Paget-Schroetter syndrome is a relatively uncommon condition related to primary thrombosis of the axillary/subclavian vein at the costoclavicular junction. Vibration injury is an unusual cause of this syndrome. We report on a 28-year-old man who presented with acute onset left arm swelling after whole-day work with a pneumatic drill. Duplex ultrasound confirmed the presence of a thrombus in his left axillary and subclavian vein, which was treated with low molecular weight heparin, eventually switched to oral anticoagulation.
{"title":"[Vascular Vibration Injury and Paget-Shroetter Syndrome].","authors":"P Pekić, D Bekić, N Marić, M Mačković","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Paget-Schroetter syndrome is a relatively uncommon condition related to primary thrombosis of the axillary/subclavian\u0000vein at the costoclavicular junction. Vibration injury is an unusual cause of this syndrome. We report on a 28-year-old man\u0000who presented with acute onset left arm swelling after whole-day work with a pneumatic drill. Duplex ultrasound confirmed\u0000the presence of a thrombus in his left axillary and subclavian vein, which was treated with low molecular weight heparin,\u0000eventually switched to oral anticoagulation.</p>","PeriodicalId":35756,"journal":{"name":"Acta Medica Croatica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35183644","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Effective physical, chemical, biochemical and immune function of the skin requires a corresponding structure of the epidermis. Filaggrin, one of epidermal proteins, is essential for the formation of corneocytes and intracellular metabolites, which in turn contribute to maintaining the stratum corneum humidity and acidic pH of the skin surface. However, a number of profilaggrin gene mutations have been described, as well as different inflammatory conditions and different external factors that all resulted in filaggrin deficiency. Filaggrin deficiency is recorded in different skin diseases and discoveries related to metabolic processing of filaggrin point to new goals in therapeutic strategies. In this preview, the main properties of the formation and metabolism of filaggrin are described, as well as clinical implications of filaggrin deficiency in the etiopathogenesis of some skin diseases.
{"title":"[Fillagrin - Multifunctional Protein].","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Effective physical, chemical, biochemical and immune function of the skin requires a corresponding structure of the\u0000epidermis. Filaggrin, one of epidermal proteins, is essential for the formation of corneocytes and intracellular metabolites,\u0000which in turn contribute to maintaining the stratum corneum humidity and acidic pH of the skin surface. However, a number\u0000of profilaggrin gene mutations have been described, as well as different inflammatory conditions and different external\u0000factors that all resulted in filaggrin deficiency. Filaggrin deficiency is recorded in different skin diseases and discoveries\u0000related to metabolic processing of filaggrin point to new goals in therapeutic strategies. In this preview, the main properties\u0000of the formation and metabolism of filaggrin are described, as well as clinical implications of filaggrin deficiency in the\u0000etiopathogenesis of some skin diseases.</p>","PeriodicalId":35756,"journal":{"name":"Acta Medica Croatica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35183641","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
H Budinčević, A Marčinko Budinčević, M Kos, S Vlašić, J Bartolović, S Benko, V Ostojić, S Soldo Butković
Patients with amyotrophic lateral sclerosis require comprehensive care with a multidisciplinary approach, which is individually adjusted to each patient. The goals of neurorehabilitation should be adjusted to the stage of disease. In early stages, physical therapy is focused on preserving and optimizing motor and respiratory function. At this stage, family should be involved to partake in desired activities and be informed regarding the natural course of the disease. In late stages, physical therapy is focused on preventing respiratory complications and contractures, and orthotics may also be recommended. The onset of dysarthria should trigger swallowing and pulmonary function testing. Swallowing maneuvers should be tried at the onset of symptoms, later feeding tubes or percutaneous gastrostomy tube is necessary. Noninvasive mechanical ventilation may delay the need of tracheostomy and invasive mechanical ventilation. The key objectives of multidisciplinary teams are to optimize medical care, facilitate communication, and thus to improve the quality of care and quality of life.
{"title":"[Multidisciplinary Management and Neurorehabilitation of Patients with Amyotrophic Lateral Sclerosis].","authors":"H Budinčević, A Marčinko Budinčević, M Kos, S Vlašić, J Bartolović, S Benko, V Ostojić, S Soldo Butković","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Patients with amyotrophic lateral sclerosis require comprehensive care with a multidisciplinary approach, which is\u0000individually adjusted to each patient. The goals of neurorehabilitation should be adjusted to the stage of disease. In early\u0000stages, physical therapy is focused on preserving and optimizing motor and respiratory function. At this stage, family\u0000should be involved to partake in desired activities and be informed regarding the natural course of the disease. In late\u0000stages, physical therapy is focused on preventing respiratory complications and contractures, and orthotics may also be\u0000recommended. The onset of dysarthria should trigger swallowing and pulmonary function testing. Swallowing maneuvers\u0000should be tried at the onset of symptoms, later feeding tubes or percutaneous gastrostomy tube is necessary. Noninvasive\u0000mechanical ventilation may delay the need of tracheostomy and invasive mechanical ventilation. The key objectives of\u0000multidisciplinary teams are to optimize medical care, facilitate communication, and thus to improve the quality of care and\u0000quality of life.</p>","PeriodicalId":35756,"journal":{"name":"Acta Medica Croatica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35183639","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Over the last 30 years, medical expenditure has increased throughout the world. The main reasons estimated to lay behind it include aging, ever more chronic diseases and new emerging diseases, new drugs, expanded indications of current drugs, and development of pharmaceutical industry. A challenge for healthcare professionals is to sustain current quality of care and enable medical innovations while attempting to contain costs. The overall goal is to demonstrate the pharmacoeconomic value, i.e. a balance of economic, humanistic and clinical outcomes.
{"title":"[Pharmacoeconomics - Challenges for Health Professionals].","authors":"P Turčić, V Benković, O Brborović, A Valent","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Over the last 30 years, medical expenditure has increased throughout the world. The main reasons estimated to lay\u0000behind it include aging, ever more chronic diseases and new emerging diseases, new drugs, expanded indications of\u0000current drugs, and development of pharmaceutical industry. A challenge for healthcare professionals is to sustain current\u0000quality of care and enable medical innovations while attempting to contain costs. The overall goal is to demonstrate the\u0000pharmacoeconomic value, i.e. a balance of economic, humanistic and clinical outcomes.</p>","PeriodicalId":35756,"journal":{"name":"Acta Medica Croatica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35183640","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
P Ivanišević, Z Čolović, V Pešutić-Pisac, V Škrabić, M Kontić, Z Kljajić
Anaplastic carcinoma of thyroid gland is one of the four most malignant tumors in humans. It appears in one or two patients per million per year. It is very rare in children. A 17-year-old female patient was admitted to the Clinical Department of ENT and Head and Neck Surgery, Split University Hospital Center, for thyroid gland surgery due to rapid growth of a node in the thyroid gland left lobe. Preoperative examination indicated benign nature of changes. Total thyroidectomy with levels VI and VII neck dissection was done. Intraoperative slide of the left lobe was malignant. Positron emission tomography and computed tomography were also done. The finding was negative. The patient was examined by an ENT-oncology team and juvenile radiotherapy was administered. It was found to be carcinoma stage IVa according to TNM classification. One year after the operation, the patient was well and had no signs of illness. This case report is a contribution to the existing but scarce knowledge of anaplastic carcinoma of thyroid gland in young patients in the world.
{"title":"[Anaplastic Thyroid Carcinoma in a 17-Year-Old Female Patient].","authors":"P Ivanišević, Z Čolović, V Pešutić-Pisac, V Škrabić, M Kontić, Z Kljajić","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Anaplastic carcinoma of thyroid gland is one of the four most malignant tumors in humans. It appears in one or two patients\u0000per million per year. It is very rare in children. A 17-year-old female patient was admitted to the Clinical Department of ENT\u0000and Head and Neck Surgery, Split University Hospital Center, for thyroid gland surgery due to rapid growth of a node in the\u0000thyroid gland left lobe. Preoperative examination indicated benign nature of changes. Total thyroidectomy with levels VI\u0000and VII neck dissection was done. Intraoperative slide of the left lobe was malignant. Positron emission tomography and\u0000computed tomography were also done. The finding was negative. The patient was examined by an ENT-oncology team and\u0000juvenile radiotherapy was administered. It was found to be carcinoma stage IVa according to TNM classification. One year\u0000after the operation, the patient was well and had no signs of illness. This case report is a contribution to the existing but\u0000scarce knowledge of anaplastic carcinoma of thyroid gland in young patients in the world.</p>","PeriodicalId":35756,"journal":{"name":"Acta Medica Croatica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35183643","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Application of supportive wound dressing is an important segment for successful result of modern treatment of chronic ulcers. The right choice of dressing is the key to faster, better, and ultimately more cost-effective treatment outcome. Due to the extremely large number of generic types and variants, the main element for proper dressing selection is to know the mechanisms of action and clinical evidence of the effectiveness because of many local factors that delay ulcer healing. The advent of wound dressing that is efficient at the three clinically identified key local factors that largely impede the healing of ulcers, i.e. exudate, infection and biofilm, has made a significant step forward in the creation of optimal conditions for faster healing of chronic ulcers. The complexity of the effects of new technologies, which integrate hidrofiber technology and Ag + technology, provides effective antimicrobial control while at the same time preventing biofilm reformation.
{"title":"[THE ROLE OF WOUND DRESSING IN BIOFILM DESTRUCTION AND REFORMATION].","authors":"Suzana Tunuković","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Application of supportive wound dressing is an important segment for successful result of modern treatment of chronic ulcers. The right choice of dressing is the key to faster, better, and ultimately more cost-effective treatment outcome. Due to the extremely large number of generic types and variants, the main element for proper dressing selection is to know the mechanisms of action and clinical evidence of the effectiveness because of many local factors that delay ulcer healing. The advent of wound dressing that is efficient at the three clinically identified key local factors that largely impede the healing of ulcers, i.e. exudate, infection and biofilm, has made a significant step forward in the creation of optimal conditions for faster healing of chronic ulcers. The complexity of the effects of new technologies, which integrate hidrofiber technology and Ag + technology, provides effective antimicrobial control while at the same time preventing biofilm reformation.</p>","PeriodicalId":35756,"journal":{"name":"Acta Medica Croatica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34514463","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Wound represents a disruption of anathomic and physiologic continuity of the skin. Regarding to the healing process, wounds can be classified as acute or chronic wounds. Quality of life is primarily concerned with the impact of chronic wounds. A wound is considered chronic if healing does not occur within expected period of time regarding to its etiology and localization. Chronic wounds can be classified as typical and atypical. The majority of wounds (95 percent) are typical ones which include ischaemic, neurotrophic and hypostatic ulcer and two separate entities: diabetic foot and decubital ulcers. An 80 percent of chronic wounds localized on lower leg are result of chronic venous insufficiency, in 5-10 percent cause is of arterial etiology, whereas the remainder is mostly neuropathic ulcer. Chronic wounds represent a significant burden to patients, health care professionals and the entire health care system. Chronic wounds affect the elderly population and it is estimated that 1-2 percent of western population suffer from it. This estimate is expected to rise due to an increasing population of the elderly and the diabetic and obesity epidemic. The WHO definition of health is "A state of complite physical, mental and social well-being and not merely the absence of disease or infirmity". Based on this definition, quality of life in relation to health may be defined as "the functional effect of an illness and it's consequent therapy upon a patient, as perceived by the patient". The domains that contribute to this effect are physical, psychological and social functioning. The patient's own perceptions of an illness were found to play an important role in explainig quality of life. Chronic wounds significantly decrease the quality of life in a number of ways such as reduced mobility, pain, unpleasant odor, sleep disturbances, social isolation and frustration, and inability to perform everyday duties. Among the most common psychological reactions to chronic diseases, including chronic wounds, are depression, anxiety, aggression and frustration. Psychological factors may not only be a consequence of delayed healing, but may also impact on wound healing. Anxiety and depression have direct influences on endocrine and immune function. About the impact of disease on quality of life and individuals' perceptions of illness, there are questionnaires and methods to analyze this, but the challenge is to move from a focus on wound management to understanding the specific needs of each individual within the context of their life.
{"title":"[QUALITY OF LIFE AND PSYCHOLOGICAL ASPECTS IN PATIENTS WITH CHRONIC LEG ULCER].","authors":"Mirna Situm, Maja Kolić, Sanja Spoljar","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Wound represents a disruption of anathomic and physiologic continuity of the skin. Regarding to the healing process, wounds can be classified as acute or chronic wounds. Quality of life is primarily concerned with the impact of chronic wounds. A wound is considered chronic if healing does not occur within expected period of time regarding to its etiology and localization. Chronic wounds can be classified as typical and atypical. The majority of wounds (95 percent) are typical ones which include ischaemic, neurotrophic and hypostatic ulcer and two separate entities: diabetic foot and decubital ulcers. An 80 percent of chronic wounds localized on lower leg are result of chronic venous insufficiency, in 5-10 percent cause is of arterial etiology, whereas the remainder is mostly neuropathic ulcer. Chronic wounds represent a significant burden to patients, health care professionals and the entire health care system. Chronic wounds affect the elderly population and it is estimated that 1-2 percent of western population suffer from it. This estimate is expected to rise due to an increasing population of the elderly and the diabetic and obesity epidemic. The WHO definition of health is \"A state of complite physical, mental and social well-being and not merely the absence of disease or infirmity\". Based on this definition, quality of life in relation to health may be defined as \"the functional effect of an illness and it's consequent therapy upon a patient, as perceived by the patient\". The domains that contribute to this effect are physical, psychological and social functioning. The patient's own perceptions of an illness were found to play an important role in explainig quality of life. Chronic wounds significantly decrease the quality of life in a number of ways such as reduced mobility, pain, unpleasant odor, sleep disturbances, social isolation and frustration, and inability to perform everyday duties. Among the most common psychological reactions to chronic diseases, including chronic wounds, are depression, anxiety, aggression and frustration. Psychological factors may not only be a consequence of delayed healing, but may also impact on wound healing. Anxiety and depression have direct influences on endocrine and immune function. About the impact of disease on quality of life and individuals' perceptions of illness, there are questionnaires and methods to analyze this, but the challenge is to move from a focus on wound management to understanding the specific needs of each individual within the context of their life.</p>","PeriodicalId":35756,"journal":{"name":"Acta Medica Croatica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34410458","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Lower leg ulcer is the most common form of ulceration of lower extremities. The prevalence of leg ulcer varies among studies from 0.1% to 0.6%. During the last decade, new concepts on the inflammatory phase in chronic ulcer have been discovered, such as the importance of metalloproteinases, growth factor, irregular muscular function, vascular insufficiency and presence of biofilm in the ulcer that prevents healing. There are several hypotheses to explain the pathophysiological steps, referring to popliteal venous hypertension. Currently, the treatment of leg ulcer relies on due knowledge of ulcer pathophysiology and making an accurate diagnosis. Today, modern supportive dressings improve the patient's quality of life; however, their targeted application according to the protocol and indications is required. A new method of efficient wound biofim exclusion today is the application of hydrofiber dressings containing a combination of silver ions and two disinfectants because they influence the exclusion and prevention of new biofilm formation in the ulcer.
{"title":"[CHRONIC WOUND--A NEW ETIOPATHOGENETIC STATE AND MODERN THERAPEUTIC APPROACH].","authors":"Sandra Marinović Kulisić","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Lower leg ulcer is the most common form of ulceration of lower extremities. The prevalence of leg ulcer varies among studies from 0.1% to 0.6%. During the last decade, new concepts on the inflammatory phase in chronic ulcer have been discovered, such as the importance of metalloproteinases, growth factor, irregular muscular function, vascular insufficiency and presence of biofilm in the ulcer that prevents healing. There are several hypotheses to explain the pathophysiological steps, referring to popliteal venous hypertension. Currently, the treatment of leg ulcer relies on due knowledge of ulcer pathophysiology and making an accurate diagnosis. Today, modern supportive dressings improve the patient's quality of life; however, their targeted application according to the protocol and indications is required. A new method of efficient wound biofim exclusion today is the application of hydrofiber dressings containing a combination of silver ions and two disinfectants because they influence the exclusion and prevention of new biofilm formation in the ulcer.</p>","PeriodicalId":35756,"journal":{"name":"Acta Medica Croatica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34514456","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The skin microbiome is the aggregate of microorganisms that reside on the surface and in deep layers of the skin. Skin is colonized by bacteria, fungi, viruses and mites, maintaining a balance. Disruption in the ecosystem results in skin infections. Chronic wounds in diabetics, elderly and immobile individuals are at risk of skin organisms to invade and become pathogenic upon breach of the skin barrier. The bacteria of the skin microbiome may contribute to delayed healing and persistent inflammation. Staphylococcus epidermidis is an invasive skin organism that causes infection, i.e. hospital acquired infection (HAl) on medical devices and form biofilm. At the most basic level, biofilm can be described as bacteria embedded in a thick, slimy barrier of sugars and proteins. The biofilm barrier protects the microorganisms from external threats. Biofilms provide a reservoir of potentially infectious microorganisms that are resistant to antimicrobial agents, and their importance in the failure of medical devices and chronic inflammatory condition is increasingly being recognized. Particular research interest exists in the association of biofilms with wound infection and non-healing, i.e. chronic wounds. There is now strong evidence that biofilm is present in the majority of chronic wounds. Specialized microscopic techniques used since 2008 have allowed several research groups to demonstrate that 60% to 90% of chronic wounds have biofilm versus only 6% of acute wounds. While many studies confirm that chronic wounds often contain a polymicrobial flora, controversy remains with regard to whether these organisms directly contribute to non-healing. It seems most likely that individual bacteria themselves are not directly responsible for non-healing wounds. Rather, there is direct correlation between the presence of four or more distinct bacterial species in a wound and non-healing, suggesting that mixed microbial populations are the cause of pathology. The most reliable method to confirm the presence of a biofilm is specialized microscopy, e.g., bright-field, fluorescence in situ hybridization (FISH), and environmental scanning electron microscope (ESEM). Surface wound cultures underestimate total wound microbiota--misleading. Histological staining of deep debrided tissue shows evidence of biofilms. Now it is recognized that the majority of microbial species in chronic wounds are anaerobic bacteria (deep swabbing techniques yield similar findings to biopsies) if samples are processed within two hours. Traditional (wound culture method) cultures have limitations because all microbes (the organisms within the biofilm) cannot be isolated in culture or cannot be detected. Therefore, the most effective methods are molecular
{"title":"[IMPACT OF BIOFILM ON HEALING AND A METHOD FOR IDENTIFYING IT IN THE WOUND].","authors":"Jasenka Skrlin","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The skin microbiome is the aggregate of microorganisms that reside on the surface and in deep layers of the skin. Skin is colonized by bacteria, fungi, viruses and mites, maintaining a balance. Disruption in the ecosystem results in skin infections. Chronic wounds in diabetics, elderly and immobile individuals are at risk of skin organisms to invade and become pathogenic upon breach of the skin barrier. The bacteria of the skin microbiome may contribute to delayed healing and persistent inflammation. Staphylococcus epidermidis is an invasive skin organism that causes infection, i.e. hospital acquired infection (HAl) on medical devices and form biofilm. At the most basic level, biofilm can be described as bacteria embedded in a thick, slimy barrier of sugars and proteins. The biofilm barrier protects the microorganisms from external threats. Biofilms provide a reservoir of potentially infectious microorganisms that are resistant to antimicrobial agents, and their importance in the failure of medical devices and chronic inflammatory condition is increasingly being recognized. Particular research interest exists in the association of biofilms with wound infection and non-healing, i.e. chronic wounds. There is now strong evidence that biofilm is present in the majority of chronic wounds. Specialized microscopic techniques used since 2008 have allowed several research groups to demonstrate that 60% to 90% of chronic wounds have biofilm versus only 6% of acute wounds. While many studies confirm that chronic wounds often contain a polymicrobial flora, controversy remains with regard to whether these organisms directly contribute to non-healing. It seems most likely that individual bacteria themselves are not directly responsible for non-healing wounds. Rather, there is direct correlation between the presence of four or more distinct bacterial species in a wound and non-healing, suggesting that mixed microbial populations are the cause of pathology. The most reliable method to confirm the presence of a biofilm is specialized microscopy, e.g., bright-field, fluorescence in situ hybridization (FISH), and environmental scanning electron microscope (ESEM). Surface wound cultures underestimate total wound microbiota--misleading. Histological staining of deep debrided tissue shows evidence of biofilms. Now it is recognized that the majority of microbial species in chronic wounds are anaerobic bacteria (deep swabbing techniques yield similar findings to biopsies) if samples are processed within two hours. Traditional (wound culture method) cultures have limitations because all microbes (the organisms within the biofilm) cannot be isolated in culture or cannot be detected. Therefore, the most effective methods are molecular</p>","PeriodicalId":35756,"journal":{"name":"Acta Medica Croatica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34514461","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}