ABSTRACT
Postoperative wound infections following spinal fusion with instrumentation often present diagnostic and therapeutic difficulties. This article reviews 34 such infections. An infection rate of 3.7% was noted. Depending on various clinical indicators, treatment strategies included short-course antibiotics, prolonged intravenous antibiotics, or intravenous antibiotics followed by suppressive antibiotics and eventual hardware removal. To eradicate these infections, removal of instrumentation is often required; this option, however, may result in an unstable spine. Treatment algorithms were developed for treatment of postoperative spinal surgical site infections and to minimize the possibility of spine instability. All patients were cured of their infections.
Subject(s)
Orthopedic Fixation Devices , Spinal Fusion , Surgical Wound Infection/therapy , Adult , Aged , Aged, 80 and over , Antibiotic Prophylaxis , Female , Humans , Male , Middle Aged , Reoperation , Surgical Wound Infection/microbiology , Surgical Wound Infection/prevention & control , Treatment OutcomeABSTRACT
The use of ketorolac was studied in patients undergoing lumbar laminectomy and those receiving lumbar fusion with or without instrumentation. Laminectomy patients in the ketorolac group used significantly less narcotic analgesic than did those in the narcotic treatment group. Ketorolac patients in both surgical categories experienced better pain control than narcotic group patients did. Laminectomy ketorolac patients experienced less sedation than did those in the narcotic group, and a similar trend was noted for fusion patients. A significant improvement in postoperative ambulation was demonstrated in the fusion ketorolac group. Postoperative total drug costs were significantly greater in both ketorolac treatment groups. A one-half day decrease in hospitalization was noted for laminectomy ketorolac patients. The overall annual financial impact of the use of ketorolac in lumbar spine patients is a net savings of $211,095.
Subject(s)
Analgesics, Non-Narcotic/therapeutic use , Hospitalization/economics , Lumbar Vertebrae/surgery , Tolmetin/analogs & derivatives , Adult , Analgesics, Non-Narcotic/economics , Analgesics, Opioid/economics , Analgesics, Opioid/therapeutic use , Cost-Benefit Analysis , Drug Costs , Female , Humans , Ketorolac , Male , Middle Aged , Pain/drug therapy , Time Factors , Tolmetin/economics , Tolmetin/therapeutic useABSTRACT
A 71-year-old woman with progressive hemiparesis had a large cerebral calculus (brain stone) removed from the temporal lobe. Her condition thereafter improved remarkably. The differential diagnosis and specific methods to determine the angiomatous nature of this almost acellular mass are discussed. Reticulin impregnation, elastic tissue stain, and electron microscopy were of greatest value.
Subject(s)
Brain Neoplasms/diagnosis , Hemangioma/diagnosis , Aged , Brain Neoplasms/pathology , Calcinosis/diagnosis , Calcinosis/pathology , Female , Hemangioma/pathology , HumansABSTRACT
Four pediatric neurosurgical patients with Gram-negative meningitis and ventriculitis were treated with parenteral and intraventricular amikacin, a new aminoglycoside. The organisms infecting these patients were resistant to multiple antimicrobial drugs but were sensitive to amikacin. Treatment was continued for 14 days after cerebrospinal fluid cultures became negative. All four patients were cured and have demonstrated no nephrotoxicity, ototoxicity, or evidence of persistent infection on follow-up examination.
