Augmented debridement for implant related chronic osteomyelitis with an absorbable, gentamycin loaded calcium sulfate/hydroxyapatite biocomposite

We report outcomes from 52 patients with chronic osteomyelitis from implant infection treated with a single stage protocol including debridement augmented with application of CERAMENT™/G biocomposite after resection of Cierny-Mader (C-M) stage III and IV chronic osteomyelitis. Mean age was 53 years with a mean follow up of 17 months. Infection was eradicated in 48 (92.3%) patients. There were four (7.7%) recurrences. Eighteen patients (35%) had a flap. Staphylococci (51%) and Enterococci (15%) were the commonest microorganisms. Local antibiotic augmentation (CERAMENT™/G biocomposite) with dead space management is effective in the treatment of implant related chronic osteomyelitis

Augmented debridement for implant related chronic osteomyelitis with an absorbable, gentamycin loaded calcium sulfate/hydroxyapatite biocomposite

We report outcomes from 52 patients with chronic osteomyelitis from implant infection treated with a single stage protocol including debridement augmented with application of CERAMENT™/G biocomposite after resection of Cierny-Mader (C-M) stage III and IV chronic osteomyelitis. Mean age was 53 years with a mean follow up of 17 months. Infection was eradicated in 48 (92.3%) patients. There were four (7.7%) recurrences. Eighteen patients (35%) had a flap. Staphylococci (51%) and Enterococci (15%) were the commonest microorganisms. Local antibiotic augmentation (CERAMENT™/G biocomposite) with dead space management is effective in the treatment of implant related chronic osteomyelitis

Evolution of the infirmary during the medieval; social, economic and religious status

The infirmary as we know it nowadays does not exist during the Middle Ages, but the various precursors of the modern hospital evolved as a result of interactions between East and West. There is hardly any research that describes the influence of the Medieval social, economic and religious status in the West and East on the infirmary. The present work aims on the development of the infirmary at Medieval time or Middle age with a short insight to previous evolution. The research was conducted in different stages. Textbooks and lectures from the Department of History and Methodology of Science of the University of Athens (UoA) and other relevant departments of Greek universities were consulted. In order to collect relevant information, the keywords “infirmary”, “medical theory”, “ antiquity”, “medieval”, “hospital”, “West” and “Asklipieion” were searched on Google, PubMed and Wikipedia. The infirmaries in the East were not simple buildings but rather a complex of clinical, teaching/education and praying areas. These institutions formed a model to the later European infirmaries. Many of the physicians of the East were ahead of their times. It is obvious that during the Middle Ages religion is a keystone for the function of the infirmary. Both in the East as in the West Christianity and Islam provide the ethical base and funding for the function and the development of new hospitals. Despite the conflict between these two worlds, their societies interacted and influenced medicine and the infirmary as an institution. It is the result of a long process of development of the relations between people, societies or even religions and the way humanity perceive its nature and the future. © 2019, Yuzuncu Yil Universitesi Tip Fakultesi. All rights reserved

Single stage treatment of diabetic calcaneal osteomyelitis with an absorbable gentamicin-loaded calcium sulphate/hydroxyapatite biocomposite: The Silo technique

Background: Chronic osteomyelitis necessities appropriate infected bone and soft tissue excision. The authors describe the Silo surgical technique for the treatment of calcaneal osteomyelitis using a new antibiotic-loaded absorbable calcium sulphate/hydroxyapatite biocomposite. Methods: The Silo method involves debridement of the dead bone and local delivery of antibiotic in drilled tunnels using the biocomposite. It is combined with multiple sampling and culture-specific systemic antibiotic treatment guided by a multidisciplinary team. Twelve consecutive diabetic patients with heel ulcers and calcaneal osteomyelitis were treated with the above method. All had comorbidities (Cierny–Mader (C–M) Class B hosts). The mean age was 68 years (range 50–85). A retrospective review of radiographs and electronic medical records was conducted. Results: Patients were followed up until clinical cure of the ulcer for a mean of 16 weeks (range 12–18). Infection was eradicated in all 12 patients with a single stage procedure following a bone preserving technique. One patient required a subsequent flap operation and six vacuum-assisted closure (V.A.C.). There was also one case of prolonged wound leakage and no calcaneal fractures. Conclusions: The Silo technique is an effective method of local delivery of antibiotics and can be effectively implemented into the single-stage treatment of calcaneal osteomyelitis offering increased bone preservation and local delivery of antibiotic, decreasing the need for a major amputation

Vertebral fracture assessment: Current research status and application in patients with kyphoplasty

Imaging of the spine is of paramount importance for the recognition of osteoporotic vertebral fractures (VFs), and standard radiography (SR) of the spine is the suggested diagnostic method but is not routinely used because of the cost and radiation exposure considerations. VF assessment (VFA) is an efficient, low radiation method for identifying VFs at the time of bone mineral density (BMD) measurement. Prediction models used to indicate the need for VFA may have little predictive power in subspecialty referral populations such as rheumatologic patients or patients who underwent kyphoplasty. Rheumatologic patients are frequently at increased risk for VFs, and VFA should be performed on an individual basis, also taking in account the guidelines for the general population. Kyphoplasty is a new minimal invasive procedure for the treatment of VFs and is being performed with increasing frequency. Following kyphoplasty, there may be a risk of new VFs in adjacent vertebrae. The assessment and follow-up of patients who underwent kyphoplasty requires repetitive X-ray imaging with the known limitations of SR. Thus, VFA may facilitate the evaluation of VFs in these patients because most of the kyphoplasty patients would fulfill the criteria. In a pilot study, we measured the BMD and performed VFA in 28 patients treated with kyphoplasty. Ratios of anterior to posterior (A/P) and middle to posterior (M/P) height were measured, and Genant's method was used to classify vertebrae accordingly. Intraobserver and interobserver reliability for A/P, M/P and the Genant's method were determined. Only 1 patient did not meet the criteria for VFA. Of the 364 available vertebrae, 295 could be analyzed. Most missing data (concerning 69 vertebrae) occurred in the upper thoracic region. Three of the 69 non-eligible vertebrae were lumbar vertebrae with cement leakage from the kyphoplasty procedure. In our hands, VFA was highly reproducible, demonstrating very good agreement in terms of intraobserver and interobserver reliability. Agreement was very good on the vertebral level, "vertebrae with kyphoplasty" level and "2 above and 1 below the kyphoplasty vertebrae" level. The application of Genant's method to these patients also resulted in perfect agreement. We believe that the potential value of VFA in patients treated with kyphoplasty requires further evaluation, particularly comparing VFA with SR and performing a longitudinal follow-up. More research will help to adopt care processes that determine which patients require VFA and how often VFA should be performed, while also considering the impact of this technique on the cost of healthcare organizations. © The Author(s) 2015. Published by Baishideng Publishing Group Inc