RESUMEN
STUDY DESIGN: Case reports and survey of literature. OBJECTIVE: Case reports of two women with tuberculosis (TB) of the spine (Pott's disease) presenting with severe back pain and diagnosed as compression fracture are described. Physicians should include Pott's disease in the differential diagnosis when patients present with severe back pain and evidence of vertebral collapse. SETTING: Ohio, USA METHODS: A review of the literature on the pathogenesis, pathophysiology, clinical presentation, diagnostic methods, treatment and prognosis of spinal TB was conducted. RESULTS: After initial delay, proper diagnosis of spinal TB was made in our patients. Microbiologic diagnosis confirmed M. tuberculosis, and appropriate medical treatment was initiated. CONCLUSIONS: Although uncommon, spinal TB still occurs in patients from developed countries, such as the US and Europe. Back pain is an important symptom. Vertebral collapse from TB may be misinterpreted as 'compression fractures' especially in elderly women. Magnetic resonance imaging scan (MRI) is an excellent procedure for the diagnosis of TB spine. However, microbiologic diagnosis is essential. Mycobacterium tuberculosis may be cultured from other sites. Otherwise, biopsy of the spine lesion should be done for pathologic diagnosis, culture and stain for M. tuberculosis. Clinicians should consider Pott's disease in the differential diagnosis of patients with back pain and destructive vertebral lesions. Proper diagnosis and anti-tuberculosis treatment with or without surgery will result in cure.
Asunto(s)
Errores Diagnósticos/prevención & control , Fracturas de la Columna Vertebral/diagnóstico por imagen , Fracturas de la Columna Vertebral/patología , Vértebras Torácicas/diagnóstico por imagen , Vértebras Torácicas/patología , Tuberculosis de la Columna Vertebral/diagnóstico por imagen , Tuberculosis de la Columna Vertebral/patología , Anciano , Dolor de Espalda/diagnóstico por imagen , Dolor de Espalda/microbiología , Dolor de Espalda/patología , Diagnóstico Diferencial , Femenino , Fiebre/microbiología , Humanos , Cifosis/diagnóstico por imagen , Cifosis/microbiología , Cifosis/patología , Persona de Mediana Edad , Mycobacterium tuberculosis/patogenicidad , Radiografía , Fracturas de la Columna Vertebral/microbiología , Vértebras Torácicas/microbiología , Resultado del Tratamiento , Tuberculosis de la Columna Vertebral/fisiopatologíaRESUMEN
Management of the neuropathic bowel is one of the major issues in the treatment of patients with severe spinal cord injury (SCI). Pulsed irrigation evacuation (PIE) has been evaluated in several small studies for the clearing of fecal impactions in patients with a neuropathic bowel. We evaluated our experience with 398 PIE procedures performed on inpatients and outpatients at our facility. It has proven to be both safe and effective in a wide variety of patients with this disorder, and is a useful addition to traditional methods in the management of the neuropathic bowel.
Asunto(s)
Estreñimiento/rehabilitación , Incontinencia Fecal/rehabilitación , Recto/inervación , Traumatismos de la Médula Espinal/rehabilitación , Irrigación Terapéutica/instrumentación , Adulto , Anciano , Estreñimiento/etiología , Diseño de Equipo , Seguridad de Equipos , Incontinencia Fecal/etiología , Femenino , Humanos , Masculino , Traumatismos de la Médula Espinal/complicaciones , Irrigación Terapéutica/métodos , Resultado del TratamientoRESUMEN
Fecal impaction is a common problem in patients with neurologic impairment. The pulsed irrigation enhanced evacuation (PIEE) procedure is a new method of clearing fecal impactions using pulses of small amounts of warm water to rehydrate stool and improve peristalsis. Thirty-seven PIEE procedures were performed on 28 patients with a variety of neurologic problems. The PIEE procedure was observed to be effective and safe. It should be a useful adjunct to a proper bowel management program.