肾上腺结核的诊断与治疗(附17例报告)

目的 提高对肾上腺结核诊断与治疗的认识.方法 回顾本院1998年1月至2011年1月收治17例肾上腺结核病例的诊断与治疗.17例病例均予实验室检查及影像学检查同时给予抗结核、长期激素替代治疗或手术处理.结果 抗结核、长期激素替代治疗或手术处理使肾上腺结核引起的Addison's病得到满意的疗效.结论 根据临床特征,结合...     

Duodenal stenosis secondary to tuberculosis. Case presentation and review of the literature

Infections caused by tuberculosis reached epidemic dimensions in the middle of the last century. Unexpectedly in the present, a growing number of new cases has been detected each year, reaching alarming figures, according to the World Health Organization. One of the most infrequent manifestations is intestinal tuberculosis, specially the one that affects duodenum and as a complication, stenosis. Its diagnosis is difficult because of similarity of this pathology with other gastrointestinal dysfunctions. Medical and surgical treatments have been proposed to afford a solution to this pathology. Due to its rareness, and the diagnostic difficulty and controversy in its treatment, we present the case of a patient diagnosed with duodenal stenosis caused by tuberculosis who was treated at the Gastrointestinal Surgery Service in our hospital.     

Epididymal tuberculosis: report of a case with particular color Doppler ultrasonography finding

Isolated tuberculous epididymitis is a rare entity. Because of the increase of this pathology, tuberculosis should be considered in the differential diagnosis of a scrotal swelling even in the absence of a history of previous tuberculosis. We report a case of isolated tuberculous epididymitis, diagnosed in an early stage, with color Doppler ultrasound findings.     

十二指肠结核19例临床分析

目的 总结十二指肠结核的临床特点和病理类型，探讨有效的诊断与治疗方法。方法 回顾性分析1962年至2001年经手术及病理证实的十二指肠结核19例患的临床资料。结果 早期症状不明显，多数患就诊或手术时已有十二指肠不全性或完全性梗阻。本组诊断主要通过影像学检查和十二指肠镜，术前确诊率68．4％。病理类型最常见为炎性增生型(14例)，其次为溃疡增生型(3例)和溃疡型(2例)。病变部位：十二指肠球部2例，十二指肠降部乳头开口以上6例，乳头开口以下、降部与横部的结合部10例，水平部1例。19例均行外科手术治疗，术后恢复顺利，无明显并发症。结论 十二指肠结核早期诊断困难，影像学检查和十二指肠镜可帮助确诊。如出现梗阻等并发症，惟一有效的治疗方法是外科手术，根据病变部位而采用相应术式是手术成功的关键。     

The radiological features of primary pulmonary tuberculosis.

A very brief review is given of the pathology of primary pulmonary tuberculosis. Numerous characteristic, but not pathognomonic, radiological appearances of primary pulmonary tuberculosis are briefly described and some of them are illustrated. The final diagnosis, however, depends on correlating the radiological picture with the clinical picture and special investigations.     

Abdominal tuberculosis--a disease revived.

Abdominal tuberculosis was common in the United Kingdom in the 18th and 19th centuries and in the first half of the 20th century. During the 1950's the recognition of Crohn's disease, the use of streptomycin and other drugs, and the pasteurisation of milk led to the virtual disappearance of abdominal tuberculosis in the western world. During the last two decades a new type, mycobacterium tuberculosis hominis, has appeared mainly in the immigrant population, especially in those from the Indian subcontinent. A retrospective review of 68 patients with abdominal tuberculosis is presented. The pathology, diagnosis and management of these cases is discussed, together with the differential diagnosis of Crohn's disease. It is suggested that the immigrant brings the disease into the United Kingdom in his mesenteric glands and that the disease is reactivated or 'revived' at some later date due to some modification of the immune process.     

Chylothorax due to tuberculosis lymphadenopathy: Report of a case

While pulmonary tuberculosis is a very frequent infection, chylothorax is an unusual manifestation of tuberculous disease. A 71-year-old woman with chylothorax is herein presented. The ductus thoracicus was ligated and lymphadenomegaly, which was adjacent to diaphragm, was resected. Based on the findings of various tests, a diagnosis of tuberculosis lymphadenitis was made. The patient was administered antituberculosis chemotherapy and has since remained asymptomatic for 1 year after the operation. In conclusion, tuberculosis lymphadenomegaly may lead to the development of chylothorax. The combination of appropriate surgical and medical treatment is an effective therapeutic strategy for this pathology.     

螺旋CT对脊椎结核的诊断价值

目的分析总结脊柱结核的CT影像表现。方法分析经手术病理、穿刺活检及临床证实的脊柱结核31例的多层螺旋CT表现。结果椎骨的溶骨性、虫蚀样、斑片状碎骨片样的骨质破坏部分伴有硬化,椎旁软组织中见砂粒状钙化寒性脓肿的形成,椎间隙变窄,累及椎管,韧带下型等是脊柱结核的常见影像学表现。结论脊柱结核CT诊断优于X平片,可直观显示椎旁脓肿及椎间盘等改变。脊椎骨质破坏形态多样,但仍有其典型CT影像特征,须与脊柱其他病变鉴别诊断。     

肝结核瘤的诊断和治疗（附9例报告）

目的：总结分析肝结核瘤临床诊断和治疗经验及影响诊断的相关因素。方法：回顾1985年11月－2001年3月间收治肝结核瘤9例，对其发病，临床表现，诊断以及治疗进行分析。结果：9例中4例临床作出有结核诊断，4例诊断为原发性肝癌，1例诊断为肝转移癌，9例均接受手术治疗，术后病理均诊断为肝结核瘤，误诊率55．6％，结论：肝结核瘤青壮年多发，女性多于男性，肝区疼痛伴发热为主要症状，B超，CT只能诊断为肝占位，B超引导下细针肝穿活检是临床诊断本病的主要方法。外科手术局部切除是治疗本病的有效方法。     

误诊为胰腺肿瘤行手术切除的胰腺结核6例临床分析

目的：探讨胰腺结核的诊断和治疗方法。方法：回顾分析近3年误诊为胰腺癌的6例胰腺结核病例。结果：6例病人中有结核病史2例。临床表现为腹痛1例,腹胀5例,体重减轻1例,便血1例。6例均经剖腹探查．病理学证实;其中4例获病灶切除。全部病例均经术后抗结核治疗。6例中出现肠瘘1例,顽固性腹泻2例,区域性门静脉高压、食管下段静脉曲张各1例。结论：胰腺结核易被误诊为胰腺肿瘤而手术,故对影像学检查证实胰腺有局限性、囊性病变伴病灶周围及后腹膜淋巴结肿大,且肿瘤指标正常者,应考虑胰腺结核可能。切除胰腺结核可能发生的并发症较为严重,手术治疗应慎重考虑。     

Testicular tuberculosis in an HIV positive patient mimicking malignancy: A case report

With the upsurge of tuberculosis infection compounded by the pandemic Human Immune Deficiency Virus (HIV), isolated testicular tuberculosis though a rarity, should be a differential diagnosis especially in the atypical age group of patients presenting with testicular swelling and in areas with high prevalence rate for tuberculosis.We present a 22 years old male with a year history of progressively increasing painless left testicular swelling with no constitutional symptoms. Both the ultrasound imaging study and fine needle aspiration cytology were equivocal. Diagnosis was established at surgical pathology after a left transinguinal orchidectomy.In areas endemic for tuberculosis an infective aetiology should always be considered for a testicular mass.     

Tuberculosis of the oesophagus

A case of primary tuberculosis of the oesophagus is presented; the patient was successfully treated by oesophagectomy. The condition, being rare, has stimulated the authors to review the literature concerning primary and secondary oesophageal tuberculosis. The history, modes of infection, the pathology, clinical picture, diagnosis, investigations, and methods of treatment are discussed. In contradistinction to the secondary disease, which is terminal, primary tuberculosis of the oesophagus is a curable disease with a fairly good prognosis. The case report shows that the surgeon should pay careful attention to the site of the anastomosis; otherwise post-operative stricture can develop. Even this responds well to dilatations and the patient can regain normal health.     

Isolated medial cuneiform tuberculosis: A case report

Skeletal involvement in extrapulmonary tuberculosis is extremely rare, and foot involvement accounts for less than 10% of osteoarticular tuberculosis. Tuberculosis osteomyelitis of the foot can also mimic a wide range of pathology. As a result, this condition is often misdiagnosed, or the true nature of the lesion is identified late in the diagnostic process. This article reports a case of tuberculosis in the medial cuneiform of a 3-year-old girl. Initially misdiagnosed as osteochondrosis, the patient returned 2 years later with a draining sinus on the medial aspect of the left midfoot. New radiographs showed a cystic lesion in the substance of the medial cuneiform. A diagnosis of tuberculosis was established after biopsy and histopathological examination of operative specimen. Antituberculosis treatment was implemented and continued for 16 months. At that time, clinical signs of infection had ceased.     

A case of co-existing pigmented villonodular synovitis and tuberculosis infection of the footand ankle

A woman presented with chronic left ankle pain and swelling with no systemic upset. Magnetic resonance imaging suggested pigmented villonodular synovitis (PVNS) of her left ankle joint and flexor hallucis longus tendon. Combined arthroscopic and open synovectomy was performed. Histological examination of the synovium confirmed the diagnosis of PVNS, but culture of the diseased synovium yielded mycobacterium tuberculosis. This case illustrates the possibility of double pathology and the importance in excluding tuberculosis infection.     

Squamous cell carcinoma in a postpneumonectomy cavity

A 55-year-old woman was referred to our department with the diagnosis of a bronchopleural fistula and empyema. Her medical history revealed that she had undergone a left pneumonectomy 25 years prior due to a destroyed lung associated with tuberculosis. Open drainage and a biopsy was performed because of the large mass detected on thoracic computed tomography. Postoperative pathology revealed squamous cell carcinoma.     

胃结核75例临床分析

目的 提高胃结核的诊断及治疗水平。方法 回顾性总结松花江流域10所医院40年经手术及病理证实的75例胃结核的临床资料。结果 X线钡剂造影和纤维胃镜检查并取活检为主要确诊手段。75例患手术治疗72例，占同期胃切除患的0．37％。本组胃结核病例溃疡型占50．7％；结核病灶与癌或溃疡灶并存型仅占5．3％。手术治疗的72例中，68例痊愈(94．4％)；术后均继续抗结核治疗6～12个月，58．8％的患随访1～13年均健康。术后早期死亡4例，分别为溃疡型2例死于出血性休克和并存型2例死于晚期癌症。非手术治疗的3例因幽门梗阻、慢性衰竭而先后在确诊后3个月内死亡。结论 临床上胃结核以溃疡型多见；手术治疗是最有效的方法。     

Establishing the diagnosis of tuberculous vertebral osteomyelitis

Purpose

The aim of this article has been to analyze the clinical and radiological data suggesting tuberculous vertebral osteomielitis (TVO), and then discuss the steps to be followed to achieve an aetiological diagnosis.

Methods

A thorough literature search was carried out to identify the best clinical and microbiological evidence for a fast and efficient diagnosis of TVO.

Results

The clinical and radiological diagnosis of spinal tuberculosis suffers from serious limitations, with a high percentage of cases requiring vertebral biopsy to reach a definitive diagnosis. The increasing incidence of multidrug-resistant tuberculosis has highlighted the insufficiency of the histopathological diagnosis and the need for microbiological diagnosis. Unfortunately, the maximum sensitivity of spinal tuberculosis cultures is 80 %, and traditional methods require 6 to 8 weeks for the isolation, identification and sensitivity study. New culture media and identification methods have improved sensitivity and reduced the time required for the identification. Molecular methods have now been integrated into a single test, with identification of the mycobacterium responsible and its sensitivity to rifampicin. Additionally, multiplex-PCR tests have been developed that allow a rapid differential diagnosis between granulomatous spondylodiscitis.

Conclusions

All patients with subacute inflammatory back or neck pain showing suggestive radiological findings should be studied to rule out TVO. If there is no clear evidence of tuberculosis from another location or indication for surgery, a percutaneous vertebral biopsy should be performed. When TVO is suspected, all spinal or paravertebral tissue samples should be sent simultaneously to pathology and microbiology laboratories for appropriate processing.

     

干酪样坏死性附睾结核声像图特征分析

目的:总结干酪样坏死性附睾结核高频彩色多普勒声像图特征,提高其超声诊断准确率。方法:对12例经手术及病理证实的干酪样坏死性附睾结核高频彩色多普勒检查结果及临床资料进行回顾性分析,同时与28例附睾炎资料对比并进行文献复习。结果:①12例患者结核菌素(PPD)试验阳性67%,患肺结核42%。②干酪样坏死性附睾结核高频声像图特征:附睾局部或全部肿大,外形失常,病变处呈不规则、不均质中等偏强或低回声,兼有局限性较小的不规则、均质低或无回声区,边界不清;高频彩色多普勒能量图:部分患者(33%)病灶见丰富或较丰富以动脉为主的动、静脉血流信号。③继发改变:干酪样坏死性附睾结核者患侧睾丸肿大,内回声增强,可有睾丸鞘膜积液,无阴囊壁增厚及腹股沟淋巴结肿大,不伴有精索静脉曲张。结论:干酪样坏死性附睾结核高频彩色多普勒声像图具有一定特征,超声对其诊断及鉴别诊断具有重要临床意义。     

Tuberculous infection after dynamic-hip screw osteosynthesis: a case report

We report the case of a 72-year-old woman who developed osteoarticular tuberculosis after dynamic hip screw osteosynthesis for a pertrocanteric fracture. Necrosis of the head and disassembly of the prosthetic material ensued. This patient had no history of pulmonary or extra-pulmonary tuberculosis. Certain diagnosis was established on the basis of pathology findings and successful antibiotic treatment associated with surgery: ablation of the implant, head-neck resection, total hip arthroplasty. Two hypothetical pathogenic mechanisms can be put forward: hematogenic dissemination from another focus and reactivation of latent local infection.     

不典型泌尿系结核的诊治(附23例报告)

目的：探讨肾结核的诊断与治疗方法。方法：回顾性分析23例肾结核患者的临床资料,将不典型泌尿系结核分为七类。结果：除膀胱刺激征、血尿等最常见的症状外,泌尿系结核的临床症状越来越不典型。除肾功能尚好的6例采用联合服药治疗,2例随访治愈外,余17例行患肾及输尿管切除术,术后病理检查诊断为肾结核。6例获得随访,2例并发结核性小膀胱,2例并发输尿管残端综合征,2例痊愈。结论：静脉肾盂造影（IVP）是肾结核首选的有诊断意义的检查方法,对不典型肾结核的诊断需要在提高认识的同时重视病史,综合分析尿细菌学及IVP检查,必要时联合逆行肾盂造影（RP）、CT检查才能确诊。个别患者只有在手术时才能确诊。强调晚期肾结核行半尿路全切除术十分重要;肾功能尚好的早期肾结核患者行三联化疗是有效的。