320 research outputs found
Rationale of Nail Antibiotic Clothing and "in vivo" animal study
No full textThe study aimed to evaluate a new gentamicin-vancomycin-impregnated (2:1) PMMA coating of an internal fixation device, miniaturized to be tested in a rabbit model of osteomyelitis, to treat bone and intramedullary infections. The device was implanted in rabbit femur, previously infected, and bacteriological, radiological and histologic investigations were performed at 7 weeks after bacterial inoculum. Osteomyelitis of the right femur was induced in general anaesthesia in 20 New Zealand male rabbits with 0.2 ml (total load 106 CFU) of methicillin-resistant Staphylococcus aureus (MRSA) in the femoral canal. Four weeks after inoculum, after debridement of the right femur canal, the animals were divided into 4 groups of 5 animals each and treated according to the following protocols: Group 1, insertion of a steel AISI316 intramedullary nail; Group 2, insertion of a PMMA intramedullary nail loaded with gentamicin and vancomycin; Group 3, no therapy, and Group 4 no fixation device and systemic antibiotic therapy for 1 week with teicoplanin i.m. (20mg/kg b.w. twice daily). At 7 weeks after inoculum, the right femurs were explanted sterilely for radiological (radiological score), microbiological, and histological tests. The radiological score showed that, between the 4 and the 7 weeks, the treatment of Group 2 (p < 0.01) and Group 4 determined an improvement in the injuries produced by the osteomyelitis. The lowest and best radiological score was observed in Group 2 that was significantly different from the other groups. The highest bacterial load in the femoral canal at sacrifice was found in Group 1 which was significantly different from Group 2 and Group 4 (p < 0.05). Finally, concerning the histological score, Group 2 produced a marked improvement (p < 0.005) of the bone injuries induced by the osteomyelitis in comparison with the other groups.
The current findings showed that the gentamicin-vancomycin impregnated PMMA nail might
effectively lead to MRSA infection healing after surgical debridement and immediate implantation
A comparative study of the use of bioactive glass S53P4 and antibiotic-loaded calcium-based bone substitutes in the treatment of chronic osteomyelitis : a retrospective comparative study
No full textThe treatment of chronic osteomyelitis often includes surgical debridement and filling the resultant void with antibiotic-loaded polymethylmethacrylate cement, bone grafts or bone substitutes. Recently, the use of bioactive glass to treat bone defects in infections has been reported in a limited series of patients. However, no direct comparison between this biomaterial and antibiotic-loaded bone substitute has been performed. In this retrospective study, we compared the safety and efficacy of surgical debridement and local application of the bioactive glass S53P4 in a series of 27 patients affected by chronic osteomyelitis of the long bones (Group A) with two other series, treated respectively with an antibiotic-loaded hydroxyapatite and calcium sulphate compound (Group B; n = 27) or a mixture of tricalcium phosphate and an antibiotic-loaded demineralised bone matrix (Group C; n = 22). Systemic antibiotics were also used in all groups. After comparable periods of follow-up, the control of infection was similar in the three groups. In particular, 25 out of 27 (92.6%) patients of Group A, 24 out of 27 (88.9%) in Group B and 19 out of 22 (86.3%) in Group C showed no infection recurrence at means of 21.8 (12 to 36), 22.1 (12 to 36) and 21.5 (12 to 36) months follow-up, respectively, while Group A showed a reduced wound complication rate. Our results show that patients treated with a bioactive glass without local antibiotics achieved similar eradication of infection and less drainage than those treated with two different antibiotic-loaded calcium-based bone substitutes
Serum deoxyribonuclease and ribonuclease in pancreatic cancer and chronic pancreatitis.
No full textSerum ribonuclease (RNase) and deoxyribonuclease (DNase) were investigated in 18 control subjects, and in 22 patients with pancreatic cancer, 13 with chronic pancreatitis and 29 with extrapancreatic diseases in order to assess their clinical usefulness in pancreatic cancer diagnosis and to evaluate whether modifications were consensual and/or age-related. Increased DNase and RNase values were found not only in a notable proportion of pancreatic cancer, but also in chronic pancreatitis and extra-pancreatic diseases. Thus the clinical value of both enzymes in pancreatic cancer diagnosis is negligible. DNase does not seem to be strictly age-dependent, whereas serum RNase does. Elevated levels of the two enzymes, when present, were consensual, suggesting that factors involved in such an increase were partially common to both
Left ventricular hypertrophy and cardiovascular risk stratification : impact and cost-effectiveness of echocardiography in recently diagnosed essential hypertensives
No full textBACKGROUND: Echocardiography is more accurate than electrocardiography in the assessment of cardiac target organ damage related to hypertension, thus leading to a more precise stratification of total cardiovascular risk. However, ultrasound examination of the heart on a routine basis remains a matter of debate. OBJECTIVE: To evaluate the impact and cost-effectiveness of echocardiographic examination on global risk stratification in low and medium-risk hypertensive patients in relation to age and sex. METHODS: A total of 580 untreated hypertensive individuals (355 men and 225 women, mean age 47.8 ± 11.4 years), classified at low to medium risk, according to routine clinical work-up suggested by the 2003 European Society of Hypertension/European Society of Cardiology guidelines, were included in the study. Total risk was reassessed by adding the results of ultrasound examination of the heart. Left ventricular hypertrophy (LVH) was defined as a left ventricular mass index of 125 g/m or more in men and 110 g/m or more in women. The impact of LVH in stratifying risk was assessed according to age (< 50 and ≥ 50 years) and sex. RESULTS: According to routine classification, 16.3% (n = 93) of the 580 patients were considered to be at low added risk and 83.7% (n = 487) at medium added risk. In the whole population, echocardiographic LVH was found in 86 patients (14.8%) who were then reclassified in the high-risk stratum. The prevalence rates of patients reclassified in the high-risk class as a consequence of LVH detection, according to age and sex, were as follows: 8.9% in men under 50 years, 12.3% in women under 50 years, 26.7% in men aged 50 years and over and 15.3% in women aged 50 years and over. The cost per detected case of LVH was €595 in patients under 50 years of age and €290 in those 50 years of age and older. CONCLUSIONS: Our findings indicate that the prevalence of LVH, and consequently the probability of upgrading the total cardiovascular risk profile, is highest in the group of old hypertensive men; echocardiography has a limited impact on the risk reclassification in younger patients and an unfavourable cost-effectiveness profile. Our data thus do not support the systematic ultrasound assessment of the heart in all uncomplicated hypertensive individuals
Carotid atherosclerosis and cardiovascular risk stratification : role and cost-effectiveness of echo-doppler examination in untreated esseential hypertensives
No full textObjective. To investigate the impact and cost-effectiveness of carotid ultrasonographic examination on total risk stratification in low-medium risk hypertensive patients in relation to age (<50 and ≥50 years) and gender. Methods. Five hundred and eighty untreated hypertensives classified at low-medium risk, after the routine work-up recommended by the 2003 ESH/ESC guidelines, were included in the study and total risk was reassessed by adding the results of carotid ultrasonography. Results. According tothe stratification based on routine work-up 16.3% of the whole population was considered at low added risk and 83.7% at medium added risk. Carotid subclinical damage was found in 158 patients (27.0%), who were then reclassified in the high-risk stratum. Prevalence rates of patients reclassified in the high-risk stratum as a consequence of carotid damage were as follows: 12.6% in men <50 years, 14.1% in women <50 years, 53.0% in men ≥50 years and 40.1% in women ≥50 years. The cost per detected case of carotid atherosclerosis was €473 in patients <50 years and €133 in those ≥50 years. Conclusions. Our results show that: (i) the use of carotid ultrasonography allows a much more accurate identification of high-risk individuals; (ii) its impact and cost-effectiveness on the risk stratification process differs markedly according to the age and gender; (iii) the selective use of this procedure in subjects at high risk of target organ damage may substantially improve the cost of primary prevention
Prevalence and correlates of advanced retinopathy in a large selected hypertensive population. The Evaluation of Target Organ Damage in Hypertension (ETODH) study
No full textObjective. To describe the prevalence of advanced retinal microvascular lesions and their associations with cardiac and extracardiac signs of target organ damage (TOD) in a large selected hypertensive population. Methods. A total of 2172 nondiabetic untreated and treated uncomplicated essential hypertensives consecutively attending for the first time our hospital outpatient hypertension clinic and included in the Evaluation of Target Organ Damage in Hypertension (ETODH), an observational ongoing registry of hypertension-related TOD, were considered for this analysis. Advanced hypertensive retinopathy was defined by the presence of any of the following lesions: flame-shaped haemorrhages, soft exudates or cotton wool spots and papilloedema. Left ventricular hypertrophy (LVH), carotid structural abnormalities, such as plaques and intima media (IM) thickening, and microalbuminuria were diagnosed according to the 2003 ESH/ESC guidelines criteria. Results. Among the whole study population, 33 patients (1.5%) were found to have advanced hypertensive retinopathy. Patients with these retinal lesions were similar to those without for age, body mass index, known duration of hypertension, smoking habit, total serum cholesterol, fasting blood glucose and prevalence of antihypertensive treatment, whereas mean systolic and diastolic blood pressures were higher in the former group. The prevalence rates of LVH, carotid plaques, carotid IM thickening and microalbuminuria in patients with and without retinopathy were 57%, 67%, 69%, 19% and 25%, 47%, 44%, 12%, respectively. In a multivariate logistic regression analysis, advanced retinopathy was significantly associated with LVH (OR=4.0), carotid IM thickening (OR=2.9), carotid plaques (OR=2.8), but not with micro albuminuria. Conclusions. Our study indicates that: (i) advanced retinopathy is a rare finding in non-diabetic hypertensive patients seen in a specialist setting, (ii) a strong relation exists between retinal microvascular lesions and cardiac and macrovascular markers of TOD
Reproducibility of dipping/nondipping pattern in untreated essential hypertensive patients : impact of sex and age
No full textOBJECTIVE: We aimed to evaluate the intrasubject short-term reproducibility of nocturnal blood pressure patterns (dipping/nondipping) in essential hypertensive patients in relation to age (<50 and ≥50 years) and sex. METHODS: A total of 619 never-treated essential grade 1 and 2 hypertensive patients (383 men, 236 women) underwent the following procedures: (1) repeated clinic blood pressure measurements, (2) routine examinations, (3) ambulatory blood pressure monitoring over two 24-h periods within 4 weeks. Dipping pattern was defined as a 10%, or more, reduction in average systolic blood pressure/ diastolic blood pressure at night compared to daytime values. RESULTS: Of the 407 patients showing a dipping pattern during the first ambulatory blood pressure monitoring period, 329 (80.1%) had the same pattern during the second ambulatory blood pressure monitoring recording. Of the 212 patients with a nondipping pattern during the first ambulatory blood pressure monitoring period, 140 (65.9%) confirmed the same pattern during the second ambulatory blood pressure monitoring period. Overall, 149 patients (24.1%) changed their initial nocturnal pattern at the second ambulatory blood pressure monitoring recording, without significant age and sex-related differences. Lower reproducibility rates of the nondipping as compared to the dipping pattern were found in the whole population as well as in men regardless of age and in younger but not in older women. CONCLUSIONS: These findings indicate that nocturnal blood pressure patterns have a limited short-term reproducibility in the whole study population as well as in different age and sex subgroups. As variability of nocturnal blood pressure patterns is not predicted by easy available clinical data, such as sex and age, a reliable classification of patients according to circadian blood pressure patterns should be obtained by repeating ambulatory blood pressure monitoring
L'indicizzazione della massa ventricolare sinistra (MVS) per la superficie corporea sottostima la prevalenza di ipertrofia ventricolare sinistra (IVS) negli ipertesi essenziali
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