A Rare Presentation of Tuberculosis

2006 ◽  
Vol 72 (1) ◽  
pp. 96-97
Author(s):  
Xian Zhao ◽  
Stephen Chen ◽  
Abe Deanda ◽  
Jon Kiev
Keyword(s):  
Musculoskeletal System ◽  
Postoperative Management ◽  
Antitubercular Therapy ◽  
Musculocutaneous Flap ◽  
Rare Presentation ◽  
Extensive Debridement ◽  
Flap Closure

Primary involvement of the musculoskeletal system with tuberculosis is rare. We present a case of a young, immunocompetent woman with primary sternal tuberculosis. The disease led to destruction of the manubrium and a portion of the gladiolus and required extensive debridement and partial sternectomy, followed by musculocutaneous flap closure. Long-term postoperative management included four-drug antitubercular therapy.

Isolated multidrug-resistant tubercular tenosynovitis of the flexor tendon of the little finger

2021 ◽  
Vol 14 (2) ◽  
pp. e238339
Author(s):  
Sunny Chaudhary ◽  
Subhajit Maji ◽  
Varun Garg ◽  
Vivek Singh
Keyword(s):  
Flexor Tendon ◽  
Extrapulmonary Tuberculosis ◽  
Functional Limitation ◽  
Clinical Signs ◽  
Multidrug Resistant ◽  
Interesting Case ◽  
Antitubercular Therapy ◽  
Histopathological Diagnosis ◽  
Rare Presentation ◽  
Little Finger

Isolated multidrug-resistant (MDR) tubercular tenosynovitis of the flexor tendons of finger without involvement of wrist is a rare presentation. Tenosynovitis of hand is an uncommon manifestation of extrapulmonary tuberculosis. Pyogenic flexor tenosynovitis of hand is frequently seen and is the closest differential. Non-specific clinical signs may lead to delay in diagnosis, which is often made after biopsy. Management includes surgical excision of necrotic tissue and infected synovium along with antitubercular therapy after histopathological diagnosis. MDR tuberculosis of hand is extremely rare and, to the best of our knowledge, has not been reported in the literature so far. We report an interesting case of MDR tubercular flexor tendon tenosynovitis of the little finger without any pulmonary involvement in an immunocompetent patient. The case was managed by complete synovectomy and second-line antitubercular therapy with complete resolution of disease and had no functional limitation.

scholarly journals MANAGEMENT OF THE SURGICAL SOLUTIONS FOR FEEDING – A PREVENTION FACTOR FOR NUTRIENT BALANCE IMPAIRMENT

2017 ◽  
Vol 64 (3) ◽  
pp. 194-200
Author(s):  
Corneliu Tudor ◽  
◽  
Costel Şavlovschi ◽  
Cristian Brănescu ◽  
Ahed El-Khatib ◽  
...  
Keyword(s):  
Nutrient Balance ◽  
Surgical Techniques ◽  
Postoperative Management ◽  
Postoperative Surveillance ◽  
Feeding Tubes ◽  
Term Evolution ◽  
Long Run ◽  
Nursing Services ◽  
Limited Period

Aim. The paper aims, thanks to the long-standing practice, to synthesize the clinical experience gained during the surgery for feeding tubes management and highlight the details we had to deal with in order to overcome the local and general difficulties. Materials and method. A retrospective study was carried out over a period of 20 years (1996-2016), on the patients who underwent surgery for placing feeding tubes in our clinic. They were analyzed: the techniques used, the long-term evolution, the complications and the incidents and the way they were solved. Results. A total of 329 patients were enrolled in the study. The surgical techniques used were: classic surgical solutions (300 cases) and percutaneous endoscopic gatrostomy (PEG, 29 cases). For classical interventions, post-operative evolution was good in 219 patients (73%) and was complicated by various accidents and incidents in 81 cases (23%). The study presents the causes that may lead to these complications, the local and general, clinical and paraclinical consequences and the correct surgical attitude, as well as particular cases that required the adaptation of the surgical techniques to local anatomical and functional polymorphism. In the long run, the jejunostomy appears to be relatively inferior to gastrostomy, in terms of toland efficiency. PEG complications were minor and transient, but the reduced number of cases and the limited period of postoperative surveillance did not allow statistically significant conclusions to be drawn. Conclusions. The postoperative management of surgical feeding solutions requires permanent collaboration between surgeon, patient and outpatient nursing services at home and requires knowing and observing of a specific nursing protocol to avoid disturbing the nutrient balance of the patient.

scholarly journals Economic components of the morbidity and rehabilitation of the musculoskeletal system as factors of the organization of the system of physical therapy at the ambulatory stage

2020 ◽  
Vol 6 (1) ◽  
pp. 57
Author(s):  
S. М. Fedorenko ◽  
M. S. Balazh ◽  
V. V. Vitomskyi ◽  
О.B. Lazarіeva ◽  
M. V. Vitomskа
Keyword(s):  
Physical Therapy ◽  
Musculoskeletal System ◽  
Economic Feasibility ◽  
Economic Consequences ◽  
Medical Reform ◽  
High Incidence ◽  
Permanent Loss ◽  
Need For Rehabilitation

<p><strong>The aim</strong>:  to consider the economic consequences of morbidity and rehabilitation of the musculoskeletal system (MSS) among the able-bodied population to confirm the economic feasibility of using physical therapy and the development of its system in the country in order to reduce losses from MSS pathologies in Ukraine.</p><p><strong>Material and methods</strong>: the data of 63 literature sources on the prevalence of MSS diseases among the working population, their economic consequences (payments for treatment, employers' losses), the role of rehabilitation, physical therapy in reducing financial costs, and the needs of the population in rehabilitation and physical therapy were analyzed.</p><p><strong>Results.</strong> Occupational diseases of the MSS are characterized by long-term disability and a high incidence of disability. The effectiveness of rehabilitation, including economic, with injuries and diseases of the MSS was given great attention in the works of domestic and foreign authors. A significant amount of research has confirmed that the funds spent on the implementation of rehabilitation are reimbursed many times by reducing the periods of temporary and permanent loss of working capacity.</p><p><strong>Conclusion.</strong> The economic feasibility of directing the funds for rehabilitation and physical therapy in pathologies of the MSS is reflected in the short duration of disability, the period of adaptation of patients to work, and the need for rehabilitation. Therefore, channeling funds into building a rehabilitation and physical therapy system in Ukraine is appropriate in the framework of medical reform and will have long-term positive economic consequences.</p>

Distinct recurrence pattern in a case of bilateral tubercular posterior uveitis: reporting a unique clinical morphology and management challenge

2021 ◽  
Vol 14 (6) ◽  
pp. e241894
Author(s):  
Deepak Soni ◽  
Samendra Karkhur ◽  
Bhavana Sharma
Keyword(s):  
Immunosuppressive Therapy ◽  
Clinical Manifestations ◽  
Posterior Uveitis ◽  
Antitubercular Therapy ◽  
Endemic Region ◽  
Posterior Scleritis ◽  
Systemic Corticosteroids ◽  
Choroidal Granuloma ◽  
Recurrence Patterns

Intraocular tuberculosis has protean clinical manifestations and remains an important etiological differential for uveitis in an endemic region. A 27-year-old male presented with visual acuity of counting fingers close to face in right (OD) and 20/25 in left eye (OS). Examination revealed a choroidal granuloma in OS and healed serpiginous-like choroiditis in OD. Antitubercular therapy was started with systemic corticosteroids. Granuloma resolved completely; however, the patient presented with neuroretinitis and posterior scleritis, as first and second recurrence, respectively, within a oneyear period. These were managed with systemic corticosteroids and immunosuppressive therapy was added, after second recurrence. The patient responded well and maintains remission. This case presented a clinical challenge with distinct recurrence patterns of tubercular posterior uveitis in the same eye, which has not been reported before. Successful management entailed use of antitubercular therapy, corticosteroids, and immunosuppressive therapy in a step-ladder approach, resulting in preservation of vision and achieving long-term remission.

Medication-Induced Musculoskeletal Changes

2019 ◽  
pp. 322-326
Author(s):  
Winnie A. Mar
Keyword(s):  
Musculoskeletal System ◽  
Gold Standard ◽  
Imaging Modality ◽  
Femoral Fractures ◽  
Osteonecrosis Of The Jaw ◽  
Bisphosphonate Therapy ◽  
Atypical Femoral Fractures ◽  
Osteoblastic Activity ◽  
Induced Changes

Chapter 117 discusses common medication-induced changes of the musculoskeletal system. The effect of corticosteroids on the musculoskeletal system, including osteoporosis and osteonecrosis, is discussed. Corticosteroids decrease osteoblastic activity, stimulate bone resorption, and decrease intestinal absorption of calcium. Complications of bisphosphonate therapy such as atypical femoral fractures and osteonecrosis of the jaw are reviewed. Myopathies and tendon pathologies are briefly discussed, as well as bony changes potentially seen with long-term voriconazole treatment. For osteoporosis, DXA scan is the gold standard, whereas radiography is usually the first imaging modality performed in patients on voriconazole therapy who present with pain.

Brain Tumors

2020 ◽  
pp. 23-42
Author(s):  
Angela M. Bohnen ◽  
Kaisorn L. Chaichana ◽  
Alfredo Quinones-Hinojosa
Keyword(s):  
Differential Diagnosis ◽  
Brain Tumors ◽  
Demyelinating Disease ◽  
Intraoperative Complications ◽  
Postoperative Management ◽  
Treatment Modalities ◽  
Adjuvant Radiation ◽  
Term Care ◽  
Metastatic Lesions

Having a general understanding of brain tumors is integral to mastering the oral board examination. For the general session, examinees should be able to identify both intra-axial and extra-axial tumors and provide a comprehensive understanding of the differential diagnosis and plan regarding treatment, while also verbalizing concepts behind the treatment modalities and articulating to a patient and family the alternative approaches as well as the complications related to management. Pathologies to familiarize oneself with include gliomas, meningiomas, metastatic lesions, and pituitary lesions. For subspecialty examinees, complex cases such as endonasal, endoscopic, keyhole, and skull base approaches should be mastered. For each case, a broad differential diagnosis should include infection, hematoma, infarction, thrombosed aneurysm, inflammation, and/or demyelinating disease. Discuss the preoperative workup the indications for surgery and surgical approach. Interpret the preoperative and postoperative imaging critically. Be prepared for potential intraoperative complications and discussion of postoperative management including adjuvant radiation and chemotherapy and long-term care.

Musculoskeletal system

2011 ◽  
pp. 411-414
Author(s):  
Dr Mark Harrison
Keyword(s):  
Musculoskeletal System ◽  
Early Mobilization ◽  
Musculoskeletal Injuries ◽  
Pharmacological Intervention ◽  
Term Outcome ◽  
Long Term Outcome ◽  
System P ◽  
Inflammatory Drugs ◽  
Anti Inflammatory

8.1 Nonpharmacological measures, 412 8.2 Nonsteroidal anti-inflammatory drugs (NSAIDs), 412 8.3 Corticosteroids, 414 8.4 Drugs used in gout and hyperuricaemia, 414 • Management of musculoskeletal injuries and diseases involves more than just pharmacological intervention. • Consideration of splinting, physiotherapy, and early mobilization can be the most effective way to ease pain and improve long-term outcome....

scholarly journals Rhino–orbito–cerebral mucormycosis following penetrating keratoplasty

2019 ◽  
Vol 2019 (11) ◽  
Author(s):  
Lina H Raffa
Keyword(s):  
Wide Spectrum ◽  
Rapid Evolution ◽  
Serum Glucose ◽  
Rapid Progression ◽  
Corneal Transplant ◽  
Cranial Nerve Involvement ◽  
Rare Presentation ◽  
Uncontrolled Diabetes ◽  
Extensive Debridement ◽  
High Index Of Suspicion

Abstract Rhino–orbito–cerebral mucormycosis (ROCM) is a potentially devastating fungal infection with a significant fatality rate. Early diagnosis and prompt management are crucial to ensure a favorable outcome due to the recognized rapid progression. This case is a rare presentation of ROCM in a patient with uncontrolled diabetes following a corneal transplant. The procedure required early surgical resection in the first 30 hours of hospitalization. The patient received wide-spectrum antibiotics and antifungal treatment and underwent extensive debridement of the necrotic area. A high index of suspicion is needed to diagnose ROCM. Any diabetic patient with sinonasal disease and/or cranial nerve involvement, irrespective of their serum glucose or glycated hemoglobin levels, is a candidate for prompt evaluation to exclude mucormycosis. The rapid evolution of our case highlights the importance of treating ROCM promptly and aggressively.

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