Treatment of Delayed Union and Septic Osteomyelitis of Metacarpus III/IV in a Calf Using Gentamicin-impregnated Collagen Sponges and Minimal External Coaptation

1998 ◽  
Vol 11 (01) ◽  
pp. 19-22 ◽  
Author(s):  
A. Steiner ◽  
Gaby Hirsbrunner
Keyword(s):  
Standard Treatment ◽  
Delayed Union ◽  
Surgical Debridement ◽  
Rigid Fixation ◽  
Skin Defect ◽  
Long Time ◽  
Metaphyseal Fracture ◽  
External Stabilization ◽  
Long Acting ◽  
Local Antibiotic

SummaryA newborn calf was admitted for evaluation of a primarily closed comminuted metaphyseal fracture of metacarpus III/IV. Closed reduction and application of transfixation pins and a fibreglass cast were performed. Ten days after pin removal, radiographs revealed that the initially healed fracture had collapsed, and osteomyelitis was diagnosed. Bacteriological culture from the deep draining tract yielded Actinomyces pyogenes and Staphylococcus aureus. Standard treatment of delayed union or nonunion caused by septic osteomyelitis consists of surgical debridement, rigid fixation, and long-time administration of antibiotics. In this case, we used surgical debridement, administration of a new long-acting local antibiotic (gentamicin- impregnated collagen sponges), and minimal external stabilization. At day 27 after initiation of this treatment, the skin defect had healed, and the fracture was stable on manual palpation.Standard treatment of delayed union or nonunion caused by septic osteomyelitis consists of surgical debridement, rigid fixation and prolonged administration of antibiotics. In the case described, we used surgical debridement, administration of a long-acting local antibiotic (gentamicin-impregnated collagen sponges), and minimal external stabilization. The promising outcome of this case and the good results in human surgery warrant further investigation in the use of gentamicin-impregnated collagen sponges in veterinary orthopaedics.

scholarly journals Intoxicação por Supervarfarina

2015 ◽  
Vol 28 (3) ◽  
pp. 389 ◽  
Author(s):  
Ana Freixo ◽  
Luís Lopes ◽  
Manuela Carvalho ◽  
Fernando Araújo
Keyword(s):  
Dosage Reduction ◽  
Treatment Guidelines ◽  
Anticoagulant Activity ◽  
International Normalized Ratio ◽  
Easy Access ◽  
Minor Bleeding ◽  
Long Time ◽  
Bleeding Episodes ◽  
Human Poisoning ◽  
Long Acting

The superwarfarin-type anticoagulant rodenticides are used throughout the world and distinguish themselves from warfarin for its high potency and long acting anticoagulant activity. Easy access to these products enables the accidental or deliberate human poisoning. A case of voluntary rodenticide poisoning (RATIBRON®) by a woman who ingested an estimated 27.5 mg of bromadiolone total quantity for two weeks, with minor bleeding episodes, whose reversal of the anticoagulant effect with the correction of the abnormal values of the clotting tests took about one month to reverse is reported here. The correction of the haemostasis defects takes usually a long time<br />and there are no treatment guidelines, but a gradually vitamin K dosage reduction, as out patients, along with the monitoring of the International Normalized Ratio levels, allows a safe evaluation of the therapeutic response.

scholarly journals Thoracic limb salvage by fibular free flap

2019 ◽  
Vol 8 (1) ◽  
pp. 351
Author(s):  
Rodrigo Banegas Ruiz ◽  
Alan I. Valderrama Treviño ◽  
Francisco Fabián Gómez Mendoza ◽  
Rodrigo A. Mendoza Aceves ◽  
Rigoberto Román Hernández ◽  
...  
Keyword(s):  
Free Flap ◽  
Skin Defect ◽  
Posterior Compartment ◽  
Anatomical Reduction ◽  
Wound Coverage ◽  
Osteosynthesis Material ◽  
Thoracic Limb ◽  
Fibula Free Flap ◽  
Metaphyseal Fracture ◽  
Fibular Free Flap

The treatment of most fractures of the ulna and radius is usually performed by anatomical reduction and internal fixation, when damage is extensive and local soft tissue cannot provide a complete wound coverage, locoregional flaps present a suitable reconstructive benefit. A 35-year-old male patient suffered an exposed diaphysio-metaphyseal fracture with multi-fragmented distal radius. The patient was evaluated during a 10-day period at the National Institute of Rehabilitation, where the osteosynthesis material and a severe infectious process with necrosis were identified. Necrosectomy of the posterior compartment and removal of the osteosynthesis material was performed, a skin defect of approximately 22x16 cm was observed with a bone gap of 6 cm of radius and ulna. a fibula-free flap is placed to correct the skin defect and an external fixative used for bone alignment. The fibular free flap presents an excellent therapeutic alternative in the resolution of bone gaps with extensive skin defect. Whenever a trained microsurgery team is available, current scales of limb injury should be considered but not utilized for therapeutic approach, always trying to shift amputation as the first option, to the very last one of them.

Coccidioidomycosis of the First Cuneiform: Successful Treatment Utilizing Local Debridement and Long-Term Ketoconazole Therapy

Foot & Ankle ◽  
1986 ◽  
Vol 6 (6) ◽  
pp. 300-304 ◽  
Author(s):  
Steven L. Buckley ◽  
J. Kenneth Burkus
Keyword(s):  
Amphotericin B ◽  
Treatment Regimen ◽  
Clinical Guidelines ◽  
Standard Treatment ◽  
Chemotherapeutic Agent ◽  
Surgical Debridement ◽  
Tarsal Bone ◽  
Antifungal Chemotherapy ◽  
Intravenous Amphotericin

Although intravenous amphotericin B is generally considered to be the standard treatment for coccidioidomycosis, the treatment of monostotic coccidioidomycosis is controversial. Long-term intravenous and oral antifungal chemotherapy has been utilized alone and in conjunction with local surgical debridement. We present a case of coccidioidal osteomyelitis of a tarsal bone successfully treated with local surgical debridement and oral ketoconazole and propose clinical guidelines for selecting the proper chemotherapeutic agent and for following the efficacy of the treatment regimen

scholarly journals Bisphosphonate-related atypical femoral fractures: A novel strategy to improve patient outcomes

2020 ◽  
Vol 27 (2) ◽  
pp. 192-197
Author(s):  
Rajpreet Sahemey ◽  
AP Nikolaides ◽  
S Bhattacharya ◽  
A Simons ◽  
P Makrides
Keyword(s):  
Femoral Fractures ◽  
Delayed Union ◽  
Bisphosphonate Therapy ◽  
Rigid Fixation ◽  
Intraoperative Complication ◽  
Intramedullary Canal ◽  
Cephalomedullary Nailing ◽  
Novel Strategy ◽  
Radiographic Data

Background: Atypical femoral fracture (AFF) is a serious adverse event associated with bisphosphonate therapy and prone to complications and delayed union. We propose a technique and management strategy to maximise bone healing and outcomes. Methods: We report on a cohort of patients with AFF using our novel technique of preparing the intramedullary canal and rigid fixation with cephalomedullary nailing. Patients were admitted under a multidisciplinary team with rehabilitation goals of early mobilisation and teriparatide initiation. Clinical and radiographic data were retrospectively reviewed. Results: Twenty-eight AFFs were treated with a mean follow-up of 58.5 weeks and a mean age of 75.2 years old. All cases achieved radiological union by a mean of 6 months and post-operative thigh pain experienced up to 8.7 weeks. No cases underwent revision or experienced intraoperative complication. Conclusion: Our surgical technique and multidisciplinary management are reproducible with excellent results in patients with this rare yet challenging injury.

Once-Daily Tiotropium Is Well Tolerated as Add-On to Standard Treatment for Patients With Symptomatic Asthma Despite Receiving Inhaled Corticosteroids and Long-Acting β 2 -Agonists

CHEST Journal ◽  
2013 ◽  
Vol 144 (4) ◽  
pp. 89A ◽  
Author(s):  
Jonathan A Bernstein ◽  
Huib AM Kerstjens ◽  
Petra Moroni-Zentgraf ◽  
Michael Engel ◽  
Hendrik Schmidt ◽  
...  
Keyword(s):  
Standard Treatment ◽  
Inhaled Corticosteroids ◽  
Once Daily ◽  
Symptomatic Asthma ◽  
Long Acting

scholarly journals Local Delivery of Antibiotics in the Context of Chronic Diabetic Foot Infection with Bony Involvement: A Case Series of 102 Patients

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0044
Author(s):  
James Widnall ◽  
David Harvey ◽  
Paul Evans ◽  
Gillian Jackson ◽  
Simon Platt
Keyword(s):  
Dead Space ◽  
Salvage Surgery ◽  
Case Series ◽  
Calcium Sulphate ◽  
Surgical Debridement ◽  
P Value ◽  
Space Management ◽  
Bony Involvement ◽  
Local Antibiotic ◽  
Antibiotic Delivery

Category: Diabetes Introduction/Purpose: Diabetic foot infection (DFI) is a devastating condition which poses risk to both life and limb. Treatment principles revolve around surgical debridement, dead space management, delivery of both local and systemic antibiotics and soft tissue cover. Dead space management and local antibiotic delivery can be achieved simultaneously by using an antibiotic loaded bone substitute. We report our retrospective case series of patients treated with surgical management involving local antibiotic delivery via calcium sulphate bone substitute (Stimulan™; Biocomposites, Keele, UK). Methods: All patients between January 2015 and June 2018 with DFI and proven bony involvement presenting to our university teaching hospital were treated via our extensive MDT approach. A total of 102 patients were included. Surgical debridement was performed along with simultaneous insertion of 10 ml calcium sulphate with 1 g vancomycin and 240 mg gentamycin. Outcome was classified as resolved, requiring prolonged treatment from other medical (endocrinologist) or surgical (plastic surgery, limb reconstruction) services or salvage surgery in the form of proximal amputation. Results: 45.1% of patients had a partial amputation at the index surgery. 52% had bony debridement and just 2.9% had soft tissue debridement in conjunction with calcium sulphate insertion. The surgical wound was primarily closed in 56.8% of patients. 7 patients had delayed wound closure and 36.2% of patients healed via secondary intention. 74 patients (72.5%) had resolution of their DFI with bony involvement following surgical intervention. 21 (20.6%) patients needed further treatment from allied specialties. 7 (6.9%) patients required salvage surgery in the form of a below knee amputation. There was no correlation between either closure type (2 p-value 0.75) or index surgery type and outcome (2 p-value 0.64). Conclusion: DFI is a difficult clinical scenario to treat effectively. An MDT approach is undoubtedly key to a good outcome. We believe that the use of calcium sulphate can be a useful adjunct at the time of surgical debridement to aid in both dead space management and allow local antibiotic delivery.

scholarly journals The use of short-acting bronchodilators in patients with chronic bronchoobstructive pathology at the present stage

2021 ◽  
pp. 91-99
Author(s):  
K. A. Zykov ◽  
V. V. Vikentyev ◽  
I. V. Goloborodova ◽  
I. I. Kopchenov ◽  
O. V. Bondarec ◽  
...  
Keyword(s):  
Real Life ◽  
Drug Regimen ◽  
Point Of View ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Short Acting ◽  
Beta Agonists ◽  
Metered Dose ◽  
Long Time ◽  
Long Acting

Inhaled short-acting bronchodilators (beta-agonists and M-anticholinergics) have been used for a long time in patients with bronchoobstructive diseases, the main representatives of which are chronic obstructive pulmonary disease (COPD) and bronchial asthma (BA). Given the fact that most patients with COPD and BA are treated with long-acting bronchodilators, the question arises about the place of short-acting drugs in modern treatment algorithms for bronchoobstructive pathology. The data on how many patients take short-acting beta-agonists and M- anticholinergics in real-life clinical practice, and how appropriate it is to use these drugs on top of prolonged drugs are provided. The Russian part of the international POPE-study analyzed the characteristics of outpatients with COPD. It was found that the vast majority of patients have short-acting bronchodilators as part of their therapy, and more than 50% of patients receive a combination of SABA and SAAC, and in most cases this is represented by a combination of fenoterol + ipratropium. Taking into account that the majority of patients with COPD and asthma receive prolonged bronchodilators, important from a practical point of view is the question of the effectiveness of short-acting drugs on the background of prolonged ones. The article discusses these aspects of therapy and provides evidence that the use of SABA and SAAC provides an opportunity to achieve additional bronchodilatation when used against the background of prolonged bronchodilators. Thus, symptomatic use of SABA and SAAC on demand in bronchoobstructive pathology have sufficient justification even in the presence of a combination of prolonged bronchodilators in patient therapy. At the same time, it is necessary to take into account the increased probability of side effects with such drug regimen. The article also discusses the issues of different types of inhalation devices for short-acting bronchodilators (nebulizers and metered-dose aerosol inhalers), provides data on their comparative effectiveness and safety. 

Long-Acting Formulations: A Promising Approach for the Treatment of Chronic Diseases

2020 ◽  
Vol 26 ◽  
Author(s):  
Somaraju Revanth Kumar ◽  
Chetan Hasmukh Mehta ◽  
Usha Y Nayak
Keyword(s):  
Chronic Diseases ◽  
Treatment Duration ◽  
Patient Adherence ◽  
Patient Needs ◽  
Pharmacokinetics And Pharmacodynamics ◽  
Long Time ◽  
Long Acting ◽  
Incomplete Treatment ◽  
Trial Phase ◽  
Treatment Profile

: Medication and patient adherence are the two main aspects of any successful treatment of chronic disease. Even though disease and its treatment existed for several hundred years ago, it still makes scientists and researchers always think about the optimization of the treatment given to patients. Understanding disease, its treatment duration, signs, symptoms, which are different from patients to the patient, make a challenge for designing an ideal formulation. The existence of conventional formulations like oral solids and liquids resulted in a partial or incomplete treatment profile as the patient needs to follow the daily pill format for a long time. In this case, long-acting formulations are designed to provide drug release for a longer duration with the advantage of patient compliance. Many of these approaches are under the clinical trial phase. Researchers have established pharmacokinetics and pharmacodynamics relationship, which shows a promising option for the treatment of chronic diseases. In this article we have discussed the importance of prescription adherence, chronic diseases and the need for long-acting formulations for the treatment of chronic diseases.

scholarly journals Non-restricted weight-bearing after modified Lapidus arthrodesis

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0003
Author(s):  
Manuel Pellegrini ◽  
Giovanni Carcuro ◽  
Natalio Cuchacovic ◽  
Gerardo Muñoz ◽  
Marcelo Somarriva
Keyword(s):  
Hallux Valgus ◽  
Weight Bearing ◽  
Clinical Results ◽  
Delayed Union ◽  
Rigid Fixation ◽  
X Rays ◽  
Non Union ◽  
Fixation Methods ◽  
First Ray

Category: Bunion, Midfoot/Forefoot Introduction/Purpose: Modified lapidus arthrodesis is performed in the treatment of different pathologies, including hallux valgus and osteoarthritis of the first cuneo-metatarsal joint. Complications of this procedure include delayed union and non-union, reported to be between 5 to 20%. To prevent them, prolonged foot unloading and rigid fixation methods have been proposed. We sought to investigate our clinical results and complications in patients operated on with a modified Lapidus arthrodesis and inmediate weight bearing in a rigid post-operative shoe. Methods: After IRB approval, we conducted a retrospective patient chart review in a single center. Dedicated foot and ankle orthopaedic surgeons performed all procedures. Patients were included if they were older than 18 years, had a minimum follow up of one year and agreed to participate in the study. Patients with neuropathy, revision arthrodesis or those with concomitant midfoot/hindfoot procedures were excluded. All patients were operated on with an inter-articular lag screw and a locking neutralization plate. Patients were allowed to weight bear without restriction in a rigid post-operative shoe from postoperative day one. An independent musculoskeletal radiologist evaluated bone consolidation of the arthrodesis in x-rays or CT scan, when available. Results: Fifteen patients (18 feet) with an average age of 47 years (15-66) met inclusion criteria. All patients were female. Mean follow up was 19 months (12-24). Surgical indications were: hallux valgus in 14 cases and cuneo-metatarsal osteoarthritis in one case. Consolidation rate was 94% (14/15). Average time for radiological consolidation was 11 weeks (7-27). One patient (6%) developed non-union and required a revision arthrodesis with bone grafting. No loss of radiological correction or malalignment of the first ray was observed at last follow-up. Conclusion: Our results suggest that modified lapidus arthrodesis with rigid fixation methods and non restricted weight bearing is a safe and effective alternative to manage first ray pathology. This approach may not increase non-union rates or affect the reduction obtained.

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