Perioperative considerations in orthopaedic patients with diabetes mellitus: a review.

Patients with diabetes mellitus are predisposed to a host of orthopaedic problems which may require surgery and many patients with orthopaedic conditions may have unrecognised hyperglycaemia presenting for the first time at surgery. This group of patients are also prone to adverse surgical outcomes like post-operative infections and poor wound healing. The control of hyperglycaemia in orthopaedic patients with diabetes mellitus is the key in optimising surgical outcome in these patients. Peri-operative insulin is the main antihyperglycaemic agent of use. The risk of hypoglycaemia with tighter peri-operative glucose control outweighs its potential benefits. Blood glucose control with insulin infusion is better than sliding scale insulin. Control of infections and promotion of wound healing are necessary adjuncts in the management to optimise surgical outcome.

Chronic recurrent multifocal osteomyelitis: a case report and review of literature.

BACKGROUND: Chronic recurrent multifocal osteomyelitis (CRMO) is a rare condition of largely unknown aetiology and pathogenesis with variable clinical and radiological features. There are no reports on CRMO to the best of our knowledge; in the West African sub region. OBJECTIVE: To present a case and review the literature on chronic recurrent multifocal osteomyelitis. METHODS: A 13-year-old male presented with a three-year history of recurrent discharging right thigh sinus and an 11-day history of a left shoulder swelling with discharging sinus. Detailed history was obtained and physical examination and radiological and microbiological tests carried out before treatments. RESULTS: There were periodic exacerbations of pain, swelling and discharge over affected areas. 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 no growth. Radiographs of the left arm, right thigh and hip showed features consistent with chronic osteomyelitis. There were associated destruction of the left hip and soft tissues welling in the left shoulder. He was principally treated with non-steroidal anti-inflammatory drugs (NSAIDs) , antibiotics and dressing of sinuses for three months and had only mild relief of clinical features but no improvement in radiological picture. CONCLUSION: Chronic recurrent multifocal osteomyelitis is a diagnosis of exclusion which is usually under diagnosed because amongst other things, not much is known about it. Successful treatment is difficult to achieve, though some authors have reported good results with combined medical and surgical treatment.

Stroke syndrome in the young due to obliterative arteritis of extracranial carotid arteries. Clinical pathological profiles.

Transient Ischemic Attack (TIA) and Cerebrovascular Accidents (CVA) are rare in the young. Extracranial carotid arterial obstruction as a cause for CVA is even more exceptional. We present two cases of TIA and CVA in patients below the age of 30. They needed bypass graft and total excision of the artery. Histological diagnosis was arteritis. The clinical, laboratory and surgical data are presented.