Debridement and Functional Rehabilitation for Achilles Tendon Infection Following Tendon Repair.

BACKGROUND: An infected Achilles tendon after tendon repair is particularly difficult to treat because of the poor vascularity of the tendon as well as the thin surrounding soft tissue. For treatment of an infected Achilles tendon following tendon repair, we first focused on complete debridement and then promoted fibrous scar healing of the Achilles tendon using functional treatment. METHODS: We retrospectively reviewed all of the medical records of 15 tertiary referral patients with postoperative infection of the Achilles tendon occurring between 2007 and 2012. The mean follow-up time was 33 months (range, 22 to 97 months). The infected tissue and the necrotic tendon were debrided, and the ankle was placed in a short leg splint for 2 weeks. The splint was then replaced with an ankle brace for the next 4 weeks. Partial weight-bearing was allowed immediately, and full weight-bearing was allowed at 2 weeks postoperatively. We assessed and recorded the physical parameters such as the range of motion, calf circumference, ability to perform a single-limb heel rise, patient satisfaction, and Arner-Lindholm scale. Laboratory tests, postoperative ultrasonography, and isokinetic plantar flexion power tests were also performed. RESULTS: At a mean time of 17 days (range, 8 to 30 days) after debridement, infection signs such as discharge from the wound, redness, and local warmth resolved. The wound had healed and the stitches were removed at a mean of 17 days following the wound repair. At the time of the latest follow-up, there were no signs of active infection. Achilles tendon continuity recovered in all patients by fibrous scar healing. Compared with the contralateral side, there was no difference in the ankle range of motion in 8 patients. According to the Arner-Lindholm scale, 9 of the 15 results were excellent and 6 were good. Ten patients were able to perform a single-limb heel rise. Eleven of 15 patients returned to their pre-injury recreational activities. Diffuse homogeneous echotexture of the Achilles tendon with continuity was observed on the ultrasonographic examination. CONCLUSIONS: In this retrospective series, radical debridement, combined with antibiotic therapy and functional rehabilitation, was successful in eradicating infection and maintaining function in patients with postoperative infection following Achilles tendon repair. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Pilot study of an oral care protocol on poststroke survivors.

PURPOSE: The pilot study purpose was to determine the effects of a new standardized oral care protocol (intervention) to usual care practices (control) in poststroke patients. DESIGN: This study is a randomized controlled clinical trial. METHOD: Fifty-one subjects were enrolled. Subjects in the intervention group received oral care twice a day including tooth brushing, tongue brushing, flossing, mouth rinse, and lip care while control patients received usual oral care. FINDINGS: Subjects in the control and intervention groups showed improvement in their oral health assessments, swallowing abilities and oral intake. There were no significant differences between the two groups. Although not statistically significant, overall prevalence of methicillin-resistant Staphylococcus aureus and methicillin-sensitive Staphylococcus aureus colonization in the control group almost doubled (from 4.8% to 9.5%), while colonization in the intervention group decreased (from 20.8% to 16.7%). CONCLUSIONS/CLINICAL RELEVANCE: These findings demonstrate the importance of oral care in the poststroke patient with dysphagia.

Unusual presentation of a spinal epidural abscess.

A 59-year-old female patient presented with a 3-day history of abdominal pain and confusion. She had no significant medical history. On admission her Glasgow Coma Scale was 14/15; she was septic and examination revealed right upper quadrant tenderness. She deteriorated quickly, becoming acidotic and hypoxic, and was sedated, intubated and transferred to the intensive care unit. Blood tests revealed raised inflammatory markers and blood cultures grew Staphylococcus aureus. Initial CT head revealed raised intracranial pressure and she was treated for meningoencephalitis. Repeat CT head 12 days later showed resolving oedema, and a lumbar puncture was attempted. This drew only frank pus and an abscess was suspected. CT spine confirmed a possible paravertebral abscess. Once extubated, MRI spine was possible which confirmed spinal epidural abscesses-1 month postadmission. These were rapidly drained by the neurosurgical team and the patient is currently receiving rehabilitation in a specialist centre.

Patients' experiences of being infected with MRSA at a hospital and subsequently source isolated.

BACKGROUND: Patients infected with methicillin-resistant Staphylococcus aureus (MRSA) during a large outbreak of E-MRSA 16 between 1997 and 2001 at Sahlgrenska University Hospital, Sweden, were moved from their speciality ward to the Clinic of Infectious Diseases for care in source isolation as long as the patient needed hospital care. AIM: To get knowledge regarding patients' experiences who contracted MRSA at the hospital and subsequently source isolated at the Clinic of Infectious Diseases. METHOD: The interviews were designed according to qualitative research. Six patients, aged 35-76 years, who contracted MRSA at Sahlgrenska hospital and subsequently source isolated for at least 1 week were interviewed. The interviews were tape-recorded and an inter-subjective analysis was accomplished. FINDINGS: The study found that the patients felt violated for having contracted MRSA at the hospital and the isolation was described as traumatic, albeit accepted because they took responsibility for not spreading MRSA. The patients felt that they did not receive rehabilitation on the same conditions as other patients and lacked information about MRSA. They felt vulnerable due to negative reactions from the nursing staff, family members and other patient's surroundings. CONCLUSION: Patients who contract MRSA need information about what the MRSA contagion involves. There is a great need for an elevated knowledge of MRSA among staff members. An increased awareness of how the contagion spreads will allay fears of MRSA among staff and patients. The source isolation should be as short as possible to minimise the feeling of confinement.

Use of a lumbosacral orthosis in the management of septic arthritis of the hip.

INTRODUCTION: Septic arthritis can lead to loss of joint motion and permanent mobility deficits because of infection and inflammatory response damaging articular structures. METHODS: A 13-year-old boy underwent five left hip surgeries after diagnosis of septic arthritis. He participated in 14 months of physical therapy, including hip stretching and manipulation. A lumbosacral orthosis (LSO) was applied to immobilize the lumbar region and isolate motion at the left hip. Treatment was divided into three phases: initial treatment, after manipulation under anesthesia, and after application of the LSO. Hip flexion range of motion (ROM) improved by 100 degrees and extension by 20 degrees. The patient returned to a high level of function, including athletics, but continued to have limited ROM and gait deviations. CONCLUSIONS: Improvement in hip ROM after application of the LSO suggests that this intervention may have applicability in treatment of hip dysfunctions.

[The ultrastructural changes to the ovaries and oviducts in experimental inflammation under the influence of eplir phonophoresis]. / Ul'trastrukturnye izmeneniia iaichnikov i iaitsevodov pri éksperimental'nom vospalenii pod vliianiem fonoforeza éplira.

Ultrastructural changes of blood vessels of ovaries and oviducts, destruction of the part of follicular epitheliocytes and disruption of other structures of blood-follicular barrier occur at the early period of experimental inflammations of appendage uterus on the background of traditional antibiotic therapy. All changes lead to atresia of growing follicules. Fibrotic-sclerotic changes develop on the 30th day and during later period. Course of eplir phonophoresis decreases ultrastructural disruptions of vessels, follicular apparatus of ovaries and oviducts epithelium. Effect of physiotherapy is manifested though activity of fibroclasts and macrophages, that regulate collagen production/resorption ratio thus preventing the development of fibrotic changes of ovary stroma and oviduct wall.

A purpose built MRSA cohort unit.

The control of hospital-acquired infection, in particular methicillin-resistant Staphylococcus aureus (MRSA) remains a challenge. Our hospital has established a purpose built 11-bed cohort unit with on-site rehabilitation for care of patients colonized with MRSA, in an attempt to improve their quality of care. Prior to the opening of this unit a number of concerns were voiced and the aim of this study was to address these. First, to establish if patient cohorting reduces the likelihood of successful decolonization, second, to evaluate the risk of staff colonization, and finally to see if successful environmental control of MRSA is possible.A patient database was established detailing patient demographics, infection rates, eradication and reacquisition rates. Staff screening was performed weekly, at the start of a period of duty. Sixty environmental sites were screened before unit opening, at 48h, six weeks and at six months. There were 88 admissions in the first six months; 62 patients were colonized with MRSA, and 26 patients (10 surgical, 16 medical) had MRSA infections. Twenty-three of 88 patients (26%) were successfully decolonized, which compares favourably with an eradication rate of 20% for the rest of the hospital. Twenty staff members participated in weekly screening. Five staff members colonized with MRSA were detected and all were successfully decolonized. Environmental control was achieved with a combination of a daily detergent clean and a once weekly clean with phenolic disinfectant. Our preliminary data suggest that, despite cohorting patients colonized with MRSA, with proper education and supervised cleaning protocols, it is possible to control environmental MRSA load, successfully decolonize patients and limit the risk of staff colonization.

[The effect of therapeutic mud on the viability and persistence properties of bacteria]. / Vliianie lechebnoi griazi na zhiznesposobnost' i persistentnye svoistva bakterii.

The influence of therapeutic salt mud on the viability and some biological properties of bacteria, responsible for their survival in the macroorganisms, was shown. Therapeutic mud had low bactericidal properties, and enterobacteria were, on the whole, even less sensitive to these properties than staphylococci. Therapeutic mud inhibited the capacity of bacteria for inactivating complement, lysozyme and the bactericidal component of the preparation of interferon and also reduced the hydrophobic properties of bacterial cells. At the same time Escherichia were found to be more susceptible to the modifying action of the mud than staphylococci. The greatest effect on the hydrophobic properties and anticomplement activity of bacteria was observed after their incubation in mud solution.