Diagnostic confusion between gastric carcinoma and gastric tuberculosis

Developing countries like developed ones need highly skilled medical personnel, referred to as 'specialists'. In the case of developing countries, the training of these specialists abroad is expensive to the sponsoring governments, imposes a lot of hardship on the doctors and, above all, the course-content of such training takes little or no cognizance of the environment in which these doctors would later practise. The developing countries also cannot afford the loss of years in valuable services which the training abroad entails. Attempts are now being made to train specialists wholly or partly at home, in some developing countries. The approach is still not much divorced from what obtains in Britain and North America, that is, one of being trained on the job, with the onus for self-education being placed on the prospective students. Such students in most developing countries of tropical Africa have little or no facilities for further education outside their places of work. It is proposed that purpose-designed postgraduate medical schools may provide a temporary solution to specialist training in developing countries of tropical Africa. Such schools would in addition provide highly skilled medical service as well as obviate the need and the expense for the setting up of government sponsored medical research and training institutes.     

Primary resistence of mycobacteria in tuberculosis patients

Primary mycobactria resistance especially in some countries may be a serious obstacle to a successful therapy and the number of patients carrier of primary resistant mycobacteria remains almost at the same level in spite of the chemotherapeutic treatments and the usually rapid recover of the newly diagnosed cases. This may probably be attributed to the fact that the number of chronic patients, spitting resistant tubercle bacilli has remained almost the same, because these patients are eliminated little by little. In our country there is a constant regression of the morbidity, but not so rapid as expected, The newly diagnosed patients are generally young and, if well treated, they heal quickly and well; moreover, they are usually not so richly bacillised as they used to be once and the severity of their disease, globally evaluated, appears also reduced. The cultural positivity at the first admission into hospital is also diminishing. From all the above facts it is obvious that in order to eradicate tuberculosis it is necessary: First - to avoid creatin chronic patients; in order to reach this goal the treatment must be the most effective possible from the very beginning: INH and Rifampin. Second - to try to cure the chronic patients and to render them abacillary of, at least, to treat them intensively, with the purpose of inducing in the infecting flora a polyresistance which reners the mycobacteria hypovirulent, especially if it includes a R/AMP resistance over 40-gamma. Third - the role of the primary resistance in the epidemiology and the evolution of tuberculosis in the various countries and in the single patients, may be very different.     

Primary gastric Burkitt''s lymphoma presenting with c-myc gene rearrangement

A polymerase chain reaction (PCR)-based rapid screening procedure was developed to test individual horn flies, Haematobia irritans irritans (L.), for the presence of a specific nucleotide substitution in the sodium channel gene sequence that has been associated with pyrethroid resistance. By a systematic optimization of reaction conditions and judicious choice of PCR primers differing in DNA sequence by a single nucleotide, we identified pyrethroid-susceptible or resistant sodium channel alleles in individual flies. Laboratory and field populations were examined by both the PCR assay and conventional filter paper bioassays with the pyrethroid cyhalothrin to verify that populations containing greater proportions of individuals with the resistant sodium channel allele DNA sequence also had higher bioassay LC50 values. The PCR assay for resistance alleles gave definitive information on the genotype of an individual fly and detected the presence of heterozygous individuals that might serve as reservoirs of resistance genes in field populations.     

Primary drug resistance to Mycobacterium tuberculosis in renal transplant recipients

The author describes artificial retention of the testicle caused by a technical mistake of the surgeon during surgery of an inguinal hernia or hydrocele. The author emphasizes the experience of the surgeon needed during "minor" operations in children.     

Primary giant granulomatous basal meningitis: an unusual presentation of tuberculosis

A case of granulomatous tuberculous meningitis in a 3-year-old child without any known primary disease in any other organ is presented. Tuberculous meningitis is an uncommon presentation of tuberculosis and is characterized by diffuse or circumscribed granulomatous involvement of the meninges, particularly at the base of the brain. Early diagnosis and treatment are essential to prevent the worst events it can bring and to improve the chances of survival. Diagnosis remains difficult because of the lack of reliable clinical diagnostic criteria.     

Primary gastric choriocarcinoma: case report with review of world literature

A case is herin reported of a primary gastric choriocarcinoma occurring in an elderly woman associated with very high titers of circulating chorionic gonadotropin. Unlike the majority of previously reported cases, in which adenocarcinomatous components were present, the tumor in this case was purely trophoblastic. The clinicopathologic findings of the previously reported cases are summarized, along with the various theories of histogenesis.     

Intestinal tuberculosis

Since the symptoms and clinical presentation of intestinal tuberculosis is nonspecific, the diagnosis is frequently delayed and may be achieved at autopsy only. Intestinal tuberculosis is very rare in Denmark, but may now be seen more often because of increasing numbers of immigrants from countries of the third world with a high prevalence of tuberculosis. A case of intestinal tuberculosis in a 28 year old Somalian female is reported. Methods of diagnosing intestinal tuberculosis are commented, and the frequent necessity of starting medical treatment before a bacteriological diagnosis is reached is emphasized.     

Miliary tuberculosis

Seventy-four cases of miliary tuberculosis were studied retrospectively. Most common symptoms and findings were fever (97.3%), elevated serum alkaline phosphatase (67.6%), and nodular shadows in the chest X-ray films (98.6%). The other findings were enlarged mediastinal lymph node (17.6%), lung cavities (23.0%), consolidation (35.1%), and pleural effusion (27.0%). Sputum cultures and urine cultures were positive for Mycobacterium tuberculosis in 76.8% and 58.6% respectively. Biopsies were positive for bone marrow aspiration (61.5%), lymph node biopsies (83.3%), liver biopsies (100%), and lung biopsies (100%). Though antituberculosis therapy was successful in most of the patients, seven patients died of miliary tuberculosis, of whom four developed adult respiratory distress syndrome.     

Abdominal tuberculosis

Tuberculosis has staged a global comeback and forms a dangerous combination with AIDS. The abdomen is one of the common sites of extrapulmonary involvement. Patients with abdominal tuberculosis have a wide range and spectrum of symptoms and signs; the disease is therefore a great mimic. Diagnosis, mainly radiological and supported by endoscopy, is difficult to make and laparotomy is required in a large number of patient. Management involves judicious combination of antitubercular therapy and surgery which may be required to treat complications such as intestinal obstruction and perforation. The disease, though potentially curable, carries a significant morbidity and mortality.