Surgical technology international
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The authors prospectively evaluated the safety and efficacy of a new fibrin sealant in patients undergoing emergency and elective cranial/spinal surgery with documented cerebrospinal fluid (CSF) leakage after sutured dural repair. This study was designed as a prospective, nonrandomized clinical trial. EVICEL® Fibrin Sealant (Johnson & Johnson, Somerville, NJ) was used in 72 patients with documented intraoperative CSF leakage after neurosurgical dural repair for a variety of pathologies. ⋯ The sealant was effective in closing intraoperative CSF leakage in all patients but one. There were no sealant-related adverse events, and all clinical outcomes were consistent with expectations for seriously ill patients undergoing prolonged neurosurgical procedures. EVICEL® Fibrin Sealant provides a safe and effective watertight closure when used as an adjunct to sutured dural repair during cranial surgery.
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Bladder dysfunctions have been treated for decades through medical treatments or surgical procedures, especially in the context of prolapse conditions and stress incontinence. Over the last decade, sacral nerve modulation (SNM) has been introduced as a further option in the treatment of some urinary and fecal symptoms. Current techniques of percutaneous implantation are limited to superficial extrapelvic nerves that expose patients to lead migration and dislocation or infections, complications that cannot be ignored. ⋯ One of these methods is the implantation of neuroprothesis-a technique called the "LION procedure"-which permits selective electrical stimulation of pelvic nerves and plexuses. One very interesting site of implantation for treatment of urinary and faecal symptoms is the pudendal nerve (PN). Stimulation of this nerve induces two different actions: a strong contraction of the sphincters-treatment of urinary and faecal incontinence and an inhibitory effect on the bladder-and treatment for bladder overactivity.
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Review Meta Analysis
Systematic review and meta-analysis of closed suction drainage versus non-drainage in primary hip arthroplasty.
The routine use of drains in surgery has been dogmatically instituted in some disciplines. Orthopaedic surgery is one such sub-speciality. The use of postoperative closed suction drainage in total hip arthroplasty (THA) has become increasingly controversial with multiple randomised control trials performed to assess the benefit to outcome in THA. ⋯ No significant difference in haematoma formation between groups (p=0.19) was elicited. The routine use of closed suction drainage systems post primary hip arthroplasty is not supported by this meta-analysis. However, the heterogeneity between studies does limit the accuracy of the meta-analysis.
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Total hip arthroplasty is associated with extensive blood loss, which is often corrected using allogeneic blood transfusions. However, Jehovah's Witnesses often refuse allogeneic blood transfusions or certain types of autologous blood transfusions due to their religious beliefs. This may represent a tremendous challenge for the orthopaedic surgeon and their team. ⋯ Ultimately, physicians should be prepared to deal with marked blood loss and respect the patients' wishes, values, and beliefs. This review focuses on studies where primary or revision total hip arthroplasty was performed in Jehovah's Witness patients. Therefore, we will illustrate that with a prepared team and an optimized patient, it is potentially quite safe to perform total hip arthroplasties in Jehovah's Witness patients.
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Osteomyelitis is a bone infection by micro-organisms. Despite advances in antibiotics and operative techniques, osteomyelitis remains an orthopaedic challenge and expensive to treat. Antimicrobial therapy is adequate for the treatment of most cases of acute osteomyelitis of any type, provided that diagnosis is made early. ⋯ Although the number of clinical studies is small, it seems that antibiotic-loaded hydroxyapatite and calcium sulfate are safe methods for local antibiotic delivery. They deliver great amounts of antibiotics locally with serum concentrations in safe margins, they obliterate the dead space, and aid in bone repair, while there is no need for a second operation for their removal. The purpose of this article is to review the recent literature concerning osteomyelitis and local antibiotic treatment with special reference to bone graft substitutes as vehicles for local antibiotic delivery.