NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines

The antibacterial action of silver is utilized in numerous consumer products and medical devices. Metallic silver, silver salts, and also silver nanoparticles are used for this purpose. The state of research on the effect of silver on bacteria, cells, and higher organisms is summarized. It can be concluded that the therapeutic window for silver is narrower than often assumed. However, the risks for humans and the environment are probably limited.

Silver as Antibacterial Agent: Ion, Nanoparticle, and Metal

In this first systematic study, we describe the influence of various surfactants and polymers on aggregation stability and antibacterial activity of silver nanoparticles (NPs) prepared by a modified Tollens process. The surfactant/polymer stabilizing effect was monitored using the newly established method based on a titration of the aqueous dispersion of the silver NPs by aqueous solution of poly(diallyldimethylammonium) chloride (PDDA). The aggregation process was evaluated by the dynamic light scattering (DLS) and UV/vis spectra measurements and finally confirmed by TEM. Among all of the investigated modifiers, two surfactants (sodium dodecyl sulfate-SDS and polyoxyethylenesorbitane monooleate-Tween 80) and one polymer (polyvinylpyrrolidone-PVP 360) exhibit superior stabilization of the silver NP dispersions against the process of aggregation. The differences in the stabilization ability of various tested substances are discussed with respect to their structure and possible mechanism of the surface inte...

Effect of Surfactants and Polymers on Stability and Antibacterial Activity of Silver Nanoparticles (NPs)

Antifungal activity of silver nanoparticles against Candida spp.

Titanium and titanium alloys are key biomedical materials because of their good biocompatibility and mechanical properties. Nevertheless, infection on and around titanium implants still remains a problem which is usually difficult to treat and may lead to eventual implant removal. As a result, preventive measures are necessary to mitigate implant-frelated infection. One important strategy is to render the implant surface antibacterial by impeding the formation of a biofilm. A number of approaches have been proposed for this purpose and they are reviewed in this article. ' 2009 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 91B: 470-480, 2009

Antibacterial coatings on titanium implants.

We assessed the clinical results and complications associated with a new endoprosthetic replacement system (Mutars®) used in 250 patients with a malignant bone or soft tissue tumor. The key features of the system are its cementless, hexagonal-shaped stem (titanium alloy), the possibility of torsion

Endoprosthetic reconstruction in 250 patients with sarcoma.

Background
Two hundred and fourteen patients with benign giant cell tumor of bone (GCTB), treated from 1980 to 2007 at the Department of Orthopedics of the University of Muenster (Germany), were analyzed in a retrospective study.

Giant cell tumor of bone: treatment and outcome of 214 cases

Lack of toxicological side-effects in silver-coated megaprostheses in humans.

Background and Objectives
The placement of megaprostheses in patients with bone sarcoma is associated with high rates of infection, despite prophylactic antibiotic administration. In individual cases, secondary amputation is unavoidable in the effort to cure infection.

Methods
The infection rate in 51 patients with sarcoma (proximal femur, n = 22; proximal tibia, n = 29) who underwent placement of a silver-coated megaprosthesis was assessed prospectively over a 5-year period, along with the treatment administered for infection. The infection rate was compared with the data for 74 patients in whom an uncoated titanium megaprosthesis (proximal femur, n = 33; proximal tibia, n = 41) was implanted.

Results
The infection rate was substantially reduced from 17.6% in the titanium to 5.9% in the silver group. Whereas 38.5% of patients in the titanium group ultimately had to undergo amputation when periprosthetic infection developed, these mutilating surgical procedures were not necessary in the study group.

Conclusions
The use of silver-coated prostheses reduced the infection rate in the medium term. In addition, less aggressive treatment of infection was possible in the group with silver-coated prostheses. Further studies with longer term follow-up periods and larger numbers of patients are warranted in order to confirm these encouraging results. J. Surg. Oncol. 2010; 101:389–395. © 2010 Wiley-Liss, Inc.

https://onlinelibrary.wiley.com/doi/epdf/10.1002/jso.21498

Reduction of periprosthetic infection with silver-coated megaprostheses in patients with bone sarcoma.

Although the recurrence rate of giant cell tumors of bone (GCTB) is relatively high exact data on treatment options for the recurrent cases is lacking. The possible surgical procedures range from repeated intralesional curettage to wide resection. Two hundred and fourteen patients with histologically certified GCTB have been treated at the authors department from 1980 to 2007. Sixty-seven patients with at least one local recurrence were included in this study. The mean follow-up was 77.3 months. The data was evaluated according the re-recurrence rate with regard to the surgical procedure for the recurrence. The mean time until the first local recurrence was 22.0 months; the mean number of recurrences per patient was 1.4. The recurrence occurred in 69.7% (46 out of 66 patients) within the first 2 years. If after intralesional procedures (curettage or intralesional resection) no adjunct was used the re-recurrence rate was 58.8% (10 out of 17 patients) and decreased to 21.7% (5 out of 23 patients) if a combination of all adjuncts (PMMA + burring) was used. The likelihood of re-recurrence was reduced by the factor 5.508 which was clearly significant (P = 0.016). In case of wide resection no re-recurrence occurred. Seven patients (10.5%) developed pulmonary metastases. Fourteen patients (20.9%) finally received an endoprosthesis; 12 due to tumor recurrence, 2 due to secondary arthritis. Recurrent GCTB can be treated by further curettage with additional burring and cementing with an acceptable re-recurrence rate of 21.7%. The rate of patients finally needing an endoprosthesis is 20.9%. Due to the high rate of pulmonary metastases recurrent GCTB may be considered as a severe disease.

Arne Streitbuerger

Papers

Endoprosthetic reconstruction in 250 patients with sarcoma.

Giant cell tumor of bone: treatment and outcome of 214 cases

Lack of toxicological side-effects in silver-coated megaprostheses in humans.

Reduction of periprosthetic infection with silver-coated megaprostheses in patients with bone sarcoma.

Treatment options for recurrent giant cell tumors of bone.