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1.  Remission rate of implant-related infections following revision surgery after fractures 
International Orthopaedics  2013;37(11):2253-2258.
In contrast to a large amount of epidemiological data regarding the incidence of implant infections after fracture management, surprisingly few have been published concerning the success of their treatment.
This was a single-centre cohort study at Geneva University Hospitals from 2000 to 2012 investigating the remission rates of orthopaedic implant infections after fracture repair and associated variables.
A total of 139 episodes were included: There were 51 women (37 %) and 28 immunosuppressed (20 %) patients with a median age and American Society of Anaesthesiologists (ASA) score of 51 years and 2 points, respectively. The infected implants were plates (n = 75, 54 %), nails (24, 17 %), wires (20), screws (10), cerclage cables or wires (3), hip screws (4) or material for spondylodesis (3). A pathogen was identified in 135 (97 %) cases, including Staphylococcus aureus (73, 52 %), coagulase-negative staphylococci (20), streptococci (7) and 19 Gram-negative rods. All patients underwent antibiotic treatment, and 128 (92 %) remained in remission at a median follow-up time of 2.6 years (range one to 13 years). In multivariate logistic regression analysis, the plate infections were significantly associated with lower remission rates [65/75, 87 %, odds ratio (OR) 0.1, 95 % confidence interval (CI) 0.01–0.90]. No associations were found for gender, age, immune status, ASA score, additional surgical interventions (OR 0.4, 95 % CI 0.1–4.1) or duration of antibiotic treatment (OR 1.0, 95 % CI 0.98–1.01).
Among all infected and removed orthopaedic implants, plates were associated with slightly lower remission rates, while the overall treatment success exceeded 90 %. The duration of antibiotic therapy did not alter the outcome.
PMCID: PMC3824899  PMID: 24052163
Implant-related infection; Implant removal; Antibiotic therapy; Remission rate; Post-traumatic osteomyelitis
2.  Risk factors for dislocation arthropathy after Latarjet procedure: a long-term study 
International Orthopaedics  2013;37(6):1093-1098.
The purpose of this study was to analyse the long-term incidence of dislocation arthropathy after a modified Latarjet procedure for glenohumeral instability.
Long-term follow-up information was obtained from a consecutive series of patients who had undergone a modified Latarjet procedure by one surgeon between 1986 and 1999. Multivariable regression analysis was performed to examine the relation between the development of a dislocation arthropathy and patients and surgery-related factors.
There were 117 patients (117 shoulders) for evaluation, (35 women and 82 men) with a mean age 28.4 ± 8.5 (range, 16–55). The mean follow-up was 16.2 years (range, ten to 22.2 years). Signs of dislocation arthropathy were found in 36 % of patients, graded as Samilson 1 in 30 %, Samilson 2 in 3 %, and 3 % Samilson 3 in 3 % of patients. Risk factors for dislocation arthropathy included surgery in patients older than 40 years of age (64.3 vs. 34.4 %; adjusted RR 2.2, 95 % CI 1.7–2.9) and lateral positioning of the transferred coracoid process in relation to the glenoid rim (82.4 vs. 30.4 %; adjusted RR 2.3, 95 % CI 1.7–3.2). Patients with hyperlaxity developed less dislocation arthropathy (15 vs. 42.5 %; adjusted RR 0.4, 95 % CI 0.1–0.95).
The development of dislocation arthropathy after the Latarjet procedure remains a source of concern in the long term. It correlates with surgery after the age of 40 and lateral coracoid transfer in relation to the glenoid rim. On the other hand, hyperlaxity seems to have a protective effect on the development of dislocation arthropathy.
PMCID: PMC3664176  PMID: 23508865
3.  Risk factors for post-traumatic osteoarthritis of the ankle: an eighteen year follow-up study 
International Orthopaedics  2012;36(7):1403-1410.
Long-term studies evaluating risk factors for development of ankle osteoarthritis (OA) following malleolar fractures are sparse.
We conducted a retrospective cohort study including consecutive patients treated by open reduction and internal fixation for malleolar fracture between January 1988 and December 1997. Perioperative information was obtained retrospectively. Patients were evaluated clinically and radiographically 12–22 years postoperatively. Radiographic ankle OA was determined on standardised radiographs using the Kellgren and Lawrence scale (grade 3–4 = advanced OA). Uni- and multivariate regression analyses were performed to determine risk factors for OA.
During the inclusion period, 373 fractures (372 patients; 9% Weber A, 58% Weber B, 33% Weber C) were operated upon. The mean age at operation was 42.9 years. There were 102 patients seen at follow-up (mean follow-up 17.9 years). Those not available did not differ in demographics and fracture type from those seen. Advanced radiographic OA was present in 37 patients (36.3%). Significant risk factors were: Weber C fracture, associated medial malleolar fracture, fracture-dislocation, increasing body mass index, age 30 years or more and length of time since surgery.
Advanced radiographic OA was common 12–22 years after malleolar fracture. The probability of developing post-traumatic OA among patients having three or more risk factors was 60–70%.
PMCID: PMC3385887  PMID: 22249843
5.  Prospective randomised study comparing screw versus helical blade in the treatment of low-energy trochanteric fractures 
International Orthopaedics  2011;35(12):1855-1861.
The purpose of this study was to compare femoral head placement, rates of reoperation and cephalic implant cut-out of a screw versus a blade for patients over age 60 with low energy trochanteric fractures (AO/OTA 31-A1, A2, and A3) treated either with sliding hip screw or cephalomedullary nail.
After surgeon selection of either hip screw or nail, hip screw patients were randomised to either a DHS (dynamic hip system screw) or DHS blade (dynamic hip system blade), while nail patients were randomised to either a Gamma3 Trochanteric Nail or a PFNA (proximal femoral nail antirotation). This resulted in a screw group (DHS and Gamma nail), and a blade group (DHS blade and PFNA). Outcome measures included tip-apex distance and zone location of the cephalic implant, as well as reoperation and implant cut-out within the first postoperative year.
A total of 335 patients were randomised, 172 to a screw and 163 to a blade. There was no significant difference concerning mean tip-apex distance, percentage of patients with a tip-apex distance >25 mm, and patients with a centre–centre position of the cephalic implant. There were 137 patients in the screw group and 132 in the blade group available for follow-up. They did not differ regarding rates of reoperation or cut-out (screw group = 2.9%; blade group = 1.5%).
Both a screw and a blade performed equally well in terms of implant placement in the femoral head and outcome.
PMCID: PMC3224624  PMID: 21387175
7.  Occurrence of fever in the first postoperative week does not help to diagnose infection in clean orthopaedic surgery 
International Orthopaedics  2010;35(8):1257-1260.
Postoperative fever is often misinterpreted as a sign of infection, especially when occurring after the third postoperative day. We assessed the epidemiology of postoperative fever in adult orthopaedic patients and its association with infection. Among 1,073 patients participating in a prospective observational study, 198 (19%) had a postoperative fever (>38°C). Thirteen patients (1.2%) had a surgical site infection and 78 patients (7.3%) had remote bacterial infections during their hospital stay. Including asymptomatic bacteriuria, 174 patients were given antibiotic therapy for a median duration of six days. In multivariate analysis, no clinical parameter was associated with fever, including haematoma (odds ratio 0.9, 95%CI 0.6–1.3), infection (1.6, 0.7–3.7), or antibiotic use (1.6, 0.9–3.0). The maximum temperature on each of the first seven postoperative days did not differ between infected and uninfected patients (Wilcoxon rank-sum tests; p > 0.10). We conclude that fever, even up to the seventh postoperative day, is not substantially helpful to distinguish infection from general inflammation in clean orthopaedic surgery.
PMCID: PMC3167428  PMID: 20871993
8.  Recurrent Osteomyelitis Caused by Infection with Different Bacterial Strains without Obvious Source of Reinfection 
Journal of Clinical Microbiology  2006;44(3):1194-1196.
Recurrence of osteomyelitis by the same bacterial strain is well known. We report three patients with a second episode of osteomyelitis at the same site caused by different strains of bacteria from the original. Formerly infected and altered bone surface might present a region of diminished resistance for a new infection.
PMCID: PMC1393085  PMID: 16517930
9.  1Design of the Primary Prevention Parameters Evaluation (PREPARE) trial of implantablecardioverter defibrillators to reduce patient morbidity [NCT00279279] 
Trials  2006;7:18.
Implantable Cardioverter Defibrillator (ICD) therapy has been proven to be beneficial and efficacious for the treatment of serious ventricular tachyarrhythmias in primary prevention patients. However, primary prevention patients appear to have a lower incidence of ventricular arrhythmias in comparison to secondary prevention patients and consequently likely experience a higher proportion of detections due to supraventricular arrhythmias. Recent trials have demonstrated that strategic and specific programming choices reduce the number of inappropriate shocks and that anti-tachycardia pacing (ATP) is an effective alternative to shock therapy for many sustained ventricular arrhythmias.
The Primary Prevention Parameters Evaluation (PREPARE) study is a multi-center cohort study, evaluating the efficacy of a pre-specified strategic profile of VT/VF detection and therapy settings in 700 primary prevention patients in an effort to safely reduce the number of shock therapies delivered. The patients, both with and without cardiac resynchronization therapy, are compared to a well-qualified set (n = 691) of historical controls derived from the MIRACLE ICD and EMPIRIC trials. This manuscript describes the design of the PREPARE study. The study results, to be presented separately, will characterize the efficacy of this programming set (PREPARE) compared with physician-tailored programming (MIRACLE ICD and EMPIRIC).
PMCID: PMC1524810  PMID: 16725036
10.  Drug Targeting Mycobacterium tuberculosis Cell Wall Synthesis: Development of a Microtiter Plate-Based Screen for UDP-Galactopyranose Mutase and Identification of an Inhibitor from a Uridine-Based Library 
A microtiter plate assay for UDP-galactopyranose mutase, an essential cell wall biosynthetic enzyme of Mycobacterium tuberculosis, was developed. The assay is based on the release of tritiated formaldehyde from UDP-galactofuranose but not UDP-galactopyranose by periodate and was used to identify a uridine-based enzyme inhibitor from a chemical library.
PMCID: PMC148999  PMID: 12499218
11.  Drug Targeting Mycobacterium tuberculosis Cell Wall Synthesis: Genetics of dTDP-Rhamnose Synthetic Enzymes and Development of a Microtiter Plate-Based Screen for Inhibitors of Conversion of dTDP-Glucose to dTDP-Rhamnose 
An l-rhamnosyl residue plays an essential structural role in the cell wall of Mycobacterium tuberculosis. Therefore, the four enzymes (RmlA to RmlD) that form dTDP-rhamnose from dTTP and glucose-1-phosphate are important targets for the development of new tuberculosis therapeutics. M. tuberculosis genes encoding RmlA, RmlC, and RmlD have been identified and expressed in Escherichia coli. It is shown here that genes for only one isotype each of RmlA to RmlD are present in the M. tuberculosis genome. The gene for RmlB is Rv3464. Rv3264c was shown to encode ManB, not a second isotype of RmlA. Using recombinant RmlB, -C, and -D enzymes, a microtiter plate assay was developed to screen for inhibitors of the formation of dTDP-rhamnose. The three enzymes were incubated with dTDP-glucose and NADPH to form dTDP-rhamnose and NADP+ with a concomitant decrease in optical density at 340 nm (OD340). Inhibitor candidates were monitored for their ability to lower the rate of OD340 change. To test the robustness and practicality of the assay, a chemical library of 8,000 compounds was screened. Eleven inhibitors active at 10 μM were identified; four of these showed activities against whole M. tuberculosis cells, with MICs from 128 to 16 μg/ml. A rhodanine structural motif was present in three of the enzyme inhibitors, and two of these showed activity against whole M. tuberculosis cells. The enzyme assay was used to screen 60 Peruvian plant extracts known to inhibit the growth of M. tuberculosis in culture; two extracts were active inhibitors in the enzyme assay at concentrations of less than 2 μg/ml.
PMCID: PMC90481  PMID: 11302803
13.  Ocular bobbing with survival 
A case is described of prolonged ocular bobbing with survival after subarachnoid haemorrhage from a pontine arteriovenous malformation. Hitherto, this sign has usually been associated with a rapidly fatal outcome.
PMCID: PMC492215  PMID: 1255213

Results 1-13 (13)