AIM:To analyze the experience within our hospital and to review the literature so as to establish the best means of diagnosis of abdominal tuberculosis. METHODS:The records of 11 patients (4 males,7 females, mean age ...AIM:To analyze the experience within our hospital and to review the literature so as to establish the best means of diagnosis of abdominal tuberculosis. METHODS:The records of 11 patients (4 males,7 females, mean age 39 years,range 18-65 years) diagnosed with abdominal tuberculosis in Harran University Hospital between January 1996 and October 2003 were analyzed retrospectively and the literature was reviewed. RESULTS:Ascites was present in all cases.Other common findings were weight loss (81%),weakness (81%),abdominal mass (72%),abdominal pain (72%),abdominal distension (63%),anorexia (45%) and night sweat (36%).The average hemoglobin was 8.2 g/dL and the average FAR was 50 mm/h (range 30-125).Elevated levels of cancer antigen CA-125 were determined in four patients.Abdominal ultrasound showed abnormalities in all cases:ascites in all,tuboovarian mass in five,omental thickening in 3,and enlarged lymph nodes (mesenteric,para-aortic) in 2.CT scans showed ascites in all,pelvic mass in 5,retroperitoneal lymphadenopathy in 4,mesenteric stranding in 4,omental stranding in 3, bowel wall thickening in 2 and mesenteric lymphadenopathy in 2.Only one patient had a chest radiograph suggestive of a new TB lesion.Two had a positive family history of pulmonary TB.None had acid-fast bacilli (AFB) in the sputum and the tuberculin test was positive in only two.Laparotomy was performed in 6 cases,laparoscopy in 4 and ultrasound- guided fine needle aspiration in 2.In those patients subjected to operation,the findings were multiple diffuse involvement of the visceral and parietal peritoneum,white ‘miliary nodules’or plaques,enlarged lymph nodes,ascites, ‘violin string’fibrinous strands,and omental thickening. Biopsy specimens showed granulomas,while ascitic fluid showed numerous lymphocytes.Both were negative for acid-fast bacilli by staining.PCR of ascitic fluid was positive for Mycobactenum tuberculosis ( M.tuberculosis) in all cases. CONCLUSION:Abdominal TB should be considered in all cases with ascites.Our experience suggests that PCR of ascitic fluid obtained by ultrasound-guided fine needle aspiration is a reliable method for its diagnosis and should at least be attempted before surgical intervention.展开更多
AIM: To assess the clinical features, yield of the diagnostic tests and outcome of abdominal tuberculosis in non-HIV patients.METHODS: Adult patients with discharge diagnosis of abdominal tuberculosis (based upon; ...AIM: To assess the clinical features, yield of the diagnostic tests and outcome of abdominal tuberculosis in non-HIV patients.METHODS: Adult patients with discharge diagnosis of abdominal tuberculosis (based upon; positive microbiology, histo-pathology, imaging or response to trial of anti TB drugs) during the period 1999 to 2004 were analyzed. Patient's characteristics, laboratory investigations, radiological, endoscopic and surgical findings were evaluated. Abdominal site involved (intestinal, peritoneal, visceral, and nodal) and response to treatment was also noted.RESULTS: There were 209 patients enrolled. One hundred and twenty-three (59%) were females. Symptoms were abdominal pain 294 (93%), fever 234 (64%), night sweats 99 (48%), weight loss 98 (47%), vomiting 75 (36%), ascites 74 (35%), constipation 64 (31%), and diarrhea 25 (12%). Sub-acute and acute intestinal obstruction was seen in 28 (13%) and 12 (11%) respectively. Radiological evidence of pulmonary tuberculosis was found in 134 (64%) patients. Basis of diagnosis of abdominal tuberculosis were radiology (Chest and barium X-Rays, Ultrasound and CT scan abdomen) in 111 (53%) and histo-pathology (tissue obtained during surgery, colonoscopy, CT or ultrasound guided biopsy, laparoscopy and upper gastro intestinal endoscopy) in 87 (42%) patients. Mycobacterium culture was positive in 6/87 (7%) patients and response to therapeutic trial of anti tubercular drugs was the basis of diagnosis in 5 (2.3%) patients. Predominant site of involvement by abdominal TB was intestinal in 103 (49%) patients, peritoneal in 87 (42%) patients, solid viscera in 10 (5%) and nodal in 9 (4%) patients. Response to medical treatment was found in 158 (76%) patients and additionally 35 (17%) patients also underwent surgery. In a 425 ± 120 d follow-up period 12 patients died (eight post operative) and no case of relapse was noted.CONCLUSION: Abdominal TB has diverse and nonspecific symptomatology. No single test is adequate for diagnosis of abdominal tuberculosis in all patients. Abdominal TB in non-HIV patients remains an ongoing diagnostic dilemma requiring a high index of clinical suspicion.展开更多
AIM: To study the patients with low gradient ascites in hospitals of Guilan Province (northern Iran).METHODS: Patients admitted in hospitals of Guilan Province with low gradient ascites from 1993 to 2000 were enrolled...AIM: To study the patients with low gradient ascites in hospitals of Guilan Province (northern Iran).METHODS: Patients admitted in hospitals of Guilan Province with low gradient ascites from 1993 to 2000 were enrolled in the study. Serum and ascitic fluid albumin levels were determined by biochemical reactions. The serum-ascitic albumin gradient (SAAG) less than 1.1 g/dL was considered low. Statistical analysis was performed with SPSS 9.0software and P<0.05 was considered statistically significant.RESULTS: Of the 148 patients enrolled in the study, 72(48.6%) were males and 76 (51.4%) were females with a mean age of 59.03±13.54 years. Tuberculous peritonitis was the most frequent cause of low gradient ascites in 68 (45.9%). Other most frequent causes were cancer in 62 (41.9%), nephrotic syndrome in 9 (6%), pancreatitis in 6 (4%). Peritoneal cancer was found in 22 (35%),ovarian and gastric cancers were found in 14 (22.5%)and 12 (19.3%), respectively. All of which were the causes of ascites. The mean SAAG was 0.68±0.19 g/dL. The mean serum and ascitic fluid albumin concentrations were higher in tuberculous patients (P<0.006), but lactate dehydrogenase (LDH) level was higher in cancer patients (P<0.0001). In peritoneal tuberculosis, mean ascitic glucose concentration was significantly lower than other patients (P<0.0001).CONCLUSION: Tuberculosis should be considered in all patients with low gradient ascites especially in developing countries (like Iran), as the first cause of ascites. In the approach to patients with low gradient ascites, ascitic fluid glucose, and LDH level are useful indicators for decision making.展开更多
A 36-year-old Philippine woman presented with dark urine and yellow sclera. Endoscopic retrograde cholangiopancreatography (ERCP) confirmed dilatation of the intrahepatic bile ducts and also showed an irregular stri...A 36-year-old Philippine woman presented with dark urine and yellow sclera. Endoscopic retrograde cholangiopancreatography (ERCP) confirmed dilatation of the intrahepatic bile ducts and also showed an irregular stricture of the common hepatic duct at the liver hilum. Histological examination of biopsies from the bile duct revealed epithelioid cell granulomas and caseous necrosis. Tubercle bacilli were then detected on polymerase chain reaction (PCR) testing of the bile, giving the diagnosis of biliary tuberculosis. Although microbiological cure was confirmed, the patient developed cicatricial stenosis of the hepatic duct. She underwent repeated treatments with endoscopic biliary drainage (EBD) tubes and percutaneous transhepatic biliary drainage (PTBD) tubes, and the stenosis was corrected after 6 years. We present a case of tuberculous biliary stricture, a condition that requires careful differentiation from the more common malignancies and needs long-term follow-up due to the risk of posttreatment cicatricial stenosis, although it is rare.展开更多
AIM: To observe the effect of anti-tuberculosis therapy on liver function of pulmonary tuberculosis patients with hepatitis B virus (HBV) infection, and to compare the differences of liver function by two treatments o...AIM: To observe the effect of anti-tuberculosis therapy on liver function of pulmonary tuberculosis patients with hepatitis B virus (HBV) infection, and to compare the differences of liver function by two treatments of antituberculosis.METHODS: Forty-seven TB patients with HBV infection and 170 TB patients without HBV infection were divided into HPBE(S) and HLAMKO treatment groups. Liver function tests before and after the treatments were performed once in 2 wk or monthly, and their clinical manifestations were recorded.RESULTS: The rate of hepatotoxicity occurred in 26 (59%)TB patients with HBV during anti-TB treatment, higher than that in 40 (24%) TB patients without HBV. Hepatotoxicity occurred in 66 out of 217 patients, and the incidence of liver dysfunction was 46.1% in HPBE(S) group, significantly higher than that in HLAMKO group (12.7%) (P<0.01).CONCLUSION: TB patients with HBV should choose HLAMKO treatment because of fewer hepatotoxicity.展开更多
Primary mammary tuberculosis is a rare entity that usually occurs in female of reproductive age. Herein three such patients including two males with ages over 80 years, who underwent surgical resection, are reported. ...Primary mammary tuberculosis is a rare entity that usually occurs in female of reproductive age. Herein three such patients including two males with ages over 80 years, who underwent surgical resection, are reported. Fine needle biopsy failed to achieve specific diagnosis before surgical operation. All of their conditions got satisfactory improvement and anti-tuberculosis chemotherapy was administered postoperatively. Previous literature related to the epidemiology, diagnosis and treatment for mammary tuberculosis will be also reviewed. Mammary tuberculosis is usually related to breast feeding women and is extremely rare in aged man. The possible mechanisms resulting in this disease in our three patients, including direct extension, reactivation, or transmitted by staffs or peers of the nursing home, would also be discussed.展开更多
The hypothesis postulating that Mycobacterium avium paratuberculosis(MAP) is the cause of Crohn's disease(CD) has been circulating for many years.Advances in molecular techniques,such as polymerase chain reaction ...The hypothesis postulating that Mycobacterium avium paratuberculosis(MAP) is the cause of Crohn's disease(CD) has been circulating for many years.Advances in molecular techniques,such as polymerase chain reaction and culture methods,have enabled researchers to demonstrate that there is an association between MAP and CD.Recently,genome-wide association studies have identified novel susceptibility genes for CD,which are critical for generation of an adaptive immune response that is protective against intracellular pathogens,including M.tuberculosis infection.However,the role of MAP as a cause of CD suffered a setback with the report that administration of antimycobacterial therapy failed to lead to a sustained response in CD patients.Accordingly,this review sought neither to confirm nor refute this,but instead to survey recent literature on the role of MAP in CD.展开更多
AIM: To assess the role of retrograde terminal ileoscopy in hematochezia patients with normal colonoscopy. METHODS: Between January 1997 and March 2005, 39 hematochezia patients (males 36, females 3, mean age 44.7 ...AIM: To assess the role of retrograde terminal ileoscopy in hematochezia patients with normal colonoscopy. METHODS: Between January 1997 and March 2005, 39 hematochezia patients (males 36, females 3, mean age 44.7 years) with a reported normal colonoscopy underwent a repeat colonoscopy. After reaching the cecum, attempt was made to localize the ileocecal valve and intubate the terminal ileum. Any abnormality in the mucosa of the terminal ileum was carefully recorded and biopsies were obtained from suspiciouslooking lesions. RESULTS: During the study period there were 39 patients admitted for hematochezia in whom colonoscopy till cecum did not reveal any abnormality. Fulllength colonoscopy till the cecum could be performed in all the patients. The terminal ileum could be intubated in 36 patients. No abnormality was noted in 31 patients. Ileal ulcers were noted in two patients. Noclularity along with ulceration of the ileal mucosa, a Dieulafoy's lesion, and an angiomatous malformation were noted in one patient each. Histological examination of the biopsies obtained from the ulcers revealed typical tuberculous lesion in the patient with nodularity and ulceration. One of the patients had typhoid ulcers and another had non-specific ulcers. CONCLUSION: Retrograde terminal ileoscopy gives limited but valuable information, in patients with hematochezia and should be attempted in all such patients.展开更多
AIM To evaluate the efficacy of thalidomide for treating troublesome cases of pediatric Crohn's disease(CD) with tuberculosis infection.METHODS A retrospective study of clinical outcome among children treated with...AIM To evaluate the efficacy of thalidomide for treating troublesome cases of pediatric Crohn's disease(CD) with tuberculosis infection.METHODS A retrospective study of clinical outcome among children treated with thalidomide was conducted. All patients had evidence of tuberculosis infection with a failure of anti-tuberculosis treatment for more than one year,and were subsequently diagnosed with CD. All the patients received thalidomide treatment with a starting dose of 1.2-2.5 mg/kg per day. Remission was defined as pediatric CD activity index less than or equal to 10.RESULTS Ten patients with CD were treated with thalidomide at an average age of 7.2 years and followed up for a median of 22.2 mo. Clinical remission rate was 60% after 9-12 mo of thalidomide treatment. One patient with no response had an interleukin-10 receptor alpha gene mutation. Erythrocyte sedimentation rate,C-reactive protein and platelet count showed a dramatic decrease; hemoglobin level and weight improved significantly after thalidomide treatment when compared with the baseline values.CONCLUSION Thalidomide is an effective and safe drug for remission of CD in pediatric patients who have been treated for tuberculosis.展开更多
Sirolimus is an immunosuppressant with expanding use in pediatric organ transplantation, dermatology and rheumatology. We report two cases of children who developed asthma like symptoms and were diagnosed with interst...Sirolimus is an immunosuppressant with expanding use in pediatric organ transplantation, dermatology and rheumatology. We report two cases of children who developed asthma like symptoms and were diagnosed with interstitial lung disease, which responded to discontinuation of sirolimus. Pediatricians should be aware about the pulmonary side effects of sirolimus.展开更多
AIM: Urea breath test (UBT) is a non-invasive diagnostic test for detecting the presence of Helicobacter pylori(H pylori).In this study we evaluated the effect of anti-tuberculosis therapy on the results of 14C-UBT.ME...AIM: Urea breath test (UBT) is a non-invasive diagnostic test for detecting the presence of Helicobacter pylori(H pylori).In this study we evaluated the effect of anti-tuberculosis therapy on the results of 14C-UBT.METHODS: Patients, with the diagnosis of tuberculosis (TB) who had a positive UBT at the point of starting antiTB therapy, were included. None had a history of peptic ulcer disease or had taken antibiotics, bismuth compounds and/or PPI in the previous month, 14C-UBT was repeated at the end of the second month and the end of treatment period and one month after completion of treatment course.RESULTS: Thirty-five patients (23 males) were enrolled.14C-UBT was negative in all 35 patients (100%) at the end of the second month and remained negative in 30cases (85.7%) at the end of the treatment course. One month after completion of treatment course, UBT remained negative in 13 patients (37.1%).CONCLUSION: Our report underscores the need for caution while interpreting urea breath test results in patients undergoing anti-TB therapy. Furthermore, the combination of drugs used in this study resulted in H pylori eradication in a minority of patients.展开更多
AIM: Although the quality of currently available urinary tests for detecting antibody to Helicobacter pylori(H pylori) have been proved in some populations, the accuracy has not been studied regarding patients who suf...AIM: Although the quality of currently available urinary tests for detecting antibody to Helicobacter pylori(H pylori) have been proved in some populations, the accuracy has not been studied regarding patients who suffer from pulmonary tuberculosis with multi-drug treatments. The present study was conducted to evaluate the accuracy of these urinary tests for antibody to H pylori in these patients. METHODS: Serum samples from 61 inpatients with pulmonary tuberculosis were tested using enzyme immunoassay, and urine samples were assayed by enzyme-linked immunosorbent assay method (URINELISA) and immunochromatography method (RAPIRAN). Medicines prescribed to the patients were recorded for medical charts, to evaluate the influences on the results of urinary tests. RESULTS: The sensitivity, specificity, and consistency of URINELJSA against the serum test were 93.1%, 65.6%, and 78.6% respectively, and those of RAPIRAN were 86.2%, 93.7%, and 90.1% respectively, which were almost equal to the data previously reported. Prescribed medicines had little influence on the results. CONCLUSION: The two urinary tests for detecting H pylori antibody have a diagnostic accuracy in patients with pulmonary tuberculosis given multiple anti-tuberculosis drugs.展开更多
The vitamin D receptor (VDR) gene is a primary candidate gene for tuberculosis susceptibility, but results of previous studies are somewhat contradictory and underpowered. Thus, it is essential to further explore th...The vitamin D receptor (VDR) gene is a primary candidate gene for tuberculosis susceptibility, but results of previous studies are somewhat contradictory and underpowered. Thus, it is essential to further explore the association between VDR gene polymorphisms and risk of pulmonary tuberculosis (PTB). Methods: A systematic review and meta-analysis about the association between Fok[, TaqI, Apal and Bsm[ polymorphisms and PTB susceptibility was conducted. Statistical Package for Social Science (Version 13.0) and Review Manager (Version 4.2, The Cochrane Collaboration) were used to analyze the data reported in studies. Results: A total of 13 studies with 2 262 cases and 2 833 controls were involved in the FokI polymorphism, and the results showed FokI polymorphism was associated with PTB susceptibility (allele f vs F: OR=1.12, 95% CI=[1.02, 1.23]; the additive effect model ff vs FF: OR=1.40, 95%CI=[1.10, 1.77]; the recessive genetic model firs Ff+FF: OR=1.39, 95%CI=[1.12, 1.71]). No significant associations were observed between TaqI (15 studies with 3 031 cases and 3 132 controls), ApaI (7 studies with 1 495 cases and 1 922 controls), BsmI (6 studies with 919 cases and 1 250 controls) variants and PTB susceptibility. Conclusion: We found variant Fokl polymorphism of VDR gene may play a risky role in PTB development, and the genetic model was presumed to be recessive.展开更多
Objective. To evaluate the diagnosis and treatment for malignant gestational trophoblastic tumor(MGTT) with pulmonary metastasis complicated with pulmonary tuberculosis. Methods. To analyze t...Objective. To evaluate the diagnosis and treatment for malignant gestational trophoblastic tumor(MGTT) with pulmonary metastasis complicated with pulmonary tuberculosis. Methods. To analyze ten cases of MGTT with pulmonary metastasis complicated with pulmonary tuberculosis in our hospital from 1980 to 1997 retrospectively. Results.From the x ray film, there are great resemblances between MGTT with pulmonary metastasis and pulmonary tuberculosis. Of 10 patients, 7 of them were examined out pulmonary tuberculosis during the chemotherapy of MGTT. Pulmonary tuberculosis appeared six months before chemotherapy in three cases. All of the patients were treated with multiagent chemotherapy. Seven patients achiceved a complete remission, 2 patients developed drug resistance and died of cerebral haemorrhage and cerebral herniation, 1 woman who had achieved a complete remission from MGTT for 14 months died of miliary tuberculosis. Conclusion. It is very important to make differential diagnosis of the MGTT with pulmonary metastasis complicated with pulmonary tuberculosis. Trying to avoid excessive anti tumor treatment owing to mistake pulmonary tuberculosis for pulmonary metastasis, and avoiding missing an opportunity of anti tuberculosis treatment because of missed diagnosis should be emphasized.展开更多
This is a study of 18 patients who had surgical treatment for spinal tuberculosis. All patients were admitted with the spinal tuberculosis and treated with a combination of anterior debridement and bone graft with po...This is a study of 18 patients who had surgical treatment for spinal tuberculosis. All patients were admitted with the spinal tuberculosis and treated with a combination of anterior debridement and bone graft with poterior internal fixaton using the Luque or Dick technique. The patients were able to walk within a few days postoperation. Three to seven years follow-ups show no recurrence. kyphosis and/or solid fusinon.展开更多
We report a 43-year-old man who presented with a right painful shoulder mass and bilateral lung masses in computed tomography(CT).Scapular mass was excised and pathology report demonstrated high-grade metastatic tumor...We report a 43-year-old man who presented with a right painful shoulder mass and bilateral lung masses in computed tomography(CT).Scapular mass was excised and pathology report demonstrated high-grade metastatic tumor.Same side lung biopsy and histopathological study characterized tuberculosis but biopsy of the left lung lesion identified adenocarcinoma of the lung.The final diagnosis was right scapular metastatic lesion from left lung adenocarcinoma.Musculoskeletal symptoms are commonly encountered in lung malignancies due to paraneoplastic syndrome or hematogenous metastasis but scapular metastasis on the other side as the presentation of lung cancer is extremely rare.展开更多
文摘AIM:To analyze the experience within our hospital and to review the literature so as to establish the best means of diagnosis of abdominal tuberculosis. METHODS:The records of 11 patients (4 males,7 females, mean age 39 years,range 18-65 years) diagnosed with abdominal tuberculosis in Harran University Hospital between January 1996 and October 2003 were analyzed retrospectively and the literature was reviewed. RESULTS:Ascites was present in all cases.Other common findings were weight loss (81%),weakness (81%),abdominal mass (72%),abdominal pain (72%),abdominal distension (63%),anorexia (45%) and night sweat (36%).The average hemoglobin was 8.2 g/dL and the average FAR was 50 mm/h (range 30-125).Elevated levels of cancer antigen CA-125 were determined in four patients.Abdominal ultrasound showed abnormalities in all cases:ascites in all,tuboovarian mass in five,omental thickening in 3,and enlarged lymph nodes (mesenteric,para-aortic) in 2.CT scans showed ascites in all,pelvic mass in 5,retroperitoneal lymphadenopathy in 4,mesenteric stranding in 4,omental stranding in 3, bowel wall thickening in 2 and mesenteric lymphadenopathy in 2.Only one patient had a chest radiograph suggestive of a new TB lesion.Two had a positive family history of pulmonary TB.None had acid-fast bacilli (AFB) in the sputum and the tuberculin test was positive in only two.Laparotomy was performed in 6 cases,laparoscopy in 4 and ultrasound- guided fine needle aspiration in 2.In those patients subjected to operation,the findings were multiple diffuse involvement of the visceral and parietal peritoneum,white ‘miliary nodules’or plaques,enlarged lymph nodes,ascites, ‘violin string’fibrinous strands,and omental thickening. Biopsy specimens showed granulomas,while ascitic fluid showed numerous lymphocytes.Both were negative for acid-fast bacilli by staining.PCR of ascitic fluid was positive for Mycobactenum tuberculosis ( M.tuberculosis) in all cases. CONCLUSION:Abdominal TB should be considered in all cases with ascites.Our experience suggests that PCR of ascitic fluid obtained by ultrasound-guided fine needle aspiration is a reliable method for its diagnosis and should at least be attempted before surgical intervention.
文摘AIM: To assess the clinical features, yield of the diagnostic tests and outcome of abdominal tuberculosis in non-HIV patients.METHODS: Adult patients with discharge diagnosis of abdominal tuberculosis (based upon; positive microbiology, histo-pathology, imaging or response to trial of anti TB drugs) during the period 1999 to 2004 were analyzed. Patient's characteristics, laboratory investigations, radiological, endoscopic and surgical findings were evaluated. Abdominal site involved (intestinal, peritoneal, visceral, and nodal) and response to treatment was also noted.RESULTS: There were 209 patients enrolled. One hundred and twenty-three (59%) were females. Symptoms were abdominal pain 294 (93%), fever 234 (64%), night sweats 99 (48%), weight loss 98 (47%), vomiting 75 (36%), ascites 74 (35%), constipation 64 (31%), and diarrhea 25 (12%). Sub-acute and acute intestinal obstruction was seen in 28 (13%) and 12 (11%) respectively. Radiological evidence of pulmonary tuberculosis was found in 134 (64%) patients. Basis of diagnosis of abdominal tuberculosis were radiology (Chest and barium X-Rays, Ultrasound and CT scan abdomen) in 111 (53%) and histo-pathology (tissue obtained during surgery, colonoscopy, CT or ultrasound guided biopsy, laparoscopy and upper gastro intestinal endoscopy) in 87 (42%) patients. Mycobacterium culture was positive in 6/87 (7%) patients and response to therapeutic trial of anti tubercular drugs was the basis of diagnosis in 5 (2.3%) patients. Predominant site of involvement by abdominal TB was intestinal in 103 (49%) patients, peritoneal in 87 (42%) patients, solid viscera in 10 (5%) and nodal in 9 (4%) patients. Response to medical treatment was found in 158 (76%) patients and additionally 35 (17%) patients also underwent surgery. In a 425 ± 120 d follow-up period 12 patients died (eight post operative) and no case of relapse was noted.CONCLUSION: Abdominal TB has diverse and nonspecific symptomatology. No single test is adequate for diagnosis of abdominal tuberculosis in all patients. Abdominal TB in non-HIV patients remains an ongoing diagnostic dilemma requiring a high index of clinical suspicion.
文摘AIM: To study the patients with low gradient ascites in hospitals of Guilan Province (northern Iran).METHODS: Patients admitted in hospitals of Guilan Province with low gradient ascites from 1993 to 2000 were enrolled in the study. Serum and ascitic fluid albumin levels were determined by biochemical reactions. The serum-ascitic albumin gradient (SAAG) less than 1.1 g/dL was considered low. Statistical analysis was performed with SPSS 9.0software and P<0.05 was considered statistically significant.RESULTS: Of the 148 patients enrolled in the study, 72(48.6%) were males and 76 (51.4%) were females with a mean age of 59.03±13.54 years. Tuberculous peritonitis was the most frequent cause of low gradient ascites in 68 (45.9%). Other most frequent causes were cancer in 62 (41.9%), nephrotic syndrome in 9 (6%), pancreatitis in 6 (4%). Peritoneal cancer was found in 22 (35%),ovarian and gastric cancers were found in 14 (22.5%)and 12 (19.3%), respectively. All of which were the causes of ascites. The mean SAAG was 0.68±0.19 g/dL. The mean serum and ascitic fluid albumin concentrations were higher in tuberculous patients (P<0.006), but lactate dehydrogenase (LDH) level was higher in cancer patients (P<0.0001). In peritoneal tuberculosis, mean ascitic glucose concentration was significantly lower than other patients (P<0.0001).CONCLUSION: Tuberculosis should be considered in all patients with low gradient ascites especially in developing countries (like Iran), as the first cause of ascites. In the approach to patients with low gradient ascites, ascitic fluid glucose, and LDH level are useful indicators for decision making.
文摘A 36-year-old Philippine woman presented with dark urine and yellow sclera. Endoscopic retrograde cholangiopancreatography (ERCP) confirmed dilatation of the intrahepatic bile ducts and also showed an irregular stricture of the common hepatic duct at the liver hilum. Histological examination of biopsies from the bile duct revealed epithelioid cell granulomas and caseous necrosis. Tubercle bacilli were then detected on polymerase chain reaction (PCR) testing of the bile, giving the diagnosis of biliary tuberculosis. Although microbiological cure was confirmed, the patient developed cicatricial stenosis of the hepatic duct. She underwent repeated treatments with endoscopic biliary drainage (EBD) tubes and percutaneous transhepatic biliary drainage (PTBD) tubes, and the stenosis was corrected after 6 years. We present a case of tuberculous biliary stricture, a condition that requires careful differentiation from the more common malignancies and needs long-term follow-up due to the risk of posttreatment cicatricial stenosis, although it is rare.
文摘AIM: To observe the effect of anti-tuberculosis therapy on liver function of pulmonary tuberculosis patients with hepatitis B virus (HBV) infection, and to compare the differences of liver function by two treatments of antituberculosis.METHODS: Forty-seven TB patients with HBV infection and 170 TB patients without HBV infection were divided into HPBE(S) and HLAMKO treatment groups. Liver function tests before and after the treatments were performed once in 2 wk or monthly, and their clinical manifestations were recorded.RESULTS: The rate of hepatotoxicity occurred in 26 (59%)TB patients with HBV during anti-TB treatment, higher than that in 40 (24%) TB patients without HBV. Hepatotoxicity occurred in 66 out of 217 patients, and the incidence of liver dysfunction was 46.1% in HPBE(S) group, significantly higher than that in HLAMKO group (12.7%) (P<0.01).CONCLUSION: TB patients with HBV should choose HLAMKO treatment because of fewer hepatotoxicity.
文摘Primary mammary tuberculosis is a rare entity that usually occurs in female of reproductive age. Herein three such patients including two males with ages over 80 years, who underwent surgical resection, are reported. Fine needle biopsy failed to achieve specific diagnosis before surgical operation. All of their conditions got satisfactory improvement and anti-tuberculosis chemotherapy was administered postoperatively. Previous literature related to the epidemiology, diagnosis and treatment for mammary tuberculosis will be also reviewed. Mammary tuberculosis is usually related to breast feeding women and is extremely rare in aged man. The possible mechanisms resulting in this disease in our three patients, including direct extension, reactivation, or transmitted by staffs or peers of the nursing home, would also be discussed.
基金Supported by Grant from Fundación de Investigación MédicaMutua Madrileía (Professor M Díaz-Rubio)
文摘The hypothesis postulating that Mycobacterium avium paratuberculosis(MAP) is the cause of Crohn's disease(CD) has been circulating for many years.Advances in molecular techniques,such as polymerase chain reaction and culture methods,have enabled researchers to demonstrate that there is an association between MAP and CD.Recently,genome-wide association studies have identified novel susceptibility genes for CD,which are critical for generation of an adaptive immune response that is protective against intracellular pathogens,including M.tuberculosis infection.However,the role of MAP as a cause of CD suffered a setback with the report that administration of antimycobacterial therapy failed to lead to a sustained response in CD patients.Accordingly,this review sought neither to confirm nor refute this,but instead to survey recent literature on the role of MAP in CD.
文摘AIM: To assess the role of retrograde terminal ileoscopy in hematochezia patients with normal colonoscopy. METHODS: Between January 1997 and March 2005, 39 hematochezia patients (males 36, females 3, mean age 44.7 years) with a reported normal colonoscopy underwent a repeat colonoscopy. After reaching the cecum, attempt was made to localize the ileocecal valve and intubate the terminal ileum. Any abnormality in the mucosa of the terminal ileum was carefully recorded and biopsies were obtained from suspiciouslooking lesions. RESULTS: During the study period there were 39 patients admitted for hematochezia in whom colonoscopy till cecum did not reveal any abnormality. Fulllength colonoscopy till the cecum could be performed in all the patients. The terminal ileum could be intubated in 36 patients. No abnormality was noted in 31 patients. Ileal ulcers were noted in two patients. Noclularity along with ulceration of the ileal mucosa, a Dieulafoy's lesion, and an angiomatous malformation were noted in one patient each. Histological examination of the biopsies obtained from the ulcers revealed typical tuberculous lesion in the patient with nodularity and ulceration. One of the patients had typhoid ulcers and another had non-specific ulcers. CONCLUSION: Retrograde terminal ileoscopy gives limited but valuable information, in patients with hematochezia and should be attempted in all such patients.
基金Supported by Medical Science and Technology Planning Project of Zhejiang Province,China,No.2015KYB430(to Hong Y)
文摘AIM To evaluate the efficacy of thalidomide for treating troublesome cases of pediatric Crohn's disease(CD) with tuberculosis infection.METHODS A retrospective study of clinical outcome among children treated with thalidomide was conducted. All patients had evidence of tuberculosis infection with a failure of anti-tuberculosis treatment for more than one year,and were subsequently diagnosed with CD. All the patients received thalidomide treatment with a starting dose of 1.2-2.5 mg/kg per day. Remission was defined as pediatric CD activity index less than or equal to 10.RESULTS Ten patients with CD were treated with thalidomide at an average age of 7.2 years and followed up for a median of 22.2 mo. Clinical remission rate was 60% after 9-12 mo of thalidomide treatment. One patient with no response had an interleukin-10 receptor alpha gene mutation. Erythrocyte sedimentation rate,C-reactive protein and platelet count showed a dramatic decrease; hemoglobin level and weight improved significantly after thalidomide treatment when compared with the baseline values.CONCLUSION Thalidomide is an effective and safe drug for remission of CD in pediatric patients who have been treated for tuberculosis.
文摘Sirolimus is an immunosuppressant with expanding use in pediatric organ transplantation, dermatology and rheumatology. We report two cases of children who developed asthma like symptoms and were diagnosed with interstitial lung disease, which responded to discontinuation of sirolimus. Pediatricians should be aware about the pulmonary side effects of sirolimus.
文摘AIM: Urea breath test (UBT) is a non-invasive diagnostic test for detecting the presence of Helicobacter pylori(H pylori).In this study we evaluated the effect of anti-tuberculosis therapy on the results of 14C-UBT.METHODS: Patients, with the diagnosis of tuberculosis (TB) who had a positive UBT at the point of starting antiTB therapy, were included. None had a history of peptic ulcer disease or had taken antibiotics, bismuth compounds and/or PPI in the previous month, 14C-UBT was repeated at the end of the second month and the end of treatment period and one month after completion of treatment course.RESULTS: Thirty-five patients (23 males) were enrolled.14C-UBT was negative in all 35 patients (100%) at the end of the second month and remained negative in 30cases (85.7%) at the end of the treatment course. One month after completion of treatment course, UBT remained negative in 13 patients (37.1%).CONCLUSION: Our report underscores the need for caution while interpreting urea breath test results in patients undergoing anti-TB therapy. Furthermore, the combination of drugs used in this study resulted in H pylori eradication in a minority of patients.
文摘AIM: Although the quality of currently available urinary tests for detecting antibody to Helicobacter pylori(H pylori) have been proved in some populations, the accuracy has not been studied regarding patients who suffer from pulmonary tuberculosis with multi-drug treatments. The present study was conducted to evaluate the accuracy of these urinary tests for antibody to H pylori in these patients. METHODS: Serum samples from 61 inpatients with pulmonary tuberculosis were tested using enzyme immunoassay, and urine samples were assayed by enzyme-linked immunosorbent assay method (URINELISA) and immunochromatography method (RAPIRAN). Medicines prescribed to the patients were recorded for medical charts, to evaluate the influences on the results of urinary tests. RESULTS: The sensitivity, specificity, and consistency of URINELJSA against the serum test were 93.1%, 65.6%, and 78.6% respectively, and those of RAPIRAN were 86.2%, 93.7%, and 90.1% respectively, which were almost equal to the data previously reported. Prescribed medicines had little influence on the results. CONCLUSION: The two urinary tests for detecting H pylori antibody have a diagnostic accuracy in patients with pulmonary tuberculosis given multiple anti-tuberculosis drugs.
基金Supported by the National Natural Science Foundation of China (30700685)the Medical Science and Technology Research Project of Chongqing Municipal Health Bureau (2009-1-06)
文摘The vitamin D receptor (VDR) gene is a primary candidate gene for tuberculosis susceptibility, but results of previous studies are somewhat contradictory and underpowered. Thus, it is essential to further explore the association between VDR gene polymorphisms and risk of pulmonary tuberculosis (PTB). Methods: A systematic review and meta-analysis about the association between Fok[, TaqI, Apal and Bsm[ polymorphisms and PTB susceptibility was conducted. Statistical Package for Social Science (Version 13.0) and Review Manager (Version 4.2, The Cochrane Collaboration) were used to analyze the data reported in studies. Results: A total of 13 studies with 2 262 cases and 2 833 controls were involved in the FokI polymorphism, and the results showed FokI polymorphism was associated with PTB susceptibility (allele f vs F: OR=1.12, 95% CI=[1.02, 1.23]; the additive effect model ff vs FF: OR=1.40, 95%CI=[1.10, 1.77]; the recessive genetic model firs Ff+FF: OR=1.39, 95%CI=[1.12, 1.71]). No significant associations were observed between TaqI (15 studies with 3 031 cases and 3 132 controls), ApaI (7 studies with 1 495 cases and 1 922 controls), BsmI (6 studies with 919 cases and 1 250 controls) variants and PTB susceptibility. Conclusion: We found variant Fokl polymorphism of VDR gene may play a risky role in PTB development, and the genetic model was presumed to be recessive.
文摘Objective. To evaluate the diagnosis and treatment for malignant gestational trophoblastic tumor(MGTT) with pulmonary metastasis complicated with pulmonary tuberculosis. Methods. To analyze ten cases of MGTT with pulmonary metastasis complicated with pulmonary tuberculosis in our hospital from 1980 to 1997 retrospectively. Results.From the x ray film, there are great resemblances between MGTT with pulmonary metastasis and pulmonary tuberculosis. Of 10 patients, 7 of them were examined out pulmonary tuberculosis during the chemotherapy of MGTT. Pulmonary tuberculosis appeared six months before chemotherapy in three cases. All of the patients were treated with multiagent chemotherapy. Seven patients achiceved a complete remission, 2 patients developed drug resistance and died of cerebral haemorrhage and cerebral herniation, 1 woman who had achieved a complete remission from MGTT for 14 months died of miliary tuberculosis. Conclusion. It is very important to make differential diagnosis of the MGTT with pulmonary metastasis complicated with pulmonary tuberculosis. Trying to avoid excessive anti tumor treatment owing to mistake pulmonary tuberculosis for pulmonary metastasis, and avoiding missing an opportunity of anti tuberculosis treatment because of missed diagnosis should be emphasized.
文摘This is a study of 18 patients who had surgical treatment for spinal tuberculosis. All patients were admitted with the spinal tuberculosis and treated with a combination of anterior debridement and bone graft with poterior internal fixaton using the Luque or Dick technique. The patients were able to walk within a few days postoperation. Three to seven years follow-ups show no recurrence. kyphosis and/or solid fusinon.
文摘We report a 43-year-old man who presented with a right painful shoulder mass and bilateral lung masses in computed tomography(CT).Scapular mass was excised and pathology report demonstrated high-grade metastatic tumor.Same side lung biopsy and histopathological study characterized tuberculosis but biopsy of the left lung lesion identified adenocarcinoma of the lung.The final diagnosis was right scapular metastatic lesion from left lung adenocarcinoma.Musculoskeletal symptoms are commonly encountered in lung malignancies due to paraneoplastic syndrome or hematogenous metastasis but scapular metastasis on the other side as the presentation of lung cancer is extremely rare.