Cases reported "Osteomyelitis"

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1/199. Myelopathy secondary to spinal epidural abscess: case reports and a review.

    Spinal epidural abscess (SEA) is a rare disease with an unknown incidence rate. This paper will illustrate that early diagnosis and rehabilitation may result in improved outcomes for patients with neck or back pain presenting with neurological deficits. Three cases of SEA in individuals without the commonly acknowledged risk factors of intravenous drug abuse (IVDA), invasive procedures, or immunosuppression were seen at our institution during a 10-month period between October 1995 and July 1996. The patients presented with neck or thoracic back pain and progressive neurological deficits without a febrile illness. Predisposing factors were thought to be urinary tract infection with underlying untreated diabetes mellitus in the first case, a history of recurrent skin infection in the second, and alcoholism without a definite source of infection in the third. leukocytosis, elevated sedimentation rate, and confirmatory findings reported on magnetic resonance imaging (MRI) led to the diagnosis of SEA in all three cases. Immediate surgical drainage and decompression followed by proper antibiotic treatment and early aggressive rehabilitation led to good functional outcomes. All the individuals became independent in activities of daily living, wheelchair mobility, and bowel and bladder management. Two eventually became ambulatory.
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keywords = spinal
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2/199. Treatment of osteomyelitis by antibiotic impregnated porous hydroxyapatite block.

    A novel drug delivery system was developed for osteomyelitis using porous hydroxyapatite blocks (HA-b) that were impregnated with antibiotics by a centrifuge method. For the experimental study, a 10 mm3 HA-b was placed in a container, mixed with an antibiotic solution and centrifuged at 1500 rpm for 15 min for the purpose of impregnating antibiotics into the pores. The slow release activity of antibiotic (Arbekacin sulfate [1-N-(S)-4 amino-2-hydroxybutyryl dibekacin]) from the HA-b was tested. An evaluation was made of the slow-releasing capabilities of the ABK from HA-b which was still maintained at 0.5 microgram/ml within 21 exchanges of PBS after 42 days. Consequently, seven patients with osteomyelitis, including one with tuberculosis and two with infected hip arthroplasty, have been treated. On a follow-up study, all of the foci had completely healed by the end of the follow-up period without complications. This new method is simple and can be performed safety as a one-stage operation.
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ranking = 0.92366442604845
keywords = tuberculosis
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3/199. Pyogenic osteomyelitis of the spine in the elderly: three cases of a synchronous non-axial infection by a different pathogen.

    STUDY DESIGN: A retrospective chart review of patients over 65 years of age treated at the spine Care Unit for pyogenic vertebral osteomyelitis. OBJECTIVES: To assess the reliability of peripheral blood, urine and sputum cultures in the treatment of pyogenic vertebral osteomyelitis in the elderly. SETTING: Study performed at the spine Care Unit, Meir Hospital, Kfar-Saba, israel. methods: The Meir hospital records were searched for patients over 65 years of age, treated at the spine Care Unit for pyogenic vertebral osteomyelitis. charts, culture results and imaging studies were reviewed. A medline literature search was performed to survey the literature regarding pyogenic vertebral osteomyelitis in the elderly with emphasis on diagnostic imaging modalities and surgical treatment. RESULTS: Three patients were identified with concurrent peripheral infection by a different organism than the organism causing the vertebral osteomyelitis. Delay in correct diagnosis led to neurologic impairment in all patients and surgical treatment was performed in all three to drain the epidural abscess, decompress the spinal cord and obtain direct tissue culture. Following decompression and epidural abscess evacuation, one patient has functionally recovered and was ambulating with a cane, two patients did not recover and remained paraparetic and ambulate in a wheelchair. CONCLUSIONS: Pyogenic vertebral osteomyelitis in the elderly can be caused by a different pathogen than that isolated from blood, sputum or urine cultures. In the elderly, a biopsy of the vertebral lesion should be obtained for susceptibility studies prior to conservative treatment with bracing and intravenous antibiotics.
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ranking = 0.25
keywords = spinal
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4/199. Fungal spinal osteomyelitis in the immunocompromised patient: MR findings in three cases.

    The MR imaging findings of fungal spinal osteomyelitis in three recipients of organ transplants showed hypointensity of the vertebral bodies on T1-weighted sequences in all cases. Signal changes and enhancement extended into the posterior elements in two cases. Multiple-level disease was present in two cases (with a total of five intervertebral disks involved in three cases). All cases lacked hyperintensity within the disks on T2-weighted images. In addition, the intranuclear cleft was preserved in four of five affected disks at initial MR imaging. MR features in candida and aspergillus spondylitis that are distinct from pyogenic osteomyelitis include absence of disk hyperintensity and preservation of the intranuclear cleft on T2-weighted images. Prompt recognition of these findings may avoid delay in establishing a diagnosis and instituting treatment of opportunistic osteomyelitis in the immunocompromised patient.
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ranking = 1.25
keywords = spinal
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5/199. Conservative management of pyogenic osteomyelitis of the occipitocervical junction.

    STUDY DESIGN: A report of three cases of pyogenic osteomyelitis of the occipitocervical junction. OBJECTIVE: To describe the conservative management of pyogenic osteomyelitis of the occipitocervical junction. SUMMARY OF BACKGROUND DATA: The therapeutic approach to inflammation of the upper cervical spine is controversial. methods: Pyogenic osteomyelitis of the occipitocervical junction is rare. In the orthopedic literature, only a few case reports with variable treatment methods are available. Three patients with pyogenic osteomyelitis of the occipitocervical junction were treated nonoperatively. Intravenous antibiotic therapy was begun after direct cultures or blood cultures were obtained. Early mobilization was accomplished by application of a halo vest. RESULTS: Two patients recovered by spontaneous fusion of the occipitocervical junction. Instability developed in the spine of one patient, but she refused further treatment. CONCLUSIONS: Diagnosis of osteomyelitis of the upper cervical spine is difficult. In cases with absence of neurologic symptoms or spinal abscess formation, treatment can be nonoperative.
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keywords = spinal
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6/199. mycobacterium bovis BCG causing vertebral osteomyelitis (Pott's disease) following intravesical BCG therapy.

    We report a case of mycobacterium bovis BCG vertebral osteomyelitis in a 79-year-old man 2.5 years after intravesical BCG therapy for bladder cancer. The recovered isolate resembled M. tuberculosis biochemically, but resistance to pyrazinamide (PZA) rendered that diagnosis suspect. High-pressure liquid chromatographic studies confirmed the diagnosis of M. bovis BCG infection. The patient was originally started on a four-drug antituberculous regimen of isoniazid, rifampin, ethambutol, and PZA. When susceptibility studies were reported, the regimen was changed to isoniazid and rifampin for 12 months. Subsequently, the patient was transferred to a skilled nursing facility for 3 months, where he underwent intensive physical therapy. Although extravesical adverse reactions are rare, clinicians and clinical microbiologists need to be aware of the possibility of disseminated infection by M. bovis BCG in the appropriate setting of clinical history, physical examination, and laboratory investigation.
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ranking = 0.92366442604845
keywords = tuberculosis
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7/199. Calvarial tuberculosis.

    We report a six-year-old boy who presented with swelling of the forehead, and had calvarial tuberculosis, a rare form of tuberculous osteitis.
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ranking = 4.6183221302423
keywords = tuberculosis
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8/199. Vertebral aspergillus osteomyelitis and acute diskitis in patients with chronic obstructive pulmonary disease.

    aspergillus osteomyelitis of the spine with acute diskitis has been well documented in immunocompromised hosts but is rare in immunocompetent patients. Predisposing factors to infection are prolonged neutropenia, hematologic malignancies, chemotherapy, history of prior spinal trauma or surgery, allograft transplantation, or any condition requiring the use of long-term immunosuppressive agents or systemic corticosteroids. patients with chronic obstructive pulmonary disease (COPD) treated with systemic corticosteroids for either long-term management or frequent exacerbations are at potential risk for such infections. patients with severe COPD treated primarily with inhaled corticosteroids are considered immunocompetent. This report describes 2 cases of aspergillus osteomyelitis with acute diskitis in apparently immunocompetent patients with COPD who, aside from brief courses of systemic corticosteroids, were using inhaled corticosteroid therapy. One patient was treated with intravenous amphotericin b alone, whereas the other received amphotericin b and underwent surgical debridement. Both have done well and were symptom free at 6-month follow-up.
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ranking = 0.25
keywords = spinal
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9/199. tuberculosis in children undergoing continuous ambulatory peritoneal dialysis.

    The incidence of tuberculosis (TB) is increasing worldwide. Due to an impairment of cellular immunity, patients with chronic renal failure are susceptible to reactivation of TB. Seventy patients were treated by continuous ambulatory peritoneal dialysis (CAPD) in our pediatric nephrology department during the years 1989-1997. TB was diagnosed in 4 patients, representing 5.7% of all CAPD patients in our department. One patient had extrapulmonary (TB osteomyelitis) and the others had pulmonary TB. All patients were treated with antituberculous drugs.Two patients with pulmonary TB were cured. Symptoms improved in the other 2 patients but they died at home for unknown reasons. We recommend that all children in regions of high prevalence of TB should be investigated for TB, especially if they have a cough or fever of unknown etiology.
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ranking = 0.92366442604845
keywords = tuberculosis
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10/199. Spinal epidural abscess - a report of six cases.

    Six cases of spinal epidural abscess are presented. All patients were young with no predisposing conditions. All were treated with laminectomy and intravenous antibiotics. The patients with no neurological deficit recovered completely, while patients with pre-existing neurological deficit had a poorer outcome. Emphasis is given to early detection and surgical management to prevent irreversible damage to the spinal cord.
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ranking = 0.5
keywords = spinal
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