Serum levels of nitric oxide and endothelin-1 in vasculopathy managed with hyperbaric oxygen therapy.

Roles of nitric oxide (NO) and endothelin-1 (ET-1) in the local regulation of blood flow under physiological conditions are important and well known, while data on their effects and interactions in conditions of hyperbaric hyperoxia is still insufficient. This was a prospective observational study which included patients who underwent hyperbaric oxygen therapy (HBOT) in accordance with existing therapeutic protocol for peripherial arterial disease (PAD) during time period of six months, between january and july of 2016. Clinical stage of PAD according to Fontain was taken into account, as well as risk factors, demographic, anthropometric and clinical characteristics of studied patients. The study included 64 patients with a mean age (±Sd) 60.2±12.7 years, of whom 28 were female. Patients' NO serum levels in all observed categories before and after HBOT were not signifficantly different, except for stage II PAD (NObefore HBOT 21.9±9.6 vs. NOafter HBOT 26.2±12.1 (p = 0.04)). On the contrary, in all studied patients ET-1 level increased signifficantly after HBOT (ET-1before HBOT 4.2±11.6 vs. ET-1after 18.3±21.0 (p < 0.001)). Treatment of PAD using HBOT leads to the predominance of vasoconstrictor effects probably caused by elevation of serum ET-1 concentrations, while other factors such as exposure time to hyperbaric conditions, activation of antioxidant molecules, and the influx of other interfering substances must be considered in interpreting the effects of NO molecules.

[Current decubitus prevention and treatment algorhytm]. / Algoritam prevencije i lijecenja dekubitusa.

Decubitus ulcer treatment options, as well as the etiology, classification and prevention guidelines are presented. The importance of a multidisciplinary approach along with prevention and education is emphasized. The National Pressure Ulcer Advisory Panel guidelines ensure contemporary decubitus ulcer treatment all over the world, while adoption of the basic algorithm is a precondition of good medical practice and nursing care. Upgrading the patient quality of life and complete healing of decubitus ulcer is definitely achievable by strict application of these recommendations.

[Role of negative pressure therapy in the treatment of chronic wounds]. / Uloga terapije negativnim tlakom u tretmanu kronicnih rana.

Negative Pressure Wound Therapy (NPWT) is one of the supportive options for chronic wound treatment. The level of negative pressure is between 40 and 125 mm Hg below ambient. Good results in increasing angiogenesis, improvement of blood flow in wounds, edema reduction, regulation of moist environment, granulation tissue stimulation and wound retraction have been proved. In addition, bacterial burden in the wound and the amount of harmful products (exotoxins, endotoxins, cytokines and matrix metalloproteinases) are also significantly reduced. Chronic wound healing time is accelerated in comparison with other conservative treatments. The NPWT can be applied in either inpatient or outpatient settings.

[Role of debridement in treatment of chronic wounds]. / Uloga debridmana u lijecenju kronicnih rana.

Debridement is the process of removing dead tissue from the wound bed. Since devitalized tissue can obstruct or completely stop healing of the wound, it is indicated to debride wound bed as part of the treatment process. The aim of debridement is to transform a chronic wound into an acute wound and to initiate the process of healing. Debridement is the foundation of each wound treatment and it has to be repeated, depending on the necrotic tissue formation. There are several types of debridement: surgical, autolytic, chemical, enzymatic, mechanical, and biological. Using previous knowledge and advances in technology, new types of debridement have been introduced. Besides standard methods, methods of pulsed lavage debridement (hydro-surgery, water-jet) and ultrasound-assisted wound treatment (UAW) are ever more widely introduced. The method of debridement the clinician will choose depends on the amount of necrotic (devitalized) tissue in the wound bed, the size and depth of the wound, the underlying disease, the possible comorbidity, as well as on the general condition of the patient. Frequently, the methods of debridement are combined in order to achieve better removal of devitalized tissue. Debridement in addition significantly reduces bacterial burden. Regardless of the method of debridement, it is essential to take pain to the lowest point.