Coccidioidomycosis results from inhaling the spores (arthroconidia) of Coccidioides species (Coccidioides immitis or Coccidioides posadasii), and is endemic in the southern United States. An even smaller proportion of all infections result in illnesses related to extrapulmonary infection. We report a case of coccidioidomycosis manifested as pelvic bone and paravertebral abscess in a Korean who has visited LA. Culture and pathology from the pelvic bone and paravertebral mass revealed Coccidioides immitis, and a diagnosis of disseminated coccidioidomycosis was made.
Abscess* ; Coccidioides ; Coccidioidomycosis* ; Diagnosis ; Inhalation ; Pathology ; Pelvic Bones* ; Spores ; United States

Coccidioidomycosis results from inhaling the spores (arthroconidia) of Coccidioides species (Coccidioides immitis or Coccidioides posadasii), and is endemic in the southern United States. An even smaller proportion of all infections result in illnesses related to extrapulmonary infection. We report a case of coccidioidomycosis manifested as pelvic bone and paravertebral abscess in a Korean who has visited LA. Culture and pathology from the pelvic bone and paravertebral mass revealed Coccidioides immitis, and a diagnosis of disseminated coccidioidomycosis was made.
Abscess* ; Coccidioides ; Coccidioidomycosis* ; Diagnosis ; Inhalation ; Pathology ; Pelvic Bones* ; Spores ; United States

OBJECTIVESTo review the patients with malignant pelvic tumors involving sacrum treated surgically and to discuss the methods of resection of tumors and reconstruction of defects.

METHODSNineteen patients with malignant pelvic tumors involving the sacrum were treated surgically in People's Hospital between July 1999 and July 2007. The series comprised 12 males and 7 females. Five patients were diagnosed with chondrosarcoma, 4 with Ewing sarcoma, 4 with osteosarcoma, 1 with malignant fibrohistiocytoma (MFH), 1 with giant cell tumor (GCT), and 4 with metastatic bone tumors. Acetabulum was preserved after resection of the iliac and sacral tumor and reconstructed with screw and rod system in 10 patients. Among this 10 patients, 5 of them were also done bone graft. Acetabulum was not preserved after resection of the iliac and sacral tumor and the defect was reconstructed with modular hemipelvic prosthesis in 9 patients.

RESULTSOncology result: 7 patients (7/19, 36.9%) had local relapse, including of 2 osteosarcoma, 2 chondrosarcoma, 2 Ewing sarcoma and 1 metastatic tumor. Two of 4 osteosarcoma, 2 of 4 Ewing sarcoma, 1 of 5 chondrosarcoma and 1 MFH patients died of lung metastasis. Two patients with metastatic lung cancer died of the disease 1 year after surgery. One patient with kidney carcinoma and 1 with thyroid carcinoma alive without of disease. Functional result: 8 patients with acetabular reconstruction after resection of pelvic and sacral tumors could walk with a cane 2 months after surgery. Average ISOLS function score was 20, including good in 3, fair in 5 and poor in 1 patient. One of the patient with modular hemipelvic prosthetic reconstruction occurred dislocation treated with 1 month after surgery and experienced open reduction. Hemipelvic prosthesis was took out in 1 patient because of the deep infection.

CONCLUSIONSFor patients with acetabulum preserved after resection of the iliac and sacral tumor, reconstructed with screw and rod system combining with bone graft is an ideal method for restoration. Bone graft with resected femoral head and neck on residual sacrum and modular hemipelvic prosthetic reconstruction after resection of the pelvic tumor involving of the secrum is a good choose.

Adolescent ; Adult ; Aged ; Child ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Orthopedic Procedures ; Pelvic Bones ; surgery ; Pelvic Neoplasms ; pathology ; surgery ; Retrospective Studies ; Sacrum ; pathology ; surgery ; Young Adult

Adolescent ; Child ; Female ; Hip Dislocation, Congenital ; diagnostic imaging ; pathology ; surgery ; Humans ; Male ; Osteotomy ; methods ; Pelvic Bones ; surgery ; Radiography

Hydatid cysts commonly affect the liver and the lung. However, they rarely involve bones with vertebral column. We hereby report a case of a female patient with cystic echinococcosis of the hip bone and ilium. She presented with a long history of frequent recurrences highlighting the dismal prognosis at this rare site. Resection of the hydatid cyst from the sacroiliac region was done with allograft and autograft (rib graft) with lumbosacroiliac fixation. Follow-up of the patient at 6 months showed no detectable abnormality on radiology and the patient was doing well.
Adult ; Bone Diseases/*diagnosis/parasitology/*pathology/surgery ; Bone Transplantation ; Echinococcosis/*diagnosis/*parasitology/surgery ; Female ; Humans ; Pelvic Bones/*parasitology/*pathology/surgery ; Recurrence

A healthy, 14-year-old boy presented with right hip pain and consequent fever after falling out of bed while sleeping. The patient could not walk and complained of severe pain with active and passive motion, which consisted mainly in extension and internal rotation of the right hip. Laboratory analysis of the peripheral blood identified leukocytosis and increased levels of acute phase reactants. Magnetic resonance imaging of the hip, which was performed with the expectation of right hip pathology, revealed cellulitis and abscess in the right psoas muscle and associated inflammatory changes in the adjacent presacral fat plane but showed no abnormal lesions in the adjacent pelvic bone and spine. Staphylococcus hominis was cultured from the blood. With empirical antibiotic therapy, the patient recovered fully. We report a case of primary psoas abscess confused with hip pathology in an immunocompetent child without underlying disease.
Abscess ; Acute-Phase Proteins ; Adolescent ; Cellulitis ; Child ; Fever ; Hip* ; Humans ; Leukocytosis ; Magnetic Resonance Imaging ; Male ; Pathology* ; Pelvic Bones ; Psoas Abscess* ; Psoas Muscles ; Spine ; Staphylococcus hominis

A healthy, 14-year-old boy presented with right hip pain and consequent fever after falling out of bed while sleeping. The patient could not walk and complained of severe pain with active and passive motion, which consisted mainly in extension and internal rotation of the right hip. Laboratory analysis of the peripheral blood identified leukocytosis and increased levels of acute phase reactants. Magnetic resonance imaging of the hip, which was performed with the expectation of right hip pathology, revealed cellulitis and abscess in the right psoas muscle and associated inflammatory changes in the adjacent presacral fat plane but showed no abnormal lesions in the adjacent pelvic bone and spine. Staphylococcus hominis was cultured from the blood. With empirical antibiotic therapy, the patient recovered fully. We report a case of primary psoas abscess confused with hip pathology in an immunocompetent child without underlying disease.
Abscess ; Acute-Phase Proteins ; Adolescent ; Cellulitis ; Child ; Fever ; Hip* ; Humans ; Leukocytosis ; Magnetic Resonance Imaging ; Male ; Pathology* ; Pelvic Bones ; Psoas Abscess* ; Psoas Muscles ; Spine ; Staphylococcus hominis

OBJECTIVETo compare technique and clinical effect of arthroscopic and conventional sectional therapy for the treatment of ischial tuberosity cyst.

METHODSFrom May 2014 and September 2016, 49 patients with symptomatic ischial tuberosity cyst were randomized divided into arthroscopic group and conventional section group by envelope method. There were 24 patients in arthroscopic group, including 16 males and 8 females aged from 42 to 81years old with an average age of (64.1±9.3) years old;the courses of disease ranged from 2 to 36 months with an average of (17.0±9.1) months;treated with removing cyst wall under arthroscopic and build artificial lacuna around cyst. There were 25 patients in conventional section group, including 11 males and 14 females aged from 47 to 79 years old with an average of (61.2±10.6) years old; the courses of disease ranged from 4 to 36 months with an average of (17.5±8.5) months;treated with cutting off lump with transverse incision. Operative time, blood loss, fluid volume, hospital stays and postoperative complication were observed and compared, VAS score were applied to evaluate pain degree.

RESULTSForty-nine patients were followed up from 6 to 18 months with an average of (11.3±3.3) months. In conventional group, 2 patients occurred incision infection, 1 case reoccurred. All patients in arthroscopic group were healed at stage I. Operative time, blood loss, fluid volume, and hospital stays in arthroscopic group were (54.7±7.7) min, (20.8±3.5) ml, (20.3±5.6) ml, (2.8±0.6) d respectively and better than that of conventional group(71.8±8.8) min, (67.3±12.0) ml, (103.6±20.3) ml, (7.8±2.9) d. Postoperative VAS score in arthroscopic group on the first day, seventh days and first month were 2.6±0.7, 0.5±0.6, 0.3±0.5, and significantly lower than that of conventional group 6.0±0.7, 3.0±1.0, 1.1±1.0 respectively(<0.05). There were no statistical difference in postoperative complications between two groups(>0.05).

CONCLUSIONSCompared with conventional group, arthroscopic for ischial tuberosity cyst has advantages of minimal invasive, less blood loss during perioperative period, less pain degree after surgery, safety and rapid recovery. But arthroscopic skills are needed for surgeons. It should be recommended in clinical practice.

Adult ; Aged ; Aged, 80 and over ; Arthroscopy ; Bone Cysts ; surgery ; Case-Control Studies ; Female ; Humans ; Male ; Middle Aged ; Operative Time ; Pelvic Bones ; pathology ; Postoperative Period ; Prospective Studies ; Treatment Outcome

OBJECTIVETo retrospectively review the different types of surgical procedures for pelvic metastases, especially for periacetabular metastases.

METHODSEighty-eight patients with pelvic metastasis received surgical treatment between July 1997 and July 2005. The series included 40 females and 48 males, with an average age of 54 years. The original sites of carcinoma included 23 from breast, 15 from lung, 13 form kidney, 3 from thyroid, 2 from bladder, 3 from prostate, 3 form liver, 7 from gastro intestine, and 3 from gynecological viscera Thirteen cases were diagnosed as unknown primary metastases. Thirty-two patients had solitary metastasis and 56 patients had multiple bone metastases. Eighteen patients had Type I pelvic resections, 50 had type II, and 10 patients had Type III and Type IV each. Surgical treatments included 72 intralesional curettages and 16 en bloc resections. In 29 patients, the bone defect after tumor resection was reconstructed with methyl acrylate alone or combined with Steinmann pins and screw-rod system. Acetabular reconstructions underwent in 50 patients. Local resections with no reconstructions were done in 5 patients, and hemipelvectomy in 4 patients.

RESULTSThe mean time of follow-up was 13 months, ranging from 6 to 24 months. Twenty-nine patients were lost follow-up. Postoperative improvements in 86 (97.8%) patients were seen in pain and mobility scores. The average VAS pain scores were 7.2 points preoperatively and 3.5 points postoperatively. Postoperative function was evaluated according to Enneking's criteria, with a mean score of 19.2 points, including 16.4 points for periacetabular lesions and 23.5 for others. Local recurrence was seen in 11 patients, the average recurrence time was 5.6 months after surgery. Surgical complications occurred in 12 patients, including 8 wound complications, 2 multi-organ function failures, 1 pulmonary embolism, and 2 dislocations.

CONCLUSIONSThe indications of surgical intervention for pelvic metastasis are severe pain and difficulty in ambulation. The surgical objective is alleviation of pain, restore the mobility and stability of the hip. The surgical procedure for most metastases is curettage and cement filling. Wide resection is an alternative method for solitary pelvic metastasis with good prognosis.

Acetabulum ; Adult ; Aged ; Aged, 80 and over ; Bone Neoplasms ; pathology ; secondary ; surgery ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Neoplasm Metastasis ; Pelvic Bones ; Retrospective Studies ; Treatment Outcome

OBJECTIVETo evaluate the surgical treatment effect of primary malignant pelvic bone tumors.

METHODSRetrospective study was carried out in 79 patients with primary malignant pelvic bone tumors treated surgically and followed up regularly between October 1992 and July 2007. In this cohort, 23 tumors were low-grade malignant of I B, and 56 tumors were high-grade malignant of II B. According to the preoperative diagnosis and the effect of chemotherapy, different methods of tumor resection and reconstruction were applied respectively. Surgical specimens were evaluated postoperatively for the surgical margins in accordance with Enneking's criteria. Functional results were assessed by MSTS system during follow-up. The mean time of follow-up was 28.6 months (range, 0-183 months). The minimum follow-up time in survival patients was 4 months.

RESULTSSeventy limb-salvage surgeries including 28 reconstructions, and 9 hemipelvectomy were carried out. In limb-salvage group, the mean MSTS functional scores both were 15 points for patients with (range, 5-29 points) or without (range, 2-30 points) reconstructions. The overall local recurrence rate was 31.6% (25/79). Statistical difference (P = 0.023) of local recurrence rate was seen between low-grade (13.0%) and high-grade (39.3%) groups. While, there was no difference (P = 0.620) between limb-salvage group (30.0%) and hemipelvectomy group (44.4%). Significant difference (P = 0.014) in local recurrence rate was found between inadequate surgical margin (intralesional and marginal margin) group (38.1%) and adequate surgical margin (wide margin) group (6.3%). In 14 patients developed postoperative distant metastasis, 12 in local recurrence group which incidence was 48.0%, compared to 2 in no-recurrence group which incidence was 3.7%, and the difference was significant (P = 0.000). The overall survival rate was 70.9%.

CONCLUSIONSWide surgical margin is essential for successful resection of primary malignant pelvic bone tumors. How to choose and improve functional reconstruction is the focus of work in the future.

Adolescent ; Adult ; Aged ; Bone Neoplasms ; diagnosis ; pathology ; surgery ; Child ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; Pelvic Bones ; Retrospective Studies ; Treatment Outcome