scholarly journals Experience with periprosthetic infection after limb salvage surgery for patients with osteosarcoma

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Tiao Lin ◽  
Qinglin Jin ◽  
Xiaolin Mo ◽  
Zhiqiang Zhao ◽  
Xianbiao Xie ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Loss ◽  
Bone Cement ◽  
Postoperative Infection ◽  
Periprosthetic Infection ◽  
Salvage Surgery ◽  
Operation Time ◽  
Limb Salvage Surgery ◽  
Second Stage ◽  
Initial Implantation

Abstract Background The rate of postoperative infection developing is higher after limb salvage surgery (LSS) following sarcoma resection compared with conventional arthroplasty. The goal of this study is to summarize our experience in management of periprosthetic joint infection (PJI) and the risk factors of early PJI after LSS. Methods Between January 2010 and July 2019, 53 patients with osteosarcoma in the lower extremities who encountered periprosthetic infection after segmental tumor endoprosthetic replacement in our center were analyzed. Detailed patient characteristics and therapeutic information were collected from database of our institution or follow-up data and we divided patients according to the interval time between infection and tumor resection (surgery-infection interval) and investigate potential risk factors. Results A total of 53 (5.08%) patients were suffered postoperative infection. The average interval between surgery and clinical signs of deep infections are 27.5 days. For the drainage culture, positive results were only presented in 11 patients (20.8%). Almost half of this study’s (47.2%) patients underwent a traditional two-stage revision, that was, after the removal of the infected prosthesis, we applied antibiotic-loaded bone cements as a spacer. The mean blood loss during initial implantation surgery and operation time both correlated with interval period between PJI and initial implantation significantly (P = 0.028, P = 0.046). For several patients which infection marker was hardly back to normal after spacer implantation, we conservatively introduced an improved combination of bone cement and prosthesis for the second-stage surgery (5.6%). There were six patients needing re-operation, of which three were due to the aseptic loosening of the prosthesis, one developed periprosthetic infection again, and two patients encountered local recurrence and underwent amputation. Two patients were dead from distal metastasis. Conclusions A two-stage revision strategy remains effective and standardized methods for PJI patients. Total operation time and blood loss during LSS of osteosarcoma are the main risk factors of early PJI. For the patients without confirmed eradiation of microorganisms, an improved combination of bone cement and prosthesis applied in the second-stage surgery could achieve satisfied functional and oncologic results.

Sublingual Misoprostol vs Intravenous Tranexamic Acid in reducing Blood Loss during Cesarean Section: A Prospective Randomized Study

2017 ◽  
Vol 9 (1) ◽  
pp. 9-13 ◽  
Author(s):  
Deepak Bose ◽  
Rasheeda Beegum
Keyword(s):  
Risk Factors ◽  
Blood Loss ◽  
Cesarean Section ◽  
Tranexamic Acid ◽  
Randomized Study ◽  
Operation Time ◽  
Prospective Randomized Study ◽  
Cord Clamping ◽  
Group I ◽  
Sublingual Misoprostol

ABSTRACT Introduction The increasing incidence of cesarean sections in India has caused a rise in the incidence of postpartum hemorrhage (PPH). There has been expanding interest in the role of misoprostol and tranexamic acid (TXA) in preventing and managing PPH during lower (uterine) segment cesarean section (LSCS). However, the lack of a published study comparing the efficacies of these drugs prompted us to conduct this study. Aims and objectives To compare the efficacies of sublingual misoprostol (600 μg) and intravenous TXA injection (500 mg) in reducing blood loss during LSCS by assessing intraoperative blood loss, perioperative hemoglobin (Hb) fall, and need for additional uterotonic agents. Materials and methods A total of 163 pregnant patients undergoing emergency/elective LSCS during the study period from 2013 to 2014 were randomly assigned to two groups — group I (82) received sublingual misoprostol 600 μg and group II (81) intravenous TXA 500 mg at cord clamping. Visual estimation of blood loss was done and 48 hours postoperative Hb and packed cell volume were measured to compare with preoperative values. Need for added uterotonics, blood transfusion, and adverse effects of drugs was assessed. The two groups were again subgrouped based on presence or absence of risk factors for PPH. Results The TXA significantly reduced blood loss compared with misoprostol (416 vs 505 mL) in patients without high-risk factors for PPH. Misoprostol caused significantly higher minor side effects while TXA reduced operation time. Conclusion The TXA can be routinely used after cord clamping along with oxytocin in patients undergoing elective/emergency LSCS to reduce perioperative blood loss, especially in those without risk factors for PPH. How to cite this article Bose D, Beegum R. Sublingual Misoprostol vs Intravenous Tranexamic Acid in reducing Blood Loss during Cesarean Section: A Prospective Randomized Study. J South Asian Feder Obst Gynae 2017;9(1):9-13.

scholarly journals Evaluation of blood loss during limb salvage surgery for pelvic tumours

2008 ◽  
Vol 33 (3) ◽  
pp. 751-756 ◽  
Author(s):  
Xiaodong Tang ◽  
Wei Guo ◽  
Rongli Yang ◽  
Shun Tang ◽  
Tao Ji
Keyword(s):  
Blood Loss ◽  
Limb Salvage ◽  
Salvage Surgery ◽  
Limb Salvage Surgery

Perioperative complications of primary posterior lumbar interbody fusion for nonisthmic spondylolisthesis: analysis of risk factors

2008 ◽  
Vol 9 (5) ◽  
pp. 403-407 ◽  
Author(s):  
Noboru Hosono ◽  
Masato Namekata ◽  
Takahiro Makino ◽  
Toshitada Miwa ◽  
Takashi Kaito ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Loss ◽  
Interbody Fusion ◽  
Perioperative Complications ◽  
Posterior Lumbar Interbody Fusion ◽  
Operation Time ◽  
Neurological Complications ◽  
Lumbar Interbody Fusion ◽  
Facet Joints ◽  
Surgeon Experience

Object Although posterior lumbar interbody fusion (PLIF) is an excellent procedure to attain circumferential decompression, it is technically demanding and can lead to various surgical complications. The authors retrospectively reviewed consecutive patients with nonisthmic spondylolisthesis who underwent PLIF to reveal the incidence and risk factors for perioperative complications of PLIF. Methods A total of 240 patients underwent PLIF. The fusion level was at L4–5 in 220, L3–4 in 18, and L5–S1 in 2. The medial walls of the fusion segment's facet joints were resected, and the VSP Spine System was used for the pedicle screw instrumentation. The operations were performed by 7 surgeons, who were divided into 4 groups according to their level of experience with spinal surgery. Results The average operation time was 175 ± 49 minutes, and the estimated blood loss was 746 ± 489 ml. A total of 90 patients (37.5%) experienced complications; 41 (17%) experienced transient neurological complications, and 18 (7.5%) experienced permanent neurological complications. The mean neurological score according to the Japanese Orthopaedic Association improved from 14.3 ± 3.8 to 24.7 ± 4.0 in the patients without complications and from 14.8 ± 3.6 to 24.0 ± 3.9 in the patients with complications. Multivariate analysis concerning the relationship between complications and risk factors (operation time, estimated intraoperative blood loss, and surgeon experience) revealed that operation time was the only significant risk factor for complications. Conclusions Perioperative complications of PLIF were more frequent in this homogeneous study group than in other studies of various implants. Total excision of the facet joints might preclude neurological complications.

scholarly journals Risk factors for local recurrences after limb-salvage surgery for high-grade osteosarcoma of the extremities

1997 ◽  
Vol 8 (9) ◽  
pp. 899-903 ◽  
Author(s):  
P. Picci ◽  
L. Sangiorgi ◽  
L. Bahamonde ◽  
P. Aluigi ◽  
J. Bibiloni ◽  
...  
Keyword(s):  
Risk Factors ◽  
Limb Salvage ◽  
Salvage Surgery ◽  
Limb Salvage Surgery ◽  
High Grade ◽  
Local Recurrences ◽  
High Grade Osteosarcoma

scholarly journals Comparison of the clinical outcomes of percutaneous vertebroplasty vs. kyphoplasty for the treatment of osteoporotic Kümmell’s disease:a prospective cohort study

2020 ◽  
Author(s):  
Jian-Zhong Chang ◽  
Ming-Jian Bei ◽  
Dong-Ping Shu ◽  
Cheng-Jun Sun ◽  
Ji-Bin Chen ◽  
...  
Keyword(s):  
Blood Loss ◽  
Bone Cement ◽  
Percutaneous Vertebroplasty ◽  
Operation Time ◽  
Cement Leakage ◽  
Significant Difference ◽  
Kummell’S Disease ◽  
Adjacent Vertebra ◽  
Kümmell’S Disease ◽  
Time Point

Abstract Background Percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) are widely used in the treatment of Kümmell's disease. The purpose of this article is to investigate the clinical efficacy of PVP and PKP for Kümmell's disease. Methods The clinical data that 56 cases of OVCF treated with either PVP (28 cases) or PKP (28 cases) and met the selection criteria from December 2015 to December 2017 were prospectively analyzed. Gender, age, course of disease, injury segment, BMD, VAS, ODI, imaging measurement indexes before surgery between the two groups showed no significant difference (all P>0.05). The bone cement leakage rate, bone cement injection amount, operation time, VAS, ODI, the rate of vertebral compression, correction rate of kyphosis and refracture rate of adjacent vertebra in 2 years were compared between the two groups to calculate clinical efficacy. Results The two groups were followed up for 24-48 months. There was no significant difference in the follow-up time, amount of bone cement injected, incidence of bone cement leakage and refracture rate of adjacent vertebra between the two groups (all P > 0.05). The operation time, intraoperative blood loss and fluoroscopy times of the PVP group were significantly lower than those of the PKP group (all P = 0.000). VAS score and ODI of the two groups were significantly lower at 1 d, 1 year and 2 years after surgery than before surgery (all P <0.05), but there was not statistically significant difference between the two groups at each time point after surgery (all P> 0.05). The rate of vertebral compression and kyphosis correction in the two groups were significantly corrected (P <0.05, respectively) and decreased significantly with time (all P <0.05), But there was not significant difference between the two groups at any time point (all P> 0.05). Conclusion Both PVP and PKP can achieve similar effects in the treatment of Kümmell's disease. Because the cost, operation time, blood loss, radiation exposure and surgical procedure of PVP are less than those of PKP, PVP has more clinical priority value.

Risk factors for severe weight loss after gastrectomy for gastric cancer.

2015 ◽  
Vol 33 (3_suppl) ◽  
pp. 38-38
Author(s):  
Kenki Segami ◽  
Toru Aoyama ◽  
Taiichi Kawabe ◽  
Shigeya Hayashi ◽  
Yousuke Makuuchi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Gastric Cancer ◽  
Weight Loss ◽  
Body Weight ◽  
Blood Loss ◽  
Total Gastrectomy ◽  
Significant Risk ◽  
Operation Time ◽  
Time Range ◽  
Eras Protocol

38 Background: Body weight loss (BWL) is frequently observed in gastric cancer patients who underwent gastrectomy for gastric cancer. Recently, we reported that severe BWL after gastrectomy was a significant risk factor for continuation of S-1 adjuvant chemotherapy. However, risk factors of BWL after surgery remain unclear. Methods: The present study retrospectively examined the patients who electively underwent curative gastrectomy for gastric cancer between January of 2012 and June of 2014. All patients received peri-operative care of ERAS protocol. %BWL was calculated by percentile of body weight at one month after surgery to preoperative body weight. Severe BWL was defined as %BWL over 10%. Risk factors for severe BWL were determined by both univariate and multivariate logistic regression analyses. Results: Two-hundred seventy eight patients were examined. Median age (range) was 68 years (27-86). Median body mass index (range) was 22 (13.4-33.5). Thirty patients had received neoadjuvant chemotherapy. Operative procedure was total gastrectomy (TG) in 97 patients (Open in 61 and laparoscopic in 36) and distal gastrectomy (DG) in 181 patients (Open in 94 and laparoscopic in 87). Median operation time (range) was 268.5 minutes (95-554). Median blood loss (range) was 115 mL (0-1600). Morbidity of grade 2 or more defined by Clavien-Dindo classification was observed in 37 patients including pancreatic fistula in 8, anastomotic leakage in 5, and abdominal abscess in 3. No mortality was found. Completion of ERAS protocol without any variance was 95.3%. Median %BWL was 6% (-4.3% to 19.5%). Both univariate and multivariate logistic analyses demonstrated that morbidity (odds rate 3.56, p=0.001), blood loss over 300ml (odds rate 2.04, p=0.0356), and total gastrectomy (odds rate 2.1, p=0.0258) were significant risk factors for severe BWL. Conclusions: Nutritional intervention trial to inhibit BWL after gastrectomy should be focused on the patients who developed morbidity, showed blood loss over 300ml, or received total gastrectomy.

scholarly journals Risk factors, medical therapies and perioperative events in limb salvage surgery: Observations from the PREVENT III multicenter trial

2005 ◽  
Vol 42 (3) ◽  
pp. 456-464 ◽  
Author(s):  
Michael S. Conte ◽  
Dennis F. Bandyk ◽  
Alexander W. Clowes ◽  
Gregory L. Moneta ◽  
Hamid Namini ◽  
...  
Keyword(s):  
Risk Factors ◽  
Limb Salvage ◽  
Salvage Surgery ◽  
Multicenter Trial ◽  
Limb Salvage Surgery ◽  
Medical Therapies

scholarly journals Risk Factors of Periprosthetic Infection in Patients with Tumor Prostheses Following Resection for Musculoskeletal Tumor of the Lower Limb

2020 ◽  
Vol 9 (10) ◽  
pp. 3133
Author(s):  
Toshifumi Fujiwara ◽  
Toshihiro Ebihara ◽  
Kazuki Kitade ◽  
Nokitaka Setsu ◽  
Makoto Endo ◽  
...  
Keyword(s):  
Risk Factors ◽  
Soft Tissue ◽  
Lower Limb ◽  
Postoperative Infection ◽  
Soft Tissue Tumor ◽  
Periprosthetic Infection ◽  
Tumor Prosthesis ◽  
Musculoskeletal Tumors ◽  
The Mean ◽  
Long Operation

Tumor prostheses for the lower limb following resection of musculoskeletal tumors is useful limb salvage management; however, as compared with routine total joint replacement, an increased incidence of deep periprosthetic infection of tumor prosthesis has been observed. The risk factors for periprosthetic infection of tumor prosthesis remain unclear. This study examines the risk factors and outcomes of periprosthetic infection. This was a retrospective observational study including 121 patients (67 males and 54 females) who underwent tumor prosthesis of the lower limb after resection of musculoskeletal tumors between 1 January 2000 and 30 November 2018. Among a total of 121 tumor prostheses, 7 were total femurs, 47 were proximal femurs, 47 were distal femurs, and 20 were proximal tibias. The incidence of postoperative infection and its risk factors were analyzed. Forty-five patients (37%) had osteosarcoma, 36 patients (30%) had bone metastasis, and 10 patients (8%) had soft-tissue tumors invading the bone. The mean operating time was 229 min, and the mean follow-up duration was 5.9 years. Deep periprosthetic infection was noted in 14 patients (12%). In the multivariate analysis, the risk factors for postoperative infection were identified as being male (hazard ratio [HR], 11.2316; p = 0.0100), soft-tissue tumor (HR, 52.2443; p = 0.0003), long operation (HR, 1.0056; p = 0.0184), and radiotherapy (HR, 6.5683; p = 0.0476). The incidence of periprosthetic infection in our institution was similar to that of previous reports. Patients undergoing tumor prosthesis of the lower limb who were male, had a soft-tissue tumor, were predicted to have a long operation, and who underwent radiation, had an increased possibility of postoperative infection.

Two-stage Reimplantation in Infected Total Knee Arthroplasty by Using Resterilized Femoral and Tibial Components with a New Polyethylene Insert: Report of 4 Cases with at Least 15 Years’ Follow-up

2021 ◽  
Vol 23 (6) ◽  
pp. 411-416
Author(s):  
Alpaslan Öztürk ◽  
Nazan Çevik ◽  
Yavuz Akalın ◽  
Oğuz Çetin ◽  
Özgür Avci( ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Bone Cement ◽  
Knee Arthroplasty ◽  
Periprosthetic Infection ◽  
Polyethylene Insert ◽  
Two Stage ◽  
Second Stage ◽  
Articulating Spacer ◽  
Total Knee

Background. This study evaluates 15 years’ results of the implantation of autoclaved femoral and tibial prosthesis components together with a new same brand polyethylene insert which were used as a temporary articulating spacer in patients with periprosthetic infection of total knee arthroplasty (TKA) in a two-stage reimplantation procedure in 6 patients.  Material and methods. The femoral and tibial prostheses of 6 patients with deep chronic periprosthetic infection of TKA who underwent elective two-stage exchange arthroplasty were autoclaved and reinserted with a new polyethylene insert of the same brand and bone cement mixed with tecoplanin in 2004. Results. Four patients were followed for 15 years. They were all female and between 47-70 years old. The infectious agent was meticillin-resistant Staphylococcus aureus (MRSA) in 3 and coagulase negative Staphy­lococcus in one patient. Patients were invited for second stage reimplantation, but they refused to undergo the second stage. Three of them had their second stage reimplantation after 15, 13 and 10 years while one patient was reinfected after 5 years, in 2009, and arthrodesis was performed. They were all happy with the result and infection free at last follow-up.  Conclusions. 1. Regarding the results of our patients, reinsertion of autoclaved femoral and tibial prostheses together with a new same brand polyethylene insert with teicoplanin loaded bone cement can be used cautiously in the management of periprosthetic deep infection of TKA. 2. That is because patients might not want the second stage reimplantation. 3. We believe that the refusal of patients to undergo the surgery shows that the single-stage treatment is effective.

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