Continuous suction and intermittent irrigation for septic coxitis

This prospective study was undertaken on 42 children with septic arthritis of the hip diagnosed within 5 days of onset of symptoms. The mode of treatment used was continuous catheter suction and intermittent saline irrigation of the hip joint together with parenteral antibiotics. All but 4 children responded to this treatment; 2 of these were less than 3 years old. We conclude that continuous suction-irrigation is effective in children older than 3 years very early in the course of the disease; the majority need not undergo arthrotomy.     

A dressing system providing fluid supply and suction drainage used for continuous or intermittent irrigation

In this article a dressing system is described that is capable of providing continuous or intermittent wound irrigation. It is based on a felt dressing provided with an adhesive cover and ports for fluid supply and suction drainage. At continuous irrigation (approximate rate, 70 ml/h), a 1-L fluid bag and a siphon about 30 cm in height are used; at intermittent irrigation (approximate rate, 60 ml/min), a 60-ml fluid bag and a suction balloon are used. In an experimental set-up it was shown that the supplied fluid diffused throughout the dressing felt and that the felt was partly saturated both during continuous and after intermittent irrigation, the effect of gravity being counteracted by capillary force and suction. The suction pressure at the drainage port and within the occlusively applied felt showed a linear relationship. The drainage of particles, while relatively impeded at low flow rates, was satisfactory at rates recommended for clinical use. The dressing felt was inert to adherence of bacteria and white blood cells. This dressing system would seem to provide access to the whole wound surface for active therapy through fluid supply and suction drainage.     

Diagnosis and therapy of septic arthritis (coxitis)

Ultrasonography helps in early diagnosis of septic arthritis in children with painful hip with high sedimentation rate and raised c-reactive protein. Native radiology and technetium bone scan are helpful in the diagnosis of coxitis only with a delay of several days. Successful therapy must consist of emergency arthrotomy and effective chemotherapy with tested antibiotics. Delayed surgical intervention risks femoral neck necrosis and coxa vara in small children, major ankylosis in the adolescent.     

Outcome of arthroscopic drainage and debridement with continuous suction irrigation technique in acute septic arthritis

Purpose

The purpose of this study was to determine the clinical course and functional outcome of acute septic arthritis treated by arthroscopic drainage and debridement with continuous suction irrigation.

Methods

Eighteen subsequent cases of acute septic arthritis of hip and knee were included in this study. Complete hemogram, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), blood sugar, liver and kidney function test was done. Plain radiographs and ultrasound of affected joints were done. Joint aspirate was analyzed for gram staining, AFB staining, culture/sensitivity, biochemistry and cytology. Quantitative CRP was repeated every third day till normal CRP level was noted. Intravenous cloxacillin 25–50 mg/kg was started according to WHO protocol and was later changed to specific antibiotics after culture reports. Arthroscopic drainage and debridement of joints was done through standard portals and two tubes were placed in each joint for continuous suction and irrigation. Continuous suction irrigation was used till the effluent saline from the joint was clear. Functional outcome was documented as per Harris hip score for hips and Lysholm score for knee joint. Scoring was done before surgery, at one month and at three months. The duration of intravenous antibiotics and hospitalization was recorded.

Results

Out of eighteen cases 83.33% were males and 14.67% females. The mean age was 22 years (±12.01). The mean duration of symptoms was 4.33 days (±1.41). According to Gachter classification 88.88% of cases were stage 2 infection and 11.12% cases in stage 1 at the time of arthroscopy. The mean duration of hospital stay was 14.61 days (±4.01). Intravenous antibiotics were given for a mean period of 9.33 days (±2.16). The mean pre-operative Harris score was 13.6 (±2.07) which improved to 98 (±1.87) at 3 months and all the cases had painless normal range of movements. Mean pre-operative Lysholm score was 38.38 (±4.29) and it improved to 98.84 (±2.19) at 3 months. There were no sequelae of septic arthritis in any case.

Conclusion

Early arthroscopic decompression and debridement of septic arthritis with continuous suction irrigation can eradicate the infection. The duration of intravenous antibiotics and the hospital stay required is shorter. The functional outcome of joints is satisfactory.     

Continuous intraluminal foley suction

This study is a retrospective review of 30 patients with polycystic kidney disease analyzing the quantitative measurements of renomegaly reported in the literature and the correlation of radiographic findings with the clinical complications of uremia, hypertension, infection, and the need for dialysis. The only significant correlation noted was between renal size and the presence of infection. There was no significant correlation between renomegaly and the presence or development of hypertension, uremia, and the need for chronic dialysis.     

Successful salvage of an infected breast prothesis by changing from continuous to intermittent suction under continuous irrigation

IntroductionImplant-based breast reconstruction is a widely performed procedure. However, prostheses are susceptible to infection and there are currently no established guidelines on treatment. In the present case, a prosthesis was salvaged by changing from continuous irrigation and suction to continuous irrigation and intermittent suction. This case report has been reported in line with the SCARE criteria [1].Presentation of caseA 50-year-old female patient underwent implant-based breast reconstruction following surgery for breast cancer. One month later, the left breast prosthesis was infected with abscesses. Surgical treatment and continuous irrigation were performed as postoperative therapy. However, recurrent infection was detected a few days after surgery. Continuous irrigation was changed to continuous irrigation with intermittent aspiration, which successfully controlled the infection.DiscussionFactors that limit the effectiveness of continuous irrigation and aspiration have not yet been identified. Inflow/discharge shunt routes may be established in continuous aspiration, and, thus, sufficient cleaning may not be possible. On the other hand, the storage of water throughout the wound in intermittent aspiration may facilitate cleaning.ConclusionIntermittent suction worked well in this patient and, thus, warrants further study.     

闭式冲洗吸引术治疗腰椎间隙感染

目的 探讨闭式冲洗引术对腰椎间盘术后椎间隙感染的治疗作用。方法 原切口进入，清除感染坏死的椎间盘组织，用闭式冲洗吸引术将冲洗管置入椎间隙，术后用大量生理盐水冲洗。并每日用抗生素通过冲洗管注入椎间隙。结果 术后第1天6例患者中5例剧烈腰痛消失，腰肌紧张缓解；1例4天后消失，6-8周后恢复行走，随访2-10年，均恢复日常生活，结论 对症状严重者早期手术，清除病灶，冲洗吸引，可以及时去除病因，有效控制炎症。     

Percutaneous suction and irrigation for the treatment of recalcitrant pyogenic spondylodiscitis

Background

The primary management of pyogenic spondylodiscitis is conservative. Once the causative organism has been identified, by blood culture or biopsy, administration of appropriate intravenous antibiotics is started. Occasionally patients do not respond to antibiotics and surgical irrigation and debridement is needed. The treatment of these cases is challenging and controversial. Furthermore, many affected patients have significant comorbidities often precluding more extensive surgical intervention. The aim of this study is to describe early results of a novel, minimally invasive percutaneous technique for disc irrigation and debridement in pyogenic spondylodiscitis.

Materials and methods

A series of 10 consecutive patients diagnosed with pyogenic spondylodiscitis received percutaneous disc irrigation and debridement. The procedure was performed by inserting two Jamshidi needles percutaneously into the disc space. Indications for surgery were poor response to antibiotic therapy (8 patients) and the need for more extensive biopsy (2 patients). Pre- and postoperative white blood cell count (WBC), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), Oswestry disability index (ODI), and visual analogue score (VAS) for back pain were collected. Minimum follow-up was 18 months, with regular interval assessments.

Results

There were 7 males and 3 females with a mean age of 67 years. The mean WBC before surgery was 14.63?×?10⁹/L (10.9–26.4) and dropped to 7.48?×?10⁹/L (5.6–9.8) after surgery. The mean preoperative CRP was 188 mg/L (111–250) and decreased to 13.83 mg/L (5–21) after surgery. Similar improvements were seen with ESR. All patients reported significant improvements in ODI and VAS scores after surgery. The average hospital stay after surgery was 8.17 days. All patients had resolution of the infection, and there were no complications associated with the procedure.

Conclusions

Our study confirms the feasibility and safety of our percutaneous technique for irrigation and debridement of pyogenic spondylodiscitis. Percutaneous irrigation and suction offers a truly minimally invasive option for managing recalcitrant spondylodiscitis or for diagnostic purposes. The approach used is very similar to discography and can be easily adapted to different hospital settings.

Level of Evidence

Level III

     

人工全髋关节置换治疗慢性感染性髋关节炎

[目的]探讨慢性感染性髋关节炎的手术治疗方法及其效果。[方法]本组12例(12髋)慢性感染性髋关节炎,皆有髋关节手术病史。明确诊断后,应彻底清创,取出内植物,锯除破坏侵蚀的股骨头颈,使用抗生素骨水泥活动性间隔器,术后抗感染治疗,3～6个月后二期重建,采用全生物型人工关节进行置换,术前Harris评分平均42.8分。[结果]所有患者二期手术切口均一期愈合,随访时间24～48个月,平均35个月,无1例在最后随访期间有感染复发。术后两年Harris评分平均89.3分,与术前Harris评分比较差异有统计学意义(P0.05)。[结论]对于慢性感染性髋关节炎治疗,不要等待,应彻底清创,取出内植物,锯除股骨头颈,抗生素骨水泥间隔器旷置,人工全髋置换。它是有效合理的治疗方法,能明显降低感染复发率,大大缩短了病程,可提高髋关节重建的成功率。     

The Wiet/Meikle suction irrigation system

We have used the disposable Wiet/Meikle Suction Irrigation System on more than 300 cases, including both otologic and neurotologic procedures. The device is provided as a convenience item to nursing, for those otolaryngologists practicing ear surgery.     

Management of the perineal wound with constant irrigation and suction after abdominoperineal excision for cancer of the rectum. A new suction/irrigation drain

The technique of primary closure of the perineal wound combined with continuous irrigation and suction of the operative site has been used in 21 patients who underwent abdominoperineal excision for cancer of the rectum or anal canal. Primary healing occurred in 19 patients within 18 days, and all patients healed within 2 months. These results are in marked contrast to those in 38 patients treated with constant suction alone, of whom only 17 healed primarily.     

Continuous versus intermittent epidural analgesia

A randomised study of 381 women was carried out to compare the obstetric outcome after epidural analgesia maintained by an intermittent top-up regimen or with a continuous infusion. The two groups were well matched with respect to age, parity, mode of onset of labour and indication for epidural. Maintenance of epidural analgesia by continuous infusion resulted in a significantly decreased need for top-up doses. A reduction in the incidence of hypotension, cardiotocographic evidence of intrapartum fetal hypoxia and Caesarean section was associated with this. It is concluded that the maintenance of epidural analgesia by continuous infusion is a safe and reliable method and may be more advantageous and less labour intensive than the traditional intermittent regimen.     

A new instrument for surface suction and removal of irrigation fluid during surgery

A new instrument for removal of intraocular/extraocular irrigating solutions during eye surgery, based on modification of a miniature otologic suction device, is now commercially available.     

Management of chronic osteomyelitis using an irrigation suction technique

Summary Fifty cases of chronic osteomyelitis were treated by closed, continuous, suction and irrigation and followed up for between six months and eight years. In group A, 25 cases were treated by irrigation with antibiotics, and in group B, 25 cases were treated by irrigation with Bitadine solution, irrespective of the culture and sensitivity reports. Appropriate antibiotics were given systemically. There was no notable difference in the results in the two groups, with an overall success rate of about 80%.

---

Résumé Cinquante cas d'ostéomyélite chronique ont été traités par irrigation continue de 1977 à 1984 et suivis de 6 mois à 8 ans. Dans le groupe A, 25 cas ont été traités par irrigation continue avec antibiotiques, et dans le groupe B, 25 cas ont été traités de même mais avec une solution de Bétadine, sans tenir compte des résultats des examens bactériologiques. Les antibiotiques appropriés ont été administrés par voie générale. Avec un pourcentage global de succès d'environ 80%, il n'y a pas de différence notable entre les résultats des deux groupes.

     

Continuous subglottic suction is effective for prevention of ventilator associated pneumonia

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether subglottic suction is an effective preventative measure for ventilator associated pneumonia (VAP) after cardiac surgery. Altogether 457 papers were found using the reported search, of which 13 presented the best evidence to answer the clinical question. The author, journal, date and country of publication, patient group studied, study type, relevant outcomes, results, and study weaknesses of these papers are tabulated. We conclude Subglottic suction significantly reduces the incidence of VAP in high risk patients (NNT of 8 if ventilated over 3 days), although the benefit is lower in elective cardiac patients. Subglottic suction is currently not commonly used, but even with marginal benefits, its use is likely to be highly cost effective.