Chronic multifocal osteomyelitis: Is infectious causation a moot point?

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Nevio Cimolai

2011-09-01

Full Text Available Summary: Chronic multifocal osteomyelitis (CMO is an uncommon disease entity with descriptions possibly emanating from the medical literature over one century ago, and there are numerous disease entities which have been historically detailed and which are probably synonymous. The illness is one of chronicity with exacerbating and remitting focal bony lesions. The differential diagnosis for a bony lesion which ultimately proves to be CMO is initially quite broad. There is no absolute pathognomonic clinical finding, and the diagnosis is highly dependent on clinical course, histopathology, and an absence of microbial infection. Recent studies have focused on immune dysfunction or dysregulation, and there are now many other diseases which are inflammatory in nature and which have been diagnosed among patients with CMO. Despite the aforementioned, the potential for direct infectious causation or indirect causation by infectious stimulation of immunity cannot be entirely excluded. Infection as a mechanism for pathogenesis must continue to be entertained. Multi-centre studies are key to future research. Key words: Osteomyelitis, Infection, SAPHO, Immunity

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

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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.

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.

The acquired hyperostosis syndrome

International Nuclear Information System (INIS)

Dihlmann, W.; Hering, L.; Bargon, G.W.

1988-01-01

Sterno-costo-clavicular hyperostosis (SCCH) is the most common manifestation of a syndrome, consisting of increased bone metabolism, mostly new bone formation and heterotopic ossification of fibrous tissue, which we have characterised as the acquired hyperostosis syndrome. In part I we discuss the terminology, radiological appearances, scintigraphy, clinical and laboratory findings, bacteriology, histology, nosology, complications, treatment and differential diagnosis of SCCH. Chronic recurrent multifocal osteomyelitis (CRMO) is regarded as a phaenotype of SCCH, depending on the age. CRMO occurs in children, adolescents and young adults, SCCH predominantly in middleaged and elderly adults. (orig.) [de

Paucity of bone scan abnormalities in a child with multifocal osteomyelitis and disseminated sepsis

International Nuclear Information System (INIS)

Trpezanovski, J.; Porn, U.; Uren, R.; Howman-Giles, R.; Mansberg, R.

2000-01-01

Full text: We present an unusual case of multifocal osteomyelitis with minimal bone scan abnormalities and markedly discordant findings on Magnetic Resonance Imaging(MRI) and gallium scans. A seven-year-old female presented with left leg, right elbow pain and fever. A bone scan was performed. Mild increased vascularity was demonstrated on the dynamic and blood pool phases of the study in the area of the right elbow. In the delayed images there was a photopenic lesion in the left distal femoral metadiaphysis and also irregular uptake in the metaphyseal regions of the long bones. Low grade soft tissue tracer uptake was seen in the left thigh and right forearm. The patient deteriorated clinically and underwent further investigations with MRI and gallium scans. The MRI showed extensive abnormalities with mulitlocular fluid collection seen throughout most of the muscle groups of both thighs suggesting myositis with an associated cellulitis and osteomyelitis of the left femur. The gallium study was markedly abnormal with increased uptake in the distal 2/3rds of the left femur, proximal 1/2 of the right femur, right proximal forearm (mid forearm extending to mid upper arm), left proximal humerus and right hemithorax especially the lower zones. Staphylococcal aureus was cultured. The patient required intensive care management and slowly responded to antibiotic therapy and surgery to drain abscesses in the thighs. A bone marrow biopsy was normal and immunological tests were performed but a result has yet to be determined. The lack of increased bone uptake in the demonstrated areas of osteomyelitis maybe explained on the basis of an overwhelming infective process inhibiting the patient's healing response. Copyright (2000) The Australian and New Zealand Society of Nuclear Medicine Inc

Primary multifocal osseous lymphoma in a child

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Sato, Takashi S.P. [University of Iowa, Carver College of Medicine, Iowa City, IA (United States); Ferguson, Polly J. [University of Iowa, Department of Pediatrics, Iowa City, IA (United States); Khanna, Geetika [Washington University, Mallinckrodt Institute of Radiology, St Louis, MO (United States)

2008-12-15

We report a case of primary multifocal osseous lymphoma in a 6-year-old girl presenting with multifocal osteolytic lesions without systemic symptoms or identifiable non-osseous primary tumor. The differential diagnoses for such a presentation include histiocytosis X, chronic recurrent multifocal osteomyelitis, acute lymphoblastic leukemia, metastatic disease, and primary bone lymphoma. Although non-Hodgkin lymphoma is common in the pediatric population, its presentation as a primary bone tumor, especially with multifocal disease, is extremely rare and is frequently misdiagnosed. We hope that awareness of this entity will help radiologists achieve timely diagnosis and intervention. (orig.)

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.

Congenital multifocal osteomyelitis at 24 weeks' gestation

International Nuclear Information System (INIS)

Raupp, Peter; Shubbar, Adil; Baichoo, Vijaymani; Samson, Gregory

2007-01-01

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.)

The SAPHO syndrome: defining the radiologic spectrum of diseases comprising the syndrome

International Nuclear Information System (INIS)

Sugimoto, H.; Tamura, K.; Fujii, T.

1998-01-01

The objective of our study was to clarify the radiologic spectrum of disease entities belonging to the SAPHO syndrome (SAPHO being an acronym for synovitis, acne, pustulosis, hyperostosis, and osteitis). A retrospective analysis of radiologic data was undertaken to determine the relationship of the osteoarthritic changes seen in palmoplantar pustulosis (PPP, n = 179), acne (n = 3), psoriasis vulgaris (PsV, n = 355), generalized pustular psoriasis (GPP, n = 25), and chronic recurrent multifocal osteomyelitis (CRMO, n = 4). Osseous changes of PPP, acne, and CRMO overlap each other; 7 PPP, 2 acne, and 3 CRMO patients manifested stenocostoclavicular hyperostosis as well as hyperostosis of the spine, pelvis, and/or femur. These findings were not seen in either PsV or GPP patients. Thirteen PsV and 4 GPP patients had peripheral arthritis and/or symmetrical sacroiliitis, which were not observed in the PPP, acne, and CRMO patients. The PPP, acne, and CRMO patients may be grouped as belonging to the single disease entity, namely SAPHO syndrome. Our findings do not support the inclusion of PsV and GPP in the spectrum of this syndrome. (orig.)

The SAPHO syndrome: defining the radiologic spectrum of diseases comprising the syndrome

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Sugimoto, H.; Tamura, K. [Department of Radiology, Jichi Medical School, 3311 Minamikawachi-machi, Kawachi-gun, Tochigi-ken, 329-04 (Japan); Fujii, T. [Department of Pathology, Jichi Medical School, 3311 Minamikawachi-machi, Kawachi-gun, Tochigi-ken, 329-04 (Japan)

1998-06-02

The objective of our study was to clarify the radiologic spectrum of disease entities belonging to the SAPHO syndrome (SAPHO being an acronym for synovitis, acne, pustulosis, hyperostosis, and osteitis). A retrospective analysis of radiologic data was undertaken to determine the relationship of the osteoarthritic changes seen in palmoplantar pustulosis (PPP, n = 179), acne (n = 3), psoriasis vulgaris (PsV, n = 355), generalized pustular psoriasis (GPP, n = 25), and chronic recurrent multifocal osteomyelitis (CRMO, n = 4). Osseous changes of PPP, acne, and CRMO overlap each other; 7 PPP, 2 acne, and 3 CRMO patients manifested stenocostoclavicular hyperostosis as well as hyperostosis of the spine, pelvis, and/or femur. These findings were not seen in either PsV or GPP patients. Thirteen PsV and 4 GPP patients had peripheral arthritis and/or symmetrical sacroiliitis, which were not observed in the PPP, acne, and CRMO patients. The PPP, acne, and CRMO patients may be grouped as belonging to the single disease entity, namely SAPHO syndrome. Our findings do not support the inclusion of PsV and GPP in the spectrum of this syndrome. (orig.) With 7 figs., 2 tabs., 30 refs.

Osteomyelitis and Osteonecrosis in Inflammatory Bowel Disease

Directory of Open Access Journals (Sweden)

Hugh J Freeman

1997-01-01

Full Text Available Osteomyelitis and osteonecrosis are skeletal disorders seen in patients with inflammatory bowel disease (IBD. Osteomyelitis usually occurs in the pelvic bones, especially in complicated Crohn's disease, presumably by direct extension from a pelvic inflammatory mass, abscess or fistulous tract. Diagnosis of osteomyelitis may be difficult and can lead to spinal extension of the septic process with a resultant neurological deficit, including paraplegia. Osteonecrosis or avascular necrosis has been reported in patients with either ulcerative colitis or Crohn's disease, often, but not exclusively, during or following steroid treatment. The disease is often multifocal, but its natural history is unknown, especially if diagnosed early with modern imaging methods, such as magnetic resonance. In IBD patients, the relationship between osteonecrosis and steroid use is unknown. An adverse steroid effect on bones, especially the femoral heads, may develop in some patients with IBD but, to date, this hypothesis remains unproven. Critical evaluation of published data reveals no consistent association between osteonecrosis and steroid treatment in IBD patients.

MULTIFOCAL CHOROIDITIS IN DISSEMINATED SPOROTRICHOSIS IN PATIENTS WITH HIV/AIDS.

Science.gov (United States)

Biancardi, Ana L; Freitas, Dayvison F S; Valviesse, Vitor R G de A; Andrade, Hugo B; de Oliveira, Manoel M E; do Valle, Antonio C F; Zancope-Oliveira, Rosely M; Galhardo, Maria C G; Curi, Andre L L

2017-01-01

In this article, the authors describe multifocal choroiditis related to disseminated sporotrichosis in patients with HIV/AIDS. We conducted a retrospective observational study of three patients infected with HIV who presented with disseminated sporotrichosis characterized by cutaneous lesions, multifocal choroiditis, and other manifestations, including osteomyelitis and involvement of the bone marrow, larynx, pharynx, and nasal and oral mucosa. Five eyes of three patients with HIV/AIDS showed multifocal choroiditis related to disseminated sporotrichosis. The CD4 counts ranged from 25 to 53 mm. All patients were asymptomatic visually. The ocular disease was bilateral in two patients. The lesion size ranged from 1/3 to 2 disc diameters. None of the patients had vitritis. Of the 12 lesions, 9 were localized in the posterior pole (Zone 1) and 3 were localized in the mild periphery (Zone 2). Multifocal choroiditis due to disseminated sporotrichosis can occur in profoundly immunosuppressed patients with HIV/AIDS.

Spondarthritis hyperostotica pustulo-psoriatica - Review and a clinical-radiological study with special emphasis on SAPHO syndrome

International Nuclear Information System (INIS)

Schilling, F.; Kessler, S.

1998-01-01

Spondarthritis hyperostotica pustulo-psoriatica (Spond.hyp.pp-Schilling), corresponding nosologically to pustulotic arthroosteitis, is a dermato-skeletal 'double system' disease of adults. It consists of the triad (a) palmo-plantar pustulosis (Ppp) or, alternatively, Koenigsbeck-Barber-type psoriasis, (b) sternocostoclavicular hyperostosis (SCCH), and (c) truncal-skeletal changes with syndesmophite-like, hyperostotic and/or parasyndesmophite-like ossifications of layers of the anterior vertebral ligament taken together in the sense of a desmophytal hyperostosis. There is also a potential for sclerosing inflammatory arthritis of the sacro-iliac joints and 'dry' inflammatory arthritis of the sacro-iliac joints and 'dry' inflammatory arthritis of peripheral joints. Thus, the pustulo-psoriatic terrain seems to have a decisive influence on osseous pathology. A total of 38 cases from a study during the years 1982 to 1992 is analysed with regard to morphological characteristics. Rare cases with diaphyseal and pelvic hyperostotic lesions subsequent to bland sclerosing osteomyelitis constitute an overlapping region to chronic recurrent multifocal osteomyelitis (CRMO) and illustrate the relationship between hyperostotic spondarthritis and CRMO. The syndromes of 'acquired hyperostosis' and 'SAPHO', the former more radiologically oriented and the latter more clinically oriented, together with mainly CRMO and hyperostotic spondarthritis and its forms, constitute the 'Spond.hyp.pp.'. Although hyperostosis is a guidepost for the radiologist and SAPHO symptoms are one for the clinician, the syndrome does not represent a diagnosis by itself and requires further differentiation. In this report the entity 'Spond.hyp.pp.' is considered and requires contributions from rheumatologically and osteologically oriented radiologist. (orig.) [de

Sclerotic changes of the manubrium sterni

International Nuclear Information System (INIS)

Jurik, A.G.; Graudal, H.; De Carvalho, A.; Aarhus Univ.

1985-01-01

Six females with nearly identical sclerotic and hyperostotic changes of the manubrium sterni are reported. Malignancies, bacterial inflammatory processes, and Paget disease, which were first suspected, could be excluded. The youngest patients also had sclerotic changes of other bones, including the lumbar spine, the pubic bone, and the clavicle, and may be classified as having ''chronic recurrent multifocal osteomyelitis'' (CRMO). The two oldest patients had ossification of the costoclavicular ligament(s) and may be classified as having ''inter-sterno-costo-clavicular ossification'' (ISCCO). One had only hyperostotic and sclerotic changes as seen in ''sterno-costo-clavicular hyperostosis'' (SCCH). The pathogenesis of these uncommon diseases is unknown, but they are all frequently associated with pustulosis palmoplantaris and have similar clinical courses and laboratory abnormalities. None of the present patients had HLA-B 27 . The similarity of the radiological abnormalities of the manubrium sterni suggests that the diseases themselves may be similar, but with different courses depending on age, CRMO being present in children and young adults and ISCCO or SCCH in older adults. (orig.)

Osteomyelitis

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... to need IV or oral (taken by mouth) antibiotics at home for several more weeks. Most teens recover completely from osteomyelitis. Can I Prevent Osteomyelitis? The easiest way to prevent yourself from getting osteomyelitis is to practice good hygiene. If you get a cut or a ...

Pediatric chronic nonbacterial osteomyelitis.

Science.gov (United States)

Borzutzky, Arturo; Stern, Sara; Reiff, Andreas; Zurakowski, David; Steinberg, Evan A; Dedeoglu, Fatma; Sundel, Robert P

2012-11-01

Little information is available concerning the natural history and optimal treatment of chronic nonbacterial osteomyelitis (CNO). We conducted a retrospective review to assess the clinical characteristics and treatment responses of a large cohort of pediatric CNO patients. Children diagnosed with CNO at 3 tertiary care centers in the United States between 1985 and 2009 were identified. Their charts were reviewed, and clinical, laboratory, histopathologic, and radiologic data were extracted. Seventy children with CNO (67% female patients) were identified. Median age at onset was 9.6 years (range 3-17), and median follow-up was 1.8 years (range 0-13). Half of the patients had comorbid autoimmune diseases, and 49% had a family history of autoimmunity. Patients with comorbid autoimmune diseases had more bone lesions (P coexisting autoimmunity was a risk factor for multifocal involvement and treatment with immunosuppressive agents. Disease-modifying antirheumatic drugs and biologics were more likely to lead to clinical improvement than NSAIDs.

SAPHO: syndrome or concept? Imaging findings

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Earwaker, J.W.S. [Department of Medical Imaging, Holy Spirit Hospital, Brisbane (Australia); Cotten, A. [Service de Radiologie OsteoArticulaire, Hopital Roger Salengro, Lille (France)

2003-06-01

The SAPHO syndrome was a term coined to include a variety of musculoskeletal disorders associated with skin conditions, mainly palmoplantar pustulosis and acne conglobata. It is more correctly a spectrum which includes the following: skin lesions, osteoarticular manifestations of synovitis hyperostosis and osteitis affecting particular target sites, and.a clinical course marked by relapses and remissions. The major sites of involvement are the anterior chest wall, the spine, long bones, flat bones, and large and small joints. The distribution and severity of involvement varies from the adult to the pediatric form of chronic recurrent multifocal osteomyelitis (CRMO). The diagnosis of SAPHO syndrome is not difficult when the typical osteoarticular lesions are located in characteristic target sites. The diagnosis is more difficult if atypical sites are involved and there is no skin disease. (orig.)

The effect of spheroidizing by thermal cycling in low concentration Cr-Mo alloy steel

International Nuclear Information System (INIS)

Yun, H.S.; Kang, C.Y.

1979-01-01

An intensive study was carried out on spheroidizing of pearlite (Sph) and number of spherical carbide in proeutectoid ferrite (No/100) of low concentration Cr-Mo steel with thermal cycling. Physical and mechanical properties of steel containing 0.33 % C with thermal cycling were compared with those of low concentration Cr-Mo steel with thermal cycling. The effect of normal heat treatment and cooling rate on spheroidizing of pearlite and precipitation of fine spherical carbide in the steels were investigated. The results obtained were as follows: 1) Thermal cycling of low concentration Cr-Mo steel promoted the spheroidizing of pearlite compared with that of steel without Cr and Mo to steel had significant effect on spheroidizing of pearlite. 2) Number of fine spherical carbides of low concentration Cr-Mo steel with thermal cycling was over 5 times to that of fine spherical carbides of hypoeutectoid steel with thermal cycling. 3) Spheroidizing of pearlite and number of fine spherical carbide in proeutectoid ferrite of low concentration Cr-Mo steel with increasing thermal cycle and cooling rate. 4) Hardness of steel with thermal cycling was decreased. However, low concentration Cr-Mo steel had little decreasing rate in hardness with increasing thermal cycle on the basis of 100 times in thermal cycle. Therefore, toughness was considered to be increased with increasing spheroidizing of pearlite without changing mechanical properties. (author)

Multimodality imaging of osteomyelitis

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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.

Salmonella osteomyelitis

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Somsri Wiwanitkit; Viroj Wiwanitkit

2016-01-01

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 s...

[Definition of the Diagnosis Osteomyelitis-Osteomyelitis Diagnosis Score (ODS)].

Science.gov (United States)

Schmidt, H G K; Tiemann, A H; Braunschweig, R; Diefenbeck, M; Bühler, M; Abitzsch, D; Haustedt, N; Walter, G; Schoop, R; Heppert, V; Hofmann, G O; Glombitza, M; Grimme, C; Gerlach, U-J; Flesch, I

2011-08-01

The disease "osteomyelitis" is characterised by different symptoms and parameters. Decisive roles in the development of the disease are played by the causative bacteria, the route of infection and the individual defense mechanisms of the host. The diagnosis is based on different symptoms and findings from the clinical history, clinical symptoms, laboratory results, diagnostic imaging, microbiological and histopathological analyses. While different osteomyelitis classifications have been published, there is to the best of our knowledge no score that gives information how sure the diagnosis "osteomyelitis" is in general. For any scientific study of a disease a valid definition is essential. We have developed a special osteomyelitis diagnosis score for the reliable classification of clinical, laboratory and technical findings. The score is based on five diagnostic procedures: 1) clinical history and risk factors, 2) clinical examination and laboratory results, 3) diagnostic imaging (ultrasound, radiology, CT, MRI, nuclear medicine and hybrid methods), 4) microbiology, and 5) histopathology. Each diagnostic procedure is related to many individual findings, which are weighted by a score system, in order to achieve a relevant value for each assessment. If the sum of the five diagnostic criteria is 18 or more points, the diagnosis of osteomyelitis can be viewed as "safe" (diagnosis class A). Between 8-17 points the diagnosis is "probable" (diagnosis class B). Less than 8 points means that the diagnosis is "possible, but unlikely" (class C diagnosis). Since each parameter can score six points at a maximum, a reliable diagnosis can only be achieved if at least 3 parameters are scored with 6 points. The osteomyelitis diagnosis score should help to avoid the false description of a clinical presentation as "osteomyelitis". A safe diagnosis is essential for the aetiology, treatment and outcome studies of osteomyelitis. © Georg Thieme Verlag KG Stuttgart · New York.

Osteomyelitis - children

Science.gov (United States)

... 13th ed. Philadelphia, PA: Elsevier; 2017:chap 21. Kaplan SL. Osteomyelitis. In: Kliegman RM, Stanton BF, St. ... Krogstad P. Osteomyelitis. In: Cherry JD, Harrison GJ, Kaplan SL, Steinbach WJ, Hotez PJ, eds. Feigin and ...

Spondarthritis hyperostotica pustulo-psoriatica - Review and a clinical-radiological study with special emphasis on SAPHO syndrome; Die Spondarthritis hyperostotica pustulo-psoriatica: Nosologische Studie mit klinischer und radiologischer Darstellung innerhalb des SAPHO-Syndroms

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Schilling, F. [Radiologische Universitaetsklinik Mainz (Germany)]|[Zentrum fuer Rheuma-Pathologie, Mainz (Germany); Kessler, S. [Radiologische Universitaetsklinik Mainz (Germany)

1998-12-01

Spondarthritis hyperostotica pustulo-psoriatica (Spond.hyp.pp-Schilling), corresponding nosologically to pustulotic arthroosteitis, is a dermato-skeletal `double system` disease of adults. It consists of the triad (a) palmo-plantar pustulosis (Ppp) or, alternatively, Koenigsbeck-Barber-type psoriasis, (b) sternocostoclavicular hyperostosis (SCCH), and (c) truncal-skeletal changes with syndesmophite-like, hyperostotic and/or parasyndesmophite-like ossifications of layers of the anterior vertebral ligament taken together in the sense of a desmophytal hyperostosis. There is also a potential for sclerosing inflammatory arthritis of the sacro-iliac joints and `dry` inflammatory arthritis of the sacro-iliac joints and `dry` inflammatory arthritis of peripheral joints. Thus, the pustulo-psoriatic terrain seems to have a decisive influence on osseous pathology. A total of 38 cases from a study during the years 1982 to 1992 is analysed with regard to morphological characteristics. Rare cases with diaphyseal and pelvic hyperostotic lesions subsequent to bland sclerosing osteomyelitis constitute an overlapping region to chronic recurrent multifocal osteomyelitis (CRMO) and illustrate the relationship between hyperostotic spondarthritis and CRMO. The syndromes of `acquired hyperostosis` and `SAPHO`, the former more radiologically oriented and the latter more clinically oriented, together with mainly CRMO and hyperostotic spondarthritis and its forms, constitute the `Spond.hyp.pp.`. Although hyperostosis is a guidepost for the radiologist and SAPHO symptoms are one for the clinician, the syndrome does not represent a diagnosis by itself and requires further differentiation. In this report the entity `Spond.hyp.pp.` is considered and requires contributions from rheumatologically and osteologically oriented radiologist. (orig.) [Deutsch] Die vorliegende Uebersicht beschreibt unter vorwiegend radiologischen Gesichtspunkten das Krankheitsbild der Spondarthritis hyperostatica

Radiodiagnostics of maxillary osteomyelitis

International Nuclear Information System (INIS)

Klemova, J.; Jenca, A.; Hanusinova, V.; Danko, J.; Ondrasovicova, J.

2006-01-01

Osteomyelitis is defined as an inflammation or infection in bone tissues - cancellous bone, bone marrow, bone compacta and periosteum due to invasion of infection from surrounding tissues. Maxillary osteomyelitis is less common disease than osteomyelitis of mandible. This can be explained by anatomical structure of maxilla which is mainly composed of sinuses and thin bone lamellae. Such a structure allows rapid propagation of the infection to the surface. There have been examined and treated 70 patients with osteomyelitis of facial bones within past 15 years at Department of stomatology and maxillo-facial surgery of P.J. Safarik University in Kosice. Only four cases were diagnosed as maxillary osteomyelitis. The aim of this study was to mention the differences in anatomy and symptoms of acute and chronic stage of maxillary osteomyelitis and to give a detailed radiographic picture of this affliction. (authors)

MR imaging of osteomyelitis

International Nuclear Information System (INIS)

Cohen, M.D.; Cory, D.A.; Broderick, N.J.; Smith, J.A.

1988-01-01

Seventeen MR studies were performed on 16 children with acute, chronic, or healed osteomyelitis. Abnormality was detected in the soft tissues and bone marrow in all patients with acute or chronic osteomyelitis. Two of three patients with heated osteomyelitis had normal soft tissues and bone marrow. There was overlap in the appearance of acute and chronic osteomyelitis. The patients with acute osteomyelitis, however, tended to have more extensive soft-tissue abnormality, to have more poorly defined margins to the soft-tissue abnormality, and more poorly defined interfaces between normal and diseased bone marrow. The signal characteristics of diseases soft tissue and marrow were compatible with prolongation of T1 and T2 relaxation times as compared with normal muscles

Late septic hip dislocation with multifocal osteomyelitis and malaria: a case report.

Science.gov (United States)

Sreenivas, T; Menon, Jagdish; Nataraj, A R

2012-12-01

A 9-year-old boy presented with high-grade fever associated with pain and swelling in right hip and left leg of 1-week duration. Pus was found on diagnostic aspiration of the right hip joint. Emergency arthrotomy was performed through anterior approach with drill holes in proximal femur and culture showed MRSA. Intravenous antibiotics were given for 4 weeks. Patient symptomatically improved in immediate postoperative period and in bed hip mobilization was started. On eighth postoperative day, child developed high-grade intermittent fever with chills and rigors and diagnosed as plasmodium falciparum malaria. Fever subsided with antimalarial treatment. On twenty-first day, patient complained pain in right hip and X-ray showed posterior hip dislocation with osteomyelitis of proximal femur. Closed reduction and hip spica application was done under general anesthesia. At follow-up, the clinical result was fair with resolution of infection and stiff hip.

Invasive aspergillosis osteomyelitis in children - a case report and review of the literature

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Winterstein, Anton R.; Bohndorf, Klaus; Vollert, Kurt [Klinikum Augsburg, Department of Radiology, Augsburg (Germany); Wagner, Theodor [Klinikum Augsburg, Department of Pathology, Augsburg (Germany); Gnekow, Astrid [Klinikum Augsburg, Department of Pediatrics, Augsburg (Germany); Roemer, Frank W. [Klinikum Augsburg, Department of Radiology, Augsburg (Germany); Boston University School of Medicine, Department of Radiology, Boston, MA (United States)

2010-08-15

Immunocompromised patients are at high risk of secondary infection associated with high morbidity. In children these complications include fungal osteomyelitis due to continuous infiltration or hematogenous spread. The case of a 4-year-old boy is presented who developed lumbalgia and thigh pain during ongoing chemotherapy for acute lymphatic leukemia. MRI revealed infarct-like lesions in the femur and L5 vertebra, which were biopsied. The histologic diagnosis was consistent with angioinvasive aspergillosis. A multifocal osseous presentation has rarely been described in children and an overview of the literature is presented. Invasive aspergillosis is a rare complication to be considered in children with MRI-detected bony lesions of infarct-like appearance. (orig.)

Invasive aspergillosis osteomyelitis in children - a case report and review of the literature

International Nuclear Information System (INIS)

Winterstein, Anton R.; Bohndorf, Klaus; Vollert, Kurt; Wagner, Theodor; Gnekow, Astrid; Roemer, Frank W.

2010-01-01

Immunocompromised patients are at high risk of secondary infection associated with high morbidity. In children these complications include fungal osteomyelitis due to continuous infiltration or hematogenous spread. The case of a 4-year-old boy is presented who developed lumbalgia and thigh pain during ongoing chemotherapy for acute lymphatic leukemia. MRI revealed infarct-like lesions in the femur and L5 vertebra, which were biopsied. The histologic diagnosis was consistent with angioinvasive aspergillosis. A multifocal osseous presentation has rarely been described in children and an overview of the literature is presented. Invasive aspergillosis is a rare complication to be considered in children with MRI-detected bony lesions of infarct-like appearance. (orig.)

Malignant transformation in chronic osteomyelitis

Directory of Open Access Journals (Sweden)

Diogo Lino Moura

Full Text Available ABSTRACT INTRODUCTION: Carcinomatous degeneration is a rare and late complication developing decades after the diagnosis of chronic osteomyelitis. OBJECTIVES: To present the results from a retrospective study of six cases of squamous cell carcinoma arising from chronic osteomyelitis. METHODS: Six cases of chronic osteomyelitis related to cutaneous squamous cell carcinoma were identified. The cause and characteristics of the osteomyelitis were analyzed, as well as time up to malignancy, the suspicion signs for malignancy, the localization and histological type of the cancer, and the type and result of the treatment. RESULTS: The mean time between osteomyelitis onset and the diagnosis of malignant degeneration was 49.17 years (range: 32-65. The carcinoma resulted from tibia osteomyelitis in five cases and from femur osteomyelitis in one. The pathological examination indicated cutaneous squamous cell carcinoma in all cases. All the patients were staged as N0M0, except for one, whose lomboaortic lymph nodes were affected. The treatment consisted of amputation proximal to the tumor in all patients. No patient presented signs of local recurrence and only one had carcinoma metastasis. CONCLUSION: Early diagnosis and proximal amputation are essential for prognosis and final results in carcinomatous degeneration secondary to chronic osteomyelitis.

Osteomyelitis beneath pressure sores

International Nuclear Information System (INIS)

Sugarman, B.; Hawes, S.; Musher, D.M.; Klima, M.; Young, E.J.; Pircher, F.

1983-01-01

Twenty-eight pressure sores were evaluated prospectively. Osteomyelitis was reported histologically in nine of 28 bones and pressure-related changes were reported in 14 bones. Roentgenograms suggested the presence of osteomyelitis in four instances of histologically proved osteomyelitis. Technetium Tc 99m medronate bone scans were highly sensitive, showing increased uptake in all cases of osteomyelitis; however, increased uptake also occurred commonly in uninfected bones due to pressure-related changes or other noninfectious causes. Cultures of bone biopsy samples usually disclosed anaerobic bacteria, gram-negative bacilli, or both. The diagnosis of osteomyelitis must be considered if a pressure sore does not respond to local therapy. If the technetium Tc 99m medronate uptake is increased in the involved area, or roentgenographic findings are abnormal, the diagnosis can only be made with certainty by histologic examination of bone. Antibacterial treatment should be selected based on the results of bone culture

Overview of research trends and problems on Cr-Mo low alloy steels for pressure vessel

International Nuclear Information System (INIS)

Chi, Byung Ha; Kim, Jeong Tae

2000-01-01

Cr-Mo low alloy steels have been used for a long time for pressure vessel due to its excellent corrosion resistance, high temperature strength and toughness. The paper reviewed the latest trends on material development and some problems on Cr-Mo low alloy steel for pressure vessel, such as elevated temperature strength, hardenability, synergetic effect between temper and hydrogen embrittlement, hydrogen attack and hydrogen induced disbonding of overlay weld-cladding

Advances in the genetically complex autoinflammatory diseases.

Science.gov (United States)

Ombrello, Michael J

2015-07-01

Monogenic diseases usually demonstrate Mendelian inheritance and are caused by highly penetrant genetic variants of a single gene. In contrast, genetically complex diseases arise from a combination of multiple genetic and environmental factors. The concept of autoinflammation originally emerged from the identification of individual, activating lesions of the innate immune system as the molecular basis of the hereditary periodic fever syndromes. In addition to these rare, monogenic forms of autoinflammation, genetically complex autoinflammatory diseases like the periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis (PFAPA) syndrome, chronic recurrent multifocal osteomyelitis (CRMO), Behçet's disease, and systemic arthritis also fulfill the definition of autoinflammatory diseases-namely, the development of apparently unprovoked episodes of inflammation without identifiable exogenous triggers and in the absence of autoimmunity. Interestingly, investigations of these genetically complex autoinflammatory diseases have implicated both innate and adaptive immune abnormalities, blurring the line between autoinflammation and autoimmunity. This reinforces the paradigm of concerted innate and adaptive immune dysfunction leading to genetically complex autoinflammatory phenotypes.

Prediction of Ductile Fracture Behaviors for 42CrMo Steel at Elevated Temperatures

Science.gov (United States)

Lin, Y. C.; Liu, Yan-Xing; Liu, Ge; Chen, Ming-Song; Huang, Yuan-Chun

2015-01-01

The ductile fracture behaviors of 42CrMo steel are studied by hot tensile tests with the deformation temperature range of 1123-1373 K and strain rate range of 0.0001-0.1 s-1. Effects of deformation temperature and strain rate on the flow stress and fracture strain of the studied steel are discussed in detail. Based on the experimental results, a ductile damage model is established to describe the combined effects of deformation temperature and strain rate on the ductile fracture behaviors of 42CrMo steel. It is found that the flow stress first increases to a peak value and then decreases, showing an obvious dynamic softening. This is mainly attributed to the dynamic recrystallization and material intrinsic damage during the hot tensile deformation. The established damage model is verified by hot forging experiments and finite element simulations. Comparisons between the predicted and experimental results indicate that the established ductile damage model is capable of predicting the fracture behaviors of 42CrMo steel during hot forging.

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.

Diagnostic strategies in osteomyelitis

International Nuclear Information System (INIS)

Wheat, J.

1985-01-01

Technetium- 99 pyrophosphate bone scanning often identifies patients with osteomyelitis before roentgenographic findings appear. However, recent studies have shown that 99 Tc bone scanning often gives false-negative results, especially in neonates. The accuracy of computed tomographic scanning and indium-111 leukocyte scanning for diagnosis of early osteomyelitis has not been established. 99 Tc bone scanning often gives false-positive results in patients with other conditions leading to bone injury and repair, such as trauma or recent surgery, further limiting the usefulness of this imaging procedure. Newer imaging techniques have not been adequately evaluated to establish their specificity. Because of their high cost and unproved accuracy, these new imaging procedures should not be routinely applied until their usefulness has been established. Bone biopsy remains the procedure of choice for establishing the diagnosis in patients suspected clinically to have osteomyelitis with negative findings on roentgenography and 99 Tc bone scanning. Although Staphylococcus aureus is the leading cause of osteomyelitis, other pathogens cause 30 to 40 percent of cases. Aspiration or biopsy of the involved bone is usually required to choose appropriate antibiotic therapy. Bone biopsy is essential in chronic osteomyelitis, since cultures of sinus drainage are unreliable. Osteomyelitis in diabetics with foot infection and in association with decubitus ulcers presents special problems. Radionuclide scanning often give false-positive results in these patients. Proper diagnosis usually requires careful assessment of clinical and roentgenographic findings. 33 references

Creep-fatigue life prediction method using Diercks equation for Cr-Mo steel

International Nuclear Information System (INIS)

Sonoya, Keiji; Nonaka, Isamu; Kitagawa, Masaki

1990-01-01

For dealing with the situation that creep-fatigue life properties of materials do not exist, a development of the simple method to predict creep-fatigue life properties is necessary. A method to predict the creep-fatigue life properties of Cr-Mo steels is proposed on the basis of D. Diercks equation which correlates the creep-fatigue lifes of SUS 304 steels under various temperatures, strain ranges, strain rates and hold times. The accuracy of the proposed method was compared with that of the existing methods. The following results were obtained. (1) Fatigue strength and creep rupture strength of Cr-Mo steel are different from those of SUS 304 steel. Therefore in order to apply Diercks equation to creep-fatigue prediction for Cr-Mo steel, the difference of fatigue strength was found to be corrected by fatigue life ratio of both steels and the difference of creep rupture strength was found to be corrected by the equivalent temperature corresponding to equal strength of both steels. (2) Creep-fatigue life can be predicted by the modified Diercks equation within a factor of 2 which is nearly as precise as the accuracy of strain range partitioning method. Required test and analysis procedure of this method are not so complicated as strain range partitioning method. (author)

An Overview of the Percutaneous Antibiotic Delivery Technique for Osteomyelitis Treatment and a Case Study of Calcaneal Osteomyelitis.

Science.gov (United States)

Karr, Jeffrey C

2017-11-01

A percutaneous antibiotic delivery technique (PAD-T) used for the adjunctive management of osteomyelitis is presented. This surgical technique incorporates a calcium sulfate and hydroxyapatite (calcium phosphate) bone void filler acting as a carrier vehicle with either an antibiotic or an antifungal medicine, delivering this combination directly into the area of osteomyelitis. The benefit of the PAD-T is reviewed with a case presentation of a successfully treated calcaneal osteomyelitis. No previously reported PAD-T using a simple bone cortex incision in the adjunctive treatment of osteomyelitis has been reported. The PAD-T safely and effectively uses a calcium sulfate and hydroxyapatite bone void filler carrier vehicle to deliver either an antibiotic or an antifungal medicine directly into the area of osteomyelitis.

Recurrent multifocal chronic osteitis in children; Osteite chronique multifocale recurrente de l`enfant

Energy Technology Data Exchange (ETDEWEB)

Quelquejay, C.; Hamidou, A.; Benosman, A.; Adamsbaum, C. [Hopital Saint-Vincent-de-Paul, 75 - Paris (France); Job-Deslandre, Ch. [Hopital Cochin, 75 - Paris (France)

1997-09-01

We have studied retrospectively a series of 10 children presenting with chronic multifocal osteomyelitis (8 girls, 2 boys, 7 to 16 years). All patients had plain films, bone scintigraphies and histological studies. Three had CT scan and/or MRI. Compared with literature data, we observed only one case of palmo-plantar pustulosis and only 2 cases of lysis of the medial extremity of the clavicle; in addition, we report one case of lateral extremity of the clavicle and 2 vertebral locations. The radiological pattern was typical: at the beginning of the disease, plain films showed lytic areas which became progressively osteosclerotic with enlargement of the bone. In all the cases, bone scintigraphy revealed high uptake areas which were often infra-clinical. The diagnosis was delayed from 3 months to 3 years. This emphasizes the difficulty of the diagnosis which relies on the association of clinical, biological and radiological elements. Biopsies are required to rule out an infectious bacterial osteomyelitis or a tumoral process. The pathogenesis of OCMR remains unknown, but the relation with the SAPHO (synovitis, acne, pustulosis, Hyperostosis, osteitis) syndrome is general accepted because of the similar features of the osteitis. The long term follow up appears to be uncertain: 6 of our patients are still symptomatic after five years despite anti inflammatory treatment. (authors). 22 refs.

Role of radiopharmaceuticals in detection of osteomyelitis

International Nuclear Information System (INIS)

Mack, J.M.; Spencer, R.P.

1990-01-01

Osteomyelitis can present as a significant diagnostic problem in medicine. Knowledge of the presence and extent of infection involving bone is important in determining treatment. In this paper the authors review the role played by radiopharmaceutical techniques in establishing the diagnosis of osteomyelitis. Osteomyelitis has been recognized as one of the most serious complications of emergency surgery to repair severe bone trauma. It is also a complication of surgery for prosthesis placement. In still other instances, osteomyelitis can be of hematogenous origin, without a major wound site. Unlike other infections, it rarely presents with acute symptoms. Osteomyelitis is divided into two categories that are time related: acute, in which clinical signs and symptoms of bone infection have been present for less than 1 month, and chronic, in which symptoms have been present for more than 1 month. The acute type is usually caused by Staphylococcus aureus in children (often secondary to skin infection), whereas in adults it can be secondary to intravenous drug abuse. Predisposing factors such as diabetes mellitus, peripheral vascular disease, and sickle cell disease are important to the outcome of osteomyelitis. One way to determine the microbe causing the infection is direct bone biopsy from the site of suspected osteomyelitis. There is one important limitation for needle biopsy in the diagnosis of osteomyelitis. Biopsies are contraindicated in the small bones of the hands and feet, because of risk of pathologic fracture (and may be relatively contraindicated after diphosphonate therapy and loss of bone mineral)

Metallurgical aspects of the weldability of Cr-Mo stabilised ferritic steels

International Nuclear Information System (INIS)

Colombe, Gerard; Petrequin, Pierre; Donati, J.R.; Zacharie, C.

1977-01-01

Results of tests performed to compare the tendency of 2.25 Cr-Mo and 9 Cr-2 Mo steels stabilised with niobium and niobium + vanadium, to different cracking phenomena susceptible to occur during welding, stress-relieving and service in the conditions of fast breeder reactors are presented

Approach to osteomyelitis treatment with antibiotic loaded PMMA.

Science.gov (United States)

Wentao, Zhang; Lei, Guangyu; Liu, Yang; Wang, Wei; Song, Tao; Fan, Jinzhu

2017-01-01

To reduce the incidence of osteomyelitis infection, local antibiotic impregnated delivery systems are commonly used as a promising and effective approach to deliver high antibiotic concentrations at the infection site. The objective of this review was to provide a literature review regarding approach to osteomyelitis treatment with antibiotic loaded PMMA. Literature study regarding osteomyelitis treatment with antibiotic loaded carriers using key terms Antibiotic, osteomyelitis, biodegradable PMMA through published articles. Hands searching of bibliographies of identified articles were also undertaken. We concluded that Antibiotic-impregnated PMMA beads are useful options for the treatment of osteomyelitis for prolonged drug therapy. Copyright © 2016 Elsevier Ltd. All rights reserved.

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 ca...

Chronic suppurative osteomyelitis of the mandible

Directory of Open Access Journals (Sweden)

K Mallikarjun

2011-01-01

Full Text Available Osteomyelitis is an infection of the bone or bone marrow, usually caused by pyogenic bacteria or mycobacterium. Osteomyelitis, inflammatory process of the bone and its structures, can be acute or chronic. Taking a journey from a nonsurgical approach to a surgical one, it appeared to be one osteomyelitis revenge against all our efforts. The pain, the pus, the new bone formation, and all the trouble, this case showed it all. The injudicious use of antibiotics and delay in providing the requisite treatment can cause devastating effects as in the case of an 11-year-old child. A case report on treating osteomyelitis through medication and realizing that surgical excision remains the only realistic approach, the report talks about the investigations and treatment planning done to deal with it.

Management of osteomyelitis of the skull base

International Nuclear Information System (INIS)

Benecke, J.E. Jr.

1989-01-01

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

Juvenile Gaucher disease simulating osteomyelitis

International Nuclear Information System (INIS)

Miller, J.H.; Ortega, J.A.; Heisel, M.A.

1981-01-01

A case in which several imaging procedures suggested juvenile Gaucher disease in a child who presented with symptomatology of osteomyelitis is discussed. The 20-month girl was given a Technetium-99m radionuclide skeletal examination which revealed intense uptake of tracer agents along the shaft of the right femur. It was also found that the liver and spleen were dramatically Ga-67 avid. The bone pain symptomatology suggested an osteomyelitis of the femur, but skeletal scintigraphy with Tc-99m-labeled bone tracer demonstrated photopenic areas involving the femur, suggesting that the bone pain may have been due to marrow packed with Gaucher cells. This overexpansion of the marrow may lead to microfractures with remodeling seen radiographically as periosteal new bone and scintigraphically as increased periosteal deposition of tracer agent. The radiogallium study was useful to exclude an underlying osteomyelitis in the involved femurs. Although juvenile Gaucher disease is unusual, it should be considered in any child who presents with the constellation of hepatosplenomegaly and bone pain simulating osteomyelitis

Juvenile Gaucher disease simulating osteomyelitis

Energy Technology Data Exchange (ETDEWEB)

Miller, J.H.; Ortega, J.A.; Heisel, M.A.

1981-10-01

A case in which several imaging procedures suggested juvenile Gaucher disease in a child who presented with symptomatology of osteomyelitis is discussed. The 20-month girl was given a Technetium-99m radionuclide skeletal examination which revealed intense uptake of tracer agents along the shaft of the right femur. It was also found that the liver and spleen were dramatically Ga-67 avid. The bone pain symptomatology suggested an osteomyelitis of the femur, but skeletal scintigraphy with Tc-99m-labeled bone tracer demonstrated photopenic areas involving the femur, suggesting that the bone pain may have been due to marrow packed with Gaucher cells. This overexpansion of the marrow may lead to microfractures with remodeling seen radiographically as periosteal new bone and scintigraphically as increased periosteal deposition of tracer agent. The radiogallium study was useful to exclude an underlying osteomyelitis in the involved femurs. Although juvenile Gaucher disease is unusual, it should be considered in any child who presents with the constellation of hepatosplenomegaly and bone pain simulating osteomyelitis.

Spinal osteomyelitis caused by Proteus mirabilis in a child

NARCIS (Netherlands)

deWeerd, W; Kimpen, JLL; Miedema, CJ

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.

Chronic osteomyelitis of the clavicle

International Nuclear Information System (INIS)

Granick, M.S.; Ramasastry, S.S.; Goodman, M.A.; Hardesty, R.

1989-01-01

Osteomyelitis of the clavicle is an uncommon disease, but it should be considered in patients who present with pain, cellulitis, or drainage in the sternoclavicular area following head and neck surgery, irradiation, subclavian vein catheterization, or immunosuppression. An idiopathic presentation is possible. In contrast to primary osteomyelitis of the clavicle, which is occasionally seen in children, secondary osteomyelitis is quite rare. It is often mistaken for a fracture or a possible neoplasm on plain x-rays. Tomograms and CT scanning are confirmatory, and in early cases, technetium-99m bone scanning can be helpful. Treatment must include early, aggressive surgical debridement of all affected tissues, followed by wound coverage with a well-vascularized flap and perioperative antibiotics

Nuclear medicine imaging of posttraumatic osteomyelitis

NARCIS (Netherlands)

Govaert, G. A.M.; Glaudemans, Andor 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

CT of osteomyelitis of the spine

International Nuclear Information System (INIS)

Golimbu, C.; Firooznia, H.; Rafii, M.

1984-01-01

Computed tomography (CT) scans were performed in 17 adults with osteomyelitis of the spine. The dominant features were paravertebral soft-tissue swelling, abscess formation, and bone erosion. In two patients there were no findings indicative of osteomyelitis on conventional radiographs, but CT revealed paravertebral abscesses and bone lysis, helping to establish the diagnosis of osteomyelitis, chiefly because of its ability to detect early erosion of spongy vertabral bone, disk involvement, paravertebral soft-tissue swelling or abscess, and extension of the pathology into the spinal canal. Furthermore, CT facilitated closed-needle biopsy, helping to establish the pathologic diagnosis

MRI in diagnostic evaluation of osteomyelitis in children

International Nuclear Information System (INIS)

Stoever, B.; Sigmund, G.; Langer, M.; Brandis, M.

1994-01-01

Several MRI investigations for detecting or excluding acute and non-post-traumatic chronic osteomyelitis were performed in 31 children, osteomyelitis was evident in 21 patients. The sensitivity of MRI for osteomyelitis was 90%, and specificity was 100%. In children with confirmed osteomyelitis 23 follow-up investigations were carried out in order to evaluate duration of the medullary edema. In uncomplicated cases only treated by antibiotics edema regression was evident after 4 weeks and completed after 12-16 weeks. In cases in whom extended concomitant soft-tissue infection was depicted regression of edema was prolonged independent of surgical intervention. The study reveals that at onset of acute osteomyelitis in children MRI can replace technetium 99m-labeled scintigraphy and reduce plain-film investigations. The results support the usefulness of MRI in discrimination of isolated soft-tissue infection and noninfectious diseases of bone. (orig.)

Whole-body MRI in children: Would a 3D STIR sequence alone be sufficient for investigating common paediatric conditions? A comparative study

International Nuclear Information System (INIS)

Merlini, Laura; Carpentier, Marc; Ferrey, Solène; Anooshiravani, Mehrak; Poletti, Pierre-Alexandre; Hanquinet, Sylviane

2017-01-01

Objectives: To test the performance of a single 3D IR T2-Weighted sequence compared to a Whole-body MRI protocol including DWI, T1-Weighted and STIR 3D IR (3S) in a pediatric population. Methods: Two radiologists (15 and 30 years of experience),reviewed WBMRIs: first the STIR alone and 2 weeks later the 3S protocol. The indications were variable. Only positive findings were explicitly reported. A third reader compared the results to gold standard (GS) exams specific for the pathology. Agreement between the two readers, sensitivity and positive predictive value of STIR were calculated. Results: fifty-four WBMRIs were included (16 suspected child abuse, 8 chronic recurrent multifocal osteomyelitis (CRMO), 11 lymphomas, 4 osteosarcomas, 9 neuroblastomas, 6 histiocytosis). The mean age was 6 years 10 months, range: 1 month to 15 years. Agreement between readers was of 0.87 [0.82–0.91] for 3D STIR, and 0.89 [0.83–0.93] for the 3S protocol. For reader 1 sensitivity of 3D STIR was 81.6% and of 3S 81.0%. For reader 2 it was 74.1% for 3D STIR and 74.7% for 3S. For both readers and for both protocols, the positive predictive value (PPV) depended on the type of disease (for example 100% histocytosis and osteosarcomas, >90% for child abuse, >85% CRMO but <70% for lymphoma and neuroblastoma). Conclusions: Sensitivities were not different between the 2 protocols, for each reader and were different between the 2 readers for each protocol.

Whole-body MRI in children: Would a 3D STIR sequence alone be sufficient for investigating common paediatric conditions? A comparative study

Energy Technology Data Exchange (ETDEWEB)

Merlini, Laura, E-mail: laura.merlini@hcuge.ch [Department of Radiology, Unit of Pediatric Radiology, University Hospital Rue Willy-Donzé 6, 1205 Geneva (Switzerland); Carpentier, Marc [Department of Epidemiology, University Hospital, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva Switzerland (Switzerland); Ferrey, Solène; Anooshiravani, Mehrak [Department of Radiology, Unit of Pediatric Radiology, University Hospital Rue Willy-Donzé 6, 1205 Geneva (Switzerland); Poletti, Pierre-Alexandre [Department of Radiology, University Hospital, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva (Switzerland); Hanquinet, Sylviane [Department of Radiology, Unit of Pediatric Radiology, University Hospital Rue Willy-Donzé 6, 1205 Geneva (Switzerland)

2017-03-15

Objectives: To test the performance of a single 3D IR T2-Weighted sequence compared to a Whole-body MRI protocol including DWI, T1-Weighted and STIR 3D IR (3S) in a pediatric population. Methods: Two radiologists (15 and 30 years of experience),reviewed WBMRIs: first the STIR alone and 2 weeks later the 3S protocol. The indications were variable. Only positive findings were explicitly reported. A third reader compared the results to gold standard (GS) exams specific for the pathology. Agreement between the two readers, sensitivity and positive predictive value of STIR were calculated. Results: fifty-four WBMRIs were included (16 suspected child abuse, 8 chronic recurrent multifocal osteomyelitis (CRMO), 11 lymphomas, 4 osteosarcomas, 9 neuroblastomas, 6 histiocytosis). The mean age was 6 years 10 months, range: 1 month to 15 years. Agreement between readers was of 0.87 [0.82–0.91] for 3D STIR, and 0.89 [0.83–0.93] for the 3S protocol. For reader 1 sensitivity of 3D STIR was 81.6% and of 3S 81.0%. For reader 2 it was 74.1% for 3D STIR and 74.7% for 3S. For both readers and for both protocols, the positive predictive value (PPV) depended on the type of disease (for example 100% histocytosis and osteosarcomas, >90% for child abuse, >85% CRMO but <70% for lymphoma and neuroblastoma). Conclusions: Sensitivities were not different between the 2 protocols, for each reader and were different between the 2 readers for each protocol.

Creep properties and simulation of weld repaired low alloy heat resistant CrMo and Mo steels at 540 deg C. Sub-project 2 - Ex-serviced 2.25Cr1M0 weld metal and cross weld repairs

Energy Technology Data Exchange (ETDEWEB)

Rui Wu; Storesund, Jan; Borggreen, Kjeld; Feilitzen, Carl von

2007-12-15

Weld repair has been carried out in an ex-serviced 10 CrMo 9 10 pipe by using 10 CrMo 9 10, 13 CrMo 4 4 and 15 Mo 3 consumables. Application of current welding procedure and consumables results in an over matched weld repair. This is verified by both creep tests and the creep simulations at even lower stresses than tested. Creep specimens have been extracted from ex-serviced 10 CrMo 9 10 parent metal (PM) and weld metal (WM), from virgin 10 CrMo 9 10 WM, from virgin 13 CrMo 4 4 WM, and from virgin 15 Mo 3 WM. In addition, cross weld specimens including weld metal, heat affected zone (HAZ) and parent metal have been taken from the ex-serviced 10 CrMo 9 10 weld joint, and from three weld repairs. In total, there are nine test series. The sequence of creep lifetime at 540 deg C at given stresses is; virgin 10 CrMo 9 10 weld metal > virgin 15 Mo 3 weld metal approx virgin 13 CrMo 4 4 weld metal approx ex-serviced 10 CrMo 9 10 weld metal >> ex-serviced 10 CrMo 9 10 parent metal > ex-serviced 10 CrMo 9 10 cross weld approx 10 CrMo 9 10 cross weld repair approx 13 CrMo 4 4 cross weld repair approx and 15 Mo 3 cross weld repair. All the series show good creep ductility. The ex-serviced 10 CrMo 9 10 parent metal shows a creep lifetime about one order of magnitude shorter than that for both the virgin parent metal and the ex-serviced 10 CrMo 9 10 weld metal, independent of stresses. Differences in creep lifetime among the ex-serviced 10 CrMo 9 10 cross weld and other cross weld repairs are negligible, simply because rupture always occurred in the ex-serviced 10 CrMo 9 10 parent metal, approximately 10 mm from HAZ, for all the cross welds. Necking is frequently observed in the ex-serviced 10 CrMo 9 10 parent metal at the opposite side of the fracture. Creep damage to a large and a small extend is found adjacent to the fracture and at the necking area, respectively. Other parts of the weld joint like weld metal and HAZ are damage-free, independent of stress, weld metal and

Nocardia brasiliensis-associated femorotibial osteomyelitis.

Science.gov (United States)

Vanegas, Samuel; Franco-Cendejas, Rafael; Cicero, Antonio; López-Jácome, Esaú; Colin, Claudia; Hernández, Melissa

2014-03-01

We report a case of femorotibial osteomyelitis due to Nocardia brasiliensis. Nocardia spp are a rare cause of bone infections, and the majority of such cases are associated with the spine. This type of osteomyelitis is uncommon, and in the immunocompetent host, is more often related to a chronic evolution following direct inoculation of the microorganism. Copyright © 2013 The Authors. Published by Elsevier Ltd.. All rights reserved.

Candida albicans osteomyelitis of the cervical spine

International Nuclear Information System (INIS)

Cha, Jang-Gyu; Hong, Hyun-Sook; Koh, Yoon-Woo; Kim, Hee-Kyung; Park, Jung-Mi

2008-01-01

Fungal osteomyelitis is a rare infection that usually develops in immunocompromised patients. Additionally, involvement of the cervical spine by Candida albicans is extremely rare; only three previous cases of Candida vertebral osteomyelitis have been reported in the literature. The diagnosis may be delayed due to nonspecific radiologic findings and a slow progression. We report the CT, MRI, bone scan, and PET-CT findings in a patient who developed Candida osteomyelitis, which was initially misdiagnosed as metastasis, at the atlas and axis following treatment for nasopharyngeal cancer. (orig.)

Oral Rehabilitation of an Osteopetrosis Patient with Osteomyelitis

OpenAIRE

Tamer Celakil; Merve Dogan; Bilge Gokcen Rohlig; Gulumser Evlioglu; Haluk Keskin

2016-01-01

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...

Aspergillus Osteomyelitis: Epidemiology, Clinical Manifestations, Management, and Outcome

Science.gov (United States)

Gamaletsou, Maria N.; Rammaert, Blandine; Bueno, Marimelle A.; Moriyama, Brad; Sipsas, Nikolaos V.; Kontoyiannis, Dimitrios P.; Roilides, Emmanuel; Zeller, Valerie; Prinapori, Roberta; Tajaldeen, Saad Jaber; Brause, Barry; Lortholary, Olivier; Walsh, Thomas J.

2014-01-01

Background The epidemiology, pathogenesis, diagnosis, and management of Aspergillus osteomyelitis are not well understood. Methods Protocol-defined cases of Aspergillus osteomyelitis published in the English literature were reviewed for comorbidities, microbiology, mechanisms of infection, clinical manifestations, radiological findings, inflammatory biomarkers, antifungal therapy, and outcome. Results Among 180 evaluable patients, 127 (71%) were males. Possible predisposing medical conditions in 103 (57%) included pharmacological immunosuppression, primary immunodeficiency, and neutropenia. Seventy-three others (41%) had prior open fracture, trauma or surgery. Eighty (44%) followed a hematogenous mechanism, 58 (32%) contiguous infections, and 42 (23%) direct inoculation. Aspergillus osteomyelitis was the first manifestation of aspergillosis in 77%. Pain and tenderness were present in 80%. The most frequently infected sites were vertebrae (46%), cranium (23%), ribs (16%), and long bones (13%). Patients with vertebral Aspergillus osteomyelitis had more previous orthopedic surgery (19% vs 0%; P=0.02), while those with cranial osteomyelitis had more diabetes mellitus (32% vs 8%; P=0.002) and prior head/neck surgery (12% vs 0%; P=0.02). Radiologic findings included osteolysis, soft-tissue extension, and uptake on T2-weighted images. Vertebral body Aspergillus osteomyelitis was complicated by spinal-cord compression in 47% and neurological deficits in 41%. Forty-four patients (24%) received only antifungal therapy, while 121(67%) were managed with surgery and antifungal therapy. Overall mortality was 25%. Median duration of therapy was 90 days (range, 10–772 days). There were fewer relapses in patients managed with surgery plus antifungal therapy in comparison to those managed with antifungal therapy alone (8% vs 30%; P=0.006). Conclusions Aspergillus osteomyelitis is a debilitating infection affecting both immunocompromised and immunocompetent patients. The most

Oral Rehabilitation of an Osteopetrosis Patient with Osteomyelitis

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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.

Oral Rehabilitation of an Osteopetrosis Patient with Osteomyelitis.

Science.gov (United States)

Celakil, Tamer; Dogan, Merve; Rohlig, Bilge Gokcen; Evlioglu, Gulumser; Keskin, Haluk

2016-01-01

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.

Comparison of low-cycle fatigue data of 2 1/4%CrMo steels

International Nuclear Information System (INIS)

Sanderson, S.J.; Petrequin, P.; Nieuwland, H.C.D.

Data files have been produced on international strain-controlled fatigue information available for 2 1/4%CrMo steels; data assessment from these files is treated in three categories viz: annealed and isothermally annealed 2 1/4%Cr1%Mo steel; normalised and tempered and quenched and tempered 2 1/4%Cr1%Mo steel; and 2 1/4%CrMo variants. The available data have been considered generally in terms of total strain range vs. cycles to failure (Nsub(f)), tensile stress at Nsub(f)/2 vs. cycles to failure and time to failure vs. cycles to failure. Where possible the continuous cycling data have been statistically analysed in terms of the elastic and plastic strain components and cycles to failure to yield best-fit equations over defined temperature (T) regimes viz: T <= 427 deg. C, 427 deg. C < T <= 550 deg. C. and 550 deg. C < T <= 600 deg. C. The behaviour of the steels within the various classifications is discussed. (author)

Multifocal Congenital Hemangiopericytoma.

Science.gov (United States)

Robl, Renata; Carvalho, Vânia Oliveira; Abagge, Kerstin Taniguchi; Uber, Marjorie; Lichtvan, Leniza Costa Lima; Werner, Betina; Mehrdad Nadji, Mehrdad

2017-01-01

Congenital hemangiopericytoma (HPC) is a rare mesenchymal tumor with less aggressive behavior and a more favorable prognosis than similar tumors in adults. Multifocal presentation is even less common than isolated HPC and hence its clinical and histologic recognition may be challenging. A newborn infant with multifocal congenital HPC causing severe deformity but with a favorable outcome after chemotherapy and surgical removal is reported. © 2016 Wiley Periodicals, Inc.

Acute osteomyelitis complicating a simple fracture. A case report.

Science.gov (United States)

Drummond-Webb, J J; Schnaid, E

1983-11-26

Osteomyelitis complicating a simple fracture is unusual, but the reason for its rarity is unknown. We report on a 9-year-old Black boy who developed acute osteomyelitis after sustaining an acute simple fracture of the femur. The causative role of trauma in acute osteomyelitis is discussed and 'the relative resistance of healthy bone' questioned.

Randschicht- und durchgreifendes Härten von 42CrMo4 nach CVD-Beschichtung

DEFF Research Database (Denmark)

Pantleon, Karen; Kessler, Olaf; Hoffmann, Franz

1999-01-01

the properties of steel substrates ready for operation. Bulk hardening and induction surface hardening as two different post-deposition heat treatments are applied on TiN-coated 42CrMo4 (AISI 4140) substrates. The results show great advantages of induction surface hardening because only low distortion appear...

Ewing sarcoma versus osteomyelitis: differential diagnosis with magnetic resonance imaging

International Nuclear Information System (INIS)

Henninger, B.; Glodny, B.; Rudisch, A.; Trieb, T.; Loizides, A.; Judmaier, W.; Schocke, M.F.; Putzer, D.

2013-01-01

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.)

Lente intra-ocular multifocal difrativa apodizada: resultados Diffractive apodized multifocal intraocular lens: results

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Virgilio Centurion

2007-12-01

Full Text Available OBJETIVO: Mostrar os resultados visuais e refracionais com lente intra-ocular multifocal difrativa apodizada. MÉTODOS: Estudo de 100 olhos de 50 pacientes com catarata, submetidos à facoemulsificação com implante bilateral de lente intra-ocular (LIO multifocal difrativa apodizada. Foi avaliada a acuidade visual binocular sem e com correção para longe e perto, a previsibilidade refracional e a freqüência de uso de óculos. RESULTADOS: A acuidade visual sem correção para longe foi de e " 20/30 em 97,56% dos olhos operados e e" J2 em 100%, sendo que 82% dos pacientes nunca usam óculos e 16% usam de forma esporádica. CONCLUSÃO: A LIO multifocal difrativa apodizada mostrou ser uma opção previsível, reproduzível e segura na correção dos vícios de refração para longe e perto durante a cirurgia da catarata, permitindo elevado índice de independência ao uso de óculos.OBJECTIVE: To show visual and refraction results using multifocal diffractive apodized intraocular lens. METHODS: The study of 100 eyes of 50 patients with cataract, submitted to phacoemulsification with bilateral implant of multifocal diffractive apodized intraocular lens (IOL. Binocular visual acuity was evaluated with and without correction for near and distance, and refraction previsibility and frequency of wearing glasses. RESULTS: Visual acuity without correction for distance was e" 20/30 in 97.56% of eyes operated on and e" J2 in 100%, of these 82% of patients never wear glasses and 16% wear glasses sporadically. CONCLUSION: Multifocal diffractive apodized IOL proved to be a foreseeable option, reproducible and safe in the correction of refraction errors for distance and near during cataract surgery, enabling a high rate of independence from the use of glasses.

Chronic Recurrent Multifocal Osteomyelitis

African Journals Online (AJOL)

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OBJECTIVE: To present a case and review the literature on chronic ... Successful treatment is difficult to achieve, though some ... named the syndrome “subacute and chronic ... An assessment of acute ... scans can cause a significant radiation.

Free intra-osseous muscle transfer for treatment of chronic osteomyelitis.

Science.gov (United States)

Lê Thua, Trung-Hau; Boeckx, Willy D; Zirak, Christophe; De Mey, Albert

2015-06-10

Chronic osteomyelitis is still a big reconstructive challenge. Even with standard care, therapeutic failures and recurrences are common. Multiple techniques of tissue transfer have increased the success rate. This study recommends free muscle transfers into the intramedullary bone cavities for treatment of chronic osteomyelitis. The review included 29 patients that were treated for chronic osteomyelitis. Osteomyelitis was located at the femur in four patients, the tibia in 22 patients, and the foot in three patients. Dead bone and scar tissue were replaced with durable free muscle flap with special attention to fill the dead space. The average age of these patients was 48.5 years old (range = 23-70 years old). The average duration of osteomyelitis was 8.2 years (range = 1-45 years). Gracilis was applied in 20 cases (69%), latissimus dorsi was used in five cases (17.2%), and rectus abdominis was performed in four cases (13.8%). There was one flap failure, one partial superficial flap necrosis, two arterial thrombosis, and one venous thrombosis. All the remaining 28 muscle flaps survived. From 1-10 years follow-up, there was one recurrence of the osteomyelitis in the distal end of the intra-medullary cavity of a femur after reconstructing using the gracilis flap. The present study demonstrated that free intramedullary muscle transfers are effective in providing a high rate of success in the treatment of chronic osteomyelitis. The secondary filling of the intramedullary cavity after extensive removal of all infected bony sequesters has proven to give a long-term arrest of chronic osteomyelitis.

Early diagnosis of osteomyelitis occurred in the jaws

International Nuclear Information System (INIS)

Choi, Eun Sook; Na, Seung Mog; Lee, Un Gyeong; Koh, Kwang Joon

1994-01-01

Early diagnosis and treatment of osteomyelitis provide good prognosis and prevent severe complications. Therefore, it is important to early diagnose and treat before the bony changes are observed in conventional radiograms. Authors experienced three cases of early osteomyelitis, and scintigrams were useful to differentiate them from other diseases. The purpose of this report was to aid in the early diagnosis and treatment of osteomyelitis occurred in the jaws. The characteristic features were as follows: 1. In clinical examination, the patients complained mild pain and localized swelling in the jaws. 2. In radiographic findings, the conventional radiograms showed relatively mild bony change in the jaws. 3. The more severe periosteal reactions were observed in radiograms in children than in adult patient. 4. It showed marked increased uptake of radioisotopes in all scintigrams. 5. The three phase bone scanning were helpful to differentiate osteomyelitis from soft tissue diseases.

Osteomyelitis Caused by Candida glabrata in the Distal Phalanx

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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.

Compression behavior of a ferritic-martensitic Cr-Mo steel

DEFF Research Database (Denmark)

Zhang, Zhenbo; Mishin, Oleg; Pantleon, Wolfgang

2012-01-01

The compression behavior of a ferritic-martensitic Cr-Mo steel is characterized for strain rates ranging from 10-4 s-1 to 10-1 s-1 and engineering strains up to 40%. Adiabatic heating causes a reduction in flow stress during continuous compression at a strain rate of 10-1 s-1. No reduction...... in the flow stress is observed if interrupted compression tests are performed with loading and holding steps. Two work-hardening stages with work-hardening rates decreasing linearly with the flow stress are identified and interpreted in terms of the KocksMecking model. The microstructural evolution...

Acute Hematogenous Osteomyelitis in a Five-Month-Old Male with Rickets

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Lucia J. Santiago

2017-01-01

Full Text Available Osteomyelitis is defined as an infection of the bone, bone marrow, and the surrounding soft tissues. Most cases of acute hematogenous osteomyelitis in children are caused by Gram-positive bacteria, principally Staphylococcus aureus. We present a case where a 5-month-old male had an acute onset of decreased movement of his left leg and increased irritability and was subsequently diagnosed with rickets and hematogenous osteomyelitis with bacteremia. The case explores a possible association between hematogenous osteomyelitis and rickets.

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.

Radiologic study of osteomyelitis of the jaw

International Nuclear Information System (INIS)

Lee, Young Ho; Ahn, Hyung Kyu

1980-01-01

The author studied age and sex distribution, etiology, affected site and several radiographic features of osteomyelitis of the jaw. And radiologic classification of osteomyelitis was also done. The material consisted of 118 males and 96 females examined and/or treated under the diagnosis of osteomyelitis during past 11 years (1970-1980.6) in SNUDH. The obtained results were as followings. 1. The incidence is the highest in teen ages (22.9%) and the lowest in seventies. (2.8%). 2. 199 cases were found in lower jaw, and 15 cases in upper jaw. 30.8% of all cases were located at the posterior portion of mandibular body comprising alveolar region. 3. Radiographic examination of osteolytic lesion revealed that 21.5% of all patients had periapical and alveolar bone rarefaction combined with osteoporotic changes were present at the same time. 4. Sclerotic lesions were seen in 62.2% of all patients and 21.5% of sclerotic lesion were diffuse or homogenous type. 5. Based on the radiologic study, classification of the osteomyelitis of the jaw was made. Localized osteolytic type was the highest in incidence (38.8%) and localized sclerotic type was the lowest (7.0%).

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.

Constitutive analysis to predict the hot deformation behavior of 34CrMo4 steel with an optimum solution method for stress multiplier

International Nuclear Information System (INIS)

Xu, Wujiao; Zou, Mingping; Zhang, Lei

2014-01-01

The hot deformation behaviors of steel 34CrMo4 is investigated by hot compression test with the temperature range of 1073–1373 K and the strain rate range of 0.01–10 s −1 . The flow behaviors of 34CrMo4 steel were characterized based on the true stress–true strain curves. The hyperbolic sine law in Arrhenius type is adopted in the constitutive modeling for 34CrMo4. Solving algorithm of the stress multiplier α in hyperbolic sine law is a key factor to guarantee the constitutive model accuracy. How to solve the stress multiplier α is investigated and an optimum solution method for α is proposed. Meanwhile, the influence of strain is incorporated in constitutive analysis by considering the effect of strain on material constants α, n, Q and A. With the optimum solution method for stress multiplier α proposed, the stress prediction is satisfactory with the higher correlation coefficient, R = 0.988 and the lower average absolute relative error, AARE = 3.44% for the entire strain rate-temperature domain. The optimum solution method for stress multiplier α can also be applied for other materials to predict the flow behavior more accurately. - Highlights: • Isothermal compression tests were conducted to study the flow behavior of 34CrMo4. • The influence of strain is incorporated in constitutive model. • An optimum solution method for stress multiplier α is proposed

Concomitant Suppurative Parotitis and Condylar Osteomyelitis.

Science.gov (United States)

Vorrasi, John; Zinberg, Geoffrey

2017-03-01

Parotitis is a common occurrence in the immunocompromised, dehydrated, and malnourished patient as a result of dysfunctional ductal and parotid cells. Inflammation can be acute or chronic based on clinical history, and it can be suppurative based on the presence of micro or macro abscess formation within the substance of the gland. This report presents a case of concomitant condylar osteomyelitis and chronic suppurative parotitis in the setting of previous methicillin-susceptible Staphylococcus aureus foot infection. Ultimately, resection of osteomyelitis, drainage of parotid infection, and intravenous antibiotic therapy led to full resolution of the infection and symptoms. The final pathology of osteomyelitis of the temporomandibular joint and methicillin-resistant S aureus infection is an unusual consequence of chronic parotitis. The patient was restored with a total joint replacement approximately 3 months after resection with no recurrence of infection after 24 months. Copyright © 2016 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

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.

Creep properties and simulation of weld repaired low alloy heat resistant CrMo and Mo steels at 540 deg C. Sub project 1 - Ex-serviced parent metal and virgin weld metals

Energy Technology Data Exchange (ETDEWEB)

Rui Wu; Storesund, Jan; Borggreen, Kjeld; Weilin Zang

2006-10-15

Many existing power generating and process plants, where low alloy heat resistant CrMo(V) steels are extensively used for critical components, have exceeded their design lifetime of usually 100,000 hours. Assessment of residual lifetime and extension of economic life by weld repair have become increasingly important and attractive. This project aims at i) performing weld repair and determining the degree of mismatching, ii) evaluating the creep properties of weld repairs, iii) analysing creep behaviour of weld repair and providing necessary data for further reliable simulations of weld repair creep behaviour in long term service, and iv), simulating and assessing lifetime and creep damage evolution of weld repair. Weld repair using 10 CrMo 9 10, 13 CrMo 4 4 and 15 Mo 3 consumables has been carried out in a service-exposed 10 CrMo 9 10 pipe. Creep specimens have been extracted from the service-exposed 10 CrMo 9 10 parent metal (PM), from the virgin 10 CrMo 9 10 weld metal (WM), from the virgin 13 CrMo 4 4 WM as well as from the virgin 15 Mo 3 WM. Iso-thermal uniaxial creep tests have been performed at 540 deg C in air. Pre- and post-metallography are carried out on the selected samples. FEM simulations using obtained creep data are executed. Pre-test metallography shows normal and acceptable weld repairs at given welding conditions. Creep tests demonstrate that the virgin 10 CrMo 9 10, 13 CrMo 4 4 and 15 Mo 3 WMs have apparently longer creep lifetime than the service-exposed CrMo 9 10 PM at higher stresses than 110 MPa. Among the weld metals, the longest creep lifetime is found in 10 CrMo 9 10. Higher creep strength and lower creep strain rate in the weld metals indicate an overmatch weld. At 95 MPa, however, lifetime of 13 CrMo 4 4 WM is surprisingly short (factors which may shorten lifetime are discussed and one more test will start to verify creep strength at low stress) and tests are still running for other two weld metals. More results regarding low stress

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.)

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...... 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...

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. Copyright © 2015 Elsevier Ltd. All rights reserved.

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

Energy Technology Data Exchange (ETDEWEB)

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

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.

Saksenaea vasiformis osteomyelitis.

OpenAIRE

Pierce, P F; Wood, M B; Roberts, G D; Fitzgerald, R H; Robertson, C; Edson, R S

1987-01-01

A 24-year-old man sustained a crush injury to the tibia, which subsequently became infected with Saksenaea vasiformis. He was treated with debridement and a free myocutaneous flap, but amputation was necessary because of mycotic osteomyelitis. S. vasiformis was recovered and identified on the basis of its characteristic morphology on cornmeal agar.

Distinguishing Osteomyelitis From Ewing Sarcoma on Radiography and MRI

Science.gov (United States)

McCarville, M. Beth; Chen, Jim Y.; Coleman, Jamie L.; Li, Yimei; Li, Xingyu; Adderson, Elisabeth E.; Neel, Mike D.; Gold, Robert E.; Kaufman, Robert A.

2017-01-01

OBJECTIVE The purpose of this study was to determine whether clinical and imaging features can distinguish osteomyelitis from Ewing sarcoma (EWS) and to assess the accuracy of percutaneous biopsy versus open biopsy in the diagnosis of these diseases. MATERIALS AND METHODS Three radiologists reviewed the radiographs and MRI examinations of 32 subjects with osteomyelitis and 31 subjects with EWS to determine the presence of 36 imaging parameters. Information on demographic characteristics, history, physical examination findings, laboratory findings, biopsy type, and biopsy results were recorded. Individual imaging and clinical parameters and combinations of these parameters were tested for correlation with findings from histologic analysis. The diagnostic accuracy of biopsy was also determined. RESULTS On radiography, the presence of joint or metaphyseal involvement, a wide transition zone, a Codman triangle, a periosteal reaction, or a soft-tissue mass, when tested individually, was more likely to be noted in subjects with EWS (p ≤ 0.05) than in subjects with osteomyelitis. On MRI, permeative cortical involvement and soft-tissue mass were more likely in subjects with EWS (p ≤ 0.02), whereas a serpiginous tract was more likely to be seen in subjects with osteomyelitis (p = 0.04). African Americans were more likely to have osteomyelitis than EWS (p = 0). According to the results of multiple regression analysis, only ethnicity and soft-tissue mass remained statistically significant (p ≤ 0.01). The findings from 100% of open biopsies (18/18) and 58% of percutaneous biopsies (7/12) resulted in the diagnosis of osteomyelitis, whereas the findings from 88% of open biopsies (22/25) and 50% of percutaneous biopsies (3/6) resulted in a diagnosis of EWS. CONCLUSION Several imaging features are significantly associated with either EWS or osteomyelitis, but many features are associated with both diseases. Other than ethnicity, no clinical feature improved diagnostic

Periostitis and osteomyelitis in chronic drug addicts

International Nuclear Information System (INIS)

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

1986-01-01

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. (orig.)

Effect of Tempering Temperature on the Microstructure and Properties of Fe-2Cr-Mo-0.12C Pressure Vessel Steel

Science.gov (United States)

Wang, Qi-wen; Li, Chang-sheng; Peng, Huan; Chen, Jie; Zhang, Jian

2018-03-01

To obtain the high-temperature strength and toughness of the medium-high-temperature-pressure steel, the microstructure evolution and mechanical properties of Fe-2Cr-Mo-0.12C steel subjected to three different tempering temperatures after being normalized were investigated. The results show that the microstructure of the sample, tempered in the range 675-725 °C for 50 min, did not change dramatically, yet the martensite/austenite constituents decomposed, and the bainite lath merged together and transformed into polygonal ferrite. At the same time, the precipitate size increased with an increase in tempering temperature. With the increase in the tempering temperature from 675 to 725 °C, the impact absorbed energy of the Fe-2Cr-Mo-0.12C steel at -40 °C increased from 257 to 325 J, and the high-temperature yield strength decreased; however, the high-temperature ultimate tensile strength tempered at 700 °C was outstanding (422-571 MPa) at different tested temperatures. The variations of the properties were attributed to the decomposition of M/A constituents and the coarsening of the precipitates. Fe-2Cr-Mo-0.12C steel normalized at 930 °C and tempered at 700 °C was found to have the best combination of ductility and strength.

Acute bacterial sternoclavicular osteomyelitis in a long-term renal transplant recipient.

Science.gov (United States)

Dounousi, Evangelia; Duni, Anila; Xiromeriti, Sofia; Pappas, Charalambos; Siamopoulos, Kostas C

2016-06-24

Kidney transplantation is the treatment of choice for a significant number of patients with end-stage renal disease. Although immunosuppression therapy improves graft and patient's survival, it is a major risk factor for infection following kidney transplantation altering clinical manifestations of the infectious diseases and complicating both the diagnosis and management of renal transplant recipients (RTRs). Existing literature is very limited regarding osteomyelitis in RTRs. Sternoclavicular osteomyelitis is rare and has been mainly reported after contiguous spread of infection or direct traumatic seeding of the bacteria. We present an interesting case of acute, bacterial sternoclavicular osteomyelitis in a long-term RTR. Blood cultures were positive for Streptococcus mitis, while the portal entry site was not identified. Magnetic resonance imaging of the sternoclavicluar region and a three-phase bone scan were positive for sternoclavicular osteomyelitis. Eventually, the patient was successfully treated with Daptomycin as monotherapy. In the presence of immunosuppression, the transplant physician should always remain alert for opportunistic pathogens or unusual location of osteomyelitis.

Computerized tomography of pelvic osteomyelitis in patients with spinal cord injuries

International Nuclear Information System (INIS)

Firooznia, H.; Rafii, M.; Golimbu, C.; Sokolow, J.

1983-01-01

Computerized tomography (CT) was performed in 19 patients with spinal cord injury (SCI) who had large pressure sores and in whom other complications were suspected. CT detected the depth, extent, and degree of undermining of the edges of the pressure sores in 19 of 27 lesions. Conventional radiography detected four cases of pelvic osteomyelitis. CT detected eight additional cases of pelvic osteomyelitis, as well as eight clinically unsuspected peripelvic and intrapelvic abscesses. Technetium-99m bone scanning was not very helpful because of localization in chronic proliferative changes of bone and widespread foci of myositis ossificans, as well as in osteomyelitis. Gallium-67 scanning detected only one of six abscesses. It was not very helpful because of confusion of abscess and osteomyelitis with intense soft tissue swelling and cellulitis, which are often associated with pressure sores in patients with chronic SCI. CT was found to be, by far, the modality of choice for detection of pelvic osteomyelitis and abscess in patients with SCI

Osteomyelitis following extraction of lower third molar during pregnancy

International Nuclear Information System (INIS)

Kim, Sang Bin; Huh, Kyung Hoe; Yi, Won Jin; Lee, Sam Sun; Kim, Mi Ja

2008-01-01

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.

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.

Chronic pyogenic osteomyelitis of long bones at specialized hospital ...

African Journals Online (AJOL)

Introduction: Chronic pyogenic osteomyelitis of long bones is common and difficult to treat. Objectives: The aim of this study was to examine the pattern of presentation and outcome of treatment of chronic osteomyelitis of long bones at specialized hospital in Nigeria. Patients and methods: Case records of patients who were ...

Saksenaea vasiformis osteomyelitis.

Science.gov (United States)

Pierce, P F; Wood, M B; Roberts, G D; Fitzgerald, R H; Robertson, C; Edson, R S

1987-01-01

A 24-year-old man sustained a crush injury to the tibia, which subsequently became infected with Saksenaea vasiformis. He was treated with debridement and a free myocutaneous flap, but amputation was necessary because of mycotic osteomyelitis. S. vasiformis was recovered and identified on the basis of its characteristic morphology on cornmeal agar. Images PMID:3584430

Multifocal osteogenic sarcoma in Paget's disease

International Nuclear Information System (INIS)

Vuillemin-Bodaghi, V.; Parlier-Cuau, C.; Laredo, J.D.; Cywiner-Golenzer, C.; Quillard, A.; Kaplan, G.

2000-01-01

The most serious complication of Paget's disease is sarcomatous degeneration of pagetic bone. Multifocal sarcomatous degeneration occurs mainly in polyostotic Paget's disease. Multifocal Paget's sarcoma is uncommon and can arise in any site. We report two cases of synchronous multifocal sarcomatous degeneration. The two patients were elderly women (aged 77 and 86 years, respectively) who developed sarcomatous lesions concomitantly, in the first case report in left ilium, left tibia, and first lumbar vertebra and in the second case report in the skull, right ilium, and sacrum. Whether these cases are due to the simultaneous development of several primaries or to metastases from a single primary remains unclear. (orig.)

Progressive Multifocal Leukoencephalopathy

Science.gov (United States)

... SEARCH Definition Treatment Prognosis Clinical Trials Organizations Publications Definition Progressive multifocal leukoencephalopathy (PML) is a disease of the white matter of the brain, caused by a virus infection ...

Efficacy of clindamycin in the treatment of Staphylococcus aureus osteomyelitis in dogs

International Nuclear Information System (INIS)

Braden, T.D.; Johnson, C.A.; Wakenell, P.; Tvedten, H.W.; Mostosky, U.V.

1988-01-01

The efficacy of clindamycin in the treatment of experimentally induced, posttraumatic Staphylococcus aureus osteomyelitis was studied in dogs. At the end of the experiment, bacteria could not be isolated from bone marrow of 15 of 16 (93.7%) dogs treated with clindamycin, whereas bacteria could not be isolated from similar specimens obtained from 6 of 13 (46.1%) untreated dogs. None of the 16 dogs treated with clindamycin had histopathologic evidence of osteomyelitis at the end of the experiment. Five of the 13 untreated control dogs had histopathologic evidence of osteomyelitis. The recovery rate was 31% in untreated dogs, whereas 94% of dogs treated with clindamycin recovered from osteomyelitis. Clindamycin, 11 mg/kg of body weight, given orally, q 12 h, for 28 days, was efficacious in the treatment of experimentally induced, posttraumatic S aureus osteomyelitis in dogs

Clinical Application of Antimicrobial Bone Graft Substitute in Osteomyelitis Treatment: A Systematic Review of Different Bone Graft Substitutes Available in Clinical Treatment of Osteomyelitis

Directory of Open Access Journals (Sweden)

T. A. G. van Vugt

2016-01-01

Full Text Available 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.

Light distribution in diffractive multifocal optics and its optimization.

Science.gov (United States)

Portney, Valdemar

2011-11-01

To expand a geometrical model of diffraction efficiency and its interpretation to the multifocal optic and to introduce formulas for analysis of far and near light distribution and their application to multifocal intraocular lenses (IOLs) and to diffraction efficiency optimization. Medical device consulting firm, Newport Coast, California, USA. Experimental study. Application of a geometrical model to the kinoform (single focus diffractive optical element) was expanded to a multifocal optic to produce analytical definitions of light split between far and near images and light loss to other diffraction orders. The geometrical model gave a simple interpretation of light split in a diffractive multifocal IOL. An analytical definition of light split between far, near, and light loss was introduced as curve fitting formulas. Several examples of application to common multifocal diffractive IOLs were developed; for example, to light-split change with wavelength. The analytical definition of diffraction efficiency may assist in optimization of multifocal diffractive optics that minimize light loss. Formulas for analysis of light split between different foci of multifocal diffractive IOLs are useful in interpreting diffraction efficiency dependence on physical characteristics, such as blaze heights of the diffractive grooves and wavelength of light, as well as for optimizing multifocal diffractive optics. Disclosure is found in the footnotes. Copyright © 2011 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

MR imaging of tuberculous vertebral osteomyelitis: pictorial review

Energy Technology Data Exchange (ETDEWEB)

Gouliamos, A.D.; Kehagias, D.T.; Lahanis, S.; Moulopoulou, E.S.; Kalovidouris, A.A.; Trakadas, S.J.; Vlahos, L.j. [Dept. of Radiology, University of Athens (Greece); Athanassopoulou, A.A. [Dept. of Radiology, Asklipiion Hospital, Athens (Greece)

2001-04-01

Vertebral osteomyelitis is one of the most common manifestations of tuberculosis. Magnetic resonance imaging is considered the main imaging modality for the diagnosis, the demonstration of the extent of the disease, and follow-up studies. Vertebral destruction involving two consecutive levels with sparing of the intervertebral disc, disc herniation into the vertebral body, epidural involvement, and paraspinal abscess are the most common MRI findings suggestive of tuberculous vertebral osteomyelitis. (orig.)

SPECT/CT in the Diagnosis of Skull Base Osteomyelitis

International Nuclear Information System (INIS)

Damle, Nishikant Avinash; Kumar, Rakesh; Kumar, Praveen; Jaganthan, Sriram; Patnecha, Manish; Bal, Chandrasekhar; Bandopadhyaya, Gurupad; Malhotra, Arun

2011-01-01

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 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.

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

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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

Pasteurella multocida Osteomyelitis: An Unusual Case Presentation

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Herbert P von Schroeder

1996-01-01

Full Text Available A healthy male farm employee developed an unusual infection caused by Pasteurella multocida. Atypical features included the chronic nature of the infection, the development of osteomyelitis of the tibia without direct animal inoculation, and lack of fever and leukocytosis. Radiographic appearance of P multocida osteomyelitis may be the result of osteoclast activation and can be confused with musculoskeletal tumour. P multocida infection requires a high degree of suspicion, and should be considered in cases of farm- or animal-related injuries even if there is no history of direct animal contact.

Effect of Elemental Sulfur and Sulfide on the Corrosion Behavior of Cr-Mo Low Alloy Steel for Tubing and Tubular Components in Oil and Gas Industry.

Science.gov (United States)

Khaksar, Ladan; Shirokoff, John

2017-04-20

The chemical degradation of alloy components in sulfur-containing environments is a major concern in oil and gas production. This paper discusses the effect of elemental sulfur and its simplest anion, sulfide, on the corrosion of Cr-Mo alloy steel at pH 2 and 5 during 10, 20 and 30 h immersion in two different solutions. 4130 Cr-Mo alloy steel is widely used as tubing and tubular components in sour services. According to the previous research in aqueous conditions, contact of solid sulfur with alloy steel can initiate catastrophic corrosion problems. The corrosion behavior was monitored by the potentiodynamic polarization technique during the experiments. Energy dispersive X-ray spectroscopy (EDS) and scanning electron microscopy (SEM) have been applied to characterize the corrosion product layers after each experiment. The results show that under the same experimental conditions, the corrosion resistance of Cr-Mo alloy in the presence of elemental sulfur is significantly lower than its resistance in the presence of sulfide ions.

Drug-induced progressive multifocal leukoencephalopathy

DEFF Research Database (Denmark)

Vermeer, N S; Straus, S M J M; Mantel-Teeuwisse, A K

2015-01-01

Progressive multifocal leukoencephalopathy (PML) has been identified as a serious adverse drug reaction (ADR) of several immunomodulatory biologicals. In this study, we contrasted the reporting patterns of PML for two biologicals for which the risk was identified at different points in their life......Progressive multifocal leukoencephalopathy (PML) has been identified as a serious adverse drug reaction (ADR) of several immunomodulatory biologicals. In this study, we contrasted the reporting patterns of PML for two biologicals for which the risk was identified at different points...

Comparison of the visual and intraocular optical performance of a refractive multifocal IOL with rotational asymmetry and an apodized diffractive multifocal IOL.

Science.gov (United States)

Alió, Jorge L; Plaza-Puche, Ana B; Javaloy, Jaime; Ayala, María José

2012-02-01

To compare the visual outcomes and intraocular optical quality observed postoperatively in patients implanted with a rotationally asymmetric multifocal intraocular lens (IOL) and an apodized diffractive multifocal IOL. Seventy-four consecutive eyes of 40 cataract patients (age range: 36 to 79 years) were divided into two groups: zonal refractive group, 39 eyes implanted with a rotationally asymmetric multifocal IOL (Lentis Mplus LS-312 IOL, Oculentis GmbH); and diffractive group, 35 eyes implanted with an apodized diffractive multifocal IOL (ReSTOR SN6AD3, Alcon Laboratories Inc). Distance and near visual acuity outcomes, contrast sensitivity, intraocular optical quality, and defocus curves were evaluated during 3-month follow-up. Calculation of the intraocular aberrations was performed by subtracting corneal aberrations from total ocular aberrations. Uncorrected near visual acuity and distance-corrected near visual acuity were better in the diffractive group than in the zonal refractive group (P=.01), whereas intermediate visual acuity (defocus +1.00 and +1.50 diopters) was better in the zonal refractive group. Photopic contrast sensitivity was significantly better in the zonal refractive group (P=.04). Wavefront aberrations (total, higher order, tilt, primary coma) were significantly higher in the zonal refractive group than in the diffractive group (P=.02). Both multifocal IOLs are able to successfully restore visual function after cataract surgery. The zonal refractive multifocal IOL provides better results in contrast sensitivity and intermediate vision, whereas the diffractive multifocal IOL provides better near vision at a closer distance. Copyright 2012, SLACK Incorporated.

Treatment options for diabetic foot osteomyelitis.

Science.gov (United States)

Senneville, Eric; Robineau, Olivier

2017-06-01

Diabetic foot osteomyelitis therapeutical options are based on antibiotic therapy and surgical resection of the infected bone(s). Surgical and medical approaches of patients suffering from a diabetic foot osteomyelitis do not oppose but are complementary and need to be discussed as a tailored manner. Areas covered: The aim of the present article is to discuss data issued from the most recent guidelines of the Infectious Diseases Society of America and the International Working Group on the Diabetic Foot on the management of the diabetic foot infection and from a search in the current literature using the terms diabetic foot osteomyelitis and treatment/therapy/therapeutical in both PubMed and Medline, restricted to the last five years. Expert opinion: Surgical removal of the entire infected bone(s) has been considered in the past as the standard treatment but medical approach of these patients has now proven efficacy in selected situations. The current emergence of bacteria, especially among Gram negative rods, resistant to almost all the available antibiotics gradually augments the complexity of the management of these patients and is likely to decrease the place of the medical approach and to worsen the outcome of these infections in the next future.

Bilateral polymicrobial osteomyelitis with Candida tropicalis and Candida krusei: a case report and an updated literature review

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....

Multi-focal Vision and Gaze Control Improve Navigation Performance

Directory of Open Access Journals (Sweden)

Kolja Kuehnlenz

2008-11-01

Full Text Available Multi-focal vision systems comprise cameras with various fields of view and measurement accuracies. This article presents a multi-focal approach to localization and mapping of mobile robots with active vision. An implementation of the novel concept is done considering a humanoid robot navigation scenario where the robot is visually guided through a structured environment with several landmarks. Various embodiments of multi-focal vision systems are investigated and the impact on navigation performance is evaluated in comparison to a conventional mono-focal stereo set-up. The comparative studies clearly show the benefits of multi-focal vision for mobile robot navigation: flexibility to assign the different available sensors optimally in each situation, enhancement of the visible field, higher localization accuracy, and, thus, better task performance, i.e. path following behavior of the mobile robot. It is shown that multi-focal vision may strongly improve navigation performance.

Cat-scratch disease osteomyelitis

International Nuclear Information System (INIS)

Heye, S.; Matthijs, P.; Campenhoudt, M. van; Wallon, J.

2003-01-01

We report on a patient who presented with osteomyelitis of a rib and adjacent abscess as a rare and atypical manifestation of cat-scratch disease. Radiographic findings showed an osteolytic lesion with adjacent mass. Biopsy, serology and polymerase chain reaction technique are essential for the final diagnosis. Prognosis is excellent with full recovery. (orig.)

Combination of Erythromycin and Curcumin Alleviates Staphylococcus aureus Induced Osteomyelitis in Rats

Directory of Open Access Journals (Sweden)

Zubin Zhou

2017-08-01

Full Text Available Osteomyelitis is commonly caused by Staphylococcus aureus. Both erythromycin and curcumin can suppress S. aureus growth, but their roles in osteomyelitis are barely studied. We aim to explore the activities of erythromycin and curcumin against chronical osteomyelitis induced by methicillin-resistant S. aureus (MRSA. Chronicle implant-induced osteomyelitis was established by MRSA infection in male Wistar rats. Four weeks after bacterial inoculation, rats received no treatment, erythromycin monotherapy, curcumin monotherapy, or erythromycin plus curcumin twice daily for 2 weeks. Bacterial levels, bone infection status, inflammatory signals and side effects were evaluated. Rats tolerated all treatments well, with no death or side effects such as, diarrhea and weight loss. Two days after treatment completion, erythromycin monotherapy did not suppress bacterial growth and had no effect in bone infection, although it reduced serum pro-inflammatory cytokines tumor necrosis factor (TNF-α and interleukin (IL-6. Curcumin monotherapy slightly suppressed bacterial growth, alleviated bone infection and reduced TNF-α and IL-6. Erythromycin and curcumin combined treatment markedly suppressed bacterial growth, substantially alleviated bone infection and reduced TNF-α and IL-6. Combination of erythromycin and curcumin lead a much stronger efficiency against MRSA induced osteomyelitis in rats than monotherapy. Our study suggests that erythromycin and curcumin could be a new combination for treating MRSA induced osteomyelitis.

Osteomyelitis of the Mandible after Dental Implants in an Immunocompetent Patient

Directory of Open Access Journals (Sweden)

Matthieu Balanger

2017-01-01

Full Text Available Dental implants are now broadly used to replace missing teeth, and the presence of infectious complications is rising. Dental implant therapy as a local risk factor for the onset of osteomyelitis and its management have not been widely explored. Here, we report an unusual case of mandibular suppurative osteomyelitis caused by Streptococcus intermedius in a healthy and immunocompetent patient secondary to mandibular implants. We describe how surgery combined with systemic application of antibiotics allowed conservation of the dental implants in the mandibular bone, discuss the probable source of contamination, and present the follow-up of the osteomyelitis.

Neonatal osteomyelitis in Nigerian infants

Energy Technology Data Exchange (ETDEWEB)

Omene, J.A.; Okolo, A.A.; Odita, J.C.

1984-07-01

Twenty-seven Nigerian infants with osteomyelitis are presented during the first 28 days of life to highlight the severity of the clinical manifestations and the radiological features of this infection. The clinical signs include limitation of movement of the extremities involved and localised swelling. Severe constitutional changes such as fever (>39/sup 0/C) and abdominal distension were common. This contrasts with results from North America and Europe which emphasize the paucity of clinical signs despite involvement of multiple sites. Multiple site involvement was encountered in only eight cases. Staphylococcus aureus, proteus mirabilis and candida albicans were the main pathogens isolated. The long bones were more frequently affected. Aggressive bone destruction was a constant radiological finding peculiar to Staphylococcal osteomyelitis while the formation of Sequestrum, are rare occurrence in the newborn, was present in six patients. The mortality rate was 7.4% and the morbidity rate was equally low.

Neonatal osteomyelitis in Nigerian infants

International Nuclear Information System (INIS)

Omene, J.A.; Okolo, A.A.; Odita, J.C.

1984-01-01

Twenty-seven Nigerian infants with osteomyelitis are presented during the first 28 days of life to highlight the severity of the clinical manifestations and the radiological features of this infection. The clinical signs inlcude limitation of movement of the extremities involved and localised swelling. Severe constitutional changes such as fever (>39 0 C) and abdominal distension were common. This contrasts with results from North America and Europe which emphasize the paucity of clinical signs despite involvement of multiple sites. Multiple site involvement was encountered in only eight cases. Staphylococcus aureus, proteus mirabilis and candida albicans were the main pathogens isolated. The long bones were more frequently affected. Aggressive bone destruction was a constant radiological finding peculiar to Staphylococcal osteomyelitis while the formation of Sequestrum, are rare occurrence in the newborn, was present in six patients. The mortality rate was 7.4% and the morbidity rate was equally low. (orig.)

Bilateral implantation of +2.5 D multifocal intraocular lens and contralateral implantation of +2.5 D and +3.0 D multifocal intraocular lenses: Clinical outcomes

NARCIS (Netherlands)

Nuijts, Rudy M. M. A.; Jonker, Soraya M. R.; Kaufer, Robert A.; Lapid-Gortzak, Ruth; Mendicute, Javier; Martinez, Cristina Peris; Schmickler, Stefanie; Kohnen, Thomas

2016-01-01

To assess the clinical visual outcomes of bilateral implantation of Restor +2.5 diopter (D) multifocal intraocular lenses (IOLs) and contralateral implantation of a Restor +2.5 D multifocal IOL in the dominant eye and Restor +3.0 D multifocal IOL in the fellow eye. Multicenter study at 8

Sonographic evaluation of acute osteomyelitis in infants

International Nuclear Information System (INIS)

Hwang, Ji Young; Lee, Sun Wha; Kim, Yoo Kyung

2002-01-01

To analyze the related sonographic findings and to determine the value of sonography in establishing the diagnosis of acute osteomyelitis in infants. The sonographic findings of eleven infants aged 10 days-4 months (mean, 45 days) with acute osteomyelitis were retrospectively evaluated. The involved bones were the femur (n=5), humerus (n=2), tibia (n=2), rib(n=1), sternum (n=1), and calcaneus (n=1). Discontinuity or destruction of cortical margins, echotexture of the metaphysis and epiphysis, the presence of subperiosteal hypoechoic lesion, adjacent soft tissue swelling, distension of the joint capsule, the echotexture of joint effusion, and dislocation or subluxation of the involved joint were evaluated. The sonographic findings were compared with the plain radiographic (n=12) and MR (n=5) findings, with special attention to the identification of the metaphyseal or epiphyseal bony lesions and the involvement of adjacent joints. The sonographic findings of osteomyelitis were cortical discontinuity or destruction (n=12), hypoechoic lesions with an echogenic rim in the metaphysis (n=12), subperiosteal hypoechoic lesions (n=8), soft tissue swelling (n=9), a distended hip joint, with echogenic fluid (n=5), ill-demarcated echogenic lesions in the capital femoral epiphysis (n=5), and a subluxated hip joint (n=3). Plain radiographs revealed well or ill-defined osteolytic lesions in the metaphysis, accompanied by cortical destruction (n=8), new periosteal bone formation (n=3) and reactive sclerosis (n=2). Abnormality of the femoral epiphyses and joint involvement were not detected on plain radiographs, and in four cases no abnormality was noted. MR imaging showed that at T1WI, affected bony lesions were of low signal intensity and enhaned, with high signal intensity at T2WI. In all cases, both metaphyseal and epiphyseal lesions were demonstrated at MRI, but in one of the three cases in which an epiphyseal lesion was seen at MRI, this was not detected at US. Sonography is

Sonographic evaluation of acute osteomyelitis in infants

Energy Technology Data Exchange (ETDEWEB)

Hwang, Ji Young; Lee, Sun Wha; Kim, Yoo Kyung [College of Medicine, Ewha Womans Univ., Seoul (Korea, Republic of)

2002-03-01

To analyze the related sonographic findings and to determine the value of sonography in establishing the diagnosis of acute osteomyelitis in infants. The sonographic findings of eleven infants aged 10 days-4 months (mean, 45 days) with acute osteomyelitis were retrospectively evaluated. The involved bones were the femur (n=5), humerus (n=2), tibia (n=2), rib(n=1), sternum (n=1), and calcaneus (n=1). Discontinuity or destruction of cortical margins, echotexture of the metaphysis and epiphysis, the presence of subperiosteal hypoechoic lesion, adjacent soft tissue swelling, distension of the joint capsule, the echotexture of joint effusion, and dislocation or subluxation of the involved joint were evaluated. The sonographic findings were compared with the plain radiographic (n=12) and MR (n=5) findings, with special attention to the identification of the metaphyseal or epiphyseal bony lesions and the involvement of adjacent joints. The sonographic findings of osteomyelitis were cortical discontinuity or destruction (n=12), hypoechoic lesions with an echogenic rim in the metaphysis (n=12), subperiosteal hypoechoic lesions (n=8), soft tissue swelling (n=9), a distended hip joint, with echogenic fluid (n=5), ill-demarcated echogenic lesions in the capital femoral epiphysis (n=5), and a subluxated hip joint (n=3). Plain radiographs revealed well or ill-defined osteolytic lesions in the metaphysis, accompanied by cortical destruction (n=8), new periosteal bone formation (n=3) and reactive sclerosis (n=2). Abnormality of the femoral epiphyses and joint involvement were not detected on plain radiographs, and in four cases no abnormality was noted. MR imaging showed that at T1WI, affected bony lesions were of low signal intensity and enhaned, with high signal intensity at T2WI. In all cases, both metaphyseal and epiphyseal lesions were demonstrated at MRI, but in one of the three cases in which an epiphyseal lesion was seen at MRI, this was not detected at US. Sonography is

The MRI appearances of early vertebral osteomyelitis and discitis

International Nuclear Information System (INIS)

Dunbar, J.A.T.; Sandoe, J.A.T.; Rao, A.S.; Crimmins, D.W.; Baig, W.; Rankine, J.J.

2010-01-01

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.

A Rare Case of Cranial Osteomyelitis Caused by Proteus Vulgaris

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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.

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

Nocardia brasiliensis vertebral osteomyelitis and epidural abscess.

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Johnson, Philip; Ammar, Hussam

2013-04-11

Nocardia species exist in the environment as a saprophyte; it is found worldwide in soil and decaying plant matter. They often infect patients with underlying immune compromise, pulmonary disease or history of trauma or surgery. The diagnosis of nocardiosis can be easily missed as it mimics many other granulomatous and neoplastic disease. We report a 69-year-old man who presented with chronic back pain and paraparesis. He was found to have Nocardial brasiliensis vertebral osteomyelitis and epidural abscess. Laminectomy and epidural wash out was performed but with no neurological recovery. This is the second reported case of N brasiliensis vertebral osteomyelitis in the literature.

Acute osteomyelitis, septic arthritis and discitis: Differences between neonates and older children

International Nuclear Information System (INIS)

Offiah, A.C.

2006-01-01

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

Three-dimensional vectorial multifocal arrays created by pseudo-period encoding

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Zeng, Tingting; Chang, Chenliang; Chen, Zhaozhong; Wang, Hui-Tian; Ding, Jianping

2018-06-01

Multifocal arrays have been attracting considerable attention recently owing to their potential applications in parallel optical tweezers, parallel single-molecule orientation determination, parallel recording and multifocal multiphoton microscopy. However, the generation of vectorial multifocal arrays with a tailorable structure and polarization state remains a great challenge, and reports on multifocal arrays have hitherto been restricted either to scalar focal spots without polarization versatility or to regular arrays with fixed spacing. In this work, we propose a specific pseudo-period encoding technique to create three-dimensional (3D) vectorial multifocal arrays with the ability to manipulate the position, polarization state and intensity of each focal spot. We experimentally validated the flexibility of our approach in the generation of 3D vectorial multiple spots with polarization multiplicity and position tunability.

Is Vancomycine Still a Choice for Chronic Osteomyelitis Empirical Therapy in Iran?

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Izadi, Morteza; Zamani, Mohammad Mahdi; Mousavi, Seyed Ahmad; Sadat, Seyed Mir Mostafa; Siami, Zeinab; Vais Ahmadi, Noushin; Jonaidi Jafari, Nematollah; Shirvani, Shahram; Majidi Fard, Mojgan; Imani Fooladi, Abbas Ali

2012-01-01

Background Pyogenic bacteria and especially Staphylococcus aurous (S. aurous) are the most common cause of chronic osteomyelitis. Not only treatment protocol of chronic osteomyelitis occasionally is amiss but also this malady responds to treatment difficultly. Objectives This study investigates antibiotic resistance pattern of S. aurous isolated from Iranian patients who suffer from chronic osteomyelitis by two methods: disk diffusion (Kirby bauyer) and E-test (Epsilometer test) to find Vancomycin susceptibility and MIC (Minimum inhibitory concentration). Patients and Methods One hundred and thirty one patients who suffer from chronic osteomyelitis which have been referred to both governmental and private hospitals at 2010 were tried out for culturing of osteomyelitis site (sites). Antibiotic susceptibility and MIC of isolated bacteria were investigated by Kirby bauyer and E-test respectively. Results Samples were collected from bone (73.4%), surrounding tissue (14.6%) and wound discharge (12%). S. aureus was isolated from 49.6% of the samples. According to disc diffusion, methicillin resistance S. aureus (MRSA) was 75% and Vancomycin resistance S. aurous (VRSA) was 0% and based on MIC, MRSA was 68.5% and VRSA was 0%. According to MIC experiments, maximum sensitivity was against to Vancomycin (90.2%) and ciprofloxacin (54.4%) respectively but based on disc diffusion, maximum sensitivity was against to Vancomycin (97.7%) and ciprofloxacin (43.2%), respectively (P = 0.001). E-test (9.8%) in comparison with Disc diffusion (2.3%) showed higher percent of intermediate susceptibility to Vancomycin (P = 0.017). Conclusions Comparison of antibiograms and MICs showed that Kirby bauyer technique especially for detection of VISA strains is not reliable comparison with E-test. Already VRSA strains have not detected in Iranian chronic osteomyelitis, Thus Vancomycin is the first choice for chronic osteomyelitis empirical therapy in Iran yet. PMID:23483042

Comparison of outcomes with multifocal intraocular lenses: a meta-analysis

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Béatrice Cochener

2011-01-01

Full Text Available Béatrice Cochener1, Antoine Lafuma2, Babak Khoshnood2, Laurène Courouve2, Gilles Berdeaux3,41Centre Hospitalier Universitaire Brest, Brest, France; 2Cemka Eval, Bourg la Reine, France; 3Alcon France, Rueil-Malmaison, France; 4Conservatoire National des Arts et Métiers, Paris, FrancePurpose: To compare the clinical outcome of different multifocal intraocular lenses (IOLs based on information reported in the international literature.Methods: All comparative clinical trials that involved implanting at least one multifocal IOL in patients with cataract or presbyopia were extracted from the literature. Clinical outcomes included uncorrected near visual acuity, uncorrected distance visual acuity, visual acuity, spectacle independence, and halos. Random effects meta-analyses were conducted to compare outcomes for the different IOL types.Results: Twenty papers were identified describing 11 monofocal IOLs and 35 multifocal IOLs (19 diffractive, including 12 ReSTOR®, 14 refractive, and two accommodative patient cohorts. Multifocal and monofocal uncorrected distance visual acuity was 0.165 (0.090–0.240 and 0.093 (0.088–0.098, respectively. Compared with monofocal IOLs, multifocal IOLs produced better uncorrected near visual acuity (0.470 [0.322–0.618] versus 0.141 [0.131–0.152]; P < 0.0001, resulting in higher spectacle independence (incidence rate ratio [IRR] 3.62 [2.90–4.52]; P < 0.0001. Compared with refractive multifocal IOLs, diffractive multifocal IOLs produced a similar uncorrected distance visual acuity (0.105 [0.098–0.111] versus 0.085 [0.029–0.140]; P ≤ 0.78, not significant and better uncorrected near visual acuity (0.217 [0.118–0.317] versus 0.082 [0.067–0.098]; P < 0.0001 resulting in higher spectacle independence (IRR 1.75 [1.24–2.48]; P < 0.001. Compared with other multifocal IOLs, ReSTOR produced a better uncorrected distance visual acuity (0.067 [0.059–0.076] versus 0.093 [0.088–0.098]; P < 0.0001 and better

Should single-phase radionuclide bone imaging be used in suspected osteomyelitis

International Nuclear Information System (INIS)

Fihn, S.D.; Larson, E.B.; Nelp, W.B.; Rudd, T.G.; Gerber, F.H.

1984-01-01

The records of 69 patients who had 86 delayed, static radionuclide bone images for suspected osteomyelitis were studied to determine the effects of this procedure on diagnosis and treatment. Sensitivity, specificity, and positive predictive value were lower than reported in several other studies. When osteomyelitis was unlikely, imaging was either negative or falsely positive and rarely affected treatment. In 46 cases where osteomyelitis was more likely, imaging potentially changed therapy in 19 but was unhelpful or misleading in 15. Static-phase images with ''definite'' interpretations, particularly when negative, are specific, but ''equivocal'' studies may lead to diagnostic and therapeutic errors. When ostemyelitis is improbable, imaging rarely changes diagnosis or therapy

Acute Osteomyelitis as Cause of Late Sepsis in a Nigerian Neonate

African Journals Online (AJOL)

section delivery, significant jaundice, and systemic infections such as pneumonia or meningitis. Some important factors in the pathogenesis of osteomyelitis include the virulence of the .... Current imaging concepts in pediatric osteomyelitis. Eur Radiol 2004;14 Suppl 4:L55‑64. 15. Faust SN, Clark J, Pallett A, Clarke NM.

VAC Therapy Direct to the Medullary Cavity for Chronic Tibial Osteomyelitis.

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Miyamura, Satoshi; Tsuji, Shigeyoshi; Iwai, Takao; Hamada, Masayuki

2016-06-01

Vacuum-assisted wound closure (VAC) is useful for difficult wound beds, although sites where bleeding or infection is expected are usually regarded as problematic for this therapy. This report outlines the treatment of chronic tibial osteomyelitis (Cierny- Mader type III) due to mixed infection with Nocardia spp and Bacteroi- des fragilis by postoperative VAC therapy direct to the medullary cavity, followed by wound coverage with a gastrocnemius myocutaneous skin flap. A 64-year-old man developed chronic left tibial os- teomyelitis after a work injury. The nonviable tissues were debrided, including a sequestrum. Nocardia spp and B. fragilis were isolated from surgical bone specimens, and chronic tibial osteomyelitis due to mixed infection was diagnosed. Postoperatively, VAC therapy was performed directly to the open medullary cavity of the tibia and sub- sequently covered the residual soft tissue defect with a gastrocnemius myocutaneous flap. The authors could not find any English literature on VAC therapy direct to the medullary cavity combined with transplantation of a myocutaneous flap for osteomyelitis. Nocardia spp can cause a variety of infections, among which osteomyelitis occupies a relatively small percentage. This case raises the possibil- ity of treating chronic tibial osteomyelitis caused by mixed infection with Nocardia spp and B. fragilis by applying postoperative VAC ther- apy directly to the medullary cavity and covering the residual wound with a gastrocnemius myocutaneous flap.

Multifocal versus monofocal intraocular lenses after cataract extraction

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Daniel Calladine

Full Text Available BACKGROUND: Good unaided distance visual acuity is now a realistic expectation following cataract surgery and intraocular lens (IOL implantation. Near vision, however, still requires additional refractive power, usually in the form of reading glasses. Multiple optic (multifocal IOLs are available which claim to allow good vision at a range of distances. It is unclear whether this benefit outweighs the optical compromises inherent in multifocal IOLs. OBJECTIVES: The objective of this review was to assess the effects of multifocal IOLs, including effects on visual acuity, subjective visual satisfaction, spectacle dependence, glare and contrast sensitivity, compared to standard monofocal lenses in people undergoing cataract surgery. METHODS: Search methods: We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register, The Cochrane Library 2012, Issue 2, MEDLINE (January 1946 to March 2012, EMBASE (January 1980 to March 2012, the metaRegister of Controlled Trials (mRCT (www.controlled-trials.com, ClinicalTrials.gov (www.clinicaltrials.gov and the WHO International Clinical Trials Registry Platform (ICTRP (www.who.int/ictrp/search/en. We did not use any date or language restrictions in the electronic searches for trials. The electronic databases were last searched on 6 March 2012. We searched the reference lists of relevant articles and contacted investigators of included studies and manufacturers of multifocal IOLs for information about additional published and unpublished studies. Selection criteria: All randomised controlled trials comparing a multifocal IOL of any type with a monofocal IOL as control were included. Both unilateral and bilateral implantation trials were included. Data collection and analysis: Two authors collected data and assessed trial quality. Where possible, we pooled data from the individual studies using a random-effects model, otherwise we tabulated data. MAIN RESULTS: Sixteen completed trials

Osteomyelitis: a current challenge

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Luciana Souza Jorge

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.

Characterization of hot bonding of bi-metal C45/25CrMo4 by plane strain compression test

Science.gov (United States)

Enaim, Mohammed; Langlois, Laurent; Zimmer-Chevret, Sandra; Bigot, Régis; Krumpipe, Pierre

2018-05-01

The need to produce multifunctional parts in order to conform to complex specifications becomes crucial in today's industrial context. This is why new processes are under study to develop multi-material parts which can satisfy this kind of requirements. This paper investigates the possibility of producing hot bonding of bi-metal C45/25CrMo4 parts by forging. This manufacturing process is a solid state joining process that involves, simultaneously, the welding and shaping of multi-material part. In this study, the C45/25CrMo4 bimetal was investigated. The forging is conducted at 1100°C and the influence of reduction rate on microstructure and bonding was investigated. The bonding model is inspired from Bay's model. Following this model, two parameters govern the solid-state bonding at the interface between materials: normal contact pressure and surface expansion. The objective is to check the bonding quality under different pressure and surface expansion. To achieve this goal, the plane strain compression test is chosen as the characterization test. Finally, simulations and experiments of this test are compared.

Radiation osteomyelitis of the mandible. Report of two cases

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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.

[Incremental cost effectiveness of multifocal cataract surgery].

Science.gov (United States)

Pagel, N; Dick, H B; Krummenauer, F

2007-02-01

Supplementation of cataract patients with multifocal intraocular lenses involves an additional financial investment when compared to the corresponding monofocal supplementation, which usually is not funded by German health care insurers. In the context of recent resource allocation discussions, however, the cost effectiveness of multifocal cataract surgery could become an important rationale. Therefore an evidence-based estimation of its cost effectiveness was carried out. Three independent meta-analyses were implemented to estimate the gain in uncorrected near visual acuity and best corrected visual acuity (vision lines) as well as the predictability (fraction of patients without need for reading aids) of multifocal supplementation. Study reports published between 1995 and 2004 (English or German language) were screened for appropriate key words. Meta effects in visual gain and predictability were estimated by means and standard deviations of the reported effect measures. Cost data were estimated by German DRG rates and individual lens costs; the cost effectiveness of multifocal cataract surgery was then computed in terms of its marginal cost effectiveness ratio (MCER) for each clinical benefit endpoint; the incremental costs of multifocal versus monofocal cataract surgery were further estimated by means of their respective incremental cost effectiveness ratio (ICER). An independent meta-analysis estimated the complication profiles to be expected after monofocal and multifocal cataract surgery in order to evaluate expectable complication-associated additional costs of both procedures; the marginal and incremental cost effectiveness estimates were adjusted accordingly. A sensitivity analysis comprised cost variations of +/- 10 % and utility variations alongside the meta effect estimate's 95 % confidence intervals. Total direct costs from the health care insurer's perspective were estimated 3363 euro, associated with a visual meta benefit in best corrected visual

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.

A model of Staphylococcus aureus bacteremia, septic arthritis, and osteomyelitis in chickens.

Science.gov (United States)

Daum, R S; Davis, W H; Farris, K B; Campeau, R J; Mulvihill, D M; Shane, S M

1990-11-01

We studied the occurrence, magnitude, and kinetics of bacteremia and the resultant osteomyelitis and septic arthritis in an avian model of Staphylococcus aureus infection. Thirty-day-old male broiler chicks were inoculated i.v. with 10(5), 10(6), or 10(7) cfu of strain Duntravis, a beta-hemolytic, coagulase-producing, capsular type 8 isolate from the synovial fluid of a 2-year-old black boy. Bacteremia occurred in 80%, 90%, and 100% of animals inoculated with 10(5), 10(6), or 10(7) cfu, respectively. The magnitude of bacteremia in surviving, bacteremic animals increased for 96 hours after inoculation and then decreased after a plateau phase. Osteomyelitis and septic arthritis occurred only in chicks that were continuously bacteremic. The occurrence of osteomyelitis was uniform among continuously bacteremic animals and developed 1 to 23 hours after inoculation. Chickens are susceptible to systemic infections with S. aureus. Bacteremia, osteomyelitis, and septic arthritis may be induced in healthy chickens without prior manipulations that depress their resistance.

A Rare Case of Clavicle Osteomyelitis in a Child and Literature Review

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Elisavet-Anna Chrysochoou

2016-01-01

Full Text Available Acute clavicle osteomyelitis in children is rare representing <3% of osteomyelitis cases. We treated a 12-year-old boy who presented with acute pain in the right clavicle and high fever for 4 days. MRI showed abnormal signal in the right clavicle with periosteal reaction. Staphylococcus aureus isolated from blood was susceptible to methicillin, clindamycin, and macrolides. Clindamycin was given intravenously for 3 wks and orally for another 3 wks with no recurrence. We reviewed clavicle osteomyelitis cases in children searching PubMed English literature. From a total of 89 studies retrieved, only 6 fulfilled the criteria and were analyzed. Sixteen patients (56% female were included with a median age of 9 yrs (range 2 wks–16 yrs. Osteomyelitis was hematogenous in most cases, with S. aureus being the most frequent cause, isolated from either blood or tissue. Symptoms included fever, swelling, and localized bone tenderness. Antimicrobial therapy lasted for 4–12 weeks (median 7.5. Three patients required drainage or curettage. Recurrence occurred in 1/16 cases (6.2% and persistence of symptoms occurred to 2/16 cases (12.5% reported before 90s with unknown antimicrobial susceptibility of the pathogen. Acute clavicle osteomyelitis mainly affects older children and has generally good prognosis. Staphylococcus aureus is most commonly implicated and surgery may be needed.

Does multifocal papillary micro-carcinoma require radioiodine ablation?

International Nuclear Information System (INIS)

Punda, A.; Markovic, V.; Eterovic, D.

2015-01-01

Full text of publication follows. Background: the thyroid carcinomas smaller than 1 cm (micro-carcinomas) comprise a significant fraction of papillary carcinomas. Excluding clinical micro-carcinomas, which present as metastatic disease, the micro-carcinomas diagnosed by ultrasound/FNAC or incidentally have very good prognosis. However, whether or not these papillary micro-carcinomas require post-surgical radioiodine ablation remains a matter of debate. Hypothesis: multi-focality is present in majority of clinical papillary micro-carcinomas and this characteristic can be used to identify the subset of non-clinical micro-carcinomas with greater malignant potential. Methods: the data on types of differentiated thyroid carcinomas diagnosed in the period 2008-2011 in the University Hospital Split were collected. Results: there were 359 patients with thyroid carcinoma, 329 (92%) of which had papillary carcinoma. About 61% (202/329) of papillary carcinomas were micro-carcinomas; most of them were diagnosed by ultrasound/FNAC (134/202= 66%), the rest were incidentalomas (48/202=24%) and clinical micro carcinomas (20/202=10%). Sixty percent (12/20) of patients with clinical micro-carcinoma and 23 patients with non-clinical micro-carcinoma (23/182=13%) had multifocal disease. Conclusion: multifocal disease is a frequent characteristic of clinical papillary thyroid micro-carcinomas, suggesting that multi-focality presents an early stage of non-clinical micro-carcinomas with more aggressive behaviour. Thus multifocal, but not uni-focal papillary micro-carcinomas may require radioiodine ablation. (authors)

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.

A case of osteomyelitis of mandibular bone in Kimura's disease

Energy Technology Data Exchange (ETDEWEB)

Kinugawa, Hiroshi; Shimada, Fumihiko; Sai, Yoshikazu; Amakata, Yoshikuni; Yoshitake, Kazusada [Shiga Univ. of Medical Science, Otsu (Japan)

1991-07-01

We experienced a case of osteomyelitis of mandibular bone in Kimura's disease. The patient received radiation therapy to head and neck area against the same disease. Bone tissue which received radiation therapy had developed malnutrition as side effect of radiation, and osteomyelitis was induced by infection from the teeth. Even in the benign soft tissue disease like Kimura's disease, especially after radiation therapy, pathologic fracture of bone may happen due to bone damage caused by radiation. (author).

Serum levels of innate immunity cytokines are elevated in dogs with metaphyseal osteopathy (hypertrophic osteodytrophy) during active disease and remission.

Science.gov (United States)

Safra, Noa; Hitchens, Peta L; Maverakis, Emanual; Mitra, Anupam; Korff, Courtney; Johnson, Eric; Kol, Amir; Bannasch, Michael J; Pedersen, Niels C; Bannasch, Danika L

2016-10-15

Metaphyseal osteopathy (MO) (hypertrophic osteodystrophy) is a developmental disorder of unexplained etiology affecting dogs during rapid growth. Affected dogs experience relapsing episodes of lytic/sclerotic metaphyseal lesions and systemic inflammation. MO is rare in the general dog population; however, some breeds (Weimaraner, Great Dane and Irish Setter) have a much higher incidence, supporting a hereditary etiology. Autoinflammatory childhood disorders of parallel presentation such as chronic recurrent multifocal osteomyelitis (CRMO), and deficiency of interleukin-1 receptor antagonist (DIRA), involve impaired innate immunity pathways and aberrant cytokine production. Given the similarities between these diseases, we hypothesize that MO is an autoinflammatory disease mediated by cytokines involved in innate immunity. To characterize immune dysregulation in MO dogs we measured serum levels of inflammatory markers in 26 MO and 102 control dogs. MO dogs had significantly higher levels (pg/ml) of serum Interleukin-1beta (IL-1β), IL-18, IL-6, Granulocyte-macrophage colony stimulating factor (GM-CSF), C-X-C motif chemokine 10 (CXCL10), tumor necrosis factor (TNF), and IL-10. Notably, recovered MO dogs were not different from dogs during active MO disease, providing a suggestive mechanism for disease predisposition. This is the first documentation of elevated immune markers in MO dogs, uncovering an immune profile similar to comparable autoinflammatory disorders in children. Copyright © 2016 Elsevier B.V. All rights reserved.

Alterations to Bone Mineral Composition as an Early Indication of Osteomyelitis in the Diabetic Foot

OpenAIRE

Esmonde-White, Karen A.; Esmonde-White, Francis W.L.; Holmes, Crystal M.; Morris, Michael D.; Roessler, Blake J.

2013-01-01

OBJECTIVE Osteomyelitis in the diabetic foot is a major risk factor for amputation, but there is a limited understanding of early-stage infection, impeding limb-preserving diagnoses. We hypothesized that bone composition measurements provide insight into the early pathophysiology of diabetic osteomyelitis. RESEARCH DESIGN AND METHODS Compositional analysis by Raman spectroscopy was performed on bone specimens from patients with a clinical diagnosis of osteomyelitis in the foot requiring surgi...

Investigation on hole manufacture in 42CrMo4 steel using 3-flute carbide drills and 6-flute cermet reamers

DEFF Research Database (Denmark)

Müller, Pavel; De Chiffre, Leonardo

2009-01-01

An investigation on cutting forces and hole quality using carbide 3-flute self-centering drills and 6-flute cermet reamers was performed on 42CrMo4 alloy steel. Different depths of cuts were analyzed with respect to cutting thrust and cutting torque, hole diameter, form and surface integrity. Goo...

A case of radiation ulcer of chest wall with osteomyelitis

International Nuclear Information System (INIS)

Baba, Kyoko; Shibata, Hirotatsu; Mouri, Mari; Uchinuma, Eiju

2005-01-01

We report a case of anterior chest skin ulcer with rib and sternum osteomyelitis following radiation therapy for post operative mammary carcinoma. Operation was performed six times including debridement with sternum and rib resection reconstruction and skin grafting. It took about one and a half years after first operation to heal the ulcer with osteomyelitis. Principle of treatment for radiation ulcer accompanied by osteomyelitis is complete resection of the damaged lesion. However, it is difficult to evaluate the exact area of the damaged lesion. Therefore it is not rare to repeat its recurrence and have trouble with its treatment. In this case, it was considered that the resected area was insufficient on the initial operation. In order to treat for radiation ulcers accompanied by osteomyelitis, enough resection of the damaged lesion in the initial operation is necessary. Ultimately, in our case, the resection of all sternum, part of the right second to fifth rib and part of left second to seventh rib was necessary. It is generally said that reconstructing bone structure is required in the case of wide defect of chest wall. Though, we did not perform reconstruction of the bone structures, there is no problem in the condition of respiratory system. The surrounding soft tissues changed to hard enough to avoid paradoxical breathing. (author)

Salmonella osteomyelitis by sickle cell anemia

International Nuclear Information System (INIS)

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

1985-01-01

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. (orig.) [de

Bilateral implantation of +2.5 D multifocal intraocular lens and contralateral implantation of +2.5 D and +3.0 D multifocal intraocular lenses: Clinical outcomes.

Science.gov (United States)

Nuijts, Rudy M M A; Jonker, Soraya M R; Kaufer, Robert A; Lapid-Gortzak, Ruth; Mendicute, Javier; Martinez, Cristina Peris; Schmickler, Stefanie; Kohnen, Thomas

2016-02-01

To assess the clinical visual outcomes of bilateral implantation of Restor +2.5 diopter (D) multifocal intraocular lenses (IOLs) and contralateral implantation of a Restor +2.5 D multifocal IOL in the dominant eye and Restor +3.0 D multifocal IOL in the fellow eye. Multicenter study at 8 investigative sites. Prospective randomized parallel-group patient-masked 2-arm study. This study comprised adults requiring bilateral cataract extraction followed by multifocal IOL implantation. The primary endpoint was corrected intermediate visual acuity (CIVA) at 60 cm, and the secondary endpoint was corrected near visual acuity (CNVA) at 40 cm. Both endpoints were measured 3 months after implantation with a noninferiority margin of Δ = 0.1 logMAR. In total, 103 patients completed the study (53 bilateral, 50 contralateral). At 3 months, the mean CIVA at 60 cm was 0.13 logMAR and 0.10 logMAR in the bilateral group and contralateral group, respectively (difference 0.04 logMAR), achieving noninferiority. Noninferiority was not attained for CNVA at 40 cm; mean values at 3 months for bilateral and contralateral implantation were 0.26 logMAR and 0.11 logMAR, respectively (difference 0.15 logMAR). Binocular defocus curves suggested similar performance in distance vision between the 2 groups. Treatment-emergent ocular adverse events rates were similar between the groups. Bilateral implantation of the +2.5 D multifocal IOL resulted in similar distance as contralateral implantation of the +2.5 D multifocal IOL and +3.0 D multifocal IOL for intermediate vision (60 cm), while noninferiority was not achieved for near distances (40 cm). Copyright © 2016 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

Unsuspected osteomyelitis in diabetic foot ulcers. Diagnosis and monitoring by leukocyte scanning with indium in 111 oxyquinoline

International Nuclear Information System (INIS)

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.

1991-01-01

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

Prevotella osteomyelitis after dental capping procedure

Directory of Open Access Journals (Sweden)

Alexander Williams

2017-01-01

Full Text Available We present a 49 year old man who presented to the emergency department with severe lower back pain of 5 days duration. One week prior he had been diagnosed with a right psoas muscle abscess and was discharged with a 28 day course of moxifloxacin after the preliminary culture from the psoas grew an anaerobic organism. MRI of the lumbar spine showed marrow edema in the L2 body, occupying most of the anterior two thirds of the body, with cortical erosion at the anteroinferior aspect of L1. Blood cultures were negative and bone biopsy of L2 showed neutrophilic invasion and reactive changes. Cultures grew Prevotella oralis. Hematogenous spread from a composite bonding procedure for exposed teeth roots is thought to be the source for the vertebral osteomyelitis. This is a plausible spread of infection in our case because it was thought that the osteomyelitis occurred first and spread to the psoas muscle.

Actinomycetes as the causative organism of osteomyelitis in sickle cell disease

International Nuclear Information System (INIS)

Barter, S.J.; Hennessy, O.

1984-01-01

The case of a 17-year-old girl with sickle cell anaemia who presented with extensive osteomyelitis due to actinomycetes is reported. Osteomyelitis in the long bones due to actinomycosis is extremely rare. A review of the literature reveals only six cases in which actinomycetes have been isolated from lesions affecting a long bone. The occurence of this condition in sickle cell haemoglobinopathy has not been previously reported. (orig.)

Maxillary Chronic Osteomyelitis Caused by Domestic Violence: A Diagnostic Challenge

Science.gov (United States)

Oliveira, Tamyris Inácio; de Carli, Marina Lara; Ribeiro Junior, Noé Vital; Pereira, Alessandro Antônio Costa; Tatakis, Dimitris N.; Hanemann, João Adolfo Costa

2014-01-01

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. PMID:25610667

Maxillary Chronic Osteomyelitis Caused by Domestic Violence: A Diagnostic Challenge

Directory of Open Access Journals (Sweden)

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.

Welding repair of the high-intermediate pressure steam casings made of Cr-Mo and Cr-Mo-V steel

International Nuclear Information System (INIS)

Mazur, Z.; Cristalinas, V.; Kubiak, J.

1996-01-01

An analysis of typical failure causes and their location at high-intermediate pressure steam turbine casing, and weldability analysis of the Cr-Mo and Cr-Mo-V steels, is carried out. basing on the steam turbine of 158 MW capacity, the internal high pressure casing failures and development of in situ repair welding technology is described. After repair, the casing was put back into service

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

Energy Technology Data Exchange (ETDEWEB)

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.

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.)

FDG PET/CT imaging in the diagnosis of osteomyelitis in the diabetic foot

International Nuclear Information System (INIS)

Kagna, Olga; Keidar, Zohar; Srour, Saher; Militianu, Daniela; Melamed, Eyal

2012-01-01

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.)

Browse Title Index

African Journals Online (AJOL)

... Multifocal tuberculous osteomyelitis/osteochondritis of ribs in patient with ... Vol 94, No 6 (2017), Musculoskeletal pain and backpack usage among .... Vol 77, No 12 (2000), Neuro-vascular injuries associated with limb fractures, Abstract PDF.

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.

Study on the hard tissue changes in osteomyelitis of the jaws using CT image

International Nuclear Information System (INIS)

An, Chang Hyeon; Choi, Bo Ram; Huh, Kyung Hoe; Yi, Won Jin; Lee, Sam Sun; Choi, Soon Chul

2009-01-01

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

Multifocal Epithelial Hyperplasia.

Science.gov (United States)

Agnew, Caitlin; Alexander, Sherene; Prabhu, Neeta

2017-01-15

Multifocal epithelial hyperplasia is a rare disease associated with human papilloma virus types 13 and 32. Diagnosis is based on clinical and histopathological findings, and most lesions are asymptomatic and regress spontaneously with time. The purpose of this paper is to describe a five-year-old girl who presented with multiple intraoral lesions on the buccal mucosa and tongue, which regressed spontaneously in 15 months.

Medical Imaging in Differentiating the Diabetic Charcot Foot from Osteomyelitis.

Science.gov (United States)

Short, Daniel J; Zgonis, Thomas

2017-01-01

Diabetic Charcot neuroarthropathy (DCN) poses a great challenge to diagnose in the early stages and when plain radiographs do not depict any initial signs of osseous fragmentation or dislocation in a setting of a high clinical index of suspicion. Medical imaging, including magnetic resonance imaging, computed tomography, and advanced bone scintigraphy, has its own unique clinical indications when treating the DCN with or without concomitant osteomyelitis. This article reviews different clinical case scenarios for choosing the most accurate medical imaging in differentiating DCN from osteomyelitis. Copyright © 2016 Elsevier Inc. All rights reserved.

Non-Bacterial Chronic Recurrent Osteomyelitis of the Clavicle

Directory of Open Access Journals (Sweden)

KL Pan

2012-03-01

Full Text Available This report details the case of a 12-year-old girl with a painful, progressive swelling of the medial portion of the clavicle with no history of trauma or other constitutional symptoms. All laboratory investigations were normal except for an elevated erythrocyte sedimentation rate (ESR. Initial plain radiographs showed a destructive lesion with magnetic resonance imaging showing features of malignancy. Biopsies revealed osteomyelitis, but with negative bacterial cultures and no evidence of malignancy. Treatment with antibiotics did not result in a favourable response. Over time, the swelling increased in size with episodic exacerbations of pain. Follow-up radiographs showed sclerosis and hyperostosis. After five years, this was recognized as non-bacterial chronic recurrent osteomyelitis of the clavicle.

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.

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.

Cryptococcal osteomyelitis: a report of 5 cases and a review of the recent literature.

Science.gov (United States)

Medaris, Leigh Ann; Ponce, Brent; Hyde, Zane; Delgado, Dennis; Ennis, David; Lapidus, William; Larrison, Matthew; Pappas, Peter G

2016-06-01

Cryptococcus neoformans is a fungal pathogen associated with advanced HIV disease and other disorders associated with immune dysfunction. The pulmonary and the central nervous system are the most common manifestations of the disease. Localised osteomyelitis as the sole manifestation of extrapulmonary disease is rare. Herein, we present five cases of Cryptococcus osteomyelitis as the only manifestation of extrapulmonary disease. We also identified 84 additional cases of isolated cryptococcal osteomyelitis in the literature. Using these data, we have made some general recommendations regarding an approach to treatment of this uncommon clinical entity. © 2016 Blackwell Verlag GmbH.

Skull Base Osteomyelitis from Otitis Media Presenting as the Collet-Sicard Syndrome

Directory of Open Access Journals (Sweden)

Wong-Kein Low

2018-01-01

Full Text Available Skull base osteomyelitis can involve the jugular foramen and its associated cranial nerves resulting in specific clinical syndromes. The Collet-Sicard syndrome describes the clinical manifestations of palsies involving cranial nerves IX, X, XI, and XII. We present a rare atypical case of skull base osteomyelitis originating from infection of the middle ear and causing the Collet-Sicard syndrome. Caused by Pseudomonas aeruginosa and Klebsiella pneumoniae, this occurred in an elderly diabetic man subsequent to retention of a cotton swab in an ear with chronic suppurative otitis media. This case report illustrates the possibility of retained cotton swabs contributing to the development of otitis media, skull base osteomyelitis, and ultimately the Collet-Sicard syndrome in the ears of immune-compromised patients with chronically perforated eardrums.

Osteomyelitis in burn patients requiring skeletal fixation

NARCIS (Netherlands)

Barret, JP; Desai, MH; Herndon, DN

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.

An unusual osteomyelitis caused by Moraxella osloensis: A case report

Directory of Open Access Journals (Sweden)

Nidal J. Alkhatib

Full Text Available Introduction: Moraxella osloensis is a gram-negative coccobacillus, that is saprophytic on skin and mucosa, and rarely causing human infections. Reported cases of human infections usually occur in immunocompromised patients. Presentation of case: We report the second case of M. osloensis-caused-osteomyelitis in literature, occurring in a young healthy man. The organism was identified by sequencing analysis of the 16S ribosomal RNA gene. Our patient was treated successfully with surgical debridement and intravenous third-generation cephalosporins. Discussion: M. osloensis has been rarely reported to cause local or invasive infections. Our case report is the second case in literature and it is different from the previously reported case in that our patient has no chronic medical problems, no history of trauma, with unique presentation and features on the MRI and intraoperative finding. Conclusion: Proper diagnosis is essential for appropriate treatment of osteomyelitis. RNA gene sequence analysis is the primary method of M. osloensis diagnosis. M. osloensis is usually susceptible to simple antibiotics. Keywords: Moraxella osloensis, Osteomyelitis, Case report

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.

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.

Hematogenous osteomyelitis in children

DEFF Research Database (Denmark)

Rud, B; Halken, S; Damholt, V

1986-01-01

approach. At follow-up after 5 (1-12) years, 3 neonates had developed severe growth disturbances despite optimal initial treatment. Acceptable results were obtained with antibiotic therapy for 6 weeks or more. We recommend ampicillin and a penicillinase-resistant penicillin, unless bacterial resistance......In a 10-year period, 31 children, including 9 infants, were treated for hematogenous osteomyelitis. Fifteen children were treated closed and 16 open. Thirteen of 14 positive cultures were Staphylococcus aureus. Three recurrences could possibly have been prevented by a more aggressive primary...

Refractive outcomes after multifocal intraocular lens exchange.

Science.gov (United States)

Kim, Eric J; Sajjad, Ahmar; Montes de Oca, Ildamaris; Koch, Douglas D; Wang, Li; Weikert, Mitchell P; Al-Mohtaseb, Zaina N

2017-06-01

To evaluate the refractive outcomes after multifocal intraocular lens (IOL) exchange. Cullen Eye Institute, Baylor College of Medicine, Houston, Texas, USA. Retrospective case series. Patients had multifocal IOL explantation followed by IOL implantation. Outcome measures included type of IOL, surgical indication, corrected distance visual acuity (CDVA), and refractive prediction error. The study comprised 29 patients (35 eyes). The types of IOLs implanted after multifocal IOL explantation included in-the-bag IOLs (74%), iris-sutured IOLs (6%), sulcus-fixated IOLs with optic capture (9%), sulcus-fixated IOLs without optic capture (9%), and anterior chamber IOLs (3%). The surgical indication for exchange included blurred vision (60%), photic phenomena (57%), photophobia (9%), loss of contrast sensitivity (3%), and multiple complaints (29%). The CDVA was 20/40 or better in 94% of eyes before the exchange and 100% of eyes after the exchange (P = .12). The mean refractive prediction error significantly decreased from 0.22 ± 0.81 diopter (D) before the exchange to -0.09 ± 0.53 D after the exchange (P exchange to 0.23 D after the exchange (P exchange can be performed safely with good visual outcomes using different types of IOLs. A lower refractive prediction error and a higher likelihood of 20/40 or better vision can be achieved with the implantation of the second IOL compared with the original multifocal IOL, regardless of the final IOL position. Copyright © 2017 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

Three Phase Bone Scintigraphy in Active and Inactive Osteomyelitis

International Nuclear Information System (INIS)

Yang, Woo Jin; Chung, Soo Kyo; Ha, Hyun Kwon; Bahk, Yong Whee

1988-01-01

To Appreciate the value of bone scintigraphy in determination of the bony infection, we performed three phase bone scintigraphy in 34 cases of osteomyelitis of extremities prospectively. They were clinically inactive in 11 and active in 23 cases. We confirmed the active osteomyelitis by operation or aspiration within one week after scintigraphy. Perfusion, blood pool and delayed images were analyzed respectively and compared with the plain roentgenograms. All 23 active lesions showed diffusely increased perfusion in affected limbs. The areas of the increased activities on blood pool images were larger than or similar to those on delayed images in 17 cases (73.9%) with active osteomyelitis and smaller in 6 cases (26.1%). 5 of the latter 6 cases showed definite soft tissue activities on blood pool images. In inactive cases bone scintigrams were completely normal in 4 cases. Two of those were normal on plain films and remaining two showed mild focal bony sclerosis. Among 7 inactive lesions, perfusion was normal in 2 cases, diffusely increased in 4 cases and diffusely decreased in 1 case. 6 of these 7 cases showed increased activities both on blood pool and delayed images and the areas of increased activities on blood pool images didn't exceed those on delayed images. Bony sclerosis was noted on plain films in those 7 inactive lesions and the extent of the sclerosis correlated well to delayed images. Large blood pool activity was characteristics of active osteomyelitis. Normal three phase bone scintigram may indicate the time to terminate the treatment, but increased activity on perfusion and blood pool scans is not absolute indication of active lesion if the extent of the lesion on the blood pool image is smaller than that on delayed image and if no definite soft tissue activity is noted on perfusion and blood pool images in clinically inactive patient.

Update on the Management of Pediatric Acute Osteomyelitis and Septic Arthritis

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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.

Comparison between OPD-Scan results and visual outcomes of monofocal and multifocal intraocular lenses Comparação dos resultados do OPD-Scan e performance visual das lentes intraoculares monofocal e multifocal

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Wilson Takashi Hida

2009-08-01

Full Text Available PURPOSE: To compare the visual outcome, contrast sensitivity and wavefront analysis of patients that underwent cataract surgery and implantation of AcrySof SN60D3 multifocal intraocular lens with those who received the AcrySof SN60AT monofocal IOL. METHODS: This was a prospective clinical trial of forty eyes that received the multifocal IOL and thirty-two eyes that received the monofocal IOL after phacoemulsification. RESULTS: Values for total and spherical aberrations in the multifocal group were statistically lower than in the monofocal group. In the monofocal group, 75% achieved uncorrected intermediate visual acuities between Jaeger 1 and 6. In the multifocal group, 75% of the eyes achieved more than Jaeger 6. At least 87.5% of the multifocal group and 6.3% of the monofocal group achieved monocular uncorrected near acuity of 20/30 (J2, N5 or better. And 90.0% of the eyes in the multifocal group and 37.5% in the monofocal group achieved an uncorrected near acuity of 20/40 (J3, N6 or better. The mean spherical error was 0.11 D in the multifocal group and -0.18 D in the monofocal group (p=0.0379. The SN60D3 group compared to SN60AT group had low contrast sensitivity (log units with statistically significant differences in 6.0 cpd in photopic conditions (p=0.014 and the SN60D3 group compared to SN60AT group had higher contrast sensitivity (log units under mesopic conditions (p=0.044. CONCLUSION: The multifocal IOLs induced less spherical aberration than monofocal IOLs and predictably good uncorrected distance and uncorrected near acuities. However, contrast sensitivity was lower in the multifocal group.OBJETIVO: Comparar a performance visual, sensibilidade ao contraste e de wavefront com OPD-Scan em pacientes submetidos a cirurgia de facoemulsificação com implante de lente intraocular AcrySof SN60D3 multifocal e AcrySof SA60AT monofocal. MÉTODOS: Quarenta olhos com a lente intraocular multifocal e trinta e dois olhos com a lente intraocular

Diabetic charcot neuroarthropathy of the foot and ankle with osteomyelitis.

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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. Copyright © 2014 Elsevier Inc. All rights reserved.

MRI findings of post-traumatic osteomyelitis of distal phalanx following neglected open fracture

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Kim, Dong Eon; Lee, Ji Hee; Bae, Kung Eun; Kang, Min Jin; Kim, Jea Hyung; Cho, Woo Ho; Jeong, Myeong Ja; Kim, Soung Hee; Kim, Ji Young; Kim, Soo Hyun [Dept. of Radiology, Inje University Sanggye Paik Hospital, Seoul (Korea, Republic of)

2017-07-15

Careful radiologic examination of the osteolytic lesion is important for patients with fracture. Differential diagnosis includes osteonecrosis, neoplasm and infections. In this report, we presented MRI findings of post-traumatic osteomyelitis following neglected open fracture of 3rd distal phalanx with open wound. Early suspicion and imaging of wound or soft tissue inflammation around osteolytic lesion could be helpful for diagnosis of osteomyelitis.

Case report 558: Multicentric Klebsiella pneumoniae (Friedlaenders bacillus) osteomyelitis in sickle cell anemia

International Nuclear Information System (INIS)

Malpani, A.R.; Sundaram, M.; Ramani, S.K.

1989-01-01

This patient represents a unique combination of multicentric osteomyelitis due to Klebsiella pneumoniae, lesions in the skull, pathological fracture of a long bone and no evidence of pulmonary disease. That Klebsiella pneumoniae osteomyelitis can occur in sickle cell anemia should be considered when such bone changes are seen. The remarkable resolution on conservative management also needs to be noted. (orig./GDG)

Multifocal choroiditis following simultaneous hepatitis A, typhoid, and yellow fever vaccination

Directory of Open Access Journals (Sweden)

Escott S

2013-02-01

Full Text Available Sarah Escott, Ahmad B Tarabishy, Frederick H DavidorfHavener Eye Institute, The Ohio State University, Columbus, OH, USAAbstract: The paper describes the first reported case of multifocal choroiditis following simultaneous hepatitis-A, typhoid, and yellow fever vaccinations. A 33-year-old male developed sudden onset of flashing lights and floaters in his right eye 3 weeks following hepatitis A, typhoid, and yellow fever vaccinations. Fundus examination and angiography confirmed the presence of multiple peripheral chorioretinal lesions. These lesions demonstrated characteristic morphologic changes over a period of 8 weeks which were consistent with a diagnosis of self-resolving multifocal choroiditis. Vaccine-induced intraocular inflammation has been described infrequently. We demonstrate the first case of self-resolving multifocal choroiditis following simultaneous administration of hepatitis A, yellow fever, and typhoid immunizations.Keywords: multifocal choroiditis, vaccination, hepatitis A, typhoid, yellow fever

Autorefraction versus subjective refraction in a radially asymmetric multifocal intraocular lens

NARCIS (Netherlands)

van der Linden, Jan Willem; Vrijman, Violette; Al-Saady, Rana; El-Saady, Rana; van der Meulen, Ivanka J.; Mourits, Maarten P.; Lapid-Gortzak, Ruth

2014-01-01

To evaluate whether the automated refraction (AR) correlates with subjective manifest (MR) refraction in eyes implanted with radially asymmetric multifocal intraocular lens (IOLs). This retrospective study evaluated 52 eyes (52 patients) implanted with a radially asymmetric multifocal IOL (LS-312

Multifocal hyperfunctioning thyroid carcinoma without metastases.

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Nishida, Akiko T; Hirano, Shigeru; Asato, Ryo; Tanaka, Shinzo; Kitani, Yoshiharu; Honda, Nobumitsu; Fujiki, Nobuya; Miyata, Kouji; Fukushima, Hideyuki; Ito, Juichi

2008-09-01

Hyperthyroidism due to thyroid carcinoma is rare, and most cases are caused by hyperfunctioning metastatic thyroid carcinoma rather than primary carcinoma. Among primary hyperfunctioning thyroid carcinoma, multifocal thyroid carcinoma is exceedingly rare, with the only one case being reported in the literature. Here, we describe the case of a 62-year-old woman with multifocal functioning thyroid carcinoma. Technetium-99m (99m Tc) scintigraphic imaging showed four hot areas in the thyroid gland. Histopathological examination of all four nodules revealed papillary carcinoma, corresponding to hot areas in the 99m Tc scintigram. DNA sequencing of the thyrotropin receptor (TSH-R) gene from all nodules revealed no mutation, indicating that activation of TSH-R was unlikely in the pathophysiogenesis of hyperfunctioning thyroid carcinoma in the present case.

Childhood Pyogenic Osteomyelitis in Abakaliki, South East Nigeria

African Journals Online (AJOL)

2018-04-20

Apr 20, 2018 ... study of all the children aged 18 years and under seen with pyogenic osteomyelitis ... Staphylococcus aureus was ... Poverty is also a limiting factor in its definitive ... type and virulence of causative organism, host immune.

Diagnostic value of MRI signs in differentiating Ewing sarcoma from osteomyelitis.

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Kasalak, Ömer; Overbosch, Jelle; Adams, Hugo Ja; Dammann, Amelie; Dierckx, Rudi Ajo; Jutte, Paul C; Kwee, Thomas C

2018-01-01

Background The value of magnetic resonance imaging (MRI) signs in differentiating Ewing sarcoma from osteomyelitis has not be thoroughly investigated. Purpose To investigate the value of various MRI signs in differentiating Ewing sarcoma from osteomyelitis. Material and Methods Forty-one patients who underwent MRI because of a bone lesion of unknown nature with a differential diagnosis that included both Ewing sarcoma and osteomyelitis were included. Two observers assessed several MRI signs, including the transition zone of the bone lesion, the presence of a soft-tissue mass, intramedullary and extramedullary fat globules, and the penumbra sign. Results Diagnostic accuracies for discriminating Ewing sarcoma from osteomyelitis were 82.4% and 79.4% for the presence of a soft-tissue mass, and 64.7% and 58.8% for a sharp transition zone of the bone lesion, for readers 1 and 2 respectively. Inter-observer agreement with regard to the presence of a soft-tissue mass and the transition zone of the bone lesion were moderate (κ = 0.470) and fair (κ = 0.307), respectively. Areas under the receiver operating characteristic curve of the diameter of the soft-tissue mass (if present) were 0.829 and 0.833, for readers 1 and 2 respectively. Mean inter-observer difference in soft-tissue mass diameter measurement ± limits of agreement was 35.0 ± 75.0 mm. Diagnostic accuracies of all other MRI signs were all value in this setting.

Diagnosis of pedal osteomyelitis in diabetic patients using current scintigraphic techniques

International Nuclear Information System (INIS)

Keenan, A.M.; Tindel, N.L.; Alavi, A.

1989-01-01

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)

A rare case of a medullary, multifocal lesion in the distal radius

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Aktas, Birol; Ozturan, Burak; Kilic, Bulent; Ozkan, Korhan

2017-01-01

In multifocal findings, the possibility of multifocal osteoid osteomas should be considered and this case helps us to be attentive for the unusual radiographical presentation of osteoid osteoma. PMID:28748099

Surgical management of maxillary and premaxillary osteomyelitis in a reticulated python (Python reticulatus).

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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

A NEW CLASSIFICATION OF OSTEOMYELITIS FOR DEVELOPING ...

African Journals Online (AJOL)

Kateee

2003-07-01

Jul 1, 2003 ... Background : The term osteomyelitis (OSM) was first coined by Nelaton in 1844. Waldvogel et al, Cierny-Mader, May et al classifications of OSM from developed countries and Meier et al's from Nigeria have been described. Objective:This new classification was developed to highlight significant pathology ...

Is there a simple, definitive, and cost-effective way to diagnose osteomyelitis in the pressure ulcer patient?

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Larson, David L; Gilstrap, Jarom; Simonelic, Kevin; Carrera, Guillermo F

2011-02-01

Despite advances in managing pressure ulcers, there is still no definitive way to diagnose bone infection (osteomyelitis) short of open biopsy. An effective, less invasive diagnostic method might result in cost savings and improved care; however, needle aspiration, computed tomography scan, magnetic resonance imaging, ultrasound, and bone scans have proven unsatisfactory in predicting osteomyelitis. The authors reviewed preoperative radiologic studies of stage IV pressure ulcer patients and their bone biopsy results to determine which radiologic studies are most diagnostic for osteomyelitis. Patients (n = 44) having surgical débridement of stage IV ulcers with open bone biopsy after prior radiographic imaging (plain films, ultrasound, computed tomography, magnetic resonance imaging, and/or nuclear bone scans) were included. Studies were interpreted by a single musculoskeletal radiologist blinded to information from the medical record and following standard radiologic criteria for the diagnosis of osteomyelitis. The percentage of patients with biopsy-proven osteomyelitis identified with imaging was 50 percent using a computed tomography scan and 88 percent using a plain film of the bony area of involvement. The overall sensitivity of either radiologic study was 61 percent. The percentage of patients without osteomyelitis identified as not having the condition by imaging was 85 percent for the computed tomography scan and 32 percent for the plain film. Overall specificity of both studies was 69 percent. Preoperative radiologic studies for osteomyelitis in a pressure ulcer are far from definitive; however, if a radiologic study is used to make that diagnosis in a stage IV pressure ulcer, it would appear that a plain film would suffice.

Osteomyelitis diagnosis by 99mTc radiolabeled aptamers

International Nuclear Information System (INIS)

Santos, S.R.; Ferreira, I.M.; Andrade, A.S.R.; Barros, A.L.B.; Cardoso, V.N.; Diniz, O.F.

2015-01-01

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 99m Tc and used for bacteria identification in an osteomyelitis experimental model. The aptamers selected to S. aureus were directly labelled with 99m Tc and were evaluated by biodistribution studies. Wistar rats with intraosseous infection in the right paw were used. A random aptamer labelled with 99m Tc was as control. Six animals were used in each group. The aptamers labeled with 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)

Diagnosing pelvic osteomyelitis beneath pressure ulcers in spinal cord injured patients: a prospective study.

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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. Copyright © 2015 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

Parenteral and oral antibiotic duration for treatment of pediatric osteomyelitis: a systematic review protocol

Science.gov (United States)

2013-01-01

Background Pediatric osteomyelitis is a bacterial infection of bones requiring prolonged antibiotic treatment using parenteral followed by enteral agents. Major complications of pediatric osteomyelitis include transition to chronic osteomyelitis, formation of subperiosteal abscesses, extension of infection into the joint, and permanent bony deformity or limb shortening. Historically, osteomyelitis has been treated with long durations of antibiotics to avoid these complications. However, with improvements in management and antibiotic treatment, standard of care is moving towards short durations of intravenous antibiotics prior to enteral antibiotics. Methods/Design The authors will perform a systematic review based on PRISMA guidelines in order to evaluate the literature, looking for evidence to support the optimal duration of parenteral and enteral therapy. The main goals are to see if literature supports shorter durations of either parenteral antibiotics and/or enteral antibiotics. Multiple databases will be investigated using a thorough search strategy. Databases include Medline, Cochrane, EMBASE, SCOPUS, Dissertation Abstracts, CINAHL, Web of Science, African Index Medicus and LILACS. Search stream will include medical subject heading for pediatric patients with osteomyelitis and antibiotic therapy. We will search for published or unpublished randomized and quasi-randomized controlled trials. Two authors will independently select articles, extract data and assess risk of bias by standard Cochrane methodologies. We will analyze comparisons between dichotomous outcomes using risk ratios and continuous outcomes using mean differences. 95% confidence intervals will be computed. Discussion One of the major dilemmas of management of this disease is the duration of parenteral therapy. Long parenteral therapy has increased risk of serious complications and the necessity for long therapy has been called into question. Our study aims to review the currently available

Multifocal osteosarcoma as second tumor after childhood retinoblastoma

International Nuclear Information System (INIS)

Potepan, P.; Laffranchi, A.; Danesini, G.M.; Spagnoli, I.; Luksch, R.; Sozzi, G.; Testi, A.; Parafioriti, A.; Giardini, R.

1999-01-01

We present a case of multifocal osteosarcoma (MFOS) arising 11.5 years after successful treatment of bilateral retinoblastoma. The clinical, imaging and pathological findings at onset, after therapy, and during follow-up are described. Fluorescent in situ hybridization did not reveal a deletion of the RB-1 retinoblastoma gene, although the presence of an inactivating mutation invisible to this method cannot be ruled out. The MFOS may have been a second multifocal tumor associated with the original retinoblastoma or a post-irradiation sarcoma with extensive metastases. (orig.)

Candida Osteomyelitis: Analysis of 207 Pediatric and Adult Cases (1970–2011)

Science.gov (United States)

Gamaletsou, Maria N.; Kontoyiannis, Dimitrios P.; Sipsas, Nikolaos V.; Moriyama, Brad; Alexander, Elizabeth; Roilides, Emmanuel; Brause, Barry; Walsh, Thomas J.

2012-01-01

Background. The epidemiology, pathogenesis, clinical manifestations, management, and outcome of Candida osteomyelitis are not well understood. Methods. Cases of Candida osteomyelitis from 1970 through 2011 were reviewed. Underlying conditions, microbiology, mechanisms of infection, clinical manifestations, antifungal therapy, and outcome were studied in 207 evaluable cases. Results. Median age was 30 years (range, ≤ 1 month to 88 years) with a >2:1 male:female ratio. Most patients (90%) were not neutropenic. Localizing pain, tenderness, and/or edema were present in 90% of patients. Mechanisms of bone infection followed a pattern of hematogenous dissemination (67%), direct inoculation (25%), and contiguous infection (9%). Coinciding with hematogenous infection, most patients had ≥2 infected bones. When analyzed by age, the most common distribution of infected sites for adults was vertebra (odds ratio [OR], 0.09; 95% confidence interval [CI], .04–.25), rib, and sternum; for pediatric patients (≤18 years) the pattern was femur (OR, 20.6; 95% CI, 8.4–48.1), humerus, then vertebra/ribs. Non-albicans Candida species caused 35% of cases. Bacteria were recovered concomitantly from 12% of cases, underscoring the need for biopsy and/or culture. Candida septic arthritis occurred concomitantly in 21%. Combined surgery and antifungal therapy were used in 48% of cases. The overall complete response rate of Candida osteomyelitis of 32% reflects the difficulty in treating this infection. Relapsed infection, possibly related to inadequate duration of therapy, occurred among 32% who ultimately achieved complete response. Conclusions. Candida osteomyelitis is being reported with increasing frequency. Localizing symptoms are usually present. Vertebrae are the most common sites in adults vs femora in children. Timely diagnosis of Candida osteomyelitis with extended courses of 6–12 months of antifungal therapy, and surgical intervention, when indicated, may improve

Repurposing the Nonsteroidal Anti-inflammatory Drug Diflunisal as an Osteoprotective, Antivirulence Therapy for Staphylococcus aureus Osteomyelitis.

Science.gov (United States)

Hendrix, Andrew S; Spoonmore, Thomas J; Wilde, Aimee D; Putnam, Nicole E; Hammer, Neal D; Snyder, Daniel J; Guelcher, Scott A; Skaar, Eric P; Cassat, James E

2016-09-01

Staphylococcus aureus osteomyelitis is a common and debilitating invasive infection of bone. Treatment of osteomyelitis is confounded by widespread antimicrobial resistance and the propensity of bacteria to trigger pathological changes in bone remodeling that limit antimicrobial penetration to the infectious focus. Adjunctive therapies that limit pathogen-induced bone destruction could therefore limit morbidity and enhance traditional antimicrobial therapies. In this study, we evaluate the efficacy of the U.S. Food and Drug Administration-approved, nonsteroidal anti-inflammatory (NSAID) compound diflunisal in limiting S. aureus cytotoxicity toward skeletal cells and in preventing bone destruction during staphylococcal osteomyelitis. Diflunisal is known to inhibit S. aureus virulence factor production by the accessory gene regulator (agr) locus, and we have previously demonstrated that the Agr system plays a substantial role in pathological bone remodeling during staphylococcal osteomyelitis. Consistent with these observations, we find that diflunisal potently inhibits osteoblast cytotoxicity caused by S. aureus secreted toxins independently of effects on bacterial growth. Compared to commonly used NSAIDs, diflunisal is uniquely potent in the inhibition of skeletal cell death in vitro Moreover, local delivery of diflunisal by means of a drug-eluting, bioresorbable foam significantly limits bone destruction during S. aureus osteomyelitis in vivo Collectively, these data demonstrate that diflunisal potently inhibits skeletal cell death and bone destruction associated with S. aureus infection and may therefore be a useful adjunctive therapy for osteomyelitis. Copyright © 2016, American Society for Microbiology. All Rights Reserved.

Acute Osteomyelitis in the Hand Due to Dog Bite Injury: A Report of 3 Cases

Directory of Open Access Journals (Sweden)

Ryun Lee

2017-09-01

Full Text Available As many people keep small dogs as pets, dog bites are common injuries, accounting for approximately 80%–90% of all animal bite injuries. These injuries usually occur on the upper extremities, most commonly on the fingers. Most of these injuries appear as simple lacerations or abrasions of the skin. Common symptoms include inflammatory reactions of the soft tissue, such as pain, swelling, erythema, and cellulitis. However, the complications of small dog bites may include joint or cartilage injuries, including acute osteomyelitis. Once osteomyelitis develops, it is difficult to diagnose since it has a latency period of approximately 2 weeks. Plain radiography, magnetic resonance imaging, and 3-phase bone scans should be performed when acute osteomyelitis is suspected, and broad-spectrum empiric antibiotic treatment should be administered for approximately 8–12 weeks. We report 3 very rare cases of acute osteomyelitis that occurred after a dog bite injury.

Role of radionuclide imaging in the diagnosis of acute osteomyelitis

International Nuclear Information System (INIS)

Demopulos, G.A.; Bleck, E.E.; McDougall, I.R.

1988-01-01

Over the last decade, the role of nuclear medicine studies in the diagnosis of acute osteomyelitis has been discussed in depth in the literature. Yet, the respective roles played in this setting by each of the commonly used radionuclide studies often are confusing. In an attempt to develop a cogent diagnostic strategy, we reviewed the literature published within the last 12 years pertaining to the use of radiophosphate bone scintigraphy as well as gallium and indium WBC imaging in the diagnosis of this condition. Based on our findings, we propose an alternative approach to the evaluation of a patient with suspected acute osteomyelitis. 63 references

Chronic suppurative osteomyelitis of subcondylar region: a case report.

Science.gov (United States)

Kumar, G Ravi; Syed, Basheer Ahmed; Prasad, N; Praveen, Sp

2013-05-01

Chronic suppurative osteomyelitis (CSO) of the maxillofacial region is primarily caused by infections of odontogenic microorganisms. It may also arise as a complication of dental extractions, maxillofacial trauma, inadequate treatment of a fracture and irradiation to the mandible. This condition is characterized by areas of devitalized bone (sequestra) which serves as a nidus for recurrent episodes of infection. This case report describes a case of CSO in an untreated right subcondylar fracture of the mandible which was successfully treated with a combination of antibiotic therapy and surgical debridement in an 8-year-old boy. How to cite this article: Kumar GR, Syed BA, Prasad N, Praveen SP. Chronic Suppurative Osteomyelitis of Subcondylar Region: A Case Report. Int J Clin Pediatr Dent 2013;6(2): 119-123.

Scleral fixation of a single-piece multifocal intraocular lens.

Science.gov (United States)

Can, Ertugrul; Basaran, M Resat; Gül, Adem

2013-01-01

We describe an ab interno technique for injector implantation of a one-piece multifocal intraocular lens (IOL). Transscleral fixation of multifocal posterior chamber IOL implantation using an injector with ab interno technique was performed in an eye of a 9-year-old girl who had undergone pars plana lensectomy 2 years before for bilateral lens subluxation with unknown etiology. No major complications were encountered during a 3-month follow-up of the patient and excellent centration was observed during the follow-up period. Her preoperative best spectacle-corrected distance visual acuity of 20/32 improved to uncorrected distance visual acuity of 20/25. Closed-loop design of IOL served the function of eyelets and position of the IOL was provided using only a 2-point fixation. Intraoperative position adjustment of the IOL provided an excellent centralization of multifocal IOL.

A multifocal collimator with circularly distributed focal points for SPECT imaging

International Nuclear Information System (INIS)

Guillemaud, R.; Grangeat, P.

1994-01-01

The authors propose a new circular multifocal collimator which has multiple axial focal points distributed on a transverse circle. This distribution provides a strong focusing at the center of the detector like a cone-beam collimator, with a good sensitivity, and a weak transverse focusing at the periphery, to ensure acquisition of sufficient data, in order to prevent truncation artifacts. For a circular acquisition trajectory, each projection set of the multifocal geometry is equivalent to a virtual cone-beam projection set with a larger detector. Due to this equivalence, the authors derive a first solution for an analytical multifocal reconstruction algorithm: to rebin the projection set from multifocal to cone-beam geometry, then to use a 3D cone-beam reconstruction algorithm. The authors propose to use the Grangeat algorithm in order to deal with a large cone-beam aperture. Finally, the authors present results on simulated data for heart phantom, for a Defrise phantom and for a MTF study. The conclusion is that, from a multifocal projection set, objects are reconstructed without truncation artifacts, with a good precision at their center and with a loss of resolution at the periphery. In addition, the 3D cone-beam artifacts are reduced with the use of the Grangeat algorithm for the reconstruction step

Evaluation of varying ductile fracture criteria for 42CrMo steel by compressions at different temperatures and strain rates.

Science.gov (United States)

Quan, Guo-zheng; Luo, Gui-chang; Mao, An; Liang, Jian-ting; Wu, Dong-sen

2014-01-01

Fracturing by ductile damage occurs quite naturally in metal forming processes, and ductile fracture of strain-softening alloy, here 42CrMo steel, cannot be evaluated through simple procedures such as tension testing. Under these circumstances, it is very significant and economical to find a way to evaluate the ductile fracture criteria (DFC) and identify the relationships between damage evolution and deformation conditions. Under the guidance of the Cockcroft-Latham fracture criteria, an innovative approach involving hot compression tests, numerical simulations, and mathematic computations provides mutual support to evaluate ductile damage cumulating process and DFC diagram along with deformation conditions, which has not been expounded by Cockcroft and Latham. The results show that the maximum damage value appears in the region of upsetting drum, while the minimal value appears in the middle region. Furthermore, DFC of 42CrMo steel at temperature range of 1123~1348 K and strain rate of 0.01~10 s(-1) are not constant but change in a range of 0.160~0.226; thus, they have been defined as varying ductile fracture criteria (VDFC) and characterized by a function of temperature and strain rate. In bulk forming operations, VDFC help technicians to choose suitable process parameters and avoid the occurrence of fracture.

Evaluation of Varying Ductile Fracture Criteria for 42CrMo Steel by Compressions at Different Temperatures and Strain Rates

Directory of Open Access Journals (Sweden)

Guo-zheng Quan

2014-01-01

Full Text Available Fracturing by ductile damage occurs quite naturally in metal forming processes, and ductile fracture of strain-softening alloy, here 42CrMo steel, cannot be evaluated through simple procedures such as tension testing. Under these circumstances, it is very significant and economical to find a way to evaluate the ductile fracture criteria (DFC and identify the relationships between damage evolution and deformation conditions. Under the guidance of the Cockcroft-Latham fracture criteria, an innovative approach involving hot compression tests, numerical simulations, and mathematic computations provides mutual support to evaluate ductile damage cumulating process and DFC diagram along with deformation conditions, which has not been expounded by Cockcroft and Latham. The results show that the maximum damage value appears in the region of upsetting drum, while the minimal value appears in the middle region. Furthermore, DFC of 42CrMo steel at temperature range of 1123~1348 K and strain rate of 0.01~10 s-1 are not constant but change in a range of 0.160~0.226; thus, they have been defined as varying ductile fracture criteria (VDFC and characterized by a function of temperature and strain rate. In bulk forming operations, VDFC help technicians to choose suitable process parameters and avoid the occurrence of fracture.

Evaluation of the inflammatory activity in chronic osteomyelitis. Contribution of the scintigraphy with polyclonal antibodies

International Nuclear Information System (INIS)

Sapienza, Marcelo Tatit

1996-01-01

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)

The influence of the hardening coolant agent on the properties of hot rolled bars of the steel 42CrMo4

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M. Stańczyk

2014-10-01

Full Text Available In the work the influence results of two different hardening coolant agents on the basic mechanical proprieties and microstructure of the round hot rolled bars were presented. The bars of 42CrMo4 steel were exposed to analysis, and for those bars in the hardening process, water and modern pro-ecological polymer cooling agents Aqua Quench MK were used.

Comparison of low-cycle fatigue data of 2 1/4 % CrMo steels

International Nuclear Information System (INIS)

Sanderson, S.J.; Petrequin, P.; Nieuwland, H.C.D.; Breuer, H.J.

1983-01-01

Data files have been produced on international strain-controlled fatigue information available for 2 1/4 %CrMo steels. The available data have been considered generally in terms of total strain range vs. cycles to failure (Nsub(f)), tensile stress at Nsub(f)/2 vs. cycles to failure and time to failure vs. cycles to failure. Where possible the continuous cycling data been statistically analysed in terms of the elastic and plastic strain components and cycles to failure to yield best-fit equations over defined temperature (T) regime viz: T 0 C, 427 0 C 0 C and 550 0 C 0 C. Increasing test temperatures result in a progressive decrease in continuous cycling fatigue endurance and sustainable stress range

Conservative management of diabetic foot osteomyelitis.

Science.gov (United States)

Acharya, S; Soliman, M; Egun, A; Rajbhandari, S M

2013-09-01

In this retrospective study, 130 patients with diabetic foot osteomyelitis were analysed. 66.9% of these healed with antibiotic treatment alone and 13.9% needed amputation, of which 1.5% were major. Presence of MRSA was associated with adverse outcome (53.3% vs 21.1%, p=0.04) which was defined as death, amputation and failure to heal. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Evaluation of Varying Ductile Fracture Criteria for 42CrMo Steel by Compressions at Different Temperatures and Strain Rates

OpenAIRE

Quan, Guo-zheng; Luo, Gui-chang; Mao, An; Liang, Jian-ting; Wu, Dong-sen

2014-01-01

Fracturing by ductile damage occurs quite naturally in metal forming processes, and ductile fracture of strain-softening alloy, here 42CrMo steel, cannot be evaluated through simple procedures such as tension testing. Under these circumstances, it is very significant and economical to find a way to evaluate the ductile fracture criteria (DFC) and identify the relationships between damage evolution and deformation conditions. Under the guidance of the Cockcroft-Latham fracture criteria, an inn...

Two cases of Pseudomonas aeruginosa epidural abscesses and cervical osteomyelitis after dental extractions.

Science.gov (United States)

Walters, Heather L; Measley, Robert

2008-04-20

Case report. To report 2 unusual cases of Pseudomonas aeruginosa epidural abscesses and cervical osteomyelitis after routine dental extractions and to review relevant literature. Pseudomonas aeruginosa is a rare cause of cervical osteomyelitis in patients after dental extractions. Only 1 prior case could be found in the literature. The cases of an 18-year-old male and a 23-year-old female are presented. PubMed was used to search for relevant literature. Our 2 patients presented with excruciating neck pain within 24 hours of routine dental extractions and, by imaging were found to have cervical epidural abscesses and osteomyelitis. Both patients were taken to the operating room for drainage and corpectomy and treated with prolonged courses of intravenous antibiotics. When seen in follow up 3 months later, neither patient demonstrated any neurologic sequelae. Pseudomonas aeruginosa epidural abscesses and osteomyelitis of the cervical spine have only rarely been reported in healthy patients after dental extractions. To our knowledge, the 2 patients reported here are only the second 2 such cases reported in the literature. Unfortunately, as in prior cases, these 2 patients had a significant delay in diagnosis. Therefore, a strong suspicion must be maintained for all patients presenting with neck pain after a recent dental extraction and appropriate imaging must be obtained urgently.

An Unusual Case of Unilateral Multifocal Choroiditis in a Young Male

African Journals Online (AJOL)

Multifocal choroiditis is a vision‑threatening disease causing inflammation at the level of retinal pigment epithelium and outer retina. We present a unique case of unilateral multifocal choroiditis in a young nonmyopic male and its subsequent course. The patient developed visual loss due to the sub‑retinal neovascular ...

Fatigue life evaluation of 42CrMo4 nitrided steel by local approach: Equivalent strain-life-time

International Nuclear Information System (INIS)

Terres, Mohamed Ali; Sidhom, Habib

2012-01-01

Highlights: → Ion nitriding treatment of 42CrMo4 steel improves their fatigue strength by 32% as compared with the untreated state. → This improvement is the result of the beneficial effects of the superficial work- hardening and of the stabilized compressive residual stress. → The notch region is found to be the fatigue crack nucleation site resulting from a stress concentration (Kt = 1.6). → The local equivalent strain-fatigue life method was found to be an interesting predictive fatigue life method for nitrided parts. -- Abstract: In this paper, the fatigue resistance of 42CrMo4 steel in his untreated and nitrided state was evaluated, using both experimental and numerical approaches. The experimental assessment was conducted using three points fatigue flexion tests on notched specimens at R = 0.1. Microstructure analysis, micro-Vickers hardness test, and scanning electron microscope observation were carried out for evaluating experiments. In results, the fatigue cracks of nitrided specimens were initiated at the surface. The fatigue life of nitrided specimens was prolonged compared to that of the untreated. The numerical method used in this study to predict the nucleation fatigue life was developed on the basis of a local approach, which took into account the applied stresses and stabilized residual stresses during the cyclic loading and the low cyclic fatigue characteristics. The propagation fatigue life was calculated using fracture mechanics concepts. It was found that the numerical results were well correlated with the experimental ones.

Characterization Of Oxide Layers Formed On 13CrMo4-5 Steel Operated For A Long Time At An Elevated Temperature

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Gwoździk M.

2015-09-01

Full Text Available The paper contains results of studies into the formation of oxide layers on 13CrMo4-5 (15HM steel long-term operated at an elevated temperature. The oxide layer was studied on a surface and a cross-section at the inner and outer surface of the tube wall. The 13CrMo4-5 steel operated at the temperature of 470°C during 190,000 hours was investigated. X-ray structural examinations (XRD were carried out, microscope observation s using an optical, scanning microscope were performed. The native material chemical composition was analysed by means of emission spark spectroscopy, while that of oxide layers on a scanning microscope (EDS. The studies on the topography of the oxide layers comprised studies on the roughness plane, which were carried out using a AFM microscope designed for 2D and 3D studies on the surface. Mechanical properties of the oxide layer – steel (substrate were characterised on the basis of scratch test. The adhesion of oxide layers, friction force, friction coefficient, scratching depth were determined as well as the force at which the layer was delaminated.

The application of rational approximation in the calculation of a temperature field with a non-linear surface heat-transfer coefficient during quenching for 42CrMo steel cylinder

Science.gov (United States)

Cheng, Heming; Huang, Xieqing; Fan, Jiang; Wang, Honggang

1999-10-01

The calculation of a temperature field has a great influence upon the analysis of thermal stresses and stains during quenching. In this paper, a 42CrMo steel cylinder was used an example for investigation. From the TTT diagram of the 42CrMo steel, the CCT diagram was simulated by mathematical transformation, and the volume fraction of phase constituents was calculated. The thermal physical properties were treated as functions of temperature and the volume fraction of phase constituents. The rational approximation was applied to the finite element method. The temperature field with phase transformation and non-linear surface heat-transfer coefficients was calculated using this technique, which can effectively avoid oscillationin the numerical solution for a small time step. The experimental results of the temperature field calculation coincide with the numerical solutions.

Sinogenic intracranial complications

DEFF Research Database (Denmark)

Kofoed, Mikkel Seremet; Fisker, Niels; Christensen, Anne Estmann

2018-01-01

We present two 11-year-old girls with chronic recurrent multifocal osteomyelitis, treated with adalimumab. Both developed severe intracranial complications to sinusitis. Patient 1 had been treated with adalimumab for 15 months when she developed acute sinusitis complicated by an orbital abscess, ...

Efficacy of anti-IL-1 treatment in Majeed syndrome

DEFF Research Database (Denmark)

Herlin, Troels; Fiirgaard, Bente; Bjerre, Mette

2013-01-01

Majeed syndrome is an autosomal recessive disorder characterised by the triad of chronic recurrent multifocal osteomyelitis, congenital dyserythropoietic anaemia and a neutrophilic dermatosis that is caused by mutations in LPIN2. Long-term outcome is poor. This is the first report detailing...

Skull base osteomyelitis: current microbiology and management.

Science.gov (United States)

Spielmann, P M; Yu, R; Neeff, M

2013-01-01

Skull base osteomyelitis typically presents in an immunocompromised patient with severe otalgia and otorrhoea. Pseudomonas aeruginosa is the commonest pathogenic micro-organism, and reports of resistance to fluoroquinolones are now emerging, complicating management. We reviewed our experience of this condition, and of the local pathogenic organisms. A retrospective review from 2004 to 2011 was performed. Patients were identified by their admission diagnostic code, and computerised records examined. Twenty patients were identified. A facial palsy was present in 12 patients (60 per cent). Blood cultures were uniformly negative, and culture of ear canal granulations was non-diagnostic in 71 per cent of cases. Pseudomonas aeruginosa was isolated in only 10 (50 per cent) cases; one strain was resistant to ciprofloxacin but all were sensitive to ceftazidime. Two cases of fungal skull base osteomyelitis were identified. The mortality rate was 15 per cent. The patients' treatment algorithm is presented. Our treatment algorithm reflects the need for multidisciplinary input, early microbial culture of specimens, appropriate imaging, and prolonged and systemic antimicrobial treatment. Resolution of infection must be confirmed by close follow up and imaging.

[Multifocal Electroretinography in Patients with Poppers Maculopathy].

Science.gov (United States)

Pahlitzsch, Milena; Salchow, Daniel; Rossel, Mirjam; Bergholz, Richard

2017-10-12

Background Maculopathy is a potential side effect of amyl nitrite or "poppers" abuse. It is characterized by a sudden, painless decrease in visual acuity. While the funduscopic changes are subtle, optical coherence tomography shows alterations of the outer retinal layers in the fovea. However, the extent of retinal dysfunction remains poorly understood. Materials/Methods We compared the multifocal electroretinogram of 6 patients with poppers maculopathy to that of a control group consisting of 6 healthy subjects. Response densities and implicit times of N1 and P1 were analyzed. Results Response densities and implicit times of both N1 and P1 were lower in the patients with poppers maculopathy than in the control group, particularly in ring 1 and rings 4 and 5. The only statistically significant finding, however, was a reduced N1 response density of one hexagon in the patient group. No significant differences were found considering the sum response or the averaged rings 1 to 5. Conclusion Compared to a healthy control group, the multifocal electroretinogram of patients with poppers maculopathy shows no relevant impairment. This contrasts the marked effect of the disease on visual acuity. In clinical practice, poppers maculopathy cannot be diagnosed by multifocal electroretinography. Georg Thieme Verlag KG Stuttgart · New York.

Influence of Nitrided Layer on The Properties of Carbon Coatings Produced on X105CrMo17 Steel Under DC Glow-Discharge Conditions

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Tomasz BOROWSKI

2016-09-01

Full Text Available In most cases, machine components, which come in contact with each other, are made of steel. Common steel types include 100Cr6 and X105CrMo17 are widely used in rolling bearings, which are subjected to high static loads. However, more and more sophisticated structural applications require increasingly better performance from steel. The most popular methods for improving the properties of steel is carburisation or nitriding. Unfortunately, when very high surface properties of steel are required, this treatment may be insufficient. Improvement of tribological properties can be achieved by increasing the hardness of the surface, reducing roughness or reducing the coefficient of friction. The formation of composite layers on steel, consisting of a hard nitride diffusion layer and an external carbon coating with a low coefficient of friction, seems to be a prospect with significant potential. The article describes composite layers produced on X105CrMo17 steel and defines their morphology, surface roughness and their functional properties such as: resistance to friction-induced wear, coefficient of friction and corrosion resistance. The layers have been formed at a temperature of 370°C in successive processes of: nitriding in low-temperature plasma followed by deposition of a carbon coating under DC glow-discharge conditions. An evaluation was also made of the impact of the nitrided layers on the properties and morphology of the carbon coatings formed by comparing them to coatings formed on non-nitrided X105CrMo17 steel substrates. A study of the surface topography, adhesion, resistance to friction-induced wear and corrosion shows the significant importance of the substrate type the carbon coatings are formed on.DOI: http://dx.doi.org/10.5755/j01.ms.22.3.7532

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.

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

Treatment of osteomyelitis defects by a vancomycin-loaded gelatin/β-tricalcium phosphate composite scaffold

Science.gov (United States)

Zhou, J.; Zhou, X. G.; Wang, J. W.; Zhou, H.; Dong, J.

2018-01-01

Objective In the present study, we aimed to assess whether gelatin/β-tricalcium phosphate (β-TCP) composite porous scaffolds could be used as a local controlled release system for vancomycin. We also investigated the efficiency of the scaffolds in eliminating infections and repairing osteomyelitis defects in rabbits. Methods The gelatin scaffolds containing differing amounts of of β-TCP (0%, 10%, 30% and 50%) were prepared for controlled release of vancomycin and were labelled G-TCP0, G-TCP1, G-TCP3 and G-TCP5, respectively. The Kirby-Bauer method was used to examine the release profile. Chronic osteomyelitis models of rabbits were established. After thorough debridement, the osteomyelitis defects were implanted with the scaffolds. Radiographs and histological examinations were carried out to investigate the efficiency of eliminating infections and repairing bone defects. Results The prepared gelatin/β-TCP scaffolds exhibited a homogeneously interconnected 3D porous structure. The G-TCP0 scaffold exhibited the longest duration of vancomycin release with a release duration of eight weeks. With the increase of β-TCP contents, the release duration of the β-TCP-containing composite scaffolds was decreased. The complete release of vancomycin from the G-TCP5 scaffold was achieved within three weeks. In the treatment of osteomyelitis defects in rabbits, the G-TCP3 scaffold showed the most efficacious performance in eliminating infections and repairing bone defects. Conclusions The composite scaffolds could achieve local therapeutic drug levels over an extended duration. The G-TCP3 scaffold possessed the optimal porosity, interconnection and controlled release performance. Therefore, this scaffold could potentially be used in the treatment of chronic osteomyelitis defects. Cite this article: J. Zhou, X. G. Zhou, J. W. Wang, H. Zhou, J. Dong. Treatment of osteomyelitis defects by a vancomycin-loaded gelatin/β-tricalcium phosphate composite scaffold. Bone Joint Res

Progressive multifocal leukoencephalopathy in transplant recipients

NARCIS (Netherlands)

Mateen, Farrah J.; Muralidharan, RajaNandini; Carone, Marco; van de Beek, Diederik; Harrison, Daniel M.; Aksamit, Allen J.; Gould, Mary S.; Clifford, David B.; Nath, Avindra

2011-01-01

Transplant recipients are at risk of developing progressive multifocal leukoencephalopathy (PML), a rare demyelinating disorder caused by oligodendrocyte destruction by JC virus. Reports of PML following transplantation were found using PubMed Entrez (1958-July 2010). A multicenter, retrospective

Foot clearance and variability in mono- and multifocal intraocular lens users during stair navigation.

Science.gov (United States)

Renz, Erik; Hackney, Madeleine; Hall, Courtney

2016-01-01

Intraocular lenses (IOLs) provide distance and near refraction and are becoming the standard for cataract surgery. Multifocal glasses increase variability of toe clearance in older adults navigating stairs and increase fall risk; however, little is known about the biomechanics of stair navigation in individuals with multifocal IOLs. This study compared clearance while ascending and descending stairs in individuals with monofocal versus multifocal IOLs. Eight participants with multifocal IOLs (4 men, 4 women; mean age = 66.5 yr, standard deviation [SD] = 6.26) and fifteen male participants with monofocal IOLs (mean age = 69.9 yr, SD = 6.9) underwent vision and mobility testing. Motion analysis recorded kinematic and custom software-calculated clearances in three-dimensional space. No significant differences were found between groups on minimum clearance or variability. Clearance differed for ascending versus descending stairs: the first step onto the stair had the greatest toe clearance during ascent, whereas the final step to the floor had the greatest heel clearance during descent. This preliminary study indicates that multifocal IOLs have similar biomechanic characteristics to monofocal IOLs. Given that step characteristics are related to fall risk, we can tentatively speculate that multifocal IOLs may carry no additional fall risk.

Diagnosis of osteomyelitis of the foot in diabetic patients: Value of 111In-leukocyte scintigraphy

International Nuclear Information System (INIS)

Larcos, G.; Brown, M.L.; Sutton, R.T.

1991-01-01

The noninvasive diagnosis of osteomyelitis of the foot in diabetic patients with currently available radiologic and radionuclide imaging techniques is often difficult. Recently, 111In-labeled leukocyte scintigraphy has been proposed as an attractive alternative. Accordingly, the authors retrospectively reviewed 51 111In-labeled leukocyte scans, 49 technetium-99m bone scans, and 49 plain radiographs obtained in 51 adults with diabetes in whom osteomyelitis of the foot was suspected. The sensitivity and specificity of these techniques were evaluated in all patients, as well as in a subgroup of 11 patients with neuroarthropathy. Results with 111In-labeled leukocyte scans were also examined in subsets of patients with soft-tissue ulcers (n = 35) and those receiving antibiotics during investigation (n = 20). Confirmation or exclusion of osteomyelitis was made surgically in 28 patients and clinically in 23. Fourteen patients had osteomyelitis. Bone scans were most sensitive (93%) but least specific (43%); plain radiographs were most specific (83%) but least sensitive (43%). 111In-labeled leukocyte scans were both sensitive (79%) and specific (78%), and remained useful in patients with neuroarthropathy, soft-tissue ulcers, and antibiotic treatment. Poor spatial resolution contributed to the false-negative and false-positive 111In-labeled leukocyte scans, suggesting that this technique should not be interpreted independent of other tests. 111In-labeled leukocyte scans are a valuable diagnostic tool for the diagnosis of pedal osteomyelitis in diabetic patients

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. © The Author(s) 2016.

Testing the efficacy of antimicrobial peptides in the topical treatment of induced osteomyelitis in rats.

Science.gov (United States)

Melicherčík, Pavel; Čeřovský, Václav; Nešuta, Ondřej; Jahoda, David; Landor, Ivan; Ballay, Rastislav; Fulín, Petr

2018-01-01

Joint replacement infections and osteomyelitis are among the most serious complications in orthopaedics and traumatology. The risk factors for these infections are often bacterial resistance to antimicrobials. One of the few solutions available to control bacterial resistance involves antimicrobials, which have a different mechanism of action from traditional antibiotics. Antimicrobial peptides (AMP) appear to be highly promising candidates in the treatment of resistant infections. We have identified several AMP in the venom of various wild bees and designed analogues that show potent antimicrobial activity and low toxicity against eukaryotic cells. The aim of the present study was to test the efficacy of one of those synthetic peptide analogues for the treatment of acute osteomyelitis invoked in laboratory rats. Femoral cavities of 20 laboratory Wistar rats were infected with Staphylococcus aureus. After 1 week, eight rats received an injectable calcium phosphate carrier alone, another eight rats were treated with a calcium phosphate mixed with AMP, and four rats were left without any further treatment. After another week, all rats were euthanized and radiographs were made of both the operated and healthy limbs. The animals with the carrier alone exhibited more severe acute osteomyelitis on radiographs in comparison to the recipients of the calcium phosphate carrier loaded AMP and untreated infected individuals. Based on the results of the above mentioned experiment, it was concluded that when injected directly into the site of femoral acute osteomyelitis, the calcium phosphate carrier mixed with AMP reduced osteomyelitis signs visible on radiographs.

Fungal osteomyelitis with vertebral re-ossification.

Science.gov (United States)

O Guinn, Devon J; Serletis, Demitre; Kazemi, Noojan

2016-01-01

We present a rare case of thoracic vertebral osteomyelitis secondary to pulmonary Blastomyces dermatitides. A 27-year-old male presented with three months of chest pains and non-productive cough. Examination revealed diminished breath sounds on the right. CT/MR imaging confirmed a right-sided pre-/paravertebral soft tissue mass and destructive lytic lesions from T2 to T6. CT-guided needle biopsy confirmed granulomatous pulmonary Blastomycosis. Conservative management with antifungal therapy was initiated. Neurosurgical review confirmed no clinical or profound radiographic instability, and the patient was stabilized with TLSO bracing. Serial imaging 3 months later revealed near-resolution of the thoracic soft tissue mass, with vertebral re-ossification from T2 to T6. Fungal osteomyelitis presents a rare entity in the spectrum of spinal infections. In such cases, lytic spinal lesions are classically seen in association with a large paraspinous mass. Fungal infections of the spinal column may be treated conservatively, with surgical intervention reserved for progressive cases manifesting with neurological compromise and/or spinal column instability. Here, we found unexpected evidence for vertebral re-ossification across the affected thoracic levels (T2-6) in response to IV antibiotic therapy and conservative bracing, nearly 3 months later. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

Imaging osteomyelitis and the diabetic foot

International Nuclear Information System (INIS)

Becker, W.

1999-01-01

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 111 In-oxin or 99m Tc-HMPAO, antigranulocyte antibodies, 99m Tc/ 111 In-human immunoglobulin, 67 Ga-citrate and 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

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)

Application of diffractive aspheric multifocal intraocular lens in the Uighur in phacoemulsification

Directory of Open Access Journals (Sweden)

Nuersimanguli·Mijiti

2016-05-01

Full Text Available AIM:To research the efficacy and safety of diffractive aspheric multifocal intraocular lens(MIOLin the Uighur in phacoemulsification to provide guidance for the clinical treatment of cataracts patients in Xinjiang region. METHODS:Two hundred and twenty-eight Uygur patients(280 eyesreceived phacoemulsification from April 2012 to March 2013 were randomly divided into multifocal group(106 cases with 146 eyesand monofocal group(122 cases with 134 eyes. Patients were followed up for 3mo. The intraocular pressure(IOP, uncorrected distance visual acuity, uncorrected near vision, best-corrected distance visual acuity and best corrected near vision were measured. The delensed rate, visual quality, and satisfaction for lenses in the form of questionnaires were compared. RESULTS:Multifocal group was better on the uncorrected near vision than monofocal group(PP>0.05. The contrast sensitivity of multifocal group under scotopia at spatial frequency 3c/d was lower than that of monofocal group(PP>0.05. Delensed rate of multifocal group was higher than that of monofocal group(PP>0.05.CONCLUSION:MIOL with phacoemulsification can provide patient good full range vision, especially on good near vision. The patients with MIOL implanted have a higher delensed rate, less postoperative adverse symptoms, quicker recovery and satisfaction.

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), N...... dependent on the strain of bacteria inoculated and on the formation of a biofilm....... with colonies of S. aureus as demonstrated immunohistochemically. By peptide nucleic acid fluorescence in situ hybridization bacterial aggregates were demonstrated to be embedded in an opaque matrix, indicating that the bacteria had formed a biofilm. Development of experimental osteomyelitis was therefore...

Radionuclide uptake during the evolution of experimental acute osteomyelitis

International Nuclear Information System (INIS)

Norris, S.H.; Watt, I.

1981-01-01

The findings of technetium 99m MDP and gallium 67 citrate scintigraphy are described in the first four days following experimental acute osteomyelitis of the tibia of rabbits. On the day of inoculation, defects in activity are observed in both the perfusion and bone phases of technetium scintigraphy. Similar defects are achieved by saline injection. On subsequent days technetium scintigraphy reveals an increased activity in the perfusion stage but a persisting defect of activity in the bone phase. Gallium activity is increased throughout the period of the study in inoculated animals but not in those injected with saline. It is concluded that 99 Tcsup(m) MDP, in its perfusion phase, and 67 Ga citrate are highly sensitive indicators of bone inflammation and that early osteomyelitis is characterized by increased activity with these agents together with a technetium bone scan defect. (author)

Power profiles of single vision and multifocal soft contact lenses.

Science.gov (United States)

Wagner, Sandra; Conrad, Fabian; Bakaraju, Ravi C; Fedtke, Cathleen; Ehrmann, Klaus; Holden, Brien A

2015-02-01

The purpose of this study was to investigate the optical zone power profile of the most commonly prescribed soft contact lenses to assess their potential impact on peripheral refractive error and hence myopia progression. The optical power profiles of six single vision and ten multifocal contact lenses of five manufacturers in the powers -1.00 D, -3.00 D, and -6.00 D were measured using the SHSOphthalmic (Optocraft GmbH, Erlangen, Germany). Instrument repeatability was also investigated. Instrument repeatability was dependent on the distance from the optical centre, manifesting unreliable data for the central 1mm of the optic zone. Single vision contact lens measurements of -6.00 D lenses revealed omafilcon A having the most negative spherical aberration, lotrafilcon A having the least. Somofilcon A had the highest minus power and lotrafilcon A the biggest deviation in positive direction, relative to their respective labelled powers. Negative spherical aberration occurred for almost all of the multifocal contact lenses, including the centre-distance designs etafilcon A bifocal and omafilcon A multifocal. Lotrafilcon B and balafilcon A seem to rely predominantly on the spherical aberration component to provide multifocality. Power profiles of single vision soft contact lenses varied greatly, many having a negative spherical aberration profile that would exacerbate myopia. Some lens types and powers are affected by large intra-batch variability or power offsets of more than 0.25 dioptres. Evaluation of power profiles of multifocal lenses was derived that provides helpful information for prescribing lenses for presbyopes and progressing myopes. Copyright © 2014 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.

Amyloid goitre following chronic osteomyelitis: case report and ...

African Journals Online (AJOL)

Amyloid goitre following chronic osteomyelitis: case report and review of literature. AZ Mohammed, ST Edino, O Ochicha. Abstract. Amyloid Goitre is a rare clinical entity associated with systemic amyloidosis. It poses a significant diagnostic and therapeutic challenge and may be confused with a neoplastic goiter. We present ...

Bioptics in sutureless intrascleral multifocal posterior chamber intraocular lens fixation.

Science.gov (United States)

Pavlidis, Mitrofanis; de Ortueta, Diego; Scharioth, Gabor B

2011-05-01

To present a technique for sutureless fixation of a three-piece, multifocal, posterior chamber intraocular lens (IOL) in the ciliary sulcus. A 24-year-old woman presented with bilateral subluxation of the crystalline lens. Two straight sclerotomies were prepared with a 24-gauge cannula 2.0 mm from the limbus 180° apart from each other. The cannula was used to create a 2.0- to 3.0-mm tunnel parallel to the limbus starting from the sclerotomies. The leading haptic of the multifocal IOL was grasped at its tip with end-gripping, 25-gauge forceps and pulled through the sclerotomy. The forceps was used to introduce the IOL haptic into the scleral tunnel parallel to the limbus. Multifocal posterior chamber IOLs were stable and well centered. No postoperative complications occurred in the 16-month follow-up period. Preoperative astigmatism was corrected after IOL implantation with corneal wavefront-guided laser epithelial keratomileusis. Sutureless fixation of multifocal posterior chamber IOL haptics in a scleral tunnel parallel to the limbus can be successful, resulting in long-term centration and three-dimensional axial stability for optimal refractive results. If necessary, postoperative wavefront-guided refractive correction can be performed to optimize final refraction. Copyright 2011, SLACK Incorporated.

Taxonomy of multi-focal nematode image stacks by a CNN based image fusion approach.

Science.gov (United States)

Liu, Min; Wang, Xueping; Zhang, Hongzhong

2018-03-01

In the biomedical field, digital multi-focal images are very important for documentation and communication of specimen data, because the morphological information for a transparent specimen can be captured in form of a stack of high-quality images. Given biomedical image stacks containing multi-focal images, how to efficiently extract effective features from all layers to classify the image stacks is still an open question. We present to use a deep convolutional neural network (CNN) image fusion based multilinear approach for the taxonomy of multi-focal image stacks. A deep CNN based image fusion technique is used to combine relevant information of multi-focal images within a given image stack into a single image, which is more informative and complete than any single image in the given stack. Besides, multi-focal images within a stack are fused along 3 orthogonal directions, and multiple features extracted from the fused images along different directions are combined by canonical correlation analysis (CCA). Because multi-focal image stacks represent the effect of different factors - texture, shape, different instances within the same class and different classes of objects, we embed the deep CNN based image fusion method within a multilinear framework to propose an image fusion based multilinear classifier. The experimental results on nematode multi-focal image stacks demonstrated that the deep CNN image fusion based multilinear classifier can reach a higher classification rate (95.7%) than that by the previous multilinear based approach (88.7%), even we only use the texture feature instead of the combination of texture and shape features as in the previous work. The proposed deep CNN image fusion based multilinear approach shows great potential in building an automated nematode taxonomy system for nematologists. It is effective to classify multi-focal image stacks. Copyright © 2018 Elsevier B.V. All rights reserved.

Osteomyelitis of the mandible in the patient with plasmocytoma – case report

Directory of Open Access Journals (Sweden)

Wioletta Anna Bal

2017-12-01

Full Text Available Osteomyelitis is an infection of bone which may be caused by infection carried to the bone via the bloodstream or from surrounding tissue. Treatment of osteomyelitis of the mandible is extremely difficult because of oral environment and teeth presence. Management often involves both debridement and antibiotic selection. Despite this, aggressive surgical interventions and conservative therapy are most important aspects of treatment. Medication-related osteonecrosis of the jaw (MRONJ is an avascular necrosis related to osteomyelitis and characterized by necrotic bone in the maxillofacial region. The prevalence of this is associated with treatment with high-potency bisphosphonates or denosumab and it seems to be getting increasingly frequent. Due to lack of prospective studies with long-term follow-up there are no recommendation for treatment of MRNOJ. The main aim of treatment of patients with MRNOJ is to continue and to support oncological treatment as well as to provide patient education, comfort to life, control of pain and to prevent from secondary infection and development of new areas of necrosis.

Heterogeneity of DNA methylation in multifocal prostate cancer.

Science.gov (United States)

Serenaite, Inga; Daniunaite, Kristina; Jankevicius, Feliksas; Laurinavicius, Arvydas; Petroska, Donatas; Lazutka, Juozas R; Jarmalaite, Sonata

2015-01-01

Most prostate cancer (PCa) cases are multifocal, and separate foci display histological and molecular heterogeneity. DNA hypermethylation is a frequent alteration in PCa, but interfocal heterogeneity of these changes has not been extensively investigated. Ten pairs of foci from multifocal PCa and 15 benign prostatic hyperplasia (BPH) samples were obtained from prostatectomy specimens, resulting altogether in 35 samples. Methylation-specific PCR (MSP) was used to evaluate methylation status of nine tumor suppressor genes (TSGs), and a set of selected TSGs was quantitatively analyzed for methylation intensity by pyrosequencing. Promoter sequences of the RASSF1 and ESR1 genes were methylated in all paired PCa foci, and frequent (≥75 %) DNA methylation was detected in RARB, GSTP1, and ABCB1 genes. MSP revealed different methylation status of at least one gene in separate foci in 8 out of 10 multifocal tumors. The mean methylation level of ESR1, GSTP1, RASSF1, and RARB differed between the paired foci of all PCa cases. The intensity of DNA methylation in these TSGs was significantly higher in PCa cases than in BPH (p epigenetic profile of recurrent tumors can be inferred from our data.

Biomimetic 3D in vitro model of biofilm triggered osteomyelitis for investigating hematopoiesis during bone marrow infections.

Science.gov (United States)

Raic, Annamarija; Riedel, Sophie; Kemmling, Elena; Bieback, Karen; Overhage, Joerg; Lee-Thedieck, Cornelia

2018-04-18

In this work, we define the requirements for a human-based osteomyelitis model which overcomes the limitations of state of the art animal models. Osteomyelitis is a severe and difficult to treat infection of the bone that develops rapidly, making it difficult to study in humans. We have developed a 3D in vitro model of the bone marrow, comprising a macroporous material, human hematopoietic stem and progenitor cells (HSPCs) and mesenchymal stromal cells (MSCs). Inclusion of biofilms grown on an implant into the model system allowed us to study the effects of postoperative osteomyelitis-inducing bacteria on the bone marrow. The bacteria influenced the myeloid differentiation of HSPCs as well as MSC cytokine expression and the MSC ability to support HSPC maintenance. In conclusion, we provide a new 3D in vitro model which meets all the requirements for investigating the impact of osteomyelitis. Implant associated-osteomyelitis is a persistent bacterial infection of the bone which occurs in many implant patients and can result in functional impairments or even entire loss of the extremity. Nevertheless, surprisingly little is known on the triangle interaction between implant material, bacterial biofilm and affected bone tissue. Closing this gap of knowledge would be crucial for the fundamental understanding of the disease and the development of novel treatment strategies. For this purpose, we developed the first biomaterial-based system that is able to mimic implant-associated osteomyelitis outside of the body, thus, opening the avenue to study this fatal disease in the laboratory. Copyright © 2018 Acta Materialia Inc. Published by Elsevier Ltd. All rights reserved.

Differences in the cyclic deformation behaviour of quenched and tempered steel 42 CrMo 4 (AISI 4140) due to stress- and strain-control; Versuchsfuehrungsbedingte Unterschiede im zyklischen Verformungsverhalten von verguetetem 42 CrMo 4 bei Spannungs- und Totaldehnungskontrolle

Energy Technology Data Exchange (ETDEWEB)

Schulze, V.; Lang, K.-H.; Voehringer, O.; Macherauch, E. [Karlsruhe Univ. (T.H.) (Germany). Inst. fuer Werkstoffkunde 1

1998-04-01

Cyclic stress-strain-curves and Manson-Coffin-plots of quenched and tempered steel 42 CrMo 4 (AISI 4140) strongly depend on whether they are determined under stress- or total-strain-control. At total-strain-controlled experiments, this is caused on the one hand by comparatively high initial stress-amplitudes which lead to distinctive cyclic work softening. On the other hand, the occuring differences in the evolution of inhomogeneous deformation patterns at both types of loading, which can be recorded by means of photoelasticity and microscopy, lead to differently distributed plastic deformations and to different integral values of plastic strain. (orig.) 11 refs.

Osteomyelitis and infarction in sickle cell hemoglobinopathies: differentiation by combined technetium and gallium scintigraphy

International Nuclear Information System (INIS)

Amundsen, T.R.; Siegel, M.J.; Siegel, B.A.

1984-01-01

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

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)

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

International Nuclear Information System (INIS)

Borges, Natalie Ferreira; Rezende, Cleuza Maria de Faria; Sanchez-Ucros, Natalia; Laguardia, Priscilla; Diniz, Simone Odilia Fernandes; Cardoso, Valbert Nascimento; Rodrigues, Carlos Jorge Simal; Santos, Raquel Gouvea dos

2009-01-01

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)

Multifocal necrotizing fasciitis following Hirshsprung's disease ...

African Journals Online (AJOL)

Multifocal necrotizing fasciitis following Hirshsprung's disease surgery away from the surgical wound site. Ahmed A. Haseeb, Shadi Okasha and Atef Elbarawi. Necrotizing fasciitis (NF) is a life-threatening infection with rapidly progressive necrosis. Escherichia coli is rarely reported as causative agent of type 2 NF.

Childhood Pyogenic Osteomyelitis in Abakaliki, South East Nigeria

African Journals Online (AJOL)

2018-04-20

Apr 20, 2018 ... [3] In general, growing children are the most vulnerable to pyogenic bone infection. However, in a recent published report, the relatively higher risk of osteomyelitis among Polynesians and Maori children compared to European children in New Zealand[2] indicates ethnicity bias in the risk of childhood bone.

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

Utility of unenhanced fat-suppressed T1-weighted MRI in children with sickle cell disease -- can it differentiate bone infarcts from acute osteomyelitis?

Science.gov (United States)

Delgado, Jorge; Bedoya, Maria A; Green, Abby M; Jaramillo, Diego; Ho-Fung, Victor

2015-12-01

Children with sickle cell disease (SCD) are at risk of bone infarcts and acute osteomyelitis. The clinical differentiation between a bone infarct and acute osteomyelitis is a diagnostic challenge. Unenhanced T1-W fat-saturated MR images have been proposed as a potential tool to differentiate bone infarcts from osteomyelitis. To evaluate the reliability of unenhanced T1-W fat-saturated MRI for differentiation between bone infarcts and acute osteomyelitis in children with SCD. We retrospectively reviewed the records of 31 children (20 boys, 11 girls; mean age 10.6 years, range 1.1-17.9 years) with SCD and acute bone pain who underwent MR imaging including unenhanced T1-W fat-saturated images from 2005 to 2010. Complete clinical charts were reviewed by a pediatric hematologist with training in infectious diseases to determine a clinical standard to define the presence or absence of osteomyelitis. A pediatric radiologist reviewed all MR imaging and was blinded to clinical information. Based on the signal intensity in T1-W fat-saturated images, the children were further classified as positive for osteomyelitis (low bone marrow signal intensity) or positive for bone infarct (high bone marrow signal intensity). Based on the clinical standard, 5 children were classified as positive for osteomyelitis and 26 children as positive for bone infarct (negative for osteomyelitis). The bone marrow signal intensity on T1-W fat-saturated imaging was not significant for the differentiation between bone infarct and osteomyelitis (P = 0.56). None of the additional evaluated imaging parameters on unenhanced MRI proved reliable in differentiating these diagnoses. The bone marrow signal intensity on unenhanced T1-W fat-saturated MR images is not a reliable criterion to differentiate bone infarcts from osteomyelitis in children.

Utility of unenhanced fat-suppressed T1-weighted MRI in children with sickle cell disease - can it differentiate bone infarcts from acute osteomyelitis?

International Nuclear Information System (INIS)

Delgado, Jorge; Bedoya, Maria A.; Green, Abby M.; Jaramillo, Diego; Ho-Fung, Victor

2015-01-01

Children with sickle cell disease (SCD) are at risk of bone infarcts and acute osteomyelitis. The clinical differentiation between a bone infarct and acute osteomyelitis is a diagnostic challenge. Unenhanced T1-W fat-saturated MR images have been proposed as a potential tool to differentiate bone infarcts from osteomyelitis. To evaluate the reliability of unenhanced T1-W fat-saturated MRI for differentiation between bone infarcts and acute osteomyelitis in children with SCD. We retrospectively reviewed the records of 31 children (20 boys, 11 girls; mean age 10.6 years, range 1.1-17.9 years) with SCD and acute bone pain who underwent MR imaging including unenhanced T1-W fat-saturated images from 2005 to 2010. Complete clinical charts were reviewed by a pediatric hematologist with training in infectious diseases to determine a clinical standard to define the presence or absence of osteomyelitis. A pediatric radiologist reviewed all MR imaging and was blinded to clinical information. Based on the signal intensity in T1-W fat-saturated images, the children were further classified as positive for osteomyelitis (low bone marrow signal intensity) or positive for bone infarct (high bone marrow signal intensity). Based on the clinical standard, 5 children were classified as positive for osteomyelitis and 26 children as positive for bone infarct (negative for osteomyelitis). The bone marrow signal intensity on T1-W fat-saturated imaging was not significant for the differentiation between bone infarct and osteomyelitis (P = 0.56). None of the additional evaluated imaging parameters on unenhanced MRI proved reliable in differentiating these diagnoses. The bone marrow signal intensity on unenhanced T1-W fat-saturated MR images is not a reliable criterion to differentiate bone infarcts from osteomyelitis in children. (orig.)

Utility of unenhanced fat-suppressed T1-weighted MRI in children with sickle cell disease - can it differentiate bone infarcts from acute osteomyelitis?

Energy Technology Data Exchange (ETDEWEB)

Delgado, Jorge; Bedoya, Maria A. [The Children' s Hospital of Philadelphia, Department of Radiology, Philadelphia, PA (United States); Green, Abby M. [The Children' s Hospital of Philadelphia, Division of Oncology, Philadelphia, PA (United States); Jaramillo, Diego; Ho-Fung, Victor [The Children' s Hospital of Philadelphia, Department of Radiology, Philadelphia, PA (United States); The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA (United States)

2015-12-15

Children with sickle cell disease (SCD) are at risk of bone infarcts and acute osteomyelitis. The clinical differentiation between a bone infarct and acute osteomyelitis is a diagnostic challenge. Unenhanced T1-W fat-saturated MR images have been proposed as a potential tool to differentiate bone infarcts from osteomyelitis. To evaluate the reliability of unenhanced T1-W fat-saturated MRI for differentiation between bone infarcts and acute osteomyelitis in children with SCD. We retrospectively reviewed the records of 31 children (20 boys, 11 girls; mean age 10.6 years, range 1.1-17.9 years) with SCD and acute bone pain who underwent MR imaging including unenhanced T1-W fat-saturated images from 2005 to 2010. Complete clinical charts were reviewed by a pediatric hematologist with training in infectious diseases to determine a clinical standard to define the presence or absence of osteomyelitis. A pediatric radiologist reviewed all MR imaging and was blinded to clinical information. Based on the signal intensity in T1-W fat-saturated images, the children were further classified as positive for osteomyelitis (low bone marrow signal intensity) or positive for bone infarct (high bone marrow signal intensity). Based on the clinical standard, 5 children were classified as positive for osteomyelitis and 26 children as positive for bone infarct (negative for osteomyelitis). The bone marrow signal intensity on T1-W fat-saturated imaging was not significant for the differentiation between bone infarct and osteomyelitis (P = 0.56). None of the additional evaluated imaging parameters on unenhanced MRI proved reliable in differentiating these diagnoses. The bone marrow signal intensity on unenhanced T1-W fat-saturated MR images is not a reliable criterion to differentiate bone infarcts from osteomyelitis in children. (orig.)

[Multifocal phakic intraocular lens implant to correct presbyopia].

Science.gov (United States)

Baikoff, G; Matach, G; Fontaine, A; Ferraz, C; Spera, C

2005-03-01

Presbyopic surgery is considered as the new frontier in refractive surgery. Different solutions are proposed: myopization of one eye, insertion of an accommodative crystalline lens, scleral surgery, the effects of which are still unknown, and finally multifocal phakic implants. We therefore decided to undertake a prospective study under the Huriet law to determine its efficacy and specify the conditions required for an anterior chamber multifocal phakic implant. Fifty-five eyes of 33 patients received an anterior chamber foldable multifocal phakic implant. Twenty-one females and 12 males underwent surgery. Initial refraction was between -5D and +5D. The implant's single addition was +2.50. Recuperating a distant uncorrected visual acuity of 0.6 or better and near uncorrected vision of Parinaud 3 or better can be considered a very good postoperative result. Average follow-up was 42.6+/-18 weeks. Mean postoperative refraction was -0.12+/-0.51 D. Mean postoperative uncorrected visual acuity was 0.78+/-0.20. Postoperative uncorrected visual acuity was Parinaud 2.3+/-0.6. Eighty-four percent of eyes operated on recuperated 0.6 or better without correction and Parinaud 3 or better without correction. Lenses in four eyes were explanted for different reasons, essentially optical, and no severe anatomical complications were observed. Placing an anterior chamber multifocal phakic implant to correct presbyopia is an effective technique with good predictability and has the advantage of being reversible in case of intolerance, optical parasite effects or undesired complications. Considering the particularity of this surgery, it is imperative to respect very strict inclusion criteria: anterior chamber depth equal to or above 3.1 mm, open angle, endothelial cell count equal to or above 2000 cells/mm2, absence of an incipient cataract or the slightest evidence of macular alteration.

Retreatments after multifocal intraocular lens implantation: an analysis

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Gundersen KG

2016-03-01

Full Text Available Kjell Gunnar Gundersen,1 Sarah Makari,2 Steffen Ostenstad,1 Rick Potvin2 1Ifocus Eye Clinic, Haugesund, Norway; 2Science in Vision, Akron, NY, USA Purpose: To determine the incidence and etiology of required retreatment after multifocal intraocular lens (IOL implantation and to evaluate the methods and clinical outcomes of retreatment.Patients and methods: A retrospective chart review of 416 eyes of 209 patients from one site that underwent uncomplicated cataract surgery with multifocal IOL implantation. Biometry, the IOL, and refractive data were recorded after the original implantation, with the same data recorded after retreatment. Comments related to vision were obtained both before and after retreatment for retreated patients.Results: The multifocal retreatment rate was 10.8% (45/416 eyes. The eyes that required retreatment had significantly higher residual refractive astigmatism compared with those who did not require retreatment (1.21±0.51 D vs 0.51±0.39 D, P<0.01. The retreatment rate for the two most commonly implanted primary IOLs, blended bifocal (10.5%, 16/152 and bilateral trifocal (6.9%, 14/202 IOLs, was not statistically significantly different (P=0.12. In those requiring retreatment, refractive-related complaints were most common. Retreatment with refractive corneal surgery, in 11% of the eyes, and piggyback IOLs, in 89% of the eyes, was similarly successful, improving patient complaints 78% of the time.Conclusion: Complaints related to ametropia were the main reasons for retreatment. Residual astigmatism appears to be an important determinant of retreatment rate after multifocal IOL implantation. Retreatment can improve symptoms for a high percentage of patients; a piggyback IOL is a viable retreatment option. Keywords: piggyback IOL, Sulcoflex, toric, STAAR, symptoms, astigmatism

Salmonella pyomyositis with concurrent sacroiliac osteomyelitis presenting as piriformis syndrome: A rare case

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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.

Pulmonary nocardiosis with osteomyelitis

International Nuclear Information System (INIS)

Bechet, R.; Granier, P.; Mourad, M.; Dufranc, A.; Adoue, D.

2007-01-01

We report a case of a 49-year-old female who developed a bronchopneumonia associated with atelectasis of the upper right lobe and back pain of bone origin. Bronchoscopy revealed an endobronchial mass at the origin of the right upper lobe bronchus. Scintigraphy showed three paravertebral spots of the seventh and eighth thoracic vertebrae, without any radiological modification. Culture of lung tissue obtained by trans-parietal punction under CT scan control became positive to Nocardia belonging to the pneumoniae complex. Positive diagnosis of pulmonary nocardiosis associated with two rare localizations was set, one was an endobronchial mass, the other was osteomyelitis of the posterior chest wall. The patient was treated with Trimethoprim ulfamethoxazole and recovered completely. (author)

[Maggot therapy for gangrene and osteomyelitis].

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Mumcuoglu, K Y; Lipo, M; Ioffe-Uspensky, I; Miller, J; Galun, R

1997-03-02

5 patients with diabetic-foot were treated by maggot therapy. The most serious case was in a 75-year-old man who had gangrene and osteomyelitis of the right foot. Proteus mirabilis, Enterococcus sp., Providencia stuartii and Staphylococcus spec. (coagulase positive) were isolated from lesions which did not respond to antibiotic therapy. The patient had twice refused amputation but agreed to maggot therapy. Larvae of the sheep blowfly Phoenicia (Lucilia) sericata were used for twice-weekly treatment over a period of 7 months. Sterile larvae were applied to the wound and replaced every 3-4 days. After 4 months of treatment, the necrotic tissue around the toes and on the sole of the foot detached from the healthy tissue. During the last 3 months of treatment the larvae removed the remaining infected tissue. As therapy progressed, new layers of healthy tissue covered the wound. The offensive odor associated with the necrotic tissue and the intense pain in the foot decreased significantly. At the end of therapy, during which there were no complaints of discomfort, he was able to walk. In the 4 other patients who had relatively superficial gangrene, the maggots debrided the wounds within 2-4 weeks. Thereafter treatment was continued with antibiotics. Maggot therapy can be recommended in cases of intractable gangrene and osteomyelitis, when treatment with antibiotics and surgical debridement have failed.

Imaging osteomyelitis and the diabetic foot

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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.

Unilateral Osteomyelitis of the Clavicle in Childhood:A Case Report

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Arezou Hemmati

2017-08-01

Full Text Available Infection of clavicle is a rare complication in children that is difficult to diagnose. The exact incidence is unknown. We report a case of osteomyelitis of the clavicle without any long term disability.

Treatment of Osteomyelitis: A Case for Disruption of the Affected Adjacent Periosteum.

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Hudson, John W; Daly, Austin P; Foster, Michael

2017-10-01

To evaluate the response of mandibular osteomyelitis treated by surgical decortication with disruption of the affected adjacent periosteum in concert with long-term targeted antibiotic therapy. The hypothesis is that, by removing the buccal cortical plate and disrupting the hypertrophically inflamed adjacent periosteum, the medullary bone will be brought in contact with bleeding tissue and circulating immunologic factors and antibiotics, which will promote definitive resolution. A retrospective review was conducted of 7 patient charts with associated radiographs from November 2010 to August 2016 treated by the first author at the University of Tennessee Medical Center (Knoxville, TN). Patients with chronic suppurative or nonsuppurative osteomyelitis of the mandible without condylar involvement or pathologic fracture were selected and treated with decortication with periosteal disruption in combination with long-term targeted antibiotic therapy. Seven patients (3 women and 4 men; mean age, 60 yr) underwent decortication with periosteal disruption of the affected area and received at least 6 weeks of targeted intravenous antibiotics. Computed tomography was performed preoperatively and a repeat study was performed after completion of antibiotics. In each case, post-treatment imaging showed definitive resolution after treatment with decortication in concert with disruption of the inflamed hypertrophic periosteum and intravenous antibiotics. Debridement of the infected cortical bone with restoration of the blood supply through disruption of the adjacent periosteum provided definitive resolution of mandibular osteomyelitis in the 7 patients treated. The hypothesis is that disruption of the affected adjacent periosteum reintroduces an immune-mediated response in concert with improved antibiotic delivery to and penetrance of the diseased mandible, aiding in definitive resolution. Decortication with periosteal disruption allows for preservation of the inferior alveolar

Clinical significance of the isolation of Staphylococcus epidermidis from bone biopsy in diabetic foot osteomyelitis

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Javier Aragón-Sánchez

2010-08-01

Full Text Available Introduction: Coagulase-negative staphylococci are considered as microorganisms with little virulence and usually as contaminants. In order to establish the role of Staphylococcus epidermidis as a pathogen in diabetic foot osteomyelitis, in addition to the isolation of the sole bacterium from the bone it will be necessary to demonstrate the histopathological changes caused by the infection. Methods: A consecutive series of 222 diabetic patients with foot osteomyelitis treated surgically in the Diabetic Foot Unit at La Paloma Hospital (Las Palmas de Gran Canaria, Canary Islands, Spain between 1 October 2002 and 31 October 2008. From the entire series including 213 bone cultures with 241 isolated organisms, we have analyzed only the 139 cases where Staphylococci were found. We analyzed several variables between the two groups: Staphylococcus aureus versus Staphylococcus epidermidis. Results: Of the 134 patients included in this study, Staphlylococcus epidermidis was found as the sole bacterium isolated in 11 cases and accompanied by other bacteria in 12 cases. Staphlylococcus aureus was found as the sole bacterium isolated in 72 cases and accompanied by other bacteria in 39 cases. Histopathological changes were found in the cases of osteomyelitis where Staphylococcus epidermidis was the sole bacterium isolated. Acute osteomyelitis was found to a lesser extent when Staphylococcus epidermidis was the sole bacterium isolated but without significant differences with the cases where Staphylococcus aureus was the sole bacterium isolated. Conclusion: Staphylococcus epidermidis should be considered as a real pathogen, not only a contaminant, in diabetic patients with foot osteomyelitis when the bacterium is isolated from the bone. No differences in the outcomes of surgical treatment have been found with cases which Staphlylococcus aureus was isolated.

[Streptococcus milleri: An unusual cause of skull extensive osteomyelitis in an immunocompetent patient].

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Duquenne, C; Dernis, E; Zehrouni, A; Bizon, A; Duquenne, M

2017-09-01

Streptococcus milleri (Streptococcus anginosus, intermedius and constellatus) are commensal organisms, which can become pathogenic and cause infection with frequent abscess formation, local or metastatic extension. Osteomyelitis of the skull has been rarely reported in this type of infection. Skull osteomyelitis due to Streptococcus milleri is reported in a 61-year-old immunocompetent man without any medical history, occurring 10 months after a head injury without any wound or complication at initial presentation. A progressive right parieto-occipital headache with worsening and increased acute phase reactants evoked a giant cell arteritis. After few days of corticosteroid therapy (0.5 mg/kg/day), diagnosis of subcutaneous abscess associated to an extensive osteomyelitis of the skull due to Streptococcus milleri was diagnosed. The outcome was favorable after drainage of one liter of pus, irrigation, debridement and antibiotherapy by amoxicillin for 8 weeks. It is necessary to discuss the differential diagnosis of giant cell arteritis particularly when symptoms are unusual. Even a short-term corticosteroid therapy may dramatically exacerbate an undetected infection. Copyright © 2017. Published by Elsevier SAS.

Scintigraphic evaluation of diabetic osteomyelitis: concise communication

International Nuclear Information System (INIS)

Park, H.M.; Wheat, L.J.; Siddiqui, A.R.; Burt, R.W.; Robb, J.A.; Ransburg, R.C.; Kernek, C.B.

1982-01-01

Researchers have reviewed the three-phase bone scans, radiographs, and histologic findings of 39 diabetic patients with serious foot problems. The sensitivity and specificity of bone scans were 83% and 75%, respectively, for osteomyelitis of the small bones of the foot. The positive and negative predictive values were 87% and 69%, respectively. The radiographs were less sensitive (62%) and less specific (69%), with predictive values of 80% (positive) and 47%

Maxillary Necrosis: A Sequelae of Fungal Osteomyelitis

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K Anbarasi

2010-01-01

Full Text Available Osteomyelitis is designated to a variety of bone diseases having inflammation as a common denominator. Persistent infection progresses to inflammation of marrow space, haversian system and periostium of affected region. Thrombosis of endothelial vessels cause necrosis and sequestrum formation. Both pyogenic and nonpyogenic infections of jaw lead to this condition. Immunosuppressed patients are more prone to mycelial infections, whereas their occurrence in immunocompetent individuals are highly unusual.

Contactin-1 and Neurofascin-155/-186 Are Not Targets of Auto-Antibodies in Multifocal Motor Neuropathy.

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Kathrin Doppler

Full Text Available Multifocal motor neuropathy is an immune mediated disease presenting with multifocal muscle weakness and conduction block. IgM auto-antibodies against the ganglioside GM1 are detectable in about 50% of the patients. Auto-antibodies against the paranodal proteins contactin-1 and neurofascin-155 and the nodal protein neurofascin-186 have been detected in subgroups of patients with chronic inflammatory demyelinating polyneuropathy. Recently, auto-antibodies against neurofascin-186 and gliomedin were described in more than 60% of patients with multifocal motor neuropathy. In the current study, we aimed to validate this finding, using a combination of different assays for auto-antibody detection. In addition we intended to detect further auto-antibodies against paranodal proteins, specifically contactin-1 and neurofascin-155 in multifocal motor neuropathy patients' sera. We analyzed sera of 33 patients with well-characterized multifocal motor neuropathy for IgM or IgG anti-contactin-1, anti-neurofascin-155 or -186 antibodies using enzyme-linked immunosorbent assay, binding assays with transfected human embryonic kidney 293 cells and murine teased fibers. We did not detect any IgM or IgG auto-antibodies against contactin-1, neurofascin-155 or -186 in any of our multifocal motor neuropathy patients. We conclude that auto-antibodies against contactin-1, neurofascin-155 and -186 do not play a relevant role in the pathogenesis in this cohort with multifocal motor neuropathy.

Ultrasonographic findings of septic arthritis and osteomyelitis in neonatal hip

International Nuclear Information System (INIS)

Lee, Seung Hoon; Jung, Kun Sik; Koh, Jung Kon; Im, Myung Ah; Kwon, Kwi Ryun; Kim, Sung Soo

2000-01-01

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.

Gram-negative diabetic foot osteomyelitis: risk factors and clinical presentation.

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Aragón-Sánchez, Javier; Lipsky, Benjamin A; Lázaro-Martínez, Jose L

2013-03-01

Osteomyelitis frequently complicates infections in the feet of patients with diabetes. Gram-positive cocci, especially Staphylococcus aureus, are the most commonly isolated pathogens, but gram-negative bacteria also cause some cases of diabetic foot osteomyelitis (DFO). These gram-negatives require different antibiotic regimens than those commonly directed at gram-positives. There are, however, few data on factors related to their presence and how they influence the clinical picture. We conducted a retrospective study to determine the variables associated with the isolation of gram-negative bacteria from bone samples in cases of DFO and the clinical presentation of these infections. Among 341 cases of DFO, 150 had a gram-negative isolate (alone or combined with a gram-positive isolate) comprising 44.0% of all patients and 50.8% of those with a positive bone culture. Compared with gram-positive infections, wounds with gram-negative organisms more often had a fetid odor, necrotic tissue, signs of soft tissue infection accompanying osteomyelitis, and clinically severe infection. By multivariate analysis, the predictive variables related to an increased likelihood of isolating gram-negatives from bone samples were glycated hemoglobin gram-negatives had a statistically significantly higher prevalence of leukocytosis and higher white blood cell counts than those without gram-negatives. In conclusion, gram-negative organisms were isolated in nearly half of our cases of DFO and were associated with more severe infections, higher white blood cell counts, lower glycated hemoglobin levels, and wounds of traumatic etiology.

Effect of multizone refractive multifocal contact lenses on standard automated perimetry.

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Madrid-Costa, David; Ruiz-Alcocer, Javier; García-Lázaro, Santiago; Albarrán-Diego, César; Ferrer-Blasco, Teresa

2012-09-01

The aim of this study was to evaluate whether the creation of 2 foci (distance and near) provided by multizone refractive multifocal contact lenses (CLs) for presbyopia correction affects the measurements on Humphreys 24-2 Swedish interactive threshold algorithm (SITA) standard automated perimetry (SAP). In this crossover study, 30 subjects were fitted in random order with either a multifocal CL or a monofocal CL. After 1 month, a Humphrey 24-2 SITA standard strategy was performed. The visual field global indices (the mean deviation [MD] and pattern standard deviation [PSD]), reliability indices, test duration, and number of depressed points deviating at P0.5% on pattern deviation probability plots were determined and compared between multifocal and monofocal CLs. Thirty eyes of 30 subjects were included in this study. There were no statistically significant differences in reliability indices or test duration. There was a statistically significant reduction in the MD with the multifocal CL compared with monfocal CL (P=0.001). Differences were not found in PSD nor in the number of depressed points deviating at P0.5% in the pattern deviation probability maps studied. The results of this study suggest that the multizone refractive lens produces a generalized depression in threshold sensitivity as measured by the Humphreys 24-2 SITA SAP.

Vacuum-Assisted Closure Combined with a Myocutaneous Flap in the Management of Osteomyelitis in a Dog

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Jeremy L. Shomper

2013-01-01

Full Text Available Case Description. A 2.5-year-old female spayed mixed breed dog presented to the Teaching Hospital for draining tracts on the left medial aspect of the tibia. Two years prior to presentation, the patient sustained a left tibial fracture, which was repaired with an intramedullary (IM pin and two cerclage wires. Multiple antimicrobials were utilized during this time. Clinical Findings. Radiographs were consistent with left tibial osteomyelitis. The implant was removed and the wound was debrided. Treatment and Outcome. A bone window on the medial aspect of the tibia was created in order to facilitate implant removal. The wound and associated bone window were treated with vacuum assisted closure (VAC in preparation for reconstructive surgery. Adjunctive VAC therapy was utilized following the caudal sartorius myocutaneous flap. Complications following this surgery included distal flap necrosis and donor site dehiscence. Clinical Relevance. This presents a difficult case of canine osteomyelitis with subsequent wound care in which VAC and a myocutaneous flap were useful adjunctive treatments for osteomyelitis. This is the first report of VAC in the management of canine osteomyelitis and management with a myocutaneous flap.

Single-Stage Treatment of Osteomyelitis for Digital Salvage by Using an Antibiotic-Eluting, Methylmethacrylate Joint-Spanning Spacer.

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Aimé, Victoria L; Kidwell, John T; Webb, Leland H

2017-06-01

Osteomyelitis of the digit is a challenging problem that can result in amputation. We describe 13 cases of osteomyelitis involving bones of the hand managed with a novel technique. We reviewed records of 12 patients (13 digits) who had joint-spanning, antibiotic-eluting (tobramycin or vancomycin), methylmethacrylate spacers placed as definitive, single-stage treatment for digital osteomyelitis. The primary outcome was digit salvage. Secondary outcomes were infection eradication (no recurrence at 3 months) and spacer removal. Patients were followed up until the infection resolved (ie, no cutaneous signs of infection, including pain, erythema, or swelling). At a mean of 24 months, 10 of 13 infections had successful one-stage treatment. One patient required a second operation to revise a soft tissue flap but the spacer remained in place. Two spacers were removed because of malalignment. An antibiotic-eluting methylmethacrylate spacer is an innovative treatment for digital osteomyelitis. In 12 consecutive patients (13 digits), we successfully salvaged the digit. Copyright © 2017 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

Degradation of mechanical properties of CrMo creep resistant steel operating under conditions of creep

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J. Michel

2012-01-01

Full Text Available Mechanical properties of a steam tube made of CrMo creep resistant steel are analysed in this contribution after up to 2,6•105 hours service life in creep conditions at temperature 530 °C and calculated stress level in the tube wall 46,5 MPa. During service life there were in the steel gradual micro structure changes, fi rst pearlite spheroidization, precipitation, coaugulation and precipitate coarsening. Nevertheless the strength and deformation properties of the steel (Re, Rm, A5, Z, and the resistance to brittle fracture and the creep strength limit, were near to unchanged after 2,1•105 hours in service. The steam tube is now in service more than 2,6•105 h.

Reading ability with pseudophakic monovision and with refractive multifocal intraocular lenses: comparative study.

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Ito, Misae; Shimizu, Kimiya

2009-09-01

To the compare the reading ability after bilateral cataract surgery in patients who had pseudophakic monovision achieved by monofocal intraocular lens (IOL) implantation and patients who had refractive multifocal IOL implantation. Department of Ophthalmology, Kitasato University Hospital, Kanagawa, Japan. This study evaluated patients who had bilateral cataract surgery using the monovision method with monofocal IOL implantation to correct presbyopia (monovision group) or who had bilateral cataract surgery with refractive multifocal IOL implantation (multifocal group). In the monovision group, the dominant eye was corrected for distance vision and the nondominant eye for near vision. The maximum reading speed, critical character size, and reading acuity were measured binocularly without refractive correction using MNREAD-J acuity charts. The monovision group comprised 38 patients and the multifocal group, 22 patients. The mean maximum reading speed was 350.5 characters per minute (cpm) +/- 62.3 (SD) in the monovision group and 355.0 +/- 53.3 cpm in the multifocal group; the difference was not statistically significant. The mean critical character size was 0.24 +/- 0.12 logMAR and 0.40 +/- 0.16 logMAR, respectively (P<.05). The mean reading acuity was 0.05 +/- 0.12 logMAR and 0.19 +/- 0.11 logMAR, respectively (P<.01). The monovision group had better critical character size and reading acuity results. The monovision method group had better reading ability; however, careful patient selection is essential.

Prospective evaluation of bone and leukocyte scintigraphy for diagnosis of chronic osteomyelitis in patients with coexistent soft-tissue pathology

International Nuclear Information System (INIS)

Jacobson, A.F.; Harley, J.D.; Lipsky, B.A.; Pecoraro, R.E.

1989-01-01

This paper reports on a study involving twenty-four patients with soft-tissue infections or wounds and radiographic abnormalities in contiguous bones possibly representing osteomyelitis who underwent three-phase T c -99 m methylene diphosphonate (MDP) bone scanning, followed by In-111 leukocyte scintigraphy (22 patients) and bone biopsy (21 patients). Chronic osteomyelitis was confirmed in 12 patients by means of biopsy cultures and in one by means of histologic findings following amputation. Four patterns of leukocyte uptake in bone were identified: definitely increased, possibly increased, normal, and decreased. The prevalence of osteomyelitis for these four leukocyte scan patterns was as follows: 89% (eight of nine patients), 40% (two of five), 20% (one of five), and 67% (two of three), respectively. A definite increase in bone uptake of In-111-labeled leukocytes usually reflects osteomyelitis, but bone biopsy may be necessary to establish the diagnosis when other scan patterns are present

Multifocal tenosynovial giant cell tumors in a child with Noonan syndrome

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Meyers, Arthur B. [Children' s Hospital of Wisconsin, Department of Radiology, Milwaukee, WI (United States); Nemours Children' s Health System/Nemours Children' s Hospital, Department of Radiology, Orlando, FL (United States); Awomolo, Agboola O. [Children' s Hospital of Wisconsin, Department of Radiology, Milwaukee, WI (United States); Szabo, Sara [Medical College of Wisconsin and Children' s Hospital of Wisconsin, Department of Pathology, Milwaukee, WI (United States); Cincinnati Children' s Hospital Medical Center, Division of Pathology and Laboratory Medicine, Cincinnati, OH (United States)

2017-03-15

Noonan syndrome is a genetic disorder with variable expression of distinctive facial features, webbed neck, chest deformity, short stature, cryptorchidism and congenital heart disease. The association of Noonan syndrome and giant cell granulomas of the mandible is widely reported. However, Noonan syndrome may also be associated with single or multifocal tenosynovial giant cell tumors, also referred to as pigmented villonodular synovitis. We report a child with Noonan syndrome, giant cell granulomas of the mandible and synovial and tenosynovial giant cell tumors involving multiple joints and tendon sheaths who was initially misdiagnosed with juvenile idiopathic arthritis. It is important for radiologists to be aware of the association of Noonan syndrome and multifocal giant cell lesions, which can range from the more commonly described giant cell granulomas of the mandible to isolated or multifocal intra- or extra-articular tenosynovial giant cell tumors or a combination of all of these lesions. (orig.)

Multifocal tenosynovial giant cell tumors in a child with Noonan syndrome.

Science.gov (United States)

Meyers, Arthur B; Awomolo, Agboola O; Szabo, Sara

2017-03-01

Noonan syndrome is a genetic disorder with variable expression of distinctive facial features, webbed neck, chest deformity, short stature, cryptorchidism and congenital heart disease. The association of Noonan syndrome and giant cell granulomas of the mandible is widely reported. However, Noonan syndrome may also be associated with single or multifocal tenosynovial giant cell tumors, also referred to as pigmented villonodular synovitis. We report a child with Noonan syndrome, giant cell granulomas of the mandible and synovial and tenosynovial giant cell tumors involving multiple joints and tendon sheaths who was initially misdiagnosed with juvenile idiopathic arthritis. It is important for radiologists to be aware of the association of Noonan syndrome and multifocal giant cell lesions, which can range from the more commonly described giant cell granulomas of the mandible to isolated or multifocal intra- or extra-articular tenosynovial giant cell tumors or a combination of all of these lesions.

Multifocal tenosynovial giant cell tumors in a child with Noonan syndrome

International Nuclear Information System (INIS)

Meyers, Arthur B.; Awomolo, Agboola O.; Szabo, Sara

2017-01-01

Noonan syndrome is a genetic disorder with variable expression of distinctive facial features, webbed neck, chest deformity, short stature, cryptorchidism and congenital heart disease. The association of Noonan syndrome and giant cell granulomas of the mandible is widely reported. However, Noonan syndrome may also be associated with single or multifocal tenosynovial giant cell tumors, also referred to as pigmented villonodular synovitis. We report a child with Noonan syndrome, giant cell granulomas of the mandible and synovial and tenosynovial giant cell tumors involving multiple joints and tendon sheaths who was initially misdiagnosed with juvenile idiopathic arthritis. It is important for radiologists to be aware of the association of Noonan syndrome and multifocal giant cell lesions, which can range from the more commonly described giant cell granulomas of the mandible to isolated or multifocal intra- or extra-articular tenosynovial giant cell tumors or a combination of all of these lesions. (orig.)

Skin rash and arthritis a simplified appraisal of less common associations.

Science.gov (United States)

Cozzi, A; Doria, A; Gisondi, P; Girolomoni, G

2014-06-01

Skin and joint manifestations are part of the clinical spectrum of many disorders. Well-known associations include psoriatic arthritis and arthritis associated with autoimmune connective tissue diseases. This review focuses on less common associations where skin lesions can provide easily accessible and valuable diagnostic clues, and directly lead to the specific diagnosis or limit the list of possibilities. This may also affect health care resources as diagnostic tests are often low-specific, highly expensive and poorly available. This group of diseases can be divided into two subsets, based on the presence/absence of fever, and then further classified according to elementary skin lesions (macular, urticarial, maculo-papular, vesico-bullous, pustular, petechial and nodular). In most instances joint involvement occurs as peripheral migrating polyarthritis. Erythematosus macular or urticarial rashes occur in most febrile disorders such as monogenic autoinflammatory syndromes, Schnitzler's syndrome, Still's disease and rheumatic fever and afebrile diseases as urticarial vasculitis. Pustular rash may be observed in chronic recurrent multifocal osteomyelitis (CRMO) and pyogenic arthritis with pyoderma gangrenosum and acne (PAPA) syndrome (both febrile) as well as in Behcet's disease and Synovitis, acne, pustulosis, hyperostosis and osteitis syndrome (both non-febrile). Papular lesions are typical of secondary syphilis, sarcoidosis, interstitial granulomatous dermatitis, papular petechial of cutaneous small-vessel vasculitis and nodular lesions of polyarteritis nodosa and multicentric reticulohistiocytosis all of which are afebrile. Differential diagnosis includes infections and drug reactions which may mimic several of these conditions. To biopsy the right skin lesion at the right time it is essential to obtain relevant histological information. © 2013 European Academy of Dermatology and Venereology.

Fatigue of the quenched and hardened steel 42CrMo4 under multiaxial in- and out-of-phase loading; Ermuedung des Stahles 42CrMo4 unter mehrachsiger, phasenverschobener Beanspruchung

Energy Technology Data Exchange (ETDEWEB)

Loewisch, G. [Stiftung Inst. fuer Werkstofftechnik, Bremen (Germany); Bomas, H.; Mayr, P.

1999-10-01

Two kinds of specimens out of the quenched and hardened steel 42CrMo4 (similar SAE 4140) were tested by combined tension-torsion in- and out-of-phase loading. The specimens batches differed in the residual stress state. Under cyclic, stress controlled loading an elastic behaviour is registrated until 50% of the life time. Then a rapid softening occurs, which correlates with the von-Mises equivalent stress in the case of in-phase loading. At high stress amplitudes, the residual stresses may be neglected. The lifetime is best described by the fatigue criterion of Zenner which considers the integral average of the stress state in every plane. This stress state is described by a linear combination of the shear stress amplitude and the normal stress amplitude. Below the cyclic yield strength, the residual stresses must be taken into account as static stresses. The comparison of the local residual stress distributions is possible by using the weakest link model of Heckel, which is described in detail. (orig.)

Actinomycotic Osteomyelitis of Maxilla Presenting as Oroantral Fistula: A Rare Case Report

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Ashalata Gannepalli

2015-01-01

Full Text Available Actinomycosis is a chronic granulomatous infection caused by Actinomyces species which may involve only soft tissue or bone or the two together. Actinomycotic osteomyelitis of maxilla is relatively rare when compared to mandible. These are normal commensals and become pathogens when they gain entry into tissue layers and bone where they establish and maintain an anaerobic environment with extensive sclerosis and fibrosis. This infection spreads contiguously, frequently ignoring tissue planes and surrounding tissues or organ. The portal of entry may be pulpal, periodontal infection, and so forth which may lead to involvement of adjacent structures as pharynx, larynx, tonsils, and paranasal sinuses and has the propensity to damage extensively. Diagnosis is often delayed and is usually based on histopathology as they are cultured in fewer cases. The chronic clinical course without regional lymphadenopathy may be essential in diagnosis. The management of actinomycotic osteomyelitis is surgical debridement of necrotic tissue combined with antibiotics for 3–6 months. The primary actinomycosis arising within the maxilla with contiguous involvement of paranasal sinus with formation of oroantral fistula is rare. Hence, we present a 50-year-old female patient with chronic sclerosing osteomyelitis of maxilla which presented as oroantral fistula with suppurative and sclerotic features.

Osteomyelitis of the calcaneus in horses: 28 cases (1972-1987)

International Nuclear Information System (INIS)

MacDonald, M.H.; Honnas, C.M.; Meagher, D.M.

1989-01-01

Medical records of 28 horses with osteomyelitis of the calcaneus were reviewed to evaluate signalment, history, diagnostic and treatment methods, outcome, and long-term follow-up information. Trauma was the most commonly reported cause (24). Physical examination revealed lameness in 27 horses, and 22 (79%) had a wound or draining tract over the plantar aspect of the calcaneus. Radiography of all horses was done prior to the initiation of treatment, and follow-up radiography was done on 20 horses. The most common radiographic findings were soft tissue swelling (25), bony lysis of the calcaneus (17), bone fragments or sequestra from the tuber calcis (13), and periosteal new bone production or bony lysis of the sustentaculum tali (5). Association could not be found between initial radiographic findings and eventual outcome of the case. Positive bacterial cultures were obtained from 13 horses. A wide variety of gram-positive, gram-negative, and anaerobic organisms were isolated. Fourteen of the 15 isolates, for which susceptibilities were reported, were susceptible to penicillin, gentamicin, or trimethoprim sulfamethoxazole. Twenty-six of the 28 horses diagnosed as having osteomyelitis of the calcaneus were treated; 16 horses were treated with surgical debridement in addition to antimicrobial treatment, and 10 horses were treated with antimicrobial agents, anti-inflammatory drugs, or supportive wound care. There was no significant difference in survival rate of horses treated surgically and those treated conservatively. Six horses that were treated were later euthanatized for problems associated with chronic osteomyelitis, and 2 horses died or were euthanatized for unrelated problems. Eighteen horses (64%) were alive at last follow-up

Differentiation of osteomyelitis and infarction in sickle-cell hemoglobinopathies using combined bone-marrow and gallium scanning

International Nuclear Information System (INIS)

Hatfield, M.K.; Kahn, C.E.; Ryan, J.W.; Martin, W.B.

1986-01-01

The clinical records and scintigrams of patients with sickle cell hemoglobinopathies in whom acute symptoms developed suggestive of possible osteomyelitis and who had undergone sequential Tc-99m bone marrow scans and gallium scintigraphy of the affected sites were reviewed. Osteomyelitis was correctly diagnosed in six of 18 cases when gallium was focally increased relative to a site of decreased or absent bone marrow activity. Of 12 episodes of infarction, both studies showed focally decreased activity in a concordant manner in 11. The remaining, false-positive study indicated slightly increased gallium in 11. The remaining, false-positive indicated slightly increased gallium concentration at a site of decreased bone marrow activity. Overall, a protocol of sequential Tc-99m bone marrow scans and gallium scintigraphy is an effective means of distinguishing osteomyelitis from infarction in patients with sickle cell hemoglobinopathies

Vertebral Osteomyelitis Caused by Mycobacterium abscessus Surgically Treated Using Antibacterial Iodine-Supported Instrumentation

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Satoshi Kato

2014-01-01

Full Text Available Mycobacterium abscessus infections rarely develop in healthy individuals, and mostly they occur in immunocompromised hosts. Vertebral osteomyelitis due to Mycobacterium abscessus is very rare and only three previous cases of spinal infection caused by Mycobacterium abscessus have been reported. Mycobacterium abscessus isolates are uniformly resistant to antituberculous agents and can display a virulent biofilm-forming phenotype. The patient was a 67-year-old woman with vertebral osteomyelitis of the L1-2. She was healthy without immune-suppressed condition, history of trauma, or intravenous drug use. The smear examination of the specimen harvested by CT-guided puncture of the paravertebral abscess revealed Mycobacterium abscessus. Her disease condition did not abate with conservative treatment using antimicrobial chemotherapy. Radical debridement of the vertebral osteomyelitis and anterior reconstruction from T12 to L2 using antibacterial iodine-supported instrumentation were performed. Chemotherapy using clarithromycin, amikacin, and imipenem was applied for 6 months after surgery as these antibiotics had been proven to be effective to Mycobacterium abscessus after surgery. Two years after surgery, the infected anterior site healed and bony fusion was successfully achieved without a recurrence of infection.

Disturbance of growth of the vertebral bodies in children and adolescents with hematogenous osteomyelitis of the vertebral column

International Nuclear Information System (INIS)

Sizov, V.A.

1987-01-01

Clinicoroentgenological changes were studied over time in 72 children and adolescents with localized hematogenous osteomyelitis of the lumbar spine. The duration of clinicoroengenological observation ranged from 1 year to 15 years. The dynamic roentgenological followup of a course of hematogenous osteomyelitis developing in the period of growth, made it possible to reveal and describe for the first time an increase in the height of the vertebral bodies which hitherto was regarded in literature as a pathognomonic sign of tuberculous spondylitis. Unlike tuberculosis, in hematogenous osteomyelitis there was an increase in the height not only of the adjacent unaffected but also of the affected vertebrae in case of their superficial or localized focal involvement

[Osteomyelitis of the temporomaxillary joint (author's transl)].

Science.gov (United States)

Winiker-Blanck, E; Wittstock, C; Braun, L; Biedermann, F

1978-01-01

Although osteomyelitis of the inferior maxilla is still relatively frequently diagnosed, manifestation of the disease in the temporomaxillary joint is a rare occurrence. The symptomatology, diagnosis, and therapy of this particular arthropathy is discussed by reference to three cases treated in recent years at the Berlin Clinic of Maxillofacial Surgery. The importance of an early diagnosis and therapy is directed attention to because of the danger of serious subsequent diseases that may result in the loss of vital functions.

A circular multifocal collimator for 3D SPECT imaging

International Nuclear Information System (INIS)

Guillemaud, R.; Grangeat, P.

1993-01-01

In order to improve sensitivity of 3D Single Photon Emission Tomography (SPECT) image, a cone-beam collimator can be used. A new circular multifocal collimator is proposed. The multiple focal points are distributed on a transaxial circle which is the trajectory of the focal points during the circular acquisition. This distribution provides a strong focusing at the center of the detector like a cone-beam collimator, with a good sensitivity, and a weak transaxial focusing at the periphery. A solution for an analytical multifocal reconstruction algorithm has been derived. Grangeat algorithm is proposed to use for this purpose in order to reconstruct with a good sensitivity the region of interest. (R.P.) 3 refs

Multifocal epithelioid hemangioendothelioma of the phalanges of the hand

International Nuclear Information System (INIS)

Bruegel, Melanie; Waldt, Simone; Woertler, Klaus; Rummeny, Ernst J.; Weirich, Gregor

2006-01-01

Epithelioid hemangioendothelioma (EH) of bone is a rare vascular neoplasm characterized by epithelioid endothelial cells and a variable biologic behaviour. The principal sites of occurrence of this osteolytic tumor are the lower extremity and the axial skeleton. Approximately half of the cases present with multifocal disease. The latter feature can be helpful in suggesting the diagnosis of a vascular tumor; on the other hand, it strengthens the need for a skeletal survey or whole-body MRI/CT. We report on the clinical, histologic and radiologic features - including CT and MRI findings - of EH in a case of multifocal disease of the phalanges of the hand, a very uncommon anatomic site of affliction. (orig.)

Research advances on multifocal electroretinogram in primary open angle glaucoma

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Feng-Fei Mo

2013-10-01

Full Text Available Primary open angle glaucoma is a chronic and progressive optic neuropathy. It can lead to serious damage of visual impairment, and it is an important eye disease of blindness. Multifocal electroretinogram is a new way to measure visual electrophysiology. It can measure electroretinogram of the whole visual field of many small parts in a relatively short period of time, and it can reflect the function of regional retina. It has an extremely important value for early diagnosis of primary open angle glaucoma. The research advances on multifocal electroretinogram in diagnosing primary open angle glaucoma were summarized in this paper.

Strength behaviour of 10CrMo9.10 steel in nonsteady-state applications

International Nuclear Information System (INIS)

Seidel, C.

2 testing runs with cyclic temperature increase were conducted on steel 10CrMo9.10 samples, i.e., at 500 degC and cyclic increase by 10, 25 and 50 degC, and at 550 degC and cyclic increase by 50 degC. Long-term strength was studied under a strain of 6.1 to 25.6 kp/mm 2 for 22,000 hours and the effect of periodical unloading was investigated on long-term strength at 550 degC. Sample loading and unloading proceeded within the range of 8.8 to 24.7 kp/mm 2 at an unloading rate of 8 to 100 %/min. Steel lifetime was not affected by the number of cycles. The effect of the changing load and of constant temperature without load on the long-term strength of the steel at 550 degC is shown graphically. The results showed a clear dependence of steel life on dwell time at the given temperature without load. (J.P.)

Multifocal fibrosclerosis: a new case report and review of the literature

Energy Technology Data Exchange (ETDEWEB)

Oguz, Kader Karli; Oguz, Oguzhan; Cila, Aysenur; Oto, Aytekin [Department of Radiology, Faculty of Medicine, Hacettepe University, Ankara (Turkey); Kiratli, Hayyam [Department of Ophthalmology, Faculty of Medicine, Hacettepe University, Ankara (Turkey); Gokoz, Aytac [Department of Pathology, Faculty of Medicine, Hacettepe University, Ankara (Turkey)

2002-05-01

A case of multifocal fibrosclerosis is presented with MR images. Bilateral sclerosing orbital pseudotumor invading cavernous sinuses were the presenting disorder. Magnetic resonance imaging showed involvement of paranasal sinuses bilaterally and multiple supratentorial dural masses. Retroperitoneal fibrosis was associated with the condition. Multifocal involvement should be considered in patients with sclerosing orbital pseudotumor and an imaging approach should be performed on the appropriate clinical condition to document possible coexistence of other disorders including retroperitoneal fibrosis, mediastinal fibrosis, sclerosing cholangitis, and Riedel's thyroiditis (orig.)

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

: Simultaneous dual isotope bone-granulocyte scintigraphic images were obtained in 42 consecutive patients in whom conventional X-ray, erythrocyte sedimentation rate, and C-reactive protein were also available. 99mTc MDP bone and 111In labelled granulocyte imaging was obtained simultaneously. The images were...... 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......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...

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...

Granulomatous salmonella osteomyelitis associated with anti-tumor necrosis factor therapy in a non-sickle cell patient: a case report

Energy Technology Data Exchange (ETDEWEB)

Gould, Elaine S.; Gilet, Anthony G. [State University of New York at Stony Brook, Department of Radiology, Stony Brook, NY (United States); Vigorita, Vincent J. [SUNY Health Sciences Center Brooklyn, Department of Pathology and Orthopedics, Brooklyn, NY (United States)

2010-08-15

Salmonella osteomyelitis is seen most commonly in patients with sickle cell disease and in those with compromised immune systems. We report on the clinical, histological and imaging findings of salmonella osteomyelitis with intraosseous abscess formation occurring in a non-sickle cell patient receiving anti-tumor necrosis factor (TNF) alpha therapy. (orig.)

Granulomatous salmonella osteomyelitis associated with anti-tumor necrosis factor therapy in a non-sickle cell patient: a case report

International Nuclear Information System (INIS)

Gould, Elaine S.; Gilet, Anthony G.; Vigorita, Vincent J.

2010-01-01

Salmonella osteomyelitis is seen most commonly in patients with sickle cell disease and in those with compromised immune systems. We report on the clinical, histological and imaging findings of salmonella osteomyelitis with intraosseous abscess formation occurring in a non-sickle cell patient receiving anti-tumor necrosis factor (TNF) alpha therapy. (orig.)

Multifocality as a prognostic factor in breast cancer patients registered in Danish Breast Cancer Cooperative Group (DBCG) 1996-2001

DEFF Research Database (Denmark)

Joergensen, L.E.; Gunnarsdottir, K.A.; Lanng, C.

2008-01-01

The purpose of this study was to investigate the prognostic influence of multifocality in breast cancer patients. In a cohort of 7196 patients there were 945 patients with multifocality. We found no prognostic influence of multifocality on overall survival when controlling for known prognostic......, Gunnarsdottir KA, Rasmussen BB, Moeller S, Lanng C. The prognostic influence of multifocality in breast cancer patients. Breast 2004;13:188-193]....... factors. We found a small but significant influence on disease-free survival (HR=1.16 [1.03-1.31]) and a strong correlation between multifocality and known prognostic factors. This was in accordance with an earlier study done on a smaller population and in a different period of time [Pedersen L...

MULTIFOCAL RETINAL INFILTRATES WITH PHLEBITIS AND OPTIC NEUROPATHY IN AN HIV-POSITIVE PEDIATRIC PATIENT.

Science.gov (United States)

Kasi, Sundeep K; Vora, Robin A; Martin, Taliva; Cunningham, Emmett T

2015-01-01

To describe an unusual presentation of bilateral HIV-associated multifocal retinal infiltrates with phlebitis and optic neuropathy in a pediatric patient from Zimbabwe, Africa. Retrospective case report of a 15-year-old boy from Zimbabwe, Africa. The patient was found to have bilateral vitritis, multifocal retinitis with phlebitis, and optic neuropathy in the setting of previously unrecognized HIV infection. Vision improved and the clinical findings resolved after treatment with intravenous corticosteroids and highly active retroviral therapy (HAART). The authors describe the occurrence and treatment of bilateral, HIV-associated multifocal retinal infiltrates with phlebitis and HIV-associated optic neuropathy in a pediatric patient from Zimbabwe, Africa.

Long-Term Visual Prognosis of Peripheral Multifocal Chorioretinitis

NARCIS (Netherlands)

Ossewaarde-van Norel, J; ten Dam-van Loon, NH; de Boer, JH; Rothova, A.

2015-01-01

Purpose To report on the clinical manifestations, complications, and long-term visual prognosis of patients with peripheral multifocal chorioretinitis and to search for predictors for a lower visual outcome. Design Retrospective consecutive observational case series. Methods setting: Institutional.

Osteomyelitis Infection of Mycobacterium marinum: A Case Report and Literature Review

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Hao H. Nguyen

2015-01-01

Full Text Available Mycobacterium marinum (M. marinum is a ubiquitous waterborne organism that grows optimally at temperatures around 30°C. It is a nontuberculous Mycobacterium found in nonchlorinated water with worldwide prevalence. It is the most common atypical Mycobacterium that causes opportunistic infection in humans. M. marinum can cause superficial infections and localized invasive infections in humans, with the hands being the sites most frequently affected. It can cause skin lesions, which are either single, papulonodular lesions, confined to an extremity, or may resemble cutaneous sporotrichosis. This infection can also cause deeper infections including tenosynovitis, bursitis, arthritis, and osteomyelitis. Disseminated infections and visceral involvements have been reported in immunocompromised patients. We here report a case of severe deep soft tissue infection with necrotizing fasciitis and osteomyelitis of the left upper extremity (LUE caused by M. marinum in an immunocompromised patient.

Martensitic transformation and residual stresses after thermomechanical treatment of heat treatable steel 42CrMo4 (SAE 4140)

Energy Technology Data Exchange (ETDEWEB)

Weise, A. [Technische Univ. Chemnitz-Zwickau, Chemnitz (Germany). Fakultaet fuer Maschinenbau und Verfahrenstechnik; Fritsche, G. [Technische Univ. Chemnitz-Zwickau, Chemnitz (Germany). Fakultaet fuer Maschinenbau und Verfahrenstechnik

1996-01-01

The influence of thermomechanical deformation on the residual stresses caused by quenching in bar shaped specimens of heat treatable steel 42CrMo4 has been investigated using a mechanical method for determining the distribution of residual stresses of the first kind. The results obtained show that the residual stress distribution after quenching is affected by the strengthening and softening of the austenite as a result of deformation and recrystallization and the modified transformation behaviour in martensite stage. An attempt is made to discuss qualitatively the influence of these changes on the generation of residual stresses as compared to results obtained after conventional hardening. (orig.).

Martensitic transformation and residual stresses after thermomechanical treatment of heat treatable steel 42CrMo4 (SAE 4140)

International Nuclear Information System (INIS)

Weise, A.; Fritsche, G.

1996-01-01

The influence of thermomechanical deformation on the residual stresses caused by quenching in bar shaped specimens of heat treatable steel 42CrMo4 has been investigated using a mechanical method for determining the distribution of residual stresses of the first kind. The results obtained show that the residual stress distribution after quenching is affected by the strengthening and softening of the austenite as a result of deformation and recrystallization and the modified transformation behaviour in martensite stage. An attempt is made to discuss qualitatively the influence of these changes on the generation of residual stresses as compared to results obtained after conventional hardening. (orig.)

A Rare Case of Multifocal Prostatic Blue Nevus

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Elias J. Farran

2018-01-01

Full Text Available Prostatic blue nevus is a rare benign pathologic diagnosis most commonly diagnosed incidentally on many different types of prostate specimens. Blue nevus is the deposition of stromal melanin characterized by spindle cells within the fibromuscular stroma which stains positive for melanin-specific stains Fontana-Masson and S100 and stains negative for CD68, HMB45, and iron stains. We report the case of a multifocal and bilateral blue nevus in a 52-year-old Hispanic male who presented with an elevated prostate-specific antigen of 4.3 and mild obstructive lower urinary tract symptoms, found by transrectal ultrasound-guided prostate needle biopsy. The biopsy also revealed benign prostatic tissue with postatrophic hyperplasia and chronic inflammation. This is the 35th reported case of prostatic blue nevus and the third to show multifocal blue nevus.

[Treatment of pubic osteomyelitis secondary to pressure sores].

Science.gov (United States)

Brunel, Anne-Sophie; Téot, Luc; Lamy, Brigitte; Masson, Raphaël; Morquin, David; Reynes, Jacques; Le Moing, Vincent

2014-01-01

There is no consensus regarding the diagnostic and therapeutic strategy for pubic osteomyelitis secondary to pelvic pressure sores. Diagnosis is often difficult and bone biopsies with microbiological and anatomical-pathological examination remain the gold standard. The rate of cicatrisation of pressure sores is low. Cleansing and negative pressure treatment are key elements of the treatment. Optimising the care management with medical-surgical collaboration is being studied in the Ostear protocol.

Successful treatment of Pseudomonas aeruginosa osteomyelitis with antibiotic monotherapy of limited duration.

Science.gov (United States)

Laghmouche, Nadir; Compain, Fabrice; Jannot, Anne-Sophie; Guigui, Pierre; Mainardi, Jean-Luc; Lonjon, Guillaume; Bouyer, Benjamin; Fernandez-Gerlinger, Marie-Paule

2017-09-01

The aim of this study was to present a 15-year experience and provide a comprehensive analysis of a large cohort of patients with Pseudomonas aeruginosa osteomyelitis. We reviewed the medical records of patients admitted to a large French university hospital for P. aeruginosa osteomyelitis over a 15-year period. Patient outcome was assessed at follow-up after at least six months. Sixty-seven patients were included, comprising 57% with chronic osteomyelitis. Polymicrobial infection was predominant (63%), and an infected device was involved in 39% patients. The overall treatment success rate was 79.1%. All but one patient were treated with a combination of surgery and antibiotic therapy. The antibiotic treatment had a mean duration of 45 days (range, 21-90 days). Single-antibiotic therapy was preferred in nearly all cases. Treatment failure was reported for 14 (21%) patients and was due to the persistence of P. aeruginosa in four cases. No significant risk factor for treatment failure was identified, especially when treatment strategies were compared. We advocate optimal surgical debridement combined with initial parenteral antibiotics for a maximum of 15 days, followed by an oral fluoroquinolone. Total treatment duration should not exceed six weeks, and antibiotic treatment with two-drug combinations does not seem necessary. Copyright © 2017 The British Infection Association. Published by Elsevier Ltd. All rights reserved.

Chronic Recurrent Multifocal Osteomyelitis: A Case Report and ...

African Journals Online (AJOL)

He had a short limb gait and shoulder asymmetry. His left shoulder was warm, erythematous and there was decreased range of movement in all directions. Investigations revealed an erythrycyte sedimentation rate (ESR) of 150mm/hr. Wound swabs taken at different times from the right thigh and shoulder sinuses revealed ...

Multifocal Aeromonas Osteomyelitis in a Child with Leukemia

Directory of Open Access Journals (Sweden)

Dimitrios Doganis

2016-01-01

Full Text Available Aeromonas hydrophila is a Gram negative organism causing both intestinal and extraintestinal disease. The case of a 14-year-old girl with underlying immunodeficiency and leukemia who developed systemic A. hydrophila infection is described in this report. While in deep bone marrow aplasia she developed fever, severe pain in the lower extremities, and swelling of the left femur. Blood culture showed Escherichia coli and A. hydrophila whereas pus culture from the soft tissue swelling showed the presence of A. hydrophila. Imaging studies showed diffuse osteolytic lesions. Patient received 5 months of intravenous and oral antibiotics and she improved clinically whereas the radiology findings persisted.

The Relationship Between Osteomyelitis Complication and Drug-Resistant Infection Risk in Diabetic Foot Ulcer: A Meta-analysis.

Science.gov (United States)

Chen, Yin; Ding, Hui; Wu, Hua; Chen, Hong-Lin

2017-09-01

In this study, we aimed to investigate the relationship between osteomyelitis complications and drug-resistant infection risk in diabetic foot ulcer. Searches of MEDLINE and ISI databases were performed for the studies. Odds ratios (ORs) for drug-resistant infection incidence were calculated for diabetic foot ulcer patients with or without osteomyelitis complications. Eleven studies (12 cohorts) with 1526 patients were included in this study. Meta-analysis showed that the summary OR was 3.343 (95% CI = 2.355-4.745; Z = 6.75, P analysis by only pooled the adjusted ORs showed that the result was robust (the summary OR = 4.081, 95% CI = 2.471-6.739). Subgroup analysis by drug-resistant type showed that the summary OR was 4.391 (95% CI = 2.287-8.394) for methicillin-resistant infection subgroup, and 2.693 (95% CI = 1.882-3.851) for multidrug-resistant infection subgroup. The meta-regression showed that drug-resistant incidence ( t = -0.90, P = .389) and published year ( t = -0.11, P = .913) were not related with the OR changes. In conclusion, our meta-analysis indicates that osteomyelitis complications are related with drug-resistant infection risk in diabetic foot ulcer. We suggest bone culture-based narrow-spectrum antibiotic therapy for osteomyelitis for prevention drug-resistant infection in diabetic foot ulcer.

Relationship between the clinical characteristics of osteomyelitis and the finding of extraosseous fat on MRI in pediatric patients

Energy Technology Data Exchange (ETDEWEB)

Mattis, Tod A. [Spectrum Health Helen Devos Children' s Hospital, Grand Rapids, MI (United States); Michigan State University, College of Human Medicine, Radiology, Grand Rapids, MI (United States); Grand Rapids Medical Education Partners, Grand Rapids, MI (United States); Borders, Heather L.; Ellinger, Doug M.; Junewick, Joseph J. [Spectrum Health Helen Devos Children' s Hospital, Grand Rapids, MI (United States); Michigan State University, College of Human Medicine, Radiology, Grand Rapids, MI (United States); Advanced Radiology Services, Grand Rapids, MI (United States)

2011-10-15

MRI is frequently utilized to evaluate patients for osteomyelitis. The findings of intramedullary and extramedullary fat globules as well as extramedullary fat-fluid levels can help improve the specificity of MRI for this diagnosis. To correlate these MRI findings with the clinical characteristics in children with osteomyelitis. A retrospective electronic medical record search for pediatric patient charts from March 2004 to November 2009 that contained the word ''osteomyelitis'' in the ''principal diagnosis'' portion of the international classification of disease (ICD) billing code. Each electronic chart was reviewed. MRI examinations of selected children were reviewed by a pediatric radiologist, a general radiologist and a transitional year resident. A total of 10 patients/11 MRI studies were included. Five of the 11 had the MRI finding of extramedullary globular fat signal. There was a significantly increased likelihood of seeing this finding in children of pubertal or postpubertal age compared to those of prepubertal age (p < 0.05). This study provides evidence that the MRI finding of extramedullary fat globules in children with acute osteomyelitis is associated with the clinical characteristic of being within or above the age range for puberty. (orig.)

Neonatal and infantile candidal arthritis with or without osteomyelitis

International Nuclear Information System (INIS)

Yousefzadeh, D.K.

1980-01-01

Four cases of candidal arthritis and osteomyelitis are presented and 17 others are reviewed from the literature. The clinical and radiographic aspects of the entity are discussed in detail and compared with those of bacterial septic arthritis. The role of predisposing factors are elaborated. An increase in the incidence of the disease is anticipated and the diagnostic difficulties are enumerated. (orig.) [de

Osteomyelitis of the maxilla in a patient with Malignant Infantile Osteopetrosis

Directory of Open Access Journals (Sweden)

Artur Aburad de Carvalhosa

2016-04-01

Full Text Available Osteopetrosis is characterized by a considerable increase in bone density resulting in defective remodeling, caused by failure in the normal function of osteoclasts, and varies in severity. It is usually subdivided into three types: benign autosomal dominant osteopetrosis; intermediate autosomal recessive osteopetrosis; and malignant autosomal recessive infantile osteopetrosis, considered the most serious type. The authors describe a case of chronic osteomyelitis in the maxilla of a 6-year-old patient with Malignant Infantile Osteopetrosis. The treatment plan included pre-maxilla sequestrectomy and extraction of erupted upper teeth. No surgical procedure was shown to be the best to prevent the progression of oral infection. Taking into account the patient's general condition, if the patient develops severe symptomatic and refractory osteomyelitis surgery should be considered. The patient and his family are aware of the risks and benefits of surgery and its possible complications.

Metaphyseal osteomyelitis in children: how often does MRI-documented joint effusion or epiphyseal extension of edema indicate coexisting septic arthritis?

Energy Technology Data Exchange (ETDEWEB)

Schallert, Erica K.; Kan, J.H.; Monsalve, Johanna; Zhang, Wei; Bisset, George S. [Texas Children' s Hospital, Department of Pediatric Radiology, Houston, TX (United States); Rosenfeld, Scott [Texas Children' s Hospital, Department of Pediatric Orthopedic Surgery, Houston, TX (United States)

2015-08-15

Joint effusions identified by MRI may accompany osteomyelitis and determining whether the joint effusion is septic or reactive has important implications on patient care. Determine the incidence of epiphyseal marrow edema, joint effusions, perisynovial edema and epiphyseal non-enhancement in the setting of pediatric metaphyseal osteomyelitis and whether this may be used to predict coexisting septic arthritis. Following IRB approval, we retrospectively evaluated children who underwent MRI and orthopedic surgical consultation for suspected musculoskeletal infection between January 2011 and September 2013. Criteria for inclusion in the study were microbiologically/pathologically proven infection, MRI prior to surgical intervention, long bone involvement and age 0-18 years. MRI exams were independently reviewed by two faculty pediatric radiologists to confirm the presence of appendicular metaphyseal osteomyelitis, to evaluate extent of edema, to determine subjective presence of a joint effusion and to assess perisynovial edema and epiphyseal non-enhancement. Any discrepant readings were reviewed in consensus. Charts and operative notes were reviewed to confirm the diagnosis of osteomyelitis and septic arthritis. One hundred and three joints with metaphyseal osteomyelitis were identified (mean age: 7.1 years; M:F 1.3:1), of whom 53% (55/103) had joint effusions, and of those, 75% (41/55) had surgically confirmed septic arthritis. The incidence of coexisting septic arthritis was 40% in the setting of epiphyseal edema, 74% in epiphyseal edema and effusion, 75% with perisynovial edema, 76% with epiphyseal non-enhancement and 77% when all four variables were present. Of these, the only statistically significant variable, however, was the presence of a joint effusion with a P-value of <0.0001 via Fisher exact test. Statistical significance for coexisting septic arthritis was also encountered when cases were subdivided into intra-articular vs. extra-articular metaphyses (P

Metaphyseal osteomyelitis in children: how often does MRI-documented joint effusion or epiphyseal extension of edema indicate coexisting septic arthritis?

International Nuclear Information System (INIS)

Schallert, Erica K.; Kan, J.H.; Monsalve, Johanna; Zhang, Wei; Bisset, George S.; Rosenfeld, Scott

2015-01-01

Joint effusions identified by MRI may accompany osteomyelitis and determining whether the joint effusion is septic or reactive has important implications on patient care. Determine the incidence of epiphyseal marrow edema, joint effusions, perisynovial edema and epiphyseal non-enhancement in the setting of pediatric metaphyseal osteomyelitis and whether this may be used to predict coexisting septic arthritis. Following IRB approval, we retrospectively evaluated children who underwent MRI and orthopedic surgical consultation for suspected musculoskeletal infection between January 2011 and September 2013. Criteria for inclusion in the study were microbiologically/pathologically proven infection, MRI prior to surgical intervention, long bone involvement and age 0-18 years. MRI exams were independently reviewed by two faculty pediatric radiologists to confirm the presence of appendicular metaphyseal osteomyelitis, to evaluate extent of edema, to determine subjective presence of a joint effusion and to assess perisynovial edema and epiphyseal non-enhancement. Any discrepant readings were reviewed in consensus. Charts and operative notes were reviewed to confirm the diagnosis of osteomyelitis and septic arthritis. One hundred and three joints with metaphyseal osteomyelitis were identified (mean age: 7.1 years; M:F 1.3:1), of whom 53% (55/103) had joint effusions, and of those, 75% (41/55) had surgically confirmed septic arthritis. The incidence of coexisting septic arthritis was 40% in the setting of epiphyseal edema, 74% in epiphyseal edema and effusion, 75% with perisynovial edema, 76% with epiphyseal non-enhancement and 77% when all four variables were present. Of these, the only statistically significant variable, however, was the presence of a joint effusion with a P-value of <0.0001 via Fisher exact test. Statistical significance for coexisting septic arthritis was also encountered when cases were subdivided into intra-articular vs. extra-articular metaphyses (P

ASPERGILLOSIS OF MANDIBLE : A RARE CASE OF OSTEOMYELITIS

OpenAIRE

ÖZTÜRK, Nurdan; ERSOY, Burak; SÖNMEZ, Ahmet; ÇELEBİLER, Özhan; NUMANOĞLU, Ayhan

2007-01-01

Aspergillus species are saprophyticus fungi which may be the cause of infection predominantly in immunocompromised hosts. Aspergillosis is usually manifested in the respiratory system and bone involvement is rarely encountered. Osteomyelitis of the mandible with aspergillus species has been reported in only two cases in the literature. Treatment mainly consists of antimicrobial therapy in combination with surgery. We report a case of aspergillosis of the mandible in a patient who was under im...

Atypical Focal Osteomyelitis as Initial Manifestation of AIDS

OpenAIRE

A. Akiki; Y. Bilde

2011-01-01

Persistent pain development after a skeletal contusion rarely poses the diagnosis of osteomyelitis. We report the case of a fibular head contusion as an initial manifestation of a focal abscess development in a healthy young patient. The traditional treatment of surgical drainage revealed the presence of an atypical Mycobacterium haemophilum isolates in the abscess. This lead to further investigations that concluded and established the diagnosis of AIDS. Conclusion. Isolation of an atypical M...

Gadolinium-DTPA enhanced MRI in neonatal osteomyelitis of the cervical-spine

NARCIS (Netherlands)

Martijn, A; van der Vliet, AM; van Waarde, WM; van Aalderen, WMC

Although the radiographic features of neonatal osteomyelitis are well described, spinal localizations are very rare and occur in about 2–4%. Clinical presentation with paresis and paralysis occurs in less than 1% (Resnick & Niwayama, 1988). In the neonate negative bone scintigraphy in the presence

Therapeutical effect on blood-flow in three-phase scanning in primary malignant tumours and acute osteomyelitis

Energy Technology Data Exchange (ETDEWEB)

Kovacic, K; Kusic, Z [Clinical Hospital Sestre Milosrdnice, Zagreb (Croatia). Dept. of Oncology and Nuclear Medicine; Cepulic, M [Children` s Hospital, Zagreb (Croatia)

1994-10-01

In the studies where the bone scan was limited only to the late static image, the main disadvantage was its nonspecifity. With three-phase bone scan the number of false positive findings was reduced by some peculiar diseases; for instance, acute hematogenous osteomyelitis. It is well known that various diseases, such as nonunion of the fracture, some surgical interventions, avascular necrosis... can imitate acute osteomyelitis on the static image. These diseases can only be differentiated from inflammation by blood-flow. Therefore, in all patients with the diagnosis of primary bone disease tumor, inflammation, trauma, aseptic necrosis... three-phase bone scintigraphy is performed. Here, only the patients with acute osteomyelitis and primary malignant bone tumors will be presented: the basic scintigram was done before the therapy started, and the second one as a part of the follow-up - in some patients during the therapy and in some after its ending. We noticed that the most reliable part of three-phase bone scan responding to the therapy is angioscintigraphy (blood-flow) and in some cases early static (blood-pool) image. These two phases, especially the first one, are in good correlation with the clinic, in contrast to the third phase which is delayed. From the presented cases it could be concluded that in acute osteomyelitis and primary malignant tumors, blood-flow and blood-pool images are unavoidable phases of the bone scanning when we want to correctly evaluate the effects of the therapy. (author).

Uncommon mandibular osteomyelitis in a cat caused by Nocardia africana.

Science.gov (United States)

de Farias, Marconi Rodrigues; Werner, Juliana; Ribeiro, Márcio Garcia; Rodigheri, Sabrina Marin; Cavalcante, Carolina Zaghi; Chi, Kung Darh; Condas, Larissa Anuska Zeni; Gonoi, Tohru; Matsuzama, Tetsuhiro; Yazama, Katsukiyo

2012-12-06

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. 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. The present report describes a rare clinical case of feline osteomyelitis caused by Nocardia africana, diagnosed based upon a combination of clinical signs, microbiological culture, cytological and histopathological findings, radiographic images, and

Dynamic bone scanning in the diagnosis and management of osteomyelitis

International Nuclear Information System (INIS)

Gandsman, E.J.; Deutsch, S.D.; Tyson, I.B.

1982-01-01

The procedure using 99m Tc-MDP (Methylene Diphosphonate) was divided into two parts: a dynamic portion designed to obtain data to calculate the blood flow to the specific bones or joints being evaluated and a static portion that consisted of a routine bone scan. This method was applied to 30 patients with osteomyelitis of various bones. The dynamic study showed a pronounced increase in flow on the affected side. This was accompanied always by a significant increase in flow in the areas proximal and distal to the area of involvement. Ten patients had sequential scans during the course of antibiotic treatment. In all ten patients the flow became more symmetrical during the course of the treatment indicating the effect of the antibiotics. In seven of these patients the flow became completely symmetrical at the end of the therapy. The static bone images remained unchanged during the antibiotic treatment and did not reflect its effect. The method of dynamic bone scanning in osteomyelitis thus provides a way to determine the effectiveness of antibiotic therapy

Acute hematogenous osteomyelitis in young children - clinical and radiological features

International Nuclear Information System (INIS)

Penushliev, T.; Brankov, O.; Georgiev, Tz.; Stoilov, S.; Panov, M.; Totev, M.

2007-01-01

Acute hematogenous osteomyelitis is a bacterial infectious disease which mainly affects the paediatrics age group. The incidence seems to decline through the last decade. The authors analyzed the clinical, bacteriological and radiological features of acute hematogenous osteomyelitis in 49 young children. Their age ranged from 12 days to 2.9 years (19 new-born and 30 babies). The most affected locus was the femur (46.9 %), followed by the humerus (40.9 %) and tibia (6.2 %). The adjacent joint was involved in 38.8 %. Up to the third day after onset of symptoms were admitted 32 children (65.3 %). A bacteriological diagnosis has been achieved in only 19 cases (38.8 %) which underwent different surgical procedures. Staphylococcus aureus (9 children; 64.3 %) was the most common causative microbe. Radiological characteristic showed mainly widening of joints, destruction of cartilage, bone destruction and osteoporosis. The median duration of antibiotic therapy was 31 days. Nine children underwent needle aspiration while another 10 required locus incision or open surgery with debridement or sequestrectomy. Definitive clinical restoration was observed in 42 cases (85.7%). (authors)

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...

Nonabsorbable-Suture-Induced Osteomyelitis: A Case Report and Review of the Literature

Directory of Open Access Journals (Sweden)

Cheng Hong Yeo

2012-01-01

Full Text Available We are reporting a case of nonabsorbable suture-induced osteomyelitis in patient who had an open rotator cuff repair with nonabsorbable Ethibond anchor suture. Patient in this case presented with very subtle clinical features of osteomyelitis of the left proximal humerus 15 years after initial rotator cuff repair surgery. Literature had shown that deep infection following rotator cuff repairs, although rare, can be easily missed and can cause severe complications. Absorbable suture had been demonstrated to be more superior, in terms of rate of deep infection, as compared to nonabsorbable suture when used in rotator cuff repair surgery. Both absorbable and nonabsorbable suture had been demonstrated to have similar mechanical properties by several different studies. The case demonstrated that initial presentation of deep infection can be subtle and easily missed by clinicians and leads to further complications.

Evaluation of refractive correction for standard automated perimetry in eyes wearing multifocal contact lenses

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Kazunori Hirasawa

2017-10-01

Full Text Available AIM: To evaluate the refractive correction for standard automated perimetry (SAP in eyes with refractive multifocal contact lenses (CL in healthy young participants. METHODS: Twenty-nine eyes of 29 participants were included. Accommodation was paralyzed in all participants with 1% cyclopentolate hydrochloride. SAP was performed using the Humphrey SITA-standard 24-2 and 10-2 protocol under three refractive conditions: monofocal CL corrected for near distance (baseline; multifocal CL corrected for distance (mCL-D; and mCL-D corrected for near vision using a spectacle lens (mCL-N. Primary outcome measures were the foveal threshold, mean deviation (MD, and pattern standard deviation (PSD. RESULTS: The foveal threshold of mCL-N with both the 24-2 and 10-2 protocols significantly decreased by 2.2-2.5 dB CONCLUSION: Despite the induced mydriasis and the optical design of the multifocal lens used in this study, our results indicated that, when the dome-shaped visual field test is performed with eyes with large pupils and wearing refractive multifocal CLs, distance correction without additional near correction is to be recommended.

The diagnostic value of 18F-FDG-PET/CT and MRI in suspected vertebral osteomyelitis - a prospective study.

Science.gov (United States)

Kouijzer, Ilse J E; Scheper, Henk; de Rooy, Jacky W J; Bloem, Johan L; Janssen, Marcel J R; van den Hoven, Leon; Hosman, Allard J F; Visser, Leo G; Oyen, Wim J G; Bleeker-Rovers, Chantal P; de Geus-Oei, Lioe-Fee

2018-05-01

The aim of this study was to determine the diagnostic value of 18 F-fluorodeoxyglucose (FDG) positron emission tomography and computed tomography (PET/CT) and magnetic resonance imaging (MRI) in diagnosing vertebral osteomyelitis. From November 2015 until December 2016, 32 patients with suspected vertebral osteomyelitis were prospectively included. All patients underwent both 18 F-FDG-PET/CT and MRI within 48 h. All images were independently reevaluated by two radiologists and two nuclear medicine physicians who were blinded to each others' image interpretation. 18 F-FDG-PET/CT and MRI were compared to the clinical diagnosis according to international guidelines. For 18 F-FDG-PET/CT, sensitivity, specificity, PPV, and NPV in diagnosing vertebral osteomyelitis were 100%, 83.3%, 90.9%, and 100%, respectively. For MRI, sensitivity, specificity, PPV, and NPV were 100%, 91.7%, 95.2%, and 100%, respectively. MRI detected more epidural/spinal abscesses. An important advantage of 18 F-FDG-PET/CT is the detection of metastatic infection (16 patients, 50.0%). 18 F-FDG-PET/CT and MRI are both necessary techniques in diagnosing vertebral osteomyelitis. An important advantage of 18 F-FDG-PET/CT is the visualization of metastatic infection, especially in patients with bacteremia. MRI is more sensitive in detection of small epidural abscesses.

Outcomes in diabetic foot ulcer patients with isolated T2 marrow signal abnormality in the underlying bone: should the diagnosis of ''osteitis'' be changed to ''early osteomyelitis''?

International Nuclear Information System (INIS)

Duryea, Dennis; Bernard, Stephanie; Flemming, Donald; Walker, Eric; French, Cristy

2017-01-01

To evaluate the variability of clinical treatment and outcomes based on reporting of diabetic foot ulcer MRI findings of adjacent marrow T2 hyperintensity with normal T1 signal. A retrospective review was conducted of 46 MRI examinations evaluating diabetic foot ulcers that demonstrated normal T1 marrow signal, but T2 marrow hyperintensity deep to the ulcer. The cohort was divided based on MRI report impressions into three groups; ''osteitis without osteomyelitis'' (OW), ''osteitis but cannot exclude early osteomyelitis'' (OCEO) and ''early osteomyelitis'' (EO). Patient demographics (age, gender) and accessory MRI findings of ulcer and sinus tract depth were recorded. Initial clinical assessment and medical treatment (route and duration of antibiotics), healing versus disease progression and histology or microbiology results were recorded. The isolated marrow T2 signal hyperintensity was reported as OW in 12 patients, OCEO in 18, and EO in 16. No statistical difference in clinical assessment was demonstrated between the OW, OCEO, and EO groups. Pathological condition was available in 15 patients within 0-7 days (mean 2.4 days) of the MRI examination, with 14 (93%) of these positive for osteomyelitis by histopathology or positive cultures. Initial diagnosis of or progression to osteomyelitis was shown in 28 patients (61%). Treatment of suspected osteomyelitis is heavily determined by clinical factors. Patients who initially demonstrate only T2 marrow signal abnormality under a diabetic ulcer are eventually diagnosed as osteomyelitis in 61% of cases and deserve aggressive treatment as early osteomyelitis when meeting clinical parameters. (orig.)

Evaluation of rotation and visual outcomes after implantation of monofocal and multifocal toric intraocular lenses.

Science.gov (United States)

Garzón, Nuria; Poyales, Francisco; de Zárate, Begoña Ortíz; Ruiz-García, Jose Luis; Quiroga, Juan Antonio

2015-02-01

To evaluate rotational stability and its influence on postoperative visual acuity of different monofocal and multifocal toric intraocular lenses (IOLs). A prospective interventional study was designed. Ninety-one patients with a mean age of 71.65 ± 11.82 years were implanted with toric IOLs after phacoemulsification. Three monofocal toric IOLs (the Lentis LT [Oculentis, Berlin, Germany], enVista [Bausch & Lomb, Rochester, NY], and AcrySof IQ [Alcon Laboratories, Inc., Fort Worth, TX]) and one multifocal toric IOL (AcrySof IQ ReSTOR; Alcon Laboratories, Inc.) were implanted. Preoperative and postoperative images were taken to calculate the misalignment due to the marking method. To evaluate rotation in the different follow-up visits, another photograph was taken 1 hour and 1, 7 and 30 days postoperatively. Refraction, uncorrected distance visual acuity (UDVA), and corrected distance visual acuity were measured 30 days postoperatively. Postoperative UDVA was 0.1 logMAR or better in 64.6% of eyes implanted with monofocal IOLs and 46.4% of eyes implanted with multifocal IOLs. The enVista toric IOL showed the best UDVA compared to the other monofocal IOLs, with 81% of eyes with 0.1 logMAR or better. The mean misalignment in the total group studied was 0.07° ± 0.60°; 69.6% of monofocal IOLs and 67.9% of multifocal IOLs showed less than 5° of rotation. A correlation was found between postoperative UDVA and rotation in the monofocal and multifocal IOLs implanted (r = 0.439 [P < .011] and = 0.787 [P = .001], respectively). At 1 month postoperatively, UDVA was slightly more affected by IOL rotation in multifocal than monofocal toric IOLs. The marking method was also effective. Copyright 2015, SLACK Incorporated.

Development of confocal 3D micro-XRF spectrometer with dual Cr-Mo excitation

International Nuclear Information System (INIS)

Kouichi Tsuji; Kazuhiko Nakano

2007-01-01

A new 3D micro-XRF instrument based on a confocal setup using two independent poly-capillary x-ray lenses and two x-ray sources (Cr and Mo targets) was developed. A full poly-capillary x-ray lens was attached to each x-ray tube. Another half poly-capillary lens was attached to a silicon drift x-ray detector (SDD). The focal spots of the three lenses were adjusted to a common position. The depth resolutions that were evaluated by use of a 10-μm thick Au foil were approximately 90 μm for the x-ray energy of Au Lα. The effects of the dual Cr-Mo x-ray beam excitation were investigated. It was confirmed that the XRF intensity of light elements was increased by applying the Cr-target x-ray tube in a confocal configuration. In the proposed confocal configuration, 3D elemental mapping of the major elements of an amaranth seed was performed nondestructively at ambient air pressure. Each element of the seed showed different mapping images in the different depth layers. (authors)

Development of confocal 3D micro-XRF spectrometer with dual Cr-Mo excitation

Energy Technology Data Exchange (ETDEWEB)

Kouichi Tsuji [Department of Applied Chemistry, Graduate School of Engineering, Osaka City University, 3-3-138 Sugimoto, Sumiyoshi-ku Osaka 558-8585 (Japan); PRESTO-JST - Precursory Research for Embryonic Science and Technology, Japan Science and Technology Agency, 4-1-8 Honcho Kawaguchi, Saitama 332-0012 (Japan); Kazuhiko Nakano [Department of Applied Chemistry, Graduate School of Engineering, Osaka City University, 3-3-138 Sugimoto, Sumiyoshi-ku Osaka 558-8585 (Japan)

2007-05-15

A new 3D micro-XRF instrument based on a confocal setup using two independent poly-capillary x-ray lenses and two x-ray sources (Cr and Mo targets) was developed. A full poly-capillary x-ray lens was attached to each x-ray tube. Another half poly-capillary lens was attached to a silicon drift x-ray detector (SDD). The focal spots of the three lenses were adjusted to a common position. The depth resolutions that were evaluated by use of a 10-{mu}m thick Au foil were approximately 90 {mu}m for the x-ray energy of Au L{alpha}. The effects of the dual Cr-Mo x-ray beam excitation were investigated. It was confirmed that the XRF intensity of light elements was increased by applying the Cr-target x-ray tube in a confocal configuration. In the proposed confocal configuration, 3D elemental mapping of the major elements of an amaranth seed was performed nondestructively at ambient air pressure. Each element of the seed showed different mapping images in the different depth layers. (authors)

Validity of automated refraction after segmented refractive multifocal intraocular lens implantation.

Science.gov (United States)

Albarrán-Diego, César; Muñoz, Gonzalo; Rohrweck, Stephanie; García-Lázaro, Santiago; Albero, José Ricardo

2017-01-01

To evaluate the clinical utility of automated refraction (AR) and keratometry (KR) compared with subjective or manifest refraction (MR) after cataract or refractive lens exchange surgery with implantation of Lentis Mplus X (Oculentis GmbH) refractive multifocal intraocular lens (IOL). Eighty-six eyes implanted with the Lentis Mplus X multifocal IOL were included. MR was performed in all patients followed by three consecutive AR measurements using the Topcon KR-8000 autorefractor. Assessment of repeatability of consecutive AR before and after dilation with phenylephrine 10%, and comparison of the AR and KR with MR using vector analysis were performed at 3mo follow-up. Analysis showed excellent repeatability of the AR measurements. Linear regression of AR versus MR showed good correlation for sphere and spherical equivalent, whereas the correlation for astigmatism was low. The mean difference AR-MR was -1.28±0.29 diopters (D) for sphere. Astigmatism showed better correlation between KR and MR. We suggest AR sphere plus 1.25 D and the KR cylinder as the starting point for MR in eyes with a Lentis Mplus X multifocal IOL. If AR measurements are equal to MR, decentration of the IOL should be suspected.

Osteomyelitis following Domestic Animal Bites to the Hand: Two Case Reports and Practical Guidelines

Directory of Open Access Journals (Sweden)

Jung Soo Lim

2016-11-01

Full Text Available Recently, the number of cases of animal bite wounds has increased significantly in concordance with an increase in the pet population around the world. The authors report two rare cases of osteomyelitis of the phalanx following cat and dog bites. On initial physical examination, signs of a severe infection were observed. Radiographs of both patients showed the presence of osteomyelitis, and in one of the patients, the diagnosis was confirmed with a bone biopsy. After use of empirical antibiotics, intravenous antibiotic therapy that matched the identified bacterium's sensitivity was initiated, and at the same time, secure dressing including debridement was performed to induce secondary healing. In addition, the patients were closely monitored with serial X-rays, and culture and blood test follow-up. One patient fully recovered without sequelae, but the other patient suffered a loss of distal interphalangeal joint motion. When dealing with bite wounds located on the hand, it is important to visit the hospital as soon as possible and receive the appropriate treatment early. Moreover, to prevent severe complications such as osteomyelitis, it is important to administer antibiotic therapy to which the cultured bacteria are sensitive, along with proper wound management and prophylactic antibiotic treatment.

[The application of laser therapy for the medical rehabilitation of the children presenting with chronic osteomyelitis].

Science.gov (United States)

Trunova, O V; Mashkov, A E; Khan, M A; Prikuls, V F; Nazarenko, N N; Supova, M V; Smirnova, S N; Larionov, K S

2015-01-01

The objective of the present study was to develop a scientifically sound rationale for the application of infrared laser radiation (IRLR) either separately or in the combination with fluctuation magnetic therapy in the medical rehabilitation of the children presenting with chronic hematogenous osteomyelitis. Another objective was to evaluate the clinical effectiveness of this therapeutic modality. Two achieve these goals, the clinical observations and special research studies were conducted in two directions with the participation of 95 patients at the age varying from 1 to 15 years. The study has demonstrated the effectiveness of the inclusion of IRLR in the medical rehabilitation program for the children with chronic hematogenous osteomyelitis in different periods of the disease. It was shown that the transcutaneous infrared irradiation of the affected area during the exacerbation of chronic osteomyelitis had a well apparent immunostimulatory effect and reduced the activity of the inflammatory process. The application of IRLR in combination with fluctuation magnetic therapy during the period of partial remission, had a more pronounced influence on the microcirculation and stimulated the regenerative and trophic processes.

Comparison of [18 F]FDG PET/CT and MRI in the diagnosis of active osteomyelitis

Energy Technology Data Exchange (ETDEWEB)

Demirev, Anastas; Mottaghy, Felix [University Hospital of Maastricht, Department of Nuclear Medicine, Maastricht (Netherlands); Weijers, Rene [University Hospital of Maastricht, Department of Radiology, Maastricht (Netherlands); Geurts, Jan; Walenkamp, Geert [University Hospital of Maastricht, Department of Orthopedic Surgery, Maastricht (Netherlands); Brans, Boudewijn [University Hospital of Maastricht, Department of Nuclear Medicine, Maastricht (Netherlands); Maastricht University Medical Centre, Department of Nuclear Medicine, PO Box 5800, Maastricht (Netherlands)

2014-05-15

In diagnosing osteomyelitis (OM) both MRI and [18 F]FDG PET-CT proved to be accurate modalities. In anticipation of the advent of hybrid PET/MRI scanners we analyzed our patient group to give direction to future imaging strategies in patients with suspected OM. In this retrospective study all patients of a tertiary referral center who underwent both an MRI and a PET for the diagnosis of OM were included. The results of those scans were evaluated using patient's histology, microbiological findings, and clinical/radiological follow-up. Additionally, ROC curve analysis of the SUVmax and the SUVmax ratio on the PET scans was performed. Two imaging strategies were simulated: first MRI followed by PET, or vice versa. Twenty-seven localizations in 26 patients were included. Both MRI and PET were shown to be accurate in our patients for the qualitative detection of OM. A cut-off value for the SUVmax of 3 gave optimal results (a specificity of 90 % with a sensitivity of 88 %). The SUVmax ratio gave a worse performance. The two simulated imaging strategies showed no difference in the final diagnosis in 20 out of 27 cases. Remarkably, 6 equivocal cases were all correctly diagnosed by the second modality, i.e., PET or MRI. Both MRI and [18 F]FDG PET were accurate in diagnosing OM in a tertiary referral hospital population. Simulation of imaging strategies showed that a combined sequential strategy was optimal. It seems preferable to use MRI as a primary imaging tool for uncomplicated unifocal cases, whereas in cases with (possible) multifocal disease or a contraindication for MRI, PET is preferred. This combined sequential strategy looks promising, but needs to be confirmed in a larger prospective study. (orig.)

Multifocal peritoneal splenosis in Tc-99m-labeled heat-denatured red blood cell scintigraphy

Energy Technology Data Exchange (ETDEWEB)

Yoon, Min Ki; Hwang, Kyung Hoon; Choe, Won Sick [Gachon University Gil Medical Center, Incheon (Korea, Republic of)

2006-06-15

A 44-year-old man with a past medical history of splenectomy came to hospital because of epigastric pain abdominopelvic computed tomography(CT) showed a soft tissue mass and multifocal variable-sized nodules as well as finding suggestive of cholecystitis. Subsequently, he underwent Tc-99m-labeled heat- denatured red blood cell(RBC) scintigraphy to evaluate the mass and nodules. The scintigraphy confirmed multifocal peritoneal splenosis in the abdominopelvic cavity.

TWO-STAGE REOSTEOSYNTHESIS OF TIBIA IN THE PATIENT WITH FRACTURE NON-UNION COMPLICATED BY POSTOPERATIVE OSTEOMYELITIS

Directory of Open Access Journals (Sweden)

I. M. Efremov

2018-01-01

Full Text Available The authors present a case report of a patient with pseudarthrosis of the right tibia complicated by chronic postoperative osteomyelitis. The development of the osteomyelitis process is caused by locked intramedullary fixation of the right tibia by a retrograde nail. Unstable fixation led to the development of acute periimplant infection and osteomyelitis.A radical surgical debridement of the focus site of chronic infection was performed by removing locking screws and nail, removal of necrotic bone tissues by handling the tibial medullary cavity by special reamers. The authors used the pulse lavage with active removal of the solution for an additional sterilization of the surgical wound and medullary cavity. A reinforced spacer impregnated with vancomycin and polyvalent bacteriophage was placed in the medullary cavity to ensure local prolonged antimicrobial therapy. Instead of the removed monomer the polyvalent bacteriophage was introduced into the polymer composition including phages against the main infectious agents in patients of traumatology and orthopedics clinic.Three months after the first stage of treatment and stabilization of laboratory parameters the patient was readmitted to the clinic. The second stage of procedure included removal of spacer, closed antegrade locked internal fixation of the right tibia and talus by a nail with an antimicrobial coating of bone cement impregnated with vancomycin and a polyvalent bacteriophage. Antimicrobial coating of the nail was made intraoperatively using an original mold.Two stage procedure allowed to achieve a stable remission of chronic osteomyelitis and stable internal fixation of tibia pseudarthrosis with preservation of the supporting function of the lower limb.

The Clinical and Molecular Characteristics of Adenocarcinoma Presented 
by Multi-focal GGO

Directory of Open Access Journals (Sweden)

Yang SONG

2018-03-01

Full Text Available Due to emphasis on early screening for lung cancer, the detection rate of multiple ground glass opacities (GGOs on computed tomography (CT image increases in recent years, and research on multifocal adenocarcinomas presented by GGOs has been thriving. It is more common in women and non-smokers and has excellent prognosis both in patients with natural history and after surgery. These clinical features suggest that it is likely to be a distinct disease entity. From the perspective of molecular genetics, lesions in the same individual are likely to have distinct clonal features. Therefore, genetic heterogeneity is the most prominent feature of multifocal pulmonary adenocarcinomas with GGOs. The genetic heterogeneity is expected to assist the diagnosis of multifocal pulmonary adenocarcinoma and intrapulmonary metastasis, and also suggests that genetic testing of the GGO lesions is of great therapeutic significance. Some GGO lesions may harvest the similar clonal feature, which provide new evidence for the theory of spread through air spaces (STAS.

[The Clinical and Molecular Characteristics of Adenocarcinoma Presented 
by Multi-focal GGO].

Science.gov (United States)

Song, Yang; Liang, Naixin; Li, Shanqing

2018-03-20

Due to emphasis on early screening for lung cancer, the detection rate of multiple ground glass opacities (GGOs) on computed tomography (CT) image increases in recent years, and research on multifocal adenocarcinomas presented by GGOs has been thriving. It is more common in women and non-smokers and has excellent prognosis both in patients with natural history and after surgery. These clinical features suggest that it is likely to be a distinct disease entity. From the perspective of molecular genetics, lesions in the same individual are likely to have distinct clonal features. Therefore, genetic heterogeneity is the most prominent feature of multifocal pulmonary adenocarcinomas with GGOs. The genetic heterogeneity is expected to assist the diagnosis of multifocal pulmonary adenocarcinoma and intrapulmonary metastasis, and also suggests that genetic testing of the GGO lesions is of great therapeutic significance. Some GGO lesions may harvest the similar clonal feature, which provide new evidence for the theory of spread through air spaces (STAS).
.

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

International Nuclear Information System (INIS)

Wenter, Vera; Albert, Nathalie L.; Lehner, Sebastian; Fendler, Wolfgang P.; Bartenstein, Peter; Mueller, Jan-Phillip; Friederichs, Jan; Militz, Matthias; Hungerer, Sven; Cyran, Clemens C.; Hacker, Marcus

2016-01-01

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 [ 18 F]FDG PET and [ 18 F]FDG PET/CT to the diagnosis of osteomyelitis and implant-associated infections, enabling timely and appropriate decision-making for further therapy options. [ 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. [ 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.)

Phase Composition of a CrMo0.5NbTa0.5TiZr High Entropy Alloy: Comparison of Experimental and Simulated Data

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Fan Zhang

2013-09-01

Full Text Available Microstructure and phase composition of a CrMo0.5NbTa0.5TiZr high entropy alloy were studied in the as-solidified and heat treated conditions. In the as-solidified condition, the alloy consisted of two disordered BCC phases and an ordered cubic Laves phase. The BCC1 phase solidified in the form of dendrites enriched with Mo, Ta and Nb, and its volume fraction was 42%. The BCC2 and Laves phases solidified by the eutectic-type reaction, and their volume fractions were 27% and 31%, respectively. The BCC2 phase was enriched with Ti and Zr and the Laves phase was heavily enriched with Cr. After hot isostatic pressing at 1450 °C for 3 h, the BCC1 dendrites coagulated into round-shaped particles and their volume fraction increased to 67%. The volume fractions of the BCC2 and Laves phases decreased to 16% and 17%, respectively. After subsequent annealing at 1000 °C for 100 h, submicron-sized Laves particles precipitated inside the BCC1 phase, and the alloy consisted of 52% BCC1, 16% BCC2 and 32% Laves phases. Solidification and phase equilibrium simulations were conducted for the CrMo0.5NbTa0.5TiZr alloy using a thermodynamic database developed by CompuTherm LLC. Some discrepancies were found between the calculated and experimental results and the reasons for these discrepancies were discussed.

Determining the origin of synchronous multifocal bladder cancer by exome sequencing

International Nuclear Information System (INIS)

Acar, Ömer; Özkurt, Ezgi; Demir, Gulfem; Saraç, Hilal; Alkan, Can; Esen, Tarık; Somel, Mehmet; Lack, Nathan A.

2015-01-01

Synchronous multifocal tumours are commonly observed in urothelial carcinomas of the bladder. The origin of these physically independent tumours has been proposed to occur by either intraluminal migration (clonal) or spontaneous transformation of multiple cells by carcinogens (field effect). It is unclear which model is correct, with several studies supporting both hypotheses. A potential cause of this uncertainty may be the small number of genetic mutations previously used to quantify the relationship between these tumours. To better understand the genetic lineage of these tumours we conducted exome sequencing of synchronous multifocal pTa urothelial bladder cancers at a high depth, using multiple samples from three patients. Phylogenetic analysis of high confidence single nucleotide variants (SNV) demonstrated that the sequenced multifocal bladder cancers arose from a clonal origin in all three patients (bootstrap value 100 %). Interestingly, in two patients the most common type of tumour-associated SNVs were cytosine mutations of TpC* dinucleotides (Fisher’s exact test p < 10 −41 ), likely caused by APOBEC-mediated deamination. Incorporating these results into our clonal model, we found that TpC* type mutations occurred 2-5× more often among SNVs on the ancestral branches than in the more recent private branches (p < 10 −4 ) suggesting that TpC* mutations largely occurred early in the development of the tumour. These results demonstrate that synchronous multifocal bladder cancers frequently arise from a clonal origin. Our data also suggests that APOBEC-mediated mutations occur early in the development of the tumour and may be a driver of tumourigenesis in non-muscle invasive urothelial bladder cancer. The online version of this article (doi:10.1186/s12885-015-1859-8) contains supplementary material, which is available to authorized users

Unusually high incidence of multifocal epithelial hyperplasia in children of the Nahuatl population of Mexico.

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Ledesma-Montes, Constantino; Mendez-Mendoza, Amilcar

2017-01-01

Multifocal epithelial hyperplasia is an uncommon disease of the oral mucosa caused by the human papilloma virus. To study the clinical and pathological findings of multifocal epithelial hyperplasia detected during an oral examination of 343 Mexican Nahuatl children from a single primary school in El Paso de Cupilco, Mexico. A thorough oral examination was performed in all children and clinical data (age, gender, location and number of lesions) were documented and analyzed. Multifocal epithelial hyperplasia was diagnosed in 110 of the 343 children (32.3%). The ages of the children varied from 5 to 15 years, and of these, 56.3% were girls. The lesions were asymptomatic, 0.2 to 3.0 cm in diameter, soft, round to oval, smooth surfaced, sessile papulonodules, similar in colour to that of the surrounding mucosa. The lesions were commonly seen on the buccal mucosa and tongue, and most affected children (85%) had less than 5 lesions. Children in the 7 to 10 years age group were most often affected. Human papillomavirus typing was not done owing to a lack of facilities. There is a high incidence of multifocal epithelial hyperplasia in Nahuatl children with a predilection for females.

Basic characterization of normal multifocal electroretinogram

International Nuclear Information System (INIS)

Fernandez Cherkasova, Lilia; Rojas Rondon, Irene; Castro Perez, Pedro Daniel; Lopez Felipe, Daniel; Santiesteban Freixas, Rosaralis; Mendoza Santiesteban, Carlos E

2008-01-01

A scientific literature review was made on the novel multifocal electroretinogram technique, the involved cell mechanisms and some of the factors modifying its results together with the form of presentation. The basic characteristics of this electrophysiological record obtained from several regions of the retina of normal subjects is important in order to create at a small scale a comparative database to evaluate pathological eye tracing. All this will greatly help in early less invasive electrodiagnosis of localized retinal lesions. (Author)

Optical implementation of multifocal programmable lens with single and multiple axes

Energy Technology Data Exchange (ETDEWEB)

Romero, Lenny A; Millan, Maria S; Perez-Cabre, Elisabet, E-mail: lenny.alexandra.romero@upc.edu [Optics and Optometry Dep. Technical University of Catalonia Violinista Vellsola 37, 08222 Terrassa (Spain)

2011-01-01

In this work we analyse the generation of a diffractive optical element (DOE) consisting of a multifocal Fresnel lens by means of an LCoS (liquid cristal on silicon) spatial light modulator (SLM). The multifocal lens is composed of a set of lenses of different focal length that share a common optical axis (coaxial combination) or have different axes in parallel (multi-axis combination). For both configurations, we present several ways to combine the phase distributions for three lenses with different focal lengths (f1, f2, f3), into a single-phase distribution addressed to the SLM. Numerical simulations were carried out along with the experimental analysis to corroborate the results.

Osteomyelitis in Cat-Scratch Disease: A Never-Ending Dilemma—A Case Report and Literature Review

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D. Donà

2018-01-01

Full Text Available Background. We performed a review of published case studies of osteomyelitis associated with cat-scratch disease to consolidate existing information on clinical presentation, diagnostic tools, therapy, and outcome, as well as presenting a case of disseminated cat-scratch disease in a 12-year-old female with skull osteomyelitis and spleen involvement. Methods. A search for articles indexed in PubMed, Embase, and Google Scholar was performed with the search terms “Bartonella,” “bone,” “osteomyelitis,” “osteolytic,” and “cat-scratch disease” limited to the immunocompetent pediatric population and articles in English. Results. 51 cases were identified. The average age was 7.8 years with equal sex distribution. Fever (84.3%, often with a prolonged course (64.7%, and osteoarticular pain (88.2% were the most common clinical findings. Lymphadenopathy was present in 64.7% of patients. Vertebral body was mainly involved (51.9%. MRI (50% and bone scintigraphy (48.1% were favored to confirm osteomyelitis, while serology was the preferred microbiological diagnostic. Various antibiotics were prescribed in combined or sequential regimens, with median duration of therapy of 23 days. About 12.5% of patients did not receive any treatment. Most patients had excellent prognosis; in particular, all patients not receiving any therapy showed complete recovery and no recurrence of symptoms. Conclusions. Bartonella henselae should be considered in differential diagnosis of localized lymphadentitis. Osteoarticular pain or limitation during cat-scratch disease in children should always be investigated for bone spreading. Owing to good prognosis, invasive procedures to obtain the bone material should be avoided. Serology is the gold standard diagnostic tool and MRI is the best radiographic technique to define bone and surrounding tissue involvement. Treatment represents a never-ending dilemma: surgical intervention or use of antibiotics is still

Phase Composition of a CrMo0.5NbTa0.5TiZr High Entropy Alloy: Comparison of Experimental and Simulated Data

OpenAIRE

Fan Zhang; Oleg N. Senkov; Jonathan D. Miller

2013-01-01

Microstructure and phase composition of a CrMo0.5NbTa0.5TiZr high entropy alloy were studied in the as-solidified and heat treated conditions. In the as-solidified condition, the alloy consisted of two disordered BCC phases and an ordered cubic Laves phase. The BCC1 phase solidified in the form of dendrites enriched with Mo, Ta and Nb, and its volume fraction was 42%. The BCC2 and Laves phases solidified by the eutectic-type reaction, and their volume fractions were 27% and 31%, respectively....

Clinical and patient-reported outcomes of bilateral implantation of a +2.5 diopter multifocal intraocular lens.

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Maxwell, Andrew; Holland, Edward; Cibik, Lisa; Fakadej, Anna; Foster, Gary; Grosinger, Les; Moyes, Andrew; Nielsen, Stephen; Silverstein, Steven; Toyos, Melissa; Weinstein, Arthur; Hartzell, Scott

2017-01-01

To assess the effectiveness and safety of a multifocal intraocular lens (IOL) with +2.5 diopter (D) additional power compared with a monofocal IOL. Fifteen sites in the United States. Prospective randomized patient- and observer-masked clinical trial. Randomized patients received multifocal or monofocal IOLs bilaterally. Visual acuity (33 cm, 40 cm, 53 cm, 60 cm, 4 m) was measured; safety was assessed through adverse event rates. Patient-reported visual outcomes were evaluated using the Visual Tasks questionnaire. The frequency and severity of visual disturbances were evaluated using the Assessment of Photic Phenomena and Lens EffectS questionnaire. The multifocal IOL (n = 155) provided better corrected distance visual acuity at 53 cm than the monofocal IOL (n = 165) (0.322 versus 0.512 logMAR; between-group difference, -0.190 logMAR; P < .0001) and 40 cm but not at 4 m. Ocular adverse event rates were less than 3.84% in both groups. Serious adverse event rates were comparable between the 2 IOL types. Patients with multifocal IOLs reported less difficulty with near tasks (with and without correction) and intermediate tasks (without correction). Difficulty with extended-intermediate and distance tasks was similar between groups. The most frequently reported self-rated severe phenomena were halos, starbursts, and glare. Most patients (monofocal ≥72%; multifocal ≥73%) reported never experiencing blurred, distorted, or double vision. The +2.5 D multifocal IOL provided better vision at 40 cm and 53 cm and similar vision at 4 m compared with the monofocal IOL. Safety profiles and visual phenomena were comparable between groups. Copyright © 2017 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

Challenges in managing paediatric osteomyelitis in the developing world: Analysis of cases presenting to a tertiary referral centre in Tanzania

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Adam M Ali

2014-01-01

Full Text Available Background: The literature on paediatric osteomyelitis in the developing world is scarce, and there have been calls for further characterisation of its epidemiology and the identification of factors that limit effective management in order to guide local service delivery. Our centre is a hospital serving a population of 11 million people in Tanzania. Materials and Methods: We identified patients 3 months. Twelve out of 13 with a time from symptom onset to presentation of <2 months did not develop recurrence. Conclusions: This is, to the best of our knowledge, the second largest study of paediatric osteomyelitis in the developing world. Major challenges facing this centre include a lack of availability of bacterial cultures and failure to attend follow-up. Delayed presentation of osteomyelitis to our centre is associated with recurrence of infection.

A Rare Multifocal Pattern of Type 2 Autoimmune Pancreatitis with Negative IgG4: A Potential Diagnostic Pitfall That May Mimic Multifocal Pancreatic Adenocarcinoma

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Partha Hota

2018-02-01

Full Text Available Autoimmune pancreatitis (AIP is an increasingly recognized form of acute pancreatitis characterized by obstructive jaundice with a rapid and dramatic treatment response to steroid therapy. Recently, AIP has been divided into two distinct phenotypes: lymphoplasmocytic sclerosing pancreatitis AIP (type 1 and idiopathic duct-centric pancreatitis AIP (type 2; each of which have their own distinct demographics, diagnostic criteria, and histopathological features. We report, to the best of our knowledge, the first case of a multifocal pattern of type 2 AIP characterized with both CT and MR imaging. This rare imaging pattern of AIP may mimic the appearance of more worrisome malignant etiologies such as multifocal pancreatic adenocarcinoma or lymphoma, with overlapping imaging characteristics potentially complicating or delaying diagnosis. Therefore, recognition of this atypical pattern of AIP and avoidance of this potential diagnostic pitfall is crucial.

Multifocal Langerhans cell sarcoma involving epidermis: a case report and review

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Wang Changsong

2012-08-01

Full Text Available Abstract Objective To study the clinico-pathological characteristics of Langerhans cell sarcoma (LCS which involving epidermis. Methods A case of primary multifocal LCS was analyzed in histopathology and immunophenotype. Results A 41-year-old man with multifocal cutaneous LCS involving the inguina and waist was reported. Clinical and pathology data were available. Neoplastic cells with markedly malignant cytological features were observed. Tumor cells exhibited irregular shape with abundant and eosinophilic red staining cytoplasm; large, irregular-shaped, showing lobulated or dented nucleus and some cells with a longitudinal nuclear groove and prominent nucleoli. The tumor cells expressed CD1a, Langerin (CD207, S-100 protein, CD68 and vimentin, and did not express pan-T or B cell markers and epithelial markers. The patient died less than 1 year after diagnosis due to local recurrence and metastasis to the lung, despite the administration of local radiation and chemotherapy. Conclusions LCS is a tumor with markedly malignant cytological features that originates from Langerhans cells. Primary multifocal neoplasms involving epidermis is even rare. Accurate diagnosis is based on the histopathological and immunohistochemical of the tumor cells. Virtual slide The virtual slide(s for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1182345104754765.

Validity of automated refraction after segmented refractive multifocal intraocular lens implantation

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César Albarrán-Diego

2017-11-01

Full Text Available AIM: To evaluate the clinical utility of automated refraction (AR and keratometry (KR compared with subjective or manifest refraction (MR after cataract or refractive lens exchange surgery with implantation of Lentis Mplus X (Oculentis GmbH refractive multifocal intraocular lens (IOL. METHODS: Eighty-six eyes implanted with the Lentis Mplus X multifocal IOL were included. MR was performed in all patients followed by three consecutive AR measurements using the Topcon KR-8000 autorefractor. Assessment of repeatability of consecutive AR before and after dilation with phenylephrine 10%, and comparison of the AR and KR with MR using vector analysis were performed at 3mo follow-up. RESULTS: Analysis showed excellent repeatability of the AR measurements. Linear regression of AR versus MR showed good correlation for sphere and spherical equivalent, whereas the correlation for astigmatism was low. The mean difference AR-MR was -1.28±0.29 diopters (D for sphere. Astigmatism showed better correlation between KR and MR. CONCLUSION: We suggest AR sphere plus 1.25 D and the KR cylinder as the starting point for MR in eyes with a Lentis Mplus X multifocal IOL. If AR measurements are equal to MR, decentration of the IOL should be suspected.

Indocyanine Green Angiographic and Multifocal Electroretinographic Features in the Diffuse and Regional Form of Bietti′s Crystalline Retinopathy

Institute of Scientific and Technical Information of China (English)

Libin Jiang; Feng Wen; Lezheng Wu; Hong Yan; Shixing Hu

2002-01-01

Prpose: To observe different features of indocyanine green angiography(ICGA) andtifocal electroretinography (ERG) in the diffuse and regional type of Bieti′sc stalline retinopathy (BCR). Thods: ICGA and the multifocal ERG were performed in two cases of the diffuse andregional type of BCR respectively. These data were compared with fluoresceinangiography (FA), standard Ganzfeld ERG, and visual field testing. Results: In the regional case, ICGA revealed reduced perfusion of the choroidalcirculation in the early phase and multiple hypofluorescent spots in the posterior pole in the late phase, due to choriocapillaris filling defect; the extent of choroiocapillaris losswas shown in early phase of ICGA and there were multifocal hyperfluorescent dotssurrounding hypofluorescent spots in late phase in the diffuse case. The multifocal ERGshowed that the central responses were markedly depressed, corresponding to the visualfield defects, while the findings of Ganzfeld ERG were normal in the regional BCR;however, both the multifocal ERG and Ganzfeld ERG were severely subnormal in thediffuse case.Conclusions: The features of ICGA and multifocal ERG are different between the diffuseand regional BCR. In the meantime, the two tools are also useful to differentiate the typeand assess the extentof evolution in BCR.

A New Type of Biphasic Calcium Phosphate Cement as a Gentamicin Carrier for Osteomyelitis

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Wen-Yu Su

2013-01-01

Full Text Available Osteomyelitis therapy is a long-term and inconvenient procedure for a patient. Antibiotic-loaded bone cements are both a complementary and alternative treatment option to intravenous antibiotic therapy for the treatment of osteomyelitis. In the current study, the biphasic calcium phosphate cement (CPC, called α-TCP/HAP (α-tricalcium phosphate/hydroxyapatite biphasic cement, was prepared as an antibiotics carrier for osteomyelitis. The developed biphasic cement with a microstructure of α-TCP surrounding the HAP has a fast setting time which will fulfill the clinical demand. The X-ray diffraction and Fourier transform infrared spectrometry analyses showed the final phase to be HAP, the basic bone mineral, after setting for a period of time. Scanning electron microscopy revealed a porous structure with particle sizes of a few micrometers. The addition of gentamicin in α-TCP/HAP would delay the transition of α-TCP but would not change the final-phase HAP. The gentamicin-loaded α-TCP/HAP supplies high doses of the antibiotic during the initial 24 hours when they are soaked in phosphate buffer solution (PBS. Thereafter, a slower drug release is produced, supplying minimum inhibitory concentration until the end of the experiment (30 days. Studies of growth inhibition of Staphylococcus aureus and Pseudomonas aeruginosa in culture indicated that gentamicin released after 30 days from α-TCP/HAP biphasic cement retained antibacterial activity.

Current data on extremities chronic osteomyelitis in southwest China: epidemiology, microbiology and therapeutic consequences.

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Wang, Xiaohua; Yu, Shengpeng; Sun, Dong; Fu, Jingshu; Wang, Shulin; Huang, Ke; Xie, Zhao

2017-11-24

The current study was designed to explore the epidemiology of extremities chronic osteomyelitis, its prognosis and the complications of the treatment methods being used in southwest China. The data from osteomyelitis patients treated at the Department of Orthopaedics, Southwest Hospital, China between May 2011 and September 2016 were collected and analysed. The study comprised 503 admitted patients, of which 416 males and 87 were females, with an average age of 40.15 ± 5.64 years. Approximately 356 cases were followed for more than 18 months; the average bone union time was 6.24 ± 0.76 months in 94.1% (335) patients, and infections were almost controlled in 93.8% patients. The rate of infection control with the induced membrane technique was higher than with the I-stage free bone graft. Iliac infection was the main complication of the induced membrane technique, and impaired joint activity was the main complication of I-stage free bone grafts. In southwest China, the incidence of haematogenous osteomyelitis, caused mainly by Staphylococcus aureus, remains very high. The speed of bone defect repair and the rate of infection control with the induced membrane technique were superior to those of I-stage free bone grafts. Internal fixation should be given priority because it offers reduced complications with no increase in the recurrence of infection.

Osteomielitis crónica esclerosante difusa Chronic diffuse sclerosing osteomyelitis

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M. Paula Aparicio M

2008-12-01

Full Text Available La osteomielitis esclerosante difusa se considera como una osteomielitis crónica primaria consistente en un proceso inflamatorio, doloroso y prolongado en el tiempo. Afecta solo a la mandíbula y es generalmente unilateral, compromete hueso basal y alveolar, y se localiza al nivel de cuerpo, ángulo, rama e incluso cóndilo. La causa es aún controversial, ya que algunos le atribuyen un origen infeccioso, mientras otros lo consideran una condición no infecciosa, como producto de sobrecargas o asociado con síndrome SAPHO (sinovitis, acné, pustulosis, hiperostosis y osteítis, pero la literatura no es concluyente. Con respecto al tratamiento, al igual que su causa, no está totalmente esclarecido y se describen a lo largo del tiempo distintas alternativas, que van desde lo conservador a lo más radical. Se presenta el seguimiento y tratamiento durante 7 meses de una paciente afectada por osteomielitis esclerosante difusa con 18 años de evolución aproximadamente, que ha sido refractaria a las alternativas terapéuticas convencionales.Diffuse sclerosing osteomyelitis is considered a chronic primary osteomyelitis consisting in an inflammatory, painful and prolonged process. It only affects the mandible and it is generally unilateral. It involves the basal and alveolar bone and it is located at the level of body, angle, branch and even condyle. The cause is more controversial, since some attribute an infectious origin to it, whereas others consider it as a non-infectious condition resulting from the overloads or associated with SAPHO syndrome (synovitis, acne, pustulosis, hyperostosis and osteitis, but literature is not concluding. Treatment as well as its cause are not totally clear. Different alternatives are described that go from the conservative to the most radical position. The 7-month follow-up and treatment of a female patient suffering from diffuse sclerosing osteomyelitis with approximately18 years of evolution that has been refractory

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

Efficacy of magnetic resonance imaging in diagnosing diabetic foot osteomyelitis in the presence of ischemia.

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Fujii, Miki; Armstrong, David G; Armsrong, David G; Terashi, Hiroto

2013-01-01

Magnetic resonance imaging (MRI) has been recognized as the most accurate imaging modality for the detection of diabetic foot osteomyelitis. However, how accurately MRI displays the extent of diabetic foot osteomyelitis in the presence of ischemia is still unclear. We retrospectively compared the preoperative MRI findings with the results of histopathologic examinations of resected bones and studied the efficacy of MRI in the diagnosis of diabetic foot osteomyelitis of different etiologies. A total 104 bones from 18 foot ulcers in 16 diabetic patients (10 men and 6 women; age range 42 to 84 years) treated by surgical intervention from 2008 to 2012 was examined. In 8 neuropathic ulcers, 29 bones were accurately diagnosed in detail using MRI, even those with severe soft tissue infection. Of 75 bones in 10 ischemic ulcers, only 7 bones evaluated by MRI after revascularization were diagnosed accurately; the other 68 could not be diagnosed because of unclear or equivocal MRI findings. On histopathologic examination, all the bones were found to be infected through the bone cortex by the surrounding infected soft tissue, not directly by articulation. Overall, preoperative MRI is effective in the diagnosis of neuropathic ulcers, but less so of ischemic ones. Copyright © 2013 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Rare Case of Aspergillus ochraceus Osteomyelitis of Calcaneus Bone in a Patient with Diabetic Foot Ulcers

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Farhang Babamahmoodi

2015-01-01

Full Text Available Diabetes is the most common metabolic disease in humans. One of the major complications of the disease is foot ulcer that is prone to infection. The most common causes of infection which have been reported in these patients are bacteria and fungi such as Candida, Aspergillus, and Rhizopus species. We report one such rare case with calcaneal osteomyelitis caused by Aspergillus ochraceus in a patient with diabetic foot osteomyelitis. The case was a 68-year-old male with a history of type II diabetes for 2 years. The patient had two ulcers on the right heel bones for the past 6 months with no significant improvement. One of the most important predisposing factors to infectious diseases, especially opportunistic fungal infection, is diabetes mellitus. Aspergillus species can involve bony tissue through vascular system, direct infection, and trauma. Proper and early diagnosis and treatment of diabetic foot infection can reduce or prevent complications, such as osteomyelitis and amputation. The annual examination of feet for skin and nail lesion, sensation, anatomical changes, and vascular circulation can be useful for prevention and control of infection.

Aggregatibacter actinomycetemcomitans osteomyelitis in a 12 year old boy: case report emphasizing the importance of tissue culture, and review of literature.

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Sharma, Ketaki; Mudgil, Poonam; Whitehall, John S; Gosbell, Iain

2017-03-14

Aggregatibacter actinomycetemcomitans most commonly causes periodontitis but has been reported to infect heart valves, soft tissue, brain and lungs, and distal bones. Osteomyelitis distal to the jaw is rarely described. We report an unusual and rare case of chronic osteomyelitis caused by A. actinomycetemcomitans in the toe of a paediatric patient, and review the available literature. The infection was managed with intravenous antibiotics followed by oral antibiotics. This is an unusual presentation of A. actinomycetemcomitans causing chronic osteomyelitis presumed due to nidation in a minimally damaged bone, associated with bacteraemia of an oral commensal. It occurred in the toe, without obvious dental predisposition; associated with minimal clinical disturbance and with muted immune response.

Predictability of uncontrollable multifocal seizures - towards new treatment options

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Lehnertz, Klaus; Dickten, Henning; Porz, Stephan; Helmstaedter, Christoph; Elger, Christian E.

2016-04-01

Drug-resistant, multifocal, non-resectable epilepsies are among the most difficult epileptic disorders to manage. An approach to control previously uncontrollable seizures in epilepsy patients would consist of identifying seizure precursors in critical brain areas combined with delivering a counteracting influence to prevent seizure generation. Predictability of seizures with acceptable levels of sensitivity and specificity, even in an ambulatory setting, has been repeatedly shown, however, in patients with a single seizure focus only. We did a study to assess feasibility of state-of-the-art, electroencephalogram-based seizure-prediction techniques in patients with uncontrollable multifocal seizures. We obtained significant predictive information about upcoming seizures in more than two thirds of patients. Unexpectedly, the emergence of seizure precursors was confined to non-affected brain areas. Our findings clearly indicate that epileptic networks, spanning lobes and hemispheres, underlie generation of seizures. Our proof-of-concept study is an important milestone towards new therapeutic strategies based on seizure-prediction techniques for clinical practice.

Imaging manifestations of progressive multifocal leukoencephalopathy

International Nuclear Information System (INIS)

Shah, R.; Bag, A.K.; Chapman, P.R.; Cure, J.K.

2010-01-01

Progressive multifocal leukoencephalopathy (PML) is a demyelinating disease caused by reactivation of JC virus in immunosuppressed patients. The diagnosis is usually suggested on imaging and confirmed by cerebrospinal fluid polymerase chain reaction (PCR) for JC virus DNA. In this article, we review the imaging manifestations of PML on computed tomography (CT), magnetic resonance imaging (MRI), diffusion-weighted imaging (DWI), diffusion tensor imaging (DTI), MR spectroscopy, single photon-emission computed tomography (SPECT) and positron-emission tomography (PET), and outline the role of imaging in follow-up and prognostication.

[Clinical results after implantation of a new segmental refractive multifocal intraocular lens].

Science.gov (United States)

Thomas, B C; Auffarth, G U; Philips, R; Novák, J; Blazek, J; Adamkova, H; Rabsilber, T M

2013-11-01

The aim of the study was a clinical evaluation of an intraocular lens (IOL) with a segmental multifocal optic design and near addition of + 3.0 D as part of a CE approval study. In a multicenter study the LENTIS Mplus LS-312 MF IOL (Oculentis) was implanted in 134 eyes of 79 patients with a mean age of 68 ± 12 years. The multifocality is achieved by implementation of a distance part and a segmented near sector. Three months after surgery, uncorrected and best corrected distance visual acuity (UCDVA and BCDVA, respectively), near visual acuity (UCNVA and BCNVA, respectively), contrast vision and patient satisfaction (questionnaire) were evaluated. The IOLs were implanted uneventfully either unilaterally or bilaterally and 3 months postoperatively (n = 86 eyes) the following mean visual acuities were obtained (logMAR): UCDVA = 0.05, BCDVA = - 0.01, UCNVA = 0.09 and BCNVA = 0.02. Contrast sensitivity (n = 25 eyes) was within normal limits. Of the 66 questioned patients 10.6% spontaneously reported halos and 3% glare. This new innovative multifocal IOL concept showed very good functional results as well as high patient satisfaction.

Acute bone crises in sickle cell disease: the T1 fat-saturated sequence in differentiation of acute bone infarcts from acute osteomyelitis

International Nuclear Information System (INIS)

Jain, R.; Sawhney, S.; Rizvi, S.G.

2008-01-01

Aim: To prove the hypothesis that acute bone infarcts in sickle cell disease are caused by sequestration of red blood cells (RBCs) in bone marrow, and to evaluate the unenhanced T1 fat-saturated (fs) sequence in the differentiation of acute bone infarction from acute osteomyelitis in patients with sickle-cell disease. Materials and methods: Two studies were undertaken: an experimental study using in-vitro packed red blood cells and normal volunteers, and a retrospective clinical study of 86 magnetic resonance imaging (MRI) studies. For the experimental study containers of packed RBCs were placed between the knees of four healthy volunteers with a saline bag under the containers as an additional control, and were scanned with the pre-contrast T1-fs sequence. Signal intensity (SI) ratios were obtained for packed RBCs:skeletal muscle and packed RBCs:saline. For the clinical study, the SIs of normal bone marrow, packed RBCs, bone and/or soft-tissue lesions, and normal skeletal muscle of 74 patients (86 MRI studies) were measured using unenhanced, T1 fat-saturated MRI. The ratios of the above SIs to normal skeletal muscle were calculated and subjected to statistical analysis. Results: Fifty-one of 86 MRI studies were included in the final analysis. The ratios of SIs for normal bone marrow, packed red cells, bone infarction, acute osteomyelitis, and soft-tissue lesions associated with bone infarct, compared with normal skeletal muscle were (mean ± SD) 0.9 ± 0.2, 2.1 ± 0.7, 1.7 ± 0.5, 1.0 ± 0.3, and 2.2 ± 0.7, respectively. The difference in the ratio of SIs of bone infarcts and osteomyelitis was significant (p = 0.003). The final diagnoses were bone infarction (n = 50), acute osteomyelitis (n = 1), and co-existent bone infarction and osteomyelitis (n = 2). Seven patients who had suspected osteomyelitis underwent image-guided aspiration. Conclusion: Acute bone infarcts in sickle cell disease are caused by sequestration of red blood cells in the bone marrow. The

Effect of pressing temperature on the wear resistance of a Co-based Cr-Mo powder alloy produced by hot pressing

Energy Technology Data Exchange (ETDEWEB)

Somunkiran, Ilyas [Firat Univ., Elazig (Turkey). Metallurgical and Materials Engineering Dept.; Balin, Ahmet [Siirt Univ. (Turkey). Dept. of Vocational High School

2016-02-01

In this study, Co-based Cr-Mo powder alloy was produced at different pressing temperatures by using hot pressing technique and abrasive wear behaviors of the produced specimens were examined. Produced specimens were exposed to abrasive wear experiment using block on disc wear test device by applying a load of 50 N with 100-mesh SiC abrasive paper. Each specimen was investigated at 25, 50, 75 and 100 m. At the end of the experiment, abrasive wear results of the specimens were determined by calculating their mass losses. Microstructural properties of the specimens which were produced at different pressing temperatures were investigated by optical and SEM examinations and their wear resistances were examined by abrasive wear experiments. Consequently, it was observed that in Co-based Cr-Mo powder alloy produced by hot pressing technique; as sintering temperature increased, size of neck formations between the powder grains increased, porosity decreased and abrasive wear resistance increased. [German] In diesem Beitrag zugrunde liegenden Studie wurde eine Co-basierte Cr-Mo-Legierung mittels Heisspressens hergestellt und der Abrasivverschleisswiderstand dieser Proben untersucht. Die hergestellten Proben wurden dem Abrasivverschleissversuch durch einen Block-Scheibe-Versuchsaufbau unterzogen, wobei eine Kraft von 50 N mit einem SiC-Papier (100 mesh) verwendet wurde. Jede Probe wurde ueber eine Distanz von 25, 50, 75 und 100 m untersucht. Am Ende der jeweiligen Experimente wurden die Abrasivverschleissergebnisse ermittelt, indem die Massenverluste berechnet wurden. Die mikrostrukturellen Eigenschaften der Proben, die bei verschiedenen Presstemperaturen hergestellt wurden, wurden mittels optischer und Rasterelektronenmikroskopie bestimmt und ihr Verschleisswiderstand anhand der Verschleissversuche ermittelt. Schliesslich wurde beobachtet, dass bei steigender Sintertemperatur der heissgespressten Co-basierten Cr-Mo-Pulverlegierung die Groesse der Einschnuerungen zwischen den

Use of Leukocyte Platelet (L-PRF Rich Fibrin in Diabetic Foot Ulcer with Osteomyelitis (Three Clinical Cases Report

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Alessandro Crisci

2018-04-01

Full Text Available In this study, the use of fibrin rich in leukocytes and platelets (L-PRF was explored to heal osteomyelitis ulcers in a diabetic foot. The goal was to standardize the utilization of L-PRF in patients with osteomyelitis to direct it for healing. L-PRF was obtained autologously from the peripheral blood of the diabetic patients (n = 3 having osteomyelitis and skin lesions for at least six months. The L-PRF and supernatant serum were inserted into the skin lesion to the bone after a surgical debridement. The evolution of lesions over time was analyzed. All three patients showed positivity to the Probe-to-Bone test and Nuclear Magnetic Resonance detected cortico-periosteal thickening and/or outbreaks of spongy cortical osteolysis in adjacency of the ulcer. The infections were caused by Cocci Gram-positive bacteria, such as S. Aureus, S. β-hemolytic, S. Viridans and Bacilli; and Gram-negative such as Pseudomonas, Proteus, Enterobacter; and yeast, Candida. The blood count did not show any significant alterations. To date, all three patients have healed skin lesions (in a patient for about two years with no evidence of infection. These preliminary results showed that L-PRF membranes could be a new method of therapy in such problematic diseases. Overall, the L-PRF treatment in osteomyelitis of a diabetic foot seems to be easy and cost-effective by regenerative therapy of chronic skin lesions. In addition, it will improve our understanding of wound healing.

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.

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

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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.)

Skull base osteomyelitis: role of three phase and hybrid SPECT/CT bone scintigraphy

International Nuclear Information System (INIS)

Chakraborty, D.; Bhattacharaya, A.; Kamaleshwaran, K.K.; Mittal, B.R.; Aggarwal, K.; Singh, B.; Bhoil, A.

2010-01-01

Full text: Skull base osteomyelitis is the infection that has spread to the skull base, beyond the external auditory canal and seen in advanced stage of malignant otitis externa. Early diagnosis of this condition includes the use of bone scintigraphy since clinical assessment alone cannot differentiate the skull base osteomyelitis from the severe type of otitis externa in which there is no extension to the adjacent bone. Objective: To determine the role of three phase bone scintigraphy and delayed SPECT/CT in detection of skull base osteomyelitis in patients with malignant otitis externa. Material and Methods: Clinical records of 20 patients (14 Males and 6 Females; mean age 72 yrs) of otitis externa with suspected skull base involvement referred for bone scintigraphies were analyzed retrospectively. Three phase bone scintigraphy was acquired under dual detector gamma camera after intravenous injection of 20 mCi (740 MBq) 99m Tc-MDP followed by SPECT/CT of the skull. Scintigraphic findings were compared with clinical symptoms, signs and diagnostic CT scan findings. Results: All the patients except one were diabetic and having elevated ESR. 18 patients presented with bilateral symptoms and rest unilateral. Cranial nerves were involved in 8 patients (40%). Ear discharge culture sensitivity report was found in three patients; it was positive for Pseudomonas aeruginosa for two patients and in Diptheroids for one. In 9 patients (45%) increased flow of tracer and 10 patients (50%) increased blood pool phase in the temporal region was found. Delayed phase images showed increased uptake in skull bone in 19 patients (95%). Hybrid SPECT/CT of the skull localized areas of increased tracer uptake to the mastoid part in 15 patients (75%), petrous part in 11 patients (55%), sphenoid in 3 patients (15%) and zygomatic bone in one patient (5%) with CT showing destructive changes in 5 patients (25%) which were corroborated with diagnostic CT findings. SPECT/CT along with three phase

Chest wall resection for multifocal osseous haemangioma.

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Weinandt, Marthe; Legras, Antoine; Mordant, Pierre; Le Pimpec Barthes, Françoise

2016-02-01

Intraosseous haemangioma is a rare and benign primary tumour of the bone. We report the case of a 76-year old woman who presented the exceptional condition of multifocal cavernous haemangiomas involving the spine and the ribs, requiring spinal and chest wall resections to confirm the diagnosis and treat the symptoms. © The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

N-3 Polyunsaturated Fatty Acids of Marine Origin and Multifocality in Human Breast Cancer.

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Lobna Ouldamer

Full Text Available The microenvironment of breast epithelial tissue may contribute to the clinical expression of breast cancer. Breast epithelial tissue, whether healthy or tumoral, is directly in contact with fat cells, which in turn could influence tumor multifocality. In this pilot study we investigated whether the fatty acid composition of breast adipose tissue differed according to breast cancer focality.Twenty-three consecutive women presenting with non-metastatic breast cancer underwent breast-imaging procedures including Magnetic Resonance Imaging prior to treatment. Breast adipose tissue specimens were collected during breast surgery. We established a biochemical profile of adipose tissue fatty acids by gas chromatography. We assessed whether there were differences according to breast cancer focality.We found that decreased levels in breast adipose tissue of docosahexaenoic and eicosapentaenoic acids, the two main polyunsaturated n-3 fatty acids of marine origin, were associated with multifocality.These differences in lipid content may contribute to mechanisms through which peritumoral adipose tissue fuels breast cancer multifocality.

N-3 Polyunsaturated Fatty Acids of Marine Origin and Multifocality in Human Breast Cancer.

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Ouldamer, Lobna; Goupille, Caroline; Vildé, Anne; Arbion, Flavie; Body, Gilles; Chevalier, Stephan; Cottier, Jean Philippe; Bougnoux, Philippe

2016-01-01

The microenvironment of breast epithelial tissue may contribute to the clinical expression of breast cancer. Breast epithelial tissue, whether healthy or tumoral, is directly in contact with fat cells, which in turn could influence tumor multifocality. In this pilot study we investigated whether the fatty acid composition of breast adipose tissue differed according to breast cancer focality. Twenty-three consecutive women presenting with non-metastatic breast cancer underwent breast-imaging procedures including Magnetic Resonance Imaging prior to treatment. Breast adipose tissue specimens were collected during breast surgery. We established a biochemical profile of adipose tissue fatty acids by gas chromatography. We assessed whether there were differences according to breast cancer focality. We found that decreased levels in breast adipose tissue of docosahexaenoic and eicosapentaenoic acids, the two main polyunsaturated n-3 fatty acids of marine origin, were associated with multifocality. These differences in lipid content may contribute to mechanisms through which peritumoral adipose tissue fuels breast cancer multifocality.

Nonsyndromic Synchronous Multifocal Central Giant Cell Granulomas of the Maxillofacial Region: Report of a Case.

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Anita Munde

2015-04-01

Full Text Available Central giant cell granuloma (CGCG is a benign proliferation of fibroblasts and multinucleated giant cells that almost exclusively occurs in the jaws. It commonly occurs in young adults showing a female predilection in the anterior mandible. Multifocal CGCGs in maxillofacial region are very rare and suggestive of systemic diseases such as hyperparathyroidism, an inherited syndrome such as Noonan-like multiple giant cell lesion syndrome or other disorders. Only 10 cases of multifocal CGCGs in the maxillofacial region without any concomitant systemic disease have been reported in the English literature. Here, we report an unusual case of 36 year-old female presented with non-syndromic synchronous, multifocal CGCGs in the left posterior mandible and left posterior maxilla without any concomitant systemic disease. Relevant literature is reviewed and the incidence, clinical features, radiological features, differential diagnosis and management of CGCGs are discussed.

Deep wound cultures correlate well with bone biopsy culture in diabetic foot osteomyelitis.

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Malone, M; Bowling, F L; Gannass, A; Jude, E B; Boulton, A J M

2013-10-01

Osteomyelitis is a major complication in patients with diabetic foot ulceration. Accurate pathogenic identification of organisms can aid the clinician to a specific antibiotic therapy thereby preventing the need for amputation. All diabetic patients with bone biopsy-confirmed osteomyelitis were included into the study: biopsies were performed either during surgical removal of infected bone or percutaneously under guided fluoroscopy through non-infected tissue. The depth and extent of the ulcer was assessed using a sterile blunt metal probe. Deep wound cultures were taken from the wound base after sharp debridement. Of 66 cases of suspected osteomyelitis in 102 joints, 34 patients had both bone biopsies and deep wound cultures over the study period. Thirty two of 34 (94%), had a history of preceding foot ulceration, and in 25 of the cases a positive probe to bone test was recorded. In a high proportion of patients, at least one similar organism was isolated from both the deep wound culture and bone biopsy procedures (25 of 34 cases, 73.5%, p<0.001). When organisms were isolated from both wound cultures and bone biopsies, the identical strain was identified in both procedures in a significant proportion of cases (16 of 25 cases, 64%, p<0.001, total sample analysis in 16 of 34 cases, 47%). Deep wound cultures correlate well with osseous cultures and provide a sensitive method in assessing and targeting likely pathogens that cause osseous infections. This will help aid the clinician in guiding antibiotic therapy in centers where bone biopsies may not be readily available. Copyright © 2013 John Wiley & Sons, Ltd.

Multifocal Synchronous Granular Cell Tumors of the Gastrointestinal Tract

OpenAIRE

Lipkin-Moore, Zachary; Thomas, Rebecca M.; Rothstein, Robin D.

2014-01-01

Granular cell tumors (GCT) are rare and unusual tumors, which are usually benign and asymptomatic. Only 5?10% of cases involve the gastrointestinal tract, most commonly as singular, non-cancerous lesions in the esophagus. We report a rare case of symptomatic, multifocal, synchronous GCT involving the esophagus, stomach, and cecum.

Single-Dose Bone Pharmacokinetics of Vancomycin in a Porcine Implant-Associated Osteomyelitis Model

DEFF Research Database (Denmark)

Bue, Mats; Hanberg, Pelle; Koch, Janne

2018-01-01

, vancomycin bone and soft tissue penetration during infection remains unclear. In eight pigs, implant-associated osteomyelitis was induced on day 0, using a Staphylococcus aureus strain. Following administration of 1,000 mg of vancomycin on day 5, vancomycin concentrations were obtained with microdialysis...

Aggregatibacter actinomycetemcomitans osteomyelitis in a 12?year old boy: case report emphasizing the importance of tissue culture, and review of literature

OpenAIRE

Sharma, Ketaki; Mudgil, Poonam; Whitehall, John S.; Gosbell, Iain

2017-01-01

Background Aggregatibacter actinomycetemcomitans most commonly causes periodontitis but has been reported to infect heart valves, soft tissue, brain and lungs, and distal bones. Osteomyelitis distal to the jaw is rarely described. Case presentation We report an unusual and rare case of chronic osteomyelitis caused by A. actinomycetemcomitans in the toe of a paediatric patient, and review the available literature. The infection was managed with intravenous antibiotics followed by oral antibiot...

Multiresistant-MRSA tricuspid valve infective endocarditis with ancient osteomyelitis locus

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Gambarati Gianpaolo

2006-07-01

Full Text Available Abstract Background Methicillin-resistant S. aureus (MRSA with low susceptibility to glycopeptides is uncommon. Case presentation The case of a 50-year-old non-drug addict patient presenting with tricuspid valve infective endocarditis (IE by MRSA resistant to vancomycin and linezolid is presented. There was response only to quinupristin/dalfopristin. He had a motorcycling accident four years before undergoing right above-the-knee amputation and orthopaedic fixation of the left limb. There were multiple episodes of left MRSA-osteomyelitis controlled after surgery and vancomycin therapy. MRSA isolated from the blood at the time of IE presented with the same profile than the isolated four years earlier. Sequential treatment with teicoplanin-cotrimoxazole and Linezolid associated to vancomycin – rifampicin – cotrimoxazole had no improvement. Infection was controlled after 28 days of therapy with quinupristin/dalfopristin. Conclusion The literature presents only a few cases of MRSA IE not susceptible to glycopeptides in not drug addicted patients. This case shows the comparison of a highly-resistant MRSA after previous S. aureus osteomyelitis treated with glycopeptides. This is the first description of successful treatment of resistant-MRSA IE of the tricuspid valve complicated by multiple pulmonary septic infarction with quinupristin/dalfopristin

[Low-frequency pulsed magnetotherapy combined with electrostimulation of biologically active points in the combined treatment of traumatic mandibular osteomyelitis].

Science.gov (United States)

Korotkikh, N G; Oreshkin, A V

1999-01-01

The results of treatment are analyzed in 51 patients (35 with exacerbation of chronic traumatic mandibular osteomyelitis and 16 with chronic traumatic mandibular osteomyelitis). Low-intensity pulsed magnetic therapy of the focus in combination with electric stimulation of segmentary bioactive points, synchronized by the patient's pulse, are proposed to be added to the therapeutic complex. Such a modality improved the regional hemodynamics, promoted liquidation of the postoperative edema on days 1-2 after intervention, and sooner than after traditional therapy repaired the energy of the patient's organism.

Targeting osteomyelitis with complete [99mTc]besilesomab and fragmented [99mTc]sulesomab antibodies: kinetic evaluations

International Nuclear Information System (INIS)

GRATZ, Stefan; KEMKE, Bendix; KEIZE, Patrik; KAMPEN, Wim U.; LUSTER, Markus; HÖFFKEN, Helmut

2016-01-01

The aim of this retrospective study was to compare the targeting of “pure” osteomyelitis (i.e., without surrounding soft tissue infection) by directly 99mTc-labelled complete immunoglobulin G (IgG) monoclonal antibody (MAb) ([99mTc]besilesomab) and by directly 99mTc-labelled fragment antigen-binding (FAb) MAb ([99mTc]sulesomab) in relation to their kinetic fate. A total of 73 patients with “pure” osteomyelitis were examined with [99mTc]besilesomab, (Scintimun®, IBA/CIS bio international, Saclay, France; N.=38) and [99mTc]sulesomab (LeukoScan®, Immunomedics Inc., Morris Plains, NJ, USA; N.=35). Kinetic data were deduced from whole-body and single-photon emission computed tomographic scans, performed 10 minutes to 24 hour p.i. (region-of-interest technique [ROI]). In targeting “pure” osteomyelitis, sensitivities at 1-4 hours were found to be higher for [99mTc]sulesomab (44% and 80% for [99mTc]besilesomab and [99mTc]sulesomab, respectively) but at significantly lower target/background (T/B) ratios than with [99mTc]besilesomab (1.8±0.3 versus 1.4±0.5 for [99mTc]besilesomab and [99mTc]sulesomab respectively; P<0.01). With [99mTc]besilesomab, there was a continuous osteomyelitis uptake over 24 hours, whereas with [99mTc]sulesomab, the maximal uptake occurred mostly within 1-4 hours, with subsequent clearance being slower for antigen-bound activity than for nonspecific background. Hence, diagnosis was possible mostly after 4h with [99mTc]sulesomab but often not before 24 hours with [99mTc]besilesomab, the later increasing significantly (P<0.01) in sensitivity (87% and 84% for [99mTc]besilesomab and [99mTc]sulesomab, respectively). These results show that the higher sensitivity of [99mTc]sulesomab in osteomyelitis targeting at earlier p.i. times does not rely on an increased antibody uptake but on a more rapid clearance of nonspecific background activity due to faster metabolism and excretion. Intact [99mTc]besilesomab show a slow, continuous uptake

Differences in the cyclic deformation behaviour of quenched and tempered steel 42 CrMo 4 (AISI 4140) due to stress- and strain-control

International Nuclear Information System (INIS)

Schulze, V.; Lang, K.-H.; Voehringer, O.; Macherauch, E.

1998-01-01

Cyclic stress-strain-curves and Manson-Coffin-plots of quenched and tempered steel 42 CrMo 4 (AISI 4140) strongly depend on whether they are determined under stress- or total-strain-control. At total-strain-controlled experiments, this is caused on the one hand by comparatively high initial stress-amplitudes which lead to distinctive cyclic work softening. On the other hand, the occuring differences in the evolution of inhomogeneous deformation patterns at both types of loading, which can be recorded by means of photoelasticity and microscopy, lead to differently distributed plastic deformations and to different integral values of plastic strain. (orig.)

A case of peripheral gangrene and osteomyelitis secondary to terlipressin therapy in advanced liver disease

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Heon Ju Lee

2013-06-01

Full Text Available Variceal bleeding and hepatorenal syndrome (HRS are serious and life-threatening complications of advanced liver disease. Terlipressin is widely used to manage both acute variceal bleeding and HRS due to its potency and long duration of action. The most severe (though rare adverse event is ischemia. The present report describes the case of a patient with gangrene and osteomyelitis secondary to terlipressin therapy. A 71-year-old male with alcoholic liver cirrhosis (Child-Pugh B and chronic hepatitis C was admitted due to a drowsy mental status. The patient had several experiences of orthopedic surgery. His creatinine level had gradually elevated to 4.02 mg/dL, and his urine output decreased to 500 mL/24 hr. The patient was diagnosed as having grade III hepatic encephalopathy (HE and type II HRS. Terlipressin and albumin were administered intravenously to treat the HRS over 11 days. Although he recovered from the HE and HRS, the patient developed peripheral gangrene and osteomyelitis in both feet. His right toes were cured with the aid of rescue therapy, but his left three toes had to be amputated. Peripheral gangrene and osteomyelitis secondary to terlipressin therapy occur only rarely, and there is no specific rescue therapy for these conditions. Thus, attention should be paid to the possibility of ischemia of the skin and bone during or after terlipressin therapy.

The multifocal electroretinogram (mfERG) in the pig

DEFF Research Database (Denmark)

Voss Kyhn, Maria; Kiilgaard, Jens Folke; Lopez, Ana Garcia

2007-01-01

To establish a method allowing multifocal electroretinography (mfERG) recording with simultaneous fundus monitoring on anaesthetized pigs. In addition we characterize the peaks of the porcine mfERG trace, and compare the visual streak area with the optic nerve head, a known non-response area....... Finally we illustrate the feasibility of the method by performing mfERG after an induced laser burn in the visual streak....

Florid Cemento-Osseous Dysplasia Simultaneous the Chronic Suppurative Osteomyelitis in Mandible.

Science.gov (United States)

Cavalcante, Mateus Barros; de Oliveira Lima, Amanda Laísa; Júnior, Marcus Antônio Brêda; Santos, Milkle Bruno Pessoa

2016-11-01

The florid cemento-osseous dysplasia is an uncommon condition nonneoplastic, of unknown cause with higher prevalence in melanodermic women, limited the maxillary bones, is characterized by the presence of dispersed and diffuse radiopaque calcifications, constituted of bone and dense cemento; however, when the bone is infected it induces the suppuration and formation of osseous sequestra, thus resulting in an osteomyelitis frame. The patient was attended in a Dental Specialties Center in the state of Alagoas, Brazil, presenting on clinical examination edema and extra oral fistula with pus drainage in hemiface submandibular of the right side. Radiographically it was possible to observe area of sclerosis and osseous sequestra involving the right side region of the mandible body, and it increases zones of the bone density. In association with clinical data and complementary diagnosis examinations, the option of treatment adopted was the complete removal of the bone fragment, followed by adaptation and plate fixation and titanium screws to reduce the risk of mandibular fracture. The aim of the present paper was to relate a clinical patient of florid cemento-osseous dysplasia simultaneous the chronic suppurative osteomyelitis, highlighting their clinical, radiographic, and histological characteristics, as well as their diagnosis and treatment.

A case of osseous scintigraphy showing focuses of multifocal tuberculosis

International Nuclear Information System (INIS)

Faurous-Vanaud, R.; Faurous, P.; Kalfa, G.; Collet, H.; Couty, H.; Artus, J.C.

1997-01-01

Incidence of tuberculosis in developed countries presents in the last years a spectacular boost. However, the osteo-articular system is afflicted by tuberculosis only in a few percent of cases and the multifocal character represents less than 5% of osseous tuberculosis. It is presented here a case of multifocal osseous tuberculosis only to stress its rarity. A woman 28 years old from Djibouti presents since 8 months an asthenia and dorsal pains long thought as psychalgia. The examination has shown a major vertebral stiffness and limitation of right haunch. The radiographs showed a scoliosis centered on D8 with modifications. The biologic data are VS = 90, CRP = 124 and the hemogram is normal. The intradermal reaction (10 U of tuberculin) is phlyctenular. The TDM indicates lytic vertebral extension on D7 - D8, the osseous scintigraphy with MDP - 99 mTc indicates no anomaly in the vascular arrival time; a few minutes after injection: dorsal and upper and of right femur hyperactivity; 2 h after injection: hyper-fixation of D7 to D9 and of the upper end of right femur. The IRM indicates para-vertebral abscess of D7 to D9 with epidural abscess; abscess in the upper part of the loge of right adductors with osseous affliction of the femur's upper end; a bacillary infectious process was a priori evoked. The patient was then placed under quadruple antibiotic-therapy anti-tuberculous care. In case of anomalous multifocal osseous scintigraphy the tuberculous affliction is part of the differential diagnosis, particularly in the immigrant populations or in HIV+ persons

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

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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.

Multifocal Intraocular Lens Results in Correcting Presbyopia in Eyes After Radial Keratotomy.

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Kim, Kyeong Hwan; Seok, Kyung-Won; Kim, Wan Soo

2017-11-01

To report results of multifocal intraocular lens (IOL) implantation in 2 patients with refractive error and presbyopia after previous radial keratotomy (RK). A refractive multifocal IOL with rotational asymmetry (LS313-MF30; Oculentis, Berlin, Germany) was implanted. The first patient was a 60-year-old man with myopia who underwent unilateral RK 20 years before. His uncorrected distance visual acuity (UDVA) was 20/400, and his distance corrected near vision was J9 in both eyes. Six months after bilateral surgery, his binocular UDVA and uncorrected near visual acuity (UNVA) improved to 20/20 and J1, respectively, although he experienced diurnal fluctuation. The second patient was a 55-year-old woman with hyperopia who underwent bilateral RK 18 years before. Uncorrected distance visual acuity was 20/25 in both eyes, but UNVA was between J9 and J10. Three months after unilateral surgery, UDVA and UNVA of the postsurgical eye improved to 20/20 and J1, respectively. Neither patient reported any significant photic phenomena, and both were satisfied with the results of treatment. The desirable clinical outcomes and levels of satisfaction expressed by these patients indicate that surgery using this particular multifocal IOL may benefit presbyopic patients with previous RK.

Usefulness of hybrid SPECT/CT for the 99mTc-HMPAO-labeled leukocyte scintigraphy in a case of cranial osteomyelitis

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Chiara Bruni

Full Text Available Cranial osteomyelitis is a potentially fatal lesion. White blood cell scanning (WBC with 99mTc-hexamethylpropylene amine oxime (HMPAO has proven highly sensitive and specific in the diagnosis and follow-up of patients with suspected osteomyelitis. In this report we show the usefulness of SPECT and transmission CT performed simultaneously using a hybrid imaging device for the functional anatomic mapping of soft tissue and cranial bone infections. 99mTc-HMPAO-labeled leukocytes scintigraphy was performed on an elderly diabetic man with an intracranial mass lesion and with suspected temporal bone infection. Planar scans were acquired 30 min, 4 h, and 24 h after injection. SPECT/CT was obtained 6 h after tracer injection, using a dual-head camera coupled with a low-power X-ray tube. The scintigraphic results were matched with the results of surgery and of clinical follow-up. The planar images alone were true-positives for abscess in this patient. SPECT/CT improves the accuracy of99mTc-HMPAO scintigraphy especially in discriminating between soft-tissue and bone involvement. In fact, SPECT/CT also showed temporal bone osteomyelitis. This result indicates that SPECT/CT performed using a hybrid device can improve imaging with 99mTc-HMPAO-labeled leukocytes in patients with suspected osteomyelitis by providing accurate anatomic localization and precise definition of the extent of infection.

Outcomes of excimer laser enhancements in pseudophakic patients with multifocal intraocular lens

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Schallhorn SC

2016-04-01

Full Text Available Steven C Schallhorn,1–3 Jan A Venter,2 David Teenan,2 Julie M Schallhorn,3 Keith A Hettinger,2 Stephen J Hannan,2 Martina Pelouskova2 1Department of Ophthalmology, University of California, San Francisco, CA, USA; 2Optical Express, Glasgow, UK; 3Department of Ophthalmology, University of Southern California, Los Angeles, CA, USA Purpose: The aim of this study was to assess visual and refractive outcomes of laser vision correction (LVC to correct residual refraction after multifocal intraocular lens (IOL implantation. Patients and methods: In this retrospective study, 782 eyes that underwent LVC to correct unintended ametropia after multifocal IOL implantation were evaluated. Of all multifocal lenses implanted during primary procedure, 98.7% were refractive and 1.3% had a diffractive design. All eyes were treated with VISX STAR S4 IR excimer laser using a convectional ablation profile. Refractive outcomes, visual acuities, patient satisfaction, and quality of life were evaluated at the last available visit. Results: The mean time between enhancement and last visit was 6.3±4.4 months. Manifest spherical equivalent changed from -0.02±0.83 D (-3.38 D to +2.25 D pre-enhancement to 0.00±0.34 D (-1.38 D to +1.25 D post-enhancement. At the last follow-up, the percentage of eyes within 0.50 D and 1.00 D of emmetropia was 90.4% and 99.5%, respectively. Of all eyes, 74.9% achieved monocular uncorrected distance visual acuity 20/20 or better. The mean corrected distance visual acuity remained the same before (-0.04±0.06 logMAR [logarithm of the minimum angle of resolution] and after LVC procedure (-0.04±0.07 logMAR; P=0.70. There was a slight improvement in visual phenomena (starburst, halo, glare, ghosting/double vision following the enhancement. No sight-threatening complications related to LVC occurred in this study. Conclusion: LVC in pseudophakic patients with multifocal IOL was safe, effective, and predictable in a large cohort of

Case report: multifocal subchondral stress fractures of the femoral heads and tibial condyles in a young military recruit.

Science.gov (United States)

Yoon, Pil Whan; Yoo, Jeong Joon; Yoon, Kang Sup; Kim, Hee Joong

2012-03-01

Subchondral stress fractures of the femoral head may be either of the insufficiency-type with poor quality bone or the fatigue-type with normal quality bone but subject to high repetitive stresses. Unlike osteonecrosis, multiple site involvement rarely has been reported for subchondral stress fractures. We describe a case of multifocal subchondral stress fractures involving femoral heads and medial tibial condyles bilaterally within 2 weeks. A 27-year-old military recruit began having left knee pain after 2 weeks of basic training, without any injury. Subsequently, right knee, right hip, and left hip pain developed sequentially within 2 weeks. The diagnosis of multifocal subchondral stress fracture was confirmed by plain radiographs and MR images. Nonoperative treatment of the subchondral stress fractures of both medial tibial condyles and the left uncollapsed femoral head resulted in resolution of symptoms. The collapsed right femoral head was treated with a fibular strut allograft to restore congruity and healed without further collapse. There has been one case report in which an insufficiency-type subchondral stress fracture of the femoral head and medial femoral condyle occurred within a 2-year interval. Because the incidence of bilateral subchondral stress fractures of the femoral head is low and multifocal involvement has not been reported, multifocal subchondral stress fractures can be confused with multifocal osteonecrosis. Our case shows that subchondral stress fractures can occur in multiple sites almost simultaneously.

Oxidation Behavior of TiAl-Based Alloy Modified by Double-Glow Plasma Surface Alloying with Cr-Mo

Science.gov (United States)

Wei, Xiangfei; Zhang, Pingze; Wang, Qiong; Wei, Dongbo; Chen, Xiaohu

2017-07-01

A Cr-Mo alloyed layer was prepared on a TiAl-based alloy using plasma surface alloying technique. The isothermal oxidation kinetics of the untreated and treated samples was examined at 850 °C. The microstructure and phase composition of the alloyed layer were analyzed by scanning electron microscope (SEM), energy dispersive spectrometer (EDS) and X-ray powder diffraction (XRD). The morphology and constituent of the oxide scales were also analyzed. The results indicated that the oxidation resistance of TiAl was improved significantly after the alloying treatment. The oxide scale eventually became a mixture of Al2O3, Cr2O3 and TiO2. The oxide scale was dense and integrated throughout the oxidation process. The improvement was mainly owing to the enhancing of scale adhesion and the preferential oxidation of aluminum brought by the alloying effect for TiAl-based alloy.

Progressive multifocal leukoencephalopathy: new concepts

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Marco A. Lima

2013-09-01

Full Text Available Progressive multifocal leukoencephalopathy (PML is a demyelinating disease of the CNS caused by reactivation of JC virus (JCV in a setting of cellular immunosuppression. Originally, PML was observed in patients with advanced HIV infection, lymphoproliferative disorders and transplant recipients. However, the widespread use of HIV antiretroviral drugs and the new selective immunomodulatory and immunosuppressive medications, such as Rituximab and Natalizumab, has recently modified the epidemiology, clinical presentation and prognosis of PML. Herein, we discuss the new concepts on PML, emphasizing the recent modification in the epidemiology; the impact of new immunomodulatory treatments in the disease, PML-IRIS (Immune reconstitution inflammatory síndrome, new treatment strategies and other JCV related CNS diseases.

Fatores técnicos intervenientes na realização do exame de eletrorretinograma multifocal (ERGmf Technical factors that influence multifocal electroretinogram (mfERG recording

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Maria Kiyoko Oyamada

2007-08-01

Full Text Available OBJETIVO: Descrever os principais fatores intervenientes observados durante a aquisição e análise do exame de eletrorretinograma multifocal (ERGmf, que afetam o registro gráfico das ondas obtidas e portanto sua análise. MÉTODOS: Análise dos fatores de erro observados durante a aquisição de 100 exames seqüenciais de eletrorretinograma multifocal, realizados com o Reti System da Roland Consult, no período de maio a julho de 2005. Os exames de eletrorretinograma multifocal foram realizados conforme recomendações internacionais, respeitando-se os parâmetros preestabelecidos do equipamento, com 61 elementos, e ângulo visual de 30º. Todos os pacientes foram submetidos à avaliação oftalmológica completa, excluindo-se aqueles com transparência inadequada de meios, córneas planas e os incapazes de visualizar as linhas de fixação. RESULTADOS: Os fatores intervenientes, que poderiam causar erros na interpretação dos resultados obtidos, observados e corrigidos durante a realização dos exames foram: fixação excêntrica, movimentação dos olhos, contração do orbicular, contração da musculatura cervical, não-correção adequada, não-transparência adequada do eletrodo corneano, deslocamento do eletrodo em geral para baixo, descentralização do suporte da lente corretora, distância inadequada paciente-monitor em pacientes com alta ametropia, altura inadequada dos olhos em relação ao centro da tela, ruído na freqüência de 60 HZ (rede elétrica e de campo eletromagnético, impedâncias elevadas. No processamento das ondas, a utilização excessiva de filtros para remoção de ruídos dos registros obtidos, pode interferir na análise dos resultados obtidos. CONCLUSÕES: Cuidados simplesmente observacionais durante a aquisição dos sinais são de importância significativa para a obtenção de registros com boa morfologia e baixo nível de ruído. Permitindo, por meio de sua pronta correção, a análise correta e

Unusual multifocal granulomatous disease caused by actinomycetous bacteria in a nestling Derbyan parrot (Psittacula derbiana).

Science.gov (United States)

Park, F J; Jaensch, S

2009-01-01

A nestling Derbyan parrot (Psittacula derbiana) was presented with unusual subcutaneous swellings of the thigh regions, and poor growth. Histological examination revealed actinomycetous bacteria associated with multifocal systemic granulomas. The clinical and pathological findings of the case are presented, and some relevant aspects of actinomycetous bacterial infections in mammals and birds are discussed. Although granulomatous disease is encountered at times in avian species, the actinomycetous bacteria (Nocardia and Actinomyces spp.) have rarely been reported in association with multifocal granulomatous disease in birds.

A paradoxical presentation of rickets and secondary osteomyelitis of the jaw in Type II autosomal dominant osteopetrosis: Rare case reports.

Science.gov (United States)

Jayachandran, S; Kumar, M Suresh

2016-01-01

Osteopetrosis is a rare genetic bone disorder arising due to a defect in the differentiation or function of osteoclast which results in a generalized increase in bone mass. Osteomyelitis is one of the most common complications because of decreased bone marrow function and compromised blood supply. Radiologist plays a vital role in diagnosing osteopetrosis. Here, we present two cases of autosomal dominant osteopetrosis Type II (ADO II) with secondary osteomyelitis changes which were reported to our department. One of these two cases presented with secondary osteomyelitis in both maxilla and mandible and features of rickets, which is very rarely seen in ADO II. To the best of our knowledge, the presentation of rickets with ADO is the first of its kind to be reported. In this paper, we describe the clinical and radiological features leading to the diagnosis of ADO in these two patients. Further, a review of the literature regarding ADO is discussed.

Optimization of hybrid laser arc welding of 42CrMo steel to suppress pore formation

Energy Technology Data Exchange (ETDEWEB)

Zhang, Yan [Hunan University, State Key Laboratory of Advanced Design and Manufacturing for Vehicle Body, Changsha (China); Hunan Institute of Science and Technology, College of Mechanical Engineering, Yueyang (China); Chen, Genyu; Mao, Shuai; Zhou, Cong; Chen, Fei [Hunan University, State Key Laboratory of Advanced Design and Manufacturing for Vehicle Body, Changsha (China)

2017-06-15

The hybrid laser arc welding (HLAW) of 42CrMo quenched and tempered steel was conducted. The effect of the processing parameters, such as the relative positions of the laser and the arc, the shielding gas flow rate, the defocusing distance, the laser power, the wire feed rate and the welding speed, on the pore formation was analyzed, the morphological characteristics of the pores were analyzed using scanning electron microscopy (SEM) and energy dispersive spectroscopy (EDS). The results showed that the majority of the pores were invasive. The pores formed at the leading a laser (LA) welding process were fewer than those at the leading a arc (AL) welding process. Increasing the shielding gas flow rate could also facilitate the reduction of pores. The laser power and the welding speed were two key process parameters to reduce the pores. The flow of the molten pool, the weld cooling rate and the pore escaping rate as a result of different parameters could all affect pore formation. An ideal pore-free weld was obtained for the optimal welding process parameters. (orig.)

Effect of plastic deformation on the supercooled austenite transformations of the Cr-Mo steel with Nb, Ti and B microadditions

International Nuclear Information System (INIS)

Adamczyk, J.; Opiela, M.

1998-01-01

Effect of plastic deformation at austenizing temperature was investigated on phase transformations, structure and hardness of the supercooled austenite transformation products of the Cr-Mo constructional steel with Nb, Ti and B microadditions. Basing on the analysis of the phase transformation plots of the supercooled undeformed austenite and of the supercooled and plastically deformed one, it was found out that direct cooling of specimens after completing their plastic deformation in the above mentioned conditions, results in significant acceleration of the α→β, and ferritic and pearlitic transformations, and in the decrease of transformation products hardness. These phenomena are of great importance for working out of the thermo-mechanical treatment of products made from the heat-treated microalloyed steel. (author)

The Mathematical Theory of Multifocal Lenses

Institute of Scientific and Technical Information of China (English)

Jacob RUBINSTEIN

2017-01-01

This paper presents the fundamental optical concepts of designing multifocal ophthalmic lenses and the mathematical methods associated with them.In particular,it is shown that the design methodology is heavily based on differential geometric ideas such as Willmore surfaces.A key role is played by Hamilton's eikonal functions.It is shown that these functions capture all the information on the local blur and distortion created by the lenses.Along the way,formulas for computing the eikonal functions are derived.Finally,the author lists a few intriguing mathematical problems and novel concepts in optics as future projects.

Optimizing outcomes with multifocal intraocular lenses

Directory of Open Access Journals (Sweden)

Gitansha Shreyas Sachdev

2017-01-01

Full Text Available Modern day cataract surgery is evolving from a visual restorative to a refractive procedure. The advent of multifocal intraocular lenses (MFIOLs allows greater spectacle independence and increased quality of life postoperatively. Since the inception in 1980s, MFIOLs have undergone various technical advancements including trifocal and extended depth of vision implants more recently. A thorough preoperative workup including the patients' visual needs and inherent ocular anatomy allows us to achieve superior outcomes. This review offers a comprehensive overview of the various types of MFIOLs and principles of optimizing outcomes through a comprehensive preoperative screening and management of postoperative complications.

Renal Function Outcomes for Multifocal Renal Neoplasms Managed by Radiofrequency Ablation

Energy Technology Data Exchange (ETDEWEB)

Gupta, Pushpender, E-mail: pugupta@wakehealth.edu; Allen, Brian C., E-mail: bcallen2@wakehealth.edu; Chen, Michael Y., E-mail: mchen@wakehealth.edu; Childs, David D., E-mail: dchilds@wakehealth.edu; Kota, Gopi, E-mail: gkota@wakehealth.edu; Zagoria, Ronald J., E-mail: rzagoria@wakehealth.edu [Wake Forest University School of Medicine, Department of Radiology (United States)

2013-10-15

Purpose: To evaluate renal function changes related to radiofrequency ablation (RFA) for the treatment of multifocal renal neoplasms. Methods: This is an institutional review board-approved, Health Insurance Portability and Accountability Act compliant retrospective study of all patients treated with computed tomography guided RFA for multifocal renal neoplasms at one institution. Fifty-seven subjects, mean age 70 (range 37-88) years, underwent RFA of 169 renal neoplasms (average size 2.0 cm). Subjects had between 2 and 8 (mean 2.96) neoplasms ablated. Estimated glomerular filtration rate (eGFR) was measured before and after RFA. Complications related to RFA were recorded. Results: eGFR decreased on average of 4.4 % per tumor treated and 6.7 % per ablation session (average 1.76 tumors treated per session). For subjects with the largest neoplasm measuring >3 cm, eGFR decreased an average of 14.5 % during the course of their treatment. If the largest neoplasm measured 2-3 cm, eGFR decreased an average of 7.7 %, and if the largest neoplasm measured <2 cm, eGFR decreased an average of 3.8 %. Subjects with reduced baseline renal function were more likely to have a greater decline in eGFR after RFA. There was a minor complication rate of 6.3 % (6 of 96 sessions), none of which required treatment, and a major complication rate of 4.2 % (4 of 96 sessions). Conclusion: RFA for the treatment of multifocal renal neoplasms results in mild decline of renal function.

PATHOMORPHOLOGICAL FEATURES OF BONE LESIONS AND CORRELATION OF CLINICAL, LABORATORY AND MORPHOMETRIC CRITERIA IN PATIENTS WITH LATENT SCLEROSING HEMATOGENOUS OSTEOMYELITIS (GARRÉ

Directory of Open Access Journals (Sweden)

V. V. Grigorovsky

2018-01-01

Full Text Available Introduction. Sclerosing hematogenous osteomyelitis of Garré (SHO holds a significant place among cases of latent hematogenous osteomyelitis. Pathomorphological studies of sclerosing hematogenous osteomyelitis are needed to improve differentiated diagnostics, to prognosticate morphology specifics of nidus and to choose the optimal treatment tactics.Purpose of the study — to identify statistical differences between manifestation patterns of various disease types and correlation between clinical, laboratorial and morphometric criteria of bone lesions in patients with sclerosing hematogenous osteomyelitis.Material and methods. The authors studied tissue fragments of affected bones of 25 patients with SHO which was diagnosed by clinical, laboratorial, visualizing and morphological methods. Gradation morphometric criteria were used to reflect condition of nidus tissues. The authors made the analysis of qualitative characters and correlation analysis of dependencies between clinical and laboratorial criteria on the one hand, and with morphometric criteria — on the other, and identified association factor. Results. Pathomorphological study of SHO nidus demonstrated variances of bone lesions in separate disease cases despite the overall similarity of morphological manifestation. About 2/3 of all cases correspond to fibrosing type whereby even small exudative inflammation sites are absent. In about 1/3 of all cases apart from fibrosis, osteosclerosis and remodeling, the osteomyelitis niduses contain microabscesses indicative of suppurative inflammation as well as the authors observed small sequestration. The maximum differences in patients with various types of SHO were identified in such parameters as share of stab microphages and erythrocyte sedimentation rate (ESR. In cases of long term morbidity the fibrosing disease type is prevailing, in cases of short term lesion (1–2 years — a fibrosing type with microabscesses formation.A series of

Autorefraction versus subjective refraction in a radially asymmetric multifocal intraocular lens

NARCIS (Netherlands)

Linden, J.W.M. van der; Vrijman, V.; El-Saady, R.; Meulen, I.J. van der; Mourits, M.P.; Lapid-Gortzak, R.

2014-01-01

PURPOSE: To evaluate whether the automated refraction (AR) correlates with subjective manifest (MR) refraction in eyes implanted with radially asymmetric multifocal intraocular lens (IOLs). METHODS: This retrospective study evaluated 52 eyes (52 patients) implanted with a radially asymmetric

Effect of Unifocal versus Multifocal Lenses on Cervical Spine Posture in Patients with Presbyopia.

Science.gov (United States)

Abbas, Rami L; Houri, Mohamad T; Rayyan, Mohammad M; Hamada, Hamada Ahmad; Saab, Ibtissam M

2018-04-04

There are many environmental considerations which may or may not lead to the development of faulty cervical mechanics. The design of near vision lenses could contribute to the development of such cervical dysfunction and consequently neck pain. Decision making regarding proper type of lens prescription seems important for presbyopic individuals. To investigate the effect of unifocal and multifocal lenses on cervical posture. Thirty subjects (18 females and 12 males) participated in the study with an age range from 40 to 64 years. Each subject wore consequently both unifocal and multifocal lenses randomly while reading. Then lateral cervical spine X-ray films were taken for each subject during each lens wearing. X-ray films were analyzed with digital software (Autocad software, 2 D) to measure segmental angles of the cervical vertebrae (Occiput/C1, C1/C2, C2/C3, C3/C4, C4/C5, C5/C6, C6/C7, C3/C7, C0/C3, and occiput/C7). Higher significant extension angle in the segments C0/C7, C1/C2, C5/C6, C6/C7, and C3/C7 (p<0.05) during multifocal lenses wearing were observed in contrast with higher flexion angle between C3/C4 and C4/C5 (p<0.05) with unifocal lenses wear. Multifocal lens spectacles produces increased extension in the cervical vertebrae angles when compared with the use of unifocal lenses.

Multifocal gastrointestinal stromal tumor (GIST) of the stomach in an 11-year-old girl

International Nuclear Information System (INIS)

Park, Jin; Rubinas, Tara C.; Fordham, Lynn A.; Phillips, J.D.

2006-01-01

A previously healthy 11-year-old girl presented with an 8-month history of anemia and left upper quadrant abdominal pain. US examination demonstrated a 9-cm cystic mass with a fluid-fluid level in the left upper quadrant with unclear organ of origin. Abdominal MR imaging demonstrated a complex cystic mass, likely arising from the stomach. Additional T2 hyperintense submucosal lesions were identified in the gastric wall. Surgical excision confirmed the diagnosis of multifocal gastric gastrointestinal stromal tumor (GIST). MR imaging was helpful in suggesting a gastric origin of the primary mass and in demonstrating multifocal disease within the stomach. (orig.)

Therapy of haematogenous osteomyelitis--a comparative study in a porcine model and Angolan children

DEFF Research Database (Denmark)

Johansen, Maria Louise; 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...

Osteomyelitis and Discitis Following Translumbar Repair of a Type II Endoleak

Energy Technology Data Exchange (ETDEWEB)

Sella, David M., E-mail: Sella.david@mayo.edu; Frey, Gregory T., E-mail: Frey.gregory@mayo.edu; Giesbrandt, Kirk, E-mail: giesbrandt.kirk@mayo.edu [Mayo Clinic, Department of Radiology (United States)

2016-03-15

Here we present the case of an 80-year-old man who developed a type II endoleak following endovascular abdominal aortic aneurysm repair. Initial attempts at treating the endoleak via a transarterial approach were unsuccessful; therefore the patient underwent percutaneous translumbar endoleak embolization. Approximately 1 month following the translumbar procedure, he developed back pain, with subsequent workup revealing osteomyelitis and discitis as a complication following repair via the translumbar approach.

Usefulness of hybrid SPECT/CT for the {sup 99m}Tc-HMPAO-labeled leukocyte scintigraphy in a case of cranial osteomyelitis

Energy Technology Data Exchange (ETDEWEB)

Bruni, Chiara; Padovano, Federico; Travascio, Laura; Schillaci, Orazio; Simonetti, Giovanni [University of Rome Tor Vergata, Rome (Italy). Dept. of Diagnostic Imaging, Molecular Imaging, Interventional Radiology and Radiotherapy]. E-mail: chiarabruni79@hotmail.com

2008-12-15

Cranial osteomyelitis is a potentially fatal lesion. White blood cell scanning (WBC) with {sup 99m}Tc-hexamethylpropylene amine oxime (HMPAO) has proven highly sensitive and specific in the diagnosis and follow-up of patients with suspected osteomyelitis. In this report we show the usefulness of SPECT and transmission CT performed simultaneously using a hybrid imaging device for the functional anatomic mapping of soft tissue and cranial bone infections. {sup 99m}Tc-HMPAO-labeled leukocytes scintigraphy was performed on an elderly diabetic man with an intracranial mass lesion and with suspected temporal bone infection. Planar scans were acquired 30 min, 4 h, and 24 h after injection. SPECT/CT was obtained 6 h after tracer injection, using a dual-head camera coupled with a low-power X-ray tube. The scintigraphic results were matched with the results of surgery and of clinical follow-up. The planar images alone were true-positives for abscess in this patient. SPECT/CT improves the accuracy of {sup 99m}Tc- HMPAO scintigraphy especially in discriminating between soft-tissue and bone involvement. In fact, SPECT/CT also showed temporal bone osteomyelitis. This result indicates that SPECT/CT performed using a hybrid device can improve imaging with {sup 99m}Tc-HMPAO-labeled leukocytes in patients with suspected osteomyelitis by providing accurate anatomic localization and precise definition of the extent of infection. (author)

Macrophage imaging by USPIO-enhanced MR for the differentiation of infectious osteomyelitis and aseptic vertebral inflammation

Energy Technology Data Exchange (ETDEWEB)

Bierry, Guillaume [University Hospital, Department of Radiology, Strasbourg (France); University Louis Pasteur, EA 3432, Strasbourg (France); Jehl, Francois [University Hospital of Strasbourg, Department of Bacteriology, Strasbourg (France); University Louis Pasteur, EA 3432, Strasbourg (France); Boehm, Nelly [University Louis Pasteur, Institute of Histology, Faculty of Medicine, Strasbourg (France); University Louis Pasteur, INSERM U666, Strasbourg (France); Robert, Philippe [Guerbet Research, Roissy (France); Dietemann, Jean-Louis; Kremer, Stephane [University Hospital, Department of Radiology, Strasbourg (France)

2009-07-15

The purpose of this study was to prospectively evaluate USPIO-enhanced MR imaging for the differentiation of vertebral infectious osteomyelitis and sterile inflammation. Vertebral osteomyelitis and sterile vertebral inflammation were induced in two groups of six rabbits each. MRI examinations were performed including unenhanced and gadolinium-enhanced fat-saturated SE T1w sequences. Once endplate enhancement was observed on the T1 gadolinium-enhanced MR sequence, a second MRI examination (SE T1w sequence) was performed 24 h after USPIO administration (45 {mu}mol Fe/kg). MR imaging was correlated with histopathological findings (macrophage immunostaining and Perls Prussian blue staining). On gadolinium-enhanced T1 sequences, a significant SNR increase in vertebral endplates was present in both groups without significant difference between the two groups (P = 0.26). On USPIO-enhanced T1 sequences, a significant SNR increase was only observed in the infection group (P = 0.03) with a significant difference in SNR between the infection and the sterile-inflammation groups (P = 0.002). Infected areas presented replacement of bone marrow by an intense macrophage infiltration, some being iron-loaded. Sterile inflammation showed a replacement of bone marrow by inflammatory tissue with only rare macrophages without any Perls blue staining. USPIO-enhanced MR imaging can distinguish infectious osteomyelitis from sterile vertebral inflammation due to different macrophage distributions in the two lesions. (orig.)

Clival osteomyelitis resulting from spread of infection through the fossa navicularis magna in a child

International Nuclear Information System (INIS)

Prabhu, Sanjay P.; Zinkus, Timothy; Cheng, Alan G.; Rahbar, Reza

2009-01-01

The fossa navicularis is a notch-like bone defect in the basiocciput that has been hitherto considered as an anatomical variant of the clivus and not previously described as a potential source of clival or skull base pathology. We report the imaging findings in a 5-year-old child who presented acutely with a retropharyngeal abscess and osteomyelitis of the clivus. Imaging after treatment revealed a ''notch-like'' defect in the anterior clivus consistent with a fossa navicularis. Based on these appearances, we postulate that the lymphoid tissue of the pharyngeal tonsil residing in the fossa navicularis served as a route through which infection spread and subsequently developed into clival osteomyelitis, which is a rare diagnosis. This case is unique, and we believe that the presence of this variant in young children may be important and is not merely an anatomical curiosity. (orig.)

Multifocal fibrosing thyroiditis: report of 55 cases of a poorly recognized entity.

Science.gov (United States)

Fellegara, Giovanni; Rosai, Juan

2015-03-01

During the course of our consultation activity, we have recognized a peculiar form of thyroiditis in which multiple foci of fibrosis, most of which were associated with reactive atypia of the surrounding follicles, are present. We have referred to this condition, both in our consultation reports and in the third series of A.F.I.P. Fascicle on Tumors of the Thyroid Gland, as "multifocal fibrosing thyroiditis" or (less frequently) "multifocal sclerosing thyroiditis," which are descriptive terms that highlight the benign/inflammatory nature of the process, its multiplicity, and its unknown pathogenesis. The aim of this study is to better define the morphologic features of this process and correlate it with some clinical data. With this purpose, the consultation files of one of the authors (J.R.) were searched for cases coded as multifocal fibrosing thyroiditis or multifocal sclerosing thyroiditis in a 20-year period ranging from January 1989 to December 2009. A total of 55 cases were identified that displayed the above-listed features. There were 51 (93%) female and 4 (7%) male patients (F/M=12.75), with ages ranging between 15 and 71 years (mean age, 47.03 y; median age, 44.5 y). Microscopically, multiple foci of fibrosis were identified in all cases, their number ranging from 2 to 51 per case (mean number, 16), with a mean diameter of 3 mm (range: 0.36 to 15.1 mm). Although heterogenous in shape and size, the individual foci were rather similar to each other in composition, being characterized by a fibrotic poorly cellular center that merged with a cellular peripheral zone. Some of the follicular structures present at the periphery of the scar and-to a lesser extent-those entrapped inside it underwent complex reactive and regenerative (atypical) changes that simulated malignancy. We discuss the differential diagnosis with other benign and malignant thyroid conditions and speculate about its pathogenesis and possible relationship with papillary thyroid microcarcinoma.

Study of the Effects of High Temperatures on the Engineering Properties of Steel 42CrMo4

Science.gov (United States)

Brnic, Josip; Turkalj, Goran; Canadija, Marko; Lanc, Domagoj; Brcic, Marino

2015-02-01

The paper presents and analyzes the experimental results of the effect of elevated temperatures on the engineering properties of steel 42CrMo4. Experimental data relating to the mechanical properties of the material, the creep resistance as well as Charpy impact energy. Temperature dependence of the mentioned properties is also shown. Some of creep curves were simulated using rheological models and an analytical equation. Finally, an assessment of fracture toughness was made that was based on experimentally determined Charpy impact energy. Based on the obtained results it is visible that the tensile strength (617 MPa) and yield strength (415 MPa) have the highest value at the room temperature while at the temperature of 700 °C (973 K) these values significantly decrease. This steel can be considered resistant to creep at 400 °C (673 K), but at higher temperatures this steel can be subjected to low levels of stress in a shorter time.

Osteomyelitis in lower limbs and pulmonary septic emboli - a case report and radiological diagnosis

International Nuclear Information System (INIS)

Doria, Angela Schwarz; Amaro Junior, Edson; Torre, Marcia Barbosa; Bogus, Luis Carlos Nogueira; Andrade, Marcio Ramalho; Barba, Mario Flores; Scatigno Neto, Andre

1996-01-01

The authors describe a case of osteomyelitis in the lower limbs with subsequent septic emboli pulmonary spread, as a complication of the prior clinical presentation. They discuss clinical and pathological aspects, as well as, the possibility of diagnosis utilizing plain radiography, computed tomography and scintigraphy. (author)

Exploring the methods of data analysis in multifocal visual evoked potentials

DEFF Research Database (Denmark)

Malmqvist, Lasse; Santiago de Abreu, Lucimar; Fraser, C.

2016-01-01

Purpose: The multifocal visual evoked potential (mfVEP) provides a topographical assessment of visual function, which has already shown potential for use in patients with glaucoma and multiple sclerosis. However, the variability in mfVEP measurements has limited its broader application. The purpo...

Facial osteomyelitis as complication of chronic sinusitis in hemophiliac-AIDS patients - scintigraphic evaluation with technetium-99m-MDP and Gallium-67

International Nuclear Information System (INIS)

Marques, Marise da Penha Costa; Wolosker, Sara; Marchiori, Edson

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 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)

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 R......, in joints with arthritis, and in bone necroses including lysis of growth plate and suppurative inflammation in the adjacent trabecular metaphysis, thus demonstrating that well-known infections manifest new, unusual lesions....

Upper Extremity Multifocal Neuropathy in a 10-Year-Old Boy Associated With NS6S Disaccharide Antibodies.

Science.gov (United States)

Edelman, Frederick; Naddaf, Elie; Waclawik, Andrew J

2015-06-01

We present a 10-year-old boy with a predominantly motor multifocal neuropathy with demyelinating and axonal changes with sensory involvement, affecting only one upper extremity. Laboratory studies revealed an elevated titer of immunoglobulin M (IgM) antibodies against the NS6S antigen. He responded to treatment with high dose intravenous immunoglobulins. Focal or multifocal immune-mediated neuropathies are not common in children and may be underdiagnosed. © The Author(s) 2014.

Antimicrobial peptides for topical treatment of osteomyelitis and prevention of implant related infections in orthopedics

Czech Academy of Sciences Publication Activity Database

Čeřovský, Václav; Nešuta, Ondřej; Dudková, Vlasta; Melicherčík, P.

2016-01-01

Roč. 22, Suppl S2 (2016), S157-S158 ISSN 1075-2617. [European Peptide Symposium /34./ and International Peptide Symposium /8./. 04.09.2016-09.09.2016, Leipzig] Institutional support: RVO:61388963 Keywords : antimicrobial peptides * osteomyelitis Subject RIV: CE - Biochemistry

Diagnostic flowcharts in osteomyelitis, spondylodiscitis and prosthetic joint infection

International Nuclear Information System (INIS)

Jutte, P.; Lazzeri, E.; Sconfienza, L. M.; Cassar-Pullicino, V.; Trampuz, A.; Petrosillo, N.; Signore, A.

2014-01-01

Infections of the bone, spine and prosthetic joints are serious and complex conditions to diagnose and to treat. Structured diagnostic workup may very well improve the accuracy and speed of diagnosis, thereby improving the outcome since treatment may very well be more successful and less harmful if timely management is started. Literature shows no uniform advise on diagnosis. The EANM organized a consensus meeting with representatives from the involved disciplines in order to develop common flowcharts for the diagnosis of osteomyelitis, spondylodiscitis and prosthetic joint infections. In this report the proceedings of this consensus meeting, including the proposed flowcharts for diagnosis, are published.

Outcomes in diabetic foot ulcer patients with isolated T2 marrow signal abnormality in the underlying bone: should the diagnosis of ''osteitis'' be changed to ''early osteomyelitis''?

Energy Technology Data Exchange (ETDEWEB)

Duryea, Dennis; Bernard, Stephanie; Flemming, Donald; Walker, Eric; French, Cristy [Milton S. Hershey Medical Center, Department of Radiology, H066, 500 University Drive, PO Box 850, Hershey, PA (United States)

2017-10-15

To evaluate the variability of clinical treatment and outcomes based on reporting of diabetic foot ulcer MRI findings of adjacent marrow T2 hyperintensity with normal T1 signal. A retrospective review was conducted of 46 MRI examinations evaluating diabetic foot ulcers that demonstrated normal T1 marrow signal, but T2 marrow hyperintensity deep to the ulcer. The cohort was divided based on MRI report impressions into three groups; ''osteitis without osteomyelitis'' (OW), ''osteitis but cannot exclude early osteomyelitis'' (OCEO) and ''early osteomyelitis'' (EO). Patient demographics (age, gender) and accessory MRI findings of ulcer and sinus tract depth were recorded. Initial clinical assessment and medical treatment (route and duration of antibiotics), healing versus disease progression and histology or microbiology results were recorded. The isolated marrow T2 signal hyperintensity was reported as OW in 12 patients, OCEO in 18, and EO in 16. No statistical difference in clinical assessment was demonstrated between the OW, OCEO, and EO groups. Pathological condition was available in 15 patients within 0-7 days (mean 2.4 days) of the MRI examination, with 14 (93%) of these positive for osteomyelitis by histopathology or positive cultures. Initial diagnosis of or progression to osteomyelitis was shown in 28 patients (61%). Treatment of suspected osteomyelitis is heavily determined by clinical factors. Patients who initially demonstrate only T2 marrow signal abnormality under a diabetic ulcer are eventually diagnosed as osteomyelitis in 61% of cases and deserve aggressive treatment as early osteomyelitis when meeting clinical parameters. (orig.)

Genomic Heterogeneity of Methicillin Resistant Staphylococcus aureus Associated with Variation in Severity of Illness among Children with Acute Hematogenous Osteomyelitis.

Directory of Open Access Journals (Sweden)

Claudia Gaviria-Agudelo

Full Text Available The association between severity of illness of children with osteomyelitis caused by Methicillin-resistant Staphylococcus aureus (MRSA and genomic variation of the causative organism has not been previously investigated. The purpose of this study is to assess genomic heterogeneity among MRSA isolates from children with osteomyelitis who have diverse severity of illness.Children with osteomyelitis were prospectively studied between 2010 and 2011. Severity of illness of the affected children was determined from clinical and laboratory parameters. MRSA isolates were analyzed with next generation sequencing (NGS and optical mapping. Sequence data was used for multi-locus sequence typing (MLST, phylogenetic analysis by maximum likelihood (PAML, and identification of virulence genes and single nucleotide polymorphisms (SNP relative to reference strains.The twelve children studied demonstrated severity of illness scores ranging from 0 (mild to 9 (severe. All isolates were USA300, ST 8, SCC mec IVa MRSA by MLST. The isolates differed from reference strains by 2 insertions (40 Kb each and 2 deletions (10 and 25 Kb but had no rearrangements or copy number variations. There was a higher occurrence of virulence genes among study isolates when compared to the reference strains (p = 0.0124. There were an average of 11 nonsynonymous SNPs per strain. PAML demonstrated heterogeneity of study isolates from each other and from the reference strains.Genomic heterogeneity exists among MRSA isolates causing osteomyelitis among children in a single community. These variations may play a role in the pathogenesis of variation in clinical severity among these children.

Influence of Near-Segment Positioning in a Rotationally Asymmetric Multifocal Intraocular Lens.

Science.gov (United States)

Song, In Seok; Yoon, Sam Young; Kim, Jae Yong; Kim, Myoung Joon; Tchah, Hungwon

2016-04-01

To compare visual performance and higher order aberrations (HOAs) based on the position of the near segment in eyes with rotationally asymmetric multifocal intraocular lenses (IOLs). Asymmetric multifocal IOLs (Lentis Mplus LS-313; Oculentis Optikgeräte GmbH, Wetzlar, Germany) were implanted with the near segment positioned either inferiorly, superiorly, or temporally. Uncorrected distance (UDVA), intermediate (UIVA), and near (UNVA) visual acuity, corrected distance visual acuity (CDVA), and distance-corrected intermediate (DCIVA) and near (DCNVA) visual acuity, contrast sensitivity, HOAs, and subjective symptom questionnaires were compared at 1 month postoperatively. Forty-five eyes from 45 patients were evaluated (n = 25, 9, and 11 eyes in the inferior, superior, and temporal groups, respectively). No significant differences in UDVA, UIVA, UNVA, CDVA, DCIVA, or DCNVA were found between the three groups (P > .05). The temporal group showed the best results in UDVA, CDVA, and DCNVA, but the inferior group showed the best results in DCIVA and UNVA and the superior group showed the best results in UIVA. Contrast sensitivity and the subjective symptom questionnaire also did not demonstrate any significant differences (P > .05). Total HOA and spherical aberration did not demonstrate any statistically significant differences (P > .05), but vertical coma and horizontal coma demonstrated significant differences based on near segment position (P < .001). The position of the near segment in eyes with rotationally asymmetric multifocal IOLs demonstrates no significant effect on visual performance. Copyright 2016, SLACK Incorporated.

Cervical osteomyelitis after carbon dioxide laser excision of recurrent carcinoma of the posterior pharyngeal wall

NARCIS (Netherlands)

Timmermans, A. Jacqueline; Brandsma, Dieta; Smeele, Ludi E.; Rosingh, Andert W.; van den Brekel, Michiel W. M.; Lohuis, Peter J. F. M.

2013-01-01

Two patients with recurrent carcinoma of the posterior pharyngeal wall, previously treated with carbon dioxide (CO2) laser excision and (chemo)radiotherapy, presented with neck pain due to cervical osteomyelitis. In one patient this led to cervical spine instability, for which a haloframe was

Delivery of gentamicin from resorbable polymeric carriers as anti-infective strategy for implant-associated osteomyelitis

NARCIS (Netherlands)

ter Boo, G.A.

2016-01-01

This thesis describes the development of gentamicin loaded resorbable polymeric carriers as anti-infective strategy for implant-associated osteomyelitis and their in vitro and in vivo evaluation. Local delivery of antibiotics has several advantages in the case of trauma to the bone and surrounding

The Effects of Hashimoto Thyroiditis on Lymph Node Metastases in Unifocal and Multifocal Papillary Thyroid Carcinoma

Science.gov (United States)

Zhu, Feng; Shen, Yi Bin; Li, Fu Qiang; Fang, Yun; Hu, Liang; Wu, Yi Jun

2016-01-01

Abstract The purpose of this study was to investigate the risk factors for central and lateral neck lymph node metastases in papillary thyroid carcinoma (PTC) and multifocal papillary thyroid carcinoma (MPTC), particularly when associated with Hashimoto thyroiditis (HT). A retrospective analysis of 763 consecutive patients who underwent total thyroidectomy with bilateral central neck dissection in the First Affiliated Hospital, College of Medicine, Zhejiang University between October 2011 and October 2014 was conducted. All patients had formal histological diagnoses of HT. Multivariable logistic regression analysis was performed to identify risk factors of neck lymph node metastases. Our study identified 277 PTC patients with HT and showed comparatively low rates of central lymph node metastases (CLNM) compared with the PTC patients without HT (37.2% versus 54.7%, P thyroid peroxidase antibody >140 IU/mL was established as the most sensitive and specific level for the prediction of MPTC based on receiver operating characteristic curve analyses. Thyroid peroxidase antibody, age, tumor size, and multifocality exhibited the ability to predict CLNM in PTC with HT patients with an area under the curve of 81.1% based on a multivariate model. Hashimoto thyroiditis was associated with increased prevalences of multifocality and capsular invasion. In contrast, HT was associated with a reduced risk of CLNM in PTC and MPTC patients, which indicated a potential protective effect. We found that the prognostic prediction model was applicable for predicting multifocality and CLNM in PTC patients with HT. PMID:26871795

Diagnostic performance of diffusion-weighted MR imaging in differentiation of diabetic osteoarthropathy and osteomyelitis in diabetic foot

International Nuclear Information System (INIS)

Abdel Razek, Ahmed Abdel Khalek; Samir, Sieza

2017-01-01

Highlights: • Excellent inter-observer agreement of ADC of bony lesions in diabetic foot. • ADC can differentiate diabetic osteoarthropathy from osteomylitis. • Diffusion MR imaging can added to routine MR imaging of diabetic foot. - Abstract: Purpose: To study the diagnostic performance of diffusion weighted MR imaging in differentiation of diabetic osteoarthropathy and osteomyelitis in diabetic foot. Patients and methods: This prospective study was carried out on 41 patients with diabetic foot, 22 males and 19 females with mean age of 51 years. They underwent diffusion-weighted MR imaging of the foot. The apparent diffusion coefficient (ADC) values of the bony lesions were calculated by two reviewers and correlated with the surgical findings or biopsy. The kappa statistic (k) was used to estimate the proportion of inter-observer agreement of two reviewers. Results: The mean ADC of acute diabetic osteoarthropathy was 1.27 ± 0.19 × 10 −3 mm 2 /s for reviewer 1 and 1.26 ± 0.21 × 10 −3 mm 2 /s for reviewer 2. The mean ADC value in diabetic osteomyelitis was 0.86 ± 0.11 × 10 −3 mm 2 /s for reviewer 1 and 0.85 ± 0.12 × 10 −3 mm 2 /s for reviewer 2. There was excellent inter-observer agreement of ADC value of bony lesions in diabetic foot by both reviewers (K = 0.93). There was statistically significant difference in the ADC values of both groups (P = 0.001). The cut-off point of ADC value of both reviewers used in differentiating acute diabetic osteoarthropathy and osteomyelitis were 0.98 × 10 −3 mm 2 /s and 1.04 × 10 −3 mm 2 /s with an accuracy of 94% and 93% and area under the curve of 0.94 and 0.93 respectively. Conclusion: We conclude that the ADC value is a non-invasive imaging parameter that can help in differentiation of diabetic osteoarthropathy from osteomyelitis with excellent inter-observer agreement.

Staphylococcus aureus sternal osteomyelitis: a rare cause of chest pain

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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.

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

Energy Technology Data Exchange (ETDEWEB)

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)

Bilateral implantation of +3.0 D multifocal toric intraocular lenses: results of a US Food and Drug Administration clinical trial.

Science.gov (United States)

Lehmann, Robert; Modi, Satish; Fisher, Bret; Michna, Magda; Snyder, Michael

2017-01-01

The purpose of this study was to evaluate the clinical outcomes of apodized diffractive +3.0 D multifocal toric intraocular lens (IOL) implantations in subjects with preoperative corneal astigmatism. This was a prospective cohort study conducted at 21 US sites. The study population consisted of 574 subjects, aged ≥21 years, with preoperative astigmatism 0.75-2.82 D, and potential postoperative visual acuity (VA) ≥0.2 logMAR, undergoing bilateral cataract removal by phacoemulsification. The intervention was bilateral implantation of aspheric apodized diffractive +3.0 D multifocal toric or spherical multifocal nontoric IOLs. The main outcome measures were monocular uncorrected near and distance VA and safety at 12 months. A total of 373/386 and 182/188 subjects implanted with multifocal toric and nontoric IOLs, respectively, completed 12-month follow-up after the second implantation. Toric IOLs were nonin-ferior in monocular uncorrected distance (4 m) and near (40 cm) VA but had >1 line better binocular uncorrected intermediate VA (50, 60, and 70 cm) than nontoric IOLs. Toric IOLs reduced cylinder to within 0.50 D and 1.0 D of target in 278 (74.5%) and 351 (94.1%) subjects, respectively. Mean ± standard deviation (SD) differences between intended and achieved axis orientation in the first and second implanted eyes were 5.0°±6.1° and 4.7°±4.0°, respectively. Mean ± SD 12-month IOL rotations in the first and second implanted eyes were 2.7°±5.8° and 2.2°±2.7°, respectively. No subject receiving toric IOLs required secondary surgical intervention due to optical lens properties. Multifocal toric IOLs were noninferior to multifocal nontoric IOLs in uncorrected distance and near VAs in subjects with preexisting corneal astigmatism and effectively corrected astigmatism of 0.75-2.82 D.

High Load Ratio Fatigue Strength and Mean Stress Evolution of Quenched and Tempered 42CrMo4 Steel

Science.gov (United States)

Bertini, Leonardo; Le Bone, Luca; Santus, Ciro; Chiesi, Francesco; Tognarelli, Leonardo

2017-08-01

The fatigue strength at a high number of cycles with initial elastic-plastic behavior was experimentally investigated on quenched and tempered 42CrMo4 steel. Fatigue tests on unnotched specimens were performed both under load and strain controls, by imposing various levels of amplitude and with several high load ratios. Different ratcheting and relaxation trends, with significant effects on fatigue, are observed and discussed, and then reported in the Haigh diagram, highlighting a clear correlation with the Smith-Watson-Topper model. High load ratio tests were also conducted on notched specimens with C (blunt) and V (sharp) geometries. A Chaboche model with three parameter couples was proposed by fitting plain specimen cyclic and relaxation tests, and then finite element analyses were performed to simulate the notched specimen test results. A significant stress relaxation at the notch root became clearly evident by reporting the numerical results in the Haigh diagram, thus explaining the low mean stress sensitivity of the notched specimens.

Outcomes of osteomyelitis in patients with diabetes: conservative vs. combined surgical management in a community hospital in Puerto Rico.

Science.gov (United States)

Maldonado-Rodríguez, Miguel; Cajigas-Feliciano, Yanniris; Torres-Torres, Nancy

2011-06-01

Diabetes predisposes patients to multiple complications, such as osteomyelitis, which, if not managed adequately, may result in amputation, sepsis, or death. This study aimed to compare the rates of amputation associated with two different treatment plans for osteomyelitis being utilized with a group of Puerto Ricans with diabetes. We reviewed the medical records of adult patients with diabetes and osteomyelitis who had been admitted to a community hospital within a two-year timeframe; a total of 169 records were reviewed. Data were analyzed using descriptive statistics, chi-square, odds ratios, and multivariate logistic regression to compare the amputation rate of patients receiving conservative management (antibiotics and/or local care alone) with that of patients receiving combined surgical treatment (any modality consisting of an initial surgical treatment plus antibiotics and/or local care). We found a general amputation rate of 34.5%. Amputation was less likely in patients undergoing combined surgical treatment (OR: 0.22; 95% IC: 0.08-0.59) than it was in those patients whose disease management was conservative. In addition, men (OR: 2.09; 95% CI: 1.04-4.23) and non-geriatric patients (OR: 3.38; 95% CI: 1.65-6.94) had higher probabilities of amputation than did women and geriatric patients, respectively. This study revealed an amputation rate among patients with diabetes that is higher than that reported in the United States (34.5% vs. 11.0% to 20.0%). We also found that the probability of amputation secondary to osteomyelitis among patients with diabetes is two times higher for men and three times higher for non-geriatric patients; combined surgical treatment was associated with a significant reduction (78%) of the probability of amputation.

The effect of high- to low-altitude adaptation on the multifocal electroretinogram

DEFF Research Database (Denmark)

Kofoed, Peter Kristian; Sander, Birgit; Zubieta-Calleja, Gustavo

2009-01-01

PURPOSE: To examine variations in retinal electrophysiology assessed by multifocal electroretinogram (mfERG) during acclimatization of native highlanders to normobaric normoxia at sea level. METHODS: Eight healthy residents of the greater La Paz area in Bolivia (3600 m above sea level) were...

Multifocal oral melanoacanthoma associated with Addison's disease and hyperthyroidism: a case report.

Science.gov (United States)

Dantas, Thinali Sousa; Nascimento, Isabelly Vidal do; Verde, Maria Elisa Quezado Lima; Alves, Ana Paula Negreiros Nunes; Sousa, Fabrício Bitu; Mota, Mário Rogério Lima

2017-01-01

Oral melanoacanthoma is a mucocutaneous, pigmented, rare, benign, and probably reactive lesion. This paper reports for the first time in the literature a case of multifocal oral melanoacanthoma in a patient diagnosed with Addison's disease and concomitant Graves' disease with hyperthyroidism. The patient presented with oral pigmented lesions, which were hypothesized to be mucosal pigmentation associated with Addison's disease. Due to their unusual clinical pattern, these oral lesions were biopsied and diagnosed as oral melanoacanthoma on histopathology and immunohistochemistry for HMB-45. At the moment of this report, the patient was being treated for her systemic conditions, but the lesions had not regressed. Reactive hyperpigmentation of the skin and mucous membranes may be found in Addison's disease and hyperthyroidism. This case reinforces the hypothesis of a reactive nature for oral melanoacanthoma and highlights the need for investigation of endocrine disorders in patients with multifocal oral melanoacanthoma.

Retrospective study on the epidemiology of the septic arthritis and acute osteomyelitis by Staphylococcus aureus in patients hospitalized at the Hospital Nacional de Ninos Dr. Carlos Saenz Herrera January 2007- September 2013

International Nuclear Information System (INIS)

Sanabria Leiva, Mariana

2014-01-01

The general epidemiology and microbiology of acute osteomyelitis and septic arthritis by Staphylococcus aureus (S. aureus) are described in children hospitalized at the Hospital de Ninos between January 2007 and September 2013. 88 patients are included in the study, of which 64% have corresponded to acute osteomyelitis, septic arthritis 21% and 15% both diagnoses. Age groups, joints and bones most affected are identified. Antibiotic sensitivity changes of the S. aureus are determined in the last 5 years. The use of imaging studies and diagnostic tests are specified in patients with acute osteomyelitis and septic arthritis. Complications, mortality and sequelae most common are established in patients. The surgical procedures are described. The clindamycin and TMP-SMX are recommended as drugs of first choice for the treatment of acute osteomyelitis and septic arthritis [es

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 affecte...

Delayed Tibial Osteomyelitis after Anterior Cruciate Ligament Reconstruction with Hamstrings Autograft and Bioabsorbable Interference Screw: A Case Report and Review of the Literature

Directory of Open Access Journals (Sweden)

Kevin S. Weiss

2017-01-01

Full Text Available Osteomyelitis following arthroscopically assisted anterior cruciate ligament (ACL reconstruction has rarely been reported in the literature. We report a case of a 20-year-old female who had delayed tibial osteomyelitis and a pretibial cyst with culture-positive, oxacillin sensitive Staphylococcus epidermidis 15 months after an ACL reconstruction with hamstring autograft. Soft tissue fixation within the tibial tunnel was with a poly-L-D-lactic acid (PLDLA bioabsorbable interference screw. The patient underwent surgical treatment with curettage, debridement, hardware removal, and bone grafting of the tibial tunnel followed by a course of intravenous antibiotics. Arthroscopic evaluation demonstrated an intact ACL graft without any evidence of intra-articular infection. The patient returned to collegiate athletics without any complications. While the most common biologic complications include pretibial cysts, granuloma formation, tunnel widening, and inflammatory reactions, infection is exceedingly rare. Late infection and osteomyelitis are also rare but can occur and should be considered in the differential diagnosis.

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.

The role of diagnostic imaging in the evaluation of suspected osteomyelitis in the foot: a critical review.

Science.gov (United States)

Harmer, James L; Pickard, James; Stinchcombe, Simon J

2011-09-01

The early diagnosis of osteomyelitis in the foot from its clinical presentation alone can be difficult particularly in cases when the early signs are subtle. Early diagnosis and subsequent early intervention are imperative to reduce the risk of chronic infection, associated early lytic changes to bone and potential long term structural complications caused by subsequent deformity and lost anatomy. Diagnostic imaging has a major role to play in the early assessment and diagnosis of bone infection, yet the choice of approach can be controversial. Several imaging modalities have been advocated, imaging of the infected foot is complex and no single test is ideal for every situation. The clinician needs to be aware of the strengths and weaknesses of each imaging modality so that the most appropriate test is selected for the individual case. Factors such as site of infection in the foot, the aggressive nature of the organism, the time since onset, previous associated surgery and co-morbidity may all play apart in the clinician's decision making process to determine the best approach in detecting the sometimes subtle changes which may be seen in some cases of osteomyelitis. This review considers the literature and highlights the advantages and disadvantages of the main imaging techniques used for the evaluation of the foot when osteomyelitis is suspected. An evidence based algorithm for the selection of appropriate imaging techniques is suggested to aid clinicians in there decision making process. Copyright © 2011 Elsevier Ltd. All rights reserved.

Autorefraction versus subjective refraction in a radially asymmetric multifocal intraocular lens.

Science.gov (United States)

van der Linden, Jan Willem; Vrijman, Violette; Al-Saady, Rana; El-Saady, Rana; van der Meulen, Ivanka J; Mourits, Maarten P; Lapid-Gortzak, Ruth

2014-12-01

To evaluate whether the automated refraction (AR) correlates with subjective manifest (MR) refraction in eyes implanted with radially asymmetric multifocal intraocular lens (IOLs). This retrospective study evaluated 52 eyes (52 patients) implanted with a radially asymmetric multifocal IOL (LS-312 MF30, Oculentis, Germany). At 3 months postoperatively, the AR and MR values were compared to determine the correlation between the sphere (S), the spherical equivalent (SE) and the astigmatic components J0 and J45. The difference of mean spherical measurement was +0.98D ± 0.62, with the AR measuring more myopic. The difference of the mean spherical equivalent was +1.11D ± 0.57, again with AR being more myopic. Both these differences were statistically significant (p < 0.001). The astigmatic components showed less differences, with the mean difference of the J0 being -0.09D ± 0.43, and the J45 of +0.04D ± 0.47, which were both not statistically significant (p = 0.123 and p = 0.531, respectively). Correlation analysis of the refractive parameters showed r(2) = 0.067, r(2) = 0.078, r(2) = 0.018 and r(2) = 0.015, respectively, all of which point to a low correlation between the AR and the MR. Autorefraction shows poor correlation to manifest subjective refraction with these radially asymmetric multifocal IOLs. The autorefraction systematically underestimates the spherical and spherical equivalent power, while the correlation between the astigmatic components was also low. Autorefraction seems not a valid starting point for manifest subjective refraction with these types of lenses, unless a corrective factor of about +1 dioptre is used. © 2014 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

Radioembolization After Portal Vein Embolization in a Patient with Multifocal Hepatocellular Carcinoma

International Nuclear Information System (INIS)

Burgmans, Mark C.; Irani, Farah G.; Chan, Wan Ying; Teo, Terence K.; Kao, Yung Hsiang; Goh, Anthony S.W.; Chow, Pierce K.; Lo, Richard H.

2012-01-01

Radioembolization is an effective locoregional therapy for patients with intermediate or advanced stage hepatocellular carcinoma (HCC). It has been shown that radioembolization is safe in patients with portal vein thrombosis. This case report describes safe radioembolization after portal vein embolization in a patient with multifocal HCC.

Modelling of the deformation of shot peened cylindrical specimens of 42 CrMo4 in uniaxial tension and deformation and of the resulting macro residual stresses; Modellierung der einachsigen Zug- und Druck-Verformung kugelgestrahlter Zylinderproben aus verguetetem 42 CrMo4 und der dabei auftretenden Makroeigenspannungsaenderungen

Energy Technology Data Exchange (ETDEWEB)

Schulze, V.; Voehringer, O.; Macherauch, E. [Karlsruhe Univ. (T.H.) (Germany). Inst. fuer Werkstoffkunde 1

1998-10-01

Tensile and compressive stress-strain-curves of shot peened and unpeened specimens of quenched and tempered 42 CrMo 4 (AISI 4140) with a diameter of 5 mm only differ in the yield strengths and in the Lueders-deformation. In comparison to the core the regions close to the surface of shot peened cylindrical specimens bear relatively large axial and tangential residual stresses and show different deformation properties. A multi-layer-model was developed to describe both the tensile as well as the compressive deformation behaviour of shot peened cylindrical specimens quantitatively. The calculated transitions from the elastic to the elastic-plastic deformation state during tensile and compressive loading agree quite well with the experimental observations. Also the changes of axial and tangential macro residual stresses after distinct tensile or compressive deformations are in best agreement with the measurements. (orig.) 29 refs.

Multifocal amelanotic conjunctival melanoma and acquired melanosis sine pigmento.

Science.gov (United States)

Paridaens, A D; McCartney, A C; Hungerford, J L

1992-03-01

Clinical and histopathological features of four cases of multifocal amelanotic malignant melanoma of the conjunctiva in association with 'acquired melanosis sine pigmento' are reported. The absence of conjunctival pigmentation in this extremely rare combination of lesions prevented early diagnosis and clinical monitoring. As a result orbital exenteration was required in three cases. This multicentric non-pigmented variety of conjunctival malignant melanoma tends to present later than pigmented forms and may require exenteration of the orbit as a primary procedure.

Testing the efficacy of antimicrobial peptides in the topical treatment of induced osteomyelitis in rats

Czech Academy of Sciences Publication Activity Database

Melicherčík, P.; Čeřovský, Václav; Nešuta, Ondřej; Jahoda, D.; Landor, I.; Ballay, R.; Fulín, P.

2018-01-01

Roč. 63, č. 1 (2018), s. 97-104 ISSN 0015-5632 R&D Projects: GA MZd(CZ) NV16-27726A; GA TA ČR(CZ) TA04010638 Institutional support: RVO:61388963 Keywords : osteomyelitis * antimicrobial peptides * Wistar rats Subject RIV: EE - Microbiology, Virology OBOR OECD: Microbiology Impact factor: 1.521, year: 2016

Hot Tensile and Fracture Behavior of 35CrMo Steel at Elevated Temperature and Strain Rate

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Zhengbing Xiao

2016-08-01

Full Text Available To better understand the tensile deformation and fracture behavior of 35CrMo steel during hot processing, uniaxial tensile tests at elevated temperatures and strain rates were performed. Effects of deformation condition on the flow behavior, strain rate sensitivity, microstructure transformation, and fracture characteristic were characterized and discussed. The results indicated that the flow stress was sensitive to the deformation condition, and fracture occurs immediately after the peak stress level is reached, especially when the temperature is low or the strain rate is high. The strain rate sensitivity increases with the deformation temperature, which indicates that formability could improve at high temperatures. Photographs showing both the fracture surfaces and the matrix near the fracture section indicated the ductile nature of the material. However, the fracture mechanisms varied according to the deformation condition, which influences the dynamic recrystallization (DRX condition, and the DRX was accompanied by the formation of voids. For samples deformed at high temperatures or low strain rates, coalescence of numerous voids formed in the recrystallized grains is responsible for fracture, while at high strain rates or low temperatures, the grains rupture mainly by splitting because of cracks formed around the inclusions.

Effectiveness of muscle coverage to manage osteomyelitis of very late onset in the irradiated chest wall

International Nuclear Information System (INIS)

Funayama, Emi; Minakawa, Hidehiko; Otani, Hidekazu; Saito, Noriko; Oyama, Akihiko; Furukawa, Hiroshi; Hayashi, Toshihiko; Saito, Akira; Yamamoto, Yuhei

2012-01-01

Radiation therapy for breast cancer has improved survival rates; however, a consequence of this is treatment-induced complications in longer-living patients. Decades after chest wall irradiation, very late onset radiation-induced osteomyelitis can develop, caused by osteoradionecrosis. This may lead to the development of small, but very refractory, skin ulcers. Many reports recommend well-vascularized tissue coverage after appropriate debridement for irradiation ulcers; however, when the ulcers are of very late onset, this sometimes causes recurrence of ulceration in non-muscle-covered areas after flap transfer. Thus, for very late onset cases, we propose treatment with an absolute muscle flap to cover both the obviously infected focus and the surrounding irradiated area. A muscle flap consisting of the entire latissimus dorsi, the shape of which is very large in the horizontal direction, satisfies this requirement. Latissimus dorsi muscle coverage for the treatment of very late onset osteomyelitis should be reappraised. (author)

Correction to: Progressive multifocal leukoencephalopathy in rituximab-treated rheumatic diseases: a rare event.

Science.gov (United States)

Berger, Joseph R; Malik, Vineeta; Lacey, Stuart; Brunetta, Paul; Lehane, Patricia B

2018-04-10

The article "Progressive multifocal leukoencephalopathy in rituximab-treated rheumatic diseases: a rare event," written by Joseph R. Berger, Vineeta Malik, Stuart Lacey, Paul Brunetta, and Patricia B. Lehane 3 , was originally published electronically on the publisher's internet portal (currently SpringerLink).

Multifocal choroiditis as the first sign of systemic sarcoidosis associated with pembrolizumab

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Qu-Knafo Lise

2017-04-01

Conclusions and importance: Pembrolizumab is an immune checkpoint inhibitor therapy used in the treatment of metastatic melanoma. We report a pembrolizumab-associated sarcoidosis revealed by a panuveitis with multifocal choroiditis. Physicians should be aware of the potential inflammatory and autoimmune disease that may be induced by immunomodulatory therapies.

Optical design of soft multifocal contact lens with uniform optical power in center-distance zone with optimized NURBS.

Science.gov (United States)

Vu, Lien T; Chen, Chao-Chang A; Yu, Chia-Wei

2018-02-05

This study aims to develop a new optical design method of soft multifocal contact lens (CLs) to obtain uniform optical power in large center-distance zone with optimized Non-Uniform Rational B-spline (NURBS). For the anterior surface profiles of CLs, the NURBS design curves are optimized to match given optical power distributions. Then, the NURBS in the center-distance zones are fitted in the corresponding spherical/aspheric curves for both data points and their centers of curvature to achieve the uniform power. Four cases of soft CLs have been manufactured by casting in shell molds by injection molding and then measured to verify the design specifications. Results of power profiles of these CLs are concord with the given clinical requirements of uniform powers in larger center-distance zone. The developed optical design method has been verified for multifocal CLs design and can be further applied for production of soft multifocal CLs.

Osteomyelitis of the base of the skull

International Nuclear Information System (INIS)

Chandler, J.R.; Grobman, L.; Quencer, R.; Serafini, A.

1986-01-01

Infection in the marrow of the temporal, occipital, and sphenoid bones is an uncommon, but increasing occurrence. It is usually secondary to infections beginning in the external auditory canal and is caused almost uniformly by the gram negative Pseudomonas aeruginosa bacteria. Technetium and gallium scintigraphy help in the early detection of such infections while CT scans demonstrate dissolution of bone in well-developed cases. Headache is the predominant symptom. Dysphagia, hoarseness, and aspiration herald the inevitable march of cranial nerves. We have diagnosed and treated 17 cases of osteomyelitis of the skull base. Although the total mortality rate is 53%, it is now a curable disease. Six of our last 8 patients remain alive, although 1 is still under treatment. Treatment is medical and requires the long-term concomitant intravenous administration of an aminoglycoside and a broad spectrum semisynthetic penicillin effective against the causative organism

Severe maxillary osteomyelitis in a Gray Wolf (Canis lupus)

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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.

Panton-valentine leukocidin enhances the severity of community-associated methicillin-resistant Staphylococcus aureus rabbit osteomyelitis.

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Anne-Claude Crémieux

Full Text Available BACKGROUND: Extensive spread of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA in the United States, and the concomitant increase in severe invasive staphylococcal infections, including osteomyelitis, in healthy children, has led to renewed interest in Panton-Valentine leukocidin (PVL. However, the pathogenetic role of PVL in staphylococcal infections remains controversial, possibly because it depends on the site of infection. METHODOLOGY/PRINCIPAL FINDINGS: We compared the course of experimental rabbit osteomyelitis due to the PVL-positive CA-MRSA strain USA 300 (LAC and its PVL-negative isogenic derivative (LACDeltapvl, using a low and a high inoculum (8x10(5 and 4x10(8 CFU. With the low inoculum, bone infection was less frequent on day 7 (D7 and day 28 (D28 with LACDeltapvl than with LAC (respectively 12/19 and 18/19 animals, p = 0.042. With the high inoculum of both strains, all the animals were infected on D7 and the infection persisted on D28 in almost every case. However, tibial bacterial counts and the serum CRP concentration fell significantly between D7 and D28 with LACDeltapvl but not with LAC. Respectively 67% and 60% of LAC-infected rabbits had bone deformation and muscle/joint involvement on D7, compared to 0% and 7% of LACDeltapvl-infected rabbits (p = 0.001 and p = 0.005 respectively. Between D0 and D28, the anti-PVL antibody titer increased significantly only with the high inoculum of LAC. CONCLUSIONS/SIGNIFICANCE: PVL appears to play a role in the persistence and rapid local extension of rabbit osteomyelitis, in keeping with the greater severity of human bone infections due to PVL-positive S. aureus. The possible therapeutic implications of these findings are discussed.

Diagnostic performance of diffusion-weighted MR imaging in differentiation of diabetic osteoarthropathy and osteomyelitis in diabetic foot

Energy Technology Data Exchange (ETDEWEB)

Abdel Razek, Ahmed Abdel Khalek, E-mail: arazek@mans.edu.eg; Samir, Sieza, E-mail: Sieza_s@mans.edu.eg

2017-04-15

Highlights: • Excellent inter-observer agreement of ADC of bony lesions in diabetic foot. • ADC can differentiate diabetic osteoarthropathy from osteomylitis. • Diffusion MR imaging can added to routine MR imaging of diabetic foot. - Abstract: Purpose: To study the diagnostic performance of diffusion weighted MR imaging in differentiation of diabetic osteoarthropathy and osteomyelitis in diabetic foot. Patients and methods: This prospective study was carried out on 41 patients with diabetic foot, 22 males and 19 females with mean age of 51 years. They underwent diffusion-weighted MR imaging of the foot. The apparent diffusion coefficient (ADC) values of the bony lesions were calculated by two reviewers and correlated with the surgical findings or biopsy. The kappa statistic (k) was used to estimate the proportion of inter-observer agreement of two reviewers. Results: The mean ADC of acute diabetic osteoarthropathy was 1.27 ± 0.19 × 10{sup −3} mm{sup 2}/s for reviewer 1 and 1.26 ± 0.21 × 10{sup −3} mm{sup 2}/s for reviewer 2. The mean ADC value in diabetic osteomyelitis was 0.86 ± 0.11 × 10{sup −3} mm{sup 2}/s for reviewer 1 and 0.85 ± 0.12 × 10{sup −3} mm{sup 2}/s for reviewer 2. There was excellent inter-observer agreement of ADC value of bony lesions in diabetic foot by both reviewers (K = 0.93). There was statistically significant difference in the ADC values of both groups (P = 0.001). The cut-off point of ADC value of both reviewers used in differentiating acute diabetic osteoarthropathy and osteomyelitis were 0.98 × 10{sup −3} mm{sup 2}/s and 1.04 × 10{sup −3} mm{sup 2}/s with an accuracy of 94% and 93% and area under the curve of 0.94 and 0.93 respectively. Conclusion: We conclude that the ADC value is a non-invasive imaging parameter that can help in differentiation of diabetic osteoarthropathy from osteomyelitis with excellent inter-observer agreement.

Lumbosacral osteomyelitis after robot-assisted total laparoscopic hysterectomy and sacral colpopexy.

Science.gov (United States)

Muffly, Tyler M; Diwadkar, Gouri B; Paraiso, Marie Fidela R

2010-12-01

We report on the transabdominal resection of infected lumbosacral bone, synthetic mesh, and sinus tract following sacral colpopexy. A 45-year-old nulliparous patient who had undergone transvaginal mesh followed by robot-assisted sacral colpopexy presented with increasing back pain and foul-smelling vaginal drainage. An epidural abscess required surgical intervention, including diskectomy, sacral debridement, and mesh removal to drain the abscess and vaginal sinus tract. Recognized complications of open prolapse procedures also manifest following minimally invasive approaches. Osteomyelitis of the sacral promontory following sacral colpopexy may require gynecologic and neurosurgical management.

A possible case of Garre's sclerosing osteomyelitis from Medieval Tuscany (11th-12th centuries).

Science.gov (United States)

Giuffra, Valentina; Vitiello, Angelica; Giusiani, Sara; Caramella, Davide; Fornaciari, Gino

2015-12-01

Archaeological excavations carried out at the castle of Monte di Croce near Florence brought to light a small cemetery complex belonging to the castle church, dated back to the 11th-12th centuries. An elite stone tomb contained the skeletal remains of a male aged 35-45 years with obvious pathology of the right tibia. The proximal metaphysis and the upper half of the diaphysis appear massively enlarged as a result of severe chronic periostitis. A transverse section illustrates complete obliteration of the medullary cavity by new spongy bone, with some large cavitations. The primary, but completely remodeled tibial shaft is still recognizable. This finding and the strong sclerotic reaction with some central cavitations rule out any form of bone tumor and indicate a chronic inflammatory disease. The morphological and radiological picture and the tibial localization suggest a diagnosis of chronic sclerosing osteomyelitis of Garré, a rare form of chronic osteomyelitis characterized by an intense periosteal reaction with little or no suppuration. Copyright © 2015. Published by Elsevier Inc.

A link between osteomyelitis and IL1RN and IL1B polymorphisms-a study in patients from Northeast Brazil.

Science.gov (United States)

Alves De Souza, Clinio; Queiroz Alves De Souza, Argos; Queiroz Alves De Souza, Maria do Socorro; Dias Leite, José Alberto; Silva De Morais, Maíra; Barem Rabenhorst, Sílvia Helena

2017-10-01

Background and purpose - Treatment failure of osteomyelitis can result from genetic susceptibility, highlighting polymorphisms of the interleukin-1 (IL-1) family members, central mediators of innate immunity and inflammation. Polymorphisms are DNA sequence variations that are common in the population (1% or more) and represent multiple forms of a single gene. We investigated the association of IL1RNVNTR (rs2234663) and IL1B-511C > T (rs16944) polymorphisms with osteomyelitis development in patients operated on because of bone trauma. Patients and methods - 153 patients who fulfilled the inclusion criteria were enrolled from a referral public hospital for trauma. All the patients were followed up daily until hospital discharge and, after this, on an outpatient basis. Patients were treated with prophylactic antimicrobials and surgery according to traumatology service protocol. The IL1RNVNTR and the IL1B-511C > T polymorphisms were determined by PCR and PCR-RFLP, respectively. Results - The IL1RN*2/*2 genotype was associated (OR: 7; p  T and IL1RNVNTR polymorphisms were associated with osteomyelitis development, which may have implications for patients with bone traumas. These data may be relevant for new therapeutic strategies for this disease.

A link between osteomyelitis and IL1RN and IL1B polymorphisms—a study in patients from Northeast Brazil

Science.gov (United States)

Alves De Souza, Clinio; Queiroz Alves De Souza, Argos; Queiroz Alves De Souza, Maria do Socorro; Dias Leite, José Alberto; Silva De Morais, Maíra; Barem Rabenhorst, Sílvia Helena

2017-01-01

Background and purpose Treatment failure of osteomyelitis can result from genetic susceptibility, highlighting polymorphisms of the interleukin-1 (IL-1) family members, central mediators of innate immunity and inflammation. Polymorphisms are DNA sequence variations that are common in the population (1% or more) and represent multiple forms of a single gene. We investigated the association of IL1RNVNTR (rs2234663) and IL1B-511C > T (rs16944) polymorphisms with osteomyelitis development in patients operated on because of bone trauma. Patients and methods 153 patients who fulfilled the inclusion criteria were enrolled from a referral public hospital for trauma. All the patients were followed up daily until hospital discharge and, after this, on an outpatient basis. Patients were treated with prophylactic antimicrobials and surgery according to traumatology service protocol. The IL1RNVNTR and the IL1B-511C > T polymorphisms were determined by PCR and PCR-RFLP, respectively. Results The IL1RN*2/*2 genotype was associated (OR: 7; p  T and IL1RNVNTR polymorphisms were associated with osteomyelitis development, which may have implications for patients with bone traumas. These data may be relevant for new therapeutic strategies for this disease. PMID:28682145

Power Profiles of Commercial Multifocal Soft Contact Lenses.

Science.gov (United States)

Kim, Eon; Bakaraju, Ravi C; Ehrmann, Klaus

2017-02-01

To evaluate the optical power profiles of commercially available soft multifocal contact lenses and compare their optical designs. The power profiles of 38 types of multifocal contact lenses-three lenses each-were measured in powers +6D, +3D, +1D, -1D, -3D, and -6D using NIMO TR1504 (Lambda-X, Belgium). All lenses were measured in phosphate buffered saline across 8 mm optic zone diameter. Refractive index of each lens material was measured using CLR 12-70 (Index Instruments, UK), which was used for converting measured power in the medium to in-air radial power profiles. Three basic types of power profiles were identified: center-near, center-distance, and concentric-zone ring-type designs. For most of the lens types, the relative plus with respect to prescription power was lower than the corresponding spectacle add. For some lens types, the measured power profiles were shifted by up to 1D across the power range relative to their labeled power. Most of the lenses were designed with noticeable amounts of spherical aberration. The sign and magnitude of spherical aberration can either be power dependent or consistent across the power range. Power profiles can vary widely between the different lens types; however, certain similarities were also observed between some of the center-near designs. For the more recently released lens types, there seems to be a trend emerging to reduce the relative plus with respect to prescription power, include negative spherical aberration, and keep the power profiles consistent across the power range.

Radionuclide methods in the diagnostics of osteomyelitis in the diabetic foot syndrome

International Nuclear Information System (INIS)

Lang, O.; Cincarova, E.; Treslova, L.; Andel, M.; Knotkova, V.; Chroustova, D.; Mala, M.

1997-01-01

31 diabetic patients with diabetic foot syndrome Wagner II-III were examined. At all patients the laboratory symptoms of the inflammation with the X-ray radiography, three phase scintigraphy of the skeleton with 99m Tc MDP or 99m Tc HDP and 99m Tc-Granulocyte were examined. The diagnosis of osteomyelitis in the diabetic foot syndrome with following long-time antibiotic therapy can be reliable determined in positive results of both radionuclide methods, first of all scintigraphy with labelled leucocytes

Disseminated osteomyelitis or bone metastases of breast cancer. 18F-FDG-PET/CT helps unravel an unusual presentation

International Nuclear Information System (INIS)

Mandegaran, Ramin; Wagner, Thomas; Debard, Alexa; Alvarez, Muriel; Marchou, Bruno; Massip, Patrice

2014-01-01

We present a case wherein striking 18 F-FDG-PET/CT findings initially considered consistent with recurrent disseminated skeletal metastases of breast cancer were later identified as an unusual presentation of disseminated chronic pyogenic osteomyelitis with Staphylococcus aureus and warneri identified on microbiological culture. A 76-year-old female with previous history of breast cancer presented with a 6-month history of pyrexia, myalgia and weight loss. Besides neutrophilia and elevated C-reactive protein, other blood indices, cultures and conventional imaging failed to identify the cause of pyrexia of unknown origin (PUO). 18 F-FDG-PET/CT demonstrated multiple widespread foci of intense FDG uptake in lytic lesions throughout the skeleton. Coupled with previous history of malignancy, findings were strongly suggestive of disseminated metastases of breast cancer. Through targeting an FDG avid lesion, 18 F-FDG-PET/CT aided CT-guided biopsy, which instead identified the lesions as chronic pyogenic osteomyelitis. Following prolonged antibiotic therapy, repeat 18 F-FDG-PET/CT demonstrated significant resolution of lesions. This case demonstrated an unusual presentation of disseminated osteomyelitis on 18 F-FDG-PET/CT and highlighted the use of 18 F-FDG-PET/CT as a trouble shooter in PUO but demonstrated that unusual presentations of benign or malignant pathologies cannot always reliably be differentiated on imaging alone without aid of tissue sampling. Furthermore, this case highlights the potential role 18 F-FDG-PET/CT could provide in assessing response to antibiotic therapy. (author)

Progressive Multifocal Leukoencephalopathy: Recent Advances and a Neuro-Ophthalmological Review.

Science.gov (United States)

Sudhakar, Padmaja; Bachman, David M; Mark, Alexander S; Berger, Joseph R; Kedar, Sachin

2015-09-01

Progressive multifocal leukoencephalopathy (PML) is a severe often fatal opportunistic infection of the central nervous system caused by reactivation of a ubiquitous polyoma virus, JC virus. Although typically characterized by multifocal asymmetric subcortical white matter lesions, it may be monofocal and affect the cortical gray matter. Among the broad spectrum of clinical manifestations that occurs with PML, visual complaints are common. Combination of representative personally observed cases of PML and comprehensive review of case series of PML from 1958 through 2014. Neuro-ophthalmic signs and symptoms were reported in approximately 20%-50% of patients with PML and can be the presenting manifestation in half of these. A majority of these presentations occur from damage to cerebral visual pathways resulting in visual field defects, cortical blindness, and other disorders of visual association. Given the decreased frequency of infratentorial and cerebellar involvement, ocular motility disorders are less common. Visual complaints occur in patients with PML and are often the presenting sign. Awareness of this condition is helpful in avoiding unnecessary delays in the diagnosis of PML and management of the underlying condition. Recent guidelines have established criteria for diagnosis of PML in the high-risk patient population and strategies to mitigate the risk in these populations.

Wide-field two-dimensional multifocal optical-resolution photoacoustic computed microscopy

Science.gov (United States)

Xia, Jun; Li, Guo; Wang, Lidai; Nasiriavanaki, Mohammadreza; Maslov, Konstantin; Engelbach, John A.; Garbow, Joel R.; Wang, Lihong V.

2014-01-01

Optical-resolution photoacoustic microscopy (OR-PAM) is an emerging technique that directly images optical absorption in tissue at high spatial resolution. To date, the majority of OR-PAM systems are based on single focused optical excitation and ultrasonic detection, limiting the wide-field imaging speed. While one-dimensional multifocal OR-PAM (1D-MFOR-PAM) has been developed, the potential of microlens and transducer arrays has not been fully realized. Here, we present the development of two-dimensional multifocal optical-resolution photoacoustic computed microscopy (2D-MFOR-PACM), using a 2D microlens array and a full-ring ultrasonic transducer array. The 10 × 10 mm2 microlens array generates 1800 optical foci within the focal plane of the 512-element transducer array, and raster scanning the microlens array yields optical-resolution photoacoustic images. The system has improved the in-plane resolution of a full-ring transducer array from ≥100 µm to 29 µm and achieved an imaging time of 36 seconds over a 10 × 10 mm2 field of view. In comparison, the 1D-MFOR-PAM would take more than 4 minutes to image over the same field of view. The imaging capability of the system was demonstrated on phantoms and animals both ex vivo and in vivo. PMID:24322226

Multifocal Visual Evoked Potential in Eyes With Temporal Hemianopia From Chiasmal Compression: Correlation With Standard Automated Perimetry and OCT Findings.

Science.gov (United States)

Sousa, Rafael M; Oyamada, Maria K; Cunha, Leonardo P; Monteiro, Mário L R

2017-09-01

To verify whether multifocal visual evoked potential (mfVEP) can differentiate eyes with temporal hemianopia due to chiasmal compression from healthy controls. To assess the relationship between mfVEP, standard automated perimetry (SAP), and Fourier domain-optical coherence tomography (FD-OCT) macular and peripapillary retinal nerve fiber layer (RNFL) thickness measurements. Twenty-seven eyes with permanent temporal visual field (VF) defects from chiasmal compression on SAP and 43 eyes of healthy controls were submitted to mfVEP and FD-OCT scanning. Multifocal visual evoked potential was elicited using a stimulus pattern of 60 sectors and the responses were averaged for the four quadrants and two hemifields. Optical coherence tomography macular measurements were averaged in quadrants and halves, while peripapillary RNFL thickness was averaged in four sectors around the disc. Visual field loss was estimated in four quadrants and each half of the 24-2 strategy test points. Multifocal visual evoked potential measurements in the two groups were compared using generalized estimated equations, and the correlations between mfVEP, VF, and OCT findings were quantified. Multifocal visual evoked potential-measured temporal P1 and N2 amplitudes were significantly smaller in patients than in controls. No significant difference in amplitude was observed for nasal parameters. A significant correlation was found between mfVEP amplitudes and temporal VF loss, and between mfVEP amplitudes and the corresponding OCT-measured macular and RNFL thickness parameters. Multifocal visual evoked potential amplitude parameters were able to differentiate eyes with temporal hemianopia from controls and were significantly correlated with VF and OCT findings, suggesting mfVEP is a useful tool for the detection of visual abnormalities in patients with chiasmal compression.

Acuidade visual em implantes bilaterais de lentes intra-oculares monofocais e multifocais Visual acuity of bilateral implants of monofocal and multifocal intraocular lenses

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Leonardo Akaishi

2003-01-01

Full Text Available OBJETIVO: Comparar a acuidade visual de longe e perto de pacientes submetidos à facoemulsificação binocular não simultânea com implante de lentes multifocais ou monofocais. MÉTODOS: Foram selecionados 20 pacientes com lentes multifocais bilaterais e outros 20 pacientes com lentes monofocais também bilaterais, com acuidade visual sem correção melhor ou igual a 0,63 (20/30, medidos separadamente, nos três primeiros meses de pós-operatório. Foi medida a acuidade visual para longe e perto com e sem correção e testes de sensibilidade ao contraste e ofuscamento. RESULTADOS: A acuidade visual sem correção para longe no grupo das monofocais teve média de 0,82 (DP± 0,16 e no grupo das multifocais, 0,94 (DP±0,12, valor de p 0,001. Os dois grupos de lentes tiveram visão com correção para longe igual a 1. No grupo das multifocais, 75% tiveram J1 e 100% tiveram J3 ou melhor sem correção. No grupo das lentes monofocais, 10% tiveram J1 e 70% tiveram J3 ou melhor sem correção. Não houve diferença significante na avaliação com o teste de sensibilidade ao contraste entre os grupos pesquisados. No teste de ofuscamento, os dois grupos tiveram redução da visão, que foi mais acentuada no grupo dos pacientes com lentes multifocais. CONCLUSÃO: A acuidade visual para longe com correção nos pacientes com implante multifocal foi semelhante a dos pacientes com implantes monofocais, embora a acuidade visual para perto no grupo em que foi implantado lente multifocal foi bastante superior ao grupo da lente monofocal. A sensibilidade ao contraste manteve-se semelhante nos dois grupos, já o ofuscamento ("glare test" no grupo multifocal foi maior que no grupo monofocal.PURPOSE: To compare distant and near visual acuity between patients submitted to bilateral nonsimultaneous facoemulsification and implantation of multifocal or monofocal intraocular lenses (IOL. METHODS: Twenty patients with bilateral multifocal IOL and 20 patients with

Primary Disseminated Multifocal Ewing Sarcoma: Results of the Euro-EWING 99 Trial

NARCIS (Netherlands)

Ladenstein, Ruth; Pötschger, Ulrike; Le Deley, Marie Cécile; Whelan, Jeremy; Paulussen, Michael; Oberlin, Odile; van den Berg, Henk; Dirksen, Uta; Hjorth, Lars; Michon, Jean; Lewis, Ian; Craft, Alan; Jürgens, Heribert

2010-01-01

Purpose To improve the poor prognosis of patients with primary disseminated multifocal Ewing sarcomas (PDMES) with a dose-intense treatment concept. Patients and Methods From 1999 to 2005, 281 patients with PDMES were enrolled onto the Euro-EWING 99 R3 study. Median age was 16.2 years (range, 0.4 to

Late hemodynamic failure following percutaneous transluminal angioplasty for long and multifocal femoropopliteal stenoses

DEFF Research Database (Denmark)

Jørgensen, B; Tønnesen, K H; Holstein, P

1991-01-01

separate segments were dilated. Following 98% initial technical success, 3-year patency was 68% for single short stenoses, as opposed to 20% for long and multifocal stenoses (p = 0.05, logrank test). Antiplatelet therapy with acetylsalicyclic acid was not found to influence occurrence of restenosis...

Multifocal dystonia, Clinical feature of Hallervorden-Spatz

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Ghelichkhani H

1998-09-01

Full Text Available Hallervorden-spatz disease is an inherited metabolic disorder with autosomal recessive trait. Onset is in late childhood or early adolescence. Clinical manifestation is variable but pyramidal and extrapyramidal signs are often prominent. Many of patients show progressive dementia and extrapyramidal symptoms. Ataxia or myoclonus is reported in the course of the disease in individual cases. Focal dystonias including tongue, eyelids (blepharospasm and optic atrophy, retinitis pigmentosa, rarely familial parkinsonism are also reported. Pathologically pigmentary degeneration of globus pallidus, substantia nigra (pars reticular and red nucleus is characteristic. In our case the main clinical feature was multifocal dystonia without obvious pyramidal or other extrapyramidal symptoms, and diagnosis was based on clinical and MRI findings.

Evaluation of refractive correction for standard automated perimetry in eyes wearing multifocal contact lenses.

Science.gov (United States)

Hirasawa, Kazunori; Ito, Hikaru; Ohori, Yukari; Takano, Yui; Shoji, Nobuyuki

2017-01-01

To evaluate the refractive correction for standard automated perimetry (SAP) in eyes with refractive multifocal contact lenses (CL) in healthy young participants. Twenty-nine eyes of 29 participants were included. Accommodation was paralyzed in all participants with 1% cyclopentolate hydrochloride. SAP was performed using the Humphrey SITA-standard 24-2 and 10-2 protocol under three refractive conditions: monofocal CL corrected for near distance (baseline); multifocal CL corrected for distance (mCL-D); and mCL-D corrected for near vision using a spectacle lens (mCL-N). Primary outcome measures were the foveal threshold, mean deviation (MD), and pattern standard deviation (PSD). The foveal threshold of mCL-N with both the 24-2 and 10-2 protocols significantly decreased by 2.2-2.5 dB ( P correction without additional near correction is to be recommended.

State of the art in imaging of osteomyelitis case children : Kit education

International Nuclear Information System (INIS)

Lahmer, Lilia

2007-01-01

Imagery is a great contribution in the exploration of osteomyelitis. It is based initially on simple examinations tests and available ultrasound and X-ray standard whose contribution is more prognostic and therapeutic indications if the clinic is typical. In the clinical forms of questionable, in the pseudo tumoral forms, in land forms, localization and germ in question unusual or special, IRM is widely indicated. The scintigraphy specific markers of infection would be the place of choice in the context of a Early diagnosis preserving the final prognosis.

[Follow-up on MEWDS by fundus perimetry and multifocal ERG with the SLO].

Science.gov (United States)

Bültmann, S; Martin, M; Rohrschneider, K

2002-09-01

Most conventional techniques for examination such as perimetry or ERG may not be sensitive enough to detect functional alterations due to MEWDS precisely. We report on a follow-up performed by fundus perimetry and the new technique of multifocal ERG using the scanning laser ophthalmoscope. A 24-year-old female patient (VA 0.2/0.8) was followed up for 7 weeks with these techniques as well as Octopus perimetry, fluorescence angiography, Ganzfeld ERG and biomicroscopy. Multifocal ERG stimulation (mfERG, Retiscan) was performed with the SLO. Visual acuity improved from 0.2 to 0.8 and the central relative scotoma disappeared while a relevant increase of P1-wave amplitudes in mfERG could be observed. Combining objective measurements from the fundus controlled SLO-mfERG and results from fundus perimetry enable good correlation of morphology and results, even for minor alterations of the macula only accessible by few established clinical examinations.

Treatment of chronic heel osteomyelitis in vasculopathic patients. Can the combined use of Integra® , skin graft and negative pressure wound therapy be considered a valid therapeutic approach after partial tangential calcanectomy?

Science.gov (United States)

Fraccalvieri, Marco; Pristerà, Giuseppe; Zingarelli, Enrico; Ruka, Erind; Bruschi, Stefano

2012-04-01

Osteomyelitis of the calcaneus is a difficult problem to manage. Patients affected by osteomyelitis of the calcaneus often have a below-the-knee amputation because of their comorbidity. In this article, we present seven cases of heel ulcerations with chronic osteomyelitis treated with Integra(®) Dermal Regeneration Template, skin graft and negative pressure wound therapy after partial tangential calcanectomy, discussing the surgical and functional results. In this casuistic of patients, all wounds healed after skin grating of the neodermis generated by Integra(®), with no patient requiring a below-knee amputation. © 2011 The Authors. © 2011 Blackwell Publishing Ltd and Medicalhelplines.com Inc.

Multifocal ERG wavelet packet decomposition applied to glaucoma diagnosis

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Rodríguez-Ascariz José M

2011-05-01

Full Text Available Abstract Background Glaucoma is the second-leading cause of blindness worldwide and early diagnosis is essential to its treatment. Current clinical methods based on multifocal electroretinography (mfERG essentially involve measurement of amplitudes and latencies and assume standard signal morphology. This paper presents a new method based on wavelet packet analysis of global-flash multifocal electroretinogram signals. Methods This study comprised twenty-five patients diagnosed with OAG and twenty-five control subjects. Their mfERG recordings data were used to develop the algorithm method based on wavelet packet analysis. By reconstructing the third wavelet packet contained in the fourth decomposition level (ADAA4 of the mfERG recording, it is possible to obtain a signal from which to extract a marker in the 60-80 ms time interval. Results The marker found comprises oscillatory potentials with a negative-slope basal line in the case of glaucomatous recordings and a positive-slope basal line in the case of normal signals. Application of the optimal threshold calculated in the validation cases showed that the technique proposed achieved a sensitivity of 0.81 and validation specificity of 0.73. Conclusions This new method based on mfERG analysis may be reliable enough to detect functional deficits that are not apparent using current automated perimetry tests. As new stimulation and analysis protocols develop, mfERG has the potential to become a useful tool in early detection of glaucoma-related functional deficits.

Spectacle Independence after Cataract Extraction in Post-Radial Keratotomy Patients Using Hybrid Monovision with ReSTOR® Multifocal and TECNIS® Monofocal Intraocular Lenses

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Isha Gupta

2014-05-01

Full Text Available Background: We report 2 patients who have undergone radial keratotomy (RK preceding ReSTOR® multifocal intraocular lens (IOL; Alcon, Fort Worth, Tex., USA implantation in their nondominant eyes and TECNIS® monofocal IOL (Abbott Medical Optics, Abbott Park, Ill., USA in their dominant eyes. Methods: Retrospective review of 2 patients who underwent hybrid monovision with ReSTOR® multifocal and TECHNIS® monofocal IOLs at the time of cataract surgery after a remote history of RK. Results: Implantation of the ReSTOR® multifocal and the TECHNIS® monofocal IOLs was successful, with no reported adverse events. The patients were able to achieve spectacle freedom. Conclusion: We report a novel technique for the management of post-RK patients to optimize their chances for spectacle independence.

A multidisciplinary approach for the treatment of complication of hematogenous osteomyelitis in children

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Yury Garkavenko Garkavenko

2016-06-01

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 characteristics of the affected bones. Along with comprehensive orthopedic treatment, bone-reconstructive surgery of the facial bones of the skull should be focused on restoration of chewing function, external respiration, speech, and facial esthetics.

Osteoblastomatosis of bone. A benign, multifocal osteoblastic lesion, distinct from osteoid osteoma and osteoblastoma, radiologically simulating a vascular tumor

International Nuclear Information System (INIS)

Kyriakos, Michael; El-Khoury, Georges Y.; McDonald, Douglas J.; Buckwalter, Joseph A.; Sundaram, Murali; DeYoung, Barry; O'Brien, Michael P.

2007-01-01

Two adult patients are described with multifocal osteolytic lesions radiologically simulating a vascular tumor. One patient had multiple bones involved. Histologically, the individual lesions had the features of the nidus of osteoid osteoma/osteoblastoma. A review of the English language medical literature yielded only one other reported case with similar features. The process is designated as osteoblastomatosis to indicate its bone-forming character, prominent osteoblast proliferation, and multiplicity. The cases are distinguished from multifocal/multicentric osteoid osteoma and osteoblastoma, and from benign and malignant vascular tumors. (orig.)

Inhibitive Effect of antibiotic-loaded beads to cure chronic osteomyelitis in developing country : Hand-made vs commercial beads

NARCIS (Netherlands)

Rasyid, Hcrmawan N.; Van Horn, Jim R.; Van der Mei, Henny C.; Soegijoko, Sooegijardjo; Busscher, Henk J.; Neut, Danielle; Ibrahim, F; Osman, NAA; Usman, J; Kadri, NA

2007-01-01

Local antibiotic-loaded beads have been approved for standard treatment of orthopaedic pathogens, especially chronic osteomyelitis. Septopal (R), the only commercial local antibiotic bead available on the market, is expensive and contains only gentamicin. This study aimed to compare the in vitro

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.

Clinical feasibility of two-step streptavidin/111In-biotin scintigraphy in patients with suspected vertebral osteomyelitis

International Nuclear Information System (INIS)

Lazzeri, Elena; Erba, Paola A.; Volterrani, Duccio; Bottoni, Antonio; Mariani, Giuliano; Pauwels, Ernest K.J.; Manca, Mario; Bodei, Lisa; Trippi, Donatella; Cristofani, Renza; Consoli, Vincenzo; Palestro, Christopher J.

2004-01-01

Streptavidin accumulates at sites of inflammation and infection as a result of increased capillary permeability. In addition to being utilised by bacteria for their own growth, biotin forms a stable, high-affinity non-covalent complex with avidin. The objective of this investigation was to determine the diagnostic performance of two-step streptavidin/ 111 In-biotin imaging for evaluating patients with suspected vertebral osteomyelitis. We evaluated 55 consecutive patients with suspected vertebral osteomyelitis (34 women and 21 men aged 27-86 years), within 2 weeks after the onset of clinical symptoms. Thirty-two of the patients underwent magnetic resonance imaging (MRI) and 24, computed tomography (CT). DTPA-conjugated biotin was radiolabelled by incubating 500 μg of DTPA-biotin with 111 MBq of 111 In-chloride. Two-step scintigraphy was performed by first infusing 3 mg streptavidin intravenously, followed 4 h later by 111 In-biotin. Imaging was begun 60 min later. Streptavidin/ 111 In-biotin scintigraphy was positive in 32/34 patients with spinal infection (94.12% sensitivity). The study was negative in 19/21 patients without infection (95.24% specificity). The corresponding results for MRI and CT were 54.17% and 35.29% (sensitivity), and 75% and 57.14% (specificity), respectively. All statistical parameters of diagnostic performance (Youden's J index, kappa measure of agreement with correct classification, accuracy, sensitivity, specificity, positive likelihood and negative likelihood) were clearly better for streptavidin/ 111 In-biotin scintigraphy than for either MRI or CT. Streptavidin/ 111 In-biotin scintigraphy is highly sensitive and specific for detecting vertebral osteomyelitis in the first 2 weeks after the onset of clinical symptoms, and is potentially very useful for guiding clinical decisions on instituting appropriate therapy. (orig.)

An adult multifocal medulloblastoma with diffuse acute postoperative cerebellar swelling: immunohistochemical and molecular genetics analysis.

Science.gov (United States)

Balik, Vladimir; Trojanec, Radek; Holzerova, Milena; Tuckova, Lucie; Sulla, Igor; Megova, Magdalena; Vaverka, Miroslav; Hrabalek, Lumir; Ehrmann, Jiri

2015-01-01

Medulloblastoma (MB), the most common malignant tumor typically affecting children, occurs only exceptionally in adults. Multifocal presentation of this malignancy in adulthood is even much rarer—only four cases with favorable postoperative course have been reported, so far. The study illustrates a very rare rapid postoperative clinical deterioration due to diffuse cerebellar swelling (DCS) in an adult multifocal MB (MMB). To the best of their knowledge, authors for the first time performed genetic analysis of MMB and demonstrated expression patterns of selected markers that put the patient within the sonic hedgehog (SHH) molecular subgroup and at least partially explain her unsatisfactory clinical course. Herein, authors summarized the relevant literature concerning this issue with the aim to determine features that would facilitate diagnosis and therapy of such a scarce clinical entity.

Posterior instrumentation, anterior column reconstruction with single posterior approach for treatment of pyogenic osteomyelitis of thoracic and lumbar spine.

Science.gov (United States)

Gorensek, M; Kosak, R; Travnik, L; Vengust, R

2013-03-01

Surgical treatment of thoracolumbar osteomyelitis consists of radical debridement, reconstruction of anterior column either with or without posterior stabilization. The objective of present study is to evaluate a case series of patients with osteomyelitis of thoracic and lumbar spine treated by single, posterior approach with posterior instrumentation and anterior column reconstruction. Seventeen patients underwent clinical and radiological evaluation pre and postoperatively with latest follow-up at 19 months (8-56 months) after surgery. Parameters assessed were site of infection, causative organism, angle of deformity, blood loss, duration of surgery, ICU stay, deformity correction, time to solid bony fusion, ambulatory status, neurologic status (ASIA impairment scale), and functional outcome (Kirkaldy-Willis criteria). Mean operating time was 207 min and average blood loss 1,150 ml. Patients spent 2 (1-4) days in ICU and were able to walk unaided 1.6 (1-2) days after surgery. Infection receded in all 17 patients postoperatively. Solid bony fusion occurred in 15 out of 17 patients (88 %) on average 6.3 months after surgery. Functional outcome was assessed as excellent or good in 82 % of cases. Average deformity correction was 8 (1-18) degrees, with loss of correction of 4 (0-19) degrees at final follow-up. Single, posterior approach addressing both columns poses safe alternative in treatment of pyogenic vertebral osteomyelitis of thoracic and lumbar spine. It proved to be less invasive resulting in faster postoperative recovery.

Osteomielitis vertebral piógena Pyogenic vertebral osteomyelitis

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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

Thermo-mechanical treatment of the Cr-Mo constructional steel plates with Nb, Ti and B additions

International Nuclear Information System (INIS)

Adamczyk, J.; Opiela, M.

2002-01-01

Results of investigations of the influence of parameters of thermomechanical treatment, carried out by rolling with controlled recrystallization, on the microstructure and mechanical properties of Cr-Mo constructional steel with Nb, Ti and B microadditions, destined for the manufacturing of weldable heavy plates, are presented. These plates show a yield point of over 960 MPa after heat treatment. Two variants of thermomechanical treatment were worked out, based on the obtained results of investigations, when rolling a plate 40 mm thick in several passes to a plate 15 mm thick in a temperature range from 1100 to 900 o C. It was found that the lack of complete recrystallization of the austenite in the first rolling variant, leads to localization of plastic deformation in form of shear bands. There exists a segregation of MC-type carbides and alloying elements in these bands, causing a distinctive reduction of the crack resistance of the steel, as also a disadvantageous anisotropy of plastic properties of plate after tempering. For plates rolled under the same conditions, using a retention shield, a nearly three times higher impact energy in - 40 o C was obtained, as also only a slight anisotropy of plastic properties, saving the required mechanical properties. (author)

Objective perimetry using a four-channel multifocal VEP system: correlation with conventional perimetry and thickness of the retinal nerve fibre layer.

Science.gov (United States)

Horn, Folkert K; Kaltwasser, Christoph; Jünemann, Anselm G; Kremers, Jan; Tornow, Ralf P

2012-04-01

There is evidence that multifocal visual evoked potentials (VEPs) can be used as an objective tool to detect visual field loss. The aim of this study was to correlate multifocal VEP amplitudes with standard perimetry data and retinal nerve fibre layer (RNFL) thickness. Multifocal VEP recordings were performed with a four-channel electrode array using 58 stimulus fields (pattern reversal dartboard). For each field, the recording from the channel with maximal signal-to-noise ratio (SNR) was retained, resulting in an SNR optimised virtual recording. Correlation with RNFL thickness, measured with spectral domain optical coherence tomography and with standard perimetry, was performed for nerve fibre bundle related areas. The mean amplitudes in nerve fibre related areas were smaller in glaucoma patients than in normal subjects. The differences between both groups were most significant in mid-peripheral areas. Amplitudes in these areas were significantly correlated with corresponding RNFL thickness (Spearman R=0.76) and with standard perimetry (R=0.71). The multifocal VEP amplitude was correlated with perimetric visual field data and the RNFL thickness of the corresponding regions. This method of SNR optimisation is useful for extracting data from recordings and may be appropriate for objective assessment of visual function at different locations. This study has been registered at http://www.clinicaltrials.gov (NCT00494923).

Dramatic course of osteomyelitis in a patient treated with immediately placed dental implants suffering from uncontrolled diabetes: A case report.

Science.gov (United States)

Doll, Christian; Hartwig, Stefan; Nack, Claudia; Nahles, Susanne; Nelson, Katja; Raguse, Jan-Dirk

2015-01-01

To report a rare and dramatic complication following immediate dental implant placement in a heavy smoker, who had a delayed diagnosis of uncontrolled diabetes. In this case report we present the dramatic course of a 64-year old female patient treated with five immediate post-extractive dental implants in the mandible, who developed osteomyelitis, which manifested initially as local peri-implant inflammation and progressed into a spontaneous jaw fracture, despite repeated surgical interventions and antibiotic courses over a 3-year period, until diabetes was diagnosed. A symptom-free status could be achieved only after partial mandibulectomy, treatment of diabetes and reconstruction with a microvascular fibula free flap. In the presence of mandibular osteomyelitis refractory to therapy, yet undiagnosed underlying pathologies, such as diabetes, should be investigated and treated urgently.

Peripheral refraction with dominant design multifocal contact lenses in young myopes

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Daniela Lopes-Ferreira

2013-04-01

Conclusion: It is possible to induce significant changes in the pattern of relative peripheral refraction in the myopic direction with commercially available dominant design multifocal contact lenses. The higher add (+3.00 D induced an significantly higher effect than the +2.00 D add lens, although an increase of 1 D in add power does not correspond to the same amount of increase in RPRE.

Arteriographic features of rare skin complications due to chronic osteomyelitis

International Nuclear Information System (INIS)

Boehm, E.; Wiebe, V.; Oelenberg, W.; Berufsgenossenschaftliche Krankenanstalten 'Bergmannsheil' Bochum

1984-01-01

In the period between 1970 and 1982, 6 carcinomas in scar tissue and 2 pseudocarcinomatous skin papillomatoses were found on the basis of chronic osteomyelitides. Amputation specimens of two carcinomas and one papillomatosis were examined by arteriography. Macroscopically carcinomas in scar tissue showed an unspecific appearance and microscopically a scarefied and partly pathological vascular appearance. Pseudocarcinomatous skin papillomatosis was distinctly hypervascular. Therefore, indications with regard to the localisation of an required exploratory excision can only be obtained from the vascular appearance of papillomatosis but not in case of a scar tissue carcinoma after osteomyelitis. Due to the overall bad blood circulation osteomyelitic scar tissue carcinoma scarcely reacts positively to a chemotherapeutic treatment. (orig.) [de

[Resection of a carpal bone row in a Pustertaler Sprinze cow with chronic purulent arthritis of the carpal joint and osteomyelitis].

Science.gov (United States)

Kofler, J; Peterbauer, C

2014-01-01

This case report describes the clinical and radiographic findings and the surgical treatment of a serofibrinous arthritis of the antebrachiocarpal joint and of a chronic purulent arthritis of the intercarpal and carpometacarpal joints with osteomyelitis of the distal carpal bones and subchondral osteomyelitis of the proximal metacarpal bones in a cow of the breed "Pustertaler Sprinze". The therapy comprised an arthrotomy of both joint spaces and the resection of the distal row of the carpal bones. The right forelimb had been immobilised for 70 days by a full limb cast. After this period, radiographs revealed an ob- vious ankylosis of the carpal joint, and the cow showed only a slight lameness. Six years postoperatively this cow was still in the herd and had produced six calves.

Multifocal demyelinating motor neuropathy and hamartoma syndrome associated with a de novo PTEN mutation.

Science.gov (United States)

Bansagi, Boglarka; Phan, Vietxuan; Baker, Mark R; O'Sullivan, Julia; Jennings, Matthew J; Whittaker, Roger G; Müller, Juliane S; Duff, Jennifer; Griffin, Helen; Miller, James A L; Gorman, Grainne S; Lochmüller, Hanns; Chinnery, Patrick F; Roos, Andreas; Swan, Laura E; Horvath, Rita

2018-05-22

To describe a patient with a multifocal demyelinating motor neuropathy with onset in childhood and a mutation in phosphatase and tensin homolog ( PTEN ), a tumor suppressor gene associated with inherited tumor susceptibility conditions, macrocephaly, autism, ataxia, tremor, and epilepsy. Functional implications of this protein have been investigated in Parkinson and Alzheimer diseases. We performed whole-exome sequencing in the patient's genomic DNA validated by Sanger sequencing. Immunoblotting, in vitro enzymatic assay, and label-free shotgun proteomic profiling were performed in the patient's fibroblasts. The predominant clinical presentation of the patient was a childhood onset, asymmetric progressive multifocal motor neuropathy. In addition, he presented with macrocephaly, autism spectrum disorder, and skin hamartomas, considered as clinical criteria for PTEN-related hamartoma tumor syndrome. Extensive tumor screening did not detect any malignancies. We detected a novel de novo heterozygous c.269T>C, p.(Phe90Ser) PTEN variant, which was absent in both parents. The pathogenicity of the variant is supported by altered expression of several PTEN-associated proteins involved in tumorigenesis. Moreover, fibroblasts showed a defect in catalytic activity of PTEN against the secondary substrate, phosphatidylinositol 3,4-trisphosphate. In support of our findings, focal hypermyelination leading to peripheral neuropathy has been reported in PTEN-deficient mice. We describe a novel phenotype, PTEN-associated multifocal demyelinating motor neuropathy with a skin hamartoma syndrome. A similar mechanism may potentially underlie other forms of Charcot-Marie-Tooth disease with involvement of the phosphatidylinositol pathway. Copyright © 2018 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology.

Comparison of Tc-99m Ciprofloxacin (Infecton) and Tc-99m Methylene diphosphonate (MDP) three-phase bone scintigraphy in the diagnosis of osteomyelitis in patients with Sickle Cell Disease

International Nuclear Information System (INIS)

Bererhi, H.; Hussein, S.; Wali, Y.

2003-01-01

The high incidence of Sickle Cell Disease (SCD) is a major health problem in Oman. These patients are more prone to infections than the general population, and in particular, they are highly susceptible to osteomyelitis. Because bone infarction is more common than osteomyelitis in SCD, an accurate and rapid differential diagnosis is essential before initiating appropriate treatment. The present prospective study evaluates the usefulness of the new radiopharmaceutical, Tc- 99m Ciprofloxacin (Infecton) for the differential diagnosis of infection and infarction in patients with SCD. Majority of subjects studied were children. The results of Tc-99m Infecton imaging were compared with those of the 3-phase bone scintigraphy using Tc- 99m Methylene diphosphonate (Tc-99m MDP). Twenty-five patients referred for ruling out infection were imaged after intravenous injection of 5.5 MBq/kg body weight of Tc-99m Infecton. First pass, blood pool and late images (at one, four and 24 hours post injection) were performed. Subsequently all patients were also studied by three-phase bone scintigraphy using Tc-99m MDP. No adverse effects were observed. The sensitivity, specificity, accuracy and positive likelihood ratio of Tc-99m Infecton imaging for osteomyelitis were 100%, 92%, 94% and 12.5 respectively. Although bone scintigraphy would rarely be used by itself as a stand-alone test in the diagnosis of osteomyelitis in patients with SCD, its corresponding values were: 88%, 64%, 71% and 2.4. The results of this study suggest that the use of Tc-99m Infecton imaging is extremely beneficial in the management of patients of Sickle Cell Disease with suspected osteomyelitis. (author)

Staphylococcal diaphyseal subacute osteomyelitis of the ulna in a child: an unusual cause of post-traumatic forearm swelling.

LENUS (Irish Health Repository)

Kearns, S R

2004-01-01

Paediatric subacute osteomyelitis (SAO) presents a diagnostic and therapeutic challenge to clinicians. Typically located in the metaphysis of long bones, diaphyseal SAO of the upper limb is rare. We present the case of a three-year-old girl referred to our fracture clinic as an occult fracture following trauma to her forearm with normal initial radiographs. Follow-up radiographs one week later showed cortical erosion of the distal ulna, while a subsequent MRI scan showed soft tissue swelling with an area of high signal in the distal ulna. A limited biopsy diagnosed staphylococcal subacute osteomyelitis of the ulna. The patient responded to high dose antibiotic therapy and made a full recovery. We present this case to highlight the high index of suspicion required to diagnose and appropriately manage this insidious condition, which may easily be confused with any number of benign and malignant bony lesions and provide a review of the relevant literature.

Application of serum natalizumab levels during plasma exchange in MS patients with progressive multifocal leukoencephalopathy

NARCIS (Netherlands)

Vennegoor, A.; Rispens, T.; van Oosten, B.W.; Wattjes, M.P.; Wondergem, M.J.; Teunissen, C.E.; van der Kleij, D.; Uitdehaag, B.M.J.; Polman, C.H.; Killestein, J.

2015-01-01

Progressive multifocal leukoencephalopathy (PML) is a severe complication of natalizumab treatment. Restoring immune function by plasmapheresis/immunoadsorption (PLEX/IA) is important for the outcome of PML. We report on four multiple sclerosis (MS) patients whom developed PML during natalizumab

Multifocal fibrosclerosis presenting as Grave's orbitopathy. Bilateral exophthalmos associated with retroperitoneal and sellar fibrosis

NARCIS (Netherlands)

van der Pol, R.; Nieuwenhuis, M. G.; Mourits, M. P.

1999-01-01

BACKGROUND: Multifocal fibrosclerosis (MF) is a rare disease that may be misdiagnosed as Graves' orbitopathy. The combination of localisations of MF presented here has not been reported before. CASE REPORT: A 44-year-old man was referred with progressive bilateral exophthalmos. CT of his chest and

Multifocal epithelial hyperplasia in a community in the Mayan area of Mexico.

Science.gov (United States)

González-Losa, Maria R; Suarez-Allén, Rosa E; Canul-Canche, Jaqueline; Conde-Ferráez, Laura; Eljure-Lopez, Nixma

2011-03-01

Multifocal epithelial hyperplasia is a pathology of the oral mucosa which has been reported in diverse ethnic groups. Human papillomavirus (HPV) types 13 and 32 DNA has been detected in these lesions. The aims of this paper are to describe the epidemiological and clinical characteristics of an outbreak in a rural community in the Mayan area of Mexico and to identify a possible route of transmission through saliva. A cross-sectional study was conducted in Chemax (Yucatan, Mexico). Clinical and epidemiological data were obtained through direct interviews. Samples of oral cells and saliva were taken. HPV 13 and 32 were identified by polymerase chain reaction using specific primers. A total of 57 patients were studied, of whom 79.1% were aged jugal mucosa, and more frequently, the tongue. HPV 13 was found in all the patients and HPV 32 in none. A total of 42 saliva samples were positive for HPV 13. Human papillomavirus type 13 is involved in multifocal epithelial hyperplasia among the Mexican Mayan population. The presence of HPV 13 in cells from saliva, combined with poor hygiene behaviors, may explain the familial distribution of the pathology. © 2011 The International Society of Dermatology.

Multifocal fibrosclerosis and IgG4-related disease involving the cardiovascular system

International Nuclear Information System (INIS)

Ishizaka, Nobukazu; Terasaki, Fumio; Sakamoto, Aiko; Imai, Yasushi; Nagai, Ryozo

2012-01-01

The cardiovascular system may be involved as a target organ of multifocal fibrosclerosis, which may manifest as idiopathic retroperitoneal fibrosis, inflammatory aortic aneurysm, inflammatory periarteritis, and inflammatory pericarditis. These pathological conditions can sometimes occur concomitantly. Idiopathic retroperitoneal fibrosis and inflammatory abdominal aortic aneurysm are both characterized by the presence of fibro-inflammatory tissue around the abdominal aorta expanding into the surrounding retroperitoneal structures, and together they may be termed 'chronic periaortitis'. Cardiovascular fibrosclerosis has become non-uncommonly encountered condition since imaging modalities have made its diagnosis more feasible. In addition, recent studies have demonstrated that a certain fraction, but not all, of cardiovascular fibrosclerosis may have a link with immunoglobulin-G4 (IgG4)-related sclerosing disease (IgG4-SD). IgG4-SD is histologically characterized by dense fibrosclerosis and infiltration of lymphocytes and IgG4-positive plasma cells, and these histopathologic findings seem to be essentially similar regardless of the organs involved. In this mini review, we summarize what is known so far about multifocal fibrosclerosis of the cardiovascular system and its association with IgG4-SD, and what remains to be clarified in future investigations. (author)

Light-distortion analysis as a possible indicator of visual quality after refractive lens exchange with diffractive multifocal intraocular lenses.

Science.gov (United States)

Brito, Pedro; Salgado-Borges, José; Neves, Helena; Gonzalez-Meijome, José; Monteiro, Manuel

2015-03-01

To study the perception of light distortion after refractive lens exchange (RLE) with diffractive multifocal intraocular lenses (IOLs). Clínica Oftalmológica das Antas, Porto, Portugal. Retrospective comparative study. Refractive lens exchange was performed with implantation of an AT Lisa 839M (trifocal) or 909MP (bifocal toric) IOL, the latter if corneal astigmatism was more than 0.75 diopter (D). The postoperative visual and refractive outcomes were evaluated. A prototype light-distortion analyzer was used to quantify the postoperative light-distortion indices. A control group of eyes in which a Tecnis ZCB00 1-piece monofocal IOL was implanted had the same examinations. A trifocal or bifocal toric IOL was implanted in 66 eyes. The control IOL was implanted in 18 eyes. All 3 groups obtained a significant improvement in uncorrected distance visual acuity (UDVA) (P refractive cylinder was less than 1.00 D in 86.7% of cases with the toric IOL. The mean light-distortion index was significantly higher in the multifocal IOL groups than in the monofocal group (P light-distortion index and CDVA. The multifocal IOLs provided excellent UDVA and functional UNVA despite increased light-distortion indices. The light-distortion analyzer reliably quantified a subjective component of vision distinct from visual acuity; it may become a useful adjunct in the evaluation of visual quality obtained with multifocal IOLs. No author has a financial or proprietary interest in any material or method mentioned. Copyright © 2015 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.