Extensive skull base osteomyelitis, devastating complication of otitis externa: A case report and review of the literature

Skull base osteomyelitis (SBO), also referred to as malignant otitis externa (MOE) in its typical form, is usually a complication of otitis externa and severe uncommon and life-threatening condition requiring early diagnosis and long-term treatment in order to avoid its neurologic sequelae. We report the case of 69 years old female with a history of uncontrolled type 2 diabetes, who presented refractory and chronic right-sided purulent otorrhea with temporal headaches for 6 months, treated with no improvement by multiple attempts of ambulatory empiric therapy. After the appearance of grade III facial palsy and painful swelling in the right periorbital and zygomatic areas, the patient consulted in our department where a CT scan showed massive cortical and trabecular destruction of the right petrous bone and the mastoid extended to the lateral orbital wall, the zygomatic arch and the greater sphenoid wing realising extensive osteomyelitis of the skull base and the lateral face. The treatment was started immediately based on intravenous broad-spectrum antibiotics. Despite aggressive long-term treatment, the patient passed away, underlying the increased SBO morbidity and mortality secondary to delayed diagnosis.

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A rare case of bilateral obstructive megaureter with a giant uretal ureterocele on the left

Russian Journal of Pediatric Surgery ◽

10.18821/1560-9510-2020-24-3-205-209 ◽

2020 ◽

Vol 24 (3) ◽

pp. 205-209

Author(s):

G. N. Rumyantseva ◽

V. N. Kartashev ◽

Marina V. Dolinina ◽

I. B. Osipov ◽

A. I. Osipov ◽

...

Keyword(s):

Left Kidney ◽

Boarding School ◽

Term Treatment ◽

Ectopic Ureterocele ◽

Surgical Department ◽

Long Term Treatment ◽

Obstructive Megaureter ◽

The Right ◽

Medical University

The article discusses a case of 4-year-old patient with a bilateral obstructive megaureter of a non-functioning left kidney and with the opening of this kidney ureter into the urethra with extravasal location of a giant ureterocele. The malformation of the urinary system was accompanied by a comorbid disease of bronchopulmonary system in the form of tuberculosis of the lungs and intra-thoracic lymph nodes. At the age of one month, due to decompensation of the only functioning right kidney, urine was withdrawn by applying a ureterostomy. Later, a proximal lateral cutaneous ureterostomy was put because of social reasons (mother refused of her baby). In two months, the next step was performed - a ureterocystoneostomy by the Cohen’s antireflux technique. After a long-term treatment for tuberculosis in clinics of Tver and St. Petersburg, at the age of 4, the girl was operated on at the first surgical department at St-Petersburg State Pediatric Medical University. Laparoscopic nephroureterectomy on the left with conversion to lower-middle laparotomy and resection of the terminal part of the left ureter with a giant ectopic ureterocele as well as closure of the ureterocutaneostomy on the right were performed. After stabilization, the child was transferred to a children’s boarding school in Tver, and currently is supervised by pediatric urologists and TB specialists.

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Retrospective analysis of ultrasound criteria for newly diagnosed extragenital endometriosis detected during preventive examinations

Tumors of female reproductive system ◽

10.17650/1994-4098-2020-16-2-44-49 ◽

2020 ◽

Vol 16 (2) ◽

pp. 44-49

Author(s):

O. E. Nechaeva ◽

I. S. Gruzdev ◽

Yu. V. Popov ◽

A. G. Kedrova ◽

V. N. Lesnyak ◽

...

Keyword(s):

Pathological Condition ◽

Delayed Diagnosis ◽

Young Patients ◽

Rapid Identification ◽

Term Treatment ◽

Ultrasound Tomography ◽

Long Term Treatment ◽

Extragenital Endometriosis ◽

Screening Ultrasound

Endometriosis is a common pathological condition characterized by the presence of endometrial glands and stroma outside the uterus, most frequently in the pelvis. Despite the ability to demonstrate infiltrative growth and tendency to local recurrence and invasion, endometriosis is considered as a benign proliferative disease. An increasing incidence of extragenital endometriosis (including that in young patients) and difficulties associated with its visualization during ultrasonography lead to a delayed diagnosis, resulting in an increase in the number of cases of advanced endometriosis, which requires long-term treatment. The improvement of a screening ultrasound tomography technique and development of specific ultrasound criteria for preventive examination will ensure rapid identification of patients requiring treatment. In this retrospective study, we analyzed 57 cases of extragenital endometriosis detected during preventive examinations of women between 2014 and 2019. Each case was analyzed with the consideration of ultrasound characteristics together with clinical and gynecological data. We evaluated location, size, contours, and structure of foci. We propose a method of extended ultrasound examination in women with suspected extragenital endometriosis.

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Absence of toxicity in patients with malignant otitis externa following long-term treatment with high dosage tobramycin

Journal of Antimicrobial Chemotherapy ◽

10.1093/jac/34.2.267 ◽

1994 ◽

Vol 34 (2) ◽

pp. 267-274 ◽

Cited By ~ 4

Author(s):

L. L. Ioannides-Demos ◽

S. C. Li ◽

E. B. Bastone ◽

D. W. Spelman ◽

R. E. Hooper ◽

...

Keyword(s):

Otitis Externa ◽

Term Treatment ◽

Long Term Treatment ◽

Malignant Otitis Externa

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Severe Daily Headache as an Uncommon Manifestation of Widespread Skull Base Osteomyelitis

Case Reports in Neurology ◽

10.1159/000500240 ◽

2019 ◽

Vol 11 (2) ◽

pp. 178-182 ◽

Cited By ~ 1

Author(s):

Jens van der Valk ◽

Frank Treurniet ◽

Jan Pieter Koopman ◽

Hille Koppen

Keyword(s):

Skull Base ◽

Final Diagnosis ◽

Petrous Bone ◽

Mastoid Process ◽

Radiological Investigation ◽

Skull Base Osteomyelitis ◽

Positron Emission ◽

Patients With Diabetes ◽

Daily Headache ◽

The Right

Temporal bone osteomyelitis has been recognized for decades as a complication of otitis externa, specifically in elderly patients with diabetes. A much less prevalent form is skull base osteomyelitis. We report a 70-year-old man with diabetes who presented to our outpatient clinic with severe chronic daily complaints of headache. The headache was located frontoparietally and kept him awake at night. Imaging (nonenhanced computed tomography [CT], magnetic resonance imaging, and positron emission tomography/CT) showed a hypermetabolic mass on the right side of the skull base, in the middle ear, and in the mastoid process, with invasion and partial destruction of the surrounding elements of the petrous bone, the occipital bone, and the sphenoid bone on the right, with extension by way of the clivus into the apex of the left petrous bone. Diagnostic puncture revealed Streptococcus pneumoniae.The final diagnosis was severe daily headache due to central skull base osteomyelitis. Our case emphasizes the need for proper clinical and radiological investigation keeping the diagnosis of skull base osteomyelitis in mind with patients with diabetes or otherwise immunocompromised status who present with chronic daily headache and otalgia.

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Atrial flutter: management

ESC CardioMed ◽

10.1093/med/9780198784906.003.0519 ◽

2018 ◽

pp. 2211-2217

Author(s):

Tilman Maurer ◽

Christine Lemes ◽

Karl-Heinz Kuck

Keyword(s):

Atrial Flutter ◽

Structural Heart Disease ◽

Term Treatment ◽

Non Invasive ◽

Surface Ecg ◽

Long Term Treatment ◽

The Common ◽

The Right ◽

Electrocardiogram Ecg

Atrial flutter (AFL) is the most common macroreentry tachycardia in patients with and without structural heart disease. In the majority of cases, the arrhythmia is associated with a pre-existing comorbidity such as heart failure or lung disease. AFL refers to an electrocardiogram (ECG) pattern of a regular tachycardia with an atrial rate of more than 240 beats per minute and a lack of an isoelectric baseline between deflections. The most frequent form is termed ‘common’ or ‘typical’ if biphasic waves are present in the inferior leads, resembling a ‘saw-tooth’ pattern. Common AFL is diagnosed in 90% of cases and its mechanism is a macroreentry within the right atrium involving the cavotricuspid isthmus. ‘Atypical’ AFL refers to any ECG flutter morphology different from the common type. While the surface ECG provides a widely available and non-invasive diagnostic tool, a definite diagnosis of the underlying tachycardia mechanism can only be established by invasive electrophysiological testing. Acute management of AFL includes measures for rate control by pharmacological treatment or rhythm control by antiarrhythmic drugs or electrical cardioversion. For long-term treatment, catheter ablation offers a safe, effective, and curative approach for common flutter and is also a treatment option for atypical AFL. Anticoagulation should be initiated according to risk stratification based on the CHA2DS2-VASc score to prevent thromboembolic complications. This chapter provides a detailed overview on the pathophysiology and electrocardiographic characteristics of AFL and discusses the clinical management of the arrhythmia.

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A case of atypical femur fracture during long-term treatment with bisphosphonates in patient with postmenopausal osteoporosis

Osteoporosis and Bone Diseases ◽

10.14341/osteo10286 ◽

2019 ◽

Vol 22 (1) ◽

pp. 18-23

Author(s):

Kira E. Zotkina ◽

Olga M. Lesnyak ◽

Aleksandr Yu. Kochish ◽

Ivan V. Sushkov

Keyword(s):

Postmenopausal Osteoporosis ◽

Femur Fracture ◽

Term Treatment ◽

Atypical Femur Fracture ◽

First Line Therapy ◽

Oral Bisphosphonate ◽

Long Term Treatment ◽

Rare Side Effect ◽

The Right

Bisphosphonates is a first-line therapy for treatment of osteoporosis. In the last decade, the number of atypical femur fracture (AFF) cases during long-term treatment with bisphosphonates has increased. The aim of this article was to analyze the literature data on this problem, to define the diagnostic criteria of AFF and to present the case of AFF in the patient who received treatment with alendronate for 3.5 years. A 78-year-old woman, receiving oral bisphosphonate for severe postmenopausal osteoporosis for 3.5 years, suddenly started feeling pain in her right thigh while walking. Three months later, she had got a fracture in middle third of the right femur after falling from her standing height. According to instrumental diagnostics, this fracture had all criteria of AFF. Blocking intramedullary osteosynthesis with shafts was performed. A retrospective analysis of soft tissue magnetic resonance imaging in the area of right thigh, done before the fracture, showed the presence of undiagnosed incomplete right femur fracture in the middle third, which subsequently led to a complete fracture. Presented clinical case demonstrates the complexity of AFF diagnostics. The purpose of the publication is to draw attention of medical specialists to the issue of this rare side effect of bisphosphonate treatment.

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Long-term treatment results and prognostic factors in skull base surgery for nasal and paranasal sinus malignancies.

Japanese jornal of Head and Neck Cancer ◽

10.5981/jjhnc1974.23.212 ◽

1997 ◽

Vol 23 (1) ◽

pp. 212-220 ◽

Cited By ~ 2

Author(s):

Hideo NAMEKI ◽

Akihisa MIYAKAWA ◽

Yasuo SATO ◽

Takashi KATO ◽

Sho KANZAKI ◽

...

Keyword(s):

Prognostic Factors ◽

Skull Base ◽

Paranasal Sinus ◽

Skull Base Surgery ◽

Term Treatment ◽

Treatment Results ◽

Long Term Treatment

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A Case of Skull Base Osteomyelitis with Multiple Cerebral Infarction

Case Reports in Otolaryngology ◽

10.1155/2016/9252361 ◽

2016 ◽

Vol 2016 ◽

pp. 1-4 ◽

Cited By ~ 3

Author(s):

Haruka Miyabe ◽

Atsuhiko Uno ◽

Takahiro Nakajima ◽

Natsue Morizane ◽

Keisuke Enomoto ◽

...

Keyword(s):

Carotid Artery ◽

Skull Base ◽

Cranial Nerve ◽

Initial Presentation ◽

Skull Base Osteomyelitis ◽

Cranial Nerve Palsies ◽

Malignant Otitis Externa ◽

Life Threatening ◽

The Right

Skull base osteomyelitis is classically documented as an extension of malignant otitis externa. Initial presentation commonly includes aural symptoms and cranial nerve dysfunctions. Here we present a case that emerged with multiple infarctions in the right cerebrum. A male in his 70s with diabetes mellitus and chronic renal failure presented with left hemiparesis. Imaging studies showed that blood flow in the carotid artery remained at the day of onset but was totally occluded 7 days later. However, collateral blood supply prevented severe infarction. These findings suggest that artery-to-artery embolization from the petrous and/or cavernous portion of the carotid artery caused the multiple infarctions observed on initial presentation. Osteomyelitis of the central skull base was diagnosed on the basis of the following findings taken together: laboratory results showing high levels of inflammation, presence ofPseudomonas aeruginosain the otorrhea and blood culture, multiple cranial nerve palsies that appeared later, the bony erosion observed on CT, and the mass lesion on MRI. Osteomyelitis was treated successfully by long-term antibiotic therapy; however, the patient experienced cefepime-induced neurotoxicity during therapy. The potential involvement of the internal carotid artery in this rare and life-threatening disease is of particular interest in this case.

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