ABSTRACT
The authors report 3 cases of spinal cord compression by vertebral collapse related to osteonecrosis. Two patients needed surgical decompression permitting pathological diagnosis. In the third case, osteonecrosis was ascertained by radiological evidence of an intravertebral vacuum phenomenon. Three etiologic factors were noticed: osteoporosis, corticotherapy, and radiotherapy. The relative frequency of neurologic complications in vertebral collapse related to osteonecrosis compared to those observed in osteoporosis is discussed.
Subject(s)
Osteonecrosis/complications , Spinal Cord Compression/etiology , Spinal Diseases/complications , Aged , Female , Humans , Middle Aged , Osteonecrosis/pathology , Spinal Diseases/pathologyABSTRACT
If cutaneous panniculitis, made of dermo-hypodermic nodules, is the most constant manifestation of pancreatic cytosteatonecrosis, articular and bony localizations are quite frequent and sometimes the first manifestation of the disease. Articular lesions: monoarthritis, oligo-arthritis and mostly polyarthritis, often assume a very inflammatory picture; the synovial fluid is oily or puriform, and has a high content of polynuclear cells or macrophages with a foamy cytoplasm, lipid droplets, triglycerides, non-esterified fatty acids, and pancreatic enzymes; the most typical synovial lesion is a cytosteatonecrosis with adipocytes showing a huge lipidic vacuole. The bony lesions are mostly osteolytic, microgeodic lesions, or more extended ones, pseudo-tumoral without soft tissue invasion: more rarely, there is a periosteal thickening, bony infarctions, or epiphyseal osteonecrosis; these lesions do not always demonstrate a hyperfixation on scintigrams. The physiopathology of these various lesions is usually linked to a diffusion of pancreatic lipases, but other enzymes or enzymatic inhibitors also intervene, as well as a cytotoxic and local inflammatory activity of the fatty acids themselves. Surgical treatment of the pancreatic lesions, when possible, is the only treatment that is truly effective.
Subject(s)
Fat Necrosis/etiology , Necrosis/etiology , Pancreatic Diseases/diagnosis , Adult , Arthritis/etiology , Bone Diseases/etiology , Bone and Bones/diagnostic imaging , Fat Necrosis/diagnosis , Female , Humans , Lipase/blood , Male , Middle Aged , Pancreas/enzymology , Panniculitis, Nodular Nonsuppurative/etiology , Radiography , Skin Diseases/etiology , Synovial Membrane/pathologyABSTRACT
The authors report three cases of vertebral osteonecrosis which presented the phenomenon of intra-vertebral space. These patients had osteoporosis with vertebral compression. Two received steroid therapy. One case progressively developed spinal cord compression and the two other cases had an associated osteonecrosis (femoral head and talus). After reviewing the literature, the authors stress the relative frequency of neurological complications, in particular spinal cord compression (7 per cent).
Subject(s)
Cauda Equina/diagnostic imaging , Nerve Compression Syndromes/etiology , Osteonecrosis/complications , Spinal Cord Compression/etiology , Spinal Diseases/complications , Adrenal Cortex Hormones/adverse effects , Aged , Female , Femur Head Necrosis/complications , Humans , Lumbar Vertebrae/diagnostic imaging , Male , Osteonecrosis/chemically induced , Osteonecrosis/diagnostic imaging , Osteoporosis/diagnostic imaging , Radiography , Spinal Diseases/chemically induced , Spinal Diseases/diagnostic imaging , Talus/diagnostic imaging , Thoracic Vertebrae/diagnostic imagingABSTRACT
A case of osteomyelitis due to Salmonella Dublin is reported by the authors who underline the features which distinguish this affection from typhous osteomyelitis, which is completely different.
Subject(s)
Osteomyelitis/etiology , Salmonella Infections , Humans , Infant , Male , Osteomyelitis/diagnostic imaging , RadiographyABSTRACT
In South Vietnam, the first Salmonella typhi resistant to chloramphenicol were isolated at the end of 1971; this resistance spread rapidly to two-thirds of S. typhi isolated; it is due to resistance plasmids which parasite most strains of S. typhi identified in Vietnam. The typhoid endemy turned into an epidemic en 1972. The clinical symptoms of typhoid fever remained just as few as before: often only a high temperature; splenomegaly is rare, hepatomegaly more frequent. Complications, specially associated ones, have been more frequently observed since 1972; the evolution of the disease is slower. Although costly, a high dose of ampicillin often proves clinically active. For the moment, an association of trimethoprime and sulfamethoxazole remains the least expensive of efficient treatments.