[Tuberculous spondylitis of vertebra with fracture, paraparesis and pleural empyema complications–case report].

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[Tuberculous spondylitis of vertebra with fracture, paraparesis and pleural empyema complications–case report].

Med Pregl. 2013 Sep-Oct;66(9-10):401-5

Authors: Ruzicić RD, Jakovljević V, Zivković V, Vujić S, Varagić P, Nikodijević P

Abstract
INTRODUCTION: Spine tuberculosis is caused by Micobacterium tuberculosis. It is localized in the vertebral body or intervertebral disc. Its diagnosis is often delayed because of nonspecific symptoms and neglected presence of tuberculosis, which leads to serious complications.
CASE REPORT: This paper presents a case of tuberculous spondylitis, which was complicated with the fracture of vertebra, paraparesis of lower extremities and pleural empyema. The treatment with antituberculous drugs started after the fracture of 10th and 11th thoracic vertebras. The therapy brought some improvement but paraparesis of lower extremities remained. In the further course of disease, inflammatory process affected the pleura. Antibiotic and antitubercular therapy with puncture of pleura were not very effective. Operation was performed on December 20th 2011: Thoracotomia lat. dex. Decorticatio pulmonum lat.dex. Seven months after surgery, the patient was without symptoms.
CONCLUSION: Tuberculous spondylitis occurs relatively frequently in clinical practice. Early diagnosis and adequate therapy of this disease can prevent the occurrence of its serious complications.

PMID: 24245450 [PubMed – indexed for MEDLINE]

Predictors of outcome in the non-operative management of thoracolumbar and lumbar burst fractures.

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Predictors of outcome in the non-operative management of thoracolumbar and lumbar burst fractures.

Br J Neurosurg. 2014 Oct;28(5):653-7

Authors: Hitchon PW, He W, Viljoen S, Dahdaleh NS, Kumar R, Noeller J, Torner J

Abstract
AIM: Burst fractures without neurological deficit are often treated successfully without surgery. A subgroup may fail non-operative treatment owing to pain, and opt for surgery. The following review was conducted to identify predictors of success or failure in the non-operative treatment of thoracolumbar burst fractures.
METHODS: A cohort of 60 patients with T11-L4 thoracolumbar burst fractures were treated non-operatively, with bed rest and bracing until the pain abated sufficiently to allow mobilization. Patients were followed prospectively for a mean ± SD of 12 ± 14 months, and their data were reviewed retrospectively.
RESULTS: Fifty-one patients successfully completed non-operative treatment. Owing to intractable pain in nine, surgery was undertaken. Ages in the non-operative and operative groups were 46 ± 18 and 68 ± 15 years respectively (p = 0.002). The residual canal and angulation at the site of the fracture were 63 ± 12% and 1.6 ± 8.4° in the non-operative group and 47 ± 15% and 6.6 ± 13.6° in the surgical group (p = 0.001 and 0.149 between groups, respectively). Regression analysis of age, gender, angulation, and residual canal showed that only age (OR, 1.099; 95% CI, 1.022-1.183; p = 0.011) and residual canal (OR, 0.795; 95% CI, 0.642-0.985; p = 0.035) were significant predictors of failure, ultimately undergoing surgery.
CONCLUSION: Non-surgical treatment was more likely to prove sufficient in patients aged 46 ± 18 years, and residual canal of 63 ± 12%, than in older patients with ages of 68 ± 15, and canal of 47 ± 15%. The latter group was more likely to fail, undergoing surgery because of pain or instability.

PMID: 24377725 [PubMed – indexed for MEDLINE]

Spinal Cord Injury After Extremity Surgery in Children With Thoracic Kyphosis.

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Spinal Cord Injury After Extremity Surgery in Children With Thoracic Kyphosis.

Clin Orthop Relat Res. 2015 Aug 5;

Authors: Pruszczynski B, Mackenzie WG, Rogers K, White KK

Abstract
BACKGROUND: Spinal cord injury is a rare complication after lower extremity surgery in children with skeletal dysplasia and thoracic kyphosis. We encountered two patients who had this complication, from among 51 (39 from Nemours/Alfred I. duPont Hospital for Children and 12 from Seattle Children’s Hospital) who underwent lower extremity surgery during an 8.5-year period (June 2004 to December 2012). Because spinal cord injury is a devastating complication likely not known to most physicians treating patients with skeletal dysplasias, we sought to examine factors that may contribute to this rare complication.
CASE DESCRIPTION: We performed a retrospective review of two patients with skeletal dysplasia who had paraplegia develop after extremity surgery. Outcome measures included operative time, vital signs, and postsurgery recovery of neurologic deficit. MR images were reviewed. Two patients were found-an 8.5-year-old boy with spondyloepiphyseal dysplasia congenita with a 76°-thoracic kyphosis apex at T4 and a 6.5-year-old boy with mucopolysaccharidosis type 1-H with an 80°-thoracic kyphosis apex at T2. Bilateral proximal femoral osteotomies or bilateral innominate and proximal femoral osteotomies had been performed. The spinal cord injuries occurred at the apex of the kyphosis as determined by clinical examination and MRI assessment. In both patients, the mean arterial blood pressure decreased below 50 mm Hg and might be a factor in the etiology of the paralysis. The first patient recovered motor function in 5 months; the second had no recovery.
LITERATURE REVIEW: Paraplegia is extremely rare after nonspine operations. Many factors contribute to the risk for a spinal cord event: low mean arterial pressure, duration of the surgery, position on the operating table, the kyphotic spine deformity, or unappreciated vascular disease. Motor-evoked potentials and somatosensory-evoked potentials together potentially provide high sensitivity and specificity for predicting a postoperative neurologic deficit.
CLINICAL RELEVANCE: Based on our two patients with skeletal dysplasia and a literature review of patients with hyperkyphosis undergoing extremity surgery, the surgeon must be aware of the risk of spinal cord injury. Careful preoperative assessment possibly including MRI of the spine is recommended. Mean arterial pressure should be maintained at a safe level; neuromonitoring should be considered.

PMID: 26242281 [PubMed – as supplied by publisher]

Topical diclofenac therapy for osteoarthritis: a meta-analysis of randomized controlled trials.

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Topical diclofenac therapy for osteoarthritis: a meta-analysis of randomized controlled trials.

Clin Rheumatol. 2015 Aug 5;

Authors: Deng ZH, Zeng C, Yang Y, Li YS, Wei J, Yang T, Li H, Lei GH

Abstract
The objective of this study was to evaluate the efficacy and safety of topical diclofenac therapy for osteoarthritis (OA). A meta-analysis of randomized controlled trials was conducted. A comprehensive literature search, covering the databases of Medline, the Cochrane Central Register of Controlled Trials, and EMBASE, was conducted in September 2014 to identify the randomized controlled trials which adopted the topical diclofenac therapy for OA. A total of nine papers were included in this meta-analysis. Topical diclofenac appears to be effective in both pain relief (standard mean differences (SMD) = 0.40; 95 % confidence interval (CI) 0.19 to 0.62; P = 0.0003) and function improvement (SMD = 0.23; 95 % CI 0.03 to 0.43; P = 0.03) when compared with the control group. The sensitivity analysis and subgroup analysis showed that the result of pain intensity was stable and reliable, while the result of physical function improvement was vague. With respect to safety, topical diclofenac demonstrated a higher incidence of adverse events such as dry skin, rash, dermatitis, neck pain, and withdrawal. Topical diclofenac is effective in pain relief as a treatment of OA. It may also have a potential effect in function improvement, which needs further studies to be explored. Although, some adverse effects were observed in the application of topical diclofenac, none of them was serious.

PMID: 26242469 [PubMed – as supplied by publisher]

[Splenic lympangioma. A rare tumour. Presentation of 3 cases and a literature review].

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[Splenic lympangioma. A rare tumour. Presentation of 3 cases and a literature review].

Cir Cir. 2015 Aug 1;

Authors: Rodríguez-Montes JA, Collantes-Bellido E, Marín-Serrano E, Prieto-Nieto I, Pérez-Robledo JP

Abstract
BACKGROUND: Lymphangiomas are benign tumours, considered to be congenital malformations of the lymphatic system that predominately affect children, with only a few cases reported in adults. The most common sites of these lesions are the neck (75%) and axillary region (20%), but rarely found in the spleen.
OBJECTIVE: A description is presented of 3 cases of incidentally detected splenic lymphangioma, one in a child and in 2 adults, respectively, as well as a literature review.
CLINICAL CASES: After a clinical and physical examination, all patients had an abdominal ultrasound, CT scan and a complete splenectomy, followed by a histopathological study on the removed spleen. Two patients were asymptomatic, and the paediatric patient referred to intermittent abdominal pain without other symptoms. The clinical and physical examinations related to the mass were negative. The final diagnosis was based on a combination of radiological and histopathological findings. Total splenectomy was undertaken in all cases without complications.
CONCLUSIONS: Splenic lymphangioma is very rare, and more so in adults. This condition is often asymptomatic and is incidentally detected by imagenology due to any other differet cause. The final diagnosis should be based on a combination of clinical, radiological, and histopathological findings. Splenectomy is the treatment of choice and the prognosis is good.

PMID: 26242820 [PubMed – as supplied by publisher]

Isolated Langerhans Cell Histiocytosis Bone Lesion in Pediatric Patients: Systematic Review and Treatment Algorithm.

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Isolated Langerhans Cell Histiocytosis Bone Lesion in Pediatric Patients: Systematic Review and Treatment Algorithm.

Otolaryngol Head Neck Surg. 2015 Aug 4;

Authors: Bezdjian A, Alarfaj AA, Varma N, Daniel SJ

Abstract
OBJECTIVE: The present study reviewed all cases reported of isolated Langerhans cell histiocytosis bone lesions in the head and neck of pediatric patients. The objective was to create a treatment algorithm to facilitate the diagnosis and management of these lesions.
DATA SOURCES: Eligible articles were identified through a comprehensive search of the following electronic databases: PubMed, Ovid Medline, Embase, and Cochrane Library.
REVIEW METHODS: Two authors independently reviewed the titles and abstracts retrieved by the electronic search concordant with the criteria for study eligibility. The lists of articles from each author were jointly reviewed and a common list created. All relevant articles were reviewed in hard copies and as full texts to justify inclusion.
RESULTS: A total of 201 patients (67% male, mean age: 8.1 ± 4.3 years) were included from 45 studies. Clinical presentations included swelling (64%), pain (9%), or both (18%). The skull (61%) and the orbit (24%) were the most common location for isolated bone lesions in the head and neck. The most frequently documented management option was resection, followed by observation, chemotherapy, and intralesional steroid injection.
CONCLUSIONS: Due to its rarity and variability in presentation and severity, treatment of these lesions has yet to be standardized. Based on the review, a diagnosis and treatment algorithm was created for head and neck surgeons when encountering these types of lesions.

PMID: 26243026 [PubMed – as supplied by publisher]

[New therapy approaches for giant cell tumors].

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[New therapy approaches for giant cell tumors].

Unfallchirurg. 2014 Oct;117(10):883-91

Authors: Panzica M, Lüke U, Omar M, Länger F, v Falck C, Krettek C

Abstract
BACKGROUND: Giant cell bone tumors (GCT) are benign but partially locally aggressive osteolytic tumors which typically occur around the knee joint in the epiphysis and metaphysis of long bones after maturation of the skeleton is completed. Due to the locally aggressive growth behavior with destruction of the bone structure, the rare possibility of pulmonary metastases in recurrent cases and a very rare possibility of malignancy, GCTs were previously also described as semimalignant bone tumors.
THERAPY: The established therapy of these tumors at the typical locations consists of intralesional curettage, extension of resection margins using a high speed trephine and defect reconstruction with bone cement. The local recurrence rate is high (10-40 %) and lowest after using thermal extension of resection margins with a high speed trephine and defect reconstruction with bone cement. For uncommon localizations, such as the spinal column and the sacrum as well as in cases of recurrence, surgical treatment is more complicated.
HISTOLOGY: Histologically, GCTs consist of osteoclastic giant and oval-shaped stromal cells which show a high expression of receptor activator of nuclear factor-κB ligand (RANKL) and decisively contribute to the osteolytic activity of the tumor. Novel pharmaceutical therapy approaches with human monoclonal RANKL antibodies interfere in this osteodestructive process in an inhibitory manner and can represent alternative treatment options just as the osteosupportive therapy with bisphosphonates.
CONCLUSION: After unsatisfactory attempts at surgical treatment of GCT patients, the new treatment option with denosumab is a promising alternative due to its effect as a monoclonal RANKL inhibitor.

PMID: 25274386 [PubMed – indexed for MEDLINE]

Transpedicle osteotomy positioning in pedicle-lengthening laminoplasty.

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Transpedicle osteotomy positioning in pedicle-lengthening laminoplasty.

Orthop Surg. 2014 Nov;6(4):313-6

Authors: Zhang ZG, Mei X, Zhang W, Liu P, Gao MF, Yang HL, Luo ZP

Abstract
Pedicle-lengthening laminoplasty is a new minimally invasive technique for surgical treatment of lumbar spinal stenosis. The procedure is performed with the assistance of fluoroscopy and involves creating a pedicle passage, transpedicle osteotomy from inside the pedicle passage and lengthening it by using an implant bilaterally to enlarge the spinal canal and neural foramen. A critical component of the procedure is the precise determination of the osteotomy site on the pedicle. The objective of this study was to examine in vitro whether fluoroscopic positioning could be used to guide the osteotomy and to define the cutting site in the pedicle-lengthening laminoplasty in relation to the posterior vertebral line. It was found that the osteotomy site was from 2.0 to 3.5 mm posterior to the posterior vertebral line. The maximum difference between the measured value and that theoretically simulated on 3-dimensional (3D) computed tomography reconstruction was 0.3 mm. The spinal canal cross-sectional area was significantly enlarged after pedicle-lengthening. Accurate placement of the osteotomy is critical in pedicle-lengthening laminoplasty. Guiding the positioning of the osteotomy based on the posterior vertebral line images provides satisfactory accuracy, suggesting a possible clinical application for our technique; however, further verification in vivo is needed.

PMID: 25430715 [PubMed – indexed for MEDLINE]