scholarly journals 321. Eleven-year Case Series of the Anatomy and Microbiology of Musculoskeletal Infections in People who Inject Drugs

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S232-S233
Author(s):  
Meredith A Schade ◽  
Abby London ◽  
Dan Lin
Keyword(s):  
Staphylococcus Aureus ◽  
Soft Tissue ◽  
Case Series ◽  
Axial Skeleton ◽  
Injection Drug ◽  
Treatment Modalities ◽  
Appendicular Skeleton ◽  
Diagnosis Codes ◽  
Lost To Follow Up

Abstract Background Complex musculoskeletal infections(MSKI) can be seen in injection drug users. The objective of the study was to describe the anatomic location and microbial etiology of MSKI. Methods This is a single center, eleven-year case series of adult patients admitted with infection of the musculoskeletal system from January 1, 2008 to December 31, 2018. Diagnosis codes for MSKI were used. As there are no diagnosis codes that specifically identify injection drug use, ICD-9 and ICD-10 codes for related diagnoses were used. The codes included opioid use disorder, drug abuse, heroin use, drug overdose, cocaine use, and methamphetamine use.Charts were then carefully reviewed to determine if a MSKI related to IDU had occurred. Fisher’s exact test was used to calculate P values. Results A total of 849 individual medical records were identified. Eighty-six distinct episodes of infection were found in eighty-two patients. Most patients were white, non-Hispanic, male, 50 years of age or younger. Tobacco use disorder(87.8%) and hepatitis C(64.6%) were common. Mental health disorders were identified in one third. The axial skeleton was involved in 61.6% and the appendicular in 25.6%. Soft tissue infection alone was present in 9%. Bacterial infections predominated with Staphylococcus aureus most frequent(67.4%) followed by Pseudomonas aeruginosa (11.6%). Candida species were uncommon. All soft tissue infections were polymicrobial. Infections of the appendicular skeleton were managed with antibiotics and surgery whereas infections of the axial skeleton were more likely to receive antibiotics alone. Seventy two percent had successfully completed treatment at one year. The remainder had relapsed due to same infection, died or were lost to follow up. Demographics of Study Population Anatomy and Microbiology of MSKI in PWID and 1-year Treatment Outcomes Anatomy and Microbiology of MSKI in PWID with Different Treatment Modalities Conclusion MSKI in PWID continue to be found in younger persons with relatively few comorbidities. The infections predominantly involve the axial skeleton and are caused most often by Staphylococcus aureus. Gram-negative infections also occur and are due to environmental bacteria. Spinal infections were managed medically whereas infections of peripheral joints were also managed with surgery. An unfortunate number had relapse of infection, died or were lost to follow-up at 1 year, demonstrating the challenges of managing MSKI in this unique population Disclosures All Authors: No reported disclosures

Case Series Regarding Parastomal Variceal Bleeding: Presentation and Management

2018 ◽  
Vol 17 (5) ◽  
pp. 0-10
Author(s):  
John Romano ◽  
Charles V. Welden ◽  
Jordan Orr ◽  
Brendan McGuire ◽  
Mohamed Shoreibah
Keyword(s):  
Portal Hypertension ◽  
High Risk ◽  
Literature Review ◽  
Variceal Bleeding ◽  
Coil Embolization ◽  
Case Series ◽  
Treatment Modalities ◽  
Post Procedure ◽  
Lost To Follow Up

Parastomal variceal bleeding (PVB) is a serious complication occurring in up to 27% of patients with an ostomy and concurrent cirrhosis and portal hypertension. The management of PVB is difficult and there are no clear guidelines on this matter. TIPS, sclerotherapy, and /or coil embolization are all therapies that have been shown to successful manage PVB. We present a case series with five different patients who had a PVB at our institution. The aim of this case series is to report our experience on the management of this infrequently reported but serious condition. We also conducted a systemic literature review focusing on the treatment modalities of 163 patients with parastomal variceal bleeds. In our series, patient 1 had embolization and sclerotherapy without control of bleed and expired on the day of intervention due to hemorrhagic shock. Patient 2 had TIPS in conjunction with embolization and sclerotherapy and had no instance of rebleed 441 days after therapy. Patient 3 did not undergo any intervention due to high risk for morbidity and mortality, the bleed self-resolved and there was no further rebleed, this same patient died of sepsis 73 days later. Patient 4 had embolization and sclerotherapy and had no instance of rebleed 290 days after therapy. Patient 5 had TIPS procedure and was discharged five days post procedure without rebleed, patient has since been lost to follow-up.

scholarly journals Retrospective Analysis of Spectrum of Presentation and Treatment Outcome in Extremity Sarcomas: A Single-Centre Experience

Sarcoma ◽  
2018 ◽  
Vol 2018 ◽  
pp. 1-5
Author(s):  
Saurabh Bansal ◽  
Kunal Das ◽  
Navneet Jain ◽  
Vipul Nautiyal ◽  
Meenu Gupta ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Soft Tissue Sarcoma ◽  
Retrospective Analysis ◽  
Treatment Modalities ◽  
Single Center Experience ◽  
Extremity Soft Tissue Sarcoma ◽  
Geographical Regions ◽  
Majority Outcome ◽  
Lost To Follow Up

Introduction. The most common site for soft tissue sarcoma is extremity. As complete surgical resection is possible in majority, outcome of this subset is relatively better. There is paucity of data regarding extremity soft tissue sarcoma (STS) from sub-Himalayan and hilly geographical regions. Materials and Methods. Retrospective analysis was done for extremity STS visiting the study center over a period of 5 years. Data were collected and analyzed for demography, disease characteristics, treatment modalities, and outcome. Result. Extremity STS constituted 32.8% of all STS enlisted. Most common subtype noted was pleomorphic STS. Metastatic disease at presentation was noted among 7/43 cases with lung being the most common metastasis site. Wide local excision was done in 37 cases while amputation was required in 5 cases. Adjuvant radiotherapy was given in 27 cases while 18 cases received adjuvant chemotherapy. At median follow-up of 47 months, the overall survival and event-free survival were noted as 47.64% and 41.49%, respectively. Conclusion. This study depicts single-center experience of extremity STS. The population analyzed was from sub-Himalayan region with significant lost to follow-up. Pooling of data from different centers has been advocated to derive conclusive results.

Gout in the Axial Skeleton

2009 ◽  
Vol 36 (3) ◽  
pp. 609-613 ◽  
Author(s):  
RUKMINI M. KONATALAPALLI ◽  
PAUL J. DEMARCO ◽  
JAMES S. JELINEK ◽  
MARK MURPHEY ◽  
MICHAEL GIBSON ◽  
...  
Keyword(s):  
Facet Joint ◽  
Case Reports ◽  
Case Series ◽  
Lumbar Vertebrae ◽  
Axial Skeleton ◽  
Ct Images ◽  
Common Finding ◽  
Appendicular Skeleton ◽  
Pars Interarticularis ◽  
A Prospective Study

Objective.Gout typically affects the peripheral joints of the appendicular skeleton and rarely involves the axial joints. The literature on axial gout is limited to case reports and case series. This preliminary study was conducted to identify the frequency and characteristics of axial gout.Methods.Six hundred thirty medical records with ICD codes 274.0, 274.82, and 274.9 for peripheral gout were reviewed. Ninety-two patients had clinical or crystal-proven gout, of which 64 had prior computed tomography (CT) images of the spine performed for various medical reasons. These CT images were reviewed for features of axial gout, which include vertebral erosions mainly at the discovertebral junction and the facet joints, deposits of tophi, and erosions in the vertebral body, epidural space, ligamentum flavum and pars interarticularis.Results.Nine of the 64 patients had radiographic changes suggestive of axial gout. Lumbar vertebrae were most commonly involved, with facet joint erosions being the most common finding. Isolated involvement of the sacroiliac joints was seen in 2 patients. Axial gout had been diagnosed clinically in only one patient.Conclusion.Radiologic changes of axial gout were more common than recognized clinically, with a frequency of 14%. Since not all patients had CT images, it is possible that the frequency of axial involvement was even greater. A prospective study is needed to further define this process.

scholarly journals Arthroscopic treatment of anteromedial ankle impingement

2020 ◽  
Vol 14 (3) ◽  
pp. 260-263
Author(s):  
Guillermo Arrondo ◽  
Daniel Gómez ◽  
Germán Joannas ◽  
Xavier Martín-Oliva ◽  
Matías Iglesias ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Range Of Motion ◽  
Case Series ◽  
Functional Results ◽  
Level Of Evidence ◽  
Bony Impingement ◽  
Soft Tissue Impingement ◽  
Arthroscopic Removal ◽  
Physical Impact

Objective: Impingement syndromes are recognized as an important cause of chronic ankle pain, which results from the entrapment of an inflamed soft-tissue component between the osteophytes. The predominant site of occurrence is the anterolateral aspect of the ankle for soft-tissue impingement, and anteromedial aspect for bony impingement. Symptoms related to the physical impact of bone or soft-tissue pain often result in limited ankle range of motion. Methods: We conducted a retrospective study of 34 patients (34 ankles) with anteromedial bony impingement. All patients underwent arthroscopy, with a mean follow-up of 34 months. Results: All osteophytes were removed, and the ankle range of motion improved. The AOFAS score improved from 73 preoperatively to 95 postoperatively. Conclusion: The arthroscopic removal of the anteromedial osteophytes of the ankle had excellent functional results. It is an effective procedure that allows rapid patient recovery. Level of Evidence IV; Therapeutic Studies; Case Series.

scholarly journals Multiple Victims of Carbon Monoxide Poisoning in the Aftermath of a Wildfire: A Case Series

2018 ◽  
Vol 31 (3) ◽  
pp. 146 ◽  
Author(s):  
Luís Ramos dos Santos ◽  
Magna Alves-Correia ◽  
Margarida Câmara ◽  
Manuela Lélis ◽  
Carmo Caldeira ◽  
...  
Keyword(s):  
Carbon Monoxide ◽  
Hyperbaric Oxygen ◽  
Clinical Symptoms ◽  
Carbon Monoxide Poisoning ◽  
Case Series ◽  
Neurological Syndrome ◽  
High Flow Oxygen ◽  
Lost To Follow Up ◽  
Mean Time

Introduction: Carbon monoxide poisoning may occur in several contexts.Material and Methods: Retrospective of 37 carbon monoxide poisoning cases that underwent hyperbaric oxygen during wildfires in Funchal in August 2016.Results: The studied sample included 37 patients, mean age of 38 years, 78% males. Ten were firefighters, four children and two pregnant victims. Neurological symptoms were the most reported. Median carboxyhemoglobin level was 3.7% (IQR 2.7). All received high-flow oxygen from admission to delivery of hyperbaric oxygen. Persistence of symptoms was the main indication for hyperbaric oxygen. Median time to hyperbaric oxygen was 4.8 hours (IQR 9.5), at 2.5 ATA for 90 minutes, without major complications. Discharge in less than 24 hours occurred in 92% of the cases. Thirty days follow-up: five patients presented clinical symptoms of late neurological syndrome; twelve patients were lost to follow-up. Carboxyhemoglobin levels on admission and mean time to hyperbaric oxygen were no different between those who did and did not develop the syndrome at 30 days (p = 0.44 and p = 0.58, respectively).Discussion: Late neurological syndrome at 30 days occurred in 20% and no new cases were reported at 12 months.Conclusion: Use of hyperbaric oxygen appears to have reduced the incidence of the syndrome. This seems to be the first Portuguese series reporting use of hyperbaric oxygen in carbon monoxide poisoning due to wildfires. The authors intend to alert to the importance of referral of these patients because the indications and benefits of this treatment are well documented. This is especially important given the ever-growing issue of wildfires in Portugal.

Outcomes of closed reduction in patients with developmental dysplasia of the hip incorporating open psoas and adductor release and using short leg cast

2021 ◽  
Vol 15 (5) ◽  
pp. 1529-1532
Author(s):  
M. S. Abdulqader ◽  
L. J. Khorsheed ◽  
Hwaizi .
Keyword(s):  
Soft Tissue ◽  
Closed Reduction ◽  
Case Series ◽  
Developmental Dysplasia ◽  
Soft Tissue Release ◽  
Plaster Of Paris ◽  
Dysplasia Of The Hip ◽  
Mid Term Results ◽  
Tönnis Grade

Background and objectives: Closed reduction and short leg spica casting are the preferred treatment options for children with developmental dysplasia of the hip. This study aimed to show the efficacy behind a standardized closed reduction for managing patients with developmental dysplasia of the hip with concomitant soft tissue releases when indicated and using a short leg plaster of Paris cast to maintain reduction and reporting mid-term results. Methods: A case series of 95 hips in 84 children aged 6-18 months who had closed reduction, with five years follow up or until next operation, involved in this study. The protocol defines acceptable concentric reduction criteria and the indications for an associated soft tissue release. All the patients were immobilized in a short leg cast for three months. Multiple follow-up radiographs were taken to assess Tönnis grade, Severin grade, acetabular index, and osteonecrosis signs. Results: A total of 48 hips were Tönnis grade 3/4 hips. At one year, 15 reductions couldn’t be maintained, and these patients needed open reduction. Of these 15 failed reductions, 7 patients were Severin 1; others were Severin 2. Of the 80 successful closed reductions, 70 hips were Severin 1. Surgical management for residual dysplasia was offered for 8 hips. Osteonecrosis was seen in 23 hips but was transient in 20. Bilateral hip dislocations and most Tönnis 4 hips were more likely to fail. Two children had severe osteonecrosis. Conclusions: Closed reduction, with subsequent adductor and psoas releases, when indicated and using a short leg plaster of Paris cast for three months, brings about good mid-term results in children with developmental dysplasia of the hip aged 6-18 months. Keywords: Developmental dysplasia of the hip, closed hip reduction, open psoas release, short leg cast.

scholarly journals Consecutive Case Series of Healed Single-Molar Sites Immediately Restored with Wide-Diameter Implants: A 1-Year Evaluation

2016 ◽  
Vol 2016 ◽  
pp. 1-8 ◽  
Author(s):  
Hadi Antoun ◽  
Pierre Cherfane ◽  
Bouchra Sojod
Keyword(s):  
Success Rate ◽  
Case Series ◽  
Marginal Bone Loss ◽  
Wide Diameter ◽  
Bone Level ◽  
One Year ◽  
Lost To Follow Up ◽  
Single Crowns

Introduction. To evaluate outcomes of wide-diameter (6 mm) implants immediately provisionalized with cement-retained single crowns in posterior molar sites.Materials and Methods. Forty-eight consecutive patients received a total of 53 moderately rough-surface, 6 mm diameter implants in healed sites. All implants were immediately provisionalized with a cement-retained provisional crown. Final prosthesis with cement-retained porcelain fused to metal crowns was delivered 3–6 months later. Patients were followed up for 1 year. Outcome measures were implant failures and success rate, complications, marginal bone levels, bone level changes, papilla index, bleeding on probing, and inflammation.Results. One patient was lost to follow-up. At one year, the implant survival and success rate were 98.1%. The mean marginal bone loss after 1 year was −0.17±1.84 mm. Ideal papilla score was recorded at 83.8% of the sites. More than 95.6% of the sites showed no bleeding or inflammation. No procedure-related or device-related adverse events were reported.Conclusion. Wide-diameter (6 mm) implants can safely and successfully replace single posterior molars. Longer follow-up studies are necessary to evaluate the long-term success of these implants.

Effectiveness of Calcium Hydroxylapatite Paste in Vocal Rehabilitation

2009 ◽  
Vol 118 (8) ◽  
pp. 546-551 ◽  
Author(s):  
M. Boyd Gillespie ◽  
Thomas S. Dozier ◽  
Terry A. Day ◽  
Bonnie Martin-Harris ◽  
Shaun A. Nguyen
Keyword(s):  
Soft Tissue ◽  
Vocal Fold ◽  
Case Series ◽  
Soft Tissue Defects ◽  
Retrospective Case ◽  
Vocal Rehabilitation ◽  
Calcium Hydroxylapatite ◽  
The Voice ◽  
Tissue Defects

Objectives We determined the effectiveness of calcium hydroxylapatite (CaHA) paste in vocal rehabilitation. Methods We examined a retrospective case series of 39 adult patients who underwent CaHA paste injection for vocal fold rehabilitation over a 5-year period. The outcomes included the change in the Voice Handicap Index (VHI) score; procedure-related complications; and the need for follow-up voice procedures. Results The VHI scores demonstrated overall improvement, with a decrease from the preoperative mean of 61.2 ± 24.0 to a postoperative mean of 35.9 ± 26.3 (p = 0.0001) after a mean follow-up time of 17.8 ± 13.6 months. The procedure was more likely to succeed in patients with paralysis and/or paresis than in patients with glottic soft tissue defects. After injection, the VHI scores worsened in 3 of 7 patients (43%) in the soft tissue defect group, compared to only 2 of 28 (7%) in the paralysis and/or paresis group (p = 0.04). Four of 7 patients with soft tissue defects (57%) required secondary vocal procedures to improve the voice, compared to only 2 of 32 (6%) in the paralysis and/or paresis group (p = 0.006). Conclusions Injection of CaHA paste results in significantly improved vocal scores in the majority of patients. Use of the paste was less satisfactory in patients with soft tissue defects because of poor retention of the paste in the scarred vocal fold remnant.

scholarly journals High Staphylococcus aureus Colonization Prevalence among Patients with Skin and Soft Tissue Infections and Controls in an Urban Emergency Department

2014 ◽  
Vol 53 (3) ◽  
pp. 810-815 ◽  
Author(s):  
Neha Kumar ◽  
Michael Z. David ◽  
Susan Boyle-Vavra ◽  
Julia Sieth ◽  
Robert S. Daum
Keyword(s):  
Staphylococcus Aureus ◽  
Soft Tissue ◽  
The United States ◽  
Antimicrobial Treatment ◽  
Soft Tissue Infections ◽  
Content Type ◽  
Treatment Regimens ◽  
Commensal Species ◽  
High Prevalence

Staphylococcus aureusis a commensal species that can also be a formidable pathogen. In the United States, an epidemic of community-acquired methicillin-resistantStaphylococcus aureus(MRSA) infections has been occurring for the last 15 years. In the context of a study in which we identified patients with skin and soft tissue infections (SSTIs) and randomized them to receive one of two antimicrobial treatment regimens, we assessedS. aureuscolonization in the nares, throat, and perianal skin on the day of enrollment and 40 days after therapy. We compared the prevalence of colonization between the SSTI patients and an uninfected control population. A total of 144 subjects and 130 controls, predominantly African American, participated in this study, and 116 returned for a 40-day follow-up visit. Of the SSTI patients, 76% were colonized withS. aureusat enrollment, as were 65% of the controls. Patients were more likely than the controls to be colonized with USA300 MRSA (62/144 [43.1%] versus 11/130 [8.5%], respectively;P< 0.001). The nares were not the most common site of colonization. The colonization prevalence diminished somewhat after antibiotic treatment but remained high. The isolates that colonized the controls were more likely than those in the patients to be methicillin-susceptibleS. aureus(MSSA) (74/84 [88.1%] versus 56/106 [52.8%], respectively;P< 0.001). In conclusion, the prevalence ofS. aureuscolonization among SSTI patients was high and often involved USA300 MRSA. The prevalence diminished somewhat with antimicrobial therapy but remained high at the 40-day follow-up visit. Control subjects were also colonized at a high prevalence but most often with a genetic background not associated with a clinical infection in this study.S. aureusis a commensal species and a pathogen. Plans for decolonization or eradication should take this distinction into account.

scholarly journals Orbital Tumors Excision without Bony Marginotomy under Local and General Anesthesia

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
Robert A. Goldberg ◽  
Daniel B. Rootman ◽  
Nariman Nassiri ◽  
David B. Samimi ◽  
Joseph M. Shadpour
Keyword(s):  
Soft Tissue ◽  
General Anesthesia ◽  
Local Anesthesia ◽  
Case Series ◽  
Ocular Motility ◽  
Orbital Tumors ◽  
Retrospective Case ◽  
Fibrous Tumor ◽  
Orbital Varix

To present our experience of removing middle to deep orbital tumors using a combination of minimally invasive soft tissue approaches, sometimes under local anesthesia.Methods.In this retrospective case series, 30 patients (13 males and 17 females) underwent tumor removal through eyelid crease (17 eyes), conjunctival (nine eyes), lateral canthal (two eyes), and transcaruncular (two eyes) approaches. All tumors were located in the posterior half of the orbit. Six cases were removed under monitored anesthesia care with local block, and 24 were under general anesthesia.Results.The median (range) age and follow-up duration were 48.5 (31–87) years old and 24.5 (4–375) weeks, respectively. Visual acuity and ocular motility showed improvement or no significant change in all but one patient at the latest followup. Confirmed pathologies revealed cavernous hemangioma (15 cases), pleomorphic adenoma (5 cases), solitary fibrous tumor (4 cases), neurofibroma (2 cases), schwannoma (2 cases), and orbital varix (1 case). None of the patients experienced recurrence.Conclusions.Creating a bony marginotomy increases intraoperative exposure of the deep orbit but adds substantial time and morbidity. Benign orbital tumors can often be removed safely through small soft-tissue incisions, without bone removal and under local anesthesia.

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