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1.
Rev. venez. cir. ortop. traumatol ; 53(1): 10-19, jun. 2021. ilus
Article in Spanish | LILACS, LIVECS | ID: biblio-1252872

ABSTRACT

El manejo de pseudoartrosis infectadas, osteomielitis y defectos óseos representa un reto enorme para el cirujano ortopedista. Hace diez años, Masquelet presentó la técnica de inducción de membrana como alternativa al manejo de las complicaciones mencionadas arriba con excelentes tasas de consolidación y erradicación del proceso infeccioso. Estudiamos una de serie de 14 casos, prospectiva, con seguimiento clínico y radiológico mínimo de 2 años (enero 2015-diciembre 2018), donde evaluamos múltiples variables en pacientes a quienes se les realizó el protocolo de Masquelet. Obtuvimos una tasa de consolidación de 85,7% (12/14). Con un tiempo promedio para alcanzarla de 6,1 meses (3-9m). Todos los pacientes que lograron la consolidación se encontraban libres de infección al final del seguimiento. Por su reproducibilidad y alta tasa de consolidación, consideramos la técnica de inducción de membrana, como una excelente opción en el manejo de pseudoartrosis infectadas complejas(AU)


The management of infected nonunions, osteomyelitis, and bone defects represents an enormous challenge for the orthopedic surgeon. Ten years ago, Masquelet presented the membrane induction technique as an alternative to the management of the complications afore mentioned with excellent rates of consolidation and eradication of the infectious process. We prospectively studied a series of 14 cases, with a clinical and radiological follow-up of at least 2 years (january 2015-december 2018). Where we evaluated multiple variables in patients who underwent the Masquelet protocol. We obtained a consolidation rate of 85.7% (12/14). With an average time to reach it of 6.1 months (3-9m). All patients who achieved union were free of infection at the end of follow-up. Due to its reproducibility and high consolidation rate, we consider the membrane induction technique an excellent option in the management of complex infected nonunions(AU)


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Osteomyelitis/complications , Pseudarthrosis/complications , Bone Transplantation , Orthopedic Procedures , Bone Diseases , Traumatology
2.
Rev. habanera cienc. méd ; 19(1): 92-101, ene.-feb. 2020. graf
Article in Spanish | LILACS, CUMED | ID: biblio-1099148

ABSTRACT

Introducción : La osteomielitis es la infección de estructuras óseas ya sea por inoculación directa a través de heridas, por vía hematógena a través de focos distantes o por contigüidad con estructuras vecinas como los oídos. Objetivo: Reportar un caso que demuestra la necesidad de seguimiento de las otitis medias con vistas a evitar recurrencias y complicaciones. Presentación del Caso: Paciente femenina, de 62 años de edad, tez blanca y ama de casa de la localidad de Baracoa, provincia Guantánamo, Cuba. Con antecedentes de otitis de un año de evolución que desarrolló osteomielitis crónica cervical y un cuadro neurológico caracterizado por cuadriparesia y dificultad para la acción asociado a la osteomielitis cervical. Se trató con vancomicina y levofloxacino durante 6 semanas y oxigenación hiperbárica con lo cual egresó totalmente rehabilitada. Conclusiones: El manejo inadecuado de la otitis puede desencadenar complicaciones graves y poco frecuentes como la osteomielitis cervical tal y como se presenta en este caso(AU)


Introduction: Osteomyelitis is the infection of the osseous structures associated with the direct inoculation of microorganisms through wounds, hematogenous route from distant focus of infection or the contiguity with neighboring structures like the ears. Objective: The aim of this paper is to demonstrate the need for medical follow-up of otitis media in order to avoid recurrence and complications of this disease. Case presentation: Sixty-two-year-old white woman, housewife, from Baracoa, Guantanamo Province, Cuba. The patient had antecedents of one-year history of otitis media. She developed cervical chronic osteomyelitis and a neurological picture that was characterized by quadriparesis and difficulty to carry out actions, which was associated with cervical osteomyelitis. She was treated with Vancomycin and Levofloxacin during 6 months and hyperbaric oxygenation that helped her to be totally recovered after discharge from hospital. Conclusions: Inadequate treatment of otitis can cause very serious and less frequent complications such as cervical osteomyelitis, as it is presented in this case(AU)


Subject(s)
Humans , Female , Middle Aged , Osteomyelitis/complications , Otitis Media/complications , Osteomyelitis/drug therapy
3.
Rev. medica electron ; 40(6): 1856-1874, nov.-dic. 2018. tab
Article in Spanish | LILACS, CUMED | ID: biblio-978707

ABSTRACT

RESUMEN Introducción: la alveolitis dentaria es una complicación pos-textracción dental, local, dolorosa y reversible del alveolo. Objetivo: caracterizar la alveolitis dental en pacientes adultos del Policlínico "René Bedia Morales", perteneciente al municipio Boyeros. Mareriales y métodos: se realizó un estudio descriptivo de corte transversal, en el Policlínico "René Bedia Morales", municipio Boyeros, provincia La Habana, en el periodo comprendido de septiembre de 2016 a septiembre de 2017. El universo estuvo constituido por 250 pacientes, de ambos sexos. Diagnosticados con alveolitis dental tras haberse realizado exodoncia durante ese periodo. La muestra quedó conformada por 187 pacientes que cumplieron con los criterios de inclusión y exclusión. Se estudiaron las variables: edad, sexo, tipo de alveolitis y factores asociados a las mismas. La información fue recogida en un modelo de recogida de datos, bajo su consentimiento informado. Resultados: el grupo de edad más afectado fue el de 35-59 años, con 47,59 %. Predominó el sexo femenino, con un 66,84 %. Prevaleció la alveolitis seca, en un 55,08 %. Relacionado con las conductas inadecuadas del paciente, la afectación fue de un 40,64 %. El no cumplimiento de las indicaciones postoperatorias y fumar, luego de la exodoncia, fueron los factores más asociados a la alveolitis seca; con un 53,48 % y un 41,18 %, respectivamente. Conclusiones: la alveolitis afectó fundamentalmente a los pacientes de 35-59 años de edad, del sexo femenino. Con mayor frecuencia predominó la alveolitis seca relacionada a las conductas inadecuadas del paciente (AU).


ABSTRACT Introduction: Dental alveolitis is a local, painful dental pos extraction complication which is reversible. Objective: Provide a characterization of dental alveolitis in René Bedia Morales policlinic at Boyeros Municipality. Materials and methods: A descriptive transversal study was performed in René Bedia Morales policlinic at Boyeros Municipality, in Havana Province. The study was performed in a time span between September 2016 to September 2017. The study universe was constituted by 250 patients of both sexes diagnosed with dental alveolitis after have made extractions in that period of time and the sample remained formed for 187 patients , that met with the criteria of inclusion and exclusion. Age, sex, type of alveolitis and associated factors were the variables considered in the present study. The data was collected in a input data form, under the patients concern. Results: The most affected age group was from 35 to 59 years old which represents a 47,59 %, being the feminine sex the predominant group which represents a 66,84 %. Dry alveolitis was predominant in 55,08 % related to inadequate behaviors within a 40,64 % The most frequent factors associated to the non-fulfillment of the pos operatory orders, such as smoking after having performed the procedure of exodontia with a 53,48 % and 41,18 % respectively. Conclusions: Alveolitis mainly affects patients within 35-59 years old, feminine sex, and also related to inadequate behaviors of the patients (AU).


Subject(s)
Humans , Adult , Osteomyelitis/complications , Patient Dropouts , Tooth Extraction/methods , Risk Factors , Oral Medicine/ethics , Dry Socket/etiology , Health Risk Behaviors , Tooth Extraction/ethics , Epidemiology, Descriptive , Cross-Sectional Studies , Dry Socket/complications , Dry Socket/diagnosis , Dry Socket/epidemiology , Emergency Medical Services
4.
An. bras. dermatol ; 92(2): 249-252, Mar.-Apr. 2017. graf
Article in English | LILACS | ID: biblio-838046

ABSTRACT

Abstract: We report a 35-year-old mulatto female patient with neurofibromatosis Type 1 who presented with facial asymmetry. The patient had two lesions: florid cemento-osseous dysplasia associated with peripheral giant cell granuloma. She was referred for surgical treatment of the peripheral giant cell granuloma and the florid cemento-osseous dysplasia was treated conservatively by a multidisciplinary team. So far, no changes have been observed in the patient's clinical status. We observed no recurrence of peripheral giant cell granuloma. To the best of our knowledge, the present case is the first report of a patient with neurofibromatosis Type 1 associated with a giant cell lesion and florid cemento-osseous dysplasia.


Subject(s)
Humans , Female , Adult , Osteomyelitis/complications , Granuloma, Giant Cell/complications , Neurofibromatosis 1/etiology , Facial Asymmetry/etiology , Fibrous Dysplasia of Bone/complications , Osteomyelitis/pathology , Osteomyelitis/diagnostic imaging , Granuloma, Giant Cell/pathology , Granuloma, Giant Cell/diagnostic imaging , Neurofibromatosis 1/pathology , Neurofibromatosis 1/diagnostic imaging , Fibrous Dysplasia of Bone/pathology , Fibrous Dysplasia of Bone/diagnostic imaging
5.
Rev. bras. cir. plást ; 32(2): 194-201, 2017. ilus, tab
Article in English, Portuguese | LILACS | ID: biblio-847361

ABSTRACT

Introdução: As complicações de ferida operatória após esternotomia para acessos cirúrgicos para procedimentos cardiovasculares variam desde pequenas deiscências até mediastinite e osteomielite do esterno. Mediastinite e osteomielite do esterno associam-se a alto risco, alta morbidade e altas taxas de mortalidade, além de altas taxas de recidiva. O tratamento nos casos de maior gravidade envolvem internação hospitalar prolongada. A utilização de antibióticos por tempo prolongado, durante a internação, e após a alta, tem impacto importante no custo global do tratamento. Mais recentemente, uma opção de tratamento envolve o amplo debridamento cirúrgico da ferida em centro cirúrgico, preparo do leito da ferida com terapia por pressão negativa, seguida do fechamento da ferida com retalhos miocutâneos ou fasciocutâneos. Aparentemente, essa estratégia traz vantagens como a melhora na qualidade de vida do paciente, menor manipulação e menor incômodo ao doente, menos sobrecarga para os profissionais de saúde envolvidos nos cuidados, menor taxa de recidiva infecciosa e, assim, redução da morbidade do tratamento como um todo. Métodos: O presente estudo tem por objetivo realizar levantamento dos pacientes vítimas dessa grave complicação que tenham sido tratados segundo protocolo desenvolvido e aprimorado no Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor - HCFMUSP), e que tenham sido operados por um mesmo cirurgião plástico, a fim de analisar o perfil epidemiológico, e eventual indicador de pior prognóstico dentre os exames colhidos habitualmente desses pacientes. Foram avaliados, retrospectivamente, os prontuários dos pacientes atendidos no InCor - HCFMUSP vítimas de infecção de esternotomia durante o ano de 2014. As variáveis analisadas foram comorbidades, intervalo entre abordagens cirúrgicas, valores de Proteína C Reativa (PCR), procedimento empregado no fechamento da ferida, complicações do tratamento, entre outros. Resultados: Os dados são essencialmente descritivos e de caráter epidemiológico: observa-se a incidência de ao menos uma comorbidade em 84% dos pacientes; média de 2,5 procedimentos cirúrgicos por paciente, variando de 1 a 7 procedimentos; queda nos níveis de PCR em 75% dos pacientes já após o primeiro procedimento cirúrgico e mortalidade de 17%, entre outros dados. Conclusão: Os dados analisados nos permitem concluir que o método padronizado adotado trouxe impacto na redução da mortalidade global dos pacientes, além da redução de recidiva e reinternações. Identificamos, ainda, indicadores de pior prognóstico como PCR e leucograma no momento do diagnóstico e indicação da aplicação do protocolo.


Introduction: Surgical wound complications after sternotomy in cardiovascular procedures include small dehiscences, mediastinitis, and sternal osteomyelitis. Mediastinitis and sternal osteomyelitis are high-risk complications associated with high rates of morbidity, mortality, and recurrence. Treatment of the most severe cases involves prolonged hospitalization. Moreover, the long-term use of antibiotics during hospitalization and after discharge significantly increases the overall cost of treatment. A recent treatment option involves extensive surgical debridement of the surgical wound, treatment of the wound bed with negative pressure therapy, and closure of the wound with myocutaneous or fasciocutaneous flaps. The advantages of this strategy include improvement of the patient's quality of life, less manipulation and less discomfort for the patient, less burden on staff involved in care, lower rate of infection recurrence, and an overall reduction of treatment morbidity. Methods: The objective of this study was to conduct a retrospective survey of patients with surgical wound complications who were treated according to a protocol developed and improved by the Heart Institute of the Clinic Hospital of the School of Medicine of the University of São Paulo (Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo­InCor/HC-FM-USP), and who underwent surgery by the same plastic surgeon. The epidemiological profiles and possible indicators of worse prognosis were determined from routine examinations performed on these patients. The medical records of patients treated at InCor/HC-FM-USP who presented with sternotomy infection in 2014 were assessed retrospectively. The analyzed variables included comorbidities, interval between surgical procedures, C-reactive protein (CRP) levels, wound closure procedures, and treatment complications, among others. Results: The data are predominantly descriptive and epidemiological. At least one comorbidity was present in 84% of cases. The mean number of surgical procedures per patient was 2.5, ranging from 1 to 7. The CRP levels decreased in 75% of patients after the first surgical procedure, and the mortality rate was 17%. Conclusion: The standardized method adopted significantly decreased the overall mortality and the rates of recurrence and readmission. Indicators of worse prognosis, including CRP levels and the leukogram, were identified at the time of diagnosis and initiation of the treatment protocol.


Subject(s)
Humans , Male , Female , Middle Aged , History, 21st Century , Osteomyelitis , Patients , Postoperative Complications , Surgical Flaps , Surgical Wound Infection , Wounds and Injuries , Medical Records , Polymerase Chain Reaction , Retrospective Studies , Negative-Pressure Wound Therapy , Mediastinitis , Osteomyelitis/surgery , Osteomyelitis/complications , Osteomyelitis/therapy , Patients/psychology , Postoperative Complications/therapy , Surgical Flaps/surgery , Surgical Wound Infection/therapy , Wounds and Injuries/surgery , Wounds and Injuries/complications , Wounds and Injuries/therapy , Medical Records/standards , Polymerase Chain Reaction/methods , Statistical Analysis , Negative-Pressure Wound Therapy/methods , Mediastinitis/surgery , Mediastinitis/therapy
6.
Arch. argent. pediatr ; 114(5): e333-e337, oct. 2016. ilus, tab
Article in Spanish | LILACS, BINACIS | ID: biblio-838277

ABSTRACT

El absceso del psoas es una enfermedad infrecuente en niños. Puede tener una presentación clínica inespecífica, ser de inicio insidioso y relacionarse o no con fiebre. El tipo más frecuente en pediatría es primario; sin embargo, en ocasiones, puede ser de origen secundario y asociarse a infecciones graves, como la osteomielitis, por lo que se requiere un alto índice de sospecha para detectarlo y tratarlo oportunamente. Presentamos un caso atípico de absceso del psoas con infiltración del cuerpo vertebral de L2 en un paciente masculino de 14 años previamente sano, sin antecedente de traumatismo ni fiebre al momento del ingreso. Se realizaron una radiografía y una ecografía, pero el diagnóstico se confirmó a través de una resonancia nuclear magnética de columna lumbosacra. Conhemocultivos positivos para Staphylococcus aureus meticilino resistente, completó 2 semanas de tratamiento antibiótico endovenoso y 4 semanas por vía oral con negativización de cultivos y resolvió por completo la sintomatología inicial.


Psoas abscess is a common disease in children. It can have a nonspecific clinical presentation, insidious onset and sometimes fever. The most common type in children is the primary one; however, it can sometimes be of secondary origin and associated with severe infections such as osteomyelitis so a high index of suspicion is required to detect and treat it promptly. We present an unusual case of psoas abscess with infiltration of the vertebral body of L2 in a 14 year old male patient previously healthy with no history of trauma or fever on admission. X-ray and ultrasound were performed but the diagnosis was confirmed by magnetic resonance imaging of the lumbosacral spine. With positive blood cultures for methicillin-resistant Staphylococcus aureus he completed 2 weeks of intravenous antibiotic therapy and 4 weeks of oral antibiotic therapy with blood cultures negativization and resolution of symptoms.


Subject(s)
Humans , Male , Adolescent , Osteomyelitis/complications , Osteomyelitis/microbiology , Spinal Diseases/complications , Spinal Diseases/microbiology , Staphylococcal Infections/complications , Psoas Abscess/complications , Methicillin-Resistant Staphylococcus aureus , Lumbar Vertebrae
7.
Rev. ADM ; 73(4): 197-200, jul.-ago. 2016. ilus
Article in Spanish | LILACS | ID: biblio-835294

ABSTRACT

Las fracturas patológicas mandibulares son poco comunes, representanel 1 a 2% de todas las fracturas. Pueden ser defi nidas como fracturasque ocurren en regiones donde el hueso ha sido debilitado bajo un procesopatológico. Los factores de causa más comunes incluyen procesosquirúrgicos tales como extracciones de terceros molares, colocación deimplantes, osteonecrosis relacionada con bifosfonatos, osteorradionecrosisde la mandíbula, osteomielitis, infecciones, tumores o lesionesquísticas. La osteomielitis es una condición infl amatoria del hueso; estapatología es uno de los factores que puede determinar el debilitamientodel hueso mandibular y causar una subsecuente fractura patológica. Laosteomielitis mandibular se puede desarrollar si una infección primaria noes manejada adecuadamente. El tratamiento de las fracturas patológicaspuede representar un reto para el profesional de la salud y difi ere segúnla etiología de la misma. Se presenta un caso de una paciente de 54 añosde edad, con una fractura mandibular patológica causada por osteomielitis,la cual fue tratada con antibioticoterapia e intervención quirúrgica.


Pathological mandibular fractures are rare, accounting for between1 and 2% of all fractures. They can be defi ned as fractures thatoccur in regions where the bone has become weakened as a result of a pathological process. Common causal factors include surgicalprocedures such as third molar removal, implant placement, bisphosphonate-related osteonecrosis, osteoradionecrosis of the jaw,osteomyelitis, infections, tumors, and cystic lesions. Osteomyelitisis an infl ammatory condition of the bone; this pathology is one ofthe factors that may prompt weakening of the mandibular boneand cause subsequent pathological fracture. Osteomyelitis of themandible may develop if a primary infection is not properly treated.Treatment of pathological mandibular fractures can be challengingand varies according to their etiology. This article looks at the caseof a 54-year-old woman with a pathological mandibular fracture caused by osteomyelitis, which was treated by means of antibioticotherapy and surgical intervention.


Subject(s)
Humans , Female , Middle Aged , Fractures, Spontaneous/etiology , Mandibular Fractures/etiology , Mandibular Fractures/therapy , Osteomyelitis/complications , Anti-Bacterial Agents/therapeutic use , Fractures, Spontaneous/surgery , Mandibular Fractures/surgery , Oral Surgical Procedures/methods , Jaw Fixation Techniques/methods
8.
Arch. argent. pediatr ; 114(2): e87-e90, abr. 2016. ilus
Article in Spanish | LILACS, BINACIS | ID: biblio-838189

ABSTRACT

La rinosinusitis es una patología muy frecuente en la infancia. Entre sus complicaciones, se encuentra la osteomielitis, rara complicación que, cuando se presenta, ocurre, principalmente, en lactantes y niños pequeños. El agente etiológico más frecuente es el Staphylococcus aureus. Clínicamente, se manifiesta con fiebre alta, edema de párpado inferior, rinorrea unilateral y edema palatino ipsilateral; luego se agrega un absceso sobre el área maxilar yuxtanasal y/o sobre los alvéolos dentarios. Secundariamente, pueden desarrollarse secuestros, expulsiones espontáneas de piezas dentarias y trayectos fistulosos, así como complicaciones orbitarias y endocraneales. El diagnóstico es, sobre todo, clínico; se confirma con tomografia computada. El tratamiento es médico quirúrgico. Se presenta un niño de 5 años de edad con rinosinusitis complicada con osteomielitis del hueso maxilar, cuyo germen responsable fue el Staphylococcus aureus meticilino resistente.


Rhinosinusitis is a very common childhood condition. Osteomyelitis is an unusual complication, which mainly occurs in toddlers and young children. The most frequent etiologic agent is Staphylococcus aureus. Iniatially, it is characterized by fever, low eyelid edema, unilateral rhinorrhea and ipsilateral palatine edema. Subsequently, abscesses develop in the maxillar yuxtanasal and/or the dental alveolar area. Secondary, it can be complicated by sequestrations, spontaneous expulsion of dental pieces and/or fistula, as well as orbital and intracranial complications. The diagnosis is based on clinical findings and is confirmed by computed tomography findings. The treatment is clinical and surgical. Here we report a five year old child, with rhinosinusitis complicated by osteomyelitis of maxillary bone, mediated by a methicillin-resistant Staphylococcus aureus infection.


Subject(s)
Humans , Male , Child, Preschool , Osteomyelitis/complications , Osteomyelitis/diagnosis , Sinusitis/complications , Staphylococcal Infections/complications , Methicillin-Resistant Staphylococcus aureus
9.
Rev. cient. odontol ; 3(2): 364-371, jul.-dic. 2015. ilus
Article in Spanish | LIPECS, LILACS, LIPECS | ID: biblio-1006815

ABSTRACT

La displasia fibrosa es una lesión congénita, lentamente progresiva que puede provocar graves alteraciones morfológicas y funcionales, y estar sujeta a complicaciones de tipo infeccioso. En este reporte de caso se presenta a un paciente masculino de 8 años de edad diagnosticado con una displasia fibrosa madura luego de un hallazgo incidental durante un examen de rutina, el paciente durante el curso de los últimos cinco años ha presentado osteomielitis a repetición en el sitio de biopsia y de exfoliación dentaría, el cuadro clínico se ha tratado mediante curetajes y aseos quirúrgicos y con la indicación antibiótica de clindamicina sin resultados positivos. Se concluye que el manejo de las displasias fibrosas maduras puede ser difícil una vez que se ha instalado un proceso infeccioso crónico sin poder dar de alta al paciente, manteniéndolo permanentemente en control. (AU)


Fibrous dysplasia is a slowly progressive congenital lesion that can cause serious morphological and functional alterations , and complications of infectious type . This case report presents a 8 years old male patient diagnosed with a mature fibrous dysplasia after an incidental finding during a routine examination, the patient during the course of the last five years has been presented recurrent osteomyelitis episodes in the biopsy site and temporal tooth during exfoliation, it has been treated by surgical curettage and clindamycin with no positive results. We conclude that the management of mature fibrous dysplasia can be difficult once a chronic infectious process has been installed without being able to discharge the patient, constantly keeping it in control.(AU)


Subject(s)
Humans , Male , Child , Osteomyelitis/complications , Clindamycin/therapeutic use , Fibrous Dysplasia of Bone/diagnosis , Fibrous Dysplasia of Bone/therapy
10.
Rev. ANACEM (Impresa) ; 8(2): 71-73, dic. 2014. ilus
Article in Spanish | LILACS | ID: biblio-997693

ABSTRACT

INTRODUCCIÓN: El condroblastoma es un tumor óseo benigno representando menos del 1 por ciento del total de tumores óseos; se presenta principalmente en jóvenes. De etiología controversial, se desarrolla habitualmente en centros secundarios de osificación en huesos largos. No hay casos que describan su existencia junto a osteomielitis ni su tratamiento quirúrgico. CASO CLÍNICO: Mujer de 15 años con antecedente de osteomielitis de inicio reciente, diagnosticada con cintigrafía y biopsia en escápula izquierda; a pesar de tratamiento médico antibiótico con cloxacilina persiste dolor, eritema, impotencia funcional y aumento de volumen progresivo. Cintigrafía de control confirma nula respuesta a tratamiento inicial. Tomografía computada (TC) informa probable proceso tumoral osteolítico cortical con reacción de partes blandas en casi la totalidad de la escápula incluyendo cavidad glenoidea. Biopsia quirúrgica informa condroblastoma sospecha de variante agresiva resolviéndose con escapulectomía total con resección de cabeza humeral y posterior pexia clavículo-humeral. Biopsia definitiva de pieza quirúrgica informa osteomielitis crónica y condroblastoma agresivo. Evolución favorable en controles posteriores sin signos de recidiva local ni a distancia. DISCUSIÓN: La nula respuesta clínica al tratamiento inicial y su progresión hizo sospechar un proceso tumoral no diagnosticado inicialmente debido a que la biopsia no incluyó focos del condroblastoma. El manejo clásico del condroblastoma consiste en curetaje y relleno con autoinjerto; pero debido a la localización atípica, posibilidad de malignización y coexistencia con proceso osteomielítico crónico se optó por cirugía innovadora que consistió en resección total y posterior pexiaclavículo-humeral


INTRODUCTION: A Chondroblastoma is a benign bone tumor, corresponding to less than 1 percent of all bone tumors, and affecting mainly young people. Commonly developing in secondary centers of ossification in large bones, there are no cases describing its existence along with osteomyelitis, nor its surgical treatment. CLINICAL CASE: Woman (15 Y/O) with a history of osteomyelitis onset caused by a recent fall is diagnosed through scintigraphy and biopsy in the left scapule. Despite treatment with cloxacillin, pain persisted, erythema developed, with a progressive increase of volume and functional impotence. Control scintigraphy confirms no response to initial treatment. Computed Tomography (CT) informs of a probable cortical osteolysis tumoral process with soft tissue reactions in almost the entire scapule including glenoid cavity. Surgical biopsy shows chondroblastoma and, suspecting an agressive variant, it is resolved to perform a total scapulectomy with resection of scapule head and subsequent humerus-claviclepexia. Definitive biopsy of surgical piece shows chronic osteomyelitis and agressive chondroblastoma. The evolution of the patient is normal on follow-up controls, not presenting any signs of local neither distant relapse. DISCUSSION: The non-existence of a response to the initial treatment and its progression made us suspect of a natural process that was not diagnosed initially because the biopsy didn't include chondroblastoma focus. The usual chondroblastoma treatment consists of curetting and autograft filling; but due to the atypical location, and the possibility of coexistence with malignant and chronic osteomyelitic process we chose to apply an innovative surgery that consisted of total resection and subsequent pexia.


Subject(s)
Humans , Adolescent , Osteomyelitis/complications , Bone Neoplasms/complications , Bone Neoplasms/diagnosis , Chondroblastoma/complications , Chondroblastoma/diagnosis , Bone Neoplasms/surgery , Chondroblastoma/surgery
11.
Rev. cuba. estomatol ; 50(1): 102-108, ene.-mar. 2013.
Article in Spanish | LILACS, CUMED | ID: lil-674103

ABSTRACT

La enfermedad de Albers-Schõmberg u osteopetrosis es un raro padecimiento óseo. La osteomielitis mandibular es una infrecuente complicación de esta enfermedad. Por ello y por lo interesante de la presentación clínica de ambas entidades, nos propusimos como objetivo presentar este caso. Este paciente masculino de 32 años con antecedentes de enfermedad de Albers- Schõmberg de tipo adulta benigna que dos años atrás acudió a consulta y refirió haberse realizado una exodoncia once meses antes, a partir de lo cual presentó aumento de volumen facial y dolor de intensidad variable con períodos de agudización. Luego del estudio clínico e imagenológico se llegó al diagnóstico de una osteomielitis mandibular como complicación de su enfermedad de base. Se aplicó terapia antimicrobiana, exéresis del hueso necrótico y oxígeno hiperbárico. A los dos años acudió a consulta con una reagudización del proceso, se le produjo la expulsión espontánea de un secuestro óseo y se decidió la realización de una mandibulectomía parcial más reconstrucción con placa mandibular. En estos momentos el paciente no presenta signos de reagudización del proceso y se mantiene bajo vigilancia estricta a los tres meses de realizada la intervención quirúrgica(AU)


Albers-Schomberg disease or osteopetrosis is a rare bone condition. Mandibular osteomyelitis is an infrequent complication of this disease. It was for this reason, alongside the peculiar clinical presentation of both entities, that we decided to present this case. A male 32-year-old patient with a history of benign adult Albers-Schomberg disease attended consultation two years ago and stated to have undergone exodontia eleven months before, after which he had had facial swelling and pain of variable intensity with acute episodes. Clinical and imaging studies led to the diagnosis of mandibular osteomyelitis as a complication of his underlying condition. Treatment consisted of antimicrobial therapy, exeresis of the necrotic bone and hyperbaric oxygen. Two years later the patient came back to consultation with a relapse of the acute pain process. Spontaneous expulsion of an osseous sequestrum was performed, followed by partial mandibulectomy and reconstruction with a mandibular plate. At this moment the patient does not present any signs of relapse of the acute pain process. Three months after surgery, he remains under strict surveillance(AU)


Subject(s)
Humans , Male , Adult , Osteomyelitis/complications , Osteomyelitis/diagnostic imaging , Osteopetrosis/etiology , Mandibular Osteotomy/methods
12.
Article in English | WPRIM | ID: wpr-144096

ABSTRACT

ABO discrepancy refers to an inconsistency between red cell and serum typings and has various causes, including hypogammaglobulinemia. IgM deficiency is a rare disorder that may accompany several conditions such as infection and autoimmune disorders. Here, we describe a case of IgM deficiency discovered during the evaluation of an ABO discrepancy in a 16-yr-old Korean boy. ABO blood grouping showed that while his cell type was O+, serum typing detected only anti-A (3+). Anti-B was not detectable at room temperature but was graded at 1+ at 4degrees C. ABO genotyping revealed an O/O genotype. His serum IgG, IgA, and IgM concentrations were 770 mg/dL (reference range: 800-1,700 mg/dL), 244 mg/dL (reference range: 100-490 mg/dL), and 13.5 mg/dL (reference range: 50-320 mg/dL), respectively. He was diagnosed with acute osteomyelitis on the basis of clinical presentation and imaging studies. The symptoms gradually improved within 3 weeks of treatment. However, the ABO discrepancy and IgM deficiency persisted even 6 months after recovery and lymphocyte subset analysis revealed CD19+ B cell deficiency. To the best of our knowledge, IgM deficiency detected by ABO discrepancy in a patient with acute osteomyelitis has not been reported before.


Subject(s)
ABO Blood-Group System/genetics , Acute Disease , Adolescent , B-Lymphocytes/cytology , Bone and Bones/diagnostic imaging , Genotype , Humans , Immunoglobulin A/blood , Immunoglobulin G/blood , Immunoglobulin M/blood , Immunologic Deficiency Syndromes/complications , Knee/diagnostic imaging , Magnetic Resonance Imaging , Male , Osteomyelitis/complications , Radiopharmaceuticals
13.
Article in English | WPRIM | ID: wpr-144089

ABSTRACT

ABO discrepancy refers to an inconsistency between red cell and serum typings and has various causes, including hypogammaglobulinemia. IgM deficiency is a rare disorder that may accompany several conditions such as infection and autoimmune disorders. Here, we describe a case of IgM deficiency discovered during the evaluation of an ABO discrepancy in a 16-yr-old Korean boy. ABO blood grouping showed that while his cell type was O+, serum typing detected only anti-A (3+). Anti-B was not detectable at room temperature but was graded at 1+ at 4degrees C. ABO genotyping revealed an O/O genotype. His serum IgG, IgA, and IgM concentrations were 770 mg/dL (reference range: 800-1,700 mg/dL), 244 mg/dL (reference range: 100-490 mg/dL), and 13.5 mg/dL (reference range: 50-320 mg/dL), respectively. He was diagnosed with acute osteomyelitis on the basis of clinical presentation and imaging studies. The symptoms gradually improved within 3 weeks of treatment. However, the ABO discrepancy and IgM deficiency persisted even 6 months after recovery and lymphocyte subset analysis revealed CD19+ B cell deficiency. To the best of our knowledge, IgM deficiency detected by ABO discrepancy in a patient with acute osteomyelitis has not been reported before.


Subject(s)
ABO Blood-Group System/genetics , Acute Disease , Adolescent , B-Lymphocytes/cytology , Bone and Bones/diagnostic imaging , Genotype , Humans , Immunoglobulin A/blood , Immunoglobulin G/blood , Immunoglobulin M/blood , Immunologic Deficiency Syndromes/complications , Knee/diagnostic imaging , Magnetic Resonance Imaging , Male , Osteomyelitis/complications , Radiopharmaceuticals
15.
Arq. int. otorrinolaringol. (Impr.) ; 16(1): 130-134, fev.-mar. 2012. ilus
Article in English, Portuguese | LILACS | ID: lil-620563

ABSTRACT

INTRODUÇÃO: A osteomielite frontal é uma complicação de rinossinusite que pode ter evolução aguda ou crônica. Há reação inflamatória com aumento da pressão intra-óssea, isquemia e necrose local, levando à formação de abscesso ósseo. Não havendo drenagem, ocorrerá descolamento do periósteo, invasão de partes moles e piora da isquemia com posterior sequestro ósseo. MÉTODO: Relato de caso de um paciente internado em serviço de emergência de outra instituição por complicação de rinossinusite que foi encaminhado para o Serviço de Otorrinolaringologia do Hospital Universitário Professor Edgard Santos da Universidade Federal da Bahia. RELATO DE CASO: Paciente masculino, 16 anos, apresentou-se ao serviço de emergência de outra instituição com cefaleia, vômitos e febre que evoluiu com edema periorbitário e frontal à esquerda, cursando com flutuação palpebral e frontal.Submetido à drenagem de abscesso palpebral e frontal, com antibioticoterapia de amplo espectro sem melhora. Encaminhado para o nosso serviço mantendo edema e flutuação em região frontal e edema leve em região periorbitária esquerda. A endoscopia nasal evidenciou edema em meato médio à esquerda e a tomografia computadorizada mostrou sinusite fronto-etmoidal à esquerda e sinais de osteomielite frontal com sequestro ósseo e empiema epidural.Submetido à cirurgia endoscópica nasossinusal, acesso externo para exérese do osso frontal acometido e drenagem do empiema epidural. Evoluiu com remissão da doença. CONSIDERAÇÕES FINAIS: A falência no diagnóstico e no tratamento das complicações da rinossinusite pode levar a sequelas e complicações fatais.O diagnóstico de osteomielite frontal é firmado pela suspeita clinica e confirmado por exames radiológicos.A cirurgia está indicada quando a evolução for insidiosa, havendo sequestro ósseo ou complicações intracranianas.


INTRODUCTION: The frontal osteomyelitis is a complication of rhinosinusitis which can evolve to acute or chronicle. There is inflammatory reaction by the increasing of intraosseous pressure, ischemia and local necrosis, leading to bone abscess formation. There is no drainage, it will occur detachment of the periosteum, soft tissue invasion and worsening of ischemia with subsequent bone sequestration. METHOD: Case report of an inpatient in an emergency service of another institution by the complication of rhinosinusitis who was referred to the Otorhinolaryngology Service of University Hospital Professor Edgard Santos of Federal University of Bahia. CASE REPORT: Male patient, 16 years-old, presented himself to the ER of another institution with cephalea, vomits and fever which evolved to periorbital edema and frontal to the left, moving to palpebral fluctuation and frontal. Subjected to frontal and palpebral abscess drainage, with broad-spectrum antibiotic therapy with no improvement. He was referred to our service keeping edema and fluctuation in region frontal and light edema in left periorbital region. The nasal endoscopy showed edema in meatus to the left and the computerized tomography showed fronto-ethmoid sinusitis to the left and signs of frontal osteomyelitis with bone sequestration and epidural empyema. Subjected to sinasal endoscopy surgery, external Access or removal of the frontal one affected and epidural empyema drainage. Evolved to the remission of the disease. FINAL CONSIDERATIONS: Failure in the diagnosis and rhinosinusitis complication treatment can lead to sequalae and fatal complications. The diagnosis of the frontal osteomyelitis is confirmed by the clinical suspicion and confirmed by radiological examination. The surgery is indicated when the evolution is insidious, there is bone sequestration and intracranial complications.


Subject(s)
Humans , Male , Adolescent , Abscess/surgery , Abscess/microbiology , Clinical Evolution , Drainage , Frontal Bone/physiopathology , Frontal Bone/pathology , Osteomyelitis/complications , Frontal Sinusitis/surgery , Frontal Sinusitis/complications , Frontal Sinusitis/microbiology , Magnetic Resonance Imaging , Tomography, X-Ray Computed
16.
An. bras. dermatol ; 86(2): 366-369, mar.-abr. 2011. ilus
Article in Portuguese | LILACS | ID: lil-587679

ABSTRACT

Doente do sexo masculino, de 78 anos, portador de uma úlcera venosa crônica na perna esquerda, com cerca de 24 anos de evolução, complicada por carcinoma espinocelular. Após o estadia mento da doença, o tratamento preconizado foi amputação acima do joelho esquerdo. A úlcera de Marjolin é a transformação maligna de uma lesão ulcerosa crônica. Trata-se de um fenômeno relativamente raro. A neoplasia maligna mais frequentemente descrita na literatura é o carcinoma espinocelular, seguido do basalioma, sarcoma e melanoma. A sua patogenia permanece pouco compreendida.


This report describes a 78-year old male patient with a chronic venous ulcer on his left leg for the past 24 years, complicated by a squamous-cell carcinoma. After staging of the disease, the treatment administered was amputation of the leg above the knee. Marjolin's ulcer consists of the malignant transformation of a chronic ulcerative lesion. It is a relatively rare phenomenon. The malignant tumor most commonly described in the literature is squamous cell carcinoma, followed by basal-cell carcinoma, sarcoma and melanoma. The pathogenesis of Marjolin's ulcer remains to be fully clarified.


Subject(s)
Aged , Humans , Male , Carcinoma, Squamous Cell/complications , Leg Ulcer/complications , Leg Ulcer/surgery , Osteomyelitis/complications , Skin Neoplasms/complications , Amputation , Chronic Disease , Carcinoma, Squamous Cell/pathology , Carcinoma, Squamous Cell/surgery , Leg Ulcer/pathology , Osteomyelitis/pathology , Osteomyelitis/surgery , Skin Neoplasms/pathology , Skin Neoplasms/surgery
17.
Article in English | WPRIM | ID: wpr-31547

ABSTRACT

Skull base osteomyelitis (SBO) is difficult to diagnose when a patient presents with multiple cranial nerve palsies but no obvious infectious focus. There is no report about SBO with septic pulmonary embolism. A 51-yr-old man presented to our hospital with headache, hoarseness, dysphagia, frequent choking, fever, cough, and sputum production. He was diagnosed of having masked mastoiditis complicated by SBO with multiple cranial nerve palsies, sigmoid sinus thrombosis, and septic pulmonary embolism. We successfully treated him with antibiotics and anticoagulants alone, with no surgical intervention. His neurologic deficits were completely recovered. Decrease of pulmonary nodules and thrombus in the sinus was evident on the follow-up imaging one month later. In selected cases of intracranial complications of SBO and septic pulmonary embolism, secondary to mastoiditis with early response to antibiotic therapy, conservative treatment may be considered and surgical intervention may be withheld.


Subject(s)
Anti-Bacterial Agents/therapeutic use , Anticoagulants/therapeutic use , C-Reactive Protein/analysis , Cranial Nerve Diseases/complications , Diagnosis, Differential , Enterobacter aerogenes/isolation & purification , Enterobacteriaceae Infections/diagnosis , Humans , Lung/pathology , Magnetic Resonance Imaging , Male , Mastoiditis/complications , Middle Aged , Osteomyelitis/complications , Pulmonary Embolism/complications , Sinus Thrombosis, Intracranial/complications , Skull Base , Sputum/microbiology , Tomography, X-Ray Computed
18.
Bol. venez. infectol ; 21(1): 34-40, ene.-jun. 2010. tab, graf
Article in Spanish | LILACS | ID: lil-721047

ABSTRACT

La osteomielitis constituye un proceso inflamatorio común del hueso. Existen factores que influyen en la incidencia y etiología tales como: estado inmunologógico, edad, sexo, traumatismo locales o enfermedades de base. A pesar de su relativa baja frecuencia es una de las principales causas infecciosas de hospitalización prolongada. Describir las características de pacientes con diagnóstico de osteomielitis egresados del Hospital de Niños J.M. de Los Ríos (HJMR) y establacer prevalencia según egresos hospitalarios. Estudio retrospectivo mediante revisión de historias médicas, descriptivo en menores de 18 años con diagnóstico de osteomielitis del Hospital de Niños "J.M. de Los Ríos", período diciembre 1998 - diciembre 2008. Análisis estadístico: medidas tendencias central y Chi cuadrado. Se revisaron 72 historias, 65,3% (47/72) masculino y 34,7% (25/72) femenino. Prevalencia de 0,14 por cada 100 egresados. Según edad 8,33% (6/72) lactantes menores 5,56% (4/72) lactantes mayores, 29% (20/72) preescolares, 29% (20/72) escolares y 27,8% (20/72) adolescentes. Promedio días hospitalización fue 42,5 ± 20,75. El 27,8% (20/72) presentaba alguna patología de base. Sitios afectados 37,5% (27/72) fémur, 23% (17/72) tibia, 6,9% (5/72) calcáneo, 6,94% (5/72) cadera y otros lugares 25% (18/72). En 45,83% (33/72) se realizó limpieza quirúrgica, en promedio a los 26,% días del ingreso (DE ± 33). el 62,5% (45/72) fueron ostemielitis agudas y 37,5% (27/72) crónica. El aislamiento micronbiológicos se logró con mayor frecuencia en el grupo de pacientes con osteomielitis crónica (P < 0,05). Un 11,11% (8/72) presentó algún tipo de secuela y 12,5% (9/72) infección nosocomial. La osteomielitis en niños tiene una prevalencia relativamente baja, pero genera hospitalizaciones prolongadas con importantes complicaciones médicas y quirúrgicas.


Osteomyelitis represents a common inflammatory process of the bone. Immnologic status, age , sex, traumatic lesions and co morbidities influence the etiology and comorbidities influence the etiology and incidence of the disease. It is one of the most important infectious causing prolonged hospitalizations. Describe the characteristics of children with osteomyelitis from J.M. de Los Ríos Children`s Hospital and calculate its prevalence. Retrospective and descriptive study through medical charts revision, including patients less than 18 years old with osteomyelitis as discharged diagnostic at Children Hospital J.M. de Los Ríos between December 1998 - December 2008. Seventy two chart were revised, 65.3% (47/72) male and 34.7% (25/72) female. The prevalence by 100 dischages by age was 8.3% (6/72) infants, 5.6% (4/72) children, 29% (20/72) pre-school children, 29% (20/72) scholer children, and 27.8% (20/72) adolescents. The average hospitalization time was 42.63 ± 20.75. Twenty of 77 children (27.8%) presented with some co morbidities. The affected bones were: 37.5% (27/72) femur, 23% (17/72) tepid bone, 6.9% (5/72) calcaneus, 6.9% (5/72) hip and others 25% (18/72). In 45.8% (33/72) the resolution was surgery, with an average of 26.5 days of hospitak stay (DE ± 24.33); 62.5% (45/72) were acute osteomyelitis, and 37.5% (27/72) chronic. The microbiologic diagnostic was more frequent in the group of chronic (p < 0.05). Sequel were present in 11% (8/72), and nosocomial infection in 12.5% (9/72). Osteomyelitis children has a relative small prevalence, but it generates prolonged hospitalizations with important complications.


Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Wounds and Injuries/complications , Wounds and Injuries/pathology , Osteomyelitis/complications , Osteomyelitis/diagnosis , Osteomyelitis/etiology , Osteomyelitis/immunology , Hospitalization , Pediatrics
20.
Article in French | AIM, AIM | ID: biblio-1265640

ABSTRACT

Objectifs : Decrire la gravite de l'atteinte osseuse et evaluer les resultats du traitement de l'osteomyelite drepanocytaire. Materiel et methodes : Il s'agissait d'une etude prospective allant deDecembre 2005 a Novembre 2006 se rapportant sur les malades admis pour osteomyelite pour causede drepanocytose confirmee. Resultat : Nous avons collige 62 cas d'osteomyelite d'originedrepanocytaire sur 120 cas d'osteomyelite; soit 51;7. L'age moyen a ete de 17 ans. Le diagnostic arepose sur la biologie et l'imagerie. 46;78de nos malades etaient drepanocytaires homozygotes. Ladouleur osseuse a ete le premier motif de consultation avec 53;2des cas. Le staphylocoque dore et lesalmonella ont ete les germes les plus frequents; soit 43;55pour chacun. Les complications ont ete notees chez 32;26dues au retard diagnostique (P 0;05). Le retard dans la prise en charge ou un traitement inadapte peut aboutir a des sequelles graves et definitives pour l'avenir fonctionnel de ces malades


Subject(s)
Academic Medical Centers , Anemia, Sickle Cell , Osteomyelitis/complications
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