Comparison of the effects of cilostazol and aspirin on wound healing in patients with diabetic foot ulcer and peripheral artery disease.

Diabetic foot ulcer (DFU) is one of the most feared complications of diabetes mellitus. Studies report that the lifetimerate of developing DFU is 25% for patients with diabetes mellitus. In addition, peripheral artery disease (PAD) is seen in approximately 50% of patients with DFU. PAD increases the risk of amputation in patients with DFU and complicates treatment. This study aimed to compare the effects of cilostazol and aspirin on wound healing in patients with DFU and PAD. In the study, DFU patients with PAD were retrospectively reviewed. They were divided into two groups. One group was administeredcilostazoland the other was administeredaspirin. Patients were evaluated according to their demographic characteristics, wound characteristics, PAD symptoms, duration of treatment, and treatment grades. There were 30 patients in the cilostazol group and 20 patients in the aspirin group. Of the patients in the cilostazol group, seven(23.3%) had Wagner's grade 2, 16 (53.3%) had grade 3, and seven (23.3%) had grade 4 DFU. In the aspirin group this rate was 25%, 55%, and 20%, respectively. The mean size of the wound in the cilostazol group was 8.1 cm (2-25 cm), whereas it was 7.6 cm (5-25 cm) in the aspirin group. The mean ankle-brachial index (ABI) of the patients was 0.90 in the cilostazol group and 0.96 in the aspirin group. Five (23.3%) of the patients in the cilostazol group had triphasic, 19 (63.3%) biphasic, and six(20%) monophasic currents in the distal popliteal vein. In the aspirin group, these rates were 35%, 50%, and 20%, respectively. Of the patients in the cilostazol group, according to the Fontaine classification, six(20%) had stage 2A, 11 (36.7%) had stage 2B, 10 (33.3%) had stage 3, and three(10%) had stage 4 symptoms. In the aspirin group, these rates were 45%, 40%, 15%, and 0%, respectively. There was a complete response to treatment in 27 patients (90%) in the cilostazol group and 11 patients (55%) in the aspirin group. Partial response was present in the other patients. The mean duration of treatment was 1.31 months (1-2 months) in the cilostazol group and 1.82 months (1-2.5 months) in the aspirin group. In this study, it was observed that wound healing was faster in the cilostazol group, complete response to treatment was higher, and improvement in PAD symptoms was better compared to the aspirin group. KEY WORDS: Aspirin, Cilostazol, Diabetic foot ulcer.

Is there a difference between two different skin disinfection methods in cardiac surgery in terms of isolated pathogens?

INTRODUCTION: In this study, our aim was to prospectively compare the different methods of patient disinfections with scrubbing + iodine + alcohol, and the povidone iodine disinfection method, which can be described as classical, in terms of the pathogens isolated on skin and during early postoperative complications. METHODOLOGY: Eighty patients undergoing a coronary artery bypass operation were included in the study. The patients were divided into two groups: group 1 (n = 48) patients who underwent scrub, iodine, followed by skin disinfection with alcohol, and group 2 (n = 32) who were treated with povidone iodine three times. The samples were immediately sent to the microbiology laboratory. Specimens from the wounds were incubated under aerobic and anaerobic conditions, and isolates were identified using standard microbiological techniques. RESULTS: In samples taken after disinfection in group 1, significantly less reproduction was observed compared to group 2 (p = 0.001). There was no difference in postoperative complications between the two groups except for pleural effusion (p = 0.040). S. epidermidis was the most frequently isolated pathogen in both groups. CONCLUSION: We did not find a study which compares scrub + alcohol + iodine and povidone iodine in our literature review. We think that our study is original in this respect. We can conclude that skin disinfection with scrub + alcohol + iodine was superior to using only povidone iodine in terms of the pathogens isolated afterwards from the wound.

The Advantages of Using Intraoperative Indocyanine Green Fluorescence Angiography for Upper Extremity Arteriovenous Malformation: A Case Report.

Vascular anomaly is a general term that includes all vascular malformations, vascular tumors, and other congenital vascular defects. Vascular malformation is the most common term, and it describes blood vessels that are abnormally formed at birth. Vascular malformations can develop in any part of the body. The most common location is in the lower extremities. Vascular malformations involve arteries, veins, or lymphatic vessels, or a combination of these. Our patient was a 22-year-old man with an arteriovenous malformation in his left forearm. He was admitted due to increased pain and swelling on his left forearm over the previous 9 months. He had 1 arterial feeder derived from the ulnar artery and 2 venous drainage systems at the magnetic resonance angiography. We used indocyanine green fluorescence angiography to assess the arteriovenous malformation during surgery. We found that it was a very useful and unique technique for assessing the anomalies of the vascular anatomy and eradicating the nidus of the arteriovenous malformation. It could prove to be very helpful in avoiding significant blood loss during surgery.

Iliac Artery Injury During Lumbar Disc Hernia Surgery.

BACKGROUND: Vascular injury complications during lumbar discectomy are rare but potentially life-threatening. Therefore, an early diagnosis and effective treatment management is required for these complications. CASE DESCRIPTION: A 50-year-old female patient was admitted to our outpatient clinic with severe back and right leg pain. She underwent surgery for right L4-5 extruded disc herniation with general anesthesia. Sudden arterial hemorrhage occurred during discectomy performed with straight disc forceps and was controlled using hemostatic materials, with no significant decrease in blood pressure. However, the patient became hypotensive near the end of the operation. The incision was quickly closed, and she was turned to supine position. Emergency abdominal ultrasound, computed tomography, and computed tomography angiography revealed an injury of the left main iliac artery, which was repaired by endovascular stenting. Laparotomy and Bogota bag were applied because of increased intrabdominal pressure at 3 hours postoperative. In addition, a retroperitoneal catheter was placed into the area of the right retroperitoneal hematoma on the first postoperative day. Tissue plasminogen activator was administered through the catheter. On postoperative day 3, the Bogota bag was removed, and the abdomen was closed. The patient was discharged without neurodeficit on day 27. Her abdominal fascial defect was closed with a synthetic graft after 5 months. CONCLUSIONS: Although lumbar discectomy is one of the most commonly performed neurosurgical procedures, the routine rules of discectomy should not be neglected. Early detection and a multidisciplinary approach can help prevent mortality in the event of vascular injury.

Emergent surgical treatment of lethal valve dysfunction during pregnancy in a last-trimester patient.

A mechanical heart valve thrombosis during pregnancy is one of the most lethal conditions to experience due to its detrimental effects on both mother and fetus. Cardiac surgery during pregnancy is reserved for cases where medical treatment fails due to harmful maternal and fetal effects. A 24-year-old female in the 38th week of pregnancy was admitted to the emergency room with aggravated dyspnea, tachypnea, and palpitations. She had 2 previous cardiac operations in her medical history. A stuck mechanical valve was diagnosed in the mitral position via transthoracic echocardiography, which had resulted from her decision to cease taking warfarin when planning to become pregnant. In pregnant patients who have prosthetic mechanical valve thrombosis, surgical approach should be considered depending on the conditions of the mother and the baby. When emergency delivery of the baby is feasible, emergent surgical treatment should be utilized for patients who are in critical condition.

Prevention of retrosternal pericardial adhesions after cardiac surgery with mitomycin C.

BACKGROUND: Retrosternal pericardial adhesions may cause significant injuries to the heart and great vessels in cases that require reoperation. Fibroblast proliferation is one of the mechanisms for adhesion formation. Inhibition of fibroblast proliferation is important in reduction of retrosternal adhesions. Mitomycin C (MMC) is able to reduce fibroblast proliferation. We aimed to determine the effect of MMC on prevention of retrosternal pericardial adhesions after primary cardiac operations. METHODS: Thirty Sprague-Dawley female rats were used in the study. The rats were divided into two groups. First group was control (n=10) and second group was MMC study group (n=20). Xiphoid cartilage resection and retrosternal abrasion via subxiphoidal incision was performed. In the study group, MMC (1mg/kg) was topically applied to the retrosternal space. After 15 days, rats were taken into reoperation and adhesion was graded. Tissue and blood samples were taken before termination procedure. Standard staining procedures and fibroblast growth factor receptor 3 antibody staining, were applied immunohistochemically to tissue samples. RESULTS: The average adhesion scores of the control (n=10) and study (n=20) (MMC; 1mg/kg) groups were 2.50 ± 1.27 and 0.70 ± 0.86, respectively. The adhesion score of the study group was lower than the control group (p<0.05). Immunohistochemical samples revealed that tissue fibroblast intensity was significantly higher in the control group than the study group (p<0.05). There was no statistical significance between two groups in case of hydroxyproline levels (p>0.05). CONCLUSION: MMC was found to be effective in the prevention of retrosternal pericardial adhesions without any delay in normal tissue regeneration.

Repair of coarctation-related aortic arch aneurysm and ventricular septal defect in an adolescent.

A saccular aortic arch aneurysm that is secondary to aortic arch coarctation and that is accompanied by a ventricular septal defect is a rare combination in the adolescent patient. Total simultaneous repair of all of these conditions is desirable, because of the higher morbidity and mortality rates of staged procedures-particularly when resection of the saccular aneurysm is delayed. Herein, we discuss the case of a 16-year-old boy who underwent simultaneous surgical correction of these malformations. With the aid of cardiopulmonary bypass on the beating heart, the coarctation and the aneurysmal segment were resected, and a tubular Dacron graft was interposed. The ascending aorta and femoral artery were both then cannulated to ensure whole-body perfusion during cardiopulmonary bypass. The ventricular septal defect was closed with the patient under cardioplegic arrest. After 10 days, he was discharged from the hospital without sequelae. We conclude that single-staged repair of cardiac abnormalities and of an aortic arch aneurysm that is secondary to coarctation of the aortic arch can be performed safely and effectively in adolescent and adult patients by use of our technique.