The use of negative pressure wound therapy with instillation and dwell time (NPWTi-d) has been shown to be effective in removing nonviable tissue, reducing bioburden, and promoting granulation tissue formation in acute and chronic infected wounds.
To illustrate the clinical efficacy of the use of pure hypochlorous acid (pHA) antimicrobially preserved wound cleansing solution as the instillation fluid for NPWTi-d (NPWTi-d/pHA) in wound bed preparation in patients with complex wounds.
The treatment protocol for use of NPWTi-d/pHA in preparing wound beds for final closure is demonstrated in 3 illustrative cases of patients with complex wounds resulting from necrotizing infection and trauma with heavy contamination. All 3 patients developed a healthy-appearing wound bed deemed suitable for primary closure an average of approximately 1 month following initial surgical debridement.
The cases presented demonstrate the ability of a pHA antimicrobially preserved wound cleansing solution used as the instillation fluid with NPWTi-d to aid in bacterial reduction, mechanical debridement, and promotion of wound healing. Use of NPWTi-d/pHA in these cases of extensive necrotizing infection and posttraumatic injury with heavy contamination allowed for final closure an average of 1 month after initial surgical debridement.

UNASSIGNED: This case report reviews the effect of combining a 250-cc bottle of standard antimicrobial, buffered sodium hypochlorite with a surgical method, low-pressure jet lavage irrigation in the outpatient setting to control difficult wound contamination. A 73-year-old man had been in treatment for over 8 years, undergoing at least 18 surgical wound debridement procedures for an extensive undermined pelvic pressure injury involving the sacrum, ischium, and greater trochanter. Cultures and polymerase chain reaction diagnostics revealed a multibacterial presence. Autofluorescent imaging (AFI) was used in 21 examinations performed after a 72-hour delay over a long weekend. The AFI contamination exceeded log 4 colony-forming units/g of tissue in all pretreatment examinations and was reduced to less than log 2 colony-forming units in 6 of 21 examinations, with the remaining 15 showing an estimated 80% or higher removal of the bacterial porphyrin \"red\" appearance. A total of 54 AFI examinations were performed using the combination treatment, and no adverse reactions were encountered. Treatment paradigms can be improved with a multifactorial approach.

This case study explores the benefits of transanal irrigation as a treatment for a patient with a spinal cord injury who was experiencing chronic constipation. In this case, the patient was having episodes of autonomic dysreflexia as a result of the constipation. This condition is unique to patients with spinal cord injury and presents a stroke risk. The article outlines the contraindications and cautions that need to be considered in assessing a patient\'s suitability for transanal irrigation, and the elements that form part of a holistic assessment by a specialist nurse.

Commonly used isotonic arthroscopic irrigation fluids, such as normal saline or lactated Ringer\'s, were initially formulated for intravenous administration so they do not replicate the physiologic properties of healthy synovial fluid. Synovial fluid plays an important role in regulating joint homeostasis such that even transient disruptions in its composition and physiology can be detrimental. Previous studies suggest that hyperosmolar solutions may be a promising alternative to traditional isotonic fluids. This manuscript sought to systematically review and synthesize previously published basic science, translational, and clinical studies on the use of hyperosmolar arthroscopic irrigation fluids to delineate the optimal fluid for clinical use. A systematic literature search of MEDLINE/PubMed and Embase databases was performed in accordance with Preferred Reporting Items for Systemic Reviews and Meta-analyses (PRISMA) guidelines. The search phrases were: (\"cartilage\" AND \"hyperosmolar\"); (\"arthroscopy\" OR \"arthroscopic\" AND \"hyperosmolar\"). The titles, abstracts, and full texts were screened for studies on hyperosmolar solutions and articular cartilage. Study quality was assessed, and relevant data were collected. A meta-analysis was not performed due to study heterogeneity. A risk of bias assessment was performed on the included translational and clinical studies. There were 10 basic science studies, 2 studies performed in translational animal models, and 2 clinical studies included in this review. Of the basic science studies, 7 utilized a mechanical injury model. The translational studies were carried out in the canine shoulder and equine stifle (knee) joint. Clinical studies were performed in the shoulder and knee. Multiple basic science, translational, and clinical studies highlight the short-term safety, cost-effectiveness, and potential benefits associated with use of hyperosmolar solutions for arthroscopic irrigation. Further work is needed to develop and validate the ideal formulation for a hyperosmolar irrigation solution with proven long-term benefits for patients undergoing arthroscopic surgeries.

High grade gliomas are the most common and most lethal primary cancers of the central nervous system.
We herein present a case report of a long-term surviving 36-year-old female diagnosed with high grade glioma, for which she underwent neurosurgery with a gross total removal of the tumor. Shortly thereafter (<3 months) she was readmitted in a desolate state due to a large recurrence. After Ethical Committee approval, proper explanation, and consent from spouse, she was subjected to a reoperation involving a post-operative infusion into the excised tumor cavity, containing a mixture of a non-physiological amino acid in millimolar concentration and a proapoptotic drug in micromolar concentration. The patient tolerated the treatment well and was discharged in a stable state thereafter. A series of follow ups revealed successive clinical improvements and after 4-6 months, she had recovered with mild left hemiparesis, meaning that she was able to carry out activities of daily living independently. Now, 5.5 years later, after the recurrence and the infusion therapy, she continues to have a mild left hemiparesis and her MRI with contrast shows no evidence of tumor.
Continuous intratumoral infusion therapy with an artificial amino acid combined with a proapoptotic drug results in complete glioma cell lysis both in vitro and in vivo.

To analyze the clinical data and next generation sequencing (NGS) results from a child with 22q11.2 deletion syndrome (22q11DS) complicated with pulmonary alveolar proteinosis (PAP) who was admitted to the Department of Pediatrics of Fuyang People\'s Hospital and to present a review of the literature.
A 9-year-old male child, whose face had a small mandible and high-arched palate, but lacked a cleft palate, had repeated respiratory tract infections and bronchiectasis. Clinical examination, computer tomography, and electronic bronchoscopy were performed. Genetic testing via NGS was undertaken. PAP was confirmed by Periodic Acid Schiff staining of milky white alveolar lavage fluid isolated by electronic bronchoscopy. A deletion of approximately 2.46 Mbp on chromosome 22q11.2 was confirmed by NGS. During hospitalization, anti-infection, nebulization, alveolar lavage, and regular application of thymosin were administered to the patient. The condition of the patient stabilized following treatment.
22q11DS and PAP are both rare diseases, and the manifestation of 22q11DS combined with PAP has not been previously reported. The diagnosis and treatment of this case will be a reference for future clinical work.

暂无摘要。

Cases of empyema associated with Histoplasma infection are rarely reported. Here, we discuss a case of Histoplasma-associated empyema successfully treated with amphotericin B intravenous and pleural infusion therapy and multiple medical thoracoscopies. A 57-year-old Chinese woman with preexisting diabetes mellitus and gastric cancer had massive left-sided pleural effusion diagnosed by chest computed tomography. Her pleural effusion was purulent through pleural catheter drainage, and the culture of the pleural fluid showed Escherichia coli and Streptococcus constellation. Histopathology of the thoracoscopic pleural biopsy after hexamine silver and PAS staining supported Histoplasma infection. The patient was treated with intravenous injection and local thoracic irrigation of amphotericin B and continuous oral administration of itraconazole. At the same time, the patient received thoracic cannulation, daily thoracic lavage and thoracoscopy for purulent and necrotic tissue removal three times during hospitalization. The patient\'s pleural effusion and necrotic tissue in the pleural cavity were significantly reduced in a short time, and the clinical symptoms were significantly improved. After discharge, the patient recovered well and had no obvious complications or sequelae. Intravenous injection and local thoracic irrigation of amphotericin B are safe and effective drug therapies to treat fungal-associated empyema such as Histoplasma. Medical thoracoscopy effectively shortens the recovery time of empyema, improving the prognosis and reducing complications.

Acute calcific tendinitis (ACT) is a relatively uncommon disorder that can involve the hand and wrist. ACT is frequently misdiagnosed due to a lack of familiarity with the condition and the clinical presentation that can be confused with other conditions. We report a case of acute calcific tendinitis of the flexor carpi ulnaris (FCU) tendon in a 68-year-old woman. She presented with acute left volar wrist pain, erythema, swelling, and restricted range of motion. Due to her inability to take nonsteroidal anti-inflammatory drugs (NSAIDs) and oral prednisone, she was treated with lavage and steroid injection of the calcified mass. Following the injection, there was dramatic improvement in her symptoms. Cortisone injection with lavage is an accepted treatment for rotator cuff calcific tendinitis and is another treatment option for ACT involving the hand and wrist.

Patients with pancreatic walled-off necrosis (WON) treated by minimally invasive approaches often require repeated necrosectomy instead of conventional open necrosectomy. A 55-year-old woman with lateral infected pancreatic WON was successfully treated by an infrequently used technique involving an ultrasonic pneumatic lithotripsy system (UPLS) and double-catheter aspirated lavage through a percutaneous drainage tract. No perioperative complications occurred. The mean operating time of the repeated procedures was 35 minutes (range, 25-48 minutes). The total hospitalization stay was 46 days, and no recurrence of the fluid collection was observed during the 15-month follow-up period. UPLS-assisted necrosectomy and double-catheter aspirated lavage is an alternative technique for lateral WON that fails to improve by percutaneous drainage. It efficiently combines disintegration and aspiration procedures and can be safely repeated under total intravenous anesthesia through sinus tracts.