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Biomedical subjects

G Cierny

Publications and source records attributed to G Cierny.

At least 37 records · Page 2Linked to original sources
PubMed1987

Indium-111 chloride imaging with ununited fractures.

Twenty patients with ununited fractures and a suspicion of infection had In-111 chloride imaging. Surgically obtained cultures were positive for infection in 12 and negative in eight patients. In-111 chloride images were positive in all 12 patients with infection but also were positive in six of the patients with negative cultures. It is not possible to differentiate infected from noninfected ununited fractures by In-111 chloride imaging.

Fractures, Ununited↗
PubMed1987

Inpatient and outpatient use of the Hickman catheter for adults with osteomyelitis.

One hundred five Hickman catheters were inserted in 96 patients with a diagnosis of osteomyelitis. There were 78 men and 18 women with a mean age of 36.4 years. The catheters were present for a total of 6903 days with a mean of 66.4 days. Sixty-five percent of the catheters were used for outpatient as well as inpatient antibiotic therapy. The mean duration of outpatient antibiotic therapy was 30 days. Nine patients had more than one catheter inserted. The overall complication rate was 20% (21/105 catheters). The infectious complication rate was 11/105 (10.5%) or 0.16/100 catheter days. The noninfectious complication rate was 10/105 (9.5%) or 0.14/100 days. The catheter had to be removed prematurely before the completion of antibiotic therapy in only five of the 105 (4.8%) catheter insertions. The Hickman catheter is a safe and effective intravenous access device for long-term antibiotic therapy in patients with osteomyelitis. Inpatient management and intravenous antibiotic therapy are facilitated by a stable and long-term access to the venous circulation. The simplicity of the device also enables it to be used in the outpatient setting, reducing the time of hospitalization and the costs of treatment.

Adolescent↗
PubMed1987

Pseudoallescheria boydii soft tissue abscess.

Pseudoallescheria boydii, a fungus often isolated from soil, commonly causes a mycetoma. Successful treatment involves resection of the infected area and appropriate antifungal chemotherapy. In vitro sensitivity of P. boydii to miconazole is usually demonstrated, but resistance to amphotericin B and 5-fluorocytosine is often observed. Limited data are available on the treatment of this infection with ketoconazole. An usual case of nontraumatic P. boydii soft tissue infection without draining sinus tracts occurred in a 50-year-old woman. Nontraumatic P. boydii soft tissue infection was diagnosed by cytologic preparation and fungal cultures of the aspirate. The patient was successfully treated with en bloc resection for four months of oral ketoconazole.

Abscess↗
PubMed1985

Indium-111 chloride imaging in chronic osteomyelitis.

Sixty-eight patients with clinically suspected chronic osteomyelitis were studied with [111In]chloride. Fifty-four images were categorized as true positive; seven were categorized as true negative. There were four false-positive studies, two of which were associated with healing cancellous bone grafts. There were three false-negative studies in patients previously treated with long-term antibiotic therapy. Images in eight noninfected healing fractures 3 to 8 mo old were normal. Three patients with infected total hip prostheses had positive images. Two patients with loose prostheses had negative images. This study shows that [111In]chloride imaging is an accurate way to localize chronic osteomyelitis and may overcome some of the disadvantages of [67Ga]citrate such as localization in noninfected healing fractures and in some loose [67Ga]citrate such as localization in noninfected healing fractures and in some loose prostheses.

Adolescent↗
PubMed1985

Indium-111 chloride imaging in the detection of infected prostheses.

Thirty-three patients with painful joint prostheses and a suspicion of infection were imaged with [111In]chloride. A final diagnosis was established by culture in 19. Of these, 12 were categorized as true positives and three as true negatives. There were two false-positive studies, occurring in patients with knee prostheses. In both, the culture was obtained by aspiration. Two false negatives were in patients with hip prostheses, one of whom had been on long-term antibiotic suppressive therapy. The sensitivity was 86%, specificity 60%, and accuracy 79%. Seventeen of the proven cases had bone imaging prior to [111In]chloride imaging. All 17 static images were positive and were not helpful in differentiating loosening from infection. Using increased uptake on the blood-pool image as a criteria for infection, the sensitivity was 89%, but the specificity was 0. Adding flow studies made little difference in interpreting the blood-pool images. This study shows that [111In]chloride accurate in evaluating infection in prosthesis than bone imaging.

Adult↗
PubMed1985

Methicillin-resistant Staphylococcus aureus osteomyelitis.

In five patients, the diagnosis of methicillin-resistant Staphylococcus aureus (MRSA) osteomyelitis was made by clinical and roentgenographic methods and confirmed by bone biopsy cultures. The treatment was staged according to the anatomic setting of the infection and the systemic and local competence of the host. Seven episodes of osteomyelitis were encountered in the five patients. Two patients had persistence of their infection and were successfully treated by additional surgical debridement, antibiotics, and adjunctive hyperbaric oxygen. Vancomycin was administered to all patients. The daily dosage of vancomycin ranged between 100 mg and 2.0 gm. The length of vancomycin therapy ranged from 19 to 56 days. Five of seven biopsy specimens grew bacterial organisms in addition to MRSA. The MIC of vancomycin for MRSA ranged between 0.39 and 1.56 micrograms/ml. Osteomyelitis was arrested in five of seven episodes, and follow-up evaluations ranged from two to 35 months. Two of five (40%) patients receiving the combination of vancomycin and tobramycin developed signs of renal toxicity. Renal function returned to normal after discontinuation of the antibiotics. MRSA osteomyelitis is usually acquired by spread from a contiguous focus of infection and is often polymicrobic in nature. Treatment with vancomycin or vancomycin plus tobramycin when the infection was polymicrobic was effective. The combination of vancomycin plus tobramycin is potentially nephrotoxic.

Adult↗
PubMed1984

Cefmenoxime therapy in bacterial osteomyelitis.

Cefmenoxime, a new parenteral beta-lactamase-resistant cephalosporin, was evaluated for safety and efficacy in 15 patients (10 male and five female) with acute (1 patient) and chronic (14 patients) osteomyelitis. Diagnosis was made by culture of the surgical biopsy specimen. Osteomyelitis was treated with 8 to 12 g of cefmenoxime per day (mean 9.1 g) for 42 to 66 days (mean 47.3). Staphylococcus aureus was the most frequently isolated organism. Minimum inhibitory concentrations (MICs) of cefmenoxime were determined and all pathogens were inhibited by 12.5 micrograms/ml or less, except for Enterobacter cloacae and Acinetobacter species, both of which had an MIC of 25.0 micrograms/ml. All patients had at least one surgical debridement. Of the 15 patients, 10 (67 percent) had the osteomyelitis "arrested." These patients have been followed up five to 14 months after completion of cefmenoxime therapy. Toxicity studies indicated mild elevations in serum glutamic oxalacetic transaminase and serum glutamic pyruvic transaminase in two patients. Cefmenoxime appears to be a safe and effective antibiotic in the treatment of osteomyelitis.

Adolescent↗
PubMed1984

The principles of the use of preventive antibiotics.

Antibiotic prophylaxis is indicated only under specific surgical settings. Appropriate antibiotic prophylaxis must take into account the type of surgery, the competence of the host, and the pharmacologic properties of the antibiotic(s). The antibiotic should be given before the surgical procedure and have an antibacterial spectrum that covers the majority of the bacterial organisms anticipated at surgery. If there is doubt about the efficacy, antibiotic prophylaxis should not be initiated.

Animals↗
PubMed1983

Primary versus delayed soft tissue coverage for severe open tibial fractures. A comparison of results.

Thirty-six Types III and IIIa open fractures of the tibial shaft are presented with a treatment protocol based on early, aggressive wound management and fracture coverage utilizing muscle, myocutaneous, or free flap techniques. There were five amputations, seven deep infections, three nonunions, and no cases of chronic osteomyelitis in the series. The criteria for inclusion in the series were definitive wound coverage by 30 days after injury and end-result records including time of union. Wound coverage was classified as early (0-7 days) or late (8-30 days). Major and minor wound healing disturbances were found in 20.8% of the early and 83.3% of the late groups, with mean union times of 4.0 months and 6.4 months, respectively. Extensive and serial debridements, coverage within five to seven days, and early bone grafting produce a viable soft tissue envelope and a favorable mesenchymal milieu for the healing of complex open fractures. This significantly improves end results with respect to union, tissue loss from infection, healing time, and cost of hospitalization and rehabilitation.

Debridement↗
PubMed1981

The management of open tibial fractures with associated soft-tissue loss: external pin fixation with early flap coverage.

Meaningful data on the management of open tibial fractures cannot be obtained unless one categorizes the injury according to fracture type, degree of soft-tissue loss, and the velocity of the injury. Treatment by converting the type III injury to a type II injury with well-vascularized soft tissue is presented. Eighteen patients with 20 type III and type IIIa wounds were treated in a prospective fashion employing a combined orthopedic and plastic surgical scheme based on the tenets of early radical debridement, a "second look" operation, muscle or muscle-skin flap cover within 5 days of injury, external pin fixation, and ambulation within the first 3 weeks of injury. All fractures united in a mean time of 4.0 months. The mean hospitalization was 4.2 weeks. There have been no chronic infection, osteomyelitis, nonunion, shortening, or tissue breakdown.

Adult↗