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 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Seven children (8 hips) with Choi's Type IV-B sequelae of septic arthritis of the hip underwent an unconventional reconstruction technique using a vascular-pedicled iliac crest graft to replace the destroyed femoral head and neck. The average age at surgery was 3.5 years, and the mean followup 7 years. Graft incorporation was observed in all patients; however, severe graft resorption was found in 1 hip, and mild resorption in 4 hips. The method of internal fixation of the iliac crest graft was not ideal and will require modification. Excellent femoral head-neck substitution with graft hypertrophy and remodeling was seen in 3 hips. In 7 hips (88%), vertical hip stability was achieved and a good range of hip motion was maintained. All children adapted very well to the operative procedures. At the final followup, the symptoms were those of limb-length discrepancy; pain was not a symptom.
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PMID:Hip reconstruction for femoral head loss from septic arthritis in children. A preliminary report. 763 38

The authors treated 31 patients with septic arthritis of the sacroiliac joint (14 patients with tuberculosis, 7 acute staphylococcal, 6 gonococcal, and 4 typhoid). The clinical presentation was vague and nonspecific, but most patients reported buttock pain, low back pain and difficulty walking. In 28 patients, the diagnosis was established after clinical examination, bone scans, hematologic investigations, and blood cultures. The diagnosis was established through arthrocentesis of the sacroiliac joint in 9 patients. In 3 patients, there was a delay in diagnosis. Twenty-nine patients improved on a conservative regimen of bed rest and antibiotics. Two patients required open drainage because of a large buttock abscess that was secondary to tuberculosis sarcoiliitis.
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PMID:Septic sacroiliitis. 764 83

A 33-yr-old male ran 10 miles, drank some beer, and developed pain in his left knee and ankle. He took some leftover antibiotics but was no better after 6 d, when a heart murmur and an aortic valve nodule were discovered. He was presumed to have endocarditis with septic arthritis and was started on intravenous antibiotics. On the second hospital day, synovial fluid analysis revealed acute gout, and the patient improved very rapidly on anti-gout therapy. The valvular nodule remained unexplained, but one very rare cause of valvular heart nodules is visceral gout. An unsuccessful attempt to resorb the nodule was made by using allopurinol. This patient demonstrates several points about gout in endurance athletes: 1) acute gout can mimic infectious endocarditis, 2) misdiagnosed or undertreated gout often leads to multiple joint involvement and sometimes to visceral tophi, and 3) athletes who exercise in warm weather and quench their thirst with cold beer are at risk for acute gout.
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PMID:Runner with gout and an aortic valve nodule. 767 64

A protocol for the management of irritable hip was assessed; this protocol avoids hospital admission while detecting all other serious causes of hip pain, in particular septic arthritis, at the earliest possible opportunity. Fifty children with painful hips were studied prospectively with immediate ultrasound guided aspiration and Gram stain of all hip effusions. Bone scintigraphy performed at an early stage was reserved for patients with unremitting symptoms. Thirty six hips were aspirated. Only two patients were admitted. The final diagnoses were transient synovitis (45 cases), Perthes' disease (three cases), fracture (one case), and septic arthritis (one case). The single case of hip sepsis was diagnosed on presentation. The traditional approach to management is questioned and the advantages of the protocol highlighted, including earliest diagnosis of sepsis and other serious pathology, avoidance of hospital admission, and the relief of pain by joint decompression.
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PMID:The irritable hip: immediate ultrasound guided aspiration and prevention of hospital admission. 763 66

Septic arthritis is a synovial infection of bacterial origin. Such a diagnosis, suggested by pain and diminished resistance to infection, should be confirmed by puncture of the joint effusion. The condition calls for emergency hospitalisation and treatment in a surgical unit. Treatment should include draining and cleaning of the joint, immobilization at least in the early stages, and double parenteral antibiotic administration. Clinical, radiological and laboratory follow-up (CRP and ESR) should be pursued. Detection of the responsible germ is often difficult and requires great care in sampling and analysis. The frequency of Haemophilus in children under 4 years of age requires adaptation of antibiotic therapy. In newborns, diagnosis is often difficult and delayed, explaining the frequency of sequelae in this age group. The only important prognostic factor is the interval before beginning treatment.
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PMID:[Septic arthritis in children]. 785 26

Cutaneous cryptococcosis is an uncommon manifestation of disseminated cryptococcal disease. We report a liver transplant recipient presenting with onset over 3 days of progressive pain and swelling of the lower extremity and foot with erythema and heat. Cryptococcal cellulitis was documented, but in retrospect the clinical presentation was indistinguishable in presentation and appearance from acute bacterial cellulitis. The patient also proved to have concomitant cryptococcal septic arthritis; the presence of cryptococcal antigen in the synovial fluid allowed a rapid and definitive diagnosis. Subsequently, cultures of skin, synovial fluid, and blood were all positive for cryptococci. Cryptococcus should be considered in the differential diagnosis of bacterial cellulitis in a liver transplant recipient not responding to antibacterial therapy.
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PMID:Cutaneous cryptococcosis mimicking bacterial cellulitis in a liver transplant recipient: case report and review in solid organ transplant recipients. 794 40

Septic arthritis (SA) in intravenous abusers is reviewed in the English literature from 1966-1992 with the purpose of registration of the bacteriological development, localization of the infected joints, clinical information and laboratory data. Eighty-three publications are available for the review. We have registered 270 joint infections caused by 264 bacteria in 257 intravenous drug abusers with SA. Since 1985 there has been a change in joint localization and bacteriology. A possible explanation is considered. Diagnosis and treatment is difficult, because of the unstable life-style and frequent compliance problems in intravenous drug abusers. SA should be considered in patients with known intravenous drug abuse, uncharacteristic pain and symptoms of osteoarticular infection. SA is often accompanied by fever, leucocytosis and elevated sedimentation rate. Bacteriological diagnosis is achieved by joint aspiration and/or blood culture. Tc-99m-MDP-(technetium-99m-methylene diphosphonate)-bone scintigraphy should be performed on joints suspected of infection which are difficult to aspirate. With adequate antibiotic treatment the prognosis is good, and the mortality is insignificant.
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PMID:[Septic arthritis in intravenous drug abuse]. 805 69

It is reported that most of the causative organisms of suppurative arthritis complicating rheumatoid arthritis (RA) is Staphylococcus aureus and that Streptococcus pneumoniae is rare, representing less than 5% of cases of suppurative arthritis complicating RA. We here report two cases of pneumococcal septic arthritis complicating RA. Both were female, and 68 and 64 years old, respectively. They had active, long-standing RA with destructed changes. Infected joints included both knees (case 1) and right knee (case 2). Pain and loss of motion in the septic joints were prominent. On admission, the physical examination showed severe redness, swelling and tenderness of the septic joints and the range of motion of those was markedly decreased. The radiograph of affected joints showed stage III. Laboratory data showed markedly elevated ESR of 127 mm/hr (case 1) and 142 mm/hr (case 2) and C-reactive protein of 49.91 mg/dl (case 1) and 30.36 mg/dl (case 2). Aspirate of the left knee of case 1 showed numerous neutrophils. Cultures of the joint fluid grew S. pneumoniae. Grossly purulent material was aspirated from the right knee of case 2 and cultures also grew S. pneumoniae. They were started on intravenous antibiotics with a good response and the function of involved joints returned to preseptic condition. The source of infection on case 1 was presumed to be otitis media because she had discharge from left ear concurrently with the exacerbation of joint symptoms. Case 2 had productive cough and cultures of sputum also disclosed S. pneumoniae when pain of right knee joint developed. The suggested source of infection was upper respiratory tract.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Two cases of pneumococcal septic arthritis complicating rheumatoid arthritis]. 831 8

Injections of local anaesthetics with or without steroids are widespread in the treatment of muscular pain. Occasionally, however, they are followed by serious bacterial infections. Three cases of septic arthritis, one localised to the hip, one to the knee and one to the sacroiliac joint are presented. One should offer great consideration to the possible complications following injections into or near joints.
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PMID:[Purulent arthritis after blockade treatment]. 834 97

We report a case of septic arthritis due to Enterococcus species and review 18 additional cases reported in the literature from 1966 through 1993 for which clinical or treatment data were available. In 11 of the 19 cases, prosthetic joints were affected (9 knees, 2 hips) and in 8 cases, native joints were affected. Of those patients with prosthetic joint infections, 6 had preexisting osteoarthritis and 3 had rheumatoid arthritis; only one patient with native joint infection had a recognized (although unspecified), preexisting joint abnormality. Pain, fever (temperature, > 37 degrees C), and tenderness were the most common clinical findings in patients with native joint infections. The microbiological diagnosis was made by culture of synovial fluid or synovial tissue (16 of 19), blood (1 of 19), or an unstated specimen (2 of 19). Polymicrobial infection was present in 6 (32%) of 19 patients. Of fourteen patients treated with either a parenteral penicillin (11 of 19) or a glycopeptide (3 of 19), 11 made an uncomplicated recovery. An aminoglycoside was also used to treat 7 of these 14 patients (4 of these 7 had prosthetic joints). All 11 prosthetic joint infections were ultimately clinically cured; for most of these patients, the original prosthesis was removed. For two patients with native joint infections, amputation of the infected limb was necessary to cure the infection.
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PMID:Enterococcal arthritis: case report and review. 878 45


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