Complications of shoulder arthroplasty: added value of SPECT/CT imaging. / Complicaciones de las prótesis de hombro: valor añadido de la imagen SPECT/TC.

The incidence of prosthetic shoulder replacements has increased considerably in recent years, as well as the complications derived from the procedure. The correct diagnosis of each type of complication is essential for therapeutic decision making, which is currently based on the information provided by radiological and nuclear medicine imaging. Nevertheless, both techniques have intrinsic limitations that could be mostly overcome with the advent of the hybrid SPECT/CT imaging, which is set to play a fundamental role in the evaluation of shoulder prostheses.

Postoperative deep wound dehiscence of thoracotomy with isolation of Corynebacterium tuberculostearicum: surgical site infection or colonization?

OBJECTIVE: Infections with Corynebacterium tuberculostearicum are very rare as in most of the cases its isolation is associated with tissue colonization rather than infection. CASE REPORT: An 80-year old female patient was sent to the consultation hour of thoracic surgery for evaluation of a symptomatic persistent unilateral pleural effusion of her right lung. The differential diagnosis included either the presence of a chronic pleural empyema or the presence of malignancy. After excluding a malignancy, a decortication of the middle and lower lobe was performed, as the two lobes could not significantly re-expand. The course was further complicated by the presence of two-times deep wound dehiscence, which made necessary a rethoracotomy. The microbiologic results of the biopsies revealed the presence of only Corynebacterium tuberculostearicum with an initially questionable clinical relevance. As soon as the antibiotic treatment for Corynebacterium tuberculostearicum began, together with the use of vacuum-assisted therapy (VAC), the closure of the thoracotomy was accelerated. CONCLUSIONS: Clinically relevant surgical site infections with Corynebacterium species in thoracic surgery are difficult to distinguish. Nevertheless, its combined surgical and antibiotic treatment is warranted when its relevance is questionable due to its resistance to broad-spectrum antibiotics as well as to its potential for the complicated clinical course.

Osteomielitis crónica por Corynebacterium striatum en una adolescente / Chronic osteomyelitis due to Corynebacterium striatum in a female adolescent

A case of a girl with chronic posttraumatic osteomyelitis of the right tibia with microbiological isolation of Bacillus spp. by conventional methods and confirmation by mass spectrometry MALDI-TOF (matrix-assisted laser desorption/ionization time-of-flight mass) of Corynebacterium striatum is presented. Diagnostic methods, clinical manifestations, and resistance pattern of these infections are described.

Se presenta el caso de una adolescente con osteomielitis crónica postraumática de la tibia derecha con aislamiento microbiológico por métodos convencionales de Bacillus spp. y confirmación por espectrometría de masas MALDI-TOF de Corynebacterium striatum, microorganismo considerado generalmente saprófito. Se describen las presentaciones clínicas de estas infecciones descritas en la literatura científica, la necesidad del diagnóstico etiológico por técnicas no convencionales y el patrón de resistencia comúnmente expresado.

[Letal endocarditis due to Corynebacterium pseudodiphtheriticum]. / Endocarditis infecciosa fatal por Corynebacterium pseudodiphtheriticum.

We present a case report of a infective endocarditis by Corynebacterium pseudodiphtheriticum in a young patient eight years old with bicuspid aortic valve that led to a severe neurological embolism and death. Corynebacterium pseudodiphtheriticum is part of the nasopharyngeal and skin flora. However, there are cases reported of endocarditis usually associated with immunocompromised patients that mostly presented a poor clinical outcome.

Endocarditis infecciosa fatal por Corynebacterium pseudodiphtheriticum / Letal endocarditis due to Corynebacterium pseudodiphtheriticum

We present a case report of a infective endocarditis by Corynebacterium pseudodiphtheriticum in a young patient eight years old with bicuspid aortic valve that led to a severe neurological embolism and death. Corynebacterium pseudodiphtheriticum is part of the nasopharyngeal and skin flora. However, there are cases reported of endocarditis usually associated with immunocompromised patients that mostly presented a poor clinical outcome.

Se presenta el caso clínico de una endocarditis infecciosa por Corynebacterium pseudodiphtheriticum en un niño de 8 años, portador de una valvulopatía aórtica bicúspide, que falleció por una embolia cerebral grave. Corynebacterium pseudodiphtheriticum forma parte de la microbiota de la piel y nasofaringe. Sin embargo, se han descrito casos de endocarditis en pacientes inmunocomprometidos, asociados, en su mayoría, a una mala evolución clínica.

[Chronic osteomyelitis due to Corynebacterium striatum in a female adolescent]. / Osteomielitis crónica por Corynebacterium striatum en una adolescente.

A case of a girl with chronic posttraumatic osteomyelitis of the right tibia with microbiological isolation of Bacillus spp. by conventional methods and confirmation by mass spectrometry MALDI-TOF (matrix-assisted laser desorption/ionization time-of-flight mass) of Corynebacterium striatum is presented. Diagnostic methods, clinical manifestations, and resistance pattern of these infections are described.

[Pseudarthrosis after fracture of the distal radius: a case report]. / Pseudarthrose nach distaler Radiusfraktur: Eine Fallbeschreibung.

We report on a seventy-year-old woman who developed a non-union of the distal radius with infection of the ulnocarpal joint after having sustained a fracture. The fistula, the distal ulna and the ulnocarpal joint were resected. Two months later we removed the non-union and carried out open reduction and internal fixation of the radius with a palmar plate. Good functional and cosmetic results were achieved.

Corynebacterium minutissimum endocarditis: a case report and review.

We present a rare case of infectious endocarditis in a 40-year old male with native valve, caused by Corynebacterium minutissimum. The diagnosis was established with transesophageal echocardiogram. The patient was managed successfully with antibiotic therapy.

Encrusted cystitis and pyelitis in children: an unusual condition with potentially severe consequences.

OBJECTIVES: To report our experience with the management of encrusted cystitis and pyelitis (EC and EP) in the pediatric population. EC and EP are well-known entities in adults but are rarely identified in children. They consist of mucosal encrustations and are due to specific microorganisms. METHODS: Between 1996 and 2001, 4 children with a mean age of 9 years (range 4 to 13) were treated for EC (n = 2), EP (n = 1), and EC and EP (n = 1). The latter was a kidney transplant recipient. We retrospectively evaluated the clinical characteristics of the patients and the results of conservative management. RESULTS: The delay between the beginning of the symptoms and the diagnosis was longer than 1 month in all cases. The diagnosis of EC was not evoked and was made during cystoscopy in all cases. EP was diagnosed during pyelotomy in 1 patient because it was evoked and confirmed by computed tomography scan in the kidney transplant recipient. Corynebacterium urealyticum was identified in the urine of all patients. EC was treated by antibiotics and endoscopic debulking, and EP was treated by antibiotics and local acidification. The duration of antibiotic therapy was between 1 and 6 months. The tolerance to local acidification of the kidneys was poor. Cure was achieved in 3 cases, but the treatment of EP failed in the kidney transplant recipient and graft removal was decided after 6 months of failed management because intractable febrile urinary tract infections became life threatening for the patient. CONCLUSIONS: EC and EP are uncommon in children; however, these diseases must be considered. They must be diagnosed rapidly and require, if possible, conservative management. Nevertheless, kidney loss can occur in transplant recipients with EP.

Experimentally induced orchitis associated with Arcanobacterium pyogenes: clinical, ultrasonographic, seminological and pathological features.

The objectives of this study were to describe the features of experimentally induced orchitis associated with Arcanobacterium pyogenes and confirm the pathogenicity of the organism for the ovine testicle. One testicle of each of nine rams was inoculated with 1.3 +/- 10(4) colony-forming-units of an A. pyogenes isolate and regular clinical, ultrasonographic, bacteriological and seminological examinations were carried out up to 204 days after challenge. The rams were sequentially euthanatized 3, 6, 9, 18, 30, 50, 71, 113 and 204 days after challenge and a gross- and histopathological examination of their testicles was performed. All rams developed clinical orchitis and general signs. The initial ultrasonographic findings were changes of size and echogenicity of the genitalia, whilst in the long-standing phase they were wider appearance of the mediastinum testis, presence of hyperechogenic foci, changes of echogenicity of the genitalia and increased echogenicity of the scrotum and tunics. The following changes in semen evaluation parametres were recorded: the pH, the percentage of dead sperms, the percentage of abnormal sperms and the number of nonsperm round cells increased, whilst the mass motility, the individual motility and the sperm concentration decreased; the following sperm defects were observed: misshapen or piriform heads, sperms with coiled tails, sperms without tail and sperms with proximal cytoplasmic droplet; at the early stages neutrophils were the prevailing nonsperm round cell type, later the proportion of immature germ cells increased and in the long-standing phase there were enlogated spermatids and leucocytes; it is noteworthy that semen evaluation parametres were restored to normal at the late stages of the disease. A. pyogenes was consistently isolated from the semen samples after challenge, as well as from the dissected genitalia. The salient post-mortem findings were: initially, subcutaneous oedema, fluid into the vaginal cavity, congested and distended vessels, increased size of the genitalia and a hard dark area inside the testicles; subsequently, there were changes of size of the genitalia, thickening of scrotum and tunics and presence of fibrin on the testicular surface; in the long-standing phase of the disorder, there were induration of scrotum and tunics with adhesion between the tunics and discolouration of the surface of the genitalia. The prominent histopathological changes were observed in the inoculated testicles; milder changes were seen in the respective epididymides; interstitial oedema, diffuse neutrophilic infiltration and extravasation were observed in the early stages after challenge; lymphocytic infiltration with concurrent fibrosis, mineralization and inspissation of the tubular elements of the seminiferous tubules and presence of vacuolated Sertoli cells were seen later; finally, regeneration of the epithelium and presence of Sertoli cells and spermatogonia with various degrees of spermatogenic activity were evident. These findings, allied to the isolation of A. pyogenes from field cases of ovine orchitis, provide clear evidence that A. pyogenes is pathogenic for the ovine genitalia; however, the mechanisms of transition of the organism from commensal to pathogenic state are not clear. It is also noteworthy that some degree of fertility was restored in the late stages of the disorder. Ultrasonography appeared to be useful for the diagnosis of intra-scrotal abnormalities, especially during investigation of the long-standing stage of the disease, after clinical findings have subsided.

[Corynebacterium urealyticum in renal trasplantation. CT and sonography imaging characteristics of encrusted cistitis and pielitis]. / Corynebacterium urealyticum en pacientes con trasplante renal. Imágenes características de la TC y ultrasonografía de la cistitis y pielitis incrustante.

PURPOSE: Its described three cases of Corynebacterium urealyticum (CU) infection in patients with renal transplantation and one of its most serious consequences: encrusted pyelitis and cystitis. It is explained the principal keys for its diagnosis, based in the appearance of alkaline pH in in urine analysis (alkaline urine), positives urinary cultures for CU, and the CT and US studies revealed the characteristic images of calcifications in the wall of renal pelvis and bladder. PATIENTS: Three male patients with renal transplantation and CU infection that caused encrusted pyelitis in two of the cases and encrusted cystitis in one case. RESULTS: Calcifications of the urinary tract were noticed in CT in all the patients. In two cases bladder stones were linear, and in the third case they were fundamentally coarse and placed in pelvis. The diagnosis suspicion showed by the images was confirmed by the use of prolonged urine cultures, necessary for detecting CU. All the patients were treated with vancomycin, with success in two of the cases and, finally needing surgery, and after loss of the graft, in the other case. CONCLUSION: Encrusted pyelitis and cystitis are cronic and severe infections of the urinary tract. Calcic struvite incrustations in the urothelium are characteristics of this infection. CT is a choice technique for the diagnosis and followup of the calcifications after treatment.

[Bladder rupture caused by spontaneous perforation of an infected urachal cyst]. / Blasenruptur durch spontane Perforation einer infizierten Urachuszyste.

Anomalies of the fetal urachus are rare. Normally, the postnatal urachus presents as a fibrous band extending from the bladder to the umbilicus. Urachal cysts may occur in postnatal life. Spontaneous perforation of urachal cysts is a very rare condition, which clinically may not be distinguishable from other acute abdominal conditions. We report a case of a 63-year-old male with a history of recurrent urinary tract infections and a bladder rupture caused by a spontaneous perforation of an infected urachal cyst. The symptomatology showed abdominal rigidity and pain, a palpable mass in the lower abdomen, and hematuria. Laboratory findings showed leukocytosis and an increased CRP level. The bladder rupture was confirmed by cystography. Bacteriologic examination identified Proteus vulgaris, Corynebacterium species, and Klebsiella pneumoniae. Most of the published cases in the literature report about intraperitoneal perforation of infected urachal cysts. In the present case, we found a spontaneous perforation of an infected urachal cyst leading to an extraperitoneal bladder rupture with an extraperitoneal limitation of the infection. The definitive therapy was complete surgical excision including a cuff of the bladder, drainage, and systemic broad-spectrum and local application of antibiotics. The further course was uneventful.