Ischemic Stroke in the Setting of Tuberculous Meningitis

The clinical syndrome of tuberculous (TB) meningitis leading to ischemic strokes is rarely seen today in immunocompetent adults native to North America. This entity is also notoriously difficult to diagnose because the presenting symptoms are often nonspecific. The authors describe a case of a man with TB meningitis which progressed to recurrent ischemic cerebral infarcts.     

Poncet病(病例报告及文献复习)

目的 探讨Poncet病的诊断与治疗。方法 通过病例报告及献复习，综述了Poncet病的发病机理、临床表现。结果 提高对Poncet病的认识。结论 临床上对风湿性或类风湿性关节炎病人均应与本病鉴别。     

含补金片方案治疗结核性渗出性胸膜炎疗效观察

目的：探讨结核性渗出性胸膜炎的治疗方法。方法：96例初治结核性胸膜炎患者随机分为2组,对照组应用普通化疗方案2HRZE（S）/4HR;治疗组在对照组基础上,强化期加用补金片治疗。观察6个月,分析两组疗效。结果：治疗2周、4周及8周末胸水吸收总有效率治疗组为83.33%、91.67%和95.83%;对照组为64.58%、72.92%和79.17%,治疗6个月胸膜肥厚与粘连发生率治疗组为14.58%,对照组为41.67%,两组比较均有显著性差异（P〈0.05）。结论：补金片可促进胸液吸收,加快临床症状消失,防止胸膜肥厚粘连,以及防止肝损害等,值得临床推广。     

结核性脑膜炎的CT分型与诊断（附20例分析）

经ＣＴ和临床确诊的２０例结核性脑膜炎进行回顾性分析。作者根据ＣＴ改变将其分为三种类型：（１）脑炎结节型；（２）结核瘤型；（３）脑积水型。并就ＣＴ诊断结核性脑膜炎的价值与限度进行了讨论。     

Raised intracranial pressure,the syndrome of inappropriate antidiuretic hormone secretion,and arginine vasopressin in tuberculous meningitis

Intracranial pressure (ICP) monitored shortly after admission over a period of 1 h in 31 children with tuberculous meningitis (TBM) was significantly higher (median 22.5 mm Hg, range 8.4–50.9 mmHg) in 19 children with laboratory evidence of the syndrome of inappropriate antidiuretic hormone secretion (SIADH) than in 12 children without such evidence (median 16.2 mmHg, range 5.8–42.5 mmHg; P = 0.027). Neither plasma nor cerebrospinal fluid arginine vasopressin (AVP) was related to ICP (r = 0.33 and 0.13 respectively). Mean arterial pressure (MAP) was measured in 23 children and a moderate correlation was found with plasma AVP (r = 0.62; P = 0.0019). In TBM, plasma AVP may be secreted as a response to raised ICP in an effort to raise MAP and maintain cerebral perfusion pressure. In this setting excess fluid may be inappropriately retained, leading to hyponatremia and hypo-osmolemia.     

关节镜下膝关节结核性滑膜炎的治疗(附10例报告)

目的探讨关节镜下结核性滑膜炎的特点和滑膜切除术的效果. 方法选择10例结核性滑膜炎,行关节镜下滑膜切除手术和活检.术后配合关节腔注射异烟肼和全身抗结核治疗. 结果所有病人随访6月～3年,术后第2天行CPM关节功能锻炼,9例膝关节屈曲从手术前90°±5°平均提高到120°±14°,伸直受限从手术前20°±3°提高到5°±1°,手术前后比较差异有显著性(t值分别为6.9、 6.3,P<0.01),JOA评分术前(44±8)分,术后(82±10)分(t=8.47,P<0.01),所有病人2个月后关节肿胀减轻,随访期间内无病变复发. 结论关节镜下切除滑膜和清理结核性肉芽组织,改善软骨营养,结合药物治疗可有效控制病情,改善关节功能.     

The value of pleural fluid anti-A60 IgM in BCG-vaccinated tuberculous pleurisy patients

Objectives   To determine if detection of IgM and IgG antibodies against mycobacterial antigen A60, together with the Mantoux tuberculin skin test (TST), could be used in the diagnosis of tuberculous pleurisy (TP) in BCG-vaccinated cases.
Methods   We investigated 125 BCG-vaccinated patients with pleural effusion. Of these, 88 had TP and 37 had non-tuberculous pleurisy (NTP). TST and anti-A60 IgM and IgG measurements by ELISA were performed in the sera and pleural effusions of both groups.
Results   Cut-off values, in optical density, for serum anti-A60 IgM, pleural fluid anti-A60 IgM, serum anti-A60 IgG and pleural fluid anti-A60 IgG were defined as 0.624, 0.614, 0.464, and 0.613, respectively. TP patients had higher IgG and IgM levels in the serum ( P  < 0.001 and P  < 0.05, respectively) and pleural effusion ( P  < 0.001 and P  < 0.001, respectively). Regardless of the diagnosis, IgG and IgM levels were higher in the sera ( P  < 0.001 and P  < 0.05, respectively) and pleural effusions ( P  < 0.001 and P  < 0.001, respectively) of TST-positive cases, and serum and pleural fluid IgM levels were higher ( P  < 0.001 and P  < 0.001, respectively) in the TST-positive TP cases. Sensitivity and specificity of TST were 65% and 68%, respectively. As a single parameter, pleural fluid anti-A60 IgM had the highest sensitivity (77%) and specificity (94%) in patients with negative TST.
Conclusion   We suggest that in populations where tuberculosis prevalence is high and BCG vaccination is common, pleural fluid anti-A60 IgM can facilitate the diagnosis of TP.     

检测LAM-IgG指标诊断与鉴别诊断结核性腹水

目的：了解检测腹水标本阿拉伯糖甘露糖脂IgG抗体（LAM－IgG)指标诊断与鉴别诊断结核性腹水的应用价值。方法：研究对象包括恶性腹水组（恶性组）38人,结核性腹水组（结核组）32人,其他良性腹水组（对照组）32人,采集腹水为检测标本,应用斑点免疫金渗滤试验（dot-IGFA)技术检测LAM－IgG。结果：LAM－IgG的阳性结果为：恶性组5．3％（2／39）,结核组65．6％（21／32）,对照组0。结论：在诊断与鉴别诊断结核性腹水方面,LAM－IgG指标的特异性,敏感性均较高,具有应用价值。