• Tuberculosis and Respiratory Diseases
• /
• v.60 no.3
• /
• pp.353-356
• /
• 2006

Acute transverse myelitis (TM) is a neurological syndrome caused by inflammation of the spinal cord. TM is rare but is frequently caused by viral or bacterial infections. TM caused by tuberculosis (TB) is extremely rare and there are no reports of TM caused by multidrug-resistant TB (MDR-TB). We report a case of acute TM due to MDR-TB in a 40-year-old man. The patient had been diagnosed with pulmonary TB and was started on the first-line anti-TB treatment. However, the chest radiographic findings were aggravated and neurological symptoms such as weakness in both lower extremities, sensory changes, and voiding difficulty were newly developed. The T2-weighted magnetic resonance image of the spine showed diffusely increased signal intensity in the spinal cord, particularly at the lower cervical and upper thoracic levels, without any definite evidence of myeloradicular compression, which is consistent with a diagnosis of TM. A drug susceptibility test revealed MDR and second-line anti-TB drugs were prescribed. The chest radiographic findings showed improvement after treatment, the mycobacterial culture converted to negative, the MRI findings improved, and there was partial improvement in the low extremity weakness. The patient has been prescribing second-line anti-TB medications for 14 months.

• Clinical and Experimental Pediatrics
• /
• v.56 no.2
• /
• pp.86-89
• /
• 2013

A retropharyngeal abscess is a rare disease entity in young infants but can develop after nasopharyngeal viral infection. Group B Streptococcus and Staphylococcus aureus are the most common pathogens in young infants, however, Mycobacterium tuberculosis is very rare. We report the case of retropharyngeal abscess and coinfection with S. aureus and M. tuberculosis in a very young infant presenting with respiratory symptoms due to upper airway obstruction. Usually tuberculous retropharyngeal abscesses are caused by the direct invasion of the bacteria from the spine via anterior longitudinal ligament of the spine. However, in this case, no associated spinal disease was observed.

• Korean Journal of Veterinary Research
• /
• v.39 no.3
• /
• pp.538-544
• /
• 1999

To elucidate the involvement of interleukin-$1{\beta}$ converting enzyme (ICE) in the course of experimental autoimmune encephalomyelitis (EAE), we induced EAE by immunizing rats with an emulsion of rat spinal cord homogenate with complete Freund's adjuvant supplemented with Mycobacterium tuberculosis (H37Ra, 5mg/ml) and then examined the expression of ICE in the spinal cord of rats with EAE. In normal rat spinal cords, ICE is constitutively, but weakly, expressed in ependymal cells, neurons, and some neuroglial cells. In EAE, many inflammatory cells are positive for ICE, and the majority of ICE+ cells were identified as ED1+ macrophages. During this stage of EAE, the number of ICE+ cells in brain cells, including neurons and astrocytes, increased and these cells also had increased ICE immunoreactivity. These findings suggest that the upregulation of ICE in both brain cells and invading hematogenous cells is stimulated by a secretory product from inflammatory cells, and that this enzyme is involved in the pathogenesis of EAE via the production of IL-1 beta.

• Korean Journal of Veterinary Research
• /
• v.40 no.3
• /
• pp.431-437
• /
• 2000

The aim of this study was to evaluate the involvement of CPP32 (caspase-3), one of the death-related enzymes, in the course of experimental autoimmune encephalomyelitis (EAE). EAE was induced in Lewis rats immunized with an emulsion of rat spinal cord homogenate with complete Freunds adjuvant supplemented with Mycobacterium tuberculosis (H37Ra, 5mg/ml). The expression of CPP32 in the spinal cords of rats with EAE was studied. In normal rat spinal cords, CPP32 is constitutively, but weakly, expressed in neurons and some neuroglial cells. In the EAE spinal cords, many inflammatory cells were positive for CPP 32, and the majority of CPP32(+) cells were identified as ED1(+) macrophages. During this stage of EAE, the number of CPP32(+) cells in brain cells, including neurons and astrocytes, increased, and these cells also had increased CPP32 immunoreactivity. CPP32 immunor eactivity was not always matched with apoptosis of inflammatory cells in EAE lesions. We speculate that CPP32, which is constitutlvely expressed in brain cells, increases in response to neuroimmunological stimulation in both brain neuronal cells and inflammatory cells. The functional role of CPP32 in neuroimmunological disorders is discussed.

• Journal of Korean Neurosurgical Society
• /
• v.30 no.11
• /
• pp.1314-1319
• /
• 2001

Objects : Because of the nonspecific nature of symptoms in tuberculous spondylitis, a delay in the diagnosis can result in progressive neurologic deficits. The authors evaluate the clinical and the radiological results of the 10 cases of surgically treated tuberculous spondylitis. Clinical materials & Methods : We retrospectively analyzed the medical records of 10 patients with tuberculous spondylitis who were treated between February 1996 and March 2000. Six patients were female, and four were male. Mean age was 43 years old, and mean follow-up period was 20.5 months. All patients were treated with 12 months of antituberculous medication postoperatively, and were followed by complete blood count, ESR, spine X-ray and MRI. Results : The lumbar spine was involved in 5 patients, the thoracic in 4, and the thoracolumbar in one. The infected vertebral bodies were 2.8 in average. The associated lesions were pulmonary tuberculosis in 3 cases, and renal tuberculosis in one. Five patients were treated by anterior debridement and fusion with bone graft using anterior instrumentation, 2 with anterior debridement and fusion with bone graft(Hong Kong procedure only), 1 with Hong Kong procedure with posterior spinal instrumentation, and 2 were managed with posterior debridement and posterior spinal instrumentation. All patients improved after operation, and the average kyphotic angle decreased postoperatively. Postoperatively, one patient had a fistula at the operative site. Conclusion : The debridement and minimal level fusion of motion segment with instrument fixation is one of surgical option for tuberculous spondyltis to preserve the spine motion segment as much as possible. Spine instability and kyphosis were prevented by anterior and posterior spinal instrumentation. But, large number of cases and longer period follow-up study in future will be needed to confirm the long term results.

• Journal of the Korean Orthopaedic Association
• /
• v.52 no.1
• /
• pp.73-82
• /
• 2017

Purpose: To assess the chronological changes of disease-related kyphosis after chemotherapy alone. Materials and Methods: A total of 101 children aged 2 to 15 years with spinal tuberculosis, accompanied by various stages of disease processes were enrolled for analysis. By utilizing the images in them, the growth plate condition and chronological changes of kyphosis after chemotherapy were analyzed at two points in time; the first assessment was at post-chemotherapy one-year and second at the final discharge. Results: Complete disc destruction in the cervical, dorsal and lumbosacral spines was observed in 2 out of 40 children (5.0%), 8 out of 30 children (26.7%), and 6 out of 31 children (19.4%), respectively. In those cases, the residual kyphosis inevitably developed. In the remaining children, the discs were intact or partially damaged. Among the 101 children kyphotic deformity was maintained without change in 20 children (19.8%). Kyphosis decreased in 14 children (13.9%), while it increased in 67 children (66.3%) with non-recoverably damaged growth plate. Conclusion: Although it is tentatively possible to predict the deformity progress or non-progress and spontaneous correction at the time of the initial treatment, its predictive accuracy is low. Therefore, assessment of the chronological changes should be performed at the end of chemotherapy. In children with progressive curve change, assessment of deformity should be continued until maturity.

• Journal of Korean Neurosurgical Society
• /
• v.38 no.4
• /
• pp.259-264
• /
• 2005

Objective : The vertebroplasty is an excellent procedure in spine compression fracture, but there are some problems such as cement leakage and difficulties in bone biopsy. Recently, the osteoplasty system is developed to solve these problems, so we will report the usefulness of the osteoplasty system. Methods : From January 2003 to November 2003, there are 9patients with simple osteoporotic spine compression fracture, 2 compression fracture patients combined with suspicious spinal metastasis, 1patient with suspicious primary bone tumor, and 2patient with infection on spine. All patients were treated using the osteoplasty system. Results : All 11 compression fracture patients were relived the back pain after the osteoplasty and there is no complication. The bone biopsies in 3 suspicious cancer patients were also effectively performed using the osteoplasty system; negative result in 2patients and positive result in 1patient. The culture result of spontaneous discitis was no growth for 48hours. The spine tuberculosis was confirm using the osteoplasty system. Conclusion : The osteoplasty system has distinguished advantages in comparison with the vertebroplasty. That is, the risk of cement leakage is lower than vertebroplasty because of low pressure delivery system. And we can obtain the specimen effectively in bone biopsy because of large cannula. In conclusion, we emphasize that the osteoplasty system is a more useful procedure in spine compression fracture especially in the patient needed bone biopsy for diagnosis.

• Tuberculosis and Respiratory Diseases
• /
• v.65 no.6
• /
• pp.517-521
• /
• 2008

A tuberculous psoas abscess is a frequently described complication of tuberculous spondylitis. Although rare, a tuberculous psoas abscess can develop without any demonstrable spinal involvement. In patients with no evidence of sponylitis, the abscess may result from direct spread from the involved lymph node or via a hematogeous route. The treatment of a psoas abscess is either drug therapy or surgical intervention in conjunction with drug therapy. Image-guided percutaneous drainage in conjunction with drug therapy is also a safe and effective treatment for a tuberculous psoas abscess. We report an unusual case of bilateral tuberculous psoas abscesses without any concomitant spinal involvement. The tuberculous psoas abscess may have formed by fistulization between the necrotic lymph node and psoas sheath. The diagnosis was confirmed by computed tomography and a histology examination of the biopsy sample. The patient improved after administering anti-tuberculous agents for 2 years along with surgical and percutaneous drainage of the abscess.

• Tuberculosis and Respiratory Diseases
• /
• v.47 no.1
• /
• pp.90-96
• /
• 1999

Background : Osteoporosis has been reported in patients with chronic obstructive pulmonary disease, but this association is not well established. This study was undertaken to determine whether the prevalence of osteoporosis was increased in patients with chronic obstructive pulmonary disease and we examined the relationship of corticosteroid administration with osteoporosis. Method: Subjects were 23 patients with chronic obstructive pulmonary disease and 20 control patients. We reviewed hospital records and measured bone mineral density using dual-energy x-ray absorptiometry(Lunar. USA). Results: Mean bone mineral density(BMD) of spine in COPD group was $0.683{\pm}0.154 g/cm^2$ and $0.971{\pm}0.212g/cm^2$ in controls(p<0.01). But there was no significant difference in femoral neck BMD. There were seventeen cases of osteoporosis and six cases of osteopenia in COPD group and three patients of osteoporosis and one case of osteopenia in controls. But, there was no significant correlation between disease duration of COPD and spinal T score(r=-0.395, p>0.05). Ten patients were received corticosteroid in COPD group. Spinal T score in steroid receiving patients were $-3.82{\pm}0.94(SD)$ and $-2.82{\pm}0.97(SD)$ in not having steroid patients(p<0.01). Cumulative dose of corticosteroid was associated with spinal T score(r=-0.424, p<0.05) and duration of corticosteroid administration also associated with spinal T score(r=-0.457. p<0.05). Spinal BMD of patients not having corticosteroid in COPD group(n=13) were significantly lower than that of controls($0.71{\pm}0.13 g/cm^2$ and $0.97{\pm}0.21 g/cm^2$, p<0.01). Conclusion : Prevalence of osteoporosis is increased in patients with chronic obstructive pulmonary disease. Especially patients who are receiving corticosteroid have high risk of osteoporosis or osteopenia and need for preventive management.

• Journal of Korean Neurosurgical Society
• /
• v.37 no.2
• /
• pp.146-149
• /
• 2005

Most primary spinal abscesses, irrespective of pathogens and anatomical locations, have better prognosis than that of secondary abscesses with spondylitis. We report a 68-year-old man, previously undertaken pulmonary resection due to tuberculosis, presented with paraparesis. Imaging studies showed primary intraspinal abscesses at T-1 and T-3 vertebral levels, semi-invasive pulmonary Aspergillosis and inflammation of the posterior mediastinum. Operative procedure and histopathological examination revealed interdural Aspergillus abscess. Despite chemotherapy, he deteriorated progressively, and spondylitis developed at corresponding vertebrae. He eventually died 6 weeks postoperatively due to pulmonary complication. The authors intended to inform that such an extradural inflammatory lesion of Aspergillus abscess should be treated carefully.