Extrapulmonary tuberculosis: clinical and epidemiologic spectrum of 636 cases

BACKGROUND: The aim of this study was to evaluate the percentage and characteristics of extrapulmonary tuberculosis (EPTB) cases in a Turkish industrial city, Kocaeli (population: 1,203,335) and to illustrate its extent as a serious health problem for this city and country. METHODS: We investigated the results of microbiologic, radiologic, and histopathologic findings of patients with extrapulmonary tuberculosis, retrospectively, who were admitted to four Tuberculous Dispensaries between 1996 and 2000. RESULTS: Six hundred thirty six cases were diagnosed with EPTB. Three hundred forty five were males (54.2%) and 291, females (45.8%). Mean age of patient cases was 22.5+/-17.1 years (range, 1-86 years); 41.4% of cases were <15 years of age and 30.9%, between 20 and 39 years of age. Contact history with tuberculosis cases was determined in 242 cases (38%); of these, 194 were <15 years of age (80.2%). The most common form of EPTB was observed to be lymph node tuberculosis (56.3%); of these cases, 256 (71.5%) had involvement in intrathoracic, 92 (25.7%) in cervical, and 10 (2.8%) in axillary lymph nodes. The second most frequent extrapulmonary form was pleural tuberculosis (31.1%). EPTB was diagnosed by histopathologic methods in 229 patients (36.0%) and by microbiologic methods in 27 (4.2%); tuberculin skin test was significantly positive (>10 mm) in 95.5% of patients. When cases were classified according to severity, 87 cases (13.7%) were found severe and 549 (86.3%) as less severe EPTB. Five hundred sixty one cases (88.2%) lived in urban areas and 75 (11.8%), in rural areas. CONCLUSIONS: EPTB is very common in early adulthood in the Kocaeli region, with lymph nodes the most common localization.     

Evaluation of fine needle aspiration cytology (FNAC) of lymph node in Mymensingh

Fine needle aspiration cytology (FNAC) is widely accepted as the accurate, sensitive, specific and cost-effective procedure in the diagnosis of lymphadenopathy. The purpose of the study was to evaluate the results of FNAC of lymph nodes in our institutions comparing with results of histopathology. We performed 117 FNAC of lymph node in a period between November 2001 to April 2002, of which, histological results were available in 81 (69.23%). Cervical lymph nodes were 102 (87.18%) and axillary lymph nodes were 15 (12.82%). Male to female ratio of the patients was 1:0.65. Patients' age ranged from 3-80 years with a median age of 23 years. FNAC diagnosis was found to be as follows: granulomatous inflammation 46 (40.35%), reactive hyperplasia 31 (27.19%), metastatic carcinoma 20 (17.54%), Non-Hodgkin's lymphoma 6(5.26%), tubercular lymphadenitis 4(3.51%), acute non-specific lymphadenitis 3(2.63%), Hodgkin's lymphoma 3(2.63%) and chronic non-specific lymphadenitis 1(0.88%). Out of 81 cases of FNAC 71(87.65%) were consisted with histopathological diagnosis of granulomatous lymphadenitis. In the malignancy of lymph node sensitivity and specificity of FNAC were 82.76% and 97.92%, respectively. So, the investigators reasonably conclude that before resort to surgical intervention FNAC may be a helpful procedure in the diagnosis of both neoplastic and non-neoplastic lesion of lymph nodes.     

1500例乳腺肿块细针吸取细胞学检查的临床应用

目的探讨细针吸取细胞学检查在乳腺肿块中的应用价值。方法复习乳腺肿物细针吸取细胞学检查1500例。与其中手术后获病理组织学诊断的415例做对照比较。结果1500例全部为女性，年龄11-88岁，平均38．6岁。415例手术病例中组织学为良性病变的197例中，细胞学诊断有1例不符，诊断为癌。组织学诊断为恶性肿瘤的218例，细胞学诊断有6例不符，诊断为良性。本组的敏感性、特异性、总准确度、假阴性和假阳性分别为97．25％，99．49％，98．31％，2．75％，和0．51％。结论细针吸取细胞学对乳腺肿物诊断具安全、可靠等优点，可作为乳腺肿物常规检查手段，值得推广应用。     

Epidemiology of extra pulmonary tuberculosis in Eastern Sudan

Objective: To investigate the epidemiological factors associated with extra pulmonary tuberculosis(EPTB) in Kassala, Eastern Sudan.Methods: Patients infected with TB(pulmonary and extra-pulmonary) documented at the hospital were interviewed with a structured questionnaire used to gather socio-demographic information. The diagnosis of EPTB cases was based on presence of tuberculous granulomas in the histological samples, positive PCR to DNA of mycobacterium tuberculosis, radiological i ndings and l uid analysis suggestive of EPTB and clinical diagnosis with adequate response to anti-tuberculous therapy.Results: A total of 985 patients with TB were enrolled in the study, including 761(77.3%) with PTB and 224(22.7%) with EPTB. The mean age(SD) of patients with PTB and EPTB was 33.2(15.4) and 34.7(14.6) years respectively. The prevalence of EPTB was at(22.7%), with TB lymphadenitis 79(35.3%), marking the frequent form of EPTB followed by peritoneal TB 27(12.05%). While residence and occupation were not associated with EPTB, those with lower level of education(OR = 0.3; coni dence intervals(CI) = 0.2-0.5; P 0.001), female(OR = 8.7, CI = 4.9-15.1, P 0.001), non vaccination(OR=70.3, CI = 34.2-144.3, P 0.001), and non smoker(OR = 0.1; CI = 0.06-0.20; P 0.001), were associated with high prevalence of EPTB. Conclusions: Around one quarter of patients with TB in this study were more likely to have EPTB. Therefore, ef ective strategic plans regarding diagnostic procedures and control measures are needed to reduce the burden of the disease in Sudan.     

丙戊酸钠治疗心律失常103例临床初步观察

本文报道口服丙戊酸钠治疗103例各型心律失常,显效47例(45.6%),好转33例(32.1%),总有效率为77.7%,其中室性早搏有效率为78%;房性早搏75%,室上性心动过速80%。本品的起效时间,在显效病例中,3天内、1周和2周完全复律者分别为17.0%,46.8%和78.7%。不良反应有恶心、呕吐、上腹部不适、嗜睡、眩晕、头昏和脱发等。     

超声引导下穿刺活检对肺外结核的诊断价值

目的 探讨如何提高超声引导下穿刺活检对肺外结核(extrapulmonary tuberculosis,EPTB)的诊断价值.方法 对152例临床疑诊结核或诊断不明病灶的患者进行超声引导下穿刺活检,综合分析组织切片加特殊染色(病理组)、基因X-Pert MTB/RIF检测(基因组)、结核菌培养(菌培组)及涂片这4种方法...     

Histopathological types of malignant lesions of esophagus and stomach

Upper part of gastrointestinal tract is common site of malignancy. Histological types of malignancy of esophagus and stomach may vary in different countries and also in different regions in the same countries. To find out the frequencies of different histological malignancies in Mymensingh region of Bangladesh, we analyzed the histopathological reports of 259 biopsy specimens examined in one pathology laboratory in Mymensingh town during the period from 6th January 2002 to 29th April 2004. Endoscopic biopsies were 234 (90.35%) and surgical biopsy specimens were 25 (9.35%). Male patients were 193 (72.52%) and female patients were 66 (25.48%). Specimens of esophagus were 73 (28.19%) and of stomach were 186 (71.81%). Out of 69 (94.53%) adequate samples of esophagus 46 (74.19%) were squamous cell carcinoma and 16 (25.81%) were adenocarcinoma. Adequate samples of stomach were 177 (95.16%) in which malignancies were found in 119 (67.23%). All the malignant tumor of stomach were in adenocarcinoma of which 82 (68.91%) were intestinal type, 17 (14.29%) were diffuse type and 20 (16.81%) mixed type. Intestinal type of gastric adenocarcinoma was found to be significantly associated with male patients (p < 0.005). From the present study it is suggested that in the Mymensingh region the common form of malignant lesion of esophagus may be squamous cell carcinoma followed by adenocarcinoma. Adenocarcinoma is the most common type of gastric malignancy of which intestinal type is more common     

细针吸取细胞学和组织学对肝细胞癌的诊断

目的 :通过研究进一步证实细胞学和组织学联合诊断肝细胞癌的价值。　 方法 :运用细胞学和组织学方法观察了 70例临床怀疑肝脏恶性肿瘤患者细针穿刺标本。　 结果 :70例中 ,细胞学肯定肝脏恶性肿瘤 56例 ( 80 % ) ,其中确诊肝细胞癌 36例 ( 64.3% )。 70例组织学诊断中 ,肯定恶性肿瘤 4 4例 ( 63% ) ,其中确诊肝细胞癌 2 9例 ( 66% ) ,转移性腺癌 15例 ( 34 % ) ,二者联合诊断阳性率达 10 0 %。　 结论 :肝细胞癌的细胞学、组织学联合检查 ,既能提高肝细胞癌诊断的阳性率( 10 0 % ) ,又可提高肝肿瘤的准确分型 ,是目前诊断肝脏肿瘤的理想方法之一     

Pattern of malignancy in clinically solitary thyroid nodule

Solitary thyroid nodule (STN) is a common thyroid disorder. Clinically recognized thyroid carcinoma constitutes less than 1% of human malignant tumours. The risk of malignancy in solitary thyroid nodule is greater than other thyroid swelling. The risk of malignancy in generalized thyroid swelling is about 3% and in solitary thyroid nodule it is about 15%. This study was carried out in Surgery and ENT Department, Mymensingh Medical college Hospital from November 2008 to October 2009 to see pattern of malignancy in clinically solitary thyroid nodule. Total 108 patients of STN was included in this study, majority of the patients were within 20-39 years age group with female predominance. In addition to thyroid swelling some patients presented with other symptoms like cervical lymphadenopathy in 6(5.56%), dysphagia 2(1.85%), hoarseness of voice 2(1.85%) and metastatic lesion in bone 1(0.92%) cases. Among 108 cases of solitary thyroid nodule only 19 cases were malignant. Patients with malignant lesion presented with shorter duration of symptoms. Out of 19 malignant cases 6(31.58%) cases presented with features of metastasis. Malignancy was more predominant in male (25.00%) than the female (14.47%) in STN. Out of 19 malignant cases, 12(63.16%) were papillary carcinoma, 5(26.31%) were follicular carcinoma and 2(10.53%) cases were medullary carcinoma. Study showed significant difference (p<0.01) between papillary & follicular carcinoma and significant difference (p<0.001) between papillary & medullary carcinoma. Papillary carcinoma was most common among all thyroid malignancies in patients with solitary thyroid nodule.     

Tubercular lymphadenitis - diagnostic evaluation

Tuberculosis is one the commonest disease affecting peripheral lymph node and cervical tubercular lymphadenitis are frequently encountered in Otolaryngological practice. Three hundred fifty six (356) cases of Fine Needle Aspiration for Cytology (FNAC) positive tubercular lymphadenitis were studied from January 2006 to December 2008. FNAC positive but histopathologically negative cases were excluded from the study. Among 356 cases of FNAC positive cervical lymphadenopathy 300 cases (84.27%) were confirmed tuberculosis on histopathological examination. Remaining 50 cases (15.73%) were diagnosed as nontubercular lymphadenitis where nonspecific lymphadenitis was the commonest finding 34(9.55%) followed by metastatic carcinoma 7(1.97%), lymphoma 6(1.08%), Kikuchiz's disease 6(1.08%), Kala-Azar 2(0.56%) & Leukemia 1(0.28%). Most of the patients presented with only multiple lymph node swelling with other symptoms, such as fever 18(5.06%), pain (15.7%), tenderness 53(14.88%), weight loss 29(8.14%), anorexia 33(9.26%). Following observations are evident from this study: i) Disease is comparatively common between 12-35 years ii) Multiple matted/discrete lymph nodes are the earliest presentation iii) Multiple lymph node is the most consistent finding for clinical diagnosis. iv) Very few patients have constitutional symptoms v) Suppuration with or without abscess formation although confirms the diagnosis even then certainty is very essential. Though the evidence of cervical tuberculosis was thought to be decreasing in developing countries the real picture seems to be different. Random survey among the whole population was not done in any country rather hospital based laboratory research was made.     

宫颈鳞状上皮内高度病变与组织学诊断的对照研究及误诊分析

目的：对照宫颈鳞状上皮内高度病变（HSIL）与组织学诊断结果,分析误诊病例,探讨宫颈上皮内高度病变的诊断方法。方法回顾性分析40例行阴道镜下宫颈活检组织学诊断和宫颈液基薄层细胞检测（TCT）诊断的宫颈鳞状上皮内高度病变患者。结果40例宫颈活检中,经组织学证实为阳性的病例有35例,其中33例为CINⅡ~Ⅲ级,2例为鳞状细胞癌。结论非典型鳞状细胞（ASC-H）以及HSIL与组织学诊断有较好的符合率。     

Benign breast lesions in Eastern Nigeria

OBJECTIVE: To characterize benign breast diseases in Eastern Nigeria and to highlight the age variations of these lesions as base line data. METHODS: The Department of Morbid Anatomy, University of Nigeria Teaching Hospital, Enugu caters for over 30 million African blacks and receives 2000 surgical pathology specimens yearly. Seven hundred and twenty-two benign breast specimens were analyzed over 5 years from 1st January 2000 to 31st December 2004, out of 1050 breast samples received. RESULTS: Of 1050 breast specimens received, 722 (68.8%) were benign. Fibroadenoma was the most common lesion with 318 cases (44%), occurring at a mean age of 16-32 years. Next was fibrocystic changes with 165 cases (22.9%) at a mean age of 23-45 years. Normal breast in the axillary tail region was seen in 32 cases (4.4%), represented as no pathology, with a mean presentation age of 20-46 years. Low grade Phyllodes tumor had 28 cases (3.9%), presenting at an average mean age of 17-32 years. Lactating adenoma had 19 (2.6%) cases. Other lesions made up less than 3% each. Benign breast lesions peaked at the 20-24 age range and then declined. Most were females. CONCLUSION: Benign breast lesions occur more frequently than malignant breast lesions with a ratio of 2.3:1 and were presented 20 years earlier than their malignant counterparts. Fibroadenoma was the most common benign lesion followed by fibrocystic disease, similar to the findings in Western Nigeria. In Northern Nigeria, fibrocystic breast disease was more common.     

A profile of lung cancer patients in Hyderabad

One hundred and sixty cases of bronchogenic carcinoma were retrospectively analysed. Male to female ratio was 8.4:1, common age group being 40-60 years. The most common (38%) radiological presentation was mass lesion. The predominant histological cell type was squamous cell carcinoma (67%). Most of the patients presented in an advanced stage of the disease of inoperability. The study underlines the various diagnostic madalities in diagnosing lung cancer and emphasises the need for practising doctors to keep in mind the possibilities of bronchogenic carcinoma in all cases of unresolved pneumonia and mass lesion on chest x-ray especially in high risk patients.     

Seropositivity and pattern of dengue infection in Dhaka city

Bangladesh is experiencing resurgence of' dengue endemic since 2000. In an attempt to see the pattern of' dengue infection we analyzed retrospectively results of 225 blood samples from patients having fever and clinically suspected to have been suffering from dengue fever who were tested for dengue IgM and IgG in Health Care Development Project (HCDP), Dhaka, an enterprise of Diabetic Association of Bangladesh (DAB) one of the largest private health care facility provider in Bangladesh. Out of 225 samples tested, a total of 156(69.33%) cases were serologically positive for dengue and 69(30.67%) were negative. Of the positive cases, 70(44.87%) were positive for Dengue IgM and 86(55.13%) were positive for Dengue IgG. which showed statistical difference between male and female (p<0.05). Both IgM and IgG, were positive in 23(14, 74%) cases. The mean age +/-SD of affected is 36.86+/-17.60 years and the maximum number of positive cases 114(73.08%) diagnosed were in the months between July-December. It is evident from the present study that dengue is endemic in Dhaka city particularly during monsoon and rainy season. Secondary dengue is more common than primary dengue and both preventive and curative measures are needed to combat this menace.     

中枢神经系统感染性疾病的病原学研究

目的 :探讨中枢神经系统感染性疾病的病原学特点。方法 :分别用双抗体夹心ELISA法和传统的细菌及真菌培养等方法检测患者血清IgM ,IgG抗体和脑脊髓液中病原体。结果 :82 3例中枢神经系统急症患者中有 12 6例 (15 .3%)单纯疱疹病毒IgM和 /或IgG阳性 ,其中 10岁以下年龄为高峰。 10 (1.2 %)例巨细胞病毒特异性IgM和 /或IgG阳性 ;8(0 .97%)例水痘 带状疱疹病毒特异性IgM和 /或IgG阳性 ;7(0 .85 %)例为结核性脑膜炎 ;6 (0 .72 %)例为新生隐球菌性脑膜炎 ;1(0 .12 %)例为脑膜炎球菌性脑膜炎。结论 :病毒 ,特别是单纯疱疹病毒 ,是中枢神经系统感染性疾病的常见病原 ;结核杆菌和新生隐球菌感染也占一定比例。     

中枢神经系统感染性疾病的病原学研究

目的：探讨中枢神经系统感染性疾病的病原学特点。方法：分别用双抗体夹心ELISA法和传统的细菌及真菌培养等方法检测患者血清IgM，IgG抗体和脑脊髓液中病原体。结果：823例中枢神经系统急症患者中有126例(15．3％)单纯疱疹病毒IgM和／或IgG阳性，其中10岁以下年龄为高峰。10(1．2％)例巨细胞病毒特异性IgM和／或IgG阳性；8(0.97％)例水痘-带状疱疹病毒特异性IgM和／或IgG阳性；7(0．85％)例为结核性脑膜炎；6(0．72％)例为新生隐球菌性脑膜炎；1(0.12％)例为脑膜炎球菌性脑膜炎。结论：病毒，特别是单纯疱疹病毒，是中枢神经系统感染性疾病的常见病原：结核杆菌和新生隐球菌感染也占一定比例。     

Childhood tuberculosis in Malawi: caseload,diagnostic practices and treatment outcomes

There were 22,982 cases of TB registered in Malawi in 1998, of which 2739 (11.9%) were children. Children accounted for 11.3% of all case notifications with smear-positive pulmonary TB (PTB), 21.3% with smear-negative PTB and 15.9% with extrapulmonary TB (EPTB). A significantly higher proportion of TB cases were diagnosed in central hospitals. Only 45% of children completed treatment. There were high rates of death (17%), default (13%) and unknown treatment outcomes (21%). Treatment outcomes were worse in younger children and in children with smear-negative PTB. In 2001, all 44 non-private hospitals in Malawi that register and treat children with tuberculosis (TB) were surveyed to determine actual diagnostic practice. This cross sectional study identified 150 children aged 14 years or below in hospital receiving anti-TB treatment, 98 with pulmonary TB (PTB) and 52 with extrapulmonary TB (EPTB). Median duration of illness was 8 weeks. Most patients had fever, no response to anti-malarial treatment and antibiotics, and 40% had a positive family history of TB. Nearly 45% had weight for age < 60%. Diagnosis was mainly based on clinical features and radiography, with less than 10% having tuberculin skin tests or HIV serology, and very few having other sophisticated investigations. Diagnostic difficulties make it difficult to accurately define the actual burden of childhood TB in Malawi. Diagnostic practices are poor and treatment outcomes unsatisfactory.     

不明原因发热229例病因诊断

目的 探讨不明原因发热(FUO)的病因.方法 回顾性分析2009年1月-2010年1月在我科就诊且符合FUO诊断标准,并完成6 ～18个月随访的229例患者的临床资料.结果 229例FUO患者中明确诊断203例(88.6%,203/229),包括感染性疾病99例(48.8%,99/203),结缔组织病68例(33.5%,68/203),肿瘤性疾病13例(6.4%,13/203),其他疾病23例(11.3%,23/203),随访至今仍未明确诊断26例(11.4%,26/229).结论 本研究显示,FUO病因多样,感染性疾病仍是主要原因,病毒感染和结核病为主要病种,结缔组织病在非感染性疾病中比例最高,成人Still病最为多见,肿瘤性疾病以淋巴瘤多见且死亡率较高.以完整病史和反复体格检查为基础,辅以必要的实验室检查或其他检查,仍是目前诊断FUO的主要策略.     

子宫内膜增殖症诊断性刮宫价值的评价

目的评价应用诊断性刮宫（简称诊刮）方法诊断子宫内膜增生症(EH)的准确性。方法对门诊诊刮为EH,短期内行子宫切除术的150例患者作病理诊断,并与诊刮诊断进行比较分析,还采用SP免疫组织化学法对38例诊刮诊断为复合型不典型增生（CAH）患者行增殖细胞核抗原（PCNA）染色。结果150例患者诊刮诊断为单纯型增生（SH）、复合型增生（CH）、单纯型不典型增生（SAH）和CAH分别为53、11、26和60例;经子宫切除后病理学诊断为SH、CH、SAH及CAH者分别为65、7、15、29例,其余34例为子宫内膜癌(EC)。诊刮对SH诊断的准确性较高,而对CAH诊断的准确性则较差;SAH、CAH并存EC显著高于SH、CH（χ2=26.3,P<0.001）。CAH并存EC者显著高于SAH（χ2=9.78,P<0.005）。绝经后不典型增生患者并存EC的可能性显著高于绝经前患者（χ2=3.93,P<0.05）。并存EC的CAH患者PCNA阳性表达率明显高于未并存EC者(P=0.02);且其表达强度也明显强于未并存EC患者（Uc=3.66,P<0.05）。结论诊刮诊断SH的准确性较高,而诊断CAH的准确性较低;CAH并存EC的比例比较高;测定PCNA的表达可能有助于判断CAH患者是否并存EC。     

103例经阴道超声检查宫腔异常回声团的宫腔镜检查与病理结果分析

目的:探讨经阴道超声检查(transvaginal sonography,TVS)对子宫内膜病变诊断的临床价值及宫腔异常回声团的成因。方法:对103例阴道超声提示“宫腔异常回声团”的患者行宫腔镜检查并取病理。结果:103例中子宫内膜息肉86例,息肉样腺肌瘤9例,子宫内膜单纯性增生2例,鳞状上皮1例,正常内膜3例,宫腔粘连1例,无组织刮出1例;TVS对子宫内膜病变检出的假阳性率3.88%,宫腔镜检查与病理诊断符合率84.47%。结论:TVS可作为子宫内膜病变的初筛手段,宫腔镜检查是确定病因的重要手段,但不能替代显微镜下的病理诊断。宫腔异常回声团多由子宫内膜息肉引起,常见于围绝经期及绝经后妇女。