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At least 613 records · Page 34Linked to original sources
PubMed2002

Spinal brace in tuberculosis of spine.

OBJECTIVE: To present our experience in the management of 22 patients with thoracolumbar spine tuberculosis (TB) using a chemotherapy regimen and locally custom-made spinal brace. METHODS: Twenty-two patients with thoracolumbar spine TB had been treated conservatively by chemotherapy and locally custom-made spinal brace and followed for 36-48 months from June 1996 to June 2000 in the Department of Orthopedics and Trauma, Algamhoria Teaching Hospital, Aden, Republic of Yemen. In 14 cases, 2 vertebrae were involved, whereas in 8 cases involvement was only of one vertebra. All had persistent back pain: 2 had neurological deficit, Frankel grade A and B (9%), and 12 (54%) had gibbus deformity. RESULTS: At the end of the observation period, all patients had no pain (based on the adjective rating scale). Fourteen thoracic and 3 psoas abscesses resolved by 18 months. Four cases (18%) had deterioration of the angle of kyphosis. Five cases (22.5%) had progressive vertebral loss. Twelve cases (84%) had bony fusion at 36 months. CONCLUSION: Chemotherapy regimen and locally custom-made spinal brace is not costly, needs neither admission nor surgical intervention that demands skills and experience and can be recommended for uncomplicated thoracolumbar spinal TB.

Adolescent↗
PubMedDate not supplied

Multiple spontaneous enterocutaneous fistulae in malakoplakia.

Malakoplakia is a rare chronic inflammatory disease, usually involving the urogenital tract. We report a patient who presented with a psoas abscess, and later developed colocutaneous fistula at the site of abscess drainage and multiple spontaneous fistulae away from the site of incision. Histology of the resected specimen showed Michaelis-Gutmann bodies, which are diagnostic of malakoplakia.

Adult↗
PubMedDate not supplied

Rare surgical complications of Crohn's disease. Clinical and therapeutic considerations.

We present our clinical experience in the management of rare surgical complications in Crohn's disease. Two hundred and eight patients affected by Crohn's disease were treated surgically between January 1992 and September 2001, at the Department of Surgical and Gastroenterological Sciences of the University of Padua. Rare surgical complications were identified in 17 patients (6.2%): 4 with small intestine adenocarcinoma, 5 with massive gastrointestinal bleeding, 5 with free peritoneal perforation and 3 with psoas abscesses. The very substantial clinical variability of Crohn's disease is a constant challenge to researchers. In particular, the high incidence of associated pathologies and complications related to Crohn's disease makes this pathology extremely disabling. In addition, this disease quite often appears to occur together with a rare complication which, though in most cases its course tends to remain unknown, at times may be potentially life-threatening. For this reason, it is crucial to suspect the occurrence of these pathologies, especially in patients responding poorly to therapy or in those whose symptoms suddenly become acute. Early diagnosis and treatment are therefore fundamental for the most appropriate treatment to be administered.

Adolescent↗
PubMed2005

[Certain aspects of the present-day diagnosis and treatment of iliopsoitis].

MR-tomography is known to be a valuable method of investigation. It allows to get a picture of thin layers of the human body in any section. In addition, it facilitates the diagnosis of inflammatory alterations to the muscles of the retroperitoneal space before the development of purulent phases of inflammation. The difficulties of the diagnosis of pyo-inflammatory diseases are leveled due to practical possibility of MRT to detect the inflammation focus.

Drainage↗
PubMed1990

Brucellosis of the spine.

Eight cases of spinal brucellosis are included in this study. Diagnosis was established by positive serology. Back pain was the most common complaint. Functional disturbance in walking was observed in three cases; in two others this was because of impairment of cord function. Clinical hepatosplenomegaly was found in one case. Subclinical organomegaly was diagnosed in two other patients. Psoas abscess was identified by computed tomographic scan in two separate cases. Response to drug therapy and surgical decompression, when indicated, resulted in complete recovery in all patients.

Adolescent↗
PubMed1990

[Obstructive uropathy as initial manifestation of Crohn disease].

A patient with renal colicky pain caused by urinary tract obstruction, as a result of psoas abscess, is presented. It was the first manifestation of Crohn's disease. A Gram negative bacteria was isolated from the abscess. The CT images performed to evaluate the abscess suggested this etiology, even though there were no previous symptoms.

Abscess↗
PubMed1988

Tuberculosis: a surgical viewpoint.

Over the past 15 years, 32 cases of tuberculosis have been seen and diagnosed in the surgical and gynaecological departments of the Northern General Hospital, Sheffield. The average age of patients was 42.8 years. Of the sites affected, 17 had head, neck or axillary swellings, 6 affected the female genital tract, 3 had intra-abdominal tuberculosis, 2 presented with soft tissue swellings on the trunk or limbs, 2 affected the male genitourinary system, whilst the remaining cases presented with an ischiorectal and psoas abscess. The time delay between initial consultation and diagnosis being established was between 1 and 8 months. In only 7 (21.8%) cases was a correct preoperative diagnosis made, with only 8 patients being clinically unwell at presentation. Twenty-three received antituberculous chemotherapy and there was one death. Tuberculosis will not be diagnosed or correctly treated unless it is considered in the differential diagnosis and appropriate specimens sent for bacteriology and histology. We conclude that tuberculosis is still prevalent in the surgical departments and both general surgeons and gynaecologists should consider the diagnosis more frequently than is currently the case.

Adolescent↗
PubMed1985

Septic arthritis of the hip joint: sonographic and CT findings.

Two patients with acute bacterial arthritis of the hip joint were suspected clinically to have a psoas abscess. For this reason a computed tomographic scan of the abdomen and pelvis (two patients) and ultrasonography (one patient) were requested. These scans showed no evidence of an abscess in the abdominal cavity nor retroperitoneum but did demonstrate a hip joint effusion which was compatible with septic arthritis.

Adolescent↗
PubMed1980

Pott's disease before Pott.

Pott's disease, i.e. caries of the spine with gibbosity, psoas abscesses and palsy, has been known since antiquity, its relation with tuberculosis suspected, as is seen in the Hippocratic writings. In the 18th century cases were studied in France and England; in the Netherlands by Hovius, Camper, Bonn and Coopmans. The most lucid descriptions however were those of SIR PERCIVALL POTT (1779). An annotated Dutch translation by DU PUI (1779) called attention to the treatment of this disease which was on the increase. In retrospect the eponym 'Pott's disease' seems well deserved.

History, 16th Century↗
PubMed1995

Pulse cyclophosphamide therapy for refractory autoimmune thrombocytopenic purpura.

Autoimmune thrombocytopenic purpura (AITP) is generally a chronic disorder in affected adults. Twenty-five percent of these patients will become refractory to routine therapy (corticosteroids and splenectomy), as well as most other available agents. Intravenous pulse cyclophosphamide therapy was used to treat 20 patients with severe refractory AITP who had previously failed to achieve a sustained remission with a mean of 4.8 agents (range 2 to 8). Patients received 1 to 4 doses (mean 2.0) of 1.0 to 1.5 g/m2 intravenous cyclophosphamide per course. Of the 20 patients treated with pulse cyclophosphamide therapy, 13 patients (65%) achieved a complete response (CR), four (20%) a partial response (PR), and three patients (15%) failed to respond. Of the 13 complete responders, eight have remained in remission with stable platelet counts during followup intervals of 7 months to 7 years (median 2.5 years). Five patients developed recurrent AITP 4 months to 3 years following a CR. Of these, two patients responded to subsequent courses of pulse cyclophosphamide therapy with current remissions of 1 and 4 years. Of the four patients who obtained a PR, two remain in partial remission after 10 months and 4 years; one relapsed after 18 months and, after retreatment, is still in remission at 6 months. Of the patient characteristics examined, duration of disease was most strongly associated with response to pulse cyclophosphamide. Side-effects of treatment included neutropenia (three patients, one of whom developed staphylococcal sepsis), acute deep venous thrombosis (two patients), and psoas abscess (one patient). Intravenous pulse cyclophosphamide should be strongly considered in the treatment of patients with refractory AITP. There is a relatively low incidence of side-effects, and it can be administered easily on an out-patient basis.

Adolescent↗
PubMed1993

[Pyogenic sacroiliitis. Presentation of 10 cases].

We report the clinical, radiological and microbiological features of ten patients diagnosed of pyogenic sacroiliitis in an Internal Medicine Department during a 13 years period. Clinical signs and radiological or scintigraphical findings were present in every case. Staphylococcus aureus was isolated in blood cultures in eight cases. We remark mean age (26.2 years), male predominance and the high prevalence of intravenous drug abuse as the main epidemiological data in our patients. Onset was acute in 60% of the cases, and subacute in the others. Erythrocyte sedimentation rate and a high white blood cell count were uniformly elevated among laboratory tests. Initial roentgenograms were normal in 60%. Bone scans were the most sensitive diagnostic aid. All the patients were treated with intravenous cloxacilin between two and eight weeks; aminoglycosides were added in four patients. We have observed two cases of psoas abscesses that required surgical drainage.

Adolescent↗
PubMed1993

Computed tomographic findings of abdominal tuberculosis--report of five cases.

Five patients with proven intra-abdominal tuberculosis were examined with computed tomography (CT) over a period of one year. This revealed hepatosplenomegaly in all five cases. Macroscopic nodules were noted in the liver and spleen in three cases. All three cases showed more severe involvement of the spleen over the liver. Other features were enlarged (para-aortic, para-caval, peripancreatic and mesenteric) nodes, ascites, stellate mesentery and thickened bowel wall. Incidental extra-abdominal findings included intrathoracic nodules, pleural effusion, pericardial effusion with constrictive pericarditis, bony osteomyelitis and psoas abscess. Follow-up CT was performed on four of the five cases and showed significant resolution of the above findings. In addition, one case showed calcification within a healing splenic nodule. The presence of macroscopic nodules detected on CT, especially in the spleen, is an unusual finding in prior reports. This paper attempts to account for its high local incidence and discusses the significance of other findings in the diagnosis of abdominal tuberculosis.

Adult↗
PubMed1993

Another look at spinal tuberculosis.

The steady decline in tuberculosis rates in Canada has led to a certain lack of awareness of the disease. We describe 7 patients with culture proven spinal tuberculosis, seen in a teaching hospital over a 10-year period. Persistent spinal pain and local tenderness were the most frequent presenting findings. There was a mean delay in diagnosis of 5.2 (range 1-18) months from the time of presentation. Only 2 patients had active extraspinal tuberculous infection. Plain spinal radiographs were the initial diagnostic procedure of choice showing a destructive vertebral lesion in 5 of 7 patients. Computed tomography (CT) played an important role in delineating the discovertebral lesion and in demonstrating a paraspinal soft tissue infection in 6 (85%) of 7 patients: psoas abscess in 4 (2 with epidural extension), epidural abscess in one, and a neck abscess in one. Magnetic resonance imaging (MRI) in one patient enabled a more complete definition of the vertebral infection and its soft tissue extensions. Two patients were successfully treated with combination antituberculous chemotherapy alone, and 5 required adjuvant surgical procedures. Our study stresses the need for increased alertness to this now uncommon but treatable spinal infection, and emphasizes the diagnostic usefulness of CT and MRI in defining subtle discovertebral lesions and in detecting unsuspected paravertebral soft tissue extension.

Abscess↗