ABSTRACT
Periprosthetic joint infection is a rare and devastating complication. Management of this complication often requires a multidisciplinary approach similar to that used for the care of patients with cancer. Several studies have reported better outcomes following total joint arthroplasties performed at specialized hospitals than those performed at general hospitals. Specialized institutions use care pathways that aid the multidisciplinary team in decision making. During the recent Musculoskeletal Infection symposium, specific issues were discussed with regard to the treatment of periprosthetic joint infection, including medical optimization, systematic approaches to infection management, and the importance of establishing registries to aid in the creation of Centers of Excellence. A Center of Excellence in periprosthetic infection could provide better overall outcomes with lower financial, physical, and emotional costs to patients.
Subject(s)
Arthritis, Infectious/therapy , Arthroplasty, Replacement/standards , Practice Guidelines as Topic , Prosthesis-Related Infections/therapy , Arthritis, Infectious/etiology , Arthroplasty, Replacement/adverse effects , Congresses as Topic , Critical Pathways/standards , Humans , Patient Care Team/standards , Prosthesis-Related Infections/etiologyABSTRACT
OBJECTIVE: To review the essential elements of the transesophageal echocardiographic examination of the aortic valve, with emphasis on the technique for performing a two-dimensional examination, the quantification of aortic stenosis and regurgitation, and the effect of this modality on cardiac surgical decision making. DESIGN: Literature review. DISCUSSION: Transesophageal echocardiographic examination of the aortic valve can provide detailed information on aortic valve structure and function, provided proper technique is utilized. This review presents the current recommendations from the American Society of Echocardiography for the performance of a two-dimensional examination of the aortic valve and for the quantification of aortic stenosis or aortic regurgitation by application of Doppler techniques. To demonstrate the applicability of transesophageal echocardiography in clinical practice, the effect of transesophageal echocardiography on the cardiac surgical management of patients with aortic valvular disease is described.
Subject(s)
Aortic Valve Insufficiency/diagnostic imaging , Aortic Valve Stenosis/diagnostic imaging , Aortic Valve/diagnostic imaging , Aortic Valve Insufficiency/surgery , Aortic Valve Stenosis/surgery , Cardiac Surgical Procedures , Echocardiography, Transesophageal , HumansSubject(s)
Atrial Fibrillation/chemically induced , Cardiac Surgical Procedures , Dopamine/adverse effects , Kidney Diseases/prevention & control , Postoperative Complications/chemically induced , Atrial Fibrillation/epidemiology , Dopamine/administration & dosage , Humans , Incidence , Ohio/epidemiology , Postoperative Complications/epidemiology , Postoperative Complications/prevention & controlABSTRACT
We present a case in which ketamine was used for long-term sedation and analgesia of a burn patient. Under escalating opiate dosages, the patient had developed persistent ileus as well as abdominal distension that caused respiratory compromise, without receiving sufficient analgesia. The opiate-sparing effect of the continuous ketamine infusion was more than 90%. The ileus resolved within 24 h. The quality of sedation also changed favorably. There were no obvious adverse effects of ketamine.
