Aspergillosis with Aspergillus osteomyelitis and diskitis after heart transplantation: surgical and medical management.

This is the report of a 49-year-old man, who could be cured of aspergillosis with Aspergillus osteomyelitis and diskitis of the lumbar spine by medical and surgical therapy after heart retransplantation. Aspergillus osteomyelitis and diskitis is a rare complication of invasive aspergillosis. Lumbar involvement is the main manifestation, followed by rare locations in the tibia, ribs, wrist, sternum, pelvis, and knee. It is nearly always secondary to pulmonary aspergillosis, which occurs in about 6% to 14% of patients after heart transplantation. For treatment, a combined surgical and medical approach is recommended, which enables quick pain relief for the patient and histologic and microbiologic diagnosis and stabilization of the spine. Because of definitive cure of osteomyelitis cannot be guaranteed by removal of the abscess, medical therapy after surgery is necessary for years.

[Functional pictures in superselective angiography of the femur head vessels]. / Funktionsaufnahmen bei der superselektiven Angiographie der Hüftkopfgefässe.

The arterial supply of the femoral head was studied by Hipp. Superselective angiographies in different positions of the hip joint contribute informations especially about the smaller vessels e.g. rami nutritii capitis. Angiographies in different positions of the hip joint were performed in twenty cases. Furthermore the results of functional stress angiographies of five patients, who underwent the transplantation of pedicle bone graft, are reported. These patients had femoral head necrosis. Especially these postoperative examination demonstrates in one case impressive deterioration of the perfusion of the pedicle bone graft in some positions of the joint.