scholarly journals An 11-Year-Old Male with Refractory Osteomyelitis

2012 ◽  
Vol 2012 ◽  
pp. 1-4
Author(s):  
Clifford T. Mauriello ◽  
Ole A. Raustol ◽  
Maria A. Aguiar ◽  
Kenji M. Cunnion
Keyword(s):  
Staphylococcus Aureus ◽  
Chronic Osteomyelitis ◽  
Proximal Phalanx ◽  
Distal Phalanx ◽  
Warning Signs ◽  
X Ray ◽  
Bacterial Cultures ◽  
Multifocal Osteomyelitis ◽  
Tissue Specimens ◽  
The Right

We present a case of empirical treatment failure for chronic osteomyelitis in a previously healthy 11-year-old male involving the distal phalanx of the right first digit. After initial debridement, empiric antibiotics were started for presumedStaphylococcus aureusinfection. Operative bacterial cultures yielded no growth. Despite three weeks of antistaphylococcal antibiotics the patient’s symptoms worsened and the destruction of bone progressed. A repeat plain X-ray revealed a new lesion in the proximal phalanx of the right second digit. The recognition of multifocal osteomyelitis led to reexamination of bone tissue specimens using special stains which demonstrated rare broad-based budding yeast. Fungal cultures eventually grewBlastomyces dermatitidis. Treatment with amphotericin B led to rapid clinical improvement. This case illustrates that clinicians must remain vigilant for warning signs that empiric treatment may be failing for presumptiveStaphylococcus aureus, provoking reconsideration of the differential diagnosis and an intensification of efforts to evaluate for alternative etiologies.

A SWOLLEN MIDDLE FINGER IN A MIDDLE-AGED FARMER

Hand Surgery ◽  
2012 ◽  
Vol 17 (01) ◽  
pp. 121-123 ◽  
Author(s):  
Somprakas Basu ◽  
Shilpi Bhadani ◽  
Vijay Kumar Shukla
Keyword(s):  
Proximal Phalanx ◽  
Middle Finger ◽  
Needle Aspiration ◽  
Excision Biopsy ◽  
Middle Aged ◽  
Cytological Examination ◽  
Diagnostic Dilemma ◽  
X Ray ◽  
The Right ◽  
Bony Erosion

Hand tumors are not common and a swollen finger poses considerable diagnostic dilemma. We present a case of a middle-aged farmer who had presented with a painless swelling of the middle finger of the right hand without any neurovascular deficit or evidence of metastasis. An X-ray of the finger showed cortical expansion and bony erosion of the proximal phalanx. A fine needle aspiration cytological examination was inconclusive. He underwent a digit amputation in view of subsequent morbidity and chances of recurrence following local excision. Biopsy proved it to be a giant cell tumor of the proximal phalanx. Following six months of treatment he is doing well. We herein highlight an unusual tumor of the finger and its diagnostic and treatment challenges.

scholarly journals Residual foreign body in the foot causing chronic osteomyelitis mimicking a pseudotumor: A case report

2020 ◽  
Vol 48 (6) ◽  
pp. 030006052092537
Author(s):  
Yin-Ming Huang ◽  
Shan-Wei Yang ◽  
Chun-Yu Chen ◽  
Chine-Jen Hsu ◽  
Wei-Ning Chang
Keyword(s):  
Foreign Body ◽  
Chronic Osteomyelitis ◽  
Osteolytic Lesion ◽  
Fluid Collection ◽  
Plantar Fascia ◽  
Resonance Imaging ◽  
X Ray ◽  
Retained Foreign Body ◽  
Magnetic Resonance Imaging Mri ◽  
The Right

Osteomyelitis from a retained foreign body should be included in the differential diagnosis of any osteolytic lesion of the foot. We report here a case of a 59-year-old man who presented with swelling over the dorsolateral aspect of the right foot. Plain x-ray showed an osteolytic lesion that mimicked a pseudotumor. Magnetic resonance imaging (MRI) showed multilocular fluid collection over the right cuboid with a hypointense lesion over the plantar fascia. The patient underwent surgery and a rubber fragment (1 cm × 0.8 cm) was removed from his foot that had been present for two years following a stabbing injury. The patient fully recovered without complication or disability.

scholarly journals Polymicrobial Infection as a Rare Cause of Osteomyelitis: Case Presentation and Review of the Literature

2021 ◽  
pp. 1-5
Author(s):  
Mohs Elisabeth ◽  
Mohs Elisabeth ◽  
Darwich A ◽  
Dally F ◽  
Assaf E ◽  
...  
Keyword(s):  
Chronic Osteomyelitis ◽  
Hematogenous Spread ◽  
Case Presentation ◽  
X Ray ◽  
Surgical Infection ◽  
Infectious Focus ◽  
Intravenous Antibiotics ◽  
Local Trauma ◽  
Oral Pathogens ◽  
The Right

This case report presents a 48-year-old patient with suspicion for chronic osteomyelitis caused by oral pathogens including species of Actinomyces, Eikenella and Stenotrophomonas. The symptoms included progressive swelling of the right thigh and hyperpyrexia with up to 41°C. Imaging methods included standard X-ray as well as MRI. Furthermore, two operations were necessary for surgical infection therapy. Histological and microbiological investigations of intraoperative samples showed polymicrobial osteomyelitis. Since local trauma could be excluded as the cause for the disease, the patient’s dental status was evaluated and proved as the possible infectious focus with a hematogenous spread. The patient was treated with intravenous antibiotics for two weeks and oral antibiotics for four further weeks. The patient’s clinical condition drastically improved with that treatment.

VERTICAL LOCKING OF THE METACARPOPHALANGEAL JOINT OF THE THUMB

Hand Surgery ◽  
2005 ◽  
Vol 10 (02n03) ◽  
pp. 279-284 ◽  
Author(s):  
Kosuke Tajima ◽  
Takashi Sasaki ◽  
Kazuyoshi Yamanaka
Keyword(s):  
Proximal Phalanx ◽  
Metacarpophalangeal Joint ◽  
Vertical Position ◽  
Collateral Ligament ◽  
X Ray ◽  
First Case ◽  
The Right ◽  
Flexion Force

Locking of the metacarpophalangeal (MP) joint of the fingers, though reported infrequently, is not rare in the literature. We will report two rare cases of the MP joint of the thumb locked in 90° of flexion (vertical locking). The first case is a 21-year-old man, punched on his right thumb by his friend, who arrived with his thumb fixed in a flexed position. The X-ray images of the right thumb showed the proximal phalanx subluxation in the palmer side in a vertical position. The second case is a 35-year-old woman with her right thumb accidentally caught in the chain of a key-holder. The locking was easily reduced without anaesthesia in both cases. We assume the mechanism was that the flexion force on the MP joint led to subluxation and the locking occurred due to the tension of the collateral ligament caused by the volar prominence of the radial condyle.

scholarly journals Radiogrametric Analysis of the Thoracic Limb Phalanges in Arabian Horses and Thoroughbred Horses

Animals ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. 2205
Author(s):  
Ozan Gündemir ◽  
Tomasz Szara ◽  
Gülsün Pazvant ◽  
Dilek Olğun Erdikmen ◽  
Sokol Duro ◽  
...  
Keyword(s):  
Proximal Phalanx ◽  
Dorsal Surface ◽  
Distal Phalanx ◽  
Correct Classification ◽  
Middle Phalanx ◽  
Classification Rate ◽  
X Ray ◽  
Thoroughbred Horses ◽  
Radiological Measurements ◽  
The Difference

In this study, it was aimed to determine the statistical differences between Arabian horses and Thoroughbred horses based on X-ray images of forelimb digital bones. Latero-medial X-ray images of digital bones of thoracic limbs were taken of 25 Arabian horses and 50 Thoroughbred healthy horses. The difference between males and females within the breed was statistically analyzed as well. Nine measurements and three indexes taken from phalanges of thoracic limbs were used. Thoroughbred horses did not differ significantly between sexes, as indicated by the ANOVA. For the Arabian horses, the length of the middle of the proximal phalanx (p < 0.05), the length of the middle of the middle phalanx (p < 0.001), and the length of the dorsal surface of the distal phalanx (p < 0.05) measurement points were found to be differentiated between sexes. In the analysis made between Thoroughbred horses and Arabian horses with no respect to sex, the critical measurement was the depth of the caput of the proximal phalanx. The discriminant analysis enabled the correct classification of 89.33% of the proximal phalanx samples to the exact breed. The correct classification rate was 77.33% in the case of middle phalanx and 54.67% in the case of distal phalanx. Measurement results of the distal phalanx were found to be insignificant between both breeds and sexes. The radiological measurements of digital bones showed that sexual dimorphism was not too expressed and that decisive differences were found between the breeds.

Low temperature x-ray microanalysis of frozen-hydrated tobacco leaves

1984 ◽  
Vol 42 ◽  
pp. 284-285
Author(s):  
S. Edith Taylor ◽  
Patrick Echlin ◽  
May McKoon ◽  
Thomas L. Hayes
Keyword(s):  
Low Temperature ◽  
Lemna Minor ◽  
Root Tips ◽  
Tobacco Leaves ◽  
X Ray ◽  
Whole Cells ◽  
Carbon Coated ◽  
The Right ◽  
Beam Currents ◽  
The University

Low temperature x-ray microanalysis (LTXM) of solid biological materials has been documented for Lemna minor L. root tips. This discussion will be limited to a demonstration of LTXM for measuring relative elemental distributions of P,S,Cl and K species within whole cells of tobacco leaves.Mature Wisconsin-38 tobacco was grown in the greenhouse at the University of California, Berkeley and picked daily from the mid-stalk position (leaf #9). The tissue was excised from the right of the mid rib and rapidly frozen in liquid nitrogen slush. It was then placed into an Amray biochamber and maintained at 103K. Fracture faces of the tissue were prepared and carbon-coated in the biochamber. The prepared sample was transferred from the biochamber to the Amray 1000A SEM equipped with a cold stage to maintain low temperatures at 103K. Analyses were performed using a tungsten source with accelerating voltages of 17.5 to 20 KV and beam currents from 1-2nA.

CLINICAL CASE OF A MALIGNANT PECOMA OF THE LUNG

2019 ◽  
Vol 65 (5) ◽  
pp. 756-759
Author(s):  
Mikhail Postolov ◽  
Nadezhda Kovalenko ◽  
K. Babina ◽  
Stanislav Panin ◽  
Yelena Levchenko ◽  
...  
Keyword(s):  
Good Condition ◽  
Lung Neoplasm ◽  
Rare Condition ◽  
Epithelioid Cell ◽  
X Ray ◽  
Perivascular Epithelioid Cell ◽  
Mesenchymal Neoplasm ◽  
Preoperative Ct ◽  
Lymph Duct ◽  
The Right

Perivascular epithelioid cell tumor (PEComa) is a rare mesenchymal neoplasm characterized by expression of both mela-nocytic and smooth muscle markers. Only 10 primary malignant lung PEComas have been reported up to date. We report a 59-year-old male who presented with a lung neoplasm, found during the routine X-ray examination. Preoperative CT-scan revealed the 3,5-cm-sized mass, located at the border of the upper, middle and lower lobes of the right lung. Patient underwent a thoracotomy, resection of the upper, middle and lower lobes of the right lung accompanied with mediastinal lymphadenectomy. After surgery, chylothorax was revealed. Conservative treatment was unsuccessful, so we performed laparoscopic clipping of the thoracic lymph duct. Patient was dismissed from hospital on the 10-th day after the second operation in good condition. In this report, we intend to increase the limited knowledge relating to natural history and optimal treatment of such a rare condition as a primary malignant lung PEComa.

scholarly journals 1369. The Spectrum of Chronic Osteomyelitis in Children

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S694-S695
Author(s):  
Marritta Joseph ◽  
Lauren Sommer ◽  
Jesus G Vallejo ◽  
Jonathon C McNeil
Keyword(s):  
Clinical Features ◽  
Hospital Admissions ◽  
Chronic Osteomyelitis ◽  
Functional Limitations ◽  
Chronic Recurrent Multifocal Osteomyelitis ◽  
Intravenous Therapy ◽  
Days Of Therapy ◽  
Common Etiology ◽  
Multifocal Osteomyelitis

Abstract Background While the majority of pediatric osteomyelitis cases are acute in nature, a significant subset present with prolonged symptoms often associated with substantial morbidity. Little data exist to guide clinicians in the management of these infections. We sought to describe the epidemiology, clinical features and management of chronic osteomyelitis in children. Methods We reviewed hospital admissions with an ICD10 code for chronic osteomyelitis from 2011-2018 at Texas Children’s Hospital. Cases were included if symptoms lasted &gt;28 days on presentation. Patients diagnosed with chronic recurrent multifocal osteomyelitis were excluded. Cases were classified as those 1) associated with a contiguous focus (CoF), 2) penetrating or open trauma, 3) orthopedic hardware (OH), 4) post-acute chronic osteomyelitis (PACO, those occurring after &gt;28 days of therapy for acute osteomyelitis) and 5) primary hematogenous chronic osteomyelitis (PHCO, those with 28 days of symptoms without other clear risk factors). Results 114 cases met inclusion criteria. The median patient age is 11.8 years and 35.9% patients had underlying comorbidities. 83% of patients underwent a surgical procedure. Cases were diverse in terms of pathogenesis (Figure 1). A microbiologic etiology was identified in 72.8% of cases and was polymicrobial in 20.2% of cases; Staphylococcus aureus was the single most common etiology (Figure 2). CoF infection was more often associated with polymicrobial etiology with or without Pseudomonas (P&lt; 0.001) and disease of the foot. PACO was caused by S. aureus in 95% of cases (p&lt; 0.001, Figure 3). The overall median duration of total therapy was 210 days. 41% were discharged from hospital on OPAT with or without later transition to oral antibiotics. 26.3% of patients had persistent functional limitations at time of last follow-up of which 46% experienced repeat hospital admission/surgery. There was no association between duration of intravenous therapy and persistent functional limitations. Figure 1. Categories of Chronic Osteomyelitis Figure 2. Microbiology of Pediatric Chronic Osteomyelitis Figure 3. Clinical Features of Pediatric Chronic Osteomyelitis Conclusion Children with chronic osteomyelitis are diverse both in terms of pathogenesis and microbiology. Pathogenesis and clinical presentation can provide clues to microbiologic etiology. Prolonged intravenous therapy does not appear to improve functional outcomes in chronic osteomyelitis Disclosures Jonathon C. McNeil, MD, Allergan (Research Grant or Support, Allergan provided ceftaroline powder for use in studies described in this abstract)

scholarly journals Unprecedented tibial bone lengthening of 33.5 cm by distraction osteogenesis for the reconstruction of a subtotal tibial bone defect. A case report and literature review

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Abdulnassir Ali ◽  
Ying Ren ◽  
Chun-Hao Zhou ◽  
Jia Fang ◽  
Cheng-He Qin
Keyword(s):  
Bone Defect ◽  
Distraction Osteogenesis ◽  
Chronic Osteomyelitis ◽  
Weight Bearing ◽  
Lower Leg ◽  
Bone Lengthening ◽  
Case Presentation ◽  
Tibial Length ◽  
Tibial Bone ◽  
The Right

Abstract Background We present a case of an immense unprecedented tibial bone lengthening of 33.5 cm. The management of chronic osteomyelitis of the right tibia with subtotal tibial bone defect, talus defect and equinus ankle deformity. We demonstrate limb reconstruction by distraction osteogenesis and correction of ankle deformity with the Ilizarov technique. Limb salvage was preferred as an alternative to amputation to restore basic limb function. Case presentation A 16-year-old male patient fell and injured his right lower leg. He attempted to treat the symptoms with traditional home remedies. During 15 months of self-treating, he developed osteomyelitis of the right tibia and had lost function in his foot. Radiology revealed immense bone defect of the right tibia, including talus bone defect and equinus deformity of the calcaneus. The patient’s right tibia was non weight-bearing, had drainage sinus just below his knee and a large scar anteriorly along the entire length of the tibia. Conclusion Upon completion of treatment, the patient was able to avoid amputation of his leg with partially restored function for weight-bearing. He carried himself without assistance after 3 years of lost function in his right leg. Tibial bone distraction osteogenesis of 33.5 cm was done after 90% of the tibial length was defected. To the best of our best knowledge, this case is one of a kind to achieve distraction of tibial bone to such length.

scholarly journals Anatomical work-up of an individual with multiple muscular variants on both forearms

2021 ◽  
Author(s):  
Peter S. Hagedorn ◽  
Bernhard Hirt ◽  
Thomas Shiozawa ◽  
Peter H. Neckel
Keyword(s):  
Carpal Tunnel ◽  
Proximal Phalanx ◽  
Neurovascular Compression ◽  
Male Body ◽  
Muscle Belly ◽  
Left Hand ◽  
Palmaris Longus ◽  
Palmar Aponeurosis ◽  
The Right ◽  
Work Up

AbstractMuscular variants of the forearm are common and frequently cause neurovascular compression syndromes, especially when interfering with the compact topography of the carpal tunnel or the Canalis ulnaris. Here, we report on a male body donor with multiple muscular normal variations on both forearms. The two main findings are (1) an accessory variant muscle (AVM) on the right forearm originating from the M. brachioradialis, the distal radius, and the M. flexor pollicis longus. It spanned the wrist beneath the Fascia antebrachia and inserted at the proximal phalanx of the digitus minimus. (2) Moreover, we found a three-headed palmaris longus variant on the left arm with proximal origin tendon and a distal, trifurcated muscle belly, with separated insertions at the palmar aponeurosis, the flexor retinaculum, and, in analogy to the accessory muscle on the contralateral arm, at the base of the proximal phalanx of the digitus minimus. We found a considerable thickening of the left-hand median nerve right before entering the carpal tunnel indicative of a possible chronic compression syndrome adding clinical relevance to this anatomical case. We also discuss the notion that both, the AVM and the contralateral three-headed palmaris variant are developmental descendants of the M. palmaris longus. Additionally, we found a previously not recorded variant of the M. palmaris brevis on the left hand.

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