Secondary anaerobic infection in a case of multidrug resistant tubercular paraspinal abscess: A rare presentation

Introduction

Paraspinal abscesses are most commonly caused by Staphylococcus aureus and some Gram-negative bacteria. In developing countries, Mycobacterium tuberculosis (MTB) contributes to almost 50 % of cases. Even in proven cases of tubercular paraspinal abscesses, secondary infection of aerobic or anaerobic bacteria is possible and should be carefully evaluated for proper management.

Case report

A type I diabetes mellitus patient presented with chronic backache and lower limb weakness and radiological investigations showed paraspinal collections suggestive of tuberculosis. The patient was then started on anti-tubercular drugs, she initially responded and then showed gradual deterioration in the form of increased pain, fever and pus discharge. Aerobic cultures of pus were sterile and anaerobic culture grew Peptoniphilus asaccharolyticus sensitive to metronidazole. Appropriate treatment had resulted in clinical improvement.

Conclusion

Suspicion about co-infection with aerobic or anaerobic bacteria should be high even in proven cases of tubercular paraspinal abscess not improving despite proper anti-tubercular therapy.

C2 Nerve Root Preservation During Posterior Fixation for Instability Secondary to Congenital Craniovertebral Junction Anomalies: Feasibility Factors and Related Outcomes

OBJECTIVE

Patients with instability because of congenital craniovertebral anomalies often have complex C1-C2 osseovascular anomalies. C2 nerve root sacrifice has been described to address such difficult anatomy during posterior C1-C2 fixation and has its own downsides. Its preservation as a recent alternative poses greater surgical challenge, and the considerations differ from other causes of craniovertebral junctional instability; the pertaining outcomes have been scarcely studied. The objective of this study was to prospectively determine the feasibility and outcomes related to C2 nerve root preservation in patients with congenital atlantoaxial dislocation (CAAD) after posterior C1-C2 fixation.

METHODS

In this observational study, 63 patients (126 nerve roots) with CAAD after posterior fixation were prospectively assessed. Underlying osseovascular anomalies affecting the feasibility of C2 nerve root preservation, and C2 nerve-related dysfunction at 12 months follow-up were analyzed.

RESULTS

The overall C2 nerve root preservation rate was 89.7%. Even in the presence of extreme joint obliquity/spondyloptosis and anomalous vertebral artery, it was feasible in about three fourths. After preservation, 28.3% patients developed new-onset C2 nerve root dysfunction: neuralgia in 2, dysesthesia in 6, and hypoesthesia/paresthesia in 9. The symptoms were not disabling in most patients.

CONCLUSIONS

In most patients with CAAD, C2 nerve root preservation is feasible despite an aberrant bony and vascular anatomy. A few patients after nerve root preservation develop related symptoms that are conservatively manageable, with no significant adverse consequences. Given the controversy in the literature on C2 nerve sacrifice-related outcomes, we favor an attempt at C2 nerve root preservation.

Bilateral persistent 'second' intersegmental vertebral arteries: illustrated with a case

Congenital craniovertebral junction deformities can be associated with an anomalous vertebral artery (VA). At times, the artery crosses the joint posteriorly (i.e., persistent first intersegmental artery) and is at risk during posterior approach. We report a new variant, wherein the bilateral VA coursed medially after exiting the C3 transverse foramina to lie beneath C2 pars interarticularis and enter the foramen magnum (without passing through C2 transverse foramen anywhere along its course). This is possibly a result of bilateral persistent second intersegmental arteries. It is pertinent to recognize this unusual variant to avoid VA injury, especially while inserting C2 pars/transarticular screw.

Geriatric medicine: model for computer-oriented research analysis

It is important to have accurate information derived from basic data about geriatric patients, not only for clinical management but to anticipate changes in the demand for services and the taking of preventive action. A model is presented for computer-oriented analysis. The collection of data is designed to cover the specific physical, physiologic and social needs of the patients both in the hospital and in the community. It must also support effective action about these needs which involve not only usage of existing facilities but the planning of preventive measures and adjustment of the provision for care. In addition, it must support clinical research when necessary. Geriatric records have specific problems, not only those of the patient's identity and clinical data but also the maintenance of psychologic and social information so that the requirements for long-term care can be assessed. This type of record facilitates comparison between groups of patients and allows measurement of inter-hospital performance relating to medical care and the planning of social programs in the community. Such records furnish the background of a more detailed statistical analysis for indicating the direction of national policy. By this means the prevalence of medical, psychologic and social demand can be studied and various preventive actions taken, including the monitoring of geriatric facilities.

Corrugation of the skull in Paget's disease of bone

Paget's disease of bone has been known for about 100 years and the usual deformities of bone, e.g. bowed tibia, large head, are well described in medical text books. However, there does not appear to have been a description of corrugation of the skull as a recognized deformity in Paget's disease. Three cases are now described to illustrate this deformity as an unusual but valuable sign in this disease.

Pulmonary function study in old age

A study was carried out in 100 patients aged between 70 and 90 years to investigate pathological and respiratory function changes in old age. Vitalograph and peak flow meter measurements were made, but blood gas analysis was only carried out in 6 patients in view of the technical difficulties. Analysis of the results showed that there was a definite, moderate, restrictive type of defect in pulmonary function in almost all the patients, in those with generalized senile changes as well as in those with a pathological condition. Blood gas analysis showed a minimum degree of alteration in oxygen tension and saturation with normal carbon dioxide tension.

"Bucket" ulcer

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