The Effectiveness of Local Antibiotics in Treating Chronic Osteomyelitis in
a Cohort of 50 Patients with an Average of 4 Years Follow-Up

The treatment of chronic osteomyelitis requires both appropriate surgical and antibiotic management. Prolonged intravenous antibiotic therapy followed by oral therapy is widely utilised. Despite this, the long-term recurrence rate can be up to 30%. A cohort of 50 patients from a 7-year period, 2003 to 2010, with chronic osteomyelitis was identified. This cohort was treated by surgical marginal resection in combination with local application of antibiotics (Collatamp G - gentamicin in a collagen fleece), a short course of systemic antibiotics post-operatively and conversion to oral antibiotics on discharge. Information was retrieved from case notes and computerized records. Outcomes from this cohort were compared with a historical cohort treated with marginal resection followed by 6 weeks of systemic antibiotics and 6 weeks of oral antibiotics. The mean follow-up duration was 3.2 years (SD 1.8). The average length of admission was 9.8 days (SD 11.4). 6 patients (12%) suffered recurrence of infection requiring further treatment. We used the Cierny and Mader classification to stratify the patients. 'A' hosts had a shorter duration of admission (7.1 days) than 'B' hosts (12.3 days). There was no significant difference between recurrence rates of 'A' and 'B' hosts. Where available, we found pre-operative C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) levels had no correlation with disease recurrence. Disease-free probability for this cohort compared favourably with the historical cohort. We believe local administration of gentamicin in a collagen fleece is a useful component in the management of chronic osteomyelitis.

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Adjunctive therapies for the nonsurgical treatment of peri-implant diseases: systemic review and meta-analysis

10.21203/rs.3.rs-15961/v3 ◽

2020 ◽

Author(s):

yuhan xiao ◽

Yichun Qin ◽

Haiyang Yu

Keyword(s):

Photodynamic Therapy ◽

Meta Analysis ◽

Cost Effective ◽

Systemic Review ◽

Cochrane Library ◽

Enamel Matrix Derivative ◽

Local Antibiotics ◽

Significant Difference ◽

Systemic Antibiotics

Abstract Background Peri-implant diseases are caused by biofilms around the implant and may lead to implant failure. Non-surgical mechanical debridement (MD) with different adjunctive therapies has been applied in the treatment of peri-implant diseases. This systematic review aimed to deduce the optimal adjunctive therapy.Methods Two independent authors screened the literature using MEDLINE and Cochrane Library. Only clinical randomized controlled trials (RCTs) about adjunctive therapies for non-surgical treatment of peri-implant diseases were included in this review. Studies selected were published before February 2020. The clinical outcomes were compared in this meta-analysis.Results: A total of 31 RCTs met the inclusion criteria. The following adjunctive interventions were compared in the included studies: modification of the prosthesis; air abrasive; Er:YAG laser; diode laser; photodynamic therapy; local antibiotics; system antibiotics; probiotics; and enamel matrix derivative. Follow-up ranged from 3 months to 1 year. A statistically significant difference was observed between MD with photodynamic therapy and MD alone at 3 months follow-up ( P < 0.01). However, such a difference was not detected between MD with chlorhexidine and MD alone at 3 months follow-up ( P = 0.61), between MD with probiotics and MD alone ( P = 0.47), and between systemic antibiotics and MD alone ( P = 0.96).Conclusion Currently, the optimal non-surgical intervention is not known. Also, among the interventions with similar efficiency, that with fewer side effects, easy to use, and cost-effective is yet to be identified. Thus, well-designed RCTs with prolonged follow-ups to assess the accurate effectiveness of therapies are imperative.

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Adjunctive therapies for the nonsurgical treatment of peri-implant diseases: systemic review and meta-analysis

10.21203/rs.3.rs-15961/v2 ◽

2020 ◽

Author(s):

yuhan xiao ◽

Yichun Qin ◽

Haiyang Yu

Keyword(s):

Photodynamic Therapy ◽

Meta Analysis ◽

Cost Effective ◽

Systemic Review ◽

Cochrane Library ◽

Enamel Matrix Derivative ◽

Local Antibiotics ◽

Significant Difference ◽

Systemic Antibiotics

Abstract Background Peri-implant diseases are caused by biofilms around the implant and may lead to implant failure. Non-surgical mechanical debridement (MD) with different adjunctive therapies has been applied in the treatment of peri-implant diseases. This systematic review aimed to deduce the optimal adjunctive therapy. Methods Two independent authors screened the literature using MEDLINE and Cochrane Library. Only clinical randomized controlled trials (RCTs) about adjunctive therapies for non-surgical treatment of peri-implant diseases were included in this review. Studies selected were published before February 2020. The clinical outcomes were compared in this meta-analysis. Results: A total of 31 RCTs met the inclusion criteria. The following adjunctive interventions were compared in the included studies: modification of the prosthesis; air abrasive; Er:YAG laser; diode laser; photodynamic therapy; local antibiotics; system antibiotics; probiotics; and enamel matrix derivative. Follow-up ranged from 3 months to 1 year. A statistically significant difference was observed between MD with photodynamic therapy and MD alone at 3 months follow-up ( P < 0.01). However, such a difference was not detected between MD with chlorhexidine and MD alone at 3 months follow-up ( P = 0.61), between MD with probiotics and MD alone ( P = 0.47), and between systemic antibiotics and MD alone ( P = 0.96). Conclusion Currently, the optimal non-surgical intervention is not known. Also, among the interventions with similar efficiency, that with fewer side effects, easy to use, and cost-effective is yet to be identified. Thus, well-designed RCTs with prolonged follow-ups to assess the accurate effectiveness of therapies are imperative.

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Adjunctive therapies for the nonsurgical treatment of peri-implant diseases: systemic review and meta-analysis

10.21203/rs.3.rs-15961/v4 ◽

2020 ◽

Author(s):

yuhan xiao ◽

Yichun Qin ◽

Haiyang Yu

Keyword(s):

Photodynamic Therapy ◽

Meta Analysis ◽

Systemic Review ◽

Cochrane Library ◽

Local Antibiotics ◽

Randomized Controlled ◽

Significant Difference ◽

Systemic Antibiotics ◽

Non Surgical Treatment

Abstract Background Peri-implant diseases are mainly caused by biofilms around the implant and may lead to implant failure. Non-surgical mechanical debridement with different adjunctive therapies has being applied in the treatment of peri-implant diseases. This systematic review aims to figure out whether one adjunctive therapy is superior to any other. Methods Two independent authors screened the literature via the MEDLINE, Cochrane Library and Science Direct. Only clinical randomized controlled trials (RCTs) that compared the efficacy of adjunctive therapies in the treatment of peri-implant diseases with non-surgical mechanical debridement (MD) were included in this review. The studies selected were published before June 2020. Comparisons of clinical outcomes were estimated using meta-analysis Results: A total of eighteen RCTs met the inclusion criteria, of which 13 articles were included in the meta-analysis. The following adjunctive interventions were compared in the included studies: modifying the prosthesis; air abrasive; photodynamic therapy; local antibiotics; systemic antibiotics; probiotics. Statistically significant difference was observed between MD with photodynamic therapy and MD alone at 3 months follow-up ( P < 0.01). There is no statistical difference between MD with chlorhexidine and MD alone in the treatment of peri-implant diseases at 3 months follow-up ( P = 0.84), so is MD with probiotics and MD alone ( P = 0.96), and so is systemic antibiotics and MD alone ( P = 0.47). Conclusion. MD adjunct with PDT is an effective treatment for peri-implant mucositis. However, there is still no effective non-surgical treatment for peri-implantitis.

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Adjunctive therapies for the nonsurgical treatment of peri-implant diseases: systemic review and meta-analysis

10.21203/rs.3.rs-15961/v1 ◽

2020 ◽

Author(s):

yuhan xiao ◽

Yichun Qin ◽

Haiyang Yu

Keyword(s):

Photodynamic Therapy ◽

Meta Analysis ◽

Systemic Review ◽

Cochrane Library ◽

Enamel Matrix Derivative ◽

Local Antibiotics ◽

Randomized Controlled ◽

Significant Difference ◽

Systemic Antibiotics

Abstract Background Peri-implant diseases are caused by biofilms around the implant and may lead to implant failure. Non-surgical mechanical debridement with different adjunctive therapies has being applied in the treatment of peri-implant diseases. This systematic review aims to figure out whether one adjunctive therapy is superior to any other. Methods Two independent authors screened the literature via the MEDLINE and Cochrane Library. Only clinical randomized controlled trials (RCTs) that compared the efficacy of adjunctive therapies in the treatment of experimental peri-implant mucositis with non-surgical mechanical debridement (MD) were included in this review. The studies selected were published before February 2020. Comparisons of clinical outcomes were estimated using meta-analysis Results: A total of thirty-one RCTs met the inclusion criteria. The following adjunctive interventions were compared in the included studies: modifying the prosthesis; air abrasive; Er:YAG laser; diode laser; photodynamic therapy; local antibiotics; system antibiotics; probiotics; enamel matrix derivative. Follow-up ranged from 3 months to 1 years. Statistically significant difference was observed between MD with photodynamic therapy and MD alone at 3 months follow-up (P < 0.01). There is no statistical difference between MD with chlorhexidine and MD alone at 3 months follow-up (P = 0.61), so is MD with probiotics and MD alone (P = 0.47), and so is systemic antibiotics and MD alone (P = 0.96). Conclusion.At present, we do not know which non-surgical intervention is superior to any other, and for the interventions having similar degrees of effectiveness we do not know which one has less side effects, is simpler and cheaper to use. It is necessary to conduct well-designed RCTs with longer follow-ups to assess the accurate effectiveness of therapies.

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Slowly resorbable biosynthetic mesh: 2-year results in VHWG grade 3 hernia repair

Hernia ◽

10.1007/s10029-021-02453-1 ◽

2021 ◽

Author(s):

M. M. J. Van Rooijen ◽

T. Tollens ◽

L. N. Jørgensen ◽

T. S. de Vries Reilingh ◽

G. Piessen ◽

...

Keyword(s):

Quality Of Life ◽

Hernia Repair ◽

Hernia Recurrence ◽

Recurrence Rates ◽

Elective Repair ◽

Significant Difference ◽

Grade 3

Abstract Introduction Information on the long-term performance of biosynthetic meshes is scarce. This study analyses the performance of biosynthetic mesh (Phasix™) over 24 months. Methods A prospective, international European multi-center trial is described. Adult patients with a Ventral Hernia Working Group (VHWG) grade 3 incisional hernia larger than 10 cm2, scheduled for elective repair, were included. Biosynthetic mesh was placed in sublay position. Short-term outcomes included 3-month surgical site occurrences (SSO), and long-term outcomes comprised hernia recurrence, reoperation, and quality of life assessments until 24 months. Results Eighty-four patients were treated with biosynthetic mesh. Twenty-two patients (26.2%) developed 34 SSOs, of which 32 occurred within 3 months (primary endpoint). Eight patients (11.0%) developed a hernia recurrence. In 13 patients (15.5%), 14 reoperations took place, of which 6 were performed for hernia recurrence (42.9%), 3 for mesh infection (21.4%), and in 7 of which the mesh was explanted (50%). Compared to baseline, quality of life outcomes showed no significant difference after 24 months. Despite theoretical resorption, 10.7% of patients reported presence of mesh sensation in daily life 24 months after surgery. Conclusion After 2 years of follow-up, hernia repair with biosynthetic mesh shows manageable SSO rates and favorable recurrence rates in VHWG grade 3 patients. No statistically significant improvement in quality of life or reduction of pain was observed. Few patients report lasting presence of mesh sensation. Results of biosynthetic mesh after longer periods of follow-up on recurrences and remodeling will provide further valuable information to make clear recommendations. Trial registration Registered on clinicaltrials.gov (NCT02720042), March 25, 2016.

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First thousand rectal cancer cases: Local recurrence and survival

Acta chirurgica iugoslavica ◽

10.2298/aci0402133k ◽

2004 ◽

Vol 51 (2) ◽

pp. 133-137 ◽

Cited By ~ 6

Author(s):

Zoran Krivokapic ◽

Goran Barisic ◽

V. Markovic ◽

Milos Popovic ◽

Sladjan Antic ◽

...

Keyword(s):

Local Recurrence ◽

Anal Verge ◽

Preoperative Staging ◽

Recurrence Rates ◽

Hartmann Procedure ◽

Cumulative Survival ◽

Colorectal Anastomoses ◽

Significant Difference ◽

Dukes C

In the period 1990 - 2002, 1674 patients with colorectal carcinoma were operated in the First Surgical Clinic, Third Department for Colorectal Surgery. In 1264 cases (75,5%) rectal carcinoma was the indication for surgical treatment. Sphincter saving procedures (SSP) were performed in 824 (65,2%), abdominoperineal resections (APR) in 340 (26,9%) and resections of rectum with definitive stoma (Hartmann procedure) in 100 (7,9%) patients. We analyzed 1095 cases where curative SSP or APR were performed. All cases where curative resection was not possible because of liver metastases or inability to excise all macroscopic disease were excluded. In the group of patients where SSP was performed (767 cases), there were 26,6% high colorectal anastomoses (8cm from anal verge), 65,4% with low (4-8cm from anal verge) and 8,0% with intersphincteric coloanal anastomosis (cm from anal verge). Patohistological exam showed 5,3% Dukes A, 53,1% Dukes B, 36,5% Dukes C and 4,9% Dukes D. In the APR group (328 cases) there were 1,5% Dukes A, 32,4% Dukes B, 62,1% Dukes C and 3,5% Dukes D. In this study we analyzed local recurrence and five-year survival in both groups. Recurrence of the disease was registered in 325 (29,6%) out of 1095 patients. Local recurrence was found in 81 (7,4%) patients. In the SSP group recurrence occured in 215 (28,0%) out of 767 curative resections. Local recurrence alone was found in 53 patients (6,9%). SSP group was also divided into two subgroups; in the first group TME was performed and in second transection of mesorectum was carried out. Analyzing local recurrence in these two groups, in the TME group it was 7,6% and in the transection group 5,6%. In the APR group recurrence was registered in 110 (33,5%) out of 328 patients while local recurrence alone was found in 28 (8,5%) cases. Analyzing mortality we found that 234 (21,4%) out of 1095 patients died during follow-up. In the SSP group 154 out of 767 patients (20,1%) died. In the TME group mortality was 21,7% and in the transection group 16,9%. Mortality in the APR group showed that 80 out of 328 (24,4%) patients died during follow-up. Analysis by the Kaplan-Meier?s test shows cumulative survival of 0,69 for all cases. In the SSP group cumulative survival is 0,72 and in the APR group 0,64 with statistically significant difference (p,001). In the TME group cumulative survival is 0,75 and in the transection group 0,72 with statistically significant difference (p,05). We believe that performing SSP should be encouraged whenever it is possible because there is no difference in local recurrence rates and survival compared to APR. Transection of mesorectum can safely be performed in most cases with tumors located more than 8 cm form anal verge. We believe that exact preoperative staging and preoperative radiotherapy could improve results.

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O12 OPEN PREPERITONEAL INGUINAL HERNIA REPAIR, TREPP VERSUS TIPP IN A RANDOMIZED CLINICAL TRIAL

British Journal of Surgery ◽

10.1093/bjs/znab396.011 ◽

2021 ◽

Vol 108 (Supplement_8) ◽

Author(s):

Willem Bökkerink ◽

Giel Koning ◽

Patrick Vriens ◽

Roland Mollen ◽

Willem Akkersdijk ◽

...

Keyword(s):

Clinical Trial ◽

Inguinal Hernia ◽

Hernia Repair ◽

Learning Curve ◽

Randomized Clinical Trial ◽

Inguinal Hernia Repair ◽

Recurrence Rates ◽

Significant Difference ◽

Related Quality

Abstract Aim The preperitoneal mesh position for inguinal hernia repair showed beneficial results regarding Chronic Postoperative Inguinal Pain (CPIP) with low recurrence rates. Two open preperitoneal techniques, the TransREctus Sheath PrePeritoneal (TREPP) and the TransInguinal PrePeritoneal (TIPP) technique, were compared in a randomized clinical trial with the hypothesis of less patients with CPIP after TREPP due to complete avoidance of nerve contact. Materials and Methods Adult patients with a primary unilateral inguinal hernia were randomized to either TREPP or TIPP in four hospitals. Prior to the trial’s start the study protocol was ethically approved and published. Outcomes included CPIP after 1 year (primary outcome) and recurrence rates, adverse events and Health related Quality of Life (secondary outcomes). Follow-up was performed at 2 weeks, 6 months and 1 year. Results Baseline characteristics were comparable in both groups. Pain was less often present after TREPP at 2 weeks and 6 months, but the CPIP at rest at 1 year was comparable 1.9% after TREPP vs 1.4% after TIPP, p = 0.535). The overall recurrence rate was higher in the TREPP group, 8.9% vs 4.6%, p = 0.022). Corrected for a learning curve for TREPP, no significant difference could be assessed (TREPP 5.7% and TIPP 4.8%, p = 0.591). Conclusions both the TREPP and TIPP technique resulted in a low incidence of CPIP after 1 year follow-up. The TREPP method can be considered a solid method for inguinal hernia repair if expertise is present. The learning curve of the TREPP techniques needs further evaluation.

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Importance of Treatment Institution in Head and Neck Cancer Radiotherapy

Otolaryngology ◽

10.1016/j.otohns.2009.03.019 ◽

2009 ◽

Vol 141 (2) ◽

pp. 172-176 ◽

Cited By ~ 12

Author(s):

Gregory J. Kubicek ◽

Fen Wang ◽

Eashwar Reddy ◽

Yelizaveta Shnayder ◽

Cristina E. Cabrera ◽

...

Keyword(s):

Head And Neck Cancer ◽

Treatment Outcome ◽

Head And Neck ◽

Neck Cancer ◽

Time Course ◽

Medical Center ◽

Recurrence Rates ◽

Historical Cohort ◽

Initial Surgery ◽

Significant Difference

OBJECTIVE: The treatment for head and neck cancer (HNC) often involves radiotherapy. Many HNC patients are treated at the academic center (AC) where the initial surgery or diagnosis was made. Because of the lengthy time course for radiotherapy, some patients are treated at community radiation facilities (non-AC) rather than the AC despite potential AC advantages in terms of experience and technology. Our goal is to determine if these potential AC advantages correspond to a difference in treatment outcome. STUDY DESIGN: Historical cohort study. SETTING: University of Kansas Medical Center, Kansas City, Kansas. SUBJECTS AND METHODS: Review of records of patients with HNC cancers evaluated at the otolaryngology (ENT) department of an AC. Each patient's information and treatment characteristics were recorded, including radiotherapy treatment venue and treatment outcome. RESULTS: Three hundred seventy-four patients were analyzed, 263 were treated at an AC and 101 at a non-AC. Patients treated at a non-AC were more likely to present with earlier stage tumors, be treated with radiation alone rather than chemoradiotherapy, and be treated with adjuvant rather than primary radiotherapy. There was no difference in overall survival or recurrence rates between AC and non-AC. CONCLUSION: Patients treated at an AC are more likely to have advanced stage tumors and receive chemoradiotherapy as their primary treatment. In analyses of matching patient subsets, there was no significant difference in patient outcomes. Patients can be treated at a non-AC without affecting outcome compared with treatment at an AC.

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Outcome of endoscopic vs microsurgical transsphenoidal resection for Cushing’s disease

Endocrine Connections ◽

10.1530/ec-17-0312 ◽

2018 ◽

Vol 7 (1) ◽

pp. R26-R37 ◽

Cited By ~ 4

Author(s):

Nidan Qiao

Keyword(s):

Recurrence Rate ◽

Cushing’S Disease ◽

Meta Analysis ◽

Cushing's Disease ◽

Recurrence Rates ◽

Microscopic Surgery ◽

Significant Difference ◽

Comprehensive Search ◽

Definition Of

Introduction It is unclear whether the proportions of remission and the recurrence rates differ between endoscopic transsphenoidal surgery (TS) and microscopic TS in Cushing’s disease (CD); thus, we conducted a systematic review and meta-analysis to evaluate studies of endoscopic TS and microscopic TS. Methods We conducted a comprehensive search of PubMed to identify relevant studies. Remission and recurrence were used as outcome measures following surgical treatment of CD. Results A total of 24 cohort studies involving 1670 adult patients were included in the comparison. Among these studies, 702 patients across 9 studies underwent endoscopic TS, and 968 patients across 15 studies underwent microscopic TS. Similar baseline characteristics were observed in both groups. There was no significant difference in remission between the two groups: 79.7% (95% CI: 73.1–85.0%) in the endoscopic group and 76.9% (95% CI: 71.3–81.6%) in the microscopic group (P = 0.485). It appears that patients who underwent endoscopic surgery experience recurrence less often than patients who underwent microscopic surgery, with recurrence proportions of 11.0% and 15.9%, respectively (P = 0.134). However, if follow-up time is taken into account, both groups had a recurrence rate of approximately 4% per person per year (95% CI: 3.1–5.4% and 3.6–5.1%, P = 0.651). Conclusions We found that remission proportion and recurrence rate were the same in patients who underwent endoscopic TS as in patients who underwent microscopic TS. The definition of diagnosis, remission and recurrence should always be considered in the studies assessing therapeutic efficacy in CD.

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Comparison of Monolateral External Fixation and Internal Fixation for Skeletal Stabilisation in the Management of Small Tibial Bone Defects following Successful Treatment of Chronic Osteomyelitis

BioMed Research International ◽

10.1155/2017/6250635 ◽

2017 ◽

Vol 2017 ◽

pp. 1-8 ◽

Cited By ~ 1

Author(s):

Yicun Wang ◽

Hui Jiang ◽

Zhantao Deng ◽

Jiewen Jin ◽

Jia Meng ◽

...

Keyword(s):

Internal Fixation ◽

External Fixation ◽

Bone Defect ◽

Fasting Blood Glucose ◽

Bone Defects ◽

Significant Difference ◽

Systemic Antibiotics ◽

Time Since Injury ◽

Small Bone

Background. To compare the salvage rate and complication between internal fixation and external fixation in patients with small bone defects caused by chronic infectious osteomyelitis debridement. Methods. 125 patients with chronic infectious osteomyelitis of tibia fracture who underwent multiple irrigation, debridement procedure, and local/systemic antibiotics were enrolled. Bone defects, which were less than 4 cm, were treated with bone grafting using either internal fixation or monolateral external fixation. 12-month follow-up was conducted with an interval of 3 months to evaluate union of bone defect. Results. Patients who underwent monolateral external fixation had higher body mass index and fasting blood glucose, longer time since injury, and larger bone defect compared with internal fixation. No significant difference was observed in incidence of complications (23.5% versus 19.3%), surgery time (156±23 minutes versus 162±21 minutes), and time to union (11.1±3.0 months versus 10.9±3.1 months) between external fixation and internal fixation. Internal fixation had no significant influence on the occurrence of postoperation complications after multivariate adjustment when compared with external fixation. Furthermore, patients who underwent internal fixation experienced higher level of daily living scales and lower level of anxiety. Conclusions. It was relatively safe to use internal fixation for stabilization in osteomyelitis patients whose bone defects were less than 4 cm and infection was well controlled.

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