Successfully treated osteomyelitis involving the entire ischium in a patient with lower-limb paraplegia (a case report)

Introduction: Pelvic bones, probably due to their anatomical features (deep location, good blood supply and other unknown reasons), are rarely affected by exogenous or hematogenous infections. Usually, the flora isolated from the infected pelvic bone is polymicrobial, with the most common microorganisms causing this type of infection being Staphylococcus aureus, Streptococcus, Pseudomonas aeruginosa. The ischial bone (os ischii) is the pelvic bone most often affected by infections, adjacent to deep IV degree decubitus wounds. These wounds are typical for patients with severe neurological symptoms—paraplegics or quadriplegics, as well as those with cerebral disorders, and the process may remain undiagnosed for a long time.Aim: The aim of this article is to focus on the difficulties associated with the early diagnosis of an infection affecting the entire ischial bone and the soft tissues of the adjacent pelvis, as well as the high risk to the patient if adequate treatment is not carried out.Patient and Methods: One patient, a 60-year-old man, with lower-limb paraplegia, after a spinal cord trauma dating back to 10 years ago, is presented.Results: After the applied treatment—resection, removal of the entire ischial bone, and soft tissue debridement, the surgical wound healed primarily, the bone and soft tissue infection of the pelvis was successfully managed. General intoxication of the body was prevented.Conclusion: Accurate and timely debridement, including the risky total excision of the os ischii, as well as the infected adjacent soft tissues in the pelvis, combined with appropriate drainage, may prove to be the only effective and life-saving procedure for the patient

Neurofibromatosis (case reports)

Introduction: Neurofibromatosis includes a group of genetic diseases that cause tumors affecting nerve tissue. They are primarily benign, but in certain cases (3–5%) may undergo malignant transformation. Both the central and peripheral nervous systems can be affected. This results in their extremely diverse clinical manifestation—from mild cases to dramatic conditions. Three types of the disease have been described—neurofibromatosis type 1 (NF1), type 2 (NF2), and type 3—schwannomatosis.Aim: The aim of this article is to pay attention to a rare disease with a variety of symptoms and course, which due to its progressive course in some patients can lead to severe functional deficits and even amputation.Materials and Methods: Two patients are presented: a 4-year-old girl with a newly discovered disease with spinal localization, as well as a 53-year-old woman who underwent repeated surgery for newly emerging tumor formations in the area of the right forearm and arm.Results: Six years after the removal of the tumor from the spinal area, the child has no complaints, no evidence of local recurrence or involvement of other organs. Three years after the operation, the patient with localization of the tumor in the upper limb has significantly improved blood supply and functional condition of the arm.Conclusion: Neurofibromatosis is a disease with a variety of clinical manifestations. Limb surgeries should be planned and performed with extreme care and individual approach due to the high risk of additional vascular damage as well as potential malignant transformation.Introduction: Neurofibromatosis includes a group of genetic diseases that cause tumors affecting nerve tissue. They are primarily benign, but in certain cases (3–5%) may undergo malignant transformation. Both the central and peripheral nervous systems can be affected. This results in their extremely diverse clinical manifestation—from mild cases to dramatic conditions. Three types of the disease have been described—neurofibromatosis type 1 (NF1), type 2 (NF2), and type 3—schwannomatosis.Aim: The aim of this article is to pay attention to a rare disease with a variety of symptoms and course, which due to its progressive course in some patients can lead to severe functional deficits and even amputation.Materials and Methods: Two patients are presented: a 4-year-old girl with a newly discovered disease with spinal localization, as well as a 53-year-old woman who underwent repeated surgery for newly emerging tumor formations in the area of the right forearm and arm.Results: Six years after the removal of the tumor from the spinal area, the child has no complaints, no evidence of local recurrence or involvement of other organs. Three years after the operation, the patient with localization of the tumor in the upper limb has significantly improved blood supply and functional condition of the arm.Conclusion: Neurofibromatosis is a disease with a variety of clinical manifestations. Limb surgeries should be planned and performed with extreme care and individual approach due to the high risk of additional vascular damage as well as potential malignant transformation