INTRODUCTION: Diabetic foot infections are frequently polymicrobial. The lower tissue concentration of systemically administered antibiotics in diabetic patients was reported. Collatamp(®)EG (Syntacoll GmbH Saal/Donau, Germany) is a bioabsorbable, gentamicin impregnated collagen spongeused for local treatment. The aim of this randomized trial was to assess influence of gentamicin-collagen sponge applied to a wound on surgical outcomes after minor amputations in diabetic patients. MATERIAL AND METHODS: Fifty diabetic patients indicated for minor amputation in 2009 at our surgery department were included in the study. Patients were pre-operatively randomised into two groups. Twenty-five patients in group A were treated with gentamicin impregnated collagen sponge applied into wound peri-operatively while 25 patients in group B had minor amputation without gentamicin sponge. RESULTS: There was no significant difference in the demographic data, procedures performed, diabetes duration and peripheral vascular disease severity between the groups. The median glycosylated haemoglobin was 6.0% (range: 4.6-9.5%) in group A and 6.2% (range: 4.0-8.4%) in control group B (non-significant). Median TcPO2 level was 44 (range: 13-67) in group A and 48 (range: 11-69) in control group B (non-significant). The median of wound healing duration in group A was 3.0 weeks (range: 1.7-17.1 weeks) compared to 4.9 weeks (range: 2.6-20.0 weeks) in control group B. This was with a statistically significant difference (p < 0.05). CONCLUSIONS: Application of gentamicin impregnated collagen sponge shortened wound healing duration after minor amputations in diabetic patients by almost 2 weeks.
- Publikační typ
- časopisecké články MeSH
UNLABELLED: OBJECTVES: We investigated whether tacrolimus (FK506) can inhibit neointimal formation in arterialised vein grafts in rats. METHODS: Lewis iliolumbar veins were implanted into the abdominal aorta of isogeneic rats. Animals in the treatment groups had daily intramuscular injections of tacrolimus at 0.2 mg/kg (group B) and 0.1 mg/kg (Group C), respectively. The control group A had no treatment. Light microscope evaluations of arterialised vein grafts were performed 30 days after operation. We determined the presence of endothelial cells, the thickness of intima and media, and the degree of infiltration by MHC class II positive, CD4 positive, and CD8 positive cells into the adventitia. RESULTS: The intimal thickness in group B (5.0±1.0 µm) was statistically lower (P < 0.05) when compared to group C (7.0±3.0 µm). The intimal thickness in untreated group A (12.7±7.0 µm) was statistically higher (P < 0.01) when compared to both treated groups B and C, respectively. The medial thickness and degree of adventitial infiltration by MHC class II positive, CD8 positive, and CD4 positive cells did not differ between groups. CONCLUSION: Treatment with tacrolimus (FK506) showed a dose dependant inhibition of neointimal hyperplasia in arterialised vein grafts in rats (Tab. 1, Fig. 3, Ref. 22).
- MeSH
- aorta abdominalis chirurgie MeSH
- hyperplazie MeSH
- imunosupresiva farmakologie MeSH
- krysa rodu rattus MeSH
- neointima prevence a kontrola MeSH
- potkani inbrední LEW MeSH
- takrolimus farmakologie MeSH
- tunica intima účinky léků patologie MeSH
- vény patologie transplantace MeSH
- zvířata MeSH
- Check Tag
- krysa rodu rattus MeSH
- mužské pohlaví MeSH
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
BACKGROUND: Incisional hernia after kidney transplantation increases patient morbidity and impacts quality of life. Reports of hernia mesh repair after kidney transplantation are rare; thus, the benefit of mesh hernioplasty in transplanted patients is assumed. However, it is also assumed that transplant patients are susceptible to incisional and mesh infections. MATERIAL/METHODS: Between January 1, 2005 and December 31, 2010, we performed 1067 kidney transplantations. Twenty-eight patients developed incisional hernias (2.6%), and mesh repair was performed in 20 of them (8 women, 12 men; median age 59.5 years, range 43 to 68 years). We retrospectively studied this latter group. We also reviewed the literature regarding the results of this treatment. RESULTS: Postoperative mortality was zero, but postoperative wound bleeding led to surgical revision in 1 patient. Wound infection did not occur. During the follow-up period we observed 4 hernia recurrences (20%). CONCLUSIONS: In conclusion, our retrospective study and review of the literature confirmed the safety and low incidence (1.1% to 3.8%) of mesh hernia repair in chronic immunosuppressed patients after renal transplantation, which has a minimal risk of wound infection and no higher risk of hernia recurrence than in non-transplant patients.
- MeSH
- chirurgické síťky MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- operace kýly metody MeSH
- polypropyleny MeSH
- pooperační komplikace etiologie chirurgie MeSH
- retrospektivní studie MeSH
- rizikové faktory MeSH
- senioři MeSH
- transplantace ledvin škodlivé účinky MeSH
- ventrální hernie etiologie chirurgie MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
- Publikační typ
- abstrakt z konference MeSH
- Publikační typ
- abstrakt z konference MeSH
Cíl: Retrospektivně zhodnotit incidenci, vybrané rizikové faktory, klinické, zobrazovací a laboratorní známky postižení viscerálních tepen u pacientů po kardiochirurgických výkonech s nutností chirurgické intervence operovaných v IKEM. Materiál a metody: V období od 1. 1. 2003 do 31. 4. 2009 bylo na Klinice kardiovaskulární chirurgie IKEM provedeno 7 971 operací srdce. U 26 pacientů se rozvinula do 30 dnů od operace srdce náhlá příhoda břišní s nutností následné chirurgické revize. Akutní uzávěr splanchnického řečiště s rozvojem střevní ischemie byl příčinou náhlé příhody břišní v devíti případech (35 %). Výsledky: Klinické známky ischemie u pacientů po kardiochirurgických výkonech nebyly nijak dramatické. Hypotenze, oběhová pod pora katecholaminy, bolest a distenze břicha byly přítomny u 80 % pacientů. V laboratorním nálezu zase dominovala elevace CRP (medián 200 mg/l) a leukocytů (medián 17,5 × 109/l). Zobrazovací metody měly při diagnostice střevní ischemie nízkou specifi citu a senzitivitu. Pooperačně zemřelo šest pacientů (66 %). Závěr: Akutní uzávěr splanchnického řečiště po kardiochirurgickém výkonu je vzácná diagnóza, která je ale zatížena vysokou morbiditou a mortalitou. Zobrazovací metody a laboratorní hodnoty mají nízkou senzitivitu a specifi citu a nevedou k časné diagnóze. Opakované posouzení klinického stavu a jeho vývoj
Aim: To retrospectively assess the incidence, selected risk factors, clinical, imaging, and laboratory signs of vascular artery involvement in patients undergoing cardiac surgery in the Prague-based Institute for Clinical and Experimental Medicine (IKEM) and requiring subsequent surgery. Materials and methods: In the period from 1 January 2003 through 31 April 2009, a total of 7,971 cardiac surgical procedures were performed at the Department of Cardiovascular Surgery, IKEM. Within 30 days postoperatively, 26 patients experienced acute abdominal pain requiring revision surgery. The cause of abdominal pain was acute occlusion of the splanchnic vascular bed in nine patients (35%). Results: The clinical signs of ischemia in patients undergoing cardiac surgery were not dramatic. Hypotension, abdominal pain and distension, and circulatory support with catecholamines were present in 80% of patients. Major laboratory fi ndings included elevated levels of C-reactive protein (median, 200 mg/l) and a white blood cell count (median, 17.5 × 109/l). The specifi city and sensitivity of imaging methods in diagnosing intestinal ischemia were low. Six patients died postoperatively (66%). Conclusion: While a rare diagnosis, acute occlusion of the splanchnic vascular bed following cardiac surgery is associated with high morbidity and mortality. Both imaging methods and laboratory values have low sensitivity and specifi city and are not helpful in establishing early diagnosis. The only right road to a correct diagnosis includes repeated assessment of the patient’s clinical status and its development by an experienced surgeon; early revision surgery, if necessary, gives the patients a chance to survive.
- MeSH
- arterie patofyziologie MeSH
- diagnostické zobrazování metody využití MeSH
- ischemie diagnóza chirurgie komplikace MeSH
- kardiochirurgické výkony metody škodlivé účinky MeSH
- komorbidita MeSH
- lidé MeSH
- medicína založená na důkazech MeSH
- mezenteriální cévní okluze chirurgie komplikace terapie MeSH
- pooperační komplikace diagnóza chirurgie MeSH
- retrospektivní studie MeSH
- rizikové faktory MeSH
- senzitivita a specificita MeSH
- splanchnický oběh MeSH
- statistika jako téma MeSH
- Check Tag
- lidé MeSH
