Osteomyelitis after Operative Fracture Treatment: A Report of 62 Cases Treated with Radical Surgery and Lincomycin (Lincocin®)

During the years 1967-1975 a total of 62 patients were treated for postoperative osteomyelitis. The lower extremities had been fractured in 89 per cent of the cases and 54 per cent were closed injuries. The fractures, mostly caused by traffic accidents and falls, had been immobilized by plates in 30 and by intramedullary nails or pins in 25 patients.

Staphylococcus aureus was cultured in 80 per cent, 68 per cent of them were resistant to penicillin, but in 84 per cent the organisms were highly lincomycin sensitive and only three patients with four osteomyelitic lesions presented lincomycin resistance.

The treatment consisted chiefly of sequestrectomies and saucerizations supported by 3-12 months of lincomycin treatment. In 30 operations a closed irrigation-suction technique was used, perfusing the wound with lincomycin solution. Stable implants should be left in place until the fracture is clinically solid whereas unstable osteosyntheses should be replaced by rigid internal or extraskeletal fixation.

At follow-up, the results were judged as good in 74 per cent, fair 8 per cent and poor 18 per cent. The amputation rate was 13 per cent.

Plates should not be used in the treatment of comminuted tibial fractures with considerable soft tissue damage.     

A comparative study of three methods of nasal irrigation

OBJECTIVE: To assess the effectiveness of three methods of nasal irrigation on distributing saline to the nasal cavity and paranasal sinuses. DESIGN:: A prospective, cross-over study. MATERIALS AND METHODS: Twelve subjects (9 patients with chronic sinusitis after functional endoscopic sinus surgery and 3 healthy controls) underwent nasal irrigation with normal saline containing Technetium 99m sulfur colloid. The distribution of radioactivity was assessed on each subject after three different irrigation techniques: metered nasal spray, nebulization with RinoFlow, and nasal douching while kneeling with the head on the floor. RESULTS: The nasal cavity was well irrigated by all three techniques. Compared with the other two methods, douching was significantly more effective in penetrating the maxillary sinus (P = .036) and frontal recess (P = .003). The sphenoid and frontal sinuses were poorly irrigated by all three techniques. CONCLUSION: Nasal douches are more effective in distributing irrigation solution to the maxillary sinus and frontal recess. This should be the method of choice for irrigating these areas.     

Acute iron ingestion

OBJECTIVE: Intoxication is one of the most common causes of admissions to emergency department in pediatric age group. Incidence of iron poisoning gradually increased because of wide spread use of iron containing drugs. METHOD: In this report, we present five cases of iron ingestion who were admitted to our emergency department within a year. RESULT: Whole bowel irrigation in addition to gastric lavage with an iron dose of over 50 mg/kg as well as deferoxamine treatment for patients in whom clinical and laboratory indications are present. CONCLUSION: The prompt recognition and treatment of children with acute iron poisoning is the single and the most critical point for decreasing the morbidity and mortality associated with iron containing products.     

Effectiveness of oxidative potential water as a root canal irrigant

AIM: The aim of this study was to evaluate the effectiveness of oxidative potential water (OPW) as an irrigant, based on its ability to remove the smear layer and/or debris from instrumented root canals. METHODOLOGY: One hundred and twenty root canals from extracted human maxillary incisors were instrumented using a conventional step-back technique with irrigation from sodium hypochlorite (NaOCl) or oxidative potential water (OPW). After instrumentation, the canals were irrigated by syringe or ultrasound using 15% EDTA or OPW as an irrigant. The volume of each irrigant used for syringe irrigation was 10, 20, and 30 mL, respectively, whilst the duration for ultrasonic irrigation was 1, 3, and 5 min, respectively. After irrigation, each root was split longitudinally in two with cutting pliers, and the specimens were prepared for SEM observation. The presence of debris and smear layer on each canal wall was assessed using a three-point scale for each parameter. RESULTS: Smear layer was effectively removed with EDTA both introduced via syringe and via ultrasonic irrigation. A similar effect was observed with OPW via syringe irrigation following instrumentation with 5% NaOCl. The canal walls in any of these cases showed open and patent dentinal tubules following smear layer removal. Some specimens irrigated with EDTA exhibited the effect of demineralization on the dentine resulting in funnelling of tubule orifices. Syringe irrigation was more effective in smear layer removal, except for ultrasonic irrigation with 15% EDTA, whilst ultrasonic irrigation was more effective in debris removal including the use of OPW as irrigant following instrumentation with 5% NaOCl. Neither syringe nor ultrasonic irrigation with OPW following instrumentation with OPW removed smear layer or debris effectively. CONCLUSIONS: The most effective irrigation technique for smear removal was 15% EDTA irrigation by means of syringe following instrumentation with 5% NaOCl solution. However, the most effective irrigation technique for debris removal was ultrasonic irrigation regardless of irrigant used. OPW irrigation by means of syringe following instrumentation with 5% NaOCl showed a similar effect to that of 15% EDTA irrigation for removal of smear layer and debris.     

Antimicrobial effectiveness of electro-chemically activated water as an endodontic irrigation solution

AIM: The aim of this in vitro study was to evaluate the antimicrobial effectiveness of electro-chemically activated water (ECA) as an endodontic irrigation solution. METHODOLOGY: The root canals of 60 caries-free, single-rooted, adult, maxillary, anterior human teeth were instrumented and irrigated in a similar method to that used for in vivo root canal treatment. The external root surface of each tooth was sealed, maintaining the access cavities patent and the root canals were inoculated with a suspension containing four bacteria. The teeth were randomly divided into four groups (n = 15). Each group was irrigated ultrasonically with one of the following solutions: distilled water (control), NaOCl (3.5%), and ECA, the latter at pHs 7.0 and 9.0. Antimicrobial effectiveness was established directly after irrigation and again 7 days later, by counting colony-forming units on blood agar plates and by spectrophotometric analysis. RESULTS: Large numbers of bacteria were present in the canals of teeth irrigated with distilled water. No bacteria were observed following irrigation with NaOCl. Neither of the ECA solutions were found to be effective against all the bacteria. Although some reduction in the number of bacteria was evident in the ECA groups, this was not statistically significant (P > 0.05) when compared to sodium hypochlorite. CONCLUSION: Within the confines of this study ECA did not demonstrate antimicrobial effectiveness.     

Effect of diltiazem and methylene blue on human sperm motility,viability and cervical mucus penetration: potential use as vas irrigants at the time of vasectomy

The purpose of this study was to identify compounds that could potentially be useful for vas irrigation at the time of vasectomy. We studied the in vitro effects of a group of membrane-active and ion-channel blocking agents on human sperm motility, viability and cervical mucus penetration. Diltiazem, an anti-arrhythmic drug, and methylene blue, an agent commonly used in vasography, showed the most promising effects with marked reduction of sperm motility and cervical mucus penetration after incubation with sperm for a short period of 15 min. Diltiazem was more effective than methylene blue in inhibiting the motility and viability of sperm. Furthermore, unlike methylene blue, diltiazem significantly compromised sperm viability. Other compounds studied, such as lidocaine, nicardipine and Neosporin((R)), showed only partial inhibitory activity. Based on the data reported herein, both diltiazem and methylene blue appear to be suitable candidates to be developed for vas irrigation at the time of vasectomy.     

The aspiration-irrigation maneuver

OBJECTIVES/HYPOTHESIS: To compare cultures obtained from the aspiration-irrigation maneuver (AIM) with other reports and compare diagnostic and therapeutic value after AIM versus the Proetz maneuver and needle aspiration-irrigation. STUDY DESIGN: Patients with radiographic evidence (mucous membrane thickness greater than 6 mm, air-fluid levels, or complete opacification) and symptoms (nocturnal cough, fever, postnasal drainage [PND], otitis, mucopurulent discharge from the nose) of sinus disease who were referred from pediatrician and/or family physician and who otherwise would be candidates for surgery were selected to receive treatment with AIM. The study was divided into three separate groups (54 patients who were age 8 years and younger, 54 patients who were age 9 years and older, and 32 adult patients who were treated with both needle aspiration and AIM. METHODS: Using Bernoulli's principle and the Venturi effect, saline and a vacuum apparatus were used to capture the contents of the sinuses for culture, and results were compared with results of needle aspirate cultures. RESULTS: Children's cultures from group 1 compared favorably with the literature (Haemophilus influenzae, Moraxella catarrhalis, and Streptococcus pneumoniae or a combination of these); cultures in patients age 9 years and older revealed a greater variety of bacteria, depending on chronicity of infection, and a high incidence of Staphylococcus aureus (beta-lactamase positive). There was a 66% correlation of AIM with needle aspiration. CONCLUSIONS: AIM was found to be a safe, simple, painless, and inexpensive adjunct to the diagnosis and treatment of sinus disease.     

Various irrigation protocols for final rinse to improve bond strengths of fiber posts inside the root canal

Irrigation after post space preparation and its effects on the bond strength of different adhesive strategies are still an issue of interest. The aim of the present study was to investigate the effects of various irrigation protocols (IPs) on the push‐out bond strengths of fiber posts. One‐hundred and fifty extracted human anterior teeth were divided into three groups (n = 50 each) and endodontically treated. The post space was irrigated before post placement using the following five IPs in each group: IP1 (control): 5 ml of distilled water; IP2: 5.25% sodium hypochlorite (NaOCl) applied with passive ultrasonic irrigation (PUI); IP3: 1% NaOCl applied with PUI; IP4: 18% ethylenediaminetetracetic acid (EDTA) followed by 5.25% NaOCl; and IP5: 2% chlorhexidine (CHX). Fiber posts placement in each group was performed using three different adhesive strategies. A self‐etch adhesive system revealed higher bond strength (16.2 ± 6.9 MPa) compared with an etch‐and‐rinse adhesive (8.5 ± 4.2 MPa) and a self‐adhesive resin cement (9.2 ± 4.7 MPa). The use of 18% EDTA/5.25% NaOCl increased the bond strength of the self‐adhesive resin cement. Conversely, this IP decreased the bond strength for the etch‐and‐rinse adhesive system, whilst 1% NaOCl enhanced the bond strength for the same system. Consequently, each adhesive strategy may need to be adapted to a specific IP.     

Effect of sanguinaria extract on development of plaque and gingivitis when supragingivally delivered as a manual rinse or under pressure in an oral irrigator

The effects on developing plaque and gingivitis following rinsing with a placebo oral rinse or an oral rinse containing 300 micrograms/ml sanguinaria extract (sanguinaria) were compared to effects produced by supragingival irrigation with dilute solutions of the rinse corresponding to 22.5 micrograms/ml sanguinaria and 90 micrograms/ml sanguinaria. The study design was a repeated measures, single-blind crossover with no oral hygiene over 2 weeks duration. After 7 and 14 [corrected] days, significantly lower plaque and gingivitis scores were obtained with use of the sanguinaria-containing rinse and irrigating solutions compared with the placebo rinse. There were no significant differences in plaque and gingivitis scores between the groups using the sanguinaria rinse and the sanguinaria irrigating solutions. A comparison [corrected] of % distribution of 0, 1 and 2+ scores also indicated that rinsing and supragingival irrigation with sanguinaria was more effective in plaque and gingivitis control than rinsing with the placebo. The results suggest that sanguinaria oral rinse may be effective in controlling plaque and gingivitis when delivered by manual rinsing or supragingival irrigation.