Tuberculosis in circulation system

Tuberculous pericarditis develops either via hematogenous or lymphangeal spread, or directly from pulmonary lesions. Tuberculous pericarditis begins with fibrin deposits, granuloma formation, and the presence of live acid-fast bacilli. A pericardial effusion, which is serous but often contains some blood with a high level of protein. Recently, PCR technology has been employed to amplify M. Tuberculosis DNA from pericardial fluid. The elevation of ADA (> 45 U/l) is supportive of the diagnosis. Tuberculous pericarditis is detected clinically either in the effusive stage by nonspecific systemic syndrome or after the development of constrictive pericarditis. The short-course treatment of tuberculous pericarditis should consist of three-drug regimen, such as INH, RFP, PZA, SM, EB. The use of prednisolone is controversial. Tuberculous myocarditis is extremely rare because of low affinity between M. Tuberculosis and myocardium. Most cases of tuberculous pericarditis are clinically silent and diagnosed at autopsy.     

Development of the diffuse endocrine system in the chicken proventriculus

The study was aimed at comparison of chemiluminescence of granulocytes during their incubation with suspensions of Pseudomonas strains isolated from various sources. The study was performed on 136 strains isolated from clinical material. The results were correlated with resistance of these bacteria to bactericidal activity of serum and their ability to produce proteolytic enzymes. It was found that strains isolated from blood and pus weakly activate granulocytes in contrary to bacteria isolated from urine and feces. Ability to pronounced activation of granulocytes was without relation to susceptibility of a given strain to action of serum. But it correlated negatively with ability to production of proteolytic enzymes. These observations indicate existence of relation between characteristics of strain and type of clinical material from which it was isolated.     

Pharmacologic management of patients with diseases of the endocrine system

Endocrine disorders are commonly seen in the general population. This article discusses the physiology, pathogenesis, and the medical and dental management of patients with thyroid, parathyroid, and pituitary gland disorders. In addition, the pharmacologic treatment, common side effects, and dental drug interactions of concern are discussed.     

Respiratory system: Part 2. Tuberculosis

AIM: The insight into the causes of late diagnosis and analysis of clinical variants of nonspecific aortic arteritis (NSAA) including rare forms--with involvement of the kidneys, intestine, lungs, heart. MATERIALS AND METHODS: Physical, laboratory and immunological tests, angiography, ultrasound dopplerography were employed in examination of 65 NSAA patients observed in 1955-1996. RESULTS: Accurate diagnosis of NSAA is made late (5 years from the first symptoms, on the average) when ischemic damage has become irreversible. The causes of such situation are outlined with special emphasis on NSAA variants running with affection of the lesser circulation vessels, coronary flow, kidneys (nephritis, amyloidosis), intestine (Crohn's disease, nonspecific ulcerative colitis). Men suffer more than women: they develop more frequently myocardial infarctions, thromboembolism. However, their arteries look better. Mechanisms of NSAA onset and progression may be related to defects in vascular endothelium, hyperproduction of antibodies to cardiolipin, antiendothelial antibodies. CONCLUSION: Management of NSAA meets with the problem of late diagnosis which means greater risk of severe vascular complications and deterioration of the prognosis.     

The effect of cervical sympathectomy on the pituitary and pineal endocrine system

It was reported previously that continuous exposure to light in male rats increased serum luteinizing hormone (LH) and bilateral cervical sympathectomy inhibited such a change. In the present report, to examine the effect of cervical sympathectomy on the pineal endocrine function, 30 male rats were assigned to five groups. The control (C) group and the light (L) group underwent sham sympathectomy as well as sham pinealectomy. The sympathectomy (S) group underwent sympathectomy and sham pinealectomy. The pinealectomy (P) group and pinealectomy-melatonine (PM) group underwent sympathectomy and pinealectomy. The C group was kept under a normal circadian rhythm for 10 days, and the other groups were kept under continuous exposure to light for the same period. The PM group received subcutaneously 10 mg.kg-1 of melatonine every day. Serum LH levels were measured 10 days following these experiments. With regard to serum LH levels, the differences among C group, L group, and S group were similar to those previously reported. It was higher in P group (2.53 +/- 0.40 ng.ml-1) than in S group (1.58 +/- 0.61 ng.ml-1), and lower in PM group (2.08 +/- 0.31 ng.ml-1) than in P group. In conclusion, it is suggested that the endocrine activity of melatonine from the pineal gland plays an important role in the appearance of the effect of cervical sympathectomy.     

Enteric nervous system and endocrine cells demonstrated in the gut in teratomas

A case of retroperitoneal teratoma, showing considerable morphological development presented as an encapsulated and pedunculated tumour with a seemingly mature intestinal loop. Markedly complex intramural nerve plexuses and numerous epithelial endocrine cells were revealed immunohistochemically in the gut tissue. Ten other mature teratomas containing gastrointestinal tissues were examined for comparison, but neither intramural ganglia nor nervous networks were found in the gut components, despite the presence of amine- and/or peptide-containing endocrine cells in all intestinal mucosa linings. Enteric endocrine cells were found to occur irrespective of the differentiation of intestinal layers or the occurrence of neural elements. These findings suggest that the epithelial endocrine cells of intestinal mucosa do not have the same origin as enteric neurons, but are rather of endodermal origin. This invertebrate well-formed teratoma, containing a highly organized enteric nervous system, suggests that teratoma and fetus in fetus are related entities distinguished by the presence of a vertebral axis.     

Tuberculosis of the breast

Tuberculosis of the breast is a rare modern disease or a forgotten diagnosis. During the last 15 years (1982-1996), 28 cases of mammary tuberculosis were reported in Japan. The initial diagnosis of almost all were carcinoma. Physical sign, mammography and USG are not so usefull for the diagnosis. It is important for the early and certain diagnosis to detect acid-fast bacilli on smear or culture and to perform pathological examination on biopsied specimen.     

Tuberculosis of the pleura

BACKGROUND: Tuberculosis is a leading cause of mortality worldwide, with a growing death rate. Pleuritis remains the most common extrapulmonary site of involvement. Epidemiologic trends have altered the presentation of disease. The advent of molecular biology has allowed new insights into disease mechanisms. In this paper, I review the salient features of pleural tuberculosis, highlighting recent epidemiologic trends and advances in diagnosis. METHODS: Literature concerning pleural tuberculosis was identified by a MEDLINE search; additional sources were identified by review of the bibliographies from these papers. RESULTS: Tuberculous pleuritis is uncommon in the United States and now more commonly reflects reactivation of old infections. Patients with coexistent tuberculosis and HIV infection have a higher rate of pleural reaction than non-HIV-infected persons. CONCLUSIONS: Closed pleural biopsy remains the diagnostic procedure of choice; newer diagnostic methods do not have favorable operating characteristics in areas of low tuberculosis incidence. Recommended anti-tuberculous therapy is identical to active pulmonary disease; corticosteroids should not be routinely given.     

Tuberculosis of the esophagus

A case of tuberculosis of the esophagus is presented in a patient with pulmonary tuberculosis. The patient, complaining of dysphagia, had esophagoscopic examination which showed a submucosal tumor with central ulceration. Tissue biopsy, under direct vision from the tumor mass, confirmed the diagnosis of tuberculosis. The patient has been asymptomatic under treatment. Both esophageal and pulmonary lesions are largely improved.     

Tuberculosis of the skull

Because tuberculosis of the skull is relatively unusual occurrence, it may not be immediately recognized. It responds readily to chemotherapy and should be suspected in disseminated tuberculosis or in any draining lesion of the skull that is sterile or fails to respond to conventional antibiotic therapy.     

Tuberculosis of the larynx

Laryngeal tuberculosis was diagnosed in two men, a 73-year-old man Dutch by birth and a 40-year-old one Turkish by birth. In the former patient it was probably primary tuberculosis, in the latter secondary (he had lung tuberculosis as well). The clinical picture was highly suggestive of laryngeal carcinoma in both patients. They both recovered with chemotherapy. Laryngeal tuberculosis may mimic laryngeal carcinoma. The diagnosis is based on Ziehl-Neelsen staining, culture and polymerase chain reaction (PCR) on Mycobacterium tuberculosis. Because laryngeal tuberculosis is highly infectious, the patient has to be nursed in isolation and people in his or her environment have to be screened. The response of laryngeal tuberculosis to chemotherapy is good.     

Tuberculosis of the breast

Twenty-one cases of mammary tuberculosis are reported and the attendant clinical and histological difficulties described. It is probable that contemporary clinicians would now make the clinical diagnosis of breast abscess or carcinoma. Furthermore, the histological features (without demonstration or culture of the organism) may be confused with those granulomatous epithelloid reactions seen in mammary duct ectasia (comedo cell mastitis, plasma cell mastitis) and in traumatic fat necrosis.     

Tuberculosis of the skin

Tuberculosis of the skin is now becoming one of the rare diseases. However, we can still see it in the patients with immunodeficiency or treated with immunosuppressants for a long time. Diagnosis of this disease is made by the characteristic clinical findings and the results of laboratory findings. This disease is divided into two types: true cutaneous tuberculosis and tuberculid. The former is produced by the proliferation of the tuberculous bacilli in the skin. Lupus vulgaris, tuberculosis verrucosa cutis, cutaneous primary tuberculosis, tuberculosis cutis orificialis and cutaneous miliary tuberculosis are included. The latter type is the skin manifestation of allergic reaction against tuberculous bacilli in the tuberculous lesions of other organs. Culture of tuberculous bacilli from the skin lesions shows usually negative. Erythema induratum Bazin, papulonecrotic tuberculid, penis tuberculid and lichen scrofulosorum are included.     

Stress, endocrine, and immune system; stress induces the onset of autoimmune diseases

Previous studies of birth certificates have not fully evaluated how accurately they identify delivery methods that have a historical component, such as repeat cesarean and vaginal birth after previous cesarean (VBAC). The authors used linked Georgia birth certificates for first and second deliveries to examine the accuracy of four reported delivery methods in the second pregnancy: vaginal (without previous cesarean), VBAC, primary cesarean, and repeat cesarean, as well as an indicator of a previous cesarean. From the immediate birth certificates, the delivery method for each of the two births was classified as vaginal (V) or cesarean section (CS), which produced possible sequences of V-V, CS-V, V-CS, and CS-CS. The delivery method for the second births to 106,049 women from 1989 through 1992 was reviewed, taking into account the historical information from the linked certificates regarding the first births. Only 42.0% of women with a CS-V sequence were correctly designated on the second birth certificate as a VBAC; 79.3% of women with a V- CS sequence were correctly designated as primary cesarean. From 1980 through 1988, birth certificates contained a check box indicating a previous cesarean (but no VBAC box). During this period, only 75.5% of 25,491 women with a previous cesarean were so designated on the birth certificate. These findings suggest that cross-sectional vital records data substantially underestimate VBAC and primary cesarean rates.     

Immunohistochemical studies of the endocrine cells within the gastro-entero-pancreatic system of Osteoglossomorpha, an ancient teleostean group

The identification and distribution of endocrine cells within the gastro-entero-pancreatic (GEP) system of five species of the Osteoglossomorpha (Osteoglossum bicirrhosum, Scleropages jardini, Pantodon buchholzi, Notopterus chitala and Gnathonemus petersii) were analyzed by immunohistochemistry. Four immunoreactive cell types were identified within the pancreatic islets (A, B, D, and F cells), using antisera directed against mammalian insulin (m-INS), somatostatins (SST-14, SST-25), and members of the pancreatic polypeptide (aPY, NPY, PYY) and glucagon (GLU, GLP) families. The B cells were located throughout the center of the islets in the five species and, in general, D cells had a similar distribution. However, immunoreactivity to anti-somatostatins varied between four of the species and G. petersii, which showed less intensely stained D cells in the islets, but greater SST immunoreactivity in both the intestinal and the stomach epithelia than in comparable epithelia of other species. For peptides of both the pancreatic polypeptide and the glucagon families, the immunoreactivity was detected at the periphery of the islets, and there was a suggestion of an interfamily colocalization of peptides in some cells. In addition, glucagon family peptides showed a scattered immunoreactivity throughout the central portion of the islets. A moderately abundant number of cells in the intestine were immunoreactive to the PP family antisera in all five species. However, immunoreactivities to GLU, GLP, SST, and m-INS antisera were variable in intestinal cells of the species. Immunoreactivity with sera raised against m-INS and PYY was also observed in the stomach of P. buchholzi. The significance of these findings is discussed in both ontogenetic and phylogenetic contexts with respect to the GEP system in actinopterygian fishes and with respect to the possibility of variable processing of prohormones in the different organs of these osteoglossomorphs.     

Tuberculosis of the tarsal conjunctiva

A woman sixty-five old presents one pronounced swelling of the eyelids at the both eyes with the appearance of the multiple chalasions. The patient at twenty-six years old presented pulmonary tuberculosis, in the present stabilized. The morphopathology exam by a fragment of tarsus and conjunctiva shows an lymphocyt inflammatory infiltration with the presence of the epithelial cells and caseation areas. At level of conjunctiva it constats the presence of tuberculum follicles that are present too at the level of Meibomius canals of excretions. The disease is considered like an allergical reaction at endotoxin of Koch bacillus, secondary by some old tubercular lesions.