Olecranon Bone Tumor Complicated by Ulnar Nerve Paresis Revealing Tuberculous Osteitis—About a Case

Introduction: The localization of bone tuberculosis at the level of the olecranon is rare and can pose a problem of differential diagnosis with a tumoral affection. Only the biopsy allows the diagnosis of certainty. The goal was to report our first case to do a review of the literature. Clinical Observation: This was a 64-year-old patient who consulted 2 years after the onset of symptoms for swelling and mechanical pain in the left elbow. On clinical examination there was a firm consistent mass measuring 6/4 cm in diameter, not very painful and hot on the posterior surface of the left elbow, accompanied by paresthesias in the territory of the ulnar nerve associated with partial functional impotence of the left forearm with little altered general condition. The X-rays of the left elbow showed extensive bone lysis of the olecranon with fracture of the base of the olecranon. The CT Scan of the elbow performed showed osteolysis of the olecranon with extensive bone reactions at the distal end of the humerus. The biopsy carried out with histological examination concluded with an aspect of tuberculous osteitis and the culture came back sterile. A curettage was performed associated with anti-tuberculosis treatment for 12 months as well as the placement of a posterior splint. The evolution at 9 months was unsatisfactory with persistence of paresis and stiffness of the elbow. Conclusion: Tuberculous osteitis of the olecranon can simulate a malignant tumor with non-specific signs of bone tuberculosis. Only the anatomopathological examination is definitive for the diagnosis. The treatment is multidisciplinary. Orthopedic evolution is difficult to predict.

Rapid remission of refractory synovitis, acne, pustulosis, hyperostosis, and osteitis syndrome in response to the Janus kinase inhibitor tofacitinib: A case report

BACKGROUND Synovitis,acne,pustulosis,hyperostosis,and osteitis(SAPHO)syndrome is a rare autoinflammatory disease for which clinical treatment has not been standardized.Janus kinase(JAK)inhibitors represent a novel therapeutic option for rheumatoid arthritis,psoriatic arthritis,and some other autoinflammatory diseases.However,the clinical utility of JAK inhibitors in treating SAPHO syndrome has not been thoroughly investigated.In this study,we describe a patient with SAPHO syndrome who failed to respond to conventional treatment but demonstrated a remarkable and rapid response to the JAK inhibitor tofacitinib.CASE SUMMARY A 62-year-old female patient presented with swelling and pain at the sternoclavicular joints,back pain that limited her activities,arthralgia in the right knee,and cutaneous lesions.Her symptoms were unresponsive to nonsteroidal anti-inflammatory drugs,disease-modifying antirheumatic drugs,Tripterygium wilfordii hook f,and bisphosphonates.SAPHO syndrome was diagnosed in accordance with dermatological and osteoarticular manifestations and abnormal inflammatory factors.Multiple image studies have illustrated bone lesions and pathological fractures of vertebral bodies.Oral treatment with tofacitinib at 5 mg twice daily with methotrexate and bisphosphonates was initiated.The patient reported that her pain symptoms were relieved after 3 d and her cutaneous lesions were reduced after 4 wk of treatment.Vertebral lesions were improved after 6 mo on tofacitinib.No serious adverse effects were noted.CONCLUSION JAK inhibitor therapy may be a promising strategy to treat SAPHO syndrome.

Condensing osteitis of the clavicle in children

AIM: To confirm the rarity of this disorder and then to evaluate the effects of antibiotic treatment alone and assess whether this could produce a complete remission of symptoms in children and adolescents.METHODS: We made a retrospective review of all cases of condensing osteitis of the clavicle in children and adolescents between January 2007 and January 2016. Outpatient and inpatient medical records, with radiographs, magnetic resonance imaging, triphasic bone scan and computed tomography scans were retrospectively reviewed. All the patients underwent biopsy of the affected clavicle and were treated with intra venous(IV) antibiotics followed by oral antibiotics.RESULTS: Seven cases of condensing osteitis of the clavicle were identified. All the patients presented with swelling of the medial end of the clavicle, and 5 out of 7 reported persisting pain. The patients' mean age at presentation was 11.5 years(range 10.5-13). Biopsy confirmed the diagnosis in all cases. All the patients completed the treatment with IV and oral antibiotics. At last follow-up visit none of the patients complained of residual pain; all had a clinically evident reduction in the swelling of the medial end of the affected clavicle. The mean follow-up was 4 years(range 2-7).CONCLUSION: Our findings show that condensing osteitis of the clavicle is a rare condition. Biopsy is needed to confirm diagnosis. The condition should be managed with IV and oral antibiotics. Aggressive surgery should be avoided.

Osteitis pubis in elite athletes:Diagnostic and therapeutic approach

Osteitis pubis(OP) is a debilitating overuse syndrome characterizing by pelvic pain and local tenderness over the pubic symphysis commonly encountered in athletes often involved in kicking, twisting and cutting activities in sports such as soccer and rugby and to a lesser degree distance running. It is a common source of groin pain in elite athletes attributable to pubis sympysis instability as the result of microtrauma caused by repetitive muscle strains on pubic bones. Diagnosis is based mainly on detailed sports history and a meticulous clinical examination, although occasionally is difficult to distinguish this nosological entity from other pathologies affecting the involved area which may occur concomitantly in the same patient. Radiologic examinations such as plain radiographs, magnetic resonance imaging and 3 phase bone isotope scanning may be helpful to differentiate from other clinical entities with similar clinical presentation. Most cases respond well to conservative treatment which includes several physical modalities and especially a progressive rehabilitation programmed individualized to each one of patients diagnosed with OP. Local injection therapies have been also been proposed as a non-operative therapeutic option for the efficient management of these patients. In refractory cases, surgical therapeutic strategies are warranted. These include several open or minimally invasive surgical interventions such as arthroscopic or open symphysis curettage, wedge or total resection of pubic sympysis, polypropylene mesh placement and pubic fusion. In this review a critical analysis of OP in elite athletes is performed with special focus on current concepts of diagnosis and management of this source of athletic groin pain.

Maxillary Osteitis in the Yalgado Ouedraogo Teaching Hospital: Epidemiological, Clinical and Therapeutic Aspects

Purpose: Report the epidemiological, clinical and therapeutic aspects of maxillary osteitis. Material and Methods: This was a descriptive, cross-sectional retrospective study carried out in the Department of Stomatology and Maxillofacial Surgery of the Yalgado OUEDRAOGO Teaching Hospital, covering a period of 7 years. Results: We registered 68 cases of maxillary osteitis with an annual hospital frequency of 9.71 cases. The mean age was 27.5 years +/-4.02 with extremes of 4 years and 72 years. Farmers/herders were the most concerned in 67.65% of the cases. Reasons for consultation were dominated by swelling of the cheek in 79.41% of cases. The average time to consultation was 7 months. Tooth decays and dental avulsions were mostly implicated in etiologies in 79.41% of the cases. Treatment provided was medical and surgical. All patients received antibiotic therapy. Surgical treatment involved 51.47% of patients. The evolution was favorable in 89.70% of the patients. Sequelae were found in 58.82% of the patients. Conclusion: Maxillary osteitis is common in our regions. Treatment is medical and surgical. It is marked by many difficulties, especially the delay in consultation.

Osteitis Condensans Ilii:Case Report

Back pain is one of the most frequent complaints during the last period of pregnancy. In a small group of patients the persistent pain during the postpartum period may be secondary to osteitis condensans ilii (OCI), and rarely can occur suddenly in the elderly. OKI is a rare benign pathology, low back or buttock pain should be suspected in patients coming from. Although the exact etiology is unknown, the most accepted hypothesis, get on the sacroiliac joint, depending on the mechanical stress, changes may develop in the iliac bone. In practice, It is important to recognise this disease as it can be potentially confused with similar causes of axial low back pain such as seronegative spondyloarthropathy, metastatic disease, or sacroilitis. Here two woman patients with low back pain and buttock pain secondary to unilateral an uncommon benign condition called osteitis condensans ilii is presented. This report emphasis the salient features and the differential diagnosis in diagnosing and managing this rare pathology.

Brown tumor of the femur and ulna in a woman with hyperparathyroidism

Objective A typical brown tumor caused by hyperparathyroidism(HPT) is rare. In this report, we describe our pathological findings along with a review of the literature to enhance understanding of the disease and prevent misdiagnosis, as well as to provide evidence for treatment and prognosis.Methods We present a case of brown tumor of the left proximal femur and pelvis in a 57-year-old woman who was admitted to our hospital(Dalian Municipal Central Hospital, Dalian, China). Pelvic computed tomography(CT) showed cystic expansile lesions in the left proximal femur and pelvis. Lung and abdominal CT also revealed multiple lytic lesions in the ribs and lumbar spine. X-ray of the left ulna and radius showed that the middle of the left ulna had a fracture caused by a brown tumor. A bone biopsy from the left proximal femur showed focal distribution of giant cells, with hemorrhage and fibrin hyperplasia. Results The patient underwent internal fixation of the left intertrochanteric fracture, and postoperative bone biopsy showed focal distribution of giant cells with hemorrhage and fibrin hyperplasia. The patient had a parathyroidectomy 5 months after discharge. Two weeks later, the patient developed a fracture in the right femoral neck and pain in the left forearm. X-ray of the left ulna and radius showed that the middle of the left ulna was affected by a pathological fracture caused by a brown tumor. The patient was debilitated and declined surgical treatment. The patient and her family chose discharge.Conclusion Brown tumor of bone, also called osteitis fibrosa cystica, is a rare non-neoplastic lesion that reflects abnormal bone metabolism in patients with HPT. However, with fine needle aspiration cytology in combination with biochemical tests, a correct diagnosis can be reached. The increase in osteoclast activity leads to decalcification and dissolution of bone, and formation of a cystic bone defect with hyperplastic fibrous tissue. This eventually becomes a brown tumor, with deformed and bleeding fibrous tissue. The patient had a typical brown tumor, as well as osteoporosis, anemia, and pathological fractures.

Iodoform: A boon in disguise

Iodoform is also known as triiodomethane a yellow crystalline solid belongs to the family of organic halogen compounds used as an antiseptic component of certain medications. It was first prepared in 1822 by electrolysis of aqueous solutions of acetone, inorganic iodides and sodium carbonates. It s antiseptic action discovered in 1880, which made it an important medicinal. It has no irritant action;it has antiseptic, disinfectant properties. In this article we are sharing our experiences of iodoform dressing in different conditions like for the cyst healing and management of dry socket, followed by a review of its various applications in literature. The open packing has been used successfully as a secondary healing method to help bone tissue healing, results were similar to secondary healing of alveolar socket after tooth extraction. Bony healing was confirmed radio graphically. The release of elemental iodine when applied to the tissue which has a mild disinfectant action with the organic tissue, iodine is slight irritant to the tissue which may promote granulation tissue formation.

Maxilla Voluminous Bone Sequesters: About 4 Clinical Cases Treated at CCTOS in CHU Cocody

Introduction: Jaw osteitis is an inflammatory disease of bone tissue causing aseptic necrosis of bone. This study aims to clarify the etiologies of osteitis of the jawbones and to describe the clinical and radiographic aspects of extensive forms. Cases Presentation: Our study concerns the clinical and radiographic examination of 4 cases of voluminous bone sequesters. The causes of osteitis are mainly infectious and due to late consultations of our populations. The development of these maxillary osteitis leads to the formation of large bone sequesters. Conclusion: The evolution towards voluminous sequesters is a combination of dental infection, poor oral hygiene, late consultation and traditional treatment.

Vertebral Brown Tumor in Childhood (Case Report)

One form of renal osteodystrophy secondary to chronic renal failure is the osteitis fibrosa cystica, which is the complication of secondary hyperparathyroidism. Osteitis fibrosa cystica is a histologically benign, tumor-like lesion of bones. Since early diagnosis and treatment of hyperparathyroidism is available nowadays, the development of osteitis fibrosa cystica has become rare. It can only be found in neglected cases and in those where the treatment of chronic renal failure is unsuccessful. We present the case of a boy, who developed osteitis fibrosa cystica as a complication of secondary hyperparathyroidism. Our article is the first to report a case about an osteitis fibrosa cystica found in a child’s vertebra and this tumor was the only one, which reached a size of approximately 10 × 15 × 15 cm. We present the CT films and X-ray pictures, the surgical solution and the results of the histological examination.

再论功能性内镜鼻窦手术概念及技术

功能性内镜鼻窦手术（functional endoscopic sinus surgery,FESS）是通过内镜鼻窦手术方式,切除患窦病变和解除阻塞,使患窦失去或减弱的生理功能得以改善或恢复。其核心是在切除病变组织和解除阻塞的同时，最大可能的减少对鼻窦架构和黏膜的破坏，