ABSTRACT
Tuberculomas in the spine are estimated to be 15 to 50 times less common than those occurring in the cranium. We experienced a case of intramedullary spinal tuberculoma and brain tuberculoma associated with pulmonary tuberculosis. A 39-year-old male was referred to the National Medical Center via emergency room because of urinary difficulty and lower limb weakness for 3 days. He had been treated with anti-tuberculosis regimens against pulmonary tuberculosis for 20 days. Spinal MRI revealed intradural intramedullary tuberculoma at T5. On the 21st day at the hospital, a generalized seizure attacked him. Brain MRI revealed multiple tuberculoma in both hemispheres, brainstem and cerebellum. He was treated anti-tuberculosis regimens and corticosteroids for 9 months. His condition improved clinically and radiologically. We report this case with a review of the literature.
Subject(s)
Adult , Humans , Male , Adrenal Cortex Hormones , Brain Stem , Brain , Cerebellum , Emergency Service, Hospital , Lower Extremity , Magnetic Resonance Imaging , Seizures , Skull , Spine , Tuberculoma , Tuberculosis, PulmonaryABSTRACT
BACKGROUND: The prevalence of pulmonary tuberculosis among the elderly is increasing in Korea and in the developed countries due to the increased elderly population and their predispositions to chronic disease, poverty and decreased immunity. To define the characteristics of pulmonary tuberculosis in the elderly, we evaluated the clinical spectrum of pulmonary tuberculosis. METHODS: We analyzed 92 patients retrospectively that were diagnosed as active pulmonary tuberculosis over the age of 65. The analysis involved patient's profiles, clinical manifestations, coexisting diseases, diagnostic methods, anti-TB medications and their side effects, and treatment outcomes. RESULTS: The results were as follows:- 1) The ratio of male to female was 2.1:1(62:30 cases) 2) Chief complaints were a cough (47.8%),dyspnea(40.2%), sputum(38.0%), chest pain(12.0%), anorexia(10.9%), and fever(9.8%). 3) 38(41.3%) of cases had a past history of pulmonary tuberculosis. 4) The coexisting diseases were:-COPD, 25 cases(27.2%);pneumonia, 17 cases(18.5%);DM, 13 cases(14.1%);and malignancy, 10 cases(10.9%). 5) The positivity of Mantoux test(5 TU, PPD-S) was 82.7%. 6) Pulmonary tuberculosis was diagnosed using the following methods : sputum AFB (Acid Fast Bacillus) smear 42.4%, sputum TB(M.Tuberculosis) culture 15.2%, sputum TB PCR (Polymerase Chain Reaction) 10.9%, bronchial washing AFB smear 2.1%, chest radiology only 25.0%. 7) Locations of radiologic lesions were RULF, 50 cases;RLLF, 50 cases, mostly, then LLLF;26 cases were leastly involved. 8) The coexisting tuberculosis were endobronchial TB(8.7%), TB pleurisy(7.6%) miliary TB(5.4%), intestinal TB(2.2%), renal TB(1.1%) 9) The proportion of treatment regimen with 1st line drug and 2nd line drug were 92.3% and 7.6%, respectively. 10) The outcome of treatment were as follows:cured 31.5%, expired 13.0%, no return 47.8%, follow-up now 7.6%. CONCLUSION: The pulmonary tuberculosis in the elderly has atypical patterns with chronic coexisting diseases. Therefore, the possibility of pulmonary tuberculosis should be considered in elderly patients with pulmonary symptoms.
Subject(s)
Aged , Female , Humans , Male , Chronic Disease , Cough , Developed Countries , Follow-Up Studies , Korea , Polymerase Chain Reaction , Poverty , Prevalence , Retrospective Studies , Sputum , Thorax , Tuberculosis , Tuberculosis, PulmonaryABSTRACT
The health conditions under which the mothers and children of Korea live are not adequate. We realize that the needs in the field of MCH a re enormous, but that it is unrealistic and unwise to use the entire health budget of 4.9 million dollars to build maternity and pediatric hospitals. There must be an extensive program to reduce the number of births as well as the number of deaths if the living standrds in Korea are to improve. The success of Korea's health program is closely related to the general economic development. Without a reduction in the number of births it seems impossible that a successful economic development program can be planned, or executed. In the first five years of the program the group successfully reached by the family planning program was largely the receptive, motivated women in the older child bearing age group. A strategic platform for the success of the next five year plan would be to concentrate on the younger less motivated mothers; to educate them to better family spacing and child care. Inclusion of family planning in a comprehensive, total maternal and child care program seems a rational and effective approach. Therefore a successful national family planning program would seem to be a sound basic platform on which to base maternal and child health work as well as the economic development program in Korea. We need not repeat here the merits of family planning in Korea. A1ready the national program has accomplished much towards improving the health of Korea's mothers and children. It is hoped that in the coming decade the family planning program will go beyond the immediate aim of curbing the explosive population growth and adopt as its long-term objective promotion of total maternal and chi1d health. This objective can only be achieved by good organization, careful planning, competent staff and an adequate budget. A comprehensive maternal and child health program should include better care of children, responsible parenthood, marriage guidance, maternity care, and sterility correction all leading to better mental and physical health.