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PubMed1975

Antibiotics in the treatment of chronic staphylococcal osteomyelitis.

Fourteen patients with chronic osteomyelitis were treated with oral penicillin, oxacillin, or cloxacillin at a dose of 5 gm/day, plus 0.5 gm of probenecid (Benemid) three or four times per day. Treatment was continued for 2 1/2 to six months. In ten patients, evidence of osteomyelitis disappeared and there has been no recurrence during follow-up periods varying from six months to 2 1/2 years. Significant hepatotoxicity was encountered in two patients; one similar patient, not in this series but receiving a similar regimen of antibiotic, developed leukipenia. Thus, patients with chronic osteomyelitis appear to benefit from such a therapeutic program, but they must be monitored closely for hepatic or hematologic toxicity.

Adolescent↗
PubMed1979

Value of bone scan in primary sternal osteomyelitis.

Roentgenographic examination of the sternum is particularly difficult and offers little clinical assistance in the early stage of acute osteomyelitis. With only a few cases of primary sternal osteomyelitis reported, there are almost no data available regarding the role of bone scan in the diagnosis of this lesion. The present case illustrates the usefulness of the scan both in diagnosis and management of sternal osteomyelitis.

Debridement↗
PubMed1977

Choice of antibiotics in management of acute osteomyelitis and acute septic arthritis in children.

A survey of 158 children with acute haematogenous osteomyelitis, and of 94 children with acute septic arthritis over an 8-year period was made to determine which bacteria cause these infections. In the osteomyelitis group the organism most frequently detected was Staphylococcus aureus (74% of cases). In 16% of cases streptococci were found. Staph. aureus was also the most frequently grown organism in cases of acute septic arthritis (55% of cases), but Haemophilus influenzae accounted for 24% of positive cultures. On the basis of the survey it is the current practice of the author to use a combination of methicillin or cloxacillin and penicillin for acute haematogenous osteomyelitis, and methicilline or cloxacillin and ampicillin for acute septic arthritis. The choice of antibiotics is vitally important as treatment must start before the results of culture are known. Repeated evaluation of trends in the pattern of causative organisms is strongly recommended, in order to be aware of changing sensitivity of organisms to antibiotics.

Adolescent↗
PubMed1977

Observations on the sequential use of 99mTc-phosphate complex and 67Ga imaging in osteomyelitis, cellulitis, and septic arthritis.

Sequential studies with 99mTc-methylene diphosphonate (99mTc-MDP) and 67Ga were performed in 40 patients to determine the role of each agent in evaluating osteomyelitis, cellulitis, and spetic arthritis. Apart from the value of 67Ga in distinguishing cellulitis from osteomyelitis, it is a good adjuvant to 99mTc-MDP imaging in chronic osteomyelitis to identify continuing or recurrent sepsis and localize the focus of infection more precisely.

Adult↗
PubMed1979

Osteomyelitis in a neonatal intensive care unit.

Neonatal osteomyelitis presents with few clinical signs despite multiple sites of involvement. Four cases of osteomyelitis due to Staphylococcus aureus or Candida albicans were encountered in a neonatal intensive care unit. Three were unsuspected clinically and were detected as incidental radiologic findings. The fourth presented with soft-tissue abscesses. Long bone metaphyses were most frequently affected. Other sites included iliac bones, clavicles, and spine. On follow-up the bones healed, but one patient was left with hip deformity secondary to destruction of the cartilaginous femoral heads and another patient developed obstructive hydrocephalus due to Candida ventriculitis. Complete skeletal survey is indicated in any infant with osteomyelitis at one site to seek additional silent areas of involvement.

Abscess↗
PubMed1977

Chronic sclerosing osteomyelitis of the mandible. Radiographic differential diagnosis from fibrous dysplasia.

Among 13 patients with chronic osteomyelitis of the lower jaw, clinical, radiologic and histologic difficulties were encountered in 5 cases, in the differential diagnosis from fibrous dysplasia. The radiologic, and in some measure the clinical and histologic features typical of the two diseases are described. Variations in the bone structure during the course of the disease, as well as periosteal new-bone formation, are characteristics of chronic osteomyelitis. When problems are encountered in differentiating between fibrous dysplasia with periodical pain and swelling, and osteomyelitis, repeated radiologic examinations are to be recommended.

Adult↗
PubMed1979

Candida osteomyelitis as a complication of parenteral nutrition in an infant. Successful treatment with flucytosine.

Hematogenous Candida osteomyelitis is described in a two-month-old infant, as a complication of Candida septicemia which occurred during a parenteral hyperalimentation regimen. Treatment with flucytosine led to full recovery. The scarcity of reports on hematogenous Candida osteomyelitis in infants, despite an increased incidence of Candida septicemia, and the non-specific symptomatology which the disease may assume in this age group, indicate the need for greater awareness of this complication. Flucytosine is an antifungal drug which can also be given by mouth and carries relatively low toxicity. We found flucytosine to be extremely effective in the treatment of disseminated infantile Candida osteomyelitis.

Administration, Oral↗
PubMed1978

[Contribution to the treatment of acute haematogenous anc chronic secondary osteomyelitis in children (author's transl)].

The possibility of utilizing antistaphylococcal vaccine and local phage lysate for complex therapy of chronic and acute haematogenous osteomyelitis in children is demonstrated on three clinical cases. The study reassurmes good experience with this therapy in adult patients with chronic osteomyelitis. The results obtained so far in children suggest that the application of antistaphylococcal vaccine and of local phage lysate positively influences the course of the osteomyelitic disease and reduces the number of relpases. In order to specify and intensify the clinical effect of the above mentioned preparations, this method is being employed in other cases of chronic and acute haematogenous osteomyelitis.

Acute Disease↗
PubMed1979

[Pathogenesis of acute osteomyelitis].

Pathogenesis of acute osteomyelitis is analyzed from the standpoint of disorders in the bone microcirculation. It is stated that in acute osteomyelitis there occur some disorders in microcirculation due to extravascular compression and intravascular occlusion of the bone vessels. The analysis of pathogenesis of acute osteomyelitis from the standpoint of disorders in the microcirculation of the osseous tissue is believed to be expedient for the correct understanding of pathological processes occurring in the bone, and for purposeful pathogenetic therapy.

Acute Disease↗
PubMed1977

Serum enzyme activity in bone tumors and osteomyelitis (LDH, GOT, GPT, CPK, CHE, ALP, AP, PP, ALD).

Enzyme activity of lactate dehydrogenase, glutamate-oxalacetate and glutamate-pyruvate transaminase, creatine phosphokinase, cholinesterase, alkaline, acid and prostatic phosphatase and aldolase has been studied in a total of 213 subjects, of whom 97 were of good health, 63 had bone tumors and 53 suffered from osteomyelitis. The activities of the majority of the enzymes were found to become significantly changed in comparison with the norm. In both patient groups, the more striking differences being noted in that of osteomyelitis. However, enzymatic activity alone does not allow to differentiate the group of bone tumors from that of osteomyelitis, the differences between these two groups not being of significance in any one of the enzymes followed.

Acid Phosphatase↗
PubMed1978

Resorption of the zygomatic arch after elevation of a depressed fracture and subsequent osteomyelitis: report of case.

A case of osteomyelitis of the zygomatic arch with complete resorption has been presented. The cause of osteomyelitis of the facial bones was discussed. Infection of the soft tissue after intraoral elevation of fractured zygomas does occur, but rarely leads to osteomyelitis and subsequent bony resorption of the underlying bone. Antibiotics have reduced the incidence of osteomyelitic infections in the past 20 years; however, a vigorous regimen of preoperative and postoperative attention to aseptic technique, proper antibiotics, and close follow-up is required to control these problems.

Adult↗
PubMed1978

Adult Haemophilus influenzae type B vertebral osteomyelitis: a case report and review of the literature.

Osteomyelitis in adults due to Haemophilus influenzae is exceedingly rare. We report a case of H. influenzae type b vertebral osteomyelitis in an adult. Review of the English literature reveals one other adult patient with H. influenzae osteomyelitis, and sporadic pediatric cases. Although a variety of predisposing host resistance factors have been postulated to account for this infection, the deficiency responsible for adult infection remains undelineated. Bone biopsy is mandatory for diagnosis when blood cultures are negative. The isolation and identification of H. influenzae may be delayed because of its fastidious growth requirements. Treatment with ampicillin or chloramphenicol appear to be most efficacious considering the antibiotic sensitivities of the organism.

Ampicillin↗
PubMed1978

[Bone transplantation in the treatment of haematogenous and posttraumatic osteomyelitis (author's transl)].

The author presents 602 patients--436 with haematogenous osteomyelitis and 166 with posttraumatic suppurative osteitis. The clinical material is analysed according to the following criteria: age, localization, morphology, kind of infection, operative methods. The author recommends bone replacement ot the donor area with allogenous cancellous bone. No complications were observed in 285 operations of this kind. The osteoplastic treatment of haematogenous osteomyelitis provides healing 86% and of posttraumatic suppurative osteitis--in 79% of the cases. Thanks to reoperations, this percentage increases to 97% for the haematogenous osteomyelitis and to 98% for posttraumatic purulent osteitis respectively.

Adolescent↗
PubMed1979

[Acute and chronic experimental posttraumatic osteomyelitis in guinea pigs].

The model of an experimental posttraumatic osteomyelitis is described. Acute and chronic osteomyelitis was produced by inoculation of 10(5) Staph. aureus or E. coli to fractured femora--stabilised or not--with intramedullar nailing. The results are discussed. The model seems to be useful to further studies on posttraumatic osteomyelitis.

Acute Disease↗
PubMed1979

Hyperbaric oxygen and chronic osteomyelitis.

Forty patients with chronic osteomyelitis were treated with hyperbaric oxygen as an adjunct to surgical therapy and antibiotics and followed for an average of 2 years with a recurrence rate of 15%. The mechanism of action of hyperbaric oxygen in osteomyelitis is probably an indirect one of improving local vascularity and potentiating phagocytosis. Many of these patients represent a refractory group with poor prognosis due to the etiology of the infection, site of involvement, and duration of infection prior to treatment. The recurrence rate following this mode of treatment seems to be primarily related to inadequate surgical management. There was no definite correlation between the site of the infection of pathologic organism and recurrence. Although this is a preliminary report, the results are encouraging. Hyperbaric oxygen may be indicated as an adjunct to good surgical and medical management, particularly in patients with refractory chronic osteomyelitis and in whom ablative surgery is under consideration as the only other means of controlling the infection.

Adolescent↗
PubMed1979

The three syndromes of iliac osteomyelitis in children.

Iliac osteomyelitis was diagnosed, in many cases after considerable delay, in twenty (2.3 per cent) of 867 children with hematogenous osteomyelitis. In ten patients coagulase-positive Staphylococcus aureus was identified. The symptoms and signs of iliac osteomyelitis depend on the direction of spread of the inflammation. The children presented with one of these syndromes: gluteal, abdominal, or lumbar disc. The diagnosis can be established early be careful physical examination: manual compression of the pelvis produces pain on the affected side, and palpation reveals tenderness over over the site of infection. The inflammatory process can be located even in early cases on a bone scan with radioactive technetium. When diagnosed early, the infection can be cured with intensive intravenous antibiotic therapy alone.

Adolescent↗
PubMed1977

Osteomyelitis in Nigerian children (a review of 40 cases).

A retrospective study of 40 children with osteomyelitis revealed that the patients presented in hospital late. Therefore chronic osteomyelitis is prevalent in Nigerian children. Sickle cell anaemia is commonly associated with osteomyelitis. Staphylococcus aureus is the comonest organism but salmonella is associated with sicklers.

Ampicillin↗
PubMed1978

Acute haematogenous osteomyelitis in Nigeria.

Acute haematogenous osteomyelitis formed less than a quarter of the 125 consecutive cases of osteomyelitis seen by the authors and followed up for a minimum of six months and an average of one year and four months. Of the twenty-nine cases of acute osteomyelitis a third occurred in patients with normal haemoglobin genotype (AA); a third of homozygous S disease (SS disease) and sickle cell haemoglobin C disease (SC disease); a quarter in sickle cell trait (AS) and haemoglobin AC trait, while in the remaining cases the haemoglobin genotype was not known. The sex incidence was equal, and children aged 1 to 15 years predominated. Most patients presented late with florid disease. Gram negative bone infection and multiple, entire diaphysial involvement were significantly commoner in SS and SC disease than in the other haemoglobin genotype. There was a high incidence of resistance of the infecting organisms to the commonly available antibiotics. Treatment was mostly conservative. There were no deaths, but the incidence and severity of complications were quite high. The significance of these results are discussed and the need for establishing the sensitivity of the infecting organism in every case and for early surgical exploration in non-sicklers are stressed.

Adolescent↗