Interventional and multimodal pain rehabilitation in a child with meralgia paresthetica.

Meralgia paresthetica is a chronic pain syndrome that is extremely rare in the pediatric population. It is manifested by hypesthesia or pain in the distribution of the lateral femoral cutaneous nerve (LFCN) and is typically caused by entrapment as the nerve passes deep to the inguinal ligament. This sensory mononeuropathy is rare in children and diagnosis is typically delayed, often leading to prolonged functional impairment and unnecessary medical testing.

The future of spinal cord stereotaxy.

The spinal cord is an integral part of central nervous system, therefore it can be expected that spinal cord has the same properties as the brain. Movement activity is realized by the activation of individual motoneurons of various spinal cord segments under the influence of analytical function of the spinal cord. When a hypothesis is accepted that the mentioned large volume of spinal cord white matter represents the entire length of neuronal network, an idea can be established that the activated motoneurons project through their reticular processes to this connecting network forming a synthetic picture of this movement and after fluent continuity the entire act of movement.

The impact of matrix metalloproteinases and their tissue inhibitors in inflammatory bowel diseases.

Background: It has been suggested that matrix metalloproteinases (MMPs) may play a role in the pathogenesis of inflammatory bowel diseases (IBD). However, the impact of serum MMPs and their inhibitors [tissue inhibitors of metalloproteinases (TIMPs)] have scarcely been investigated in the same experimental setting in ulcerative colitis (UC) and Crohn's disease (CD) as well as their correlation with IBD activity.

Methods: MMP-2, MMP-7, MMP-9, TIMP-1 and TIMP-2 serum antigen levels were determined in 23 patients with UC, 25 patients with CD and 10 healthy control patients by enzyme-linked immunoassay technique.

The role of inflammation and proteinases in tumor progression.

Chronic inflammation is an important risk factor for the development of cancers. The link between chronic inflammation and the risk of developing cancer is now well established. At least 20% of all cancers arise in association with infection and chronic inflammation.

Diagnosis and management of chronic infection.

High-energy penetrating extremity injuries are often associated with severe open fractures that have varying degrees of soft-tissue contamination and tenuous soft-tissue coverage. The result is a relatively high prevalence of chronic osteomyelitis compared with that in civilian trauma patients. Diagnosing chronic osteomyelitis requires a careful history and thorough physical and radiographic examinations.

Surgical treatment of osteomyelitis.

Chronic osteomyelitis is refractory to nonsurgical treatment due to a resilient, infective nidus that harbors sessile, matrix-protected pathogens bound to substrate surfaces within the wound. Curative treatment mandates physical (surgical) removal of the biofilm colony, adjunctive use of antibiotics to eliminate residual phenotypes, and efforts to optimize the host response throughout therapy. Patient selection, therapeutic options, and the treatment format are determined by the Cierny/Mader staging system, while reconstruction is governed by the integrity/stability of the affected bone(s) and quality/quantity parameters of the soft-tissue envelope.

Considerations on physiological mechanisms of spinal cord movement performance according to cerebral stimuli.

The process of communication between brain and spinal cord remains unclear. Therefore an attempt supported by spinal cord stereotaxy was made to disclose the physiological mechanisms underlying the cooperation between the brain and spine as generated by the spinal cord. The initializing stimulus was the discovery of motoneuron location in all spinal cord segments providing an organic substrate for spinal cord stereotaxy.

[Reflection on the physiological mechanisms of movements controlled by the spinal cord-brain interaction].

The process of communication between brain and spinal cord remains unclear. Therefore an attempt supported by spinal cord stereotaxy was made to disclose the physiological mechanism underlying the cooperation between brain and spine as generated by the spinal cord. The initializing stimulus was the discovery of motoneuron location in all spinal cord segments providing the organic substrate for spinal cord stereotaxy.

Treatment of chronic infection.

Failure of an acute inflammatory response to resolve a wound infection heralds a cascade of events that affects the host and pathogens, culminating in a chronic, refractory condition. The factors contributing to this outcome include immune compromise of the host, antimicrobial resistance, wound-healing deficiencies, and the adherence of pathogens to themselves and wound surfaces via an impenetrable, resistant biofilm. To eradicate chronic infection, the pathogens, biofilm, surfaces available for adherence, and compromised tissue must be removed.

Periprosthetic total joint infections: staging, treatment, and outcomes.

Forty-three patients having 49 treatment protocols for periprosthetic total joint infections were staged prospectively, using an osteomyelitis classification system designed to stratify treatment selection according to patient risk factors. Implant salvage was possible in 66% of the infections treated within 30 days of the surgical procedure or within 14 days of symptom onset after a late, septic event. After debridement and implant removal, 88% of the patients with long-standing, refractory infections now have infection-free, functional reconstructions; 64% of these patients have a new, total joint replacement at the original site of treatment.

Osteogenic protein-1 (bone morphogenetic protein-7) in the treatment of tibial nonunions.

Background: The role of bone morphogenetic proteins (BMPs) in osseous repair has been demonstrated in numerous animal models. Recombinant human osteogenic protein-1 (rhOP-1 or BMP-7) has now been produced and was evaluated in a clinical trial conducted under a Food and Drug Administration approved Investigational Device Exemption to establish both the safety and efficacy of this BMP in the treatment of tibial nonunions. The study also compared the clinical and radiographic results with this osteogenic molecule and those achieved with fresh autogenous bone.

Infected tibial nonunions (1981-1995). The evolution of change.

Between 1981 and 1995, 150 consecutive cases of middiaphyseal, infected nonunions of the tibia were treated prospectively on the author's osteomyelitis service. Thirty-nine (78%) of the 49 patients seen between 1981 and 1986 and 94 (93%) of the 101 patients seen 1986 through 1994 underwent successful salvage protocols with a minimum followup of 5 years. The difference in outcomes seen in the two groups eloquently reflects the emergence of specific pharmaceutic, technical, and biologic advances earmarking these two, distinct eras of care.

Osteomyelitis debridement techniques.

Debridement of chronic osteomyelitis can be technically demanding and difficult. The surgical principles that govern treatment of osteomyelitis involve an atraumatic approach and complete removal of all devitalized tissue and foreign material. Despite recent advances in medical science, the quality of surgical debridement remains the most critical factor in the successful management of chronic orthopaedic infections.

Delayed local treatment of rabbit tibial fractures with biodegradable cefazolin microspheres.

The prevention of infection is a primary objective in the treatment of open fractures. The objective of this study was to compare the efficacy of biodegradable, poly (DL-lactide-co-glycolide) cefazolin microspheres and free cefazolin powder in Staphylococcus aureus contaminated rabbit tibial fractures when treatment was delayed for 2 hours. Fractures were produced in the tibia of rabbits, inoculated with Staphylococcus aureus, and 2 hours later treated by either direct local application of cefazolin microspheres or an equivalent dose of free cefazolin powder.

Segmental tibial defects. Comparing conventional and Ilizarov methodologies.

Forty-four consecutive patients with segmental debridement defects of the tibia had limb-salvage surgery. Twenty-one patients (Group I) were managed using methods as described by Ilizarov. Twenty-three patients (Group II) underwent conventional treatment with massive cancellous grafts and tissue transfers.

Invasive infection due to Apophysomyces elegans in immunocompetent hosts.

A previously well 59-year-old man developed necrotizing, invasive cellulitis and subsequent osteomyelitis at what was judged to be the site of a bite or sting. The pathogen isolated was Apophysomyces elegans. Eventually, in addition to treatment with intravenous amphotericin B, en bloc resection was required for cure.

Evaluation of biodegradable cefazolin sodium microspheres for the prevention of infection in rabbits with experimental open tibial fractures stabilized with internal fixation.

Immediate internal fixation of severe open tibial fractures usually is contraindicated due to the high risk of infection. The objective of this study was to evaluate the efficacy of local antibiotic therapy with biodegradable poly-(DL-lactide-co-glycolide) cefazolin-loaded microspheres for the prevention of infection in experimental open fractures stabilized with internal fixation. Rabbits with experimental tibial fractures that were contaminated with Staphylococcus aureus were treated with local application of cefazolin microspheres, an equivalent local dose of free Ancef powder, or systemic Ancef therapy.

Bony reconstruction in the lower extremity.

The reconstructions of large debridement defects of the tibia are difficult and, at times, discouraging. To maximize the potential for limb salvage, a rigorous patient selection algorithm is essential. Each therapeutic option must consider various host factors, anatomic restraints, physician skills, and institutional resources.

In vitro and in vivo evaluation of antibiotic diffusion from antibiotic-impregnated polymethylmethacrylate beads.

The elution of antibiotics from antibiotic-impregnated polymethylmethacrylate (PMMA) beads was measured in mongrel dogs. The antibiotics, used in mixture with Simplex cement, included cefazolin (Ancef; 4.5 g/40 g cement powder), ciprofloxacin (Cipro; 6 g/40 g powder), clindamycin (Cleocin; 6 g/40 g powder), ticarcillin (Ticar; 12 g/40 g powder), tobramycin (Nebcin; 9.

Evaluation of biodegradable ampicillin anhydrate microcapsules for local treatment of experimental staphylococcal osteomyelitis.

Successful treatment of chronic osteomyelitis requires sustained high concentrations of antibiotics locally within the infected bone. The efficacy of biodegradable (poly-DL-lactide-co-glycolide) microspheres containing 30.7% ampicillin anhydrate for the local treatment of experimental staphylococcal osteomyelitis was evaluated in rabbits.

Ankle arthrodesis in the presence of continuous sepsis. Indications, methods, and results.

On 26 patients, 28 ankle fusions were performed and followed 2 or more years. A functional limb salvage was gained in 25 limbs (96%) with an overall arrest rate of 92%. There was one amputation (4%).