An Autologous Protein-Based Topical Ointment for Hard-to-Heal Skin Wounds: A Multiple Case Series.

BACKGROUND: There is increasing evidence regarding the wound healing potential of platelet-derived autologous by-products. We provide preliminary data regarding the use of a new plasma rich in growth factors-derived autologous topical ointment for the management of hard-to-heal wounds. CASES: Four patients suffering from difficult-to-heal wounds were treated with the autologous ointment. Within 2 to 8 weeks, all wounds healed completely with no signs of infection or functional impairment of the affected limbs. No adverse events were reported. CONCLUSION: Randomized and controlled trials are needed to determine the clinical efficacy of the autologous ointment. Nevertheless, results from this multiple case series indicate that this approach may be useful for accelerating the re-epithelization of difficult-to-heal wounds.

Biological Approach for Managing Severe Gunshot Wounds: A Case Report.

BACKGROUND: Autologous formulations rich in bioactive proteins promote cutaneous tissue regeneration. This case report describes our experiences with a platelet-based autologous formulation in the management of a hard-to-heal and severe gunshot wound. CASE: A healthy, 34-year-old man suffered an accidental gunshot wound of his right foot. After cleansing with saline and application of vacuum-assisted closure therapy for a period of 5 weeks, the resulting full-thickness wound had a surface area of 20 cm and did not show progress toward closure despite ongoing treatment. Plasma-rich growth factor (PRGF) therapy was used in order to promote tissue regeneration. The patient's own blood was drawn, centrifuged, and platelet-rich plasma was obtained. Intradermal injections of freshly activated platelet-rich plasma were administered into the wound edges, and a fibrin membrane was applied on the wound bed. Afterward, a novel topical ointment based on the patient's own growth factors was used as a daily therapy over the affected tissue. RESULTS: This full-thickness wound healed after 16 weeks of autologous growth factor therapy. The patient was able to walk without pain. CONCLUSION: Plasma-rich growth factor therapy successfully healed this full-thickness wound that did not respond to a period of 5 weeks with negative pressure wound therapy using a vacuum-assisted device. Healing occurred after 16 weeks of treatment, and he was able to resume walking without pain or functional deficits.

TCR-γ expression in primary cutaneous T-cell lymphomas.

Primary cutaneous γδ T-cell lymphomas (PCGD-TCLs) are considered a subgroup of aggressive cytotoxic T-cell lymphomas (CTCLs). We have taken advantage of a new, commercially available antibody that recognizes the T-cell receptor-γ (TCR-γ) subunit of the TCR in paraffin-embedded tissue. We have analyzed a series of 146 primary cutaneous T-cell lymphomas received for consultation or a second opinion in the CNIO Pathology Department. Cases were classified according to the World Health Organization 2008 classification as mycosis fungoides (MF; n=96), PCGD-TCLs (n=5), pagetoid reticulosis (n=6), CD30(+) primary cutaneous anaplastic large cell lymphomas (n=5), primary cutaneous CD8 aggressive epidermotropic CTCLs (n=3), primary cutaneous CTCL, not otherwise specified (n=4), and extranodal nasal-type NK/T-cell lymphomas primarily affecting the skin or subcutaneous tissue (n=11). Sixteen cases of the newly named lymphomatoid papulosis type D (LyP-D; n=16) were also included. In those cases positive for TCR-γ, a further panel of 13 antibodies was used for analysis, including TIA-1, granzyme B, and perforin. Clinical and follow-up data were recorded in all cases. Twelve cases (8.2%) were positive for TCR-γ, including 5 PCGD-TCLs, 2 MFs, and 5 LyP-Ds. All 5 PCGD-TCL patients and 1 MF patient died of the disease, whereas the other MF patient and all those with LyP-D were alive. All cases expressed cytotoxic markers, were frequently CD3(+)/CD8(+), and tended to lose CD5 and CD7 expressions. Eight of 12 and 5 of 11 cases were CD30(+) and CD56(+), respectively. Interestingly, 5/12 TCR-γ-positive cases also expressed TCR-BF1. All cases analyzed were negative for Epstein-Barr virus-encoded RNA. In conclusion, TCR-γ expression seems to be rare and is confined to cytotoxic primary cutaneous TCLs. Nevertheless, its expression is not exclusive to PCGD-TCLs, as TCR-γ protein can be found in other CTCLs. Moreover, its expression does not seem to be associated with bad prognosis by itself, as it can be found in cases with good and bad outcomes.

Cura de orificio de salida de catéter: ciprofloxacino versus suero hipertónico 20 % / No disponible

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[Selective digestive decontamination]. / Descontaminación digestiva selectiva.

OBJECTIVES: The objectives of the study were: to explain our protocol of selective digestive decontamination (SDD); to know the therapeutic activity that the protocol implies in the nursing staff; to assess the impact on the incidence of ventilatorassociated pneumonia. METHODS DESIGN: Prospective descriptive study for time measurements, and non randomized comparative study for the incidence of ventilatorassociated pneumonia. We calculate time means and 95 percent confidence interval (CI). We calculate ventilatorassociated pneumonia relative risk and number-needed-to-treat (NNT). SETTING: Intensive care unit with 13 beds reference for neurocritical illness. STUDY PERIOD: Control group from November-2001 to April-2002. Treatment group from May-2002 to November 2002. PATIENTS: consecutive patients who were admitted in our intensive care department with mechanical ventilation for more than 48 hours.Results. A total of 122 consecutive patients were included: control group 62 patients, treatment group 60 patients. We have recorded 136 SDD administration time and 16 vigilance culture records. The SDD administration mean time was 8.11 minutes (95% CI, 7.59-8.63). Morning Nursing Duty Schedule spent significantly more time mean 10.7 minutes (95% CI, 9.87- 11.89) than afternoon 8.1 (95% CI, 7.20-9.08) (p < 0.05) and night 6.9 (95% CI, 6.39-7.46). There was a significant difference between time spent in SDD administration in trauma patients (p < 0.05) 7.45 (95% CI, 6.63-8.27) and medical patients 8.71 minutes (95% CI, 8.41-9.01). We spent a mean of 9 minutes (CI 8-10) in culture sampling. In the treatment group the ventilator associated pneumonia incidence relative risk was 0.28 (CI 0.13-0.63) with a NNT of 4 (CI 3-8). CONCLUSION: In our patients SDD administration represents the 2.5% of our therapeutic activity time per patient and reduces the ventilator associated pneumonia risk.

Descontaminación digestiva selectiva / Selective digestive decontamination

Objetivo. Dar a conocer nuestro protocolo de descontaminación digestiva selectiva (DDS). Conocer la carga de trabajo que supone. Comparar la repercusión sobre la incidencia de neumonía asociada a ventilación mecánica (NAVM).Pacientes y método. Diseño: Estudio prospectivo descriptivo, para la medición de tiempos y comparativo no randomizado para la incidencia de NAVM. Se presentan medias de tiempos con intervalos de confianza (IC) del 95 por ciento. Calculamos el riesgo relativo (RR) de NAVM y el número necesario de pacientes a tratar (NNT). Ámbito: Unidad de cuidados intensivos (UCI) de trece camas, referencia de neurocríticos. Período: Grupo control (GC) -62 pacientes- de noviembre de 2001 a abril de 2002; grupo DDS -60 pacientes- de mayo a noviembre de 2002. Sujetos. Pacientes consecutivos ingresados en UCI que precisaron ventilación mecánica durante más de 48 h. Resultados. Se realizaron 136 registros de tiempos de administración de DDS y 16 de obtención de cultivos de vigilancia. Tiempo medio para la administración de DDS: 8,11 min (IC del 95 por ciento, 7,59-8,63). El turno de mañana fue el que consumió más tiempo, media 10,7 min (IC del 95 por ciento, 9,47-11,89) (p < 0,05), frente a 8,1 min (IC del 95 por ciento, 7,20-9,08) el turno de tarde y 6,9 min (IC del 95 por ciento, 6,39-7,46) el de noche. Hubo diferencia significativa entre el tiempo empleado en enfermos médicos respecto a traumáticos (p < 0,05): 8,71 min (IC del 95 por ciento, 8,41-9,01) frente a 7,45 min (IC del 95 por ciento, 6,63-8,27), respectivamente. En la toma de cultivos invertimos una media de 9 min (IC del 95 por ciento, 8-10). Para la incidencia de NAVM: RR del GDDS respecto al del GC fue de 0,28 (IC del 95 por ciento, 0,13-0,63) con un NNT de 4 (IC del 95 por ciento, 3-8).Conclusiones. En nuestros pacientes la DDS consume el 2,5 por ciento de nuestro tiempo asistencial y disminuye el riesgo de NAVM (AU)