The course of inflammatory mediators after elective orthopedic interventions

PURPOSE OF THE STUDY: The aim of the study was to characterize the changes of C-reactive protein, erythrocyte sedimentation rate, white blood count and body temperature by serial measurements after different types of uncomplicated orthopedic surgery. METHODS: The uncomplicated course of 180 patients after elective total hip and knee arthroplasties, ventral and dorsal spinal fusions and diagnostic knee and shoulder arthroscopies were analyzed. RESULTS: The maximal CRP-values were recorded on the second or third day after operation. The peak levels correlated with the extent of the procedures and reached 1.28-17.71 mg/dl. The ESR increased to maximal rates five to six days after surgery and remained elevated during the 14 days of the investigation period. WBC and body temperature showed a slow and uncharacteristic increase followed by a slow and irregular decrease. CONCLUSION: Awareness of the typical pattern of CRP, ESR, WBC and body temperature may help to evaluate the early postoperative course. The CRP is a sensitive marker. ESR, WBC and body temperature are less costly but a poor diagnostic aid for the early detection of postoperative complications especially infections.     

Principles of joint protection in inflammatory joint disease with special reference to biomechanical status

With respect to rehabilitation in inflammatory joint diseases, the activity of the disease, the influence of the disease on the physical ability and social and psychological situation of the patient should all be taken into consideration and treatment then planned accordingly. In the present article, special attention is paid to the biomechanical situation in the diseased joints of the upper and lower extremities, respectively. In the shoulder and elbow joints, the muscles working with long levers and the loading of joints create large intra-articular forces. In the hands the vulnerable joints are under high intra-articular stress because of loading in all situations in daily life. As the result of synovitis and destruction of cartilage, instability is often present. In the lower extremities, the hips and knees are under great strain when moving, rising from chairs, and walking on stairs. Much can be done to reduce loading on the joints. In the upper extremities splinting and the use of suitable technical aids are essential. In the lower extremities good quadriceps muscles and hip extensor muscles as well as correct loading techniques are essential. Whenever walking aids are used, they should be tried out with attention to grip function and the condition of the shoulder and elbow joints, as well as to the need of unloading the lower extremities. A walking aid should always be checked again later. A daily contracture prophylaxis program should help to prevent deformities. Strength training should be performed with attention to the intra-articular loading and stability of the joints.     

Prevention of infection after total joint replacement. Experiments with a canine model

An experiment was done in dogs to evaluate how efficient each of several techniques was in preventing infection after a total joint arthroplasty. The techniques that were studied were intraoperative irrigation with saline solution or with antimicrobial solution, perioperative systemic administration of antibiotics, and the addition of an antibiotic to bone cement. Irrigation with saline solution did not reduce the incidence of infection. A slight reduction was found after irrigation with neomycin solution and after systemic administration of cefazolin solution. The use of bone cement containing gentamicin caused a statistically significant reduction in the rate of infection; in fact, no infection developed in any animal that was treated with bone cement containing gentamicin. There was excellent but not absolute correlation between findings on culture that indicated the presence of infection and histological evidence of inflammation.     

Brain abscess: with special reference to infection by pseudomonas

Eighty cases of brain abscess treated in the University Hospital, BHU, Varanasi, India have been reviewed. Chronic suppurative otitis media was the commonest cause, followed by compound injuries. The overall mortality was 15%. In seven cases the causative organism was pseudomonas, resistant to most antibiotics. Prior to the availability of CT the mortality was 23.3%; after the routine use of CT for diagnosis the mortality fell to 10%. A high mortality (57%) was observed in patients who had pseudomonas. The best results were in patients who had been managed by excision of the abscess capsule.     

Clinical predictors of elective total joint replacement in persons with end-stage knee osteoarthritis

Background  

Arthritis is a leading cause of disability in the United States. Total knee arthroplasty (TKA) has become the gold standard to manage the pain and disability associated with knee osteoarthritis (OA). Although more than 400 000 primary TKA surgeries are performed each year in the United States, not all individuals with knee OA elect to undergo the procedure. No clear consensus exists on criteria to determine who should undergo TKA. The purpose of this study was to determine which clinical factors will predict the decision to undergo TKA in individuals with end-stage knee OA. Knowledge of these factors will aid in clinical decision making for the timing of TKA.     

General infection prevention in abdominal surgery with special reference to intestinal decontamination

In surgery prophylaxis for infection is necessary, because patients are immunocompromised due to the underlying disease and the operation while at the same time being increasingly exposed to potentially pathogenic germs. Prophylaxis is based on the control of endogenous and exogenous microorganisms. For this purpose either systemic or locally active topical agents may be employed. Systemically active substances are applied with the aim to kill and eliminate invasive microorganisms in deep tissue levels, either by their own biological activity or by stimulating specific or unspecific host immune reactions. Local topical measures in contrast are to prevent the primary contact between microorganisms and host. The central pillar of systemic measures is the perioperative systemic antibiotic prophylaxis, immunonutrition is beginning to gain importance, and in the future possibly substances such as G-CSF, which directly stimulate the immune system, may be employed. Standard topical measures are sterilization and desinfection while decontamination of the digestive tract has until now not found a wide spread acceptance. For certain indications especially high risk surgical resections with anastomoses at the level of the oesophagus or the lower rectum it is possible to eliminate endogenous intestinal microorganisms effectively using topical decontamination in combination with systemic antibiotics and improve the surgical results, especially anastomotic healing.     

Candida urinary tract infection with special reference to ascending pyelonephritis]

The pathogenesis of Candida urinary tract infection (UTI) has been investigated clinically and experimentally with special reference to ascending pyelonephritis in rats. Among the Candida species, Candida albicans was most frequently isolated from clinical specimens including urine in two medical centers, one in Japan and the other in the United States. The isolates of C. albicans serotype B showed a significantly lower susceptibility to 5-fluorocytosine compared to those of serotype A (p less than 0.01). The distribution pattern of the serum antibody titers against C. albicans in 20 candiduria patients (C. albicans 19 and Candida tropicalis 1) was similar to that in 23 bacterial complicated UTI patients. All patients with candiduria had underlying diseases of the urinary tract, such as neurogenic bladder, bladder cancer or benign prostatic hyperplasia: indwelling urinary catheters were present in 15 patients and all had received antimicrobial agents before the study. Ascending Candida pyelonephritis has been investigated in female rats which were transurethrally inoculated into the bladder with C. albicans ATCC 10259 strain. The incidence of Candida pyelonephritis was approximately 80% in rats treated with cyclophosphamide and more than 70% in rats with partial ureteral obstruction. There was a significant relationship between renal and urinary Candida cell populations (p less than 0.01). Furthermore, a significant relationship was revealed between renal Candida cell populations and histological grades of pyelonephritis (p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)     

Prophylaxis with cefamandole nafate in elective orthopedic surgery

A prospective, randomized, double-blind study was conducted to determine the efficacy of cefamandole nafate in reducing infections in general orthopedic procedures. Of 743 patients initially entered into the study, 715 (362 on cefamandole, 353 on placebo) fulfilled the requirements of the protocol. The infection rate was 1.6% for the cefamandole-treated group and 4.2% for the placebo group. In operations lasting longer than two hours, there were two infections in the cefamandole group and seven infections in the placebo group (p less than 0.05). Staphylococcus aureus and gram-negative bacilli were the common pathogens. Adverse side effects were limited to transient elevations in liver enzymes.