Antibiotic-loaded bone void filler accelerates healing in a femoral condylar rat model.

AIMS: Demineralised bone matrix (DBM) is rarely used for the local delivery of prophylactic antibiotics. Our aim, in this study, was to show that a graft with a bioactive glass and DBM combination, which is currently available for clinical use, can be loaded with tobramycin and release levels of antibiotic greater than the minimum inhibitory concentration for Staphylococcus aureus without interfering with the bone healing properties of the graft, thus protecting the graft and surrounding tissues from infection. MATERIALS AND METHODS: Antibiotic was loaded into a graft and subsequently evaluated for drug elution kinetics and the inhibition of bacterial growth. A rat femoral condylar plug model was used to determine the effect of the graft, loaded with antibiotic, on bone healing. RESULTS: We found that tobramycin loaded into a graft composed of bioglass and DBM eluted antibiotic above the minimum inhibitory concentration for three days in vitro. It was also found that the antibiotic loaded into the graft produced no adverse effects on the bone healing properties of the DBM at a lower level of antibiotic. CONCLUSION: This antibiotic-loaded bone void filler may represent a promising option for the delivery of local antibiotics in orthopaedic surgery. Cite this article: Bone Joint J 2016;98-B:1126-31.

Miliaria profunda.

Miliaria profunda is an uncommon but highly characteristic disorder that can be disabling. We describe a patient with miliaria profunda who responded to therapy with anhydrous lanolin and isotretinoin. Clinical features, pathogenesis, differential diagnosis, and therapy are reviewed.

Incidence, significance, and kinetic mechanism responsible for leukemoid reactions in patients in the neonatal intensive care unit: a prospective evaluation.

OBJECTIVE: To prospectively investigate the incidence, significance, and kinetic mechanism responsible for leukemoid reactions in patients in the neonatal intensive care unit (NICU). DESIGN: We prospectively studied all infants admitted to the NICU at the University of Florida who, during a period of 12 consecutive months, had a leukemoid reaction. All those identified had a standardized evaluation consisting of (1) karyotype analysis, (2) bacterial cultures, (3) evaluations for toxoplasmosis, other (congenital syphilis and viruses), rubella, cytomegalovirus, and herpes simplex virus) (TORCH), (4) determination of blood viscosity, (5) use of marrow aspirates for morphology, clonogenic progenitor cell assays, and cell-cycle analysis of progenitors, (6) determination of serum concentrations of granulocyte and granulocyte-macrophage colony-stimulating factors, and (7) serial complete blood cell counts until the leukemoid reaction remitted. RESULTS: During 12 months, 707 patients were admitted to the NICU and 4262 complete blood cell counts were performed on samples from these patients. A leukemoid reaction was identified in nine patients, all of whom were preterm (born at 24 to 38 weeks' gestation). Peak blood leukocyte concentrations were 51.7 +/- 15.6 x 10(3)/microl (mean +/- SD). The leukemoid reactions were detected during the first 4 days of life in seven patients, on day 9 in one, and on day 25 in one. An abnormal karyotype (47, XY, +21) was present in one infant. Mothers of four infants had received betamethasone antenatally. None had elevated whole blood viscosity or positive findings on bacterial or TORCH evaluations. None of the bone marrow findings were consistent with steroid-induced leukocytosis; all studies indicated accelerated neutrophil production. Serum concentrations of granulocyte-macrophage colony-stimulating factor were either negligible or nondetectable. Serum granulocyte colony-stimulating factor was elevated in three patients, low in two, and nondetectable in four. The leukemoid reactions persisted for 5 to 32 days, the longest being in the patient with trisomy 21. CONCLUSIONS: Leukemoid reactions were not particularly rare in our NICU (1.3% of patients). The reactions were not associated with hyperviscosity and, except in one patient with a karyotype abnormality, were transient. The responsible kinetic mechanism was increased neutrophil production, not steroid-induced leukocytosis.

Papular mucinosis associated with acquired immunodeficiency syndrome.

Papular mucinosis, also known as lichen myxedematosus, is a rare, idiopathic disorder in which focal deposits of mucin accumulate in the dermis. It has been previously reported in two patients with human immunodeficiency virus infection; we describe a third such case and note the presence of a granuloma adjacent to the mucin deposit. We also comment on other clinical manifestations of cutaneous mucin deposition and granuloma formation in human immunodeficiency virus infection.

Multiple endocrine neoplasia type III: case report and review.

Multiple endocrine neoplasia type III (MEN 3), also known as MEN 2b, is a syndrome that may be recognized at a young age by its characteristic numerous mucosal neuromas and marfanoid habitus. These features are generally evident before the development of medullary thyroid carcinoma and pheochromocytoma, allowing for early diagnosis and intervention. Much has been learned recently in this regard to reduce morbidity and mortality. In addition, periodic screening of first-degree relatives of patients with MEN 3 has proved effective in detecting familial cases. Finally, new findings have been made regarding the etiology of MEN 3, with potentially wide-ranging implications.

The role of posterior lumbotomy in the management of surgical stone disease.

A total of 50 consecutive patients underwent posterior lumbotomy for removal of upper third ureteral or renal pelvic stones between June 1983 and October 1986. Morbidity was low, hospitalization was brief and 100 per cent of the patients were rendered free of stones postoperatively. Dorsal lumbotomy compares favorably with other currently available methods for the management of selected patients with calculous disease.

Sinus tarsi pain: case history.

An attempt was made to give the podiatrist some insight into the differential diagnosis of sinus tarsi pain. One possible etiology is discussed in detail along with case presentation and treatment.