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Tytuł pozycji:

Hyperbaric oxygen therapy for primary sternal osteomyelitis: a case report.

Tytuł:
Hyperbaric oxygen therapy for primary sternal osteomyelitis: a case report.
Autorzy:
de Nadai TR; Department of Surgery and Anatomy, Ribeirão Preto Faculty of Medicine, University of São Paulo, Brazil Avenida Bandeirantes, 3900, Ribeirão Preto, SP, 14048-900, Brazil. .
Daniel RF
de Nadai MN
da Rocha JJ
Féres O
Źródło:
Journal of medical case reports [J Med Case Rep] 2013 Jun 27; Vol. 7, pp. 167. Date of Electronic Publication: 2013 Jun 27.
Typ publikacji:
Journal Article
Język:
English
Imprint Name(s):
Original Publication: [London] : BioMed Central, [2007-
References:
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Entry Date(s):
Date Created: 20130629 Date Completed: 20130705 Latest Revision: 20211021
Update Code:
20240104
PubMed Central ID:
PMC3700748
DOI:
10.1186/1752-1947-7-167
PMID:
23806012
Czasopismo naukowe
Introduction: Primary osteomyelitis of the sternum is a rare condition, which accounts for 0.3% of all cases of osteomyelitis reported in the literature. The diagnosis requires a high degree of suspicion and confirmation by percutaneous biopsy. The treatment consists of resection of the periosteum and affected bone. Despite reports of successful conservative treatment using antibiotics alone, early surgical intervention plus bacterial control is the definitive treatment; it reduces morbidity, and is the most cost-effective approach for the patient. We report a case of primary osteomyelitis surgically treated with debridement and antibiotics, followed by hyperbaric oxygen therapy.
Case Presentation: A 39-year-old Brazilian man without a significant medical history presented with primary osteomyelitis. After a normal chest radiograph and normal laboratory test results, he was treated with 2 weeks of nonsteroidal anti-inflammatory drugs. One month later a presumptive diagnosis of Tietze syndrome was made and he was prescribed prednisolone (60mg/day) for 3 weeks. The following month he presented to our service with swelling, redness, and warmth in the area between his left third and fourth ribs. Subsequent magnetic resonance imaging revealed a large collection of liquid (8.8×6.8×20.2cm) in his chest wall, between the body and the manubrium of the sternum. An area of soft, friable tissue with a large amount of pus was found in his sternum during surgical debridement. Subsequent treatment consisted of antibiotic therapy using metronidazole and cefotaxime plus hyperbaric oxygen therapy. On postoperative day 10 the incision was sutured. The patient was discharged on postoperative day 15 on a regimen of oral ciprofloxacin, and completed hyperbaric oxygen therapy as an out-patient.
Conclusions: The satisfying outcome of this patient reflects the quick action to promote surgical debridement and use of antibiotics, which are both recommended treatments. The closure of the wound in 10 days after debridement suggests that the hyperbaric oxygen therapy might have indirectly, but not conclusively, aided in the premature closure of the wound, avoiding a longer healing by second intention or muscle flap rotation closure.

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