phenylephrine-hydrochloride and Joint-Diseases

A wide variety of bacterial species, many usually regarded as of low pathogenicity, were isolated from septic joints after operation for total hip or knee joint replacement in a multi-centre trial of ultraclean air in operating rooms. The prophylactic antibiotics generally used appeared to reduce considerably the rates of infection with most species but to be ineffective against 'gut' organisms. For about half the septic infections involving Staphylococcus aureus nasal swabs had been obtained from the patient and operating staff at the time of operation for insertion of the prosthesis. Strains of Staph, aureus isolated from these and from the infected joints were phage typed and tested for antibiotic sensitivity. A probable source among the carriers was found for seven out of the 14 infections and a possible source for another five. Very small numbers of Staph. aureus were needed to initiate infection.

Topics: Air Microbiology; Bacteria; Carrier State; Hip Joint; Hip Prosthesis; Humans; Joint Diseases; Joint Prosthesis; Knee Joint; Knee Prosthesis; Nose; Perineum; Staphylococcal Infections; Staphylococcus aureus; Surgical Wound Infection

The effectiveness of high-titre rubella immunoglobulin was tested on rubella-susceptible female juveniles or young adults after intranasal immunization with rubella strain RA 27/3, 20 ml of rubella immunoglobulin having been administered intramuscularly to 56 subjects at different times (1, 3 and 5 days) after the immunization. The effect was demonstrated by seroconversion and virus isolation from the throat. In the control subjects (26) the secroconversion was 96% and in 42% of subjects virus was demonstrated in the throat. Early administration of rubella immunoglobulin (up to three days after immunization) depressed the seroconversion rate to 55% and virus isolation rate to 17.5%. Later administration (five days after immunization) increased the conversion rate to 81%, the isolation rate to 31%. There were no serious side effects of the immunization and the injection of the immunoglobulin. The results indicate that on early administration of an adequate amount of high-titre rubella immunoglobulin a protective effect can be expected, although this favourable effect-obtained in the conditions of this study-cannot be unreservedly transposed to the situation in wild virus infections.

Topics: Adolescent; Antibodies, Viral; Antibody Formation; Antigens, Viral; Child; Female; Fever; Headache; Humans; Immunity, Maternally-Acquired; Immunoglobulins; Joint Diseases; Nose; Rubella; Rubella Vaccine; Rubella virus; Time Factors

We report our experience with the endoscopic endonasal approaches (EEA) for different craniocervical junction (CCJ) disorders to analyse outcomes and demonstrate the importance and feasibility of anterior C1 arch preservation or its reconstruction. Between January 2009 and December 2013, 10 patients underwent an endoscopic endonasal approach for different CCJ pathologies at our Institution. In 8 patients we were able to preserve the anterior C1 arch, while in 2 post-traumatic cases we reconstructed it. The CCJ disorders included 4 cases of irreducible anterior bulbo-medullary compression secondary to rheumatoid arthritis or CCJ anomalies, 4 cases of inveterate fractures of C1 and/or C2 and 2 tumours. Pre- and postoperative neuroradiological evaluation was always obtained by magnetic resonance imaging (MRI), computed tomographic (CT) scanning and dynamic cranio-vertebral junction x-ray. Pre- and postoperative neurologic disability assessment was obtained by Ranawat classification for patients with rheumatoid arthritis and by Nurick classification for the others. At a mean follow-up of 31 months (range: 14-73 months), an improvement of at least one Ranawat or Nurick classification level was observed in 6 patients, while in another 4 patients neurological conditions were stable. Radiological follow-up revealed an adequate bulbo-medullary decompression in all patients and a regular bone fusion in cases of C1 and/or C2 fractures. In all patients spinal stability was preserved and none required subsequent posterior fixation. The endoscopic endonasal surgery provided adequate exposure and a low morbidity minimally invasive approach to the antero-medial located lesions of the CCJ, resulting in a safe, effective and well-tolerated procedure. This approach allowed preservation of the anterior C1 arch and the avoidance of a posterior fixation in all patients of this series, thus preserving the rotational movement at C0-C2 segment and reducing the risk of a subaxial instability development.. Riportiamo la nostra esperienza con l’approccio endoscopico endonasale (EEA) in una serie consecutiva di 10 pazienti affetti da lesioni anteriori della giunzione cranio-cervicale. L’obiettivo dello studio è analizzare l’outcome di questi pazienti focalizzando l’attenzione sulla possibilità di preservare o ricostruire l’arco anteriore di C1, quale importante elemento di stabilità della giunzione cranio-cervicale. Dal gennaio 2009 al dicembre 2013, 10 pazienti con patologia della giunzione craniocervicale sono stati operati mediante approccio endoscopico endonasale. Le lesioni trattate includevano 4 casi di non riducibile compressione bulbo-midollare extradurale anteriore della giunzione (secondarie ad artrite reumatoide o anomalie della giunzione), 4 casi di fratture inveterate di C1 o del dente dell’epistrofeo e 2 casi lesioni tumorali. La valutazione clinica pre- e postoperatoria è stata effettuata mediante la scala di Ranawat per i casi di artrite reumatoide e di Nurick per gli altri. Il follow-up radiologico comprendeva invece RM, TC e RX con prove morfo-dinamiche per eventuale preesistente severa instabilità. Dopo l’approccio EEA puro alla giunzione craniocervicale, nessun paziente ha presentato un peggioramento neurologico, né si sono verificate significative complicanze. Al follow-up medio di 31 mesi (range 14-73 mesi), un miglioramento di almeno un livello della classificazione Ranawat o Nurick si è osservato in 6 pazienti mentre gli altri 4 sono rimasti stabili. Il follow-up neuroradiologico ha documentato in tutti i casi un’adeguata decompressione bulbo-midollare, mentre nei casi di frattura di C1 o C2 una regolare fusione ossea delle rime di frattura. Nessun paziente ha presentato segni di instabilità e non è stata pertanto necessaria alcuna procedura di stabilizzazione e fusione posteriore. L’approccio endoscopico endonasale garantisce un’adeguata esposizione delle lesioni antero-mediali della giunzione craniocervicale. Nella nostra serie di pazienti tale procedura ha permesso di preservare o ricostruire l’arco anteriore di C1, evitando quindi una sintesi posteriore e la relativa perdita di movimento rotazionale C0-C2 e l’instabilità subassiale.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Cervical Vertebrae; Female; Humans; Joint Diseases; Male; Middle Aged; Natural Orifice Endoscopic Surgery; Nose; Occipital Bone; Organ Sparing Treatments; Young Adult

The goal of this study was to compare the indications, benefits, and complications between the endoscopic endonasal approach (EEA) and the microscopic transoral approach to perform an odontoidectomy. Transoral approaches have been standard for odontoidectomy procedures; however, the potential benefits of the EEA might be demonstrated to be a more innocuous technique. The authors present their experience with 12 consecutive cases that required odontoidectomy and posterior instrumentation.. Twelve consecutive cases of craniovertebral junction instability with or without basilar invagination were diagnosed at the National Institute of Neurology and Neurosurgery in Mexico City, Mexico, between January 2009 and January 2013. The EEA was used for 5 cases in which the odontoid process was above the nasopalatine line, and was compared with 7 cases in which the odontoid process was beneath the nasopalatine line; these were treated using the transoral microscopic approach (TMA). Odontoidectomy was performed after occipital-cervical or cervical posterior augmentation with lateral mass and translaminar screws. One case was previously fused (Oc-C4 fusion). The senior author performed all surgeries. American Spinal Injury Association scores were documented before surgical treatment and after at least 6 months of follow-up.. Neurological improvement after odontoidectomy was similar for both groups. From the transoral group, 2 patients had postoperative dysphonia, 1 patient presented with dysphagia, and 1 patient had intraoperative CSF leakage. The endoscopic procedure required longer surgical time, less time to extubation and oral feeding, a shorter hospital stay, and no complications in this series.. Endoscopic endonasal odontoidectomy is a feasible, safe, and well-tolerated procedure. In this small series there was no difference in the outcome between the EEA and the TMA; however, fewer complications were documented with the endonasal technique.

Topics: Adolescent; Adult; Atlanto-Axial Joint; Endoscopy; Female; Humans; Joint Diseases; Magnetic Resonance Imaging; Male; Middle Aged; Nose; Odontoid Process; Retrospective Studies; Treatment Outcome; Video Recording; Young Adult

Mycoplasma bovis is an important bacterial pathogen in cattle, producing a variety of clinical diseases. The organism, which requires specialized culture conditions and extended incubation times to isolate and identify, is frequently associated with concurrent infection with other pathogens which can potentially be more easily identified. Real-time polymerase chain reaction (real-time PCR) is a valuable diagnostic technique that can rapidly identify infectious agents in clinical specimens. A real-time PCR assay was designed based on the uvrC gene to identify M. bovis in diagnostic samples. Using culture as the gold standard test, the assay performed well in a variety of diagnostic matrices. Initial validation testing was conducted on 122 milk samples (sensitivity: 88.9% [95% confidence interval (CI): 68.4-100%], specificity: 100%); 154 lung tissues (sensitivity: 89.0% [95% CI: 83.1-94.9%], specificity: 97.8% [95% CI: 93.5-100%]); 70 joint tissue/fluid specimens (sensitivity: 92.3% [95% CI: 82.1-100%], specificity: 95.5% [95% CI: 89.3-100%]); and 26 nasal swabs (sensitivity: 75.0% [95% CI: 45.0-100%], specificity: 83.3% [95% CI: 66.1-100%]). Low numbers of other sample matrices showed good agreement between results of culture and PCR. A review of clinical cases from 2009 revealed that, in general, PCR was used much more frequently than culture and provided useful diagnostic information in conjunction with clinical signs, signalment, and gross and histopathologic lesions. Diagnostic performance of the real-time PCR assay developed as a testing method indicates that it is a rapid, accurate assay that is adaptable to a variety of PCR platforms and can provide reliable results on an array of clinical samples.

Topics: Animals; Cattle; Cattle Diseases; Joint Diseases; Lung; Milk; Mycoplasma bovis; Mycoplasma Infections; Nose; Polymerase Chain Reaction; Reproducibility of Results; Sensitivity and Specificity

Topics: Gout; Humans; Joint Diseases; Male; Middle Aged; Nose; Polynesia; Skin Ulcer; Toe Joint

This study compared specific phenotypic and potential virulence characteristics of Staphylococcus aureus isolates from invasive infections and nasal carriers. Three hundred and sixty isolates were studied; 154 from septicaemia (69 line associated, 85 non-line), 79 from continuous ambulatory peritoneal dialysis (CAPD) peritonitis, 64 from bone/joint infections and 64 from healthy nasal carriers. The isolates were tested for production of enterotoxins (SE) A, B, C or E, toxic shock syndrome toxin-1 (TSST-1) protein A, and also for lipolytic, proteolytic, fibrinolytic and haemolytic activities. In addition phage typing, crystal violet reaction, urease and galactose breakdown were studied. Seventy-one percent of isolates were enterotoxigenic. Production of SEA was significantly lower amongst the bone/joint isolates. Production of SEB, was lower among the control group compared with CAPD, bone/joint, and non-line septicaemia isolates. SEE production was higher among the bone/joint isolates compared with the CAPD and non-line septicaemias and production of TSST-1 was significantly higher among nasal isolates compared with isolates causing infection. Almost all of the isolates were lipolytic, with highest activity amongst nasal and bone/joint isolates. Fibrinolytic activity was similar in the five groups of isolates. Proteolytic activity ranged from 35 to 62% of isolates with the lowest frequency among septicaemia isolates. In all, 80-90% of isolates were haemolytic, although CAPD isolates were less likely to be haemolytic. Isolates from the control and CAPD group more frequently belonged to phage group I. TSST-1 does not appear to be an important requirement for invasive infections, but SEB may be. Proteolysis and intensity of lipolysis appear to be less important in septicaemia, and haemolysis may not be important in CAPD peritonitis.

Topics: Bacterial Toxins; Bone Diseases; Cytotoxins; Endopeptidases; Enterotoxins; Fibrinolysis; Hemolysin Proteins; Humans; Infections; Joint Diseases; Lipolysis; Nose; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis; Phenotype; Sepsis; Staphylococcal Protein A; Staphylococcus aureus; Superantigens; Virulence

This is the first description of long-term follow-up of a case of Freeman-Sheldon syndrome. Microstomia was treated with a mouth expander for 2 to 3 hours per day before active orthodontic treatment. Separate impressions were necessary in each quadrant of both upper and lower jaws because of limited mouth opening.. Orthodontic treatment improved the patient's Class II malocclusion, which was accompanied by crowding and a deep bite.

Topics: Adolescent; Child; Contracture; Exercise Therapy; Eyelids; Facial Muscles; Follow-Up Studies; Humans; Joint Diseases; Lip; Longitudinal Studies; Male; Malocclusion, Angle Class II; Microstomia; Nose; Orthodontics, Corrective; Syndrome

In vitro collagen binding of 216 Staphylococcus aureus isolates from patients with various diagnoses was studied. Polymerase chain reaction was used to examine these isolates regarding the existence of the corresponding cna gene. Distribution of capsular polysaccharide (CP) types was examined. Fifty-six (57%) of 99 S. aureus isolates from patients with endocarditis or bacteremic bone or joint infection were cna-positive compared with 65 (56%) of 117 isolates from bacteremic patients without signs of bone or joint infection (P = .99). There was a good correlation between in vitro collagen binding and presence of the cna gene. These data suggest that collagen binding is not a prerequisite for the development of endocarditis, osteomyelitis, or septic arthritis. There was no significant difference in the distribution of CP types among various patient groups, although there was a strong association between CP type 8 and the existence of the cna gene.

Topics: Antibodies, Bacterial; Antigens, Bacterial; Bacteremia; Bone Diseases, Infectious; Carrier Proteins; Carrier State; Collagen; Endocarditis, Bacterial; Gene Expression; Genes, Bacterial; Humans; Joint Diseases; Nose; Polymerase Chain Reaction; Polysaccharides, Bacterial; Staphylococcal Infections; Staphylococcus aureus; Wound Infection

Topics: Carrier State; DNA, Bacterial; Electrophoresis, Gel, Pulsed-Field; Female; Humans; Joint Diseases; Knee Joint; Knee Prosthesis; Middle Aged; Nose; Respiratory Therapy; Rhinitis, Allergic, Perennial; Staphylococcal Infections; Staphylococcus aureus; Steroids

Hereditary gingival fibromatosis is frequently an isolated condition of little consequence apart from a cosmetic problem and occasional associations with hypertrichosis and/or epilepsy. There are, however, several uncommon or rare eponymous syndromes described in which gingival fibromatosis can be a feature: these include the Zimmermann-Laband, Murray-Puretic-Drescher, Rutherfurd, Cowden and Cross syndromes. This paper describes two siblings with features of the rare Zimmermann-Laband syndrome and discusses the major aspects of this and other eponymous syndromes that may be associated with hereditary gingival fibromatosis.

Topics: Adolescent; Child; Ear, External; Female; Fibromatosis, Gingival; Fingers; Humans; Joint Diseases; Male; Nails, Malformed; Nose; Syndrome; Toes

Topics: Disarticulation; Humans; Joint Diseases; Nose; Rhinoplasty