Osteoblastoma of the femur in a patient with recurrent paronychia : case report

Background: Osteoblastoma is a rare primary benign bone tumor that has varied radiologic presentation depending on the affected site. In selected cases, differential diagnosis with subacute osteomyelitis is necessary. Case Report: The authors present the case of a 23 year-old male with recurrent paronychia diagnosed with osteoblastoma of the femur. On the basis of CT and MRI findings, osteosarcoma, ABC, enchondroma, chondromyxoid fibroma, and Brodie's abscess were excluded from differential diagnosis, with the last option being the second most probable diagnosis given the coexistence of chronic pyogenic process. Discussion: Plain film findings in osteoblastoma and Brodie's abscess may be strikingly similar with an osteolytic lesion surrounded by prominent sclerosis. The nature of the lesion can be further elucidated by cross-sectional imaging. CT helps to assess the lesion matrix and presence or absence of sequestra or fistulae, while MRI defines the extent of the changes in bone marrow cavity and soft tissues

Characterization of transcription within sdr region of Staphylococcus aureus

Staphylococcus aureus is an opportunistic pathogen responsible for various infections in humans and animals. It causes localized and systemic infections, such as abscesses, impetigo, cellulitis, sepsis, endocarditis, bone infections, and meningitis. S. aureus virulence factors responsible for the initial contact with host cells (MSCRAMMs—microbial surface components recognizing adhesive matrix molecules) include three Sdr proteins. The presence of particular sdr genes is correlated with putative tissue specificity. The transcriptional organization of the sdr region remains unclear. We tested expression of the sdrC, sdrD, or sdrE genes in various in vitro conditions, as well as after contact with human blood. In this work, we present data suggesting a separation of the sdr region into three transcriptional units, based on their differential reactions to the environment. Differential reaction of the sdrD transcript to environmental conditions and blood suggests dissimilar functions of the sdr genes. SdrE has been previously proposed to play role in bone infections, whilst our results can indicate that sdrD plays a role in the interactions between the pathogen and human immune system, serum or specifically reacts to nutrients/other factors present in human blood

Zastosowanie miejscowe substytutu kości na bazie siarczanu wapnia w leczeniu przewlekłej infekcji po rekonstrukcji więzadła krzyżowego przedniego. Wyniki w trzech przypadkach i przegląd piśmiennictwa

Introduction. We report the results of revision surgery in recurrent infection after anterior cruciate ligament reconstruction (ACLR) consisting of graft canal debridement and the local application of a calcium sulfate bone substitute (CSBS) with the addition of gentamicin and vancomycin in graft canal and infected foci. Materials and methods. Three patients (3 knees) were operated due to a chronic and unsuccessfully treated knee infection after ACLR. Two patients underwent multiple previous revisions (4 and 9, respectively). In all cases, the tibial ACL graft canal and adjacent bone foci were debrided. Post debridement defects in the femur and tibia and the graft tunnel in the tibia were filled with CSBS with an addition of gentamicin and vancomycin. If the absence of the ACL graft was stated, the tibial canal was closed from the joint side with a collagen sponge with gentamicin. Results. After a follow-up of 20 to 26 months, all patients obtained a complete resolution of inflammation and CRP normalization. No side effects related to CSBS were observed. There was no deterioration in the knee function and stability compared to the pre-revision status. Conclusions. CSBS with the addition of gentamicin and vancomycin applied in the graft canal and inflammatory foci in the surrounding cancellous bone proved to be effective and unrelated to complications in chronic infection after ACLR. Level of Evidence: IV (case series).Wstęp. Opisujemy wyniki operacji rewizyjnych w nawracającej infekcji po rekonstrukcji więzadła krzyżowego przedniego (RWKP) polegających na oczyszczeniu kanałów i aplikacji substytutu kości – siarczanu wapnia z dodatkiem gentamycyny oraz wankomycyn wewnątrz kanałów oraz w ognisku zapalnym. Materiał i metody. Trzech pacjentów (3 stawy kolanowe) zostało zoperowanych z powodu przewlekłej i bezskutecznie leczonej infekcji stawu kolanowego po RWKP. Dwoje Pacjentów przeszło wcześniej wiele operacji rewizyjnych (kolejno 4 i 9). We wszystkich przypadkach kanał piszczelowy przeszczepu WKP i otaczająca go kość zostały oczyszczone. Pozostała po oczyszczeniu przestrzeń w kości udowej oraz piszczelowej zostały wypełnione przy użyciu substytutu kości – siarczanu wapnia z dodatkiem gentamycyny oraz wankomycyny. W przypadku stwierdzenia braku przeszczepu WKP kanał piszczelowy został zaślepiony od strony stawu przy użyciu gąbki gentamycynowej. Wyniki. W okresie obserwacji wahającym się od 20 do 26 miesięcy u wszystkich pacjentów osiągnięto całkowite ustąpienie objawów infekcji oraz normalizację stężenia CRP. Nie zaobserwowano żadnych efektów ubocznych działania siarczanu wapnia. Nie wystąpiło pogorszenie funkcji żadnego ze stawów ani pogorszenia stabilności stawu w porównaniu do czasu sprzed operacji rewizyjnej. Wnioski. Substytut kości – siarczan wapnia z dodatkiem gentamycyny oraz wankomycyny podany do kanału po przeszczepie oraz w ognisko zapalne w otaczającej kości gąbczastej okazuje się być efektywnym w leczeniu przewlekłej infekcji po RWKP, a jednocześnie jest niezwiązany z powikłaniami. Wartość dowodów: IV (seria przypadków)

An aggressive course of pyoderma gangrenosum mimicking bacterial osteomyelitis after open reduction and internal fixation of a distal radius fracture with a titanium plate

Pyoderma gangrenosum (PG) is a rare condition characterized by the development of aseptic, non-healing skin ulcers. Any skin trauma, such as a surgical incision, can trigger an outbreak of lesions. Our case and literature review show that a physician should consider PG in every event of a non-healing, aseptic wound after surgery. The treatment of PG requires collaboration within a multidisciplinary team and immunosuppressive therapy is the first line of treatment, while surgical interventions should be avoided in the active stage of PG

Czy zmiany ST-T elektrokardiogramu są wynikiem zapalenia osierdzia i mięśnia sercowego - czy zawału serca. Koronarografia nie zawsze rozstrzyga wątpliwość. Opis 4 przypadków

Abstract: Four males aged 17-42 years with ST-T segment changes suggesting perimyocarditis or non-Q acute myocardial infarction are presented. Coronary agiography was performed to establish the final diagnosis. Three patients had normal coronary arteries; two of them had typical clinical signs of perimyocarditis whereas the third patient had less typical changes. The fourth patient was a smoker, had a family history of coronary heart disease and left ventricular dysfunction due to a non-Q wave apical infarction. In this patient coronary angiography revealed small atheromatous plaques in the distal part of left anterior descending artery as well as left main and right coronary artery spasm. Angiospastic aetiology of infarction and probable endothelial dysfunction due to myocarditis were diagnosed. The authors conclude that coronary angiography is not always helpful if clinical, electrocardiographic and biochemical signs of perimyocarditis are observed