scholarly journals Similarities and Differences between Clavicular Bacterial Osteomyelitis and Nonbacterial Osteitis: Comparisons of 327 Reported Cases

2021 ◽  
Vol 2021 ◽  
pp. 1-11
Author(s):  
Nan Jiang ◽  
Ping Zhang ◽  
Wei-ran Hu ◽  
Zi-long Yao ◽  
Bin Yu
Keyword(s):  
Chronic Phase ◽  
Sinus Tract ◽  
Current Evidence ◽  
Lateral Side ◽  
Cure Rate ◽  
Reactive Protein ◽  
Medial Side ◽  
Long Duration ◽  
Disease Term ◽  
Similarities And Differences

Background. Currently, both clavicular bacterial osteomyelitis (BO) and nonbacterial osteitis (NBO) remain not well understood owing to their much lower incidences. This study is aimed at summarizing similarities and differences between clavicular BO and NBO based on comparisons of literature-reported cases. Methods. We searched the PubMed and Embase databases to identify English published literature between January 1st, 1980, and December 31st, 2018. Inclusion criteria were studies evaluating clinical features, diagnosis, and treatment of clavicular BO and NBO, with eligible data for synthesis analysis. Results. Altogether, 129 studies with 327 patients were included. Compared with BO, clavicular NBO favored females ( P < 0.001 ) and age below 20 years ( P < 0.001 ) and mostly presented in a chronic phase (disease term exceeding 2 months) ( P < 0.001 ). Although local pain and swelling were the top two symptoms for both disorders, fever, erythema, and a sinus tract were more frequently found in BO patients ( P < 0.01 ). Although they both favored the medial side, lesions in the clavicular lateral side mostly occurred in BO patients ( P = 0.002 ). However, no significant differences were identified regarding the serological levels of white blood cell count ( P = 0.06 ), erythrocyte sedimentation rate ( P = 0.27 ), or C-reactive protein ( P = 0.33 ) between BO and NBO patients before therapy. Overall, the BO patients achieved a statistically higher cure rate than that of the NBO patients ( P = 0.018 ). Conclusions. Females, age below 20 years, and a long duration of clavicular pain and swelling may imply NBO. While the occurrence of a sinus tract and lesions in the lateral side may be clues of BO, inflammatory biomarkers revealed limited values for differential diagnosis. BO patients could achieve a better efficacy than the NBO patients based on current evidence.

scholarly journals Differential Contribution of the Medial and the Lateral Side of the Joint to Symptoms in Knee Osteoarthritis: A Radiographic and Laboratory Analysis in the Nagahama Study

Cartilage ◽  
2021 ◽  
pp. 194760352110258
Author(s):  
Kazuya Nigoro ◽  
Hiromu Ito ◽  
Tomotoshi Kawata ◽  
Shinichiro Ishie ◽  
Yugo Morita ◽  
...  
Keyword(s):  
Knee Osteoarthritis ◽  
Clinical Outcomes ◽  
Knee Pain ◽  
High Sensitivity ◽  
Analysis Of Covariance ◽  
Radiographic Evaluation ◽  
Radiographic Feature ◽  
Lateral Side ◽  
Cross Sectional ◽  
Medial Side

Objective: This cross-sectional study aimed to explore the differences of the medial and lateral sides of the knee joint and precise radiographic abnormalities in contribution to the knee pain and clinical outcomes. Design: Participants 60 years or older who underwent radiographic evaluation were included. Knee radiography was assessed using grading systems of the Osteoarthritis Research Society International (OARSI) atlas. The Japanese Knee Osteoarthritis Measure (JKOM) was evaluated as clinical outcomes. Serum high-sensitivity C-reactive protein (hsCRP) was used to evaluate systemic inflammation. We divided the participants into normal, medial-, lateral-, and medial & lateral-OA types and compared their JKOM using an analysis of covariance. Furthermore, we analyzed the relationship between the knee pain and stiffness of JKOM and the grading of each radiographic feature using a multiple regression model. Results: Lateral- and medial & lateral-OA groups had a significantly worse symptoms in the total and the pain score, especially in movement subscales, in JKOM score. Lateral-OA groups had higher hsCRP than medial-OA group. Multivariate analysis showed that medial joint space narrowing (JSN), and lateral femoral and tibial osteophytes significantly affected knee pain (adjusted odds ratios: 1.73, 1.28, and 1.55, respectively). The radiographic changes are associated with pain more in JSN in the medial side and osteophytes in the lateral side. Conclusion: Lateral- and medial & lateral-OA groups showed worth symptom. In addition, medial JSN and lateral osteophytes have potent effects on the knee pain.

scholarly journals Assessment of Acetabulum Deformity During Preoperative Planning for Hip Arthroplasty

2019 ◽  
Vol 25 (3) ◽  
pp. 153-164
Author(s):  
D. V. Martynenko ◽  
V. P. Voloshin ◽  
L. A. Sherman ◽  
K. V. Shevyrev ◽  
S. A. Oshkukov ◽  
...  
Keyword(s):  
Acetabular Component ◽  
Hip Joint ◽  
Preoperative Planning ◽  
Bone Defects ◽  
Lateral Side ◽  
X Rays ◽  
Two Dimensional ◽  
Acetabular Coverage ◽  
Anatomical Features ◽  
Medial Side

Purpose of the study — to improve the two-dimensional planning of total hip joint arthroplasty to ensure precise positioning of the acetabular component in the deformed acetabulum. Materials and methods. Features of roentgenological anatomy of acetabulum and its coverage were studied on 1058 hip joint x-rays in the AP view in accordance with the procedure developed by the authors to define acetabular square — the site of standard positioning of a spherical femoral head in the acetabulum or of a hemispherical acetabular component. The method consisted of identifying the apex of “teardrop” figure; the most lateral points of the pelvic terminal line and roof of the acetabulum; superior part of the acetabular cavity; medial and inferior points of acetabular coverage, and building the sides of acetabular square — medial, inferior, lateral and superior boundary lines. Connection of “teardrop” apex and lateral point of the pelvic terminal line formed the medial side of acetabular square, and a perpendicular to that line drawn through the “teardrop” apex to its inferior side. The lateral side was drawn either through the intersection of the ascending diagonal line — bisector from the top of the “teardrop” figure with the contour of the acetabulum roof, or was a part of the projection of the most lateral point of the acetabular roof on the inferior side of the square. The superior side was a perpendicular connecting the intersection of the ascending diagonal and lateral bounding lines with the medial side of the acetabular square. The area of the deformed acetabular cavity located outside of the acetabular square was assessed as the acetabular defect. Results. Method of defining the acetabular square allowed to identify types of ratios between acetabular cavity and acetabular coverage in transverse (9 types) and longitudinal (7 types) direction. Combination of transverse ratio of acetabular cavity and coverage with longitudinal type allowed to define the options of acetabular deformities in two-dimensional view. The authors identified 25 types of acetabular deformities. Bone defects of acetabular walls were of the major importance among all anatomical features. Cranial defect of acetabulum was observed in 450 cases, medial wall defect — in 38 cases, defect including cranial and medial areas — in 7 cases. Conclusion. The method suggested by the authors to determine acetabular square and acetabular deformity variations allows to screen the anatomical features of the acetabulum during two-dimensional preoperative planning and to make an informed decision on the need to use other planning techniques. The type of acetabular deformity identified during preoperative planning allows to elaborate the indications for replacement of acetabular bone defects and/or resection of acetabular osteophytes.

How to use C-reactive protein

2018 ◽  
Vol 104 (3) ◽  
pp. 150-153
Author(s):  
Emma M Dyer ◽  
Thomas Waterfield ◽  
Hannah Baynes
Keyword(s):  
Emergency Department ◽  
Clinical Practice ◽  
Antibiotic Therapy ◽  
Inflammatory Markers ◽  
Biochemical Test ◽  
Current Evidence ◽  
C Reactive Protein ◽  
Paediatric Emergency Department ◽  
Reactive Protein ◽  
Paediatric Emergency

A 3-month-old baby is brought to the paediatric emergency department by their parents because of a fever. You decide to check their inflammatory markers. Their C-reactive protein (CRP) level comes back as 20 mg/L. Does this affect whether or not you start antibiotic therapy? Does it influence your decision to admit or discharge the patient? CRP is a commonly used biochemical test and yet its use is constantly debated and challenged. We look at the current evidence and suggest the best way to use this test in clinical practice.

Chagas Disease Chemotherapy: What Do We Know So Far?

2021 ◽  
Vol 27 ◽  
Author(s):  
Aline Araujo Zuma ◽  
Wanderley de Souza
Keyword(s):  
Host Cell ◽  
Chagas Disease ◽  
Chronic Phase ◽  
Cell Types ◽  
Neglected Tropical Disease ◽  
Cell Type ◽  
Cure Rate ◽  
New Compounds

: Chagas disease is a Neglected Tropical Disease (NTD), and although endemic in Latin America, affects around 6-7 million people infected worldwide. The treatment of Chagas disease is based on benznidazole and nifurtimox, which are the only available drugs. However, they are not effective during the chronic phase and cause several side effects. Furthermore, BZ promotes cure in 80% of the patients in the acute phase, but the cure rate drops to 20% in adults in the chronic phase of the disease. In this review, we present several studies published in the last six years, which describes the antiparasitic potential of distinct drugs, from the synthesis of new compounds aiming to target the parasite, as well as the repositioning and the combination of drugs. We highlight several compounds for having shown results that are equivalent or superior to BZ, which means that they should be further studied, either in vitro or in vivo. Furthermore, we stand out the differences in the effects of BZ on the same strain of T. cruzi, which might be related to methodological differences such as parasite and cell ratios, host cell type and the time of adding the drug. In addition, we discuss the wide variety of strains and also the cell types used as a host cell, which makes it difficult to compare the trypanocidal effect of the compounds.

scholarly journals Preoperative Somatostatin Analogues in Patients with Newly-diagnosed Acromegaly: A Systematic Review and Meta-analysis of Comparative Studies

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Chengxian Yang ◽  
Ge Li ◽  
Shenzhong Jiang ◽  
Xinjie Bao ◽  
Renzhi Wang
Keyword(s):  
Systematic Review ◽  
Comparative Studies ◽  
Meta Analysis ◽  
Somatostatin Analogues ◽  
Long Term Results ◽  
Current Evidence ◽  
Cochrane Library ◽  
Cure Rate ◽  
Short Term

Abstract Biochemical remission after transsphenoidal surgery is still unsatisfied in acromegaly patients with macroadenomas, especially with invasive macroadenomas. Concerning the impact of preoperative somatostatin analogues (SSAs) on surgical outcomes, previous studies with limited cases reported conflicting results. To assess current evidence of preoperative medical treatment, we performed a systematic review and meta-analysis of comparative studies. A literature search was conducted in Pubmed, Embase, and the Cochrane Library. Five randomized controlled trials (RCT) and seven non-RCT comparative studies were included. These studies mainly focused on pituitary macroadenomas though a small number of microadenoma cases were included. For safety, preoperative SSAs were not associated with elevated risks of postoperative complications. With respect to efficacy, the short-term cure rate was improved by preoperative SSAs, but the long-term cure rate showed no significant improvement. For invasive macroadenomas, the short-term cure rate was also improved, but the long-term results were not evaluable in clinical practice because adjuvant therapy was generally required. In conclusion, preoperative SSAs are safe in patients with acromegaly, and the favorable impact on surgical results is restricted to the short-term cure rate in macroadenomas and invasive macroadenomas. Further well-designed RCTs to examine long-term results are awaited to update the finding of this meta-analysis.

scholarly journals Medial and Lateral Malleoli Impose Anatomical Constraints on Total Ankle Arthroplasty Design

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0010
Author(s):  
Jeffrey E. Bischoff ◽  
Sandra Snyder ◽  
J. Chris Coetzee ◽  
Stuart Miller ◽  
Terrence Philbin
Keyword(s):  
Total Ankle Arthroplasty ◽  
Lateral Side ◽  
Talar Dome ◽  
Taper Angle ◽  
Ankle Arthroplasty ◽  
Medial Side ◽  
Paired Student ◽  
Significant Difference ◽  
Lateral Lines ◽  
Statistical Shape

Category: Ankle Introduction/Purpose: Contemporary total ankle arthroplasty (TAA) techniques reconstruct the tibiotalar articulation while preserving the medial and lateral malleoli. The malleoli place anatomic constraints on the design of the talar component of the TAA system. If these constraints are not respected, then proper placement of the talar component may be compromised intra- operatively, or unintended contact between the prosthesis and bone may occur post-operatively. The goal of this study was therefore to quantify the medial and lateral malleolar boundaries. Methods: The orientation of the talus from a frontal view was quantified based on CT scans of left leg, non-arthritic specimens (n=89; 52M/37F) (Figure 1a). The talar dome was identified as the portion of the talus superior to the talar neck. The frontal profile of the dome defined by a plane positioned through the medial and lateral high points was extracted for each specimen. Statistical shape analysis was performed to identify the modes of variation of the frontal profile. Medial and lateral lines were fit to each profile, and resulting angles relative to the superior-inferior axis were measured. A paired student t-test (P<.05) was used to assess differences between the medial and lateral malleolus. Results: Figure 1b shows the average frontal profile of the talar dome, as well as ±1 and ±2 standard deviations. The average medial and lateral taper angles of the talus were 15.5° ± 5.9° and 7.6° ± 2.9°, respectively, with the lateral taper angle being significantly smaller than the medial taper angle (P<.001). The medial taper increased with talus size (as measured by the medial- lateral width of the dome) whereas the lateral taper decreased with talus size (Figure 1c), though both regressions were weak (R2 < 0.1). No statistically significant difference in taper angles was found between genders. Conclusion: Restoration of the bicondylar articulation geometry of the tibiotalar joint is an important design goal for TAA. One aspect of this geometry is the anatomic constraints imposed by the medial and lateral malleoli, to minimize unexpected impingement of the TAA prostheses with surrounding anatomic structures. Here, we have quantified those constraints through analysis of the medial and lateral taper of the talus, showing an increased taper angle on the medial side of the talus as compared to the lateral side.

The Relationship of the Position of the Metatarsal Heads and Peak Plantar Pressure

2003 ◽  
Vol 24 (4) ◽  
pp. 349-353 ◽  
Author(s):  
René E. Weijers ◽  
Geert H.I.M. Walenkamp ◽  
Henk van Mameren ◽  
Alphons G.H. Kessels
Keyword(s):  
Plantar Pressure ◽  
Lateral Side ◽  
Ct Scanner ◽  
Plantar Pressures ◽  
Medial Side ◽  
Plantar Pressure Distribution ◽  
Peak Plantar Pressure ◽  
The Right ◽  
Relationship Of ◽  
The Relationship

We test the premise that peak plantar pressure is located directly under the bony prominences in the forefoot region. The right foot of standing volunteers was examined in three different postures by a CT-scanner. The plantar pressure distribution was simultaneously recorded. The position of the metatarsal heads and the sesamoids could be related to the corresponding local peak plantar pressures. The metatarsal heads 1, 4, and 5 had a significantly different position than the local peak plantar pressures. The average difference in distance between the position of the metatarsal heads and the peak plantar pressure showed a significant correlation: on the medial side the head was located more distally to the local peak plantar pressure, on the lateral side more proximally. The findings suggest that normal plantar soft tissue is able to deflect a load. The observations might improve insight into the function of the normal forefoot and might direct further research on the pathological forefoot and on the design of footwear.

MRI Analysis of Anteroposterior Stability in the Normal Human Knee

2009 ◽  
Author(s):  
Sally Arno ◽  
Rachel Forman ◽  
Philip Glassner ◽  
Ravinder Regatte ◽  
Peter S. Walker
Keyword(s):  
Shear Force ◽  
Medial Meniscus ◽  
Sagittal Plane ◽  
The Body ◽  
Lateral Side ◽  
Human Knee ◽  
Medial Side ◽  
Normal Human ◽  
Femoral Rollback ◽  
High Range

During activities the knee experiences compressive forces caused by the weight of the body and muscle forces. However, there is also an anterior shear force pushing the femur forwards on the tibia. It is likely to be important to the feeling of stability that the shear force is resisted so as to limit the anterior femoral displacement. The dished bearing surface of the medial tibial compartment in combination with the medial meniscus may well perform this function. In contrast, the lateral tibial surface is convex in the sagittal plane and the meniscus is too mobile to offer any anteroposterior (AP) restraint. Therefore, we hypothesize that if an anterior or posterior force is applied to the femur relative to the tibia, AP stability is provided by the medial side, while the lateral side allows for femoral rollback to facilitate a high range of flexion. At any flexion angle, rotational laxity will occur about a point on the medial side.

scholarly journals Digital Radiographic Assessment of Knee Joint Space with its Clinical Significances

2020 ◽  
Vol 5 (1) ◽  
pp. 976-980
Author(s):  
Dil Islam `Mansur ◽  
Subindra Karki ◽  
Dilip Kumar Mehta ◽  
Pragya Shrestha ◽  
Sunima Maskey
Keyword(s):  
Knee Joint ◽  
Joint Space Width ◽  
Joint Space ◽  
Left Knee ◽  
Lateral Side ◽  
Cross Sectional ◽  
Mean Values ◽  
Medial Side ◽  
Digital Radiograph ◽  
The Right

Introduction: The knee joint space is seen on anteroposterior radiograph as a radiolucent area between lower end of femur and upper end of tibia which is an indirect way of evaluating the knee cartilage thickness.  Objective: This study was aimed to determine the knee joint space in the medial and lateral compartments of the knee joint using digital radiograph.  Methodology : This was cross-sectional study. It consisted of digital radiographs of knee joint of 320 individuals. The medial and lateral joint space width of each knee joint was measured using the scale in the computerized software.  Results: The mean values for medial and lateral joint space widths were found to be 6.11±1.57 mm and 7.92±1.66 mm of the right knee joint respectively and 5.99±1.47 mm and 8.18±1.69 mm of the left knee joint respectively. In males, mean values for joint space widths were 6.37±1.58 mm on medial side and 8.21±1.67 mm on lateral side of the right knee; and 6.24±1.56 mm on medial side and 8.33±1.64 mm on lateral side of the left knee. In Females, these values were 5.89±1.53 mm on medial side and 7.66±1.62 mm on lateral side of the right knee; and 5.79±1.37 mm on medial side and 8.06±1.72 mm on lateral side of the left knee.  Conclusions: It was concluded that the lateral joint space was greater than the medial joint space in both knees. The joint space widths were found to be reasonably constant with increasing age among studied population.

Impact of Additional Cytogenetic Alterations At Diagnosis on Prognosis of CML: Long-Term Observation From 1151 Patients of the Randomized CML Study IV

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 782-782
Author(s):  
Alice Fabarius ◽  
Armin Leitner ◽  
Andreas Hochhaus ◽  
Martin C Müller ◽  
Claudia Haferlach ◽  
...  
Keyword(s):  
Board Of Directors ◽  
Y Chromosome ◽  
Research Funding ◽  
Blast Crisis ◽  
Chronic Phase ◽  
Current Evidence ◽  
Prognostic Impact ◽  
Advisory Committees ◽  
Major Route ◽  
The Impact

Abstract Abstract 782 Introduction: Current evidence indicates that acquired genetic instability in chronic myeloid leukemia (CML) as a consequence of the t(9;22)(q34;q11) and the resulting BCR-ABL fusion causes the continuous acquisition of additional chromosomal aberrations (ACA) and mutations and thereby progression to accelerated phase and blast crisis (BC). Around 10 –12% of patients in chronic phase (CP) CML have ACA already at diagnosis. During the course of the disease this number rises to 80% in BC. Acquisition of ACA during treatment is considered as a poor prognostic indicator, whereas the impact of ACA at diagnosis is controversial. Patients and methods: Clinical and cytogenetic data of 1151 out of 1311 patients with Philadelphia and BCR-ABL positive CP CML randomized until 2009 to the German CML-Study IV were investigated in a prospective study. There were 459 females (40%) and 692 males (60%). Median age was 53 years (range, 16–88). All patients were treated with imatinib alone or in combination with interferon alpha or araC. The impact of ACA at diagnosis on time to complete cytogenetic and major molecular remission (CCR, MMR) and progression-free and overall survival (PFS, OS) was investigated. Written informed consent was obtained from all patients prior to entering the study. Results: At diagnosis 1003/1151 patients (87%) had the standard t(9;22)(q34;q11) only and 69 patients (6.0%) had a variant t(v;22). In 60 of 69 patients with t(v;22), only one further chromosome was involved in the translocation, in 7 patients two, and in 2 patients three further chromosomes were involved. Seventy-nine patients (6.9%) had ACA. Of these, 38 patients (3.3%) lacked the Y chromosome (-Y) and 41 patients (3.6%) had ACA except -Y. Sixteen of the 41 patients had major-route ACA (+8, i(17)(q10), +der(22)t(9;22)(q34;q11), ider(22)(q10)t(9;22)(q34;q11)) and 25 minor-route ACA [e.g. t(3;12), t(4;6), t(2;16), t(1;21)]. In patients with major-route ACA, trisomy 8 was the most frequent additional alteration (n=9). +der(22)t(9;22)(q34;q11) was observed in six patients, isochromosome (17)(q10) in five patients and ider(22)(q10)t(9;22)(q34;11) in three patients. After a median observation time of 5.3 years for patients with t(9;22), t(v;22), -Y, minor- and major-route ACA median times to CCR were 1.01, 0.95, 0.98, 1.49 and 1.51 years, to MMR 1.40, 1.58, 1.65, 2.49 and > 7 years, 5-year PFS 90%, 81%, 88%, 96% and 50% and 5-year OS 92%, 87%, 91%, 96% and 53%, respectively. In patients with major-route ACA times to CCR and MMR were longer. PFS and OS were shorter (p<0.001) than with standard t(9;22)(q34;q11). Loss of Y chromosome had no influence on time to CCR or MMR, PFS and OS. Conclusion: We conclude that the prognostic impact of additional cytogenetic findings at diagnosis of CML is heterogeneous and consideration of their types may be important. Major-route ACA identify a small group of patients with significantly poorer prognosis as compared to all other patients requiring early and more intensive intervention such as stem cell transplantation. Disclosures: Hochhaus: Novartis: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; BMS: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Pfizer: Honoraria, Membership on an entity's Board of Directors or advisory committees; Ariad: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding. Haferlach:MLL Munich Leukemia Laboratory: Employment, Equity Ownership. Kneba:Hoffmann La Roche: Honoraria.

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