Intralesional Epidermal Growth Factor for Diabetic Foot Ulcers.

OBJECTIVE: To determine the role of the intralesional recombinant epidermal growth factor (rEGF) in the healing and prevention of extremity amputation in advanced diabetic foot ulcer patients. STUDY DESIGN: Observational study. PLACE AND DURATION OF STUDY: Department of Cardiovascular Surgery, Duzce State Hospital, Duzce, Turkey, between November 2018 and September 2019. METHODOLOGY: A total of 58 patients with diabetic foot ulcers that were treated at the study place were enrolled. The lesions were graded with Wagner Classification System. EGF (75 microg of Heberprot-P) vials were stored at +4°C and cold-chain requirements were followed. EGF 5 mL was dissolved with 0.09% saline solution; and 0.5-1 ml of the solution was injected into the tissues and edge of the lesions regularly. The data was evaluated at the end of two years of the treatment period. The primary objective was wound healing, formation of granulation tissue; and the secondary objective was the prevention of lower extremity amputation. RESULTS: Diabetic foot ulcers wound healing was achieved in 93.1% (n=54) of patients with the formation of granulation tissue. The complete recovery was observed in 94.1% (n=32) of the patients who had Grade III and IV lesions. Lower extremity amputation was performed in two (3.4%) subjects. The lesions of two patients required flap surgery. The most common adverse events were tremor and syncope. CONCLUSION: Recombinant epidermal growth factor is highly effective for the treatment of diabetic foot ulcers and prevention of extremity amputation. Intralesional rEGf provides efficient and safe wound healing/closure in patients with diabetic foot ulcers. Key Words: Amputation, Epidermal growth factor, Diabetic foot, Wound healing.

Results of carotid endarterectomy under regional anesthesia.

OBJECTIVE: The purpose of this study is to assess the efficacy of carotid endarterectomy (CEA) surgery under regional anesthesia and to report early mid-term results. METHODS: Data for 42 patients who underwent CEA were reviewed retrospectively between January 2013 and June 2015. Of the patients, 60% (n=25) were male and 40% (n=17) were female. The mean age was 74.03 years. Early and midterm mortality, intraoperative stroke, and complication rates were calculated by reviewing patient's data at the end of 2 years. RESULTS: The level of carotid stenosis was over 70% in 83% (n=35) of the patients. Seventeen percent (n=7) of the patients had 60% carotid stenosis. Forty patients received regional anesthesia and two patients received general anesthesia. The mean cross-clamp time was 13.08 min. The mean operation time was 53.09 min. No early post-operative deaths occurred. The midterm (24 months) mortality rate was 2% (n=1). Recurrent atheromatous plaque was found in 2% (n=1) of the patients. CONCLUSION: Our study demonstrated that CEA surgery may be safely performed under regional anesthesia will acceptable low mortality and morbidity rate.

Diagnostic accuracy of copeptin and NT-proBNP level in predicting mortality and postoperative prognosis in coronary surgery with respect to EuroSCORE risk.

Introduction: During the last few years, many modifications in risk stratification of all cardiac surgical patients have been reported based on EuroSCORE. Aim: In this study we aimed to interpret copeptin and NT-proBNP levels in patients who had undergone coronary surgery with respect to EuroSCORE. Material and methods: We investigated the correlation between pre-operative copeptin and NT-proBNP levels with respect to mortality and post-operative complications via EuroSCORE II in the 484 enrolled patients. In terms of analyzing mortality the first 30 days were taken into account and duration of hospital stay was considered for prognosis. The statistical significance of copeptin and NT-proBNP with respect to EuroSCORE II ≥ 2 was studied. Results: The critical threshold levels of mortality for NT-proBNP was 1296 pg/ml and for copeptin was 116 pmol/l in patients whose EuroSCORE II ≥ 2. Mortality increases 9.04-fold in cases with EuroSCORE ≥ 2, 5.04-fold when NT-proBNP level is > 1296 pg/ml. A dramatic outcome was observed in copeptin levels as mortality increased 138.17-fold when copeptin was > 116 pmol/l. Conclusions: Increased levels of copeptin and NT-proBNP negatively affect mortality and complication rates in isolated cardiac surgery patients.

Is Surgical Thrombo-Embolectomy in Acute Limb Ischemia Still Advantageous in Patients More Than 65 Years of Age?

OBJECTIVE: In this study, we investigated the benefits of using Fogarty balloon catheterization in the treatment of acute leg ischemia with respect to amputation, fasciotomy, and mortality in older patients. METHODS: A total of 102 patients age >65 who had a Fogarty thrombo-embolectomy for acute thromboembolic limb ischemia were investigated retrospectively. Patients were evaluated based on Rutherford IIa and IIb criteria and duration of ischemia. Duration of ischemia was divided into 3 categories (as 0 to 4, 4 to 8, and >8 hours) to evaluate the effect of ischemia period on vital parameters and mortality. Analysis with Cox regression showed that 30-day mortality was associated with older age and number of comorbidities such as amputation and fasciotomy. RESULTS: In 102 patients >65 years of age who underwent embolectomy, rates were 7.2% fasciotomy (n = 7) and 13.7% amputation (n = 14), and 10 patients died (9.8%). According to multiple regression analysis, the surgical risk increases 1074 times when each year is added to the chronological age of over  65 years. CONCLUSION: In a majority of cases, limb salvage can be obtained via simple embolectomy rather than risking intravenous iodinated contrast. Although alternatives in older patients are limited, the Fogarty catheter should be regarded as a first-line treatment because of its ease of use and low complication rate.

Comparison of Two Sternal Closure Techniques Based on Risk Factors: A Prospective, Observational Study.

BACKGROUND: Stainless steel wires are still commonly used as a sternum closure technique. However, it can cause fatal complications due to rupture and dehiscence. It was anticipated that the sternal Cable System (Pioneer Surgical Technology Inc., Marquette, MI, USA) could provide a better sternal fixation and reduce the possible complications. Materials and Method. A total of 100 patients (57 male, 43 female) at high risk of dehiscence were included in this prospective observational study. Among those with EuroSCORE value of 4 and above, patients with chronic lung disease, chronic kidney disease, diabetes mellitus, obesity, smoking, body mass index, advanced age, and resurgery were operated in two separate centers. Standard steel wires (n: 51) used for sternotomy were compared with the sternal cable (n: 49). Early and late sternal dehiscence rates were compared in the study. The relationship between risk factors causing dehiscence and both methods was assessed statistically. RESULTS: Early dehiscence rates were 6.4% in those closed with a sternal cable (n: 3) and 11.8% in those closed with a sternal wire (n: 6) (p < 0.05)). In risky patients, body mass index was the most determining parameter in terms of sternum dehiscence risk. CONCLUSION: In risky patients, we recommend the sternal cable system as a good and reliable closure technique to achieve a more stable and compact sternum.