The Evidence Behind Peroxide in Orthopedic Surgery.

Peroxide is a strong oxidizing agent and disinfectant frequently used in orthopedic surgery. The authors conducted a systematic literature review of peroxide in orthopedic surgery, evaluating use, complications, efficacy, and appropriate concentrations. One hundred seventy-five reports were identified, with 24 being eligible for analysis. Orthopedic surgeons used peroxide for irrigation and bacterial reduction in various procedures. Complications included cytotoxicity, allergic reactions, suture damage, and inflammation. Use of the standard concentration of 3% peroxide and standard time in situ are without evidence. Laboratory studies suggest that diluted concentrations retain the benefit of bacterial decolonization without increasing the risk for complications. [Orthopedics. 2018; 41(6):e756-e764.].

Short-term Outcomes Following Concussion in the NFL: A Study of Player Longevity, Performance, and Financial Loss.

BACKGROUND: A short-term protocol for evaluation of National Football League (NFL) athletes incurring concussion has yet to be fully defined and framed in the context of the short-term potential team and career longevity, financial risk, and performance. PURPOSE: To compare the short-term career outcomes for NFL players with concussions by analyzing the effect of concussions on (1) franchise release rate, (2) career length, (3) salary, and (4) performance. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: NFL player transaction records and publicly available injury reports from August 2005 to January 2016 were analyzed. All players sustaining documented concussions were evaluated for a change to inactive or DNP ("did not participate") status. A case-control design compared franchise release rates and remaining NFL career span. Career length was analyzed via survival analysis. Salary and performance differences were analyzed with publicly available contract data and a performance-scoring algorithm based on position/player level. RESULTS: Of the 5894 eligible NFL players over the 11-year period, 307 sustained publicly reported concussions resulting in the DNP injury protocol. Analysis of the probability of remaining in the league demonstrated a statistically significantly shorter career length for the concussion group at 3 and 5 years after concussion. The year-over-year change in contract value for the concussion group resulted in a mean overall salary reduction of $300,000 ± $1,300,000 per year (interquartile range, -$723,000 to $450,000 per year). The performance score reduction for all offensive scoring players sustaining concussions was statistically significant. CONCLUSION: This retrospective study demonstrated that NFL players who sustain a concussion face a higher overall franchise release rate and shorter career span. Players who sustained concussions may incur significant salary reductions and perform worse after concussion. Short-term reductions in longevity, performance, and salary after concussion exist and deserve additional consideration.

Penile metastasis from rectal carcinoma.

We are presenting a 65-year old patient with metastatic carcinoma of the penis which was discovered 19 months after abdomino-perineal resection for rectal cancer (Duke A). There was also metastasis in the perineum and one rib. Penile biopsy and cavernosography were carried out and established the metastatic nature. The patient declined further therapy and died 5 months after diagnosis.

The changing pattern of cholelithiasis in Lagos.

Colo-rectal carcinoma, diverticular disease and cholecystitis which are prevalent in the industrialised world are very rare in the African population. The last two decades have, however witnessed a big socio-economic change with incorporation of western dietary items, especially in the Nigerian urban areas. Collection of 69 cases of cholecystitis over a five year period contrasts sharply with the earlier reports in Nigeria. The female to male ratio is 5.3 to 1. The age range is 10-66 years, median female 36.9 +/- 11.3 S.D., and male 49 +/- 7.1 S.D. Probable factors contributing to the increased occurrence may include increased admittance to hospitals, incorporation of the western dietary items in the diet of the urbanised Nigerians and oral contraceptive pills.

Depression of cell-mediated immunity in diabetes.

Parameters of cell-mediated and humoral-mediated immunity were measured in ten infection-free, insulin-dependent, controlled diabetic patients and in ten similar but nondiabetic patients awaiting elective operations. Tests performed included total and differential leukocyte counts, neutrophil reduction of nitroblue tetrazolium, mitogen response of lymphocyte to phytohemagglutinin, ratio of thymus-derived to bone marrow-derived lymphocytes, serum immunoglobulins IgA, IgG, and IgM, macrophage inhibition factor, serum zinc, and reaction to skin test antigens. Diabetics had a significantly (P less than .05) decreased mean response response to phytoheagglutinin stimulation and a lowered ratio of thymus-derived to bone marrow-derived lymphocytes. These findings support the concept of depressed cell-mediated immunity in the controlled, adult diabetic and might explain the propensity of the uncontrolled diabetic to increased frequency and severity of bacterial infection.

Hepatic support with hepatocyte suspensions in a permeable membrane dialyzer.

Hepatic support by whole liver, liver slice, or hepatocyte perfusion is unsatisfactory. A new concept of support with circulating hepatocytes on one side of a cuprophan membrane and blood from an anhepatic pig on the other was evaluated in 19 dialysis experiments. Levels of pyruvate metabolism and oxygen utilization were similar to those obtained when liver cells in a centrifuge are perfused with oxygenated plasma. Of six anhepatic pigs given late hepatic support, five showed neurologic improvement. One had concomitant improvement in electroencephalographic results. A membrane hemodiolysis unit in which hepatocytes circulate against blood from an anhepatic animal is the most suitable extracorporeal liver support unit described so far. Its simplicity allows repeated and prolonged use.

Intestinal obstruction in Nigerian children.

A 10-yr review of acute intestinal obstruction in 280 Nigerian children reveals that the condition is the major cause of surgical emergencies in Nigerian children, as in children of other developing countries. These are significant differences of pediatric intestinal obstruction in developing countries, as compared with the pattern in other parts of the world. Intussuscaption was the leading cause followed by incarcerated or strangulated hernia. Lateness in presentation was common, with a resulting high morbidity and prolonged hospital stay. The overall mortality was 16%, but mortality of 33% was recorded in the neonatal group.

Metronidazole retention enema in the management of severe intestinal amoebiasis.

Metronidazole is a drug of proven efficacy in amoebiasis; however its use is restricted in patients who cannot take the drug by mouth, because of severe complications of the disease. Preliminary studies in eight control subjects show that rapid absorption and high serum levels are achieved after rectal administration of 2 gm. of metronidazole in 200 ml. of normal saline. Six patients with severe intestinal amoebiasis treated with metronidazole retention enema are presented, and they illustrate the efficacy of the new method of therapy. The efficacy of metronidazole in anaerobic bacteriodes infection and its proven amoebicidal effcet also indicate the possible use of the metronidazole retention enema technique in bowel preparation for colonic surgery in developing countries.