The wound area as a parameter guiding the timing of abdominal closure in the management of patients undergoing open abdominal procedures

OBJECTIVE

Surgical site infections (SSI) are incomparably troublesome and complicated, and some of them require an open abdomen (OA) procedure. While deciding the timing of abdominal closure, wound area calculation method and laboratory parameters can be used to guide the timing of abdominal closure after OA procedures.

PATIENTS AND METHODS

The records of the patients who had undergone open abdomen during their treatment course and were followed up with vacuum-assisted closure (VAC) technique between December 2015 and December 2019 were retrospectively analyzed. The laboratory results before the first VAC application and the results after the VAC change were compared to determine a predictive parameter. The ImageJ program was used in five patients to compare the size of the wounds at the time of the decision to close them and before the first VAC application.

RESULTS

102 patients were analyzed. The ratio of the last wound area to the wound area at the time of the first VAC application in five patients was 0.30, 0.41, 0.34, 0.27, 0.46 (mean: 0.36, standard deviation: 0.078) which were measured and calculated by ImageJ software.

CONCLUSIONS

We think that the concept of wound reduction ratio, which was calculated by a computer program, can be used as a concrete equivalent of the wound closure eligibility criteria decided by clinical experience.

Predictive value of neutrophiltolymphocyte ratio in the severity of non-alcoholic fatty liver disease among type 2 diabetes patients

BACKGROUND

Non-alcoholic fatty liver disease is a progressive inflammatory disease that ultimately results in cirrhosis and liver failure. It is assosiciated with two step hit scenario; the first step is fat accumulationin liver and in the second step inflammation and fibrosis are the major compenents. The incidence of this disease is increasing worldwide, following rising incidences of obesity and diabetes mellitus.

AIM

The aim of this study is to analyze the relationship between non-alcoholic fatty liver disease andseverity and neutrophil-to-lymphocyte ratio among the patients having type 2 diabetes mellitus.

METHODS

This study involved 143 patients with type 2 diabetes who were placed into four groups (grade 0, 1, 2, 3) based on steatosis level due to blinded ultrasonographic evaluation. Biochemical parameters and counts of total white blood cells, neutrophils, and lymphocytes were determined. Neutrophil-to-lymphocyte ratio was compared across the four patient groups.

RESULTS

Levels of hemoglobin A1c, creatinine, alanine aminotransferase, high-density lipoprotein cholesterol and triglycerides were significantly different between the four patient groups (ANOVA p-values: p <0.001, p=0.011, p=0.002, p=0.034, p=0.002, respectively). Counts of white blood cells, neutrophils, lymphocytes, and neutrophil-to-lymphocyte ratio significantly differed between the groups (p <0.001). Neutrophil-to-lymphocyte ratio was positively correlated with steatosis grade (p < 0.001).

CONCLUSIONS

Neutrophil-to-lymphocyte ratio increases with increasing grade of non-alcoholic fatty liver disease in patients with type 2 diabetes, and may be a convenient marker to follow progression of non-alcoholic fatty liver disease. (Acta gastro-enterol. belg., 2016, 79, 295-300).