scholarly journals Surgical treatment outcome after serial debridement of infected nonunion—A retrospective cohort study

2021 ◽  
Author(s):  
Markus Rupp ◽  
Stefanie Kern ◽  
Nike Walter ◽  
Lydia Anastasopoulou ◽  
Reinhard Schnettler ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Inpatient Treatment ◽  
Retrospective Cohort ◽  
Long Bone ◽  
Treatment Concept ◽  
Infected Nonunion ◽  
Major Complications ◽  
Staged Treatment ◽  
Bony Consolidation

Abstract Purpose Reported outcome after multiple staged surgical treatment of infected nonunion is scarce. We, therefore, asked: (1) What is the clinical outcome in infected nonunion patients after multiple staged revision surgery? (2) Are different pathogens evidenced after surgical treatment in patients who have undergone more or less surgeries? Methods All enrolled patients were surgically treated for long bone-infected nonunion between January 2010 and March 2018. Besides patients´ demographics outcome in terms of bony consolidation and major complications defined as death during inward treatment, amputation and recurrence of infection during follow-up of at least 12 months were assessed. Microbiological findings were assessed and compared between two groups with less than five versus five or more surgical revisions. Results Bone consolidation was achieved in 86% of the patients while complications such as femoral or transtibial amputation, recurrence of infection or even death during inpatient treatment could be evidenced in six patients (14%). In patients who underwent multiple-stage surgery for five or more times, germ changes and repeated germ detection was more common than in patients with less surgeries. Conclusions Surgical treatment of infected nonunions poses a high burden on the patients with major complications occurring in about 14% of the patients using a multiple staged treatment concept. Future prospective studies comparing outcomes after limited with multiple staged revision surgeries are necessary.

scholarly journals Polymicrobial infections and microbial patterns in infected nonunions – a descriptive analysis of 42 cases

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Markus Rupp ◽  
Stefanie Kern ◽  
Tobias Weber ◽  
Tamina D. Menges ◽  
Reinhard Schnettler ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Descriptive Analysis ◽  
Polymicrobial Infection ◽  
Long Bone ◽  
Diagnostic Tools ◽  
Infected Nonunion ◽  
Tissue Samples ◽  
Microbiological Testing ◽  
Polymicrobial Infections

Abstract Background Frequencies of polymicrobial infection and pathogens evidenced in course of infected nonunion treatment are largely unknown. Therefore, this study aims at investigating microbial patterns in infected nonunions. Methods Surgically treated patients with long bone infected nonunion admitted between January 2010 and March 2018 were included in the study. Microbiological culture and polymerase-chain-reaction results of tissue samples of initial and follow-up revision surgeries were assessed and compared with patient and treatment characteristics. Results Forty two patients with a mean age of 53.9 ± 17.7 years were included. In six patients (14.3%) polymicrobial infection was evident. A change of pathogens evidenced in course of the treatment occurred in 21 patients (50%). In 16 patients (38.1%) previously detected bacteria could be determined by microbial testing after further revision surgery. Staphylococcus aureus was most often detected (n = 34, 30.6%), followed by Enterococcus spp. (n = 25, 22.5%) and Staphylococcus epidermidis (n = 18, 16.2%). Five Staphylococcus aureus were resistant to methicillin (MRSA). In patients without polymicrobial infection or further germ detection in course of the treatment, 86.4% of the infections were due to Staphylococcus spp.. Infections due to Streptococcus spp. and gram-negative bacteria were only present in patients with polymicrobial infection and germ-change in course of the treatment. Conclusion A low rate of polymicrobial infections was evidenced in the present study. Germ-change often occurs in course of revision surgeries. Prospective studies with more sensitive diagnostic tools are necessary to elucidate the therapeutical relevance of microbiological testing results for surgical as well as medical treatment in infected nonunions.

scholarly journals Giant Osteofibrous Dysplasia (Ossifying Fibroma) of the Tibia: Case Report and Review of Treatment Modalities

Sarcoma ◽  
2004 ◽  
Vol 8 (1) ◽  
pp. 51-56 ◽  
Author(s):  
Eitan Segev ◽  
Josephine Issakov ◽  
Eli Ezra ◽  
Shlomo Wientroub ◽  
Itzchak Meller
Keyword(s):  
Case Report ◽  
Surgical Treatment ◽  
Proximal Tibia ◽  
Skeletal Maturity ◽  
Complete Healing ◽  
Treatment Modalities ◽  
Ossifying Fibroma ◽  
Osteofibrous Dysplasia ◽  
Staged Treatment

We present a case of giant osteofibrous dysplasia (OFB) of the proximal tibia with 15 years of follow-up. The tumor recurred after first biopsy and curettage done at the age of 6 years and, again, 4 years later. Following recurrence, the option of amputation was suggested. Staged treatment of curettage, cryosurgery, bone cement as a temporary spacer with internal fixation at age 12 years, followed by bone grafting at age 14 years, led to complete healing. The staged protocol for treatment is proposed as an alternative to more radical solutions. It is suggested to postpone surgical treatment towards skeletal maturity.

scholarly journals Understanding the natural history of adult temporal lobe epilepsy

2015 ◽  
Vol 42 (S1) ◽  
pp. S26-S26
Author(s):  
L Hernandez-Ronquillo ◽  
JF Tellez-Zenteno ◽  
S Buckley ◽  
L Ladino-Malagon ◽  
W Adam
Keyword(s):  
Cohort Study ◽  
Surgical Treatment ◽  
Temporal Lobe Epilepsy ◽  
Temporal Lobe ◽  
Retrospective Cohort ◽  
Late Onset ◽  
Common Type ◽  
Descriptive Statistics ◽  
History Of

Temporal lobe epilepsy (TLE) is the most common type of epilepsy in adults. The literature in this field supports the notion than many patients become candidates for surgery and little is known about the group of patients who do not require surgical treatment. This is a retrospective cohort study that included all patients with TLE assessed and followed by the Saskatchewan Epilepsy Program since 2007. Mild course was defined as patients not having seizures, using or not AEDs at last follow up. Severe course of TLE was considered in patients with continuous seizures and patients who had epilepsy surgery. Descriptive statistics were used. OR and CI were calculated. One hundred and fifty nine patients were included. Age of patients at last follow up was 46.04 + 14.4 (range 19-88) years. Mean follow up of patients was 43.46+ 22.6 (6 to 84) months. Fourth six patients (29%) were seizure-free with AEDS (mild course TLE) and 113 (61%) had severe course of TLE. Patients with mild course of TLE were older (p 0.002), with a late onset of epilepsy (p< 0.001) and their epilepsy evolution was shorter (p<0.001). Our study shows that not all the patients with TLE require surgery and that a fair percentage of patients can be controlled with medication.

STUDY ON OUTCOME OF TREATMENT OF NONUNION LONG BONE FRACTURE

2021 ◽  
pp. 12-14
Author(s):  
M. Ganesh Kumar ◽  
M. Sivakumar
Keyword(s):  
Long Bone ◽  
Long Bones ◽  
Infected Nonunion ◽  
Treatment Protocols ◽  
Limb Reconstruction ◽  
Long Bone Fracture ◽  
Lost To Follow Up ◽  
Age Range ◽  
Written Informed Consent

The aim of the study is to analyze the outcome of treatment of infected Nonunion of long bones using limb reconstruction system and to reveal its real usefulness Nonunion is diagnosed, until clinical or radiographic evidence shows healing has ceased and that union is highly improbable. Nonunion is dened as “established when a minimum of 9 months has elapsed since injury and the fracture shows no visible progressive signs of healing for 3 months This is a prospective and retrospective study which consists of 30 cases in the age range from 20 yrs to 65 yrs Patients who were lost to follow up were not included in this study. Our institution approved our treatment protocols and all patients gave written informed consent. ASAMI' criteria were used to analyze the results in our study. In this study we conducted, we could achieve a success rate of 80%, giving good encouraging results to most of our patients. Hence we conclude that the Indian version of the Limb reconstruction system is effective and convenient method for the treatment of infected nonunion of long bones. This can also be used to correct the limb length discrepancies simultaneously, which can arise during the course of the treatment.

Epicardial cryoablation as surgical treatment for atrial fibrillation: One year follow up in 84 patients

2008 ◽  
Vol 56 (S 1) ◽  
Author(s):  
R Uhl ◽  
I Marcolino ◽  
E Zimmer ◽  
F Beyersdorf ◽  
E Eschenbruch
Keyword(s):  
Atrial Fibrillation ◽  
Surgical Treatment ◽  
One Year

Case of follow-up and successful surgical treatment rare form of subaortic membrane in infant

2017 ◽  
Vol 14 (3) ◽  
pp. 161-165
Author(s):  
A.I. Kim ◽  
Т.V. Rogova ◽  
R.М. Кurganov ◽  
Е.V. Kholmanskaya
Keyword(s):  
Surgical Treatment ◽  
Rare Form ◽  
Subaortic Membrane

Delayed Pancreatic Metastasis of Renal Clear Cell Carcinoma

2013 ◽  
Vol 13 (2) ◽  
pp. 79-80
Author(s):  
Zane Simtniece ◽  
Gatis Kirsakmens ◽  
Ilze Strumfa ◽  
Andrejs Vanags ◽  
Maris Pavars ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Surgical Treatment ◽  
Cell Carcinoma ◽  
Clear Cell ◽  
Clear Cell Carcinoma ◽  
Primary Tumour ◽  
Renal Clear Cell Carcinoma ◽  
Pancreatic Metastasis ◽  
Distal Pancreatic Resection

Abstract Here, we report surgical treatment of a patient presenting with pancreatic metastasis (MTS) of renal clear cell carcinoma (RCC) 11 years after nephrectomy. RCC is one of few cancers that metastasise in pancreas. Jaundice, abdominal pain or gastrointestinal bleeding can develop; however, asymptomatic MTS can be discovered by follow-up after removal of the primary tumour. The patient, 67-year-old female was radiologically diagnosed with a clinically silent mass in the pancreatic body and underwent distal pancreatic resection. The postoperative period was smooth. Four months after the surgery, there were no signs of disease progression.

Patients with “benign” Chiari I malformations require surgical decompression at a low rate

2019 ◽  
Vol 23 (4) ◽  
pp. 498-506 ◽  
Author(s):  
Tofey J. Leon ◽  
Elizabeth N. Kuhn ◽  
Anastasia A. Arynchyna ◽  
Burkely P. Smith ◽  
R. Shane Tubbs ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Posterior Fossa ◽  
Multivariate Logistic Regression Analysis ◽  
Large Cohort ◽  
Initial Evaluation ◽  
Published Data ◽  
Posterior Fossa Decompression ◽  
Signal Abnormality ◽  
Chiari I

OBJECTIVEThere are sparse published data on the natural history of “benign” Chiari I malformation (CM-I)—i.e., Chiari with minimal or no symptoms at presentation and no imaging evidence of syrinx, hydrocephalus, or spinal cord signal abnormality. The purpose of this study was to review a large cohort of children with benign CM-I and to determine whether these children become symptomatic and require surgical treatment.METHODSPatients were identified from institutional outpatient records using International Classification of Diseases, 9th Revision, diagnosis codes for CM-I from 1996 to 2016. After review of the medical records, patients were excluded if they 1) did not have a diagnosis of CM-I, 2) were not evaluated by a neurosurgeon, 3) had previously undergone posterior fossa decompression, or 4) had imaging evidence of syringomyelia at their first appointment. To include only patients with benign Chiari (without syrinx or classic Chiari symptoms that could prompt immediate intervention), any patient who underwent decompression within 9 months of initial evaluation was excluded. After a detailed chart review, patients were excluded if they had classical Chiari malformation symptoms at presentation. The authors then determined what changes in the clinical picture prompted surgical treatment. Patients were excluded from the multivariate logistic regression analysis if they had missing data such as race and insurance; however, these patients were included in the overall survival analysis.RESULTSA total of 427 patients were included for analysis with a median follow-up duration of 25.5 months (range 0.17–179.1 months) after initial evaluation. Fifteen patients had surgery at a median time of 21.0 months (range 11.3–139.3 months) after initial evaluation. The most common indications for surgery were tussive headache in 5 (33.3%), syringomyelia in 5 (33.3%), and nontussive headache in 5 (33.3%). Using the Kaplan-Meier method, rate of freedom from posterior fossa decompression was 95.8%, 94.1%, and 93.1% at 3, 5, and 10 years, respectively.CONCLUSIONSAmong a large cohort of patients with benign CM-I, progression of imaging abnormalities or symptoms that warrant surgical treatment is infrequent. Therefore, these patients should be managed conservatively. However, clinical follow-up of such individuals is justified, as there is a low, but nonzero, rate of new symptom or syringomyelia development. Future analyses will determine whether imaging or clinical features present at initial evaluation are associated with progression and future need for treatment.

Sign in / Sign up

Export Citation Format

Share Document