21 research outputs found
Metal levels in corrosion of spinal implants
Corrosion affects spinal instrumentations and may cause local and systemic complications. Diagnosis of corrosion is difficult, and nowadays it is performed almost exclusively by the examination of retrieved instrumentations. We conducted this study to determine whether it is possible to detect corrosion by measuring metal levels on patients with posterior instrumented spinal fusion. Eleven asymptomatic patients, with radiological signs of corrosion of their stainless steel spinal instrumentations, were studied by performing determinations of nickel and chromium in serum and urine. Those levels were compared with the levels of 22 patients with the same kind of instrumentation but without evidence of corrosion and to a control group of 22 volunteers without any metallic implants. Statistical analysis of our results revealed that the patients with spinal implants without radiological signs of corrosion have increased levels of chromium in serum and urine (P < 0.001) compared to volunteers without implants. Corrosion significantly raised metal levels, including nickel and chromium in serum and urine when compared to patients with no radiological signs of corrosion and to volunteers without metallic implants (P < 0.001). Metal levels measured in serum have high sensibility and specificity (area under the ROC curve of 0.981). By combining the levels of nickel and chromium in serum we were able to identify all the cases of corrosion in our series of patients. The results of our study confirm that metal levels in serum and urine are useful in the diagnosis of corrosion of spinal implants and may be helpful in defining the role of corrosion in recently described clinical entities such as late operative site pain or late infection of spinal implant
Infected Vertebroplasty Due to Uncommon Bacteria Solved Surgically: A Rare and Threatening Life Complication of a Common Procedure
Case report. OBJECTIVE: The aim of this work is to describe a case
of infected vertebroplasty due to uncommon bacteria solved surgically with 2
years of follow-up and to discuss 6 other cases found in literature. SUMMARY OF
BACKGROUND DATA: Vertebroplasty is a well-known and useful technique for the
treatment of painful osteoporotic vertebral fractures. Complications, such as
cord or root compression or pulmonary embolisms, are infrequent and are mainly
related with the frequent escape of cement throughout the vertebral veins.
Infection is even more rare, but when it occurs is difficult to manage and can be
a life-threatening complication. METHODS: A 63-year-old-man had a spondylitis of
L2 after vertebroplasty. The patient was initially managed with antibiotics
without clinical improvement. Surgical treatment by anterior debridement and
anterior and posterior stabilization was done. The bacteria isolated from the
intraoperative cultures were Serratia marcescens, Stenotrophomonas maltophilia,
and Burkholderia cepacia. After surgery, the patient was treated with antibiotics
for 3 month. RESULTS: After 2 years of follow-up, the patient was free of pain,
without signs of infection, and a correct fusion was achieved. CONCLUSION: When
facing an infected vertebroplasty, initial conservative treatment with needle
biopsy culture and antibiotic administration are a rational option to start. If
this treatment fails, surgical debridement is then indicated in order to remove
the infected tissue and the acrylic cement and to stabilize the spine. Although
this can be an effective treatment, it could be a difficult and hazardous
surgical procedure
Nonreferral of Possible Soft Tissue Sarcomas in Adults: A Dangerous Omission in Policy
Introduction. The aim of this study is to compare outcomes in three groups of STS patients treated in our specialist centre: patients referred immediately after an inadequate initial treatment, patients referred after a local recurrence, and patients referred directly, prior to any treatment. Patients and methods. We reviewed all our nonmetastatic extremity-STS patients with a minimum follow-up of 2 years. We compared three patient groups: those referred directly to our centre (group A), those referred after an inadequate initial excision (group B), and patients with local recurrence (group C). Results. The study included 174 patients. Disease-free survival was 73%, 76%, and 28% in groups A, B, and C, respectively (P < .001). Depth, size, and histologic grade influenced the outcome in groups A and B, but not in C. Conclusion. Initial wide surgical treatment is the main factor that determines local control, being even more important than the known intrinsic prognostic factors of tumour size, depth, and histologic grade. The influence on outcome of initial wide local excision (WLE), which is made possible by referral to a specialist centre, is paramount
Voluntary Bilateral Scapulothoracic Dissociation
tudy design: Case report.
Objective: To report a rare case of voluntary scapulothoracic dislocation and its treatment.
Background data: Scapulothoracic dissociation is a rare condition. We report a case of a teenager who could volun- tarily dislocate her scapulae.
Results: The patient was treated surgically by fixating her scapula to the contralateral transverse process and carrying out associated muscle plication. Now, after a 12-year follow-up, the patient is asymptomatic.
Conclusions: Fixation of the scapula to the contralateral transverse process and plication of associated muscles is a valid treatment for this condition
Nonreferral of possible soft tissue sarcomas in adults: a dangerous omission in policy
Introduction. The aim of this study is to compare outcomes in three groups of STS patients treated in our specialist centre: patients referred immediately after an inadequate initial treatment, patients referred after a local recurrence, and patients referred directly, prior to any treatment. Patients and methods. We reviewed all our nonmetastatic extremity-STS patients with a minimum follow-up of 2 years. We compared three patient groups: those referred directly to our centre (group A), those referred after an inadequate initial excision (group B), and patients with local recurrence (group C). Results. The study included 174 patients. Disease-free survival was 73%, 76%, and 28% in groups A, B, and C, respectively (P < .001). Depth, size, and histologic grade influenced the outcome in groups A and B, but not in C. Conclusion. Initial wide surgical treatment is the main factor that determines local control, being even more important than the known intrinsic prognostic factors of tumour size, depth, and histologic grade. The influence on outcome of initial wide local excision (WLE), which is made possible by referral to a specialist centre, is paramount
Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries
Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely