Relation between mouth and haematogenous infection in total joint replacements

OBJECTIVE

To investigate the source of infections associated with orthopaedic prostheses.

DESIGN

Analysis of four infections of prosthetic joints with case records; minimum inhibitory and minimum bactericidal concentrations and sodium dodecylsulphate polyacrylamide gel electrophoresis of the cell wall polypeptides of the Streptococcus sanguis isolates from the mouth and infected prostheses; examination of the patients' mouths for periodontal disease and caries.

SUBJECTS

Four adults (three men) aged 58-83.

RESULTS

For each patient the strain of S sanguis isolated from the mouth was indistinguishable from that isolated from the prosthesis. All patients had severe periodontal disease and caries.

CONCLUSIONS

The mouth was probably the source of bacterial infection in the prosthetic joints of these patients; the route of infection was possibly haematogenous. Incipient oral infection should be treated before joint replacement, and oral health should be maintained indefinitely.

Use of a eutectic mixture of local anaesthetics in the release of preputial adhesions: is it a worthwhile alternative?

OBJECTIVE

To see if a eutectic mixture of local anaesthetics (EMLA) could be used effectively for the release of preputial adhesions as a day case procedure.

PATIENTS AND METHODS

A total of 36 consecutive symptomatic children had their preputial adhesions separated under local anaesthetic with EMLA.

RESULTS

The procedure was successful in 27 children. Of these, 16 remained symptom free at 9 to 12 months follow up although five children had slight recurrence of adhesions. The other 11 children were listed for circumcision at 2 weeks following the procedure because of marked recurrence of adhesions.

CONCLUSION

EMLA cream is a good alternative to general anaesthetics in the separation of preputial adhesions. The technique is operator-dependent and better results were obtained when one person was using it regularly. Separation of adhesions is a worthwhile procedure in boys with symptomatic non-retractile foreskins.

Early mobilization after operative repair of ruptured Achilles tendon

The results of 19 patients in a pilot study in which early mobilization after operative repairs of ruptured Achilles tendons are presented. Serial ultrasound scanning of the repaired tendon showed satisfactory healing. Muscle function was analysed isokinetically and gait symmetry was examined using kinetic analysis. Normal strength of plantarflexion and dorsiflexion was achieved with almost normal range of ankle movement. All patients had normal gait kinetic parameters and symmetry. Normal activities were regained rapidly, and 15 out of 19 patients returned to their pre-injury status. There were no reruptures.