Unicameral bone cyst of the lunate in an adult: case report

We report a case of a symptomatic unicameral (simple) bone cyst of the lunate in a 42-year- old woman. The lesion was treated with curettage and cancellous autogenous iliac bone grafting. At five years of follow-up the wrist was pain free, there were no limitations of motion, and the radiographs showed complete obliteration of the cavity. To the best of our knowledge, no other unicameral bone cyst of the lunate has been reported in an adult. Cysts with significant cavities at the carpal bones in an adult should be approached cautiously, as they may require early curettage and bone grafting for healing, before collapse and degenerative changes occur

Nadir bir dirsek ağrısı nedeni: Hegemann hastalığı

WOS: 000376564200037Non-traumatic elbow pain is rarely seen in children and pre-adolescents. Osteochondral lesions may be the source of chronic elbow pain, swelling, and loss of motion in children or adolescents. Osteochondritis dissecans (OCD) is described as a lesion of subchondral bone resulting in separation of the articular cartilage and subchondral bone. It is found primarily in the knee, ankle, and elbow joints. Since osteochondrosis of the elbow primarily involves capitellum, few papers involving osteonecrosis of the trochlea have been reported. This paper discusses a pre-adolescent boy with clinical and radiographic signs consistent with unilateral osteochondral lesion of the trochlea humeri, with no history of recent trauma. The patient had insidious onset of right elbow pain during daily activities for the last 3 weeks. After usage of long arm splint for 2 weeks, persistence of the symptoms necessitated MRI of the affected elbow. After the diagnosis, non-operative management was achieved. Care should be taken for the affected children to recognize any residual deformity and to treat it properly at follow up.Travma olmaksızın dirsek ağrısı çocuklarda ergenlik öncesi dönemde nadir görülür. Bu dönemde kronik dirsek ağrısı, şişlik ve eklem hareket kaybı osteokondral lezyonlara bağlı olabilir. Osteokondritis dissekans, subkondral kemik ile eklem kıkırdağının subkondral kemikteki bir lezyona bağlı ayrışması olarak tanımlanır. Özellikle diz, ayak bileği ve dirsek eklemlerinde görülür. Dirsek osteokondrozunda birincil olarak kapitellum etkilenmekteyken, troklea osteonekrozu ile ilgili az sayıda olgu bildirilmiştir. Bu yazıda yakın zamanda travma öyküsü olmayan, ergenlik öncesi dönemde bulunan, klinik ve radyolojik olarak tek taraflı troklea osteokondral lezyonu ile uyumlu olan bir olgu sunulmuştur. Hastada son 3 haftadır daha önce belirti vermeyen, günlük aktivitelerde ortaya çıkan sağ dirsek ağrısı mevcuttu. 2 hafta uzun kol atelde takip edilen hastada şikayetlerin devamı üzerine dirsek MR görüntülemesine ihtiyaç duyuldu. Tanı konduktan sonra cerrahi dışı tedavi ile başarılı sonuç elde edildi. Çocuklarda rezidüel deformitenin tanınması ve uygun tedavisi için takipte dikkatli olunmalıdır

Gouty arthritis at interphalangeal joint of foot after sildenafil use: A case report

INTRODUCTION: Interphalangeal joint of foot is a very unusual location for gouty arthritis and sildenafil use may cause this phenomenon. PRESENTATION OF CASE: A 58-year-old hypertensive man was admitted to hospital with pain and swelling over interphalengeal joint of his right great toe. His health history included the use of diuretics for a long time and his last gout attack was two years ago at first metatarsophalengeal joint of right foot. Sildenafil, a selective inhibitor of phosphodiesterase type 5 (PDE5), was administered in case of erectile dysfunction for two months. Subsequently, he had several episodes of pain and swelling at first interphalangeal joint of right great toe. Both the onset and recurrence of symptoms were just seen the day after sildenafil use. The patient was free of symptoms after discontinuation of the drug. After an initial evaluation, gout was diagnosed on the basis of synovial fluid analysis. DISCUSSION: This case demonstrates a rare location of gouty arthritis with an uncommon etiology: sildenafil. Regarding the clinical data, the discussion was made to expand the horizon for diagnosis of patients with similar symptoms, to identify risk factors for gout relevant to elderliness, and to review the management of gout. CONCLUSION: Sildenafil use may cause gouty arthritis, and surgical decompression may be helpful for definitive diagnosis and symptom relief in atypical presentation of gout

Mortality predictors of Staphylococcus aureus bacteremia: A prospective multicenter study

Background: Staphylococcus aureus is one of the causes of both community and healthcare-associated bacteremia. The attributable mortality of S. aureus bacteremia (SAB) is still higher and predictors for mortality and clinical outcomes of this condition are need to be clarified. In this prospective observational study, we aimed to examine the predictive factors for mortality in patients with SAB in eight Turkish tertiary care hospitals. Methods: Adult patients with signs and symptoms of bacteremia with positive blood cultures for S. aureus were included. All data for episodes of SAB including demographics, clinical and laboratory findings, antibiotics, and outcome were recorded for a 3-year (2010-2012) period. Cox proportional hazard model with forward selection was used to assess the independent effect of risk factors on mortality. A 28-day mortality was the dependent variable in the Cox regression analysis. Results: A total of 255 episodes of SAB were enrolled. The median age of the patients was 59years. Fifty-five percent of the episodes were considered as primary SAB and vascular catheter was the source of 42.1%. Healthcare associated SAB was defined in 55.7%. Blood cultures yielded methicillin-resistant S. aureus (MRSA) as a cause of SAB in 39.2%. Initial empirical therapy was inappropriate in 28.2%. Although overall mortality was observed in 52 (20.4%), 28-day mortality rate was 15.3%. Both the numbers of initial inappropriate empirical antibiotic treatment and the median hours to start an appropriate antibiotic between the cases of fatal outcome and survivors after fever onset were found to be similar (12/39 vs 60/216 and 6 vs 12h, respectively; p>0.05). High Charlson comorbidity index (CCI) score (p=0.002), MRSA (p=0.017), intensive care unit (ICU) admission (p<0.001) and prior exposure to antibiotics (p=0.002) all were significantly associated with mortality. The Cox analysis defined age [Hazard Ratio (HR) 1.03; p=0.023], ICU admission (HR 6.9; p=0.002), and high CCI score (HR 1.32; p=0.002) as the independent predictive factors mortality. Conclusions: The results of this prospective study showed that age, ICU stay and high CCI score of a patient were the independent predictors of mortality and MRSA was also significantly associated with mortality in SAB