11/17. Unrecognized staphylococcal pyarthrosis with rheumatoid arthritis.Four patients whose rheumatoid arthritis (RA) was complicated by staphylococcal arthritis were identified. All patients had active, long-standing disease with destructive changes. Affected joints included hip (two patients), knee (one patient), and shoulder (one patient). pain and loss of motion in the affected joint were prominent, but toxic features of pyogenic infections--hectic fever, chills, sweats, local warmth, or erythema--were conspicuously absent. Two patients had moderate fever and three patients had mild leukocytosis. No patient was leukopenic. When present, fever was attributed to infected decubiti or urinary tract infection and treated with antibiotics. Therapy with corticosteroids and nonsteroidal antiinflammatory drugs (NSAIDs) probably masked symptoms and delayed the correct diagnosis. Purulent synovial effusions were discovered serendipitously--during arthrography (knee), attempted Girdlestone procedure (hip), and aspiration prior to steroid injection (shoulder). sepsis was included in the preoperative diagnoses only once (hip). Prior instrumentation (aspiration or injection) of the affected joint was not a feature in any patients, although one patient had undergone insertion of a knee prosthesis one year prior to sepsis. Infectious organisms were staphylococcus aureus in three patients and staphylococcus epidermidis in one. Severe sequelae ensued in three of four patients: death from recurrent sepsis (one patient), loss of prosthesis leading to knee arthrodesis (one patient), and protracted sepsis with additional pyarthrosis (one patient). The only patient to regain preseptic joint function (shoulder) had not been on long-standing corticosteroids. Pyarthrosis must be considered in RA patients with unusually painful or stiff joints even in the absence of toxic symptoms.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
12/17. Spiral CT with multiplanar reconstruction in the diagnosis of sternoclavicular osteomyelitis.OBJECTIVE. The purpose of this study was to determine whether contrast-enhanced spiral ct scanning supplemented by multiplanar reconstruction is of value in the evaluation of suspected infection of the sternoclavicular joints. MATERIALS AND methods. Seven patients with suspected infection of the sternoclavicular joints were evaluated with spiral CT using narrow collimation (4 mm) and close interscan reconstruction (2-4 mm). All patients were scanned immediately following the injection of 120 ml Omnipaque-300 at a rate of 3 ml/s. Spiral CT scans were of 24 or 32 s duration and done as single-breath-hold studies. All images were then filmed at soft tissue and bone settings (window width 2300, window center 270). In selected cases, coronal, sagittal, and/or oblique reconstruction of data was done for review. RESULTS. All studies were successfully completed without any interscan or intrascan motion. In six cases, infections of the sternoclavicular joint was found, including five cases of osteomyelitis of the clavicular head. The scans obtained during the phase of high contrast enhancement allowed definition of the extension into the soft tissue and muscle. Bone windows demonstrated subtle cortical and periosteal abnormalities. CONCLUSION. Imaging of the sternoclavicular joints with standard CT can be difficult due to interscan motion and the inability to get good data sets for reconstruction. Spiral CT with 24- to 32-s acquisition allows high quality images enabling detection of disease and definition of extent of disease, thus helping to guide patient management.- - - - - - - - - - ranking = 2keywords = motion (Clic here for more details about this article) |
13/17. Spiral CT of musculoskeletal pathology: preliminary observations.Spiral or helical computed tomography (CT) allows the rapid acquisition of volumes of CT data in a 24- to 32-s time frame. Rapid data acquisition is accompanied by the ability to reconstruct the images at any pre-determined interval (1-10 mm). This technique is optimal for studies requiring iodinated vascular contrast because it allows data acquisition during the peak contrast levels, optimizing lesion detection. The technique is also excellent for studies that need two- and/or three-dimensional reconstruction as it decreases the chance of interscan motion. Spiral CT has significant potential for a wide range of musculoskeletal imaging applications including in musculoskeletal infection, soft tissue tumors, trauma, and in the oncologic patient.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
14/17. Bacteraemia due to recurrent reinfection with staphylococcus epidermidis associated with defective opsonisation and procidin function in serum.AIMS--To differentiate between reinfection and relapsing infection with staphylococcus epidermidis in a middle-aged woman with defective opsonisation and procidin function in serum. methods--Microbiological typing was done by biotyping, phage typing, and polyacrylamide gel electrophoresis of radiolabelled bacterial proteins (radioPAGE method). Polymorphonuclear cell function was assessed in vitro by phagocytosis and killing of candida albicans; measurement of neutrophil random locomotion and chemotaxis; reduction of nitroblue tetrazolium after stimulation by opsonised Candida and a radiometric saccharomyces opsonisation assay. The effect of plasma infusions on opsonic activity was assessed by chemiluminescence using control polymorphonuclear leucocytes with a laboratory strain of S epidermidis opsonised with either patient or control serum. RESULTS--Recurrent reinfection with different strains of staphylococcus epidermidis rather than relapsing infection was confirmed as having occurred by typing bacterial strains. The RadioPAGE method detected all the S epidermidis strains involved in this patient's illness. The patient's serum was shown to be defective in both opsonin and procidin function. The defects were correctable in vitro by the addition of normal serum. Clinical recovery occurred after repeated infusions of normal fresh frozen plasma and prolonged antibacterial treatment; antibacterial treatment alone was insufficient. CONCLUSIONS--The radioPAGE method is useful in distinguishing recurrent reinfection with S epidermidis from relapsing infection with this organism. Elucidation of the nature of, and underlying predisposition to, infection in the patient studied allowed a rational treatment plan of plasma infusion combined with antibacterial treatment to be devised which ultimately proved successful.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
15/17. endophthalmitis and orbital cellulitis after radial keratotomy.PURPOSE: To report the findings concerning three patients with endophthalmitis and one with panophthalmitis and orbital cellulitis radial keratotomy surgery. methods: One man referred with panophthalmitis and orbital cellulitis and three women referred with endophthalmitis were treated. RESULTS: After radial keratotomy surgery, during which no microperforation or macroperforation had been reported, a severe pseudomonas panophthalmitis and orbital cellulitis developed in the man. All vision was lost in that eye. staphylococcus epidermidis endophthalmitis developed in one woman, streptococcus pneumoniae endophthalmitis in the second woman and pseudomonas endophthalmitis in the third woman, after undergoing radial keratotomy procedures during which microperforations occurred. In the latter patient, bilateral simultaneous surgery was performed, but only one eye became infected. The latter two infections resulted in light perception and hand motion vision respectively. In three cases, an initial keratitis was located in the inferior cornea. CONCLUSIONS: Severe bacterial endophthalmitis can occur after radial keratotomy surgery, even in the absence of microperforation during the procedure. Any evidence of postoperative keratitis must be regarded seriously and treated aggressively. Despite use of this approach, the effect on final visual acuity can be devastating.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
16/17. Nonunion of the humerus following intramedullary nailing treated by Ilizarov hybrid fixation.A case of a posttraumatic humeral shaft nonunion, after intramedullary stabilization with a Seidel nail, is presented. Severe osteoporosis, an oligotrophic nonunion, subclinical infection, and adhesive capsulitis of the glenohumeral joint were present. Due to the subclinical infection and severe osteoporosis, other major invasive therapeutic options such as intramedullary nailing or compression plating and bone grafting were not applicable. Nonoperative treatment was also not indicated secondary to the pain and disability present. External fixation with the Ilizarov hybrid fixator seemed to offer a minimally invasive treatment modality without the need of additional bone grafting. After fourteen weeks of "callus massage," consisting of closed alternating compression and distraction with an Ilizarov hybrid fixator, osseous consolidation was achieved. Eight months after Ilizarov treatment the patient had returned to work as a mechanic. At the one-year follow-up examination, the patient presented pain free and with near normal shoulder and elbow motion, with stable osseous consolidation of the humerus. In some cases of nonunion of the humerus shaft, when standard treatment options are not recommended, external fixation with an Ilizarov hybrid fixator may offer a salvage procedure with a successful clinical outcome.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
17/17. Pyogenic infections of the sacro-iliac joint.In 3 cases of pyogenic infection of the sacro-iliac joint, the diagnosis was difficult. Limp, buttock pain and upper sciatica were the most common presenting symptoms. Differential limitation of hip motion, positive straight leg raising, a positive Gaenslen test and pain on pelvic compression were frequent fingings. Increased E.S.R., W.B.C. count and fever were seen in 2/3 cases. Plain and tomographic x-rays are often helpful but bone scan has been helpful in localizing early lesions. Treatment after early diagnosis may consist of antibiotics and immobilization alone while in the more chronic cases surgical drainage and debridement may be necessary.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
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