The use of a kaolin-based hemostatic dressing to attenuate bleeding in dogs: A series of 4 cases.

OBJECTIVE: To describe the use of a synthetic hemostatic dressing, QuikClot Combat Gauze (QCG), in dogs with bleeding wounds. CASE SERIES SUMMARY: Two dogs presented with bleeding traumatic wounds, and QCG was used to achieve hemostasis during stabilization of these dogs. In the other 2 dogs, QCG was used to help attenuate bleeding associated with a surgical procedure. NEW OR UNIQUE INFORMATION PROVIDED: While hemostatic dressings have been widely studied and used in human medicine, there is minimal information on the use and efficacy of these hemostatic dressings in veterinary medicine. This case series describes the use of QCG in dogs with hemorrhaging wounds. QCG could be a valuable resource in veterinary emergency and critical care settings.

Tendon transfer to unossified bone in a porcine model: potential implications for early tibialis anterior tendon transfers in children with clubfeet.

PURPOSE: Tibialis anterior tendon transfers (TATT) are commonly performed in young children following Ponseti casting for clubfeet. The classic TATT involves advancing the tendon through a hole drilled in the ossified cuneiform. The aim of this study was to determine if tendons transferred through unossified bones have untoward effects on subsequent bone development. METHOD: Twenty-five piglets underwent one of five surgical procedures. An 18-gauge needle was then used to place a tunnel through the bony or cartilaginous portion of the calcaneus (through direct visualization) and isolated slips of the flexor digitorum superficialis (FDS) were placed through the tunnels, as determined by surgical procedure. Radiographic and/or histologic evaluations of the calcaneal apophyses were then performed. A discrete (1-4) and dichotomous "Normal" or "Abnormal" scoring system was developed and its reliability assessed to grade the appearance of the calcanei. Calcaneal appearances following the surgical procedures were then compared with controls. The average load to failure of a subset of transferred tendons was then compared using an MTS machine. RESULTS: The proposed apophyseal grading system (1-4) demonstrated an intraclass correlational coefficient (ICC) for consistency of 0.92 [95% confidence interval (CI) 0.88 < ICC < 0.95] and ICC for agreement of 0.91 (95% CI 0.86 < ICC < 0.95), indicating strong agreement and consistency. Similarly, Fleiss' kappa for the 1-4 scoring system was found to be 0.67, indicating substantial agreement between reviewers. When the 1-4 system was translated into the dichotomous scheme "Normal" and "Abnormal", the kappa value increased to 0.94, indicating strong agreement. Forty-six apophyses (13 control and 33 operative) were assessed using this scoring scheme. Apophyseal transfers were significantly more abnormal than controls (p < 0.0001), while no difference in abnormalities was found following tunnel placement alone (p = 1). Mechanical testing of the tendons transferred to bone or through the cartilaginous apophysis demonstrated no significant differences (p = 0.2). CONCLUSION: Tendon transfers through unossified bones altered subsequent bone development. SIGNIFICANCE: While the long-term consequence of these structural changes is unknown, these findings suggest that tendon transfers through unossified bones should be avoided and alternative methods of tendon fixation explored.

Device-associated infection rates and extra length of stay in an intensive care unit of a university hospital in Wroclaw, Poland: International Nosocomial Infection Control Consortium's (INICC) findings.

PURPOSE: The aim of this study was to determine device-associated health care-associated infections (DA-HAI) rates, microbiologic profile, bacterial resistance, and length of stay in one intensive care unit (ICU) of a hospital member of the International Nosocomial Infection Control Consortium (INICC) in Poland. MATERIALS AND METHODS: A prospective DA-HAI surveillance study was conducted on an adult ICU from January 2007 to May 2010. Data were collected by implementing the methodology developed by INICC and applying the definitions of DA-HAI provided by the National Healthcare Safety Network at the US Centers for Disease Control and Prevention. RESULTS: A total of 847 patients hospitalized for 9386 days acquired 206 DA-HAIs, an overall rate of 24.3% (95% confidence interval [CI], 21.5-27.4), and 21.9 (95% CI, 19.0-25.1) DA-HAIs per 1000 ICU-days. Central line-associated bloodstream infection rate was 4.01 (95% CI, 2.8-5.6) per 1000 catheter-days, ventilator-associated pneumonia rate was 18.2 (95% CI, 15.5-21.6) per 1000 ventilator-days, and catheter-associated urinary tract infection rate was 4.8 (95% CI, 3.5-6.5) per 1000 catheter-days. Length of stay was 6.9 days for those patients without DA-HAI, 10.0 days for those with central line-associated bloodstream infection, 15.5 days for those with ventilator-associated pneumonia, and 15.0 for those with catheter-associated urinary tract infection. CONCLUSIONS: Most DA-HAI rates are lower in Poland than in INICC, but higher than in the National Healthcare Safety Network, expressing the feasibility of lowering infection rates and increasing patient safety.

[Severe acute respiratory distress syndrome complicating type A (H1N1) influenza treated with extracorporeal CO2 removal]. / Zespól ostrej niewydolnosci oddechowej w przebiegu grypy AH1N1 leczony skutecznie pozaustrojowa eliminacja CO2 .

BACKGROUND: The influenza pandemic of 2009 was reported to be frequently associated with pulmonary complications, including ARDS. We report the case of a morbidly obese, 37-year-old, AH1N1-infected woman, who was admitted to a regional hospital because of rapidly progressing respiratory failure. She was treated successfully with high frequency oscillatory ventilation (HFOV) and low-flow extracorporeal CO2 removal. CASE REPORT: The patient was admitted to a regional hospital because of severe viral infection, diabetes and hypertension that developed during pregnancy. On admission, she was deeply unconscious (GCS 5), hypotonic and anuric. Conventional ventilation, veno-venous haemofiltration, antibiotics and antiviral therapy (oseltamivir) did not improve the patient's condition, and she was transferred to a tertiary referral centre. Immediately before the transfer, she suffered two cardiac arrest episodes. They were successfully reversed. On admission, the patient was hypercapnic (PaCO2 150 mm Hg/20 kPa), acidotic (pH 6.92) and hyperkinetic (HR 120 min-1, CO 12.7 L min-1). Total lung compliance was 21 mL cm H2O-1, and SAP/DAP was 63/39 mm Hg). The PaO2/FIO2 index was 85. HFOV was instituted for 48 h, resulting in a marked improvement in gas exchange, however any manipulations caused immediate deterioration in the patient's condition. Extracorporeal CO2 removal was commenced and continued for 120 h, resulting in gradual improvement and eventual weaning from artificial ventilation after 17 days. Further treatment was complicated by septic shock due to Pseudomonas aeruginosa infection of the vagina, treated with piperacillin/tazobactam. The patient eventually recovered and returned to her regional hospital after 24 days. DISCUSSION: During the 2009 pandemic, a high number of pulmonary complications were observed all over the world. Viral infections are especially difficult to treat and the CESAR study indicated that the use of ECMO or extracorporeal CO2 removal devices may result in a lower mortality when compared with standard therapy. We conclude that the use of a simple CO2 removal device can be beneficial in complicated cases of AH1N1 influenza.

[Haemorrhagic shock complicating acute pancreatitis]. / Wstrzas krwotoczny w przebiegu powilanego zapalenia trzustki.

BACKGROUND: Acute pancreatitis may be accompanied by a number of complications. They include diffuse peritonitis, intra-abdominal and retroperitoneal abscesses, and severe haemorrhage. These complications are the cause of approximately 50% of all deaths in acute pancreatitis. CASE REPORT: A 33-year-old man was admitted to ITU with septic shock, due to acute pancreatitis and necrosis after multiple surgeries. On the fifth day after admission, his condition deteriorated due to respiratory distress and massive bleeding from the splenic region requiring surgical packing. On the next day, the bleeding became critical. More than 2000 mL of blood was evacuated from the peritoneal cavity, the bleeding site was re-packed, and the patient was transfused with RBCs, FFP and 0.04 mg kg(-1) of recombinant factor VIIa concentrate. This resulted in haemostasis, however the subsequent clinical course was complicated by septic shock, perforation of the transverse colon and peritonitis. The patient eventually recovered and was discharged home after 105 days in hospital. CONCLUSION: Multifactorial management of acute pancreatitis is essential; in cases of severe haemorrhage, surgical packing and administration of recombinant factor VIIa concentrate are key components of successful treatment.