Use of cryopreserved umbilical cord with negative pressure wound therapy for complex diabetic ulcers with osteomyelitis

OBJECTIVE

The objective of this study was to evaluate the combined use of cryopreserved human umbilical cord (cUC) allograft and negative pressure wound therapy (NPWT) in treating complex diabetic foot ulcers (DFUs) with bone exposure and osteomyelitis. These types of wound are known to carry a high morbidity and mortality.

METHODS

A single-center, retrospective chart review was performed to assess the efficacy of the combined use of cUC with NPWT, by the same surgeon, to help promote the closure of complex DFUs presenting with biopsy-proven osteomyelitis. Change in wound size and volume, time to wound closure, and number of cUC applications were assessed.

RESULTS

We identified of 14 wounds in 13 patients, with an average initial wound area of (mean±standard devaition) 33.2±21.7cm² and wound volume of 52±26.2cm³. All achieved complete re-epithelialisation with an average time to closure of 24.0±10.9 weeks, using between 2-5 cUC applications. No adverse events were noted and none of the wounds required limb amputation during the a follow-up of 24 months for each patient.

CONCLUSION

The results suggest that combined use of cUC and NPWT may be effective in improving the healing of complex DFUs that present with osteomyelitis. Prospective, randomised controlled trials are warranted to confirm this efficacy as well as its potential applications in other chronic wounds.

A single-centre, retrospective study of cryopreserved umbilical cord/amniotic membrane tissue for the treatment of diabetic foot ulcers

OBJECTIVE

Histopathological studies have shown a prolonged inflammatory phase in wounds of patients with diabetes, delaying formation of mature granulation tissue and reducing wound tensile strength, making these wounds difficult for physicians to heal. Cryopreserved human umbilical cord (cUC) tissues possess unique anti-inflammatory and anti-scarring properties and have been found to help improve closure of these chronic wounds.

METHOD

A retrospective chart review was performed to assess the efficacy of cUC as an advanced treatment modality to help promote the closure of chronic DFUs. Overall healing rate, duration to wound closure, and number of cUC applications used to achieve closure were used to assess cUC treatment efficacy.

RESULTS

A total of 32 wounds in 29 patients treated at a single health-care centre were included in the study population The average initial wound area for all wounds was 10.6 ± 2.15cm². Of the 32 wounds 28 achieved complete epithelialisation for an overall healing rate of 87.5%. Average time to wound closure was 13.8 ± 1.95 weeks with a median of 9 weeks and an average of 1.68 ± 0.18 cUC applications.

CONCLUSION

The results suggest cUC allograft may be effective in improving the healing of DFUs ulcers as well as potentially reducing the medical costs associated with chronic DFUs due to the low number of applications needed to achieve complete wound closure. Prospective, randomised controlled trials are suggested to better understand the efficacy of cUC in chronic wound healing.

DECLARATION OF INTEREST

Dr Raphael is a paid speaker for Amniox Medical, Inc.

To tell or not to tell? Revealing the diagnosis in multiple sclerosis

We review briefly (1) the history of patient-physician relationship and its evolution from a physician-centered to patient-centered model; (2) the impact of the McDonald Criteria for Multiple Sclerosis (MS); (3) why it is important to tell patients of their diagnosis; (4) how physicians should disclose the diagnosis to patients; (5) dealing with suspected MS; and (6) prognosis and treatment. For the majority of clinically definite MS patients we advocate disclosure, identify steps for physicians to communicate the diagnosis and propose a framework to follow when revealing a diagnosis of MS.

Spherulite crystals in synovial tissue of a patient with recurrent monoarthritis

Frozen, unstained sections of synovial tissue of a 38-year-old man with recurrent monoarthritis and hyperuricemia were studied. Negatively birefringent crystals in a spherulite form were detected by using a compensated polarized light microscope. It is postulated that in some cases of gout the first stage of crystallization is in the spherulite form.

Fermentation Methods for Protein Enrichment of Cassava and Corn with Candida tropicalis

Candida tropicalis grows on soluble starch, corn, and cassava powders without requiring that these substrates be previously hydrolyzed. C. tropicalis possesses the enzyme needed to hydrolyze starch, namely, an α-amylase. That property has been used to develop a fermentation process whereby C. tropicalis can be grown directly on corn or cassava powders so that the resultant mixture of biomass and residual corn or cassava contains about 20% protein, which represents a balanced diet for either animal fodder or human food. The fact that no extra enzymes are required to hydrolyze starch results in a particularly efficient way of improving the nutritional value of amylaceous products, through a single-step fermentation process.

[Brain localization of South American blastomycosis. Considerations apropos of 9 cases]

Lesões encefálicas produzidas pelo Paracoccidioides brasiliensis têm sido registradas na literatura com relativa freqüência. Os autores chamam a atenção para a dificuldade diagnóstica dêstes processos que, na quase totali- dade, constituem-se de achados cirúrgicos ou de necropsia. A síndrome de hipertensão intracraniana é a manifestação mais comum, levando quase sempre ao diagnóstico de tumor intracraniano. Os exames complementares, inclusive o líquido cefalorraqueano, são pobres em dados específicos; o encontro do parasita, assim como a positividade das reações de fixação de complemento e de precipitação nesse humor, são raramente verificadas. A natureza da afecção só tem sido suspeitada quando existem lesões paracocci-dióicas conhecidas em outros órgãos. Nove casos de blastomicose sul-americana com localização encefálica são estudados. Sete foram submetidos a intervenções cirúrgicas, dêstes, 3 tiveram boa evolução, sendo os únicos que sobreviveram de tôda a série. Nos três casos foi empregada, em épocas diversas depois da intervenção cirúrgica, anfotericina B pelas vias intravenosa ou intratecal. Os autores consideram a excição cirúrgica dos granulomas encefálicos imprescindível, mormente quando existem sinais de compressão bem localizadas. Após o ato cirúrgico a administração de anfotericina B, pelas vias intravenosa ou intratecal, deve ser prescrita a fim de evitar possíveis recidivas da moléstia.