Autopsy-Based Assessment of Extent and Type of Osteomyelitis in Advanced-Grade Sacral Decubitus Ulcers: A Histopathologic Study

2003 ◽  
Vol 127 (12) ◽  
pp. 1599-1602
Author(s):  
Elizabeth E. Türk ◽  
Michael Tsokos ◽  
G. Delling
Keyword(s):  
Soft Tissue ◽  
Chronic Osteomyelitis ◽  
Imaging Techniques ◽  
Decubitus Ulcer ◽  
Medical Problem ◽  
Considerable Proportion ◽  
Decubitus Ulcers ◽  
Source Of Infection ◽  
Bone Biopsies ◽  
Life Threatening

Abstract Context.—Decubitus ulcers constitute a serious medical problem, often encountered in association with hospitalization or institutionalization in senior citizens' or nursing homes. Potentially life-threatening sepsis has been reported to originate not only from soft tissue infection, but also from osteomyelitis as a complication of involvement of bone tissue in decubitus ulcers. Objective.—To assess the histopathology of osseous structures involved in grade IV decubitus ulcers. Design.—Autopsy-based histopathologic assessment of the presence and extent of osteomyelitis on os sacrum specimens from 28 deceased individuals with grade IV sacral decubitus ulcers using an undecalcified preparation following plastic embedding (staining with Goldner, Kossa modification, toluidine blue, and Giemsa). Results.—The histologic findings were classified in 4 types of pathomorphologic changes: type 1, decubitus ulcer confined to soft tissue, no inflammation (n = 7); type 2, decubitus ulcer involving bone, no inflammation (n = 7); type 3, decubitus ulcer involving bone, inflammation of soft tissue, no osteomyelitis (n = 1); and type 4, decubitus ulcer involving bone, presence of osteomyelitis (n = 13). Type 4 changes are further described as follows: type 4a, chronic osteomyelitis alone (n = 6); and type 4b, chronic and acute osteomyelitic changes (n = 7). More than half of the cases (n = 15) showed no inflammatory reaction within the medullary cavity (types 1–3). In all cases with osteomyelitis, inflammation was exclusively confined to the superficial parts of the os sacrum. Chronic osteomyelitis was seen in all cases in which osteomyelitis was present. In addition, mild acute osteomyelitic changes were observed in 7 cases. Severe liquefying osteomyelitis affecting deeper layers of the os sacrum was not found. Sepsis was present in 2 cases; in one of these cases, the decubitus ulcer was considered a possible source of infection. Conclusions.—Our results provide evidence that in cases of grade IV decubitus ulcers, the macroscopic aspect and clinical imaging techniques may lead to an overestimation of the extent of osseous involvement. We suggest that the investigation of bone biopsies is not necessary in a considerable proportion of cases of grade IV decubitus ulcers in patients without sepsis, as the minor osseous alterations are of little consequence when establishing a therapeutic approach.

scholarly journals Trauma-Induced Coagulopathy: Overview of an Emerging Medical Problem from Pathophysiology to Outcomes

Medicines ◽  
2021 ◽  
Vol 8 (4) ◽  
pp. 16
Author(s):  
Gabriele Savioli ◽  
Iride Francesca Ceresa ◽  
Luca Caneva ◽  
Sebastiano Gerosa ◽  
Giovanni Ricevuti
Keyword(s):  
Major Trauma ◽  
Management Strategies ◽  
Medical Problem ◽  
Current Evidence ◽  
Potential Drug ◽  
The Past ◽  
Trauma Induced Coagulopathy ◽  
Threatening Condition ◽  
Life Threatening ◽  
Trauma Mortality

Coagulopathy induced by major trauma is common, affecting approximately one-third of patients after trauma. It develops independently of iatrogenic, hypothermic, and dilutive causes (such as iatrogenic cause in case of fluid administration), which instead have a pejorative aspect on coagulopathy. Notwithstanding the continuous research conducted over the past decade on Trauma-Induced Coagulopathy (TIC), it remains a life-threatening condition with a significant impact on trauma mortality. We reviewed the current evidence regarding TIC diagnosis and pathophysiological mechanisms and summarized the different iterations of optimal TIC management strategies among which product resuscitation, potential drug administrations, and hemostatis-focused approaches. We have identified areas of ongoing investigation and controversy in TIC management.

scholarly journals Imaging of Joint and Soft Tissue Involvement in Systemic Lupus Erythematosus

2021 ◽  
Vol 23 (9) ◽  
Author(s):  
Andrea Di Matteo ◽  
Gianluca Smerilli ◽  
Edoardo Cipolletta ◽  
Fausto Salaffi ◽  
Rossella De Angelis ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Soft Tissue ◽  
Lupus Erythematosus ◽  
Structural Damage ◽  
Structural Changes ◽  
Soft Tissues ◽  
Imaging Techniques ◽  
Joint Involvement ◽  
Systemic Lupus ◽  
Muscle Involvement

Abstract Purpose of Review To highlight the potential uses and applications of imaging in the assessment of the most common and relevant musculoskeletal (MSK) manifestations in systemic lupus erythematosus (SLE). Recent Findings Ultrasound (US) and magnetic resonance imaging (MRI) are accurate and sensitive in the assessment of inflammation and structural damage at the joint and soft tissue structures in patients with SLE. The US is particularly helpful for the detection of joint and/or tendon inflammation in patients with arthralgia but without clinical synovitis, and for the early identification of bone erosions. MRI plays a key role in the early diagnosis of osteonecrosis and in the assessment of muscle involvement (i.e., myositis and myopathy). Conventional radiography (CR) remains the traditional gold standard for the evaluation of structural damage in patients with joint involvement, and for the study of bone pathology. The diagnostic value of CR is affected by the poor sensitivity in demonstrating early structural changes at joint and soft tissue level. Computed tomography allows a detailed evaluation of bone damage. However, the inability to distinguish different soft tissues and the need for ionizing radiation limit its use to selected clinical circumstances. Nuclear imaging techniques are valuable resources in patients with suspected bone infection (i.e., osteomyelitis), especially when MRI is contraindicated. Finally, dual energy X-ray absorptiometry represents the imaging mainstay for the assessment and monitoring of bone status in patients with or at-risk of osteoporosis. Summary Imaging provides relevant and valuable information in the assessment of MSK involvement in SLE.

Cervicofacial Emphysema Secondary to Facebow Injury: A Case Report

2009 ◽  
Vol 33 (4) ◽  
pp. 333-336
Author(s):  
Marco Cicciù ◽  
Giovanni Battista Grossi ◽  
Mario Beretta ◽  
Davide Farronato ◽  
Concetta Scalfaro ◽  
...  
Keyword(s):  
Case Report ◽  
Soft Tissue ◽  
Subcutaneous Emphysema ◽  
Clinical Case ◽  
Dental Procedure ◽  
Life Threatening ◽  
Facial Area ◽  
Orthodontic Device ◽  
Physical Findings

Aim: To report the clinical case of a child with facial and periorbital emphysema caused by an orthodontic device. Case report: An 11-year-old child presented to our clinic showing moderate swelling of the left facial area. Based on his dental history, physical findings, and instrument examinations, the diagnosis of cervicofacial emphysema was established, caused by disengagement of the facebow. One week later, all swelling and crepitus had disappeared without complications. Most patients who develop subcutaneous emphysema after a dental procedure have only moderate local swelling, which normally resolves spontaneously and without complications within a week. However, the spread of large amounts of air into the deeper spaces may cause life-threatening sequelae. Conclusions: Orthodontists should be aware that the use of extraoral traction applied via a facebow can cause soft tissue injures and emphysema of the cervicofacial region. It is important to avoid misdiagnosis and to appropriately inform patient and parents about this condition.

Updates and Advances: Pediatric Musculoskeletal Infection Imaging Made Easier for Radiologists and Clinicians

2021 ◽  
Vol 25 (01) ◽  
pp. 167-175
Author(s):  
Michael S. Furman ◽  
Ricardo Restrepo ◽  
Supika Kritsaneepaiboon ◽  
Bernard F. Laya ◽  
Domen Plut ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Imaging Techniques ◽  
Daily Clinical Practice ◽  
Infants And Children ◽  
Imaging Evaluation ◽  
Musculoskeletal Infection ◽  
Wide Range ◽  
Life Threatening ◽  
Optimal Patient Management

AbstractInfants and children often present with a wide range of musculoskeletal (MSK) infections in daily clinical practice. This can vary from relatively benign superficial infections such as cellulitis to destructive osseous and articular infections and life-threatening deep soft tissue processes such as necrotizing fasciitis. Imaging evaluation plays an essential role for initial detection and follow-up evaluation of pediatric MSK infections. Therefore, a clear and up-to-date knowledge of imaging manifestations in MSK infections in infants and children is imperative for timely and accurate diagnosis that, in turn, can result in optimal patient management. This article reviews an up-to-date practical imaging techniques, the differences between pediatric and adult MSK infections, the spectrum of pediatric MSK infections, and mimics of pediatric MSK infections encountered in daily clinical practice by radiologists and clinicians.

scholarly journals IL-7 Immunotherapy in a Non-Immunocompromised Patient with Intractable Fungal Wound Sepsis

2021 ◽  
Author(s):  
Isaiah R Turnbull ◽  
Monty B Mazer ◽  
Mark H Hoofnagle ◽  
John P Kirby ◽  
Jennifer M Leonard ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Cell Function ◽  
Fungal Infections ◽  
Immunocompromised Patient ◽  
Host Immunity ◽  
Wound Sepsis ◽  
Trichosporon Asahii ◽  
Life Threatening ◽  
Aggressive Debridement ◽  
Anti Fungal

Abstract A non-immunocompromised patient developed life-threatening soft-tissue infection with Trichosporon asahii, Fusarium, and Saksenaea that progressed despite maximum anti-fungal therapies and aggressive debridement. IL-7 immunotherapy resulted in clinical improvement, fungal clearance, reversal of lymphopenia, and improved T-cell function. Immunoadjuvant therapies to boost host immunity may be efficacious in life-threatening fungal infections.

scholarly journals Intravascular Shunt in Management of Limb Trauma- A Review

2021 ◽  
pp. 274-281
Author(s):  
Hashem Bark Awadh Abood ◽  
Abdulaziz Munahi Alanazi ◽  
Falah Bader Alhajraf ◽  
Wejdan Nawaf Mesfer Alotaibi ◽  
Bushra Saad Alghamdi ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Lower Limb ◽  
Patient Survival ◽  
Survival Rates ◽  
Tissue Loss ◽  
Vascular Injuries ◽  
Limb Trauma ◽  
Life Threatening ◽  
Arterial Insufficiency ◽  
Soft Tissue Loss

Vascular injuries to the upper or lower limb in the context of significant soft tissue loss, fractures, or other life-threatening injuries are associated with a high amputation rate. Complex extremity vascular injuries in which acute arterial insufficiency combined with severe or prolonged shocks are unacceptable because warm, warm, skeletal muscle time is often exceeded before adequate revascularization, and are associated with extended ischemia periods or fractures or soft tissue wounds. Revascularizing the limb is essential for the success of the limb rescue. Selective intravascular temporary shunting hence allows better overall care of the patient and can therefore be predicted to increase both limb rescue and patient survival rates. The aim of this article was to review and summarize results of previous literature regarding effectiveness on intravascular shunting as management of limb trauma as well as reviewing its potential complications.

Neonatal and Pediatric Pressure Injuries Secondary to Limb Splinting for Intravascular Access: Case Series and Literature Review

2018 ◽  
Vol 23 (2) ◽  
pp. 108-116 ◽  
Author(s):  
Kyrie A. Sweeney ◽  
Kate Cogill ◽  
Katrina Davis ◽  
Jacqueline I. Jauncey-Cooke
Keyword(s):  
Literature Review ◽  
Case Series ◽  
Decubitus Ulcer ◽  
Evidence Base ◽  
Infants And Children ◽  
Cochrane Library ◽  
Decubitus Ulcers ◽  
Paediatric Hospital ◽  
Pressure Injury ◽  
The Cochrane Library

Abstract Aim: This review aims to present a case series on pressure injury (PI) formation secondary to limb-splinting for preservation of peripheral intravascular catheter (PIVC) access in neonatal and pediatric patients. A literature review was undertaken to analyze the existing knowledge base on this phenomenon. Background: Medical devices and attachments are considered a risk factor for PI development in neonates, infants, and children. Three cases of PI formation caused by contact with limb boards used to preserve PIVC access were identified in an Australian tertiary pediatric facility during 2016. Methods: A literature search was conducted during December 2017 using the Cumulative Index of Nursing and Allied Health, Excerpta Medica database, MEDLINE, PubMed, and the Cochrane Library. Keywords used were pressure injury(ies), pressure ulcer, pressure ulcers, decubitus ulcer, and decubitus ulcers. Articles were excluded if published before 2006, patients were adolescents or adults, and if injuries were not caused by PIVC-associated limb-splinting. Patients included in the case series were identified through screening of admissions in one ward of a tertiary paediatric hospital. Results: Five low-quality studies were included in the literature review. Three children were included in the case series. Each child acquired a PI subsequent to limb-splinting and taping adjacent to a PIVC. Hydration, nutritional state, and oxygenation did not appear to contribute to PI development in these cases. Conclusions: There is a gap in the evidence base pertaining to PIVC splinting and its involvement with PI formation in neonates, infants, and children. The existing literature provides low-quality evidence this problem exists; thus, further research is recommended.

Skin and Soft Tissue Infections

2015 ◽  
Author(s):  
Daniel J. Pallin
Keyword(s):  
Soft Tissue ◽  
Necrotizing Fasciitis ◽  
Bacterial Infections ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Skin Infections ◽  
Soft Tissue Infections ◽  
Protective Mechanisms ◽  
Contact Precautions ◽  
Life Threatening ◽  
Plantar Warts

The skin is the largest organ of the human body, and has diverse functions including protection from infection, temperature regulation, sensation, and immunologic and hormonal functions. Skin infections occur when the skin’s protective mechanisms fail. Some infections may be life-threatening (eg, necrotizing fasciitis) or may require the patient to be placed on contact precautions; thus, the initial goals of assessment of patients with skin and soft tissue infections are to assess the patient’s stability and to determine whether precautions are necessary to protect others. This review covers the pathophysiology, stabilization and assessment, diagnosis and treatment, and disposition and outcomes for a variety of skin and soft tissue infections. Figures show an algorithm for treatment of bacterial infections of the skin, and photographs of  various infections including necrotizing fasciitis, cellulitis, an abscess caused by methicillin-resistant Staphylococcus aureus, a furuncle, a carbuncle, nonbullous and bullous impetigo, echythma, folliculitis, anthrax lesion, tinea corporis, condyloma acuminatum, and plantar warts. Tables list cellulitis treatment with particular exposures, the dermatophytoses, and yeast infections of skin and mucous membranes. This review contains 16 highly rendered figures, 3 tables, and 32 references.

Basics of Imaging Techniques in Evaluation of Soft Tissue Tumors

2017 ◽  
Author(s):  
Emily Alanna Aherne ◽  
Sinchun Hwang
Keyword(s):  
Magnetic Resonance Imaging ◽  
Computed Tomography ◽  
Positron Emission Tomography ◽  
Magnetic Resonance ◽  
Soft Tissue ◽  
Imaging Techniques ◽  
Soft Tissue Tumors ◽  
Emission Tomography ◽  
Resonance Imaging ◽  
Positron Emission

Medical imaging plays a pivotal role in the detection, diagnosis, and clinical management of primary soft tissue tumors. Various imaging modalities have been used, and each modality offers unique advantages in the workup of soft tissue tumors by localizing the lesions in different compartments of the body and characterizing macroscopic tissue composition of the lesions in a noninvasive and safe manner. We review the clinical role and technical aspects of the frequently used imaging modalities, including magnetic resonance imaging (MRI), computed tomography, ultrasonography, positron emission tomography, and plain radiography with an emphasis on MRI as a mainstay imaging modality and a brief discussion of advanced techniques. We also review imaging features of common soft tissue tumors that can be detected and characterized using current imaging techniques. This review contains 54 figures, 1 table and 37 references.   Key words: computed tomography, diffusion-weighted imaging, imaging, magnetic resonance imaging, positron emission tomography, soft tissue, technique, tumor, ultrasonography

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