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Biomedical subjects

G H Walenkamp

Publications and source records attributed to G H Walenkamp.

At least 19 recordsLinked to original sources
PubMed2001

Gentamicin PMMA beads and other local antibiotic carriers in two-stage revision of total knee infection: a review.

Local antibiotic carriers are available as resorbable carriers (e.g. gentamicin-loaded collagen) and non resorbable carriers, mostly gentamicin-loaded bone cement in the form of beads or spacers. The release of the antibiotic may differ largely, depending on the properties of the carrier. In the use of spacers the release may remain too low, resulting in subinhibitory gentamicin concentrations. Revision of late deep infection of a knee prosthesis includes extraction, debridement and the use of local and systemic antibiotics. Reimplantation can be performed if healing is appropriate and the bone stock reaches. Otherwise arthrodesis is necessary.

Anti-Bacterial Agents↗
PubMed2000

Surgical treatment of aspergillus spondylodiscitis.

Four cases of aspergillus spondylodiscitis were treated with operative debridement and fusion. In this rarely encountered mycotic infection of the spine in immunocompromised patients rapid destruction of the intervertebral disc and vertebral bodies can occur. In advanced cases antimycotic drug therapy is thought to be ineffective and a forcing indication for surgery exists when the destruction is progressive and spinal cord compression is imminent or manifest. Spinal instrumentation can be of help in maintaining or restoring spinal stability and maintaining spinal alignment. In our four patients the aspergillus spondylodiscitis was successfully eradicated and fusion achieved. In two of three patients with a neurologic deficit, this deficit disappeared. Two patients died within 6 months after the operative treatment, due to complications related to the underlying illness. One patient was left with a subtotal paraplegia.

Adult↗
PubMed1999

Cervical spondylodiscitis after removal of a fishbone. A case report.

STUDY DESIGN: A case report of cervical spondylodiscitis after removal of a lodged fishbone. OBJECTIVES: To present a rare case of cervical spondylodiscitis and to inform the readers that a lodged fishbone can give rise to this complication after its removal. SUMMARY OF BACKGROUND DATA: In the literature, only one mention of this complication was found. METHODS: The literature, clinical presentation, technical examinations, and treatment are reviewed. RESULTS: Prolonged antibiotic treatment and immobilization of the cervical spine resulted in a cure of the spondylodiscitis. CONCLUSIONS: After removal of a lodged fishbone, a cervical spondylodiscitis is possible, but this is a very rare complication. In this patient, conservative treatment resulted in a cure of the infection. Successive magnetic resonance imaging investigations showed the extent of the destruction of the vertebral bodies and disc very well, as well as the curation of the spondylodiscitis after 5 months.

Aged↗
PubMed1998

[One hundred years of orthopedics in the Netherlands. IX. The treatment of chronic osteomyelitis].

Chronic osteomyelitis is characterized by cicatrization of the focus of infection with deteriorating vascularization, which makes the disease increasingly difficult to treat. The treatment in chronic osteomyelitis consists primarily in surgical debridement of the scarified focus of infection; stabilization with external fixation allows better treatment. Following debridement, local antibiotic treatment is possible with gentamicin containing cement beads, if necessary combined with systemic antibiotic treatment. If the infection heals well, a reconstruction may, if necessary, be carried out: bone defects frequently necessitate bone transplantation, bone segment shifting (Ilizarov method) or free muscle flap grafts. In the future, resistant bacteria will make healing harder. There will be more possibility to use resorbable antibiotic vehicles and bone-replacing biomaterials.

Antibiotic Prophylaxis↗
PubMed1998

Osteomyelitis treated with gentamicin-PMMA beads: 100 patients followed for 1-12 years.

We treated 100 patients having osteomyelitis with debridement and gentamicin-PMMA beads and followed them for 5 (1-12) years. 66 of the infections were chronic, in 18 cases combined with arthritis and in 3 cases with pseudarthrosis. They underwent 117 "treatment periods", consisting of one or more operations (total 152), in most cases with an interval of 2 weeks. No systemic antibiotics were necessary besides the local antibiotic treatment in 52 of the treatment periods. Healing was achieved in 92 patients, in 78 after a single treatment period which included 1-5 operations, in 14 after two or three treatment periods. Healing was more difficult to achieve when the infection was chronic, especially with a duration of more than 6 years or when caused by elective surgery. Local antibiotic treatment with gentamicin PMMA beads has the advantage that the wound can be closed primarily and that a higher local antibiotic concentration in the tissues can be achieved, often making systemic antibiotic treatment unnecessary.

Adolescent↗
PubMed1997

New model for chronic osteomyelitis with Staphylococcus aureus in sheep.

The purpose of this study was to develop a large animal model for chronic osteomyelitis, suitable for toxicologic research and therapeutic intervention studies. Osteomyelitis was induced in 52 healthy adult Texel sheep by injecting a sclerosing agent and a hemolytic strain of Staphylococcus aureus into the proximal tibial marrow cavity. Evaluation was done by clinical, radiologic, bacteriologic, and histologic parameters for 3 months. Clinical signs of infection consisted of localized soft tissue swelling, pain during the acute phase, and limping in all sheep. Radiologic features were moderate to extensive periosteal reaction, cortical lysis, mild to extensive new bone formation, and frequent development of sequestra limited to the proximal part of the tibia. Cultures were positive for the same strain of Staphylococcus aureus in all but one sheep. Histology showed chronic active inflammation, osteolysis, new woven bone formation, debris, clusters of bacteria, and surrounding granulation tissue. It was necessary to administer a single prophylactic dose of antibiotics 1 hour after surgery to prevent fatal sepsis. It was concluded that sheep are a suitable model for chronic osteomyelitis.

Animals↗
PubMed1996

Local corticosteroid injection versus Cyriax-type physiotherapy for tennis elbow.

We performed a prospective, randomised trial on 106 patients to compare the effects of local corticosteroid injections with physiotherapy as advocated by Cyriax in the treatment of tennis elbow. The main outcome measures were the severity of pain, pain provoked by resisted dorsiflexion of the wrist, and patient satisfaction. At six weeks 22 of 53 patients in the injection group were free from pain compared with only three in the physiotherapy group. In the corticosteroid-treated group 26 patients had no pain on resisted dorsiflexion of the wrist compared with only three in the physiotherapy group. Thirty-five patients who had injections and 14 who had physiotherapy were satisfied with the outcome of treatment at six weeks. At the final assessment there were 18 excellent and 18 good results in the corticosteroid group and one excellent and 12 good results in the physiotherapy group. There was a significant increase in grip strength in both groups but those with injections had a significantly better result. After one year there were no significant differences between the two groups. Half of the patients, however, had received only the initial treatment, 20% had had combined therapy and 30% had had surgery. We conclude that at six weeks, treatment with corticosteroid injections was more effective than Cyriax physiotherapy and we recommend it because of its rapid action, reduction of pain and absence of side-effects.

Adult↗
PubMed1994

Intervertebral infection caused by Streptococcus milleri. A case report.

Intervertebral infection caused by Streptococcus milleri is described in a 45-year-old man. Initially, a tuberculous infection was suspected; this diagnosis resulted in a considerable delay in correct diagnosis and treatment. The patient recovered well with combined medical-surgical treatment. Streptococcus milleri, a common inhabitant of the gastrointestinal tract, comprises a variety of strains implicated in deep-seated purulent infections. Although reports of this are rare, S. milleri can be the offending organism in intervertebral disk infections.

Anti-Bacterial Agents↗
PubMed1991

How predictable is rehabilitation after hip fracture? A prospective study of 134 patients.

In a prospective study of 134 consecutive patients treated for hip fracture, rehabilitation was influenced by sociomedical factors, but not by fracture type or treatment. Success of rehabilitation was to a large extent predictable using mental and general health status. Discharge of the patients to their prefracture residence was accurately predicted in 80/89 of successful and 11/28 of failed rehabilitations. Four months after the fracture, 86/92 successful and 11/17 failed rehabilitations were predicted. More accurate prediction of rehabilitation is limited by the complexity of the rehabilitation process.

Activities of Daily Living↗
PubMed1989

Metabolic characteristics of in vitro cultured human chondrocytes in relation to the histopathologic grade of osteoarthritis.

Isolated human chondrocytes derived from healthy and osteoarthritic (OA) cartilage were cultured in high density in a newly designed microculture system. The severity of OA was graded according to a modified histopathologic score originally described by Mankin et al. Chondrocytes from adult patients with OA showed 35S-sulphate and 3H-thymidine incorporation in vitro, which increased with severity of the disease through Mankin 11-12. Incorporation rapidly declined after Mankin 11-12. Both matrix synthesis and cell proliferation were strongly reduced in the severe grades of OA. Histologic examination of the newly formed cartilage was only possible if the chondrocytes were derived from less severe grades of OA. Microscopy showed healthy chondrocytes surrounded by newly synthesized matrix, which stained well with specific dyes, indicating the ability of the cells to synthesize normal matrix components. The phenotype of human articular chondrocytes, derived from different grades of OA, was maintained in a high-density culture system. The data suggest dysregulation of the cell metabolism in OA cartilage. The increased cell metabolism was directly related to the histopathologic grade of OA.

Aged↗
PubMed1986

Gentamicin-PMMA beads. Pharmacokinetic and nephrotoxicological study.

Five patients treated with gentamicin-polymethylmethacrylate (PMMA) beads were monitored during the treatment of nine to 14 days. Kinetic data of the gentamicin delivery were gathered constantly by multiple samples of blood and urine. The treatment with 48-360 beads caused a gentamicin serum concentration of 0.03-0.4 micrograms/ml and a renal excretion rate of 3-40 micrograms/min. The total amount of gentamicin excreted after the whole treatment was 20%-70%, with an in vivo half-life of 5.7-10 days. The gentamicin appeared to be released constantly during the entire treatment (nine to 14 days); the beads are kinetically slow release carriers. Despite precise measurement of tubular and glomerular renal function, no nephrotoxicity could be demonstrated. This local antibiotic gentamicin therapy may use the blood bone barrier effectively as a protection of the body against a very high local gentamicin concentration.

Adult↗
PubMed1983

The effect of surgery on the renal excretion of beta 2-microglobulin.

Surgical trauma causes an increase in the renal excretion rate of beta 2-microglobulin whilst creatinine excretion is not influenced. The increase in the renal excretion rate of beta 2-microglobulin is probably the result of an increased release of beta 2-microglobulin by the cells which exceeds a maximum in the active tubular reabsorption of the compound by the proximal tubule cell. The renal excretion of beta 2-microglobulin is proportional to the relative clinical trauma score.

Beta-Globulins↗