Outcomes and Treatment of Lumbosacral Spinal Tuberculosis: A Retrospective Study of 53 Patients

Study Strategy

A retrospective clinic study.

Purpose

To evaluate the efficacy of conservative and surgical treatment for lumbosacral tuberculosis.

Methods

This study retrospectively reviewed 53 patients with lumbosacral tuberculosis who were treated in our institution between January 2005 and January 2011. There were 29 males and 24 females with average ages of 37.53 ± 17.28 years (range 6–72 years). 11 patients were given only anti-TB drugs; the remainder underwent anterior debridement, interbody fusion with and without instrumentation, or one-stage anterior debridement combined with posterior instrumentation. Outcome data for these patients included neurologic status, lumbosacral angle, erythrocyte sedimentation rate value(ESR) and C-reactive protein value(CRP) were assessed before and after treatment.

Results

The mean lumbosacral angles were 23.00°± 2.90°in the conservatively treated patients and 22.36°± 3.92o in the surgically treated patients. At the final follow-up, this had improved to 24.10o ± 2.96°in the conservatively treated patients and 28.13° ± 1.93°in the surgically treated patients (all P < 0.05). There were statistically significant differences before and after treatment in terms of ESR and CRP (all P < 0.05). All patients achieved bone fusion. The mean follow-up period was 32.34 ± 8.13 months (range 18 to 55 months). The neurological deficit did not worsen in any of the patients.

Conclusions

It has been proven that conservative and surgical treatments are safe and effective and produce good clinical outcomes for patients with lumbosacral tuberculosis. The advantages of operation include thoroughness of debridement, decompression of the spinal cord, and adequate spinal stabilization.     

Dog Movie Stars and Dog Breed Popularity: A Case Study in Media Influence on Choice

Fashions and fads are important phenomena that influence many individual choices. They are ubiquitous in human societies, and have recently been used as a source of data to test models of cultural dynamics. Although a few statistical regularities have been observed in fashion cycles, their empirical characterization is still incomplete. Here we consider the impact of mass media on popular culture, showing that the release of movies featuring dogs is often associated with an increase in the popularity of featured breeds, for up to 10 years after movie release. We also find that a movie''s impact on breed popularity correlates with the estimated number of viewers during the movie''s opening weekend—a proxy of the movie''s reach among the general public. Movies'' influence on breed popularity was strongest in the early 20^th century, and has declined since. We reach these conclusions through a new, widely applicable method to measure the cultural impact of events, capable of disentangling the event''s effect from ongoing cultural trends.     

Conservative Treatment of Chronic Heart Block

A study of 203 patients with chronic heart block treated with oral long-acting isoprenaline showed that 85 (42%) were maintained satisfactorily on the drug for a mean period of 18.2 months. The survival rates at one, two, and three years were 76%, 64%, and 57% respectively. In 115 patients treatment by pacing became necessary to control symptoms, and in these patients the survival rates at one, two and three years were 83%, 72%, and 60%.The two most valuable guides to patients'' response to oral isoprenaline are the response to a trial dose of intravenous isoprenaline and the type of dysrhythmia associated with their Adams-Stokes attacks. Patients with heart failure with slow ventricular rates and those with angina of effort do not respond to treatment with sympathomimetic drugs.The majority of patients with chronic heart block are elderly, and in view of the complexity of pacing systems, and the need for skilled supervision of paced patients, oral long-acting isoprenaline remains of value in the longterm management of chronic heart block, provided patients are carefully selected for this form of therapy.     

A Longitudinal Study of Decision Making in the Process of Acquiring a Dog

To prevent potential problems in the relationship between people and their dogs, it is important to engage in a thoughtful decision-making process with regard to acquiring a dog. To map the most important elements in the decision-making process, a social cognitive model was applied using seven psychological constructs: perceived advantages of having a dog; perceived disadvantages; the social norm; self-efficacy; optimism; expected commitment; and the intention to acquire a dog. People who were planning to acquire a dog within one year were asked to fill in an online questionnaire and another one 14 months later. The social cognitive constructs were operationalized in the baseline questionnaire, and in the follow-up participants were asked to report whether they had actually acquired a dog during the 14-month interval. The sample (n?=?588) largely consisted of females (88%) and those who had a high level of education (64%). The mean age of the participants was 40.9 years. The data showed significant relations among the decision-making variables, and significant differences between demographic variables related to these. In univariate longitudinal analyses, several social cognitive variables significantly predicted acquiring a dog in the 14-month period. When intention to acquire a dog was entered into the multivariate model, it remained the only predictor (OR = 2.16, p?<?0.001); the model explained 33% of the variance in acquiring a dog. It was possible to assess the main constructs that play a role in decision making regarding acquiring a dog: Most baseline measures were related to actual later behavior, also when taking into account all changes in other internal and external factors that may have taken place. Insight into the decision-making process makes it possible to intervene in it for the good of people, dogs, and their relationships.     

Conservative Treatment of de Quervain's Disease

Thirty patients with de Quervain''s disease were treated by injection of hydrocortisone acetate and lignocaine. A 93% incidence of complete relief of symptoms was obtained after 18 months. It is recommended that this is the treatment of choice before resorting to surgery.     

The Clinical Outcomes of Surgical Treatment of Noncontiguous Spinal Tuberculosis: A Retrospective Study in 23 Cases

Study design

A retrospective clinical study.

Objective

To evaluate the clinical efficacy of the surgical treatment of noncontiguous spinal tuberculosis (NSTB), and to discuss its therapeutic strategies.

Methods

We performed a retrospective review of clinical and radiographic data that were prospectively collected on 550 consecutive spinal tubercular patients including 27 patients who were diagnosed and treated as NSTB in our institution from June 2005 to June 2011. Apart from 4 patients being treated conservatively, the remainder received surgery by posterior transforaminal debridement, interbody fusion with instrumentation, posterior instrumentation and anterior debridement with fusion in a single or two-stage operation. The clinical outcomes were evaluated before and after treatment in terms of hematologic and radiographic examinations, bone fusion and neurologic status. The Oswestry Disability Index score was determined before treatment and at the last follow-up visit.

Results

23 patients (15 M/8F), averaged 44.6±14.2 years old (range, 19 to 70 yd), who received surgical treatment, were followed up after surgery for a mean of 52.5±19.5 months (range, 24 to 72 months). The kyphotic angle was changed significantly between pre- and postoperation (P<0.05). The mean amount of correction was 12.6±7.2 degrees, with a small loss of correction at last follow-up. All patients achieved solid bone fusion. No patients with neurological deficit deteriorated postoperatively. Neither mortalities nor any major complications were found. There was a significant difference of Oswestry Disability Index scores between preoperation and the final follow-up.

Conclusion

The outcomes of follow-up showed that posterior and posterior-anterior surgical treatment methods were both viable surgical options for NSTB. Posterior transforaminal debridement, interbody fusion and posterior instrumentation, as a less invasive technique, was feasible and effective to treat specific tubercular foci.     

Dog Ownership in the West Indies: A Case Study From the Bahamas

ABSTRACT

Results from several studies in The Bahamas, which included 511 interviews with residents and data on 776 dogs, are reported. The composition and characteristics of the dog population are described. The majority of dogs, both owned and unowned, are local mongrels called “potcakes.” The median age of the dog population is three years. Potcakes are given a lower level of health care than dogs considered to resemble a recognised breed. Many dogs have no place in the household and are able to roam. The dynamics of the owned and unowned dog populations are derived, and abandoned dogs are shown to sustain the free-roaming population. The free-roaming dog population breeds throughout the year but it has a breeding cycle longer than six months, which is probably caused by its ill health. Despite the nuisance caused by unowned dogs, residents are tolerant towards them, and over half the households feed dogs they do not own. The changes in pet ownership required to increase the welfare of dogs are discussed.