Proteases and chronic leg ulcers.

AIM: The aim of this study was to compare the effect of cadexomer on reducing wound surface area of leg ulcers compared to that obtained in a group patients whose ulcers were treated by compression therapy. METHODS: For each ulcer group, wound surface area was calculated at day 0 and after 28 days of treatment: this allowed to calculate the average wound surface area reduction, the percent reduction in wound size, as well as the weekly wound size reduction index. RESULTS: In the cadexomer-treated ulcers the total wound area reduction was 9.67 cm(2)/week, with a weekly wound size reduction index per patient of 0.96 cm(2); in the controls (compression therapy-treated patients) the total wound area reduction was 6.11 cm(2)/week, with a weekly reduction index per patient of 0.61 cm(2). At the end of treatment, in the group of patients whose ulcers were treated with cadexomer ointment the average wound size reduction was 43%, whereas in the control-treated patient group the average wound size reduction was 28%. CONCLUSION: These data suggest that cadexomer can play an important role in the healing of chronic leg ulcers.

Comparison between intravenous iloprost and vasoactive drugs in limb ischemia IIB severe. A retrospective analysis.

AIM: Peripheral arterial vascular disease is caused by atherosclerosis. The severity of peripheral arterial disease is closely associated with the risk of myocardial infarction, ischemic stroke, and death from vascular causes. Approximately 1/3 of patients with peripheral disease have typical claudication. The goals of treatment for patients with claudication are to relieve their exertional symptoms, increase walking capacity, and globally improve their quality of life. In the peripheral arterial disease IIB stage, with claudication < 100 meters, no useful medical therapy is available. Aim of this investigation is to analyse, in a retrospective way, two groups of patients treated with vasodilator drugs or iloprost. METHODS: Data from 99 patients were registered: 79 patients were treated regularly with iloprost, administered for 10 days, 4 times a year. The 2nd group of 20 patients was treated with buflomedil 600 mg/die or pentoxifilline 1200 mg/die. The end point was the pain-free walking distance (PFWD) evaluated with treadmill test at basal conditions and at 3, 6, 12, 18 months. RESULTS: Treatment groups showed no difference as for occurrence of by-pass surgery or endovascular procedures during follow-up. Improvement in PFWD was significantly more evident in patients treated with iloprost as compared with the control (P = 0.02). Even considering the PFWD variations at any follow-up step vs basal value, we always observed a statistically significant difference with iloprost, P < 0.0001. CONCLUSIONS: The study suggests that iloprost may be effective in improving walking distance in severe IIB stage peripheral arterial vascular disease.

Plasma levels of E-selectin in normolipemic and hyperlipemic arteriopathic patients after vasoactive and lipid-lowering treatment.

BACKGROUND: The authors studied the plasma levels of E-selectin in a group of arteriopathic patients, before and after vasoactive and lipid-lowering treatment. METHODS: The series consisted of 73 subjects (53 males, 20 females, aged 54 +/- 9 suffering from occlusive peripheral arteriopathy; 21 subjects with total cholesterol (TC) below 200 mg/dl were considered as normolipemics (group A); 24 subjects with TC between 200 and 240 mg/dl, mild hypercholesterolemics (group B); 18 with TC above 240 mg/dl, severe hypercholesterolemic (group C); 10 subjects who had high triglyceride values (above 200 mg/dl), (group D); 12 normal controls were also considered. All patients underwent a vasoactive treatment for 15 days; group B also underwent a standard hypolipidic diet (phase I NCEP, lipid 30% die) groups C and D underwent the same diet associated respectively with simvastatin (200 mg/die) and bezafibrate (400 mg/die). For each sample of plasma before and after treatment the determination of levels of E-selectin was carried out by an immunoenzymatic method (kit ELISA Amersham). RESULTS: In groups A-B-C-D a reduction of the plasma levels of E-selectin was found, which was significant (p < 0.05), for group C and D, compared to controls. In groups A-B-D significant changes of E-selectin were not found after treatment; in group C the difference between the values after treatment and at baseline was significant (p < 0.05). CONCLUSIONS: The reduction of the E-selectin plasma levels was proportional to the values of total cholesterol and triglycerides; the chronicity and the dyslipidemia may be responsible for the basal diminished biosynthetic endothelial function; in the severe hypercholesterolemics the lipid-lowering treatment caused a significant decrease of E-selectin, due to a probable reduced endothelial irritation dependent on the hyperlipemic stress.