Randomized single-blind trial of topical ketanserin for healing acceleration of diabetic foot ulcers.

The objective of this study was to determine the efficacy of topically applied ketanserin for healing acceleration of diabetic foot ulcers. From August 1993 to September 1994, 140 NIDDM patients entered a randomized single-blind trial of topical ketanserin (Sufrexal, Janssen Pharmaceuticals; n = 69) vs. normal saline (labeled here as placebo; n = 71). All patients were subjected to surgical debridement of necrotic tissue and lavage with normal saline. Wounds were < 100 cm2 in area. Persons with NIDDM and foot ulcers Wagner 2 and 3 with a median of 8 (interquartile range 4-26) weeks duration were included. Ulcer area was measured at 0, 4, 8 and 12 weeks. The groups were similar in age, sex, years of diabetes duration, obesity, ulcer Wagner type, number of previous amputations and surgical debridements during this hospital stay. Average percent reduction in ulcer area at 12 weeks was 87% for ketanserin vs. 63% for placebo (p < 0.001). The regression equations for the least-squares fit to the area (y) against time (x) data points were y = 43.46-3.181x (r = -0.995) for ketanserin and y = 39.46-2.016x (r = -0.999) for placebo (p < 0.01). The 95% confidence limits for slopes were -3.181 +/- 0.98 and -2.016 +/- 0.15. Thus, average daily reduction in ulcer area was 4.5 mm2/day for ketanserin vs. 2.88 mm2/day for placebo. In conclusion, topical ketanserin significantly accelerated wound healing in diabetic neurotrophic foot ulcers when applied as part of a comprehensive healing program.

[Delay in hospitalization, diagnosis and surgical intervention in acute appendicitis]. / Retardo en la hospitalización, el diagnóstico y la intervención quirúrgica de la apendicitis aguda.

AIMS: To assess if self-medication delays diagnosis and Surgical Treatment in acute appendicitis and increases morbidity, mortality and hospital stay as well. DESIGN: Retrospective, comparative and observational study. STATISTICS: Chi square, exact Fisher test. SUBJECTS AND STUDY GROUPS: 57 patients were subjected to appendectomy and were stratified in three groups according to the lapse of time between initiation of symptoms and hospitalization: group A less than 24 h (n = 20), group B between 24 and 48 h (n = 17), and group C more than 48 h (n = 20). RESULTS: Groups B and C showed a significant delay for both diagnosis (p < 0.001) and surgical intervention (p < 0.001) in relation to group A. The incidence of acute abdomen presentation showed a positive trend with time of hospitalization (p = 0.03). Self-medication increased from group A to C (p < 0.001). Groups B and C showed a complication rate of 24 and 25%, respectively (p > 0.05). Conversely, group A had not complications (p < 0.05). In addition there was a 5% mortality due to sepsis in group C. Finally, hospital stay was longer in groups B and C (p < 0.001). CONCLUSIONS: Self-medication correlated with delayed hospitalization, diagnosis, treatment and complications. Hospital stay was consequently longer.