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Biomedical subjects

M Zlitni

Publications and source records attributed to M Zlitni.

17 recordsLinked to original sources

[Cold parapharyngeal abscess in spondylodiscitis].

BACKGROUND: The principle danger of pharyngeal abscess is the risk of rupture overflow into the upper respiratory track. Pyogenic abscesses are the most frequent and tuberculosis is rare. We report two cases of retro and parapharyngeal abscesses with tuberculous spondylodiscitis. CASE REPORTS: The first case occurred in a 54-year-old woman, the second in a 19-year-old man. Both had a laterocervical swelling associated with a oropharyneal bulge that progressed over several months. Computed tomography showed abscess formation and spinal disease in both cases. Drainage of the abscess led to the distological diagnosis of tuberculosis. Medical management was successful with resolution of the abscess and spinal lesions. DISCUSSION: Spinal tuberculosis should be suspected in patients with a parapharyngeal abscess without detectable portal that progresses slowly. A biopsy specimen is required for diagnosis. Magnetic resonance imaging can provide early evidence of spondylodiscities. Medical treatment is indicated.

Adult↗

Hydatid cyst of bone: diagnosis and treatment.

Osseous hydatidosis is a rare occurrence of hydatid disease. Anatomoclinical changes are, however, peculiar to this localization. From the anatomopathologic standpoint, this localization marks the torpid, insidious progression of the parasite into bone tissue, leading to an immediate diffuse, extensive, invasion process, so complete surgical eradication is rarely possible. From the clinical standpoint, whatever the localization may be, we are surprised by the latency of this affection, the patient being treated at an advanced stage, when radiologic lesions are already extensive, and the complications, especially in the spinal area, are severe. Owing to the poor biologic findings, the diagnosis of osseous hydatidosis is still primarily based on roentgenographic findings. Sometimes, however, the diagnosis is established only after surgery. Treatment of osseous hydatidosis is closer to oncologic therapy than to the usual surgical treatment of visceral hydatid cysts. Because of the poor results with medical treatment, osseous hydatidosis must be treated by a radical operation with wide excision, adapted to each localization. In the main, the prognosis of osseous hydatidosis remains poor, especially with spinal and pelvic localizations, which are the most frequent ones. The prognosis and treatment of osseous hydatidosis belong in the same category as a locally malignant lesion.

Bone Diseases↗

[Vertebral actinomycosis with spinal cord compression. A case report].

INTRODUCTION: Vertebral involvement of actinomycosis is extremely rare and associated spinal cord compression is unusual. EXEGESIS: We report a case of a 31-year-old man with vertebral actinomycosis presenting with spinal cord compression. Magnetic resonance imaging demonstrated a paravertebral abscess and lytic areas on the vertebral body of C5 requiring emergency surgery and antibiotic treatment. The patient was still asymptomatic after 12 months of follow-up. CONCLUSION: Clinical aspects of this unusual localization are reviewed. Treatment may be particularly difficult.

Abscess↗

[Tumorous calcinosis in hemodialysis: anatomo-clinical study apropos of 3 cases].

Three patients (2 females, 1 male) with a mean age of 51.4 years receiving long term hemodialysis affected by tumoral calcinosis were analysed. Clinical, radiological and pathological features were evaluated and pathogenic were reviewed. The joints involved int the cases presented in this report were the hip shoulder and finger. The lesions were bilateral in shoulder. An increased calcium-phosphorus product (Ca x P) was observed in all patients with secondary hyperparathyroidism in one case. Surgery was carried out in all patients. No relapse of the tumoral calcinosis was observed after surgery. The most important pathogenic factor involved in uremic tumoral calcinosis is an increase in calcium-phosphorus product (Ca x P) not necessarily related to hyperparathyroidism. Therefore, maintaining the calcium x phosphate product within the normal range appears to be the most important factor ito prevent the appearance of uraemic tumoral calcinosis.

Adult↗

[Lipoma arborescens of the knee: contribution of x-ray computed tomography. Apropos of a new case].

The authors report a case of a synovial lipoma of the knee in a 40 years old man who suffered from chronic instability of the right knee associated to an extensive joint swelling and recurrent hydarthrosis. Ultrasonography and arthrography showed a synovial process and the computerized tomography showed an inhomogeneous low density due to its fat content suggesting a synovial lipoma arborescens of the knee. Final diagnosis was confirmed by histological examination of the arthroscopic biopsy. The authors discuss, through out their case and a review of the literature, modern investigation findings and indication for surgical treatment of this disease.

Adult↗

[Tuberculosis of the trochanter. Apropos of 17 cases].

This paper presents a short study of 17 cases of tuberculosis of the greater trochanter seen during a period of 19 years at the National Orthopaedic Institute in Tunis. The onset of the infection is slow with patients presenting at a mean of 7 years after initial symptoms. The diagnosis is confirmed by biopsy and culture of the organism. Management is based on treatment with antituberculous drugs, although surgical excision of the lesion is sometimes required. Successful resolution of the symptoms is usually achieved unless the hip joint becomes involved. Our patients showed good results at a mean follow up of 5 1/2 years.

Adolescent↗

Osteoid osteoma of the acetabulum.

Osteoid osteoma of the acetabulum can be expected to cause nonspecific symptoms of hip inflammation. In a sixteen year old girl, investigation by routine radiographs and a bone scan suggested a focus of inflammation with a nidus and sclerosis of the acetabulum and overgrowth of the head and neck of the femur. Removal of the lesion by an anterior approach with dislocation of the hip gave excellent results when seen after three years with a normal gait and normal hip motion.

Acetabulum↗

Extensive vertebral hydatidosis. A study.

An exceptional case of vertebral hydatidosis with involvement of the cervical, dorsal, lumbar and sacral segments of the spine is presented. Vertebral hydatidosis is a rare form of hydatid disease. It is found in less than 2% of all cases in echinococcosis. The initial parasite localization is usually univertebral. Extensive primary lesions were related to massive infestation by tapeworm ova at multivertebral levels. At this stage, the disease presents as a malignant tumor resistant to all surgical procedures. The prognosis is poor because of severe neurological complications and inexorable spinal destruction. The hope remains that in the future an effective medical parasiticidal treatment will be available.

Adult↗

Vertebral hydatidosis and paraplegia.

We report the management of two children and 11 adults with paraplegia secondary to vertebral hydatidosis. Destruction of pedicles, posterior vertebral elements and discs as well as the vertebral bodies was common and all six patients with thoracic disease had involvement of adjacent ribs. The 13 patients had a total of 42 major surgical procedures; two patients died from postoperative complications and four from complications of the disease and paraplegia. All eight patients initially treated by laminectomy or anterior decompression alone relapsed within two years and seven required further surgery. Circumferential decompression and grafting gave the best results, six of nine patients being in remission an average of three years and six months later. The prognosis for such patients is poor; remission is the aim, rather than cure. Anthelminthic drugs may improve the prognosis, but radical surgery is likely to remain the keystone of treatment in the foreseeable future.

Adolescent↗

Tibial defect due to acute haematogenous osteomyelitis: treatment and results in twenty-one children.

The management of twenty-one children with a defect of the tibial shaft due to acute haematogenous osteomyelitis is described. Half the defects were due to removal of the sequestrum before the involucrum had formed. Only four patients, all under ten years of age, had spontaneous regeneration of the shaft. Eleven children had a posterior tibiofibular graft and six had a transfer of the ipsilateral fibular diaphysis. The results of operation were superior to those of spontaneous regeneration. All the grafts united and the children returned home to lead normal lives. Shortening was only a problem when growth plates or adjacent joints had been damaged. We now leave the sequestrum for up to one year after the onset of infection. If the involucrum fails to form we reconstruct the tibia as soon as possible after sequestrectomy.

Acute Disease↗