Spinal osteomyelitis: a review of 10 years' experience.

Spinal osteomyelitis is an infrequent cause of back pain, but it can cause severe neurologic compromise or death if not treated effectively. We report 71 cases of spinal osteomyelitis. Ninety-three percent of patients complained of back pain that had been present for several weeks (average: 59 days) at the time of hospitalization. Localized tenderness and an elevated erythrocyte sedimentation rate were often the only abnormal signs. Plain radiographs were abnormal in 39 to 56 cases. At our institution, computed tomography-guided biopsy was safe and effective, yielding a pathogenic organism in 19 of 30 procedures vs 24 of 32 cultures of open surgical specimens.

Breast conservation therapy. Severe breast fibrosis after radiation therapy in patients with collagen vascular disease.

Two patients with collagen vascular disease (rheumatoid arthritis and scleroderma) had extremely poor cosmetic results after breast radiation therapy (RT). The patient with rheumatoid arthritis received 5251 cGy at 210 cGy per day, followed by a 1600 cGy iridium-192 implant boost. Between 8 and 11 months post-RT she had severe breast fibrosis, retraction, and pain that required a mastectomy for relief. The patient with scleroderma received 5040 cGy at 180 cGy per day without a boost. Between 1 and 4 months post-RT the systemic symptoms of scleroderma progressed and the breast became hard and retracted. Both rheumatoid arthritis and scleroderma are chronic systemic diseases characterized by severe inflammation and an autoimmune component. The presence of scleroderma at or before treatment should be considered a contraindication to breast RT, whereas the presence of active rheumatoid arthritis should be considered a relative contraindication. An autoimmune mechanism will be presented to explain both the fibrosis and the systemic progression of collagen vascular disease that was observed.