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Diabetes

A recent study in Diabetes Care evaluated whether medical hyperspectral technology (HT) was effective in predicting diabetic foot ulcer healing. Hyperspectral technology is a diagnostic scanning tool used to quantify tissue oxyhemoglobin (HT-oxy) and deoxyhemoglobin (HT-deoxy).

 

Subjects included 10 patients with type 1 diabetes who had a combined 21 foot ulcer sites, 13 patients with type 1 diabetes without ulcers, and 14 control subjects who did not have diabetes. HT-oxy and HT-deoxy were measured up to 4 times in a 6-month period at or near the ulcer area and on the upper and lower extremity distant from the ulcer. These values were used to calculate an HT healing index for each site.

 

The sensitivity of the HT index for predicting ulcer healing when evaluated on images taken at the first visit was 93%; specificity, 86%; positive predictive value, 93%; and negative predictive value, 86%. Therefore, HT can be used to predict diabetic foot ulcer healing by identifying tissue oxygenation and microvascular abnormalities.

 

Source: Khaodhiar L, Dinh T, Schomacker KT, et al. The use of medical hyperspectral technology to evaluate microcirculatory changes in diabetic foot ulcers and to predict clinical outcomes. Diabetes Care 2007;30:903-10.

 

Burns

Topical, gel-based nitric oxide promotes reepithelialization and wound closure when applied to full-thickness burns in rats, according to a study published in the April 2007 issue of World Journal of Surgery.

 

Histologic study showed that nitric oxide significantly increased inflammatory cell infiltration compared to the control group. A higher expression of myeloperoxidase as a result of this increase was noted using immunoblotting.

 

Immunohistochemistry study using CD31, a marker for endothelial cells, showed that nitric oxide also stimulated angiogenesis. A significant increase in collagen synthesis in the wound bed was detected using a procollagen antibody, thus demonstrating that nitric oxide speeds up wound closure, concluded the researchers.

 

Source: Zhu H, Ka B, Murad F. Nitric oxide accelerates the recovery from burn wounds. World J Surg 2007;31:624-31.

 

Venous Ulcers

The effectiveness of the SCD EXPRESS intermittent pneumatic compression system to increase popliteal vein volume flow and capacity when used in combination with a 4-layer bandage system was evaluated in a study published in the April 2007 issue of the European Journal of Vascular and Endovascular Surgery.

 

Eighteen patients (median age = 76 years) with venous leg ulcers were studied, for a total of 20 limbs. Using duplex ultrasonography, the total volume flow (TVF) and peak systolic velocity (PSV) were measured in the popliteal vein without bandage, with a 4-layer bandage in place, and at least 15 minutes after applying the SCD compression system on top of the 4-layer bandage.

 

The median TVF was 71 mL/min without bandage, 112 mL/min with a 4-layer bandage, and 291 mL/min with the SCD system combined with the 4-layer bandage; the median PSV was 8.4 cm/sec without bandage, 13 cm/sec with a 4-layer bandage, and 27 with the SCD system combined with the 4-layer bandage. The median venous clinical severity score (VCSS) was 17; the median venous segmental disease score (VSDS) for reflux was 4.5.

 

The researchers concluded that adding the SCD system to a 4-layer bandage system increased TVF and PSV 3-fold, demonstrating that the SCD EXPRESS compression system accelerates venous flow in patients with venous leg ulcers who are already receiving treatment using a 4-layer bandage system.

 

Source: Kalodiki E, Ellis M, Kakkos SK, et al. Immediate hemodynamic effect of the additional use of the SCD EXPRESS Compression System in patients with venous ulcers treated with the four-layer compression bandaging system. Eur J Vasc Endovas Surg 2007;33:483-7.