ABSTRACT
This multicenter, retrospective study evaluated the wound healing and limb salvage outcomes over a 4-year period in 3,830 patients in 39 hospital-affiliated Wound Care Centers. These centers provide comprehensive outpatient wound care for chronic, nonhealing wounds. Two distinct outcomes were identified: (1) wound healing with comprehensive wound care (CWC) alone, and (2) wound healing with comprehensive wound care plus platelet releasate (CWC+PR). Data were analyzed with respect to healing and limb salvage in two groups: 1,019 patients who received CWC and 2,811 patients who received CWC+PR. Analysis of the standardized, customized database showed that overall healing rates were higher (p < .00001) and amputation rates were lower (p = .00005) in the CWC+PR group than in the CWC group. In addition, when healing rates were analyzed according to underlying condition, patients with all underlying conditions except autoimmune disorders showed higher healing rates in the CWC+PR group than in the CWC group. This study showed that patients treated with comprehensive wound care plus topical use of autologous platelet releasate had significantly higher rates of wound healing and increased limb salvage for most wounds than those treated with comprehensive wound care alone.
Subject(s)
Amputation, Surgical , Leg Ulcer/therapy , Platelet Factor 4/therapeutic use , Platelet-Derived Growth Factor/therapeutic use , Transforming Growth Factor beta/therapeutic use , Wound Healing , Chronic Disease , Combined Modality Therapy , Humans , Leg Ulcer/etiology , Outcome Assessment, Health Care , Retrospective StudiesABSTRACT
A 51-year-old, nonobese man with diabetes mellitus had marked hyperinsulinemia (70 to 120 muU per milliliter; 502 to 860 pmol per liter) and fasting hyperglycemia (140 to 170 mg per 100 ml; 7.8 to 9.4 mmol per liter). Plasma proinsulin, glucagon, growth hormone, and cortisol levels were normal; insulin antibodies and insulin-receptor antibodies were not detected. The patient showed relatively normal insulin sensitivity, and insulin receptors on circulating monocytes were within the normal range. Insulin from the patient's serum bound to IM-9 lymphocytes and rat adipocytes approximately 40 per cent as well as insulin standards. Its biologic activity on rat adipocytes averaged 15 per cent of that expected from its immunologic concentration. The impaired biologic activity of this patient's circulating insulin was probably due to a structural abnormality. Subsequent studies of the patient's insulin (fortuitously obtained from his pancreas during a laparotomy for a pancreatic cyst) have confirmed this conclusion. (N Engl J Med 302:129-135, 1980).
Subject(s)
Diabetes Mellitus/etiology , Insulin/blood , Blood Glucose/metabolism , Chemical Phenomena , Chemistry , Electrophoresis, Disc , Humans , Insulin/immunology , Insulin/isolation & purification , Insulin Resistance , Male , Middle Aged , Receptor, Insulin/analysisABSTRACT
Insulin isolated from the pancreas of a diabetic patient with fasting hyperinsulinaemia showed decreased activity in binding to cell membrane insulin receptors and in stimulating cellular 2-deoxyglucose transport and glucose oxidation. Chemical studies suggest that the isolated hormone is a mixture of normal insulin and an abnormal variant which contains a leucine for phenylalanine substitution at position 24 or 25 of the insulin B-chain.
