Influence of the bone block position on the tunnel enlargement in ACL reconstruction

Tunnel enlargement can appear after anterior cruciate ligament reconstruction. We investigated the influence of the bone block position of a patellar tendon autograft on the tunnel enlargement in the femur and in the tibia from two aspects. On the one hand, we examined the influence of the tunnel position in respect to the ap-diameter. On the other hand, we examined the influence of the bone block depth in respect to the joint line. In a crossover study over three years, 103 knees with primary ACL reconstruction were included. The incidence of tunnel enlargement measured on X-rays after one year was 52% (n=103) in the femur and 81% (n=103) in the tibia. The average diameter of enlargement was 1.4 mm (14%) in the femur and 2.7 mm (27%) in the tibia. No correlation between the tunnel position and the tunnel enlargement in the sagital plane could be found. However, there is a significant positive correlation between the size of tunnel enlargement and the bone block depth in the femur and in the tibia. There is an average tunnel enlargement of about 0.6 mm (6%) per 10 mm deeper bone plug depth. The relative excess length of the patella tendon favors the development of tunnel enlargement. The effect of the bone block depth on the tunnel enlargement is equal in the femur and the tibia

Treatment of streptococcal endocarditis with a single daily dose of ceftriaxone sodium for 4 weeks. Efficacy and outpatient treatment feasibility

OBJECTIVE--To evaluate the efficacy and safety of ceftriaxone sodium in the treatment of streptococcal endocarditis. DESIGN--An open, multicenter, noncomparative study with a follow-up of patients for 4 months to 5 years. SETTING--Internal medicine wards and outpatient clinics of hospitals of various sizes in three European countries. PATIENTS--Fifty-nine patients with defined criteria for streptococcal endocarditis. INTERVENTION--Ceftriaxone sodium administered at a once-daily dose of 2 g for 4 weeks. MAIN OUTCOME MEASURES--Clinical outcome and microbiological cure rate. RESULTS--Among the 59 patients, 55 completed the treatment and were followed up for 4 months to 5 years. No patients showed evidence of relapse. Treatment was completely uneventful in 42 patients (71%). A cardiac valve was replaced in four patients (7%) receiving antimicrobial therapy and in six patients (10%) who had completed antimicrobial therapy. One of the 10 valves taken for culture at surgery was positive, but only for microorganisms that were different from the microorganism isolated before the treatment. The treatment had to be interrupted in four patients because of drug allergy. Other side effects were mild except for two cases of reversible neutropenia. The treatment was easy to administer: 27 patients (46%) had no permanent intravenous catheter at any time, seven patients (12%) had such a catheter for less than 4 days. Twenty-three patients (39%) were discharged from the hospital less than 2 weeks after admission. CONCLUSIONS.--Ceftriaxone sodium administered at a once-daily dose of 2 g appears to be an effective and safe treatment of streptococcal endocarditis. In hospitals, this agent may be more convenient to administer than penicillin G with or without aminoglycosides. Some patients may even be treated as outpatients

Piezoelectric osteotomy in hand surgery: first experiences with a new technique

BACKGROUND: In hand and spinal surgery nerve lesions are feared complications with the use of standard oscillating saws. Oral surgeons have started using a newly developed ultrasound bone scalpel when performing precise osteotomies. By using a frequency of 25–29 kHz only mineralized tissue is cut, sparing the soft tissue. This reduces the risk of nerve lesions. As there is a lack of experience with this technique in the field of orthopaedic bone surgery, we performed the first ultrasound osteotomy in hand surgery. METHOD: While performing a correctional osteotomy of the 5th metacarpal bone we used the Piezosurgery(® )Device from Mectron [Italy] instead of the usual oscillating saw. We will report on our experience with one case, with a follow up time of one year. RESULTS: The cut was highly precise and there were no vibrations of the bone. The time needed for the operation was slightly longer than the time needed while using the usual saw. Bone healing was good and at no point were there any neurovascular disturbances. CONCLUSION: The Piezosurgery(® )Device is useful for small long bone osteotomies. Using the fine tip enables curved cutting and provides an opportunity for new osteotomy techniques. As the device selectively cuts bone we feel that this device has great potential in the field of hand- and spinal surgery

Fate of drugs during wastewater treatment

This is the post-print version of the final paper published in TrAC Trends in Analytical Chemistry. The published article is available from the link below. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. Copyright @ 2013 Elsevier B.V.Recent trends in the determination of pharmaceutical drugs in wastewaters focus on the development of rapid multi-residue methods. This review addresses recent analytical trends in drug determination in environmental matrices used to facilitate fate studies. Analytical requirements for further fate evaluation and tertiary process selection and optimization are also discussed.EPSRC, Northumbrian Water, Anglian Water, Severn Trent Water, Yorkshire Water, and United Utilities

The effects of subgingival application of ozonated olive oil gel in patient with localized aggressive periodontitis. A clinical and bacteriological study

AbstractThis study evaluates the effect of subgingival application of ozonated olive oil gel as an adjunct to scaling and root planing (SRP) in aggressive periodontitis.Material & methodsThirty patients were randomly selected and equally divided into: Group I received SRP only, group II received SRP and ozonated olive oil gel (Oxactiv). Subgingival application of ozone gel was performed following initial SRP and at 7, 14 and 21 days. Clinical measurements included pocket depth (PD), plaque index (PI), gingival index (GI), bleeding on probing (BOP) and clinical attachment level (CAL). Real time PCR was carried out to determine the effect of the treatment on both Aggregatibacter actinomycetemcomitans (Aa) and Porphyromonas gingivalis (Pg). Clinical measurements and Plaque samples for PCR were recorded at baseline, one, three and six months after treatment.ResultsThe results showed improvement in all clinical parameters in (group II) which was maintained up to six months (P < 0.05). However, this improvement was best following one month but gradually decrease at 3 and 6 months. Whereas SRP alone resulted in a significant improvement only up to one month for BOP, PPD and CAL parameters and up to three months for the PI and GI scores as compared to baseline values.Microbiological resultsRevealed significant reduction of the mean Pg and Aa DNA copies at 1 and 3 months for (groupII), whereas group I resulted in slight reduction up to 1 month only followed by gradual increase reaching baseline values. There was no significant difference between groups at three and six months regarding Pg DNA copies. There was a significant difference between groups at the one and three months periods in term of number of Aa copies (P < 0.001, P < 0.05 respectively).ConclusionThe study concluded that (Oxactiv) gel could be a promising adjunct to SRP in the treatment of aggressive periodontitis

Inactivation combined with cell lysis of Pseudomonas putida using a low pressure carbon dioxide microbubble technology

BACKGROUND Inactivation processes can be classified into non-thermal inactivation methods such as ethylene oxide and γ-radiation, and thermal methods such as autoclaving. The ability of carbon dioxide enriched microbubbles to inactivate Pseudomonas putida suspended in physiological saline, as a non-thermal sterilisation method, was investigated in this study with many operational advantages over both traditional thermal and non-thermal sterilisation methods. RESULTS Introducing carbon dioxide enriched microbubbles can achieve ∼2-Log reduction in the bacterial population after 90 min of treatment, addition of ethanol to the inactivation solution further enhanced the inactivation process to achieve 3, 2.5 and 3.5-Log reduction for 2%, 5% and 10 %( v/v) ethanol, respectively. A range of morphological changes was observed on Pseudomonas cells after each treatment, and these changes extended from changing cell shape from rod shape to coccus shape to severe lesions and cell death. Pseudomonas putida KT 2440 was used as a model of gram-negative bacteria. CONCLUSION Using CO2 enriched microbubbles technology has many advantages such as efficient energy consumption (no heat source), avoidance of toxic and corrosive reagents, and in situ treatment. In addition, many findings from this study could apply to other gram-negative bacteria

Adverse Drug Reactions in Hospital In-Patients: A Prospective Analysis of 3695 Patient-Episodes

Adverse drug reactions (ADRs) are a major cause of hospital admissions, but recent data on the incidence and clinical characteristics of ADRs which occur following hospital admission, are lacking. Patients admitted to twelve wards over a six-month period in 2005 were assessed for ADRs throughout their admission. Suspected ADRs were recorded and analysed for causality, severity and avoidability and whether they increased the length of stay. Multivariable analysis was undertaken to identify the risk factors for ADRs. The 5% significance level was used when assessing factors for inclusion in multivariable models. Out of the 3695 patient episodes assessed for ADRs, 545 (14.7%, 95% CI 13.6–15.9%) experienced one or more ADRs. Half of ADRs were definitely or possibly avoidable. The patients experiencing ADRs were more likely to be older, female, taking a larger number of medicines, and had a longer length of stay than those without ADRs. However, the only significant predictor of ADRs, from the multivariable analysis of a representative sample of patients, was the number of medicines taken by the patient with each additional medication multiplying the hazard of an ADR episode by 1.14 (95% CI 1.09, 1.20). ADRs directly increased length of stay in 147 (26.8%) patients. The drugs most frequently associated with ADRs were diuretics, opioid analgesics, and anticoagulants. In conclusion, approximately one in seven hospital in-patients experience an ADR, which is a significant cause of morbidity, increasing the length of stay of patients by an average of 0.25 days/patient admission episode. The overall burden of ADRs on hospitals is high, and effective intervention strategies are urgently needed to reduce this burden