A new principle for the diagnosis morphea in the onset of the disease

BACKGROUND: Because of the low specificity morphea clinical manifestations in early stages, the differential diagnosis is difficult. AIMS: The purpose of the research is to propose a new diagnostic method for early stages of localized scleroderma. MATERIALS AND METHODS: During 20112020, 77 patients with clinical manifestations of morphea and 127 controls were examined and included in the study at the LenOblCenter. All participants were conducted a transcutaneous oximetry with the TCM-400 Radiometer apparatus. The tissue oxygen perfusion (tcpO2) level from 40 to 50 mm Hg was considered as a reversible decrease, from 30 to 40 mm hg was a borderline decline and the value below 30 mm hg was critical. The following diagnostic skin biopsy was conducted in all 77 patients RESULTS: Skin biopsy allowed to form 4 research groups: 40 patients with morphea, 12 patients with granuloma annulare, 15 patients with small plaque parapsoriasis and 10 individuals with large plaque parapsoriasis. 7 (17.5%) patients with morphea had normal tcpO2 values, 9 (22.5%) patients had significant decrease of tcpO2, 24 patients (60%) showed a reversible decrease of tcpO2. 3/12 (25%) patients with granuloma annulare and 1 patient (10%) with large plaque parapsoriasis had minor oxygen level decrease. Measurement on the healthy skin showed tcpO2 decrease in patients with comorbidities ― 3/77 (3.9%) in research group and 28/127 (22%) in controls. CONCLUSIONS: Transcutaneous oximetry is a new perspective direction in the diagnostic algorithm of the morphea based on the pathogenesis and morphological features of the disease.

What Is Currently the Role of TcPO2 in the Choice of the Amputation Level of Lower Limbs? A Comprehensive Review

Some patients still require major amputation for lower extremity peripheral arterial disease treatment. The purpose of pre-operative amputation level selection is to determine the most distal amputation site with the highest healing probability without re-amputation. Transcutaneous oximetry (TcPO2) can detect viable tissue with the highest probability of healing. Several factors affect the accuracy of TcPO2; nevertheless, surgeons rely on TcPO2 values to determine the optimal amputation level. Background about the development of TcPO2, methods of measurement, consequences of lower limb amputation level, and the place of TcPO2 in the choice of the amputation level are reviewed herein. Most of the retrospective studies indicated that calf TcPO2 values greater than 40 mmHg were associated with a high percentage of successful wound healing after below-knee-amputation, whereas values lower than 20 mmHg indicated an increased risk of unsuccessful healing. However, a consensus on the precise cut-off value of TcPO2 necessary to assure healing is missing. Ways of improvement for TcPO2 performance applied to the optimization of the amputation-level are reported herein. Further prospective data are needed to better approach a TcPO2 value that will promise an acceptable risk of re-amputation. Standardized TcPO2 measurement is crucial to ensure quality of data.

The Influence of Combined Physical Therapy Procedures on Oxygen Partial Pressure in Tissues Surrounding Ulcer in Patients With Venous Leg Ulcers

Venous ulcers in lower legs remain a profound treatment problem in contemporary medicine. Proper healing requires, among other things, sufficient blood supply and provision of suitable amount of oxygen to the treated tissues. The aim of the study was to assess the influence of combined physical therapy applied in patients with chronic venous leg ulcers on the oxygen partial pressure values. Fifty-four patients (25 females and 29 males), in the age range of 38 to 89 years with chronic venous leg ulcers, underwent a cycle of 15 procedures with the use of Laserobaria-S device. During a procedure, the patient’s lower limb was simultaneously exposed to oxygen having the pressure of 1.5 ATA, low-frequency magnetic field, and low-energy light radiation. Before procedures, directly after the first procedure, as well as on completion of the entire therapeutic cycle, the patients underwent oxygen partial pressure measurements in the tissues surrounding the ulceration area, by means of transcutaneous oximetry, with the use of Medicap Précise 8008s device. The combined physical therapy shows a statistically significant increase of oxygen partial pressure values in tissues surrounding the ulceration, from the average of 68.63 ± 17.04 mm Hg before commencing the therapeutic cycle, to the average of 74.20 ± 18.92 mm Hg after the first procedure ( P < .001) and to the average value of 83.79 ± 20.74 mm Hg ( P < .001) after completion of therapeutic cycle. Combined physical therapy procedures cause a statistically significant increase of oxygen partial pressure values in tissues surrounding the ulceration, assessed using the objective method of transcutaneous oximetry, both in women and men.

SURGICAL METHODS OF TREATMENT OF CHRONIC DISTAL ISCHEMIA OF UPPER EXTREMITIES

Summary. Introduction. Indications for operations on the arterial arc of the brush can bediagnosed distal thromboembolism, thrombosis and occlusion of the arteries with stored the main blood flow through the arteries of the forearm. Purpose of the study. Improve the treatment results for patients with chronic upper limb ischemia. Materials and methods. We have analyzed the result of the treatment of 64 patients with chronic arterial ischemia of the upper limbs. All interventions were performed under conduction anesthesia by interscalene brachial plexus block under ultrasound control. Results. Digital periarterial sympathectomy gives a pronounced long-lasting effect, it can be regarded as a method of choice in the treatment ucral ischemia of the hand. Direct intervention on arterial arch of hand in some cases allows to restore the main blood flow, which significantly improves treatment results. Data triplex scanning arterial arch of the hand and finger arteries and transcutaneous oximetry indicate the increase of linear blood flow velocity and decrease of the index of peripheral vascular resistance in all cases. Dynamics of evaluation of serum nitric oxide and VEGF in venous blood of the affected limb shows the increase of the studied parameters, confirming the effectiveness of sympathectomy to improve blood supply. Conclusions. Digital periarterial sympathectomy in Raynaud’s syndrome and obliterating atherosclerosis allows to achieve better treatment results than the rib sympathectomy.

Hyperbaric Oxygen Therapy in Non Healing Wounds in a Referral Hospital of Bangladesh

Introduction: The therapeutic use of oxygen under pressure is known as hyperbaric oxygen therapy (HBOT) and has been used to assist wound healing for almost 40 years. The purpose of the present study was to see the outcome of hyperbaric oxygen therapy following its use in non healing wounds. Methods: This prospective observational study was conducted in the Department of Plastic Surgery, Dhaka Medical College Hospital, Dhaka, from March 2016 to February 2017 for a period of 12 (twelve) months. The study was carried out on patients with non healing wounds. Patients were initially assessed with detailed history, clinical examination and investigations, and then treated with hyperbaric oxygen therapy for 90 minutes per session in 6 days a week for 25 cycles. Wound was assessed clinically, and with transcutaneous oximetry and laboratory investigations. Results: Eighty patients were included, where 52 (65.0%) patients had diabetic ulcer, followed by post traumatic wound (14) and venous ulcer (7). Fifty nine (73.75%) patients had initial wound size of < 50 cm2 with mean size 14.78 ± 12.5 cm2. Wound size reduction rate after 15 cycles of HBOT was 42.78%, and after 25 cycles of HBOT it was 61.21%. Among the 80 patients, 60 (75.0%) had moderate amount of discharge before HBOT; 19 (31.67%) & 25 (41.67%) reduced to small & no discharge after 25 cycles of HBOT respectively. 39 (48.75%) patients had serosanguineous discharge before HBOT, followed by 36 (45.0%) and 5 (6.25%) patients with purulent and serous discharge. Among the 39 patients with serosanguineous discharge, 15 (38.46%) & 20 (51.28%) patients had serous & no discharge after 25 cycles of HBOT respectively. Before starting HBOT, mean transcutaneous oximetry was 58.26 ± 3.84 mmHg, and it was 62.1 ± 6.27 mmHg and 66.92 7.52 mmHg after 15 and 25 cycles of HBOT respectively. Conclusion: So it can be stated that the hyperbaric oxygen therapy is a good option in treating different non healing wounds. J Bangladesh Coll Phys Surg 2019; 37(3): 109-118