Outcome of dogs diagnosed with concurrent intrahepatic portosystemic shunts and vertebral lesions: six cases (2016-2022).

OBJECTIVES: To describe the clinical outcome of dogs diagnosed with concurrent discospondylitis/vertebral physitis and congenital intrahepatic portosystemic shunts. MATERIALS AND METHODS: Medical records from two academic institutions were searched for dogs diagnosed with discospondylitis and/or vertebral physitis, and a concurrent intrahepatic portosystemic shunt. Dogs were excluded if they did not undergo attenuation of their shunt, did not have a single congenital intrahepatic shunt and did not have at least 90 days of follow-up. RESULTS: Six dogs met the inclusion criteria and were included in the study. Discospondylitis alone was diagnosed in four dogs, vertebral physitis alone in one dog and both discospondylitis and vertebral physitis in one dog. Three dogs had a right divisional intrahepatic portosystemic shunt, and three dogs had a left divisional intrahepatic portosystemic shunt. Median duration of antimicrobial therapy was 112 days (range 14 to 240 days). Clinical resolution of discospondylitis and vertebral physitis was noted in all dogs. Endovascular attenuation was performed in all dogs a median of 82 days after presentation (range 1 to 317 days). No perioperative or postoperative complications occurred. All dogs were alive at the last available follow-up a median of 513 days after presentation (range 224 to 1504 days) and free of clinical signs associated with discospondylitis or vertebral physitis, as well as their portosystemic shunt. CLINICAL SIGNIFICANCE: Dogs with intrahepatic portosystemic shunts may concurrently develop discospondylitis and vertebral physitis. With antimicrobial therapy and endovascular embolisation of their portosystemic shunt, all dogs in this study had a good outcome with clinical resolution of both disease processes. However, long-term follow-up was not obtained in all cases.

Surgical Treatment of Brucellar Cervical Epidural Abscess.

OBJECTIVES: Brucellar cervical epidural abscess (CEA) is a rare condition with potentially permanent neurological damage if left untreated. This study aims to define the clinical presentation of brucellar CEA and evaluate the outcome of surgical treatment, specifically decompression and fusion surgery. The findings will contribute to understanding whether all patients with brucellar CEA could benefit from this surgical intervention. METHODS: A retrospective study on brucellar spondylitis was conducted at the First Hospital of Jilin University from August 2018 to August 2022. During this period, a total of 37 patients were diagnosed with brucellar spondylitis at the hospital. Out of the 37 cases, six patients (16.2%) were confirmed to have CEA through cervical magnetic resonance imaging examination and serology test results.. RESULTS: Six patients were diagnosed with brucellar CEA (16.2%), of whom 5 successfully underwent anterior cervical decompression and fusion surgery. One patient had a large prevertebral abscess that could only be drained. In combination with effective antibiotic therapy, the clinical performance of the 5 patients who underwent surgery improved after the surgery. The remaining one patient required delayed surgery due to instability of the cervical spine. The follow-up period of all the 6 patients was 6 months. CONCLUSIONS: Brucellosis should be considered as a potential cause of CEA, especially in endemic areas. Timely detection and effective management of this condition are crucial in order to minimize the associated morbidity and mortality. For patients with detectable brucellar CEA, we recommend decompression and fusion surgery.

Cervical brucellar spondylitis causing incomplete limb paralysis

Abstract Brucellosis, a zoonosis with worldwide distribution, is a systemic infection caused by bacteria of the genus Brucella. Meanwhile, brucellosis often causes complications, such as osteoarticular involvement, and spondylitis is the most prevalent and important clinical form. Here, is a case of cervical brucellar spondylitis causing incomplete limb paralysis in a middle-aged male. The diagnosis was based on clinical history, and supported by Brucella serology and magnetic resonance imaging. Quadruple antibacterial treatment continued for four weeks. In this case, the epidural abscess causing spinal cord compression resolved without surgery. In addition, the patient had recovered from most of the neurologic deficits.

High cervical spine spondylodiscitis management and literature review / Espondilodiscite da coluna cervical alta: manejo e revisão da literatura

Summary Spondylodiscitis affecting the cervical spine is the most unusual type. Disease progression can be dramatic, even causing quadriplegia and death. We present an unusual case that progressed with osteolytic lesions between C2 and C3, causing cord compression and epidural abscess. The patient was treated surgically by a double approach and improved without neurological deficits and with better inflammatory markers. We reviewed the current literature on the subject.

Resumo A espondilodiscite, que acomete a coluna cervical, é a de localização mais rara. Pode ter uma evolução dramática, inclusive causando tetraplegia e óbito. Apresentamos um caso atípico que evoluiu com lesões osteolíticas entre C2 e C3, causando compressão medular e abscesso epidural. O paciente foi submetido a tratamento cirúrgico por dupla abordagem e evoluiu bem, sem déficits neurológicos e com melhora dos marcadores inflamatórios. Revisamos a literatura vigente sobre o assunto.

Uso del fibroscopio en el manejo de la vía aérea de la espondiloartritis anquilopoyética: reporte de un caso / Use of the fiberscope in the management of the airway of the ankylopoietic spondylarthritis: a case report

La espodilitis anquilopoyética se caracteriza por brotes leves o moderados de espondilitis activa que alternan con períodos de inactivación total o casi total de la enfermedad con incapacidad. Se presenta el caso de una paciente sometida a artroplastia total de cadera derecha, ya que su enfermedad provocó una artrosis degenerativa de dicha cadera con incapacidad para la marcha. Por los test predictivos realizados por el personal experimentado durante el manejo de la vía aérea en el momento de la intubación a través del fibroscopio fue catalogada como vía aérea difícil.

The ankylopoietic spondylitis is characterized for mild or moderate outbreaks of active spondylitis that alternate with total or almost total periods of inactivación of the disease with incapacity. A case of a patient submitted to a total arthroplasty of the right hip is presented, since this disease caused to her a degenerative arthrosis of the said hip with incapacity for the march. Due to the predictable tests carried out by the experienced personnel during the management of the airway at the intubation moment through the fiberscope was catalogued as a difficult one.

Varón de 45 años con tumoración lumbar / A 45 year-old male with lumbar tumours

Hombre de 45 años, con antecedente de infección por virus de la hepatitis B, que consultó por tumoración en la región lumbar desde hace 3 meses. En la exploración se aprecia fuerza muscular disminuida en miembros inferiores, la radiografía de tórax presenta engrosamiento pleural apical bilateral, la prueba de Mantoux fue positiva. La resonancia magnética nuclear lumbar reveló aplastamiento del cuerpo vertebral D4 y absceso de partes blandas a nivel de L1. El estudio microbiológico reveló presencia de Mycobacterium tuberculosis complex. Con el diagnóstico de enfermedad de Pott, se inició tratamiento. Desde la utilización de fármacos antituberculosos la afectación espinal se presenta de forma esporádica pero continúa siendo una enfermedad que provoca morbilidad elevada. El tratamiento de la afectación vertebral se basa en medicamentos antituberculosos y cirugía (AU)

A 45 year old Filipino male, with history of Hepatitis B virus infection, was seen in his primary care clinic with a lumbar mass for the past three months. On physical examination the lower limbs showed decrease strength, chest X-rays showed bilateral thickening of the apical pleura, the Mantoux skin test was positive and a lumbar magnetic resonance imaging study showed a compression fracture of D4 vertebral body and soft-tissue abscess in L1. Microbiological examination was positive for M. tuberculosis complex, and with the diagnosis of Pott's disease, he began treatment. With the advent of anti-tuberculosis drugs, spinal involvement of tuberculosis is rare, but it continues to have a high impact on morbidity. Treatment of vertebral involvement is based on anti-tuberculosis drugs and surgery (AU)

Absceso epidural espinal con espondilitis. Descripción de un caso / Spinal epidural absceso with spondylitis. Case report]

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Tuberculosis pulmonar en relación con adalimumab: estudio de 3 casos / Pulmonary Tuberculosis Associated to Adalimumab: a Study of 3 Cases

Los fármacos antagonistas del factor de necrosis tumoral alfa representan un importante avance en el tratamiento de enfermedades inflamatorias como la artritis reumatoide, las espondiloartropatías y la enfermedad inflamatoria intestinal. Se reconoce el incremento de tuberculosis con infliximab, pero disponemos de menos datos que relacionen la tuberculosis específicamente con adalimumab. Presentamos los casos de 2 pacientes con artritis reumatoide y un paciente con espondilitis anquilopoyética en tratamiento con adalimumab, que desarrollaron tuberculosis pulmonar y diseminada a pesar de seguir las medidas de cribado y profilaxis recomendadas por las guías, y revisamos la asociación entre el tratamiento con antagonistas del factor de necrosis tumoral alfa y tuberculosis (AU)

Tumour necrosis factor-alpha antagonist drugs represent a significant advance in the treatment of inflammatory diseases, such as rheumatoid arthritis, spondyloarthropathies, and intestinal inflammatory disease. The increase in tuberculosis with infliximab is known, but there is less data available that specifically associates tuberculosis with adalimumab. We present the cases of 2 patients with rheumatoid arthritis and one patient with ankylopoietic spondylitis on treatment with adalimumab, who developed pulmonary and disseminated tuberculosis despite following the screening and prophylaxis measures recommended in guidelines. We also review the association between treatment with tumour necrosis factor-alpha antagonists and tuberculosis (AU)

Espondilitis y endocarditis por Streptococcus viridans / Spondylitis and Streptococcus viridans endocarditis

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Escalas de avaliação aplicadas à espondilite anquilosante pertinentes à fisioterapia / Ankylosing spondylitis evaluation scale related to physical therapy

A espondilite anquilosante (EA) é uma doença inflamatória crônica que acomete preferencialmente o esqueleto axial. A patologia evolui de forma insidiosa e é potencialmente debilitante, levando a redução da qualidade de vida dos indivíduos acometidos. Este estudo teve como objetivo realizar uma revisão literária das escalas de avaliação em EA (BASFI - Bath Ankylosing Spondylitis Functional Index, DFI - Dougado´s Functional Index, EVA – Escala Visual Analógica e BASDAI - Bath Ankylosing Spondylitis Disease Activity Index) pertinentes à fisioterapia, especificamente dos domínios: função, dor, mobilidade da coluna, rigidez e avaliação global do paciente, presentes na área SM-ARD/Fisioterapia. Foi abordada também uma escala de avaliação radiológica, SASSS (Stoke Ankylosing Spondylitis Spine Score). A revisão estendeu-se de outubro a dezembro de 2006, mediante pesquisas em livros de acervos particulares e públicos e em base de dados. Constatou-se neste estudo a necessidade da realização de pesquisas, metodologias ou complementos visando à validação de instrumentos no Brasil que sirvam de esclarecimento sobre o dinamismo e comportamento da EA diante da intervenção fisioterapêutica.

The Ankylosing Spondylitis (AS) is a chronic inflammatory disease that affects the axial skeleton. The pathology develops in an insidious way and it is potentially debilitated, taking reduction of the life quality. The objective of this study was to make a literature review of the evaluation scales in AS (BASFI - Bath Ankylosing Spondylitis Functional Index, DFI - Dougado´s Functional Index, VAS – Visual Analog Scale e BASDAI - Bath Ankylosing Spondylitis Disease Activity Index) related with physical therapy, specifically of the domains: function, pain, mobility of the column, rigidity and the patient's global evaluation, present in SM-ARD/ physical therapy area. This review showed also a scale of radiologic evaluation, SASSS (Stoke Ankylosing Spondylitis Spine Score). The literature revision was performed from October to December 2006, using books of private and public collections and data basis. It was verified, in this study, the need of researches, methodologies or complements aiming at the validation of instruments in Brazil in order to explain the dynamism and behavior of AS with physical therapy intervention.

Absceso gigante del psoas secundario a osteomielitis pélvica / Giant psoas abscess secondary to pelvic osteomyelitis

El absceso primario del psoas, aunque es común, sobre todo en los trópicos está habitualmente infradiagnosticado, puede que porque tradicionalmente se ha asociado a espondilitis tuberculosa. Es una patología extremadamente rara en la infancia y sus diagnóstico es difícil y habitualmente tardío (AU)

Primary pyogenic psoas abscess, although quite a common condition, particularly in the tropics, is often overlooked as a clinical entity, probable because a psoas abscess has been traditionally associated with tuberculous spondylitis. Is a pathology extremely rare in the child and the diagnosis is difficult and often delayed (AU)

Espondilitis atlantoaxoidea. Una causa infrecuente de tortícolis / Atloaxoid spondylitis. An infrequent cause of torticolis

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Un caso de meningitis por Staphylococcus aureus después de anestesia epidural obstétrica / A case of meningitis caused by Staphylococcus aureus following obstetric epidural anaesthetic

Las complicaciones infecciosas secundarias a una anestesia epidural obstétrica, absceso epidural, meningitis y espondilitis son raras y excepcionales. Estas enfermedades sobrevienen esencialmente sobre un campo frágil y como consecuencia de una contaminación directa en el lugar de la punción, o bien son debidas a una contaminación indirecta a partir de un foco infeccioso vecino, o de una contaminación indirecta por vía hematógena. Aportamos un caso de meningitis iatrógena por Staphylococcus aureus que sobrevino después de una anestesia epidural, tras una probable brecha o traumatismo en la duramadre (AU)