Biomedical subjects

G Walenkamp

Publications and source records attributed to G Walenkamp.

6 recordsLinked to original sources

PubMed2000

Antibiotic prophylaxis for surgery for proximal femoral and other closed long bone fractures.

BACKGROUND: Antibiotic prophylaxis has been established policy for major surgical operations for many years. In fracture fixation, the effectiveness, and the duration of administration, have been a matter of debate. OBJECTIVES: To assess the effects of the prophylactic administration of antibiotics in patients undergoing surgical management of hip or other long bone fractures. SEARCH STRATEGY: We searched MEDLINE, EMBASE, Current Contents, Dissertation Abstracts, and Index to UK Theses, and bibliographies of identified articles. Trials were also obtained from the Cochrane Musculoskeletal Injuries Group trials register. Date of the most recent search: end of 1997. SELECTION CRITERIA PARTICIPANTS: Any patients with a hip or other closed long bone fracture undergoing surgery for internal fixation or replacement arthroplasty. INTERVENTIONS: Any regimen of systemic antibiotic prophylaxis administered at the time of surgery. OUTCOME MEASURES: Wound infection (deep and superficial), urinary tract infection, respiratory tract infection, adverse effects of prophylaxis, economic evaluations. DATA COLLECTION AND ANALYSIS: Both reviewers independently selected trials for inclusion, and assessed methodological quality and extracted data. Where possible, data were pooled and Peto odds ratios and absolute risk reductions, each with 95% confidence intervals, calculated. MAIN RESULTS: Twenty one randomised trials of only poor or moderate quality were included. The comparisons tested fell within six comparison groups, principally multiple dose or a single dose of antibiotic versus a placebo or no treatment. Antibiotic prophylaxis reduces wound, urinary and respiratory tract infections in patients undergoing surgery for closed fracture fixation. Economic modelling has indicated that this is a cost-effective intervention. There are limited data for the incidence of adverse effects, but as expected they appear to be more common in those receiving antibiotics. REVIEWER'S CONCLUSIONS: Antibiotic prophylaxis should be offered to those undergoing surgery for closed fracture fixation. On ethical grounds, further placebo controlled randomised trials of the effectiveness of antibiotic prophylaxis in closed fracture surgery are unlikely to be justified. Trials addressing the cost-effectiveness of different effective antibiotic regimens would need to be very large and may not be feasible.

Antibiotic Prophylaxis↗

PubMed1998

The Madura foot: an "innocent foot mycosis"?

With the increased movement of the world population, acquaintance with the clinical picture of the Madura foot is of growing importance beyond its original endemic areas. The characteristic triad of symptoms consists of indurated swelling, multiple sinus tracts with purulent discharge filled with grains and localization at the foot. An increasing number of new etiologic agents are recognized today. For a better choice of therapy an adequate diagnostic procedure is essential ; a deep biopsy for histology appears to give a more substantial contribution to identification of the causal organism than culture. The treatment which should be started early, is at first essentially a drug treatment. However, in spite of high expectations with regard to new antimycotic drugs, amputation or disarticulation is often inevitable even today, particularly when the lesion is caused by Eumycetes. The first two documented patients with this disease in the Netherlands are described. They developed serious deformities of the lower extremity despite long-term use of antimycotic and antibiotic medication.

Adult↗

PubMed1993

Lateral extensor release for tennis elbow. A prospective long-term follow-up study.

A prospective study was done of the results of lateral release of the common extensor origin in sixty-three patients who had a tennis elbow. Fifty-seven of these patients were followed for a mean of fifty-nine months (range, fifty to sixty-five months). At the time of the operation, the extensor origin was macroscopically normal in all but six patients. Forty-seven (76 per cent) of the sixty-two patients who were evaluated at one year had no pain or only slight pain, whereas before the operation three patients (5 per cent) had had slight pain and sixty (95 per cent), severe pain. Of the fifty-seven patients who were re-examined after five years, fifty-two (91 per cent) had no pain or only slight pain. At one year, twenty patients (32 per cent) had an excellent over-all result; twenty-three (37 per cent), a good result; twelve (19 per cent), a fair result; and seven (11 per cent), a poor result. At five years, there were thirty-two excellent results (56 per cent), nineteen good results (33 per cent), four fair results (7 per cent), and two poor results (4 per cent). No association between the preoperative findings and the results of the operation was found. It was concluded that lateral extensor release, a relatively simple operation that can be performed in an outpatient setting, may be regarded at this time as the operative procedure with which other operations for tennis elbow should be compared.

Adult↗

PubMed1989

Small PMMA beads improve gentamicin release.

The in vivo release of gentamicin base from conventional polymethyl methacrylate 7-mm beads was compared with that from the recently introduced 3 x 5-mm minibeads. The release in 14 days from minibeads was 93 percent of their gentamicin content, while the large beads released an average of 24 percent. The volume of the minibeads is one fifth of that of the large beads. Owing to the improved release combined with the smaller size, total release from minibeads in a cavity may be some seven times that from large beads. When in smaller cavities a strong bactericidal effect is desired, minibeads are to be preferred to large beads.

Bacterial Infections↗

PubMed1989

Silicone arthroplasty for hallux rigidus. Implant wear and osteolysis.

Between 1980 and 1985, silicone hemiprostheses were implanted because of hallux rigidus in 58 feet of 43 patients who were followed up after an average of 5 years. The majority were satisfied and had good function without pain. However, the toes had shortened because of implant wear, and there was considerable associated osteolysis.

Adolescent↗

PubMed1989

Bone reaction to silicone metatarsophalangeal joint-1 hemiprosthesis.

The incidence of inflammatory response to silicone implants in the first metatarsophalangeal joint was investigated. In 34 of 59 silicone arthroplasties, cysts were noticed in the proximal phalanx after a mean follow-up period of 59 months. In the metatarsal head, cysts were seen in 40 cases. Histologic examination showed that the cysts were filled with an avascular cellular stroma containing histiocytes and multinucleated giant cells, opsonizing wear debris of the prosthesis. Because of this destructive process, caution is advised when using silicone prostheses in young, active people.

Adolescent↗