scholarly journals Comparison Between Pyogenic Postoperative and Native Vertebral Osteomyelitis : Clinical Features, Curative Effect and Analysis of Prognostic Factors

2021 ◽  
Author(s):  
maimaitiaili abudurexiti ◽  
maierdan maimaiti ◽  
Mulade Maierdan ◽  
Tao Xu ◽  
xieraili saimaiti ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Antibiotic Therapy ◽  
Internal Fixation ◽  
Recurrence Rate ◽  
Vertebral Osteomyelitis ◽  
Lumbar Vertebrae ◽  
Thoracic Vertebrae ◽  
Curative Effect ◽  
Vertebral Involvement ◽  
The Difference

Abstract BackgroundPyogenic spondylodiscitis(PS) is a potentially life-threatening infection burdened with high morbidity rates. Despite the rising incidence, the proper diagnosis and treatment of PS are still controversial. Postoperative Vertebral Osteomyelitis(PVO) is a clinical challenge, for there were few reports about the treatment results of PVO before, and further more few studies have compared PVO with native vertebral osteomyelitis(NVO). The purpose of this study was to compare and describe the microbiology, clinical characteristics, treatment and curative effect between PVO and NVO, and analyze the prognostic factors as well. MethodsThe clinical data of 52 patients with pyogenic spondylitis admitted to the Spine Surgery Department of the First Affiliated Hospital of Xinjiang Medical University from January 2010 to December 2019 were retrospectively analyzed. There were 30 patients in native vertebral osteomyelitis (NVO) group, including 18 males and 12 females, with an average age of 50.47 ± 20.45 years old (aged from 15 to 73); 22 patients in postoperative vertebral osteomyelitis (PVO) group, including 13 males and 9 females, with an average age of 51.45 ± 16.97 years old (aged from 14 to 73). In Group NVO, 23 cases (76.7%) were located in lumbar vertebrae, 5 cases (16.7%) in thoracic vertebrae and 2 cases (6.7%) in cervical vertebrae; in Group PVO, 16 cases (72.7%) in lumbar vertebrae and 6 cases (27.3%) in thoracic vertebrae. 29 patients had had neurological dysfunction before surgery was taken. There were 26 cases of grade D (16 cases in Group NVO and 10 cases in Group PVO) and 3 cases of grade C (1 case in Group NVO and 2 cases in Group PVO), following the instructions of American Spinal Injury Association (Asia) neurological function classification. All patients were given bed rest, nutritional support and antibiotic therapy; surgical treatment for patients with poor outcomes or aggravated symptoms. Patients were followed up at 1, 3, 6 and 12 months after surgery, including leukocyte count, ESR and CRP, X-ray, CT three-dimensional reconstruction and MRI were performed. The changes of visual analogue scale (VAS) and Asia neurological function classification were observed to evaluate the clinical efficacy simultaneously. ResultsAll patients were followed up for 12-24 months. Till the last follow-up, 3 patients in Group NVO recurred, the recurrence rate was 10% (3 / 30), 9 patients in Group PVO recurred, the recurrence rate was 40.1% (9 / 22), the recurrence rate of Group PVO was higher than that of Group NVO, the difference was statistically significant (P = 0.009). Both groups were treated with intravenous and oral antibiotics, and the time of antibiotic treatment in Group PVO was longer than that in Group NVO, however the difference was not statistically significant (P = 0.094, P = 0.062). Among 44 patients with spinal internal fixation, 13.6% (1 NVO, 5 PVO) had recurrent infection after internal fixation. Therefore, we took re-operation to remove the internal fixator for infection control, patients recovered after conservative treatment such as immobilization and systemic anti infection. The numerical value of leukocytes, C-reactive protein, ESR and VAS scores of the two groups were significantly lower than those before surgery, the difference was statistically significant (P < 0.001). In Group NVO, 16 cases recovered from Asia grade D to grade E, 1 case from grade C to grade D; 10 cases in Group PVO recovered from grade D to grade E and 2 cases recovered from grade C to grade D. There was no significant difference between these two groups (P > 0.05). By univariate analysis, multiple vertebral involvement and abscess formation (P = 0.003, P = 0.025) were significantly associated with PS recurrence; there was a tendency for PS recurrence among microbial infection (OR = 1.889), spinal prosthesis (OR = 7.083) and allogenic bone (OR = 2.032), yet not obvious. By multivariate analysis, we found that multiple vertebral involvement (OR= 12.656, 95% CI: 1.536-104.303, P = 0.018) was a risk factor for PS recurrence. ConclusionThe treatment of PVO is more challenging than NVO, especially in the cases of spinal implant infection. Although the antibiotic treatment time of PVO is longer than that of NVO, the recurrence rate of PVO is higher. Longer antibiotic therapy and, if necessary, surgical debridement or removal of implants are important approaches to successful treatment of PVO.

scholarly journals Clinical Statistical Analysis with Comparison between Pelvic and Non-pelvic Chondrosarcoma

2021 ◽  
Vol 36 (3) ◽  
pp. e271-e271
Author(s):  
Sayed Abdulla Jami1, ◽  
Shi Jiandang ◽  
Brotendu Shekhar Roy ◽  
Zhanwen Zhou ◽  
Liu Chang Hao
Keyword(s):  
Prognostic Factors ◽  
Local Recurrence ◽  
Recurrence Rate ◽  
Local Recurrence Rate ◽  
Survival Rates ◽  
Significant Difference ◽  
Grade Ii ◽  
The Difference ◽  
Early Local Recurrence ◽  
Male To Female

Objectives: Chondrosarcomas are rare tumors with a variable biological characteristic. Their treatment clinically and surgically is controversial. Analysis of the clinical statistics and prognostic factors of pelvic chondrosarcoma provides a reference for clinical diagnosis and treatment. Methods: A total of 73 cases of chondrosarcoma were collected, including 24 pelvic samples, from 2008 to 2017 from the hospital database and divided into two groups: pelvic chondrosarcoma and non-pelvic chondrosarcoma. The clinical characteristics and prognostic factors of pelvic chondrosarcoma were analyzed using different statistical methods. Results: Among the 24 pelvic chondrosarcoma patients, the ratio of male to female was 1.4:1, and the median age was 43.5 years. According to the classification proposed by Enneking, there were five grade I, 14 grade II, and five grade III. Histological grading of chondrosarcoma was grade I in one case, II in 15 cases, and III in eight cases. The histological type was 17 conventional, three dedifferentiated, two secondary, one myxoid, and one mesenchymal. The overall survival rates for 24 cases at three, five, and 10 years were 82.2±8.1%, 77.3±8.9%, and 52.4±12.1%, respectively. The local recurrence rate of pelvic chondrosarcoma after surgical resection (83.3%) was significantly higher than that of other sites (34.7%), and the difference was statistically significant (p < 0.001). The final proportion of amputation rate (50.0%) was also higher than other parts (20.4%), with a statistically significant difference (p =0.010). The total survival of the two groups was not significantly different (p =0.216). Conclusions: Chondrosarcoma of bone generally has an excellent prognosis when optimally diagnosed and treated by an experienced team of specialists. Pelvic chondrosarcoma has a higher local recurrence rate than the other sites and tends to result in amputation. Early local recurrence after surgery indicates a poor prognosis.

The Skeleton of Giraffes

2021 ◽  
pp. 342-381
Author(s):  
Graham Mitchell
Keyword(s):  
Cervical Vertebrae ◽  
Lumbar Vertebrae ◽  
Average Density ◽  
Cross Sectional Area ◽  
Thoracic Vertebrae ◽  
Sectional Area ◽  
Average Chemical Composition ◽  
Cross Sectional ◽  
Limb Bones ◽  
The Difference

The giraffe skeleton consists of ~170 bones. The dry mass of the skeleton is 70 g.kg-1 body mass. The average chemical composition of their bones is 33% minerals (mainly calcium and phosphorus in a ratio of 2:1), 34% collagen, and 33% water. The skull contributes ~10%, the vertebrae ~25% and the limb bones ~65% to skeleton mass. The average density of all bones is 1.6 g cm-3, ranging from 0.8 g cm-3 (cervical vertebrae) to 2.0 g cm-3 (limb bones). Resistance to fracture by vertebrae depends on their cross-sectional area, and is greatest in cervical and the first few thoracic vertebrae. Resistance to fracture by limb bones depends on wall thickness (the difference between inner and outer diameter), which is uniquely thick. The growth of all limb bones except the humerus follows a geometric pattern (length and diameter increase at the same rate) which confers resistance to compression stress. The humerus follows an elastic pattern (diameter increases faster than length) a pattern that resists bending stress. Giraffes bones are exceptionally straight which further reduces bending stresses. The torque generated by the mass of the head and neck is resisted by the ligamentum nuchae which is exceptionally well-developed in giraffes, extends from the lumbar vertebrae to the occipital crest, can have a diameter of ~10 cm, and can support loads of ~1.8 tonnes before rupturing. As a giraffe grows muscle cross-sectional area (and contraction strength) declines and the duty factor reduces, both of which reduce the risk of fracture.

The clinical analysis of endoscopic pancreaticobiliary separation in the treatment of occult pancreaticobiliary reflux

2020 ◽  
Author(s):  
Zhao Gang ◽  
Zhang Cheng ◽  
Cai Hao ◽  
Xu An An ◽  
Li Hai Dong ◽  
...  
Keyword(s):  
Bile Duct ◽  
Recurrence Rate ◽  
Endoscopic Sphincterotomy ◽  
Clinical Analysis ◽  
Endoscopic Retrograde ◽  
Curative Effect ◽  
Papillary Tumour ◽  
Significant Difference ◽  
The Difference ◽  
Pancreatic Reflux

Abstract Objective To investigate the aetiology of occult pancreaticobiliary reflux (OPBR) and the curative effect of EST in patients with cholecystolithiasis. Methods The clinical data of 47 OPBR patients with cholecystolithiasis from October 2013 to October 2016 were analyzed retrospectively.Results The average gallbladder bile amylase (GBA) of 47 patients was 864 ± 575 U/L. Forty patients underwent endoscopic retrograde cholangiopancreatography (ERCP), among which 26 patients were diagnosed with papillitis, 16 patients with peripapillary diverticulum, 14 patients with nipple overlength, five patients with nipple atrophy, three patients with ampullary calculi and two patients with papillary tumour. Thirty-three patients underwent endoscopic sphincterotomy (EST), after the operation, 16 patients reexamined GBA, in which 15 patients had normal GBA, and the difference of GBA was statistically significant (1161 ± 764 U/L vs 47 ± 17 U/L, t=5.641, P<0.05). After following up of 1 to 4 years, 27 patients without cholecystectomy who underwent EST had no recurrence of calculus, and in 9 patients who did not undergo EST, two patients had a recurrence of calculus. There was a significant difference in the recurrence rate of calculus (χ2=21.340, P<0.05). Conclusion Pancreaticobiliary junction disease is an essential cause of OPBR and cholecystolithiasis formation. EST can reduce the retention of pancreatic reflux juice both in gallbladder and bile duct and can reduce the recurrence rate of cholecystolithiasis after choledochoscopic lithotomy.

Single-stage autogenous bone grafting and internal fixation in the surgical management of pyogenic discitis and vertebral osteomyelitis

2001 ◽  
Vol 94 (1) ◽  
pp. 1-7 ◽  
Author(s):  
Gregory J. Przybylski ◽  
Ashwini D. Sharan
Keyword(s):  
Antibiotic Therapy ◽  
Internal Fixation ◽  
Vertebral Osteomyelitis ◽  
Single Stage ◽  
Neurological Deficits ◽  
Autogenous Bone ◽  
Antibiotic Administration ◽  
Content Type ◽  
Intravenous Antibiotics ◽  
Fine Print

Object. Patients with deep wound infections complicating previously placed internal instrumentation have been successfully treated by debridement and prolonged postoperative antibiotic therapy, which avoided removal of the hardware. Comparatively fewer patients with pyogenic discitis and vertebral osteomyelitis (PDVO) have undergone single-stage debridement, arthrodesis, and internal fixation. The purpose of this study was to determine the efficacy of combining debridement, arthrodesis in which iliac autograft is used, and segmental internal fixation in a single-stage procedure for patients in whom nonoperative management of PDVO has failed. Methods. A retrospective analysis of 17 consecutive patients with PDVO treated between July 1996 and September 1999 was performed. Follow-up data (mean 30 months) included office examinations and telephone interviews, and patients were grouped according to the duration of preoperative antibiotic therapy. All patients experienced significant postoperative reduction in pain, and those with neurological deficits improved. Eleven patients were independently ambulatory, and three required a walker; only five had been ambulating independently preoperatively. Two patients died during the 1st postoperative week of medical complications; another developed a wound dehiscence that was managed with debridement, prolonged antibiotic administration, and removal of the hardware 1 year later. In no case was pseudarthrosis demonstrated on dynamic radiography. Most patients received only a 6-week course of intravenous antibiotics postoperatively. Conclusions. The authors conclude that single-stage debridement, arthrodesis, and internal fixation can be effective in the treatment of PDVO. A 6-week course of postoperative intravenous antibiotics may be sufficient in patients with few risk factors. The harvesting of iliac autograft through the same operative exposure may not increase the risk of secondary infection.

scholarly journals Differences in Radiation Exposure of CT-Guided Percutaneous Manual and Powered Drill Bone Biopsy

2021 ◽  
Author(s):  
Sebastian Zensen ◽  
Sumitha Selvaretnam ◽  
Marcel Opitz ◽  
Denise Bos ◽  
Johannes Haubold ◽  
...  
Keyword(s):  
Radiation Exposure ◽  
Diagnostic Yield ◽  
Bone Biopsy ◽  
Lumbar Vertebrae ◽  
Bone Lesions ◽  
Anatomical Location ◽  
Thoracic Vertebrae ◽  
Level Of Evidence ◽  
Ct Guided ◽  
Bone Biopsies

Abstract Purpose Apart from the commonly applied manual needle biopsy, CT-guided percutaneous biopsies of bone lesions can be performed with battery-powered drill biopsy systems. Due to assumably different radiation doses and procedural durations, the aim of this study is to examine radiation exposure and establish local diagnostic reference levels (DRLs) of CT-guided bone biopsies of different anatomical regions. Methods In this retrospective study, dose data of 187 patients who underwent CT-guided bone biopsy with a manual or powered drill biopsy system performed at one of three different multi-slice CT were analyzed. Between January 2012 and November 2019, a total of 27 femur (A), 74 ilium (B), 27 sacrum (C), 28 thoracic vertebrae (D) and 31 lumbar vertebrae (E) biopsies were included. Radiation exposure was reported for volume-weighted CT dose index (CTDIvol) and dose–length product (DLP). Results CTDIvol and DLP of manual versus powered drill biopsy were (median, IQR): A: 56.9(41.4–128.5)/66.7(37.6–76.2)mGy, 410(203–683)/303(128–403)mGy·cm, B: 83.5(62.1–128.5)/59.4(46.2–79.8)mGy, 489(322–472)/400(329–695)mGy·cm, C: 97.5(71.6–149.2)/63.1(49.1–83.7)mGy, 627(496–740)/404(316–515)mGy·cm, D: 67.0(40.3–86.6)/39.7(29.9–89.0)mGy, 392(267–596)/207(166–402)mGy·cm and E: 100.1(66.5–162.6)/62.5(48.0–90.0)mGy, 521(385–619)/315(240–452)mGy·cm. Radiation exposure with powered drill was significantly lower for ilium and sacrum, while procedural duration was not increased for any anatomical location. Local DRLs could be depicted as follows (CTDIvol/DLP): A: 91 mGy/522 mGy·cm, B: 90 mGy/530 mGy·cm, C: 116 mGy/740 mGy·cm, D: 87 mGy/578 mGy·cm and E: 115 mGy/546 mGy·cm. The diagnostic yield was 82.4% for manual and 89.4% for powered drill biopsies. Conclusion Use of powered drill bone biopsy systems for CT-guided percutaneous bone biopsies can significantly reduce the radiation burden compared to manual biopsy for specific anatomical locations such as ilium and sacrum and does not increase radiation dose or procedural duration for any of the investigated locations. Level of Evidence Level 3.

scholarly journals PFNA-II Internal Fixation Helps Hip Joint Recovery and Improves Quality of Life of Patients with Lateral-Wall Dangerous Type of Intertrochanteric Fracture

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Weilu Mu ◽  
Junlin Zhou
Keyword(s):  
Internal Fixation ◽  
Hip Joint ◽  
Intertrochanteric Fracture ◽  
Operation Time ◽  
Lateral Wall ◽  
Intraoperative Blood Loss ◽  
Function Score ◽  
Curative Effect ◽  
Hip Function

Objective. To analyze the effect of PFNA-II internal fixation on hip joint recovery and quality of life (QOL) in patients with lateral-wall dangerous type of intertrochanteric fracture. Methods. One hundred and twelve patients with lateral-wall dangerous type of intertrochanteric fracture who underwent surgical treatment in our hospital from May 2017 to May 2019 were selected as the participants of the study. Based on the treatment method, all the enrolled patients were divided into two groups: proximal femoral nail antirotation (PFNA group; n = 59 ) who received closed reduction and minimally invasive PFNA internal fixation and dynamic hip screw group (DHS; n = 53 ) who received internal fixation. The clinical indicators, curative effect, hip function score, pain degree, postoperative QOL score, and complications were compared between the two groups. Results. The operation time, intraoperative blood loss, postoperative drainage volume, and the incidence of postoperative complications in PFNA group were statistically lower than those in DHS group ( P < 0.05 ). The curative effect in PFNA group was notably better than that in DHS group. There were no significant differences in scores of hip function, visual analogue scale (VAS), and QOL between the two groups before operation ( P > 0.05 ). However, the hip function score and QOL score increased in both groups after surgery, and the increase was more significant in the PFNA group, while the VAS score decreased in both groups, and the decrease in PFNA group was more significant ( P < 0.05 ). Conclusion. PFNA internal fixation for the treatment of lateral-wall dangerous type of intertrochanteric fracture has the advantages of short operation time, less intraoperative blood loss, effective improvement of hip joint function, and fewer postoperative complications, which is worthy of clinical application.

Difficulties in diagnosing vertebral osteomyelitis in a child

2021 ◽  
Vol 14 (1) ◽  
pp. e236037
Author(s):  
Jonathan Holzmann ◽  
Sunday Pam ◽  
Geoffrey Clark
Keyword(s):  
False Negative ◽  
Vertebral Osteomyelitis ◽  
Delayed Diagnosis ◽  
Abdominal Ultrasound ◽  
Clinical Suspicion ◽  
Thoracic Vertebrae ◽  
Negative Results ◽  
False Negative Results ◽  
The Face ◽  
Initial Imaging

Vertebral osteomyelitis is a rare diagnosis and often delayed diagnosis in children. This is a case of a child presenting with fever, back pain and raised C reactive protein who was found to have a Staphylococcus aureus (S.aureus) bacteraemia. Initial imaging with CT, MRI of the spine and abdominal ultrasound failed to demonstrate a vertebral osteomyelitis or identify another source of the bacteraemia. Due to the high clinical suspicion of a spinal source of the infection, second-line investigations were arranged. A bone scan identified an area of increase metabolic activity in the 12th thoracic vertebrae (T12) and subsequently a diagnosis was confirmed with a focused MRI of T12. This serves as an opportunity to discuss the diagnostic difficulty presented by paediatric vertebral osteomyelitis and more generally the need for clinicians to pursue their clinical suspicion in the face of false negative results to make an accurate and timely diagnosis.

The Aggregation Induced Emission Probe of Detecting Enhanced Permeation and Retention Effects is Structured for Evaluating the Applicability of Nanotherapy to Different Tumor Individuals

2021 ◽  
Vol 21 (12) ◽  
pp. 6054-6059
Author(s):  
Yuelan Liang ◽  
Ya-Nan Chang ◽  
Xue Li ◽  
Ziteng Chen ◽  
Jiaxin Zhang ◽  
...  
Keyword(s):  
Patient Evaluation ◽  
Curative Effect ◽  
Aggregation Induced Emission ◽  
Epr Effect ◽  
Negative Linear Correlation ◽  
Patient Will ◽  
Model Mouse ◽  
The Difference ◽  
The Individual ◽  
Clinical Transformation

Enhanced permeation and retention (EPR) effect, the mechanism by which nanodrugs accumulate in tumors and acquire superior curative effect. The questions of these mechanisms occur because of limited clinical transformation of engineered nanomaterials after 30 years. The difference of EPR limits the therapeutic effect of nanodrugs in the individual patient. Evaluation of the EPR effect in the individual patient will aid in selecting patients who will accumulate higher amounts of nanotherapeutics and show better therapeutic efficacy. Based on varied TIMP1/MMP-9 in serum, an aggregation-induced emission luminogen probe was designed and constructed to detect and evaluate the EPR effect in model mouse. The result showed that the ratio of TIMP1/MMP-9 (in the range 0.2–1.2) and fluorescence intensity of the probe were negative linear correlation and the effects of BSA-rhodamine accumulation in tumor were individualized differences as well as correlated with the relative ratio of TIMP-1/MMP-9 in serum. Our data support the development of these biomarkers probes based on the personalized nanotherapy of tumor.

The locomotor system

2013 ◽  
Author(s):  
Martin E. Atkinson
Keyword(s):  
Vertebral Column ◽  
Cervical Vertebrae ◽  
Lumbar Vertebrae ◽  
Posterior Wall ◽  
Axial Skeleton ◽  
Intervertebral Discs ◽  
Central Canal ◽  
The Body ◽  
Thoracic Vertebrae ◽  
Locomotor System

The locomotor system comprises the skeleton, composed principally of bone and cartilage, the joints between them, and the muscles which move bones at joints. The skeleton forms a supporting framework for the body and provides the levers to which the muscles are attached to produce movement of parts of the body in relation to each other or movement of the body as a whole in relation to its environment. The skeleton also plays a crucial role in the protection of internal organs. The skeleton is shown in outline in Figure 2.1A. The skull, vertebral column, and ribs together constitute the axial skeleton. This forms, as its name implies, the axis of the body. The skull houses and protects the brain and the eyes and ears; the anatomy of the skull is absolutely fundamental to the understanding of the structure of the head and is covered in detail in Section 4. The vertebral column surrounds and protects the spinal cord which is enclosed in the spinal canal formed by a large central canal in each vertebra. The vertebral column is formed from 33 individual bones although some of these become fused together. The vertebral column and its component bones are shown from the side in Figure 2.1B. There are seven cervical vertebrae in the neck, twelve thoracic vertebrae in the posterior wall of the thorax, five lumbar vertebrae in the small of the back, five fused sacral vertebrae in the pelvis, and four coccygeal vertebrae—the vestigial remnants of a tail. Intervertebral discs separate individual vertebrae from each other and act as a cushion between the adjacent bones; the discs are absent from the fused sacral vertebrae. The cervical vertebrae are small and very mobile, allowing an extensive range of neck movements and hence changes in head position. The first two cervical vertebrae, the atlas and axis, have unusual shapes and specialized joints that allow nodding and shaking movements of the head on the neck. The thoracic vertebrae are relatively immobile. combination of thoracic vertebral column, ribs, and sternum form the thoracic cage that protects the thoracic organs, the heart, and lungs and is intimately involved in ventilation (breathing).

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