Background: Permanent abdominal wall closure in patients undergoing damage-control laparotomy is achieved using techniques involving separation and advancement of abdominal wall components along with surgical mesh. However, these techniques are costly, morbid, and time-consuming. We compared outcomes following permanent abdominal closure using component separation (CS) with non-cross-linked porcine acellular dermal matrix (PADM) versus temporizing split-thickness skin graft (STSG) closure. Materials and methods: A retrospective review identified eleven patients who underwent damage-control laparotomies from January 2010 to June 2011. Outcomes assessed included hospital length of stay (LOS), days on ventilator, size of defect and tissue matrix, and postoperative functionality. Results: Of the eleven patients identified, primary closure was achieved in five, CS/PADM closure in four, and STSG closure in two. Those with primary closure were excluded from the study. In the CS/PADM group, large defects (.24×20 cm) were successfully closed using CS with PADM. Patients in the CS/PADM group had reduced third-space fluid loss, less difficulty in managing the open abdominal wound, and decreased risks for potential enterocutaneous fistulae, and intra-abdominal abscess formation. Total hospital LOS and days on the ventilator were also significantly reduced in the CS/PADM group compared with the STSG group. Conclusion: Early abdominal closure using CS/PADM was safe and effective in these patients, and may be cost-effective because only one operation is required. The shorter hospital LOS and days on the ventilator observed versus STSG closure appear promising, although further study is required.
We report a 64-year-old man with arthritis and nodules to describe that this picture can be caused by normo-lipidemic xanthomas. Light and electron microscopy (EM) plus polymerase chain reaction (PCR) studies were performed for diagnosis and investigation. These showed features typical of xanthomas plus PCR and EM evidence of possible infection with Chlamydia pneumoniae as a pathogenetic mechanism deserving consideration. With such rare diseases, any clues to possible mechanisms seem important to record and thus to encourage future investigations. This uncommon cause of arthritis and nodules had been confused with rheumatoid arthritis by others in this case.
We report a 64-year-old man with arthritis and nodules to describe that this picture can be caused by normo-lipidemic xanthomas. Light and electron microscopy (EM) plus polymerase chain reaction (PCR) studies were performed for diagnosis and investigation. These showed features typical of xanthomas plus PCR and EM evidence of possible infection with Chlamydia pneumoniae as a pathogenetic mechanism deserving consideration. With such rare diseases, any clues to possible mechanisms seem important to record and thus to encourage future investigations. This uncommon cause of arthritis and nodules had been confused with rheumatoid arthritis by others in this case.
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