Summary
Despite the lack of clear evidence, there is an increasing tendency for guidelines to prefer IGRA over TST in IMIDs or to recommend both TST and IGRA to enhance sensitivity. We believe the use of either test is acceptable for LTBI screening. Clinicians could consider starting with IGRAs in individuals with a history of Bacille
Calmette-Guerin (BCG) vaccination after infancy or with repeated BCG vaccinations. When the index of suspicion for LTBI is high, both IGRA and TST could be performed, especially prior to initiating TNF-alpha inhibitor therapy. Regardless of the test used, it is important to remember that in the face of immune-suppression, both IGRA and TST can be falsely negative and are thus only diagnostic STI571 chemical structure aids – they will need to be interpreted with other clinical and risk factor data.”
“Minimally invasive or “”minimal access surgery”" (MAS) is being utilized with increasing frequency to reduce approach-related morbidity in the lumbar spine. This paper describes our minimal access technique for posterior bilateral transforaminal lumbar interbody fusion (TLIF) and spinal instrumentation in a patient with high-grade spondylolisthesis grade (Myerding Grade III) with 5-year follow-up.
A 24-year-old lady presented with mechanical back pain and left leg L5 radiculopathy. On examination, she was a thin lady with an obvious step deformity
in the lower lumbar spine and otherwise, a normal neurological examination.
Imaging showed a grade see more III isthmic L5-S1 spondylolisthesis with foraminal stenosis and focal CUDC-907 kyphotic alignment of 20A degrees [slip angle (SA) = 70A degrees]. Conservative measures had failed, and a decision was made to proceed with a MAS-TLIF approach.
The estimated blood loss was less than 100 ml, operating time 150 min, and post-operative hospital stay was 4 days. Post-operatively the patient had significant improvement of back and radicular pain. Improvement in ODI was substantial and sustained at 5 years. A solid fusion was achieved at 8 months. The slip percentage improved from 68 % (pre-op) to 28 % (post-op) and the focal alignment to 20A degrees lordosis (SA = 110A degrees).
A MAS approach for selected patients with a mobile high-grade spondylolisthesis is feasible, safe and clinically effective, with the added benefit of reduced soft-tissue disruption. Our result of this technique suggests that the ability to correct focal deformity, and achieve excellent radiographic and clinical outcome is similar to the open procedure.”
“Purpose of review
To summarize recent policy and guideline updates that have significant consequences for the clinical use of dual-energy X-ray absorptiometry (DXA) in the diagnosis and treatment of osteoporosis and, thus, the prevention of fractures and associated morbidity and mortality.