Peripheral hemodynamics in patients with posttraumatic osteomyelitis of leg bones]

Complex examination of peripheral hemodynamics with rheovasography, US-dopplerography and laser flowmetry was carried out in 67 patients with posttraumatic osteomyelitis of leg bones. In these patients before treatment there were sings of functional spasm of popliteal artery, increase of circulatory resistance in the bed of anterior and posterior tibial arteries, decrease of precapillary vessels reactivity by hypertonic type, decrease of capillary elasticity, their spasm, difficulty of blood outflow from great and middle veins. During treatment by transsosseous osteosynthesis main-changed type of blood flow, unstable vascular tones, decrease of greater artery elasticity, hypertoe of pre- and postcapillary small vessels were found. After treatment normalization of vascular tone, balance of status of pre- and postcapillary vessels, normal reaction of capillaries to functional test were demonstrated.     

Immunity disorders in an acute destructive pancreatitis and methods of their correction

Immune status in patients with destructive pancreatitis (DP) in long persisting disease and after performance of operative intervention was studied. Signs of secondary combined immunodeficiency were revealed, manifested by decrease of absolute quantity of all lymphocytes populations by 20-70% and concentration of immunoglobulins in blood serum by more than 40%. Conventional therapy did not influence indexes of immunogramm while using immunoglobulin for intravenous injection (IGII), besides saturation of blood by antibodies, the complement activities are increasing as well as indexes of the phagocytes functional state. Application of IGII had promoted the decrease of the patients state severity, normalization of clinico-laboratory data, causing the mortality lowering (P < 0.05), decrease of the treatment duration of survived patients (P < 0.05).     

Surgical correction of the late consequences of posttraumatic spinal disorders

This retrospective study was performed to evaluate the results of the treatment of late posttraumatic spinal disorders. Five patients with thoracolumbar kyphosis, two with paralytic kyphoscoliosis and two with posttraumatic instability with pain but without neurologic symptoms and apparent deformity, were treated surgically. Various surgical procedures were performed depending on the pathologic conditions. Corrections achieved in the sagittal and frontal planes were analyzed on radiographs after a mean follow-up of 4.4 years. In cases of angular kyphosis, the deformity measured 48.8 degrees on average before operation and 9.3 degrees afterward. Preoperative neurologic impairments were improved in all cases. Patients with paralytic scoliosis benefited from an average surgical correction of 68%. The restoration of truncal balance helped the patients to regain a normal sitting posture. Pain was reduced in all patients after surgery, as it was in patients with low back pain caused by posttraumatic instability without deformity. The results of the current study emphasize the importance of adequate management of spinal injuries to prevent late spinal sequelae.     

Adult posttraumatic osteomyelitis of the tibia

Posttraumatic tibial osteomyelitis results from trauma or nosocomial infection from the treatment of trauma that allows organisms to enter bone, proliferate in traumatized tissue, and cause subsequent bone infection. The resulting infection is usually polymicrobial. The patient may be classified using the May and the Cierny-Mader classification systems. The diagnosis is based on the isolation of the pathogen(s) from the bone, or blood cultures. Appropriate therapy of posttraumatic tibial osteomyelitis includes adequate drainage, thorough debridement, obliteration of dead space, stabilization when necessary, wound protection, and specific antimicrobial therapy.     

Actinomycotic osteomyelitis of the facial bones and mandible

Actinomyces israelii is a part of the human oral flora and thus is more commensal than pathogenic. Oral trauma, accidental or purposeful, can precipitate its introduction into the soft tissues, to which infection is usually confined. The case presented is one in which, over a span of two decades (1956 to 1977), the extraction of a mandibular tooth resulted in a chronic actinomycotic osteomyelitis, destroying first the mandible, then both maxillae, and then the right zygoma, with decreased vision and proptosis despite repeated medical and surgical intervention. Adequate treatment required removal of the sequestrum and excision of all infected granulation tissue, scars, and involucra until healthy bone was exposed. Intravenous penicillin was administered for 2 weeks, followed by a 6-month course of oral penicillin. The patient was followed for 4 years and remained disease free.     

Closed distraction epiphysiolysis for leg lengthening and axis correction of the leg in children

The distraction-epiphyseolysis is a method of leg-lengthening and allows to correct leg-deformities. A daily lengthening of 1 mm enhances ossification and enables a maximum lengthening of 8-10 cm. The indications, contra-indications and the method are described.     

Tissue oxygenation in the treatment of chronic posttraumatic osteomyelitis

Complex examination of 117 patients with chronic posttraumatic osteomyelitis (ChPO) was performed. Choice of tactics of treatment of patients with ChPO should be individual and dependent first of all on the general state of the patients. Oxygen barotherapy is thought to be an effective element of the complex treatment.     

Diagnostic errors in hematogenic osteomyelitis of the pelvic bones

The authors have analysed the caused of frequent diagnostic errors in the primary diagnosis which reach 51.2% in 41 patients with hematogenic osteomyelitis of the pelvis. A high percentage of diagnostic errors is caused by more frequent occurrence of hematogenic osteomyelitis of the pelvis in the adults aged 20 to 60 and older who are "not expected" to have hematogenic osteomyelitis which is considered to be a disease characteristic of children and adolescents, by an inadequacy between the provoking etiologic factor and the subsequent development of the disease and by disguise of hematogenic osteomyelitis of the pelvis with symptoms of other frequently occurring diseases. The character of the diagnostic errors is clearly linked with the localization of the process in the bones of the pelvis.