51
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García Marcos S, Borrego FJ, Martínez de la Victoria JM, Sánchez Perales C, García Cortés MJ, Pérez del Barrio P, Parras L, Pérez Bañasco V. [Ileocecal tuberculosis during hemodialysis simulating carcinoma of the colon]. Nefrologia 2001; 21:314-8. [PMID: 11471313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023] Open
Abstract
Extrapulmonary tuberculosis is more frequent in hemodialysis patients than in the general population but intestinal localization is an unusual presentation of this infectious disease. We report a 60 year old patient on regular hemodialysis with intestinal tuberculosis masquerading as colon cancer. The patient presented with rectal bleeding, abdominal pain and fever and the radiological findings were compatible with ileocecal carcinoma. After surgery histological examination showed non-caseating granulomas but mycobacterial culture was not available. We performed a colonoscopy and obtained a biopsy of colonic mucosa for culture and other analyses. We identified acid-fast bacilli with Ziehl-Neelsen staining of formaldehyde preserved, paraffin-embedded tissue from the hemicolectomy and the colonic mucosal biopsy. Treatment with isoniazid, rifampicin and pyrazinamide for nine months was successful and well tolerated. Intestinal tuberculosis is a rare entity that we must keep in mind in a patient with abdominal pain, unexplained fever, digestive bleeding and particularly with a positive tuberculin reaction. When culture is not possible we can obtain intestinal samples by colonoscopy and use appropriate staining of paraffin-embedded tissues.
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MESH Headings
- Adenocarcinoma/diagnosis
- Adenocarcinoma/secondary
- Cecal Diseases/complications
- Cecal Diseases/diagnosis
- Cecal Diseases/microbiology
- Cecal Diseases/surgery
- Cholecystectomy
- Colectomy
- Colonic Neoplasms/diagnosis
- Diagnosis, Differential
- Diagnostic Errors
- Female
- Fever/etiology
- Gallbladder Diseases/diagnosis
- Gallbladder Diseases/surgery
- Humans
- Ileal Diseases/complications
- Ileal Diseases/diagnosis
- Ileal Diseases/microbiology
- Ileal Diseases/surgery
- Intestinal Perforation/etiology
- Kidney Failure, Chronic/complications
- Kidney Failure, Chronic/therapy
- Melena/etiology
- Middle Aged
- Peritoneal Neoplasms/diagnosis
- Peritoneal Neoplasms/secondary
- Peritonitis, Tuberculous/diagnosis
- Polycystic Kidney, Autosomal Dominant/complications
- Renal Dialysis
- Tuberculoma/complications
- Tuberculoma/diagnosis
- Tuberculoma/microbiology
- Tuberculoma/surgery
- Tuberculosis, Gastrointestinal/complications
- Tuberculosis, Gastrointestinal/diagnosis
- Tuberculosis, Gastrointestinal/microbiology
- Tuberculosis, Gastrointestinal/surgery
- Tuberculosis, Lymph Node/diagnosis
- Tuberculosis, Lymph Node/surgery
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Affiliation(s)
- S García Marcos
- Servicio de Nefrología, Hospital General de Especialidades Ciudad de Jaén, Jaén
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52
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53
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Moirangthem GS, Singh NS, Bhattacharya KN, Chito TH, Singh LD. Gastric outlet obstruction due to duodenal tuberculosis: a case report. Int Surg 2001; 86:132-4. [PMID: 11918239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
Abstract
A 17-year-old boy was operated on for gastric outlet obstruction; laparotomy revealed a mass with nodules in the first part of the duodenum and multiple mesenteric lymph nodes. The histopathological examination of the duodenal mass and the lymph nodes showed caseating tuberculosis. Because of the rarity of duodenal tuberculosis, the case is reported herewith.
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Affiliation(s)
- G S Moirangthem
- GI Endoscopic Surgery Unit, Regional Institute of Medical Sciences, Imphal, India
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54
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Kezirian EJ, Alsarraf R, Lykins C, Futran ND. Imaging quiz case 3. Cervical tuberculous lymphadenopathy (scrofula). Arch Otolaryngol Head Neck Surg 2000; 126:1501,1504-5. [PMID: 11115293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
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55
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Messina M, Carfagna L, Meucci D, Ferrucci E, Tallarico R. [Cervical lymphadenitis caused by mycobacteria. Our experience]. MINERVA CHIR 2000; 55:847-53. [PMID: 11310183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
BACKGROUND Mycobacterial infections are extremely complex diseases, either due to the various clinical manifestations, or to the various involved kind of mycobacteria, or to the different sensibility to antibiotics. The authors review retrospectively their series, evaluating the management of pediatric cervical lymphadenitis due to mycobacterical etiology. METHODS From 1975 to 1998, at the Department of Pediatric Surgery of the university of Siena, 88 children were evaluated for laterocervical lymphadenopathy. Among these, 29 children, aged from 14 months to 13 years, were diagnosed as affected with lymphoadenopathy due to mycobacteria. Therapy of choice was the association of surgery and antibiotics. This behaviour allowed us to approach both advanced lesions, in active colliquation, and progressive ones. RESULTS Results were unquestionably positive, with a complete resolution and good esthetical results in 93.2% of cases. In 6.8% of cases there was a recurrence, which required reintervention. CONCLUSIONS On the basis of our series, we agree with the international literature in affirming that, in cases of mycobacterial lymphadenopathy, a combined antibiotic and surgical therapy is necessary. However, controversy about such a complex and difficult pathology is opened and unsolved.
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Affiliation(s)
- M Messina
- Cattedra di Chirurgia Pediatrica, Università degli Studi, Siena, Italia.
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56
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Abstract
We report on a 10-year old boy suffering from chronic abdominal pain. Clinical examination and imaging modalities revealed that the patient had mesenteric cysts. Exploratory laparotomy revealed two mesenteric cysts of various size and multiple enlarged mesenteric lymph nodes. M. tuberculosis was identified and histology of the specimens proved the existence of abdominal tuberculosis.
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Affiliation(s)
- H Emir
- Department of Pediatric Surgery, Cerrahpasa Medical Faculty, Istanbul University, Turkey
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57
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Khromtsov SV. [Complicated course of lymphatic system tuberculosis]. Probl Tuberk 2000:49-50. [PMID: 10838914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
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58
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Abstract
A retrospective study was carried out on 57 children, presenting with non-tuberculous mycobacterial (NTM) lymphadenitis of the head and neck, over a 12 year period. Cultures recovered 56 Mycobacterium avium-intracellulare (MAI), and one Mycobacterium kansasaii. Anti-mycobacterial agents were used in seven patients only. On the basis of the initial operation there were two groups. Group 1 (11 patients) had an excision, and Group 2 (46 patients) had incision and drainage (30 patients), incision and curettage (13 patients), or aspiration (three patients). There was no significant difference in the makeup of these two groups. However, Group 1 had significantly lower number of re-operations than Group 2, P<0.01, and achieved a significantly greater healing rate than Group 2, P<0.001. In Group 2 those who had an excision following failure of the first operation were significantly more likely to heal than those who did not, P<0. 005. Operative excision gives a lower rate of re-operation, and a higher rate of healing than other procedures. The treatment, natural history, clinical presentation, pathogenesis, and diagnosis of NTM cervical lymphadenitis are discussed.
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Affiliation(s)
- D Flint
- Department of Otorhinolaryngology, Starship Childrens Hospital, Auckland, New Zealand
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59
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Takeuchi H, Suzuki M, Unno M, Kakita T, Matsuno S, Nakura H. Splenic vein occlusion secondary to tuberculous lymphadenitis at the splenic hilum: report of a case. Surg Today 2000; 30:383-5. [PMID: 10795875 DOI: 10.1007/s005950050606] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
We report a patient with splenic vein occlusion (SVO) secondary to tuberculosis. A 17-year-old male patient with mild epigastric pain and splenomegaly was found to have gastric varices by gastroscopy, and SVO by selective angiography. At operation, the splenic vein was occluded by hard fibrous tissue at the splenic hilum, and thus a splenectomy was performed. A microscopic examination of the tissue revealed caseous necrosis surrounded by epithelioid cells and Langhans-type giant cells. Although there were no other findings suggesting intestinal tuberculosis, it seemed that tuberculous lymphadenitis of the splenic hilum most likely caused the occlusion of the splenic vein. Because specific tests for tuberculosis were negative in both immunohistochemical staining for bacille Calmette-Guérin and polymerase chain reaction of DNA for Mycobacterium tuberculosis, the time of infection was assumed to have occurred a long time before. SVO can sometimes be seen in pancreatic diseases, but this patient with tuberculosis appears to be the first such reported case in the English literature.
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Affiliation(s)
- H Takeuchi
- First Department of Surgery, Tohoku University School of Medicine, Sendai, Japan
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60
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Chumakov FI, Gerasimenko NV. [Isolated tuberculosis of pharyngeal and palatine tonsils in child]. Vestn Otorinolaringol 2000:58. [PMID: 10771619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
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61
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Khan MQ, Al-Qahtani AQ, Al-Momen S, Aldhurais SA, Ahmad M. Widespread tuberculous calcification. Saudi Med J 2000; 21:386-9. [PMID: 11533826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023] Open
Abstract
We are reporting an unusual case of widespread abdominal calcifications, in the peri-colic mesentery, liver and spleen. The diagnostic laparoscopy showed multiple encapsulated calcified hard rounded masses of varying size and shape, with marked adhesions in and around the bowel and mesentery. Histopathology identified them as calcified lymph nodes, but was unable to highlight the pathogenesis of these calcifications. The diagnosis of post tuberculous calcification of lymph nodes is made on the basis of exclusion. The subject was reviewed, to the best of our knowledge, there is no similar case, with such an extent of abdominal calcifications reported in the literature.
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Affiliation(s)
- M Q Khan
- Department of Internal Medicine, Dammam Central Hospital, Dammam, Kingdom of Saudi Arabia.
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62
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Boiarkina OF, Malashenkov EA, Puchkova TV, Ariél' BM. [Variant of lymphogenic tuberculosis simulating cavity in lung]. Probl Tuberk 2000:55-7. [PMID: 10715965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
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63
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Affiliation(s)
- F Yilmaz
- Department of Pathology, Faculty of Medicine, Dicle University, Diyarbakir, Turkey
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64
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Bajpai M, Nambhirajan L, Dave S, Gupta AK. Surgery in tuberculosis. Indian J Pediatr 2000; 67:S53-7. [PMID: 11129909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
Tuberculosis in children involves many organs and systems including lymphatics, lungs, CNS, GIT and genitourinary. Although the mainstay of treatment is medical, surgery has a definite role under specific circumstances. It is important to differentiate atypical mycobacterial infection wherein surgery is the primary modality of treatment. The lung is most commonly involved in tuberculosis and besides bronchoscopy, thoracic procedures range from tube thoracostomy to decortication and lung resection. Neurotuberculosis constitutes almost half the cases of extrapulmonary tuberculosis and tuberculous meningitis (TBM) is the commonest type of CNS involvement. Hydrocephalus is a late complication of TBM and shunt surgery is indicated when signs and symptoms of raised intracranial pressure persist despite adequate medical therapy. Abdominal tuberculosis could be peritoneal or gastrointestinal. Either form can complicate the other and each can present in acute, subacute or chronic form. Surgical therapy is reserved for complications like strictures, fistulae and GI bleed. Genitourinary tuberculosis constitutes 15-20% of all extrapulmonary disease and epididymitis is the most common manifestation in the males. Surgery is generally reserved for management of complications such as ureteral strictures, perinephric abscesses and nonfunctioning kidneys.
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Affiliation(s)
- M Bajpai
- Department of Paediatric Surgery, All India Institute of Medical Sciences, New Delhi
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65
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Klin B, Boldur I, Sandbank J, Schpirer Z, Vinograd I. [Atypical mycobacterial cervical lymphadenitis in children]. Harefuah 1999; 137:612-4, 679. [PMID: 10959386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Scrofula (mycobacterial cervical lymphadenitis) has been well-known for thousands of years. Atypical mycobacteria were first categorized by Timpe and Runyon in 1954. Treatment has varied over the centuries, from exclusion therapy in ancient Greece, through digitalis, iodide, chemotherapy, and surgical excision. The varied differential diagnosis and consequent diagnostic and therapeutic challenges make reassessment of this almost forgotten disease necessary. 21 patients with typical mycobacterial cervical lymphadenitis seen in over the past 5 years were reviewed. Age distribution ranged from 1-14 years, with peak incidence at 4 years; 9 were boys and 12 girls. Most presented with nontender, palpable neck masses and minimal constitutional complaints. Adenopathy was unilateral in all cases but 2. Mycobacterium avium-intracellulare and M. fortuitum were the main causative organisms. All underwent excision of the affected nodes. Long-term follow-up has been uneventful, except for 1 case of local recurrence requiring re-excision. This study emphasizes the marked variability in the clinical presentation of scrofula in children, stressing the importance of the differential diagnosis between tuberculous and atypical mycobacterial cervical lymphadenitis. The treatment of choice for the latter is complete excision of the affected nodes. Other treatment is followed by recurrence and unnecessary complications and should be avoided.
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Affiliation(s)
- B Klin
- Dept. of Pediatric Surgery, Assaf Harofeh Medical Center, Zerifin
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66
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Abstract
BACKGROUND The role of surgery in the management of airway obstruction from lymphobronchial tuberculosis is discussed in the present article. METHODS Nine patients were operated on over a 4-year period and are currently presented. The age of the patients ranged between 5 and 28 months and 7 patients were male. Six patients required preoperative ventilation due to respiratory failure and all received standard posterolateral thoracotomies. Partial dissection and enucleation of bulky lymph nodes was performed in all but 1 patient. In that patient, the group of lymph nodes could be removed fully, including the sheath. RESULTS All patients showed marked improvement and were weaned off the ventilator between 24 and 72 hours postoperatively. Long term follow-up was available in 7 patients and they are all doing well and are free of symptoms. CONCLUSIONS Enucleation of mediastinal lymph nodes obstructing the airways in young patients with lymphobronchial tuberculosis is safe. It successfully relieves obstruction and is devoid of complication providing that incision, evacuation, and curettage of lymph nodes is performed avoiding overzealous dissection.
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Affiliation(s)
- K A Papagiannopoulos
- Department of Cardiothoracic Surgery, University of Stellenbosch, Tygerberg Hospital, Cape Town, South Africa.
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67
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Jäckel MC, Witt O, Eber SW, Eiffert H, Laskawi R. [Postoperative antibiotic therapy of cervical lymphadenitis caused by nontuberculous, atypical mycobacteria]. Laryngorhinootologie 1999; 78:450-4. [PMID: 10488466 DOI: 10.1055/s-2007-996907] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Cervical lymphadenitis caused by atypical mycobacteria is increasingly observed in immunocompetent children between 1 and 5 years of age. Surgical excision of all affected lymph nodes represents the treatment of choice. However, due to the infiltrative nature of the disease, surgery is occasionally unable to provide a complete cure and is associated with a high risk of recurrence. Such cases might derive benefit from an additional antibiotic therapy. METHODS The study includes 4 children with demonstrated or clinically suspected nontuberculous mycobacterial lymphadenitis, in whom partial surgery had been performed. Postoperatively, two patients were treated with clarithromycin, rifabutin, and protionamide, the others with clarithromycin alone. Antibiotics were administered orally for 6-12 weeks and were continued four weeks after local signs of inflammation were no longer detectable. RESULTS In all cases, symptoms of lymphadenitis resolved within 1-2 months and did not recur. One patient was affected by WHO grade I leukopenia after 6 weeks, which soon disappeared after administration of rifabutin and protionamid had been discontinued. CONCLUSIONS Postoperative antibiotic therapy seems to be an effective approach to treat residual disease following incomplete surgery. It remains to be clarified, however, if such a therapy should comprise combinations of agents or if administration of clarithromycin alone might be sufficient.
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68
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Iablonskiĭ SV, Kovshenkova ID, Kadnikova ON. [On the differential diagnosis of median cysts of the neck]. Vestn Otorinolaringol 1999:40-1. [PMID: 10380610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
A case is reported of a 8-year-old girl with a median cyst of the neck treated surgically. Histologically, it was tuberculous lymphadenitis. It is recommended to account for peripheral lymph node tuberculosis in differential diagnosis of median cysts of the neck.
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69
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Hermann W, Alberty J, Stoll W. [Interesting case no. 25. Cervical tuberculous lymphadenitis]. Laryngorhinootologie 1999; 78:353-5. [PMID: 10439357 DOI: 10.1055/s-2007-996886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- W Hermann
- Klinik und Poliklinik für Hals-, Nasen- und Ohrenheilkunde der Westfälischen Wilhelms-Universität Münster
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70
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Abstract
BACKGROUND Atypical mycobacteria have long been recognized as a cause of cervicofacial adenitis in otherwise healthy children. The disease is nearly always localized but if left untreated the involved lymph nodes caseate and discharge. The management of this condition has been considered to be surgical with techniques including aspiration, incision and drainage, curettage and excision. METHODS Cases of atypical mycobacterial cervicofacial adenitis treated by curettage at the Canberra Hospital, ACT, Australia, are reviewed. RESULTS Ten cases successfully treated with curettage are reported. Two patients experienced delayed healing of their wounds and one required a second curettage 7 months after primary excision for recurrent disease. CONCLUSION Curettage is a safe and effective means of treating atypical mycobacterial cervicofacial adenitis in children. The primary cure rate of 70% is less than that for excision of the involved nodes (92% cure rate), which is the standard treatment for this disease.
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Affiliation(s)
- J A Fergusson
- Department of Paediatric Surgery, The Canberra Hospital, Australian Capital Territory, Australia
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71
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Khmel' OV. [The late results of the surgical treatment of patients with tuberculosis of the intrathoracic lymph nodes]. Klin Khir 1999:45-6. [PMID: 10050398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
The late follow-up results of surgical treatment of 87 patients with the intrathoracic lymph nodes tuberculosis were studied up. The follow-up have constituted from 2 to 25 years. The tuberculosis reactivation was not revealed. The ability to work was restored in the shortest period of time in majority of patients.
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72
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Guo B, Liu W, Shao B. [Radical neck dissection in treating cervical lymph node tuberculosis]. Zhonghua Jie He He Hu Xi Za Zhi 1998; 21:352-4. [PMID: 11326892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
OBJECTIVE To evaluate the significance of radical neck dissection in treatment of mixed-type cervical lymph node tuberculosis. METHOD One hundred twenty-two cases with mixed-type cervical lymph node tuberculosis were treated with radical neck dissection and the results of the treatment were reported. The size, number, location and pathologic types of abscess, fistula and lymph node were also analyzed. RESULT All the patients were cured without relapse during 1-7 year follow-up. Spreading antegrade infection and chronic recurrence were found to be the characteristics of mixed-type cervical lymph node tuberculosis. CONCLUSION Radical neck dissection is an effective and safe approach for treating the disease.
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Affiliation(s)
- B Guo
- Mudanjiang Hospital, Mudanjiang 157009
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73
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Süoğlu Y, Erdamar B, Cölhan I, Katircioğlu OS, Cevikbas U. Tuberculosis of the parotid gland. J Laryngol Otol 1998; 112:588-91. [PMID: 9764307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
The presentation of tuberculosis as an isolated parotid lump is rare. In this paper, six cases with tuberculous parotitis are reported which were evaluated as a benign parotid neoplasm in 216 specimens pre-operatively. All but one of them had no previous history of tuberculosis and all had a parotid lump as a sole symptom for at least one year. The diagnosis of tuberculosis was made, after superficial parotidectomy, by histopathology. Parenchymal involvement and intraparotid lymph node involvement with tuberculosis were seen in five and three patients, respectively. Two of the patients had lymph node involvement outside the parotid area. One of six patients had a coincidental Warthin tumour. A surgical approach is not only therapeutic but also diagnostic when other diagnostic tools fail.
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Affiliation(s)
- Y Süoğlu
- Department of Otorhinolaryngology, Istanbul University, Istanbul School of Medicine, Turkey
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74
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Jiang J, Wang D. [Diagnosis and surgical treatment of tuberculosis of mesentric lymph nodes]. Zhonghua Jie He He Hu Xi Za Zhi 1998; 21:273-5. [PMID: 11326948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
OBJECTIVE To evaluate the diagnosis, operative indication and therapeutic result of tuberculosis of mesentric lymph nodes. METHOD Fifty-nine cases with tuberculosis of mesentric lymph nodes surgically treated at two hospitals from July 1976 to July 1997 were retrospectively analyzed. RESULT Only 14 cases were correctly diagnosed before operation. Operative treatment for the tuberculosis of mesentric lymph nodes represented a safe, effective treatment with few complications and no operative death. CONCLUSION Because patients with tuberculosis of mesentric lymph nodes show no characteristic manifestations, laboratory methods (e.g. polymerase chain reaction), peritoneoscopy, CT scanning and B mode ultrosound techniques should also be considered for diagnosis of the disease. The acute or chronic ileus, hemorrhage of digestive tract, intestinal perforation or fistula, intra-abdominal large tuberculous abscess and abdominal sinus caused by tuberculosis of mesentric lymph nodes should be surgically treated. The exploratory laparotomy also should be performed on the patients with abdominal mass or those whose diagnosis of neoplasm could not be ruled out. The postoperative antituberculosis chemotherapy should be continued to decrease the occurrence of complications.
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Affiliation(s)
- J Jiang
- General Surgery Department, Southwest Hospital, Third Military Medical University, Chongqing 400038
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75
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Mihălţan F, Paleru C, Galbenu P, Ulmeanu R, Prisăcaru L. [Diagnostic difficulties--salvage diagnostic thoracotomies]. Pneumoftiziologia 1998; 47:109-12. [PMID: 10386133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
The authors are presenting the difficulties of diagnosis, in clearing up the etiology in two cases, where the acceptance of the exploring thoracotomy, influenced the prognostic and permitted to settle up the diagnosis. We are passing through, at this occasion, also the indications of this kind of operation.
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Affiliation(s)
- F Mihălţan
- Serviciul pneumoftiziologie, Institutul de Pneumoftiziologie Marius Nasta
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76
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Delaunois L, Garrino MG. [Manifestations, diagnosis and treatment of non-tuberculous mycobacterial infections in non-immunodepressed patients]. Rev Mal Respir 1997; 14 Suppl 5:S130-41. [PMID: 9496598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Non-tuberculous mycobacteria (NTM) can be the etiologic agents of chronic pulmonary disease, lymphadenitis, skin and soft-tissue infection and disseminated disease in non-immunocompromised patients. The recognition of disease needs repeated isolation of the NTM from bronchopulmonary secretions or from tissue biopsies, and its identification by specific laboratory methods. A wide spectrum of clinical presentations and severity of disease can be found, from spontaneous healing to progressive and destructive lung disease, and death, according to predisposing conditions and mycobacterial species. The choice of surgical and drug treatment will depend on identification of specific pathogen and clinical evaluation.
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MESH Headings
- Antitubercular Agents/therapeutic use
- Biopsy
- Bronchoalveolar Lavage Fluid/microbiology
- Cause of Death
- Disease Progression
- Humans
- Immunocompetence
- Lymphadenitis/drug therapy
- Lymphadenitis/microbiology
- Lymphadenitis/surgery
- Mycobacterium Infections, Nontuberculous/diagnosis
- Mycobacterium Infections, Nontuberculous/drug therapy
- Mycobacterium Infections, Nontuberculous/physiopathology
- Mycobacterium Infections, Nontuberculous/surgery
- Mycobacterium avium-intracellulare Infection/diagnosis
- Mycobacterium avium-intracellulare Infection/drug therapy
- Mycobacterium kansasii/classification
- Mycobacterium xenopi/classification
- Nontuberculous Mycobacteria/classification
- Nontuberculous Mycobacteria/physiology
- Risk Factors
- Soft Tissue Infections/drug therapy
- Soft Tissue Infections/microbiology
- Soft Tissue Infections/surgery
- Tuberculosis/diagnosis
- Tuberculosis/drug therapy
- Tuberculosis/physiopathology
- Tuberculosis/surgery
- Tuberculosis, Cutaneous/diagnosis
- Tuberculosis, Cutaneous/drug therapy
- Tuberculosis, Cutaneous/physiopathology
- Tuberculosis, Cutaneous/surgery
- Tuberculosis, Lymph Node/diagnosis
- Tuberculosis, Lymph Node/drug therapy
- Tuberculosis, Lymph Node/physiopathology
- Tuberculosis, Lymph Node/surgery
- Tuberculosis, Pulmonary/diagnosis
- Tuberculosis, Pulmonary/drug therapy
- Tuberculosis, Pulmonary/physiopathology
- Tuberculosis, Pulmonary/surgery
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Affiliation(s)
- L Delaunois
- Cliniques de l'Université Catholique de Louvain Mont-Godinne, Yvoir, Belgique
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77
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Balquet P, Larroquet M, Philippe-Chomette P, Gruner M. [The role of surgery in tuberculosis in children]. Rev Mal Respir 1997; 14 Suppl 5:S121-3. [PMID: 9496596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Despite increasingly rigorous preventive measures which have limited the number of cases in France, the number of children undergoing surgery for tuberculosis has remained unchanged. Over the last ten years we operated on 40 children in our pediatric unit. In 10 cases, surgery was indicated for diagnosis, in 19 cases surgery was required in an emergency situation during treatment and in 11 the operation was performed at the stage of sequellae. The type of surgery depended on the clinical situation. Thoracoscopy was used for surgical diagnosis and to empty caseous nodes in the lateral tracheal chain but was generally impossible at the sequellae stage.
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Affiliation(s)
- P Balquet
- Service de Chirurgie viscérale infantile, Hôpital d'enfants Armand-Trousseau, Paris
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78
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Riquet M, Souilamas R. [Surgery of thoracic and pulmonary tuberculosis and the sequelae of its treatment in adults]. Rev Mal Respir 1997; 14 Suppl 5:S105-20. [PMID: 9496595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Surgery for tuberculosis was the starting point for thoracic and cardiovascular surgery in the modern day, but its place was more and more restricted to the treatment of the disease. Excisions (lobectomies, pneumonectomies, segmentestomies) currently represent the majority of operations, after this come operations on the pleura (decortication) and rarely those on the thoracic wall (thoracoplasty, parietectomy). The indications for excision are principally encountered with disease of the parenchyma itself: progressive disease under treatment or with resistant tubercle bacilli, sequelae of parenchymal complications (infections, aspergilloma or haemoptysis) and certain forms of atypical mycobacteria, and also a small but significant group in which excisions are aimed at diagnosis. Sometimes excisions are associated by necessity with decortication for pleural disease which may or may not have originally been intended for the underlying parenchyma or the lesions may be the sequelae of previous complications of treatment such as collapse therapy. Occasionally surgery is indicated in the treatment of lymph node masses in the mediastinum which have not responded to antituberculous therapy and during the treatment bronchial complications have evolved or there have been other sequelae. As for the indications for surgery of the thoracic wall such as thoracoplasty, they appear more than ever obsolete and even if they are still used in certain complications of surgery, they have apart from a few exceptions, lost their original therapeutic role in tuberculosis. However, currently there is a recrudescence of tuberculosis favoured by certain socio-economic situations and strengthened by the appearance of TB cultures which are more and more resistant. The surgery of tuberculosis in its oldest forms (thoracoplasty and removal of cavities) can no longer be said to be the surgery of the past. They proved in the old days that they could cure. Surgery has once more its place in the therapeutic arsenal of new forms of the disease and indirectly in limiting the risk of spread it has a role to play in prevention.
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Affiliation(s)
- M Riquet
- Service de Chirurgie Thoracique, Hôpital Laennec, Paris
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79
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Lardinois D, Furrer M, Mouton W, Gugger M, Ris HB. [Surgical aspects of mycobacterioses. Evolution during the last 20 years]. Schweiz Med Wochenschr 1997; 127:1961-8. [PMID: 9480536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Tuberculosis remains one of the major infectious diseases. Its incidence has grown in immigrants and in immunosuppressed patients, and, moreover, cases of drug resistance are on the increase. The goal of this study was to analyze the implications of these new developments and surgical experience in our patients. METHODS The cases of 104 patients with tuberculosis hospitalized between 1975 and 1995 were reviewed retrospectively. RESULTS 22% of the patients (23/104) were immigrants. No HIV-positive patients were described but association with debilitating diseases was frequent. Diagnosis was chiefly by histology. The culture was positive in only 30/104 patients (29%). Drug resistance was seen in only one patient (1%). 72/104 patients (69.2%) presented with an infection of the pulmonary parenchyma, 21/104 (20.2%) with pleural tuberculosis including tuberculous empyema, 3/104 (2.9%) with tuberculosis of the chest wall and 8/104 (7.7%) with mediastinal tuberculosis. Surgery was performed in 84/104 patients (80.8%). The chief indications were suspected carcinoma in 39/84 cases (46.4%), destroyed lung in 11/84 (13.1%), empyema combined with bronchopleural fistula in 10/84 (11.9%), enlarged mediastinal lymph-nodes of unknown dignity in 7/84 (8.3%), recurrent pleural effusion in 5/84 (5.9%) and bronchial stenosis in 4/84 (4.8%). CONCLUSION The number of surgical patients with tuberculosis has remained fairly stable over the last 20 years, but the proportion of immigrants has grown since 1990. Thoracoscopy is playing an increasingly important role in the diagnosis and surgical treatment of tuberculosis (recurrent pleural effusion, resection of peripheral pulmonary nodules turning out to be tuberculoma).
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Affiliation(s)
- D Lardinois
- Clinique de chirurgie cardiaque, vasculaire et thoracique, Hôpital universitaire de l'Ile, Berne
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80
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Gallesio C, De Gioanni PP, Fasciolo A. [Tuberculous lesions of the cervico-facial area. A case load of 20 years]. Minerva Stomatol 1997; 46:507-12. [PMID: 9432555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Tuberculosis is a granulomatous inflammatory process consequent to infection by Mycobacterium tuberculosis (human or bovine type). In the maxillofacial district easily the most frequent localisation is the laterocervical and submandibular lymph nodes. MATERIALS AND METHODS The series presented here includes cases of specific tubercular infection of the maxillo-facial district observed by the Division of Maxillo-Facial Surgery of the University of Turin during the period 1975 and 1995. RESULTS 121 surgically-treated benign cervical lesions were examined of which 25 cases were found to be specifically tubercular, representing 21% of the total. In addition to the cases treated surgically during the period in question a further 12 cases of specific tubercular adenopathy were diagnosed which were treated using medical treatment alone. The clinical trend observed in these patients was variable but almost constantly characterised by scarce subjective symptomatology. CONCLUSIONS Diagnostic ascertainment, according to our experience, must be complete and include an accurate family and individual anamnesis, a careful objective examination, hematochemical tests (hemochrome, ESR), cervical and lung X-rays and bacterioscopic tests using fine needle aspiration. From a therapeutic point of view, in agreement with the majority of papers, the authors affirm that surgery appears to be the most indicated form of treatment.
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Affiliation(s)
- C Gallesio
- Dipartimento di Fisiopatologia Clinica, Università degli Studi, Torino
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81
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Abstract
Although its protective effect is contested and the risk of contracting tuberculosis is rather low nowadays, BCG vaccination is frequently performed. Changes of strain repeatedly led to an increased complication rate. In Austria between 1990 and 1991, of 3386 newborn babies (Strain Pasteur) 116 developed lymphadenitis 3 to 28 weeks after vaccination. The affected children received four types of treatment: nothing specific, isoniazid, or surgery with and without isoniazid. Surgical treatment was found to be necessary in 96 cases. Bacilli were successfully grown in culture in 46% of cases up to week 20 after vaccination; but later than 20 weeks no culture became positive. All cultured bacteria were isoniazid-sensitive. From our data we drew the following conclusions: isoniazid therapy did not prove successful when inflamed lymph nodes exceeded a certain size. Suppurative lymphadenitis in lymph nodes exceeding 1.0 to 1.5 cm usually led to infiltration or even perforation of the skin. Surgery prevents these complications and significantly reduces healing time. Adjuvant isoniazid therapy cannot be recommended, except for generalized BCG tuberculosis.
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Affiliation(s)
- P Hengster
- Department of Pediatric Surgery, Innsbruck University Hospital, Austria
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82
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Abstract
Mediastinal tuberculous lymphadenitis is a relatively rare disorder and it is sometimes hard to identify the acid-fast bacilli involved or its specific pathological findings. We employed thoracoscopy to obtain diagnostic material from a 25-year-old woman with a newly-appearing mediastinal mass despite antituberculous therapy for cervical tuberculous lymphadenitis. Thoracoscopy also proved effective in the curative surgical procedure, i.e. resection of the abscess wall as far as possible, debridement of the remaining wall, irrigation, and instillation of streptomycin into the abscess and thoracic cavity. Postoperatively the patient has followed a favorable course for one year.
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Affiliation(s)
- T Suzuki
- Department of Thoracic and Cardiovascular Surgery, Showa University, Fujigaoka Hospital, Yokohama, Japan
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83
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Sasaki H, Ohta T, Sakuma H, Nishikawa T, Kataoka D, Chida M, Maeda S. [A case of mediastinal tuberculous lymphadenitis with tracheal stenosis]. Kyobu Geka 1997; 50:503-5. [PMID: 9185451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
68-year-old female was introduced our hospital for productive cough and dyspnea. Chest X ray film showed right upper mediastinal mass and tracheal stenosis. Chest CT showed mediastinal mass with calcifying lesion. ESR at 1 hour was 50 mm and CRP was 1.08 micrograms/ml. Because of progressive dyspnea, the operation was performed without further assessment. We found a mass of adhesive lymph nodes by the side of trachea. We removed it and it turned out to be tuberculous lymphadenitis. Postoperative PPD skin test showed strongly positive reaction. She has taken medication by antituberculous drugs and lives well without complications.
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Affiliation(s)
- H Sasaki
- Department of Respiratory Surgery, Oota-Nishinouchi Hospital, Koriyama, Japan
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84
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Akhtar J, Howatson AG, Raine PA. Atypical mycobacterial infection in childhood: a "surgical disease'. J R Coll Surg Edinb 1997; 42:110-1. [PMID: 9114683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Atypical mycobacterial (AMB) infection is an important cause of lymph node enlargement in children. Over the period, January 1992 to December 1993, 17 patients with lymphadenitis because of AMB infection were treated at the Royal Hospital for Sick Children in Glasgow. These case notes of the patients were reviewed. The mean age at presentation was 5.37 years (range 1.5-10.6 years). The patients had a short history (1-11 weeks) of unilateral single focus, usually cervicofacial (16/17), disease. The tuberculin skin test was not helpful in diagnosis (negative in 14/15). Primary excision was curative (11/11). Incision and drainage of an abscess or drainage with partial excision led to chronically discharging sinus in all cases (6/6). AMB were not always seen on staining (11/17) of drained or excised material and cultures were negative in eight cases. The diagnosis in the remaining patients was made on the basis of clinical features and particular histopathological patterns. We are currently assessing the use of polymerase chain reaction (PCR) techniques for making the diagnosis in non-cultured cases.
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Affiliation(s)
- J Akhtar
- Department of Paediatric Surgery and Pathology, Royal Hospital for Sick Children, Yorkhill, Glasgow, UK
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85
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Beiler HA, Eckstein TM, Roth H, Daum R. Specific and nonspecific lymphadenitis in childhood: etiology, diagnosis, and therapy. Pediatr Surg Int 1997; 12:108-12. [PMID: 9156832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Over a period of 4 years, 39 children with lymphadenitis were treated surgically; in 31 cases cervical lymph nodes were the main location. In 9 cases the lymphadenitis was caused by mycobacterial infection. Staphylococcus aureus was the most frequent causative organism of unspecific lymphadenitis (11 cases). The therapy of choice appears to be surgical treatment and medical care after operation. Especially in mycobacterial lymphadenitis, complete surgical excision of the lymph node is decisive for definitive healing. There was only 1 case of therapy-resistant, relapsing cervical lymphadenitis that needed a second operation. Causative organisms in this case were Mycobacterium avium and Mycobacterium intracellulare. All other patients showed an uneventful postoperative clinical course. We believe that a consequent diagnostic process and cooperation between the pediatric surgeon and pediatrician are necessary for effective therapy.
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Affiliation(s)
- H A Beiler
- Department of Pediatric Surgery, University of Heidelberg, Im Neuheimer Feld 110, D-69120 Heidelberg, Germany
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86
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Abstract
Four patients admitted to the Hacettepe University Department of Pediatric Surgery between 1987 and 1995, two with Bacille Calmette-Guérin (BCG) lymphadenitis and two with multisystem postvaccination tuberculosis (MPT), are presented. The hospital records and records of the Ministery of Health Tuberculosis Control Department were evaluated to determine the complications of BCG vaccine. The most common complication was lymphadenitis with or without suppuration (0.3 per thousand - 3 per thousand). Surgical intervention was required in two BCG lymphadenitis cases and two cases of MPT. Involved lymph nodes were excised in two lymphadenitis cases. Colostomy and percutaneous nephrostomy was performed in the first case of MPT in addition to triple antituberculous drug therapy. Although BCG lymphadenitis is self limited, chronically discharging nodes and tumor-like lymphadenopathy masses need to be excised. On the other hand, MPT has a silent nature with resistance to antituberculous drug therapy. Surgical intervention may be required, directed to the involved systems.
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Affiliation(s)
- I Karnak
- Department of Pediatric Surgery, Hacettepe University Faculty of Medicine, Ankara, Turkey
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87
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Makarova UE. [Duration of treatment and followup of patients operated for peripheral lymph nodes tuberculosis]. Probl Tuberk 1997:14-7. [PMID: 9235571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The paper analyzes patients with localized caseous necrotic tuberculosis of the peripheral lymph nodes, who were treated with antituberculous agents and underwent early surgical interventions. Follow-ups of the patients' status, changes in the clinical signs of the disease, hemograms, ESR, and immunological parameters revealed that the duration of the basic treatment regimen and follow-ups averaged 5 months and 4 years, respectively.
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88
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Watters DA. Surgery for tuberculosis before and after human immunodeficiency virus infection: a tropical perspective. Br J Surg 1997; 84:8-14. [PMID: 9043439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
AIM To review from a tropical perspective the presentation and management of tuberculosis and how it is affected by coexistent human immunodeficiency virus (HIV) infection. METHODS A 20-year literature review using Medline (National Library of Medicine, Washington, DC, USA) searches of the terms tuberculosis, HIV and acquired immune deficiency syndrome (AIDS) by site, body system and geographical region was undertaken. RESULTS The dual epidemic of HIV and tuberculosis now afflicts well over 4 million people. In subSaharan Africa 20-50 per cent of patients with pulmonary tuberculosis and 60-90 per cent of those with extrapulmonary tuberculosis are HIV positive. Tuberculosis presents both with generalized systemic symptoms, and with symptoms and signs according to the site of involvement. Specific sites reviewed include lymph nodes, abdomen, bones and joints, pleural and pericardial spaces, and genitourinary system. CONCLUSION All surgeons need to be aware of the manifestations of tuberculosis at different sites and the effects of HIV infection. HIV-positive patients are more likely to present with systemic illness and multiple sites of involvement, and to respond poorly to major surgery. Surgical management is generally limited to making a diagnosis or treating life-threatening complications.
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MESH Headings
- AIDS-Related Opportunistic Infections/surgery
- Humans
- Mycobacterium avium-intracellulare Infection/complications
- Mycobacterium avium-intracellulare Infection/surgery
- Peritonitis, Tuberculous/complications
- Peritonitis, Tuberculous/surgery
- Tuberculosis/complications
- Tuberculosis/surgery
- Tuberculosis, Gastrointestinal/complications
- Tuberculosis, Gastrointestinal/surgery
- Tuberculosis, Lymph Node/complications
- Tuberculosis, Lymph Node/surgery
- Tuberculosis, Osteoarticular/complications
- Tuberculosis, Osteoarticular/surgery
- Tuberculosis, Pleural/complications
- Tuberculosis, Pleural/surgery
- Tuberculosis, Urogenital/complications
- Tuberculosis, Urogenital/surgery
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89
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Abstract
The earliest images of medicine and surgery in Western art are from the late Middle Ages. Although often attractive, at that time they were illustrative and mirrored the text on how to diagnose or treat a specific condition. These drawings in medieval manuscripts represent management of abscesses, perianal infection and fistulas, amputation, and wound dressings. With the Renaissance, art in all its forms flourished, and surgeons were represented at work draining carbuncles, infected bursae, and mastoiditis; managing ulcers, scrofula, and skin infections; and performing amputations. Specific diagnosis can be made, such as streptococcal infection in the discarded leg of the miraculous transplantation performed by Saints Cosmas and Damian and in the works of Rembrandt van Rijn and Frederic Bazille. Evocations of cytokine activity are evident in works by Albrecht Dürer, Edvard Munch, and James Tissot. The iconography of society's view of a surgeon is apparent and often not complimentary. The surgeon's art is a visual art. Astute observation leads to early diagnosis and better results in surgical infection and the septic state. Learning to see what we look at enhances our appreciation of the world around us but, quite specifically, makes us better clinicians.
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Affiliation(s)
- J L Meakins
- Department of Surgery, McGill University, Montreal, Quebec
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90
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Abstract
Non-tuberculous mycobacteria are the most frequent cause of mycobacterial cervical lymphadenitis in children. Although uncommon, the incidence in recent years has shown a marked increase. Its early differentiation from tuberculous mycobacterial lymphadenitis is essential as the treatment of choice is early surgical excision rather than antituberculous chemotherapy. Three such cases are reported with emphasis on the differential diagnosis and management.
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Affiliation(s)
- M S Falworth
- Department of Maxillofacial Surgery, Bedford General Hospital, UK
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91
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Abstract
OBJECTIVE to review the clinical features and management of tuberculosis of the head and neck and to identify those features which may aid diagnosis. DESIGN retrospective study. SETTING teaching hospital, England, UK. SUBJECTS Twenty-three patients with tuberculosis of the head and neck diagnosed by culture of specimens obtained by fine needle biopsy (n = 8) or by open biopsy of the lumps in the neck (n = 15) who presented between 1990 and 1993. MAIN OUTCOME MEASURES methods of diagnosis and management. RESULTS thirteen of the 23 patients (57%) presented with either a fluctuant mass or a discharging sinus in the neck. Nine (39%) had uncomplicated enlarged lymph nodes and 12 (55%) had systemic symptoms. The supraclavicular region was the most common site (n = 11) and 8 of these 11 had abnormalities in the chest radiograph. In 3 patients the disease was resistant to treatment with standard antituberculous treatment. CONCLUSIONS atypical mycobacterial lymphadenitis is usually resistant to standard antituberculous treatment, so it is essential to obtain a microbiological diagnosis. Excision is usually the treatment of choice for such patients.
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MESH Headings
- Adolescent
- Adult
- Antitubercular Agents/therapeutic use
- Biopsy, Needle
- Child
- Child, Preschool
- Clavicle
- Cutaneous Fistula/diagnosis
- Cutaneous Fistula/microbiology
- Diagnosis, Differential
- Female
- Head
- Humans
- Lymph Nodes/microbiology
- Lymph Nodes/pathology
- Male
- Middle Aged
- Mycobacterium Infections, Nontuberculous/diagnosis
- Mycobacterium Infections, Nontuberculous/drug therapy
- Mycobacterium Infections, Nontuberculous/surgery
- Neck
- Radiography
- Retrospective Studies
- Tuberculosis, Lymph Node/diagnosis
- Tuberculosis, Lymph Node/drug therapy
- Tuberculosis, Lymph Node/pathology
- Tuberculosis, Lymph Node/surgery
- Tuberculosis, Multidrug-Resistant/diagnosis
- Tuberculosis, Multidrug-Resistant/drug therapy
- Tuberculosis, Multidrug-Resistant/surgery
- Tuberculosis, Pulmonary/diagnosis
- Tuberculosis, Pulmonary/diagnostic imaging
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Affiliation(s)
- C N Penfold
- Oral and Facial Surgery Unit, Glan Clwyd Hospital, Rhyl, UK
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92
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Iwanaga T, Nishida T, Taniguchi T, Kishikawa R, Ikdea T, Tsurutani H, Hirose T, Nishima S. [Three cases of tuberculous mediastinal lymphadenitis]. Nihon Kyobu Shikkan Gakkai Zasshi 1996; 34:621-6. [PMID: 8741525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Mediastinal lymph node involvement is uncommon in intrathoracic tuberculosis. We report three cases of this disease, each of which had a different clinical course. Chest CT scans showed preferential involvement of right paratracheal nodes, central areas of relatively low density with peripheral rim enhancement after injection of contrast medium. Specimens obtained by mediastinoscopy and fiberoptic bronchoscopy revealed acid-fast bacilli in all cases. In view of its relative frequency, tuberculous mediastinal lymphadenitis in adults must be distinguished from other causes of mediastinal masses.
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Affiliation(s)
- T Iwanaga
- Department of Pulmonary Medicine, National Minami-Fukuoka Chest Hospital, Fukuoka, Japan
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93
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Abstract
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 submandibular. 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.
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Affiliation(s)
- J E Wright
- Department of Paediatric Surgery, John Hunter Hospital, Newcastle, New South Wales, Australia
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94
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Abstract
Treatment with clarithromycin plus rifabutin in children with nontuberculous mycobacterial lymphadenitis was associated with resolution of chronic sinus formation and discharge after incomplete excision in five of five cases, and involution of the enlarged lymph nodes in two of three cases treated without surgery.
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Affiliation(s)
- C Berger
- Infectious Diseases Unit, University Children's Hospital, Zurich, Switzerland
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95
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Vítková E, Galliová J, Krepela K, Kubín M. Adverse reactions to BCG. Cent Eur J Public Health 1995; 3:138-41. [PMID: 8535371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
In the post-war period the following BCG vaccines were successively in use for preventive vaccination in the Czech territory: (a) Copenhagen BCG, 1947-1950, (b) Prague BCG 725, 1951-1980, (c) Moscow BCG, 1981-1993, and (d) Behring BCG, from 1994 onwards. These BCG substrains can be now identified by modern methods of molecular genetics. Introducing the Moscow BCG brought about an elevated incidence of iatrogenic local and regional lymph node adverse reactions compared with the previous Prague BCG product and, as a new phenomenon, bone and joint involvements in children vaccinated at birth. The aim of this study was to analyze the incidence of postvaccination adverse reactions reported in the period from 1981 to 1993 as related to the Moscow BCG vaccine and, to demonstrate the effect of lower vaccination dosage on their frequency. The concentration of the Moscow BCG varied from 11 to 22.6 x 10(6) (average 16.2) CFU per 1 mg. In the period when full dose of BCG (0.05 mg per 0.1 ml) was applied to newborns 437 local and 195 regional lymph node complications were recorded, i.e. 0.08% of vaccinated were affected, demanding antituberculosis chemotherapy in 6.5% and surgical interventions in 24%. When the lowered vaccination dose (0.025 mg per 0.1 ml) was inoculated to newborns the local adverse reactions rose paradoxically affecting 0.1% of vaccinated but the regional lymph node reactions fell considerably to reach 0.01%; the demand for chemotherapy and surgery also fell down to 3.1 and 4.8% respectively. Bone and joint adverse involvements were recorded in 28 cases, i.e. in 3.7 per 10(5) of those vaccinated with the full dose.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- E Vítková
- State Institute for Drug Control, Prague, Czech Republic
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96
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Yang S, Hao F, Zhang L. [Diagnosis and surgical treatment of tuberculous lymphadenopathy of hilar and mediastinal lymph nodes]. Zhonghua Jie He He Hu Xi Za Zhi 1995; 18:230-1, 256. [PMID: 8697518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Fifty-eight patients with hilar and mediastinal tuberculous lymphadenopathy treated with surgical operation were reported. The authors presented their preliminary experience in diagnosis, surgical technique and satisfactory outcome. The concluded that in certain situation, thoractomy is indicated for both acquiring objective, accurate diagnosis and definitive, effective treatment.
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97
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Abstract
One hundred patients with tuberculous mastitis were referred to the Tata Memorial Hospital, a cancer center, with a clinical diagnosis of malignancy. This study identifies the possible causes of misdiagnosis and reviews the management of these patients. A lump in the breast with or without ulceration was the commonest presentation, the others being diffuse nodularity and multiple sinuses. Concomitant axillary lymph nodes were found in one-third of the patients. Tuberculosis lesions such as nodular mastitis, disseminated mastitis, and sclerosing lesions clinically mimicked a fibroadenoma, carcinoma, and fibrocystic mastitis depending on the mode of presentation. A young, multiparous, lactating woman with a lesion should arouse the suspicion of tuberculous mastitis, although pretherapeutic pathologic confirmation of a benign disease is mandatory. Mammography, fine-needle aspiration cytology, and excision biopsy for this purpose are successful in 14%, 12%, and 60% of cases, respectively. Acid-fast bacilli were identified in 12% patients. All patients received antituberculous chemotherapy, and 14% patients required simple mastectomy, due to either lack of response to chemotherapy (10%) or large painful, ulcerative lesions involving the entire breast (4%). Axillary dissection was performed in only 8% patients with large ulcerated axillary nodes. All patients, followed for a minimum of 2 years, were free of disease after therapy.
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Affiliation(s)
- S R Shinde
- Department of Surgical Oncology, Tata Memorial Hospital, Parel, Bombay, India
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98
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Carvajal Balaguera J, Mallagray Casas S, Martínez Cruz R, Dancausa Monge A. [Bronchoesophageal fistula and broncholithiasis]. Arch Bronconeumol 1995; 31:184-7. [PMID: 7743065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Bronchoesophageal fistulas (BEF) in an adult, whether acquired or congenital, are uncommon but bronchoesophageal perforation secondary to broncholithiasis caused by calcified mediastinal adenopathy and leading to the formation of a fistulous tract is extremely rare. We present a case of acquired BEF in a 57-years-old women who presented cough with expectoration of broncholiths, hemoptysis and cough after swallowing liquid or solid hemoptysis and cough after swallowing liquid or solid foods. The chest film and computed tomographic scan showed calcified mediastinal adenopathy. Endoscopic examination of the esophagus revealed no mucosal abnormality. A bronchial esophageal fistula was identified at the level of the 1/3 midesophagus just below the carina in the esophagogram. The bronchoscopy showed a polypoid area located in the medial side of the right main bronchus. There was no evidence of neoplasm. The patient underwent excision of fistula and interposition of pleural bundle after completing a right posterolateral thoracotomy. The postoperative course was uneventful and the patient has been doing well on follow-up.
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Schanaider A, Madi K. Intra-abdominal tuberculosis in acquired immunodeficiency syndrome. Diagnosis and management. Int Surg 1995; 80:147-51. [PMID: 8530232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Tuberculosis (TB) in human immunodeficiency virus (HIV) immunosuppressed patients is characterized by extra-pulmonary disease in as many of 70% of them. If intestinal or lymph node involvement occurs, the differential diagnosis between an acute abdomen and other non surgical conditions may be a challenging problem. The authors analyzed eight double infected patients (TB and acquired immunodeficiency syndrome AIDS), who were admitted to the University Hospital (HUCFF) of the Federal University of Rio de Janeiro. This association should be considered when abdominal pain, anemia, fever, weight loss and abdominal lymph node enlargement are present. Bacteriology of body fluids, abdominal ultrasound (US) and computed tomography scans (CT) combined with guided needle aspiration biopsies, barium examination, colonoscopy and laparoscopy, can not only elucidate the diagnosis but also be helpful in assessing an appropriate management. Thus a systematic evaluation often yields an etiology and a correct therapeutic indication reducing the high mortality rate.
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MESH Headings
- AIDS-Related Opportunistic Infections/diagnosis
- AIDS-Related Opportunistic Infections/pathology
- AIDS-Related Opportunistic Infections/surgery
- Adult
- Biopsy, Needle
- Brazil
- Diagnostic Imaging
- Female
- HIV-1
- Humans
- Lymph Nodes/pathology
- Male
- Middle Aged
- Peritoneum/pathology
- Peritonitis, Tuberculous/diagnosis
- Peritonitis, Tuberculous/pathology
- Peritonitis, Tuberculous/surgery
- Tuberculosis, Gastrointestinal/diagnosis
- Tuberculosis, Gastrointestinal/pathology
- Tuberculosis, Gastrointestinal/surgery
- Tuberculosis, Lymph Node/diagnosis
- Tuberculosis, Lymph Node/pathology
- Tuberculosis, Lymph Node/surgery
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Affiliation(s)
- A Schanaider
- Department of Surgery and Pathology, Federal University of Rio de Janeiro, Brazil
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Abstract
Between 1985 and 1991, we treated 6 children, aged 2 months to 3 years, who required an invasive procedure for the management of complications caused by enlarged mediastinal lymph nodes secondary to tuberculosis. Radiologic and endoscopic studies revealed bronchial involvement by lymph nodes, with endobronchial granulomas and lobar or pulmonary obstruction in 4 patients and marked tracheal and esophageal stenosis produced by extrinsic compression in the remaining 2. Pathologic study of the lymph node or bronchial samples from the 6 patients disclosed granulomas with caseous necrosis and Langhans' giant cells. All the children were treated with a standard 6-month drug regimen consisting of isoniazid, rifampicin, and pyrazinamide. Five of the patients underwent thoracotomy for the purpose of nodal curettage or excision. In 1, upper right lobectomy and bronchoplasty were necessary. The sixth patient was treated by endoscopic resection of the granulomas. There was no postoperative morbidity, and radiologic and endoscopic evidence of resolution of the lesions was observed in all the patients. In our experience, surgical treatment, when performed as a coadjuvant treatment for tracheobronchial complications stemming from mediastinal tuberculous lymphadenitis, results in the resolution of the lesions and has no related morbidity.
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Affiliation(s)
- J Freixinet
- Thoracic Surgery Service, Nuestra Señora Del Pino Universitary Hospital, Las Palmas de Gran Canaria, Canary Islands, Spain
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