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Objective To understand the clinical features of hepatic tuberculosis. Methods The clinical manifestations, laboratory findings, treatment, and prognosis of a case of hepatic tuberculosis were analyzed. Similar cases were identified from PubMed database during the period from 2013 to 2017 using search terms "Liver/Hepatology/Hepatic Tuberculosis". The clinical data of the identified patients with hepatic tuberculosis were reviewed and analyzed. Results The 16-year-old male patient presented with cough and abdominal distension. His sputum was positive for acid-fast bacillus. CT showed low-density spaceoccupying lesions. After anti-tuberculosis treatment, the lesion disappeared. Hepatic tuberculosis was finally considered, which was caused by disseminated tuberculosis. Literature search identified 63 similar cases. In summary, the 64 cases(containing this one)included 38 males and 26 females with age from 11 months to 77 years. Tuberculosis in other site or underlying disease was found in 39 cases. The main clinical manifestations were fever(51.6％), abdominal pain(50.0％), weight loss(31.2％), loss of appetite(25.0％), tiredness/weakness(21.9％), and nausea/vomiting(20.3％). Low-density space-occupying lesions were the main features on CT image. The diagnosis was confirmed by histopathological and/or bacteriological testing in 59 patients. Five patients were diagnosed after diagnostic anti-tuberculosis treatment was effective. Overall, 36 patients were cured, 19 improved, and 3 died.Conclusions The clinical symptoms of hepatic tuberculosis are atypical. Imaging combined with histopathological examination of the liver is the preferred method for diagnosis of hepatic tuberculosis. Anti-tuberculosis treatment and timely surgical treatment is usually effective with good outcomes.
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Objective To understand the clinical features of splenic tuberculosis. Methods The clinical manifestations, laboratory tests, treatment outcomes of a case of splenic tuberculosis caused by hematogenous pulmonary tuberculosis were analyzed. Related literatures about splenic tuberculosis were also reviewed. Results The patient was a 19-year-old male. Cough, fever, night sweats, and weight loss were the main manifestations. Thoracoscopy revealed tuberculosis and imaging suggested splenic tuberculosis and tuberculosis in multiple body sites. Anti-tuberculosis treatment was effective in improving patient conditions. According to literature review, there are two types of splenic tuberculosis: primary splenic tuberculosis or as part of hematogenous pulmonary tuberculosis.The clinical manifestations of primary splenic tuberculosis are usually atypical. Immune deficiency is a significant risk factor of splenic tuberculosis. The main clinical manifestations of splenic tuberculosis are splenomegaly, fever, digestive system symptoms, and occasionally spontaneous splenic rupture (3/32). Most of the patients with splenic tuberculosis (28/32) were cured or improved by anti-tuberculosis treatment and/or splenectomy. Conclusions The onset of splenic tuberculosis is mostly insidious and clinical symptoms usually atypical. The diagnosis relies on radiographic findings, biopsy and pathological examination. Anti-tuberculosis and selective splenectomy are the effective treatment. The outcome of splenic tuberculosis is good in most patients.
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Objective To identify drug resistance status of Mycobacterium tuberculosis (MTB) strains by the GenoType MTBDRplus line-probe assay (LPA),compare its performance with traditional drug susceptibility testing (DST),and to assess its predictive value for the prognosis of patients with drug resistance tuberculosis.Methods Pulmonary tuberculosis patients who visited Zhuji People's Hospital,Zhejiang Province during February 2011 and January 2012 with a positive result of sputum smear at baseline were all recruited.A total of 275 culture positive specimens were collected,then isolated and cultured for Mycobacterium tuberculosis in the laboratory.DST were performed,meanwhile,GenoType MTBDRplus were also applied to detect resistance to isoniazid (INH) and rifampin (RMP).All the tuberculosis patients who were recruited were followed,including sputum culture and chest radiography.Results There were 192 strains showing drug resistance both by DST and MTBDRplus LPA.Fourteen multidrug resistant (MDR),21 INH mono-resistant and 2 RMP mono-resistant strains were detected by DST.As for GenoType MTBDRplus LPA,MDR,INH mono-resistant and RMP mono-resistant strains were 14,18 and 2,respectively.Taken DST as the gold standard,LPA was more accurate in the detection of resistance to RMP,while it failed to detect 23.8％ (5/21) of the INH-resistant strains.We analyzed the prognosis of patients with drug resistance by GenoType MTBDRplus LPA,the rates of treatment success were 84 ％ (110/131),9/15,3/11 in patients infected with susceptible,INH mono-resistant and MDR strains,respectively.For the 2 cases of RMP mono-resistanee,one was cured and the other failed.The predictive value of molecular drug resistance test for treatment failure in INH mono-resistant patients was 40.0 ％,while that was 83.5 ％ for treatment success in INH susceptible patients.The predictive value for treatment failure in RMP mono-resistant patients was 50.0％,while that was 81.5％ for treatment success in RMP susceptible patients.The predictive value for treatment failure in MDR patients was 72.7％,while that was 81.1％ for treatment success in patients without MDR.Conclusion The GenoType MTBDRplus LPA assay is a rapid and reliable diagnostic test for resistance of MTB,which can be used to predict the prognosis of drug resistant tuberculosis in the clinical practice.
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OBJECTIVE:To compare the cost-effectiveness and quality of survival among different therapeutic regimens for diabetic patients with sulfonylureas secondary failure(SSF).METHODS:The cost-effectiveness and the effects on patients life quality of four therapeutic schemes(group A: mixed-human insulin;group B:repaglinide and metformin;group C:repaglinide and acarbose;group D:glipizide,metfonmin and novolin N) were compared using cost-effectiveness analysis in pharmacoeconomics and DSQOL(diabetic patients’ score on quality of life).RESULTS:Group A showed the best clinical efficiency,with cost-effectiveness ratio significantly lower,physiological and psychological dimension scores significantly higher and social dimension score significantly lower than in all the other 3 groups,and all were of significant differences,but no significant differences were noted in therapeutic dimension score as compared with the other 3 groups.CONCLUSION:Insulin is optimal among four schemes in the treatment of diabetic patients with sulfonylureas secondary failure in the cost-effectiveness analysis, and it has the best efficacy in the improvement of patients’ physiology and psychology.
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Objective Through co-culture Kupffer cells with hepatocyte in vitro,to understand the influence of Kupffer cells on the growth、morphology and metabolism of hepatocyte.Methods In-situ IV collagenase two-step perfusion method to digest SD rat liver,apply low speed centrifugalization to isolate parenchymal hepatic cells and densitygradient centrifugation by percoll fluid to isolate Kupffer cells respectively.Inoculate hepatocyte cells into 6 holes culture plate to culture alone and/or co-culture with Kupffer cells in the proportion six to one,the growth,morphous of hepatocyte are observed under the light microscope and the level of albumin and glucose in the culture supernatant are detected by automatic biochemistry meter,and compare synthesis function and metabolism of hepatocytes culture alone and coculture with Kupffer cells.Results The hepatocytes of culture alone their growth and developed to normal hepatocytes morphous quickly,2 weeks later the cells death occurs,after 21 days the hepatocytes culture alone are totaly death,when hepatocytes co-culture with kupffer cells that proliferate slower than that culture alone.The hepatocites beginning to death 48 hours later, and totally death after 10 days co-culture.The culture supernatant was collected and tested the level of albumin and glucose at 24 hours intervals.In culture alone group,the albumin level is significant higher than in co-culture group at 48h、96h、120h、144h、168h(P