Comparison of WIFi, University of Texas and Wagner Classification Systems as Major Amputation Predictors for Admitted Diabetic Foot Patients: A Prospective Cohort Study.

INTRODUCTION: Classifications systems are powerful tools that could reduce the length of hospital stay and economic burden. The Would, Ischemia, and Foot Infection (WIFi) classification system was created as a comprehensive system for predicting major amputation but is yet to be compared with other systems. Thus, the objective of this study is to compare the predictive abilities for major lower limb amputation of WIFi, Wagner and the University of Texas Classification Systems among diabetic foot patients admitted in a tertiary hospital through a prospective cohort design. MATERIALS AND METHODS: Sixty-three diabetic foot patients admitted from June 15, 2019 to February 15, 2020. Methods included one-on-one interview for clinico-demographic data, physical examination to determine the classification. Patients were followed-up and outcomes were determined. Pearson Chi-square or Fisher's Exact determined association between clinico-demographic data, the classifications, and outcomes. The receiver operating characteristic (ROC) curve determined predictive abilities of classification systems and paired analysis compared the curves. Area Under the Receiver Operating Characteristic Curve (AUC) values used to compare the prediction accuracy. Analysis was set at 95% CI. RESULTS: Results showed hypertension, duration of diabetes, and ambulation status were significantly associated with major amputation. WIFi showed the highest AUC of 0.899 (p = 0.000). However, paired analysis showed AUC differences between WIFi, Wagner, and University of Texas classifications by grade were not significantly different from each other. CONCLUSION: The WIFi, Wagner, and University of Texas classification systems are good predictors of major amputation with WIFi as the most predictive.

Hyperbaric Oxygen Therapy Improves Glucose Homeostasis in Type 2 Diabetes Patients: A Likely Involvement of the Carotid Bodies.

The carotid bodies (CBs) are peripheral chemoreceptors that respond to hypoxia increasing minute ventilation and activating the sympathetic nervous system. Besides its role in ventilation we recently described that CB regulate peripheral insulin sensitivity. Knowing that the CB is functionally blocked by hyperoxia and that hyperbaric oxygen therapy (HBOT) improves fasting blood glucose in diabetes patients, we have investigated the effect of HBOT on glucose tolerance in type 2 diabetes patients. Volunteers with indication for HBOT were recruited at the Subaquatic and Hyperbaric Medicine Center of Portuguese Navy and divided into two groups: type 2 diabetes patients and controls. Groups were submitted to 20 sessions of HBOT. OGTT were done before the first and after the last HBOT session. Sixteen diabetic patients and 16 control individual were included. Fasting glycemia was143.5 ± 12.62 mg/dl in diabetic patients and 92.06 ± 2.99 mg/dl in controls. In diabetic patients glycemia post-OGTT was 280.25 ± 22.29 mg/dl before the first HBOT session. After 20 sessions, fasting and 2 h post-OGTT glycemia decreased significantly. In control group HBOT did not modify fasting glycemia and post-OGTT glycemia. Our results showed that HBOT ameliorates glucose tolerance in diabetic patients and suggest that HBOT could be used as a therapeutic intervention for type 2 diabetes.

Chondrosarcoma of the hyoid bone: Case report and review of the literature.

INTRODUCTION: Chondrosarcomas are cartilaginous tumors that range from low-grade tumors with low metastatic potential to high-grade aggressive tumors with premature and high metastatic rate. Low-grade types have few karyotype abnormalities and are near-diploid, while high-grade chondrosarcomas originate from complex karyotypes and are aneuploid. The most common karyotype aberrations found include 12q13-15 and 9p21 rearrangements. Here, it is presented a case of chondrosarcoma of the hyoid bone with its image, surgical procedure and pathological correlation as well as a review of the literature. CASE PRESENTATION: A sixty-three year old man presented with a large cervical mass located at submental level. The CT scan revealed a voluminous and well-limited mass of 5 x 4 x 3 cm located in the suprahyoid region. The operative finding revealed a grade 2 chondrosarcoma originating from the hyoid bone. DISCUSSION: Chondrosarcoma of the. hyoid bone is a rare pathology, thus making it difficult to diagnose. Fine needle biopsies have high diagnostic accuracy, although correct grading is only obtained 46% of the time. CT scan is the golden standard to characterize tumor extension and origin. Surgical excision is the treatment of choice for chondrosarcoma.

Papillary thyroid carcinoma of thyroglossal duct cyst: a retrospective analysis.

BACKGROUND: The incidence of thyroglossal duct cyst (TDC) carcinoma is uncommon (approximately 1%) and rarely reported in the literature. Treatment modalities have included tumourectomy, Sistrunk's procedure and/or total thyroidectomy. AIM: To try and determine the most adequate surgical approach for papillary thyroid carcinoma (PTC) arising in TDC. RESULTS: We reviewed the clinical charts of 22 patients with PTC of TDC treated between January 1974 and December 2008 (0.63% of the total of 3458 patients with PTC treated over that period). All patients underwent the Sistrunk's procedure. Fourteen (64%) were submitted to total thyroidectomy and 11 of these patients were ablated with lodine131. Seven (50%) of the 14 patients treated with total thyroidectomy had tumour both in the thyroid gland and in TDC but lymph node metastases were present only in four. None of the patients died of the disease and all of them are still alive without recurrence with a mean follow-up of 8 years (range: 2-27 years). The mean survival rate of the patients submitted to total thyroidectomy (n= 14) was not statistically different from that of patients treated with the Sistrunk's procedure alone (9.23 +/- 7.65 vs. 8.95 +/- 6.22, p= 0.940). CONCLUSION: Papillary thyroid carcinoma arising in thyroglossal duct cysts is a very rare malignant tumour. In spite of the multifocal character of several of our cases, their analysis showed that the prognosis in the vast majority of patients with TDC carcinoma is excellent. Moreover, we found no relation between outcome and surgical procedure.

Moderate leukocyte infiltration in the lower turbinate mucosa after a two-week intranasal administration of mometasone furoate, azelastine or salmon calcitonin.

OBJECTIVE: We used light microscopy to search for local changes of the nasal mucosa associated with daily intranasal administration of mometasone furoate (MF), azelastine (AZ) or salmon calcitonin (SC). STUDY DESIGN: Biopsies of the lower nasal turbinate were obtained from four groups of 8 individuals after 14 days of daily administration of a saline solution (control group) or of MF AZ and SC. METHODS: Small biopsies of the anterior portion of the lower nasal turbinate were collected with the help of a Hartmann forceps under direct visual inspection. The samples were processed for light microscopy and morphometric analysis. Inflammatory infiltration (neutrophils and lymphocytes) of the nasal mucosa was evaluated by a semiquantitative method. Unpaired t test and Bernoulli distribution were applied to evaluate statistical differences between data from the different groups of samples. RESULTS: Samples of the turbinate mucosa of all of the drug-treated groups showed a moderate enhancement in infiltrating neutrophils when compared with the samples from the control group. Infiltration of lymphocytes in the turbinate chorion was significantly different from controls only in the MF and AZ-treated groups. CONCLUSIONS: Intranasal treatment with MF AZ or SC does not cause significant changes in the general architecture of the nasal mucosa. A moderate inflammatory response of the turbinate mucosa, that was expressed by leukocyte infiltration of epithelium and chorion, was observed in all of the 3 drug-treated groups of patients after the 2-week course of intranasal deposition of MF, AZ or SC.

Hyperbaric oxygen improves nasal air flow.

OBJECTIVE: We investigated whether hyperbaric oxygen (HBO2) treatment is able to cause any changes in the nasal peak inspiratory flow (NPIF) values of patients submitted to this therapy. STUDY DESIGN: NPIF was measured in a group of 13 patients who were submitted to at least 10 sessions of 75 minutes long HBO2 treatments over a period of 20 days. HBO2 was prescribed to the patients to treat hearing loss, diabetic ulcers or chronic inflammatory disease. Three timings were chosen to perform the NPIF measurements: during HBO2, five minutes before and five minutes after the treatment. METHODS: For NPIF evaluation, the highest inspiratory flow of three inspirations was recorded. To search for statistical differences between NPIF measurements at the three different timings of the HBO2 treatment, we have analysed the data using the repeated measures ANOVA test with the Epsilon lower bound correction for the F ratio. RESULTS: NPIF values were significantly higher when the patients were inside the HBO2 chamber when compared with NPIF measurements obtained in the same individuals five minutes before starting or five minutes after ending the treatment. A small but significant increase in NPIF values was detected in patients five minutes after stopping the HBO2 treatment, in comparison with values obtained five minutes before initiating the therapy. NPIF values remained stable along the 10 HBO2 sessions, i.e. with repetition of the HBO2 treatments, NPIF values were not further enhanced. CONCLUSIONS: Exposure to HBO2 causes significant improvement in nasal air flow. This increase is restricted mostly to the period that the patients are inside the hyperbaric chamber. Further investigations are needed to determine the relative contributions of enhancement in air pressure and in oxygen concentration (that characterize HBO2) in the enhancement of nasal air flow. The herein finding may be helpful in future investigations on the treatment of nasal or sinus diseases.

Estenosis traqueal y atrógena por intubación endotraqueal: estudio de 20 casos clínicos / Iatrogenic tracheal stenosis following endotracheal intubation: a study of 20 clinical cases

Realizamos un estudio retrospectivo de veinte casos de estenosis traqueal pura por intubación endotraqueal, diagnosticados y tratados en nuestro centro entre 1995 y 1999. De los veinte pacientes estudiados 17 eran hombres (85%) y tres (15%) eran mujeres, con edades comprendidas entre 9 y 68 años (32,8 ± 14,9 años). La extensión del segmento estenosado varió entre los 2 y 5 cm (3,3 ± 1,2 cm). Todos estos casos fueron tratados quirúrgicamente por vía externa para resección del segmento estenosado y posterior anastomosis traqueo-traqueal. Los resultados clínicos evaluados entre el tercer y sexto mes postoperatorio fueron: 16 casos (80%) con buen resultado, dos casos (10%) con resultado satisfactorio y dos resultados insatisfactorios (10%), verificando que la existencia de una estenosis, para un nivel de confianza del 5%, está relacionada con el tiempo de intubación y la edad del paciente (R=0,478, p= 0,033) (AU)

The authors report a case review series of 20 patients with tracheal stenosis after prolonged oral or nasotracheal intubation who underwent surgical treatment between 1995 and 1999. Seventeen were male (85%) and three (15%) were female. The age varied between 9 and 68 years (32.8 +/- 14.9 years). The stenotic area of the airway was limited to the trachea, and its length varied between 2 and 5 cm (3.3 +/- 1.2 cm.). All patients were treated surgically with an external approach for reconstruction after stenosis ablation. Follow up was at three and six months after surgery there were: 16 cases with (80%) good results, two (10%) with satisfactory results and two unsatisfactory (10%). We found a statistically significant correlation (Spearman correlation) of 5% level between the period of tracheal intubation and patient's age (R = 0.478, p = 0.033) (AU)

Acute mastoiditis in children--our experience.

The incidence of acute mastoiditis and the number of complications has changed since the 1950s, despite the increasing antibiotic effectiveness. Other series concluded that the incidence of acute mastoiditis is rising in the recent years, which can be justified by the antibiotic resistance of the microorganisms and the absence of paracentesis in the treatment of acute otitis media. Our aim is to approach risk factors, clinical presentation, diagnosis and treatment of acute mastoiditis. We reviewed 62 clinical records of patients in pediatric age, observed in D. Estefania Hospital Lisbon, between January 1993 and December 1997. There was a relative homogenous distribution during the 5 years of the study period. The patient age ranged from 5 months to 14 years. They all were treated with intravenous antibiotics. The mean duration of treatment was 7.4 days. We registered 15 complications: 14 retroauricular subperiosteal abscesses and one subdural empyema. The most common isolated microorganism was Streptococcus pneumoniae. We found no statistic difference (P > 0.1) in the incidence of acute mastoiditis between the 5 years of the study.