Biomedical subjects

R Bouillet

Publications and source records attributed to R Bouillet.

At least 19 recordsLinked to original sources

PubMed1997

Antibiotic-loaded plaster of Paris implants coated with poly lactide-co-glycolide as a controlled release delivery system for the treatment of bone infections.

Plaster of Paris implants containing vancomycin (60 mg/g of carrier) were prepared in order to be used as local delivery system for the treatment of bone infections. The regulation of the release rate was performed by coating the carrier with a polylactide-co-glycolide polymer composed by 10% (w/w) polyglycolic acid and 90% (w/w) racemic poly (D,L-lactic acid). The release of the antibiotic from the biodegradable matrix was evaluated in vitro. From this investigation, it is clear that the drug elution depends on the coating depth. After a burst effect occurring on the first day of the experiment, therapeutic concentrations were measured during one week when uncoated implants were used. The coating allowed decrease of the burst effect and extended efficient release to more than five weeks when the implants were embedded with six layers (162 microns) of PLA45GA10. This delivery system was implanted into the femoral condyle of rabbits. It was shown that the in vivo release was also closely regulated by the coating depth. In all bone tissues (bone marrow and cortical bone) surrounding the pellets, the drug concentration exceeded the Minimum Inhibitory Concentration for the common causative organisms of bone infections (Staphylococcus aureus) for at least four weeks without inducing serum toxic levels. Due to its cheapness, facility of use and sterilization, biocompatibility and biodegradability, plaster of Paris coated with PLA45GA10 polymer giving a controlled release of vancomycin appears to be a promising sustained release delivery system of antibiotics for the treatment of bone and joint infections.

Animals↗

PubMed1995

Biodegradable implants for potential use in bone infection. An in vitro study of antibiotic-loaded calcium sulphate.

Local antibiotic therapy by diffusion from plaster of Paris beads has proved promising in bone surgery. Sustained local delivery depends on thermostability, so we tested the antibacterial activity of 11 antibiotic solutions after storage at 37 degrees C using a microbiological method. Cephalosporins and penicillins were unstable, but aminoglycosides remained fully stable with 100% activity after 2 weeks. About 60% of the initial bactericidal activity of quinolone, glycopeptides and sodium fusidate were still detectable after 2 weeks. Release of these antibiotics from plaster of Paris beads was evaluated in vitro. Even those in the same family differed in their release rate. Plaster beads with sodium fusidate were the most effective association. A therapeutic level of glycopeptides, aminoglycosides and amoxicillin was leached for about 3 weeks. Cephalosporins and sodium amoxicillin were released in 2 to 3 days, and quinolone beads were too brittle to be used. Plaster of Paris, which is cheap, biocompatible and biodegradable, is an excellent carrier for sodium fusidate, aminoglycosides and glycopeptides.

Aminoglycosides↗

PubMed1993

[Plaster of Paris: a carrier for antibiotics in the treatment of bone infections].

Local antibiotherapy by diffusion from plaster of Paris is a promising method in orthopedic surgery. Nevertheless, the characteristics of this matrix have not yet been extensively studied with respect to regulation of drug-carrier capacity. From the careful comparative investigation of five commercialized plasters of Paris, it appears that the material must be constituted of fine homogeneous crystals devoid of any additive in order to obtain reproducible implants which are sufficiently hard. This condition determines their use as a biodegradable filler of bone cavities. Because of the antimicrobial spectrum, diffusion velocity and synergistic effect of sodium fusidate, amoxicillin trihydrate and sodium amoxicillin, this association of antibiotics with the plaster of Paris appears to be a useful sterilizing delivery system. The plaster of Paris allows a significant release of sodium amoxicillin during the first 3 days. This is followed by an important sustained liberation of sodium fusidate and amoxicillin trihydrate for one week. Finally, the local release of sodium fusidate for at least 2 weeks at concentrations higher than the minimum inhibition concentrations (MIC) of the most frequently infecting pathogens in osteomyelitis, will allow the sterilization of bone cavities.

Anti-Bacterial Agents↗

PubMed1992

[The treatment of rigid hallux using Swanson's silastic implant (single and double stem). Clinical, radiological and podobarographic review with a 16-year maximum follow-up].

Twenty-eight cases of hallux rigidus treated with the Swanson Silastic implant (single and double stem) were reviewed, with an 8-year follow-up. The skin complication rate was significant. Long-term patient satisfaction was good. Radiologic findings were alarming: implants seem to wear out quickly on the articular side, and granulomatous reactions develop around the stems. Dynamic pedobarography shows decreased pressure under the first ray, with transfer of the weight to the midmetatarsal heads, sometimes on the external edge of the foot. The authors review the international literature on the etiology, pathology and treatment of hallux rigidus. Surgical indications and techniques are specified.

Adult↗

PubMed1992

[Ischemic necrosis of the femoral head following osteosynthesis of an extracapsular fracture].

The authors have reviewed 6 cases of avascular necrosis of the femoral head which occurred after internal fixation of an extracapsular fracture in the adult. This is a rare and poorly described complication. Several pathogenic hypotheses are discussed, but none could be retained formally. The aim of this article is to point out this type of complication, which still lacks a satisfactory explanation.

Aged↗

PubMed1991

[The use of Partridge plates in the treatment of femoral diaphysis fractures near a prosthesis in elderly patients].

Spiral or comminuted fractures of the femoral shaft in the vicinity of a prosthesis in the elderly patient have been encountered with increasing frequency and may be very difficult to treat. The use of a combination of multiple nylon cerclage straps and plates as described by Partridge is a satisfactory alternative to either conservative treatment in traction or a metallic internal fixation. The authors report their experience with this method in a series of 6 patients aged 74 to 91 years. The surgical trauma was minimal, early mobilization was possible, and the fractures united at a normal rate with abundant periosteal callus.

Aged↗

PubMed1990

Treatment of sciatica. A comparative survey of complications of surgical treatment and nucleolysis with chymopapain.

Chymopapain in the treatment of sciatica by chemonucleolysis has become widespread in the United States and Europe since the approval of this drug for general use by the Food and Drug Administration. Potentially, the increased use of this drug by surgeons with relatively little experience could be expected to cause an increase in the complication rate. This report analyzes the results of a questionnaire sent to surgeons in 316 departments who have recently treated a total of 43,662 patients with this technique. The complication rate was 3.7% (1606 incidents). Of these, 192 (0.45%) were severe. The study revealed that the frequency of severe allergic reactions is lower in Europe than in the United States. Twice the number of anaphylactic reactions occurred with local and neuroleptic anesthesia compared to local or general anesthesia alone. The risk of infectious discitis is low, but a strict sterile technique is mandatory. Neurologic complications were rare, but included 15 cauda equina, one meningeal hemorrhage, a case of epilepsy, and two cases of paraplegia. The rate of complications in this study is comparable to two previous studies; thus, the expected increase in complications has not occurred. For comparison, a survey of 2051 patients treated surgically showed a complication rate of 26% (534 incidents), including 86 (4.2%) severe complications. Among the surgically treated patients, there was a perioperative complication rate of 9.75% (200 incidents) and a postoperative complication rate of 14% (290 incidents), resulting in three deaths. Thus, the surgical treatment was responsible for six times the number of incidents and ten times more severe incidents than for patients treated by nucleolysis.

Adolescent↗

PubMed1989

[Treatment of chronic osteomyelitis in Africa with plaster implants impregnated with antibiotics].

Nineteen African patients with osteomyelitis were treated by curettage of the lesions and packing of the bone cavities with plaster of Paris pellets containing antibiotics (Fucidin and Amoxycillin). Of 18 patients followed, 16 showed wound healing in an average of 3 to 6 weeks. Eight patients had regular roentgenographic examinations during a minimum of two months. In six of these patients, healing of the lesions and a significant osteogenic reaction were observed. The plaster pellets were resorbed in 3 to 6 weeks in all patients, and no signs of rejection were noted. In spite of insufficient follow-up due to medical conditions in Africa (Zaire), the study confirms the advantages of this simple treatment of osteomyelitis in underdeveloped countries.

Adolescent↗

PubMed1987