Sudden onset of paraplegia from acute aortic occlusion: a review of 2 cases and their unique presentation.

Acute aortic occlusion is an uncommon entity requiring prompt recognition and intervention to limit morbidity and mortality. We describe 2 patients with acute aortic occlusion who presented uniquely with sudden onset of paraplegia. In addition, we highlight their circuitous diagnostic course and the adverse impact of diagnostic delay in their management and outcome.

Vacuum-assisted wound closure of deep sternal infections in high-risk patients after cardiac surgery.

BACKGROUND: Sternal wound infections are a serious complication arising from cardiac surgery. Recently, the general application of negative pressure to wounds by vacuum-assisted closure (VAC) therapy has shown enhanced granulation and wound contraction. Here we examine the effect of VAC on sternal wounds. METHODS: We collected and statistically analyzed quantitative VAC performance data and outcomes with a retrospective review on a consecutive cohort of 22 patients treated with VAC for post-cardiac surgery wound complications. RESULTS: Sternal wound infections became evident on average at 21.0 days after surgery, associated with dehiscence (82%), sternal instability (59%), fluid collection by computed tomography (73%), and osteomyelitis (41%). Cultures most commonly identified Staphylococcus aureus (50%). Prompt irrigation and debridement were performed on all patients, and VAC therapy was applied at approximately 7.3 days after diagnosis. Vacuum-assisted closure induced granulation of 71% of the sternal wound area by 7 days, with a daily drainage of approximately 84 mL. By 14 days, there was a 54% reduction in wound size, and patients were discharged after approximately 19.5 days and placed on home therapy. Vacuum-assisted closure was discontinued at approximately 36.7 days with an average reduction in sternal wound size of 80%. Extensive secondary surgical closure, requiring muscle flaps, was avoided in 64% of patients, whereas 28% of patients required no surgical reconstruction for wound closure. No complications were related to VAC use. CONCLUSIONS: In contrast to our earlier studies, adjunctive VAC therapy markedly reduced required surgical interventions, reoperation for persistent infections, and the hospitalization period. Thus, VAC provides a viable and efficacious adjunctive method by which to treat postoperative wound infection after medial sternotomy.

Caspases from apoptotic myocytes degrade extracellular matrix: a novel remodeling paradigm.

Induction of smooth muscle cell apoptosis is critical to the reversal of severe structural remodeling in hypertensive pulmonary arteries during disease regression. This process involves coordinated resorption of pathologically deposited extracellular matrix, including elastin, and occurs in the presence of serine elastase and matrix metalloproteinase inhibitors. Here, we show that apoptotic smooth muscle cells exhibit extensive degradation of elastin coincident with cell surface immunolocalization and release of caspases. We further document that recombinant caspase-2, -3, and -7 are potently elastolytic. These enzymes are present in an active form on apoptotic cell surfaces and caspase inhibitors attenuate their elastolytic activity. Our results reveal a previously undescribed function for apoptotic cells and a novel paradigm whereby removal of cells is coordinated with degradation of excess extracellular matrix during remodeling in development and disease.