Objective. To analyze clinical picture and composition of pathogens of hematogenous pyogenic vertebral osteomyelitis (PVO) based on the records of a regional clinic admitting patients with this disease. Material and Methods. A retrospective monocenter analysis of medical records of patients who underwent treatment for hematogenous PVO at the Tyumen Regional Clinical Hospital No. 2 in 2006-2017 was carried out. The nature of the isolated microflora was studied based on 209 inpatient medical records. Out of them, 68 patients were conservatively treated, and 141 were operated on. Ninety three bacterial strains were isolated from the surgical material in 77 patients, 20 strains-from aspiration biopsy in 32 patients, 21 strains-from blood in 20 patients. Results. The causative agent of PVO was identified in 117 (56.0 %) patients including gram-positive flora in 56.3 % of cases. The main pathogens were Staphylococcus spp. (53.8 %). Oxacillin-sensitive S. aureus (MSSA) was isolated in 35.5 % of cases, its resistant form (MRSA) in 3.3 %. In 26 (12.4 %) patients, two or more pathogens were detected with a predominance of staphylococcal flora. Conclusion. The most common cause of hematogenous PVO is gram-positive flora with a predominance of S. aureus (38.8 %). Anaerobes were identified in 30.6 % of cases. In 26 (12.4 %) cases, more than one pathogen was isolated. There were no significant differences in the form of the disease with gram-positive and gram-negative flora, and polymicrobial lesions (p = 0.498). S. aureus is more common Цель исследования. Анализ клинической картины и состава возбудителей гематогенного остеомиелита позвоночника по данным областной клиники, концентрирующей у себя пациентов с данным заболеванием. Материалы и методы. Проведен ретроспективный моноцентровой анализ медицинской документации пациентов, проходивших лечение с диагнозом «гематогенный остеомиелит позвоночника» в 2006-2017 гг. в областной клинической больнице № 2 (Тюмень). По данным 209 медицинских карт стационарных больных изучен характер выделенной микрофлоры. Консервативно пролечены 68 пациентов, оперированы-141. Из операционного материала у 77 больных выделено 93 штамма бактерий, при пункции очага поражения-у 32 пациентов 20 штаммов, из крови-у 20 человек 21 штамм. Результаты. Возбудитель гематогенного остеомиелита позвоночника идентифицирован у 117 (56,0 %) пациентов, в том числе грамположительная флора-в 56,3 % наблюдений. Основными возбудителями являлись Staphylococcus spp. (53,8 %). S. aureus, чувствительный к оксациллину (MSSA), определен в 35,5 % случаев, его резистентная форма (MRSA)-в 3,3 %. У 26 (12,4 %) больных выявлено два и более возбудителей с преобладанием стафилококковой флоры. Заключение. Наиболее частой причиной гематогенного остеомиелита позвоночника является грамположительная флора с преобладанием S. aureus (38,8 %). Анаэробы идентифицированы в 30,6 % наблюдений. В 26 (12,4 %) наблюдениях выделено более одного возбудителя. Значимых различий по форме заболевания при грамположительной, грамотрицательной флоре и полимик...
The article summarizes information about the head ganglia (the sympathetic ganglia and in the sensory cranial nerves). Gives а brief historical background on the history issue and relevance of the topic. Characterized by each node with its topography and lesion clinic. The described process of treatment, and prospects for new therapies. Raised the issue of the significance of the defeat ganglia, namely, the suffering of the sick and forced treatment costs (due to the complex differential diagnosis). In a biological sense, pain first appears in chordates and during evolution, as well as transformations of the brain and spinal cord, it acquires new types, localization and significance for the performance of a living organism. And facial pain, being a nosology with a multidisciplinary approach in diagnosis and treatment, demonstrates both its complexity and importance in human life.
Introduction. Protein-energy malnutrition in patients with cerebral palsy is an urgent problem. Given the high frequency of cerebral palsy orthopedic complications requiring surgical treatment, it is necessary to determine the impact of the initial nutritional status on the effectiveness of treatment. Purpose of the study: to analyze the impact of the initial nutritional status on the rehabilitation potential and motor abilities of children with cerebral palsy after orthopedic single-event multilevel surgeries. Materials and methods. The inclusion criteria were the age less than 18 years at the time of examination, spastic form of cerebral palsy, and a single-event multilevel surgical intervention due to orthopedic complications of cerebral palsy in medical history. Results. Lower indices of motor abilities after single-event multilevel surgeries were registered in patients with protein-energy malnutrition according to the FMS (5,50, and 500 meters) and the Gillette scale (p = 0.020, p = 0.026, p = 0.048, p = 0.008, respectively). Conclusion. The initial normal nutritional status before surgery has a positive effect on the rehabilitation potential and motor abilities of children with cerebral palsy after orthopedic single-event multilevel surgeries. Further research on this issue is needed.
Introduction Diagnosis and treatment of vertebrogenic pain syndrome caused by multilevel lumbar spondylolysis is crucial for patients of different age groups. Objective To report a clinical case of diagnosis and treatment of a two-level lumbar spondylolysis in a 16-year-old male patient, and review the relevant literature. Material and methods We had an experience of treatment and follow-up of a 16-year-old athlete who presented with low back pain and was diagnosed with spondylolysis of the pars interarticularis at the L3 and L5 levels. Diagnostic workup included patient history, physical examination, diagnostic imaging (plain radiograph, computed tomography). Scientific publications from modern medical databases were used for literature review. A total of 32 relevant articles brought out between 1975 and 2019 were reviewed. Results The 16-year-old athlete was diagnosed with multilevel spondylolysis of lumbar spine based on patient history, physical examination data and diagnostic imaging of lumbar spine. No pathognomonic clinical findings were revealed. The diagnosis was confirmed with computed tomography. Conservative treatment was initiated for the patient and a long-termfollow- up was available. Literature review included epidemiologic data characterizing multilevel lumbar spondylolysis: the indicence, patients' gender and age. Major etiological factors, common localization of the pathology, the incidence of spondylolysis and spondylolisthesis, treatment strategy including surgical procedures are described. Discussion There is a small number of scientific publications describing different aspects of multilevel spondylolysis of the lumbar spine in the current medical literature. The diagnosis is often delayed for the reason. The natural history of pain in adolescent athletes sustaining the load placed on them in both training and competition can be helpful for timely diagnosis. Conclusion The implications of this clinical case report can be practical for accentuation of multilevel spondylolysis of the lumbar spine among Russian specialists, contribute to medical knowledge and extend to both early diagnosis and efficient management.
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