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Gauld R, Walter G, Zhu R. Pollen food allergy syndrome secondary to molds and raw mushroom cross-reactivity: a case report. Allergy Asthma Clin Immunol 2024; 20:2. [PMID: 38178177 PMCID: PMC10765729 DOI: 10.1186/s13223-023-00865-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 12/06/2023] [Indexed: 01/06/2024]
Abstract
BACKGROUND Pollen food allergy syndrome (PFAS) is an immunoglobulin E (IgE) mediated reaction that causes oropharyngeal pruritus or angioedema due to homologous proteins present in the culprit food as well as a sensitizing aeroallergen. This cross-reactivity has been well established between pollen and fruits/vegetables. Given the evolutionary similarity between all fungi; cross-reactivity between spore forming microfungi and edible macrofungi have been suggested, however only a limited number of case reports have ever been published on this phenomenon. We present a case of a patient who experiences pollen food allergy syndrome-like symptoms following lightly cooked mushroom ingestion who otherwise was able to tolerate cooked mushrooms. We then review the literature to highlight the limited studies of an underrecognized PFAS cross-reactivity between molds and mushrooms. CASE PRESENTATION A 15-year-old male presents with symptoms of seasonal and perennial allergic rhinitis was found to have multiple environmental sensitizations to molds via skin prick testing (C. gramineum, A. Pullulans and B. cinerea) and ImmunoCAP serum-specific IgE (A. alternata, C. herbarum, and P. notatum). He developed throat pruritus and subjective throat tightness following ingestion of mushroom containing pizza. ImmunoCAP serum specific IgE to whole mushroom was negative but fresh food prick testing to fresh portobello mushroom and cremini mushroom were both positive with a negative test to canned mushroom. The patient then underwent a graded oral challenge and successfully tolerated canned mushrooms. CONCLUSION This case highlights the potential cross-reactivity between microfungi aeroallergens and edible fungi, leading to PFAS-like reactions in susceptible individuals. The patient's ability to tolerate canned mushrooms suggests a possible heat-labile protein as the cause of the reaction, similar to PFAS patients tolerating cooked but not raw fruits/vegetables. Positive skin prick test to both spore-forming fungi and edible fungi with negative and whole mushroom IgE results further support the hypothesis of cross-reactivity and sensitization. Further research is needed to identify the specific allergenic proteins involved in these cross-reactions and the susceptible species of mold and mushroom. Understanding these components will contribute to improved diagnosis and management of mold and mushroom allergies, and enhance our knowledge of allergenic cross-reactivity in general.
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Affiliation(s)
- Ryan Gauld
- Division of Clinical Immunology and Allergy, Department of Medicine, Western University, London, ON, Canada
| | - Graham Walter
- Division of Clinical Immunology and Allergy, Department of Medicine, Western University, London, ON, Canada
| | - Rongbo Zhu
- Division of Clinical Immunology and Allergy, Department of Medicine, Western University, London, ON, Canada.
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Walter G, Jeimy S, Liddy C, Guglani S, Ellis AK, Blair A, Kobayaa H, Chad Z, Keely E. Utility of eConsults for COVID-19 vaccine-related concerns in Ontario: a cross-sectional analysis. Allergy Asthma Clin Immunol 2023; 19:38. [PMID: 37143148 PMCID: PMC10158700 DOI: 10.1186/s13223-023-00789-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 04/06/2023] [Indexed: 05/06/2023]
Abstract
BACKGROUND The Champlain BASE™ and Ontario eConsult services are virtual platforms that serve to facilitate contact between primary care providers and specialists across Ontario, relaying patient-specific questions to relevant specialists via a secure web-based platform. Despite ample evidence regarding the general effectiveness of these platforms, their utility as it pertains to clinical concerns regarding COVID-19 vaccines has not yet been explored. METHODS We performed a cross-sectional descriptive analysis of COVID-19 vaccine related eConsults on Ontario patients completed by five allergy specialists between February and October of 2021. 4318 COVID-19 vaccine-related eConsults were completed in total during this time; with 1857 completed by the five allergists participating in this analysis. Question types/content were categorized using a taxonomy developed through consensus on a weighted monthly sample of 499 total cases. Data regarding whether external resources were required to answer each eConsult, impact on primary care provider referral decisions, and allergy consultant response times were collected. A 2-question survey was completed by primary care providers following eConsultation and results were collected. RESULTS 41.08% of eConsults received involved safety concerns regarding COVID-19 vaccine administration in the setting of prior allergic disease and another 36.1% involved a potential reaction the first dose of a COVID-19 vaccine. 72.1% of eConsults were answered by specialist without needing external resources, and only 9.8% of all eConsults received resulted in a recommendation for formal in-person referral to Clinical Immunology & Allergy specialist or another subspecialty. Average time to complete eConsult was 16.4 min, and 79.7% of PCP eConsult queries which would have traditionally resulted in formal consultation were resolved based on advice provided in the eConsult without need for in-person assessment. CONCLUSIONS Our study demonstrates the utility of the eConsult service as it pertains to COVID-19 vaccine-related concerns. The eConsult platform proved an effective tool in diverting the need for in-person assessment by an Allergist or other medical specialty. This is significant given the large volume of eConsults completed by Allergists, and demonstrates the impact of an effective electronic delivery of care model during a time of strained resources and public health efforts directed at mass vaccination.
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Affiliation(s)
- Graham Walter
- Department of Medicine, University of Western Ontario, London, ON, Canada.
- Divison of Clinical Immunology & Allergy, University of Western Ontario, London, ON, Canada.
| | - Samira Jeimy
- Department of Medicine, University of Western Ontario, London, ON, Canada
- Divison of Clinical Immunology & Allergy, University of Western Ontario, London, ON, Canada
| | - Clare Liddy
- Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Sheena Guglani
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Anne K Ellis
- Division of Allergy & Immunology, Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Amy Blair
- Division of Pediatric Clinical Immunology & Allergy, University of Toronto, Toronto, ON, Canada
| | | | - Zave Chad
- Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada
| | - Erin Keely
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
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Walter G, Brant A, Kim H. Food protein-induced enterocolitis syndrome in response to salmon roe and trout roe. J Allergy Clin Immunol Glob 2023; 2:122-123. [PMID: 37780111 PMCID: PMC10509918 DOI: 10.1016/j.jacig.2022.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 09/19/2022] [Accepted: 09/22/2022] [Indexed: 10/03/2023]
Abstract
Clinical implications herein, we describe the first case in the medical literature of food protein-induced enterocolitis syndrome in response to specific fish roe.
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Affiliation(s)
- Graham Walter
- Department of Medicine, Western University, London, Ontario, Canada
- Division of Clinical Immunology and Allergy, Western University, London, Ontario, Canada
| | - Adam Brant
- Division of Neurosurgery, Community Regional Medical Center, Fresno, Calif
| | - Harold Kim
- Department of Medicine, Western University, London, Ontario, Canada
- Division of Clinical Immunology and Allergy, Western University, London, Ontario, Canada
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Dreborg S, Walter G, Kim H. International recommendations on epinephrine auto-injector doses often differ from standard weight-based guidance: a review and clinical proposals. Allergy Asthma Clin Immunol 2022; 18:102. [PMID: 36471385 PMCID: PMC9724388 DOI: 10.1186/s13223-022-00736-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 10/25/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND In anaphylaxis, the dosing of injectable epinephrine in medical settings has been arbitrarily recommended to be 0.01 mg/kg of body weight. For ethical reasons, there have been no dose-response studies or double-blind studies performed on patients with active anaphylaxis. Intramuscular delivery of epinephrine has been the standard. Auto-injectors for use in the treatment of anaphylaxis are available in four strengths (0.1, 0.15, 0.3, and 0.5 mg). However, in many countries, only the 0.15 and 0.3 mg strengths are available. Consequently, many adult, heavy patients are prescribed the 0.3 mg dose, which may result in only one-fifth to one-third of the recommended weight-based dose being administered in heavy patients experiencing anaphylaxis. Underdosing may have therefore contributed to mortality in anaphylaxis. OBJECTIVE To review the doses of epinephrine recommended for the treatment of anaphylaxis in the community, and assess whether recommendations should be made to increase dosing for heavy adult patients in hopes of avoiding future deaths from anaphylaxis. METHODS We reviewed multiple national and international recommendations for the dosing of epinephrine. We also reviewed the literature on adverse drug reactions from epinephrine, lethal doses of epinephrine, and epinephrine dose-finding studies. RESULTS The majority of national and regional professional societies and authorities recommend epinephrine delivered by auto-injectors at doses far lower than the generally accepted therapeutic dose of 0.01 mg/kg body weight. Furthermore, we found that the recommendations vary even within regions themselves. CONCLUSIONS We suggest prescribing more appropriate doses of epinephrine auto-injectors based on weight-based recommendations. There may be some exceptions, such as for patients with heart disease. We hypothesize that these recommendations will lead to improved outcomes of anaphylaxis.
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Affiliation(s)
- Sten Dreborg
- grid.8993.b0000 0004 1936 9457Department of Child and Adolescent Allergology, Women’s and Children’s Health, University of Uppsala, Uppsala, Sweden
| | - Graham Walter
- grid.39381.300000 0004 1936 8884Department of Medicine, Western University, London, ON Canada ,grid.39381.300000 0004 1936 8884Division of Clinical Immunology and Allergy, Western University, London, ON Canada
| | - Harold Kim
- grid.39381.300000 0004 1936 8884Department of Medicine, Western University, London, ON Canada ,grid.39381.300000 0004 1936 8884Division of Clinical Immunology and Allergy, Western University, London, ON Canada ,grid.25073.330000 0004 1936 8227Department of Medicine, McMaster University, Hamilton, ON Canada
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Walter G. Kräfte zwischen immergierten Teilchen — ihr Einfluß auf das Fließverhalten von Suspensionen. Eine Übersicht. TENSIDE SURFACT DET 2021. [DOI: 10.1515/tsd-1972-090507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Walter G, Richert Q, Ponnampalam A, Sharma A. Acute superior mesenteric vein thrombosis in the setting of cytomegalovirus mononucleosis: a case report and review of the literature. Lancet Infect Dis 2021; 21:e202-e207. [PMID: 34000241 DOI: 10.1016/s1473-3099(20)30782-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 08/27/2020] [Accepted: 09/21/2020] [Indexed: 12/16/2022]
Abstract
Cytomegalovirus is a viral genus of the overarching family Herpesviridae, and is of particular importance because of its relevance to human disease. This association is predominantly due to human cytomegalovirus, a well-studied pathogen. In addition to the mononucleosis syndrome that can occur during acute cytomegalovirus viraemia, this virion has been recurrently implicated as a provoking factor for thromboembolic disease in the published scientific literature. As physicians increasingly forgo extensive laboratory investigation in the setting of clinical hypercoagulability, it has also become evident that in some circumstances whether or not a particular investigation alters clinical management is not necessarily the only important question. Viraemia as a provoking factor for thrombosis stands as such an example. The aim of this Grand Round is to further explore the role of cytomegalovirus as it pertains to thromboembolic disease, especially in the present era of viral-associated thromboembolism.
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Affiliation(s)
- Graham Walter
- Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada.
| | - Quinlan Richert
- Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
| | - Arjuna Ponnampalam
- Section of Hematology/Oncology, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada; CancerCare Manitoba, Manitoba, Winnipeg, Canada
| | - Aditya Sharma
- Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada; Section of General Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
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Walter G, Lyubetska H, Sharma A. Fever in a lung transplant recipient. Cleve Clin J Med 2020; 87:735-741. [PMID: 33229389 DOI: 10.3949/ccjm.87a.19132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Graham Walter
- Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
| | - Hanna Lyubetska
- Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
| | - Aditya Sharma
- Department of Internal Medicine, Section of General Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
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Vandenborne K, Kim S, Willcocks R, Morales J, Lingineni K, Barnard A, Schmidt S, Daniels M, Triplett W, Larkindale J, Walter G, Rooney W, Steering Committe DMR. MUSCLE IMAGING – MRI. Neuromuscul Disord 2020. [DOI: 10.1016/j.nmd.2020.08.163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Walter G, Kalicinsky C. Adult-onset IgE-mediated food allergy at a Winnipeg allergy clinic: a case series. Allergy Asthma Clin Immunol 2020; 16:85. [PMID: 33014083 PMCID: PMC7526386 DOI: 10.1186/s13223-020-00483-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 09/17/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND It is a putatively understood phenomenon that the overall prevalence of allergic disease has been increasing in recent decades-particularly in industrialized nations. Despite this, there is a relative scarcity of data concerning the development of food-related allergic disease in the adult population. In addition, the paucity of data as it pertains to the Canadian population is particularly marked when compared to other nations. We sought to determine common culprit foods and the reactions they elicited in a series of 14 patients seen in the Winnipeg allergy and immunology clinic. METHODS We conducted a retrospective review of patients identified by academic allergists in Winnipeg, Manitoba as fitting criteria for adult-onset IgE-mediated food allergy from May 2018-July 2020. We included patients with IgE-mediated symptoms, including the pollen-food syndrome which developed at the age of 16 or later. We collected data regarding the food which induced the reaction, what the reaction was, and any concomitant atopic disease. RESULTS The most common culprit food identified was shellfish, followed by finfish, pollen-food syndrome, and wheat/flour. The most common reaction experienced was anaphylaxis, followed by food-dependent exercise-induced anaphylaxis and isolated (muco)cutaneous symptoms. With regard to concomitant atopic disease, allergic rhinitis/rhinoconjunctivitis stood out as the most prevalent. CONCLUSIONS Adult-onset food allergy-particularly with resultant anaphylaxis-is an important phenomenon to recognize, even when patients have previously tolerated the food in question.
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Affiliation(s)
- Graham Walter
- Department of Internal Medicine, University of Manitoba, Winnipeg, Canada
| | - Chrystyna Kalicinsky
- Department of Internal Medicine, University of Manitoba, Winnipeg, Canada
- Section of Allergy and Clinical Immunology, University of Manitoba, Winnipeg, Canada
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Walter G, Kalicinsky C, Warrington R, Miguel M, Reyes J, Rubin TS. Delivery of subcutaneous immunoglobulin by rapid "push" infusion for primary immunodeficiency patients in Manitoba: a retrospective review. Allergy Asthma Clin Immunol 2020; 16:34. [PMID: 32426003 PMCID: PMC7218483 DOI: 10.1186/s13223-020-00431-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 04/30/2020] [Indexed: 12/29/2022] Open
Abstract
Background Both intravenous and subcutaneous human immune globin G (IgG) replacement (IVIG and SCIG, respectively) reduce severe infection and increase serum IgG levels in primary immune deficiency disorder (PIDD) patients who require replacement. SCIG can be administered either with the aid of an infusion pump, or by patients or caregivers themselves, using butterfly needles and a syringe (“SCIG push”). SCIG offers advantages over IVIG, including higher steady state IgG levels, improved patient quality of life indicators, and decreased cost to the healthcare system, and for these reasons, SCIG has been increasingly used in Manitoba starting in 2007. We sought to determine the effectiveness of SCIG push in our local adult PIDD population. Methods We conducted a retrospective chart review of all adult patients enrolled in the SCIG push program in Manitoba, Canada from its inception in November 2007 through September 2018. We included patients who were naïve to IgG replacement prior to SCIG, and those who had received IVIG immediately prior. We collected data regarding serum IgG levels, antibiotic prescriptions, hospital admissions, and adverse events during a pre-defined period prior to and following SCIG initiation. Statistical significance was determined via two-tailed t-test. Results 62 patients met inclusion criteria, of whom 35 were on IVIG prior and 27 were IgG replacement naïve. SCIG push resulted in an increase in serum IgG levels in those naïve to IgG replacement, as well as in those who received IVIG prior. SCIG push also resulted in a statistically significant reduction in number of antibiotic prescriptions filled in the naïve subgroup, and no significant change in antibiotics filled in the IVIG prior group. 8/62 PIDD patients (12.9%) left the SCIG program during our review period for varying reasons, including side-effects. Conclusions In a real-life setting, in the Manitoba adult PIDD population, SCIG push is an effective method of preventing severe infections, with most patients preferring to continue this therapy once initiated.
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Affiliation(s)
- Graham Walter
- 1Department of Internal Medicine, University of Manitoba, Winnipeg, Canada
| | - Chrystyna Kalicinsky
- 1Department of Internal Medicine, University of Manitoba, Winnipeg, Canada.,2Section of Allergy and Clinical Immunology, University of Manitoba, Winnipeg, Canada
| | - Richard Warrington
- 1Department of Internal Medicine, University of Manitoba, Winnipeg, Canada.,2Section of Allergy and Clinical Immunology, University of Manitoba, Winnipeg, Canada
| | - Marianne Miguel
- 3Section of Pediatric Allergy and Clinical Immunology, University of Manitoba, Winnipeg, Canada
| | - Jeannette Reyes
- 2Section of Allergy and Clinical Immunology, University of Manitoba, Winnipeg, Canada
| | - Tamar S Rubin
- 3Section of Pediatric Allergy and Clinical Immunology, University of Manitoba, Winnipeg, Canada.,4Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada
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Finkel R, Vandenborne K, Sweeney H, Finanger E, Tennekoon G, Shieh P, Willcocks R, Walter G, Rooney W, Forbes S, Triplett W, Yum S, Mancini M, MacDougall J, Fretzen A, Bista P, Nichols A, Donovan J. O.42Treatment of young boys with Duchenne muscular dystrophy with the NF-κB inhibitor edasalonexent showed a slowing of disease progression as assessed by MRI and functional measures. Neuromuscul Disord 2019. [DOI: 10.1016/j.nmd.2019.06.596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Lajaunie R, Kraiem H, Lucarelli A, Dubois F, Rasouly N, Walter G, About V, Djossou F, Epelboin L. [Risk of Infection Following Implant of Artificial Penile Nodule, Bouglous or Dominos: A Case Report in French Guiana]. ACTA ACUST UNITED AC 2019; 112:114-118. [PMID: 31478616 DOI: 10.3166/bspe-2019-0082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 06/18/2019] [Indexed: 11/20/2022]
Abstract
Implant of artificial penile nodule (APN) is a socio-cultural practice, linked to penitentiary environment in French Guiana. Physicians are often unfamiliar with its existence. Although serious complications remain low regarding the high prevalence of this practice, urgent cares could be required. Indeed, implant of nodule can have functional sequelae, and sometimes life-threatening consequences, especially if infection occurs and spreads. We have reported the case of a 23-year-old male who presented an infection of the penis after the implant of two APN. Removal of the nodules associated with oral antibiotics was needed. We also present CT-scan images of another patient, as an example of fortuitous discovery of these nodules. We finally discuss the various complications already described in literature.
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Affiliation(s)
- R Lajaunie
- Unité des maladies infectieuses et tropicales, centre hospitalier Andrée-Rosemon (CHAR), F-97300 Cayenne, Guyane française, France
| | - H Kraiem
- Service d'accueil des urgences, CHAR, F-97300 Cayenne, Guyane française, France
| | - A Lucarelli
- Hôpital de jour adultes, CHAR, F-97300 Cayenne, Guyane française, France
| | - F Dubois
- Unité des maladies infectieuses et tropicales, centre hospitalier Andrée-Rosemon (CHAR), F-97300 Cayenne, Guyane française, France
| | - N Rasouly
- Service de radiologie, CHAR, F-97300 Cayenne, Guyane française, France
| | - G Walter
- Unité des maladies infectieuses et tropicales, centre hospitalier Andrée-Rosemon (CHAR), F-97300 Cayenne, Guyane française, France
| | - V About
- Service d'accueil des urgences, CHAR, F-97300 Cayenne, Guyane française, France.,Unité carcérale de soins ambulatoires, centre pénitentiaire de Remire-Montjoly, F-97354 Remire-Montjoly, Guyane française, France
| | - F Djossou
- Unité des maladies infectieuses et tropicales, centre hospitalier Andrée-Rosemon (CHAR), F-97300 Cayenne, Guyane française, France.,Équipe EA 3593, Écosystèmes amazoniens et pathologie tropicale, université de la Guyane, F-97300 Cayenne, Guyane française, France
| | - L Epelboin
- Unité des maladies infectieuses et tropicales, centre hospitalier Andrée-Rosemon (CHAR), F-97300 Cayenne, Guyane française, France.,Équipe EA 3593, Écosystèmes amazoniens et pathologie tropicale, université de la Guyane, F-97300 Cayenne, Guyane française, France
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Thill P, Dahuron L, Berlioz A, Bisser S, Beillard E, Walter G, Nacher M, Demar M, Djossou F, Epelboin L. Incidence élevée de la fièvre Q en Guyane : une étude épidémiologique entre 2009 et 2017. Med Mal Infect 2019. [DOI: 10.1016/j.medmal.2019.04.378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Bonifay T, Walter G, Abboud P, Epelboin L, Bellaud G, Bleibtreu A, Dournon N, Henn A, Lemaignen A, Nguyen L, Rossi B, Sanderink D. Analyse rétrospective des épidémies d’arbovirus du XIXe siècle : alors dengue ou chikungunya ? Med Mal Infect 2019. [DOI: 10.1016/j.medmal.2019.04.289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Baizet C, Ouar-Epelboin S, Walter G, Mosnier E, Moreau B, Djossou F, Epelboin L. Decreased antibiotic susceptibility of Enterobacteriaceae causing community-acquired urinary tract infections in French Amazonia. Med Mal Infect 2019; 49:63-68. [DOI: 10.1016/j.medmal.2018.09.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 05/11/2018] [Accepted: 09/21/2018] [Indexed: 12/22/2022]
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Richard F, Vandenborne K, Sweeney H, Finanger E, Tennekoon G, Shieh P, Willcocks R, Walter G, Rooney W, Forbes S, Triplett W, Yum S, Mancini M, MacDougall J, Fretzen A, Bista P, Nichols A, Donovan J. DMD CLINICAL THERAPIES I. Neuromuscul Disord 2018. [DOI: 10.1016/j.nmd.2018.06.144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Forbes S, Batra A, Baligand C, Vandenborne K, Walter G. DMD TREATMENT: ANIMAL MODELS. Neuromuscul Disord 2018. [DOI: 10.1016/j.nmd.2018.06.253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Arora H, Willcocks R, Forbes S, Triplett W, Rooney W, Wang D, Daniels M, Finanger E, Tennekoon G, Brandsema J, Sweeney H, Walter G, Vandenborne K. DUCHENNE MUSCULAR DYSTROPHY - PHYSIOTHERAPY. Neuromuscul Disord 2018. [DOI: 10.1016/j.nmd.2018.06.353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Moriceau O, Musset L, Barbosa R, Larzek Y, Michaud C, Abboud P, Walter G, Cebe M, Djossou F, Mosnier E. Nouvelles stratégies de dépistage de terrain du paludisme : importance et rôle de l’infirmier coordinateur sur le projet PALUSTOP. Med Mal Infect 2018. [DOI: 10.1016/j.medmal.2018.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Roman-laverdure B, Viavant L, Abboud P, Walter G, Mezani A, Vesin G, Mosnier E, Rufray V, Djossou F, Epelboin L. Connaissance, attitude et pratique des chiroptérologues vis-à-vis de la rage en Amazonie française. Med Mal Infect 2018. [DOI: 10.1016/j.medmal.2018.04.275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Walter G. [Evidence of anti-infection strategies in trauma surgery]. Unfallchirurg 2017; 120:1090-1091. [PMID: 29116374 DOI: 10.1007/s00113-017-0436-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- G Walter
- Abteilung Septische Chirurgie, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Friedberger Landstr. 430, 60389, Frankfurt am Main, Deutschland.
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Willcocks R, Forbes S, Lott D, Senesac C, Arora H, Barnard A, Harrington A, Daniels M, Finanger E, Tennekoon G, Finkel R, Wang D, Rooney W, Walter G, Sweeney H, Vandenborne K. Magnetic resonance biomarkers in the proximal and distal upper extremity in a large cohort of boys with Duchenne muscular dystrophy. Neuromuscul Disord 2017. [DOI: 10.1016/j.nmd.2017.06.122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Valdes A, Epelboin L, Mosnier E, Walter G, Vesin G, Abboud P, Blanchet D, Blaise N, Demar M, Djossou F. Primaquine 30 mg/j vs 15 mg/j pendant 14 j pour la prévention des reviviscences de Plasmodium vivax de l’adulte dans une région d’Amérique : où en sommes-nous ? Med Mal Infect 2017. [DOI: 10.1016/j.medmal.2017.03.237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Sanderink D, Melenotte C, Walter G, Bidaud B, Jauréguiberry S, Mahamat A, Demar M, Abboud P, Djossou F, Epelboin L. La fièvre Q chronique en Amérique latine : une entité méconnue. Étude transversale en Guyane. Med Mal Infect 2017. [DOI: 10.1016/j.medmal.2017.03.245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Affiliation(s)
- G. Walter
- Kernforschungszentrum Karlsruhe GmbH, Institut für Kernphysik, Postfach 3640 D-7500 Karlsruhe 1, Federal Republic of Germany
| | - B. Leugers
- Kernforschungszentrum Karlsruhe GmbH, Institut für Kernphysik, Postfach 3640 D-7500 Karlsruhe 1, Federal Republic of Germany
| | - F. Käppeler
- Kernforschungszentrum Karlsruhe GmbH, Institut für Kernphysik, Postfach 3640 D-7500 Karlsruhe 1, Federal Republic of Germany
| | - Z. Y. Bao
- Kernforschungszentrum Karlsruhe GmbH, Institut für Kernphysik, Postfach 3640 D-7500 Karlsruhe 1, Federal Republic of Germany
| | - G. Reffo
- Laboratorio Dati Nucleari, Ente Nazionale per l’Energie Alternative, Bologna, Italy
| | - F. Fabbri
- Laboratorio Dati Nucleari, Ente Nazionale per l’Energie Alternative, Bologna, Italy
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Affiliation(s)
- A. Kavetsky
- TRACE Photonics, Inc., 1680 West Polk Avenue, Charleston, Illinois 61920
| | - G. Yakubova
- TRACE Photonics, Inc., 1680 West Polk Avenue, Charleston, Illinois 61920
| | - M. Sychov
- TRACE Photonics, Inc., 1680 West Polk Avenue, Charleston, Illinois 61920
| | - Q. Lin
- TRACE Photonics, Inc., 1680 West Polk Avenue, Charleston, Illinois 61920
| | - G. Walter
- TRACE Photonics, Inc., 1680 West Polk Avenue, Charleston, Illinois 61920
| | - D. Chan
- TRACE Photonics, Inc., 1680 West Polk Avenue, Charleston, Illinois 61920
| | - S. Yousaf
- TRACE Photonics, Inc., 1680 West Polk Avenue, Charleston, Illinois 61920
| | - H. Socarras
- TRACE Photonics, Inc., 1680 West Polk Avenue, Charleston, Illinois 61920
| | - J. Abrefah
- Pacific Northwest National Laboratory, Richland, Washington 99352
| | - K. Bower
- TRACE Photonics, Inc., 1680 West Polk Avenue, Charleston, Illinois 61920
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Gramlich Y, Walter G, Gils J, Hoffmann R. [Early Results of Adjuvant Topical Treatment of Recurrent Osteomyelitis with Absorbable Antibiotic Carriers]. Z Orthop Unfall 2017; 155:35-44. [PMID: 28081583 DOI: 10.1055/s-0042-112228] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Background Treatment of musculoskeletal infections principally consists of radical surgical debridement and systemic administration of antibiotics. Additional local antibiotic therapy is not yet generally established, and lacks evidence-based proof of efficacy. Nonetheless, there are a variety of practical approaches, as most specialised departments are unwilling to forego this option. The established polymethylmetacrylate (PMMA) carrier system has a number of practical disadvantages. This has led to the increased use of absorbable carrier systems, and those based on calcium sulphate have given particularly encouraging results. In this article, we present our experience with this procedure in the treatment of osteomyelitis. There is currently no standard procedure or algorithm for the use of local antibiotic carriers in the treatment of recurrent osteomyelitis. Material and Methods Between February 2014 and May 2015, a total of 93 patients were treated with an absorbable carrier of topical antibiotics based on calcium sulphate. These patients had suffered from a recurrence of osteomyelitis that had been unsuccessfully treated by the primary implantation of a PMMA chain and systemic antibiotics. The treatment algorithm consisted of radical debridement, followed by implantation of a commercial PMMA chain. If no remission of the infection was observed, the chains were surgically removed and replaced with an absorbable carrier system and antibiotics chosen in accordance with the resistogram. Pursuant to the classification of Cierny and Mader, 10 patients were classified as type I, 5 as type II, 55 as type III and 23 as type IV. The mean follow-up period was 11 months. Two carrier systems, Osteoset® and Herafill®, were purchased from Wright Medical Technology Inc., Arlington, TN, USA and Heraeus Medical GmbH, Wehrheim, Germany, respectively. These were used as supplied for tobramycin and gentamycin. In the case of Osteoset, it was also possible to add an additional arbitrary, water-soluble antibiotic. Systemic administration of antibiotics was carried out in parallel in accordance with the resistogram. Results The most common clinical entities were femoral (36 %) and tibial (29 %) osteitis. Vancomycin (38 %) and tobramycin (38 %) were the most frequently used topical antibiotics, followed by gentamycin (17 %), ceftriaxone (4 %), fosfomycin (2 %) and colistin (1 %). Systemic administration of antibiotics was carried out in parallel, in accordance with the resistogram. In 85 % of all patients, remission was achieved. Infections with methicillin-resistant Staphylococcus aureus (MRSA; 62 %) and Pseudomonas aeruginosa (43 %) showed significantly poorer remission rates. The bacterial spectrum was primarily composed of Staphylococcus aureus (28 %), Staphylococcus epidermidis (22 %), Pseudomonas aeruginosa (7 %) and Enterococcus faecalis (5 %), as well as Escherichia coli and Klebsiella oxytoca (4 %). Conclusion Topical adjuvant antibiotic therapy based on an absorbable carrier system offers an expedient extension of the treatment of osteomyelitis. The remission rate of 85 % for recurrent infections encouraged the use of a therapeutic alternative for many patients. We developed an algorithm for the treatment of osteomyelitis, which includes the application of local antibiotics with different compositions and absorbable carriers. We present early results of successful treatment of patients with recurrent osteomyelitis, after futile topical therapy with non-absorbable antibiotic chains.
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Affiliation(s)
- Y Gramlich
- Unfallchirurgie und orthopädische Chirurgie, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main
| | - G Walter
- Unfallchirurgie und orthopädische Chirurgie, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main
| | - J Gils
- Unfallchirurgie und orthopädische Chirurgie, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main
| | - R Hoffmann
- Unfallchirurgie und orthopädische Chirurgie, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main
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Sweeney H, Vandenborne K, Walter G, Rooney B. MRI as a biomarker for DMD disease progression and implications for clinical trials. Neuromuscul Disord 2016. [DOI: 10.1016/j.nmd.2016.06.446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Bista P, Walter G, Vandenborne K, Lee B, Nichols A, Donovan J. Serum pro-inflammatory proteins have potential utility as biomarkers for NF-kB targeting approaches in DMD. Neuromuscul Disord 2016. [DOI: 10.1016/j.nmd.2016.06.266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Maltman C, Walter G, Yurkov V. A Diverse Community of Metal(loid) Oxide Respiring Bacteria Is Associated with Tube Worms in the Vicinity of the Juan de Fuca Ridge Black Smoker Field. PLoS One 2016; 11:e0149812. [PMID: 26914590 PMCID: PMC4767881 DOI: 10.1371/journal.pone.0149812] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 02/04/2016] [Indexed: 01/24/2023] Open
Abstract
Epibiotic bacteria associated with tube worms living in the vicinity of deep sea hydrothermal vents of the Juan de Fuca Ridge in the Pacific Ocean were investigated for the ability to respire anaerobically on tellurite, tellurate, selenite, selenate, metavanadate and orthovanadate as terminal electron acceptors. Out of 107 isolates tested, 106 were capable of respiration on one or more of these oxides, indicating that metal(loid) oxide based respiration is not only much more prevalent in nature than is generally believed, but also is an important mode of energy generation in the habitat. Partial 16S rRNA gene sequencing revealed the bacterial community to be rich and highly diverse, containing many potentially new species. Furthermore, it appears that the worms not only possess a close symbiotic relationship with chemolithotrophic sulfide-oxidizing bacteria, but also with the metal(loid) oxide transformers. Possibly they protect the worms through reduction of the toxic compounds that would otherwise be harmful to the host.
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Affiliation(s)
- Chris Maltman
- Department of Microbiology, University of Manitoba, Winnipeg, Canada
| | - Graham Walter
- Department of Microbiology, University of Manitoba, Winnipeg, Canada
| | - Vladimir Yurkov
- Department of Microbiology, University of Manitoba, Winnipeg, Canada
- * E-mail:
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Barnard A, Romero de Mello Sa S, Willcocks R, Senesac C, Finkel R, Forbes S, Sweeney H, Tennekoon G, Triplett W, Lott D, Wang D, Byrne B, Hammers D, Pham J, Rooney W, Finanger E, Walter G, Vandenborne K, Russman B. Genetic polymorphisms modify intramuscular fat infiltration in Duchenne muscular dystrophy. Neuromuscul Disord 2015. [DOI: 10.1016/j.nmd.2015.06.252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Willcocks R, Triplett W, Lott D, Forbes S, Dastgir J, Bönnemann C, Vandenborne K, Walter G. Quantitative MRI and MRS detect alterations in muscle quality in both congenital muscular dystrophy and Duchenne muscular dystrophy. Neuromuscul Disord 2015. [DOI: 10.1016/j.nmd.2015.06.393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Stiegler A, Schaletzky R, Walter G, Wüst R, Abele H, Goelz R, Farger G, Wiatr G, Fallgatter AJ, Batra A. Olanzapine treatment during pregnancy and breastfeeding: a chance for women with psychotic illness? Psychopharmacology (Berl) 2014; 231:3067-9. [PMID: 24938920 DOI: 10.1007/s00213-014-3647-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Accepted: 05/30/2014] [Indexed: 01/16/2023]
Affiliation(s)
- A Stiegler
- University Hospital of Psychiatry and Psychotherapy Tuebingen, Calwerstr. 14, 72076, Tuebingen, Germany,
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Habs D, Rudolph D, Kester O, Thirolf P, Reiter P, Schwalm D, Walter G, Van Duppen P, Eberth J. Physics with REX-ISOLDE and MINIBALL. ACTA ACUST UNITED AC 2014. [DOI: 10.1007/s002180050294] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Fleiter N, Walter G, Bösebeck H, Vogt S, Büchner H, Hirschberger W, Hoffmann R. Clinical use and safety of a novel gentamicin-releasing resorbable bone graft substitute in the treatment of osteomyelitis/osteitis. Bone Joint Res 2014; 3:223-9. [PMID: 25005841 PMCID: PMC4112779 DOI: 10.1302/2046-3758.37.2000301] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objective A clinical investigation into a new bone void filler is giving
first data on systemic and local exposure to the anti-infective
substance after implantation. Method A total of 20 patients with post-traumatic/post-operative bone
infections were enrolled in this open-label, prospective study.
After radical surgical debridement, the bone cavity was filled with
this material. The 21-day hospitalisation phase included determination
of gentamicin concentrations in plasma, urine and wound exudate, assessment
of wound healing, infection parameters, implant resorption, laboratory
parameters, and adverse event monitoring. The follow-up period was
six months. Results Systemic exposure to gentamicin after implantation was very low
as local gentamicin concentrations were measured in wound exudate
after six to ten hours. There were no signs of infectious complication
throughout the clinical phase. Four patients had recurrent infections
several weeks to months after implantation. The outcome was deemed successful
by remission of infection in 16 (80%) of these problematic long-term
treated patients. Safety laboratory measurements did not indicate
nephrotoxic or hepatotoxic effects. Conclusions Local application of calcium sulphate/carbonate bone void filler
comprising gentamicin revealed sufficient active local levels of
the antibiotic by simultaneous significant low systemic exposure
in patients with mostly chronic osteomyelitis/osteitis. The material
was safe and well tolerated. Cite this article: Bone Joint Res 2014;3:223–9.
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Affiliation(s)
- N Fleiter
- Berufsgenossenschaftliche Unfallklinik, Friedberger Landstraße 430, 60389, Frankfurt, Germany
| | - G Walter
- Berufsgenossenschaftliche Unfallklinik, Friedberger Landstraße 430, 60389, Frankfurt, Germany
| | - H Bösebeck
- Heraeus Medical, Philipp-Reiss-Strasse 8/13, 61273 Wehrheim, Germany
| | - S Vogt
- Heraeus Medical, Philipp-Reiss-Strasse 8/13, 61273 Wehrheim, Germany
| | - H Büchner
- Heraeus Medical, Philipp-Reiss-Strasse 8/13, 61273 Wehrheim, Germany
| | - W Hirschberger
- Facharztpraxis Chirurgie-Maintaunus, Dr. Enderle, Hirschberger & Partner, Waldstraße 9, 65812 Bad Soden, Germany
| | - R Hoffmann
- Berufsgenossenschaftliche Unfallklinik, Friedberger Landstraße 430, 60389, Frankfurt, Germany
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Walter G, Vernier M, Million M, Seng P, Stein A. COL08-02 : Infections ostéo-articulaires à germes anaérobies : séries de 61 cas. Med Mal Infect 2014. [DOI: 10.1016/s0399-077x(14)70075-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Walter G, Vernier M, Pinelli PO, Million M, Coulange M, Seng P, Stein A. Bone and joint infections due to anaerobic bacteria: an analysis of 61 cases and review of the literature. Eur J Clin Microbiol Infect Dis 2014; 33:1355-64. [DOI: 10.1007/s10096-014-2073-3] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Accepted: 01/28/2014] [Indexed: 11/30/2022]
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Walter G, Kemmerer M, Hoffmann R. [Treatment of septic olecranon and patellar bursitis by excision and vacuum-assisted closure therapy]. Z Orthop Unfall 2013; 151:353-7. [PMID: 23963983 DOI: 10.1055/s-0033-1350612] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Treatment of septic olecranon and patellar bursitis differs considerably and is currently under discussion. We therefore performed a retrospective study of our patients with septic bursitis in the past 5 years. PATIENTS AND METHOD Between March 2007 and February 2012 we treated 79 patients with septic olecranon (n = 43) and patellar (n = 36) bursitis surgically: 61-males, 18 females, age 51 (range: 11-91) years. Four patients had not been treated before, 25 had suffered recurrences after 1-10 previous procedures, and 9 patients had not improved after conservative therapy. 34 patients presented with traumatic rupture or fistula of their bursae. In all cases we performed a radical bursectomy and vacuum-assisted therapy for 4 to 5 days. In addition, patients received systemic antibiotics. We phoned all patients and were successful in 57 cases (72 %). We questioned these patients for range of movement, limitations at work, pain, sensibility disorder, satisfaction with the result and further surgical procedures. In all cases we took tissue specimens for cultures, in 48 preparations histological examination was performed. RESULTS Microbiological and histological results are discussed in detail. 40 patients were free of complaints, 15 complained of mild pain, 54 of 57 had unlimited range of motion. Minor discomforts at desk work were reported by 5 of 43 patients, 12 out of 36 patient reported discomfort when performing on their knees. There was no recurrence in the period of investigation. CONCLUSION We recommend our treatment concept for septic olecranon and patellar bursitis because patient satisfaction is high and recurrences are reliably avoided. The soft tissue is spared, so that plastic covering procedures are seldom necessary.
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Affiliation(s)
- G Walter
- Septische Chirurgie, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Deutschland.
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Kappler C, Staubach R, Abdulazim A, Kemmerer M, Walter G, Hoffmann R. [Hindfoot arthrodesis for post-infectious ankle destruction using an intramedullary retrograde hindfoot nail]. Unfallchirurg 2013; 117:348-54. [PMID: 23455847 DOI: 10.1007/s00113-012-2341-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Limb salvage after operations with deep infections of the ankle is often successful using arthrodesis of the hindfoot. The aim of this study was to evaluate the results of arthrodesis using a retrograde intramedullary nail following post-infectious ankle destruction. PATIENTS AND METHODS Between 2007 and 2010 a total of 44 patients were treated with tibiotalocalcaneal (TTC) arthrodesis and 14 patients with tibiocalcaneal (TC) arthrodesis using a retrograde hindfoot nail after quieting of infection. Evaluation included the American Orthopaedic Foot and Ankle Society (AOFAS) and the short-form 12-item (SF-12) scores. RESULTS Of the 58 patients 49 (35 male and 14 female) could be followed-up. The average time of follow-up was 18 months and the mean age was 58 years. In 85.7 % bony union could be achieved and 10.2 % suffered from reinfections. The mean results achieved in the different scores were AOFAS 56 and SF-12 39.1 (physical health summary scale) and 46.1 (mental health summary scale). Statistical analysis showed a significantly higher rate of bony fusion for TTC arthrodesis. Bony non-union showed a significant correlation to patients with reinfection and to diabetic patients. CONCLUSIONS Hindfoot arthrodesis for treatment of septic arthritis after infections is possible by using an intramedullary nail. The results show a high rate of fusion with an acceptable reinfection rate and good patient acceptance.
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Affiliation(s)
- C Kappler
- Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Friedberger Landstraße 430, 60389, Frankfurt, Deutschland,
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Schneider S, Bahmer T, Metzger F, Reif A, Polak T, Walter G, Eberle MC, Fallgatter A, Ehlis AC. 1609 – How first- and second-generation antipsychotics differentially improve anterior cingulate cortex (ACC) function in schizophrenic patients - an event-related potential study. Eur Psychiatry 2013. [DOI: 10.1016/s0924-9338(13)76607-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Renner B, Walter G, Strauss J, Fromm MF, Zacher J, Brune K. Preoperative administration of etoricoxib in patients undergoing hip replacement causes inhibition of inflammatory mediators and pain relief. Eur J Pain 2011; 16:838-48. [PMID: 22337568 PMCID: PMC3437501 DOI: 10.1002/j.1532-2149.2011.00062.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2011] [Indexed: 01/14/2023]
Abstract
OBJECTIVE Administering cyclooxygenase-2 inhibitors preoperatively appears attractive since these drugs reduce post-operative pain, but do not increase the risk of post-operative bleeds, asthmatic attacks and stress-related gastrointestinal ulcers. In a former investigation, we could show that post-operative administration of etoricoxib reduces prostaglandin production in wound fluid, but the onset of action is variable due to delayed post-operative absorption. METHODS In this study, we investigated the preoperative administration of etoricoxib in patients undergoing hip replacement. They received 120 mg etoricoxib or placebo 2 h before surgery and 1 day after in a double-blinded, randomized, parallel group design. RESULTS A total of 11 patients were randomized (placebo n = 5; verum n = 6). We found high and constant levels of the drug in blood, central nervous system and wound fluid already at the end of surgery (t(max) < 2 h). This was accompanied by inhibition of prostaglandin production in the wound tissue (treatment p < 0.05), suppression of interleukin 6 increase in plasma (treatment p < 0.01), and - despite existing standard pain relief procedures - higher satisfaction with analgesics (time vs. treatment p < 0.05) and less demand for opioids (treatment p < 0.01) and intrathecal bupivacaine (treatment p = 0.05) administration. CONCLUSION Administration of etoricoxib 2 h before surgery allows for an effective drug concentration in critical tissues, a reduction of the production of pro-inflammatory mediators and for better pain relief.
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Affiliation(s)
- B Renner
- Institute of Experimental and Clinical Pharmacology and Toxicology, University of Erlangen-Nürnberg, Erlangen, Germany.
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Kappler C, Abdulazim A, Kemmerer M, Walter G, Hoffmann R. Die tiefe Infektion nach osteosynthetischer Versorgung hüftgelenknaher Femurfrakturen – Behandlungsergebnisse und Lebensqualität. Z Orthop Unfall 2011; 150:67-74. [DOI: 10.1055/s-0031-1280262] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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Koennecke HC, Belz W, Berfelde D, Endres M, Fitzek S, Hamilton F, Kreitsch P, Mackert BM, Nabavi DG, Nolte CH, Pohls W, Schmehl I, Schmitz B, von Brevern M, Walter G, Heuschmann PU. Factors influencing in-hospital mortality and morbidity in patients treated on a stroke unit. Neurology 2011; 77:965-72. [DOI: 10.1212/wnl.0b013e31822dc795] [Citation(s) in RCA: 223] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Scheld SM, Schmidt-Horlohé K, Fuchs S, Kemmerer M, Walter G, Hoffmann R. [Osteomyelitis of the costae caused by salmonella]. Unfallchirurg 2011; 115:836-9. [PMID: 21826496 DOI: 10.1007/s00113-011-2058-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Salmonella enterica serotype Enteritidis was detected in a 34-year-old, previously healthy patient who suffered from osteomyelitis of the costae. Radical surgical debridement and antibiotic therapy were able to stop the infection. An abdominal flap and a thoracic flap were used to cover the soft tissue defect.
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Affiliation(s)
- S M Scheld
- Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Frankfurt am Main, Deutschland.
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Schmidt HGK, Tiemann AH, Braunschweig R, Diefenbeck M, Bühler M, Abitzsch D, Haustedt N, Walter G, Schoop R, Heppert V, Hofmann GO, Glombitza M, Grimme C, Gerlach UJ, Flesch I. [Definition of the Diagnosis Osteomyelitis-Osteomyelitis Diagnosis Score (ODS)]. Z Orthop Unfall 2011; 149:449-60. [PMID: 21544785 DOI: 10.1055/s-0030-1270970] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
AIM The disease "osteomyelitis" is characterised by different symptoms and parameters. Decisive roles in the development of the disease are played by the causative bacteria, the route of infection and the individual defense mechanisms of the host. The diagnosis is based on different symptoms and findings from the clinical history, clinical symptoms, laboratory results, diagnostic imaging, microbiological and histopathological analyses. While different osteomyelitis classifications have been published, there is to the best of our knowledge no score that gives information how sure the diagnosis "osteomyelitis" is in general. METHOD For any scientific study of a disease a valid definition is essential. We have developed a special osteomyelitis diagnosis score for the reliable classification of clinical, laboratory and technical findings. The score is based on five diagnostic procedures: 1) clinical history and risk factors, 2) clinical examination and laboratory results, 3) diagnostic imaging (ultrasound, radiology, CT, MRI, nuclear medicine and hybrid methods), 4) microbiology, and 5) histopathology. RESULTS Each diagnostic procedure is related to many individual findings, which are weighted by a score system, in order to achieve a relevant value for each assessment. If the sum of the five diagnostic criteria is 18 or more points, the diagnosis of osteomyelitis can be viewed as "safe" (diagnosis class A). Between 8-17 points the diagnosis is "probable" (diagnosis class B). Less than 8 points means that the diagnosis is "possible, but unlikely" (class C diagnosis). Since each parameter can score six points at a maximum, a reliable diagnosis can only be achieved if at least 3 parameters are scored with 6 points. CONCLUSION The osteomyelitis diagnosis score should help to avoid the false description of a clinical presentation as "osteomyelitis". A safe diagnosis is essential for the aetiology, treatment and outcome studies of osteomyelitis.
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Affiliation(s)
- H G K Schmidt
- Septische Knochen- und Weichteilchirurgie, Schön Klinik HH Eilbek, Dehnhaide 120, Hamburg.
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List J, Lesemann A, Wiener E, Walter G, Hopmann D, Schreiber S, Ruprecht K. A new case of chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids. Brain 2011; 134:e185; author reply e186. [DOI: 10.1093/brain/awr035] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Walter G, Stahl B, Nagel R, Gellert R, Rück DM, Müller M, Klingelhöfer G, Kankeleit E, Soltani-Farshi M, Baumann H. A Depth Selective Mössbauer Study of ion Implanted Stainless Steel. ACTA ACUST UNITED AC 2011. [DOI: 10.1557/proc-504-277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
ABSTRACTHigh austenitic stainless steel of composition Fe62Ni2OCrl8 was implanted with Eu ions and analyzed with Depth Selective Conversion Electron Mössbauer Spectroscopy (DCEMS). DCEMS gives information about the depth profile of phases, in this case about implantation induced changes in phase composition as function of depth. The samples were complementary analyzed with Rutherford Backscattering Spectrometry (RBS) to get the element profile of the implanted ions. The main experimental result is a martensitic transformed depth region that coincides with the Eu depth distribution. The potential of DCEMS for application in the field of materials modification by implantation techniques is demonstrated.
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Walter G, Welsch F, Hoffmann R. [Intercompartment soft tissue emphysema after arthroscopic meniscus resection. Case report and differential diagnosis]. Unfallchirurg 2010; 115:226-33. [PMID: 21076910 DOI: 10.1007/s00113-010-1870-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Soft-tissue emphysema following surgical procedures needs prompt and accurate diagnosis in order not to miss severe infections, such as clostridial myonecrosis and necrotizing fasciitis. We report the case of a 32-year-old patient who developed massive crepitation of the right leg and thoracic wall after knee arthroscopy had been performed a few days earlier. He was readmitted under suspicion of gas gangrene. This could not be ruled out by preoperative examinations as a subacute infection existed in the range of the infrapatellar incision. A mini-arthrotomy was carried out to exclude necrotizing soft tissue infection and to rinse the joint. An intercompartment emphysema could be confirmed intraoperatively. The postoperative course was uneventful. The main differential diagnoses of benign soft Tissue emphysema are summarized and treatment options are recommended.
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Affiliation(s)
- G Walter
- Abteilung für Septische Chirurgie, BG-Unfallklinik Frankfurt/Main, Friedberger Landstr. 430, 60389, Frankfurt/Main, Deutschland.
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Bierwagen U, Walter G, Hoffmann R. Kniegelenksarthrodese – Lebensqualität und Vergleich der Methoden. Z Orthop Unfall 2010; 148:566-72. [DOI: 10.1055/s-0030-1249852] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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