A case of the active intestinal tuberculosis detected during the examination of the right pleural effusion

A 76-year-old female was admitted to our hospital because of fever and the right pleural effusion. On the analysis of pleural effusion, the total cell count was 6720/microliter with 95% lymphocytes, and ADA was 38.1 U/l. The culture of pleural effusion was negative, and the smear and PCR for Mycobacterium were also negative. For examinations, we performed eterography that showed cicatricial strictures of intestine. X-ray examination of the colonated colonoscopy showed ulcers (circular type), shortening of the colon, Bauhin's value insufficiency and diverticulum-like deformity. Then, she was diagnosed as intestinal tuberculosis. The smear and PCR of biopsy specimens from the lesion were positive, and antituberculotic therapy was effective. Finally, the culture of pleural effusion for Mycobacterium tuberculosis was positive after 8 weeks. We thought intestinal examination may be useful for the diagnosis of tuberculosis, when lymphocyte-rich exudative pleural effusion of unknown etiology is seen.     

Adrenocortical function in patients with active pulmonary tuberculosis

STUDY OBJECTIVE: To assess adrenal function in patients with acute pleuropulmonary tuberculosis (APT) and compare it with that function in patients with community-acquired pneumonia (CAP). PATIENTS: Over a period of 6 months all consecutive patients 18 years of age or older with newly diagnosed APT and CAP were entered into the study. MEASUREMENTS: The whole patients had the following investigations: 1) Serum Na+, K+ and glucose concentrations 2) Systolic and diastolic blood pressures. 3) An ultrasonographic study of the adrenal glands. 4) A standard ACTH stimulation test. RESULTS: There was no significative difference in the serum cortisol level between the two groups at any time of the ACTH stimulation test (basal, 30 and 60 minutes), neither when taking into account the increments between basal and 60 minutes after stimulation serum cortisol levels. All patients in both groups had normal ACTH stimulation test with a peak stimulated cortisol level at 60 minutes > 504 nmol/L. CONCLUSIONS: We did not find evidence of adrenal cortical dysfunction in patients with acute pleuropulmonary tuberculosis or with community-acquired pneumonia in our hospital.     

A case of Kartagener's syndrome associated with pulmonary tuberculosis, pneumothorax and pulmonary aspergilloma

A case of Kartagener's syndrome associated with multiple pulmonary complication was presented. A 19-year-old man was admitted to our hospital because of pulmonary tuberculosis in May 1972. He had been diagnosed as Kartagener's syndrome because of the presence of chronic parasinusitis, bronchiectasis and complete situs inversus. His chest radiographs in Dec 1972 revealed left pneumothorax. Chest radiographs in Aug 1975 appeared aspergilloma in the right middle lung field. He was administrated intravenous and oral anti-fungal agent and transbronchial installation of Amphotericin-B because of hemoptysis. Chest radiographs in July 1980 resolved the aspergilloma and his symptom were also resolved. In 1996, he had no pulmonary symptoms and respiratory failure. We consider that the Kartagener's syndrome was good prognosis with adequate pulmonary therapy.     

Carpal tunnel syndrome in childhood. A case of early onset

INTRODUCTION: The carpal tunnel syndrome (CTS) is the commonest neuropathy due to compression to be seen in adults. There are very few cases in the literature referring to patients of paediatric age, particularly those under ten years old. Most of these young patients had a metabolic disorder (mucopolysaccharidosis (MPS) or mucolipidosis (ML). In fact, as many as 90% of the MPS had CTS, sometimes subclinically. This syndrome is caused by compression of the median nerve at the level of the carpal tunnel, to which multiple factors may contribute, both local and systemic, as reviewed in this paper. The clinical findings differ from those in adults, but the appearance of suggestive symptoms and signs should make one suspect the condition and request an electromyographic study (EMG) which would be diagnostic. CLINICAL CASE: We describe the case of a five year old girl, with a clinical history suggesting the presence of a carpal tunnel syndrome for 12 months and characterized by paraesthesia and limitation of flexon-extension movements of the fingers of the affected hand, with pain on movement. The symptoms appeared on waking in the morning, gradually improved as the day advanced and became bilateral over a period of six months. The diagnosis was confirmed by EMG and MR helped to clarify the aetiology. CONCLUSION: The interesting aspect of this article is the youth of the patient, the absence of known etiological factors and the presence of tenosynovitis detected on MR as has been described in some idiopathic/familial forms.     

The spectrum of endocrine dysfunction in active pulmonary tuberculosis

OBJECTIVE: To determine the expected neonatal outcome in a hypothetical obstetric population with various screening and intrapartum management protocols for the prevention of neonatal group B streptococcal infections. METHODS: We used decision analysis to investigate the performance of various antenatal and intrapartum group B streptococcal screening protocols combined with selective or universal intrapartum antibiotic prophylaxis in preventing neonatal early-onset group B streptococcal disease. Population characteristics, screening test performance, and treatment efficacy profiles were abstracted from previous investigations. RESULTS: In the absence of screening or treatment, the estimated neonatal attack rate and mortality rate were 3.6 and 0.60 cases per 1000 neonates, respectively. Universal antenatal screening at 26-28 weeks' gestation and selective intrapartum prophylaxis (treatment of colonized women with risk factors) or nonselective prophylaxis (treatment of all colonized women) had attack rates of 1.64 and 1.08 and mortality rates of 0.21 and 0.18 cases per 1000 neonates, respectively. Rapid intrapartum screening and selective prophylaxis had an estimated attack rate of 1.92-2.58 and a mortality rate of 0.26-0.40 cases per 1000 neonates, with results dependent upon the time required to attain test results. Similarly, rapid intrapartum screening and nonselective prophylaxis had an attack rate of 1.44-2.30 and a mortality rate of 0.24-0.38 cases per 1000 neonates. Empirical prophylaxis of all women delivering prematurely, regardless of culture status, had an attack rate of 2.40 and mortality rate of 0.36 cases per 1000 neonates. CONCLUSIONS: Under ideal circumstances, antenatal group B streptococcal screening at 26-28 weeks' gestation with vaginal-rectal cultures and subsequent intrapartum prophylaxis is associated with lower projected neonatal attack and mortality rates than protocols using rapid intrapartum screening methods. However, in a non-research population, difficulties frequently encountered with antenatal screening procedures may minimize these differences.     

A case of malignant mesothelioma of the pleura and the peritoneum detected by sudden onset of back pain and pleural effusion and ascites

A case of malignant mesothelioma of the pleura and the peritoneum is reported. In April 1996, a 40-year-old men noticed sudden onset of back pain. Radiographic examinations and MRI revealed pleural effusions, ascites, ringed enhanced tumorous lesions in the right posterior diaphragm along the abdominal aorta, and marked thickening of the right diaphragm with moderate signal intensity. On thoracoscopic surgery, there were white small nodules on the intercostal parietal pleura. Tumor cells of a tubulopapillary pattern had large rounded nuclei and eosinophilic cytoplasms in a partially glandlike arrangement. Cytoplasms of tumor cells stained for alcian blue disappeared after hyaluronidase digestion. Immunohistochemical examinations showed positive staining for keratin but negative for CEA. Electron micrographs showed numerous long thin microvilli, desmosomes and intermediate tonofilaments. From these findings, malignant mesothelioma was diagnosed. The malignant mesothelioma cells of the pleura in this case were considered to disseminate the peritoneum directly through the diaphragm or its lymphatic canals. MRI and thoracoscopic surgery were useful for the demonstration of the pleural disseminations and abdominal invasions.     

The use of sputum induction for establishing a diagnosis in patients with suspected pulmonary tuberculosis in Malawi

SETTING: There has been a marked increase in notified cases of smear-negative pulmonary tuberculosis in Malawi since 1986. One reason for this may be related to the difficulties of getting adequate samples of expectorated sputum from patients. Sputum induction with nebulized hypertonic saline may be a simple way of obtaining a better specimen. OBJECTIVE: To examine the value of sputum induction for detecting cases of smear-positive tuberculosis. DESIGN: Sputum induction was performed on 82 adults presenting to the Queen Elizabeth Central Hospital, Blantyre, Malawi with clinically suspected pulmonary tuberculosis who were expectorated sputum smear-negative or unproductive of sputum. The induced sputum smear was examined for acid-fast bacilli and cultured for mycobacteria. RESULTS: Sputum was successfully induced from 73 of the 82 patients (26 previously smear-negative and 47 previously unproductive). The induced sputum was smear-positive in 18 patients (5 previously smear-negative and 13 unproductive). Cultures were positive for Mycobacterium tuberculosis in the 18 smear-positive patients and a further 12 that had been smear-negative. 94 cases of smear-positive pulmonary tuberculosis were notified during the study period. 18 (19%) were as a result of sputum induction. CONCLUSION: Sputum induction is a useful technique for improving the case detection rate of smear-positive tuberculosis in Malawi.     

Outcome of 17 patients with portal venous gas detected by CT

OBJECTIVE: Portal venous gas has historically been associated with a poor prognosis. The clinical outcomes of 17 patients with portal venous gas detected by CT were reviewed. CONCLUSION: Portal venous gas seen on CT was associated with a 71% survival rate. Patients with a history of vascular surgery or bowel obstruction may have a higher mortality, and careful clinical evaluation is mandatory in this patient population.     

A case of oophoritis detected by gallium-67-citrate scintigraphy

Intraoperative radioimmunolocalization is a potentially useful technique for staging gastric neoplasms without resorting to extensive surgical intervention. Before preoperative immunohistochemical typing for the presence or absence of tumor-associated glycoprotein (TAG) 72, we performed intraoperative radioimmunodetection on three patients presenting with gastric carcinoma using a whole monoclonal antibody (B72.3) marked with Indium-111 injected 1 week before operation. The results were calculated on the number of lymph node stations and yielded a high sensitivity due to a specificity of 72% and the absence of false negatives. Intraoperative radioimmunolocalization is a promising method for noninvasive staging of both early and advanced gastric carcinoma.     

A case of miliary tuberculosis with brain tuberculoma, following intraocular tuberculosis

A 52-year-old woman with visual loss of her left eye consulted a ophthalmology clinic. She was conducted left vitrectomy and administered corticosteroid under the diagnosis of uveitis of unknown cause. But her visual acuity was not improved. Although re-surgery was planned, pus retention was found in her left eye. After her left eye was resected, fever and general malaise appeared suddenly. Her chest X-ray film revealed diffuse micronodular opacities. Acid-fast bacilli were detected from her sputum and identified to be Mycobacterium tuberculosis. She was diagnosed miliary tuberculosis, and then antituberculous chemotherapy consisting of 4 drugs was started. Granulomatous inflammation destructing retina and numerous acid-fact bacilli were found in histologic examination of the resected eye. This case was thought to be miliary tuberculosis disseminated from intraocular tuberculosis. After 2 months of therapy, neurologic symptoms which might be caused by brain tuberucloma appeared and deteriorated rapidly. But by adding corticosteroid to antituberculous therapy, symptoms were diminished gradually.     

A case of bronchopleural fistula detected by monitoring plasma endothelin-1

Levels of endothelin (ET)-1 peptide are transiently increased after major physical stress. While studying sequential changes in plasma ET-1 levels during various types of stress, we noticed that the level of plasma ET-1 began to rise 10 days post-operatively in one patient with lung cancer who had undergone a left lower lobectomy. 35 days postoperatively a bronchopleural fistula became clinically manifest. The case is presented and the use of plasma ET-1 as an indicator is discussed.     

Cost-benefit analysis of the active screening of pulmonary tuberculosis in a recluse population entering prison

BACKGROUND: In spanish prisons, tuberculosis is a serious problem of public health and health authorities don't take it seriously. OBJECTIVE: To prove the efficiency of pulmonary tuberculosis case-finding on arrival at prison in order to get location resources in this activity. METHODS: Cost-benefit analysis of a case-finding program compared with to wait for diagnostic to illness. The sensitivity of test was fixed in 80% and the specificity in 99.99%. The cost was based on market prices. Sensitivity analysis was done in every variables as well as tridimensional analysis in those one of more influence. RESULTS: The case-finding was efficient on prevalences of tuberculosis over 5 per mil. Its efficiency was hardly affected by discount social rates or the sensitivity of diagnostic tests. The prevalence of illness, the cost of diagnostic activities as well as the success of treatment and the specificity of diagnostic tests used had as influence on the efficiency model. The tridimensional analysis proved that the case-finding of pulmonary tuberculosis has efficiency on low prevalences (1 per thousand), provided the number of people cured is a 5% higher than the alternative one and the costs of case-finding less than 1,000 pesetas per subject. CONCLUSIONS: The case-finding pulmonary tuberculosis on arrival at prisons is of high efficiency. In a cost-opportunity situation (location of available resources, penitentiary and extrapenitentiary) the program is very efficacious taking into account the fact of higher prevalence of pulmonary tuberculosis in this people.     

A case of multiple intracerebral cavernous angioma presenting with seizures at the onset

Herein we describe a patient in whom a renal mass had been detected. He had no previous urological symptoms or signs, but had undergone laryngectomy in 1989 for well-differentiated squamous cell carcinoma of the glottic region. The radiological and ultrasound evaluations disclosed a right renal mass, a mass in the ipsilateral adrenal gland and a polypoid mass in the gallbladder. The patient underwent radical nephrectomy, adrenalectomy and cholecystectomy. The surgical specimens of the gallbladder and adrenal gland showed histological evidence of clear cell carcinoma with the same characteristics as those of the primary renal tumor.     

Pneumotomy in treatment of patients with pulmonary tuberculosis complicated by aspergillosis

The ability of soil bacteria to produce amino acids (alanine, aspartic acid, leucine, arginine, glutamic acid, and lysine) was related to the ability to dissolve inorganic phosphate. With the exception of lysine, amino acid production increased with increasing ability to dissolve phosphate.