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At least 1,153 records · Page 64Linked to original sources
PubMed1994

[Aspects and value of MRI in the diagnosis and follow-up of common microbes infectious spondylodiscitis. Apropos of 25 clinically and biologically suspected patients].

This work is about 25 patients clinically and biologically suspected of spondylodiscitis (27 levels). All of them had a MRI exam before disco-vertebral needle biopsy and treatment. The results are compared to those of literature. Each infectious spondylitis case (19 cases) had a new MRI exam each three months. This study conclude to the great sensibility of MRI (89%) in the diagnosis of infectious spondylitis and to the limited interest of it in the follow-up of spondylodiscitis.

Adolescent↗
PubMed1994

Candida albicans spondylodiscitis and vertebral osteomyelitis in patients with intravenous heroin drug addiction. Report of 3 new cases.

We describe 3 patients with a history of intravenous (iv) heroin addiction presenting with indolent, persisting lumbar pain. Clinical findings and initial investigations were unremarkable. Gallium scintigraphy revealed septic spondylodiscitis, and cultures of material obtained by biopsy were positive for Candida albicans in all 3 cases. Two patients were treated with iv amphotericin B and the other with fluconazole with excellent results. Surgical treatment was needed only in one patient because of neurological involvement.

Adult↗
PubMed1993

[Spondylodiscitis with spinal and radicular involvement. Limits of conservative treatment].

During 1988 to 1992 18 patients with spondylodiscitis and neurological deficits were treated in our clinic. Tuberculous spondylodiscitis was diagnosed in 4 patients and 14 suffered from non specific spondylodiscitis. The mean age was 59 years (range 25-77). 16 (89%) of the patients had risk factors like diabetes mellitus, genitourinary tract infection, respiratory tract infection, rheumatism, intervertebral disc operation and old spine fracture. MR-tomography revealed the most valuable diagnostic method. 14 patients with progressive spinal cord compression, and root lesions because of gross vertebral damage and epidural abscess underwent operative removal of the focus with intercorporal spondylodesis. Postoperative neurological examination revealed improvement in 7 and no changes in the other 7 patients. In 4 patients with non specific spondylodicitis and radicular deficits conservative treatment was performed and spontaneous interbody fusion without persisting neurological complaints occurred.

Abscess↗
PubMedDate not supplied

[Dixon's technic for fat suppression. Its potential applications in combination with gadolinium-DTPA].

Modification of the Dixon technique enables the reconstruction of water and fat images operating at midfield strength. The technique was combined with intravenous administration of gadolinium-DTPA in five patients with lumbosacral spine conditions, four patients with soft tissue neoplasms and three with skeletal neoplasms; all patients were examined at 0.5 T. Mean attenuation of fat signal in T1-weighted images was 85% and implied a redistribution of the gray-scale dynamic range. This allowed easier appreciation of normal and abnormal enhancement in both areas containing fat tissue and areas without it. This was useful in the evaluation of fresh scars in two patients recently submitted to lamino-discectomy and of the prevertebral extension of the inflammatory process in one patient with spondylodiscitis. In the patients with soft tissue neoplasms the combination of fat suppression and Gadolinium was helpful to assess lesion size. Finally, in the patients with skeletal neoplasms fat-suppressed images obviated for the lesion disappearance observed on conventional T1-weighted SE images after contrast administration. The combination of intravenous administration of gadolinium-DPTA with Dixon's fat-suppression technique is a new promising capability of midfield MRI.

Adipose Tissue↗
PubMed1994

Intervertebral infection caused by Streptococcus milleri. A case report.

Intervertebral infection caused by Streptococcus milleri is described in a 45-year-old man. Initially, a tuberculous infection was suspected; this diagnosis resulted in a considerable delay in correct diagnosis and treatment. The patient recovered well with combined medical-surgical treatment. Streptococcus milleri, a common inhabitant of the gastrointestinal tract, comprises a variety of strains implicated in deep-seated purulent infections. Although reports of this are rare, S. milleri can be the offending organism in intervertebral disk infections.

Anti-Bacterial Agents↗
PubMed1993

[Tuberculous spondylodiscitis. Diagnostic elements and value of MRI. Apropos of a cervical localization].

The authors report a case of tuberculous spondylodiscitis with an intracanalar ant retropharyngeal involvement. This pathology is recently increasing like the immunodeficiency syndromes. Cervical tissue compression and neurological signs are the main clinical findings. Among the radiological explorations of disco-vertebral infections, the value of MRI study is now admitted. Using of T1 and T2 weighted sequences and Gadolinium injection provides the positive diagnosis, and well visualizes the extent: low signal of vertebral body, decrease and low signal of discal space, prevertebral and retrovertebral enlargement with a low signal intensity of the abscess in T1 weighted sequence and enhancement following Gd-DTPA administration; high signal intensity of vertebral body, prevertebral and epidural masses and abscess in T2 weighted sequence. The authors describe the evolutive features of Pott's disease and the value of MRI in the post-therapeutic course: T1-signal increases while enhancement following Gd-DTPA administration decreases and T2-signal decreases. The differential diagnosis with chordomas, metastasis, and pyogenic spondylodiscitis is well assessed by MRI.

Cervical Vertebrae↗
PubMed1993

Vertebral aspergillosis. A case report and review of the literature.

A case of Aspergillus osteomyelitis of the spine is presented and the world literature is reviewed, for a total of 32 cases. Aspergillus osteomyelitis is rare, but the spine is most frequently affected. It can be induced hematogenously, by contiguity or by direct inoculation. Up to now medical treatment has been based on amphotericin B, but its toxicity is problematic. Itraconazole and fluconazole do not have this shortcoming. Additional surgery has been advocated in the past. In the present series combined medical-surgical treatment (20 cases) led to a higher survival rate (70%) than medical treatment (12 cases: 58%), but neurological recovery was much more frequent in the second group (40% versus 13%).

Aspergillosis↗
PubMed1993

Nonspecific diskitis in children. A nonmicrobial disease?

Eighteen patients were treated for nonspecific diskitis (diskitis without microbial cause) at the University Children's Hospital in Helsinki during 1970-1990. The mean age at admission was three years three months. The characteristic findings were restriction of spinal mobility and an elevated erythrocyte sedimentation rate (ESR). Radiographic narrowing of the affected disk space was seen four to five weeks after the initial symptoms. An operative biopsy was made in 16 patients, the histologic diagnosis being chronic or subacute nonspecific inflammation in ten, other nonspecific changes in two, and normal tissue in five. Treatment was either bed rest and antimicrobial medication, or bed rest alone. After a follow-up period of five months to nine years, all patients were clinically normal. All but two had radiographic signs of healed disk space defects. Nonspecific diskitis in children is an entity with unknown cause. The clinical picture is typical, but diagnostic difficulties may be encountered during the first weeks when radiographic signs are absent. The disease is self-limiting in most cases, and only minor radiographic changes remain after healing. The results after routine operative biopsy raise the question of a possible nonmicrobial cause.

Biopsy↗
PubMed1993

[Fistulous pulmonary abscess in the bronchi detected by staphylococcal spondylodiscitis, with the presence of bony sequestra in the bronchial secretions].

The authors report the case of a man aged 70 who was admitted to hospital for staphylococcal pulmonary suppuration which occurred during the long-term follow-up for an osteosynthesis for a fractured humerus. The diagnosis of a pulmonary abscess in contiguity with a staphylococcal spondylodiscitis was only established by computed tomographic examination and the aspiration from a vertebral body. The outcome was fatal, despite appropriate antibiotic treatment, on account of the past medical history of the patient. The diagnosis might have been made by the presence of osseous sequestra in the bronchial secretions, the bronchial fistulae in contiguity with the vertebral column was confirmed at autopsy.

Aged↗
PubMed1993

[Study of spondylodiscitis with magnetic resonance. Use of gadolinium-DTPA].

Eighteen patients suffering from spondylodiscitis were examined with MRI and 22 pathologic levels were identified: 1 cervical, 6 thoracic and 15 lumbosacral. As for etiology, 4 cases were tubercular, 3 strepto-staphylococcal, 3 brucellar 1 strepto-bacteroides and 11 of unknown origin. Five patients underwent MR follow-up 4-9 months after the clinical onset. SE T1- and T2-weighed sequences were always performed and 11 patients, with 13 pathologic levels, also underwent SE T1-weighted sequences with i.v. Gd-DTPA administration. No correlation could be made between the signal intensity of the involved vertebral bodies and disks and etiology. On SE T1-weighted sequences 91% of the vertebral bodies were hypointense, whereas the intervertebral disks were hypointense in 55% of cases and isointense in 45%. On SE T2-weighted sequences, the vertebrae appeared hyperintense in 65% of the cases while the disks were hyperintense in 55% and isointense in 41%. After Gd-DTPA injection signal intensity increased in 100% of cases, both at the body and at the disk. In 6 cases an inflammatory infiltration of the intracanalar structures was found, whose identifications was possible, in 4 cases, only after contrast medium injection. In the follow-up of 5 cases at 4-9 months the vertebral bodies remained hypointense in 3 cases on T1-weighted sequences, while in 2 cases signal intensity tended to normalize. Signal normalized in 4 cases on T2-weighted sequences. In 2 follow-up examinations disk structures were never depicted, neither on T1- nor on T2-weighted sequences. To conclude, T1-weighted sequences appear to be more sensitive than T2-weighted sequences to demonstrate inflammatory processes in the vertebral bodies, while the two sequences are equivalent to evaluate the disks. Gadolinium-enhanced T1-weighted sequences were more sensitive than the T1- and T2-weighted ones, especially to assess the extent of inflammatory processes into the spinal canal and to evaluate their persistence. The authors suggest the use of unenhanced and enhanced SE T1-weighted sequences only at least in the follow-up of spondylodiscitis.

Adolescent↗
PubMed1993

[The role of echography in osteolytic tubercular abscesses].

Tubercular abscesses are relatively common complications of tubercular spondylodiscitis. Fifty-one patients with suspected abscesses were selected from a group of 97 patients with tubercular spondylodiscitis and submitted to US. In 10 cases CT was performed before US and detected 7 abscesses, all of them confirmed by US. In the extant 41 cases, CT followed US; in 13 cases only US poorly visualized ilio-psoas muscles. As for the group of 23 patients who underwent both CT and US, if the former method is assumed as the reference gold standard, overall US sensitivity is 97% (1 false negative) and its specificity is 100%. In all cases where US findings were accurate and specific enough, CT was not performed; the patients were followed every seventh month and no abscesses found. US showed abscesses in the iliac fossa in 20 cases, along the psoas fascia in 6 and in the thighs in 3 cases. Two cases of gluteal localization were observed, together with 1 Grynfelt's triangle abscess, 1 Petit's triangle and 1 Scarpa's triangle abscesses; finally, 1 abscess was found in the knee. The most common appearance of tubercular abscesses is a hypoechoic and inhomogeneous pattern; sometimes caseum makes the abscess solid and hyperechoic. Calcifications were unusual in our series. All patients were submitted to percutaneous drainage under US guidance. The results proved US to allow the early and unquestionable diagnosis of tubercular abscesses and to confirm clinical suspicion. Moreover, US is also useful to guide percutaneous drainage and to follow the patients after drainage. As for CT, it remains the method of choice to depict vertebral involvement, but, in our series, it exhibited no significant advantages over US in the study of abscessual lumbar collections.

Abscess↗