RESUMO
Fusobacterium spp. son bacterias anaerobias Gram negativas. La osteomielitis vertebral por dichas bacterias es muy rara, de hecho, sólo podemos encontrar 11 casos en la literatura. Se presenta un caso de un varón de 46 años con dolor lumbar irradiado a la pierna derecha, de varias semanas de evolución y que no respondió al tratamiento con AINEs. Para el diagnóstico se utiliza la RMN, una biopsia con drenaje de la colección y una PCR universal seguida de secuenciación de ADNr 16S, con la que se obtuvo el diagnóstico microbiológico del paciente, identificando un Fusobacterium nucleatum como responsable. Posteriormente se pautó clindamicina como tratamiento final. En conclusión, la espondilodiscitis por Fusobacterium spp. es una entidad rara y su diagnóstico es a menudo difícil, tanto por las características clínicas como por la dificultad de obtener el diagnóstico microbiológico apropiado. La biopsia vertebral y las técnicas moleculares microbiológicas como la PCR ADNr Universal, son esenciales para la identificación del organismo y permiten la determinación de un diagnóstico y un tratamiento antibiótico apropiados.
Fusobacterium spp. are Gram negative anaerobe bacteria. Vertebral osteomyelitis caused by these bacteria is very unusual; in fact, we could only find 11 cases in the literature. We report the case of a male, 46 year-old patient who had had lumbar pain for several weeks that irradiated to the right leg, and did not respond to NSAID treatment. The work-up included MRI, biopsy with draining of the collection and a universal PCR followed by 16S rDNA sequencing. The latter was used to make the microbiologic diagnosis, which identified Fusobacterium nucleatum as the causative agent. Final treatment consisted of clindamycin. In conclusion, spondylodiscitis due to Fusobacterium spp. is a rare and difficult to diagnose entity, due both to its clinical characteristics and to the difficulty in making the right microbiologic diagnosis. Vertebral biopsy and molecular microbiologic techniques such as Universal PCR rDNa, are essential to identifying the organism, making the diagnosis and prescribing appropriate antibiotic therapy.
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Discite/diagnóstico , Discite/microbiologia , Fusobacterium nucleatum , Infecções por Fusobacterium/diagnósticoRESUMO
Fusobacterium spp. are Gram negative anaerobe bacteria. Vertebral osteomyelitis caused by these bacteria is very unusual; in fact, we could only find 11 cases in the literature. We report the case of a male, 46 year-old patient who had had lumbar pain for several weeks that irradiated to the right leg, and did not respond to NSAID treatment. The work-up included MRI, biopsy with draining of the collection and a universal PCR followed by 16S rDNA sequencing. The latter was used to make the microbiologic diagnosis, which identified Fusobacterium nucleatum as the causative agent. Final treatment consisted of clindamycin. In conclusion, spondylodiscitis due to Fusobacterium spp. is a rare and difficult to diagnose entity, due both to its clinical characteristics and to the difficulty in making the right microbiologic diagnosis. Vertebral biopsy and molecular microbiologic techniques such as Universal PCR rDNa, are essential to identifying the organism, making the diagnosis and prescribing appropriate antibiotic therapy.
Assuntos
Discite/diagnóstico , Discite/microbiologia , Infecções por Fusobacterium/diagnóstico , Fusobacterium nucleatum , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
BACKGROUND: The natural history of a knee subjected to total meniscectomy leads to poor outcomes, so we should be careful with these lesions. Meniscal transplantation may be a proper treatment for these patients as it involves a good medium-term survival. MATERIAL AND METHOD: We report the case of a 52 year-old male who underwent meniscal transplantation and developed left gonarthrosis. The surgical approach consisted of medial longitudinal arthrotomy and implantation of a posterior stabilized prosthesis after releasing the soft tissues, which were very retracted. RESULTS: At the one year follow-up the operated knee had an articular range of 0-110 degrees, with no gap and no pain; no external support was required for walking. CONCLUSIONS: Despite the fact that most case series report good short- and medium-term results, some patients do not have good results and need a total knee prosthesis.
Assuntos
Artroplastia do Joelho , Meniscos Tibiais/transplante , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
INTRODUCTION: Treatment of grade III Rockwood acromioclavicular lesions continues to be controversial. A new surgical technique for reduction using minimally invasive surgery provides good results. The purpose of this paper is to present the short and medium-term results of a series of patients with grade III acromioclavicular dislocations who underwent surgery. METHODS: Prospective assessment of a series of 14 patients with acromioclavicular dislocation who underwent surgery from May 2009 to June 2010 consisting of open reduction and synthesis with coracoclavicular fixation with a double anchor. Radiologic, functional and personal satisfaction parameters were assessed. RESULTS: Statistically significant radiologic results were obtained, which reflect a correct reduction. An "excellent" mean score was obtained in the functional assessment using the Imatani test. Patients reported subjective satisfaction during the interviews at the outpatient visits. CONCLUSIONS: There are only a few papers reporting postoperative results with this surgical technique. Without a control group it is not possible to make a comparison with orthopedic treatment, so comparisons were made with published series using classical techniques. The surgical technique provides similar results; it is simple, inexpensive and has not shown to have any postoperative complications during a mean follow-up of 13.7 months. Surgical treatment of grade III acromioclavicular lesions using this surgical technique has provided appropriate results in this group of patients.