结核性多发性肝脓疡2例

回顾性分析我院近年收治的2例结核性多发性肝脓肿病例，并对该病的临床表现、诊断、治疗进行讨论。2例患者经常规抗结核治疗后肝脏病变消失，半年后随访未见复发。医隹应充分认识结核性多发性肝脓肿的特点，并在临床工作中加以鉴别。     

Specific features of tuberculous uveitis pathomorphology]

There have been great changes in the clinical picture and course of ocular tuberculosis in the 90s versus the 70-80s. There has been a upward trend in the incidence of ocular tuberculosis in the population, in children and teenagers in particular. Patients with tuberculous uveitis involving the posterior eye makes up over 70%. A specific eye tissue inflammatory process is mainly exudative and infiltrative with rapid development of the complications masking a tuberculous focus, which hampers treatment and causes a significant decrease in visual functions.     

Two cases of tuberculous peritonitis and clinical significance of serum CA-125

We had recently experienced two cases of tuberculous peritonitis. One was suspected of ovarian cancer but finally diagnosed as tuberculosis by the exploratory laparotomy. The other was found out casually at the operation of benign ovarian tumor. Both cases accompanied with pulmonary tuberculosis. Tuberculous peritonitis should be considered in the differential diagnosis in patients with abdominal disorders. Remarkable elevation of serum CA-125 related to ovarian cancer was found in both cases. It was suggested that level of serum CA-125 might be useful for diagnosis and monitoring of the disease.     

Two cases of tuberculous peritonitis with liver cirrhosis complicated by refractory ascites

We present two cases of tuberculous peritonitis with liver cirrhosis complicated by refractory ascites. Case 1 was a 59-year-old female with alcoholic liver cirrhosis. She was admitted to our hospital because of diarrhea, anorexia and inflammatory reactions on a blood test. She had a high fever of 38°C or more and refractory ascites. Tubercle bacilli infection was suspected based on increased levels of serum CA125 and adenosine deaminase (ADA) in ascites. Laparoscopic examination showed white nodules on the peritoneum, and histologic study confirmed tuberculous nodules. The same bacteria were isolated from culture of ascites. Case 2 was a 55-year-old female with hepatitis C virus-infected liver cirrhosis. She was admitted because of high fever and abdominal fullness due to ascites. High levels of serum CA125 and ADA in ascites and ineffectiveness of treatment with antibiotics plus diuretics led us to start anti-tuberculous therapy before definitive diagnosis. Tuberculus bacillus was later isolated from culture of ascites. It is difficult to make early diagnosis of tuberculous peritonitis in cirrhotic patients with ascites due to a lack of specific symptoms. However, determination of serum CA125 and ADA in ascites and the acid-fast bacterial culture of ascites are useful for early diagnosis.     

结核性脑膜炎二例

例1,男性,30岁。发热、咳嗽、胸闷、头痛20ｄ,精神障碍1ｄ。查体:体温38.5℃,神志模糊,颈强直,克氏征(+),布氏征(+)。下颌离胸可容三横指。双肺呼吸音低。心律整齐,无杂音。四肢腱反射减弱,肌力肌张力正常,病理反射()。入院后腰穿:脑压30ｍｍＨｇ,全程脑脊液浅红,ＲＢＣ120×106/Ｌ,边缘不整的ＲＢＣ占95%,ＷＢＣ125×106/Ｌ,其中单核细胞0.78,中性0.22。蛋白质2.88ｇ/Ｌ,糖0.29ｍｍｏｌ/Ｌ,氯化物110ｍｍｏｌ/Ｌ。涂片未找到抗酸杆菌。Ｘ线示双肺散在对称性小斑点状粟粒状阴影。最后诊断:结核性脑膜炎、急性粟粒型肺结核。例2,女性,38岁。…     

Diagnosis of tuberculous uveitis: clinical application of an interferon-gamma release assay

M. tuberculosis is a possible cause of uveitis; the diagnosis is often difficult. The aim of this study is to evaluate, in this context, the application of an interferon gamma assay, the SpotTB?. The prospective study, in patients presenting with uveitis without obvious cause and not resolving with local treatment, compared the therapeutic approach (giving antituberculous treatment or not) with and without the result of the SpotTB?. The analyses included 23 patients: 78% had received BCG; 78% had isolated ocular involvement; 22% had associated mediastinal lymphadenopathy. The results of the IDR and the SpotTB? were concordant in 61%, discordant in 22% and non-evaluable in 17% of cases. In the patients with isolated ocular involvement the SpotTB? avoided treatment in five and reinforced the decision not to treat in 13 others. In the patients with mediastinal lymphadenopathy, the SpotTB? reinforced the diagnosis of sarcoidosis in four cases (one lost from view). In conclusion, when infection with M. tuberculosis is considered in the aetiology of uveitis the SpotTB? allows, in a significant number of cases, the avoidance of antituberculous treatment.     

Evaluating 82 cases of tuberculous meningitis

Tuberculous meningitis (TBM) is not the most common but the most serious clinical form of extrapulmonary tuberculosis. Serious complications resulting from difficulties in diagnosis and treatment of the disease makes it an important health problem. In our study, 82 patients with TBM, followed up in our clinic between January 1998-December 2002, are evaluated with their clinical and laboratory properties. 52% of our patients were females, 48% were males and their ages ranged from 15 to 70 with a mean of 32 years. The diagnosis was based on patients' history, clinical and laboratory properties, cerebrospinal fluid (CSF) findings and radiographic findings. 59% of our patients were grade II clinically, 29% were grade I, and 23% were grade III. Mostly observed complaints were headache (87%) and nausea-vomiting (63%) and fever (45%) and mostly seen physical findings were stiff neck (70%), alterations in consciousness (57%). Pleocytosis in CSF was detected in 94%, low CSF glucose level in 87%, and elevated CSF protein level in 82% of the patients. From CSF samples of 40 patients, out of total 82, Mycobacterium tuberculosis was isolated on Loewenstein-Jensen medium (49%). Nineteen patients had tuberculomas, 13 had basal meningitis, and 11 had hydrocephalus on cranial radiographic studies. 28% had miliary pattern and 26% had active infiltration and cavities on chest roentgenogram. A four-drug antituberculous regimen was administered for 88% of the patients and dexamethasone treatment was administered for 75%; 56 (68.3%) patients recovered from the illness, 14 (17%) patients had slight and 4 (4.9%) patients had serious neurological sequeales and 8 (9.8%) patients died in spite of tuberculous therapy. As a conclusion, TBM is an infectious disease with high morbidity and mortality rates. Various prognosis patterns may be observed according to the clinical grade of the patient on application. When suspected, an early diagnosis and early treatment of the disease are the most important factors which effect complication and mortality rates.     

Four cases of the tuberculous adenitis

We report four cases of tuberuculosis with the lymph nodes swelling in the porta hepatis. Case 1 is 52 years-old man, who was admitted to our hospital because of anorexia. The chest X-ray film showed abnormal shadow and he was diagnosed as tuberculosis by sputum examination. At the time of hospitalization, patient's conjunctiva is icteric on physical examination. The serum T-Bil was 3.21 mg/dL and D-Bil was 2.54 mg/dL. The enhanced CT showed compression of the extrahepatic common bile duct which was caused by enlarged lymph nodes secondary to tuberculous adenitis. Case 2 is 25 years-old man, who was admitted to our hospital because of low grade fever and lower abdominal pain. The chest X-ray film showed abnormal shadow and he was diagnosed as tuberculosis by sputum examination. An enhanced CT showed the swelling of the lymph nodes in the porta hepatis. Case 3 is 21 years-old woman, who visited the outpatient clinic bacause of neck lymph node swelling. And she was diagnosed as tuberculous adenitis of the cervical lymph-nodes by the neck lymph node biopsy. The patient complained of upper abdominal pain during the clinical course. The enhanced CT showed the swelling of the lymph nodes in the porta hepatis. A Case 4 is 31 years-old man, who visited to outpatient clinic bacause of fever. The chest X-ray film showed mediastinal lymphadenopathy, and he was diagnosed as tuberculosis by the thoracoscopic biopsy. The enhanced abdominal CT showed lymph nodes swelling in the porta hepatis. All of lymph nodes swelling found in our four cases markedly reduced in size on abdominal enhanced CT or ultrasonography after the initiation of anti-tuberculous standard chemotherapy. Symptom of all cases got better as well. In these clinical circumstances, it was clinically important to rule out malignant lymphoma and lymphadenopathy caused by cancer. The enhanced abdominal CT were useful for diagnosis and follow-up as tuberculous adenitis.     

Determining the level of malondialdehyde in patients with different types of tuberculous uveitis

A clinical follow-up of 52 tuberculous uveitis patients showed that the choice of an appropriate plan of pathogenetic treatment and prognosis of the disease outcome requires differentiation of types of a tuberculous process in the eye. A new method has been suggested for determining the type of the tuberculous uveitis course by studying changes in the blood content of malonic dialdehyde (increase, decrease or absence of changes).     

结核性胸膜炎118例治疗体会

近年来由于耐药结核菌的产生与扩散，结核病发病率在全球范围内有所回升，是一严重的公共卫生问题。会东县疾病预防控制中心结防科1998—2007年收治118例结核性渗出性胸膜炎，现对其进行回顾性分析，报告如下。     

Evaluation of 105 cases with tuberculous pleurisy

Tuberculous pleurisy has still importance in the group of exudative pleurisy. In this study we aimed to evaluate clinical, radiological, biochemical, bacteriological and histopathological findings of 105 cases with tuberculous pleurisy retrospectively, between January 1999 and December 2002. Female/male ratio was approximately 1/9 and mean age was 32.6 (range: 15-68). The common symptoms were chest pain (75.2%), cough (54.3%) and dyspnea (47.6%). In 17% cases parenchymal lesions were seen in the chest radiography while parenchymal lesions were found 52% of patients by computed tomography. Adenosine deaminase levels in pleural fluid were high in 80% of cases. PPD reactions was found positive in 84.7% of case. Sputum was studied in 52 cases. In 6 (11.5%) patients both ARB and culture were positive but in 4 (7.7%) patients was only culture positive. Pleural fluid ARB examination of all patients was negative whereas culture was positive only in 5 (5%) of patients. In two patients pleural biopsy material culture was positive for ARB. Cytological examination of pleural fluid revealed lymphocyte predominance in 81 (81%) of cases. Eighty one patients had pleural biopsy and pathologic evaluation revealed tuberculosis in 59 (73%) of them. At the end of the treatment 24 (23%) patients had pleural thickening. Pleural fluid LDH level of the patients with pleural thickening was higher than the other patients significantly (p=0.024). It is concluded that, pleural biopsy is the most effective diagnostic method for the tuberculous pleurisy and in the patient with elevated pleural LDH level, pleural thickening seems more.     

Early treatment of tuberculous uveitis improves visual outcome: a 10-year cohort study

Purpose

Diagnosis of tuberculous uveitis (TBU) is often challenging and is usually made after excluding other causes of uveitis. We analysed the characteristics of TBU and variables associated with visual outcome.

Methods

A retrospective, observational analysis was performed in patients with presumptive TBU who were started on specific TB treatment between January 2006 and June 2016. Demographic, clinical, radiological, analytical and ophthalmic examination variables were studied. After completing TB treatment, a follow-up of at least 9 months was performed. A univariate and logistic regression analysis was applied to identify the variables associated with visual acuity and recurrences of uveitis.

Results

Forty affected eyes of 24 individuals were identified; 79% of patients were diagnosed during the last 3 years of the study period. Median delay from onset of symptoms to diagnosis was 12 weeks. Loss of visual acuity was the most frequent symptom (87.5%). Posterior uveitis was the most frequent localization (72.9%); 19 patients (79.2%) presented at least one of the Gupta signs predictive of TBU, but there were no confirmed diagnoses.

Outcome

There was improvement in visual acuity in 74.4% of the eyes, but a complete response was achieved only in 56.4%. There was recurrence in two patients. The initiation of treatment?≥?24 weeks after onset of symptoms was significantly associated with no improvement (p?=?0.026).

Conclusion

TBU can cause permanent damage to visual acuity, particularly in patients with delayed diagnosis. A prompt initiation of systemic TB treatment is essential to improve visual prognosis.

     

结核性脑膜炎324例临床分析

目的探讨结核性脑膜炎临床特点早期诊断,误诊等问题。方法对我院收治的结核性脑膜炎324例,就临床特点化疗效果早期诊断,鞘内注药,误诊原因等进行分析。结果发病早期患者占26.5%,中期占53.7%。平均33天。临床表现主要为发热、头疼,恶心,呕吐。本组病例均给于合理抗结核药治疗,其中有86例鞘内注药治疗,收到较好疗效。结论早期诊断是治疗的关键,合理标准化用药可提高疗效。重危患者可鞘内注药,疗效甚高。     

28例结核性脑膜炎临床分析

目的总结结核性脑膜脑炎的临床特点。方法分析我院明确诊断的28例结核性脑膜炎患者的临床资料。结果 22例病情好转出院,2例转神经外科,3例自动出院,1例死亡。结论早就诊、早诊断、早治疗是决定结核性脑膜炎预后的关键因素。     

结核性脑膜炎96例临床分析

目的 分析结核性脑膜炎的临床表现、诊断和治疗特点,以提高对该病的诊治水平.方法 对2006年6月至2010年10月我院收治的96例结核性脑膜炎患者的临床资料、实验室检查结果、诊断及预后情况进行总结分析.结果 本组96例结核性脑膜炎多呈慢性或亚急性起病,临床表现以发热、头痛、呕吐为主,脑脊液改变以压力、白细胞、蛋白升高、葡萄糖、氯化物降低为主.87.5％合并颅外结核.头颅CT或MRI检查异常51例,表现为脑积水、结核瘤、脑室扩张、多发病灶等.经正规抗结核治疗,临床治愈52例,好转25例,14例未见好转,自动出院或转院治疗,5例死亡.结论 患者的临床表现、脑脊液、头颅CT或MRI检查、是否合并颅外结核感染及正规抗结核治疗是否有效,是诊断结核性脑膜炎的重要依据;早期诊断及合理治疗可提高结核性脑膜炎的治愈率.