Introduction: The main causative agent of spinal infections is Mycobacterium Tuberculosis, followed by saprophytes of the skin. The most affected segment is the lumbar, followed by the thoracic. Objective: Case report. Results: A previously healthy 40-year-old man with posterior cervical pain and myelopathy was referred to our spine service for vertebral destruction syndrome in C3-C4 and altered carbohydrate metabolism. Microdiscectomy and abscess drainage were performed and a biopsy was taken for definitive diagnosis. Multiresistant Serratia Marcescens was isolated in the culture. Both the myelopathy and carbohydrate intolerance were resolved as the infection was resolved. Conclusion: The significance of this case lies in the infective presentation of the S. Marcescens in an immunocompetent person, since it is mainly an opportunistic microorganism, and in the atypical location. The most commonly isolated pathogen is Mycobacterium Tuberculosis, followed by Staphylococcus aureus. Identification of the causative agent is essential to the initiation of antibiotic therapy. Therefore, microbiological isolation plays a fundamental role in the treatment, recovery and quality of life of the patient. Level of evidence V; Case report.
Resumo Objetivo Definir a eficácia da biópsia vertebral percutânea guiada por fluoroscopia. Métodos Este é um estudo prospectivo de pacientes com síndrome de destruição vertebral em uma instituição. Os pacientes foram submetidos a biópsias vertebrais transpediculares percutâneas guiadas por fluoroscopia, com obtenção de tecido ósseo e tecido do disco intervertebral, para estudo histopatológico e microbiológico. Idade, sexo, segmento vertebral, estado neurológico, e resultados de biópsia e de cultura foram analisados. Resultados A idade média dos pacientes foi de 53,8 anos (gama: 2 a 83 anos), e o principal local acometido da coluna foi a segmento lombar, em 62% dos casos. Segundo a escala de disfunção da American Spinal Injury Association (ASIA), no pré-operatório, 49% dos pacientes foram classificados como ASIA E, e 100% apresentavam dor. A etiologia definitiva foi identificada em 83% dos pacientes. A etiologia foi agrupada em três categorias: infecciosa, neoplásica, e degenerativa (osteoporótica). O grupo infeccioso era composto por 36% dos pacientes da amostra, e Staphylococcus aureus foi o agente mais comumente identificado; em 34,9% dos casos, a etiologia era neoplásica, principalmente mieloma múltiplo e doença metastática por câncer de próstata; 21,7% dos pacientes apresentavam osteoporose. O tempo cirúrgico médio foi de 47,5 minutos, e a perda média de sangue foi de 10 mL. Nenhuma complicação foi relatada. Conclusão Nesta série, a biópsia percutânea transpedicular guiada por fluoroscopia teve 83% de eficácia no diagnóstico etiológico da síndrome de destruição vertebral. Este procedimento minimamente invasivo deve ser considerado bom, fácil, barato e reprodutível, com baixo risco de complicações em curto e longo prazos.
Una pelvis inestable puede contribuir a la inestabilidad hemodinámica. El empleo oportuno de fijadores externos disminuye en un 14% la mortalidad asociada. Los fijadores externos pueden ser empleados como tratamiento estabilizador permanente mientras se garantice una reducción satisfactoria. Métodos y pacientes: estudio retrospectivo, descriptivo, realizado de septiembre 2014 a diciembre 2017, que incluyó 28 expedientes de pacientes con diagnóstico de fractura de pelvis. Las variables estudiadas fueron año de la lesión, sexo y edad del paciente, mecanismo de la lesión, compromiso del anillo pélvico, clasificación de Tile, tratamiento y mortalidad. Resultados: quedaron incluidos 28 pacientes del sector civil del CHMH, 19 masculinos y 9 femeninos; la edad promedio fue de 32.7 años. El 42.8% de los pacientes no requirió procedimiento quirúrgico de urgencia; al 42.8% se le colocó un fijador externo de urgencia por inestabilidad pélvica; a 14.28% se le sometió a laparotomía y al 7.14% a aseo quirúrgico. El tratamiento definitivo en el 42.85% fue conservador, 17.85% continuaron con fijador externo, 25% reducción abierta y fijación interna con placas y, 10.71% con una combinación de placas y tornillos sacroilíacos; 3.5% solo con tornillo sacroilíaco. La mortalidad fue de 7.14%. Conclusiones: El uso oportuno de fijador externo en pelvis inestable favorece el pronóstico de los pacientes, independientemente de si se deja como tratamiento definitivo. Se prefiere la osteosíntesis con fijación interna tras la estabilización inicial con fijador externo. La mortalidad es similar a lo reportado por otros autores. LUX MÉDICA, AÑO 13, NÚMERO 38, MAYO-AGOSTO 2018, PP 3-8.
Background. Bilateral traumatic hip dislocation in children is a very rare orthopedic emergency. Few case reports are available in literature. Clinical case. A 4-year-old male child case with a trivial mechanism of injury is presented. Closed reduction in emergency department was achieved after 24 hours of injury, he was placed on Bucks skin traction for 4 days and during 4 weeks in a spica cast. There was not either clinical sign nor images of early or late complications during follow up until he reached skeletal maturity. Discussion. Hip dislocation in children is a rare emergency with an incidence of 0.8 cases per million per year, its treatment should not be delayed to minimize late complications such as osteonecrosis, recurrent dislocations, osteoarthritis, neurological lesions, coxa magna and heterotopic ossification. The reported incidence for hip osteonecrosis is 36.4% for late (6 hours) and 8.2% after early (6 hours) reduction. After 12 years of follow up no complication was found although the reduction was made 24 hours later. Conclusions. After immediate reduction a 4 to 6 weeks immobilization period is an effective treatment. Close monitoring to timely identify and treat any further complication is mandatory.
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