Two patients were referred to surgery with failed attempt of EV, but patients refused surgery and were followed up consequently. Patients who had larger aneurysms with an increased risk of rupture underwent aneurysmectomy and splenectomy. Conservative management was decided on two patients initially: A patient who was previously operated on for a sigmoid colon tumor, and had an aneurysm size of 15 mm and another patient with a surgical history of thoracic aortic dissection with an aneurysm size of 18 mm. One patient who underwent surgery had post-operative pancreatic fistula and was treated with percutaneous drainage. The treatment of the remaining 12 patients was completed without any further complications. CONCLUSION: Splenic artery aneurysm treatment should be individualized. Endovascular treatment can be considered for patients with stable aneurysms larger than 2 cm in the elective setting. Open surgical treatment should be considered in patients with ruptured SAA or hemodynamically unstable, complicated patients.

Is the increased ozone dosage key factor for its anti-inflammatory effect in an experimental model of mesenteric ischemia?

BACKGROUND: Ischemia/reperfusion injury of the intestines is a severe surgical condition. This study aimed to reveal ozone therapy effects with relatively increased ozone dosage in a created ischemia/reperfusion injury model. METHODS: In this study, 24 albino Wistar rats were examined in three groups. Rats in the control group (CG, n=8) underwent only a laparotomy. In the sham group (SG, n=8) and ozone group (OG, n=8), the superior mesenteric artery (SMA) of the rats was occluded for 1 h. After deoccluding the SMA, the abdomen was closed, physiological saline was infused intraperitoneally in the SG, and an increased ozone/oxygen mixture dose (from 0.7 mg/kg to 1 mg/kg) was infused intraperitoneally in the OG. Small intestine samples were obtained at the 24th h for histopathological examination of intestinal mucosal injury and evaluated according to the Chiu score. In addition, Malondialdehyde and Myeloperoxidase levels were evaluated for oxidant levels, whereas, Glutathione (GSH) enzyme activity was measured to evaluate the tissue antioxidant system. RESULTS: Histopathologically, the Chiu score was the lowest in the CG. It was lower in the OG compared to the SG showing the ameliorating effect of ozone on the intestinal mucosa. Chiu score in the OG was higher compared to that in the CG, but not statistically significant. A significantly higher GSH level was observed in the OG compared to the SG, proving antioxidant activity. CONCLUSION: In this experimental model of ischemia/reperfusion in rats, treatment with an increased ozone level decreased the inflammatory process through antioxidant mechanisms and reduced intestinal mucosal damage. However, the effectiveness of ozone therapy depends on its dosages.

Hybrid Nanoplatforms Comprising Organic Nanocompartments Encapsulating Inorganic Nanoparticles for Enhanced Drug Delivery and Bioimaging Applications.

Organic and inorganic nanoparticles (NPs) have attracted significant attention due to their unique physico-chemical properties, which have paved the way for their application in numerous fields including diagnostics and therapy. Recently, hybrid nanomaterials consisting of organic nanocompartments (e.g., liposomes, micelles, poly (lactic-co-glycolic acid) NPs, dendrimers, or chitosan NPs) encapsulating inorganic NPs (quantum dots, or NPs made of gold, silver, silica, or magnetic materials) have been researched for usage in vivo as drug-delivery or theranostic agents. These classes of hybrid multi-particulate systems can enable or facilitate the use of inorganic NPs in biomedical applications. Notably, integration of inorganic NPs within organic nanocompartments results in improved NP stability, enhanced bioavailability, and reduced systemic toxicity. Moreover, these hybrid nanomaterials allow synergistic interactions between organic and inorganic NPs, leading to further improvements in therapeutic efficacy. Furthermore, these platforms can also serve as multifunctional agents capable of advanced bioimaging and targeted delivery of therapeutic agents, with great potential for clinical applications. By considering these advancements in the field of nanomedicine, this review aims to provide an overview of recent developments in the use of hybrid nanoparticulate systems that consist of organic nanocompartments encapsulating inorganic NPs for applications in drug delivery, bioimaging, and theranostics.

A rare cause of intestinal obstruction in children: signet-ring cell adenocarcinoma of the colon.

BACKGROUND: Signet-ring cell adenocarcinoma of the colon is well-recognized in adult patients who are extremely rare and not well-documented in children. Our study aims to raise awareness about this rare disease and its long-term outcomes. METHODS: We retrospectively evaluated patients with signet-ring cell colon adenocarcinoma. RESULTS: Six patients, three boys and three girls, with a mean age of 14.83 (range, 13-17 years), presented with signs of intesti-nal obstruction and were diagnosed with signet-ring cell colon adenocarcinoma. All patients had air-fluid levels on abdominal X-ray. Abdominal ultrasonography of all patients revealed subileus. Abdominal computed tomography was performed in five patients, and pre-operative colonoscopy was conducted in two patients before the emergency intervention. All of the patients underwent emergent exploratory laparotomy with the preliminary diagnosis of acute abdomen. In two patients, debulking surgery followed by a stoma was performed. The remaining four patients were treated with anastomosis following intestinal resection. All girls had metastases on the ovary. One of the patients died due to the burden of multiple metastases in the early period, and three died in the sixth post-operative year. We have been following the remaining two patients since then. CONCLUSION: Although signet-ring cell carcinomas (SRCCs) are rare, they should be considered in the differential diagnosis of acute abdomen and intestinal obstruction in pediatric patients. Despite early diagnosis and treatment, SRCC has a poor prognosis in the pediatric population.

Endoscopic pilonidal sinus treatment (EPSIT) versus sinus laser therapy (SiLaT) for sacrococcygeal pilonidal sinus.

Introduction: New surgical treatment methods are being investigated in sacrococcygeal pilonidal sinus disease. Minimal invasive methods such as endoscopic pilonidal sinus treatment (EPSIT) and sinus laser therapy (SiLaT) have promising results and advantages of laparoscopic surgery. Aim: To compare the efficiency and safety of EPSIT with SiLaT. Material and methods: Seventy-three patients with pilonidal sinus who had undergone EPSIT or SiLaT within 2 years were evaluated retrospectively. Data of patients' demographics, complications and postoperative course were collected and compared between the two groups. Results: We analyzed seventy-three patients who underwent EPSIT or SiLaT, with a mean age of 23.4 ±8.4 (12-46) years and body mass index (BMI) of 25.5 ±4.5 (18-38) kg/m2. Among them, 36 patients (26 males, ten females) underwent EPSIT and 37 patients (27 males, ten females) underwent SiLaT. Mean operative time was similar for both groups (32.3 ±14.8 vs. 31.0 ±14.8; p = 0.757). Early complications (minimal bleeding) were recorded in 2 patients in the SiLaT group. The duration of analgesic use was significantly lower in the EPSIT group compared to the SiLaT group (1.3 ±0.5 (1-3) vs. 1.9 ±1.1 (1-5); p = 0.005). The mean postoperative time of total wound healing was similar for both groups: 23.6 ±14.7 (12-90) vs. 25.2 ±14.5 (14-90) days (p = 0.385). There was no significant difference in the average time of return to total daily activity (3.4 ±0.9 (2-5) vs. 3.6 ±1.2 (2-7) days, p = 0.679). There were no significant differences between the groups regarding late postoperative complications (recurrence: 7). Conclusions: Both methods have similar early and late complications. The duration of need for analgesic usage was shorter in EPSIT patients.

Comparison of hyperbaric oxygen and ozone treatment for ischemia/re-perfusion injury in an experimental testicular torsion model.

BACKGROUND: This study aims to compare the effects of medical ozone (MO) therapy and hyperbaric oxygen (HBO) therapy in an experimental testicular torsion model by measuring the oxidant and antioxidant markers and examining the histopathological tissue damage findings. METHODS: Thirty-two Wistar rats are used and are divided into four groups; (1) sham group (SG), (2) only ischemia/reperfusion (I/R) by testicular torsion, (3) HBO administered group, and (4) MO administered group. No torsion was conducted in the SG. In all other groups, rats underwent testicular torsion followed by detorsion to create an I/R model. After I/R, HBO was injected in the HBO group, and in the MO group, intraperitoneal ozone was applied. At the end of 1 week, testicular tissues were obtained for biochemical analyzes and histopathological examinations. Biochemically, malondialdehyde (MDA) levels were measured for oxidant activity, and superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) levels were measured for antioxidant activity. Furthermore, the testicles were evaluated histopathologically. RESULTS: Both HBO and MO have significantly decreased MDA levels, compared with sham and I/R groups, resulting in decreased oxidation effects. The antioxidant GSH-Px levels in the HBO and MO groups were significantly higher than in the sham and I/R groups. In addition, the antioxidant SOD levels in the HBO group were significantly higher than sham, I/R, and MO groups. Therefore, the antioxidant effect of HBO was observed to be superior to MO, specifically considering SOD levels. Histopathologically, there was no significant difference between the groups (p>0.05). CONCLUSION: The study may extrapolate that both HBO and MO are antioxidant agents that can be used in testicular torsion. HBO treatment might improve the cellular antioxidant capacity due to increased antioxidant marker levels more than MO therapy. However, further studies are needed with a larger sample size.

Next-generation sequencing of prolidase gene identifies novel and common variants associated with low prolidase in coronary artery ectasia.

BACKGROUND: Decreased collagen biosynthesis and increased collagenolysis can cause ectasia progression in the arterial walls. Prolidase is a key enzyme in collagen synthesis; a decrease in prolidase activity or level may decrease collagen biosynthesis, which may contribute to ectasia formation. Considering that, the variations in PEPD gene encoding prolidase enzyme were evaluated by analyzing next-generation sequencing (NGS) for the first time together with known risk factors in coronary artery ectasia (CAE) patients. METHODS: Molecular analysis of the PEPD gene was performed on genomic DNA by NGS in 76 CAE patients and 76 controls. The serum levels of prolidase were measured by the sandwich-ELISA technique. RESULTS: Serum prolidase levels were significantly lower in CAE group compared to control group, and it was significantly lower in males than females in both groups (p < 0.001). On the other hand, elevated prolidase levels were observed in CAE patients in the presence of diabetes (p < 0.001), hypertension (p < 0.05) and hyperlipidemia (p < 0.05). Logistic regression analysis demonstrated that the low prolidase level (p < 0.001), hypertension (p < 0.02) and hyperlipidemia (p < 0.012) were significantly associated with increased CAE risk. We identified four missense mutations in the PEPD gene, namely G296S, T266A, P365L and S134C (novel) that could be associated with CAE. The pathogenicity of these mutations was predicted to be "damaging" for G296S, S134C and P365L, but "benign" for T266A. We also identified a novel 5'UTR variation (Chr19:34012748 G>A) in one patient who had a low prolidase level. In addition, rs17570 and rs1061338 common variations of the PEPD gene were associated with low prolidase levels in CAE patients, while rs17569 variation was associated with high prolidase levels in both CAE and controls (p < 0.05). CONCLUSIONS: Our findings indicate that the low serum prolidase levels observed in CAE patients is significantly associated with PEPD gene variations. It was concluded that low serum prolidase level and associated PEPD mutations may be potential biomarkers for the diagnosis of CAE.

Femoral artery aneurysm developed on intimal sarcoma: Case report.

Intimal angiosarcoma is a rare vascular malignancy, and diagnosis is very difficult due to nonspecific symptoms. There are controversial points regarding the diagnosis, treatment and follow-up of intimal angiosarcomas. The purpose of this case report was to evaluate the diagnosis and treatment process of a patient diagnosed with femoral artery intimal angiosarcoma. Furthermore, in line with previous studies, it was aimed to illuminate controversial points. A 33-year-old male patient, who had been operated on due to ruptured femoral artery aneurysm, was diagnosed with intimal angiosarcoma with the pathology result. Recurrence was observed during clinical follow-up, and the patient was treated with chemotherapy and radiotherapy. Since there was no response to treatment, the patient underwent aggressive surgery including the surrounding tissues. No recurrence or metastasis was observed in the patient's 10th month follow-up. Although intimal angiosarcoma is rare, it should be considered in differential diagnosis when femoral artery aneurysm is detected. The most important step in treatment is aggressive surgery, but adding chemo-radiotherapy to the treatment should be considered.

Continuous-Flow Production of Liposomes with a Millireactor under Varying Fluidic Conditions.

Continuous-flow production of liposomes using microfluidic reactors has demonstrated advantages compared to batch methods, including greater control over liposome size and size distribution and reduced reliance on post-production processing steps. However, the use of microfluidic technology for the production of nanoscale vesicular systems (such as liposomes) has not been fully translated to industrial scale yet. This may be due to limitations of microfluidic-based reactors, such as low production rates, limited lifetimes, and high manufacturing costs. In this study, we investigated the potential of millimeter-scale flow reactors (or millireactors) with a serpentine-like architecture, as a scalable and cost-effective route to the production of nanoscale liposomes. The effects on liposome size of varying inlet flow rates, lipid type and concentration, storage conditions, and temperature were investigated. Liposome size (i.e., mean diameter) and size dispersity were characterised by dynamic light scattering (DLS); z-potential measurements and TEM imaging were also carried out on selected liposome batches. It was found that the lipid type and concentration, together with the inlet flow settings, had significant effects on the properties of the resultant liposome dispersion. Notably, the millifluidic reactor was able to generate liposomes with size and dispersity ranging from 54 to 272 nm, and from 0.04 to 0.52 respectively, at operating flow rates between 1 and 10 mL/min. Moreover, when compared to a batch ethanol-injection method, the millireactor generated liposomes with a more therapeutically relevant size and size dispersity.

Spontaneous transvaginal small bowel evisceration following hysterectomy: a case report.

Transvaginal small bowel evisceration is a rare, life-threatening condition, requiring urgent surgical intervention. In our case, ischemia developed in the intestinal segment with evisceration, with a laceration in the small intestine of the mesentery, and finally, a small bowel resection was required. An 89-year-old woman was brought to the hospital with a sudden onset of abdominal pain, which lasted for 4 hours. Upon the examination, it was found that approximately 50 cm of the small intestine was eviscerated from the vagina, with its mesentery. The intestines were edematous, and also there were signs of ischemia on the mesentery. The patient was urgently transferred to surgery. Functional end-to-end anastomosis was performed, following a 70 cm small bowel resection. The vaginal defect was repaired transvaginally. Transvaginal small bowel evisceration is rarely described in the literature. It is most commonly seen in postmenopausal, elderly women who underwent vaginal surgery before and who have enterocele. The treatment is an emergent surgical approach. Surgical treatment should be based on individual patient. Various surgical techniques have been described for the repair of transvaginal small bowel evisceration, such as vaginal, abdominal, laparoscopic, and combined approaches. Transvaginal small bowel evisceration should be considered in the differential diagnosis of patients with a sudden onset abdominal pain. Patients with an increased risk for transvaginal small bowel evisceration are postmenopausal women and patients who underwent vaginal surgery before. After the accurate diagnosis, patients should be operated as soon as possible, and necessary surgery should be done.

P-glycoprotein polymorphism and levothyroxine bioavailability in hypothyroid patients.

OBJECTIVES: P-glycoprotein (P-gp) contributes to the disposition of a wide variety of drugs; therefore, single nucleotide polymorphisms (SNPs) in the P-gp coding gene might affect its activity. It is well known that personalized medicine, instead of empirical treatment, is a clinically important approach for enhancing responses among patients. Indeed, there is a need to evaluate the association between SNPs of P-gp encoded multidrug resistance genes (MDR1, ABCB1), and the dosage requirements of these drugs. In the present study, we evaluated the association between the dosage of Levothyroxine (L-T4) and three common SNPs (C1236T, G2677T/A and C3435T). METHODS: Genotyping was done using a real-time PCR platform with DNA samples isolated from the venous blood of ninety post thyroidectomy hypothyroid patients. Thyroid hormone levels were measured as routine biochemistry laboratories in the Medical School of Istanbul University. RESULTS: In the genotype analysis, the minor allele frequencies were 0.48 for C1236T, 0.51 for G2677T/A, and 0.51 for C3435T. In the haplotype-based analysis, T1236T2677T3435 and C1236G2677C3435 were observed as major haplotypes (50.2 and 32.6%, respectively), in agreement with previous studies. The administered dose of L-T4 to achieve physiological thyroid hormone levels was found to be similar in all genotypes and haplotypes, indicating that there is no significant association between MDR1 polymorphisms and L-T4 doses. CONCLUSION: Because of conflicted previous reports about the genetic contribution of MDR1 polymorphisms to drug disposition, further studies with large numbers of participants are required to clarify this influence.

Easy-to-perform and cost-effective fabrication of continuous-flow reactors and their application for nanomaterials synthesis.

The translation of continuous-flow microreactor technology to the industrial environment has been limited by cost and complexity of the fabrication procedures and the requirement for specialised infrastructure. In the present study, we have developed a significantly more cost-effective and easy-to-perform fabrication method for the generation of optically transparent, continuous-flow reactors. The method combines 3D printing of master moulds with sealing of the PDMS channels' replica using a pressure-sensitive adhesive tape. Morphological characterisation of the 3D printed moulds was performed and reactors were fabricated with an approximately square-shaped cross-section of 1 mm2. Notably, they were tested for operation over a wide range of volumetric flow rates, up to 20 ml/min. Moreover, the fabrication time (i.e., from design to the finished product) was <1 day, at an average material cost of ∼£5. The flow reactors have been applied to the production of both inorganic nanoparticles (silver nanospheres) and organic vesicular systems (liposomes), and their performance compared with reactors produced using more laborious fabrication methods. Numerical simulations were performed to characterise the transport of fluids and chemical species within the devices. The developed fabrication method is suitable for scaled-up fabrication of continuous-flow reactors, with potential for application in biotechnology and nanomedicine.

Association between genetic polymorphism and levothyroxine bioavailability in hypothyroid patients.

Thyroid hormones play a vital role in the human body for growth and differentiation, regulation of energy metabolism, and physiological function. Hypothyroidism is a common endocrine disorder, which generally results from diminished normal circulating concentrations of serum thyroxine (fT4) and triiodothyronine (fT3). The primary choice in hypothyroidism treatment is oral administration of levothyroxine (L-T4), a synthetic T4 hormone, as approximately 100-125 µg/day. Generally, dose adjustment is made by trial and error approach. However, there are several factors which might influence bioavailability of L-T4 treatment. Genetic background could be an important factor in hypothyroid patients as well as age, gender, concurrent medications and patient compliance. The concentration of thyroid hormones in tissue is regulated by both deiodinases enzyme and thyroid hormone transporters. In the present study, it was aimed to evaluate the effects of genetic differences in the proteins and enzymes (DIO1, DIO2, TSHR, THR and UGT) which are efficient in thyroid hormone metabolism and bioavailability of L-T4 in Turkish population. According to our findings, rs225014 and rs225015 variants in DIO2, which catalyses the conversion of thyroxine (pro-hormone) to the active thyroid hormone, were associated with TSH levels. It should be given lower dose to the patients with rs225014 TT and rs225015 GG genotypes in order to provide proper treatment with higher effectivity and lower toxicity.

A rare cause of hemoperitoneum: A case report of ruptured ileocolic artery aneurysm.

Visceral artery aneurysm (VAA) is very rare among vascular pathologies. Incidence reported in autopsy series and angiographic studies varies between 0.1% and 0.2%. Most cases are asymptomatic and are diagnosed as result of complications, or incidentally, when imaging is performed for another reason. Three percent of VAAs are superior mesenteric artery (SMA) terminal branch aneurysms. Intra- and/or extraperitoneal bleeding due to ruptured aneurysm is life-threatening condition and requires emergent intervention. Therefore, surgical or endovascular interventional treatment must be performed rapidly after diagnosis. Presently described is case of ileocolic artery aneurysm in a patient admitted with abdominal pain, nausea, and vomiting. Endovascular intervention had been planned; however, during hospitalization, aneurysm ruptured and emergent surgery was performed. Review of the literature is also presented.

Damage-control laparoscopic partial cholecystectomy with an endoscopic linear stapler.

OBJECTIVE: Several damage-control procedures have been described in the literature in case of severe Calot's triangle inflammation and fibrosis. In this report, we describe patients who underwent laparoscopic partial cholecystectomy using an endoscopic linear stapler. MATERIALS AND METHODS: Five patients with acute cholecystitis underwent laparoscopic partial cholecystectomy in our clinic between January - December 2011. All patients had severe fibrosis and inflammation of Calot's triangle. The anterior and posterior walls of the gallbladder were totally resected if possible. The gallbladder was transected at its neck or Hartmann's pouch, leaving a remnant gallbladder pouch behind. RESULTS: Five patients had laparoscopic partial cholecystectomy with an endoscopic linear stapler. The main symptom of all patients on admission to the emergency room was abdominal pain. The mean time for the surgical procedure was 140 minutes (range, 120-180 minutes). Inflammation and fibrosis of Calot's triangle was detected in all patients during surgery and a phlegmonous gallbladder was detected in one patient. Surgical drains were used in all patients and no biliary leakage was detected. Remnant common bile duct calculi were detected in one patient and this patient underwent endoscopic retrograde cholangiopancreatography one month after surgery. CONCLUSIONS: When a reliable view of Calot's triangle cannot be obtained due to severe inflammation and fibrosis during laparoscopy, laparoscopic partial cholecystectomy seems to be a safe and feasible alternative to open surgery with an acceptable morbidity rate.

Elbow AVF configurations and indications.

INTRODUCTION: Brescia-Cimino radiocephalic arteriovenous fistula (AVF) remains the first-choice vascular access procedure for patients in need of long-term hemodialysis. The average life expectancy of patients receiving hemodialysis has increased in recent years and many patients now live longer and require secondary or tertiary procedures. Elbow fistulas should only rarely be constructed as primary fistulas. The aim of the surgeon must be not only to achieve a functioning fistula, but to avoid possible complications other than failure to mature (FTM), like distal ischemia and cardiac failure and to save the vessels as much as possible for future procedures. BACKGROUND: Both arterial and venous anatomy of the elbow and upper arm have significant variations. The surgeon must be aware of these variations during the operation, and try not to harm the vasculature of the extremity while trying to construct a functioning fistula. The main advantages of elbow fistulas are the opportunity to have multiple outflows, preservation of the major veins in their original place with no dissection and giving no harm to them, and having a longer outflow tract for cannulation. CONCLUSIONS: In the elbow, beginning to construct an AVF with the perforating vein is the most advantageous. If the perforating vein is not available or has been used before, median cubital vein, its branches, median antecubital vein or other available nearby veins may be used depending on the anatomy. Perforating vein should be ligated if any other elbow vein is used to prevent flow to deep veins.

Intralesional application of epidermal growth factor in limb-threatening ischemic diabetic foot ulcers.

OBJECTIVE: The intralesional injection of recombinant human epidermal growth factor (EGF-IL), a new therapy, has been claimed to prevent major amputations in advanced diabetic foot lesions. In this study, the efficacy of EGF-IL on advanced diabetic foot ulcers (DFU) was reviewed. METHODS: Intralesional 75 µg EGF application (Heberprot-P® 75, Heber Biotec, Havana, Cuba) to 12 diabetic foot lesions in 11 patients (8 males, 3 females; mean age: 62.2±10.6 years) was evaluated. Most of the patients had undergone revascularization and received hyperbaric oxygen therapy (HBOT) and negative pressure wound therapy (NPWT), along with standard care, but failed to heal. After amputation was offered as the final option, EGF-IL was applied to evaluate its effects. RESULTS: Two patients underwent amputation, while 10 lesions of the remaining 9 patients healed completely. CONCLUSION: Our results prove that intralesional application of EGF can prevent amputations in advanced diabetic foot cases with an ischemic component. However, evidence in the literature supporting its use remains lacking, and its high cost presents an additional problem. Thus, we believe that intralesional application of EGF should be an option for ischemic wounds only after vascular evaluation (and intervention when possible), HBOT, NPWT, and standard care have proven insufficient.

Arterial disease and vascular access in diabetic patients.

PURPOSE: There are conflicting reports on the effects of diabetes on the outcomes of hemodialysis access procedures. While some found no negative effects, others reported deleterious effects of diabetes on vascular access outcomes. Why is there concern about diabetes and related vascular problems on vascular access procedures? What are the differences of diabetic patients and their vasculature from that of nondiabetics? Do they have an effect on hemodialysis vascular access outcomes? We will try to find answers to these questions in light of the available evidence. METHODS: Recent literature on arterial disease in diabetes and end-stage renal disease (ESRD), and the effects on vascular access outcomes were searched in order to find answers to above questions. RESULTS: There are conflicting and controversial reports on the effects of preexisting vascular problems due to diabetes and chronic kidney disease (CKD) on the outcomes of hemodialysis access procedures. Diabetic vasculature, especially in patients with ESRD, has some specific problems, the most important of which seem to be the calcification and stiffening of the arteries. CONCLUSIONS: Although some authors report inferior outcomes of vascular access procedures in diabetic patients, there is evidence that most of the problems encountered can be dealt with by careful patient selection, surgical skill, and experience.

Esophageal transection.

Herein, a case of intramural esophageal dissection is reported and the literature is reviewed. Intramural esophageal dissection is a rare but well described condition that is characterized by a laceration between the esophageal mucosa and submucosa but without perforation. A female patient aged 86 years was hospitalized with a diagnosis of abdominal aortic aneurysm. After placement of an aortic stent, she was started on intravenous heparin. After the procedure, the patient had retching and vomiting due to sedative drugs. On the first day after the procedure, the patient experienced sudden-onset chest pain, hematemesis, back pain and odynophagia. A hematoma was detected in the thoracic esophagus, which was opened during endoscopy and began to bleed suddenly owing to air insufflation. A false lumen was visualized within the esophagus. There was no perforation. The patient was followed up conservatively and discharged from the hospital uneventfully. In conclusion, we propose that esophageal transection, a condition that is widely regarded as relatively benign in the literature, has the potential to lead to perforation. It would be expected that most cases of esophageal transection would be managed conservatively.