Analysis of Treatment and Prognosis of 863 Patients with Spinal Tuberculosis in Guizhou Province

The objective of this study was to investigate the treatment and prognosis of patients with spinal tuberculosis in Guizhou province. A total of 863 patients with spinal tuberculosis admitted to our hospital from 2006 to 2017 were included in this study. All patients underwent standardized quadruple antituberculosis treatment. Eighty patients were lost to follow-up due to a change of their contact information or noncompliance. A total of 783 patients completed the follow-up. The average follow-up period was 20.33 ± 8.77 months (range: 6 to 38 months). Among these patients, 145 patients underwent conservative treatment, while 638 patients underwent surgical treatment. All patients in the surgery group were treated with lesion removal, bone graft fusion, and internal fixation. Preoperative and postoperative standard quadruple antituberculosis treatment was administered. The clinical efficacy was evaluated according to erythrocyte sedimentation rate (ESR), c-reactive protein (CRP), visual analogue scale (VAS), Cobb angle correction, neurological functional recovery, and interbody fusion with bone graft and tuberculosis outcome. A total of 608 patients achieved clinical cure. The symptoms, physical signs, blood tests and imaging findings were improved in 143 patients. Twenty patients showed refractory clinical symptoms, and 12 patients had local tuberculosis recurrence. Conservative and surgical treatments are the mainstream treatments for spinal tuberculosis. According to the patients’ individual conditions, individualized treatments should be used to achieve good efficacy. Standardized antituberculosis treatment should be applied over the course of spinal tuberculosis.

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Chondrosternal Arthritis in Infant: An Unusual Entity

Case Reports in Orthopedics ◽

10.1155/2014/652539 ◽

2014 ◽

Vol 2014 ◽

pp. 1-4

Author(s):

Athina Nikolarakou ◽

Dana Dumitriu ◽

Pierre-Louis Docquier

Keyword(s):

Clinical Symptoms ◽

Therapeutic Option ◽

White Blood Cells ◽

Laboratory Data ◽

C Reactive Protein ◽

Reactive Protein ◽

History Of ◽

Local Tenderness ◽

Wait And See

Primary arthritis of chondrosternal joint is very rare and occurs in infants less than 18 months of age. Presentation is most often subacute but may be acute. Child presents with a parasternal mass with history of fever and/or local signs of infection. Clinical symptoms vary from a painless noninflammatory to a painful mass with local tenderness and swelling, while fever may be absent. Laboratory data show low or marginally raised levels of white blood cells and C-reactive protein, reflecting, respectively, the subacute or acute character of the infection. It is a self-limiting affection due to the adequate immune response of the patient. Evolution is generally good without antibiotherapy with a progressive spontaneous healing. A wait-and-see approach with close follow-up in the first weeks is the best therapeutic option.

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Multiple Victims of Carbon Monoxide Poisoning in the Aftermath of a Wildfire: A Case Series

Acta Médica Portuguesa ◽

10.20344/amp.9811 ◽

2018 ◽

Vol 31 (3) ◽

pp. 146 ◽

Cited By ~ 3

Author(s):

Luís Ramos dos Santos ◽

Magna Alves-Correia ◽

Margarida Câmara ◽

Manuela Lélis ◽

Carmo Caldeira ◽

...

Keyword(s):

Carbon Monoxide ◽

Hyperbaric Oxygen ◽

Clinical Symptoms ◽

Carbon Monoxide Poisoning ◽

Case Series ◽

Neurological Syndrome ◽

High Flow Oxygen ◽

Lost To Follow Up ◽

Mean Time

Introduction: Carbon monoxide poisoning may occur in several contexts.Material and Methods: Retrospective of 37 carbon monoxide poisoning cases that underwent hyperbaric oxygen during wildfires in Funchal in August 2016.Results: The studied sample included 37 patients, mean age of 38 years, 78% males. Ten were firefighters, four children and two pregnant victims. Neurological symptoms were the most reported. Median carboxyhemoglobin level was 3.7% (IQR 2.7). All received high-flow oxygen from admission to delivery of hyperbaric oxygen. Persistence of symptoms was the main indication for hyperbaric oxygen. Median time to hyperbaric oxygen was 4.8 hours (IQR 9.5), at 2.5 ATA for 90 minutes, without major complications. Discharge in less than 24 hours occurred in 92% of the cases. Thirty days follow-up: five patients presented clinical symptoms of late neurological syndrome; twelve patients were lost to follow-up. Carboxyhemoglobin levels on admission and mean time to hyperbaric oxygen were no different between those who did and did not develop the syndrome at 30 days (p = 0.44 and p = 0.58, respectively).Discussion: Late neurological syndrome at 30 days occurred in 20% and no new cases were reported at 12 months.Conclusion: Use of hyperbaric oxygen appears to have reduced the incidence of the syndrome. This seems to be the first Portuguese series reporting use of hyperbaric oxygen in carbon monoxide poisoning due to wildfires. The authors intend to alert to the importance of referral of these patients because the indications and benefits of this treatment are well documented. This is especially important given the ever-growing issue of wildfires in Portugal.

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How to select the fusion and fixation range of thoracolumbar and lumbar tuberculosis: A retrospective clinical study

10.21203/rs.3.rs-22774/v1 ◽

2020 ◽

Author(s):

Yang zong qiang ◽

Liu chang hao ◽

Niu ning kui ◽

Tang jing ◽

Sayed Abdulla Jami ◽

...

Keyword(s):

Bone Graft ◽

Clinical Efficacy ◽

Clinical Data ◽

Spinal Tuberculosis ◽

Operation Time ◽

Adjacent Vertebral Body ◽

Surgery Group ◽

Surgical Methods ◽

Retrospective Clinical Study

Abstract Purpose To investigate the clinical data of thoracolumbar and lumbar spinal tuberculosis with diseased and non-diseased intervertebral surgery, evaluate the clinical efficacy of the two surgical methods, and explore how to choose the fusion of fixation range. Methods Among 221 patients with thoracolumbar and lumbar tuberculosis were categorized into two groups. 118 patients were in the diseased intervertebral surgery group (lesion vertebral pedicle fixation, group A) and there were 103 patients in the non-diseased intervertebral surgery group (1 or 2 vertebral fixation groups at the above and below levels of the affected vertebra, group B). Both groups of patients were treated with primary or staging, anterior combined complete lesion removal, bone graft fusion, and internal fixation. By analyzing of clinical data and the clinical efficacy of the two surgical methods in thoracolumbar and lumbar tuberculosis was evaluated. Results The mean follow-up duration was 65months (range 50–68 months). There were no significant differences in laboratory examination, VAS scores, and the Cobb angle correction rate and the angle loss, however, significant differences between the two groups in operation time, blood loss, drainage volume, and transfusion, the diseased intervertebral surgery group was significantly better than the non-diseased intervertebral surgery group. Meanwhile, the bone graft was fused entirely at the last follow-up. Conclusion Under the conditions of strictly grasping the indications for surgery, intervertebral surgery for thoracolumbar and lumbar tuberculosis is safe, effective, and feasible, and it can effectively restore its physiological curvature and reduce the degeneration of the adjacent vertebral body.

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Long-term application of hydroxychloroquine could not prevent the infection of COVID-19

The Journal of Infection in Developing Countries ◽

10.3855/jidc.13527 ◽

2020 ◽

Vol 14 (12) ◽

pp. 1368-1373

Author(s):

Yin Zhu ◽

Yongping Chen ◽

Yuewen Gong ◽

Aijun Pan ◽

Huijie Ding ◽

...

Keyword(s):

Clinical Symptoms ◽

Oxygen Intake ◽

Case Presentation ◽

Reactive Protein ◽

Ceftriaxone Sodium ◽

Hospital Stays ◽

Hs Crp ◽

Current Report

Introduction: Current pandemic of the coronavirus induced disease 2019 (COVID-19) presents an urgent issue to the world due to lack of vaccine and medication. Hydroxychloroquine (HCQ) has generated a lot of controversies whether it is effective in prevention and treatment of COVID-19. Current report presents a 63-year-old woman who has taken HCQ for many years but still infected by COVID-19. Case presentation: A patient with rheumatoid arthritis came to the clinic with fever and sore throat. The patient has been treated with 200 mg HCQ per day since 2016. Laboratory tests showed that the patient had lymphopenia, increased levels of high-sensitive C-reactive protein (hs-CRP) and serum Interleukin-6 (IL-6). Chest radiography showed that the patient had pneumonia. Throat swab test confirmed COVID-19 positive. On admission, she was treated with nebulized interferon alfa-2b, oral Lopinavir/Ritonavir, and ceftriaxone sodium for the COVID-19 in addition to HCQ. The patient stayed in hospital for 18 days, recovered from oxygen intake, and eventually discharged from hospital. Follow up investigation showed the patient developed antibody against COVID-19. Conclusions: Long-term application of HCQ could not prevent COVID-19 infection, but whether HCQ exerts benefit to alleviation of clinical symptoms and duration of hospital stays remains to be further investigated.

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Brucellar reproductive system injury: A retrospective study of 22 cases and review of the literature

Journal of International Medical Research ◽

10.1177/0300060520924548 ◽

2020 ◽

Vol 48 (6) ◽

pp. 030006052092454

Author(s):

Yan Zhou ◽

Songsong Xie ◽

Rongjiong Zheng ◽

Qinqi Dai ◽

Zheng Xu ◽

...

Keyword(s):

Reproductive System ◽

Chronic Prostatitis ◽

Clinical Symptoms ◽

Drug Regimen ◽

Review Of The Literature ◽

Male Patients ◽

Patient Prognosis ◽

Medical University ◽

Lost To Follow Up

Objective We aimed to describe the clinical characteristics and prognosis of 22 patients with Brucella-induced reproductive system injury. Methods We assessed 22 patients with reproductive system injury between 2010 and 2018 at The First Affiliated Hospital of Xinjiang Medical University. Results The disease is predominant in men. Male patients had orchitis, erectile dysfunction, prostatitis, and urethral stricture, while female patients had vaginitis and cervicitis. Some patients had laboratory abnormalities and liver injury. Patients received combination therapy of rifampicin and doxycycline. Doxycycline combined with levofloxacin or moxifloxacin was administered to patients with rifampicin intolerance. All patients had received antibiotic therapy for at least 6 weeks. One patient was lost to follow-up, one patient relapsed because of osteoarthropathy, and one patient had dysuria resulting from chronic prostatitis. The clinical symptoms resolved in the other patients, and the overall patient prognosis was good. Conclusion Clinicians should pay attention to brucellosis-induced reproductive system damage. The two-drug regimen of rifampicin+doxycycline is recommended for these patients. Doxycycline combined with levofloxacin or moxifloxacin should be used in patients with brucellosis-induced reproductive system damage who have rifampicin intolerance. The treatment course should be at least 6 weeks.

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The Role of External Banding Valvuloplasty in the Surgical Management of Chronic Deep Venous Disease

Phlebology The Journal of Venous Disease ◽

10.1177/026835559400900103 ◽

1994 ◽

Vol 9 (1) ◽

pp. 8-12 ◽

Cited By ~ 6

Author(s):

H. Schanzer ◽

M. Skladany ◽

E. C. Peirce

Keyword(s):

Venous Insufficiency ◽

Clinical Symptoms ◽

Tertiary Care ◽

Symptomatic Improvement ◽

Venous Stasis ◽

Venous Disease ◽

Muscle Pump ◽

Lost To Follow Up

Objective: Correction of venous reflux by perivalvular banding in patients suffering from chronic venous stasis secondary to primary valvular incompetence. Design: Prospective study in a group of patients with severe venous insufficiency. One patient (one extremity) was lost to follow-up. Setting: Tertiary care teaching hospital. Patients: Twelve patients (13 extremities) with severe or moderate venous insufficiency. Interventions: Correction of valvular incompetence by narrowing a valvular ring with an external band. Twenty-seven bands were fitted to incompetent valves of 13 extremities. Main outcome measures: Abolition of reflux and improvement of muscle pump measured by clinical, plethysmographic and venographic criteria. Results: Symptomatic improvement was found in 10 extremities (77%) and complete correction of reflux on venography in eight extremities (67%). Plethysmographically measured reflux improved in 6 extremities (50%) and muscle pump function improved in 7 extremities (58%). No correlation was found between plethysmographic and clinical or venographic outcome. Conclusion: Perivalvular banding can correct reflux and alleviate clinical symptoms of chronic venous stasis in patients with primary valvular incompetence. Selection of patients, valves to be corrected, necessary degree of valvular ring narrowing and need for additional interventions should be further investigated.

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The Clinical Characteristics, Perioperative Management, and Treatment Outcomes of Spinal Tuberculosis Associated With Diabetes Mellitus

10.21203/rs.3.rs-829561/v2 ◽

2021 ◽

Author(s):

Hongqi Zhang ◽

Lige Xiao ◽

Mingxing Tang ◽

Yang Sun ◽

Guanteng Yang

Keyword(s):

Diabetes Mellitus ◽

Surgical Treatment ◽

Perioperative Management ◽

Spinal Tuberculosis ◽

Perioperative Period ◽

Demographic Information ◽

Antituberculosis Treatment ◽

Strategic Factors ◽

Patient Demographic Information

Abstract Background. To report a preliminary experience of surgical treatment for patients with spinal tuberculosis (STB) associated with diabetes mellitus (DM) and discuss the strategic factors that should be considered.Methods. A retrospective study of DMSTB patients who underwent surgical treatment between January 2012 and April 2018 in our center was carried out. For each patient: demographic information, perioperative management, laboratory examination, radiographic assessments, and clinical outcomes were reviewed.Results. A total of 17 patients were included (11 males and 6 females), with a mean age of 57.53±9.25 years and a follow-up of 28±3.00 mos. Hypertension, Osteoporosis, and Hypoproteinemia were the most common complication. All patients passed the perioperative period smoothly, the 3 months follow-up showed the CRP and ESR have a significant decline, and the final follow-up shows both CRP and ESR back to normal, and there were a significant improvement of serum albumin levels. The Bone fusion time is 9.88±2.65 mos.Conclusions. Perioperative management of DMSTB patients is a complicated issue with numerous factors to be considered. Spinal surgery can achieve satisfactory outcomes in these patients if the glycemic level remains well controlled, nutritional supplementation is adequate, and antituberculosis treatment is sufficient.

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Transforaminal interbody debridement and fusion with antibiotics impregnated bone graft to treat pyogenic discitis and vertebral osteomyelitis: A technique note with preliminary result.

10.21203/rs.3.rs-41300/v1 ◽

2020 ◽

Author(s):

Hsiao-Kang Chang ◽

Meng-Ling Lu ◽

Adam M. Wegner ◽

Re-Wen Wu ◽

Sung-Hsiung Chen ◽

...

Keyword(s):

Surgical Treatment ◽

Infection Control ◽

Bone Graft ◽

Vertebral Osteomyelitis ◽

Case Series ◽

Spinal Instability ◽

Intractable Pain ◽

Angle Correction ◽

Antibiotic Duration

Abstract Background Surgical treatment of pyogenic discitis and vertebral osteomyelitis (PDVO) is indicated for neurologic deficit, spinal instability, unknown pathogen, poorly controlled infection, or intractable pain. Although the posterior-only approach has been proved a safe, effective procedure that minimizes the risks and complications of anterior or staged surgery, parenteral antibiotic treatment for 4–6 weeks postoperatively is still necessary. We hypothesized that antibiotic-impregnated bone graft used in an all posterior approach could result in infection control and shorten the postoperative course of pyogenic discitis and vertebral osteomyelitis. Methods 21 consecutive patients with pyogenic discitis and vertebral osteomyelitis of the lumbar or thoracic spine were treated with transforaminal interbody debridement and fusion (TIDF) with antibiotic-impregnated bone graft (AIBG) between March 2014 and January 2017. Minimum follow up was 2 years. Outcomes included visual analog scale (VAS) back pain, ASIA scale for neurological status, kyphotic angle correction, fusion status, and functional outcome using Kirkaldy-Willis criteria, and c-reactive protein (CRP) levels. CRP levels from pre-op, immediately post-op, and 1, 2, 4 & 6 wks post operatively and the duration of treatment with postoperative IV antibiotics in our patients was compared to our previous case series in which TIDF was performed without AIBG. Results Surgical treatment for PDVO resulted in clinical improvement and adequate infection control. There was no difference in pre-op CRP levels between the two groups. Despite shorter post-op IV antibiotic duration (Mean 21.0 d vs 39.8 d), the AIBG group had a stable decline in CRP levels and continued to decrease at 1, 2, 4 & 6 weeks, with significantly lower CRP levels at 6 weeks compared to bone graft without antibiotics. VAS scores improved from a mean of 7.2 to 2.3 one month postoperatively. Patients who had increased kyphotic angles had an average angle correction of 7.9° at last follow-up. Conclusion The technique of TIDF combined with AIBG can achieve local infection control with faster reduction in CRP, leading to shorter antibiotic duration for pyogenic discitis and vertebral osteomyelitis

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Selection of the fusion and fixation range in the intervertebral surgery to correct thoracolumbar and lumbar tuberculosis: a retrospective clinical study

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04335-0 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Zongqiang Yang ◽

Changhao Liu ◽

Ningkui Niu ◽

Jing Tang ◽

Jiandang Shi ◽

...

Keyword(s):

Bone Graft ◽

Spinal Tuberculosis ◽

Spinal Column ◽

Operation Time ◽

Pedicle Fixation ◽

Post Surgery ◽

Surgery Group ◽

Surgical Methods ◽

Retrospective Clinical Study

Abstract Background To compare the diseased verses the non-diseased intervertebral surgery used in the treatment of thoracolumbar and lumbar spinal tuberculosis and to explore the best choice of fusion of fixation range. Methods Two hundred twenty-one patients with thoracolumbar and lumbar tuberculosis were categorized into two groups. One hundred eighteen patients underwent the diseased intervertebral surgery (lesion vertebral pedicle fixation, Group A) and 103 patients underwent the non-diseased intervertebral surgery (1 or 2 vertebral fixation above and below the affected vertebra, group B). Spinal tuberculosis diagnosis was confirmed in both groups of patients before lesion removal, bone graft fusion, and internal fixation. Clinical data and efficacy of the two surgical methods were then evaluated. Results The mean follow-up duration for both procedures was 65 months (50–68 months range). There were no significant differences in laboratory examinations, VAS scores, and the Cobb angle correction rate and the angle loss. However, significant differences existed in the operation time, blood loss, serosanguineous drainage volume, and blood transfusion requirement between the two groups. The diseased intervertebral surgery group performed significantly better than the non-diseased intervertebral surgery group in all of these areas. In both cases, the bone graft fused completely with the normal bone by the last follow-up, occuring at 50–86 months post surgery. Conclusion The diseased intervertebral surgery is a safe and feasible option for the treatment of thoracolumbar and lumbar tuberculosis. It effectively restores the physiological curvature of the spine and reduces the degeneration of adjacent vertebral bodies in the spinal column.

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Clinical outcomes of patients lost to follow-up and factors affecting follow-up loss after total knee arthroplasty

10.21203/rs.3.rs-902654/v1 ◽

2021 ◽

Author(s):

Jung-Ro Yoon ◽

Phil Sun Park ◽

Tae Hyuck Yoon ◽

Seung Hoon Lee

Keyword(s):

Total Knee Arthroplasty ◽

Clinical Outcomes ◽

Knee Arthroplasty ◽

Social Economic ◽

Clinical Symptoms ◽

Economic Factors ◽

Factors Affecting ◽

Total Knee ◽

Lost To Follow Up

Abstract Background The hypotheses were as follows: 1) the clinical outcome of patients lost to follow-up after total knee arthroplasty (TKA) will be different compared to patients with follow-up; 2) follow-up rate will be affected by various social economic factors. Methods Patients who underwent TKA between March 2019 and February 2020 were retrospectively included. Patients lost to follow-up were defined as patients who did not undergo follow-up 6 months after TKA; all patients were divided into follow-up and follow-up loss groups. Western Ontario and McMaster Universities Osteoarthritis (WOMAC) and Knee Society Score (KSS) were measured before surgery. After surgery, WOMAC, KSS function, and satisfaction were measured via telephone. Age, sex, unilateral or bilateral TKA, distance from hospital, presence of a family, and insurance were investigated. Results A total of 137 patients were included in the study. There were 92 (67.2%) patients that followed up 6 months after TKA, on the other hand, 45 patients (32.8%) were lost to follow-up. There was no difference in clinical outcomes (WOMAC, p = 0.932; KSS clinical, p = 0.450) and satisfaction (pain: p = 0.230, function: p = 0.300) between two groups. Age, sex, unilateral or bilateral TKA, distance from hospital, presence of a family, and insurance had no effect on follow-up rates. Conclusion The clinical outcomes of patients lost to follow-up after TKA did not show a difference from those who were followed up. Age, sex, unilateral or bilateral TKA, distance from hospital, presence of a family, insurance status, and postoperative clinical symptoms did not affect the follow-up rate.

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