An 11-year-old boy with pharyngitis and cough: Lemierre syndrome.

By London Spine
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An 11-year-old boy with pharyngitis and cough: Lemierre syndrome.

BMJ Case Rep. 2013;2013

Authors: Mação P, Cancelinha C, Lopes P, Rodrigues F

Abstract
The authors present the case of an 11-year-old boy with pharyngitis, treated with amoxicillin, that worsened on day 7, with cough, high fever and refusal to eat. Lethargy and respiratory distress were noted. Based on radiographic findings of bilateral infiltrates he was diagnosed with pneumonia and started on intravenous ampicillin and erythromycin. Two days later he complained of right-sided neck pain and a palpable mass was identified. An ultrasound showed partial thrombosis of the right internal jugular vein and a lung CT scan revealed multiple septic embolic lesions. Lemierre syndrome was diagnosed, antibiotic treatment adjusted and anticoagulation started. A neck CT-scan showed a large parapharyngeal abscess. His clinical condition improved gradually and after 3 weeks of intravenous antibiotics he was discharged home on oral treatment. This case illustrates the importance of diagnosing Lemierre syndrome in the presence of pharyngitis with localised neck pain and respiratory distress, to prevent potentially fatal complications.

PMID: 23616317 [PubMed – in process]

Lumbar Bone Mineral Density Phantomless Computed Tomography Measurements and Correlation with Age and Fracture Incidence.

By London Spine
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Lumbar Bone Mineral Density Phantomless Computed Tomography Measurements and Correlation with Age and Fracture Incidence.

Traffic Inj Prev. 2015 Oct 8;16(sup2):S153-S160

Authors: Weaver AA, Beavers KM, Hightower RC, Lynch SK, Miller AN, Stitzel JD

Abstract
OBJECTIVE: Low bone quality is a contributing factor to motor vehicle crash (MVC) injury. Quantification of occupant bone mineral density (BMD) is important from an injury causation standpoint. The first aim of this study was to validate a technique for measuring lumbar volumetric BMD (vBMD) from phantomless computed tomography (CT) scans. The second aim was to apply the validated phantomless technique to quantify lumbar vBMD in Crash Injury Research and Engineering Network (CIREN) occupants for correlation with age, fracture incidence, and osteopenia/osteoporosis diagnoses.
METHODS: Quantitative CT (qCT) and dual-energy X-ray absorptiometry (DXA) were collected prospectively for 50 subjects and used to validate a technique to measure vBMD from 281 phantomless CT scans of CIREN occupants. Hounsfield unit (HU) measurements were collected from the L1-L5 vertebrae, right psoas major muscle, and anterior subcutaneous fat for all subjects and from 3 phantom ports with known mg/cc calcium hydroxyapatite values for the validation group. qCT calibration was accomplished using regressions between the phantom HU and mg/cc values to convert L1-L5 HU values to mg/cc. A phantomless calibration technique was developed where the fat and muscle HU values were linearly regressed against fat (-69 mg/cc) and muscle (77 mg/cc) to establish a conversion for L1-L5 HU measurements to mg/cc. vBMD calculated from qCT versus the phantomless method was compared for the 50 subjects to assess agreement and a mg/cc osteopenia threshold was established using DXA T-scores. CIREN HU measurements were converted to mg/cc using the phantomless technique and the mg/cc osteopenia threshold was used to compare vBMD to age, fracture incidence, and osteopenia comorbidity classifications in CIREN.
RESULTS: Linear regression of lumbar vBMD derived from the qCT versus phantomless calibrations showed excellent agreement (R(2) = 0.87, P <.0001). A 145 mg/cc threshold for osteopenia was established (sensitivity = 1, specificity = 0.57) and 44 CIREN occupants had vBMD below this threshold. Of these 44 occupants, 64% were not classified as osteopenic in CIREN, but vBMD suggested undiagnosed osteopenia. Age was negatively correlated with vBMD in both sexes (P <.0001) and CIREN occupants with less than 145 mg/cc vBMD sustained an average 1.7 additional rib/sternum fractures (P =.036).
CONCLUSIONS: Because lumbar vBMD was estimated from phantomless CT scans with accuracy similar to qCT, the phantomless technique can be broadly applied to both prospectively and retrospectively assess patient bone quality for research and clinical studies related to MVCs, falls, and aging.

PMID: 26436225 [PubMed – as supplied by publisher]

Comparing the early efficacies of autologous bone grafting and interbody fusion cages for treating degenerative lumbar instability in patients of different ages.

By London Spine
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Comparing the early efficacies of autologous bone grafting and interbody fusion cages for treating degenerative lumbar instability in patients of different ages.

Int Orthop. 2016 Feb 1;

Authors: Zhong HZ, Tian DS, Zhou Y, Jing JH, Qian J, Chen L, Zhu B

Abstract
PURPOSE: The aim of this study was to compare the early efficacies of interbody fusion using autologous bone graft or an interbody fusion cage in a modified transforaminal lumbar interbody fusion (TLIF) in patients of different ages with degenerative lumbar instability.
METHODS: Data from 33 patients with double-segment degenerative lumbar instability treated with a modified TLIF combined with a posterior fixation system from December 2008 to June 2014 were retrospectively analyzed. The two segments separately received an interbody bone graft fusion and an interbody fusion cage. Patients were divided by age into group A (middle-aged and elderly group, age ≥ 55 years, n = 13) and group B (young adult group, age < 55 years, n = 20). The clinical efficacy of the modified TLIF combined with a posterior fixation system was assessed using the Japanese Orthopaedic Association (JOA), Oswestry Disability Index (ODI), and Visual Analogue Scale (VAS) scores obtained before and after surgery, and at final follow-up. We measured the mean intervertebral space height, intervertebral foramen height, lumbar lordosis angle, and inter-technique differences in the mean intervertebral space height and intervertebral foramen height. Interbody fusion was evaluated using the Suk standard.
RESULTS: Patients in group A followed-up for 19.15 ± 8.01 months. Patients in group B followed-up for 14.80 ± 5.47 months. The post-operative JOA, ODI, VAS, and lumbar lordosis angle were improved significantly. Moreover, the early clinical follow-up effect was good. In group A, significant differences in the intervertebral foramen height post-surgery and at final follow-up, and the mean intervertebral space height at final follow-up were noted. The intervertebral foramen and space heights were increased in the interbody cage group. In group B, a significant difference in the intervertebral foramen height at final follow-up was noted. The mean intervertebral space height post-surgery and at final follow-up was significantly increased between the two fusion methods. Bony fusion was achieved in all cases. The fusion time of autologous bone graft and interbody fusion cage was 5.46 ± 1.20 months and 6.77 ± 1.01 months respectively in group A, and 5.50 ± 1.28 months and 6.35 ± 1.76 months respectively in group B, the difference in fusion time between techniques was significant.
CONCLUSION: At different ages, the interbody fusion cages can better preserve the intervertebral space and the intervertebral foramen height. However, autologous bone graft can rapidly achieve a bony fusion. Interbody fusion cages are therefore ideal for young adults, while autologous bone grafting is ideal for middle-aged and elderly patients who receive a modified TLIF.

PMID: 26830783 [PubMed – as supplied by publisher]

A trimodality approach in the management of metastatic low-grade epithelioid hemangioendothelioma of the bone.

By London Spine
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A trimodality approach in the management of metastatic low-grade epithelioid hemangioendothelioma of the bone.

BMJ Case Rep. 2015;2015

Authors: Saste A, Cabrera Fernandez DF, Gulati R, Gamalski S

Abstract
A 29-year-old man presented with a 2-week history of severe pain in the left foot with no preceding history of trauma. A left foot radiograph demonstrated a cortical lucency in the mid-distal shaft of the third metatarsal bone. MRI of the left foot showed an expansile lesion in the same location. A staging bone scan showed a focal uptake in the known lucency in the left third metatarsal and in the proximal left femur. A subsequent left hip radiograph demonstrated a lucency in the intertrochanteric region. CT scan of the chest, abdomen and pelvis was unremarkable. A biopsy of the left third metatarsal expansile lesion performed during an incision and curettage procedure revealed an epithelioid haemangioma (EHE) of the bone. MRI of the left hip performed in response to the findings on the bone scan showed metastatic disease in the left intertrochanteric region. A prophylactic left hip fixation surgery with an interlocking intramedullary femoral nail was therefore undertaken to avoid a pathological fracture of the left hip from the metastatic disease. Simultaneously, a left hip biopsy was performed, which also revealed an EHE. The patient underwent external beam radiation to the left femoral head and neck. This was followed by fractionated radiosurgery to the left third metatarsal. Once the left foot wound had healed, the patient subsequently received four cycles of doxorubicin and ifosfamide. A restaging positron emission tomography CT carried out after completion of therapy showed no metabolic evidence of residual primary tumour or metastasis. More than 2 years after completing his trimodality therapy, the patient remains fully functional and symptom free.

PMID: 26184358 [PubMed – as supplied by publisher]