Negative pressure dressing for promoting wound healing of purpura fulminans in a newborn with homozygous protein C deficiency

Negative pressure wound therapy in pediatric surgery: How and when to use

INTRODUCTION

Negative pressure wound therapy (NPWT) has been widely adopted to treat laparostomy, abdominal compartment syndrome (ACS) and complicated wounds associated with tissue loss. The method presents specific aspects, advantages and indications in Pediatrics. Our aim is to review the evidence available about NPWT in children.

METHODS

Active search for papers about NPWT in Pediatric patients. Papers referring to orthopedic problems, wound complications after Cardiac Surgery or burns were excluded.

RESULTS

The method shows good results to treat ACS, complicated wounds and abdominal wall malformations in neonates, including prematures. Periwound skin protection, monitoring of fluid losses and fine tuning of negative pressure levels according to age are necessary. Less pain, quicker recovery, less frequent dressing changes, possible recovery of exposed surgical hardware, granulation and shrinkage of the wound are advantages of the method over other kinds of dressing. NPWT is contraindicated over blood vessels and exposed nerves. Debridement is needed before usage over necrotic areas. Enteric fistulae are not contraindications. Complications are rare, mainly foam retention and dermatitis/skin maceration. The possibility of fistulae being caused by NPWT remains debatable.

CONCLUSION

NPWT is widely used in Pediatrics, including neonates and premature, but the evidence available about the method is scarce and low quality. Complications are uncommon and mostly manageable. A possible causal relationship between NPWY and enteric fistula remains unclear. Adult devices and parameters have been adapted to children's use. Extra care is needed to protect the delicate tissues of Pediatric patients. Comparative research to define differential costs, indications and advantages of the method, specific indications and limits of NWTP in Pediatrics is needed.

TYPE OF STUDY

Review.

EVIDENCE LEVEL

IV.

The effect of Diosmin on the blood proteome in a rat model of venous thrombosis

Diosmin is the aglycone moiety of diosmetin (3',5,7 trihydroxy-4'methoxy radicals flavonoids), a naturally occurring flavone glycoside, whose antithrombotic effect was studied in rats. This study was designed to find the protein changes of venous thrombosis in Wistar rats comparing conditions with and without Diosmin treatment by two-dimensional gel electrophoresis (2-DE), and investigate the effect of a crucial protein known as CEP350 on human vascular endothelial cell growth. Through prior chromatographic purification with macroporous absorption resin (AB-8) and polyamide, Diosmin was isolated from Galium verum L. by solvent extraction, then purified to 98% purity using HPLC. Wistar rats were divided into control group, model group, and prevention group. And their venous thrombosis tissue segments were dissected and prepared for histopathological examination and detection of plasma protein C (PC). Next, proteomic analysis was performed with the samples. Low-abundance proteins of the three groups were separated by two-dimensional gel electrophoresis (2-DE). 2-DE analysis revealed that 191 protein spots were differentially expressed among those three groups. For protein identification, we selected six spots to use matrix assisted laser desorption/ionization-time of flight-mass spectrometry (MALDI-TOF-MS) detection, and then do the homology search in NCBI database. Considering characteristics of these proteins, we proposed CEP350 is related to spindle assembly. Furthermore, we used Lipofectamine 2000 to transfect HUVECs with CEP350 siRNA and evaluated the extent of silencing using real time-polymerase chain reaction (RT-PCR). Cells were stained for immunofluorescence with tubulin-tracker red, and structural changes were analyzed using laser scanning confocal microscope. We concluded that CEP350 depletion decreased microtubule stability. Dosmin could modulate the assemble of spindle from unevenly distributing and protect body from varicose veins by regulating CEP350.

Protein C deficiency: a case review

Protein C (PC) deficiency is a rare but life-threatening bleeding disorder that can present in the immediate neonatal period. This article presents the case of a baby girl with acute and progressive neonatal purpura fulminans as the presenting feature of PC deficiency. Other common complications of this disease include ophthalmic problems and central nervous system (CNS) changes. Management consists of correcting the coagulopathy, intensive wound care including negative-pressure dressings and skin grafting, and supportive care for the ophthalmic and CNS issues. Long-term follow-up consists of lifelong anticoagulant therapy to avoid recurrence of these complications.

Enterocutaneous fistula secondary to purpura fulminans in a preterm infant

Enterocutaneous fistula in newborns and preterms is a well-recognized complication after necrotizing enterocolitis and abdominal surgical procedures/percutaneous interventions. However, to our knowledge, enterocutaneous fistula associated with purpura fulminans has not been reported before. Herein we report a preterm infant with purpura fulminans who developed cutaneous necrotic lesions on anterior abdominal wall. Adherence of necrotic abdominal skin to the adjacent intestinal wall resulted in enterocutaneous fistula. The patient was treated conservatively with bowel rest and antibiotics. The fistula was surgically closed 2 months later.

Genetic variations and their influence on risk and treatment of venous thrombosis

Venous thrombosis (VT) is a highly prevalent disease. Risk factors can be genetic or acquired. The well-established genetic polymorphisms predisposing to thrombophilic disorders can be divided into rare 'loss-of-function mutations' in anticoagulant proteins and common 'gain-of-function mutations' in procoagulant proteins, which are weaker risk factors. In addition to functional polymorphisms, defects in common pathways affecting biosynthesis or clearance of plasma coagulation factors and their relations to VT risk have been detected. Recently, investigations regarding genetic variations and response to drug treatment, relevant for the pathogenesis as well as therapy of venous thromboembolism have been performed. The methodical advances in genetic research have led to the identification of a number of new variants with still unclear association to VT. This review aims to discuss the established genetic risk factors as well as some candidate predictors of VT. Further, the recent developments in pharmacogenomics are reviewed.