prednisolone-hemisuccinate and Postoperative-Complications

A 67-years-old man suffered from relapsing moderate fever and back pain after arthroscopy of the knee under peridural anaesthesia. Antibiotics given for suspected iatrogenic infection was started, but was without improvement. After 4 months under several antibiotic regimes his condition rapidly deteriorated with high fever, excruciating lumbar back pain associated with elevated ESR/WBC (ESR = erythrocyte sedimentation rate, WBC = white blood cell count) along with arthritis of the shoulders, wrists, knees and ankles. Physical findings comprised swelling and restricted movement of the affected joints as well as pain related stiffness and immobility of the spine, but no neurological abnormalities.. An magnetic resonance imaging (MRI) of the lumbar spine revealed the uncommon finding of multilevel facet joint arthritis at lumbar L2/3 and L4/5, accompanied by cystic erosions of the lamina and widespread dorsal soft tissue edema. Serum uric acid was 11 mg/dl. Uric acid was found in the synovial fluid of the knees.. The fever, spinal symptoms as well as imaging findings improved together with the peripheral arthritis when treatment with colchicine and steroids was started, establishing the diagnosis of spinal gout. In the following year, no further or back pain or fever occurred. Despite continued allopurinol therapy the gouty arthritis of the peripheral joints re-occurred.. Despite its rarity, spinal gout should be considered in the differential diagnosis of intractable back pain and fever especially when imaging studies reveal posterior element involvement.

Topics: Aged; Allopurinol; Arthritis, Gouty; Arthroscopy; Back Pain; Colchicine; Diagnosis, Differential; Drug Therapy, Combination; Fever of Unknown Origin; Follow-Up Studies; Glucocorticoids; Gout Suppressants; Humans; Knee; Lumbar Vertebrae; Magnetic Resonance Imaging; Male; Postoperative Complications; Prednisolone; Spondylarthritis; Tomography, X-Ray Computed; Ultrasonography; Uric Acid

The labyrinthine fistula continues to be one of the most common complications in ears with cholesteatoma. Fifty-one patients with labyrinthine fistula were identified in a series of 1243 cases with cholesteatoma operated upon between 1989 and 1993 at the University ENT Clinic Wuerzburg. The surgical management concept comprised of removing the cholesteatoma matrix, categorizing the fistula type, and immediate covering of the labyrinthine capsule defect with bone dust, perichondrium and fibrin glue. The classification system of the fistulae used in the study used the depth of labyrinthine involvement as a criterion and also took into account the possibility of intentional or accidental damage to the labyrinth during surgical manipulation (Fig. 1). From 1991 on, patients were treated with 500 mg of Presnisolon 21 hydrogen succinate in a single intravenous dose, at the time the fistula was corrected. The postoperative hearing results were graded based on the extend of preservation of inner ear function at or near the preoperative level. None of the patients who had corticosteroid therapy suffered a profound sensory neural hearing loss (Fig. 2, 3), whereas five ears without steroids and a deep fistula lost function completely. The study concluded that corticosteroids have a beneficial impact on postoperative outcome in cases with severe injury to the membranous labyrinth.

Topics: Adult; Aged; Anti-Inflammatory Agents; Auditory Threshold; Bone Conduction; Cholesteatoma, Middle Ear; Female; Fistula; Hearing Loss, Sensorineural; Humans; Infusions, Intravenous; Labyrinth Diseases; Male; Middle Aged; Postoperative Complications; Prednisolone; Premedication; Reoperation; Treatment Outcome

Topics: Adult; Appendectomy; Drug Eruptions; Humans; Injections, Intravenous; Male; Patch Tests; Postoperative Complications; Prednisolone; Skin

Topics: Betamethasone; Dexamethasone; Female; Glucocorticoids; Hemorrhage; Humans; Inflammation; Male; Pacemaker, Artificial; Postoperative Complications; Prednisolone