Subject(s)
Rhytidoplasty/history , Attitude , History, 20th Century , History, 21st Century , HumansABSTRACT
BACKGROUND: Cervical necrotizing fasciitis is an aggressive infection that can be rapidly fatal if aggressive therapies are not initiated early. Negative pressure wound therapy has been established as an effective tool in promoting wound healing, but its use in the acutely infected wound has been avoided because it limits frequent irrigations and standard dressing changes. METHODS: We discuss a novel application of negative pressure wound therapy with instillation in an immunocompromised patient with extensive cervical necrotizing fasciitis. RESULTS: The negative pressure wound therapy with instillation provided pain relief by minimizing the frequency of dressing changes, increased the speed of healing, helped to control infection, and facilitated the development of a healthy wound bed sufficient for reconstruction with a split thickness skin graft. CONCLUSION: The role of negative pressure wound therapy with instillation continues to expand and can be used in the management of both acute and chronic wounds in the head and neck.
Subject(s)
Anti-Bacterial Agents/administration & dosage , Fasciitis, Necrotizing/diagnosis , Fasciitis, Necrotizing/surgery , Methicillin-Resistant Staphylococcus aureus/isolation & purification , Negative-Pressure Wound Therapy/methods , Staphylococcal Infections/surgery , Debridement/methods , Fasciitis, Necrotizing/immunology , Follow-Up Studies , Humans , Immunocompromised Host , Instillation, Drug , Male , Middle Aged , Neck , Severity of Illness Index , Skin Transplantation/methods , Staphylococcal Infections/diagnosis , Treatment Outcome , Wound Healing/physiologySubject(s)
Budesonide/adverse effects , Cushing Syndrome/chemically induced , Cytochrome P-450 CYP3A/metabolism , HIV Protease Inhibitors/pharmacology , Aged , Atazanavir Sulfate , Budesonide/pharmacokinetics , Cytochrome P-450 CYP3A Inhibitors , Drug Interactions , Glucocorticoids/adverse effects , Glucocorticoids/pharmacokinetics , HIV Infections/drug therapy , HIV Protease Inhibitors/adverse effects , Humans , Male , Oligopeptides/adverse effects , Oligopeptides/pharmacology , Pyridines/adverse effects , Pyridines/pharmacology , Ritonavir/adverse effects , Ritonavir/pharmacologyABSTRACT
OBJECTIVES/HYPOTHESIS: Excitotoxic and related inflammatory injury are implicated in the spiral ganglion degeneration seen with Meniere's disease and endolymphatic hydrops (ELH). Excitotoxicity is initiated with glutamate elevation and associated with downstream increases in reactive oxygen species resulting in inflammation-mediated neuronal degeneration. This study tests the hypothesis that interruption of the initial and/or downstream aspects of excitotoxicity should provide hearing protection in ELH-associated hearing loss. STUDY DESIGN: This study tests whether riluzole, a glutamate release inhibitor, and dimethylsulfoxide (DMSO), an anti-inflammatory and antioxidant solvent with favorable properties at the level of glutamate receptors, can protect against early-stage hearing loss in a mouse model of ELH. METHODS: The Phex(Hyp-Duk) mouse spontaneously develops ELH and postnatal hearing loss. Starting at postnatal day 6 (P6), daily injections of riluzole + DMSO or just DMSO were administered. Untreated mutants served as controls. At P21, P25, and P30, hearing function was assessed by recording auditory brainstem responses. A cochlear function index was developed to assess global cochlear function at each time point. RESULTS: Compared to no treatment, DMSO provided significant hearing protection (P < .05). The riluzole + DMSO also showed protection, but it was statistically indistinguishable from DMSO alone; a synergistic increase in protection with riluzole was not observed. CONCLUSIONS: This study demonstrates pharmacological hearing protection in an animal model of ELH. The results support the assertion that inflammatory (reactive oxygen species) injury, which is part of the excitotoxic pathway, contributes to the development of ELH-associated hearing loss.
