Osteomielitis crónica recurrente: un reto diagnóstico y terapéutico / Chronic recurrent osteomyelitis: a diagnostic and therapeutic challenge

Introducción. La osteomielitis crónica recurrente (OCR) es una rara enfermedad caracterizada por lesiones óseas inflamatorias asépticas uni- o multifocales. Objetivo. Valorar características clínicas y la respuesta al tratamiento con AINE de los pacientes con OCR. Materiales y métodos. Cinco niños con OCR valorados de forma retrospectiva por un periodo de 8 años, los cuales fueron diagnosticados basándose en los hallazgos clínicos, analíticos, estudio anatomopatológico de las lesiones y pruebas de imagen. Resultados. El 40% presentó afectación multifocal y el 60% unifocal. El 80% eran del sexo masculino (4/5), la edad media al momento del diagnóstico 13 años (r: 11-15 años), los huesos más frecuentemente afectados fueron la clavícula y la tibia representado el 18,2%, el síntoma más común fue el dolor presentándose en todos los pacientes, la fiebre apareció en el 20% de los casos. Los estudios de imagen como la TAC y la RM fueron eficaces en el 100% y en todos la biopsia objetivó infiltrado linfoplasmocitario. Después de un seguimiento medio de 5,9 años se observó una buena respuesta al tratamiento en el 100%, con una recurrencia media a los 5,25 meses. Conclusiones. Los resultados anodinos de la mayoría de los estudios clínicos para valorar OCR y la similitud en la presentación clínica de esta con muchas patologías infecciosas o tumorales hace que su diagnóstico represente un verdadero reto, por otra parte el tratamiento con AINE puede considerarse una buena opción terapéutica inicial (AU)

Introduction. Chronic recurrent osteomyelitis (CRO) is a rare disease characterised by unifocal or multifocal aseptic inflammatory bony lesions. Objective. To evaluate clinical features and response to treatment with non-steroidal anti-inflammatory drugs in patients with CRO. Materials and methods. A retrospective assessment was conducted on 5 children with OCR over a period of 8 years. They had been diagnosed based on clinical, laboratory findings, histological study of injuries, and imaging test. Results. Multifocal disease was observed in 40% of cases, and unifocal in 60%. The large majority (80%) were male, with a mean age at diagnosis of 13 years (range: 11-15 years). The bones most frequently affected were the clavicle and tibia, representing 18.2%. The most common presenting symptom was pain in all patients, with fever being present in 20% of cases. Imaging studies such as CT and MRI were effective in 100%, and in all cases the biopsy reported a lymphoplasmacytic infiltrate. After a mean follow-up of 5.9 years, there was a good treatment response in 100%, with a mean recurrence at 5.25 months being observed. Conclusions. The anodyne results of most clinical studies to assess CRO, and the similarity in clinical presentation of this with many infectious or tumour diseases makes its diagnosis a real challenge. On the other hand treatment with NSAIDs can be considered a good initial therapeutic option (AU)

Chronic recurrent osteomyelitis: A diagnostic and therapeutic challenge. / Osteomielitis crónica recurrente: un reto diagnóstico y terapéutico.

INTRODUCTION: Chronic recurrent osteomyelitis (CRO) is a rare disease characterised by unifocal or multifocal aseptic inflammatory bony lesions. OBJECTIVE: To evaluate clinical features and response to treatment with non-steroidal anti-inflammatory drugs in patients with CRO. MATERIALS AND METHODS: A retrospective assessment was conducted on 5 children with OCR over a period of 8 years. They had been diagnosed based on clinical, laboratory findings, histological study of injuries, and imaging test. RESULTS: Multifocal disease was observed in 40% of cases, and unifocal in 60%. The large majority (80%) were male, with a mean age at diagnosis of 13 years (range: 11-15 years). The bones most frequently affected were the clavicle and tibia, representing 18.2%. The most common presenting symptom was pain in all patients, with fever being present in 20% of cases. Imaging studies such as CT and MRI were effective in 100%, and in all cases the biopsy reported a lymphoplasmacytic infiltrate. After a mean follow-up of 5.9 years, there was a good treatment response in 100%, with a mean recurrence at 5.25 months being observed. CONCLUSIONS: The anodyne results of most clinical studies to assess CRO, and the similarity in clinical presentation of this with many infectious or tumour diseases makes its diagnosis a real challenge. On the other hand treatment with NSAIDs can be considered a good initial therapeutic option.

Experimental inflammation of the rat distal colon inhibits ion secretion in the proximal colon by affecting the enteric nervous system.

Intestinal inflammation causes hyporesponsiveness of the inflamed tissue to secretagogues but little is known about the behaviour of the areas proximal to the site of inflammation. We studied the responses of the proximal segment of the colon to carbachol, histamine, isobutylmethylxanthine (IBMX) and vasoactive intestinal peptide (VIP) in rats with trinitrobenzenesulphonic acid (TNBS)-induced, chronic inflammation of the distal colon. Macroscopic and biochemical analysis ruled out the presence of inflammation in the proximal colon. When mounted in Ussing chambers under voltage-clamp conditions, basal transport and conductance were not affected. However, the maximum response in the concentration/response curves (short-circuit current) for carbachol and histamine was reduced in TNBS-treated rats, without changes in the EC(50). This effect corresponded to reduced chloride secretion, as demonstrated by ion substitution experiments. The responses to IBMX and VIP were virtually unaffected. The inhibitory effect was abolished by pretreatment with the neural blockers tetrodotoxin and lidocaine but not indomethacin, suggesting that the enteric nervous system is responsible for the inhibition. In conclusion, chronic distal inflammation of the distal colon results in inhibition of calcium-dependent secretion in the proximal colon via a reduction of the contribution of the enteric nervous system.