Operative results after xiphoidectomy in patients with xiphodynia.

BACKGROUND: Xiphodynia, the painful xiphoid process, is a rare condition with an atypical presentation. Symptoms differ in severity and site, and can consist of chest, throat, and upper abdominal pain. Primarily, other more severe causes of these symptoms need to be excluded. After this exclusion as xiphodynia is diagnosed, treatment can consist of a multitude of options, since there is no consensus regarding the optimal treatment. The aim of this study was to describe the outcomes and efficacy of one of the options, namely surgical resection of the xiphoid in patients with xiphodynia. METHODS: In this retrospective case series, all consecutive patients that underwent xiphoidectomy for xiphodynia between January 2014 and December 2017 were included. Patients' medical files including pre-operative work up, NRS scores, surgical outcomes, and follow up were reviewed. All patients received a questionnaire with follow-up questions. RESULTS: A total of 19 patients were included. None of the patients had surgery-related complications. Response rate of the questionnaire was 84% and showed that 94% of patients had an improvement of complaints after surgery, with 10 patients (63%) being totally pain free, after a mean follow-up from 34 months after surgery. CONCLUSIONS: Xiphoidectomy is feasible and safe for the treatment of patients with xiphodynia with an improvement of complaints in nearly all patients.

Fall-related injuries in Amsterdam: Frail older women at risk.

Unintentional falls are a common cause of injury, especially among older persons. This study evaluates risk factors such as gender and age on morbidity and mortality after unintentional falls. Data were collected retrospectively for patients with a unintentional fall who were presented to the emergency department in 2013. A total of 3,217 patients were included; the majority were female. Patients over 65 years of age had a significant higher mortality and a longer length of hospital stay. Older women are at risk for sustaining a fall-related injury. Female gender is furthermore associated with increased length of stay in the hospital. Prevention should focus especially on these frail patients.

Wound Infections Following Implant removal below the knee: the effect of antibiotic prophylaxis; the WIFI-trial, a multi-centre randomized controlled trial.

BACKGROUND: In the Netherlands about 18,000 procedures with implant removal are performed annually following open or closed reduction and fixation of fractures, of which 30-80% concern the foot, ankle and lower leg region. For clean surgical procedures, the rate of postoperative wound infections (POWI) should be less than ~2%. However, rates of 10-12% following implant removal have been reported, specifically after foot, ankle and lower leg fractures. Currently, surgeons individually decide if antibiotics prophylaxis is given, since no guideline exists. This leads to undesirable practice variation. The aim of the study is to assess the (cost-)effectiveness of a single intravenous gift of Cefazolin prior to implant removal following surgical fixation of foot, ankle and/or lower leg fractures. METHODS: This is a double-blind randomized controlled trial in patients scheduled for implant removal following a foot, ankle or lower leg fracture. Primary outcome is a POWI within 30 days after implant removal. Secondary outcomes are quality of life, functional outcome and costs at 30 days and 6 months after implant removal. With 2 x 250 patients a decrease in POWI rate from 10% to 3.3% (expected rate in clean-contaminated elective orthopaedic trauma procedures) can be detected (Power = 80%, 2-sided alpha = 5%, including 15% lost to follow up). DISCUSSION: If administration of prophylactic antibiotics prior to implant removal reduces the infectious complication rate, this will offer a strong argument to adopt this as standard practice of care. This will consequently lead to less physical and social disabilities and health care use. A preliminary, conservative estimation suggests yearly cost savings in the Netherlands of € 3.5 million per year. TRIAL REGISTRATION: This study is registered at Clinicaltrials.gov ( NCT02225821 ) and the Netherlands Trial Register ( NTR4393 ) and was granted permission by the Medical Ethical Review Committee of the Academic Medical Centre on October 7 2014.

[Necrotising soft-tissue infections: diagnostics and treatment]. / Necrotiserende wekedeleninfecties: diagnostiek en behandeling.

Necrotising soft-tissue infections occur in the soft tissue compartment consisting of the dermis, subcutaneous tissue, superficial fascia (fascia of Scarpa), deep fascia and muscle. Although this severe and acutely life-threatening infection has a low incidence, both GPs and specialists will see a necrotizing soft-tissue infection more than once during their career. The mortality related to necrotising soft-tissue infections has been halved during the past 15 years from nearly 40 to 20% due to adequate treatment. Laboratory examination and X-ray findings could be of added value, but the gold standard remains biopsy of the fascia and Gram staining. Treatment consists of prompt volume resuscitation in case of sepsis, administration of broad spectrum antibiotics and surgical debridement; this debridement should be as skin-sparing as possible. The use of hyperbaric oxygen therapy has remained a controversial issue, unless a patient has gas gangrene, caused by Clostridium species. A multidisciplinary treatment and admission to a tertiary intensive care unit are indispensable for the treatment of a septic patient with necrotizing soft-tissue infection.