A prospective, randomised, controlled, multi-centre comparative effectiveness study of healing using dehydrated human amnion/chorion membrane allograft, bioengineered skin substitute or standard of care for treatment of chronic lower extremity diabetic ulcers
Zelen C.M.,Professional Education and Research Institute |
Gould L.,Kent Hospital |
Serena T.E.,Serena Group |
Carter M.J.,Strategic Solutions Inc. |
And 2 more authors.
International Wound Journal | Year: 2015
A prospective, randomised, controlled, parallel group, multi-centre clinical trial was conducted at three sites to compare the healing effectiveness of treatment of chronic lower extremity diabetic ulcers with either weekly applications of Apligraf® (Organogenesis, Inc., Canton, MA), EpiFix® (MiMedx Group, Inc., Marietta, GA), or standard wound care with collagen-alginate dressing. The primary study outcome was the percent change in complete wound healing after 4 and 6 weeks of treatment. Secondary outcomes included percent change in wound area per week, velocity of wound closure and a calculation of the amount and cost of Apligraf or EpiFix used. A total of 65 subjects entered the 2-week run-in period and 60 were randomised (20 per group). The proportion of patients in the EpiFix group achieving complete wound closure within 4 and 6 weeks was 85% and 95%, significantly higher (all adjusted P-values ≤ 0·003) than for patients receiving Apligraf (35% and 45%), or standard care (30% and 35%). After 1 week, wounds treated with EpiFix had reduced in area by 83·5% compared with 53·1% for wounds treated with Apligraf. Median time to healing was significantly faster (all adjusted P-values ≤0·001) with EpiFix (13 days) compared to Apligraf (49 days) or standard care (49 days). The mean number of grafts used and the graft cost per patient were lower in the EpiFix group campared to the Apligraf group, at 2·15 grafts at a cost of $1669 versus 6·2 grafts at a cost of $9216, respectively. The results of this study demonstrate the clinical and resource utilisation superiority of EpiFix compared to Apligraf or standard of care, for the treatment of diabetic ulcers of the lower extremities. © 2015 John Wiley & Sons Ltd and Medicalhelplines.com Inc.
Omeroglu H.,Eskiehir Osmangazi University |
Agus H.,Tepecik Teaching and Research Hospital |
Bicimoglu A.,Kent Hospital |
Tumer Y.,Ankara Numune Teaching and Research Hospital
Journal of Pediatric Orthopaedics | Year: 2012
Background: We aimed to evaluate experienced surgeons' decisions regarding the need for secondary surgery in developmental dysplasia of the hip (DDH) at 5 to 7 years of age. Methods: We selected 21 hips from 17 patients who had mid-term and skeletally mature radiographs and who had neither had complications nor secondary surgery until skeletal maturity after having an initial soft tissue surgery for DDH before the age of 18 months. Twenty experienced orthopaedic surgeons evaluated the mid-term follow-up radiographs of these hips in terms of their need for secondary surgery. Results: On the basis of management grading of the observers at mid-term follow-up, the risk of unnecessary surgical management was 12% in hips that would eventually be normal at skeletal maturity. The risk of not performing needed surgery was 40% in hips that would eventually become dysplastic at skeletal maturity. Experience of the surgeons in terms of years had no significant effect on the management decisions. The center-edge angle, the acetabular index angle (AIA), percentage of femoral head coverage, Shenton line, and the acetabular angle of Sharp were the 5 most commonly used radiographic parameters at mid-term follow-up to assess whether a secondary surgery would be needed. Center-edge angle, AIA, femoral head coverage, and Shenton line correlated, whereas the acetabular angle did not significantly correlate with surgeons' quantitative management decisions on the basis of mid-term radiographs. Conclusions: Experienced surgeons are more likely to opt for nonoperative management in hips that show no ischemic changes or instability at 5 to 7 years of age even in the presence of slightly abnormal radiographic measurements. AIA is considered the best radiographic parameter for making decisions regarding the need for secondary surgery in DDH at 5 to 7 years of age. Level of Evidence: Level II prognostic study. © 2012 by Lippincott Williams & Wilkins.
Hasdemir C.,Ege University |
Vuran O.,Ege University |
Yuksel A.,Kent Hospital |
Yavuzgil O.,Ege University
PACE - Pacing and Clinical Electrophysiology | Year: 2013
We present a case of 38-year-old woman with stress cardiomyopathy presenting to the emergency department with a 1-week history of recurrent syncope due to sustained polymorphic ventricular tachycardia. ©2012, The Authors. Journal compilation ©2012 Wiley Periodicals, Inc.
Kurt S.,Tepecik Training and Research Hospital |
Toz E.,Tepecik Training and Research Hospital |
Canda M.T.,Kent Hospital |
Sahin C.,Tepecik Training and Research Hospital |
Tasyurt A.,Tepecik Training and Research Hospital
European Journal of Obstetrics Gynecology and Reproductive Biology | Year: 2015
Objective: To investigate the relationship between two connective tissue pathologies: striae and pelvic organ prolapse (POP). Study design: Four hundred and eighty-eight women who had undergone gynaecological surgery were divided into two groups. The study group (n = 244) consisted of symptomatic patients with POP, and the control group (n = 244) consisted of cases who underwent surgery for benign gynaecological conditions without evidence of POP. The groups were compared in terms of the presence, intensity and severity of striae, as well as their general characteristics. Results: The presence of striae (p = 0.001), number of striae (p = 0.001) and Davey score (p = 0.00001) were significantly higher in the study group, and the absence of striae was more common in the control group (p = 0.00001). According to multivariate analysis, the presence of striae, an increased number of striae (>15) and a Davey score >2 increased the risk of POP 1.29 fold (p = 0.03, 95% confidence interval [CI] 1.14-1.35), 1.19 fold (p = 0.04, 95% CI 1.14-1.25) and 2.51 fold (p = 0.01, 95% CI 1.66-3.78), respectively. Conclusion: Striae may serve as a promising marker for POP. In particular, women who develop striae should be cautious about their risk for developing POP in the future, and should be informed about preventive methods for POP. © 2014 Elsevier Ireland Ltd. All rights reserved.
Akan M.,Kent Hospital
Anaesthesia, Pain and Intensive Care | Year: 2016
Postoperative intensive care management of transplanted cases has shown a rapid development since the introduction of liver transplantation (LT). While one-year survival rate after LT was 79% in 1998, it raised to 90% in 2008, and while ten-year survival rate was 33% in 1998, it raised to 66% in 2010 owing to improvements in preoperative optimization, surgical technique, intraoperative anesthesia management, organ preservation, intensive care and immunosuppressive treatment. Rapid hemodynamic stabilization, correction of severe coagulopathy, respiratory stabilization and early weaning from mechanical ventilation, appropriate fluid-electrolyte therapy, preservation of renal function, prevention of graft rejection and prophylaxis/treatment of infection are particularly important in intensive care management of liver transplanted patients. Since early postoperative period is critical, close monitoring, stabilization and maintenance of cardiorespiratory functions, frequent examination of graft function, early identification of complications and prompt treatment of extrahepatic organ failure are mandatory in order to reduce mortality/morbidity.
Perdrizet G.A.,Kent Hospital
Connecticut Medicine | Year: 2014
The purpose of this monograph is to narrow the knowledge gap between current medical practice and hyperbaric oxygen therapy. Graduate medical education has not kept pace with the expanding science and practice of hyperbaric medicine. The number of hyperbaric chambers in the state of Connecticut has increased by >400% during the past five years. A brief overview of the science and practice of hyperbaric oxygen therapy is presented, with additional resources identified where more in-depth coverage can be found. The reader will find the basics of hyperbaric medical practice reviewed and be able to recognize diagnoses that are appropriate for referral to a hyperbaric medical center. The intended audience is practitioners who have had no formal exposure to hyperbaric medicine or chronic wound care.
Mozdzanowski C.,Kent Hospital |
Perdrizet G.A.,Kent Hospital
Undersea and Hyperbaric Medicine | Year: 2014
Objective: Otic barotrauma (OBT) is an adverse event seen in patients receiving hyperbaric oxygen (HBO2) therapy. After encountering a case of painless tympanic perforation during HBO2 therapy of a diabetic patient with the diagnosis of neuropathic Wagner Grade III foot ulcer, we hypothesized that peripheral neuropathy of the lower extremity may be associated with an increased risk of asymptomatic OBT during HBO2 therapy. Methods: The medical records of all HBO2 patients during a one-year period of time were reviewed. Subjects were selected based on otoscopic documentation of OBT and divided into two groups based on the presence or absence of lower extremity peripheral neuropathy. Time to therapeutic compression, presence or absence of ear-related symptoms and modified Teed (mTeed) scores were compared between the two groups. Results: A total of 38 patients with OBT, 18 neuropathic and 20 non-neuropathic, were identified. Asymptomatic OBT occurred more frequently in the neuropathic vs. non-neuropathic group (56% vs. 5%, p<0.001). mTeed scores were significantly greater in the neuropathic vs. non-neuropathic group (mTeed 1, 30% vs. 61%; mTeed 2, 65% vs. 36%; mTeed 3, 4% vs. 3%; p = 0.032). Mean compression times were shorter in the neuropathic vs. non-neuropathic group (10. 5 ± 1.8 vs. 14.4 ± 3.3 minutes, p<0.001). Conclusions: The presence of peripheral neuropathy of the lower extremity may be associated with a significantly greater incidence of asymptomatic otic barotrauma during HBO2 therapy. Copyright © 2014 Undersea & Hyperbaric Medical Society, Inc.
Daoud E.G.,Kent Hospital
Critical Care and Shock | Year: 2015
Since its birth in the mid eighties of the last century, airway pressure release ventilation (APRV) has been a victim of much debate about its clinical use, benefits, and possible harms. With growing body of literature and evidence, APRV is gaining more acceptance and enthusiasm. Interesting research has been conducted in regards to its benefits in prevention of acute respiratory distress syndrome (ARDS), reduction of extra vascular lung water (EVLW), reduction in ventilator-induced lung injury (VILI), reduction of dead space, weaning off. mechanical ventilation, improvement of hemodynamics, improvement in oxygenation, impact on mortality, its use as a non-invasive mode of ventilation, and its role in improving lung procurement for transplantation. The research and clinical application has expanded beyond the adult patients to include critically ill pediatric patients and critically ill animals. This article will review some of the plethora of research done in an attempt to promote its implementation to the bedside. © 2015, Indonesian Society of Critical Care Medicine. All rights reserved.
Perdrizet G.A.,Kent Hospital
Connecticut Medicine | Year: 2014
Advances in the treatment of chronic wounds have steadily occurred over the past decade and include the specialized use of dynamic compression therapy, implementation of moist wound care techniques, chronic lymphedema therapy, negative pressure wound therapy, arterial compression therapy and application of offloading devices. General medical practitioners should recognize when timely patient referral to a comprehensive wound care center is indicated. The clinical practice of HBOT and its scientific basis has also advanced significantly during this same time period. HBOT is a therapeutic tool with many qualities that are unique to medical care and enable difficult and otherwise untreatable conditions to be safely and effectively managed. Level 1 evidence exists for HBOT and the therapeutic indications are growing. It is the responsibility of all practitioners to become informed about the modern principles and practice of HBOT . Clinicians should take the advice of Mark Twain: "Supposing is good but finding out is better." It is the responsibility of educational institutions and medical societies to become informed and actively engaged in hyperbaric medical care, education and research. This will benefit our patients as well as our systems of medical care. There is now ample access to hyperbaric oxygen facilities and expertise within the state. There is a growing need for HBOT services due to the rising incidence of obesity and diabetes combined with an aging demographic. Appropriate networks and patterns of referral have lagged behind this demand due to a generalized lack of understanding of the true risks, benefits and indications for HBOT . This review will hopefully begin to address this problem. Hyperbaric medicine is in an early phase of development. The current and future demand for clinical services will drive development of research and edu-cational programs. Only through continued efforts to perform high quality research and education will the full potential of HBOT be realized. Much remains to be done. As systems for the delivery of healthcare enter an era of population management, the regenerative potential of hyperbaric therapies should improve quality of and reduce costs and enable us to meet the challenge of providing care for the growing population of chronic wound patients.
Karatayli-Ozgursoy S.,Dr Sami Ulus Childrens Hospital |
Demireller A.,Kent Hospital
Ear, Nose and Throat Journal | Year: 2012
We report our experience with hyoid suspension surgery in patients with obstructive sleep apnea (OSA) diagnosed on the basis of polysomnographic criteria. We conducted a prospective, observational study of 20 patients-18 males and 2 females, aged 15 to 52 years (mean: 42.1)-who were treated at our tertiary care center. All patients underwent hyoid suspension surgery and uvulopalatopharyngoplasty (UPPP) in a single session. Postoperative success was defined as either (1) a reduction in the apnea-hypopnea index (AHI) from 20 or higher to less than 20 or (2) a reduction in AHI of at least 50%. Postoperative follow-up polysomnography indicated that surgery was successful in 18 of 20 patients (90%). No important complications were observed. We conclude that hyoid suspension surgery is an effective procedure with low morbidity for the treatment of OSA in selected patients with hypopharyngeal obstruction. We believe it is a good option for those patients who will not or cannot tolerate therapy with continuous positive airway pressure. © 2012 Vendome Group, LLC.