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Query: UMLS:C0011849 (diabetes)
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Forty-six patients (23M, 23F) ranging in age from 19 to 79 yr with a clinical history of a nonunion fracture, surgery, diabetes or a soft-tissue infection were studied with [111In]oxine WBCs to detect osteomyelitis. There were 27 true-positive, nine true-negative, two false-positive and one false-negative. The false-positives and the false-negative occurred in patients with soft-tissue infections overlying the area of interest. All diagnoses were confirmed by intraoperative bone biopsies and cultures. Bone biopsy and scan were performed within 2 days of each other in 39 patients. The overall sensitivity was 97% (27/28), specificity, 82% (9/11) and the diagnostic accuracy, 92% (36/39). The remaining seven patients had negative [111In]WBC scans several months after positive bone biopsies and definite antibiotic treatment. This suggests that [In]WBC scans become negative after appropriate therapy is undertaken. Interobserver data was obtained from four nuclear physicians of varying experience blinded to clinical information. A high degree of agreement was found in over 90% of the cases. This study demonstrates the utility of [111In]WBC scans in the diagnosis and follow-up of complicated osteomyelitis and a high level of interobserver agreement in scan interpretation.
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PMID:Indium-111-labeled white blood cells in the detection of osteomyelitis complicated by a pre-existing condition. 337 11

Pyarthrosis of the knee was treated in 30 patients by arthroscopic decompression and lavage, coupled with parenteral and oral antibiotics. There were 21 men and nine women patients whose ages ranged from 6 months to 65 years of age. Twenty-two patients were considered to have a hematogenous origin as a cause of their pyarthrosis, and eight were caused by penetrating trauma. Twenty-eight of these patients had the onset of symptoms within 72 h prior to arthroscopy. Two adults had the onset of their symptoms 1 week prior to treatment. Follow-up has ranged from 6 months to 5 years. Staphylococcus aureus was cultured in 20 knees, Streptococcus pneumonia in three knees, Haemophilus influenzae in four knees, and Neisseria gonorrhoeae in one knee. The average hospital stay among 22 children aged 12 years or younger was 3.50 days. The other eight patients had an average hospital stay of 9.50 days. Three adults with diabetes and other medical problems, such as renal failure, had an average hospital stay of 17.33 days. Excellent results were obtained in 28 (93.3%) of 30 patients and good results were obtained in two (6.7%) of 30 patients. There were no poor results or recurrences, and no cases of osteomyelitis occurred. This method of treatment markedly reduces the morbidity and hospital stay of patients with a septic knee.
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PMID:Arthroscopic treatment of the septic knee. 348 36

Serum C-reactive protein (CRP) and alpha 1-acid glycoprotein (AAG) levels were studied in 188 patients undergoing heart operations with cardiopulmonary bypass. Mediastinitis or osteomyelitis of the sternum or both developed in 10 patients on postoperative day 4 to 13 (median, day 9). The mean CRP levels on day 2 were lower in patients with later deep sternal wound infection (9.1 +/- 1.5 mg/dl [mean +/- standard error]) compared with patients without major infections (14.0 +/- 0.8 mg/dl; p = 0.103 [univariate logistic regression]). AAG levels on day 2 reacted in a similar manner, yielding 78.2 +/- 5.5 mg/dl and 100.9 +/- 2.7 mg/dl, respectively (p = 0.0004). No correlation was found between CRP or AAG and duration of cardiopulmonary bypass, number of blood transfusions, or total protein levels on day 2. The white blood cell count (WBC) on day 2 was 13.1 +/- 1.7 X 10(3)/microliter for patients with infection and 9.7 +/- 0.3 for those without infection. Multivariate logistic regression analysis revealed that AAG, WBC, and CRP on day 2 were significant risk factors sufficiently predicting the probability of a deep sternal infection. After adjustment for these three variables, other variables (age, sex, total protein on day 2, diabetes mellitus, type of operation, duration of cardiopulmonary bypass, length of operation, repeat thoracotomy for bleeding, number of blood transfusions on the day of operation, intraaortic balloon pumping, reoperation, emergency operation, and surgeon's professional status) were not of additional significance. The goodness of fit of the statistical model was confirmed by a high correspondence between predicted and observed cases of deep sternal infection.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Early prediction of deep sternal wound infection after heart operations by alpha-1 acid glycoprotein and C-reactive protein measurements. 349 Feb 32

A case of septic arthritis and osteomyelitis of the wrist with group B beta-hemolytic streptococci in an adult is reported. Neonatal septic arthritis and osteomyelitis caused by this organism have been previously reported. While rare in the adult, sporadic cases of septic arthritis and osteomyelitis have been seen. The elderly patient with diabetes seems to be a high-risk patient. Underlying chronic arthritis may confuse or delay the diagnosis.
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PMID:Group B beta-hemolytic streptococcal arthritis and osteomyelitis of the wrist. 354 62

Cefsulodin, a narrow-spectrum cephalosporin with excellent antipseudomonal activity was used to treat 48 patients with 51 Pseudomonas aeruginosa infections. These included osteomyelitis, infected prostheses, post-operative and post-traumatic superficial wounds, decubitus and stasis ulcers, lower respiratory tract infections and infections of the urinary tract. Many of the patients were compromised by underlying debilitating conditions such as severe trauma, diabetes mellitus, vascular impairment, and abuse of alcohol and drugs. In cases of polymicrobial infections, a concomitant non-antipseudomonal antibiotic was sometimes administered. Cefsulodin was administered intravenously to 47 patients and by intramuscular injections to one individual. The dosage ranged from 0.5 to 2.0 g every six hr and duration of therapy was from 4 to 70 days. A satisfactory clinical response was observed in 88% of the patients. P. aeruginosa was eradicated from 76% of the infection sites. Failures, which included relapse within one year, were generally associated with prior severe trauma or vascular impairment in cases of osteomyelitis. Reinfections and superinfections developed in 12 individuals. Adverse reactions reported for two patients were nausea and vomiting. A third patient had transient increases in alkaline phosphatase and SGOT. These data indicate that cefsulodin is an effective and safe antibiotic in various types of P. aeruginosa infections.
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PMID:Cefsulodin treatment for serious Pseudomonas aeruginosa infections. 377 Feb 90

Group B streptococcal bacteremia outside the perinatal setting is not commonly emphasized. This report reviews all episodes of group B streptococcal bacteremia during a four and a half year period in a large community teaching hospital. Fourteen episodes occurred in neonates, four in parturient women, and 28 in other adults. Bacteremic adults were usually elderly with an average age of 68 years. Group B streptococcal bacteremia occurred in adults with various underlying diseases, including diabetes mellitus, liver disease, peripheral vascular disease, and hematologic disease, and in those receiving long-term steroid therapy. Infections causing group B streptococcal bacteremia in adults included decubitus ulcers, pneumonia, endocarditis, cellulitis, arthritis, osteomyelitis, and meningitis. Thirteen of 28 episodes of group B streptococcal bacteremia in adults were hospital-acquired. Overall mortality in adults was 70 percent. Group B streptococcal bacteremia in adults outside of the perinatal setting is associated with significant underlying diseases and has a high mortality.
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PMID:Group B streptococcal bacteremia in a community teaching hospital. 388 11

The effectiveness and safety of parenterally administered ceftazidime were assessed in 20 patients with infections caused by Pseudomonas aeruginosa or Serratia marcescens. There were six infections involving the urinary tract, six wound infections, one respiratory tract infection, three septicaemias, one empyema, one mastoiditis and two infections of the epididymis. Sixteen of the isolates were resistant to at least one aminoglycoside antibiotic. Fifteen patients were clinically and bacteriologically cured, two patients improved, but had relapses and three patients showed no response. The lack of clinical response was due to the development of resistance by P. aeruginosa in two patients with osteomyelitis, one of whom also had diabetes mellitus. The third patient who had chronic lymphocytic leukaemia developed post-operative osteomyelitis and septicaemia with serratia. She did not respond to treatment. Side effects consisted of a positive direct Coomb's test without evidence of haemolysis in two patients and a mild maculopapular rash in one patient.
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PMID:Treatment of Pseudomonas and Serratia infections with ceftazidime. 392 82

The records of 28 patients who underwent 37 ray resections at Hines Veterans' Administration Hospital and Loyola University Medical Center were reviewed. Indications included localized gangrene, osteomyelitis, or both. Underlying medical diagnoses included diabetes, chronic ethanol abuse, arteriosclerosis obliterans, and gout. The overall success rate was only 34%. These results suggest that the usefulness of ray resections as a definitive procedure in such cases may be limited.
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PMID:Ray resections in the insensitive or dysvascular foot: a critical review. 398 24

The efficacy and safety of ticarcillin plus clavulanic acid in the treatment of patients with infections of soft tissue, bone, and joint were evaluated in this open study. Clinical diagnoses included osteomyelitis, soft tissue abscess or ulcer, cellulitis, bite wound, traumatic or postoperative cellulitis, necrotizing fasciitis, septic arthritis, septic bursitis, and septic thrombophlebitis. Trauma or underlying disease such as diabetes mellitus or vascular insufficiency was common (more than 50 percent) in the patient population. Clinical efficacy was evaluable in 66 patients who received 3 g of ticarcillin and 0.1 g of clavulanic acid every four or six hours for a mean of 23.4 days. A satisfactory clinical response was observed in 92 percent of the patients. Major pathogens isolated were Enterobacteriaceae, anaerobic cocci, Staphylococcus aureus, and beta-hemolytic Streptococcus. Of the 143 isolates recovered from 55 bacteriologically evaluable cases, 87 percent were eradicated by therapy. Overall, a satisfactory bacteriologic outcome occurred in 93 percent of the patients, and the pathogen(s) persisted in 7 percent. More than 98 percent of the isolates were susceptible to ticarcillin plus clavulanic acid in vitro. Emergence of resistance during therapy occurred with three strains of Pseudomonas aeruginosa. Adverse drug-related reactions required discontinuation of treatment in two patients, although other minor abnormal laboratory findings were common. These results indicate that ticarcillin plus clavulanic acid offers safe and effective therapy for infections of soft tissue, bone, and joint.
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PMID:Safety and efficacy of ticarcillin plus clavulanic acid in the treatment of infections of soft tissue, bone, and joint. 407 81

In an 11-year-old girl with congenital insensitivity to pain, diagnosis depended on three diagnostic features: pain sensation absent from birth; entire body affected; all other sensory modalities and deep tendon reflexes present. The cause of this disease is unknown. Other diseases to be considered when insensitivity to pain is present are diabetes, lues, and syringomyelia. Less common neurologic diseases are congenital sensory neuropathy with or without anhidrosis, familial dysautonomia (Riley-Day syndrome), and sensory radicular neuropathy. The three orthopedic manifestations of congenital insensitivity to pain are recurrent fractures, neuropathic (Charcot's) joints, and osteomyelitis. Management is based on proper appreciation of the disease. Prevention of complications is important. Treatment of fractures and osteomyelitis is straightforward. However, the treatment of neuropathic joints demands caution and is done best nonsurgically.
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PMID:Orthopedic aspects of congenital insensitivity to pain. 618 64


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