Cervical osteomyelitis and an epidural abscess: an unusual form of cat-scratch disease in one case

Background The association of cervical osteomyelitis with epidural abscess is extremely rare; atypical symptomatology is what makes diagnosing and management challenging. This case is the sixth case reported in the literature. The objective of our study is to describe the clinical manifestation and treatment approach. Case presentation A 71-year-old male with no medical history, who was admitted to the emergency room for C7-T1 spinal cord compression caused by Bartonella henselae, marked improvement after decompression by evacuating the empyema and antibiotic course. Conclusion Cat-scratch disease or subacute regional lymphadenitis is a bacterial infection caused by Bartonella henselae; children and adolescents are mostly infected. Systemic complications are rare; the prevalence of bone damage is estimated at 0.1 to 0.3%. Our case allows a literature review of and put in focus on our diagnostic and therapeutic attitude.

Cure odontoiatriche e cisti mucose del seno mascellare

During dental treatment it is not uncommon to find the presence of asymptomatic mucous cysts of the maxillary sinus on dental panoramic radiography. The aetiology is still little known. Watchful waiting still seems to be the most suitable therapeutic attitude.

Toxic Anterior Segment Syndrome (TASS)

Cataract surgery is ranked among the most frequent operations, affecting a population over 65 years of age.Its prognosis is often favorable, however, there are rare complications including inflammation of the anterior segment known as Anterior Segment Toxicity Syndrome . the majority of our patients were men and diabetes appear in almost half and all our patients present various symptoms the first 24 hours dominated by the attack of the anterior segment our therapeutic attitude consists in the use of corticosteroids and hypotonizers with a good evolution in the majority of patients.

Preprosthetic Management of “Flabby Ridge” on Edentulous Patient

For edentulous patients, the integrity of the osteomucosal-bearing surface is a significant factor for the balance of the future removable prosthesis. The supporting tissues are influenced by several factors. Physiological bone resorption, senescence, and changes caused by systemic diseases and polypharmacy lead to modifications in these tissues. Similarly, trauma caused by an ill-fitted prosthesis influences the degree of bone resorption and the development of hyperplastic tissue. The etiology of bone resorption is multifactorial and complex, with continuous individual variations that are often unexplained. Although, no study has been able to establish the importance of the different factors in relation to each other, it is often reported that chronic excessive mechanical pressure in relation to occlusal constraints is responsible for the appearance of local resorption’s areas. The aim of this work is to present, through three clinical cases, the various factors involved in the alteration of the osteomucous-bearing surface and eventually, possible therapeutic attitude to deal with.

Basic Principles for Therapeutic Relationship and Practice in Gestalt Theoretical Psychotherapy

Summary Gestalt Theoretical Psychotherapy, in the broader sense of the term, has developed in various forms on both sides of the Atlantic since the 1920s. Gestalt Theoretical Psychotherapy, in the narrower sense of the term, came into being in the second half of the 1970s in German-speaking countries. In Austria, it is a state-approved, independent scientific psychotherapy method since 1995, and an integrative psychotherapeutic approach based on the Gestalt theory of the Berlin School. With reference to this comprehensive, consistent, scientific theory, this article presents the basic concepts of therapeutic practice in the field of Gestalt psychotherapy. Starting from the overarching whole to the parts, the paper first examines the concept of therapeutic relationship and therapeutic attitude, and then describes the basic principles of the practical design of the therapeutic process.

Critical Realism: The Epistemic Position of Gestalt Theoretical Psychotherapy

Summary In this contribution, I discuss the relevance of epistemological models for psychotherapy. Despite its importance epistemology is seldom explicitly dealt with in the psychotherapeutic landscape. Based on the presentation of “Critical Realism (CR),” the epistemological position of Gestalt Theoretical Psychotherapy (GTP), I intend to show to which extent this explanatory model supports a differentiated understanding of problems between human beings, arising from the differences in experiencing “reality.” The presentation deals explicitly with some conclusions that can be drawn from the CR model for practical psychotherapeutic work. In particular, the aspects of basic therapeutic attitude, therapeutic relationship, and praxeology are highlighted.

The Association of a Floating Elbow and a Homolateral Dislocated Floating Shoulder (About a Case)

The floating elbow is a rare lesion, characterized by the presence of a fracture of the humerus and one or both bones of the homolateral forearm. Double disturbances of the upper suspensory shoulder complex, commonly referred to as “floating shoulder” injuries, are ipsilateral fractures of the clavicle and scapula with loss of bone attachment of the glenoid. The combination of a floating elbow and floating shoulder is extremely rare, added an ipsilateral dislocation of the glenohumeral remains exceptional. No case has been reported in the literature of such a lesional association. This observation makes it possible to describe an extremely rare lesion, by proposing the therapeutic attitude and the prognosis.

Colonic Stent as “Bridge to Surgery” and Its Complications: A Case Report

Introduction: Endoluminal colonic stents can be used as a palliative solution in case of neoplastic subocclusions of the bowel and in some cases, they have been proposed as a temporary solution, in place of the derivative stoma, waiting for radical surgery. The "bridge to surgery" solution however can be complicated by perforations or dislocations that can make the patient's cancer treatment more complex. Case Presentation: A seventy-nine-year-old female patient presented a medium sigma adenocarcinoma that was treated initially with a stent to solve the bowel subocclusion. The procedure was complicated by a perforation that leaded to a modification of the TNM stage and consequently of the oncological therapeutic attitude. Conclusion: Self expandable stents could be used to solve the bowel occlusion to replace the derivative stoma performed in urgency. These procedures guarantee a better quality of life and generally less morbidity. However, an accurate assessment of the risks resulting from the positioning of the stents is necessary, avoiding the implant of the stent in tortuous or angled sections of the bowel with a high risk of decubitus and consequently of micro or macro perforations.

Immediate Postextractional Implant Insertion in Posterior Maxilla. Therapeutic Attitude

The immediate postextractional implant insertion is a specific way of surgical approach to implanto-prosthetic treatment. This article addresses the indications, advantages, and surgical techniques of immediate postextraction insertion, illustrated with a clinical case. Objectives: presentation of the indications, advantages and surgical procedure of immediate postextractional implant insertion. Materials and methods: The present study considered the presentation of a case in which we opted for the insertion of implants immediately postextractionally as a therapeutic attitude. Results and discussions: The advantages and disadvantages of this therapeutic technique were represented as follows. The advantage of this technique is given by the shortening of the time necessary to complete the treatment until the prosthetic phase, the disadvantage being represented by the insertion of the implant in positions sometimes less advantageous to the prosthesis. Also, the fact that we could not preserve the alveolar ridge, keeping the bone volume necessary to insert the implant in the best position of the prosthesis by complying with the biomechanical principles, made over time, a series of complications that occurred due to vicious insertion of the implant and non-compliance with those biomechanical principles. Conclusions: The analysis of the case as a whole, represents the main premise from which any dental treatment must be started, so that the functionality of the prosthetic and aesthetic reconstruction will have to be taken into account when we choose the best treatment option.

AB0683 IS THE NEW ASDAS NOMENCLATURE IN LINE WITH THERAPEUTIC DECISION MAKING IN PATIENTS WITH AXIAL SPONDYLOARTHRITIS?

Background:The Assessment of SpondyloArthritis international Society (ASAS) proposed in 2018 a change in the nomenclature of the Ankylosing Spondylitis Disease Activity Score (ASDAS) for monitoring disease activity in axial spondyloarthritis (axSpA), renaming the previously status of moderate disease activity as low disease activity status, with the presumption that this better reflects the perception that the doctor and the patient have about the disease situation. However, this decision was not data-driven.Objectives:To evaluate the association between the state of low disease activity according to the new ASDAS nomenclature and the therapeutic decision in patients with axSpA.Methods:Longitudinal retrospective study in which patients with axSpA recruited in a secondary hospital were included. All patients with clinical diagnosis of axSpA who started treatment with a first inhibitor of tumor necrosis factor between January 2014 and June 2019 were included. At each follow-up visit, disease activity assessments (including BASDAI and CRP) and the therapeutic decision of the doctor were collected. Later, the ASDAS was calculated and disease status at each visit was classified according to the new nomenclature (inactive, low, high and very high activity). Using descriptive statistics, the association between the disease activity status and the therapeutic decision was evaluated.Results:A total of 304 visits were analyzed in 104 patients with axSpA. Out of these, 57% were women, 47% had a subtype of non-radiographic axSpA and 42% were HLA-B27 positive. The mean (standard deviation) age at diagnosis was 46.9 (12.5) years. In the visits with an ASDAS showing a status of low activity, the therapeutic attitude was not to intensify the treatment in 98.2% of the cases. However, in visits with an ASDAS status of high or very high disease activity, treatment was intensified in 33.7% and 82.8% of cases, respectively.Conclusion:In clinical practice, the status of disease activity initially classified by the ASDAS as moderate disease activity is currently considered to represent low disease activity status based on the therapeutic attitude of following a non-intensification strategy in this situation. These data support the recent change in the nomenclature of disease activity states according to the ASDAS.References:[1]Machado PM, Landewé R, van der Heijde D. Assessment of Spondyloarthritis international Society (ASAS). Ankylosing Spondylitis Disease Activity Score (ASDAS): 2018 update of the nomenclature for disease activity states. Ann Rheum Dis 2018; 77:1539-1540.Figure 1.Association between the state of disease activity according to the new ASDAS nomenclature and the therapeutic decision.Disclosure of Interests:Blanca Garcia-Magallon Consultant of: MSD, Speakers bureau: Pfizer, Amgen, Celgene, MSD, María del Carmen Castro Villegas: None declared, Rosa Rosselló: None declared, Victoria Navarro-Compán Consultant of: Abbvie, Lilly, Novartis, Pfizer, UCB, Speakers bureau: AbbVie, MSD, Lilly, Novartis, Pfizer, UCB