Adjunctive systemic hyperbaric oxygen therapy in treatment of severe prevalently ischemic diabetic foot ulcer. A randomized study.

OBJECTIVE: To evaluate the effectiveness of systemic hyperbaric oxygen therapy (s HBOT) in addition to a comprehensive protocol in decreasing major amputation rate in diabetic patients hospitalized for severe foot ulcer. RESEARCH DESIGN AND METHODS: From August 1993 to August 1995, 70 diabetic subjects were consecutively admitted into our diabetologic unit for foot ulcers. All the subjects underwent our diagnostic-therapeutic protocol and were randomized to undergo s-HBOT. Two subjects, one in the arm of the treated group and one in the arm of nontreated group, did not complete the protocol and were therefore excluded from the analysis of the results. Finally, 35 subjects received s-HBOT and another 33 did not. RESULTS: Of the treated group (mean session = 38.8 +/- 8), three subjects (8.6%) underwent major amputation: two below the knee and one above the knee. In the nontreated group, 11 subjects (33.3%) underwent major amputation: 7 below the knee and 4 above the knee. The difference is statistically significant (P = 0.016). The relative risk for the treated group was 0.26 (95% CI 0.08-0.84). The transcutaneous oxygen tension measured on the dorsum of the foot significantly increased in subjects treated with hyperbaric oxygen therapy: 14.0 +/- 11.8 mmHg in treated group, 5.0 +/- 5.4 mmHg in nontreated group (P = 0.0002). Multivariate analysis of major amputation on all the considered variables confirmed the protective role of s-HBOT (odds ratio 0.084, P = 0.033, 95% CI 0.008-0.821) and indicated as negative prognostic determinants low ankle-brachial index values (odds ratio 1.715, P = 0.013, 95% CI 1.121-2.626) and high Wagner grade (odds ratio 11.199, P = 0.022, 95% CI 1.406-89.146). CONCLUSIONS: s-HBOT, in conjunction with an aggressive multidisciplinary therapeutic protocol, is effective in decreasing major amputations in diabetic patients with severe prevalently ischemic foot ulcers.

Polyomavirus inclusion bodies in chicken caecal epithelium.

In this case report we describe the light microscopic and transmission electron microscopic appearance of polyomavirus inclusions in caecal epithelial cells from a chicken with diarrhoea and intestinal parasites. The DNA in situ hybridization technique demonstrated that the polyomavirus reported here is different from polyomaviruses observed in psittaciformes. The chicken polyomavirus described may share some homologous base sequences with psittaciforme polyomavirus; however, the viruses are different. Clinicians and pathologists should be aware that polyomavirus can infect chickens and that polyomavirus inclusion bodies can be found in chicken caecal epithelial cells.

Assessment of visual contrast sensitivity in hyperbaric oxygen.

Hyperbaric oxygen therapy is used in ophthalmology in ischemic pathologies of the anterior and posterior segments. Our experiment was done on a healthy group of volunteers aged between 10 and 50 yr. We examined the subject's vision before and after acute HBO exposure (60 min at 2.5 atm abs with pure oxygen) to verify whether vasoconstriction induced by hyperoxemia can influence eyesight. We measured the psychophysical determination of the threshold contrast according to Maione-Maffei's zebra test. The results demonstrated that contrast sensitivity is significantly improved for almost all the studied frequencies in normal subjects after acute HBO exposure. We hypothesize that the visual system has a reserve which is activated by an improvement of retinal oxygenation.

[Recurrent digestive hemorrhage of jejunal angioma]. / Emorragia digestiva ricorrente da angioma del digiuno.

A case of obscure recurrent gastrointestinal bleeding in a 78 year old man is reported. Selective mesenteric angiography made it possible to identify the site of hemorrhage in the upper jejunum. The pre- and intraoperative problems in case of small bowel vascular lesions are reviewed.

[Erythrocyte membrane in Duchenne muscular dystrophy. II. Fluidity of lipids in dystrophic patients and their families]. / Studi sulle membrane eritrocitarie nella distrofia muscolare tipo Duchenne: II-fluidita' dei lipidi nei soggetti distrofici e nei familiari.

Electron spin resonance techniques was used to study the fluidity of intact and hemoglobin free erythrocyte membranes from patients with Duchenne muscular distrophy and from members of their family. A greater mobility of spin label motion was observed only at the surface of hemoglobin free membranes in the patients. These studies suggest alterations in lipid-protein interaction, indicating in Duchenne muscular distrophy a generalized membrane abnormality.

[Erythrocyte membrane in Duchenne muscular dystrophy. III. Modifications of acetylcholinesterase]. / Studi sulle membrane eritrocitarie nella distrofia muscolare tipo Duchenne: III--modificazioni dell' acetilcolinesterasi.

Membrane-bound acetylcholinesterase was assayed in erythrocyte ghosts from patients with Duchenne Muscular Distrophy and from the members of their family. Modifications was observed both in Km and Vmax, indicating changes in conformations of the enzyme.

[Fistulas complicating diverticular disease of the colon]. / Le fistole complicanti la malattia diverticolare del colon.

Five patients were admitted to the 1st and 2nd Division of General Surgery of Soronno Hospital between July '75 and September '78 suffering from fistulas complicating colon diverticulosis. A sixth patient, operated on for diverticulitis, developed a stercoraceous cutaneous fistula in the postoperative period. This was closed by conservative therapy. A woman patient suffering from colo-enteric fistula, was not operated because she refused. In all operated patients, broad resection of the sigmoid was carried out with end-to-end anastomosis. In three cases a caecostomy was formed to protect the anastomosis. All operated patients were treated preoperatively with laxatives, clysters and intestinal antibiotics, prevalently paromomycin and in one case neomycin plus base erythromycin. Surgery led to the cure of all patients treated.