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Biomedical subjects

D Seligson

Publications and source records attributed to D Seligson.

At least 73 records · Page 4Linked to original sources
PubMed1993

Long-term implantation of gentamicin-polymethylmethacrylate antibiotic beads.

Fifty-two chronic osteomyelitis patients treated with gentamicin-polymethylmethacrylate (Septopal) antibiotic bead chains were observed retrospectively to explore the relationship between the duration of bead implantation and clinical results. Group A contained 35 asymptomatic patients who had elective bead removal based on protocol, surgeon's preference, and patient variables. Group B consisted of 17 patients who retained the antibiotic beads. The presence or absence of redness, abscess, drainage, pain, or swelling at the wound site was documented for clinical evaluation. Findings indicate that Septopal bead chain implants exhibit higher success (remission) rates with increasing length of duration without increasing the risk of complications.

Adult↗
PubMed1993

The antibiotic bead pouch technique. The management of severe compound fractures.

In a consecutive series of 704 compound fractures, 227 open fractures in 204 patients were managed with the antibiotic bead pouch technique. There were 16 Grade I compound fractures, 83 Grade II fractures, and 128 Grade III open fractures. The mean patient age was 35.25 years (range, 14-87). The Injury Severity Score (ISS) ranged from 9 to 57, with a mean of 15. Porous plastic film is placed over the soft-tissue defect to establish a "closed" bead-hematoma-fracture environment containing high local levels of antibiotic at the fracture site. All patients had serial wound debridements and parenteral systemic antibiotics (cefazolin, tobramycin, penicillin). Bead pouch changes ranged from one to seven per patient (mean, two). During these changes, 1248 cultures were taken, 78 (6.25%) of which were positive in 34 patients. Seventeen patients developed clinical signs consistent with an infection. The wound infection rate was 0% in Grade I open fractures, 1.2% in Grade II compound fractures, and 8.6% in Grade III open fractures. The osteomyelitis rate was 0% in Grade I compound fractures, 2.4% in Grade II open fractures, and 5.5% in Grade III compound fractures. Wound closure was obtained in 134 fractures with delayed primary closure of the skin, in 53 fractures with flap coverage, and in 23 fractures with split-thickness skin graft. Coverage was not completed in 17 wounds, at which time an amputation was performed or death occurred. Time of closure ranged from one to 32 days (mean, 7.1 days).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1993

Comparison of the clinical efficacy and tolerance of gentamicin PMMA beads on surgical wire versus combined and systemic therapy for osteomyelitis.

These data do not prove a statistical superiority of conventional antibiotics or Septopal in the treatment of chronic osteomyelitis. This result, however, is complicated by the biased data set represented by the combined treatment. The data do suggest that cost of treatment is considerably less in patients who are treated with local antibiotics (i.e., Septopal) alone. The rate of adverse experiences was directly related to the use of parenteral antibiotics, with higher rates of adverse experiences in the conventional and combined treatment groups. Furthermore, the Cierny-Mader Physiologic Class had the best correlation with outcome, suggesting that host factors are probably of critical importance in inducing remission of chronic osteomyelitis. This protocol was not designed to test the role of debridement in the treatment of osteomyelitis: it was assumed that debridement would be the same in both groups. It is the investigators' strong opinion, however, that adequacy of debridement was an important determinant in quiescence or recurrence in the study patients. Similarly, there was no strict control for adequacy of soft-tissue coverage provided by local or distant tissue transfer. Again, the investigators believe that adequacy, including viability and durability, of soft-tissue covering was an important determinant for the end result in these patients. Other covariants such as smoking, history, nutritional status, and other measures of general health will be added to this model when data are available. This analysis will allow definition of the appropriate clinical situations in which use of Septopal alone or combined with parenteral antibiotic is indicated.

Anti-Bacterial Agents↗
PubMed1992

The use of antibiotic-impregnated polymethylmethacrylate beads to prevent the evolution of localized infection.

The effect of antibiotic bead chains on the evolution of infection cannot be studied entirely in man due to the ethical problems of obtaining valid controls. Therefore, a model of musculoskeletal injury was devised in rabbits by making a paraspinal wound, fracturing a spinous process, and contaminating the wound with 1 x 10(4) colony-forming units/ml of Staphylococcus aureus. These contaminated wounds were treated with tobramycin-containing polymethylmethacrylate (PMMA) beads. Control rabbits were either treated with PMMA beads that did not contain antibiotic, treated with IM tobramycin, or left untreated. At 5 days, six of eight animals treated with antibiotic-impregnated beads had no recoverable organisms. Six of eight rabbits receiving IM tobramycin had wound infections, and five of five in whom non-antibiotic-containing beads had been implanted had significant wound infections, with one of the five dying of sepsis on the 3rd day of the experiment. The clinical course of infected controls was the same as the course of those animals receiving IM antibiotics and the same as those in whom beads without antibiotics were implanted. That is, the rabbits had grossly infected wounds and the organisms recovered were of the same type as those implanted. This research shows a highly statistically significant effect of tobramycin-containing antibiotic beads in retarding the evolution of an experimental Staphylococcus infection in rabbits.

Animals↗
PubMed1992

[Treatment of type II B open fracture--therapeutic regimen and results].

A consecutive series of 119 type III B compound fractures in 103 patients was treated at the University of Louisville from May 1983 to May 1989. All patients had timely irrigation of their wounds, serial wound debridements, external skeletal stabilization and parenteral systemic antibiotics (penicillin, cefazolin, tobramycin). 96 open fractures were managed with the supplemental local use of tobramycin-PMMA-beads. There were 13.5% wound infections and 10.1% osteomyelitis observed. The additional local antibiotic therapy was of significant (p less than 0.001, p less than 0.025) benefit to lower both infectious complications. The amputation rate was overall 5%, 9.7% for the lower leg. Four patients died due to multiple trauma.

Adolescent↗
PubMed1992

Bacterial adherence to plain and tobramycin-laden polymethylmethacrylate beads.

Antibiotic-impregnated polymethylmethacrylate (PMMA) bead chains are in current clinical use for prophylaxis and management of osteomyelitis. The in vivo interaction between PMMA beads and an experimentally infected wound is examined. Two modes of bacterial adherence to plain PMMA beads are demonstrated. In this report, tobramycin-sensitive bacteria did not attach to tobramycin-laden beads. Therefore, implanted PMMA beads should contain an antibiotic to which the infecting bacteria is sensitive.

Animals↗
PubMed1991

Treatment of compound fractures.

Management of compound fractures remains a challenge to the surgeon. Methods to decrease patient morbidity include early fracture stabilization and sequential débridement. External fixation remains the standard; however, early internal fixation in low-grade injuries may be an acceptable option. Early soft tissue coverage is critical. The use of prophylactic parenteral antibiotics has decreased the incidence of acute infection and chronic osteomyelitis. Supplemental use of local antibiotic polymethyl methacrylate (PMMA) beads appears to further diminish the morbidity in high-grade open fractures.

Administration, Topical↗
PubMed1991

Management of supracondylar fractures of the femur with the GSH intramedullary nail: preliminary report.

The GSH supracondylar nail is a closed section rigid intramedullary device that combines the biomechanical advantages of intramedullary fixation with the stability of rigid internal fixation for the management of supracondylar fractures of the femur. The use of this implant is indicated in the management of distal comminuted nonarticular fractures and fractures with intraarticular extension. Intramedullary fixation provides improved fracture stabilization in both elderly patients with osteoporotic metaphyseal bone and in younger patients with extensively comminuted fractures. The experience with the GSH supracondylar nail has shown that it provides better results than supracondylar plating for the stabilization of acute fractures or revision of failed internal fixation.

Adult↗
PubMed1991

Malgaigne's fracture: the Larrey variant--a case report.

A rare Malgaigne fracture with caudal displacement of the acetabular section is presented. This variant has not received significant mention in existing literature. It is important because it changes the approach to initial stabilization. Treatment is best accomplished with ORIF and placement of a sacral bar. Significant complications would occur if this variant were mistaken and treated with traction.

Accidents, Traffic↗
PubMed1991

Factors in pin tract infections.

To determine the factors pertinent to the etiology of pin tract infections, 214 pins in 42 patients were examined prospectively at the time of pin removal. Eighty-nine (41.6%) pin tracts were inflamed, 49 (22.9%) pins had loose anchorages, and 160 (74.8%) pin tips cultured positive for bacteria. The predominant organism cultured was Staphylococcus epidermidis (90.6%), considered nonvirulent, followed by virulent Staphylococcus aureus (37.5%), and Escherichia coli (9.4%). There were 32 loose, inflamed pin tracts. This correlation was statistically significant (P less than .005). There were 40 loose pins whose pin tips had positive cultures. Loose pins correlated for infection with virulent species of bacteria at a highly significant level (P less than .005). Results demonstrate that most pins possess bacterial colonization. Clinically, this means that either inflamed pin tracts or pins with cultures positive for invasive organisms are probably loose and should be removed. Also, mechanical factors are the critical variable in determining the flora of external fixation pins.

Adolescent↗
PubMed1991

Multicenter trial of Collagraft as bone graft substitute.

Collagraft (Zimmer and Collagen Corporation) consists of a mixture of porous beads composed of 60% hydroxyapatite and 40% tricalcium phosphate ceramic and fibrillar collagen. When mixed with autogenous bone marrow, it serves as an effective bone graft substitute. Since September 1986, this material has been used in a multiclinic prospective trial, randomized against cancellous iliac crest autografts in the treatment of long bone fractures. To date, 267 patients have entered this study with 128 patients receiving cancellous autograft and 139 patients receiving Collagraft. At 6- and 12-month follow-ups, Collagraft appears to function as well as autogenous graft when used in the treatment of acute long bone fractures.

Adolescent↗
PubMed1991

Antibiotic-impregnated beads. Part I: Bead implantation versus systemic therapy.

Parenteral antibiotic therapy for acute bone infections, soft-tissue infections, and osteomyelitis may result in high serum concentrations associated with nephrotoxic, ototoxic, and allergic complications. Conversely, the local release of antibiotics into the wound with the use of antibiotic-impregnated cement or antibiotic-impregnated polymethylmethacrylate beads has been found effective and does not induce negative effects or result in systemic concentrations of clinical significance. The antibiotic-impregnated cement beads are fabricated on a surgical steel wire, and they have bimodal elution properties. They provide local antibiotic concentrations that surpass the minimum inhibitory concentrations for pathogens commonly isolated in orthopaedic infections. Their use effectively controls chronic osteomyelitis and acute musculoskeletal infections. Compared with systemic antibiotic therapy, the incidence of nephrotoxic, ototoxic, and hypersensitivity reactions is significantly diminished. The beads release 5% of the antibiotic within the first 24 hours. The sustained elution then progressively diminishes to undetectable levels within a few weeks or months.

Anti-Bacterial Agents↗
PubMed1991

Antibiotic-impregnated beads. Part II: Factors in antibiotic selection.

Part I of this series discussed the advantages of implanted antibiotic-impregnated polymethylmethacrylate beads over systemic therapy for managing chronic osteomyelitis and acute musculoskeletal infections. Numerous antibiotics are available for use in polymethylmethacrylate. However, specific characteristics should be considered prior to therapeutic selection: the antibiotic should be water-soluble, bactericidal, nontoxic to tissues, and readily available in powder form. In this concluding segment, the organisms most commonly cultured from orthopaedic infections and appropriate combinations of antibiotics and bone cements are outlined.

Aminoglycosides↗
PubMed1990

What's in a nail?

To determine the incidence of subclinical infection using routine swab methods in asymptomatic patients, 30 consecutive hollow intramedullary nails were studied. Variables identified were leukocyte count and differential, patient complaints, time elapsed from injury to nail implantation, duration of nail implantation, and the size of the nail. Specimens were gathered from the lumen of intramedullary nails using the routine swab method for bacterial culture as well as fungal and acid-fast growth. This material was also subjected to pathologic review with routine hematoxylin and eosin staining. There were no significant positive cultures in this study. The pathologic review indicated that the material in the canal of an intramedullary nail was either granulation tissue, fibrous tissue, or osseous tissue. No patient had a deep or superficial wound infection after implant removal. The results of this study indicate that the material in the lumen of the hollow intramedullary nail will fail to grew organisms when the swab method is used in gathering the specimen or the material is sent for quantitative bacteriology.

Adolescent↗
PubMed1990

The prophylactic use of antibiotic impregnated beads in open fractures.

Four hundred four compound fractures were reviewed in 339 patients treated between August 1983 and November 1987. The 252 males and 87 females had a mean age of 33 years (range, 14-86). One hundred twenty-seven (31.4%) fractures were classified as Grade I, 153 (38.9%) as Grade II, and 124 (30.7%) as Grade III by Gustilo's classification. The mean Injury Severity Score was 15 (range, 9-57). Three hundred thirty-four of the open fractures (82.7%) were managed with antibiotic-impregnated bead chains (tobramycin) and systemic antibiotic prophylaxis (cefazolin, tobramycin, and penicillin). Seventy open fractures (17.3%) received systemic antibiotic prophylaxis (cefazolin, tobramycin, and penicillin) without supplemental use of the antibiotic beads. All open fractures underwent acute irrigation and debridement. In the 404 fractures 46.5% of wounds were closed primarily, 12.9% underwent delayed primary closure, 7.9% were left open, and 32.7% were temporized by the antibiotic bead pouch technique until definitive flap coverage and skin grafting were performed. Of the 404 fractures evaluated, 17 (4.2%) developed an acute wound infection. Of these wound infections, eight (11.4%) were in the group managed with systemic antibiotics alone. By comparison, nine (2.7%) of open fractures treated with combined systemic antibiotics and antibiotic-impregnated beads developed an infection. Chronic osteomyelitis developed in 18 of 404 open fractures (4.5%). Ten (14.3%) open fractures which developed osteomyelitis were managed with systemic antibiotics whereas eight (2.4%) fractures managed with systemic antibiotics and antibiotic-impregnated beads developed a chronic infection.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Topical↗
PubMed1990

A preliminary experience: the Ilizarov external fixator.

The Ilizarov external fixator, though developed over 35 years ago in the Soviet Union, is only now gaining popularity in the United States. Its design and versatility allow the physician to treat a wider range of limb maladies than other external fixation systems (eg, the Hoffmann device). The Ilizarov method of fixation also permits treatment of some orthopedic conditions that were previously considered to be untreatable, such as dwarfism. The device can be used to correct limb length discrepancies, manage open and closed fractures, nonunions, and bony or soft tissue deformities. A review of the first 25 cases performed at the University of Louisville revealed 15 which have been successfully completed with significant, but manageable complications, and 10 cases which are still in progress.

Adult↗