Pagets Spine
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This document discusses a 42-year-old man presenting with back pain who was diagnosed with a fracture of the L2 vertebra after a slip and fall accident. Imaging revealed features consistent with Paget's disease involving the L2-L3 vertebrae. The document then provides background information on Paget's disease, including its epidemiology, typical radiographic and histologic findings, differential diagnosis, evaluation and treatment with bisphosphonates. Risks of long-term bisphosphonate therapy discussed include atypical femur fractures and potential malignant transformation of Paget's lesions.
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Lecture paget’s disease of the spine
This document summarizes a case of Paget's disease of the spine in a 42-year-old man who presented with back pain after a slip and fall. Imaging revealed a compression fracture at L2. Paget's disease is characterized by disorganized bone remodeling leading to enlarged and deformed bones. Treatment involves bisphosphonates which suppress bone turnover. Potential risks of long-term bisphosphonate use include atypical femur fractures and malignant transformation of pagetic bone.
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Osteomyelitis is an inflammatory process of bone caused by microbial infection. It can be acute, subacute, or chronic depending on duration. Common causes include hematogenous spread from other infections as well as direct introduction through open fractures or wounds. In acute osteomyelitis, infection starts in the metaphysis and can spread through bone canals, potentially crossing the growth plate in children. Chronic osteomyelitis results from inadequate treatment of acute infection and is characterized by persistent infection, bone necrosis, and sinus tract formation. Staging systems help classify osteomyelitis based on extent of bone and soft tissue involvement.
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This document discusses osteomyelitis, an infection of the bone marrow. It begins by defining osteomyelitis and discussing its etiology, or causes. Common causes include dental infections, trauma, and hematogenous spread. The pathogenesis, or mechanism by which it develops, is then explained. Bacterial infection leads to inflammation, tissue necrosis, and vascular damage within the bone. Over time, this can progress to form sequestra - dead bone fragments. Symptoms vary depending on whether the infection is acute or chronic, but may include pain, swelling, fever, and bone destruction visible on x-rays. The document continues with further sections on classification, diagnosis, and treatment of osteomyelitis.
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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
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This document summarizes a case of Paget's disease of the spine in a 42-year-old man who presented with back pain after a slip and fall. Imaging revealed a compression fracture at L2. Paget's disease is characterized by disorganized bone remodeling leading to enlarged and deformed bones. Treatment involves bisphosphonates which suppress bone turnover. Potential risks of long-term bisphosphonate use include atypical femur fractures and malignant transformation of pagetic bone.
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Osteomyelitis is a bone infection that can be acute, subacute, or chronic. Acute osteomyelitis typically affects children and is caused by hematogenous spread of bacteria like Staphylococcus aureus to the metaphysis. This causes bone destruction, formation of dead bone (sequestrum), and surrounding inflammatory new bone (involucrum). Chronic osteomyelitis persists for months or years, with intermittent flare ups of symptoms. Treatment involves prolonged antibiotics and often surgical drainage, debridement of infected bone, and bone reconstruction procedures. Complications can include pathological fractures, joint damage, and sinus tract infections.
Osteomyelitis
Osteomyelitis is an inflammatory process of bone caused by microbial infection. It can be acute, subacute, or chronic depending on duration. Common causes include hematogenous spread from other infections as well as direct introduction through open fractures or wounds. In acute osteomyelitis, infection starts in the metaphysis and can spread through bone canals, potentially crossing the growth plate in children. Chronic osteomyelitis results from inadequate treatment of acute infection and is characterized by persistent infection, bone necrosis, and sinus tract formation. Staging systems help classify osteomyelitis based on extent of bone and soft tissue involvement.
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Complication of acute osteomyelitis
This document discusses the complications that can arise from acute osteomyelitis. It divides complications into general complications, like sepsis and pyrexia, and local complications. Local complications are more common in developing countries due to delays in diagnosis and treatment. Common local complications include chronic osteomyelitis, acute pyogenic arthritis in joints near infected bone, pathological fractures through weakened bone, and growth plate disturbances leading to limb deformities.
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This document discusses osteomyelitis, an inflammatory condition of the bone and bone marrow. It defines osteomyelitis and outlines predisposing factors like immunocompromisation, hypovascularity, and microbial virulence. It also describes the pathogenesis, microbiology, classification systems, clinical presentation, investigations, and treatment approaches for osteomyelitis. Treatment involves both conservative measures like antibiotics and rest, as well as surgical interventions like incision and drainage, tooth extractions, sequestrectomy, and in severe cases, jaw resection and reconstruction.
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Osteomyelitis is an infection of bone that can affect the jaws. It originates from Greek words meaning "bone marrow infection". The infection causes ischemia and necrosis of the infected bone. It can be acute or chronic, suppurative or nonsuppurative. Common causes are odontogenic infections, trauma, surgery, and hematogenous spread. Symptoms include swelling, pain, and draining sinus tracts. Treatment involves antibiotics, surgical drainage, debridement of necrotic bone, and hyperbaric oxygen therapy in some cases.
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K. Grätz, MD, DMD
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Rämistrasse 100
8091 Zurich
Switzerland
E-mail: klaus.graetz@usz.ch
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Professor and Former Head
Department of Oral and Maxillofacial Surgery
Lucerne General Hospital
Spitalstrasse
6000 Lucerne 16
Switzerland
E-mail: nicolas.hardt@ksl.ch
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Spitalstrasse
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K. Grätz, MD, DMD
Professor and Head
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Rämistrasse 100
8091 Zurich
Switzerland
E-mail: klaus.graetz@usz.ch
N. Hardt, MD, DMD
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This document provides information on chronic osteomyelitis, including types, pathology, diagnosis, and treatment. It notes that chronic osteomyelitis is usually caused by delayed or inadequate treatment of acute osteomyelitis, which allows spread of infection and bone death. Key features include sequestra (dead bone), involucrum (dense bone overlying sequestra), sinus tracts, and irregular thickened bone visible on x-ray. Treatment involves surgery to remove dead bone and tissue along with antibiotics to eliminate infection. Complications can include exacerbations, growth abnormalities, fractures, or rarely malignant changes in long-standing cases.
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2) A 61-year-old male patient presented with dysphonia and was found to have a pedunculated polypoid lesion on his left vocal cord, which was surgically excised and determined to be a laryngeal myxoma based on histopathological examination.
3) Laryngeal myxoma should be considered in the differential diagnosis of benign laryngeal masses as it can resemble a vocal polyp clinically but requires biopsy for definitive diagnosis.
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3. Chest wall tumors can be either benign or malignant, with malignant tumors like fibrous histiocytoma and chondrosarcoma requiring wide resection for treatment.
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This document discusses rickets, including its causes, signs and symptoms, diagnosis, and treatment. Rickets is caused by a lack of vitamin D, calcium, or phosphate, which can result from inadequate sunlight exposure, poor nutrition, liver or kidney diseases, and some medications. Clinical features include bone deformities, muscle weakness, and growth delays. Diagnosis involves physical exam, lab tests showing low calcium and vitamin D levels and high alkaline phosphatase, and x-rays revealing bone changes. Treatment focuses on high dose vitamin D supplementation in the short term, followed by lower lifelong doses, along with ensuring adequate calcium and phosphate intake.
glimpse on osteoarticular T B
Osteoarticular tuberculosis is a common disease globally and in India, with involvement of bones and joints in around 30% of tuberculosis cases. It occurs most commonly in the spine, hip, knee, and other joints. It spreads hematogenously from a primary pulmonary or other visceral lesion. Spinal involvement often leads to deformities like gibbus formation or neurological complications like paraplegia. Treatment involves anti-tubercular medications like ATT along with rest and surgery if needed to drain abscesses or decompress nerves. Hip involvement can progress through stages of synovitis, arthritis, and advanced destruction requiring treatments like joint debridement, arthrodesis, or excision arthroplasty.
Bones And Muscles
1. The document discusses several skeletal developmental and genetic disorders including osteogenesis imperfecta, as well as metabolic bone diseases such as osteoporosis, renal osteodystrophy, osteomalacia, rickets, and hyperparathyroidism.
2. Inflammatory bone disorders including osteomyelitis, sarcoidosis, Paget's disease of bone, and osteonecrosis are described. Trauma and fracture repair processes are also summarized.
3. Several primary bone tumors are discussed including osteoid osteoma, osteosarcoma, chondroma, osteochondroma, and chondroblastoma.
Bones And Muscles
1. The document discusses several skeletal developmental and genetic disorders including osteogenesis imperfecta, as well as metabolic bone diseases such as osteoporosis, renal osteodystrophy, osteomalacia, rickets, and hyperparathyroidism.
2. Inflammatory bone disorders including osteomyelitis, sarcoidosis, Paget's disease of bone, and osteonecrosis are described. Trauma and fracture repair processes are also summarized.
3. Several primary bone tumors are discussed including osteoid osteoma, osteosarcoma, chondroma, osteochondroma, and chondroblastoma.
POTT’S SPINE-1676656384.pptx
Pott's disease, or spinal tuberculosis, is caused by Mycobacterium tuberculosis infection of the spine. It spreads hematogenously from a primary site, usually the lungs. Common presentations include localized or radicular back pain, stiffness, and the development of cold abscesses. Radiographically, Pott's disease most often appears as paradiscal involvement, showing narrowing of the disc space between two adjacent vertebrae. Other patterns include central lesions within a single vertebral body or anterior lesions along the vertebral edge. Advanced cases result in vertebral collapse and kyphotic deformity.
Neuropathic (Charcots) joints
Jean-Martin Charcot first described neuropathic arthropathy in 1868. It is a progressive joint condition characterized by dislocations, fractures, and deformities that results from sensory or autonomic neuropathy from various conditions like diabetes, MS, alcoholism, etc. The pathophysiology involves both repetitive microtrauma from loss of sensation and an inflammatory process induced by neurovascular changes. It commonly affects the foot, knee, and hip. Diagnosis is made clinically and radiographically, showing features like joint destruction and deformity. Treatment involves casting, bracing, and surgery like fusion for advanced cases.
Heel pain
This document provides an overview of various causes of heel pain and structures in the heel area that can generate heel pain. It discusses conditions like plantar fasciitis, heel spurs, plantar enthesopathy, plantar bursitis, and heel fat pad syndrome. Diagnosis is usually based on clinical history and physical exam findings, and imaging like x-rays, ultrasound, and MRI can help diagnose and rule out other conditions. Treatment depends on the underlying cause but may include rest, ice, anti-inflammatories, orthotics, corticosteroid injections, and rarely surgery.
2478236.ppt
Here are the key points regarding anti-TB treatment in special situations:
- For liver disease, pyrazinamide should be avoided if possible due to hepatotoxicity. Fewer hepatotoxic drugs or alternative regimens may be needed depending on severity of liver disease.
- For renal impairment, doses of ethambutol and pyrazinamide need adjustment. Streptomycin should be avoided. A 2HRZE/4HR regimen is recommended.
- For pregnancy, the standard regimen is generally safe except streptomycin due to ototoxicity risk to fetus. Pyridoxine supplementation is recommended for isoniazid. Treatment is important for successful pregnancy outcome.
1 perthese diagnosis & classification
Prof Anisuddin Bhatti Paediatric orthopaedic surgeon Dr. Ziauddin University Hospital Clifton, Karachi delivered Lectures to trainees and Junior consultants on PERTHES' part-1, [Pathogenesis, Diagnosis, Classification and case discussion] on 20th February 2021, through Dr. Ziauddin Hospital Clifton Webinar series. Part-2 on Perthes' management to be delivered on 6th March 2021. he declares few pictures & material taken from Google.com and mostly his own patients
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Pagets Spine
- 1. Paget’s Disease of the Spine Spine conference Tuesday May 25th, 2021
- 2. 42 yo man cc: back pain HPI: slip and fall 1/8/16 seen at pat 1st then referred to ER due to L2 fx, CT obtained in ER Dx: fx PMH: very healthy PSH: none FH: bro passed away ca SH: manager married 2 children nonsmoker Meds: none Exam 6’0” 187 lb nonfocal axial pain
- 9. HEMAGIOMA Organized (pillars) Trabeculae orientation Maximized along stress Areasprominent trabecular pattern sclerotic vertebra with vertical trabeculae: Corduroy sign lytic calvarial lesions with spoke- wheel appearance irregular and lytic in long bones, with a honeycomb appearance Jail house vertebra
- 10. Sir James Paget 1814-1899 St Bartholomew Hospital London British Surgeon and Pathologist Breast Cancer description, inflammation of nipple osteitis deformans. As a medical student in his first winter session, he discovered the pathogen for trichinosis, a parasitic disease caused by Trichinella spiralis, a minute roundworm that infests the musclesof the human body, and which is usually acquired by eating infected pork. Paget was friends with Charles Darwin and Thomas Henry Huxley
- 11. Prof. Stuart Ralston - Solving the Mysteries of Paget's Disease The University of Edinburgh 2011 https://youtu.be/9mogcgQqbxg
- 12. Uncoupling of the normal equilibrium of bone formation and resorption
- 15. plywood
- 18. Cutting cones
- 24. Axial cut CT
- 27. L2 L2L3 L3 L3L4
- 34. epidemiology 7-10x more 1970’s England highest rates Rates now decreased by 50% in general; rare <50 yo; mean 59 +/- 14; Polyostotic>monostotic; pelvis,lumbar,femur, tspine, skull, tibia rare in hands/feet
- 35. 1. Mixed lucent and dense areas 2. ENLARGES the bone itself 3. loss of junction of cortical and cancellous areas 4. deformity
- 37. Blade of grass Osteoclastic phase Long bone v-shaped lesion
- 38. Mixed stage lysis and sclerosis
- 42. PAGETS DISEASE OF BONE
- 46. Discs can degeriorate due to loss of endplate nutrient diffusion Extraosseous extension
- 47. Early pagets with posterior spinous process
- 52. Intranuclear inclusion bodies in an electron micrograph 9,000 magnification
- 53. Paramyxovirus (mumps) causes intranuclear inclusion bodies
- 56. 1995-2008
- 57. BISPHOPHONATES • Nitrogen-containing bisphosphonates (N-BPs) 1. Alendronate Fosamax (Merck, Whitehouse Station, New Jersey) 2. Ibandronate Boniva (Roche, San Francisco, California) 3. Pamidronate Aredia(Novartis, East Hanover, New Jersey) 4. Risedronate Actonel (Warner Chilcott, Rockaway, New Jersey) 5. Zoledronate Reclast (Novartis, East Hanover, New Jersey) • Non-nitrogen-containing bisphosphonates (n-BPs) 1. Etidronate Didronel (Proctor and Gamble, Cincinnati, Ohio) 2. Tiludronate Skelid (Sanofi Aventis, Bridgewater, New Jersey
- 61. Femur fracture in women • Shane E (May 2010). "Evolving data about subtrochanteric fractures and bisphosphonates". N. Engl. J. Med. 362 (19): 1825–7 (12 in 14,195 women) compared to the common hip fractures (272 in 14,195 women) Odvina CV, Zerwekh JE, Rao DS, et al. Severely suppressed bone turnover: a potential complication of alendronate therapy. J Clin Endocrinol Metab 2005;90:1294–1301
- 62. Malignant transformation of paget’s in this case osteosarcoma
- 63. thanks