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51.
We present a 40-year-old woman complaining of worsening chest pain. She was previously treated with a prolonged course of antibiotics for suspected sternal osteomyelitis. Radiological investigations were suggestive of ongoing inflammation within the manubriosternal joint. Formal surgical debridement yielded evidence corroborating the diagnosis although microbiological samples were negative. Prolonged empirical treatment with intravenous antibiotics leads to a complete resolution of symptoms. Primary culture-negative manubriosternal septic arthritis is rare, and suboptimal treatment, particularly if confused with other conditions such as synovitis, acne, pustulosis, hyperostosis and osteitis (SAPHO) syndrome, compounds its considerable morbidity. 相似文献
52.
Backround
Voriconazole is a novel triazole antifungal with a broad spectrum including Aspergillus species. We conducted an open, noncomparative multicenter study to evaluate the efficacy and safety of voriconazole in subacute invasive and chronic pulmonary aspergillosis (CPA).Methods
Patients without profound neutropenia and a proven or probable diagnosis of subacute invasive aspergillosis (IA) or CPA received voriconazole 200 mg twice daily for a period of 4-24 weeks as primary or salvage therapy. Dose escalation was allowed if efficacy was suboptimal, and toleration and safety were satisfactory. Response was assessed by clinical, radiological and mycological changes. A complete or partial response in subacute IA and improved or stable in CPA were assessed as favorable responses.Results
Of 39 patients treated, 36 were assessable. The majority of patients had subacute IA (n = 21), proven in all 11 extra-pulmonary and in 23/25 (92%) of the pulmonary cases. Voriconazole was given as primary therapy in 22 (61%). All patients receiving salvage therapy (n = 14) had refractory IA, having failed itraconazole or amphotericin B (AmB) or both. Overall, a complete or partial response was seen in 9/21(43%) of subacute IA and improved or stable in 12/15 (80%) of those with CPA. Adverse events, mainly liver function test abnormalities, skin reactions, and visual disturbances were mild and transient, leading to early discontinuation of treatment in 5 cases.Conclusions
In patients with subacute IA and CPA, voriconazole was efficacious as salvage or primary therapy. 相似文献53.
54.
Bong-Jin Lee Seong-Tae Kim Min Geun Yoon Sung-Soo Kim Myung-Sang Moon 《Clinics in Orthopedic Surgery》2011,3(3):254-257
Pyogenic spondylitis involving only the posterior element of a vertebra is rare. To the best of our knowledge, there have been no reports of osteomyelitis of the transverse process. We report here on a 45-year-old male with a one month history of swelling associated with lower back pain. The magnetic resonance imaging showed a paraspinal soft tissue mass, and computed tomography revealed a fine osteolytic lesion in the right transverse process of the 5th lumbar spine, and this was all consistent with chronic osteomyelitis. A mixed staphylococcal infection was identified. Open drainage, resection of the transverse process and intravenous injection of anti-staphylococcal antibiotics resolved the back pain and reduced the erythrocyte sedimentation rate to normal. Pyogenic osteomyelitis of the transverse process is extremely rare, which can cause a misdiagnosis or a delayed diagnosis. Careful consideration of this disease is needed when evaluating patients who complain of back pain. 相似文献
55.
Enrique Marco de Lucas Andrés González Mandly Agustín Gutiérrez Raúl Pellón Laura Martín-Cuesta Javier Izquierdo Elena Sánchez Eva Ruiz Fernando Quintana 《Clinical rheumatology》2009,28(3):315-320
Computed tomography (CT)-guided biopsy of the spine is considered a safe, accurate, and relatively inexpensive examination
technique. Our purpose was to determine the diagnostic accuracy of CT-guided biopsies exclusively for vertebral osteomyelitis.
A retrospective study was performed from a consecutive series of 72 patients with confirmed vertebral osteomyelitis with 46
CT-guided biopsies performed in 40 patients. Biopsy specimens were sent for bacteriologic and cytologic analysis. An adequate
specimen for microbiologic examination was not obtained in one case and not enough sample for additional pathologic examination
in 17 cases. The mean age of patients was 58 years, with a range of 1–88 years, including 24 men and 16 women. The level of
spinal biopsy was thoracic in 18 (40%) and lumbar in 28 (60%). The analysis revealed the infection agent in 20 cases (43%
sensitivity). Diagnostic rates obtained in patients with previous antibiotic treatment were significantly lower (23% vs. 60%,
p = 0.013). Computed tomography-guided fine-needle aspiration biopsy is an important tool in the diagnostic evaluation of vertebral
osteomyelitis. However, this technique yields a lower diagnostic rate than previously reported biopsy of neoplastic vertebral
lesions, especially if performed in patients with previous antibiotic treatment. 相似文献
56.
报告了应用改良开放植骨技术治疗17例慢性骨髓炎患者的护理.术前皮肤准备时注意减少皮肤表面损伤;做好床边隔离措施,强调医务人员手卫生,预防院内交叉感染发生.术后保证创面有效负压吸引,及时处理漏气和引流管堵塞;加强外固定器的管理,预防针道感染发生;注意取骨区、植皮区的观察与护理,促进切口愈合.本组植皮后骨髓炎得到控制,创面愈合,缺损骨生长,治疗周期为1~5个月.骨折愈合时间4~18个月,无骨不连、再次骨折发生. 相似文献
57.
外固定支架治疗胫骨骨折内固定术后骨髓炎及软组织缺损 总被引:3,自引:1,他引:2
曹燕明 《中国矫形外科杂志》2001,8(9):876-878
目的:使用外固定支架治疗21例骨折内固定术后骨髓炎或软组织坏死缺损的患者,总结用外固定支架治疗这类疾病的临床规律。方法:用单侧多功能外固定支架,治疗21例内固定术后出现感染或软组织坏死缺损的患者,术中拆除内固定材料,清除骨髓炎病灶,用旋转皮瓣、肌瓣转移、植皮、髂骨植骨等方法,术前术后用敏感抗菌素。结果:病人骨髓炎症状消失,2例需再次髂骨植骨,3个月-1年内拆除外固定支架,无1例截肢。优良率71.4%。结论:使用外固定支架治疗内固定术后骨髓炎或软组织坏死缺损的病人,可有效地消除骨髓炎,并同时保持骨折的稳定性,保证骨折顺利愈合。 相似文献
58.
59.
《Journal of chemotherapy (Florence, Italy)》2013,25(5):542-550
AbstractOsteoarticular infections, although uncommon, represent a severe condition in neonates. Infections in newborns are largely of an acute nature, transmitted by hematogenous means. The most frequently observed etiological agents are: Staphylococcus aureus, Gram negative and group B Streptococcus spp. In the majority of acases the metaphyses of the long bone are the most commonly implicated sites, although infection may spread to the contiguous epiphysis and joint in neonates. Diagnosis of acute septic arthritis and osteomyelitis may be hindered, especially in neonates, due to the manifestation of less clear-cut characteristic symptoms and signs compared to in children. When osteomyelitis is suspected, imaging techniques used in association with blood and tissue cultures are the most reliable diagnostic tests. Antimicrobial treatment should be administered for 3-4 weeks, initially intravenously, later switching to oral medication. Surgery is indicated to drain acute abscesses or when no improvement is achieved following antibiotic treatment. 相似文献
60.
The use of bone anchors as a superior fixation for suburethral slings is becoming popular. We present a case report of pubic
osteomyelitis and granuloma after bone anchor placement. A 71-year-old woman underwent placement of a vaginal wall sling using
pubic bone anchors placed through a suprapubic incision. Recurrent swelling of the mons pubis required re-exploration and
removal of the anchors from an infected pubic bone. When symptoms persisted over the following 10 months, the patient underwent
repeat surgery and excision of a pubic bone granuloma. The use of bone anchors in suburethral sling surgery is associated
with possible increase in patient morbidity, and no benefit to the patient has been shown. 相似文献