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1.
Leah H. Cobb Emily M. McCabe Lauren B. Priddy 《Journal of orthopaedic research》2020,38(10):2091-2103
Osteomyelitis, or the infection of the bone, presents a major complication in orthopedics and may lead to prolonged hospital visits, implant failure, and in more extreme cases, amputation of affected limbs. Typical treatment for this disease involves surgical debridement followed by long-term, systemic antibiotic administration, which contributes to the development of antibiotic-resistant bacteria and has limited ability to eradicate challenging biofilm-forming pathogens including Staphylococcus aureus—the most common cause of osteomyelitis. Local delivery of high doses of antibiotics via traditional bone cement can reduce systemic side effects of an antibiotic. Nonetheless, growing concerns over burst release (then subtherapeutic dose) of antibiotics, along with microbial colonization of the nondegradable cement biomaterial, further exacerbate antibiotic resistance and highlight the need to engineer alternative antimicrobial therapeutics and local delivery vehicles with increased efficacy against, in particular, biofilm-forming, antibiotic-resistant bacteria. Furthermore, limited guidance exists regarding both standardized formulation protocols and validated assays to predict efficacy of a therapeutic against multiple strains of bacteria. Ideally, antimicrobial strategies would be highly specific while exhibiting a broad spectrum of bactericidal activity. With a focus on S. aureus infection, this review addresses the efficacy of novel therapeutics and local delivery vehicles, as alternatives to the traditional antibiotic regimens. The aim of this review is to discuss these components with regards to long bone osteomyelitis and to encourage positive directions for future research efforts. 相似文献
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Hillmann JS; Mesgarzadeh M; Revesz G; Bonakdarpour A; Clancy M; Betz RR 《Radiology》1987,165(3):769-773
Proximal femoral focal deficiency, an uncommon congenital anomaly, necessitates early radiologic classification for surgical planning and treatment. Objective radiographic criteria, including femoral length index, acetabular depth index, acetabular angle index, and shape of the proximal femur were determined in 49 patients before cartilaginous ossification of the femoral capital epiphysis; final classification was based on follow-up radiographs or findings at arthrography or surgery. These parameters were analyzed to determine the accuracy and contributions of each in classification. Correct classification into one of three groups was possible in 86% of cases with use of three of the parameters: femoral length index, acetabular depth index, and shape of the proximal femur. The acetabular angle was found to contribute insignificantly to classification. Magnetic resonance imaging, used in only one case, depicted the nonossified cartilaginous femoral capital epiphysis, thus obviating the need for invasive diagnostic procedures and facilitating early classification. 相似文献
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A controlled trial of scheduled replacement of central venous and pulmonary-artery catheters. 总被引:12,自引:0,他引:12
D K Cobb K P High R G Sawyer C A Sable R B Adams D A Lindley T L Pruett K J Schwenzer B M Farr 《The New England journal of medicine》1992,327(15):1062-1068
BACKGROUND. The incidence of infection increases with the prolonged use of central vascular catheters, but it is unclear whether changing catheters every three days, as some recommend, will reduce the rate of infection, It is also unclear whether it is safer to change a catheter over a guide wire or insert it at a new site. METHODS. We conducted a controlled trial in adult patients in intensive care units who required central venous or pulmonary-artery catheters for more than three days. Patients were assigned randomly to undergo one of four methods of catheter exchange: replacement every three days either by insertion at a new site (group 1) or by exchange over a guide wire (group 2), or replacement when clinically indicated either by insertion at a new site (group 3) or by exchange over a guide wire (group 4). RESULTS. Of the 160 patients, 5 percent had catheter-related bloodstream infections, 16 percent had catheters that became colonized, and 9 percent had major mechanical complications. The incidence rates (per 1000 days of catheter use) of bloodstream infection were 3 in group 1, 6 in group 2, 2 in group 3, and 3 in group 4; the incidence rates of mechanical complications were 14, 4, 8, and 3, respectively. Patients randomly assigned to guide-wire-assisted exchange were more likely to have bloodstream infection after the first three days of catheterization (6 percent vs. 0, P = 0.06). Insertions at new sites were associated with more mechanical complications (5 percent vs. 1 percent, P = 0.005). CONCLUSIONS. Routine replacement of central vascular catheters every three days does not prevent infection. Exchanging catheters with the use of a guide wire increases the risk of bloodstream infection, but replacement involving insertion of catheters at new sites increases the risk of mechanical complications. 相似文献
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All Seattle-area cardiologists and 25 per cent of selected other physicians were queried by mail to determine whether they recommended CPR (cardiopulmonary resuscitation) training for families of their patients. Two-thirds reported that they advocated training for some patients' families, but only 52 per cent of cardiologists and 37 per cent of the others did so for families of at least half of the patients considered at risk. Physicians who had performed out-of-hospital CPR or had received advanced or recent training were more likely to recommend instruction. 相似文献
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Combined open and laparoscopic approach to chronic pain following open inguinal hernia repair 总被引:1,自引:0,他引:1
Introduction: Chronic groin pain is the most common long-term complication after open inguinal hernia repair. Traditional surgical management
of the associated neuralgia consists of injection therapy followed by groin exploration, mesh removal, and nerve transection.
The resultant hernia defect may be difficult to repair from an anterior approach. We evaluate the outcomes of a combined laparoscopic
and open approach for the treatment of chronic groin pain following open inguinal herniorrhaphy. Methods: All patients who underwent groin exploration for chronic neuralgia after a prior open inguinal hernia repair were prospectively
analyzed. Patient demographics, type of prior hernia repair, and prior nonoperative therapies were recorded. The operation
consisted of a standard three trocar laparoscopic transabdominal preperitoneal hernia repair, followed by groin exploration,
mesh removal, and nerve transection. Outcome measures included recurrent groin pain, numbness, hernia recurrence, and complications.
Results: Twelve patients (11 male and 1 female) with a mean age of 41 years (range 29–51) underwent combined laparoscopic and open
treatment for chronic groin pain. Ten patients complained of unilateral neuralgia, one patient had bilateral complaints, and
one patient complained of orchalgia. All patients failed at least two attempted percutaneous nerve blocks. Prior repairs included
Lichtenstein (n=9), McVay (n=1), plug and patch (n=1), and Shouldice (n=1). There were no intraoperative complications or wound infections. With a minimum of 6 weeks follow up, all patients were
significantly improved. One patient complained of intermittent minor discomfort that required no further therapy. Two patients
had persistent numbness in the ilioinguinal nerve distribution but remained satisfied with the procedure. Conclusions: A combined laparoscopic and open approach for postherniorrhaphy groin pain results in good to excellent patient satisfaction
with no perioperative morbidity. It may be the preferred technique for the definitive management of chronic neuralgia after
prior open hernia repair. 相似文献