肠结核误诊为克罗恩病2例

肠结核患者2例因反复腹泻1年入院, 被误诊为克罗恩病. 经病理、胸片及痰涂片确诊为肠结核. 本文提示肠结核与克罗恩病鉴别诊断困难, 暂时不能确诊时, 应首先考虑按结核病处理这一相对安全的原则.     

Clinical analysis of primary small intestinal disease： A report of 309 cases

AIM: To evaluate the major clinical symptom, etiology, and diagnostic method in patients with primary small intestinal disease in order to improve the diagnosis. METHODS: A total of 309 cases with primary small intestinal disease were reviewed, and the major clinical symptoms, etiology, and diagnostic methods were analyzed. RESULTS: The major clinical symptoms included abdominal pain (71%), abdominal mass (14%), vomiting (10%), melaena (10%), and fever (9%). The most common disease were malignant tumor (40%). diverticulum (32%) and benign tumor (10%). Duodenal disease was involved in 36% of the patients with primary small intestinal diseases. The diagnostic rate for primary small intestinal diseases by double-contrast enteroclysis was 85.6%. CONCLUSION: Abdominal pain is the most common clinical symptom in patients with primary small intestinal disease. Malignant tumors are the most common diseases. Duodenum was the most common part involved in small intestine. Double-contrast enteroclysis was still the simplest and the most available examination method in diagnosis of primary small intestinal disease. However, more practical diagnostic method should be explored to improve the diagnostic accuracy.     

Splenectomy in far-advanced Hodgkin''s disease; report of five cases

Five patients with far-advanced Hodgkin’s disease and with evidence of hematopoietic failure were treated by splenectomy in order to determine whether: (1)the course of the disease could be modified, (2) the hematologic picture improved,and (3) responsiveness to nitrogen mustard or x-ray therapy restored. These patients showed a transient slight improvement in their hematologic status, butthe course of the disease possibly was accelerated, and the patients all diedwithin thirteen weeks, without showing renewed suitability or increased responsiveness to therapy.

On the basis of our data and a review of thirty cases from the literature, it isconcluded that splenectomy is not a useful procedure its Hodgkin’s disease, exceptfor certain specific indications. These may be: (1) an apparently solitary splenictumor; (2) acquired hemolytic anemia, although this process may be better controlled in some cases by treating the underlying Hodgkin’s disease with x-rays,nitrogen mustard, or triethylene melamine ; (3) thrombocytopenic purpura,which appears to be more profound than is to be expected from the severity andextent of Hodgkin’s disease; and (4) hypersplenism. Hematopoietic depressionin the vast majority of patients with Hodgkin’s disease, however, cannot beattributed to splenic overactivity or malfunction.

Submitted on October 23, 1953 Accepted on December 17, 1953     

Fournier's disease: a report of 9 cases

Nine cases of Fournier's gangrene diagnosed between 1982 and 1989 are reported. All were males with a mean age of 76 (47-82 years). Seven had a history of alcoholism and one had non insulin-dependent diabetes. Six patients also had an anal fistula which may have been the starting point of the infection. The causal agents were two anaerobes (Clostridium perfringens and Bacteroides fragilis) two gram-negatives (Morganella morgagni and Pseudomonas aeruginosa) and one, an unidentified gram-positive. In three patients a mixed intestinal flora was isolated and in another no germs were found. All were treated with broad-spectrum antibiotics and surgery. Seven patients survived and two died.     

Human intestinal sarcosporidiosis: report of six cases

Specimens of resected small intestine from six patients aged 3 to 70 years with acute enteritis contained sexual forms of sarcosporidia. Histopathologically, the diagnoses were either segmental eosinophilic enteritis or segmental necrotizing enteritis. The presence of sarcosporidia in market beef (Bos indicus), and the patients' habit of eating the beef uncooked in the form of chili-hot dishes, suggest that the species is an ox-man parasite similar to Sarcocystis hominis (Railliet and Lucet, 1891) Dubey, 1976. Presence of numerous Gram-positive bacilli in segmental necrotizing enteritis suggests an interplay between two etiological agents in producing the hosts' inflammatory responses. Five patients recovered after resection, but one died due to extensive necrosis of the intestinal wall and leakage at the site of anastomosis. Only conventional antibiotics were given after the operations. None of the five surviving patients has had recurrent enteritis for at least 1 year.     

Kikuchi-Fujimoto's disease and connective tissue disease: a report of three cases

INTRODUCTION: Kikuchi-Fujimoto's disease or histiocytic necrotizing lymphadenitis, clinicopathological entity of unknown aetiology, is a rare and benign cause of cervical lymphadenopathies. It can be associated with various auto-immune diseases especially systemic lupus erythematous (SLE) or with some infectious agents. EXEGESIS: This report describes a survey of three patients who developed Kikuchi's lymphadenitis occurring concomitantly with connective tissue disease: LES in two cases and non determined connective tissue disease in the other case. Comparing the clinical, histopathological and evolutionary findings to the literature allows to identify the main features of this self-limiting disorder: occurrence in young women; clinical presentation with cervical lymphadenopathy in a context of fever and asthenia. The definite diagnosis is usually made through histopathological examination of a lymph node biopsy. Disease course is generally favourable with spontaneous resolution within few weeks. It may be improved with corticosteroid treatment in patients with systemic involvement. Prognosis is related to the associated disease. CONCLUSION: Kikuchi-Fujimoto's disease is a rare and benign cause of cervical lymphadenopathy that could resemble lymphoma, tuberculosis and may be associated with a characterized systemic disease.     

Hydatid disease of bone: a report of 2 cases

INTRODUCTION: The hydatid cyst of Echinococcus granulosus tends to develop in liver. The primary bone hydatidosis is rare. EXEGISIS: The authors report 2 cases of primary hydatidosis of bone in a 57 year old men and 60 year old diabetic women. The symptoms and signs were not specific. The ultrasound investigation: standard radiography and computed tomographic scan, was suggestive of the lesion. The chest radiograph and the abdominal ultrasound were normal. Serological tests for hydatid disease were positive. The two patients have surgical excision and medical treatment: Albendazole administrated for 6 months. Histologic evidence confirmed the diagnosis. The outcome was good for both patients without recurrence after 2 years. CONCLUSION: Through these 2 cases and a review of the literature, the authors analyse the epidemiological and clinical aspects of bone hydatidosis and discuss the therapeutic procedures.