Functional assessment of autologous platelet-rich plasma (PRP) after long-term storage at -20 °C without any preservation agent

BACKGROUND

Platelet-rich plasma (PRP) is increasingly being used in the treatment of chronic wounds, pathologies of the musculoskeletal system, and in cosmetic medicine; however, the preparation of platelet-rich plasma is both time-consuming and requires invasive intervention. Additional costs are introduced if special equipment is used during preparation. The aim of the present study is to test whether autologous platelet-rich plasma (PRP) preserves the feature of growth factor release when stored at -20 °C after preparation.

METHOD

Autologous PRP concentrates were prepared using whole blood samples obtained from 20 healthy subjects and divided into three parts to form three groups. Epidermal growth factor (EGF), vascular endothelial growth factor (VEGF), platelet derived growth factor-AB (PDGF-AB), insulin-like growth factor 1 (IGF-1), transforming growth factor-beta (TGF-β), and P-Selectin levels were immediately analysed in the control group. The other groups were defined as the experimental groups and were stored at -20 °C and analysed on the 7th and the 14th days. The same growth factors were tested in the experimental groups.

RESULTS

The growth factors (EGF, VEGF, PDGF-AB, IGF-1, TGF-β) and P-selectin levels were significantly decreased in the autologous PRP samples stored at -20 °C compared to the control group.

CONCLUSION

The growth factor levels on days 7 and 14 suggest that autologous PRP can be stored at -20 °C without preservative agents, although in vivo studies are required in order to evaluate the clinical efficacy of the detected growth factor levels.

The Protective Effects of Epigallocatechin Gallate Against Distant Organ Damage After Severe Skin Burns--Experimental Study Using a Rat Model of Thermal Trauma

BACKGROUND

Epigallocatechin gallate (EGCG), a green tea polyphenol, has potent antioxidant properties.

OBJECTIVES

The purpose of the present study was to examine the possible preventative effects of EGCG against internal organ injury due to large-surface skin burns in a rat model.

MATERIAL AND METHODS

The study design involved three groups of rats: a sham group and two groups with 25-30% full-thickness burns: (a) the sham group without burns or treatment (n=18); (b) the control burn group (burns+sterile saline, n=18); and (c) the burn treatment group (burns+treatment with EGCG, n=18). EGCG was administered intraperitoneally immediately after the thermal injury, and daily in 100 μmol/kg doses. Kidney and lung tissue samples were taken to determine the levels of malondialdehyde (MDA), superoxide dismutase (SOD), tumor necrosis factor-α (TNF-α), and glutathione peroxidase (GPX) after the first, third and seventh post-burn days.

RESULTS

In the EGCG-treated burn group, SOD and GPX activity were significantly higher than in the burn control group. Additionally, MDA and TNF-α levels were significantly lower in the EGCG-treated burn group.

CONCLUSIONS

Based on this study, it might be anticipated that EGCG treatment may be beneficial in burn injury cases.

Effect of epigallocatechin gallate on ischemia-reperfusion injury: an experimental study in a rat epigastric island flap

Epigallocatechin gallate (EGCG), a polyphenol derived from green tea, is known to have potent antioxidant and anti-inflammatory properties. The aim of this study was to investigate the protective effects of EGCG against ischemia reperfusion injury in the epigastric artery island flap model in rats. The experiment was designed with two groups (control n=40, experiment n=40) of rats with epigastric artery island flaps. Each main group was randomly divided into five sub-groups to apply ischemia at different time intervals (0, 3, 6, 9 and 12 hours). Thirty minutes prior to reperfusion, 100 μmol/kg of EGCG was injected intraperitoneally, and this injection was repeated after 12 hours and continued as a daily injection. Similarly, 2 ml of sterile saline was administered to the rats in the control groups. Superoxide dismutase, glutathione peroxidase, malondialdehyde and tumor necrosis factor alpha levels, together with neutrophil counts, were measured in the tissues taken from the distal portions of the flaps 24 hours after reperfusion. Additionally, flap necrosis was examined on the seventh day after reperfusion. Superoxide dismutase levels were significantly lower in all control groups, and Malondialdehyde and Tumor Necrosis Factor Alpha levels were significantly higher in all control groups. Glutathione peroxidase levels were found to be significantly lower in the control groups after 0, 3, 9 and 12 hours of ischemia. There was no statistically significant difference between the groups undergoing 0, 3, 9 or 12 hours of ischemia with regard to the neutrophil count. Partial flap necrosis occurred in the 9-hour ischemia groups, and significantly lower rates of necrosis were observed in the experimental groups compared to the control groups. The findings of our study showed that EGCG has a protective effect against ischemia-reperfusion injury in skin flaps in the epigastric island flap model.

Tramadol as a local anaesthetic in tendon repair surgery of the hand

This double-blind pilot study compared the local anaesthetic effects of tramadol plus adrenaline with lidocaine plus adrenaline during surgery to repair hand tendons. Twenty patients were randomly allocated to receive either 5% tramadol plus adrenaline (n = 10) or 2% lidocaine plus adrenaline (n = 10). Injection site pain and local skin reactions were recorded. At 1-min intervals after injection of the anaesthetic agent, the degree of sensory blockade was assessed by the patient reporting the extent to which they felt a pinprick, light touch and a cold sensation. Pain felt during surgical incision was also recorded. There was no difference in the quality of sensory blockade or the incidence of side effects between the two groups. Only patients treated with tramadol did not require additional post-operative analgesia. A combination of tramadol plus adrenaline provided a local anaesthetic effect similar to that of lidocaine plus adrenaline.

The effects of onion extract on hypertrophic and keloid scars

OBJECTIVE

To evaluate the therapeutic activity of topical onion extract in gel form on hypertrophic and keloid scars, focusing on problems such as elevation, redness, hardness, itching and pain.

METHOD

This comparative prospective study assigned 60 patients to three groups. Group I was treated with onion extract alone, group 2 with silicon gel sheet alone and 3 group with a combination of onion extract and silicon gel sheet.

RESULTS

In the group comparisons, a significant difference was observed at the end of six months in the colour parameter between group I and group 2 and in the height parameter between group I and group 3 (ANOVA post-hoc Tukey's test, p<0.01 and p<0.05 respectively). The onion extract was more effective in relation to scar colour, while the silicon gel sheet was superior in decreasing the height of scar (paired sample t-test, p<0.001). In addition, the most effective therapeutic results were obtained when the silicon gel sheet treatment was combined with onion extract in group 3.

CONCLUSION

Onion extract improved hypertrophic and keloids scars via multiple mechanisms. However, it was statistically ineffective in improving scar height and itching. For this reason, onion extract therapy should be used in combination with an occlusive silicon dressing to achieve a satisfying decrease in scar height.

An unusual case of lymphedema tarda

BACKGROUND

Lymphedema is the result of the equilibrium between the load to be cleared and the transport capacity of the clearing system. Lymphedema may be classified as primary or secondary, based on the underlying etiology. Primary lymphedema is an unusual disorder characterized by inadequate lymphatic drainage. Lymphedema tarda is a rare form of primary lymphedema.

CASE REPORT

The case of lymphedema tarda documented here was chronic, progressive, and resistant to medical therapy and recurred several times after previous operations.

CONCLUSIONS

We performed two-staged operations and we recommend that the staged excisional procedures offers reliable long-term improvement and minimizes postoperative complications in chronic advanced lymphedema.

Cross-Sectional Internal Diameters of Radial, Thoracodorsal, and Dorsalis Pedis Arteries in Children: Relationship to Subject Sex, Age, and Body Size

The purpose of this study was to determine the average diameter of the radial, thoracodorsal, and dorsalis pedis arteries in a pediatric population and to evaluate the relationship of these measurements to the subject's age, sex, height, weight, and body mass index (BMI). The internal diameters of the radial, thoracodorsal, and dorsalis pedis arteries were non-invasively studied in 45 normotensive, presumed normal children of various ages (4 to 14 years) with the use of a Doppler system. The average diameters of the radial, thoracodorsal, and dorsalis pedis arteries in females and males were as follows: radial artery 1.39 (SD +/- 0.18) mm and 1.57 (SD +/- 0.18) mm; thoracodorsal artery 1.27 (SD +/- 0.11) mm and 1.36 (SD +/- 0.2) mm; and dorsalis pedis artery 1.22 (SD +/- 0.08) mm and 1.34 (SD +/- 0.12) mm. These were correlated with the age, height, weight, and BMI. Gender had a strong influence on the diameter of these arteries. In a linear regression model, weight was found to be statistically the best independent variable for predicting radial and dorsalis pedis diameters, whereas age was the best predictor for the diameter of the thoracodorsal artery. The diameters of these three arteries in an age group of 4 to 14 years ranged between 1 to 2 mm. The age and weight of the children predicted the diameters of the peripheral arteries.

Beneficial effects of Ebselen on corrosive esophageal burns of rats

AIM

This study was evaluated to investigate the efficacy of Ebselen, which is an organoselenium compound and glutathione peroxidase mimic, on the prevention of stricture development after esophageal caustic injuries in the rat.

METHODS

Thirty healthy male Wistar albino rats were utilized in this study. The rats were randomly allotted into one of three experimental groups: group A (sham) animals were uninjured. Caustic esophageal burn was created by applying 1 ml of 37.5% NaOH to the distal esophagus. Group B rats were injured but untreated. Group C rats were injured and received Ebselen (10 mg/kg/day) via the oral route. Blood and tissue samples for the biochemical and histopathological analysis were taken all rats at the end (28th day) of the experiment. Oxidative stress is believed to play a role in the pathogenesis of corrosive esophageal burns. To assess changes in the cellular antioxidant defense system, we measured the activities of antioxidant enzymes (such as glutathione peroxidase (GSHPx), superoxide dismutase (SOD), and catalase (CAT)) in esophagus homogenates. We also measured esophageal tissue malondialdehyde (MDA) levels, a marker of lipid peroxidation, to determine whether there is an imbalance between oxidant and antioxidant status. Efficacy of the treatment was assessed by measuring the stenosis index and histopathologic damage score and biochemically by determining tissue hydroxyproline content, lipid peroxidation and antioxidant enzyme levels.

RESULTS

The stenosis index in group B was significantly increased compared with group A and C (P<0.05). The hydroxyproline level was significantly increased in group B compared with group A and C (P<0.05). In group B, the histopathologic damage score was significantly higher than in group C (P<0.05). Treatment with Ebselen decreased tissue hydroxyproline levels, histological damage, and the stenosis index. Caustic esophageal burn increased the lipid peroxidation and also decreased the antioxidant enzyme levels in group B. Ebselen treatments for 28 days decreased the elevated lipid peroxidation and also increased the reduced antioxidant enzyme levels. Live weights of the rats was significantly decreased in group B compared with group A and C (P<0.05).

CONCLUSION

It is concluded that Ebselen has a preventive effect in the development of fibrosis and decrease the lipid peroxidation, and increase the antioxidant defense system activity in an experimental model of corrosive esophagitis in rats.

Caffeic acid phenethyl ester improves oxidative organ damage in rat model of thermal trauma

Severe burn injuries cause functional impairment in distant internal organs. Although this mechanism is not clear, it is possible that free radical toxicity plays an important role. Research in animals and clinical studies have shown that there is a close relationship between a lipid peroxidative reaction and secondary pathological changes following thermal injury. It has been demonstrated that antioxidant treatment prevents oxidative tissue damage associated with thermal trauma. This study was designed to determine the possible protective effect of caffeic acid phenethyl ester (CAPE) treatment against oxidative damage in the kidney and lung induced by thermal injury. Rats were decapitated either 1, 3 or 7 days after burn injury. CAPE was administered intraperitoneally immediately after thermal injury. Kidney and lung tissues were taken for the determination of malondialdehyde (MDA) level, myeloperoxidase (MPO), catalase (CAT), superoxide dismutase (SOD) and xanthine oxidase (XO) activities. Severe skin thermal injury caused a significant decrease in SOD and CAT activities, as well as significant increases in MDA level, XO and MPO activities in tissues during the postburn period. Treatment of rats with CAPE (10 micromol/kg) significantly elevated the decreased SOD and CAT activities, while it decreased MDA levels and MPO as well as XO activity.

No-vertical-scar technique versus inverted T-scar technique in reduction mammoplasty: a two-center comparative study

Currently, a reverse T-shaped scar remains in the infraareolar area after most of the frequently used techniques for reduction mammoplasty. A two-center study was performed for an understanding of the effects from the amount of scars on the aesthetic satisfaction of patients. Long-term follow-up results for 24 patients who underwent the McKissock (inverted T-scar) technique (group 1) in a university hospital were compared with the results for 29 patients who underwent a "no-vertical-scar technique" (group 2) at another hospital in terms of aesthetic results. With this aim, a questionnaire was designed to assess the patients' degree of aesthetic satisfaction with different aspects. Additionally, the most current photos of each patient were evaluated for aesthetic results by four physicians and four medical students. Areola-fold and nipple-notch distances were measured as an objective evaluation. The significance of the results was tested using dependent or independent sample t tests. Notch-nipple and areola-fold distances both were greater in group 2 than in group 1, both preoperatively and postoperatively (p < 0.001). The personal satisfaction questionnaire showed that the group 2 patients rated scar satisfaction and postoperative activity levels higher (p < 0.001) than the group 1 patients (p < 0.05), but that group 1 rated nipple position higher (p < 0.05). There was no significant difference between the two groups in terms of general aesthetic satisfaction. Physicians who evaluated patient photos ranked the scars of group 2 as significantly superior to those of group 1 (p < 0.01), whereas they did not rate other features as significantly different. However students could not determine any superiority of any feature between the two groups. The no-vertical-scar technique gives the impression of a breast that has not undergone surgery because it leaves no scars in the infraareolar area and invisible scars in other areas. This situation improves the degree of satisfaction for patients in the postoperative period. When the general aesthetic success and the ratio of complications were evaluated, the no-vertical-scar technique was found to be just as successful as the T- scar technique, which is practiced widely.

Spotting the signs: a case of late diagnosed painful calciphylaxis

Although the number of cases of calciphylaxis is increasing, it is often not diagnosed until a late stage, increasing the risk of mortality. A characteristic is purple, mottled and painful lesions, which have a tendency to become necrotic.

Dual Synergistic Effect: The Effect of Dexamethasone Plus Carnitine on Skin Flap Survival

Dexamethasone has well-known useful effects in dealing with the progression of necrosis. Carnitine is an endogenous cofactor, for having a regulatory action on the energy flow from different oxidative sources. The aim of this study was to determine whether combined local dexamethasone and systemic carnitine administration would result in an additive enhancement of skin flap survival in the rat model. A rectangular (3 cm x 11 cm) dorsal random skin flap was elevated on the rats and then sutured back into its original site with separate sutures. Overall, 40 rats were allocated randomly into 4 groups: Group 1 (control group, n = 10), group 2 (Dexamethasone group, n = 10, 2.5 mg/kg), group 3 (carnitine group, n = 10, 100 mg/kg), group 4 (dexamethasone plus carnitine group, n = 10).The mean flap survival area was 57.50 +/- 5.2% (mean survival area +/- SD) in control group (group 1), 71.5 +/- 4.8% in the dexamethasone group (group 2), 73.0 +/- 5.5% in the carnitine group (group 3), 85.30 +/- 6.1% in the dexamethasone plus carnitine group (group 4). In conclusion, based on the findings of this experimental study, the synergistic effect of carnitine and dexamethasone on skin flap viability is determined.

Morphology of the gluteal region in the female population 5 to 83 years of age

This study evaluated the development of gluteal region morphology in the female population 5 to 83 years of age. For the study, 132 female subjects were placed into four groups: prepubertal (ages 5 to 8 years; n = 10), pubertal (ages 9 to 14 years; n = 38) postpubertal (ages 15 to 41 years; n = 34), and menopausal-postmenopausal (older than 42 years; n = 29). The age, weight, and height of the subjects were routinely recorded, and body mass index was estimated. In addition, 11 measurements were performed on the gluteal region. The data were analyzed by Pearson and Spearmen correlation analyses using SSPS 11.0 for Windows. In the prepubertal group, the intergluteal sulcus and infragluteal sulci did not actively change. Weight gain was the major factor influencing the shape of the gluteal region, whereas age had no effect. In the puberty group, the gluteal region expanded in all directions. During this period, it was difficult to determine any specific relation between measurements because of significant correlation involving all parameters. However, it should be mentioned that among the four groups, only in pubertal group did age significantly affect the shape of the gluteal region. In other three groups, weight seemed to be a major determinant. In the pospubertal and menopausal-postmenopausal groups, the buttocks sagged with weight gain, contrary to the belief that this happens with aging. This causes movement of the infragluteal sulci in downward and lateral directions as well as lengthening of intergluteal sulcus. Although the gluteal shape is open to the effects of demographic factors such as ethnicity, feeding habits, and lifestyle, according to these findings, it might be advised that in the assessment of the gluteal region morphology, it would be better to consider its dynamic nature. Reshaping its only one part, which can be devastating unless the whole gluteal region and upper limb are addressed.

Evaluation by Scintigraphy of Hindlimb Ischemia in a Rat Model

The subject of ischemia-reperfusion has commonly been studied in rat hindlimb models. Unfortunately, in these experiments, the ischemia procedures lack standardization. For this reason, the authors evaluated the reliability of rat ischemia models described in the literature using scintigraphy. The study comprised six groups. Each consisted of ten male Wistar rats; five of them underwent methoxy-isobutyl-isonitrile (MIBI) scintigraphy, which is specific for muscle, and the others underwent methylene diphosphanate (MDP) scintigraphy, which is specific for bone. In Group 1, only the iliac artery was ligated; in Group 2, the iliac artery and its branches, except for the superficial epigastric artery, were ligated; in Group 3, the iliac artery and vein were ligated; in Group 4, the iliac artery and all branches, including the superficial epigastric artery, were ligated; in Group 5, in addition to ligation of the iliac artery and its branches, the skin was incised circumferentially around the pelvic girdle; in Group 6, a tourniquet was applied to the limb at the pelvic level. After 2-hr warm ischemia, a radioactive tracer was injected intravenously. In the MIBI group, images were taken at the twentieth minute and second hour after injection, and in the MDP group, at the fifth minute and third hour after injection. The radioactivity in both hind limbs of the animal was measured, and the ratio of the control to the ischemic limb was calculated. In the first five groups, there was no necrosis in the ischemic limb at the end of 2 weeks. The measured radioactivity in the ischemic limb was lower than that of the control limb in all groups. The ratio of activity obtained from the control limb to that of the ischemic limb in the tourniquet group was significantly higher, compared to other groups in both MIBI and MDP evaluations (p < 0.005). Significant ischemia was also seen in the skin incision group (Group 5). A low-flow state was observed in the ischemic limb in Groups 1-4 using both scintigraphic modalities. The tourniquet method (Group 6) provided almost complete limb ischemia, compared to other arterial ligation methods, and it is practical to use for complete ischemia when studying the physiology of replantation or free flaps.

Calciphylaxis involving both the upper and lower extremities

Calciphylaxis is an uncommon complication of end stage renal disease (ESRD) and secondary hyperparathyroidism. It characterized by cutaneous necrosis with mural calcifications and thrombosis in the small vessels of dermis. It is important to diagnose and treat, because of mortality rate from calciphylaxis is very high. We present the case of a patient with ESRD and type II diabetes mellitus developing calciphylaxis of the both upper and lower extremities had normal corrected calcium-phosphate product level. After amputation, necrosis was showed rapid progression resulting in death in one month.

Caffeic acid phenethyl ester improves oxidative organ damage in rat model of thermal trauma

Severe burn injuries cause functional impairment in distant internal organs. Although this mechanism is not clear, it is possible that free radical toxicity plays an important role. Research in animals and clinical studies have shown that there is a close relationship between a lipid peroxidative reaction and secondary pathological changes following thermal injury. It has been demonstrated that antioxidant treatment prevents oxidative tissue damage associated with thermal trauma. This study was designed to determine the possible protective effect of caffeic acid phenethyl ester (CAPE) treatment against oxidative damage in the kidney and lung induced by thermal injury. Rats were decapitated either 1, 3 or 7 days after burn injury. CAPE was administered intraperitoneally immediately after thermal injury. Kidney and lung tissues were taken for the determination of malondialdehyde (MDA) level, myeloperoxidase (MPO), catalase (CAT), superoxide dismutase (SOD) and xanthine oxidase (XO) activities. Severe skin thermal injury caused a significant decrease in SOD and CAT activities, as well as significant increases in MDA level, XO and MPO activities in tissues during the postburn period. Treatment of rats with CAPE (10 micromol/kg) significantly elevated the decreased SOD and CAT activities, while it decreased MDA levels and MPO as well as XO activity.

Complications of minor cutaneous surgery in patients under anticoagulant treatment

Anticoagulant use is common in the elderly population. The role of these medications in the postoperative period is not well defined. We designed a prospective study to evaluate the incidence of postoperative complications in patients taking aspirin and warfarin. A prospective study was performed on 102 patients undergoing minor cutaneous plastic surgery. The number of subjects using regular aspirin, warfarin, and that of the patients with no anticoagulant medication were 37, 21, and 44, respectively. Complications were defined as minor, moderate, or major based on predetermined criteria. Of patients taking warfarin, 57% had some complication, significantly more than complications in the control group. The number of major complications in the warfarin group was significantly higher than those of the control and aspirin groups (p = 0.02). Also, the total number of complications in the warfarin group was significantly higher than the control group, but there was no significant difference between aspirin and control groups (p > 0.05). Cutaneous surgery in patients who receive warfarin is associated with a risk of major complication, but this risk does not exist in the patients receiving chronic aspirin treatment.