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Biomedical subjects

Frank J Eismont

Publications and source records attributed to Frank J Eismont.

9 recordsLinked to original sources
PubMed2006

Efficacy of linezolid versus vancomycin in the treatment of methicillin-resistant Staphylococcus aureus discitis: a controlled animal model.

STUDY DESIGN: A rabbit model was used to assess the efficacy of linezolid and vancomycin for the treatment of discitis due to methicillin-resistant Staphylococcus aureus (MRSA). Nontreated controls were used for comparison. OBJECTIVE: The purpose of this study was to determine if there was a therapeutic difference between using linezolid and vancomycin in the treatment of MRSA discitis. SUMMARY OF BACKGROUND DATA: Vancomycin is currently the gold standard treatment for medical management of MRSA discitis. Linezolid is a relatively new drug that has been approved for treatment of MRSA infections, but currently there is no research demonstrating its efficacy at treating infections of the disc space. METHODS: Twenty-four rabbits were inoculated with MRSA at two adjacent lumbar disc spaces via an anterior retroperitoneal approach. Six rabbits were to receive only pain medication and to serve as controls. Ten rabbits were assigned to a 5-day course of intravenous vancomycin, and 8 were assigned to a 5-day course of intravenous linezolid. Disc spaces were sent for quantitative culture after the 5-day treatment course. RESULTS: The mean culture growth for the disc spaces was not statistically different between the linezolid treated group and the nontreated controls. While vancomycin treatment did lead to lower bacterial loads when compared with controls, the reduction was not statistically significant. When bacterial counts for the vancomycin group and linezolid group were compared, vancomycin treatment resulted in less bacterial growth. This difference was statistically significant. CONCLUSIONS: Linezolid is a clinically attractive alternative to vancomycin due to its mild side effect profile and oral bioavailability. However, in this MRSA discitis model with a short treatment course, vancomycin was superior to linezolid.

Acetamides↗
PubMed2006

Oncologic and functional outcome following sacrectomy for sacral chordoma.

BACKGROUND: Sacral chordoma is a rare, low to intermediate-grade tumor that poses substantial challenges in terms of timely diagnosis and adequate treatment. Few studies have examined the oncologic and functional outcomes of patients treated for sacral chordoma. METHODS: The clinical records of sixteen patients who had undergone sacrectomy for chordoma between 1985 and 2001 were evaluated retrospectively. All patients underwent resection by means of a sequential combined anterior and posterior approach. Patients were followed clinically at six-month intervals following recovery from the index surgical procedure. The disease onset, treatment, hospital stay, recurrence rates, survival, adjuvant therapy, functional outcome measures, and complications were evaluated. RESULTS: The average age at the time of diagnosis was sixty-one years. The mean tumor size was 15.2 cm in diameter, and all patients had a resection involving S1 or S2. The mean duration of follow-up was sixty-six months, and the tumor recurred in twelve of the sixteen patients. The mean time to metastasis was fifty months. Four patients were clinically disease-free at a mean follow-up of 94.5 months, while five patients died as a result of progressive local or metastatic disease at a mean follow-up of 31.4 months. Only one patient had normal bowel and bladder control postoperatively, and only three were able to walk without assistive devices. Eight patients had wound complications, and one patient had a deep-vein thrombosis. With the numbers available, neither negative margins at the time of initial tumor resection nor adjuvant radiation therapy had a significant impact on survival or local recurrence. More cephalad levels of resection were associated with significantly worse bowel (p = 0.01) and bladder (p = 0.01) control. Complications were frequent and were more common with a larger tumor size at the time of presentation (p = 0.034). CONCLUSIONS: The treatment of sacral chordoma is an arduous clinical undertaking that requires a multidisciplinary approach and attention to detail from the outset. Despite aggressive well-planned surgical management and adherence to strict surveillance protocols, frequent recurrence and the late onset of metastatic disease are to be expected in a substantial proportion of patients, especially those with a very large chordoma or one at a more cephalad level. Adequate surgical treatment results in substantial functional impairment and numerous complications; however, it does offer the possibility of long-term disease-free survival. We advocate an attempt at complete resection, when there is still a possibility of cure, and aggressive treatment of local recurrences. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.

Adolescent↗
PubMed2005

Infections of the spine in patients with human immunodeficiency virus.

BACKGROUND: Musculoskeletal infections in patients with the human immunodeficiency virus (HIV) have been described. However, the prevalence, specific characteristics, and outcomes of spinal infections in these patients have not been studied in a large group of patients to our knowledge. METHODS: The computerized records of all patients discharged with the diagnosis of spinal osteomyelitis, discitis, epidural abscess, or tuberculosis from our institution from October 1994 through September 2000 were reviewed. Patients with the diagnosis of HIV were identified, and the charts were examined in detail. RESULTS: During the six-year period, 7338 unique patients who were HIV positive were admitted. Seventeen (0.23%) of them were treated for a spinal infection. The prevalence of spinal infection was 23.2 per 10,000 admissions of HIV-positive patients and 7.1 per 10,000 admissions of HIV-negative patients (p < 0.0001). Eight patients who had discitis and/or osteomyelitis had a mean CD4 T-cell count of 339.6 cells/mm(3), and all eight had clinical resolution of the infection after six to twelve weeks of appropriate antibiotic therapy. In contrast, six patients who had spinal tuberculosis had a mean CD4 count of 75.7 cells/mm(3) (p = 0.005), and one of them died during the hospitalization. The remaining three patients, who had epidural abscesses, had a mean CD4 count of 20.67 cells/mm(3) (p = 0.001), and two of them died. CONCLUSIONS: Discitis and/or osteomyelitis occurs in HIV-positive patients with a mild-to-moderate decrease (>/=200 cells/mm(3)) in the CD4 T-cell count, and the infection responds to appropriate antibiotics. Patients with a more severely decreased CD4 count (50 to 200 cells/mm(3)) may have spinal tuberculosis develop, and patients with the lowest CD4 counts are more likely to have epidural abscesses develop. The three fatalities in this study occurred in these two groups of patients. As a group, HIV-positive patients are significantly more likely to have a spinal infection develop than are HIV-negative patients (p < 0.0001). Although the CD4 count can be used as a predictor of the clinical course, identification of the organism remains paramount in the treatment of this complex patient population.

AIDS-Related Opportunistic Infections↗
PubMed2004

Antifungal penetration into normal rabbit nucleus pulposus.

STUDY DESIGN: A rabbit model was used to assess the penetration into the nucleus pulposus of 3 commonly used antifungal medications: amphotericin B, amphotericin B lipid complex, and fluconazole. OBJECTIVES: The purpose of this study was to quantitate the penetration of antifungal medications into the normal rabbit nucleus pulposus. SUMMARY OF BACKGROUND DATA: Fungal infections of the spine are rarely, if ever, treated with medical management alone. Although antibiotic penetration into the nucleus pulposus has been studied extensively, no previous studies have attempted to quantitate the penetration of antifungals into the nucleus pulposus. METHODS: Twenty-four rabbits were given 2 doses of 1 of the antifungal medications studied. One hour after completion of the second dose, the animal was killed and the thoracolumbar spine was excised en bloc. Specimens of nucleus pulposus and serum were obtained and sent to an outside laboratory for analysis. Gas chromatography was used to determine the fluconazole tissue levels, and a bioassay was used to measure amphotericin B tissue levels. RESULTS: Three animals in the amphotericin B group died either after the first or second dose of medication was administered. Although amphotericin B and amphotericin B lipid complex did not show adequate penetration into the nucleus pulposus in 12 out of 12 animals, fluconazole reached therapeutic tissue levels in 5 out of 7 animals. CONCLUSIONS: Fluconazole showed superior penetration into the nucleus pulposus in an uninfected rabbit model when compared to amphotericin B and amphotericin B lipid complex. These findings were found to be statistically significant (P = 0.021), and they suggest that fluconazole may be a better choice for empiric therapy of fungal spine infections while cultures and sensitivities are pending.

Amphotericin B↗
PubMed2004

Cervical spine and spinal cord injuries: recognition and treatment.

Cervical spine injuries are frequently encountered in any practice treating patients in the emergency department or outpatient trauma victims. When upper or lower cervical spine injuries are suspected, immediate immobilization, physical and neurologic examination, and radiographic evaluation are imperative. For spinal cord injuries, knowledge of microscopic and cellular pathology helps to determine appropriate management.

Cervical Vertebrae↗
PubMed2002

Surgical options for the treatment of cervical spondylotic myelopathy.

Cervical spondylotic myelopathy is a disease of the cervical spinal cord that results from circumferential compression of the degenerative cervical spine, often in a congenitally narrow spinal canal. Surgical recommendations must be based on patient characteristics, symptoms, function, and neuroradiologic findings. ACDF is an excellent option for one- or two-level spondylosis without retrovertebral disease. Anterior corpectomy and strut grafting may provide an improved decompression and is ideal for patients with kyphosis or neck pain. Laminectomy historically yields poor results from late deformity and late neurologic deterioration but yields improved results with good surgical technique. Laminoplasty was developed to address cervical stenosis of three or more segments and compares favorable with anterior corpectomy and fusion for neurologic recovery. Laminoplasty has a lower complication rate than corpectomy and strut grafting but has a higher incidence of postoperative axial symptoms.

Cervical Vertebrae↗
PubMed2002

Orthopaedic recertification.

This report summarizes a symposium presented at the 2001 Annual Meeting of the American Orthopaedic Association that was designed to assess the current status of recertification by the American Board of Orthopaedic Surgery (ABOS) and to determine how it will change in the near future. Recertification is a process whereby the general public is assured of quality medical care by a competent and knowledgeable physician. As a professional organization, we have an obligation to provide quality care. The nature of the public demand for standards ensuring competence and the history of recertification in orthopaedic surgery are examined. The recertification of commercial airline pilots is reviewed, as it provides a model of an unrelated but highly skilled profession requiring intellectual and technical proficiency. The goals and plans of the American Board of Medical Specialties (ABMS), which encompasses the views of all twenty-four major specialty boards including orthopaedic surgery, are reviewed. Finally, the future plans of the ABOS for recertification are considered.

Certification↗