Osteomyelitis Of Bone Research Articles

Evaluating the effectiveness of advanced platelet-rich fibrin, photobiomodulation, pentoxifylline, and Alveogyl in the treatment of alveolar osteitis: a randomized controlled clinical trial

BackgroundAlveolar osteitis is a type of small-scale osteomyelitis of the alveolar bone that occurs after tooth extraction, the etiology of which remains unknown, and alternative methods are being investigated for its treatment. The aim of this study was to compare the effectiveness of advanced platelet-rich fibrin (A-PRF), photobiomodulation (PBM), and Alveogyl (butamben, idoform, eugenol), which have shown success in the treatment of alveolar osteitis, with that of pentoxifylline (PTX) to determine whether PTX could be an alternative treatment for alveolar osteitis.MethodsThis study included 80 healthy volunteers diagnosed with alveolar osteitis in the extraction sockets of their mandibular first, second, and third molars. The patients were divided into four groups, with 20 patients in each group: A-PRF, PBM, PTX, and Alveogyl. After physiological saline irrigation, the patients were treated according to their respective group. The patients were followed up on the 2nd, 4th, 7th, and 14th days. Primary outcomes included pain assessment and the evaluation of soft tissue healing. Pain was assessed via the visual analog scale (VAS), soft tissue healing was evaluated via the Landry Healing Index (LHI), and granulation tissue was measured. Age and sex were used as study variables. The data were analyzed via ANOVA and post hoc tests to compare the treatment groups.ResultsThere was no statistically significant difference in the mean VAS score between the groups (p > 0.05). However, the degree of reduction in the VAS score increased in the following order: A-PRF, PBM, PTX, and Alveogyl. In the LHI data, there was a statistically significant difference in the mean scores between the groups, with Alveogyl being favored preoperatively and PBM being favored at the 2nd week (p < 0.05). Statistically significant differences were observed in granulation tissue measurements on the preoperative day, as well as on Days 4 and 7, in favor of Alveogyl on Day 4 and PBM on Day 7 (p < 0.05). The greatest increase in granulation tissue scores was observed in the A-PRF group, whereas the greatest change in LHI scores was observed in the PBM group. PTX did not produce a statistically significant difference in soft tissue healing, although there were periods when it showed results similar to those of Alveogyl and PBM. There were significant differences between the VAS score, granulation tissue score and LHI score in terms of age and sex within the time periods followed.ConclusionThe findings of this study indicate that although PTX has similar efficacy in terms of wound healing and analgesic properties to the methods used, it does not offer significant advantages. Compared with other methods, A-PRF and PBM have provided better results in the treatment of alveolar osteitis, particularly regarding pain and soft tissue healing.Trial registrationThe study was retrospectively registered in the clinical trial registry with the number TCTR20231014003 on 14.10.2023.

Efficacy of Bone Regeneration Cell Therapy Using Mesenchymal Stem Cells Originating from Embryonic Stem Cells in Animal Models; Bone Defects and Osteomyelitis.

Bone defects are commonly encountered due to accidents, diseases, or aging, and the demand for effective bone regeneration, particularly for dental implants, is increasing in our aging society. Mesenchymal stem cells (MSCs) are promising candidates for regenerative therapies; however, obtaining sufficient quantities of these cells for clinical applications remains challenging. DW-MSCs, derived from embryonic stem cells and developed by Daewoong Pharmaceutical, exhibit a robust proliferative capacity even after extensive culture. This study explores the therapeutic potential of DW-MSCs in various animal models of bone defects. DW-MSCs were expanded for over 13 passages for in vivo use in rat and canine models of bone defects and osteomyelitis. The research focused on the in vivo osteogenic differentiation of DW-MSCs, the establishment of a fibrin-based system for bone regeneration, the assessment of bone repair following treatment in animal models, and comparisons with commercially available bone grafts. Results showed that DW-MSCs exhibited superior osteogenic differentiation compared to other materials, and the fibrinization process not only preserved but enhanced their proliferation and differentiation capabilities through a 3D culture effect. In both bone defect models, DW-MSCs facilitated significant bone regeneration, reduced inflammatory responses in osteomyelitis, and achieved effective bone healing. The therapeutic outcomes of DW-MSCs were comparable to those of commercial bone grafts but demonstrated qualitatively superior bone tissue restructuring. Our findings suggest that DW-MSCs offer a promising approach for bone regeneration therapies due to their high efficacy and anti-inflammatory properties.

Takeout or delivery? Reoperation rates in lower extremity long bone osteomyelitis treated with debridement and local antibiotic delivery systems

BackgroundEarly diagnosis and treatment of osteomyelitis is essential to prevent potential complications including sepsis, extensive bone resection, amputation, and death. Despite current treatment strategies for management of osteomyelitis, recurrence rates reported in the literature are upwards of 25 %. Current evidence comparing the efficacy of differing surgical treatments of osteomyelitis is inconclusive. The purpose of this study is to compare rates of re-debridement and amputation in patients who receive either debridement alone or debridement with placement of local antibiotic delivery systems as initial treatment for lower extremity long bone osteomyelitis. MethodsA retrospective cohort study was performed to investigate complication rates after surgical treatment methods for osteomyelitis of the femur and tibia. The rates of re-debridement and amputation were compared in patients who received either debridement alone or debridement with placement of local antibiotic delivery systems. ResultsThis study reports 73 % lower rates of re-debridement after debridement and local antibiotic delivery in tibial osteomyelitis, and 83 % lower rates of re-debridement after debridement and placement of local antibiotic delivery systems in femoral osteomyelitis compared to debridement alone. There was no significant difference in amputation rates between treatment groups for either tibial (7.4 vs 5.7 %; OR: 1.31; 95 % CI, 0.92–1.87) or femoral osteomyelitis (2.4 vs 1.4 %; OR: 1.65; 95 % CI, 0.71–4.01). ConclusionThere was a significantly decreased likelihood of re-debridement for patients who underwent initial treatment with combined debridement and placement of antibiotic delivery systems compared to debridement alone. Providers may consider this when comparing treatment options for their patients with lower extremity osteomyelitis.

Nontuberculous Mycobacterial Infective Endocarditis: A Systematic Review of Clinical Characteristics and Outcomes.

Infective endocarditis (IE) due to nontuberculous mycobacteria (NTM) is a rare infection, and several outbreaks have been reported in the last 2 decades. However, the clinical spectrum is still poorly understood. This systematic review aimed to evaluate the clinical characteristics and outcomes in NTM IE. We searched the major electronic databases (PubMed, Scopus, and Google Scholar) with appropriate keywords to December 2023. We included studies based on predefined diagnostic criteria, and relevant data were collected on clinical presentation and treatment outcomes. The study was registered with PROSPERO (CRD42023492577). A total of 97 studies were reviewed, encompassing 167 patients with NTM IE. The earliest cases were reported in 1975, involving M chelonae and M fortuitum. M chimaera was the most prevalent species (38.9%), though rapidly growing NTM (RGM) were more common than slow-growing NTM (SGM; 59.3% vs 40.7%). Disseminated NTM infection occurred in 84% of cases, with bone marrow infiltration and osteomyelitis as frequent manifestations. Prosthetic valves were the main risk factor, present in 63.5% of cases. In native valve IE, nearly all cases (n = 27, 96%) were attributed to RGM. The overall mortality rate was 44.9%, with conservative management without surgery associated with poorer outcomes (66.7% vs 30.6%). Mortality was comparable between SGM and RGM IE, although relapses were more common in SGM IE (17.6% vs 1.9%). This review highlights the changing epidemiology of NTM IE with the emergence of RGM IE. Disseminated infections in the setting of prosthetic valves warrant NTM evaluation. The high mortality rate necessitates the role of early surgery.

The Occurrence and Outcomes of Cemento-Osseous Dysplasias (COD) in the Jaw Bones of the Population of Lower Silesia, Poland.

Background: Cemento-osseous dysplasias (CODs) are rare lesions of the jawbone. Their occurrence, localization, type, size, and shape can vary between cases. This fibro-osseous lesion is typically found in the jaw near tooth-bearing areas and is often asymptomatic, discovered incidentally, and may be associated with the periapical region of the teeth. In rare cases, COD can lead to secondary bone osteomyelitis. Currently, there is limited information in the literature on the occurrence and characteristics of COD. This paper's main aim was to focus on the authors' COD experience in the lower Silesian area. Methods: A retrospective evaluation of radiographies (RTG-Panx, cone-beam computed tomography (CBCT)) was conducted on patients treated, diagnosed, or consulted by the authors. A statistical correlation analysis was made to establish any relationship within the gathered data. Results: COD is predominantly an incidental finding in the mandibular bone near tooth apices. It is most commonly diagnosed in females. Both CBCT and panoramic radiographies are generally sufficient for diagnosing the lesion. COD rarely requires treatment. Conclusions: COD lesions are mostly discovered incidentally during routine radiographies or cone-beam computed tomography (CBCT) scans. In most cases, clinical and radiological monitoring is sufficient, along with evaluating the teeth's response to cold stimuli and assessing the surrounding bone structures. Biopsies or tooth extractions are seldom necessary. When oral hygiene is well-maintained and no periapical inflammation is present, COD lesions typically remain asymptomatic.

Sinusitis y edema frontal. ¿Qué sospechar?

Pott’s puffy tumour is a rare complication of sinusitis, a very common disease. It is a fluctuating swelling of the forehead resulting from a subperiosteal abscess secondary to osteomyelitis of the frontal bone. The progressive spread of the infection may cause serious complications and lead to a surgical emergency, which has an impact on patient outcomes and morbidity. Its incidence has progressively decreased with the introduction of vaccines and antibiotics, although its actual magnitude is unknown due to underdiagnosis. However, nearly 50 cases have been detected in the last 40 years, so clinicians should be aware of this disease and continue to consider it.

Pott's Puffy Tumor in Young Age: A Systematic Review and Our Experience.

Background: Pott's Puffy Tumor (PPT) in young-age patients is a rare clinical entity characterized by osteomyelitis of the frontal bone with a subperiosteal abscess collection. Previous reviews primarily consist of small, retrospective case series and anecdotal reports. This study aims to present the largest, most up-to-date systematic review of essential clinical findings, diagnostic modalities, microbiologic considerations, and treatment approaches for managing PPT in pediatric and adolescent populations. Methods: PubMed, Scopus, and Web of Science databases were systematically screened until 3 January 2024. The protocol of this investigation was registered on PROSPERO in January 2024, and the systematic review was performed according to the PRISMA statement. The study included 184 patients from 109 articles and an additional case from the authors' institution. Results: PPT commonly stems from untreated rhinosinusitis, respectively, acute pansinusitis, frontal acute rhinosinusitis and chronic rhinosinusitis, and direct head trauma. Infections typically involve a polymicrobial anaerobe-predominant microbiome. Computed tomography and magnetic resonance imaging are routinely used for presurgical assessment and posttreatment surveillance. Intracranial complications were significantly associated with the type of surgical treatment (p value < 0.0001). Conclusions: PPT is a significant and relatively morbid disease often under-recognized and misdiagnosed due to its variable clinical presentation. Management includes both antimicrobial therapy and surgical intervention, emphasizing the importance of an interdisciplinary approach.

Management of chronic septic nonunion of the femur associated with an extended drug resistant nosocomial germ: a case report

Introduction and Importance: Septic nonunion of long bones poses significant treatment challenges, often necessitating extended hospital stays and multiple surgical interventions. This report details a chronic septic nonunion of the femur, complicated by drug-resistant pathogens, managed through an integrated surgical approach. Case Presentation: A 32-year-old male with a history of infected nonunion and multiple failed surgeries presented with a vast bone defect and osteomyelitis. Treatment involved single-session debridement, bone resection, intramedullary fixation, and trifocal segment bone transport using the Limb Reconstruction System (LRS) and Masquelet technique. After eight months, the patient achieved radiologic and clinical bone healing, regained full ambulation, and resumed work without re-infection over an 18-months follow-up. Clinical Discussion: The management of septic nonunion, particularly with drug-resistant infections, requires a multifaceted approach. This case exemplifies the efficacy of combining radical bone resection, targeted debridement, and advanced reconstructive techniques. The use of antibiotic-impregnated cement beads and bone transport procedures played pivotal roles in the successful outcome. While such procedures can be complex and necessitate vigilant monitoring, they are crucial for improving treatment success and functional recovery. Conclusion: Septic nonunion caused by extended drug-resistant germs of the lower extremity long bones can be managed in a single-session bone resection and debridement, local antibiotic administration, and later bone defect reconstruction.

Management of Comminuted Frontal Depressed Fracture Using Split Calvarial Graft: A Novel Technique

AbstractFrontal depressed fracture generally results from high-speed motor vehicle accidents. The frontal fractures can be closed or open depending upon the involvement of the overlying skin. Frontal fracture can be comminuted if the bone is broken in at least two or more places. Because of the proximity of the frontal bone to critical structures like the frontal sinus, frontal dura with underlying brain parenchyma, and orbit with its content, an injury resulting in a frontal depressed fracture can result in a multitude of clinical symptoms. If not addressed promptly with an experienced team, these fractures can result in cerebrospinal fluid leak, osteomyelitis of the frontal bone, meningitis, and ocular and olfactory dysfunction with poor cosmetic outcomes. Thus, repairing the frontal depressed fracture should be considered a priority. The standard practice is to elevate the depressed fracture and repair any dural defect. In case of a comminuted fracture, elevation is not possible, and we generally remove the fracture pieces and repair the defect using titanium mesh. In this case report, we propose a novel technique of repair of the defect using a split calvarial graft, which is fashioned after separating the outer table from the inner table of the posterior frontal bone. This technique reduces the theoretical risk of infection and is cost-effective as our procedure does not require any external implant in cranioplasty.

Calcium Sulfate Disks for Sustained-Release of Amoxicillin and Moxifloxacin for the Treatment of Osteomyelitis.

The purpose of this in vitro study was to develop calcium sulfate (CS)-based disks infused with an antimicrobial drug, which can be used as a post-surgical treatment modality for osteomyelitis. CS powder was embedded with 10% antibiotic, amoxicillin (AMX) or moxifloxacin (MFX), to form composite disks 11 mm in diameter that were tested for their degradation and antibiotic release profiles. For the disk degradation study portion, the single drug-loaded disks were placed in individual meshes, subsequently submerged in phosphate-buffered saline (PBS), and incubated at 37 °C. The disks were weighed once every seven days and analyzed via Fourier-transform infrared spectroscopy, X-ray diffraction, energy dispersive X-ray spectroscopy, and scanning electron microscopy. During the antibiotic release analysis, composite disks were placed in PBS solution, which was changed every 3 days, and analyzed for antibiotic activity and efficacy. The antibacterial effects of these sustained-release composites were tested by agar diffusion assay using Streptococcus mutans (S. mutans) UA 159 as an indicator strain. The degradation data showed significant increases in the degradation of all disks with the addition of antibiotics. Following PBS incubation, there were significant increases in the amount of phosphate and decreases in the amount of sulfate. The agar diffusion assay demonstrated that the released concentrations of the respective antibiotics from the disks were significantly higher than the minimum inhibitory concentration exhibited against S. mutans over a 2-3-week period. In conclusion, CS-antibiotic composite disks can potentially serve as a resorbable, osteoconductive, and antibacterial therapy in the treatment of bone defects and osteomyelitis.

Intracranial complications secondary to acute bacterial sinusitis requiring neurosurgical intervention before and after the onset of the COVID-19 pandemic.

Intracranial complications of acute bacterial sinusitis are rare pathologies that occur in children, and are associated with significant neurological morbidity and mortality. There is a subjective concern among neurosurgeons that the incidence of this rare disease has increased since the onset of the novel COVID-19 pandemic. The primary objective of this study was to review the presentation and management of patients admitted at the authors' institution with intracranial extension of sinusitis, to better understand the local disease burden relative to the COVID-19 pandemic. This is a single-center retrospective observational cohort study. The patients underwent neurosurgical intervention for intracranial extension of sinusitis between January 1, 2007, and March 1, 2023. The historical cohort was defined as those patients who presented prior to March 2020. Clinical covariates such as surgical and microbiological data were collected and analyzed. A total of 78 patients (55 historical, 23 new) were included; they had a median age of 11.7 years and a male predominance of 69.2%. There was a significant increase in the annual rate of neurosurgical intervention for suppurative intracranial extension of acute bacterial sinusitis after the onset of the COVID-19 pandemic, with an average of 4.2 cases per year prior to March 2020 compared to 7.7 cases per year after that date (p = 0.013). This increase was largely driven by the unprecedented case volume of 13 cases in 2022. Patients in the new cohort were older (p = 0.009) and more likely to have Pott's puffy tumor/frontal bone osteomyelitis (p = 0.003) at the time of presentation than patients in the historical cohort. Patients in the new cohort had lower rates of readmission within 30 days of discharge than those in the historical cohort (p = 0.047). In both cohorts, patients with seizure on presentation were more likely to have neurological sequelae at last follow-up (p = 0.004), which occurred at a median of 2.9 months after discharge. Clinicians encountering pediatric patients presenting with persistent symptoms of acute bacterial sinusitis must have a high index of suspicion for suppurative intracranial extension. Prompt neuroimaging and subsequent neurosurgical intervention are critical to ensure timely diagnosis and treatment. The results in this study show a significant increase in the number of neurosurgical interventions for suppurative intracranial extension of sinusitis per year after the onset of the COVID-19 pandemic. Further research is needed to understand the underlying pathophysiology of this clinical phenomenon.

Pubic bone osteomyelitis and fistulas after radiation therapy of the pelvic region: patient-reported outcomes and urological management of a rare but serious complication

PurposeThis study investigated late urinary adverse events (UAEs) in patients who underwent pelvic radiation therapy, with a focus on occurrence, diagnostic characteristics and the impact of subsequent extirpative surgery with the need of urinary diversion on quality of life.MethodsA retrospective analysis of 20 patients after pelvic radiotherapy (2016–2022) was conducted. Data included demographics, perioperative details, oncological parameters, and patient-reported outcomes. Imaging (CT, MRI) was examined for early manifestations of late UAEs.ResultsIn the study cohort, prostate cancer was the primary malignancy in 85% with a mean radiation dose of 84 Gray over 35 days. Time to diagnosis of late UAEs was 4.0 years post-radiation. Radiological assessment demonstrated a progressive increase in typical CT and MRI features of pubic bone osteomyelitis over time. Surgical interventions, mainly cystectomy, were required with variable outcomes in patient-reported post-surgery quality of life.ConclusionDiagnosing and managing late UAEs after pelvic radiation necessitate an understanding of their occurrence, diagnostic features and appropriate management strategies. Early imaging, particularly MRI, is crucial for timely diagnosis and treatment planning. Variable post-surgery quality of life underscores the importance of a multidisciplinary approach in managing late UAEs. The study contributes to understanding these complications and emphasizes their consideration in post-radiation follow-up care.

Therapeutic effect of calcaneal beak-like fracture secondary to calcaneal osteomyelitis caused by diabetic foot

To explore clinical effect of vancomycin calcium sulfate combined with internal fixation on calcaneal beak-like fracture secondary to calcaneal osteomyelitis caused by diabetic foot. From April 2018 to October 2021, a retrospective analysis was performed on 5 patients with calcaneal bone osteomyelitis secondary to diabetic foot, including 2 males and 3 females, aged from 48 to 60 years old;diabetes course ranged from 5 to 13 years;the courses of diabetic foot disease ranged from 18 to 52 days;5 patients were grade Ⅲ according to Wagner classification. All patients were treated with debridement, vancomycin bone cement implantation, negative pressure aspiration at stageⅠ, vancomycin calcium sulfate and internal fixation at stageⅡfor calcaneal beak-like fracture. Surgical incision and fracture healing time were recorded, and the recurrence of osteomyelitis was observed. American Orthopedic Foot Andankle Society (AOFAS) score and exudation at 12 months after operation were evaluated. Five patients were successfully completed operation without lower extremity vascular occlusion, and were followed up for 16 to 36 months. The wound healing time after internal fixation ranged from 16 to 26 days, and healing time of fractures ranged from 16 to 27 weeks. AOFAS score ranged from 65 to 91 at 12 months after operation, and 2 patients got excellent result, 2 good and 1 fair. Among them, 1 patient with skin ulcer on the back of foot caused by scalding at 5 months after operation (non-complication), was recovered after treatment;the wound leakage complication occurred in 2 patients, and were recovered after dressing change. No osteomyelitis or fracture occurred in all patients. Vancomycin calcium sulfate with internal fixation in treating calcaneal osteomyelitis secondary to calcaneal osteomyelitis caused by diabetic foot could not only control infection, but also promote fracture healing, and obtain good clinical results.

Serial MRI to monitor the progression of a case of sphenoid bone osteomyelitis in a dog (Canis familiaris)

AbstractA 2‐year‐5‐month‐old, male, neutered, crossbreed dog presented with third eyelid protrusion, right eye exophthalmos and facial hyperaesthesia. Neurological examination was suggestive of a lesion affecting the right optic nerve. Magnetic resonance imaging allowed a presumptive diagnosis of sphenoid bone osteomyelitis, meningitis and right‐sided optic neuritis. The dog was discharged with clindamycin (13 mg/kg/8 h), amoxicillin–clavulanate (25 mg/kg/8 h), gabapentin (10 mg/kg/8 h), paracetamol (15 mg/kg/8 h) and prednisolone (0.5 mg/kg/24 h). Paracetamol, gabapentin and prednisolone were gradually stopped. A 3‐month follow‐up revealed right‐eye blindness. Magnetic resonance imaging showed improvement in changes compatible with osteomyelitis and meningitis resolution, prompting clindamycin cessation. At the 6‐month follow‐up, magnetic resonance imaging indicated only right optic nerve atrophy. Amoxicillin–clavulanate was stopped. There had been no relapses at 12‐month follow‐up. Serial magnetic resonance imaging studies were pivotal in adjusting antibiotic therapy, and instilled confidence for treatment cessation upon lesion resolution. This marked the first use of serial magnetic resonance imaging to modulate sphenoid bone osteomyelitis treatment in dogs.

Pott's puffy tumor: An unusual complication of rhino-orbito-cerebral mucormycosis

ObjectiveTo describe clinicoradiological features and surgical outcomes in a series of nine patients with rhino-orbito-cerebral mucormycosis (ROCM) who presented with Pott's puffy tumor (ROCM-PPT) MethodsThe records of nine patients with ROCM-PPT seen between March 2020 and December 2021 were analysed. Clinical features, radiology, histopathology, operative findings, management and outcome were noted. Frontal sinus pneumatisation and outflow tract configuration was compared between patients and controls with ROCM and no PPT. ResultsROCM-PPT was diagnosed in 9 of 284 (3.2 %) patients with ROCM seen during the study period. There were six (66.7 %) males and the median age was 54 (IQR 46–60) years. Eight (88.9 %) patients had diabetes mellitus and seven (77.8 %) had been COVID-19 positive. Radiological features of osteomyelitis, subperiosteal abscess formation and dural enhancement were seen in all patients. No significant differences in pneumatisation or frontal sinus outflow tract configuration were noted between patients and controls. All patients underwent a craniectomy with frontal bone debridement and frontal sinus exteriorisation. All patients were treated with anti-fungal agents for several months. All patients had symptomatic improvement at a median follow-up of 21 (IQR 18–23) months. Repeat CT/MRI scans showed disease regression/resolution in six out of eight (75 %) patients with follow-up imaging, and stable disease in two others. ConclusionsROCM-PPT is a rare, delayed complication of mucormycosis that was seen in larger numbers during the recent COVID-19 pandemic. Aggressive debridement of osteomyelitic bone and antifungal therapy results in a good outcome.

Sphingolipid-Induced Bone Regulation and Its Emerging Role in Dysfunction Due to Disease and Infection.

The human skeleton is a metabolically active system that is constantly regenerating via the tightly regulated and highly coordinated processes of bone resorption and formation. Emerging evidence reveals fascinating new insights into the role of sphingolipids, including sphingomyelin, sphingosine, ceramide, and sphingosine-1-phosphate, in bone homeostasis. Sphingolipids are a major class of highly bioactive lipids able to activate distinct protein targets including, lipases, phosphatases, and kinases, thereby conferring distinct cellular functions beyond energy metabolism. Lipids are known to contribute to the progression of chronic inflammation, and notably, an increase in bone marrow adiposity parallel to elevated bone loss is observed in most pathological bone conditions, including aging, rheumatoid arthritis, osteoarthritis, and osteomyelitis. Of the numerous classes of lipids that form, sphingolipids are considered among the most deleterious. This review highlights the important primary role of sphingolipids in bone homeostasis and how dysregulation of these bioactive metabolites appears central to many chronic bone-related diseases. Further, their contribution to the invasion, virulence, and colonization of both viral and bacterial host cell infections is also discussed. Many unmet clinical needs remain, and data to date suggest the future use of sphingolipid-targeted therapy to regulate bone dysfunction due to a variety of diseases or infection are highly promising. However, deciphering the biochemical and molecular mechanisms of this diverse and extremely complex sphingolipidome, both in terms of bone health and disease, is considered the next frontier in the field.

(141) Surgical Outcomes of Infrapubic Insertion of the Inflatable Penile Prosthesis in 175 Transmen After Phalloplasty

Abstract Introduction Historically, inflatable penile prostheses (IPP) insertion in a neophallus has an estimated 40-50% surgical revision rate. Objective To review the surgical outcomes of a single center’s experience with the infrapubic approach to insertion of the IPP after phalloplasty in transmen. Methods The infrapubic prosthesis insertion after phalloplasty (IPIP) technique involves a horizontal incision anterior to the pubic symphysis, which allows dissection of the neophallus channel, the Space of Retzius, and the scrotal pocket. Surgical outcomes using the Titan (Coloplast, Minneapolis, MN) IPP by a single surgeon (MLC) were analyzed between October 2017 and June 2023. Complications were reviewed and categorized into erosions, infections, device malposition and malfunction, and less common events like necrosis and urinary tract injury. Results The IPIP technique was performed on 175 phalloplasty patients by a single surgeon (MLC): 156 patients had a prior RF phalloplasty, and 19 had a prior ALT phalloplasty. The mean followup was 32.8 months. Surgical revision was required in 35 patients (20%). There were 10 pump erosions through the neoscrotum, 1 glans erosion, 9 infections, 6 pump malpositions in the neoscrotum, 6 cylinder malposition in the neophallus, 3 mechanical malfunctions with broken tubing, 2 urethral injuries, 2 bladder injuries, and 1 glans necrosis. There were no instances of implant detachment from the pubic bone anchor site, osteomyelitis, nor total phallus loss. Conclusions Data for the IPIP technique using the commercially available Coloplast Titan IPP suggest a reduction in neophallus prosthetic surgical revision rates compared to previous reports. Longer term studies with patient reported outcomes are required for further evaluation. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast, Boston Scientific.

Multifocal Long Bone Osteomyelitis as a Complication of Disseminated Cat Scratch Disease.

Multifocal Long Bone Osteomyelitis as a Complication of Disseminated Cat Scratch Disease.

Pott's Puffy Tumor Initially Presenting as Eyelid Swelling without Typical Forehead Swelling: A Case Report.

Pott's puffy tumor is a rare complication of frontal sinusitis characterized by frontal bone osteomyelitis with a subperiosteal abscess typically presenting with forehead swelling. We herein report a 21-year-old man with Pott's puffy tumor presenting as eyelid swelling on the opposite side of the sinusitis, without typical forehead swelling. Initially treated for sinusitis and pre-septal cellulitis with poor response, head magnetic resonance imaging revealed bilateral subdural abscesses and osteomyelitis of the frontal and bilateral parietal bones, leading to the diagnosis. When frontal sinusitis and eyelid swelling are unresponsive to antibiotics, Pott's puffy tumor should be considered, even in the absence of forehead swelling.

Machine Learning Algorithm: Texture Analysis in CNO and Application in Distinguishing CNO and Bone Marrow Growth-Related Changes on Whole-Body MRI.

The purpose of this study is to analyze the texture characteristics of chronic non-bacterial osteomyelitis (CNO) bone lesions, identified as areas of altered signal intensity on short tau inversion recovery (STIR) sequences, and to distinguish them from bone marrow growth-related changes through Machine Learning (ML) and Deep Learning (DL) analysis. We included a group of 66 patients with confirmed diagnosis of CNO and a group of 28 patients with suspected extra-skeletal systemic disease. All examinations were performed on a 1.5 T MRI scanner. Using the opensource 3D Slicer software version 4.10.2, the ROIs on CNO lesions and on the red bone marrow were sampled. Texture analysis (TA) was carried out using Pyradiomics. We applied an optimization search grid algorithm on nine classic ML classifiers and a Deep Learning (DL) Neural Network (NN). The model's performance was evaluated using Accuracy (ACC), AUC-ROC curves, F1-score, Positive Predictive Value (PPV), Mean Absolute Error (MAE) and Root-Mean-Square Error (RMSE). Furthermore, we used Shapley additive explanations to gain insight into the behavior of the prediction model. Most predictive characteristics were selected by Boruta algorithm for each combination of ROI sequences for the characterization and classification of the two types of signal hyperintensity. The overall best classification result was obtained by the NN with ACC = 0.91, AUC = 0.93 with 95% CI 0.91-0.94, F1-score = 0.94 and PPV = 93.8%. Between classic ML methods, ensemble learners showed high model performance; specifically, the best-performing classifier was the Stack (ST) with ACC = 0.85, AUC = 0.81 with 95% CI 0.8-0.84, F1-score = 0.9, PPV = 90%. Our results show the potential of ML methods in discerning edema-like lesions, in particular by distinguishing CNO lesions from hematopoietic bone marrow changes in a pediatric population. The Neural Network showed the overall best results, while a Stacking classifier, based on Gradient Boosting and Random Forest as principal estimators and Logistic Regressor as final estimator, achieved the best results between the other ML methods.