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1.
BMJ Case Rep ; 14(2)2021 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-33526521

RESUMO

Vertebral osteomyelitis is an infection of the vertebrae that can lead to spinal degeneration, most commonly caused by Staphylococcus aureus Here, we report an unusual case of pyogenic osteomyelitis caused by Gardnerella vaginalis and Streptococcus parasanguinis in a 61-year-old postmenopausal woman. The patient presented with a 2-week history of worsening lower back pain and fever and a recent episode of cystitis following re-engagement of sexual activity. Imaging revealed a deterioration of vertebrae discs and spinal canal stenosis at the L3-L4 levels with a formation of abscess in the right psoas muscle. Needle aspiration of the abscess identified G. vaginalis and S. parasanguinis and the patient was successfully treated with a 6-week course of ceftriaxone and metronidazole. This case describes an unusual coinfection of two pathogens that normally reside in the urogenital tract and oral cavity, respectively, and highlights the risk posed when these organisms breach the body's normal barriers.


Assuntos
Discite/microbiologia , Gardnerella vaginalis/isolamento & purificação , Vértebras Lombares , Osteomielite/microbiologia , Abscesso do Psoas/microbiologia , Infecções Estreptocócicas/microbiologia , Streptococcus/isolamento & purificação , Antibacterianos/uso terapêutico , Técnicas de Cultura , Discite/diagnóstico por imagem , Discite/tratamento farmacológico , Discite/fisiopatologia , Feminino , Infecções por Bactérias Gram-Positivas/diagnóstico , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Infecções por Bactérias Gram-Positivas/microbiologia , Humanos , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Osteomielite/diagnóstico por imagem , Osteomielite/tratamento farmacológico , Osteomielite/fisiopatologia , Pós-Menopausa , Abscesso do Psoas/diagnóstico por imagem , Abscesso do Psoas/tratamento farmacológico , Estenose Espinal/fisiopatologia , Infecções Estreptocócicas/diagnóstico , Infecções Estreptocócicas/tratamento farmacológico
2.
Surg Clin North Am ; 100(4): 707-725, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32681871

RESUMO

Chronic wounds often are the result of bone deformities, compounded by musculotendinous and ligamentous imbalance. Sensory neuropathy places patients at greater risk for acute wounds to develop into chronic wounds. Etiologies of these deforming forces include Charcot neuroarthropathy, trauma, and congenital and acquired neuromuscular disorders. Management of these deformities ranges from simple relief of pressure with soft inserts to bracing for mechanical instability. Correction of more complex deformities requires resection of bone, osteotomies, fusions, and external fixation. Tendon and ligament imbalance must be addressed at all levels of deformity. Postoperatively, patients must be re-evaluated for continuation of orthoses and bracing.


Assuntos
Articulação do Tornozelo/cirurgia , Pé/cirurgia , Cicatrização/fisiologia , Ferimentos e Lesões/cirurgia , Traumatismos do Tornozelo/fisiopatologia , Traumatismos do Tornozelo/cirurgia , Braquetes , Doença Crônica , Desbridamento , Desenho de Equipamento , Traumatismos do Pé/fisiopatologia , Traumatismos do Pé/cirurgia , Humanos , Aparelhos Ortopédicos , Osteomielite/fisiopatologia , Osteomielite/cirurgia , Lesões dos Tecidos Moles/cirurgia , Retalhos Cirúrgicos , Tendinopatia/fisiopatologia , Tendinopatia/cirurgia , Ferimentos e Lesões/fisiopatologia
3.
BMC Med Genet ; 21(1): 102, 2020 05 12.
Artigo em Inglês | MEDLINE | ID: mdl-32397996

RESUMO

BACKGROUND: Syndrome of synovitis acne pustulosis hyperostosis osteitis (SAPHO) and chronic recurrent multifocal osteomyelitis (CRMO) present two diseases of a dermatologic and rheumatologic spectrum that are variable in manifestation und therapeutic response. Genetic risk factors have long been assumed in both diseases, but no single reliable factor has been identified yet. Therefore, we aimed to clinically characterize a patient group with syndrome of synovitis acne pustulosis hyperostosis osteitis (SAPHO) (n = 47) and chronic recurrent multifocal osteomyelitis (CRMO)/ chronic non-bacterial osteomyelitis (CNO) (n = 9) and analyze a CRMO candidate gene. METHODS: Clinical data of all patients were collected and assessed for different combinations of clinical symptoms. SAPHO patients were grouped into categories according to the acronym; disease-contribution by pathogens was evaluated. We sequenced coding exons of FBLIM1. RESULTS: Palmoplantar pustular psoriasis (PPP) was the most common skin manifestation in CRMO/CNO and SAPHO patients; most SAPHO patients had sterno-costo-clavicular hyperostosis. The most common clinical category of the acronym was S_PHO (n = 26). Lack of pathogen detection from bone biopsies was more common than microbial isolation. We did not identify autosomal-recessive FBLIM1 variants. CONCLUSIONS: S_PHO is the most common combination of symptoms of its acronym. Genetic analyses of FBLIM1 did not provide evidence that this gene is relevant in our patient group. Our study indicates the need to elucidate SAPHO's and CRMO/CNO's pathogenesis.


Assuntos
Síndrome de Hiperostose Adquirida/genética , Moléculas de Adesão Celular/genética , Proteínas do Citoesqueleto/genética , Predisposição Genética para Doença , Osteomielite/genética , Síndrome de Hiperostose Adquirida/fisiopatologia , Adolescente , Adulto , Criança , Feminino , Humanos , Hiperostose/genética , Hiperostose/fisiopatologia , Masculino , Osteomielite/fisiopatologia , Psoríase/genética , Psoríase/fisiopatologia , Fatores de Risco
4.
J Wound Care ; 29(1): 5-10, 2020 Jan 02.
Artigo em Inglês | MEDLINE | ID: mdl-31930948

RESUMO

OBJECTIVE: To analyse the predictive role of inflammatory markers in the healing time of diabetic foot osteomyelitis treated by surgery or antibiotics. METHODS: An observational study of patients with diabetic foot ulcers (DFU) and clinically suspected osteomyelitis. The patients underwent surgical or antibiotic treatment for bone infection in a specialised diabetic foot unit. Blood samples were taken from each patient to analyse biomarkers. The main outcome was the number of weeks until healing occurred. RESULTS: A total of 116 patients took part in the study. The number of weeks until healing was similar for both groups (surgical n=96 and antiobiotic n=20, treatments). No association was observed among biomarkers as predictors of time-to-healing. CONCLUSION: There is not enough evidence to define the prognostic role of inflammatory markers in the healing time of DFUs complicated with diabetic foot osteomyelitis, regardless of the treatment administered.


Assuntos
Biomarcadores/sangue , Pé Diabético/tratamento farmacológico , Pé Diabético/cirurgia , Osteomielite/tratamento farmacológico , Osteomielite/cirurgia , Idoso , Antibacterianos/uso terapêutico , Pé Diabético/sangue , Pé Diabético/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Ortopédicos , Osteomielite/sangue , Osteomielite/fisiopatologia , Valor Preditivo dos Testes , Prognóstico , Fatores de Tempo , Resultado do Tratamento , Cicatrização/fisiologia
5.
Eur J Orthop Surg Traumatol ; 30(1): 153-156, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31471738

RESUMO

INTRODUCTION: The treatment of long-bone osteomyelitis has long been a difficult problem. Recently, antibiotic-impregnated intramedullary rods for the treatment of infected long-bone fractures have been gaining popularity but they are quite difficult to fabricate. Recently, a new technique that utilizes mineral oil to coat the inside of a chest tube mold prior to introduction of cement has been proven to ease fabrication. We hypothesized that the use of mineral oil would alter the elution characteristics of tobramycin from the intramedullary device. METHODS: Two groups of antibiotic nails were fabricated under sterile conditions. The control group utilized a chest tube mold. The study group utilized a chest tube that was coated with mineral oil prior to cement injection. Each intramedullary nail was placed in pooled human serum and incubated under physiologic conditions. The level of tobramycin in each sample was measured at timepoints 0, 1, 6, and 24 h. RESULTS: There was no significant difference when comparing control with the experimental group at any timepoint. Antibiotic nails eluted tobramycin at a rapid rate in the first 6 h of exposure to serum, regardless of their preparation with oil or without oil. The rate of elution fell precipitously between 6 and 24 h. CONCLUSION: We believe that although this study, as with any study, cannot perfectly recreate in vivo conditions, we have clearly shown that mineral oil has no significant effect on elution of tobramycin from antibiotic nails.


Assuntos
Fixação Intramedular de Fraturas/efeitos adversos , Óleo Mineral/farmacologia , Osteomielite/cirurgia , Infecção da Ferida Cirúrgica/tratamento farmacológico , Tobramicina/farmacocinética , Pinos Ortopédicos , Estudos de Casos e Controles , Materiais Revestidos Biocompatíveis , Sistemas de Liberação de Medicamentos , Fraturas do Fêmur/cirurgia , Fixação Intramedular de Fraturas/métodos , Fraturas Expostas/diagnóstico , Fraturas Expostas/cirurgia , Humanos , Kentucky , Osteomielite/etiologia , Osteomielite/fisiopatologia , Valores de Referência , Amostragem , Sensibilidade e Especificidade , Infecção da Ferida Cirúrgica/cirurgia , Fraturas da Tíbia/cirurgia , Tobramicina/farmacologia
7.
Injury ; 50(11): 2075-2083, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31447211

RESUMO

BACKGROUND: The bone transport technique has been a well-known method in the treatment of osteomyelitis of the long bones with large segmental bone defects. However, one of the major drawbacks with this traditional technique is the long-lasting consolidation period, which may entail infectious and non-infectious complications. To overcome this drawback, several techniques were developed, one of which is acute shortening and re-lengthening. The aims of this study were: 1) to present our experience with a new modified technique of acute shortening and re-lengthening using a monolateral external fixator combined with a retrograde intramedullary nail, and 2) to compare its results with the classic Ilizarov bone transport method in the management of infected non-unions of the distal femur with bone loss. METHODS: This retrospective study compared these two techniques. 17 patients were treated using our modified technique of acute shortening and re-lengthening (Group A); 15 patients were treated using segmental bone transport (Group B). The average follow-up was 66 months (range: 24-180) in Group A and 70 months (range: 24-240) in Group B. The mean bone loss was 5.5 cm (range: 3-10) in Group A and 5.9 cm (range: 3-10) in Group B. The primary outcome of the present study was to compare the external fixator time (EFT) and external fixation index (EFI) between the two groups. The bone and functional status were also assessed. RESULTS: The mean EFI was lower in Group A (mean: 31.8 days/cm; range: 24-50) than in Group B (mean 48.7 days/cm; range: 40-100) (p = 0.02). The mean EFT was shorter in Group A (mean: 120 days; range: 100-150) than in Group B (mean: 290 days; range: 100-400) (p = 0.0003). With respect to the bone and functional results, no difference was observed. CONCLUSIONS: Although both techniques could be employed safely in the treatment of infected non-union of the distal femur with size defects ranging between 3 cm and 10 cm, our modified technique of acute shortening and re-lengthening may confer greater patient satisfaction because of shorter EFI.


Assuntos
Alongamento Ósseo/métodos , Fraturas do Fêmur/cirurgia , Fixação de Fratura/métodos , Fraturas não Consolidadas/cirurgia , Desigualdade de Membros Inferiores/cirurgia , Adulto , Alongamento Ósseo/instrumentação , Pinos Ortopédicos , Fixadores Externos , Feminino , Fraturas do Fêmur/diagnóstico por imagem , Fraturas do Fêmur/microbiologia , Fraturas do Fêmur/fisiopatologia , Fraturas não Consolidadas/diagnóstico por imagem , Fraturas não Consolidadas/microbiologia , Fraturas não Consolidadas/fisiopatologia , Humanos , Desigualdade de Membros Inferiores/diagnóstico por imagem , Desigualdade de Membros Inferiores/fisiopatologia , Masculino , Pessoa de Meia-Idade , Osteomielite/complicações , Osteomielite/diagnóstico por imagem , Osteomielite/fisiopatologia , Estudos Retrospectivos , Resultado do Tratamento
8.
Pediatr Rheumatol Online J ; 17(1): 45, 2019 Jul 18.
Artigo em Inglês | MEDLINE | ID: mdl-31319856

RESUMO

BACKGROUND: Chronic non-bacterial osteomyelitis (CNO) is an autoinflammatory disorder of the skeletal system of yet unknown etiology. Patients present with local bone pain and inflammation and - to our experience - often suffer from functional impairment with significant disabilities of daily life. The objective of this study was to assess physical activity, fitness and health-related quality of life (HRQOL) in adolescents with established diagnosis of CNO versus healthy controls (HC). METHODS: 15 patients with CNO and 15 age and gender matched HC aged 13-18 years, completed questionnaires, performed an incremental exercise test with gas exchange measures up to voluntary fatigue and wore an accelerometer over 7 days at home to assess physical activity behavior. RESULTS: At the time of assessment, 5 CNO patients were in clinical, one in radiological and 5 in clinical and radiological remission. 7 did not receive any therapy at the time of assessment. The results of the exercise test and of the accelerometry did not show any significant difference between CNO and HC. However, reported sports participation was lower in patients with CNO and PedsQL3.0 and 4.0 showed significant lower values in most of the scores indicating reduced HRQOL. CONCLUSION: Although most CNO patients showed a favorable course of disease without any relevant differences in objective measurements of physical activity and fitness versus HC at the time of assessment, questionnaires revealed perceived limitations. Further studies are needed to measure HRQOL and to validate questionnaires in patients with CNO against objective measures including more participants with a higher level of disease activity.


Assuntos
Exercício Físico , Osteomielite/fisiopatologia , Aptidão Física , Qualidade de Vida , Acelerometria , Adolescente , Estudos de Casos e Controles , Criança , Doença Crônica , Teste de Esforço , Feminino , Humanos , Masculino , Osteomielite/psicologia , Esportes
9.
J Orthop Res ; 37(10): 2067-2076, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31329305

RESUMO

The clinical impact of bacterial infections on bone regeneration has been incompletely quantified and documented. As a result, controversy exists about the optimal treatment strategy to maximize healing of a contaminated defect. Animal models are extremely useful in this respect, as they can elucidate how a bacterial burden influences quantitative healing of various types of defects relative to non-infected controls. Moreover, they may demonstrate how antibacterial treatment and/or bone grafting techniques facilitate the osteogenic response in the harsh environment of a bacterial infection. Finally, it a well-known contradiction that osteomyelitis is characterized by uncontrolled bone remodeling and bone loss, but at the same time, it can be associated with excessive new bone apposition. Animal studies can provide a better understanding of how osteolytic and osteogenic responses are related to each other during infection. This review discusses the in vivo impact of bacterial infection on osteogenesis by addressing the following questions (i) How does osteomyelitis affect the radiographic bone appearance? (ii) What is the influence of bacterial infection on histological bone healing? (iii) How do bacterial infections affect quantitative bone healing? (iv) What is the effect of antibacterial treatment on the healing outcome during infection? (v) What is the efficacy of osteoinductive proteins in infected bones? (vi) What is the balance between the osteoclastic and osteoblastic response during bacterial infections? (vii) What is the mechanism of the observed pro-osteogenic response as observed in osteomyelitis? © 2019 The Authors. Journal of Orthopaedic Research© published by Wiley Periodicals, Inc. on behalf of Orthopaedic Research Society. J Orthop Res 37:2067-2076, 2019.


Assuntos
Infecções Bacterianas/fisiopatologia , Regeneração Óssea , Osteomielite/fisiopatologia , Animais , Antibacterianos/uso terapêutico , Infecções Bacterianas/tratamento farmacológico , Proteínas Morfogenéticas Ósseas/uso terapêutico , Humanos , Osteoblastos/fisiologia , Osteoclastos/fisiologia , Osteogênese , Osteomielite/diagnóstico por imagem , Osteomielite/tratamento farmacológico
10.
Injury ; 50(11): 1790-1794, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31324342

RESUMO

INTRODUCTION: This study aims to identify patient and intra-operative factors that contribute to non-union in locked lateral plating for distal femoral fractures. METHODS: Systematic searches of English-language articles in Ovid Medline, PubMed, Embase, Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews were undertaken in February 2018 according to the PRISMA guidelines. The search terms were (fracture or fracture*) AND (distal femur or distal femoral) AND (malunion or non-union). Eligible studies published at any time reported non-union rates and compared patient and intraoperative factors in patients who underwent locked lateral plating for traumatic distal femoral fractures. The quality of included papers was assessed using The Journal of Bone and Joint Surgery levels of evidence (Wright et al., 2003), and further appraised using the Downs and Black score (Downs and Black, 1998). RESULTS: Eight studies investigating 1380 distal femoral fractures were found to satisfy the inclusion and exclusion criteria. These studies analysed a variety of patient and intra-operative factors that may contribute to non-union. These include high BMI, open fracture, comminution, fracture infection, stainless steel plate material, shorter working length, open reduction and internal fixation when compared with minimally invasive plate osteosynthesis, high construct rigidity scores and purely locking screw constructs. CONCLUSION: This review has identified multiple factors which potentially contribute to non-union including stainless steel plate material, high construct rigidity scores and purely locking screw constructs. These findings may reflect that overly rigid plating constructs can contribute to non-union. However, they should be taken in the context of heterogeneity amongst included studies, with further research necessary to support these findings.


Assuntos
Fraturas do Fêmur/cirurgia , Fixação Interna de Fraturas , Fraturas não Consolidadas/etiologia , Índice de Massa Corporal , Placas Ósseas , Fraturas do Fêmur/fisiopatologia , Fixação Interna de Fraturas/efeitos adversos , Fixação Interna de Fraturas/métodos , Consolidação da Fratura/fisiologia , Fraturas Cominutivas/complicações , Fraturas Cominutivas/fisiopatologia , Fraturas Expostas/complicações , Fraturas Expostas/fisiopatologia , Fraturas não Consolidadas/fisiopatologia , Humanos , Osteomielite/complicações , Osteomielite/fisiopatologia , Falha de Prótese
11.
BMJ Case Rep ; 12(7)2019 Jul 27.
Artigo em Inglês | MEDLINE | ID: mdl-31352398

RESUMO

We present an elderly diabetic man with left hallux pain and drainage who was initially diagnosed with acute gouty arthritis using the diagnostic rule for acute gout and monosodium urate crystals presented on synovial fluid analysis. Further investigation with surgical debridement, plain X-ray, MRI and wound culture revealed concomitant Citrobacter koseri septic arthritis with osteomyelitis. C. koseri is considered an opportunistic infection that rarely causes musculoskeletal infections. Acute gouty arthritis and septic arthritis are rarely seen occurring concomitantly in the same joint and are often difficult to differentiate due to similar findings on exam and imaging. The present case illustrates that osteomyelitis with an opportunistic organism can present concomitantly with acute gouty arthritis, and the diagnosis of one should not exclude the other.


Assuntos
Antibacterianos/uso terapêutico , Artrite Gotosa/microbiologia , Citrobacter koseri/patogenicidade , Pé Diabético/fisiopatologia , Infecções por Enterobacteriaceae/diagnóstico , Ertapenem/uso terapêutico , Osteomielite/diagnóstico , Idoso de 80 Anos ou mais , Artrite Gotosa/terapia , Desbridamento , Pé Diabético/microbiologia , Infecções por Enterobacteriaceae/fisiopatologia , Infecções por Enterobacteriaceae/terapia , Humanos , Masculino , Osteomielite/fisiopatologia , Osteomielite/terapia , Combinação Piperacilina e Tazobactam/uso terapêutico , Resultado do Tratamento , Vancomicina/uso terapêutico
12.
Diabetes Metab Syndr ; 13(2): 959-963, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31336551

RESUMO

BACKGROUND AND AIM: Diabetic foot is a major comorbidity of diabetes, with 15-25% of diabetic patients developing diabetic foot ulcer during their lifetime. Other major diabetic foot complications include cellulitis, abscess, wet gangrene, dry gangrene, and necrotizing fasciitis. Dry gangrene involves tissue necrosis due to chronic ischemia whereby the tissue becomes numb, dry, wrinkled, and dead. Although diabetic foot complications have been extensively studied in literature, there is limited data on the management of dry gangrene. METHODS: We report a case series of 12 patients with diabetes-related dry gangrene in the toes, initially planned to be managed conservatively with autoamputation. RESULTS: One patient had an autoamputation, while eight patients underwent surgical amputations (six major amputations, two minor amputations) for better clinical outcomes. Two patients died, while no change was observed in one patient even after 12 months of follow-up. CONCLUSION: Managing diabetic dry toe gangrene by waiting for autoamputation may lead to worse clinical outcomes and should be practiced cautiously on a case-by-case basis. Early surgical intervention should be opted to improve patients' quality of life.


Assuntos
Amputação/estatística & dados numéricos , Diabetes Mellitus Tipo 2/fisiopatologia , Pé Diabético/complicações , Gangrena/cirurgia , Osteomielite/fisiopatologia , Qualidade de Vida , Dedos do Pé/cirurgia , Idoso , Feminino , Seguimentos , Gangrena/epidemiologia , Gangrena/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Arábia Saudita/epidemiologia , Cicatrização
13.
Stem Cells Transl Med ; 8(10): 1084-1091, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31179644

RESUMO

Bone infections are a frequent cause for large bony defects with a reduced healing capacity. In previous findings, we could already show diminished healing capacity after bone infections, despite the absence of the causing agent, Staphylococcus aureus. Moreover, these bony defects showed reduced osteoblastogenesis and increased osteoclastogenesis, meaning elevated bone resorption ongoing with an elevated B-cell activity. To overcome the negative effects of this postinfectious inflammatory state, we tried to use the regenerative capacity of mesenchymal stem cells derived from adipose tissue (adipose-derived stem cells [ASCs]) to improve bone regeneration and moreover were curious about immunomodulation of applicated stem cells in this setting. Therefore, we used our established murine animal model and applicated ASCs locally after sufficient debridement of infected bones. Bone regeneration and resorption as well as immunological markers were investigated via histology, immunohistochemistry, Western blot, and fluorescence-activated cell scanning (FACS) analysis and µ-computed tomography (CT) analysis. Interestingly, ASCs were able to restore bone healing via elevation of osteoblastogenesis and downregulation of osteoclasts. Surprisingly, stem cells showed an impact on the innate immune system, downregulating B-cell population. In summary, these data provide a fascinating new and innovative approach, supporting bone healing after bacterial infections and moreover gain insights into the complex ceremony of stem cell interaction in terms of bone infection and regeneration. Stem Cells Translational Medicine 2019;8:1084-1091.


Assuntos
Tecido Adiposo/metabolismo , Linfócitos B/metabolismo , Células-Tronco Mesenquimais/metabolismo , Osteomielite/fisiopatologia , Tecido Adiposo/citologia , Animais , Diferenciação Celular , Feminino , Humanos , Masculino , Camundongos
15.
Arch Orthop Trauma Surg ; 139(7): 1025-1031, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31093754

RESUMO

Osteitis of the fingers is a serious infection that needs early diagnosis and appropriate surgical debridement and antibiotic treatment of the infected bone. If the effects of treatments are insufficient, long-term antibiotic treatment and repeated operations could be required. In worst cases, some patients may have to undergo amputation. Recently, the usefulness of the Masquelet technique in extensive traumatic bone defects has been reported. We herein describe two cases of immunocompromised patients with purulent osteitis involving joint destruction of the finger treated by two-stage arthrodesis using the Masquelet technique. They obtained good infection control and better function of the finger than before the operation. Moreover, there was no recurrence of the infection. The Masquelet technique could be an alternative technique for osteitis with high risk of amputation.


Assuntos
Antibacterianos/administração & dosagem , Artrodese , Desbridamento/métodos , Articulações dos Dedos , Falanges dos Dedos da Mão , Osteomielite , Idoso , Artrodese/instrumentação , Artrodese/métodos , Feminino , Articulações dos Dedos/diagnóstico por imagem , Articulações dos Dedos/cirurgia , Falanges dos Dedos da Mão/diagnóstico por imagem , Falanges dos Dedos da Mão/cirurgia , Humanos , Hospedeiro Imunocomprometido , Imagem por Ressonância Magnética/métodos , Masculino , Osteomielite/diagnóstico , Osteomielite/etiologia , Osteomielite/fisiopatologia , Osteomielite/cirurgia , Recuperação de Função Fisiológica , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
16.
Injury ; 50(4): 827-833, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30878258

RESUMO

BACKGROUND: Early diagnosis of acute posttraumatic osteomyelitis (POM) is of vital importance for avoiding devastating complications. Diagnosing POM is difficult due to the lack of a highly specific and sensitive test, such as in myocardial infarct, stroke and intracranial bleeding. Serum inflammatory markers, C-reactive protein (CRP), procalcitonin (PCT), white blood cells (WBC) can support clinical findings but they are not able to differentiate between inflammatory response to infection and the host response to non-infection insult with high specificity and sensitivity. AIM: The objectives of the study were to investigate whether the biochemical and immunoinflammatory patient profile could facilitate postoperative monitoring, guide the antibiotic treatment and timing of revision surgery. PATIENTS AND METHODS: This prospective nonrandomised cohort study included 86 patients after high-energy injury to the shin requiring primary surgical treatment (open or closed reduction and internal fixation of tibial fracture). Values of the biochemical and immunoinflammatory profile were measured on admission (ADD), first postoperative day (POD1) and fourth-postoperative day (POD4). RESULTS: We discovered on our sample that the development of POM is associated with increased CRP on ADD, POD1 and decreased albumins on POD4. Further studies are needed to prove that these differences can be useful in diagnosing the risk of infection. The assessment of other important risk factors such as: the extent of soft tissue damage, multiple fractures, transfusion rate, need for conversion primary external fixation to intramedullary (IM) nailing or locking plate fixation can empower our clinical judgment of POM. CONCLUSIONS: We can improve prediction of posttraumatic osteomyelitis by using the perioperative inflammatory biomarker CRP in combination with postoperative albumins levels and other associated independent risk factors.


Assuntos
Proteína C-Reativa/metabolismo , Osteomielite/sangue , Complicações Pós-Operatórias/sangue , Albumina Sérica Humana/metabolismo , Infecção da Ferida Cirúrgica/sangue , Fraturas da Tíbia/sangue , Reação de Fase Aguda/sangue , Adulto , Feminino , Fixação Interna de Fraturas , Humanos , Masculino , Pessoa de Meia-Idade , Osteomielite/etiologia , Osteomielite/fisiopatologia , Período Pós-Operatório , Valor Preditivo dos Testes , Estudos Prospectivos , Infecção da Ferida Cirúrgica/fisiopatologia , Fraturas da Tíbia/imunologia , Fraturas da Tíbia/fisiopatologia , Fraturas da Tíbia/cirurgia
17.
Med Mycol ; 57(8): 1011-1017, 2019 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-30753591

RESUMO

Candida osteomyelitis is a debilitating disease that is difficult to diagnose and treat. As there are no animal models or prospective studies for this uncommon infection, little is known about the pathogenesis, diagnosis, or treatment. We therefore sought to establish an animal model for the study of the pathophysiology, diagnostic modalities, and therapeutic interventions of Candida osteomyelitis. We developed a modified version of the Norden rabbit model of tibial osteomyelitis, in which the right tibia was inoculated intraoperatively with different inocula of C. albicans or normal saline as control. On days 7, 14, and 21 after inoculation, the animals underwent bone radiography, 18-fluoro-2-deoxy-D-glucose positron emission tomography combined with computed tomography (PET/CT) scan, and blood sampling for blood cultures, blood counts, erythrocyte sedimentation rate, and Candida mannan antigen serum levels. On day 21, animals were euthanized, and infected tibias harvested for culture and histology. Among eight evaluable animals inoculated with 1 × 106 to 1 × 107 cfu, histology and bone cultures established the presence of Candida osteomyelitis in seven, with a host response of neutrophils, mononuclear cells, multinucleate giant cells, fibrosis, and necrosis. Infected animals demonstrated radiological signs of osteomyelitis with significantly increased tracer uptake in 18FDG-PET/CT scans (P < .01) and elevated serum mannan levels (P < .01). All blood cultures were negative. Indices of inflammation were only slightly increased. In conclusion, we report successful establishment of a new animal model of Candida albicans osteomyelitis that may be applicable to advancing our understanding of the pathophysiology, diagnostic modalities, and treatment of this debilitating infection.


Assuntos
Candida albicans/crescimento & desenvolvimento , Candidíase/patologia , Modelos Animais de Doenças , Osteomielite/patologia , Animais , Células Sanguíneas/patologia , Análise Química do Sangue , Candidíase/fisiopatologia , Fluordesoxiglucose F18/administração & dosagem , Histocitoquímica , Masculino , Mananas/sangue , Osteomielite/fisiopatologia , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Coelhos , Compostos Radiofarmacêuticos/administração & dosagem , Tíbia/diagnóstico por imagem , Tíbia/microbiologia , Tíbia/patologia
18.
Eur J Pediatr ; 178(4): 575-579, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30734096

RESUMO

Pyogenic sacroiliitis (PS) is rare with less than 100 pediatric cases reported in the medical literature. To better characterize PS in the pediatric population, we investigated a series of children presenting with PS. Retrospective data analysis was done at an academic tertiary center between the years of 2000 and 2017. All hospitalized children ≤ 16 years of age with PS were evaluated. Of the 894 children hospitalized with osteoarticular infections, 18 were diagnosed with PS (2%) and are included in the review. Two clinically distinct groups were identified. PS in infants (n = 13, 72.2%, mean age 1.1 years) had an indolent course and a faster recovery without any bacterial source identified. In contrast, the group of older children (n = 5, 27.8%, mean age 11.6 years) had a more complicated course and a higher rate of identified bacterial infections.Conclusion: We describe an under-recognized entity of PS in infants with a mild clinical course and fast recovery that differ from the "classical" septic sacroiliitis. Infants with PS did not suffer from invasive complications, and pathogen characteristics of older children were not identified. Infants with fever, irritability, decreased range of motion in the pelvic area, and pain during diapering should alert the clinician to this diagnosis. What is Known: • Pediatric pyogenic sacroiliitis is an extremely rare condition usually caused by Staphylococcus aureus with highest incidence in adolescents. • The diagnosis of PS is challenging due to its rarity and difficulty in assessing the sacroiliac joint. What is New: • We describe an under-recognized entity of PS in infants with a mild clinical course, without invasive complications and with fast recovery that differ from "classical" septic sacroiliitis. • Infants with fever, irritability, decreased range of motion in the pelvic area and pain during diapering should raise clinical suspicion of this diagnosis.


Assuntos
Sacroileíte/etiologia , Infecções Estafilocócicas/complicações , Adolescente , Fatores Etários , Antibacterianos/administração & dosagem , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Imagem por Ressonância Magnética , Masculino , Osteomielite/diagnóstico por imagem , Osteomielite/tratamento farmacológico , Osteomielite/etiologia , Osteomielite/fisiopatologia , Estudos Retrospectivos , Sacroileíte/diagnóstico por imagem , Sacroileíte/tratamento farmacológico , Sacroileíte/fisiopatologia , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/fisiopatologia
19.
Oper Neurosurg (Hagerstown) ; 17(5): 443-451, 2019 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-30690618

RESUMO

BACKGROUND: While recent data has demonstrated the utility of lumbar pedicle screws for the treatment of vertebral osteomyelitis, the data are limited for thoracic pedicle screws. OBJECTIVE: To investigate the effectiveness of thoracic pedicle screws for the surgical treatment of vertebral osteomyelitis. METHODS: A retrospective review of all operations performed by 2 spinal neurosurgeons from 1999 to 2012 yielded 30 cases of vertebral osteomyelitis that were treated with thoracic pedicle screws. Sixteen (53%) of which underwent combined anterior and posterior fusion and 14 patients (47%) underwent standalone posterior fusion. Postoperative records were analyzed for pertinent clinical, laboratory, and radiographic data. RESULTS: Of the 30 patients, 21 were males (70%), 8 were females (27%), and 1 was transsexual (3%). The mean age was 47 yr (range 18-69). The most common organism cultured was Staphylococcus aureus in 12 cases (50%). The mean patient stay in the hospital was 12.4 d after surgery (range 5-38 d). The mean antibiotic duration after discharge was 8 wk (range 1-24 wk). Of the 25 patients with long-term follow-up (mean, 49 mo), 92% had improved back pain (6/25 marked improvement, 17/25 complete resolution), 83% had improved muscle weakness (8/18 marked improvement, 7/18 complete resolution), and 100% had improved urinary incontinence (3/8 marked improvement, 5/8 complete resolution). Two patients (7%) required additional surgical revision due to instrumentation failure or wound infection. CONCLUSION: This study demonstrates the efficacy of utilizing thoracic pedicle screws as a primary intervention to treat vertebral osteomyelitis.


Assuntos
Osteomielite/cirurgia , Parafusos Pediculares , Doenças da Coluna Vertebral/cirurgia , Fusão Vertebral/métodos , Vértebras Torácicas/cirurgia , Adolescente , Adulto , Idoso , Antibacterianos/uso terapêutico , Dor nas Costas/fisiopatologia , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Debilidade Muscular/fisiopatologia , Osteomielite/fisiopatologia , Estudos Retrospectivos , Doenças da Coluna Vertebral/fisiopatologia , Fusão Vertebral/instrumentação , Resultado do Tratamento , Incontinência Urinária/fisiopatologia , Adulto Jovem
20.
Afr Health Sci ; 19(4): 3154-3159, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32127892

RESUMO

Background: Cemento-osseous dysplasia (COD) is a fibro-osseous jaw bone lesion. The affected bone in COD progressively becomes sclerotic, poorly vascularized and susceptible to secondary osteomyelitis. Objective: To provide a clinico-pathologic appraisal of COD in a South African patient population. Methods: Archived records of 133 patients diagnosed with COD were reviewed for patient demographics, COD location, COD type, osteomyelitis or simple bone cyst secondary to COD. Results: The mean age was 53.4 ± 13.5 years with a 94.7% female predilection. COD mainly affected the mandible (57.1%), followed by involvement of both jaws (38.3%) and maxilla (4.5%). Florid COD was the most prevalent (69.9%), followed by focal COD (18%) and periapical COD (12%). Florid COD showed a clear trend of increasing with age, peaking in the sixth decade and decreasing thereafter. Osteomyelitis and simple bone cyst presented as complications of COD in 74.4% and 5.3% of cases respectively, while 21.8% of all cases of jaw osteomyelitis during the study period were secondary to COD. Conclusion: A higher frequency of jaw osteomyelitis secondary to COD was found compared to previous studies. No significant association was shown between any of the COD types and secondary osteomyelitis.


Assuntos
Grupo com Ancestrais do Continente Africano/estatística & dados numéricos , Displasia Fibrosa Óssea/diagnóstico , Displasia Fibrosa Óssea/epidemiologia , Displasia Fibrosa Óssea/fisiopatologia , Osteomielite/diagnóstico , Osteomielite/epidemiologia , Osteomielite/fisiopatologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , África do Sul/epidemiologia , Adulto Jovem
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