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BACKGROUND: Diabetic foot ulcers are one disabling complication of diabetes mellitus. Pirfenidone (PFD) is a potent modulator of extracellular matrix. Modified diallyl disulfide oxide (M-DDO) is an antimicrobial and antiseptic agent. AIM: To evaluate efficacy of topical PFD + M-DDO in a randomized, double-blind trial versus ketanserin in the treatment of noninfected chronic DFU. METHODS: Patients received PFD + M-DDO or ketanserin for 6 months. Relative ulcer volume (RUV) was measured every month; biopsies were taken at baseline and months 1 and 2 for histopathology and gene expression analysis for COL-1α, COL-4, KGF, VEGF, ACTA2 (α-SMA), elastin, fibronectin, TGF-ß1, TGF-ß3, HIF-1α, and HIF-1ß. RESULTS: Reduction of median RUV in the PFD + M-DDO group was 62%, 89.8%, and 99.7% at months 1-3 and 100% from months 4 to 6. Ketanserin reduced RUV in 38.4%, 56%, 60.8%, 94%, 94.8%, and 100% from the first to the sixth month, respectively. Healing score improved 4.5 points with PFD + M-DDO and 1.5 points with ketanserin compared to basal value. Histology analysis revealed few inflammatory cells and organized/ordered collagen fiber bundles in PFD + M-DDO. Expression of most genes was increased with PFD + M-DDO; 43.8% of ulcers were resolved using PFD + M-DDO and 23.5% with ketanserin. CONCLUSION: PFD + M-DDO was more effective than ketanserin in RUV reduction.

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BACKGROUND: Hypoplasia of the internal carotid artery is a rare congenital malformation. It has been mainly associated with aneurysms and other pathologies but not in association with paraganglioma. The incidence is 0.01% of all the anomalies of carotid vessels. Although the exact cause is unknown, it is thought to represent a sequel to an insult due to mechanical causes or hemodynamic stress but perhaps also involves aspects of molecular biology of embryonic development. CLINICAL CASE: We describe the case of a 37 year-old female patient with paraganglioma associated with hypoplasia of the internal carotid artery, which was found incidentally during surgery. Previous angiographic studies as well as other analyses were carried out, but we failed to detect hypoplasia of the internal carotid artery. Tumor was removed along with ligation of the external carotid artery due to injury. The hypoplastic internal carotid artery was left intact. CONCLUSION: Angiographic studies of the base of the skull are important as well as hemodynamic analysis in order to not overlook these anomalies. The patient had a satisfactory evolution without sequelae.

Antecedentes: la hipoplasia de la arteria carótida interna es una rara malformación congénita. Se le ha relacionado principalmente con aneurismas y otros padecimientos, pero no con paraganglioma. Su incidencia es menor de 0.01% de todas las anomalías de los vasos carotídeos. Aunque su origen exacto no se conoce, se cree que es una secuela de una lesión provocada por causas mecánicas o por estrés hemodinámico; sin embargo, también pudieran estar implicados aspectos de biología molecular del desarrollo embrionario. Caso clínico: se describe un caso raro de una mujer de 37 años de edad con paraganglioma concomitante con hipoplasia de la arteria carótida interna. En estudios angiográficos y análisis rutinarios previos no se había detectado alteración de la arteria carótida interna. En la intervención se extirpó el tumor y se ligó la arteria carótida externa dado que estaba involucrada en la lesión; se dejó intacta la arteria carótida interna hipoplásica. Conclusión: es importante realizar estudios angiográficos de la base del cráneo, así como análisis hemodinámicos para no pasar por alto estas anomalías. La evolución fue satisfactoria y sin secuelas.

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BACKGROUND: Due to the complexity of the diabetic foot, its high frequency of amputations and accompanying immunosuppression, treatment is difficult. We tested the usefulness of glycophosphopetical immunoregulator as adjuvant therapy for diabetic foot injury. METHODS: We carried out a prospective double-blind randomized controlled study with 19 patients per group with diabetic foot injury III and IV (Wagner injury classification). The study group was treated orally with glycophosphopeptical (1 g/every 8 h for 4 weeks). Control group was treated with placebo. Both groups received conventional treatment: wound debridement, antibiotic therapy and metabolic control. Area and depth of injury was measured at the beginning of the study and after 2 months. Patients who were healed or showed improvement were quantified as well with serum levels of TNF-α, interferon-γ and IL-1ß, 15 days after treatment initiation. RESULTS: The study group was comprised of 13 males and six females (mean age 61.6 ± 14.9 years) and the control group was comprised of five females and 14 males (mean age 56.7 ± 14.6 years). At the end of the study, the area and depth of the lesions were significantly lower in the study group (p <0.05). There were 13 amputations in the study group vs. 17 in the control group. In the group treated with glycophosphopeptical, there were 15 patient who were healed or improved and four failures vs. seven patients in the control group who were healed or improved and 12 failures. There were only four failures in the study group vs. seven in the control group with 12 failures (p = 0.03). TNF-α was lower in the study group than in the control group (p <0.02). CONCLUSION: Glycophosphopeptical is useful as adjuvant therapy in diabetic foot injuries.

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Los aneurismas de las arterias carótidas son raros. Presentamos un caso de origen no ateroscleroso. Fue tratado quirúrgicamente. Se revisan los aspectos fisiopatológicos, diagnóstico diferencial y tratamiento quirúrgicos encontrados en la literatura mundial.

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