[Community-acquired bacterial septic arthritis in adults: diagnosis and treatment]. / Arthrite septique bactérienne communautaire chez l'adulte: du diagnostic au traitement.

The diagnosis of acute native joint bacterial infection can be difficult, because of its non- specific clinical and biological manifestation. Its management is often an emergency. Following a joint puncture, early joint lavage is performed, either by surgical drainage or by repeated arthrocentesis; and accompanied by systemic antibiotics, of which the ideal duration and route of administration remains unknown. The postoperative care is characterized by joint mobilization to avoid joint stiffening.

Effects of removal of the acetabular labrum in a sheep hip model.

OBJECTIVE: The aim of this study was to learn whether partial resection of the acetabular labrum would lead to degenerative arthritis in an ovine model. METHODS: A 2 cm segment of labrum was removed from one hip in 18 mature Swiss Alpine sheep and a sham procedure was performed on the opposite side. Animals were permitted ad lib activity until sacrifice at 6, 12 or 24 weeks. The hip joint was removed en bloc, and loaded with a force of one body weight, using a custom device designed to recreate a physiologic joint reaction force. While under load, the joint was plunge frozen, and then fixed by freeze substitution using aldehydes in methanol/acetone solvents. The entire joint was embedded in methacrylate and sectioned in a standardized frontal plane following the reaction force and including the femoral neck and the acetabular fossa. The sections were evaluated for concentricity and evidence of arthrosis. Six hip joints of three sheep with no surgical procedure were loaded with high or low loads and served as non-surgical controls. RESULTS: Degenerative changes were present in all surgical hips, but the changes were symmetrical and mild. In 16 of 18 hips, the labrum regenerated to the extent that dense fibrous scar extending from the surgically denuded origin filled the defect. CONCLUSION: Resection of the labrum does not cause rapid degeneration or altered stability of the sheep hip.

Fluid resuscitation in infantile hypertrophic pyloric stenosis.

UNLABELLED: The purpose of this analysis was to investigate biochemical disturbances at presentation and initial fluid resuscitation before surgery in infantile pyloric stenosis. The charts of 139 consecutive infants (113 boys and 26 girls) between 7 d and 20 wk of age with hypertrophic pyloric stenosis were reviewed. The infants were treated at the Department of Pediatric Surgery, University of Bern, Switzerland, in the period between 1987 and 1997. A trend towards hypokalaemia (13 of the 139 patients), hypochloraemia (39 patients) and especially metabolic alkalosis (98 patients) was frequently noted on admission. In 84 patients, data on fluid management and on circulating sodium, potassium, chloride and the acid-base balance immediately before surgery were also available. In these patients a significant correlation was found between the parenteral chloride dose given for fluid repair (y = 0.310 x; r = 0.54; p < 0.001) and the changes in plasma bicarbonate. The equation indicates that a chloride dose of 10 mmol/kg body weight is required to reduce plasma bicarbonate on average by 3 mmol/. CONCLUSION: Since assessment of the fluid volume stated by physical examination and history is inaccurate in infants with vomiting, the severity of metabolic alkalosis helps to define the amount of fluid required for repair.