Peripheral vascular disease may manifest as either arterial stenosis or calcification of the arterial wall. Arterial stenosis is characterized by a lowered ankle-brachial-pressure index (ABPI), whereas calcified arteries lead to an increased ABPI. The current study investigates whether inflammatory and oxidative stress markers differ in low versus high ABPI groups suggesting different biochemical processes. Eighty-seven patients attending the diabetes complications clinic agreed to the study. Participants were divided into a low (<1.07) and a high (>1.23) ABPI tertile groups and compared for traditional and emerging biomarker differences. A clinical history and demographic data were obtained. Emerging biomarkers included C-reactive protein, interleukin-6, 8-hydroxy deoxy-guanosine, D-dimer, reduced glutathione and malondialdehyde. Data was analyzed using a Student T-test with significance set at 0.05. A multivariate normal linear regression model was applied to determine the contributions of traditional and emerging biomarkers to the classification of low and high ABPI. No differences were observed between the two groups for the traditional biomarkers but D-dimer (p < 0.001) and glutathione (p < 0.05) were significantly different between the groups. The best model for predicting ABPI class included the emerging biomarkers C-reactive protein, D-dimer and Interleukin-6 combined with BGL, HbA1c and SBP (p < 0.001) as compared to the best traditional biomarker model of HbA1c, atherogenic index of plasma, low-density lipoprotein and SBP (p < 0.05). A decreased inflammatory component with increased oxidative stress is more likely to lead to calcification of the arteries and a higher ABPI, despite normal BGL, HbA1c and cholesterol profile. Our study shows that emerging biomarkers provide a sound basis for differentiating pathophysiological processes associated with low and high ABPI. Traditional biomarkers showed a high accuracy for identification of low ABPI in our model but failed to do better than chance for identification of high ABPI, suggesting different pathophysiological pathways that include oxidative stress and inflammatory components. Clinically, validation of novel and more comprehensive risk factors for PVD sheds light on the etiology of the disease and mechanics of progression toward better preventative care, early detection and targeted drug delivery.

The object of this study was to investigate the bridging treatment of enteric fistulae by vacuum-assisted closure (VAC) therapy in patients with open abdomen.

To compare physical morbidity and health-related quality of life (HRQOL) in breast cancer patients who received standard axillary dissection (ALND) or sentinel lymph node biopsy (SLNB), followed by axillary dissection only in the case of sentinel-node positivity, within a randomised clinical trial.Patients with early breast cancer ≤ 3 cm and clinically negative axilla were randomly allocated to ALND or SLNB. All patients underwent physical examination every 6 months in order to assess any arm-related symptoms. A subset of patients completed the SF-36 quality of life questionnaire and the Psychological General Well Being Index (PGWBI) before randomisation, at 6 and 12 months after surgery and yearly thereafter. Results of the first 24 months are reported.Six-hundred and seventy-seven patients were available for analysis: 341 patients randomised to the ALND group and 336 to the SLNB group. Six months after surgery, the SLNB group had significantly less lymph-oedema, movement restrictions, pain and numbness with respect to the ALND group. Lymph-oedema was also significantly reduced at 12 months and numbness remained significantly less frequent in the SLNB arm at all time points. Three-hundred and ten patients participated in the HRQOL assessment. The mean scores of the PGWB questionnaire general index and anxiety domain were significantly better in the SLNB group than in the ALND group but the difference ceased to be significant at 24 months.The SLNB is associated with reduced arm morbidity without evidence of a negative impact on psychological well being. While waiting for long-term results of ongoing randomised clinical trials, the SLNB may be proposed for early stage breast cancer patients after adequate information on the expected advantages and the possible risks.

Diabetes and its complications is increasing world-wide, making the identification and of disease progression and appropriate management increasingly difficult. Ulceration of the lower limb is a common complication of diabetes and requires careful assessment and follow-up of the wound characteristics. The lack of wound specialists and economic factors such as time to attend an appointment in metropolitan clinics as well as travel has led to the development of The Wound Healing Analysis Tool (WHAT). The program was tested on 16 images obtained at a podiatric health clinic and results compared to the clinical specialist. The program achieved 87% accuracy for this trial indicating that it may be a useful adjunct for initial screening of wounds and effectiveness of treatment outcomes.

Obwohl Richtlinien für die Behandlung von unterschiedlichen Ätiologien (Dekubitus, Ulcus cruris, Diabetisches Fußsyndrom etc.) und Pflegestandards bei Patienten mit chronischen Wunden bereits publiziert wurden, kann ein Großteil der Patienten davon nicht profitieren. Anhand einer 83-jährigen Patientin werden stellvertretend für eine Vielzahl von, vor allem geriatrischen, Patienten die existierenden Defizite auch aus der Sicht der Angehörigen dargestellt und analysiert. Es wird versucht Lösungsmöglichkeiten und Erfahrungen aufzuzeigen, um diesen Patienten eine adequate und effiziente Behandlung zukommen zu lassen. Die Kalkulationen aus internationalen Analysen, aber auch die Analysen aus eigenen laufenden Projekten belegen ein beträchtliches Einsparungspotential für die Kostenträger bei gleichzeitig qualitativ und quantitative besserem Behandlungserfolg.

Abstract Abstract #5150 Objective: Objective cosmetic analyses are important to reproducibly evaluate cosmetic outcome after oncoplastic surgery, breast conserving surgery or new radiotherapy methods such as partial breast irradiation. We developed a new objective scoring software, the breast analysing tool (BAT), to measure cosmesis using a single frontal picture. Method: Images from 129 breast cancer patients after breast conserving therapy and radiotherapy were analysed with the software. Distances from the breast border to the nipple, from the Jugulum to the nipple and the breast circumference of one breast was subtracted from the other. The difference in pixels transferred to a breast symmetry index (BSI) by using a mathematic formula. This results in a BSI ranging between 0 (excellent cosmesis) and 11 (bad cosmesis). The results were correlated with the subjective Harris scale ranging from 1-4 (excellent, good, fair and poor cosmesis) and another objective tool, the breast cancer conserving treatment cosmetic result (bcct.core) software. Subjective analyses were done by students (n=4), surgeons (n=10) and experts in breast surgery (n=2) as well as by international experts using a Delphi procedure (n=13). Results: All subjective scores significantly (p<0.05) correlated with the BAT score with a Pearson correlation coefficient of 0.719 (students), 0.697 (surgeons), 0.760 (experts local) and 0.60 (experts international). There was also a significant correlation between the bcct.core and the BAT software with a correlation coefficient of 0.581. Conclusion: The BAT software is ready to be used for prospective and retrospective trials in local breast cancer therapy. Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 5150.

Background: Pressure ulcers, ulcus cruris and surgical wound infections and disorders belong to the most frequent diseases in our medical system. Treatment of such chronic wounds is often troubled due to subjective documentation, which is usually imprecise. Judging slight changes of lesions is often almost impossible, even for experienced health professionals. Existing computer-based documentation tools allow only measurement of wound size and are actually impractical and not cost effective.Methods: We have developed a new, computer-based, easy-to-use wound analysing tool by using a "no-touch technique''. This semiautomatic software can exactly measure the size of a lesion, including vertical and horizontal diameter, area and circumference, by analysing a picture taken by a digital camera. To straighten out the photo, a calibration marker is placed next to the wound which optimizes the quality of the analysis. Furthermore, the system is capable of tissue validation. Necrosis, fibrin and granulation tissue are automatically distinguished and quantied, which is essential for judging the wound-healing process. After finishing the analysis, a report is created and saved in a database together with all the collected data and pictures.Results: Histological samples of chronic wounds have been taken and surveyed which the have approved the validity of the analyses. Additionally, several independant observers have demonstrated the efficacy of the system by analysing the same lesion. Measuring the size and the tissue types of a wound takes about 90 seconds per lesion. Creating a report with suggestions for therapy needs 4 min.Conclusions: Our newly developed tool is easy to use, accurate and cheap. The software runs on common PCs and the pictures can be taken by an ordinary state-of-the-art digital camera. With this tool swift analyses of wounds can be performed, objectively stating the size and the tissue composition of the lesions, which is impossible for the naked human eye.

Redon drains are still used to suction wounds for vacuum sealing. Vacuum-assisted closure (V.A.C.((R)); Kinetic Concepts Inc, San Antonio, TX) is a computer-controlled therapy system for delivering topical negative pressure therapy. The efficiency of V.A.C. in the treatment of pressure ulcers was prospectively studied in a randomised controlled trial in which patients with pressure ulcers were randomly assigned to negative pressure wound therapy (NPWT) using either V.A.C. or Redon bottles. The target parameters were absolute and relative proportion of wound area consists of granulation tissue, fibrin and necrosis. Other outcome measures were the number of dressing changes and time invested using each system. The study was terminated after a post hoc analysis after inclusion of ten patients because of the significantly better results when using V.A.C., and the substantially larger care effort needed in the Redon group compared with the V.A.C. group. An increase in surface granulation tissue of 54% was observed in the V.A.C. group, and a reduction in the Redon group (P = 0.001). The Redon group showed an increase in fibrin tissue at the wound base of 21.8%, whereas in the V.A.C group, a 27% reduction was observed (P = 0.035). Necrosis was reduced in the V.A.C. group, but this difference did not reach significance. Redon bottles are not a good alternative for V.A.C. therapy for delivering NPWT.

Redon drains are still used to suction wounds for vacuum sealing. Vacuum-assisted closure (V.A.C.(R); Kinetic Concepts Inc, San Antonio, TX) is a computer-controlled therapy system for delivering topical negative pressure therapy. The efficiency of V. A. C. in the treatment of pressure ulcers was prospectively studied in a randomised controlled trial in which patients with pressure ulcers were randomly assigned to negative pressure wound therapy (NPWT) using either V. A. C. or Redon bottles. The target parameters were absolute and relative proportion of wound area consists of granulation tissue, fibrin and necrosis. Other outcome measures were the number of dressing changes and time invested using each system. The study was terminated after a post hoc analysis after inclusion of ten patients because of the significantly better results when using V. A. C., and the substantially larger care effort needed in the Redon group compared with the V. A. C. group. An increase in surface granulation tissue of 54% was observed in the V. A. C. group, and a reduction in the Redon group (P = 0.001). The Redon group showed an increase in fibrin tissue at the wound base of 21.8%, whereas in the V. A. C group, a 27% reduction was observed (P = 0.035). Necrosis was reduced in the V. A. C. group, but this difference did not reach significance. Redon bottles are not a good alternative for V. A. C. therapy for delivering NPWT.

Colorectal DiseaseVolume 9, Issue 6 p. 572-573 VAC and fistula formation T. Wild, T. Wild Medical University, Vienna, Austria.E-mail: thomas.wild@meduniwien.ac.atSearch for more papers by this authorP. Goetzinger, P. Goetzinger Medical University, Vienna, Austria.E-mail: thomas.wild@meduniwien.ac.atSearch for more papers by this authorB. Telekey, B. Telekey Medical University, Vienna, Austria.E-mail: thomas.wild@meduniwien.ac.atSearch for more papers by this author T. Wild, T. Wild Medical University, Vienna, Austria.E-mail: thomas.wild@meduniwien.ac.atSearch for more papers by this authorP. Goetzinger, P. Goetzinger Medical University, Vienna, Austria.E-mail: thomas.wild@meduniwien.ac.atSearch for more papers by this authorB. Telekey, B. Telekey Medical University, Vienna, Austria.E-mail: thomas.wild@meduniwien.ac.atSearch for more papers by this author First published: 15 June 2007 https://doi.org/10.1111/j.1463-1318.2007.01309.xCitations: 10Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume9, Issue6July 2007Pages 572-573 RelatedInformation

Vacuum therapy is an efficient alternative to conservative wound care and creates new possibilities for the treatment of a variety of chronic and acute wounds. Already more than two thousand years ago vacuum treatment was applied in traditional Chinese medicine and also today vacuum therapy is used more and more frequently in daily clinical practice. The positive effects of the therapy are based on the stimulation of blood flow, formation of granulation tissue, angiogenesis, as well as cell proliferation, accelerated secondary wound closure and the removal of bacteria from the wound. As can be demonstrated based on a clinical picture of the open abdomen, vacuum therapy based on KCI's (Kinetic Concepts Inc) VA.C. system (Vacuum Assisted Closure) provides a possibility for not only accelerating the healing process, but also significantly lowering mortality. Since vacuum therapy in the form of the V.A.C. system represents a relatively expensive intervention, a comparison with conventional healing methods is demonstrated. Clinical studies with high evidence level show that both economic and clinical advantages of the vacuum therapy speak for its application. Savings with respect to the faster healing rates, the reduced dressing changes, as well as hospital stay and the care requirements, and the reduction of subsequent illnesses, compensate for the higher initial costs. Although many reports exist on treatment successes with the application of V.A.C. therapy, there are several cases for which vacuum therapy is contraindicated. In order to make sure that V.A.C. therapy is effective, a range of precautions and contraindications are described. The European Wound management Association (EWMA) just wrote a position paper on V.A.C. therapy. This is available at www.ewma.org.

The cosmetic result after breast surgery is an important marker in clinical studies. Most authors used subjective scales to judge breast cosmesis. However, inter-observer discrepancies are very high and the use of such subjective scales for prospective trials is highly disputed. In this study we present for the first time a new invented breast symmetry index (BSI). This BSI is calculated by subtracting the size and the shape between both breasts (frontal view and side view). The BSI is measured with a software system called breast analysing tool (BAT) from digital photographs. The photographs of 27 patients have been analysed with this software by different physicians to evolve inter-observer reproducibility. The Harris scale for subjective cosmetic analyses has been correlated with the BSI. In our study the inter-observer reproducibility was excellent (Pearson correlation r=0.9; p<0.05) and the BSI was able to significantly differentiate between good and bad cosmesis (BSI values from 0%d to 30%d is good, BSI>30%d is bad cosmesis). Thus the BSI may be used for clinical studies.

In this paper a novel pelletising process is described utilising one-axial compression. Compression tests of saw dust samples were conducted at different applied forces, moisture contents, process temperatures and hold up times using a compression cell powered by an Instron testing machine. Additionally the effect of heating in saturated and unsaturated atmosphere was studied. The densities of loaded and relaxed pellets and the tensile strengths of the compacts were used as quality criteria. Furthermore the pore size distributions of wood the pellets from the presented experiments were obtained by mercury porosimetry and compared to those of commercial wood pellets.

Chronic wounds are a growing challenge for physicians and health insurance agencies. The burden of affected patients is enormous, because of pain but also because of long‐lasting therapies and dependence on nursing services. In other areas of medicine, computer‐based diagnostics is established, yet, accurate wound documentation is rarely conducted and is often limited to size measurement with a ruler and a rough photo documentation. Objective assessment of lesions by evaluation of granulation tissue, fibrin coverage and necrosis is not performed. The aim of this study was to investigate the spread and variety in judgement of a chronic wound. A diabetic ulcer was described by 16 wound therapists (eight physicians and eight nurses). Granulation tissue, fibrin coverage, necrosis, size and depth of the lesion, wound exudate and wound edges were judged, and the therapeutical consequences were determined. Study data show an extensive inhomogeneity and a wide spread of the results, like in no other field of medical diagnostics. This could be shown in the group of physicians, as well as in the group of nursing personnel. As the choice of treatment by a specialist is based upon the assessment of the wound, it is possible that in practice it can lead to suboptimal therapy. This is a consequence of varying treating physicians and subsequent changes in treatment regimens. This results in a prolongation of treatment and burden for the patient. Circumstances like this contribute to rising of costs in this area of the health care system. The goal is to apply objective wound diagnostic technologies in the field of chronic wounds to catch up with other diagnostic procedures.