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Accessible Agent-Fatty Acid Coatings of Titanium Prostheses for Local Prevention and Treatment of Anti-Microbial Infections
Klemens Vertesich,
Thomas Mayrhofer,
Reinhard Windhager,
Klaus-Dieter Kühn
Issue:
Volume 6, Issue 6, December 2018
Pages:
146-153
Received:
9 August 2018
Accepted:
23 August 2018
Published:
7 November 2018
DOI:
10.11648/j.js.20180606.11
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Abstract: Prosthetic joint infection represents a major issue in arthroplasty. Local anti-infective treatment is not established in cementless prosthetic surgery. The aim of this study was to perform simulate a perioperative application of agent-fatty acid complexes on surfaces of primary and revision prosthetic material. Further, it was aimed to investigate the efficacy of these coatings by in vitro microbiological tests. Coating of cemetless titanium prostheses with gentamicin-palmitate and octenidine-laurate was performed by using a spray gun system. Coating with vancomycin eluted in trilaurin was performed by dipping of the prostheses in the solution. The prostheses were incubated in phosphate buffered saline for 7 days. Microbiological testing was performed with inhibition areolae testing for S. aureus, S. epidermidis, MRSA and C. albicans. Coating of prosthetic material was reliable and reproducible with two different techniques, dipping and spraying. The surface-concentrations of agents have reached 195μg/cm2 for gentamicin, 460μg/cm2 for octenidine and 323μg/cm2 for vancomycin. Agents inhibited S. epidermidis and S. aureus growth for seven days, C. albicans for three days and MRSA for two days. Agent-fatty acid coatings used in this study represent a biodegradable layer with good biocompatibility and comparable anti-infective efficacy as in cemented surgery due to the use of established agents, even if low concentrations are used. Modular and individual anti-infective coating was reproducibly and reliably performed by dipping coating, which may represent a potential perioperative coating approach.
Abstract: Prosthetic joint infection represents a major issue in arthroplasty. Local anti-infective treatment is not established in cementless prosthetic surgery. The aim of this study was to perform simulate a perioperative application of agent-fatty acid complexes on surfaces of primary and revision prosthetic material. Further, it was aimed to investigate...
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Meek Micro-grafting Technique in Reduction of Mortality and Hospital Stay in Patients With Extensive Burns in a Resource Constrained Setting
Nangole Ferdinand Wanjala,
Ogallo John Paul,
Ochieng Raduma Sephania
Issue:
Volume 6, Issue 6, December 2018
Pages:
154-158
Received:
24 September 2018
Accepted:
8 November 2018
Published:
19 December 2018
DOI:
10.11648/j.js.20180606.12
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Abstract: Burns contributes to significant mortality. Among reasons for high mortality is inadequate burn wound management especially in patients with extensive burns and limited donor sites. Majority of the resource constrained countries donot have allografts or tissue cultures that would enable prompt and easy cover ages of such wounds. Skin graft Harvesting techiques such as the Meek micrografts are considered expensive and are thus not available. Patients with extensive burn wounds in many resource constrained countries as a result of this do have poor outcomes with high mortality and prolonged hospital stay. This was a prospective study on patients with extensive burns operated on with theMeek micro-grafting technique in a tertiary teaching Hospital in Kenya. Variables analysed included, total burn surface area, sessions of skin grafts, length of Hospital stay, donor site morbidity and mortality. Twenty five patients with extensive burn wounds were managed with the micro grafting technique over the last three years. The mean total burn surface area for the patients was 46.7 percent with the range of 24 to 72 percent. Five patients died while undergoing treatment giving a mortality rate of 20 percent compared to a mortality rate of 35 percent reported in our centre for patients with the similar burn surface area operated on with the mesh technique. The mean length of Hospital stay was 73.92 days compared to a Hospital stay length of 97.4 days previously reported prior to this technique. The mean donor size surface area was 15.8%. The average length of time the donorsite wounds healed was 16.7 days. Three patients had wound sepsis at the donor site that healed after dressing with silver based dressing materials. Meek micro grafting technique allows for extensive coverage of burn wounds with a relatively small donorsite. The technique is associated with reduced donor site morbidity, mortality and length of Hospital stay. This technique should be encouraged in many burn centers in developing countries where there are patients with extensive burn wounds.
Abstract: Burns contributes to significant mortality. Among reasons for high mortality is inadequate burn wound management especially in patients with extensive burns and limited donor sites. Majority of the resource constrained countries donot have allografts or tissue cultures that would enable prompt and easy cover ages of such wounds. Skin graft Harvesti...
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Abdominal Cocoon Syndrome as a cause of Intestinal Obstruction: A Case Report
Balachandran Premkumar,
Sayed Mohammed Afsal,
Ramamurthee Kannaiyan,
Senguttuvan Pandian,
Ranjini Ramachandran
Issue:
Volume 6, Issue 6, December 2018
Pages:
159-161
Received:
12 October 2018
Accepted:
5 November 2018
Published:
19 December 2018
DOI:
10.11648/j.js.20180606.13
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Abstract: Abdominal cocoon syndrome is also known as sclerosing encapsulating peritonitis, characterized by small bowel encapsulation by a fibro-collagenous membrane or “cocoon”. It is a rare cause of intestinal obstruction and has been reported predominantly in adolescent girls living in tropical/subtropical region. The cause and pathogenesis of the condition have not been elucidated. Prolonged administration of practalol, meconium peritonitis, and tuberculous infection of the female genital tract have been incriminated as possible causes. Timely and accurate imaging and diagnosis is important to avoid morbidity and mortality. Preoperative diagnosis is difficult. It is usually diagnosed during surgery. Simple excision of the membrane and lysis of the adhesions produces optimal results. Breaking of adhesions needs to be done carefully; to prevent damage to serosal surface and perforation. This case report is of a 38yr old lady who presented with sub-acute intestinal obstruction that was secondary to an abdominal cocoon and was managed by Laparoscopic surgery in our hospital.
Abstract: Abdominal cocoon syndrome is also known as sclerosing encapsulating peritonitis, characterized by small bowel encapsulation by a fibro-collagenous membrane or “cocoon”. It is a rare cause of intestinal obstruction and has been reported predominantly in adolescent girls living in tropical/subtropical region. The cause and pathogenesis of the conditi...
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Factors Associated with a Short-Term Revision of Total Knee Arthroplasty
Gómez Cáceres Abel,
Carnero Martín de Soto Pablo,
Fernández de Arróyabe Sáez de Ojer Naiara,
Montes Molinero David,
Aguiar García Francisco,
García de Quevedo Puerta David
Issue:
Volume 6, Issue 6, December 2018
Pages:
162-166
Received:
25 October 2018
Accepted:
13 November 2018
Published:
19 December 2018
DOI:
10.11648/j.js.20180606.14
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Abstract: Background: To present the short-term complications that required revision surgery on total knee arthroplasty (TKAs) performed during the 2012-2013 period. Objective: To study the relation of complication appearance and type with the prosthesis model and surgical team experience. Methods: Study of patients undergoing TKA at our center between January 2012 and June 2013. Surgical teams were stratified according to the experience of the surgeon. Two different implants were utilized for this study. The following postoperative data were collected: indication for review, time of follow-up from the intervention to the indication for review (in months) and the reason for revision. A total of 322 TKAs were performed. The follow-up time from the placement of the first prosthesis was 35.48 ± 10.23 months. A revision was indicated for 60 of the 322 implanted prostheses (18.6%). The most frequent causes were aseptic loosening in 22 cases (37.9%), and anterior pain in 19 cases (32.8%). According to the prosthetic model, 11 revisions belonged to the A model (18.3%), and 49 (81%) to the B model. These results were statistically significant (p <0.001). Odds Ratio 5.78 (95% CI: 2.87-11.62). In teams with no expert in arthroplasty, the percentage of revision for instability was 8.3%; in teams with one expert, it was 4%; and in teams with two experts, it was 0%. Discussion: There is an increase in the number of reviews in knee arthroplasty surgery. The reasons for failure of total knee arthroplasty depend on several factors, including surgical techniques, implants, demographic variants, etc. The experience of the surgeon seems to influence the number of revisions. Patellofemoral kinematics also influences the evolution of total knee arthroplasty. One of the most important factors is the trochlear groove. Although the optimal troclear design has not been established. Conclusions: The prosthetic model seems to influence the survival of total knee arthroplasty. It is preferable that the surgical team always include a surgeon with expertise in knee arthroplasty.
Abstract: Background: To present the short-term complications that required revision surgery on total knee arthroplasty (TKAs) performed during the 2012-2013 period. Objective: To study the relation of complication appearance and type with the prosthesis model and surgical team experience. Methods: Study of patients undergoing TKA at our center between Janua...
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Quantitative Assessment of Prognosticators for Rectal Cancer’s Local Recurrence and Distant Metastases
Haytham Abudeeb,
Ajogwu Ugwu,
Lucy Campbell,
Arijit Mukherjee
Issue:
Volume 6, Issue 6, December 2018
Pages:
167-172
Received:
30 October 2018
Accepted:
12 November 2018
Published:
19 December 2018
DOI:
10.11648/j.js.20180606.15
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Abstract: Rectal cancer treatment outcome has improved considerably in the TME era often with the use neoadjuvant chemoradiotherapy. However, the risk of local recurrence/distant metastases could be as high as 10%. We have designed a retrospective cohort study to assess risk factors associated with local recurrence/distant metastasis after primary curative rectal resection. Our analysis of the colorectal database in a district general hospital involved review of 131 patients who had a curative resection between 2007 and 2013. 22 patients of the 131 had local recurrence/distant metastases. We reviewed the risk factors as gender, neoadjuvant chemoradiotherapy, type of operation, anastomotic leak, tumour differentiation, EMVI, CRM and Dukes C and performed a quantitative assessment. Looking at risk factors, the presence of EMVI was found to have a statistically significant association with recurrence and distant metastases (p=0.0006) followed by poor differentiation (p= 0.038) and Dukes C (p=0.045) while CRM involvement (p=0.054), Neoadjuvant chemoradiotherapy (p=0.657), type of resection (p=0.740), Anastomotic leak (p=0.761) and gender (p=0.901) shown no obvious statistical association with recurrence or distant metastases A larger multi-centre study may help in validating our observation.
Abstract: Rectal cancer treatment outcome has improved considerably in the TME era often with the use neoadjuvant chemoradiotherapy. However, the risk of local recurrence/distant metastases could be as high as 10%. We have designed a retrospective cohort study to assess risk factors associated with local recurrence/distant metastasis after primary curative r...
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Complicated Evolution of Superior Vena Cava Syndrome Post Cardiac Surgery
Adrian Fernando Narváez Muñoz,
Javier Aristides Rodriguez Herrera,
Daniela Albina Ibarra Vargas,
Carlos Ivan Soledispa Suarez,
Maxwell Ruben Velasco Salazar,
Carlos Alfredo Venegas Arteaga
Issue:
Volume 6, Issue 6, December 2018
Pages:
173-177
Received:
2 December 2018
Accepted:
17 December 2018
Published:
22 January 2019
DOI:
10.11648/j.js.20180606.16
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Abstract: Introduction: Superior vena cava syndrome (SVCS) is the clinical manifestation of superior vena cava (SVC) obstruction, with a severe reduction in venous backflow to the right atrium. Symptoms classically include neck, facial and upper limb swelling, development of swollen collateral veins on the front of the chest wall, shortness of breath, coughing, headache, stridor and other neurological complaints, which may all be exacerbated by different postures. CASE REPORT: A 31-year-old man, with a sinus venosus atrial septal defect (SVASD) and partial anomalous pulmonary venous return (PAPVC), was undergone to surgery, in the postoperative course showed a superior vena cava syndrome (SVCS). A second surgery to solve this complication was performed nevertheless, some days after this intervention, the patient developed SVCS symptom’s once again. A new strategy with a large stent implantation in the superior vena cava had acceptable results. The patient kept asymptomatic during four months. Discussion: This syndrome is a rare complication after cardiac surgery; it is associated mostly with bicaval cannulation; various causes such as localized hematoma, swollen absorbable hemostat, and narrowing of the SVC by surgical sutures have been reported. There are no exact guidelines for the clinical management of SVCS. The treatments include long-term anticoagulation, thrombolysis, percutaneous transluminal balloon angioplasty, stent implantation, and open surgical reconstruction. CONCLUSION: This article highlights the importance of bear in mind the potential risk of SVCS during cardiac surgery with bicaval cannulation, whereby the proper precautions must be taken into account. Another outstanding fact of this case report shows the value of working with interventional cardiology department as a team to reach successful results in the benefit of the patients.
Abstract: Introduction: Superior vena cava syndrome (SVCS) is the clinical manifestation of superior vena cava (SVC) obstruction, with a severe reduction in venous backflow to the right atrium. Symptoms classically include neck, facial and upper limb swelling, development of swollen collateral veins on the front of the chest wall, shortness of breath, coughi...
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