Zusammenfassung Einleitung Anhand einer Fallserie berichten wir über unsere ersten Erfahrungen mit einer intrathorakalen Unterdrucktherapie (ITNPT) in der stadienadaptierten Therapie des Pleuraempyems (PE). Material und Methoden Die ITNPT ist eine Weiterentwicklung der Unterdrucktherapie für die intrathorakale Anwendung. Nach thoraxchirurgischem offenen Débridement wurde ein intrathorakaler Unterdruckverband installiert. Als Drainageelemente verwendeten wir eine dünne offenporige doppellagige Drainagefolie (OF) mit offenporigen Polyurethanschäumen (PUS). Ausschließlich die OF wurde in direktem Kontakt zum Lungenparenchym angelegt. Die Unterdruckerzeugung erfolgte mit einer elektronischen Pumpe (kontinuierlicher Sog, −75 mm Hg). In der Revisionthorakotomie wurde je nach Lokalbefund die ITNPT beendet oder fortgeführt. Ergebnisse Es wurden 31 Patienten im PE-Stadium II und III behandelt. Die ITNPT erfolgte bereits beim Primäreingriff (n = 17) oder bei Revision (n = 14). Die ITNPT erfolgte über einen Dauer von m = 10 Tagen (2–18 Tage), Wechselintervall m = 4 d (2–6 d). Die intrathorakaler Unterdruckverband-Anlage wurde in m = 3,5 (1–6) mal vorgenommen. Die Empyemhöhle verkleinerte und reinigte sich unter dem Sog kontinuierlich. Die OF hat ein minimales Eigenvolumen bei maximaler Resorptionsoberfläche. Nach Anlage des Unterdrucks besteht kein intrathorakales Totvolumen, das Parenchym kann sich entfalten. Diskussion Die schonenden Materialeigenschaften der OF ermöglichen die ITNPT zur Behandlung des Pleuraempyems. Es ist eine gezielte lokale intrathorakale Sanierung des septischen Focus in Ergänzung zur operativen Therapie möglich. Das Behandlungsregime erfordert wiederholte operative Verbandswechsel. Die Methode ist geeignet zur Behandlung komplizierter PIeuraempyeme im Stadium II und III. Konklusion Die OF kann als intrathorakales Drainageelement zur ITNPT bei Pleuraempyemen verwendet werden. Das Indikationsspektrum der Unterdrucktherapie erweitert sich um diese neue Anwendungsoption.
The oral delivery of bacteria in the human intestine is of great interest because of its potential to correct the gut microbiota and treat inflammatory bowel diseases. The aim of this study was to evaluate sodium N-(2-sulfonatoethyl)chitosan gel cross-linked with glutaraldehyde as a delivery carrier for probiotic bacteria to the gut using in vitro and in vivo experiments. The bacterial test strain was B. subtilis 20. The cytotoxicity of the gel was evaluated via cell culture using flow cytometry and light microscopy. The gel as a delivery system was assessed by the dye release in medium with different pH levels in vitro, and by bacterial titer monitoring in mouse feces using the microbiology method in vivo. Results of an in vitro experiment showed that tested gel has no cytotoxicity. The use of gel as a carrier for bacterial delivery into the intestine was more effective than oral gavage of bacterial suspension. Therefore, gel delivery of bacteria decreased the titer level by up to two times. However, a gavage of bacterial suspension decreased the titer level by over 200 times. Tested gel has the potential to be a carrier for the safe delivery of bacteria to the intestine through the stomach, reducing the rate of the elimination of probiotic bacteria from the intestine.
Background We report our initial experience with intrathoracic negative pressure therapy (ITNPT) in the stage-adjusted treatment of pleural empyema (PE) based on a case series. Materials and methods ITNPT represents a further development for intrathoracic use. After thoracic surgical open debridement, an intrathoracic negative pressure dressing was inserted. The drainage elements were a thin open-pore double-layer drainage film (OF) with open-pore polyurethane foams (PUF). Only the OF was placed in direct contact with the lung parenchyma. Negative pressure was generated using an electronic pump (continuous suction, −75 mm Hg). In revision thoracotomies, ITNPT was stopped or continued depending on local findings. Results In total, 31 patients with stage II and III pleural empyema underwent ITNPT, which was administered during the primary procedure (n = 17) or at revision (n = 14). Treatment duration was a mean of 10 days (2–18 days) with a mean change interval of 4 days (2–6 days). Intrathoracic negative pressure dressings were applied a mean of 3.5 (1–6) times. The empyema cavity continuously reduced in size and was cleansed by the suction. The OF has a minimum intrinsic volume with maximum absorption surface. Once negative pressure is established, there is no intrathoracic dead volume and the parenchyma can expand. The protective material properties of OF make ITNPT suitable for the treatment of pleural empyema. Targeted local intrathoracic drainage of the septic focus is a possible adjunct to surgery. The surgical dressings must be changed repeatedly. The method is suitable for the treatment of complex stage II and III pleural empyemas. Conclusion The OF can be used as an intrathoracic drainage element for ITNPT in pleural empyema. This new application option expands the range of indications for negative pressure therapy.
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