Abstract: The incidence of complications of paranasal sinusitis have been progressively decreasing since the advent of antibiotics. Most of the complications that have occurred are secondary to sub-acute or chronic sinusitis. A few patients, however, still present with a complication of an acute sinusitis infection. Four cases are presented in detail and 14 cases are summarized which presented with an acute complication as the primary presenting complaint. Sinusitis was not an obvious component in most of these cases, and none of the 18 patients had any previously known sinus disease. The paper was limited to a discussion of complications involving the orbit, the tissues surrounding the sinuses, and the intracranial cavity. Basic information regarding these topics was reviewed. The first case report described a young boy with cellulitis of the orbit and cheek secondary to a maxillary sinusitis. Neither the cellulitis nor the sinusitis responded to the medical treatment until trephine and irrigation of the sinus was performed. The second case report described a young man with a frontal subperiosteal abscess and orbital cellulitis secondary to frontal sinusitis. His treatment consisted of drainage of the abscess and performance of a frontal sinus trephine. The third case described a young man with maxillary, ethmoid and sphenoid sinusitis and a secondary cavernous sinus thrombosis. The maxillary sinuses were drained and the patient was given high doses of intravenous antibiotics and decongestants but he was not anticoagulated. Apart from the central retinal artery thrombosis resulting in the left eye, recovery was complete. The fourth case report described a young lady who had undergone a renal transplant and was maintained on immunosuppressant medications. She developed a meningitis secondary to maxillary sinusitis. Complete recovery occurred on medical treatment alone. The other 14 cases were summarized in a table. These cases were then discussed and recommendations were made regarding management of these complications. It was concluded that with antibiotics in adequate closes, it is now safe to perform a sinus trephine much earlier in the course of the disease than has previously been advocated. Eight of the 18 were drained in the acute phase and there was no evidence of osteomyelitis or other sequella secondary to this procedure. Indeed, six of these patients required surgical drainage before the fever or the complications would respond to therapy. It is suggested that immediate surgical drainage and irrigation is indicated when sinusitis does not respond or becomes clinically worse after 24-48 hours of treatment with systemic antibiotics and decongestants; or when acute suppurative local infection or septic intracranial complications are present. The sinuses should be irrigated frequently with saline until the return remains clear for 48 hours. The majority of the organisms isolated were staphylococci, coagulase negative and coagulase positive. Four cultures grew no organisms but since routine cultures for anaerobic organisms were not performed these could not be eliminated as a factor in the infection. The majority of cases were treated with high doses of intravenous antibiotics and these were only given intramuscularly 24 to 48 hours after the fever had subsided and the clinical symptoms were resolving. The total duration of antibiotic treatment varied considerably within this series. It is recommended that complicated acute sinusitis should be treated as though an osteomyelitis is actually present. The systemic antibiotics should be continued for a full week after fever disappears before changing to oral antibiotics. The total duration of antibiotic therapy should be for four to six weeks. In treating meningitis, high doses of broad spectrum antibiotics were used until culture sensitivities were available. Examination of cerebrospinal fluid was emphasized. On adequate treatment the C.S.F. sugar levels should rise above the initial values and no demonstrable micro-organism should be present after 24 hours. It was noted that intracranial abscesses can occur with minimal symptoms and that fever is not necessarily present. If any doubt exists an arteriogram or other investigations should be performed.

Abstract: 1. Continued follow-up of the 113 children with acute osteomyelitis previously reported and a study of a further thirty-eight proven cases has not changed our opinion that the correct management is rest and effective antibiotics. Operation should be undertaken only if pus is detectable clinically. 2. Bacteriological evidence shows that the flora causing this disease are less sensitive to benzylpenicillin than ten years ago and that a proportion are also likely to become resistant to methicillin and cloxacillin. 3. The most effective antibiotic combination used was fusidic acid and erythromycin. This lowered the failure rate to 10·5 per cent in thirty-eight proven cases. Two of the four failures were in haemophilus infections. No staphylococcal infection of a long bone became chronic, and all lesions were healed within three months of onset. 4. The duration of treatment (twenty-one days) and the method of splintage (removable plaster slabs) remained the same as in the previous series. 5. Careful watch must be kept on the incidence of haemophilus infections. If it rises, increasing the erythromycin or adding ampicillin may be necessary. 6. Use of the newer aqueous suspension of fusidic acid may lower the incidence of troublesome vomiting (12 per cent in this series). 7. Only 7 per cent of staphylococcus aureus infections in this hospital, and 17 per cent of such infections in our thirty-eight cases were sensitive to benzylpenicillin. It is thought that this drug has outlived its usefulness in osteomyelitis. 8. It is recommended that, on diagnosis, fusidic acid aqueous suspension 5 millilitres should be given three times a day to children aged one to five, and 10 millilitres twice a day for children aged six to twelve, with erythromycin stearate 30 milligrams per kilogram of body weight each day in divided doses.

Abstract: Carnaghan (1) described a spondylitis involving the sixth and/or seventh thoracic vertebrae due to Staphylococcus pyogenes in commercial chickens between 7 and 16 weeks of age. The vertebral bodies were enlarged, and the resulting spinal cord compression caused affected chickens to squat most of the time. The condition was reproduced experimentally by intravenous inoculation of S. pyogenes. Similar lesions in both chickens and turkeys were reported by Wise (6), who also reproduced the vertebral lesions. Nairn (4) reported infection of thoracic vertebrae 5-7 in spontaneous cases of staphylococcal osteomyelitis in the turkey and was able to produce osteomyelitis in this region in turkeys with intravenous inoculations of Escherchia coli or S. aureus. Similar spondylitis involving the sixth and seventh thoracic vertebrae in broiler chickens and turkeys has been observed at the Western College of Veterinary Medicine, Saskatoon, Canada. This report describes spondylitis involving the first thoracic vertebra in broiler chickens.

Abstract: Strontium 87m scanning was performed on 30 children with suspected infection involving the musculoskeletal system. All 20 patients, who in final analysis were considered to have septic arthritis, osteomyelitis, or diskitis, had positive scans. In only two instances did the roentgenograms show osseous lesions at the time of scanning. Strontium 87m scanning appears to be a very sensitive indicator of infection, whether in bone or joints. A negative scan would appear to rule out the presence of an active infection of bone or joints.

Abstract: Foreign bodies of the hypopharynx may result in serious complications several weeks after their removal. Persistent symptoms should alert the physician to continuing infection. Osteomyelitis of the cervical spine has been seen as a complication of a foreign body in the hypopharynx which had penetrated the posterior pharyngeal wall.

Abstract: A. D., an eight and one-half year-old girl, was severely bitten while attempting to take a plate of food away from the family pet, a large bulldog. She was hospitalized for surgical repair of deep lacerations of her upper left arm, and lesser injury to the forearm. Three of the upper arm lacerations extended down to the periosteum, but actual penetration of the periosteum was not recorded in the surgical report (day I) and an x-ray film taken on admission was normal. She was

Abstract: Summary An outbreak of lameness with sudden onset and high morbidity in a flock of 12-wk-old turkeys is reported. The lameness was associated with osteomyelitis caused by Yersinia pseudotuberculosis serotype IA. The condition was reproduced experimentally.

Abstract: ✓ Two cases of osteomyelitis of the spine caused by Pseudomonas aeruginosa are described The organism apparently was introduced by contaminated syringes or needles used by heroin addicts This organism and the pathology should be kept in mind in patients known to have been heroin addicts and who are suffering from spinal problems especially if there is evidence of infection

Abstract: Radiographs of 52 patients revealed pointed deformity of one or more of the tubular bones, caused by sensory neuropathic osteopathy in half the cases. Other underlying disorders were rheumatoid arthritis, progressive systemic sclerosis, frostbite, and partial amputation of an extremity. The concepts “concentric atrophy” and “gradual absorption” are considered erroneous. Osteomyelitis is believed to have no essential role in the formation of this deformity. The pointed configuration is due mainly to the repair process following bone destruction or defect.

Abstract: This is a case report of an unusual injury to the cervical esophagus and arytenoid associated with a traumatic disruption of the sternoclavicular joint. The patient presented with symptoms of mediastinitis. Osteomyelitis of the clavicle occurred as a postoperative complication necessitating surgical resection of the medial portion of the clavicle.

Abstract: Osteomyelitis of a spinous process Is unusual, and this paper describes two cases. The first was the result of a hæmatogenous spread of infection, and and the second, a direct complication of a laminectomy.

Abstract: Severe osteomyelitic lesions of the cervical vertebrae developed in two patients after injury of the neck by shell splinters, although the vertebrae had not been damaged by the initial injury. This complication seems to be very uncommon, as no similar cases could be found in the literature of the last 20 years. The possibility of vertebral osteomyelitis should be kept in mind in all injuries of the neck. Early effective treatment, that consists of immobilization and antibiotics, should be started on appearance of first localizing clinical signs and before the radiologic confirmation of the diagnosis.

Abstract: A 35-year-old man had osteomyelitis complicating fibrous dysplasia of the left frontal bone. Historical, radiological, operative, and pathological evidence is given to demonstrate the dual pathology of the lesion in this particular case.

Abstract: 17 patients with lower respiratory tract infections, 8 with deep Staphylococcus aureus wound infections, 5 with erysipelas and 1 with Staph. aureus osteomyelitis were treated with 1 g cephalexin 4 times daily. 27 patients were cured and 3 improved. One patient with Staph. aureus pneumonia failed to respond to therapy. In one patient the drug had to be withdrawn because of nausea and vomiting. Two more patients complained of nausea and one of these patients developed a skin rash 10 days after therapy was instituted. No other side-effects were observed. Cephalexin is a useful drug in the treatment of lower respiratory tract and soft tissue infections. It may also be helpful in the therapy of acute osteomyelitis.