Chronic recurrent multifocal osteomyelitis: A multidisciplinary experience of 22 pediatric cases with a mean follow-up of 27 months.

BACKGROUND: Chronic recurrent multifocal osteomyelitis (CRMO) is not a well known disorder among nonpediatricians. The aim of this study is to retrospectively evaluate the clinical outcomes of twenty-two CRMO patients presenting to two referral centres. METHODS: This retrospective study included twenty-two children (12 males, 10 females; mean age 13 years; range 7-17 years). The diagnosis was based on clinical, radiological, and pathological findings. Data were retrieved from hospital charts. RESULTS: The mean delay in diagnosis was 26 months (range, 0-96 months). The mean follow-up after diagnosis was 27.4 months (range, 6-47 months). Symptoms included pain, limping, local swelling, morning stiffness, and fever. 18 patients had multifocal and 4 patients had unifocal disease. Bone lesions were detected with whole-body or local MRI (Magnetic Resonance Imaging). The mean number of bone lesions was 2.5 (range, 1-8). Ten cases underwent biopsy to exclude malignancy and infection. Prior to diagnosis, cast immobilization or curettage was erroneously performed in four patients. One patient suffered from vertebral compression fracture. There is no growth disturbance or deformity in any patient. CONCLUSION: This study demonstrated that early recognition of the disease can be improved by using Bristol criteria which should be evaluated by a multidisciplinary team rather than one single specialist. In this way, the reliability of these criteria is improved and the treatment could be given earlier with decreased delay in diagnosis. This multidisciplinary approach is also important for decision for biopsy, timely aggressive medical treatment, and follow-up of the disease to minimise possible complications.

[Comparison of non-invasive mechanical ventilation with helmet or face mask in patients with acute exacerbation of chronic obstructive pulmonary disease]. / Kronik obstrüktif akciger hastaliginin akut alevlenmesinde uygulanan noninvaziv mekanik ventilasyonda helmet ile yüz maskesinin karsilastirilmasi

Exacerbation of chronic obstructive pulmonary disease (COPD) is one of the frequent causes of acute respiratory failure. In our study, we aimed to compare helmet with face mask in noninvasive mechanical ventilation (NIMV) on patients who had acute respiratory failure because of exacerbation of COPD in intensive care unit (ICU). Thirty patients, taken into ICU for exacerbation of COPD, were included in the study. Patients were divided into two groups as face mask group (Group Y) and helmet group (Group H). Appropriate mechanical ventilation settings were recorded after the starting period and NIMV was applied to patients continuously for two hours with these settings. Respiratory frequency (f), blood gas (PaO(2), PaCO(2), PH) and PaO(2)/FiO(2) values and hemodynamic data of all patients were recorded periodically. Compliance of patients were evaluated with patient tolerance scale (PTS). Duration of stay of the patients in ICU and complications were also noted. Demographic characteristics of patients, mechanical ventilator settings and hemodynamic data of the patients in the two groups were found to be similar (p>0.05). Frequency values measured during NIMV are also similar at all measurement times (p>0.05). It was determined that there was a remarkable decrease in respiratory frequency, in both groups after the application of NIMV (p< 0.001). There was no difference with respect to PaO(2), PH and PaO(2)/FiO(2) values at all measurement times, between groups (p> 0.05). PaCO(2) values in the beginning were similar in both groups but PaCO(2) measured at other measurement times for group H were statistically higher compared to the other group (p< 0.05). PTC score measured at during NIMV in group H were remarkably higher (p< 0.05). Helmet developed as an alternative to face mask has a better patient tolerance and accordingly in increases success rate in NIMV. But it must be keeping mind that the decrease in PaCO(2) value is slow with helmet.

Rosai-Dorfman Disease of the Talus in a Child: A Case Report.

BACKGROUND: Primary Rosai-Dorfman disease of bone is a rare disorder. Radiologic and clinical evaluation is insufficient in differentiating malignancy from these lesions. METHODS: We present a talar lesion in a 17-month-old boy who presented with deterioration in gait pattern, limping, pain, and swelling of the left ankle of 4-months' duration. Curettage and demineralized bone matrix grafting were performed. RESULTS: At 1 year after surgery, complete clinical and radiological healing was obtained. CONCLUSIONS: Primary RDD of bone may present a diagnostic challenge. The condition must be included in the differential diagnosis of lytic or lucent lesions of the skeleton. Curettage and grafting provide satisfactory outcomes in talar RDD lesion in the pediatric age group.