In vitro action of combinations of selected antimicrobial agents and adult bovine articular cartilage (sesamoid bone)

Reimplantation of an extruded osteoarticular segment of the distal tibia in a 14-year-old girl. Case report and review of the literature

This case report describes the reimplantation of a 15-cm osteoarticular segment of the distal tibia in a 14-year-old girl who was hit by a truck. The bone fragment was debrided and reimplanted on the day of injury. A free flap was performed within 1 week. Bony union was achieved without complication. At 5-year follow-up, the patient is able to ambulate for several hours at a time without an assistive device, although arthritis of the ankle joint is present. She scores 43.8 on the physical component of the 36-Item Short Form Health Survey and 49.0 on the mental component. The patient states that she is very pleased with her outcome. This seems to be the first description of an osteoarticular segment reimplantation of a long bone in the orthopaedic literature.

Prospective study to determine the penetration of iodide into the anterior chamber following preoperative application of topical 1.25% povidone-iodine

BACKGROUND

Povidone-iodine is currently the agent of choice for pre-operative antisepsis in ophthalmology. Due to experimental and analytical constraints, iodine absorption into the anterior chamber (AC) has not yet been studied. However, knowledge of the details of iodine transfer into the aqueous humor (AH) is critical for risk assessment of local and/or systemic side effects

METHODS

Following a 2-min antisepsis with 1.25% povidone-iodine, the AC of eligible cataract patients was penetrated with a 26-gauge cannula prior to any other intraocular manipulation. To distinguish between the iodine absorbed into the AC and that remaining in the hypodermic delivery syringe, we studied three different groups of specimens: (i) AH from the AC (n=19); (ii) Ringer's solution aspirated through the cannula after penetration into and immediate withdrawal from the AC without subsequent decontamination (n=8); and (iii) Ringer's solution aspirated through the cannula after penetration into and immediate withdrawal from the AC, and subsequent decontamination of its outer surface (n=5). Patients with pre-operative epithelial defects were excluded from the study. To measure iodine absorption, iodide levels in samples were determined chromatographically (ion-pair chromatography) and electrochemically (gold electrode).

RESULTS

There was no difference (P=0.815) between detectable amounts of iodide in groups I and II (median: 24.0 microg/dl and 28.9 microg/dl, respectively). Only group III (median: 5.2 microg/dl) showed a statistically significant lower level of iodide than did groups I or II (P=0.019 and P=0.011, respectively).

CONCLUSIONS

A healthy ocular surface behaves as a barrier to the penetration of iodine into the AC. Any detectable iodide in the AH after antisepsis should therefore be considered harmless.

Systemic Iodine Absorption after Preoperative Antisepsis Using Povidone-Iodine in Cataract Surgery – An Open Controlled Study

After preoperative conjunctival and periorbital antisepsis with povidone-iodine (PVP-I), the systemic absorption of iodine after cataract surgery was measured to evaluate the risk of thyroid side effects. Five different combinations of PVP-I alone or in combination with PVP-I-free antiseptics were applied to the conjunctiva and periorbital skin. An iodine-free product served as control. Iodide and creatinine in urine were analyzed before intervention and 24 and 48 h postoperatively. Depending on the concentration and application site, 0.3-4.5% of the total applied iodine or 3.6-45.4% of the free iodine were absorbed. The range of urine iodine excretion was between 11.7 and 71.0 mug iodine/g creatinine, depending on the PVP-I concentration and the site of application. The increase in iodine excretion was significant at 24 h postoperatively in trials receiving PVP-I both periorbitally and conjunctivally, depending of the concentration used. Because the iodine absorption is only slight and of doubtful clinical relevance, presurgical conjunctival antisepsis can be achieved with 1.25% PVP-I; so far clinically manifest anamnestic thyroid disorders are excluded. Presently, periorbital skin antisepsis with PVP-I cannot be recommended until data on thyroid metabolism in the population have been collected and evaluated, especially in a region currently or previously deficient in iodine.

Effect of selected wound antiseptics on adult articular cartilage (bovine sesamoid bone) in the presence of Escherichia coli and Staphylococcus aureus

After removing an inoculum of 10(8)-10(9) cfu of Escherichia coli (E. coli) or Staphylococcus aureus (S. aureus) effectively within 2 h from bovine sesamoid bones (bsb) using the iodophore Betaisodona [0.5 and 1.0% (v/v) PVP-I], the biguanide polihexanide (PHMB) [0.005 and 0.01% (v/v)], and the bispyridinamine Octenidine (Oct) [0.005 and 0.01% (v/v)] the metabolic effect on proteoglycans (PG) in bsb was investigated by subsequent culture of bsb for 7 d and biosynthetically labeling with (35)S-sulfate for a period of 24 h. The treatment with the iodophore stimulates the incorporation of (35)S-sulfate into PG, whereas that of Oct was toxic. The PHMB treatment was both tolerated and effective only when it was used at low concentrations (0.005%). The antiseptic treatment did not result in an increase of catabolism of PG. This in vitro study clearly demonstrates that irrigation of cartilage with an antiseptic should be limited to an effective concentration and treatment time compatible with antiseptic function. Iodophores have no negative feedback on cartilage metabolism, moreover, they stimulate chondrocytes in vitro. Cationic antiseptics are not suited as irrigating solutions.