Critical evaluation on proper antithrombotic treatment in different groups of patients undergoing vascular surgery

Antithrombotic treatment including anticoagulants and antiplatelets has evolved during the last decades, and several recommendations have been included in the latest guidelines regarding the proper management of patients undergoing vascular surgery. However, there are significant differences compared to older recommendations, and indications vary among patients with peripheral artery disease, carotid disease, and abdominal aortic aneurysm. In this mini review, we critically evaluate all these data to produce useful conclusions for everyday clinical practice. © 2018 Hellenic Society of Cardiolog

Autologous platelet-rich plasma for nonhealing ulcers: A comparative study

Purpose: The use of platelet-rich plasma (PRP) for the treatment of nonhealing ulcers is a relatively new technique. Although it seems to result in a satisfying level of healing and low complication rates, data regarding its effectiveness remain sparse. This study aims to evaluate the potential therapeutic effects of PRP on chronic nonhealing ulcers. Materials and Methods: This was a prospectively designed study comparing outcomes between patients treated with PRP (Group A, n=15) and patients treated conventionally (Group B, n=12) for different types of nonhealing ulcers. In Group A, PRP was produced from the patients’ own peripheral blood samples and was applied on the ulcer once every week. In Group B, patients were treated conventionally, without applying PRP. The total treatment period was 5 weeks. Results: Both groups were similar regarding age, sex, comorbidities, and time of treatment. In Group A, patients showed a nonsignificant reduction of 4.5 mm2 in ulcer area (P=0.190) and a reduction of more than 1 mm in depth (P=0.0006), while Group B showed an increase of 108±80.5 mm2 in ulcer area after 5 weeks (P=0.016). The healing rate (HR) in Group A was stable and positive throughout the treatment period, while HR in Group B was initially negative but became positive after the 3rd week. Conclusion: PRP application once a week promotes the healing of chronic ulcers. It improves the ulcer’s depth and HR, although its effect on ulcer area seems to be nonsignificant. However, larger comparative series are still needed to confirm these findings. Copyright © 2019, The Korean Society for Vascular Surgery

A cautionary case of microbial solidarity: concurrent isolation of VIM-1-producing Klebsiella pneumoniae, Escherichia coli and Enterobacter cloacae from an infected wound

The emergence and spread of acquired metallo-b-lactamases (MBLs) represents a worldwide problem. In Greek hospitals, the occurrence of MBL producers is currently endemic in Klebsiella pneumoniae, and sporadic among species of Enterobacter and Escherichia coli.1 We report herein the simultaneous recovery of K. pneumoniae, Enterobacter cloacae and E. coli producing VIM-1-type MBL from an infected wound. The patient was born prematurely with Arnold–Chiari syndrome and duodenal atresia, both corrected surgically. This was complicated by Enterococcus faecium bacteraemia and urinary tract infections [extended-spectrum β-lactamase (ESBL)-producing K. pneumoniae and E. coli]. Antibiotic history included cefuroxime (perioperatively), vancomycin, amikacin and meropenem. Subsequent cultures were negative. However, fever recurred, with breakdown of a dorsal surgical wound. Swab cultures from the exudate yielded K. pneumoniae, E. cloacae and E. coli, which were resistant to carbapenems and susceptible to aztreonam, amikacin, fluoroquinolones and colistin. The three isolates showed an identical susceptibility profile. Blood cultures were negative; a CT scan excluded deep-tissue …...