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    • Spinal TB has a wide variety of manifestations and

    2018-11-12

    Spinal TB has a wide variety of manifestations, and the infected spinal vertebra causes inflammation and instability, which initially constitutes axial pain. The most common symptom in our patients was back pain (77%) and systemic symptoms such as fever were seldom noticed (8%), which were consistent with other reports. As the inflammation proceeds, osseous destruction ensues and more instability can cause deformity and compressing the cord or spinal roots, subsequently causing neurological deficits. In addition, overt infection and spreading through weakened tissue can progress to abscess formation, which can cause rad51 and neurological deficits as well. In our study, the patients with complete paralysis (15%) and fecal or urinary incontinence (8%) were much more frequent than that in western Taiwan. This may be due to the limited medical institutes in a large geographic area and uneven distribution of medical hospitals in eastern Taiwan. In addition to the neurological symptoms, our data showed more vertebral segments involvement compared to the report in western Taiwan. Images are important for diagnosis and clinical decision making in treating spinal TB, diagnostic role of various imaging modalities have been discussed in previous literature. Magnetic resonance imaging (MRI) and spiral computed tomography are most commonly used nowadays. MRI has appreciable accuracy, and thus is favored in evaluation the neuronal damage in patients with spinal TB. In addition, our two patients had noncontiguous spinal TB, as similar prevalence reported from other studies. Kaila et al had reported that with whole spinal MRI, the incidence of multiple-level noncontiguous spinal tuberculosis reaches 71.4%. The prevalence of noncontiguous spinal TB in our study can be even higher if all patients received whole spinal MRI. Thus, whole spinal MRI for spinal TB needs to be considered for possible multiple-level noncontiguous lesions. The rate of disc involvement in our study was 38%; an even higher rate was published in a previous study. This can be a conflict with our previous knowledge that M. tuberculosis cannot cause disc destruction in comparison with pyogenic spinal infection. Chang et al also reported that spinal TB can cause discitis at a considerable rate, but this is less prevalent and less severe compared with pyogenic spondylitis. The disease distribution in spinal vertebral bodies showed a thoracolumbar spine predominance, in over half of all cases with spinal TB. Our disease distribution was similar to that of other reports. Most of our patients received surgical managements plus anti-TB drugs in spite of medical treatment only (82%), and platelets percentage was analogous to that in western Taiwan and slightly higher than that from France, and much higher than that in Kenya (25.6%). In the available clinical outcomes of our 36 patients, 29 patients received surgery and most (76%) achieved clinical improvement; only 29% of patients without surgery achieved neurological improvement. Patients rad51 of TB spine who received surgery had a better clinical outcome. In recent studies, the surgery of TB spondylitis may improve quality of life and infection control, especially in patients infected by multidrug resistant strands. Pharmacologic therapy for treatment of spinal TB is generally the same as for pulmonary TB. For patients without previous pharmacologic therapy for TB, 6 months of therapy with the four-drug combination (isoniazid, rifampin, ethambutol, and pyrazinamide in first 2 months, and above agents without pyrazinamide in the following 4 months) is sufficient. Reports have demonstrated that a 6-month short-course treatment is not inferior to longer treatment courses. In our patients, the treatment course was from 9 months to 1 year, as mentioned in previous TB treatment guidlines.
    Introduction In the first four decades of life, trauma is the leading cause of death and disability in most countries. Total annual trauma-related costs in terms of wage losses, medical expenses, insurance administration, and indirect work losses, as well as emotional costs, impose an overwhelming burden on family members and the general community. Trauma is a complicated surgical disease that requires timely, specialized, and team-approached care. Many clinical studies have shown that severely injured patients have the best outcome at designated trauma centers, where overall trauma care from the accident scene to in-hospital care, and even to rehabilitation, is well orchestrated. However, establishment of such a system requires extensive financial resources and cooperation between hospitals. In addition, the unpredictable nature of trauma care may generate increasing demands for various hospital services, and can thus potentially disrupt other programs in the hospital. Furthermore, the different trauma patient populations, injury patterns, and distinctive cultures and customs in Taiwan prevent the adoption of established foreign trauma systems.