The safe zone for blinded sternal interventions based on CT evaluation of midline congenital sternal foramina

International Nuclear Information System (INIS)

Boruah, Deb K.; Dhingani, Dhaval D.; Achar, Shashidhar; Augustine, Antony; Mahanta, Kangkana; Prakash, Arjun; Yadav, Rajnikant R.

2016-01-01

The aim of this study was to evaluate the safe zone for performing blind sternal procedures based on computed tomography (CT) evaluation of congenital midline sternal foramina using multidetector computed tomography (MDCT). This retrospective study was carried out on 1,180 patients who underwent MDCT of the thorax from March 2015 to February 2016. The MDCT images were evaluated in axial and reformatted planes. Morphometry and prevalence of midline congenital sternal foramina (SF) and manubrio-foraminal distance (MFD) were evaluated. The safe zone was defined for a blinded intervention, based on palpable anatomical landmarks. Data were presented in terms of percentage, mean ± standard deviation and calculations were carried out using Microsoft Excel. The prevalence of SF in our study sample was 11.6 %. The majority of SF were located in a typical position in the lower sternal body at the level of fifth costo-chondral junction (CCJ) in 108 patients (78.8 %). The structure directly beneath the SF was mediastinal fat in 73 patients (53.3 %), followed by anterior pericardium in 44 patients (32.1 %) and lung parenchyma in 20 patients (14.6 %). The mean MFD in our study population was 11.90 ± 1.31 cm. Sternal interventions should be avoided at the level of fourth to sixth CCJ, which is considered the danger zone. An intervention at the fourth to sixth CCJ may lead to disastrous consequences in patients who have SF. (orig.)

The safe zone for blinded sternal interventions based on CT evaluation of midline congenital sternal foramina

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Boruah, Deb K.; Dhingani, Dhaval D.; Achar, Shashidhar; Augustine, Antony; Mahanta, Kangkana [Assam Medical College and Hospital, Department of Radio-diagnosis, Dibrugarh, Assam (India); Prakash, Arjun [NIMHANS, Department of Radio-diagnosis, Bangalore, Karnataka (India); Yadav, Rajnikant R. [Sanjay Gandhi Post Graduate Institute and Medical Sciences, Department of Radio-diagnosis, Lucknow (India)

2016-12-15

The aim of this study was to evaluate the safe zone for performing blind sternal procedures based on computed tomography (CT) evaluation of congenital midline sternal foramina using multidetector computed tomography (MDCT). This retrospective study was carried out on 1,180 patients who underwent MDCT of the thorax from March 2015 to February 2016. The MDCT images were evaluated in axial and reformatted planes. Morphometry and prevalence of midline congenital sternal foramina (SF) and manubrio-foraminal distance (MFD) were evaluated. The safe zone was defined for a blinded intervention, based on palpable anatomical landmarks. Data were presented in terms of percentage, mean ± standard deviation and calculations were carried out using Microsoft Excel. The prevalence of SF in our study sample was 11.6 %. The majority of SF were located in a typical position in the lower sternal body at the level of fifth costo-chondral junction (CCJ) in 108 patients (78.8 %). The structure directly beneath the SF was mediastinal fat in 73 patients (53.3 %), followed by anterior pericardium in 44 patients (32.1 %) and lung parenchyma in 20 patients (14.6 %). The mean MFD in our study population was 11.90 ± 1.31 cm. Sternal interventions should be avoided at the level of fourth to sixth CCJ, which is considered the danger zone. An intervention at the fourth to sixth CCJ may lead to disastrous consequences in patients who have SF. (orig.)

Bone tissue density modification in treatment of shin pseudoarthrosis by transosseous compressive osteosynthesis

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Tishkov N.V.

2011-12-01

Full Text Available Objective is to detect bone mineral density along the shin according to «Esperanto» levels by Hounsfield's scale. Materials and methods. The analysis of density modification in 25 patients with pseudoarthrosis of tibia with predominant localization in a lower one-third of bone has been carried out. Results. By means of computed tomography it has been revealed that the bone tissue density of the tibia in the process of false joint union when using the compressive variant of combined transosseous osteosynthesis has changed according to the regularity reproducing phase character of the accumulation of mineral substances in the bone. Conclution. The growth of mineral density of the bone tissue during treatment spreads in the directions from proximal and distal metaepiphyses to the zone of pseudoarthrosis knitting

Sternal chondrosarcoma

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Nelson Perelman Rosenberg

2003-01-01

Full Text Available Sternal neoplasms are extremely rare. It is difficult to make prospective evaluations due to the lack of consistent reports in the literature. The authors report the case of a woman in her seventies, who presented a chondrosarcoma of the sternum, treated by them.

The role of arterial vascularity in pathogenesis of infected pseudoarthrosis of the lower leg

International Nuclear Information System (INIS)

Konarski, K.

1993-01-01

A series of 250 femoral arteriographies performed in patients with leg pseudoarthrosis served to asses condition of arteries of the extremity. It was found that vascular injuries contribute significantly to pathogenesis of union disorders in lower leg fractures. (author)

Sternal tuberculosis | Sachdeva | Annals of Medical and Health ...

African Journals Online (AJOL)

Extra‑pulmonary tuberculosis constitutes 15‑20% of total tuberculosis (TB) case load in immuno‑competent patients. Affliction of the skeletal system is rare with still rarer presentation of sternal osteomyelitis even in endemic countries. A patient with primary sternal TB presenting with multiple cutaneous sinuses over the ...

Femoral neck pseudoarthrosis in a polio patient treated with closed reduction and cell therapy

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M.A. Codesido

2017-04-01

Full Text Available Poliomyelitis disease affects the anterior horns cells of the spinal cord and certain motor nuclei of the brain stem. Paralysis type is flaccid and asymmetrical and result in muscular imbalance.Due to this, in case of having a hip muscles involvement, degenerative or posttraumatic, total hip arthroplasty is normally contraindicated because of the excessive risk of hip dislocation. In cases of subcapital femoral neck fractures the femoral head vascularization is a main concern, and in cases of neglected fracture with pseudoarthrosis the vascular status to the head must be investigated prior to further decisions.We report the case of a femoral neck fracture non-union after a missed femoral neck fracture in a polio affected leg treated with cannulated screws and percutaneous autologous injection of processed total nuclear cells (TNC mixed with putty demineralized bone matrix. Keywords: Pseudoarthrosis, Poliomyelitis, Cell therapy, Femoral neck

Sternal fractures as a manifestation of abusive injury in children

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Hechter, Sloane; Manson, David [Department of Diagnostic Imaging, Hospital for Sick Children, 555 University Ave, Toronto, Ontario, M5G 1X8 (Canada); Huyer, Dirk [Department of Pediatrics, Division of Suspected Child Abuse and Neglect, Hospital for Sick Children, Toronto, Ontario (Canada)

2002-12-01

Sternal fractures are rare injuries in children. The rarity of this injury is likely due to both the relative plasticity of the pediatric thorax and to the difficulty in establishing a radiographic diagnosis without dedicated views. Current literature suggests that this injury in young children is highly specific for abusive injury.Hypothesis. Sternal fractures are not highly specific for abusive injury. Materials and methods. This was a retrospective radiographic and clinical chart review of all documented sternal fractures over an 11-year period at a large pediatric hospital.Results. Of 12 children with sternal fractures identified, four were {<=}2 years of age and eight were {>=}3 years of age. The mechanism of injury was suspicious for child abuse in two children. Both of these children were {<=}2 years of age. In one toddler, an unwitnessed injury resulted in extensive initial familial anxiety until abusive injury was excluded.Conclusion. Sternal fractures are unusual injuries, yet they, in themselves, are not highly specific for abusive injury. (orig.)

Congenital Pseudoarthrosis of Medial Malleolus in A Young Soccer Player – Diagnosis in Clinical setting of Ankle Sprain

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Giuliano Cerulli

2014-01-01

Full Text Available Introduction: We report a case of a young female soccer player affected by congenital medial bilateral malleolus pseudoarthrosis and os subfibulare. Congenital pseudoarthrosis is the failure of the bones to fuse prior or at birth. The etiology is still unknown, although frequency is high in subjects affected by neurofibromatosis or correlated syndromes, so it has been suggested that these congenital disorders may be the cause of congenital pseudoarthrosis. Case Report: Our patient, a 16-year-old female, high level soccer player, was referred to us following a right ankle sprain during a match. She reported no medical history of tibia-tarsus joint injuries or disease. Pain, swelling and functional impairment were noted immediately after the accident. Standard radiographs in the emergency department revealed a displaced fracture of the medial malleolus and the presence of os subfibularis. The patient was transferred to our Traumatology and Orthopaedic Department to undergo malleolus ostheosynthesis. Before surgery swelling, functional impairment and intense pain at the medial malleolus level were confirmed. However, there was no radiological opening of ankle, instability or pronation pain; furthermore the flexion-extension was preserved with slight pain. Twenty-four hours later a considerable remission of symptoms was evident with increased range of motion and reduction in the swelling and post-traumatic edema. A radiograph on the left ankle to compare with that of the right ankle was necessary to overcome the discrepancy between the radiological diagnosis and the clinical examination. The radiographic results of both medial malleoli were comparable although on the left the os subfibularis was absent. Since the diagnosis of fracture by the association between the radiographs and the symptomatology was doubtful, a bilateral CT was performed. The scan revealed a medial bilateral malleolus pseudoarthrosis and an accessory right subfibularis nucleus

Isolated sternal fracture - a swing-related injury in two children

International Nuclear Information System (INIS)

DeFriend, D.E.; Franklin, K.

2001-01-01

Isolated fracture of the sternum is an uncommon injury in a child. We report two cases of sternal fracture following falls from swings, which illustrate the mechanisms of injury in sternal fracture. One fracture resulted from a flexion compression injury of the thoracic spine, which has very rarely been reported in children. Sternal fracture should be considered in the differential diagnosis of acute chest pain in a child where there has been an activity involving hyperflexion force. (orig.)

Sternal fractures as a manifestation of abusive injury in children

International Nuclear Information System (INIS)

Hechter, Sloane; Manson, David; Huyer, Dirk

2002-01-01

Sternal fractures are rare injuries in children. The rarity of this injury is likely due to both the relative plasticity of the pediatric thorax and to the difficulty in establishing a radiographic diagnosis without dedicated views. Current literature suggests that this injury in young children is highly specific for abusive injury.Hypothesis. Sternal fractures are not highly specific for abusive injury. Materials and methods. This was a retrospective radiographic and clinical chart review of all documented sternal fractures over an 11-year period at a large pediatric hospital.Results. Of 12 children with sternal fractures identified, four were ≤2 years of age and eight were ≥3 years of age. The mechanism of injury was suspicious for child abuse in two children. Both of these children were ≤2 years of age. In one toddler, an unwitnessed injury resulted in extensive initial familial anxiety until abusive injury was excluded.Conclusion. Sternal fractures are unusual injuries, yet they, in themselves, are not highly specific for abusive injury. (orig.)

Assessment of The Clinical Outcome of IM rod Fxation in The Treatment of Tibial Congenital Pseudoarthrosis

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Mehdi Ramezan Shirazi

2009-08-01

Full Text Available Background:Pseudoarthrosis of the tibia poses one of the most challenging treatment problems in all of orthopedics.The goal of the study was to assess the clinical outcome of intramedullary rod fixation in its treatment.Methods:The results of the management for nine patients with pseudoarthrosis of the tibia with IM rod fixation were reviewed retrospectively between 1986 - 2006. The mean duration of follow up was 8.95 years (range,3.5 months to 14.2 years.The   mean age of the patients at the latest follow up was 13.5 years (range, 9 to 23 years.Results:Initial union of the fracture site occurred in seven of nine patients with the mean duration of 7.6 months (range, 3.5 to 15.5 months.Five patients had limb length discrepancy with the mean of 7.2 cm (range,1.5 - 12 cm.Three of them were treated with tibia lengthening procedure with the Ilizarov method.One had a peroneal nerve palsy postoperatively.Two patients had refracture treated with casting and rod exchange. Electrical stimulation was applied in two patients but it was impossible to predict how much it played a role in the union.Conclusion: IM rod fixation technique has a satisfactory functional outcome.The   technique has a high level of acceptance by parents and patients. It should be recommended as the treatment of choice for the management of congenital pseudoarthrosis of the tibia.  

Preliminary experience with a new device for delayed sternal closure strategy in cardiac surgery.

Science.gov (United States)

Santini, Francesco; Onorati, Francesco; Telesca, Mariassunta; Faggian, Giuseppe; Mazzucco, Alessandro

2012-06-01

Open chest management with delayed sternal closure (DSC) is a valuable strategy in the management of patients with postcardiotomy hemodynamic instability or severe coagulopathy. The conventional extemporized material available for off-label sternal stenting however may limit its efficacy. We evaluated outcomes of patients with refractory severe postcardiotomy cardiogenic shock (SPCCS) treated with DSC using a novel temporary sternal spreader (NTSS) which allows myocardial recovery by progressive controlled approximation of the sternal edges. Seven patients (4 male, mean age 66.5 ± 5 years) with refractory SPCCS showing acute hemodynamic instability at sternal closure, were implanted with the NTSS, consisting of stainless-steel branches linked to 2 diverging plates of polyether-ether ketone, whose progressive opening/closing mechanism can be controlled from outside the chest with a rotating steel wire. The sternal wound was closed by an elastic membrane to achieve a sterile field. Swan-Ganz monitoring was employed, and clinical outcomes evaluated. The device was successfully implanted in all patients without device-related complications or failures. Progressive approximation of sternal edges, titrated on cardiac index values, was successfully completed allowing subsequent uneventful sternal closure in all. Mean time from SPCCS to sternal closure was 70 ± 21 hours. No patient developed infective complications or late hemodynamic instability after device removal and sternal closure. One patient (14%) died of multiorgan failure on postoperative day 9. Despite the limited number of patients enrolled, the NTSS proved safe and effective in allowing complete myocardial recovery after SPCCS, avoiding hemodynamic instability related to abrupt sternal closure, with no occurrence of infective complications.

Improved results of the vacuum assisted closure and Nitinol clips sternal closure after postoperative deep sternal wound infection.

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Tocco, Maria Pia; Costantino, Alberto; Ballardini, Milva; D'Andrea, Claudio; Masala, Marcello; Merico, Eusebio; Mosillo, Luigi; Sordini, Paolo

2009-05-01

Postoperative deep sternal wound infection is a severe complication of cardiac surgery, with a high mortality rate and a high morbidity rate. The objective of this prospective study is to report our experience with the vacuum assisted closure (VAC) system for the management of deep wound infection. We also devised an innovative closure technique post VAC therapy using thermo reactive clips. The advantage of this technique is that the posterior face of the sternum does not have to be separated from the mediastinal structures thus minimising the risk of damage. From October 2006 to October 2008, we prospectively evaluated 21 patients affected by mediastinitis after sternotomy. Nineteen patients had sternotomy for coronary artery bypass grafting (CABG), one patient for aortic valve replacement (AVR) and another one for ascending aortic replacement (AAR). All patients were treated with the VAC system at the time of infection diagnosis. When the wound tissue appeared viable and the microbiological cultures were negative, the chest was closed using the most suitable procedure for the patient in question; nine patients were closed using pectoralis flaps, nine patients using Nitinol clips, one patient with a combined technique (use of Nitinol clips and muscle flap), one patient with a direct wound closure and another patient, who needed AAR with a homograft performed in another institution, was closed using sternal wires. We had no mortality; wound healing was successfully achieved in all patients. In more than 50% of the patients, the VAC therapy allowed direct sternal resynthesis. The average duration of the vacuum therapy was 26 days (range 14-37 days). VAC is a safe and effective option in the treatment of post-sternotomy mediastinitis, with excellent survival and immediate improvement of local wound conditions; furthermore, the use of Nitinol clips after VAC therapy demonstrated to be a safe and non-invasive option for sternal resynthesis. After VAC therapy, a

Standard restrictive sternal precautions and modified sternal precautions had similar effects in people after cardiac surgery via median sternotomy (‘SMART’ Trial: a randomised trial

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Md Ali Katijjahbe

2018-04-01

Full Text Available Question: In people who have undergone cardiac surgery via median sternotomy, does modifying usual sternal precautions to make them less restrictive improve physical function, pain, kinesiophobia and health-related quality of life? Design: Two-centre, randomised, controlled trial with concealed allocation, blinded assessors and intention-to-treat analysis. Participants: Seventy-two adults who had undergone cardiac surgery via a median sternotomy were included. Intervention: Participants were randomly allocated to one of two groups at 4 (SD 1 days after surgery. The control group received the usual advice to restrict their upper limb use for 4 to 6 weeks (ie, restrictive sternal precautions. The experimental group received advice to use pain and discomfort as the safe limits for their upper limb use during daily activities (ie, less restrictive precautions for the same period. Both groups received postoperative individualised education in hospital and via weekly telephone calls for 6 weeks. Outcome measures: The primary outcome was physical function assessed by the Short Physical Performance Battery. Secondary outcomes included upper limb function, pain, kinesophobia, and health-related quality of life. Outcomes were measured before hospital discharge and at 4 and 12 weeks postoperatively. Adherence to sternal precautions was recorded. Results: There were no statistically significant differences in physical function between the groups at 4 weeks (MD 1.0, 95% CI –0.2 to 2.3 and 12 weeks (MD 0.4, 95% CI –0.9 to 1.6 postoperatively. There were no statistically significant between-group differences in secondary outcomes. Conclusion: Modified (ie, less restrictive sternal precautions for people following cardiac surgery had similar effects on physical recovery, pain and health-related quality of life as usual restrictive sternal precautions. Similar outcomes can be anticipated regardless of whether people following cardiac surgery are managed with

Autoimmune Myasthenia Gravis after Sternal Fracture

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Jens A. Petersen

2012-01-01

Full Text Available We report a 54-year-old woman who suffered a commotio cerebri, whiplash injury and a chest trauma with sternal fracture due to a high-velocity car accident. Two months later, she developed unilateral ptosis and blurred vision, which worsened during the day. Multiple diagnoses were suggested, ranging from thoracic outlet syndrome towards depression. Symptoms persisted and five years later, the patient consulted a neurologist. Laboratory analysis revealed significantly elevated levels of antibodies to acetylcholine receptors, and the diagnosis of myasthenia gravis was made. Speculatively, the damage of retrosternal thymic remnants due to a sternal fracture might have precipitated the condition or exacerbated subclinical disease.

Aseptic techniques(practical guide no.3)

International Nuclear Information System (INIS)

Nappa, Andres; Souto Pais, Beatriz

1994-01-01

Definition of aseptic techniques in relation with the labor of Radiopharmacy.Control of environment and working areas.Control of materials entered into an aseptic area: water, nitrogen,vials,stoppers,needles and syringes. Personnel and manipulations control,choosing of materials,precautions in the aseptic manipulation and sterility preservation during usage life. Bacteriological membrane filtration in sterilized conditions. Work in a laminar flow unit. Protocol of Practical task 3. Bibliography

Sternal instability measured with radiostereometric analysis. A study of method feasibility, accuracy and precision

DEFF Research Database (Denmark)

Vestergaard, Rikke Falsig; Søballe, Kjeld; Hasenkam, John Michael

2018-01-01

BACKGROUND: A small, but unstable, saw-gap may hinder bone-bridging and induce development of painful sternal dehiscence. We propose the use of Radiostereometric Analysis (RSA) for evaluation of sternal instability and present a method validation. METHODS: Four bone analogs (phantoms) were sterno...... modality feasible for clinical evaluation of sternal stability in research. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02738437 , retrospectively registered.......BACKGROUND: A small, but unstable, saw-gap may hinder bone-bridging and induce development of painful sternal dehiscence. We propose the use of Radiostereometric Analysis (RSA) for evaluation of sternal instability and present a method validation. METHODS: Four bone analogs (phantoms) were...

Cetuximab induced aseptic meningitis

OpenAIRE

Ulrich, A; Weiler, S; Weller, M; Rordorf, T; Tarnutzer, A A

2015-01-01

We report a 67-year-old man with recurrent advanced oropharyngeal squamous cell carcinoma who developed aseptic meningitis, with first symptoms arising approximately 9hours after the first administration of cetuximab, and review the literature to identify key signs and symptoms of this condition. Cetuximab is a monoclonal antibody targeting the epidermal growth factor receptor which has been rarely associated with aseptic meningitis. Besides the case description, a MEDLINE search was performe...

Femoral pseudoarthrosis and knee stiffness: long-term results of a one-stage surgical approach.

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Gomes, João L Ellera; Ruthner, Roberto P; Moreira, Luiz

2010-02-01

The objective of this study was to analyze the surgical results of the simultaneous treatment of femoral pseudoarthrosis and knee stiffness using a combined one-stage approach (quadricepsplasty + osteoperiosteal decortications + bone autografting + fracture stabilization). Twelve patients (six men) followed up for a minimum of 10 years and who had undergone surgery for these combined procedures were contacted for evaluation. Their mean age at the time of the surgery was 30 years (standard deviation, SD 15; range 22-65 years), and mean time from initial trauma was 16 months (SD 6, range 10-32 months). Mean range of motion improved from 10 degrees (SD 9) to 112 degrees (SD 13) postoperatively. Fractures healed in all patients, and improvement in their range of motion was statistically significant (Student's t-test = 31; P time interval since disease onset (Pearson correlation = -0.672; P = 0.017). Postoperative recovery was uneventful, and no deaths or severe complications occurred in this series. Despite increased tissue handling, blood loss and postoperative morbidity, the simultaneous treatment of femoral pseudoarthrosis and knee stiffness was successful, and results suggested that the earlier a combined approach is used, the better the outcome may be.

MRT of scaphoid pseudo-arthrosis using Gd-DTPA. Staging and clinical correlation

International Nuclear Information System (INIS)

Vogl, T.J.; Beutel, F.; Wilhelm, K.; Tempka, A.; Schedel, H.; Haas, R.; Felix, R.

1994-01-01

During a period of two years, 134 patients with pseudo-arthrosis of the scaphoid were examined by conventional radiography and by MRI in the course of a prospective study. The aim of the study was to define radiological staging using contrast enhanced MRI in order to improve the prognostic criteria. All MRI examinations were carried out with a 1.5 Tesla scanner (SP63) using a surface coil and T 1 weighted spin echo sequences in sagittal and frontal projection and frontal FLASH T 2 -sequences and axial spin echo T 2 sequences. The T 1 weighted SE sequences in frontal projection were carried out before and after iv contrast (0.1 mmol Gd-DTPA/kg KG). All sequences were compared with conventional radiographs and the operative findings. Eight patients in stage 0 showed high signal intensity of both fragments in T 1 weighted SE sequences and at surgery there was good vascularisation. In 22 cases there was reduced signal intensity in at least one fragment (stage I). 45 patients with scaphoid pseudo-arthrosis showed complete signal loss but marked contrast uptake with still vital nuclei at surgery (stage II). In 22 patients, there was no increase in signal intensity after contrast and complete loss of vitality of the fragments at surgery. Staging was not possible in 37 patients because of previous operative intervention. The use of contrast enhanced MRI provides additional information compared with conventional radiography or plain MRI. (orig.) [de

The usefulness of sagittal reformation for diagnosis of sternal fracture

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Im, Dong Jin; Hahn, Seok; Kim, Young Ju [Dept. of Radiology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju (Korea, Republic of)

2014-01-15

The purpose of our study was to evaluate the usefulness of sagittal reformation of chest computed tomography for the diagnosis of sternal fracture after trauma. We retrospectively reviewed medical records and chest computer tomography (CT) of 716 patients in the emergency department after trauma between January and December 2010. Two radiologists investigated chest CT images. We investigated numbers and locations of sternal fractures on axial images only and on both axial and sagittal images for each radiologist. First, radiologist found sternal fractures in 58 patients (70.7%) on only axial images, and 80 (97.5%) on both axial and sagittal images. Second, radiologist found fractures in 67 patients (81.7%) on axial image only and 81 (98.7%) on both axial and sagittal images. The sensitivity increased after adding sagittal reformation images for each radiologist (p < 0.05, respectively). On the axial images, the interobserver agreement was low (k 0.596) between the two radiologists. However, on both axial and sagittal images, the interobserver agreement increased (k = 0.872). Sagittal reformation of chest CT increases the chance of diagnosis for sternal fracture and leads to early diagnosis resulting in appropriate treatment.

The usefulness of sagittal reformation for diagnosis of sternal fracture

International Nuclear Information System (INIS)

Im, Dong Jin; Hahn, Seok; Kim, Young Ju

2014-01-01

The purpose of our study was to evaluate the usefulness of sagittal reformation of chest computed tomography for the diagnosis of sternal fracture after trauma. We retrospectively reviewed medical records and chest computer tomography (CT) of 716 patients in the emergency department after trauma between January and December 2010. Two radiologists investigated chest CT images. We investigated numbers and locations of sternal fractures on axial images only and on both axial and sagittal images for each radiologist. First, radiologist found sternal fractures in 58 patients (70.7%) on only axial images, and 80 (97.5%) on both axial and sagittal images. Second, radiologist found fractures in 67 patients (81.7%) on axial image only and 81 (98.7%) on both axial and sagittal images. The sensitivity increased after adding sagittal reformation images for each radiologist (p < 0.05, respectively). On the axial images, the interobserver agreement was low (k 0.596) between the two radiologists. However, on both axial and sagittal images, the interobserver agreement increased (k = 0.872). Sagittal reformation of chest CT increases the chance of diagnosis for sternal fracture and leads to early diagnosis resulting in appropriate treatment.

Congenital superior sternal cleft repair using our modified Sally technique: A case report

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Tomoyuki Kuwata

2014-12-01

Full Text Available We report the case of an 8-month-old male neonate who underwent reconstructive surgery for a congenital superior sternal cleft to decrease the risk of commotio cordis. With regard to use of the Sally technique for the repair of a relatively wide cleft (4 × 4 cm, we were concerned about respiratory problems caused by compression following closure of the sternal halves. By closing the sternal halves imperfectly, elevation of intrapleural pressure can be avoided to some extent. By bridging the surplus resected cartilage from the lower sternum over the gap of the upper sternum, the heart is protected by more rigid material. We recommend our modified Sally technique because it is both flexible and effective for sternal cleft repair.

Investigation of Sternal Photoplethysmography – Design of a Vital Sign Patch

DEFF Research Database (Denmark)

Chreiteh, Shadi

%). In the second study, sternal PPG recording was conducted from 30 admitted patients with either asthma or Chronic Obstructive Pulmonary Disease (COPD). We compared the SpO2 levels simultaneously obtained from the sternal PPG recording and a conventional finger pulse oximeter. The Pearson correlation between...... to 36 breaths/min the Pearson correlation was 0.93 (p

Enhanced Sternal Healing via Platelet-Rich Plasma and Biodegradable Gelatin Hydrogel.

Science.gov (United States)

Shibata, Masafumi; Takagi, Gen; Kudo, Mitsuhiro; Kurita, Jiro; Kawamoto, Yoko; Miyagi, Yasuo; Kanazashi, Mikimoto; Sakatani, Takashi; Naito, Zenya; Tabata, Yasuhiko; Miyamoto, Masaaki; Nitta, Takashi

2018-05-16

Platelet-rich plasma (PRP) contains numerous growth factors and promotes bone fracture healing. The aim of this study was to evaluate the effectiveness of the controlled release of PRP from biodegradable gelatin hydrogel for promoting healing in a rabbit ischemic sternal model. PRP was prepared from the whole blood of a Japanese white rabbit. Sixteen rabbits were randomized into four groups (each n = 4) and all underwent median sternotomy and bilateral internal thoracic artery removal. Before the sternum was closed, the following solutions were applied between the sternum incisions in three of the groups: 30 mg of gelatin hydrogel incorporating 300 μL of phosphate-buffered saline, 300 μL of a solution form of PRP, or 30 mg of gelatin hydrogel incorporating 300 μL of PRP (PRP+Gel). The fourth group acted as a control. Sternal healing was evaluated by histology and micro-computed tomography 7 days after the intervention. The PRP+Gel group showed a significantly higher proportion of fibrosis within the fracture area (an indicator of sternal healing) than the other groups and a significantly higher mean intensity of osteocalcin. These results indicate that the controlled release of PRP from locally applied gelatin hydrogel was markedly effective in enhancing sternal healing in the early postoperative period. This novel therapy could potentially help prevent complications such as deep sternal wound infection and could result in early postoperative ambulation after median sternotomy.

Sternal instability measured with radiostereometric analysis. A study of method feasibility, accuracy and precision.

Science.gov (United States)

Vestergaard, Rikke Falsig; Søballe, Kjeld; Hasenkam, John Michael; Stilling, Maiken

2018-05-18

A small, but unstable, saw-gap may hinder bone-bridging and induce development of painful sternal dehiscence. We propose the use of Radiostereometric Analysis (RSA) for evaluation of sternal instability and present a method validation. Four bone analogs (phantoms) were sternotomized and tantalum beads were inserted in each half. The models were reunited with wire cerclage and placed in a radiolucent separation device. Stereoradiographs (n = 48) of the phantoms in 3 positions were recorded at 4 imposed separation points. The accuracy and precision was compared statistically and presented as translations along the 3 orthogonal axes. 7 sternotomized patients were evaluated for clinical RSA precision by double-examination stereoradiographs (n = 28). In the phantom study, we found no systematic error (p > 0.3) between the three phantom positions, and precision for evaluation of sternal separation was 0.02 mm. Phantom accuracy was mean 0.13 mm (SD 0.25). In the clinical study, we found a detection limit of 0.42 mm for sternal separation and of 2 mm for anterior-posterior dislocation of the sternal halves for the individual patient. RSA is a precise and low-dose image modality feasible for clinical evaluation of sternal stability in research. ClinicalTrials.gov Identifier: NCT02738437 , retrospectively registered.

Deep Sternal Wound Infection after Open-Heart Surgery: A 13-Year Single Institution Analysis.

Science.gov (United States)

Juhl, Alexander Andersen; Hody, Sofie; Videbaek, Tina Senholt; Damsgaard, Tine Engberg; Nielsen, Per Hostrup

2017-04-20

The present study aimed to compare the clinical outcome for patients with or without muscle flap reconstruction after deep sternal wound infection due to open-heart surgery. The study was a retrospective cohort study, including patients who developed deep sternal wound infection after open-heart surgery in the Western Denmark Region from 1999 to 2011. Journals of included patients were reviewed for clinical data regarding the treatment of their sternal defect. Patients were divided into two groups depending on whether they received a muscle-flap-based sternal reconstruction or traditional rewiring of the sternum. A total of 130 patients developed deep sternal wound infection in the study period. In all, 12 patients died before being discharged, leaving a total of 118 patients for analysis. Of these, 50 (42%) patients received muscle flap reconstruction. Muscle flap recipients had significantly longer total hospital stays (p <0.001). However, after receiving muscle flap reconstruction, patients were discharged after a median of 14 days, with 74% not needing additional surgery. It is difficult to predict which patients eventually require muscle flap reconstruction after deep sternal wound infection. Although patients receiving muscle flap reconstructions have longer hospital stays, they are quickly discharged after the reconstruction.

Reducing surgical nurses' aseptic practice-related stress.

Science.gov (United States)

Aholaakko, Teija-Kaisa

2011-12-01

This paper aims to explore aseptic practice-related stress in surgery. The objectives are to define stress-related factors and the means to reduce the stress. Occupational stress is related to personal characteristics: job satisfaction and physiological and psychological well-being. The stress symptoms are often classified as part of a negative mood. Nurses have expressed stress when deadening their conscience to external demands with co-workers or internal working role-related demands. Surgery nurses expect fair division of work and compliance with rules. The hospital management, technology and the medical profession, instead of the needs of the patient, are recognised as a danger in the development of surgery nurses' role. A qualitative stimulated recall interview was performed in the surgery of the university hospital. Thirty-one operations were videotaped, and 31 nurses interviewed during videotape stimulation. The 1306 text pages were transcripted and analysed by a qualitative membership categorisation device analysis. The analysis revealed aseptic practice-related stress which constructed a sixteen level category. The membership categorisation identified connections between qualitatively attributed personnel and seven stress factors: working experience; time; equipment; person; patient; working morals and power. Final analysis revealed nurses reducing aseptic practice-related stress by safe, peaceful, competent and relative means. The aseptic practice-related stress varied from positive motivating feelings to exhaustion. The stress was experienced by medical and nursing co-workers and reduced by means which varied according to expertise and co-workers. This study showed needs for both the shared multiprofessional documentation of aseptic practice and better adherence to recommendations. Constructive means are useful when solving conflicts and replacing person-related aseptic practice with evidence-based. They may support nurses' professional growth, reduce

Secondary omental and pectoralis major double flap reconstruction following aggressive sternectomy for deep sternal wound infections after cardiac surgery

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Shirasawa Bungo

2011-04-01

Full Text Available Abstract Background Deep sternal wound infection after cardiac surgery carries high morbidity and mortality. Our strategy for deep sternal wound infection is aggressive strenal debridement followed by vacuum-assisted closure (VAC therapy and omental-muscle flap reconstrucion. We describe this strategy and examine the outcome and long-term quality of life (QOL it achieves. Methods We retrospectively examined 16 patients treated for deep sternal wound infection between 2001 and 2007. The most recent nine patients were treated with total sternal resection followed by VAC therapy and secondary closure with omental-muscle flap reconstruction (recent group; whereas the former seven patients were treated with sternal preservation if possible, without VAC therapy, and four of these patients underwent primary closure (former group. We assessed long-term quality of life after DSWI by using the Short Form 36-Item Health Survey, Version 2 (SF36v2. Results One patient died and four required further surgery for recurrence of deep sternal wound infection in the former group. The duration of treatment for deep sternal wound infection in the recent group was significantly shorter than that in previous group (63.4 ± 54.1 days vs. 120.0 ± 31.8 days, respectively; p = 0.039. Despite aggressive sternal resection, the QOL of patients treated for DSWI was only minimally compromised compared with age-, sex-, surgical procedures-matched patients without deep sternal wound infection. Conclusions Aggressive sternal debridement followed by VAC therapy and secondary closure with an omental-muscle flap is effective for deep sternal wound infection. In this series, it resulted in a lower incidence of recurrent infection, shorter hospitalization, and it did not compromise long-term QOL greatly.

Reliability of sternal instability scale (SIS) for transverse sternotomy in lung transplantation (LTX).

Science.gov (United States)

Fuller, Louise M; El-Ansary, Doa; Button, Brenda; Bondarenko, Janet; Marasco, Silvana; Snell, Greg; Holland, Anne E

2018-01-25

A surgical incision for bilateral sequential lung transplantation (BSLTX) is the "clam shell" (CSI) approach via bilateral anterior thoracotomies and a transverse sternotomy to allow for sequential replacement of the lungs. This can be associated with significant post-operative pain, bony overriding or sternal instability. The sternal instability scale (SIS) is a non-invasive manual assessment tool that can be used to detect early bony non-union or instability following CSI; however, its reliability is unknown. This prospective blinded reliability study aimed to assess intra-rater and inter-rater reliability of the SIS following lung transplantation. Participants post BSLTX aged older than 18 years underwent sternal assessment utilizing the SIS. Two assessors examined the sternum using a standardized protocol at two separate time points with a test-re-test time of 48 hours. The outcome measure was SIS tool using four categories from 0 (clinically stable) to 3 (separated sternum with overriding). In total, 20 participants (75% female) with a mean age of 48 years (SD 17) and mean pain score of 3 out of 10 were included, 60% having well healed wounds and 25% reporting symptoms of sternal clicking. The most painful self-reported painful activity was coughing. The SIS demonstrated excellent reliability with a kappa = 0.91 by different assessors on the same day, and kappa = 0.83 for assessments by the same assessor on different days. The SIS is a reliable manual assessment tool for evaluation of sternal instability after CSI following BSLTX and may facilitate the timely detection and management of sternal instability.

Pseudoarthrosis and ankylosis of the vertebral spine without sacroiliitis associated with Takayasu's arteritis: review of the association

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Schuetz, C.T.; Anderson, S.E. [Department of Diagnostic Radiology, University Hospital of Berne, Inselspital, 3010 Berne (Switzerland); Aeberli, D.; Oertle, S. [Department of Rheumatology, University Hospital of Berne, Inselspital, 3010 Berne (Switzerland)

2002-09-01

Pseudoarthrosis and ankylosis of the vertebral spine associated with Takayasu's arteritis is extremely rare. We present a patient with the entity who was HLA-B27 negative and had normal sacroiliac joints. The association between Takayasu's arteritis and ankylosing spondylitis appears real but seemingly rare. (orig.)

Chest reconstruction using a custom-designed polyethylene 3D implant after resection of the sternal manubrium

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Lipińska J

2017-08-01

Full Text Available Joanna Lipińska,1 Leszek Kutwin,1 Marcin Wawrzycki,1 Leszek Olbrzymek,2 Sławomir Jabłoński1 1Department of Thoracic Surgery, General and Oncological Surgery, Medical University of Lodz, 2Ledo, Lodz, Poland Introduction: Resection of manubrium or body of the sternum is associated with a necessity of chest wall reconstruction. Large sternal defects require the use of different types of implants to ensure acceptable esthetic effect for the patient and chest stabilization. Aim: The purpose of this case report is to present a novel method of reconstruction of manubrium removed due to renal cancer metastasis to the sternum.Case: We present the case of a patient, who had underwent right nephrectomy for clear cell kidney cancer, diagnosed with a metastatic tumor in the sternum resulting in destruction of manubrium. The patient undergone tumor resection with primary reconstruction with an individual prosthesis. Sternal defect was filled with a personalized, computed tomography scan-based 3D-milled implant made of polyethylene.Results: Sternal reconstruction was uneventful. The patient endured surgery well, and has been under surveillance in outpatient clinic, without any respiration disorders, implant movement or local recurrence.Conclusion: Custom-designed sternal implants created by 3D technique constitute an interesting alternative for previous methods of filling defects after resection of a tumor in this location. Keywords: 3D-milled implant, thoracoplasty, reconstructive surgery, chest reconstruction, sternal metastasis, sternal implant, sternal tumor 

Multifilament Cable Wire versus Conventional Wire for Sternal Closure in Patients Undergoing Major Cardiac Surgery

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You Na Oh

2015-08-01

Full Text Available Background: Stainless steel wiring remains the most popular technique for primary sternal closure. Recently, a multifilament cable wiring system (Pioneer Surgical Technology Inc., Marquette, MI, USA was introduced for sternal closure and has gained wide acceptance due to its superior resistance to tension. We aimed to compare conventional steel wiring to multifilament cable fixation for sternal closure in patients undergoing major cardiac surgery. Methods: Data were collected retrospectively on 1,354 patients who underwent sternal closure after major cardiac surgery, using either the multifilament cable wiring system or conventional steel wires between January 2009 and October 2010. The surgical outcomes of these two groups of patients were compared using propensity score matching based on 18 baseline patient characteristics. Results: Propensity score matching yielded 392 pairs of patients in the two groups whose baseline profiles showed no significant differences. No significant differences between the two groups were observed in the rates of early mortality (2.0% vs. 1.3%, p=0.578, major wound complications requiring reconstruction (1.3% vs. 1.3%, p＞0.99, minor wound complications (3.6% vs. 2.0%, p=0.279, or mediastinitis (0.8% vs. 1.0%, p=1.00. Patients in the multifilament cable group had fewer sternal bleeding events than those in the conventional wire group, but this tendency was not statistically significant (4.3% vs. 7.4%, p=0.068. Conclusion: The surgical outcomes of sternal closure using multifilament cable wires were comparable to those observed when conventional steel wires were used. Therefore, the multifilament cable wiring system may be considered a viable option for sternal closure in patients undergoing major cardiac surgery.

Multifilament Cable Wire versus Conventional Wire for Sternal Closure in Patients Undergoing Major Cardiac Surgery.

Science.gov (United States)

Oh, You Na; Ha, Keong Jun; Kim, Joon Bum; Jung, Sung-Ho; Choo, Suk Jung; Chung, Cheol Hyun; Lee, Jae Won

2015-08-01

Stainless steel wiring remains the most popular technique for primary sternal closure. Recently, a multifilament cable wiring system (Pioneer Surgical Technology Inc., Marquette, MI, USA) was introduced for sternal closure and has gained wide acceptance due to its superior resistance to tension. We aimed to compare conventional steel wiring to multifilament cable fixation for sternal closure in patients undergoing major cardiac surgery. Data were collected retrospectively on 1,354 patients who underwent sternal closure after major cardiac surgery, using either the multifilament cable wiring system or conventional steel wires between January 2009 and October 2010. The surgical outcomes of these two groups of patients were compared using propensity score matching based on 18 baseline patient characteristics. Propensity score matching yielded 392 pairs of patients in the two groups whose baseline profiles showed no significant differences. No significant differences between the two groups were observed in the rates of early mortality (2.0% vs. 1.3%, p=0.578), major wound complications requiring reconstruction (1.3% vs. 1.3%, p>0.99), minor wound complications (3.6% vs. 2.0%, p=0.279), or mediastinitis (0.8% vs. 1.0%, p=1.00). Patients in the multifilament cable group had fewer sternal bleeding events than those in the conventional wire group, but this tendency was not statistically significant (4.3% vs. 7.4%, p=0.068). The surgical outcomes of sternal closure using multifilament cable wires were comparable to those observed when conventional steel wires were used. Therefore, the multifilament cable wiring system may be considered a viable option for sternal closure in patients undergoing major cardiac surgery.

Aseptic meningitis in children: analysis of 506 cases.

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Athanasios G Michos

Full Text Available BACKGROUND: Non-polio human enteroviruses are the leading cause of aseptic meningitis in children. The role of enterovirus PCR for diagnosis and management of aseptic meningitis has not been fully explored. METHODOLOGY/PRINCIPAL FINDINGS: A retrospective study was conducted to determine the epidemiological, clinical, and laboratory characteristics of aseptic meningitis and to evaluate the role of enterovirus PCR for the diagnosis and management of this clinical entity. The medical records of children who had as discharge diagnosis aseptic or viral meningitis were reviewed. A total of 506 children, median age 5 years, were identified. The annual incidence rate was estimated to be 17/100,000 children less than 14 years of age. Most of the cases occurred during summer (38% and autumn (24%. The dominant clinical symptoms were fever (98%, headache (94% and vomiting (67%. Neck stiffness was noted in 60%, and irritation in 46% of the patients. The median number of CSF cell count was 201/mm(3 with polymorphonuclear predominance (>50% in 58.3% of the cases. Enterovirus RNA was detected in CSF in 47 of 96 (48.9% children tested. Children with positive enterovirus PCR had shorter hospitalization stay as compared to children who had negative PCR or to children who were not tested (P = 0.01. There were no serious complications or deaths. CONCLUSIONS: Enteroviruses accounted for approximately one half of cases of aseptic meningitis. PCR may reduce the length of hospitalization and plays important role in the diagnosis and management of children with aseptic meningitis.

Vacuum-assisted closure in the treatment of sternal wound infection after cardiac surgery.

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Simek, Martin; Nemec, Petr; Zalesak, Bohumil; Kalab, Martin; Hajek, Roman; Jecminkova, Lenka; Kolar, Milan

2007-12-01

Vacuum-assisted closure (VAC) was primarily designed for the treatment of pressure ulcers or chronic, debilitating wounds. Recently, VAC has become an encouraging treatment modality for sternal wound infection after cardiac surgery, providing superior results to conventional treatment strategies. From November 2004 to September 2006, 34 patients, undergoing VAC therapy for sternal wound infection following cardiac surgery, were prospectively evaluated. Ten patients (29 %) were treated for superficial sternal wound infection and 24 (71 %) for deep sternal wound infection. The median age was 69.9 years (range 48 to 82) and the median BMI was 33.4 kg/m(2) (range 28 to 41). Twenty patients (59 %) were women and 19 patients (59 %) were diabetics. Owing to sternal wound infection complications, 16 patients (47 %) were readmitted to the department. VAC was used following the previous failure of the conventional treatment strategy in 7 patients (21 %). Thirty-three patients (97 %) were treated successfully. One patient (3 %) died of multiple organ failure. The overall length of hospitalization was 34.6 days (range 9 to 62). The median number of dressing changes was 4.6 (range 3 to 10). The median VAC treatment time until surgical closure was 9.2 days (range 6 to 21 days). VAC therapy was solely used as a bridge to definite wound closure. Three patients (9 %) with chronic fistula were re-admitted 1 to 6 months after VAC therapy. VAC therapy is a safe and reliable option in the treatment of sternal wound infection in cardiac surgery. VAC therapy should be considered an effective adjunct to conventional treatment modalities for the treatment of extensive and life-threatening wound infections following cardiac surgery, particularly in the presence of risk factors.

MANAGEMENT OF PSEUDOARTHROSIS OF SHAFT HUMERUS BY PLATING (FIVE YEARS FOLLOW UP – A CASE STUDY

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Shirish Virupanna

2016-02-01

Full Text Available Pseudoarthrosis is a condition where union at fracture site is very difficult to obtain. But sticking to the very basic principles of management of non-union – that is freshening at fracture site, removal of sclerotic bone, reaming of medullary canal, rigid fixation and abundant bone grafting-helps in achieving the goal. In the below case, all the steps were carried out and the fracture has healed two months postoperatively.

MR analysis of sternal bone marrow using STIR in hematologic diseases

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Kozawa, Eito [Saitama Medical School, Moroyama (Japan)

1998-12-01

The magnetic resonance (MR) signal intensity pattern of sternal bone marrow was examined in 21 normal volunteers and 10 patients with aplastic anemia (n=4), multiple myeloma (2), AML (2), gammaglobulinemia (1) and MDS (1) using a sagittal STIR sequence. Double Echo STIR images (TR/TI/TE/NEX=2000/180/20, 100/1) were obtained with a CP body array coil. Craniocaudal phase-encoding with a handmade positioning device effectively avoided overlapping artifacts due to cardiac pulsation. In the normal volunteers, age showed a significant inverse correlation with the calculated SIR (signal intensity ratio of bone marrow relative to subcutaneous fat) using STIR with short TE. The SIR in the sternal body was significantly higher than that in the manubrium (p<0.05). Knowledge of the sternal bone marrow distribution according to age is useful for evaluating hematologic diseases. The proposed method provided high spatial resolution and an excellent bone marrow signal, and may be useful for determining site for aspiration. (author)

Surveyed opinion of American trauma, orthopedic, and thoracic surgeons on rib and sternal fracture repair.

Science.gov (United States)

Mayberry, John C; Ham, L Bruce; Schipper, Paul H; Ellis, Thomas J; Mullins, Richard J

2009-03-01

Rib and sternal fracture repair are controversial. The opinion of surgeons regarding those patients who would benefit from repair is unknown. Members of the Eastern Association for the Surgery of Trauma, the Orthopedic Trauma Association, and thoracic surgeons (THS) affiliated with teaching hospitals in the United States were recruited to complete an electronic survey regarding rib and sternal fracture repair. Two hundred thirty-eight trauma surgeons (TRS), 97 orthopedic trauma surgeons (OTS), and 70 THS completed the survey. Eighty-two percent of TRS, 66% of OTS, and 71% of THS thought that rib fracture repair was indicated in selected patients. A greater proportion of surgeons thought that sternal fracture repair was indicated in selected patients (89% of TRS, 85% of OTS, and 95% of THS). Chest wall defect/pulmonary hernia (58%) and sternal fracture nonunion (>6 weeks) (68%) were the only two indications accepted by a majority of respondents. Twenty-six percent of surgeons reported that they had performed or assisted on a chest wall fracture repair, whereas 22% of surgeons were familiar with published randomized trials of the surgical repair of flail chest. Of surgeons who thought rib fracture or sternal fracture repair was rarely, if ever, indicated, 91% and 95%, respectively, specified that a randomized trial confirming efficacy would be necessary to change their negative opinion. A majority of surveyed surgeons reported that rib and sternal fracture repair is indicated in selected patients; however, a much smaller proportion indicated that they had performed the procedures. The published literature on surgical repair is sparse and unfamiliar to most surgeons. Barriers to surgical repair of rib and sternal fracture include a lack of expertise among TRS, lack of research of optimal techniques, and a dearth of randomized trials.

Premature sternal fusion in gonadal dysgenesis with coarctation

International Nuclear Information System (INIS)

Herman, T.E.; Kushner, D.C.; Cleveland, R.H.

1985-01-01

In reviewing lateral chest roentgenograms in three infants with Turner's syndrome and aortic coarctation, and in infant with mixed gonadal dysgenesis and aortic coarctation, we have found obvious sternal fusion abnormalities which are reported here. (orig./MG)

Molecular Identification of Bacteria from Aseptically Loose Implants

Science.gov (United States)

Kobayashi, Naomi; Procop, Gary W.; Krebs, Viktor; Kobayashi, Hideo

2008-01-01

Polymerase chain reaction (PCR) assays have been used to detect bacteria adherent to failed orthopaedic implants, but some PCR assays have had problems with probable false-positive results. We used a combination of a Staphylococcus species-specific PCR and a universal PCR followed by DNA sequencing to identify bacteria on implants retrieved from 52 patients (92 implants) at revision arthroplasty. We addressed two questions in this study: (1) Is this method able to show the existence of bacterial DNA on presumed aseptic loosed implants?; and (2) What proportion of presumed aseptic or culture-negative implants was positive for bacterial DNA by PCR? Fourteen implants (15%) were believed infected, whereas 74 implants (85%) were believed aseptic. Each implant was sonicated and the resulting solution was submitted for dual real-time PCR assay and culture. All implants believed aseptically loose were culture-negative, but nine of the 74 (12%) had bacterial DNA by PCR; two (2.7%) were PCR-positive and also showed histologic findings suggestive of infection. Uniquely developed PCR and bacterial sequencing assays showed bacterial DNA on 12% of implants removed for presumed aseptic loosening. Additional studies are needed to determine the clinical importance of bacterial DNA detected by PCR but not by conventional culture. Level of Evidence: Level III, diagnostic study. See the Guidelines for Authors for a complete description of levels of evidence. PMID:18438724

Bilateral Subpectoral Interfascial Plane Catheters for Analgesia for Sternal Fractures: A Case Report.

Science.gov (United States)

Raza, Irfan; Narayanan, Madankumar; Venkataraju, Arun; Ciocarlan, Alexandra

2016-01-01

Sternal fractures occur after deceleration injuries such as falls and road traffic accidents. Recovery from isolated fractures is excellent, but mortality increases dramatically with concurrent chest injuries such as rib fractures and soft tissue injuries. Short-term complications include chest pain, which prevents patients from taking deep breaths and coughing, thereby predisposing them to chest infections. We present a case of a 73-year-old woman with sternal fracture in whom enteral analgesia was inadequate and who was intolerant to intravenous opiates. The patient was successfully treated with a continuous infusion of local anesthetic into the subpectoral interfascial plane. We also discuss the use and potential benefits of the subpectoral interfascial plane block in the treatment of pain from sternal fractures.

Giant Leaking Colloid Cyst Presenting with Aseptic Meningitis

DEFF Research Database (Denmark)

Bakhtevari, Mehrdad Hosseinzadeh; Sharifi, Guive; Jabbari, Reza

2015-01-01

BACKGROUND: Colloid cysts are benign third ventricle lesions that need to be diagnosed correctly because of their association with sudden death. Chemical or aseptic meningitis is a rare presentation of a colloid cyst. METHODS: We present a case of a 69-year-old man with fever, alteration of mental...... status, and meningismus. Microbiological examination of the cerebrospinal fluid revealed aseptic meningitis. Brain imaging revealed a third ventricular colloid cyst with hydrocephalus. RESULTS: The tumor was resected via endoscopic intervention. There were no persistent operative complications related...... to the endoscopic procedure. CONCLUSIONS: Chemical or aseptic meningitis is an unusual clinical manifestation of a colloid cyst, complicating the differential diagnosis, especially in the elderly....

Amoxicillin-induced aseptic meningoencephalitis

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Radi Shahien

2010-06-01

Full Text Available Radi Shahien1, Vetaly Vieksler1, Abdalla Bowirrat11Department of Neurology and Neurophysiology, Ziv Medical Center, Safed, IsraelAbstract: Meningitis is usually produced by an infectious agent, but there are multiple noninfectious causes. Drug-induced aseptic meningitis (DIAM is an important entity and has been reported as an uncommon adverse reaction with numerous agents. Thus, DIAM constitutes a diagnostic and patient management challenge. We present a patient with three episodes of aseptic meningitis due to amoxicillin, and then review the literature on this rare idiosyncratic event which may occur after local or systemic drug administration. A 77-year-old man was admitted to our hospital with fever, headache, and neck stiffness. Seven days before admission he had a dental and gingival inflammation. He was treated with two oral doses of 500 mg daily of amoxicillin for one week. The seventh day he awoke with the complaints that prompted hospital admittance. Amoxicillin was stopped 1 day before his admission. From his history we knew of two similar episodes: The first episode was after a dental procedure 3 months before this incident. He had received a 1-week course of postprocedure amoxicillin of 500 mg daily and had similar headache, fever, and chills during the entire course of treatment. He wasn’t admitted to the hospital, because he stopped taking amoxicillin and he felt spontaneous pain relief after taking symptomatic pain treatment. The second episodes was 6 months after his first admission, he had been admitted to our hospital with the same symptoms. Amoxicillin was stopped and changed with intravenous (IV ceftriaxone (CTRX for 10 days due to suspected partial untreated meningitis. The patient improved rapidly within 2 days and was discharged from the hospital. On the basis of these three confirmed episodes of meningitis after recurrent exposure to amoxicillin, with repetitive negative testing for viral, bacterial, and mycobacterial

Radiation sterilization of plastic packing materials and aseptic packaging

International Nuclear Information System (INIS)

Tokuoka, Keiko

1986-01-01

In the present day of 'satiation', quality, not quantity, is emphasized for foods, the consumers being oriented toward raw and healthy foodstuff. Aseptic Packaging is excellent means of conservation. While conventionally chemicals have been used for sterilization of packing materials for aseptic packaging, the sterilization by radiation is used in part recently. The following are described : history of aseptic packaging and its features, sterilization by radiation, γ-ray sterilization of large-sized containers, the development of an aseptic packaging system using electron rays, the occurrence of offensive odors from packing materials (comparison of odors from various materials, volatile substances occurring in irradiated polyethylene, influence of film grade upon the formation of carboxylic acid, influence of the irradiation conditions upon the occurrences of volatile substances, volatile substances occurring in the irradiation of bag-in-box packing materials), changes in properties of the packing materials. (Mori, K.)

Severe aseptic meningitis with hydrocephalus following iotrolan myelography: A case report

Energy Technology Data Exchange (ETDEWEB)

Kim, Jae Hyoung; Ha, Choong Kun; Ahn, In Oak [Gyeongsang National University College of Medicine, Jinju (Korea, Republic of)

1993-05-15

A case of severe aseptic meningitis with communicating hydrocephalus following iotrolan myelography is presented. The patient's condition improved very quickly after corticosteroid therapy. Rapid improvement and absence of pathogenic organisms in the CSF culture strongly favor an aseptic meningitis. This is the first reported case of aseptic meningitis with the secondary development of hydrocephalus caused by iotrolan myelography.

Severe aseptic meningitis with hydrocephalus following iotrolan myelography: A case report

International Nuclear Information System (INIS)

Kim, Jae Hyoung; Ha, Choong Kun; Ahn, In Oak

1993-01-01

A case of severe aseptic meningitis with communicating hydrocephalus following iotrolan myelography is presented. The patient's condition improved very quickly after corticosteroid therapy. Rapid improvement and absence of pathogenic organisms in the CSF culture strongly favor an aseptic meningitis. This is the first reported case of aseptic meningitis with the secondary development of hydrocephalus caused by iotrolan myelography

Failure analysis of the fractured wires in sternal perichronal loops.

Science.gov (United States)

Chao, Jesús; Voces, Roberto; Peña, Carmen

2011-10-01

We report failure analysis of sternal wires in two cases in which a perichronal fixation technique was used to close the sternotomy. Various characteristics of the retrieved wires were compared to those of unused wires of the same grade and same manufacturer and with surgical wire specifications. In both cases, wire fracture was un-branched and transgranular and proceeded by a high cycle fatigue process, apparently in the absence of corrosion. However, stress anlysis indicates that the effective stress produced during strong coughing is lower than the yield strength. Our findings suggest that in order to reduce the risk for sternal dehiscence, the diameter of the wire used should be increased. Copyright © 2011 Elsevier Ltd. All rights reserved.

Drug induced aseptic meningitis

African Journals Online (AJOL)

PROF. EZECHUKWU

2013-09-29

Sep 29, 2013 ... Abstract. Drug-induced aseptic meningitis (DIAM) is a rare but important and often challenging diagnosis for the physician. Intake of antimicrobials, steroids, anal- gesics amongst others has been implicated. Signs and symptoms generally develop within 24-48 hours of drug ingestion. The pa- tient often ...

Surgical repair of a congenital sternal cleft in a cat.

Science.gov (United States)

Schwarzkopf, Ilona; Bavegems, Valerie C A; Vandekerckhove, Peter M F P; Melis, Sanne M; Cornillie, Pieter; de Rooster, Hilde

2014-07-01

To describe the clinical findings, diagnosis, and treatment of an incomplete cleft of the 5th-8th sternebra and a cranioventral abdominal wall hernia in a 2 month old Ragdoll kitten and to evaluate the short- and long-term outcome. Clinical report. Ragdoll cat (n = 1), 2 months old. Sternal cleft was confirmed by thoracic radiographs. Computed tomography (CT) was used to plan an optimal surgical approach. A ventral median incision was made, starting at the 3rd sternebra and extended into the abdomen. Ostectomy of the proximal part of the 5th left sternebra was performed. Lateral periosteal flaps were created, unfolded, and absorbable monofilament sutures preplaced to facilitate closure and the repair was reinforced by 2 peristernal sutures. A bone graft was applied, and the free margin of the omentum was sutured to the cranial aspect of the wound. No major complications occurred. At 3 weeks, CT scan confirmed approximation of the hemisternebrae and at 10 months, complete fusion of the hemisternebrae had not occurred, but a strong connection of the sternal bars was present. Sternal cleft is a rare congenital abnormality that can be corrected surgically with favorable outcome. © Copyright 2014 by The American College of Veterinary Surgeons.

Aseptic techniques(practical guide no.3); Practico no.3-Tecnicas asepticas

Energy Technology Data Exchange (ETDEWEB)

Nappa, Andres; Souto Pais, Beatriz [Centro de Investigaciones Nucleares, Montevideo (Uruguay)

1994-12-31

Definition of aseptic techniques in relation with the labor of Radiopharmacy.Control of environment and working areas.Control of materials entered into an aseptic area: water, nitrogen,vials,stoppers,needles and syringes. Personnel and manipulations control,choosing of materials,precautions in the aseptic manipulation and sterility preservation during usage life. Bacteriological membrane filtration in sterilized conditions. Work in a laminar flow unit. Protocol of Practical task 3. Bibliography

Sex estimation from sternal measurements using multidetector computed tomography.

Science.gov (United States)

Ekizoglu, Oguzhan; Hocaoglu, Elif; Inci, Ercan; Bilgili, Mustafa Gokhan; Solmaz, Dilek; Erdil, Irem; Can, Ismail Ozgur

2014-12-01

We aimed to show the utility and reliability of sternal morphometric analysis for sex estimation.Sex estimation is a very important step in forensic identification. Skeletal surveys are main methods for sex estimation studies. Morphometric analysis of sternum may provide high accuracy rated data in sex discrimination. In this study, morphometric analysis of sternum was evaluated in 1 mm chest computed tomography scans for sex estimation. Four hundred forty 3 subjects (202 female, 241 male, mean age: 44 ± 8.1 [distribution: 30-60 year old]) were included the study. Manubrium length (ML), mesosternum length (2L), Sternebra 1 (S1W), and Sternebra 3 (S3W) width were measured and also sternal index (SI) was calculated. Differences between genders were evaluated by student t-test. Predictive factors of sex were determined by discrimination analysis and receiver operating characteristic (ROC) analysis. Male sternal measurement values are significantly higher than females (P discrimination analysis, MSL has high accuracy rate with 80.2% in females and 80.9% in males. MSL also has the best sensitivity (75.9%) and specificity (87.6%) values. Accuracy rates were above 80% in 3 stepwise discrimination analysis for both sexes. Stepwise 1 (ML, MSL, S1W, S3W) has the highest accuracy rate in stepwise discrimination analysis with 86.1% in females and 83.8% in males. Our study showed that morphometric computed tomography analysis of sternum might provide important information for sex estimation.

Sternal Aspiration of Bone Marrow in Dogs: A Practical Approach for Canine Leishmaniasis Diagnosis and Monitoring

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Rosa Paparcone

2013-01-01

Full Text Available Bone-marrow aspirate material is commonly considered as one of the most sensitive tissues for a reliable diagnosis of leishmaniasis. The procedure herein described may permit less experienced veterinarians to be familiar with a quick and safe assessment method for leishmaniasis diagnosis in their patients. Animals are positioned in right lateral recumbency, and the area corresponding to the second, third, or fourth sternebra is identified and aseptically prepared. A 18-gauge needle connected to a 10 mL syringe is driven through the skin, up to the bone wall, and firmly pushed forward while rotating. Entry into the sternebra’s cavity is clearly perceived by the fall of resistance offered by the cortex. Some 2,500 sternal bone-marrow samplings were safely and efficiently performed on 887 dogs of different breeds and aging from 6 months to 14 years, during eight years of clinical activity for routine diagnosis of canine leishmaniasis in pets or for the efficacy evaluation of anti-Leishmania immunobiologicals in dogs naturally exposed to parasite transmission. Most of the samples (1716 were from 387 dogs enrolled for anti-Leishmania vaccine studies. The safety of the method was particularly assessed on these dogs that as per study protocol were submitted to repeated bone-marrow aspirations (2–4 per year in follow-up examinations.

Solitary sternal lesions in breast cancer. Lesiones esternales unicas en cancer de mama

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Morales, R; Cano, R; Mendoza, G [Instituto Peruano de Energia Nuclear, Lima (Peru); Guzman, C; Cotrina, M; Aguilar, C [Instituto Nacional de Enfermedades Neoplasicas, Lima (Peru)

1993-12-01

In a retrospective review of bone scans performed in 1740 patients with breast cancer from January 1988 to April 1993, twenty had a solitary sternal lesion. Etiology was found correlating this finding with pathology, x-rays and/or final outcome. Nineteen lesions were due to metastases and one to infection. This experience suggests that solitary sternal lesions in breast cancer patients are uncommon and are most frequently (95%) associated with malignant etiology. (Authors). 10 refs., 2 figs.

Sternal Healing after Coronary Artery Bypass Grafting Using Bilateral Internal Thoracic Arteries: Assessment by Computed Tomography Scan

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Yoon Cheol Shin

2015-02-01

Full Text Available Background: This study aimed to investigate sternal healing over time and the incidence of poor sternal healing in patients undergoing coronary artery bypass graft (CABG surgery using bilateral internal thoracic arteries. Methods: This study enrolled 197 patients who underwent isolated CABG using skeletonized bilateral internal thoracic arteries (sBITA from 2006 through 2009. Postoperative computed tomography (CT angiography was performed on all patients at monthly intervals for three to six months after surgery. In 108 patients, an additional CT study was performed 24 to 48 months after surgery. The axial CT images were used to score sternal fusion at the manubrium, the upper sternum, and the lower sternum. These scores were added to evaluate overall healing: a score of 0 to 1 reflected poor healing, a score of 2 to 4 was defined as fair healing, and a score of 5 to 6 indicated complete healing. Medical records were also retrospectively reviewed to identify perioperative variables associated with poor early sternal healing. Results: Three to six months after surgery, the average total score of sternal healing was 2.07±1.52 and 68 patients (34.5% showed poor healing. Poor healing was most frequently found in the manubrium, which was scored as zero in 72.6% of patients. In multivariate analysis, the factors associated with poor early healing were shorter post-surgery time, older age, diabetes mellitus, and postoperative renal dysfunction. In later CT images, the average sternal healing score improved to 5.88±0.38 and complete healing was observed in 98.2% of patients. Conclusion: Complete sternal healing takes more than three months after a median sternotomy for CABG using sBITA. Healing is most delayed in the manubrium.

Evolution and functional significance of derived sternal ossification patterns in ornithothoracine birds

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O’connor, J. K.; Zheng, X.-T.; Sullivan, C.; Chuong, C.-M.; Wang, X.-L.; Li, A.; Wang, Y.; Zhang, X.-M.; Zhou, Z.-H.

2017-01-01

The midline pattern of sternal ossification characteristic of the Cretaceous enantiornithine birds is unique among the Ornithodira, the group containing birds, nonavian dinosaurs and pterosaurs. This has been suggested to indicate that Enantiornithes is not the sister group of Ornithuromorpha, the clade that includes living birds and their close relatives, which would imply rampant convergence in many nonsternal features between enantiornithines and ornithuromorphs. However, detailed comparisons reveal greater similarity between neornithine (i.e. crown group bird) and enantiornithine modes of sternal ossification than previously recognized. Furthermore, a new subadult enantiornithine specimen demonstrates that sternal ossification followed a more typically ornithodiran pattern in basal members of the clade. This new specimen, referable to the Pengornithidae, indicates that the unique ossification pattern observed in other juvenile enantiornithines is derived within Enantiornithes. A similar but clearly distinct pattern appears to have evolved in parallel in the ornithuromorph lineage. The atypical mode of sternal ossification in some derived enantiornithines should be regarded as an autapomorphic condition rather than an indication that enantiornithines are not close relatives of ornithuromorphs. Based on what is known about molecular mechanisms for morphogenesis and the possible selective advantages, the parallel shifts to midline ossification that took place in derived enantiornithines and living neognathous birds appear to have been related to the development of a large ventral keel, which is only present in ornithuromorphs and enantiornithines. Midline ossification can serve to medially reinforce the sternum at a relatively early ontogenetic stage, which would have been especially beneficial during the protracted development of the superprecocial Cretaceous enantiornithines. PMID:26079847

Experience with Vacuum-assisted closure of sternal wound infections following cardiac surgery and evaluation of chronic complications associated with its use.

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Bapat, Vinayak; El-Muttardi, Naguib; Young, Christopher; Venn, Graham; Roxburgh, James

2008-01-01

We report our experience in use of Vacuum-assisted closure therapy (VAC) in the treatment of poststernotomy wound infection with emphasis on recurrent wound-related problems after use of VAC and their treatment. Between July 2000 and June 2003, 2706 patients underwent various cardiac procedures via median sternotomy. Forty-nine patients with postoperative sternal wound infection (1.9%) were managed with VAC. Wounds were classified as either superficial sternal wound infection (28 patients) or deep sternal wound infection (21 patients). In the superficial sternal wound infection group, 23 patients had VAC as definitive treatment (GroupA), while five patients (Group B) had VAC followed by surgical closure. Similarly, in the deep sternal wound infection group, 12 patients had VAC as definitive treatment (Group C), while nine patients had VAC followed by surgical closure (Group D). Patients were discharged after satisfactory wound closure. Upon discharge patients were followed up at interval of three to six months. Recurrent sternal problems when identified were investigated and additional surgical procedures were carried out when necessary. There were nine deaths, all due to unrelated causes except in one patient who died of right ventricular rupture (Group C). Nine patients in Group A had recurrent wound problems of which six had VAC system for > 21 days. Three patients underwent extensive debridement due to sternal osteomyelitis. All eight patients in Group B presented with chronic wound-related problems and underwent multiple debridements. Four patients had laparoscopic omental flaps. In contrast 14 patients (Group B and D) who were treated with shorter duration of VAC followed by either a flap or direct surgical closure, did not present with recurrent problems. VAC therapy is a safe and reliable option in the treatment of sternal wound infection. However, prolonged use of VAC system as a replacement for surgical closure of sternal wound appears to be associated

Microbial Load in Septic and Aseptic Procedure Rooms.

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Harnoss, Julian-Camill; Assadian, Ojan; Diener, Markus Karl; Müller, Thomas; Baguhl, Romy; Dettenkofer, Markus; Scheerer, Lukas; Kohlmann, Thomas; Heidecke, Claus-Dieter; Gessner, Stephan; Büchler, Markus Wolfgang; Kramer, Axel

2017-07-10

Highly effective measures to prevent surgical wound infections have been established over the last two decades. We studied whether the strict separation of septic and aseptic procedure rooms is still necessary. In an exploratory, prospective observational study, the microbial concentration in an operating room without a room ventilating system (RVS) was analyzed during 16 septic and 14 aseptic operations with the aid of an air sampler (50 cm and 1 m from the operative field) and sedimentation plates (1 m from the operative field, and contact culture on the walls). The means and standard deviations of the microbial loads were compared with the aid of GEE models (generalized estimation equations). In the comparison of septic and aseptic operations, no relevant differences were found with respect to the overall microbial concentration in the room air (401.7 ± 176.3 versus 388.2 ± 178.3 CFU/m 3 ; p = 0.692 [CFU, colony-forming units]) or sedimentation 1 m from the operative field (45.3 ± 22.0 versus 48.7 ± 18.5 CFU/m 2 /min; p = 0.603) and on the walls (35.7 ± 43.7 versus 29.0 ± 49.4 CFU/m 2 /min; p = 0.685). The only relevant differences between the microbial spectra associated with the two types of procedure were a small amount of sedimentation of Escherichia coli and Enterococcus faecalis in septic operations, and of staphylococcus aureus and pseudomonas stutzeri in aseptic operations, up to 30 minutes after the end of the procedure. These data do not suggest that septic and aseptic procedure rooms need to be separated. In interpreting the findings, one should recall that the study was not planned as an equivalence or non-inferiority study. Wherever patient safety is concerned, high-level safety concepts should only be demoted to lower levels if new and convincing evidence becomes available.

Case report 400: Unilateral fusion of odontoid to lateral mass of C1 with pseudoarthrosis on left

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Nyska, M; Margulies, J Y; Gomori, J M; Beauvoir, G

1986-11-01

A case is described of a 19-year-old woman who presented with pain in the neck of several months duration. Torticolis and limitation of rotation of the head and neck to the right were observed. Plain films of the cervical spine were interpreted as normal, but plain film tomography and CT studies demonstrated an unusual anomaly, consisting of fusion of the odontoid process to the right lateral mass of C1 and a pseudoarthrosis in the anterior mass on the left side. (orig./SHA).

Mesenchymal Stem/Stromal Cells from Discarded Neonatal Sternal Tissue: In Vitro Characterization and Angiogenic Properties

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Shuyun Wang

2016-01-01

Full Text Available Autologous and nonautologous bone marrow mesenchymal stem/stromal cells (MSCs are being evaluated as proangiogenic agents for ischemic and vascular disease in adults but not in children. A significant number of newborns and infants with critical congenital heart disease who undergo cardiac surgery already have or are at risk of developing conditions related to inadequate tissue perfusion. During neonatal cardiac surgery, a small amount of sternal tissue is usually discarded. Here we demonstrate that MSCs can be isolated from human neonatal sternal tissue using a nonenzymatic explant culture method. Neonatal sternal bone MSCs (sbMSCs were clonogenic, had a surface marker expression profile that was characteristic of bone marrow MSCs, were multipotent, and expressed pluripotency-related genes at low levels. Neonatal sbMSCs also demonstrated in vitro proangiogenic properties. Sternal bone MSCs cooperated with human umbilical vein endothelial cells (HUVECs to form 3D networks and tubes in vitro. Conditioned media from sbMSCs cultured in hypoxia also promoted HUVEC survival and migration. Given the neonatal source, ease of isolation, and proangiogenic properties, sbMSCs may have relevance to therapeutic applications.

Treatment of sternal wound infection with vacuum-assisted closure.

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Dezfuli, Bobby; Li, Chin-Shang; Young, J Nilas; Wong, Michael S

2013-02-01

Previous work has demonstrated the efficacy of vacuum-assisted closure (VAC) in the treatment of poststernotomy local wound infections, compared to historical treatment protocol. The negative pressure has been found to protect wounds against contamination, prevent wound fluid retention, increase blood flow, and increase rates of granulation tissue formation. For this study, a retrospective analysis compared patients receiving VAC as definitive treatment versus bridging to delayed flap closure. Sixteen patients developed sternal wound infections after cardiac surgeries at the authors' institution from 2006 to 2008. Data was gathered regarding patient comorbidities, treatment method, and outcome. Study objectives included assessment of risk factors that warranted secondary surgicalclosure and examination of long-term followup where VAC was thedefinitive treatment modality. Group A (n = 12) had VAC as the final treatment modality. Group B (n = 4) required myocutaneous flap closure. One patient in Group B passed away prior to flap surgery. Both groups had similar risk factors, except Group B had a higher risk of body mass index (BMI) > 35 that was near statistically significant (P = 0.085; odds ratio = 0.0, 95% CI = [0.0 - 1.21]). Group A required a shorter hospital stay on average. Long-term follow-up showed the majority of Group A had completely healed sternal wounds 2-3 years from initial cardiac surgery. Vacuum-assisted closure as definitive treatment modality is a successful, first line therapy for local superficial sternal wound infections. When deep infections occur, however, VAC as bridge-to-flap coverage is recommended over attempted secondary healing with VAC. .

Location of Sternal Fractures as a Possible Marker for Associated Injuries

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Max J. Scheyerer

2013-01-01

Full Text Available Introduction. Sternal fractures often occur together with serious and life-threatening additional injuries. This retrospective study was designed to assess concomitant injuries and develop a correlation between fracture location and the severity of injury. Methods. All patients ( diagnosed with a fracture of the sternum by means of a CT scan were analysed with respect to accident circumstances, fracture morphology and topography, associated injuries, and outcome. Results. Isolated sternal fractures occurred in 9%. In all other admissions, concomitant injuries were diagnosed: mainly rip fractures (64%, injury to the head (48%, the thoracic spine (38%, lumbar spine (27%, and cervical spine (22%. Predominant fracture location was the manubrium sterni. In these locations, the observed mean ISS was the highest. They were strongly associated with thoracic spine and other chest injuries. Furthermore, the incidence of head injuries was significantly higher. ICU admission was significantly higher in patients with manubrium sterni fractures. Conclusion. Sternal fractures are frequently associated with other injuries. It appears that the fracture location can provide important information regarding concomitant injuries. In particular, in fractures of manubrium sterni, the need for further detailed clinical and radiologic workup is necessary to detect the frequently associated injuries and reduce the increased mortality.

Analysis of hip perfusion at early and reversible stages of aseptic hip necrosis

International Nuclear Information System (INIS)

Predic, P.; Dodig, D.; Karner, I.

2002-01-01

Aim: A proper early diagnosis of aseptic hip necrosis is very important for further therapy.Since there has always been a question of the amount of perfusion in hips at different stages of aseptic hip necrosis we tried to impartially examine the perfusion in hips at early and reversible stages of aseptic hip necrosis. Material and Methods:Study included 143 patients with aseptic hip necrosis.The 550-740 MBq of Tc-99m-DPD were on bolus injected.All patients were subjected to 3-phase scintigraphy of hips and quantitative calculation of relative perfusion in the artery phase (3T) at early and repeated at reversible stages of aseptic hip necrosis. Results: At the early stage of aseptic hip necrosis the obtained 3T was decreased from 0.94-0.69 (3T=0.80).Scintigrams showed a moderate increase or diffuse accumulation. At the reversible stages we obtained 3T decreased from 0.92-0.71 (3T=0.79) thus evidencing hypoperfusion.Scintigrams showed an diffuse increased accumulation. Conclusion: With the aseptic hip necrosis quantitative analysis of perfusion in the artery phase-3T indicates that the perfusion is decreased at all stages of the process which however shows a significantly falling trend with the progress of the disease

A new cable-tie based sternal closure system: description of the device, technique of implantation and first clinical evaluation

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Grapow Martin TR

2012-06-01

Full Text Available Abstract Background Wire closure still remains the preferred technique despite reasonable disadvantages. Associated complications, such as infection and sternal instability, cause time- and cost-consuming therapies. We present a new tool for sternal closure with its first clinical experience and results. Methods The sternal ZipFixTM System is based on the cable-tie principle. It primarily consists of biocompatible Poly-Ether-Ether-Ketone implants and is predominantly used peristernally through the intercostal space. The system provides a large implant-to-bone contact for better force distribution and for avoiding bone cut through. Results 50 patients were closed with the ZipFixTM system. No sternal instability was observed at 30 days. Two patients developed a mediastinitis that necessitated the removal of the device; however, the ZipFixTM were intact and the sternum remained stable. Conclusions In our initial evaluation, the short-term results have shown that the sternal ZipFixTM can be used safely and effectively. It is fast, easy to use and serves as a potential alternative for traditional wire closure.

[Vacuum-assisted closure therapy for the treatment of sternal wound infection after cardiac surgery].

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Nishimura, K; Nakamura, Y; Harada, S; Saiki, M; Marumoto, A; Kanaoka, Y; Nishimura, M

2009-11-01

Sternal wound infection is still one of the critical and challenging complications after cardiac surgery. Vacuum-assisted closure (VAC) therapy is a unique and simple system that helps promote wound healing. We report 3 cases with the sternal wound infection after cardiac surgery, in which VAC therapy was applied between January, 2005 and April, 2007. Two of them had good response to VAC therapy and had their wound healed after 3 and 5 weeks, respectively. However, the remaining case, in which bilateral internal thoracic artery had been taken down for coronary artery bypass grafting (CABG) and osteomyelitis of the sternum was not well controlled, did not respond to VAC therapy. Our results suggested that VAC might facilitate wound healing of the patients with sternal wound infection only after abscess was drained and opened, while it might not be useful for the patents with osteomyelitis.

CT scan of bacterial and aseptic meningitis

International Nuclear Information System (INIS)

Takemoto, Kazumasa; Saiwai, Shigeo; Tamaoka, Koichi

1983-01-01

CT scans of the patients with aseptic and bacterial meningitis were reviewed and compared to previous reports. In aseptic meningitis, no abnormal CT findings were observed. In bacterial meningitis, CT findings were ventricular dilatation, subdural fluid collection, parenchymal low density, intracerebral hematoma and meningeal enhancement after contrast injection. Three patients among 48 suffered from status epileptics during the course of the illness. All of 3 patients developed parenchymal inhomogeneous low density and progressive ventricular dilatation which did not improve after ventricular peritoneal shunt surgery. We believe that these changes are most likely due to hypoxic hypoxemia during epileptic seizure and meningitis itself seems to play a little role. (author)

Paediatric Investigators Collaborative Network on Infections in Canada (PICNIC study of aseptic meningitis

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Robinson Joan L

2006-04-01

Full Text Available Abstract Background The seasonality, clinical and radiographic features and outcome of aseptic meningitis have been described for regional outbreaks but data from a wider geographic area is necessary to delineate the epidemiology of this condition. Methods A retrospective chart review was completed of children presenting with aseptic meningitis to eight Canadian pediatric hospitals over a two-year period. Results There were 233 cases of proven enteroviral (EV meningitis, 495 cases of clinical aseptic meningitis and 74 cases of possible aseptic meningitis with most cases occurring July to October. Headache, vomiting, meningismus and photophobia were more common in children ≥ 5 years of age, while rash, diarrhea and cough were more common in children Conclusion The clinical presentation of aseptic meningitis varies with the age of the child. Absence of CSF pleocytosis is common in infants

[Aseptic cutaneous breast abscesses associated with ulcerative colitis].

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Sallé de Chou, C; Ortonne, N; Hivelin, M; Wolkenstein, P; Chosidow, O; Valeyrie-Allanore, L

2016-02-01

Inflammatory bowel diseases are associated with a broad range of cutaneous lesions. Herein we report the first case of aseptic skin abscesses associated with ulcerative colitis. Since March 2008, a 40-year-old woman presented with bilateral mammary abscesses, relapsing despite repeated antibiotic treatment. She was followed for ulcerative colitis diagnosed in 2011 by means of a rectal biopsy. Despite four surgical procedures, there was no improvement in her mammary abscesses and bilateral mastectomy was then proposed because of the persistent symptoms. Her general state of health remained stable. Clinically, there were bilateral inflammatory nodes with fistulae and pus. These lesions were extremely painful. Mild inflammatory syndrome was noted, but the immunological tests revealed nothing of note. Bacteriological, parasitological and mycological tests on biopsy specimens were negative. Histological examination of a surgical biopsy revealed lymphoplasmacytic infiltration of the dermis and subcutis with altered polymorphonuclear cells and epithelioid granuloma. The CT-scan showed no other remote lesions. The final diagnosis was cutaneous aseptic abscess syndrome associated with ulcerative colitis. Colchicine 1mg/day was initiated and resulted in regression of the skin lesions, with complete remission at one year of follow-up. Aseptic abscess syndrome must be considered in the event of recurrent aseptic cutaneous abscesses which may be associated with inflammatory bowel disease. Surgery should be avoided and treatment should be based on suitable drug therapy. Copyright © 2016. Published by Elsevier Masson SAS.

The changing epidemiology of pediatric aseptic meningitis in Daejeon, Korea from 1987 to 2003

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Lee Mi-Hee

2005-11-01

Full Text Available Abstract Background Aseptic meningitis is a relatively frequent childhood disease and virologic data suggest that enteroviruses are the commonest etiologic agents. We evaluated the epidemiologic characteristics of aseptic meningitis in Daejeon, South Korea from 1987 to 2003. Methods 2201 medical records of children with aseptic meningitis admitted to The Catholic University of Korea, Daejeon St Mary's Hospital were retrospectively analyzed. Results Outbreaks of aseptic meningitis were observed in 1990, 1993, 1996, 1997, 2001 and 2002. The age distribution of cases was relatively uniform, with a higher incidence in those aged P = 0.001. Neurologic sequelae were observed in 0.7% of the patients. Conclusion Aseptic meningitis, rare before the 1980s in Korea, has since become a common clinical entity. Since 1990, outbreaks of aseptic meningitis have occurred every 1 to 3 years in Daejeon in keeping with Korea-wide epidemics. The frequency of disease affecting children less than one year of age may reflect herd immunity to the epidemic strain.

Plating versus wiring for fixation of traumatic rib and sternal fractures

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Mostafa Kamel Abd-Elnaim

2017-12-01

Conclusions: Plating of rib and sternal fractures had better outcome than wiring, regarding better chest wall stability and restoration of chest contour; also it had shorter intensive care unit, hospital and ventilator days.

Sternal Osteomyelitis and Abscess Caused by Elbowing during a Basketball Game

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Hideo Ichimura

2012-01-01

Full Text Available A 15-year-old boy was referred to our hospital for further investigation and treatment of sternal osteomyelitis due to blunt chest trauma, more specifically elbowing during a basketball game 19 days earlier. On an initial presentation, his chest was markedly swollen and chest computed tomography demonstrated a sternal fracture and massive fluid collection in the chest wall. Since his general condition remained fairly good, we initially selected minimal drainage concomitant with antibiotics; if it was unsuccessful, we planned to switch to a more radical debridement procedure. The patient recovered without further invasive intervention and was discharged on postoperative day 26. There is no sign of recurrence six months after operation. This case report indicates that minimal drainage would be a good option for treatment in a phased strategy.

The laparoscopically harvested omental flap for deep sternal wound infection

NARCIS (Netherlands)

van Wingerden, Jan J.; Coret, Matijn E. H.; van Nieuwenhoven, Christianne A.; Totté, Eric R.

2010-01-01

To report our experience with the laparoscopically harvested omental flap in the treatment of deep sternal wound infection, and to present a modification and introduce two supportive techniques in the perioperative management. Between June 2005 and September 2007, six patients with grade IV (El

Aseptic Plant Culture System (APCS), Phase II

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National Aeronautics and Space Administration — Aseptic plant culture plays a significant role in biotechnology and plant physiology research, and in vegetative propagation of many plant species. The development...

Management of sternal precautions following median sternotomy by physical therapists in Australia: a web-based survey.

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Tuyl, Lara J; Mackney, Jennifer H; Johnston, Catherine L

2012-01-01

Sternal precautions are utilized within many hospitals with the aim of preventing the occurrence of sternal complications (eg, infection, wound breakdown) following midline sternotomy. The evidence base for sternal precaution protocols, however, has been questioned due to a paucity of research, unknown effect on patient outcomes, and possible discrepancies in pattern of use among institutions. The objective of this study was to investigate and document the use of sternal precautions by physical therapists in the treatment of patients following median sternotomy in hospitals throughout Australia, from immediately postsurgery to discharge from the hospital. A cross-sectional, observational design was used. An anonymous, Web-based survey was custom designed for use in the study. The questionnaire was content validated, and the online functionality was assessed. The senior cardiothoracic physical therapist from each hospital identified as currently performing cardiothoracic surgery (N=51) was invited to participate. The response rate was 58.8% (n=30). Both public (n=18) and private (n=12) hospitals in all states of Australia were represented. Management protocols reported by participants included wound support (n=22), restrictions on lifting and transfers (n=23), and restrictions on mobility aid use (n=15). Factors influencing clinical practice most commonly included "workplace practices/protocols" (n=27) and "clinical experience" (n=22). Limitations The study may be limited by response bias. Significant variation exists in the sternal precautions and protocols used in the treatment of patients following median sternotomy in Australian hospitals. Further research is needed to investigate whether the restrictions and precautions used are necessary and whether protocols have an impact on patient outcomes, including rates of recovery and length of stay.

Skeletal height estimation from regression analysis of sternal lengths in a Northwest Indian population of Chandigarh region: a postmortem study.

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Singh, Jagmahender; Pathak, R K; Chavali, Krishnadutt H

2011-03-20

Skeletal height estimation from regression analysis of eight sternal lengths in the subjects of Chandigarh zone of Northwest India is the topic of discussion in this study. Analysis of eight sternal lengths (length of manubrium, length of mesosternum, combined length of manubrium and mesosternum, total sternal length and first four intercostals lengths of mesosternum) measured from 252 male and 91 female sternums obtained at postmortems revealed that mean cadaver stature and sternal lengths were more in North Indians and males than the South Indians and females. Except intercostal lengths, all the sternal lengths were positively correlated with stature of the deceased in both sexes (P regression analysis of sternal lengths was found more useful than the linear regression for stature estimation. Using multivariate regression analysis, the combined length of manubrium and mesosternum in both sexes and the length of manubrium along with 2nd and 3rd intercostal lengths of mesosternum in males were selected as best estimators of stature. Nonetheless, the stature of males can be predicted with SEE of 6.66 (R(2) = 0.16, r = 0.318) from combination of MBL+BL_3+LM+BL_2, and in females from MBL only, it can be estimated with SEE of 6.65 (R(2) = 0.10, r = 0.318), whereas from the multiple regression analysis of pooled data, stature can be known with SEE of 6.97 (R(2) = 0.387, r = 575) from the combination of MBL+LM+BL_2+TSL+BL_3. The R(2) and F-ratio were found to be statistically significant for almost all the variables in both the sexes, except 4th intercostal length in males and 2nd to 4th intercostal lengths in females. The 'major' sternal lengths were more useful than the 'minor' ones for stature estimation The universal regression analysis used by Kanchan et al. [39] when applied to sternal lengths, gave satisfactory estimates of stature for males only but female stature was comparatively better estimated from simple linear regressions. But they are not proposed for the

MR features in patients with residual paralysis following aseptic meningitis

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Suh, Dae Chul; Park, Young Seo [College of Medicine, Asan Meidcal Center, University of Ulsan, Seoul (Korea, Republic of)

1991-01-15

MR studies were performed in three patients with paralysis in the lower extremities. Poliomyelitis-like paralysis can be caused by neurovirulent strains of nonpolioenteroviruses. Entervirus 71 (EV 71) is documented as one of the potentially neurovirulent strains and a causative agent of some epidemics (1-7). The clinical manifestations associated with the EV 71 infection include aseptic meningitis, hand-food-mouth disease (HFMD), acute respiratory illness and gastrointestinal disease(6). Although rarely fatal, flaccidparalysis can be followed by EV 71 induced aseptic meningitis. Anterior horn cell necrosis was suggested on MR in two patients with residual paralysis (7). MR features, however, have not yet been described in detail. In this report we present three cases of patients with clinical evidence of EV 71 induced aseptic meningitis whose MR studies showed residual changes in spinal cord.

MR features in patients with residual paralysis following aseptic meningitis

International Nuclear Information System (INIS)

Suh, Dae Chul; Park, Young Seo

1991-01-01

MR studies were performed in three patients with paralysis in the lower extremities. Poliomyelitis-like paralysis can be caused by neurovirulent strains of nonpolioenteroviruses. Entervirus 71 (EV 71) is documented as one of the potentially neurovirulent strains and a causative agent of some epidemics (1-7). The clinical manifestations associated with the EV 71 infection include aseptic meningitis, hand-food-mouth disease (HFMD), acute respiratory illness and gastrointestinal disease(6). Although rarely fatal, flaccidparalysis can be followed by EV 71 induced aseptic meningitis. Anterior horn cell necrosis was suggested on MR in two patients with residual paralysis (7). MR features, however, have not yet been described in detail. In this report we present three cases of patients with clinical evidence of EV 71 induced aseptic meningitis whose MR studies showed residual changes in spinal cord

An outbreak of aseptic meningitis in Podlaskie Voivodeship in 2014

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Magda Orzechowska

2016-12-01

Full Text Available Enteroviruses cause common infections with various clinical course and forms, such as hand-foot-and-mouth disease (Boston exanthem disease, herpangina, myocarditis and pericarditis, widespread myositis (epidemic pleurodynia, Bornholm disease, or aseptic inflammation of the nervous system, among children and adolescents. An increase in aseptic meningitis cases of enteroviral aetiology, including the E30 virus, was occasionally observed in various European countries. In 2014, an outbreak of aseptic meningitis was reported in Podlaskie Voivodeship. A total of 640 cases were reported between June 1 and November 30, 2014, of which 228 had confirmed enteroviral aetiology. Summer and autumn seasons favour the incidence of viral infections of the central nervous system. Symptomatic infections are more common in males than females. Infections with enterovirus show the tendency to form endemic regions.

Aseptic Plant Culture System (APCS), Phase I

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National Aeronautics and Space Administration — Aseptic plant culture plays a significant role in biotechnology and plant physiology research and in vegetative propagation of many plant species. The development of...

Deep sternal wound infection after coronary artery bypass surgery: management and risk factor analysis for mortality.

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Yumun, Gunduz; Erdolu, Burak; Toktas, Faruk; Eris, Cuneyt; Ay, Derih; Turk, Tamer; As, Ahmet Kagan

2014-08-01

Deep sternal wound infection is a life-threatening complication after cardiac surgery. The aim of this study was to investigate the factors leading to mortality, and to explore wound management techniques on deep sternal wound infection after coronary artery bypass surgery. Between 2008 and 2013, 58 patients with deep sternal wound infection were analyzed. Risk factors for mortality and morbidity including age, gender, body mass index, smoking status, chronic renal failure, hypertension, diabetes, and treatment choice were investigated. In this study, 19 patients (32.7%) were treated by primary surgical closure (PSC), and 39 patients (67.3%) were treated by delayed surgical closure following a vacuum-assisted closure system (VAC). Preoperative patient characteristics were similar between the groups. Fourteen patients (24.1%) died in the postoperative first month. The mortality rate and mean duration of hospitalization in the PSC group was higher than in the VAC group (P = .026, P = .034). Significant risk factors for mortality were additional operation, diabetes mellitus, and a high level of EuroSCORE. Delayed surgical closure following VAC therapy may be associated with shorter hospitalization and lower mortality in patients with deep sternal wound infection. Additional operation, diabetes mellitus, and a high level of EuroSCORE were associated with mortality.

Cat scratch disease complicated with aseptic meningitis and neuroretinitis

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Vitor Laerte Pinto Jr.

Full Text Available Cat scratch disease (CSD is a self limited condition characterized by fever, lymph node enlargement and less often eye involvement. Central nervous system involvement by Bartonella henselae infection is possibly an important cause of morbidity; its role as an agent of aseptic meningitis is unknown. We report a case of a 40 years-old man with CSD accompanied by aseptic meningitis and neuroretinitis. Serum indirect immmunofluorescence (IFI assays for B. henselae were positive and the cerebrospinal fluid (CSF analysis showed mononuclear pleocytosis and increased level of protein. Serological tests for other etiologies were negative. The patient responded well to antibiotic therapy with oral doxycicline plus rifampin and in the 12th day of hospitalization evolved to total regression of the headache and partial regression of the visual loss. Clinicians should consider CSD as a differential diagnosis when assessing previously healthy patients with aseptic meningitis associated with regional lymphadenopathy and epidemiological history of feline contact.

Magnetic thermometry in the aseptic processing of foods containing particulates (abstract)

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Ghiron, Kenneth; Litchfield, Bruce

1997-04-01

Aseptic processing of foods has many advantages over canning, including higher efficiency, lighter packaging, better taste, and higher nutritional value. Aseptic processing is different from canning where the food and container are sterilized together. Instead, a thin stream of food is heated and the packaging is independently sterilized before the food is placed in the package. However, no aseptic processes have been successfully filed with the FDA for foods containing sizable solid particles because of uncertainties in the thermal sterilization of the particles (e.g., soup). We have demonstrated that by inserting small paramagnetic particles in the interior of the simulated and real food particles, the local temperature can be measured. With this information, any questions about the adequate sterilization of the particles can be resolved. The measurements were done by directing the food stream through a magnetic field and sensing the voltages induced in a pickup coil by the motion of the magnetized particles. Details of the equipment design and data analysis will be discussed along with an introduction to the aseptic processing of foods.

Correlated evolution of sternal keel length and ilium length in birds

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Tao Zhao

2017-07-01

Full Text Available The interplay between the pectoral module (the pectoral girdle and limbs and the pelvic module (the pelvic girdle and limbs plays a key role in shaping avian evolution, but prior empirical studies on trait covariation between the two modules are limited. Here we empirically test whether (size-corrected sternal keel length and ilium length are correlated during avian evolution using phylogenetic comparative methods. Our analyses on extant birds and Mesozoic birds both recover a significantly positive correlation. The results provide new evidence regarding the integration between the pelvic and pectoral modules. The correlated evolution of sternal keel length and ilium length may serve as a mechanism to cope with the effect on performance caused by a tradeoff in muscle mass between the pectoral and pelvic modules, via changing moment arms of muscles that function in flight and in terrestrial locomotion.

Efficacy of a novel strategy for poststernotomy deep sternal infection after thoracic aorta replacement using a prosthetic graft.

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Kuriyama, Motone; Yoshida, Yukitaka; Ninomiya, Hitoshi; Yamamoto, Shin; Sasaguri, Shiro; Akita, Shinsuke; Mitsukawa, Nobuyuki

2018-05-01

Poststernotomy deep sternal wound infections are persistent and occasionally fatal, especially in cases involving prosthetic grafts, because of their complicated structure and virtual impossibility of removal. We aimed to verify the influence of cooperation with plastic surgeons and our novel strategy for treating deep sternal wound infection after aortic replacement on cardiovascular surgery outcomes. Nine hundred eighty-three consecutive patients were divided into two groups: an early group (2012-2013) and a late group (2014-2015). The late group had received cooperatively improved perioperative wound management: our novel strategy of deep sternal infection based on radical debridement and immediate reconstruction decided by reference to severities of the patient's general condition and widespread infection by early intervention of plastic surgeons. The groups were analysed retrospectively. Binary variables were analysed statistically with the Fisher exact test and continuous variables with the Mann-Whitney U test. Inter-group differences were assessed with the chi-square test. Twenty of 390 cases in the early group and 13 of 593 cases in the late group were associated with deep sternal infection. Morbidity rates of deep sternal wound infection and associated mortality rates 1 year after reconstruction surgery were significantly less (p infection also reduced associated mortality rates. Facilities should consider the early inclusion of plastic surgeons in the treatment of patients undergoing aortic replacement to facilitate better outcomes. Copyright © 2018 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

Role of Negative-Pressure Wound Therapy in Deep Sternal Wound Infection After Open Heart Surgery

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Cemalettin Aydın

2013-08-01

Full Text Available Introduction: Mediastinitis is a devastating complication in open heart surgery. The most common treatments after debridement are rewiring with antibiotic irrigation. Vacuum assisted closure therapy is a recently introduced technique that promotes the healing of difficult wounds, including post-sternotomy mediastinitis.Patients and Methods: Forty one patients with deep sternal wound infection were divided into two groups based on the treatment method used. Twenty two patients with post-cardio to my deep sternal wound infection were treated primarily by vacuum assisted closure method (group A and 19 patients with deep sternal wound infection who received closed mediastinal irrigation were treated with antibiotics (group B between January 2006 and January 2010.Results: The two groups were compared. Three patients died during treatment in group B. The median healing time was significantly shorter in group A (mean, 13.5 ± 3.2 days compared to 18 days (mean, 21.2 ± 16.4 days in group B (p< 0.001. Deep sternal wound infection showed no recurrences after the vacuum treatment, while 7 (24% patients in group B suffered recurrences. Hospital stay was significantly shorter in group A (median, 30.5 days; mean, 32.2 ± 11.3 days vs. median, 45 days; mean, 49.2 ± 19.3 days (p= 0.001.Conclusion: A significantly shorter healing time was confirmed with vacuum assisted closure. Hospital stay remained significantly shorter in group A (35 vs. 46 days.

A novel tantalum-containing bioglass. Part II. Development of a bioadhesive for sternal fixation and repair

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Alhalawani, Adel MF. [Department of Mechanical & Industrial Engineering, Ryerson University, Toronto, Ontario (Canada); Li Ka Shing Knowledge Institute, St. Michael' s Hospital, Toronto, Ontario, Canada. (Canada); Mehrvar, Cina [Department of Mechanical & Industrial Engineering, Ryerson University, Toronto, Ontario (Canada); Stone, Wendy [Department of Chemistry and Biology, Ryerson University, Toronto, Ontario (Canada); Waldman, Stephen D. [Li Ka Shing Knowledge Institute, St. Michael' s Hospital, Toronto, Ontario, Canada. (Canada); Department of Chemical Engineering, Ryerson University, Toronto, Ontario (Canada); Towler, Mark R., E-mail: mtowler@ryerson.ca [Department of Mechanical & Industrial Engineering, Ryerson University, Toronto, Ontario (Canada); Li Ka Shing Knowledge Institute, St. Michael' s Hospital, Toronto, Ontario, Canada. (Canada)

2017-02-01

With over a million median sternotomy surgeries performed worldwide every year, sternal wound complications have posed a serious risk to the affected patients. A rigid therapeutic sternal fixation device has therefore become a necessity. In this work, the incorporation of up to 0.5 mol% of tantalum pentoxide (Ta{sub 2}O{sub 5}), in exchange for zinc oxide (ZnO), into the SiO{sub 2}-ZnO-CaO-SrO-P{sub 2}O{sub 5} glass system is presented. The effect of Ta incorporation on the physical, chemical and biological properties of the glass polyalkenoate cements (GPCs) prepared from them have been presented in this manuscript. The data obtained have confirmed that Ta{sub 2}O{sub 5} incorporation into the reference glass system results in increased working times, radiopacity, ion solubility, and long-term mechanical stability. The formulated glass systems have also shown clear antibacterial and antifungal activity against both Gram-negative (Escherichia coli) and Gram-positive prokaryotes (Staphylococcus aureus and Streptococcus epidermidis), as well as eukaryotes (Fusarium solani). Cytotoxicity testing showed that Ta incorporation results in no toxicity effect and may simulate osseo-integration when tested in animal models. These new metallic-containing biomaterial adhesives have been developed for sternal fixation and repair. As a permanent implant, the formulated adhesives can be used in conjunction with sternal cable ties to offer optimal fixation for patients and reduce post-operative complications such as bacterial infection and pain from micro-motion. - Highlights: • Novel cements based on a tantalum-containing ionomer glass are presented. • The cements resulted in increased working times and long-term mechanical stability. • The cements exhibited both antibiotic and antimycotic activity. • The cements tested did not display any cytotoxic effects. • These cements have potential for sternal fixation and repair.

Impact of deep sternal wound infection management with vacuum-assisted closure therapy followed by sternal osteosynthesis: a 15-year review of 23,499 sternotomies.

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Baillot, Richard; Cloutier, Daniel; Montalin, Livia; Côté, Louise; Lellouche, François; Houde, Chanel; Gaudreau, Geneviève; Voisine, Pierre

2010-04-01

This study was undertaken to examine the outcome of patients with deep sternal wound infection (DSWI) now treated with vacuum-assisted closure (VAC) therapy as a bridge to sternal osteosynthesis with horizontal titanium plate fixation. From 1992 to 2007, a consecutive cohort of 23,499 patients underwent open-heart surgery (OHS) in our institution. The period under study was divided in two according to the use of therapeutic modalities: conventional (1992-2001, N=118 DSWI): debridement/drainage with primary closure and irrigation (N=37), debridement/drainage, open packing followed by pectoralis myocutaneous flaps (PMFs) (N=81); contemporary (2002-2007, N=149 DSWI): conventional treatment (N=24) and VAC therapy (N=125/83.8%). VAC was followed by sternal osteosynthesis with horizontal titanium plates in 92 patients (61.7%). DSWI was diagnosed in 267 out of 23 499 (1.1%) patients of our entire series according to Center for Disease Control - Atlanta (CDC) criteria, 118 out of 13 180 (0.9%) in the first and 149 out of 10 319 (1.4%) in the second period (p=0.001). Hospital mortality (N=267/23,499) has been 10.25% for the entire cohort under study without any difference between groups (1992-2001: 11.4%; 2002-2007: 9.1%, p=0.67). More recently, VAC therapy (N=125) was associated with a lower mortality (4.8% vs 14.1%, p=0.01). Stepwise multivariable logistic regression analysis for both periods revealed that prolonged intubation in the intensive care unit (ICU), use of bilateral internal thoracic artery grafting (BIMA), diabetes, re-operation for bleeding and body mass index (BMI) >30 kgm(-2) are the most powerful predictors of DSWI. In the more recently treated patients using VAC therapy, combined procedures (valve and graft) also emerged as a significant predictor. For the entire study, Staphylococcus epidermidis (49.6%) has been the most frequently identified pathogen, followed by Staphylococcus aureus (38.8%). Methicillin-resistant S.aureus (MRSA) was observed in 4

Reconstruction of Chest Wall by Cryopreserved Sternal Allograft after Resection of Aneurysmal Bone Cyst of Sternum

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Kambiz Sheikhy

2017-01-01

Full Text Available A 20-year-old female was referred to our hospital due to deformity and bulging in anterior aspect of chest wall in sternal area. Chest X-ray and CT scan confirmed a large mass with destruction of sternum. Pathologic diagnosis after incisional biopsy was compatible with aneurysmal bone cyst. We resected sternum completely and reconstructed large anterior defect by a cryopreserved sternal allograft. In follow-up of patient there was no unstability of chest wall with good cosmetic result.

Factors associated with methicillin-resistant coagulase-negative staphylococci as causing organisms in deep sternal wound infections after cardiac surgery

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R. Sommerstein

2015-07-01

Full Text Available Established preoperative antibiotic prophylaxis in cardiac surgery is ineffective against methicillin-resistant coagulase-negative staphylococci (CoNS. This case–control study aimed to determine factors predicting deep sternal wound infections due to methicillin-resistant CoNS. All cardiac surgery patients undergoing sternotomy between June 2009 and March 2013 prospectively documented in a Swiss tertiary care center were included. Among 1999 patients, 82 (4.1% developed deep sternal wound infection. CoNS were causal in 36 (44% patients, with 25/36 (69% being methicillin resistant. Early reintervention for noninfectious causes (odds ratio (OR 4.3; 95% confidence interval (CI 1.9–9.5 was associated with methicillin-resistant CoNS deep sternal wound infection. Among CoNS deep sternal wound infection, perioperative antimicrobial therapy (p 0.002, early reintervention for noninfectious causes (OR 7.9; 95% CI 0.9–71.1 and time between surgery and diagnosis of infection over 21 days (OR 10.8; 95% CI 1.2–97.8 were associated with methicillin resistance. These findings may help to better tailor preoperative antimicrobial prophylaxis.

Flexible walled container having membrane fitment for use with aseptic filling apparatus

International Nuclear Information System (INIS)

Davis, J.C.; Reiss, R.J.; Rica, A.F.

1984-01-01

There is disclosed an aseptic flexible walled container having a rigid fitment member cooperative with an aseptic filling apparatus and including a neck, outer flanges surrounding the neck, a frangible membrane and an outer end rim receptive of an hermetically sealed lid. The neck is formed with an internal chamferred seating shoulder for fluid-tight engagement with a fill tube. One outer flange cooperates with clamping jaws of the aseptic filling apparatus for detachably sealing the fitment to a sterilizing chamber and placing it in position for insertion of the filling tube which ruptures the membrane and permits the aseptic introduction of product to the container's interior. The other outer flange is secured to an opening in a wall of the flexible container. The joined fitment and container are presterilized prior to filling. Selected materials for the multi-ply container walls and the fitment permit the container to withstand gamma ray and other sterilization treatment, heat and pressure while maintaining required strength. After the container is aseptically filled, such as with flowable food product, the fill tube is withdrawn and a lid is hermetically sealed onto the rim of the fitment. A heat shield adjacent a container wall surrounds the fitment to protect the container from excessive heat generated by the associated filling apparatus during filling

Tratamento da pseudartrose infectada da tíbia pelo método de Ilizarov: técnica do encurtamento agudo com subseqüente alongamento Treatment of infected pseudoarthrosis of the tibia by Ilizarov's method: technique using acute compression and subsequent distraction

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Jorge Luiz Borges

2007-09-01

Full Text Available OBJETIVO:Comprovar a eficácia do tratamento da pseudartrose infectada da tíbia pelo método de Ilizarov, utilizando a técnica do encurtamento agudo do foco da pseudartrose com posterior alongamento ósseo. MÉTODOS: Foram estudados 20 pacientes adultos portadores de pseudartrose unilateral infectada da tíbia, tratados no período entre novembro de 1993 e setembro de 2000. No pós-operatório, os pacientes foram avaliados quanto a dor, necessidade de órtese, avaliação da mobilidade articular, retorno às atividades normais do dia-a-dia e/ou do trabalho, consolidação da pseudartrose, cura da infecção, existência de deformidades ósseas, discrepância no comprimento dos membros e consolidação óssea na área do regenerado ósseo. RESULTADOS: Os resultados funcionais foram: excelentes em 10 pacientes (50%, bons em oito (40%, regulares em um (5% e ruins em um paciente (5%. O tempo de consolidação da pseudartrose, do segmento ósseo alongado e o tempo de uso do fixador foram proporcionais à extensão da perda óssea. CONCLUSÃO: O método de Ilizarov, associado ao encurtamento agudo com subseqüente alongamento ósseo, mostrou-se eficaz para o tratamento da pseudartrose infectada da tíbia.OBJECTIVE: To verify the effectiveness of treating the infected pseudoarthrosis of the tibia by Ilizarov's method using the technique of acute compression of the focus of pseudoarthrosis with later bone distraction. METHODS: 20 adult patients with unilateral infected pseudoarthrosis of the tibia treated from November 1993 to September 2000 were studied. In the postoperative period, the patients were evaluated for pain, orthesis requirement, joint mobility, return to daily life activities and/or to work, union of the pseudoarthrosis, cure of the infection, presence of bone deformities, discrepancy in limb length, and bone union in the bone regenerate area. RESULTS: Functional results were: excellent in 10 patients (50%, good in eight (40%, regular in

Dynamics of biochemical and immunological blood markers in patients with pseudoarthrosis of the femoral neck after total hip arthroplasty

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S. E. Bondarenko

2017-08-01

Full Text Available The importance of biomarkers to predict recovery following total hip arthroplasty (THA is still unclear to clinicians. To assess the preoperative biomarkers of patients with pseudoarthrosis of the femoral neck and their dynamics in the early postoperative period after THA, 50 patients aged 33 to 82 years old, 18 males and 32 females diagnosed with pseudoarthrosis of the femoral neck after failed internal fixation and failed conservative management were studied. The control group consisted of 30 healthy people aged 27 to 50 years, 13 males, 17 females. Patients’ blood was examined for biochemical markers upon admission, and then on the 7th and 14th days after surgery. Their blood serum content of total protein, albumin, glycoproteins, sialic acids, chondroitin sulfates, haptoglobin, glucose, cholesterol, triglycerides, ALT, AST, alkaline phosphatase, GGT, acid phosphatase, thymol index; interleukins (IL-1, IL-4 and IL-6. and C-reactive protein was measured. The content of glycoproteins in the blood exceeded the norm by 2.3 times, chondroitin sulfate by 4.7 times, sialic acids by 1.5 times, haptoglobin by 55.8%, fibrinogen by 19.1%, globulin by 19,6%, alkaline phosphatase activity by 72.3%, IL-1 by 94.7 and IL-6 by 3 times, C-reactive protein by 2.6 times. After THA there was a gradual decrease in blood biochemical and immunological markers. The most informative laboratory markers were glycoproteins, chondroitin sulfates, sialic acids, haptoglobin, activity of alkaline phosphatase, IL-1, IL-6 and IL-4, and C-reactive protein. Subsequent research is required to validate these dynamics.

Pseudomass of the sternal manubrium in osteogenesis imperfecta

International Nuclear Information System (INIS)

Yekeler, Ensar; Kumbasar, Basak; Dursun, Memduh; Tunaci, Mehtap; Cantez, Serdar; Emiroglu, Halil Haldun

2003-01-01

Skeletal abnormalities such as hypertrophic callus formation and ''popcorn'' calcifications are rare radiological findings of osteogenesis imperfecta, causing tumor-like appearances on imaging. We report on a 7-year-old girl with osteogenesis imperfecta presenting with hepatomegaly and palpable lymphadenopathy in the left inguinal region on physical examination. Computed tomography examination revealed a high-density mass-like lesion of the manubrium sterni. Ultrasonography and a lateral roentgenogram of the chest verified that this was a pseudomass caused by a bowed sternal manubrium. (orig.)

[Recurrent aseptic meningitis secondary to taking ibuprofen and ketorolac].

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Cano Vargas-Machuca, E; Mondéjar-Marín, B; Navarro-Muñoz, S; Pérez-Molina, I; Garrido-Robres, J A; Alvarez-Tejerina, A

Aseptic meningitis is a process that is characterised by an inflammatory reaction of the meninges that is not due to any infectious agent. Its aetiology is varied and is most frequently caused by rheumatologic and/or autoimmune processes, chemical or medication-induced meningitis, the most notable drugs involved being antibiotics and non-steroidal anti-inflammatory drugs (NSAI). We report the case of a 70-year-old male, with no relevant history, who was admitted to hospital five times over a period of 16 months because of acute meningitis with polymorphonuclear pleocytosis, high protein levels in cerebrospinal fluid and normal glucose in cerebrospinal fluid. No evidence of an infectious causation, chemical meningitis, carcinomatosis or autoimmune disease was found and the patient was diagnosed with recurrent aseptic meningitis. It was found that the patient had taken ibuprofen or ketorolac on several occasions, a few hours before the appearance of symptoms. These episodes were quickly resolved after withdrawal of this medication. A number of NSAI have been reported as inducers of aseptic meningitis, one of the most notable being ibuprofen. We report the case of a patient who, as a consequence of taking ibuprofen and ketorolac, presented episodes of recurrent aseptic meningitis. To our knowledge this side effect of ketorolac has not been reported before. Its clinical features are impossible to differentiate from those of infectious meningitis. Diagnosis is reached by exclusion and a careful pharmacological study, including over-the-counter drugs like some of the NSAI, must be performed in patients with this condition, since it is a problem that can easily be solved by withdrawing the drug that causes it.

Quality comparison of continuous steam sterilization segmented-flow aseptic processing versus conventional canning of whole and sliced mushrooms.

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Anderson, N M; Walker, P N

2011-08-01

This study was carried out to investigate segmented-flow aseptic processing of particle foods. A pilot-scale continuous steam sterilization unit capable of producing shelf stable aseptically processed whole and sliced mushrooms was developed. The system utilized pressurized steam as the heating medium to achieve high temperature-short time processing conditions with high and uniform heat transfer that will enable static temperature penetration studies for process development. Segmented-flow technology produced a narrower residence time distribution than pipe-flow aseptic processing; thus, whole and sliced mushrooms were processed only as long as needed to achieve the target F₀  = 7.0 min and were not overcooked. Continuous steam sterilization segmented-flow aseptic processing produced shelf stable aseptically processed mushrooms of superior quality to conventionally canned mushrooms. When compared to conventionally canned mushrooms, aseptically processed yield (weight basis) increased 6.1% (SD = 2.9%) and 6.6% (SD = 2.2%), whiteness (L) improved 3.1% (SD = 1.9%) and 4.7% (SD = 0.7%), color difference (ΔE) improved 6.0% (SD = 1.3%) and 8.5% (SD = 1.5%), and texture improved 3.9% (SD = 1.7%) and 4.6% (SD = 4.2%), for whole and sliced mushrooms, respectively. Segmented-flow aseptic processing eliminated a separate blanching step, eliminated the unnecessary packaging of water and promoted the use of bag-in-box and other versatile aseptic packaging methods. Segmented-flow aseptic processing is capable of producing shelf stable aseptically processed particle foods of superior quality to a conventionally canned product. This unique continuous steam sterilization process eliminates the need for a separate blanching step, reduces or eliminates the need for a liquid carrier, and promotes the use of bag-in-box and other versatile aseptic packaging methods. © 2011 Institute of Food Technologists®

Failure of aseptic revision total knee arthroplasties.

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Leta, Tesfaye H; Lygre, Stein Håkon L; Skredderstuen, Arne; Hallan, Geir; Furnes, Ove

2015-02-01

In Norway, the proportion of revision knee arthroplasties increased from 6.9% in 1994 to 8.5% in 2011. However, there is limited information on the epidemiology and causes of subsequent failure of revision knee arthroplasty. We therefore studied survival rate and determined the modes of failure of aseptic revision total knee arthroplasties. This study was based on 1,016 aseptic revision total knee arthroplasties reported to the Norwegian Arthroplasty Register between 1994 and 2011. Revisions done for infections were not included. Kaplan-Meier and Cox regression analyses were used to assess the survival rate and the relative risk of re-revision with all causes of re-revision as endpoint. 145 knees failed after revision total knee arthroplasty. Deep infection was the most frequent cause of re-revision (28%), followed by instability (26%), loose tibial component (17%), and pain (10%). The cumulative survival rate for revision total knee arthroplasties was 85% at 5 years, 78% at 10 years, and 71% at 15 years. Revision total knee arthroplasties with exchange of the femoral or tibial component exclusively had a higher risk of re-revision (RR = 1.7) than those with exchange of the whole prosthesis. The risk of re-revision was higher for men (RR = 2.0) and for patients aged less than 60 years (RR = 1.6). In terms of implant survival, revision of the whole implant was better than revision of 1 component only. Young age and male sex were risk factors for re-revision. Deep infection was the most frequent cause of failure of revision of aseptic total knee arthroplasties.

Sternal fracture: isolated lesion versus polytrauma from associated extrasternal injuries--analysis of 1,867 cases.

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Odell, David D; Peleg, Kobi; Givon, Adi; Radomislensky, Irina; Makey, Ian; Decamp, Malcolm M; Whyte, Richard; Gangadharan, Sidhu P; Berger, Robert L

2013-09-01

Sternal fractures fall into two distinct categories as follows: (1) isolated sternal fracture (ISF) without associated injury and (2) polytrauma sternal fracture (PSF) with associated extrasternal injury. PSF can be sufficiently severe to require hospitalization, while ISF is usually a mild insult manageable in an ambulatory setting. Nonetheless, most patients with ISF are hospitalized. The disconnect between treatment based on existing evidence and actual clinical practice may be caused in large part by the small patient cohorts in published studies conducive to inaccurate conclusions. This article addresses the issue by analyzing prospectively collected data on a far larger population than hitherto available. The Israeli National Trauma Registry (INTR) collects data prospectively on patients admitted to trauma centers in Israel. We analyzed the INTR database on sternal fractures for demographics, mechanisms and severity of injury, diagnostic evaluation, treatment, and outcomes. Between 1997 and 2008, the INTR received data on 1,867 consecutive patients hospitalized with sternal fractures. The injury was sustained most often during motor vehicle accidents (84.1%), followed by falls (10.3%) and other blunt or penetrating mechanisms (5.6%). ISF was sustained in 26.4%, and PSF was sustained in 73.6%. Associated injuries involved most parts of the body. Cardiac contusions or lacerations were diagnosed in 1.8% of the 1,867 patients. ISF was associated with a lower incidence of cardiorespiratory compromise, more favorable trauma scores (Glasgow Coma Scale [GCS] score > 14, Revised Trauma Score > 11), and use of fewer intensive care facilities or operations compared with PSF. Endotracheal intubation, chest tube insertion, or thoracotomy was not performed in any ISF patient but was performed in 16.9% of the PSF cohort. The differences between ISF and PSF were statistically significant in all analyzed indices of injury severity. This study produced compelling evidence that

Scoring system to guide decision making for the use of gentamicin-impregnated collagen sponge to prevent deep sternal wound infection.

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Benedetto, Umberto; Raja, Shahzad G

2014-11-01

The effectiveness of the routine retrosternal placement of a gentamicin-impregnated collagen sponge (GICS) implant before sternotomy closure is currently a matter of some controversy. We aimed to develop a scoring system to guide decision making for the use of GICS to prevent deep sternal wound infection. Fast backward elimination on predictors, including GICS, was performed using the Lawless and Singhal method. The scoring system was reported as a partial nomogram that can be used to manually obtain predicted individual risk of deep sternal wound infection from the regression model. Bootstrapping validation of the regression models was performed. The final populations consisted of 8750 adult patients undergoing cardiac surgery through full sternotomy during the study period. A total of 329 patients (3.8%) received GICS implant. The overall incidence of deep sternal wound infection was lower among patients who received GICS implant (0.6%) than patients who did not (2.01%) (P=.02). A nomogram to predict the individual risk for deep sternal wound infection was developed that included the use of GICS. Bootstrapping validation confirmed a good discriminative power of the models. The scoring system provides an impartial assessment of the decision-making process for clinicians to establish if GICS implant is effective in reducing the risk for deep sternal wound infection in individual patients undergoing cardiac surgery through full sternotomy. Copyright © 2014 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

Pseudomass of the sternal manubrium in osteogenesis imperfecta

Energy Technology Data Exchange (ETDEWEB)

Yekeler, Ensar; Kumbasar, Basak; Dursun, Memduh; Tunaci, Mehtap [Department of Radiology, Istanbul University, Istanbul Faculty of Medicine, 34390, Capa, Istanbul (Turkey); Cantez, Serdar; Emiroglu, Halil Haldun [Department of Pediatrics, Istanbul University, Istanbul Faculty of Medicine, 34390, Capa, Istanbul (Turkey)

2003-06-01

Skeletal abnormalities such as hypertrophic callus formation and ''popcorn'' calcifications are rare radiological findings of osteogenesis imperfecta, causing tumor-like appearances on imaging. We report on a 7-year-old girl with osteogenesis imperfecta presenting with hepatomegaly and palpable lymphadenopathy in the left inguinal region on physical examination. Computed tomography examination revealed a high-density mass-like lesion of the manubrium sterni. Ultrasonography and a lateral roentgenogram of the chest verified that this was a pseudomass caused by a bowed sternal manubrium. (orig.)

Mumps vaccine virus strains and aseptic meningitis.

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Bonnet, Marie-Claude; Dutta, Anil; Weinberger, Clement; Plotkin, Stanley A

2006-11-30

Mumps immunization can easily be included in national schedules, particularly if combined with measles or measles and rubella vaccines, but debate continues concerning the relative safety of various licensed mumps vaccine strains. The opportunities for control of mumps are also being affected by differences in the cost of the vaccines prepared with different strains of mumps virus. The present report evaluates available data on the association of the Urabe and other strains of mumps vaccine with the occurrence of aseptic meningitis. We also review the comparative immunogenicity and efficacies of the most widely used mumps vaccines in controlled clinical trials and field evaluations, and briefly examine relative cost as it relates to the implementation of national immunization programs. We conclude that extensive experience with the most widely used mumps vaccine strains in many countries has shown that the risk-benefit ratio of live mumps vaccines is highly favourable for vaccination, despite the occasional occurence of aseptic meningitis.

Aseptic necrosis of femoral head complicating thalassemia

International Nuclear Information System (INIS)

Orzincolo, C.; Castaldi, G.; Scutellary, P.N.; Bariani, L.; Pinca, A.

1986-01-01

Aseptic necrosis of the femoral head is described in 4 patients, selected from 280 patients with homozygous β-thalassemia (Cooley anemia). The incidence of the complication appears to be very high (14.5per mille) in thalassemia, compared to the general population. The possible mechanism are discussed. (orig.)

Diabetes Mellitus and Hyperglycemia and the Risk of Aseptic Loosening in Total Joint Arthroplasty.

Science.gov (United States)

Maradit Kremers, Hilal; Schleck, Cathy D; Lewallen, Eric A; Larson, Dirk R; Van Wijnen, Andre J; Lewallen, David G

2017-09-01

It is unknown to what extent diabetes mellitus modifies the long-term risk of aseptic loosening in total hip arthroplasty (THA) and total knee arthroplasty (TKA). We examined the association between diabetes mellitus, perioperative hyperglycemia, and the likelihood of revisions for aseptic loosening. We studied 16,085 primary THA and TKA procedures performed at a large tertiary care hospital between 2002 and 2009. All blood glucose values around the time of surgery (within 1 week) were retrieved. Subsequent revision surgeries and the reasons for revision were ascertained through the institutional joint registry. Multivariate Cox models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) for aseptic loosening associated with diabetes mellitus and hyperglycemia adjusting for age, gender, body mass index, and surgery type. A total of 2911 (18%) surgeries had a diagnosis of diabetes mellitus at the time of surgery. Glucose testing was performed at least once in 7055 (44%) procedures within ±1 week of surgery. Although diabetic patients did not experience a higher risk of revision for aseptic loosening (HR, 0.87; 95% CI, 0.55-1.38), higher preoperative glucose values on the day before surgery were significantly associated with both the overall risk of revisions (HR, 2.80; 95% CI, 1.00-7.85) and revisions for aseptic loosening (HR, 4.95; 95% CI, 1.26-19.54). High preoperative hyperglycemia is a potential risk factor for aseptic loosening in THA and TKA. Copyright © 2017 Elsevier Inc. All rights reserved.

Risk Factors for Complications after Reconstructive Surgery for Sternal Wound Infection

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Ichiro Hashimoto

2014-05-01

Full Text Available Background Although the utility of flaps for the treatment of sternal wound infections following median sternotomy has been reported for 30 years, there have been few reports on the risk factors for complications after reconstruction. The objective of this investigation was to identify factors related to complications after the reconstruction of sternal wound infections. Methods A retrospective analysis of 74 patients with reconstructive surgery after sternal wound infection over a 5-year period was performed. Clinical data including age, sex, body mass index (BMI, comorbidities, bacterial culture, previous cardiac surgery, wound depth, mortality rate, type of reconstructive procedure, and complication rate were collected. Results The patients' BMI ranged from 15.2 to 33.6 kg/m2 (mean, 23.1±3.74 kg/m2. Wound closure complications after reconstructive surgery were observed in 36.5% of the cases. The mortality rate was 2.7%. Diabetes mellitus significantly affected the rate of wound closure complications (P=0.041. A significant difference in the number of complications was seen between Staphylococcus aureus (S. aureus and coagulase-negative Staphylococci (P=0.011. There was a correlation between harvesting of the internal thoracic artery and postoperative complications (P=0.048. The complication rates of the pectoralis major flap, rectus abdominis flap, omentum flap, a combination of pectoralis major flap and rectus abdominis flap, and direct closure were 23.3%, 33.3%, 100%, 37.5%, and 35.7%, respectively. Conclusions Diabetes mellitus, S. aureus, harvesting of the internal thoracic artery, and omentum flap were significant factors for complications after reconstruction. The omentum flap volume may be related to the complications associated with the omentum flap transfer in the present study.

Extramedullary spinal teratoma presenting with recurrent aseptic meningitis.

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Mpayo, Lucy L; Liu, Xiao-Hong; Xu, Man; Wang, Kai; Wang, Jiao; Yang, Li

2014-06-01

Spinal teratomas are extremely rare; they constitute meningitis. A 7-year-old boy presented with paroxysmal abdominal pain and a history of recurrent aseptic meningitis. Kernig and Brudzinski signs were present. Lumber puncture revealed pleocytosis with no evidence of bacteria growth. Imaging of the spine revealed a cystic lesion in spinal cord at thoracic level 9-11. Endoscopic excision of the cyst was successfully performed. Surgical and histopathological findings confirmed extramedullary matured teratoma. As the symptomatic attacks of spontaneous rupture of spinal teratoma resemble presentations of Mollaret meningitis, spinal teratoma should be considered in the differential diagnosis of Mollaret meningitis. We describe a rare example of spinal teratoma causing recurrent meningitis. Spine imaging should be considered in individuals with recurrent aseptic meningitis as this promotes earlier diagnosis, more appropriate treatment, and improved neurological outcome. Copyright © 2014 Elsevier Inc. All rights reserved.

Comparative Analysis of Direct Hospital Care Costs between Aseptic and Two-Stage Septic Knee Revision

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Kasch, Richard; Merk, Sebastian; Assmann, Grit; Lahm, Andreas; Napp, Matthias; Merk, Harry; Flessa, Steffen

2017-01-01

Background The most common intermediate and long-term complications of total knee arthroplasty (TKA) include aseptic and septic failure of prosthetic joints. These complications cause suffering, and their management is expensive. In the future the number of revision TKA will increase, which involves a greater financial burden. Little concrete data about direct costs for aseptic and two-stage septic knee revisions with an in depth-analysis of septic explantation and implantation is available. Questions/Purposes A retrospective consecutive analysis of the major partial costs involved in revision TKA for aseptic and septic failure was undertaken to compare 1) demographic and clinical characteristics, and 2) variable direct costs (from a hospital department’s perspective) between patients who underwent single-stage aseptic and two-stage septic revision of TKA in a hospital providing maximum care. We separately analyze the explantation and implantation procedures in septic revision cases and identify the major cost drivers of knee revision operations. Methods A total of 106 consecutive patients (71 aseptic and 35 septic) was included. All direct costs of diagnosis, surgery, and treatment from the hospital department’s perspective were calculated as real purchase prices. Personnel involvement was calculated in units of minutes. Results Aseptic versus septic revisions differed significantly in terms of length of hospital stay (15.2 vs. 39.9 days), number of reported secondary diagnoses (6.3 vs. 9.8) and incision-suture time (108.3 min vs. 193.2 min). The management of septic revision TKA was significantly more expensive than that of aseptic failure ($12,223.79 vs. $6,749.43) (p costs of explantation stage ($4,540.46) were lower than aseptic revision TKA ($6,749.43) which were again lower than those of the septic implantation stage ($7,683.33). All mean costs of stays were not comparable as they differ significantly (p cost drivers were the cost of the implant and

Magnetic resonance imaging in the evaluation of patients with aseptic meningoencephalitis and connective tissue disorders

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Appenzeller, Simone; Kobayashi, Eliane; Costallat, Lilian T.L.; Zanardi, Veronica de Araujo; Ribeiro Neto, Jose Menezes; Damasceno, Benito Pereira; Cendes, Fernando [Universidade Estadual de Campinas, SP (Brazil). Faculdade de Ciencias Medicas

2000-03-01

To describe the role of magnetic resonance imaging (MRI) in the evaluation of patients with chronic and recurrent aseptic meningitis. Method: A retrospective study of five patients with aseptic meningoencefalitis diagnosed by clinical and CSF findings. CT scans showed without no relevant findings. Results: MRI showed small multifocal lesions hyperintense on T2 weight images and FLAIR, with mild or no gadolinium enhancement, mainly in periventricular and subcortical regions. Meningoencephalitis preceded the diagnosis of the underlying disease in four patients (Behcet's disease or systemic lupus erythematosus). After the introduction of adequate treatment for the rheumatic disease, they did not present further symptoms of aseptic meningoencephalitis. Conclusion: Aseptic meningoencephalitis can be an early presentation of an autoimmune disease. It is important to emphasize the role of MRI in the diagnosis and follow-up of these patients. (author)

Magnetic resonance imaging in the evaluation of patients with aseptic meningoencephalitis and connective tissue disorders

International Nuclear Information System (INIS)

Appenzeller, Simone; Kobayashi, Eliane; Costallat, Lilian T.L.; Zanardi, Veronica de Araujo; Ribeiro Neto, Jose Menezes; Damasceno, Benito Pereira; Cendes, Fernando

2000-01-01

To describe the role of magnetic resonance imaging (MRI) in the evaluation of patients with chronic and recurrent aseptic meningitis. Method: A retrospective study of five patients with aseptic meningoencefalitis diagnosed by clinical and CSF findings. CT scans showed without no relevant findings. Results: MRI showed small multifocal lesions hyperintense on T2 weight images and FLAIR, with mild or no gadolinium enhancement, mainly in periventricular and subcortical regions. Meningoencephalitis preceded the diagnosis of the underlying disease in four patients (Behcet's disease or systemic lupus erythematosus). After the introduction of adequate treatment for the rheumatic disease, they did not present further symptoms of aseptic meningoencephalitis. Conclusion: Aseptic meningoencephalitis can be an early presentation of an autoimmune disease. It is important to emphasize the role of MRI in the diagnosis and follow-up of these patients. (author)

Magnetic resonance imaging in the evaluation of patients with aseptic meningoencephalitis and connective tissue disorders

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APPENZELLER SIMONE

2000-01-01

Full Text Available OBJECTIVE: To describe the role of magnetic resonance imaging (MRI in the evaluation of patients with chronic and recurrent aseptic meningitis.METHOD: A retrospective study of five patients with aseptic meningoencefalitis diagnosed by clinical and CSF findings. CT scans showed without no relevant findings. RESULTS: MRI showed small multifocal lesions hyperintense on T2 weighted images and FLAIR, with mild or no gadolinium enhancement, mainly in periventricular and subcortical regions. Meningoencephalitis preceded the diagnosis of the underlying disease in four patients (Behçet´s disease or systemic lupus erythematosus. After the introduction of adequate treatment for the rheumatic disease, they did not present further symptoms of aseptic meningoencephalitis. CONCLUSION: Aseptic meningoencephalitis can be an early presentation of an autoimmune disease. It is important to emphasize the role of MRI in the diagnosis and follow-up of these patients.

EFFECT OF PASTEURIZATION TEMPERATURE AND ASEPTIC FILLING ON THE SHELF-LIFE OF MILK

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Rodrigo Rodrigues PETRUS

2011-12-01

Full Text Available Aseptic filling process can contribute to extend the shelf-life of pasteurized milk. However, this technology is not still commercially practiced in Brazil for this product. The aim of this study was to evaluate the effect of the pasteurization temperature and aseptic filling on the stability of milk packaged in high density polyethylene bottle (HDPE. Three batches of one hundred bottles each were processed at 72, 83, and 94ºC/15s, followed by aseptic packaging and storage at 9ºC, simulating a deficient cold chain scenario as found in the Brazilian market. Microbiological stability evaluation was based on mesophilic and psychrotrophic counts. Sensory shelf-life was estimated according to the ratings assigned to the attributes appearance, aroma, flavor and overall appreciation of milk samples. The pasteurization temperature, in the range investigated, did not affect the shelf-life of milk, which lasted up to 11 days for the three processed batches. The aseptic filling, associated to the employed thermal treatments, did not extend the shelf-life of milk stored under the abuse condition of 9°C, considering that the commercial product shelf-life in Brazil is of about 10 days.

Risk factors for total hip arthroplasty aseptic revision.

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Khatod, Monti; Cafri, Guy; Namba, Robert S; Inacio, Maria C S; Paxton, Elizabeth W

2014-07-01

The purpose of this study was to evaluate patient, operative, implant, surgeon, and hospital factors associated with aseptic revision after primary THA in patients registered in a large US Total Joint Replacement Registry. A total of 35,960 THAs registered from 4/2001-12/2010 were evaluated. The 8-year survival rate was 96.7% (95% CI 96.4%-97.0%). Females had a higher risk of aseptic revision than males. Hispanic and Asian patients had a lower risk of revision than white patients. Ceramic-on-ceramic, ceramic-on-conventional polyethylene, and metal-on-conventional polyethylene bearing surfaces had a higher risk of revision than metal-on-highly cross-linked polyethylene. Body mass index, health status, diabetes, diagnosis, fixation, approach, bilateral procedures, head size, surgeon fellowship training, surgeon and hospital volume were not revision risk factors. Copyright © 2014 Elsevier Inc. All rights reserved.

La tuberculose sternale: à propos de 2 cas | Ouarssani | Pan African ...

African Journals Online (AJOL)

On rapporte deux cas de tuberculose sternale âgés respectivement de 45 ans et de 10ans, colligés au service de pneumologie, l'examen histologique et bactériologique ont permis d'affirmer le diagnostic de tuberculose, et le traitement antibacillaire a permis une évolution favorable .A la lumière de ces observations, les ...

Effect of the degree of sternal depression on the cardiac rotation in pectus excavatum: evaluation with spiral CT

International Nuclear Information System (INIS)

Yu Jianqun; Yang Zhigang; Li Zhenlin; Guo Yingkun; Lu Chunyan; Zhang Mei

2004-01-01

Objective: To evaluate the effects of the degree of sternal depression on the cardiac rotation in pectus excavatum by using spiral CT. Methods: Spiral CT features of 32 patients with surgically corrected pectus excavatum were retrospectively reviewed. They included 27 males and 5 females ranging in age from 6 months to 17 years (mean, 6.3 years). Analysis was based on relationship among the degree of sternal depression, CT depression index, cardiac rotation angle, and PV angle. Results: 32 cases of pectus excavatum presented the sternal depression (21 ± 7) mm, CT depression index 2.9 ± 1.8, cardiac rotation angle (55.9 ± 9.8) degree, and PV angle (49.8 ± 14.0) degree, respectively. The sternal depression (17 mm) in cases with CT depression index less than 2.4 was smaller than those with CT depression index 2.4-2.9 (21 mm) and CT depression index larger than 2.9 (27 mm) (F 5.39, P<0.01). Cardiac rotation angle (49.7 degree) in cases with CT depression index less than 2.4 was smaller than those with CT depression index 2.4-2.9 (55.5 degree) and CT depression index larger than 2.9 (66.9 degree) (F=7.44, P<0.01). PV angle (58.7 degree) in cases with CT depression index less than 2.4 was larger than those with CT depression index 2.4-2.9 (46.5 degree) and CT depression index more than 2.9 (42.4 degree) ( F=3.33, P<0.05). Cardiac rotation angle of pectus excavatum had positive correlation with the CT depression index (γ=0.73, P<0.01). Conclusion: Spiral CT is a better tool for revealing chest deformity and corresponding cardiac rotation. The degree of sternal depression in pectus excavatum directly influences the cardiac rotation, and they had positive correlation. (authors)

Effect of age on the incidence of aseptic meningitis following immunization with monovalent mumps vaccine.

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Muta, Hiromi; Nagai, Takao; Ito, Yuhei; Ihara, Toshiaki; Nakayama, Tetsuo

2015-11-09

The purpose of this study was to determine the risk of aseptic meningitis after mumps vaccination in younger children compared with older children. This prospective cohort study included a total of 21,465 children under 18 years of age who had received the first dose of three of the Japanese mumps monovalent vaccine. We compared the cumulative incidence of aseptic meningitis for 30 days after vaccination among the following age groups: ≤ 1, 2, 3-4, and ≥ 5 years old. We also investigated the cumulative incidence of salivary gland swelling, a fever (≥ 38°C) lasting at least 3 days during the 10 to 25 days following immunization, vomiting of 3 times or more, headache, and seizure. A total of 10 aseptic meningitis, 551 salivary gland swelling, 844 fevers, 669 vomiting, 757 headaches, and 29 seizure cases were identified. The cumulative incidence of aseptic meningitis increased with age (0.016%, 0.021%, 0.066%, and 0.096%, respectively). Statistical significance was observed between children ≥ 3 years old and those mumps vaccine that is currently available for use in Japan may be administered in children less than 3 years of age in order to complicate a less aseptic meningitis after immunization. Copyright © 2015 Elsevier Ltd. All rights reserved.

[Early aseptic loosening of the CF 30 femoral stem].

Science.gov (United States)

Kovanda, M; Havlícek, V; Hudec, J

2007-02-01

The CF 30 stem in combination with a cementless acetabulum was used at the First Department of Orthopedic Surgery in Brno in the years 1994 to 1995. From the second year following implantation, aseptic stem loosening was recorded. In order to find explanation of this early loosening, the authors, in cooperation with the Institute of Solid Mechanics, Mechatronics and Biomechanics, carried out the stress-strain analysis in a model system. Eighty patients (31 men and 49 women) received a cemented CF30 femoral component in 1994. Of them, 16 patients underwent revision arthroplasty, three died of causes unrelated to the surgery, and four were lost to follow-up. The final clinical and radiographic check-up was carried out in 2001. The results of a comprehensive examination were available in 57 patients with a CF30 stem. The patients were evaluated on the basis of the Harris hip score and anteroposterior radiographs of the hip. X-ray films obtained immediately after surgery and those taken at regular intervals during follow-up were compared. The following characteristics were noted: translucent lines in individual zones along the stem at the cement-bone interface; osteolysis, i. e., non-linear translucent areas, at least 5 mm long, at the cement-bone interface; and subsidence of the femoral component, i. e., migration of the stem distal to the tip of the greater trochanter. The CF 30 stem survival curve showed that aseptic stem loosening occurred from post-implantation year 2, and increased during the following years. At 6 years and 6 months, a total of 16 patients underwent revision surgery, involving reimplantation in 14 and implant removal in 2 patients. Potential causes of aseptic loosening: Polyethylene wear.However, no acetabular loosening was found in this group, although acetabular components are reported to become loose more often than femoral components. By comparison of the stem survival curves for Poldi and CF 30 stems it appeared that, at 6 years and 6 months

Aseptic necrosis in caisson workers: a new set of decompression tables.

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Downs, G J; Kindwall, E P

1986-06-01

There is a high incidence of aseptic necrosis and decompression sickness among caisson workers due to inadequate decompression using the current OSHA decompression tables (1-7). Because of this, a new set of tables--Autodec III-O2--was developed which more effectively eliminates nitrogen from the body and, therefore, should decrease the incidence of both bends and aseptic necrosis. The Autodec III-O2 schedule's superiority was statistically significant at a level of 0.08 compared to the OSHA table. It is our conclusion that OSHA should adopt the Autodec III-O2 schedule as a replacement for the current decompression tables.

Recurrent aseptic meningitis in association with Kikuchi-Fujimoto disease: case report and literature review

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Komagamine Tomoko

2012-09-01

Full Text Available Abstract Background Kikuchi Fujimoto disease (KFD, or histiocytic necrotising lymphadenitis, is a benign and self-limiting condition characterised by primarily affecting the cervical lymph nodes. Recurrent aseptic meningitis in association with KFD is extremely rare and remains a diagnostic challenge. Case presentation We report a 28-year-old man who presented 7 episodes of aseptic meningitis associated with KFD over the course of 7 years. Histopathological findings of enlarged lymph nodes led to the diagnosis of KFD. The patient’s headache and lymphadenopathy spontaneously resolved without any sequelae. Conclusions A diagnosis of KFD should be considered when enlarged cervical lymph nodes are observed in patients with recurrent aseptic meningitis. A long-term prognosis remains uncertain, and careful follow-up is preferred.

77 FR 21783 - Guidance on Media Fills for Validation of Aseptic Preparations for Positron Emission Tomography...

Science.gov (United States)

2012-04-11

...] Guidance on Media Fills for Validation of Aseptic Preparations for Positron Emission Tomography Drugs... Aseptic Preparations for Positron Emission Tomography (PET) Drugs.'' This guidance is intended to help... Preparations for Positron Emission Tomography (PET) Drugs.'' Most PET drugs are designed for parenteral...

Multicenter Quality Improvement Project to Prevent Sternal Wound Infections in Pediatric Cardiac Surgery Patients.

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Woodward, Cathy; Taylor, Richard; Son, Minnette; Taeed, Roozbeh; Jacobs, Marshall L; Kane, Lauren; Jacobs, Jeffrey P; Husain, S Adil

2017-07-01

Children undergoing cardiac surgery are at risk for sternal wound infections (SWIs) leading to increased morbidity and mortality. Single-center quality improvement (QI) initiatives have demonstrated decreased infection rates utilizing a bundled approach. This multicenter project was designed to assess the efficacy of a protocolized approach to decrease SWI. Pediatric cardiac programs joined a collaborative effort to prevent SWI. Programs implemented the protocol, collected compliance data, and provided data points from local clinical registries using Society of Thoracic Surgery Congenital Heart Surgery Database harvest-compliant software or from other registries. Nine programs prospectively collected compliance data on 4,198 children. Days between infections were extended from 68.2 days (range: 25-82) to 130 days (range: 43-412). Protocol compliance increased from 76.7% (first quarter) to 91.3% (final quarter). Ninety (1.9%) children developed an SWI preprotocol and 64 (1.5%) postprotocol, P = .18. The 657 (15%) delayed sternal closure patients had a 5% infection rate with 18 (5.7%) in year 1 and 14 (4.3%) in year 2 P = .43. Delayed sternal closure patients demonstrated a trend toward increased risk for SWI of 1.046 for each day the sternum remained open, P = .067. Children who received appropriately timed preop antibiotics developed less infections than those who did not, 1.9% versus 4.1%, P = .007. A multicenter QI project to reduce pediatric SWIs demonstrated an extension of days between infections and a decrease in SWIs. Patients who received preop antibiotics on time had lower SWI rates than those who did not.

Etiologies and Management of Aseptic Meningitis in Patients Admitted to an Internal Medicine Department.

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Jarrin, Irène; Sellier, Pierre; Lopes, Amanda; Morgand, Marjolaine; Makovec, Tamara; Delcey, Veronique; Champion, Karine; Simoneau, Guy; Green, Andrew; Mouly, Stéphane; Bergmann, Jean-François; Lloret-Linares, Célia

2016-01-01

Several studies have focused on the clinical and biological characteristics of meningitis in order to distinguish between bacterial and viral meningitis in the emergency setting. However, little is known about the etiologies and outcomes of aseptic meningitis in patients admitted to Internal Medicine.The aim of the study is to describe the etiologies, characteristics, and outcomes of aseptic meningitis with or without encephalitis in adults admitted to an Internal Medicine Department.A retrospective cohort study was conducted in the Internal Medicine Department of the Lariboisière Hospital in Paris, France, from January 2009 to December 2011. Clinical and biological characteristics of aseptic meningitis were recorded. These included cerebrospinal fluid analysis, results of polymerase chain reaction testing, final diagnoses, and therapeutic management.The cohort included 180 patients fulfilling the criteria for aseptic meningitis with (n = 56) or without (n = 124) encephalitis. A definitive etiological diagnosis was established in 83 of the 180 cases. Of the cases with a definitive diagnosis, 73 were due to infectious agents, mainly enteroviruses, Herpes Simplex Virus 2, and Varicella Zoster Virus (43.4%, 16.8%, and 14.5% respectively). Inflammatory diseases were diagnosed in 7 cases. Among the 97 cases without definitive diagnoses, 26 (26.8%) remained free of treatment throughout their management whereas antiviral or antibiotic therapy was initiated in the emergency department for the remaining 71 patients. The treatment was discontinued in only 10 patients deemed to have viral meningitis upon admission to Internal Medicine.The prevalence of inflammatory diseases among patients admitted to internal medicine for aseptic meningitis is not rare (4% of overall aseptic meningitis). The PCR upon admission to the emergency department is obviously of major importance for the prompt optimization of therapy and management. However, meningitis due to viral agents or

Results of Three-Dimensional Conformal Radiation Therapy for the Treatment of a Solitary Sternal Relapse of Breast Cancer

International Nuclear Information System (INIS)

Kim, Hae Young; Huh, Seung Jae; Park, Won; Choi, Do Ho; Kang, Min Kyu; Yang, Jung Hyun; Nam, Seok Jin; Im, Young Hyuck

2008-01-01

To evaluate the response and survival rate after three-dimensional conformal radiation therapy (3D-CRT) of patients with a solitary sternal relapse of breast cancer. Seventeen patients between May 1996 and June 2005 were evaluated with the salvage 3D-CRT treatment of a solitary sternal relapse of breast cancer. The treatment fields included the gross tumor volume with 2 cm margins. The total radiation dose was 35.0 ∼61.5 Gy (biologic effective dose of 43.7 ∼76.9 Gy10 using an α/β ratio of 10 Gy), with a daily dose of 1.8∼3.0 Gy. The tumor response was evaluated by the change in maximum tumor size via follow up CT scans 1∼3 months after the completion of treatment. An objective tumor response was achieved in all patients, with a complete response in 5 patients and a partial response in 12 patients. The 5-year overall survival rate was 51.9% (median survival time: 27 months), and the most important factor affecting overall survival was the disease-free interval (interval from primary surgery of breast cancer to the development of sternal metastasis): The 5-year overall survival rate was 61.8% for patients with a disease-free interval ≥12 months and 0.0% for patients < with disease-free interval <12 months (p=0.03). The response to 3D-CRT was good in patients with solitary sternal relapse of breast cancer. Particularly, patients with long disease-free interval from primary surgery survived significantly longer than patients with short disease-free interval from primary surgery

Potential application of quantitative microbiological risk assessment techniques to an aseptic-UHT process in the food industry.

Science.gov (United States)

Pujol, Laure; Albert, Isabelle; Johnson, Nicholas Brian; Membré, Jeanne-Marie

2013-04-01

Aseptic ultra-high-temperature (UHT)-type processed food products (e.g., milk or soup) are ready to eat products which are consumed extensively globally due to a combination of their comparative high quality and long shelf life, with no cold chain or other preservation requirements. Due to the inherent microbial vulnerability of aseptic-UHT product formulations, the safety and stability-related performance objectives (POs) required at the end of the manufacturing process are the most demanding found in the food industry. The key determinants to achieving sterility, and which also differentiates aseptic-UHT from in-pack sterilised products, are the challenges associated with the processes of aseptic filling and sealing. This is a complex process that has traditionally been run using deterministic or empirical process settings. Quantifying the risk of microbial contamination and recontamination along the aseptic-UHT process, using the scientifically based process quantitative microbial risk assessment (QMRA), offers the possibility to improve on the currently tolerable sterility failure rate (i.e., 1 defect per 10,000 units). In addition, benefits of applying QMRA are (i) to implement process settings in a transparent and scientific manner; (ii) to develop a uniform common structure whatever the production line, leading to a harmonisation of these process settings, and; (iii) to bring elements of a cost-benefit analysis of the management measures. The objective of this article is to explore how QMRA techniques and risk management metrics may be applied to aseptic-UHT-type processed food products. In particular, the aseptic-UHT process should benefit from a number of novel mathematical and statistical concepts that have been developed in the field of QMRA. Probabilistic techniques such as Monte Carlo simulation, Bayesian inference and sensitivity analysis, should help in assessing the compliance with safety and stability-related POs set at the end of the manufacturing

Tremendous bleeding complication after vacuum-assisted sternal closure

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Isgro Frank

2011-02-01

Full Text Available Abstract Vacuum-assisted closure (VAC of complex infected wounds has recently gained popularity among various surgical specialties. The system is based on the application of negative pressure by controlled suction to the wound surface. The effectiveness of the VAC System on microcirculation and the promotion of granulation tissue proliferation are proved. No contraindications for the use in deep sternal wounds in cardiac surgery are described. In our case report we illustrate a scenario were a patient developed severe bleeding from the ascending aorta by penetration of wire fragments in the vessel. We conclude that all free particles in the sternum have to be removed completely before negative pressure is used.

Effect of Storage on Quality and Acceptance of Aseptically ...

African Journals Online (AJOL)

Ashgourd (Benincasa hispida) juice was formulated with the help of Response Surface Methodology (RSM) and the storage stability of the juice was investigated. The juice was aseptically processed, sterilized at 137ıC for 4 seconds and packaged in 6 layer laminated packet under sterilized environment.

Major bleeding during negative pressure wound/V.A.C.® - therapy for postsurgical deep sternal wound infection - a critical appraisal

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Segers Patrique

2011-09-01

Full Text Available Abstract Negative-pressure wound therapy, commercially known as vacuum-assisted closure (V.A.C.® therapy, has become one of the most popular (and efficacious interim (prior to flap reconstruction or definite methods of managing deep sternal wound infection. Complications such as profuse bleeding, which may occur during negative-pressure therapy but not necessarily due to it, are often attributed to a single factor and reported as such. However, despite the wealth of clinical experience internationally available, information regarding certain simple considerations is still lacking. Garnering information on all the factors that could possibly influence the outcome has become more difficult due to a (fortunate decrease in the incidence of deep sternal wound infection. If more insight is to be gained from fewer clinical cases, then various potentially confounding factors should be fully disclosed before complications can be attributed to the technique itself or improvements to negative-pressure wound therapy for deep sternal wound infection can be accepted as evidence-based and the guidelines for its use adapted. The authors propose the adoption of a simple checklist in such cases.

Staphylococcus aureus sternal osteomyelitis: a rare cause of chest pain

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Kaur M

2015-10-01

Full Text Available Chest pain is a common presenting symptom with a broad differential. Life-threatening cardiac and pulmonary etiologies of chest pain should be evaluated first. However, it is critical to perform a thorough assessment for other sources of chest pain in order to limit morbidity and mortality from less common causes. We present a rare case of a previously healthy 45 year old man who presented with focal, substernal, reproducible chest pain and Staphylococcus aureus bacteremia who was later found to have primary Staphylococcus aureus sternal osteomyelitis.

Sternal wound complications after primary isolated myocardial revascularization: the importance of the post-operative variables.

NARCIS (Netherlands)

Noyez, L.; Druten, J.A.M. van; Mulder, J.; Schroen, A.M.; Skotnicki, S.H.; Brouwer, R.

2001-01-01

OBJECTIVE: Select pre-, peri-, and post-operative variables, predictive for sternal wound complications (SWC), in a clinical setting. METHODS: We analyzed pre-, peri-, and post-operative data of 3815 patients who underwent a primary isolated bypass grafting. 100 patients (2.6%) had post-operative

A review of eleven cases of tuberculosis presenting as sternal wound abscess after open heart surgery.

Science.gov (United States)

Tabaja, Hussam; Hajar, Zeina; Kanj, Souha S

2017-10-01

Sternal wound infection with Mycobacterium tuberculosis is an uncommon yet highly challenging disease that can be quite insidious with various presentations. We hereby provide a review of 10 cases in current literature and describe an additional case which illustrates the difficulties associated with diagnosis. We used PubMed and Google search engine to search the literature for all published papers reporting on cases of sternal M. tuberculosis infections post open-heart surgeries. A total of 11 cases were presented, including a case of our own. The majority were males and were exposed to endemic areas. The average age was 59.6 ± 15.5 years. Coronary artery bypass surgery accounted for 73% of procedures and the average time to symptoms onset was 12.2 ± 16.6 months. Diabetes was the most reported non-cardiac comorbidity. Presenting symptoms varied and only 5 patients had other organs involved. Blood tests and radiographic studies were neither sensitive nor specific. M. tuberculosis culture on debrided tissues was the most sensitive test but often forgotten initially. Diagnostic delay was seen in almost all cases, often leading to unnecessary courses of antibiotics and aggressive surgical interventions. Finally, all patients responded well to anti-tuberculosis treatment, with reported treatment duration ranging from 9 to 12 months. M. tuberculosis infection of the sternum should be suspected in late-onset sternal wound infections post open-heart surgery especially when the course is chronic and indolent.

The use of antibiotic-impregnated cement beads in the management of sternal osteomyelitis after treatment for malignant lymphoma

International Nuclear Information System (INIS)

Nakabayashi, Yohei; Kikuchi, Noriaki; Ogino, Toshihiko; Kim, Cholsu; Miyazaki, Ryouta; Sadahiro, Mitsuaki

2010-01-01

Currently, the majority of patients who develop Hodgkin's disease can be cured with radiotherapy and/or chemotherapy. A long follow up of cured patients has shown that the cumulative toxicity from treatment related complication rivals the mortality from Hodgkin's disease. We present a 38-year old male with Hodgkin's disease, treated with radiation and chemotherapy, who developed cardiac infarction and severe mediastinal fibrosis. After median sternotomy for cardiac bypass operation, he suffered from sternal osteitis and superior mediastinitis. A radical debridement must be avoided to protect the bypassed conduit embedded in the extended severe mediastinal fibrosis. Then after appropriate debridement and management of methicillin-resistant Staphylococcus aureus (MRSA) infection, latissimus dorsi myocutaneous flap transfer and use of vancomycin-impregnated cement beads achieved infection control. In this study we present our experience with bibliographical discussion. With the concept presented in this study, however, a consistent cure and prevention from subsequent infection-related morbidity and mortality were achieved even in the subset of the most severe, recalcitrant cases of sternal osteitis, and with an unacceptable rate of complications. This justifies the invasive nature of the procedure and suggests its application not only as a salvage operation for failures after previous interventions, but also as a primary approach for severe sternal osteomyelitis. (author)

A clinical study of short-term sternal photoplethysmography: recordings from patients with obstructive airways diseases

DEFF Research Database (Denmark)

Chreiteh, Shadi; Saadi, Dorthe Bodholt; Belhage, Bo

2016-01-01

and commercially accepted range. We then compared the SpO2 levels simultaneously obtained from the sternal PPGs and a commercially available finger pulse oximeter on 28 admitted patients with either asthma or Chronic Obstructive Pulmonary Disease (COPD). The Pearson correlation between the SpO2 levels estimated...

Aseptic meningitis in Germany associated with echovirus type 13

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Schreier Eckart

2001-09-01

Full Text Available Abstract Background Echoviruses are the commonest cause of aseptic meningitis. Echovirus type 13 which has not been isolated in Germany over a long period of time was the predominant enterovirus serotype associated with different local outbreaks of aseptic meningitis in Germany in 2000. Methods Virus isolation was performed from cerebrospinal fluid and stools. In order to study the genetic relationship of echovirus type 13 isolates, sequence analysis of a part of VP1 (~300 nt was carried out. Isolates from different geographic regions were compared to each other as well as to elder viruses (prototype strain from 1953, four isolates from 1965–1986. Results Overall, 55 isolates of echovirus type 13 were obtained from different parts of Germany. It was shown that the new isolated strains have a very high degree of homology on the nucleotide level (> 98% but differ significantly from the old strains (76–85%. Conclusions a Rare enterovirus serotypes can cause serious illness. b The molecular drift has also been shown for other enterovirus serotypes.

Detection of periprosthetic joint infections in presumed aseptic patients

DEFF Research Database (Denmark)

Xu, Yijuan; Lorenzen, Jan; Thomsen, Trine Rolighed

2016-01-01

Title: Detection of periprosthetic joint infections in presumed aseptic patients Yijuan Xu1, Jan Lorenzen1, Trine Rolighed Thomsen1,2, Kathrin Kluba3, Kathrin Chamaon3, Christoph Lohmann3 1. Danish Technological Institute, Aarhus, Denmark 2. Center for Microbial Communities, Department of Biotech......Title: Detection of periprosthetic joint infections in presumed aseptic patients Yijuan Xu1, Jan Lorenzen1, Trine Rolighed Thomsen1,2, Kathrin Kluba3, Kathrin Chamaon3, Christoph Lohmann3 1. Danish Technological Institute, Aarhus, Denmark 2. Center for Microbial Communities, Department...... of Biotechnology, Chemistry and Environmental Engineering, Aalborg University, Denmark 3. Department of Orthopaedics, Otto-von-Guericke University of Magdeburg, Germany Aim: ”The HypOrth project (New approaches in the development of Hypoallergenic implant material in Orthopaedics: Steps to personalised medicine......) aims to investigate adverse immune reactions to implant materials. For this project, it is of utmost importance to exclude patients with periprosthetic joint infections (PJIs). The aim of this study was to rule out PJIs in included patients using prolonged culture and next generation sequencing (NGS...

Mesenteric Lymphadenopathy in Childhood Epidemic Aseptic Meningitis: Sonographic Features and Clinical Significance

International Nuclear Information System (INIS)

Mun, Sung Hee; Park, Young Chan; Lee, Young Hwan

2006-01-01

To evaluate the sonographic features of mesenteric lymphadenopathy in childhood epidemic aseptic meningitis and to assess their clinical significance. Thirty-three patients (25 male, 8 female: mean age, 8.6 years) with a diagnosis of aseptic meningitis were prospectively evaluated with abdominal ultrasonography for the presence of enlarged mesenteric nodes. The size and number of enlarged mesenteric lymph nodes were analyzed in relationship with the patient's age, between the patients with abdominal pain or diarrhea (16 cases, 48%) and asymptomatic patients (17 cases, 52%). Mesenteric lymphadenopathy was seen in 31 patients (94%), all 16 symptomatic and 15 of the 17 asymptomatic patients. The number of enlarged nodes was most prevalent between 6-10, seen in 16 patients (52%) and the largest node ranged in size from 4 to 8 mm. Among the 31 patients with mesenteric lymphadenopathy, the mean size of the largest node was statistically different between the symptomatic (6.0 mm) and asymptomatic (5.0 mm) groups (p = 0.021). The number of enlarged nodes and the patient's age were not statistically different between the two groups. Mesenteric lymphadenopathy was seen in almost all cases of childhood epidemic aseptic meningitis, and may be related to the mesenteric lymphadenitis caused by enterovirus

Mesenteric Lymphadenopathy in Childhood Epidemic Aseptic Meningitis: Sonographic Features and Clinical Significance

Energy Technology Data Exchange (ETDEWEB)

Mun, Sung Hee; Park, Young Chan; Lee, Young Hwan [Catholic University of Daegu, College of Medicine, Daegu (Korea, Republic of)

2006-09-15

To evaluate the sonographic features of mesenteric lymphadenopathy in childhood epidemic aseptic meningitis and to assess their clinical significance. Thirty-three patients (25 male, 8 female: mean age, 8.6 years) with a diagnosis of aseptic meningitis were prospectively evaluated with abdominal ultrasonography for the presence of enlarged mesenteric nodes. The size and number of enlarged mesenteric lymph nodes were analyzed in relationship with the patient's age, between the patients with abdominal pain or diarrhea (16 cases, 48%) and asymptomatic patients (17 cases, 52%). Mesenteric lymphadenopathy was seen in 31 patients (94%), all 16 symptomatic and 15 of the 17 asymptomatic patients. The number of enlarged nodes was most prevalent between 6-10, seen in 16 patients (52%) and the largest node ranged in size from 4 to 8 mm. Among the 31 patients with mesenteric lymphadenopathy, the mean size of the largest node was statistically different between the symptomatic (6.0 mm) and asymptomatic (5.0 mm) groups (p = 0.021). The number of enlarged nodes and the patient's age were not statistically different between the two groups. Mesenteric lymphadenopathy was seen in almost all cases of childhood epidemic aseptic meningitis, and may be related to the mesenteric lymphadenitis caused by enterovirus

Survey to explore understanding of the principles of aseptic technique: Qualitative content analysis with descriptive analysis of confidence and training.

Science.gov (United States)

Gould, Dinah J; Chudleigh, Jane; Purssell, Edward; Hawker, Clare; Gaze, Sarah; James, Deborah; Lynch, Mary; Pope, Nicola; Drey, Nicholas

2018-04-01

In many countries, aseptic procedures are undertaken by nurses in the general ward setting, but variation in practice has been reported, and evidence indicates that the principles underpinning aseptic technique are not well understood. A survey was conducted, employing a brief, purpose-designed, self-reported questionnaire. The response rate was 72%. Of those responding, 65% of nurses described aseptic technique in terms of the procedure used to undertake it, and 46% understood the principles of asepsis. The related concepts of cleanliness and sterilization were frequently confused with one another. Additionally, 72% reported that they not had received training for at least 5 years; 92% were confident of their ability to apply aseptic technique; and 90% reported that they had not been reassessed since their initial training. Qualitative analysis confirmed a lack of clarity about the meaning of aseptic technique. Nurses' understanding of aseptic technique and the concepts of sterility and cleanliness is inadequate, a finding in line with results of previous studies. This knowledge gap potentially places patients at risk. Nurses' understanding of the principles of asepsis could be improved. Further studies should establish the generalizability of the study findings. Possible improvements include renewed emphasis during initial nurse education, greater opportunity for updating knowledge and skills post-qualification, and audit of practice. Copyright © 2018 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Anatomic study of the vascular perfusion of the sternum and its clinical relevance in deep sternal wound infection

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Spindler, Nick

2017-06-01

Full Text Available Introduction: Deep sternal wound infections (DSWI are a rare but devastating complication after median sternotomy. Minor perfusion in bone and soft tissue, especially after recruiting the internal mammary artery for bypass supports the development of wound infection and nonunion of the sternal bone. The aim of the study was the macroscopic and radiological presentation of the vascular system supplying the sternum, in particular the compensating blood supply routes in the event that the internal mammary artery is no longer available after use as a bypass vessel.Method: This anatomic study was carried out on the anterior chest wall of 7 specimens. The thorax plates of 7 specimens were analyzed macroscopically after microsurgical preparation. Different anatomic preparations were produced using different contrast or form-giving substances. Radiological analysis and three-dimensional reconstructions were performed to show alternative, collateral sternal vessel perfusion under estimation of the loss of the internal thoracic artery due to a bypass.Results: The length of the ITA (internal thoracic artery, measured from the beginning of the first rib to the division into the superior epigastric artery and musculophrenic artery, was an average of 16.3 cm. On average, 18.5 branches were delivered from each artery, 10 medially to the sternum supply, and the intercostal muscle. Conclusion: Our analysis gives an overview of the macroanatomic vessel system supplying the sternal bone, describing especially a common trunk deriving from the ITA and supplying multiple branches and playing an important role in building a collateral circulation of the sternum.For better evaluation, in vivo CT analysis with contrast media should be performed in patients prior to the operation and directly after the use of the double ITA to demonstrate the change in perfusion of the sternum.In the future, preconditioning of the sternum by coiling the deriving branches could become an

Morphological approach of the sternal foramen: an anatomic study and a short review of the literature.

Science.gov (United States)

Gkantsinikoudis, N; Chaniotakis, C; Gkasdaris, G; Georgiou, N; Kapetanakis, S

2017-01-01

The sternal foramen (SF) constitutes a specific anatomic defect in sternum, indicating an impaired fusion of ossificated segments, which occurs either in an anatomical part of the sternum or in sternal joints. The aim of this article is to provide baseline statistical data about the variations of the SF, to present a short review of the relevant literature and to compare results with other studies and populations. We review relevant literature, and we present data obtai-ned from skeletal samples of known population and sex. A total of 35 well-preserved dried sterna from the prefecture of Eastern Macedonia and Thrace, Greece, were selected: 20 men and 15 women with a mean age of 55 ± 6 years old. Measurements were made with a sliding calliper and photographic documentation. The incidence of the SF in the 35 dried specimens was 14.2%, 4 men (20% of male sample) and 1 woman (6.6% of female sample) and 80% of sternal foramina were observed in male individuals. The SF was found in the sternum body (2 cases, 40% of foramina), in xiphoid process (2 cases, 40% of foramina) and in sternoxiphoidal junction (1 case, 20% of foramina). All of the sterna presented 1 single visible SF. Two anatomically unique cases were identified throughout these 5 sterna, both belonging in male subjects. The SF constitutes a relatively common variation with great radiological, clinical, and forensic significance. Presence of a SF with irregular bony margins complicates considerably radiological differential diagnosis. Awareness of this important anatomic variation is fundamental for clinicians and autopsy pathologists, in order to avoid severe fatal complications and elucidate the exact cause of death, respectively.

Sternal Cleft and Pectus Excavatum: A Combined Approach for the Correction of a Complex Anterior Chest Wall Malformation in a Teenager.

Science.gov (United States)

Tocchioni, Francesca; Ghionzoli, Marco; Lo Piccolo, Roberto; Deaconu, Diana E; Facchini, Flavio; Milanez De Campos, Jose R; Messineo, Antonio

2015-06-01

Congenital sternal cleft is a rare chest wall malformation. Because of the flexibility of the chest in infants, surgical repair should be performed by primary closure in the neonatal period. In adolescents and adults, different techniques have been suggested to overcome the lack of sternal bone tissue. We describe a very rare case of an 18-year-old woman with a complete bifid sternum associated with pectus excavatum for whom a satisfactory cosmetic and functional result was obtained by adequate surgical planning, which entailed a combination of two standardized surgical techniques. Copyright © 2015 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Dual infection with hepatitis A and E virus presenting with aseptic meningitis: a case report.

Science.gov (United States)

Naha, Kushal; Karanth, Suman; Prabhu, Mukhyaprana; Sidhu, Manpreet Singh

2012-07-01

We report the case of a young male who presented with features of aseptic meningitis and elevated serum liver enzymes, but no symptoms or signs suggestive of an acute hepatitis. Subsequently, he was diagnosed with dual infection with hepatitis A and E viruses, and recovered completely with symptomatic therapy. Isolated aseptic meningitis, unaccompanied by hepatitic features is an unusual presentation of a hepatotrophic viral infection, and is yet to be reported with hepatitis A and E virus co-infection. Copyright © 2012 Hainan Medical College. Published by Elsevier B.V. All rights reserved.

Validation of the aseptic filling at the Parenteral Products Plant 3 in BioCen

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Marisol Álvarez-González

2016-07-01

Full Text Available As part of the continuous improvement process, a new parenterals production plant (PPP3 was constructed at the National Center for Bioproducts. The validation of the aseptic filling process is a key element to carry out before manufacturing products. Therefore, the aim of this work was to obtain documented evidence that all the operations were carried out according the regulations of Good Manufacturing Practices for liquid and lyophilized sterile products during the aseptic filling at the Parenterals Product Plant 3. The study was designed for lyophilized products connected to the manifold of the peristaltic pump and to the four rotary piston pumps. Besides, during the filling operation four interventions were planned. The validation was carried out with three consecutive batches of media fill. In the first processed lot no vial was contaminated, but in the second and third lots there was one contaminated vial. For that reason, an investigation was performed in order to know the cause of the contamination. Finally, with this wok the validated condition was obtained, following the regulations of Good Manufacturing Practices for sterile liquids and lyophilizes products during the aseptic filling process at the Parenterals Products Plant 3.

A diagnostic dilemma: drug-induced aseptic meningitis in a 45-year-old HIV-positive man.

LENUS (Irish Health Repository)

Rowley, D

2014-03-01

We describe a case of aseptic meningitis following the administration of moxifloxacin in a 45-year-old man with human immunodeficiency virus (HIV). At presentation he was receiving tuberculosis treatment on a modified regimen following severe hepatotoxicity; this included moxifloxacin, started 8 days previously. Initial cerebrospinal fluid (CSF) analysis was grossly abnormal. Anti-viral and -bacterial treatments were started. All microbiological tests proved negative and his moxifloxacin was withheld resulting in a complete normalisation of CSF. Drug-induced aseptic meningitis is a diagnosis of exclusion and presents a serious diagnostic dilemma. The decision to withhold medication cannot be taken lightly.

Major bleeding during negative pressure wound/VAC (R) - therapy for postsurgical deep sternal wound infection - a critical appraisal

NARCIS (Netherlands)

van Wingerden, J.J.; Segers, P.; Jekel, L.

2011-01-01

Negative-pressure wound therapy, commercially known as vacuum-assisted closure (V.A.C.(R)) therapy, has become one of the most popular (and efficacious) interim (prior to flap reconstruction) or definite methods of managing deep sternal wound infection. Complications such as profuse bleeding, which

Correlation of quantitative histopathological morphology and quantitative radiological analysis during aseptic loosening of hip endoprostheses.

Science.gov (United States)

Bertz, S; Kriegsmann, J; Eckardt, A; Delank, K-S; Drees, P; Hansen, T; Otto, M

2006-01-01

Aseptic hip prosthesis loosening is the most important long-term complication in total hip arthroplasty. Polyethylene (PE) wear is the dominant etiologic factor in aseptic loosening, which together with other factors induces mechanisms resulting in bone loss, and finally in implant loosening. The single-shot radiograph analysis (EBRA, abbreviation for the German term "Einzel-Bild-Röntgenanalyse") is a computerized method for early radiological prediction of aseptic loosening. In this study, EBRA parameters were correlated with histomorphological parameters of the periprosthetic membrane. Periprosthetic membranes obtained from 19 patients during revision surgery of loosened ABG I-type total hip pros-theses were analyzed histologically and morphometrically. The pre-existing EBRA parameters, the thickness of the PE debris lay-er and the dimension of inclination and anteversion, were compared with the density of macrophages and giant cells. Addi-tionally, the semiquantitatively determined density of lymphocytes, plasma cells, giant cells and the size of the necrotic areas were correlated with the EBRA results. All periprosthetic membranes were classified as debris-induced type membranes. We found a positive correlation between the number of giant cells and the thickness of the PE debris layer. There was no significant correlation between the number of macrophages or all semiquantitative parameters and EBRA parameters. The number of giant cells decreased with implant duration. The morphometrically measured number of foreign body giant cells more closely reflects the results of the EBRA. The semiquantitative estimation of giant cell density could not substitute for the morphometrical analysis. The density of macrophages, lymphocytes, plasma cells and the size of necrotic areas did not correlate with the EBRA parameters, indicating that there is no correlation with aseptic loosening.

Irradiation as a means of sterilizing packaging materials for aseptic systems

International Nuclear Information System (INIS)

Blundell, M.J.

1985-01-01

Long shelf life of foodstuffs is essential in order to feed the nations of the world. For 'wet' products which quickly deteriorate in air, the use of refrigeration, retort processing and preservatives can be considered. For example, the metal can will continue to be a reliable means of keeping meat and vegetable products in good condition for long periods at ambient conditons. Today, people require food items to be free of preservatives and with a flavour and texture very close to the original, at all times of the year, at lowest cost. Minimal heat processing and immediate filling into a pre-sterilised container without any possibility of contact with the atmosphere, is the logical route to take to meet these requirements and constitutes an aseptic system. The filled product remains in prime condition for many months without the need for refrigeration and preservatives. Irradiation is a convenient and cheap means of pre-sterilising plastic bags for Bag-in-Box systems and the writer will describe how fruit juices and fruit purees are now being packaged aseptically in South Africa and overseas

[Serotype distribution of enteroviruses isolated from paediatric cases prediagnosed as aseptic meningitis between 2001-2004 period].

Science.gov (United States)

Ozkaya, Etem; Uysal, Gülnar; Atak, Tunca; Alkan, Mehmet

2005-01-01

Enteroviruses have major clinical and public health importance and are one of the leading causes of aseptic meningitis. There are many diseases with similar clinical symptoms and cerebrospinal fluid (CSF) findings of aseptic meningitis, thus virus isolation and identification is crucial for definitive diagnosis. Virological diagnosis is nonetheless important to distinguish between induced meningitis and other treatable causes of disease with a similar clinical picture. A total of 249 samples obtained from 246 cases (age range: 0-15 years), prediagnosed as aseptic meningitis, were sent to Virology Laboratory of Refik Saydam Hygiene Center. The patients were followed at Department of Pediatric Infectious Diseases in the Social Security Hospital, Ankara, Turkey, between 2001 and 2004. Stool (n: 180), CSF (n: 54) and throat swab (n: 15) samples have been inoculated to RD (rhabdomyosarcoma), Hep-2 (human epithelioma) and L20B (transgenic mice) cell lines, and followed up for the presence of cytopathic effects. A total of 95 enterovirus strains were isolated from 85 (34.6%) cases, and serotyped by using RIVM (National Institute of Public and the Environment, Nederlands) antisera with microneutralization method. As a result, the most frequently isolated types were found as echovirus type 30 (n: 24) and coxsackievirus type B (n: 19), which were most frequently isolated between July to October. This is the first report from Turkey for aseptic meningitis cases due to echovirus type 25 (n:3), 18 (n:2), 14 (n:1), 13 (n:4), 11 (n:6), 9 (n:1), 6 (n:9), 5 (n:1), 4 (n:1) and coxsackievirus type A9 (n:1).

Synovitis, acne, pustulosis, hyperostosis and osteitis (SAPHO) syndrome presenting a primary sternal lesion

International Nuclear Information System (INIS)

Serrano, Carlos A.; Leani, Marcelo J.; Rieu, Juan; Serrano, Santiago O.; Dettano, Veronica

2003-01-01

SAPHO syndrome-acronym for synovitis, acne, pustules, hyperostosis and osteitis, is a nosological entity including multiple affections with cutaneous and osteoarticular involvement. We report the case of a 59 years old female patient that consulted due to an acute sternal pain. After some months the patient showed a palm-plantar pustular exanthem, acne and fever. SAPHO syndrome was diagnosed based on a CT, an osseous gammagraphy and a biopsy of cutaneous lesions. The current actual tendency is to consider the SAPHO syndrome as a seronegative arthropathy with a similar pathophysiology to Reiter's syndrome. (author)

Aseptic necrosis of the femoral head after pregnancy: a case report

OpenAIRE

Nassar, Kawtar; Rachidi, Wafae; Janani, Saadia; Mkinsi, Ouafa

2016-01-01

A documented case of beginning aseptic necrosis of the femoral head associated with pregnancy together with a review of the literature about this rare complication of pregnancy is presented. The known risk factors of osteonecrosis are; steroid use, alcoholism, organ transplantation, especially after kidney transplant or bone marrow transplantation bone, systemic lupus erythematosus, dyslipidemia especially hypertriglyceridemia, dysbaric decompression sickness, drepanocytosis and Gaucher's dis...

The HeartShield device reduces the risk for right ventricular damage in patients with deep sternal wound infection.

Science.gov (United States)

Ingemansson, Richard; Malmsjö, Malin; Lindstedt, Sandra

2014-01-01

Right ventricular rupture, resulting in serious bleeding, is a life-threatening complication associated with negative-pressure wound therapy (NPWT) in cardiac surgery. The use of a rigid barrier between the heart and the sharp sternal edges has been successfully tested on pigs. In the present article, we demonstrate increased safety in NPWT through the use of the HeartShield device. Six patients were treated with a specially designed device in combination with NPWT. The device consists of a horizontally placed disk covered in foam. The back of the T-shaped device sticks up between the sternal edges and up above skin level. This part of the device is also covered in foam. Drainage is performed through two holes at the top of the device. The device and foam are changed every second to third day, and -120 mm Hg of continuous therapy is used. Six patients were treated with traditional NPWT, serving as control group. No signs of calluslike formation were seen on the right ventricle in the group treated with the HeartShield device. In the conventional NPWT control group, all six patients had calluslike formation (>1 × 2 cm2) on the anterior part of the right ventricle. All patients in the HeartShield group had grade 1 epicardial petechial bleeding (the right ventricle. In the control group, one patient had grade 1 (2.0 cm2) epicardial petechial bleeding on the right ventricle. No major bleeding or mortality was observed in either group during the course of the study. The use of the HeartShield device significantly minimizes the contact between the right ventricle and the sternal edges, thereby decreasing the risk for life-threatening complications due to bleeding.

Herpes simplex virus type 2-associated recurrent aseptic (Mollaret's meningitis in genitourinary medicine clinic: a case report

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Abou-Foul AK

2014-03-01

Full Text Available Ahmad K Abou-Foul, Thajunisha M Buhary, Sedki L Gayed Department of Genitourinary Medicine, Royal Blackburn Hospital, East Lancashire Hospitals NHS Trust, Blackburn, UK Introduction: Cases of idiopathic recurrent benign aseptic meningitis were first described by Mollaret. Today, herpes simplex virus (HSV is considered the cause of most cases of Mollaret's meningitis. Case report: A 40-year-old male was referred to our genitourinary medicine clinic with recurrent genital herpetic lesions. He had HSV-2-positive genital ulcers 8 years earlier. One year after the first infection, he developed severe recurrent attacks of headache associated with meningitis symptoms. The results of all radiological and biochemical tests were normal, but the patient reported a correlation between his attacks and genital herpes flare-ups. We diagnosed the patient with Mollaret's meningitis and started him on continuous suppressive acyclovir therapy, which resulted in marked clinical improvement. Discussion: Mollaret's meningitis is a rare form of idiopathic recurrent aseptic meningitis that has a sudden onset, short duration, and spontaneous remission with unpredictable recurrence. We believe that the presence of concurrent or recurrent mucocutaneous herpetic lesions can aid its diagnosis, prior to which, affected patients usually have many unnecessary investigations and treatments. Therefore, detailed sexual history should be sought in all patients with aseptic meningitis, and clinicians should also ask about history of recurrent headaches in all patients with recurrent herpetic anogenital lesions. Continuous suppressive acyclovir therapy may reduce the frequency and severity of attacks and can dramatically improve lifestyle. Keywords: HSV-2 virus, acyclovir, Mollaret's meningitis, recurrent aseptic meningitis, HSV-2 virus, viral meningitis, acyclovir

Major bleeding during negative pressure wound/V.A.C.®--therapy for postsurgical deep sternal wound infection--a critical appraisal

NARCIS (Netherlands)

van Wingerden, Jan J.; Segers, Patrique; Jekel, Lilian

2011-01-01

Negative-pressure wound therapy, commercially known as vacuum-assisted closure (V.A.C.®) therapy, has become one of the most popular (and efficacious) interim (prior to flap reconstruction) or definite methods of managing deep sternal wound infection. Complications such as profuse bleeding, which

Irradiated or aseptically prepared frozen dairy desserts: acceptability to bone marrow transplant recipients

International Nuclear Information System (INIS)

Dong, F.M.; Hashisaka, A.E.; Rasco, B.A.; Einstein, M.A.; Mar, D.R.; Aker, S.N.

1992-01-01

Sterile ice cream and frozen yogurt were offered to immunosuppressed patients recovering from bone marrow transplantation. To obtain sterile products, two of the dairy desserts (prepackaged ice cream and frozen yogurt bars) were exposed to 40 kGy of cobalt 60 irradiation. Four different flavors of ice cream were aseptically prepared under a laminar airflow hood using commercially sterilized ingredients. A commercially sterile, frozen milk-based drink on the low-microbial menu served as the control. Ratings of the seven products by 17 patients indicated that a frozen vanilla milk-based drink and aseptically prepared chocolate ice cream were highly acceptable to recovering immunosuppressed patients who have difficulty eating most foods. However, the seven desserts received higher ratings from a sensory panel of healthy individuals than from the patient panel, confirming that new foods for the low-microbial diet should be ''market-tested'' by the targeted patient population before inclusion in the menu

Irradiated or aseptically prepared frozen dairy desserts: acceptability to bone marrow transplant recipients.

Science.gov (United States)

Dong, F M; Hashisaka, A E; Rasco, B A; Einstein, M A; Mar, D R; Aker, S N

1992-06-01

Sterile ice cream and frozen yogurt were offered to immunosuppressed patients recovering from bone marrow transplantation. To obtain sterile products, two of the dairy desserts (prepackaged ice cream and frozen yogurt bars) were exposed to 40 kGy of cobalt 60 irradiation. Four different flavors of ice cream were aseptically prepared under a laminar airflow hood using commercially sterilized ingredients. A commercially sterile, frozen milk-based drink on the low-microbial menu served as the control. Ratings of the seven products by 17 patients indicated that a frozen vanilla milk-based drink and aseptically prepared chocolate ice cream were highly acceptable to recovery immunosuppressed patients who have difficulty eating most foods. However, the seven desserts received higher ratings from a sensory panel of healthy individuals than from the patient panel, confirming that new foods for the low-microbial diet should be "market-tested" by the targeted patient population before inclusion in the menu.

Acute and subchronic oral toxicity studies in rats of a hydrolyzed chicken sternal cartilage preparation.

Science.gov (United States)

Schauss, A G; Merkel, D J; Glaza, S M; Sorenson, S R

2007-02-01

Two acute and subchronic oral toxicity studies were conducted in rats to evaluate safety of a patented preparation of hydrolyzed chicken sternal cartilage (BioCell Collagen II) containing collagen type II, chondroitin sulfate, and hyaluronic acid. In the acute oral toxicity study, five males and five females of Sprague-Dawley rats were administered a single dose of 5000 mg of the test product per kg body weight and observed for 14 days. All animals survived and exhibited normal body weight gain throughout the study. Macroscopic necropsy examination conducted on day 15 revealed no gross pathological lesions in any of the animals. In the subchronic study, Sprague-Dawley rats (40 males, 40 females) were divided into four same-sex groups (10 animals/group). Animals in each group were administered daily either 0, 30, 300 or 1000 mg of the test product per kg of body weight for over 90 days. All animals survived and showed no significant changes in their body weights and histopathology. Although some differences were observed between the treated and control animals in several parameters, they were generally not dose-related or considered to be of toxicological significance. In conclusion, the results from the two oral toxicity studies with male and female young adult rats indicated that the test preparation from hydrolyzed chicken sternal cartilage collagen (BioCell Collagen II) was well tolerated at all four doses tested.

Management plan for deep sternal wound infection targeting to survival free of recurrence: A prospective evaluation study

Directory of Open Access Journals (Sweden)

Ibrahim Kasb

2016-10-01

Conclusion: Management of DSWI is tedious, has prolonged hospital stay and is associated with high morbidity and mortality rates. Management of DSWI must be personalized according to findings on exploration of the sternal wound and flap coverage must be initiated only when the patient is bacteriologically free. Both PMF and/or VOF provided high acceptable success rate defined as survival free of DSWI recurrence.

Influence of recycling rate increase of aseptic carton for long-life milk on GWP reduction

International Nuclear Information System (INIS)

Mourad, Anna Lucia; Garcia, Eloisa E.C.; Vilela, Gustavo Braz; Von Zuben, Fernando

2008-01-01

Tetra Pak, through intensive cooperation with its supply chain, increased the post-consumer recycling rate of the aseptic packaging for long-life milk in the last 10 years. In continuation of a previous study that presented a superior overall performance in terms of reduction of the consumption of natural resources, air emissions and most of the water emissions, the objective of the present work was to apply life cycle assessment (LCA) to measure the global warming potential (GWP). The system was assessed using as functional unit 1000 liters of milk packaged in Tetra Pak Aseptic containers. The reduction of greenhouse gas emissions was calculated for recycling rates of 2%, 22%, 30%, 40% and 70% of the post-consumer residues in Scenarios I (only cardboard recycling) and II (total aseptic laminate recycling). Scenario I showed a 14% reduction in GWP, representing 26 kg of avoided CO 2 equiv. emitted due to the efforts of Tetra Pak to increase the recycling rate from 2% (2000) to 22% (2004). If it will be possible to increase the recycling rate to 70% of post-consumer packages in the future, a 48% reduction of GWP could be attained. Methane exhibited the greatest mass reduction among the greenhouse emissions, since it is emitted during the production of cardboard and also as a result of anaerobic degradation in landfills. The total reduction of the energy requirements of the system due to the increase of the recycling rate (from 2% to 22%) is 154 MJ/1000 liters, a saving of 7%. Scenario II (which considers additional polyethylene and aluminum recycling) has a smaller effect on GWP reduction than Scenario I, since PE/AL represent only 25% of the total mass of the container. The major benefit of the recycling of aseptic cartons is the reduction of the amounts of virgin materials required and the consequent reduction of air emissions. The results of this study can be used to encourage the collection of post-consumer milk cartons as part of environmental education

Legal, ethical, and procedural bases for the use of aseptic techniques to implant electronic devices

Science.gov (United States)

Mulcahy, Daniel M.

2013-01-01

animals often mask the signs of infection to avoid attracting predators (Wobeser 2006). Guidance specific to sterilization of electronic devices for implantation is limited in the wildlife record (Burger et al. 1994; Mulcahy 2003). Few biologists have been formally trained in aseptic technique, but most biologists know that electronic devices should be treated in some way to reduce the chance for infection of the host animal by bacteria, viruses, parasites, and fungi. Most biologists (73%) who implant devices into fishes believe aseptic techniques are important (Wagner and Cooke 2005). However, I maintain that many biologists find it difficult to place the concept of asepsis into practice in their work because of confusion about what constitutes aseptic technique, a lack of surgical knowledge and training, the perception of increased costs, or the belief that aseptic surgeries are impractical or unnecessary for their application. Some have even argued that, while compromising surgical techniques in the field might result in complications or mortalities, the money saved would allow for a compensatory increase in sample size (Anderson and Talcott 2006). In this paper I define aseptic surgical techniques, document the legal and professional guidance for performing aseptic surgeries on wild animals, and present options for sterilizing electronic devices and surgical instruments for field use.

A Fuzzy Expert System for Distinguishing between Bacterial and Aseptic Meningitis

Directory of Open Access Journals (Sweden)

Mostafa Langarizadeh

2015-05-01

Full Text Available Introduction Bacterial meningitis is a known infectious disease which occurs at early ages and should be promptly diagnosed and treated. Bacterial and aseptic meningitis are hard to be distinguished. Therefore, physicians should be highly informed and experienced in this area. The main aim of this study was to suggest a system for distinguishing between bacterial and aseptic meningitis, using fuzzy logic.    Materials and Methods In the first step, proper attributes were selected using Weka 3.6.7 software. Six attributes were selected using Attribute Evaluator, InfoGainAttributeEval, and Ranker search method items. Then, a fuzzy inference engine was designed using MATLAB software, based on Mamdani’s fuzzy logic method with max-min composition, prod-probor, and centroid defuzzification. The rule base consisted of eight rules, based on the experience of three specialists and information extracted from textbooks. Results Data were extracted from 106 records of patients with meningitis (42 cases with bacterial meningitis in order to evaluate the proposed system. The system accuracy, specificity, and sensitivity were 89%, 92 %, and 97%, respectively. The area under the ROC curve was 0.93, and Kappa test revealed a good level of agreement (k=0.84, P

Ionizing radiations in aseptic bottling: a comparison between technologies and safety requirements [beverages

International Nuclear Information System (INIS)

Bottani, E.; Rizzo, R.; Vignali, G.

2006-01-01

Ionizing radiations, commonly adopted in the medical field, are recently experiencing a wide diffusion in industrials applications. One of the most widespread uses of ionizing radiations refers to foodstuffs and packaging sterilization. In the aseptic bottling area, the application of this technology on polymeric caps is quickly developing. In such application, sterilization could be obtained with beta-rays, generated by an electron beam, or with gamma-rays, emitted by a radioactive source. After a brief explanation of physical properties of ionizing radiations, the aim of this paper is to discuss the use of radiations in aseptic bottling. Based on results available in literature, radiations effects on treated materials are discussed, as well as safety requirements aiming at reducing risks related to radiation exposure. Finally, sterilization plants with gamma and beta radiation are compared, with the aim of examining functioning principles and management complexity. As a result of the comparison between the two technologies, the electron beam (beta-rays) adoption for caps sterilization process proves to be preferable [it

A method of experimental rheumatoid arthritis induction using collagen type II isolated from chicken sternal cartilage.

Science.gov (United States)

Su, Zhaoliang; Shotorbani, Siamak Sandoghchian; Jiang, Xugan; Ma, Rui; Shen, Huiling; Kong, Fanzhi; Xu, Huaxi

2013-07-01

At present, collagen‑induced arthritis (CIA) is the best known and most extensively used model for the immunological and pathological characteristics of human rheumatoid arthritis (RA). This model is useful not only in aiding our understanding of the pathogenesis of this disease, but also in the development of new therapies. Bovine, porcine and human collagen has been used to induce CIA; however, response has been identified to vary between strains and injection conditions, and false positive results and reduced potency are common as a result of minor contaminants or deglycosylated protein. Therefore, in the present study, type II collagen (CII) was isolated and purified from chicken sternal cartilage and was found to successfully induce the RA model. Furthermore, T helper 17 (Th17) cells were observed to infiltrate the joint on day 45 following induction by CII. In vitro, expression of toll‑like receptor 2 (TLR2) increased in peritoneal macrophages stimulated by CII. In addition, blockage of TLR2 was identified to markedly decrease levels of TGF‑β and IL‑6 in the cell culture supernatant. The results indicate that CII isolated from chicken sternal cartilage may be recognized by TLR2 on macrophages, leading to TGF‑β and IL‑6 production and subsequent activation of Th17 cells which mediates CIA development.

Performance Analysis of Exam Gloves Used for Aseptic Rodent Surgery

Science.gov (United States)

LeMoine, Dana M; Bergdall, Valerie K; Freed, Carrie

2015-01-01

Aseptic technique includes the use of sterile surgical gloves for survival surgeries in rodents to minimize the incidence of infections. Exam gloves are much less expensive than are surgical gloves and may represent a cost-effective, readily available option for use in rodent surgery. This study examined the effectiveness of surface disinfection of exam gloves with 70% isopropyl alcohol or a solution of hydrogen peroxide and peracetic acid (HP–PA) in reducing bacterial contamination. Performance levels for asepsis were met when gloves were negative for bacterial contamination after surface disinfection and sham ‘exertion’ activity. According to these criteria, 94% of HP–PA-disinfected gloves passed, compared with 47% of alcohol-disinfected gloves. In addition, the effect of autoclaving on the integrity of exam gloves was examined, given that autoclaving is another readily available option for aseptic preparation. Performance criteria for glove integrity after autoclaving consisted of: the ability to don the gloves followed by successful simulation of wound closure and completion of stretch tests without tearing or observable defects. Using this criteria, 98% of autoclaved nitrile exam gloves and 76% of autoclaved latex exam gloves met performance expectations compared with the performance of standard surgical gloves (88% nitrile, 100% latex). The results of this study support the use of HP–PA-disinfected latex and nitrile exam gloves or autoclaved nitrile exam gloves as viable cost-effective alternatives to sterile surgical gloves for rodent surgeries. PMID:26045458

Performance analysis of exam gloves used for aseptic rodent surgery.

Science.gov (United States)

LeMoine, Dana M; Bergdall, Valerie K; Freed, Carrie

2015-05-01

Aseptic technique includes the use of sterile surgical gloves for survival surgeries in rodents to minimize the incidence of infections. Exam gloves are much less expensive than are surgical gloves and may represent a cost-effective, readily available option for use in rodent surgery. This study examined the effectiveness of surface disinfection of exam gloves with 70% isopropyl alcohol or a solution of hydrogen peroxide and peracetic acid (HP-PA) in reducing bacterial contamination. Performance levels for asepsis were met when gloves were negative for bacterial contamination after surface disinfection and sham 'exertion' activity. According to these criteria, 94% of HP-PA-disinfected gloves passed, compared with 47% of alcohol-disinfected gloves. In addition, the effect of autoclaving on the integrity of exam gloves was examined, given that autoclaving is another readily available option for aseptic preparation. Performance criteria for glove integrity after autoclaving consisted of: the ability to don the gloves followed by successful simulation of wound closure and completion of stretch tests without tearing or observable defects. Using this criteria, 98% of autoclaved nitrile exam gloves and 76% of autoclaved latex exam gloves met performance expectations compared with the performance of standard surgical gloves (88% nitrile, 100% latex). The results of this study support the use of HP-PA-disinfected latex and nitrile exam gloves or autoclaved nitrile exam gloves as viable cost-effective alternatives to sterile surgical gloves for rodent surgeries.

Association between Apoptotis and CD4+/CD8+ T-Lymphocyte Ratio in Aseptic Loosening after Total Hip Replacement

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Landgraeber, Stefan; von Knoch, Marius; Löer, Franz; Brankamp, Jochen; Tsokos, Michael; Grabellus, Florian; Schmid, Kurt Werner; Totsch, Martin

2009-01-01

Particle-induced osteolysis is a major cause of aseptic loosening after total joint replacement. While the osteolytic cascade initiated by cytokine release from macrophages has been studied extensively, the involvement of T-lymphocytes in this context is controversial and has been addressed by only a few authors. In a former study we detected that the quantity of T-lymphocytes may be influenced by apoptosis in patients with aseptic loosening. In this study we intended to find out more details about the apoptosis-induced shifting of the T-cell number. We focused our interest on the CD4+ and CD8+ T-cells and their relative ratio. Caspase-3 cleaved was evaluated immunohistochemically to detect apoptotic T-cells in capsules and interface membranes from patients with aseptic hip implant loosening and a varying degree of caspase-3 cleaved expression in CD4+ and CD8+ T-lymphocytes was detected. Moreover, a relationship between the intensity of the apoptotic reactions and the radiological extent of osteolysis was observed. The number of CD4+ cells was decreased in the presence of strong apoptotic reactions, respectively extensive osteolysis, while CD8+ cells were affected to a much lower degree. Thus, the CD4+/CD8+ ratio changed from 1.0 in cases with only small areas of periprosthetic osteolysis and minimally intense apoptosis to 0.33 in cases with large areas of osteolysis. This may suggest a causal relationship between the apoptosis-induced shift in the CD4+/CD8+ ratio and the osteolysis respectively aseptic loosening. It is possible that these findings may lead to a new understanding of particle-induced osteolysis. PMID:19214244

The risk of aseptic meningitis associated with the Leningrad-Zagreb mumps vaccine strain following mass vaccination with measles-mumps-rubella vaccine, Rio Grande do Sul, Brazil, 1997.

Science.gov (United States)

da Silveira, Claudio Marcos; Kmetzsch, Claudete Iris; Mohrdieck, Renate; Sperb, Alethea Fagundes; Prevots, D Rebecca

2002-10-01

Few data are available on the risk of aseptic meningitis following vaccination with the Leningrad-Zagreb (L-Z) strain of mumps vaccine. In 1997 the mumps vaccine was introduced into the state of Rio Grande do Sul in Brazil through mass vaccination with mumps-measles-rubella (MMR), targeting children aged 1-11 years. Five municipalities used exclusively MMR vaccine containing the L-Z strain of mumps. An outbreak of aseptic meningitis was observed shortly after the mass campaign. To estimate the risk of aseptic meningitis associated with this strain, we analysed vaccination and meningitis case surveillance data from the selected municipalities. A case of vaccine-associated aseptic meningitis was defined as one with a pleocytosis of 10-1,500 leukocytes/ml and occurring within 15-35 days after vaccine receipt. We estimated a risk of 2.9 cases per 10,000 doses of L-Z administered, equivalent to 1 case per 3,390 doses administered. The overall risk of aseptic meningitis following the campaign was increased 12.2-fold (95% CI: 6.0-24.7) compared with the same period in 1995-1996. Following the mass campaign, the incidence of mumps declined 93% during 1998-2000. Vaccination with the L-Z strain of mumps vaccine as part of a mass campaign was associated with a significantly increased risk of aseptic meningitis. Decisions about type of mumps vaccine and mumps vaccination strategies must consider vaccine safety issues in addition to other criteria.

Developmental dysplasia of the hip, age, BMI, place of residence and tobacco abuse increase the odds of aseptic loosening in Chinese patients.

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Chuanlong Wu

Full Text Available PURPOSE: The purpose of this hospital-based case-control study was to evaluate the patient-related risk factors for aseptic loosening after total hip arthroplasty (THA and total knee arthroplasty (TKA in Chinese patients. METHODS: From January 2000 to December 2012, 67 patients undergoing THA and TKA who developed aseptic loosening were detected as case subjects and 336 patients without aseptic loosening, matched by the year of index surgery and type of surgery, were selected as controls. Conditional logistic regression was used to compute odds ratios (ORs and 95% confidence intervals (CIs. RESULTS: The demographic factors and comorbid conditions associated with a risk-adjusted increase in aseptic loosening (in decreasing order of significance were a rural place of residence (OR = 2.28; 95% CI: 1.21-4.30; p = 0.011, body mass index (BMI ≥ 28 kg/m(2 (vs. 18.5-28 kg/m(2 (OR = 2.29; 95% CI: 1.19-4.41; p = 0.013, developmental dysplasia of the hip (DDH (OR = 2.91; 95% CI: 1.11-7.66; p = 0.030, tobacco abuse (OR = 2.88; 95% CI: 1.05-7.89; p = 0.039, and age <45 years (vs. 45-65 years (OR = 2.63; 95% CI: 1.01-6.80; p = 0.047. CONCLUSIONS: Patients aged <45 years and those with a BMI of ≥ 28 kg/m(2, a preoperative diagnosis of DDH, history of tobacco abuse, or living in rural areas are at increased risk for aseptic loosening after THA and TKA in Chinese population. Additional systematic large-scale studies are needed to verify these results.

Successful human infection with P. falciparum using three aseptic Anopheles stephensi mosquitoes: a new model for controlled human malaria infection.

Directory of Open Access Journals (Sweden)

Matthew B Laurens

Full Text Available Controlled human malaria infection (CHMI is a powerful method for assessing the efficacy of anti-malaria vaccines and drugs targeting pre-erythrocytic and erythrocytic stages of the parasite. CHMI has heretofore required the bites of 5 Plasmodium falciparum (Pf sporozoite (SPZ-infected mosquitoes to reliably induce Pf malaria. We reported that CHMI using the bites of 3 PfSPZ-infected mosquitoes reared aseptically in compliance with current good manufacturing practices (cGMP was successful in 6 participants. Here, we report results from a subsequent CHMI study using 3 PfSPZ-infected mosquitoes reared aseptically to validate the initial clinical trial. We also compare results of safety, tolerability, and transmission dynamics in participants undergoing CHMI using 3 PfSPZ-infected mosquitoes reared aseptically to published studies of CHMI using 5 mosquitoes. Nineteen adults aged 18-40 years were bitten by 3 Anopheles stephensi mosquitoes infected with the chloroquine-sensitive NF54 strain of Pf. All 19 participants developed malaria (100%; 12 of 19 (63% on Day 11. The mean pre-patent period was 258.3 hours (range 210.5-333.8. The geometric mean parasitemia at first diagnosis by microscopy was 9.5 parasites/µL (range 2-44. Quantitative polymerase chain reaction (qPCR detected parasites an average of 79.8 hours (range 43.8-116.7 before microscopy. The mosquitoes had a geometric mean of 37,894 PfSPZ/mosquito (range 3,500-152,200. Exposure to the bites of 3 aseptically-raised, PfSPZ-infected mosquitoes is a safe, effective procedure for CHMI in malaria-naïve adults. The aseptic model should be considered as a new standard for CHMI trials in non-endemic areas. Microscopy is the gold standard used for the diagnosis of Pf malaria after CHMI, but qPCR identifies parasites earlier. If qPCR continues to be shown to be highly specific, and can be made to be practical, rapid, and standardized, it should be considered as an alternative for diagnosis

Epidemiological and clinical studies on aseptic meningitis in 377 cases, 3

International Nuclear Information System (INIS)

Nishimura, Masaaki; Kondo, Tomio; Takashima, Akira; Kono, Shinya; Yamashina, Manabu

1984-01-01

Brain CT scan performed in the acute phase of aseptic meningitis in 88 cases revealed abnormal findings in 5 consisting of 2 of cerebral edema, 2 of subdural hygroma and one of cerebral atrophy. Clinical findings showed no particular relation to the age, but cerebral edema was observed in the cases of possible cephalomeningitis diagnosed on the basis of accompanying convulsion and disturbance of consciousness. Abnormal findings were associated with 25% of symptoms diagnosed more than 4 days after onset. (Chiba, N.)

Treatment of gram-positive deep sternal wound infections in cardiac surgery -experiences with daptomycin-

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Coskun Kasim O

2011-09-01

Full Text Available Abstract The reported incidence of deep sternal wound infection (DSWI after cardiac surgery is 0.4-5% with Staphylococcus aureus being the most common pathogen isolated from infected wound sternotomies and bacteraemic blood cultures. This infection is associated with a higher morbidity and mortality than other known aetiologies. Little is reported about the optimal antibiotic management. The aim of the study is to quantify the application of daptomycin treatment of DSWI due to gram-positive organisms post cardiac surgery. We performed an observational analysis in 23 cases of post sternotomy DSWI with gram-positive organisms February 2009 and September 2010. When the wound appeared viable and the microbiological cultures were negative, the technique of chest closure was individualised to the patient. The incidence of DSWI was 1.46%. The mean dose of daptomycin application was 4.4 ± 0.9 mg/kg/d and the average duration of the daptomycin application was 14.47 ± 7.33 days. In 89% of the patients VAC therapy was used. The duration from daptomycin application to sternal closure was 18 ± 13.9 days. The parameters of infection including, fibrinogen (p = 0.03, white blood cell count (p = 0.001 and C-reactive protein (p = 0.0001 were significantly reduced after daptomycin application. We had no mortality and wound healing was successfully achieved in all patients. Treatment of DSWI due to gram-positive organisms with a daptomycin-containing antibiotic regimen is safe, effective and promotes immediate improvement of local wound conditions. Based on these observations, daptomycin may offer a new treatment option for expediting surgical management of DSWI after cardiac surgery.

Daptomycin as a possible new treatment option for surgical management of Methicillin-Resistant Staphylococcus aureus sternal wound infection after cardiac surgery

Directory of Open Access Journals (Sweden)

Emmert Alexander

2010-08-01

Full Text Available Abstract We present a case of a 77-year old female who had undergone a coronary artery bypass grafting with an aortic valve replacement and developed three month later a Methicillin-Resistant Staphylococcus aureus (MRSA sternal wound infection which was successful treated with Daptomycin combined with vacuum-assisted closure (VAC.

[Validation of a clinical prediction rule to distinguish bacterial from aseptic meningitis].

Science.gov (United States)

Agüero, Gonzalo; Davenport, María C; Del Valle, María de la P; Gallegos, Paulina; Kannemann, Ana L; Bokser, Vivian; Ferrero, Fernando

2010-02-01

Despite most meningitis are not bacterial, antibiotics are usually administered on admission because bacterial meningitis is difficult to be rule-out. Distinguishing bacterial from aseptic meningitis on admission could avoid inappropriate antibiotic use and hospitalization. We aimed to validate a clinical prediction rule to distinguish bacterial from aseptic meningitis in children, on arriving to the emergency room. This prospective study included patients aged or = 1000 cells/mm(3), CSF protein > or = 80 mg/dl, peripheral blood absolute neutrophil count > or = 10.000/mm(3), seizure = 1 point each. Sensitivity (S), specificity (E), positive and negative predictive values (PPV and NPV), positive and negative likelihood ratios (PLR and NLR) of the BMS to predict bacterial meningitis were calculated. Seventy patients with meningitis were included (14 bacterial meningitis). When BMS was calculated, 25 patients showed a BMS= 0 points, 11 BMS= 1 point, and 34 BMS > or = 2 points. A BMS = 0 showed S: 100%, E: 44%, VPP: 31%, VPN: 100%, RVP: 1,81 RVN: 0. A BMS > or = 2 predicted bacterial meningitis with S: 100%, E: 64%, VPP: 41%, VPN: 100%, PLR: 2.8, NLR:0. Using BMS was simple, and allowed identifying children with very low risk of bacterial meningitis. It could be a useful tool to assist clinical decision making.

Rapid and Minimally Traumatic Replacement of Stimulator Extension Cables: Technical Note on a Novel Use for Sternal Wire.

Science.gov (United States)

Henderson, Fraser; Takacs, Istvan

2017-01-01

Troubleshooting of deep brain stimulators (DBSs, Activa SC/PC/RC Medtronic PLC, Minneapolis, Minnesota, USA) sometimes results in a decision to replace a tunneled stretch-coil extension cable. We present a simple technique to accomplish this atraumatically without a tunneling tool. In the treatment of patients with a DBS, complication avoidance and efficiency of operative time are paramount. We sought to find the safest, most effective, and fastest method of performing the conceptually simple yet technically nuanced act of replacing lead extension cables. We connected #6 (8.0 metric) surgical steel 18″ (45-cm) monofilament (Ethicon US, LLC, Somerville, New Jersey, USA), also known as #6 sternal wire, in line with DBS extension cables (Medtronic DBS Extension 37086-60) in novel fashion to overcome intraprocedural hurdles encountered during the past decade in a busy functional neurosurgery service. Patients tolerate the procedure well and return home shortly after recovery with no complications. A less expensive and faster technique for passing pulse generator extension cables may be the use of a sternal wire. Using the described technique, pulse generators may be quickly and safely adjusted from side to side and site to site as the clinical situation dictates. Copyright © 2016 Elsevier Inc. All rights reserved.

Aseptic necrosis of the femoral head after pregnancy: a case report.

Science.gov (United States)

Nassar, Kawtar; Rachidi, Wafae; Janani, Saadia; Mkinsi, Ouafa

2016-01-01

A documented case of beginning aseptic necrosis of the femoral head associated with pregnancy together with a review of the literature about this rare complication of pregnancy is presented. The known risk factors of osteonecrosis are; steroid use, alcoholism, organ transplantation, especially after kidney transplant or bone marrow transplantation bone, systemic lupus erythematosus, dyslipidemia especially hypertriglyceridemia, dysbaric decompression sickness, drepanocytosis and Gaucher's disease. Among the less established factors, we mention procoagulations abnormalities, HIV infection, chemotherapy. We report a case of osteonecrosis of femoral head after pregnancy.

A new technique for repair of a dislocated sternoclavicular joint using a sternal tension cable system.

Science.gov (United States)

Janson, Jacques T; Rossouw, Gawie J

2013-02-01

An unstable anterior or posterior sternoclavicular joint dislocation can cause severe morbidity with poor shoulder movement and strength. These dislocations need to be repaired, which can be challenging. Many different procedures have been described to obtain a stable joint fixation with varying results. We report a new technique for repairing a sternoclavicular joint dislocation by using a figure-of-eight sternal cable system. This procedure is relatively simple and reproducible to create a stable and functional sternoclavicular joint. Copyright © 2013 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

A comparative study of the incidence of aseptic meningitis in symptomatic natural mumps patients and monovalent mumps vaccine recipients in Japan.

Science.gov (United States)

Nagai, Takao; Okafuji, Teruo; Miyazaki, Chiaki; Ito, Yuhei; Kamada, Makoto; Kumagai, Takuji; Yuri, Kenji; Sakiyama, Hiroshi; Miyata, Akiko; Ihara, Toshiaki; Ochiai, Hitoshi; Shimomura, Kunihisa; Suzuki, Eitaro; Torigoe, Sadayoshi; Igarashi, Masahiro; Kase, Tetsuo; Okuno, Yoshinobu; Nakayama, Tetsuo

2007-03-30

To compare the incidence of aseptic meningitis associated with symptomatic natural mumps infection and in mumps vaccine recipients, we conducted a prospective comparative study. Consecutive samples of 1051 children with mumps were enrolled by 10 pediatricians and 21,465 vaccine recipients by 143 pediatric primary care practitioners, from January 1, 2000 to January 1, 2003. Parents used a daily diary to record symptoms during the period of illness (15 days) or 30-day period following immunization. Mumps infection was confirmed by virus isolation and/or detection of mumps virus genome in salivary and CSF samples. The incidence of aseptic meningitis was 13/1051 (1.24%) in patients with symptomatic natural mumps infection and was estimated to be 0.7-1.1% of overall infection in considering asymptomatic infection, and 10/21,465 (0.05%) in vaccine recipients. Although aseptic meningitis is a clear side effect of the mumps vaccine, the incidence is considerably lower than among those with symptomatic natural infection. Our results provide an informative data for consideration to resume mumps vaccine as a part of routine immunization schedule for Japanese children.

Controlled Human Malaria Infection of Tanzanians by Intradermal Injection of Aseptic, Purified, Cryopreserved Plasmodium falciparum Sporozoites

NARCIS (Netherlands)

Shekalaghe, S.; Rutaihwa, M.; Billingsley, P.F.; Chemba, M.; Daubenberger, C.A.; James, E.R.; Mpina, M.; Juma, O. Ali; Schindler, T.; Huber, E.; Gunasekera, A.; Manoj, A.; Simon, B.; Saverino, E.; Church, L.W.; Hermsen, C.C.; Sauerwein, R.W.; Plowe, C.; Venkatesan, M.; Sasi, P.; Lweno, O.; Mutani, P.; Hamad, A.; Mohammed, A.; Urassa, A.; Mzee, T.; Padilla, D.; Ruben, A.; Sim, B.K.; Tanner, M.; Abdulla, S.; Hoffman, S.L.

2014-01-01

Controlled human malaria infection (CHMI) by mosquito bite has been used to assess anti-malaria interventions in > 1,500 volunteers since development of methods for infecting mosquitoes by feeding on Plasmodium falciparum (Pf) gametocyte cultures. Such CHMIs have never been used in Africa. Aseptic,

Strontium-doped calcium polyphosphate/ultrahigh molecular weight polyethylene composites: A new class of artificial joint components with enhanced biological efficacy to aseptic loosening

International Nuclear Information System (INIS)

Gu, Zhipeng; Huang, Bingxue; Li, Yiwen; Tian, Meng; Li, Li; Yu, Xixun

2016-01-01

To enhance implant stability and prolong the service life of artificial joint component, a new approach was proposed to improve the wear resistance of artificial joint component and endow artificial joint component with the biological efficacy of resistance to aseptic loosening. Strontium calcium polyphosphate (SCPP) were interfused in ultrahigh molecular weight polyethylene (UHMWPE) by a combination of liquid nitrogen ball-milling and flat-panel curing process to prepare the SCPP/UHMWPE composites. The micro-structure, mechanical characterization, tribological characterization and bioactivities of various SCPP/UHMWPE composites were investigated. The results suggested that this method could statistically improve the wear resistance of UHMWPE resulting from a good SCPP particle dispersion. Moreover, it is also observed that the SCPP/UHMWPE composites-wear particles could promote the production of OPG by osteoblasts and decrease the production of RANKL by osteoblasts, and then increase the OPG/RANKL ratio. This indicated that the SCPP/UHMWPE composites had potential efficacy to prevent and treat aseptic loosening. Above all, the SCPP/UHMWPE composites with a suitable SCPP content would be the promising materials for fabricating artificial joint component with ability to resist aseptic loosening. - Highlights: • SCPP/UHMWPE composites could enhance biological efficacy of resistance to aseptic loosening. • SCPP would improve biological efficacy with a few sacrifice of wear resistance. • The results might provide a promising wear-resistant material for fabricating acetabular cup.

Strontium-doped calcium polyphosphate/ultrahigh molecular weight polyethylene composites: A new class of artificial joint components with enhanced biological efficacy to aseptic loosening

Energy Technology Data Exchange (ETDEWEB)

Gu, Zhipeng [College of Polymer Science and Engineering, Sichuan University, Chengdu 610065 (China); Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu 610041 (China); Huang, Bingxue; Li, Yiwen [College of Polymer Science and Engineering, Sichuan University, Chengdu 610065 (China); Tian, Meng [Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu 610041 (China); Li, Li [Department of Oncology, the 452 Hospital of Chinese PLA, Chengdu 610021 (China); Yu, Xixun, E-mail: yuxixun@163.com [College of Polymer Science and Engineering, Sichuan University, Chengdu 610065 (China)

2016-04-01

To enhance implant stability and prolong the service life of artificial joint component, a new approach was proposed to improve the wear resistance of artificial joint component and endow artificial joint component with the biological efficacy of resistance to aseptic loosening. Strontium calcium polyphosphate (SCPP) were interfused in ultrahigh molecular weight polyethylene (UHMWPE) by a combination of liquid nitrogen ball-milling and flat-panel curing process to prepare the SCPP/UHMWPE composites. The micro-structure, mechanical characterization, tribological characterization and bioactivities of various SCPP/UHMWPE composites were investigated. The results suggested that this method could statistically improve the wear resistance of UHMWPE resulting from a good SCPP particle dispersion. Moreover, it is also observed that the SCPP/UHMWPE composites-wear particles could promote the production of OPG by osteoblasts and decrease the production of RANKL by osteoblasts, and then increase the OPG/RANKL ratio. This indicated that the SCPP/UHMWPE composites had potential efficacy to prevent and treat aseptic loosening. Above all, the SCPP/UHMWPE composites with a suitable SCPP content would be the promising materials for fabricating artificial joint component with ability to resist aseptic loosening. - Highlights: • SCPP/UHMWPE composites could enhance biological efficacy of resistance to aseptic loosening. • SCPP would improve biological efficacy with a few sacrifice of wear resistance. • The results might provide a promising wear-resistant material for fabricating acetabular cup.

Excacerbation of systemic lupus erythematodes, aseptic meningitis and acute mental symptoms, following metrizamide lumbar myelography

Energy Technology Data Exchange (ETDEWEB)

Gelmers, H J

1984-01-01

A clinical constellation of excacerbation of systemic lupus erythematodes (SLE), together with aseptic meningitis, and acutre mental symptoms occurred following lumbar myelography with metrizamide. Excacerbation of SLE has not been previously described following myelography with any contrast agent. Meningeal reactions and acute mental symptoms have been reported earlier, but this clinical constellation is new.

Excacerbation of systemic lupus erythematodes, aseptic meningitis and acute mental symptoms, following metrizamide lumbar myelography

International Nuclear Information System (INIS)

Gelmers, H.J.

1984-01-01

A clinical constellation of excacerbation of systemic lupus erythematodes (SLE), together with aseptic meningitis, and acutre mental symptoms occurred following lumbar myelography with metrizamide. Excacerbation of SLE has not been previously described following myelography with any contrast agent. Meningeal reactions and acute mental symptoms have been reported earlier, but this clinical constellation is new. (orig.)

Added value of experts' knowledge to improve a quantitative microbial exposure assessment model--Application to aseptic-UHT food products.

Science.gov (United States)

Pujol, Laure; Johnson, Nicholas Brian; Magras, Catherine; Albert, Isabelle; Membré, Jeanne-Marie

2015-10-15

In a previous study, a quantitative microbial exposure assessment (QMEA) model applied to an aseptic-UHT food process was developed [Pujol, L., Albert, I., Magras, C., Johnson, N. B., Membré, J. M. Probabilistic exposure assessment model to estimate aseptic UHT product failure rate. 2015 International Journal of Food Microbiology. 192, 124-141]. It quantified Sterility Failure Rate (SFR) associated with Bacillus cereus and Geobacillus stearothermophilus per process module (nine modules in total from raw material reception to end-product storage). Previously, the probabilistic model inputs were set by experts (using knowledge and in-house data). However, only the variability dimension was taken into account. The model was then improved using expert elicitation knowledge in two ways. First, the model was refined by adding the uncertainty dimension to the probabilistic inputs, enabling to set a second order Monte Carlo analysis. The eight following inputs, and their impact on SFR, are presented in detail in this present study: D-value for each bacteria of interest (B. cereus and G. stearothermophilus) associated with the inactivation model for the UHT treatment step, i.e., two inputs; log reduction (decimal reduction) number associated with the inactivation model for the packaging sterilization step for each bacterium and each part of the packaging (product container and sealing component), i.e., four inputs; and bacterial spore air load of the aseptic tank and the filler cabinet rooms, i.e., two inputs. Second, the model was improved by leveraging expert knowledge to develop further the existing model. The proportion of bacteria in the product which settled on surface of pipes (between the UHT treatment and the aseptic tank on one hand, and between the aseptic tank and the filler cabinet on the other hand) leading to a possible biofilm formation for each bacterium, was better characterized. It was modeled as a function of the hygienic design level of the aseptic

Aseptic meningitis outbreak associated with echovirus 30 among high school football players--Los Angeles County, California, 2014.

Science.gov (United States)

Croker, Curtis; Civen, Rachel; Keough, Kathleen; Ngo, Van; Marutani, Amy; Schwartz, Benjamin

2015-01-02

On August 4, 2014, the Acute Communicable Disease Control Program of the Los Angeles County Department of Public Health received a report of three aseptic meningitis cases among football players at a county high school. An investigation was conducted to determine the extent of the outbreak, identify potential exposures, and recommend control measures. An outbreak-associated aseptic meningitis case was defined as an illness of any team or family member with onset during July 28-August 11 with 1) cerebrospinal fluid pleocytosis and negative bacterial culture or 2) an emergency department visit with headache, fever, and stiff neck. Ten cases were identified; nine in males, and one in a female; patient ages ranged from 13 to 17 years. All the patients sought care at an emergency department, and five were hospitalized, resulting in 12 total hospital days. All 10 patients have recovered. Eight patients were football players, and two were siblings of football players. The most affected subgroup was the junior varsity football team, with seven cases out of 57 players (attack rate = 12.3%); the relative risk for aseptic meningitis was higher among players who were linemen than among those who were not linemen (relative risk = 5.4 [p = 0.03]). Of the 10 patients, eight tested positive by polymerase chain reaction for enterovirus, and two were not tested. Echovirus testing was performed at the California Viral and Rickettsial Disease Laboratory. Of the eight specimens testing positive for enterovirus, seven tested positive for echovirus 30, and one specimen could not be typed because of insufficient quantity.

Teaching aseptic technique for central venous access under ultrasound guidance: a randomized trial comparing didactic training alone to didactic plus simulation-based training.

Science.gov (United States)

Latif, Rana K; Bautista, Alexander F; Memon, Saima B; Smith, Elizabeth A; Wang, Chenxi; Wadhwa, Anupama; Carter, Mary B; Akca, Ozan

2012-03-01

Our goal was to determine whether simulation combined with didactic training improves sterile technique during ultrasound (US)-guided central venous catheter (CVC) insertion compared with didactic training alone among novices. We hypothesized that novices who receive combined didactic and simulation-based training would perform similarly to experienced residents in aseptic technique, knowledge, and perception of comfort during US-guided CVC insertion on a simulator. Seventy-two subjects were enrolled in a randomized, controlled trial of an educational intervention. Fifty-four novices were randomized into either the didactic group or the simulation combined with didactic group. Both groups received didactic training but the simulation combined with didactic group also received simulation-based CVC insertion training. Both groups were tested by demonstrating US-guided CVC insertion on a simulator. Aseptic technique was scored on 8 steps as "yes/no" and also using a 7-point Likert scale with 7 being "excellent technique" by a rater blinded to subject randomization. After initial testing, the didactic group was offered simulation-based training and retesting. Both groups also took a pre- and posttraining test of knowledge and rated their comfort with US and CVC insertion pre- and posttraining on a 5-point Likert scale. Subsequently, 18 experienced residents also took the test of knowledge, rated their comfort level, and were scored while performing aseptic US-guided CVC insertion using a simulator. The simulation combined with didactic group achieved a 167% (95% confidence interval [CI] 133%-167%) incremental increase in yes/no scores and 115% (CI 112%-127%) incremental increase in Likert scale ratings on aseptic technique compared with novices in the didactic group. Compared with experienced residents, simulation combined with didactic trained novices achieved an increase in aseptic scores with a 33.3% (CI 16.7%-50%) increase in yes/no ratings and a 20% (CI 13

A case of aseptic vertebral necrosis in the context of metastatic lumbar disease

International Nuclear Information System (INIS)

Panow, C.; Valavanis, A.

2002-01-01

Aseptic bone necrosis has many well recognized etiologies: caisson disease, corticosteroids, alcohol, Gaucher's disease and sickle cell anemia being a few of a long list. Little attention has been paid to metastatic disease as a possible cause and we were unable to find reference in the literature to this association. We present imaging features of metastatic Ewing's sarcoma involving the vertebral spine, which, in certain aspects, mimics other well-known entities of this region, such as Kuemmell's and Scheuermann's diseases. (orig.)

Biosurfactant production using mixed cultures under non-aseptic conditions

International Nuclear Information System (INIS)

Vipulanandan, C.; Ghurye, G.L.; Willson, R.C.

1994-01-01

The use of surfactants is of increasing interest for remediation of petroleum hydrocarbons in groundwater and soil. Surfactants increase the accessibility of adsorbed hydrocarbons and mobilize immiscible petroleum hydrocarbons for treatment. Biosurfactants have the advantage of biodegradability and non-toxicity over their synthetic counterparts, and can be produced from renewable sources. In this study the production of biosurfactant from molasses was investigated in continuously stirred batch reactors. The effects of substrate concentration, yeast extract and peptone on biomass accumulation and biosurfactant production were investigated. Biosurfactant production was quantified by surface tension reduction and critical micelle dilution (CMD). Biosurfactant production was directly correlated with biomass production, and was improved with the addition of yeast extract. Centrifugation of the whole broth reduced surface tension. The performance of the biosurfactant produced from molasses under non-aseptic condition is comparable to other published results

Mitigated infection in so called aseptic loosening of the total endoprosthesis of the big joints

OpenAIRE

Koudela, Karel

2008-01-01

The theme of the work is infection in the aseptic loosening of total joint replacement of large joints. Thesis topic is very timely, since inflammatory complications accompanying large joint arthroplasty is one of the causes of failure of total joint replacement and subsequent revision surgery represents a major problem of health, social and economic. PhD thesis summarizes the known aspects of this issue.

The history of the management of sternal osteomyelitis and mediastinitis - from Hippocrates until today.

Science.gov (United States)

Ennker, Ina Carolin; Ennker, Jürgen C

2014-01-01

Even during the time of Hippocrates, Galen and their colleagues recognized mediastinal affections. However, they were not considered with the surgical treatment. First progress in the treatment options of this severe disease, still denoted as 'terra incognita', over to today's gold standard are pictured. The mediastinitis-registry which was founded by the German Society for Thoracic and Cardiovascular Surgery (DGTHG) in 2011 and the recent establishment of the study group to adopt a guideline 'diagnosis and therapy of postoperative mediastinitis/sternal osteomyelitis following cardiac surgery' are attempts to a standardization of the treatment. Substantial advancement in the treatment of postoperative mediastinitis could be achieved in the past. The mortality dropped as low as less than 10%. With these implementations more benefit for the patients' outcome can be expected.

No demonstrable association between the Leningrad-Zagreb mumps vaccine strain and aseptic meningitis in a large clinical trial in Egypt.

Science.gov (United States)

Sharma, H J; Oun, S Aly; Bakr, S S Abou; Kapre, S V; Jadhav, S S; Dhere, R M; Bhardwaj, S

2010-04-01

To address the claim that the Leningrad-Zagreb (L-Z) mumps vaccine strain is causally associated with aseptic meningitis, a prospective, post-marketing safety study was conducted with a measles-mumps-rubella vaccine (MMR) (TRESIVAC(R); Serum Institute of India Ltd., Pune, India), which uses the L-Z strain as its mumps component in Egypt. In all, 453 119 children (65 423 children aged 16-24 months and 329 211 children aged 5-7 years) received MMR. The control groups which, as a result of local health regulations, were slightly younger than vaccinees, comprised 12 253 and 46 232 children, respectively. Using questionnaires, the parents recorded solicited local, systemic and neurological adverse events for up to 42 days post-vaccination. All data were analysed externally on an intention-to-treat basis by individuals not participating in the study. Local and/or systemic reactions were reported in a small percentage of participants, with pain, fever and parotitis being the most common signs among vaccinees in both age groups. No case of aseptic meningitis, encephalitis, anaphylaxis or convulsions was observed in any participant. Thus, in this series of more than 450 000 Egyptian children, the L-Z mumps vaccine strain in this vaccine did not cause aseptic meningitis. The vaccine is considerably cheaper than Western competitors and a valid alternative to other MMR vaccines.

The unsuspected prosthetic joint infection : incidence and consequences of positive intra-operative cultures in presumed aseptic knee and hip revisions.

Science.gov (United States)

Jacobs, A M E; Bénard, M; Meis, J F; van Hellemondt, G; Goosen, J H M

2017-11-01

Positive cultures are not uncommon in cases of revision total knee and hip arthroplasty (TKA and THA) for presumed aseptic causes. The purpose of this study was to assess the incidence of positive intra-operative cultures in presumed aseptic revision of TKA and THA, and to determine whether the presence of intra-operative positive cultures results in inferior survival in such cases. A retrospective cohort study was assembled with 679 patients undergoing revision knee (340 cases) or hip arthroplasty (339 cases) for presumed aseptic causes. For all patients three or more separate intra-operative cultures were obtained. Patients were diagnosed with a previously unsuspected prosthetic joint infection (PJI) if two or more cultures were positive with the same organism. Records were reviewed for demographic details, pre-operative laboratory results and culture results. The primary outcome measure was infection-free implant survival at two years. The incidence of unsuspected PJI was 27 out of 340 (7.9%) in TKA and 41 out of 339 (12.1%) in THA. Following revision TKA, the rate of infection-free implant survival in patients with an unsuspected PJI was 88% (95% confidence intervals (CI) 60 to 97) at two years compared with 98% (95% CI 94 to 99) in patients without PJI (p = 0.001). After THA, the rate of survival was similar in those with unsuspected PJI (92% (95% CI 73 to 98) at two years) and those without (94% (95% CI 89 to 97), p = 0.31). Following revision of TKA and THA for aseptic diagnoses, around 10% of cases were found to have positive cultures. In the knee, such cases had inferior infection-free survival at two years compared with those with negative cultures; there was no difference between the groups following THA. Cite this article: Bone Joint J 2017;99-B:1482-9. ©2017 The British Editorial Society of Bone & Joint Surgery.

Impact of vacuum-assisted closure (VAC) therapy on clinical outcomes of patients with sternal wound infections: a meta-analysis of non-randomized studies.

Science.gov (United States)

Falagas, Matthew E; Tansarli, Giannoula S; Kapaskelis, Anastasios; Vardakas, Konstantinos Z

2013-01-01

To examine the impact of VAC therapy on mortality of patients with sternal wound infections after cardiothoracic surgery. Controversial results regarding mortality of patients with sternal wound infections were published. We performed a systematic search in PubMed and Scopus. Mortality was the primary outcome of the meta-analysis. Recurrences, complications and length of stay were secondary outcomes. Twenty-two retrospective studies including 2467 patients were eligible for inclusion. Patients treated with VAC had significantly lower mortality compared to those treated without VAC [2233 patients, RR = 0.40, (95% CI 0.28, 0.57)]. This finding was consistent regardless of the study design, the exclusion of studies with positive findings, the criteria for establishment of the compared groups, the time of mortality assessment or the type of infections under study, provided that adequate data was available. VAC therapy was associated with fewer recurrences (RR = 0.34, 95% CI: 0.19-0.59). The meta-analysis did not show any difference in the length of stay (RR = -2.25, 95% CI: -7.52-3.02). VAC therapy was associated with lower mortality than other surgical techniques in retrospective cohorts of patients with DSWIs following cardiothoracic surgery.

Sternal wound infection revisited

International Nuclear Information System (INIS)

Liberatore, M.; Fiore, V.; D'Agostini, A.; Prosperi, D.; Iurilli, A.P.; Santini, C.; Baiocchi, P.; Galie, M.; Di Nucci, G.D.; Sinatra, R.

2000-01-01

Sternal wound infections (SWIs) can be subdivided into two types, superficial or deep, that require different treatments. The clinical diagnosis of superficial SWI is normally easy to perform, whereas the involvement of deep tissues is frequently difficult to detect. Therefore, there is a need for an imaging study that permits the assessment of SWIs and is able to distinguish between superficial and deep SWI. The present work was a prospective study aiming to evaluate the role of technetium-99m hexamethylpropylene amine oxime ( 99m Tc-HMPAO) labelled leucocyte scan in SWI management. Twenty-eight patients with suspected SWIs were included in the study. On the basis of clinical examination they were subdivided into three groups: patients with signs of superficial SWI (group 1), patients with signs of superficial SWI and suspected deep infection (group 2) and patients with suspected deep SWI without superficial involvement (group 3). Ten patients previously submitted to median sternotomy, but without suspected SWI, were also included in the study as a control group (group 4). All patients with suspected SWI had bacteriological examinations of wound secretion, if present. In addition 99m Tc-HMPAO labelled leucocyte scan was performed in all patients. The patients of groups 1, 2 and 3 were treated on the basis of the clinical signs and microbiological findings, independently of the scintigraphic results. The patients of group 4 did not receive treatment. The final assessment of infection was based on histological and microbiological findings or on long-term clinical follow-up. Sensitivity, specificity, accuracy and positive and negative predictive values for scintigraphic and non-scintigraphic results were calculated. In the diagnosis of superficial and deep SWI, clinical and microbiological examination (combined) yielded, respectively, a sensitivity of 68.7% and 100%, a specificity of 77.3% and 80.8%, an accuracy of 73.7% and 86.8%, a positive predictive value of 68

Aseptic loosening of the femoral implant after cemented total hip arthroplasty in dogs: 11 cases in 10 dogs (1991-1995)

International Nuclear Information System (INIS)

Edwards, M.R.; Egger, E.L.; Schwarz, P.D.

1997-01-01

Objective-To determine clinical signs, radiographic findings, results of surgical management, and potential causes of aseptic loosening of the femoral implant (ALFI) in dogs that have undergone cemented total hip arthroplasty (THA). Design-Retrospective study. Animals-11 cases of ALFI in 10 dogs. Procedure-Medical records of all dogs undergoing THA revision surgery were reviewed. Only dogs with ALFI were included. The prosthesis and cement were removed by creating a longitudinal osteotomy of the cranial femoral cortex. Postoperative radiographs of all dogs that underwent THA during the study period were reviewed. Results-The most common clinical sign was intermittent, subtle. or non-weight-bearing lameness. On radiographs obtained after THA, contact of the distal stem tip with cortical endosteum was evident in all dogs. Radiographic changes at the time of diagnosis of ALFI included asymmetric periosteal reaction along the femoral diaphysis, radiolucent lines between the prosthesis and cement, altered implant position, and femoral fracture. Surgical revision yielded good or excellent results in 9 cases. In 1 dog. the implant became infected; in another, aseptic loosening recurred. Aseptic loosening was significantly more common in dogs in which there was contact between the distal stem tip and cortical endosteum than in dogs in which there was no contact. Clinical Implications-ALFI is an uncommon, but important, complication of THA, and radiography is warranted in dogs with clinical signs of ALFI. Initial centering of the prosthetic stem within the femoral shaft may reduce the incidence of ALFI

Design of equipment safety & reliability for an aseptic liquid food packaging line through maintenance engineering

OpenAIRE

Riccetti, Sauro

2011-01-01

This thesis was submitted for the degree of Doctor of Philosophy and awarded by Brunel University. The organisation of maintenance, in the Aseptic Liquid Food (ALF) industry, represents an important management task that enables a company to pursue higher manufacturing effectiveness and improved market share. This research is concerned with the process to design and implement maintenance tasks. These two complementary processes (design and implementation) have been thought and designed to a...

The history of the management of sternal osteomyelitis and mediastinitis – from Hippocrates until today

Directory of Open Access Journals (Sweden)

Ennker, Ina Carolin

2014-06-01

Full Text Available Even during the time of Hippocrates, Galen and their colleagues recognized mediastinal affections. However, they were not considered with the surgical treatment. First progress in the treatment options of this severe disease, still denoted as ‘terra incognita’, over to today’s gold standard are pictured.The mediastinitis-registry which was founded by the German Society for Thoracic and Cardiovascular Surgery (DGTHG in 2011 and the recent establishment of the study group to adopt a guideline ‘diagnosis and therapy of postoperative mediastinitis/sternal osteomyelitis following cardiac surgery’ are attempts to a standardization of the treatment. Substantial advancement in the treatment of postoperative mediastinitis could be achieved in the past. The mortality dropped as low as less than 10%. With these implementations more benefit for the patients’ outcome can be expected.

The history of the management of sternal osteomyelitis and mediastinitis – from Hippocrates until today

Science.gov (United States)

Ennker, Ina Carolin; Ennker, Jürgen C.

2014-01-01

Even during the time of Hippocrates, Galen and their colleagues recognized mediastinal affections. However, they were not considered with the surgical treatment. First progress in the treatment options of this severe disease, still denoted as ‘terra incognita’, over to today’s gold standard are pictured. The mediastinitis-registry which was founded by the German Society for Thoracic and Cardiovascular Surgery (DGTHG) in 2011 and the recent establishment of the study group to adopt a guideline ‘diagnosis and therapy of postoperative mediastinitis/sternal osteomyelitis following cardiac surgery’ are attempts to a standardization of the treatment. Substantial advancement in the treatment of postoperative mediastinitis could be achieved in the past. The mortality dropped as low as less than 10%. With these implementations more benefit for the patients’ outcome can be expected. PMID:26504718

Clavicles, interclavicles, gastralia, and sternal ribs in sauropod dinosaurs: new reports from diplodocidae and their morphological, functional and evolutionary implications.

Science.gov (United States)

Tschopp, Emanuel; Mateus, Octávio

2013-03-01

Ossified gastralia, clavicles and sternal ribs are known in a variety of reptilians, including dinosaurs. In sauropods, however, the identity of these bones is controversial. The peculiar shapes of these bones complicate their identification, which led to various differing interpretations in the past. Here we describe different elements from the chest region of diplodocids, found near Shell, Wyoming, USA. Five morphotypes are easily distinguishable: (A) elongated, relatively stout, curved elements with a spatulate and a bifurcate end resemble much the previously reported sauropod clavicles, but might actually represent interclavicles; (B) short, L-shaped elements, mostly preserved as a symmetrical pair, probably are the real clavicles, as indicated by new findings in diplodocids; (C) slender, rod-like bones with rugose ends are highly similar to elements identified as sauropod sternal ribs; (D) curved bones with wide, probably medial ends constitute the fourth morphotype, herein interpreted as gastralia; and (E) irregularly shaped elements, often with extended rugosities, are included into the fifth morphotype, tentatively identified as sternal ribs and/or intercostal elements. To our knowledge, the bones previously interpreted as sauropod clavicles were always found as single bones, which sheds doubt on the validity of their identification. Various lines of evidence presented herein suggest they might actually be interclavicles - which are single elements. This would be the first definitive evidence of interclavicles in dinosauromorphs. Previously supposed interclavicles in the early sauropodomorph Massospondylus or the theropods Oviraptor and Velociraptor were later reinterpreted as clavicles or furculae. Independent from their identification, the existence of the reported bones has both phylogenetic and functional significance. Their presence in non-neosauropod Eusauropoda and Flagellicaudata and probable absence in rebbachisaurs and Titanosauriformes shows a

Cloning higher plants from aseptically cultured tissues and cells

Science.gov (United States)

Krikorian, A. D.

1982-01-01

A review of aseptic culture methods for higher plants is presented, which focuses on the existing problems that limit or prevent the full realization of cloning plants from free cells. It is shown that substantial progress in clonal multiplication has been made with explanted stem tips or lateral buds which can be stimulated to produce numerous precocious axillary branches. These branches can then be separated or subdivided and induced to root in order to yield populations of genetically and phenotypically uniorm plantlets. Similarly, undifferentiated calluses can sometimes be induced to form shoots and/or roots adventitiously. Although the cell culture techniques required to produce somatic embryos are presently rudimentary, steady advances are being made in learning how to stimulate formation of somatic or adventive embryos from totipotent cells grown in suspension cultures. It is concluded that many problems exist in the producing and growing of totipotent or morphogenetically competent cell suspensions, but the potential benefits are great.

MRT of scaphoid pseudo-arthrosis using Gd-DTPA. Staging and clinical correlation; MRT der Skaphoidpseudarthrose mit Gd-DTPA. Stadieneinteilung und klinische Korrelation

Energy Technology Data Exchange (ETDEWEB)

Vogl, T.J. [Freie Univ. Berlin (Germany). Strahlenklinik und Poliklinik; Beutel, F. [Freie Univ. Berlin (Germany). Strahlenklinik und Poliklinik; Wilhelm, K. [LMU Muenchen (Germany). Abt. fuer Handchirurgie; Tempka, A. [Freie Univ. Berlin (Germany). Klinik fuer Unfall- und Wiederherstellungschirurgie; Schedel, H. [Freie Univ. Berlin (Germany). Strahlenklinik und Poliklinik; Haas, R. [Freie Univ. Berlin (Germany). Strahlenklinik und Poliklinik; Felix, R. [Freie Univ. Berlin (Germany). Strahlenklinik und Poliklinik

1994-11-01

During a period of two years, 134 patients with pseudo-arthrosis of the scaphoid were examined by conventional radiography and by MRI in the course of a prospective study. The aim of the study was to define radiological staging using contrast enhanced MRI in order to improve the prognostic criteria. All MRI examinations were carried out with a 1.5 Tesla scanner (SP63) using a surface coil and T{sub 1} weighted spin echo sequences in sagittal and frontal projection and frontal FLASH T{sub 2}-sequences and axial spin echo T{sub 2} sequences. The T{sub 1} weighted SE sequences in frontal projection were carried out before and after iv contrast (0.1 mmol Gd-DTPA/kg KG). All sequences were compared with conventional radiographs and the operative findings. Eight patients in stage 0 showed high signal intensity of both fragments in T{sub 1} weighted SE sequences and at surgery there was good vascularisation. In 22 cases there was reduced signal intensity in at least one fragment (stage I). 45 patients with scaphoid pseudo-arthrosis showed complete signal loss but marked contrast uptake with still vital nuclei at surgery (stage II). In 22 patients, there was no increase in signal intensity after contrast and complete loss of vitality of the fragments at surgery. Staging was not possible in 37 patients because of previous operative intervention. The use of contrast enhanced MRI provides additional information compared with conventional radiography or plain MRI. (orig.) [Deutsch] Im Rahmen einer prospektiven Studie wurden in einem Zeitraum von 2 Jahren 134 Patienten mit einer Skaphoidpseudarthrose (SPA) vergleichend konventionell roentgenologisch und magnetresonanztomographisch untersucht. Ziel der Studie war die Erstellung einer klinisch radiologischen Stadieneinteilung mit Hilfe der kontrastverstaerkten MRT zur Verbesserung von Prognosekriterien. Alle MRT-Untersuchungen wurden an einem 1,5 Tesla-Geraet (SP63) mittels einer Oberflaechenspule unter Verwendung von T{sub 1

Reamed intramedullary exchange nailing in the operative treatment of aseptic tibial shaft nonunion.

Science.gov (United States)

Hierholzer, Christian; Friederichs, Jan; Glowalla, Claudio; Woltmann, Alexander; Bühren, Volker; von Rüden, Christian

2017-08-01

The aim of this study was to evaluate a standardized treatment protocol regarding the rate of secondary bone union, complications, and functional outcome. This study was started as a prospective study in a single Level I Trauma Centre between 2003 and 2012. The study group consisted of 188 patients with the diagnosis of an aseptic tibial shaft nonunion. Exchange nailing was performed following a standardized surgical protocol. Long-term follow-up was analyzed for rate of bone healing and functional outcome. Osseous healing was achieved in 182 out of 188 patients (97 %). In 165 out of 188 patients (88 %), bone healing was observed timely and uneventfully after a single exchange nailing procedure. An open approach was necessary in 32 patients (17 %). Twenty-three patients (12 %) required additional therapy such as extracorporeal shock wave therapy. Post-operative complications were observed in seven patients (4 %). Almost all patients demonstrated osseous healing within 12 months, with the majority of osseous healing occurring within six months. A relevant shortening of the fractured tibia was observed in 20 out of 188 patients (11 %). After a median follow-up of 23 months (range 12-45 months), outcome was evaluated using the assessment system of Friedman/Wyman. In summary, 154 out of 188 patients (82 %) had a good functional long-term result. Reamed intramedullary exchange nailing including correction of axis alignment is a safe and effective treatment of aseptic tibial shaft nonunion with a high rate of bone healing and a good radiological and functional long-term outcome.

Endotoxin as a cause of aseptic meningitis after radionuclide cisternography

International Nuclear Information System (INIS)

Cooper, J.F.; Harbert, J.C.

1975-01-01

The role of pyrogens in aseptic meningitis after radionuclide cisternography was studied by means of the Limulus test, a sensitive detector of endotoxin. During a 15-month period, 39 reactions associated with cisternography were reported. Ten samples of specific lots of the radioactive drugs implicated in 20 of these reactions were tested and all reacted strongly positive to the Limulus test. The less sensitive rabbit pyrogen test was negative for these preparations when tested on a dose-per-weight basis. Our findings apparently provide clinical evidence for the observation made in animals that endotoxin is at least 1,000 times more toxic intrathecally than intravenously. The data implicate endotoxin contamination as a cause of adverse reactions to radionuclide cisternography. We conclude that the USP pyrogen test is insufficiently sensitive for intrathecal injectables and should be supplemented by the Limulus test. (auth)

Use of a sternal elevator to reverse complete airway obstruction secondary to anterior mediastinal mass in an anesthetized child

Directory of Open Access Journals (Sweden)

Maria E. Linnaus

2016-05-01

Full Text Available Patients with an anterior mediastinal mass pose significant risk for cardiorespiratory compromise during surgical procedures and general anesthesia. Several techniques have been described to reverse airway obstruction in these patients. In extreme circumstances, patients may require cardiac bypass or extracorporeal membrane oxygenation (ECMO until definitive treatment of the mass and patient stabilization is achieved. We present a case in which the RulTract® system was used for emergency sternal elevation as a bridge to ECMO in acute respiratory collapse in an 11-year-old female with a minimally symptomatic anterior mediastinal mass.

Aseptic minimum volume vitrification technique for porcine parthenogenetically activated blastocyst.

Science.gov (United States)

Lin, Lin; Yu, Yutao; Zhang, Xiuqing; Yang, Huanming; Bolund, Lars; Callesen, Henrik; Vajta, Gábor

2011-01-01

Minimum volume vitrification may provide extremely high cooling and warming rates if the sample and the surrounding medium contacts directly with the respective liquid nitrogen and warming medium. However, this direct contact may result in microbial contamination. In this work, an earlier aseptic technique was applied for minimum volume vitrification. After equilibration, samples were loaded on a plastic film, immersed rapidly into factory derived, filter-sterilized liquid nitrogen, and sealed into sterile, pre-cooled straws. At warming, the straw was cut, the filmstrip was immersed into a 39 degree C warming medium, and the sample was stepwise rehydrated. Cryosurvival rates of porcine blastocysts produced by parthenogenetical activation did not differ from control, vitrified blastocysts with Cryotop. This approach can be used for minimum volume vitrification methods and may be suitable to overcome the biological dangers and legal restrictions that hamper the application of open vitrification techniques.

Gastro-oesophageal reflux in large-sized, deep-chested versus small-sized, barrel-chested dogs undergoing spinal surgery in sternal recumbency.

Science.gov (United States)

Anagnostou, Tilemahos L; Kazakos, George M; Savvas, Ioannis; Kostakis, Charalampos; Papadopoulou, Paraskevi

2017-01-01

The aim of this study was to investigate whether an increased frequency of gastro-oesophageal reflux (GOR) is more common in large-sized, deep-chested dogs undergoing spinal surgery in sternal recumbency than in small-sized, barrelchested dogs. Prospective, cohort study. Nineteen small-sized, barrel-chested dogs (group B) and 26 large-sized, deep-chested dogs (group D). All animals were premedicated with intramuscular (IM) acepromazine (0.05 mg kg -1 ) and pethidine (3 mg kg -1 ) IM. Anaesthesia was induced with intravenous sodium thiopental and maintained with halothane in oxygen. Lower oesophageal pH was monitored continuously after induction of anaesthesia. Gastro-oesophageal reflux was considered to have occurred whenever pH values > 7.5 or < 4 were recorded. If GOR was detected during anaesthesia, measures were taken to avoid aspiration of gastric contents into the lungs and to prevent the development of oesophagitis/oesophageal stricture. The frequency of GOR during anaesthesia was significantly higher in group D (6/26 dogs; 23.07%) than in group B (0/19 dogs; 0%) (p = 0.032). Signs indicative of aspiration pneumonia, oesophagitis or oesophageal stricture were not reported in any of the GOR cases. In large-sized, deep-chested dogs undergoing spinal surgery in sternal recumbency, it would seem prudent to consider measures aimed at preventing GOR and its potentially devastating consequences (oesophagitis/oesophageal stricture, aspiration pneumonia). Copyright © 2016 Association of Veterinary Anaesthetists and American College of Veterinary Anesthesia and Analgesia. Published by Elsevier Ltd. All rights reserved.

Why does it take so long? ‘Lean processing’ in the aseptic compounding unit at the Midland Regional Hospital Tullamore

LENUS (Irish Health Repository)

Greene, C

2011-06-01

Increasing numbers of oncology\\/haematology patients attending Midland Regional Hospital Tullamore (MRHT) has increased the workload of the Regional Oncology Haematology Pharmacy (ROHP) compounding unit. Staff restrictions require optimisation of current workflow practices. This audit (November 2010 and June 2011) focused on workflow in the aseptic compounding unit.\\r\

Bone scintigraphy in idiopathic aseptic femoral head necrosis (IAFHN)

Energy Technology Data Exchange (ETDEWEB)

Dodig, D; Ugarkovic, B; Orlic, D

1983-01-01

Idiopathic aseptic femoral head necrosis (IAFHN) is a disease of unknown aetiology most commonly affecting adults, producing functional impairment of the hip joint and immobility. Characteristic macroscopic, microscopic and radiologic features include: (1) changes in joint cartilage, (2) subchondral necrotic area, (3) changes in fibrous tissue, and (4) osteosclerosis and vascular proliferation. The diagnosis is based on clinical and X-ray examinations. More recently scintigraphy has been used in diagnosing IAFHN. It is a very sensitive, but non-specific method. Nineteen patients aged 25-57 years were included in our study. Scintigrams were divided in four groups: (1) normal, (2) uniformly increased activity in the femoral head, (3) non-uniformly increased activity in the femoral head, and (4) a photon deficient area in the femoral head. A comparison of scintigraphy and radiological examination suggests that a photon deficient area corresponds with stage III of radiological classification, non-uniformly increased activity with stage II, and uniformly increased activity with stage I. These results indicate that scintigraphy can be used for staging of disease.

Impact of donor arm cleaning with different aseptic solutions for prevention of contamination in blood bags.

Science.gov (United States)

Patel, Tanvi G; Shukla, Rinku V; Gupte, Snehalata C

2013-03-01

Transfusion associated sepsis cases are encountered occasionally and bacterial transmission remains the major cause. The goal of our study was to compare the efficacy of disinfectants in phlebotomy site preparation. After selection of donor the antecubital fossa area of the arm was disinfected with different types of disinfectants namely sprit (70% isopropyl alcohol), povidone iodine (0.5% w/v available iodine in distilled water), savlon (1.5% v/v chlorhexidine gluconate solution and 3.0% cetrimide solution) and combination of sprit and povidone iodine. Swabs were collected from 20 donors using a sterile forceps, after cleaning with different antiseptic solutions. Swab was streaked on blood agar plate aseptically and the plate was incubated at 37°C for 24 h. Colonies were counted and a single colony was re-cultured by growing on nutrient and Mac-Conkey agar. The biochemical characteristics were determined by performing Gram staining, Motility, Catalase and Oxidase tests. The mean values of colonies were significantly higher with savlon compared to other three solutions. The difference was statistically significant by "t" test (t values 1.7-3.0; P bag were aseptically inoculated in aerobic and anaerobic culture bottles to be tested on BacT/Alert system. The bag containing donor's blood did not show any contamination when three cleanings were carried out using sprit, povidone iodine and spirit respectively.

In vitro comparison of the biological activity of alumina ceramic and titanium particles associated with aseptic loosening

International Nuclear Information System (INIS)

Ding Yue; Qin Chuqiang; Xu Jie; Huang Dongsheng; Fu Yuru

2012-01-01

Prosthetic wear particles are thought to play a central role in the initiation and development of periprosthetic osteolysis, leading to aseptic loosening of prostheses. This study aimed to compare the biological activity of ceramic and titanium particles that are associated with particle-induced, aseptic joint loosening. Different sizes of alumina-ceramic particles and titanium particles were prepared to stimulate murine macrophage cells RAW 264.7, of which the expressions of tumor necrosis factor alpha (TNF-alpha) and receptor activator of nuclear factor-κB ligand (RANKL) were measured by qPCR and ELISA at various time points. In the presence of all particles, the expression of TNF-alpha increased in a time-dependent manner, whereas the expression of RANKL showed no regular expression patterns. Notably, particles of smaller sizes provoked significantly higher levels of TNF-alpha and RANKL than those of larger sizes. Compared to the titanium particles, the ceramic particles provoked a significantly lower production of TNF-alpha. Thus, the bioactivities of titanium and alumina ceramic particles were inversely proportional to the sizes of the particles, and the expression of RANKL was not parallel to that of TNF-alpha. The successful outcome of ceramic-on-ceramic artificial joint prostheses may be attributed to the low biological activity of ceramic particles, as evidenced here. (paper)

Laser welding of thin polymer films to container substrates for aseptic packaging

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Brown, N.; Kerr, D.; Jackson, M. R.; Parkin, R. M.

2000-03-01

Keyhole laser welding of polymers is a subject well covered and researched, but relatively little information exists regarding the welding of thin polymer films, particularly to a heavier substrate. This paper presents the design of a suitable test apparatus for laser welding thin film to a heavier substrate, and shows the results of an investigation into the feasibility of laser welding multi-layer polymer film lids to tubs for the manufacture of aseptic food containers. A consistent weld, free from defects, is the key to process success. Typical welding defects have been synthesised in order to investigate, and consequently remove, their cause. The result is a reliable welding method based on even film clamping. With careful attention to machine design, a seal of high mechanical strength and chemical integrity is possible.

Percutaneous bone cement refixation of aseptically loose hip prostheses: the effect of interface tissue removal on injected cement volumes

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Malan, Daniel F. [Leiden University Medical Center, Department of Orthopaedics, Leiden (Netherlands); Delft University of Technology, Department of Intelligent Systems, Delft (Netherlands); Valstar, Edward R. [Leiden University Medical Center, Department of Orthopaedics, Leiden (Netherlands); Delft University of Technology, Department of Biomechanical Engineering, Delft (Netherlands); Nelissen, Rob G.H.H. [Leiden University Medical Center, Department of Orthopaedics, Leiden (Netherlands)

2014-11-15

To quantify whether injected cement volumes differed between two groups of patients who underwent experimental minimally invasive percutaneous cement injection procedures to stabilize aseptically loose hip prostheses. One patient group was preoperatively treated using gene-directed enzyme prodrug therapy to remove fibrous interface tissue, while the other group received no preoperative treatment. It was hypothesized that cement penetration may have been inhibited by the presence of fibrous interface tissue in periprosthetic lesions. We analyzed 17 patients (14 female, 3 male, ages 72-91, ASA categories 2-4) who were treated at our institution. Osteolytic lesions and injected cement were manually delineated using 3D CT image segmentation, and the deposition of injected cement was quantified. Patients who underwent preoperative gene-directed enzyme therapy to remove fibrous tissue exhibited larger injected cement volumes than those who did not. The observed median increase in injected cement volume was 6.8 ml. Higher cement leakage volumes were also observed for this group. We conclude that prior removal of periprosthetic fibrous interface tissue may enable better cement flow and penetration. This might lead to better refixation of aseptically loosened prostheses. (orig.)

Mechanical instability and titanium particles induce similar transcriptomic changes in a rat model for periprosthetic osteolysis and aseptic loosening

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Mehdi Amirhosseini

2017-12-01

Full Text Available Wear debris particles released from prosthetic bearing surfaces and mechanical instability of implants are two main causes of periprosthetic osteolysis. While particle-induced loosening has been studied extensively, mechanisms through which mechanical factors lead to implant loosening have been less investigated. This study compares the transcriptional profiles associated with osteolysis in a rat model for aseptic loosening, induced by either mechanical instability or titanium particles. Rats were exposed to mechanical instability or titanium particles. After 15 min, 3, 48 or 120 h from start of the stimulation, gene expression changes in periprosthetic bone tissue was determined by microarray analysis. Microarray data were analyzed by PANTHER Gene List Analysis tool and Ingenuity Pathway Analysis (IPA. Both types of osteolytic stimulation led to gene regulation in comparison to unstimulated controls after 3, 48 or 120 h. However, when mechanical instability was compared to titanium particles, no gene showed a statistically significant difference (fold change ≥ ±1.5 and adjusted p-value ≤ 0.05 at any time point. There was a remarkable similarity in numbers and functional classification of regulated genes. Pathway analysis showed several inflammatory pathways activated by both stimuli, including Acute Phase Response signaling, IL-6 signaling and Oncostatin M signaling. Quantitative PCR confirmed the changes in expression of key genes involved in osteolysis observed by global transcriptomics. Inflammatory mediators including interleukin (IL-6, IL-1β, chemokine (C-C motif ligand (CCL2, prostaglandin-endoperoxide synthase (Ptgs2 and leukemia inhibitory factor (LIF showed strong upregulation, as assessed by both microarray and qPCR. By investigating genome-wide expression changes we show that, despite the different nature of mechanical implant instability and titanium particles, osteolysis seems to be induced through similar biological

The inhibitory effect of strontium-doped calcium polyphosphate particles on cytokines from macrophages and osteoblasts leading to aseptic loosening in vitro

International Nuclear Information System (INIS)

Huang, Chengcheng; Yu, Xixun; Gu, Zhipeng; Li, Li; Zhang, Xu

2014-01-01

Aseptic loosening is a common cause of joint implant failure in humans. In order to enhance implant stability, we need to develop a new material that not only promotes the wear resistance of components of an artificial joint, but also possesses the pharmaceutical efficacy of protecting patients against aseptic loosening. Strontium-doped calcium polyphosphate (SCPP) has been found to have this potential ability. The goal of this study is to respectively quantify the levels of TNF-α (for macrophages), receptor activator of NF- k B ligand (RANKL) and osteoprotegerin (OPG) (for osteoblasts) when osteoblasts and macrophages are challenged with various particles (including SCPP). In this study, the osteoblasts ROS 17/2.8 and macrophages RAW 264.7 were challenged with various wear particles (8% SCPP, the molar percentage of Sr in SCPP is 8%, UHMWPE, hydroxyapatite (HA) and CPP). The secretion of TNF-α (from RAW 264.7), OPG and RANKL protein (from ROS 17/2.8) was analyzed by ELISA. The OPG and RANKL mRNA from ROS 17/2.8 was detected by RT-PCR. The data of ELISA indicated that the amount of TNF-α challenged with 8% SCPP particles was more than three-fold lower than that of all other test groups. The ratio of OPG/RANKL in the 8% SCPP group was significantly increased compared to that of all other test groups. The results of OPG and RANKL mRNA expression showed the same tendency as the ELISA results. In general, this study showed that 8% SCPP particles can inhibit the expression of TNF-α and RANKL, promote the expression of OPG so that SCPP can inhibit bone resorption and promote bone formation, and then inhibit aseptic loosening. Thus SCPP could be a promising material for the construction of artificial joints. (paper)

[Clinical, epidemiological, and etiological studies of adult aseptic meningitis: a report of 12 cases of herpes simplex meningitis, and a comparison with cases of herpes simplex encephalitis].

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Himeno, Takahiro; Shiga, Yuji; Takeshima, Shinichi; Tachiyama, Keisuke; Kamimura, Teppei; Kono, Ryuhei; Takemaru, Makoto; Takeshita, Jun; Shimoe, Yutaka; Kuriyama, Masaru

2018-01-26

We treated 437 cases of adult aseptic meningitis and 12 cases (including 2 recurrent patients; age, 31.8 ± 8.9 years; 7 females) of herpes simplex meningitis from 2004 to 2016. The incidence rate of adult herpes simplex meningitis in the cases with aseptic meningitis was 2.7%. One patient was admitted during treatment of genital herpes, but no association was observed between genital herpes and herpes simplex meningitis in the other cases. The diagnoses were confirmed in all cases as the cerebrospinal fluid (CSF) was positive for herpes simplex virus (HSV)-DNA. For diagnosis confirmation, the DNA test was useful after 2-7 days following initial disease onset. Among other types of aseptic meningitis, the patients with herpes simplex meningitis showed relatively high white blood cell counts and relatively high CSF protein and high CSF cell counts. CSF cells showed mononuclear cell dominance from the initial stage of the disease. During same period, we also experienced 12 cases of herpes simplex encephalitis and 21 cases of non-hepatic acute limbic encephalitis. Notably, the patients with herpes simplex meningitis were younger and their CSF protein and cells counts were higher than those of the patients with herpes simplex encephalitis.

[Vacuum-assisted Closure (VAC) Treatment for Sternal Infection in a Patient after Cardiovascular Surgery; Report of a Case].

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Shima, Shotaro; Okamura, Kennichi; Morizumi, Sei; Kanamori, Taro; Ichihara, Tetsuya; Kawata, Mitsuhiro; Suematsu, Yoshihiro

2015-03-01

One year ago, a 42-year-old woman underwent aortic root replacement because of a pseudoaneurysm that developed at the site of an anastomosis after ascending aortic replacement for acute aortic dissection. Six months later, she complained of fever and cough. A computed tomography revealed recurrence of the peudoaneurysm at the proximal anastomosis of the aortic root replacement. After emergency re-do aortic root replacement, she was admitted to intensive care unit (ICU) without sternal closure because of mediastinitis. The mediastinitis was managed by debridement and lavage drainage, followed by vacuum-assisted closure (VAC) treatment. The VAC treatment facilitated wound healing and active rehabilitation using a portable device. Finally, the wound was closed completely using a skin graft. VAC treatment is considered very useful in a case of post-sternotomy madiastinitis.

USE OF SCORE AND CEREBROSPINAL FLUID LACTATE DOSAGE IN DIFFERENTIAL DIAGNOSIS OF BACTERIAL AND ASEPTIC MENINGITIS.

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Pires, Frederico Ribeiro; Franco, Andréia Christine Bonotto Farias; Gilio, Alfredo Elias; Troster, Eduardo Juan

2017-01-01

To evaluate Bacterial Meningitis Score (BMS) on its own and in association with Cerebrospinal Fluid (CSF) lactate dosage in order to distinguish bacterial from aseptic meningitis. Children diagnosed with meningitis at a tertiary hospital between January/2011 and December/2014 were selected. All data were obtained upon admission. BMS was applied and included: CSF Gram staining (2 points); CSF neutrophil count ≥1,000 cells/mm3 (1 point); CSF protein ≥80 mg/dL (1 point); peripheral blood neutrophil count ≥10,000 cells/mm3 (1 point) and seizures upon/before arrival (1 point). Cutoff value for CSF lactate was ≥30 mg/dL. Sensitivity, specificity and negative predictive value of several BMS cutoffs and BMS associated with high CSF lactate were evaluated for prediction of bacterial meningitis. Among 439 eligible patients, 94 did not have all data available to complete the score, and 345 patients were included: 7 in bacterial meningitis group and 338 in aseptic meningitis group. As predictive factors of bacterial meningitis, BMS ≥1 had 100% sensitivity (95%CI 47.3-100), 64.2% specificity (58.8-100) and 100% negative predictive value (97.5-100); BMS ≥2 or BMS ≥1 associated with high CSF lactate also showed 100% sensitivity (47.3-100); but 98.5% specificity (96.6-99.5) and 100% negative predictive value (98.3-100). 2 point BMS in association with CSF lactate dosage had the same sensitivity and negative predictive value, with increased specificity for diagnosis of bacterial meningitis when compared with 1-point BMS.

Current literature and imaging techniques of aseptic lymphocyte-dominated vasculitis-associated lesions (ALVAL)

International Nuclear Information System (INIS)

Duggan, P.J.; Burke, C.J.; Saha, S.; Moonim, M.; George, M.; Desai, A.; Houghton, R.

2013-01-01

Aseptic lymphocyte-dominated vasculitis-associated lesions (ALVAL) are a recognized complication of metal-on-metal bearing hip prostheses. There is an impending concern regarding the future investigation and management of patients who have received such implants. The current literature is discussed, and the current guidelines for management of these patients in the UK are reviewed. The various imaging techniques available, such as computed tomography, metal artefact reduction magnetic resonance imaging, and ultrasound are discussed and evaluated with respect to the assessment of patients with suspected ALVAL. The histopathological findings are discussed with images of the tissue changes provided. Images of the radiological findings are also provided for all general radiological methods. ALVAL and its radiological presentation is an important issue that unfortunately may become a significant clinical problem

Description of a widespread outbreak of aseptic meningitis due to echovirus 30 in Rio de Janeiro state, Brazil

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Vitor Laerte Pinto Junior

Full Text Available Echovirus 30 belongs to the genus Enterovirus and is widely associated with aseptic meningitis (AM outbreaks. In Brazil epidemics due to this serotype were reported in several states but in Rio de Janeiro, before this study, it was only involved in sporadic episodes. We retrospectively collected data from AM notifications charts and enterovirus isolation database from Rio de Janeiro State Health Department (RJSHD and Enterovirus Reference Laboratory in the year of 2005. An outbreak of AM was detected during March, April and May associated with a high cell culture isolation rate for echovirus 30 (17.4%. Male children with ages varying from 1 to 9 years were more affected. Of the 22 patients with confirmed echovirus 30 disease, clinical information was available in eight; fever, headache and vomiting were the most common manifestations. CSF analysis showed a typical pattern of viral infection with median of cellularity of 100 cells/mm³ and mononuclear cell predominance in 64.7% of the cases. The median of protein and glucose levels of 49 mg/dL and 56.5 mg/dL. The fatality rate was null. Despite its benign course and the lack of treatment options, aseptic meningitis surveillance is crucial for early identification of causative agents of outbreaks, which helps to avoid additional testing and inappropriate use of antimicrobials.

Delayed Sternal Closure in Infant Heart Surgery-The Importance of Where and When: An Analysis of the STS Congenital Heart Surgery Database.

Science.gov (United States)

Nelson-McMillan, Kristen; Hornik, Christoph P; He, Xia; Vricella, Luca A; Jacobs, Jeffrey P; Hill, Kevin D; Pasquali, Sara K; Alejo, Diane E; Cameron, Duke E; Jacobs, Marshall L

2016-11-01

Delayed sternal closure (DSC) is commonly used to optimize hemodynamic stability after neonatal and infant heart surgery. We hypothesized that duration of sternum left open (SLO) was associated with rate of infection complications, and that location of sternal closure may mitigate infection risk. Infants (age ≤365 days) undergoing index operations with cardiopulmonary bypass and DSC at STS Congenital Heart Surgery Database centers (from 2007 to 2013) with adequate data quality were included. Primary outcome was occurrence of infection complication, defined as one or more of the following: endocarditis, pneumonia, wound infection, wound dehiscence, sepsis, or mediastinitis. Multivariable regression models were fit to assess association of infection complication with: duration of SLO (days), location of DSC procedure (operating room versus elsewhere), and patient and procedural factors. Of 6,127 index operations with SLO at 100 centers, median age and weight were 8 days (IQR, 5-24) and 3.3 kg (IQR, 2.9-3.8); 66% of operations were STAT morbidity category 4 or 5. At least one infection complication occurred in 18.7%, compared with 6.6% among potentially eligible neonates and infants without SLO. Duration of SLO (median, 3 days; IQR, 2-5) was associated with an increased rate of infection complications (p < 0.001). Location of DSC procedure was operating room (16%), intensive care unit (67%), or other (17%). Location of DSC was not associated with rate of infection complications (p = 0.45). Rate of occurrence of infectious complications is high among infants with sternum left open following cardiac surgery. Longer duration of SLO is associated with increased infection complications. Copyright © 2016 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Comparative experimental evaluation of the efficacy of Prostamol Uno and Samprost on rat model of chronic aseptic prostate inflammation.

Science.gov (United States)

Pahomova, A V; Borovskaja, T G; Fomina, T I; Ermolaeva, L A; Vychuzhanina, A V; Rumpel, O A; Granstrem, O K; Baranova, O V

2011-11-01

Comparative experimental evaluation of the efficiency of prostatotropic drugs Prostamol Uno and Samprost on the model of the chronic aseptic prostate inflammation in rats was performed. It was established that peptide drug Samprost decelerates sclerotic processes in the prostate gland to a greater extent than herbal preparation Prostamol Uno. Both products equally stimulate secretory activity of the gland. Prostamol Uno, unlike Samprost, prevents the development of reduced sexual motivation, one of the complications of chronic prostatitis.

Effect of pilot-scale aseptic processing on tomato soup quality parameters.

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Colle, Ines J P; Andrys, Anna; Grundelius, Andrea; Lemmens, Lien; Löfgren, Anders; Buggenhout, Sandy Van; Loey, Ann; Hendrickx, Marc Van

2011-01-01

Tomatoes are often processed into shelf-stable products. However, the different processing steps might have an impact on the product quality. In this study, a model tomato soup was prepared and the impact of pilot-scale aseptic processing, including heat treatment and high-pressure homogenization, on some selected quality parameters was evaluated. The vitamin C content, the lycopene isomer content, and the lycopene bioaccessibility were considered as health-promoting attributes. As a structural characteristic, the viscosity of the tomato soup was investigated. A tomato soup without oil as well as a tomato soup containing 5% olive oil were evaluated. Thermal processing had a negative effect on the vitamin C content, while lycopene degradation was limited. For both compounds, high-pressure homogenization caused additional losses. High-pressure homogenization also resulted in a higher viscosity that was accompanied by a decrease in lycopene bioaccessibility. The presence of lipids clearly enhanced the lycopene isomerization susceptibility and improved the bioaccessibility. The results obtained in this study are of relevance for product formulation and process design of tomato-based food products. © 2011 Institute of Food Technologists®

Aseptic necrosis at multiple localisations in a lupus patient with lymphoma.

Science.gov (United States)

Bazso, A; Bazso, T; Szodoray, P; Poor, G; Kiss, E

2014-04-01

Avascular or aseptic necrosis is a well-defined entity leading to the degradation of cellular elements of the bone. The pathogenesis of osteonecrosis (ON) is still unknown. There are two main types of ON: traumatic or non-traumatic. Several clinical entities could associate with ON, systemic diseases, environmental factors, pregnancy, systemic autoimmune or rheumatic diseases, thrombophilia, corticosteroid therapy, cytotoxic dugs, infections, metabolic and hematologic diseases, etc. Corticosteroids (CS) are still the most frequently used therapeutic options in the early phase and during flares of these diseases. Inflammatory cytokines and antibodies have been described to participate in the pathogenesis of ON. The infiltrative disorders of the bone marrow could also contribute to the development of ON. Hereby, we describe a female patient with NHL followed by SLE in whom ON has developed at least in two localisations. Lupus flare, long-term CS therapy, lymphoma relapse or the presence of antiphospholipid antibodies were excluded. Although the bi-localised ON could be contributed to immunologic factors or trauma, the exact aetiology in this case could not be elucidated.

Innovative food processing technology using ohmic heating and aseptic packaging for meat.

Science.gov (United States)

Ito, Ruri; Fukuoka, Mika; Hamada-Sato, Naoko

2014-02-01

Since the Tohoku earthquake, there is much interest in processed foods, which can be stored for long periods at room temperature. Retort heating is one of the main technologies employed for producing it. We developed the innovative food processing technology, which supersede retort, using ohmic heating and aseptic packaging. Electrical heating involves the application of alternating voltage to food. Compared with retort heating, which uses a heat transfer medium, ohmic heating allows for high heating efficiency and rapid heating. In this paper we ohmically heated chicken breast samples and conducted various tests on the heated samples. The measurement results of water content, IMP, and glutamic acid suggest that the quality of the ohmically heated samples was similar or superior to that of the retort-heated samples. Furthermore, based on the monitoring of these samples, it was observed that sample quality did not deteriorate during storage. © 2013. Published by Elsevier Ltd on behalf of The American Meat Science Association. All rights reserved.

BIOTECHNOLOGICAL APPROACHES FOR CONSERVATION OF THE ENDANGERED SPECIES Crambe koktebelica (JUNGE N. BUSCH AND EFFECT OF ASEPTIC IN VITRO CULTIVATION ON ITS BIOCHEMICAL PROPERTIES

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Pushkarova

2016-08-01

Full Text Available The aim of the study was to establish efficient protocols of seed surface sterilization with further multiplication in vitro for threatened species Crambe koktebelica (Junge N. Busch and to show the effect of biotechnological approach (in vitro cultivation of biodiversity conservation on plants biochemical properties. Seed surface sterilization was carried out according to the original method with further microclonal multiplication of aseptic sprouts from lateral buds on the Murashige and Skoog (MS medium supplemented with different concentrations of growth regulators. Fatty acid content was determined using Gas chromatography-mass spectrophotometry of fatty acid ethers. Antioxidant activity was determined using 2.2-diphenyl-1-picrylhydrazyl radical scavenging method. Total soluble protein content was measured using Bradford method and polyfructan content determination was based upon ketosugars ability to color in the acidic environment with resorcinol. Plants that were grown under in vitro and in vivo conditions and seeds were used in this research. Efficient protocol of surface sterilization that resulted in 45% of aseptic seed material 50% of which has sprouted was elaborated for C. koktebelica as well as fast microclonal multiplication methods that provided with up to 5.25 ± 0.50 new formed plantlets from 1 lateral bud (on the MS medium that contained 1 mg/L of 6-benzylaminopurine. It was also shown that aseptic cultivation benefits to saturated fatty acid accumulation and increases protein content but on the other hand it reduces unsaturated fatty acid amount and polyfructan content as well as antioxidant activity of plant material. Obtained data confirms the prospect of biotechnology approach to biodiversity conservation and suggest the necessity of father in vitro cultivation effect on biochemical composition of plant study.

Combined bone scintigraphy with 99mTc-MDP and 99mTc-ciprofloxacin in differentiation of hip and knee prosthesis aseptic loosening and infection: A preliminary study

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Pucar Dragan

2017-01-01

Full Text Available Background/Aim. Although the number of new primary implantation of hip and knee prostheses every year increases, the rate of failed arthroplasty is nearly the same. The main question is whether it is an aseptic instability or instability caused by infection. The aim of this preliminary study was an attempt with combined 99mTc-ciprofloxacin and 99mTc-methylene diphosphonate (MDP bone scintigraphy to improve diagnostic accuracy in the differentiation of hip and knee prosthesis aseptic loosening and periprosthetic joint infection. Methods. Inclusion criteria of patients for this study were based on suspected periprosthetic joint infection: painful prosthetic joint, restricted joint movements and increased value of erythrocyte sedimentation rate or levels of C-reactive protein. We examined 20 patients with implanted 14 hip and 6 knee prosthesis. All patients also underwent plain radiography of suspected joint. In all patients, three-phase 99mTc-MDP bone scintigraphy was performed. Three to five days after the bone scan, we performed scintigraphy using 99mTc-ciprofloxacin with the calculation of accumulation index. Periprosthetic joint infection was confirmed on the basis of microbiological findings. Results. Periprosthetic joint infection was confirmed in fourteen of twenty observed joints, in five of them the aseptic loosening was present and in one patient’s symptoms were not related to the prosthesis (poor biomechanics of prosthetic joints caused by weaknesses of muscle. Estimated sensitivity/specificity for 99mTc-MDP bone scintigraphy alone were 100/17%; for 99mTc-ciprofloxacin scintigraphy were 85,7/100%. Sensitivity and specificity were 92,3% and 83,3%, respectively for results obtained with combined assessment by both methods. Our study confirmed the high negative predictive value of 99mTc-MDP bone scan. The negative result of bone scan virtually excludes the possibility of periprosthetic infection. On the other hand, positive findings of

Plasmodium falciparum malaria challenge by the bite of aseptic Anopheles stephensi mosquitoes: results of a randomized infectivity trial.

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Kirsten E Lyke

2010-10-01

Full Text Available Experimental infection of malaria-naïve volunteers by the bite of Plasmodium falciparum-infected mosquitoes is a preferred means to test the protective effect of malaria vaccines and drugs. The standard model relies on the bite of five infected mosquitoes to induce malaria. We examined the efficacy of malaria transmission using mosquitoes raised aseptically in compliance with current Good Manufacturing Practices (cGMPs.Eighteen adults aged 18-40 years were randomized to receive 1, 3 or 5 bites of Anopheles stephensi mosquitoes infected with the chloroquine-sensitive NF54 strain of P. falciparum. Seventeen participants developed malaria; fourteen occurring on Day 11. The mean prepatent period was 10.9 days (9-12 days. The geometric mean parasitemia was 15.7 parasites/µL (range: 4-70 by microscopy. Polymerase chain reaction (PCR detected parasites 3.1 (range: 0-4 days prior to microscopy. The geometric mean sporozoite load was 16,753 sporozoites per infected mosquito (range: 1,000-57,500. A 1-bite participant withdrew from the study on Day 13 post-challenge and was PCR and smear negative.The use of aseptic, cGMP-compliant P. falciparum-infected mosquitoes is safe, is associated with a precise prepatent period compared to the standard model and appears more efficient than the standard approach, as it led to infection in 100% (6/6 of volunteers exposed to three mosquito bites and 83% (5/6 of volunteers exposed to one mosquito bite.ClinicalTrials.gov NCT00744133.

Metal is not inert: role of metal ions released by biocorrosion in aseptic loosening--current concepts.

Science.gov (United States)

Cadosch, Dieter; Chan, Erwin; Gautschi, Oliver P; Filgueira, Luis

2009-12-15

Metal implants are essential therapeutic tools for the treatment of bone fractures and joint replacements. The metals and metal alloys used in contemporary orthopedic and trauma surgery are well tolerated by the majority of patients. However, complications resulting from inflammatory and immune reactions to metal implants have been well documented. This review briefly discusses the different mechanisms of metal implant corrosion in the human body, which lead to the release of significant levels of metal ions into the peri-implant tissues and the systemic blood circulation. Additionally, this article reviews the effects of the released ions on bone metabolism and the immune system and discusses their involvement in the pathophysiological mechanisms of aseptic loosening and metal hypersensitivity in patients with metal implants.

Pyrolysis of aseptic packages (tetrapak) in a laboratory screw type reactor and secondary thermal/catalytic tar decomposition

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Haydary, J., E-mail: juma.haydary@stuba.sk [Institute of Chemical and Environmental Engineering, Faculty of Chemical and Food Technology, Slovak University of Technology, Radlinského 9, 812 37 Bratislava (Slovakia); Susa, D.; Dudáš, J. [Institute of Chemical and Environmental Engineering, Faculty of Chemical and Food Technology, Slovak University of Technology, Radlinského 9, 812 37 Bratislava (Slovakia)

2013-05-15

Highlights: ► Pyrolysis of aseptic packages was carried out in a laboratory flow reactor. ► Distribution of tetrapak into the product yields was obtained. ► Composition of the pyrolysis products was estimated. ► Secondary thermal and catalytic decomposition of tars was studied. ► Two types of catalysts (dolomite and red clay marked AFRC) were used. - Abstract: Pyrolysis of aseptic packages (tetrapak cartons) in a laboratory apparatus using a flow screw type reactor and a secondary catalytic reactor for tar cracking was studied. The pyrolysis experiments were realized at temperatures ranging from 650 °C to 850 °C aimed at maximizing of the amount of the gas product and reducing its tar content. Distribution of tetrapak into the product yields at different conditions was obtained. The presence of H{sub 2}, CO, CH{sub 4}, CO{sub 2} and light hydrocarbons, HCx, in the gas product was observed. The Aluminum foil was easily separated from the solid product. The rest part of char was characterized by proximate and elemental analysis and calorimetric measurements. The total organic carbon in the tar product was estimated by elemental analysis of tars. Two types of catalysts (dolomite and red clay marked AFRC) were used for catalytic thermal tar decomposition. Three series of experiments (without catalyst in a secondary cracking reactor, with dolomite and with AFRC) at temperatures of 650, 700, 750, 800 and 850 °C were carried out. Both types of catalysts have significantly affected the content of tars and other components in pyrolytic gases. The effect of catalyst on the tetrapack distribution into the product yield on the composition of gas and on the total organic carbon in the tar product is presented in this work.

Peculiarities of X-ray appearances of aseptic necrosis of head of the femur in adults and children and their connection with bio mechanical factors

International Nuclear Information System (INIS)

Suslova, O.Ya.; Shargorodskij, C.S.; Antipova, A.A.; Naumenko, N.A.; Kresnyj, D.I.

1987-01-01

260 patients aged from 3 to 56 with aseptic necrosis of head of the femur are examined. Experimental biomechanical simulation of load conditions on femur head and cotyloid cavity was carried out at phantom devices using tensiometry, ichnographic and polarization-optical methods. Peculiarities of X-ray appearances of asceptic necrosis with respect to age are studied. A definite connection between asceptic necrosis and biomechanical factors is established

Intramedullary nailing for the treatment of aseptic femoral shaft non-unions after plating failure: effectiveness and timing.

Science.gov (United States)

Megas, Panagiotis; Syggelos, Spyros A; Kontakis, Georgios; Giannakopoulos, Andreas; Skouteris, Georgios; Lambiris, Elias; Panagiotopoulos, Elias

2009-07-01

This retrospective, multicentre study aimed to evaluate reamed intramedullary nailing (IMN) for the treatment of 30 cases of aseptic femoral shaft non-union after plating failure. Following nailing, 29 non-unions had healed by a mean 7.93 months. In one case a hypertrophic non-union required renailing after 8 months, using a nail of greater diameter, and united within five further months. Healing times were not related to whether the fracture was open or closed, the type non-union or the type of fracture. The delay from the initial plating to intramedullary nailing had a statistically significant effect on healing time and final outcome. This treatment is cost effective and should be implemented as soon as the non-union is diagnosed.

Differentiation between peri-prosthetic infection and aseptic loosening using quantitative analysis of triphasic 99Tcm-MDP bone scintigraphy

International Nuclear Information System (INIS)

Li Xinxin; Zhang Yanyan; Zhang Weifang; Mao Yuan; Zhao Meixin

2013-01-01

Objective: To differentiate between peri-prosthetic infection and aseptic loosening using quantitative analysis of triphasic bone scintigraphy. Methods: Twenty-eight patients (9 males, 19 females; mean age 67.5 years, range 49-80 years) with recurrent joint pain after arthroplasty were retrospectively assessed. All patients underwent triphasic bone scintigraphy. ROI of each joint was drawn and the ratios of affected to unaffected side were calculated. The ratios of blood flow phase, blood pool phase, static phase, C-reactive protein (CRP) and erythrocyte sedimentation (ESR) were quantitatively analyzed by ROC curve. The final diagnosis was based on microbiological and histological examinations. The optimal cut-off value was chosen based on the ideal sensitivity and specificity. Results: Nine patients were diagnosed as septic loosening, 17 patients aseptic loosening, 1 patient bursitis of hip joint and 1 patient suture reaction. Taking the positive results of blood flow phase or blood pool phase as standard for diagnosing septic loosening, the sensitivity, specificity and accuracy of bone scintigraphy were 7/9, 78.9% (15/19) and 78.6% (22/28), respectively. The AUC of blood pool phase was 0.942, and the sensitivity and specificity were 8/9 and 78.9% (15/19), respectively, with the optimal cut-off value of 1.40. The AUCs of blood flow ratio and CRP were 0.816 and 0.795, with cut-off values of 1.53 and 1.20, respectively. The AUCs of static phase ratio and ESR were 0.474 and 0.722, respectively, both P>0.05. Conclusions: For the diagnosis of septic loosening, quantitative analysis of triphasic 99 Tc m -MDP bone scintigraphy, particularly with the ratio of blood pool phase, is more accurate than qualitative analysis. (authors)

Iterative co-creation for improved hand hygiene and aseptic techniques in the operating room: experiences from the safe hands study.

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Erichsen Andersson, Annette; Frödin, Maria; Dellenborg, Lisen; Wallin, Lars; Hök, Jesper; Gillespie, Brigid M; Wikström, Ewa

2018-01-04

Hand hygiene and aseptic techniques are essential preventives in combating hospital-acquired infections. However, implementation of these strategies in the operating room remains suboptimal. There is a paucity of intervention studies providing detailed information on effective methods for change. This study aimed to evaluate the process of implementing a theory-driven knowledge translation program for improved use of hand hygiene and aseptic techniques in the operating room. The study was set in an operating department of a university hospital. The intervention was underpinned by theories on organizational learning, culture and person centeredness. Qualitative process data were collected via participant observations and analyzed using a thematic approach. Doubts that hand-hygiene practices are effective in preventing hospital acquired infections, strong boundaries and distrust between professional groups and a lack of psychological safety were identified as barriers towards change. Facilitated interprofessional dialogue and learning in "safe spaces" worked as mechanisms for motivation and engagement. Allowing for the free expression of different opinions, doubts and viewing resistance as a natural part of any change was effective in engaging all professional categories in co-creation of clinical relevant solutions to improve hand hygiene. Enabling nurses and physicians to think and talk differently about hospital acquired infections and hand hygiene requires a shift from the concept of one-way directed compliance towards change and learning as the result of a participatory and meaning-making process. The present study is a part of the Safe Hands project, and is registered with ClinicalTrials.gov (ID: NCT02983136 ). Date of registration 2016/11/28, retrospectively registered.

Surgical treatment of isolated aseptic acetabular loosening of the hip joint

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Zvereva К.Р.

2017-09-01

Full Text Available Aseptic acetabular loosening is one of the most common complications of primary hip arthroplasty Its treatment is possible in the volume of replacement of only the endoprosthesis cup with the preservation of a stable correctly oriented femoral component. The sequence of actions consists of provision of access to the acetabulum component and its replacement, after which the necessary offset is selected by changing the size of the head and installing a new pair of friction. Currently, the vast majority of the installed heads during the primary and revision hip replacement have a standard size forthe cone of the femoral component 12/14mm. According to the observations, in 3% of cases, there are femoral components with non-standard cone sizes 11/13 mm, usually established 7-8 years ago. The absence of heads forthe necessary cone leads to the need to replace the stable correctly oriented femoral component, which is accompanied by an increase in the time of intervention, the volume of intraoperative blood loss and the risk of intraopera-tive peri-prosthetic fracture. We represent the clinical case of a 75-year-old patient with a dislocation of the acetabular component and a stable correctly oriented femoral component, which during the audit intervention due to the lack of heads for an irregular cone size, total replacement of the components was made.

Femoral component loosening after hip resurfacing arthroplasty

International Nuclear Information System (INIS)

Zustin, Jozef; Sauter, Guido; Hahn, Michael; Morlock, Michael M.; Ruether, Wolfgang; Amling, Michael

2010-01-01

Before the re-introduction of the current generation of total hip resurfacing arthroplasty, component loosening and osteolysis were of great concern to the orthopaedic community. Early, mid- and long-term clinical results are encouraging, but component loosening still exists. Macroscopic, contact radiographic and histopathological analyses after undecalcified preparation of bone tissue specimens were performed. To investigate the frequency and morphological patterns of the loosening of the femoral component, we analysed a series of 190 retrieved femoral remnants that were revised for aseptic failures. Thirty-five (18.4%) hips were revised for clinical and/or radiographic loosening of the femoral component. Pseudoarthrosis (n = 17; median in situ time: 16 weeks, interquartile range [IQR]: 9 to 34), collapsed osteonecrosis (n = 5; median in situ time: 79 weeks, IQR: 63 to 97), cement-socket debonding (n = 3; median in situ time: 89 weeks, IQR: 54 to 97) and at later follow-up bone-cement loosening (n = 10; median in situ time: 175 weeks; IQR 112 to 198; p =0.005) were distinct patterns of the femoral remnant-implant loosening. Fibrocartilaginous metaplasia of interface bone trabeculae (n = 38; median in situ time: 61 weeks, IQR: 32 to 138) was strongly associated with femoral component loosening (p = 0.009). Both the trabecular hyperosteoidosis (n = 32; median in situ time: 71 weeks, IQR 50 to 129) and excessive intraosseous lymphocyte infiltration (n = 12; median in situ time: 75 weeks, IQR 51 to 98) at the bone-cement interface correlated strongly with fibrocartilaginous metaplasia (p = 0.001 and p = 0.016 respectively) and all three lesions were associated with the female gender (p = 0.021, p = 0.009, and p = 0.051). Femoral component loosening at early follow-up was mostly caused by pathological changes of the femoral remnant bone tissue: pseudoarthrosis and collapsed osteonecrosis. Fibrocartilaginous metaplasia was frequently observed in hips with femoral

Aseptic Abscesses and Inflammatory Bowel Disease: Two Cases and Review of Literature

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Natasha Bollegala

2017-01-01

Full Text Available Background. Aseptic abscesses (AA are sterile lesions that represent an extraintestinal manifestation (EIM of inflammatory bowel disease (IBD. Though Canada has the highest prevalence of IBD in the world, reports of IBD-associated AA are absent in Canada. This may represent a different IBD phenotype or underrecognition and underreporting. Purpose. To explore AA as a possible EIM of IBD and evaluate clinical and investigative findings among patients with IBD-associated AA. Methods. Retrospective chart and literature reviews were performed to find cases of IBD-associated AA at our institution and in the literature. Results. We identified 2 cases of IBD-associated AA in our institution. Both patients had ulcerative colitis and presented with fever, abdominal pain, and weight loss. Radiological workup and aspiration showed sterile splenic abscesses. The AA were unresponsive to antibiotics. One patient improved on corticosteroids and one underwent splenectomy. We retrieved 37 cases of IBD-associated AA from the literature. All patients showed no evidence of infection, failed to resolve with antibiotics, and, if attempted, improved on corticosteroids. Conclusions. Our cases are the first reported in Canada. They support literature which suggests AA as an EIM of IBD and may help increase recognition and reporting of this phenomenon.

Analysis of enterovirus types in patients with symptoms of aseptic meningitis in 2014 in Shandong, China.

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Chen, Peng; Lin, Xiaojuan; Liu, Guifang; Wang, Suting; Song, Lizhi; Tao, Zexin; Xu, Aiqiang

2018-03-01

We reviewed the epidemiological and clinical characteristics of 927 aseptic meningitis patients in Shandong in 2014, and the phylogeny of predominant enterovirus (EV) types causing this disease was analyzed. A total of 209 patients that were positive for EV were identified by both cell culture and a reverse transcription-seminested PCR in cerebrospinal fluid samples. The positive patients were most likely to be children within 15 years of age, had symptoms such as fever, vomiting and nausea (P＜ .05). The 209 EV sequences belonged to 11 types, and coxsackievirus B5, echovirus types 6 and 30 were predominant types. VP1 analysis exhibited multiple lineages were co-circulating. The significance of the study could come from the fact that surveillance is important to monitor the prevalence of EV types in population, which shows enterovirus meningitis maintains an important public health problem in China. Copyright © 2018 Elsevier Inc. All rights reserved.

Interleukin-6 in serum and in synovial fluid enhances the differentiation between periprosthetic joint infection and aseptic loosening.

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Thomas M Randau

Full Text Available The preoperative differentiation between septic and aseptic loosening after total hip or knee arthroplasty is essential for successful therapy and relies in part on biomarkers. The objective of this study was to assess synovial and serum levels of inflammatory proteins as diagnostic tool for periprosthetic joint infection and compare their accuracy with standard tests. 120 patients presenting with a painful knee or hip endoprosthesis for surgical revision were included in this prospective trial. Blood samples and samples of intraoperatively acquired joint fluid aspirate were collected. White blood cell count, C-reactive protein, procalcitonin and interleukin-6 were determined. The joint aspirate was analyzed for total leukocyte count and IL-6. The definite diagnosis of PJI was determined on the basis of purulent synovial fluid, histopathology and microbiology. IL-6 in serum showed significantly higher values in the PJI group as compared to aseptic loosening and control, with specificity at 58.3% and a sensitivity of 79.5% at a cut-off value of 2.6 pg/ml. With a cut-off >6.6 pg/ml, the specificity increased to 88.3%. IL-6 in joint aspirate had, at a cut-off of >2100 pg/ml, a specificity of 85.7% and sensitivity of 59.4%. At levels >9000 pg/ml, specificity was almost at 100% with sensitivity just below 50%, so PJI could be considered proven with IL-6 levels above this threshold. Our data supports the published results on IL-6 as a biomarker in PJI. In our large prospective cohort of revision arthroplasty patients, the use of IL-6 in synovial fluid appears to be a more accurate marker than either the white blood cell count or the C-reactive protein level in serum for the detection of periprosthetic joint infection. On the basis of the results we recommend the use of the synovial fluid biomarker IL-6 for the diagnosis of periprosthetic joint infection following total hip and knee arthroplasty.

Interleukin-6 in serum and in synovial fluid enhances the differentiation between periprosthetic joint infection and aseptic loosening.

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Randau, Thomas M; Friedrich, Max J; Wimmer, Matthias D; Reichert, Ben; Kuberra, Dominik; Stoffel-Wagner, Birgit; Limmer, Andreas; Wirtz, Dieter C; Gravius, Sascha

2014-01-01

The preoperative differentiation between septic and aseptic loosening after total hip or knee arthroplasty is essential for successful therapy and relies in part on biomarkers. The objective of this study was to assess synovial and serum levels of inflammatory proteins as diagnostic tool for periprosthetic joint infection and compare their accuracy with standard tests. 120 patients presenting with a painful knee or hip endoprosthesis for surgical revision were included in this prospective trial. Blood samples and samples of intraoperatively acquired joint fluid aspirate were collected. White blood cell count, C-reactive protein, procalcitonin and interleukin-6 were determined. The joint aspirate was analyzed for total leukocyte count and IL-6. The definite diagnosis of PJI was determined on the basis of purulent synovial fluid, histopathology and microbiology. IL-6 in serum showed significantly higher values in the PJI group as compared to aseptic loosening and control, with specificity at 58.3% and a sensitivity of 79.5% at a cut-off value of 2.6 pg/ml. With a cut-off >6.6 pg/ml, the specificity increased to 88.3%. IL-6 in joint aspirate had, at a cut-off of >2100 pg/ml, a specificity of 85.7% and sensitivity of 59.4%. At levels >9000 pg/ml, specificity was almost at 100% with sensitivity just below 50%, so PJI could be considered proven with IL-6 levels above this threshold. Our data supports the published results on IL-6 as a biomarker in PJI. In our large prospective cohort of revision arthroplasty patients, the use of IL-6 in synovial fluid appears to be a more accurate marker than either the white blood cell count or the C-reactive protein level in serum for the detection of periprosthetic joint infection. On the basis of the results we recommend the use of the synovial fluid biomarker IL-6 for the diagnosis of periprosthetic joint infection following total hip and knee arthroplasty.

Utilization of Aseptic Seedling Explants for In vitro Propagation of Indian Red Wood

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Kishore Kumar CHIRUVELLA

2013-12-01

Full Text Available Micropropagation has been advocated as one of the most viable biotechnological tool for ex situ conservation of rare, endangered endemic medicinal plants germplasm. Rapid clonal micropropagation protocol for large-scale multiplication of an endemic medicinal plant Soymida febrifuga (Meliaceae was established from 15-day aseptic seedling cotyledonary node and shoot tip explants. High frequency of sprouting and shoot differentiation was observed from cotyledonary node explants compared to shoot tip, on Murashige and Skoog (MS medium fortified with BA, KN, 2-iP and CM. Of the cytokinins used, BA (3.0 mgl-1 supported highest average number and maximum multiple shoot differentiation (16.6. In vitro proliferated shoots were multiplied rapidly by culturing nodal segments as microcuttings, further subcultured on the same media for elongation. Elongated shoots upon transfer to MS medium fortified with IBA showed rooting within two weeks of culture. Rooted plantlets were successfully hardened and 75% of rooted shoots successfully survived on establishment to the soil. Plants looked healthy with no visually detectable phenotypic variations. This protocol provides a successful and rapid technique that can be used for ex situ conservation minimizing the pressure on wild populations and contributes to the conservation of this endemic medicinally potent flora.

Idiopathic Facial Aseptic Granuloma in a 13-Year-Old Boy Dramatically Improved with Oral Doxycycline and Topical Metronidazole: Evidence for a Link with Childhood Rosacea

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Camille Orion

2016-07-01

Full Text Available Idiopathic facial aseptic granuloma (IFAG is a rare, benign pediatric dermatological lesion that occurs in children between 8 months and 13 years of age. The pathogenesis of IFAG is still unclear but it is likely to be associated with granulomatous rosacea in childhood. Here we describe a case of IFAG in a 13-year-old boy who showed a dramatic response to oral doxycycline and topical metronidazole, which supports the hypothesis that IFAG may belong to the spectrum of rosacea.

[Analysis of surgical treatment with pectoralis major muscle flap for deep sternal infection after cardiac surgery: a case series of 189 patients].

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Liu, Dong; Wang, Wenzhang; Cai, Aibing; Han, Zhiyi; Li, Xiyuan; Ma, Jiagui

2015-03-01

To analyze and summarize the clinical features and experience in surgical treatment of deep sternal infection (DSWI). This was a retrospective study. From January 2008 to December 2013, 189 patients with secondary DSWI after cardiac surgery underwent the pectoralis major muscle flap transposition in our department. There were 116 male and 73 female patients. The mean age was (54 ± 21) years, the body mass index was (26. 1 ± 1. 3) kg/m2. The incidence of postoperation DSWI were after isolated coronary artery bypass grafting (CABG) in 93 patients, after other heart surgery plus CABG in 13 patients, after valve surgery in 47 patients, after thoracic aortic surgery in 16 patients, after congenital heart disease in 18 patients, and after cardiac injury in 2 patients. Clean patients' wound and extract secretions, clear the infection thoroughly by surgery and select antibiotics based on susceptibility results, and then repair the wound with appropriate muscle flap, place drain tube with negative pressure. Of all the 189 patients, 184 used isolate pectoralis, 1 used isolate rectus, and 4 used pectoralis plus rectus. The operative wounds of 179 patients were primary healing (94. 7%). Hospital discharge was postponed by 1 week for 7 patients, due to subcutaneous wound infection. Subcutaneous wound infection occurred again in 8 patients 1 week after hospital discharge, and their wounds healed after wound dressing. Nine patients (4. 7%) did not recover, due to residue of the sequestrum and costal chondritis, whom were later cured by undergoing a second treatment of debridement and pectoralis major muscle flap transposition. Eight patients died, in which 2 died of respiratory failure, 2 died of bacterial endocarditis with septicemia, 2 died of renal failure, 1 died of intraoperative bleeding leading to brain death and the 1 died of heart failure. The mortality rate was 4. 2% . The average length of postoperative hospital stay was (14 ± 5) days. The longest postoperative

Another cause of chest pain: Staphylococcus aureus sternal osteomyelitis in an otherwise healthy adult

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Vacek TP

2014-09-01

Full Text Available Thomas P Vacek, Shahnaz Rehman, Shipeng Yu, Ankush Moza, Ragheb Assaly Department of Internal Medicine, The University of Toledo Medical Center, Toledo OH, USAAbstract: Chest pain requires a detailed differential diagnosis with good history-taking skills to differentiate between cardiogenic and noncardiogenic causes. Moreover, when other symptoms such as fever and elevated white blood cell count are involved, it may be necessary to consider causes that include infectious sources. A 53-year-old female with no significant past medical history returned to the hospital with recurrent complaints of chest pain that was constant, substernal, reproducible, and exacerbated with inspiration and expiration. The chest pain was thought to be noncardiogenic, as electrocardiography did not demonstrate changes, and cardiac enzymes were found to be negative for signs of ischemia. The patient's blood cultures were analyzed from a previous admission and were shown to be positive for Staphylococcus aureus. The patient was started empirically on vancomycin, which was later switched to ceftriaxone as the bacteria were more sensitive to this antibiotic. A transthoracic echocardiogram did not demonstrate any vegetation or signs of endocarditis. There was a small right pleural effusion discovered on X-ray. Therefore, computed tomography as well as magnetic resonance imaging of the chest were performed, and showed osteomyelitis of the chest. The patient was continued on intravenous ceftriaxone for a total of 6 weeks. Tests for HIV, hepatitis A, B, and C were all found to be negative. The patient had no history of childhood illness, recurrent infections, or previous trauma to the chest, and had had no recent respiratory infections, pneumonia, or any underlying lung condition. Hence, her condition was thought to be a case of primary sternal osteomyelitis without known cause.Keywords: substernal, pleuritic, myocardial infarction, differential

An unusual case of primary human immunodeficiency virus infection presenting as mononucleosis-like syndrome and acute aseptic meningoencephalitis. Report of a case and review of the literature

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Marcelo Corti

2014-01-01

Full Text Available Clinical presentation of primary human immunodeficiency virus (HIV infection includes a wide spectrum of manifestations from asymptomatic infection to a symptomatic and severe illness. Central nervous system involvement should be always considered as a severe clinical form of primary HIV infection. Physicians should be aware to the broad clinical spectrum of primary HIV infection. We report a case of a female with diagnosis of mononucleosis-like syndrome and acute aseptic meningoencephalitis during primary HIV infection.

Vascularized osseous graft for scaphoid

International Nuclear Information System (INIS)

Mendez Daza, Carlos Hernan; Mathoulin, Cristophe

2004-01-01

The most commonly used technique for treatment of pseudo-arthrosis of the scaphoid is osteo-synthesis with Kirschnet wires and cortical sponge grafts. Results reported by different teams using this procedure show no more than 90% osseous consolidation, especially in cases where vascularisation of the proximal fragment of the scaphoid is compromised. Here we present a series of ten cases of pseudo-arthrosis of the scaphoid, treated using a new surgical technique involving a vascularized osseous graft of the distal radius. Using this procedure we obtained 100% consolidation, with no complications either during the procedure or immediately post-operatively. Patients returned to work in week 15 on average. In 4 cases we observed discomfort in the area of the scar, which was successfully treated using local cortisone injection. The results obtained are very similar to those seen in the literature on the different techniques for vascularized osseous grafts for pseudo-arthrosis of the scaphoid

Congenital pseudoarthrosis of clavicula

OpenAIRE

Korkmaz, Ahmet; Aydoğdu, Ayşe Yavuz

2014-01-01

Right clavicula fracture was found in a male patient who was brought to our outpatient clinic at the age of 7 days with a complaint of swelling on the right clavicula. The patient had no history of difficult delivery or resuscitation. He was born at term by spontaneous vaginal delivery with a birth weight of 3 340 g from the first pregnancy of his mother and there was no consanguinity between the parents. Orthopaedic examination repeated at the age of 2 months revealed pathological movement i...

Utilization of Aseptic Seedling Explants for In vitro Propagation of Indian Red Wood

Directory of Open Access Journals (Sweden)

Kishore Kumar CHIRUVELLA

2013-12-01

Full Text Available Micropropagation has been advocated as one of the most viable biotechnological tool for ex situ conservation of rare, endangered endemic medicinal plants germplasm. Rapid clonal micropropagation protocol for large-scale multiplication of an endemic medicinal plant Soymida febrifuga (Meliaceae was established from 15-day aseptic seedling cotyledonary node and shoot tip explants. High frequency of sprouting and shoot differentiation was observed from cotyledonary node explants compared to shoot tip, on Murashige and Skoog (MS medium fortified with BA, KN, 2-iP and CM. Of the cytokinins used, BA (3.0 mgl-1 supported highest average number and maximum multiple shoot differentiation (16.6. In vitro proliferated shoots were multiplied rapidly by culturing nodal segments as microcuttings, further subcultured on the same media for elongation. Elongated shoots upon transfer to MS medium fortified with IBA showed rooting within two weeks of culture. Rooted plantlets were successfully hardened and 75% of rooted shoots successfully survived on establishment to the soil. Plants looked healthy with no visually detectable phenotypic variations. This protocol provides a successful and rapid technique that can be used for ex situ conservation minimizing the pressure on wild populations and contributes to the conservation of this endemic medicinally potent flora.

Media-fill simulation tests in manual and robotic aseptic preparation of injection solutions in syringes.

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Krämer, Irene; Federici, Matteo; Kaiser, Vanessa; Thiesen, Judith

2016-04-01

The purpose of this study was to evaluate the contamination rate of media-fill products either prepared automated with a robotic system (APOTECAchemo™) or prepared manually at cytotoxic workbenches in the same cleanroom environment and by experienced operators. Media fills were completed by microbiological environmental control in the critical zones and used to validate the cleaning and disinfection procedures of the robotic system. The aseptic preparation of patient individual ready-to-use injection solutions was simulated by using double concentrated tryptic soy broth as growth medium, water for injection and plastic syringes as primary packaging materials. Media fills were either prepared automated (500 units) in the robot or manually (500 units) in cytotoxic workbenches in the same cleanroom over a period of 18 working days. The test solutions were incubated at room temperature (22℃) over 4 weeks. Products were visually inspected for turbidity after a 2-week and 4-week period. Following incubation, growth promotion tests were performed with Staphylococcus epidermidis. During the media-fill procedures, passive air monitoring was performed with settle plates and surface monitoring with contact plates on predefined locations as well as fingerprints. The plates got incubated for 5-7 days at room temperature, followed by 2-3 days at 30-35℃ and the colony forming units (cfu) counted after both periods. The robot was cleaned and disinfected according to the established standard operating procedure on two working days prior to the media-fill session, while on six other working days only six critical components were sanitized at the end of the media-fill sessions. Every day UV irradiation was operated for 4 h after finishing work. None of the 1000 media-fill products prepared in the two different settings showed turbidity after the incubation period thereby indicating no contamination with microorganisms. All products remained uniform, clear, and light

Results of hip arthroplasty using Paavilainen technique in patients with congenitally dislocated hip

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R. M. Tikhilov

2014-01-01

Full Text Available The purpose of the study was to analyze the medium- and long-term results of hip arthroplasty using Paavilainen technique in patients with the congenitally dislocated hip. Methods: From 2001 to 2012 180 operations were carried out were using the Paavilainen technique in 140 patients with high dislocation of the hip (Crowe IV. All patients were clinically evaluated using the Harris Hip Score (HHS, VAS and radiography. Statistical analysis was performed using the Pearson correlation coefficients, multiple regression analysis and classification trees analysis. Results: The average Harris score improved from preoperative 41.6 (40,3-43,5 to 79.3 (77,9-82,7 at final follow-up, and the difference was significant. Early complications were 9% (the most frequent were fractures of the proximal femur, later - 16.7% (pseudoarthrosis of the greater trochanter, 13.9%; disclocations-1,1%, aseptic loosening of the components - 1.7%, reoperation performed in 8.3% of cases. Such factors as age and limb length has statistically significant effect on functional outcomes. Established predictive model allows to get the best possible functional outcome in such patients with severe dysplasia. Conclusions: Total Hip arthroplasty using the Paavilainen technique is an effective method of surgical treatment in patients with the congenitally dislocated hip, but it is technically difficult operation with a high incidence of complications in comparison with standard primary total hip replacement.

Iron Supplementation Effects on Redox Status following Aseptic Skeletal Muscle Trauma in Adults and Children.

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Deli, Chariklia K; Fatouros, Ioannis G; Paschalis, Vassilis; Tsiokanos, Athanasios; Georgakouli, Kalliopi; Zalavras, Athanasios; Avloniti, Alexandra; Koutedakis, Yiannis; Jamurtas, Athanasios Z

2017-01-01

Exercise-induced skeletal muscle microtrauma is characterized by loss of muscle cell integrity, marked aseptic inflammatory response, and oxidative stress. We examined if iron supplementation would alter redox status after eccentric exercise. In a randomized, double blind crossover study, that was conducted in two cycles, healthy adults ( n = 14) and children ( n = 11) received daily either 37 mg of elemental iron or placebo for 3 weeks prior to and up to 72 h after an acute eccentric exercise bout. Blood was drawn at baseline, before exercise, and 72 h after exercise for the assessment of iron status, creatine kinase activity (CK), and redox status. Iron supplementation at rest increased iron concentration and transferrin saturation ( p exercise, while no changes occurred in children. Iron supplementation increased TBARS at 72 h after exercise in both adults and children; no changes occurred under placebo condition. Eccentric exercise decreased bilirubin concentration at 72 h in all groups. Iron supplementation can alter redox responses after muscle-damaging exercise in both adults and children. This could be of great importance not only for healthy exercising individuals, but also in clinical conditions which are characterized by skeletal muscle injury and inflammation, yet iron supplementation is crucial for maintaining iron homeostasis. This study was registered at Clinicaltrials.gov Identifier: NCT02374619.

Colgajo de omento para tratamiento de dehiscencia de herida esternal Omental flap for management of sternal wound dehiscence

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A. Pérez García

2013-03-01

Full Text Available La mediastinitis es una de las complicaciones más graves de la cirugía cardíaca. Aparece en el 0,5-5 % de las esternotomías y esta incidencia es mucho mayor en pacientes diabéticos, obesos, inmunodeprimidos, con enfermedad pulmonar obstructiva crónica (EPOC, etc. Presentamos el caso de una paciente diabética, obesa mórbida, que sufre mediastinitis tras doble by-pass coronario. Para la cobertura del defecto se empleó un colgajo de epiplon tunelizado transdiafragmático. El colgajo omental permite cubrir grandes defectos además de que posee capacidad antimicrobiana y favorece la revascularización tisular. Las características de este colgajo hacen que actualmente deba considerarse como primera elección en pacientes con grandes defectos esternales y trastornos de la inmunidad y la cicatrización.Mediastinitis is one of the most serious complications from cardiac surgery. It is reported to occur in 0'5-5 % of sternotomy incisions, and this incidence is much higher in diabetic patients, obese, immunocompromised, COPD, etc. We report a case of a diabetic and morbid obese woman suffering mediastinitis after double coronary bypass surgery. For the reconstruction a transdiaphragmatic tunnelled omental flap was used. The omentum is useful to cover large defects. It has antiinfective properties and promotes revascularization of neighbouring tissues. Omental flap can be a highly effective treatment for patients with large sternal wounds and immune disorders and wound healing disorders.

Treatment of the femoral neck peudoarthrosis in childhood: Case report

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Vukašinović Zoran

2013-01-01

Full Text Available Introduction. Femoral neck fractures in children and adolescents are rare. However, their complications are frequent - avascular necrosis, femoral neck pseudoarthrosis, premature physeal closure with consequent growth disturbance and coxa vara deformity. Case Outline. A 9.5­year­old boy was injured in a car accident, and femoral neck fracture was diagnosed. Prior to admission at our hospital he was surgically treated several times. He was admitted at our hospital eight months following the accident. On the X­ray transcervical pseudoarthrosis of the femoral neck was found, as well as coxa vara deformity and metaphyseal avascular necrosis. He was operated at our hospital; all previously placed ostefixation material was removed, valgus osteotomy of 30 degrees was done as well as additional local osteoplasty using the commercial osteoindactive agent (Osteovit®. Postoperatively, we applied skin traction, bed rest and physical therapy. At the final follow­up, the patient was recovered completely. He is now painless, the legs are of equal length, range of movements in the left hip is full, life activity is normal. The X­ray shows that the femoral neck pseudoarthrosis is fully healed. Conclusion. This case is presented in order to encourage other colleagues to challenge the problematic situation such as this one. Also, we would like to remind them what one should think about and what should be taken into consideration in the primary treatment of femoral neck fractures in children. Valgus femoral osteotomy, as a part of the primary treatment of femoral neck fracture in children (identically as in the adults can prevent the occurrence of femoral neck pseudoarthrosis.

Iron Supplementation Effects on Redox Status following Aseptic Skeletal Muscle Trauma in Adults and Children

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Chariklia K. Deli

2017-01-01

Full Text Available Exercise-induced skeletal muscle microtrauma is characterized by loss of muscle cell integrity, marked aseptic inflammatory response, and oxidative stress. We examined if iron supplementation would alter redox status after eccentric exercise. In a randomized, double blind crossover study, that was conducted in two cycles, healthy adults (n=14 and children (n=11 received daily either 37 mg of elemental iron or placebo for 3 weeks prior to and up to 72 h after an acute eccentric exercise bout. Blood was drawn at baseline, before exercise, and 72 h after exercise for the assessment of iron status, creatine kinase activity (CK, and redox status. Iron supplementation at rest increased iron concentration and transferrin saturation (p<0.01. In adults, CK activity increased at 72 h after exercise, while no changes occurred in children. Iron supplementation increased TBARS at 72 h after exercise in both adults and children; no changes occurred under placebo condition. Eccentric exercise decreased bilirubin concentration at 72 h in all groups. Iron supplementation can alter redox responses after muscle-damaging exercise in both adults and children. This could be of great importance not only for healthy exercising individuals, but also in clinical conditions which are characterized by skeletal muscle injury and inflammation, yet iron supplementation is crucial for maintaining iron homeostasis. This study was registered at Clinicaltrials.gov Identifier: NCT02374619.

Prevention of Cardiac Implantable Electronic Device Infections: Single Operator Technique with Use of Povidone-Iodine, Double Gloving, Meticulous Aseptic/Antiseptic Measures and Antibiotic Prophylaxis.

Science.gov (United States)

Manolis, Antonis S; Melita, Helen

2017-01-01

Cardiac implantable electronic device (CIED) implantation is complicated by infection still at a worrisome rate of 2-5%. Since early on during device implantation procedures, we have adopted an infection-preventive technique which has hitherto resulted in effective prevention of infections. Herein we present our results of applying this technique by a single operator in a prospective series of 762 consecutive patients undergoing device implantation. A meticulous search for and treatment of active, occult, or smoldering infection was undertaken preoperatively. An aseptic/antiseptic technique was used for implantation of each device. Skin preparation is thorough with initial cleansing performed with alcohol followed by povidone-iodine 10% solution, which is also used in the wound and inside the pocket. In addition, we routinely use double gloving, and IV antibiotic prophylaxis 1 hour before and for 48 hours afterwards followed by oral antibiotic for 2-3 days after discharge. The skin is closed with absorbable sutures. The study includes 382 patients having a new pacemaker (n = 333) or battery change, system upgrade or lead revision (n = 49), and 380 patients having a new implantable cardioverter-defibrillator (ICD) (n = 296) or device replacement/upgrade/lead revision (n = 84). The pacemaker group, aged 70.2 ± 16.5 years, includes 18% VVI, 49% DDD, 29% VDD, and 4% cardiac resynchronization therapy (CRT) devices. The ICD group, aged 61.3 ± 13.0 years, with a mean ejection fraction of 36 ± 13%, includes 325 ICD and 55 CRT implants. Over 26.6 ± 33.4 months for the pacemaker group and 36.6 ± 38.3 months for the ICD group, infection occurred in one patient in each group (0.26%) having a device replacement. A consistent and strict approach of aseptic/antiseptic technique with the use of double gloving and povidone-iodine solution within the pocket plus a 4-day regimen of antibiotic prophylaxis minimizes infections in CIED implants. © 2016 Wiley Periodicals, Inc.

Three dimensional images of the sternum in children with using MDCT

International Nuclear Information System (INIS)

Kim, Young Tong; Kim, Hyun Cheol; Bae, Won Kyung; Kim, Il Young

2006-01-01

We wanted to analyze the three dimensional images with using multidetector CT scanning of the sternum in children, and we wanted to compare the CT findings with the children's age. We studied the three dimensional images of the sternum of 67 children (62 were boys and 5 were girls). The age of the children was 3-15 years old (mean age:7.5). We evaluated the number of sternal bodies, the presence of the xiphoid process and the bifid shape of each sternal body. The number of sternal bodies was from three to five; 30 patients had 3 bodies, 25 patients had 4 bodies and 5 patients had 2. The number of sternal bodies was 3.4 in Group I, 3.5 in Group II and 3.9 in Group III. As the children's age increased, the number of sternal body was statistically increased. When the number of sternal bodies was three, the mean age of children was 5.4 year; when it was four or five, the mean age of children was 8.1 year. The children's age was increased as the number of sternal bodies increased. The mean age of the children with a xiphoid process was 7.0 years, and the mean age of children without a xiphoid process was 8.1. There was no statistical difference between the two groups with or without xiphoid process. Among the 67 children, 9 had the bifid shape in the 3rd portion of the sternal body, 5 had the bifid shape in 4th portion, 2 had the bifid shape in 2nd portion and 1 had the bifid shape in 5th portion. The number of sternal bodies was mostly three or four. The number of sternal bodies was related to the children's age. Three is no relationship between children's age and the presence of the xiphoid process. The bifid shapes are mostly shown in the 3rd and 4th portion of the sternal body

A Randomized Trial to Assess the Contribution of a Novel Thorax Support Vest (Corset) in Preventing Mechanical Complications of Median Sternotomy.

Science.gov (United States)

Caimmi, Philippe P; Sabbatini, Maurizio; Kapetanakis, Emmanouil I; Cantone, Silvia; Ferraz, Marcus V; Cannas, Mario; Tesler, Ugo F

2017-06-01

Mechanical complications of median sternotomy may cause significant morbidity and mortality in cardiac surgical patients. This study was aimed at assessing the role of Posthorax support vest (Epple, Inc., Vienna, Austria) in the prevention of sternal complications and the improvement of anatomical healing in patients at high risk for mechanical sternal dehiscence after cardiac surgery by mean of median sternotomy. A prospective, randomized, study was performed and 310 patients with predisposing factors for sternal dehiscence after sternotomy for cardiac surgery were included. The patients were divided into two groups: patients who received the Posthorax support vest after surgery, and patients who did not. Primary variables assessed included the incidence of mechanical sternal complications, the quality of sternal healing, the rate of re-operation, the duration of hospitalization, rate and duration of hospital, re-admission for sternal complications. Secondary variables assessed were the post-operative pain, the number of requests for supplemental analgesia and the quality of life measured by means of the EQ-5D format. Patients using vest demonstrated a lower incidence of mechanical sternal complications, a better anatomical sternum healing, lower hospital stay, no re-operations for sternal dehiscence before discharge and lower re-admissions for mechanical sternal complication. In addition, patients using a vest reported a better quality of life with better freedom from limitations in mobility, self-care, and pain. Our findings demonstrate that the use of the Posthorax vest reduces post-sternotomy mechanical complications and improves the healing of the sternotomy, the clinical course, and the post-operative quality of life.

Sternal Route More Effective than Tibial Route for Intraosseous Amiodarone Administration in a Swine Model of Ventricular Fibrillation.

Science.gov (United States)

Burgert, James M; Martinez, Andre; O'Sullivan, Mara; Blouin, Dawn; Long, Audrey; Johnson, Arthur D

2018-01-01

The pharmacokinetics of IO administered lipid soluble amiodarone during ventricular fibrillation (VF) with ongoing CPR are unknown. This study measured mean plasma concentration over 5 minutes, maximum plasma concentration (Cmax), and time to maximum concentration (Tmax) of amiodarone administered by the sternal IO (SIO), tibial IO (TIO), and IV routes in a swine model of VF with ongoing CPR. Twenty-one Yorkshire-cross swine were randomly assigned to three groups: SIO, TIO, and IV. Ventricular fibrillation was induced under general anesthesia. After 4 minutes in VF, 300 mg amiodarone was administered as indicated by group assignment. Serial blood specimens collected at 30, 60, 90, 120, 150, 180, 240, and 300 seconds were analyzed using high performance liquid chromatography with tandem mass spectrometry. The mean plasma concentration of IV amiodarone over 5 minutes was significantly higher than the TIO group at 60 seconds (P = 0.02) and 90 seconds (P = 0.017) post-injection. No significant differences in Cmax between the groups were found (P <0.05). The Tmax of amiodarone was significantly shorter in the SIO (99 secs) and IV (86 secs) groups compared to the TIO group (215 secs); P = 0.002 and P = 0.002, respectively. The SIO and IV routes of amiodarone administration were comparable. The TIO group took nearly three times longer to reach Tmax than the SIO and IV groups, likely indicating depot of lipid-soluble amiodarone in adipose-rich tibial yellow bone marrow. The SIO route was more effective than the TIO route for amiodarone delivery in a swine model of VF with ongoing CPR. Further investigations are necessary to determine if the kinetic differences found between the SIO and TIO routes in this study affect survival of VF in humans.

洁净手术室无菌台质量动态调查及预防措施探讨%Dynamic investigation and preventive measures of aseptic table in clean operating rooms

Institute of Scientific and Technical Information of China (English)

陶晓燕; 冯惠娟; 沈郁; 钱小毛

2013-01-01

OBJECTIVE To investigate the dynamic change of quality of aseptic table in clean operating room and discuss the prevention measures.METHODS We investigated 5 surgeries in each one clean operating room of hundred level,two clean operating room of thousand level and two clean operating room of ten thousand level.Drape and scissors were smeared to take culture and tampon were taken into 10ml sterilized saline water to take culture.The sampling was performed respectively at 1 hour,2 hour,3 hour,4 hour after the start of the surgery.It was judged as qualified that there was no strains of bacteria isolated.The qualified rates of the various samples at various segments were taken for statistical analysis.RESULTS Bacteria was not detected in 2 hours on the drape surface but then was positive culture after three hours as compared with that after four hours on surface of scissors and tampon bacteria were detected,the difference in the qualified rate was not statistically significant.Six monitoring points in 3 surgery were tested unqualified among the 25 surgeries,all the results were 1 CFU/plate.One point was in thousand level operating room and bacteria were detected on tampon after four hours.Five positive monitoring points were in ten thousand level operating room and bacteria were detected once on surface of drapes after one hour in NO.1 room and after four hours in NO.2,on surface of scissor and in tampon after four hours,the difference in the qualified rate was not statistically significant.The unqualified aseptic tables may related to the extended operation duration,the frequent flow of people and materials,and poor consciousness of aseptic operation and substandard action of the medical staff.CONCLUSION It is effective to ensure the quality of aseptic tables to intensify the consciousness of aseptic operation and make the environment management and people and logistic management strict.%目的 �

Estabilidade dos carotenoides,antocianinas e vitamina C presentes no suco tropical de acerola (Malpighia emarginata DC. adoçado envasado pelos processos Hot-Fill e asséptico Stability of carotenoids, anthocyanins and vitamin C presents in acerola sweetened tropical juice preserved by hot fill and aseptic processes

Directory of Open Access Journals (Sweden)

Claisa Andréa Silva de Freitas

2006-10-01

Full Text Available As frutas tropicais são muito aceitas pelos consumidores, e são importantes fontes de componentes antioxidantes. A acerola, conhecida por conter grandes quantidades de vitamina C, é também rica em antocianinas e carotenóides. O presente trabalho teve por objetivo avaliar a estabilidade dos carotenóides totais, antocianinas totais e vitamina C do suco tropical de acerola adoçado, elaborado pelos processos Hot Fill (garrafas de vidro e asséptico (embalagens cartonadas, durante 350 dias de armazenamento em condições similares às de comercialização (28ºC ± 2ºC. Ao final do experimento observou-se que não houve perdas de antocianinas totais para o processo Hot Fill, no entanto, para o processo asséptico constatou-se uma redução de 86,89% dos teores iniciais. Os valores de carotenóides totais permaneceram inalterados nas amostras do processo asséptico, enquanto nas do Hot Fill houve uma redução de 12,5%. Constatou-se redução nos teores de vitamina C da ordem de 23,61% para o processo Hot Fill e de 35,95% para o processo asséptico.Tropical fruits are widely accepted by consumers, and important sources of antioxidant compounds. Acerola, known to have high vitamin C levels, is also rich in anthocyanins and carotenoids. The purpose of this work was to evaluate the stability of the total carotenoids, total anthocyanins and ascorbic acid of the acerola sweetened tropical juice produced by the Hot Fill (glass bottles and aseptic (packings carton process during 350 days of storage in similar conditions of trade (28ºC ± 2ºC. It was observed that there were not losses of total anthocyanins for the process Hot Fill, however for the aseptic process a reduction of 86.89% of the initial values was observed. The values of total corotenoids stayed unaffected in the samples of the aseptic process, while in the one of the Hot Fill there was a reduction of 12.5%. A reduction in the values of ascorbic acid of 23.61% was observed for the Hot

Ingestion of BioCell Collagen®, a novel hydrolyzed chicken sternal cartilage extract; enhanced blood microcirculation and reduced facial aging signs

Directory of Open Access Journals (Sweden)

Schwartz SR

2012-07-01

Full Text Available Stephen R Schwartz,1 Joosang Park21International Research Services Inc, Port Chester, NY, USA; 2BioCell Technology, LLC, Newport Beach, CA, USAAbstract: Skin aging and its clinical manifestation is associated with altered molecular metabolism in the extracellular matrix of the dermis. In a pilot open-label study, we investigated the effect of a dietary supplement, BioCell Collagen® (BCC, which contains a naturally occurring matrix of hydrolyzed collagen type II and low-molecular-weight hyaluronic acid and chondroitin sulfate, in 26 healthy females who displayed visible signs of natural and photoaging in the face. Daily supplementation with 1 g of BCC for 12 weeks led to a significant reduction of skin dryness/scaling (76%, P = 0.002 and global lines/wrinkles (13.2%, P = 0.028 as measured by visual/tactile score. Additionally, a significant increase in the content of hemoglobin (17.7%, P = 0.018 and collagen (6.3%, P = 0.002 in the skin dermis was observed after 6 weeks of supplementation. At the end of the study, the increase in hemoglobin remained significant (15%, P = 0.008, while the increase in collagen content was maintained, but the difference from baseline was not significant (3.5%, P = 0.134. This study provides preliminary data suggesting that dietary supplementation with BCC elicits several physiological events which can be harnessed to counteract natural photoaging processes to reduce visible aging signs in the human face. A controlled study is necessary to verify these observations.Keywords: BioCell Collagen, chicken sternal cartilage extract, hydrolyzed collagen type II, low-molecular-weight hyaluronic acid, skin aging

operative treatment of primary bone tumours of the femur and the tibia

African Journals Online (AJOL)

can cause infection, pseudoarthrosis and pathological fracture. Objective: The purpose of ... after several re-surgeries. Key words: Bone tumour, Femur, Tibia, Resection, Allograft .... stress, the length of the graft, the realization of an arthrodesis ...

Osseous scintigraphy and auxiliary graft. Scintigraphie osseuse et greffe d'appoint

Energy Technology Data Exchange (ETDEWEB)

Khelifa, F.; Siles, S. (Hopital de la Timone, 13 - Marseille (France)); Puech, B.

1992-12-01

The scintigraphy could be a good way to survey the osseous graft: three cases are studied in which were recognized the presence of a graft, surinfection, graft lysis, pseudo-arthrosis, algodystrophy. 8 refs., 5 figs.

Osseous scintigraphy and auxiliary graft

International Nuclear Information System (INIS)

Khelifa, F.; Siles, S.; Puech, B.

1992-01-01

The scintigraphy could be a good way to survey the osseous graft: three cases are studied in which were recognized the presence of a graft, surinfection, graft lysis, pseudo-arthrosis, algodystrophy. 8 refs., 5 figs

Canine serum C-reactive protein as a quantitative marker of the inflammatory stimulus of aseptic elective soft tissue surgery.

Science.gov (United States)

Kjelgaard-Hansen, Mads; Strom, Henriette; Mikkelsen, Lars F; Eriksen, Thomas; Jensen, Asger L; Luntang-Jensen, Michael

2013-09-01

C-reactive protein (CRP) is an established serum marker for the presence of systemic inflammation in dogs. Results from previous experimental and clinical studies suggest that CRP concentrations also quantitatively reflect the degree and progress of an inflammatory process, suggesting its use for inflammation monitoring. The objective was to investigate whether the canine CRP response in serum correlates with the amount of trauma and the consequent inflammatory response after 3 standard aseptic soft-tissue surgical procedures in 3 groups of dogs. A total of 24 client-owned intact female dogs of various breeds were enrolled in a clinical study with random allocation into 2 surgical groups, for either conventional, open-approach ovariohysterectomy (OVH; n = 14) or laparoscopic assisted OVH (n = 10). In addition, a group of 8 male Beagles from a laboratory animal facility underwent vasectomy, serving as the third and mildest surgical trauma group. Serum CRP was measured pre- and at 4, 8, 12, 23, and 27 hours postsurgery. Cumulative concentration over time and point concentrations of CRP were correlated with the surgical trauma impact level. There was a significant surgery trauma-related difference in cumulative CRP concentrations among the 3 groups, and also in the 12 hours postsurgery concentration. The CRP response varied according to the degree of surgical trauma on 3 standardized levels, thus supporting the use of canine serum concentrations of CRP as an inflammatory activity indicator and monitoring marker. © 2013 American Society for Veterinary Clinical Pathology.

Post-market Surveillance Study With the HYPERION Hip Endoprosthesis System in Defect Reconstruction

Science.gov (United States)

2017-12-19

Osteoarthritis; Avascular Necrosis; Rheumatoid Arthritis; Functional Deformities; Pseudoarthrosis; Revision of Endoprosthesis-treated Hips; Fracture, Proximal Humeral; Provision of Non-endoprosthetic Previous Operations of the Hip Joint (e.g., Transposition Osteotomies); Femur Fracture; Pseudarthrosis; Trochanteric Fractures; Bridging of Large Bone Defects; Revisions

Prospective, randomized, controlled trial of polymer cable ties versus standard wire closure of midline sternotomy.

Science.gov (United States)

Marasco, Silvana F; Fuller, Louise; Zimmet, Adam; McGiffin, David; Seitz, Michael; Ch'ng, Stephanie; Gangahanumaiah, Shivanand; Bailey, Michael

2018-04-16

Midline sternotomy remains the most common access incision for cardiac operations. Traditionally, the sternum is closed with stainless steel wires. Wires are well known to stretch and break, however, leading to pain, nonunion, and potential deep sternal wound infection. We hypothesized that biocompatible plastic cable ties would achieve a more rigid sternal fixation, reducing postoperative pain and analgesia requirements. A prospective, randomized study compared the ZIPFIX (De Puy Synthes, West Chester, Pa) sternal closure system (n = 58) with standard stainless steel wires (n = 60). Primary outcomes were pain and analgesia requirements in the early postoperative period. Secondary outcome was sternal movement, as assessed by ultrasound at the postoperative follow-up visit. Groups were well matched in demographic and operative variables. There were no significant differences between groups in postoperative pain, analgesia, or early ventilatory requirements. Patients in the ZIPFIX group had significantly more movement in the sternum and manubrium on ultrasound at 4 weeks. ZIPFIX sternal cable ties provide reliable closure but no demonstrable benefit in this study in pain or analgesic requirements relative to standard wire closure after median sternotomy. Crown Copyright © 2018. Published by Elsevier Inc. All rights reserved.

Reconstruction of congenital tibial pseudarthrosis by revascularized fibular transplants

NARCIS (Netherlands)

Bos, K. E.; Besselaar, P. P.; van der Eyken, J. W.; Taminiau, A. H.; Verbout, A. J.

1993-01-01

Seven patients with congenital Boyd type II pseudoarthrosis of the tibia and fibula were treated with a revascularized osteocutaneous fibular graft from the contralateral side. Follow-up ranged from 20 to 96 months (mean 67 months). All patients had previously undergone major surgery (mean three

Bone Gap Management Using Linear Rail System (LRS): Initial ...

African Journals Online (AJOL)

Background: Vascularized fibular grafting, free fibular graft, tibia profibula synostosis, amputation with a good prosthesis and Ilizarov technique are some of the suitable options for managing bone gaps that result from trauma or treatment of tumours, bone infection, congenital pseudoarthrosis and repeated failed ...

Journal of Surgical Technique and Case Report - Vol 6, No 1 (2014)

African Journals Online (AJOL)

Treatment of Pseudoarthrosis After Minimally Invasive Hallux Valgus Correction · EMAIL FREE FULL TEXT EMAIL FREE FULL TEXT DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT. M Cianforlini, C Rosini, M Marinelli, L de Palma, 39-42. http://dx.doi.org/10.4103/2006-8808.135153 ...

Manglende evidens for skadelig effekt på knogleheling ved behandling med NSAID

DEFF Research Database (Denmark)

Janum, Susanne; Kristensen, Billy Bjarne

2012-01-01

discard of NSAID for postoperative pain relief in uncomplicated cases. However, NSAID should be considered a potentiel risk factor of impaired bone healing and avoided in patients with a high risk of pseudoarthrosis. Recommended daily doses should be respected and duration of treatment should be limited....

Cell-based Assay System for Predicting Bone Regeneration in Patient Affected by Aseptic Nonunion and Treated with Platelet Rich Fibrin.

Science.gov (United States)

Perut, Francesca; Dallari, Dante; Rani, Nicola; Baldini, Nicola; Granchi, Donatella

Regenerative strategies based on the use of platelet concentrates as an autologous source of growth factors (GF) has been proposed to promote the healing of long bone nonunions. However, the relatively high failure rate stimulates interest in growing knowledge and developing solutions to obtain the best results from the regenerative approach. In this study we evaluated whether a cell-based assay system could be able to recognize patients who will benefit or not from the use of autologous platelet preparations. The autologous serum was used in culture medium to promote the osteogenic differentiation of normal bone-marrow stromal cells (BMSC). Blood samples were collected from 16 patients affected by aseptic long bone nonunion who were candidates to the treatment with autologous platelet-rich fibrin. The osteoinductive effect was detected by measuring the BMSC proliferation, the mineralization activity, and the expression of bone-related genes. Serum level of basic fibroblast growth factor (bFGF) was considered as a representative marker of the delivery of osteogenic GFs from platelets. Laboratory results were related to the characteristics of the disease before the treatment and to the outcome at 12 months. Serum samples from "good responders" showed significantly higher levels of bFGF and were able to induce a significantly higher proliferation of BMSC, while no significant differences were observed in terms of osteoblast differentiation. BMSC-based assay could be a useful tool to recognize patients who have a low probability to benefit from the use of autologous platelet concentrate to promote the healing of long bone nonunion.

Is there a place for radionuclide bone scintigraphy in the ...

African Journals Online (AJOL)

... shown the importance of bone scintigraphy in the detection of fractures in radiographnegative skeletal trauma.T-3 The early detection and immobilisation of fractures of the scaphoid are thought to be essential in preventing the disabling sequelae of avascular necrosis and pseudo-arthrosis,4 Several studies allude to the

Six heads of origin of sternocleidomastoid muscle: a rare case | Kaur ...

African Journals Online (AJOL)

A morphological variation in the origin of the right sternocleidomastoid muscle was encountered during routine dissection of the neck for undergraduate students. We found six heads of the sternocleidomastoid muscle, two sternal and four clavicular heads. The two sternal heads were lying side by side, while two clavicular ...

Comparison of the effects of sternal and tibial intraosseous administered resuscitative drugs on return of spontaneous circulation in a swine model of cardiac arrest.

Science.gov (United States)

O'Sullivan, Mara; Martinez, Andre; Long, Audrey; Johnson, Michelle; Blouin, Dawn; Johnson, Arthur D; Burgert, James M

2016-01-01

Compare vasopressin, amiodarone, and epinephrine administration by sternal intraosseous (SIO), tibial intraosseous (TIO), and intravenous (IV) routes in a swine model of cardiac arrest. Prospective, randomized, between subjects, experimental design. Laboratory. Male Yorkshire-cross swine (N = 35), seven per group. Swine were randomized to SIO, TIO, IV, cardiopulmonary resuscitation (CPR) with defibrillation, or CPR-only groups. Ventricular fibrillation (VF) was induced under general anesthesia. Mechanical CPR began 2 minutes postarrest. Vasopressin (40 U) was administered to the SIO, TIO, and IV groups 4 minutes postarrest. Defibrillation was performed and amiodarone (300 mg) was administered 6 minutes postarrest. Defibrillation was repeated, and epinephrine (1 mg) was administered 10 minutes postarrest. Defibrillation was repeated every 2 minutes and epinephrine repeated every 4 minutes until return of spontaneous circulation (ROSC) or 26 postarrest minutes elapsed. Rate of ROSC, time to ROSC, and odds of ROSC. There were no significant differences in rate of ROSC between the SIO and TIO (p = 0.22) or IV groups (p = 1.0). Time to ROSC was five times less in the SIO group than the TIO group (p = 0.003) but not compared to IV (p = 0.125). Time to ROSC in the IV group was significantly less than the TIO group (p = 0.04). Odds of ROSC for the SIO group were five times higher compared to the TIO group but same as IV. Odds of ROSC in the IV group were higher than the TIO group. There was a statistically significant delay in the time to ROSC and a clinically significant difference in odds of ROSC when resuscitative drugs, including lipophilic amiodarone, were administered by the TIO route compared to the SIO and IV routes in a swine model of sudden cardiac arrest. Further investigations are warranted to isolate the mechanism behind these findings.

Disease: H01429 [KEGG MEDICUS

Lifescience Database Archive (English)

Full Text Available H01429 Aseptic meningitis The term aseptic meningitis can be used broadly to include all types of meningiti...s with negative bacterial cultures from cerebrospinal fluid. Etiology of aseptic meningitis... is very wide and includes both viral and non-viral infections, drugs, malignancy, and systemic illness. Viral meningitis... constitutes the most common cause of aseptic meningitis and...Kumar R ... TITLE ... Aseptic meningitis: diagnosis and management. ... JOURNAL ... Indian J Pediatr 72:57-63 (2005) DOI:10.1007/BF02760582 ...

Colagenopatía y meningitis aséptica recurrente en una paciente de 88 años Colagenopathy and recurrent aseptic meningitis in an 88 year old patient

Directory of Open Access Journals (Sweden)

Fernando J. VAzquez

2004-02-01

Full Text Available La meningitis aséptica recurrente (MAR en ancianos es rara y generalmente es secundaria a drogas. Su asociación a colagenopatías en ancianos ha sido raramente informada. El Síndrome de Sjögren (SS en ocasiones afecta el sistema nervioso central, pero la MAR asociada a SS es rara en este grupo etario. Se presenta una paciente de 88 años, autoválida, con antecedentes de xerostomía, xeroftalmos, Raynaud, disfagia y agrandamiento parotídeo recurrente autolimitado. En el año 2001 cursó una meningitis linfocítica y evolucionó con recuperación completa. Un año después volvió a presentar una meningitis linfocítica aséptica. Se descartaron causas infecciosas. Se demostró FAN 1/160 con patrón nucleolar moteado, Ac anti Ro y anti RNP positivos y anticoagulante lúpico positivo. Se confirmó sequedad ocular y la biopsia de labio fue compatible con SS. Evolucionó con resolución completa en 10 días sin tratamiento. Se interpretó como una enfermedad mixta del tejido conectivo (EMTC con síntomas predominantemente de SS, que cursó una MAR en su forma pura. La EMTC y el SS deberían ser considerados entre los diagnósticos diferenciales de la MAR, inclusive en ancianos.Recurrent aseptic meningitis (RAM infrequent in elderly patients and generally secondary to drugs. Its association with rheumatologic diseases is also seldom reported in the elderly. Sjögren Syndrome (SS sometimes affects the central nevous system, but the association between recurrent meningitis and SS is rare, specially in this age-group. We present an 88 year-old autovalid patient, with a history of xerostomia, xerophthalmia, Raynaud, dysphagia, and recurrent parotid enlargement. In 2001 she developed a lymphocytic meningitis with a complete remission. A year later, she developed again an aseptic lymphocytic meningitis. We ruled out infeccious causes. We found a FAN titer 1/160 with a nucleolar-mottled pattern, positive anti Ro and anti RNP antibodies and a positive

The effect of body position on the 'hanging drop' method for identifying the extradural space in anaesthetized dogs.

Science.gov (United States)

Naganobu, Kiyokazu; Hagio, Mitsuyoshi

2007-01-01

To assess the accuracy of the 'hanging drop method' for identifying the extradural space in anaesthetized dogs positioned in sternal or lateral recumbency. Prospective randomized-experimental study. Seventeen clinically healthy adult dogs, 10 females and seven males weighing 8.4-26.2 kg. Dogs were positioned in either sternal (n = 8) or lateral (n = 9) recumbency under general anaesthesia. A 20 SWG spinal needle pre-filled with 0.9% saline was advanced through the skin into the lumbosacral extradural space and the response of the saline drop recorded, i.e. whether it: 1) was aspirated from the hub into the needle; 2) remained within the hub, or 3) moved synchronously with i) spontaneous respiration, ii) heart beat or iii) manual lung inflation. The position of the needle tip was ultimately determined by positive contrast radiography. One dog positioned in lateral recumbency was excluded from the study because bleeding occurred from the needle hub. Saline was aspirated into the needle in seven of eight dogs held in sternal recumbency but in none of the dogs positioned in lateral recumbency. Accurate needle tip placement in the extradural space was confirmed by positive contrast radiography in all dogs. The 'hanging drop' method, when performed with a spinal needle, appears to be a useful technique for identifying the location of the extradural space in anaesthetized medium-sized dogs positioned in sternal, but not in lateral recumbency. The technique may yield 'false negative' results when performed in dogs positioned in sternal recumbency.

A Study to Assess the Association of Aseptic Practices Being Followed and its Effect on the Overall Outcome of Selected Special Care Newborn Units (SCNUs of Madhya Pradesh at Different Levels.

Directory of Open Access Journals (Sweden)

Mahore RK

2015-04-01

Full Text Available The neonatal mortality rate in India is high and stagnant. Special Care Newborn Units (SCNUs have been set up at different levels of Health Care Delivery System to provide quality newborn-care services in several hospitals to meet this challenge. Many units are located in the districts where the burden of neonatal deaths is high, and access to special newborn care is poor. The study was conducted to assess the functioning of SCNUs in six centers of India. The evaluation was based on an analysis of secondary data from the six units that had been functioning for at least three year. A cross-sectional survey was also conducted to assess the availability of Quality care and Aseptic practices implemented at different levels of SNCUs. Descriptive statistics were used for analyzing the inputs (Quality care and aseptic practices and outcomes (morbidity and mortality. The rate of mortality among admitted neonates was taken as the key outcome variable to assess the performance of the units. Chi-square test was used for analyzing the trend of case-fatality rate over a period of 3 years considering the first year of operationalization as the base. Correlation coefficients were estimated to understand the possible association of case-fatality rate with factors, such as bed:doctor ratio, bed:nurse ratio, average duration of stay, and bed occupancy rate, and the asepsis score was determined. The rates of admission increased from a median of 16.7 per 100 deliveries in 2012 to 19.5 per 100 deliveries in 2014. The case-fatality rate shows progressive decline in all the units in Last 3 years. Proportional mortality due to sepsis and low birthweight (LBW declined significantly over two years (LBW <2.5 kg. The major reasons for admission and the major causes of deaths were birth asphyxia, sepsis, and LBW/prematurity. The units had a varying nurse:bed ratio (1:1-1:2.14. The bed occupancy rate ranged from 83% to 121% (median 115%, and the average duration of stay

Nipple placement in simple mastectomy with free nipple grafting for severe gynecomastia.

Science.gov (United States)

Murphy, T P; Ehrlichman, R J; Seckel, B R

1994-11-01

Severe gynecomastia with excessive skin is difficult to treat by only periareolar excision or suction-assisted lipectomy or both. In these patients, total mastectomy and free nipple grafting may be the best option. Placement of the nipple, however, has been arbitrary. With use of 20 "aesthetically perfect" men as models, standard nipple distances were identified. The average sternal notch-to-nipple measurement was 21 cm. In addition, two consistent ratios were identified. The nipple plane was located 0.33 times the distance from the sternal notch to the pubis, and the internipple distance was 0.23 times the chest circumference. With use of preoperatively obtained measurements of the sternal notch to pubis and chest circumference, accurate nipple placement can be accomplished.

Treatment of Pseudoarthrosis After Minimally Invasive Hallux Valgus ...

African Journals Online (AJOL)

access techniques enable correction of 80-90% of hallux valgus deformities solely via hallux manipulation without removal of the eminence or open lateral release yielding more than 90% excellent and good results.[2,4,5] Nonunion is rarely reported. We describe our operative technique for nonunion following minimally ...

Pseudoarthrosis following proximal humeral fractures: A possible mechanism

Energy Technology Data Exchange (ETDEWEB)

Rooney, P.J.; Cockshott, W.P.

1986-01-01

A small series of four patients with pseudarthrosis of the proximal humeral shaft is reported. These patients all had restricted movement of the shoulder joint prior to the trauma, three as a result of rheumatoid arthritis and one due a surgical fusion of the glenohumeral joint. It is suggested that pseudarthrosis is more likely under these circumstances and that pursuit of union of the fracture in such patients may not always be necessary.

Experiences of Indian Health Workers Using WhatsApp for Improving Aseptic Practices With Newborns: Exploratory Qualitative Study

Science.gov (United States)

Livesley, Nigel

2018-01-01

Background Quality improvement (QI) involves the following 4 steps: (1) forming a team to work on a specific aim, (2) analyzing the reasons for current underperformance, (3) developing changes that could improve care and testing these changes using plan-do-study-act cycles (PDSA), and (4) implementing successful interventions to sustain improvements. Teamwork and group discussion are key for effective QI, but convening in-person meetings with all staff can be challenging due to workload and shift changes. Mobile technologies can support communication within a team when face-to-face meetings are not possible. WhatsApp, a mobile messaging platform, was implemented as a communication tool by a neonatal intensive care unit (NICU) team in an Indian tertiary hospital seeking to reduce nosocomial infections in newborns. Objective This exploratory qualitative study aimed to examine experiences with WhatsApp as a communication tool among improvement team members and an external coach to improve adherence to aseptic protocols. Methods Ten QI team members and the external coach were interviewed on communication processes and approaches and thematically analyzed. The WhatsApp transcript for the implementation period was also included in the analysis. Results WhatsApp was effective for disseminating information, including guidance on QI and clinical practice, and data on performance indicators. It was not effective as a platform for group discussion to generate change ideas or analyze the performance indicator data. The decision of who to include in the WhatsApp group and how members engaged in the group may have reinforced existing hierarchies. Using WhatsApp created a work environment in which members were accessible all the time, breaking down barriers between personal and professional time. The continual influx of messages was distracting to some respondents, and how respondents managed these messages (eg, using the silent function) may have influenced their perceptions of

Experiences of Indian Health Workers Using WhatsApp for Improving Aseptic Practices With Newborns: Exploratory Qualitative Study.

Science.gov (United States)

Pahwa, Parika; Lunsford, Sarah; Livesley, Nigel

2018-03-01

Quality improvement (QI) involves the following 4 steps: (1) forming a team to work on a specific aim, (2) analyzing the reasons for current underperformance, (3) developing changes that could improve care and testing these changes using plan-do-study-act cycles (PDSA), and (4) implementing successful interventions to sustain improvements. Teamwork and group discussion are key for effective QI, but convening in-person meetings with all staff can be challenging due to workload and shift changes. Mobile technologies can support communication within a team when face-to-face meetings are not possible. WhatsApp, a mobile messaging platform, was implemented as a communication tool by a neonatal intensive care unit (NICU) team in an Indian tertiary hospital seeking to reduce nosocomial infections in newborns. This exploratory qualitative study aimed to examine experiences with WhatsApp as a communication tool among improvement team members and an external coach to improve adherence to aseptic protocols. Ten QI team members and the external coach were interviewed on communication processes and approaches and thematically analyzed. The WhatsApp transcript for the implementation period was also included in the analysis. WhatsApp was effective for disseminating information, including guidance on QI and clinical practice, and data on performance indicators. It was not effective as a platform for group discussion to generate change ideas or analyze the performance indicator data. The decision of who to include in the WhatsApp group and how members engaged in the group may have reinforced existing hierarchies. Using WhatsApp created a work environment in which members were accessible all the time, breaking down barriers between personal and professional time. The continual influx of messages was distracting to some respondents, and how respondents managed these messages (eg, using the silent function) may have influenced their perceptions of WhatsApp. The coach used WhatsApp to

Analysis of 18 F-FDG uptake patterns in PET for diagnosis of septic and aseptic loosening after total hip arthroplasty

International Nuclear Information System (INIS)

Cremerius, U.; Niethard, F.U.; Mumme, T.; Reinartz, P.; Wirtz, D.; Buell, U.

2003-01-01

Aim: Identification of typical patterns for fluorodeoxyglucose (FDG) uptake in positron emission tomography (PET) to detect aseptic loosening of hip prosthesis (acetabular and/or femoral component) and prosthetic infection. Methods: 18 patients with painful hip prosthesis underwent PET using a dedicated full ring scanner after application of 200-300 MBq FDG. The interface between bone and surrounding soft tissue or bone as displayed on coronal slices was divided into 12 segments in accordance with the classifications of Delee and Gruen. FDG uptake in each of the segments was scored (0-3) by two independent observers. Intraoperative findings were regarded as the gold standard. Results: After surgical revision 14 acetabular components and 9 femoral components were found to be loose and prosthetic infection was present in 7 prostheses. Loosening of the acetabular component was correlated to enhanced uptake in the middle of the acetabular interface, while loosening of the femoral component was correlated to enhanced uptake in the proximal and middle segment of the lateral femoral interface and the proximal segment of the medial femoral interface. A similar pattern was found in prosthetic infection with high uptake along the middle portion of the lateral femoral interface. In 6 of 7 infected prostheses loosening of the acetabular and of the femoral component was present. Taking the typical uptake patterns as criteria for loosening and grade 3 uptake as an additional criterion for septic loosening the accuracy of PET imaging in the detection of loosening of the acetabular or the femoral component and of prosthetic infection was 72, 78 and 89%, respectively. Conclusion: This pilot study presents FDG-PET as a promising diagnostic tool for patients with painful hip prostheses. Its clinical value should be evaluated in a larger patient population. (orig.) [de

Two cases of congenital defects within transverse processes of lumbar spine

International Nuclear Information System (INIS)

Malawski, S.; Sokolski, B.

1993-01-01

Two cases of congenital defects of transverse processes of lumbar spine causing lumbalgia are described. The first one was produced by direct contact of the elongated processes with subsequent pseudoarthrosis. Hypertrophied processes caused stenosis around intervertebral foramen and irritated posterior neural branch in the second case. Surgical resection of the hypertrophied transverse processes has brought the cure. (author)

CoCrMo alloy vs. UHMWPE Particulate Implant Debris Induces Sex Dependent Aseptic Osteolysis Responses In Vivo using a Murine Model

Science.gov (United States)

Landgraeber, Stefan; Samelko, Lauryn; McAllister, Kyron; Putz, Sebastian; Jacobs, Joshua.J.; Hallab, Nadim James

2018-01-01

Background: The rate of revision for some designs of total hip replacements due to idiopathic aseptic loosening has been reported as higher for women. However, whether this is environmental or inherently sex-related is not clear. Objective: Can particle induced osteolysis be sex dependent? And if so, is this dependent on the type of implant debris (e.g. metal vs polymer)? The objective of this study was to test for material dependent inflammatory osteolysis that may be linked to sex using CoCrMo and implant grade conventional polyethylene (UHMWPE), using an in vivo murine calvaria model. Methods: Healthy 12 week old female and male C57BL/6J mice were treated with UHMWPE (1.0um ECD) or CoCrMo particles (0.9um ECD) or received sham surgery. Bone resorption was assessed by micro-computed tomography, histology and histomorphometry on day 12 post challenge. Results: Female mice that received CoCrMo particles showed significantly more inflammatory osteolysis and bone destruction compared to the females who received UHMWPE implant debris. Moreover, females challenged with CoCrMo particles exhibited 120% more inflammatory bone loss compared to males (p<0.01) challenged with CoCrMo implant debris (but this was not the case for UHMWPE particles). Conclusion: We demonstrated sex-specific differences in the amount of osteolysis resulting from CoCrMo particle challenge. This suggests osteo-immune responses to metal debris are preferentially higher in female compared to male mice, and supports the contention that there may be inherent sex related susceptibility to some types of implant debris. PMID:29785221

Chronological study for solitary bone metastasis in the sternum from breast cancer with bone scintigraphy

International Nuclear Information System (INIS)

Miyoshi, Hidenao; Otsuka, Nobuaki; Sone, Teruki; Nagai, Kiyohisa; Tamada, Tsutomu; Mimura, Hiroaki; Yanagimoto, Shinichi; Tomomitsu, Tatsushi; Fukunaga, Masao

1999-01-01

Since breast cancer is frequently associated with bone metastasis, bone scintigraphies have been performed to determine pre-operative staging and to survey postoperative bone metastasis. The sternum, in particular, is a site at which is difficult to differentiate between benign bone disease and bone metastasis, because of varied uptake and wide individual variations. In this study, chronological bone images were scintigraphied in six cases with solitary sternal metastasis and three cases with benign bone disease including two fracture cases and one arthritis case. On bone scintigrams in which solitary sternal metastasis appeared, increased uptake was found in five cases, and photon deficiency was observed in one case. During follow-up scintigraphies, abnormal accumulations, such as hot spots and cold lesions, increased in the bone metastasis while abnormal uptake disappeared or was unchanged in the benign bone disease cases. On CT, four cases showed osteolytic change, and one exhibited osteosclerotic change. These findings indicate that sternal metastasis usually shows osteolytic change, even if a hot lesion is recognized on bone scintigraphy. In solitary sternal metastasis, for which early diagnosis is difficult, both an integrated diagnosis using other imaging techniques and chronological bone scintigraphy are important. (author)

Effect of body position on respiratory system volumes in anesthetized red-tailed hawks (Buteo jamaicensis) as measured via computed tomography.

Science.gov (United States)

Malka, Shachar; Hawkins, Michelle G; Jones, James H; Pascoe, Peter J; Kass, Philip H; Wisner, Erik R

2009-09-01

To determine the effects of body position on lung and air-sac volumes in anesthetized and spontaneously breathing red-tailed hawks (Buteo jamaicensis). 6 adult red-tailed hawks (sex unknown). A crossover study design was used for quantitative estimation of lung and air-sac volumes in anesthetized hawks in 3 body positions: dorsal, right lateral, and sternal recumbency. Lung volume, lung density, and air-sac volume were calculated from helical computed tomographic (CT) images by use of software designed for volumetric analysis of CT data. Effects of body position were compared by use of repeated-measures ANOVA and a paired Student t test. Results for all pairs of body positions were significantly different from each other. Mean +/- SD lung density was lowest when hawks were in sternal recumbency (-677 +/- 28 CT units), followed by right lateral (-647 +/- 23 CT units) and dorsal (-630 +/- 19 CT units) recumbency. Mean lung volume was largest in sternal recumbency (28.6 +/- 1.5 mL), followed by right lateral (27.6 +/- 1.7 mL) and dorsal (27.0 +/- 1.5 mL) recumbency. Mean partial air-sac volume was largest in sternal recumbency (27.0 +/- 19.3 mL), followed by right lateral (21.9 +/- 16.1 mL) and dorsal (19.3 +/- 16.9 mL) recumbency. In anesthetized red-tailed hawks, positioning in sternal recumbency resulted in the greatest lung and air-sac volumes and lowest lung density, compared with positioning in right lateral and dorsal recumbency. Additional studies are necessary to determine the physiologic effects of body position on the avian respiratory system.

Recurrent Bilateral Breast Abscesses after Sternotomy

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Hamza Cinar

2012-01-01

Full Text Available Median sternotomy is the most commonly used incision in cardiothoracic procedures. Development of breast abscess after sternotomy is a very rare situation. We present a case of sternal wound infection with recurrent bilateral breast abscess after sternotomy. Our case is the first and only case in the literature due to the presence of sternal wound infection with recurrent bilateral breast abscess after sternotomy.

Treatment of olecranon bursitis: a systematic review.

Science.gov (United States)

Sayegh, Eli T; Strauch, Robert J

2014-11-01

The optimal management of olecranon bursitis is ill-defined. The purposes of this review were to systematically evaluate clinical outcomes for aseptic versus septic bursitis, compare surgical versus nonsurgical management, and examine the roles of corticosteroid injection and aspiration in aseptic bursitis. The English-language literature was searched using PubMed, Cumulative Index to Nursing and Allied Health Literature, Physiotherapy Evidence Database, Allied and Complementary Medicine, and Cochrane Central Register of Controlled Trials. Analyses were performed for clinical resolution and complications after treatment of aseptic and/or septic olecranon bursitis. Twenty-nine studies containing 1278 patients were included. Compared with septic bursitis, aseptic bursitis was associated with a significantly higher overall complication rate (p = 0.0108). Surgical management was less likely to clinically resolve septic or aseptic bursitis (p = 0.0476), and demonstrated higher rates of overall complications (p = 0.0117), persistent drainage (p = 0.0194), and bursal infection (p = 0.0060) than nonsurgical management. Corticosteroid injection for aseptic bursitis was associated with increased overall complications (p = 0.0458) and skin atrophy (p = 0.0261). Aspiration did not increase the risk of bursal infection for aseptic bursitis. Based primarily on level IV evidence, nonsurgical management of olecranon bursitis is significantly more effective and safer than surgical management. The clinical course of aseptic bursitis appears to be more complicated than that of septic bursitis. Corticosteroid injection is associated with significant risks without improving the outcome of aseptic bursitis. Therapeutic IV.

Olecranon bursitis.

Science.gov (United States)

Reilly, Danielle; Kamineni, Srinath

2016-01-01

Bursitis is a common medical condition, and of all the bursae in the body, the olecranon bursa is one of the most frequently affected. Bursitis at this location can be acute or chronic in timing and septic or aseptic. Distinguishing between septic and aseptic bursitis can be difficult, and the current literature is not clear on the optimum length or route of antibiotic treatment for septic cases. The current literature was reviewed to clarify these points. The reported data for olecranon bursitis were compiled from the current literature. The most common physical examination findings were tenderness (88% septic, 36% aseptic), erythema/cellulitis (83% septic, 27% aseptic), warmth (84% septic, 56% aseptic), report of trauma or evidence of a skin lesion (50% septic, 25% aseptic), and fever (38% septic, 0% aseptic). General laboratory data ranges were also summarized. Distinguishing between septic and aseptic olecranon bursitis can be difficult because the physical and laboratory data overlap. Evidence for the optimum length and route of antibiotic treatment for septic cases also differs. In this review we have presented the current data of offending bacteria, frequency of key physical examination findings, ranges of reported laboratory data, and treatment practices so that clinicians might have a better guide for treatment. Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Two cases of congenital defects within transverse processes of lumbar spine; Dwa przypadki wad wrodzonych wyrostkow poprzecznych ledzwiowego odcinka kregoslupa

Energy Technology Data Exchange (ETDEWEB)

Malawski, S.; Sokolski, B. [Klinika Ortopedii, Centrum Medyczne Ksztalcenia Podyplomowego, Otwock (Poland)

1993-12-31

Two cases of congenital defects of transverse processes of lumbar spine causing lumbalgia are described. The first one was produced by direct contact of the elongated processes with subsequent pseudoarthrosis. Hypertrophied processes caused stenosis around intervertebral foramen and irritated posterior neural branch in the second case. Surgical resection of the hypertrophied transverse processes has brought the cure. (author). 4 refs, 6 figs.

Can patients determine the level of their dysphagia?

OpenAIRE

Ashraf, Hafiz Hamad; Palmer, Joanne; Dalton, Harry Richard; Waters, Carolyn; Luff, Thomas; Strugnell, Madeline; Murray, Iain Alexander

2017-01-01

AIM To determine if patients can localise dysphagia level determined endoscopically or radiologically and association of gender, age, level and pathology. METHODS Retrospective review of consecutive patients presenting to dysphagia hotline between March 2004 and March 2015 was carried out. Demographics, clinical history and investigation findings were recorded including patient perception of obstruction level (pharyngeal, mid sternal or low sternal) was documented and the actual level of obst...

Rib fractures in coronary bypass patients: radionuclide detection

International Nuclear Information System (INIS)

Greenwald, L.V.; Baisden, C.E.; Symbas, P.N.

1983-01-01

Sternal retraction can cause the first rib to be fractured posteriorly, injuring the brachial plexus. The authors conducted bone scans of 24 consecutive open-heart surgery patients and found an unexpectedly high number of rib fractures which in all but one case had not been seen on the chest radiograph. Bone scans are recommended whenever there is unexplained non-incisional pain in a patient who has undergone sternal retraction

Microbiological studies on bacterial isolates from penicillins filling ...

African Journals Online (AJOL)

Aseptic processing is a critical method for the preparation of thermolabile sterile parenteral drug products. Sterile β-lactam antibiotics are extremely deactivated by heat, so the method of choice for their processing is through aseptic filling. The consequences of contamination on aseptically-filled products are harmful to the ...

Evaluation of the BioVigilant IMD-A, a novel optical spectroscopy technology for the continuous and real-time environmental monitoring of viable and nonviable particles. Part II. Case studies in environmental monitoring during aseptic filling, intervention assessments, and glove integrity testing in manufacturing isolators.

Science.gov (United States)

Miller, Michael J; Walsh, Michael R; Shrake, Jerry L; Dukes, Randall E; Hill, Daniel B

2009-01-01

This paper describes the use of the BioVigilant IMD-A, a real-time and continuous monitoring technology based on optical spectroscopy, to simultaneously and instantaneously detect, size, and enumerate both viable and nonviable particles in a variety of filling and transfer isolator environments during an aseptic fill, transfer of sterilized components, and filling interventions. Continuous monitoring of three separate isolators for more than 16 h and representing more than 28 m3 of air per isolator (under static conditions) yielded a mean viable particle count of zero (0) per cubic meter. Although the mean count per cubic meter was zero, the detection of very low levels of single viable particles was randomly observed in each of these sampling runs. No viable particles were detected during the manual transfer of sterilized components from transfer isolators into a filling isolator, and similar results were observed during an aseptic fill, a filling needle change-out procedure, and during disassembly, movement, and reassembly of a vibrating stopper bowl. During the continuous monitoring of a sample transfer port and a simulated mousehole, no viable particles were detected; however, when the sampling probe was inserted beyond the isolator-room interface, the IMD-A instantaneously detected and enumerated both viable and nonviable particles originating from the surrounding room. Data from glove pinhole studies showed no viable particles being observed, although significant viable particles were immediately detected when the gloves were removed and a bare hand was allowed to introduce microorganisms into the isolator. The IMD-A technology offers the industry an unprecedented advantage over growth-based bioaerosol samplers for monitoring the state of microbiological control in pharmaceutical manufacturing environments, and represents significant progress toward the acceptance of microbiology process analytical technology solutions for the industry.

Syphilitic aseptic meningitis

Science.gov (United States)

Meningitis - syphilitic; Neurosyphilis - syphilitic meningitis ... Syphilitic meningitis is a form of neurosyphilis . This condition is a life-threatening complication of syphilis infection. Syphilis is ...

Ultrasound of Sternal Fracture

Directory of Open Access Journals (Sweden)

Shadi Lahham

2015-12-01

Full Text Available A 61-year-old female was brought in by ambulance after being the restrained driver of a head-on motor vehicle collision at 40MPH. There was positive airbag deployment and intrusion from the other vehicle. During workup, the patient complained of midline chest pain, and left chest wall pain. The patient was not in acute respiratory distress, and had the following vital signs: temperature 37°C, heart rate 84, blood pressure of 150/64, respiratory rate 18, and oxygen saturation of 97% on two liters of oxygen. On physical exam, breath sounds were heard bilaterally, with no acute cardiopulmonary issues identified. A bruise was identified on the lower abdomen, which was thought to be a potential seatbelt sign. A focused assessment with sonography for trauma was negative, and an ultrasound of additional chest and mediastinal structures was performed for the chest tenderness.

Manubrial stress fractures diagnosed on MRI: report of two cases and review of the literature.

Science.gov (United States)

Baker, Jonathan C; Demertzis, Jennifer L

2016-06-01

In contrast to widely-reported sternal insufficiency fractures, stress fractures of the sternum from overuse are extremely rare. Of the 5 cases of sternal stress fracture published in the English-language medical literature, 3 were in the sternal body and only 2 were in the manubrium. We describe two cases of manubrial stress fracture related to golf and weightlifting, and present the first report of the MR findings of this injury. In each of these cases, the onset of pain was atraumatic, insidious, and associated with increased frequency of athletic activity. Imaging was obtained because of clinical diagnostic uncertainty. On MRI, each patient had a sagittally oriented stress fracture of the lateral manubrium adjacent to the first rib synchondrosis. Both patients had resolution of pain after a period of rest, with subsequent successful return to their respective activities. One patient had a follow-up MRI, which showed resolution of the manubrial marrow edema and fracture line. Based on the sternal anatomy and MR findings, we hypothesize that this rare injury might be caused by repetitive torque of the muscle forces on the first costal cartilage and manubrium, and propose that MRI might be an effective means of diagnosing manubrial stress fracture.

Manubrial stress fractures diagnosed on MRI: report of two cases and review of the literature

Energy Technology Data Exchange (ETDEWEB)

Baker, Jonathan C.; Demertzis, Jennifer L. [Washington University School of Medicine, Mallinckrodt Institute of Radiology, Musculoskeletal Section, St Louis, MO (United States)

2016-06-15

In contrast to widely-reported sternal insufficiency fractures, stress fractures of the sternum from overuse are extremely rare. Of the 5 cases of sternal stress fracture published in the English-language medical literature, 3 were in the sternal body and only 2 were in the manubrium. We describe two cases of manubrial stress fracture related to golf and weightlifting, and present the first report of the MR findings of this injury. In each of these cases, the onset of pain was atraumatic, insidious, and associated with increased frequency of athletic activity. Imaging was obtained because of clinical diagnostic uncertainty. On MRI, each patient had a sagittally oriented stress fracture of the lateral manubrium adjacent to the first rib synchondrosis. Both patients had resolution of pain after a period of rest, with subsequent successful return to their respective activities. One patient had a follow-up MRI, which showed resolution of the manubrial marrow edema and fracture line. Based on the sternal anatomy and MR findings, we hypothesize that this rare injury might be caused by repetitive torque of the muscle forces on the first costal cartilage and manubrium, and propose that MRI might be an effective means of diagnosing manubrial stress fracture. (orig.)

Manubrial stress fractures diagnosed on MRI: report of two cases and review of the literature

International Nuclear Information System (INIS)

Baker, Jonathan C.; Demertzis, Jennifer L.

2016-01-01

In contrast to widely-reported sternal insufficiency fractures, stress fractures of the sternum from overuse are extremely rare. Of the 5 cases of sternal stress fracture published in the English-language medical literature, 3 were in the sternal body and only 2 were in the manubrium. We describe two cases of manubrial stress fracture related to golf and weightlifting, and present the first report of the MR findings of this injury. In each of these cases, the onset of pain was atraumatic, insidious, and associated with increased frequency of athletic activity. Imaging was obtained because of clinical diagnostic uncertainty. On MRI, each patient had a sagittally oriented stress fracture of the lateral manubrium adjacent to the first rib synchondrosis. Both patients had resolution of pain after a period of rest, with subsequent successful return to their respective activities. One patient had a follow-up MRI, which showed resolution of the manubrial marrow edema and fracture line. Based on the sternal anatomy and MR findings, we hypothesize that this rare injury might be caused by repetitive torque of the muscle forces on the first costal cartilage and manubrium, and propose that MRI might be an effective means of diagnosing manubrial stress fracture. (orig.)

Risk analysis and outcome of mediastinal wound and deep mediastinal wound infections with specific emphasis to omental transposition

LENUS (Irish Health Repository)

Parissis, Haralabos

2011-09-19

Abstract Background To report our experience, with Deep mediastinal wound infections (DMWI). Emphasis was given to the management of deep infections with omental flaps Methods From February 2000 to October 2007, out of 3896 cardiac surgery patients (prospective data collection) 120 pts (3.02%) developed sternal wound infections. There were 104 males & 16 females; (73.7%) CABG, (13.5%) Valves & (9.32%) CABG and Valve. Results Superficial sternal wound infection detected in 68 patients (1.75%) and fifty-two patients (1.34%) developed DMWI. The incremental risk factors for development of DMWI were: Diabetes (OR = 3.62, CI = 1.2-10.98), Pre Op Creatinine > 200 μmol\\/l (OR = 3.33, CI = 1.14-9.7) and Prolong ventilation (OR = 4.16, CI = 1.73-9.98). Overall mortality for the DMWI was 9.3% and the specific mortality of the omental flap group was 8.3%. 19% of the "DMWI group", developed complications: hematoma 6%, partial flap loss 3.0%, wound dehiscence 5.3%. Mean Hospital Stay: 59 ± 21.5 days. Conclusion Post cardiac surgery sternal wound complications remain challenging. The role of multidisciplinary approach is fundamental, as is the importance of an aggressive early wound exploration especially for deep sternal infections.

Outbreak of Enterovirus - 71 Meningitis in Calicut

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CK Sasidharan

2016-04-01

Full Text Available Objective: Enterovirus 71(EV 71 causes wide spectrum of infections ranging from asymptomatic conditions to clinical syndromes like diarrhea, rash, hand-foot-and mouth disease (HFMD, herpangina, aseptic meningitis, encephalitis, myocarditis, acute flaccid paralysis, bulbar and brainstem encephalitis Guillain Barre syndrome, pulmonary haemorrhage. This study deals with an outbreak of aseptic meningitis in children caused by EV 71 virus. Methods: The authors report an outbreak of aseptic meningitis in children in and around Calicut in June 2008. Clinical and laboratory study was done in collaboration with National Centre for Disease Control, New Delhi. 149 children with aseptic meningitis were studied and followed up from June 2008 to May 2009. Result: All children had clinical features suggestive of aseptic meningitis and serology showed the rising antibody titre against EV 71 virus infection. CSF analysis also showed four fold rise in antibodies in one and ≥ 1:2 neutralising antibodies titer against EV- 71 in four samples indicating meningitis due to EV-71. Conclusion: EV 71 was identified as the causative agent of the outbreak of aseptic meningitis in the study and the fact that the EV 71 infection has evolved from minor illness like HFMD to major illness like aseptic meningitis from the same locality is truly alarming.

Update Review and Clinical Presentation in Congenital Insensitivity to Pain and Anhidrosis

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L. M. Pérez-López

2015-01-01

Full Text Available Introduction. Congenital insensitivity to pain and anhidrosis (CIPA or hereditary sensory and autonomic neuropathy type IV is an extremely rare syndrome. Three clinical findings define the syndrome: insensitivity to pain, impossibility to sweat, and mental retardation. This pathology is caused by a genetic mutation in the NTRK1 gene, which encodes a tyrosine receptor (TrkA for nerve growth factor (NGF. Methods. The consultation of a child female in our center with CIPA and a tibia fracture in pseudoarthrosis encouraged us to carefully review literature and examine the therapeutic possibilities. A thorough review of literature published in Pubmed was done about CIPA and other connected medical issues mentioned in the paper. Conclusions. The therapeutic approach of CIPA remains unclear. The preventive approach remains the only possible treatment of CIPA. We propose two new important concepts in the therapeutic approach for these patients: (1 early surgical treatment for long bone fractures to prevent pseudoarthrosis and to allow early weight bearing, decreasing the risk of further osteopenia, and (2 bisphosphonates to avoid the progression of osteopenia and to reduce the number of consecutive fractures.

Allergic reaction to stainless steel sternotomy wires requiring removal: A case report and literature review.

Science.gov (United States)

Lopez, J; Sachithanandan, A; Leow, M

2016-06-01

Hypersensitivity to stainless steel sternal sutures are an uncommon occurrence. We present a case of such a patient who developed chronic tissue overgranulation over a sternotomy wound eight weeks post-operatively. Primary suspicion was infection, a more common complication however radiological and laboratory investigation showed otherwise. Conservative management provided limited ephemeral success. After ensuring adequate sternal bone healing, the sutures and granulation tissue were eventually surgically removed without complication and the reoperated wound healed well.

Rapid detection of enterovirus in cerebrospinal fluid by a fully-automated PCR assay is associated with improved management of aseptic meningitis in adult patients.

Science.gov (United States)

Giulieri, Stefano G; Chapuis-Taillard, Caroline; Manuel, Oriol; Hugli, Olivier; Pinget, Christophe; Wasserfallen, Jean-Blaise; Sahli, Roland; Jaton, Katia; Marchetti, Oscar; Meylan, Pascal

2015-01-01

Enterovirus (EV) is the most frequent cause of aseptic meningitis (AM). Lack of microbiological documentation results in unnecessary antimicrobial therapy and hospitalization. To assess the impact of rapid EV detection in cerebrospinal fluid (CSF) by a fully-automated PCR (GeneXpert EV assay, GXEA) on the management of AM. Observational study in adult patients with AM. Three groups were analyzed according to EV documentation in CSF: group A = no PCR or negative PCR (n=17), group B = positive real-time PCR (n = 20), and group C = positive GXEA (n = 22). Clinical, laboratory and health-care costs data were compared. Clinical characteristics were similar in the 3 groups. Median turn-around time of EV PCR decreased from 60 h (IQR (interquartile range) 44-87) in group B to 5h (IQR 4-11) in group C (p<0.0001). Median duration of antibiotics was 1 (IQR 0-6), 1 (0-1.9), and 0.5 days (single dose) in groups A, B, and C, respectively (p < 0.001). Median length of hospitalization was 4 days (2.5-7.5), 2 (1-3.7), and 0.5 (0.3-0.7), respectively (p < 0.001). Median hospitalization costs were $5458 (2676-6274) in group A, $2796 (2062-5726) in group B, and $921 (765-1230) in group C (p < 0.0001). Rapid EV detection in CSF by a fully-automated PCR improves management of AM by significantly reducing antibiotic use, hospitalization length and costs. Copyright © 2014 Elsevier B.V. All rights reserved.

Estimation of respiratory rates based on photoplethysmographic measurements at the sternum

DEFF Research Database (Denmark)

Chreiteh, Shadi; Belhage, Bo; Hoppe, Karsten

2015-01-01

rate is extracted using photoplethysmography (PPG) on the chest bone (sternum). Sternal PPG signals were acquired from 10 healthy subjects resting in a supine position. As reference signals, finger PPG, electrocardiogram (ECG), and capnography were simultaneously recorded during spontaneous and paced...... breathing. The sternal PPG signals were then compared with the reference signals in terms of Bland-Altman analysis, the power spectrum analysis and the magnitude squared coherence. The Bland-Altman analysis showed an average bias of 0.21 breaths/min between RR extracted from sternal PPG and capnography....... The respiratory power content at the sternum was 78.8 (38) % in terms of the median and (the interquartile range). The cardiac content was 19 (18.4) % within the cardiac region. The results from the magnitude squared coherence analysis was 0.97 (0.09) in the respiratory region (6 to 27 breaths/min) and 0.98 (0...

Photobiomodulation of surgical wound dehiscence in a diabetic individual by low-level laser therapy following median sternotomy

Directory of Open Access Journals (Sweden)

Snehil Dixit

2013-01-01

Full Text Available In this single case study, we attempt to outline the possible effect of low-level laser therapy (LLLT on delayed wound healing and pain in chronic dehiscent sternotomy of a diabetic individual. The methods that were employed to evaluate changes pre and post irradiation were wound photography, wound area measurement, pressure ulcer scale of healing (PUSH, and visual analogue scale (VAS for pain. After irradiation, proliferation of healthy granulation tissue was observed with decrease in scores of PUSH for sternal dehiscence and VAS for bilateral shoulders and sternal dehiscence. We found that LLLT irradiation could be a novel method of treatment for chronic sternal dehiscence following coronary artery bypass grafting, as it augments wound healing with an early closure of the wound deficit. Hence, this might be translated into an early functional rehabilitation and decreased pain perception of an individual following surgical complication.

Diurnal rhythm and concordance between objective and subjective hot flashes: The Hilo Women’s Health Study

Science.gov (United States)

Sievert, Lynnette L.; Reza, Angela; Mills, Phoebe; Morrison, Lynn; Rahberg, Nichole; Goodloe, Amber; Sutherland, Michael; Brown, Daniel E.

2010-01-01

Objective To test for a diurnal pattern in hot flashes in a multi-ethnic population living in a hot, humid environment. To examine rates of concordance between objective and subjective measures of hot flashes using ambulatory and laboratory measures. Methods Study participants aged 45–55 were recruited from the general population of Hilo, Hawaii. Women wore a Biolog hot flash monitor, kept a diary for 24-hours, and also participated in 3-hour laboratory measures (n=199). Diurnal patterns were assessed using polynomial regression. For each woman, objectively recorded hot flashes that matched subjective experience were treated as true positive readings. Subjective hot flashes were considered the standard for computing false positive and false negative readings. True positive, false positive, and false negative readings were compared across ethnic groups by chi-square analyses. Results Frequencies of sternal, nuchal and subjective hot flashes peaked at 15:00 ± 1 hour with no difference by ethnicity. Laboratory results supported the pattern seen in ambulatory monitoring. Sternal and nuchal monitoring showed the same frequency of true positive measures, but non-sternal electrodes picked up more false positive readings. Laboratory monitoring showed very low frequencies of false negatives. There were no ethnic differences in the frequency of true positive or false positive measures. Women of European descent were more likely to report hot flashes that were not objectively demonstrated (false negative measures). Conclusions The diurnal pattern and peak in hot flash occurrence in the hot humid environment of Hilo was similar to results from more temperate environments. Lack of variation in sternal vs. non-sternal measures, and in true positive measures across ethnicities suggests no appreciable effect of population variation in sweating patterns. PMID:20220538

Result of Surgical Treatment of Pseudoarthrosis of the Patella ...

African Journals Online (AJOL)

We noted 2 cases of osteopenia of the patella, a patellofemoral arthrosis in 4 cases, and a lower post operative patella in every patient with an average index of Caton- Deschamps at 0.34 cm (From 0.15 to 0.51 cm) were observed. Two malunion of fractures and an amyotrophy compared with healthy thigh were observed.

Skeletal Complications in Neurofibromatosis Type 1: the Role of Neurofibromin Haploinsufficiency in Defective Skeletal Remodeling and Bone Healing in NF1

Science.gov (United States)

2009-01-01

pathogenesis of pseudoarthrosis of the tibia (1). Health reports from the Vanderbilt mouse colony indicated exposure to mouse parvo virus (MPV) and...facility following the quarantine period and two, clean, consecutive monthly health reports, consistent with BIDMC Animal Research Facility animal...M.D., Sowa, H., Starbuck , M., Liu, X., Ron, D., Parada, L.F., and Karsenty, G. 2006. ATF4 mediation of NF1 functions in osteoblast reveals a

Avascular Necrosis of Acetabulum: The Hidden Culprit of Resistant Deep Wound Infection and Failed Fixation of Fracture Acetabulum - A Case Report.

Science.gov (United States)

K, Kandhari V; M, Desai M; S, Bava S; N, Wade R

2015-01-01

Chances of avascular necrosis of acetabulum are rare as it enjoys a rich blood supply. But cases of post - traumatic avascular necrosis of acetabulum following fracture of posterior column have been well documented. Importance of identifying and suspecting the avascular necrosis of acetabulum is essential in cases of failed fixation of fracture acetabulum, previously operated using extensile approach to acetabulum; either extended anterior ilio - femoral or tri - radiate approach. Such patients usually present with repeated deep bone infection or with early failure of fixation with aseptic loosening and migration of its components. We present a similar case. 40 years female presented with inadequately managed transverse fracture of left acetabulum done by anterior extended ilio-inguinal approach. The fixation failed. She presented 6 months later with painful hip. Cemented total hip replacement was performed with reconstruction of acetabulum by posterior column plating. Six months postoperatively patient presented with dislodgement of cup, pelvic discontinuity and sinus in the thigh. Two stage revision surgery was planned. First implant, removal; debridement and antibiotic spacer surgery was performed. At second stage of revision total hip replacement, patient had Paprosky grade IIIb defect in acetabulum. Spacer was removed through the posterior approach. Anterior approach was taken for anterior plating. Intra-operatively external iliac pulsations were found to be absent so procedure was abandoned after expert opinion. Postoperatively digital subtraction angiography demonstrated a chronic block in the external iliac artery and corona mortis was the only patent vascular channel providing vascular to the left lower limb. Thus, peripheral limb was stealing blood supply from the acetabulum to maintain perfusion. Patient was ultimately left with pelvic discontinuity, excision arthroplasty and pseudoarthrosis of the left hip. Avascular necrosis of acetabulum is a rare

Conteo diferencial de leucocitos del líquido cefalorraquídeo y tiempo de evolución de la infección en recién nacidos con meningitis aséptica Differential leukocyte count in cerebrospinal fluid and time of infection progression in children with aseptic meningitis

Directory of Open Access Journals (Sweden)

Manuel Díaz Álvarez

2012-09-01

Full Text Available Objetivo: comprobar si un predominio de polimorfonucleares en el líquido cefalorraquídeo de pacientes neonatales con meningitis aséptica es frecuente y si tiene relación con el tiempo de evolución de la infección. Métodos: estudio retrospectivo de recién nacidos con meningitis aséptica, que ingresaron en el Servicio de Neonatología del Hospital Pediátrico Universitario "Juan M. Márquez", entre los años 1992-2007. Se analizaron las características de los leucocitos en el examen citoquímico del líquido cefalorraquídeo y su relación con el tiempo de evolución de la infección. Resultados: la mayoría de los 291 pacientes mostraron conteo de leucocitos del líquido cefalorraquídeo con valores en la mediana discretamente elevados. Los valores medios para el porcentaje de leucocitos polimorfonucleares estuvieron por debajo del 40 % para cualquiera de los intervalos de progresión de tiempo en la evolución de la infección. El análisis del tiempo de duración de la infección previa al diagnóstico de meningitis aséptica con el conteo de leucocitos y conteo absoluto y diferencial de polimorfonucleares en el líquido cefalorraquídeo, mostró que no hay relación estadística significativa, por lo que no dependen linealmente del tiempo de duración de la infección. Conclusiones: el predominio de polimorfonucleares en el líquido cefalorraquídeo no se circunscribe a las primeras horas de la infección y no depende del tiempo de duración de la infección.Objective: to confirm whether polymorphonuclear leukocytes frequently predominate in the cerebrospinal fluid of neonates with aseptic meningitis and whether there is association between this predominance and time of the infection progression. Methods: a retrospective study of newborns with aseptic meningitis, who were admitted to the neonatology service of "Juan M. Marquez" university pediatric hospital from 1992 to 2007. The characteristics of leukocytes were analyzed in the

Problems with Excessive Residual Lower Leg Length in Pediatric Amputees

OpenAIRE

Osebold, William R; Lester, Edward L; Christenson, Donald M

2001-01-01

We studied six pediatric amputees with long below-knee residual limbs, in order to delineate their functional and prosthetic situations, specifically in relation to problems with fitting for dynamic-response prosthetic feet. Three patients had congenital pseudoarthrosis of the tibia secondary to neurofibromatosis, one had fibular hemimelia, one had a traumatic amputation, and one had amputation secondary to burns. Five patients had Syme's amputations, one had a Boyd amputation. Ages at amputa...

Aortic valve replacement in a patient with severe nickel allergy.

Science.gov (United States)

Lusini, Mario; Barbato, Raffaele; Spadaccio, Cristiano; Chello, Massimo

2011-11-01

Nickel allergy can raise clinical problems in patients undergoing cardiac surgery who require sternal closure with stainless steel wire. We describe the case of a 51-year-old woman with severe nickel allergy who underwent aortic valve replacement with a nickel-free ON-X prosthesis and sternal closure by Fiberwire # 2 suture without complications. Considering its biocompatibility and its mechanical characteristics including optimal strength and knot resistance, this suture might be a viable alternative in patients in which the use of stainless steel wire is contraindicated. © 2011 Wiley Periodicals, Inc.

[PVD-silicoating before cementation of zirconia-based knee prostheses effects better cement adhesion and lower aseptic loosening rates].

Science.gov (United States)

Marx, R; Faramarzi, R; Oberbach, T; Begand, S; Grätz, N; Wirtz, D C

2012-02-01

CoCrMo alloys are contraindicated for allergy patients. For these patients, cemented or uncemented prostheses made of titanium alloy are indicated. Uncemented prostheses, however, have low primary retention, particularly the tibial components of knee joint prostheses because of the lack of a positive locking. Therefore, for knee replacement cemented CoCrMo prostheses may be suitable also for allergy sufferers if these are masked by ZrN or TiNbN layers. Alternatively the CoCrMo alloy may be replaced by high-strength oxide ceramics. For adhesion of bone cement to the ceramic surface, however, only inefficient mechanical retention spots are exposed as compared with a metal surface. Undercuts generated by corundum blasting, although highly efficient on a CoCrMo surface, are not such efficient centres on a ceramic surface due to its brittleness. Therefore, the mechanical component of retention is significantly reduced. When specific adhesion between bone cement and surface does not exist due to physical and chemical forces, the hydrolytic stability will be insufficient. Micromotions are promoted and early aseptic loosening is predictable. Silicoating of the ceramic surface will allow specific adhesion and can result in better hydrolytic stability of bonding. In order to evaluate the effectiveness of silicoating the bond strengths of blasted (mean size of corundum grains 50 µm) and silicate layered alumina-toughened zirconia (ATZ) surfaces were compared with "as fired" surfaces by utilising TiAlV probes (diameter 6 mm) for traction-adhesive strength testing. Samples machined out of CoCrMo alloy were utilised for reference. After preparing the samples for traction-adhesive strength testing (sequence: substrate, silicate and silane, protective lacquer [PolyMA], bone cement, TiAlV probe) they were aged up to 360 days at 37 °C in Ringer's solution. The bond strengths observed for all ageing intervals were well above 20 MPa and much higher and more hydrolytically

The Effect of Sterile Acellular Dermal Matrix Use on Complication Rates in Implant-Based Immediate Breast Reconstructions

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Jun Ho Lee

2016-11-01

Full Text Available BackgroundThe use of acellular dermal matrix (ADM in implant-based immediate breast reconstruction has been increasing. The current ADMs available for breast reconstruction are offered as aseptic or sterile. No published studies have compared aseptic and sterile ADM in implant-based immediate breast reconstruction. The authors performed a retrospective study to evaluate the outcomes of aseptic versus sterile ADM in implant-based immediate breast reconstruction.MethodsImplant-based immediate breast reconstructions with ADM conducted between April 2013 and January 2016 were included. The patients were divided into 2 groups: the aseptic ADM (AlloDerm group and the sterile ADM (MegaDerm group. Archived records were reviewed for demographic data and postoperative complication types and frequencies. The complications included were infection, flap necrosis, capsular contracture, seroma, hematoma, and explantation for any cause.ResultsTwenty patients were reconstructed with aseptic ADM, and 68 patients with sterile ADM. Rates of infection (15.0% vs. 10.3%, flap necrosis (5.0% vs. 7.4%, capsular contracture (20.0% vs. 14.7%, seroma (10.0% vs. 14.7%, hematoma (0% vs. 1.5%, and explantation (10.0% vs. 8.8% were not significantly different in the 2 groups.ConclusionsSterile ADM did not provide better results regarding infectious complications than aseptic ADM in implant-based immediate breast reconstruction.

Morphological and anatomical examinations of the dog's sternum in particular consideration of x-ray examination, CT, dissection, mazeration and histological examination

International Nuclear Information System (INIS)

Wilhelm, M.L.

2000-06-01

Material consisted of 100 sterna of dogs and 964 x-rays of dogs from the archives of the clinic for radiology. The sterna of puppies (0 to 3 months old) and juvenile dogs (3 to 18 months old) showed a typical appearance. 20 adult dogs didn't show any morphological alteration of the sternum. Exostoses were found in 31 cases, 17 dogs showed formation of osseous bridges, and 21 dogs showed arthrosis of sternocostal joints. Most frequently (34 cases) ossification of the synchondrosis xiphosternalis was found. Other alterations were distortion of the whole sternum, varying number of sternebrae, a blunt manubrium sterni, a reduced 6th sternebra, sternal dysraphism, sclerosis, subluxations, synchondral ossification, variations of the synchondrosis' width, and exostoses at the sternal ends of rib cartilage. Evaluation of x-rays from the archives made it possible to demonstrate the disposition of age groups and breeds to certain alterations. Dogs of higher age, German shepherd dogs, Spaniels and Dachshunds were most frequently afflicted by sternal exostoses and synchondral ossification. (author)

Usefulness of three dimensional reconstructive images for thoracic trauma induced fractures

Energy Technology Data Exchange (ETDEWEB)

Koh, Kyung Hun; Kim, Dong Hun; Kim, Young Sook; Byun, Joo Nam [Chosun University Hospital, Gwangju (Korea, Republic of)

2006-09-15

We wanted to evaluate the usefulness of three-dimensional reconstructive images using multidetector computed tomography (MDCT) for thoracic traumatic patients visiting emergency room. 76 patients with fractures of the 105 patients who visited our emergency room with complaints of thoracic trauma were analyzed retrospectively. All the patients had thoracic MDCT performed and the three-dimensional reconstructive images were taken. The fractures were confirmed by axial CT, the clinical information, whole body bone scanning and the multiplanar reformation images. Plain x-ray images were analyzed by the fractured sites in a blind comparison of two radiologists' readings, and then that finding was compared with the axial CT scans and the three-dimensional reconstructive images. The fracture sites were rib (n 68), sternum (n = 14), clavicle (n = 6), scapula (n = 3), spine (n = 5) and combined fractures (n = 14). Plain x-ray and axial CT scans had a correspondency of 0.555 for the rib fractures. Axial CT scans and the three-dimensional reconstructive images had a correspondency of .952. For sternal fractures, those values were 0.692 and 0.928, respectively. The axial CT scans and three-dimensional reconstructive images showed sensitivities of 94% and 91% for rib and other fractures, respectively, and 93% and 100% for sternal fracture, respectively. Three-dimensional reconstructive image had an especially high sensitivity for the diagnosis of sternal fracture. While evaluating thoracic trauma at the emergency room, the three-dimensional reconstructive image was useful to easily diagnose the extent of fracture and it was very sensitive for detecting sternal fracture.

Usefulness of three dimensional reconstructive images for thoracic trauma induced fractures

International Nuclear Information System (INIS)

Koh, Kyung Hun; Kim, Dong Hun; Kim, Young Sook; Byun, Joo Nam

2006-01-01

We wanted to evaluate the usefulness of three-dimensional reconstructive images using multidetector computed tomography (MDCT) for thoracic traumatic patients visiting emergency room. 76 patients with fractures of the 105 patients who visited our emergency room with complaints of thoracic trauma were analyzed retrospectively. All the patients had thoracic MDCT performed and the three-dimensional reconstructive images were taken. The fractures were confirmed by axial CT, the clinical information, whole body bone scanning and the multiplanar reformation images. Plain x-ray images were analyzed by the fractured sites in a blind comparison of two radiologists' readings, and then that finding was compared with the axial CT scans and the three-dimensional reconstructive images. The fracture sites were rib (n 68), sternum (n = 14), clavicle (n = 6), scapula (n = 3), spine (n = 5) and combined fractures (n = 14). Plain x-ray and axial CT scans had a correspondency of 0.555 for the rib fractures. Axial CT scans and the three-dimensional reconstructive images had a correspondency of .952. For sternal fractures, those values were 0.692 and 0.928, respectively. The axial CT scans and three-dimensional reconstructive images showed sensitivities of 94% and 91% for rib and other fractures, respectively, and 93% and 100% for sternal fracture, respectively. Three-dimensional reconstructive image had an especially high sensitivity for the diagnosis of sternal fracture. While evaluating thoracic trauma at the emergency room, the three-dimensional reconstructive image was useful to easily diagnose the extent of fracture and it was very sensitive for detecting sternal fracture

Semicircular Horizontal Approach in Breast Reduction: Clinical Experience in 38 Cases

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Hee Su Shin

2015-07-01

Full Text Available BackgroundVarious techniques are used for performing breast reduction. Wise-pattern and vertical scar techniques are the most commonly employed approaches. However, a vertical scar in the mid-lower breast is prominent and aesthetically less pleasant. In contrast, a semicircular horizontal approach does not leave a vertical scar in the mid breast and transverse scars can be hidden in the inframammary fold. In this paper, we describe the experiences and results of semicircular horizontal breast reductions performed by a single surgeon.MethodsBetween September 1996 and October 2013, our senior author used this technique in 38 cases in the US and at our institution. We used a superiorly based semicircular incision, where the upper skin paddle was pulled down to the inframammary fold with the nipple-areola complex pulled through the keyhole.ResultsThe average total reduction per breast was 584 g, ranging from 286 to 794 g. The inferior longitudinal pedicle was used in all the cases. The average reduction of the distance from the sternal notch to the nipple was 13 cm (range, 11-15 cm. The mean decrease in the bra cup size was 1.7 cup sizes (range, a decrease of 1 to 3. We obtained very satisfactory results with a less noticeable scar, no complication such as necrosis of the nipple or the skin flap, wound infection, aseptic necrosis of the breast tissue, or wound dehiscence. One patient had a small hematoma that resolved spontaneously.ConclusionsThis technique is straightforward and easy to learn, and offers a safe, effective, and predictable way for treating mammary hypertrophy.

Pseudoarthrosis of medial tibial plateau fracture-role of alignment procedure

Directory of Open Access Journals (Sweden)

Devgan Ashish

2013-04-01

Full Text Available 【Abstract】 Nonunion in tibial plateau fractures is very rare. Limited literature is available on Pubmed search on intraarticular tibial nonunion. Most of the cases reported have been following failed surgical treatment and none was neglected fractures. Three patients of isolated and neglected medial tibial plateau nonunion with almost similar demo-graphic profile are reported in this paper. All the three pa-tients were managed by minimally invasive compression fixation using lag screws supplemented with limb realign-ment procedure of high tibial osteotomy. We discussed the injury mechanism, management and rehabilitation in such cases and reviewed the available literature regarding such a presentation. Key words: Fracture healing; Tibial fractures; Frac-ture fixation; Osteotomy

Significance of the sexual openings and supplementary structures on the phylogeny of brachyuran crabs (Crustacea, Decapoda, Brachyura), with new nomina for higher-ranked podotreme taxa.

Science.gov (United States)

Guinot, Danièle; Tavares, Marcos; Castro, Peter

2013-01-01

The patterns of complexity of the male and female sexual openings in Brachyura, which have been the source of uncertainties and conflicting opinions, are documented, together with a study of the morphologies of the coxal and sternal gonopores in both sexes, penises, spermathecae, and gonopods. The vulvae, male gonopores and penises are described among selected taxa of Eubrachyura, and their function and evolution examined in the context of a wide variety of mating behaviours. The location of female and male gonopores, the condition of the penis (coxal and sternal openings and modalities of protection), and related configurations of thoracic sternites 7 and 8, which are modified by the intercalation of a wide sternal part (thoracic sternites 7 and 8) during carcinisation, show evidence of deep homology. They represent taxonomic criteria at all ranks of the family-series and may be used to test lineages. Of particular significance are the consequences of the posterior expansion of the thoracic sternum, which influences the condition, shape, and sclerotisation of the penis, and its emergence from coxal (heterotreme) to coxo-sternal, which is actually still coxal (heterotreme), in contrast to a sternal emergence (thoracotreme). The heterotreme-thoracotreme distinction results from two different trajectories of the vas deferens and its ejaculatory duct via the P5 coxa (Heterotremata) or through the thoracic sternum (Thoracotremata). Dissections of males of several families have demonstrated that this major difference not only affects the external surface (perforation of the coxa or the sternum by the ejaculatory duct) but also the internal anatomy. There is no evidence for an ejaculatory duct passing through the articular membrane between the P5 coxa and the thoracic sternum in any Brachyura, even when the sternal male gonopore is very close to the P5 coxa. Trends towards the coxo-sternal condition are exemplified by multistate characters, varying from a shallow

Viral aetiology of central nervous system infections in adults admitted to a tertiary referral hospital in southern Vietnam over 12 years

NARCIS (Netherlands)

Tan, Le Van; Thai, Le Hong; Phu, Nguyen Hoan; Nghia, Ho Dang Trung; Chuong, Ly Van; Sinh, Dinh Xuan; Phong, Nguyen Duy; Mai, Nguyen Thi Hoang; Man, Dinh Nguyen Huy; Hien, Vo Minh; Vinh, Nguyen Thanh; Day, Jeremy; Chau, Nguyen Van Vinh; Hien, Tran Tinh; Farrar, Jeremy; de Jong, Menno D.; Thwaites, Guy; van Doorn, H. Rogier; Chau, Tran Thi Hong

2014-01-01

Central nervous system (CNS) infections are important diseases in both children and adults worldwide. The spectrum of infections is broad, encompassing bacterial/aseptic meningitis and encephalitis. Viruses are regarded as the most common causes of encephalitis and aseptic meningitis. Better

Congenital pseudarthrosis of clavicle, differential diagnosis pathology

International Nuclear Information System (INIS)

Vergara A, Enrique; Villamarin, Fernando; Pina Q, Marcela

2006-01-01

The congenital pseudarthrosis of clavicle is a rare entity, frequently appearing without association to other pathologies and does not cause important limitations in the children. It can confuse with other traumatic pathologies like clavicle fracture. Most of the patients complain about the aesthetics and few times for pain. The treatment is generally surgical there is controversy about of carrying out surgery. We reported two clinical cases with pseudoarthrosis of the right clavicle that they received surgical treatment with satisfactory results.

Surgical debridement, vacuum therapy and pectoralis plasty in poststernotomy mediastinitis.

Science.gov (United States)

Ennker, I C; Pietrowski, D; Vöhringer, L; Kojcici, B; Albert, A; Vogt, P M; Ennker, J

2009-11-01

In cardiac surgery poststernotomy mediastinitis continues to be a serious cause of morbidity and mortality. We report our experience with vacuum-assisted closure (VAC) therapy followed by reconstruction with M. pectoralis muscle flaps as treatment for deep sternal wound infections. Our group performed a retrospective analysis of 3630 consecutive cardiac surgical patients using median sternotomy from 11/2004 to 11/2007. After removing sternal wires, necrotic debris and potentially infective material, restabilisation of the sternum was performed and VAC therapy was employed. Wound closure and subsequent reconstruction were performed using a bilateral pectoralis muscle plasty. Of the analysed patients 16 female and 29 male patients suffered from deep sternal wound infections and were treated with VAC. The most common risk factors were diabetes mellitus odds ratio (OR 3.5), chronic obstructive pulmonary disease (COPD) (OR 2.9), use of bilateral mammarian artery (OR 2.0) and obesity (1.8). The median age of patients with deep sternal infections was similar to control patients. Staphylococcus epidermis was the most common pathogen (37.8%) followed by Enterococcus faecilis (22.2%) and Staphylococcus aureus (17.8). In 22.2% no pathogen could be detected. The 30 day mortality was 0%, the in-hospital mortality was 15.6%. The results of our studies demonstrate that vacuum therapy in conjunction with early and aggressive debridement is an effective strategy for treating poststernotomy mediastinitis. We consider pectoralis major muscle flap reconstruction as a safe technique and regard it as the primary choice for wound closure in poststernotomy mediastinitis. (c) 2009 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

Radiographic signs of open median sternotomy in neonates and infants

Energy Technology Data Exchange (ETDEWEB)

Wu, George [Children' s Hospital of Philadelphia, Department of Radiology, Philadelphia, PA (United States); Geisinger Medical Center, Danville, PA (United States); Jaimes, Camilo; Markowitz, Richard I. [Children' s Hospital of Philadelphia, Department of Radiology, Philadelphia, PA (United States); Gaynor, J.W. [The Children' s Hospital of Philadelphia, Department of Surgery, Philadelphia, PA (United States)

2012-06-15

Leaving the median sternotomy wound open following cardiac surgery is employed to avoid cardiovascular compression. Horizontal struts can be used. Radiologists interpreting portable radiographs might be unaware of the open median sternotomy (OMS). To describe the frequency of radiographic signs of OMS and to increase awareness among radiologists to prevent misdiagnosis of pneumothorax and pneumomediastinum. Radiographs of 41 infants (17 girls/24 boys) with OMS were studied (age range 2 days to 8 months, mean 33 days). Central lucency and sternal edges were noted. Interclavicular distances before and after sternotomy were compared. Central lucency was seen in 25/41 (61%) children. Sternal struts were apparent in 27 (66%). In 14 without struts, central lucency was present in 8 (57%). In 27 children with struts, central lucency was present in 17 (63%) and absent in 10 (37%). Split sternal centers were identified in 6/41 (15%). The mean interclavicular distance was 23.5 mm (SD = 4.39) before sternotomy and 38.2 mm (SD = 7.0 mm) after sternotomy (P < 0.001). OMS has characteristic signs in the majority of cases. Recognition of these findings is useful and can prevent misinterpretation. (orig.)

21 CFR 108.35 - Thermal processing of low-acid foods packaged in hermetically sealed containers.

Science.gov (United States)

2010-04-01

... FDA 2541 (food canning establishment registration) information including (but not limited to) his name... FDA 2541a (food canning establishment process filing for all methods except aseptic), or Form FDA 2541c (food canning establishment process filing for aseptic systems). These forms are available from...

Manglende evidens for skadelig effekt på knogleheling ved behandling med NSAID

DEFF Research Database (Denmark)

Janum, Susanne; Kristensen, Billy Bjarne

2012-01-01

The use of NSAIDs for postoperative pain management following orthopaedic surgery or during conservative treatment of fractures is controversial. Experimental animal models suggest NSAIDs inhibit bone healing. In a review of the literature, there was no clinical evidence to support categorical...... discard of NSAID for postoperative pain relief in uncomplicated cases. However, NSAID should be considered a potentiel risk factor of impaired bone healing and avoided in patients with a high risk of pseudoarthrosis. Recommended daily doses should be respected and duration of treatment should be limited....

Prevalence of complications in neuromuscular scoliosis surgery

DEFF Research Database (Denmark)

Sharma, Shallu; Wu, Chunsen; Andersen, Thomas

2013-01-01

.71 %) followed by implant complications (PR = 12.51 %), infections (PR = 10.91 %), neurological complications (PR = 3.01 %) and pseudoarthrosis (PR = 1.88 %). Revision, removal and extension of implant had highest PR (7.87 %) followed by malplacement of the pedicle screws (4.81 %). Rates of individual studies...... have moderate to high variability. The studies were heterogeneous in methodology and outcome types, which are plausible explanations for the variability; sensitivity analysis with respect to age at surgery, sample size, publication year and diagnosis could also partly explain this variability...

Storage stability of cashew apple juice preserved by hot fill and aseptic processes Estabilidade do suco de caju preservado pelo método ''hot fill'' e processo asséptico

Directory of Open Access Journals (Sweden)

Maria Cecília Oliveira Costa

2003-12-01

Full Text Available Cashew (Anacardium occidentale L. apples from Pacajus, Ceará State, Brazil, were processed into high pulp content juice. The juice was packed either by hot fill or an aseptic process and evaluated for physical, physical-chemical, and sensorial changes during a 12-month storage period at room temperature. The results indicated that pH, soluble solids, total acidity, total sugar content and color did not change significantly during storage nor were affected by the type of filling. The sensorial analysis showed that juice acceptance remained high throughout the storage period regardless of the filling system. Differences in juice viscosity persisted between both processes.Pedúnculos de caju (Anacardium occidentale L. de Pacajus, Estado do Ceará, Brasil, foram processados na forma de suco com alto teor de polpa. O suco foi acondicionado através do processo hot fill ou asséptico e verificada as alterações físicas, físico-químicas e sensoriais durante armazenagem por doze meses à temperatura ambiente. Os resultados indicaram que pH, sólidos solúveis, acidez total, conteúdo de açúcar e cor não mudaram de modo significativo durante a armazenagem nem foram afetadas pelo modo de acondicionamento. Análise sensorial mostrou que a aceitação do suco foi mantida alta durante o período de armazenagem a despeito do sistema de enchimento. Diferenças na viscosidade dos sucos persistiram entre ambos processos.

[Vacuum-assisted closure as a treatment modality for surgical site infection in cardiac surgery].

Science.gov (United States)

Simek, M; Nemec, P; Zálesák, B; Hájek, R; Kaláb, M; Fluger, I; Kolár, M; Jecmínková, L; Gráfová, P

2007-08-01

The vacuum-asssited closure has represented an encouraging treatment modality in treatment of surgical site infection in cardiac surgery, providing superior results compared with conventional treatment strategies, particularly in the treatment of deep sternal wound infection. From November 2004 to January 2007, 40 patients, undergoing VAC therapy (VAC system, KCI, Austria, Hartmann-Rico Inc., Czech Republic) for surgical site infection following cardiac surgery, were prospectively evaluated. Four patients (10%) were treated for extensive leg-wound infection, 10 (25%) were treated for superficial sternal wound infection and 26 (65%) for deep sternal wound infection. The median age was 69.9 +/- 9.7 years and the median BMI was 33.2 +/- 5.0 kg/m2. Twenty-three patients (57%) were women and diabetes was present in 22 patients (55%). The VAC was employed after the previous failure of the conventional treatment strategy in 7 patients (18%). Thirty-eight patients (95%) were successfully healed. Two patients (5%) died, both of deep sternal infetion consequences. The overall length of hospitalization was 36.4 +/- 22.6 days. The median number of dressing changes was 4.6 +/- 1.8. The median VAC treatment time until surgical closure was 9.7 +/- 3.9 days. The VAC therapy was solely used as a bridge to the definite wound closure. Four patients (10%) with a chronic fistula were re-admitted with the range of 1 to 12 months after the VAC therapy. The VAC therapy is a safe and reliable option in the treatment of surgical site infection in the field of cardiac surgery. The VAC therapy can be considered as an effective adjunct to convetional treatment modalities for the therapy of extensive and life-threatening wound infection following cardiac surgery, particurlarly in the group of high-risk patients.

Nurses infection prevention practices in handling injections: A case ...

African Journals Online (AJOL)

The adherence to basic infection prevention procedures/aseptic techniques in handling of injections by health workers is still a concern. The adherence to aseptic techniques in handling injections is significantly associated with the nurses to patients ratios. Therefore, it is imperative to improve nurse to patient ratio in public ...

Bone marrow aspiration

Science.gov (United States)

Iliac crest tap; Sternal tap; Leukemia - bone marrow aspiration; Aplastic anemia - bone marrow aspiration; Myelodysplastic syndrome - bone marrow aspiration; Thrombocytopenia - bone marrow aspiration; Myelofibrosis - bone marrow aspiration

An analysis of changes on plain chest films after open-heart surgery

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Choi, See Sung; Kim, Byung Chan; Won, Jong Jin [Wonkwang University College of Medicine, Seoul (Korea, Republic of)

1988-08-15

This retrospective study was performed to detect thoracic change on chest films after open-heart surgery. Authors reviewed total 160 cases who underbent median sternotomy from July 1984 to January 1988. The results were as follows: 1. Although all cases showed mediastinal widening by the mean 29.9% (SD 16.2), there was no case of reoperation due to excessive mediastinal hemorrhage. 2. Among 160 cases, 87 cases (54%) showed thoracic alterations after surgery. 3. Abnormal sternal findings were radiolucent vertical line in 15 cases (9%), sternal dehiscence in 4 cases (2%), sternal osteomyelitis in 4 cases (2%). 4. The types of pulmonary parenchymal lesions were 24 cases (15%) of atelectasis, 15 cases (9%) of pneumonia and 3 cases (2%) of pulmonary edema. 5. Pleural effusion was noted in 39 cases (24%). 6. Among the abnormal extra-alveolar air collections, there were pneumothorax in 10 cases (6%), pneumomediastinum and pneumopericardium in 29 cases (18%), and pneumoperitoneum in 5 cases (3%). 7. In 23 cases with phrenic nerve paralysis, the involved site was left in all and the associated pulmonary infiltration in left lower love was found in 82% (19/23). 8. 4 cases of cardiac tamponade developed 9 to 20 days after surgery ('late' form)

Chest wall reconstruction with autologas rib grafts in dogs and report of a clinic case.

Science.gov (United States)

Tunçözgür, B; Elbeyli, L; Güngör, A; Işik, F; Akay, H

1999-09-01

Nowadays, in chest wall reconstruction prosthetic materials are generally used. However, the rejections of prosthetic materials and infections frequently occur in chest wall reconstruction, especially after radiotherapy or resection that is performed due to infections. We used 10 mongrel dogs and performed resections of 8 cm diameter on their chest walls. In the reconstruction of these defects, in five of the subjects, we used two free rib grafts with periosteum to be resected from the contralateral side and in other five subjects, we used free rib grafts without periosteum. After this experimental study, sternal resection was performed in a 24-year-old man because of sternal osteomyelitis. First to obtain rib grafts with periosteum, partial resection was performed to 5th, 7th, and 9th ribs of the lateral left side. After, total sternal resection, end to end anastomosis was performed to the 2nd, 3rd, 4th and 5th anterior ends of the ribs. Autogeneous rib grafts were found to be enough to provide chest wall stabilization. The contralateral autogeneous free rib grafts can successfully be used in reconstruction of wide chest wall defects. This method is found to be effective and sufficient to prevent infection, rejection and to provide stabilization.

An analysis of changes on plain chest films after open-heart surgery

International Nuclear Information System (INIS)

Choi, See Sung; Kim, Byung Chan; Won, Jong Jin

1988-01-01

This retrospective study was performed to detect thoracic change on chest films after open-heart surgery. Authors reviewed total 160 cases who underbent median sternotomy from July 1984 to January 1988. The results were as follows: 1. Although all cases showed mediastinal widening by the mean 29.9% (SD 16.2), there was no case of reoperation due to excessive mediastinal hemorrhage. 2. Among 160 cases, 87 cases (54%) showed thoracic alterations after surgery. 3. Abnormal sternal findings were radiolucent vertical line in 15 cases (9%), sternal dehiscence in 4 cases (2%), sternal osteomyelitis in 4 cases (2%). 4. The types of pulmonary parenchymal lesions were 24 cases (15%) of atelectasis, 15 cases (9%) of pneumonia and 3 cases (2%) of pulmonary edema. 5. Pleural effusion was noted in 39 cases (24%). 6. Among the abnormal extra-alveolar air collections, there were pneumothorax in 10 cases (6%), pneumomediastinum and pneumopericardium in 29 cases (18%), and pneumoperitoneum in 5 cases (3%). 7. In 23 cases with phrenic nerve paralysis, the involved site was left in all and the associated pulmonary infiltration in left lower love was found in 82% (19/23). 8. 4 cases of cardiac tamponade developed 9 to 20 days after surgery ('late' form).

MR findings of spondylolysis

International Nuclear Information System (INIS)

Ojiri, Hiroya; Fukuda, Kunihiko; Hashimoto, Toru; Doi, Michiko; Irie, Takeo; Tatsuno, Satoshi; Tada, Shinpei; Toyoda, Keiko.

1994-01-01

We reviewed MR images of 50 patients with spondylolisthesis to disclose MR findings of spondylolysis. In almost half of our series, spondylolysis was detected as a low signal intensity band traversing in the pairs interarticularis on both T1 and T2 weighted images. Sagittal images was superior to axial image in detection of the low signal intensity band. In some patients, a focal high signal intensity accompanying the low signal intensity band was considered to be fluid collection within pseudoarthrosis due to spondylolysis on T2-weighted image. (author)

MR findings of spondylolysis

Energy Technology Data Exchange (ETDEWEB)

Ojiri, Hiroya; Fukuda, Kunihiko; Hashimoto, Toru; Doi, Michiko; Irie, Takeo; Tatsuno, Satoshi; Tada, Shinpei (Jikei Univ., Tokyo (Japan). School of Medicine); Toyoda, Keiko

1994-08-01

We reviewed MR images of 50 patients with spondylolisthesis to disclose MR findings of spondylolysis. In almost half of our series, spondylolysis was detected as a low signal intensity band traversing in the pairs interarticularis on both T1 and T2 weighted images. Sagittal images was superior to axial image in detection of the low signal intensity band. In some patients, a focal high signal intensity accompanying the low signal intensity band was considered to be fluid collection within pseudoarthrosis due to spondylolysis on T2-weighted image. (author).

''The dermal internal brassiere flap,'' a new modification of inferior pedicle breast reduction technic.

Science.gov (United States)

Temel, Metin; Karakaş, Ali O; Dokuyucu, Recep; Türkmen, Arif

2015-06-01

The inferior pedicle mammaplasty is particularly applied to large breasts with a long sternal notch to nipple distance. The present study reports modifications developed to solve the bottoming-out deformity, the lack of upper pole fullness and the wound healing problems seen at the reverse T-zone, known disadvantages of the inferior pedicle reduction mammaplasty, and evaluates postoperative sensation. A total of 110 patients with a mean age of 32 underwent the same technique. In this technique, two pairs of quadrangular and triangular flaps were planned from the skin of resection sites. The triangular dermal flaps and quadrangular flaps were suspended from the periosteum of the 2nd and 4th ribs, respectively. The distance from the nipple to inframammary fold was measured at the postoperative 1st month and 1st year. In the postoperative period, a nipple-inframammary fold distance increase of over 2 cm was determined as bottoming-out deformity. Sensation evaluations were performed by subjective and objective tests. The mean sternal notch to nipple distance was 35.00 cm. After operation, the mean distance between the sternal notch and the nipple was 20.00 cm. NAC examination revealed normal sensation in all patients. Whereas the preoperative mean areolar threshold value was 36.70 g/mm(2), the postoperative first-year mean areolar pressure threshold value was 35.50 g/mm(2) (p value was 25.30 g/mm(2), whereas the postoperative first-year mean nipple pressure threshold value was 26.00 g/mm(2) (p = 0.5471). The postoperative first-month mean sternal notch to nipple distance value of the patients was 20.00 cm, whereas the postoperative first-year mean sternal notch to nipple distance value of the patients was 20.00 cm, (p = 0.0648). The postoperative first-month mean nipple to submammary fold distance value of the patients was 10.50 cm, the postoperative first-year mean nipple to submammary fold distance value of the patients was 11.00 cm (p disadvantages of the inferior

Is there a role for robotic totally endoscopic coronary artery bypass in patients with a colostomy?

Science.gov (United States)

Gibber, Marc; Lehr, Eric J; Kon, Zachary N; Wehman, P Brody; Griffith, Bartley P; Bonatti, Johannes

2014-01-01

Preoperative colostomy presents a significant risk of sternal wound complications, mediastinitis, and ostomy injury in patients requiring coronary artery bypass grafting. Less invasive procedures in coronary surgery have a potential to reduce the risk of sternal wound healing problems. Robotic totally endoscopic coronary artery bypass grafting in patients with a colostomy has not been reported. We describe a case of completely endoscopic coronary surgery using the da Vinci Si system in a patient with a transverse colostomy. Single left internal mammary artery grafting to the left anterior coronary artery was performed successfully on the beating heart. We regard this technique as the least invasive method of surgical coronary revascularization with a potential to reduce the risk of surgical site infection and mediastinitis in patients with a colostomy.

The concept of negative pressure wound therapy (NPWT after poststernotomy mediastinitis – a single center experience with 54 patients

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Vogt Peter M

2009-01-01

Full Text Available Abstract Deep sternal infections, also known as poststernotomy mediastinitis, are a rare but often fatal complication in cardiac surgery. They are a cause of increased morbidity and mortality and have a significant socioeconomic aspect concerning the health system. Negative pressure wound therapy (NPWT followed by muscular pectoralis plasty is a quite new technique for the treatment of mediastinitis after sternotomy. Although it could be demonstrated that this technique is at least as safe and reliable as other techniques for the therapy of deep sternal infections, complications are not absent. We report about our experiences and complications using this therapy in a set of 54 patients out of 3668 patients undergoing cardiac surgery in our institution between January 2005 and April 2007.

The concept of negative pressure wound therapy (NPWT) after poststernotomy mediastinitis--a single center experience with 54 patients.

Science.gov (United States)

Ennker, Ina C; Malkoc, Anita; Pietrowski, Detlef; Vogt, Peter M; Ennker, Juergen; Albert, Alexander

2009-01-12

Deep sternal infections, also known as poststernotomy mediastinitis, are a rare but often fatal complication in cardiac surgery. They are a cause of increased morbidity and mortality and have a significant socioeconomic aspect concerning the health system. Negative pressure wound therapy (NPWT) followed by muscular pectoralis plasty is a quite new technique for the treatment of mediastinitis after sternotomy. Although it could be demonstrated that this technique is at least as safe and reliable as other techniques for the therapy of deep sternal infections, complications are not absent. We report about our experiences and complications using this therapy in a set of 54 patients out of 3668 patients undergoing cardiac surgery in our institution between January 2005 and April 2007.

Median sternotomy - gold standard incision for cardiac surgeons

Directory of Open Access Journals (Sweden)

Radu Matache

2016-05-01

Full Text Available Sternotomy is the gold standard incision for cardiac surgeons but it is also used in thoracic surgery especially for mediastinal, tracheal and main stem bronchus surgery. The surgical technique is well established and identification of the correct anatomic landmarks, midline tissue preparation, osteotomy and bleeding control are important steps of the procedure. Correct sternal closure is vital for avoiding short- and long-term morbidity and mortality. The two sternal halves have to be well approximated to facilitate healing of the bone and to avoid instability, which is a risk factor for wound infection. New suture materials and techniques would be expected to be developed to further improve the patients evolution, in respect to both immediate postoperative period and long-term morbidity and mortality

SPECT scintigraphy with HDP and Mab BW 250/183 of loosened hip endoprothesis

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Predic, P [Hospital Celje, Celje (Sierra Leone); Gregoric, E [Hospital Izola, Izola (Sierra Leone); Dodig, D [Clinical Hospital Centre, Zagreb (Croatia). Dept. of Nuclear Medicine and Radiation Protection

1994-10-01

Main problem of the loosened hip endoprothesis is in distinguishing between the aseptic and septic loosening of endoprothesis. The study involved 27 pts with a loosened hip; 15 pts with aseptic and 12 pts with septic loosening. The patients were injected 550-770 MBq Tc-99m-HDP and underwent SPECT scintigraphy of the hips to repeat then the examination with only 370 MBq Tc-99m-Mab Bw 230/183. HDP application evidenced positive accumulation at the endoprothesis in all patients with a loosened hip while Mab Bw 250/183 only in the patients with septic loosening. Conclusion: SPECT scintigraphy of hip endoprothesis with HDP and Mab BW 250/183 allows differential diagnosing between septic and aseptic hip loosening and hereby a correct therapeutical approach. (author).

Bone and bone marrow function of reconstructed chest wall after surgical correction of pectus excavatum

International Nuclear Information System (INIS)

Watanabe, Yoh; Magara, Tatsuo; Kobayashi, Hiroaki; Ichihashi, Takumi; Hikishima, Hiroshi

1984-01-01

Bone and Bone marrow functions of the reconstructed chest wall after surgical correction of the funnel chest deformities were evaluated by scanning method. In our series, three kinds of operative procedures were employed; strut method for adult cases, sternal turnover method with and without muscle pedicle for infant cases. Bone function was scanned by sup(99m)Tc-methylene-diphosphonate and bone marrow function was evaluated by sup(99m)Tc-sulfur-colloid. For the cases undergone each surgical procedure, bone and bone marrow scan were done at short term after surgery (within 30 days), at intermediate stage (one month to 12 months), and at long term stage (beyond one year). The results were as follows: By the evaluation at the long term stage of the cases undergoing strut method, bone as well as bone marrow scan visualized normal view of the reconstructed sternum. Regarding the cases undergone sternal turnover method without muscle pedicle, or free graft implantation of the plastron, the bone scan at the long term follow-up stage showed abnormal finding, i.e. hypo-, or defect-visualization of the inverted sternum, in 11.5% of the cases. Furthermore, bone marrow scan showed abnormality in 33.3% of the cases. On the other hand, the cases undergone sternal turnover method with muscle pedicle, in which blood supply to the plastron were preserved by the connection from superior epigastric artery to internal mammary artery, showed no abnormality as far as at the long term follow-up study neither in bone scan nor bone marrow scan. However, in the evaluation at short term after surgery, 50% of the cases undergoing bone scan showed abnormality. In addition, in this stage 85.7% of the bone marrow scan showed abnormal finding. These abnormality, however, normalized within 6 months for bone scan and 12 months for bone marrow scan, in contrast to the results of the cases undergone sternal turnover without pedicle. (J.P.N.)

A BMP responsive transcriptional region in the chicken type X collagen gene.

Science.gov (United States)

Volk, S W; Luvalle, P; Leask, T; Leboy, P S

1998-10-01

Bone morphogenetic proteins (BMPs) were originally identified by their ability to induce ectopic bone formation and have been shown to promote both chondrogenesis and chondrocyte hypertrophy. BMPs have recently been found to activate a membrane serine/threonine kinase signaling mechanism in a variety of cell types, but the downstream effectors of BMP signaling in chondrocyte differentiation remain unidentified. We have previously reported that BMP-2 markedly stimulates type X collagen expression in prehypertrophic chick sternal chondrocytes, and that type X collagen mRNA levels in chondrocytes cultured under serum-free (SF) conditions are elevated 3- to 5-fold within 24 h. To better define the molecular mechanisms of induction of chondrocyte hypertrophy by BMPs, we examined the effect of BMPs on type X collagen production by 15-day chick embryo sternal chondrocytes cultured under SF conditions in the presence or absence of 30 ng/ml BMP-2, BMP-4, or BMP-7. Two populations of chondrocytes were used: one representing resting cartilage isolated from the caudal third of the sterna and the second representing prehypertrophic cartilage from the cephalic third of the sterna. BMP-2, BMP-4, and BMP-7 all effectively promoted chondrocyte maturation of cephalic sternal chondrocytes as measured by high levels of alkaline phosphatase, diminished levels of type II collagen, and induction of the hypertrophic chondrocyte-specific marker, type X collagen. To test whether BMP control of type X collagen expression occurs at the transcriptional level, we utilized plasmid constructs containing the chicken collagen X promoter and 5' flanking regions fused to a reporter gene. Constructs were transiently transfected into sternal chondrocytes cultured under SF conditions in the presence or absence of 30 ng/ml BMP-2, BMP-4, or BMP-7. A 533 bp region located 2.4-2.9 kb upstream from the type X collagen transcriptional start site was both necessary and sufficient for strong BMP responsiveness

Test of over-garments sterilization by gamma rays

International Nuclear Information System (INIS)

Bensiam, R.; Kahoul, A.S.; Meral, A.S.; Guemati, M.; Oularbi, S.; Boussaha, A.

1988-12-01

The aseptic state is absolutely necessary for a successful result of surgical operation. A single object badly cleaned and contaminated by microbes in the operating room may be the cause of the operation failure. The use of aseptic medical requisites is consequently essential to guarantee the security of the clinical practices. Besides, the asepsis prevents the nosocomial infections process that occurs in the hospitals and health centres

Нижнегоризонтальные электрохирургические желудочно-кишечные анастомозы

OpenAIRE

Шаймарданов, Р.; Купкенов, М.

2005-01-01

The original aseptic electrosurgical gastroentero-anastomosis after stomach resection is suggested. Anastomosis is formed on greater curvature of stomach stump without opening of anastomosed organs lumen. The advantages of anastomosis are the simplicity of performance, asepticity absence of prerequisites for development of anastomosites and bleeding from anastomosis. The suggested anastomosis was used in 51 patients during stomach resection performed for various indications with good immediat...

Early subsidence of shape-closed hip arthroplasty stems is associated with late revision. A systematic review and meta-analysis of 24 RSA studies and 56 survival studies.

Science.gov (United States)

van der Voort, Paul; Pijls, Bart G; Nieuwenhuijse, Marc J; Jasper, Jorrit; Fiocco, Marta; Plevier, Josepha W M; Middeldorp, Saskia; Valstar, Edward R; Nelissen, Rob G H H

2015-01-01

Few studies have addressed the association between early migration of femoral stems and late aseptic revision in total hip arthroplasty. We performed a meta-regression analysis on 2 parallel systematic reviews and meta-analyses to determine the association between early migration and late aseptic revision of femoral stems. Of the 2 reviews, one covered early migration data obtained from radiostereometric analysis (RSA) studies and the other covered long-term aseptic revision rates obtained from survival studies with endpoint revision for aseptic loosening. Stems were stratified according to the design concept: cemented shape-closed, cemented force-closed, and uncemented. A weighted regression model was used to assess the association between early migration and late aseptic revision, and to correct for confounders. Thresholds for acceptable and unacceptable migration were determined in accordance with the national joint registries (≤ 5% revision at 10 years) and the NICE criteria (≤ 10% revision at 10 years). 24 studies (731 stems) were included in the RSA review and 56 studies (20,599 stems) were included in the survival analysis review. Combining both reviews for the 3 design concepts showed that for every 0.1-mm increase in 2-year subsidence, as measured with RSA, there was a 4% increase in revision rate for the shape-closed stem designs. This association remained after correction for age, sex, diagnosis, hospital type, continent, and study quality. The threshold for acceptable migration of shape-closed designs was defined at 0.15 mm; stems subsiding less than 0.15 mm in 2 years had revision rates of less than 5% at 10 years, while stems exceeding 0.15 mm subsidence had revision rates of more than 5%. There was a clinically relevant association between early subsidence of shape-closed femoral stems and late revision for aseptic loosening. This association can be used to assess the safety of shape-closed stem designs. The published research is not sufficient

Scintigraphy of spinal disorders in adolescents

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Mandell, G.A. (Dept. of Medical Imaging, Alfred I. duPont Inst., Wilmington, DE (United States)); Harcke, H.T. (Dept. of Medical Imaging, Alfred I. duPont Inst., Wilmington, DE (United States))

1993-08-01

Bone scintigraphy in adolescents is useful in helping to differentiate between developmental (atypical lumbar Scheuermann disease), infectious (discitis, osteomyelitis), neoplastic (osteoid osteoma, osteoblastoma), and traumatic (occult fractures, spondylolysis, pseudoarthrosis) disease of the spine. Double-phase (blood pool, delayed images) scintigraphy can characterize the pattern (i.e., linear in fracture, ovoid in nidus of osteoid osteoma). Single-photon emission computed tomography (SPECT) can be helpful in detecting the subtle presence of stress reaction (spondylolyses) not noted on routine planar scintigraphy and radiography. Bone scintigraphy is most beneficial when correlated with other imaging modalities in refining the diagnosis of spinal diseases. (orig.)

Scintigraphy of spinal disorders in adolescents

International Nuclear Information System (INIS)

Mandell, G.A.; Harcke, H.T.

1993-01-01

Bone scintigraphy in adolescents is useful in helping to differentiate between developmental (atypical lumbar Scheuermann disease), infectious (discitis, osteomyelitis), neoplastic (osteoid osteoma, osteoblastoma), and traumatic (occult fractures, spondylolysis, pseudoarthrosis) disease of the spine. Double-phase (blood pool, delayed images) scintigraphy can characterize the pattern (i.e., linear in fracture, ovoid in nidus of osteoid osteoma). Single-photon emission computed tomography (SPECT) can be helpful in detecting the subtle presence of stress reaction (spondylolyses) not noted on routine planar scintigraphy and radiography. Bone scintigraphy is most beneficial when correlated with other imaging modalities in refining the diagnosis of spinal diseases. (orig.)

Vapor Phase Hydrogen Peroxide Sanitization of an Isolator for Aseptic Filling of Monoclonal Antibody Drug Product - Hydrogen Peroxide Uptake and Impact on Protein Quality.

Science.gov (United States)

Hubbard, Aaron; Reodl, Thomas; Hui, Ada; Knueppel, Stephanie; Eppler, Kirk; Lehnert, Siegfried; Maa, Yuh-Fun

2018-03-15

A monoclonal antibody drug product (DP) manufacturing process was transferred to a different production site, where aseptic filling took place within an isolator that was sanitized using vapor phase hydrogen peroxide (VPHP). A quality-by-design approach was applied for study design to understand the impact of VPHP uptake in the isolator on DP quality. A combination of small-scale and manufacturing-scale studies was performed to evaluate the sensitivity of the monoclonal antibody to hydrogen peroxide (H2O2) as well as VPHP uptake mechanisms during the filling process. The acceptable H2O2 level was determined to be 100 ng/mL for the antibody in the H2O2 spiking study; protein oxidation was observed above this threshold. The most prominent sources of VPHP uptake were identified to be via the silicone tubing assembly (associated with the peristaltic pumps) and open, filled vials. Silicone tubing, an effective depot to H2O2, could absorb VPHP during different stages of the filling process and discharge H2O2 into the DP solution during filling interruptions. A small-scale isolator model, established to simulate manufacturing-scale conditions, was a useful tool in understanding H2O2 uptake in relation to tubing dimensions and VPHP concentration in the isolator air (or atmosphere). Although the tubing assembly had absorbed a substantial amount of VPHP during the decontamination phase, the majority of H2O2 could be removed during tubing cleaning and sterilization in the subsequent isolator aeration phase, demonstrating that H2O2 in the DP solution is taken up primarily via atmospheric VPHP residues in the isolator during filling. Picarro sensor monitoring suggested that the validated VPHP aeration process generates reproducible residual VPHP profiles in isolator air, thus allowing small-scale studies to provide more relevant recommendations on tubing size and interruption time limits for commercial manufacturing. The recommended process parameters were demonstrated to be

PATTERNS OF SEVEN AND COMPLICATED MALARIA IN CHILDREN

African Journals Online (AJOL)

GB

2014-01-01

Jan 1, 2014 ... appearance and irregular margin without any calcification ... lung with sternum and mediastinal plus cervical lymph node ... imaging (MRI) of the sternum (5). CT scan is .... presenting as a bleeding sternal mass. Open J.

Radiation therapy for resistant sternal hydatid disease

International Nuclear Information System (INIS)

Ulger, S.; Barut, H.; Tunc, M.; Aydinkarahaliloglu, E.; Aydin, E.; Karaoglanoglu, N.; Gokcek, A.

2013-01-01

Hydatid disease is a zoonotic infectious disease for which there are known treatment procedures and effective antibiotics; however, there are resistant cases that do not respond to medication or surgery. We report a case diagnosed as hydatid disease of the chest wall and treated with radiation therapy (RT) after medical and surgical therapy had failed. In conclusion, RT represents an alternative treatment modality in resistant cases. (orig.)

Comparisons Of The Effects Of Medetomidine, Lidocaine And Their ...

African Journals Online (AJOL)

... with a one-week interval between subsequent injections. Lumbosacral epidural injection of medetomidine and medetomidine-lidocaine combinations induced behavioral changes characterized by ataxia, swaying movements, tail flaccidity, low head carriage, sternal and lateral recumbency posture coupled with salivation.

Combined bilateral idiopathic necrosis of the humerus and femur heads: Bone scan, X-ray, CT, and MRI findings

International Nuclear Information System (INIS)

Piepenburg, R.; Hahn, K.; Doll, G.; Grimm, J.

1992-01-01

Untreated aseptic bone necroses close to a joint commonly leads to severe secondary arthrosis and destruction of the joint within a short time. Therefore, only a diagnosis in an early stage of the disease offers the chance of a successful joint- preserving therapy. In cases of clinically suspected aseptic bone necrosis but still negative or doubtful X-ray findings, bone scans or MRI are reliable methods of verifying the diagnosis. (orig./MG) [de

Combined bilateral idiopathic necrosis of the humerus and femur heads: Bone scan, X-ray, CT, and MRI findings. Kombinierte beidseitige idiopathische Nekrose der Humerus- und Femurkoepfe: Skelettszintigraphie, Roentgen-, CT- und MRT-Befunde

Energy Technology Data Exchange (ETDEWEB)

Piepenburg, R.; Hahn, K. (Mainz Univ. (Germany). Klinik fuer Nuklearmedizin); Doll, G. (Mainz Univ. (Germany). Klinik fuer Roentgendiagnostik); Grimm, J. (Mainz Univ. (Germany). Orthopaedische Klinik)

1992-12-01

Untreated aseptic bone necroses close to a joint commonly leads to severe secondary arthrosis and destruction of the joint within a short time. Therefore, only a diagnosis in an early stage of the disease offers the chance of a successful joint- preserving therapy. In cases of clinically suspected aseptic bone necrosis but still negative or doubtful X-ray findings, bone scans or MRI are reliable methods of verifying the diagnosis. (orig./MG).

Clinical and haematological features of stress induced Babesiusis in ...

African Journals Online (AJOL)

Studies on actively stressedB. equi infected premuned indigenous polo horses, manifested severe clinical syndromes characterised by partial anorexia, hyperthermia, lethergy, extreme weakness, marked dehydration, ecchymotic third eye lid, pale mucous membranes, sternal recumbency and coma. Some horses showed ...

Effect of Deinococcus radiodurans on uptake of 134Cs by Brassica oleracea

International Nuclear Information System (INIS)

Zhu Cong; Guo Jiangfeng

2008-01-01

Deinococcus radiodurans was inoculated into the soil which was spiked with 134 Cs to investigate its effect on chemical speciation of 134 Cs. The relationship between chemical speciation of 134 Cs and its absorbtion capacity by cabbage (Brassica oleracea) in the presence of D. radiodurans was also investigated. The results showed that an increase of 28.64%-38.17 % in content of 134 Cs in residual phase was observed with presence of D. radiodurans in comparison with the aseptic control. The amounts of radiocesium uptaken by cabbage were about 12100Bq/g under aseptic conditions, however, which were about 8500Bq/g with the presence of D. radiodurans. The proportion of 134 Cs taken up by cabbage decreased about 29% in comparison with the aseptic control. The chemical speciation could be influenced by D. radiodurans so that its uptake by plants could be reduced. (authors)

An unusual cause of pain post ankle arthrodesis in patients with rheumatoid arthritis.

LENUS (Irish Health Repository)

Burke, Neil G

2012-02-01

Rheumatoid arthritis is an autoimmune disease which frequently affects the ankle and foot. End stage ankle arthritis from rheumatic disease is commonly managed by the established practice of ankle arthrodesis. Among the adverse sequelae causing pain following this surgery is infection, pseudo-arthrosis and non-union. Stress fracture of the distal third is a recognised but unusual cause of pain of tibia following ankle arthrodesis. The authors\\' present three patients with rheumatoid arthritis who sustained a stress fracture of the distal tibia following arthrodesis, and discuss the contributing factors and highlight the need for orthopaedic surgeons to be suspicious of this complication post surgery.

Editorial Commentary: Got Evidence? What We Really Need Is an Algorithm for Treating Symptomatic Bipartite Patella.

Science.gov (United States)

Fithian, Donald C

2018-05-01

Bipartite patella is an uncommon but potentially troublesome problem for young athletes. Numerous uncontrolled retrospective studies have reported good results after various treatments. What is needed are studies that will guide workup and support treatment decisions based on the condition of the cartilage surfaces of the fragment, presence of pseudoarthrosis, and size and location of the fragment. To support decisions, we need prospective comparative studies, either randomized or, at least, prospective cohort studies that identify patients at the time of presentation, document key decision points, and follow patients to successful resolution of symptoms. Copyright © 2018 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Can patients determine the level of their dysphagia?

Science.gov (United States)

Ashraf, Hafiz Hamad; Palmer, Joanne; Dalton, Harry Richard; Waters, Carolyn; Luff, Thomas; Strugnell, Madeline; Murray, Iain Alexander

2017-02-14

To determine if patients can localise dysphagia level determined endoscopically or radiologically and association of gender, age, level and pathology. Retrospective review of consecutive patients presenting to dysphagia hotline between March 2004 and March 2015 was carried out. Demographics, clinical history and investigation findings were recorded including patient perception of obstruction level (pharyngeal, mid sternal or low sternal) was documented and the actual level of obstruction found on endoscopic or radiological examination (if any) was noted. All patients with evidence of obstruction including oesophageal carcinoma, peptic stricture, Schatzki ring, oesophageal pouch and cricopharyngeal hypertrophy were included in the study who had given a perceived level of dysphagia. The upper GI endoscopy reports (barium study where upper GI endoscopy was not performed) were reviewed to confirm the distance of obstructing lesion from central incisors. A previously described anatomical classification of oesophagus was used to define the level of obstruction to be upper, middle or lower oesophagus and this was compared with patient perceived level. Three thousand six hundred and sixty-eight patients were included, 42.0% of who were female, mean age 70.7 ± 12.8 years old. Of those with obstructing lesions, 726 gave a perceived level of dysphagia: 37.2% had oesophageal cancer, 36.0% peptic stricture, 13.1% pharyngeal pouches, 10.3% Schatzki rings and 3.3% achalasia. Twenty-seven point five percent of patients reported pharyngeal level (upper) dysphagia, 36.9% mid sternal dysphagia and 25.9% lower sternal dysphagia (9.5% reported multiple levels). The level of obstructing lesion seen on diagnostic testing was upper (17.2%), mid (19.4%) or lower (62.9%) or combined (0.3%). When patients localised their level of dysphagia to a single level, the kappa statistic was 0.245 ( P dysphagia were accurate in localising the obstructing pathology. With respect to pathology, patients

The investigation of the design of hybrid operating room

International Nuclear Information System (INIS)

Jiang Weihao; Li Jun

2011-01-01

Objective: To investigate the design of the interventional operating room that can meet the needs of modern DSA operation, and the overall arrangement of the hybrid operating room should be reasonable, practical and perspective. Methods: The experience and understanding obtained from the designing and planning of the new Building of Radiology and Surgery in authors' hospital were summarized. In order to meet the requirements of aseptic surgical practices and a full-featured hybrid operating room the following factors should be carefully and synthetically taken into account: the room size, the functional sub-areas, the operational procedures, the aseptic specification, etc. Results: The sufficient verification and scientific design were the important link for building a hybrid operating room. It could provide the surgeons and interventional physicians with more alternative operating methods and it could represent the development trend of medical technology. Conclusion: When planning and designing a new DSA operating room, various factors related to the interventional procedures, such as the room size, the functional sub-areas, the operational procedures and the aseptic specification, should be carefully and synthetically taken into account. The standard of aseptic procedure must be strictly complied with and the various functional sub-areas need to be rationally distributed. The design of hybrid operating room, which joins the functions of both open surgery and interventional management together, should be scientific, practical and perspective. (authors)

Analysis of {sup 18} F-FDG uptake patterns in PET for diagnosis of septic and aseptic loosening after total hip arthroplasty

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Cremerius, U.; Niethard, F.U. [Rheinisch-Westfaelische Technische Hochschule Aachen (Germany). Klinik fuer Nuklearmedizin; Mumme, T.; Reinartz, P.; Wirtz, D. [Rheinisch-Westfaelische Technische Hochschule Aachen (Germany). Orthopaedische Klinik; Buell, U.

2003-12-01

Aim: Identification of typical patterns for fluorodeoxyglucose (FDG) uptake in positron emission tomography (PET) to detect aseptic loosening of hip prosthesis (acetabular and/or femoral component) and prosthetic infection. Methods: 18 patients with painful hip prosthesis underwent PET using a dedicated full ring scanner after application of 200-300 MBq FDG. The interface between bone and surrounding soft tissue or bone as displayed on coronal slices was divided into 12 segments in accordance with the classifications of Delee and Gruen. FDG uptake in each of the segments was scored (0-3) by two independent observers. Intraoperative findings were regarded as the gold standard. Results: After surgical revision 14 acetabular components and 9 femoral components were found to be loose and prosthetic infection was present in 7 prostheses. Loosening of the acetabular component was correlated to enhanced uptake in the middle of the acetabular interface, while loosening of the femoral component was correlated to enhanced uptake in the proximal and middle segment of the lateral femoral interface and the proximal segment of the medial femoral interface. A similar pattern was found in prosthetic infection with high uptake along the middle portion of the lateral femoral interface. In 6 of 7 infected prostheses loosening of the acetabular and of the femoral component was present. Taking the typical uptake patterns as criteria for loosening and grade 3 uptake as an additional criterion for septic loosening the accuracy of PET imaging in the detection of loosening of the acetabular or the femoral component and of prosthetic infection was 72, 78 and 89%, respectively. Conclusion: This pilot study presents FDG-PET as a promising diagnostic tool for patients with painful hip prostheses. Its clinical value should be evaluated in a larger patient population. (orig.) [German] Ziel: Identifikation von Befundmustern in der Positronenemissionstomographie (PET) mit {sup 18}F

Long-term trend of bone development in the contemporary teenagers of Chinese Han nationality.

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Wang, Ya-Hui; Ying, Chong-Liang; Wan, Lei; Zhu, Guang-You

2012-08-01

To further improve the accuracy of bone age identification using the time of secondary ossification center appearance and epiphyseal fusion of 7 joints to estimate the age of living individuals. DR films were taken from 7 parts including sternal end of clavical and the left side of shoulder, elbow, carpal, hip, knee and ankle joints of 1 709 individuals who came from eastern China, central China and southern China, whose ages were between 11.0 and 20.0 years. From those 7 joints 24 osteal loci were selected as bone age indexes, which could better reflect age growth of teenagers. The characteristics of secondary ossification center appearance and epiphyseal fusion were observed, and the mean and age range of secondary ossification center appearance and epiphyseal fusion were calculated. The fusion time of the 24 epiphyses were advanced at different degrees, the most obvious epiphyses the sternal end of clavicle, scapular acromial end, distal end of the radius, distal end of the ulna, iliac crest, ischial tuberosity, the upper and lower end of tibia and fibula. The appearance time of sternal end of clavicle, scapular acromial end, iliac crest and ischial tuberosity epiphyses were all found to be after the age of 12, and the female's age, approximately 1 year ahead of schedule in comparison with the male's. The relevant forensic information and data for bone age identification should be updated every 10-15 years so as to provide accurate and objective evidence for court testimony, conviction and sentencing.

Evaluation the consistency of location of moist desquamation and skin high dose area for breast cancer patients receiving adjuvant radiotherapy after breast conservative surgery

International Nuclear Information System (INIS)

Sun, Li-Min; Huang, Eng-Yen; Liang, Ji-An; Meng, Fan-Yun; Chang, Gia-Hsin; Tsao, Min-Jen

2013-01-01

To evaluate whether the location of moist desquamation matches high dose area for breast cancer patients receiving adjuvant radiotherapy (RT) after breast conservative surgery. One hundred and nine breast cancer patients were enrolled to this study. Their highest skin dose area (the hot spot) was estimated from the treatment planning. We divided the irradiated field into breast; sternal/parasternal; axillary; and inframammary fold areas. The location for moist desquamation was recorded to see if it matches the hot spot. We also analyzed other possible risk factors which may be related to the moist desquamation. Forty-eight patients with 65 locations developed moist desquamation during the RT course. Patients with larger breast sizes and easy to sweat are two independent risk factors for moist desquamation. The distribution of moist desquamation occurred most in the axillary area. All nine patients with the hot spots located at the axillary area developed moist desquamation at the axillary area, and six out of seven patients with the hot spots located at the inframammary fold developed moist desquamation there. The majority of patients with moist desquamation over the breast or sternal/parasternal areas had the hot spots located at these areas. For a patient with moist desquamation, if a hot spot is located at the axillary or inframammary fold areas, it is very likely to have moist desquamation occur there. On the other hand, if moist desquamation occurs over the breast or sternal/parasternal areas, we can highly expect these two areas are also the hot spot locations

Estimation of optimal nasotracheal tube depth in adult patients.

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Ji, Sung-Mi

2017-12-01

The aim of this study was to estimate the optimal depth of nasotracheal tube placement. We enrolled 110 patients scheduled to undergo oral and maxillofacial surgery, requiring nasotracheal intubation. After intubation, the depth of tube insertion was measured. The neck circumference and distances from nares to tragus, tragus to angle of the mandible, and angle of the mandible to sternal notch were measured. To estimate optimal tube depth, correlation and regression analyses were performed using clinical and anthropometric parameters. The mean tube depth was 28.9 ± 1.3 cm in men (n = 62), and 26.6 ± 1.5 cm in women (n = 48). Tube depth significantly correlated with height (r = 0.735, P < 0.001). Distances from nares to tragus, tragus to angle of the mandible, and angle of the mandible to sternal notch correlated with depth of the endotracheal tube (r = 0.363, r = 0.362, and r = 0.546, P < 0.05). The tube depth also correlated with the sum of these distances (r = 0.646, P < 0.001). We devised the following formula for estimating tube depth: 19.856 + 0.267 × sum of the three distances (R 2 = 0.432, P < 0.001). The optimal tube depth for nasotracheally intubated adult patients correlated with height and sum of the distances from nares to tragus, tragus to angle of the mandible, and angle of the mandible to sternal notch. The proposed equation would be a useful guide to determine optimal nasotracheal tube placement.

Packaging's Contribution for the Effectiveness of the Space Station's Food Service Operation

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Rausch, B. A.

1985-01-01

Storage limitations will have a major effect on space station food service. For example: foods with low bulk density such as ice cream, bread, cake, standard type potato chips and other low density snacks, flaked cereals, etc., will exacerbate the problem of space limitations; package containers are inherently volume consuming and refuse creating; and the useful observation that the optimum package is no package at all leads to the tentative conclusion that the least amount of packaging per unit of food, consistent with storage, aesthetics, preservation, cleanliness, cost and disposal criteria, is the most practical food package for the space station. A series of trade offs may have to be made to arrive at the most appropriate package design for a particular type of food taking all the criteria into account. Some of these trade offs are: single serve vs. bulk; conventional oven vs. microwave oven; nonmetallic aseptically vs. non-aseptically packaged foods; and comparison of aseptic vs. nonaseptic food packages. The advantages and disadvantages are discussed.

Chronic meningitis in systemic lupus erythematosus: An unusual etiology

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Anu Gupta

2014-01-01

Full Text Available Chronic aseptic meningitis is a rare manifestation of systemic lupus erythematosus (SLE. Apart from immunological causes and drugs, the aseptic meningitis group can include some unidentified viral infections that cannot be detected by routine microbiological testing. It is imperative to do complete cerebrospinal fluid (CSF workup before implicating the symptoms to disease activity or drugs, as untreated infections cause significant mortality in SLE. We present a case of young female with SLE who presented with chronic meningitis of an uncommon etiology.

[Bilateral pathological sub-trochanteric fracture in a long-term biphosphonate user].

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Kľoc, P; Tomčovčík, L; Kľoc, J

2011-01-01

The number of papers reporting the occurrence of specific pathological fractures in long-term biphosphonate users has recently increased. They refer to the forms of stress fracture probably resulting from an extreme decrease in bone turnover, which may involve sub-trochanteric or isolated transverse fractures, or short transverse fractures with a unicortical beak in an area of cortical hypertrophy. At the time of prodromal signs and symptoms, cortical bone at the site of impeding fracture appears rougher on radiographs. Gradually, an incomplete fracture develops, with a subsequent complete fracture often sustained without any mechanism of injury noted. The occurrence of such fractures is reported in the range of 2 to 8 years from the start of biphosphonate use. The fractures are often bilateral and, at the time the first occurs, it is often possible to diagnose contralateral pathological changes similar to those before the first fracture. The paper presents the case of a female patient who sustained a bilateral pathological sub-trochanteric fracture; the first fracture occurred after 5 and the other after 9 years of Rizendronat use. She was followed up for unilateral incomplete sub-trochanteric fracture from the fourth year of its use. In that period, magnetic resonance imaging showed a pathological finding in the contralateral extremity. She had already had prodromal signs manifested as lasting hip pain before the first fracture. Both fractures were surgically treated. Thirty-three months later she had to undergo repeat surgery for pseudoarthrosis at the site of the first fracture. The pseudoarthrosis healed without complications. However, in the second fracture non-union was still present at 7 months after surgery. The patient took Rizendronat during the whole treatment period and thereafter. In the discussion, certain aspects of long-term biphosphonate use are addressed, as well as some preventive, diagnostic and therapeutic procedures related to this rare

tumeur maligne des gaines nerveuses périphériques révélant une ...

African Journals Online (AJOL)

The histological exam revealed a malignant peripheral nerve sheath tumor. A larger resection was performed carrying away the sternal manubrium and adjacent tissues with a reconstruction by bits of ribs but within invaded surgical limits. Precocious recurence has observed 3 months later which was treated by surge-.

NJP Number 39 Vol 1, 2012.cdr

African Journals Online (AJOL)

Prof Ezechukwu

2007-08-04

Aug 4, 2007 ... xiphoid process (bifid sternum) with the heart ... diaphragm does not develop, and the paired ... through the resulting sternal and abdominal wall ... variants have been described by Toyoma et al. He ... (SCBU) of Aminu Kano Teaching Hospital Kano ... and include craniofacial and central nervous system.

Thoracic Ectopia Cordis in an Ethiopian Neonate

African Journals Online (AJOL)

GB

2017-03-01

Mar 1, 2017 ... Thoracic Ectopia Cordis in an Ethiopian Neonate. Henok Tadele*. 1 ... the chest wall. Initial treatment included covering the heart with sterile-saline soaked dressing, starting systemic antibiotics and supportive care. A staged ... of thoracoabdominal EC, anterior diaphragmatic hernia, lower sternal defect and ...

Wearable Oximetry for Harsh Environments

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characterize the types and significance of motion artifacts that will need to be mitigated. The forehead was confirmed to be an excellent site with...respect to signal quality, but signal corruption from changes in contact pressure will need to be mitigated. The sternal locations are initially assessed

JOS JOURNAL 2

African Journals Online (AJOL)

Page 1 ... associated structural congenital anomalies. The term Benign neonatal hemangiomatosis was first. [4] proposed by Sternal et al consisting of a syndrome of hundreds of hemangiomas occurring exclusively .... Stanley P, Geer GD, Miller JH, Gilanz V,. Landing BH, Boechat IM. Infantile hepatic hemangiomas: clinical ...

Pentalogy of cantrell: A report of three cases | Sowande | Journal of ...

African Journals Online (AJOL)

Pentalogy of Cantrell is a rare upper midline syndrome that may present in association with anomalies outside the torso. The pentad - the supraumbilical body wall defect, sternal defect, deficiency of the anterior diaphragm, defect of the diaphragmatic pericardium, and the intracardiac anomalies - was first described by ...

Congenital tricuspid valve disease and testicular agenesis: a case ...

African Journals Online (AJOL)

This is a report of a case of congenital tricuspid valve disease presenting with heart failure and pulmonary hypertension. Cardinal clinical features include breathlessness, easy fatigability since childhood, stunted growth, cyanosis, finger clubbing, a pansystolic murmur loudest at the left sternal edge in the fourth intercostal ...

Poststernotomy mediastinitis: a classification to initiate and evaluate reconstructive management based on evidence from a structured review.

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van Wingerden, Jan J; Ubbink, Dirk T; van der Horst, Chantal M A M; de Mol, Bas A J M

2014-11-23

Early recognition and, where possible, avoidance of risk factors that contribute to the development of poststernotomy mediastinitis (PSM) form the basis for successful prevention. Once the presence of PSM is diagnosed, the known risk factors have been shown to have limited influence on management decisions. Evidence-based knowledge on treatment decisions, which include the extent and type of surgical intervention (other than debridement), timing and others is available but has not yet been incorporated into a classification on management decisions regarding PSM. Ours is a first attempt at developing a classification system for management of PSM, taking the various evidence-based reconstructive options into consideration. The classification is simple to introduce (there are four Types) and relies on the careful establishment of two variables (sternal stability and sternal bone viability and stock) prior to deciding on the best available reconstructive option. It should allow better insight into why treatment decisions fail or have to be altered and will allow better comparison of treatment outcomes between various institutions.

Dose measurements in mammography

International Nuclear Information System (INIS)

Kainberger, F.; Kallinger, W.

1977-01-01

Dose measurements at the mamma during mammography were carried out in the form of direct measurement with thermoluminescent dosimetry. Measurement was done for the in- and outcoming doses at the mamma, the dose exposure of the sternal region and the scattered rays above the symphysis, the latter as parameter for the genetic radiation exposure. As expected, the dose of the smooth radiation used for mammography showed a strong decrease at the outcome point in comparison with the income point. Surprisingly high was the scattered radiation in the sternal region. A corresponding protection by lead plates could be taken into consideration. Extremely low is the scattered radiation above the symphysis. Even measurements with the very sensitive calcium fluoride dosimeters did not reveal any practically important dose in the symphysis region. Most measurement values remained below the determinable dose of 0.3mR. Some maximal values varied in the range of 3-1 mR. (orig.) [de

Our experience with two cardioplegic solutions: dextrose versus non-dextrose in adult cardiac surgery.

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Lessen, Ronald; DiCapua, John; Pekmezaris, Renee; Walia, Rajni; Bocchieri, Karl; Jahn, Lynda; Akerman, Meredith; Lesser, Martin L; Hartman, Alan

2012-09-01

Intraoperative hyperglycemia has been observed to be associated with increased morbidity and mortality after cardiac surgery. Dextrose cardioplegia is used for its cardioprotective effects but may lead to intraoperative hyperglycemia and more postoperative complications. This was a retrospective observational study. Patient records (n = 2301) were accessed from a large database at a tertiary care facility. The two groups (dextrose vs. nondextrose) were then matched using preoperative variables of age, sex, body mass index, wound exposure time, preoperative HbA1c levels, renal failure, hypertension, and prior cerebrovascular disease. The following outcomes were recorded: 30-day mortality, sternal wound infection, stroke, and highest glucose level on cardiopulmonary bypass. The dextrose cardioplegia group showed statistically higher intraoperative glucose levels (272.76 +/- 55.92 vs. 182.79 +/- 45, p value = .0001). There was no difference in postoperative mortality, sternal wound infections or stroke incidence, nor in other secondary outcomes. The type of cardioplegia solution was shown to affect glucose levels; however, there was no effect on postoperative complication rates.

Tuberculous osteomyelitis/arthritis of the first costo-clavicular joint and sternum.

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Patel, Prasan; Gray, Robin R

2014-12-28

A young Somali immigrant presents with a two-year history of a large, firm, painful right anterolateral chest wall sternal mass. The patient denied any history of trauma or infection at the site and did not have a fever, erythematous lesion at the site, clubbing, or lymphadenopathy. A lateral chest radiograph demonstrated a low density mass isolated to the subcutaneous soft tissue overlying the sternum, ribs and clavicle. Computed tomography (CT) with contrast demonstrated a cystic lesion in the right anterolateral chest wall deep to the pectoralis muscle. Enhanced CT of the chest demonstrated sclerosis and destruction of the rib and costochondral joint and manubrio-sternal joint narrowing. Ultrasound-guided biopsy and aspiration returned 500 cc of purulent, cloudy yellow, foul-smelling fluid. Acid-fact bacilli stain and the nucleic acid amplification test identified and confirmed Mycobacterium tuberculosis. A diagnosis of tuberculous osteomyelitis/septic arthritis was made and antibiotic coverage for tuberculosis was initiated.

Primary Osteosarcoma of the Sternum: A case Report and Review of the Literature

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Masoud Pezeshki Rad

2014-10-01

Full Text Available Osteosarcoma (osteogenic sarcoma: OS is the most common primary malignant bone tumor of long bones, whereas primary osteosarcoma of chest wall, especially in sternum, is extremely rare. We report a 57-year-old man with an immobile slow growing mass located in the middle of the sternum. The patient had no significant pain or tenderness and the past medical history was not remarkable. CT-scan showed a large densely sclerotic sternal mass and MRI revealed an extensive central signal loss within the tumor because of necrosis. We performed a CT-guided needle biopsy, but it was inconclusive. After an incisional biopsy, a high-grade osteosarcoma of the sternum was diagnosed. The patient underwent subtotal sternal resection and reconstruction using synthetic mesh and bone cement followed by chemotherapy and external beam radiotherapy. After one year of follow-up, the patient is back to normal life and is doing the daily activities without problem. By this time, focal recurrence or metastatic disease did not occur.

MRI of aseptic osteonecrosis in children with acute lymphoblastic leukemia; Kernspintomographie von aseptischen Osteonekrosen bei Kindern und Jugendlichen mit einer akuten lymphoblastischen Leukaemie

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Engelbrecht, V.; Scherer, A.; Moedder, U. [Duesseldorf Univ. (Germany). Inst. fuer Diagnostische Radiologie; Bruder, M. [Duesseldorf Univ. (Germany). Kinderklinik; Koerholz, D. [Leipzig Univ. (Germany). Kinderonkologie

2000-04-01

Purpose: To evaluate the incidence, localisation, and course of symptomatic aseptic osteonecrosis (AON) in children undergoing treatment for acute lymphoblastic leukemia (ALL). Methods: 72 MRI examinations obtained from 26 children with bone pain selected from a group of 121 children with ALL were evaluated retrospectively. The area of the AON was determined by computer assisted planimetry. Follow-up examinations after 2-5 years were considered. Results: 10/121 (8.3%) of the children had symptomatic AON, the number of lesions varied between 1 and 24 per child. 62/66 lesions were localized within the lower extremities. 58% of the AON were positioned in the epiphysis and 42% in the meta- and diaphysis. The mean area of AON was 7.6 cm{sup 2} with a range of 0.5 to 50 cm{sup 2}. Follow-up examinations revealed a regression in 19 AON, no change in 43 and a progression in 4 lesions. AON within the epiphysis with joint involvement or lesions greater than 9 cm{sup 2} more frequently showed a progression of AON with final joint destruction. An elevated risk for AON was seen in children older than 10 years and in children with intensified chemotherapy due to high-risk ALL. Conclusion: AON is a common complication in ALL-children under chemotherapy. Most frequently, the course is benign but large AON with joint involvement have an elevated risk for progression of AON with final joint destruction. (orig.) [German] Ziel: Erfassung von Haeufigkeit, Lokalisation und Verlauf von symptomatischen aseptischen Osteonekrosen (AON) bei Kindern und Jugendlichen unter der Therapie einer akuten lymphoblastischen Leukaemie (ALL). Methoden: In einer Gruppe von 121 Kindern mit ALL (Alter 1-17 Jahre) wurden retrospektiv 72 MRT der Extremitaeten bei 26 Kindern mit Knochenschmerzen bezueglich der Zahl, Groesse und Lokalisation von AON ausgewertet. Die Flaeche von AON wurde planimetrisch bestimmt. Verlaufskontrollen erstreckten sich ueber 2-5 Jahre. Ergebnisse: 10/121 (8,3%) der Kinder wiesen

Chemical composition of scent-gland secretions in an old world monkey (Mandrillus sphinx): influence of sex, male status, and individual identity.

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Setchell, Joanna M; Vaglio, Stefano; Moggi-Cecchi, Jacopo; Boscaro, Francesca; Calamai, Luca; Knapp, Leslie A

2010-03-01

Primates are traditionally considered to be microsmatic, with decreased reliance on olfactory senses in comparison to other sensory modalities such as vision. This is particularly the case for Old World monkeys and apes (catarrhines). However, various lines of evidence suggest that chemical communication may be important in these species, including the presence of a sternal scent-gland in the mandrill. We investigated the volatile components of mandrill odor using gas chromatography-mass spectrometry. We identified a total of 97 volatile components in 88 swabs of the sternal gland secretion and 95 samples of sternal gland hair saturated with scent-gland secretion collected from 27 males and 18 females. We compared odor profiles with features of the signaler using principle components and discriminant function analyses and found that volatile profiles convey both variable (age, dominance rank in males) and fixed (sex, possibly individual identity) information about the signaler. The combination of an odor profile that signals sex, age, and rank with increased motivation to scent-mark and increased production of secretion in high-ranking males leads to a potent signal of the presence of a dominant, adult male with high testosterone levels. This may be particularly relevant in the dense Central African rain forest which mandrills inhabit. By contrast, we were unable to differentiate between either female cycle stage or female rank based on odor profiles, which accords with behavioral studies suggesting that odor signals are not as important in female mandrills as they are in males. The similarity of our findings to those for other mammals and in primates that are more distantly related to humans suggests a broader role for odor in primate communication than is currently recognized.

Double vs single internal thoracic artery harvesting in diabetic patients: role in perioperative infection rate

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Parolari Alessandro

2008-06-01

Full Text Available Abstract Background The aim of this prospective study is to evaluate the role in the onset of surgical site infections of bilateral internal thoracic arteries harvesting in patients with decompensated preoperative glycemia. Methods 81 consecutive patients with uncontrolled diabetes mellitus underwent elective CABG harvesting single or double internal thoracic arteries. Single left ITA was harvested in 41 patients (Group 1, 50.6%, BITAs were harvested in 40 (Group 2, 49.4%. The major clinical end points analyzed in this study were infection rate, type of infection, duration of infection, infection relapse rate and total hospital length of stay. Results Five patients developed sternal SSI in the perioperative period, 2 in group 1 and 3 in group 2 without significant difference. All sternal SSIs were superficial with no sternal dehiscence. The development of infection from the time of surgery took 18.5 ± 2.1 and 7.3 ± 3.0 days for Groups 1 and 2 respectively. The infections were treated with wound irrigation and debridement, and with VAC therapy as well as with antibiotics. The VAC system was removed after a mean of 12.8 ± 5.1 days, when sterilization was achieved. The overall survival estimate at 1 year was 98.7%. Only BMI was a significant predictor of SSI using multivariate stepwise logistic regression analysis (Odds Ratio: 1.34; 95%Conficdence Interval: 1.02–1.83; p value: 0.04. In the model, the use of BITA was not an independent predictor of SSI. Conclusion CABG with bilateral pedicled ITAs grafting could be performed safely even in diabetics with poor preoperative glycaemic control.

Meningitis aséptica concurrente con infección del tracto urinario en recién nacidos Aseptic meningitis concomitant with urinary tract infection in newborns

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Manuel Díaz Álvarez

2011-06-01

Full Text Available INTRODUCCIÓN. Trabajos publicados recientemente han destacado el hallazgo de meningitis aséptica (MA en lactantes pequeños, concomitante con infección del tracto urinario (ITU. El objetivo de esta investigación fue determinar la frecuencia de tal presentación. MÉTODOS. Se realizó un estudio descriptivo, retrospectivo que incluyó a 626 recién nacidos con ITU, ingresados en el Hospital Pediátrico Universitario «Juan Manuel Márquez» entre febrero de 1992 y diciembre de 2008, y a quienes se les realizó una punción lumbar. Se comparó la frecuencia de MA e ITU con los informes documentados en la literatura médica. RESULTADOS. La frecuencia de MA concomitante con ITU fue del 7,0 % (IC 95 %: 4,9-9,1 %. Los resultados promedio del examen citoquímico del líquido cefalorraquídeo mostraron que la pleocitosis fue el indicador más notable entre los que comúnmente se miden. La frecuencia encontrada fue similar a la de los informes internacionales. CONCLUSIONES. Es llamativa la incidencia de MA concomitante con ITU en los recién nacidos y en concordancia con lo reportado internacionalmente. La concomitancia de MA e ITU puede ser multifactorial, y es posible que se presenten factores causales en algunos pacientes, o casuales en otros casos.INTRODUCTION. Papers recently published have emphasized the finding of the aseptic meningitis (AM in small infants, concomitant with a urinary tract infection (UTI. The aim of present research was to determine the frequency of this type of presentation. METHODS. A retrospective and descriptive study was conducted including 626 newborns presenting with UTI, admitted in the "Juan Manuel Márquez" University Children Hospital between February, 1992 and December, 2008 who underwent a lumbar puncture. The AM and UTI frequency was compared with informed reports in medical literature. RESULTS. The frequency of AM concomitant with UTI was of 7.0% (95% CI. 4,9-9,1%. The mean results of cytochemical examination

A financial analysis of revision hip arthroplasty: the economic burden in relation to the national tariff.

Science.gov (United States)

Vanhegan, I S; Malik, A K; Jayakumar, P; Ul Islam, S; Haddad, F S

2012-05-01

Revision arthroplasty of the hip is expensive owing to the increased cost of pre-operative investigations, surgical implants and instrumentation, protracted hospital stay and drugs. We compared the costs of performing this surgery for aseptic loosening, dislocation, deep infection and peri-prosthetic fracture. Clinical, demographic and economic data were obtained for 305 consecutive revision total hip replacements in 286 patients performed at a tertiary referral centre between 1999 and 2008. The mean total costs for revision surgery in aseptic cases (n = 194) were £11 897 (sd 4629), for septic revision (n = 76) £21 937 (sd 10 965), for peri-prosthetic fracture (n = 24) £18 185 (sd 9124), and for dislocation (n = 11) £10 893 (sd 5476). Surgery for deep infection and peri-prosthetic fracture was associated with longer operating times, increased blood loss and an increase in complications compared to revisions for aseptic loosening. Total inpatient stay was also significantly longer on average (p < 0.001). Financial costs vary significantly by indication, which is not reflected in current National Health Service tariffs.

Clinical characteristics and outcomes of the meningitides in systemic lupus erythematosus.

Science.gov (United States)

Baizabal-Carvallo, José Fidel; Delgadillo-Márquez, German; Estañol, Bruno; García-Ramos, Guillermo

2009-01-01

The meningitides are rare but well-identified complications in patients with systemic lupus erythematosus (SLE). To determine the clinical characteristics, risk factors, prevalence and outcomes of the meningitides (septic and aseptic) in patients with SLE. From January 1988 to December 2006, we identified patients with SLE and septic or aseptic meningitis. We identified 25 episodes of meningitis in 23 patients with SLE, from a total of 1,411 SLE patients (1.63%); in 15 out of 25 episodes, a microorganism was identified. Mycobacterium tuberculosis, Listeria monocytogenes and Criptococcus neoformans represented the main microorganisms. In 10 episodes, aseptic meningitis was diagnosed. Lymphopenia, steroid use, chronic damage and systemic activity of SLE were frequent in both kinds of meningitis. Although the clinical presentation did not differ significantly, patients with septic meningitis had more residual neurological deficits (p = 0.04). Meningitis was observed in about 1.6% of the patients with SLE; in 40% of the cases, no microorganism could be isolated. A residual neurological deficit was more common in patients with septic meningitis. Copyright (c) 2008 S. Karger AG, Basel.

Can patients determine the level of their dysphagia?

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Ashraf, Hafiz Hamad; Palmer, Joanne; Dalton, Harry Richard; Waters, Carolyn; Luff, Thomas; Strugnell, Madeline; Murray, Iain Alexander

2017-01-01

AIM To determine if patients can localise dysphagia level determined endoscopically or radiologically and association of gender, age, level and pathology. METHODS Retrospective review of consecutive patients presenting to dysphagia hotline between March 2004 and March 2015 was carried out. Demographics, clinical history and investigation findings were recorded including patient perception of obstruction level (pharyngeal, mid sternal or low sternal) was documented and the actual level of obstruction found on endoscopic or radiological examination (if any) was noted. All patients with evidence of obstruction including oesophageal carcinoma, peptic stricture, Schatzki ring, oesophageal pouch and cricopharyngeal hypertrophy were included in the study who had given a perceived level of dysphagia. The upper GI endoscopy reports (barium study where upper GI endoscopy was not performed) were reviewed to confirm the distance of obstructing lesion from central incisors. A previously described anatomical classification of oesophagus was used to define the level of obstruction to be upper, middle or lower oesophagus and this was compared with patient perceived level. RESULTS Three thousand six hundred and sixty-eight patients were included, 42.0% of who were female, mean age 70.7 ± 12.8 years old. Of those with obstructing lesions, 726 gave a perceived level of dysphagia: 37.2% had oesophageal cancer, 36.0% peptic stricture, 13.1% pharyngeal pouches, 10.3% Schatzki rings and 3.3% achalasia. Twenty-seven point five percent of patients reported pharyngeal level (upper) dysphagia, 36.9% mid sternal dysphagia and 25.9% lower sternal dysphagia (9.5% reported multiple levels). The level of obstructing lesion seen on diagnostic testing was upper (17.2%), mid (19.4%) or lower (62.9%) or combined (0.3%). When patients localised their level of dysphagia to a single level, the kappa statistic was 0.245 (P dysphagia were accurate in localising the obstructing pathology. With respect to

adenome parathyroidien intrathymique

African Journals Online (AJOL)

Observation : The authors present the case of a 19-year-old man with the diagnosis of primary hyperparathyroidism. The. Sestamibi scintigraphy showed an abnormal hyperfixation in the sus sternal hollow. The diagnosis of an intrathymic para- thyroïd adenoma was evoked. An adenectomy was performed using a cervical ...

Outcome in design-specific comparisons between highly crosslinked and conventional polyethylene in total hip arthroplasty

DEFF Research Database (Denmark)

Johanson, Per-Erik; Furnes, Ove; Ivar Havelin, Leif

2017-01-01

assessed risk of revision for any reason and for aseptic loosening using Cox regression adjusted for age, sex, femoral head material and size, surgical approach, stem fixation, and presence of hydroxyapatite coating (uncemented cups). Results - The CPE version of the ZCA cup had a risk of revision for any...... for any reason and revision due to aseptic loosening and/or osteolysis. Patients and methods - Using the Nordic Arthroplasty Register Association (NARA) database, we identified cup and liner designs where either XLPE or CPE had been used in more than 500 THAs performed for primary hip osteoarthritis. We...

MR imaging of sickle cell patients: Comparison during pain-free and crisis states

International Nuclear Information System (INIS)

Brogdon, B.G.; Williams, J.P.; Mankad, V.N.; Harpen, M.D.; Moore, R.B.

1986-01-01

The MR imaging appearance of long bones and femoral heads of patients with sickle cell disease during a pain-free steady state and during a crisis-pain state was compared with the MR imaging appearance of matched healthy control subjects. A distinctive signal change in the narrow spaces of the long bones of patients with sickle cell disease was seen at all times. Distinct signal changes during pain crises were found in the marrow of a significant number of patients. Changes associated with aseptic necrosis, when present, did not differ from changes seen in aseptic necrosis of other causes

Evaluation of the Thorax of Manduca sexta for Flapping Wing Micro Air Vehicle Applications

Science.gov (United States)

2012-03-01

consisting of the sternal and pleural plates, was modeled as a braced structure because it is much stiffer than the tergal plate and does not bend...more than 45 minutes. This is long enough to kill the specimen without crystallizing most of the liquid in the muscles. This method was only used for

Feather retention force in broilers ante-, peri-, and post-mortem as influenced by electrical and carbon dioxide stunning.

Science.gov (United States)

Buhr, R J; Cason, J A; Rowland, G N

1997-11-01

Stunning and slaughter trials were conducted to evaluate the influence of stunning method (electrical 50 V alternating current, CO2 gas: 0 to 40% for 90 s or 40 to 60% for 30 s) on feather retention force (FRF) in commercial broilers. Feathers from the pectoral, sternal, and femoral feather tracts were sampled with a force gauge before stunning (ante-mortem) and contralaterally either after stunning (peri-mortem from 0.5 to 4 min) or after stunning and bleeding (post-mortem from 2 to 6 min). Prior to stunning, ante-mortem FRF values varied among assigned stunning methods only for the pectoral (7%) feather tract. After stunning, peri-mortem FRF values were higher only for the sternal tract (11% for 40 to 60% CO2 for 30 s); whereas after stunning and bleeding, post-mortem FRF values were lower than ante- or peri-mortem only for the sternal tract (10% lower for 40 to 60% CO2 for 30 s). Peri- and post-mortem FRF values did not differ among stunning methods for the pectoral and femoral feather tracts. Small changes in FRF values occurred from ante-mortem to peri-mortem (-1 to +12%), and from ante-mortem to post-mortem (-2 to +8%) across stunning methods. A significant increase was determined for only the pectoral tract (7%) from ante- to peri-mortem across stunning methods. Electrically stunned broilers that were not bled gained weight in excess of the 36 feathers removed (0.16%), apparently due to body surface water pickup during the brine-stunning process, whereas CO2-stunned broilers lost weight due to excretion of cloacal contents (-0.31 to -0.98%). The change in body weight among stunning methods was significant (P defeathering efficiency may not differ after scalding.

Are two really always better than one? Results, concerns and controversies in the use of bilateral internal thoracic arteries for coronary artery bypass grafting in the elderly: a systematic review and meta-analysis.

Science.gov (United States)

Deo, Salil V; Altarabsheh, Salah E; Shah, Ishan K; Cho, Yang Hyun; McGraw, Michael; Sarayyepoglu, Basar; Medalion, Benjamin; Markowitz, Alan H; Park, Soon J

2015-04-01

Bilateral internal thoracic artery grafting appears to be the preferred method to achieve durable long-term coronary artery revascularization. However, data reporting the benefit of this technique in the elderly is very conflicting. We performed a systematic review of available literature (till November 2014) using multiple databases to identify studies comparing clinical events in patients undergoing coronary artery bypass grafting using either a single or double internal thoracic artery in the elderly. While early mortality was the primary end-point of inclusion, other adverse events compared were sternal wound infection (deep and superficial), stroke and peri-operative myocardial infarction. Individual and pooled odd's ratios were calculated using the Mantel-Haenzel method (random effect model); sensitivity analysis was performed. Results are presented using 95% confidence intervals. Nine retrospective studies (4479 BITA, 7733 LITA patients) fulfilled search criteria. Deep sternal wound infection was significantly higher after BITA harvest [OR 1.86 (1.3-2.5); I(2) = 0%; p < 0.01]. Early mortality (BITA 3.6% vs SITA 3.1%; p = 0.86), stroke [OR 0.7(0.4-1.1); p = 0.1], and peri-operative myocardial infarction (BITA 4.3% vs SITA 2.3%; p = 0.1) were comparable in both cohorts. Long-term survival favored the BITA cohort in two propensity matched studies. The incidence of deep sternal wound infection may be significantly higher after the harvest of both internal thoracic arteries in the elderly. While other post-operative adverse events are comparable, data regarding the long-term survival advantage in this cohort is conflicting. Hence, the use of both internal thoracic arteries in this age group needs to be invidualized. Copyright © 2015 IJS Publishing Group Limited. Published by Elsevier Ltd. All rights reserved.

Effect of pre-operative octenidine nasal ointment and showering on surgical site infections in patients undergoing cardiac surgery.

Science.gov (United States)

Reiser, M; Scherag, A; Forstner, C; Brunkhorst, F M; Harbarth, S; Doenst, T; Pletz, M W; Hagel, S

2017-02-01

To evaluate the effect of pre-operative octenidine (OCT) decolonization on surgical site infection (SSI) rates. Before-and-after cohort study. Patients undergoing an elective isolated coronary artery bypass graft (CABG) procedure: control group (1 st January to 31 st December 2013), N=475; intervention group (1 st January to 31 st December 2014), N=428. The intervention consisted of nasal application of OCT ointment three times daily, beginning on the day before surgery, and showering the night before and on the day of surgery with OCT soap. A median sternotomy was performed in 805 (89.1%) patients and a minimally invasive direct coronary artery bypass procedure was performed in 98 (10.9%) patients. Overall, there was no difference in SSI rates between the control and intervention groups (15.4% vs 13.3%, P=0.39). The rate of harvest site SSIs was significantly lower in patients in the intervention group (2.5% vs 0.5%, P=0.01). Patients who had undergone a median sternotomy in the intervention group had a significantly lower rate of organ/space sternal SSIs (1.9% vs 0.3%, P=0.04). However, there was a trend towards an increased rate of deep incisional sternal SSIs (1.2% vs 2.9%, P=0.08). Multi-variate analysis did not identify a significant protective effect of the intervention (odds ratio 0.79, 95% confidence interval 0.53-1.15, P=0.27). Pre-operative decolonization with OCT did not reduce overall SSI rates in patients undergoing an elective isolated CABG procedure, but significantly decreased harvest site and organ/space sternal SSIs. Randomized controlled trials, including controlled patient adherence to the intervention, are required to confirm these observations and to determine the clinical utility of OCT in pre-operative decolonization. Copyright © 2016 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

Mediastinitis after coronary artery bypass grafting: the effect of vacuum-assisted closure versus traditional closed drainage on survival and re-infection rate.

Science.gov (United States)

Risnes, Ivar; Abdelnoor, Michael; Veel, Terje; Svennevig, Jan Ludvig; Lundblad, Runar; Rynning, Stein Erik

2014-04-01

Mediastinitis is treated with either vacuum-assisted closure (VAC) or traditional closed drainage (TCD) with irrigation. The aim of the study was to determine the effect of the two treatments on mortality and re-infection rate in a source population, using 21 314 consecutive patients undergoing isolated coronary artery bypass grafting (CABG) from January 1997 to October 2010. Median observation time was 2·9 years in the VAC group and 8·0 years in the TCD group. The epidemiological design was of an exposed (VAC, n = 64) versus non-exposed (TCD, n = 66) cohort with two endpoints: (1) mortality and (2) failure of sternal wound healing or re-infection. The crude effect of treatment technique versus endpoint was estimated by univariate analysis. Stratification analysis by the Mantel-Haenszel method was performed to quantify confounders and to pinpoint effect modifiers. Adjustment for confounders was performed using Cox regression analysis. Mediastinitis was diagnosed 6-105 (median 14) days after primary operation in the VAC group and 13 (5-29) days in the TCD group. There was no difference between groups in long-term survival. Failure of sternal wound healing or re-infection occurred less frequently in the VAC group (6%) than in the TCD group (21%; relative risk = 0·29, 95% CI = 0·06-0·88, P = 0·01). There are concerns for increase in right ventricle rupture in VAC compared with TCD. There was no difference in survival after VAC therapy and TCD therapy of post-CABG mediastinitis. Failure of sternal wound healing or re-infection was more common after TCD therapy. © 2012 The Authors. International Wound Journal © 2012 Medicalhelplines.com Inc and John Wiley & Sons Ltd.

Electromyographic permutation entropy quantifies diaphragmatic denervation and reinnervation.

Directory of Open Access Journals (Sweden)

Christopher Kramer

Full Text Available Spontaneous reinnervation after diaphragmatic paralysis due to trauma, surgery, tumors and spinal cord injuries is frequently observed. A possible explanation could be collateral reinnervation, since the diaphragm is commonly double-innervated by the (accessory phrenic nerve. Permutation entropy (PeEn, a complexity measure for time series, may reflect a functional state of neuromuscular transmission by quantifying the complexity of interactions across neural and muscular networks. In an established rat model, electromyographic signals of the diaphragm after phrenicotomy were analyzed using PeEn quantifying denervation and reinnervation. Thirty-three anesthetized rats were unilaterally phrenicotomized. After 1, 3, 9, 27 and 81 days, diaphragmatic electromyographic PeEn was analyzed in vivo from sternal, mid-costal and crural areas of both hemidiaphragms. After euthanasia of the animals, both hemidiaphragms were dissected for fiber type evaluation. The electromyographic incidence of an accessory phrenic nerve was 76%. At day 1 after phrenicotomy, PeEn (normalized values was significantly diminished in the sternal (median: 0.69; interquartile range: 0.66-0.75 and mid-costal area (0.68; 0.66-0.72 compared to the non-denervated side (0.84; 0.78-0.90 at threshold p<0.05. In the crural area, innervated by the accessory phrenic nerve, PeEn remained unchanged (0.79; 0.72-0.86. During reinnervation over 81 days, PeEn normalized in the mid-costal area (0.84; 0.77-0.86, whereas it remained reduced in the sternal area (0.77; 0.70-0.81. Fiber type grouping, a histological sign for reinnervation, was found in the mid-costal area in 20% after 27 days and in 80% after 81 days. Collateral reinnervation can restore diaphragm activity after phrenicotomy. Electromyographic PeEn represents a new, distinctive assessment characterizing intramuscular function following denervation and reinnervation.

Pheromones and exocrine glands in Isoptera.

Science.gov (United States)

Costa-Leonardo, Ana Maria; Haifig, Ives

2010-01-01

Termites are eusocial insects that have a peculiar and intriguing system of communication using pheromones. The termite pheromones are composed of a blend of chemical substances and they coordinate different social interactions or activities, including foraging, building, mating, defense, and nestmate recognition. Some of these sociochemicals are volatile, spreading in the air, and others are contact pheromones, which are transmitted by trophallaxis and grooming. Among the termite semiochemicals, the most known are alarm, trail, sex pheromones, and hydrocarbons responsible for the recognition of nestmates. The sources of the pheromones are exocrine glands located all over the termite body. The principal exocrine structures considered pheromone-producing glands in Isoptera are the frontal, mandibular, salivary or labial, sternal, and tergal glands. The frontal gland is the source of alarm pheromone and defensive chemicals, but the mandibular secretions have been little studied and their function is not well established in Isoptera. The secretion of salivary glands involves numerous chemical compounds, some of them without pheromonal function. The worker saliva contains a phagostimulating pheromone and probably a building pheromone, while the salivary reservoir of some soldiers contains defensive chemicals. The sternal gland is the only source of trail-following pheromone, whereas sex pheromones are secreted by two glandular sources, the sternal and tergal glands. To date, the termite semiochemicals have indicated that few molecules are involved in their chemical communication, that is, the same compound may be secreted by different glands, different castes and species, and for different functions, depending on the concentration. In addition to the pheromonal parsimony, recent studies also indicate the occurrence of a synergic effect among the compounds involved in the chemical communication of Isoptera. Copyright © 2010 Elsevier Inc. All rights reserved.

Diurnal rhythm and concordance between objective and subjective hot flashes: the Hilo Women's Health Study.

Science.gov (United States)

Sievert, Lynnette L; Reza, Angela; Mills, Phoebe; Morrison, Lynn; Rahberg, Nichole; Goodloe, Amber; Sutherland, Michael; Brown, Daniel E

2010-01-01

The aims of this study were to test for a diurnal pattern in hot flashes in a multiethnic population living in a hot, humid environment and to examine the rates of concordance between objective and subjective measures of hot flashes using ambulatory and laboratory measures. Study participants aged 45 to 55 years were recruited from the general population of Hilo, HI. Women wore a Biolog hot flash monitor (UFI, Morro Bay, CA), kept a diary for 24 hours, and also participated in 3-hour laboratory measures (n = 199). Diurnal patterns were assessed using polynomial regression. For each woman, objectively recorded hot flashes that matched subjective experience were treated as true-positive readings. Subjective hot flashes were considered the standard for computing false-positive and false-negative readings. True-positive, false-positive, and false-negative readings were compared across ethnic groups by chi analyses. Frequencies of sternal, nuchal, and subjective hot flashes peaked at 1500 +/- 1 hours with no difference by ethnicity. Laboratory results supported the pattern seen in ambulatory monitoring. Sternal and nuchal monitoring showed the same frequency of true-positive measures, but nonsternal electrodes picked up more false-positive readings. Laboratory monitoring showed very low frequencies of false negatives. There were no ethnic differences in the frequency of true-positive or false-positive measures. Women of European descent were more likely to report hot flashes that were not objectively demonstrated (false-negative measures). The diurnal pattern and peak in hot flash occurrence in the hot humid environment of Hilo were similar to results from more temperate environments. Lack of variation in sternal versus nonsternal measures and in true-positive measures across ethnicities suggests no appreciable effect of population variation in sweating patterns.

Pulmonary gas exchange and acid–base status during immobilisation of black rhinoceroses (Diceros bicornis in Zimbabwe

Directory of Open Access Journals (Sweden)

Åsa Fahlman

2016-12-01

Full Text Available When immobilising wildlife, adverse side effects can include hypoxaemia, acidosis and hypertension. Pulmonary gas exchange and acid–base status were evaluated during immobilisation of 25 free-ranging and one boma-held black rhinoceros (Diceros bicornis in Zimbabwe. The effect of different body positions on arterial oxygenation was evaluated. A combination of the following drugs was used: an opioid (etorphine or thiafentanil, azaperone and an a2 -adrenoceptor agonist (detomidine or xylazine. Respiratory and heart rates, rectal temperature and pulse oximetry–derived haemoglobin oxygen saturation were recorded. Serial arterial blood samples were analysed immediately in the field. Marked hypoxaemia and hypercapnia were recorded in immobilised free-ranging black rhinoceroses. Arterial oxygenation was higher during sternal compared to lateral recumbency. Most rhinoceroses developed acidaemia of respiratory and metabolic origin. Initially high lactate concentrations in free-ranging rhinoceroses decreased during immobilisation. Pulse oximetry was unreliable in the detection of hypoxaemia. Positioning in sternal recumbency and routine use of oxygen supplementation are recommended in the management of immobilised rhinoceroses as measures to improve arterial oxygenation.

Biopretreatment of palm oil mill effluent by thermotolerant polymer-producing fungi

Directory of Open Access Journals (Sweden)

Masao Ukita

2001-11-01

Full Text Available Palm oil industry is one of the three major agro-industries in Southern Thailand and generates large quantities of effluent with high organic matter (BOD and COD values of 58,000 and 110,000 mg/l, respectively, total solids and suspended solids (70,000 and 40,000 mg/l, respectively, oil & grease (25,600 mg/l, and has a low pH (4.5. Conventional anaerobic ponding system is normally employed in palm oil mills to treat the effluent. To increase its efficiency, biopretreatment to remove the organic matter and oil & grease by thermotolerant polymer-producing fungi was investigated. The palm oil mill effluent (POME was treated by the two thermotolerant polymer-producing fungi, Rhizopus sp. ST4 and Rhizopus sp. ST29, at 45ºC under aseptic and septic conditions. Rhizopus sp. ST4 gave the same oil & grease removal (84.2% under both conditions but COD removal under septic condition (62.2% was 8.8% higher than that under aseptic condition (53.4%. On the contrary, Rhizopus sp. ST 29 under aseptic condition showed 11% and 25.4% higher oil & grease removal (91.4% and COD removal (66.0% than those under septic condition. Comparison between the two isolates under aseptic condition revealed that Rhizopus sp. ST29 exhibited higher oil & grease removal (91.4% as well as COD removal (66.0% than those of Rhizopus sp. ST4 (84.2% and 53.4%, respectively. Under septic condition, Rhizopus sp. ST4 gave higher oil & grease removal (84.2% and COD removal (62.2% than did Rhizopus sp. ST 29 (80.5 and 40.6%, respectively.

Radionuclide imaging of the painful joint replacement: past, present and future

Energy Technology Data Exchange (ETDEWEB)

Palestro, Christopher J. [Long Island Jewish Medical Center, New Hyde Park, NY (United States)]. E-mail: palestro@lij.edu

2002-09-01

Differentiating aseptic loosening from infection as the cause of prosthetic joint failure is difficult because both entities are similar, clinically and histopathologically. Aseptic loosening frequently result from an immune reaction to the prosthesis. There is inflammation with an influx of histiocytes, giant cells, lymphocytes and plasma cells. Pro inflammatory cytokines and proteolytic enzymes are secreted, causing osteolysis and loosening. These same events occur in infection except that neutrophils, rarely present in aseptic loosening, area invariably present in infection. Clinical signs and symptoms, laboratory tests, X-rays and joint aspiration are insensitive, nonspecific or both. Artifacts produced by the metallic hardware hamper cross-sectional imaging modalities. Radionuclide imaging is not affected by the presence of metallic hardware and is very useful for evaluating the painful prosthesis. Bone scintigraphy, with and accuracy of 50%-70% is a useful screening test, since a normal study effectively excludes a prosthetic complication. Adding gallium-67, a nonspecific inflammation-imaging agent, improves the accuracy of bone scintigraphy to 70%-80%. The accuracy of combined leukocyte/marrow imaging, 90%, is the highest among available radionuclide studies. Its success is due to the fact that leukocytes imaging is most sensitive for detecting neutrophil mediated inflammations. Inflammatory conditions that are neutrophil-poor, even though large numbers of other leukocytes may be present, (such as the aseptically loosened joint prosthesis) go undetected. The success of leukocyte/marrow imaging is tempered by the limitations of in vitro labeling. In vivo labeling has been investigated and a murine monoclonal anti-granulocyte antibody appears promising. Some investigations have focused on F-18 FDG imaging, although specificity is a concern with this agent. (author)

Human prosthetic joint infections are associated with myeloid-derived suppressor cells (MDSCs): Implications for infection persistence.

Science.gov (United States)

Heim, Cortney E; Vidlak, Debbie; Odvody, Jessica; Hartman, Curtis W; Garvin, Kevin L; Kielian, Tammy

2017-11-15

Prosthetic joint infection (PJI) is a devastating complication of joint arthroplasty surgery typified by biofilm formation. Currently, mechanisms whereby biofilms persist and evade immune-mediated clearance in immune competent patients remain largely ill-defined. Therefore, the current study characterized leukocyte infiltrates and inflammatory mediator expression in tissues from patients with PJI compared to aseptic loosening. CD33 + HLA-DR - CD66b + CD14 -/low granulocytic myeloid-derived suppressor cells (G-MDSCs) were the predominant leukocyte population at sites of human PJI compared to aseptic tissues. MDSCs inhibit T cell proliferation, which coincided with reduced T cells in PJIs compared to aseptic tissues. IL-10, IL-6, and CXCL1 were significantly elevated in PJI tissues and have been implicated in MDSC inhibitory activity, expansion, and recruitment, respectively, which may account for their preferential increase in PJIs. This bias towards G-MDSC accumulation during human PJI could account for the chronicity of these infections by preventing the pro-inflammatory, antimicrobial actions of immune effector cells. Animal models of PJI have revealed a critical role for MDSCs and IL-10 in promoting infection persistence; however, whether this population is prevalent during human PJI and across distinct bacterial pathogens remains unknown. This study has identified that granulocytic-MDSC infiltrates are unique to human PJIs caused by distinct bacteria, which are not associated with aseptic loosening of prosthetic joints. Better defining the immune status of human PJIs could lead to novel immune-mediated approaches to facilitate PJI clearance in combination with conventional antibiotics. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

Radionuclide imaging of the painful joint replacement: past, present and future

International Nuclear Information System (INIS)

Palestro, Christopher J.

2002-01-01

Differentiating aseptic loosening from infection as the cause of prosthetic joint failure is difficult because both entities are similar, clinically and histopathologically. Aseptic loosening frequently result from an immune reaction to the prosthesis. There is inflammation with an influx of histiocytes, giant cells, lymphocytes and plasma cells. Pro inflammatory cytokines and proteolytic enzymes are secreted, causing osteolysis and loosening. These same events occur in infection except that neutrophils, rarely present in aseptic loosening, area invariably present in infection. Clinical signs and symptoms, laboratory tests, X-rays and joint aspiration are insensitive, nonspecific or both. Artifacts produced by the metallic hardware hamper cross-sectional imaging modalities. Radionuclide imaging is not affected by the presence of metallic hardware and is very useful for evaluating the painful prosthesis. Bone scintigraphy, with and accuracy of 50%-70% is a useful screening test, since a normal study effectively excludes a prosthetic complication. Adding gallium-67, a nonspecific inflammation-imaging agent, improves the accuracy of bone scintigraphy to 70%-80%. The accuracy of combined leukocyte/marrow imaging, 90%, is the highest among available radionuclide studies. Its success is due to the fact that leukocytes imaging is most sensitive for detecting neutrophil mediated inflammations. Inflammatory conditions that are neutrophil-poor, even though large numbers of other leukocytes may be present, (such as the aseptically loosened joint prosthesis) go undetected. The success of leukocyte/marrow imaging is tempered by the limitations of in vitro labeling. In vivo labeling has been investigated and a murine monoclonal anti-granulocyte antibody appears promising. Some investigations have focused on F-18 FDG imaging, although specificity is a concern with this agent. (author)

Food packaging materials and radiation processing of food: a brief review

International Nuclear Information System (INIS)

Chuaqui-Offermanns, N.

1989-01-01

Food is usually packaged to prevent microbial contamination and spoilage. Ionizing radiation can be applied to food-packaging materials in two ways: (i) sterilization of packaging materials for aseptic packaging, and (ii) radiation processing of prepackaged food. In aseptic packaging, a sterile package is filled with a sterile product in a microbiologically controlled environment. In irradiation of prepackaged food, the food and the packaging material are irradiated simultaneously. For both applications, the radiation stability of the packaging material is a key consideration if the technology is to be used successfully. To demonstrate the radiation stability of the packaging material, it must be shown that irradiation does not significantly alter the physical and chemical properties of the material. The irradiated material must protect the food from environmental contamination while maintaining its organoleptic and toxicological properties. Single-layer plastics cannot meet the requirements of either application. Multilayered structures produced by coextrusion would likely satisfy the demands of radiation processing prepackaged food. In aseptic packaging, the package is irradiated prior to filling, making demands on toxicological safety less stringent. Therefore, multilayered structures produced by coextrusion, lamination or co-injection moulding could satisfy the requirements. (author)

Cerebrospinal fluid lactate level as a diagnostic biomarker for bacterial meningitis in children.

Science.gov (United States)

Mekitarian Filho, Eduardo; Horita, Sérgio Massaru; Gilio, Alfredo Elias; Nigrovic, Lise E

2014-02-27

Cerebrospinal fluid (CSF) lactate is a potential biomarker for bacterial meningitis in children. To this end, we performed a single-center retrospective cohort study of children from Sao Paulo, Brazil, with CSF pleocytosis to evaluate the ability of CSF lactate to distinguish between children with bacterial and aseptic meningitis. We determined the optimum cutoff point for CSF lactate using receiver-operator curve (ROC) analysis. We identified 451 children of whom 40 (9%) had bacterial meningitis. Children with bacterial meningitis had a higher median CSF lactate level [9.6 mmol/l, interquartile range (IQR) 3.2-38.5 mmol/l bacterial meningitis vs. 2.0 mmol/l, IQR 1.2-2.8 mmol/l aseptic meningitis]. A CSF lactate cutoff point of 3.0 mmol/l had a sensitivity of 95% [95% confidence interval (CI) 83-99%), specificity of 94% (95% CI 90-96%) and negative predictive value of 99.3% (95% CI 97.7-99.9%) for bacterial meningitis. In combination with a validated meningitis clinical prediction rule, the CSF lactate level can be used to distinguish between bacterial and aseptic meningitis in children with CSF pleocytosis.

Central Nervous System Infections in Denmark

Science.gov (United States)

2018-02-04

Central Nervous System Infections; Bacterial Meningitis; Viral Meningitis; Aseptic Meningitis; Encephalitis; Brain Abscess; Neuroborreliosis; Neurosyphilis; Lyme Disease; Tertiary Syphilis; Cerebral Abscess; Meningitis

Case report of challenges in the management of a rare ductal ...

African Journals Online (AJOL)

Case report: A 6 month old male infant referred to our unit on account of failure to thrive, cyanosis since birth, easy fatigability and breathlessness. On examination he was small for age with tachycardia and a grade III pansystolic murmur at the left lower sternal edge. Chest radiograph revealed an “egg on side” cardiac ...

Acute changes in clinical breast measurements following bra removal: Implications for surgical practice

Directory of Open Access Journals (Sweden)

Joanna Scurr

2015-03-01

Conclusions: Internipple distance and breast projection can be measured first following bra removal, followed by sternal notch to nipple distance, any measures associated with the vertical nipple position should be made more than 6 min after bra removal. These guidelines have implications for breast surgery, particularly for unilateral reconstruction based on the residual breast position.

Nipple Sparing Mastectomy: Does Breast Morphological Factor Related to Necrotic Complications?

Directory of Open Access Journals (Sweden)

Prakasit Chirappapha, MD

2014-01-01

Conclusions: Large glandular specimen increases the risk of NAC necrosis. The degree of ptosis and the distance between the sternal notch and the NAC have no significant impact on necrotic complications in NSM. To reduce the necrotic complications in large breast after NSM, reconstruction should better be performed with autologous flap or slow skin expansion using the expander technique.

99Tcm-MDP imaging for the diagnosis of joint infection after total hip arthroplasty

International Nuclear Information System (INIS)

Li Yuan; Wang Qian; Yue Minggang

2013-01-01

Objective: To investigate the value of 99 Tc m -MDP imaging for the differential diagnosis between infection and aseptic loosening after total hip arthroplasty. Methods: During February 2008 to August 2011, 74 patients (32 males, 42 females, average age (64.3±11.2) years) with hip pain after arthroplasty underwent 3-phase (blood flow, blood pool and bone phases) 99 Tc m -MDP imaging. All patients had measurements of serum C reactive protein (CRP) and erythrocyte sedimentation rate (ESR). Joint infection was defined as either increased peri-prosthetic soft tissue activity during perfusion and blood pool phases or increased peri-prosthetic bone activity during uptake phase, or positive in all 3 phases. Aseptic loosening was defined as having negative 99 Tc m -MDP in all 3 phases. Clinical diagnosis was chosen as the gold standard. The blood flow-pool imaging was compared with the serum examinations. χ 2 test was used for statistical analysis. Results: There were 74 symptomatic joints in 74 patients, including 24 joint infections and 50 aseptic loosening. For the detection of peri-prosthetic infection, combined perfusion-blood-pool phase was more accurate than bone uptake phase (90.5% (67/74) vs 55.4% (41/74); χ 2 =23.159, P<0.001), with the sensitivity of 91.7% (22/24) vs 70.8% (17/24) and specificity of 90.0% (45/50) vs 48.0% (24/50), respectively. The blood flow-pool imaging was also more accurate than CRP (73.0% (54/74); χ 2 =7.656, P<0.05) and ESR (71.6% (53/74); χ 2 =8.633, P<0.05), respectively. Conclusion: 99 Tc m -MDP perfusion/blood flow-pool imaging is an accurate modality for differentiating peri-prosthetic infection from aseptic loosening in patients with hip pain after arthroplasty. (authors)

Left-sided approach for cardiac procedure and thoracoplasty in a patient with Marfan syndrome.

Science.gov (United States)

Shimamura, J; Kubota, H; Sudo, K

2012-02-01

We present a case of a 20-year-old female in whom we successfully performed a simultaneous Bentall procedure and thoracoplasty by initially removing only the left side of the costal cartilages. This modified sternal elevation technique offered chest stability and an excellent surgical view, and the postoperative course was satisfactory. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

The Lost Art of Whole Blood Transfusion in Austere Environments

Science.gov (United States)

2015-04-01

Norway; 2Department of Immunology and Transfusion Medicine, Haukeland University Hospital, Bergen, Norway; 3Department of Anesthesia and Intensive Care...intravenously or intraosseously will increase the CO and hence the BP because the circulation is constricted severely with low circulating blood volume...lactate monitor). & Establish an intravenous or intraosseous route. For intraosseous route, sternal access is preferred. & The initial fluid of choice is

Nonadecadienone, a New Termite Trail-Following Pheromone Identified in Glossotermes oculatus (Serritermitidae)

Czech Academy of Sciences Publication Activity Database

Hanus, Robert; Šobotník, Jan; Krasulová, Jana; Jiroš, Pavel; Žáček, Petr; Kalinová, Blanka; Dolejšová, Klára; Cvačka, Josef; Bourguignon, T.; Roisin, Y.; Lacey, M. J.; Sillam-Dusses, David

2012-01-01

Roč. 37, č. 1 (2012), s. 55-63 ISSN 0379-864X R&D Projects: GA ČR GAP506/10/1570 Institutional research plan: CEZ:AV0Z40550506 Keywords : Glossotermes * Serritermitidae * sternal gland * termites * trail-following pheromone * (10Z,13Z)-nonadeca-10,13-dien-2-one Subject RIV: CC - Organic Chemistry Impact factor: 3.222, year: 2012

Mechanical comparative analysis of three different types of sutures in different dimensions tendons - experimental study

Directory of Open Access Journals (Sweden)

Medeiros Raimundo Nonato R.

2002-01-01

Full Text Available The authors present sixteen patients with congenital kyphosis treated by posterior spinal arthrodesis. A homologous or autogenous iliac bone graft was used. The patients walked with Risser-Cotrel body cast in the 6 months of postoperatory period. The mean time of follow-up was 58,25 months and the mean age of the patients at time of surgery was 9,3 years. The mean angular value of the congenital kyphosis before surgery was 50,44masculine Cobb and after ther surgery it was 46,94masculine Cobb. One of the patients who had curve of 69masculine Cobb, presented pseudoarthrosis. The final results were good in 10, regular in 4 and bad in 2 patients. The need of the diagnostic and precocious treatment is recommended by authors.

Radiologic findings in neurofibromatosis

Energy Technology Data Exchange (ETDEWEB)

Kim, Dai Young; Jeon, Seok Chol; Lee, Kwan Se; Yeon, Kyung Mo; Choo, Dong Woon [Seoul National University College of Medicine, Seoul (Korea, Republic of)

1979-12-15

Neurofibromatosis is an uncommon but certainly not a rare hereditary disorder, probably of neuralcrest origin, involving not only neuroectoderm and mesoderm but also endoderm and characterized by cafe au lait spots and cutaneous and subcutaneous tumors, with secondary mesodermal defects responsible for protean osseous abnormalities and various manifestations in other systems. This paper is a study of confirmed 143 cases of neurofibromatosis collected for past 8 years. In this analysis, special attention was given to the selected 37 cases which showed abnormal findings on radiological examinations. Overall male to female ratio was 1 : 1.3. The most frequent kind of abnormalities was vertebral kyphoscoliosis in 12 cases. Among the more pathognomonic but uncommon abnormalities to neurofibromatosis, we experienced each 2 cases of lambdoid defect, pseudoarthrosis and renovascular hypertension, and 1 cases of sphenoid bone absence.

Pediatric Patient with Incidental Os Odontoideum Safely Treated with Posterior Fixation Using Rod-Hook System and Preoperative Planning Using 3D Printer: A Case Report.

Science.gov (United States)

Sakai, Toshinori; Tezuka, Fumitake; Abe, Mitsunobu; Yamashita, Kazuta; Takata, Yoichiro; Higashino, Kosaku; Nagamachi, Akihiro; Sairyo, Koichi

2017-05-01

Os odontoideum is often found incidentally. Surgical treatment is recommended for patients with atlantoaxial instability or neurologic deficits. Although various techniques have been used for C1-C2 fusion in adults, the use of these procedures in children is not widely accepted. We present a 12-year-old boy with incidental os odontoideum and obvious C1-C2 instability, in which bony union was achieved safely and successfully by posterior fixation using a rod-hook system and perioperative planning using a three-dimensional printer. At the 2-year follow-up, bone formation around the gap of the dens, which has been generally considered as pseudoarthrosis, was obtained after union of the posterior element of C1-C2. Georg Thieme Verlag KG Stuttgart · New York.

Anterior pseudoarthrectomy for symptomatic Bertolotti's syndrome.

Science.gov (United States)

Malham, Gregory M; Limb, Rebecca J; Claydon, Matthew H; Brazenor, Graeme A

2013-12-01

Painful L5/S1 pseudoarthrosis has been previously managed with posterior excision and/or lumbar fusion. To our knowledge, the anterior approach for L5/S1 pseudoarthrectomy in the treatment of Bertolotti's syndrome has not been described. We present two patients with severe symptomatic L5/S1 pseudoarthroses that were successfully excised via an anterior retroperitoneal approach with 2 year clinical and radiological follow-up. The literature regarding surgical treatments for Bertolotti's syndrome is reviewed. The technique for an anterior retroperitoneal approach is described. This approach has been safe and effective in providing long term symptomatic relief to our two patients. Further studies comparing the outcomes of anterior versus posterior pseudoarthrectomy will guide the management of this condition. Copyright © 2013 Elsevier Ltd. All rights reserved.

An in vivo study on the effect of coating stability on osteointegration performance of collagen/hyaluronic acid multilayer modified titanium implants.

Science.gov (United States)

Ao, Haiyong; Zong, Jiajia; Nie, Yanjiao; Wan, Yizao; Zheng, Xiebin

2018-03-01

Aseptic loosening of implant is one of the main causes of Ti-based implant failure. In our previous work, a novel stable collagen/hyaluronic acid (Col/HA) multilayer modified titanium coatings (TCs) was developed by layer-by-layer (LBL) covalent immobilization technique, which showed enhanced biological properties compared with TCs that were physically absorbed with Col/HA multilayer in vitro . In this study, a rabbit model with femur condyle defect was employed to compare the osteointegration performance of them. Results indicated that Col/HA multilayer with favourable stability could better facilitate osteogenesis around implants and bone-implant contact. The Col/HA multilayer covalent-immobilized TC may reduce aseptic loosening of implant.

Identificação da microbiota fúngica de ambientes considerados assépticos Identification of the fungic microbiota isolated in areas considered aseptic

Directory of Open Access Journals (Sweden)

Maria Elisabete Sbrogio de Almeida

1988-06-01

Full Text Available Objetivou-se isolar e identificar a microbiota fúngica em ambientes considerados assépticos, através de exposições com meios de cultivo adequados, em três épocas distintas do ano, antes e imediatamente após as manobras técnicas realizadas em três áreas de trabalho: ambiente aberto, ambiente fechado sem filtração de ar e ambiente fechado com filtração de ar, utilizadas em produção de imunobiológicos. Os meios ágar-Sabouraud e ágar-soja, enriquecidos com 0,2% de extrato de levedura e sem cloranfenicol, foram estudados quanto à sua eficácia no isolamento de bolores e leveduras, considerando-se o número de colônias desenvolvidas e a freqüência dos diversos fungos isolados. Isolaram-se 67 espécimens, sendo 64 fungos filamentosos (bolores e três leveduras. Dos bolores, 54 pertenciam a 22 gêneros da divisão Deuteromycota, famílias Moniliaceae e Dematiaceae, cinco amostras filamentosas foram incluídas na ordem Agonomycetales (Mycelia Sterilia, e uma amostra foi classificada na divisão Deuteromycota, ordem Sphaeropsidales, classe Coelomycetes. Da divisão Zygomycota, ordem Mucorales, família Mucoraceae, um único mucoráceo foi identificado até gênero. As três leveduras pertenciam também à divisão Deuteromycota (Fungi Imperfecti, família Cryptococcaceae, e foram identificadas como sendo duas Rhodotorula rubra e uma Torulopsis candida. Comprovou-se que o número de colônias isoladas aumentou após a realização das monobras técnicas e que a filtração de ar através de filtros tipo HEPA, reduzindo o número de colônias isoladas nos ambientes fechados, aumenta a segurança do trabalho; comumente é recomendada para áreas de atividade técnica cujos resultados satisfatórios estão diretamente relacionados com uma baixa incidência de contaminantes.The isolation and identification of the fungic microbiota present in areas considered aseptic (open and/or restricted, with or without air filtration (HEPA filters

CT and MRI findings in patients with neuroinfections

International Nuclear Information System (INIS)

Piekarska, A.; Zboinska, J.; Piekarski, J.

2005-01-01

Although in most patients a diagnosis of neuroinfection is not based on the results of brain imaging, there is a trend to perform MRI or CT on any patient in whom such infection is suspected. However, in selected cases, especially in patients with brain abscess or with herpetic encephalitis, brain CT and/or MRI are essential for diagnosis. Therefore we decided to analyze the results of computed tomography and magnetic resonance imaging of the brains of patients with neuroinfections and to assess the usefulness of these imaging methods in clinical practice. Brain imaging (CT and/or MRI) was performed in 106 cases (62 purulent and 44 aseptic ingoencephalitis patients). The results were analyzed in subgroups of patients with different etiology of neuroinfection. In 40 of the 58 patients (68.9%) with purulent meningoencephalitis on whom computed tomography was made, the image revealed the pathology. In the remaining 18 cases (31.1%) the results were normal. In all 4 patients on whom only MRI was done, the results were abnormal (4/4, 100%). Among the 41 patients with aseptic meningoencephalitis on whom computed tomography was done, the pathology was found in 11 (26.8%). Of the 20 patients who underwent brain MRI, the pathology was depicted in 12 (12/20, 60.0%). In 4 of the 24 patients (16.7%) with aseptic meningoencephalitis on whom only computed tomography was done, the results were abnormal. In 2 of the 3 patients (66.7%) on whom MRI was done as the only radiological examination, the results were abnormal. The pathology was found on the radiograms of 11 of the 17 patients (64.7%) in whom both imaging methods were used. In the remaining 6 of these 17 cases (6/17, 35.3%) neither CT nor MRI revealed any abnormality. Altogether, of the 44 patients with aseptic meningoencephalitis in whom brain imaging was performed, pathology was depicted in 17 (38.7%). 1. The high percentage of abnormal CT and MR images in patients with meningoencephalitis warrants the use of brain

Trial production of x-ray protective coat in clinico-orthodontics and evaluation of efficiency

Energy Technology Data Exchange (ETDEWEB)

Fukui, H; Nezu, F; Arita, M; Numata, K; Nishioka, T [Nihon Univ., Tokyo. School of Dentistry

1977-09-01

The authors produced for trial an x-ray protective coat for patients which could be used for any type of dental roentogenography particularly by clinicoorthodontists and could easily exert a sufficient protective effect. The trial product is of coat type covering the front, sides, and back of the trunk and is made of vinyl sheet containing lead and rubber sheet containing lead. When patients put on the coat during cephalography, the internally absorbed dose was decreased greatly in the back corresponding to the 7th cervical vertebra and the area of thyroid and considerably in the area of right joint and the area corresponding to the center of the sternal shaft. The protective effect of the coat was also great in ortho-pantomography in regions corresponding to hemopoietic tissues abundant in bone-marrow, such as the areas of bilateral joints the back corresponding to the 7th cervical vertebra, and the area corresponding to the center of sternal shaft. Internally absorbed doses in different regions due to various types of roentgenography were tabulated. The x-ray protective coat was described to be useful not only in orthodontics but also in roentogenography in the craniocervical region.

Trial production of x-ray protective coat in clinico-orthodontics and evaluation of efficiency

International Nuclear Information System (INIS)

Fukui, Hatsuo; Nezu, Fumio; Arita, Masatoshi; Numata, Keisuke; Nishioka, Toshio

1977-01-01

The authors produced for trial an x-ray protective coat for patients which could be used for any type of dental roentogenography particularly by clinicoorthodontists and could easily exert a sufficient protective effect. The trial product is of coat type covering the front, sides, and back of the trunk and is made of vinyl sheet containing lead and rubber sheet containing lead. When patients put on the coat during cephalography, the internally absorbed dose was decreased greatly in the back corresponding to the 7th cervical vertebra and the area of thyroid and considerably in the area of right joint and the area corresponding to the center of the sternal shaft. The protective effect of the coat was also great in ortho-pantomography in regions corresponding to hemopoietic tissues abundant in bone-marrow, such as the areas of bilateral joints the back corresponding to the 7th cervical vertebra, and the area corresponding to the center of sternal shaft. Internally absorbed doses in different regions due to various types of roentgenography were tabulated. The x-ray protective coat was described to be useful not only in orthodontics but also in roentogenography in the craniocervical region. (Chiba, N.)

40 CFR 180.1225 - Decanoic acid; exemption from the requirement of a tolerance.

Science.gov (United States)

2010-07-01

... acid (up to 170 ppm per application) on food contact surfaces such as equipment, pipelines, tanks, vats, fillers, evaporators, pasteurizers and aseptic equipment in restaurants, food service operations, dairies...

A Cohort Study of the Natural History of Odontoid Pseudoarthrosis Managed Nonoperatively in Elderly Patients.

Science.gov (United States)

Hong, Jennifer; Zaman, Rifat; Coy, Shannon; Pastel, David; Simmons, Nathan; Ball, Perry; Mirza, Sohail; Abdu, William; Pearson, Adam; Lollis, S Scott

2018-06-01

Although the primary goal of treatment of type II odontoid fracture is bony union, some advocate continued nonsurgical management of minimally symptomatic older patients who have fibrous union or minimal fracture motion. The risk of this strategy is unknown. We reviewed our long-term outcomes after dens nonunion to define the natural history of Type II odontoid fractures in elderly patients managed nonoperatively. A retrospective chart review of 50 consecutive adults aged 65 or older with Type II odontoid fracture initially managed nonsurgically from 1998 to 2012 at a single tertiary care institution was conducted. Particular attention was paid to patients who had orthosis removal despite absent bony fusion. Patients were contacted prospectively by telephone and followed until death, surgical intervention, or last known contact. Fifty patients initially were managed nonsurgically; of these, 21 (42.0%) proceeded to bony fusion, 3 (6%) underwent delayed surgery for persistent instability, and 26 (52%) had orthosis removal despite the lack of solid arthrodesis on imaging. The last group had a median follow-up of 25 months (range 4-158 months), with 20 of 26 (76.9%) followed until death. Of these patients, 1 patient developed progressive quadriplegia and dysphagia 11 months after initial injury. Compared with patients with spontaneous union, patients with nonunion had shorter life expectancy, despite no significant differences between the groups with respect to age, sex, injury mechanism, radiographic variables, or follow-up duration. Orthosis removal despite fracture nonunion may be reasonable in elderly patients with Type II dens fractures. Copyright © 2018 Elsevier Inc. All rights reserved.

Radiation shielding in dental radiography

International Nuclear Information System (INIS)

Stenstroem, B.; Rehnmark-Larsson, S.; Julin, P.; Richter, S.

1983-01-01

The protective effect in the thyroid region from different types of radiation shieldings at intraoral radiography has been studied as well as the reduction of the absorbed dose to the sternal and the gonadal regions. The shieldings tested were five different types of leaded aprons, of which three had an attached leaded collar and the other two were used in combination with separate soft leaded collars. Furthermore one of the soft leaded collars and an unflexible horizontal leaded shield were tested separately. Two dental x-ray machines of 60 and 65 kVp with rectangular and circular tube collimators were used. The exposure time corresponded to speed group E film. The absorbed doses were measured with two ionization chambers. No significant difference in the protective effect in the thyroid gland could be found between the different types of radiation shieldings. There was a dose reduction by approximately a factor of 2 to the thyroid region down to 0.08 mGy per full survey using parallelling technique, and below 0.001 mGy per single bitewing exposure. The shieldings reduced the thyroid dose using bisecting-angle technique by a factor of 5 down to 0.15 mGy per full survey (20 exposures). In the sternal region the combinations of apron and collar reduced the absorbed dose from a full survey to below 2 μGy compared with 18 μGy (parallelling) and 31 μGy (biscting-angle) without any shielding. With the horizontal leaded shield a reduction by a factor of 6 was obtained but no significant sternal dose reduction could be detected from the soft collar alone. The gonadal dose could be reduced by a factor of 10 with the horizontal leaded shield, parallelling technique and circular collimator. Using leaded aprons the gonadal dose was approximately one per cent of the dose without any shielding, i.e. below 0.01 μGy per single intraoral exposure. (Authors)

Adaptation of regenerants of Vaccinium corymbosum L. and ...

African Journals Online (AJOL)

The benchmark analysis of the structured-functional particularities of regeneration ... the structured-functional organization regeneration (a mobile system) can be ... Key words: Aseptic culture, greenhouse, open ground, anatomical structure, ...

38 ORIGINAL ARTICLE

African Journals Online (AJOL)

Boaz

contraceptifs hormonaux pourraient augmenter le risque d'acquisition de la candidose vulvo-vaginale. INTRODUCTION .... the inclusion criteria had a complete pelvic examination under aseptic ..... Revista iberoamericana de micologia. 2003 ...

Ten Year Follow-Up of Gap Balanced, Rotating Platform Total Knee Arthroplasty in Patients Under 60 Years of Age.

Science.gov (United States)

Lee, Jason H; Barnett, Steven L; Patel, Jay J; Nassif, Nader A; Cummings, Dennis J; Gorab, Robert S

2016-01-01

68 patients (91 primary total knee arthroplasties) were evaluated at a mean 10-year, minimum 5 year follow up in patients younger than sixty years of age utilizing the gap balanced, rotating platform design. Follow up assessment included implant survivorship, adverse events, x-rays, Knee Society rating system and clinical evaluation. Three revisions were performed with only one for aseptic loosening at 45 months. Two manipulations were performed in the early postoperative period. Survivorship of the rotating platform, gap balanced knee was 96.7% using surgical revision for any reason and 98.9% using aseptic loosening as endpoints. The rotating platform design using the gap balancing technique in young patients had excellent survivorship at 10-year mean follow up. Copyright © 2016 Elsevier Inc. All rights reserved.

Need for three-dimensional imaging in postsurgical ''falled back'' syndrome

International Nuclear Information System (INIS)

Zinreich, S.J.; Wang, H.; Long, D.M.; Quinn, C.M.; Rosenbaum, A.E.

1987-01-01

One hundred ten patients with persistent symptoms after low back surgery were examined with direct axial CT, 2D multiplanar, and 3D imaging. Sixty-three of these patients had lumbar spinal fusion. The 3D images were found to best display the integrity of fusion (assessed by continuity, pseudoarthrosis, incomplete fusion, transitional syndrome) in 44 of the 63 patients (65%). In 55 of the 110 patients lateral spinal stenosis was found; in 43% (24 of 55) this was uncovered on the 3D images. 3D also better showed the extent and type of surgery performed in 23% (26 of 110). Furthermore, 15 pars interarticularis, four facet fractures, and eight spinal malalignments were perceived only on 3D. 3D image afforded additional information over the direct axial and multiplanar reconstruction techniques in 63 of 110 patients

Total femur arthroplasty for revision hip failure in osteogenesis imperfecta: limits of biology

Directory of Open Access Journals (Sweden)

Pablo Sanz-Ruiz, PhD, MD

2017-09-01

Full Text Available Osteogenesis imperfecta (OI is a rare congenital disease characterized by alterations in bone quality, with susceptibility to fractures, instability, deformities, and osteoarthrosis. Prosthetic surgery in these patients is associated with an abnormally high rate of implant failures. On the other hand, abnormal bone fragility adds to the complexity of revision surgery in such individuals—thus representing a genuine challenge for the orthopaedic surgeon. We present a case of femoral reconstruction in a patient with OI and prosthetic loosening after reconstruction secondary to femoral septic pseudoarthrosis. Intramedullary total femoral reconstruction was carried out after exceeding the biological reconstruction limits. This is the first reported instance of the use of an intramedullary total femur arthroplasty as salvage technique in an OI patient. This technique should be considered when we have exceeded biological limits for femoral fixation.

Scintigraphic diagnosis of pseudo-arthroses following Harrington's spondylodesis

Energy Technology Data Exchange (ETDEWEB)

Bostel, F.; Georgi, P.; Springorum, H.W.; Puhl, W.

1982-01-01

The development of pseudoarthroses is the most common complication following operative treatment of severe scoliosis. Early recognition of this event is important to prevent recurrence of the curvature. The diagnosis is not possible by radiological examination of the rigid spine. Routine reexploration implies a second operation, which is unnecessary in the majority of patients with stable fusion. In an attempt to develop a non-invasive method for the diagnosis of pseudo-arthroses, bone scintigrams were carried out in 29 patients with idiopathic scoliosis twelve months after a Harrington's spondylodesis. In 24 patients (82.8%) a definite conclusion could be drawn, either of stable fusion (65.5%) or pseudo-arthrosis formation (17.3%). No pseudoarthroses were missed by scintigraphy. These results indicate that bone scintigraphy plays an important role in the post-operative care after Harrington's spondylodesis.

High bacterial contamination rate of electrocautery tips during total hip and knee arthroplasty.

Science.gov (United States)

Abdelaziz, Hussein; Zahar, Akos; Lausmann, Christian; Gehrke, Thorsten; Fickenscher, Helmut; Suero, Eduardo M; Gebauer, Matthias; Citak, Mustafa

2018-04-01

The aim of the study was to quantify the bacterial contamination rate of electrocautery tips during primary total joint replacement (TJR), as well as during aseptic and septic revision TJR. A total of 150 electrocautery tips were collected between April and July 2017. TJR surgeries were divided into three groups: (1) primary, (2) aseptic and (3) septic revisions. In each group, a total of 50 electrocautery tips were collected. A monopolar electrocautery with a reusable stainless-steel blade tip was used in all cases. The rate of bacterial contamination was determined for all groups. Correlation of exposure time and type of surgery was analyzed. The overall bacterial contamination rate was 14.7% (95% CI 9.4 to 21.4%). The highest contamination rate occurred in the septic revision group (30.0%; 95% CI 17.9 to 44.6%), followed by the primary cases group (10.0%; 95% CI 3.3 to 21.8%) and the aseptic revision group (4.0%; 95% CI 0.5 to 13.7%). Exposure time did not affect the bacterial contamination rate. In 12 out of 15 (80%) contaminations identified in the septic group, we found the same causative microorganism of the prosthetic joint infection on the electrocautery tip. The bacterial contamination of the electrocautery tips is relatively high, especially during septic hip revision arthroplasty. Electrocautery tips should be changed after debridement of infected tissue.

Protein synthesis and intestinal flora in piglets

International Nuclear Information System (INIS)

Namioka, Shigeo

1980-01-01

Utilization of non-protein nitrogen (NPN) by the flora in piglet colon was studied by administration of 15 N-urea and 15 N-ammonium salt to aseptic piglets and to SPF piglets which had been acclimatized to a clean environment after settling of intestinal flora. Administration of 15 N-urea did not result in 15 N uptake by any tissue-constituting protein at any site of the aseptic piglets, almost all 15 N being excreted into the urine. In contrast, the tissue and skeletal muscle of the SPF piglets showed incorporated 15 N from urea. Urea was converted, by urease of the intestinal flora, into NH 3 , which was absorbed from the mucosa of the intestinal tract to reach the liver where it was synthesized into glutamic acid, followed by conversion into various amino acids. 15 N-ammonium administration produced a significant amount of 15 N even in the tissue protein of the aseptic piglets. After NPN administration, the liver protein-constituting amino acid fraction showed 15 N-labeling of almost all essential, as well as non-essential amino acids. Culture of colonic flora with 15 N-urea revealed 15 N-labeling of all amino acids that constituted bacterial cells, indicating the presence of urea recycling mediated by bacterial urease in single rumen animals.(Chiba, N.)

Acute generalised exanthematous pustulosis.

Science.gov (United States)

Criton, S; Sofia, B

2001-01-01

Acute generalised exanthernatous pustulosis (AGEP) is a condition characterised by sudden onset of non-follicular aseptic pustules all over the body. It is distinct from pustular psoriasis with characteristic morphology, histopathology and evolution.

Variação da concentração de vitamina C, ºBrix e acidez em néctar de laranja em embalagens cartonadas = Modification of vitamin C concentration, Brix and acidity in orange nectar in aseptic packaging

Directory of Open Access Journals (Sweden)

Telma Lucia de Oliveira

2007-07-01

Full Text Available Amostras de néctar de laranja, acondicionadas em embalagens cartonadas, foram armazenadas em local climatizado (25°C e em refrigerador (4°C. Durante oito semanas, análises de vitamina C, Brix e acidez foram realizadas no momento da abertura daembalagem, e seu produto residual foi ainda analisado durante quatro dias de estocagem em refrigerador. Analisando-se os resultados das variáveis por métodos estatísticos, observou-se que a temperatura de armazenagem influencia a quantidade de vitamina C do néctar delaranja. Ocorre decréscimo significativo na concentração de vitamina C, mas não há influência da temperatura de armazenagem no Brix e acidez do produto. O tempo de armazenamento influencia vitamina C, Brix e acidez. Constata-se, ainda, que após oito semanas de estocagem e quatro dias de abertura da embalagem a quantidade de vitamina C,em um copo de 200 mL do néctar de laranja estudado, supre a necessidade média diária de um adulto (60 mg.Samples of orange nectar in aseptic packaging were stored incontrolled room temperature (25°C and in a refrigerator (4°C. For eight weeks, analyses of vitamin C, Brix and acidity were conducted as the packages were opened, and their residual products were further analyzed during a period of four days stored in a refrigerator.By using statistical models from the results found, it was concluded that storage temperature influences the quantity of vitamin C in orange nectar. There was a significant decrease in vitamin C concentration in nectar, but storage temperature does not influenceacidity or Brix. Storage time does influence vitamin C, Brix and acidity. It was concluded that after eight weeks of storage and four days of opening the package, the amount of vitamin C in a 200 mL glass of orange nectar is enough to supply the average needed dailyintake (60 mg of vitamin C for an adult.

Comparison of electromyographic activity during the bench press and barbell pulloverexercises

OpenAIRE

Campos, Yuri de Almeida Costa; Silva, Sandro Fernandes da

2014-01-01

The aim of the study was to compare the electromyographic (EMG) activity of the following muscles: clavicular portion of pectoralis major, sternal portion of pectoralis major, long portion of triceps brachii, anterior deltoid, posterior deltoid and latissimus dorsi during dynamic contractions between flat horizontal bench press and barbell pulloverexercises. The sample comprised 12 males individuals experienced in resistance training. The volunteers made three visits to the laboratory. The fi...

Omental Herniation: A Rare Complication of Vacuum-Assisted Closure of Infected Sternotomy Wound

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Philemon Gukop

2012-01-01

Full Text Available Vacuum-assisted closure (VAC has recently been adopted as an acceptable modality for management of sternotomy wound infections. Although generally efficacious, the use of negative pressure devices has been associated with complications such as bleeding, retention of sponge, and empyema. We report the first case of greater omental hernia as a rare complication of vacuum-assisted closure of sternal wound infection following coronary artery bypass grafting.

Auditing Safety of Compounding and Reconstituting of Intravenous Medicines on Hospital Wards in Finland.

Science.gov (United States)

Suvikas-Peltonen, Eeva; Palmgren, Joni; Häggman, Verner; Celikkayalar, Ercan; Manninen, Raija; Airaksinen, Marja

2017-01-01

On the hospital wards in Finland, nurses generally reconstitute intravenous medicines, such as antibiotics, analgesics, and antiemetics prescribed by doctors. Medicine reconstitution is prone to many errors. Therefore, it is important to identify incorrect practices in the reconstitution of medicine to improve patient safety in hospitals. The aim of this study was to audit the compounding and reconstituting of intravenous medicines on hospital wards in a secondary-care hospital in Finland by using an assessment tool and microbiological testing for identifying issues posing patient safety risks. A hospital pharmacist conducted an external audit by using a validated 65-item assessment tool for safe-medicine compounding practices on 20 wards of the selected hospital. Also, three different microbiological samples were collected to assure the aseptics. Practices were evaluated using a four-point rating scale of "never performed," "rarely performed," "often performed," and "always performed," and were based on observation and interviews with nurses or ward pharmacists. In addition, glove-, settle plate-, and media fill-tests were collected. Associations between microbial sample results and audit-tool results were discussed. Altogether, only six out of the 65 items were fully implemented in all wards; these were related to logistic practices and quality assurance. More than half of the wards used incorrect practices ("rarely performed" or "never performed") for five items. Most of these obviated practices related to aseptic practices. All media-fill tests were clean but the number of colony forming units in glove samples and settle- plate samples varied from 0 to >100. More contamination was found in wards where environmental conditions were inadequate or the use of gloves was incorrect. Compounding practices were [mostly] quite well adapted, but the aseptic practices needed improvement. Attention should have been directed particularly to good aseptic techniques and

(1→3)-β-d-Glucan and Galactomannan for Differentiating Chemical "Black Particles" and Fungal Particles Inside Peritoneal Dialysis Tubing.

Science.gov (United States)

Leelahavanichkul, Asada; Pongpirul, Krit; Thongbor, Nisa; Worasilchai, Navaporn; Petphuak, Kwanta; Thongsawang, Bussakorn; Towannang, Piyaporn; Lorvinitnun, Pichet; Sukhontasing, Kanya; Katavetin, Pisut; Praditpornsilpa, Kearkiat; Eiam-Ong, Somchai; Chindamporn, Ariya; Kanjanabuch, Talerngsak

2016-01-01

♦ Aseptic, sheet-like foreign bodies observed inside Tenckhoff (TK) catheter lumens (referred to as "black particles") are, on gross morphology, hardly distinguishable from fungal colonization because these contaminants adhere tightly to the catheter. Detection of fungal cell wall components using (1→3)-β-d-glucan (BG) and galactomannan index (GMI) might be an alternative method for differentiating the particles. ♦ Foreign particles retrieved from TK catheters in 19 peritoneal dialysis patients were examined microscopically and cultured for fungi and bacteria. Simultaneously, a Fungitell test (Associates of Cape Cod, Falmouth, MA, USA) and a Platelia Aspergillus ELISA assay (Bio-Rad Laboratories, Marnes-La-Coquette, France) were used to test the spent dialysate for BG and GMI respectively. ♦ Of the 19 patients, 9 had aseptic black particles and 10 had fungal particles in their tubing. The fungal particles looked grainy, were tightly bound to the catheter, and appeared more "colorful" than the black particles, which looked sheet-like and could easily be removed by milking the tubing. Compared with effluent from patients having aseptic particles, effluent from patients with fungal particles had significantly higher levels of BG (501 ± 70 pg/mL vs. 46 ± 10 pg/mL) and GMI (10.98 ± 2.17 vs. 0.25 ± 0.05). Most of the fungi that formed colonies inside the catheter lumen were molds not usually found in clinical practice, but likely from water or soil, suggesting environmental contamination. Interestingly, in all 10 patients with fungal colonization, visualization of black particles preceded a peritonitis episode and TK catheter removal by approximately 1-3 weeks; in patients with aseptic particles, a 17-week onset to peritonitis was observed. ♦ In all patients with particle-coated peritoneal dialysis tubing, spent dialysate should be screened for BG and GMI. Manipulation of the TK catheter by squeezing, hard flushing, or even brushing to dislodge black

Prediction of bacterial meningitis based on cerebrospinal fluid pleocytosis in children

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Sofia Águeda

Full Text Available Children with cerebrospinal fluid pleocytosis are frequently treated with parenteral antibiotics, but only a few have bacterial meningitis. Although some clinical prediction rules, such as bacterial meningitis score, are of well-known value, the cerebrospinal fluid white blood cells count can be the initial available information. Our aim was to establish a cutoff point of cerebrospinal fluid white blood cell count that could distinguish bacterial from viral and aseptic meningitis. A retrospective study of children aged 29 days to 17 years who were admitted between January 1st and December 31th, 2009, with cerebrospinal fluid pleocytosis (white blood cell > 7 µL-1 was conducted. The cases of traumatic lumbar puncture and of antibiotic treatment before lumbar puncture were excluded. There were 295 patients with cerebrospinal fluid pleocytosis, 60.3% females, medium age 5.0 ± 4.3 years distributed as: 12.2% 1-3 months; 10.5% 3-12 months; 29.8% 12 months to 5 years; 47.5% >5 years. Thirty one children (10.5% were diagnosed with bacterial meningitis, 156 (52.9% viral meningitis and 108 (36.6% aseptic meningitis. Bacterial meningitis was caused by Neisseria meningi tidis (48.4%, Streptococcus pneumoniae (32.3%, other Streptococcus species (9.7%, and other agents (9.7%. cerebrospinal fluid white blood cell count was significantly higher in patients with bacterial meningitis (mean, 4839 cells/µL compared to patients with aseptic meningitis (mean, 159 cells/µL, p < 0.001, with those with aseptic meningitis (mean, 577 cells/µL, p < 0.001 and with all non-bacterial meningitis cases together (p < 0.001. A cutoff value of 321 white blood cell/µL showed the best combination of sensitivity (80.6% and specificity (81.4% for the diagnosis of bacterial meningitis (area under receiver operating characteristic curve 0.837. Therefore, the value of cerebrospinal fluid white blood cell count was found to be a useful and rapid diagnostic test to distinguish

Browse Title Index

African Journals Online (AJOL)

Items 51 - 100 of 207 ... ... temperatures on the proximate composition and sensory attributes of ... on Quality and Acceptance of Aseptically Processed Ashgourd Juice, Abstract ... of Fermented Maize Supernatant and Sodom Apple Coagulant on ...

Energy sources of yoghurt bacteria and enhancement of their ...

African Journals Online (AJOL)

Administrator

2011-05-23

May 23, 2011 ... starter culture consists of two symbiotically growing bacteria, S. thermophilus .... inoculated aseptically with pure colonies of the bacterial isolates. All ..... load and enzyme production of indigenously isolated yeast. Pak. J. Bot.

Sternal development in the pediatric population: evaluation using computed tomography

International Nuclear Information System (INIS)

Delgado, Jorge; Jaimes, Camilo; Gwal, Kriti; Jaramillo, Diego; Ho-Fung, Victor

2014-01-01

The normal development of the sternum using CT imaging is not known. To describe the normal development of the sternum in children on chest CT imaging. CT imaging of 300 patients (150 male, 150 female), mean age: 4.97 years (range: 0.01-9.9 years), were evaluated retrospectively. The presence and number of ossification centers in the manubrium, each individual mesosternal segment and the xiphoid were reviewed. Additionally, the vertical and horizontal fusion between ossification centers was evaluated. Differences among age and gender were calculated. Descriptive statistics, analysis of variances (ANOVA), chi-square and Fisher exact tests were performed for statistical analysis. Manubrium: A single ossification center was seen in 88% of cases and two or three ossification centers were seen in 12%. More manubrial ossification centers were correlated to a younger age (P 0.05). Xiphoid: Absence was seen in 67% of the patients. Bifid xiphoid was seen in 1% of the patients. The normal development of the different components of the sternum is a process with wide variation among children. The large variability of mesosternal ossification center types should not be confused with pathology. (orig.)

EPIDERMAL CHARACTERS OF BACCHARIS (ASTERACEAE SPECIES USED IN TRADITIONAL MEDICINE

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FREIRE SUSANA E.

2007-06-01

Full Text Available A morphological study of 38 species of Baccharis used in traditional medicinewas carried out to provide some epidermal characters that will contribute to theknowledge of the genus. The present study revealed: 1 seven different types oftrichomes: conical, aseptate fl agellate, fi liform fl agellate, 1-armed, 2-4-armed,bulbiferous fl agellate, and glandular biseriate; 2 that 28 of the total of 38 specieshave trichomes in tufts; 3 six different types of stomata: anomocytic, anisocytic,cyclocytic, actinocytic, tetracytic, and staurocytic; 4 that some trichome types,such as 2-4-armed (B. dracunculifolia and aseptate fl agellate branched (B. trinervis,show a high diagnostic value; 5 that the stomata types can be used to differentiatespecies with similar trichomes type (e.g. B. trimera and B. articulata.Illustrations of the studied characters are provided.

Acute mediastinitis: multidetector computed tomography findings following cardiac surgery

International Nuclear Information System (INIS)

Macedo, Clarissa Aguiar de; Baena, Marcos Eduardo da Silva; Uezumi, Kiyomi Kato; Castro, Claudio Campi de; Lucarelli, Claudio Luiz; Cerri, Giovanni Guido

2008-01-01

Postoperative mediastinitis is defined as an infection of the organs and tissues in the mediastinal space, with an incidence ranging between 0.4% and 5% of cases. This disease severity varies from infection of superficial tissues in the chest wall to fulminant mediastinitis with sternal involvement. Diagnostic criterion for postoperative detection of acute mediastinitis at computed tomography is the presence of fluid collections and gas in the mediastinal space, which might or might not be associated with peristernal abnormalities such as edema of soft tissues, separation of sternal segments with marginal bone resorption, sclerosis and osteomyelitis. Other associated findings include lymphadenomegaly, pulmonary consolidation and pleural/ pericardial effusion. Some of these findings, such as mediastinal gas and small fluid collections can be typically found in the absence of infection, early in the period following thoracic surgery where the effectiveness of computed tomography is limited. After approximately two weeks, computed tomography achieves almost 100% sensitivity and specificity. Patients with clinical suspicion of mediastinitis should be submitted to computed tomography for investigating the presence of fluid collections to identify the extent and nature of the disease. Multidetector computed tomography allows 3D images reconstruction, contributing particularly to the evaluation of the sternum. (author)

Operative fixation of chest wall fractures: an underused procedure?

Science.gov (United States)

Richardson, J David; Franklin, Glen A; Heffley, Susan; Seligson, David

2007-06-01

Chest wall fractures, including injuries to the ribs and sternum, usually heal spontaneously without specific treatment. However, a small subset of patients have fractures that produce overlying bone fragments that may produce severe pain, respiratory compromise, and, if untreated mechanically, result in nonunion. We performed open reduction and internal fixation on seven patients with multiple rib fractures-five in the initial hospitalization and two delayed--as well as 35 sternal fractures (19 immediate fixation and 16 delayed). Operative fixation was accomplished using titanium plates and screws in both groups of patients. All patients with rib fractures did well; there were no major complications or infections, and no plates required removal. Clinical results were excellent. There was one death in the sternal fracture group in a patient who was ventilator-dependent preoperatively and extubated himself in the early postoperative period. Otherwise, the results were excellent, with no complications occurring in this group. Three patients had their plates removed after boney union was achieved. No evidence of infection or nonunion occurred. The excellent results achieved in the subset of patients with severe chest wall deformities treated initially at our institution and those referred from outside suggest that operative fixation is a useful modality that is likely underused.

Evaluation of cardiopulmonary parameters and recovery from anesthesia in cougars (Puma concolor anesthetized with detomidine/ketamine and isoflurane or sevoflurane

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Verônica B. Albuquerque

2016-01-01

Full Text Available Abstract: The aim of this study was to assess the cardiopulmonary effects, the onset time after the administration of a detomidine/ketamine combination, and the recovery from anesthesia of cougars (Puma concolor anesthetized with detomidine/ketamine and isoflurane or sevoflurane for abdominal ultrasound imaging. Fourteen animals were randomly allocated into two experimental groups: GISO (n=7 and GSEVO (n=7. Chemical restraint was performed using 0.15mg/kg detomidine combined with 5mg/kg ketamine intramuscularly; anesthesia induction was achieved using 2mg/kg propofol intravenously and maintenance with isoflurane (GISO or sevoflurane (GSEVO. The following parameters were assessed: heart rate, respiratory rate, systolic and diastolic arterial blood pressure, mean arterial blood pressure, oxyhemoglobin saturation, rectal temperature, central venous pressure, and end-tidal carbon dioxide. The time to sternal recumbency (TSR and time to standing position (TSP were also determined. There was not statistically significant difference for the cardiopulmonary variables or TSP whereas TSR was significantly shorter in GSEVO. The time to onset of anesthesia was 11.1±1.2 minutes and 11.3±1.8 minutes for GISO and GSEVO, respectively. The anesthesia of cougars with detomidine/ketamine and isoflurane or sevoflurane was conducted with safety, cardiopulmonary stability, and increased time to sternal recumbency in the GISO group.

[Use and versatility of titanium for the reconstruction of the thoracic wall].

Science.gov (United States)

Córcoles Padilla, Juan Manuel; Bolufer Nadal, Sergio; Kurowski, Krzysztof; Gálvez Muñoz, Carlos; Rodriguez Paniagua, José Manuel

2014-02-01

Chest wall deformities/defects and chest wall resections, as well as complex rib fractures require reconstruction with various prosthetic materials to ensure the basic functions of the chest wall. Titanium provides many features that make it an ideal material for this surgery. The aim is to present our initial results with this material in several diseases. From 2008 to 2012, 14 patients were operated on and titanium was used for reconstruction of the chest wall. A total of 7 patients had chest wall tumors, 2 with sternal resection, 4 patients with chest wall deformities/defects and 3 patients with severe rib injury due to traffic accident. The reconstruction was successful in all cases, with early extubation without detecting problems in the functionality of the chest wall at a respiratory level. Patients with chest wall tumors including sternal resections were extubated in the operating room as well as the chest wall deformities. Chest trauma cases were extubated within 24h from internal rib fixation. There were no complications related to the material used and the method of implementation. Titanium is an ideal material for reconstruction of the chest wall in several clinical situations allowing for great versatility and adaptability in different chest wall reconstructions. Copyright © 2013 AEC. Published by Elsevier Espana. All rights reserved.

Acute mediastinitis: multidetector computed tomography findings following cardiac surgery

Energy Technology Data Exchange (ETDEWEB)

Macedo, Clarissa Aguiar de [Universidade de Sao Paulo (USP), SP (Brazil). Faculdade de Medicina. Instituto do Coracao (InCor)]. E-mail: clarissaaguiarm@yahoo.com.br; Baena, Marcos Eduardo da Silva [Instituto do Coracao (InCor), Sao Paulo, SP (Brazil). Unit of Ultrasonography; Uezumi, Kiyomi Kato [Instituto do Coracao (InCor), Sao Paulo, SP (Brazil). Unit of Computed Tomography; Castro, Claudio Campi de [Instituto do Coracao (InCor), Sao Paulo, SP (Brazil). Unit of Magnetic Resonance Imaging; Lucarelli, Claudio Luiz [Instituto do Coracao (InCor), Sao Paulo, SP (Brazil). Center of Diagnosis; Cerri, Giovanni Guido [Universidade de Sao Paulo (USP), SP (Brazil). School of Medicine. Dept. of Radiology

2008-07-15

Postoperative mediastinitis is defined as an infection of the organs and tissues in the mediastinal space, with an incidence ranging between 0.4% and 5% of cases. This disease severity varies from infection of superficial tissues in the chest wall to fulminant mediastinitis with sternal involvement. Diagnostic criterion for postoperative detection of acute mediastinitis at computed tomography is the presence of fluid collections and gas in the mediastinal space, which might or might not be associated with peristernal abnormalities such as edema of soft tissues, separation of sternal segments with marginal bone resorption, sclerosis and osteomyelitis. Other associated findings include lymphadenomegaly, pulmonary consolidation and pleural/ pericardial effusion. Some of these findings, such as mediastinal gas and small fluid collections can be typically found in the absence of infection, early in the period following thoracic surgery where the effectiveness of computed tomography is limited. After approximately two weeks, computed tomography achieves almost 100% sensitivity and specificity. Patients with clinical suspicion of mediastinitis should be submitted to computed tomography for investigating the presence of fluid collections to identify the extent and nature of the disease. Multidetector computed tomography allows 3D images reconstruction, contributing particularly to the evaluation of the sternum. (author)

Disease: H00396 [KEGG MEDICUS

Lifescience Database Archive (English)

Full Text Available cations such as aseptic meningitis, pediatric deafness, and orchitis. Infectious disease ... Mumps virus [GN:T4...inflammation of parotid glands and fever. Mortality is rare, but it often accompanied by more serious compli

Acute generalised exanthematous pustulosis

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Criton S

2001-01-01

Full Text Available Acute generalised exanthernatous pustulosis (AGEP is a condition characterised by sudden onset of non-follicular aseptic pustules all over the body. It is distinct from pustular psoriasis with characteristic morphology, histopathology and evolution.

Pectus excavatum

International Nuclear Information System (INIS)

Kim, Young Tong; Cho, Won Soo; Bae, Won Kyung; Kim, Il Young

2002-01-01

Pectus excavatum in which the sternum is depressed and the anterior chest wall is concave in shape, is the most common congenital deformity to affect this region of the body. Various deformities involving depression or protrusion are caused by the degree and location of the sternal depression, and associated deformities such as a tilted sternum and anterior convexity of costal cartilages may occur. The most common associated disorders are Poland syndrome, Marfan syndrome and scoliosis

Pectus excavatum

Energy Technology Data Exchange (ETDEWEB)

Kim, Young Tong; Cho, Won Soo; Bae, Won Kyung; Kim, Il Young [College of Medical, Soonchunhyang Univ., Chonan (Korea, Republic of)

2002-06-01

Pectus excavatum in which the sternum is depressed and the anterior chest wall is concave in shape, is the most common congenital deformity to affect this region of the body. Various deformities involving depression or protrusion are caused by the degree and location of the sternal depression, and associated deformities such as a tilted sternum and anterior convexity of costal cartilages may occur. The most common associated disorders are Poland syndrome, Marfan syndrome and scoliosis.

A new species and first record of Pulmoniscus Leistikow, 2001 (Isopoda, Oniscidea, Philosciidae from Colombia

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Carlos Mario López-Orozco

Full Text Available Abstract A new species of Pulmoniscus Leistikow, 2001 from Department of Bolívar, Colombia, is described. It constitutes the first record of the genus for the country and for the continental portion of the Neotropics. Pulmoniscus turbanaensis n. sp. is distinguished by the male pereopod 7 ischium with concave sternal margin and the shape of the male pleopod 1. In addition, ecological remarks and a distribution map are provided.

Aerobic Degradation of Drill Muds by Axenic and Mixed Bacterial ...

African Journals Online (AJOL)

Prof. Ogunji

significant difference in the degradation of the drilling muds by the isolates (p > 0.05). ... the potentials of some indigenous bacteria to biodegrade drilling muds used in ... transported to the laboratory aseptically for evaluation, in labeled plastic.

Title: Effect of abiotic stress on reduction of microbial contamination ...

African Journals Online (AJOL)

TERI

2016-03-23

Mar 23, 2016 ... to 36% reduced microbial contamination in aseptic culture establishment ... collected from farmer's field of Assam, India. .... Average weight loss (%) ± SE. 0 .... Asian J. Plant Sci. 6:496-501. Holdgate DP, Zandvoort EA (1997).

ADAPTATION OF REGENERANTS OF Vaccinium Corymbosum L

African Journals Online (AJOL)

Kutas

2011-05-09

May 9, 2011 ... Adaptation of regenerants of Vaccinium corymbosum ... functions of the sheet plants growing in an aseptic culture, in hothouses or open ground .... L. (Koralle) were preserved in alcohol-acetic acid (3:1). ..... and soil moisture.

Effects of Prosthesis Stem Tapers on Stress Distribution of Cemented Hip Arthroplasty

International Nuclear Information System (INIS)

Abdullah, Abdul Halim; Nor, Mohd Asri Mohd; Saman, Alias Mohd; Tamin, Mohd Nasir; Kadir, Mohammed Rafiq Abdul

2010-01-01

Aseptic loosening effects are critical issues in encouraging long term stability of cemented hip arthroplasty. Stress shielding is believed to be an important factor that contributes to the aseptic loosening problems. The numerous changes in the prosthesis stem design are intended to minimize the stress shielding and aseptic loosening problems and to improve the long term performance of the implants. In this study, the stress distribution in cemented hip arthroplasty is established using finite element method. The taper of the prosthesis is designed to be 3 deg. at anterior/posterior, 3 deg. at medial/lateral and 10 deg. from wide lateral to narrow medial. Major muscle loads and contact forces are simulated for walking (toe-off phase) and stair climbing load cases. Effects of prosthesis stem tapers on the resulting stress distribution are investigated. Results show that compressive stress dominates in the medial plane while tensile stress in the lateral plane of the femur. The corresponding stress levels of intact femur for walking and stair-climbing load cases are 22 and 29 MPa, respectively. The magnitude of Tresca stress for the THA femur in stair-climbing load case remains higher in the region of 85 MPa while the walking load case induces around 40 MPa. The stress range in the straight and single taper stem prosthesis is lower than 260 MPa, while localized Tresca stress is in the order of the yield strength of Ti-6Al-4V alloy for double and triple taper stem design.

Microbial contamination of single-and multiple-dose vials after opening in a pulmonary teaching hospital

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Shadi Baniasadi

Full Text Available OBJECTIVES: Intravenous therapy is a complex procedure usually requiring the preparation of the medication in the clinical area before administration to the patient. Breaches in aseptic technique may result in microbial contaminations of vials which is a potential cause of different avoidable infections. We aimed to investigate the prevalence and pattern of microbial contamination of single- and multiple-dose vials in the largest pulmonary teaching hospital in Iran. METHODS: In a period of 2 months, opened single- and multiple-dose vials from different wards were sampled by a pharmacist. The name of the medication, ward, labeling of the vials, the date of opening, and storing temperature were recorded for each vial. Remained contents of each vial were cultured using appropriate bacterial and fungal growth media. RESULTS: Microbial contamination was identified in 11 of 205 (5.36% of vials. The highest contamination rate was 14.28% for vials used in interventional bronchoscopy unit. The most frequent contaminated medication was insulin. Gram-positive bacteria (81.82% were more significantly involved than gram-negative ones (9.09% and fungi (9.09%, with the highest frequency for Staphylococcus epidermidis . CONCLUSIONS: Our data demonstrate that repeated use of vials especially if basic sterility measures are disobeyed can cause microbial contamination of administered products to the patients. Infection preventionists are responsible to train health care workers regarding aseptic techniques and apply guidelines for aseptic handling of intravenous solutions.

Microbial contamination of single-and multiple-dose vials after opening in a pulmonary teaching hospital

Directory of Open Access Journals (Sweden)

Shadi Baniasadi

2013-02-01

Full Text Available OBJECTIVES: Intravenous therapy is a complex procedure usually requiring the preparation of the medication in the clinical area before administration to the patient. Breaches in aseptic technique may result in microbial contaminations of vials which is a potential cause of different avoidable infections. We aimed to investigate the prevalence and pattern of microbial contamination of single- and multiple-dose vials in the largest pulmonary teaching hospital in Iran. METHODS: In a period of 2 months, opened single- and multiple-dose vials from different wards were sampled by a pharmacist. The name of the medication, ward, labeling of the vials, the date of opening, and storing temperature were recorded for each vial. Remained contents of each vial were cultured using appropriate bacterial and fungal growth media. RESULTS: Microbial contamination was identified in 11 of 205 (5.36% of vials. The highest contamination rate was 14.28% for vials used in interventional bronchoscopy unit. The most frequent contaminated medication was insulin. Gram-positive bacteria (81.82% were more significantly involved than gram-negative ones (9.09% and fungi (9.09%, with the highest frequency for Staphylococcus epidermidis . CONCLUSIONS: Our data demonstrate that repeated use of vials especially if basic sterility measures are disobeyed can cause microbial contamination of administered products to the patients. Infection preventionists are responsible to train health care workers regarding aseptic techniques and apply guidelines for aseptic handling of intravenous solutions.

PDA survey of quality risk management practices in the pharmaceutical, devices, & biotechnology industries.

Science.gov (United States)

Ahmed, Ruhi; Baseman, Harold; Ferreira, Jorge; Genova, Thomas; Harclerode, William; Hartman, Jeffery; Kim, Samuel; Londeree, Nanette; Long, Michael; Miele, William; Ramjit, Timothy; Raschiatore, Marlene; Tomonto, Charles

2008-01-01

In July 2006 the Parenteral Drug Association's Risk Management Task Force for Aseptic Processes, conducted an electronic survey of PDA members to determine current industry practices regarding implementation of Quality Risk Management in their organizations. This electronic survey was open and publicly available via the PDA website and targeted professionals in our industry who are involved in initiating, implementing, or reviewing risk management programs or decisions in their organizations. One hundred twenty-nine members participated and their demographics are presented in the sidebar "Correspondents Profile". Among the major findings are: *The "Aseptic Processing/Filling" operation is the functional area identified as having the greatest need for risk assessment and quality risk management. *The most widely used methodology in industry to identify risk is Failure Mode and Effects Analysis (FMEA). This tool was most widely applied in assessing change control and for adverse event, complaint, or failure investigations. *Despite the fact that personnel training was identified as the strategy most used for controlling/minimizing risk, the largest contributors to sterility failure in operations are still "Personnel". *Most companies still rely on "Manufacturing Controls" to mitigate risk and deemed the utilization of Process Analytical Technology (PAT) least important in this aspect. *A majority of correspondents verified that they did not periodically assess their risk management programs. *A majority of the correspondents desired to see case studies or examples of risk analysis implementation (as applicable to aseptic processing) in future PDA technical reports on risk management.

COMMUNITY MEDICINE & PRIMARY HEALTH CARE

African Journals Online (AJOL)

ajiboro

control, diseases may be readily transmitted from patient to patient and to a ... threatening infections such as severe acute. 3 exposure to the microbial flora of .... aseptically the various agar plates with sterile wire ... using a scoring system.

Total excision of intramedullary epidermoid cyst in one case

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PU Ke

2013-12-01

Full Text Available Clinical experience of total excision in a 14-year-old female with intramedullary epidermoid cyst was reported. The patient with L3-4 intramedullary epidermoid cyst underwent total excision through posterior median approach under microscopy. The patient was admitted for progressive strephexopodia and urinary and fecal incontinence. Preoperative imaging examination showed scoliosis, incontionous L4-S1 and abnormal signal of L3-4. Total excision and spinal remodeling were performed under intraoperative neurophysiological monitoning. Epidermoid cyst and its membrane were totally removed without aseptic meningitis after surgery, and the neurologic symptoms of the patient were gradually improved. Completely removing the membrane of epidermoid cyst is the key point to prevent recurrence and aseptic meningitis postoperatively. Dissection should be strictly in accordance with the boundaries of the membrane and the spinal cord, in order to avoid spinal cord injury.

Kikuchi-Fujimoto disease: an unusual association with acute renal failure

Directory of Open Access Journals (Sweden)

Amanda Feliciano da Silva

Full Text Available Kikuchi-Fujimoto disease, also known as histiocytic necrotizing lymphadenitis of unknown etiopathogenesis, is a self-limited disease which frequently appears as feverish lymphadenomegaly, thus creating the need for differential diagnosis with lymphoma, systemic lupus erythematosus (SLE, infectious mononucleosis, cat-scratch disease, and toxoplasmosis with lymphonodal impairment. However, there are cases in which it may evolve with complications such as aseptic meningitis, cerebellar ataxia, and aseptic myocarditis. We are presenting a case of a 24-year-old man who had an initial picture of arthralgia, evening fever and adenomegaly. Kikuchi disease was diagnosed through lymph node biopsy with immunohistochemistry and evolves with severe systemic manifestations, such as pericarditis with cardiac tamponade, pneumonitis, hepatitis, and acute kidney failure - the latter has not been reported in literature yet. There was significant improvement of the clinical picture with prednisone

PRODUCTION OF THE NEW ANTIMALARIAL DRUG ARTEMISININ IN SHOOT CULTURES OF ARTEMISIA-ANNUA L

NARCIS (Netherlands)

WOERDENBAG, HJ; LUERS, JFJ; VANUDEN, W; PRAS, N; MALINGRE, TM; ALFERMANN, AW

From aseptically grown Artemisia annua plantlets, shoot cultures were initiated. Using different concentrations of auxine, cytokinine and sucrose, a suitable culture medium was developed, with respect to the growth of the shoots and their artemisinin accumulation. Nitrate concentration and

5539 Volume 11 No. 7 December 2011 STUDIES ON THERMAL ...

African Journals Online (AJOL)

A R VIJAY

2011-12-07

Dec 7, 2011 ... Research Scholar, Dept. of Fish Processing Technology, College of Fisheries .... was tightly screwed into the can body with a rubber gasket so as to ..... Ranganna S Handbook of Canning and Aseptic Packaging, Tata McGraw ...

Imageological measurement of the sternoclavicular joint and its clinical application.

Science.gov (United States)

Li, Ming; Wang, Bo; Zhang, Qi; Chen, Wei; Li, Zhi-Yong; Qin, Shi-Ji; Zhang, Ying-Ze

2012-01-01

Dislocation of the sternoclavicular joint is rare. However, posterior dislocation compressing important structures in the mediastinum may be fatal. Early diagnosis and prompt therapy of sternoclavicular joint dislocation are important. Computed tomography (CT) is an optimal means to investigate sternoclavicular joint anatomy; however, there are few reports on the imageological anatomical features of the sternoclavicular joint. The study investigated imageological anatomical features, and a new plate was devised according to these data to treat sternoclavicular joint dislocation. Fifty-three healthy Chinese volunteers examined with chest CT were included in the study. The coronal, sagittal, and axial images of the sternoclavicular region were reconstructed. The sternal head diameter in the inferolateral-to-superomedial direction, length of the clavicular notch, and angle between the clavicular notch and sternum were measured on coronal images. The angle between the presternum and trunk was measured on sagittal images. The following dimensions were measured on axial images: anteroposterior dimensions of the sternal head, clavicular notch, and presternum; width of the sternoclavicular joint; distance between bilateral clavicles; and minimal distance from the presternum to the underlying structures in the thoracic cavity. A new plate was designed according to the above data and was used to repair six sternoclavicular joint dislocations. All cases were followed up with a range of 9 to 12 months. The proximal clavicle is higher than the presternum in a horizontal position. On axial images, the anteroposterior dimension of the sternal head was longer than the presternum, and the center region of the presternum was thinner than the edges. The left sternoclavicular joint space was (0.82 ± 0.21) cm, and the right was (0.87 ± 0.22) cm. Among the structures behind the sternum, the left bilateral innominate vein ran nearest to the presternum. The distance from the anterior

Induction of a chronic myocardial infarction in the laboratory animal - experimental model

Science.gov (United States)

POP, IONEL CIPRIAN; GRAD, NICOLAE-OVIDIU; PESTEAN, COSMIN; TAULESCU, MARIAN; MIRCEAN, MIRCEA; MIRONIUC, ION-AUREL

2013-01-01

Introduction Ischemic heart disease is a major public health problem in western countries. Appropriate animal experimental models of chronic myocardial infarction is an essential first step in order to investigate and develop new therapeutic interventions. Aim The aim of this study was to find an optimal place for a coronary artery ligation to induce an optimal chronic myocardial infarction and also a new heart approach that will not require oro-tracheal intubation. Material and methods To achieve these goals we used a group of rabbits and after induction of anesthesia and cardiac exposure by rib osteotomy (rib III, IV and V) at the costo-sternal junction level on the right side we performed three different left anterior descending artery (LAD) ligation at different distances (5, 10 and 15 mm) in relation to the apex. Thirty days after the acute myocardial infarction, we correlated laboratory investigations (serology, ECG, cardiac ultrasound) with histopathological findings. Results Heart approach achieved by rib osteotomy (rib III, IV and V) at the costo-sternal junction level on the right side, maintains the integrity of the ribcage, allowing it to take part in respiratory movements and the animal model does not need oro-tracheal intubation. Ligation of LAD at 15 mm from the apex was incompatible with life; ligation of LAD at 5 mm from the apex does not achieved transmural myocardial infarction and ligation of LAD at 10 mm from the apex achieved a transmural myocardial infarction of the left ventricle which also involved the distal part of the interventricular septum. Conclusion Ligation of LAD at 10 mm from the apex achieved a transmural myocardial infarction of the left ventricle, is in an easily accessible area from technical point of view, it is sufficiently expanded to induce hemodynamic effects that can be quantified with paraclinical examination and also it is compatible with the experimental animal life. If the heart is approached by rib III, IV and V

40 CFR 180.1159 - Pelargonic acid; exemption from the requirement of tolerances.

Science.gov (United States)

2010-07-01

..., vats, fillers, evaporators, pasteurizers and aseptic equipment in restaurants, food service operations, dairies, breweries, wineries, beverage and food processing plants. [62 FR 28364, May 23, 1997, as amended... (CONTINUED) PESTICIDE PROGRAMS TOLERANCES AND EXEMPTIONS FOR PESTICIDE CHEMICAL RESIDUES IN FOOD Exemptions...

Prevention : T

NARCIS (Netherlands)

Boot, Willemijn; Vogely, H. Charles

2017-01-01

Joint replacement is a successful surgical procedure that provides pain relief, restores joint function and improves the quality of life of patients. A minority of patients will experience complications like aseptic failure or prosthetic joint infection (PJI; Tande and Patel 2014).

Phylogeny and taxonomy of the genus Cylindrocladiella

NARCIS (Netherlands)

Lombard, L.; Shivas, R.G.; To-anun, C.; Crous, P.W.

2012-01-01

The genus Cylindrocladiella was established to accommodate Cylindrocladium-like fungi that have small, cylindrical conidia and aseptate stipe extensions. Contemporary taxonomic studies of these fungi have relied on morphology and to a lesser extent on DNA sequence comparisons of the internal

Effect of light and aeration on the growth of Sclerotium rolfsii in vitro

African Journals Online (AJOL)

aghomotsegin

2013-12-04

Ainsworth, 1961) impregnated with streptomycin, and incubated for seven days at 28 ± 2°C. The fungal growth on 5th day, which arose through the sclerotial bodies was cut by inoculation loop and transferred aseptically to the PDA ...

E-Beam - a new transfer system for isolator technology

International Nuclear Information System (INIS)

Sadat, Theo; Huber, Thomas

2002-01-01

In every aseptic filling application, the sterile transfer of goods into the aseptic area is a challenge, and there are many different ways to do it. With isolator technology a higher sterility assurance level (SAL) is achieved. This SAL is only as good as the weakest segment in the chain of manufacturing. The transfer of goods into and out of the isolator is one of these critical segments. Today different techniques, some already well established, others still very new, are available on the market like: dry heat tunnel, autoclave, pulsed light, rapid transfer systems (RTP), H 2 O 2 tunnel, UV light, etc. all these systems are either not applicable for continuous transfer, only good for heat-compatible materials like glass, or do not guarantee a 6 log spore reduction. E-Beam opens new perspectives in this field. With E-beam technology it is possible to transfer heat-sensitive (plastic), pre-sterilised materials at high speed, continuously into an aseptic area. E-Beam unifies three different technologies, that result in a very efficient and high-speed decontamination machine designed for the pharmaceutical industry. First, there is the electron beam that decontaminates the goods and an accurate shielding that protects the surrounding from this beam. Second, there is the conveyor system that guarantees the output and the correct exposure time underneath the beam. And third, there is the isolator interface to provide correct differential pressure and clean air inside the tunnel as well as the decontamination of the tunnel with H 2 O 2 prior to production. The E-beam is a low-energy electron beam, capable of decontaminating any kind of surface. It penetrates only a few micrometers into the material and therefore does not deform the packaging media. Currently, machines are being built to transfer pre-sterilised syringes, packed in plastic tubs with a Tyvek cover into an aseptic filling isolator with the following data: decontamination efficiency of 10 6 (6 log spore

Intravenous Therapy: Hazards, Complications and Their Prevention ...

African Journals Online (AJOL)

Breaks in aseptic techniques, faulty handling of parenteral fluid containers, failure to discard out-dated intravenous solutions and tubings contribute to occurrence of intravenous-associated sepsis. Improper technique and lack of pharmaceutical knowledge when adding drugs into intravenous fluids contribute to ...

Pinning down loosened prostheses : imaging and planning of percutaneous hip refixation

NARCIS (Netherlands)

Malan, Daniel Francois

2015-01-01

This thesis examines how computer software can be used to analyse medical images of an aseptically loosening hip prosthesis, and subsequently to plan and guide a minimally invasive cement injection procedure to stabilize the prosthesis. We addressed the detection and measurement of periprosthetic

Uoaé Adegboro, MD. Adegboro, MD. Adegboro, MD. Editor.

African Journals Online (AJOL)

Dr Oboro VO

promoting aseptic procedures, so as to prevent nosocomial infections, such as endocarditis, meningitis, septicaemia, osteomyelitis, nephritis, etc, in dental practice. Such complications could be life-threatening, particularly in these days of multidrug resistant bacterial infections. A common cause of bloodstream infection is ...

Temperature control in a continuously mixed bioreactor for solid-state fermentation

NARCIS (Netherlands)

Nagel, F.J.J.I.; Tramper, J.; Bakker, M.S.N.; Rinzema, A.

2001-01-01

A continuously mixed, aseptic paddle mixer was used successfully for solid-state fermentation (SSF) with Aspergillus oryzae on whole wheat kernels. Continuous mixing improved temperature control and prevented inhomogeneities in the bed. Respiration rates found in this system were comparable to those

Effect of levothyroxine therapy on dyslipidemia in hypothyroid patients

African Journals Online (AJOL)

Arun Kumar Agnihotri

hypothyroidism (both subclinical and overt hypothyroidism), its association with ... with dyslipidemia, replacement therapy with levothyroxine resulted in reversal to .... aseptically after 12 hours overnight fasting for lipid ..... Workers in the field also observed that restoration ... between SCH and metabolic syndrome (MetS) and.

Effects of different media concentartions on callogensis in sugar cane

African Journals Online (AJOL)

SAM

2014-03-12

Mar 12, 2014 ... INTRODUCTION. Plant tissue culture techniques have become a powerful tool for studying and ... productivity mainly depends on genetic variability available and ... Maintenance of aseptic environment. Sterilization of ... appropriate concentration of sucrose and iron source ... Total number of explants ...

Teaching sterile skills in anesthesia : Is providing context helpful for robust skill acquisition?

NARCIS (Netherlands)

Cnossen, Fokeltje; Paul, Katja; Lettinga, Roelof; Wietasch, Johann

2015-01-01

Epidural anesthesia is an invasive medical procedure for pain relief. However, current teaching methods are not sufficient for acquiring proper aseptic technique in this procedure (Friedman et al., 2008). In the present study we examined whether a context-providing method, previously successfully

Can finite element models detect clinically inferior cemented hip implants?

NARCIS (Netherlands)

Stolk, J.; Maher, S.A.; Verdonschot, N.J.J.; Prendergast, P.J.; Huiskes, R.

2003-01-01

Rigorous preclinical testing of cemented hip prostheses against the damage accumulation failure scenario will reduce the incidence of aseptic loosening. For that purpose, a finite element simulation is proposed that predicts damage accumulation in the cement mantle and prosthetic migration. If the

The ascomycete genus Sordaria

OpenAIRE

Guarro, J.; Arx, von, J.A.

1987-01-01

Sordaria is restricted to coprophilous, soil-, or seed-borne Pyrenomycetes with aseptate, elongate ascospores with a gelatinous, amorphous sheath. The genus is redescribed and a key to fourteen accepted species is given. A checklist of all taxa described as Sordaria is added.