scholarly journals Prontosan® soluzione e Prontosan® Debridement Pad nel trattamento di diversi tipi di ferite cutanee: dichiarazioni basate su opinioni di esperti, serie di casi e revisione della letteratura/Prontosan® solution and Prontosan® Debridement Pad in the treatment of different types of cutaneous wounds: expert-based statements, case series and review of the literature

2019 ◽  
Vol 3 (3) ◽  
Author(s):  
Angela Peghetti ◽  
Diletta Olivari ◽  
Silvia Tedesco ◽  
Andrea Bellingeri ◽  
Marino Ciliberti ◽  
...  
Keyword(s):  
Literature Review ◽  
Chronic Wounds ◽  
Wound Care ◽  
Evidence Synthesis ◽  
New Technology ◽  
Case Series ◽  
Sono State ◽  
Review Of The Literature ◽  
Combined System ◽  
New Device

Prontosan® Debridement Pad (PDP; B. Braun) è un nuovo presidio disegnato per migliorare il processo di debridement meccanico. In questo lavoro riportiamo i risultati di un complesso progetto condotto al fine di sviluppare consenso tra gli esperti sul migliore modo di impiegare questa nuova tecnologia nella pratica clinica. Il progetto si è articolato in tre fasi. Nella prima è stata condotta una estesa revisione della letteratura che ha condotto ad identificare, analizzare criticamente e a riassumere in formato strutturato 27 studi clinici pertinenti. Nella seconda fase le evidenze disponibili sono state discusse in modo sistematico con un pannello di 10 esperti, i quali hanno formulato 12 raccomandazioni per l'impiego clinico del PDP. Queste raccomandazioni sono state quindi sottoposte a votazione formale attraverso il metodo GRADE. Infine, nei mesi successivi, 13 casi clinici provenienti dalla pratica clinica routinaria e trattati in accordo con le raccomandazioni stabilite sono stati raccolti e vengono qui presentati. Nel complesso, i dati disponibili in letteratura e quelli raccolti dalla pratica clinica confermano l'efficacia del PDP come strumento per il debridement meccanico, offrendo vantaggi significativi per una ottimale Wound Bed Preparation e per il controllo del dolore. Il nostro progetto può inoltre essere utile per ottimizzare l'impiego pratico di questo nuovo promettente dispositivo. Prontosan® Debridement Pad (PDP; B. Braun) is a new device designed for mechanical debridement. This paper summarizes the results of a complex initiative aimed to develop consensus among a panel of wound care experts about the optimal use of this new technology. An extensive review of the literature found 27 pertinent papers, which underwent a formal process of critical appraisal and evidence extraction by two independent methodologists. Results are displayed in an evidence report. 12 practical recommendations, concerning management of acute and chronic wounds, have been developed and approved. Main point of strength of this project is the use of a systematic approach to literature review, evidence synthesis and presentation, development and measurement of expert consensus. Moreover, expert panel provided further clinical data, through the reporting of 13 clinical cases managed according to abovementioned recommendations, with a particular focus on burns and chronic ulcers treatment, both in adult and pediatric patients. Overall, results from literature review and from clinical experience confirm that the combined system Prontosan® Solution and PDP is a promising tool useful in the critical phase of debridement in acute and chronic wounds treatment. Efficacy in debris removal and pain reduction are the main points of strength. Our project may contribute to optimize clinical use of this innovative device.

scholarly journals Long-term outcomes of acromegaly treated with fractionated stereotactic radiation: case series and literature review

2017 ◽  
Vol 4 (4) ◽  
pp. 255-262
Author(s):  
Ryan Rhome ◽  
Isabelle M Germano ◽  
Ren-Dih Sheu ◽  
Sheryl Green
Keyword(s):  
Systematic Review ◽  
Literature Review ◽  
Case Series ◽  
Tumor Control ◽  
Pituitary Neoplasms ◽  
Review Of The Literature ◽  
Biochemical Control ◽  
Low Incidence

Abstract Background Growth hormone (GH)-secreting pituitary adenomas represent an uncommon subset of pituitary neoplasms. Stereotactic radiosurgery (SRS) and fractionated stereotactic radiotherapy (FSRT) have been used as primary or adjuvant treatment. The purpose of this study is to report the long-term tumor control and toxicity from our institution and to perform a systematic literature review of acromegaly patients treated with FSRT. Methods We retrospectively reviewed all patients treated with FSRT (median dose 50.4 Gray [Gy], range 50.4–54 Gy) between 2005 and 2012 who had: 1) GH-secreting adenoma with persistently elevated insulin growth factor-1 (IGF-1) despite medical therapy and 2) clinical follow up >3 years after FSRT. Patients were treated with modern FSRT planning techniques. Biochemical control was defined as IGF-1 normalization. Systematic review of the literature was performed for FSRT in acromegaly. Results With a median follow-up of 80 months, radiographic control was achieved in all 11 patients and overall survival was 100%. Long-term biochemical control was achieved in 10 patients (90.9%) with either FSRT alone (36.4%) or FSRT with continued medical management (45.5%). No patient experienced new hypopituitarism, cranial nerve dysfunctions, or visual deficits. Our systematic review found published rates of biochemical control and hypopituitarism vary, with uniformly good radiographic control and low incidence of visual changes. Conclusions Adjuvant FSRT offered effective long-term biochemical control and radiographic control, and there was a lower rate of complications in this current series. Review of the literature shows variations in published rates of biochemical control after FSRT for acromegaly, but low incidence of serious toxicities.

scholarly journals Hereditary haemorrhagic telangiectasia and pregnancy: a review of the literature

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Olivier Dupuis ◽  
Laura Delagrange ◽  
Sophie Dupuis-Girod
Keyword(s):  
Heart Failure ◽  
Literature Review ◽  
Arteriovenous Malformations ◽  
Case Reports ◽  
Case Series ◽  
Main Body ◽  
Hereditary Haemorrhagic Telangiectasia ◽  
Review Of The Literature ◽  
Management Decisions ◽  
Recurrent Epistaxis

Abstract Background Hereditary haemorrhagic telangiectasia (HHT) is a dominantly inherited genetic vascular disorder that has prevalence of 1:5000 to 1:8000, and which is characterised by recurrent epistaxis, cutaneous telangiectasia, and arteriovenous malformations (AVMs) that affect many organs including the lungs, gastrointestinal tract, liver, and central nervous system. The aim here was to carry out a review of the literature on HHT complications during pregnancy in order to guide management decisions. Main body A literature review was carried out to analyse all publications on complications that occurred during pregnancy in women with HHT. The PubMed/Medline and Scopus databases were searched. The complications observed in HHT women during pregnancy were then described. The authors identified 5 case series and 31 case reports that describe the evolution of 1577 pregnancies in 630 women with HHT. The overall maternal death rate described in the case series was estimated at 1.0% of pregnancies in the case series and 2 maternal deaths occurred in 31 pregnancy case reports. Severe maternal complications occurred in 2.7 to 6.8% of pregnancies in the case series. Severe complications occurred mostly in the second and third trimester in non-diagnosed and non-screened HHT patients. Severe complications were related to visceral involvement. The most frequent complications were related to pulmonary arteriovenous malformations (PAVMs) (haemothorax (n = 10), haemoptysis (n = 4), and severe hypoxaemia (n = 3)). Neurological complications were related to PAVMs in one case (right to left shunt) and to cerebral arteriovenous malformations (CAVM) and intracranial haemorrhage in 2 cases. Complications were related to hepatic arteriovenous malformations (HAVMs) in 8 cases (acutely decompensated heart failure due to hepatic involvement (n = 1), dyspnoea related to heart failure (n = 5), and hepatobiliary necrosis (n = 2)). Conclusion Based on the literature review, most pregnancies in HHT women occur normally. However, these pregnancies should be considered high-risk, given the potential life-threatening events related to AVM rupture. Furthermore, there is currently no international consensus regarding the medical follow-up of pregnancy in women with HHT and the aim here was to carry out a review of the literature in order to guide screening and management decisions for this rare disease.

Outcomes of Conventional Wound Treatment in a Comprehensive Wound Center

2006 ◽  
Vol 72 (4) ◽  
pp. 314-317 ◽  
Author(s):  
Gabriel Akopian ◽  
Susan P. Nunnery ◽  
Jenny Piangenti ◽  
Pam Rankin ◽  
Chugo Rinoie ◽  
...  
Keyword(s):  
Growth Factor ◽  
Chronic Wounds ◽  
Wound Care ◽  
Case Series ◽  
Wound Treatment ◽  
Care Clinic ◽  
Treatment Type ◽  
Diabetic Wounds ◽  
Human Skin Equivalent ◽  
Growth Factor Treatment

Conventional wound care is the elementary treatment modality for treating chronic wounds. However, early treatment with topical growth factors may be needed for a subset of chronic wounds that fail to heal with good wound care alone. A prospective nonrandomized case series from a single-community outpatient wound care clinic is presented here in an effort to identify the subset of chronic wounds that may require early adjuvant intervention. There were 378 consecutive patients with 774 chronic wounds of varying etiology. All patients received 4 weeks of conventional wound care, including weekly debridement and twice-daily dressing changes. Wounds not reduced by 50 per cent volume at 4 weeks were nonrandomly treated with human skin equivalent (Apligraf®), platelet-derived wound healing factor, or platelet-derived growth factor isoform BB (becaplermin gel, Regranex®). A total of 601 of 774 (78%) wounds healed regardless of treatment type. The median time to heal for all wounds was 49 days (interquartile range = 26–93). More women than men healed (85% vs 71%, respectively, P < 0.0001). Diabetic wounds were as likely to heal as nondiabetic wounds (78% vs 80%, P = 0.5675). Wounds that did not heal had larger volumes and higher grade compared with wounds that healed (P < 0.0001 for both variables). The data presented here show that the majority of chronic wounds will heal with conventional wound care, regardless of etiology. Large wounds with higher grades are less responsive to conventional wound care and will benefit from topical growth factor treatment early in the treatment course.

scholarly journals Models Used in Clinical Decision Support Systems Supporting Healthcare Professionals Treating Chronic Wounds: Systematic Literature Review (Preprint)

2017 ◽  
Author(s):  
Clara Schaarup ◽  
Louise Bilenberg Pape-Haugaard ◽  
Ole Kristian Hejlesen
Keyword(s):  
Health Care ◽  
Decision Support ◽  
Literature Review ◽  
Clinical Decision Support ◽  
Systematic Literature Review ◽  
Health Care Professionals ◽  
Chronic Wounds ◽  
Wound Care ◽  
Clinical Decision ◽  
Decision Support Models

BACKGROUND Chronic wounds such as diabetic foot ulcers, venous leg ulcers, and pressure ulcers are a massive burden to health care facilities. Many randomized controlled trials on different wound care elements have been conducted and published in the Cochrane Library, all of which have only a low evidential basis. Thus, health care professionals are forced to rely on their own experience when making decisions regarding wound care. To progress from experience-based practice to evidence-based wound care practice, clinical decision support systems (CDSS) that help health care providers with decision-making in a clinical workflow have been developed. These systems have proven useful in many areas of the health care sector, partly because they have increased the quality of care, and partially because they have generated a solid basis for evidence-based practice. However, no systematic reviews focus on CDSS within the field of wound care to chronic wounds. OBJECTIVE The aims of this systematic literature review are (1) to identify models used in CDSS that support health care professionals treating chronic wounds, and (2) to classify each clinical decision support model according to selected variables and to create an overview. METHODS A systematic review was conducted using 6 databases. This systematic literature review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement for systematic reviews. The search strategy consisted of three facets, respectively: Facet 1 (Algorithm), Facet 2 (Wound care) and Facet 3 (Clinical decision support system). Studies based on acute wounds or trauma were excluded. Similarly, studies that presented guidelines, protocols and instructions were excluded, since they do not require progression along an active chain of reasoning from the clinicians, just their focus. Finally, studies were excluded if they had not undergone a peer review process. The following aspects were extracted from each article: authors, year, country, the sample size of data and variables describing the type of clinical decision support models. The decision support models were classified in 2 ways: quantitative decision support models, and qualitative decision support models. RESULTS The final number of studies included in the systematic literature review was 10. These clinical decision support models included 4/10 (40%) quantitative decision support models and 6/10 (60%) qualitative decision support models. The earliest article was published in 2007, and the most recent was from 2015. CONCLUSIONS The clinical decision support models were targeted at a variety of different types of chronic wounds. The degree of accessibility of the inference engines varied. Quantitative models served as the engine and were invisible to the health care professionals, while qualitative models required interaction with the user.

scholarly journals Multi-Modal Treatment Approach to Painful Rib Syndrome: Case Series and Review of the Literature

2016 ◽  
Vol 3;19 (3;3) ◽  
pp. E465-E471 ◽  
Author(s):  
Andrew Germanovich
Keyword(s):  
Literature Review ◽  
Chest Wall ◽  
Treatment Plan ◽  
Case Series ◽  
Intercostal Nerve ◽  
Pain Clinic ◽  
Review Of The Literature ◽  
Presenting Symptoms ◽  
Modal Treatment ◽  
Manual Manipulation

Background: Mechanical chest wall pain is a common presenting complaint in the primary care office, emergency room, and specialty clinic. Diagnostic testing is often expensive due to similar presenting symptoms that may involve the heart or lungs. Since the chest wall biomechanics are poorly understood by many clinicians, few effective treatments are offered to patients with rib-related acute pain, which may lead to chronic pain. Objective: This case series and literature review illustrates biomechanics involved in the pathogenesis of rib-related chest wall pain and suggests an effective multi-modal treatment plan using interventional techniques with emphasis on manual manipulative techniques. Study Design: Case series and literature review. Setting: Pain clinic in an academic medical center. Results: This is a case series of 3 patients diagnosed with painful rib syndrome using osteopathic palpatory physical examination techniques. Ultrasound-guided intercostal nerve blocks were followed by manual manipulation of mechanically displaced ribs as a part of our multi-modal treatment plan. A review of the literature was undertaken to clarify nomenclature used in the description of rib-related pain, to describe the biomechanics involved in the pathogenesis of mechanical rib pain, and to illustrate the use of effective manual manipulation techniques. Limitation: This review is introductory and not a complete review of all manual or interventional pain management techniques applicable to the treatment of mechanical ribrelated pain. Conclusions: Manual diagnostic and therapeutic skills can be learned by physicians to treat biomechanically complex rib-related chest wall pain in combination with interventional imageguided techniques. Pain physicians should learn certain basic manual manipulation skills both for diagnostic and therapeutic purposes.: Key words: Chest wall pain, rib pain, intercostal neuralgia, slipping rib syndrome, chest pain, intercostal nerve block, chest trauma

scholarly journals Management of Calcium Channel Antagonist Overdose with Hyperinsulinemia-Euglycemia Therapy: Case Series and Review of the Literature

2012 ◽  
Vol 2012 ◽  
pp. 1-5 ◽  
Author(s):  
Shiwan K. Shah ◽  
Sanjeev Kumar Goswami ◽  
Rajesh V. Babu ◽  
Gulshan Sharma ◽  
Alexander G. Duarte
Keyword(s):  
Literature Review ◽  
Supportive Care ◽  
Calcium Channel ◽  
Fluid Resuscitation ◽  
Calcium Channel Antagonist ◽  
Case Series ◽  
Review Of The Literature ◽  
Calcium Channel Antagonists ◽  
Drug Overdoses ◽  
Potential Use

Calcium channel antagonists (CCAs) are commonly involved in drug overdoses. Standard approaches to the management of CCA overdoses, including fluid resuscitation, gut decontamination, administration of calcium, glucagon, and atropine, as well as supportive care, are often ineffective. We report on two patients who improved after addition of hyperinsulinemia-euglycemia (HIE) therapy. We conclude with a literature review on hyperinsulinemia-euglycemia therapy with an exploration of the physiology behind its potential use.

Efficacy of Hydromechanical Therapy in Nonhealing, Chronic Wounds as a Cost- and Clinically Effective Wound Care Modality

2021 ◽  
Vol 33 (11) ◽  
pp. 296-303
Author(s):  
Haley DesJardins ◽  
Sydney Char ◽  
Patrick Marasco ◽  
Yung-Chang Hsu ◽  
Lifei Guo
Keyword(s):  
Chronic Wounds ◽  
Chronic Wound ◽  
Wound Care ◽  
Tap Water ◽  
Case Series ◽  
Cost Savings ◽  
Clinical Results ◽  
Potential Cost ◽  
Term Care ◽  
Pressurized Irrigation

Introduction. Chronic wounds pose a widespread challenge to health care, with many new, costly wound care modalities introduced in recent years with varying degrees of success. Bacterial biofilms have been postulated as one of the main culprits of the stagnation of chronic wound healing. For years, surgical fields have used pressurized irrigation for cleansing surgical wounds, but its utility in managing nonhealing chronic wounds has often been overlooked. Objective. In this case series, the authors aimed to demonstrate that hydromechanical therapy with pressurized irrigation can be a cost-effective and clinically effective wound care modality. Materials and Methods. The authors present 6 clinical cases of difficult nonhealing wounds managed with hydromechanical therapy with pressurized irrigation, a follow-up from the initial case report. Other, often more expensive modalities, had previously failed. In all 6 cases, irrigation was performed using tap water or saline either at home or long-term care facilities. Literature that focused on the mechanism of healing from hydromechanical therapy was reviewed. Results. All chronic wounds in the series reached stable healing. The authors speculate that such healing was achieved through biofilm disruption and tissue stimulation with a mechanical impact. Literature supporting this hypothesis is presented. Conclusions. The current clinical results offer a new perspective on the role of a traditional surgical modality of hydromechanical therapy in chronic wound care and on the associated opportunity of potential cost savings.

Decreasing Pain and Increasing the Rate of Chronic Wound Closure With the Use of a Noninvasive Bioelectronic Medical Device: A Case Series

2021 ◽  
Vol 33 (5) ◽  
pp. 119-126
Author(s):  
David Hatch ◽  
Michael Lavor
Keyword(s):  
Wound Closure ◽  
Chronic Wounds ◽  
Wound Care ◽  
Case Series ◽  
Current Therapy ◽  
Pain Level ◽  
Average Percentage ◽  
Individualized Care ◽  
Wound Size ◽  
Wound Pain

Introduction. Chronic wounds are a source of significant morbidity. Medical and scientific efforts are ongoing to further therapeutic modalities improving pain scores and augmenting healing while decreasing complications and reducing the social and economic burden of wounds. Electrical current therapy, or electrical stimulation (ES), has been shown to decrease and modulate both acute and chronic pain; however, understanding of the role of ES in wound closure is limited. Objective. This single-center case series reports use of a topical ultrahigh frequency ES (UHF-ES) therapy to decrease wound pain and improve the rate of closure in difficult-to-heal wounds in 9 patients. Materials and Methods. Initially, each patient underwent individualized care of their chronic wounds for a minimum of 8 weeks, after which adjunct UHF-ES therapy was provided 3 times per week for an average of 8 additional weeks. Wound size and pain level were documented for the period before and after UHF-ES. Results. Overall, pain improved across the 9 patients. One patient was insensate, and another experienced an increase in pain during treatment. Of the 8 patients with sensation, 7 (88%) experienced a decrease in wound pain, with an average 3.4-point reduction per 10-point visual analog scale. Average pain level was 4.14 before treatment and 0.71 after. The average wound size was 5.70 cm2 ± 5.23 cm2 approximately 8 weeks before the initiation of treatment, 4.34 cm2 ± 4.51 cm2 at the time of treatment, and 1.2 cm2 ± 1.75 cm2 at the conclusion of treatment. The average percentage of wound closure with individualized wound care alone was 23.77%, which increased to 64.58% with the addition of UHF-ES therapy. The weekly percentage of wound closure was statistically significant (P = .0027) between the 2 treatment methods. Conclusions. While additional research into the use of ES (namely, UHF-ES in wound healing) is warranted, the device reported herein may be an effective, safe, and low-cost adjunct treatment in the care of chronic, difficult-to-heal wounds.

scholarly journals Wound bed preparation: a case series using polyhexanide and betaine solution and gel—a UK perspective

2020 ◽  
Vol 29 (7) ◽  
pp. 380-386
Author(s):  
Leanne Atkin ◽  
John Stephenson ◽  
Dawn M Cooper
Keyword(s):  
Chronic Wounds ◽  
Wound Care ◽  
Case Series ◽  
Wound Irrigation ◽  
Irrigation Solution ◽  
New Treatment ◽  
The Uk ◽  
Wound Bed Preparation ◽  
Dressing Change ◽  
Observation Period

Objective: The burden of wound care within the NHS is estimated at a cost of £5.3 billion per year and is set to rise annually by 30%. This case series describes the results of using polyhexanide (PHMB) and betaine wound irrigation solution and gels (Prontosan, B.Braun Medical Ltd., UK) across the UK in hard-to-heal (also described as chronic) wounds up to 20 years' duration, with an observation period of greater than one month. Over half of the hard-to-heal wounds were healed and vast improvements to all other wounds were observed. Improvements to wound bed condition were reported as early as two days after commencing initial treatment, with decreases in malodour, exudate, slough and pain reported across the case series. In addition to wound bed improvements, a reduction in dressing change frequency of 55% was observed in hard-to-heal wounds under the new treatment regime.

Immunosuppression as efficient therapy for Eosinophilic cholangitis: A case series and review of the literature

2018 ◽  
Vol 56 (01) ◽  
pp. E2-E89
Author(s):  
D Reher ◽  
C Schramm ◽  
F Brinkert ◽  
A Lohse ◽  
C Weiler-Normann
Keyword(s):  
Case Series ◽  
Review Of The Literature ◽  
Eosinophilic Cholangitis
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