Tuberculous and non‐tuberculous cervical lymphadenopathy incidence and distribution in Somalia from 2016 to 2020: A review of 241 cases

ObjectiveTo determine the incidence of tuberculous lymphadenitis (TBL) and other pathologies in cervical lymphadenopathies in Somalia and accompanying radiological findings.MethodsIn this hospital‐based retrospective study, the demographic characteristics, pathology results and radiological findings of 263 patients who underwent ultrasound (US)‐guided cervical lymph node biopsy between January 2016 and February 2020 were analyzed.ResultsOf 241 patients 118 men and 123 women (mean age 27.9 ± 18.1 years) included in the study, 46.1% (n = 111) were diagnosed as necrotizing granulomatous lymphadenitis (caseified, consistent with TBL) and 21.6% (n = 12, atypical lymphoid cells and n = 40, metastases) as malignancy. The most common type of metastasis was squamous cell cancer (n = 31), and the primary source of most of them was esophageal cancer (16/31, 51.6%). The age of patients with TBL was significantly lower than that of non‐TBL (21.9 ± 14.6 vs. 41.9 ± 24.6, P = 0.003) and the incidence of TBL in pediatric patients was statistically higher (58.0% vs. 21.5%, P = 0.019). The rate of patients with TBL being localized at level 4 and level 5 was significantly more than non‐TBL patients (18.0% vs. 10.0% and 23.4% vs. 10.8%, respectively, P = 0.01). Half of patients with TBL who have chest radiography had pathological findings; consolidation and bronchopneumonia were present in 52.6% of them. There were 2 patients with paravertebral abscess and one patient with gastrointestinal tuberculosis.ConclusionIn Somalia, in the presence of cervical lymphadenopathy, after diagnosis by using US‐guided biopsy; primarily considering of TBL and malignancy, thoracic involvement should be investigated, and esophageal carcinoma must be excluded in terms of metastatic lymph node.     

肺结核合并糖尿病的临床分析

目的探讨肺结核合并糖尿病的临床体征、肺部特征、影像学检查特征、实验室检查情况。方法选取本院2008年1月至2012年12月收治的肺结核合并糖尿病患者56例,对这些患者的临床诊断、检查资料进行回顾性总结分析。结果本组56例患者肺结核的临床症状表现为咳嗽30例（53.57%）,发烧16例（28.57%）,胸部疼痛20例（35.71%）,咯血10例（17.86%）,四肢乏力16例（28.57%）,胸腔积液8例（14.29%）,没有明显症状14例（25%）;本组患者临床肺部体征表现为呼吸音减弱11例（19.64%）,湿罗音18例（32.14%）,没有肺部体征27例（48.21%）;胸部DR影像学检查表现存在肺叶或段状分布的实质性病变或者肺不张特征40例（71.43%）,结节或者肿块样病变15例（26.79%）,不典型空洞21例（37.5%）,弥漫性粟粒结节3例（5.36%）;实验室检查表现白细胞升高24例（25%）,白细胞减少4例（7.14%）,血沉增快48例（85.71%）,结核菌素试验强阳性38例（67.86%）。结论对于肺结核合并糖尿病病例的临床诊断应进行相关检查并结合患者的临床体征进行综合判断。     

颈胸交界处椎体结核的个性化手术治疗策略

目的探讨颈胸交界处椎体结核个性化手术治疗方法。方法回顾性分析2006年6月-2012年6月收治的16例颈、胸交界处椎体结核,6例采用低位下颈椎前方入路联合胸骨柄劈开术,5例采用右侧前方经肩胛下开胸入路,5例采用单纯经后路入路,行病灶清除、椎体间钛网植入（或植骨）及内固定术治疗。结果16例均获得随访,时间平均2年,患者血红细胞沉降率恢复正常,植骨完全融合,无螺钉松动、脱落及钢板断裂等并发症。术后神经功能恢复按Frankel分级,全部恢复到E级。结核病灶无复发,术后后凸Cobb角较术前明显改善,末次随访后凸Cobb角无明显丢失。结论颈胸交界处椎体结核应根据不同节段椎体及椎体破坏程度选择不同的手术入路及固定方法。     

65例脊柱结核的临床分析

目的 :分析脊柱结核的临床特点 ,提高对本病的诊治水平。方法 :回顾性分析我院1988～2002年脊柱结核患者临床资料65例。结果 :脊柱结核发病年龄呈上升趋势 ,患者早期对症状重视不够 ,部分医生对该病认识不全面 ,使患者确诊较晚。结论 :早期明确诊断、病灶清除彻底、脊髓压迫后及时减压同期前方植骨是脊柱结核手术的关键 ;正确的术式及入路选择是完成手术的基础 ;坚持规律、足量服药是彻底治愈的保证 ;新技术的应用使该病能得到更好的疗效。     

摩洛哥塔扎地区颈部淋巴结肿大42例

颈部软组织结核在我国,特别是大中城市日渐减少。回顾性分析笔者援助摩洛哥期间,颈部结核性淋巴结炎等淋巴结肿大病例42例,报道如下。     

结核性中耳乳突炎的临床特征及疗效分析

目的 探讨结核性中耳乳突炎的临床特点以及手术疗效.方法 回顾性分析经病理学证实的16例(18耳)结核性中耳乳突炎的临床表现、影像学特征以及治疗方法,并随访其预后.结果 16例(18耳)患者均表现为耳流脓、听力下降,并发重度感音神经性聋患者3例(4耳),并发周围性面神经麻痹患者3例.16例颞骨高分辨率CT均表现为鼓室、乳突充满软组织密度影,其中骨质破坏11例(12耳),颞骨内存在死骨7例(7耳).16例患者中伴发肺结核7例.15例患者接受了手术治疗去除病灶并联合抗结核治疗.除2例患者术前经穿孔的鼓膜取活检明确诊断为结核性中耳乳突炎外,其余14例患者均为术中或者术后确诊.除1例患者失访外其余15例患者均随访1年以上,中耳乳突结核无复发,3例面神经麻痹患者基本恢复正常.结论 对于顽固性耳流脓,影像学提示鼓室、乳突充满软组织密度影且存在骨质破坏或者死骨者,应仔细询问是否有结核病史,以便鉴别结核性中耳乳突炎.手术去除病灶并结合抗结核治疗对该病有较高的治愈率.     

对艾滋病合并肺结核患儿实施药学监护的探讨

目的 探讨临床药师对1例艾滋病合并肺结核患儿实施药学监护实践的经验与体会.方法 深入临床,发现实际存在或潜在的用药问题,协助医师调整治疗方案,对患儿进行健康用药教育,包括①抗结核“四联”方案可能引起尿色发红、消化道症状、肝功能损害、皮疹等;②抗病毒治疗时应防止阳光照射皮肤,避免烈性皂类;③定期监测血常规、血脂、乳酸、肝功能等.结果 治疗2d后,患儿抗巨细胞病毒抗体弱阳性,结核病治疗14 d出院;出院时肝功能ALT由入院时84 U/L降至43 U/L.临床药师充分发挥药学专长,提高了临床治疗效果.结论 临床药师参与临床药物治疗,可促进药物合理使用.     

胸壁结核的外科治疗

目的 探讨胸壁结核的临床特点及疗效。方法 回顾性分析28例胸壁结核患者的临床资料。所有患者均行病灶清除术治疗,术后抗结核治疗9—12个月。结果 所有患者均获得治愈,随访1-2年无复发。结论 胸壁结核是以胸壁冷脓肿为主要特点,其主要治疗方法是手术治疗结合术前、术后抗结核药物治疗,而手术成功的关键是彻底清除病灶,消灭死腔。     

Spondylitis with epidural abscess and spinal tuberculoma as a major cause of myeloradiculopathy: a case report

Tuberculosis is caused by Mycobacterium tuberculosis, a slow-growing aerobic bacillus. The primary site of infections can be in the lungs, mediastinum lymph nodes, mesentery, gastrointestinal tract, genitourinary system, or any other viscera. We described a case of a 52-year-old Indonesian female who presented weakness in upper and lower extremities with low back pain and stiffness of the muscle since 4 months ago and getting worse over 1 week. She has no history of pulmonary tuberculosis. Then the patient underwent a laboratory examination, chest X-ray, vertebrae X-ray, and MRI examination for further evaluation. Both examinations revealed tuberculous spondylitis with epidural abscess and intramedullary tuberculoma. The patient was administered an antituberculosis drug therapy, and the surgery was scheduled after three months of treatment.     

上海市黄浦区1990—2013年肺结核疫情分析

[目的] 了解上海市黄浦区肺结核疫情的流行特征,评价防治工作的成效。[方法] 运用生态学研究方法对1990-2013年黄浦区肺结核流行特征和趋势进行分析。[结果] 1990-2013年,黄浦区肺结核的平均发病率为37.37/10万,发病总体呈逐渐下降趋势;平均死亡率为0.47/10万。老年男性(65岁以上)人群的发病率较高。病例中离退人员、工人、家务及待业者所占比例最高。[结论] 1990-2013年,肺结核防控的效果显著。但大众的防控知识和意识欠缺、不规范治疗、耐药率高、流动人口众多等都对结核病防治带来挑战。结核病患者的诊断、治疗、管理仍需完善。