Retrospective study: The diagnostic accuracy of conventional forceps biopsy of gastric epithelial compared to endoscopic submucosal dissection (STROBE compliant).

Infectious Diseases Society of America.

Staphylococcus aureus is a major human pathogen that causes a wide range of clinical infections. It is a leading cause of bacteremia and infective endocarditis as well as osteoarticular, skin and soft tissue, pleuropulmonary, and device-related infections. This review comprehensively covers the epidemiology, pathophysiology, clinical manifestations, and management of each of these clinical entities. The past 2 decades have witnessed two clear shifts in the epidemiology of S. aureus infections: first, a growing number of health care-associated infections, particularly seen in infective endocarditis and prosthetic device infections, and second, an epidemic of community-associated skin and soft tissue infections driven by strains with certain virulence factors and resistance to β-lactam antibiotics. In reviewing the literature to support management strategies for these clinical manifestations, we also highlight the paucity of high-quality evidence for many key clinical questions.

Staphylococcus aureus Infections: Epidemiology, Pathophysiology, Clinical Manifestations, and Management

Modern techniques have reduced the frequency of infections that are associated with prosthetic joints, but such infections continue to pose difficult problems in clinical management. Advances in understanding biofilms and the pathogenesis of microbial interactions with the implant have led to more rational approaches to therapy. This review offers guidance in establishing the diagnosis correctly and an algorithm summarizing the appropriate medical and surgical options.

/pdf/prosthetic-joint-infections-qrunwr5dn0.pdf

Prosthetic-Joint Infections

http://academic.oup.com/milmed/article-pdf/146/7/506/24126715/milmed-146-7-506.pdf

Goodman and Gilman's The Pharmacological Basis of Therapeutics

The question of whether simultaneous bilateral knee replacement is associated with an increased risk of perioperative morbidity and mortality remains controversial. There are no true prospective randomized studies that address this question. There is general agreement that the risk is higher for older patients and for those with considerable medical comorbidities, particularly those with a history of cardiac disease. There is no general agreement on the appropriate threshold for age or comorbidities in order to minimize risk. Based on available retrospective data, there is evidence to suggest that there may be some patient selection bias favoring patients with simultaneous bilateral knee replacements; despite this bias, the perioperative risks are higher for these healthier patients. The highest risk for the patient having simultaneous bilateral knee replacement seems to be that of early postoperative mortality followed by the risk of a cardiac event. The risks of thromboembolic, gastrointestinal, and neurologic dysfunction also are increased. These patients also have a higher likelihood of requiring homologous blood transfusions and of requiring posthospitalization transfer to a rehabilitation center. Because of the absence of established patient selection criteria, thresholds for assessment of the increased risks, the patient having simultaneous bilateral replacement faces an increased risk of perioperative mortality and morbidity on a random basis. Patients should be aware of this information when deciding whether to proceed with simultaneous bilateral knee replacement.

Bilateral total knee replacement using the same anesthetic is not justified by assessment of the risks.

The clinical presentation is a useful guide for selecting the treatment of an infected total knee arthroplasty. Prosthesis retention is indicated in patients with infections that occur within 30 days after arthroplasty and in patients with well-functioning prostheses who develop an acute late hematogenous infection. Debridement attempts should be open and not arthroscopic. When prosthesis removal is required, the preferred approach is a delayed reconstructive technique, the 2-staged reimplantation, rather than a direct-exchange procedure. The use of block spacers or mobile articulating devices to deliver high-dose local antibiotics is recommended between implant removal and delayed revision surgery. The use of antibiotic-loaded acrylic cement for cemented prostheses or antibiotic-soaked bone-graft with cementless prostheses is helpful in the overall cure rate of infection.

Managing the infected knee: as good as it gets.

It is important to diagnose prosthetic joint infection accurately because the medical and surgical treatment of prosthetic joint infection differs from that of other causes of prosthetic joint failure. Recognition of the presence or absence of infection at or before the time of surgery is important in directing the appropriate surgical approach. Recovery and susceptibility testing of the infecting organism are essential to the selection of appropriate anti-infective therapy.

The diagnosis of prosthetic joint infection: current techniques and emerging technologies.

Low sensitivity of periprosthetic tissue PCR for prosthetic knee infection diagnosis

Between January 1976 and December 1985, 3620 carpal tunnel releases were done at the Mayo Clinic. A deep postoperative infection developed in 17 (0.47%) patients. These 17 were compared with a control group of 102 patients to identify possible risk factors. Statistically significant risk factors included intraoperative instillation of steroid solution into the carpal canal, flexor tendon synovectomy, prolonged operative time, and use of a surgical drain. Infection incidence was 0.87% in males and 0.25% in females (statistically significant). Seven (41%) of the 17 patients had a suboptimal result at final follow-up.

Arlen D. Hanssen

Papers

Bilateral total knee replacement using the same anesthetic is not justified by assessment of the risks.

Managing the infected knee: as good as it gets.

The diagnosis of prosthetic joint infection: current techniques and emerging technologies.

Low sensitivity of periprosthetic tissue PCR for prosthetic knee infection diagnosis

Deep postoperative wound infection after carpal tunnel release