Severe deep neck infections successfully treated with negative pressure wound therapy with instillation - a case report

Background: Deep neck infection (DNI) is a life-threatening complication associated with significant mortality and morbidity rates. The most common causes of DNI are the tonsilitis, dentitis, salivary glands inflammation, malignancies, and foreign bodies. As a result of neck infection, patients are at high risk of potential secondary complications which include: descending mediastinitis, pleural empyema, septicemia, jugular vein thrombosis, pericarditis. We presented a case of successful management of DNI with the utility of negative pressure wound therapy with instillation (iNPWT). Method: A 37-year-old male with deep neck infection due to dentitis was qualified for iNPWT. Due to previous incisions and drainage of the neck abscesses, some undermined wounds drained towards each other’s were revealed with an excessive amount of purulent content. Standard NPWT dressing was placed and polyurethane foam was covered with contact layer dressing. Additionally, an inflow drain was placed within one of the wounds in regard to instill an antimicrobial solution. The wound was instilled four times daily. Results: The patient underwent a total of eight iNWPT sessions. Locally, a reduction in purulent content was achieved with a decrease of wounds’ dimensions and improvement of wound bed granulation. Moreover, improvement of the patient’s general condition and decrease of inflammatory markers was achieved. Conclusions: iNPWT may play an important role in the management of combined, complicated wounds due to DNI. The instilled antimicrobial solution facilitates dissolving and removing of the purulent content that impairs the wound healing

Zastosowanie sonoelastografii w diagnostyce i monitorowaniu leczenia zapaleń oraz choroby autoimmunologicznej tarczycy

Sonoelastography (USE) is a constantly evolving imaging technique used for the noninvasive and objective estimation of tissue stiffness. Several USE methods have been developed, including Quasi-Static or Strain Elastography and Shear Wave Elastography. The utility of USE has been demonstrated in differentiating between malignant and benign thyroid lesions. Recently, USE has been applied in the evaluation of thyroiditis and autoimmune thyroid disease (AITD).Thyroid inflammatory illnesses constitute a diverse group of diseases and may manifest various symptoms. These conditions may share some parallel clinical, biochemical, and ultrasonographic features, which can lead to diagnostic difficulties. USE may be an additional tool, supporting other methods in the diagnosis and treatment monitoring of thyroid diseases, other than thyroid nodular disease.The aim of this article was to analyse and summarise the available literature on the applicability of different elastographic techniques in the diagnosis, differentiation and monitoring of various types of thyroiditis and AITD. Advantages and limitations of this technique are also discussed. (Endokrynol Pol 2014; 65 (6): 520–531)Sonoelastografia (USE) jest stale rozwijającą się techniką obrazowania stosowaną do nieinwazyjnej i obiektywnej oceny sprężystości tkanki. Jak dotąd opracowano wiele metod USE, które można podzielić na dwie zasadnicze grupy: quasi-statyczną elastografię i elastografię fali poprzecznej (SWE). Wykazano wysoką skuteczność USE w różnicowaniu łagodnych i złośliwych zmian ogniskowych w gruczole tarczowym. Coraz częściej USE znajduje zastosowanie w ocenie zapaleń gruczołu tarczowego, w tym autoimmunologicznej choroby tarczycy (AITD). Zapalne choroby tarczycy stanowią bardzo zróżnicowaną grupę chorób, których wczesne objawy są nieswoiste. Trudności diagnostyczne mogą wynikać zarówno ze wspólnych cech klinicznych, biochemicznych, jak i ultrasonograficznych zapaleń tarczycy. Sonoelastografia może być uznana za dodatkowe narzędzie, wspierające inne stosowane metody w diagnostyce i monitorowaniu leczenia chorób tarczycy innych niż choroba guzkowa tarczycy.Celem niniejszego artykułu była analiza i podsumowanie dostępnej literatury na temat możliwości zastosowania technik elastograficznych w rozpoznawaniu, różnicowaniu i monitorowaniu różnych typów zapalenia gruczołu tarczowego. Przedstawiono zarówno wady, jak i zalety stosowania tej techniki w chorobach tarczycy. (Endokrynol Pol 2014; 65 (6): 520–531)

Predicted and observed in-hospital mortality after left main coronary artery stenting in 204 patients

Background: The purpose of this study was to compare risk predicted using available risk scores and actual outcomes in patients with left main coronary artery disease undergoing percutaneous coronary intervention with stent implantation (PCI LM). Methods: We studied 204 patients treated with elective or emergent coronary angioplasty. We estimated in-hospital mortality using the EuroSCORE, Parsonnet and GRACE risk scores and compared this data with actual in-hospital mortality. Results: There were no deaths among 62 patients undergoing elective PCI LM regardless of the estimated risk. Acute coronary syndrome (ACS) was diagnosed in all 142 patients undergoing emergent PCI LM. Mortality in this group was 24% (34/142). Area under receiver operating characteristic curve (AUC) values for the EuroSCORE, Parsonnet and GRACE risk scores in patients with ACS were 0.812 (p = 0.0001), 0.857 (p = 0.0001), and 0.870 (p = 0.0001), respectively. No statistically significant differences were found when these AUC values for different evaluated risk scores were compared. Overall, the EuroSCORE and Parsonnet risk scores had no discriminative value, as all deaths occurred in the highest risk group. Only the GRACE risk score discriminated risk among intermediate- and high-risk patients with ACS. Conlusions: The EuroSCORE and Parsonnet scoring systems are of no value in predicting periprocedural mortality risk in patients undergoing elective PCI LM. Overall, discriminative ability of the EuroSCORE, Parsonnet, and GRACE risk scores in unselected patients with ACS undergoing emergent PCI LM was good. In this group of patients, the EuroSCORE and Parsonnet scoring systems had no discriminative value in low and moderate risk patients. Only the GRACE risk score discriminated risk among intermediate and high risk patients. (Cardiol J 2008; 15: 268-276

Genetic continuity, isolation, and gene flow in Stone Age Central and Eastern Europe

Abstract The genomic landscape of Stone Age Europe was shaped by multiple migratory waves and population replacements, but different regions do not all show the same patterns. To refine our understanding of the population dynamics before and after the dawn of the Neolithic, we generated and analyzed genomic sequence data from human remains of 56 individuals from the Mesolithic, Neolithic and Eneolithic across Central and Eastern Europe. We found that Mesolithic European populations formed a geographically widespread isolation-by-distance zone ranging from Central Europe to Siberia, which was already established 10 000 years ago. We also found contrasting patterns of population continuity during the Neolithic transition: people around the lower Dnipro Valley region, Ukraine, showed continuity over 4 000 years, from the Mesolithic to the end of Neolithic, in contrast to almost all other parts of Europe where population turnover drove this cultural change, including vast areas of Central Europe and around the Danube River

Ocena ryzyka a rzeczywiste wyniki implantacji stentu do pnia lewej tętnicy wieńcowej u 204 chorych w okresie okołozabiegowym

Wstęp: Celem niniejszej pracy było porównanie ryzyka oszacowanego na podstawie powszechnie dostępnych modeli z rzeczywistymi wynikami leczenia chorych ze zwężeniem pnia lewej tętnicy wieńcowej metodą angioplastyki wieńcowej (PCI) z implantacją stentu. Metody: Obserwacji poddano grupę 204 pacjentów zakwalifikowanych do angioplastyki wieńcowej w trybie planowym i natychmiastowym. Oceniano śmiertelność szacowaną na podstawie skal EuroSCORE, Parsonneta, GRACE oraz śmiertelność rzeczywistą w badanej grupie chorych w okresie obserwacji wewnątrzszpitalnej. Wyniki: W badanej populacji nie stwierdzono zgonów wśród 62 osób leczonych w trybie planowym w żadnej z grup ryzyka. U wszystkich 142 chorych poddanych PCI z implantacją stentu w trybie natychmiastowym rozpoznano ostry zespół wieńcowy (ACS). W tej grupie zmarły 34 osoby (24%). Pola powierzchni pod krzywą ROC (AUC) dla skal EuroSCORE, GRACE i Parsonneta w grupie osób z ACS wynosiło odpowiednio: 0,812 (p = 0,0001), 0,857 (p = 0,0001) i 0,870 (p = 0,0001). Porównanie AUC dla analizowanych skal nie wykazało różnic istotnych statystycznie. Skale EuroSCORE i Parsonneta nie miały zdolności dyskryminacji ryzyka chorych (wszystkie zgony wystąpiły w grupie najwyższego ryzyka). Jedynie skala GRACE różnicowała ryzyko chorych z ACS w grupie umiarkowanego i wysokiego ryzyka. Wnioski: Modele oceny ryzyka EuroSCORE i Parsonneta nie mają zastosowania w ocenie okołozabiegowego ryzyka zgonu podczas planowego zabiegu implantacji stentu do pnia lewej tętnicy wieńcowej. Zdolność dyskryminacyjna skal EuroSCORE, GRACE i Parsonneta w niewyselekcjonowanej grupie chorych z ACS poddanych zabiegowi PCI z implantacją stentu była dobra. W tej grupie pacjentów skale EuroSCORE i Parsonneta nie cechowały się zdolnościami różnicowania chorych z niskim i umiarkowanym ryzykiem; jedynie skala GRACE różnicowała pacjentów w grupach ryzyka umiarkowanego i wysokiego

The Application of Negative Pressure Wound Therapy with Installation in Diabetic Foot Associated with Phlegmon

The negative pressure wound therapy in the treatment of diabetic foot ulcers was used successfully for many years. In the case of complications associated with infection by this type of wound treatment to give very good results. From many years of sustained research on a device that could combine the advantages of the negative pressure wound therapy and drainage flow. Finally, in the last year, the first V.A.C. Ulta (KCI, USA) devices were included to the Polish hospital departments. In this paper we present a case of a patient of successfully using a negative pressure wound therapy with installation via a set of V.A.C. Ulta in the ischemic diabetic foot syndrome complicated by phlegmon and tissue necrosis. The patient was treated in stages. In first stage was performed angioplasty of critically stenosis of the superficial femoral artery segment. Secondly, the resection of the necrotic bone revised fingers and forefoot was conducted, and in the third step the negative pressure wound therapy with installation was used. Finally, the wound was closed by the intermediate thickness skin graft. The total duration of treatment was 21 days. The patient in good general condition with a completely healed wound was discharged. Currently, after the supply with orthopedic equipment, patient regained full mobility

Ancient woodland indicator plant species in the parks and gardens of the Pomeranian Cistercian Trail

The research aimed to make an inventory of the vascular flora of 11 parks and gardens of the Pomeranian Cistercian Trail, with particular emphasis on taxa attached to old deciduous forests. A total of 62 species were registered, recognised as indicators of old deciduous forests in Poland. The presence of species of this group was confirmed in all of the analysed objects, but their number varied from 7 to 50. The group of ancient woodland species includes forest species for which the light indicator values are lower than or equal to 4 (plants of shadowy places, with a relative light intensity). The group of indicator species also includes forest geophytes and forest myrmecochores, autochores and barochores, as well as woodland species that can tolerate stress, under the classification of ecological strategy types S, S/CSR, S/SC and S/SR

Severe deep neck infections successfully treated with negative pressure wound therapy with instillation - a case report

Background: Deep neck infection (DNI) is a life-threatening complication associated with significant mortality and morbidity rates. The most common causes of DNI are the tonsilitis, dentitis, salivary glands inflammation, malignancies, and foreign bodies. As a result of neck infection, patients are at high risk of potential secondary complications which include: descending mediastinitis, pleural empyema, septicemia, jugular vein thrombosis, pericarditis. We presented a case of successful management of DNI with the utility of negative pressure wound therapy with instillation (iNPWT). Method: A 37-year-old male with deep neck infection due to dentitis was qualified for iNPWT. Due to previous incisions and drainage of the neck abscesses, some undermined wounds drained towards each other’s were revealed with an excessive amount of purulent content. Standard NPWT dressing was placed and polyurethane foam was covered with contact layer dressing. Additionally, an inflow drain was placed within one of the wounds in regard to instill an antimicrobial solution. The wound was instilled four times daily. Results: The patient underwent a total of eight iNWPT sessions. Locally, a reduction in purulent content was achieved with a decrease of wounds’ dimensions and improvement of wound bed granulation. Moreover, improvement of the patient’s general condition and decrease of inflammatory markers was achieved. Conclusions: iNPWT may play an important role in the management of combined, complicated wounds due to DNI. The instilled antimicrobial solution facilitates dissolving and removing of the purulent content that impairs the wound healing