Intramuscular, intravenous and oral levetiracetam in dogs: safety and pharmacokinetics.

Intravenous (IV) levetiracetam (LEV) is available for humans for bridge therapy when the oral route is unavailable. We investigated the safety and pharmacokinetics of LEV administered intramuscularly (IM), IV, and orally to dogs. Six Hound dogs received 19.5-22.6 mg/kg of LEV IM, IV and orally with a wash-out period in between. All dogs received 500 mg LEV orally and 5 mL of 100 mg/mL LEV IM. Three dogs received 500 mg of LEV IV and three dogs received 250 mg LEV IV with 250 mg given perivascularly to approximate extravasation. Safety was assessed using a pain scale at time of IM administration and histopathological examination 24 h to 5 days after injection. Intravenous LEV half-life was 180 +/- 18 min. Bioavailability of IM LEV was 100%. Mean time to T(max) after IM was 40 +/- 16 min. The mean C(max) IM was 30.3 +/- 3 mug/mL compared to the C(0) of 37 +/- 5 mug/mL for IV. Mean inflammation score (0-4 scale) for IM LEV was 0.28 and for saline 0.62. Extravasation did not cause tissue damage. Parenteral LEV is well tolerated and appears safe following IM and IV injections in dogs. Parenteral LEV should be evaluated for use in dogs with epilepsy.

Control of orthopedic nosocomial wound infections.

The catastrophic effects of deep sepsis as a complication of total joint replacement, especially the hip and the knee, are well documented. This review identifies risk factors predisposing to surgical wound infection. Proven, investigational, and theoretic methods of reducing nosocomial wound infection rates, particularly pertaining to orthopedic procedures, are given.

Total hip arthroplasty: review of long-term results in 185 cases.

Review of 185 consecutive Muller total hip arthroplasties five to nine years after operation showed that 14 patients had died and that three deaths were directly related to the surgery. Of these, 37 patients (54 hips) could not be located and were excluded. Another patient, nonambulatory for an unrelated cause, was also excluded. A total of 126 hips in 104 patients were available for clinical and roentgenographic examinations with a minimal follow-up of five years. The final result was excellent in 70%, good in 10%, fair in 5%, and poor in 15%. One deep infection required removal of the prosthesis. There was no sciatic nerve injury. Five hips dislocated postoperatively and six others had recurrent subluxation. Replacement of the acetabular component was required in four hips, three because of loosening and the other for malposition in association with paraparesis. Trochanteric osteotomy was done in nine hips and four failed to unite. There was roentgenographic evidence of femoral component loosening in 28% of the hips and 8% required replacement. Poor cement filling and varus positioning of the femoral stem contributed to loosening.

Displaced tibial shaft fractures: a comparison of treatment methods.

Eighty-five overriding tibial shaft fractures (46 open, 39 closed) were treated at Ochsner Foundation Hospital between 1960 and 1972. Nine different treatment methods were employed by seven orthopedic surgeons. The best results were obtained in the nine patients treated by open reduction and either compression plating or external skeletal fixation with compresssion. All healed primarily in the briefest time and none had a complication.

Electrical stimulation in treatment of delayed union and nonunion of fractures and osteotomies.

This study reviews the cases of 52 patients with 52 ununited fractures and osteotomies who were treated with two methods of electrical stimulation, one surgical, the other nonsurgical. Seventeen patients, 14 of whom had concomitant bone grafting, had implantation of a bone growth stimulator. There were three synovial pseudarthroses but no active infection in this group. The overall success rate in healing of the fractures was 82%. Thirty-five patients, of whom four had initial concomitant bone grafting, were treated with pulsing electromagnetic fields (PEMF). There were six draining infections but no pseudarthrosis in this group. Two nonunions healed after bone grafting was combined with PEMF treatment, when the latter alone had failed. Eighty-one percent of the fractures united, and drainage ceased in five of the six infections.

Cervical spondylotic dysphagia.

Reported is a patient who had severe dysphagia caused by cervical osteophytes. Both of the cervical vertebral spurs were excised, and anterior interbody stabilization was unnecessary. In the diagnosis of such patients, esophagoscopy is recommended, but it must be done with extreme care because of the increased risk of esophageal perforation. Treatment may consist of reassurance and a trial of anti-inflammatory agents if the symptoms are minimal, but definitive treatment, usually associated with complete recovery, is surgical excision.

Aseptic necrosis of the femoral head. Treatment with bone grafts of doubtful value.

A heterogeneous group of 17 patients with aseptic necrosis of the femoral head had treatment of 23 hips by bone grafting. Phemister-type tibial grafts were used in 20 and iliac grafts in 3. All hips were evaluated before and after grafting according to roentgenographic stage of disease and the Hospital for Special Surgery Rating System. We found no exact correlation between roentgenographic stage and clinical manifestations. It is concluded that bone grafting treatment of this condition is warranted in only the very earliest stage of the disease when roentgenographic examination shows that normal femoral head contour is preserved and there are only subtle mottled densities scattered throughout the anterosuperior region. In this series, no benefit was derived from bone grafting in later stages of the disease.

Müller curved-stem total hip arthroplasty: long-term follow-up of 185 consecutive cases.

We reviewed 185 consecutive Müller total hip arthoplasties ten to 14 years after operation. Of the 32 patients with 42 arthroplasties who had died within the ten-year period, three had had revisions and five had died of causes related to the operation, including two late infections. Sixty-five hips in 56 living patients were available for clinical and roentgenographic evaluation. An additional 30 hips had been revised for various reasons. When the roentgenographically loose components were combined with the revised ones, the overall incidence of aseptic loosening was 40% for the femoral component and 12.6% for the acetabular component. As previously reported, the combined incidence of loose and revised components at 6 1/2 years was 27.7% for the femoral component and 3.2% for the acetabular component. Therefore, in the intervening five years, the rate of femoral loosening remained about the same, while the rate of acetabular loosening increased. There was a positive correlation between the incidence of loosening of the femoral component and male sex, deficient cementing, and varus position. There was no significant wear of the acetabular component.

Experience with total hip replacement at Ochsner Clinic.

Eighty-four patients had 97 total hip replacement procedures. Standard Müller components were used in the first 40 operations; the Aufranc-Turner acetabular component was used with the Müller-femoral component in the final 57 procedures. The trochanter was detached only in exceptional circumstances. Seventy-six patients with 87 replacements were followed up for 12 to 34 months. Complications, occasionally multiple, occurred in more than one third of our patients; thromboembolic disease was the most frequent. No significant wound complications occurred; there was no infection. In 71 replacements the results were excellent; in 15, good; and in 1 fair.