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Query: UMLS:C0243026 (sepsis)
 52,417 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The first 100 cases of the 135 THARIES surface replacement procedures with 4--32 months follow-up, are evaluated in terms of clinical results, radiographic information and complications. The short but detailed follow-up suggests that this procedure was an excellent alternative for the younger and more active population. The overall hip ratings (pain, walking and function) and range of motion are comparable to that of stem-type total hip replacements. When the THARIES and conventional hip results are further compared in 34 patients matched by sex and age for 3 major etiological groups (osteoarthritis, osteonecrosis and congenital hip dysplasia), the interim results are essentially comparable for both types. Three cases in the first 100 have required revision. One patient (no. 1) with osteoporosis, chondrolysis and arthrofibrosis following slipped capital femoral epiphysis had loose femoral and acetabular components 24 months postoperatively. He was revised to a T-28 hip replacement. The polyethylene socket in another patient (no. 4), the first dysplastic hip in this series, was 20 nm uncovered superiorly, became loose and was revised 9 months postoperatively. Now 15 months postoperative with a more medial THARIES acetabulum, the patient continues to have a good result. Another patient (no. 12) with bilateral dysplastic hips became progressively more disabled due to heterotopic bone, which was then excised 18 months postoperatively. Radiographic studies of the THARIES sockets demonstrate radiolucent zones at the cement-bone interfaces of the acetabulum in 88 cases, partial in 51 and complete in 37. Three hips were currently considered to have evidence of progressive socket loosening but are active and asymptomatic. There have been no femoral neck fractures in this series which we attribute to the custom fitting ability inherent in the range of components, the reaming protocol and the various remodelling guides. There have been no prosthetic breakages, subluxations, dislocations or sepsis. The complications observed in this series are minor and comparable to that of many other total hip arthroplasty operations. Nerve palsy and trochanteric separation have not been major problems although one existing peroneal nerve dysfunction and one trochanteric migration emphasize the need to minimize these complications by careful handling of the operative leg, and an accurate trochanteric reattachment technique.
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PMID:THARIES surface replacements: a review of the first 100 cases. 10 70

A fatally ending index case of septic osteoarthritis that was diagnosed retrospectively initiated this report. This patient had severe, asymmetrically distributed metaphyseal growth disturbances at many long bones. In order to determine the features of early radiologic diagnosis we report the findings of 7 further patients with neonatal septic osteoarthritis with clinical and radiological follow-up. The most important observation for early radiologic diagnosis of osteoarthritis is the displacement of fat layers along the metaphysis. Other findings of the soft tissues have the same diagnostic value as bone destruction and subperiosteal new bone formation found one to three weeks later on roentgenfilms. Detecting early signs of osteoarthritis helps in localizing the focus for bacteriologic diagnosis, which is said to be more successful than blood cultures. Diagnosing a joint empyema initiates surgical intervention for pressure relief in order to avoid necrosis of the epiphysis as seen in the femoral head in septic arthritis of the hip joint. Early diagnosis and treatment prior to destruction of the growing cartilage is necessary to avoid growth disturbances and length discrepancies of long bones. In cases of sepsis a so called "babygram" and a repeat examination 10 to 14 days later is mandatory.
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PMID:[Osteoarthritis in the neonate. Radiologic diagnosis and follow-up observations (author's transl)]. 15 14

The authors have observed three instances of sepsis due to Mycobacterium fortuitum complicating total hip replacement for osteoarthritis. The case histories are fully described. The requirements are given for recognition of the organism which grows on special culture media and which may be mistaken for Mycobacterium tuberculosis. This feature explains why, in some cases, the organism may not be discovered. Antibiotics were ineffective but the general condition of the patient was not greatly affected.
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PMID:[Mycobacterium fortuitum infection after total hip prosthesis. A report of 3 cases (author's transl)]. 15 87

Osteoarthritis by definition involves a progressive degeneration in one or many synovial joints and has a multifaceted etiology. The limitation of pathologic responses to an initial insult minimizes the value of microscopic examination of the tissues long after the original injury. The cornerstone of diagnosis has been the plane film x-ray examination, which allows the study and comparison of macroscopic changes that are common to osteoarthritis and aids in diagnosing other causes of arthritis. Synovial fluid analysis in doubtful diagnoses is useful in ruling out specific arthritides such as infection or crystal induced arthritis, or in pinpointing inflammation as a factor in the individual case. Synovial fluid studies are especially important in allowing recognition of conditions in which appropriate treatment can prevent secondary osteoarthritis, e.g., sepsis. This technique may also be necessary to rule out sepsis before implant joint reconstitution.
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PMID:Diagnosis of osteoarthritis: the value of laboratory tests. 45 Apr 9

A review of 41 patients in whom knee fusion was performed mainly for degenerative arthritis and sepsis disclosed that only 15% of patients were without complications. Complications were numerous and appeared both early and late - persistent knee and back pain were the most common. Many patients were unable to return to work or to participate in social activities. The optimal position for fusion is 15 to 20 degrees of flexion, which results in a smoother gait and less difficulty for the patient in driving a car. Because of the continued refinement in total knee joint replacement, the indications for knee arthrodesis should be confined to the treatment of chronic infection and failed total joint replacement.
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PMID:Knee arthrodesis: long-term results. 127 15

Interleukin-1 (IL-1) is a 17-kDa pro-inflammatory cytokine synthesized from a variety of cell types primarily in association with disease states or during host perturbation such as immune responses. At pM or even fM concentrations, IL-1 triggers various responses in nearly all cells. It appears that there is little or no major role for IL-1 in homoeostatic mechanisms. There are two IL-1's (alpha and beta) each with its distinct sequence; there are two IL-1 receptors. Disease states such as local and systemic infection, septic shock, degenerative arthritis and autoimmune diseases such as nephritis, vasculitis and inflammatory bowel disease appear to be mediated, in part, by IL-1. Organ failure, capillary leak and death occur in animals after a combination of tumour necrosis factor (TNF) and IL-1 which is more effective in inducing these changes than either cytokine alone. IL-1 is also a potent inducer of endothelial cell adhesion molecules, IL-6, and IL-8, a neutrophil chemotactic and activating factor. Strategies for reducing the effects of IL-1 have been based on suppression of transcription, translation, or secretion; more recently, receptor blockade has been a new approach. A naturally occurring IL-1-specific receptor antagonist (IL-1ra), which shares 40% conserved amino-acid homology with IL-1 beta, binds to IL-1 surface receptors with the same affinity as IL-1 but does not possess agonist activity and acts as a competitive inhibitor of IL-1. Studies using the IL-1ra to block endogenous IL-1 in a variety of animal disease models suggest that IL-1 plays a key role in triggering the cascade of inflammatory responses. In addition, the IL-1ra reduces the spontaneous production of growth factors and proliferation of leukaemic cells. The IL-1ra may be an advantageous therapy in patients with sepsis, diabetes, inflammatory bowel, arthritis and cancer.
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PMID:Reduction of inflammation by decreasing production of interleukin-1 or by specific receptor antagonism. 139 23

Thorotrast, a colloidal suspension of 252Th dioxide, was widely used as a radiographic contrast medium for more than 25 y after its clinical practice introduction in 1930. Its excellence as a contrast medium was ultimately eclipsed by its long-term associated morbidities, and its use essentially ended by 1954. This case history presents the clinical events in the last 10 y of life in a patient injected with Thorotrast in 1953. This patient developed three previously described Thorotrast-associated morbidities: pneumococcus sepsis due to functional asplenia and reticuloendothelial system blockade, an enlarging Thorotrastoma (inflammatory mass) at the injection site, and a fatal blood dyscrasia. In addition, she developed three clinical syndromes where a Thorotrast association may exist. She suffered from severe spinal column osteoarthritis and vertebral collapse. An abnormal bone-density measurement implies the presence of radiodense radioactive thorium or its degradation products as potentially responsible. She had evidence of chronic immune system disregulation with immunoglobulin excess, auto antibodies, and cell-mediated immunity deficiency. This condition is similar to that found in patients infected with human immunodeficiency virus and may suggest a shared etiology in reticuloendothelial system damage. Lastly, she developed dense bilateral cataracts. This case history illustrates the temporal relationship of a variety of symptoms. Discussion is directed at review of previous data and support for new associations.
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PMID:Clinical consequences of Thorotrast in a long-term survivor. 152 4

Four patients with osteoarthritis of the hip, who developed septic arthritis of the affected joint, are reported. The septic arthritis developed insidiously and was diagnosed with difficulty. One patient died, two required subsequent joint excision, and one arthrodesis despite antibiotics. The presence of a recognised predisposing factor to septic arthritis, such as rheumatoid arthritis or a surgically replaced joint, can provide a diagnostic pointer. These cases suggest that osteoarthritis, similarly, is a predisposing factor. It is concluded that joint sepsis should be considered if a patient with osteoarthritis develops new symptoms from a single joint with associated systemic features.
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PMID:Septic arthritis complicating hip osteoarthritis. 161 47

Revision operations for nonunion following total ankle arthrodesis for total ankle arthroplasty (TAA) were reviewed in ten patients. Operations averaged 2.0 years after prior arthrodesis attempts and featured external fixation in seven, internal fixation in one, percutaneous pin fixation in one, and cast immobilization only in one. Bone graft was used in seven. Union was achieved in 78%. The one complication was an infection in a patient with prior sepsis. The results were considered excellent in three, good in one, fair in three, and poor in two of the nine patients with adequate follow-up evaluation (average, 7 years). Despite successful arthrodesis, residual symptoms were common because of factors such as hindfoot degenerative arthritis and malalignment.
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PMID:Salvage of nonunion following ankle arthrodesis for failed total ankle arthroplasty. 206 Feb 24

For arthritis or arthralgia there is no simple system for diagnostic analysis, but whether it is polyarthritis or monoarthritis, acute or chronic in onset, some general rules apply. Common causes include osteoarthritis (primary and secondary) and viral infection. Drugs should be considered, including those inducing gout. It is still imperative not to miss rheumatic fever, sepsis and tuberculosis in assessment. We may encounter more cases of Lyme disease presenting as arthritis.
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PMID:Arthralgia: a diagnostic strategy. 224 64


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