Assuntos
Colágeno Tipo I , Osteomielite , Peptídeos , Biomarcadores/urina , Doença Crônica , Colágeno Tipo I/urina , Difosfonatos , Humanos , Osteomielite/urina , Peptídeos/urinaRESUMO
OBJECTIVES: To determine long-term outcomes and costs of Ilizarov bone transport and flap coverage for lower limb salvage. DESIGN: Case series with retrospective review of outcomes with at least 6-year follow-up. SETTING: Academic tertiary care medical center. PATIENTS: Thirty-four consecutive patients with traumatic lower extremity wounds and tibial defects who were recommended amputation but instead underwent complex limb salvage from 1993 to 2005. INTERVENTION: Flap reconstruction and Ilizarov bone transport. MAIN OUTCOME MEASUREMENTS: Outcomes assessed were flap complications, infection, union, malunion, need for chronic narcotics, ambulation status, employment status, and need for reoperations. A cost analysis was performed comparing this treatment modality to amputation. RESULTS: Thirty-four patients (mean age: 40 years) were included with 14 acute Gustilo IIIB/C defects and 20 chronic tibial defects (nonunion with osteomyelitis). Thirty-five muscle flaps were performed with 1 flap loss (2.9%). The mean tibial bone defect was 8.7 cm, mean duration of bone transport was 10.8 months, and mean follow-up was 11 years. Primary nonunion rate at the docking site was 8.8% and malunion rate was 5.9%. All patients achieved final union with no cases of recurrent osteomyelitis. No patients underwent future amputations, 29% required reoperations, 97% were ambulating without assistance, 85% were working full time, and only 5.9% required chronic narcotics. Mean lifetime cost per patient per year after limb salvage was significantly less than the published cost for amputation. CONCLUSIONS: The long-term results and costs of bone transport and flap coverage strongly support complex limb salvage in this patient population.
Assuntos
Transplante Ósseo/economia , Técnica de Ilizarov/economia , Retalho Miocutâneo/economia , Osteomielite/economia , Osteomielite/urina , Fraturas da Tíbia/economia , Fraturas da Tíbia/cirurgia , Adolescente , Adulto , Idoso , Amputação Cirúrgica/economia , Amputação Cirúrgica/estatística & dados numéricos , Transplante Ósseo/estatística & dados numéricos , California/epidemiologia , Terapia Combinada/economia , Terapia Combinada/estatística & dados numéricos , Comorbidade , Feminino , Fraturas Mal-Unidas , Custos de Cuidados de Saúde/estatística & dados numéricos , Humanos , Técnica de Ilizarov/estatística & dados numéricos , Estudos Longitudinais , Extremidade Inferior/cirurgia , Masculino , Pessoa de Meia-Idade , Retalho Miocutâneo/estatística & dados numéricos , Osteomielite/epidemiologia , Prevalência , Estudos Retrospectivos , Terapia de Salvação/economia , Terapia de Salvação/estatística & dados numéricos , Fraturas da Tíbia/epidemiologia , Resultado do Tratamento , Adulto JovemRESUMO
A 53-year-old woman with systemic lupus erythematosus presented with a 3-day history of fever and coughing. Diagnosis of pneumococcal bronchitis was made based on symptoms and positivity of pneumococcal urinary antigen test. On day 3, severe low back pain acutely occurred. Pneumococcal vertebral osteomyelitis and psoas abscess was diagnosed 17 days later by yield of penicillin-susceptible S. pneumoniae strain in blood cultures and drainage fluid. Although pneumococcal urinary antigen test is a useful tool for the diagnosis of pneumococcal pneumonia, we should consider the possibility of pneumococcal infections other than pneumonia or overwhelming bacteremia in immunosuppressive patients when urinary antigen test is positive.
Assuntos
Vértebras Lombares , Osteomielite/diagnóstico , Osteomielite/microbiologia , Infecções Pneumocócicas/diagnóstico , Abscesso do Psoas/diagnóstico , Doenças da Coluna Vertebral/microbiologia , Antígenos de Bactérias/urina , Feminino , Humanos , Lúpus Eritematoso Sistêmico/complicações , Pessoa de Meia-Idade , Osteomielite/complicações , Osteomielite/urina , Infecções Pneumocócicas/complicações , Infecções Pneumocócicas/urina , Abscesso do Psoas/complicações , Abscesso do Psoas/urina , Doenças da Coluna Vertebral/urina , Streptococcus pneumoniae/imunologiaAssuntos
Bacteriemia/complicações , Infecções Estafilocócicas/complicações , Staphylococcus aureus/isolamento & purificação , Artrite Infecciosa/microbiologia , Artrite Infecciosa/urina , Bacteriemia/microbiologia , Embolia/microbiologia , Embolia/urina , Endocardite/microbiologia , Endocardite/urina , Humanos , Osteomielite/microbiologia , Osteomielite/urina , Estudos Prospectivos , Estudos Retrospectivos , Choque Séptico/microbiologia , Choque Séptico/urinaRESUMO
Chronic infections of bone such as osteomyelitis are frequent events, especially in immunocompromised or diabetic patients, and costly on a national level. Incorrect treatment or delayed diagnosis may lead to loss of the affected extremity or mandible. The aim of this study was to assess the possible value of urinary lysylpyridinoline (LP) and hydroxylysylpyridinoline (HP) concentrations in the monitoring of mandibular osteomyelitis. Patients were assigned to the following groups: group 1 (n=85), control; group 2a (n=38), patients with active disease; group 2b (n=25), patients of group 2a 6 months after successful treatment; group 2c (n=7), patients of group 2a with ongoing osteomyelitis 6 months after treatment. The range and upper limit of normal values (HP(max) and LP(max)) were determined in group 1. Levels of LP and HP were measured by high-performance liquid chromatography and fluorescence detection. There was a significant decrease (mean 45.43% for HP and 32.12% for LP) in samples of group 2b compared to 2a (P<0.001 for HP and LP). There was a significant increase in HP values in samples from group 2c compared to 2a (P=0.018). The urinary concentrations of HP and LP appear to act as a marker of disease activity, with a decrease reflecting treatment success and an increase or stable values indicating persistent disease. An inexpensive tool (US$5 per analysis) for the monitoring of osteomyelitis is described.
Assuntos
Aminoácidos/urina , Doenças Mandibulares/urina , Osteomielite/urina , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/urina , Cromatografia/métodos , Métodos Epidemiológicos , Feminino , Fluorescência , Humanos , Masculino , Doenças Mandibulares/diagnóstico , Doenças Mandibulares/cirurgia , Pessoa de Meia-Idade , Osteomielite/diagnóstico , Osteomielite/cirurgia , Recidiva , Fatores SexuaisRESUMO
Deep-seated Candida infections are challenging to diagnose by noninvasive means, and new modalities are needed to improve the yield of such investigations. Reported here is a case of Candida tropicalis vertebral osteomyelitis complicating epidural catheterisation in a diabetic patient with complicated abdominal sepsis. The diagnosis was supported by detection of increased D-arabinitol/L-arabinitol ratios in urine samples, and failure of medical management was indicated by elevated D-arabinitol/L-arabinitol ratios, which later decreased to baseline with successful surgical debridement and prolonged antifungal therapy.
Assuntos
Candidíase/diagnóstico , Cateterismo/efeitos adversos , Osteomielite/diagnóstico , Álcoois Açúcares/urina , Idoso , Analgesia Epidural , Candida/isolamento & purificação , Candidíase/microbiologia , Candidíase/urina , Humanos , Masculino , Osteomielite/microbiologia , Osteomielite/urina , Coluna Vertebral/patologiaRESUMO
Osteomyelitis was induced artificially by injecting Staphylococcus aureus culture in the tibiae of young rabbits. Weekly estimations of hydroxyproline in urine were done for six weeks. It was found that the osteomyelitic rabbits excreted more hydroxyproline (about 96%) two weeks after the infection in comparison to the control animals and it continued to be very high (about 138%) six weeks after the infection. The results indicate that urinary hydroxyproline reflects degradation of collagen fibers in the bone, and may be an indicator of the severity of the disease.
Assuntos
Hidroxiprolina/urina , Osteomielite/urina , Animais , Peso Corporal , Colágeno/metabolismo , Modelos Animais de Doenças , Hemodinâmica , Osteomielite/microbiologia , Coelhos , Infecções Estafilocócicas/urinaAssuntos
Osteíte/urina , Osteomielite/urina , Tuberculina/administração & dosagem , Tuberculose Osteoarticular/urina , 17-Hidroxicorticosteroides/urina , Adolescente , Adulto , Epinefrina/urina , Feminino , Humanos , Ácido Hidroxi-Indolacético/urina , Injeções Intradérmicas , Masculino , Norepinefrina/urinaRESUMO
The authors demonstrated in the urine of certain patients a peptide form of hydroxyproline and of glutamic acid. This peptide was found in patients with Paget's disease who presented clinical and laboratory signs of an evolutive episode and in other patients who presented restructuration of bone of a radiologicaly type. This peptide was one of the factors determining the increase in the total hydroxyprolinuria. The demonstration of the peptide provokes discussion as to its origin, and also of the possibility of using it as a biochemical parameter.