effect of different infectious organisms on platelet count and platelet indices in VLBW infants with septicemia

Preterm and VLBW infants are at increased susceptibility to sepsis with subtle nonspecific initial presentations therefore, they require much vigilance so that sepsis can be identified and treated effectively. Thrombocytopenia with counts less than 100,000 may occur in neonatal sepsis. MPV and PDW have been shown to be significantly elevated in infants with sepsis after 2-3 days of life. Our objectives were to study the effect of different organisms causing neonatal sepsis in VLBW infants on platelet count and platelet indices. Fifty VLBW infants with culture proven neonatal sepsis admitted to the NICU of the neonatal department at Al Galaa Teaching Maternity Hospital were studied prospectively over a six months period. All babies who were suspected of having sepsis had a full sepsis screen and were culture proven, following a full clinical evaluation. Platelet count and platelet indices including PDW and MPV were calculated. The results were statistically analyzed using student t-test. The mortality rate in culture proven sepsis infants in this study was 10%. Thrombocytopenia, defined as platelet count <100.000/mm[3], was observed in 35/50 [70%] of cases. The initial platelet count at the onset of sepsis was statistically significantly higher with gram-positive organisms [190.520 +/- 7.310/mm[3]] than with Gram-negative [121.670 +/- 4.850/mm[3]] and fungal organisms [112.480 +/- 4.100/mm[3]]. The MPV and PDW in newborns with sepsis showed statistically significant increase from base line, and were statistically significantly higher in fungal and Gm - ve sepsis than in Gm + ve sepsis group [p<0.05]. Common organisms causing neonatal sepsis in VLBW infants exert different effects on platelet count and platelet indices

Free vascularized flaps for the treatment of traumatic chronic infected wounds of the leg

In this study microvascular free tissue transfers have been performed for soft tissue and bone reconstruction of the leg in 22 patients with chronic traumatic bone wounds. The mean period of chronic bone exposure and drainage was 3.5 months, with a range of 2 months to 1 year. The mean age was 23.4 years, and included 20 male and 2 female patients. The criteria for the diagnosis of chronic bone wounds applied for patient selection in this study included: Chronic open draining bony wounds for more than 6 weeks, a positive culture from the wound at the time of debridement, and X-ray findings consistent with chronic bone infections. Patients were classified into 4 types according to the zone of injury. In type 1 a free latissimus dorsi muscle was used for soft tissue reconstruction, in type 2 a free latissimus and-fixation of the tibia with a plate or external fixator, in type 3 a free latissimus flap and an external fixator for bone transport and in type 4 an osteocutaneous free vascularized fibula was used to reconstruct both soft tissue and bone. Patients were followed up for an average of 24 months. In all patients the flaps survived and there was control of the infection and union of bone. All patients were able to weight bear and return to their original work. From the results of this study we concluded that our policy of extensive debridment followed by reconstruction of both bone and soft tissue by microvascular surgical techniques proved to be effective and reliable.

Outcome of retained two stage exchange arthroplasties in the treatment of infected total knee replacement

We studied the outcome of retained two stage exchange arthroplasties that were implanted as a method of treatment of infected total knee replacements. Among a group of 31 infected knees, we were left with 18 patients that were followed for minimum of 2 years. The mean age distribution at the last follow up was 69 years, with an equal distribution between males and females. Sixteen patients [88.8%] had their primary replacement for primary osteoarthritis and 2 patients [11.2%] were rheumatoid patients. Presentation varied between pain, swelling, warmth, stiffness and /or reduction in mobility. The shortest period of presentation with infection following the primary knee replacement was two weeks and the longest was 115 months, with an average of 21.3 months. A full diagnostic workup was carried out before an infection diagnosis could be established. Patients were subjected to the well known two stage exchange arthroplasty protocol with a first stage debridement and removal of prosthesis and all cements, followed by insertion of a cement spacer. The first stage was followed by a period of antibiotics of a minimum of 6 weeks until all laboratory evidence of infection has been cleared, with clinical quiescence. This was followed by a second stage revision total knee with insertion of a new prosthesis. The shortest period of follow up was 2 years and the longest was 5.5 years, with an average follow up of 3.1 years. At the last follow up, patients were evaluated based on the Knee Society Scoring System. The lowest knee score was 18 and the highest was 94 with a mean of 68.2. The lowest functional score was 5 and the highest was 100 with a mean functional score of 56.1. It was observed that the functional score was much lower than the knee score due to associated general ill health of this group of elderly patients. However, the results obtained were generally felt to be superior to other salvage procedures namely, arthrodesis, resection arthroplasty or amputation which are generally left for failed other modalities of treatment. Still, there is a lot or room for improvement if more laboratory and microbiological facilities were available, in a specialized centre dedicated for the management of these difficult cases

Supraclavicular decompression for neurogenic thoracic outlet syndrome; an individually tailored approach

The objective of this study was to evaluate the clinical outcome of supraclavicular decompression for thoracic outlet syndrome, and whether first rib resection is needed in all cases. 51 patients underwent 58 procedures, 7 being bilateral. There were 48 females and 3 males. The mean age was 26 years. 88% had lower plexus symptoms, and 5% had a motor deficit. The most sensitive provocative test was the plexus compression test [95%]. Through a supraclavicular approach, the plexus was explored, and the compressing agents resected. Intraoperative dynamic assessment of the plexus was an important part of the procedure. Using the Balci et al, staging system, 90% obtained a good to excellent result at latest follow up. Minimal complications were encountered in this series. In conclusion, the supraclavicular approach affords an excellent exposure of the plexus elements and its compressing agents, and allows dealing with them successfully. The extent of the decompression is individually assessed based upon the patient symptoms, the provocative positioning aggravating his symptoms, the operative findings and the intraoperative dynamic assessment of the plexus including provocative tests, and longitudinal traction of the arm. The final aim should be a plexus free of compression