Duodenal tuberculosis: a review of the clinicopathologic features and management of twelve cases

A retrospective analysis of twelve cases of duodenal tuberculosis is presented herein. The average age of the patients was 31.4 years with a male to female ratio of 2:1. The presenting complaints were duodenal obstruction in six patients and subacute intestinal obstruction in three. None of the patients had associated pulmonary tuberculosis. Eight patients had isolated duodenal tuberculosis, two of whom were successfully treated with antitubercular drugs. In four patients, the diagnosis was established at laparotomy by the presence of tubercles over the duodenum. Five patients required a bypass procedure for obstruction caused by the duodenal tuberculosis and one patient was operated on for uncontrollable bleeding from a tubercular duodenal ulcer. All patients remained symptom free after treatment, whether medical or surgical. Thus, in areas where tuberculosis is endemic, even in the absence of pulmonary tuberculosis, duodenal tuberculosis should be suspected in patients with upper gastrointestinal obstruction or in patients with peptic ulcer like symptoms not responding to medical therapy.     

Primary Duodenal Tuberculosis: a Case Report

Gastroduodenal tuberculosis (TB) is a rare condition and is often associated with pulmonary TB. We report the case of a primary duodenal TB in an immunocompetent patient without evidence of pulmonary TB. Diagnosis of this disease is difficult and is often confused with chronic peptic ulcer disease. Literature data concerning this challenging diagnosis are analysed.     

胰头癌胆肠梗阻的简易腹腔镜内引流术治疗初探

目的 探讨治疗胰头癌胆管和/或十二指肠梗阻较简易的腹腔镜手术方法。方法 施行腹腔镜探查术(LE)、腹腔镜胆总管支架术(LCBDS)、腹腔镜联合术后胆道镜连续支架术(LCCDS)、腹腔镜肝总管-十二指肠架桥内引流术(LCHDB)、腹腔镜胃空肠吻合及胆囊空肠架桥内引流术(LGCJB)、腹腔镜胃空肠吻合及肝总管空肠架桥内引流术(LGHJB),治疗胰头癌胆管和/或十二指肠梗阻。结果 19例CT增强扫描怀疑胰头癌,临床怀疑转移而行内引流术。LE怀疑转移病灶取标本中9例病理报告胰腺癌,10例未证实。19例中15例手术获成功(无胆漏、内引流通畅、黄疸减轻或消退),1例中转开腹放置塑料支架,1例少量胆漏腹腔引流自愈,1例LCBDS术后15d死于肝肾肺功能衰竭,1例LCBDS术后15d死于肝肾功能衰竭。结论 选择合适病例,采用较简易的腹腔镜内引流术治疗胰头癌胆管和/或十二指肠梗阻有效、可行。     

Diagnosis and management of isolated pancreatic tuberculosis: recent experience and literature review

The increased reporting of tuberculosis of the pancreas is related to a worldwide increase in tuberculosis and an increase in emigration from countries where tuberculosis is endemic into countries where more sophisticated healthcare and radiological imaging are available. Three recent cases of pancreatic tuberculosis in Auckland, New Zealand, emphasize that tuberculosis should now be included in the differential diagnosis of a pancreatic mass. Diagnostic indicators include emigration from, or recent travel to, a country where tuberculosis is endemic, the association of a pancreatic mass with fever, the presence of abdominal pain and a cystic pancreatic mass in a younger male. Radiological appearances might be similar to a mucinous cystic neoplasm or could show a pancreatic mass with involvement of peripancreatic lymph nodes or a mass centred in a peripancreatic lymph node. When the diagnosis is suspected an human immunodeficiency virus test and a comprehensive screening for tuberculosis at other sites should be performed. If tuberculosis is unable to be diagnosed then pancreatic biopsy and culture is indicated. Endoscopic ultrasound with fine needle aspiration for cytology is likely to become the preferred technique. Most patients have an excellent clinical response to standard antituberculosis regimens.     

Mycobacterium tuberculosis meningitis: a report of twelve cases and a literature review

Twelve recent cases of Mycobacterium tuberculosis meningitis were presented, and the literature was reviewed. There are no particularly new or unique therapies or approaches to the management of this most serious disease. The major obstacle to successful diagnosis and treatment of tuberculous meningitis continues to be a lack of clinical suspicion of its presence. As illustrated in the cases presented, it has been our experience that patients already moribund or nonresponsive do not respond, regardless of the intervention undertaken. The most sensitive and economical method of detecting M. tuberculosis in the CSF may be LPA. However, this has not yet been widely validated or accepted. Larger volumes of CSF should be sent to the laboratory for testing and centifuged to about 5x concentrations before both acid-fast bacilli staining and culture are attempted. If tuberculous meningitis is suspected, three-drug therapy can be started immediately without jeopardizing subsequent culture confirmation of the presence of the TB bacillus. In addition, these patients must be followed closely to detect hydrocephalus at the earliest possible moment. When patients fail to respond to appropriate antituberculosis and pressure-reducing therapy, hydrocephalus should be actively sought by either CT or radioisotope cisternography. Although the decision to proceed to ventricular drainage or shunting must be individually made in adult patients with infection-related hydrocephalus, we agree with others that surgical intervention should be considered early and should be performed if the level of consciousness deteriorates, intracranial pressure increases, or ventricular enlargement or enhancing basal exudates are identified on CT.     

Isolated hepatic tuberculosis: report of five cases and review of the literature

Tuberculosis is one of the most common and well-described infectious diseases, with a worldwide distribution and a vast spectrum of clinical manifestations. Involvement of the liver alone by tuberculosis is, however, uncommon. It usually presents as a protracted illness frequently associated with jaundice and hepatomegaly. It can, therefore, mimic primary or metastatic liver malignancies. We report five cases of isolated hepatic tuberculosis, emphasizing the importance of obtaining a tissue diagnosis in all subjects with suspicious liver lesions to avoid missing the uncommon but curable hepatic tuberculosis. Received for publication on Sept. 28, 1998; accepted on Feb. 16, 1999     

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。     

Isolated tuberculosis of the spleen: A case report and review of literature

Isolated involvement of spleen in tuberculosis is a rare entity, particularly among immunocompetent hosts. Herein, we present a 28-year-old man with left abdominal discomfort for 2 years who was found to have a cystic lesion in spleen on evaluation. Eventually, he was diagnosed to have isolated splenic tuberculosis with an involvement of a single lymph node at the splenic hilum. In this rare form of tuberculosis, it seems that splenectomy in addition to standard antitubercular therapy is curative.     

肝门静脉积气3例并文献分析

目的 总结分析肝门静脉积气(hepatic portal venous gas,HPVG)的产生原因、诊断及治疗.方法 回顾菏泽市立医院2018年3月至2019年10月诊治的3例HPVG病例,结合国内报道的HPVG病例,总结分析HPVG的临床特点、诊治经过和预后.结果 本组3例HPVG中1例由腹腔感染引起,1例由肠坏死...     

Laparoscopic management of bowel perforation by ingested pins and needles: Report of two cases with a literature review

A sharp pin or needle depicted on a routine abdominal X‐ray film presents a rather alarming picture. Apparently, this intriguing entity has received scant attention thus far; a review of the literature found only 22 cases reported in sufficient detail for evaluation over the past four decades. Herein, we add two cases of our own. When all these cases are analyzed, a remarkably consistent – and rather peculiar – pattern of clinical features emerges. For example, young women are commonly involved and a history of ingestion is often absent, as are the abdominal signs. More recently, the advent of laparoscopy has allowed the surgical treatment to continue evolving as the feasibility of this approach gains recognition as a preferable option. Including the present two cases, there have been only five patients successfully managed totally by laparoscopic exploration and extraction. In the most recent four cases where there were no signs of the foreign body at laparoscopy, intraoperative fluoroscopy greatly aided in the localization of the elusive slender object.     

误诊误治跟骨结核2例

骨结核易造成误诊误治,2005年5月-2005年11月,我院收治2例误诊误治跟骨结核患者,报道如下。 1病例资料 病例1,女,34岁。因右跟骨结核并感染术后20d入院。患者于2004年11月无明显诱因出现右足跟疼痛,于2005年4月在外院住院治疗,诊断为“右跟骨化脓性骨髓炎”,行切开排脓术。病检结果示：跟骨结核。术后抗结核治疗,创口每日换药20d未愈。于5月来我院就诊。入院检查：右跟骨外侧可见一约2cm创口,窦道形成,创缘坏死,有脓血性液体渗出。见图1。     

Spinal tuberculosis: A review

Abstract

Spinal tuberculosis is a destructive form of tuberculosis. It accounts for approximately half of all cases of musculoskeletal tuberculosis. Spinal tuberculosis is more common in children and young adults. The incidence of spinal tuberculosis is increasing in developed nations. Genetic susceptibility to spinal tuberculosis has recently been demonstrated. Characteristically, there is destruction of the intervertebral disk space and the adjacent vertebral bodies, collapse of the spinal elements, and anterior wedging leading to kyphosis and gibbus formation. The thoracic region of vertebral column is most frequently affected. Formation of a ‘cold’ abscess around the lesion is another characteristic feature. The incidence of multi-level noncontiguous vertebral tuberculosis occurs more frequently than previously recognized. Common clinical manifestations include constitutional symptoms, back pain, spinal tenderness, paraplegia, and spinal deformities. For the diagnosis of spinal tuberculosis magnetic resonance imaging is more sensitive imaging technique than x-ray and more specific than computed tomography. Magnetic resonance imaging frequently demonstrates involvement of the vertebral bodies on either side of the disk, disk destruction, cold abscess, vertebral collapse, and presence of vertebral column deformities. Neuroimaging-guided needle biopsy from the affected site in the center of the vertebral body is the gold standard technique for early histopathological diagnosis. Antituberculous treatment remains the cornerstone of treatment. Surgery may be required in selected cases, e.g. large abscess formation, severe kyphosis, an evolving neurological deficit, or lack of response to medical treatment. With early diagnosis and early treatment, prognosis is generally good.     

Takayasu arteritis: clinical features and management: report of 272 cases

BACKGROUND: Takayasu's arteritis is a condition of unknown aetiology with an unpredictable natural history. Most of the literature available has originated from Asia, with a few contributions from Africa where the pattern of the disease may be different. This is a single institution's experience review. METHODS: Data were obtained retrospectively from the angiographic and medical records of patients treated at Groote Schuur Hospital over the period 1952-2002. The criteria for inclusion were those proposed by the Aortitis Syndrome Research Committee of Japan and the American College of Rheumatology. RESULTS: Two hundred and seventy-two patients were identified. The mean age at presentation was 25 years (range 14-66 years) and 75% were female. Only 8% were Caucasian. Hypertension was the most common presentation (77%) and was usually a consequence of renal artery stenosis or aortic coarctation. Cardiac failure was the most common problem. Cerebrovascular symptoms were recorded in 20%. Convincing evidence of tuberculosis was present in 20%. The entire aorta was involved in 70% of cases. Thirty per cent had aortic bifurcation involvement. Occlusions were noted in 93% and aneurysms in 46%. Vascular reconstruction was performed on 115 occasions in 99 patients, with an operative mortality of 4%. Cardiac failure was the usual cause of death. One hundred and six patients (39%) were followed for a minimum of 5 years. No further progression of disease was noted in 70 patients. CONCLUSION: The natural history and prognosis of Takayasu's arteritis still remain poorly defined.     

肾上腺结核的诊断与治疗(附4例报道及文献复习)

目的 提高对肾上腺结核诊断与治疗的认识。方法 回顾本院4例肾上腺结核病例的诊断与治疗结合文献复习。4例病例均予生化、B超和CT检查及抗结核、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,结合生化和肾上腺影像学检查或手术切除病理检查确定肾上腺结核诊断。抗结核、长期激素替代或手术是治疗肾上腺结核的主要方法。     

Primary carcinosarcoma of the liver: clinicopathologic features of 5 cases and a review of the literature

Carcinosarcoma of the liver is very rare worldwide. The terminology and pathogenesis of hepatic carcinosarcoma remain controversial issues. In this article, we studied the clinicopathologic features of 5 cases of hepatic carcinosarcomas (matching the World Health Organization definition), analyzed the clinical data, histologic and immunohistochemical (IHC) results, and discussed the terminology, pathologic differential diagnoses, pathogenesis, and prognosis. The patients were 40 to 68 years old, and included 4 males and 1 female. All patients were Hepatitis B surface antigen positive with para-tumorous cirrhosis. The largest dimensions of the neoplasms ranged from 6.0 to 14.0 cm. Satellite nodules, portal vein tumor thrombi, direct invasion into local tissues (right diaphragm, right adrenal gland, and gastric wall) as well as metastatic foci in lungs and abdominal lymph nodes were identified. Pathologically, the neoplasms consisted of carcinomatous and sarcomatous components. The carcinomatous components were exclusively conventional hepatocellular carcinomas in all 5 cases, whereas the sarcomatous components exhibited complex features. Confirmed by IHC studies, the sarcomatous elements in different cases included rhabdomyosarcomas, malignant fibrous histiocytomas, fibrosarcoma, and poorly differentiated spindle cells without distinctive differentiation. Furthermore, the sarcomatous elements in these 5 neoplasms stained negative for all the epithelial markers we applied for IHC staining, which support the pathologic diagnosis of carcinosarcoma rather than sarcomatoid carcinoma. The presence of transitional zones between carcinomatous and sarcomatous components may support the transformation theory. Four patients with palliative hepatectomy died within 6 months, whereas 1 patient is still alive 21 months after radical resection. The poor prognosis of hepatic carcinosarcoma may be due to their highly invasive and metastatic features. Radical resection of early stage hepatic carcinosarcoma may contribute to a relatively optimistic prognosis.     

Skeletal tuberculosis in children in the Western world: 18 new cases with a review of the literature

Purpose  The occurrence of pediatric skeletal (extra-spinal) tuberculosis in the developed world is extremely rare. The purpose of this study was to review the cases at our institutions. Methods  We performed a retrospective review of all pediatric biopsy-proven skeletal (extra-spinal) cases of tuberculosis over a five-year period. Results  Eighteen patients of biopsy-proven tuberculosis were identified. The mean age was 12 years (range 7–20). Lesion locations included: distal humerus, ulna, scapula, acetabulum, proximal femur, proximal tibia, distal tibia, and calcaneus. All had symptoms of pain, swelling, and stiffness. Five cases had multi-focal involvement. Twenty-four lesions were noted in 18 patients. Nineteen lesions were cystic in nature at presentation. The sedimentation rate was normal in six and purified protein derivative (PPD) was negative in five patients. All received chemotherapy. Six patients underwent surgery. Conclusions  The diagnosis of pediatric skeletal tuberculosis can be made with good correlation of clinical, radiographic, and laboratory findings. Biopsy and culture are the gold standards in diagnosis. Prognosis is good with chemotherapy and non-operative management. Surgical intervention may be needed in select cases.     

结直肠癌并急性结肠梗阻的外科处理--附225例临床分析

目的　探讨结、直肠癌并急性结肠梗阻病例的外科处理原则和方法。方法　回顾性分析我院自１９８２ 年至１９９８ 年收治的２２５ 例结、直肠癌并急性结肠梗阻病例,结合近年国内、外文献,综合评价其外科处理方法。结果　２２５ 例患者均经手术治疗,出现并发症２３ 例;死亡１３ 例,病死率为５－８ ％ ,其余均痊愈出院。结论　结、直肠癌并急性结肠梗阻的处理要根据病人的全身情况和肿瘤的局部情况来进行综合判定。适应证掌握恰当,一期肿瘤切除和吻合术是安全的。     

临床肾结核32年回顾（附349例分析）

回顾分析了３４９例肾结核的临床资料，发现近年来肾结核不典型病例显著增加，从而造成明显的延误诊断现象。肾结核早期诊断中，尿ＰＣＲＴＢＤＮＡ检查阳性率高，可作为常规措施推广使用。Ｂ超在肾结核的诊断中特异性差，仅为初选病人的筛选手段，确诊时需强调ＩＶＵ的特征性改变。随着抗痨药物的不断发展，药物治疗肾结核的适应证有扩大趋势