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A case of primary hyperparathyroidism with advanced osteitis fibrosa cystica but without any subperiosteal phalangeal bone resorption is described. A review of this unusual radiological feature is presented. High-detail magnification radiography (microradiography) is advocated for the early diagnosis of bony defects in hyperparathyroidism.
Two cases of spontaneous septic osteitis of the pubis in patients who had not previously undergone intrapelvic or abdominal surgery are presented. Early diagnosis and evaluation of the immunological system are discussed. Drainage of the pus and thorough debridement of the affected bone are the hallmarks of correct treatment. The administration of suitable antibiotics with simultaneous correction of immunological deficiencies will result in eventual cure.
Posttraumatic bone infection very often signifies a life threatening complication. However, it must no longer be accepted that amputation of the afflicted limb be the logical treatment of such a complication. A surgeon who offers the advantages of operative treatment of a fracture to his patient must also be able to control its complications. Osteitis can be treated with a good chance of success. In our clinic 29 bone infections were treated, 13 of them healing without substantial restrictions, 7 with distinct discomfort and 4 with arthrodesis, i.e. 83% healed. However, the treatment may require months and may necessitate further operative interventions. The transfer of such a patient from an acute care hospital to a high altitude clinic offers -- besides the medical and psychological advantage of a continuous long-term treatment plan -- the climatic conditions of sun and high altitude air which apparently act very favorably on the healing process of chronic infections. Of course, the possibility of competent surgical interventions must exist. Thus, with proper therapy the disastrous chain of errors beginning mainly with poor initial care through insufficient treatment can be broken.
A rare association of prostatic adenocarcinoma with osteitis deformans (Paget's disease) is reported. The diagnosis suspected on the basis of simultaneous increased concentrations of acid and alkaline phosphatases was documented only through repeated biopsies of prostate.
In 50 cases of chronical osteitis it is demonstrated that after sanitation of the remaining cavity by short time application of PMMA-chain a qualified bed for cancellous bone graft can be created. The followup 15 months after PMMA application shows a demonstrable improvement of the bone infection. In 26 cases no more fistula was seen. The short time application of the chain for 10--14 days with consecutive bone grafting shows the best results.
Removal of septic foci in putrid infection of the bone is an important step in the treatment of post-traumatic osteitis. The methods employed so far, such as through-drainage and siphonage, as well as gentamycin-PMMA chains, have very obvious drawbacks although they have definitely achieved favourable results. Taurolin Gel , a preparation consisting of denatured collagen in combination with the chemotherapeutic Taurolin 4%, is theoretically capable of eliminating these drawbacks. Clinical application appeared justified on the basis of good results obtained with the drainage solution of Taurolin, as well as in the course of experiments. Results have been obtained mostly in a single application in 50 cases documented and followed up; these results were equivalent to those obtained by means of the other methods. In consideration of the advantages with regard to application and effect, the authors believe that testing of this substance on a larger scale should be recommended.
Advances in the diagnosis and treatment of invasive Pseudomonas osteitis have improved the prognosis of this condition. The addition of hyperbaric oxygen therapy to the newer antibiotic regimens appears to enhance their efficacy. Radionuclide scanning can result in earlier diagnoses and also determine an end point for therapy. Surgical intervention should be reserved for those patients who do not respond to medical therapy and should be governed by knowledge of the temporal bone histopathology from available specimens.
Osteitis deformans is a relatively common disease in Caucasians, but rare in the indigenous people in Africa. Three cases of Paget's disease occuring in South African Negroes are reported here. Gene marker studies confirmed the absence of Caucasoid genes in these patients.
A case of B.C.G. osteitis occuring after an attempt at the restoration of immune function in a patient with Hodgkin's disease. The diagnosis was based upon histological study of a biopsy specimen and the discovery of a B.C.G. strain. Tuberculostatic therapy resulted in local healing. The various complications and side-effects of B.C.G. immunotherapy are reported in the discussion: local reactions, regional lymphadenopathy, systemic infections, hypersensitivity phenomena, pulmonary, bone marrow and hepatic involvement.
We reviewed the case of three of our own patients who had osteomyelitis of the symphysis pubis, as well as those of twenty-five patients described in the literature. The early symptoms of osteomyelitis of the symphysis mimic those of osteitis pubis. Osteomyelitis almost invariably is preceded by urological or gynecological surgery (often when a technical complication has occurred), and does not respond to shortterm antibiotic treatment. Characteristic radiographic findings develop. Osteomyelitis of the symphysis pubis should be treated by debridement and curettage, together with long-term treatment with an appropriately high dose of antibiotics.
The report on the experience with skeletal scintigraphy in case of osteitis discusses the clinical use of this method. It is shown that with correct indication scintigraphy can furnish early diagnosis and in many cases additional valuable information.
Osseous infections have a special importance among the various polymorphic osteoarticular troubles of drepanocytemia. From 92 cases, the authors emphasize 4 points: --Osteitis and osteomyelitis are frequent, specially in the homozygotic form. --Salmonellae are the prevailing pathogenic bacterias. --Osteomyelitis caused by staphylococcus have, in drepanocytic patients, a more serious and more expanding evolution than in other patients. --Anatomic and radiologic features as well as evolution are different in the staphylococcal forms and in the salmonellal ones in which, most often, surgery may be discarded.
Successful treatment of osteitis fibrosa with 1alpha-hydroxycholecalciferol (1alpha-OHD3) in 9 patients with end-stage chronic renal failure was associated with a significant increase in plasma levels of immunoreactive calcitonin (iCT) independently of changes in plasma calcium, and a decrease in levels of parathyroid hormone (iPTH). In 9 further patients whose plasma alkaline phosphatase activity failed to suppress with 1alpha-OHD3, changes in iPTH were associated with proportionate changes in iCT. This suggests that a rise in endogenous calcitonin (CT) secretion contributes to the success of treatment with 1alpha-OHD3. In 13 further patients, injections of salmon CT induced a fall in plasma calcium and phosphate which was proportional to the prevailing level of plasma alkaline phosphatase. These data provide further evidence that bone resorption can be effectively inhibited when CT levels are raised either by exogenous CT or its endogenous stimulation.
Three cases of hematogenous cranial osteitis are described. The etiology in two cases was a staphylococcus aureus infection from meningeal septicemia. One of these patients died and chronic osteomyelitis developed in the second case. The third case was one of multifocal tuberculous infection, localized in the cranium but asymptomatic. The last case was a Gradenigo-Lannois syndrome, and its etiology, either chronic otitis or sphenoidal sinusitis, is discussed.
Osteitis pubis in athletes is an inflammatory condition of the pubic symphysis and surrounding muscular insertions. It is of uncertain etiology, however, and is seen particularly in those sports requiring sprinting and sudden changes of direction. There is a paucity of literature of this condition occurring in players of American football. This report presents two such cases and details proposed etiology and a specific management protocol.
A case of 49 years old cattle farm employee who developed intermediate cuneiform osteitis after stabbing the dorsum of the foot with a tool. The bone became entirely necrotic and has been removed surgically. An instillation combined with local and systemic antibiotic therapy resulted in cure. After 3.5 years of follow-up neither static nor dynamic disabilities of the foot have been found.
Tuberculous osteitis is a rare condition that can be difficult to differentiate from bone tumor on X-ray films. The purpose of this retrospective study was to analyse the epidemiologic, diagnostic and therapeutic aspects of this disorder. Data from 25 patients (13 men; 12 women; mean age = 37) were collected between 1984 and 1993. The source of contagion was traced in 32% of the cases and 24% of patients were known as tuberculous. Patients searched medical attention because of pain in 84% of cases. The greater trochanter was involved in more than 50% of cases. The definite diagnosis was obtained by examination of a surgical biopsy and the anti-bacillary treatment led to recovery in all cases. This study highlights that tuberculosis must be considered when investigating a bone lacuna, all the more so when the greater trochanter is involved, in a country where tuberculosis is endemic.
The results of the clinical trials with ofloxacin in the treatment of osteitis are presented. The drug was used according to 3 regimens: 200 mg thrice a day, 200 mg twice a day and 400 mg once a day for 6 to 24 months. The disease diagnosis was based on the bacteriological investigation of the biopsy specimens and hemocultures. The isolates were shown to be susceptible to ofloxacin. The majority of the patients (78 per cent) was treated with ofloxacin after the preliminary surgical operations. The treatment was started with the ofloxacin intravenous administration in a dose of 400 mg followed by the drug oral use in the same dose once a day for at least 14 days. The most frequent causative agents were: Staphylococcus aureus (52 per cent of the cases) and Staph.epidermidis (13.7 per cent of the cases) which were eradicated in 91.7 and 93.9 per cent of the cases respectively when the ofloxacin MICs were 0.26 and 0.22 mg/l respectively. The number of the gram-negative isolates on the whole amounted to 72.56 per cent and that of the gram-negative isolates amounted to 27.46 per cent of all the pathogens. As for the latter Pseudomonas aeruginosa and Enterobacter spp. were the most frequent (11.14 and 5.4 per cent respectively). The eradication of the pathogens amounted to 80.6 and 94.43 per cent respectively when the drug MICs were 1.78 and 0.42 mg/l respectively. The regimen with the drug oral use in a dose of 400 mg once a day proved to be the most expedient. It provided the complete therapeutic effect, minimum cost and maximum comfort for the patients.