Ceforanide vs. cephalothin concentrations in total joint arthroplasty.

Total joint arthroplasty is a common orthopedic procedure and requires prophylactic antibiotic coverage to prevent infections in the operated joint. The antibiotics routinely used for prophylaxis are the cephalosporins. This study compared bone, synovial fluid, and plasma concentrations of ceforanide with cephalothin concentrations in 30 patients undergoing elective total hip or total knee arthroplasty. Ceforanide provided significantly higher plasma concentrations for 61-110 minutes postdose than did cephalothin (p less than 0.025 and p less than 0.005). No difference was noted between the two antibiotics for the bone concentrations in the total hip arthroplasty group; however, cephalothin concentrated to a greater degree in the bone of patients undergoing total knee arthroplasty (p less than 0.05). Cephalothin achieved higher concentrations in the synovial fluid than did ceforanide (p less than 0.05). Both antibiotics were well tolerated and no postoperative infections were noted in either group.

A 50-cm fillet flap for preservation of maximal lower extremity residual limb length.

A 50-cm fillet flap permitted above-knee amputation in lieu of hip disarticulation in a 20-year-old woman who had sustained severe injuries in a motorcycle accident. Although the flap was unusually long, the principles followed were the same as those for posterior flaps used in below-knee amputations and fillet flaps of the digits. The flap allowed preservation of maximal length in the residual limb and fully sensible skin coverage, both of which facilitated prosthetic usage.

Protein-losing enteropathy complicating the Mustard procedure.

Protein-losing enteropathy is a reported complication of several cardiac diseases. Recently we encountered a patient with protein-losing enteropathy acquired as a late surgical complication of the Mustard procedure. An obstructed superior vena caval conduit was repaired surgically and the enteropathy was resolved.