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Biomedical subjects

J Evrard

Publications and source records attributed to J Evrard.

At least 19 recordsLinked to original sources
PubMed1999

[Infection prophylaxis in open leg fractures. Comparison of a dose of pefloxacin and 5 days of cefazolin-oxacillin. A randomized study of 616 cases].

THE PURPOSE OF THE STUDY: Was to compare the efficacy of a single 800 mg injection of Pefloxacin (PF) versus 2 days of cefazolin (1 gr.Q.6 H) followed by 3 days of oxacillin (1 gr.Q.8 H) in patients with an open tibial fracture and to examine the predictive factors for infection. A double-blind double dummy, multicentric, randomized trial was performed. 616 adults with an open tibial fracture requiring single-stage bone coverage were included. The end point was wound infection within 3 months. RESULTS: Within 3 months, 21/316 patients were infected in the PF group (6.6 p. 100) versus 24/300 in the CZ-OX group (8 p. 100), the difference was not significant (95 p. 100 Cl for difference: -4.8 p. 100 to 2.1 p. 100). Twenty one strains were isolated in 18 infected patients in the PF group, and 27 in 20 patients in the CZ-OX group. Negative gram bacteria were less frequent in the PF group (10 p. 100) than in the CZ-OX group (48 p. 100), and positive gram bacteria were more frequent in the PF group (90 p. 100) than in the CZ-OX group (52 p. 100). Independent risk factors for infection were severe contamination, widespread contusion, unstable fracture, positive sample in the emergency room and at the end of surgery. Resistant infecting bacteria rate was 24 p. 100 in infected cases. CONCLUSION: There was no difference in infection rates after surgery for open tibial fractures between a 800 mg injection of Pefloxacin and 2 days of pephazolin followed by 3 days of oxacillin. Infecting bacteria were mainly nosocomially acquired.

Adult↗
PubMed1998

[Neonatal type 1 pneumococcal meningitis and maternal septicemia].

The most common organisms in neonatal meningitis are group B streptococcus and Gram negative enteric bacteriae. Although Neisseria meningitidis, Haemophilus influenzae and Streptococcus pneumoniae are the most frequent causes of meningitis in infancy and childhood, they are uncommon in newborns. We report one case of neonatal meningitis and maternal septicemia.

Ampicillin↗
PubMed1994

Infection in massive bone allografts sterilised by radiation.

Massive bone allografts sterilised by radiation have been used in our hospital since 1985. The 164 consecutive reconstructions which we carried out before December 1990 were in equal part for tumour resections and revision arthroplasties associated with major bone defects. The allografts were used as intercalary or composite graft-prosthesis reconstructions. Fourteen (8.5%) skin sloughs or infections occurred, all but one after operations for malignant tumours. The grafts never appeared to be responsible. Infection after malignant tumour resection most commonly occurred at the knee when preoperative radiation had been used. Twenty-five reconstructions were performed in the presence of infection, which only recurred in one case. Twelve infections were treated, but 2 other patients died for other reasons within a year. One patient had to have an amputation and one had persistent infection. In the other cases, the infection healed. Only two debridements alone were successful. Removal of the graft and replacement with antibiotic-loaded cement was the most effective treatment.

Adolescent↗
PubMed1993

[Primary arthritis of the hip in adults].

Between 1950 and 1991 the authors have treated 45 adults with primary septic arthritis of the hip, not including tuberculosis. The mortality rate was 13%. There is an accompanying septicaemia, or, more commonly, a bacteraemia, and other general and local factors are often present. The diagnosis may be obvious, but in 50% of cases the presentation may be atypical and the clinical diagnosis uncertain. Confirmation of the diagnosis is by a positive culture from the aspirate, and a Staphylococcus is the usual organism found. The various methods of management used are discussed and the literature analyzed. Wide drainage of the hip is recommended. Arthrodesis is now rarely necessary, and a total replacement arthroplasty may be undertaken when the infection has been controlled. Six out of seven such procedures carried out in their unit in the last 10 years have been successful.

Adolescent↗
PubMed1992

[One stage revision of infected total hip replacements with replacement of bone loss by allografts. Study of 90 cases of which 46 used bone allografts].

We usually manage infected total hip replacements by a one stage revision. We have reviewed 90 cases operated on before 1988. Notable bone loss was frequently encountered and reconstructed using allografts. In all cases complete surgical debridement was performed and a cemented total hip replacement implanted. Bone allografts were used in 46 cases. Systemic antibiotics and antibiotic loaded cement were utilised. There were 17 failures (19%); one patient died soon after operation, there were 8 obvious infections (9%), 1 hip was thought to be infected although the prosthesis was not loose, and 7 femoral prostheses became loose of which 3 were due to mechanical failure and the remainder had no obvious explanation. Infection with staphylococcus aureus and pseudomonas had a statistical correlation with failure, but other factors including the preoperative status and the use of allografts did not appear to influence the result. Allograft femoral heads from the bone bank were found to be reliable for reconstruction of the acetabulum and small femoral defects. With major femoral bone loss we preferred massive irradiated cortical allografts. The quality of the bone reconstruction was probably the most important factor in the good functional results observed in 79% of cases. Effective surgical debridement and an appropriate antibiotic regime will allow a successful one stage revision procedure. The use of allografts gave a reliable reconstruction of the bone loss and was not associated with an increased rate of failure.

Acetabulum↗
PubMed1992

[Role of tibial-fibular grafting in the treatment of infected pseudarthrosis of the tibia].

The author presents a series of 112 patients, suffering an infected fracture or nonunion of the tibia, and operated on by intertibio-fibular grafting (ITFG), between 1960 to 1990. 110 of them were followed up during average 5 years. Some points of the technic are detailed. The whole treatment associates immobilization, antibiotherapy, cleaning procedures and eventually complementary grafting. All patients were consolidated, 73 after ITFG alone, 13 by association, in the same stage, of an open cancellous filling, following Papineau technique. 24 needed a complementary grafting, among them 7 because a technical flaw. 5 iterative fractures were observed, only one of them has not united. 96 patients were cured of any sepsis, most often by associated cleaning procedures, achieved either before or after ITFG. It existed 14 persistent draining sinus, but only 4 may be considered as real failures. The involvement of the ankle joint was unfortunately quite frequent, but it did not seem to be the consequence of the synostosis, but rather of the duration of immobilization. After review of the literature, the other methods of treatment were discussed, particularly these of Papineau and of Ilizarov. The conclusion was that each method has indications, but the ITFG must keep the largest place, being indicated in about two cases out of three.

Adult↗
PubMed1991

A scoring system in predicting the risk of intestinal stricture in necrotizing enterocolitis.

Of 46 infants with a diagnosis of necrotizing enterocolitis (NEC) admitted to the neonatal intensive care unit over the period 1981-1985, 40 have been followed from 2 to 6 years after the acute episode. A contrast enema (CE) to look for intestinal strictures (IS) was performed either during the first months in surgically managed patients, or between 2 and 6 years in asymptomatic patients. Clinical, laboratory and radiology parameters collected during the 7 days following NEC were used to establish a score which was correlated with radiological data obtained after CE. Of the 40 infants, 17 developed symptomatic or asymptomatic IS and 16 of these 17 infants has a score greater than or equal to 7. Nineteen of the 23 patients without IS had a score less than 7. We conclude that the proposed score established on day 8 after onset of NEC helps to identify infants at higher risk of developing IS and for whom closer follow up appears necessary.

Enterocolitis, Pseudomembranous↗
PubMed1990

[Treatment of bone infection by plaster of Paris pellets impregnated with antibiotics].

In two prospective clinical trials, the authors treated 83 chronic osteomyelitis from various origins by sequestrectomy completed with insertion of Plaster of Paris pellets impregnated with antibiotics. After a review of the experimental and clinical reports on the subjects, the authors give their results: 61.5% of healings and 38.5% of failures. Because of the small number of cases, it was not possible to find out an explanation for this fair results. However wide extension of the lesions, which is frequent in chronic haematogenous osteomyelitis, seems to be a contraindication to the technics. The authors conclude to the necessity of carrying up new experiments with new antibiotics and large series of patients in order to point out the righted indications of the method.

Adolescent↗
PubMed1989

[Evaluation of therapeutic trials published apropos of antibiotic prophylaxis in orthopedic surgery].

The authors review all the randomized clinical trials published since 1970 which evaluate the efficacy of antibiotic prophylaxis in orthopaedic surgery. Evaluation of the quality of these trials was based on two clinical and four methodological criteria. They also take into account reports which aim to define the best antibiotic prophylactic protocol, particularly with regard to the duration of treatment. In conclusion, although the majority of trials do not escape criticism, the efficacy of antibiotic prophylaxis in orthopaedic surgery can be considered as demonstrated. The duration of treatment is still an open problem. At the present time, the duration of drainage defines the length of antibiotherapy.

Anti-Bacterial Agents↗
PubMed1988

Two-day cefamandole versus five-day cephazolin prophylaxis in 965 total hip replacements. Report of a multicentre double blind randomised trial.

The aim of this trial was to compare a 5-day course of cephazolin with a regimen of 2 days of cefamandole in 965 total hip replacements (488 in the cefamandole group and 477 in the cephazolin group). The effect of the prophylactic antibiotic on the bacterial colonization of drains (mean duration of drainage: 3.2 +/- 0.3 days) and on the susceptibility of colonizing organisms was assessed. No significant difference was observed in the percentage of infected drains between the two groups. The cefamandole group had a lower rate of Gram-negative organisms (23% versus 44%, p less than 0.01). The rate of deep infections within one year after operation was 0.7% in the cefamandole group versus 0.5% in the cephazolin group, and the difference is not significant. Cefamandole given for two days appears to be an effective prophylaxis against sepsis in total hip replacements.

Aged↗
PubMed1987

Valorization of rapeseed meal. 3. Effects of glucosinolate content on food intake, weight gain, liver weight and plasma thyroid hormone levels in growing rats.

Seven groups of 10 growing rats each were fed a control diet or rapeseed diets with glucosinolate contents ranging from 4.4 to 36.6 mM/kg DM. After a 5-day adaptation period, the rats were fed ad libitum for 17 days. The food intake of the experimental groups was maximal after 11 days and was, on an average, 4 to 45% lower than that of the control group. The differences were still greater during the last 7 days. Daily weight gain was also maximal after 8 days and began to decrease, dropping to 1 g during the last days. There were negative curvilinear relationships between food intake or weight gain and diet glucosinolate content. Liver weight (g/100 g of body weight) was not significantly altered by glucosinolate intakes between 0.08 and 0.39 mM/day. However, in the groups fed the diets with the lowest glucosinolate contents, plasma triiodothyronine (T3) and thyroxine (T4) levels were 50% lower than in the control group and 70 or 80% lower, respectively, with the diets having the highest glucosinolate contents.

Animals↗
PubMed1987

Valorization of rapeseed meal. 4. Effects of iodine, copper and ferrous salt supplementation in growing rats.

Ten groups of 10 growing male rats (65 g) were fed ad libitum either a control diet or rapeseed diets (15 mM glucosinolates/kg DM) supplemented either with l- alone, l- and Cu++ (2 levels), l- + Cu++ and methionine or l- and Fe++ (2 levels) (table 1) for 35 days. When the rapeseed diets were given as powder or as mash, food intake decreased 24 and 32%, respectively; live weight gain was reduced by 36 and 46%, liver weight increased 20 and 33%, thyroïd gland was 3 and 4 times as big, and a 30 and 50% decrease in the T4 plasma level was noted (table 2). l- supplementation did not prevent the deleterious effects of rapeseed meal feeding. l- and Fe++ supplementation had detrimental effects on food intake, live weight gain and kidney weight, but beneficial effects on liver and thyroïd weights and on plasma thyroïd hormone levels. The low level of l- and Cu++ supplementation suppressed the depressive effects of rapeseed meal on food intake and live weight gain and reduced the deleterious effects on kidney, liver and thyroïd weights and on plasma thyroïd hormone levels, whereas the higher level almost suppressed them. The results are discussed considering the likelihood of a bivalent cation effect on glucosinolates.

Animals↗