Burden of traumatic spine fractures in Tehran, Iran.

UNLABELLED: ABSTRACT: BACKGROUND: The Disability-Adjusted Life Year (DALY) was designed by the World Health Organization (WHO) to measure, compare, and analyze the burden of various diseases. To the best of our knowledge, this is the first study on the assessment of burden of traumatic spinal fracture (TSF) in an Iranian community. We estimated burden of TSF includes both isolated (iTSF) and associated injuries related to traumatic spinal fractures (aTSF) in Tehran, the capital of Iran, for the year 2006-2007 using DALYs. METHODS: Burden of TSF was estimated based on information provided by the national data on Iranian trauma, data from the WHO, and literature data using disease modeling (DISMOD). Incidence of TSF and associated injuries were obtained from two population based studies and National Trauma Data Bank in Iran, while duration, and relative risk of mortality (RRM) were obtained from WHO data and the literature. The incidence, duration, and relative risk of mortality (RRM) were used to calculate DALY for TSF. To calculate DALY, the years of life lost because of premature mortality (YLL) were added to the number of years lost because of disability (YLD). DALYs were calculated separately for both iTSF and aTSF. In-hospital YLD and post-hospital YLL for iTSF and in-hospital YLL and YLD were calculated for aTSFs. RESULTS: TSF incidence was 16.35 (95%CI: 3.4-48.0) per 100,000. The incidence of TSF in males was more than twice that of females. The largest DALYs were seen in 15-29 years. The highest burden of associated injuries of TSF was related to spinal cord and head injury. DALYs for aTSF were estimated to be 2496.9 years (32.0 DALY/100,000 population). The YLD and YLL were almost similar. Total DALY for iTSF and aTSF was 2568.9 years (32.92 DALY/100,000 population). Based on the risk extracted from the literature, post-hospital increased risk of mortality was increased by 1318 DALY (16.89 DALY/100,000 population). CONCLUSION: This study showed a considerable burden for TSFs mainly due to associated injuries and increased lifelong RRM in patients with TSF

Effect of milrinone on short-term outcome of patients with myocardial dysfunction undergoing coronary artery bypass graft: A randomized controlled trial

Background: Myocardial dysfunction needing inotropic support is a typical complication after on-pump cardiac surgery. In this study, we evaluate the effect of milrinone on patients with ventricular dysfunction undergoing coronary artery bypass graft (CABG). Methods: Seventy patients with impaired left ventricular function [left ventricular ejection fraction (LVEF) < 35%] undergoing on-pump CABG were enrolled. Patients were randomized to receive either an intraoperative bolus of milrinone (50 &#956;g/kg) or saline as placebo followed by a 24-hour infusion of each agent (0.5 &#956;g/kg/min). Hemodynamic parameters and transthoracic echocardiographic measurement of systolic and diastolic functions were the variables evaluated. Results: Serum levels of creatine phosphokinase (CPK), the MB isoenzyme of creatine kinase (CK-MB), occurrence of myocardial ischemia or infarction, and mean duration of using inotropic agents were significantly lower in the milrinone group (p < 0.05). There were no significant differences between the two groups regarding the development of ventricular arrhythmia, duration of cardiopulmonary bypass, intra-aortic balloon pump and inotropic support requirement, duration of mechanical ventilation, duration of intensive care unit stay and mortality rate. Although mean pre-operative LVEF was significantly lower in the milrinone group, there was no significant difference between post-operative LVEFs. Conclusions: We suggest that perioperative administration of milrinone in patients undergoing on-pump CABG, especially those with low LVEF, is beneficial. (Cardiol J 2010; 17, 1: 73-78

Revision Total Knee Arthroplasty: Infection should be Ruled Out in All Cases

We hypothesized that some aseptic revision total knee arthroplasty failures are indeed caused by occult infection. This prospective study recruited 65 patients undergoing revision total knee arthroplasty. The mean follow-up period was 19 months. Collected synovial fluid was analyzed by Ibis T5000 biosensor (Abbott Molecular Inc, Ill; a multiplex polymerase chain reaction technology). Cases were considered as infected or aseptic based on the surgeon\u27s judgment and Ibis findings. Based on Ibis biosensor, 17 aseptic cases were indeed infected that had been missed. Of these 17 cases, 2 developed infection after the index revision. A considerable number of so-called aseptic failures seem to be occult infections that were not adequately investigated and/or miscategorized as aseptic failure. We recommend that all patients undergoing revision arthroplasty be investigated for periprosthetic joint infection. Copyright © 2012 Elsevier Inc. All rights reserved

Risk factors for surgical site infection following total joint arthroplasty.

BACKGROUND: Currently, most hospitals in the United States are obliged to report infections that occur following total joint arthroplasty to the Centers for Disease Control and Prevention through the National Healthcare Safety Network surveillance. The objective of this study was to identify the risk factors of surgical site infections that were reported to the Centers for Disease Control and Prevention from a single institution. METHODS: For this study, 6111 primary and revision total joint arthroplasties performed from April 2010 to June 2012 were identified. Surgical site infection cases captured by infection surveillance staff on the basis of the Centers for Disease Control and Prevention definition were identified. Surgical site infection cases with index surgery performed at another institution were excluded. All cases were followed up for one year for development of surgical site infection. The model for predictors of surgical site infection was created by logistic regression and was validated by bootstrap resampling. RESULTS: Of all performed total joint arthroplasties, surgical site infection developed in eighty cases (1.31% [95% confidence interval, 1.02% to 1.59%]). The highest rate of surgical site infection was observed in revision total knee arthroplasty (4.57% [95% confidence interval, 2.31% to 6.83%]) followed by revision total hip arthroplasty (1.94% [95% confidence interval, 0.75% to 3.13%]). Among the variables examined, the predictive factors of surgical site infection were higher Charlson Comorbidity Index (odds ratio for a Charlson Comorbidity Index of ≥2, 2.29 [95% confidence interval, 1.32 to 3.94] and odds ratio for a Charlson Comorbidity Index of 1, 2.09 [95% confidence interval, 1.06 to 4.10]), male sex (odds ratio, 1.79 [95% confidence interval, 1.11 to 2.89]), and revision total knee arthroplasty (odds ratio, 3.13 [95% confidence interval, 1.17 to 8.34]), and a higher level of preoperative hemoglobin (odds ratio, 0.85 per point [95% confidence interval, 0.73 to 0.98 per point]) was protective against surgical site infection. The C-statistic of the model was 0.709 without correction and 0.678 after bootstrap correction, indicating that the model has fair predictive power. CONCLUSIONS: Low preoperative hemoglobin level is one of the risk factors for surgical site infection and preoperative correction of hemoglobin may reduce the likelihood of postoperative surgical site infection. LEVEL OF EVIDENCE: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence

Spinal tuberculosis: diagnosis and management.

The spinal column is involved in less than 1% of all cases of tuberculosis (TB). Spinal TB is a very dangerous type of skeletal TB as it can be associated with neurologic deficit due to compression of adjacent neural structures and significant spinal deformity. Therefore, early diagnosis and management of spinal TB has special importance in preventing these serious complications. In order to extract current trends in diagnosis and medical or surgical treatment of spinal TB we performed a narrative review with analysis of all the articles available for us which were published between 1990 and 2011. Althoug h the development of more accurate imaging modalities such as magnetic resonance imaging and advanced surgical techniques have made the early diagnosis and management of spinal TB much easier, these are still very challenging topics. In this review we aim to discuss the diagnosis and management of spinal TB based on studies with acceptable design, clearly explained results and justifiable conclusions

Low rate of infection control in enterococcal periprosthetic joint infections.

BACKGROUND: Enterococcal periprosthetic joint infections (PJIs) are rare after joint arthroplasty. These cases are usually reported in series of PJIs caused by other pathogens. Because few studies have focused only on enterococcal PJIs, management and control of infection of these cases have not yet been well defined. QUESTIONS/PURPOSES: We asked (1) what is the proportion of enterococcal PJI in our institutes; and (2) what is the rate of infection control in these cases? METHODS: We respectively identified 22 and 14 joints with monomicrobial and polymicrobial PJI, respectively, caused by enterococcus. The diagnosis of PJI was made based on the presence of sinus tract or two positive intraoperative cultures. PJI was also considered in the presence of one positive intraoperative culture and abnormal serology. We determined the proportion of enterococcal PJI and management and control of infection in these cases. Minimum followup was 1.5 years (mean, 3.2 years). RESULTS: The proportion of monomicrobial enterococcal PJI was 2.3% (22 of 955 cases of PJI). Mean number of surgeries was two (range, 1-4). Initial irrigation and débridement was performed in 10 joints and eight patients needed reoperation. Seven of the 16 joints were initially managed using two-stage exchange arthroplasty and did not need further operation. Six patients had a definitive resection arthroplasty. Salvage surgeries (fusion and above-knee amputation) were performed in three cases (8%). The infection was ultimately controlled in 32 of the 36 patients. CONCLUSIONS: Management of enterococcal PJI is challenging and multiple operations may need to be performed to control the infection. LEVEL OF EVIDENCE: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence

Transdermal Lidocaine for Perioperative Pain: a Systematic Review of the Literature.

PURPOSE OF REVIEW: The purpose of this review is to provide a summary of the perioperative studies that have examined transdermal lidocaine (lidocaine patch) as an analgesic and put the evidence in context of the likely overall benefit of transdermal lidocaine in the perioperative period. RECENT FINDINGS: Several randomized controlled trials have been published in the past 4 years that concluded transdermal lidocaine can reduce acute pain associated with laparoscopic trocar or cannula insertion. Transdermal lidocaine may reduce short-term pain after surgery in selected surgery types and has a low risk of toxicity but its overall clinical utility in the perioperative setting is questionable. Transdermal lidocaine does not consistently reduce opioid consumption after surgery and has not been shown to improve patient function

Predictors of perioperative blood loss in total joint arthroplasty.

UNLABELLED: UPDATE The print version of this article has errors that have been corrected in the online version of this article. In the Materials and Methods section, the sentence that reads as During the study period, our institution offered preoperative autologous blood donation to all patients who were scheduling for total joint arthroplasty with a hemoglobin level of no less than 11 mg/dL or a hematocrit level of at least 33%. in the print version now reads as During the study period, our institution offered preoperative autologous blood donation to all patients who were scheduling for total joint arthroplasty with a hemoglobin level of no less than 11 g/dL or a hematocrit level of at least 33%. in the online version. In Table III, the footnote that reads as The values are given as the estimate and the standard error in milligrams per deciliter. in the print version now reads as The values are given as the estimate and the standard error in grams per deciliter. in the online version. BACKGROUND: Despite advances in surgical and anesthetic techniques, lower-extremity total joint arthroplasty is associated with considerable perioperative blood loss. As predictors of perioperative blood loss and allogenic blood transfusion have not yet been well defined, the purpose of this study was to identify clinical predictors for perioperative blood loss and allogenic blood transfusion in patients undergoing total joint arthroplasty. METHODS: From 2000 to 2008, all patients undergoing unilateral primary total hip or knee arthroplasty who met the inclusion criteria were enrolled in the study. Perioperative blood loss was calculated with use of a previously validated formula. The predictors of perioperative blood loss and allogenic blood transfusion were identified in a multivariate analysis. RESULTS: Eleven thousand three hundred and seventy-three patients who underwent total joint arthroplasty, including 4769 patients who underwent total knee arthroplasty and 6604 patients who underwent total hip arthroplasty, were evaluated. Multivariate analysis indicated that an increase in blood loss was associated with being male (263.59 mL in male patients who had undergone total hip arthroplasty and 233.60 mL in male patients who had undergone total knee arthroplasty), a Charlson Comorbidity Index of \u3e3 (293.99 mL in patients who had undergone total hip arthroplasty and 167.96 mL in patients who had undergone total knee arthroplasty), and preoperative autologous blood donation (593.51 mL in patients who had undergone total hip arthroplasty and 592.30 mL in patients who had undergone total knee arthroplasty). In patients who underwent total hip arthroplasty, regional anesthesia compared with general anesthesia reduced the amount of blood loss. The risk of allogenic blood transfusion increased with the amount of blood loss in the patients who underwent total hip arthroplasty (odds ratio, 1.43 [95% confidence interval, 1.40 to 1.46]) and the patients who underwent total knee arthroplasty (odds ratio, 1.47 [95% confidence interval, 1.42 to 1.51]), but the risk of blood transfusion increased with the Charlson Comorbidity Index only in patients who underwent total knee arthroplasty (odds ratio, 3.2 [95% confidence interval, 1.99 to 5.15]). The risk of allogenic blood transfusion decreased with preoperative autologous blood donation in patients who underwent total hip arthroplasty (odds ratio, 0.01 [95% confidence interval, 0.01 to 0.02]) and patients who underwent total knee arthroplasty (odds ratio, 0.02 [95% confidence interval, 0.01 to 0.03]). CONCLUSIONS: This study identified some clinical predictors for blood loss in patients undergoing total joint arthroplasty that we believe can be used for implementing more effective blood conservation strategies. LEVEL OF EVIDENCE: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence