The treatment of chronic osteomyelitis requires both appropriate surgical and antibiotic management.
Prolonged intravenous antibiotic therapy followed by oral therapy is widely utilised. Despite this, the long-term
recurrence rate can be up to 30%.A cohort of 50 patients from a 7-year period, 2003 to 2010, with chronic osteomyelitis was identified. This cohort was
treated by surgical marginal resection in combination with local application of antibiotics (Collatamp G - gentamicin in a
collagen fleece), a short course of systemic antibiotics post-operatively and conversion to oral antibiotics on discharge.
Information was retrieved from case notes and computerized records. Outcomes from this cohort were compared with a
historical cohort treated with marginal resection followed by 6 weeks of systemic antibiotics and 6 weeks of oral
antibiotics.The mean follow-up duration was 3.2 years (SD 1.8). The average length of admission was 9.8 days (SD 11.4). 6 patients
(12%) suffered recurrence of infection requiring further treatment. We used the Cierny and Mader classification to stratify
the patients. 'A' hosts had a shorter duration of admission (7.1 days) than 'B' hosts (12.3 days). There was no significant
difference between recurrence rates of 'A' and 'B' hosts. Where available, we found pre-operative C-reactive protein (CRP)
and erythrocyte sedimentation rate (ESR) levels had no correlation with disease recurrence. Disease-free probability for
this cohort compared favourably with the historical cohort.We believe local administration of gentamicin in a collagen fleece is a useful component in the management of chronic
osteomyelitis.
Multiple focal lesions identified at imaging within the testis are not always of the same histology. This can be suspected in some cases basing on US texture. Recognition that lesions are multiple and an indication of their locations within the testis is the most important role of imaging and may help pathologists correctly sample the specimen to establish nature of each of them. Presence of multiple lesions is regarded as a contraindication to testicular sparing surgery. In two of our patients, one lesion was benign. Then, when the procedure is indicated all lesions have to be sampled and assessed by pathologists before deciding between conservative or radical technique.
Testicular trauma is common, usually trivial and rarely requires hospital attendance, but if it does, then imaging becomes essential as scrotal assessment may be difficult due to pain and/or scrotal disruption. Ultrasound (US) assumes a crucial role as other cross-sectional modalities have a limited use in the acute presentation. Despite the acceptable accuracy of conventional US techniques, there are limitations which hinder a thorough evaluation, critically the assessment of tissue viability, crucial for clinical management and prognosis. Contrast-enhanced ultrasound (CEUS) has been shown to offer improved flow visualisation and tissue perfusion compared with conventional Doppler techniques. CEUS can accurately and confidently demonstrate the viability of testicular parenchyma, delineate fracture lines and haematomas and guide treatment for testis-sparing surgery or orchidectomy. The purpose of this review is to present the literature, familiarise physicians with the principles of CEUS and findings of scrotal trauma and illustrate the main abnormalities through characteristic and educative cases.
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