Clinical study of drug-loaded calcium sulfate in the treatment of hematogenous osteomyelitis in children.

BACKGROUND: At present, good results have been obtained in the treatment of hematogenous osteomyelitis(HO) in children by the use of drug-loaded calcium sulfate, but there are few clinical studies reported. The aim of this study was to investigate the clinical efficacy of radical debridement combined with drug-laden calcium sulphate antibiotics in paediatric haematogenous osteomyelitis. METHODS: In this study, we retrospectively analyzed the clinical data of 15 cases of pediatric hematogenous osteomyelitis admitted to our hospital in recent years. A total of 15 pediatric patients with HO treated in our hospital from January 2018 to February 2022 were included for evaluation. RESULTS: All 15 patients were treated with drug-laden calcium sulfate, and the antibiotic of choice was vancomycin in 14 cases and vancomycin combined with gentamicin in 1 case. The follow-up period ranged from 12 to 36 months, with a mean follow-up time of 24.73 months, and all children were treated with drug-laden calcium sulfate with satisfactory clinical outcomes. The results of serological examination showed that the preoperative white blood cell count level, C-reactive protein and erythrocyte sedimentation rate were higher than the postoperative ones, and the differences were statistically significant (P < 0.05).After the operation, referring to the treatment standard of McKee's osteomyelitis, 15 cases were cured without recurrence; According to the Lower Extremities Functional Scale, 12 cases were excellent, 2 cases were good and 1 case was moderate, with an excellent rate of 93.33%. Children with lower limb involvement could walk with full weight bearing, and gait was basically normal. CONCLUSION: Drug-loaded calcium sulfate is a good therapeutic method for the treatment of hematogenous osteomyelitis in children, with a effect of reducing complications and reducing recurrence.

Does the ratio of the carpal tunnel inlet and outlet cross-sectional areas in the median nerve reflect carpal tunnel syndrome severity?

Although ultrasound measurements have been used in previous studies on carpal tunnel syndrome to visualize injury to the median nerve, whether such ultrasound data can indicate the severity of carpal tunnel syndrome remains controversial. The cross-sectional areas of the median nerve at the tunnel inlet and outlet can show swelling and compression of the nerve at the carpal. We hypothesized that the ratio of the cross-sectional areas of the median nerve at the carpal tunnel inlet to outlet accurately reflects the severity of carpal tunnel syndrome. To test this, high-resolution ultrasound with a linear array transducer at 5-17 MHz was used to assess 77 patients with carpal tunnel syndrome. The results showed that the cut-off point for the inlet-to-outlet ratio was 1.14. Significant differences in the inlet-to-outlet ratio were found among patients with mild, moderate, and severe carpal tunnel syndrome. The cut-off point in the ratio of cross-sectional areas of the median nerve was 1.29 between mild and more severe (moderate and severe) carpal tunnel syndrome patients with 64.7% sensitivity and 72.7% specificity. The cut-off point in the ratio of cross-sectional areas of the median nerve was 1.52 between the moderate and severe carpal tunnel syndrome patients with 80.0% sensitivity and 64.7% specificity. These results suggest that the inlet-to-outlet ratio reflected the severity of carpal tunnel syndrome.

Thoracoscopy-assisted first rib resection for the treatment of thoracic outlet syndrome caused by fibrous dysplasia: A report of two cases.

This study reports two rare cases of thoracic outlet syndrome (TOS) caused by fibrous dysplasia of the first rib. Two patients, aged 19 and 29 years old, were admitted with TOS in the lower trunk of the brachial plexus caused by an inflated first rib. In these two cases symptoms included hypoesthesia of the anterior medial aspect of the forearm and two fingers in the ulnar side, and progressive weakness of the upper limbs. Surgery was required to resect the first rib. Transaxillary and supraclavicular excisions were challenging to perform due to the involvement of the subclavian vasculature and brachial plexus. Thoracoscopy was used in these cases in order to peel the pleura off the first rib and facilitate resection by the supraclavicular approach. None of the patients exhibited nerve or vascular complications following the surgery.

Managing pediatric thoracic outlet syndrome.

BACKGROUND: Thoracic outlet syndrome (TOS) is largely overlooked in children and adolescents because the condition is not widely viewed as a pediatric disorder. This study aimed to clarify the causes, best treatment approaches, and prognosis for young patients with TOS. METHODS: A retrospective study was conducted on 13 patients, from 4 to 13 years of age, with TOS. Ten children underwent surgical treatment, and three were treated conservatively. All patients received local nerve blocks on two occasions and were followed-up for more than 2 years. RESULTS: Among the 10 children who underwent surgery, six school-aged children returned to school 10 to 14 days after surgery. Parents of the three children treated conservatively reported that activity within the affected limb and overall muscle strength had increased in their children and none of the three children had complained about discomfort in the affected limb. CONCLUSION: A diagnosis of TOS should be considered when a child or adolescent has neck and shoulder discomfort, hand numbness, and upper limb weakness. As with adults with TOS, detailed physical examination is the key to diagnosing pediatric TOS. Conservative treatment is effective for young TOS patients who have mild changes in the length and thickness of the affected limb and is an option when parents refuse surgical treatment.