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P Holtom

Publications and source records attributed to P Holtom.

11 recordsLinked to original sources
PubMed2003

A prolonged case of Mycobacterium marinum flexor tenosynovitis: radiographic and histological correlation, and review of the literature.

We report on a 30-year-old man with prolonged Mycobacterium marinum flexor tenosynovitis. Due to low clinical suspicion, diagnosis was not made until 8 years after initial presentation. The history and magnetic resonance and tissue examination findings are consistent with mycobacterial tenosynovitis. These findings are presented, together with a review of the literature.

Adult↗
PubMed2000

Prospective, randomized, double-blind study comparing single-agent antibiotic therapy, ciprofloxacin, to combination antibiotic therapy in open fracture wounds.

OBJECTIVE: The purpose of this study was to compare the efficacy of a single agent, ciprofloxacin, with that of combination antibiotic therapy consisting of cefamandole and gentamicin in all types of open fracture wounds. STUDY DESIGN: A prospective double-blind randomized clinical trial. SETTING: A Level 1 trauma center. PATIENTS: One hundred ninety-five consecutive patients with 203 open fractures were enrolled over a twenty-month period. Twenty-nine fractures from low-velocity gunshot wounds were excluded, and three other patients were excluded because of protocol violations. Our final number of patients were 163, with 171 open fractures. MAIN OUTCOME MEASUREMENT: The infection rates for Type I and Type II open fractures for both antibiotic groups were calculated. The infection rate of Type III open fractures for both antibiotic groups was also calculated. Chi-square analysis with Yates correction was used to assess statistical significance of two treatment groups. RESULTS: The infection rate for Types I and II open fractures in the ciprofloxacin group was 5.8 percent and 6 percent for the cefamandole/gentamicin group (p = 1.000). The infection rate for Type III open fractures for the ciprofloxacin group was 31 percent (8 of 26) versus 7.7 percent (2 of 26) for the cefamandole/gentamicin group (p = 0.079). There were no statistically significant differences in infection rate between the group treated with ciprofloxacin and that treated with cefamandole/gentamicin for Types I and II open fracture wounds. However, there appeared to be a high failure rate for the ciprofloxacin Type III open fracture group, with patients being 5.33 times more likely to become infected than those in the combination therapy group. Although this difference was not statistically significant, possibly because of the small sample size, there was a definite trend toward statistical significance. CONCLUSION: Single-agent antibiotic therapy with ciprofloxacin is effective in treatment of Type I and Type II open fracture wounds. However, on the basis of our results, we cannot recommend ciprofloxacin alone for Type III wounds. Possibly one can use fluoroquinolones in combination therapy, specifically as an alternate to an aminoglycoside.

Adult↗
PubMed1999

Culture results in open wound treatment with muscle transfer for tibial osteomyelitis.

Fifty-three patients who underwent a two-staged protocol of debridement and muscle flap coverage for chronic osteomyelitis of the tibia between 1991 and 1996 were evaluated. All patients underwent a thorough debridement of all nonviable tissue and bone at initial debridement. Multiple cultures were taken, including aerobic, anaerobic and fungal cultures from the pus, soft tissue, bone curettings and bone. All patients were treated with open wound management and dressing changes. Between 2 to 7 days, median 4 days, all patients underwent a second debridement with a complete set of identical cultures, and immediate soft tissue muscle transfer. There were 42 free vascularized and 11 local tissue transfers. The 53 patients were classified according to the Cierny-Mader classification for chronic osteomyelitis. Twenty-four patients had Stage IVA osteomyelitis, 10 patients had Stage IIIA osteomyelitis, nine patients had Stage IIIB osteomyelitis, eight patients had Stage IVB osteomyelitis, one patient had Stage IA osteomyelitis, and one patient had Stage IIB osteomyelitis. All 53 patients had positive cultures at the time of their initial debridement, and 14 of 53 (26%) had a positive culture at the time of the second debridement. Based on the results, it seems from a bacteriologic stand-point that the second debridement allows for the opportunity for redebridement and wound sterilization of organisms that still may be present.

Adolescent↗
PubMed1999

Outcome of infected total knee utilizing a staging system for prosthetic joint infection.

This study reviews, over a 5-year period, the records of 70 consecutive patients with prosthetic knee infection and evaluates outcomes as a function of a staging system for prosthetic joint infection. The staging system for prosthetic joint infection was divided into three main categories that include infection type, systemic host grade, and local extremity grade. Outcome indices analyzed included Knee Society Score (KSS), complication rate, amputation rate, and rate of permanent resection. We show that categorizing and stratifying data for patients with infected total knee arthroplasty are useful. A universally accepted staging system would allow for more objective comparisons of treatments and may eventually define particular treatment regimens for particular classes of patients.

Aged↗
PubMed1998

Circulating CD34+ counts and apheresis planning.

The success of peripheral blood progenitor cell (PBPC) transplantation depends upon harvesting adequate numbers of cells and accurate prediction of when to commence apheresis. Although peripheral white cell count (WBC) is commonly used to identify when to initiate apheresis it does not uniformly predict the CD34+ content of the apheresis product nor the number of exchange procedures required. We investigated whether the peripheral blood CD34+ count would not only predict harvest yield but whether it would also predict the number of apheresis procedures needed to generate at least 2 x 10(6)/kg CD34+ cells. CD34+ counts were performed over an 8-month period on the peripheral blood and PBPC harvests of all patients undergoing leucopheresis. Regression analysis showed a highly significant correlation between peripheral blood CD34+ count and yield of CD34+ cells in the apheresis product. The regression plot with WBC was weaker. We have shown that a peripheral CD34+ count > or = 62 x 10(6)/l is required to confidently achieve an adequate harvest in one apheresis, two aphereses are needed if the initial count is > or = 40 x 10(6)/l. Therefore peripheral blood CD34+ counts not only are able to determine the threshold at which to commence apheresis but are useful in predicting apheresis requirements and planning demands on the apheresis service.

Adult↗
PubMed1997

Salvage of the septic ankle with concomitant tibial osteomyelitis.

Five patients with concomitant distal tibia osteomyelitis and ankle sepsis with an open, draining wound were treated. All of the patients were men with an average age of 54.8 years. All of the bone infections were polymicrobial and had open draining wounds. A standardized protocol of radical soft tissue and bone debridement, soft tissue transfer, intravenous antibiotics, and delayed ankle fusion was employed. All five fusions were successful on first attempt, with an average time to fusion of 3.5 months. All patients were free of infection at an average follow-up of 27 months. We believe our aggressive treatment protocol can salvage these extremities and preclude amputation in properly selected cases.

Adult↗
PubMed1995

Results of bone grafting for infected tibial nonunion.

Thirty-two patients with infected tibial nonunions were treated, including 24 men and 8 women whose ages ranged from 21 to 72 years (mean, 40 years). Thirty of 32 patients had bone defects < 3 cm. Using the Cierney-Mader classification of osteomyelitis, 11 of 32 (35%) patients were Stage 4A, and 21 of 32 (65%) patients were Stage 4B. All patients had irrigation, debridement, and stabilization using an external fixation device. Twenty-seven (84%) patients had muscle transfers. The time between initial debridement and muscle transfer ranged from 3 to 24 days (mean, 4 days). Bone grafting was performed between 6 weeks and 8 months (mean, 8 weeks) after soft tissue coverage. Patients received intravenous antibiotics for 2 to 6 weeks (mean, 6 weeks). Twenty patients received anterior grafting, 10 received posterolateral grafting, and 2 received both. Followup times ranged from 12 to 49 months (mean, 28 months). Twenty-nine of the 32 (91%) patients had tibial unions between 3 to 10 months (mean, 5.5 months) after bone grafting. The 3 failed tibias united after posterolateral grafting. Infection was controlled in all 32 patients. Autogenous cancellous bone grafting using infection control principles is an effective means to treat infected tibial nonunions.

Adult↗
PubMed1994

Comparison of the results of bacterial cultures from multiple sites in chronic osteomyelitis of long bones. A prospective study.

We evaluated the results of aerobic, anaerobic, and fungal cultures of specimens that had been obtained from multiple sites in thirty patients who had traumatic osteomyelitis with a sinus track. In each patient, we obtained specimens of material from the sinus track; specimens of purulent fluid, of soft tissue, and of bone obtained from curettage; and specimens from the bed of the involved bone. More than one organism grew on culture of the specimens from twenty-one of the patients; more than three organisms, from those of eleven patients; and ten organisms, from those of two patients. The same organisms grew on culture of the specimens from every site in only fourteen (47 per cent) of the thirty patients. We recommend that specimens of material from the sinus track; specimens of purulent material, of soft tissue, and of bone obtained from curettage; and specimens from the bed of the involved bone be obtained for culture before the treatment of chronic osteomyelitis with a draining sinus, so that as many of the infecting organisms as possible will be identified.

Bacteria, Aerobic↗
PubMed1993

Septopal beads and autogenous bone grafting for bone defects in patients with chronic osteomyelitis.

Thirty-five patients with chronic osteomyelitis were treated with autogenous bone grafts for bone defects. Of 35 patients, two were lost to follow-up evaluation. There were 27 men and six women. The age range was from 18 to 62 years (median age, 29 years). The bones included 22 tibias, nine femurs, and two ulnas. The size of the bone defects ranged from 2.5 x 15 cm (median defect, 2.5 x 6 cm). The length of infection ranged from two to 540 months (median, 31 months). Twenty patients had nonunions and 19 patients required soft-tissue muscle transfers. Patients were treated with systemic antibiotics and/or gentamicin (Septopal) antibiotic beads. Twelve patients were treated with Septopal beads. The range of follow-up evaluation was 24 to 68 months (median, 47 months). Thirty-one of 33 patients had one bone-graft procedure and two patients required two. The time from initial debridement and infection control to bone graft for patients not requiring soft-tissue muscle flaps was one to six weeks (median time, four weeks). For patients requiring soft-tissue muscle transfer, the range was six to nine weeks (median, six weeks). The median time to bone-graft incorporation was six months. All fractures united. Complications included two refractures from auto accidents in the immediate postoperative period, one partial muscle loss, one skin-graft loss, four pin tract draining sites, and two antibiotic-related skin rashes. There was one recurrent infection, and the infection arrest rate was 97%.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMedDate not supplied

The incidence of joint involvement with adjacent osteomyelitis in pediatric patients.

Sixty-six patients admitted to our institution over an 8-year period with the diagnosis of osteomyelitis were analyzed to determine the incidence of adjacent joint involvement. Patients with osteomyelitis of the hand, foot, spine, and extraarticular pelvis were excluded from this study. The average age was 5.8 years (range, 1 month to 17 years). Forty-two percent of our patients who had osteomyelitis had evidence of adjacent joint involvement (either septic or nonseptic). One third of our patients had evidence of septic joint involvement. The most commonly involved joint was the knee. There was no difference in the incidence of adjacent joint involvement in those patients who were younger than 18 months compared with the incidence in older children. Our study suggests that the incidence of adjacent joint involvement in children who have osteomyelitis is higher than that suggested in the literature. We believe that careful evaluation of the adjacent joint should be an important part of the evaluation of any child who has osteomyelitis.

Adolescent↗