BackgroundTwo-stage revision is the standard procedure for periprosthetic knee infection. But when to perform the second-stage is still under debate. We attempt to search the reliable indicators, risk factors, and proper timing for the second-stage revision.MethodsWe reviewed and followed 81 infected total knee arthroplasty patients who underwent two-stage revision from January 2010 to January 2014. Our cohort included 56 males and 25 females, all patients were confirmed as PJI with the same phenotypic cultures. The average age was 64.8 ± 8.21 (range 36–78) months. The mean follow-up time was 46.5 ± 17.6 (range 12–72) months after the second-stage surgeries. The diagnostic parameters including serum C-reaction protein, erythrocyte sedimentation rate, and intraoperative frozen section at the time of re-implantation were analyzed. The spacer detention time and antibiotic treatment time were compared.ResultsTen of them went through failed first- or second-stage surgeries. The overall success rate was 87.7%. The intraoperative frozen section is a good indicator at the time of re-implantation; the sensitivity and specificity is 90 and 83.1%. Serum CRP and ESR showed poor diagnostic value at time of re-implantation. Atypical pathogen infection, positive FS, and previous sinus were high-risk factors for failure of two-stage revision. Spacer detention time between 12 and 16 weeks had higher success rate than over 16 weeks.ConclusionThe proper timing of re-implantation should be combined with disappearance of clinical symptoms and negative intraoperative FS with spacer detention time at 12 to 16 weeks.
Our study revealed the clinical and pathological characteristics of IKC, including the absence of inflammatory sign, lesion partially embedded in the tarsus and protruding beneath the conjunctiva with the intracystic keratinous contents, stratified squamous epithelium linings, string-like keratin contents from the histopathology sections, and strongly immunoreactivity to antibodies against epithelial membrane antigen. A complete excision of cysts with adjacent tarsectomy by transconjunctival approach was proved to be an effective treatment for prevention of recurrence.
In situ device (ISD) and circular disposable device (CDD) are used for optimizing male circumcision (MC), but evidence to explore the characteristics of these two devices is insufficient. In order to explore this issue systematically and provide reliable evidence, ten published randomized controlled trials (RCTs) exploring the safety and efficacy of ISDs and CDDs were included (involving 4649 men). Moderate quality of the RCTs included was found after assessment. Pairwise meta-analyses and network meta-analyses were processed in stata 13.0 and AIDDS v1.16.6 respectively. According to the outcomes that were statistically significant in both pairwise and network meta-analyses, ISD was found to have less intraoperative blood loss (IB), less operative time (OT) and less incidence of wound bleeding (WB) than conventional circumcision (CC); ISD was found to have less WB but more wound healing time (WHT) than CDD; CDD was found to have less IB and less OT than CC. CDD tended to have the best wound healing condition and least pain experience; ISD tended to have the least IB, least OT, least WB, and highest satisfaction rate. With their own superiorities in many aspects, CDD and ISD are both safe and effective devices for optimizing MC.
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