Cervicofacial non-tuberculous mycobacterial lymphadenitis: clinical determinants of incomplete surgical removal

In patients with non-tuberculous mycobacterial cervicofacial lymphadenitis, incomplete surgical removal of infected lymph nodes leads to delayed healing and a higher recurrence rate, with eventual spontaneous drainage through the skin. However, complete surgical removal is not always achievable due to the extent of the infected tissue and proximity to vulnerable structures, such as the facial or accessory nerve. The aim of this study was to identify the clinical determinants of the (in)ability to perform complete surgical removal. The electronic health records of patients aged 0–15 years with bacteriologically proven non-tuberculous mycobacterial cervicofacial lymphadenitis, who underwent surgical treatment and preoperative sonographic imaging, were analysed. This was a case–control study. A total of 103 patients met the inclusion criteria. Most of the infections were unilateral, submandibular, and caused by Mycobacterium avium. Multiple logistic regression analysis revealed that higher age (odds ratio 1.24, 95% confidence interval 1.04–1.47) and fistulization (odds ratio 3.15, 95% confidence interval 1.13–8.75) were significantly associated with a limited ability to surgically remove all infected tissue. However, a larger sonographic lymph node size was not significantly associated. These findings could aid clinicians when informing the parent(s)/guardian(s) of the patient preoperatively and in properly estimating the intraoperative and postoperative course.     

Ischemic Stroke in the Setting of Tuberculous Meningitis

The clinical syndrome of tuberculous (TB) meningitis leading to ischemic strokes is rarely seen today in immunocompetent adults native to North America. This entity is also notoriously difficult to diagnose because the presenting symptoms are often nonspecific. The authors describe a case of a man with TB meningitis which progressed to recurrent ischemic cerebral infarcts.     

Poncet病(病例报告及文献复习)

目的 探讨Poncet病的诊断与治疗。方法 通过病例报告及献复习，综述了Poncet病的发病机理、临床表现。结果 提高对Poncet病的认识。结论 临床上对风湿性或类风湿性关节炎病人均应与本病鉴别。     

含补金片方案治疗结核性渗出性胸膜炎疗效观察

目的：探讨结核性渗出性胸膜炎的治疗方法。方法：96例初治结核性胸膜炎患者随机分为2组,对照组应用普通化疗方案2HRZE（S）/4HR;治疗组在对照组基础上,强化期加用补金片治疗。观察6个月,分析两组疗效。结果：治疗2周、4周及8周末胸水吸收总有效率治疗组为83.33%、91.67%和95.83%;对照组为64.58%、72.92%和79.17%,治疗6个月胸膜肥厚与粘连发生率治疗组为14.58%,对照组为41.67%,两组比较均有显著性差异（P〈0.05）。结论：补金片可促进胸液吸收,加快临床症状消失,防止胸膜肥厚粘连,以及防止肝损害等,值得临床推广。     

结核性脑膜炎的CT分型与诊断（附20例分析）

经ＣＴ和临床确诊的２０例结核性脑膜炎进行回顾性分析。作者根据ＣＴ改变将其分为三种类型：（１）脑炎结节型；（２）结核瘤型；（３）脑积水型。并就ＣＴ诊断结核性脑膜炎的价值与限度进行了讨论。     

Raised intracranial pressure,the syndrome of inappropriate antidiuretic hormone secretion,and arginine vasopressin in tuberculous meningitis

Intracranial pressure (ICP) monitored shortly after admission over a period of 1 h in 31 children with tuberculous meningitis (TBM) was significantly higher (median 22.5 mm Hg, range 8.4–50.9 mmHg) in 19 children with laboratory evidence of the syndrome of inappropriate antidiuretic hormone secretion (SIADH) than in 12 children without such evidence (median 16.2 mmHg, range 5.8–42.5 mmHg; P = 0.027). Neither plasma nor cerebrospinal fluid arginine vasopressin (AVP) was related to ICP (r = 0.33 and 0.13 respectively). Mean arterial pressure (MAP) was measured in 23 children and a moderate correlation was found with plasma AVP (r = 0.62; P = 0.0019). In TBM, plasma AVP may be secreted as a response to raised ICP in an effort to raise MAP and maintain cerebral perfusion pressure. In this setting excess fluid may be inappropriately retained, leading to hyponatremia and hypo-osmolemia.     

关节镜下膝关节结核性滑膜炎的治疗(附10例报告)

目的探讨关节镜下结核性滑膜炎的特点和滑膜切除术的效果. 方法选择10例结核性滑膜炎,行关节镜下滑膜切除手术和活检.术后配合关节腔注射异烟肼和全身抗结核治疗. 结果所有病人随访6月～3年,术后第2天行CPM关节功能锻炼,9例膝关节屈曲从手术前90°±5°平均提高到120°±14°,伸直受限从手术前20°±3°提高到5°±1°,手术前后比较差异有显著性(t值分别为6.9、 6.3,P<0.01),JOA评分术前(44±8)分,术后(82±10)分(t=8.47,P<0.01),所有病人2个月后关节肿胀减轻,随访期间内无病变复发. 结论关节镜下切除滑膜和清理结核性肉芽组织,改善软骨营养,结合药物治疗可有效控制病情,改善关节功能.     

Abscess-forming granulomatous lymphadenitis: Histological typing of suppurative granulomas and clinicopathological findings with special reference to cat scratch disease

In order to clarify the histological and immunohistochemical characteristics of suppurative granuloma in abscess-forming granulomatous lymphadenitis (AGL), and the relation between AGL and cat scratch disease (CSD), 36 cases of AGL were studied. The combined results showed that there were two types of suppurative granulomas. The suppurative granulomas histologically revealed small lymphocytes of predominantly T cell phenotype distributed among the epithelioid histiocytes bordering central necrotic areas in the suppurative granulomas. These suppurative granulomas could be further subdivided into two groups, mainly those with and without the intermingling of large transformed cells of B-cell phenotypes: Type B granuloma with large transformed B cells and Type A without large transformed B cells. Both types of granulomas were observed in a varying degree in most cases. According to the predominant type of granulomas, 36 patients with AGL were further classified into two groups: Group I of Type A dominance and Group II of Type B dominance. Warthin-Starry (WS) silver stain positive bacteria, which are said to be a causative agent of CSD, were present in about 50% of both groups. No Brown-Hopps' Gram-positive bacteria, fungus, toxoplasma, Chlamydia or Bacillus Calmette-Guerin antigen were found in any case. Clinically, there was no significant difference between these two groups. On the other hand, the detection of WS-positive bacteria seemed to have some relationship with the duration of disease and the history of exposure to cats, and 70% of AGL cases occurred in autumn without a single concurrent epidemic.