Iatrogenic pyogenic osteomyelitis of C-1 and C-2 treated with transoral decompression and delayed posterior occipitocervical arthrodesis

2007 ◽  
Vol 7 (6) ◽  
pp. 664-668 ◽  
Author(s):  
Patrick J. Reid ◽  
Paul J. Holman
Keyword(s):  
Antibiotic Therapy ◽  
Facet Joint ◽  
Trigger Point ◽  
Corticosteroid Injection ◽  
Craniocervical Junction ◽  
Anterior Decompression ◽  
The Right ◽  
Pyogenic Osteomyelitis ◽  
Posterior Instrumented Fusion ◽  
Transoral Decompression

✓The authors describe a case of osteomyelitis of the craniocervical junction caused by iatrogenic infection of the spine during corticosteroid injection therapy. This 58-year-old diabetic man presented with acute exacerbation of neck pain that had began 4 months prior to admission. He did not experience the associated fever, chills, or sweats, but he did notice transient weakness in the right upper extremity. A computed tomography (CT) scan of the cervical spine demonstrated a destructive process involving the odontoid and the left occipitocervical and atlantoaxial joints that was not present on a CT obtained 2 months earlier, just before trigger-point and left-sided C1–2 facet joint corticosteroid injections. A diagnosis of staphylococcal osteomyelitis was made, and initial treatment with external immobilization and appropriate antibiotic therapy failed to control radiographically demonstrated and clinical progression. The patient was successfully treated using staged anterior decompression and posterior instrumented fusion with prolonged antibiotic therapy. To the authors' knowledge this case is the first reported instance of iatrogenic pyogenic osteomyelitis of the craniocervical junction successfully treated with anterior decompression and delayed posterior arthrodesis.

Persistent Apical Periodontitis: Bacterial Taxonomic Analysis and Treatment Through Intentional Replantation

2020 ◽  
Author(s):  
Fernando Eduardo Coria-Valdiosera
Keyword(s):  
Antibiotic Therapy ◽  
Root Canal ◽  
Resistance Mechanisms ◽  
Apical Periodontitis ◽  
Infectious Process ◽  
Identification Of Bacteria ◽  
The Right ◽  
Apical Lesions ◽  
Endodontic Retreatment

Introduction: The microorganisms own different resistance mechanisms that allow them to resist the chemo-mechanical cleanliness of root canal and antibiotic therapies causing the persistence of apical lesions. Methods: This clinical case describes a male patient diagnosed with pulp necrosis in the right lower central incisor due to trauma, which developed apical periodontitis manifesting itself extra orally. Root canal treatment along with antibiotic therapy was performed, but because the infectious process persisted, endodontic retreatment and a new antibiotic therapy were carried out, however, the clinical evolution was not favorable. For this reason, the intentional replantation was chosen as the outright treatment, performing apicectomy and curettage of the periapical lesion, from which the isolation and taxonomic study of microorganisms were carried out, with the respective antibiogram. Results: In the 10-day clinical follow-up, the extraoral infectious process disappeared almost completely and 6 months later, a complete repair of the bone tissue was observed on the tomography. Conclusion: A better understanding of the persistence of apical periodontitis was achieved by taxonomic identification of bacteria and the intentional replantation allowed to remove the apical biofilm gaining an excellent wound healing.

Brodie’s Abscess of the Proximal Humerus Metaphysis: A Case Report

2021 ◽  
Vol 11 (9) ◽  
Author(s):  
Nilesh Vishwakarma ◽  
Shaival Chauhan ◽  
Shrey S Binyala ◽  
Sanjeev K Singh
Keyword(s):  
Case Report ◽  
Shoulder Joint ◽  
Proximal Part ◽  
Focal Lesion ◽  
Posterior View ◽  
Brodie’S Abscess ◽  
Magnetic Resonance Imaging Mri ◽  
The Right ◽  
Pyogenic Osteomyelitis ◽  
Metaphyseal Region

Introduction:Primary subacute pyogenic osteomyelitis, or Brodie’s abscess was initially documented by Sir Benjamin Brodie in 1832. We present a case report with a 6-months follow-up period, demonstrating the successful diagnosis and surgical treatment of a focal lesion of the proximal metaphysis of the right humerus in a 21-years-old female. The pathology of hematologic osteomyelitis and its role in the development of a subacute abscess along with a review of literature and an in detail description of the pathogenesis of Brodie’s abscess is discussed and submitted. Case Report:A 21- years -old healthy female with a history of fall sustaining injury to the right shoulder one 1 year back followed by which she presented to the outpatient clinic with a swelling over her right shoulder. The patient was managed conservatively with analgesics and was relieved of pain over a course of one 1 week of medications, the patient now presents with pain and swelling in the right shoulder joint on and off since the episode of fall one 1 year back, which had increased over a period of past one 1 week. A week before the most recent presentation she started experiencing some discomfort and pain in her right shoulder. No recent trauma was reported. A mild swelling appeared over the proximal part of the humerus. There were no constitutional symptoms of fever or any illness reported. On examination, there was noted a painful restriction of ROM at the right shoulder joint with no rotator cuff injury. Laboratory investigations were suggestive of raised inflammatory markers. Radiograph of the right shoulder taken in the true antero-posterior view with the shoulder in the neutral rotation was suggestive of an oval lucency with surrounding sclerosis in the proximal metaphyseal region of the humerus. Magnetic resonance imaging MRI of the right shoulder joint showed features consistent with Brodie’s abscess in the proximal metaphyseal region of the humerus. Surgical debridement of the abscess w

scholarly journals Systemic antibiotic therapy of patients with acute bacterial sinusitis taking into account resistance

2021 ◽  
pp. 172-177
Author(s):  
S. V. Starostina ◽  
D. A. Sivokhin
Keyword(s):  
Antibiotic Therapy ◽  
Severe Disease ◽  
Viral Disease ◽  
Systemic Antibiotic ◽  
Systemic Antibiotic Therapy ◽  
Causative Agents ◽  
Intracranial Complications ◽  
Acute Bacterial Rhinosinusitis ◽  
Third Line ◽  
The Right

Acute rhinosinusitis is one of the most common diseases in the world. According to statistics, about 10 million cases are registered in Russia every year.Acute bacterial rhinosinusitis (ABRS) in most cases develops as a result of an acute respiratory viral disease, proceeds easily and it does not require antibiotic therapy. However, it significantly reduces the patient's quality of life in cases of moderate and severe disease, and in the absence of timely treatment, can lead to intracranial complications (meningitis, encephalitis, intracranial abscesses, etc.) and orbital (reactive edema of the eyelid, phlegmon of the orbit, periorbital abscesses, etc.). To avoid complications, with exacerbation of rhinosinusitis, it is necessary to choose the right antibiotic therapy, taking into account the resistance of the microorganisms that caused the disease.The article describes the differential diagnosticprinciples of bacterial rhinosinusitis according to the latest recommendations and research in this area, the most common antibiotic-resistant pathogens in the practice of an ENT doctor are presented, the issue of choosing the correct systemic antibiotic therapy for the treatment of patients with moderate and severe acute bacterial rhinosinusitis is considered according to modern data on the sensitivity of bacterial pathogens to antibacterial drugs prescribed in the otorhinolaryngologist's practice. The article presents data on a new universal cephalosporin of the 3rd generation (the active ingredient is cefditoren), as a second- and third-line drug, due to its high activity against most causative agents of acute bacterial rhinosinusitis, and clinical observation using the above antibacterial agent within the framework of the considered topics.

Short-term Changes After Corticosteroid Injections Into the Normal Tendons of Rabbits: A Controlled Randomized Study

2019 ◽  
Vol 47 (3) ◽  
pp. 721-728 ◽  
Author(s):  
Kandir Genesio Innocenti Dinhane ◽  
Alexandre Leme Godoy-Santos ◽  
Alexandre Todorovic Fabro ◽  
Maria Regina Moretto ◽  
Igor Deprá ◽  
...  
Keyword(s):  
Single Injection ◽  
Corticosteroid Injection ◽  
Healing Process ◽  
Test Group ◽  
Control Group ◽  
Placebo Control ◽  
Short Term ◽  
Calcaneal Tendon ◽  
The Right ◽  
Corticosteroid Injections

Background: Corticosteroid injections in or around tendons for the treatment of athletic injuries are a common practice among orthopaedic surgeons and are apparently efficacious in the short term, although controversies persist related to local complications. Purpose: This study evaluated short-term (48 hours) biomechanical, biochemical, and histological alterations after a single injection of betamethasone into the normal tendons of rabbits. Study Design: Controlled laboratory study. Methods: A total of 72 New Zealand White rabbits were randomly divided into 2 groups: the test group—in which 36 animals underwent 1 intratendinous injection of betamethasone (1.4 mg / 0.2 mL) in the right calcaneal tendon; the control group—in which the right calcaneal tendon of 36 animals was injected with saline (placebo control group) and the left calcaneal tendon was left untreated for normal standards (normal control). Forty-eight hours later, animals were euthanized and tendons were harvested. Metalloproteinase (MMP1 and MMP2) and interleukin (IL1 and IL6) expression levels, biomechanical resistance (load × elongation parameters), and histomorphometry (hematoxylin and eosin and picrosirius red stains for collagen fibers, tenocytes, and inflammatory cells) were analyzed in the tendons. Results: The test group had a significant reduction in MMP2 expression as compared with the control groups ( P = .027). Regarding the other parameters, there were no additional significant differences between the groups. Conclusion: A single injection of corticosteroid into normal calcaneal tendons did not trigger acute local morphological, structural, or biomechanical injuries at 48 hours, but it did promote a significant decrease in MMP2 levels. Additional studies are needed with increased duration of follow-up, various doses, and multiple injections and in tendinopathic models. Clinical Relevance: Some previous studies demonstrated early structural changes in tendons after a single corticosteroid injection, which was not corroborated by the present study. Metalloproteinase decrease is usually associated with a reduction in collagen degradation, which would be protective for the healing process. More studies are necessary to confirm the possible beneficial effect of these results in the long term and for tendinopathies.

Appendicitis

2016 ◽  
Author(s):  
David Scordino
Keyword(s):  
Antibiotic Therapy ◽  
Acute Inflammation ◽  
Surgical Intervention ◽  
Significant Risk ◽  
Disease Course ◽  
Lower Quadrant ◽  
Nonoperative Therapy ◽  
Atypical Presentations ◽  
The Right ◽  
Right Lower Quadrant

Appendicitis is caused by acute inflammation of the appendix (usually secondary to obstruction) and can result in perforation, leading to peritonitis, sepsis, and/or abscess formation. Symptomatology includes anorexia, nausea, vomiting, and periumbilical pain (later localizing to the right lower quadrant). Patients at the extremes of age and pregnant women may have atypical presentations and higher rates of perforation and complications. Most patients suspected of having appendicitis receive prompt surgical intervention (usually laparoscopic). Antibiotic therapy, initiated preoperatively, varies for perforated vs nonperforated appendicitis. In patients with evidence of a contained abscess, nonoperative therapy is considered, as abscess is evidence of a prolonged disease course (more than 5 days) prior to presentation. On imaging, patients may have a well-circumscribed abscess or phlegmon; if immediate surgical intervention is attempted, there is significant risk of morbidity due to adhesions to adjacent tissues.

Congenital arthrogryposis associated with atlantoaxial subluxation and dysraphic abnormalities

2000 ◽  
Vol 93 (1) ◽  
pp. 130-132
Author(s):  
Wolf O. Luedemann ◽  
Marcos S. Tatagiba ◽  
Sami Hussein ◽  
Madjid Samii
Keyword(s):  
Traffic Accident ◽  
Craniocervical Junction ◽  
Atlantoaxial Subluxation ◽  
Arthrogryposis Multiplex Congenita ◽  
Good Clinical Outcome ◽  
Content Type ◽  
Dorsal Stabilization ◽  
A Minor ◽  
Transoral Decompression ◽  
Fine Print

✓ The authors report the case of a 27-year-old woman with an arthrogryposis multiplex congenita (AMC) associated with atlantoaxial subluxation. To the authors' knowledge, this is the first report of its kind. The authors review the literature with reference to dysraphic abnormalities associated with atlantoaxial subluxation and with AMC. The patient presented with severe tetraparesis following a minor traffic accident. She underwent a procedure in which transoral decompression and dorsal stabilization were performed and, postoperatively, made a good clinical outcome. The authors stress the need for diagnostic neuroimaging of the craniocervical junction in patients with AMC.

Spectral Analysis of Heart Rate Variability during Trigger Point Acupuncture

2014 ◽  
Vol 32 (3) ◽  
pp. 273-278 ◽  
Author(s):  
Yoji Kitagawa ◽  
Kenichi Kimura ◽  
Sohei Yoshida
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Heart Rate Variability ◽  
Spectral Analysis ◽  
Tibialis Anterior ◽  
Trigger Point ◽  
Tibialis Anterior Muscle ◽  
Trigger Points ◽  
Control Group ◽  
The Right

Objectives To clarify changes in the cardiovascular autonomic nervous system function due to trigger point acupuncture, we evaluated differences in responses between acupuncture at trigger points and those at other sites using spectral analysis of heart rate variability. Methods Subjects were 35 healthy men. Before measurements began the subjects were assigned to a trigger point acupuncture or control group based on the presence/absence of referred pain on applying pressure to a taut band within the right tibialis anterior muscle. The measurements were conducted in a room with a temperature of 25°C, with subjects in a long sitting position after 10 min rest. Acupuncture needles were retained for 10 min at two sites on the right tibialis anterior muscle. ECG was performed simultaneously with measurements of blood pressure and the respiratory cycle. Based on the R–R interval on the ECG, frequency analysis was performed, low-frequency (LF) and high-frequency (HF) components were extracted and the ratio of LF to HF components (LF/HF) was evaluated. Results The trigger point acupuncture group showed a transient decrease in heart rate and an increase in the HF component but no significant changes in LF/HF. In the control group, no significant changes were observed in heart rate, the HF component or LF/HF. There were no consistent changes in systolic or diastolic blood pressure in either group. Conclusions These data suggest that acupuncture stimulation of trigger points of the tibialis anterior muscle transiently increases parasympathetic nerve activity.

Transoral decompression for myelopathy caused by rheumatoid arthritis of the cervical spine

1972 ◽  
Vol 37 (4) ◽  
pp. 493-497 ◽  
Author(s):  
Michael H. Sukoff ◽  
Milton M. Kadin ◽  
Terrance Moran
Keyword(s):  
Rheumatoid Arthritis ◽  
Cervical Spine ◽  
Cervical Myelopathy ◽  
Transoral Approach ◽  
Anterior Decompression ◽  
Posterior Decompression ◽  
Content Type ◽  
Transoral Decompression ◽  
Fine Print

✓ A case of rheumatoid cervical myelopathy that responded to posterior decompression and fusion is presented. Progression of the disease ultimately required anterior decompression through a transoral approach.

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