NON-TUBERCULOUS MYCOBACTERIAL LYMPHADENITIS

Background: Non-tuberculous mycobacterial lymphadenitis has been recognized since medieval times by an array of names. The condition is familiar to paediatricians and paediatric surgeons but it often is not recognized in its early stages. A paediatric surgeon's experience of the condition in Newcastle over 30 years is reviewed. Methods: A personal series of children with non-tuberculous mycobacterial lymphadenitis treated in Newcastle from 1966 to 1994 is reviewed. Clinical diagnosis was supported by multiple Mantoux skin testing in most patients using human purified protein derivative (PPD) and avian antigens. All were treated surgically with histological confirmation of the diagnosis. A total of 89 patients were encountered. Twenty-two were seen in hospital practice between 1966 and 1976 and have already been reported. The current paper presents the results of analysis of the clinical features, diagnosis and surgical treatment of the remaining 67 patients seen in paediatric surgical practice between 1976 and 1994. Results: There was equal sex distribution. Ages ranged from 1 to 10 years, with none under 1 year, and 82% of the patients were in the pre-school age group. Cervical lymph nodes were involved in all, the majority being jugulo-digastric or subman-dibular. Surgical excision by limited dissection of lymph nodes was performed in 55 patients with one recurrence, and by excision and curettage in eight patients with two recurrences. Simple bacterial wound infection occurred in four patients and two had prolonged postoperative suppuration as a result of mycobacterial wound infection. Paresis of the mandibular or cervical branch of the facial nerve occurred in 50% of patients where the nerve was at risk, but the majority of these recovered although it took over 6 months in some children. Culture for mycobacterial organisms was positive in only 29 patients. Conclusions: The diagnosis of non-tuberculous mycobacterial lymphadenitis is clinical and its early recognition requires an awareness of the condition. It can be confirmed by multiple Mantoux testing or fine needle aspiration biopsy. The treatment is local excision of the affected lymph nodes. Histological examination and mycobacterial culture should be performed.     

Motorcycle passenger's burn of the right foot: prevention of a peculiar type of accident

The right feet of two children, passengers on small motorcycles, were caught between the rear wheels and the exhaust boxes, leading to deep burns. This type of accident is on the increase in Japan. Treatment and prevention of such burns are discussed. We suggest that an improvement in the motorcycle will be a solution.     

腋窝淋巴结结核临床病理分析与探讨

目的探讨腋窝淋巴结结核的临床病理及淋巴循环途径,以引起对这个特殊部位结核病变的重新认识,减少漏诊和误诊的发生。方法对8例腋窝淋巴结结核患者活检标本,常规福尔马林固定,石蜡包埋切片,HE染色,显微镜观察分析。结果干酪坏死型3例,增殖型4例,粘连混合型1例。结论在结核杆菌耐药的今天,腋窝淋巴结结核病核已成为常见的结核病变,在临床上不能随意臆断为转移癌或淋巴肉瘤或其他普通性炎症,应认真了解和剖析腋窝淋巴的循环途径,提高对腋窝淋巴结结核病变诊断的正确性。     

A Case of Kikuchi's Disease Presenting with Unique Facial Involvement

Kikuchi''s disease (KD), or histiocytic necrotizing lymphadenitis, is a rare, self-limited lymphadenopathy, typically in young women, that usually remits spontaneously and does not recur. KD is clinically characterized by cervical lymphadenopathy and a high fever. Extranodal involvement (skin, arthritis, meningitis) rarely occurs. When KD is involved in a skin lesion, it presents with various shapes, but rarely manifests with symmetrically distributed, erythematous, firm nodules only on the face. In this report, we describe a patient with KD and unique skin manifestations.     

高频超声在小儿肠系膜淋巴结炎诊断中的应用

目的：探讨小儿肠系膜淋巴结炎的超声表现,研究高频超声在诊断小儿肠系膜淋巴结炎中的应用。方法：对150例经临床确诊的小儿肠系膜淋巴结炎患儿的肠系膜淋巴结超声表现进行观察。结果：治疗前后炎症肠系膜淋巴结的位置分布、大小、彩色血流信号丰富程度都有其特征性变化。结论：高频超声可以通过观察小儿肠系膜淋巴结的位置分布、大小、彩色血流信号的变化作出诊断,给临床提供很大的帮助。     

针刺治疗小儿慢性肠系膜淋巴结炎近远期疗效观察

[目的]评价针刺治疗小儿慢性肠系膜淋巴结炎的临床疗效。[方法]将120例慢性肠系膜淋巴结炎患儿随机分为两组,每组60例。对照组予头孢呋辛钠抗感染治疗,治疗组穴取四缝穴、内关、中脘、足三里等,予针刺治疗。1周为1疗程,1个疗程后评定疗效。[结果]治疗组愈显率与总有效率分别为91.7%、98.3%,对照组分别为86.7%、95%,两组疗效有显著性差异（均P〈0.05）,两组患儿治疗前后症状体征积分比较治疗前均有下降,差异均有非常显著性意义（P〈0.01）;治疗组治疗后症状体征积分低于对照组,差异有显著性意义（P〈0.05）。治疗后三个月,治疗组复发率为3.6%,治疗后六个月,治疗组复发率为1.9%,分别显著低于对照组的57.7%,54%（P〈0.01）。[结论]针刺法治疗小儿慢性肠系膜淋巴结炎不但具有确切的近期临床疗效,而且远期疗效稳定,复发率低,值得临床推广。     

Interleukin‐6 and lipopolysaccharide‐binding protein in acute appendicitis in children

The aim of the study was to evaluate the diagnostic accuracy of interleukin‐6 (IL‐6) and lipopolysaccharide‐binding protein (LBP) in children with acute appendicitis (AA) and to compare this with the diagnostic accuracy of routinely used C‐reactive protein (CRP) and white blood cell (WBC) count. Eighty‐two consecutive children admitted to our Department because of suspected AA were enrolled in this prospective study and classified into two groups: group 1 (49 children who underwent surgery for AA) and group 2 (33 children with no surgery with diagnosis of non‐specific abdominal pain or sonographic mesenteric lymphadenitis). There were no negative appendectomies during the time of the study. The patients were further classified into three subgroups: subgroup 1A (43 patients with advanced AA), subgroup 2A (11 patients with mesenteric lymphadenitis) and subgroup 2B (10 patients with non‐specific abdominal pain). The perforation rate was 32.7?%. WBC count and serum CRP, IL‐6 and LBP were measured on admission. Area under receiver operating characteristic (ROC) curve (AUC), sensitivity, specificity and predictive values were evaluated. Serum IL‐6 and LBP were significantly higher in group 1 than in group 2. The highest AUC for AA was that for IL‐6 (0.776), followed by WBC count (0.684), CRP (0.637) and LBP (0.635). In conclusion, only IL‐6, determined on admission, showed medium diagnostic accuracy, while other laboratory markers showed low diagnostic accuracy for AA in children. The new laboratory markers therefore do not significantly improve the diagnosis of AA.     

Estimation of apoptosis and cell proliferation in histiocytic necrotizing lymphadenitis using immunohistochemical double staining

The aim of the present study was to estimate the relationship between apoptosis and cell proliferation in histiocytic necrotizing lymphadenitis (HNL). Fifteen patients with HNL were retrospectively analyzed. The patients were divided into three groups according to the proportion of the necrotic area as follows: necrosis (+), necrotic area <25%; necrosis (++), necrotic area 25–50%; and necrosis (+++), necrotic area >50%. Immunohistochemical double staining was performed for CD3 plus caspase-3 and for Ki-67 plus caspase-3 and positive cells were counted in two areas: one without and one with obvious apoptotic features. Most caspase-3-positive cells were also stained for CD3 (area exhibiting obvious apoptotic features: average, 92.3%). Furthermore, various proportions of both Ki-67- and caspase-3-positive cells were detected in all the groups (range, 5–70%). In the area with obvious apoptotic changes, the average percentage of both Ki-67- and caspase-3-positive cells (38.6%) was higher than that in the area without obvious apoptotic features (16.3%). A proportion of cells in HNL undergo proliferation and apoptosis simultaneously, such as neoplastic cells, thereby exhibiting rapid cell cycles.     

Light-chain-restricted germinal centres in reactive lymphadenitis: report of eight cases

Aims:  Light-chain-restricted germinal centres are generally associated with the existence of a neoplastic lymphoproliferative disorder. The aim was to present a series of cases with persistent lymph node enlargement that featured some germinal centres showing light chain immunoglobulin restriction.
Methods and results:  A series of six reactive lymphadenitis and two Castleman's disease cases was analysed by immunohistochemistry, IgH-polymerase chain reaction (PCR) and microdissected PCR. In all cases some germinal centres contained a population of plasma cells and plasmacytoid germinal centre cells showing light chain immunoglobulin restriction. In three cases the monotypic cells also showed distinct Bcl-2 expression. Two of the cases showed a predominant IgH rearrangement on a florid polyclonal background and one had an IgH monoclonal rearrangement, as revealed by PCR. Microdissected germinal centre PCR revealed a dominant repeated band in one of three cases and in another case a non-repeated clonal peak was observed. One of the patients developed a follicular lymphoma, which became evident from a subsequent biopsy.
Conclusions:  These findings may be a manifestation of an underlying disorder in the regulation of the immune response, or an exaggeration of the germinal centre oligoclonal nature. This should be taken into account in the differential diagnosis of follicular hyperplasia.     

高频超声诊断小儿急性肠系膜淋巴结炎的临床价值

目的：总结分析高频超声诊断小儿急性肠系膜淋巴结炎声像图的特征及临床价值。方法：我院2008年1月～2009年12月应用高频超声诊断小儿急性肠系膜淋巴结炎56例。结果：56例患儿在脐周发现多个肿大的淋巴结,肿大的肠系膜淋巴结形态多为椭圆形,边界清晰,呈低回声,皮髓质结构显示清晰,L/S〉2。彩色多普勒超声可探及较丰富的血流信号,阻力指数0.50～0.65。经过抗炎等对症治疗后患儿的症状缓解,10 d后复查超声显示,淋巴结数量、淋巴结长、短径（mm）均较治疗前明显缩短,且淋巴结长短径比明显提高（t值分别为12.364、15.342、3.475、2.364,P〈0.05）。结论：高频超声诊断小儿急性肠系膜淋巴结炎具有无创、经济、简便、可重复检查等优点,可以作为诊断小儿急性肠系膜淋巴结炎首选的检查方法之一。