Giovannini Cesar Figueiredo

Aspectos clínicos e terapêuticos da osteomielite vertebral por fungos: análise secundária de dados

OBJECTIVES: to assess the bibliometric, clinical and therapeutic features of fungal vertebral osteomyelitis case reports, retrieved from electronic databases. METHODS: systematic review with secondary data analysis done on proven cases from Medline, Embase and Lilacs databases and active search of referenced published reports, since 1966 until 2004. RESULTS: there was a growing trend from 1966 to 2004 (R2 = 0.5518) in the 318 retrieved cases of fungal vertebral osteomyelitis: 218/318 (68.5%) of them from 1990 on. Reports with diagnosis from North America prevailed (148/318 [46.5%]). The most common causative agent was Candida spp (131/318 [41.2%]), followed by Aspergillus spp (102/318 [32.1%]). Time elapsed between symptom appearance and diagnosis ranged from one week to 9.6 years, mean 24.4±41.6 weeks. The lumbar-sacral spine was the most affected segment (188/318 [59.1%]), and the cervical spine was involved in only 24/318 descriptions (7.5%). The combination L2+L3 was the most frequent infectious event (35/318 [11%]); L2 and L3 were the most affected vertebrae (84/318 [26.4%]). Surgical treatment was carried out in 194/307 (63.2%) cases. Arthrodesis was the surgical procedure performed in 91/307 (29.6%) with clear notification. There was a growing trend of azole compound utilization, in substitution to amphotericin B, between 1966-1989 (10/37) and 1990-2004 (40/63). CONCLUSION: fungal vertebral osteomyelitis has been more frequently reported since the 1990s. Great attention to the possibility of this diagnosis is necessary so that the fungal vertebral infection is not missed due to the lack of a routine mycological search in a general microbiology laboratory.

Dystrophic calcinosis in a child with a thumb sucking habit: case report

We present an uncommon case of a 3-year-old boy with a finger sucking habit who developed dystrophic calcification in his left thumb. Two years after excision, there was no recurrence, and the thumb retained full range of motion. We also discuss its probable pathogenesis and present a brief review of the literature about orthopedic complications in the hand due to this habit.

An uncommon presentation: 66 year-old woman with a tumor-like medial meniscal cyst - a case report

Meniscal cysts are well-defined and documented lesions that were first reported by Nicaise in 1883 (according to Kurian, 2003)1 and are located adjacent to the peripheral margin of the meniscus. They are almost always associated with a meniscal tear.2 Even though Barrie3 reported meniscal cysts in up to 7% of patients undergoing meniscectomy, others have stated that the true prevalence is probably about 1% of patients who undergo meniscectomy4. In addition, while some authors have advocated that lateral meniscal cysts are three to ten times more common than medial cysts5, others have stated that medial cysts are more frequent6;7. Meniscal cysts are most often seen in young adults and occur more frequently in men than women.8

Reconstruction of extensor mechanism in a painful knee with multipartite patella

T he bipartite patella is estimated to have a prevalence ranging from 0.2--6% in an adult population. Symptoms usually arise in adolescence but also may occur in pre-adolescents and elderly people. The cause of the entity is considered to be either a developmental variation of the ossification centers or a nonunion of disseminated ossification centers from surrounding muscle stress on the patella. The literature reports variants of bipartite, tripartite and a unique case of quadripartite patella. The bipartite patella does become painful during activities requiring repeated use of the extensor mechanism, implying that microtrauma may be a factor in its development. Surgical treatment is indicated for fragments when there is limited mobility and intractable pain despite conservative treatment and after knee injuries. We report an uncommon presentation of a 47-year-old man with bilateral multipartite (five parts) patella that required resection of the fragments and extensor mechanism reconstruction of the right knee to achieve pain relief.