Curative Effect of Oblique Lateral Interbody Fusion in the Treatment of Lumbar Tuberculosis

Objective: This research aimed to investigate the curative effect of oblique lateral interbody fusion (OLIF) in the treatment of lumbar tuberculosis. Methods: A total of 32 patients, including 18 males and 14 females (29-58 years old, with the mean age of 47) who were admitted to our hospital from October 2016 to June 2020 and treated with oblique lateral interbody fusion combined with vertebral screw internal fixation, were retrospectively collected. The segmental distribution of lesions was L2- L316 cases, L3-L411 cases and L4-L55 cases. At first, preoperative antituberculous drug treatment was standardized for 2-4 weeks. Furthermore, intraoperative blood loss, operation time, postoperative complications, ESR, CRP, VAS, JOA and ASIA scores were recorded before and after surgery and at the last follow-up. In addition, antituberculous drug therapy was regulated continuously after surgery.Results: All patients were followed up for 12-17 months, with an average of 14 months. ① The average operation time was (132.5±21.4) min, and the intraoperative blood loss was (227.3±43.1) ml. ② Preoperative ESR was (74.56±15.43) mmol/h, and CRP was (43.21±19.37) mg/L. Seven days after surgery, ESR was (42.37±19.26) mmol/h, and CRP was (22.51±18.42) mg/L. In the last follow-up, ESR was (9.25±4.13) mmol/h, and CRP was (8.17±3.21) mg/L. They have statistically significant differences before surgery, seven days after the surgery and in the last follow-up (P<0.05). ③ The average VAS score before surgery was (7.21±1.40) points, the average JOA score was (18.24±4.13) points, the average VAS score seven days after surgery was (2.23±1.32) points, the average JOA score was (24.72±3.19) points, and the average VAS score in the last follow-up was (1.63±0.54) points. JOA score was (27.72±2.61). They have statistically significant differences before surgery, seven days after the surgery and in the last follow-up (P<0.05) ④Six patients had neurologic symptoms with ASIA grade D before surgery, 2 patients recovered to Grade E seven days after surgery, and the remaining 4 patients also recovered to grade E in the last follow-up. Besides, 26 patients were graded as Grade E before surgery, seven days after surgery and in the last follow-up. ⑤ After surgery, 1 patient suffered psoas major muscle damage, which was manifested as reduced hip flexion strength of the lower extremity, and returned to normal three weeks later. Apart from that, none of the patients had complications such as abdominal organ injury and poor wound healing. Conclusion: OLIF is a new minimally invasive method for treating lumbar tuberculosis, with short operation time, less blood loss, convenient operation, thorough removal of lesions, and good long-term follow-up effect. It is worthy of promotion and application.

Neglected tuberculous trochanteric bursitis in an adolescent girl: A case report and literature review

Tuberculous trochanteric bursitis (TTB) is an extremely rare form of extrapulmonary tuberculosis. Due to a low clinical suspicion and poor collaboration among medical professionals, the diagnosis of TTB can be often delayed. In this report, we describe a case of neglected TTB in an adolescent girl that initially presented with right thigh swelling and fluctuance. The patient underwent repeated unsuccessful surgical treatment; however, dull pain and periodic wound drainage remained for eight years. Complete excision of fistula and trochanteric bursa and one year of oral antituberculous drug therapy led to complete recovery. This case report highlights tuberculosis as a diagnostic challenge, when rare localizations are affected. In addition, this report addresses several diagnostic pitfalls and reviews the literature regarding TTB in adolescent patients. Orthopedic surgeons need to consider TTB, when swelling, fluctuance or repeated wound drainage are present on the thigh.

Synthesis and characterization of isoniazid immobilized polylactide-co-glycolide nanoparticles

This article considers someaspects of synthesis and characterizationof polylactide-co-glycolide nanoparticles immobilized withthe antituberculous drug isoniazid. The influence of some synthesis parameters of nanoparticles (the ratio of drug substance:polymer and surfactant concentration) onproperties of the obtained nanosomal drug form of isoniazid has been studied. Optimal conditions for obtainingthenanoparticles with the best physicochemical parameters such as: particle size, polydispersity, conversion, etc. have been found. These nanoparticlescan be used asdrug carriers.The results revealed thata polymer: drug ratio of 1:1 and the use of 3% Twin 80 are necessaryto obtain stable emulsions of nanoparticles of polylactide-co-glycolide with satisfactory characteristics. Average size of the obtained particles was 196.4 nm,and the polydispersity value was 0.323. The aggregation stability of nanoparticles during 4 hours at temperatures of 4ºC and 20ºC has been evaluated. The morphology of the obtained nanoparticles has been studied.Analysis of nanoparticles was characterized by various instrumental methods includinggas chromatography and thermogravimetrytechniques. The resulting nanoparticles of polylactide-co-glycolide immobilized with isoniazid are stable in time andcanprolong the action of the drug. In vitrorelease of isoniazid from polylactide-co-glycolide nanoparticles hasbeen studied.

Pseudomonas laryngeal perichondritis: unexpected diagnosis

A 57-year-old male chronic smoker with underlying diabetes mellitus presented with dysphonia associated with cough, dysphagia and reduced effort tolerance of 3 months’ duration. Videoendoscope finding revealed bilateral polypoidal and erythematous true and false vocal fold with small glottic airway. The patient was initially treated as having tuberculous laryngitis and started on antituberculous drug. However, no improvement was observed. CT of the neck showed erosion of thyroid cartilage, which points to laryngeal carcinoma as a differential diagnosis. However, the erosion was more diffuse and appeared systemic in origin. The diagnosis of laryngeal perichondritis was made when the histopathological examination revealed features of inflammation, and the tracheal aspirate isolated Pseudomonas aeruginosa. The patient made a good recovery following treatment with oral ciprofloxacin.

Drug Induced Hepatitis pada Tuberkulosis Paru dengan Multisite Tuberkulosis Ekstraparu

Background: Tuberculosis (TB) continues to be a major health problem in developing country. Lung is the most common site for Mycobacterium tuberculosis (MTB) infection, but dissemination may occur to any part of the body resulting in extrapulmonary TB. Hepatotoxicity is one of the most frequent adverse events that occur during TB treatment. Case: A 35-year-old female patient came with cough, dyspnea, fever, abdominal pain, history of mass in right inguinal lymph node, and malnutrition. Histopathology from excisional biopsy of inguinal lymph node showed granulomatous inflammation. Computed tomography of abdomen showed intraabdominal TB. Chest X-ray showed right pleural effusion, with exudate pleural fluid and mononuclear dominant. After 1 week consuming antituberculous drug, patient got nausea and vommiting, increased of ALT and AST, total and direct bilirubin. Antituberculous drug was stopped and switched to levofloxacin, ethambutol, and streptomycin. After clinical improvement and liver function return to normal, desensitization of rifampicin and isoniazide was started. Desensitization started with rifampicin for three days, and followed with isoniazide for three days. In total, the patient got rifampicin, isoniazide, and ethambutol for 9 months. Evaluation of treatments are clinical improvement and weight gain. Acid fast baccili sputum was negatif, no pleural effusion on chest X-ray, and normal abdominal ultrasound. Conclusion: MTB can spread to other organs which cause multisite extrapulmonary TB. Side effect can occur during TB treament, and this is not the reason to stop the therapy. Individual ATD therapy shows good response in this case.