Cases reported "Osteomyelitis"

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11/72. Management of pathological fracture neck of the femur following recent osteomyelitis in a child.

    Fracture neck of the femur is rare in children and occurs following severe trauma. Several recommendations have been made for the treatment of displaced transcervical fracture type 11 (Delbet classification). However there are no recommendations when such a fracture occurs after recent acute osteomyelits of the neck of the femur. The management of a case is described with the outcome after 36 months.
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12/72. osteopetrosis, femoral fracture, and chronic osteomyelitis caused by staphylococcus aureus small colony variants (SCV) treated by girdlestone resection--6-year follow-up.

    Chronic osteomyelitis caused by staphylococcus aureus small colony variants in combination with osteopetrosis is a unique combination of disorders that confronted us with major challenges. The therapeutic approach included four serial debridements and antimicrobial therapy. The aggressive treatment led to an instability of the brittle and hard osteopetrotic bone, and after 11 weeks, a fracture of the femoral neck occurred. A salvage procedure of the femur was performed, and the cultures obtained during this intervention remained negative. At a 6-year follow-up, the girdlestone situation still showed an acceptable functional outcome without any recurrence of osteomyelitis.
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13/72. aspergillus flavus epidural abscess and osteomyelitis in a diabetic patient.

    A 63-year-old man had a history of diabetes mellitus for more than 10 years and took oral hypoglycemic agents regularly. He visited Taipei veterans General Hospital with the complaint of progressive weakness in all 4 limbs and neck pain for 6 months. Computed tomography of the cervical spine revealed increased soft tissue density in the epidural space from C2 to C5 with cord compression. Surgical decompression was done and aspergillus flavus was isolated from the inflammatory tissue. He was initially treated with oral itraconazole 200 mg 3 times per day for 4 days and then twice daily. Later, the treatment regimen was shifted to intravenous amphotericin b 25 mg/d. He died of intraventricular hemorrhage and complicated fungal meningoencephalitis 2 weeks postlaminectomy. This case reminds us that a prolonged history of back pain accompanied with peripheral neuropathy in diabetic patients should raise the suspicion of Aspergillus epidural abscess. Prompt aggressive diagnostic testing and management is needed to improve the likelihood of a good outcome of these patients.
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14/72. Cervical epidural abscess: approaches to diagnosis.

    We report on two cases of cervical epidural abscess (CEA). Their clinical presentation included fever, neck pain and symptoms of neural compression, and the presence of epidural abscess was documented by surgery. Several imaging methods were used to establish a prompt diagnosis of CEA in both patients. Magnetic Resonance image provided a noninvasive means of visualize both extent in the spinal canal and paravertebral locations. None of the other currently used imaging modalities could provide the same information alone. The role of these techniques in diagnosing this condition is discussed.
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15/72. Vertebral osteomyelitis following manipulation of spondylitic necks--a possible risk.

    Neurological complications of neck manipulation are well recognised but are usually due to acute vascular incidents. However, we describe two patients with cervical spondylosis, who developed staphylococcal osteomyelitis of the cervical spine with progressive tetraplegia, apparently following manipulation of the neck by a chiropractor. Although it is possible that the manipulation resulted in cervical spine trauma sufficient to cause local haemorrhage, the area becoming a nidus for infection, it is also conceivable that the patients underwent neck manipulation in an attempt to relieve pain due to an already existing osteomyelitis of the cervical spine, and the manipulation may have hastened the onset of spinal cord paralysis. Clearly, this could have occurred, as the average time between the onset of symptoms and diagnosis of vertebral osteomyelitis in most published series is about 2 months. Approximately 80% of cases of osteomyelitis occur in the 50-70 age group, a group in which cervical spondylosis is extremely common. It would seem that neck manipulation is particularly contraindicated in older patients with cervical spondylosis.
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16/72. Corrective valgus osteotomy after free vascularized fibula transfer for the treatment of osteomyelitis at the neck of the femur: case report.

    Reconstruction using a free vascularized fibula was performed on a long bony defect after osteomyelitis of the proximal femur. For this type of bone defect, a double-barrel fibular graft is recommended. The authors used this procedure for a 58-year-old male who had osteomyelitis of the left proximal femur. As osteotomy through a transplanted fibula can be safely performed, abduction osteotomy should be considered when coxa vara remains after reconstruction with a free vascularized fibula transfer.
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17/72. An aseptic meningitis picture from incipient brain abscess.

    A preadolescent with headache and stiff neck presented for emergency department care. The presumptive diagnosis of viral meningitis was entertained on the basis of clinical examination and cerebrospinal fluid analysis. Events subsequent to his release from the department formed the stimulus for this report. It is apparent that patients with complicated sinusitis may present with a constellation of findings consistent with viral meningitis.
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18/72. Primary non-Hodgkin's lymphoma of the mandible. Report of a case.

    A case of a 45-year-old white man admitted for an osteomyelitis and subsequently diagnosed affected by an IE stage, diffuse high grade large B cell non-Hodgkin's lymphoma of the mandible is reported. The patient presented a swelling in the right mandibular region with paraesthesia of the ipsilateral lower lip without nodal involvement of the neck. After an incisional biopsy, which showed a diffuse high grade large B-cell non-Hodgkin's lymphoma, the patient was staged and treated with CEOP protocol for six courses and subsequently external beam radiation therapy with complete remission of the lesion.
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19/72. DentaScan: a new diagnostic method for evaluating mandibular and maxillary pathology.

    Although computerized tomography (CT) is valuable for evaluating head and neck pathology, it can be suboptimal when evaluating the presence or extent of mandibular and maxillary involvement by tumor, infection, or other pathology. The presence of dental restoration artifact, CT gantry positioning problems, and the inability to obtain cross-sectional images will diminish the accuracy of standard CT images. A program, termed either DentaScan or multiplanar reformation (CT/MPR), eliminates these problems by processing axial CT scan information to obtain true cross-sectional images and panoramic views of the mandible and maxilla. In this study, DentaScan imagery was used in 26 patients whose mandibles or maxillas were affected by tumor, osteomyelitis, or other pathology. CT scanning with multiplanar reformation proved useful in the precise location, assessment, monitoring, and treatment of various pathologies of the mandible and maxilla. Selected case studies illustrate the therapeutic implications and advantages of this new imaging technique.
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20/72. Rapid manifestation of cervical vertebral osteomyelitis.

    Within 10 days after cystoscopy causing urosepsis this patient developed persistant neckpain as initial symptom of vertebral osteomyelitis. E. coli was isolated from urine, blood cultures and later from bone biopsy. Antibiotic treatment did not stop the progress of the disease. A transverse spinal cord syndrome occurred due to a pathological fracture of C5 and C6 and operative decompression was necessary. The rapid onset of osteomyelitis was impressive. For effective treatment of bacterial osteomyelitis a bone biopsy is sometimes unavoidable and indicated.
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