INTRODUCTION: It is hypothesized that systemically administered antibiotics penetrate wound sites more effectively during negative pressure wound therapy (NPWT). However, there is a lack of clinical data from patients who receive NPWT for deep sternal wound infection (DSWI) after open-heart surgery. Here, we evaluated vancomycin penetration into exudate in this patient group. PATIENTS AND METHODS: For this prospective observational study, we enrolled 10 consecutive patients treated with NPWT for post-sternotomy DSWI. On the first sampling day, serum and exudate samples were synchronously collected at 0 (pre-dose), 0.5, 1, 2, 3 and 6 h after vancomycin administration. On the following three consecutive days, additional samples were collected, only before vancomycin administration. RESULTS: The ratio of average vancomycin concentration in wound exudate to in serum was higher for free (unbound) (1.51 ± 0.53) than for total (bound + unbound) (0.91 ± 0.29) concentration (p = 0.049). The percentage of free vancomycin was higher in wound exudate than serum (0.79 ± 0.19 vs. 0.46 ± 0.16; p = 0.04). Good vancomycin wound penetration was maintained on the following three days (vancomycin trough exudate-to-serum concentration ratio > 1). The total hospital stay was significantly longer in patients with DSWI (46 ± 11.6 days) versus without DSWI (14 ± 11.7 days) (p < 0.001). There was no in-hospital or 90-day mortality. Two patients experienced late DSWI recurrence. All-cause mortality was 4.8% during a median follow-up of 2.5 years. CONCLUSION: Vancomycin effectively penetrates wound exudate in patients receiving NPWT for DSWI after open-heart surgery.The protocol for this study was registered at ClinicalTrials.gov on July 16, 2024 (NCT06506032).

• MeSH
• antibakteriální látky * farmakokinetika   aplikace a dávkování   MeSH
• exsudáty a transsudáty metabolismus   mikrobiologie   MeSH
• infekce chirurgické rány * MeSH
• kardiochirurgické výkony * škodlivé účinky   MeSH
• lidé středního věku MeSH
• lidé MeSH
• prospektivní studie MeSH
• senioři MeSH
• sternotomie * škodlivé účinky   MeSH
• sternum chirurgie   MeSH
• terapie ran pomocí řízeného podtlaku * metody   MeSH
• vankomycin * aplikace a dávkování   farmakokinetika   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• pozorovací studie MeSH

BACKGROUND: Patients with severe aortic stenosis present frequently (∼50%) with concomitant obstructive coronary artery disease. Current guidelines recommend combined surgical aortic valve replacement (SAVR) and coronary artery bypass grafting (CABG) as the preferred treatment. Transcatheter aortic valve implantation (TAVI) and fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) represent a valid treatment alternative. We aimed to test the non-inferiority of FFR-guided PCI plus TAVI versus SAVR plus CABG in patients with severe aortic stenosis and complex coronary artery disease. METHODS: This international, multicentre, prospective, open-label, non-inferiority, randomised controlled trial was conducted at 18 tertiary medical centres across Europe. Patients (aged ≥70 years) with severe aortic stenosis and complex coronary artery disease, deemed feasible for percutaneous or surgical treatment according to the on-site Heart Team, were randomly assigned (1:1) to FFR-guided PCI plus TAVI or SAVR plus CABG according to a computer-generated sequence with random permuted blocks sizes stratified by site. The primary endpoint was a composite of all-cause mortality, myocardial infarction, disabling stroke, clinically driven target-vessel revascularisation, valve reintervention, and life-threatening or disabling bleeding at 1 year post-treatment. The trial was powered for non-inferiority (with a margin of 15%) and if met, for superiority. The primary and safety analyses were done per an intention-to-treat principle. This trial is registered with ClinicalTrials.gov (NCT03424941) and is closed. FINDINGS: Between May 31, 2018, and June 30, 2023, 172 patients were enrolled, of whom 91 were assigned to the FFR-guided PCI plus TAVI group and 81 to the SAVR plus CABG group. The mean age of patients was 76·5 years (SD 3·9). 118 (69%) of 172 patients were male and 54 (31%) patients were female. FFR-guided PCI plus TAVI resulted in favourable outcomes for the primary endpoint (four [4%] of 91 patients) versus SAVR plus CABG (17 [23%] of 77 patients; risk difference -18·5 [90% CI -27·8 to -9·7]), which was below the 15% prespecified non-inferiority margin (pnon-inferiority<0·001). FFR-guided PCI plus TAVI was superior to SAVR plus CABG (hazard ratio 0·17 [95% CI 0·06-0·51]; psuperiority<0·001), which was driven mainly by all-cause mortality (none [0%] of 91 patients vs seven (10%) of 77 patients; p=0·0025) and life-threatening bleeding (two [2%] vs nine [12%]; p=0·010). INTERPRETATION: The TCW trial is the first trial to compare percutaneous treatment versus surgical treatment in patients with severe aortic stenosis and complex coronary artery disease, showing favourable primary endpoint and mortality outcomes with percutaneous treatment. FUNDING: Isala Heart Centre and Medtronic.

• MeSH
• aortální stenóza * chirurgie   komplikace   MeSH
• chirurgická náhrada chlopně metody   MeSH
• frakční průtoková rezerva myokardu * MeSH
• koronární angioplastika * metody   MeSH
• koronární bypass * metody   MeSH
• lidé MeSH
• nemoci koronárních tepen * chirurgie   komplikace   terapie   MeSH
• prospektivní studie MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• transkatetrální implantace aortální chlopně * metody   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• hodnocení ekvivalence MeSH
• multicentrická studie MeSH
• srovnávací studie MeSH

Ischemic stroke is a common and serious condition. Timely restoration of cerebral perfusion is crucial for improving patient outcomes and reducing economic impacts. For three decades, alteplase has been the only established pharmacological treatment, often combined with endovascular therapy. Tenecteplase, a newer generation of fibrinolytic therapy, is recommended by the ESO 2023 guidelines as a suitable alternative to alteplase, particularly if treatment is initiated within 4.5 hours of symptom onset. Tenecteplase offers higher fibrin specificity, lower binding to PAI-1, and a longer plasma half-life compared to alteplase, allowing for single bolus administration. Clinical studies have shown that tenecteplase 0.25 mg/kg achieves better recanalization and clinical improvement without increased risk of bleeding. It is equally effective and safe as alteplase, with meta-analyses indicating improved recanalization and clinical outcomes at a lower risk of bleeding. Tenecteplase is a suitable alternative for treating iNCMP, especially within 4.5 hours of symptom onset. Its single bolus administration simplifies hospital management and improves the logistics of transporting patients to specialized centers.

• MeSH
• fibrinolýza účinky léků   MeSH
• ischemická cévní mozková příhoda * diagnóza   farmakoterapie   MeSH
• klinická studie jako téma MeSH
• lidé MeSH
• reperfuze klasifikace   metody   MeSH
• tenektepláza * aplikace a dávkování   farmakologie   terapeutické užití   MeSH
• tkáňový aktivátor plazminogenu farmakologie   terapeutické užití   MeSH
• trombolytická terapie klasifikace   metody   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• přehledy MeSH

Ischemické cievne mozgové príhody v zadnej cirkulácii predstavujú 20 % až 25 % všetkých ischemických mozgových príhod. Stanovenie diagnózy znamená výzvu najmä pri nešpecifickom a menej závažnom klinickom obraze. Môže byť ovplyvnené aj nízkou senzitivitou CT vyšetrenia v akútnej fáze mozgovej príhody. Nesprávna alebo oneskorená diagnostika ohrozuje pacientov vysokým rizikom skorej recidívy a zhoršuje ich výsledný klinický stav. Všeobecné zásady liečby sú rovnaké ako u pacientov s postihnutím prednej mozgovej cirkulácie. Intravenózna trombolýza zlepšila prognózu pacientov bez zvýšeného rizika komplikácií. Endovaskulárna liečba oklúzie arteria basilaris znížila úmrtnosť a mieru invalidizácie pacientov, stále však prevažná časť pacientov prežíva s rôznou mierou invalidizácie alebo zomiera.

Ischemic strokes in the posterior circulation represent 20 % to 25 % of all ischemic strokes. Making the diagnosis could be difficult, especially with a non-specific and less serious clinical picture. Low sensitivity of CT examination in the acute phase of stroke can complicate diagnosis. Incorrect or delayed diagnosis puts patients at high risk of early recurrence and worsens their clinical condition. The general principles of treatment are the same as for patients with lesions of the anterior cerebral circulation. Intravenous thrombolysis improved the prognosis of patients without an increased risk of complications. Endovascular treatment of basilar artery occlusion has reduced patient mortality and disability rates, but most patients nonetheless either survive with varying degrees of disability or die.

• MeSH
• arteria basilaris * patologie   účinky léků   MeSH
• endovaskulární výkony klasifikace   metody   MeSH
• ischemická cévní mozková příhoda * diagnóza   farmakoterapie   klasifikace   MeSH
• klinická studie jako téma MeSH
• lidé MeSH
• počítačová rentgenová tomografie metody   MeSH
• trombolytická terapie klasifikace   metody   MeSH
• vertebrobazilární insuficience diagnóza   etiologie   farmakoterapie   klasifikace   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• přehledy MeSH

INTRODUCTION: We investigated the burden of microembolic signals (MES) in patients with acute ischaemic stroke (AIS) and atrial fibrillation (AF), assessing their impact on functional outcomes. PATIENTS AND METHODS: This multicentre international prospective cohort study involved patients with AIS and either a known or newly diagnosed anticoagulant-naïve AF. All centres utilised the same transcranial Doppler machine for 1-h monitoring with bilateral 2 MHz probes within 24 h of symptom onset. Recordings underwent MES analysis by a blinded central reader. The primary objectives were to ascertain the MES proportion and its association with functional outcomes assessed by the modified Rankin scale (mRS) score at 90 days. RESULTS: Between September 2019 and May 2021, we enrolled 61 patients, with a median age of 78 years (interquartile range 73-83) and a median stroke severity score of 11 (interquartile range 4-18). MES were observed in 14 patients (23%), predominantly unilateral (12/14, 86%), with a median rate of 6 counts/hour (interquartile range 4-18). MES occurrence was higher post-thrombectomy and among those with elevated brain natriuretic peptide levels (p < 0.05). A worse mRS score of 3-6 was more frequent in patients with MES, occurring in 11/14 (79%), compared to those without MES, 20/47 (43%), with an adjusted odds ratio of 5.04 (95% CI, 1.15-39.4), p = 0.04. CONCLUSIONS: Nearly a quarter of patients with AIS and AF exhibited silent microembolization after the index event. Detecting MES within 24 h post-stroke (using transcranial Doppler) could signify a marker of poor functional outcomes. Subsequent trials will assess if very early antithrombotic treatment might enhance outcomes in this highly selective group of cardioembolic stroke patients. (Clinicaltrials.gov ID: NCT06018090).

• MeSH
• fibrilace síní * komplikace   MeSH
• intrakraniální embolie diagnostické zobrazování   MeSH
• ischemická cévní mozková příhoda * diagnostické zobrazování   terapie   MeSH
• lidé MeSH
• prospektivní studie MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• trombektomie MeSH
• ultrasonografie dopplerovská transkraniální * metody   MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH

Spektrum cievnych anomálií s rôznym biologickým správaním je veľmi široké. Vaskulárne anomálie sa rozdeľujú na vaskulárne malformácie a vaskulárne nádory – hemangiómy. Hoci mnohé z nich vyzerajú podobne, ich klinická manifestácia je rozmanitá – od nezávažného samolimitujúceho priebehu po život ohrozujúce komplikácie vyžadujúce intenzívny multidisciplinárny terapeutický prístup. Nezriedka sa aj v odbornej praxi všetky cievne anomálie nesprávne nazývajú hemangiómy. Je veľmi dôležité správne klasifikovať a pomenovať cievnu anomáliu, aby sme mohli zvoliť správnu liečbu a zabrániť vzniku závažných komplikácií. Z vaskulárnych nádorov sa u detí najčastejšie vyskytuje infantilný hemangióm (IH). Je to lézia s úplne typickým biologickým správaním a na jej odlíšenie od iných cievnych anomálií zvyčajne stačí dobre odobratá anamnéza. Iba malá časť IH predstavuje pre dieťa riziko a vyžaduje systémovú alebo kombinovanú multimodálnu liečbu. Vaskulárne malformácie predstavujú heterogénnu skupinu zvyčajne vývinových odchýlok cievneho systému a môžu postihovať ktorýkoľvek typ ciev. Často ide o zmiešané cievne lézie. Symptomatické vaskulárne malformácie sú u detí zriedkavé a mnohokrát predstavujú pre lekárov diagnosticko-terapeutickú výzvu. Prinášame kazuistiku nesyndrómového pacienta, u ktorého sa vyskytli dve zriedkavé symptomatické cievne anomálie vyžadujúce multiodborovú starostlivosť. Korešpondenčná autorka: MUDr. Michaela Murgašová Klinika detí a dorastu JLF UK a UNM Kollárova 2 036 01 Martin Slovenská republika murgasovam@zoznam.sk

The spectrum of vascular anomalies with different biological behavior is very wide. They are divided into vascular malformations and vascular tumors – hemangiomas. Although many of them look similar, their clinical manifestation is different – from a mild self-limiting course to life-threatening complications requiring an intensive multidisciplinary therapeutic approach. Frequently, even in professional practice, all vascular anomalies are incorrectly called hemangiomas. It is very important to classify and name the vascular anomaly correctly so that we can choose the right treatment and prevent serious complications. Infantile hemangioma (IH) is the most common vascular tumor in children. It is a lesion with a completely typical biological behavior and a well-taken history is usually sufficient to distinguish it from other vascular anomalies. Only a small part of IH represents a risk to the child and requires systemic or combined multimodal treatment. Vascular malformations represent a heterogeneous group of usually developmental abnormalities of the vascular system and can affect any type of vessels. These are often mixed vascular lesions. Symptomatic vascular malformations are rare in children and often are diagnostic and therapeutic challenge for doctors. We present a case report of a non-syndromic patient with two rare symptomatic vascular anomalies requiring multidisciplinary care.

• MeSH
• cévní malformace diagnóza   klasifikace   MeSH
• dítě MeSH
• endovaskulární výkony klasifikace   metody   MeSH
• kapilární hemangiom * diagnostické zobrazování   diagnóza   MeSH
• karotido-kavernózní píštěl * diagnostické zobrazování   diagnóza   klasifikace   komplikace   MeSH
• kojenec MeSH
• lidé MeSH
• magnetická rezonanční angiografie metody   MeSH
• metoprolol farmakologie   terapeutické užití   MeSH
• novorozenec MeSH
• prednison farmakologie   terapeutické užití   MeSH
• Check Tag
• dítě MeSH
• kojenec MeSH
• lidé MeSH
• mužské pohlaví MeSH
• novorozenec MeSH
• Publikační typ
• kazuistiky MeSH

Background: We report a successful wound treatment of a chronic ulcer with bone exposure using a somehow forgotten technique of creating burr holes into the bone. Most clinics would promote flap surgery to cover wounds with bone exposure, however, in some cases invasive surgery is not mandatory. We bring up an alternative treatment for such cases. Case: We report a case of chronic ulcers on both lower extremities in a 43-year-old Caucasian male. He suffers from a leukocytoclastic vasculitis and sarcoidosis which is medicated by immunosuppressive medication. The patient‘s wounds were initially treated with mechanical debridement and split-thickness skin grafts, however, his wounds tended to worsen the more they were manipulated and finally resulted in tibial bone exposure. After levelling up his immune suppressive drugs, the wounds finally stabilized but didn’t heal after several weeks of follow-up. The wound was ultimately treated by placing burr holes in the underlying cortical bone. Conclusion: Chronic ulcers with bone exposure at the lower leg are challenging to treat. They often require local or free flap surgery. In some cases, because of underlying systemic disease, it is mandatory to stay away from invasive flap surgery. With this case, we like to put under attention an old technique of decorticating the exposed bone to promote secondary wound healing. It has been described mainly for scalp injuries, however, we have proven the viability of this technique for pretibial wounds as well.

• MeSH
• bércové vředy chirurgie   etiologie   patologie   terapie   MeSH
• dospělí MeSH
• imunosupresiva škodlivé účinky   MeSH
• komorbidita MeSH
• lidé MeSH
• poranění dolní končetiny chirurgie   komplikace   patologie   terapie   MeSH
• terapie neúspěšná MeSH
• tibie * chirurgie   patologie   zranění   MeSH
• záchrana končetiny metody   MeSH
• zákroky plastické chirurgie * metody   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH

• MeSH
• výkony cévní chirurgie MeSH
• Publikační typ
• biografie MeSH
• nekrology MeSH

• O autorovi
• Gregor, Zdeněk, 1944-2024 Autorita

PICC-port představuje nový druh dlouhodobého žilního přístupu, který je indikován čím dál častěji z důvodu snížení rizika komplikací při zavádění a výborného estetického efektu ve srovnání s porty hrudními. Jedná se o další generaci portů, která nahradila historicky zaváděné pažní nebo brachiální porty, kdy nevhodně prováděná implantace nevedla k rozšíření jejich používání pro vysoký výskyt komplikací. Při dodržení moderních doporučení se stává PICC-port ve specifických klinických situacích žilním vstupem první volby.

The PICC-port is a novel type of long-term venous access device that is increasingly indicated for use because of the reduced risk of complications during insertion and excellent aesthetic effect when compared with a chest port. It is the next generation of ports that has replaced the previously inserted arm or brachial ports in which inappropriate implantation hindered their widespread use due to high rates of complications. When modern recommendations are followed, the PICC-port can become the first-choice venous access in specific clinical situations.

• MeSH
• antitumorózní látky aplikace a dávkování   MeSH
• cévní přístupy MeSH
• intravenózní infuze metody   MeSH
• lidé MeSH
• nádory farmakoterapie   MeSH
• periferní katetrizace * metody   MeSH
• Check Tag
• lidé MeSH

INTRODUCTION: Thoracic aorta false aneurysms (TAFA) are unexplored complications after cardiac surgery associated with significant morbidity and mortality. Therefore, the purpose of this study was to examine the clinical profiles, surgical techniques, and operative outcomes, of patients treated for TAFA at a single institution. METHODS: From 1996 to 2022, 112 patients were treated for aortic pseudoaneurysm (mean age 55 ± 14 years, 78 patients were male). In the majority of the patients (90%) TAFA developed after previous cardiovascular surgery, the most common diagnosis and surgical procedure preceding the TAFA development was an aortic dissection (52%) and Bentall procedure (47%). In the rest of the cohort, the leading cause was trauma. RESULTS: Sixty-one percent of patients were indicated for reintervention (surgical reoperation, endoluminal graft implantation, septal occluder implantation, coil embolization, or a combination of procedures). Overall, 52 patients had undergone cardiac reoperation. TAFA was resected and the aorta was repaired in 55% or replaced in 45%. Operative mortality was 5.7%. In postoperative follow-up, a hypoechogenic lesion encircling aortic prosthesis was present in 94%, therefore it was determined as a negative prognostic factor. The mean follow-up was 13.2 ± 19.4 years. CONCLUSION: Although there is no specific approach how to prevent TAFA development, maintaining normal blood pressure and regular follow-up should be applied. More frequent follow-ups should be performed in patients with a hypoechogenic lesion encircling and aortic prosthesis. Early detection during long-term postoperative follow-up, an individually tailored approach of a multidisciplinary team is necessary for favorable treatment outcomes.

• MeSH
• aneurysma hrudní aorty * chirurgie   MeSH
• aorta thoracica chirurgie   diagnostické zobrazování   MeSH
• časové faktory MeSH
• cévy - implantace protéz škodlivé účinky   MeSH
• dospělí MeSH
• endovaskulární výkony škodlivé účinky   MeSH
• kombinovaná terapie MeSH
• lidé středního věku MeSH
• lidé MeSH
• nepravé aneurysma * chirurgie   etiologie   diagnostické zobrazování   terapie   MeSH
• pooperační komplikace etiologie   chirurgie   MeSH
• reoperace MeSH
• retrospektivní studie MeSH
• rizikové faktory MeSH
• senioři 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