Initial clinical experiences with a new,portable, single‐use negative pressure wound therapy device

Since the introduction of negative pressure wound therapy in combination with reticulated open cell foam (NPWT/ROCF) in 1997, the clinical and economic benefits of this therapy have been showed in several randomised‐controlled studies. This article describes the clinical application of a new portable NPWT unit. The V.A.C.Via? Therapy System (KCI USA, Inc., San Antonio, TX) offers continuous negative pressure and dynamic pressure control for wound treatment of low exudating (<80 ml/day), small‐to‐medium size wounds, grafts and flaps in all care settings, including homecare. We describe four cases in which this new device was successfully used.     

Ablación pediátrica con catéter: características y resultados del procedimiento en un centro terciario de referencia

Introduction and objectives

Catheter ablation has become the treatment of choice in an increasing number of arrhythmias in children and adolescents. There is still limited evidence of its use at a national level in Spain. The aim was to describe the characteristics and results of a modern monocentric series form a referral tertiary care centre.

两种不同方法处理坏死黑痂创面的疗效观察

目的探讨两种不同方法处理坏死黑痂创面的疗效。方法选择2010年5月～2011年6月23例（创面25处）坏死黑痂创面患者作为对照组．2011年7月～2012年7月19例（创面24处）坏死黑痂创面患者作为实验组,两组均在基础疾病及抗感染治疗同时,对照组患者创面给予一次性清创加改良封闭式负压引流治疗,实验组患者创面给予直接或黑痂深层切开加改良封闭式负压引流治疗,并适时逐次清创．肉芽组织生长好部位点状植皮。比较两组患者创面完成清创时间、清创出血量及8周治疗效果。结果两组患者创面完成清创时间、清创出血量及8周治疗效果比较,均P〈0．05,差异具有统计学意义,实验组患者完成清创时间明显短于对照组,清创出血量明显少于对照组、8周治愈率明显高于对照组。结论坏死黑痂创面采用直接或黑痂深层切开后加改良封闭式负压引流治疗,并适时逐次清创．肉芽组织生长好部位给予点状植皮治疗效果优于一次性清创加改良封闭式负压引流治疗。     

Vacuum-assisted closure: a new method for treating patients with giant omphalocele

Introduction

Closure of giant omphalocele can present a surgical challenge. Neither silo, skin flap, nor primary closure has been successful in treating all patients. We present a novel application of the vacuum-assisted closure (VAC) device, which allows for improved results in these difficult cases.

Methods

The VAC device (KCI, San Antonio, Tex) consisted of a sponge applied directly to the bowel and liver, covered with impermeable transparent dressing, and attached to a low negative pressure system. The sponge was changed every 3 to 5 days under local sedation.

Patients

All 3 patients had giant omphaloceles. The first infant, a 34 week gestational age (WGA) male, was initially treated with silo reduction, which disrupted after 21 days. The large mass of bowel and liver made primary closure impossible. The VAC was applied for 45 days. The viscera was easily reduced and subsequently covered with acellular dermal matrix (AlloDerm). The VAC was reapplied, and the small remaining defect was skin-grafted. The second male infant was a 34 WGA male infant who became septic after failure of prosthetic mesh closure. The VAC was applied for 22 days after removal of the mesh. The infection resolved, and the defect size was reduced, allowing for skin flap closure. Mesh infection and development of an enterocutaneous fistula in the last patient, a 37 WGA female child, were treated by mesh removal and application of the VAC for 36 days. The VAC allowed for control of the fistula output and development of a healthy granulation bed.

Results

Vacuum-assisted closure was associated with (1) rapid shrinkage and reduction of the viscera (22-45 days); (2) cleansing of the wound; (3) excellent granulation; (4) maintenance of a sterile environment; and (5) ease of use, with changes possible at the bedside.

Conclusion

The VAC device should be considered a safe and effective alternative in treating complicated cases of giant omphalocele until a more definitive closure method can be used.     

Immunogenicity and safety of a novel liposomal influenza subunit vaccine (INFLUSOME-VAC) in young adults

Influenza and its complications account for substantial morbidity and mortality among young adults and especially among the elderly. In young adults, immunization provides 70-90% protection, while among the elderly the vaccine may be only 30-40% effective; hence the need for new, more immunogenic vaccines. We compared the safety and immunogenicity of a novel IL-2-supplemented liposomal influenza vaccine (designated INFLUSOME-VAC) with that of a commercial subunit vaccine and a commercial split virion vaccine in young adults (mean age 28 years) in the winter of 1999-2000. Seventy-three healthy young adults were randomly assigned to be vaccinated intramuscularly with the following: a commercial subunit vaccine (n = 17, group A), INFLUSOME-VAC (n = 36, group B), and a commercial split virion vaccine (n = 20, group C). The three vaccines contained equal amounts of hemagglutinin (approximately 15 microg each) from the strains A/Sydney (H3N2), A/Beijing (H1N1), and B/Yamanashi. INFLUSOME-VAC induced higher geometric mean HI titers and higher-fold increases in HI titers against all three strains, compared with the two commercial vaccines. In addition, seroconversion rates for the A/Sydney and B/Yamanashi strains were significantly higher (P < 0.05) compared with the split virion vaccine, and significantly higher for the three strains compared with the subunit vaccine (69-97% vs 35-65%, P < or = 0.02). Moreover, the anti-neuraminidase response was significantly greater (P = 0.05) in group B vs group A. INFLUSOME-VAC caused mild local pain at the injection site in a significantly higher proportion of the vaccinees (83%). Thus, INFLUSOME-VAC is an immunogenic and safe vaccine in young adults.     

Cerebral hypomyelination associated with biallelic variants of FIG4

The lipid phosphatase gene FIG4 is responsible for Yunis‐Varón syndrome and Charcot‐Marie‐Tooth disease Type 4J, a peripheral neuropathy. We now describe four families with FIG4 variants and prominent abnormalities of central nervous system (CNS) white matter (leukoencephalopathy), with onset in early childhood, ranging from severe hypomyelination to mild undermyelination, in addition to peripheral neuropathy. Affected individuals inherited biallelic FIG4 variants from heterozygous parents. Cultured fibroblasts exhibit enlarged vacuoles characteristic of FIG4 dysfunction. Two unrelated families segregate the same G>A variant in the +1 position of intron 21 in the homozygous state in one family and compound heterozygous in the other. This mutation in the splice donor site of exon 21 results in read‐through from exon 20 into intron 20 and truncation of the final 115 C‐terminal amino acids of FIG4, with retention of partial function. The observed CNS white matter disorder in these families is consistent with the myelination defects in the FIG4 null mouse and the known role of FIG4 in oligodendrocyte maturation. The families described here the expanded clinical spectrum of FIG4 deficiency to include leukoencephalopathy.     

Veno-occlusive disease in a child with rhabdomyosarcoma after conventional chemotherapy: report of a case and review of the literature

Although veno-occlusive disease of the liver is a well-known complication of high-dose chemotherapy and bone marrow transplantation, it has rarely been observed in children who receive conventional chemotherapy. Most cases in the literature consists of children with Wilms tumor. It has been very uncommon in rabdomyosarcoma patients until recently, although they commonly receive similar anticancer agents. Here the authors report a 2-year-old boy with rhabdomyosarcoma who developed veno-occlusive disease while receiving VAC (vincristine, actinomycin D, cyclophosphamide) chemotherapy regimen according to the IRS-IV protocol. The patient gradually recovered during 2 weeks with supportive treatment only.     

Comparative study of the microvascular blood flow in the intestinal wall,wound contraction and fluid evacuation during negative pressure wound therapy in laparostomy using the V.A.C. abdominal dressing and the ABThera open abdomen negative pressure therapy system

To compare the changes in microvascular blood flow in the small intestinal wall, wound contraction and fluid evacuation, using the established V.A.C. abdominal dressing (VAC dressing) and a new abdominal dressing, the ABThera open abdomen negative pressure therapy system (ABThera dressing), in negative pressure wound therapy (NPWT). Midline incisions were made in 12 pigs, which were subjected to treatment with NPWT using the VAC or ABThera dressing. The microvascular blood flow in the intestinal wall, were measured before and after the application at topical negative pressures of ?50, ?75 and ?125 mmHg, using laser Doppler velocimetry. Wound contraction and fluid evacuation were also measured. Baseline blood flow was defined as 100% in all settings. The blood flow was significantly reduced, to 64·6 ± 6·7% (P < 0·05) after the application of ?50 mmHg using the VAC dressing, and to 65·3 ± 9·6% (P < 0·05) after the application of ?50 mmHg with the ABThera dressing. The blood flow was significantly reduced, to 39·6 ± 6·7% (P < 0·05) after the application of ?125 mmHg using VAC, and to 40·5 ± 6·2% (P < 0·05) after the application of ?125 mmHg with ABThera. No significant difference in the reduction in blood flow could be observed between the two groups. The ABThera system gave significantly better fluid evacuation from the wound compared to the VAC system. There was no difference between the dressings regarding the reduction in blood flow, but the ABThera dressing afforded better drainage of the abdomen and better wound contraction than the VAC dressing.