A total 12 cases of tuberculous spondylitis of thoracic spine had been treated by anterior decompression and interbody fusion through extrapleural approach from March, 1979 to June, 1980. In this study, six impending or complete paraplegics were included. Prognosis of paraplegia depends on its grade, duration and local pathology. Extrapleural approach seems to offer the following advantages over all the other ones; lesser risk, no Iimitation of surgical fleid, less chance of contaminating pleural cavity, less postoperative complications, especially indicated for the elderly paraplegics of Incomplete or complete type and less cumbersome Immediate postoperative care.
Aged ; Decompression ; Humans ; Paraplegia ; Pathology ; Pleural Cavity ; Postoperative Care ; Postoperative Complications ; Prognosis ; Spine ; Spondylitis ; Tuberculosis, Spinal

Dislocation of index metacarpophalangeal joint is complex and usually cannot be reduced by closed method. It is a relatively rare injury and there are no widely published studies on its management. We have experienced a case combined with osteochondral fracture of the dorsoulnar aspect of metacarpal head and reduced it using extensor tendon splitting simplified technique with good results. This technique is seemed te be simpler and safer than volar approach described by Kaplan.
Dislocations ; Head ; Metacarpophalangeal Joint ; Methods ; Tendons

Pseudoxanthoma elasticum (PXE)-like disorder with multiple coagulation factor deficiency is a genetic disease characterized by dystrophic mineralization of the connective tissue in multiple organs such as the skin, arteries, and retina. Patients with this disorder have excessive folding and sagging of the skin with loss of recoil, as well as coagulopathy. Crohn's disease is a chronic inflammatory condition of the gastrointestinal tract, which primary affects the small intestine, often leading to malnutrition. Here, we describe the case of a 25-year-old woman who presented with these diseases. We found that nutrient deficiency due to long-term Crohn's disease aggravated the coagulopathy associated with PXE-like disorder.
Adult ; Arteries ; Blood Coagulation Factors* ; Connective Tissue ; Crohn Disease* ; Female ; Gastrointestinal Tract ; Humans ; Intestine, Small ; Malnutrition ; Pseudoxanthoma Elasticum ; Retina ; Skin

We report a case of duodenal metastasis from squamous cell carcinoma of the cervix confirmed by histopathological diagnosis. A 48-year-old woman was diagnosed with uterine cervix cancer stage IVB and underwent chemotherapy. During follow-up after chemotherapy, a mass suspicious of malignancy was found at the 3rd portion of the duodenum on the magnetic resonance imaging of the abdomen. Esophagogastroduodenoscopy with biopsy was done for an ulcerofungating mass at the 3rd portion of the duodenum. Squamous cell carcinoma was confirmed on the biopsy which was same as the histopathological diagnosis confirmed by cervix biopsy and right supraclavicular lymph node biopsy resulting from metastasis of cervix. Since 1981, only ten cases of small bowel metastasis from squamous cell carcinoma of cervix have been reported. It is exceedingly rare to find metastasis to the duodenum from uterine cervix cancer.
Abdomen ; Biopsy ; Carcinoma, Squamous Cell* ; Cervix Uteri* ; Diagnosis ; Drug Therapy ; Duodenum ; Endoscopy, Digestive System ; Female ; Follow-Up Studies ; Humans ; Lymph Nodes ; Magnetic Resonance Imaging ; Middle Aged ; Neoplasm Metastasis* ; Uterine Cervical Neoplasms

Background/Aims: Direct‐acting antivirals (DAAs) have been approved for hepatitis C virus (HCV) treatment in patients with end-stage renal disease (ESRD) on hemodialysis. Nevertheless, the complicated comedications and their potential drug-drug interactions (DDIs) with DAAs might limit clinical practice in this special population. Methods: The number, class, and characteristics of comedications and their potential DDIs with five DAA regimens were analyzed among HCV-viremic patients from 23 hemodialysis centers in Taiwan. Results: Of 2,015 hemodialysis patients screened in 2019, 169 patients seropositive for HCV RNA were enrolled (mean age, 65.6 years; median duration of hemodialysis, 5.8 years). All patients received at least one comedication (median number, 6; mean class number, 3.4). The most common comedication classes were ESRD-associated medications (94.1%), cardiovascular drugs (69.8%) and antidiabetic drugs (43.2%). ESRD-associated medications were excluded from DDI analysis. Sofosbuvir/velpatasvir/voxilaprevir had the highest frequency of potential contraindicated DDIs (red, 5.6%), followed by glecaprevir/pibrentasvir (4.0%), sofosbuvir/ledipasvir (1.3%), sofosbuvir/velpatasvir (1.3%), and elbasvir/grazoprevir (0.3%). For potentially significant DDIs (orange, requiring close monitoring or dose adjustments), sofosbuvir/velpatasvir/voxilaprevir had the highest frequency (19.9%), followed by sofosbuvir/ledipasvir (18.2%), glecaprevir/pibrentasvir (12.6%), sofosbuvir/velpatasvir (12.6%), and elbasvir/grazoprevir (7.3%). Overall, lipid-lowering agents were the most common comedication class with red-category DDIs to all DAA regimens (n=62), followed by cardiovascular agents (n=15), and central nervous system agents (n=10). Conclusions HCV-viremic patients on hemodialysis had a very high prevalence of comedications with a broad spectrum, which had varied DDIs with currently available DAA regimens. Elbasvir/grazoprevir had the fewest potential DDIs, and sofosbuvir/velpatasvir/voxilaprevir had the most potential DDIs.