Early diagnosis of spinal tuberculosis.

Spinal tuberculosis (STB) is a common manifestation of extrapulmonary tuberculosis (TB). STB accounts for around 2% of all cases of TB and around 15% of extrapulmonary TB cases. The World Health Organization has proposed a global strategy and targets for TB prevention, care, and control after 2015. Under this strategy, patients will receive standard care according to the recommendations and guidelines after confirmation of STB diagnosis. However, current recommendations and guidelines focus on disease and medication therapy management, and recommendations for early detection or decision-making algorithms regarding STB are lacking. In this review, we identified five key components for early diagnosis: (1) risk factors for STB; (2) common symptoms/signs of STB; (3) significant neuroradiological findings of STB; (4) significant laboratory findings of STB, including positive interferon-γ release assays and nonpyogenic evidence in initial laboratory data; and (5) significant clinical findings of STB. Individualized consideration for each patient with STB is essential, and we hope that the algorithm established in this review will provide a valuable tool for physicians who encounter cases of STB.

Intraosseous Gouty Tophus in the Talus: A Case Report.

Isolated intraosseous gouty invasion is a rare presentation of gout. Although most patients will have a history of gouty arthritis or hyperuricemia, others will have an insidious onset of local pain, tenderness without significant swelling, or inflammation. Surgical debridement is the mainstay of treatment for intraosseous tophus formation.

Surgical treatment of intramuscular, infiltrating lipoma.

Lipoma may occasionally be found within the muscle, which is the intramuscular, infiltrating lipoma. Intramuscular, infiltrating lipoma is an uncommon lesion, and local recurrence can be expected if the surgical margin is not clear. We report 8 patients in a 2-year period diagnosed with intramuscular, infiltrating lipoma who were treated by marginal excision combined with wide excision in the Department of Orthopaedic Surgery, Changhua Christian Hospital. The surgical results were satisfactory, and no local recurrence was noted in an average followup period of 40 months. Surgical excision is the best way to treat the symptomatic intramuscular, infiltrating lipoma. Careful preoperative evaluation and complete tumor excision with clear margins are most important to ensure successful surgical results.

Surgical treatment of symptomatic sacral cysts: report of 5 cases.

Sacral cysts are collections of cerebrospinal fluid (CSF) between the endoneurium and the perineurium of the sacral nerve root sheath. Surgery is recommended for large cysts with symptoms attributable to them. We report 5 patients with symptomatic sacral cysts treated at our institution, including 1 male and 4 females with an average age of 51.8 years (range, 36-66 years). Surgical intervention included posterior laminectomy, direct excision of the cysts and repair, and replication or cover of the dura defect by sutures or biomaterials. Pathologic examination disclosed cystic lesions with a fibrous wall without an inner arachnoid lining. All patients recovered and remained symptom-free for 39.6 months (range, 30-51 months). Treatment methods for symptomatic sacral cysts vary. Direct decompression and cyst excision are effective methods with highly successful rates and expectations.

Tumoral calcinosis of the shoulder.

Tumoral calcinosis is a rare clinical and histopathologic syndrome that causes the formation of calcium salt crystal deposits in periarticular soft tissue. This soft tissue calcification typically behaves as a large-sized tumor. However, the mechanism is unknown for the massive periarticular calcification caused by tumoral calcinosis. In addition, tumor calcinosis occurs infrequently in patients who have been on long-term hemodialysis and have end-stage renal disease (ESRD). This report describes a 40-year-old male uremia patient on long-term hemodialysis. This patient developed a huge tumor mass and pain over the left shoulder and was diagnosed with tumoral calcinosis. Although common treatments include management of metabolic levels such as calcium and phosphate, in some cases, surgical intervention may be needed. In this patient case, complete surgical excision was done successfully with an excellent outcome at the 2-year follow-up.

A cross sectional study in patients with confirmed spinal tuberculosis in central Taiwan: Analysis of preliminary clinical presentation and neuroradiological findings.

Spinal tuberculosis (STB) can cause significant functional impairment. The purpose of the present study was to analyze the factors at preliminary presentation and the neuroradiological findings in STB patients. We performed a retrospective cross-sectional analysis of cases with a definitive diagnosis of STB. Four patients with confirmed mycobacterial infection and histopathological findings confirming TB were identified. We noted two key clinical indicators. We also identified seven key neuroradiological findings associated with STB lesions. A high degree of clinical suspicion along with nine neuroradiological findings described in this study are important for STB diagnosis and for starting treatment with antituberculosis agents.