scholarly journals Clinical and morphological characteristics with markers of reparation in neuropathic diabetic foot ulcers.

2015 ◽  
Vol 18 (3) ◽  
pp. 70-76 ◽  
Author(s):  
Elena Yurievna Komelyagina ◽  
Evgenia Aleksandrovna Kogan ◽  
Mikhail Borisovich Antsiferov
Keyword(s):  
Smooth Muscle ◽  
Diabetic Foot ◽  
Smooth Muscle Actin ◽  
Morphological Characteristics ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
Muscle Actin ◽  
Ki 67 ◽  
Group 3 ◽  
Group 1

Aim. To compare the clinical and morphological characteristics of chronic diabetic foot ulcers and the markers of repair.Materials and Methods.We included 26 patients with neuropathic diabetic foot syndrome who had signs of severe peripheral neuropathy. Biopsies were performed from the margin and central part of the lesion and were fixed in a 10% formalin solution before being placed on paraffin slides and stained with hematoxylin and eosin. We assessed the percentages of necrotic, granulation and fibrotic tissues and the severity of vascular hyalinosis. Immunohistochemistry was performed with initial antibodies to Ki-67 (a marker of proliferation), smooth muscle actin (a marker of myofibroblast synthesis) and cytokeratin (a marker of epithelisation). For analysis, the samples were divided into three groups by the length of time the ulcer had been present: group 1 (≤90 days; 9 samples), group 2 (91–365 days; 10 samples) and group 3 (365 days; 9 samples).Results. The patients of group 3 were older than those of groups 1 and 2 (53.7±2.7 vs 51.7±5.9 vs 59.9±5.6 years; p=0.04). There were no differences in the duration of diabetes, glycated haemoglobin or severity of neuropathy. The percentage of necrotic tissue was higher in group 1 (33.7%±21.7% vs 11.0%±3.9% vs 12.8%±6.1%; p=0.02) and the percentage of fibrotic tissue was highest in group 3 (21.1%±21.0% vs 35.5%±19.8% vs 54.4%±23.9%; p=0.001). However, the amount of granulation tissue was not different between the groups (45.2%±21.1% vs 53.5%±21.1% vs 32.8%±26.3%; p=0.4). There was also no difference in the severity of vascular hyalinosis between the groups (p=0.9). Expression of Ki-67 was higher in groups 1 and 2, implying a greater capacity to regenerate. The expression of smooth muscle actin and cytokeratin was higher in groups 1 and 2 but without statistical significance.Conclusion. The morphological characteristics and regenerative capacities of neuropathic diabetic foot ulcers differ with the duration the ulcer has been present. Patients with ulcers for less than 1 year were characterised by higher cell proliferation but lower fibrosis. Neuropathic diabetic foot ulcers that are unable to heal over a year are characterised by incomplete regeneration and higher levels of fibrosis. Thus, different treatment approaches are needed depending on how long an ulcer has been present.

Benefits of Acidifying Agents in Local Therapy of Diabetic Foot Ulcers Infected by Pseudomonas sp: A Pilot Study

2019 ◽  
Vol 18 (3) ◽  
pp. 262-268 ◽  
Author(s):  
Vladimíra Fejfarová ◽  
Hana Tibenská ◽  
Jitka Niklová ◽  
Robert Bém ◽  
Michal Dubský ◽  
...  
Keyword(s):  
Pilot Study ◽  
Diabetic Foot ◽  
Local Treatment ◽  
Local Therapy ◽  
Study Groups ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
Pseudomonas Sp ◽  
Group 2 ◽  
Group 1

Infections caused by Pseudomonas sp are difficult to resolve by antibiotics (ATBs) and local therapy. The aim of our pilot study was to assess the effect of different local agents—particularly acidifying solutions—on the healing of diabetic foot ulcers (DFUs), eradication of pathogens, and economic costs related to DFU therapy. In this case study, we monitored 32 DFU patients infected by Pseudomonas species. Patients were divided into 2 groups according to the local therapy provided: group 1 (n = 15)—modern local treatment; group 2 (n = 17)—acidifying antiseptic solutions. The study groups differed only with regard to ATB usage prior to enrolment in the study ( P = .004), but did not differ with regard to age, diabetes control, peripheral arterial disease, or microcirculation status. During the follow-up period, DFUs healed in 20% of cases in group 1, but there were no cases of healing in group 2 (NS). The length of ATB therapy, the number of new osteomyelitis, lower limb amputations, and the changes of DFUs status/proportions did not differ significantly between study groups. Pseudomonas was eradicated in 67% of cases in group 1 and in 65% of cases in group 2. The local treatment given to group 2 patients was associated with lower costs ( P < .0001). Conclusion. Acidifying agents had the same effect as modern healing agents on wound healing, the number of amputations, and the eradication of Pseudomonas. Moreover, therapy performed using acidifying solutions proved in our pilot study markedly cheaper.

scholarly journals Effect of Direct Oral Anticoagulants for Ulcer Epithelization and Laser Doppler Flowmetry Parameters In Patients with Diabetic Foot Syndrome and Atrial Fibrillation

2021 ◽  
Vol 17 (4) ◽  
pp. 552-556
Author(s):  
V. I. Petrov ◽  
N. V. Rogova ◽  
T. N. Кuzmina ◽  
A. S. Lishuta
Keyword(s):  
Diabetic Foot ◽  
Pulse Wave ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
Doppler Flowmetry ◽  
Group 2 ◽  
Respiratory Wave ◽  
Group 1

Aim. To study changes in epithelialization of diabetic foot ulcers and parameters of laser Doppler flowmetry (LDF) in patients with diabetic foot syndrome (DFS) and atrial fibrillation (AF) during complex therapy with the addition of direct oral anticoagulants (DOAC).Material and methods. An open-label comparative randomized study in parallel groups was performed. Patients with neuroischemic DFS and persistent FA without previous anticoagulant therapy were randomized into two groups: combination therapy for DFS and rivaroxaban (group 1; n=24) or combination therapy for DFS and dabigatran (group 2; n=22). Changes in local status in diabetic foot ulcers, coagulogram parameters and LDF were studied at 4 and 12 weeks.Results. Complete epithelialization of diabetic foot ulcers after 12 weeks was found in 14 (58.3%) patients in group 1, and in 10 (45.4%) patients in group 2. Statistically significant improvements in LDF parameters were found in both groups in both groups: an increase in the microcirculation index by 53.5% (p=0.02), pulse wave by 124.0% (p=0.003), respiratory wave by 59.4% (p=0.007) was found in group 1. An increase in the microcirculation index by 48.5% (p=0.02), pulse wave by 73.1% (p=0.003), respiratory wave by 47.1% (p=0.03) were found in group 2.Conclusion. Positive statistically significant changes in epithelialization of diabetic foot ulcers and LDF parameters were found in patients with DFS and AF during 12 weeks of complex therapy with the addition of DOACs (rivaroxaban and dabigatran). Further research for DOACs in DFS patients is needed.

Intranodal Palisaded Myofibroblastoma

2007 ◽  
Vol 131 (2) ◽  
pp. 306-310 ◽  
Author(s):  
Thong Nguyen ◽  
Mahmoud A. Eltorky
Keyword(s):  
Smooth Muscle ◽  
Smooth Muscle Actin ◽  
Muscle Actin ◽  
Ki 67 ◽  
Female Ratio ◽  
Male Female Ratio ◽  
Microscopic Features ◽  
Intranodal Palisaded Myofibroblastoma ◽  
Slow Growing ◽  
Cut Surface

Abstract Intranodal palisaded myofibroblastoma (IPM) usually presents as a painless, slow-growing inguinal mass. Our review of 42 cases from 13 publications indicates that two thirds of IPMs occur between the ages of 45 and 55 years, the male-female ratio is 2:1, and there is a lack of ethnic predilection. Grossly, the IPM cut surface shows areas of hemorrhage. Five microscopic features are seen: (a) compressed remnants of lymphoid tissue at the periphery; (b) spindle cells with nuclear palisading; (c) intraparenchymal hemorrhage and erythrocyte extravasation; (d) so-called amianthoid fibers; and (e) intracellular and extracellular fuchsinophilic bodies that stain positive for smooth muscle actin. Immunohistochemically, IPM is positive for smooth muscle actin and cyclin D1 and negative for S100, glial fibrillary acidic protein, CD34, and desmin, and it shows a low proliferative index of Ki-67. Electron microscopy demonstrates features of myofibroblasts and smooth muscle cells. Excellent prognosis is seen after surgical treatment, with an approximately 6% recurrence rate and no malignant transformation.

scholarly journals Topical Administration of Pirfenidone Increases Healing of Chronic Diabetic Foot Ulcers: A Randomized Crossover Study

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
Marcela Janka-Zires ◽  
Paloma Almeda-Valdes ◽  
Ana Cecilia Uribe-Wiechers ◽  
Sonia Citlali Juárez-Comboni ◽  
Joel López-Gutiérrez ◽  
...  
Keyword(s):  
Crossover Study ◽  
Diabetic Foot ◽  
Conventional Treatment ◽  
Topical Administration ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
Group 2 ◽  
To Receive ◽  
Randomized Crossover Study ◽  
Group 1

Only 30 percent of chronic diabetic foot ulcers heal after 20 weeks of standard treatment. Pirfenidone is a drug with biological, anti-inflammatory, and antifibrotic effects. The aim of this study was to evaluate the effect of topical pirfenidone added to conventional treatment in noninfected chronic diabetic foot ulcers. This was a randomized crossover study. Group 1 received topical pirfenidone plus conventional treatment for 8 weeks; after this period, they were switched to receive conventional treatment only for 8 more weeks. In group 2, the order of the treatments was the opposite. The end points were complete ulcer healing and size reduction. Final data were obtained from 35 ulcers in 24 patients. Fifty-two percent of ulcers treated with pirfenidone healed before 8 weeks versus 14.3% treated with conventional treatment only (P=0.025). Between 8 and 16 weeks, 30.8% ulcers that received pirfenidone healed versus 0% with conventional treatment (P=0.081). By week 8, the reduction in ulcer size was 100% [73–100] with pirfenidone versus 57.5% with conventional treatment [28.9–74] (P=0.011). By week 16, the reduction was 93% [42.7–100] with pirfenidone and 21.8% [8–77.5] with conventional treatment (P=0.050). The addition of topical pirfenidone to conventional treatment significantly improves the healing of chronic diabetic noninfected foot ulcers.

scholarly journals Efficacy and safety of the combination of isosorbide dinitrate spray and chitosan gel for the treatment of diabetic foot ulcers: A double-blind, randomized, clinical trial

2018 ◽  
Vol 15 (4) ◽  
pp. 348-351 ◽  
Author(s):  
Sylvia Elena Totsuka Sutto ◽  
Yunuen Itzet Rodríguez Roldan ◽  
Ernesto German Cardona Muñoz ◽  
Teresa Arcelia Garcia Cobian ◽  
Sara Pascoe Gonzalez ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Isosorbide Dinitrate ◽  
Diabetic Foot ◽  
Smooth Muscle Actin ◽  
Healing Process ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
Number Of Patients ◽  
Chitosan Gel ◽  
Better Than

Aim: To evaluate whether a combination of isosorbide dinitrate spray and chitosan gel (10%) topically applied can have additive benefits for management of diabetic foot ulcers. Methods: In a randomized, placebo-controlled, double-blinded clinical trial, 68 patients were divided into four groups: Group 1: treated with chitosan gel; Group 2: isosorbide dinitrate spray; Group 3: combination of isosorbide dinitrate spray and chitosan gel; Group 4: placebo. Results: Histological analyses showed a significant regeneration in all groups ( p < 0.001). On the final assessment of the ulcer, using the combination was found a wound closure percentage of 71 ± 30, 70 ± 27 using isosorbide dinitrate, 58 ± 30 with chitosan and 50 ± 16 with placebo. The number of patients who achieved complete ulcer closure was six using the combination, four with isosorbide dinitrate, three with chitosan and one with placebo. The progression in the healing process of the ulcer showed marked inmunohistochemical differences of Von Willebrand Factor, desmin, vascular endothelial growth factor-A and α-smooth muscle actin in all groups ( p < 0.001), but without notable differences between them. Conclusion: The combination was better than placebo to reduce the dimensions of the ulcer, accelerate healing and increase the number of patients who achieved complete closure of the ulcer, but the combination was not better than chitosan or isosorbide dinitrate used separately.

scholarly journals A Rare Ovarian Tumor: Primitive Leiomyosarcoma of the Ovary

2017 ◽  
Vol 1 (2) ◽  
Keyword(s):  
Smooth Muscle ◽  
Ovarian Tumor ◽  
Poor Prognosis ◽  
Malignant Tumors ◽  
Smooth Muscle Actin ◽  
Proliferation Index ◽  
Muscle Actin ◽  
Ki 67 ◽  
Eosinophilic Cytoplasm ◽  
Mitotic Proliferation

The primitive leiomyosarcoma of the ovary is rare and represents less than 1% of malignant tumors. It has a poor prognosis and frequently occurs during the postmenopausal period. We report two cases of this tumor in order to determine their epidemiological, histopathological, and evolutive aspects. Material and methods: The study material was consisted of ovariectomies fixed in 10% formalin. The sampled ovaries were subjected to usual techniques of inclusion in paraffin wax. These routine techniques were completed by immunohistochemistry assay using smooth muscle anti-actin, anti-desmin, anti-vimentin, and mitotic proliferation index (Ki-67). Results: Histological examination has shown a proliferation of fusiform cells, which were more or less fascicled in both cases. Tumor cells had a poorly-limited eosinophilic cytoplasm containing an elongated or an oval nucleus presenting an hyperchromatic or a vesicular feature. The nuclei were nucleolated. The anisocaryose was intense with more than 20 mitoses for 10 HPF. The positivity of anti-smooth muscle actin, anti-desmin, and anti-vimentin confirmed the diagnostic of leiomyosarcoma. Conclusion: The ovarian leiomyosarcoma is a rare with a poor prognosis.

Efficacy of Recombinant Human Epidermal Growth Factor (Regen-D 150) in Healing Diabetic Foot Ulcers: A Hospital-Based Randomized Controlled Trial

2019 ◽  
Vol 19 (2) ◽  
pp. 158-164 ◽  
Author(s):  
Vijay Viswanathan ◽  
Udyama Juttada ◽  
Mary Babu
Keyword(s):  
Growth Factor ◽  
Epidermal Growth Factor ◽  
Diabetic Foot ◽  
Complete Healing ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
Human Epidermal Growth Factor ◽  
Epidermal Growth ◽  
Group 2 ◽  
Group 1

To validate the efficacy of recombinant human epidermal growth factor (hEGH) in healing diabetic foot ulcers (DFUs) at biochemical and molecular levels. A total of 50 noninfected DFU subjects were recruited for the study and divided into 2 groups based on the treatment application on the subjects. Group 1: DFU subjects treated with hEGH gel-based product called Regen-D 150 (n = 27) and group 2: DFU subjects treated with alternative placebo as the control group (n = 23). Patients were observed for 30 days and punch biopsy was taken at days 0 and 14. Histologic analysis was done to study the matrix alignment, cellular infiltration, and differentiation of epithelial layers. Biochemical analysis was done to quantitatively estimate the amount of collagen and proteoglycans regenerated in the wound area. Complete healing of ulcers was observed in 21 (78%) subjects in group 1, whereas only 12 (52%) subjects among group 2 reported of complete healing of ulcer after completion of the study period of 30 days. Collagen and fibroblasts were significantly developed in group 1 when observed in the follow-up samples. Healing time of the wound among the group 1 subjects was significantly less than the group 2 subjects (45 ± 12 vs 72 ± 18 days, P < .0001) and even showed a better blood glucose level. Early and regular application of the hEGH on DFUs will lead to prevention of leg amputations and would serve to act as a major treatment therapy for healing of chronic wounds.

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