AIMS: A pulsed electric field (PF) energy source is a novel potential option for catheter ablation of ventricular arrhythmias (VAs) as it can create deeper lesions, particularly in scarred tissue. However, very limited data exist on its efficacy and safety. This prospective observational study reports the initial experience with VA ablation using focal PF. METHODS AND RESULTS: The study population consisted of 44 patients (16 women, aged 61 ± 14years) with either frequent ventricular premature complexes (VPCs, 48%) or scar-related ventricular tachycardia (VT, 52%). Ablation was performed using an irrigated 4 mm tip catheter and a commercially available PF generator. On average, 16 ± 15 PF applications (25 A) were delivered per patient. Acute success was achieved in 84% of patients as assessed by elimination of VPC or reaching non-inducibility of VT. In three cases (7%), a transient conduction system block was observed during PF applications remotely from the septum. Root analysis revealed that this event was caused by current leakage from the proximal shaft electrodes in contact with the basal interventricular septum. Acute elimination of VPC was achieved in 81% patients and non-inducibility of VT in 83% patients. At the 3-month follow-up, persistent suppression of the VPC was confirmed on Holter monitoring in 81% patients. In the VT group, the mean follow-up was 116 ± 75 days and a total of 52% patients remained free of any VA. CONCLUSION: Pulsed electric field catheter ablation of a broad spectrum of VA is feasible with acute high efficacy; however, the short-term follow-up is less satisfactory for patients with scar-related VT.
- MeSH
- elektrofyziologické techniky kardiologické MeSH
- jizva etiologie MeSH
- katetrizační ablace * metody škodlivé účinky MeSH
- komorová tachykardie * chirurgie patofyziologie MeSH
- komorové extrasystoly * chirurgie patofyziologie diagnóza MeSH
- lidé středního věku MeSH
- lidé MeSH
- prospektivní studie MeSH
- senioři MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- pozorovací studie MeSH
Since 1970 surgeons have managed deep burns by surgical debridement and autografting. We tested the hypothesis that enzymatic debridement with NexoBrid would remove the eschar reducing surgery and achieve comparable long-term outcomes as standard of care (SOC). In this Phase 3 trial, we randomly assigned adults with deep burns (covering 3-30% of total body surface area [TBSA]) to NexoBrid, surgical or nonsurgical SOC, or placebo Gel Vehicle (GV) in a 3:3:1 ratio. The primary endpoint was complete eschar removal (ER) at the end of the debridement phase. Secondary outcomes were need for surgery, time to complete ER, and blood loss. Safety endpoints included wound closure and 12 and 24-months cosmesis on the Modified Vancouver Scar Scale. Patients were randomized to NexoBrid (n = 75), SOC (n = 75), and GV (n = 25). Complete ER was higher in the NexoBrid versus the GV group (93% vs 4%; P < .001). Surgical excision was lower in the NexoBrid vs the SOC group (4% vs 72%; P < .001). Median time to ER was 1.0 and 3.8 days for the NexoBrid and SOC respectively (P < .001). ER blood loss was lower in the NexoBrid than the SOC group (14 ± 512 mL vs 814 ± 1020 mL, respectively; P < .0001). MVSS scores at 12 and 24 months were noninferior in the NexoBrid versus SOC groups (3.7 ± 2.1 vs 5.0 ± 3.1 for the 12 months and 3.04 ± 2.2 vs 3.30 ± 2.76 for the 24 months). NexoBrid resulted in early complete ER in >90% of burn patients, reduced surgery and blood loss. NexoBrid was safe and well tolerated without deleterious effects on wound closure and scarring.
Burn injuries are a significant global health concern, with more than 11 million people requiring medical intervention each year and approximately 180,000 deaths annually. Despite progress in health and social care, burn injuries continue to result in socioeconomic burdens for victims and their families. The management of severe burn injuries involves preventing and treating burn shock and promoting skin repair through a two-step procedure of covering and closing the wound. Currently, split-thickness/full-thickness skin autografts are the gold standard for permanent skin substitution. However, deep burns treated with split-thickness skin autografts may contract, leading to functional and appearance issues. Conversely, defects treated with full-thickness skin autografts often result in more satisfactory function and appearance. The development of tissue-engineered dermal templates has further expanded the scope of wound repair, providing scar reductive and regenerative properties that have extended their use to reconstructive surgical interventions. Although their interactions with the wound microenvironment are not fully understood, these templates have shown potential in local infection control. This narrative review discusses the current state of wound repair in burn injuries, focusing on the progress made from wound cover to wound closure and local infection control. Advancements in technology and therapies hold promise for improving the outcomes for burn injury patients. Understanding the underlying mechanisms of wound repair and tissue regeneration may provide new insights for developing more effective treatments in the future.
- MeSH
- hojení ran MeSH
- jizva etiologie prevence a kontrola chirurgie MeSH
- kůže patologie MeSH
- lidé MeSH
- popálení * chirurgie patologie MeSH
- transplantace kůže metody MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
Abdominal wall defects encompass a broad spectrum of musculo-fasciocutaneous anomalies. We present case of a 42-year-old woman with a history of multimorbidity and bilateral subcostal scars. The patient underwent incisional ventral hernia repair and abdominoplasty performed by a general surgeon at another institution. However, she developed extensive necrosis of the cutaneous-fatty panniculus between the bilateral subcostal incisions and the abdominoplasty incision. The patient presented with a medial area of 50 × 60 cm with loss of soft tissue vitality and necrotic plaques. Tangential escharotomies were performed to remove devitalized tissue, and management of the open wound included hydrocolloid and alginate dressings. Finally, a defect of 45 × 40 cm was achieved. Three tissue expanders were used to reconstruct the abdominal wall, allowing sufficient adjacent autologous tissue to be harvested for definitive correction of the abdominal defect. An acceptable aesthetic result was observed 5 years after surgery. This report highlights the importance of adequate evaluation of the previously scarred abdominal wall prior to abdominoplasty.
- MeSH
- abdominální hernie * chirurgie MeSH
- abdominoplastika škodlivé účinky MeSH
- dospělí MeSH
- incizní kýla * chirurgie MeSH
- jizva chirurgie etiologie MeSH
- lidé MeSH
- ventrální hernie * chirurgie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
Cieľ práce: Popísať prípad ektopickej gravidity v jazve po cisárskom reze a jej úspešnú liečbu použitím techniky sonograficky riadenej vákuumaspirácie. Kazuistika: Prezentovaný je prípad 35-ročnej pacientky s anamnézou dvoch cisárskych rezov odoslanej obvodným gynekológom v 6. týždni tehotenstva s podozrením na patologickú lokalizáciu gravidity v jazve po cisárskom reze. Dokumentovaný je postup diagnostiky a liečby ektopickej gravidity v jazve po predchádzajúcich cisárskych rezoch úspešne vyriešenej použitím sonograficky riadenej vaginálnej vákuumaspirácie. Záver: Gravidita v jazve po cisárskom reze vzniká ako následná komplikácia predchádzajúcich cisárskych rezov či iných inštrumentálnych výkonov na maternici. Použitie techniky sonograficky riadenej vákuumaspirácie sa javí ako úspešná metóda liečby gravidity v jazve po cisárskom reze.
Objective: To describe the case of ectopic pregnancy in the scar after caesarean section and its successful treatment using the technique of sonographically controlled vacuum aspiration. Case report: The case of a 35-year-old patient with a history of two caesarean sections referred by a district gynecologist in the 6th week of pregnancy with suspected pathological localization of pregnancy in a scar after a previous caesarean section. The procedure for the diagnosis and treatment of ectopic pregnancy in the scar after previous caesarean sections has been successfully resolved using sonographically controlled vaginal vacuum aspiration. Conclusion: Caesarean scar pregnancy occurs as a complication of previous caesarean section or other uterine instrumental performances. The use of the sonographically controlled vacuum aspiration technique appears to be a successful method of treating pregnancy in a scar after a caesarean section. Publication ethics: The Editorial Board declares that the manuscript met the ICMJE "uniform requirement
- MeSH
- císařský řez škodlivé účinky MeSH
- dospělí MeSH
- intervenční ultrasonografie metody MeSH
- jizva diagnostické zobrazování etiologie MeSH
- lidé MeSH
- mimoděložní těhotenství * chirurgie diagnostické zobrazování etnologie MeSH
- těhotenství MeSH
- vakuová kyretáž MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
- MeSH
- adherence pacienta MeSH
- dehiscence operační rány * ošetřování psychologie terapie MeSH
- hojení ran MeSH
- jizva etiologie komplikace MeSH
- kineziologie aplikovaná metody MeSH
- kombinovaná terapie metody MeSH
- komorbidita MeSH
- lidé MeSH
- management bolesti metody MeSH
- nekróza terapie MeSH
- pahýl po amputaci MeSH
- pooperační bolest terapie MeSH
- psychické trauma etiologie MeSH
- senioři MeSH
- tejpovací páska * MeSH
- úzkost etiologie MeSH
- výsledek terapie MeSH
- zmatenost etiologie MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- Publikační typ
- kazuistiky MeSH
OBJECTIVES: This study sought to determine new reference cutoffs for normal unipolar voltage (UV) and bipolar voltage (BV) that would be adjusted for the LV remodeling. BACKGROUND: The definition of "normal" left ventricular (LV) endocardial voltage in patients with post-infarct scar is still lacking. The reference voltage of the noninfarcted myocardium (NIM) may differ between patients depending on LV structural remodeling and the ensuing interstitial fibrosis. METHODS: Electroanatomic voltage mapping was integrated with isotropic late gadolinium-enhanced cardiac magnetic resonance in 15 patients with nonremodeled LV and 12 patients with remodeled LV (end-systolic volume index >50 ml/m2 with ejection fraction <47% assessed by cardiac magnetic resonance). Reference voltages (fifth percentile values) were determined from pooled NIM segments without late gadolinium enhancement. RESULTS: The cutoffs for normal BV and UV were ≥3.0 and ≥6.7 mV for nonremodeled LV and ≥2.1 and ≥6.4 mV for remodeled LV. Endocardial low-voltage area (LVA) defined by the adjusted cutoffs corresponded better to late gadolinium enhancement-detected scar than did LVA defined by uniform cutoffs. In 15 patients who underwent successful ablation of ventricular tachycardia, the LVA contained >97% of targeted evoked delayed potentials. Insights from whole-heart T1 mapping revealed more fibrotic NIM in patients with remodeled LV compared with nonremodeled LV. CONCLUSIONS: This study found substantial differences in endocardial voltage of NIM in post-infarct patients with remodeled versus nonremodeled LV. The new adjusted cutoffs for "normal" BV and UV enable a patient-tailored approach to electroanatomic voltage mapping of LV.
- MeSH
- elektrofyziologické techniky kardiologické * MeSH
- endokard diagnostické zobrazování fyziologie patofyziologie MeSH
- infarkt myokardu komplikace patofyziologie MeSH
- jizva diagnostické zobrazování etiologie patofyziologie MeSH
- katetrizační ablace MeSH
- komorová tachykardie etiologie patofyziologie chirurgie MeSH
- lidé středního věku MeSH
- lidé MeSH
- magnetická rezonance kinematografická MeSH
- magnetická rezonanční tomografie MeSH
- referenční hodnoty MeSH
- remodelace komor fyziologie MeSH
- senioři MeSH
- studie případů a kontrol MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- Klíčová slova
- dyskolorace,
- MeSH
- dermatochirurgické výkony * škodlivé účinky MeSH
- infekce chirurgické rány etiologie prevence a kontrola MeSH
- jizva * etiologie terapie MeSH
- krvácení při operaci prevence a kontrola MeSH
- lidé MeSH
- pooperační komplikace * etiologie terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
- MeSH
- chronická bolest epidemiologie chirurgie MeSH
- dekubity etiologie chirurgie MeSH
- fantomová končetina diagnóza etiologie chirurgie ultrasonografie MeSH
- jizva diagnóza etiologie chirurgie MeSH
- lidé MeSH
- neurom diagnóza etiologie chirurgie MeSH
- pahýl po amputaci * inervace krevní zásobení MeSH
- poranění periferního nervu diagnostické zobrazování etiologie chirurgie MeSH
- Check Tag
- lidé MeSH
