The treatment of deep shoulder infection and glenohumeral instability with debridement, reverse shoulder arthroplasty and postoperative antibiotics.

We retrospectively reviewed 21 patients (22 shoulders) who presented with deep infection after surgery to the shoulder, 17 having previously undergone hemiarthroplasty and five open repair of the rotator cuff. Nine shoulders had undergone previous surgical attempts to eradicate their infection. The diagnosis of infection was based on a combination of clinical suspicion (16 shoulders), positive frozen sections (> 5 polymorphonuclear leukocytes per high-power field) at the time of revision (15 shoulders), positive intra-operative cultures (18 shoulders) or the pre-operative radiological appearances. The patients were treated by an extensive debridement, intravenous antibiotics, and conversion to a reverse shoulder prosthesis in either a single- (10 shoulders) or a two-stage (12 shoulders) procedure. At a mean follow-up of 43 months (25 to 66) there was no evidence of recurrent infection. All outcome measures showed statistically significant improvements. Mean abduction improved from 36.1 degrees (sd 27.8) pre-operatively to 75.7 degrees (sd 36.0) (p < 0.0001), the mean forward flexion from 43.1 degrees (sd 33.5) to 79.5 degrees (sd 43.2) (p = 0.0003), and mean external rotation from 10.2 degrees (sd 18.7) to 25.4 degrees (sd 23.5) (p = 0.0037). There was no statistically significant difference in any outcome between the single-stage and the two-stage group.

A preliminary study on gram-negative bacteria (GNB) and their endotoxins in a gin house in India.

The presence of byssinosis, an occupational disease found among cotton mill workers, has been well documented in different parts of the world. The disease develops due to exposure to environmental cotton dust. Evidence suggests that the causative agent for the disease is gram-negative bacteria (GNB) and their endotoxins present on the cotton fibers. An investigation was carried out in a gin house in western India. Environmental dust samples were collected by vertical elutriator (VE). Airborne dust concentrations were very high in the working environment: 2.11 mg/m3 in ginning and 0.95 mg/m3 in the press department (p < 0.05), which was higher than the threshold limit value collected by VE (0.2 mg/m3), and higher than the permissible exposure limit for respirable dust (0.5 mg/m3 for nontextile industries using cotton). In the office control site, the dust concentration was 0.31 mg/m3. The Occupational Safety and Health Administration's cotton dust standard permissible exposure limit for respirable dust is 0.2 mg/m3 in yarn manufacturing, 0.75 mg/m3 in slashing and weaving, and 0.5 mg/m3 in nontextile industries using cotton. These samples also showed high concentrations of airborne endotoxin (p < 0.001) in ginning and pressing (2.77 and 1.52 micro g/m3) compared with the office control site (0.009 micro g/m3 measured by Limulus amoebocyte lysate technique). Total enumeration of airborne GNB was carried out qualitatively by the petri plate exposure method and quantitatively by an Andersen 6-stage viable sampler and VE. GNB were recovered in quite high numbers. Among all the GNB, Enterobacter agglomerans were the dominant bacterial flora. Results indicate that gin workers are occupationally exposed to airborne GNB and endotoxins, and require masks.