Aim and Objective:To know the biological behavior of ankle and foot tuberculosis (AFTB) and to know the reasons for delay in diagnosis and treatment of AFTB in our population.Materials and Methods:Patients with non-healing ulcers/sinuses/swellings in the ankle and foot region are the subjects of present study. Detailed clinical history, physical examination and relevant investigations were done in all cases. Pus/wound discharge for acid fast bacillus (AFB) study and biopsy from wound margin/sinus tract was taken in all the cases.Results:During the period from July 2007-June 2012, 20 cases of AFTB were treated. Out of them five cases were difficult to diagnose and a mean period of 6 month to 5year was elapsed before final diagnosis was established. Out of these five cases – three cases were diabetic with ulcers and sinuses in the heel and ankle region. One case was wrongly diagnosed as angiodysplasia with A-V malformation of foot and diagnosis was delayed for 5 year. In one case of rheumatoid arthritis with abscess in ankle joint, the diagnosis was delayed for 1year.Conclusion:AFTB is very rare condition. AFTB is suspected in cases with long standing pain/swelling/discharging sinus in the foot and thorough investigations is must to differentiate from other foot diseases. Diagnosis is delayed due to lack of clinical suspicion and non-confirmatory biopsy reports. Early diagnosis and ATT for 9-18 months is must in all cases of AFTB to prevent joint involvement and other complications.
Introduction:Incidence of chronic subdural hematoma (CSDH) is about 5/100,000/year in the general population and still rising. Two surgical techniques, namely, burr-hole evacuation (BHE) versus twist-drill evacuation (TDE) are commonly used to manage such patients but the preferred surgical method continues to attract debate, and the time for an evidence-based approach is now overdue. In vogue with recent trends, a minimally invasive surgical approach is considered as best; therefore, we tried to establish the hypothesis that TDE is as safe and as effective as BHE for CSDH treatment.Materials and Methods:A prospective, randomized, controlled study including forty patients was conducted. The primary outcome variable studied was clinically significant recurrence rate. The secondary outcome variables in postoperative period and follow-up assessment of the patients include Glasgow coma scale (GCS), Markwalder grade, postoperative complication, and operative mortality rate.Results:In our study, results of BHE seem to be superior than TDE in terms of recurrence rate (5% vs. 15%), complication rate (15% vs. 20%), and mean Markwalder neurological grading score and mean GCS at time of discharge (0.16 vs. 0.45 and 14.95 vs. 14.65, respectively). TDE seems to be better than BHE in terms of duration of hospital stay (7.4 vs. 8.05). However, these differences were not statistically significant. TDE is having the advantage of being performed at bedside without the need of monitored anesthesia and anesthetist, time saving, and least invasive. Overall results were comparable across both techniques without any significant difference.Conclusion:Although both techniques appear to be similar in respect of their primary and secondary outcome variables, but TDE is having the advantage of being performed at bedside without the need of monitored anesthesia and anesthetist, time saving, and small incision.
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