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Hyperbaric oxygen therapy for osteomyelitis
Injun/ (1984) 16, 139-141
139
Printedin Great Britain
Abstracts BACTERIOLOGY AND INFECTION
I N J U R I E S OF T H E H E A D A N D S P I N E
Airborne c o n t a m i n a t i o n o f w o u n d s In a multi-hospital trial of ultra-clean air ventilation for total joint replacement operations there was a good correlation between air contamination at operation and the subsequent joint sepsis rate; the mean values of air contamination and mean bacterial counts of wound wash-out samples taken at operation were also correlated. It was inferred from the data, that by far the largest proportion of bacteria found in the wounds after the insertion of prostheses reached the wound by the airborne route; with the mean levels of airborne bacteria in the control series the proportion transmitted by air was as high as 95 per cent. Though the risks of joint sepsis varied widely among the different hospitals of the trial, the effect of ultraclean air in the operating room was similar in all the hospitals. Lidwell O. M., Lowbury E. J. L., Whyte W., Blowers R., Stanley S. J. and Lowe D. (1983) Airborne contamination of wounds in joint replacement operations: the relationship to sepsis rates. J. Hosp. Infect. 4, 111.
Use of Harrington rods
Infection following hip or knee replacement A multi-hospital randomized prospective study on over 8000 operations for total hip or knee replacement showed a significantly lower joint infection rate after operations in theatres provided with ultra-clean air conditions than in theatres with standard ventilation; antibiotic prophylaxis was also associated with a lower incidence of joint infection. Many types of bacteria, most of them weakly pathogenic, were isolated from infected joints at revision operations. The antibiotics used for prophylaxis generally appeared to be effective against most species, though not against intestinal organisms. Strains of Staphylococcus aureus isolated from the nares of patients and operating staff at the time of the operation were phage-typed and tested for antibiotic sensitivity in about half of the patients who later developed Staph. aureus joint sepsis; for seven out of fourteen infections a probable source was found in a carrier, and a possible source was found for a further five infections. Lidwell O. M., Lowbury E. J. L., Whyte W., Blowers R., Stanley S. J. and Lowe D. (1983) Bacteria isolated from deep joint sepsis after operations for total hip or knee replacement, aad the sources of infections with Staphylococcus aureus. J. Hosp. Infect. 4, 19.
Neonatal tetanus Neonatal tetanus affects 1 in every 82 and kills 1 in every 110 infants born in the town of Juba in southern Sudan. It is also an important cause of death in adult life both in southern Sudan and in many other regions of the developing world. One vehicle of infection could be the fine string-like roots used to tie the umbilical cord. To prevent neonatal tetanus governments and aid-giving agencies should distribute to women and midwives kits containing a sterile blade, a sterile ligature, 2 or 3 sterile adhesive dressings for the umbilical stump, and 2 or 3 sterile swabs. Woodruff A. W., El Bashir E. A., Yugusuk A. Z., Grant J., Baya E. I. and El Suni A. (1984) Neonatal tetanus: mode of infection, prevalence, and prevention in southern Sudan. Lancet 1, 378.
Thirty-eight cases showing the value of the use of Harrington rods for comfort, stability and early activity. Complications included four deep venous thromboses; with two pulmonary embolisms, one of which was fatal; one case of septicaemia; three infected urines; four rods became broken or displaced. Patients were followed for two to four and a half years. All but one had local bone grafts, without which the rods were liable to break or come loose. Both compression and distraction had a place in fixation. Svensson O., Aaro S. and C)hlen G. (1984) Harrington instrumentation for thoracic and lumbar vertebral fractures. Acta Orthop. Scand. 55, 38. Intracranial h a e m a t o m a The study showed that the most ominous effects of a blow on the head were a fracture of the skull and impaired orientation. When both were present one victim in four would develop an intracranial haematoma. When neither was present, one person in 6000 attending a casualty department might develop a haematoma. Mendelow A. D., Teasdale G., Jennett B., Bryden J., Hessett C. and Murray G. (1983) Risks of intracranial haematoma in head injured adults. Br. Med. J. 287, 1173.
Hyperbaric oxygen therapy for osteomyelitis Osteomyelitis was found in just under 5 per cent of over 5000 patients with spinal paralysis. It was usually the result of pressure ulcers but few cases followed injury and operations. Together with other methods of treatment, hyperbaric oxygen appeared to have some advantage. Eltorai I., Hart G. B. and Strauss M. B. (1984) Osteomyelitis in the spinal cord injury: a review and a preliminary report on the use of hyperbaric oxygen therapy. Paraplegia 22, 17.
THORACIC AND ABDOMINAL
INJURIES
Bronchial perforation An electric current entering a man's mouth caused rupture of a bronchus, with surgical emphysema and pneumothoraces. Complete recovery followed artificial ventilation, without need of surgical treatment. Bowler G. S. and Gordon I. J. (1983) Perforation of a bronchus due to electrical injury. Br. Med. J. 287, 1346.
FRACTURES AND DISLOCATIONS Dislocations associated with epileptic fits Two cases of dislocations associated with epileptic fits are reported: one with anterior dislocation of both shoulders and the other with repeated dislocation of the jaw. Sadhra K. (1984) Unusual dislocations associated with epileptic fits. Br. Med. J. 288, 681.
139
Printedin Great Britain
Abstracts BACTERIOLOGY AND INFECTION
I N J U R I E S OF T H E H E A D A N D S P I N E
Airborne c o n t a m i n a t i o n o f w o u n d s In a multi-hospital trial of ultra-clean air ventilation for total joint replacement operations there was a good correlation between air contamination at operation and the subsequent joint sepsis rate; the mean values of air contamination and mean bacterial counts of wound wash-out samples taken at operation were also correlated. It was inferred from the data, that by far the largest proportion of bacteria found in the wounds after the insertion of prostheses reached the wound by the airborne route; with the mean levels of airborne bacteria in the control series the proportion transmitted by air was as high as 95 per cent. Though the risks of joint sepsis varied widely among the different hospitals of the trial, the effect of ultraclean air in the operating room was similar in all the hospitals. Lidwell O. M., Lowbury E. J. L., Whyte W., Blowers R., Stanley S. J. and Lowe D. (1983) Airborne contamination of wounds in joint replacement operations: the relationship to sepsis rates. J. Hosp. Infect. 4, 111.
Use of Harrington rods
Infection following hip or knee replacement A multi-hospital randomized prospective study on over 8000 operations for total hip or knee replacement showed a significantly lower joint infection rate after operations in theatres provided with ultra-clean air conditions than in theatres with standard ventilation; antibiotic prophylaxis was also associated with a lower incidence of joint infection. Many types of bacteria, most of them weakly pathogenic, were isolated from infected joints at revision operations. The antibiotics used for prophylaxis generally appeared to be effective against most species, though not against intestinal organisms. Strains of Staphylococcus aureus isolated from the nares of patients and operating staff at the time of the operation were phage-typed and tested for antibiotic sensitivity in about half of the patients who later developed Staph. aureus joint sepsis; for seven out of fourteen infections a probable source was found in a carrier, and a possible source was found for a further five infections. Lidwell O. M., Lowbury E. J. L., Whyte W., Blowers R., Stanley S. J. and Lowe D. (1983) Bacteria isolated from deep joint sepsis after operations for total hip or knee replacement, aad the sources of infections with Staphylococcus aureus. J. Hosp. Infect. 4, 19.
Neonatal tetanus Neonatal tetanus affects 1 in every 82 and kills 1 in every 110 infants born in the town of Juba in southern Sudan. It is also an important cause of death in adult life both in southern Sudan and in many other regions of the developing world. One vehicle of infection could be the fine string-like roots used to tie the umbilical cord. To prevent neonatal tetanus governments and aid-giving agencies should distribute to women and midwives kits containing a sterile blade, a sterile ligature, 2 or 3 sterile adhesive dressings for the umbilical stump, and 2 or 3 sterile swabs. Woodruff A. W., El Bashir E. A., Yugusuk A. Z., Grant J., Baya E. I. and El Suni A. (1984) Neonatal tetanus: mode of infection, prevalence, and prevention in southern Sudan. Lancet 1, 378.
Thirty-eight cases showing the value of the use of Harrington rods for comfort, stability and early activity. Complications included four deep venous thromboses; with two pulmonary embolisms, one of which was fatal; one case of septicaemia; three infected urines; four rods became broken or displaced. Patients were followed for two to four and a half years. All but one had local bone grafts, without which the rods were liable to break or come loose. Both compression and distraction had a place in fixation. Svensson O., Aaro S. and C)hlen G. (1984) Harrington instrumentation for thoracic and lumbar vertebral fractures. Acta Orthop. Scand. 55, 38. Intracranial h a e m a t o m a The study showed that the most ominous effects of a blow on the head were a fracture of the skull and impaired orientation. When both were present one victim in four would develop an intracranial haematoma. When neither was present, one person in 6000 attending a casualty department might develop a haematoma. Mendelow A. D., Teasdale G., Jennett B., Bryden J., Hessett C. and Murray G. (1983) Risks of intracranial haematoma in head injured adults. Br. Med. J. 287, 1173.
Hyperbaric oxygen therapy for osteomyelitis Osteomyelitis was found in just under 5 per cent of over 5000 patients with spinal paralysis. It was usually the result of pressure ulcers but few cases followed injury and operations. Together with other methods of treatment, hyperbaric oxygen appeared to have some advantage. Eltorai I., Hart G. B. and Strauss M. B. (1984) Osteomyelitis in the spinal cord injury: a review and a preliminary report on the use of hyperbaric oxygen therapy. Paraplegia 22, 17.
THORACIC AND ABDOMINAL
INJURIES
Bronchial perforation An electric current entering a man's mouth caused rupture of a bronchus, with surgical emphysema and pneumothoraces. Complete recovery followed artificial ventilation, without need of surgical treatment. Bowler G. S. and Gordon I. J. (1983) Perforation of a bronchus due to electrical injury. Br. Med. J. 287, 1346.
FRACTURES AND DISLOCATIONS Dislocations associated with epileptic fits Two cases of dislocations associated with epileptic fits are reported: one with anterior dislocation of both shoulders and the other with repeated dislocation of the jaw. Sadhra K. (1984) Unusual dislocations associated with epileptic fits. Br. Med. J. 288, 681.