Comparative analysis of tuberculous and brucellar spondylodiscitis

Our aim was to compare the clinical, radiological and prognostic features of spontaneous spondylodiscitis secondary to tuberculosis (TS) and brucellosis (BS). This prospective study involved 41 patients diagnosed with spondylodiscitis. Of these, 18 (43.1%) had BS and 23 (56.1%) had TS. The mean age of TS patients was 52 ± 13.43 years and older than BS patients (P < 0.001). A prolonged clinical course of the disease, constitutional symptoms, lymphocytosis, increased erythrocyte sedimentation rate (ESR), presence of posterior vertebrae lesions and psoas abscesses were significantly more frequent in the TS group. There are significant clinical, biological and radiological differences between TS and BS. These differences permit a presumptive aetiological diagnosis and orient the initial empirical medical treatment while awaiting a final microbiological diagnosis.     

The clinical spectrum of osteoarticular tuberculosis in non-human immunodeficiency virus patients in a defined area of northwestern Spain (1988-1997)

OBJECTIVE: To examine the frequency and clinical manifestations of osteoarticular tuberculosis in non-human immunodeficiency virus (HIV) patients during the past 10 years in a northwestern area of Spain. METHODS: The charts of all patients older than 14 years of age, not HIV-infected, and diagnosed as having osteoarticular tuberculosis at the Xeral-Calde Hospital from 1988 through 1997 were reviewed. All patients were residents of the region of Lugo. The diagnosis of osteoarticular tuberculosis was made on the basis of a positive culture for Mycobacterium tuberculosis from synovial fluid, joint tissue or paravertebral abscess or by histological findings of caseating granulomas in biopsied tissue. RESULTS: Thirty-two HIV-negative patients (20 men and 12 women) were diagnosed with osteoarticular tuberculosis. The average annual incidence rate of osteoarticular tuberculosis in the combined (male and female) non-HIV population > or = 15 years of age was 15.68/million (95% CI: 10.25; 21.11); males 20.02/million (95% CI: 11.25; 28.79); females 11.52/million (95% CI: 5.00; 18.03). The age at the time of diagnosis was 60.8 +/- 17.5 years. Peripheral monoarthritis was observed in 16 of the 32 cases. The knee was the most frequent site of peripheral tuberculous arthritis (31%), but involvement of the non-weight-bearing joints (50%) was also common. Spondylitis involving the lower thoracic and upper lumbar vertebrae (31%) and unilateral sacroiliitis (19%) were less commonly observed. In general, patients with osteoarticular tuberculosis had a long duration of symptoms of the disease prior to the diagnosis (median: 5.5 months). The tuberculin skin test was negative in 3 cases. Chest radiograph was abnormal in only 6 of 32 patients (19%). The ESR (mean +/- SD) at the time of diagnosis was 55.7 +/- 29.0 mm/hr. Computed tomography was very useful in detecting early involvement of the sacroiliac joints and in defining the extent of the abscesses and the severity of the involvement in patients with spondylitis. All patients received chemotherapy for tuberculosis. None of them suffered relapses of tuberculosis. CONCLUSION: Tuberculosis is a major source of osteoarticular complications in northwestern Spain. The prevailing low level of clinical suspicion may explain the long delay to the diagnosis in most patients. A greater awareness of the possibility of this severe complication, especially in the elderly people or in high-risk populations, would be advisable.     

Prevalence of ossification of posterior longitudinal ligament in patients with ankylosing spondylitis

OBJECTIVE: To determine the prevalence of ossification of the posterior longitudinal ligament (OPLL) in patients with ankylosing spondylitis (AS). METHODS: A cross-sectional radiological examination was performed in patients diagnosed with AS. A bone and joint radiologist screened and confirmed the cervical radiographs of these patients. A review of the medical records was also conducted to investigate the relationship between the clinical manifestations and the actual expression of OPLL in patients with AS. RESULTS: Among 544 patients with AS, 470 (86.4%) were men and 96.1% were HLA-B27-positive. The mean age was 34.3 +/- 9.3 years and mean disease duration was 12.4 +/- 7.2 years. After reviewing the cervical radiographs, OPLL was found in 19 patients (3.5%; 95% CI 1.9, 5.0). The mean age of these 19 patients was 39.9 +/- 10.7 years, and the male to female ratio was 18:1. Interestingly, a statistically significant number of patients who expressed OPLL were older (p = 0.007). However, we were unable to determine whether OPLL was significantly associated with AS disease duration, peripheral arthritis, anterior uveitis/iritis, HLA-B27, anterior atlantoaxial subluxation, diffuse idiopathic skeletal hyperostosis, or other paraspinal ligament disorders. CONCLUSION: Our study showed that the frequency of OPLL in Korean patients with AS was 3.5%, which was considerably lower than previously reported values (15.5% in 103 Mexican AS). We were able to determine that OPLL in AS was associated with older age.     

Bacterial spondylodiskitis: pyogenic or tuberculous?

We retrospectively studied the epidemiological, clinical, radiological and evolutive aspects of bacterial spondylodiskitis observed in 39 patients diagnosed from January 1989 to December 1998, in order to find criteria to distinguish between pyogenic spondylodiskitis (PS) and tuberculous spondylodiskitis (TS). During the study period, we collected 13 patients (33.3%) with PS and 26 patients (66.7%) with TS. The mean age was 44 years. The delay in diagnosis was much longer in TS (8.4 months) than in PS (2 months). Diagnosis was certain in 6 cases (46%) of PS and in 12 cases (46%) of TS. Clinically, paravertebral abscesses and neurologic complications were significantly more frequent in TS. The main causative agents in PS were staphylococci. Diagnosis of spondylodiskitis is based on the imaging techniques, especially magnetic resonance imaging which is more sensitive and specific than computed tomography. Except in patients with positive blood cultures or positive urine culture in PS, and isolation of Mycobacterium tuberculosis in another visceral foci in TS, bacteriologic diagnosis was based on discovertebral needle biopsy. The yield of this technique was poor in our study (12.5%), even if bacteriologic confirmation of spondylodiskitis was made in 15 patients (38.5%). In the other cases, diagnosis rested on a set of clinical, biological and radiological criteria.     

Current aspects of spinal tuberculosis: apropos of 16 case reports]

We retrospectively studied the epidemiological, clinical, histological and evolutive aspects of vertebral tuberculosis diagnosed in all consecutive patients recruited in 2 Parisian hospitals between January 1990 and July 1997. The diagnosis relied on a vertebral involvement associated with evidence of tuberculosis (culture of local puncture yielded Mycobacterium tuberculosis) or presumption of tuberculosis (evidence of other tuberculous focus, histological data, good outcome under specific treatment). Sixteen patients (mean age: 41 years; sex ratio: 1.29) have been included; thirteen were migrants. The main symptoms, which appeared within a mean period of 3 months were vertebral pain (13/16) and alteration of patient's general conditions (8/16). RMN imaging showed spondylitis (10/16), spondylodiscitis (4/16) and involvement of posterior arch (8/16). Inflammatory syndrome was present in 14 cases. The diagnosis of vertebral tuberculosis was confirmed in 12 cases according to the results of culture and/or histological grounds of local puncture. The diagnosis of vertebral tuberculosis was presumed in the 4 other cases according to the isolation of M. tuberculosis from an other site (2 cases), the characteristic histological pattern of a lymphadenopathy (1 case), and a favorable outcome upon specific treatment (1 case). All the patients were cured without complications with the exception of one patient who developed a spinal cord compression.     

Clinical comparison of active primary tuberculosis in recent years and the past]

Three hundred and forty-four cases of active primary tuberculosis admitted to the National Sanatorium Seiransou Hospital from 1980 to 1987 were studied and compared with 101 cases admitted from 1966 to 1969. None had a previous history of tuberculosis, and all were diagnosed via positive smears for acid-fast bacilli and/or positive Mycobacterium tuberculosis cultures. The age distribution showed that in the recent cases, the highest incidence among the male patients was observed in the middle-age group (30-59 yr) and in the older age group (over 60 yr) among the female patients. In the earlier cases, the younger (under 29 yr) and middle-age groups showed a higher incidence than the older age group for both sexes. However, when the prevalence rate was calculated for recent and past cases using the total population of the districts where the patients lived, it was observed that tuberculosis was most prevalent among the older age group for both sexes. Seventy percent of these cases were admitted to the hospital due to self-conscious symptoms, and 20% were referred as a result of mass-screening chest X-ray examinations. The rest of cases were discovered by routine radiographs taken during admission for unrelated illnesses. Some of the middle- and older-aged patients had predisposing factors, such as diabetes mellitus, gastric ulcers and malignancy, in their past histories or as complicating diseases. Twenty percent of all cases had a family history of tuberculosis. In most cases, a second family member was admitted with tuberculosis within 10 years after the first family member's presentation; however, some cases developed after 30-40 years. This fact suggests a possible hereditary or genetic disposition rather than direct transmission of M. tuberculosis. Drug resistance was observed in 5-19% of the primary cases, highest in the younger age group, in whom tuberculous lesions revealed on chest X-rays were unilateral rather than bilateral as in the older patients. Radiograph findings were primarily infiltrative in the past, whereas cavitation was the prominent feature in recent cases. Tuberculin skin testing was 90% positive in all groups except the older-age males, whose positivity rate was 71%. In the past, 25% of the cases were treated with both surgery and chemotherapy, including SM, PAS and INH, whereas only 2.5% were operated in recent cases. There were 11 cases (3.2%) of extrapulmonary tuberculosis that included involvement of the urinary tract, larynx, ribs and cervical lymph nodes.(ABSTRACT TRUNCATED AT 400 WORDS)     

Diagnosing tuberculous spondylitis: patients with back pain referred to a rheumatology outpatient department

The onset of tuberculous spondylitis is insidious in nature, with various clinical presentations, slow development of radiographic abnormalities, and nonspecific constitutional symptoms. This lack of specific symptoms causes delays in diagnosis. Magnetic resonance imaging demonstrates osteitis, intraosseous abscesses, paravertebral and epidural soft tissue extensions and abscesses, discitis, multilevel involvement of spinal cord or nerve root compression, and scoliosis. We present six patients with tuberculous spondylitis referred to our outpatient department with back pain resistant to medical therapy. All of them were women aged from 25 to 58 years (mean 44.6). The diagnosis of tuberculous spondylitis was based on clinical presentation, radiographic and/or MRI evidence of focal destructive vertebral lesions (with paravertebral mass), and positive bacteriological findings of Mycobacterium tuberculosis. The combined antituberculous chemotherapy consisted of 1.0 g/day streptomycin for 1 month, 25 mg/kg ethambutol or 25 mg/kg pyrazinamide, 600 mg/day rifampicin, and 300 mg/day isoniazid. The duration of therapy was 12 months. All the patients recovered without any sequelae. The mean follow-up period was 28 months (range 12–48). Magnetic resonance imaging is considered the main imaging modality for patients with suspected tuberculous spondylitis; it must be included in differential diagnosis of back pain and, if it is diagnosed in early stages, antituberculous chemotherapy enables satisfactory outcome.     

Clinical, laboratory findings and microbiologic characterization of bronchiectasis in Thai patients

OBJECTIVE: The aim of the present study was to characterize the clinical features, underlying disease states, laboratory findings and microbiological characterization of bronchiectasis in Thai patients. METHODOLOGY: For a 2-year period all consecutive patients diagnosed with bronchiectasis at Phramongkutklao Hospital, Bangkok, Thailand, were recruited. Data including history, physical examination, underlying disease and laboratory studies were carefully reviewed and recorded. RESULTS: Fifty patients diagnosed with bronchiectasis were enrolled. Their mean age was 58 years. The most common background aetiology was tuberculosis. Six per cent of the patients were diagnosed as having diffuse panbronchiolitis. Normal chest radiographs were found in 10%. The common organisms isolated were Pseudomonas aeruginosa (20%), Haemophilus influenzae (14%), Klebsiella pneumoniae (14%) and Streptococcus pneumoniae (6%). Non-tuberculous mycobacteria which included Mycobacterium kansasii and Mycobacterium chelonae were found in 6%. CONCLUSION: We report the characteristics of bronchiectasis in Thai patients. The most common identifiable aetiology was tuberculosis.     

Tuberculous anal sepsis

INTRODUCTION: Tuberculosis is a neglected cause of anal sepsis, often is not recognized, and therefore is not treated properly. METHOD: All patients were reviewed who had tuberculous anal sepsis diagnosed by histology reports of fistulectomy specimens or abscess scrapings from January 1990 to April 1999. RESULTS: Twenty patients (median age, 53 years; 18 males) with anal tuberculous sepsis were identified. They presented with abscesses (n=2), abscesses and fistulas (n=6), or fistulas (n=12). All patients had a long history of anal complaints (3 months to 20 years), for which 15 patients were operated on previously. Nearly all fistulas (17/18) were complex, and secondary tracks or additional complicating features were common, even at first presentation. Eight patients had active concurrent pulmonary tuberculosis, and six showed evidence of previous pulmonary tuberculosis. Six patients had no signs of concurrent or previous tuberculosis elsewhere. Recurrence was observed only in cases where tuberculosis was initially not recognized, and antitubercular treatment therefore was not started. CONCLUSION: Contrary to views held previously, anal tubercular sepsis seems to have characteristic clinical features. It should be considered in cases of known pulmonary or extrapulmonary tuberculosis or if anal sepsis is persistent, recurrent, or complex in nature.     

Clinical and radiographic manifestations of tuberculous spondylitis in adults

Data on 348 adult patients with tuberculous spondylitis treated in 1994-1999 are analyzed. The radiation manifestations of spondylitis first occurring in maturity, which amount to 82.3% in the clinical setting were studied in 112 patients. In 50% of cases, spondylitis was a manifestation of multiorgan tuberculosis. The proportion of those with onset in youth increased (27.9). Isolated lesions of the corpus vertebrae were more frequently detected. The processes involving 2 vertebrae were predominant (61.2%), but complicated by foci at new levels. There was a drastic increase in the proportion of disseminated and multi-levelled spondylitis involving 3-9 vertebrae (36.9%). The exudative component of the inflammation was much pronounced, abscesses were extensive in all forms of spondylitis. Spinal cord deficit was noted in 68% of cases of thoracic and cervical spondylitis. MRI should be used for early diagnosis and determination of the extent of a process.     

六例布鲁氏菌性脊柱炎误诊为腰椎结核临床分析

目的: 对误诊为腰椎结核的布鲁氏菌性脊柱炎患者进行分析,探讨布鲁氏菌性脊柱炎的治疗结局。 方法: 收集陕西省结核病防治院2018年6月至2021年6月误诊为腰椎结核的6例布鲁氏菌性脊柱炎患者的临床资料,对临床症状、实验室检查结果、影像学表现、治疗方法及随访结果进行分析。 结果: 6例患者中,男性4例,女性2例;年龄54~81岁,平均(63.00±10.15)岁;2例有布鲁氏菌病接触史,3例有牧区及牛羊接触史,1例接触史不详;1例合并陈旧性肺结核,1例硬膜外脓肿患者行手术治疗。病程20d至1年,平均(4.17±1.32)个月;误诊时间7~24d,平均(15.66±5.53)d;病变部位位于腰2~3椎体2例,腰3~4椎体1例,腰4~5椎体2例,腰5~骶1椎体并发硬膜外脓肿1例。6例患者X线检查均表现为椎间隙狭窄,椎体为边缘型骨质破坏且与增生硬化交替出现,邻近椎间骨桥形成;1例高热,体温>39℃,为波状热,其余5例体温正常;2例结核菌素纯蛋白衍生物(PPD)皮肤试验弱阳性,3例一般阳性,3例结核抗体阳性,2例结核蛋白芯片(LAM抗体)及结核感染T细胞斑点试验(T-SPOT.TB)阳性。所有患者通过虎红平板凝集试验初筛及试管凝集试验阳性确诊为布鲁氏菌性脊柱炎,经盐酸多西环素、利福平治疗12周,随访6个月,最终4例治愈,2例好转,未见复发。 结论: 布鲁氏菌性脊柱炎一般有疾病接触史,通过热型及实验室检查可确诊,布鲁氏菌性脊柱炎患者总体预后良好。     

Causes of pleural exudates in a region with a high incidence of tuberculosis

OBJECTIVE: To define the causes of exudative pleural effusions in our region. METHODOLOGY: A retrospective study was performed on consecutive patients with exudative pleural effusion seen in our hospital during a 4-year period. RESULTS: Of 186 patients with a mean age (+/- SD) of 51.2 (+/- 19.2) years with exudative pleural effusions, 131 (70.4%) were males and 55 (29.6%) were females. The most frequent cause of exudative pleural effusions was tuberculosis (44.1%), followed by malignancy (29.6%). The majority (94.5%) of malignant pleural effusions were due to lung cancer. Apart from a patient with bilateral pleural effusions due to cryptococcosis, patients with tuberculous pleural effusion (mean age (+/- SD), 39.7 (+/- 17.5)) were significantly younger than the rest (P < 0.05). Tuberculous effusions were most frequent in the first five decades (60/82, 73.2%) and were the most common type of pleural effusion, accounting for 60 (69.8%) of 86 cases, in this age range. Malignant effusions were more frequent among the older age groups, 74.5% (41/55) of patients with malignant effusions being older than 50 years. Most types of pleural effusions showed a preference for the right side. Of the 44 cases of large effusions, 28 (63.6%) were caused by malignancy. CONCLUSIONS: In our region with a high incidence of tuberculosis, the most frequent cause of pleural exudates is tuberculosis followed by malignancy, particularly lung cancer.     

Peritoneal tuberculosis: 27 cases in the suburbs of northeastern Paris]

SETTING: Peritoneal tuberculosis did not disappear from France during the 1990s. OBJECTIVE: To determine the characteristics of peritoneal tuberculosis in the north-eastern suburbs of Paris. METHOD: A retrospective study of cases diagnosed with peritoneal tuberculosis between 1990 and 1998 in five suburban hospitals in the north-east region of Paris. RESULTS: Twenty-seven cases of adult peritoneal tuberculosis were diagnosed. There were nine women and 18 men, with a mean age of 37.5 years, 88.9% of whom were foreign born. General and digestive symptoms--abdominal pain and/or ascites--were present in 96.3% of the cases. The mean delay in treatment was 30 days. Peritoneal involvement was isolated in 25.9% of cases, and associated with pulmonary tuberculosis in 40.7% or hepatic tuberculosis in 25.9%. Co-infection with HIV (human immunodeficiency virus) was present 14.8% of cases. Culture of ascites fluid, laparoscopy and/or laparotomy (n = 17), with directed biopsy, aided in the formal diagnosis of peritoneal tuberculosis in 59.2%. One relapse and one case of multiresistance were observed. The mean duration of treatment was 9 months (range 6-12 months). Three patients received treatment with corticosteroids, and 91.2% of the patients achieved cure without sequelae. CONCLUSION: Peritoneal tuberculosis is not rare in the Paris region. The diagnosis should be suspected in case with ascites and fever, and can be confirmed by laparoscopy with sampling for bacteriology and histology. The methods of treatment need to be standardised.     

Prevalence of hip osteoarthritis in Iceland.

OBJECTIVE: To assess the prevalence of primary hip osteoarthritis (OA) in Iceland. To compare the prevalence of primary hip OA in Iceland with published rates of primary hip OA for related Scandinavian populations. METHODS: Roentgenographs were examined of 1530 Icelandic people 35 years or older (653 males, 877 females) subjected to colon radiography during the years 1990-1996. The radiographs examined represent approximately 40% of all colon radiographs taken in Iceland during this period. After exclusion of non-primary hip OA cases, the minimum hip joint space was measured with a mm ruler. Presence of hip OA was defined as a minimum joint space of 2.5 mm or less on an anteroposterior radiograph. Intraclass correlation coefficients for inter and intraobserver variability of assessment of mm joint space were 0.91 and 0.95, respectively. RESULTS: Of the 1517 people included, 227 hips in 165 patients (77 men, 88 women) were diagnosed as having radiological primary hip OA. The mean age at colon examination for these patients was 68 (35-89) years. The overall prevalence of coxarthrosis among all examined patients 35 years and older was 10.8% (12% for men, 10% for women), rising from 2% at 35-39 years to 35.4% for those 85 years or older. If the population structure (age and sex distribution) for those older than 35 years in Iceland was used to standardise prevalence for both Iceland and south Sweden (using previously published data for south Sweden), the age and sex standardised prevalence of hip OA for those older than 35 years in Iceland was 8%, compared with 1.2% for south Sweden. CONCLUSIONS: The prevalence of radiological primary hip OA is very high in Iceland, and in excess of fivefold higher than the prevalence found by using similar techniques in studies on related populations in southern Scandinavia. The rate difference is particularly notable for those younger than 70 years.     

Brucellar spondylitis: a detailed analysis based on current findings

Three hundred thirty-one cases of brucellosis included in a 10-year prospective protocol were reviewed to identify and follow up patients with spondylitis. Of 20 patients (17 male and three female; mean age, 54 years), spondylitis was diagnosed soon after onset of the brucellosis in 15, there were significant systemic symptoms in 17, and blood cultures were positive for Brucella melitensis in 14. The main symptom was vertebral pain. The commonest radiographic changes were narrowing of the disk and epiphysitis. The discrete character of radiographic alterations and negative uptake on bone scanning caused diagnostic delays in three patients. 99mTc bone scans finally became abnormal in all patients, but were not useful for follow-up because low uptake persisted after the clinical status stabilized. Three patients had paravertebral abscesses; in two of them fever and pain persisted despite antibiotic therapy until diagnosis and surgical drainage. Finally, all patients were cured, ten with sequelae. Brucellar spondylitis often had an acute clinical course with bacteremia. Because neither clinical nor radiographic changes one year after onset were significant, long-term follow-up is not considered necessary except when paravertebral abscess is suspected.     

Childhood diabetes mellitus in Ethiopians

Of 1088 consecutive Ethiopian diabetic patients registered over 9 years 80 (7.4%) were diagnosed at or before age 15 years. There were 48 girls and 32 boys, with mean age of onset of 10.1 years. Diabetes had been present 10 years or less in 62, 11 to 20 years in 15, and more than 20 years in only 2. Twenty-two were rural, 27 had poverty certificates. Twenty-three have known diabetic relatives. The original mode of presentation could not be verified in 16, 7 presented in ketoacidosis, 5 were diagnosed by a diabetic relative, and the rest presented with the rapid onset of classical symptoms. To date, 43 have been ketoacidotic at least once. No pancreatic calcification was seen in 34 abdominal radiographs. Three of 6 newly diagnosed patients tested had islet cell surface antibodies. Three cases, initially suggestive of 'tropical malnutrition diabetes', evolved into typical type 1 diabetes. Serious complicating illnesses were tuberculosis (6), bacterial endocarditis (1) and rhinocerebral mucormycosis (1). Six patients have had metabolic cataracts. Ten patients (12%) have died, 4 of ketoacidosis and 4 of diabetic nephropathy. Childhood diabetes mellitus in Ethiopians is clinically very similar to type 1 diabetes elsewhere.     

Increased risk of colorectal cancer in ulcerative colitis patients diagnosed after 40 years of age.

BACKGROUND: The association between ulcerative colitis (UC) and colorectal cancer (CRC) is well established. Retrospective data show a 5.4% CRC incidence rate among patients with pancolitis and suggest that cancer surveillance should be provided to patients following eight to 10 years of extensive UC. AIM: To identify premalignant risk factors for UC patients and to determine whether current recommendations for cancer surveillance need reviewing. PATIENTS AND METHODS: A retrospective audit was conducted of adult patients with UC who were diagnosed with CRC between 1991 and 2002 in five hospitals in Edmonton, Alberta. RESULTS: Thirty-one cases of CRC (68% male) were identified. In this group, the mean ages at diagnosis were 44.4 years for UC patients and 60.1 years for CRC patients. For patients in whom the initial data of diagnosis of UC could be determined (n=29), the median duration of UC at the time of CRC diagnosis was 16 years. Patients diagnosed with UC after 40 years of age (n=15, mean age 64 years) progressed more rapidly to CRC than patients diagnosed before 40 years of age (n=14, mean age 23 years). The median durations of UC before development of CRC were 22 years and 10 years, respectively, for patients with a diagnosis of UC before and after 40 years of age (OR 11.5, 95% CI 2.41 to 20.16; P=0.00029). Only four patients (13%) were enrolled in an appropriate cancer-screening program. Nine of these UC patients (29%) who were older than 40 years of age developed CRC before the 10-year point. CONCLUSIONS: In the present study, patients diagnosed with UC after 40 years of age developed CRC more rapidly than those diagnosed before 40 years of age. This finding suggests that patients who are diagnosed with UC after 40 years of age should undergo CRC surveillance earlier than current recommendations.     

Prevalence of thyroid dysfunction in Turner's syndrome: a long-term follow-up study and brief literature review.

Thyroid dysfunction, especially hypothyroidism caused by Hashimoto's thyroiditis is more frequently observed in girls with Turner's syndrome (TS). The aim of the present study was to evaluate prevalence, etiology, karyotype distribution and age at onset of thyroid pathology in girls with TS. Data recorded in 84 girls with TS attending our clinic were analyzed. The mean age +/- standard deviation [SD] at their initial evaluation was 10.3 +/- 3.7 years (range, 0.5 to 19 years) and the mean period of observation was 8.4 +/- 4.4 years. The thyroid function had been evaluated at least once per year in all patients and thyroid autoantibodies (ATA) were available in 51 (60.7%). Hypothyroidism was detected in 24% of the studied subjects and hyperthyroidism in 2.5%. Elevated values of thyroid autoantibodies were detected in 42% of girls with TS, whose ATA had been determined, and 65% had hypothyroidism. Thyroid dysfunction was first noted after the age of 8 years with no difference in the distribution of new cases at the different ages or pubertal stages. There was no difference in the incidence of thyroid dysfunction related to the type of karyotype abnormality. Thyroid dysfunction is more frequently encountered in girls with TS (hypothyroidism: 24% in the total group and 65% in those with positive ATA, hyperthyroidism: 2.5%). Thyroid dysfunction was observed after the age of 8 years with no difference in the occurrence of new cases in the various age groups thereafter. Hence, thyroid function should be evaluated yearly in girls with TS past the age of 8 years and more frequently in those with positive thyroid autoantibodies.     

Age-dependent alterations in clinical features of pulmonary tuberculosis]

Age-related changes in clinical features of 182 patients diagnosed as having pulmonary tuberculosis from positive culture results of tubercle bacilli were extensively investigated. The percentage of cases detected using mass miniature radiophotography (MMR) was highest in the patients aged 30-39 years, and then decreased with increasing age. It was only 16-19% in those aged 60 years or older. Certain conditions, such as cardiovascular diseases, hypertension, diabetes mellitus, malignancy and other lung diseases, were common in the patients aged 60 years or older. Systemic symptoms, including weight loss and anorexia, and physical abnormalities, including fever and crackles, were common in these patients. Anemia tended to be predominant in the patients aged 60 years or older. The middle/lower lobes were involved more frequently in these patients, in whom the disease distribution was more than one lobe, or disseminated. Positive smear results and negative anergy were more frequently noted in the patients aged 60 years or older. The mortality from tuberculosis in these patients was 4% (7 cases). Although gastrointestinal disorder due to antitubercular drugs was more common in the patients aged 80 years or older, eosinophilia was less frequently observed. Today, improved conditions, better sanitation and the development of new chemotherapeutic agents have contributed to the decline of tuberculosis among the general population. But more efficient procedures that allow the early detection or diagnosis of pulmonary tuberculosis in the elderly should be achieved as soon as possible.