RESUMO
BACKGROUND: In Indian subcontinent where tuberculosis is endemic, the spinal infection was thought to be due to mycobacterium tuberculosis in most of the cases. Hence there is a practice of treating these patients with empirical antitubercular treatment. However, recent guidelines advice biopsy and tissue diagnosis before starting antibiotics. OBJECTIVE OF STUDY: Our retrospective study analyses the role of biopsy in establishing the microbiological diagnosis and thus identifying the incidence of pyogenic and tubercular spondylodiscitis presented to a tertiary care centre. MATERIALS AND METHODS: All patients who were diagnosed as spondylodiscitis by clinical and radiological criteria and who underwent biopsy were included in the study and data was retrieved from medical records and PACS. Criteria for tubercular spondylodiscitis included presence of mycobacterium tuberculosis either in smear/gene Xpert, or histopathological evidence of tuberculosis. Organism isolation other than MTB or absence of tubercular granuloma and response to antibiotics were considered as non-tubercular aetiology. RESULTS: Our study achieved 84% (n-63) accuracy for first biopsy and 34 patients (53.96%) were diagnosed as pyogenic spondylodiscitis. Organisms were isolated in 11 cases (32%) of pyogenic spondylodiscitis and tubercular bacilli in 17 cases (65%) of tubercular spondylodiscitis. Aspiration of pus yielded better isolation of organisms (P < 0.001) in pyogenic spondylodiscitis. 11% of cases showed drug resistant tuberculosis. CONCLUSION: We conclude that there is an increasing trend of pyogenous spondylodiscitis compared to tubercular spondylodiscitis in patients presenting to tertiary care centre, hence biopsy is essential to start antimicrobials.
Assuntos
Antibacterianos/uso terapêutico , Biópsia por Agulha/métodos , Discite , Mycobacterium tuberculosis , Tuberculose da Coluna Vertebral , Antibacterianos/classificação , Biópsia com Agulha de Grande Calibre/métodos , Diagnóstico Diferencial , Discite/microbiologia , Discite/patologia , Resistência Microbiana a Medicamentos , Feminino , Humanos , Índia/epidemiologia , Masculino , Técnicas Microbiológicas/métodos , Pessoa de Meia-Idade , Mycobacterium tuberculosis/efeitos dos fármacos , Mycobacterium tuberculosis/isolamento & purificação , Seleção de Pacientes , Estudos Retrospectivos , Supuração/microbiologia , Tuberculose da Coluna Vertebral/diagnóstico , Tuberculose da Coluna Vertebral/patologiaRESUMO
Giant cell tumour of the distal humerus is rare. We report one such case in a 30-year-old man who underwent wide resection of the tumour followed by total elbow arthroplasty using a cemented 'sloppy-hinged' total elbow prosthesis. At the 18-month follow-up, the patient had pain-free range of motion of 15º to 120º and no evidence of recurrence.
