ABSTRACT
SETTING: The diagnosis of bone and joint tuberculosis (BTB) is difficult, and diagnostic delays often occur. A reliable serological test detecting anti-mycobacterial antibodies would thus be of some use in this form of the disease. OBJECTIVE: To evaluate the diagnostic accuracy of an assay detecting IgG against 38-kDa and 16-kDa recombinant mycobacterial antigens in BTB. MATERIALS AND METHODS: In a prospective study, serum samples from 124 subjects were examined: 30 BTB cases, 40 non-specific bone and joint infection patients (NSBI), 30 lung cancer patients (LC), and 24 healthy volunteers (HC). An ELISA-based test (Pathozyme TB complex plus) was used. RESULTS: The cut-off level was established at 150 U/ml according to receiver operating characteristic (ROC) curves. The quantified level of sensitivity of the test detecting BTB was 56%, at a specificity of 99%. The positive and negative predictive values were respectively 94% and 88%. Mean IgG level in the BTB group was 470 +/- 761 U/ml (mean +/- SD), and was significantly higher than the antibody level in the control groups (NSBI 58 +/- 42 U/ml, LC 43 +/- 38 U/ml, HC 40 +/- 29 U/ml). CONCLUSION: The test presents an acceptable level of sensitivity and very good specificity in the diagnosis of BTB, and can be used in combination with other methods to increase diagnostic accuracy in this disease.
Subject(s)
Antigens, Bacterial/immunology , Immunoglobulin G/blood , Lipoproteins/immunology , Tuberculosis, Osteoarticular/immunology , Adult , Aged , Aged, 80 and over , Antibodies, Bacterial/analysis , Enzyme-Linked Immunosorbent Assay , Female , Humans , Male , Middle Aged , Predictive Value of Tests , Prospective Studies , Sensitivity and SpecificityABSTRACT
Results of surgical treatment for supraacetabular cystic changes in 8 middle-aged females are presented. Complete excision and filling the defect with iliac autografts has been performed, histological examination of the change followed in all cases. No inflammatory, systemic or neoplasmatic changes were identified. Good results were achieved and hip osteoarthritis delayed. Surgery proved useful in treatment for supraacetabular cystic changes in the hip.
Subject(s)
Acetabulum/surgery , Bone Cysts/surgery , Adult , Female , Humans , Middle Aged , Treatment OutcomeABSTRACT
The diagnosis and treatment for tuberculosis of the spine, based on own material from years 1992-97 (CMKP Orthopedic Department, Otwock) is presented. One hundred twenty nine patients were treated in these years, 85 of them surgically. The disease appeared usually in 4th, 5th or 6th decade of life, two adjacent vertebral bodies within lower thoracic spine were involved. Contemporary surgical methods as well as approved antibacterial treatment protocols are presented. Twenty-five per cent patients displayed symptoms of neurological impairment, namely paresis or plegia of the lower extremities. Good results of treatment in 85% of cases and only 3% poor results prove efficiency of the management suggested.
Subject(s)
Tuberculosis, Spinal/diagnosis , Tuberculosis, Spinal/therapy , Adult , Aged , Female , Humans , Male , Middle Aged , Retrospective Studies , Treatment OutcomeABSTRACT
Complications caused by manipulation therapy in 3 cases of spine condition and 22 cases of vertebral disc disease observed in relatively short period of time are presented. In the first instance the patients were not diagnosed by physician. In the second one in all cases the nucleus pulposus protruded under the anterior ligament or into the spinal canal. It resulted in marked worsening of the patient's condition. The mechanism of disc damage has been determined intraoperatively. The authors conclude that manual therapy not preceded by precise diagnosis is highly hazardous.
