Subject(s)
Adrenal Cortex Hormones/adverse effects , Femur Head Necrosis/surgery , Kidney Transplantation/physiology , Adolescent , Adult , Female , Femur Head Necrosis/chemically induced , Femur Head Necrosis/diagnostic imaging , Humans , Kidney Transplantation/immunology , Male , Middle Aged , Prognosis , Radiography , Surgical Procedures, Operative/methodsABSTRACT
Osteoid osteoma in the base of the coracoid process of the scapula is very rare and diagnosis and treatment often is delayed. A lesion in this atypical location may seem surgically unreachable. This report is of a case of osteoid osteoma in the base of coracoid process in a 14-year-old female. The lesion had been diagnosed as a nontumorous condition and overlooked for four years. Computed tomography and magnetic resonance imaging revealed a nidus in the base of the coracoid process. The en bloc excision of the osteoid osteoma was managed by an anterior approach using an osteotomy of the coracoid process. A 12-month follow-up examination revealed no symptoms and computed tomography showed bone healing with no recurrence of the tumor.
Subject(s)
Bone Neoplasms/surgery , Osteoma, Osteoid/surgery , Scapula/surgery , Adolescent , Bone Neoplasms/diagnosis , Female , Humans , Osteoma, Osteoid/diagnosis , Radionuclide Imaging , Tomography, X-Ray ComputedABSTRACT
To determine the clinical role of rifampin containing antibiotic combination and modified two-stage exchange arthroplasty with a vancomycin loaded polymethylmethacrylate (PMMA) spacer for the treatment of orthopaedic implant related Staphylococcus epidermidis infections, a prospective study was initiated. A total of 10 patients, with a mean age of 59 years (range: 32 to 78 years) were included in the study. The mean follow up was 23.4 months (range: 16 to 36 months). Six patients had an infected hemiarthroplasty of the hip, three had infected total hip arthroplasty, and one had an infected femoral neck fracture with implant failure and pseudoarthrosis. All had culture-proven Staphylococcus epidermidis infections, six of the isolates were methicillin resistant. Following debridement and implantation of a PMMA spacer, a rifampin-vancomycin antibiotic protocol was initiated until the erythrocyte sedimentation rate and C-reactive protein levels were within normal limits. After reimplantation and discharge from the hospital, oral antibiotics with rifampin-ciprofloxacin were continued for three to six months. At the final follow-up none of the patients had any clinical or laboratory signs of infection. Although this study includes a limited number of patients and relatively short-term follow-up the results indicate that in the presence of orthopaedic implant infection with Staphylococcus epidermidis, modified two-stage exchange arthroplasty using a vancomycin-loaded PMMA spacer and a rifampin-containing antibiotic protocol may be beneficial.
Subject(s)
Arthroplasty, Replacement, Hip/instrumentation , Hip Prosthesis/adverse effects , Prosthesis-Related Infections/drug therapy , Rifampin/administration & dosage , Staphylococcal Infections/drug therapy , Staphylococcus epidermidis/isolation & purification , Vancomycin/administration & dosage , Adult , Aged , Anti-Bacterial Agents/administration & dosage , Arthroplasty, Replacement, Hip/methods , Chronic Disease , Female , Follow-Up Studies , Humans , Male , Middle Aged , Prospective Studies , Prosthesis-Related Infections/surgery , Reoperation , Staphylococcal Infections/surgery , Treatment OutcomeABSTRACT
Calcific myonecrosis is a rare and late sequela of compartment syndrome, which becomes symptomatic years after the initial trauma. We diagnosed this condition in a 64-year old man, 42 years after he sustained a shot-gun wound to the right lower leg. Total excision of a peripherally calcified, cystic mass, continuous with the anterior tibial muscle belly resulted in complete resolution of symptoms. Consideration of the diagnosis is warranted in patients with a history of major injury who develop a soft tissue mass in the traumatized compartment. The treatment of choice is marginal excision.
Subject(s)
Calcinosis/pathology , Calcinosis/surgery , Muscular Diseases/pathology , Muscular Diseases/surgery , Calcinosis/etiology , Follow-Up Studies , Humans , Leg , Male , Middle Aged , Muscular Diseases/etiology , Necrosis , Treatment Outcome , Wounds, Gunshot/complicationsABSTRACT
Melanoma can metastasize to almost every organ and tissue. Although bone metastases have been reported frequently, the authors are aware of only a single report of intra-articular synovial metastasis. A case of metastatic melanoma, mimicking degenerative medial meniscal tear of the right knee, is presented. Further examination revealed asymptomatic metastases in the liver, subcutaneous tissue, and left trochanter minor. Arthroscopic examination revealed widespread synovial metastasis and a palliative arthroscopic synovectomy was performed.
Subject(s)
Bone Neoplasms/secondary , Ear Neoplasms/pathology , Knee Joint/pathology , Melanoma/secondary , Synovial Membrane/pathology , Arthrography , Arthroscopy , Bone Neoplasms/diagnosis , Bone Neoplasms/surgery , Diagnosis, Differential , Ear Neoplasms/diagnosis , Ear Neoplasms/surgery , Endoscopy , Follow-Up Studies , Humans , Knee Joint/diagnostic imaging , Knee Joint/surgery , Male , Melanoma/diagnosis , Melanoma/surgery , Middle Aged , Neoplasm Recurrence, Local , Palliative Care , Retrospective Studies , SynovectomyABSTRACT
Teicoplanin-impregnated plaster of Paris beads were made and in vitro release properties were studied. Teicoplanin was released in an initial massive dose, with a rapid decline during the first three days, followed by a slowly declining prolonged release up to 30 days. The release tested by diffusion in gelose and high-performance liquid chromatography was found to be 21.4% and 28.2%, respectively, of the amount theoretically present in the beads. Plaster of Paris is a resorbable, nontoxic biomaterial that has already been used to fill dead spaces in bone and deliver antibiotics in the treatment of chronic osteomyelitis. The addition of teicoplanin, a new antistaphylococcal agent with low known bacterial resistance, is a promising alternative. Follow-up tests in vivo, simulating local conditions of the osteomyelitic bone, are necessary to prove efficacy.
