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Sample records for chronic osteomyelitis contribution

  1. Chronic recurrent multifocal osteomyelitis

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    Wedman, Jan; van Weissenbruch, Ranny

    2005-01-01

    We report what is, to our best knowledge, the first case of chronic recurrent multifocal osteomyelitis (CRMO) in which the frontal and sphenoid bones were involved. Characterized by a prolonged and fluctuating course of osteomyelitis at different sites, CRMO is self-limited, although sequelae can oc

  2. [Chronic recurrent multifocal osteomyelitis].

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    Schilling, F; Eckardt, A; Kessler, S

    2000-01-01

    The aim of this paper is to give a detailed description of the so-called "chronic recurrent multifocal osteomyelitis" (CRMO). The clinical, radiological and histopathological results of an analysis of 29 cases (15 children/adolescents and 14 adults) are presented and correlated to current data from the literature. We could delinate the following points: 1. CRMO is a systemic aseptic inflammation of the bone marrow (Osteitis), it can occur polytopically and association with pustulous dermatologic symptoms is possible. 2. It is not a rare disease 3. Osteomyelitis is probably "reactive" and a plasma-cell sclerotic process with ist own characteristic histologic three-phase course. 4. We could observe 5 specific types of localization which can be documented by X-ray or bone scan. 5. Accompanying arthritis os often present, especially "sympathetic coxitis". 6. The use of drugs in treatment of CRMO (i.e. azithromycin, calcitonin, and bisphosphonates) is discussed. In conclusion we want to point out, that 1. 99mTC bone scan should always be performed when there is suspicion for CRMO to reveal the pattern of affection, 2. the rheumatologist and dermatologist should be contacted, 3. operation is normally not necessary for treatment of the mostly self-limitin disease, and 4. the term "SAPHO syndrome" should be avoided, further differentiation of the diagnosis is necessary.

  3. Chronic recurrent multifocal osteomyelitis.

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    Roderick, Marion R; Ramanan, Athimalaipet V

    2013-01-01

    Chronic recurrent multifocal osteomyelitis (CRMO) is an autoinflammatory bone disease occurring primarily in children and adolescents. Episodes of systemic inflammation occur due to immune dysregulation without autoantibodies, pathogens or antigen-specific T cells. CRMO is characterised by the insidious onset of pain with swelling and tenderness over the affected bones. Clavicular involvement was the classical description; however, the metaphyses and epiphyses of long bones are frequently affected. Lesions may occur in any bone, including vertebrae. Characteristic imaging includes bone oedema, lytic areas, periosteal reaction and soft tissue reaction. Biopsies from affected areas display polymorphonuclear leucocytes with osteoclasts and necrosis in the early stages. Subsequently, lymphocytes and plasma cells predominate followed by fibrosis and signs of reactive new bone forming around the inflammation. Diagnosis is facilitated by the use of STIR MRI scanning, potentially obviating the need for biopsy and unnecessary long-term antibiotics due to incorrect diagnosis. Treatment options include non-steroidal anti-inflammatory drugs and bisphosphonates. Biologics have been tried in resistant cases with promising initial results. Gene identification has not proved easy although research in this area continues. Early descriptions of the disease suggested a benign course; however, longer-term follow up shows that it can cause significant morbidity and longer-term disability. Although it has always been thought of as very rare, the prevalence is likely to be vastly underestimated due to poor recognition of the disease.

  4. Chronic Pseudomonas aeruginosa cervical osteomyelitis

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    Sujeet Kumar Meher

    2016-01-01

    Full Text Available Pseudomonas aeruginosa is a rare cause of osteomyelitis of the cervical spine and is usually seen in the background of intravenous drug use and immunocompromised state. Very few cases of osteomyelitis of the cervical spine caused by pseudomonas aeruginosa have been reported in otherwise healthy patients. This is a case presentation of a young female, who in the absence of known risk factors for cervical osteomyelitis presented with progressively worsening neurological signs and symptoms.

  5. Recurrent chronic suppurative osteomyelitis of the mandible

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    Rajkumar G

    2010-01-01

    Full Text Available Osteomyelitis of the maxillofacial skeleton is a rare condition in recent times. The combination of antibiotic therapy and surgical debridement is effective in the treatment of chronic suppurative osteomyelitis (CSO. This case report describes the successful surgical treatment of CSO of the mandible in an 18-year-old adult. Treatment included a pre-surgical course of antibiotics followed by sequestrectomy, resection of the coronoid process and removal of the pathologically fractured condylar process of the left side of the mandible. On post-operative clinical review at 1 week, the extra oral draining sinus healed with improved mouth opening.

  6. Evaluation of the inflammatory activity in chronic osteomyelitis. Contribution of the scintigraphy with polyclonal antibodies; Avaliacao de atividade inflamatoria em osteomielite cronica. Contribuicao da cintilografia com anticorpos policlonais

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    Sapienza, Marcelo Tatit

    1996-07-01

    Active chronic osteomyelitis or complicating osteomyelitis (superimposed on diseases that changes the normal bone structure fractures, post-surgery, prosthesis) can be difficult to diagnose by anatomic radiological imaging modalities, like plain radiograph and CT. These diseases frequently cause also increased bone remodeling, leading to nonspecific uptake of Tc-99m-bone scan agents and gallium-67. New radiopharmaceuticals with greater inflammation/infection avidity and specificity are being developed, including the nonspecific polyclonal immunoglobulin (IgG) labeled with technetium-99. Tc-99m-IgG may be available as a ready to use kit, with no reported side effects, low patient absorbed radiation dose and low cost. The mechanism of IgG uptake at the inflammation site has not been fully elucidated yet. Specific (receptor linking, physico-chemical immunoglobulin properties) and nonspecific mechanisms (enhanced vascular permeability and macromolecular exudate) has been suggested. IgG scintigraphy results are affected by the isotope, labeling procedure adopted and characteristics of the inflammatory focus. Nineteen patients with suspected osteomyelitis (active chronic osteomyelitis or violated bone osteomyelitis) were studied by Tc-99m-IgG scintigraphy (directly labeled polyclonal immunoglobulin, Sandoglobuilina - Sandoz). All patients also underwent standard three-phase bone scintigraphy using methylene diphosphonate (Tc-99m-MDP), gallium-67 scintigraphy and plain radiographs. Infection was found in 8 sites. Sensitivity and specificity for Tc-99m-MDP, gallium-67 and Tc 99m-IgG scintigraphy were, respectively, 88 and 36%, 75 and 73%,88 and 82%. All patients with false positive IgG scintigraphies had previous surgery. Other current scintigraphic procedures used in the diagnosis of osteomyelitis are also reviewed. (author)

  7. Optimal management of chronic osteomyelitis: current perspectives

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    Pande KC

    2015-08-01

    Full Text Available Ketan C Pande Raja Isteri Pengiran Anak Saleha Hospital, Bandar Seri Begawan, BruneiAbstract: Chronic osteomyelitis is a challenging condition to treat. It is seen mostly after open fractures or in implant-related infections following treatment of fractures and prosthetic joint replacements. Recurrence of infection is well known, and successful treatment requires a multidisciplinary team approach with surgical debridement and appropriate antimicrobial therapy as the cornerstone of treatment. Staging of the disease and identification of the causative microorganism is essential before initiation of treatment. Important surgical steps include radical debridement of necrotic and devitalized tissue, removal of implants, management of resultant dead space, soft-tissue coverage, and skeletal stabilization or management of skeletal defects. The route of administration and duration of antimicrobial therapy continues to be debated. The role of biofilm is now clearly established in the chronicity of bone infection, and newer modalities are being developed to address various issues related to biofilm formation. The present review addresses various aspects of chronic osteomyelitis of long bones seen in adults, with a review of recent developments. Keywords: osteomyelitis, infection, biofilm, bone, therapy, treatment

  8. Chronic recurrent multifocal osteomyelitis: a rare skeletal disorder.

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    Aygun, Deniz; Barut, Kenan; Camcioglu, Yildiz; Kasapcopur, Ozgur

    2015-08-25

    Chronic recurrent multifocal osteomyelitis (CRMO) is a rare non-infectious inflammatory bone disease of unknown aetiology. CRMO mainly affects the metaphyses of long bones and spine in children and young adolescents. It presents with recurrent episodes of bone pain and fever, resembling bacterial osteomyelitis, but cultures of lesions are sterile and it is unresponsive to antibiotic therapy. We report a case of a 3-year-old boy diagnosed with CRMO, who was initially treated for bacterial osteomyelitis, and received prolonged antibiotic therapy for chronic pain, and swelling of mandible and ulna. CRMO should be kept in mind in the differential diagnosis of chronic bone pain and osteomyelitis unresponsive to antibiotic treatment.

  9. Case report: treatment of chronic osteomyelitis.

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    Wolfe, Cameron R

    2011-06-01

    Presented is a case of chronic methicillin-resistant Staphylococcus aureus osteomyelitis, which was unsuccessfully treated with multiple courses of debridement and potent antibiotic therapies. Amputation of the patient's lower limb was believed to be the only option remaining. A compassionate access program, with approval from the US Food and Drug Administration and the institutional review board, enabled the patient to undergo a course of treatment with oral fusidic acid (CEM-102). The patient tolerated the drug well, with no significant toxicities noted to date. His infection improved rapidly, his flap healed, he has returned to work part-time, and he continues to take daily suppressive doses of oral CEM-102.

  10. Imaging of chronic recurrent multifocal osteomyelitis.

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    Khanna, Geetika; Sato, Takashi S P; Ferguson, Polly

    2009-01-01

    Chronic recurrent multifocal osteomyelitis (CRMO) is an autoinflammatory disorder of children and young adults that is characterized by nonbacterial osteomyelitis. Patients typically present with multifocal bone pain secondary to sterile osseous inflammation, and the disease has a relapsing and remitting course. The cause of CRMO remains unclear, although the results of several studies have suggested a genetic component. The typical imaging findings of CRMO include lytic and sclerotic lesions in the metaphyses of long bones and the medial clavicles. Other common sites of disease are the vertebral bodies, pelvis, ribs, and mandible. CRMO is often bilateral and multifocal at presentation. Owing to the lack of a diagnostic test, CRMO remains a diagnosis of exclusion. Although generally a self-limiting disease, CRMO can have a prolonged course and result in significant morbidity. Radiologists can be the first to suggest this diagnosis given its characteristic radiographic appearance and distribution of disease. Radiologists should be familiar with the typical imaging findings of CRMO to prevent unnecessary multiple biopsies and long-term antibiotic treatment in children with CRMO.

  11. [Chronic recurrent multifocal osteomyelitis of the spine : Children and adolescent].

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    von der Höh, N H; Völker, A; Jeszenszky, D; Heyde, C-E

    2016-06-01

    Chronic non-bacterial osteomyelitis (CNO) in childhood and adolescence is a non-infectious autoinflammatory disease of the bone with partial involvement of adjacent joints and soft tissue. The etiology is unknown. The disease can occur singular or recurrent. Individual bones can be affected and multiple lesions can occur. Chronic recurrent multifocal osteomyelitis (CRMO) shows the whole picture of CNO. Accompanying but temporally independent of the bouts of osteomyelitis, some patients show manifestations in the skin, eyes, lungs and the gastrointestinal tract. The article gives an overview of the clinical manifestations, diagnostic procedures, and treatment options for CRMO involvement of the spine based on the current literature and our own cases.

  12. Periostitis and osteomyelitis in chronic drug addicts

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    Taylor, C.R.; Lawson, J.P.

    1986-03-01

    Periostitis and osteomyelitis can occur in drug addicts not only by hematogeneous dissemination of the infecting organisms, but as a result of introduction of bacteria by direct injection into periosteum or injection through infected skin and subcutaneous tissues. A spectrum of examples of osteomyelitis of the bones of the forearm in drug addicts is presented to illustrate this phenomenon. Neglect of these infections and the trauma of continued injections can lead to extensive tissue and bone loss.

  13. Case report 834: Chronic sclerosing osteomyelitis of the mandible with long bone periostitis.

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    Stewart, A; Carneiro, R; Pollock, L; Shaw, D

    1994-04-01

    We present the case of a patient with primary chronic osteomyelitis of the mandible, the radiological appearance of which is compatible with a diagnosis of chronic sclerosing osteomyelitis. The accompanying femoral and tibial periosteal reactive new bone formation and the benign clinical course suggest that this presentation may represent a form of chronic multifocal osteomyelitis.

  14. Syndromes with chronic non-bacterial osteomyelitis in the spine.

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    Kubaszewski, Łukasz; Wojdasiewicz, Piotr; Rożek, Marcin; Słowińska, Iwona E; Romanowska-Próchnicka, Katarzyna; Słowiński, Radosław; Poniatowski, Łukasz A; Gasik, Robert

    2015-01-01

    Chronic non-bacterial osteomyelitis (CNO) has been known for over of 40 years. It is an underrecognized entity due to the low number of described cases and poor propagation awareness of the problem. Chronic non-bacterial osteomyelitis is usually confused with infectious spondylodiscitis or malignant lesions, both primary and metastatic. Failing to consider CNO as one of possible lesions of the spine among an array of differential diagnoses may lead to a prolonged ineffective treatment increasing treatment-related morbidity. In this paper the authors describe these two syndromes, with a possible autoimmune background - chronic recurrent multifocal osteomyelitis (CRMO) and SAPHO syndrome - that include CNO being among the manifestations. The authors present the spinal symptomatology of CNO for both syndromes published so far to help spine clinicians organize the information for better usage in everyday clinical practice.

  15. Syndromes with chronic non-bacterial osteomyelitis in the spine

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    Kubaszewski, Łukasz; Wojdasiewicz, Piotr; Rożek, Marcin; Romanowska-Próchnicka, Katarzyna; Słowiński, Radosław; Poniatowski, Łukasz A.; Gasik, Robert

    2016-01-01

    Chronic non-bacterial osteomyelitis (CNO) has been known for over of 40 years. It is an underrecognized entity due to the low number of described cases and poor propagation awareness of the problem. Chronic non-bacterial osteomyelitis is usually confused with infectious spondylodiscitis or malignant lesions, both primary and metastatic. Failing to consider CNO as one of possible lesions of the spine among an array of differential diagnoses may lead to a prolonged ineffective treatment increasing treatment-related morbidity. In this paper the authors describe these two syndromes, with a possible autoimmune background – chronic recurrent multifocal osteomyelitis (CRMO) and SAPHO syndrome – that include CNO being among the manifestations. The authors present the spinal symptomatology of CNO for both syndromes published so far to help spine clinicians organize the information for better usage in everyday clinical practice. PMID:27407266

  16. Update: Cytokine Dysregulation in Chronic Nonbacterial Osteomyelitis (CNO

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    Sigrun R. Hofmann

    2012-01-01

    Full Text Available Chronic nonbacterial osteomyelitis (CNO with its most severe form chronic recurrent multifocal osteomyelitis (CRMO is a non-bacterial osteitis of yet unknown origin. Secondary to the absence of both high-titer autoantibodies and autoreactive T lymphocytes, and the association with other autoimmune diseases, it was recently reclassified as an autoinflammatory disorder of the musculoskeletal system. Since its etiology is largely unknown, the diagnosis is based on clinical criteria, and treatment is empiric and not always successful. In this paper, we summarize recent advances in the understanding of possible etiopathogenetic mechanisms in CNO.

  17. Chronic sclerosing osteomyelitis of the iliac bone. Etiological possibilities

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    Jurik, A.G.; Moeller, S.H.; Mosekilde, L.

    1988-03-01

    An adolescent with chronic recurrent multifocal osteomyelitis located to both iliac bones and an adult with pustulotic arthro-osteitis, involving the left iliac bone, an invertebral space, and the sternoclavicular, first sternocostal, manubriosternal and single peripheral joints are described. Their iliac bone changes were identical, except for the occurrence of bilateral changes in the adolescent, and ankylosis of the sacroiliac joint in the adult. It is suggested that chronic recurrent multifocal osteomyelitis and pustulotic arthro-osteitis may be related diseases with age-dependent differences.

  18. Microbiota associated with chronic osteomyelitis of the jaws

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    Elerson Gaetti-Jardim Júnior

    2010-12-01

    Full Text Available Chronic osteomyelitis of maxilla and mandible is rare in industrialized countries and its occurrence in developing countries is associated with trauma and surgery, and its microbial etiology has not been studied thoroughly. The aim of this investigation was to evaluate the microbiota associated with osteomyelitis of mandible or maxilla from some Brazilian patients. After clinical and radiographic evaluation, samples of bone sequestra, purulent secretion, and biopsies of granulomatous tissues from twenty-two patients with chronic osteomyelitis of mandible and maxilla were cultivated and submitted for pathogen detection by using a PCR method. Each patient harbored a single lesion. Bacterial isolation was performed on fastidious anaerobe agar supplemented with hemin, menadione and horse blood for anaerobes; and on tryptic soy agar supplemented with yeast extract and horse blood for facultative bacteria and aerobes. Plates were incubated in anaerobiosis and aerobiosis, at 37ºC for 14 and 3 days, respectively. Bacteria were cultivated from twelve patient samples; and genera Actinomyces, Fusobacterium, Parvimonas, and Staphylococcus were the most frequent. By PCR, bacterial DNA was detected from sixteen patient samples. The results suggest that cases of chronic osteomyelitis of the jaws are usually mixed anaerobic infections, reinforcing the concept that osteomyelitis of the jaws are mainly related to microorganisms from the oral environment, and periapical and periodontal infections may act as predisposing factors.

  19. Imaging of chronic osteomyelitis; Chronische Infektionen des Skelettsystems. Bildgebende Diagnostik

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    Glaser, C.; Matzko, M.; Reiser, M. [Klinikum Grosshadern, Muenchen (Germany). Inst. fuer Radiologische Diagnostik

    2000-06-01

    The diagnosis of chronic osteomyelitis is made on the basis of clinical, radiologic and histologic findings. The role of imaging in patients with known chronic osteomyelitis is to detect and to delineate areas of active infection. To correctly interpret the imaging findings, it is essential to take both the individual clinical findings and previous imaging studies into account. Reliable signs of active infection are bone marrow abscess, sequestra and sinus tract formation. Only the combined evaluation of bony changes together with alterations of the adjacent soft tissues provides good diagnostic accuracy. Projection radiography gives an overview of the condition of the bone, which provides the basis for follow-up and the selection of further imaging modalities. Computed tomography can be used to evaluate even discrete or complex bony alterations and to guide percutaneous biopsy or drainage. Magnetic resonance imaging achieves the best diagnostic sensitivity and specificity and provides superior contrast as well as anatomical resolution in both bone marrow and soft tissues. In this paper the features and clinical relevance of imaging in primary chronic osteomyelitis, posttraumatic osteomyelitis, tuberculous spondylitis and osteomyelitis of the diabetic foot are reviewed, with particular respect to MRI. (orig.) [German] Die Diagnose der chronischen Osteomyelitis wird durch Klinik, Bildgebung und Histologie gestellt. Bei bekannter chronischer Osteomyelitis soll die Bildgebung einen floriden Prozess und die betroffenen Kompartimente herausarbeiten. Die Klinik des Patienten, seine individuelle Krankheitskonstellation und die Verlaufsbeobachtung sind essentiell fuer die Befundinterpretation. Erst die kombinierte Beurteilung der Veraenderungen am Knochen selbst sowie die der umgebenden Weichteile fuehrt zu einer validen Aussage. Sichere Zeichen einer floriden Osteomyelitis sind lediglich (Knochenmarks)abzess, Sequester und Fistelgang. Die Projektionsradiographie gibt

  20. Treatment of chronic osteomyelitis with one-stage allograft

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    LU Wei-ju; LI Bin; BAO Ni-rong; QIAN Hong-bo; ZENG Xiao-feng; XU Bin; CHEN Yong; ZHAO Jian-ning

    2006-01-01

    Objective: To avoid disadvantages of two-stage cancellus bone autograft, we investigated the feasibility of one-stage allograft for reconstructing the bone defect resulting from debridement of chronic osteomyelitis in limbs.Methods: Between Feb. 1999 and Apr. 2004, 35 cases of chronic osteomyelitis (8 cases of nonunion )underwent one-stage allograft after debridement in our hospital.Results: Thirty-five cases were followed up for an average period of 28 months (range, 13 to 55 months), in which 32 cases (91.43%) were found no infection, and 3cases (8.57 %) were confirmed recurrence of infection.Four out of 8 cases of bone nonunion healed in 9.5 months on average (range, 3 to 12 months), and another case also acquired union after redebridement and autograft of ilium due to infection recurrence 35 days after surgery.Renonunion occurred in 3 cases, 2 out of whom healed after secondary operation with autograft. One case of renonunion and 2 cases of infection recurrence refused further treatment.Conclusions: A high rate of infection arrest can be attained when one-stage allograft is used to reconstruct the bone defect of chronic osteomyelitis after debridement in limbs. Therefore, chronic osteomyelitis should not be regarded as a contraindication to one-stage allogeneic bone grafting. Renonuion, however, achieves a relatively high rate, especially in cases of segmental bone defect.

  1. Chronic recurrent multifocal osteomyelitis--report of eight patients.

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    Handrick, W; Hörmann, D; Voppmann, A; Schille, R; Reichardt, P; Tröbs, R B; Möritz, R P; Borte, M

    1998-12-01

    The authors undertook a retrospective review of the clinical records and radiologic findings of eight children with chronic, recurrent multifocal osteomyelitis (CRMO). This disease is a recognized clinicopathologic entity with typical radiographic findings, mostly in the metaphyses of the long bones. The diagnosis is one of exclusion without pathognomonic findings. The patients were treated with non-steroidal anti-inflammatory drugs. There was no evidence of altered bone growth or abnormal joint development. It is concluded that CRMO is a distinct clinical entity that is different from acute or subacute bacterial osteomyelitis. Recognition of this condition is important to avoid treatment with antibiotics and repeated operations.

  2. Maxillary Chronic Osteomyelitis Caused by Domestic Violence: A Diagnostic Challenge

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    Tamyris Inácio Oliveira

    2014-01-01

    Full Text Available Maxillary osteomyelitis is a rare condition defined as inflammation of the bone primarily caused by odontogenic bacteria, with trauma being the second leading cause. The present report documents a rare case of maxillary osteomyelitis in a 38-year-old female who was the victim of domestic violence approximately a year prior to presentation. Intraoral examination revealed a lesion appearing as exposed bony sequestrum, with significant destruction of gingiva and alveolar mucosa in the maxillary right quadrant, accompanied by significant pain, local edema, and continued purulence. Teeth numbers 11, 12, 13, 14, and 15 were mobile, not responsive to percussion, and nonvital. Treatment included antibiotic therapy for seven days followed by total enucleation of the necrotic bone tissue and extraction of the involved teeth. Microscopic findings confirmed the clinical diagnosis of chronic suppurative osteomyelitis. Six months postoperatively, the treated area presented complete healing and there was no sign of recurrence of the lesion.

  3. Treatment of a chronic Scedosporium apiospermum vertebral osteomyelitis. Case report.

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    German, John W; Kellie, Susan M; Pai, Manjunath P; Turner, Paul T

    2004-12-15

    Scedosporium apiospermum is a rare cause of fungal vertebral osteomyelitis that may result in chronic infection requiring multiple surgical interventions and long-term medical therapy. This case is the seventh one reported in the literature and is the first to include salvage surgery of a previous major spinal reconstruction. This report is also the first to describe the use of the new antifungal agent voriconazole. In treating this case of chronic vertebral osteomyelitis, several principles are emphasized from both the surgical and medical perspectives. From a surgical perspective, the use of salvage surgery, temporary avoidance of spinal instrumentation, and an appropriate choice of graft materials are emphasized. From a medical perspective, confirmation of the diagnosis, the need for long-term antifungal therapy, the need for long-term patient compliance, and the use of the new antifungal agent voriconazole are emphasized. Application of these principles has led to an adequate 2-year outcome.

  4. Osteofibrous dysplasia of clavicle clinically mimicking chronic osteomyelitis

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    Nirmal Raj Gopinathan

    2016-01-01

    Full Text Available Osteofibrous dysplasia or ossifying fibroma is an uncommon benign fibro-osseous lesion of childhood, commonly described in the maxilla and the mandible. Among long bones, it usually presents in the tibia as a painless swelling or anterior bowing. Ossifying fibroma of clavicle has never been reported in English literature, to the best of our knowledge. Here, we would like to present an unusual case of osteofibrous dysplasia of clavicle clinically mimicking chronic osteomyelitis.

  5. MR findings of squamous cell carcinoma arising from chronic osteomyelitis of the tibia: A case report

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    Han, Dong Hwa; Lee, Ji Hae; Cho, Woo Ho; Kim, Jae Hyung; Jeong, Myeong Ja; Kim, Soung Hee; Kim, Ji Young; Kim, Soo Hyun; Kang, Mi Jin; Bae, Kyung Eun [Dept. of Radiology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul (Korea, Republic of)

    2016-05-15

    Malignant transformation is a rare and late complication of untreated chronic osteomyelitis. Known radiographic findings of the malignant transformation of chronic osteomyelitis are osteolytic or mixed sclerotic and osteolytic lesions with or without soft tissue mass. But its magnetic resonance (MR) imaging findings are rarely described in the literature. We experienced a case of an 82-year-old man diagnosed with squamous cell carcinoma arising from long standing chronic osteomyelitis of the tibia. Our case indicates that radiologists should consider the possibility of malignant transformation in patients with untreated chronic osteomyelitis, with enhancing soft tissue mass invading and extending through underlying bone cortex and medulla on MR imaging.

  6. Staphylococcus aureus isolates from chronic osteomyelitis are characterized by high host cell invasion and intracellular adaptation, but still induce inflammation.

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    Kalinka, Julia; Hachmeister, Marie; Geraci, Jennifer; Sordelli, Daniel; Hansen, Uwe; Niemann, Silke; Oetermann, Sylvia; Peters, Georg; Löffler, Bettina; Tuchscherr, Lorena

    2014-11-01

    Osteomyelitis is a severe inflammatory disease of the bone that is mainly caused by Staphylococcus aureus. Particularly, bone infections are difficult to treat and can develop into a chronic course with a high relapsing rate despite of antimicrobial treatments. The complex interaction of staphylococci with osseous tissue and the bacterial ability to invade host cells are thought to determine the severity of infection. Yet, defined bacterial virulence factors responsible for the pathogenesis of osteomyelitis have not been clearly identified. The aim of this study was to detect S. aureus virulence factors that are associated with osteomyelitis and contribute to a chronic course of infection. To this purpose, we collected 41 S. aureus isolates, each 11 from acute osteomyelitis (infection period less than 2 months), 10 from chronic osteomyelitis (infection period more than 12 months), 10 from sepsis and 10 from nasal colonization. All isolates were analyzed for gene expression and in functional in-vitro systems. Adhesion assays to bone matrix revealed that all isolates equally bound to matrix structures, but invasion assays in human osteoblasts showed a high invasive capacity of chronic osteomyelitis isolates. The high invasion rate could not be explained by defined adhesins, as all infecting strains expressed a multitude of adhesins that act together and determine the level of adhesion. Following host cell invasion isolates from chronic osteomyelitis induced less cytotoxicity than all other isolates and a higher percentage of Small-colony-variant (SCV)-formation, which represents an adaptation mechanism during long-term persistence. Isolates from acute and chronic osteomyelitis strongly produced biofilm and highly expressed agr and sarA that regulate secreted virulence factors and induced an inflammatory response in osteoblasts. In conclusion, chronic osteomyelitis isolates were characterized by a high host cell invasion rate, low cytotoxicity and the ability to

  7. Chronic multifocal non-bacterial osteomyelitis in hypophosphatasia mimicking malignancy

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    Warmuth-Metz Monika

    2007-01-01

    Full Text Available Abstract Background Hypophosphatasia (HP is characterized by a genetic defect in the tissue-nonspecific alkaline phosphatase (TNSALP gene and predominantly an autosomal recessive trait. HP patients suffer from reduced bone mineralization. Biochemically, elevated concentrations of substrates of TNSALP, including pyridoxal-5'-phosphate and inorganic pyrophosphate occur in serum, tissues and urine. The latter has been associated with chronic inflammation and hyperprostaglandinism. Case presentation We report on 2 affected children presenting with multifocal inflammatory bone lesions mimicking malignancy: A 6 years old girl with short stature had been treated with human growth hormone since 6 months. Then she started to complain about a painful swelling of her left cheek. MRI suggested a malignant bone lesion. Bone biopsy, however, revealed chronic inflammation. A bone scan showed a second rib lesion. Since biopsy was sterile, the descriptive diagnosis of chronic non-bacterial osteomyelitis (CNO was established. The diagnostic tests related to growth failure were repeated and subsequent analyses demonstrated a molecular defect in the TNSALP gene. The second girl (10 years old complained about back pain after she had fallen from her bike. X rays of her spine revealed compressions of 2 thoracic vertebrae. At first these were considered trauma related, however a bone scan did show an additional lesion in the right 4th rib. A biopsy of this rib revealed a sterile lympho- plasmocytoid osteomyelitis suggesting multifocal CNO. Further analyses did show a decreased TNSALP in leukocytes and elevated pyridoxal phosphate in plasma, suggesting a heterozygous carrier status of HP. Conclusion Chronic bone oedema in adult HP and chronic hyper-prostaglandinism in childhood HP do suggest that in some HP patients bone inflammation is present in conjunction with the metabolic defect. Sterile multifocal osteomyelitis could be demonstrated. Non-steroidal anti

  8. Epigenetic Modification Mediates the Increase of LAG-3(+) T Cells in Chronic Osteomyelitis.

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    Wang, Yicun; Wang, Jun; Meng, Jia; Jiang, Hui; Zhao, Jianning; Qian, Hongbo; Chen, Tao

    2016-12-27

    Immune suppression plays critical roles in the development of chronic osteomyelitis, and the mechanisms underlying the development of immune suppression in chronic osteomyelitis have attracted much attention. LAG-3 is an important suppressor of T cell activation, but the role of LAG-3 in the immune regulation of chronic osteomyelitis is currently unknown. We sought to demonstrate if LAG-3 plays crucial roles in chronic osteomyelitis progression and has effects on immune suppression and exhausting of T cells, and what is the mechanism underlying LAG-3 deregulation in chronic osteomyelitis. We examined the expression of LAG-3 in the T cells of peripheral blood of 50 healthy controls and 50 patients with chronic osteomyelitis by flow cytometry. Clinical data were analyzed to determine the correlation between inflammation index and LAG-3 expression. Moreover, we isolated the CD4(+) T cells from healthy controls and chronic osteomyelitis patients to compare cell proliferation and IFN-γ production. Chromatin immunoprecipitation assays were utilized to analyze the epigenetic modification on LAG-3 expression in T cells. We found that LAG-3 was significantly increased in the T cells of peripheral blood from chronic osteomyelitis patients. Subsequently, clinical data analysis suggested that the higher expression of LAG-3 was associated with severer inflammation situation. Consistently, LAG-3(+)CD4(+) T cells exhibited impaired cell proliferation and IFN-γ secretion. Deregulation of histone methylation mediated the increase of LAG-3(+) T cells during chronic osteomyelitis. Taken together, our study demonstrates the increase of LAG-3(+) T cells and its immune regulatory roles in chronic osteomyelitis progression, suggesting new mechanisms and potential therapeutic targets for chronic osteomyelitis.

  9. Vertebral manifestation of chronic recurrent multifocal osteomyelitis (CRMO); Wirbelsaeulenmanifestationen der chronischen rekurrierenden multifokalen Osteomyelitis (CRMO)

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    Schilling, F. [Mainz Univ. (Germany). Klinik und Poliklinik fuer Radiologie; Rheinland-Pfaelzisches Rheumazentrum, Mainz/Bad Kreuznach (Germany); Fedlmeier, M. [Rheuma-Kinderklinik, Garmisch-Partenkirchen (Germany); Eckardt, A. [Mainz Univ. (Germany). Orthopaedische Klinik und Poliklinik; Kessler, S. [Mainz Univ. (Germany). Klinik und Poliklinik fuer Radiologie

    2002-10-01

    Chronic recurrent multifocal osteomyelitis (CRMO) is a systemic osteo-articular disease that is characterized by a sterile, primarily chronic osteomyelitis with various distribution patterns of the individual lesions. In this article, we describe the 'axial type' with predominant involvement of the spine, which represents 13 of our 41 CMRO cases of different age groups. The important element of its diagnosis is the typical lympho-plasmacellular spondylitis that can be detected and staged by scintigraphy, MRI and conventional radiography. Potentially affected are all vertebrae from the mid-cervical spine to the sacrum. One or several segments can be involved, sometimes as transient inflammatory edema, sometimes as 'migratory spondylitis' or 'saltatory spondylitis', but also as chronic sclerosing type with early radiographically detectable manifestation. Vertebral deformity due to compression and total collapse (vertebra plana) are rare. A complicated course with patulous perivertebral edema can lead to concomitant symptomatic inflammatory changes in adjacent regions and organs. In the course of CRMO, spondylodiscitis only develops as secondary destruction following the spondylitis. This can help to differentiate spondyloarthropathies from CRMO that is initially detected as primary lesion in the spine. While CRMO generally has a good prognosis, its radiological differentiation from rheumatology conditions plays an important role. (orig.) [German] Die chronische rekurrierende multifokale Osteomyelitis (CRMO) ist ein osteo-artikulaeres Systemleiden, das durch sterile, primaer chronische Osteomyelitiden gekennzeichnet ist und mit krankheitsdominanten Lokalisationen verschiedene Befallmustertypen aufweist. In dieser Arbeit wird die Wirbelsaeulenmanifestation ('Vertebraltyp') geschildert, die ein Drittel aller CRMO-Faelle betrifft und im Rahmen unseres CRMO-Kollektivs (n=41) mit 13 Faellen aller Altersstufen vertreten ist. Das

  10. The surgical treatment of chronic recurrent hematogenous osteomyelitis in children

    Directory of Open Access Journals (Sweden)

    Sukhrob Zayniev

    2013-04-01

    Full Text Available The results of surgical treatment of 178 patients with chronic recurrent osteomyelitis of the tube bones have been analyzed. It has been proposed the tactic of surgical treatment consisting of the tear of tissues for a distance of the diaphysis of the affected bone, cautious periosteum exfoliation from the bone, longitudinal osteotomy, sequestrnecrectomy with full restoration structure of intramedullary canal along the whole length, lavage and ultrasound cavitation with antiseptic solution. The performed surgical tactic secured the most radical sanation of the osteomyelitic focus and improved the treatment results of this severe pathology.

  11. Current Understanding of the Pathogenesis and Management of Chronic Recurrent Multifocal Osteomyelitis

    OpenAIRE

    Ferguson, P. J.; M. Sandu

    2012-01-01

    Chronic recurrent multifocal osteomyelitis (CRMO) is an inflammatory disorder that primarily affects children. Its hallmark is recurring episodes of sterile osteomyelitis. The clinical presentation is insidious onset of bone pain with or without fever. Laboratory studies typically reveal nonspecific evidence of inflammation. Radiologic imaging and histologic appearance resemble those of infectious osteomyelitis. There is a strong association with inflammatory disorders of the skin and intesti...

  12. Chronic recurrent multifocal osteomyelitis manifested as painful clavicular swelling: a case report

    OpenAIRE

    Bleckwenn, Markus; Sommer, Bernd; Weckbecker, Klaus

    2014-01-01

    Background Chronic recurrent multifocal osteomyelitis is a form of non-bacterial osteomyelitis which occurs primarily in childhood. In some cases painful bone swelling occurs. After a malignancy has been ruled out, antibiotic therapy is often started to treat the osteomyelitis. The course of this benign disease is self-limiting and is not positively affected by the antibiotic therapy. Case presentation A 14-year-old German girl from South Africa came to the surgery with painful swelling in th...

  13. Elephantiasis nostras verrucosa complicated with chronic tibial osteomyelitis.

    Science.gov (United States)

    Turhan, Egemen; Ege, Ahmet; Keser, Selcuk; Bayar, Ahmet

    2008-10-01

    Elephantiasis nostras verrucosa represents an infrequent clinical entity with cutaneous changes characterized by dermal fibrosis, hyperkeratotic verrucous and papillamotous lesions resulting from chronic non-filarial lymphedema secondary to infections, surgeries, tumor obstruction, radiation, congestive heart failure, and obesity. Although recurrent streptococcal lymphangitis is believed to play a critical role in the origin of elephantiasis nostras verrucosa, the exact pathogenesis of the disorder is not yet clear. Therapeutic efforts should aim to reduce lymph stasis, which will also lead to improvement of the cutaneous changes but unfortunately there is no specific treatment for advanced cases. In this report, we present a patient who was treated by below knee amputation as a result of elephantiasis nostras verrucosa complicated with chronic tibial osteomyelitis.

  14. Congenital Insensitivity to Pain with Anhidrosis (CIPA Manifested with Chronic Osteomyelitis; A Case Report

    Directory of Open Access Journals (Sweden)

    Fatih Kucukdurmaz

    2014-03-01

    Full Text Available      Chronic osteomyelitis is a very rare entity among children. Also congenital insensitivity to pain with anhidrosis (CIPA is a very rare autosomal-recessive disease  of the nervous system which is one of the hereditary sensory and autonomic neuropathies (HSAN. Loss of pain, fever due to anhidrosis, recurrent fractures, chronic osteomyelitis, mental retardation, self mutilation, wound ulcers can be seen. We present a 10-year-old boy with loss of generalized pain sensation, chronic osteomyelitis on his right distal femur, bilateral corneal opacities, and decreased mental capacity.

  15. Salvage of a Below Knee Amputation Utilizing Rotationplasty Principles in a Patient with Chronic Tibial Osteomyelitis

    OpenAIRE

    Moralle, Matthew R.; Stekas, Nicholas D.; Reilly, Mark C.; Sirkin, Michael S.; Adams, Mark R.

    2016-01-01

    Introduction: Chronic osteomyelitis is a disease that requires fastidious treatment to eliminate. However, when eradication is unable to be achieved through exhaustive modalities of antibiotic therapy and multiple debridements, significant resection of the infected bone and soft tissue must be considered, including amputation. Here we report of a salvage procedure for chronic osteomyelitis of the left tibia by employing a rotationplasty to avoid an above knee amputation and instead provide th...

  16. The value of SPET/CT in chronic osteomyelitis

    Energy Technology Data Exchange (ETDEWEB)

    Horger, Marius; Pfannenberg, Christina; Dammann, Florian; Claussen, Claus D. [Department of Diagnostic Radiology, Eberhard-Karls Universitaet, Hoppe-Seyler-Str. 3, 72076, Tuebingen (Germany); Eschmann, Susanne Martina; Bares, Roland [Department of Nuclear Medicine, Eberhard-Karls-Universitaet, Tuebingen (Germany); Storek, Dieter [Department of Traumatology and Orthopaedic Surgery, Eberhard-Karls-Universitaet, Tuebingen (Germany); Vonthein, Reinhard [Department of Medical Biometry, Eberhard-Karls-Universitaet, Tuebingen (Germany)

    2003-12-01

    Immunoscintigraphy with technetium-99m labelled anti-granulocyte antibodies (AGA) is an equivalent technique to imaging with in vitro-labelled leucocytes, which is now considered state of the art in the diagnostic work-up of patients with suspected post-traumatic chronic osteomyelitis. In this study, we evaluated the use of a combined single-photon emission tomography/computed tomography (SPET/CT) device to improve detection and anatomical definition of inflammatory bone lesions. Twenty-seven patients with 29 sites of suspected bone infection underwent immunoscintigraphy with 750 MBq {sup 99m}Tc-labelled AGA. Planar scans were acquired immediately, 4 h and 24 h after injection, and combined SPET/CT was performed using a dual-head multifunctional gamma camera equipped with a low-power X-ray system. Accumulation of AGA in inflammatory lesions was quantitated, comparing uptake at 4 and 24 h after injection. The validation was based on culture data derived from surgical or biopsy samples (20 lesions in 18 patients) or clinical follow-up without further therapy for more than 6 months (nine lesions). On a lesion-by-lesion basis 19 true positive, one false positive and nine true negative findings were obtained. SPET/CT correctly identified the location of all positive foci in the appendicular skeleton and that of a cold lesion in the axial skeleton. It also enabled differentiation between soft tissue infection, septic arthritis and osteomyelitis, as well as between cortical, corticomedullary and subperiosteal foci. Sensitivity was identical for SPET and SPET/CT (100%), whereas specificity was improved from 78% to 89% by the use of SPET/CT. Combined SPET/CT improves the accuracy of immunoscintigraphy by allowing correct differentiation between soft tissue infection and bone involvement. This technique may gain clinical relevance in the selection of patients for surgical therapy. (orig.)

  17. Chronic Recurrent Multifocal Osteomyelitis Causing an Acute Scoliosis

    Directory of Open Access Journals (Sweden)

    Alexander Armstrong

    2013-01-01

    Full Text Available Study Design. A Case Report. Objective. We present a 15-year-old girl with an acute atypical scoliosis secondary to chronic recurrent multifocal osteomyelitis (CRMO. Summary of Background Data. CRMO is a rare nonpyogenic inflammatory bone condition with unclear aetiology. CRMO mainly affects the metaphyses of long bones, the pelvis, shoulder girdle, and less commonly the spine. Methods. Our case presented with a 6-month history of worsening thoracic back pain, asymmetry of her shoulders and abnormal posture. Whole spine radiographs revealed a right atypical thoracic scoliosis. Magnetic Resonance Imaging showed abnormal signal on the short TI inversion recovery (STIR sequences in multiple vertebrae. A bone biopsy demonstrated evidence of fibrosis and chronic inflammatory changes. Interval MRI scans revealed new oedematous lesions and disappearance of old lesions. Symptoms improved. Results. It is important to consider CRMO as an acute cause of atypical scoliosis. Malignancy, pyogenic infections and atypical presentations of juvenile arthritis need excluding. Conclusion. This 24-month follow-up describes a rare cause of an atypical scoliosis and fortifies the small amount of the currently available literature. The case highlights the relapsing and remitting nature of CRMO with new lesions developing and older lesions burning out. We advise close radiological surveillance and symptomatic management.

  18. Contribution of Reduced Interleukin-10 Levels to the Pathogenesis of Osteomyelitis in Children with Sickle Cell Disease.

    Science.gov (United States)

    Sarray, Sameh; Almawi, Wassim Y

    2015-09-01

    Osteomyelitis is a significant complication of sickle cell disease (SCD), and several factors contribute to its pathogenesis, including altered expression of proinflammatory and anti-inflammatory cytokines. In view of the role of interleukin-10 (IL-10) as an anti-inflammatory cytokine, we tested the notion that SCD osteomyelitis is associated with a reduction in IL-10 secretion and, hence, precipitation of a proinflammatory state. Study subjects comprised 52 SCD patients with confirmed diagnosis of osteomyelitis and 165 age- and gender-matched SCD patients with negative histories of osteomyelitis. Results obtained showed that IL-10 serum levels in SCD osteomyelitis patients were significantly lower than those of control SCD patients. Receiver operating characteristic (ROC) analysis demonstrated that altered IL-10 serum levels predicted the development of osteomyelitis, and the mean area under ROC curves of IL-10 was 0.810 among SCD patients with osteomyelitis. A systematic shift in IL-10 serum levels toward lower values was seen in osteomyelitis cases, with an increased osteomyelitis risk associated with decreased IL-10 levels. Multivariate logistic regression analyses confirmed the independent association of reduced IL-10 with osteomyelitis after controlling for sickle hemoglobin (HbS), fetal hemoglobin (HbF), platelet count, and white blood cell (WBC) count. These data support the strong association of decreased IL-10 levels with osteomyelitis, thereby supporting a role for IL-10 in osteomyelitis follow-up.

  19. Phage therapy of staphylococcal chronic osteomyelitis in experimental animal model

    Directory of Open Access Journals (Sweden)

    Chandan Kishor

    2016-01-01

    Full Text Available Background & objectives: Methicillin resistant Staphylococcus aureus (MRSA are the commonest cause of osteomyelitis. The aim of this study was to evaluate the role of an alternative therapy i.e. application of S. aureus specific bacteriophages in cases of osteomyelitis caused by MRSA in animal model. Methods: Twenty two rabbits were included in this study. The first two rabbits were used to test the safety of phage cocktail while the remaining 20 rabbits were divided into three groups; group A (n=4 to assess the establishment of osteomyelitis; group B (n=4 osteomyelitis developed but therapy started only after six weeks; and group C (n=12 osteomyelitis developed and therapy started after three weeks. Groups B and C rabbits were treated with four doses of cocktail of seven virulent bacteriophages at the interval of 48 h. Comparison between three groups was made on the basis of observation of clinical, radiological, microbiological, and histopathological examinations. Results: Experimental group rabbits recovered from the illness in the subsequent two weeks of the therapy. Appetite and activity of the rabbits improved, local oedema, erythema and induration subsided. There were minimal changes associated with osteomyelitis in X-ray and histopathology also showed no signs of infection with new bone formation. Control B group rabbits also recovered well from the infection. Interpretation & conclusions: The present study shows a potential of phage therapy to treat difficult infections caused by multidrug resistant bacteria.

  20. Association between chronic osteomyelitis and deep-vein thrombosis. Analysis of a nationwide population-based registry.

    Science.gov (United States)

    Lin, T-Y; Chen, Y-G; Huang, W-Y; Lin, C-L; Peng, C-L; Sung, F-C; Kao, C-H

    2014-09-02

    Studies on the association between chronic osteomyelitis and deep vein thrombosis (DVT) and pulmonary thromboembolism (PE) are scarce. The aim of this study was to analyse a nationwide population-based database for association between DVT or PE after a diagnosis of chronic osteomyelitis. This nationwide population-based cohort study was based on data obtained from the Taiwan National Health Insurance Database from 1998 to 2008, with a follow-up period extending to the end of 2010. We identified patients with chronic osteomyelitis using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes. The patients with chronic osteomyelitis and comparison controls were selected by 1:1 matching on a propensity score. The propensity score was calculated by a logistic regression to estimate the probability of the treatment assignment given the baseline variables including age, sex, and Charlson comorbidity index score. We analysed the risks of DVT and PE by using Cox proportional hazards regression models, including sex, age, and comorbidities. In total, 24,335 chronic osteomyelitis patients and 24,335 controls were enrolled in the study. The risk of developing DVT was 2.49-fold in patients with chronic osteomyelitis compared with the comparison cohort, after adjusting for age, sex, and comorbidities. The multiplicative increased risks of DVT were also significant in patients with chronic osteomyelitis with any comorbidity. In conclusion, physicians should consider chronic osteomyelitis in their evaluation of risk factors for DVT.

  1. Systematic approach to treat chronic osteomyelitis through localized drug delivery system: Bench to bed side

    Energy Technology Data Exchange (ETDEWEB)

    Bhattacharya, Rupnarayan [Department of Plastic Surgery, R. G. Kar Medical College and Hospital (RGKMCH), Kolkata 700004 (India); Kundu, Biswanath, E-mail: biswa_kundu@rediffmail.com [Biocermics and Coating Division, CSIR — Central Glass and Ceramic Research Institute (CSIR-CGCRI), Kolkata 700032 (India); Nandi, Samit Kumar, E-mail: samitnandi1967@gmail.com [Department of Veterinary Surgery and Radiology, West Bengal University of Animal and Fishery Sciences (WBUAFS), Kolkata 700037 (India); Basu, Debabrata [Biocermics and Coating Division, CSIR — Central Glass and Ceramic Research Institute (CSIR-CGCRI), Kolkata 700032 (India)

    2013-10-15

    Chronic osteomyelitis is a challenging setback to the orthopedic surgeons in deciding an optimal therapeutic strategy. Conversely, patients feel frustrated of the therapeutic outcomes and development of adverse drug effects, if any. Present investigation deals with extensive approach incorporating in vivo animal experimentation and human application to treat chronic osteomyelitis, using antibiotic loaded porous hydroxyapatite scaffolds. Micro- to macro-porous hydroxyapatite scaffolds impregnated with antibiotic ceftriaxone–sulbactam sodium (CFS) were fabricated and subsequently evaluated by in vivo animal model after developing osteomyelitis in rabbit tibia. Finally 10 nos. of human osteomyelitis patients involving long bone and mandible were studied for histopathology, radiology, pus culture, 3D CT etc. up to 8–18 months post-operatively. It was established up to animal trial stage that 50N50H samples [with 50–55% porosity, average pore size 110 μm, higher interconnectivity (10–100 μm), and moderately high drug adsorption efficiency (50%)] showed efficient drug release up to 42 days than parenteral group based on infection eradication and new bone formation. In vivo human bone showed gradual evidence of new bone formation and fracture union with organized callus without recurrence of infection even after 8 months. This may be a new, alternative, cost effective and ideal therapeutic strategy for chronic osteomyelitis treatment in human patients. - Highlights: • Chronic osteomyelitis is challenging setback to decide optimal therapeutic strategy. • Micro- to macro-porous antibiotic CFS impregnated HAp scaffolds were fabricated. • Complete in vivo animal trial done after developing osteomyelitis in rabbit tibia. • Clinical trial showed fracture union without recurrence of infection after 8 months. • This may be a new, alternative, cost effective and ideal therapeutic strategy.

  2. The propeller flap for chronic osteomyelitis of the lower extremities: a case report.

    Science.gov (United States)

    Rubino, C; Figus, A; Mazzocchi, M; Dessy, L A; Martano, A

    2009-10-01

    The goals of the treatment of chronic osteomyelitis are infection eradication with systemic antibiotic therapy and local management with radical excision of the infected tissue and obliteration of the remaining dead space. Adequate debridement and coverage with a well-vascularised tissue are mandatory for successful outcomes. Use of muscle covering for chronic osteomyelitis in the lower extremities is considered the best procedure. However, there have been instances where debridement of the bone tissue did not leave a deep cavity along the leg bones and fasciocutaneous flaps can be used in these instances to cover the defect and to restore function without recurrence of the disease. Recently, free non-muscle flaps have been used and assessed for chronic osteomyelitis or covering of exposed bone. Perforator flaps have been shown to be well vascularised due to a structural haemodynamic enhancement. In the light of these findings we report a successful case of chronic osteomyelitis of the right fibula treated with excision of the affected tissue and covering with a propeller flap. Instead of free flap covering, in order to optimise surgical reconstruction, reducing the operative time, donor and recipient site morbidity and risk of total flap failure, local perforator flaps and particularly the propeller flap may be indicated in the treatment of chronic osteomyelitis in selected patients when the defect is limited and there is no need to fill a deep bone cavity or a dead space. To our knowledge, this the first report of the use of a propeller flap in the treatment of chronic osteomyelitis in the lower extremities.

  3. Alterations of blood serum parameters in patients with chronic hematogenous osteomyelitis

    Institute of Scientific and Technical Information of China (English)

    Sadrudin Magomedov; Larisa Polishchuk

    2015-01-01

    Objective:To examine metabolic disorders of major components of organic basis of bone tissue in patients with chronic hematogenous osteomyelitis and response to surgical treatment. Methods: The cubital vein puncture was conducted to take blood for analysis in patients with chronic hematogenous osteomyelitis. The activity of collagenase and hyaluronidase, elastin, elastase and total content of glycosaminoglycans were measured in blood serum. Results: The study revealed an enhancement of catabolic phase of metabolism of the main components in bone organic matrix during the relapse of inflammation. It was evidenced by indicators reflecting the synthetic and catabolic phases of the main components of the connective tissue collagen and glycosaminoglycans. The effective therapeutic treatments led to the reduction and normalization of studied compounds. Conclusions: The initial development of hematogenous osteomyelitis happens in a background of metabolic disorders of the main components of organic matrix of bone tissue, and normalizes upon effective therapy.

  4. Whole body MRI in the diagnosis of chronic recurrent multifocal osteomyelitis.

    LENUS (Irish Health Repository)

    Kennedy, M T

    2012-06-01

    Chronic recurrent multifocal osteomyelitis (CRMO) is a diagnosis of exclusion primarily in children and adolescents. As part of the essential criteria for the diagnosis of CRMO, multifocal lesions must be identified. We present the case of an 11-year-old boy with CRMO, whose diagnosis was facilitated by the use of whole body magnetic resonance imaging (WBMR), but not isotope bone scanning.

  5. Current understanding of the pathogenesis and management of chronic recurrent multifocal osteomyelitis.

    Science.gov (United States)

    Ferguson, Polly J; Sandu, Monica

    2012-04-01

    Chronic recurrent multifocal osteomyelitis (CRMO) is an inflammatory disorder that primarily affects children. Its hallmark is recurring episodes of sterile osteomyelitis. The clinical presentation is insidious onset of bone pain with or without fever. Laboratory studies typically reveal nonspecific evidence of inflammation. Radiologic imaging and histologic appearance resemble those of infectious osteomyelitis. There is a strong association with inflammatory disorders of the skin and intestinal tract in affected individuals and their close relatives, suggesting a shared pathophysiology and supporting a genetic component to disease susceptibility. Two genetic syndromes have CRMO as a prominent phenotype-Majeed syndrome and deficiency of the interleukin-1 receptor antagonist-and suggest that interleukin-1 may be a key cytokine in disease pathogenesis. This review briefly summarizes the main clinical and radiologic aspects of the disease and then focuses on genetics and pathophysiology and provides an update on treatment.

  6. Role of Nasal Endoscopy in Chronic Osteomyelitis of Maxilla and Zygoma: A Case Report

    Directory of Open Access Journals (Sweden)

    J. S. Arunkumar

    2011-01-01

    Full Text Available Osteomyelitis of the jaws was relatively common before the era of antibiotic therapy and preventive and restorative dentistry. Osteomyelitis is an acute or chronic inflammatory process that can involve cortical and trabecular aspects of bone or bone marrow. Cranial bones are infrequently involved, but spreading of inflammation with involvement of surrounding structures represents important risk, such as cerebral abscess, encephalitis, or meningitis. The mandible is more commonly involved than the maxilla. Dentogenic infections cause 38% of mandibular and 25% of maxillary involvement. Involvement of zygoma is very rare. Factors like viral fevers, malnutrition, malaria, anemia,tobacco chewing, immunodeficiency, osteopetrosis, Paget’s disease of bone, and florid cemento-osseous dysplasia (FCOD result in decreased vascularity of the affected bone, predisposing to the development of osteomyelitis. We present a case of osteomyelitis of left maxilla and zygoma with oroantral fistula in an immunocompetent adult male caused by dentogenic infection. The complete resolution of infection was gained with surgical treatment using nasal endoscope and antibiotic therapy. The aims of this paper are to illustrate diagnostic patterns, to report radiographic findings and surgical treatment using nasal endoscope in a case of osteomyelitis of maxilla and zygoma. The prognosis and cosmetic results are discussed.

  7. Chronic Sclerosing Osteomyelitis of the Mandible Treated with Hemimandibulectomy and Fibular Free Flap Reconstruction.

    Science.gov (United States)

    Singh, Shubhi; Graham, M Elise; Bullock, Martin; Rigby, M H; Taylor, S Mark; Trites, Jonathan R B; Hart, Robert D

    2015-12-01

    Primary chronic osteomyelitis of the mandible is a rare condition that presents with a long-standing chronic facial swelling over the mandible, pain with mastication, and trismus. With no clinically appreciated acute phase, the aetiology often remains unknown. Many patients achieve adequate symptom control with broad-spectrum antibiotics, hyperbaric oxygen therapy and surgical debridement, or decortication of bone sequestration. However, because of the rarity of primary chronic osteomyelitis and the extensive involvement of the mandible that can result, we present a case of a 32-year-old woman with chronic disease of the left mandible requiring a left hemimandibulectomy and fibular free flap reconstruction. Few such cases have been reported in the literature, which require such extensive resection and reconstruction to control long-standing symptoms.

  8. Multimodality imaging of osteomyelitis

    Energy Technology Data Exchange (ETDEWEB)

    Elgazzar, A.H. [Cincinnati Univ. Medical Center, OH (United States); Abdel-Dayem, H.M. [Dept. Radiology, New York Medical College, Valhalla, NY (United States)]|[Dept. of Radiology, St. Vinvent`s Hospital and Medical Center, New York, NY (United States); Clark, J.D. [Cincinnati Univ. Medical Center, OH (United States); Maxon, H.R. [Cincinnati Univ. Medical Center, OH (United States)

    1995-09-01

    After a brief introduction outlining some basic principles regarding the diagnosis of osteomyelitis, pathophysiologic aspects are reviewed. Advantages and disadvantages of each imaging modality and their applications in different forms of osteomyelitis are discussed. The use of different imaging modalities in the diagnosis of special forms of osteomyelitis, including chronic, diabetic foot, and vertebral osteomyelitis, and osteomyelitis associated with orthopedic appliances and sickle cell disease is reviewed. Taking into account the site of suspected osteomyelitis and the presence or absence of underlying pathologic changes and their nature, an algorithm summarizing the use of various imaging modalities in the diagnosis of osteomyelitis is presented. (orig.). With 13 figs., 9 tabs.

  9. The evaluation of staphylococci strains isolated from nasal and bone cultures in patients with chronic osteomyelitis

    Directory of Open Access Journals (Sweden)

    Mehmet Uluğ

    2012-09-01

    Full Text Available Objectives: In this study, it was aimed to determine theprevalence of nasal carriage of S. aureus in chronic osteomyelitis,assessed trends in methicillin resistance withtime, and evaluated the bone and nasal cultures in staphylococcalchronic osteomyelitis.Materials and methods: Bone and nasal cultures wereperformed intra-operative and pre-operatively from 43patients with chronic osteomyelitis. Inoculation was performedon 5% sheep blood and eosine-methylen-blueagar. The samples were incubated at 37°C for 24 hours.Catalase and coagulase tests were performed on Grampositive coccus strains. Antimicrobial susceptibilities of allS. aureus strains were evaluated by disc diffusion methodaccording to CLSI for oxacillin and other antibiotics.Results: In this study pre-operative nasal cultures andintra-operative bone cultures obtained between May 2005and September 2006 were evaluated retrospectively. Ofthe 43 nasal cultures, 31 (72% yielded staphylococcalstrain, of these 18 (58% were S. aureus. Of the 18 S.aureus strains, 13 (72.2% have methicilline resistance.On the other hand, of the 43 bone cultures, 29 (67.4%yielded staphylococci strain, of these 23 (79.3% were S.aureus. Of the 23 S. aureus strains, 52.1% have methicillineresistance. Overall the similarity rate of staphylococcalstrains was 38% (11/29, while considering the statusof strains resistant to antibiotics; this ratio was 24% (7/29.Conclusions: Nasal S. aureus carriage rate (58% in patientswith chronic osteomyelitis was higher than the communityand the other patient groups. However, the surveillancecultures can give knowledge about the causativepathogen of 25% of the culture negative cases.Key words: Chronic osteomyelitis, nasal carriage, Staphylococcusaureus, bone culture

  10. Chronic suppurative osteomyelitis with proliferative periostitis related to a fully impacted third molar germ: a report of two cases

    Science.gov (United States)

    2016-01-01

    In prolonged chronic osteomyelitis, chronic inflammation and low-grade infections can result in new periosteal bone formation. Chronic osteomyelitis with proliferative periostitis (traditionally termed Garré's sclerosing osteomyelitis) mainly affects children and young adults. Here, we present two rare cases of an 11-year-old and a 12-year-old patient with suppurative chronic osteomyelitis with proliferative periostitis without any definitive infection source, such as dental caries or periodontitis. The source of infection was likely to be related to the development of a lower right third molar germ with follicular space widening. Management involved antibiotics and the removal of the third molar germ and surgical debridement. Disease remission and a normal appearance was observed at the six-month follow-up visit. PMID:27595089

  11. Chronic suppurative osteomyelitis with proliferative periostitis related to a fully impacted third molar germ: a report of two cases.

    Science.gov (United States)

    Park, Joonhyoung; Myoung, Hoon

    2016-08-01

    In prolonged chronic osteomyelitis, chronic inflammation and low-grade infections can result in new periosteal bone formation. Chronic osteomyelitis with proliferative periostitis (traditionally termed Garré's sclerosing osteomyelitis) mainly affects children and young adults. Here, we present two rare cases of an 11-year-old and a 12-year-old patient with suppurative chronic osteomyelitis with proliferative periostitis without any definitive infection source, such as dental caries or periodontitis. The source of infection was likely to be related to the development of a lower right third molar germ with follicular space widening. Management involved antibiotics and the removal of the third molar germ and surgical debridement. Disease remission and a normal appearance was observed at the six-month follow-up visit.

  12. Chronic sternal osteomyelitis complicating primary manubriosternal septic arthritis.

    Science.gov (United States)

    Sinha, S; Sinha, A; Nagarajah, K; Oei, E L; Critchley, P; McNally, M A

    2006-11-01

    We present a 40-year-old woman complaining of worsening chest pain. She was previously treated with a prolonged course of antibiotics for suspected sternal osteomyelitis. Radiological investigations were suggestive of ongoing inflammation within the manubriosternal joint. Formal surgical debridement yielded evidence corroborating the diagnosis although microbiological samples were negative. Prolonged empirical treatment with intravenous antibiotics leads to a complete resolution of symptoms. Primary culture-negative manubriosternal septic arthritis is rare, and suboptimal treatment, particularly if confused with other conditions such as synovitis, acne, pustulosis, hyperostosis and osteitis (SAPHO) syndrome, compounds its considerable morbidity.

  13. Foci of chronic circumscribed osteomyelitis (Brodie's abscess) that traverse the epiphyseal plate.

    Science.gov (United States)

    Bogoch, E; Thompson, G; Salter, R B

    1984-03-01

    We observed six children who presented with chronic circumscribed osteomyelitis involving the adjacent metaphysis and epiphysis of a long bone, communicating through and damaging the growth cartilage of the epiphyseal plate. Four of the six children were less than or equal to 10 years of age. All six patients presented with the mild symptoms and subtle clinical findings that are characteristic of "Brodie's abscess," which is usually confined to metaphyseal, or occasionally epiphyseal, bone. Four children were treated with antibiotics and by surgical evacuation of the abscess, with visualization of the defect in the epiphyseal plate. Two children were treated with antibiotics alone, initially by the intravenous route. At follow-up 2-14 years after treatment, all affected children had a normal result without evidence of growth disturbance. There are seven previously reported cases of chronic circumscribed osteomyelitis traversing the epiphyseal plate that resulted in growth disturbance. Based on our experience and that reported in the literature, we believe that the intravenous administration of appropriate antibiotics in high doses, followed by oral antibiotics, is sufficient treatment for some children presenting with this condition. The pathogenic organism is likely to be Staphylococcus aureus. Surgical evacuation of the lesion should be performed for acute osteomyelitis involving the epiphyseal plate, for sinus formation or drainage into a synovial joint, for failure of the patient to respond clinically to nonoperative therapy, and for confirmation of the diagnosis if doubt exists.

  14. Skull involvement in a pediatric case of chronic recurrent multifocal osteomyelitis.

    Science.gov (United States)

    Watanabe, Toru; Ono, Hiroyuki; Morimoto, Yoshitaka; Otsuki, Yoshiro; Shirai, Masami; Endoh, Akira; Naito, Masaaki; Inoue, Yoshiya; Hongo, Teruaki

    2015-08-01

    An 11-year-old boy was diagnosed with chronic recurrent multifocal osteomyelitis (CRMO) and presented with right sacro-femoral and occipital lesions. Initially, a tumor was suspected. However, the bone biopsy showed osteomyelitis with a negative bacterial culture. Bone scintigraphy revealed inflammatory changes on multiple bone lesions. The slight elevation in inflammatory markers such as C-reactive protein was of little clinical value. He was diagnosed with CRMO by sacral biopsy, and the clinical course progressed, with the presence of a new occipital lesion observed after the 1-year follow-up. The administration of non-steroidal anti-inflammatory drugs successfully improved his clinical symptoms. The presence of a skull lesion in the occipital bone of a pediatric patient with CRMO has not been previously reported.

  15. A therapeutic delivery system for chronic osteomyelitis via a multi-drug implant based on three-dimensional printing technology.

    Science.gov (United States)

    Wu, Weigang; Ye, Chenyi; Zheng, Qixin; Wu, Gui; Cheng, Zhaohui

    2016-08-01

    Chronic osteomyelitis is difficult to be cured and often relapses, which presents to be a great challenge to clinicians. We conducted this original study to explore the efficiency of therapeutic alliance for chronic osteomyelitis by a multi-drug implant based on three-dimensional printing technology. We designed and fabricated preciously a multi-drug implant with a multi-layered concentric cylinder construction by three-dimensional (3D) printing technology. Levofloxacin and tobramycin were incorporated into the drug implant in a specific sequence. The drug release property of the drug implant was assayed in vitro We also developed an animal model of chronic osteomyelitis to estimate the effect of the 3D printed multi-drug implant. The results showed that the multi-drug implant had a sustained and programmed drug release property. Levofloxacin and tobramycin which were released from the multi-drug implant worked in tandem to enhance pharmacodynamic action which was similar to a tumor chemotherapy program and were sufficient to treat chronic osteomyelitis. These findings imply that the administration of 3D printed multi-drug implant would be a potential therapeutic method for chronic osteomyelitis. Further studies are required.

  16. Levofloxacin loaded mesoporous silica microspheres/nano-hydroxyapatite/polyurethane composite scaffold for the treatment of chronic osteomyelitis with bone defects.

    Science.gov (United States)

    Wang, Qi; Chen, Cheng; Liu, Wen; He, Xiaoqiang; Zhou, Nian; Zhang, Dongli; Gu, Hongchen; Li, Jidong; Jiang, Jiaxing; Huang, Wei

    2017-02-02

    Chronic osteomyelitis is a prolonged persistent disease accompanied by bone destruction and sequestrum formation, it is very difficult to treat. Antibiotic loaded polymethyl methacrylate (PMMA) has been used in clinical. However, when PMMA was implanted in the body, the deficiencies is that it is non-biodegradable and a second operation is needed. Here, we synthesize a novel levofloxacin loaded mesoporous silica microspheres/nano-hydroxyapatite/polyurethane composite scaffolds, and evaluated the therapeutic effect in treating chronic osteomyelitis with bone defects in rabbit model compared with bulk PMMA. X-ray, Micro CT, gross pathology as well as immunohistochemical staining were performed at predesignated time points (1, 3, 6 and 12 weeks). Our results demonstrated that the efficiency of mesoporous silica microspheres/nano-hydroxyapatite/polyurethane composite scaffolds loaded with 5 mg levofloxacin was much better at treating bone defects than the other groups. This novel synthetic scaffold may provide a solution for the treatment of chronic osteomyelitis.

  17. Levofloxacin loaded mesoporous silica microspheres/nano-hydroxyapatite/polyurethane composite scaffold for the treatment of chronic osteomyelitis with bone defects

    Science.gov (United States)

    Wang, Qi; Chen, Cheng; Liu, Wen; He, Xiaoqiang; Zhou, Nian; Zhang, Dongli; Gu, Hongchen; Li, Jidong; Jiang, Jiaxing; Huang, Wei

    2017-01-01

    Chronic osteomyelitis is a prolonged persistent disease accompanied by bone destruction and sequestrum formation, it is very difficult to treat. Antibiotic loaded polymethyl methacrylate (PMMA) has been used in clinical. However, when PMMA was implanted in the body, the deficiencies is that it is non-biodegradable and a second operation is needed. Here, we synthesize a novel levofloxacin loaded mesoporous silica microspheres/nano-hydroxyapatite/polyurethane composite scaffolds, and evaluated the therapeutic effect in treating chronic osteomyelitis with bone defects in rabbit model compared with bulk PMMA. X-ray, Micro CT, gross pathology as well as immunohistochemical staining were performed at predesignated time points (1, 3, 6 and 12 weeks). Our results demonstrated that the efficiency of mesoporous silica microspheres/nano-hydroxyapatite/polyurethane composite scaffolds loaded with 5 mg levofloxacin was much better at treating bone defects than the other groups. This novel synthetic scaffold may provide a solution for the treatment of chronic osteomyelitis. PMID:28150731

  18. Garre's chronic diffuse sclerosing osteomyelitis of the sacrum: a rare condition mimicking malignancy.

    LENUS (Irish Health Repository)

    Nasir, N

    2012-02-03

    Garre\\'s chronic diffuse sclerosing osteomyelitis (DSOM) is a rare disease that occurs most commonly in the mandible. We present a case of sacral DSOM that simulated an expanding destructive sacral tumour. Treatment was conducted on the basis of the available experience with the mandibular form of the disease, with partial symptomatic relief, but progressive sclerosis of the sacral lesion. To the best of our knowledge, this is the first case initially presenting in the sacrum. As an osteolytic expanding lesion simulating malignancy, it is important to recognize this entity in the sacrum.

  19. Severe chronic osteomyelitis caused by Morganella morganii with high population diversity

    Directory of Open Access Journals (Sweden)

    Jialiang Zhu

    2016-09-01

    Full Text Available A case of chronic osteomyelitis probably caused by Morganella morganii, occurring over a period of 30 years, is reported. The organism was identified through a combination of sample culture, direct sequencing, and 16S RNA gene amplicon sequencing. Further whole-genome sequencing and population structure analysis of the isolates from the patient showed the bacterial population to be highly diverse. This case provides a valuable example of a long-term infection caused by an opportunistic pathogen, M. morganii, with high diversity, which might evolve during replication within the host.

  20. Severe chronic osteomyelitis caused by Morganella morganii with high population diversity.

    Science.gov (United States)

    Zhu, Jialiang; Li, Haifeng; Feng, Li; Yang, Min; Yang, Ronggong; Yang, Lin; Li, Li; Li, Ruoyan; Liu, Minshan; Hou, Shuxun; Ke, Yuehua; Li, Wenfeng; Bai, Fan

    2016-09-01

    A case of chronic osteomyelitis probably caused by Morganella morganii, occurring over a period of 30 years, is reported. The organism was identified through a combination of sample culture, direct sequencing, and 16S RNA gene amplicon sequencing. Further whole-genome sequencing and population structure analysis of the isolates from the patient showed the bacterial population to be highly diverse. This case provides a valuable example of a long-term infection caused by an opportunistic pathogen, M. morganii, with high diversity, which might evolve during replication within the host.

  1. 慢性骨髓炎诊断与治疗%Diagnosis and Treatment of Chronic Osteomyelitis

    Institute of Scientific and Technical Information of China (English)

    龙光桥

    2016-01-01

    骨髓炎是骨科领域中的顽固病症,易演变成慢性骨髓炎。早期诊断和规范治疗对于防治慢性骨髓炎具有重要的意义。中西医结合治疗慢性骨髓炎是一套综合的治疗方法,值得深入研究。%Osteomyelitis is a stubborn illness in the field of orthopedic, and it is easy to be evolved into chronic osteomyelitis. It is of great significance to early diagnosis and standard treatment for preventing and treating the osteomyelitis. The integrated Chinese and Western medicine for chronic osteomyelitis is a comprehensive therapic method, and it’s worth to be further studied.

  2. Chronic recurrent multifocal osteomyelitis with an atypical presentation in an adult man

    Energy Technology Data Exchange (ETDEWEB)

    Hong, Cheng William [University of California San Francisco, Department of Radiology and Biomedical Imaging, San Francisco, CA (United States); Cleveland Clinic, Lerner College of Medicine, Cleveland, OH (United States); Hsiao, Edward C. [University of California San Francisco, Division of Endocrinology and Metabolism, and the Institute for Human Genetics, Department of Medicine, San Francisco, CA (United States); Horvai, Andrew E. [University of California San Francisco, Department of Pathology, San Francisco, CA (United States); Link, Thomas M. [University of California San Francisco, Department of Radiology and Biomedical Imaging, San Francisco, CA (United States)

    2015-09-15

    We present the case of a 33-year-old man with no significant medical history who developed right scapular pain, left-sided sacroiliac joint pain, and lower back pain, and was eventually diagnosed with chronic recurrent multifocal osteomyelitis (CRMO). Imaging demonstrated multiple scattered T2-hyperintense lesions on MRI at the spine and the left SI joint, some of which progressed and one regressed in size on follow-up. Histopathology demonstrated only non-specific chronic inflammation compatible with CRMO. No evidence of infectious organisms or neoplastic processes was found. The pain was relapsing and remitting in nature. Laboratory investigations were notable for no evidence of hematologic malignancy or infection, but only a mild increase in alkaline phosphatase. This case highlights that CRMO, despite being thought of as a childhood-onset disease, can present in adults as well, and also provides illustrative examples of imaging and histological findings. (orig.)

  3. Mutation screening of the IL-1 receptor antagonist gene in chronic non-bacterial osteomyelitis of childhood and adolescence

    NARCIS (Netherlands)

    Beck, C.; Girschick, H. J.; Morbach, H.; Schwarz, T.; Yimam, T.; Frenkel, J.; van Gijn, M. E.

    2011-01-01

    Objective Chronic non-bacterial osteomyelitis CNO is an inflammatory disorder of the musculoskeletal system with unknown etiology. In addition to bone inflammation, patients may present with inflammatory involvement of other tissues including, e.g.,skin. Recently, a novel syndrome due to deficiency

  4. Chronic mandibular osteomyelitis with suspected underlying synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO syndrome: a case report

    Directory of Open Access Journals (Sweden)

    Osako T

    2012-02-01

    Full Text Available Yumi Mochizuki, Ken Omura, Hideaki Hirai, Takuma Kugimoto, Toshimitu Osako, Takahide TaguchiDepartment of Oral and Maxillofacial Surgery, Oral Restitution, Division of Oral Health Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, JapanAbstract: Chronic mandibular osteomyelitis is an intractable disease. In recent years, some case reports have related this disease process to synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO syndrome, which is chronic with frequent remissions and exacerbations. This report describes a case of chronic mandibular osteomyelitis suspected to be SAPHO syndrome. A 68-year-old woman presented with pain on the left side of the mandible. On the basis of clinical and radiological findings, chronic mandibular diffuse sclerosing osteomyelitis was initially diagnosed. We administrated oral clarithromycin (400 mg daily and levofloxacin (500 mg daily, and her pain subsequently resolved. On 99mTc-labeled methylene diphosphonate scintigraphy, tracer uptake in the asymptomatic mandible was unchanged, but there was increasing tracer uptake in the sternocostal and sternoclavicular joints, compared with 99mTc-labeled methylene diphosphonate scintigraphic findings of the first visit. We diagnosed SAPHO syndrome and administrated oral sodium risedronate hydrate (2.5 mg daily. Although there has been no pain or swelling in the area of the left mandibular lesion, we have followed up on other skin and osteoarticular manifestations in conjunction with other medical departments.Keywords: SAPHO syndrome, diffuse sclerosing osteomyelitis, 14-membered ring macrolide antibiotics, new quinolone antibiotics, bisphosphonates

  5. Chronic recurrent multifocal osteomyelitis: typical patterns of bone involvement in whole-body bone scintigraphy.

    Science.gov (United States)

    Acikgoz, Gunsel; Averill, Lauren W

    2014-08-01

    Chronic recurrent multifocal osteomyelitis (CRMO) is an autoinflammatory bone disease of unknown etiology. It affects children and adolescents predominantly and occurs mostly in the female population. It is characterized by the insidious onset of pain and swelling, with a fluctuating clinical course of relapses and remissions. Typically, several bones are affected, either synchronously or metachronously, and bilateral involvement is common. CRMO most commonly affects the metaphysis of long bones, especially the tibia, femur, and clavicle. The spine, pelvis, ribs, sternum, and mandible may also be affected. Although lesions are mostly multiple, patients may present with a single symptomatic focus. Radiographic findings may be negative early in the course of the disease. Bone scintigraphy is useful in determining the presence of abnormality and the extent of disease. The imaging and clinical features of CRMO overlap with those of infectious osteomyelitis, bone malignancy, and inflammatory arthritis. Nonetheless, CRMO can be confidently diagnosed with the recognition of typical imaging patterns in the appropriate clinical setting. This article reviews imaging findings with special emphasis on bone scintigraphy and specific disease sites.

  6. Effective treatment with interferon-alpha in chronic recurrent multifocal osteomyelitis.

    Science.gov (United States)

    Andersson, R

    1995-10-01

    Chronic recurrent multifocal osteomyelitis (CRMO) is a rare disease of unknown etiology characterized by multiple osteomyelitic changes in the predominantly metaphysial regions of long bones. It was first described by Giedon et al. in 1972. Cultures for all known microorganisms are negative. Pain is the most common symptom, and sometimes soft tissue swelling is present. Patients are usually treated with nonsteroidal antiinflammatory drugs (NSAIDs) or corticosteroids and respond, at least partly, to these treatments. CRMO is most commonly seen in children and is in the majority of cases self-limiting but has a protracted course of several years. Some patients have a more prolonged disease period, as in the patient reported here. Treatment with corticosteroids in children has the risk of causing growth retardation as a potential adverse effect, and alternative treatments are of great interest. In the actual paper, a successful treatment with interferon-alpha 2b in a 34-year-old man with CRMO is presented.

  7. Neck of Femur Fracture in a Patient with a Chronic Osteomyelitis of the Ipsilateral Foot

    Directory of Open Access Journals (Sweden)

    Anne-Carolin Döring

    2016-01-01

    Full Text Available This case report describes a successful two-stage treatment in a 75-year-old male with a displaced neck of femur fracture, also suffering from an active chronic osteomyelitis of the ipsilateral calcaneus. In our case, a below-knee amputation was performed first, followed by total hip arthroplasty two weeks later. At 15-month follow-up, full recovery of the prefracture level of activities of daily living without significant impairment was obtained. Only a few cases of total hip arthroplasty in amputees have been published, but the indication for surgery was mainly traumatic or advanced osteoarthritis. Treating patients with this type of comorbidities is challenging; therapeutic dilemmas can be major. The management in cases like these requires a thorough evaluation and a clear surgical and medical treatment plan, preferably conducted by a multidisciplinary orthogeriatric team.

  8. Neck of Femur Fracture in a Patient with a Chronic Osteomyelitis of the Ipsilateral Foot

    Science.gov (United States)

    Döring, Anne-Carolin; Vochteloo, Anne J. H.; van Doorn, Kees; Huis in 't Veld, Rianne M. H. A.

    2016-01-01

    This case report describes a successful two-stage treatment in a 75-year-old male with a displaced neck of femur fracture, also suffering from an active chronic osteomyelitis of the ipsilateral calcaneus. In our case, a below-knee amputation was performed first, followed by total hip arthroplasty two weeks later. At 15-month follow-up, full recovery of the prefracture level of activities of daily living without significant impairment was obtained. Only a few cases of total hip arthroplasty in amputees have been published, but the indication for surgery was mainly traumatic or advanced osteoarthritis. Treating patients with this type of comorbidities is challenging; therapeutic dilemmas can be major. The management in cases like these requires a thorough evaluation and a clear surgical and medical treatment plan, preferably conducted by a multidisciplinary orthogeriatric team. PMID:27843662

  9. A missense mutation in pstpip2 is associated with the murine autoinflammatory disorder chronic multifocal osteomyelitis.

    Science.gov (United States)

    Ferguson, Polly J; Bing, Xinyu; Vasef, Mohammed A; Ochoa, Luis A; Mahgoub, Amar; Waldschmidt, Thomas J; Tygrett, Lorraine T; Schlueter, Annette J; El-Shanti, Hatem

    2006-01-01

    Chronic recurrent multifocal osteomyelitis (CRMO) is an autoinflammatory disorder that primarily affects bone but is often accompanied by inflammation of the skin and/or gastrointestinal tract. The etiology is unknown but evidence suggests a genetic component to disease susceptibility. Although most cases of CRMO are sporadic, there is an autosomal recessive syndromic form of the disease, called Majeed syndrome, which is due to homozygous mutations in LPIN2. In addition, there is a phenotypically similar mouse, called cmo (chronic multifocal osteomyelitis) in which the disease is inherited as an autosomal recessive disorder. The cmo locus has been mapped to murine chromosome 18. In this report, we describe phenotypic abnormalities in the cmo mouse that include bone, cartilage and skin inflammation. Utilizing a backcross breeding strategy, we refined the cmo locus to a 1.3 Mb region on murine chromosome 18. Within the refined region was the gene pstpip2, which shares significant sequence homology to the PSTPIP1. Mutations in PSTPIP1 have been shown to cause the autoinflammatory disorder PAPA syndrome (pyogenic arthritis, pyoderma gangrenosum and acne). Mutation analysis, utilizing direct sequencing, revealed a single base pair change c.293T --> C in the pstpip2 gene resulting in a highly conserved leucine at amino acid 98 being replaced by a proline (L98P). No other mutations were found in the coding sequence of the remaining genes in the refined interval, although a 50 kb gap remains unexplored. These data suggest that mutations in pstpip2 may be the genetic explanation for the autoinflammatory phenotype seen in the cmo mouse.

  10. Multiple-azole-resistant Aspergillus fumigatus osteomyelitis in a patient with chronic granulomatous disease successfully treated with long-term oral posaconazole and surgery.

    NARCIS (Netherlands)

    Hodiamont, C.J.; Dolman, K.M.; Berge, I.J. Ten; Melchers, W.J.G.; Verweij, P.E.; Pajkrt, D.

    2009-01-01

    We describe a patient with chronic granulomatous disease and proven Aspergillus fumigatus osteomyelitis of the midfoot, while receiving itraconazole-prophylaxis. The isolate proved resistant to itraconazole as well as voriconazole, and showed reduced susceptibility to posaconazole. Although molecula

  11. Chronic mandibular osteomyelitis with suspected underlying synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome: a case report.

    Science.gov (United States)

    Mochizuki, Yumi; Omura, Ken; Hirai, Hideaki; Kugimoto, Takuma; Osako, Toshimitu; Taguchi, Takahide

    2012-01-01

    Chronic mandibular osteomyelitis is an intractable disease. In recent years, some case reports have related this disease process to synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome, which is chronic with frequent remissions and exacerbations. This report describes a case of chronic mandibular osteomyelitis suspected to be SAPHO syndrome. A 68-year-old woman presented with pain on the left side of the mandible. On the basis of clinical and radiological findings, chronic mandibular diffuse sclerosing osteomyelitis was initially diagnosed. We administrated oral clarithromycin (400 mg daily) and levofloxacin (500 mg daily), and her pain subsequently resolved. On (99m)Tc-labeled methylene diphosphonate scintigraphy, tracer uptake in the asymptomatic mandible was unchanged, but there was increasing tracer uptake in the sternocostal and sternoclavicular joints, compared with (99m)Tc-labeled methylene diphosphonate scintigraphic findings of the first visit. We diagnosed SAPHO syndrome and administrated oral sodium risedronate hydrate (2.5 mg daily). Although there has been no pain or swelling in the area of the left mandibular lesion, we have followed up on other skin and osteoarticular manifestations in conjunction with other medical departments.

  12. Chronic Osteomyelitis in Sternum Mimicking Bone Metastasis of Lung Cancer Patient

    Energy Technology Data Exchange (ETDEWEB)

    Im, Hyung Jun; Kim, Yu Keong; Lee, Sang Mi; Lee, Won Woo; Kim, Sang Eun [Seoul National University Bundang Hospital, Seoul (Korea, Republic of)

    2009-06-15

    Primary sternal osteomyelitis without predisposing factors is a rare condition, and it is hardly differentiated from metastatic bone tumor especially in patient with the history of primary malignancy because osteomyelitis shares frequently common findings with metastatic bone lesion on {sup 18}F-FDG PET and bone scan. Although there have been several publications of primary osteomyelitis mimicking bone metastasis in the spine or extremities, we report a case of primary sternal osteomyelitis in the patient with lung cancer, which has, to our knowledge, not been reported before.

  13. Mycotic aneurysm of the femoral artery resulting from mismanagement of a pathological femur fracture due to chronic osteomyelitis: a case report

    Directory of Open Access Journals (Sweden)

    Mwaka Erisa Sabakaki

    2013-01-01

    Full Text Available Abstract Introduction Mycotic aneurysms are rarely listed among the possible complications of osteomyelitis of the long bones. To the best of our knowledge this is the first case of chronic osteomyelitis associated with a pathological fracture of the femur and a mycotic aneurysm of the femoral artery. Case presentation We present the case of a 13-year-old Ugandan boy who was referred to our hospital with chronic osteomyelitis associated with a pathological fracture of the right femur and a mycotic aneurysm of the femoral artery. He underwent a successful above-knee amputation and is currently undergoing rehabilitation. Conclusions Aneurysms associated with chronic osteomyelitis of the long bones are very rare. However, in Africa, where people often still believe in crude traditional remedies, they should be considered among the possible diagnoses especially where acute injuries of the limbs are massaged and manipulated.

  14. 慢性骨髓炎治疗的研究进展%Treatment of chronic osteomyelitis: An update

    Institute of Scientific and Technical Information of China (English)

    褚立涛

    2013-01-01

    慢性骨髓炎是骨科医师面临的一项临床难题.近些年,随着医学、药学及材料学的研究进展,其治疗方法的研究也有了长足进步.文中就目前慢性骨髓炎治疗研究的现状及进展作一综述.%Chronic osteomyelitis is a clinical challenge to orthopedists. However, with the development of medical, pharmaceutical and material sciences, great progress has been made in the study and treatment of the disease. This review highlights the current advances in the treatment of chronic osteomyelitis.

  15. Whole clavicle sequestration from chronic osteomyelitis in a 10 year old boy: A case report and review of the literature

    Directory of Open Access Journals (Sweden)

    Agu Thaddeus Chika

    2016-03-01

    Full Text Available Chronic osteomyelitis is a childhood disease and so it is not uncommon to diagnose it in a 10 year old boy who is suffering from pains and discharging sinuses from the left shoulder girdle. What is not common is the involvement of the clavicle in this infective process and even more uncommon is for the whole length of the clavicle to sequester. This case report describes a rare case of chronic osteomyelitis of the left clavicle in which the entire length was removed as a sequestrum during surgery. And despite the removal of an entire length of the clavicle in the patient, there was no functional deficit and there was also no shoulder asymmetry.

  16. Antimicrobial photodynamic therapy in chronic osteomyelitis induced by Staphylococcus aureus: An in vitro and in vivo study

    Science.gov (United States)

    dos Reis Júnior, João Alves; de Assis, Patrícia Nascimento; Paraguassú, Gardênia Matos; de Vieira de Castro, Isabele Cardoso; Trindade, Renan Ferreira; Marques, Aparecida Maria Cordeiro; Almeida, Paulo Fernando; Pinheiro, Antônio Luiz Barbosa

    2012-09-01

    Osteomyelitis it is an acute or chronic inflammation in the marrow spaces in the superficial or cortical bone, and associated to bacterial infection. Chronic osteomyelitis represents a major health problem due to its difficult treatment and increased morbidity. Antimicrobial photodynamic therapy (APT) by laser is a treatment based on a cytotoxic photochemical reaction in which, a bright light produced by a laser system and an active photosensitizer absorbed by cells leads an activation that induces a series of metabolic reactions that culminates a bacterial killing. The aim of this study was to assess, both in vitro and in vivo, the effect of lethal laser photosensitization on osteomyelitis. On the in vitro study a diode laser (λ660nm; 40mW; o/ = 0.4 cm2; 5 or 10 J/cm2) and 5, 10 and 15μg/mL toluidine blue (TB) were tested and the best parameter chosen for the in vivo study. The concentration of 5μg/mL was selected to perform the decontamination of infected by Staphylococcus aureus tibial bone defects in rats. The results were performed by ANOVA test. On the in vitro studies all PDTs groups in the different concentrations reduced significantly (p<0,001) the amount of bacteria. On the in vivo study PDT group presented a bacterial reduction of 97,4% (P<0,001). The photodynamic therapy using toluidine blue was effective in reducing the staphiloccocus aureus in both in vitro and in vivo studies.

  17. Successful treatment of chronic recurrent multifocal osteomyelitis with indomethacin: a preliminary report of five cases.

    Science.gov (United States)

    Abril, Juan Carlos; Ramirez, Ana

    2007-01-01

    Chronic recurrent multifocal osteomyelitis (CRMO) is a disease of children and young adults. Clinically, the disease is characterized by the insidious onset of local pain and swelling in affected bones. Its course is one of intermittent periods of exacerbation and remission with successive bones affected. The pathogenesis of CRMO remains unknown, although an autoinflammatory disorder may be the cause, with inflammation of bone. This lesion is radiologically characterized as multiple lucencies surrounded by defined zones of patchy but dense sclerosis, cortical thickening from periosteal new bone formation, and increased bone size with different bones involved. Multiple therapeutic regimens had shown only a partial or temporary response. Because indomethacin has been successfully applied in inhibition of ossification and inflammatory processes, we initiated therapy with indomethacin in patients with CRMO. We report on the cases of 5 patients who responded dramatically to treatment with indomethacin. All underwent progressive clinical improvement (mean, 2.8 months). Radiological lesions disappeared after a mean period of 10.5 months. In 1 case where treatment was started late, small osteolytic zones persisted but with no clinical consequences. There were no additional recurrences or new bones affected during follow-up period (mean, 4 years). Our observation indicates that indomethacin may be an effective treatment for CRMO.

  18. Clinical Characteristics and Treatment of Extremity Chronic Osteomyelitis in Southern China: A Retrospective Analysis of 394 Consecutive Patients.

    Science.gov (United States)

    Jiang, Nan; Ma, Yun-Fei; Jiang, Yi; Zhao, Xing-Qi; Xie, Guo-Ping; Hu, Yan-Jun; Qin, Cheng-He; Yu, Bin

    2015-10-01

    Although extremity chronic osteomyelitis is common in China, updated data were still limited regarding its characterizations. The present study aimed to review clinical features of extremity chronic osteomyelitis in Southern China.A retrospective analysis was conducted in the patients who had sought medical attention from January 2010 to April 2015 for extremity chronic osteomyelitis in Nanfang Hospital in Southern China. Clinical data were collected and analyzed.A total of 394 patients (307 males and 87 females) were included, giving a gender ratio of 3.53. The median age at first diagnosis was 42 years for all. The most frequent type was traumatic osteomyelitis (262 cases, 66.50%), which was mainly caused by open injury (166 cases, 63.36%) and during a road accident (91 cases, 34.73%). Single-site infection accounted for 81.98% (323 cases), with tibia (126 cases), femur (79 cases), calcaneus (37 cases), and toes (37 cases) as the top sites. The positive rate of intraoperative culture was 70.63% (214/303), 78.97% (169/214) of which was monomicrobial infection. Staphylococcus aureus (59 cases) was the most frequent bacteria for monomicrobial infection, followed by Pseudomonas aeruginosa (29 cases) and Escherichia coli (11 cases). The positive ratios of preoperative serum white blood cell (WBC), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), procalcitonin (PCT), interleukin-6 (IL-6), and tumor necrosis factor alpha (TNF-α) were 21.63%, 64.92%, 53.27%, 42.25%, 72.82%, and 66.67%, respectively. The most frequently used intravenous antibiotic was cephalosporins. The overall cure rate was 77.74%, with a total amputation rate of 16.75%.In this representative Chinese cohort, extremity chronic osteomyelitis was mostly caused by open injury and during a road accident, predominated in males and favored the tibia. S. aureus was the most frequent pathogenic organism. Preoperative elevated levels of serum IL-6, TNF-α, and ESR may be helpful diagnostic

  19. 38 CFR 4.43 - Osteomyelitis.

    Science.gov (United States)

    2010-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Osteomyelitis. 4.43... DISABILITIES Disability Ratings The Musculoskeletal System § 4.43 Osteomyelitis. Chronic, or recurring, suppurative osteomyelitis, once clinically identified, including chronic inflammation of bone marrow,...

  20. Acute postoperative osteomyelitis in femur fracture: contribution of bone scintilography (case report)

    Energy Technology Data Exchange (ETDEWEB)

    Borges, Natalie Ferreira; Rezende, Cleuza Maria de Faria; Sanchez-Ucros, Natalia; Laguardia, Priscilla [Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG (Brazil). Escola de Veterinaria; Diniz, Simone Odilia Fernandes; Cardoso, Valbert Nascimento [Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG (Brazil). Faculdade de Farmacia; Rodrigues, Carlos Jorge Simal [Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG (Brazil). Faculdade de Medicina; Santos, Raquel Gouvea dos [Centro de Desenvolcimento da Tecnologia Nuclear (CDTN/CNEN-MG), Belo Horizonte, MG (Brazil). Lab. de Radiobiologia

    2009-07-01

    The treatment of bone fractures is aimed at consolidating and returns of function as soon as possible and can be performed by different methods. Treatment with the plate in fractures of the femur in bridge aims not to address the location of fracture and stabilize it, maintaining the anatomical axis by the fixation of proximal and distal segments. Postoperative follow-up of the fracture is necessary to evaluate the irrigation of the bone structure and the effect of the method. The scintigraphy is a method capable of assessing the degree of bone remodeling and the presence or absence of local bone homeostasis. The objective of this report is to present the case of a rabbit, male, which was subjected to osteotomy and fixation of the femoral diaphysis by means of the plate in the bridge. After 10 days the animal was subjected to scintigraphic and radiographic evaluations. The animal came to death and an autopsy was performed on the same when it was observed macroscopy consistent with acute osteomyelitis due to contamination postoperative time. Radiographic evaluation in acute osteomyelitis is unclear. The methods assist in the scintigraphic diagnosis of osteomyelitis by allowing the detection of functional changes in this infectious process. The bone scintigraphy with diphosphonates labeled with technetium-99m shows increased bone turnover in the infected area and its high sensitivity, even in an early stage makes it the method of choice in the diagnosis of acute osteomyelitis in patients without prior bone disease and bone radiologically normal. (author)

  1. CHRONIC OSTEOMYELITIS: A BACTERIOLOGICAL STUDY WITH SPECIAL REFERENCE TO STAPHYLOCOCCUS AUREUS

    Directory of Open Access Journals (Sweden)

    Sanjoy Chakravarty

    2015-01-01

    Full Text Available Advances in the identification of infections and early diagnosis of Osteomyelitis have led to the improved management of Osteomyelitis. This study was undertaken to determine the bacteriological profile of Osteomyelitis and the antibiotic resistance pattern of various isolates obtained as it is an important cause of morbidity. A total of 50 patients of Osteomyelitis either attending the outpatient department or admitted in the wards of a teaching and tertiary care hospita l in Sikkim from October 2013 to October, 2014 were included in the study. All those patients who were clinically and/ or radiologically suspected of having Osteomyelitis were enrolled as cases. Pus/ pus swabs or sequestrum samples taken aseptically were c ultured aerobically at 37 0 C for 18 - 24 hours in Blood and Mac Conkey agar plates. Culture isolates were identified by a series of standard biochemical reactions. Antibiotic susceptibility was tested on Mueller Hinton agar by Kirby Bauer disc diffusion met hod. Betalactamase production of S. aureus strains were verified by iodometric filter paper and acidometric agar plate methods. S. aureus strains were screened for methicillin resistance by using conventional microbiological methods. S. aureus turned out t o be the most common organism isolated. Other organism isolated were P. Aeruginosa, Proteus spp., Klebsiella spp., E. coli, Enterobacter spp., S. epidermitis, Streptococcus pyogens and Enterococcus spp. Beta - lactamase production and methicillin resistance was seen in S. aureus strains respectively. Multidrug resistance was observed in other strains. Infection caused by Methicillin resistant S. aureus and multidrug resistant organisms are posing a major challenge in the treatment of Osteomyelitis. So, appropriate drug selected by antibiotic sensitivity testing should be used to treat Osteomyelitis

  2. Chronic recurrent multifocal osteomyelitis: how to suggest this diagnosis?; L`osteite chronique recurrente multifocale. Un diagnostic qu`il faut savoir evoquer

    Energy Technology Data Exchange (ETDEWEB)

    Saint-Martin, Ch. [UCL Cliniques Saint-Luc, Bruxelles (Belgium); Kurelovic, I.; Soler, C.; Geoffray, A. [Fondation Laval, 06 - Nice (France); Durckel, J. [Hopital Hautepierre, 67 - Strasbourg (France)

    1997-09-01

    Chronic recurrent multifocal osteomyelitis is a rare disorder that affects children and teenagers. Clinically, it is characterized by insidious onset of local swelling and pain in several metaphyses. A symmetric, recurrent and multifocal pattern is usual. Spinal involvement is possible. Inconstant association with a cutaneous affection (palmo-plantar pustulosis, acne fulminans, psoriasis), or less frequently with an inflammatory chronic gut disorder is described. Pathogenesis usually recognized is an enthesopathy. Enthesitis may progress to the osseous part of the enthese and produce an aseptic chronic osteomyelitis. Biopsy specimen with culture is certainly necessary to rule out bacterial osteomyelitis and bone tumor. It is particularly true when the bone lesion is isolated. Disease course is benign and self-limited. The clinical course is characterized by recurrences and remissions occurring for 6 to 10 years. Treatment based on non steroid anti-inflammatory drugs is usually effective. (authors). 17 refs.

  3. Imaging of chronic recurrent multifocal osteomyelitis of childhood first presenting with isolated primary spinal involvement

    Energy Technology Data Exchange (ETDEWEB)

    Anderson, S.E. [Department of Radiology, University Hospital of Bern, Inselspital, 3010, Bern (Switzerland); Heini, P.; Kalbermatten, D. [Department of Orthopedic Surgery, University Hospital of Bern, Inselspital, Bern (Switzerland); Sauvain, M.J. [Department of Pediatric Rheumatology, University Hospital of Bern, Inselspital, Bern (Switzerland); Stauffer, E. [Department of Pathology, University Hospital of Bern, Inselspital, Bern (Switzerland); Geiger, L. [Section Nuclear Medicine, Department of Radiology, University Hospital of Bern, Inselspital, Bern (Switzerland); Johnston, J.O. [Department of Orthopedic Surgery, University of California at San Francisco, San Francisco, California (United States); Roggo, A. [Department of Surgery, University Hospital of Bern, Inselspital, Bern (Switzerland); Steinbach, L.S. [Department of Radiology, University of California at San Francisco, San Francisco, California (United States)

    2003-06-01

    Initial presentation with primary spinal involvement in chronic recurrent multifocal osteomyelitis of childhood (CRMO) is rare. Our objective was to review the imaging appearances of three patients who had CRMO who initially presented with isolated primary spinal involvement.Design and patients The imaging, clinical, laboratory and histology findings of the three patients were retrospectively reviewed. Imaging included seven spinal MR imaging scans, one computed tomography scan, nine bone scans, two tomograms and 16 radiographs. These were reviewed by two musculoskeletal radiologists and a consensus view is reported. All three patients presented with atraumatic spinal pain and had extensive bone spinal pathology. The patients were aged 11, 13 and 12 years. There were two females and one male.Results and conclusions The initial patient had thoracic T6 and T8 vertebra plana. Bone scan showed additional vertebral body involvement. Follow-up was available over a 3 year period. The second patient had partial collapse of T9 and, 2 years later, of C6. Subsequently extensive multifocal disease ensued and follow-up was available over 8 years. The third patient initially had L3 inferior partial collapse and 1 year later T8 involvement with multifocal disease. Follow-up was available over 3 years. The imaging findings of the three patients include partial and complete vertebra plana with a subchondral line adjacent to endplates associated with bone marrow MR signal alterations. Awareness of the imaging appearances may help the radiologist to include this entity in the differential diagnosis in children who present with spinal pathology and no history of trauma. Histopathological examination excludes tumor and infection but with typical imaging findings may not always be necessary. (orig.)

  4. Spinal involvement in chronic recurrent multifocal osteomyelitis (CRMO) in childhood and effect of pamidronate.

    Science.gov (United States)

    Hospach, Toni; Langendoerfer, Micha; von Kalle, Tekla; Maier, Jan; Dannecker, Guenther E

    2010-09-01

    There are only a few studies that address the frequency and type of spinal involvement in patients with chronic recurrent multifocal osteomyelitis (CRMO) as well as the outcome of these patients treated with pamidronate (PAM). We performed a retrospective study on patients with CRMO and analyzed clinical and pain assessments as well as regional and whole body MRI findings and compared with posttreatment findings. Of 102 children and adolescents with CRMO, 27 (26%) had involvement of the spine. Vertebral deformities were seen in 14 of these 27 patients, scoliosis or kyphosis in 6. After routine whole body MRI, 19 complained of back pain, whereas eight were asymptomatic with spinal lesions detected incidentally. A total of 72 spinal lesions were detected, thoracic vertebrae being the most commonly affected. Seven patients were treated with PAM; all of whom had vertebral deformities and ongoing back pain. Pain resolution was achieved within 3 months of PAM treatment in every case. One patient subsequently developed a pain amplification syndrome. Repeat MRI performed at a mean interval of 13 months revealed partial or complete resolution of vertebral hyperintensities in every patient. Improvement of vertebral height was seen in a total of three vertebrae in two patients. Severe side effects were not observed. In conclusion, we demonstrated that spinal involvement and associated vertebral deformities with or without kyphoscoliosis are not rare in CRMO, and PAM appears to be an effective and safe treatment for this condition. Although controlled studies are urgently needed, the use of PAM for refractory CRMO with extended spinal involvement (vertebral deformities, kyphosis, and scoliosis) should be considered, especially after failing of conventional therapy.

  5. Increased subsequent risk of erectile dysfunction among middle and old age males with chronic osteomyelitis: a nationwide population-based cohort study.

    Science.gov (United States)

    Wang, H-Y; Chao, C-H; Lin, C-L; Tseng, C-H; Kao, C-H

    2016-07-01

    Chronic inflammation may cause endothelial dysfunction and atherosclerosis, resulting in subsequent erectile dysfunction (ED). We examined the relationship between chronic osteomyelitis, which is a chronic inflammatory disease, and ED. A retrospective cohort study was conducted using data from the National Health Insurance Research Database. After excluding patients <40 years of age, 677 male patients newly diagnosed with chronic osteomyelitis (COM) from 1 January 2000 to 31 December 2011 were identified for the study. The non-osteomyelitis comparison cohort consisted of 2706 male participants. The incidence of ED was 2.66-fold higher in the COM cohort than in the non-osteomyelitis cohort (4.01 vs 1.51 per 10 000 person-years). After adjusting for age and comorbidities of coronary heart disease, hypertension, hyperlipidemia, depression, stroke, diabetes, peripheral vascular disease, chronic kidney disease, chronic obstructive pulmonary disease and asthma, the patients with COM had a 2.82-fold risk of ED (95% confidence interval=1.44-5.56). The incidence of ED increased with that of comorbidities in both cohorts. The highest hazard ratio was in patients between 40 and 59 years of age who had COM. Our data showed, for the first time, that COM is a possible risk factor for the development of ED.

  6. Glove and PICO: a novel technique for treatment of chronic wound due to osteomyelitis of the hand.

    Science.gov (United States)

    Narayan, Nitisha; Edwards, Daren; Ragoowansi, Raj H

    2014-06-02

    Chronic wounds on the dorsum of the hand are often challenging to treat. Vacuum-assisted closure has enjoyed widespread use in recent years for many difficult chronic wounds as an alternative to surgery. Unfortunately, owing to the unique anatomy of the hand, it is usually very difficult to get a seal without significantly immobilising the hand. We report a case of a chronic wound on the dorsum of the hand as a result of osteomyelitis in a 37-year-old man, which was treated with Single Use Negative Pressure Wound Therapy, 'PICO' (Smith and Nephew Co, UK). We combined the PICO dressing with a rubber glove to get a good seal enabling appropriate suction without immobilising the hand. Once the wound bed was ready, the defect was covered with a reverse forearm flap.

  7. Treating low- and medium-potency bisphosphonate-related osteonecrosis of the jaws with a protocol for the treatment of chronic suppurative osteomyelitis: report of 7 cases.

    NARCIS (Netherlands)

    Alons, K.; Kuijpers, S.C.; Jong, Edo de; Merkesteyn, J.P.R. van

    2009-01-01

    OBJECTIVE: Treatment of bisphosphonate-related osteonecrosis of the jaws has been reported to be very difficult. In this article a small series of 7 patients, treated with a relatively simple protocol, similar to the treatment of chronic suppurative osteomyelitis, consisting of surgery and antimicro

  8. Chronic recurrent multifocal osteomyelitis demonstrated by Tc-99m methylene diphosphonate bone scan

    DEFF Research Database (Denmark)

    Lise, Hobolt; Nemery, Michel; Albrectsen, Jens;

    2008-01-01

    A 12-year-old Middle Eastern girl presented with abdominal pain, weight loss, and intermittent pain in both thighs. She was initially suspected of Crohn disease, but this diagnosis was excluded after extensive gastromedical evaluation. Plain x-rays of the femora were normal, whereas the initial T...... osteomyelitis (CRMO). The patient's symptoms disappeared spontaneously, but reappeared 1.5 years later, which led to a new MDP bone scan that showed normal findings. Udgivelsesdato: 2008-Jan...

  9. The use of Papineau technique for the treatment of diabetic and non-diabetic lower extremity pseudoarthrosis and chronic osteomyelitis

    Directory of Open Access Journals (Sweden)

    Vasilios D. Polyzois

    2011-03-01

    Full Text Available The treatment of 31 consecutive adult patients, ages 25–67 years with chronic draining osteomyelitis (12 cases or infected pseudarthrosis (19 cases by the Papineau technique was retrospectively reviewed. The initial injury was an open fracture in 24 patients and a closed fracture in 7 patients. In all cases an Ilizarov circular external fixation device was used for the stabilization of the fracture or for bone lengthening. Mean follow-up for the group was 20 months (range, 10 months to 5 years and there was successful limb salvage in all cases with eradication of infection and bone consolidation was achieved. The Ilizarov circular external fixation was removed at a mean of 18 weeks (range, 14–24 weeks. The mean time to bone union was 5 months (range, 4–10 months. All patients returned to their pre-treatment activity levels or better.

  10. Staged treatment strategy for chronic osteomyelitis%慢性骨髓炎的分期治疗策略

    Institute of Scientific and Technical Information of China (English)

    赵刚; 齐明; 张伯松; 黄雷

    2012-01-01

    Background: Chronic osteomyelitis is a difficult problem. The purpose of this article is to apply a proper method to solve it. Objective: The aim of the study is to explore the effects of application of debridement, irrigation and vacuum sealing drainage combined with implantation of calcium phosphate or cement impregnated with antibiotics in treatment of chronic osteomyelitis. Methods: From March 2008 to March 2012, 27 patients were treated by using debridement, wound irrigation and vacuum sealing drainage in the first stage, and implanted with calcium phosphate or cement loaded with antibiotics in the second stage. There were 21 males and 6 females with an average age of 38 years (range, 20 to 77 years). Osteomyelitis occurred in tibia in 17 cases, in femur in 7 cases and calcaneus in 3 cases. Results: All the patients were followed up for 27 (6-51) months on average. Of them, 25 patients were cured , but the infection in 2 cases were unfortunately uncontrolled. Conclusions: Staged treatment by means of debridment, irrigation and VSD in the first stage, and implantation calcium phosphate or cement loaded with antibiotics in the second stage, is a effective method of chronic osteomyelitis.%背景:慢性骨髓炎是骨科临床的疑难杂症之一,本文旨在探讨一种目前比较合理的治疗方式.目的:探讨运用灌洗负压引流和可吸收人工骨或者骨水泥混合抗生素分期治疗慢性骨髓炎的临床效果.方法:2008年3月至2012年3月采用一期清创灌洗负压引流,二期可吸收人工骨或者骨水泥混合抗生素植入治疗27例慢性骨髓炎患者,男21例,女6例;年龄20~77岁,平均38岁;骨髓炎发生部位:胫腓骨17例,股骨7例,跟骨3例.结果:27例患者均得到随访,随访时间6~51个月(平均27个月),25例痊愈,2例复发.结论:一期清创、灌洗负压引流,二期可吸收人工骨或者骨水泥混合抗生素治疗慢性骨髓炎可以取得良好的临床疗效.

  11. Therapy of haematogenous osteomyelitis

    DEFF Research Database (Denmark)

    Johansen, Louise Kruse; Koch, Janne; Kirketerp-Møller, Klaus;

    2013-01-01

    It is generally accepted that surgery is necessary for the proper treatment of chronic haematogenous osteomyelitis (HO) in children. However, the correct timing of surgery and the technique most effective for debridement of infectious bone tissue is debated. Theoretically, large animal models of HO...

  12. RESULTS OF THE FOSFOMYCIN APPLICATION FOR THE IMPREGNATION OF BONE REPLACEMENT MATERIALS IN THE TREATMENT OF CHRONIC OSTEOMYELITIS

    Directory of Open Access Journals (Sweden)

    V. A. Konev

    2016-01-01

    Full Text Available Aim – to evaluate in the experimental study in vitro the duration of antimicrobial activity of fosfomycin-impregnated bone cement and to study the dynamics of radiological and morphological changes depending on the local antibiotic therapy in two-stage treatment of chronic osteomyelitis in rabbits.Materials and methods. Duration of antimicrobial activity of bone cement (depuy cmw1 gentamicin with fosfomycin in vitro was studied in comparison to cements with vancomycin and controls without additional antibiotics. Presence of the lysis zone of bacterial cultures was evaluated (Staphylococcus aureus ATCC6538 and ATCC33591, Klebsiella pneumoniae ATCC33495 and Escherichia coli ATCC25922 after application of 10 μl of the solution, collected from the cement samples after incubation for 24 hours. For the in vivo experiment, Chinchilla rabbits (n = 20 with local osteomyelitis of the tibia underwent two-stage treatment where substitution of the bone defect at stage I was performed with PMMA and stage II – with the bioresorbable material based on hydroxyapatite and triclacium phosphate (ReproBone. In an experience group (n = 10 before setting osteoreplacement materials with fosfomycin (group FOSFO, and by control (n = 10 – vancomycin (group VANCO. X-ray imaging was performed on the 1st and 21st day after installation of the cement spacer, and 45th day after substitution of the spacer with the bioresorbable material. Microbiological analysis of the samples was performed intraoperatively and on the 7th, 14th day after each stage. Histological study was conducted in both groups on the 14th, 21th day after stage I and 45th day after stage II of the treatment.Results. Maximal duration of antimicrobial activity in vitro was observed in samples of PMMA with fosfomycin whereas minimal – in control samples of gentamicin-based bone cement. Relief of the infection was attained in all animals while application of fosfomycin resulted in a more

  13. Increased Risk of New-Onset Fibromyalgia Among Chronic Osteomyelitis Patients: Evidence From a Taiwan Cohort Study.

    Science.gov (United States)

    Chen, Jiunn-Horng; Muo, Chih-Hsin; Kao, Chia-Hung; Tsai, Chon-Haw; Tseng, Chun-Hung

    2017-02-01

    Chronic inflammation, which changes the neurotransmitter metabolism and kindles neuroendocrine system dysfunction in the central nervous system, might cause fibromyalgia (FM) formation. In FM patients without traditional FM risk factors, such as hypertension, hyperlipidemia, diabetes, sleep disorder, depression, and anxiety, the chronic inflammatory process is a possible risk factor for FM. Thus, we investigated whether chronic osteomyelitis (COM), a disease characterized by chronic inflammation, increases FM risk. Including data for 1 million enrollees, the Longitudinal Health Insurance Database was used, and 1,244 COM patients without FM history and 4,976 randomly selected sex- and age-matched control subjects without COM or FM history were extracted. The development of FM over a 13-year follow-up period from 1999 to 2011 was evaluated, and FM risk was estimated using the Cox proportional regression model. The aforementioned FM risk factors were more common in COM patients, who had a significantly greater FM risk than did the control subjects. Compared with those who had no associated risk factors, patients with COM had a greater FM risk than did the control subjects (adjusted hazard ratio [aHR] = 1.32, 95% confidence interval [CI], .99-1.75). Younger people had an even greater risk (age younger than 35 years: aHR = 1.58, 95% CI, 1.03-2.44; age 60 years or older: aHR = 1.03, 95% CI, .78-1.36). To our knowledge, this is the first study to link COM to an enhanced risk of FM development. The results imply that COM is a predictor of FM, suggesting that close follow-up for patients with COM is required to prevent FM, especially in younger populations.

  14. 慢性难治性骨髓炎动物模型制备与鉴定%Preparation and identification of chronic and refractory osteomyelitis animal model

    Institute of Scientific and Technical Information of China (English)

    黄金亮; 唐辉; 范新宇; 徐永清

    2012-01-01

    Objective To discuss the experimental method of preparation and identification of chronic and refractory osteomyelitis animal model. Methods The rabbit's chronic osteomyelitis model was prepared based on literature method. After the model was determined, the model animals received debridement and sensitive antibiotic treatment for 2 w. Clinical and X - ray manifestation were observed. Myeloid tissue bacterial culture and histological observation were carried out. At last, based on the histological observation, the establishment of chronic and refractory osteomyelitis model was determined. Results Ten animals had local soft tissue lump,and X - ray film showed local soft tissue swelling shadow,hyperosteogeny and low - density cavity shadow in 20 ones. The results of myeloid tissue bacterial cultures in 25 ones were positive. The histological observation of 21 ones showed chronic inflammatory changes. Conclusion The chronic and refractory osteomyelitis models of twenty one experimental animals are prepared successfully, which verifies that this method can successfully prepare animal models of chronic refractory osteomyelitis with an achievement ratio of 56. 8% .%目的 探讨慢性难治性骨髓炎动物模型制备与鉴定的实验方法.方法 根据文献方法制备兔的慢性骨髓炎模型,模型确定后,给予尽可能彻底的清创及敏感抗生素治疗2 w,再观察临床表现、大体观、X线表现以及行骨髓组织细菌培养、组织学观察,最后以组织学观察为基础,确定慢性难治性骨髓炎模型的建立.结果 10只局部出现软组织肿块,20只动物X线片提示局部软组织肿胀影、骨质增生、低密度空洞影;25只骨髓组织细菌培养阳性,21只组织学观察呈慢性炎症改变.结论 21只实验动物慢性难治性骨髓炎模型制备成功,证实此法可成功制备慢性难治性骨髓炎动物模型,成功率为56.8%.

  15. Phenol-Soluble Modulins Contribute to Early Sepsis Dissemination Not Late Local USA300-Osteomyelitis Severity in Rabbits.

    Directory of Open Access Journals (Sweden)

    Benjamin Davido

    Full Text Available In bone and joint infections (BJIs, bacterial toxins are major virulence factors: Panton-Valentine leukocidin (PVL expression leads to severe local damage, including bone distortion and abscesses, while α-hemolysin (Hla production is associated with severe sepsis-related mortality. Recently, other toxins, namely phenol-soluble modulins (PSMs expressed by community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA strain USA300 (LAC WT were shown to have ex vivo intracellular cytotoxic activity after S. aureus invasion of osteoblasts, but their in vivo contribution in a relatively PVL-sensitive osteomyelitis model remains poorly elucidated.We compared the outcomes of experimental rabbit osteomyelitises induced with pvl+hla+psms+ LAC WT and its isogenic Δpsm derivatives (LAC Δpsmα and LAC Δpsmαβhld using an inoculum of 3 × 108 CFUs. Mortality, hematogenous spread (blood culture, spleen and kidney, lung and bone involvements were assessed in two groups (non-survivors of severe sepsis and survivors sacrificed on day (D 14.Severe sepsis-related mortality tended to be lower for Δpsm derivatives (Kaplan-Meier curves, P = .06. Non-survivors' bone LAC-Δpsmα (6.9 log10 CFUs/g of bone, P = .04 or -Δpsmαβhld (6.86 log10 CFUs/g of bone, P = .014 densities were significantly higher than LAC WT (6.43 log10 CFUs/g of bone. Conversely, lung Δpsmαβhld CFUs were significantly lower than LAC WT (P = .04. LAC Δpsmα, Δpsmαβhld and WT induced similar bone damage in D14 survivors, with comparable bacterial densities (respectively: 5.89, 5.91, and 6.15 log10 CFUs/g of bone. Meanwhile, pulmonary histological scores of inflammation were significantly higher for LAC Δpsmα- and Δpsmαβhld-infected rabbits compared to LAC WT (P = .04 and .01, respectively but with comparable lung bacterial densities.Our experimental results showed that deactivating PSM peptides significantly limited bacterial dissemination from bone during the early

  16. Vertebral osteomyelitis without disc involvement

    Energy Technology Data Exchange (ETDEWEB)

    Kamani, I.; Syed, I.; Saifuddin, A. E-mail: asaifuddin@aol.com; Green, R.; MacSweeney, F

    2004-10-01

    Vertebral osteomyelitis is most commonly due to pyogenic or granulomatous infection and typically results in the combined involvement of the intervertebral disc and adjacent vertebral bodies. Non-infective causes include the related conditions of chronic recurrent multifocal osteomyelitis (CRMO) and SAPHO (synovitis, acne, pustulosis, hyperostosis, and osteitis) syndrome. Occasionally, these conditions may present purely within the vertebral body, resulting in various combinations of vertebral marrow oedema and sclerosis, destructive lesions of the vertebral body and pathological vertebral collapse, thus mimicking neoplastic disease. This review illustrates the imaging features of vertebral osteomyelitis without disc involvement, with emphasis on magnetic resonance imaging (MRI) findings.

  17. Salmonella Osteomyelitis.

    Science.gov (United States)

    McAnearney, S; McCall, D

    2015-10-01

    Salmonella infection can cause four predominant clinical syndromes: enteric fever, acute gastroenteritis, bacteraemia with or without metastatic infection, and the asymptomatic carrier state. Salmonella as an aetiological agent in osteomyelitis is essentially rare and salmonella osteomyelitis in itself is predominantly seen in patients with haemoglobinopathies such as sickle cell disease or thalassemia. There are very few cases reported in the literature in which salmonella osteomyelitis is seen in otherwise healthy individuals. We describe here a case of salmonella osteomyelitis in a young gentleman with no significant comorbidities who presented with fever and severe back pain, having returned from recent foreign travel. It is therefore important to consider uncommon pathogens in the differential diagnosis of travellers with prolonged fever and insidious symptoms.

  18. The diagnostic value of [{sup 18}F]FDG PET for the detection of chronic osteomyelitis and implant-associated infection

    Energy Technology Data Exchange (ETDEWEB)

    Wenter, Vera; Albert, Nathalie L.; Lehner, Sebastian; Fendler, Wolfgang P.; Bartenstein, Peter [University of Munich, Department of Nuclear Medicine, Munich (Germany); Mueller, Jan-Phillip; Friederichs, Jan; Militz, Matthias; Hungerer, Sven [BG Trauma Center Murnau, Murnau (Germany); PMU Salzburg, Salzburg (Austria); Cyran, Clemens C. [University of Munich, Institute for Clinical Radiology, Munich (Germany); Hacker, Marcus [University of Vienna, Department of Nuclear Medicine, Vienna (Austria); Department of Biomedical Imaging and Image-guided Therapy, Vienna (Austria)

    2016-04-15

    The diagnosis of osteomyelitis and implant-associated infections in patients with nonspecific laboratory or radiological findings is often unsatisfactory. We retrospectively evaluated the contributions of [{sup 18}F]FDG PET and [{sup 18}F]FDG PET/CT to the diagnosis of osteomyelitis and implant-associated infections, enabling timely and appropriate decision-making for further therapy options. [{sup 18}F]FDG PET or PET/CT was performed in 215 patients with suspected osteomyelitis or implant-associated infections between 2000 and 2013. We assessed the diagnostic accuracy of both modalities together and separately with reference to intraoperative microbial findings, with a mean clinical follow-up of 69 ± 49 months. Infections were diagnosed clinically in 101 of the 215 patients. PET and PET/CT scans revealed 87 true-positive, 76 true-negative, 38 false-positive, and 14 false-negative results, indicating a sensitivity of 86 %, a specificity of 67 %, a positive predictive value (PPV) of 70 %, a negative predictive value (NPV) of 84 % and an accuracy of 76 %. The sensitivity of PET/CT was 88 %, but specificity, PPV, NPV and accuracy (76 %, 76 %, 89 % and 82 %, respectively) were higher than those of stand-alone PET. [{sup 18}F]FDG PET is able to identify with high sensitivity the presence of osteomyelitis in orthopaedic surgery patients with nonspecific clinical symptoms of infection. (orig.)

  19. An initial assessment of therapeutic value of strontium 85 isotope in treatment of chronic osteomyelitis in adults; Wstepna ocena wartosci terapeutycznej izotopu strontu 85 w leczeniu przewleklego zapalenia kosci u doroslych

    Energy Technology Data Exchange (ETDEWEB)

    Wieczorek, M.; Pizio, Z.; Kotarska-Kurp, D. [Szpital MSW, Opole (Poland)]|[Wojewodzki Szpital Zespolony, Opole (Poland)

    1993-12-31

    An initial assessment of treatment of chronic osteomyelitis in 16 adults with strontium 85 is presented. A dose 3.5-5 times greater than standard scintigraphic one was administered. In 3 cases the dose has been repeated because of the persistence of infection. The radionuclide was well tolerated. In 14 cases ceasing of osteomyelitis have been achieved. Laboratory tests showed no abnormalities. (author). 6 refs, 3 figs.

  20. Osteomyelitis with proliferative periostitis: an unusual case.

    Science.gov (United States)

    Tong, Antonio C K; Ng, Irene O L; Yeung, K M Au

    2006-11-01

    Chronic osteomyelitis with subperiosteal new bone formation results from periosteal reaction to chronic inflammatory/infectious stimulation. In the maxillofacial region, it has traditionally been termed Garrè's osteomyelitis with proliferative periostitis and more recently periostitis ossificans. The term Garrè's osteomyelitis has been regarded as a misnomer by many authors in the recent literature. The term chronic osteomyelitis with proliferative periostitis, although cumbersome, is considered to be the most accurate description of the pathology. It usually affects the mandible of young patients secondary to dental infection. Management involves removal of the source of infection and antibiotic treatment. We present an unusual case of chronic osteomyelitis with proliferative periostitis affecting the mandible of a 12-year-old patient. The source of infection was related to the developing lower left third molar, which had apparently no communication with the oral cavity.

  1. Through the looking glass; bioactive glass S53P4 (BonAlive®) in the treatment of chronic osteomyelitis.

    LENUS (Irish Health Repository)

    McAndrew, J

    2013-09-01

    In terms of eradication, osteomyelitis represents one of the most challenging infective conditions in medicine and surgery. In recent years, the use of bioactive glass in conjunction with antimicrobial therapy has emerged as a viable new treatment.

  2. Maxillary osteomyelitis in two Scottish terrier dogs with chronic ulcerative paradental stomatitis.

    Science.gov (United States)

    Boutoille, Florian; Hennet, Philippe

    2011-01-01

    Two Scottish terrier dogs were presented for recurrent oral problems. They were diagnosed with refractory chronic ulcerative paradental stomatitis and necrosis of the incisive and maxillary bones. Both dogs were treated with a combination of bilateral rostral maxillectomy and tooth extractions. The ostectomy was performed with a specific cutting device using piezoelectric bone surgery technology. These two cases show that a precise evaluation of dogs is essential for the diagnose of chronic ulcerative paradental stomatitis and its differentiation from mucocutaneous autoimmune diseases.

  3. 负压封闭引流治疗慢性骨髓炎的疗效观察%Clinical observation of VSD in treatment of chronic osteomyelitis

    Institute of Scientific and Technical Information of China (English)

    李飞; 宁建; 徐爱飞

    2012-01-01

    目的 观察负压封闭引流(VSD)治疗慢性骨链炎的临床疗效.方法 12例慢性骨髓炎患者先采取病灶清除处理,再给予负压封闭引流治疗,Ⅰ期封闭创面,Ⅱ期植骨,伴有软组织缺损较多者植皮或皮瓣移植修复肢体.结果 12例患者病灶清除后创面肉芽组织生长良好,血液循环丰富,局部组织无水肿,通过Ⅱ期植骨、植皮或皮瓣移植修复,均愈合,无复发.结论 负压封闭引流治疗慢性骨髓炎疗效显著,安全可靠,值得临床推广应用.%Objective To observe the clinical efficacy of VSD in treatment of chronic osteomyelitis. Methods 12 patients with chronic osteomyelitis were first treated with debridement. then treated with VSD. Ⅰ period of wound clo-sure. Ⅱ period of transplanting bone. The limbs of soft tissue defects higher were treated with transplanting skin or transplanting flap repair. Results The granulation tissue of facial trauma in 12 patients after debridement grew well, blood circulation were rich, local tissue was no edema. Patients were healed without recurrence through Ⅱ period of transplanting bone, transplanting skin and transplanting flap repair. Conclusion The treatment of VSD for chronic osteomyelitis has a significant effect, safe and reliable. It should be worthy of clinical application.

  4. VSD在治疗急慢性骨髓炎中的应用%Application of VSD in the treatment of acute and chronic osteomyelitis

    Institute of Scientific and Technical Information of China (English)

    申运山; 贺超

    2015-01-01

    Objective To summarize the effect of Vacuum Sealing Drainage on the treatment of acute and chronic osteomyelitis. Methods Take after debridement treatment with VSD on acute and chronic osteomyelitis. Using suturing, skin-grafting and skin flap transplation to repair the wound after the granulation tissue turn to be fresh and infection was controlled. Results Most symptoms of patients were controlled soon. After 3-6 months, they get the second stage bone grafting or bone flap operation. All of the wound were healing or not infection again after 6-18 months follow-up. Conclusion VSD is one of the effective methods for the treatment of acute and chronic osteomyelitis.%目的 总结封闭式负压引流治疗急慢性骨髓炎的效果. 方法 对急慢性骨髓炎清创后应用VSD治疗,待创面肉芽组织新鲜、感染控制后,采用缝合、植皮及皮瓣修复创面. 结果 绝大多数患者症状很快得以控制,3~6个月后行二期植骨术或骨瓣转移术,术后随访6~18个月,未出现伤口不愈合或感染复发. 结论 封闭式负压引流是治疗急慢性骨髓炎的有效方法之一.

  5. The Clinical Investigated on Traditional Chinese Medicine Treatment of Chronic Osteomyelitis%中医治疗慢性骨髓炎的临床探析

    Institute of Scientific and Technical Information of China (English)

    王晓峰

    2015-01-01

    Objective The clinical efficacy of traditional Chinese medicine in treatment of chronic osteomyelitis is to be investigated. Methods Choose 84 chronic osteomyelitis patients who are treated in hospital from June 2013 to June 2014 and separate them into control group and study group according to different treatment methods. 41 patients in control group are given conventional treatment,while 43 patients in study group are given traditional Chinese medicine treatment. And then observe and compare the treatment efficacy of the two groups after treatment. Results The treatment efficiency in study group is much higher than control group;there is a treatment differential between the two groups,such a differential has statistic value(P<0.05). Conclusion The traditional Chinese medicine treatment is quite effective to cure chronic osteomyelitis with high efficiency,which is worthy to be promoted and applied clinical y.%目的:观察中医治疗对慢性骨髓炎的临床效果。方法搜集2013年6月~2014年6月我院接收的慢性骨髓炎84例患者,按照治疗方法差异分为对照组与研究组。对对照组41例实施常规治疗,对研究组43例实施中医治疗。观察并比较对照组、研究组的治疗效果。结果两组相比,研究组治疗有效率较高,有明显差异,有统计学意义(P<0.05)。结论中医治疗慢性骨髓炎的临床效果较好,有效率高。

  6. Current situation and progress in limb salvage therapy for chronic osteomyelitis%慢性骨髓炎保肢治疗现状及进展

    Institute of Scientific and Technical Information of China (English)

    王军; 李宗原; 王陶

    2014-01-01

    慢性骨髓炎治疗周期长,效果差,截肢率高,是创伤骨科临床中的难题之一。近年来保肢治疗成为慢性骨髓炎研究的热点,该文综述慢性骨髓炎保肢治疗涉及的病灶清除、骨缺损治疗、软组织覆盖、患肢骨稳定、抗生素治疗以及辅助治疗的现状及进展。%Treatment of chronic osteomyelitis is difficult in the field of orthopaedic trauma surgery, with long therapy course, poor clinical results and high amputation rate. In recent years, limb salvage has gradually become a research hotspot. In this paper, present situation and progress in limb salvage therapy for chronic osteomyelitis were reviewed, involving the aspects of debridement, treatment of bone defect, soft tissue coverage, stabilization of affected bone, antibiotic treatment and adjuvant therapy.

  7. Diode laser osteoperforation and its application to osteomyelitis treatment

    Science.gov (United States)

    Privalov, Valeriy A.; Krochek, Igor V.; Lappa, Alexander V.

    2001-10-01

    Laser osteoperforation, previously studied in experiment in rabbits at treatment for acute purulent osteomyelitis (Privalov V. et.al., SPIE Proc., v.3565., pp. 72-79), was applied in clinic to 36 patients with chronic purulent osteomyelitis and to 6 patients (children) with acute haematogenic osteomyelitis. Diode lasers of 805 and 980 nm wavelength were used. There was achieved full recovery in all acute cases, and stable remission in chronic cases during all the observation period (1 - 2.5 years).

  8. Chronic recurrent multifocal osteomyelitis (CRMO) and synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome with associated neutrophilic dermatoses: a report of seven cases and review of the literature.

    Science.gov (United States)

    Tlougan, Brook E; Podjasek, Joshua O; O'Haver, Judith; Cordova, Katherine B; Nguyen, Xuan H; Tee, Ronald; Pinckard-Hansen, Kay C; Hansen, Ronald C

    2009-01-01

    A growing body of literature has identified the association between neutrophilic dermatoses and multifocal, aseptic bone lesions in children, termed chronic recurrent multifocal osteomyelitis (CRMO). Classically, patients present with swelling, pain, and impaired mobility of the affected area, with skin lesions developing concurrently or in the future. Bone biopsy reveals inflammatory changes consistent with infectious osteomyelitis, but cultures and histologic staining invariably fail to identify an infectious source. Patients are refractory to antibiotic therapy, but dramatically respond to systemic steroids and may need to be maintained on low-dose steroids to prevent relapse. Numerous authors have suggested that CRMO and synovitis, acne, pustulosis, hyperostosis, osteitis (SAPHO) syndrome lie along the same clinical spectrum. In fact some believe that CRMO is the pediatric presentation of SAPHO. The two syndromes share numerous characteristics, including osteitis, a unifocal or multifocal presentation, hyperostosis, and pustulosis, which all occur in a generally healthy individual. Our seven patients, five of whom were diagnosed with CRMO, and two of whom were diagnosed with SAPHO syndrome further strengthen the idea that CRMO and SAPHO syndrome do indeed lie along the same clinical spectrum. In addition, we include two rare cases of pediatric Sweet's syndrome with evidence of pathergy.

  9. Garre′s sclerosing osteomyelitis

    Directory of Open Access Journals (Sweden)

    Suma R

    2007-05-01

    Full Text Available Garre′s sclerosing osteomyelitis is a specific type of chronic osteomyelitis that mainly affects children and young adults. This disease entity is well-described in dental literature and is commonly associated with an odontogenic infection resulting from dental caries. This paper describes a case of Garre′s osteomyelitis in a 10-year-old boy, in whom the condition arose following pulpoperiapical infection in relation to permanent mandibular right first molar. Clinically the patient presented with bony hard, non-tender swelling and the occlusal radiograph revealed pathognomic feature of "onion skin" appearance. The elimination of periapical infection was achieved by endodontic therapy and the complete bone remodeling was seen radiographically after three months follow-up.

  10. 持续灌洗引流治疗慢性骨髓炎护理分析%Continuous lavage drainage treatment of chronic osteomyelitis nursing analysis

    Institute of Scientific and Technical Information of China (English)

    郭云清

    2015-01-01

    目的:观察分析持续灌洗引流治疗慢性骨髓炎护理对术后恢复情况的影响,为临床治疗提供可靠依据。方法随机选取2012年—2014年分析30例慢性骨髓炎患者资料,本组患者均是先行病灶彻底清除手术,关闭创面之后进行敏感抗生素的持续灌洗引流。结果30例慢性脊髓炎经过持续灌洗引流之后,康复情况良好,并且对护理的满意度较高。结论在持续灌洗引流期间进行良好的护理,可以有效降低引流导管堵塞的概率,减少患者治疗时间,对患者康复具有积极意义。%Objective To observe the analysis of continuous irrigation drainage for the treatment of chronic osteomyelitis nursing effect on postoperative recovery, to provide reliable basis for clinical treatment.Methods Randomly selected from 2012-2014 to analyze the data of 30 cases of chronic osteomyelitis patients, all patients in the group is the first complete focal cleaning operation,continuous lavage closed wound drainage after the sensitive antibiotics.Results 30 cases of chronic inflammation of the spinal cord after continuous drainage,recovering well, and higher satisfaction with care.Conclusion Good nursing care during continuous lavage drainage, can effectively reduce the probability of the drainage catheter jam,reduce patient treatment time,the patient rehabilitation has a positive meaning.

  11. 唐汉钧教授治疗慢性骨髓炎经验%Prof. Tang Hanjun's Experience on the Treatment of Chronic Osteomyelitis

    Institute of Scientific and Technical Information of China (English)

    刘晓鸫; 赵津平; 唐汉钧

    2001-01-01

    Prof. Tang Hanjun has paid attention to the therapeutical principles of spleen strengthening, qi benefing, damp eliminating, blood-circulation activat ing, blood-stasis removing, kidney invigorating and bone strengthening for the treatment of chronic osteomyelitis, and preferred the combination of internal use and exter nal use of Chinese herbal drugs. His experience obtained a good clinical effect.%唐汉钧教授治疗慢性骨髓炎,重视健脾益气利湿、活血化瘀、补肾填精壮骨之法,采用内服、外用结合治疗本病,收到了较好的临床疗效。

  12. 郭艳幸教授治疗慢性骨髓炎经验%Experience of Professor GUO Yan-xing for treating chronic osteomyelitis

    Institute of Scientific and Technical Information of China (English)

    陈刚; 郭艳幸

    2013-01-01

    郭艳幸教授治疗慢性骨髓炎,重视清热解毒化瘀、健脾益气化湿、肝脾肾同治、动静互补平衡之法,采用内服、外用结合治疗本病,收到了较好的临床疗效。%Professor GUO Yan-xing treatment of chronic osteomyelitis, pays much attention to Qingre Jiedu, Jianpi Yiqi, treating liver, spleen and kidney together, and the complementary of static and dynamic balance, the use of oral combined with external therapy for the disease, receives a good clinical efficacy.

  13. Radionucleotide scanning in osteomyelitis

    Energy Technology Data Exchange (ETDEWEB)

    Sachs, W.; Kanat, I.O.

    1986-07-01

    Radionucleotide bone scanning can be an excellent adjunct to the standard radiograph and clinical findings in the diagnosis of osteomyelitis. Bone scans have the ability to detect osteomyelitis far in advance of the standard radiograph. The sequential use of technetium and gallium has been useful in differentiating cellulitis and osteomyelitis. Serial scanning with technetium and gallium may be used to monitor the response of osteomyelitis to antibiotic therapy.

  14. Lung abscess combined with chronic osteomyelitis of the mandible successfully treated with video-assisted thoracoscopic surgery.

    Science.gov (United States)

    Arai, Hiromasa; Inui, Kenji; Watanabe, Keisuke; Watanuki, Kei; Okudela, Koji; Tsuboi, Masahiro; Masuda, Munetaka

    2015-04-01

    With the progress of antibiotic therapy, the mortality of lung abscess has been improved, and surgical intervention has declined. However, surgery is still required in selected cases that are intractable to antibiotic treatment. Video-assisted thoracoscopic surgery (VATS) is beneficial for treatment and/or diagnosis of pulmonary disease as it provides a less invasive surgical technique and reduces prolongation of post-operative recovery. However, the indication of VATS lobectomy for lung abscess is controversial as a result of particular complications, i.e. wet lung, intrapleural adhesion and ease of bleeding. We herein report a rare combination of lung abscess and osteomyelitis of mandible resulting from the same pathogen successfully treated with VATS lobectomy. We propose VATS lobectomy for lung abscess. This procedure might be the best treatment candidate for selected cases of lung abscess.

  15. Low ifeld MRI in the differential diagnosis of chronic osteomyelitis and osteosarcoma around the knee%膝周慢性骨髓炎与骨肉瘤的低场MRI鉴别诊断

    Institute of Scientific and Technical Information of China (English)

    丁长青; 许若峰; 王文生; 孙迎迎; 罗慧; 代兰兰

    2014-01-01

    Objective:To investigate the value of low ifeld MRI in the differential diagnosis of chronic osteomyelitis with osteosarcoma around the knee.Method:A retrospective review of the 0.35T MRI data of chronic osteomyelitis (15 cases) and osteosarcoma (6 cases) confirmed clinically,the related literatures were also reviewed.Results:All patients were with bone destruction and bone sclerosis.The lesions scattered patchy distribution,“Penumbra sign”, “Sinus sign” and “Mass effusion around the bone syndrome” were more speciifc signs of chronic osteomyelitis. The lesions showed continuous distribution,presenting as “Stiff sign” and “Codman triangle sign” were more common in osteosarcoma.Conclusion:Understanding the low ifeld MRI features is helpful to the diagnosis and differential diagnosis of chronic osteomyelitis and osteosarcoma around the knee.%目的:探讨低场MRI对膝周慢性骨髓炎与骨肉瘤的鉴别诊断价值。方法:回顾性分析临床证实的膝周长骨慢性骨髓炎(15例)和骨肉瘤(6例)0.35T MRI资料并复习文献。结果:两组均有骨破坏及骨硬化。病变散在条片状分布,半影征、骨周大量积液征、窦道征为慢性骨髓炎较为特异的征象;而病变较连续分布并呈僵硬征及Codman三角征更多见于骨肉瘤。结论:熟悉膝周慢性骨髓炎与骨肉瘤的低场MRI表现特点有助于诊断及鉴别诊断。

  16. Candidal Vertebral Osteomyelitis in the Midst of Renal Disorders

    Science.gov (United States)

    Kumar, Anil; Rao, Srivatsa Nagaraja; Kumar, Krishna; Karim, Shamsul

    2016-01-01

    Vertebral osteomyelitis also known as discitis/pyogenic spondylitis refers to inflammation of the vertebral disc space. It is commonly seen in men and adults more than 50 years of age. Fungal osteomyelitis is a rare scenario compared to its bacterial counterpart. Spinal epidural abscess is a dangerous complication associated with vertebral osteomyelitis. Here, we report two cases of vertebral osteomyelitis caused by Candida tropicalis in patients with renal disorders (stage 5 chronic kidney disease and nephropathy). One of the case discussed here presented with spinal epidural abscess. Both the patients were started on antifungal therapy. One patient responded to treatment while the other was lost to follow up. PMID:27190806

  17. 清创术联合中药治疗慢性骨髓炎的效果及机制探讨%Effects of debridement plusTCM medicine on chronic osteomyelitis

    Institute of Scientific and Technical Information of China (English)

    罗换新; 王志新; 王长安; 张开; 耿昕; 张凯

    2015-01-01

    髓炎具有疗效高、复发率低的优点,调节机体免疫应答、降低炎症反应可能是其重要的机制。%Objective: To observe efficacy of the debridement plus TCM medicine on chronic osteomyelitis. Methods: 120 cases of chronic osteomyelitis were randomly divided into the study group and the control group, 60 cases for each group. The control group took conventional surgery and antibiotic treatment; the study group was added the Jiangu decoction. Results: In the study group, the cured, improved, invalid were 37 cases (61.67%), 19 cases (31.67%) and 4 cases (6.67%); In the control group those were 26 cases (43.33%), 21 cases (35.00% ) and 13 cases (21.67%); the difference was statistically significant,Z =-2.392,P=0.017. In the study group WBC, ESR, h-CRP, IL-2, IL-6 and IgG improvement were better,P=0.000. The recurrence rate were 5.4% and 26.9%,x2 = 5.885,P = 0.015. Conclusion: Debridement plus TCM medicine for chronic osteomyelitis can get high efficacy, low recurrence rate, modulation of immune response, and reduce inflammation.

  18. Preparation and evaluation of rabbit model of chronic osteomyelitis%兔慢性骨髓炎模型的建立及效果评价

    Institute of Scientific and Technical Information of China (English)

    李亮亮

    2015-01-01

    目的:探讨慢性骨髓炎动物模型的制备。方法40只新西兰大白兔采用胫骨近端髓腔内注入金黄色葡萄球菌及鱼甘油酸钠,4周后观察局部皮肤软组织情况、X线表现、细菌学检查及组织学检查。结果所有兔均出现局部软组织肿胀、窦道,34只兔出现明显的放射学改变,如骨膜反应,骨皮质溶解等,36只兔髓腔组织培养出现金黄色葡萄球菌菌落生长,病理检查可见死骨形成及大量炎性细胞浸润。结论兔胫骨近端髓腔注入金黄色葡萄球菌及鱼肝油酸钠制备慢性骨髓炎模型,方法简单、效果可靠,值得推广。%Objective To prepare and evaluate animal model of chronic osteomyelitis.Methods Forty New Zealand white rabbits were involved in the experiment and the bacterial suspension of the Staphylococcus aureus and sodium morrhuate were injected into the proximal tibial marrow cavity of the rabbits.Evaluation was done by clinical, radiologic, bacteriologic and histologic parameters after four weeks.Results All of the rabbits had local soft tissue lump and sinus.Thirty-four rabbits showed obvious radiological evi-dence, such as periosteal reaction and dissolution of cortical bone.The culture of myeloid tissue showed the growth of Staphylococcus aureus in thirty-six rabbits, the histologic observation of which indicated the development of sequestra and large amount of inflammato-ry cells.Conclusions The chronic osteomyelitis of rabbit can be induced by injecting Staphylococcus aureus and sodium morrhuate into the proximal tibial marrow cavity.This method is simple and reliable, which is worthy of promotion.

  19. 颅骨慢性骨髓炎的手术治疗%SURGICAL TREATMENT OF CHRONIC OSTEOMYELITIS OF THE SKULL

    Institute of Scientific and Technical Information of China (English)

    卢元刚; 岑瑛; 卿勇; 王怀胜

    2011-01-01

    Objective To summarize the treatment of chronic osteomyelitis of the skull and its effectiveness.Methods Between January 2004 and February 2009, 24 patients with chronic osteomyelitis of skull were diagnosed and treated, including 16 males and 8 females with an average age of 45.6 years (range, 18-56 years). The mean disease duration was 5.8 years (range, 3-11 years). The causes included infection after craniotomy in 3 cases, burn in 15 cases, and electrical injury in 6 cases, and the leision was located at the frontal and parietal of the skull in 10 cases, at the temporal and parietal of skull in 8 cases, and at the occipital of the skull in 6 cases. The soft tissue defects ranged from 7 cm × 6 cm to 19 cm × 12 cm, and the skull defects ranged from 5 cm × 4 cm to 10 cm × 7 cm. After wide thorough debridement of necrotic tissue, soft tissue defects were repaired with adjacent scalp flap in 12 cases, trapezius myocutaneous flap in 6 cases, and free anterolateral thigh flap in 6 cases; the flap size ranged from 8 cm × 7cm to 20 cm × 13 cm. The donor sites were sutured directly or covered with splitthickness skin. Results All pathological examinations showed pyogenic osteomyelitis of the skull, and localized squamous carcinoma was found in 1 case. One patient had sub-flap infection at 2 weeks after operation, and healing was achieved after surgical removal of residual tissue; the remaining flaps survived, and incision healed by first intention. All patients were followed up 10 months to 4 years with an average of 2 years after operation. The color and texture of the flaps were good. No recurrence of osteomyelitis happened during follow-up. The patient diagnosed as having localized squamous carcinoma was followed up 4 years without recurrence. At 3 to 6 months after operation, 8 patients had headache or felt dizzy, and the skull was reconstructed by the titanium meshes. Conclusion In patients with chronic osteomyelitis of skull, the infected foci should be

  20. 影像学检查在慢性骨髓炎诊断中的研究进展%Progress in imaging research on the diagnosis of chronic osteomyelitis

    Institute of Scientific and Technical Information of China (English)

    张岩; 朱彦丞; 张子韬; 邱旭升; 陈一心

    2016-01-01

    The imaging techniques have been widely used in the diagnosis of chronic osteomyelitis,including plain radiography,magnetic resonance imaging,computed tomography and radionuclide imaging.Plain radiography is useful in the early detection of suspected osteomyelitis,but its sensitivity is low.Due to its high resolution and sensitivity,MRI has been the most widely used but its specificity is relatively poor.CT is mainly recommended for diagnosis of chronic osteomyelitis in complicated anatomic regions.Radionuclide imaging will have prospects of broad application due to its diverse radiotracers and high sensitivity.This paper reviewed the research of imaging modalities in diagnosis of chronic osteomyelitis.%影像学检查在慢性骨髓炎诊断中应用广泛.目前常用方法主要有4种,分别为X线片、MRI、CT和放射性核素显像.X线片可早期发现慢性骨髓炎,但敏感度较低;MRI分辨率高,敏感度高,应用最广,但特异性较低;CT主要用于解剖定位困难部位的诊断,应用相对局限;放射性核素显像的示踪剂选择多样,其敏感度高且研究前景广.本文就影像学检查方法在慢性骨髓炎诊断中的研究作一综述.

  1. 肌皮瓣移植治疗跟骨慢性骨髓炎并皮肤缺损的护理%Nursing of the Chronic Calcaneal Osteomyelitis Combined with Soft Tissue Defect Repair with Myocutaneous Flaps

    Institute of Scientific and Technical Information of China (English)

    严若芬; 骆渊城; 于德美

    2012-01-01

    目的 探讨肌皮瓣移植治疗跟骨慢性骨髓炎并皮肤缺损的护理方法.方法 经过合理的术前指导,精心术后皮瓣血运观察,及时有效的处理血管危象,并做好持续冲洗引流的护理,观察皮瓣成活及慢性跟骨骨髓炎的愈合情况.结果 肌皮瓣移植治疗跟骨慢性骨髓炎并皮肤缺损的患者,皮瓣完全成活,伤口愈合,骨髓炎治愈无复发,患者术后功能恢复良好.结论 正确的术前指导,严格的术后观察,及时有效的处理,正确的术后持续冲洗,是肌皮瓣移植治疗跟骨慢性骨髓炎并皮肤缺损护理的关键.%Objective:Study on the nursing methods of the chronic calcaneal osteomyelitis combined with soft tissue defect repair with myocutaneous flaps Methods:By reasonable of preoperative instruction, elaborate flap blood revolve postoperative, timely and effective management of vascular crisis, and doing well the nurse of continuous irrigation, observed flap surviving and chronic calcaneal osteomyelitis healing Results:all cases transplanted myocutaneous flaps survived, the wound healed, without recurrence of calcaneal osteomyelitis. The function recovery is satisfactory. Conclusion:The key successful factors for the nursing of myocutaneous flap repairing chronic calcaneal osteomyelitis with soft tissue defect is correct preoperative instruction strict postoperative observation timely and effective management right continuous irrigation.

  2. Ciprofloxacin resistant osteomyelitis following typhoid fever

    OpenAIRE

    Ayeni, Itunuayo V; Calver, Graeme

    2012-01-01

    Salmonella typi is a rare cause of chronic osteomyelitis in a non-sickle cell patient. The authors report the case of a 25-year-old gentleman with a history of typhoid fever and an infected skin nodule on his left forearm 5 years prior to the diagnosis. He was referred to our orthopaedic colleagues with chronic osteomyelitis and underwent debridement of the bone for which samples grew Salmonella typhi. He was commenced on intravenous ceftriaxone 2 g once daily for 6 weeks followed by oral azi...

  3. Imaging in osteomyelitis: Special features in childhood; Bildgebung bei Osteomyelitis: Besonderheiten im Kindesalter

    Energy Technology Data Exchange (ETDEWEB)

    Wandl-Vergesslich, K.A. [UOG MR-Einrichtung, Univ. Wien (Austria); Breitenseher, M. [UOG MR-Einrichtung, Univ. Wien (Austria); Fotter, R. [Universitaetsklinik fuer Radiologie und Zentralroentgeninstitut, Graz (Austria)

    1996-10-01

    The prognosis of acute hematogenous osteomyelitis in children ist mainly influenced by early diagnosis and prompt initiation of antibiotic and surgical therapy. In this age group, two forms of manifestation are differentiated: Osteomyelitis in infants up to 18 months and juvenile osteomyelitis until the closure of the epiphyseal plate. Osteomyelitis in infants is often accompanied by septic arthritis of the adjacent joint. In juvenile osteomyelitis, the disease is mostly confined to the metaphysis. Plain films and ultrasonography represent the basic imaging modalities. Depending on the age of the child, the clinical course of the disease and the availability of the various methods, MRI and multiphase bone scintigraphy can be performed for further imaging. CT is of only limited value and should only be used for special cases concerning chronic osteomyelitis. (orig.) [Deutsch] Die fruehzeitige Diagnose und das prompte Einsetzen der antibiotischen und chirurgischen Therapie sind fuer die Prognose der akuten hematogenen Osteomyelitis im Kindesalter von entscheidender Bedeutung. In dieser Altersgruppe werden 2 Manifestationsformen unterschieden. Die vor Beendigung des 18. Lebensmonats auftretende Saeuglingsosteomyelitis und die danach bis zum Schluss der Epiphysenfuge in Erscheinung tretende juvenile Form. Bei der Saeuglingsosteomyelitis kommt es in vielen Faellen zu einem Befall des benachbarten Gelenks, bei der juvenilen Osteomyelitis bleibt der primaere Befall fast immer auf die Metaphyse beschraenkt. Die Eckpfeiler der Bildgebung stellen das Nativroentgen und die Ultraschalluntersuchung dar. Je nach Alter des Kindes, klinischem Verlauf und Verfuegbarkeit der Methoden stehen MRT und die Dreiphasenknochenszintigraphie als weiterfuehrende Untersuchungsmethoden zur Verfuegung. Die CT hat begrenzte Aussagekraft und sollte nur besonderen klinischen Fragestellungen im Rahmen einer chronischen Osteomyelitis vorbehalten bleiben. (orig.)

  4. The one-stage surgical treatment of traumatic chronic osteomyelitis on the calcaneus%一期手术治疗跟骨创伤性慢性骨髓炎

    Institute of Scientific and Technical Information of China (English)

    陈琴; 黄凯

    2016-01-01

    目的:探讨腓动脉穿支(肌)皮瓣联合载抗生素人工骨一期治疗跟骨创伤性慢性骨髓炎的临床疗效。方法对32例跟骨创伤性慢性骨髓炎患者在一期扩创彻底清除骨髓炎病灶的基础上采用载抗生素人工骨植骨抗感染、切取腓动动脉穿支(肌)皮瓣覆盖创面的方式修复治疗。结果患者均获得随访,时间6~32个月。皮瓣均成活,外观形态良好。骨髓炎无复发情况,骨折愈合情况良好,无畸形愈合,骨性愈合时间为6~9.8个月。结论腓动脉穿支(肌)皮瓣联合载抗生素人工骨一期治疗跟骨创伤性慢性骨髓炎是治疗创伤性慢性骨髓炎较理想的方法。%Objective To discuss the clinical efficacy of debridement, peroneal artery perforator ( muscle) flap com-bined with bone substitute contained antibiotics one-stage treatment of traumatic chronic osteomyelitis on the calcane-us. Methods On the basis of debridement and complete removal of the osteomyelitis lesion,32 cases of patients with traumatic chronic osteomyelitis on the calcaneus were used bone graft contained antibiotics anti-infective, peroneal ar-tery perforator ( muscle) flap to cover the wound. Results All 32 patients were followed up for 6~32 months. Pa-tients with skin flap were survival, with good shape, no recurrence of osteomyelitis. Fracture got healing well, no de-formity healing occurred, bony healing time was 6~9. 8 months. Conclusions Peroneal artery perforators ( muscle) flap combined with bone contained antibiotics one-stage treatment of traumatic chronic osteomyelitis on the calcaneus is an ideal method.

  5. Diabetic foot ulceration with osteomyelitis: the importance of early detection

    OpenAIRE

    Tranter, Jennifer; McIntosh, Caroline

    2008-01-01

    This case study explores the\\ud management of a chronic diabetic\\ud foot ulcer complicated by severe\\ud soft tissue infection (cellulitis) and\\ud bony infection (osteomyelitis) in a\\ud patient with type 2 diabetes.

  6. [Spiral computed tomography in the diagnosis of limb osteomyelitis].

    Science.gov (United States)

    Vasil'ev, A Iu; Bulanova, T V; Onishchenko, M P

    2003-01-01

    The results of radiation studies in 121 patients of different age (4 to 75 years) examined for limb osteomyelitis are analyzed. All the patients underwent routine X-ray study and computed tomography (CT), 26 patients had X-ray fistulography; 8, linear tomography; 10, CT fistulography; 6, scintigraphy, and 15, ultrasound study. Acute hematogenous osteomyelitis (AHO), chronic hematogenous osteomyelitis (CHO), and atypical (here Garre's sclerosing osteomyelitis and Brodie's abscess) osteomyelitis were ascertained in 10.6, 26.4, and 10.1% of cases, respectively. Posttraumatic osteomyelitis was diagnosed in almost 50% of the patients. CT defined the phase of chronic limb osteomyelitis. Spiral CT has proven to be the most effective technique for diagnosing limb osteomyelitis as compared with routine X-ray study: the accuracy of X-ray study was 81.8%, its sensitivity, 84.9%, and specificity, 60.0% and those of computed tomography were 96.7, 99.1, and 80.0%, respectively.

  7. Amebic osteomyelitis in an immunocompromised patient.

    Science.gov (United States)

    Breland, Matthew; Beckmann, Nicholas

    2016-09-01

    Acanthamoeba spp. are pathogenic protozoa that are uncommonly encountered. They tend to infect immunocompromised patients, most often causing cutaneous lesions and in some instances granulomatous amebic encephalitis, as well as rare instances of dissemination to other organs. We present a case of amebic osteomyelitis of the fibula in a patient with rejection of a transplanted kidney who was chronically immune-suppressed.

  8. Facial osteomyelitis as complication of chronic sinusitis in hemophiliac-AIDS patients - scintigraphic evaluation with technetium-99m-MDP and Gallium-67; Osteomielitis da face como complicacao de sinusite cronica em hemofilicos aideticos - avaliacao cintilografica com {sup 99m} Tc-MDP e {sup 67} Ga

    Energy Technology Data Exchange (ETDEWEB)

    Marques, Marise da Penha Costa [Universidade Federal, Rio de Janeiro, RJ (Brazil). Faculdade de Medicina. Dept. de Otorrinolaringologia e Oftalmologia; Wolosker, Sara [Universidade Federal, Rio de Janeiro, RJ (Brazil). Faculdade de Medicina. Dept. de Radiologia; Marchiori, Edson [Universidade Federal Fluminense, Niteroi, RJ (Brazil). Dept. de Radiologia

    1997-01-01

    In the paper six cases of facial osteomyelitis as a complication of chronic sinusitis in hemophiliac-AIDS patients are reported. Osteomyelitis was suggested by an increasing of erythrocyte sedimentation rate. The diagnosis was confirmed by a positive {sup 99m} Tc MDP scintigraphy. The patients were submitted to clinical treatment. The erythrocyte sedimentation rate and 67-gallium citrate scans were used in the follow-up of the therapy. Three patients had negative gallium after three weeks of organism-specific antibiotic therapy; in two patients the gallium scintigraphy remained positive. One patient did not undergo the radionuclide scan for this clinical conditions. These results suggest that MDP scans showed higher sensitivity and specificity in detection of bone disease in chronic sinusitis. Gallium scans appeared to be valuable tool in the follow-up of the infection. There are no reports in the literature of osteomyelitis as a complication of chronic sinusitis in AIDS patient. (author) 43 refs., 4 figs.

  9. 负压治疗技术在急、慢性骨感染中的应用%Treatment of acute and chronic osteomyelitis with negative pressure wound therapy

    Institute of Scientific and Technical Information of China (English)

    谭延斌; 李杭; 潘志军; 郑强; 李建兵; 冯钢

    2008-01-01

    Objective To investigate the treatment of acute and chronic osteomyelitis with negative pressure wound therapy.Method Thirty cases of acute and chronic osteomyelitis were treated with negative presage wound therapy,assisted with debridement,autodermoplasty and myo-cutaneous flap surgery.Results No evidence of relapse was found in all cases treated with negative pressure wound thempy.All the patients were followed up,range from 6 to 23 months,the average was 13.6 months.Condusion The negative pressure wound thempy maybe a simple,effective and inexpensive method,and could be one of the favorable therapy in the treatment of acute and chronic osteomyelitis.%目的 探讨负压治疗技术在治疗急、慢性骨感染中的价值.方法 采用负压治疗技术.即在一段时间内将伤口置于密闭强力负压状态,治疗急、慢性骨感染患者30例(33个部位),辅助清创手术,应用敏感抗生素,应用植皮、肌皮瓣转移等方法闭合创面.结果 29个部位通过1次负压治疗就可达到创面闭合条件.所有患者均获随访,随访时间6~23个月,平均13.6个月,感染无复发.结论 负压治疗技术能有效控制急、慢性骨感染,缩短治疗时间,在骨感染治疗中有较好的应用前景.

  10. Analysis of pathogens and drug sensitivity on 87 cases of chronic suppurative osteomyelitis%87例慢性化脓性骨髓炎病原菌构成及药敏分析

    Institute of Scientific and Technical Information of China (English)

    陈爱宝; 龚琦; 宋建辉; 曾国庆

    2012-01-01

    Objective To analyse constitutes strains of pathogenic bacteria and drug sensitivity test of 87 cases of chronic suppurative osteomyelitis. Methods Bacteria culture and drug sensitive test were performed by taking sinus secretions or tissue in deep focus of infection from patients with chronic suppurative osteomyelitis. Results A total of 120 strains of pathogenic bacteria were isolated. From high to low infection rate the top 3 bacteria as Staphylococcus aureus ( 30% ), Pseudomonas aeruginosa (25% ), Escherichia coli ( 14.2% ). Vancomycin, imipenem were the highest rate of sensitive drug. Conclusion The main pathogens of chronic suppurative osteomyelitis were composed with Staphylococcus aureus, Pseudomonas aeruginosa. Drug sensitive test is the important basis for selection of antibiotics.%目的 分析87 例慢性化脓性骨髓炎的病原菌菌种构成、药敏实验结果.方法 取慢性化脓性骨髓炎患者窦道深部分泌物或病灶组织做细菌培养及药敏试验.结果 共培养出病原菌120 株,感染率由高到低前三位菌为金黄色葡萄球菌(占30%)、铜绿假单胞菌(占25%)、大肠埃希菌(占14.2%).万古霉素、亚胺培南是敏感率最高药物.结论 慢性化脓性骨髓炎的病原菌构成以金黄色葡萄球菌、铜绿假单胞菌为主,药敏试验是选用抗菌药物的重要依据.

  11. Recommendations for the treatment of osteomyelitis.

    Science.gov (United States)

    Lima, Ana Lucia L; Oliveira, Priscila R; Carvalho, Vladimir C; Cimerman, Sergio; Savio, Eduardo

    2014-01-01

    With the advances in surgical treatment, antibiotic therapy and the current resources for accurate diagnosis and differentiated approaches to each type of osteomyelitis, better results are being obtained in the treatment of this disease. After a careful literature review carried out by a multiprofessional team, some conclusions were made in order to guide medical approach to different types of osteomyelitis, aiming to obtain better clinical outcomes and reducing the social costs of this disease. Acute and chronic osteomyelitis are discussed, with presentation of the general epidemiological concepts and the commonly used classification systems. The main guidelines for the clinical, laboratory and imaging diagnosis of infections are discussed, as well as the guidelines for surgical and antimicrobial treatments, and the role of hyperbaric oxygen as adjuvant therapy.

  12. Charcot foot and ankle with osteomyelitis

    Directory of Open Access Journals (Sweden)

    Ryan Donegan

    2013-10-01

    Full Text Available This paper presents a review of the current literature discussing topics of Charcot osteoarthropathy, osteomyelitis, diagnosing osteomyelitis, antibiotic management of osteomyelitis, and treatment strategies for management of Charcot osteoarthropathy with concurrent osteomyelitis.

  13. Low-cost antibiotic delivery system for the treatment of osteomyelitis in developing countries

    NARCIS (Netherlands)

    Rasyid, Hermawan Nagar

    2009-01-01

    Although application of biomaterials has been one of the major assets in modern medicine to improve the quality of life of patients, occurrence of a chronic osteomyelitis is still a serious health threat to the individual patient. Chronic osteomyelitis can result in morbidity affecting the viability

  14. Periostitis ossificans (Garrè's osteomyelitis): An unusual case.

    Science.gov (United States)

    Singh, Deepesh; Subramaniam, Priya; Bhayya, Panduranga Deepak

    2015-01-01

    Garrè's sclerosing osteomyelitis is a specific type of chronic osteomyelitis that mainly affects children and young adults and is commonly associated with odontogenic infection. The paper describes an unusual case of Garrè's osteomyelitis in an 11-year-old boy, in whom the condition arose following poor oral hygiene and periodontal problems in relation to permanent mandibular left first molar. Clinically the patient presented with bony hard, nontender swelling and the occlusal radiograph revealed pathognomic feature of "onion skin" appearance.

  15. Utilization Analysis of Traditional Patent Chinese Drugs in 116 Cases of Chronic Osteomyelitis%116例慢性骨髓炎患者中成药应用情况分析

    Institute of Scientific and Technical Information of China (English)

    雷凯君

    2011-01-01

    Objective To evaluate the utilization status of traditional patent Chinese drugs in chronic osteomyelitis patients in our hospital.Methods The orthopedic use status of traditional patent Chinese drugs with chronic osteomyelitis in our hospital during January to December 2009 was analyzed retrospectively and statistically. Results Among all patients in this study, the use rale of traditional patent Chinese drugs was 100%.Conclusion The utilization of traditional Chinese drugs in our hospital as TCM hospital is reasonable. But some problems such as inappropriate us and too long duration of administration exist, which should be further standardized.%目的 评价医院骨科慢性骨髓炎患者中成药应用情况.方法 回顾性调查2009年1月至2009年12月骨科慢性骨髓炎患者中成药应用资料.结果 中成药使用率为100%.结论 中成药使用情况较合理,但仍存在用药不当、用药时间长等问题,需进一步规范.

  16. I期植骨与抗生素灌洗引流治疗慢性骨髓炎%Drainage in the Treatment of Chronic Osteomyelitis with Antibi Ootics Lavage I Stage Bone Grafting

    Institute of Scientific and Technical Information of China (English)

    王福大; 王雪明; 常海林; 马启东

    2015-01-01

    Objective To investigate the thorough debridement of the lesion after one-stage bone grafting and antibiotic lavage clinical ef icacy in the treatment of chronic osteomyelitis. Methods 22 cases of chronic osteomyelitis patients underwent thorough debridement, intraoperative one-stage bone grafting, and on the basis of bacterial culture and drug sensitivity test results, and the sensitive antibiotic solution catheter for closed negative pressure drainage in the treatment of continuous ir igation. Results The 22 patients, 21 cases (95.5%) infection is cured and obtained bone healing; 1 cases (4.5%) of patients with recur ent infection. Fol ow up of 1.5 months to 5 years, average 3.25 years. Conclusion Postoperative osteomyelitis radical debridement, I combined with bone graft for treatment of antibiotic solution lavage continuous negative pressure drainage, can cure rate and bone healing rate of postoperative infection for more than 95%, stable short term and long term ef ect. Is an ef ective clinical method of radical osteomyelitis.%目的探讨彻底病灶清除术后I期植骨与抗生素灌洗引流治疗慢性骨髓炎的临床疗效。方法对22例慢性骨髓炎患者行彻底病灶清除术,术中I期自体骨植骨,并依据细菌培养和药物敏感试验结果,联和敏感抗生素溶液置管行闭式持续灌洗负压引流术治疗。结果22例患者中,21例(95.5豫)感染治愈并获得骨愈合;1例(4.5豫)患者感染复发。随访时间1.5个月~5年,平均3.25年。结论骨髓炎病灶彻底清除术后,I期植骨联合抗生素溶液持续灌洗负压引流术治疗,可以获得95豫以上的术后感染治愈率及骨性愈合率,近远期疗效稳定。是根治骨髓炎的有效临床方法。

  17. 庆大霉素-壳聚糖纳米粒治疗兔慢性骨髓炎的实验研究%Study of treatment of chronic osteomyelitis of rabbit with gentamicin loaded chitosan nanospheres

    Institute of Scientific and Technical Information of China (English)

    李亮亮; 王黎明; 金成哲; 徐燕; 唐成

    2012-01-01

    目的:探讨庆大霉素-壳聚糖纳米粒(gentamicin loaded chitosan nanospheres,GS/CS NPs)对兔慢性胫骨骨髓炎的治疗作用.方法:取48只兔制作慢性胫骨骨髓炎模型,造模3周后行大体观察及患肢X线检查.44只兔造模成功后行不同治疗,A组:未特殊治疗;B组:患肢髓腔壳聚糖纳米粒填塞;C组:患肢髓腔庆大霉素粉末填塞;D组:患肢髓腔GS/CS NPs填塞.治疗3周后行患肢X线片检查及Norden评分、髓腔大体观及髓腔内容物细菌学培养,患肢标本行组织学观察及Smeltzer病理评分.结果:治疗3周后A、B、C组均出现明显的慢性骨髓炎X线表现,髓腔脓肿形成,髓腔内容物细菌学培养阳性,组织学观察示中性粒细胞浸润、骨小梁破坏,A、B组尚可见死骨形成,D组治疗后未见明显阳性表现.Norden评分D组较A、B、C组均有统计学意义(P<0.05),Smeltzer病理评分D组较A、B、C组均有统计学意义(P<0.05).结论:庆大霉素-壳聚糖纳米粒作为局部释药系统治疗兔慢性骨髓炎具有良好的效果.%Objective; To investigate the effect of gentamicin loaded chitosan nanospheres(GS/CS NPs) on the treatment of chronic osteomyelitis of rabbit. Methods: Forty-eight rabbits were used to establish the chronic osteomyelitis model,and observation of affected limb and X-ray were done 3 weeks later. Forty-four rabbits had symptoms and signs of chronic osteomyelitis and were divided into 4 groups. Group A has no treatment,group B was treated with chitosan nanospheres,group C was treated with gentamicin sulfate, and group D was treated with GS/CS NPs. The X-Ray,observation of the bone marrow cavity,bacterial culture and the HE staining were done after 3 weeks of treatment. Results-. After 3 weeks of treatment,the X-Ray of groups A~C showed apparent signs of chronic osteomyelitis,the formation of abscess were observed in bone marrow cavity,and the cultures of the Staphylococcus aureus were positive. The HE staining of

  18. Chronic bacterial osteomyelitis: prospective comparison of {sup 18}F-FDG imaging with a dual-head coincidence camera and {sup 111}In-labelled autologous leucocyte scintigraphy

    Energy Technology Data Exchange (ETDEWEB)

    Meller, J.; Siefker, U.; Lehmann, K.; Meyer, I.; Schreiber, K.; Altenvoerde, G.; Becker, W. [Goettingen Univ. (Germany). Abt. fuer Nuklearmedizin; Koester, G. [Dept. of Orthopedics, Goettingen Univ. (Germany); Liersch, T. [Dept. of Traumatic Surgery, Goettingen Univ. (Germany)

    2002-01-01

    Indium-111-labelled white blood cells ({sup 111}In-WBCs) are currently considered the tracer of choice in the diagnostic work-up of suspected active chronic osteomyelitis (COM). Previous studies in a limited number of patients, performed with dedicated PET systems, have shown that [{sup 18}F]2'-deoxy-2-fluoro-D-glucose (FDG) imaging may offer at least similar diagnostic accuracy. The aim of this prospective study was to compare FDG imaging with a dual-head coincidence camera (DHCC) and {sup 111}In-WBC imaging in patients with suspected COM. Thirty consecutive non-diabetic patients with possible COM underwent combined skeletal scintigraphy (30/30 patients), {sup 111}In-WBC imaging (28/30 patients) and FDG-PET with a DHCC (30/30 patients). During diagnostic work-up, COM was proven in 11/36 regions of suspected skeletal infection and subsequently excluded in 25/36 regions. In addition, soft tissue infection was present in five patients and septic arthritis in three. {sup 111}In-WBC imaging in 28 patients was true positive in 2/11 regions with proven COM and true negative in 21/23 regions without further evidence of COM. False-positive results occurred in two regions and false-negative results in nine regions suspected for COM. Most of the false-negative results (7/9) occurred in the central skeleton. If the analysis was restricted to the 18 regions with available histology (n=17) or culture (n=1), {sup 111}In-WBC imaging was true positive in 2/18 regions, true negative in 8/18 regions, false negative in 7/18 regions and false positive in 1/18 regions. FDG-DHCC imaging was true positive in 11/11 regions with proven COM and true negative in 23/25 regions without further evidence of COM. False-positive results occurred in two regions. If the analysis was restricted to the 19 regions with available histology (n=18) or culture (n=1), FDG-DHCC imaging was true positive in 9/9 regions with proven COM and true negative in 10/10 regions without further evidence of COM. It

  19. Micro Data: Wearable Devices Contribute to Improved Chronic Disease Management.

    Science.gov (United States)

    Bianchi, Andria; Parke, Bob

    2016-01-01

    Issues involving chronic disease prevention and management (CDPM) are prevalent in today's aging society, and suggestions for improvement are essential to treat this patient demographic effectively. This article addresses the use of wearable devices for the medical community to improve CDPM by relying on the accumulation of micro data. For the patient, we recognize that these devices can be an effective tool to facilitate real-time monitoring of their vital signs and activity levels. With real-time monitoring and earlier responses, individuals can benefit by preventing, delaying or reducing exacerbations of chronic diseases. Use of these devices also has great benefit to the person and has the potential to decrease the individual's emergency room visits, hospital admissions and re-admissions. As patients and their healthcare providers work together to identify cumulative trends in their micro data, transitions in care planning will be enhanced, further contributing to improved chronic disease management.

  20. MRI Features and Diagnostic Utility of Chronic Osteomyelitis%慢性骨髓炎的MRI表现及诊断价值

    Institute of Scientific and Technical Information of China (English)

    钟文美

    2013-01-01

    目的 分析慢性骨髓炎的MRI表现,探讨MRI的诊断价值.方法 对经手术病理证实的11例慢性骨髓炎进行回顾性分析,均行患侧骨X线平片及MR检查,其中6例同时行MR增强扫描检查.结果 11例慢性骨髓炎中,6例位于股骨,2例位于肱骨,2例位于胫骨,1例位于锁骨;MRI显示病变多位于骨干近干骺端,范围广泛,边缘模糊,骨干增粗、部分变形,骨皮质多不规则增厚,边缘毛糙;8例骨髓腔内可见脓肿形成,TlWI呈低或等信号,T2WI呈高信号,壁厚,边缘稍模糊,增强扫描明显环形强化,脓肿周围骨松质内可见片状长T1长T2信号,边界模糊;1例局部可见软组织团块影,T1WI呈低信号,T2WI呈高低混杂信号,增强扫描明显不均匀强化;2例见肉芽肿形成,T1WI呈等信号,T2WI呈高信号,其中1例中央可见不规则长T1稍长T2信号坏死区,增强扫描实性部分明显强化,坏死区不强化;3例病例可见死骨形成,4例见骨膜水肿,2例见骨膜增厚,5例见骨膜新生骨形成,3例见窦道形成,1例见骨包壳形成;周围肌肉间隙模糊,内均可见条索状或片状长T1长T2信号.本组中,10例患者MRI诊断明确,1例同时不除外骨纤维结构不良.结论 MRI显示慢性骨髓炎的脓肿、骨膜反应、周围软组织改变及窦道优于X线,对指导临床治疗及进行疗效评价有较大的应用价值.%Objective To analyse the MRI features of chronic osteomyelitis and evaluate the diagnostic utility of MRI for diagnosing it. Methods The X-ray and MR plain images of 11 cases with chronic osteomyelitis confirmed by surgery and pathology were analyzed retrospectively. At the same time,6 cases received post-contrast MR exams. Result Among all the 11 cases,6 lesions located at thighbones,2 humeri,2 tibias,l clavical. MRI images show that most of cases were located at blackbone nearby metaphysic with wide range and blurred boundary. The blackbone thicken and some of them were out of shape,.Bone cortex

  1. Osteomielitis crónica supurativa en el maxilar superior: reporte de un caso clínico Chronic osteomyelitis suppurative in the maxilar superior: report of a clinical case

    Directory of Open Access Journals (Sweden)

    L.N. Souza

    2010-12-01

    Full Text Available La Osteomielitis es una infección del tejido óseo que involucra a todas las estructuras del hueso provocada por microorganismos. El cuadro clínico se caracteriza generalmente por la presencia de fístula de drenaje, dolor intenso, inflamación, movilidad de los dientes involucrados en la zona afectada, fiebre y edema. El tratamiento consiste en medicamentoso y/o quirúrgico. En este artículo se presenta un caso de Osteomielitis crónica supurativa en el maxilar superior, que acomete a un paciente del sexo femenino de 82 años, en el cual se discuten los aspectos diagnósticos e histopatológicos como el tratamiento correspondiente del caso.Osteomyelitis is an infection of bone tissue that involves all structures of the bone caused by microorganisms. The clinical picture is generally characterized by the presence of fistula drainage, severe pain, swelling, mobility of teeth involved in the affected area, fever and edema. Treatment involves medication and / or surgery. This article presents a case of chronic suppurative osteomyelitis in the maxilar superior of a female 82 years old patient, as well as a discussion of clinical and histopathological aspects and the treatment employed.

  2. Osteomyelitis in horses.

    Science.gov (United States)

    Goodrich, Laurie R

    2006-08-01

    Much has been learned in the past decade about osteomyelitis. The inhibitory mechanisms of the "biofilm slime" layer that is formed by bacterial extracapsular exopolysaccharides and binds to bone, joints, and implants are now better understood than in the past. The surface colonization of bacteria that occurs within these biofilms is a biologic phenomenon that is somewhat unique to orthopedic infections. This survival strategy of bacteria is effective, and it is important for veterinarians who treat osteomyelitis to be aware of current diagnostic and therapeutic treatment modalities. The practitioner should be aware of the most common bacteria associated with osteomyelitis and the traditional treatments that are still used. Current therapeutic treatment modalities, such as antibiotic- impregnated polymethylmethacrylate, antibiotic-impregnated plaster of Paris, and regional perfusion, have become routine, however, and have been responsible for improving the prevention and outcome of osteomyelitis in the horse. It is the intent of this article to make equine veterinarians aware of current information as well as the future treatments of osteomyelitis.

  3. Treatment of Chronic Tibial Osteomyelitis Using External Fixation with Debridement and vacuum Sealing Drainage%外固定架结合 VSD 治疗慢性胫骨骨髓炎

    Institute of Scientific and Technical Information of China (English)

    张清华; 刘正; 张光武; 刘家帮

    2015-01-01

    目的:探讨外固定架结合彻底清创、真空负压引流术(vacuum sealing drainage,VSD)治疗慢性胫骨骨髓炎的疗效。方法2009年1月至2012年12月,采用外固定架结合彻底清创、真空负压引流方法治疗慢性胫骨骨髓炎69例,男62例,女7例。通过观察创面愈合情况、有无复发等指标评估疗效。结果清创术后13~42 d(平均23.3 d),67例患者感染得到控制,创面愈合,感染控制率97%,随访6~34个月(平均17. 4个月),无复发;2例患者多次行清创和真空负压引流术,感染无法控制,最终行截肢手术。结论外固定架结合彻底清创、真空负压引流术是治疗慢性胫骨骨髓炎的有效方法。%Objective To explore the therapeutic effect of chronic tibial osteomyelitis with external fixator,debridement and vacuum sealing drainage. Methods From January 2009 to December 2012,69 patients with chronic tibial osteomyelitis were treated by external fixation ,debridement and vacuum sealing drainage. Through the long - term following up,analyze its curative effect. Results Postoperation 13 to 42 days(mean 23. 3 days),the infection were cured in 67cases with sinus disap-peared and wound healing,the recovery rate of infection is 97% ,no relapse or fracture occurred during 6 to 34 months(aver-age of 17. 4 months)follow - up. Two patients after multiple(2 to 7,mean 4. 2)debridement and vacuum sealing drainage,in-fection can not be controlled,and amputation surgery were ultimately carried out. Conclusion External fixator combined de-bridement,vacuum drainage technique is an effective method for the treatment of chronic tibial osteomyelitis.

  4. A Case of Pediatric Q Fever Osteomyelitis Managed Without Antibiotics.

    Science.gov (United States)

    Khatami, Ameneh; Sparks, Rebecca T; Marais, Ben J

    2015-12-01

    Q fever osteomyelitis, caused by infection with Coxiella burnetti, is rare but should be included in the differential diagnosis of children with culture-negative osteomyelitis, particularly if there is a history of contact with farm animals, and/or granulomatous change on histologic examination of a bone biopsy specimen. We describe a case of Q fever osteomyelitis in a 6-year-old boy in which a decision was made not to treat the patient with combination antimicrobial agents, balancing possible risks of recurrence against potential side effects of prolonged antibiotic treatment. The patient had undergone surgical debridement of a single lesion and was completely asymptomatic after recovery from surgery. This case suggests that a conservative approach of watchful waiting in an asymptomatic patient with chronic Q fever osteomyelitis may be warranted in select cases when close follow-up is possible.

  5. Amebic osteomyelitis in an immunocompromised patient

    Directory of Open Access Journals (Sweden)

    Matthew Breland, MD

    2016-09-01

    Full Text Available Acanthamoeba spp. are pathogenic protozoa that are uncommonly encountered. They tend to infect immunocompromised patients, most often causing cutaneous lesions and in some instances granulomatous amebic encephalitis, as well as rare instances of dissemination to other organs. We present a case of amebic osteomyelitis of the fibula in a patient with rejection of a transplanted kidney who was chronically immune-suppressed.

  6. A history of osteomyelitis from the Journal of Bone and Joint Surgery: 1948 TO 2006.

    Science.gov (United States)

    Klenerman, L

    2007-05-01

    Osteomyelitis is one of the oldest diseases known. It took many years before the acute infection could be brought under control with antibiotics and chronic osteomyelitis remains difficult to manage. The modern history of the disease is reflected in the pages of the Journal of Bone and Joint Surgery.

  7. 慢性骨髓炎患者焦虑抑郁的心理分析及其健康教育干预%Psychological Analysis of Chronic Osteomyelitis Patients With Anxiety and Depression and its Health Education Intervention

    Institute of Scientific and Technical Information of China (English)

    程杏云; 张瑞; 朱金水

    2016-01-01

    Objective To analyze the causes of chronic osteomyelitis with anxiety and depression in patients with psychological, take interventions to improve the health level of nurses.Methods The anxiety and depression self rating scale (SAS), and self rating scale (SDS) of 480 chronic osteomyelitis patients with anxiety and depression status in Shanghai City were taken as random sampling, analysis of causes, the symptoms of anxiety and depression, take early psychological intervention measures of health education. The intervention before and after the anxiety depression psychological changes.ResultsThe intervention before the scores of SAS and SDS, respectively (72.23±5.18) and (56.28.12±3.12) points, and after the intervention respectively (28.19±2.17) and (19.369±1.29), compared with before intervention, there was significant difference (P<0.01).Conclusion Chronic osteomyelitis patients facing a marital, low economic treatment, work and life stress, anxiety and depression of adverse psychologological seriously affected the mental health, the mental health education intervention, help to improve the physical and mental health and quality of nursing care of patients with chronic osteomyelitis.%目的:分析慢性骨髓炎患者焦虑抑郁心理产生的原因,采取针对性的干预措施,提高护士健康水平。方法采用焦虑抑郁自评量表(SAS)及自评量表(SDS)对上海市480名慢性骨髓炎患者的焦虑抑郁状况进行随机抽查,分析其焦虑抑郁的原因,采取早期心理健康教育干预措施,比较其干预前后焦虑抑郁心理的变化。结果干预前SAS、SDS评分分别为(72.23±5.18)分和(56.28.12±3.12)分,干预后分别为(28.19±2.17)分和(19.369±1.29)分,与干预前比较,差异有统计学意义(P<0.01)。结论慢性骨髓炎患者面临婚姻问题,经济待遇低,工作及生活压力等,焦虑抑郁不良心理严重影响其心理健康,通过健康心

  8. Osteomyelitis in turkeys

    Science.gov (United States)

    Turkey osteomyelitis complex (TOC) is a condition in which apparently healthy, usually male birds have infections that are hidden in their bones, joints, and muscles. Some of these birds have a green liver, which provides a method for detecting these carcasses in the processing plant. Our research h...

  9. Lymfom fejltolket som osteomyelitis

    DEFF Research Database (Denmark)

    Brand, Eske; Klit, Jakob

    2015-01-01

    Patients are admitted based on a tentative diagnosis. If that is incorrect it may have negative consequences for the patient and the system. In this case we present an eight-month elucidation with several diagnostic procedures with a tentative diagnosis of osteomyelitis. This diagnosis was kept...

  10. Ciprofloxacin resistant osteomyelitis following typhoid fever.

    Science.gov (United States)

    Ayeni, Itunuayo V; Calver, Graeme

    2012-07-13

    Salmonella typi is a rare cause of chronic osteomyelitis in a non-sickle cell patient. The authors report the case of a 25-year-old gentleman with a history of typhoid fever and an infected skin nodule on his left forearm 5 years prior to the diagnosis. He was referred to our orthopaedic colleagues with chronic osteomyelitis and underwent debridement of the bone for which samples grew Salmonella typhi. He was commenced on intravenous ceftriaxone 2 g once daily for 6 weeks followed by oral azithromycin 500 mg once daily for a further 6 weeks. The purpose of this case report is to consider the possible mode for antibiotic resistance. In this patient, the authors believe that partial treatment of the typhoid fever 5 years prior to diagnosis of osteomyelitis enabled antibiotic resistance to ciprofloxacin. Furthermore, the authors believe that the infected nodule was the result of direct inoculation with the Salmonella organism which then acted as a focus for further infections.

  11. Gram-negative osteomyelitis: clinical and microbiological profile

    Directory of Open Access Journals (Sweden)

    Vladimir Cordeiro de Carvalho

    2012-02-01

    Full Text Available INTRODUCTION: Despite the growing interest in the study of Gram-negative bacilli (GNB infections, very little information on osteomyelitis caused by GNB is available in the medical literature. OBJECTIVES AND METHODS: To assess clinical and microbiological features of 101 cases of osteomyelitis caused by GNB alone, between January 2007 and January 2009, in a reference center for the treatment of high complexity traumas in the city of São Paulo. RESULTS: Most patients were men (63%, with median age of 42 years, affected by chronic osteomyelitis (43% or acute osteomyelitis associated to open fractures (32%, the majority on the lower limbs (71%. The patients were treated with antibiotics as inpatients for 40 days (median and for 99 days (median in outpatient settings. After 6 months follow-up, the clinical remission rate was around 60%, relapse 19%, amputation 7%, and death 5%. Nine percent of cases were lost to follow-up. A total of 121 GNB was isolated from 101 clinical samples. The most frequently isolated pathogens were Enterobacter sp. (25%, Acinetobacter baumannii (21% e Pseudomonas aeruginosa (20%. Susceptibility to carbapenems was about 100% for Enterobacter sp., 75% for Pseudomonas aeruginosa and 60% for Acinetobacter baumannii. CONCLUSION: Osteomyelitis caused by GNB remains a serious therapeutic challenge, especially when associated to nonfermenting bacteria. We emphasize the need to consider these agents in diagnosed cases of osteomyelitis, so that an ideal antimicrobial treatment can be administered since the very beginning of the therapy.

  12. Subacute, tetracycline-responsive, granulomatous osteomyelitis in an adult man, consistent with Q fever infection.

    Science.gov (United States)

    Bayard, Cornelia; Dumoulin, Alexis; Ikenberg, Kristian; Günthard, Huldrych F

    2015-12-09

    Osteomyelitis due to Coxiella burnetii infection is a rare condition in adults. We report the case of a healthy young man presenting with subacute osteomyelitis of the left cheek bone, evolving gradually after an episode of acute febrile illness. Histological evaluation confirmed subacute granulomatous inflammation. Despite antibody titres not reaching the standard cut-off for chronic Q fever (phase I IgG 1/160, phase II IgG 1/2560), osteomyelitis was radiologically and histologically confirmed. A 6-month course of doxycycline/hydroxychloroquine brought clinical and radiological cure while various conventional antibiotic treatments had failed to improve the clinical condition. Currently, at 6-month follow-up, no relapse has occurred and antibody titres have declined. A shorter course of doxycycline/hydroxychloroquine than that used for chronic Q fever osteomyelitis may be sufficient to treat subacute Q fever osteomyelitis in some cases.

  13. The establishment of experimental chronic osteomyelitis induced by staphylococcus aureus in rabbits%兔胫骨慢性骨髓炎动物模型的建立

    Institute of Scientific and Technical Information of China (English)

    卢旻鹏; 蒋电明; 权正学; 黄伟; 曹何; 况尚如; 李广州

    2010-01-01

    Objective To analyze the relationship between the inoculation dose of the bacteria of Staphylococcus aureus ATCC25923 and the severity of experimental Staphylococcus aureus osteomyelitis in rabbits. Methods Thirty-six healthy New Zealand white rabbits were randomized into 4 groups: control group and experimental groups A, B, C. There were 10 rabbits in every experimental group and 6 rabbits in control group. Five percent sodium morrhuate (0. 1 ml) and serial dilutions of the bacteria of Staphylococcus aureus ATCC25923 [3 × 108 to 3 × 109 colony-forming units ( CFU)/ml]suspended in saline or saline alone were inoculated into the proximal metaphysis of the tibia. No antibiotics were used to prevent fatal sepsis. The severity of experimental Staphylococcus aureus osteomyelitis in rabbits was evaluated by clinical, radiologic,bacteriologic and histologic parameters at the 4th week after infection. Results There was clinical progression of the disease observed by draining wounds, a postoperative limp that subsided in all rabbits, and varied periods of anorexia despite an average increase in body weight. There were varying degrees of BMD decrease, decreased bone trabeculae and bone trabecular space widening in experimental groups at the 4th week after infection.Slices indicated that there were varying degrees of neutrophil infiltration, necrosis of marrow cells and interstitial hemorrhage. Gross pathologic and radiographic criteria were used to grade the severity of experimental staphylococcus aureus osteomyelitis in rabbits. The grading of experimental groups A, B, and C was respectively stage 1 to 2 osteomyelitis, stage 2 to 3 osteomyelitis, stage 3 to 4 osteomyelitis. Conclusion The bacteria of Staphylococcus aureus ATCC25923 suspended in saline was inoculated into the proximal metaphysis of the tibia and can induce osteomyelitis. The severity of experimental Staphylococcus aureus osteomyelitis in rabbits was aggravated with the increase of the bacteria amount

  14. Osteomielite crônica multifocal recorrente da mandíbula: relato de três casos Chronic recurrent multifocal osteomyelitis of the mandible: report of three cases

    Directory of Open Access Journals (Sweden)

    Luciana B. Paim

    2003-10-01

    Full Text Available OBJETIVO: Relatar três casos de osteomielite crônica multifocal recorrente de mandíbula. A osteomielite crônica multifocal recorrente é uma doença inflamatória, com acometimento de um ou mais ossos, sem patógenos isolados nas áreas afetadas, sendo o envolvimento da mandíbula raramente descrito na literatura. DESCRIÇÃO: Caso 1 - paciente feminina, com 13 anos, após tratamento dentário evoluiu com dor mandibular e febre. A paciente foi tratada com antibióticos por osteomielite, evoluindo com aumento progressivo da mandíbula e pustulose palmoplantar. A cintilografia óssea mostrou hipercaptação difusa da mandíbula. A redução da tumoração mandibular foi evidenciada com a indometacina e sessões de câmara hiperbárica. Caso 2 - paciente feminina, com 9 anos, apresentou dor e edema em região de mandíbula direita recorrente por três anos. O diagnóstico de osteomielite foi realizado e introduzido amoxicilina. Após três meses, a tomografia computadorizada mostrou osteólise mandibular difusa. Indometacina e câmara hiperbárica foram introduzidas, porém a paciente apresentou recidiva e foi tratada com prednisona, rofecoxib e metotrexato. Caso 3 - paciente masculino, com 10 anos, apresentou pustulose palmoplantar e aumento difuso da mandíbula recorrente. A tomografia computadorizada de mandíbula evidenciou osteólise mandibular, e a cintilografia óssea, hipercaptação difusa. O paciente foi tratado com prednisona. O rofecoxib foi substituído após duas recidivas. COMENTÁRIOS: A osteomielite crônica multifocal recorrente da mandíbula pode apresentar um curso doloroso prolongado, com intervalos de atividade e remissão do processo inflamatório. O seu reconhecimento é importante para evitar uma antibioticoterapia prolongada e procedimentos invasivos desnecessários.OBJECTIVE: To report three cases of chronic recurrent multifocal osteomyelitis of the mandible, an inflammatory disease affecting one or more bones with

  15. Local osteogenic expression of cyclooxygenase-2 and systemic response in porcine models of osteomyelitis

    DEFF Research Database (Denmark)

    Johansen, Louise K.; Iburg, Tine M.; Nielsen, Ole L.;

    2012-01-01

    It is suggested that cyclooxygenase 2 (COX-2) derived prostaglandins contributes to the progressive bone loss seen in osteomyelitis lesions. In the present study we examined the expression of COX-2 in bones from 23 pigs with experimental osteomyelitis. Osteomyelitis was induced with Staphylococcus...... in vivo study showing an early wave of COX-2 mediated bone resorption during osteomyelitis. Therefore, treatment aiming to reduce the break down of bone tissue directed by the COX-2 pathway might be suggested early in the course of the disease....

  16. Maxillary Osteomyelitis: A Rare Entity

    Directory of Open Access Journals (Sweden)

    Ayaaz Habib

    2016-01-01

    Full Text Available Osteomyelitis of the maxilla is now a rare event with the advent of antibiotics. The two predominant causes are odontogenic infections and sinusitis. Immunocompromised states such as diabetes, HIV, and malnutrition increase the risk of osteomyelitis. It is important to recognize this early as it is a difficult entity to treat with potentially serious consequences. We report an unusual case of right sided maxillary osteomyelitis in a lady with poorly controlled diabetes in rural Lincolnshire. Biopsy of the right maxillary bone showed features of acute osteomyelitis. This responded well to a prolonged course of oral antibiotics.

  17. A Rare Case of Cranial Osteomyelitis Caused by Proteus Vulgaris

    Directory of Open Access Journals (Sweden)

    Hakan Uslu

    2011-03-01

    Full Text Available Osteomyelitis of the calvarial bones can cause serious complications such as brain abscess, due to the close proximity to adjacent brain structures. Development of the purulent secretion in surgery and traumatic scalp injuries must be considered as a possibility of osteomyelitis possibility. Generally gram positive, rarely gram negative bacteria and mix agents, can be isolated in infection. Especially chronic pyogenic osteomyelitis agents can be isolated from chronic infections such as tuberculosis. In cranial osteomyelitis diagnosis, radiological diagnosis has a very important place together with the clinical diagnosis. However, infection can usually show late findings radiologically. In treatment, antibiotic treatment is absolutely essential as well as removal of the infected part of the bone. Due to antibiotic treatment lasting between 6-12 weeks, organizing the antibiotic protocols according to the results of culture-antibiograms, which were provided from purulent secretions, has the most important role in the success of surgical treatment. In Proteus sp. infections, for choice of suitable treatment, determination of the type of bacteria is important. For exact diagnosis, histopathological examination of the bone tissue must be carried out. In this report, a case with cranial osteomyelitis caused by Proteus vulgaris which is a gram negative bacteria causing anaerobic infections and classified in the Enterobacteriaceae family is presented. The patient was treated with surgery and appropriate antibiotics. Early recognition of this condition, planning the best treatment strategy and taking precautions to prevent complications, is mandatory for a better outcome.

  18. Nanocidals therapy for osteomyelitis

    Science.gov (United States)

    Qadri, Shahnaz Majid

    Infection is a major medical problem that causes serious complications including patient death. The mortality rate of invasive infection has reduced significantly since the introduction of antibiotherapy. However, the resistance to antibiotic is becoming a serious medical problem that resulted in high medical cost. The overall aim of this study is to evaluate a potential inorganic route (metalo-antibiotic) to treat localized infections that require long-term antibiotic treatment combined with medical and surgical intervention. In this study osteomyelitis (bone infection) was selected as a model to evaluate the inorganic route to treat infection. Osteomyelitis is a progressive infection that could result in amputation and patient death. The metalo-antibiotics are faster to develop than antibiotics and have shown great efficacy against a wide range of bacterial infection. A unique composition of particles with ability to extend their residual efficacy on bacteria for an extended time compared to conventional antibiotics was synthesized and evaluated in this study. The in vitro experiments demonstrated the metalo-antibiotics to treat cellular internal infections without damaging the home cell. The in vivo toxicity experiments demonstrated a tolerance of the particles for doses that are 20 times higher than the anticipated treatment dose. A murine mouse model for osteomyelitis was developed. The efficacy of the metalo-antibiotics on the induced osteomyelitis was evaluated. A significant decrease in infection in the bones treated with nanoparticles was observed. By delivering optimal concentration of nanoparticles in mouse models there was no sign of pathology seen in mouse. Overall, this study has two main impacts: a) creation of inorganic routes to fight against bacterial infection particularly those requiring long-term antibiotic or surgical treatment b) reduction of critical technical risk through generation of pre-clinical data of the employment of inorganic

  19. Osteomyelitis due to Bacillus cereus in an adolescent: case report and review.

    Science.gov (United States)

    Schricker, M E; Thompson, G H; Schreiber, J R

    1994-06-01

    Non-anthracis Bacillus species associated with clinical infections are usually dismissed as contaminants or nonpathogens. As opportunists, however, Bacillus organisms can cause significant systemic infections including bacteremia, endophthalmitis, and pneumonia. Osteomyelitis with non-anthracis Bacillus organisms has been described in adults, although to our knowledge it has been described only once in a child. We report a case of chronic osteomyelitis due to Staphylococcus aureus and superinfection with Bacillus cereus in a 13-year-old adolescent. A Bacillus isolate should be considered a true pathogen in children with chronic osteomyelitis who have a poor clinical response to antistaphylococcal therapy.

  20. 慢性磷性颌骨骨髓炎的临床探讨%Clinical study of chronical phosphorus osteomyelitis of the jaw

    Institute of Scientific and Technical Information of China (English)

    谢玲; 王卫红; 许彪; 朱谨; 夏斌

    2012-01-01

    目的 探讨慢性磷性颌骨骨髓炎的临床特点及其机理,为临床及黄磷职业病诊断提供依据.方法 对6例因黄磷中毒引起颌骨骨髓炎患者的临床资料进行回顾性分析.结果 6例患者中,上颌骨4例,下颌骨2例.2例下颌骨磷性骨髓炎患者诊断为职业病.结论 磷性颌骨骨髓炎不仅发生于下颌骨,也可发生于上颌骨.上颌骨也应作为黄磷作业的健康检查及职业病诊断参考.%Objective To investigate the clinical characteristics and mechanism of yellow phosphorus jaw osteomelitis so as to provide the basis for clinical diagnosis of this occupational disease. Methods Clinical data of six patients suffering from jaw osteomyelitis due to yellow phosphorus poisoning in their jaw were reviewed retrospectively. Results Among those cases four cases' disease occurred in maxillas,two in mandibles. Only two patients suffering from mandibular yellow phosphorus osteomelitis were diagnosed to contract occupational disease in the end. Conclusions Yellow phosphorus osteomyelitis occurs not only in the mandible but also in the maxilla. With regard to yellow phosphorus workers,the maxillas should not been ruled out when health inspection is carried out.

  1. MRI of intraosseous fistulous systems and sequesters in chronic osteomyelitis with standard spin echo sequences, highly selective chemical-shift imaging, diffusion weighted imaging, and magnetization-transfer; MRT-Darstellung intraossaerer Sequester und Fistelsysteme bei chronischer Osteomyelitis durch Standardsequenzen, hochselektive Chemical-Shift-Bildgebung, Diffusionsgewichtung und Magnetisierungstransfer

    Energy Technology Data Exchange (ETDEWEB)

    Bitzer, M.; Hartmann, J.; Geist-Barth, B.; Stern, W.; Seemann, M.; Pereira, P.; Claussen, C.D. [Abteilung fuer Radiologische Diagnostik, Klinikum der Eberhart-Karls-Universitaet Tuebingen (Germany); Schick, F. [Sektion fuer Experimentelle Radiologie, Klinikum der Eberhard-Karls-Universitaet Tuebingen (Germany); Krackhardt, T. [Berufsgenossenschaftliche Klinik, Tuebingen (Germany); Morgalla, M. [Chirurgische Klinik, Klinikum der Eberhard-Karls-Universitaet Tuebingen (Germany)

    2002-11-01

    Purpose: To study and test the impact of modern MRI techniques in diagnostic imaging in the evaluation of intra-osseous fistulous systems and sequesters. Materials and Methods: In a prospective study, nine patients with chronic osteomyelitis of the legs were examined by MRI. Patients with clinical signs of osteomyelitis requiring surgery were included in the study. T1-weighted spin echo (SE) sequences, proton density (PD) and T2-weighted fast spin echo (FSE) sequences, water- and fat-selective FSE sequences, and diffusion weighted (DW) PSIF sequences were used preoperatively. Furthermore, magnetizing transfer (MT) with gradient echo (GRE) sequences was evaluated. Results: Water selective sequences revealed the highest sensitivity for the detection of fistulas (100%), providing the best delineation of the extent of the entire fistulous systems. Fat-selective sequences (sensitivity 55.6%) and T1-weighted sequences (sensitivity 77.8%) displayed fistulas as hypointense bands, which, however, cannot be well differentiated from cortical bone in the transcortical areas. PD and T2-weighted images were found to have a poor sensitivity (55.6% and 66.7%) for fistulas in any location. The sensitivity of water-selective sequences to demonstrate intraosseous sequesters was 100%. The sensitivity was low for the other sequences. In 4 of 5 patients with surgically proven infection, DW and MT revealed an abnormal spatial distribution, with high diffusion in the central parts of the fistulas and high MT effect peripherally surrounding a weak MT effect centrally. (orig.) [German] Zielsetzung: Die vorliegende Arbeit soll die Moeglichkeiten des Einsatzes spezieller Sequenztechniken der MRT bei der Diagnostik von intraossaeren Fisteln und Sequestern pruefen und beschreiben. Material und Methode: In einer prospektiven Studie wurden 9 Patienten mit chronischen Osteomyelitiden der unteren Extremitaeten kernspintomographisch untersucht. Die MRT-Befunde wurden qualitativ anhand der Operations

  2. 下肢慢性创伤性骨髓炎患者感染病原菌情况分析%Analysis of Infectious Pathogens in Patients with Chronic Osteomyelitis

    Institute of Scientific and Technical Information of China (English)

    董洪先; 黄富国; 钟刚; 肖聪; 刘国明; 靳家诚; 陈彦影

    2012-01-01

    Objective To analyze the distribution of cultured bacteria from chronic osteomyelitis patients, and provide a basis for clinical medicine. Methods We retrospectively analyzed the bacterial culture results of the secretions from 91 patients with chronic osteomyelitis treated in our hospital from January 2006 to December 2010. Among them, there were 78 males and 13 females aged from 5 to 78 years averaging at (41.3 ± 8.35) years. The duration of the disease ranged from 47 days to more than 7 months, averaging (68.6 ± 14.57) days. The total course of antibiotic-taking was longer than 7 days for all the patients. Results A total of 113 pathogen strains were isolated from 65 secretion samples, including 72 Gram-negative bacteria accounting for 63.71% and 41 gram-positive bacteria accounting for 36.28%. Drug susceptibility results showed basic resistance of Gram-positive bacteria to conventional penicillin, rare resistance to carbapenem, and no resistance to vancomycin. Gram-negative bacteria were basically resistant to penicillin and cephalosporins, but not resistant to cefoperazone-sulbactam. Conclusion Enhancing the monitoring of pathogens for patients with chronic osteomyelitis is extremely necessary for the rational clinical use of antibiotics.%目的 分析下肢慢性创伤性骨髓炎患者创面细菌培养分布情况,为临床用药提供依据.方法 对2006年1月-2010年12月收治的91例慢性骨髓炎患者创面分泌物细菌培养标本结果进行回顾性调查分析.其中男78例,女13例;年龄5~78岁,平均41.3岁.病程47d~7个月,平均68.6 d.使用抗生素总疗程均>7d.结果 65例创面细菌培养阳性患者共分离出113株病原菌,其中G-菌72株,占63.71%;G+菌41株,占36.28%.药敏结果显示,G+菌对常规青霉素类基本耐药,碳青霉烯类耐药菌株少见,对万古霉素耐药菌株尚未出现.G-菌对青霉素类及头孢菌素类耐药较高,对头孢哌酮-舒巴坦无耐药.结论 加强对慢性

  3. Efficacy of fosfomycin compared to vancomycin in treatment of implant-associated chronic methicillin-resistant Staphylococcus aureus osteomyelitis in rats.

    Science.gov (United States)

    Poeppl, Wolfgang; Lingscheid, Tilman; Bernitzky, Dominik; Schwarze, Uwe Y; Donath, Oliver; Perkmann, Thomas; Kozakowski, Nicolas; Plasenzotti, Roberto; Reznicek, Gottfried; Burgmann, Heinz

    2014-09-01

    Fosfomycin monotherapy was compared to therapy with vancomycin for the treatment of implant-associated methicillin-resistant Staphylococcus aureus (MRSA) osteomyelitis in an experimental rat model. The proximal tibiae were inoculated with 15 μl of a suspension containing 1×10(8) to 5×10(8) CFU/ml of a clinical isolate of MRSA with simultaneous insertion of a titanium wire. Four weeks later, treatment was started for 28 days with either 50 mg/kg of body weight vancomycin intraperitoneally twice daily (n=11) or 75 mg/kg fosfomycin intraperitoneally once daily (n=10). Eleven animals were left untreated. After treatment, quantitative cultures from bone were found to be positive for MRSA in all animals in the untreated group (median, 3.29×10(6) CFU/g of bone) and the vancomycin group (median, 3.03×10(5) CFU/g of bone). In the fosfomycin group, MRSA was detectable in 2 out of 10 (20%) animals (3.42×10(2) and 1.51×10(3) CFU/g of bone). Vancomycin was superior to the no-drug control (P=0.002), and fosfomycin was superior to the no-drug control and vancomycin (P<0.001). The cultures from the wires were positive in all untreated animals (median, 2.5×10(3) CFU/implant), in 10 animals in the vancomycin group (median, 1.15×10(3) CFU/implant), and negative in all animals in the fosfomycin group. Based on the bacterial counts from the implants, vancomycin was not superior to the no-drug control (P=0.324), and fosfomycin was superior to the no-drug control and vancomycin (P<0.001). No emergence of resistance was observed. In conclusion, it was demonstrated that fosfomycin monotherapy is highly effective for the treatment of experimental implant-associated MRSA osteomyelitis.

  4. Jaw Osteomyelitis as a Complication of Sickle Cell Anaemia in Three Omani Patients; Case reports and literature review

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    Hilal Al-Ismaili

    2017-03-01

    Full Text Available Sickle cell anaemia (SCA is a common haemoglobinopathy among people from the Middle East, the Afro-Caribbean region, the Mediterranean and East India. While osteomyelitis of the long bones is a welldocumented complication of SCA, there are few documented cases of SCA patients presenting with jaw osteomyelitis. We report three SCA patients with chronic jaw osteomyelitis who presented to the Department of Oral Health, Sultan Qaboos University Hospital, Muscat, Oman, between 2009 and 2013. Two of the patients had osteomyelitis of the mandible and the third had osteomyelitis of the maxilla. In addition, a brief review of the literature is presented focusing on the clinical presentation, diagnosis and management of jaw osteomyelitis among patients with SCA.

  5. Charcot foot and ankle with osteomyelitis

    OpenAIRE

    Donegan, Ryan; Sumpio, Bauer; Peter A. Blume

    2013-01-01

    This paper presents a review of the current literature discussing topics of Charcot osteoarthropathy, osteomyelitis, diagnosing osteomyelitis, antibiotic management of osteomyelitis, and treatment strategies for management of Charcot osteoarthropathy with concurrent osteomyelitis.Keywords: Charcot foot; osteomyelitis; diabetes mellitus; infection; neuropathy(Published: 1 October 2013)Citation: Diabetic Foot & Ankle 2013, 4: 21361 - http://dx.doi.org/10.3402/dfa.v4i0.21361

  6. SUCCESSFUL TREATMENT OF OSTEOMYELITIS IN LEPROSY PATIENTS BY HOMEOPATHIC MEDICINE

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    D. Chakraborty

    2013-12-01

    Full Text Available Osteomyelitis, a major complication of neuropathic feet in leprosy may occur as a result of infiltration of Mycobacterium leprae in the periosteum of bones or due to secondary bacterial infection of chronic plantar ulcer. There is no effective treatment for healing of planter ulcer and osteomyelitis. Keeping in mind of the limitation of conservative treatment, twenty patients who completed with multi drug therapy but suffering from neuropathic foot with ulcer was treated with Mercurius solubilis, a homoeopathic medicine in 200 potency for one year. All these patients had different degrees of osteomyelitic changes and after treatment showed regeneration and remodeling of bones which may be considered as significant improvement. Based on the radiological finding it may be concluded that Mercurius solubilis found to be effective in the treatment of osteomyelitis in leprosy affected patients.

  7. Fungal arthritis and osteomyelitis.

    Science.gov (United States)

    Kohli, Rakhi; Hadley, Susan

    2005-12-01

    Fungal arthritis and osteomyelitis are uncommon diseases and generally present in an indolent fashion. The incidence of fungal bone and joint dis-ease is increasing with an increase in the prevalence of factors predisposing to invasive fungal disease, such as the use of central venous catheters, broad spectrum antibiotics, immunosuppression, and abdominal surgery. Definitive diagnosis relies on bone or synovial culture or biopsy. Successful management has traditionally consisted of amphotericin B in combination with surgical debridement. Given the rarity of this disease, treatment is not well defined, but reports of success with the use of azole antifungal agents, including itraconazole, fluconazole, voriconazole, and posaconazole, are promising.

  8. Osteomyelitis: a current challenge

    Directory of Open Access Journals (Sweden)

    Luciana Souza Jorge

    2010-06-01

    Full Text Available Over the last 30 years, the pathogenesis of osteomyelitis has almost been totally elucidated, and many factors responsible for the persistence of this infection have been identified. Numerous antimicrobial agents with distinct spectrums of action, pharmacokinetics, and pharmacodynamics have been used in its treatment. Surgical techniques, including muscle grafts, the Ilizarov technique, and antibiotic bone cements, have been applied. However, bone infections are still a challenge. Despite the importance of isolation and identification of microorganisms to determine the antimicrobial treatment of bone infections, there are few systematic national studies about the etiological profile of these diseases. This article describes the current knowledge of osteomyelitis and summarizes published national data based on the experience of different Orthopedic and Traumatology Services. In general, S. aureus was described as an important etiological agent; however, the difference in design of national studies makes a comparison between the prevalence of bone infection, the associated risk factors, and the different therapeutic approaches difficult. In conclusion, effort is necessary in order to stimulate systematic national studies in different Orthopedics and Traumatology Services to obtain a better consensus on preventive measures and therapies of bone infections.

  9. Periostitis ossificans (Garrè′s osteomyelitis: An unusual case

    Directory of Open Access Journals (Sweden)

    Deepesh Singh

    2015-01-01

    Full Text Available Garrè′s sclerosing osteomyelitis is a specific type of chronic osteomyelitis that mainly affects children and young adults and is commonly associated with odontogenic infection. The paper describes an unusual case of Garrè′s osteomyelitis in an 11-year-old boy, in whom the condition arose following poor oral hygiene and periodontal problems in relation to permanent mandibular left first molar. Clinically the patient presented with bony hard, nontender swelling and the occlusal radiograph revealed pathognomic feature of "onion skin" appearance.

  10. Tuberculous osteomyelitis of the maxilla: A rarest of rare case report

    Science.gov (United States)

    Gupta, Ramesh; Garg, Meenu; Gupta, Ajay Kumar; Anand, C.

    2014-01-01

    Tuberculosis is a chronic granulomatous systemic infectious disease caused by Mycobacterium tuberculosis. The oral lesions found in tuberculosis are relatively rare and may present as ulcers, erythematous patches, indurated lesions, nodules or as bony jaw lesions. Oral tubercular lesions sometimes present a confusing clinical presentation and can be overlooked. Hence, we document a case of tuberculous osteomyelitis of the maxilla in a 19-year-old female patient, who was initially treated for multiple periodontal dental abscesses, which later proved to be tubercular osteomyelitis of the maxilla. Although it is a rare occurrence, the differential diagnosis of tuberculous osteomyelitis must always be considered when it fails to respond to routine therapy. PMID:25937732

  11. Novel Therapies for Acinetobacter Osteomyelitis

    Science.gov (United States)

    2009-01-01

    Acinetobacter baumannii , Osteomyelitis, Colistin 16. SECURITY CLASSIFICATION OF: 17. LIMITATION OF ABSTRACT 18. NUMBER OF PAGES 19a. NAME OF...Words: Multi-Drug Resistant, Acinetobacter baumannii , Osteomyelitis, Colistin Page 1 of 21 John Wiley & Sons, Inc. Journal of Orthopaedic Research 1...which is responsible for >80% of OM infections, 12 Acinetobacter baumannii -calcoaceticus complex (ABC) are Gram-negative, non-fermentative, non-spore

  12. Severe Osteomyelitis and Septic Arthritis due to Serratia marcescens in an Immunocompetent Patient

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    Hiba Hadid

    2015-01-01

    Full Text Available Septic arthritis and osteomyelitis due to Serratia marcescens in immunocompetent patients without risk factors are extremely rare. Here, we report a case of septic arthritis and severe adjacent osteomyelitis of the tibia due to Serratia marcescens in a diabetic community-dweller patient. The patient had no contact with healthcare workers or facilities and had no chronic disease except for poorly controlled diabetes. Without predisposing risk factors, this type of infection is extremely rare, even in diabetics.

  13. Septic arthritis and osteomyelitis due to the chromoblastomycosis agent Fonsecaea pedrosoi.

    Science.gov (United States)

    De Guzman, Leonidiz; Perlman, David C; Hubbard, Christopher E

    2012-07-01

    Fonsecaea pedrosoi is the most common agent of chromoblastomycosis, a chronic localized fungal infection of the skin and subcutaneous tissues mainly involving the lower extremities. We report a rare case of septic arthritis and osteomyelitis due to the chromoblastomycosis agent F pedrosoi, which was successfully treated with arthrotomy and debridement, followed by a long course of oral antifungal therapy. To our knowledge, this is the second case of F pedrosoi osteomyelitis treated successfully to be ever reported.

  14. Osteomyelitis of the foot and ankle: diagnosis, epidemiology, and treatment.

    Science.gov (United States)

    Lindbloom, Benjamin J; James, Eric R; McGarvey, William C

    2014-09-01

    Osteomyelitis of the foot and ankle is a common, potentially devastating condition with diagnostic and treatment challenges. Understanding the epidemiology and pathogenesis of osteomyelitis can raise clinical suspicion and guide testing and treatments. History and physical examination, laboratory studies, vascular studies, histologic and microbiologic analyses, and various imaging modalities contribute to diagnosis and treatment. Treatment including empiric broad-spectrum antibiotics and surgery should take a multidisciplinary approach to optimize patient factors, ensure eradication of the infection, and restore function. Optimization of vascular status, soft tissues, limb biomechanics, and physiologic state of the patient must be considered to accelerate and ensure healing.

  15. Tuberculous sternal osteomyelitis.

    Science.gov (United States)

    Cataño, Juan Carlos; Galeano, Daniela; Botero, Juan Camilo

    2014-10-01

    A 32-year-old female patient with systemic lupus erythematosus presented with 1 month of nocturnal subjective fevers, night sweats, poor appetite, malaise, 8-kg weight loss, and a 6-cm painful sternal mass. She had normal vital signs with a physical examination notable only for the presence of a fluctuating sternal mass. A computed tomographic scan of the thorax showed a 67 × 32 × 27-mm sternal mass associated with severe sternal osteomyelitis (Fig. 1); then a surgical drainage was performed, and abundant caseous material was removed, leaving a penrose drain (Fig. 2). Histologic examination of the bone tissue revealed extensive necrosis and granulomas with multinucleated giant cells. The bone, secretion, and soft tissue were negative for acid-fast bacillae on Ziehl-Neelsen stain; but culture grew Mycobacterioum tuberculosis, and she was started on 4 first-line antituberculosis medications, showing rapid symptomatic improvement, and was discharged 4 weeks after admission (Fig. 3).

  16. 改良胸大肌肌瓣转移治疗心脏外科术后慢性胸骨骨髓炎疗效%Curative effect of repairing transfer of pectoralis major muscle flap on chronic sternum osteomyelitis after ;cardiac surgery

    Institute of Scientific and Technical Information of China (English)

    刘磊; 姚建民; 高永顺; 崔振田; 陆龙

    2015-01-01

    Objective To investigate the surgical method and curative effect of treating chronic sternum osteomyelitis after cardiac surgery with repairing transfer of pectoralis major muscle flap. Methods The patients with chronic sternum osteomyelitis after cardiac surgery (n=56) were chosen from Jan. 2008 to Aug. 2014, and among them 36 with simple sternum osteomyelitis, 11 with sternum osteomyelitis accompanied by costal chondritis and 9 with sternum osteomyelitis accompanied by suppurative infection in mediastinum. During the cardiac surgery, complete debridement and removing source of infection were carried out, and enough pectoralis major muscle flap was transferred to fill sternum defect. Negative pressure drainage was applied continuously and sensitive antibiotics were administered for preventing infection after cardiac surgery. The clinical efficacy was observed and followed up. Results All patients were followed up for 4 m to 12 m (averagely 8 m). There were 51 patients (91.1%) with phase I healing of incision, 3 (5.3%) with a few secretion at drainage outlet and healed after dressing changes for 1 w, and 2 (3.6%) with poor incision healing and cured after cardiac surgery again. There were no patients with incision re-infection, formation of chronic sinus tract and recrudescence of sternum osteomyelitis. All patients had normal functions of upper limbs. Conclusion The curative effect of repairing transfer of pectoralis major muscle flap is reliable in treatment of sternum osteomyelitis after cardiac surgery without more incisions, which is suitable for clinical application.%目的:探讨利用改良胸大肌肌瓣转移治疗心脏外科术后慢性胸骨骨髓炎的手术方法及临床效果。方法入选2008年1月~2014年8月在北京军区总医院收治心脏外科术后出现慢性胸骨骨髓炎患者56例。其中单纯胸骨骨髓炎36例,胸骨骨髓炎伴肋软骨炎11例,胸骨骨髓炎伴纵隔内感染9例。术中彻底扩创清除感染源

  17. Biomaterials approaches to treating implant-associated osteomyelitis.

    Science.gov (United States)

    Inzana, Jason A; Schwarz, Edward M; Kates, Stephen L; Awad, Hani A

    2016-03-01

    Orthopaedic devices are the most common surgical devices associated with implant-related infections and Staphylococcus aureus (S. aureus) is the most common causative pathogen in chronic bone infections (osteomyelitis). Treatment of these chronic bone infections often involves combinations of antibiotics given systemically and locally to the affected site via a biomaterial spacer. The gold standard biomaterial for local antibiotic delivery against osteomyelitis, poly(methyl methacrylate) (PMMA) bone cement, bears many limitations. Such shortcomings include limited antibiotic release, incompatibility with many antimicrobial agents, and the need for follow-up surgeries to remove the non-biodegradable cement before surgical reconstruction of the lost bone. Therefore, extensive research pursuits are targeting alternative, biodegradable materials to replace PMMA in osteomyelitis applications. Herein, we provide an overview of the primary clinical treatment strategies and emerging biodegradable materials that may be employed for management of implant-related osteomyelitis. We performed a systematic review of experimental biomaterials systems that have been evaluated for treating established S. aureus osteomyelitis in an animal model. Many experimental biomaterials were not decisively more efficacious for infection management than PMMA when delivering the same antibiotic. However, alternative biomaterials have reduced the number of follow-up surgeries, enhanced the antimicrobial efficacy by delivering agents that are incompatible with PMMA, and regenerated bone in an infected defect. Understanding the advantages, limitations, and potential for clinical translation of each biomaterial, along with the conditions under which it was evaluated (e.g. animal model), is critical for surgeons and researchers to navigate the plethora of options for local antibiotic delivery.

  18. Osteomyelitis: an overview of antimicrobial therapy

    Directory of Open Access Journals (Sweden)

    Diana Gomes

    2013-03-01

    Full Text Available Osteomyelitis is an inflammatory bone disorder caused by infection, leading to necrosis and destruction of bone. It can affect all ages, involve any bone, become a chronic disease and cause persistent morbidity. Treatment of osteomyelitis is challenging particularly when complex multiresistant bacterial biofilm has already been established. Bacteria in biofilm persist in a low metabolic phase, causing persistent infection due to increased resistance to antibiotics. Staphylococcus aureus and Staphylococcus epidermidis are the most common causative organism responsible for more than 50% of osteomyelitis cases. Osteomyelitis treatment implies the administration of high doses of antibiotics (AB by means of endovenous and oral routes and should take a period of at least 6 weeks. Local drug delivery systems, using non-biodegradable (polymethylmethacrylate or biodegradable and osteoactive materials such as calcium orthophosphates bone cements, have been shown to be promising alternatives for the treatment of osteomyelitis. These systems allow the local delivery of AB in situ with bactericidal concentrations for long periods of time and without the toxicity associated with other means of administration. This review examines the most recent literature evidence on the causes, pathogeneses and pharmacological treatment of osteomyelitis. The study methodology consisted of a literature review in Google Scholar, Science Direct, Pubmed, Springer link, B-on. Papers from 1979 till present were reviewed and evaluated.A osteomielite é um processo inflamatório do tecido ósseo, de origem infecciosa, que resulta em destruição inflamatória, necrose e formação de novo osso. Pode aparecer em qualquer idade, afetar qualquer osso e tornar-se uma doença crônica com morbidade persistente. Apesar dos progressos na quimioterapia infecciosa, o tratamento da osteomielite é caro e difícil, em particular quando associada à presença de biofilmes bacterianos

  19. Progress of different drug delivery route of vancomycin for the treatment of chronic osteomyelitis%万古霉素不同给药途径治疗慢性骨髓炎的研究进展

    Institute of Scientific and Technical Information of China (English)

    龙亚周; 朱泽兴; 于燕; 张树明

    2016-01-01

    慢性骨髓炎(COM)主要特点为局部死骨形成、软组织感染,病情反复发作,耐甲氧西林金黄色葡萄球菌(MRSA)是其常见致病菌.万古霉素作为治疗MRSA感染的敏感抗生素,在MRSA引起的COM治疗中起着重要的作用.目前,治疗方式分为全身用药和局部用药,全身用药以静脉给药为主;局部用药包括应用局部载药装置、局部抗生素灌洗和局部动脉灌注.万古霉素有效性取决于病灶组织中游离的万古霉素是否达到有效药物浓度,靶组织药物浓度低于最小抑菌浓度导致治疗无效,浓度介于突变选择窗时诱导细菌耐药,浓度过高可能导致急性肾衰竭.因此,在强调万古霉素治疗有效性的同时兼顾其耐药性及肾毒性就显得尤为重要.全身用药方式靶向作用弱,并发症多;局部用药可靶向作用于病灶,将成为未来治疗COM的有效方式.不同给药途径对局部药物浓度影响很大,使其成为影响COM局部药物浓度的重要因素.%Chronic osteomyelitis (COM) is an infectious disease caused by methicillin-resistant Staphylococcus aureus (MRSA),the main characteristics of COM including local dead bone formation,soft tissue infection,and repeatedly attacks.As a sensitive antibiotic,vancomycin plays an important role in the therapy of COM caused by MRSA.Currently,drug treatment is divided into systemic and topical,systemic medication is given priority to intravenous drug delivery;local drug application including local delivery device and local antibiotics lavage and regional arterial perfusion.In practice,its validity depends on whether free drug concentration of vancomycin has riched the effective concentration in the organization.Nevertheless,low concentration lead to treatment failure and even induce drug-resistance bacteria,meanwhile high concentration may cause acute renal failure.So when using vancomycin for the treatment of chronic osteomyelitis,both drug resistance and renal toxicity is

  20. Cryptococcal osteomyelitis in the ribs

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    Sethi Somika

    2010-01-01

    Full Text Available Isolated cryptococcal osteomyelitis, in an immunocompetent, is rare and only a few cases have been reported in literature. We present the case of a 30-year-old man presented with pain on the left side of chest with fever and gradually increasing swelling in left lateral lower aspect of chest. Investigation revealed a lytic lesion in the anterior end of left 6 th rib with normal CD4 count. He was tested negative for HIV antigen. Excision of the sixth rib, morphologically revealed cryptococcal osteomyelitis and the patient was given anti-fungal treatment for six months.

  1. Aspergillus Osteomyelitis of the Skull.

    Science.gov (United States)

    Nicholson, Simon; King, Richard; Chumas, Paul; Russell, John; Liddington, Mark

    2016-07-01

    Osteomyelitis of the craniofacial skeleton is rare, with fungal pathogens least commonly implicated. The authors present 2 patients of osteomyelitis of the skull caused by Aspergillus spp. and discuss the diagnosis, clinicopathological course, and management strategies.Late recurrence seen in this type of infection warrants long-term follow-up and a high index of suspicion for the clinical signs associated with recurrence.Such patients would benefit from their surgical debridement being planned and managed via a specialist craniofacial unit, so as to utilize the most aesthetically sensitive approach and the experience of specialists from several surgical disciplines.

  2. Lumbar Aspergillus osteomyelitis mimicking pyogenic osteomyelitis in an immunocompetent adult.

    Science.gov (United States)

    Yoon, Kyeong-Wook; Kim, Young-Jin

    2015-04-01

    Spinal Aspergillus osteomyelitis is rare and occurs mostly in immunocompromised patients, but especially very rare in immunocompetent adult. This report presents a case of lumbar vertebral osteomyelitis in immunocompetent adult. A 53-year-old male who had no significant medical history was admitted due to complaints of back pain radiating to the flank for the last 3 months, followed by a progressive motor weakness of both lower limbs. Lumbar magnetic resonance imaging (MRI) demonstrated osteomyelitis and diskitis, suspected to be a pyogenic condition rather than a tuberculosis infection. Despite antibiotic treatment for several weeks, the symptoms worsened, and finally, open surgery was performed. Surgical biopsy revealed an Aspergillus infection and medical treatment with amphotericin B was started. It can be diagnosed early through an MRI; biopsy is very important but difficult, and making the correct differential diagnosis is essential for avoiding unexpected complications. The authors report a case of lumbar Aspergillus osteomyelitis in an immunocompetent adult and reviewed previously described cases of spinal aspergillosis.

  3. 99Tcm-MDP骨三相显像在慢性骨髓炎外科手术治疗中的应用%Application of 99Tcm-MDP Three-Phase Bone Scintigraphy in the Surgery of Chronic Osteomyelitis

    Institute of Scientific and Technical Information of China (English)

    吉蘅山; 薛杨波; 朱虹; 胡裕效; 张垒

    2014-01-01

    Objective To investigate the effect of 99Tcm-MDP three-phase bone scintigraphy in the surgery of chronic osteomyelitis. Methods Combined with surgical operation methods, the 99Tcm-MDP three-phase bone scintigraphy data of 34 patients with chronic osteomyelitis who were recruited from 2002 to 2008 in our hospital was analyzed to explore the diagnostic and therapeutic value of 99Tcm-MDP three-phase bone scintigraphy in chronic osteomyelitis. Results The A/N ratio was increased in 28 patients in blood lfow phase, which indicated that the positive rate of chronic osteomyelitis in blood lfow phase was 82.4%. The abnormal gather of tracer agent was occurred in soft tissues of 10 patients in blood pool phase and bones of 34 patients in delayed phase, which indicated that the positive rates of chronic osteomyelitis in blood pool phase and delayed phase were 29.4% and 100%, respectively. Conclusion The scope, position and size of bone lesions can be evaluated with 99Tcm-MDP three-phase bone scintigraphy, which can provide a correct guidance for the surgeon to thoroughly remove necrotic tissue of bone lesions.%目的:探讨99Tcm-MDP骨三相显像在慢性骨髓炎外科手术治疗中的作用。方法回顾性分析我科2002~2008年34例慢性骨髓炎患者99Tcm-MDP骨三相显像的资料,结合临床骨科手术方法,探讨99Tcm-MDP骨三相显像对慢性骨髓炎的诊断及治疗价值。结果34例患者中,28例患者血流相患/健侧摄取比值(A/N比值)明显增加,阳性率为82.4%;血池相10例患者软组织内可见示踪剂异常浓聚,阳性率为29.4%;延迟相34例患者骨骼均可见示踪剂异常浓聚,阳性率为100%。结论核素骨三相显像可以评估病灶的范围、死骨的大小及位置,为术中彻底清除骨性病灶的坏死组织提供正确的指导作用。

  4. Spinal osteomyelitis caused by Proteus mirabilis in a child

    NARCIS (Netherlands)

    deWeerd, W; Kimpen, JLL; Miedema, CJ

    1997-01-01

    Osteomyelitis due to Proteus mirabilis is rare. Spinal osteomyelitis caused by this organism has only been described in adults. This is the first paediatric case of P. mirabilis vertebral osteomyelitis.

  5. Calcaneal Osteomyelitis due to Non-tuberculous Mycobacteria: A Case Report

    Science.gov (United States)

    Yi, Tae-Im; Choe, Yeo-Reum; Kim, Joo-Sup; Kwon, Kye-Won

    2016-01-01

    Osteomyelitis is a bone infection caused by bacteria or other germs. Gram-positive cocci are the most common etiological organisms of calcaneal osteomyelitis; whereas, non-tuberculous mycobacteria (NTM) are rarely documented. We reported a case of NTM calcaneal osteomyelitis in a 51-year-old female patient. She had been previously treated in many local clinics with multiple local steroid injection over 50 times and extracorporeal shock-wave therapy over 20 times with the impression of plantar fasciitis for 3 years prior. Diagnostic workup revealed a calcaneal osteomyelitis and polymerase chain reaction assay on bone aspirate specimens confirmed the diagnosis of non-tuberculous mycobacterial osteomyelitis. The patient had a partial calcanectomy with antitubercular therapy. Six months after surgery, a follow-up magnetic resonance imaging showed localized chronic osteomyelitis with abscess formation. We continued anti-tubercular therapy without operation. At 18-month follow-up after surgery and comprehensive rehabilitation therapy, she was ambulating normally and able to carry out her daily activities without any discomfort. PMID:26949685

  6. Management of osteomyelitis of the skull base

    Energy Technology Data Exchange (ETDEWEB)

    Benecke, J.E. Jr. (Otologic Medical Group, Inc., Los Angeles, CA (USA))

    1989-12-01

    Osteomyelitis of the skull base is the most severe form of malignant otitis externa. As a result of having treated 13 patients with skull base osteomyelitis over a 4-year period, we have developed a method of staging and monitoring this malady using gallium and technetium scanning techniques. Stage I is localized to soft tissues, stage II is limited osteomyelitis, and stage III represents extensive skull base osteomyelitis. All stages are treated with appropriate antipseudomonal antibiotics. The duration of therapy depends upon the clearing of inflammation as shown on the gallium scan. Each case must be looked at independently and not subjected to an arbitrary treatment protocol.

  7. Fungal osteomyelitis and septic arthritis.

    Science.gov (United States)

    Bariteau, Jason T; Waryasz, Gregory R; McDonnell, Matthew; Fischer, Staci A; Hayda, Roman A; Born, Christopher T

    2014-06-01

    Management of fungal osteomyelitis and fungal septic arthritis is challenging, especially in the setting of immunodeficiency and conditions that require immunosuppression. Because fungal osteomyelitis and fungal septic arthritis are rare conditions, study of their pathophysiology and treatment has been limited. In the literature, evidence-based treatment is lacking and, historically, outcomes have been poor. The most common offending organisms are Candida and Aspergillus, which are widely distributed in humans and soil. However, some fungal pathogens, such as Histoplasma, Blastomyces, Coccidioides, Cryptococcus, and Sporothrix, have more focal areas of endemicity. Fungal bone and joint infections result from direct inoculation, contiguous infection spread, or hematogenous seeding of organisms. These infections may be difficult to diagnose and eradicate, especially in the setting of total joint arthroplasty. Although there is no clear consensus on treatment, guidelines are available for management of many of these pathogens.

  8. Osteomyelitis in the diabetic foot

    OpenAIRE

    Malhotra, Rishi; Chan, Claire Shu-Yi; Nather, Aziz

    2014-01-01

    Osteomyelitis (OM) is a common complication of diabetic foot ulcers and/or diabetic foot infections. This review article discusses the clinical presentation, diagnosis, and treatment of OM in the diabetic foot. Clinical features that point to the possibility of OM include the presence of exposed bone in the depth of a diabetic foot ulcer. Medical imaging studies include plain radiographs, magnetic resonance imaging, and bone scintigraphy. A high index of suspicion is also required to make the...

  9. 30例外固定架骨搬运术治疗慢性骨髓炎患者的护理研究%Nursing study on 30 exception handling operation fixator for the treatment of patients with chronic osteomyelitis

    Institute of Scientific and Technical Information of China (English)

    刘芹

    2016-01-01

    Objective To explore the nursing methods of external fixator in treatment of patients with chronic osteomyelitis handling. Methods Our hospital treated during January April 2013 to 2015 years of 30 cases of chronic osteomyelitis patients as subjects and were randomly assigned to the control group and the observation group, 15 cases in each, two groups of patients underwent external fixator handling therapy, peri operative period of observation group were given comprehensive nursing intervention, the control group with routine care, the proportion of two groups of clinical curative effect and complications.Results The total effective rate of the observation group was significantly higher than that of the control group, the difference between the two groups was significantly higher than that in the control groupP<. The complication rate in observation group was significantly lower than that in control group, the difference between the groups wasP< 0.05.Conclusion Patients with chronic osteomyelitis by external fixator handling operation treatment after treated with comprehensive nursing intervention, is conducive to the treatment effect, and to reduce complications, should promote the nursing mode.%目的:探讨外固定架骨搬运术治疗慢性骨髓炎患者的护理方法。方法:选择我院于2013年4月至2015年1月期间收治的30例慢性骨髓炎患者作为受试对象,随机分为对照组和观察组,各15例,两组患者均行外固定架骨搬运术治疗,围术期观察组给予综合护理干预,对照组按常规护理,比例两组临床疗效及并发症情况。结果:观察组总有效率显著高于对照组,组间差异P<0.05。观察组并发症率显著低于对照组,组间差异P<0.05。结论:慢性骨髓炎患者采用外固定架骨搬运术治疗后给予综合护理干预,有利于治疗效果,并减少并发症,应推广该护理模式。

  10. A Case of Skull Base Osteomyelitis with Multiple Cerebral Infarction

    Directory of Open Access Journals (Sweden)

    Haruka Miyabe

    2016-01-01

    Full Text Available Skull base osteomyelitis is classically documented as an extension of malignant otitis externa. Initial presentation commonly includes aural symptoms and cranial nerve dysfunctions. Here we present a case that emerged with multiple infarctions in the right cerebrum. A male in his 70s with diabetes mellitus and chronic renal failure presented with left hemiparesis. Imaging studies showed that blood flow in the carotid artery remained at the day of onset but was totally occluded 7 days later. However, collateral blood supply prevented severe infarction. These findings suggest that artery-to-artery embolization from the petrous and/or cavernous portion of the carotid artery caused the multiple infarctions observed on initial presentation. Osteomyelitis of the central skull base was diagnosed on the basis of the following findings taken together: laboratory results showing high levels of inflammation, presence of Pseudomonas aeruginosa in the otorrhea and blood culture, multiple cranial nerve palsies that appeared later, the bony erosion observed on CT, and the mass lesion on MRI. Osteomyelitis was treated successfully by long-term antibiotic therapy; however, the patient experienced cefepime-induced neurotoxicity during therapy. The potential involvement of the internal carotid artery in this rare and life-threatening disease is of particular interest in this case.

  11. Biodegradable vs non-biodegradable antibiotic delivery devices in the treatment of osteomyelitis

    NARCIS (Netherlands)

    Kluin, Otto S.; van der Mei, Henny C.; Busscher, Henk J.; Neut, Danielle

    2013-01-01

    Introduction: Chronic osteomyelitis, or bone infection, is a major worldwide cause of morbidity and mortality, as it is exceptionally hard to treat due to patient and pathogen-associated factors. Successful treatment requires surgical debridement together with long-term, high antibiotic concentratio

  12. Nuclear medicine imaging of posttraumatic osteomyelitis

    NARCIS (Netherlands)

    Govaert, G.A.M.; Glaudemans, A W J M

    2016-01-01

    INTRODUCTION: Early recognition of a possible infection and therefore a prompt and accurate diagnostic strategy is essential for a successful treatment of posttraumatic osteomyelitis (PTO). However, at this moment there is no single routine test available that can detect osteomyelitis beyond doubt a

  13. Vertebral osteomyelitis: clinical features and diagnosis.

    Science.gov (United States)

    Eren Gök, S; Kaptanoğlu, E; Celikbaş, A; Ergönül, O; Baykam, N; Eroğlu, M; Dokuzoğuz, B

    2014-10-01

    We aimed to describe clinical and diagnostic features of vertebral osteomyelitis for differential diagnosis and treatment. This is a prospective observational study performed between 2002 and 2012 in Ankara Numune Education and Research Hospital in Ankara, Turkey. All the patients with vertebral osteomyelitis were followed for from 6 months to 3 years. In total, 214 patients were included in the study, 113 out of 214 (53%) were female. Out of 214 patients, 96 (45%) had brucellar vertebral osteomyelitis (BVO), 63 (29%) had tuberculous vertebral osteomyelitis (TVO), and 55 (26%) had pyogenic vertebral osteomyelitis (PVO). Mean number of days between onset of symptoms and establishment of diagnosis was greater with the patients with TVO (266 days) than BVO (115 days) or PVO (151 days, p 15 mm, sensitivity was 0.66, specificity was 0.97, positive predictive value was 0.89, negative predictive value was 0.88, and receiver operating characteristics area was 0.8. Tuberculous and brucellar vertebral osteomyelitis remained the leading causes of vertebral osteomyelitis with delayed diagnosis. In differential diagnosis of vertebral osteomyelitis, consumption of unpasteurized cheese, dealing with husbandry, sweating, arthralgia, hepatomegaly, elevated alanine transaminase, and lumbar involvement in magnetic resonance imaging were found to be predictors of BVO, thoracic involvement in magnetic resonance imaging and tuberculin skin test > 15 mm were found to be predictors of TVO, and history of spinal surgery and leucocytosis were found to be predictors of PVO.

  14. Gambaran Roentgenologi Diffuse Sclerosing Osteomyelitis Pada Mandibula

    OpenAIRE

    Yolanda, Desri

    2008-01-01

    Osteomielitis pada rahang adalah suatu penyakit yang disebabkan penyebaran radang yang meliputi bagian-bagian dari pada tulang rahang. Osteomielitis dapat diartikan sebagai peradangan pada tulang dan sumsum tulang yang pada dasarnya merupakan infeksi mikroorganisme. Dahulu penyakit ini sangat ditakuti orang, karena akibat yang ditimbulkannya dapat menyebabkan kematian. Osteomilitis dapat diklasifikasikan menjadi dua yaitu suppurative osteomyelitis dan non suppurative osteomyelitis. Salah ...

  15. Bilateral polymicrobial osteomyelitis with Candida tropicalis and Candida krusei

    DEFF Research Database (Denmark)

    Kaldau, Niels Christian; Brorson, Stig; Jensen, Poul Einar

    2012-01-01

    We present a case of bilateral polymicrobial osteomyelitis with Candida tropicalis and Candida krusei, and review the literature on Candida osteomyelitis.......We present a case of bilateral polymicrobial osteomyelitis with Candida tropicalis and Candida krusei, and review the literature on Candida osteomyelitis....

  16. [Mandibular osteomyelitis in a patient with ankylosing spondylitis with severe axial and peripheral involvement].

    Science.gov (United States)

    Tomotani, Daniere Yurie Vieira; Miranda, Aryádine Allinne Machado de; Almeida, Lorena Penha; Mubarac, Rebecca Souza; Neves, Anne Christine Garcia; Ribeiro, Sandra Lúcia Euzébio

    2012-01-01

    Ankylosing spondylitis (AS) is a chronic inflammatory disease that affects mainly the axial skeletal system, causing pain and functional incapacity. The peripheral joint involvement occurs in 30 to 40% of cases. Osteomyelitis of the mandible was relatively common before the advent of preventive antibiotic therapy and restorative dentistry. Currently, the infection of the facial bones is a rare condition, being the odontogenic infection the most responsible for cases with mandibular involvement. The authors report the case of a EA patient, with severe peripheral involvement, which progressed to osteomyelitis of the jaw, secondary to the odontogenic infection due to delay in diagnosis and treatment.

  17. Skull-base Osteomyelitis: a Dreaded Complication after Trivial Fall and Inadequate Management

    Directory of Open Access Journals (Sweden)

    Kundan Mittal

    2015-10-01

    Full Text Available Introduction: Skull-based osteomyelitis is bony infection which generally originates from inadequately treated chronic infection, adjoining tissue infection or after trauma.Case: 11 month female child had a trivial fall while standing near a bucket. The child developed fracture of right clavicle and left orbital swelling which was inadequately treated. This resulted in in spread of infection to adjoining tissues, skull bones, sinuses and brain.Conclusion: Cranial base osteomyelitis is rare but dreaded condition which requires early diagnosis and prompt treatment to avoid mortality and morbidity in form of neurological deficits and permanent disability

  18. Could stress contribute to pain-related fear in chronic pain?

    Directory of Open Access Journals (Sweden)

    Sigrid eElsenbruch

    2015-12-01

    Full Text Available Learning to predict pain based on internal or external cues constitutes a fundamental and highly adaptive process aimed at self-protection. Pain-related fear is an essential component of this response, which is formed by associative and instrumental learning processes. In chronic pain, pain-related fear may become maladaptive, drive avoidance behaviors and contribute to symptom chronicity. Pavlovian fear conditioning has proven fruitful to elucidate associative learning and extinction involving aversive stimuli, including pain, but studies in chronic pain remain scarce. Stress demonstrably exerts differential effects on emotional learning and memory processes, but this has not been transferred to pain-related fear. Within this perspective, we propose that stress could contribute to impaired pain-related associative learning and extinction processes and call for interdisciplinary research. Specifically, we suggest to test the hypotheses that (1 extinction-related phenomena inducing a re-activation of maladaptive pain-related fear (e.g., reinstatement, renewal likely occur in everyday life of chronic pain patients and may alter pain processing, impair perceptual discrimination and favour overgeneralization; (2 acute stress prior to or during acquisition of pain-related fear may facilitate the formation and/or consolidation of pain-related fear memories, (3 stress during or after extinction may impair extinction efficacy resulting in greater reinstatement or context-dependent renewal of pain-related fear; and (4 these effects could be amplified by chronic stress due to early adversity and/or psychiatric comorbidity such as depression or anxiety in patients with chronic pain.

  19. Application of perforator flaps to repair chronic osteomyelitis with soft tissue defect in the distal lower extremity%应用穿支皮瓣治疗下肢远端慢性骨髓炎并皮肤缺损

    Institute of Scientific and Technical Information of China (English)

    潘朝晖; 王剑利; 蒋萍萍; 薛山; 刘学胜

    2010-01-01

    treatment of foot disease, the mean score was 84.5. Conclusion Free or pedicled perforator flap has been shown to be well vascularised, and it is feasible for the treatment of chronic osteomyelitis with soft-tissue defect in the distal lower extremity.%目的 探讨游离或带蒂穿支皮瓣在治疗下肢远端慢性骨髓炎并皮肤缺损创面修复中的应用价值.方法 应用穿支皮瓣游离或带蒂移位修复胫前及足踝部慢性骨髓炎并皮肤缺损28例.游离移植13例:采用股前外侧穿支皮瓣修复胫前2例,踝前3例,足背2例,足跟2例;小腿外侧腓动脉穿支皮瓣修复足背4例.带蒂移位15例:胫后动脉穿支皮瓣修复胫前4例,修复内踝2例;腓动脉外踝后上穿支皮瓣修复足跟6例,外踝及足背各1例;第1跖背动脉穿支皮瓣修复近节(足母)趾背侧1例.抗生素液灌流伤口7例,万古霉素明胶海绵残腔填塞8例.结果 1例胫后动脉穿支皮瓣出现静脉回流不足,表浅坏死,自行愈合,其余皮瓣无坏死.随访6个月~2年,2例复发,分别经1次和2次手术后愈合,其余均一期愈合,皮瓣外形满意.3例行二期骨移植.最后一次随访时,患者可行走,患肢完全负重,按足部疾患治疗效果标准评定平均为84.5分.结论 游离或带蒂穿支皮瓣血供良好,可用于治疗残腔不大的慢性骨髓炎并皮肤缺损.

  20. Sclerosing osteomyelitis of Garré periostitis ossificans.

    Science.gov (United States)

    Belli, Evaristo; Matteini, Claudio; Andreano, Tiziana

    2002-11-01

    Sclerosing osteomyelitis of Garré is a rare syndrome; the mandible is the most commonly affected bone segment in the cervicofacial region. This chronic disease is characterized by a nonsuppurative ossifying periostitis with subperiosteal bone formation, commonly reactive to a mild infection or irritation. The differential diagnosis must be made with similar clinical conditions with hard mandibular swelling associated with bony sclerosis. Presumptive diagnosis can be achieved by radiology, but such diagnosis must be confirmed by histology. The aim of therapy is to remove the cause when recognized, aided by an adequate antibiotic therapy. Clinical, radiographic, and histologic features are presented in this case report.

  1. Eumycetoma Osteomyelitis of the Calcaneus in a Child: A Radiologic-Pathologic Correlation following Total Calcanectomy

    Directory of Open Access Journals (Sweden)

    Tamer Ahmed EL-Sobky

    2015-01-01

    Full Text Available Fungi are unusual causes of pedal osteomyelitis in children and adolescents. Eumycetoma is a chronic cutaneous and subcutaneous infection caused by various genera of fungi. A provisional diagnosis of foot mycetoma is made after clinical assessment. Radiologic-pathologic correlation is an essential supplement for the accurate diagnosis of osteoarticular infections. This paper aims to sensitize orthopedic surgeons, radiologists, and pathologists to the importance of correlative imaging findings in relation to surgical and microscopic pathology in osteoarticular infections, specifically eumycetoma osteomyelitis of the foot. From our review of the published data, the present case is the first report of radiologic-pathologic correlation in eumycetoma osteomyelitis of the calcaneus. This paper describes a case of eumycetoma osteomyelitis of the calcaneus in a child in which diagnostic X-rays and magnetic resonance imaging (MRI were correlated with the surgical and microscopic pathologic features, for establishing an appropriate diagnosis and treatment. We conclude that there is a significant agreement between radiologic and pathologic evaluation for assessment of eumycetoma osteomyelitis of the calcaneus. Radiologic-pathologic correlation amplified our interpretation of imaging information available on plain radiographs and MRI and augmented diagnostic confidence. Similarly, anatomic-histopathological correlations consolidated diagnostic accuracy.

  2. Does hypokalemia contribute to acute kidney injury in chronic laxative abuse?

    Directory of Open Access Journals (Sweden)

    Eun-Young Lee

    2015-06-01

    Full Text Available Prolonged hypokalemia from chronic laxative abuse is recognized as the cause of chronic tubulointerstitial disease, known as “hypokalemic nephropathy,” but it is not clear whether it contributes to acute kidney injury (AKI. A 42-year-old woman with a history of chronic kidney disease as a result of chronic laxative abuse from a purging type of anorexia nervosa (AN-P, developed an anuric AKI requiring hemodialysis and a mild AKI 2 months later. Both episodes of AKI involved severe to moderate hypokalemia (1.2 and 2.7 mmol/L, respectively, volume depletion, and mild rhabdomyolysis. The histologic findings of the first AKI revealed the remnants of acute tubular necrosis with advanced chronic tubulointerstitial nephritis and ischemic glomerular injury. Along with these observations, the intertwined relationship among precipitants of recurrent AKI in AN-P is discussed, and then we postulate a contributory role of hypokalemia involved in the pathophysiology of the renal ischemia-induced AKI.

  3. Osteomyelitis diagnosis by {sup 99m}Tc radiolabeled aptamers

    Energy Technology Data Exchange (ETDEWEB)

    Santos, S.R.; Ferreira, I.M.; Andrade, A.S.R., E-mail: sararoberta7@hotmail.com, E-mail: imendesf@yahoo.com.br, E-mail: antero@cdtn.br [Centro de Desenvolvimento da Tecnologia Nuclear (CDTN/CNEN-MG), Belo Horizonte, MG (Brazil); Barros, A.L.B.; Cardoso, V.N.; Diniz, O.F., E-mail: brancodebarros@yahoo.com.br, E-mail: valbertcardoso@yahoo.com.br, E-mail: simoneodilia@yahoo.com.br [Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG (Brazil). Faculdade de Farmacia. Departamento de Analises Clinicas e Toxicologicas

    2015-07-01

    Osteomyelitis, which is characterized by progressive inflammatory destruction and new opposition of bone, is still a difficult infection to treat. The clinical diagnosis in late stages is achieved easily, but an early diagnosis is more challenging. Staphylococcus aureus is a common agent found in osteomyelitis and bone prostheses infection. Diagnosis by scintigraphy has advantages because it is a non-invasive procedure and is able to perform an early diagnosis even before anatomic changes. Thus, nuclear medicine could contribute to an accurate diagnosis since specific radiopharmaceuticals were developed. In this study, aptamers selected to Staphylococcus aureus were labeled with {sup 99m}Tc and used for bacteria identification in an osteomyelitis experimental model. The aptamers selected to S. aureus were directly labelled with {sup 99m}Tc and were evaluated by biodistribution studies. Wistar rats with intraosseous infection in the right paw were used. A random aptamer labelled with {sup 99m}Tc was as control. Six animals were used in each group. The aptamers labeled with {sup 99m}Tc were able to identify the infection foci caused by S. aureus displaying a target/non-target ratio of 2,23 ± 0,20, after 3 h. The control group presented a target/non-target ratio 1,08 ± 0.23. The results indicated that the radiolabeled aptamers were able to identify specifically the infection foci and they should be further explored for infection diagnosis by scintigraphy. (author)

  4. Macrophage-to-Myofibroblast Transition Contributes to Interstitial Fibrosis in Chronic Renal Allograft Injury.

    Science.gov (United States)

    Wang, Ying-Ying; Jiang, Hong; Pan, Jun; Huang, Xiao-Ru; Wang, Yu-Cheng; Huang, Hong-Feng; To, Ka-Fai; Nikolic-Paterson, David J; Lan, Hui-Yao; Chen, Jiang-Hua

    2017-02-16

    Interstitial fibrosis is an important contributor to graft loss in chronic renal allograft injury. Inflammatory macrophages are associated with fibrosis in renal allografts, but how these cells contribute to this damaging response is not clearly understood. Here, we investigated the role of macrophage-to-myofibroblast transition in interstitial fibrosis in human and experimental chronic renal allograft injury. In biopsy specimens from patients with active chronic allograft rejection, we identified cells undergoing macrophage-to-myofibroblast transition by the coexpression of macrophage (CD68) and myofibroblast (α-smooth muscle actin [α-SMA]) markers. CD68(+)/α-SMA(+) cells accounted for approximately 50% of the myofibroblast population, and the number of these cells correlated with allograft function and the severity of interstitial fibrosis. Similarly, in C57BL/6J mice with a BALB/c renal allograft, cells coexpressing macrophage markers (CD68 or F4/80) and α-SMA composed a significant population in the interstitium of allografts undergoing chronic rejection. Fate-mapping in Lyz2-Cre/Rosa26-Tomato mice showed that approximately half of α-SMA(+) myofibroblasts in renal allografts originated from recipient bone marrow-derived macrophages. Knockout of Smad3 protected against interstitial fibrosis in renal allografts and substantially reduced the number of macrophage-to-myofibroblast transition cells. Furthermore, the majority of macrophage-to-myofibroblast transition cells in human and experimental renal allograft rejection coexpressed the M2-type macrophage marker CD206, and this expression was considerably reduced in Smad3-knockout recipients. In conclusion, our studies indicate that macrophage-to-myofibroblast transition contributes to interstitial fibrosis in chronic renal allograft injury. Moreover, the transition of bone marrow-derived M2-type macrophages to myofibroblasts in the renal allograft is regulated via a Smad3-dependent mechanism.

  5. Epidemiology of acute vertebral osteomyelitis in Denmark

    DEFF Research Database (Denmark)

    Krogsgaard, M R; Wagn, P; Bengtsson, J

    1998-01-01

    We studied the epidemiology of acute, non-tuberculous, hematogenous vertebral osteomyelitis in Denmark during 1978-1982. 137 patients fulfilled the criteria for acute vertebral osteomyelitis. The incidence was 5/mill/year. There were no cases in the age group 20-29 years. The highest incidence......-1993, the relative number of reported patients with vertebral osteomyelitis had increased in the age group 20-49 years, compared to 1978-1982, but the incidence was highest in the group aged 60-79 years....

  6. Research progress on animal models of bone defects due to osteomyelitis%骨髓炎骨缺损动物模型构建研究进展

    Institute of Scientific and Technical Information of China (English)

    袁承杰; 翁蔚宗; 周启荣; 苏佳灿

    2016-01-01

    Traumatic osteomyelitis and chronic osteomyelitis have been common diseases in orthopedics. The characteris-tics of osteomyelitis, such as delayed healing, high morbidity, and high recurrence rate contribute to its intractability. Also, osteomyelitis tends to result in bone defects. In recent years, with the development of composite bone graft substitutes and biological deliver, bone tissue therapeutic methods for the contaminated bone defect have stepped further, various scaffold materials have been applied in clinic. However, pre-research is essential before new techniques are performed in clinic, and it is crucial for experimental researches to perform homogeneous animal models better. An excellent animal model is a plat-form for variable control, and also provides primary data reference for clinic. The aim of this review is to prospect the study progress on animal models of bone defects due to osteomyelitis.%创伤性骨髓炎以及慢性难治性骨髓炎已经成为骨科常见疾病之一,该病治疗困难,病情迁延不愈,复发率和致残率高,同时创伤初期和慢性感染很可能导致骨缺损。近年来随着复合人工骨替代材料和生物载药系统的研究,感染性骨缺损的骨组织工程治疗方法不断深入,部分支架材料应用于临床实践。但新技术转化应用于临床实践需要进行临床前研究,如何更好地建立同质性动物模型对实验研究起至关重要的作用。优秀且标准的实验动物模型构建为研究者提供了控制各种影响因素的操作平台,有利于不同研究之间进行比较,继而为解决后续的临床实践应用提供第一手资料。本文主要对近年来骨髓炎骨缺损动物模型构建的相关研究进展作一综述。

  7. Chronic Conditions, Workplace Safety, And Job Demands Contribute To Absenteeism And Job Performance.

    Science.gov (United States)

    Jinnett, Kimberly; Schwatka, Natalie; Tenney, Liliana; Brockbank, Claire V S; Newman, Lee S

    2017-02-01

    An aging workforce, increased prevalence of chronic health conditions, and the potential for longer working lives have both societal and economic implications. We analyzed the combined impact of workplace safety, employee health, and job demands (work task difficulty) on worker absence and job performance. The study sample consisted of 16,926 employees who participated in a worksite wellness program offered by a workers' compensation insurer to their employers-314 large, midsize, and small businesses in Colorado across multiple industries. We found that both workplace safety and employees' chronic health conditions contributed to absenteeism and job performance, but their impact was influenced by the physical and cognitive difficulty of the job. If employers want to reduce health-related productivity losses, they should take an integrated approach to mitigate job-related injuries, promote employee health, and improve the fit between a worker's duties and abilities.

  8. A Case of Aerococcus Urinae Vertebral Osteomyelitis

    Science.gov (United States)

    Jerome, Michael; Slim, Jihad; Sison, Raymund; Marton, Randy

    2015-01-01

    Aerococcus urinae is an aerobic, alpha hemolytic gram positive coccus bacterium that grows in pairs or clusters. We report the first case of vertebral osteomyelitis due to A. urinae. This has not been previously reported in the literature. PMID:26069429

  9. Management of melioidosis osteomyelitis and septic arthritis.

    Science.gov (United States)

    Shetty, R P; Mathew, M; Smith, J; Morse, L P; Mehta, J A; Currie, B J

    2015-02-01

    Little information is available about several important aspects of the treatment of melioidosis osteomyelitis and septic arthritis. We undertook a retrospective review of 50 patients with these conditions in an attempt to determine the effect of location of the disease, type of surgical intervention and duration of antibiotic treatment on outcome, particularly complications and relapse. We found that there was a 27.5% risk of osteomyelitis of the adjacent bone in patients with septic arthritis in the lower limb. Patients with septic arthritis and osteomyelitis of an adjacent bone were in hospital significantly longer (p = 0.001), needed more operations (p = 0.031) and had a significantly higher rate of complications and re-presentation (p = 0.048). More than half the patients (61%), most particularly those with multifocal bone and joint involvement, and those with septic arthritis and osteomyelitis of an adjacent bone who were treated operatively, needed more visits to theatre.

  10. [Treatment of osteomyelitis with oral bactericidal antibiotics-- description of 9 cases].

    Science.gov (United States)

    Major, S; Chuard, C; Regamey, C

    1996-01-27

    The efficacy of oral bactericidal antibiotics in the treatment of osteomyelitis is analyzed retrospectively by a review of 9 cases histories. The first patient was treated in 1982. Clinical and laboratory controls were reviewed up to 1.1.1995. In 6 patients S. aureus was isolated, while in 3 patients the organism could not be cultured but gram + cocci were almost likely. 5 cases of osteomyelitis were acute, 4 were chronic and in one case there was an infection of an artificial knee prothesis. The isolated S. aureus were sensitive to the antibiotics prescribed. 8 patients received a combination of flucloxacillin (2-4 g/day) and rifampicin (600 mg/day); one patient was treated with the combination amoxicillin/clavulanic acid (1500/425 mg/day) followed by ofloxacin (400 mg/day) and finally co-trimoxazole (320/1600 mg/day). 3 patients received all antibiotics orally; in 6 patients oral administration followed a short intravenous course of the antibiotic combination. The duration of treatment varied between 6 and 23 weeks. Follow-up extended over 9 months (n = 1), 14 months (n = 3), 4-7 years (n = 3), and 10-12 years (n = 2). In 8 cases the osteomyelitis was cured (89%). In our view, a combination of bactericidal oral antibiotics with good penetration into bone tissue can be prescribed in selected cases of osteomyelitis to shorten or even avoid the standard intravenous therapy of acute or chronic diseases.

  11. Osteomyelitis of the Mandible in an Adolescent.

    Science.gov (United States)

    Di Fiore, Peter M; Cerrud, Clinio C; Buckley, Ian A; Demian, Nagi M

    2015-01-01

    A 13-year-old female, who had been experiencing episodes of mandibular pain and swelling for approximately six months, was referred to a university urgent care dental clinic for evaluation after receiving endodontic treatment. At the referral examination, clinical and radiographic findings were suggestive of osteomyelitis. The purpose of this report is to present the possible etiology, clinical and radiographic findings and surgical management of mandibular osteomyelitis in an adolescent patient.

  12. Eosinophilia due to osteomyelitis in a dog.

    Science.gov (United States)

    Dehghani, Seifollah N; Hajighahramani, Shahin

    2005-09-01

    A dog with a lesion in the left elbow area and presence of purulent materials was referred to hospital; history, clinical examination, laboratory test and radiological evaluation of the dog proved the presence of osteomyelitis. Eosinophilia was evident by haematologic test. Intensive antibiotic, anti-inflammatory medication, local wound management and restricted physical activity, improved osteomelitis condition and reduced eosinophil number. Therefore it seemed that osteomyelitis was the cause of eosinophilia in this dog.

  13. Biofilm in Osteomyelitis caused by a Rare Pathogen, Morganella morganii : A Case Report.

    Science.gov (United States)

    De, Asmita; Raj, Hirak Jyoti; Maiti, Prasanta Kumar

    2016-06-01

    Morganella morganii is a member of Enterobacteriaceae family, whose natural habitat is the human gastrointestinal tract. It rarely causes infection alone and is generally encountered in immunosuppressed patients. Osteoarticular pathologies are not commonly observed with Morganella morganii and infections by it have high mortality rate. Biofilm colonization is a causative factor behind the chronicity and/or refractoriness of certain infections. Biofilms colonize on inert medical devices, prosthesis, fibrosed tissues, sinus tracts as well as dead bones as in case of chronic osteomyelitis. Morganella morganii is not a common pathogen to produce biofilm. In this case report, we present a 56-year-old male patient with chronic osteomyelitis of right proximal tibia caused by biofilm producing strain of Morganella morganii, following trauma.

  14. Expression changes of hippocampal energy metabolism enzymes contribute to behavioural abnormalities during chronic morphine treatment

    Institute of Scientific and Technical Information of China (English)

    Xiao-Lan Chen; Jing-Gen Liu; Gang Lu; Ying-Xia Gong; Liang-Cai Zhao; Jie Chen; Zhi-Qiang Chi; Yi-Ming Yang; Zhong Chen; Qing-lin Li

    2007-01-01

    a result of chronic morphine treatment contributes to the development of drug-induced symptoms such as morphine withdrawal jumping and memory impairment.

  15. Osteomyelitis caused by Achromobacter xylosoxidans

    Directory of Open Access Journals (Sweden)

    Takashi Shinha

    2015-01-01

    Full Text Available Achromobacter xylosoxidans is an aerobic, nonfermenting gram-negative rod and described as a waterborne bacterium since it habits aquatic environments ubiquitously. It has frequently been isolated from aquatic surroundings in the hospital and from various human body sites. Although occasionally considered a non-pathogen, A. xylosoxidans has been associated with outbreaks of nosocomial infection due to contaminated fluids. Moreover, a wide variety of infectious etiologies due to A. xylosoxidans has been reported primarily in immunocompromised individuals. Heightened awareness of this bacterium and associated clinical importance is warranted for clinicians since its broad disease spectrum in humans and frequent multi-drug resistance may result in an increased mortality rate. In this report, we describe a case of osteomyelitis caused by A. xylosoxidans in a patient with a history of diabetes mellitus.

  16. Osteomyelitis caused by Achromobacter xylosoxidans.

    Science.gov (United States)

    Shinha, Takashi; Oguagha, Ifeanyi C

    2015-01-01

    Achromobacter xylosoxidans is an aerobic, nonfermenting gram-negative rod and described as a waterborne bacterium since it habits aquatic environments ubiquitously. It has frequently been isolated from aquatic surroundings in the hospital and from various human body sites. Although occasionally considered a non-pathogen, A. xylosoxidans has been associated with outbreaks of nosocomial infection due to contaminated fluids. Moreover, a wide variety of infectious etiologies due to A. xylosoxidans has been reported primarily in immunocompromised individuals. Heightened awareness of this bacterium and associated clinical importance is warranted for clinicians since its broad disease spectrum in humans and frequent multi-drug resistance may result in an increased mortality rate. In this report, we describe a case of osteomyelitis caused by A. xylosoxidans in a patient with a history of diabetes mellitus.

  17. Contribution of Inflammation to Vascular Disease in Chronic Kidney Disease Patients

    Directory of Open Access Journals (Sweden)

    Suliman Mohamed

    2008-01-01

    Full Text Available Chronic kidney disease (CKD is characterized by an exceptionally high mortality rate, much of which results from cardiovascular disease (CVD. Chronic low-grade inflammation, as evidenced by increased levels of pro-inflammatory cytokines and C-reactive protein (CRP, is a common feature of CKD and may cause atherosclerotic CVD through various pathogenetic mechanisms. Evidence suggests that persistent inflammation may also be a risk factor for progression of CKD, which may result in a vicious inflammation-driven circle. The causes of inflammation in CKD are multifactorial. The influence of various comorbidities may contribute to inflammation in the setting of progressive loss of renal function. Available data suggest that pro-inflammatory cytokines also play a central role in the genesis of the metabolic syndrome. There is a lack of epidemiological data on the prevalence and consequences of inflammation in relation to protein-energy wasting (PEW and CVD in CKD patients from developing countries. The ′westernization′ of nutritional intakes and changes of life style besides the high prevalence of chronic infections in developing countries are possible additive contributors to a high prevalence of inflammation, PEW and CVD among CKD patients. Also, genetic differences may affect inflammatory responses and nutritional status and, thus, the susceptibility to CVD in different regions.

  18. 壳聚糖微球/抗生素自固化磷酸钙骨水泥复合材料治疗慢性骨髓炎的临床研究%Clinical Study of Chronic Osteomyelitis Treated with Chitosan Microspheres/Self-setting Calcium Phosphate Cement Composites Mixed with Antibiotics

    Institute of Scientific and Technical Information of China (English)

    高志刚; 王一羽; 潘姿璇

    2013-01-01

    Objective To study of chronic osteomyelitis treated with chitosan microspheres /self-setting cal-cium phosphate cement composites mixed with antibiotics .Methods From April 2009 to March 2012,34 patients with chronic osteomyelitis were involved,30 males and 4 females,aging from 23 to 65 years old,average of 40.2 years old.All the patients were treated with local debridement ,removal of dead bone,chitosan microspheres/self-setting calcium phos-phate cement composites mixed with antibiotics implantation and Kawashima continuous washing therapy .Results The mean follow-up period was 14.52 ±2.62 months(ranging 8~22 months),32 cases received chitosan microspheres/self-setting calcium phosphate cement composites mixed with antibiotics implantation achieved bony union ,2 cases healed af-ter dressing change drainage,and no systemic abnormal reaction and complications happened in all patients .Conclusion Thorough debridement,chitosan microspheres/self-setting calcium phosphate cement composites mixed with antibiotics implantation and Kawashima continuous washing therapy for treatment of chronic osteomyelitis is a simple and effective method.%  目的探讨壳聚糖微球/抗生素自固化磷酸钙骨水泥治疗慢性骨髓炎的临床疗效。方法2009年4月~2012年3月共收治34例慢性骨髓炎患者,其中男30例,女4例,年龄23~65岁,平均40.2岁。对所有患者局部行彻底清创、去除死骨,壳聚糖微球/抗生素自固化磷酸钙骨水泥植入并同时行川岛式持续冲洗疗法治疗。结果术后均获8~22(14.52±2.62)个月随访。经壳聚糖微球/抗生素自固化磷酸钙骨水泥植入32例患者一次痊愈,2例患者经换药引流后愈合,所有病例未出现全身异常反应和并发症。结论经彻底清创、壳聚糖微球/抗生素自固化磷酸钙骨水泥植入并同时行川岛式持续冲洗疗法治疗是治疗慢性骨髓炎简单而有效的方法。

  19. The study of orthotopic transplantation by inactivated infection bone and autologous platelet-rich plasma combined with bone marrow on chronic osteomyelitis%感染骨灭活原位移植自体富血小板血浆复合骨髓治疗慢性骨髓炎

    Institute of Scientific and Technical Information of China (English)

    贝朝涌; 唐际存; 王锐英; 辛林伟; 魏凌云; 伍志海; 李强

    2012-01-01

    目的:评价感染骨灭活原位移植自体富血小板血浆复合骨髓治疗慢性骨髓炎的疗效.方法:40只新西兰大白兔,随机分成两组,制成慢性骨髓炎模型.以感染灶最严重处为中心,线锯截取出死骨及感染骨2.0 cm煮沸灭活15 min,原位移植并闭合伤口.实验组术后局部注射制备好的自体富血小板血浆复合骨髓悬液,隔周1次,连续注射3周.对照组注射生理盐水.分别于术后第4、8、12、16周处死5只动物,行X线观察、组织学观察.结果:实验组成骨修复X线评分、组织学评分均高于对照组,两组之间差异有显著性(P<0.05).结论:感染骨灭活原位移植可作为骨支架,自体富血小板血浆复合骨髓,具有抗感染及促进成骨的双重作用,治疗慢性骨髓炎效果良好.%Objective To evaluate the treatment effect of orthotopic transplantation by inactivated infection bone and autologous platelet-rich plasma combined with bone marrow on chronic osteomyelitis. Methods Forty New Zealand white rabbits were randomly divided into two groups. A model of chronic osteomyelitis was performed. At the center of the most serious foci, the sequestrum and infected bone (2.0 cm) were removed, which boiled for 15 minutes. Then the orthotopic transplantation was performed, the wound was closed. The treatment group was injected with autologous platelet-rich plasma combined with bone marrow suspension in local foci after the operation, once every other week, continuous 3 weeks. The control group was injected with normal saline. Five animals were sacrificed respectively after 4 , 8, 12, 16 weeks. The treatment effect was evaluated by radiographs and histological analysis. Results Compare with control group, osteoblast repaired X-ray scores, histological scores of bone repaired in the treatment group were significance increased. The result has statistical significance (P < 0.05).Conclusions Orthotopic transplantation of inactivated infection bone can be

  20. Clinical observation of self Chinese herbal medicine prescription in the treatment of chronic suppurative osteomyelitis after firearm wound of hand and foot%自拟中药方治疗手足火器伤后慢性化脓性骨髓炎临床观察

    Institute of Scientific and Technical Information of China (English)

    于爱军; 丁海生; 周志玲; 袁进国; 丁英奇

    2014-01-01

    目的:探讨自拟中药方外敷治疗手足火器伤后慢性化脓性骨髓炎的临床效果。方法将66例手足火器伤后慢性化脓性骨髓炎患者随机分为治疗组和对照组各33例。对照组给予常规治疗和护理措施,治疗组在对照组基础上加用自拟中药方外敷患处。比较2组术前症状控制情况、急性期症状消退时间、术后创口愈合情况及不良反应情况。结果治疗组待术时间短于对照组,术前症状控制及术后创口愈合情况均优于对照组,差异均有统计学意义(P ﹤0.05)。结论自拟中药方外敷治疗手足火器伤后慢性化脓性骨髓炎可有效控制临床症状,缩短疗程,提高疗效及生存质量,值得临床推广应用。%Objective To discussion the clinical effect of self Chinese herbal medicine prescription in the treatment of chronic suppurative osteomyelitis after firearm wound of hand and foot. Methods 66 cases of patients with chronic suppurative osteomyelitis after firearm wound of hand and foot were randomly divided into treatment group and control group,each of 33 ca-ses. Control group received conventional treatment and care measures,treatment group were given with self Chinese herbal med-icine prescription based on control group. Compared the symptom control situation before surgery,acute symptoms subside time,postoperative wound healing situation and adverse reactions of two groups. Results The time to be surgery of treatment group was shorter than control group,the postoperative symptom control situation and wound healing situation were better than control group,the differences were statistically significant(P ﹤ 0. 05). Conclusion The treatment of self Chinese herbal medi-cine prescription for chronic suppurative osteomyelitis after firearm wound of hand and foot can effectively control symptoms and shorten the course of treatment,improve the efficacy and quality of life,worthy of clinical application.

  1. Contributions of spinal D-amino acid oxidase to chronic morphine-induced hyperalgesia.

    Science.gov (United States)

    Ma, Shuai; Li, Xin-Yan; Gong, Nian; Wang, Yong-Xiang

    2015-12-10

    Spinal D-amino acid oxidase (DAAO) is an FAD-dependent peroxisomal flavoenzyme which mediates the conversion of neutral and polar D-amino acids (including D-serine) to the corresponding α-keto acids, and simultaneously produces hydrogen peroxide and ammonia. This study has aimed to explore the potential contributions of spinal DAAO and its mediated hydrogen peroxide/D-serine metabolism to the development of morphine-induced hyperalgesia. Bi-daily subcutaneous injections of morphine to mice over 7 days induced thermal hyperalgesia as measured by both the hot-plate and tail-immersion tests, and spinal astroglial activation with increased spinal gene expression of DAAO, glial fibrillary acidic protein (GFAP) and pro-inflammatory cytokines (interleukin-1β (IL-1β), interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α)). Subcutaneous injections of the potent DAAO inhibitor CBIO (5-chloro-benzo[D]isoxazol-3-ol) prevented and reversed the chronic morphine-induced hyperalgesia. CBIO also inhibited both astrocyte activation and the expression of pro-inflammatory cytokines. Intrathecal injection of the hydrogen peroxide scavenger PBN (phenyl-N-tert-butylnitrone) and of catalase completely reversed established morphine hyperalgesia, whereas subcutaneous injections of exogenous D-serine failed to alter chronic morphine-induced hyperalgesia. These results provided evidence that spinal DAAO and its subsequent production of hydrogen peroxide rather than the D-serine metabolism contributed to the development of morphine-induced hyperalgesia.

  2. Multifocal bacterial osteomyelitis in a renal allograft recipient following urosepsis.

    Science.gov (United States)

    Valson, A T; David, V G; Balaji, V; John, G T

    2014-05-01

    Non-tubercular bacterial osteomyelitis is a rare infection. We report on a renal allograft recipient with osteomyelitis complicating urosepsis, manifesting as a multifocal infection poorly responsive to appropriate antibiotics and surgical intervention and culminating in graft loss.

  3. Bone Circulatory Disturbances in the Development of Spontaneous Bacterial Chondronecrosis with Osteomyelitis: A Translational Model for the Pathogenesis of Femoral Head Necrosis

    Directory of Open Access Journals (Sweden)

    Robert F. Wideman

    2013-01-01

    Full Text Available This review provides a comprehensive overview of the vascularization of the avian growth plate and its subsequent role in the pathogenesis of bacterial chondronecrosis with osteomyelitis (BCO, femoral head necrosis. BCO sporadically causes high incidences of lameness in rapidly growing broiler (meat-type chickens. BCO is believed to be initiated by micro-trauma to poorly mineralized columns of cartilage cells in the proximal growth plates of the leg bones, followed by colonization by hematogenously distributed opportunistic bacteria. Inadequate blood flow to the growth plate, vascular occlusion, and structural limitations of the microvasculature all have been implicated in the pathogenesis of BCO. Treatment strategies have been difficult to investigate because under normal conditions the incidence of BCO typically is low and sporadic. Rearing broilers on wire flooring triggers the spontaneous development of high incidences of lameness attributable to pathognomonic BCO lesions. Wire flooring imposes persistent footing instability and is thought to accelerate the development of BCO by amplifying the torque and shear stress imposed on susceptible leg joints. Wire flooring per se also constitutes a significant chronic stressor that promotes bacterial proliferation attributed to stress-mediated immunosuppression. Indeed, dexamethasone-mediated immunosuppression causes broilers to develop lameness primarily associated with avascular necrosis and BCO. Prophylactic probiotic administration consistently reduces the incidence of lameness in broilers reared on wire flooring, presumably by reducing bacterial translocation from the gastrointestinal tract that likely contributes to hematogenous infection of the leg bones. The pathogenesis of BCO in broilers is directly relevant to osteomyelitis in growing children, as well as to avascular femoral head necrosis in adults. Our new model for reliably triggering spontaneous osteomyelitis in large numbers of

  4. Eryptotic Phenotype in Chronic Myeloid Leukemia: Contribution of Neutrophilic Cathepsin G

    Directory of Open Access Journals (Sweden)

    Rukmini Govekar

    2012-01-01

    Full Text Available In pathological conditions with concurrent neutrophilia, modifications of erythrocyte membrane proteins are reported. In chronic myeloid leukemia (CML, a myeloproliferative disease wherein neutrophilia is accompanied by enhanced erythrophagocytosis, we report for the first time excessive cleavage of erythrocyte band 3. Distinct fragments of band 3 serve as senescent cell antigens leading to erythrophagocytosis. Using immunoproteomics, we report the identification of immunogenic 43 kDa fragment of band 3 in 68% of CML samples compared to their detection in only 38% of healthy individuals. Thus, excessive fragmentation of band 3 in CML, detected in our study, corroborated with the eryptotic phenotype. We demonstrate the role of neutrophilic cathepsin G, detected as an immunogen on erythrocyte membrane, in band 3 cleavage. Cathepsin G from serum adsorbs to the erythrocyte membrane to mediate cleavage of band 3 and therefore contribute to the eryptotic phenotype in CML.

  5. Abductor hallucis muscle flap with circular external fixation for Charcot foot osteomyelitis: a case report

    Directory of Open Access Journals (Sweden)

    Crystal L. Ramanujam

    2011-05-01

    Full Text Available Complicated soft tissue defects of the diabetic foot often call for alternative methods to traditional primary closure. Despite the popularity of microvascular free flaps, local muscle flaps can offer reliable reconstruction for these challenging wounds with shorter surgical times and reduced complication rates. In this article, the authors describe the successful use of the abductor hallucis muscle flap and external fixation for soft tissue reconstruction of a chronic Charcot foot wound and osteomyelitis in a diabetic patient.

  6. Uncommon mandibular osteomyelitis in a cat caused by Nocardia africana

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    de Farias Marconi

    2012-12-01

    Full Text Available Abstract Background Nocardiosis is an unusual infection in companion animals characterized by suppurative to pyogranulomatous lesions, localized or disseminated. Cutaneous-subcutaneous, pulmonary and systemic signs are observed in feline nocardiosis. However, osteomyelitis is a rare clinical manifestation in cats. Nocardia cyriacigeorgica (formerly N. asteroides sensu stricto, Nocardia brasiliensis, Nocardia otitidiscaviarum, and Nocardia nova are the most common pathogenic species identified in cats, based on recent molecular classification (16S rRNA gene. The present report is, to our knowledge, the first case of mandibular osteomyelitis in a cat caused by Nocardia africana, diagnosed based upon a combination of methods, including molecular techniques. Case presentation A one-year-old non-neutered female cat, raised in a rural area, was admitted to the Companion Animal Hospital-PUCPR, São José dos Pinhais, State of Paraná, Brazil, with a history a progressive facial lesion, difficulty apprehending food, loss of appetite, apathy and emaciation. Clinical examination showed fever, submandibular lymphadenitis, and a painless, 8 cm diameter mass, which was irregularly-shaped, of firm consistency, and located in the region of the left mandible. The skin around the lesion was friable, with diffuse inflammation (cellulitis, multiple draining sinuses, and exudation of serosanguinous material containing whitish “sulfur” granules. Diagnosis was based initially in clinical signs, microbiological culture, cytological, and histopathological findings, and radiographic images. Molecular sequencing of 16S rRNA of isolate allowed diagnosis of Nocardia africana. Despite supportive care and antimicrobial therapy based on in vitro susceptibility testing the animal died. Conclusion The present report describes a rare clinical case of feline osteomyelitis caused by Nocardia africana, diagnosed based upon a combination of clinical signs, microbiological

  7. Oxidized Phospholipid OxPAPC Activates TRPA1 and Contributes to Chronic Inflammatory Pain in Mice

    Science.gov (United States)

    Liu, Boyi; Tai, Yan; Caceres, Ana I.; Achanta, Satyanarayana; Balakrishna, Shrilatha; Shao, Xiaomei; Fang, Junfan

    2016-01-01

    Oxidation products of the naturally occurring phospholipid 1-palmitoyl-2-arachidonoyl-sn-glycerol-3-phosphatidylcholine (PAPC), which are known as OxPAPC, accumulate in atherosclerotic lesions and at other sites of inflammation in conditions such as septic inflammation and acute lung injury to exert pro- or anti-inflammatory effects. It is currently unknown whether OxPAPC also contributes to inflammatory pain and peripheral neuronal excitability in these conditions. Here, we observed that OxPAPC dose-dependently and selectively activated human TRPA1 nociceptive ion channels expressed in HEK293 cells in vitro, without any effect on other TRP channels, including TRPV1, TRPV4 and TRPM8. OxPAPC agonist activity was dependent on essential cysteine and lysine residues within the N-terminus of the TRPA1 channel protein. OxPAPC activated calcium influx into a subset of mouse sensory neurons which were also sensitive to the TRPA1 agonist mustard oil. Neuronal OxPAPC responses were largely abolished in neurons isolated from TRPA1-deficient mice. Intraplantar injection of OxPAPC into the mouse hind paw induced acute pain and persistent mechanical hyperalgesia and this effect was attenuated by the TRPA1 inhibitor, HC-030031. More importantly, we found levels of OxPAPC to be significantly increased in inflamed tissue in a mouse model of chronic inflammatory pain, identified by the binding of an OxPAPC-specific antibody. These findings suggest that TRPA1 is a molecular target for OxPAPC and OxPAPC may contribute to chronic inflammatory pain through TRPA1 activation. Targeting against OxPAPC and TRPA1 signaling pathway may be promising in inflammatory pain treatment. PMID:27812120

  8. Conservative treatment in a patient with diabetic osteomyelitis

    DEFF Research Database (Denmark)

    Jeppesen, Sune Møller; Frokjaer, J.; Yderstraede, K.

    2015-01-01

    Diabetic foot ulcers are commonly complicated by bone involvement and osteomyelitis. Diagnosing diabetic osteomyelitis can be problematic. However, positive findings at clinical examination and X-ray may set the diagnosis. Recent guidelines suggest that selected cases of diabetic osteomyelitis can...... be treated conservatively with antibiotics. We report on the successful treatment of a 52-year-old man with diabetes with osteomyelitis in the distal phalanx of a toe. On X-ray, the affected phalanx appeared completely eroded. However, regeneration of the bone tissue was observed following outpatient...... treatment with antibiotics. We therefore encourage doctors to provide conservative treatment for selected cases of diabetic osteomyelitis....

  9. Aspergillus vertebral osteomyelitis in immunocompetent patients

    Directory of Open Access Journals (Sweden)

    Somika Sethi

    2012-01-01

    Full Text Available Fungal infections are one of the important cause of morbidity and mortality in immunocompromised patients. Aspergillus vertebral osteomyelitis is extremely rare. We report two cases of aspergillus vertebral osteomyelitis in immunocompetent men in the absence of an underlying disorder. The clinical and radiological findings were suggestive of Pott′s spine. The absolute CD4, CD8 counts and their ratio were normal. The HIV status was negative in both patients. Both patients underwent surgical decompression. The histopathology of tissue obtained were suggestive of aspergillus osteomyelitis. One patient had antifungal treatment for 3 months and was doing well at 1 year followup, whereas other patient did not turnup after 2 months.

  10. Vertebral Osteomyelitis and Septic Arthritis Associated With Staphylococcus hyicus in a Juvenile Peregrine Falcon ( Falco peregrinus ).

    Science.gov (United States)

    Maier, Kristina; Fischer, Dominik; Hartmann, Antje; Kershaw, Olivia; Prenger-Berninghoff, Ellen; Pendl, Helene; Schmidt, Martin J; Lierz, Michael

    2015-09-01

    A 6-week-old, parent-reared peregrine falcon ( Falco peregrinus ) was presented with spastic hypertonus of its hind limbs of unknown origin and duration. Radiologic examination revealed smooth periosteal reactions ventrally at thoracic vertebrae 5 to 7. Contrast-enhanced computed tomography identified the swelling as inflammation; antibiotic, antimycotic, anti-inflammatory, and analgesic treatments were initiated, and vitamins and minerals were supplemented. Because the bird's condition did not improve after 10 days, it was euthanatized and submitted for postmortem examination. On histopathologic examination, chronic, active osteomyelitis was diagnosed in thoracic vertebrae 5 to 7, and chronic, active arthritis was present in both the right shoulder and left elbow joints. Staphylococcus hyicus was isolated from these 3 locations, as well as from lungs and liver, indicating a chronic septic staphylococcosis. Although infections with Staphylococcus species are occasional causes of vertebral osteomyelitis in juvenile poultry with active growth plates, it is only sporadically reported in raptors and companion birds. This case report is the first description of the clinical features and diagnostic and pathologic findings in a juvenile peregrine falcon with hematogenous osteomyelitis and arthritis associated with septicemia caused by S hyicus.

  11. Kingella kingae osteomyelitis of the clavicle.

    Science.gov (United States)

    Rotbart, H A; Gelfand, W M; Glode, M P

    1984-08-01

    Kingella kingae is the most recent addition to the list of etiologic agents causing osteomyelitis and septic arthritis in previously well children. A case is presented of a child with K. kingae osteomyelitis of the clavicle--an uncommon site of infection due to any organism. In the hope of facilitating the detection and treatment of this increasingly recognized pathogen, a brief discussion of its microbiologic characteristics and a summary of the patients reported to date with bone and joint infections due to this organism are included. To our knowledge, this is the first discussion of K. kingae in the orthopedic literature.

  12. Ceftobiprole: First Reported Experience in Osteomyelitis

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    A MacDonald

    2010-01-01

    Full Text Available A 74-year-old man with long-standing diabetes presented with advanced infection of the right forefoot associated with septic arthritis and osteomyelitis involving the second and third metatarsophalangeal joints. Polymicrobial infection, which included methicillin-resistant Staphylococcus aureus, was documented. First-line antibiotic therapy, which included vancomycin, was not tolerated. A durable cure was obtained following a six-week course of intravenous ceftobiprole medocaril combined with local surgery. The present report is the first to administer intravenous ceftobiprole medocaril to a patient with methicillin-resistant S aureus-associated septic arthritis and osteomyelitis.

  13. Ceftobiprole: First reported experience in osteomyelitis.

    Science.gov (United States)

    Macdonald, A; Dow, G

    2010-01-01

    A 74-year-old man with long-standing diabetes presented with advanced infection of the right forefoot associated with septic arthritis and osteomyelitis involving the second and third metatarsophalangeal joints. Polymicrobial infection, which included methicillin-resistant Staphylococcus aureus, was documented. First-line antibiotic therapy, which included vancomycin, was not tolerated. A durable cure was obtained following a six-week course of intravenous ceftobiprole medocaril combined with local surgery. The present report is the first to administer intravenous ceftobiprole medocaril to a patient with methicillin-resistant S aureus-associated septic arthritis and osteomyelitis.

  14. Cryptococcal osteomyelitis and meningitis in a patient with non-hodgkin's lymphoma treated with PEP-C.

    Science.gov (United States)

    To, Christina A; Hsieh, Robert W; McClellan, James Scott; Howard, Walter; Fischbein, Nancy J; Brown, Janice M Y; Felsher, Dean W; Fan, Alice C

    2012-09-07

    The authors present the first case report of a patient with lymphoma who developed disseminated cryptococcal osteomyelitis and meningitis while being treated with the PEP-C (prednisone, etoposide, procarbazine and cyclophosphamide) chemotherapy regimen. During investigation of fever and new bony lesions, fungal culture from a rib biopsy revealed that the patient had cryptococcal osteomyelitis. Further evaluation demonstrated concurrent cryptococcal meningitis. The patient's disseminated cryptococcal infections completely resolved after a full course of antifungal treatment. Cryptococcal osteomyelitis is itself an extremely rare diagnosis, and the unique presentation with concurrent cryptococcal meningitis in our patient with lymphoma was likely due to his PEP-C treatment. It is well recognised that prolonged intensive chemotherapeutic regimens place patients at risk for atypical infections; yet physicians should recognise that even chronic low-dose therapies can put patients at risk for fungal infections. Physicians should consider fungal infections as part of the infectious investigation of a lymphopaenic patient on PEP-C.

  15. Cryptococcal osteomyelitis and meningitis in a patient with non-hodgkin’s lymphoma treated with PEP-C

    Science.gov (United States)

    To, Christina A; Hsieh, Robert W; McClellan, James Scott; Howard, Walter; Fischbein, Nancy J; Brown, Janice M Y; Felsher, Dean W; Fan, Alice C

    2012-01-01

    The authors present the first case report of a patient with lymphoma who developed disseminated cryptococcal osteomyelitis and meningitis while being treated with the PEP-C (prednisone, etoposide, procarbazine and cyclophosphamide) chemotherapy regimen. During investigation of fever and new bony lesions, fungal culture from a rib biopsy revealed that the patient had cryptococcal osteomyelitis. Further evaluation demonstrated concurrent cryptococcal meningitis. The patient’s disseminated cryptococcal infections completely resolved after a full course of antifungal treatment. Cryptococcal osteomyelitis is itself an extremely rare diagnosis, and the unique presentation with concurrent cryptococcal meningitis in our patient with lymphoma was likely due to his PEP-C treatment. It is well recognised that prolonged intensive chemotherapeutic regimens place patients at risk for atypical infections; yet physicians should recognise that even chronic low-dose therapies can put patients at risk for fungal infections. Physicians should consider fungal infections as part of the infectious investigation of a lymphopaenic patient on PEP-C. PMID:22962380

  16. The contributions of balance to gait capacity and motor function in chronic stroke.

    Science.gov (United States)

    Lee, Kyoung Bo; Lim, Seong Hoon; Kim, Young Dong; Yang, Byung Il; Kim, Kyung Hoon; Lee, Kang Sung; Kim, Eun Ja; Hwang, Byong Yong

    2016-06-01

    [Purpose] The aim of this study was to identify the contributions of balance to gait and motor function in chronic stroke. [Subjects and Methods] Twenty-three outpatients participated in a cross-sectional assessment. Gait ability was assessed using the functional ambulation category, self-paced 10-m walking speed, and fastest 10-m walking speed. Standing balance and trunk control measures included the Berg Balance Scale and the Trunk Impairment Scale. Univariate and multivariate regression analyses were performed. [Results] Balance was the best predictor of the FAC, self-paced walking speed, and fastest walking speed, accounting for 57% to 61% of the variances. Additionally, the total score of TIS was the only predictor of the motor function of the lower limbs and the dynamic balance of TIS was a predictor of the motor function of the upper limbs, accounting for 41% and 29% of the variance, respectively. [Conclusion] This study demonstrated the relative contribution of standing balance and trunk balance to gait ability and motor function. They show that balance has a high power of explanation of gait ability and that trunk balance is a determinant of motor function rather than gait ability.

  17. Rotary blood-supplied patches for the treatment of osteomyelitis of the bones of the foot and the distal third of the tibia

    Directory of Open Access Journals (Sweden)

    V. V. Yurkevich

    2012-01-01

    Full Text Available The results of 112 transpositions of blood receiving complexes tissue foot applied in the treatment of chronic posttraumatic osteomyelitis of the bones of the foot and the distal third of the shin. Positive results were obtained in 86,6% of patients with recovery to work in 81,5% of the patients. The authors argue that the proposed blood receiving complexes tissue foot in the treatment of chronic posttraumatic osteomyelitis of the bones of the foot and the distal third of the shin allow to depart from the practice of multistage operations, reduce the time of hospital treatment. The algorithm for help in the treatment of chronic posttraumatic osteomyelitis of the bones of the foot and the distal third of the shin.

  18. Diverse Bacterial Groups Contribute to the Alkane Degradation Potential of Chronically Polluted Subantarctic Coastal Sediments.

    Science.gov (United States)

    Guibert, Lilian M; Loviso, Claudia L; Borglin, Sharon; Jansson, Janet K; Dionisi, Hebe M; Lozada, Mariana

    2016-01-01

    We aimed to gain insight into the alkane degradation potential of microbial communities from chronically polluted sediments of a subantarctic coastal environment using a combination of metagenomic approaches. A total of 6178 sequences annotated as alkane-1-monooxygenases (EC 1.14.15.3) were retrieved from a shotgun metagenomic dataset that included two sites analyzed in triplicate. The majority of the sequences binned with AlkB described in Bacteroidetes (32 ± 13 %) or Proteobacteria (29 ± 7 %), although a large proportion remained unclassified at the phylum level. Operational taxonomic unit (OTU)-based analyses showed small differences in AlkB distribution among samples that could be correlated with alkane concentrations, as well as with site-specific variations in pH and salinity. A number of low-abundance OTUs, mostly affiliated with Actinobacterial sequences, were found to be only present in the most contaminated samples. On the other hand, the molecular screening of a large-insert metagenomic library of intertidal sediments from one of the sampling sites identified two genomic fragments containing novel alkB gene sequences, as well as various contiguous genes related to lipid metabolism. Both genomic fragments were affiliated with the phylum Planctomycetes, and one could be further assigned to the genus Rhodopirellula due to the presence of a partial sequence of the 23S ribosomal RNA (rRNA) gene. This work highlights the diversity of bacterial groups contributing to the alkane degradation potential and reveals patterns of functional diversity in relation with environmental stressors in a chronically polluted, high-latitude coastal environment. In addition, alkane biodegradation genes are described for the first time in members of Planctomycetes.

  19. Diverse Bacterial Groups Contribute to the Alkane Degradation Potential of Chronically Polluted Subantarctic Coastal Sediments

    Energy Technology Data Exchange (ETDEWEB)

    Guibert, Lilian M.; Loviso, Claudia L.; Borglin, Sharon; Jansson, Janet K.; Dionisi, Hebe M.; Lozada, Mariana

    2015-11-07

    We aimed to gain insight into the alkane degradation potential of microbial communities from chronically polluted sediments of a subantarctic coastal environment using a combination of metagenomic approaches. A total of 6178 sequences annotated as alkane-1-monooxygenases (EC 1.14.15.3) were retrieved from a shotgun metagenomic dataset that included two sites analyzed in triplicate. The majority of the sequences binned with AlkB described in Bacteroidetes (32 ± 13 %) or Proteobacteria (29 ± 7 %), although a large proportion remained unclassified at the phylum level. Operational taxonomic unit (OTU)-based analyses showed small differences in AlkB distribution among samples that could be correlated with alkane concentrations, as well as with site-specific variations in pH and salinity. A number of low-abundance OTUs, mostly affiliated with Actinobacterial sequences, were found to be only present in the most contaminated samples. On the other hand, the molecular screening of a large-insert metagenomic library of intertidal sediments from one of the sampling sites identified two genomic fragments containing novel alkB gene sequences, as well as various contiguous genes related to lipid metabolism. Both genomic fragments were affiliated with the phylum Planctomycetes, and one could be further assigned to the genus Rhodopirellula due to the presence of a partial sequence of the 23S ribosomal RNA (rRNA) gene. This work highlights the diversity of bacterial groups contributing to the alkane degradation potential and reveals patterns of functional diversity in relation with environmental stressors in a chronically polluted, high-latitude coastal environment. In addition, alkane biodegradation genes are described for the first time in members of Planctomycetes.

  20. Salmonella osteomyelitis by sickle cell anemia

    Energy Technology Data Exchange (ETDEWEB)

    Rausch, H.; Tran, V.T.; Boeckmann, U.

    1985-10-01

    Case report of a 28 year old black sickle cell anemia patient with salmonella osteomyelitis of the radius. Aside from sickle cell anemia patients this skeletal complication of enteric salmonellosis is an extreme rarity. Description of the typical roentgenological features includes intracortical fissures and sequestration.

  1. Extensive thoracolumbosacral vertebral osteomyelitis after Lemierre syndrome

    NARCIS (Netherlands)

    Kempen, D. H R; van Dijk, M.; Hoepelman, A. I M; Oner, F. C.; Verlaan, J. J.

    2015-01-01

    Purpose: To present a unique case of multilevel vertebral osteomyelitis after Lemierre syndrome. Methods: A previously healthy 27-year-old man presented in the Emergency Department in septic shock because of Lemierre syndrome for which he was subsequently treated with intravenous benzylpenicillin fo

  2. Antimicrobial peptides : Experimental prevention of osteomyelitis

    NARCIS (Netherlands)

    Stallmann, H.P.

    2007-01-01

    The first chapter introduces the main concepts of this manuscript: osteomyelitis (bone infection), bacterial resistance and antimicrobial peptides (AMPs). As part of a solution to the first two problems, AMPs were investigated for the experimental prevention of infection. The first chapter introduc

  3. Osteomyelitis in burn patients requiring skeletal fixation

    NARCIS (Netherlands)

    Barret, JP; Desai, MH; Herndon, DN

    2000-01-01

    Deep and severe burns often present with the exposure of musculoskeletal structures and severe deformities. Skeletal fixation, suspension and/or traction are part of their comprehensive treatment. Several factors put burn patients at risk for osteomyelitis, osteosynthesis material being one of them.

  4. Histologic, Clinical, and Radiologic Findings of Alveolar Bone Expansion and Osteomyelitis of the Jaws in Cats.

    Science.gov (United States)

    Bell, C M; Soukup, J W

    2015-09-01

    The objective of this study was to characterize clinical, radiologic, and histologic patterns of alveolar bone expansion and osteomyelitis in cats. Based on case materials submitted as surgical biopsy specimens, alveolar bone pathology was diagnosed in 28 cats. These cats had a total of 37 oral lesions with clinical and radiologic changes that involved bone and/or teeth, including periodontitis, bone expansion, tooth resorption, and/or chronic osteomyelitis; 32 lesions were evaluated by histopathology. Canine teeth were affected in 19 cats (27 affected teeth), with bilateral lesions in 5 (26.3%) cats. The caudal premolar and/or molar regions were affected in 10 cats (10 affected sites). All biopsy sites evaluated by a review of clinical images and/or radiographs had evidence of periodontitis. Clinical photographs showed expansion of alveolar bone in 13 of 16 (81%) biopsy sites evaluated. Radiologically, rarifying osseous proliferation of alveolar bone was seen at 26 of 27 (96%) biopsy sites, and tooth resorption occurred at 15 of 18 (83%) sites. Histologically, the tissue samples from canine sites had compressed trabeculae of mature remodeled bone, loose fibrous stroma with paucicellular inflammation, and mild proliferation of woven bone. Tissue samples from the premolar/molar biopsy sites were often highly cellular with mixed lymphoplasmacytic and chronic suppurative inflammation, ulceration with granulation tissue, and robust proliferation of woven bone. Alveolar bone expansion and osteomyelitis in cats occurs in conjunction with periodontal inflammation and frequently with tooth resorption.

  5. Factors contributing to intervention fidelity in a multi-site chronic disease self-management program

    Directory of Open Access Journals (Sweden)

    Pitt Seraphine

    2006-10-01

    Full Text Available Abstract Background and objectives Disease self-management programs have been a popular approach to reducing morbidity and mortality from chronic disease. Replicating an evidence-based disease management program successfully requires practitioners to ensure fidelity to the original program design. Methods The Florida Health Literacy Study (FHLS was conducted to investigate the implementation impact of the Pfizer, Inc. Diabetes Mellitus and Hypertension Disease Self-Management Program based on health literacy principles in 14 community health centers in Florida. The intervention components discussed include health educator recruitment and training, patient recruitment, class sessions, utilization of program materials, translation of program manuals, patient retention and follow-up, and technical assistance. Results This report describes challenges associated with achieving a balance between adaptation for cultural relevance and fidelity when implementing the health education program across clinic sites. This balance was necessary to achieve effectiveness of the disease self-management program. The FHLS program was implemented with a high degree of fidelity to the original design and used original program materials. Adaptations identified as advantageous to program participation are discussed, such as implementing alternate methods for recruiting patients and developing staff incentives for participation. Conclusion Effective program implementation depends on the talent, skill and willing participation of clinic staff. Program adaptations that conserve staff time and resources and recognize their contribution can increase program effectiveness without jeopardizing its fidelity.

  6. [Vertebral osteomyelitis caused by Streptococcus agalactiae in healthy adults. Description of 2 new cases].

    Science.gov (United States)

    Rivero Marcotegui, M; Hidalgo Ovejero, A; Lecumberri, M Cía; Otermin Maya, I; Pereda García, A

    2009-10-01

    The importance of Streptococcus agalactiae as a pathogen in nonpregnant adults has been widely recognized in recent years, especially in the elderly or immunocompromised patients. Two cases of vertebral osteomyelitis caused by S. agalactiae in young patients with no known underlying diseases or predisposing factor to infection are reported. A systematic review of the literature (MEDLINE, 1976-May 2008) was performed, 10 cases previously reported in the literature of vertebral osteomyelitis due to S. agalactiae being found in adults under 65 years of age with no predisposing risk factors for infection, most of which have been reported over the last 10 years. We believe that this microbial etiology should be considered in patients of any age and immunological status. Other factors, other than increasing the number of patients with chronic diseases, explaining the increased rate of S. agalactiae infections in adults need to be studied.

  7. Radionuclide imaging in the evaluation of osteomyelitis and septic arthritis

    Energy Technology Data Exchange (ETDEWEB)

    Kim, E.E.; Haynie, T.P.; Podoloff, D.A.; Lowry, P.A.; Harle, T.S. (Univ. of Texas M.D. Anderson Hospital, Houston (USA))

    1989-01-01

    Despite controversy over its exact role, radionuclide imaging plays an important role in the evaluation of patients suspected of having osteomyelitis. The differentiation between osteomyelitis and cellulitis is best accomplished by using a three-phase technique using Tc-99m methylene diphosphonate (MDP). Frequently, it is necessary to obtain multiple projections and magnification views to adequately assess suspected areas. It is recommended that a Ga-67 or In-111 leukocyte scan be performed in those cases where osteomyelitis is strongly suspected clinically and the routine bone scan is equivocal or normal. Repeated bone scan after 48 to 72 h may demonstrate increased radioactivity in the case of early osteomyelitis with the initial photon-deficient lesion. In-111 leukocyte imaging is useful for the evaluation of suspected osteomyelitis complicating recent fracture or operation, but must be used in conjunction with clinical and radiographic correlation. The recognition of certain imaging patterns appears helpful to separate osteomyelitis from septic arthritis or cellulitis. 83 references.

  8. Non-contiguous multifocal vertebral osteomyelitis caused by Serratia marcescens.

    Science.gov (United States)

    Lau, Jen Xin; Li, Jordan Yuanzhi; Yong, Tuck Yean

    2015-03-01

    Serratia marcescens is a common nosocomial infection but a rare cause of osteomyelitis and more so of vertebral osteomyelitis. Vertebral osteomyelitis caused by this organism has been reported in few studies. We report a case of S. marcescens vertebral discitis and osteomyelitis affecting multiple non-contiguous vertebras. Although Staphylococcus aureus is the most common cause of vertebral osteomyelitis, rare causes, such as S. marcescens, need to be considered, especially when risk factors such as intravenous heroin use, post-spinal surgery and immunosuppression are present. Therefore, blood culture and where necessary biopsy of the infected region should be undertaken to establish the causative organism and determine appropriate antibiotic susceptibility. Prompt diagnosis of S. marcescens vertebral osteomyelitis followed by the appropriate treatment can achieve successful outcomes.

  9. The water channel aquaporin-1 contributes to renin cell recruitment during chronic stimulation of renin production.

    Science.gov (United States)

    Tinning, Anne R; Jensen, Boye L; Schweda, Frank; Machura, Katharina; Hansen, Pernille B L; Stubbe, Jane; Gramsbergen, Jan Bert; Madsen, Kirsten

    2014-12-01

    Both the processing and release of secretory granules involve water movement across granule membranes. It was hypothesized that the water channel aquaporin (AQP)1 directly contributes to the recruitment of renin-positive cells in the afferent arteriole. AQP1(-/-) and AQP1(+/+) mice were fed a low-salt (LS) diet [0.004% (wt/wt) NaCl] for 7 days and given enalapril [angiotensin-converting enzyme inhibitor (ACEI), 0.1 mg/ml] in drinking water for 3 days. There were no differences in plasma renin concentration at baseline. After LS-ACEI, plasma renin concentrations increased markedly in both genotypes but was significantly lower in AQP1(-/-) mice compared with AQP1(+/+) mice. Tissue renin concentrations were higher in AQP1(-/-) mice, and renin mRNA levels were not different between genotypes. Mean arterial blood pressure was not different at baseline and during LS diet but decreased significantly in both genotypes after the addition of ACEI; the response was faster in AQP1(-/-) mice but then stabilized at a similar level. Renin release after 200 μl blood withdrawal was not different. Isoprenaline-stimulated renin release from isolated perfused kidneys did not differ between genotypes. Cortical tissue norepinephrine concentrations were lower after LS-ACEI compared with baseline with no difference between genotypes. Plasma nitrite/nitrate concentrations were unaffected by genotype and LS-ACEI. In AQP1(-/-) mice, the number of afferent arterioles with recruitment was significantly lower compared with AQP1(+/+) mice after LS-ACEI. We conclude that AQP1 is not necessary for acutely stimulated renin secretion in vivo and from isolated perfused kidneys, whereas recruitment of renin-positive cells in response to chronic stimulation is attenuated or delayed in AQP1(-/-) mice.

  10. 国产庆大霉素聚甲基丙烯酸甲酯珠链治疗儿童慢性骨髓炎的临床报告%Clinical Study of Homemade G-PMM-BC in Treatment of Chronic Osteomyelitis in Children

    Institute of Scientific and Technical Information of China (English)

    谢金瑞

    1985-01-01

    Gentamycin-polymethymethacrylate beaded chain(homemade)is a new therapy for chronic osteomyelitis in children.In the recent 23 cases,the efficacy rate is about 95.65%.Bacterial culture showed positive results in 17 cases(mainly staphylococci aureus).Among them,16 cases displayed high or middle degree of sensitivity to gentamycin.In one case where pseudomonas seruginosa was in a tolerant state,the treatment was of no avail.No damage to the hepatic and renal functions was reported,nor that to the auditory nerve and vestibular function.Two patients with accompanying kidney disease also responded well when given symptomatic treatment with it after their diseases had become stable.Healing of the incision by first stage has a rate of 82.6%.As against traditional treatment employed in 21 control cases,the new therapy has proved more effective.%@@ 庆大霉素聚甲基丙烯酸甲酯珠链(简称庆大霉素珠链)是一种治疗骨关节软组织感染的药物新剂型.本文报告我院采用岳阳制药厂生产的庆大霉素珠链,治疗儿童慢性骨髓炎23例的治疗结果,并同本院1980~1981年用传统方法治疗的儿童慢性骨髓炎21例作对照.

  11. Aflatoxin exposure may contribute to chronic hepatomegaly in Kenyan school children

    DEFF Research Database (Denmark)

    Gong, Yun Yun; Wilson, Shona; Mwatha, Joseph K;

    2012-01-01

    Presentation with a firm type of chronic hepatomegaly of multifactorial etiology is common among school-age children in sub-Saharan Africa.......Presentation with a firm type of chronic hepatomegaly of multifactorial etiology is common among school-age children in sub-Saharan Africa....

  12. Ceftobiprole: First Reported Experience in Osteomyelitis

    OpenAIRE

    2010-01-01

    A 74-year-old man with long-standing diabetes presented with advanced infection of the right forefoot associated with septic arthritis and osteomyelitis involving the second and third metatarsophalangeal joints. Polymicrobial infection, which included methicillin-resistant Staphylococcus aureus, was documented. First-line antibiotic therapy, which included vancomycin, was not tolerated. A durable cure was obtained following a six-week course of intravenous ceftobiprole medocaril combined with...

  13. Chronic Comorbidities Contribute to the Burden and Costs of Persistent Asthma

    OpenAIRE

    2015-01-01

    Background. We aimed to study the prevalence of chronic comorbidities in asthma patients and the costs of health care use associated with asthma with comorbidities. Material and Methods. We analysed the prevalence of the four most common chronic diseases in asthma patients in 2008–2014 in Finland. Prevalence of coronary artery disease, diabetes and dyslipidaemia, hypertension, epilepsy, inflammatory bowel disease, rheumatic diseases, and severe psychiatric disease was studied by register of t...

  14. RECONSTRUCTIVE MICROSURGERY IN THE TREATMENT OF SURFACE FORMS OF CALCANEal OSTEOMYELITIS

    Directory of Open Access Journals (Sweden)

    E. S. Tsybul’

    2016-01-01

    Full Text Available One of the most common complications associated with the treatment of calcaneus fracturesis, a necrosis of the edges of the surgical wound and as a result – chronic nonhealing ulcers of the heel region and osteomyelitis of the calcaneus. In the structure of skeletal lesions osteomyelitic chronic osteomyelitis of the calcaneus occurs in 3.1–14.8% of cases, and in relation to the bones of the foot – up to 51%. At the same time after open fractures of the total incidence of deep infection from soft tissue even higher than that for the surface (12.2% vs. 9.6%. The traditional approach to the treatment of osteomyelitis of the calcaneus is often accompanied by poor performance with recurrent osteomyelitis process and highsubsequent disability of working age.Objective: to identify opportunities and assess the effectiveness of the use of reconstructive microsurgery techniques in the treatment of patients with superficial forms of osteomyelitis of the calcaneus, accompanied by the presence of soft tissue defect.Materials and мethods.The results of treatment of 28 patients with superficial forms of osteomyelitis of the calcaneus, which in the period from 2006 to 2013 in RNIITO them. R.R.Vredena were performed reconstructive plastic surgery using microsurgical techniques. Defects covering tissues were located on the sole (20 and back-side surfaces (8 of the calcaneus. Scope of interventions included the radical surgical treatment of osteomyelitis focus, marginal resection of the affected heel bone and tissue replacement of defect cover flap with axial blood supply.Results. With the localization of the defect cover tissues to non-reference surface of the heel region was carried out free plastic ray skin-fascial flap (9 cases. When the location of the defect on the plantar surface of the heel region favored medial plantar flap (10 cases. However, the presence of scarring and damage to the medial plantar artery was performed

  15. Caveolin-1 contributes to realgar nanoparticle therapy in human chronic myelogenous leukemia K562 cells

    Directory of Open Access Journals (Sweden)

    Shi D

    2016-11-01

    Full Text Available Dan Shi,1,* Yan Liu,1,* Ronggang Xi,1 Wei Zou,2 Lijun Wu,3 Zhiran Zhang,1 Zhongyang Liu,1 Chao Qu,1 Baoli Xu,1 Xiaobo Wang1 1Department of Pharmacy, The 210th Hospital of People’s Liberation Army, 2College of Life Science, Liaoning Normal University, Dalian, Liaoning, 3Department of Pharmaceutics, College of Pharmacy, Harbin Medical University, Harbin, Heilongjiang, People’s Republic of China *These authors contributed equally to this work Abstract: Chronic myelogenous leukemia (CML is characterized by the t(9;22 (q34;q11-associated Bcr-Abl fusion gene, which is an essential element of clinical diagnosis. As a traditional Chinese medicine, realgar has been widely used for the treatment of various diseases for >1,500 years. Inspired by nano-drug, realgar nanoparticles (NPs have been prepared with an average particle size of <100 nm in a previous work. Compared with coarse realgar, the realgar NPs have higher bioavailability. As a principal constituent protein of caveolae, caveolin-1 (Cav-1 participates in regulating various cellular physiological and pathological processes including tumorigenesis and tumor development. In previous studies, it was found that realgar NPs can inhibit several types of tumor cell proliferation. However, the therapeutic effect of realgar NPs on CML has not been fully elucidated. In the present paper, it was demonstrated that realgar NPs can inhibit the proliferation of K562 cells and degrade Bcr-Abl fusion protein effectively. Both apoptosis and autophagy were activated in a dose-dependent manner in realgar NPs treated cells, and the induction of autophagy was associated with class I phosphoinositide 3-kinase/protein kinase B/mammalian target of rapamycin pathway. Morphological analysis indicated that realgar NPs induced differentiation effectively in CML cells. Furthermore, it was identified that Cav-1 might play a crucial role in realgar NP therapy. In order to study the effects of Cav-1 on K562 cells during

  16. Early adversity contributes to chronic stress induced depression-like behavior in adolescent male rhesus monkeys.

    Science.gov (United States)

    Zhang, Zhi-Yi; Mao, Yu; Feng, Xiao-Li; Zheng, Na; Lü, Long-Bao; Ma, Yuan-Ye; Qin, Dong-Dong; Hu, Xin-Tian

    2016-06-01

    Chronic stress is an important cause for depression. However, not everyone who is exposed to chronic stress will develop depression. Our previous studies demonstrated that early adversity can cause lasting changes in adolescent rhesus monkeys, but depressive symptoms have not been observed. Compared to adults, it is still unknown that whether adolescent rhesus monkeys experiencing early adversity are more likely to develop depressive symptoms. In this study, we investigated the long term relationship between early adversity, chronic stress and adolescent depression for the first time. Eight male rhesus monkeys were reared in maternal separation (MS) or mother-reared (MR) conditions. All of them went through unpredictable chronic stress for two months at their age four. The stressors included space restriction, intimidation, long illumination and fasting. Behavioral and physiological data were collected during the experiment. The results showed that, compared with the MR group, the locomotor activity of MS group was significantly decreased after one month of chronic stress while huddling up and stereotypical behaviors were significantly increased. Moreover, this trend continued and even worsened at the second month. Significantly higher hair cortisol levels and lower body weight were observed in MS group after two months of stress. These results indicate that early adversity is one of the environmental factors which can increase the susceptibility of depression when experiencing chronic stress in the later life. This will further clarify the important roles of early environmental factors in the development of adolescent depression and children rearing conditions should receive more attention.

  17. Reduced tonic inhibition in the dentate gyrus contributes to chronic stress-induced impairments in learning and memory.

    Science.gov (United States)

    Lee, Vallent; MacKenzie, Georgina; Hooper, Andrew; Maguire, Jamie

    2016-10-01

    It is well established that stress impacts the underlying processes of learning and memory. The effects of stress on memory are thought to involve, at least in part, effects on the hippocampus, which is particularly vulnerable to stress. Chronic stress induces hippocampal alterations, including but not limited to dendritic atrophy and decreased neurogenesis, which are thought to contribute to chronic stress-induced hippocampal dysfunction and deficits in learning and memory. Changes in synaptic transmission, including changes in GABAergic inhibition, have been documented following chronic stress. Recently, our laboratory demonstrated shifts in EGABA in CA1 pyramidal neurons following chronic stress, compromising GABAergic transmission and increasing excitability of these neurons. Interestingly, here we demonstrate that these alterations are unique to CA1 pyramidal neurons, since we do not observe shifts in EGABA following chronic stress in dentate gyrus granule cells. Following chronic stress, there is a decrease in the expression of the GABAA receptor (GABAA R) δ subunit and tonic GABAergic inhibition in dentate gyrus granule cells, whereas there is an increase in the phasic component of GABAergic inhibition, evident by an increase in the peak amplitude of spontaneous inhibitory postsynaptic currents (sIPSCs). Given the numerous changes observed in the hippocampus following stress, it is difficult to pinpoint the pertinent contributing pathophysiological factors. Here we directly assess the impact of a reduction in tonic GABAergic inhibition of dentate gyrus granule cells on learning and memory using a mouse model with a decrease in GABAA R δ subunit expression specifically in dentate gyrus granule cells (Gabrd/Pomc mice). Reduced GABAA R δ subunit expression and function in dentate gyrus granule cells is sufficient to induce deficits in learning and memory. Collectively, these findings suggest that the reduction in GABAA R δ subunit-mediated tonic inhibition

  18. Osteomyelitis associated with Nocardiopsis composta in a dog.

    Science.gov (United States)

    Salas, Elisa N; Royal, Debra; Kurz, Lance; Loy, J Dustin

    2015-05-01

    We report the first detection of Nocardiopsis composta in association with osteomyelitis in a young male miniature Australian shepherd dog. Findings included suppurative osteomyelitis containing intralesional Fite's acid fast bacilli, aerobic culture of branching Gram-positive rods, and positive identification via phenotypic analysis and 16S rDNA sequencing.

  19. Screening for Osteomyelitis Using Thermography in Patients with Diabetic Foot

    Directory of Open Access Journals (Sweden)

    Makoto Oe

    2013-01-01

    Full Text Available One of the most serious complications of diabetic foot (DF is osteomyelitis, and early detection is important. To assess the validity of thermography to screen for osteomyelitis, we investigated thermographic findings in patients with both DF and osteomyelitis. The subjects were 18 diabetic patients with 20 occurrences of DF who visited a dermatology department at a hospital in Tokyo and underwent evaluation by magnetic resonance imaging (MRI and thermography between June 2010 and July 2012. Osteomyelitis was identified by MRI. Thermographs were taken of the wounds and legs after bed rest of more than 15 minutes. Two wound management researchers evaluated the range of increased skin temperature. There were three types of distribution of increased skin temperature: the periwound, ankle, and knee patterns. Fisher’s exact test revealed that the ankle pattern was significantly more common in the group with osteomyelitis than in the group without osteomyelitis (P=0.011. The positive predictive value was 100%, and the negative predictive value was 71.4%. Our results suggest that an area of increased skin temperature extending to the ankle can be a sign of osteomyelitis. Thermography might therefore be useful for screening for osteomyelitis in patients with DF.

  20. Brain Magnetic Resonance Imaging Does Not Contribute to the Diagnosis of Chronic Neuroborreliosis

    Energy Technology Data Exchange (ETDEWEB)

    Aalto, A.; Sjoewall, J.; Davidsson, L.; Forsberg, P.; Smedby, Oe. [Div. of Radiology, Dept. of Medicine and Care, and Div. of Infectious Diseases, Dept. of Molecular and Clinical Medicine, Linkoeping Univ., Linkoeping (Sweden)

    2007-09-15

    Background: Borrelia infections, especially chronic neuroborreliosis (NB), may cause considerable diagnostic problems. This diagnosis is based on symptoms and findings in the cerebrospinal fluid but is not always conclusive. Purpose: To evaluate brain magnetic resonance imaging (MRI) in chronic NB, to compare the findings with healthy controls, and to correlate MRI findings with disease duration. Material and Methods: Sixteen well-characterized patients with chronic NB and 16 matched controls were examined in a 1.5T scanner with a standard head coil. T1- (with and without gadolinium), T2-, and diffusion-weighted imaging plus fluid-attenuated inversion recovery (FLAIR) imaging were used. Results: White matter lesions and lesions in the basal ganglia were seen in 12 patients and 10 controls (no significant difference). Subependymal lesions were detected in patients down to the age of 25 and in the controls down to the age of 43. The number of lesions was correlated to age both in patients ( = 0.83, P<0.01) and in controls ( = 0.61, P<0.05), but not to the duration of disease. Most lesions were detected with FLAIR, but many also with T2-weighted imaging. Conclusion: A number of MRI findings were detected in patients with chronic NB, although the findings were unspecific when compared with matched controls and did not correlate with disease duration. However, subependymal lesions may constitute a potential finding in chronic NB.

  1. Possible contribution of chronic inflammation in the induction of cancer in rheumatic diseases.

    Science.gov (United States)

    Cutolo, Maurizio; Paolino, Sabrina; Pizzorni, Carmen

    2014-01-01

    Several chronic inflammatory conditions and autoimmune diseases involving different organs and tissues have been found at risk of progression to cancer. A wide array of proinflammatory cytokines, prostaglandins, nitric oxide products, and matricellular proteins are closely involved in premalignant and malignant transition of cells almost always in a background of chronic inflammation. Interestingly, epigenetic perturbations (i.e. miRNA aberrations, altered DNA methylation) together with important steroid hormone metabolic changes (i.e. oestrogens), or the altered vitamin D concentrations that may unbalance the immune / inflammatory response, have been found linked to the risk and severity in several chronic inflammatory conditions, as well as in cancer. In particular, it is evident, that not only the parent oestrogen but also oestrogen metabolites should be taken into account when this process is evaluated, specially the formation of catecholoestrogen metabolites, that are capable of forming either stable or depurinating DNA adducts, which can cause extensive DNA damage. It is interesting that today the successful treatment of several chronic immune/inflammatory rheumatic diseases is obtained also by using medications initially developed for their use in oncology. The circadian increase of growth factors, specially during the late night, in both chronic inflammation and in cancer patients, as well as the presence of oestrogen-regulated circadian mechanisms, suggests further important links.

  2. Bone SPECT/CT detection of a sequestrum in chronic-infected nonunion of the tibia

    DEFF Research Database (Denmark)

    Madsen, Jan L

    2008-01-01

    Abstract: Sequestra are dead pieces of bone most often seen in long bones affected with prior or current infection. In addition to antibiotic therapy, chronic osteomyelitis with sequestration requires surgical debridement for cure. The author presents a case of tibial fracture associated with chr......Abstract: Sequestra are dead pieces of bone most often seen in long bones affected with prior or current infection. In addition to antibiotic therapy, chronic osteomyelitis with sequestration requires surgical debridement for cure. The author presents a case of tibial fracture associated...... with chronic osteomyelitis, nonunion, and the presence of a sequestrum that was detected by bone SPECT/CT.  ...

  3. Chronic Hepatitis C and Antiviral Treatment Regimens: Where Can Psychology Contribute?

    Science.gov (United States)

    Evon, Donna M.; Golin, Carol E.; Fried, Michael W.; Keefe, Francis J.

    2013-01-01

    Objective: Our goal was to evaluate the existing literature on psychological, social, and behavioral aspects of chronic hepatitis C viral (HCV) infection and antiviral treatment; provide the state of the behavioral science in areas that presently hinder HCV-related health outcomes; and make recommendations for areas in which clinical psychology…

  4. Increased late sodium current contributes to the electrophysiological effects of chronic, but not acute, dofetilide administration

    NARCIS (Netherlands)

    Qiu, Xiaoliang S.; Chauveau, Samuel; Anyukhovsky, Evgeny P.; Rahim, Tania; Jiang, Ya Ping; Harleton, Erin; Feinmark, Steven J.; Lin, Richard Z.; Coronel, Ruben; Janse, Michiel J.; Opthof, Tobias; Rosen, Tove S.; Cohen, Ira S.; Rosen, Michael R.

    2016-01-01

    Background - Drugs are screened for delayed rectifier potassium current (I Kr) blockade to predict long QT syndrome prolongation and arrhythmogenesis. However, single-cell studies have shown that chronic (hours) exposure to some I Kr blockers (eg, dofetilide) prolongs repolarization additionally by

  5. [Challenges and opportunities: contributions of the Advanced Practice Nurse in the chronicity. Learning from experiences].

    Science.gov (United States)

    Appleby, Christine; Camacho-Bejarano, Rafaela

    2014-01-01

    Undoubtedly, our society is facing new economic, political, demographic, social and cultural challenges that require healthcare services able to meet the growing health needs of the population, especially in dealing with chronic conditions. In this new context, some countries such as the United Kingdom have made a firm commitment to develop new models for chronic patients care based on the introduction of new figures of Advanced Practice Nurses, which includes 4 cornerstones of professional practice: advanced clinical skills, clinical management, teaching and research. The implementation of this new figures implies a redefinition of professional competencies and has its own accreditation system and a specific catalogue of services adapted to the population requirements, in order to provide chronic care support from Primary Care settings. This trajectory allows us analysing the process of design and implementation of these new models and the organizational structure where it is integrated. In Spain, there are already experiences in some regions such as Andalucia and the Basque Country, focused on the creation of new advanced nursing roles. At present, it is necessary to consider suitable strategic proposals for the complete development of these models and to achieve the best results in terms of overall health and quality of life of patients with chronic conditions, improving the quality of services and cost-effectiveness through a greater cohesion and performance of healthcare teams towards the sustainability of healthcare services and patient satisfaction.

  6. Successful Treatment of Fungal Osteomyelitis with Voriconazole in a Patient with CGD

    Directory of Open Access Journals (Sweden)

    Mahsa Oaji

    2010-12-01

    Full Text Available Background:Chronic granulomatous disease (CGD is an immunodeficiency affecting phagocytic leukocytes. Defective respiratory burst mechanism renders the affected patients to be susceptible to catalase positive microorganisms. With the great successes in antibacterial prophylaxis and therapy, fungal infections are a persistent problem. Invasive aspergillosis is the most important cause of mortality in CGD. Case Presentation: We describe a nine year-old boy with CGD who presented with aspergillus induced skull osteomyelitis. He was successfully treated with voriconazole after initial failure of amphotericin B therapy. Conclusion: Currently, newer triazoles are recommended as initial therapy for invasive aspergillosis in immunodeficiency states such as CGD.

  7. Gas gangrene and osteomyelitis of the foot in a diabetic patient treated with tea tree oil

    OpenAIRE

    Cooney, Derek R; Cooney, Norma L.

    2011-01-01

    Diabetic foot wounds represent a class of chronic non-healing wounds that can lead to the development of soft tissue infections and osteomyelitis. We reviewed the case of a 44-year-old female with a diabetic foot wound who developed gas gangrene while treating her wound with tea tree oil, a naturally derived antibiotic agent. This case report includes images that represent clinical examination and x-ray findings of a patient who required broad-spectrum antibiotics and emergent surgical consul...

  8. Bone Scintigraphic Findings in MRSA Osteomyelitis.

    Science.gov (United States)

    Cornejo, Patricia; Mandell, Gerald A

    2016-02-01

    Methicillin-resistant Staphylococcus aureus osteomyelitis is a severe form of infection characterized by multifocal or multiple segmental osseous involvement and subperiosteal abscess formation with increased frequency of extraosseous complications including pyomyositis, septic thrombus, and septic arthritis. Bone scan showed long segment and/or multifocal involvement in 4 of 5 patients with areas of abnormal increased and decreased uptake. The clinical presentations included limp and/or pain. Joint involvement was seen in 4 cases. Bone scan abnormalities correlated well with MRI findings of severe and extensive bone disease, abscess formation, muscle, as well as joint and soft tissue involvement.

  9. Contributions of Ernst L. Wynder to chronic disease control worldwide and to preventive medicine.

    Science.gov (United States)

    Weisburger, John H

    2006-10-01

    Ernst L. Wynder is internationally known for his important discoveries in the field of human chronic disease causation, that is the underlying mechanisms, studied in various animal models, as a foundation for recommendations on the prevention of these diseases. These include coronary heart disease, and the main human cancers including cancer of the lung, caused by traditional smoking habits, and the nutritionally linked cancers, namely cancer of the breast, prostate, colon, pancreas, and urinary bladder. Much of this research was performed in a chronic disease prevention institution--created by Dr. Wynder--the American Health Foundation. There were outreach programs to educate people about proper lifestyles to secure disease prevention, including beginning health education in children.

  10. ASSESSMENT OF LIFESTYLE-RELATED RISK FACTORS CONTRIBUTING FOR CHRONIC NON COMMUNICABLE DISEASE IN PATIENTS VISITING RURAL TERTIARY CARE HOSPITAL

    Directory of Open Access Journals (Sweden)

    Dahal Prasanna

    2013-06-01

    Full Text Available Chronic Non-communicable diseases remain an area of high public health concern especially in developing countries where growing middle class and ever changing lifestyle have led to the rapid increase in the burden of non-communicable disease. The study aimed to assess various lifestyle and behavioral risk factors contributing for non-communicable chronic disease in patients visiting rural tertiary care hospital. A total of 152 patients were selected and analyzed in the study out of which 49 (32.22% were female and 102 (67.78% were male. The average age of the male patients were found to be 61.79years (SD±9.28 and females were 57.1years (SD±10.3. Majority of patients were from lower socioeconomic and educational status. Various risk factors contributing for chronic non-communicable disease that are identified in the study were advance age i.e. > 40years 142 (93.42%, genetically risk factor 46 (30.26%, poor income status 120 (78.95%, occupational exposure to dust, smoke and irritants 111 (73.03%, high body mass index (BMI75 (49.34%, stress 110 (72.37%, inadequate sleep 5 (3.29%, smoking habit 69 (45.4%, Alcohol consuming habit 63 (41.48%, lack of physical activity 59 (38.81%, rare fruit consuming habit 72 (47.37% and less vegetable consumption i.e. ≤ 1/day were 32 (21.05%. Study concluded that substantially high levels of the various lifestyle and behavioral related risk factors such as poor socioeconomic status, smoking, alcohol consumption, high BMI or obesity, stress etc, were significantly associated in patients with chronic disease.

  11. Chronic Comorbidities Contribute to the Burden and Costs of Persistent Asthma

    Directory of Open Access Journals (Sweden)

    Paula Kauppi

    2015-01-01

    Full Text Available Background. We aimed to study the prevalence of chronic comorbidities in asthma patients and the costs of health care use associated with asthma with comorbidities. Material and Methods. We analysed the prevalence of the four most common chronic diseases in asthma patients in 2008–2014 in Finland. Prevalence of coronary artery disease, diabetes and dyslipidaemia, hypertension, epilepsy, inflammatory bowel disease, rheumatic diseases, and severe psychiatric disease was studied by register of the Social Insurance Institution of Finland. The costs of health care services were collected from the registries maintained by the National Institute for Health and Welfare (THL. Results. Prevalence of asthma was 4.6% in 2014. Diabetes was among the four most common comorbidities in all the age groups. The other common comorbidities were hypertension (≥46 years; 12.9–37.6%, severe psychiatric disorders (age groups of 16–59 years; 1.4–3.5%, and ischaemic heart disease (≥60 years; 10–25%. In patients with both asthma and diabetes, the costs of hospitalization were approximately 169% compared with patients with asthma alone. Conclusions. Prevalence of asthma increases by tenfold when aging. The comorbidity diversity and rate are age-dependent. Prevalence of diabetes as comorbidity in asthma has increased. Costs of hospitalizations in asthma approximately double with chronic comorbidities.

  12. Structural Biology Contributions to the Discovery of Drugs to Treat Chronic Myelogenous Leukemia

    Science.gov (United States)

    Cowan-Jacob, Sandra W.; Fendrich, Gabriele; Floersheimer, Andreas; Furet, Pascal; Liebetanz, Janis; Rummel, Gabriele; Rheinberger, Paul; Centeleghe, Mario; Fabbro, Doriano; Manley, Paul W.

    This case study illustrates how the determination of multiple co-crystal structures of the protein tyrosine kinase c-Abl was used to support drug discovery efforts leading to the design of nilotinib, a newly approved therapy for imatinib-intolerant and - resistant chronic myelogenous leukemia. Chronic myelogenous leukemia (CML) results from the BCR-Abl onco-protein, which possesses a constitutively activated Abl tyrosine kinase domain. Although many chronic-phase CML patients treated with imatinib as first-line therapy maintain excellent, durable responses, patients who have progressed to advanced-stage CML frequently fail, or lose their response to therapy, often due to the emergence of drug-resistant mutants of the protein. More than 60 such point mutations have been detected in imatinib-resistant patients. We determined the crystal structures of wild-type and mutant Abl kinase in complex with imatinib and other small molecule Abl inhibitors, with the aim of understanding the molecular basis for resistance and to aid in the design and optimization of inhibitors active against the resistance mutants. These results are presented in a way which illustrates the approaches used to generate multiple structures, the type of information that can be gained and the way this information is used to support drug discovery.

  13. Structural biology contributions to the discovery of drugs to treat chronic myelogenous leukaemia

    Energy Technology Data Exchange (ETDEWEB)

    Cowan-Jacob, Sandra W., E-mail: sandra.jacob@novartis.com; Fendrich, Gabriele; Floersheimer, Andreas; Furet, Pascal; Liebetanz, Janis; Rummel, Gabriele; Rheinberger, Paul; Centeleghe, Mario; Fabbro, Doriano; Manley, Paul W. [Novartis Institutes for Biomedical Research, Basel (Switzerland)

    2007-01-01

    A case study showing how the determination of multiple cocrystal structures of the protein tyrosine kinase c-Abl was used to support drug discovery, resulting in a compound effective in the treatment of chronic myelogenous leukaemia. Chronic myelogenous leukaemia (CML) results from the Bcr-Abl oncoprotein, which has a constitutively activated Abl tyrosine kinase domain. Although most chronic phase CML patients treated with imatinib as first-line therapy maintain excellent durable responses, patients who have progressed to advanced-stage CML frequently fail to respond or lose their response to therapy owing to the emergence of drug-resistant mutants of the protein. More than 40 such point mutations have been observed in imatinib-resistant patients. The crystal structures of wild-type and mutant Abl kinase in complex with imatinib and other small-molecule Abl inhibitors were determined, with the aim of understanding the molecular basis of resistance and to aid in the design and optimization of inhibitors active against the resistance mutants. These results are presented in a way which illustrates the approaches used to generate multiple structures, the type of information that can be gained and the way that this information is used to support drug discovery.

  14. Ewing sarcoma versus osteomyelitis: differential diagnosis with magnetic resonance imaging

    Energy Technology Data Exchange (ETDEWEB)

    Henninger, B.; Glodny, B.; Rudisch, A.; Trieb, T.; Loizides, A.; Judmaier, W.; Schocke, M.F. [Innsbruck Medical University, Department of Radiology, Innsbruck (Austria); Putzer, D. [Innsbruck Medical University, Department of Nuclear Medicine, Innsbruck (Austria)

    2013-08-15

    To find and evaluate characteristic magnetic resonance imaging (MRI) patterns for the differentiation between Ewing sarcoma and osteomyelitis. We identified 28 consecutive patients referred to our department for MRI (1.5 T) of an unclear bone lesion with clinical symptoms suggestive of Ewing sarcoma or osteomyelitis. MRI scans were re-evaluated by two experienced radiologists, typical MR imaging features were documented and a diagnostic decision between Ewing sarcoma and osteomyelitis was made. Statistical significance of the association between MRI features and the biopsy-based diagnosis was assessed using Fisher's exact test. The most clear-cut pattern for determining the correct diagnosis was the presence of a sharp and defined margin of the bone lesion, which was found in all patients with Ewing sarcoma, but in none of the patients with osteomyelitis (P < 0.0001). Contrast enhancing soft tissue was present in all cases with Ewing sarcoma and absent in 4 patients with osteomyelitis (P = 0.0103). Cortical destruction was found in all patients with Ewing sarcoma, 4 patients with osteomyelitis did not present any cortical reaction (P = 0.0103). Cystic or necrotic areas were identified in 13 patients with Ewing sarcoma and in 1 patient with osteomyelitis (P = 0.004). Interobserver reliability was very good (kappa = 1) in Ewing sarcoma and moderate (kappa = 0.6) in patients with osteomyelitis. A sharp and defined margin, optimally visualized on T1-weighted images in comparison to short tau inversion recovery (STIR) images, is the most significant feature of Ewing sarcoma in differentiating from osteomyelitis. (orig.)

  15. [Osteomyelitis: a probable, uncommon etiology agent].

    Science.gov (United States)

    Cuoco, F; Borzani, I; Torcoletti, M; Beltrami, V; Petaccia, A; Corona, F

    2015-06-01

    The relation of infectious agents to arthritis is an area of great interest to the rheumatologist. Septic arthritis of bacterial origin accounts for approximately 6.5% of all childhood arthritides. Septic arthritis usually results from haematogenous spread from a focus of infection elsewhere in the body, but also by direct extension of an infection from overlying soft tissues or bone or traumatic invasion of the joint. As a result, if a focus of underlying osteomyelitis breaks throught the metaphysis, it may enter the joint and result in septic arthritis. Systemic signs of illness are fever, severe bone pain, and tenderness with or without local swelling. A wide range of microorganism can cause septic arthritis in children; Staphylococcus aureus and nongroup A and B streptococci are most common overall. However, different organisms are more common at some ages and in certain circumstances. Kingella kingae is an emerging pathogen in young children under 4 years of age. The clinical presentation of K. kingae invasive infection is often subtle and may be associated to mild to moderate biologic inflammatory responses. Affected children often have few signs and symptoms of osteoarticular infections. Early MRI is useful in differentiating K kingae from Gram-positive cocci in osteoarticular infections. Cartilaginous involvement, modest soft tissue and bone reaction suggest K. kingae. It's very important to include K. kingae in differential diagnosis of osteoarticular infections in young children. We report an unusual case of osteomyelitis: clinical manifestations and MRI are suggestive for K kingae infection.

  16. Imaging osteomyelitis and the diabetic foot

    Energy Technology Data Exchange (ETDEWEB)

    Becker, W. (Gottingen Univ. (Germany). Dep. of Nuclear Medicine)

    1999-03-01

    The clinical diagnosis of osteomyelitis and the diabetic foot is in most of the patients not possible without imaging the bone. The clinical problem is to diagnose infection as early, as reliable and as cheap as possible to prevent the possible longstanding and life-threatening complications. For imaging a lot of different radiological and nuclear medicine methods are available. This article focuses on the possible results of conventional plain radiography and tomography, computed tomography and magnetic resonance imaging as radiological and on bone scan, autologous white blood cell scintigraphy with [sup 111]In-oxin or [sup 99m]Tc-HMPAO, antigranulocyte antibodies, [sup 99m]Tc/[sup 111]In-human immunoglobulin,[sup 67] Ga-citrate and [sup 99m]Tc-nanocelloids. Different methods after different answers. Radiological methods give detailed pathological answers, nuclear medicine methods answer questions of specificity such as leukocyte infiltration. If osteomyelitis is suspected, plain radiography should be the first, three phase bone scintigraphy the second and infection specific radiopharmaceuticals the third step of examination. Only in negative images with high clinical suspicion CT or MRI should be the final imaging procedure. In the diabetic foot imaging cascade should also start with plain radiography, followed by three phase bone scintigraphy or MRI. If clinically neuropathy is present specific nuclear medicine imaging should be performed.

  17. Osteomyelitis following extraction of lower third molar during pregnancy

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Sang Bin; Huh, Kyung Hoe; Yi, Won Jin; Lee, Sam Sun [Department of Oral and Maxillofacial Radiology, and Dental Research Institute, School of Dentistry, Seoul National University, Seoul (Korea, Republic of); Kim, Mi Ja [Department of Dentistry, Hangang Sacred Heart Hospital, Hallym University, Seoul (Korea, Republic of)

    2008-09-15

    A 27-year-old female was referred to our hospital postpartum due to rapid aggravation of facial swelling. She was diagnosed with osteomyelitis on clinical, radiological, and histopathological examinations, but the possibility of malignancy was not excluded. Clinical signs and symptoms such as facial swelling and discomfort were improved with four months of antibiotics treatment. This is a case of an osteomyelitis progressed from infected extraction socket in a woman with physiological changes of pregnancy. Decreased immunological response, increased sex hormone and calcium regulatory hormones regulate the response of the bone infection. We report this case for helping the diagnosis of unusual form of osteomyelitis in pregnancy and postpartum.

  18. Attenuated TLRs in middle ear mucosa contributes to susceptibility of chronic suppurative otitis media.

    Science.gov (United States)

    Si, Yu; Zhang, Zhi Gang; Chen, Sui Jun; Zheng, Yi Qing; Chen, Yu Bin; Liu, Yi; Jiang, Huaili; Feng, Lian Qiang; Huang, Xi

    2014-08-01

    The variability in the recovery of otitis media (OM) is not well understood. Recent data have shown a critical role for toll-like receptors (TLRs) in inflammatory responses to bacteria. It remains unclear whether TLRs-mediated mucosal immunity plays a role in the OM recovery. The etiology, pathological profile, expression levels of TLR2, TLR4, TLR5, TLR9 and proinflammatory cytokines were measured in human middle-ear mucosae sampled from three subject groups: non-OM group, chronic otitis-media (COM) group, and chronic suppurative otitis-media (CSOM) group. Of the 72 ears, 86.11% CSOM patients were positive for bacteria. The cellular makeup of the middle ear mucosa differs among the three groups. Mucosae from the CSOM group presented chronic inflammation or suppurative inflammation in the rudimentary stroma, mainly with infiltration of monocytes and macrophages. The mRNA and protein levels of TLR2, TLR4, and TLR5 exhibited no difference between the non-OM and COM groups but were significantly lower in the CSOM group. Conversely, there was no significant difference in the TLR9 level among the three groups. Furthermore, proinflammatory cytokines TNF-α, IL-1β, IFN-γ, IL-6 were up-regulated in the CSOM group. This study provides evidence that the variability in clinical otitis media recovery might be associated with the variability in the expression of mucosal TLRs. Reduced TLR levels in the middle-ear mucosa might cause weak host response to bacteria, persistent inflammation and susceptibility to CSOM.

  19. 中药复方托毒生髓方治疗慢性骨髓炎的实验研究%Experimental study of Chinese herbal compound Tuodu Shengsui concoction (托毒生髓方) in treatment of chronic osteomyelitis

    Institute of Scientific and Technical Information of China (English)

    李素那; 钱丽旗; 郑彬丽; 于洋; 高飞; 杨丁友; 武冰; 孙大铭

    2012-01-01

    目的:观察中药复方托毒生髓方治疗慢性骨髓炎的疗效.方法:45只家兔随机分成4组:空白对照组正常饲养;其余3组制备慢性骨髓炎动物模型:右胫骨内侧钻开0.5 cm×1.0 cm骨窗,注入鱼肝油酸钠0.5 ml和5× 106 CFU/ml金黄色葡萄球菌悬液0.5ml,骨蜡封闭骨缺损,3周后X线检查证实模型复制成功.托毒生髓方组以托毒生髓方提取液灌胃(5 ml,每日2次)和局部外洗(10 ml,每日4次),庆大霉素组和模型组分别以庆大霉素稀释液10 ml或生理盐水10ml外洗,每日2次或4次.治疗2个月,于治疗开始后第20、40、60天行白细胞计数、血清溶菌酶含量检测和动物病变肢体X线检查.结果:模型组白细胞计数和血清溶菌酶含量于各观察时间点均较空白对照组明显下降(P<0.01),庆大霉素组虽有所恢复,但仍明显低于空白对照组,托毒生髓方组则较模型组和庆大霉素组明显升高(P<0.01),治疗第60天均接近空白对照组(P>0.05).治疗第60天,托毒生髓方组X线诊断分型明显轻于模型组和庆大霉家组(P<0.01).治疗第20天X线影像显示,模型组则出现新的骨内脓肿及高密度坏死骨影像,庆大霉素组髓腔狭窄或消失,而托毒生髓方组炎症反应消退,原有的骨干畸形重新塑形.结论:托毒生髓方对于慢性骨髓炎兔模型病变部位的炎症控制以及骨结构恢复和髓腔再通有较好疗效,其机制可能与提高免疫力和促进成骨(没有检测促进成骨的指标,建议删除)有关.%Objectives To observe the effect of Chinese herbal compound Tuodu Shengsui concoction (托毒生髓方 ) in treatment of chronic osteomyelitis in rabbits. Methods: Sixty rabbits were randomly divided into four groups. Rabbits in normal control group were fed ordinary fodder. The model of chronic osteomyelitis was replicated in rabbits of the other 3 groups: an aperture measuring 0. 5 cm×1.0 cm in the right tibia of rabbits was formed by

  20. Impaired toll like receptor-7 and 9 induced immune activation in chronic spinal cord injured patients contributes to immune dysfunction

    Science.gov (United States)

    Gungor, Bilgi; Kahraman, Tamer; Gursel, Mayda; Yilmaz, Bilge

    2017-01-01

    Reduced immune activation or immunosuppression is seen in patients withneurological diseases. Urinary and respiratory infections mainly manifested as septicemia and pneumonia are the most frequent complications following spinal cord injuries and they account for the majority of deaths. The underlying reason of these losses is believed to arise due to impaired immune responses to pathogens. Here, we hypothesized that susceptibility to infections of chronic spinal cord injured (SCI) patients might be due to impairment in recognition of pathogen associated molecular patterns and subsequently declining innate and adaptive immune responses that lead to immune dysfunction. We tested our hypothesis on healthy and chronic SCI patients with a level of injury above T-6. Donor PBMCs were isolated and stimulated with different toll like receptor ligands and T-cell inducers aiming to investigate whether chronic SCI patients display differential immune activation to multiple innate and adaptive immune cell stimulants. We demonstrate that SCI patients' B-cell and plasmacytoid dendritic cells retain their functionality in response to TLR7 and TLR9 ligand stimulation as they secreted similar levels of IL6 and IFNα. The immune dysfunction is not probably due to impaired T-cell function, since neither CD4+ T-cell dependent IFNγ producing cell number nor IL10 producing regulatory T-cells resulted different outcomes in response to PMA-Ionomycin and PHA-LPS stimulation, respectively. We showed that TLR7 dependent IFNγ and IP10 levels and TLR9 mediated APC function reduced substantially in SCI patients compared to healthy subjects. More importantly, IP10 producing monocytes were significantly fewer compared to healthy subjects in response to TLR7 and TLR9 stimulation of SCI PBMCs. When taken together this work implicated that these defects could contribute to persistent complications due to increased susceptibility to infections of chronic SCI patients. PMID:28170444

  1. Osteomyelitis Caused by Candida glabrata in the Distal Phalanx

    Science.gov (United States)

    Hibino, Naohito; Sairyo, Koichi; Yoshioka, Shinji; Yamano, Masahiro; Henmi, Tatsuhiko

    2014-01-01

    Osteomyelitis caused by Candida glabrata is rare and its optimal treatment is unknown. Here we report a case of osteomyelitis caused by C. glabrata in the distal phalanx in a 54-year-old woman. Despite partial resection of the nail and administering a 1-month course of antibiotics for paronychia, the local swelling remained and an osteolytic lesion was found. C. glabrata osteomyelitis of the distal phalanx was later diagnosed after curettage. Thereafter, the patient was treated with antifungal agents for 3 months. The infection eventually resolved, and radiological healing of the osteolytic lesion was achieved. Antifungal susceptibility testing should be performed in the case of osteomyelitis caused by nonalbicans Candida species, due to their resistance to fluconazole. PMID:25215255

  2. Osteomyelitis Caused by Candida glabrata in the Distal Phalanx

    Directory of Open Access Journals (Sweden)

    Shunichi Toki

    2014-01-01

    Full Text Available Osteomyelitis caused by Candida glabrata is rare and its optimal treatment is unknown. Here we report a case of osteomyelitis caused by C. glabrata in the distal phalanx in a 54-year-old woman. Despite partial resection of the nail and administering a 1-month course of antibiotics for paronychia, the local swelling remained and an osteolytic lesion was found. C. glabrata osteomyelitis of the distal phalanx was later diagnosed after curettage. Thereafter, the patient was treated with antifungal agents for 3 months. The infection eventually resolved, and radiological healing of the osteolytic lesion was achieved. Antifungal susceptibility testing should be performed in the case of osteomyelitis caused by nonalbicans Candida species, due to their resistance to fluconazole.

  3. Congenital multifocal osteomyelitis at 24 weeks' gestation

    Energy Technology Data Exchange (ETDEWEB)

    Raupp, Peter; Shubbar, Adil; Baichoo, Vijaymani; Samson, Gregory [Al Corniche Hospital, Department of Neonatology, P.O. Box 3788, Abu Dhabi (United Arab Emirates)

    2007-12-15

    We report an extremely rare case of congenital nonsyphilitic osteomyelitis in a very preterm infant, providing a unique illustration of the radiological appearances at birth, which may serve as a reference to facilitate diagnosis. (orig.)

  4. Oral Rehabilitation of an Osteopetrosis Patient with Osteomyelitis

    Directory of Open Access Journals (Sweden)

    Tamer Celakil

    2016-01-01

    Full Text Available Osteopetrosis is a congenital disorder characterized by increasing osteoclastic function resulting in osteomyelitis in the jaws. Orofacial findings in osteopetrosis patients are unerupted, malformed, or delayed teeth and many dental caries due to vulnerable enamel and dentin and osteomyelitis. Many reports have described that maxilla is an uncommon site of occurrence for osteomyelitis due to cortical bone morphology and collateral circulation. This report aims to discuss clinical features and prosthodontic management of a patient with clinical features of adult form of osteopetrosis and osteomyelitis in both jaws. The patient has reported better masticatory and speech efficiency with removable dentures in maxillary and mandibular jaw and also self-esteem improvement and family interaction.

  5. Staphylococcus lugdunensis: A Rare Pathogen for Osteomyelitis of the Foot.

    Science.gov (United States)

    Kear, Shelby; Smith, Collin; Mirmiran, Roya; Hofinger, Diedre

    2016-01-01

    Staphylococcus lugdunensis is an aggressive gram-positive bacteria that can lead to devastating infections in humans. S. lugdunensis has been associated with rare cases of osteomyelitis of the vertebra, prosthetic implants, and endocarditis. Reports of this organism associated with osteomyelitis of the foot or ankle have been infrequent. We present a unique case of acute osteomyelitis of a foot caused by S. lugdunensis after a patient stepped on a thorn. Our case is unique, because the radiographic changes were noted within 4 days, despite normal plain films and magnetic resonance images on the day of admission. This finding suggests the aggressiveness and virulence of S. lugdunensis. In addition, we report the first case of foot osteomyelitis as a result of isolated S. lugdunensis that involved 2 distinct specimens with 2 different antibiotic sensitivity reports.

  6. Symphysis Pubis Osteomyelitis with Bilateral Adductor Muscles Abscess

    Directory of Open Access Journals (Sweden)

    Saad M. Alqahtani

    2014-01-01

    Full Text Available Osteomyelitis of the pubis symphysis is a rare condition. There have been various reports in the literature of inflammation and osteomyelitis as well as septic arthritis of pubic symphysis. However, due to the fact that these conditions are rare and that the usual presenting symptoms are very nonspecific, osteomyelitis of the pubic symphysis is often misdiagnosed, thus delaying definitive treatment. We present a case that to our knowledge is the first case in literature of osteomyelitis of the pubic symphysis in a 17-year-old boy with juvenile idiopathic arthritis (JIA, which was initially misdiagnosed and progressed to bilateral adductor abscesses. A high suspicion of such condition should be considered in a JIA patient who presents with symphysis or thigh pain.

  7. Effects of Implant-Associated Osteomyelitis on Cefuroxime Bone Pharmacokinetics

    DEFF Research Database (Denmark)

    Tøttrup, Mikkel; Bue, Mats; Koch, Janne;

    2016-01-01

    Background: The prolonged antibiotic therapy that is often needed for successful management of osteomyelitis may be related to incomplete penetration of antibiotics into the target site. The objective of this study was to assess the effects of implant-associated osteomyelitis on cefuroxime...... penetration into bone.  Methods: Implant-associated osteomyelitis using a Staphylococcus aureus strain was induced in the right tibia in ten pigs. After five days and following administration of 1500 mg of cefuroxime, measurements of cefuroxime were obtained using microdialysis for eight hours in the implant...... cavity up to MICs of 2 mg/L compared with the other tissues, but the time was shorter for higher MICs.  Conclusions: Cefuroxime penetration into infected cancellous bone was incomplete but comparable with that in healthy bone. The destructive bone processes associated with acute osteomyelitis reduced...

  8. Early medical skull surgery for treatment of post-traumatic osteomyelitis 5,000 years ago.

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    Pierpaolo Petrone

    Full Text Available Here we describe the findings of a unique example of the early techniques adopted in neurosurgery around 5000 years ago, consisting in a double well healed skull trephination associated with a post-cranial traumatic event occurring intra vitam to a young male from the Early Chalcolithic cemetery of Pontecagnano (South Italy, ca. 4,900 - 4,500 cal BP. Morphological, X-ray and 3D-CT scan skull-cap evaluation revealed that the main orifice was produced by scraping, obtained by clockwise rotary motion of a right-handed surgeon facing the patient, while the partial trephination was carried out by using a stone point as a drilling tool. In both cases, bone regrowth is indicative of the individual's prolonged postoperative survival and his near-complete recovery. The right femur shows a poorly healed mid-shaft fracture presumably induced by a high energy injury, and a resulting chronic osteomyelitis, affecting both femurs by hematogenous spread of the infection. Our observations on the visual and radiological features of skull and femur lesions, along with evidence on the timing of experimental bone regrowth vs. healing of lower limb fractures associated to long-term bone infections now suggest that this young man underwent a double skull trephination in order to alleviate his extremely painful condition induced by chronic osteomyelitis, which is thought to have been the cause of death.

  9. Leg ulcer and osteomyelitis due to methicillin-susceptible Staphylococcus aureus infection after fracture repair treatment: a case highlighting the potential role of prostaglandin E₁ vasodilator.

    Science.gov (United States)

    Bentivegna, Erminia; Citarrella, Emanuele; Vivaldi, Roberto; De Luca, Dario; Maira, Giovanna Grazia; Casuccio, Alessandra; Di Carlo, Paola

    2015-03-01

    Prostaglandins appear to reduce biofilm formation and chronicization of infections, and stimulate a rapid and effective clearance of infecting micro-organisms. We report a case of recovery from methicillin-susceptible Staphylococcus aureus (MSSA) osteomyelitis after multidisciplinary management with antibiotics, anti-thrombotics and prostaglandin E1 (PGE1) vasodilator, in a patient with tibial plateau fracture repaired with internal fixation devices. A 47-year-old HIV-negative male with chronic ulcer on the proximal third of the left leg was admitted to the Orthopaedic Unit of the Orestano Clinic in Palermo, Italy, for suspected osteomyelitis. A biopsy of the skin ulcer and blood cultures were performed and resulted positive for MSSA. Labelled leukocyte scintigraphy confirmed osteomyelitis. No clinical improvement was observed after combined antibiotic treatment with rifampicin plus trimethoprim-sulfamethoxazole. The patient underwent a 4-day therapeutic cycle: PGE1 (alprostadil 60 mg/day IV) combined with nadroparin calcium plus gentamicin, followed by treatment with aminaftone plus sulodexide plus levofloxacin. At discharge, the patient's painful symptoms had completely resolved and the ulcer had cicatrized; recovery from osteomyelitis was confirmed by scintigraphy. This treatment protocol including PGE1 may result in a significant improvement in quality of life and functional status of patients with a reduction in direct and indirect costs and economic benefit for the National Health Service.

  10. Primary tuberculous osteomyelitis of the mandible- A Rare Case Report-

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    Ashalata

    2011-01-01

    Full Text Available Tuberculous osteomyelitis of mandible is an extremely rare condition, particularly in comparison to pyogenic infections andneoplastic diseases involving the mandible. Although a rare occurrence, the differential diagnosis of tuberculous osteomyelitismust always keep in dentist’s mind when the routine therapy fails to respond. Here, we report an unusual case of primarytubercular osteomyelitis of the mandible where the biopsy of the lesion alone has lead to near final diagnosis of the case andthere after antitubercular therapy subsided the swelling.

  11. Osteomyelitis of the mandible due to Aggregatibacter (Actinobacillus actinomycetemcomitans

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    Antony Beena

    2009-01-01

    Full Text Available Aggregatibacter (Actinobacillus actinomycetemcomitans is a capnoic gram negative coccobacilli known to produce juvenile periodontitis. This organism was isolated in pure culture from an unusual case of osteomyelitis of the mandible. The patient was treated with tetracycline, which is the drug of choice for A. actinomycetemcomitans and the clinical response improved. From our limited review of the literature, it appears that this is the first case of osteomyelitis due to A.actinomycetemcomitans reported in India.

  12. Acute Osteomyelitis of the Symphysis Pubis after Inguinal Hernia Surgery

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    Recep Tekin

    2015-01-01

    Full Text Available Osteomyelitis of pubic symphysis is infectious inflammatory condition of the symphysis pubis and rare complication of surgery around inguinal and groin region. It should be kept in mind in the differential diagnosis of lower pelvic pain and should be sought in cases of pelvic insufficiency fractures. Herein, we present a case of a 55-year-old man with osteomyelitis of the symphysis pubis following inguinal hernia surgery for diagnosis and management of this rare condition.

  13. Post-traumatic osteomyelitis due to aeromonas species

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    Gunasekaran L

    2009-01-01

    Full Text Available We report a case of Aeromonas osteomyelitis due to injury in a sewage worker. He presented with cellulitis of the left foot. Radiographs showed evidence of osteomyelitis involving the head and neck of the fifth metatarsal. Aeromonas species was isolated from the tissue and swab from the foot. The head and neck of the fifth metatarsal were excised and the patient improved on 4 weeks of intravenous meropenem followed by 4 weeks of oral clindamycin and ciprofloxacin.

  14. Sexuality as an Independent Variable: The Contribution to (or Protection against) Chronic Disease,

    Science.gov (United States)

    1978-01-05

    science has come to indict a long list of risk factors in disabling and fatal diseases: dietary intake, physical exercise activities , food chain pollutants...a plausible notion that sexual activity contributes to health outcome in a manner beyond merely serving as a mode for transmission of infectious...array the distribution of sexual activity against the distribution of health outcome is suggested.-. C-7, A3 Ś" . ... i p.1 The purpose of this

  15. Pamidronate treatment of chronic noninfectious inflammatory lesions of the mandible in children.

    Science.gov (United States)

    Compeyrot-Lacassagne, Sandrine; Rosenberg, Alan M; Babyn, Paul; Laxer, Ronald M

    2007-07-01

    Noninfectious inflammatory lesions of the mandible occur in chronic recurrent multifocal osteomyelitis (CRMO). Diffuse sclerosing osteomyelitis of the mandible (DSOM) is a condition thought to be a localized form of CRMO. Recently, bisphosphonate therapy, and particularly intravenous pamidronate, has been proposed as a treatment for patients with both CRMO and DSOM who do not improve with nonsteroidal antiinflammatory drug treatment. We report our experience using pamidronate in 2 children with chronic noninfectious osteomyelitis affecting the mandible. We describe the clinical and radiographic features and the treatment, side effects, and clinical and radiographic responses. Our experience suggests that pamidronate is an effective second-line therapy.

  16. Rapid Sequestration of Leishmania mexicana by Neutrophils Contributes to the Development of Chronic Lesion.

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    Benjamin P Hurrell

    2015-05-01

    Full Text Available The protozoan Leishmania mexicana parasite causes chronic non-healing cutaneous lesions in humans and mice with poor parasite control. The mechanisms preventing the development of a protective immune response against this parasite are unclear. Here we provide data demonstrating that parasite sequestration by neutrophils is responsible for disease progression in mice. Within hours of infection L. mexicana induced the local recruitment of neutrophils, which ingested parasites and formed extracellular traps without markedly impairing parasite survival. We further showed that the L. mexicana-induced recruitment of neutrophils impaired the early recruitment of dendritic cells at the site of infection as observed by intravital 2-photon microscopy and flow cytometry analysis. Indeed, infection of neutropenic Genista mice and of mice depleted of neutrophils at the onset of infection demonstrated a prominent role for neutrophils in this process. Furthermore, an increase in monocyte-derived dendritic cells was also observed in draining lymph nodes of neutropenic mice, correlating with subsequent increased frequency of IFNγ-secreting T helper cells, and better parasite control leading ultimately to complete healing of the lesion. Altogether, these findings show that L. mexicana exploits neutrophils to block the induction of a protective immune response and impairs the control of lesion development. Our data thus demonstrate an unanticipated negative role for these innate immune cells in host defense, suggesting that in certain forms of cutaneous leishmaniasis, regulating neutrophil recruitment could be a strategy to promote lesion healing.

  17. The Contribution of Small Airway Obstruction to the Pathogenesis of Chronic Obstructive Pulmonary Disease.

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    Hogg, James C; Paré, Peter D; Hackett, Tillie-Louise

    2017-04-01

    The hypothesis that the small conducting airways were the major site of obstruction to airflow in normal lungs was introduced by Rohrer in 1915 and prevailed until Weibel introduced a quantitative method of studying lung anatomy in 1963. Green repeated Rohrer's calculations using Weibels new data in 1965 and found that the smaller conducting airways offered very little resistance to airflow. This conflict was resolved by seminal experiments conducted by Macklem and Mead in 1967, which confirmed that a small proportion of the total lower airways resistance is attributable to small airways Hogg, Macklem, and Thurlbeck used this technique to show that small airways become the major site of obstruction in lungs affected by emphysema. These and other observations led Mead to write a seminal editorial in 1970 that postulated the small airways are a silent zone within normal lungs where disease can accumulate over many years without being noticed. This review provides a progress report since the 1970s on methods for detecting chronic obstructive pulmonary disease, the structural nature of small airways' disease, and the cellular and molecular mechanisms that are thought to underlie its pathogenesis.

  18. Kingella kingae osteoarthritis and osteomyelitis in children.

    Science.gov (United States)

    Clément, J L; Berard, J; Cahuzac, J P; Gaubert, J

    1988-01-01

    Kingella kingae is still a poorly understood germ which is responsible for osteoarticular infections. We observed nine cases of osteoarthritis involving K. kingae in children. They included 4 cases of arthritis, 2 of osteomyelitis, and 3 of spondylodiscitis. The germ was cultured in all cases by direct surgical approach or by needle aspiration of the septic locus. Evolution was always good after immobilization and nonspecific antibiotherapy. Our nine clinical cases, along with the few cases already published, allow us to state that K. kingae shows a strong affinity for bones and joints in the young child. Clinical presentation is nonspecific. The bacterial sampling must be cultured in enriched atmospheres (CO2). The strains are sensitive to most common antibiotics.

  19. Serratia marcescens osteomyelitis in Cushing's disease.

    Science.gov (United States)

    Martins, Hugo F G; Raposo, Alexandra; Baptista, Isabel; Almeida, Julio

    2015-11-30

    We report a case of a 46-year-old man with fever, hypotension and arthralgias of the ankles and knees after brain surgery for a pituitary tumour causing Cushing's disease. Blood and urine cultures isolated Serratia marcescens; antibiotic susceptibility testing showed sensitivity to piperacillin-tazobactan and ciprofloxacin. Articular MRI showed inflammation and necrosis of both knees and ankles, and left hip and right elbow (compatible with osteomyelitis). Culture of an ankle abscess on the ankle joint was positive for Serratia marcescens. Bone scintigraphy confirmed osteomyelitic lesions. Medical treatment included antibiotics and strong opioid therapy for 14 weeks. The patient was discharged clinically improved maintaining ciprofloxacin for 24 additional weeks based on clinical and analytic recovery.

  20. Erysipelothrix Rhusiopathiae Endocarditis and Presumed Osteomyelitis

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    Marc Romney

    2001-01-01

    Full Text Available Erysipelothrix rhusiopathiae is known to cause infections in humans following exposure to decaying organic matter or animals colonized with the organism, such as swine and fish. Invasive infections with this organism are unusual and are manifested primarily as infective endocarditis. The present report is believed to be the first to report a case of E rhusiopathiae endocarditis and presumptive osteomyelitis. E rhusiopathiae appears to have intrinsic resistance to vancomycin. Because vancomycin is often used empirically for the treatment of endocarditis, rapid differentiation of E rhusiopathiae> from other Gram-positive organisms is critical. In patients with endocarditis caused by a Gram-positive bacillus and epidemiological risk factors for E rhusiopathiae exposure, empirical treatment with vancomycin should be reconsidered.

  1. Chronic Stress Contributes to Cognitive Dysfunction and Hippocampal Metabolic Abnormalities in APP/PS1 Mice

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    Bing Han

    2017-03-01

    Full Text Available Background/Aims: Stress response is determined by the brain, and the brain is a sensitive target for stress. Our previous experiments have confirmed that once the stress response is beyond the tolerable limit of the brain, particularly that of the hippocampus, it will have deleterious effects on hippocampal structure and function; however, the metabolic mechanisms for this are not well understood. Methods: Here, we used morris water maze, elisa and gas chromatography-time of flight/mass spectrometry to observe the changes in cognition, neuropathology and metabolomics in the hippocampus of APP/PS1 mice and wild-type (C57 mice caused by chronic unpredictable mild stress (CUMS, we also further explored the correlation between cognition and metabolomics. Results: We found that 4 weeks of CUMS aggravated cognitive impairment and increased amyloid-β deposition in APP/PS1 mice, but did not affect C57 mice. Under non-stress conditions, compared with C57 mice, there were 8 different metabolites in APP/PS1 mice. However, following CUMS, 3 different metabolites were changed compared with untreated C57 mice. Compared to APP/PS1 mice, there were 7 different metabolites in APP/PS1+CUMS mice. Among these alterations, 3-hydroxybutyric acid, valine, serine, beta-alanine and o-phosphorylethanolamine, which are involved in sphingolipid metabolism, synthesis and degradation of ketone bodies, and amino acid metabolism. Conclusion: The results indicate that APP/PS1 mice are more vulnerable to stress than C57 mice, and the metabolic mechanisms of stress-related cognitive impairment in APP/PS1 mice are related to multiple pathways and networks, including sphingolipid metabolism, synthesis and degradation of ketone bodies, and amino acid metabolism.

  2. The contribution of spinal glial cells to chronic pain behaviour in the monosodium iodoacetate model of osteoarthritic pain

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    Sagar Devi

    2011-11-01

    Full Text Available Abstract Background Clinical studies of osteoarthritis (OA suggest central sensitization may contribute to the chronic pain experienced. This preclinical study used the monosodium iodoacetate (MIA model of OA joint pain to investigate the potential contribution of spinal sensitization, in particular spinal glial cell activation, to pain behaviour in this model. Experimental OA was induced in the rat by the intra-articular injection of MIA and pain behaviour (change in weight bearing and distal allodynia was assessed. Spinal cord microglia (Iba1 staining and astrocyte (GFAP immunofluorescence activation were measured at 7, 14 and 28 days post MIA-treatment. The effects of two known inhibitors of glial activation, nimesulide and minocycline, on pain behaviour and activation of microglia and astrocytes were assessed. Results Seven days following intra-articular injection of MIA, microglia in the ipsilateral spinal cord were activated (p Conclusions Here we provide evidence for a contribution of spinal glial cells to pain behaviour, in particular distal allodynia, in this model of osteoarthritic pain. Our data suggest there is a potential role of glial cells in the central sensitization associated with OA, which may provide a novel analgesic target for the treatment of OA pain.

  3. The α5 subunit containing GABAA receptors contribute to chronic pain.

    Science.gov (United States)

    Bravo-Hernández, Mariana; Corleto, José A; Barragán-Iglesias, Paulino; González-Ramírez, Ricardo; Pineda-Farias, Jorge B; Felix, Ricardo; Calcutt, Nigel A; Delgado-Lezama, Rodolfo; Marsala, Martin; Granados-Soto, Vinicio

    2016-03-01

    It has been recently proposed that α5-subunit containing GABAA receptors (α5-GABAA receptors) that mediate tonic inhibition might be involved in pain. The purpose of this study was to investigate the contribution of α5-GABAA receptors in the loss of GABAergic inhibition and in formalin-induced, complete Freund's adjuvant (CFA)-induced and L5 and L6 spinal nerve ligation-induced long-lasting hypersensitivity. Formalin or CFA injection and L5 and L6 spinal nerve ligation produced long-lasting allodynia and hyperalgesia. Moreover, formalin injection impaired the rate-dependent depression of the Hofmann reflex. Peripheral and intrathecal pretreatment or post-treatment with the α5-GABAA receptor antagonist, L-655,708 (0.15-15 nmol), prevented and reversed, respectively, these long-lasting behaviors. Formalin injection increased α5-GABAA receptor mRNA expression in the spinal cord and dorsal root ganglia (DRG) mainly at 3 days. The α5-GABAA receptors were localized in the dorsal spinal cord and DRG colabeling with NeuN, CGRP, and IB4 which suggests their presence in peptidergic and nonpeptidergic neurons. These receptors were found mainly in small and medium sized neurons. Formalin injection enhanced α5-GABAA receptor fluorescence intensity in spinal cord and DRG at 3 and 6 days. Intrathecal administration of L-655,708 (15 nmol) prevented and reversed formalin-induced impairment of rate-dependent depression. These results suggest that α5-GABAA receptors play a role in the loss of GABAergic inhibition and contribute to long-lasting secondary allodynia and hyperalgesia.

  4. Tyrosine Phosphorylation of NR2B Contributes to Chronic Migraines via Increased Expression of CGRP in Rats

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    Xiping Liang

    2017-01-01

    Full Text Available Tyrosine phosphorylation of NR2B (NR2B-pTyr, a subunit of the N-methyl-D-aspartate (NMDA receptor, has been reported to develop central sensitization and persistent pain in the spine, but its effect in chronic migraines has not been examined. We hypothesized that tyrosine phosphorylation of NR2B contributes to chronic migraines (CM through calcitonin gene-related peptide (CGRP in rats. Ninety-four male Sprague-Dawley rats were subjected to seven inflammatory soup (IS injections. In a subset of animals, the time course and location of NR2B tyrosine phosphorylation were detected by western blot and immunofluorescence double staining. Another set of animals were given either genistein, vehicle, or genistein and recombinant CGRP. The mechanical threshold was measured, the expressions of NR2B-pTyr, NR2B, and CGRP were quantified using western blot, and nitric oxide (NO was measured with the nitric acid reductase method. NR2B-pTyr expression, in neurons, peaked at 24 hours after CM. Genistein improved the mechanical threshold and reduced migraine attacks 24 and 72 hours after CM. Tyrosine phosphorylation of NR2B decreased the mechanical threshold and increased migraine attacks via upregulated CGRP expression in the rat model of CM. Thus, tyrosine phosphorylation of NR2B may be a potential therapeutic target for treatment of CM.

  5. Tyrosine Phosphorylation of NR2B Contributes to Chronic Migraines via Increased Expression of CGRP in Rats

    Science.gov (United States)

    Liang, Xiping; Wang, Sha; Qin, Guangcheng; Xie, Jingmei; Tan, Ge; Zhou, Jiying; McBride, Devin W.

    2017-01-01

    Tyrosine phosphorylation of NR2B (NR2B-pTyr), a subunit of the N-methyl-D-aspartate (NMDA) receptor, has been reported to develop central sensitization and persistent pain in the spine, but its effect in chronic migraines has not been examined. We hypothesized that tyrosine phosphorylation of NR2B contributes to chronic migraines (CM) through calcitonin gene-related peptide (CGRP) in rats. Ninety-four male Sprague-Dawley rats were subjected to seven inflammatory soup (IS) injections. In a subset of animals, the time course and location of NR2B tyrosine phosphorylation were detected by western blot and immunofluorescence double staining. Another set of animals were given either genistein, vehicle, or genistein and recombinant CGRP. The mechanical threshold was measured, the expressions of NR2B-pTyr, NR2B, and CGRP were quantified using western blot, and nitric oxide (NO) was measured with the nitric acid reductase method. NR2B-pTyr expression, in neurons, peaked at 24 hours after CM. Genistein improved the mechanical threshold and reduced migraine attacks 24 and 72 hours after CM. Tyrosine phosphorylation of NR2B decreased the mechanical threshold and increased migraine attacks via upregulated CGRP expression in the rat model of CM. Thus, tyrosine phosphorylation of NR2B may be a potential therapeutic target for treatment of CM.

  6. Contribution of influenza to acute exacerbations of chronic obstructive pulmonary disease in Kashmir, India, 2010-2012.

    Science.gov (United States)

    Koul, Parvaiz A; Khan, Umar H; Asad, Romana; Yousuf, Rubaya; Broor, Shobha; Lal, Renu B; Dawood, Fatimah S

    2015-01-01

    We estimate the contribution of influenza to hospitalizations for acute exacerbations of chronic obstructive pulmonary disease (AECOPD) in Kashmir, India. Prospective surveillance for influenza among patients hospitalized with AECOPD was conducted at a tertiary care hospital. Patients had clinical data collected and nasal/throat swabs tested for influenza viruses. Outcomes among patients with and without influenza were compared with logistic regression adjusting for age and underlying conditions. During October 2010-September 2012, 498 patients hospitalized with AECOPD were enrolled, of whom 40 (8%) had received influenza vaccine. Forty (8%) had influenza; influenza virus detection peaked in winter (January-March). Patients with influenza were more likely to die during hospitalization (adjusted OR 3.4, CI 1.0-11.4) than those without.

  7. Hypokalemia, its contributing factors and renal outcomes in patients with chronic kidney disease.

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    Hsiao-Han Wang

    Full Text Available BACKGROUND: In the chronic kidney disease (CKD population, the impact of serum potassium (sK on renal outcomes has been controversial. Moreover, the reasons for the potential prognostic value of hypokalemia have not been elucidated. DESIGN PARTICIPANTS & MEASUREMENTS: 2500 participants with CKD stage 1-4 in the Integrated CKD care program Kaohsiung for delaying Dialysis (ICKD prospective observational study were analyzed and followed up for 2.7 years. Generalized additive model was fitted to determine the cutpoints and the U-shape association between sK and end-stage renal disease (ESRD. sK was classified into five groups with the cutpoints of 3.5, 4, 4.5 and 5 mEq/L. Cox proportional hazard regression models predicting the outcomes were used. RESULTS: The mean age was 62.4 years, mean sK level was 4.2±0.5 mEq/L and average eGFR was 40.6 ml/min per 1.73 m(2. Female vs male, diuretic use vs. non-use, hypertension, higher eGFR, bicarbonate, CRP and hemoglobin levels significantly correlated with hypokalemia. In patients with lower sK, nephrotic range proteinuria, and hypoalbuminemia were more prevalent but the use of RAS (renin-angiotensin system inhibitors was less frequent. Hypokalemia was significantly associated with ESRD with hazard ratios (HRs of 1.82 (95% CI, 1.03-3.22 in sK 5 mEq/L conferred 1.6-fold (95% CI,1.09-2.34 increased risk of ESRD compared with sK = 4.5-5 mEq/L. Hypokalemia was also associated with rapid decline of renal function defined as eGFR slope below 20% of the distribution range. CONCLUSION: In conclusion, both hypokalemia and hyperkalemia are associated with increased risk of ESRD in CKD population. Hypokalemia is related to increased use of diuretics, decreased use of RAS blockade and malnutrition, all of which may impose additive deleterious effects on renal outcomes.

  8. Daily physical activity and its contribution to the health-related quality of life of ambulatory individuals with chronic stroke

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    Rand Debbie

    2010-08-01

    Full Text Available Abstract Background Participation in daily physical activity (PA post-stroke has not previously been investigated as a possible explanatory variable of health-related quality of life (HRQL. The aims were 1 to determine the contribution of daily PA to the HRQL of individuals with chronic stroke and 2 to assess the relationship between the functional ability of these individuals to the amount of daily PA. Methods The amount of daily PA of forty adults with chronic stroke (mean age 66.5 ± 9.6 years was monitored using two measures. Accelerometers (Actical were worn on the hip for three consecutive days in conjunction with a self-report questionnaire [the PA Scale for Individuals with Physical Disabilities (PASIPD]. The daily physical activity was measured as the mean total accelerometer activity counts/day and the PASIPD scores as the metabolic equivalent (MET hr/day. HRQL was assessed by the Physical and Mental composite scores of the Medical Outcomes Study Short-Form 36 (SF-36 in addition to the functional ability of the participants. Correlation and regression analyses were performed. Results After controlling for the severity of the motor impairment, the amount of daily PA, as assessed by the PASIPD and accelerometers, was found to independently contribute to 10-12% of the variance of the Physical Composite Score of the SF-36. No significant relationship was found between PA and the Mental Composite Score of the SF-36.The functional ability of the participants was found to be correlated to the amount of daily PA (r = 0.33 - 0.67, p Conclusion The results suggest that daily PA is associated with better HRQL (as assessed by the Physical composite score of the SF-36 for people living with stroke. Daily PA should be encouraged to potentially increase HRQL. Accelerometers in conjunction with a self-report questionnaire may provide important measures of PA which can be monitored and modified, and potentially influence HRQL.

  9. Do frequent moderate exacerbations contribute to progression of chronic obstructive pulmonary disease in patients who are ex-smokers?

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    Dreyse J

    2015-03-01

    Full Text Available Jorge Dreyse,1 Orlando Díaz,1 Paula Repetto,2 Arturo Morales,1 Fernando Saldías,1 Carmen Lisboa11Department of Pulmonary Diseases, School of Medicine, 2School of Psychology, Pontificia Universidad Católica de Chile, Santiago, ChileBackground: In addition to smoking, acute exacerbations are considered to be a contributing factor to progression of chronic obstructive pulmonary disease (COPD. However, these findings come from studies including active smokers, while results in ex-smokers are scarce and contradictory. The purpose of this study was to evaluate if frequent acute moderate exacerbations are associated with an accelerated decline in forced expiratory volume in one second (FEV1 and impairment of functional and clinical outcomes in ex-smoking COPD patients.Methods: A cohort of 100 ex-smoking patients recruited for a 2-year follow-up study was evaluated at inclusion and at 6-monthly scheduled visits while in a stable condition. Evaluation included anthropometry, spirometry, inspiratory capacity, peripheral capillary oxygen saturation, severity of dyspnea, a 6-minute walking test, BODE (Body mass index, airflow Obstruction, Dyspnea, Exercise performance index, and quality of life (St George’s Respiratory Questionnaire and Chronic Respiratory Disease Questionnaire. Severity of exacerbation was graded as moderate or severe according to health care utilization. Patients were classified as infrequent exacerbators if they had no or one acute exacerbation/year and frequent exacerbators if they had two or more acute exacerbations/year. Random effects modeling, within hierarchical linear modeling, was used for analysis.Results: During follow-up, 419 (96% moderate acute exacerbations were registered. At baseline, frequent exacerbators had more severe disease than infrequent exacerbators according to their FEV1 and BODE index, and also showed greater impairment in inspiratory capacity, forced vital capacity, peripheral capillary oxygen saturation

  10. Current asthma contributes as much as smoking to chronic bronchitis in middle age: a prospective population-based study

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    Dharmage SC

    2016-08-01

    Full Text Available Shyamali C Dharmage,1 Jennifer L Perret,1,2, John A Burgess,1 Caroline J Lodge,1 David P Johns,3 Paul S Thomas,4 Graham G Giles,1,5 John L Hopper,1,6 Michael J Abramson,7,8 E Haydn Walters,3,9, Melanie C Matheson1 1Allergy and Lung Health Unit, Center for Epidemiology and Biostatistics, The University of Melbourne, 2Institute for Breathing and Sleep (IBAS, Melbourne, VIC, 3“Breathe Well” Center of Research Excellence for Chronic Respiratory Disease and Lung Ageing, School of Medicine, University of Tasmania, Hobart, TAS, 4Inflammation and Infection Research, Faculty of Medicine, University of New South Wales, Sydney, NSW, 5Cancer Epidemiology Center, Cancer Council Victoria, Melbourne, VIC, Australia; 6Department of Public Health, Seoul National University, Seoul, South Korea; 7Allergy, Immunology and Respiratory Medicine, The Alfred Hospital, Melbourne, 8School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 9School of Medicine, University of Tasmania, Hobart, TAS, Australia Background and objective: Personal smoking is widely regarded to be the primary cause of chronic bronchitis (CB in adults, but with limited knowledge of contributions by other factors, including current asthma. We aimed to estimate the independent and relative contributions to adult CB from other potential influences spanning childhood to middle age.Methods: The population-based Tasmanian Longitudinal Health Study cohort, people born in 1961, completed respiratory questionnaires and spirometry in 1968 (n=8,583. Thirty-seven years later, in 2004, two-thirds responded to a detailed postal survey (n=5,729, from which the presence of CB was established in middle age. A subsample (n=1,389 underwent postbronchodilator spirometry between 2006 and 2008 for the assessment of chronic airflow limitation, from which nonobstructive and obstructive CB were defined. Multivariable and multinomial logistic regression models were used to estimate

  11. Potential contribution of Type I lung epithelial cells to chronic neonatal lung disease

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    Henry J. Rozycki

    2014-05-01

    Full Text Available The alveolar surface is covered by large flat Type I cells (alveolar epithelial cells 1, AEC1. The normal physiological function of AEC1s involves gas exchange, based on their location in approximation to the capillary endothelium and their thinness, and in ion and water flux, as shown by the presence of solute active transport proteins, water channels, and impermeable tight junctions between cells. With the recent ability to produce relatively pure cultures of AEC1 cells, new functions have been described. These may be relevant to lung injury, repair and the abnormal development that characterizes bronchopulmonary dysplasia. To hypothesize a potential role for AEC1 in the development of lung injury and abnormal repair/development in premature lungs, evidence is presented for their presence in the developing lung, how their source may not be the Type II cell (AEC2 as has been assumed for forty years, and how the cell can be damaged by same type of stressors as those which lead to bronchopulmonary dysplasia (BPD. Recent work shows that the cells are part of the innate immune response, capable of producing pro-inflammatory mediators, which could contribute to the increase in inflammation seen in early bronchopulmonary dysplasia. One of the receptors found exclusively on AEC1 cells in the lung, called RAGE, may also have a role in increased inflammation, and to alveolar simplification. While the current evidence for AEC1 involvement in BPD is circumstantial and limited at present, the accumulating data supports several hypotheses and questions regarding potential differences in the behavior of AEC1 cells from newborn and premature lung compared with the adult lung.

  12. Emergence of coryneforms in osteomyelitis and orthopaedic surgical site infections

    Directory of Open Access Journals (Sweden)

    Meher Rizvi

    2011-07-01

    Full Text Available BackgroundCoryneform species other than Corynebacterium diphtheriae are coming up as important pathogens with the potential to cause serious and life-threatening infections not only in immunocompromised but in immunocompetent individuals as well. The exact infectious potential of these bacteria and their rational antimicrobial treatment is a challenging but essential task.Method The study was conducted in the Department of Microbiology and the Department of Orthopaedics, JNMCH, AMU, Aligarh between August 2007 and May 2009. Pus samples were collected from patients of osteomyelitis and other bone infections including orthopaedic surgical site infections. The Corynebacterium species isolated in the study was identified using standard microbiological techniques and antimicrobial sensitivity testing was done by Kirby bauer disc diffusion method.ResultsA total of 312 Corynebacterium species were isolated. The majority of the coryneforms were isolated from the immunocompetent patients 270 (86.54%. C.jeikium was the most common coryneform isolated. Nearly half of the patients 153 (49.04% had acute infection caused by Corynebacterium species after orthopaedic surgery, a quarter 66 (21.15% had chronic infection and 72 (23.08% patients had device-related infection. Coryneforms exhibited maximum resistance to aminoglycosides (58.65% and β-lactams (penicillin group- 57.55%. C.jeikium was found to be the most resistant amongst all the Corynebacterium species.ConclusionThe study highlights the fact that the coryneforms are no longer just opportunistic pathogens but they are also becoming important pathogens among immunocompetent individuals as well. The emergence of drug resistance amongst these isolates is of most concern. More studies should be done on identification and on antimicrobial susceptibility of these organisms for the proper treatment of patients with such infections.

  13. Clinico-radiological improvement in an immunocompetent patient presented with scedosporium apiospermum osteomyelitis.

    Science.gov (United States)

    Mohan, Rahul; Gopakumar, T S

    2016-01-01

    Scedosporium apiospermum is frequently found as a saprophyte in soil, sewage and contaminated water. Its manifestations in immunocompetent patients are usually localised and in immunodeficient patients, it causes invasive systemic diseases. We are reporting the case of a 40-year-old male, who presented with pain, oedema and multiple discharging sinuses over the lateral aspect of the left foot with history of thorn prick. On examination, there were multiple active sinuses with tenderness and local rise in temperature. Calcaneum on palpation showed a thickened and irregular surface with limitation of ankle and subtalar movements. Blood investigations showed a moderate rise in ESR and CRP. X-rays showed typical features of chronic osteomyelitis with sclerosis, cavities and irregular bone contour. CT report showed features of osteomyelitis involving calcaneum, talus, cuneiforms and navicular bone with periarticular soft tissue involvement and mild focal collection in the calcaneum. On repeated culture, it was found to be scedosporium apiospermum fungus. We managed the case with voriconazole therapy and it responded with excellent clinical and radiological improvement by 9 months.

  14. Staphylococcal endogenous endophthalmitis in association with pyogenic vertebral osteomyelitis.

    Science.gov (United States)

    Steeples, L R; Jones, N P

    2016-01-01

    PURPOSE To describe pyogenic vertebral osteomyelitis as a rare infection associated with endogenous endophthalmitis.METHODS A retrospective review of three patients with endogenous endophthalmitis and sepsis due to underlying Staphylococcal vertebral osteomyelitis presenting during a 21-month time period. The ophthalmic and systemic features and management and outcomes are presented.RESULTS One patient developed unilateral endophthalmitis with cervical spine osteomyelitis, Staphylococcus aureus being isolated from blood cultures. The second presented with bilateral endophthalmitis with disseminated Methicillin-resistant S. aureus (MRSA) infection, with thoracic and lumbar discitis and para-spinal abscesses. MRSA was cultured from vitreous, blood, and synovial fluid. Both patients received prolonged courses of intravenous antibiotics. Intravitreal antibiotic therapy was used in the second patient. Excellent visual and systemic outcomes were achieved in both cases with no ocular complications. The third patient developed lumbar osteomyelitis following spinal surgery and presented with disseminated S. aureus sepsis including unilateral endogenous endophthalmitis. Despite systemic antibiotics and intensive care the patient died.CONCLUSIONS Endogenous endophthalmitis should be suspected in septic patients developing eye symptoms. Endogenous endophthalmitis with staphylococcal bone infection is a rare but serious condition. Osteomyelitis should be considered as an infective source in any such patient reporting bone pain or reduced spinal mobility. Prompt investigation and treatment can achieve favourable visual and systemic outcomes.

  15. Activation of ERK/CREB pathway in spinal cord contributes to chronic constrictive injury-induced neuropathic pain in rats

    Institute of Scientific and Technical Information of China (English)

    Xue-song SONG; Jun-li CAO; Yan-bing XU; Jian-hua HE; Li-cai ZHANG; Yin-ming ZENG

    2005-01-01

    Aim: To investigate whether activation and translocation of extracellular signalregulated kinase (ERK) is involved in the induction and maintenance of neuropathic pa in, and effects of activation and translocation of ERK on expression of pCREB and Fos in the chronic neuropathic pain.Methods: Lumbar intrathecal catheters were chronically implanted in male Sprague-Dawley rats.The left sciatic nerve was loosely ligated proximal to the sciatica's trifurcation at approximately 1.0 mm intervals with 4-0 silk sutures.The mitogen-activated protein kinase kinase (MEK) inhibitor U0126 or phosphorothioate-modified antisense oligonucleotides (ODN) were intrathecally administered every 12 h, 1 d pre-chronic constriction injury (CCI) and 3 d post-CCI.Thermal and mechanical nociceptive thresholds were assessed with the paw withdrawal latency (PWL) to radiant heat and yon Frey filaments.The expression of pERK, pCREB, and Fos were assessed by both Western blotting and immunohistochemical analysis.Results: Intrathecal injection of U0126 or ERK antisense ODN significantly attenuated CCI-induced mechanical allodynia and thermal hyperalgesia.CCI significantly increased the expression of p-ERK-IR neurons in the ipsilateral spinal dorsal horn to injury, not in the contralateral spinal dorsal horn.The time courses of pERK expression showed that the levels of both cytosol and nuclear pERK, but not total ERK, were increased at all points after CCI and reached a peak level on postoperative d 5.CCI also significantly increased the expression of pCREB and Fos.Phospho-CREB-positive neurons were distributed in all laminae of the bilateral spinal cord and Fos was expressed in laminae Ⅰ and Ⅱ of the ipsilateral spinal dorsal horn.Intrathecal injection of U0126 or ERK antisense ODN markedly suppressed the increase of CCI-induced pERK, pCREB and c-Fos expression in the spinal cord.Conclusion:The activation of ERK pathways contributes to neuropathic pain in CCI rats, and the function of pERK may

  16. Chronic exposure of ecosystems and public to elements in trace contributions; L'exposition chronique des ecosystemes et du public aux elements en traces contributions

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2004-07-01

    The needs in radiation protection come towards the question of chronic contaminations by trace elements or radioactive compounds. The chronicity induces to take into account a whole of redistribution mechanisms more important than the only ways of the most direct transfer. In the case of environment, that is going to become one of the way of public contamination is a target to protect, the important work is to link the contamination situation to eventual consequences on the ecosystems situation. (N.C.)0.

  17. [Case report: cutaneous tuberculosis and tuberculous osteomyelitis].

    Science.gov (United States)

    Celikbaş, Aysel Kocagul; Ulu, Ayfegül; Ergönül, Onder; Eren, Sebnem; Baykam, Nurcan; Dokuzoguz, Başak

    2005-01-01

    In this report, a 27 years old male patient diagnosed to have skin and bone tuberculosis (TB) has been presented. The patient admitted to the hospital with the complaints of fever, weight loss and night sweats. Patient's history revealed that following a trauma a skin lesion in the right ankle was developed and this was followed by the development of many lesions in different parts of the body. The lesions persisted despite the use of various antibiotics since a year. It has been recorded that his father has already been receiving anti-tuberculosis treatment. Osteomyelitis was detected in the distal part of right tibia by computerized tomography, and Mycobacterium tuberculosis was isolated from the specimens of skin lesion. The patient was immunocompetent, and there was no pulmonary involvement. Isoniazid (INAH), rifampin (RIF), ethambutol and morphozinamid therapy has been started and completed to 12 months with INAH and RIF. In the post-treatment follow-up of patient for one year, no relapse was detected. As a result, tuberculosis should be considered in patients with persistent skin lesions especially in endemic countries.

  18. Do frequent moderate exacerbations contribute to progression of chronic obstructive pulmonary disease in patients who are ex-smokers?

    Science.gov (United States)

    Dreyse, Jorge; Díaz, Orlando; Repetto, Paula B; Morales, Arturo; Saldías, Fernando; Lisboa, Carmen

    2015-01-01

    Background In addition to smoking, acute exacerbations are considered to be a contributing factor to progression of chronic obstructive pulmonary disease (COPD). However, these findings come from studies including active smokers, while results in ex-smokers are scarce and contradictory. The purpose of this study was to evaluate if frequent acute moderate exacerbations are associated with an accelerated decline in forced expiratory volume in one second (FEV1) and impairment of functional and clinical outcomes in ex-smoking COPD patients. Methods A cohort of 100 ex-smoking patients recruited for a 2-year follow-up study was evaluated at inclusion and at 6-monthly scheduled visits while in a stable condition. Evaluation included anthropometry, spirometry, inspiratory capacity, peripheral capillary oxygen saturation, severity of dyspnea, a 6-minute walking test, BODE (Body mass index, airflow Obstruction, Dyspnea, Exercise performance) index, and quality of life (St George’s Respiratory Questionnaire and Chronic Respiratory Disease Questionnaire). Severity of exacerbation was graded as moderate or severe according to health care utilization. Patients were classified as infrequent exacerbators if they had no or one acute exacerbation/year and frequent exacerbators if they had two or more acute exacerbations/year. Random effects modeling, within hierarchical linear modeling, was used for analysis. Results During follow-up, 419 (96% moderate) acute exacerbations were registered. At baseline, frequent exacerbators had more severe disease than infrequent exacerbators according to their FEV1 and BODE index, and also showed greater impairment in inspiratory capacity, forced vital capacity, peripheral capillary oxygen saturation, 6-minute walking test, and quality of life. However, no significant difference in FEV1 decline over time was found between the two groups (54.7±13 mL/year versus 85.4±15.9 mL/year in frequent exacerbators and infrequent exacerbators, respectively

  19. [Acute osteomyelitis and septic arthritis in children: one year experience].

    Science.gov (United States)

    Timsit, S; Pannier, S; Glorion, C; Chéron, G

    2005-01-01

    To describe bacteriologic epidemiology of bone and joint infections, a total of 52 osteomyelitis, 52 arthritis and 20 osteoarthritis of children aged one month to 15 years during a one-year period (2001) were included in a retrospective unicentric review. The mean age was 3,9 +/-3,6 years. Fever and pain were the most common clinical symptoms. The site of infection was single in 95%, involving lower extremities in 80%. Bone scintigraphy was abnormal in 71% of osteomyelitis. Positive cultures was obtained in 29% of all cases (blood cultures: 20%, aspiration cultures: 29%), but in 42% of cases which have both blood and aspiration cultures. Thirty-six bacteria were identified: 19 Staphylococcus (14 aureus), ten Streptococcus (four pneumoniae), three Salmonella, three Kingella kingae, one Moraxella. All the isolates were susceptible to the empiric antibiotic therapy. Outcome was good in 100% of osteomyelitis and in 96% of arthritis.

  20. Emphysematous osteomyelitis: a case report and review of the literature.

    Science.gov (United States)

    Luey, Christopher; Tooley, Debbie; Briggs, Simon

    2012-03-01

    We report the case of a 15-year-old girl with pelvic and sacral emphysematous osteomyelitis caused by Fusobacterium necrophorum. This infection was cured following four surgical procedures and 4 weeks of intravenous then 4 weeks of oral antibiotics. We review our case alongside the 24 previously reported cases of emphysematous osteomyelitis in the literature. The 25 cases include 15 monomicrobial and 10 polymicrobial infections. The causative organism(s) in all but three cases included an anaerobe or a member of the Enterobacteriaceae family. A significant underlying comorbidity was reported in 18 cases. At least 15 cases required one or more surgical procedures. There was a significant associated mortality with eight (32%) patients dying in hospital at 7 to 56 days after the diagnosis of emphysematous osteomyelitis.

  1. Radiation osteomyelitis of the mandible. Report of two cases

    Energy Technology Data Exchange (ETDEWEB)

    Molla, M.R.; Nishio, Juntaro; Matsuya, Tokuzo; Miyazaki, Tadashi (Osaka Univ. (Japan). School of Dentistry)

    1982-12-01

    Radiation therapy for the head and neck malignant tumor may often cause osteoradionecrosis of the mandible, leading to radiation osteomyelitis with a source of infection. The present study demonstrates two cases with radiation osteomyelitis of the mandible to discuss the etiology, radiological findings and preventive measure for this type of bone disease. The results indicate that, 1) A higher dose in external radiotherapy may claimed to be a potent factor to cause osteoradionecrosis and post irradiation periodontitis of the tooth associated with pain, may be preliminary symptom of leading radiation osteomyelitis, where a delayed healing of tooth extraction is an accelerating factor responsible for rapid progress of osteomyelitic changes. 2) Once infection sets in post irradiated bone, radio-osteomyelitic change is quite progressive even after various conservative measure. 3) Only radiological change in those cases is a slow formation of sequestrum time ranging from 7 to 10 months, with a gradual separation of dead bone as a large mass.

  2. Subperiosteal abscess in a child. Trueta's osteomyelitis hypothesis undermined?

    Science.gov (United States)

    Weenders, S G M; Janssen, N E; Landman, G W D; van den Berg, F P

    2015-10-01

    Subperiosteal abscess formation is almost exclusively seen secondary to underlying hematogenous infected osteomyelitis or secondary as a result of a contagious focus. We present an unusual case of a 9-year-old girl with progressive ankle pain due to an isolated subperiosteal abscess of the distal fibula without concomitant osteomyelitis. The subperiosteal abscess was most likely caused by hematogenous spread to the periosteal region of the distal fibula located above the highly vascularized metaphysis. Remarkably, there were no signs of osteomyelitis on either MRI or during surgical inspection. She was successfully treated with debridement and antibiotic therapy. We hypothesize that subperiosteal abscess formation near the metaphysis originates in the periosteal region and not from outward extension from the sinusoidal veins in the intrametaphyseal area to the cortex and subperiosteal region.

  3. SPECT/CT in the Diagnosis of Skull Base Osteomyelitis

    Energy Technology Data Exchange (ETDEWEB)

    Damle, Nishikant Avinash; Kumar, Rakesh; Kumar, Praveen; Jaganthan, Sriram; Patnecha, Manish; Bal, Chandrasekhar; Bandopadhyaya, Gurupad; Malhotra, Arun [All India Institute of Medical Sciences, New Delhi (India)

    2011-09-15

    Skull base osteomyelitis is a potentially fatal disease. We demonstrate here the utility of SPECT/CT in diagnosing this entity, which was not obvious on a planar bone scan. A {sup 99mT}c MDP bone scan with SPECT/CT was carried out on a patient with clinically suspected skull base osteomyelitis. Findings were correlated with contrast enhanced CT (CECT) and MRI. Planar images were equivocal, but SPECT/CT showed intense uptake in the body of sphenoid and petrous temporal bone as well as the atlas corresponding to irregular bone destruction on CT and MRI. These findings indicate that SPECT/CT may have an additional role beyond planar imaging in the detection of skull base osteomyelitis.

  4. Adult hippocampal neurogenesis along the dorsoventral axis contributes differentially to environmental enrichment combined with voluntary exercise in alleviating chronic inflammatory pain in mice.

    Science.gov (United States)

    Zheng, Jie; Jiang, Ying-Ying; Xu, Ling-Chi; Ma, Long-Yu; Liu, Feng-Yu; Cui, Shuang; Cai, Jie; Liao, Fei-Fei; Wan, You; Yi, Ming

    2017-03-14

    Cognitive behavioral therapy, such as environmental enrichment combined with voluntary exercise (EE-VEx), is under active investigation as an adjunct to pharmaceutical treatment for chronic pain. However, the effectiveness and underlying mechanisms of EE-VEx remain unclear. In mice with intra-plantar injection of complete Freund's adjuvant (CFA), our results revealed that EE-VEx alleviated perceptual, affective and cognitive dimensions of chronic inflammatory pain. These effects of EE-VEx on chronic pain were contingent on the occurrence of adult neurogenesis in the dentate gyrus in a functionally dissociated manner along the dorsoventral axis: neurogenesis in the ventral dentate gyrus participated in alleviating perceptual and affective components of chronic pain by EE-VEx, whereas neurogenesis in the dorsal dentate gyrus was involved in EE-VEx's cognitive-enhancing effects. Chronic inflammatory pain was accompanied by decreased levels of brain-derived neurotrophic factor (BDNF) in the dentate gyrus, which were reversed by EE-VEx. Over-expression of BDNF in the dentate mimicked the effects of EE-VEx. Our results demonstrate distinct contribution of adult hippocampal neurogenesis along the dorsoventral axis to EE-VEx's beneficial effects on different dimensions of chronic pain.SIGNIFICANCE STATEMENTEnvironmental enrichment combined with voluntary exercise (EE-VEx) is under active investigation as an adjunct to pharmaceutical treatment for chronic pain, but its effectiveness and underlying mechanisms remain unclear. In a mouse model of inflammatory pain, the present study demonstrates that the beneficial effects of EE-VEx on chronic pain depend on adult neurogenesis with a dorsoventral dissociation along the hippocampal axis. Adult neurogenesis in the ventral dentate gyrus participates in alleviating perceptual and affective components of chronic pain by EE-VEx, whereas that in the dorsal pole is involved in EE-VEx's cognitive-enhancing effects in chronic pain.

  5. Childhood osteomyelitis-incidence and differentiation from other acute onset musculoskeletal features in a population-based study

    Directory of Open Access Journals (Sweden)

    Reiseter Tor

    2008-10-01

    Full Text Available Abstract Background Osteomyelitis can be difficult to diagnose and there has previously not been a prospective approach to identify all children in a defined geographic area. The aim of this study was to assess the annual incidence of osteomyelitis in children, describe the patient and disease characteristics in those with acute ( Methods In a population-based Norwegian study physicians were asked to refer all children with suspected osteomyelitis. Children with osteomyelitis received follow-up at six weeks, six months and thereafter as long as clinically needed. Results The total annual incidence rate of osteomyelitis was 13 per 100 000 (acute osteomyelitis 8 and subacute osteomyelitis 5 per 100 000. The incidence was higher in patients under the age of 3 than in older children (OR 2.9, 95%: CI 2.3–3.7. The incidence of non-vertebral osteomyelitis was higher than the incidence of vertebral osteomyelitis (10 vs. 3 per 100 000; p = .002. Vertebral osteomyelitis was more frequent in girls than in boys (OR 7.0, 95%: CI 3.3–14.7. ESR ≥ 40 mm/hr had the highest positive predictive laboratory value to identify osteomyelitis patients at 26% and MRI had a positive predictive value of 85%. Long-bone infection was found in 16 (43% patients. ESR, CRP, white blood cell count, neutrophils and platelet count were higher for patients with acute osteomyelitis than for patients with subacute osteomyelitis. Subacute findings on MRI and doctor's delay were more common in subacute osteomyelitis than in acute osteomyelitis patients. Blood culture was positive in 26% of the acute osteomyelitis patients and was negative in all the subacute osteomyelitis patients. Conclusion The annual incidence of osteomyelitis in Norway remains high. ESR values and MRI scan may help to identify osteomyelitis patients and differentiate acute and subacute osteomyelitis.

  6. [Postoperative Osteomyelitis of a Distal Phalanx Caused by Raoultella ornithinolytica].

    Science.gov (United States)

    Schmutz, N; Adler, T; Schelhorn, N; Wirz, S; Fricker, R

    2016-06-01

    We report on a case of osteomyelitis of a distal phalanx of the right ring finger of a 62-year-old patient, which occurred 11 months after transosseous-transungual refixation of a closed flexor digitorum profundus tendon avulsion caused by Raoultella ornithinolytica. R. ornithinolytica is an encapsulated Gram-negative aerobic bacillus. In the literature only 13 cases of human infection by R. ornithinolytica are mentioned. To the best of our knowledge, this is the first case of an osteomyelitis caused by R. ornithinolytica.

  7. Diabetic charcot neuroarthropathy of the foot and ankle with osteomyelitis.

    Science.gov (United States)

    Ramanujam, Crystal L; Stapleton, John J; Zgonis, Thomas

    2014-10-01

    One of the most devastating foot and/or ankle complications in the diabetic population with peripheral neuropathy is the presence of Charcot neuroarthropathy (CN). In recent years, diabetic limb salvage has been attempted more frequently as opposed to major lower extremity amputation for CN of the foot and ankle with ulceration and/or deep infection. Treatment strategies for osteomyelitis in the diabetic population have evolved. This article reviews some of the most common surgical strategies recommended for the diabetic patient with CN of the foot and/or ankle and concomitant osteomyelitis.

  8. Sternal osteomyelitis after bacillus Calmette-Guérin vaccination

    Directory of Open Access Journals (Sweden)

    Rolandas Selvestravičius

    2016-09-01

    Full Text Available Presented here is the case of a nine-month-old boy with the osteomyelitis of the upper area sternum caused by bacillus Calmette-Guerin (BCG, the Danish 1331 strain vaccine against tuberculosis. Upon examination, a swelling of approximately 2×3 cm diameter was observed in the upper sternal area. The mass was hard, fixed and sensitive to palpation with no local skin hyperaemia. Chest X-rays revealed a round mass anterior to the sternum, suggesting a diagnosis of osteomyelitis. A consequent sternal biopsy was performed and Mycobacterium bovis BCG was identified by a positive growth culture.

  9. Calcaneal osteomyelitis due to Achromobacter xylosoxidans: a case report.

    Science.gov (United States)

    Ozer, Kadri; Kankaya, Yuksel; Baris, Ruser; Bektas, Cem Inan; Kocer, Ugur

    2012-12-01

    Achromobacter xylosoxidans (A. xylosoxidans) has been described as an opportunistic pathogen causing infection. The case we describe is that of an elderly man who had osteomyelitis of calcaneal bone caused by A. xylosoxidans. As far as we are aware there are only 5 cases of osteomyelitis with A. xylosoxidans in the literature. Impaired defensive mechanism of the foot in direct contact with this waterborne bacterium can cause this disease. Because of the high level of antibiotic resistance of this bacterium, clinically more attention should be paid to patients who have impaired defensive mechanisms in their extremities, for example free flaps.

  10. Sternal Osteomyelitis after Bacillus Calmette-Guérin Vaccination

    Science.gov (United States)

    Selvestravičius, Rolandas; Sučilienė, Elena; Saniukas, Kęstutis; Bobelytė, Odeta; Usonis, Vytautas

    2016-01-01

    Presented here is the case of a nine-month-old boy with the osteomyelitis of the upper area sternum caused by bacillus Calmette-Guerin (BCG), the Danish 1331 strain vaccine against tuberculosis. Upon examination, a swelling of approximately 2×3 cm diameter was observed in the upper sternal area. The mass was hard, fixed and sensitive to palpation with no local skin hyperaemia. Chest X-rays revealed a round mass anterior to the sternum, suggesting a diagnosis of osteomyelitis. A consequent sternal biopsy was performed and Mycobacterium bovis BCG was identified by a positive growth culture. PMID:27777704

  11. Chronic Myelogenous Leukemia Cells Contribute to the Stromal Myofibroblasts in Leukemic NOD/SCID Mouse In Vivo

    Directory of Open Access Journals (Sweden)

    Ryosuke Shirasaki

    2012-01-01

    Full Text Available We recently reported that chronic myelogenous leukemia (CML cells converted into myofibroblasts to create a microenvironment for proliferation of CML cells in vitro. To analyze a biological contribution of CML-derived myofibroblasts in vivo, we observed the characters of leukemic nonobese diabetes/severe combined immunodeficiency (NOD/SCID mouse. Bone marrow nonadherent mononuclear cells as well as human CD45-positive cells obtained from CML patients were injected to the irradiated NOD/SCID mice. When the chimeric BCR-ABL transcript was demonstrated in blood, human CML cells were detected in NOD/SCID murine bone marrow. And CML-derived myofibroblasts composed with the bone marrow-stroma, which produced significant amounts of human vascular endothelial growth factor A. When the parental CML cells were cultured with myofibroblasts separated from CML cell-engrafted NOD/SCID murine bone marrow, CML cells proliferated significantly. These observations indicate that CML cells make an adequate microenvironment for their own proliferation in vivo.

  12. Complete Healing of the Diabetic Ulcerative Osteomyelitis with Atherectomy and Flexible Stent

    Directory of Open Access Journals (Sweden)

    Veysel Temizkan

    2014-06-01

    Full Text Available Diabetes mellitus is a chronic disease that causes arterial and neurological disorders. Extremities threatening a diabetic foot ulcer might occur in the long term, especially in irregular glycemia levels. A multidisciplinary approach including infection treatment, pressure relief in the wound and arterial revascularization is important for limb salvage and to prevent such life-threatening complications as septicemia. Compared to the surgery, endovascular procedures can be performed with low complication rates in diabetic foot ulcers complicated with infection. Atherectomy is an alternative to the classical percutaneous angioplasty techniques, especially in totally occluded lesions. We are reporting complete healing of osteomyelitis associated with critical limb ischemia, resistant to classical treatment with debridement, antibacterial therapy and hyperbaric oxygen therapy, by atherectomy following long-segment flexible stent implantation. [Arch Clin Exp Surg 2014; 3(3.000: 193-196

  13. Unusual presentation of osteoid osteoma mimicking osteomyelitis in a 27-month-old infant

    Energy Technology Data Exchange (ETDEWEB)

    Bhat, Ishwar; Zerin, Jeffrey Michael; Bloom, David Adam [Department of Pediatric Imaging, Children' s Hospital of Michigan, Detroit, Michigan (United States); Mooney, James Francis III [Department of Orthopedic Surgery, Children' s Hospital of Michigan, Detroit, Michigan (United States)

    2003-06-01

    Osteoid osteoma is an uncommon, benign disorder of bone that is most often encountered in school-age children and in adolescents. It is quite rare in children under the age of 3 years. We report a case of osteoid osteoma with unusual clinical and imaging features in a 27-month-old toddler who presented with a limp and swelling of the right knee. Initial clinical evaluation, plain films, and computed tomography (CT) were strongly suggestive of chronic osteomyelitis involving the distal right femoral metadiaphysis. The appearance on nuclear medicine bone scan, however, was typical of osteoid osteoma. A biopsy of the lesion was taken and histological examination confirmed the diagnosis of osteoid osteoma. The misleading clinical and imaging features in this case are discussed. (orig.)

  14. Recurrent digital infections and osteomyelitis in monozygotic twins with congenital analgesia and compulsive onychophagia.

    Science.gov (United States)

    Iorio, Matthew L; Barbour, John R

    2014-07-01

    Congenital insensitivity to pain is a rare sensory neuropathy that manifests with multiple and recurrent injuries secondary to a lack of negative pain stimuli. When present with compulsive onychophagia, prompt recognition and behavioral management to prevent chronic digital infection or amputation is imperative. We present the case of two 7 year-old monozygotic twins that presented with congenital insensitivity to pain and compulsive onychophagia without directed parental counseling or behavioral modification strategies. The presenting child was noted to have an acute digital felon and osteomyelitis of several distal phalanges, and the sister had a similar history with distal phalangeal amputations. The occurrence of these overlapping disorders in monozygotic twins has not been previously reported, however, patient and parental education with behavioral modifications of injurious and compulsive behavior is the cornerstone of management. In addition, we have provided a review of the diagnosis for clinical differentiation.

  15. Treatment of Calcaneal Fracture With Severe Soft Tissue Injury and Osteomyelitis: A Case Report.

    Science.gov (United States)

    Karns, Michael; Dailey, Steven K; Archdeacon, Michael T

    2015-01-01

    Advancements in surgical technique have resulted in the ability to reconstruct lower extremity injuries that would have previously been treated by amputation. Currently, a paucity of data is available specifically addressing limb amputation versus reconstruction for calcaneal fractures with severe soft tissue compromise. Reconstruction leaves the patient with their native limb; however, multiple surgeries, infections, chronic pain, and a poor functional outcome are very real possibilities. We present the case of a complex calcaneal fracture complicated by soft tissue injury and osteomyelitis that highlights the importance of shared decision-making between patient and surgeon when considering reconstruction versus amputation. This case exemplifies the need for open communication concerning the risks and benefits of treatment modalities while simultaneously considering the patient's expectations and desired outcomes.

  16. Osteomyelitis and septic arthritis caused by Kingella kingae.

    OpenAIRE

    Davis, J M; Peel, M M

    1982-01-01

    The clinical and bacteriological findings in two cases of osteomyelitis and one case of septic arthritis caused by Kingella kingae are presented. This appears to be the first report providing clear evidence for a pathogenic role for this species in bone and joint infections.

  17. Osteomyelitis and septic arthritis caused by Kingella kingae.

    Science.gov (United States)

    Davis, J M; Peel, M M

    1982-02-01

    The clinical and bacteriological findings in two cases of osteomyelitis and one case of septic arthritis caused by Kingella kingae are presented. This appears to be the first report providing clear evidence for a pathogenic role for this species in bone and joint infections.

  18. Salmonella spinal osteomyelitis: A case report and review of literature

    Directory of Open Access Journals (Sweden)

    Acharya Shankar

    2004-10-01

    Full Text Available A case of vertebral osteomyelitis is presented where initial presumptive diagnosis of tuberculous infection was made on clinico-radiological grounds but eventually turned out to be Salmonella infection upon exploration, biopsy and culture. Patient recovered completely following debridement and appropriate antibiotics (fluoro-quinolones for a period of six weeks. Internal fixation allowed early ambulation.

  19. Osteomyelitis in Military Personnel Wounded in Iraq and Afghanistan

    Science.gov (United States)

    2008-02-01

    of Osteomyelitis Initial Episode n 103 (%) Recurrence n 36 (%) Any gram-negative bacteria* 94 (91) 12 (33) Acinetobacter baumannii -calcoaceticus...indicates male; F, female; Abc, Acinetobacter baumannii -calcoaceticus complex; E. coli, Eschericia coli; P. aeruginosa, Pseudomonas aeruginosa; CNS...Gray PJ. Multidrug-resistant Acinetobacter extremity infections in soldiers. Emerg Infect Dis. 2005;11:1218–1224. 8. Acinetobacter baumannii infections

  20. An orbital fistula complicating anaerobic frontal sinusitis and osteomyelitis

    NARCIS (Netherlands)

    H.J. Simonsz (Huib); H.J.F. Peeters; G.M. Bleeker

    1982-01-01

    textabstractA patient is described with an orbital fistula complicating frontal sinusitis and osteomyelitis of the frontal bone. The fistula was excised, but a fortnight later an acute exacerbation occurred. From the discharging pus a Staphylococcus aureus was cultured and from mucosa obtained durin

  1. Complications of Candidemia in ICU Patients: Endophthalmitis, Osteomyelitis, Endocarditis.

    Science.gov (United States)

    Kauffman, Carol A

    2015-10-01

    Bloodstream infection with Candida species is not uncommon in the intensive care unit setting and has the potential to distribute organisms to many different organ systems causing secondary infections, such as endophthalmitis, osteomyelitis, and endocarditis. In some patients, these types of infections become manifested shortly after the episode of candidemia. In others, especially vertebral osteomyelitis, weeks pass before the diagnosis is entertained. Endophthalmitis should be sought by a retinal examination in all patients early after an episode of candidemia. Both osteomyelitis and endocarditis are less common complications of candidemia than endophthalmitis. In patients who manifest symptoms or signs suggesting these infections, magnetic resonance imaging and transesophageal echocardiography, respectively, are extremely helpful diagnostic tests. Newer approaches to the treatment of these infections allow the use of better tolerated, safer antifungal agents. Endophthalmitis is often treated with fluconazole or voriconazole, and the echinocandins are increasingly used, instead of amphotericin B, as initial therapy for osteomyelitis and endocarditis before step-down therapy to oral azole agents.

  2. PVL PRODUCING MRSA OSTEOMYELITIS IN NEONATE - A RARE PRESENTATION

    Directory of Open Access Journals (Sweden)

    Nayana Prabha

    2014-01-01

    Full Text Available This is the first reported case of osteomyelitis caused by Panton - Valentine - Leucocidin (PVL producing (MRSA Methicillin Resistant Staphylococcus Aureus in a newborn. The presence of multiple abscesses , necrotizing fasciitis , severe leucopenia and thrombocytopenia should prompt one to cons ider PVL producing Community acquired - MRSA

  3. Osteomyelitis: a review of currently used imaging techniques

    Energy Technology Data Exchange (ETDEWEB)

    Sammak, B.; Abd El Bagi, M; Al Shahed, M.; Al Nabulsi, J.; Youssef, B.; Al Thagafi, M. [Department of Radiology, Riyadh Armed Forces Hospital, Riyadh (Saudi Arabia); Hamilton, D. [Department of Medical Physics, Riyadh Armed Forces Hospital (Saudi Arabia)

    1999-06-01

    Conventional radiographs remain the initial imaging modality involved in the diagnosis of osteomyelitis. Bone scintigraphy and its specific agents did not only eliminate the problems of inherent low sensitivity of conventional radiographs, but also increased the specificity to higher degrees. Spiral CT, on the other hand, has solved several diagnostic problems, such as osteomyelitis of the sterno-clavicular junction and hidden areas in the pelvic bones. Magnetic resonance imaging with its multiplanar capability, greater anatomic details and excellent soft tissue bone marrow contrast resolution has a significant role in surgical planning and limb preservation. Ultrasound and US-guided aspiration has recently been involved in the diagnosis and management of osteomyelitis with several advantages particularly in children. Our goal in this review is to outline the ability of various imaging techniques by comparing their strengths and weaknesses in the diagnosis of osteomyelitis. Finally, we suggest various imaging algorithms for specific clinical scenarios. Spondylitis and septic arthritis are not discussed in this review. (orig.) With 7 figs., 43 refs.

  4. Vertebral osteomyelitis associated with cat-scratch disease

    NARCIS (Netherlands)

    Hulzebos, CV; Koetse, HA; Kimpen, JLL; Wolfs, TFW

    1999-01-01

    We describe a patient with vertebral osteomyelitis and paravertebral soft-tissue collections associated with cat-scratch disease (CSD). Diagnosis was established on the basis of histologic examination and serological and polymerase chain reaction (PCR) tests. Treatment consisted of administration of

  5. Forbedret diagnostik af osteomyelitis hos børn?

    DEFF Research Database (Denmark)

    Afzelius, Pia; Alstrup, Aage Kristian Olsen; Schønheyder, Henrik Carl;

    Osteomyelitis er en alvorlig sygdom. Tidlig diagnose og påbegyndelse af behandlingen er vigtigt for at forhindre sygdomsudviklingen og for at reducere potentielt alvorlige komplikationer. Konventionel røntgenundersøgelse udført tidligt i forløbet kan ikke udelukke akut osteomyelitis. MRI......, knogleskintigrafi og CT er centrale billeddiagnostiske metoder til diagnostik af akut osteomyelitis hos børn. MRI betragtes ofte som værende den bedste billeddannende metode, men er ikke altid tilgængelig og kræver anæstesi af små børn. Knogleskintigrafi påviser osteoblastaktivitet og anses for at være yderst...... sensitiv men er ikke særlig specifik. 18F-fluordeoxyglucose (FDG) PET har måske den højeste diagnostiske nøjagtighed for bekræftelse/udelukkelse af kronisk osteomyelitis sammenlignet med knogleskintigrafi, MRI og leukocytskintigrafi. Imidlertid har de fleste studier kun anvendt 18F-FDG PET ved mistanke om...

  6. The MRI appearances of early vertebral osteomyelitis and discitis

    Energy Technology Data Exchange (ETDEWEB)

    Dunbar, J.A.T.; Sandoe, J.A.T. [Department of Microbiology, Leeds General Infirmary, Leeds LS1 3EX (United Kingdom); Rao, A.S. [Department of Orthopaedics, Leeds General Infirmary, Leeds LS1 3EX (United Kingdom); Crimmins, D.W. [Department of Neurosurgery, Leeds General Infirmary, Leeds LS1 3EX (United Kingdom); Baig, W. [Department of Cardiology, Leeds General Infirmary, Leeds LS1 3EX (United Kingdom); Rankine, J.J., E-mail: james.rankine@leedsth.nhs.u [Department of Radiology, Leeds General Infirmary, Leeds LS1 3EX (United Kingdom); Leeds Musculoskeletal Biomedical Research Unit, Leeds (United Kingdom)

    2010-12-15

    Aim: To describe the magnetic resonance imaging (MRI) appearances in patients with a clinical history suggestive of vertebral osteomyelitis and discitis who underwent MRI very early in their clinical course. Materials and methods: A retrospective review of the database of spinal infections from a spinal microbiological liaison team was performed over a 2 year period to identify cases with clinical features suggestive of spinal infection and an MRI that did not show features typical of vertebral osteomyelitis and discitis. All patients had positive microbiology and a follow up MRI showing typical features of spinal infection. Results: In four cases the features typical of spinal infection were not evident at the initial MRI. In three cases there was very subtle endplate oedema associated with disc degeneration, which was interpreted as Modic type I degenerative endplate change. Intravenous antibiotic therapy was continued prior to repeat MRI examinations. The mean time to the repeat examination was 17 days with a range of 8-22 days. The second examinations clearly demonstrated vertebral osteomyelitis and discitis. Conclusion: Although MRI is the imaging method of choice for vertebral osteomyelitis and discitis in the early stages, it may show subtle, non-specific endplate subchondral changes; a repeat examination may be required to show the typical features.

  7. Adiponectin Potentially Contributes to the Antidepressive Effects of Baduanjin Qigong Exercise in Women With Chronic Fatigue Syndrome-Like Illness.

    Science.gov (United States)

    Chan, Jessie S M; Li, Ang; Ng, Siu-Man; Ho, Rainbow T H; Xu, Aimin; Yao, Tzy-Jyun; Wang, Xiao-Min; So, Kwok-Fai; Chan, Cecilia L W

    2017-03-13

    Our recent study demonstrates that adiponectin signaling plays a significant role in mediating physical exercise-exerted effects on hippocampal neurogenesis and antidepression in mice. Whether the findings can be translated to humans remains unknown. This study aimed to investigate the effects of Baduanjin Qigong exercise on adiponectin and to evaluate whether adiponectin is involved in the antidepressive effects of Qigong exercise on chronic fatigue syndrome (CFS)-like illness. This is a randomized, waitlist-controlled trial. One hundred eight female participants were randomly assigned to either Qigong exercise or waitlist groups. Sixteen 1.5-h Qigong lessons were conducted. Outcome measures were taken at three time points. Baseline adiponectin levels were negatively associated with body weight, body mass index, waist circumference, hip circumference, and waist/hip ratio in women with CFS-like illness. Compared with the waitlist control, Qigong exercise significantly reduced anxiety and depression symptoms and significantly raised plasma adiponectin levels (median = 0.8 vs. -0.1, p Qigong exercise were associated with decreases in depression scores for the Qigong group (r = -0.38, p = 0.04). Moreover, adjusted linear regression analysis further identified Qigong exercise and change in adiponectin levels as the significant factors accounting for reduction of depression symptoms. Baduanjin Qigong significantly increased adiponectin levels in females with CFS-like illness. Decreases in depression symptoms were associated with increases in adiponectin levels following Qigong exercise, indicating that the potential contribution of adiponectin to Qigong exercise elicited antidepressive effects in human subjects.

  8. Fibrinogen Aα Thr312Ala polymorphism specifically contributes to chronic thromboembolic pulmonary hypertension by increasing fibrin resistance.

    Directory of Open Access Journals (Sweden)

    Ji-Feng Li

    Full Text Available BACKGROUND: Polymorphisms are associated with chronic thromboembolic pulmonary hypertension (CTEPH and pulmonary thromboembolism (PTE, but no polymorphism specific to CTEPH but not PTE has yet been reported. Fibrin resistance is associated with CTEPH, but the mechanism has not been elucidated. METHODS: Polymorphisms were analyzed in 101 CTEPH subjects, 102 PTE subjects and 108 healthy controls by Massarray or restriction fragment length polymorphism (RFLP. Plasmin-mediated cleavage of fibrin was characterized in 69 subjects (29 with CTEPH, 21 with PTE and 19 controls. RESULTS: Genotype frequencies and allele frequencies of fibrinogen Aα Thr312Ala were significantly higher in CTEPH subjects than in controls and PTE subjects, while there was no difference between PTE subjects and controls. The odd ratio (OR 2.037 and 95% confidence interval (95% CI, 1.262-3.289 showed that Thr312Ala polymorphism was a risk factor for CTEPH but not PTE. Fibrin from CTEPH subjects was more resistant to lysis than that from PTE subjects and controls. Fibrin resistance was significantly different between Aα Thr312Ala (A/G genotypes within CTEPH subjects, and the fibrin with GG genotype was more resistant than that with AA and AG genotype. CONCLUSIONS: Fibrinogen Aα Thr312Ala (A/G polymorphism was associated with CTEPH, but not PTE, suggesting that the fibrinogen Aα Thr312Ala polymorphism may act as a potential biomarker in identifying CTEPH from PTE. GG genotype polymorphism contributes to CTEPH through increasing fibrin resistance, implying that PTE subjects with fibrinogen Aα GG genotype may need long-term anticoagulation therapy.

  9. 载药组织工程支架的构建及其治疗兔慢性骨髓炎的疗效%Fabrication of drug-loaded tissue engineering scaffold and its curative effect for chronic osteomyelitis in rabbits

    Institute of Scientific and Technical Information of China (English)

    向柄彦; 郭元

    2015-01-01

    <0.05).HE staining showed massive infiltration of inflammatory cells and destroyed bone trabeculas in groups Ⅰ and Ⅱ,trabecular bone arranged neatly in groups Ⅲ and Ⅳ,and thicker trabecular bone in group Ⅳ than in group Ⅲ.Marrow culture showed obvious pale yellow colony formation in groups Ⅰ and Ⅱ,but no colony formation in groups Ⅲ and Ⅳ.Conclusions Vancomycin/BMP-2-loaded tissue engineering scaffolds are constructed successfully.Drug-loaded n-HAP/CS composite scaffold is identified as an ideal implant material for treatment of chronic osteomyelitis in rabbits

  10. Ertapenem for treatment of osteomyelitis: a case series

    Directory of Open Access Journals (Sweden)

    Johnson Melissa D

    2011-11-01

    Full Text Available Abstract Background Ertapenem is a once-daily broad spectrum carbapenem that is increasingly used to treat polymicrobial osteomyelitis due to diabetic foot and traumatic wound infections. However, limited data exists on ertapenem use for osteomyelitis. This study aimed to characterize outcomes and adverse effects with empiric use of ertapenem for osteomyelitis. Findings A total of 112 patients presenting to Duke, Durham Regional or Durham VA Medical Centers with a suspected diagnosis of osteomyelitis and ertapenem use from 11/2001 to 8/2009 were screened, and 12 subjects met inclusion criteria for the study. Mean age was 60 ± 16 years, 68% were female, 75% were Caucasian, and the most common comorbidities included diabetes (58%, peripheral vascular disease (42%, and history of tobacco use (75%. Over half of the patients presented to a primary care clinic or emergency room greater than six months after the onset of clinical symptoms. Bone culture was obtained for diagnostic guidance in only two cases; and surgical intervention was pursued in three cases. Patients received a mean duration of 34.6 ± 7.8 days of therapy, and in three cases, subsequent suppressive oral antibiotics were given. Six (50% patients met criteria for clinical success, defined as resolution of clinical signs and symptoms of infection such that discontinuation of antibiotics was deemed appropriate at end of ertapenem therapy, without recurrence at one year follow-up. No adverse drug effects were noted. Conclusions In this case series of mostly community-acquired, lower extremity osteomyelitis, bone biopsy was infrequent, and an average six-week course of empiric ertapenem was well-tolerated with curative rates of 50% at one year.

  11. Hyperprolactinemia contributes to reproductive deficit in male rats chronically administered PDE5 inhibitors (sildenafil and tadalafil and opioid (tramadol

    Directory of Open Access Journals (Sweden)

    V.U. Nna

    2016-09-01

    Conclusion: Serum prolactin concentration correlated negatively with male reproductive hormones and may play a major role in reproductive deficits associated with chronic use of PDE5 inhibitors and opioids.

  12. Role of MRI in the diagnosis and treatment of osteomyelitis in pediatric patients

    Institute of Scientific and Technical Information of China (English)

    Brian; S; Pugmire; Randheer; Shailam; Michael; S; Gee

    2014-01-01

    Osteomyelitis is a significant cause of morbidity in children throughout the world. Multiple imaging modalities can be used to evaluate for suspected osteomyelitis, however magnetic resonance imaging(MRI) has distinct advantages over other modalities given its ability to detect early changes related to osteomyelitis, evaluate the true extent of disease, depict extraosseous spread of infection, and help guide surgical manage-ment. MRI has assumed a greater role in the evaluation of osteomyelitis with the increase in musculoskeletal infections caused by methicillin-resistant Staphylococ-cus aureus which have unique imaging features that are well-demonstrated with MRI. This review focuses primarily on the use of MRI in the evaluation of osteo-myelitis in children and will include a discussion of the clinically important and characteristic findings on MRI of acute bacterial osteomyelitis and related conditions.

  13. Natural course of hematogenous pyogenic osteomyelitis (a retrospective study of 110 cases.

    Directory of Open Access Journals (Sweden)

    Kharbanda Y

    1991-04-01

    Full Text Available Hundred and ten consecutive cases in acute and various stages of chronicity were studied. Incidence regarding age, sex, bone affected and complications was established. The optimum way to manage osteomyelitis in different stages was sought. It was found that in acute stage early decompression of bone leads to resolution of disease. Hip involvement leads to necrosis of capital epiphysis and should be treated on an emergency basis. In the sub-acute stage it is necessary to protect the weakened bone. In chronic stage, we suggest sequestrectomy only after adequate involucrum has formed properly. Antibiotics in acute stage should be instituted as early as possible and should be continued for three weeks after the fever subsides. Antibiotics in sub-acute and chronic stage are given only in cases of reactivation of infection and around the time of surgery. Surgery, when required should be performed without too much soft tissue damage especially the covering periosteum. But repeated surgery should be avoided as they lead to cicatrization of muscles and further sequestration of bone.

  14. Osteomyelitis pubis caused by Kingella kingae in an adult patient: Report of the first case

    OpenAIRE

    Wilmes Dunja; Omoumi Patrick; Squifflet Jean; Cornu Olivier; Rodriguez-Villalobos Hector; Yombi Jean

    2012-01-01

    Abstract Background Kingella kingae is the second most common pathogen causing paediatric arthritis and is described to be the causative bacteria in some paediatric osteomyelitis. Its microbiological detection is particularly difficult due to its slow growing. To our best knowledge this is the first case description of osteomyelitis pubis caused by this microorganism. Case presentation We report the unusual case of pubic osteomyelitis with soft tissue abcess caused by Kingella kingae in an ad...

  15. THE ANALYSIS OF THE DIABETIC FOOT OSTEOMYELITIS AT A TERTIARY CARE CENTER - A PROSPECTIVE STUDY

    OpenAIRE

    Mithun N; Pattanashetty; Reshmina; Sharath Babu; Harikrishna; Sreedhar Reddy; Ramakrishna J

    2015-01-01

    INTRODUCTION : India is considered as the diabetic capital of the world. Diabetic foot osteomyelitis is considered as one of the severe complications of diabetes mellitus. Diabetic foot osteomyelitis tends to complicate around one third of diabetic foot infections. In v iew of this we conducted a prospective study on the bacteriological analysis of diabetic foot osteomyelitis at a tertiary care center. MATERIALS AND METHODS : A prospective study was perform...

  16. A 73-Year-Old Male with Cervical Spine Osteomyelitis Presenting as Urosepsis.

    Science.gov (United States)

    Kakarlapudi, H; Speirs, S; Lal, A P; Alaie, D; Petrillo, R; Ashraf, M B; Kolanuvada, B; Bhargava, M

    2015-01-01

    Vertebral osteomyelitis is a serious debilitating infection if not detected early. Involvement of cervical vertebrae is usually seen in the presence of specific risk factors. Urinary tract infection commonly spreads to the lumbar vertebrae. This is a case presentation of an elderly male who, in the absence of specific risk factors for cervical osteomyelitis, presented with symptoms of urinary tract infection and was found to have cervical spine osteomyelitis.

  17. Osteomyelitis and pyogenic infection of the sacroiliac joint. MRI findings and review

    Energy Technology Data Exchange (ETDEWEB)

    Haliloglu, M. [Dept. of Radiology, Indiana University School of Medicine, Indianapolis, IN (United States); Kleiman, M.B. [Dept. of Pediatrics, Indiana University School of Medicine, Indianapolis, IN (United States); Siddiqui, A.R. [Division of Nuclear Medicine, Indiana University School of Medicine, Indianapolis, IN (United States); Cohen, M.D. [Dept. of Radiology, Indiana University School of Medicine, Indianapolis, IN (United States)

    1994-09-01

    Acute pyogenic sacroiliac joint infection and osteomyelitis of adjacent bones often present with severe, poorly localized lower back, pelvic of hip pain. Five cases of sacroiliac joint infection or sacroiliac bone osteomyelitis were evaluated by MRI. MRI may be a helpful diagnostic tool to evaluate early changes of infection in the sacroiliac area. It is very sensitive for detecting bone marrow abnormalities; however, it is non-specific and can not accurately differentiate osteomyelitis from sacroiliitis. (orig.)

  18. Unilobed Rotational Flap for Plantar Hallux Interphalangeal Joint Ulceration Complicated by Osteomyelitis.

    Science.gov (United States)

    Boffeli, Troy J; Hyllengren, Shelby B

    2015-01-01

    Diabetes-related neuropathic ulcers located at the plantar aspect of the hallux interphalangeal joint are often chronic or recurrent and frequently become complicated by osteomyelitis. Once infected, treatment will typically involve hallux amputation. Although intended as a definitive procedure, amputation of the first toe is not desirable from a cosmetic or functional standpoint and often leads to transfer ulcers at adjacent locations of the foot. Reconstructive wound surgery, combined with limited bone resection, is possible if the infection is caught early before the local tissue and bone have become necrotic. In addition to neuropathy, biomechanical issues, including ankle equinus, hallux limitus, hallux extensus, and hallux valgus, predispose patients with diabetes mellitus to developing plantar hallux ulcers. We commonly employ a proximal based unilobed plantar rotational flap combined with hallux interphalangeal joint arthroplasty as an alternative to hallux amputation. We present a typical case with long-term follow-up to highlight our flap protocol, including patient selection criteria, flap design, surgical technique, bone resection and biopsy pearls, staging timeline, and a typical postoperative course. Periodic follow-up during the next 72 months for unrelated conditions allowed long-term monitoring with no recurrence of osteomyelitis or subsequent amputation. The foot remained ulcer free 6 years later. The benefits of this surgical approach include complete excision of the ulcer, adequate exposure for bone resection, early bone biopsy before the spread of infection or necrosis of local tissue, flap coverage with viable soft tissue, and partial offloading of mechanical pressure at the plantar interphalangeal joint.

  19. The contribution of negative reproductive experiences and chronic medical conditions to depression and pain among Israeli women.

    Science.gov (United States)

    Sarid, Orly; Segal-Engelchin, Dorit; Cwikel, Julie

    2012-01-01

    This study of 302 Israeli women sought to investigate the associations among stressful reproductive experiences (e.g. fertility problems, abortions, and traumatic births), chronic medical conditions, pain, and depression. The specific aims of the study were to examine (1) the effect of stressful reproductive experiences, chronic medical conditions, and pain on depressive symptoms and (2) the effect of stressful reproductive experiences, chronic medical conditions, and depressive symptoms on pain. Our findings corroborate with previous studies demonstrating that depression and pain are two interrelated, but different phenomena, which have both common and distinct risk factors. The findings are discussed in the light of stress and adaptation theories that point to the long-term effects of stressful life events on emotional and physiological aspects such as depression and pain.

  20. Development of osteomyelitis secondary to a snakebite: Case Report

    Directory of Open Access Journals (Sweden)

    Bilsev Ince

    2016-09-01

    Full Text Available The Viperidae family is responsible for most of the venomous snakebites in Anatolia. Toxicity symptoms may be local such as edema, hyperemia, blisters, necrosis, lymphadenopathy, and ecchymosis or hematological, including high white blood cell (WBC, neutrophilia, decrease in hemoglobin, thrombocytopenia, international normalized ratio (INR elongation, and increase in creatine kinase (CK, tumor necrosis factor alpha (TNF and #945;, and lactate dehydrogenase (LDH. Antivenom thera- py should be provided if hyperemia continues and/or edema does not regress. Complications are very low in envenomation cases related to Viperidae bites with proper treatment and follow-up. Otherwise, complications can progress to necrosis, acute renal failure, compartment syndrome, amputation, and death may be seen. However, no report in the literature has described osteomyelitis as a late complication of snakebite. In this study, we present an osteomyelitis case caused by snakebite culminating in amputation because of the inadequate treatment. [Arch Clin Exp Surg 2016; 5(3.000: 180-183

  1. Salmonella newport causing osteomyelitis in a patient with diabetes.

    Science.gov (United States)

    Weston, Natasha; Moran, Ed

    2015-11-24

    Salmonella is a foodborne pathogen that commonly causes intestinal symptoms. Bacteraemia and extraintestinal infections have been documented within the literature, and are more frequently associated with immunodeficiency and general debilitation. We discuss the case of a previously well 36-year-old man who presented with a septic knee and new-onset diabetes. Imaging confirmed osteomyelitis and a Brodie's abscess, with blood and tissue cultures revealing the isolate Salmonella enterica newport. He denied any previous gastrointestinal symptoms, recent travel, change in usual dietary habit or symptoms of diabetes. So far there have only been three reported cases of S. newport causing osteomyelitis. We discuss the incidence of Salmonella infections, including extraintestinal symptoms, its relation to immunodeficiency and the disease burden of S. newport.

  2. Clinical Differences Between Monomicrobial and Polymicrobial Vertebral Osteomyelitis.

    Science.gov (United States)

    Issa, Kimona; Pourtaheri, Sina; Stewart, Tyler; Faloon, Michael; Sahai, Nikhil; Mease, Samuel; Sinha, Kumar; Hwang, Ki; Emami, Arash

    2016-11-11

    Little literature exists examining differences in presentation and outcomes between monomicrobial and polymicrobial vertebral infections. Seventy-nine patients treated for vertebral osteomyelitis between 2001 and 2011 were reviewed. Patients were divided into monomicrobial and polymicrobial cohorts based on type of infection. Various characteristics were compared between the 2 groups. The 26 patients with a polymicrobial infection were older and had a higher mortality rate, lower clearance of infection, larger infection, more vertebral instability, higher erythrocyte sedimentation rate at presentation, and longer mean length of stay. There were no significant differences in Oswestry Disability Index scores at final follow-up, but there were differences in presentation and clinical outcomes between monomicrobial and polymicrobial vertebral osteomyelitis. Patients may benefit from counseling regarding their disease type and potential prognosis. [Orthopedics. 201x; xx(x):xx-xx.].

  3. MORPHOLOGICAL EVALUATION OF CONSEQUENCES OF LONG BONE OSTEOMYELITIS IN CHILDREN

    Directory of Open Access Journals (Sweden)

    Y. E. Garkavenko

    2012-01-01

    Full Text Available The authors studied morphological changes in bone, cartilage and soft tissue from the zone of old inflammation and far from it in 36 children with pathological hip dislocation, in 23 - with limb shortening, in 13 - with pseudoarthrosis and long bone defects after osteomyelitis. Morphological assessment of proximal femur tissue in children, who had hematogenous osteomyelitis in early childhood, identified severe changes in cartilage and bone tissue which accompanied by muscle pathology. The state of the femoral head articular cartilage and acetabulum in patients with pathological hip dislocation is characterized by degenerative changes of varying severity (up to the formation of necrobiosis and necrosis focus, by the replacement of hyaline cartilage by tissue, formed by the type of fibrous cartilage and fibrous (scar tissue. This picture did not have significant differences depending on the osteomyelitis prescription. Directly in the area of the former inflammatory process, as well as in the ends of pseudoarthrosis bone fragments of long bone the degenerative changes of bone tissue with the signs of resorption and low-grade osteogenic activity are marked. The morphological texture of the femur diaphysis, located far from the old inflammation, did not differ from normal. It may indicate its potency for normal bone formation. Muscle tissue in the area of old inflammation keeps the signs of unevenly expressed degeneration and atrophy. Far from this zone muscle tissue doesn’t differ from its usual structure. The described morphological changes can serve as justification for the improvement of methods of surgical treatment in children with consequences of osteomyelitis.

  4. Osteomyelitis variolosa with fracture: A unique case report

    Directory of Open Access Journals (Sweden)

    Pradeep K Singh

    2012-01-01

    Full Text Available Smallpox has been eradicated completely but its unique pathology and sequlae are still found in routine clinical practice. We present a report of a patient having osteomyelitis variolosa in both elbow joints and wrist with fracture of humerus. The condyles were typically elongated as central portion of distal humerus absorbed. The fracture united uneventfully following stabilization with dynamic compression plate and bone grafting. Patient had satisfactory elbow function at the end of the last follow-up.

  5. Diabetic foot complicated by vertebral osteomyelitis and epidural abscess

    OpenAIRE

    Alessandro Mantovani; Maddalena Trombetta; Chiara Imbriaco; Riccardo Rigolon; Lucia Mingolla; Federica Zamboni; Francesca Dal Molin; Dario Cioccoloni; Viola Sanga; Massimiliano Bruti; Enrico Brocco; Michela Conti; Giorgio Ravenna; Fabrizia Perrone; Vincenzo Stoico

    2016-01-01

    Summary Vertebral osteomyelitis (or spondylodiscitis) is steadily increasing in Western countries and often results from hematogenous seeding, direct inoculation during spinal surgery, or contiguous spread from an infection in the adjacent soft tissue. We present the case of a 67-year-old white patient with type 2 diabetes who went to Hospital for high fever, back pain, and worsening of known infected ulcers in the left foot. Despite intravenous antibiotic treatment and surgical debridement o...

  6. Osteomyelitis in the diabetic foot: diagnosis and management.

    Science.gov (United States)

    Game, Frances L

    2013-09-01

    Although osteomyelitis of the foot in diabetes remains common in specialist foot clinics across the world, the quality of published work to guide clinicians in the diagnosis and management is generally poor. Diagnosis should be based primarily on clinical signs supported by results of pathologic and radiologic investigations. Although the gold standard comes from the histologic and microbiological examination of bone, clinicians should be aware of the problems of sampling error. This lack of standardization of diagnostic criteria and of consensus on the choice of outcome measures poses further difficulties when seeking evidence to support management decisions. Experts have traditionally recommended surgical removal of infected bone but available evidence suggests that in many cases (excepting those in whom immediate surgery is required to save life or limb) a nonsurgical approach to management of osteomyelitis may be effective for many, if not most, patients with osteomyelitis of the diabetic foot. The benefits and limitations of both approaches need, however, to be established in prospective trials so that appropriate therapy can be offered to appropriate patients at the appropriate time, with the patients' views taken fully into account.

  7. Ultrasonographic findings of septic arthritis and osteomyelitis in neonatal hip

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Seung Hoon; Jung, Kun Sik; Koh, Jung Kon; Im, Myung Ah; Kwon, Kwi Ryun; Kim, Sung Soo [Pohang Sunlim Hospital, Handong University, Pohang (Korea, Republic of)

    2000-06-15

    To evaluate ultrasonographic findings of neonatal patients who confirmed and treated as hip joint septic arthritis and osteomyelitis. We retrospectively examined clinical feature and radiologic findings of 7 neonatal patients ranging from 8 to 28 days of age who were examined from January 1966 to December 1998 at nursery and were confirmed and treated on the diagnosis of septic arthritis and osteomyelitis. Clinical features of the patients were comparatively analyzed with radiologic findings including plain radiographs, ultrasonography, bone scan and MRI. We emphasized importance of ultrasonographic findings of these patients. Ultrasonography was performed first of all in all cases after the symptom onset. Other examinations were performed on the same day or a few days later after ultrasonography. Ultrasonography revealed abnormal finding in 85.7% (6/7) of all cases. Plain radiographs revealed abnormal findings in 28.6% (2/7). Bone scan revealed decreased uptake in 66.7%(2/3). MRI revealed abnormal signal intensity in 100%(3/3). Ultrasonographic findings of the patients were deep soft swelling in 85.7% (6/7) of all cases, periosteal elevation in 57.1% (4/7), synovial thickening in 42.8% (3/7), synovial effusion in 42.8%(3/7), echogenic debris or clot in 28.5% (2/7), cortical erosion in 28.5% (2/7), and subperiosteal abscess in 14.2% (1/7). Ultrasonography is a useful modality to diagnose septic arthritis and osteomyelitis in neonatal hip.

  8. A systematic review of animal models for Staphylococcus aureus osteomyelitis

    Directory of Open Access Journals (Sweden)

    W Reizner

    2014-03-01

    Full Text Available Staphylococcus aureus (S. aureus osteomyelitis is a significant complication for orthopaedic patients undergoing surgery, particularly with fracture fixation and arthroplasty. Given the difficulty in studying S. aureus infections in human subjects, animal models serve an integral role in exploring the pathogenesis of osteomyelitis, and aid in determining the efficacy of prophylactic and therapeutic treatments. Animal models should mimic the clinical scenarios seen in patients as closely as possible to permit the experimental results to be translated to the corresponding clinical care. To help understand existing animal models of S. aureus, we conducted a systematic search of PubMed and Ovid MEDLINE to identify in vivo animal experiments that have investigated the management of S. aureus osteomyelitis in the context of fractures and metallic implants. In this review, experimental studies are categorised by animal species and are further classified by the setting of the infection. Study methods are summarised and the relevant advantages and disadvantages of each species and model are discussed. While no ideal animal model exists, the understanding of a model’s strengths and limitations should assist clinicians and researchers to appropriately select an animal model to translate the conclusions to the clinical setting.

  9. Management of sternal osteomyelitis and mediastinal infection following median sternotomy

    Institute of Scientific and Technical Information of China (English)

    GAO Ju; WANG Wen-zhang; WANG You-li; LU Shu-qiang; CAI Ai-bing; YANG Zhi-fu; HAN Zhi-yi; LI Jiu-jiang; WEN Yu-ming; GENG Feng-yong

    2010-01-01

    Background Median sternotomy is considered the most usually performed procedure in cardiac operations. This study aimed to assess clinical effectiveness of bilateral pectoralis major muscle flaps (BPMMF) for management of sternal osteomyelitis and mediastinal infection following median sternotomy.Methods Clinical data were collected and retrospectively analyzed from twelve patients who underwent the BPMMF transposition for management of sternal osteomyelitis and mediastinal infection following median sternotomy from January 2006 to June 2009. Procedure consisted of rigorous debridement of necrotic tissues, dead space obliteration using the BPMMF, and placement of drainage tubes connected to a negative pressures generator for adequate drainage.Results No patients died of drainage, and all 12 patients had viable BPMMF when discharged from hospital. At 1 week post discharge, 2 patients presented with sternal infection but recovered following local debridement and medication. No patients showed infection recurrence during the follow-up period over 10 months.Conclusions Sternal osteomyelitis and mediastinal infection following median sternotomy may be effectively managed through rigorous debridement of infected soft tissues, resection of the damaged stermal segment, transposition of the BPMMF to fill the damaged sternum resulting from debridement, and adequate postoperative drainage.

  10. Sequential real-time PCR assays applied to identification of genomic signatures in formalin-fixed paraffin-embedded tissues: a case report about brucella-induced osteomyelitis.

    Science.gov (United States)

    Zhang, Binxue; Wear, Douglas J; Stojadinovic, Alexander; Izadjoo, Mina

    2013-01-01

    Brucellosis is a zoonotic infection transmitted from animals to human by ingestion of infected food products, direct contact with an infected animal, or inhalation of aerosols. Brucella infection-induced osteomyelitis may present only with nonspecific clinical and radiographic findings, mild elevations in serum inflammatory markers, as well as nonspecific histological changes. We studied a case of an Iraqi war veteran with multifocal vertebral body and left iliac bone lesions on radio nucleotide scans and magnetic resonance imaging, clinically suspected osteomyelitis possibly because of Brucella. Although histomorphological findings were nonspecific, consisting of chronic inflammatory cell infiltrate and reactive fibrosis, tissue gram and silver impregnation stains of bone biopsies were informative, revealing gram-negative coccobacilli consistent in size with Brucella species. Total nucleic acids were extracted from formalin-fixed paraffin-embedded tissues and amplified by sequential real-time polymerase chain reaction, targeting genes coding (1) outer membrane protein (omp-31) of Brucella species and (2) insertion sequence (IS711) of Brucella abortus (b-abt). Polymerase chain reaction results confirmed B. abortus as the causative pathogens for presumed diagnosis of Brucella osteomyelitis.

  11. Mandibular Actinomyces osteomyelitis complicating florid cemento-osseous dysplasia: case report

    Directory of Open Access Journals (Sweden)

    Edwards Sean P

    2011-07-01

    Full Text Available Abstract Background Apart from neoplastic processes, chronic disfiguring and destructive diseases of the mandible are uncommon. Case Presentation We report, perhaps for the first time, the simultaneous occurrence of two such conditions in one patient, in a case that emphasizes the importance of bone biopsy in establishing the correct diagnosis. Florid cemento-osseous dysplasia (FCOD is a chronic, disfiguring condition of the maxillofacial region. This relatively benign disease is primarily observed in middle-aged women of African ancestry. Cervicofacial actinomycosis is an uncommon and progressive infection caused by bacilli of the Actinomyces genus that typically involves intraoral soft tissues but may also involve bone. The accurate diagnosis of actinomycosis is critical for successful treatment. A diagnosis of osteomyelitis caused by Actinomyces bacteria was diagnosed by bone biopsy in a 53 year-old African-American woman with a longstanding history of FCOD after she presented with a new draining ulcer overlying the mandible. Conclusions Clinicians should be aware of the possibility of actinomycosis arising in the setting of FCOD, and the importance of bone biopsy and cultures in arriving at a definitive and timely diagnosis.

  12. Osteomyelitis of sternum and rib after breast prosthesis implantation: A rare or underestimated infection?

    Science.gov (United States)

    Seng, Piseth; Alliez, Antoine; Honnorat, Estelle; Menard, Amelie; Casanova, Dominique; Stein, Andreas

    2014-01-01

    Sternum and rib osteomyelitis complicated from breast implant infection is rare. We report a case of early sternum and rib osteomyelitis occurred during breast implant infection managed in an inter-regional referral center for bone/joint infections in the south of France. PMID:26793446

  13. Osteomyelitis of sternum and rib after breast prosthesis implantation: A rare or underestimated infection?

    Directory of Open Access Journals (Sweden)

    Piseth Seng

    2015-01-01

    Full Text Available Sternum and rib osteomyelitis complicated from breast implant infection is rare. We report a case of early sternum and rib osteomyelitis occurred during breast implant infection managed in an inter-regional referral center for bone/joint infections in the south of France.

  14. Bone scintigraphy for neonatal osteomyelitis: simulation by extravasation of intravenous calcium

    Energy Technology Data Exchange (ETDEWEB)

    Balsam, D.; Goldfarb, C.R.; Stringer, B.; Farruggia, S.

    1980-04-01

    Intravenously administered calcium gluconate has become increasingly popular in the treatment of neonatal tetany. Occasionally, extravasation results in cellulitis, leading to a clinical diagnosis of superimposed osteomyelitis. Osseous scintigraphy, as the accepted modality in the early detection of osteomyelitis, would tend to be used in this circumstance. This case illustrates a false-positive result, probably due to soft-tissue calcification.

  15. Role of computed tomography and radionuclide scintigraphy in the localization of osteomyelitis in flat bones

    Energy Technology Data Exchange (ETDEWEB)

    Hernandez, R.J.; Conway, J.J.; Poznanski, A.K.; Tachdjian, M.O.; Dias, L.S.; Kelikian, A.S.

    1985-03-01

    The combined use of radionuclide scintigraphy and computed tomography is recommended for evaluating children with laboratory and clinical data suggestive of flat bone osteomyelitis despite normal conventional radiographs. In addition, computed tomography may be helpful in the presence of abnormal radiographs in determining the exact location of the focus of osteomyelitis and the most suitable route for appropriate drainage or to obtain culture material.

  16. Risk factors for developing osteomyelitis in patients with diabetic foot wounds

    NARCIS (Netherlands)

    Lavery, Lawrence A.; Peters, Edgar J. G.; Armstrong, David G.; Wendel, Christopher S.; Murdoch, Douglas P.; Lipsky, Benjamin A.

    2009-01-01

    Aims: Osteomyelitis worsens the prognosis in the diabetic foot, but predisposing factors remain largely undefined, In a prospectively followed cohort we assessed risk factors for developing osteomyelitis. Methods: We enrolled consecutive persons with diabetes who presented to a managed-care diabetes

  17. Streptococcus viridans osteomyelitis and endocarditis following dental treatment: a case report

    OpenAIRE

    Choudhury, Maitrayee; Patel, Brijesh R; Patel, Minal; Bashir, Tariq

    2009-01-01

    Vertebral osteomyelitis is an uncommon complication of infective endocarditis with the organism Streptococcus viridans being a rare cause of the condition. This case highlights an unusual presentation of Streptococcus viridans associated with infective endocarditis and pyogenic osteomyelitis in a patient following a dental procedure.

  18. Prediction of the course of acute odontogenic pathology with pronounced osteomyelitis by immunoglobulin and cytokin evaluation

    Directory of Open Access Journals (Sweden)

    A. I. Yaremenko

    2013-01-01

    Full Text Available The aim of our trial was detection of the most significant clinico-laboratory factors in the saliva and blood samples of the patients with odontogenic osteomyelitis in order to predict severity of the clinical course of osteomyelitis and to choose the optimal treatment tactics.

  19. Results of immunoscintigraphy of osteomyelitis (LeukoScan) {sup trademark}; Ergebnisse zur Immunszintigraphie der Osteomyelitis (LeukoScan) {sup trademark}

    Energy Technology Data Exchange (ETDEWEB)

    Gratz, S.; Becker, W. [Goettingen Univ. (Germany). Abt. fuer Nuklearmedizin

    2000-05-01

    99mTc-labeled antigranulocyte monoclonal antibody Fab' fragments have shown a high sensitivity and specificity for detecting osteomyelitis in prospective studies. We retrospectively evaluated the use of LeukoScan {sup trademark} (Immunomedics, Morris Plains, N.J.) in clinical routine for the detection of bone and soft tissue infections and we want to present the results of our findings as well as some of the more interesting cases in this occasion. Imaging infection can be performed fast and easy with {sup 99m}Tc-Fab' fragments due to a fast targeting of infection and good background clearance, which increases in imaging quality. The application of {sup 99m}Tc-Fab' fragments gives good results in patients with bone and soft tissue infections of peripheral bones, as well as in patients with infected prostheses and infected arthritis. The use of {sup 99m}Tc-Fab' fragments should not be limited to these patients only, since good results can also be achieved in patients with infections of vascular grafts, of appendicitis and of endocarditis as well. A higher number of false-negative results has to be expected in case of subacute/chronic infections instead. Independent of the grade of infection acute/subacute infections of the spine always show 'cold lesions'. If cold lesions are used as guide for diagnosing a pathologic finding, an increase in sensitivity together with a decrease in specificity can be achieved. (orig.) [German] {sup 99m}Tc-markierte Antigranulozytenantikoerper-Fab'-Fragmente konnten in prospektiven Studien eine hohe Sensitivitaet und Spezifitaet bei der Detektion von Osteomyelitiden unter Beweis stellen. Retrospektiv haben wir die Anwendung von {sup 99m}Tc-markierten Fab'-Fragmenten ({sup 99m}Tc-Fab') (LeukoScan {sup trademark}, Immunomedics, Morris Plains, N.J.) in der klinischen Routine zum Nachweis von Knochen- und Weichteilentzuendungen ausgewertet und moechten einen Teil unserer Ergebnisse sowie einige

  20. Contribution of chronic diseases to disability in elderly people in countries with low and middle incomes: a 10/66 Dementia Research Group population-based survey

    Science.gov (United States)

    Sousa, Renata M; Ferri, Cleusa P; Acosta, Daisy; Albanese, Emiliano; Guerra, Mariella; Huang, Yueqin; Jacob, KS; Jotheeswaran, AT; Rodriguez, Juan J Llibre; Pichardo, Guillermina Rodriguez; Rodriguez, Marina Calvo; Salas, Aquiles; Sosa, Ana Luisa; Williams, Joseph; Zuniga, Tirso; Prince, Martin

    2009-01-01

    Summary Background Disability in elderly people in countries with low and middle incomes is little studied; according to Global Burden of Disease estimates, visual impairment is the leading contributor to years lived with disability in this population. We aimed to assess the contribution of physical, mental, and cognitive chronic diseases to disability, and the extent to which sociodemographic and health characteristics account for geographical variation in disability. Methods We undertook cross-sectional surveys of residents aged older than 65 years (n=15 022) in 11 sites in seven countries with low and middle incomes (China, India, Cuba, Dominican Republic, Venezuela, Mexico, and Peru). Disability was assessed with the 12-item WHO disability assessment schedule 2.0. Dementia, depression, hypertension, and chronic obstructive pulmonary disease were ascertained by clinical assessment; diabetes, stroke, and heart disease by self-reported diagnosis; and sensory, gastrointestinal, skin, limb, and arthritic disorders by self-reported impairment. Independent contributions to disability scores were assessed by zero-inflated negative binomial regression and Poisson regression to generate population-attributable prevalence fractions (PAPF). Findings In regions other than rural India and Venezuela, dementia made the largest contribution to disability (median PAPF 25·1% [IQR 19·2–43·6]). Other substantial contributors were stroke (11·4% [1·8–21·4]), limb impairment (10·5% [5·7–33·8]), arthritis (9·9% [3·2–34·8]), depression (8·3% [0·5–23·0]), eyesight problems (6·8% [1·7–17·6]), and gastrointestinal impairments (6·5% [0·3–23·1]). Associations with chronic diseases accounted for around two-thirds of prevalent disability. When zero inflation was taken into account, between-site differences in disability scores were largely attributable to compositional differences in health and sociodemographic characteristics. Interpretation On the basis

  1. Essential Contributions of Serotonin Transporter Inhibition to the Acute and Chronic Actions of Fluoxetine and Citalopram in the SERT Met172 Mouse.

    Science.gov (United States)

    Nackenoff, Alex G; Moussa-Tooks, Alexandra B; McMeekin, Austin M; Veenstra-VanderWeele, Jeremy; Blakely, Randy D

    2016-06-01

    Depression is a common mental illness and a leading cause of disability. The most widely prescribed antidepressant medications are serotonin (5-HT) selective reuptake inhibitors (SSRIs). Although there is much support for 5-HT transporter (SERT) antagonism as a basis of antidepressant efficacy, this evidence is indirect and other targets and mechanisms have been proposed. In order to distinguish SERT-dependent and -independent effects of SSRIs, we developed a knock-in mouse model whereby high-affinity interactions of many antidepressants at SERT have been ablated via knock-in substitution (SERT Met172) without disrupting 5-HT recognition or uptake. Here we utilize the C57BL/6J SERT Met172 model to evaluate SERT dependence for the actions of two widely prescribed SSRIs, fluoxetine and citalopram, in tests sensitive to acute and chronic actions of antidepressants. In the tail suspension and forced swim tests, fluoxetine and citalopram fail to reduce immobility in SERT Met172 mice. In addition, SERT Met172 mice are insensitive to chronic fluoxetine and citalopram administration in the novelty induced hypophagia test (NIH) and fail to exhibit enhanced proliferation or survival of hippocampal stem cells. In both acute and chronic studies, SERT Met172 mice maintained sensitivity to paroxetine, an antidepressant that is unaffected by the Met172 mutation. Together, these studies provide definitive support for an essential role of SERT antagonism in the acute and chronic actions of two commonly used SSRIs in these tests, and reinforce the utility of the SERT Met172 model for isolating SERT/5-HT contributions of drug actions in vivo.

  2. Clinical and tomography evolution of frontal osteomyelitis: Case report

    Directory of Open Access Journals (Sweden)

    Raquel Crisóstomo Lima Verde1, , , , ,

    2012-01-01

    Full Text Available Introduction: The frontal osteomyelitis is a complication of rhinosinusitis which can evolve to acute or chronicle. There is inflammatory reaction by the increasing of intraosseous pressure, ischemia and local necrosis, leading to bone abscess formation. There is no drainage, it will occur detachment of the periosteum, soft tissue invasion and worsening of ischemia with subsequent bone sequestration. Method: Case report of an inpatient in an emergency service of another institution by the complication of rhinosinusitis who was referred to the Otorhinolaryngology Service of University Hospital Professor Edgard Santos of Federal University of Bahia. Case Report: Male patient, 16 years-old, presented himself to the ER of another institution with cephalea, vomits and fever which evolved to periorbital edema and frontal to the left, moving to palpebral fluctuation and frontal. Subjected to frontal and palpebral abscess drainage, with broad-spectrum antibiotic therapy with no improvement. He was referred to our service keeping edema and fluctuation in region frontal and light edema in left periorbital region. The nasal endoscopy showed edema in meatus to the left and the computerized tomography showed fronto-ethmoid sinusitis to the left and signs of frontal osteomyelitis with bone sequestration and epidural empyema. Subjected to sinasal endoscopy surgery, external Access or removal of the frontal one affected and epidural empyema drainage. Evolved to the remission of the disease. Final Considerations: Failure in the diagnosis and rhinosinusitis complication treatment can lead to sequalae and fatal complications. The diagnosis of the frontal osteomyelitis is confirmed by the clinical suspicion and confirmed by radiological examination. The surgery is indicated when the evolution is insidious, there is bone sequestration and intracranial complications.

  3. RIPK3-Mediated Necroptosis and Apoptosis Contributes to Renal Tubular Cell Progressive Loss and Chronic Kidney Disease Progression in Rats.

    Science.gov (United States)

    Zhu, Yongjun; Cui, Hongwang; Xia, Yunfeng; Gan, Hua

    2016-01-01

    Tubulointerstitial fibrosis (TIF) is caused by the progressive loss of renal tubular cells and the consequent replacement of the extracellular matrix. The progressive depletion of renal tubular cells results from apoptosis and necroptosis; however, the relative significance of each of these cell death mechanisms at different stages during the progression of chronic kidney disease (CKD) remains unclear. We sought to explore the mechanisms of renal tubular cell death during the early and intermediate stages of chronic renal damage of subtotal nephrectomied (SNx) rats. The results of tissue histological assays indicated that the numbers of necrotic dying cells and apoptotic cells were significantly higher in kidney tissues derived from a rat model of CKD. In addition, there was a significant increase in necroptosis observed by transmission electron microscopy (TEM) and an increase in the proportion of TUNEL-positive cells in kidney tissues from SNx rats compared with control rats, and necrostatin-1 (Nec-1) could inhibit necroptosis and reduce the proportion of TUNEL-positive cells. More importantly, we observed a significant increase in the incidence of necroptosis compared with apoptosis by TEM in vivo and in vitro and a significant increase in the proportion of TUNEL-positive tubular epithelial cells that did not express caspase-3 compared with those expressing cleaved caspase-3 in vitro. Furthermore, treatment with Nec-1 and zVAD strongly reduced necroptosis- and apoptosis-mediated renal tubular cell death and decreased the levels of blood urea nitrogen and serum creatinine and tubular damage scores of SNx rats. These results suggest that necroptotic cell death plays a more significant role than apoptosis in mediating the loss of renal tubular cells in SNx rats and that effectively blocking both necroptosis and apoptosis improves renal function and tubular damage at early and intermediate stages of CKD.

  4. Pyogenic spinal osteomyelitis: a review of 61 cases.

    Science.gov (United States)

    Silverthorn, K G; Gillespie, W J

    1986-02-12

    The presentation and outcome of 61 cases of nontuberculous spinal osteomyelitis were reviewed. Although the commonest presentation was subacute, with back pain predominating, 10% had septicaemia and 7% paraperesis or paraplegia. Most infections were caudal to the fourth thoracic vertebra. One third were associated with preceding urinary, respiratory, dental or abdominal sepsis. Staphylococcus aureus was the infecting organism in 85% of isolates. Delay in diagnosis was frequent. There were four deaths, and seven individuals remained severely disabled: outcome was otherwise satisfactory. An algorithm for the investigation and management of this uncommon but serious condition is proposed.

  5. Staphylococcus aureus sternal osteomyelitis: a rare cause of chest pain

    Directory of Open Access Journals (Sweden)

    Kaur M

    2015-10-01

    Full Text Available Chest pain is a common presenting symptom with a broad differential. Life-threatening cardiac and pulmonary etiologies of chest pain should be evaluated first. However, it is critical to perform a thorough assessment for other sources of chest pain in order to limit morbidity and mortality from less common causes. We present a rare case of a previously healthy 45 year old man who presented with focal, substernal, reproducible chest pain and Staphylococcus aureus bacteremia who was later found to have primary Staphylococcus aureus sternal osteomyelitis.

  6. Confronting a dramatic situation: the charcot foot complicated by osteomyelitis.

    Science.gov (United States)

    Dalla Paola, Luca

    2014-12-01

    Charcot osteoarthropathy is a serious complication of diabetic neuropathy. Its prevalence in the diabetic population varies in the literature in relation to certain variables, such as the method of assessment, clinical or instrumental; the population studied; and the scope of the selection. This article is intended as a review of the recent literature concerning Charcot osteoarthropathy in its evolution and complications characterized by the development of ulceration and subsequent bone infection. Diagnosis and treatment strategies--either medical or surgical--are discussed both for Charcot arthropathy and osteomyelitis.

  7. Osteomyelitis in leukocyte adhesion deficiency type 1 syndrome

    DEFF Research Database (Denmark)

    Jabbari Azad, Farahzad; Ardalan, Maryam; H.Rafati, Ali;

    2010-01-01

    Leukocyte adhesion deficiency type 1 (LAD-1) is a rare, inherited immunodeficiency that affects one per million people yearly and usually presents with recurrent, indolent bacterial infections of the skin, mouth, and respiratory tract and impaired pus formation and wound healing. A 13-year-old gi......(10.60%). A plain radiography of the left leg revealed osteomyelitis. It is highly suggested that patients diagnosed mild to moderate LAD-1 with recurrent skin infection and simultaneous weak response to conventional therapy undergo (BMT) marrow transplant to prohibit subsequent life...

  8. Clinical outcomes of osteomyelitis patients infected with methicillin-resistant Staphylococcus aureus USA-300 strains.

    Science.gov (United States)

    Peyrani, P; Allen, M; Seligson, D; Roberts, C; Chen, A; Haque, N; Zervos, M; Wiemken, T; Harting, J; Christensen, D; Ramirez, R

    2012-03-01

    Methicillin-resistant Staphylococcus aureus (MRSA) USA-300 strains have emerged as an important cause of community-acquired infections. These strains have been recognized as an etiology of osteomyelitis but data on their incidence and outcomes are limited. We retrospectively studied the incidence and clinical outcomes of MRSA USA-300 osteomyelitis in patients at the University of Louisville Hospital and the Henry Ford Health System between January 2007 and March 2008. Pulsed-field gel electrophoresis was used to determine USA type. Clinical outcomes were defined as management success versus failure at 12 months. Chi-square tests, Fisher exact tests, and Mann-Whitney tests were used to compare patient characteristics on the basis of clinical outcomes and USA type. Of the 50 patients with MRSA osteomyelitis, 27 (54%) had the USA-300 strain. Clinical failure was identified in 22% (6/27) of the patients with MRSA USA-300 and in 30% (7/23) of the patients with MRSA non-USA-300 osteomyelitis (P = .509). Our results showed that MRSA USA-300 is a significant etiology of MRSA osteomyelitis. With current surgical and medical management, outcomes of patients with MRSA USA-300 osteomyelitis are similar to those of patients with MRSA non-USA-300 osteomyelitis.

  9. Mesenchymal stromal cell implantation for stimulation of long bone healing aggravates Staphylococcus aureus induced osteomyelitis.

    Science.gov (United States)

    Seebach, Elisabeth; Holschbach, Jeannine; Buchta, Nicole; Bitsch, Rudi Georg; Kleinschmidt, Kerstin; Richter, Wiltrud

    2015-07-01

    Large bone defects requiring long-term osteosynthetic stabilization or repeated surgeries show a considerable rate of infection. Mesenchymal stromal cells (MSCs) have been successfully used to enhance bone regeneration, but their powerful immunomodulatory effects may impose an enhanced risk for osteomyelitis development. In order to unravel whether implantation of MSCs aggravates a simultaneous bone infection, a hydrogel-supported osteomyelitis ostectomy model was developed in which rats received a femoral bone defect with rigid plate-fixation. After fibrin-assisted transfer of Staphylococcus aureus (SA), effects of MSC implantation on osteomyelitis development were quantified over 3-4 weeks. All SA-infected animals developed an acute local osteomyelitis with significantly increased blood neutrophil count, abscess formation and bone destruction. MSC-treatment of infected defects aggravated osteomyelitis according to a significantly elevated osteomyelitis score and enhanced distal bone loss with spongy alteration of cortical bone architecture. Increased attraction of macrophages, osteoclasts and regulation of pro- and anti-inflammatory mediators were potential MSC actions. Overall trophic actions of MSCs implanted into non-sterile bone defects may enhance an infection and/or exacerbate osteomyelitis. Studies on antibiotic carrier augmentation or antibiotic treatment are warranted to decide whether MSC implantation is a safe and promising therapy for orthopedic implant-stabilized bone defects at high risk for development of infection.

  10. 长骨骨髓炎与骨肉瘤的影像学鉴别诊断%IMAGEOLOGICAL DIFFERENTIAL DIAGNOSIS OF LONG-BONE OSTEOMYELITIS AND OSTEOSARCOMA

    Institute of Scientific and Technical Information of China (English)

    姜春雷; 舒强; 刘吉华

    2011-01-01

    目的 探讨影像学表现对长骨骨髓炎和骨肉瘤的鉴别诊断价值.方法 回顾性分析 59 例长骨急、慢性骨髓炎和 56 例长骨骨肉瘤病人X线、CT和MRI征象.结果 骨髓炎组和骨肉瘤组比较,破坏周围松质骨硬化差异无统计学意义(P>0.05),跨过骺板侵犯骨骺、骨皮质改变、骨干髓腔形态改变、MR检查中病变在脂肪抑制T WI边界清晰、骨膜新生骨类型、死骨形成以及松质骨内脓肿差异有显著性(X=9.050~20.647,PWI压脂像中边界清晰和X线检查中CODMAN三角形成是诊断骨肉瘤的可靠征象,髓腔内脓肿和死骨形成是骨髓炎的特异性征象.%Objective To evaluate the value of imageological manifestations in differential diagnosis of osteomyelitis and osteosarcoma in long bone. Methods The signs on X-ray, CT and MRI in 59 cases with acute or chronic osteomyelitis and 55 with osteosarcoma were analyzed retrospectively. Results Between osteomyelitis and osteosarcoma, the differences of signs were not significant in terms of destruction of spongy bone sclerosis (P>0.05), however, the differences between the two groups were significant in terms of epiphysis invasion acrossing epiphyseal plate, changes of bone cortex and marrow cavity of diaphysis,sharpness of boundary of lesion in sequence T2WI on MR imaging, type of periosteal new bone, sequestration and abscess in spongy bone (x2=9.050-20.647,P<0.01;P=0. 001,0. 000). Conclusion Whether epiphyseal disks are strided over and epiphysis involved, changes of marrow cavity, or of bone cortex are of value for differential diagnosis of osteomyelitis and osteosarcoma. On MR, sharpness of bounder in T2 WI and CODMAN triangle on X-ray are reliable signs for diagnosis of osteosarcoma; abscess in medullary cavity and sequestration are specific signs of osteomyelitis.

  11. Indoxyl Sulfate Impairs Endothelial Progenitor Cells and Might Contribute to Vascular Dysfunction in Patients with Chronic Kidney Disease

    Directory of Open Access Journals (Sweden)

    Cheng-Jui Lin

    2016-12-01

    Full Text Available Background/Aims: Indoxyl sulfate (IS is a protein-bound uremic toxin that accumulates in patients with chronic kidney disease (CKD. We explored the effect of IS on human early endothelial progenitor cells (EPCs and analyzed the correlation between serum IS levels and parameters of vascular function, including endothelial function in a CKD-based cohort. Methods: A cross-sectional study with 128 stable CKD patients was conducted. Flow-mediated dilation (FMD, pulse wave velocity (PWV, ankle brachial index, serum IS and other biochemical parameters were measured and analyzed. In parallel, the activity of early EPCs was also evaluated after exposure to IS. Results: In human EPCs, a concentration-dependent inhibitory effect of IS on chemotactic motility and colony formation was observed. Additionally, serum IS levels were significantly correlated with CKD stages. The total IS (T-IS and free IS (F-IS were strongly associated with age, hypertension, cardiovascular disease, blood pressure, PWV, blood urea nitrogen, creatine and phosphate but negatively correlated with FMD, the estimated glomerular filtration rate (eGFR, hemoglobin, hematocrit, and calcium. A multivariate linear regression analysis also showed that FMD was significantly associated with IS after adjusting for other confounding factors. Conclusions: In humans, IS impairs early EPCs and was strongly correlated with vascular dysfunction. Thus, we speculate that this adverse effect of IS may partly result from the inhibition of early EPCs.

  12. Genetic contribution of catechol-O-methyltransferase polymorphism (Val158Met) in children with chronic tension-type headache.

    Science.gov (United States)

    Fernández-de-las-Peñas, César; Ambite-Quesada, Silvia; Rivas-Martínez, Inés; Ortega-Santiago, Ricardo; de-la-Llave-Rincón, Ana Isabel; Fernández-Mayoralas, Daniel M; Pareja, Juan A

    2011-10-01

    Our aim was to investigate the relationship between Val158Met polymorphisms, headache, and pressure hypersensitivity in children with chronic tension-type headache (CTTH). A case-control study with blinded assessor was conducted. Seventy children with CTTH associated with pericranial tenderness and 70 healthy children participated. After amplifying Val158Met polymorphism by polymerase chain reactions, we assessed genotype frequencies and allele distributions. We classified children according to their Val158Met polymorphism: Val/Val, Val/Met, Met/Met. Pressure pain thresholds (PPT) were bilaterally assessed over the temporalis, upper trapezius, second metacarpal, and tibialis anterior muscles. The distribution of Val158Met genotypes was not significantly different (p = 0.335), between children with CTTH and healthy children, and between boys and girls (p = 0.872). Children with CTTH with the Met/Met genotype showed a longer headache history compared with those with Met/Val (p = 0.001) or Val/Val (p = 0.002) genotype. Children with CTTH with Met/Met genotype showed lower PPT over upper trapezius and temporalis muscles than children with CTTH with Met/Val or Val/Val genotype (p < 0.01). The Val158Met catechol-O-methyltransferase (COMT) polymorphism does not appear to be involved in predisposition to suffer from CTTH in children; nevertheless, this genetic factor may be involved in the phenotypic expression, as pressure hypersensitivity was greater in those CTTH children with the Met/Met genotype.

  13. Klotho Reduction in Alveolar Macrophages Contributes to Cigarette Smoke Extract-induced Inflammation in Chronic Obstructive Pulmonary Disease.

    Science.gov (United States)

    Li, Lingling; Wang, Yujie; Gao, Wei; Yuan, Cheng; Zhang, Sini; Zhou, Hong; Huang, Mao; Yao, Xin

    2015-11-13

    Abnormal inflammation and accelerated decline in lung function occur in patients with chronic obstructive pulmonary disease (COPD). Klotho, an anti-aging protein, has an anti-inflammatory function. However, the role of Klotho has never been investigated in COPD. The aim of this study is to investigate the possible role of Klotho by alveolar macrophages in airway inflammation in COPD. Klotho levels were assessed in the lung samples and peripheral blood mononuclear cells of non-smokers, smokers, and patients with COPD. The regulation of Klotho expression by cigarette smoke extract (CSE) was studied in vitro, and small interfering RNA (siRNA) and recombinant Klotho were employed to investigate the role of Klotho on CSE-induced inflammation. Klotho expression was reduced in alveolar macrophages in the lungs and peripheral blood mononuclear cells of COPD patients. CSE decreased Klotho expression and release from MH-S cells. Knockdown of endogenous Klotho augmented the expression of the inflammatory mediators, such as MMP-9, IL-6, and TNF-α, by MH-S cells. Exogenous Klotho inhibited the expression of CSE-induced inflammatory mediators. Furthermore, we showed that Klotho interacts with IκBα of the NF-κB pathway. Dexamethasone treatment increased the expression and release level of Klotho in MH-S cells. Our findings suggest that Klotho plays a role in sustained inflammation of the lungs, which in turn may have therapeutic implications in COPD.

  14. Deficient cytokine expression and neutrophil oxidative burst contribute to impaired cutaneous wound healing in diabetic, biofilm-containing chronic wounds.

    Science.gov (United States)

    Nguyen, Khang T; Seth, Akhil K; Hong, Seok J; Geringer, Matthew R; Xie, Ping; Leung, Kai P; Mustoe, Thomas A; Galiano, Robert D

    2013-01-01

    Diabetic patients exhibit dysregulated inflammatory and immune responses that predispose them to chronic wound infections and the threat of limb loss. The molecular underpinnings responsible for this have not been well elucidated, particularly in the setting of wound biofilms. This study evaluates host responses in biofilm-impaired wounds using the TallyHo mouse, a clinically relevant polygenic model of type 2 diabetes. No differences in cytokine or Toll-like receptor (TLR) expression were noted in unwounded skin or noninoculated wounds of diabetic and wild-type mice. However, diabetic biofilm-containing wounds had significantly less TLR 2, TLR 4, interleukin-1β, and tumor necrosis factor-α expression than wild-type wounds with biofilm (all p oxidative burst activity. This translated into a log-fold greater bacterial burden and significant delay of wound epithelization for biofilm-impaired diabetic wounds at 10 days postwounding. These results suggest that impaired recognition of bacterial infection via the TLR pathway leading to inadequate cytokine stimulation of antimicrobial host responses may represent a potential mechanism underlying diabetic susceptibility to wound infection and ulceration.

  15. Anemia of chronic disease

    Science.gov (United States)

    ... disease Long-term infections, such as bacterial endocarditis, osteomyelitis (bone infection), HIV/AIDS , hepatitis B or hepatitis ... disease Crohn disease Erythropoietin test Juvenile idiopathic arthritis Osteomyelitis Rheumatic fever Ulcerative colitis Review Date 2/1/ ...

  16. Treatment of osteomyelitis with antibiotic-soaked porous glass ceramic.

    Science.gov (United States)

    Kawanabe, K; Okada, Y; Matsusue, Y; Iida, H; Nakamura, T

    1998-05-01

    We have developed a new drug delivery system using porous apatite-wollastonite glass ceramic (A-W GC) to treat osteomyelitis. A-W GC (porosity, 70% and 20% to 30%), or porous hydroxyapatite (HA) blocks (porosity 35% to 48%) used as controls, were soaked in mixtures of two antibiotics, isepamicin sulphate (ISP) and cefmetazole (CMZ) under high vacuum. We evaluated the release concentrations of the antibiotics from the blocks. The bactericidal concentration of ISP from A-W GC was maintained for more than 42 days, but that from HA decreased to below the detection limit after 28 days. The concentrations of CMZ from both materials were lower than those of ISP. An in vivo study using rabbit femora showed that an osseous concentration of ISP was maintained at eight weeks after implantation. Osteoconduction of the A-W GC block was good. Four patients with infected hip arthroplasties and one with osteomyelitis of the tibia have been treated with the new delivery system with excellent results.

  17. Kingella kingae infections in paediatric patients: 5 cases of septic arthritis, osteomyelitis and bacteraemia.

    Science.gov (United States)

    Birgisson, H; Steingrimsson, O; Gudnason, T

    1997-01-01

    Kingella kingae is a Gram-negative rod most often recognized as 1 of the organisms causing septic arthritis and osteomyelitis in children. Infection caused by K. kingae had not been diagnosed in Iceland until 5 cases were diagnosed at the Paediatric Department at the University Hospital of Iceland over a 1 year period. In this report we describe these 5 children with invasive infection caused by K. kingae (2 with septic arthritis, 1 with osteomyelitis, 1 with septic arthritis and osteomyelitis, and 1 with bacteraemia) and review the literature. All bacterial isolates were identified by the Bactec culture system.

  18. Osteomyelitis or Charcot neuro-osteoarthropathy? Differentiating these disorders in diabetic patients with a foot problem.

    Science.gov (United States)

    Ertugrul, Bulent M; Lipsky, Benjamin A; Savk, Oner

    2013-11-05

    Both osteomyelitis and Charcot neuro-osteoarthropathy (CN) are potentially limb-threatening complications of diabetic neuropathy, but they require quite different treatments. Almost all bone infections in the diabetic foot originate from an infected foot ulcer while diabetic osteoarthropathy is a non-infectious process in which peripheral neuropathy plays the critical role. Differentiating between diabetic foot osteomyelitis and CN requires careful evaluation of the patient, including the medical history, physical examination, selected laboratory findings, and imaging studies. Based on available studies, we review the approaches to the diagnostic differentiation of osteomyelitis from CN of the foot in diabetic patients.

  19. Osteomyelitis or Charcot neuro-osteoarthropathy? Differentiating these disorders in diabetic patients with a foot problem

    Directory of Open Access Journals (Sweden)

    Bulent M. Ertugrul

    2013-11-01

    Full Text Available Both osteomyelitis and Charcot neuro-osteoarthropathy (CN are potentially limb-threatening complications of diabetic neuropathy, but they require quite different treatments. Almost all bone infections in the diabetic foot originate from an infected foot ulcer while diabetic osteoarthropathy is a non-infectious process in which peripheral neuropathy plays the critical role. Differentiating between diabetic foot osteomyelitis and CN requires careful evaluation of the patient, including the medical history, physical examination, selected laboratory findings, and imaging studies. Based on available studies, we review the approaches to the diagnostic differentiation of osteomyelitis from CN of the foot in diabetic patients.

  20. Acute osteomyelitis, septic arthritis and discitis: Differences between neonates and older children

    Energy Technology Data Exchange (ETDEWEB)

    Offiah, A.C. [Department of Radiology, Great Ormond Street Hospital for Children, London WC1N 3JH (United Kingdom)]. E-mail: offiaa@gosh.nhs.uk

    2006-11-15

    There are aetiological, clinical, radiological and therapeutic differences between musculoskeletal infection in the neonate (and infant) and in older children and adults. Due to the anatomy and blood supply in neonates, osteomyelitis often co-exists with septic arthritis. Discitis is more common in infants whereas vertebral body infection is more common in adults. This review article discusses the important clinical and radiological differences that in the past have led many authors to consider neonatal osteomyelitis a separate entity from osteomyelitis in the older child.

  1. Mycotic osteomyelitis due to Scedosporium Apiospermum: MR imaging-pathologic correlation

    Energy Technology Data Exchange (ETDEWEB)

    Sydnor, Malcolm K.; Knight, Thomas E. [Department of Radiology, Medical College of Virginia Hospital, Virginia Commonwealth University, P. O. Box 980615, Richmond, 23298-0615, VA (United States); Kaushik, Shaifali [Department of Radiology, VA Medical Center, 100 Emancipation Drive, 23667, Hampton, VA (United States); Department of Radiology, Medical College of Virginia Hospital, Virginia Commonwealth University, P. O. Box 980615, Richmond, 23298-0615, VA (United States); Bridges, C.Lee [Department of Pathology, Medical College of Virginia Hospital, Virginia Commonwealth University, P.O. Box 980662, Richmond, 23298-0662, VA (United States); McCarty, John M. [Department of Internal Medicine, Medical College of Virginia Hospital, Virginia Commonwealth University, P.O. Box 980157, Richmond, 23298-0662, VA (United States)

    2003-11-01

    Mycotic osteomyelitis is rare and occurs in immunocompromised patients after inoculation of the pathogen at a penetrating trauma site. Mycotic osteomyelitis due to Scedosporium Apiospermum is extremely rare, with only 13 cases of septic arthritis reported previously. Ours is only the third case of S. apiospermum osteomyelitis in an immunocompromised patient and the only patient with a histopathologic diagnosis from an amputation specimen. Recognition of this pathogen may be delayed due to insidious onset and negative joint fluid cultures, often requiring synovial or bone biopsies to establish the diagnosis. Delay in appropriate treatment may result in disseminating infection or even death. (orig.)

  2. Lung carcinogenesis from chronic obstructive pulmonary disease: characteristics of lung cancer from COPD and contribution of signal transducers and lung stem cells in the inflammatory microenvironment.

    Science.gov (United States)

    Sekine, Yasuo; Hata, Atsushi; Koh, Eitetsu; Hiroshima, Kenzo

    2014-07-01

    Chronic obstructive pulmonary disease (COPD) and lung cancer are closely related. The annual incidence of lung cancer arising from COPD has been reported to be 0.8-1.7 %. Treatment of lung cancer from COPD is very difficult due to low cardiopulmonary function, rapid tumor growth, and resistance to molecularly targeted therapies. Chronic inflammation caused by toxic gases can induce COPD and lung cancer. Carcinogenesis in the inflammatory microenvironment occurs during cycles of tissue injury and repair. Cellular damage can induce induction of necrotic cell death and loss of tissue integrity. Quiescent normal stem cells or differentiated progenitor cells are introduced to repair injured tissues. However, inflammatory mediators may promote the growth of bronchioalveolar stem cells, and activation of NF-κB and signal transducer and activator of transcription 3 (STAT3) play crucial roles in the development of lung cancer from COPD. Many of the protumorgenic effects of NF-κB and STAT3 activation in immune cells are mediated through paracrine signaling. NF-κB and STAT3 also contribute to epithelial-mesenchymal transition. To improve lung cancer treatment outcomes, lung cancer from COPD must be overcome. In this article, we review the characteristics of lung cancer from COPD and the mechanisms of carcinogenesis in the inflammatory microenvironment. We also propose the necessity of identifying the mechanisms underlying progression of COPD to lung cancer, and comment on the clinical implications with respect to lung cancer prevention, screening, and therapy.

  3. Angiotensin II type 1a receptors in subfornical organ contribute towards chronic intermittent hypoxia-associated sustained increase in mean arterial pressure.

    Science.gov (United States)

    Saxena, Ashwini; Little, Joel T; Nedungadi, T Prashant; Cunningham, J Thomas

    2015-03-01

    Sleep apnea is associated with hypertension. The mechanisms contributing to a sustained increase in mean arterial pressure (MAP) even during normoxic awake-state remain unknown. Rats exposed to chronic intermittent hypoxia for 7 days, a model of the hypoxemia associated with sleep apnea, exhibit sustained increases in MAP even during the normoxic dark phase. Activation of the renin-angiotensin system (RAS) has been implicated in chronic intermittent hypoxia (CIH) hypertension. Since the subfornical organ (SFO) serves as a primary target for the central actions of circulating ANG II, we tested the effects of ANG II type 1a receptor (AT1aR) knockdown in the SFO on the sustained increase in MAP in this CIH model. Adeno-associated virus carrying green fluorescent protein (GFP) and small-hairpin RNA against either AT1aR or a scrambled control sequence (SCM) was stereotaxically injected in the SFO of rats. After recovery, MAP, heart rate, respiratory rate, and activity were continuously recorded using radiotelemetry. In the normoxic groups, the recorded variables did not deviate from the baseline values. Both CIH groups exhibited significant increases in MAP during CIH exposures (P SCM-injected group exhibited a sustained increase in MAP (P SCM-CIH group. Our data indicate that AT1aRs in the SFO are critical for the sustained elevation in MAP and increased FosB/ΔFosB expression in forebrain autonomic nuclei associated with CIH.

  4. Current perspectives on the contribution of inhaled corticosteroids to an increased risk for diabetes onset and progression in patients with chronic obstructive pulmonary disease.

    Science.gov (United States)

    Herth, Felix J F; Bramlage, Peter; Müller-Wieland, Dirk

    2015-01-01

    Recent studies have suggested that inhaled corticosteroids (ICS) play a role in the development of hyperglycemia and type-2 diabetes in patients with chronic obstructive pulmonary disease (COPD). Nevertheless, this corticosteroid-associated adverse effect remains controversial. Moreover, the pharmacokinetic properties and patient characteristics that might contribute to an increased risk for diabetes upon ICS exposure have not been thoroughly investigated. In the present review, we critically discuss current evidence regarding the relationship between ICS therapy in COPD patients and an increased risk for the incidence and progression of type-2 diabetes. In addition, we address therapeutic conditions, clinical implications, and future perspectives related to this potentially important ICS-associated adverse effect in COPD patients.

  5. Clinical Application of Antimicrobial Bone Graft Substitute in Osteomyelitis Treatment: A Systematic Review of Different Bone Graft Substitutes Available in Clinical Treatment of Osteomyelitis.

    Science.gov (United States)

    van Vugt, T A G; Geurts, J; Arts, J J

    2016-01-01

    Osteomyelitis is a common occurrence in orthopaedic surgery, which is caused by different bacteria. Treatment of osteomyelitis patients aims to eradicate infection by debridement surgery and local and systemic antibiotic therapy. Local treatment increases success rates and can be performed with different antimicrobial bone graft substitutes. This review is performed to assess the level of evidence of synthetic bone graft substitutes in osteomyelitis treatment. According to the PRISMA statement for reporting systematic reviews, different types of clinical studies concerning treatment of osteomyelitis with bone graft substitutes are included. These studies are assessed on their methodological quality as level of evidence and bias and their clinical outcomes as eradication of infection. In the fifteen included studies, the levels of evidence were weak and in ten out of the fifteen studies there was a moderate to high risk of bias. However, first results of the eradication of infection in these studies showed promising results with their relatively high success rates and low complication rates. Due to the low levels of evidence and high risks of bias of the included studies, these results are inconclusive and no conclusions regarding the performed clinical studies of osteomyelitis treatment with antimicrobial bone graft substitutes can be drawn.

  6. Diabetes induces stable intrinsic changes to myeloid cells that contribute to chronic inflammation during wound healing in mice

    Directory of Open Access Journals (Sweden)

    Pauline Bannon

    2013-11-01

    Acute inflammation in response to injury is a tightly regulated process by which subsets of leukocytes are recruited to the injured tissue and undergo behavioural changes that are essential for effective tissue repair and regeneration. The diabetic wound environment is characterised by excessive and prolonged inflammation that is linked to poor progression of healing and, in humans, the development of diabetic foot ulcers. However, the underlying mechanisms contributing to excessive inflammation remain poorly understood. Here we show in a murine model that the diabetic environment induces stable intrinsic changes in haematopoietic cells. These changes lead to a hyper-responsive phenotype to both pro-inflammatory and anti-inflammatory stimuli, producing extreme M1 and M2 polarised cells. During early wound healing, myeloid cells in diabetic mice show hyperpolarisation towards both M1 and M2 phenotypes, whereas, at late stages of healing, when non-diabetic macrophages have transitioned to an M2 phenotype, diabetic wound macrophages continue to display an M1 phenotype. Intriguingly, we show that this population predominantly consists of Gr-1+ CD11b+ CD14+ cells that have been previously reported as ‘inflammatory macrophages’ recruited to injured tissue in the early stages of wound healing. Finally, we show that this phenomenon is directly relevant to human diabetic ulcers, for which M2 polarisation predicts healing outcome. Thus, treatments focused at targeting this inflammatory cell subset could prove beneficial for pathological tissue repair.

  7. Complicating osteomyelitis imaged with Tc-99m MDP, In-111 granulocytes, and Ga-67 citrate

    Energy Technology Data Exchange (ETDEWEB)

    Schauwecker, D.S.; Park, H.M.; Mock, B.H.; Burt, R.W.; Kernick, C.B.; Ruoff, A.C. III; Sinn, H.J.; Wellman, H.N.; Vamc, R.L.R.

    1984-01-01

    Gallium-67 and 3-phase bone scan (3P) studies, though very sensitive, are not very specific in evaluating suspected osteomyelitis (OM) which is superimposed upon other diseases that cause increased bone turnover (IBT). The authors compared In-111 acetylacetone labeled granulocytes (In-111) GRAN) with 3P in 57 such patients; 29 of these patients had Ga-67 studies as well. In-111 GRAN had a sensitivity of 100% in acute OM, 62% in chronic OM, and a specificity of 96%. Gallium-67 ruled out OM when the study was normal; it diagnosed OM when the relative uptake of Ga-67 exceeded the uptake of Tc-99m MDP, or when the skeletal distribution of Ga-67 was different from that of the TC-99m MDP. Unfortunately, these criteria were met in only 28% of the subjects. The simple approach of increased Ga-67 activity meant OM gave a sensitivity of 100%, but an unacceptable specificity of 38%. Chronic cellulitis or long-standing decubiti were seldom detected by IN-111 GRAN. Clinically obvious soft tissue infections or cellulitis were seen with In-111 GRAN 27% of the time, and 17% of the time with Ga-67. The authors conclude that when added to 3P, In-111 GRAN provided more useful information than did Ga-67. A combination of all 3 studies did not significantly increase the diagnostic yield. Performing In-111 GRAN without 3P in patients with IBT is not recommended since the 3P provides anatomic information that aids in the differentiation of OM from soft tissue infections.

  8. Spontaneous kyphotic collapse followed by autostabilisation secondary to cervical osteomyelitis in an intravenous drug abuser.

    Science.gov (United States)

    Arun, Ranganathan; Kasbekar, Anand Vijay; Mehdian, S M Hossein

    2007-12-01

    There is a high risk of cervical osteomyelitis in intravenous drug abusers due to the use of jugular veins for administration of drugs. Here described is a case of rapid vertebral body destruction at two levels leading to a progressive kyphotic deformity followed by autofusion, secondary to cervical osteomyelitis. The case report goes on to hypothesise about the unique manner of progression of untreated cervical osteomyelitis with a rapid onset of kyphotic deformity and associated severe bone destruction in an intravenous drug abuser. Due to the high incidence of osteomyelitis in intravenous drug abusers, there should be a low threshold to investigate for this condition and early magnetic resonance imaging is vital. It alerts the treating spine surgeon to the fact that early immobilisation is crucial in these cases to prevent a severe impending deformity that can be surgically challenging.

  9. Extra-osseous fat fluid level: a specific sign for osteomyelitis

    Energy Technology Data Exchange (ETDEWEB)

    Kumar, Jyoti; Bandhu, Suman; Kumar, Atin [All India Institute of Medical Sciences, Department of Radiology, New Delhi (India); Alam, Shah [All India Institute of Medical Sciences, Department of Orthopedics, New Delhi (India)

    2007-06-15

    Osteomyelitis may pose as a diagnostic dilemma on various imaging modalities and may be confused with neoplasms and other pathology. Although a rare finding, extra-osseous fat fluid level, especially when associated with spongy bone destruction, can be considered a specific sign of osteomyelitis. Previously, only two cases of extra-osseous fat fluid level in osteomyelitis have been reported, one on computed tomography (CT) and the other on magnetic resonance imaging (MRI). The former was a case of septic arthritis with intra-articular fat fluid level. A case of osteomyelitis is presented with the demonstration of extra-osseous fat fluid level. Our case is unique in providing exquisite CT and MRI correlation. (orig.)

  10. Thoracolumbar Scoliosis Due to Cryptococcal Osteomyelitis: A Case Report and Review of the Literature.

    Science.gov (United States)

    Li, Zheng; Liang, Jinqian; Shen, Jianxiong; Qiu, Guixing; Weng, Xisheng

    2016-02-01

    Cryptococcus neoformans causes opportunistic infections in immunocompromised patients, with vertebral osteomyelitis being a very rare involvement.This study is to present a case of thoracolumbar scoliosis occurring in the setting of cryptococcal osteomyelitis.Pharmacological intervention with anticryptococcal medicine and medical management of immune hemolytic anemia were administered. After initial acute stabilization, she underwent spinal debridement and fusion on October 29, 2008. She eventually recovered fully from this episode with no subsequent mechanical instability or neurological deficits on subsequent clinic follow-ups.To the best of our knowledge, there have been no reports describing the onset of spinal cryptococcal osteomyelitis along with immune hemolytic anemia. We suggest a comprehensive algorithm for the diagnosis of vertebral cryptococcal osteomyelitis.

  11. 非典型骨髓炎的影像学表现及治疗%Radiography,clinical diagnosis and treatment of atypical pyogenic osteomyelitis

    Institute of Scientific and Technical Information of China (English)

    张开刚; 尚凯; 马玉栋; 王军

    2012-01-01

    目的 分析非典型骨髓炎的影像学表现探讨诊疗方法.方法观察24例非典型骨髓炎患者影像学表现,并与手术病理结果进行对照.结果 24例患者术后病理均证实为骨髓炎.显示软组织肿胀:X线平片10例,CT 18例,MRI 21例;显示骨膜反应:X线平片15例,CT 18例,MRI未见;显示骨髓腔密度增高:X线平片11例,CT 16例,MRI 24例;显示骨皮质增厚:X线平片10例,CT 14例,MRI 18例.结论 MRI对非典型骨髓炎的早期诊断、鉴别诊断帮助较大,X 线平片仍是基础.X线平片、CT结合MR检查是非典型骨髓炎的早期诊断和鉴别诊断的重要手段.非典型慢性骨髓炎影像学表现不典型,误诊、漏诊率较高,认识其临床及影像学表现可以提高诊疗水平.%Objective To analyze the radiography features of clinical atypical pyogenic osteomyelitis and to explore treatment method. Methods The radiography signs of 24 cases with atypical pyogenic osteomyelitis, were compared with the surgical pathology findings. Results The post operational pathology of 24 cases were confirmed atypical pyogenic osteomyelitis. Demonstrates soft tissue swelling case: X-ray plain film 10 cases, CT 18 cases, MRI 21cases; demonstrates periosteal reaction:X-ray plain film 15 cases,CT 18 cases, MRI0 cases; demonstrates increased density of marrow cavity:X-ray plain film 11 cases,CT 16 cases,MRI 24 cases; demonstrates thickening of bone cortex: X-ray plain film 10 cases,CT 14 cases,MRI 18 cases. Conclusions MRI helps a lot in early diagnosis and differential diagnosis of atypical pyogenic osteomyelitis, whereas X-ray plain radiography is still the basis of each diagnosis. X-ray, CT with MR imaging is an important means in the early diagnosis and differential diagnosis of atypical pyogenic osteomyelitis. Atypical imaging findings of chronic osteomyelitis is not typical, misdiagnosis rate was relatively high, awareness of the clinical and imaging findings can improve the level of diagnosis

  12. Technetium bone scanning as an aid in the diagnosis of atypical acute osteomyelitis in children

    Energy Technology Data Exchange (ETDEWEB)

    Letts, R.M.; Afifi, A.; Sutherland, J.B.

    1975-06-01

    Technetium bone scanning is a simple, safe and accurate method for the diagnosis of acute osteomyelitis in children whose presenting clinical findings are atypical of bone infection. Bone scanning was effective in the localization of the exact site of osteomyelitis, thus facilitating needle aspiration as well as subsequent surgical decompression. Technetium bone scanning is a diagnostic technique for determining bone infection in children who are unable to communicate adequately or in those whose signs have been modified by previous inadequate antibacterial therapy.

  13. Salmonella Osteomyelitis in Previously Healthy Children: Report of 4 Cases and Review of the Literature.

    Science.gov (United States)

    Tsagris, Vasileios; Vliora, Christianna; Mihelarakis, Ioannis; Syridou, Garyfallia; Pasparakis, Dimitrios; Lebessi, Evangelia; Tsolia, Maria

    2016-01-01

    Salmonella osteomyelitis in children is an uncommon condition, typically associated with hemoglobinopathies or other underlying disorders. Only few cases have been reported in children without predisposing factors. We describe 4 cases of Salmonella osteomyelitis in otherwise healthy children. Since treatment duration is expected to be prolonged, the practice of direct inoculation of aspirates into blood culture bottles appears to be essential for diagnosis and targeted therapy.

  14. Anaerobic osteomyelitis of femoral head with intraosseous, intra-articular, bursal and muscle pneumatosis

    Energy Technology Data Exchange (ETDEWEB)

    Potocki, Jason [Department of Orthopaedic Surgery, Medical College of Virginia Hospital, Virginia Commonwealth University, PO Box 980257, Richmond, VA 23298-0615 (United States); Kaushik, Shaifali [Department of Radiology, Medical College of Virginia Hospital, Virginia Commonwealth University, 401 N 12th Street, 3-407A, PO Box 980615, Richmond, VA 23298-0615 (United States); Mira, Jose L. [Department of Pathology, Medical College of Virginia Hospital, Virginia Commonwealth University, PO Box 980662, Richmond, VA 23298-0662 (United States)

    2003-01-01

    A case is presented of anaerobic osteomyelitis with intraosseous pneumatosis resulting in extension of gas in soft tissue structures and femur in a patient with mitral valve vegetation and bacteremia. The finding of intraosseous pneumatosis and its extension into the hip joint, iliopsoas bursa and subgluteus medius bursa is depicted. Intraosseous pneumatosis is a rare but concerning finding for osteomyelitis in the absence of a penetrating wound, recent surgery, biopsy or fracture. (orig.)

  15. Conservative Surgery of Diabetic Forefoot Osteomyelitis: How Can I Operate on This Patient Without Amputation?

    Science.gov (United States)

    Aragón-Sánchez, Javier; Lázaro-Martínez, Jose L; Alvaro-Afonso, Francisco Javier; Molinés-Barroso, Raúl

    2015-06-01

    Surgery is necessary in many cases of diabetic foot osteomyelitis. The decision to undertake surgery should be based on the clinical presentation of diabetic foot osteomyelitis. Surgery is required when the bone is protruding through the ulcer, there is extensive bone destruction seen on x-ray or progressive bone damage on sequential x-ray while undergoing antibiotic treatment, the soft tissue envelope is destroyed, and there is gangrene or spreading soft tissue infection. Several issues should be taken into account when considering surgery for treating diabetic foot osteomyelitis. It is necessary to have a surgeon available with diabetic foot expertise. Regarding location of diabetic foot osteomyelitis, it is important to consider whether isolated bone or a joint is involved. In cases in which osteomyelitis is associated with a bone deformity, surgery should be able to correct this. The surgeon should always reflect about whether extensive/radical surgery could destabilize the foot. The forefoot is the most frequent location of diabetic foot osteomyelitis and is associated with better prognosis than midfoot and hindfoot osteomyelitis. Many surgical procedures can be performed in patients with diabetes and forefoot ulcers complicated by osteomyelitis while avoiding amputations. Performing conservative surgeries without amputations of any part of the foot is not always feasible in cases in which the infection has destroyed the soft tissue envelope. Attempting conservative surgery in such cases risks infected tissues remaining in the wound bed leading to failure. The election of different surgical options depends on the expertise of the surgeons selected for the multidisciplinary teams. It is the aim of this article to provide a sample of surgical techniques in order to remove the bone infection from the forefoot while avoiding amputations.

  16. Osteomyelitis caused by Pantoea agglomerans in a closed fracture in a child.

    Science.gov (United States)

    Labianca, Luca; Montanaro, Antonello; Turturro, Francesco; Calderaro, Cosma; Ferretti, Andrea

    2013-02-01

    Development of osteomyelitis in a closed fracture is rare. Although it has been reported that trivial trauma may be associated with the subsequent development of acute osteomyelitis, no evidence has been found that fractures are involved in the etiology of osteomyelitis. Only 25 cases (11 in adolescents) of osteomyelitis after closed fracture have been reported in literature. The authors report a case of osteomyelitis in an 8-year-old girl after a forearm fracture involving the diaphysis of the radius and ulna. Radiographic examinations were performed 5, 14, and 30 days after trauma. At last examination, the forearm appeared swollen and red. Blood culture and radiographs confirmed the clinical suspicion of osteomyelitis. The cultures grew Pantoea agglomerans, a saprophytic gram-negative bacterium commonly isolated from plants, flowers, seeds, water, and soil and sensitive to all of the most common antibiotics. After the arm was immobilized, high doses of intravenous antibiotics were administered for 4 weeks, and oral antibiotics were prescribed for an additional 4 weeks. The patient responded well to treatment. Twelve months after the initial injury, the patient regained full elbow and wrist flexion-extension range of motion. Based on their experience and a review of the literature, the authors suggest that bone infection be considered for patients with closed fractures complicated by excessive or prolonged pain and swelling with evident signs of inflammation where no other obvious infection is apparent. Moreover, in children, bacterial infection may cause osteomyelitis more frequently than in adults, but no evidence exists that a closed fracture increases the incidence of osteomyelitis in children with a systemic infection.

  17. Clivus osteomyelitis secondary to Enterococcus faecium infection in a 6-year-old girl.

    Science.gov (United States)

    Rusconi, R; Bergamaschi, S; Cazzavillan, A; Carnelli, V

    2005-09-01

    A 6-year-old girl was diagnosed to suffer from clivus osteomyelitis secondary to Enterococcus faecium infection. On the basis of the magnetic resonance image, the abscess was drained via the posterior wall of the pharyngeal tract immediately. Subsequent antibiotic therapy allowed rapid improvement and long-term healing of the osteomyelitic process without any side effect. Osteomyelitis or abscess of the clivus is very rare in adult patients and extremely rare in children. Some etiopathogenetic hypotheses are discussed in this case.

  18. Osteomyelitis or Charcot neuro-osteoarthropathy? Differentiating these disorders in diabetic patients with a foot problem

    OpenAIRE

    Bulent M. Ertugrul; Lipsky, Benjamin A.; Savk, Oner

    2013-01-01

    Both osteomyelitis and Charcot neuro-osteoarthropathy (CN) are potentially limb-threatening complications of diabetic neuropathy, but they require quite different treatments. Almost all bone infections in the diabetic foot originate from an infected foot ulcer while diabetic osteoarthropathy is a non-infectious process in which peripheral neuropathy plays the critical role. Differentiating between diabetic foot osteomyelitis and CN requires careful evaluation of the patient, including the med...

  19. Diabetic foot infections with osteomyelitis: efficacy of combined surgical and medical treatment

    OpenAIRE

    Widatalla, AbuBakr H. H.; Mahadi, Seif ElDin I.; Shawer, Mohamed A.; Mahmoud, Shadad M.; Abdelmageed, A.E.; Ahmed, Mohamed ElMakki

    2012-01-01

    Diabetic foot infections are a high risk for lower extremity amputation in patients with dense peripheral neuropathy and/or peripheral vascular disease. When they present with concomitant osteomyelitis, it poses a great challenge to the surgical and medical teams with continuing debates regarding the treatment strategy. A cohort prospective study conducted between October 2005 and October 2010 included 330 diabetic patients with osteomyelitis mainly involving the forefoot (study group) and 1,...

  20. Micro-CT analyses of historical bone samples presenting with osteomyelitis

    Energy Technology Data Exchange (ETDEWEB)

    Lamm, C.; Pietschmann, P. [Medical University Vienna (MUV), Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Vienna (Austria); Dockner, M.; Weber, G.W. [University of Vienna, Department of Anthropology, Vienna (Austria); University of Vienna, Core Facility for Micro-Computed Tomography, Vienna (Austria); Pospischek, B.; Winter, E.; Patzak, B. [Museum of Natural History (NHM), Collection of Anatomical Pathology in the Madhouse Tower, Vienna (Austria); Pretterklieber, M. [Medical University of Vienna (MUV), Department of Applied Anatomy, Vienna (Austria)

    2015-10-15

    Osteomyelitis is an inflammation of the bone marrow mainly caused by bacteria such as Staphylococcus aureus. It typically affects long bones, e.g. femora, tibiae and humeri. Recently micro-computed tomography (μCT) techniques offer the opportunity to investigate bone micro-architecture in great detail. Since there is no information on long bone microstructure in osteomyelitis, we studied historic bone samples with osteomyelitis by μCT. We investigated 23 femora of 22 individuals suffering from osteomyelitis provided by the Collection of Anatomical Pathology, Museum of Natural History, Vienna (average age 44 ±19 years); 9 femora from body donors made available by the Department of Applied Anatomy, Medical University of Vienna (age range, 56-102 years) were studied as controls. Bone microstructure was assessed by μCT VISCOM X 8060 II with a minimal resolution of 18 μm. In the osteomyelitic femora, most prominent alterations were seen in the cortical compartment. In 71.4 % of the individuals with osteomyelitis, cortical porosity occurred. 57.1 % of the individuals showed cortical thinning. In 42.9 % trabecularisation of cortical bone was observed. Osteomyelitis is associated with severe alterations of cortical bone structure otherwise typically observed at old age such as cortical porosity and cortical thinning. (orig.)

  1. Predictors of Outcomes in Diabetic Foot Osteomyelitis Treated Initially With Conservative (Nonsurgical) Medical Management: A Retrospective Study

    OpenAIRE

    Zeun, P.; Gooday, C.; Nunney, I.; Dhatariya, K

    2016-01-01

    The optimal way to manage diabetic foot osteomyelitis remains uncertain, with debate in the literature as to whether it should be managed conservatively (ie, nonsurgically) or surgically. We aimed to identify clinical variables that influence outcomes of nonsurgical management in diabetic foot osteomyelitis. We conducted a retrospective study of consecutive patients with diabetes presenting to a tertiary center between 2007 and 2011 with foot osteomyelitis initially treated with nonsurgical m...

  2. [Psoas abscess and lumbar spine osteomyelitis: case report].

    Science.gov (United States)

    Silva, Ana M; Schmalbach, Lauwence A

    2016-10-01

    Psoas abscess is a common disease in children. It can have a nonspecific clinical presentation, insidious onset and sometimes fever. The most common type in children is the primary one; however, it can sometimes be of secondary origin and associated with severe infections such as osteomyelitis so a high index of suspicion is required to detect and treat it promptly. We present an unusual case of psoas abscess with infiltration of the vertebral body of L2 in a 14 year old male patient previously healthy with no history of trauma or fever on admission. X-ray and ultrasound were performed but the diagnosis was confirmed by magnetic resonance imaging of the lumbosacral spine. With positive blood cultures for methicillin-resistant Staphylococcus aureus he completed 2 weeks of intravenous antibiotic therapy and 4 weeks of oral antibiotic therapy with blood cultures negativization and resolution of symptoms.

  3. Skull Base Osteomyelitis in the Emergency Department: A Case Report

    Directory of Open Access Journals (Sweden)

    Mustafa Burak Sayhan

    2011-01-01

    Full Text Available Skull base osteomyelitis (SBO is a rare clinical presentation and usually occurs as a complication of trauma or sinusitis. A 5-year-old child presented to the emergency department with a three-week history of fever associated with drowsiness and left parietal headache, and a week's history of swelling on the left frontoparietal soft tissue. He had suffered a penetrating scalp injury four month ago. On physical examination, there was a tender swelling with purulent stream on the lateral half of his scalp. His vital signs are within normal limits. Plain X-ray of the skull showed a lytic lesion on the left frontoparietal bone. A cranial computed tomography (CT scan demonstrated a large subgaleal abscess at the left frontoparietal region. SBO possesses a high morbidity and mortality; therefore, prompt diagnosis and appropriate treatment are mandatory to prevent further complications and to reduce morbidity and mortality significantly.

  4. Septic Arthritis and Osteomyelitis Caused by Pasteurella multocida.

    Science.gov (United States)

    Vranis, Neil; Paryavi, Ebrahim; Christian, Matthew; Joshi, Manjari; Pensy, Raymond A

    2015-07-01

    This report presents a case of progressive septic arthritis and osteomyelitis caused by a rare pathogen, Pasteurella multocida, thought to be provoked by the use of systemic corticosteroids. Despite initial improvement after antibiotics and surgical procedure, the patient returned with new, associated symptoms 1 month later. This concurrent set of circumstances leading to a life-threatening condition has not been reported, to the best of our knowledge. Physicians aware of such a case will be better prepared to diagnose, treat, and educate their patients. Additionally, the diagnostic challenge presented by this case report emphasizes the need for vigilance and thoroughness in obtaining histories from patients presenting with seemingly benign complaints, especially in vulnerable populations, such as infants, pregnant women, and immunocompromised adults.

  5. Severe maxillary osteomyelitis in a Gray Wolf (Canis lupus)

    Science.gov (United States)

    Barber-Meyer, Shannon

    2012-01-01

    Dental injuries to or abnormalities in functionally important teeth and associated bones in predators may significantly reduce the ability to kill and consume prey (Lazar et al. 2009). This impairment is likely exacerbated in coursing predators, such as Gray Wolves, that bite and hold onto fleeing and kicking prey with their teeth. Damage to carnassials (upper fourth premolar, P4, and lower first molar, M1) and associated bones in Gray Wolves may especially inhibit the consumption of prey because these teeth slice meat and crush bone. Here I report maxillary osteomyelitis involving the carnassials in a wild Gray Wolf from northeastern Minnesota of such severity that I hypothesize it ultimately caused the Gray Wolf to starve to death.

  6. Diagnosing osteomyelitis: evaluation and significance of multiple tracer bone imaging

    Energy Technology Data Exchange (ETDEWEB)

    Quinn, W.B.; Graebner, J.E.; Arenson, D.J.

    The use of various radioactive compounds in the diagnosis of osteomyelitis has been the topic of discussion by numerous authors. A great number of bone imaging agents have been experimented with and clinically applied with varying results. It is the intention of this article to detail and compare the use of two such agents: technetium-99m phosphonate, a phosphorus compound radioactively labeled with an isotope of technetium, and gallium citrate 67, a radioactive isotope of gallium. Both of these materials have specific indications and limitations. However, used in the proper setting, either singularly or in conjunction, they give the clinician precise information about pathologic processes. It is the clinician's careful interpretation of both positive and negative test results that enables him to make proper diagnosis and thus institute appropriate therapy.

  7. "Neonatal septic arthritis and osteomyelitis. Evaluation of risk factors "

    Directory of Open Access Journals (Sweden)

    Nili F

    2001-11-01

    Full Text Available Neonatal septic arthritis and osteomyelitis is not prevalent in first month of the life in new borne children. According to anatomic specifications of bones in this period, the manifestation of disease is different from other periods of life and the disability induced, will be serious and permanent. In this investigation, 31 infants with the diagnosis of septic arthritis and osteomyelitis were studied during 10 years. Hyperbilirubinemia (58.1 percent, emergency cesarean (25.8 percent, umbilical vessel catheterization (26.6 percent, permaturity (12.9 percent, perinatal asphyxia (9.7 percent, scalp laceration (6.5 percent, omphalitis & previous bone fracture (6.5 percent were the most common findings among predisposing factors. Previous hospital admission was detected in 19 patients (67.3 percent and multiple bone involvements demonstrated in 12 (38.7 percent. From those who had risk factors, 42.3 percent had multiple bone lesions. Only 5 patients (16.12 percent had no predisposing factors. The mean age for diagnosis and seeking admission were 23 and 30 days respectively and the mean age of diagnosis at surgery was over 72 hours in 15 (48.38 percent cases. All with delaying in requesting admission had destructive changes in their joints. Knee and hip were most involved (77.3 percent. The most common microorganisms found in this study were staphylococcus aureus and klebsiella. Of all, 47 percent were gram negative & 53 percent gram positive microorganisms. Existence of risk factors and previous hospital admission in the majority of cases accompanied by microorganisms such as methiciline resistant S.aureus and klebsiella as a causative agents who were also resistant to empirical antibiotics demonstrated the role of nosocomial infections as an important cause of infection.

  8. Combining in vitro protein detection and in vivo antibody detection identifies potential vaccine targets against Staphylococcus aureus during osteomyelitis.

    Science.gov (United States)

    den Reijer, P Martijn; Sandker, Marjan; Snijders, Susan V; Tavakol, Mehri; Hendrickx, Antoni P A; van Wamel, Willem J B

    2017-02-01

    Currently, little is known about the in vivo human immune response against Staphylococcus aureus during a biofilm-associated infection, such as osteomyelitis, and how this relates to protein production in biofilms in vitro. Therefore, we characterized IgG responses in 10 patients with chronic osteomyelitis against 50 proteins of S. aureus, analyzed the presence of these proteins in biofilms of the infecting isolates on polystyrene (PS) and human bone in vitro, and explored the relation between in vivo and in vitro data. IgG levels against 15 different proteins were significantly increased in patients compared to healthy controls. Using a novel competitive Luminex-based assay, eight of these proteins [alpha toxin, Staphylococcus aureus formyl peptide receptor-like 1 inhibitor (FlipR), glucosaminidase, iron-responsive surface determinants A and H, the putative ABC transporter SACOL0688, staphylococcal complement inhibitor (SCIN), and serine-aspartate repeat-containing protein E (SdrE)] were also detected in a majority of the infecting isolates during biofilm formation in vitro. However, 4 other proteins were detected in only a minority of isolates in vitro while, vice versa, 7 proteins were detected in multiple isolates in vitro but not associated with significantly increased IgG levels in patients. Detection of proteins was largely confirmed using a transcriptomic approach. Our data provide further insights into potential therapeutic targets, such as for vaccination, to reduce S. aureus virulence and biofilm formation. At the same time, our data suggest that either in vitro or immunological in vivo data alone should be interpreted cautiously and that combined studies are necessary to identify potential targets.

  9. 灌洗疗法治疗小儿急性骨髓炎%Irrigation Therapy for Acute Osteomyelitis

    Institute of Scientific and Technical Information of China (English)

    张锡庆; 朱锦祥; 杨震; 徐洪军; 徐明山

    1985-01-01

    Infection of bone and joint is a common and severe disease in infants and children,usually complicated by cardiac and pulmonic infections.Delayed diagnosis and inadequate treatment may lend to chronic osteomyelitis with poor prognosis.During the years from 1980 to 1983,29 cases were treated by irrigation method in our hospital with a cure-rate of 86.2%.Treatment of complications is discussed.Early irrigation therapy can be applied where complicating unilateral osteomyelitis occurs at the upper end of the femur.In case the femoral neck has been damaged,irrigation of the area with the help of curet rage will help restore the function of the hip joint.When complicating cardiac and pulmonic infections are present,operation should be postponed till the patient's condition becomes stable under medical treatment.Needle aspiration is helpful in early diagnosis.Antibiotics should be given for 6-8 weeks postoperatively.Technique of irrigation is also described.%@@ 骨与关节化脓性感染,在婴幼儿是一种常见而严重的疾患,常因合并脓毒败血症或心肺感染而引起严重后果,或因延迟诊断致治疗不当而转为慢性,影响小儿生长发育造成畸形.近年来,我们采用灌洗疗法治疗急性骨髓炎取得良好效果,1980~1983年共治疗29例,本文就急性血源性骨髓炎20例作一初步小结.

  10. Decreased TFR/TFH ratio in SIV-infected rhesus macaques may contribute to accumulation of TFH cells in chronic infection

    Science.gov (United States)

    Chowdhury, Ankita; Estrada Del Rio, Perla Maria; Tharp, Greg K; Trible, Ronald P; Amara, Rama R; Chahroudi, Ann; Reyes-Teran, Gustavo; Bosinger, Steven E.; Silvestri, Guido

    2015-01-01

    T follicular helper cells (TFH) are critical for the development and maintenance of germinal centers (GC) and humoral immune responses. During chronic HIV/SIV infection TFH accumulate, possibly as a result of antigen persistence. The HIV/SIV-associated TFH expansion may also reflect lack of regulation by suppressive follicular regulatory CD4+ T-cells (TFR). TFR are natural regulatory T-cells (TREG) that migrate into the follicle and, similarly to TFH, up-regulate CXCR5, Bcl-6, and PD1. Here we identified TFR as CD4+CD25+FoxP3+CXCR5+PD1hiBcl-6+ within lymph nodes of rhesus macaques (RM) and confirmed their localization within the GC by immunohistochemistry. RNA sequencing showed that TFR exhibit a distinct transcriptional profile with shared features of both TFH and TREG, including intermediate expression of FoxP3, Bcl-6, PRDM1, IL-10, and IL-21. In healthy, SIV-uninfected RM, we observed a negative correlation between frequencies of TFR and both TFH and GC B-cells as well as levels of CD4+ T-cell proliferation. Following SIV infection, the TFR/TFH ratio was reduced with no change in the frequency of TREG or TFR within the total CD4+ T-cell pool. Finally, we examined whether higher levels of direct virus infection of TFR were responsible for their relative depletion post-SIV infection. We found that TFH, TFR and TREG sorted from SIV- infected RM harbor comparable levels of cell-associated viral DNA. Our data suggests that TFR may contribute to the regulation and proliferation of TFH and GC B-cells in vivo and that a decreased TFR/TFH ratio in chronic SIV infection may lead to unchecked expansion of both TFH and GC B-cells. PMID:26297764

  11. Difficult situations managing diabetic foot. Evidences and personal views: is to operate on patients with diabetic foot osteomyelitis old-fashioned?

    Science.gov (United States)

    Senneville, Eric; Nguyen, Sophie

    2014-12-01

    Both medical and surgical approaches have been shown to be effective in the treatment of patients with diabetic foot osteomyelitis (DFO). In patients with risk factors of bad outcome such as major bone destruction, concomitant acute infections requiring drainage, problems in limb perfusion, highly resistant bacteria, and contraindication for or patient refusal of prolonged antibiotic therapy, the choice of surgery does not require further discussion. On the contrary, modest changes of bone on imaging assessment and no limiting factors as described above make medical treatment an attractive option for patients with DFO provided the rules of antibiotic treatment of chronic osteomyelitis are respected. The key question may not be to oppose surgery and medical treatment but to identify patients who need surgery and those who do not. There is currently no classification or score system that may allow physician to decide whether medical or surgical approach is best adapted to a given patient, and so both experience and skill of the multidisciplinary team appear paramount for guiding the choice of the best adapted ("tailored") strategy in a given patient. In this regard, it would be interesting to compare surgical and medical approaches for DFO that apparently may benefit from one or another (ie, bone lesions seen on plain radiographs of the foot but without bone fragmentation or multiple sites of osteomyelitis, no contraindication to prolonged antibiotic therapy, and location of bone involvement that may allow conservative surgery). Given the current available data on the therapeutic options of DFO, it appears that surgery for those patients is obviously not an old-fashioned option.

  12. Differential contributions of STAT5A and STAT5B to stress protection and tyrosine kinase inhibitor resistance of chronic myeloid leukemia stem/progenitor cells.

    Science.gov (United States)

    Casetti, Luana; Martin-Lannerée, Séverine; Najjar, Imen; Plo, Isabelle; Augé, Sylvie; Roy, Lydia; Chomel, Jean-Claude; Lauret, Evelyne; Turhan, Ali G; Dusanter-Fourt, Isabelle

    2013-04-01

    STAT5 fulfills essential roles in hematopoietic stem cell (HSC) self-renewal and chronic myeloid leukemia (CML), a prototypical stem cell malignancy. However, the specific contributions of the two related genes STAT5A and STAT5B have not been determined. In this study, we used a RNAi-based strategy to establish participation of these genes to CML disease and persistence following targeted therapy. We showed that STAT5A/STAT5B double-knockdown triggers CML cell apoptosis and suppresses both normal and CML HSC long-term clonogenic potential. STAT5A and STAT5B exhibited similar prosurvival activity, but STAT5A attenuation alone was ineffective at impairing growth of normal and CML CD34(+) cells isolated at diagnosis. In contrast, STAT5A attenuation was sufficient to enhance basal oxidative stress and DNA damage of normal CD34(+) and CML cells. Furthermore, it weakened the ability to manage exogenous oxidative stress, increased p53 (TRP53)/CHK-2 (CHEK2) stress pathway activation, and enhanced prolyl hydroxylase domain (PHD)-3 (EGLN3) mRNA expression. Only STAT5A and its transactivation domain-deficient mutant STAT5AΔ749 specifically rescued these activities. STAT5A attenuation was also active at inhibiting growth of CML CD34(+) cells from patients with acquired resistance to imatinib. Our findings show that STAT5A has a selective role in contributing to stress resistance through unconventional mechanisms, offering new opportunities to eradicate the most primitive and tyrosine kinase inhibitor-resistant CML cells with an additional potential to eradicate persistent stem cell populations.

  13. Reproducibility of arterial stiffness and wave reflections in chronic obstructive pulmonary disease: the contribution of lung hyperinflation and a comparison of techniques.

    Science.gov (United States)

    Stone, Ian S; John, Leonette; Petersen, Steffen E; Barnes, Neil C

    2013-11-01

    Significant cardiovascular morbidity and mortality exists in chronic obstructive pulmonary disease (COPD). Arterial stiffness is raised in COPD and may be a mechanistic link. Non-invasive assessment of arterial stiffness has the potential to be a surrogate outcome measure, although no reproducibility data exists in COPD patients. Two studies (23 and 33 COPD patients) were undertaken to 1) assess the Vicorder reproducibility of carotid-femoral pulse wave velocity and Augmentation index in COPD; 2) compare it to SphygmoCor; and 3) assess the contribution of lung hyperinflation to measurement variability. There were excellent correlations and good agreement between repeat Vicorder measurements for carotid-femoral pulse wave velocity (r = 0.96 (p lung hyperinflation (as measured by residual volume percent predicted, total lung capacity percent predicted or the ratio of inspiratory capacity to residual volume) and variability of measurements in either study. In COPD, measurement of carotid-femoral pulse wave velocity is highly reproducible, not affected by lung hyperinflation and suitable as a surrogate endpoint in research studies. Day-to-day variation in augmentation index highlights the importance of such studies prior to the planning and undertaking of clinical COPD research.

  14. Anatomical and Patholog ical Basis for the Classification of Acute Hematogenous Osteomyelitis in Children%小儿急性血源性骨髓炎分型的病理解剖学基础

    Institute of Scientific and Technical Information of China (English)

    吉士俊; 纪树荣; 刘卫东; 周永德

    1986-01-01

    @@ Calandruccio将小儿急性血源性骨髓炎分为婴儿型与儿童型~((1)),但其命名不够确切,临床特点及病理解剖学基础缺乏详尽阐述.本文结合我院近年来85例急性骨髓炎1~10年随访资料,分为急性骨骺骨髓炎和急性骨干骨髓炎两型,并从小儿骺板成熟前后的骨骼解剖特点探讨两型的临床、病理的区别,以及临床意义.%Acute osteomyelitis in children shoud be divided into anepiphyseal type and a diaphyseal type according to the material that we obtained through following up 85 cases with acute osteomyelitis.Both of types have an obvious difference in affected age,region,clinical features,incidence of chronic osteomyelitis and residual deformities,The classification is based on whether the epiphysis was affected or not.The pathological development of two types are stated depending on the anatomical characteristics before and after maturing ration of epiphysis,It is very important that the epiphyseal csteomyelitis be early diagn osed.It can prevent severe residual deformities caused by the epiphysis being destroyed.

  15. Osteomielitis vertebral piógena Pyogenic vertebral osteomyelitis

    Directory of Open Access Journals (Sweden)

    Pedro P. Perrotti

    2009-10-01

    Full Text Available La osteomielitis vertebral piógena (OVP es una localización poco frecuente (2-7% Se confirma con el aislamiento de un microorganismo de una vértebra, disco intervertebral, absceso epidural o paravertebral. Se describe una serie de casos por la infrecuente presentación de esta enfermedad, que puede ser consulta inicial en los servicios de clínica médica y por su sintomatología inespecífica que supone una dificultad diagnóstica. Tanto la columna lumbar como la dorsal fueron los sitios más afectados. El dolor dorsolumbar y la paraparesia fueron los síntomas más frecuentes de presentación. En ocho pacientes se aislaron Staphylococcus aureus, en uno Escherichia coli y en el restante Haemophylus sp. Se observó leucocitosis sólo en tres pacientes, y en dos velocidad de sedimentación globular mayor de 100 mm/h. Los diez pacientes presentaron imágenes características de osteomielitis vertebral piógena en la resonancia nuclear magnética. Dentro de las complicaciones, los abscesos paravertebrales y epidurales fueron los más frecuentes (en cinco enfermos. Además, un paciente presentó empiema pleural. De los diez pacientes de esta serie, siete recibieron inicialmente tratamiento médico empírico y luego específico para el germen aislado. En los restantes el tratamiento fue guiado de acuerdo al antibiograma. A dos enfermos fue necesario realizarles laminectomía descompresiva por compromiso de partes blandas y a otros dos estabilización quirúrgica por inestabilidad espinal, observándose buena evolución en todos los casos. Esta serie demuestra que, ante un paciente con dolor dorsolumbar y síntomas neurológicos se deberá tener en cuenta esta entidad para evitar un retraso en el tratamiento.Pyogenic osteomyelitis seldom affects the spine (2-7%. It is diagnosed by the isolation of a bacterial agent in the vertebral body, the intervertebral disks or from paravertebral or epidural abscesses. We report a retrospective study of ten

  16. Temporal bone osteomyelitis: the relationship with malignant otitis externa, the diagnostic dilemma, and changing trends.

    Science.gov (United States)

    Chen, Jia-Cheng; Yeh, Chien-Fu; Shiao, An-Suey; Tu, Tzong-Yang

    2014-01-01

    Fifty-five patients hospitalized for osteomyelitis of the temporal bone between 1990 and 2011 were divided into two study groups: group 1 was patients collected from 1990 to 2001 and group 2 was composed of patients between 2002 and 2011. Clinical diagnostic criteria and epidemiologic data were analyzed to illustrate the altering features of osteomyelitis of the temporal bone. Group 1 patients were characterized by high prevalence of diabetes and more commonly suffered from otalgia, otitis externa and granulation tissue in the external auditory canal and higher positive culture for Pseudomonas aeruginosa. Noticeable changing trends were found between both groups, including declining prevalence of diabetes, fewer patients complaining of pain or presenting with otitis externa, and canal granulation, and increased variety of pathogens in group 2. We should highlight the index of clinical suspicion for osteomyelitis of the temporal bone, even in nondiabetic or immunocompetent patients. Painless otorrhea patients were also at risk of osteomyelitis of the temporal bone, especially patients with previous otologic operation. Increased multiplicity of pathogens amplified the difficulty of diagnosis for osteomyelitis of the temporal bone.

  17. Temporal Bone Osteomyelitis: The Relationship with Malignant Otitis Externa, the Diagnostic Dilemma, and Changing Trends

    Directory of Open Access Journals (Sweden)

    Jia-Cheng Chen

    2014-01-01

    Full Text Available Fifty-five patients hospitalized for osteomyelitis of the temporal bone between 1990 and 2011 were divided into two study groups: group 1 was patients collected from 1990 to 2001 and group 2 was composed of patients between 2002 and 2011. Clinical diagnostic criteria and epidemiologic data were analyzed to illustrate the altering features of osteomyelitis of the temporal bone. Group 1 patients were characterized by high prevalence of diabetes and more commonly suffered from otalgia, otitis externa and granulation tissue in the external auditory canal and higher positive culture for Pseudomonas aeruginosa. Noticeable changing trends were found between both groups, including declining prevalence of diabetes, fewer patients complaining of pain or presenting with otitis externa, and canal granulation, and increased variety of pathogens in group 2. We should highlight the index of clinical suspicion for osteomyelitis of the temporal bone, even in nondiabetic or immunocompetent patients. Painless otorrhea patients were also at risk of osteomyelitis of the temporal bone, especially patients with previous otologic operation. Increased multiplicity of pathogens amplified the difficulty of diagnosis for osteomyelitis of the temporal bone.

  18. Herpes Zoster Induced Osteomyelitis in the Immunocompromised Patients: A 10-year Multicenter Study

    Directory of Open Access Journals (Sweden)

    Reza Tabrizi

    2014-09-01

    Full Text Available Statement of the Problem: Alveolar bone necrosis induced by Herpes zoster infection is considered as a rare manifestation of osteomyelitis and few case reports are presented in the literature. Purpose: The aim of this study was to evaluate mandibular osteomyelitis caused by herpes zoster in the immunocompromised patients with histopathologically documented osteomyelitis in the mandible and herpes zoster infection. Materials and Method: 30 patients were recruited in this cross-sectional study. 19 patients were completely edentulous, 4 patients were partially edentulous and 7 with complete dentition. In all cases, specimens were analyzed using a conventional polymerase chain reaction (PCR test for varicella zoster virus. Results: 16 patients underwent dialysis, 9 patients received chemotherapy treat-ments and 5 patients had transplantation (four kidneys and one liver. Histopa-thological assessment demonstrated a nonspecific bone necrosis exhibiting an eosinophilic, homogeneous non-vital bone tissue with peripheral resorption sur-rounded by reactive connective tissue. PCR test was positive in 21 cases. Conclusion: This study demonstrated that the frequency of osteomyelitis induced by herpes zoster could be more than the records provided by previous studies. Histopathological findings might be nonspecific in such patients. PCR test was not positive for all HZ induced osteomyelitis patients.

  19. Prolonged anti-bacterial activity of ion-complexed doxycycline for the treatment of osteomyelitis.

    Science.gov (United States)

    Oh, Se Heang; Nam, Bo Ra; Lee, In Soo; Lee, Jin Ho

    2016-01-01

    The main purposes of the present study are the fabrication of an ion-complexed antibiotic which allows for the continuous release of the drug for sufficient periods of time without any additional matrix leading to unfavorable tissue responses, and the feasibility study of the ion-complexed antibiotic as a therapeutic system for osteomyelitis using an animal model. An ion-complexed doxycycline (icDX) as an antibiotic was prepared by simple mixing of positively charged doxycycline hyclate (DX) and negatively charged multivalent Na2HPO4 (2Na(+) HPO4(2-)) aqueous solutions. The icDX showed a controlled release of the DX up to 6 weeks. From the in vivo feasibility study using an osteomyelitis rat model, the icDX group showed a more effective therapeutic effect for the osteomyelitis, at 3 and 6 weeks, compared to the non-treated control and free DX groups. This was due to the sustained release of DX from the icDX in the osteomyelitis bone (medullary cavity) without migration. These findings suggest that the icDX may be a promising local delivery system in the clinical field for the treatment of the osteomyelitis.

  20. Antibiotic-eluting hydrophilized PMMA bone cement with prolonged bactericidal effect for the treatment of osteomyelitis.

    Science.gov (United States)

    Oh, Eun Jo; Oh, Se Heang; Lee, In Soo; Kwon, Oh Soo; Lee, Jin Ho

    2016-05-01

    Osteomyelitis is still considered to be one of the major challenges for orthopedic surgeons despite advanced antiseptic surgical procedures and pharmaceutical therapeutics. In this study, hydrophilized poly(methyl methacrylate) (PMMA) bone cements containing Pluronic F68 (EG79PG28EG79) as a hydrophilic additive and vancomycin (F68-VAcements) were prepared to allow the sustained release of the antibiotic for adequate periods of time without any significant loss of mechanical properties. The compressive strengths of the bone cements with Pluronic F68 compositions less than 7 wt% were not significantly different compared with the control vancomycin-loaded bone cement (VAcement). TheF68 (7 wt%)-VAcement showed sustained release of the antibiotic for up to 11 weeks and almost 100% release from the bone cement. It also prohibited the growth ofS. aureus(zone of inhibition) over six weeks (the required period to treat osteomyelitis), and it did not show any notable cytotoxicity. From an animal study using a femoral osteomyelitis rat model, it was observed that theF68 (7 wt%)-VAcement was effective for the treatment of osteomyelitis, probably as a result of the prolonged release of antibiotic from the PMMA bone cement. On the basis of these findings, it can be suggested that the use of Pluronic F68 as a hydrophilic additive for antibiotic-eluting PMMA bone cement can be a promising strategy for the treatment of osteomyelitis.

  1. Neglected Foreign Body, the Cause of Navicular Osteomyelitis in A Paediatric Foot: A Case Report

    Directory of Open Access Journals (Sweden)

    Chandrashekara C.M

    2013-07-01

    Full Text Available Introduction: Foreign body injuries with date thorns, metal and wooden splinters are common in Middle East region, as most of it is desert. Some of the injuries lead to cellulitis or abscess formation, if neglected or improperly managed results in osteomyelitis or septic arthritis of foot structures. This is the first report of isolated navicular osteomyelitis following neglected foreign body in a paediatric foot. Case Report: A 10 year old male patient presented with discharging sinus in left mid-foot 3 years after penetrating injury with wooden splinter. The diagnosis of navicular osteomelitis is confirmed with plain radio-graphs. The ultrasound of foot was done to localize the foreign bodies. Patient was treated with complete removal of foreign body (wooden splinters, surgical debridement and combination of IV and oral cloxacillin for period of 6 weeks. At 18 months follow up, patient had painless foot with no recurrence or collapse of navicular bone. Conclusion: The neglected foreign body can result in osteomyelitis of small bones of foot in pediatric patient. The ultrasound is more useful tool in localizing foreign bodies; those are not radio-opaque. Early and prompt diagnosis with adequate treatment of established osteomyelitis by complete removal of foreign body, curettage and antibiotics can give good results. Keywords: Osteomyelitis; Navicular bone; Foreign body; Paediatric.

  2. [Osteomyelitis in cat scratch disease: a case report and literature review].

    Science.gov (United States)

    Dusser, P; Eyssette-Guerreau, S; Koné-Paut, I

    2013-06-01

    Cat scratch disease is the most common zoonosis in humans and its typical expression is a persistent benign regional adenopathy. In some rare cases, mono- or multifocal osteomyelitis is described. In this paper, we report the case of bone lesions in a 13-year-old girl infected with cat scratch disease. We have also undertaken a literature review and analyzed 60 other such cases. The manifestation of a bone lesion associated with cat scratch disease was characterized by a mono- or multifocal infectious osteomyelitis, fever, and a general alteration of the patient's health. The most frequent location of osteomyelitis was in the spine. Magnetic resonance imaging appeared the most sensitive test to highlight the bone lesions. Serological findings help reinforce the diagnosis of cat scratch disease caused by Bartonella henselae infection. Osteomyelitis in cat scratch disease is rare but not exceptional. Therefore, it is essential to think about this hypothesis in case of osteomyelitis associated with a general alteration of the patient's health, especially if the lesions are multifocal and if there is a known history of cat contact.

  3. An Uncommon Feature of Chronic Granulomatous Disease in a Neonate

    Directory of Open Access Journals (Sweden)

    Razieh Afrough

    2016-01-01

    Full Text Available Chronic Granulomatous Disease (CGD represents recurrent life-threatening bacterial and fungal infections and granuloma formation with a high mortality rate. CGD’s sign and symptoms usually appear in infancy and children before the age of five; therefore, its presentation in neonatal period with some uncommon features may be easily overlooked. Here we describe a case of CGD in a 24-day-old boy, presenting with a diffuse purulent vesiculopustular rash and multiple osteomyelitis.

  4. Improving diagnostic criteria for Propionibacterium acnes osteomyelitis: a retrospective analysis.

    Science.gov (United States)

    Asseray, Nathalie; Papin, Christophe; Touchais, Sophie; Bemer, Pascale; Lambert, Chantal; Boutoille, David; Tequi, Brigitte; Gouin, François; Raffi, François; Passuti, Norbert; Potel, Gilles

    2010-07-01

    The identification of Propionibacterium acnes in cultures of bone and joint samples is always difficult to interpret because of the ubiquity of this microorganism. The aim of this study was to propose a diagnostic strategy to distinguish infections from contaminations. This was a retrospective analysis of all patient charts of those patients with >or=1 deep samples culture-positive for P. acnes. Every criterion was tested for sensitivity, specificity, and positive likelihood ratio, and then the diagnostic probability of combinations of criteria was calculated. Among 65 patients, 52 (80%) were considered truly infected with P. acnes, a diagnosis based on a multidisciplinary process. The most valuable diagnostic criteria were: >or=2 positive deep samples, peri-operative findings (necrosis, hardware loosening, etc.), and >or=2 surgical procedures. However, no single criterion was sufficient to ascertain the diagnosis. The following combinations of criteria had a diagnostic probability of >90%: >or=2 positive cultures + 1 criterion among: peri-operative findings, local signs of infection, >or=2 previous operations, orthopaedic devices; 1 positive culture + 3 criteria among: peri-operative findings, local signs of infection, >or=2 previous surgical operations, orthopaedic devices, inflammatory syndrome. The diagnosis of P. acnes osteomyelitis was greatly improved by combining different criteria, allowing differentiation between infection and contamination.

  5. Histone 3.3 Participates in a Self-Sustaining Cascade of Apoptosis That Contributes to the Progression of Chronic Obstructive Pulmonary Disease

    Science.gov (United States)

    Barrero, Carlos A.; Perez-Leal, Oscar; Aksoy, Mark; Moncada, Camilo; Ji, Rong; Lopez, Yolanda; Mallilankaraman, Karthik; Madesh, Muniswamy; Criner, Gerard J.; Kelsen, Steven G.

    2013-01-01

    Rationale: Shifts in the gene expression of nuclear protein in chronic obstructive pulmonary disease (COPD), a progressive disease that is characterized by extensive lung inflammation and apoptosis, are common; however, the extent of the elevation of the core histones, which are the major components of nuclear proteins and their consequences in COPD, has not been characterized, which is important because extracellular histones are cytotoxic to endothelial and airway epithelial cells. Objectives: To investigate the role of extracellular histones in COPD disease progression. Methods: We analyzed the nuclear lung proteomes of ex-smokers with and without the disease. Further studies on the consequences of H3.3 were also performed. Measurements and Main Results: A striking finding was a COPD-specific eightfold increase of hyperacetylated histone H3.3. The hyperacetylation renders H3.3 resistant to proteasomal degradation despite ubiquitination; when combined with the reduction in proteasome activity that is known for COPD, this resistance helps account for the increased levels of H3.3. Using anti-H3 antibodies, we found H3.3 in the airway lumen, alveolar fluid, and plasma of COPD samples. H3.3 was cytotoxic to lung structural cells via a mechanism that involves the perturbation of Ca2+ homeostasis and mitochondrial toxicity. We used the primary human airway epithelial cells and found that the antibodies to either the C or N terminus of H3 could partially reverse H3.3 toxicity. Conclusions: Our data indicate that there is an uncontrolled positive feedback loop in which the damaged cells release acetylated H3.3, which causes more damage, adds H3.3 release, and contributes toward the disease progression. PMID:23924319

  6. Osteomyelitis pubis caused by Kingella kingae in an adult patient: Report of the first case

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    Wilmes Dunja

    2012-10-01

    Full Text Available Abstract Background Kingella kingae is the second most common pathogen causing paediatric arthritis and is described to be the causative bacteria in some paediatric osteomyelitis. Its microbiological detection is particularly difficult due to its slow growing. To our best knowledge this is the first case description of osteomyelitis pubis caused by this microorganism. Case presentation We report the unusual case of pubic osteomyelitis with soft tissue abcess caused by Kingella kingae in an adult patient of 66 years with a history of end-stage renal disease and breast carcinoma. Diagnosis was based on imaging and the microorganism was isolated from Computed Tomography-guided aspiration of synovial fluid. The infection resolved completely after twelve weeks of treatment with oral amoxicillin. Conclusion This case description highlights the importance in osteoarticular infections of systematic inoculation of synovial liquid in BACTEC vials to optimise the detection of causative organisms, which can necessitate specific treatments.

  7. Pelvic osteomyelitis in a 15-year-old girl: case report.

    Science.gov (United States)

    Tural Kara, Tugce; Ozdemir, Halil; Fitoz, Suat; Ciftci, Ergin; Ince, Erdal

    2016-10-01

    Pelvic osteomyelitis is a rare infection. Ilium, ischium, pubis and acetabulum are commonly affected sites. Pelvic radiography, pelvic magnetic resonance and scintigraphy are useful imaging techniques for diagnosis. However, diagnoses should be confirmed with bone biopsy from the lesion. Sometimes diagnosis is delayed because of deep localization of infection site. Here in, we report a 15-year-old girl with left groin pain who was diagnosed as pelvic osteomyelitis one month after initial symptoms. Patient was successfully treated with antibiotics for 8 weeks. In conclusion, although pelvic osteomyelitis is an unusual infection in childhood, it should be considered as differential diagnoses of pain in groin, hips, thigh, abdomen and spine. If diagnosis is suspicious, empiric treatment should be started quickly, because it will be possible to achieve satisfactory clinical results with effective treatment.

  8. Pathological fracture of the right distal radius caused by Enterobacter aerogenes osteomyelitis in an adult.

    Science.gov (United States)

    Lin, Te-Yu; Chi, Hung-Wei; Wang, Ning-Chi

    2010-05-01

    A pathological fracture is a break in a diseased bone caused by weakening of the bone structure by a pathological process with no identifiable trauma. Acute bacterial osteomyelitis that results in pathological fractures in the extremities is rare in adults. To our knowledge, we report the first case of Enterobacter aerogenes osteomyelitis of the right distal radius, complicated with a pathological fracture, in a 79-year-old man with diabetes, which was diagnosed by radiological, microbiological, and histopathological examinations. He recovered well after an 8-week course of antibiotics and surgical debridement. This highlights the fact that radial osteomyelitis should be included in the differential diagnosis when an elderly diabetic patient with no history of trauma presents with pain in the forearm.

  9. Osteomyelitis and infarction in sickle cell hemoglobinopathies: differentiation by combined technetium and gallium scintigraphy

    Energy Technology Data Exchange (ETDEWEB)

    Amundsen, T.R.; Siegel, M.J.; Siegel, B.A.

    1984-12-01

    Clinical records and scintigrams were reviewed of 18 patients with sickle cell hemoglobinophaties who had undergone combined technetium and gallium scintigraphy during 22 separate episodes of suspected osseous infection. The combined scintigrams were correctly interpreted as indicating osteomyelitis in four studies. Of 18 studies in patients with infarction, the combined scintigrams were correctly interpreted in 16 and showed either no local accumulation of Ga-67 or less accumulation than that of Tc-99m MDP at symptomatic sites. In the other two studies, the scintigrams were falsely interpreted as indicating osteomyelitis and showed congruent, increased accumulation of both Tc-99, MDP and Ga-67. This pattern must be considered indeterminate. Overall, the results indicate that the combination of technetium and gallium scintigraphy is an effective means to distinguish osteomyelitis from infarction in patients with sickle cell hemoglobinopathies.

  10. Update on the Management of Pediatric Acute Osteomyelitis and Septic Arthritis

    Directory of Open Access Journals (Sweden)

    Luca Castellazzi

    2016-06-01

    Full Text Available Acute osteomyelitis and septic arthritis are two infections whose frequencies are increasing in pediatric patients. Acute osteomyelitis and septic arthritis need to be carefully assessed, diagnosed, and treated to avoid devastating sequelae. Traditionally, the treatment of acute osteoarticular infection in pediatrics was based on prolonged intravenous anti-infective therapy. However, results from clinical trials have suggested that in uncomplicated cases, a short course of a few days of parenteral antibiotics followed by oral therapy is safe and effective. The aim of this review is to provide clinicians an update on recent controversies and advances regarding the management of acute osteomyelitis and septic arthritis in children. In recent years, the emergence of bacterial species resistant to commonly used antibiotics that are particularly aggressive highlights the necessity for further research to optimize treatment approaches and to develop new molecules able to fight the war against acute osteoarticular infection in pediatric patients.

  11. Orbital necrotizing fasciitis and osteomyelitis caused by arcanobacterium haemolyticum: a case report.

    Science.gov (United States)

    Stone, Lindsay A; Harshbarger, Raymond J

    2015-01-01

    The facial region is infrequently affected by necrotizing infections. Orbital necrotizing infections are even rarer, seen following trauma, local skin infection, and sinusitis. The authors report a unique case of orbital necrotizing fasciitis and osteomyelitis resulting from Arcanobacterium Haemolyticum ethmoid sinusitis. No prior occurrences of Arcanobacterial species orbital necrotizing fasciitis/osteomyelitis have been reported.A 16-year-old boy presented to the ER with a 3-day history of fever, chills, headache, and sinus pressure. CT scan revealed soft tissue swelling of the right orbit, forehead, and ethmoid sinusitis. Within 24 hours of admission, he suffered rapidly progressive swelling and erythema of the right orbit and forehead with diminished visual acuity, despite broad-spectrum antibiotics. Orbital exploration revealed frankly necrotic fascia and periosteum along the superior aspect. Lateral canthotomy, cantholysis, decompression of the optic nerve, and soft tissue debridement with bone biopsy was performed. Operative specimens isolated Arcanobacterium Haemolyticum. Pathologic examination revealed right orbital osteomyelitis.

  12. Update on the Management of Pediatric Acute Osteomyelitis and Septic Arthritis.

    Science.gov (United States)

    Castellazzi, Luca; Mantero, Marco; Esposito, Susanna

    2016-01-01

    Acute osteomyelitis and septic arthritis are two infections whose frequencies are increasing in pediatric patients. Acute osteomyelitis and septic arthritis need to be carefully assessed, diagnosed, and treated to avoid devastating sequelae. Traditionally, the treatment of acute osteoarticular infection in pediatrics was based on prolonged intravenous anti-infective therapy. However, results from clinical trials have suggested that in uncomplicated cases, a short course of a few days of parenteral antibiotics followed by oral therapy is safe and effective. The aim of this review is to provide clinicians an update on recent controversies and advances regarding the management of acute osteomyelitis and septic arthritis in children. In recent years, the emergence of bacterial species resistant to commonly used antibiotics that are particularly aggressive highlights the necessity for further research to optimize treatment approaches and to develop new molecules able to fight the war against acute osteoarticular infection in pediatric patients.

  13. Pathology and biofilm formation in a porcine model of staphylococcal osteomyelitis

    DEFF Research Database (Denmark)

    Johansen, L K; Koch, J; Frees, D;

    2012-01-01

    A porcine model was used to examine the potential of human and porcine Staphylococcus aureus isolates to induce haematogenously spread osteomyelitis. Pigs were inoculated in the right femoral artery with one of the following S. aureus strains: S54F9 (from a porcine lung abscess; n = 3 animals......), NCTC-8325-4 (a laboratory strain of human origin; n = 3 animals) and UAMS-1 (a human osteomyelitis isolate; n = 3 animals). Two pigs were sham inoculated with saline. At 11 or 15 days post infection the animals were scanned by computed tomography before being killed and subjected to necropsy...... examination. Osteomyelitis lesions were present in the right hind limb of all pigs inoculated with strain S54F9 and in one pig inoculated with strain NCTC-8325-4. Microscopically, there was extensive loss of bone tissue with surrounding granulation tissue. Sequestrated bone trabeculae were intermingled...

  14. Blood perfusion in osteomyelitis studied with [(15)O]water PET in a juvenile porcine model

    DEFF Research Database (Denmark)

    Jødal, Lars; Nielsen, Ole L; Afzelius, Pia;

    2017-01-01

    BACKGROUND: Osteomyelitis is a serious disease which can be difficult to treat despite properly instituted antibiotic therapy. This appears to be related at least partly to degraded vascularisation in the osteomyelitic (OM) lesions. Studies of perfusion in OM bones are, however, few and not quant......BACKGROUND: Osteomyelitis is a serious disease which can be difficult to treat despite properly instituted antibiotic therapy. This appears to be related at least partly to degraded vascularisation in the osteomyelitic (OM) lesions. Studies of perfusion in OM bones are, however, few...... that perfusion will be less elevated in OM lesions than in soft tissue (ST) infection. The study comprised 11 juvenile pigs with haematogenous osteomyelitis induced by injection of Staphylococcus aureus into the right femoral artery 1 week before scanning (in one pig, 2 weeks). The pigs were dynamically PET...

  15. FDG PET/CT imaging in the diagnosis of osteomyelitis in the diabetic foot

    Energy Technology Data Exchange (ETDEWEB)

    Kagna, Olga; Keidar, Zohar [Rambam Health Care Campus, Department of Nuclear Medicine, POB 9602, Haifa (Israel); Srour, Saher; Militianu, Daniela [Rambam Health Care Campus, Department of Diagnostic Imaging, Haifa (Israel); Melamed, Eyal [Rambam Health Care Campus, Department of Orthopedics, Haifa (Israel)

    2012-10-15

    Osteomyelitis, the most serious complication of the diabetic foot, occurs in about 20 % of patients. Early diagnosis is crucial. Appropriate treatment will avoid or decrease the likelihood of amputation. The objective of this study was to assess the value of FDG PET/CT in diabetic patients with clinically suspected osteomyelitis. Enrolled in this prospective study were 39 consecutive diabetic patients (29 men and 10 women, mean age 57 years, range 28-71 years) with 46 suspected sites of foot infection. Of these 39 patients, 38 had type 2 and 1 type 1 diabetes for 4-25 years, and 28 were receiving treatment with insulin. FDG PET/CT was interpreted for the presence, intensity (SUVmax) and localization of increased FDG foci. Final diagnosis was based on histopathology and bacteriology of surgical samples, or clinical and imaging follow-up. Osteomyelitis was correctly diagnosed in 18 and excluded in 21 sites. Of 20 lesions with focal bone FDG uptake, 2 were false-positive with no further evidence of osteomyelitis. Five sites of diffuse FDG uptake involving more than one bone on CT were correctly diagnosed as diabetic osteoarthropathy. FDG PET/CT had a sensitivity, specificity and accuracy of 100 %, 92 % and 95 % in a patient-based analysis and 100 %, 93 % and 96 % in a lesion-based analysis, respectively, for the diagnosis of osteomyelitis in the diabetic foot. FDG PET/CT was found to have high performance indices for evaluation of the diabetic foot. The PET component identified FDG-avid foci in sites of acute infection which were precisely localized on fused PET/CT images allowing correct differentiation between osteomyelitis and soft-tissue infection. (orig.)

  16. Diagnosing pelvic osteomyelitis beneath pressure ulcers in spinal cord injured patients: a prospective study.

    Science.gov (United States)

    Brunel, A-S; Lamy, B; Cyteval, C; Perrochia, H; Téot, L; Masson, R; Bertet, H; Bourdon, A; Morquin, D; Reynes, J; Le Moing, V

    2016-03-01

    There is no consensus on a diagnostic strategy for osteomyelitis underlying pressure ulcers. We conducted a prospective study to assess the accuracy of multiple bone biopsies and imaging to diagnose pelvic osteomyelitis. Patients with clinically suspected osteomyelitis beneath pelvic pressure ulcers were enrolled. Bone magnetic resonance imaging (MRI) and surgical bone biopsies (three or more for microbiology and one for histology per ulcer) were performed. Bacterial osteomyelitis diagnosis relied upon the association of positive histology and microbiology (at least one positive culture for non-commensal microorganisms or three or more for commensal microorganisms of the skin). From 2011 to 2014, 34 patients with 44 pressure ulcers were included. Bacterial osteomyelitis was diagnosed for 28 (82.3%) patients and 35 (79.5%) ulcers according to the composite criterion. Discrepancy was observed between histology and microbiology for 5 (11.4%) ulcers. Most common isolates were Staphylococcus aureus (77.1%), Peptostreptococcus (48.6%) and Bacteroides (40%), cultured in three or more samples in 42.9% of ulcers for S. aureus and ≥20% for anaerobes. Only 2.8% of ulcers had three or more positive specimens with coagulase-negative staphylococci, group B Streptococcus, and nil with enterococci and Pseudomonas aeruginosa. Staphylococcus aureus, Proteus and group milleri Streptococcus were recovered from one sample in 22.8%, 11.4% and 11.4% of ulcers, respectively. Agreement was poor between biopsies and MRI (κ 0.2). Sensitivity of MRI was 94.3% and specificity was 22.2%. The diagnosis of pelvic osteomyelitis relies on multiple surgical bone biopsies with microbiological and histological analyses. At least three bone samples allows the detection of pathogens and exclusion of contaminants. MRI is not routinely useful for diagnosis.

  17. Salmonella pyomyositis with concurrent sacroiliac osteomyelitis presenting as piriformis syndrome: A rare case.

    Science.gov (United States)

    Phadke, P S; Gandhi, A R; More, S A; Joshirao, R P

    2017-01-01

    A-21-year old male admitted with fever and piriformis syndrome, typically associated with gluteal region pain radiating down the thigh, was evaluated and found to have pyomyositis involving piriformis and osteomyelitis with sacroiliac joint affection on radiological imaging. Salmonella serotype typhi was isolated from blood culture. He was treated with intravenous Ceftriaxone for 6 weeks with signs of recovery documented clinically as well as on imaging studies. Salmonella pyomyositis with osteomyelitis in an immunocompetent patient with no previous hematological or endocrine disorder makes this case an unusual presentation.

  18. Bug on the back: vertebral osteomyelitis secondary to fluoroquinolone resistant Salmonella typhi in an immunocompetent patient.

    Science.gov (United States)

    Shrestha, Pragya; Mohan, Sachin; Roy, Satyajeet

    2015-11-27

    Although Salmonella osteomyelitis is commonly seen in immunocompromised patients, it may occasionally affect an immunocompetent host. Symptoms are usually non-specific, such as fever, abdominal or back pain; hence it should be considered in the differential diagnosis of patients with a history of travel to endemic regions. Fluoroquinolone resistance is rising and non-responsive patients should be treated with ampicillin, trimethoprim-sulfamethoxazole and ceftriaxone. We present a case of acute T8-T11 osteomyelitis with cord compression caused by a fluoroquinolone resistant strain of Salmonella typhi.

  19. Right ventricular wall abscess in structurally normal heart after leg osteomyelitis: First case.

    Science.gov (United States)

    Ahmad, Tanveer; Pasarad, Ashwini Kumar; Kishore, Kolkebaile Sadanand; Maheshwarappa, Nandakumar Neralakere

    2016-09-01

    A 3-year-old girl presented with fever and acute dyspnea for 4 days. She had suffered an injury to the left lower leg 3 weeks earlier, with abscess formation. Magnetic resonance imaging showed osteomyelitis of the lower tibia. Echocardiography showed a mass in the right ventricular wall. She underwent concomitant heart surgery for removal of the right ventricular mass and limb arthrotomy. We believe this is a first reported case in which a ventricular wall abscess developed in a structurally normal heart following leg osteomyelitis.

  20. Study on the hard tissue changes in osteomyelitis of the jaws using CT image

    Energy Technology Data Exchange (ETDEWEB)

    An, Chang Hyeon; Choi, Bo Ram; Huh, Kyung Hoe; Yi, Won Jin; Lee, Sam Sun; Choi, Soon Chul [School of Dentistry, Seoul National University, Seoul (Korea, Republic of)

    2009-09-15

    To assess the clinical findings and hard tissue changes of osteomyelitis of the jaws using computed tomographic (CT) image analysis. We reviewed and interpreted the CT images of 163 patients (64 males and 99 females, age range from 10 to 87 years) who visited the Seoul National University Dental Hospital from April 23, 2006 to December 31, 2008 and were diagnosed as osteomyelitis of the jaws through clinical, radiologic, and histopathologic examination. Each CT findings was investigated for frequency, correlation with age and gender. Of the 163 patients, 31 (19.0%) were affected on the maxilla, 135 (82.8%) were affected on the mandible, and 3 (1.8%) were affected on the both jaws simultaneously. The mean age of the patients who were affected on the maxilla was 61.0 years and that of the patients who were affected on the mandible was 56.2 years. On the maxilla, the most frequent site of disease was the posterior area (83.9%) and on the mandible, mandibular body (83.0%), followed by angle (48.1%), ramus (38.5%), condyle (13.3%), incisal area (9.6%), and coronoid process (3.0%). Among the 31 maxillary osteomyelitis, defect in the trabecular bone was observed in 28 (90.3%), osteosclerosis 20 (64.5%), defect in the cortical bone 27 (87.1%), sequestrum 17 (54.8%), and periosteal reaction 2 (6.5%). Among the 135 mandibular osteomyelitis, defect in the trabecular bone was observed in 100 (74.1%), osteosclerosis 104 (77.0%), defect in the cortical bone 116 (85.9%), sequestrum 36 (26.7%), and periosteal reaction 67 (49.6%). Of our cases, the maxillary osteomyelitis was visibly observed more frequently in females than males. The incidence is the highest in seventies (28.8%) and the lowest in teens (3.1%). The osteomyelitis of the jaws was observed more frequently in males than females before the age of 50, and observed more frequently in females after the age of 50. The most noticeable point was that the sequestrum was observed more often on maxillary osteomyelitis and the

  1. Salmonella pyomyositis with concurrent sacroiliac osteomyelitis presenting as piriformis syndrome: A rare case

    Directory of Open Access Journals (Sweden)

    P S Phadke

    2017-01-01

    Full Text Available A-21-year old male admitted with fever and piriformis syndrome, typically associated with gluteal region pain radiating down the thigh, was evaluated and found to have pyomyositis involving piriformis and osteomyelitis with sacroiliac joint affection on radiological imaging. Salmonella serotype typhi was isolated from blood culture. He was treated with intravenous Ceftriaxone for 6 weeks with signs of recovery documented clinically as well as on imaging studies. Salmonella pyomyositis with osteomyelitis in an immunocompetent patient with no previous hematological or endocrine disorder makes this case an unusual presentation.

  2. A Case of Transient, Isolated Cranial Nerve VI Palsy due to Skull Base Osteomyelitis

    Directory of Open Access Journals (Sweden)

    Brijesh Patel

    2014-01-01

    Full Text Available Otitis externa affects both children and adults. It is often treated with topical antibiotics, with good clinical outcomes. When a patient fails to respond to the treatment, otitis externa can progress to malignant otitis externa. The common symptoms of skull bone osteomyelitis include ear ache, facial pain, and cranial nerve palsies. However, an isolated cranial nerve is rare. Herein, we report a case of 54-year-old female who presented with left cranial nerve VI palsy due to skull base osteomyelitis which responded to antibiotic therapy.

  3. Contributions of societal and geographical environments to "chronic Lyme disease": the psychopathogenesis and aporology of a new "medically unexplained symptoms" syndrome.

    Science.gov (United States)

    Sigal, Leonard H; Hassett, Afton L

    2002-08-01

    Lyme disease is a relatively well-described infectious disease with multisystem manifestations. Because of confusion over conflicting reports, anxiety related to vulnerability to disease, and sensationalized and inaccurate lay media coverage, a new syndrome, "chronic Lyme disease," has become established. Chronic Lyme disease is the most recent in a continuing series of "medically unexplained symptoms" syndromes. These syndromes, such as fibromyalgia, chronic fatigue syndrome, and multiple chemical sensitivity, meet the need for a societally and morally acceptable explanation for ill-defined symptoms in the absence of objective physical and laboratory findings. We describe factors involved in the psychopathogenesis of chronic Lyme disease and focus on the confusion and insecurity these patients feel, which gives rise to an inability to adequately formulate and articulate their health concerns and to deal adequately with their medical needs, a state of disorganization termed aporia.

  4. Chronic immune activation in HIV-1 infection contributes to reduced interferon alpha production via enhanced CD40:CD40 ligand interaction.

    Directory of Open Access Journals (Sweden)

    Norbert Donhauser

    Full Text Available Although a signature of increased interferon (IFN-alpha production is observed in HIV-1 infection, the response of circulating plasmacytoid dendritic cells (PDC to Toll-like receptor ligand stimulation is substantially impaired. This functional PDC deficit, which we specifically observed in HIV-1 infected individuals with less than 500 CD4+ T cells/µl, is not well understood. We provide evidence that the peripheral IFN-alpha production in HIV-1 infection is actively suppressed by the enhanced interaction of CD40 ligand (CD40L, a member of the tumor necrosis factor family, and its receptor CD40, which are both upregulated upon immune activation. Plasma levels of soluble CD40L were significantly higher in untreated HIV-1 infected individuals (n = 52 than in subjects on long-term antiretroviral therapy (n = 62, p<0.03 and in uninfected control donors (n = 16, p<0.001. Concomitantly, cell-associated CD40L and the expression of the receptor CD40 on the PDC were significantly upregulated in HIV-1 infection (p<0.05. Soluble and cell-associated CD40L inhibited the PDC-derived IFN-alpha production by CpG oligodeoxynucleotides dose-dependently. This suppressive effect was observed at much lower, physiological CD40L concentrations in peripheral blood mononuclear cells (PBMC of HIV-1 infected individuals compared to controls (p<0.05. The CpG-induced IFN-alpha production in PBMC of HIV-1 infected donors was directly correlated with PDC and CD4+ T cell counts, and inversely correlated with the viral loads (p<0.001. In HIV-1 infected donors with less than 500 CD4+ T cells/µl, the CpG-induced IFN-alpha production was significantly correlated with the percentage of CD40-expressing PDC and the level of CD40 expression on these cells (p<0.05, whereas CD40L plasma levels played a minor role. In addition, low-dose CD40L contributed to the enhanced production of interleukin 6 and 8 in PBMC of HIV-1 infected donors compared to controls. Our data support

  5. Unsuspected osteomyelitis in diabetic foot ulcers. Diagnosis and monitoring by leukocyte scanning with indium in 111 oxyquinoline

    Energy Technology Data Exchange (ETDEWEB)

    Newman, L.G.; Waller, J.; Palestro, C.J.; Schwartz, M.; Klein, M.J.; Hermann, G.; Harrington, E.; Harrington, M.; Roman, S.H.; Stagnaro-Green, A. (Mount Sinai Medical Center, New York, NY (USA))

    1991-09-04

    The prevalence of osteomyelitis in diabetic foot ulcers is unknown. Early diagnosis of this infection is critical, as prompt antibiotic treatment decreases the rate of amputation. The authors therefore assessed the prevalence of osteomyelitis in 35 diabetic patients with 41 foot ulcers. They compared results of roentgenograms, leukocyte scans with indium In 111 oxyquinoline, and bone scans with the diagnostic criterion standards of bone histologic and culture findings. Leukocyte scans were repeated at 2- to 3-week intervals during antibiotic treatment. Consecutive samples were obtained from 54 diabetic patients. Thirty-five patients with 41 foot ulcers were included. As determined by bone biopsy and culture, osteomyelitis was found to underlie 28 (68%) of 41 diabetic foot ulcers. Only nine (32%) of the 28 cases were diagnosed clinically by the referring physician. Underscoring the clinically silent nature of osteomyelitis in these ulcers, 19 (68%) of 28 occurred in outpatients, 19 (68%) of 28 occurred in ulcers not exposing bone, and 18 (64%) of 28 had no evidence of inflammation on physical examination. All patients with ulcers that exposed bone had osteomyelitis. Of the imaging tests, the leukocyte scan had the highest sensitivity, 89%. In patients with osteomyelitis, the leukocyte scan image intensity decreased by 16 to 34 days of antibiotic treatment and normalized by 36 to 54 days. The majority of diabetic foot ulcers have an underlying osteomyelitis that is clinically unsuspected. Leukocyte scans are highly sensitive for diagnosing osteomyelitis in diabetic foot ulcers and may be useful for monitoring the efficacy of antibiotic treatment. The recommend that diabetic patients with foot ulcers that expose bone should be treated for osteomyelitis.

  6. "The contribution of chronic diseases to the prevalence of dependence among older people in Latin America, China and India: a 10/66 Dementia Research Group population-based survey"

    OpenAIRE

    Salas Aquiles; de Rodriguez Juan; Pichardo Guillermina; Liu Zhaorui; Hernandez Milagros; Jacob KS; AT, Jotheeswaran; Huang Yueqin; Guerra Mariella; Acosta Daisy; Ferri Cleusa P; Sousa Renata M; Sosa Ana; Williams Joseph; Zuniga Tirso

    2010-01-01

    Abstract Background The number of older people is set to increase dramatically worldwide. Demographic changes are likely to result in the rise of age-related chronic diseases which largely contribute to years lived with a disability and future dependence. However dependence is much less studied although intrinsically linked to disability. We investigated the prevalence and correlates of dependence among older people from middle income countries. Methods A one-phase cross-sectional survey was ...

  7. In vitro elution of vancomycin from biodegradable osteoconductive calcium phosphate-polycaprolactone composite beads for treatment of osteomyelitis.

    Science.gov (United States)

    Makarov, C; Cohen, V; Raz-Pasteur, A; Gotman, I

    2014-10-01

    In this work, osteoconductive composite materials comprising a large volume fraction of a bioresorbable calcium phosphate ceramic (CaP) and a smaller amount of a polycaprolactone polymer (PCL) were studied as a degradable antibiotic carrier material for treatment of osteomyelitis. Beads loaded with 1 and 4wt.% vancomycin were prepared by admixing dissolved drug to an in situ synthesized dicalcium phosphate (DCP)-PCL or solution-mixed beta-tricalcium phosphate (βTCP)-PCL composite powder followed by high pressure consolidation of the blend at room temperature. Vancomycin release was measured in phosphate-buffered saline (PBS) at 37°C. All the beads gradually released the drug over the period of 4-11weeks, depending on the composite matrix homogeneity and porosity. Mathematical modeling using the Peppas equation showed that vancomycin elution was diffusion controlled. The stability of the antibiotic after high pressure application at room temperature was demonstrated by high-performance liquid chromatography-mass spectrometry (HPLC-MS) studies and MIC testing. The preservation of the structure and activity of vancomycin during the processing of composite beads and its sustained in vitro release profile suggest that high pressure consolidated CaP-PCL beads may be useful in the treatment of chronic bone infections as resorbable delivery vehicles of vancomycin and even of thermally unstable drug substances.

  8. Thoracic osteomyelitis and epidural abscess formation due to cat scratch disease: case report.

    Science.gov (United States)

    Dornbos, David; Morin, Jocelyn; Watson, Joshua R; Pindrik, Jonathan

    2016-12-01

    Osteomyelitis of the spine with associated spinal epidural abscess represents an uncommon entity in the pediatric population, requiring prompt evaluation and diagnosis to prevent neurological compromise. Cat scratch disease, caused by the pathogen Bartonella henselae, encompasses a wide spectrum of clinical presentations; however, an association with osteomyelitis and epidural abscess has been reported in only 4 other instances in the literature. The authors report a rare case of multifocal thoracic osteomyelitis with an epidural abscess in a patient with a biopsy-proven pathogen of cat scratch disease. A 5-year-old girl, who initially presented with vague constitutional symptoms, was diagnosed with cat scratch disease following biopsy of an inguinal lymph node. Despite appropriate antibiotics, she presented several weeks later with recurrent symptoms and back pain. Magnetic resonance imaging revealed 2 foci of osteomyelitis at T-8 and T-11 with an associated anterior epidural abscess from T-9 to T-12. Percutaneous image-guided vertebral biopsy revealed B. henselae by polymerase chain reaction analysis, and she was treated conservatively with doxycycline and rifampin with favorable clinical outcome.

  9. Fusarium Osteomyelitis in a Patient With Pearson Syndrome: Case Report and Review of the Literature

    Science.gov (United States)

    Hiebert, Rachael M.; Welliver, Robert C.; Yu, Zhongxin

    2016-01-01

    Fusarium species are ubiquitous fungi causing a wide array of infections, including invasive disease in the immunosuppressed. We present a fusarium bone infection in a child with Pearson syndrome and review the literature. Ten cases of fusarium osteomyelitis were reported in the past 40 years, and we review the treatments. PMID:27757410

  10. Non-infectious osteomyelitis of the mandible in a young woman

    DEFF Research Database (Denmark)

    Rasmussen, Anne Q; Andersen, Ulrik B; Jørgensen, Niklas R

    2014-01-01

    after 12 months. The bone pain was significantly reduced six months after treatment and had disappeared 24 months after treatment. CONCLUSION: We report an unusual localization of non-infectious osteomyelitis of the jaw in a young woman. Even though the presentation was in the jaw, her condition...

  11. Influence of the location of nonischemic diabetic forefoot osteomyelitis on time to healing after undergoing surgery.

    Science.gov (United States)

    Cecilia-Matilla, Almudena; Lázaro-Martínez, José Luis; Aragón-Sánchez, Javier; García-Álvarez, Yolanda; Chana-Valero, Pedro; Beneit-Montesinos, Juan Vicente

    2013-09-01

    The forefoot has been reported as the most frequent location of osteomyelitis in the feet of patients with diabetes. The forefoot includes toes and metatarsal heads as common locations of bone infections, but the anatomy of these bones is quite different. As a result, such differences in anatomy may have an impact on the outcomes. The aim of the present study was to determine whether different locations of osteomyelitis in the forefoot have any influence on time to healing after undergoing surgery in a prospective series including 195 patients without peripheral arterial disease and osteomyelitis confirmed by histopathology. Location of the lesion was classified into 4 groups: hallux, first metatarsal head, lesser metatarsal heads, and lesser toes. The time required to achieve healing and the cumulative rate of wounds healed and likelihood of healing were analyzed at 4, 8, and 12 weeks after surgery. Time of healing (mean ± SD) in the whole series was 10.7 ± 8.4 weeks. Osteomyelitis located in the lesser toes has a higher probability of healing by the fourth week (odds ratio [OR] = 5.7, 95% confidence interval [CI] = 2.8-11.6, P forefoot.

  12. A novel observation of pubic osteomyelitis due to Streptococcus viridans after dental extraction: a case report

    Directory of Open Access Journals (Sweden)

    Naqvi Naseem

    2008-07-01

    Full Text Available Abstract Introduction Pubic osteomyelitis should be suspected in athletic individuals with sudden groin pain, painful restriction of hip movements and fever. It is an infrequent and confusing disorder, which is often heralded by atypical gait disturbance and diffuse pain in the pelvic girdle. The most common pathogen is Staphylococcus aureus but, on occasions, efforts to identify infectious agents sometimes prove negative. Pubic osteomyelitis due to Streptococcus viridans has not been reported previously in the literature. Case presentation We describe the case of a fit 24-year-old athlete, who had a wisdom tooth extracted 2 weeks prior to the presentation, which could have served as a port of entry and predisposed the patient to transient bacteraemia. Conclusion S. viridans is well known for causing infective endocarditis of native damaged heart valves, but to the best of the authors' knowledge it has not been reported previously as a cause of pubic osteomyelitis. We believe that this case should alert physicians to the association between dental procedures and osteomyelitis of the pubis secondary to S. viridans.

  13. Diagnosis of pedal osteomyelitis in diabetic patients using current scintigraphic techniques

    Energy Technology Data Exchange (ETDEWEB)

    Keenan, A.M.; Tindel, N.L.; Alavi, A. (Hospital of the Univ. of Pennsylvania, Philadelphia (USA))

    1989-10-01

    Seventy-seven diabetic patients with suspected osteomyelitis of the foot were evaluated by three-phase bone scintigraphy (TPBS), indium 111-labeled white blood cell scintigraphy (WBCS), roentgenography, or some combination thereof. Retrospective analysis after clinical and pathologic follow-up indicated that the sensitivity of TPBS alone in the diagnosis of osteomyelitis was 100%, with a specificity of only 38% and an accuracy of 63%; the sensitivity of WBCS alone was 100%, with a specificity of 78% and an accuracy of 87%; and the combination of TPBS and WBCS yielded a sensitivity of 100%, with a specificity of 79% and an accuracy of 87%. Roentgenography yielded a sensitivity of 69%, with a specificity of 82% and an accuracy of 76%. The results of this study demonstrate that WBCS is superior to TPBS in the diagnosis of osteomyelitis in the diabetic foot, and TPBS adds little when viewed in conjunction with WBCS. Based on our observations and because of the high prevalence of neuropathic joint disease and other causes of false-positive bone scans, we believe that WBCS alone is adequate for evaluation of suspected pedal osteomyelitis in diabetic patients, particularly when the suspected lesion is located in the tarsometatarsal region in contrast to the toe region (7% vs 44% specificity and 28% vs 69% accuracy, respectively, for TPBS in these two regions, compared with 100% vs 68% specificity and 100% vs 80% accuracy, respectively, for WBCS in the same two regions).

  14. [Importance of bone scanning and osteoscintimetry for assessing development of acute haematogenic childhood osteomyelitis (author's transl)].

    Science.gov (United States)

    Fotter, R; Höllwarth, M

    1980-01-01

    Bone scanning with 99m-Tc-MDP is generally used for the early diagnosis of acute haematogenic childhood osteomyelitis. The combination of this method with radionuclide osteoscintimetry and the evaluation of the relative uptake ratio supply objective criteria for assessing the development of the disease. They permit statements as to the morphological and functional aspects of the disease and thus facilitate clinical assessment.

  15. Clinical, morphological, and molecular characterization of Penicillium canis, sp. nov., isolated from a dog with osteomyelitis

    Science.gov (United States)

    Infections caused by Penicillium spp. are rare in dogs, and the prognosis in these cases is poor. An unknown species of Penicillium was isolated from a bone lesion in a young dog with osteomyelitis of the right ilium. Extensive diagnostic evaluation did not reveal evidence of dissemination. Resoluti...

  16. Actinobacillus pleuropneumoniae osteomyelitis in pigs demonstrated by fluorescent in situ hybridization

    DEFF Research Database (Denmark)

    Jensen, Tim Kåre; Boye, Mette; Hagedorn-Olsen, T.;

    1999-01-01

    Necrotizing osteomyelitis and fibrinopurulent arthritis with isolation of Actinobacillus pleuropneumoniae serotype 2 is reported in two pigs from a herd with lameness and mild coughing problems among 8 to 12-week-old pigs. Application of fluorescent in situ hybridization targeting 16S ribosomal RNA...

  17. Effects of antiresorptive agents on osteomyelitis: novel insights into the pathogenesis of osteonecrosis of the jaw

    DEFF Research Database (Denmark)

    Li, Dan; Gromov, Kirill; Proulx, Steven T;

    2010-01-01

    The effects of antiresorptive agents (e.g., alendronate [Aln], osteoprotegerin [OPG]) on bone infection are unknown. Thus, their effects on implant-associated osteomyelitis (OM) were investigated in mice using PBS (placebo), gentamycin, and etanercept (TNFR:Fc) controls. None of the drugs affected...

  18. Fusarium falciforme vertebral abscess and osteomyelitis: case report and molecular classification

    Science.gov (United States)

    Fusarium is a ubiquitous filamentous mold that rarely causes disease in immunocompetent humans but can be fatal in immunocompromised hosts. We report an unusual case of vertebral abscess and osteomyelitis in a patient with an autoimmune disorder who was on long term glucocorticoids. Multilocus DNA s...

  19. Posttraumatic tuberculous osteomyelitis of the foot-A rare case report

    Institute of Scientific and Technical Information of China (English)

    Gauresh Vargaonkar; P.Sathyamurthy; Varun Kumar Singh; Sunil Mallojwar

    2015-01-01

    Skeletal tuberculosis developing after trauma is a rare occurrence.We report a rare case of posttraumatic tubercular osteomyelitis of mid-tarsal bone of the right foot.Patient was treated with regular dressing and anti-tubercular drugs.Posttraumatic skeletal tuberculosis should be considered in patient with nonhealing ulcer.

  20. Sternoclavicular Osteomyelitis in an Immunosuppressed Patient: A Case Report and Review of the Literature.

    Science.gov (United States)

    Khan, Kamran; Wozniak, Susan E; Mehrabi, Erfan; Giannone, Anna Lucia; Dave, Mitul

    2015-12-28

    BACKGROUND Sternoclavicular osteomyelitis is a rare disease, with less than 250 cases identified in the past 50 years. We present a rare case of sternoclavicular osteomyelitis in an immunosuppressed patient that developed from a conservatively treated dislocation. CASE REPORT A 62-year-old white man with a history of metastatic renal cell carcinoma presented to the emergency department (ED) with a dislocated left sternoclavicular joint. He was managed conservatively and subsequently discharged. However, over subsequent days he began to experience pain, fever, chills, and night sweats. He presented to the ED again and imaging revealed osteomyelitis. In the operating room, the wound was aggressively debrided and a wound vac (vacuum-assisted closure) was placed. He was diagnosed with sternoclavicular osteomyelitis and placed on a 6-week course of intravenous Nafcillin. CONCLUSIONS Chemotherapy patients who sustain joint trauma normally associated with a low risk of infection should be monitored thoroughly, and the option to discontinue immunosuppressive therapy should be considered if signs of infection develop.

  1. Calcaneal osteomyelitis presenting with acute tarsal tunnel syndrome: a case report

    Directory of Open Access Journals (Sweden)

    Shariff Sajid

    2010-02-01

    Full Text Available Abstract Introduction Cases of acute tarsal tunnel syndrome are rare. To the best of our knowledge, we describe the only reported case of acute posterior tibial nerve compression resulting from adjacent haemotogenous pyogenic calcaneal osteomyelitis. Case presentation A previously healthy 38-year-old Caucasian woman developed symptoms of acute tarsal tunnel syndrome in her right foot over a six-day period. No antecedent trauma or systemic symptoms were noted. Magnetic resonance imaging and bone scan imaging, followed by surgical decompression and bone biopsy confirmed a diagnosis of Staphylococcus aureus calcaneal osteomyelitis. Her pain and paraesthesia disappeared after the operation, while her inflammatory markers normalised during a 12-week course of antibiotics. After four years she has remained asymptomatic without any indication of recurrence. Conclusion This case is not just unique in describing osteomyelitis as a cause of tarsal tunnel syndrome, because haemotogenous calcaneal osteomyelitis is in itself a rare pathology. We recommend considering infection as a differential diagnosis in patients presenting with acute tarsal tunnel syndrome.

  2. Efficacy of antibiotic-impregnated polymethylmethacrylate beads in a rhesus macaque (Macaca mulatta) with osteomyelitis.

    Science.gov (United States)

    Kelly, Kristi R; Kapatkin, Amy R; Zwingenberger, Allison L; Christe, Kari L

    2012-08-01

    Here we describe the successful surgical implementation of antibiotic-impregnated polymethylmethacrylate beads in a rhesus macaque (Macaca mulatta) with marked osteomyelitis. The macaque presented to the veterinary clinic with grossly contaminated bite wounds in the left ankle secondary to conspecific trauma. Radiographic findings were highly suggestive of osteomyelitis. Additional differential diagnoses included bony infarct, fracture, and cellulitis. In light of the location of the lesion and extensive tissue trauma, the animal had a poor prognosis. Systemic, broad-spectrum antibiotics were instituted. After 2 wk of care, lesions did not respond to empirical therapies. On consultation, a veterinary orthopedic surgeon at another facility recommended placement of antibiotic-impregnated polymethylmethacrylate beads at the sites of osteomyelitis. The animal underwent minor surgery in which beads were introduced into the wound. The monkey had a positive response to therapy. The animal regained full function and was returned to outdoor social housing. Veterinarians are encouraged to consider using antibiotic-impregnated polymethylmethacrylate beads when treating osteomyelitis in other nonhuman primates and in other traditional laboratory animal species.

  3. Th17 cytokine deficiency in patients with Aspergillus skull base osteomyelitis

    NARCIS (Netherlands)

    Delsing, C.E.; Becker, K.L.; Simon, A.; Kullberg, B.J.; Bleeker-Rovers, C.P.; Veerdonk, F.L. van de; Netea, M.G.

    2015-01-01

    BACKGROUND: Fungal skull base osteomyelitis (SBO) is a severe complication of otitis externa or sinonasal infection, and is mainly caused by Aspergillus species. Here we investigate innate and adaptive immune responses in patients with Aspergillus SBO to identify defects in the immune response that

  4. A multidisciplinary approach for the treatment of complication of hematogenous osteomyelitis in children

    Directory of Open Access Journals (Sweden)

    Юрий Евгеньевич Гаркавенко

    2016-06-01

    Full Text Available Background.Severe orthopedic complications of osteomyelitis occurred in 22%–71.2% of children with osteomyelitis in previous studies. At the same time 26.5% of children with complications of osteomyelitis, according to data of The Turner Scientific and Research Institute for Children’s Orthopedics, have multiple bone lesions. The challenges involved in the orthopedic treatment of musculoskeletal system disorders are diverse and complex. In some cases, inadequate attention is paid to the need to treat the facial bones of the skull, temporomandibular joint (TMJ, and jaw bones.Aim.The aim of this paper is to demonstrate the need for a variety of options and to determine the best strategies for comprehensive medical rehabilitation, involving orthopedic and maxillofacial surgeons and other healthcare providers, for children with complications of osteomyelitis, who had destruction of the long tubular bones of the jaw.Materials and methods.Between 2011 and 2015 26 children (10 males and 16 females aged 1.5–17 years with multiple localized lesions after osteomyelitis were treated in The Turner Scientific and Research Institute for Children’s Orthopedic. In addition to severe orthopedic disorders, there has been a loss of TMJ, which resulted in severe functional impairment and impaired development of the facial bones of the skull.Results.There was a individualized approach to the treatment of pediatric patients with complications of osteomyelitis. Early diagnosis and proper treatment prevented severe changes in the musculoskeletal system and maxillofacial area in pediatric patients.Conclusion.The modern concept of comprehensive medical rehabilitation of children with complications of osteomyelitis should include an interdisciplinary approach involving orthopedic and maxillofacial surgeons. Early diagnosis in children ensures the timely formation of individualized rehabilitation programs, designed to improve the anatomical and functional

  5. Surgical management of maxillary and premaxillary osteomyelitis in a reticulated python (Python reticulatus).

    Science.gov (United States)

    Latney, La'Toya V; McDermott, Colin; Scott, Gregory; Soltero-Rivera, Maria M; Beguesse, Kyla; Sánchez, Melissa D; Lewis, John R

    2016-05-01

    CASE DESCRIPTION A 1-year-old reticulated python (Python reticulatus) was evaluated because of a 2-week history of wheezing and hissing. CLINICAL FINDINGS Rostral facial cellulitis and deep gingival pockets associated with missing rostral maxillary teeth were evident. Tissues of the nares were swollen, resulting in an audible wheeze during respiration. Multiple scars and superficial facial wounds attributed to biting by live prey were apparent. Radiographic examination revealed bilateral, focal, rostral maxillary osteomyelitis. TREATMENT AND OUTCOME Wound irrigation, antimicrobials, and anti-inflammatory drug treatment resulted in reduced cellulitis. A 3-week regimen that included empirical antimicrobial treatment and improved husbandry resulted in resolution of the respiratory sounds and partial healing of bite wounds, but radiographic evaluation revealed progressive maxillary osteomyelitis. Microbial culture of blood yielded scant gram-positive cocci and Bacillus spp, which were suspected sample contaminants. Bilateral partial maxillectomies were performed; microbial culture and histologic examination of resected bone confirmed osteomyelitis with gram-positive cocci. Treatment with trimethoprim-sulfamethoxazole was initiated on the basis of microbial susceptibility tests. Four months later, follow-up radiography revealed premaxillary osteomyelitis; surgery was declined, and treatment with trimethoprim-sulfamethoxazole was reinstituted. Eight months after surgery, the patient was reevaluated because of recurrent clinical signs; premaxillectomy was performed, and treatment with trimethoprim-sulfamethoxazole was prescribed on the basis of microbial culture of bone and microbial susceptibility testing. Resolution of osteomyelitis was confirmed by CT 11 months after the initial surgery. CONCLUSIONS AND CLINICAL RELEVANCE Focal maxillectomies and premaxillectomy were successfully performed in a large python. Surgical management and appropriate antimicrobial treatment

  6. Animal models of hematogenous Staphylococcus aureus osteomyelitis in long bones: a review

    Directory of Open Access Journals (Sweden)

    Johansen LK

    2013-08-01

    Full Text Available Louise Kruse Johansen, Henrik Elvang JensenDepartment of Veterinary Disease Biology, Faculty of Health and Medical Science, University of Copenhagen, Frederiksberg, DenmarkAbstract: Hematogenous osteomyelitis (HO, especially due to Staphylococcus aureus, is primarily reported in children and occurs when blood-borne bacteria settle in the metaphysis of a long bone and mediate an inflammatory response. The literature contains several reports on animal models aiming to simulate pediatric HO, in order to investigate the pathogenesis and for therapeutic use. In these models, osteomyelitis lesions develop subsequently to bacteremia, which can be induced by either intravenous or intra-arterial inoculation of bacteria. Intravenous inoculation is not optimal because of the ethical aspects of the extensive systemic reaction and the unpredictable identity of bones being infected. Also, intravenous inoculation often has to be combined with the induction of artificial bone necrosis in order to have macroscopic lesions. In contrast, models based on intra-arterial inoculation and subsequent development of local osteomyelitis, are the most accurate and predictable way to extrapolate to pediatric cases of HO. The most commonly used animal species for modeling of HO are rabbits, chickens, and mice, whereas, less frequently, dogs, rats, and pigs have been applied. The use of intra-arterial inoculation, without simultaneous artificial bone necrosis for the development of HO lesions has only been used in porcine models. Because of the similarity of human and porcine physiology, metabolic rate, and size, porcine models of HO are advantageous. Therefore, porcine models based on the intra-arterial induction of osteomyelitis are the most refined HO models.Keywords: hematogenous osteomyelitis, animal models, Staphylococcus aureus

  7. Alendronate-coated long-circulating liposomes containing 99mtechnetium-ceftizoxime used to identify osteomyelitis.

    Science.gov (United States)

    Ferreira, Diego dos Santos; Boratto, Fernanda Alves; Cardoso, Valbert Nascimento; Serakides, Rogéria; Fernandes, Simone Odília; Ferreira, Lucas Antônio Miranda; Oliveira, Mônica Cristina

    2015-01-01

    Osteomyelitis is a progressive destruction of bones caused by microorganisms. Inadequate or absent treatment increases the risk of bone growth inhibition, fractures, and sepsis. Among the diagnostic techniques, functional images are the most sensitive in detecting osteomyelitis in its early stages. However, these techniques do not have adequate specificity. By contrast, radiolabeled antibiotics could improve selectivity, since they are specifically recognized by the bacteria. The incorporation of these radiopharmaceuticals in drug-delivery systems with high affinity for bones could improve the overall uptake. In this work, long-circulating and alendronate-coated liposomes containing (99m)technetium-radiolabeled ceftizoxime were prepared and their ability to identify infectious foci (osteomyelitis) in animal models was evaluated. The effect of the presence of PEGylated lipids and surface-attached alendronate was evaluated. The bone-targeted long-circulating liposomal (99m)technetium-ceftizoxime showed higher uptake in regions of septic inflammation than did the non-long-circulating and/or alendronate-non-coated liposomes, showing that both the presence of PEGylated lipids and alendronate coating are important to optimize the bone targeting. Scintigraphic images of septic or aseptic inflammation-bearing Wistar rats, as well as healthy rats, were acquired at different time intervals after the intravenous administration of these liposomes. The target-to-non-target ratio proved to be significantly higher in the osteomyelitis-bearing animals for all investigated time intervals. Biodistribution studies were also performed after the intravenous administration of the formulation in osteomyelitis-bearing animals. A significant amount of liposomes were taken up by the organs of the mononuclear phagocyte system (liver and spleen). Intense renal excretion was also observed during the entire experiment period. Moreover, the liposome uptake by the infectious focus was

  8. Apoptosis-associated uncoupling of bone formation and resorption in osteomyelitis

    Science.gov (United States)

    Marriott, Ian

    2013-01-01

    The mechanisms underlying the destruction of bone tissue in osteomyelitis are only now being elucidated. While some of the tissue damage associated with osteomyelitis likely results from the direct actions of bacteria and infiltrating leukocytes, perhaps exacerbated by bacterial manipulation of leukocyte survival pathways, infection-induced bone loss predominantly results from an uncoupling of the activities of osteoblasts and osteoclasts. Bacteria or their products can directly increase osteoclast formation and activity, and the inflammatory milieu at sites of infection can further promote bone resorption. In addition, osteoclast activity is critically regulated by osteoblasts that can respond to bacterial pathogens and foster both inflammation and osteoclastogenesis. Importantly, bone loss during osteomyelitis is also brought about by a decline in new bone deposition due to decreased bone matrix synthesis and by increased rates of osteoblast apoptosis. Extracellular bacterial components may be sufficient to reduce osteoblast viability, but the causative agents of osteomyelitis are also capable of inducing continuous apoptosis of these cells by activating intrinsic and extrinsic cell death pathways to further uncouple bone formation and resorption. Interestingly, bacterial internalization appears to be required for maximal osteoblast apoptosis, and cytosolic inflammasome activation may act in concert with autocrine/paracrine death receptor-ligand signaling to induce cell death. The manipulation of apoptotic pathways in infected bone cells could be an attractive new means to limit inflammatory damage in osteomyelitis. However, the mechanism that is the most important in bacterium-induced bone loss has not yet been identified. Furthermore, it remains to be determined whether the host would be best served by preventing osteoblast cell death or by promoting apoptosis in infected cells. PMID:24392356

  9. Differences in the Clinical Outcome of Osteomyelitis by Treating Specialty: Orthopedics or Infectology.

    Science.gov (United States)

    Arias Arias, Carolina; Tamayo Betancur, Maria Carolina; Pinzón, Miguel Alejandro; Cardona Arango, Doris; Capataz Taffur, Cesar Antonio; Correa Prada, Edgar

    2015-01-01

    Osteomyelitis is a heterogeneous infection with regard to etiology and treatment, and currently no single management protocol exists. Management of the condition is typically an interdisciplinary approach between orthopedics and infectious disease; however, the orthopedist is often the person who manages treatment. The aim of the study was to determine differences in the outcome of osteomyelitis according to its treating specialty and to identify factors associated with the recurrence of the disease. An ambispective cohort study of 129 patients with osteomyelitis was conducted and the proportions for qualitative variables and central tendency and dispersion measures for quantitative variables were calculated; the latter were tested for normality using the Shapiro-Wilk test. A bivariate analysis was conducted with measures of association based on the chi square test and crude relative risk. A logistic regression model was applied and statistical significance was set at p orthopedics or infectious disease. Patients who were treated by an orthopedist alone presented a greater risk of relapse or reinfection (RR = 4.6; 95% CI 2.3;8.9). Risk factors of osteomyelitis recurrence as determined in the regression model included the following: age of 57 years or older (RR = 1.3; 95% 0.3;5.2), long bones (RR = 1.9; 95% CI 0.5;7.1), fracture (RR = 5.0; 95% CI 0.4;51.4), monotherapy (RR = 3.0; 95% CI 0.6;14.5), receiving less than 4 weeks of antibiotics (RR = 1.5; 95% CI 0.2;10.1), inadequate treatment (RR = 3.1; 95% CI 0.4;20.1), and receiving orthopedics treatment (RR = 5.5; 95% CI 1.6;18.2). Most patients evaluated jointly by orthopedics and infectious disease received adequate treatment for osteomyelitis and had fewer relapses.

  10. Percutaneous treatment of chronic MRSA osteomyelitis with a novel plant-derived antiseptic

    Directory of Open Access Journals (Sweden)

    Boeck Harry

    2001-05-01

    Full Text Available Abstract Background Antibiotic-resistant bacteria such as methicillin-resistant Staphylococcus aureus (MRSA and vancomycin-resistant enterococcus (VRE, are an increasing problem world-wide, causing intractable wound infections. Complex phytochemical extracts such as tea tree oil and eucalypt-derived formulations have been shown to have strong bactericidal activity against MRSA in vitro. Polytoxinol (PT antimicrobial, is the trade name of a range of antimicrobial preparations in solution, ointment and cream form. Methods We report the first use of this drug, administered percutaneously, via calcium sulphate pellets (Osteoset,TM, into bone, to treat an intractable MRSA infection of the lower tibia in an adult male. Results and Discussion Over a three month period his symptoms resolved with a healing response on x-ray and with a reduced CRP.

  11. [Computed tomography semiotics of osteonecrosis and sequestration in chronic hematogenic osteomyelitis].

    Science.gov (United States)

    D'iachkova, G V; Mitina, Iu L

    2007-01-01

    Based on the data of computed tomography, radiography and densitometry in 39 patients the authors describe in detail the signs of osteonecrosis and sequestration of different localization and extension.

  12. Unusual bone-scan findings in acute osteomyelitis: case report. [/sup 99m/Tc tracer technique

    Energy Technology Data Exchange (ETDEWEB)

    Russin, L.D.; Staab, E.V.

    1976-07-01

    In osteomyelitis, bone-scan findings precede the appearance of bone changes on radiographs. In cases where focal ischemia occurs, the earliest scan finding may be a cold area that later becomes hot as active periostitis develops.

  13. Bone infection in patients suspected of complicating osteomyelitis: the diagnostic value of dual isotope bone-granulocyte scintigraphy

    DEFF Research Database (Denmark)

    Buhl, Thora; Stentzer, Kim; Hede, Adam;

    2005-01-01

    AIM: The purpose of this study was to evaluate the diagnostic value of dual isotope bone-granulocyte scintigraphy in patients with known bone pathology clinically suspected of osteomyelitis, i.e. complicating osteomyelitis, using per-operative bacterial culture from bone as reference. METHODS...... interpreted as positive for osteomyelitis if regions of interests of pathologic 111In granulocyte accumulation included 99mTc MDP activity on the bone images (except in the spine). RESULTS: The sensitivity, specificity, and accuracy were 84, 71 and 79%, respectively, for simultaneous, dual isotope bone......-granulocyte scintigraphy, higher than the other diagnostic parameters. CONCLUSION: Simultaneous bone-granulocyte scintigraphy is a valuable diagnostic tool in diagnosing osteomyelitis complicating other bone pathology with or without soft-tissue infection....

  14. Clinical Management of Suppurative Osteomyelitis, Bisphosphonate-Related Osteonecrosis, and Osteoradionecrosis: Report of Three Cases and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Eduardo Pereira Guimarães

    2013-01-01

    Full Text Available In the past, osteomyelitis was frequent and characterized by a prolonged course, treatment response uncertainty, and occasional disfigurement. Today, the disease is less common; it is believed that the decline in prevalence may be attributed to increased availability of antibiotics and improvement of overall health patterns. Currently, more common osteomyelitis variants are seen, namely, osteoradionecrosis (ORN and bisphosphonate-related osteonecrosis of the jaws (BRONJ. Osteomyelitis, ORN, and BRONJ can present with similar symptoms, signs, and radiographic findings. However, each condition is a separate entity, with different treatment approaches. Thus, accurate diagnosis is essential for adequate management and improved patient prognosis. The aim of this paper is to report three cases of inflammatory lesions of the jaws—osteomyelitis, ORN, and BRONJ—and to discuss their etiology, clinical aspects, radiographic findings, histopathological features, treatment options, and preventive measures.

  15. Chronic pancreatitis

    Science.gov (United States)

    Chronic pancreatitis - chronic; Pancreatitis - chronic - discharge; Pancreatic insufficiency - chronic; Acute pancreatitis - chronic ... alcohol abuse over many years. Repeated episodes of acute ... chronic pancreatitis. Genetics may be a factor in some cases. ...

  16. Contribution of technetium-99m hexamethylpropylene amine oxime labelled leucocyte scintigraphy to the diagnosis of diabetic foot infection

    Energy Technology Data Exchange (ETDEWEB)

    Devillers, A.; Moisan, A.; Garin, E.; Bourguet, P. [CRLCC Eugene Marquis, Service de Medecine Nucleaire, Rennes (France); Hennion, F.; Poirier, J.Y. [CHRU Pontchaillou, Service d`Endocrinologie, Rennes (France)

    1998-02-01

    We conducted a prospective study in order to evaluate the contribution of technetium-99m hexamethylpropylene amine oxime (HMPAO) labelled leucocyte scintigraphy to the diagnosis and follow-up of osteomyelitis in the diabetic foot. The study was conducted between October 1992 and November 1996 and included 42 patients (30 men and 12 women; mean age 63 years) with diabetes mellitus (type 1, n = 22, type 2, n = 20) who had a total of 56 diabetic foot ulcers. The initial exploration included standard radiography, three-phase bone scintigraphy and {sup 99m}Tc-HMPAO labelled leucocyte scintigraphy (HMPAO-LS), performed within a 3-day interval. For the 56 ulceration sites, 26 cases of osteomyelitis were diagnosed: ten on the basis of radiographic and histological/bacteriological criteria after bone biopsy, 11 after radiographic follow-up and five on the basis of biopsy results alone. No osteomyelitis was present at 30 sites, there were seven cases of cellulitis. The sensitivity and specificity of {sup 99m}Tc-HMPAO-LS were 88.4% and 96.6% respectively (23 true-positives, 29 true-negatives, one false-positive, three false-negatives). The accuracy of radiography, {sup 99m}Tc-methylene diphosphonate and HMPAO-LS was 69.6%, 62.5%, and 92.9%, respectively. Follow-up scintigraphy (n = 14) 4 months after initial diagnosis and 1 month after antibiotic withdrawal confirmed cure of osteomyelitis despite the absence of complete clinical regression of the ulcers. In conclusion, {sup 99m}Tc-HMPAO labelled leucocyte scintigraphy was found to be an excellent method for the diagnosis of osteomyelitis in the diabetic foot. It can contribute to follow-up, particularly when clinical regression of perforating ulcers is incomplete and cure of osteomyelitis must be confirmed in order that antibiotic treatment may be discontinued. (orig.) With 5 figs., 3 tabs., 28 refs.

  17. Evidence for HLA class II susceptible and protective haplotypes for osteomyelitis in pediatric patients with sickle cell anemia.

    Science.gov (United States)

    Al-Ola, K; Mahdi, N; Al-Subaie, A M; Ali, M E; Al-Absi, I K; Almawi, W Y

    2008-05-01

    We investigated the association of human leukocyte antigen (HLA) class II alleles and haplotypes with the pathogenesis of sickle cell anemia (SCA) osteomyelitis. SCA patients comprised 42 patients with osteomyelitis and 150 patients without osteomyelitis; HLA-DRB1* and HLA-DQB1* genotyping was performed by polymerase chain reaction-sequence-specific priming (SSP). DRB1*100101 (P value corrected for the number of different alleles tested, Pc=0.003) was positively associated with osteomyelitis. At the haplotype level, DRB1*100101-DQB1*050101 (Pc=0.001) was more prevalent among patients, while DRB1*030101-DQB1*0201 (Pc=0.020) and DRB1*040101-DQB1*0302 (Pc=0.039) were more prevalent among SCA controls, thereby conferring disease susceptibility or protection to these haplotypes, respectively. These results show that specific HLA haplotypes influence SCA osteomyelitis risk and that specific HLA types may serve as markers for identifying SCA patients at high risk for osteomyelitis.

  18. Diagnosing Diabetic Foot Osteomyelitis in Patients Without Signs of Soft Tissue Infection by Coupling Hybrid 67Ga SPECT/CT With Bedside Percutaneous Bone Puncture

    OpenAIRE

    Aslangul, Elisabeth; M’Bemba, Jocelyne; Caillat-Vigneron, Nadine; Coignard, Sophie; Larger, Etienne; Boitard, Christian; Lipsky, Benjamin A.

    2013-01-01

    OBJECTIVE Successful treatment of osteomyelitis is more likely with accurate diagnosis and identification of the causative pathogens. This typically requires obtaining a specimen of bone, usually by image-guided biopsy. We sought to develop a simpler bedside method for definitively diagnosing osteomyelitis. RESEARCH DESIGN AND METHODS Over 2 years, we enrolled consecutive patients presenting to our diabetic foot clinic with a foot ulcer and clinically suspected osteomyelitis but without soft ...

  19. Gentamicin coating of plasma chemical oxidized titanium alloy prevents implant-related osteomyelitis in rats.

    Science.gov (United States)

    Diefenbeck, M; Schrader, C; Gras, F; Mückley, T; Schmidt, J; Zankovych, S; Bossert, J; Jandt, K D; Völpel, A; Sigusch, B W; Schubert, H; Bischoff, S; Pfister, W; Edel, B; Faucon, M; Finger, U

    2016-09-01

    Implant related infection is one of the most feared and devastating complication associated with the use of orthopaedic implant devices. Development of anti-infective surfaces is the main strategy to prevent implant contamination, biofilm formation and implant related osteomyelitis. A second concern in orthopaedics is insufficient osseointegration of uncemented implant devices. Recently, we reported on a macroporous titanium-oxide surface (bioactive TiOB) which increases osseointegration and implant fixation. To combine enhanced osseointegration and antibacterial function, the TiOB surfaces were, in addition, modified with a gentamicin coating. A rat osteomyelitis model with bilateral placement of titanium alloy implants was employed to analyse the prophylactic effect of gentamicin-sodiumdodecylsulfate (SDS) and gentamicin-tannic acid coatings in vivo. 20 rats were randomly assigned to four groups: (A) titanium alloy; PBS inoculum (negative control), (B) titanium alloy, Staphylococcus aureus inoculum (positive control), (C) bioactive TiOB with gentamicin-SDS and (D) bioactive TiOB plus gentamicin-tannic acid coating. Contamination of implants, bacterial load of bone powder and radiographic as well as histological signs of implant-related osteomyelitis were evaluated after four weeks. Gentamicin-SDS coating prevented implant contamination in 10 of 10 tibiae and gentamicin-tannic acid coating in 9 of 10 tibiae (infection prophylaxis rate 100% and 90% of cases, respectively). In Group (D) one implant showed colonisation of bacteria (swab of entry point and roll-out test positive for S. aureus). The interobserver reliability showed no difference in the histologic and radiographic osteomyelitis scores. In both gentamicin coated groups, a significant reduction of the histological osteomyelitis score (geometric mean values: C = 0.111 ± 0.023; D = 0.056 ± 0.006) compared to the positive control group (B: 0.244 ± 0.015; p < 0.05) was observed. The

  20. The nursing contribution to chronic disease management: a whole systems approach: Report for the National Institute for Health Research Service Delivery and Organisation programme

    OpenAIRE

    Kendall , Sally; Wilson, Patricia M.; Procter, Susan; Brooks, Fiona; Bunn, Frances; Gage, Heather; McNeilly, Elaine

    2010-01-01

    Background Transforming the delivery of care for people with Long Term Conditions (LTCs) requires understanding about how health care policies in England and historical patterns of service delivery have led to different models of chronic disease management (CDM). It is also essential in this transformation to analyse and critique the models that have emerged to provide a more detailed evidence base for future decision making and better patient care. Nurses have made, and continue to make, ...