Retrospective Study about Medical and Surgical Combination Therapy for Advanced Cervical Tuberculous Lymphadenitis / 결핵및호흡기질환

BACKGROUND: In principle, cervical tuberculous lymphadenitis (CTBL) is a medical disease that may require surgical treatment, particularly in young women who complain of psychosocial and cosmetic problems. We encountered 13 cases of aggravated CTBL treated surgically despite the appropriate course of antituberculous chemotherapy. We report the clinical characteristis of these cases. METHODS: The clinical data of 13 patients with aggravated CTBL requiring surgical treatment from January 2000 to December 2006 at the Department of Chest Medicine, Internal Medicine and Plastic Surgery, National Medical Center was reviewed retrospectively. RESULTS: Twelve of the 13 cases (92%) were female. The most common age was 21~30 years (69%). Multiple nodes were palpated in 11 cases (85%). The supraclavicular lymph nodes were sites the most commonly involved (54%). The other involved sites in the order of decreasing frequency were the jugular chain, posterior cervical, submandibular and infraauricular lymph nodes. A palpable mass was the most commonsymptom. Neck pain was reported in 3 cases (23%). General symptoms such as weight loss, fatigue, anorexia and night sweats were noted in 5 cases (38%). Respiratory symptoms such as cough, sputum, hemoptysis, dyspnea and chest pain were observed in 4 cases (31%). Pulmonary tuberculosis was noted in 11 cases (85%). Other extrapulmonary tuberculosis coexisted in 4 cases (31%). This suggests that surgical CTBLs may be manifestations of a systemic disease and might be difficult to treat. Most cases (92%) were stages 2 and 3 at the initial diagnostic period but all cases fell into stage 4 and 5 when reassesed before surgery. The average duration of anti-TB chemotherapy before and after surgery was 10.2 and 15.2 months, respectively. The 13 patients were followed up until June. 2008. Among them, 2 cases had newly developed CTBL and the other 11cases showed no recurrence. CONCLUSION: In principle, CTBL is the medical disease. However, despite the appropriate course of anti-TB chemotherapy, CTBL can progress to a more advanced stages and grow rapidly to a large-sized or fistulous mass with a persistent abscess. Surgical treatment may be inevitable for patients with psychosocial and cosmetic problems caused by these masses, particularly in young women.

A Case of Tuberculous Esophagorespiratory Fistula Managed by Silicone - Covered Self - Expendable Metal Stent / 대한소화기내시경학회지

Esophagorespiratory fistulas resulting from Mycobacterium tuberculosis infection are rare. Whereas most esophagorespiratory fistulas are absolute indication for direct surgical closure, this may not be necessary in the case of those of tuberculous origin. If diagnosed early, the infection and the complicating fistula could be treated effectively with anti- tuberculous chemotherapy without the need for surgical intervention. Despite the sugges- tion of a trend away from direct surgical closure in recent years, it seems that anti tuberculous chemotherapy may not result in healing of the fistula in all patients. So we report a case of tuberculous esophagorespiratory fistula that has severe aspiration pneumorua and effectively treated with implantation of silicone-covered self-expandable metal stent and antituberculous chemotherapy.