Tuberculosis en cabeza y cuello. Experiencia en la Patagonia chilena y revisión de la literatura / Tuberculosis in head and neck. Experience in Chilean Patagonia and literature review

La tuberculosis (TBC) es una de las patologías infecciosas que más muertes ha producido a nivel mundial, sobrepasando al virus de inmunodeficiencia humana (VIH). En Chile a pesar de la baja incidencia de la patología, aun no es posible llegar a su erradicación. La TBC es una enfermedad que habitualmente compromete el pulmón, sin embargo, en ocasiones compromete otros sitios del organismo, siendo la ubicación en cabeza y cuello una de las más importantes. Las manifestaciones clínicas son variadas y el curso de estas puede ser larvado, simulando otras patologías de mayor frecuencia en el ámbito otorrinolaringológico y transformando su diagnóstico en un desafío mayor. En este artículo se presentan tres casos clínicos diagnosticados y manejados en nuestra en región, además de una revisión de la literatura disponible en relación a la presentación clínica, orientación diagnóstica y tratamiento de la patología.

Tuberculosis is one of the infectious diseases which has produced more deaths around the world, even more than human immunodeficiency virus. In Chile, despite of the low incidence, there is still not possible to eradicate it. Tuberculosis is a disease which commonly compromises lungs, however, in some occasions involves another site of the organism, been the location in head and neck one of the most important. The clinical features are diverse and the natural history of those can be masked, for this reason it can simulate another more frequent disease in otolaryngology field, making the diagnosis a real challenge. In this article, we present three clinical cases diagnosed and treated in our region, besides, a review of the available literature related with the clinical presentation, diagnosis orientation and treatment of this pathology.

Clinical study of movable external fixation for elbow tuberculosis / 中国骨伤

OBJECTIVE@#To compare clinical effect of movable external fixation and fusion fixation for the treatment of elbow tuberculosis.@*METHODS@#From October 2013 to June 2019, 52 patients with elbow tuberculosis treated with standard antituberculosis therapy were divided into movable external fixation group and fusion fixation group according to treatment methods. In group A, there were 25 patients, including 11 males and 14 females, aged from 24 to 75 years old with an average of (42.81± 9.01) years old; the courses of diseases ranged from 2 to 9 months with an average of (3.96±1.45) months. In group B, there were 27 patients, including 15 males and 12 females, aged from 23 to 77 years old with an averageof (44.08±7.44) years old; the courses of diseases ranged from 2 to 7 months with an average of (3.88±1.67) months. All patients were performed focus debridement. Intraoperative blood loss, operative time were compared between two groups. VAS score before operation, 2 weeks and 12 months after operation were applied to evaluate pain relieve;Mayo elbow performance score (MEPS) before operation, 1 and 12 months after operation were used to evaluate clinical effect;changes of erythrocyte sedimentation rate (ESR) and Creactive protein, CRP) before operation, 3 weeks after antituberculosis therapy, 1 week and 6 months after operation were compared between two groups.@*RESULTS@#All patients were followed up from 12 to 20 months with an average of (13.50±4.85) months. No mixed infection and recurrence of tuberculosis occurred. There were no statistical differences in intraoperative blood loss and operative time(@*CONCLUSION@#For elbow tuberculosis, movable external fixation and fusion fixation have equal effect in operative time, amount of bleeding and control of tuberculosis infection indicator. Movable external fixation need earlier functional exercise, not conducive to pain relief at early stage, which may be better than fusion fixation, it is worth clinical promoting.

Gallbladder tubrculosis mimicking malignancy: A rare case report.

Summary: Gallbladder tuberculosis is an extremely rare disorder even in endemic region. It often mimics gallbladder malignancy as both of them share some common presentations. This entity is very rarely diagnosed pre-operatively as neither clinical features nor radiology are pathognomonic of gallbladder tuberculosis. The case reported here presented as chronic calculous cholecystitis with mass at gallbladder neck. Patient underwent laparotomy with suspicion of gallbladder carcinoma, which was eventually diagnosed as a case of gallbladder TB following histopathological examination of the resected specimen. He also had pulmonary TB in association and was completely cured with short course antitubercular chemotherapy.

Tubercular ileal perforation - atypical, acute presentation in a renal transplant recipient - a case report.

Summary: Extrapulmonary tuberculosis (TB) is more common than pulmonary TB in immuno-suppressed renal transplant recipients. Atypical presentation of TB and disseminated TB is known in transplant recipients. Usually intestinal TB presents with pain abdomen, intermittent subacute intestinal obstruction, diarrhoea and/or constitutional symptoms like fever and weight loss. Here we report a case of renal allograft recipient on regular hospital follow up, presented with acute abdomen with no previous symptoms of fever, weight loss or abdominal symptoms and was diagnosed to have tubercular ileal perforation on exploratory laporatomy and confirmed by histopathological examination. This patient succumbed to the illness due to sepsis despite timely surgery, broad spectrum antibiotics and antitubercular therapy.

Abdominal tuberculosis: varied presentations

To study various clinical presentations and outcome of management of abdominal tuberculosis. This prospective study was conducted in the Surgical Unit-1 Ghulam Mohammad Maher Medical College Hospital Sukkur and Al-Khair Hospital Sukkur, from July 2006 to June 2009. The 65 patients admitted through out patient department and emergency with abdominal catastrophes. Ages ranged between 14 to 70 years. Out of 65 patients 37 were males and 28 were females. All the patients were evaluated with history, examination and investigations. 34 patients were operated and the respected tissue sent for histopathology to conform the diagnosis of tuberculosis. Out of 65 cases of abdominal tuberculosis, 37 were male and 28 female. The mean age was 30.9 years with SD 14.19 years [range 14 to 70 years]. The mean duration of symptoms at presentation was 6 months [range 14 month to 24 months]. 34 [52.3%] out of 65 patients were admitted with different complications in which 10 [29.4%] presented with peritonitis due to gut perforation, 9 [26.5%] with sub-acute intestinal obstruction, 8 [23.5%] with abdominal mass, 5 [14.7%] with acute appendicitis and 2 [5.9%] with umbilical fistula. Surgery was performed in all these patients, Stricturoplasty done in 13 [38.3%], Ileostomy in 8 [23.5%], resection anastomosis in 5 [14.7%], Right Hemicolectomy in 5 [14.7%] and adhesionolysis and biopsy in 3 [8.8%] patients. Diagnosis in these patients was confirmed with biopsy. Morbidity and mortality in this group was 40.2% and 17.6% respectively. Early diagnosis of the abdominal tuberculosis is possible only by the specific investigations like PCR. As these are not available in the remote areas of sindh so the general surgeons in the peripheral tertiary care hospitals have to face such patients with complications. Early diagnosis of ATB can be made by. high index of clinical suspicion to symptoms of abdominal pain, weight loss, low grade fever and vague ill health of more than one month duration and refractory to conventional treatment associated with raised ESR, positive Montoux test. To above symptomatology if empirical ATT is started early many of the complications of ATB can be avoided

Spectrum of breast tuberculosis

To determine the presentation of breast tuberculosis, diagnostic methods and surgical treatments. A case series. This study was conducted at Dow University of Health Sciences and Tuberculosis Clinic at Bantwa Hospital, Kharadar, Karachi, from April 1999 to March 2007. Clinically diagnosed patients of breast tuberculosis, confirmed by laboratory work-up, were included in this study. Detailed history and examination of both breast and axillae were the primary diagnostic measures. Complete blood counts, ESR, Mantoux test, ultrasound, mammogram, fine needle aspiration cytology, staining for acid-fast bacilli both smear and culture were performed. Core biopsy for lumps more than 5 cm and wide excision biopsy for the lump less than 5 cm were the methods applied. Pre-designed research proforma was filled and descriptive statistics of age, site, side, clinical presentations, investigations were recorded and surgical treatment done. Anti-tuberculosis treatment was given to all patients. Thirty patients were studied with mean age of 28.4 years ranging from 16-48 years. Bilateral breast involvement was seen in 2 patients with 14 cases involving the right and left breast. Lymph node involvement was present in 7. Pulmonary tuberculosis was seen in 4 patients. Multifocal disease was present in 27 patients. The clinical presentation was with lump in 6, discharging sinuses in 14, cold abscess in 8, and non-healing ulcer in 2 patients. There were 5 lactating mothers. Montoux test was positive in 5, AFB smear and culture were positive in 3. Only AFB culture was positive in 4. Five patients required core biopsy for diagnosis of confirmation of lump more than 5 cm and wide excision biopsy was required in 7 patients with lump less than 5 cm. Despite antituberculous treatment, surgical management was required in 21 [70%] cases. Tuberculosis of the breast, simulating the carcinoma breast and granulomatous mastitis very closely and are difficult to be differentiated without tissue diagnosis. Surgical management is more often required

study of 86 cases of abdominal tuberculosis

The aim of this study was to evaluate the varied presentation, morbidity/ mortality and outcome of various surgical procedures done in patients with abdominal tuberculosis. Case Series. Surgical Unit III and IV Bolan Medical College Complex Hospital Quetta, from January 2005 to June 2007. All those patients who were clinically suspected to have abdominal tuberculosis, supported by investigation and gross morphological findings at surgery and histopathologically proven caseating granulomas were included in this study. A total of 86 patients were managed during the study period. The mean age of patients was 35.6 years and male to female ratio of 1:2. Primary intestinal tuberculosis was found in 78%. About 52.3% of patients had single or multiple strictures involving the distal ileum and ileocaecal region. 27.9% of patient had mass in the ileocaecal region. Perforation was recorded in 19.8% cases. Mortality was 2.3%. Major postoperative complications occurred in 13.9% of patients. All patients were prescribed anti tuberculosis drugs for a period of 12 months. The median follow up was 6 month. 82.5% of patients were doing well till the last visit. Patients who present with bowel obstruction especially sub acute or chronic, should have a complete workup to prove or rule out intestinal tuberculosis. In the presence of bowel perforation with faecal peritonitis and intra-abdominal sepsis, ileostomy is a safer procedure than primary anastomosis

History of thoracic surgery in Iran

The field of thoracic surgery is a postgraduate sub-specialty of general surgery and has developed considerably in Iran during the recent decades. Nowadays, thoracic surgery procedures are performed by specialists who have been trained specifically in this field and the quality of care given is in line with international standards. This paper addresses the history of thoracic surgery in Iran. Data were collected through interview of professors, review of archives and personal albums and data present in the council of medical education. Almost 80 years ago, general surgeons used to perform thoracic surgical procedures. But closed-circuit anesthesia was not prevalent in Iran until 1940 and there was no training available in the country for thoracic surgeons. Antibiotics were not available and surgeons were not acquainted with new methods to evacuate the pleural space [chest tube and under water seal drainage]. The only procedures performed were limited to management of emergencies, trauma and abscess drainage. Surgical intervention for treatment of tuberculosis in some patients was one of the factors responsible for development of this field of surgery. General surgeons trained abroad that came back to Iran were familiar with the principles of thoracic surgery and would perform it. In some army medical centers and some centers affiliated to foreign countries, thoracic surgeries were performed by Iranian or foreign physicians. Professor Yahya Adl used to perform thoracic surgeries and taught it to his residents. In 1951, Dr. Sadegh Ghazi and shortly after, Dr. Anwar Shakki started operations in Bou-Ali and Abo-Hossein Hospitals at the request of the TB charity foundation. They were the pioneers who started to perform TB, lung and thoracic surgeries. They were educated in France. The period of 1951-1961 can be considered as the initiation period of thoracic surgery as a subspecialty in Iran. Afterwards, this field was extended to the Masih Daneshvari, Sorkheh Hesar and army medical centers. In early 1950, cardiac and vascular surgeon graduates from the USA and other countries who had returned home established the field of thoracic surgery at Tehran University and other universities. Thus, official training in this field was started. In 1984, thoracic surgery became a postgraduate sub- specialty field approved by the medical education council. Thus far, over 80 physicians have graduated in this field most of which are working in academic fields throughout the country. Tehran, Shaheed Beheshti and Tabriz Universities of Medical Sciences have departments approved for training thoracic surgery fellows. In many universities and several medical centers, trained surgeons have established thoracic surgery wards and are working in this field

Tuberculose da parede torácica: relato de caso / Tuberculosis of thoracic wall: case report

Relatamos um caso de tuberculose da parede torácica em um paciente do sexo feminino, de três anos de idade, apresentando ao exame clínico massa na parede anterior do tórax, em projeção do terço superior do esterno. A radiografia do tórax não demonstrou anormalidades. Ao ultra-som o aspecto era predominantemente sólido, e na tomografia computadorizada apresentava-se como massa heterogênea associada a destruição óssea e cartilagínea, com realce após a injeção do contraste endovenoso, sem sinais de acometimento do parênquima pulmonar. A biópsia da lesão evidenciou processo inflamatório crônico granulomatoso do tipo tuberculóide, com extensas áreas de necrose caseosa. A pesquisa de bacilo álcool-ácido resistente (BAAR) no material foi positiva.

Costo-transversectomy for tuberculous spondylitis

Thirteen cases of tuberculosis of the dorsal spine with paravertebral abscess and weakness of both lower limbs were treated between July 1993 to July 1995. Eight cases were male [62%] and five female [38%]. Age ranged from 11 years to 65 years. Costotransversectomy was selected as the spinal decompression procedure. Ninety two percent of the patients improved and were able to walk within three to nine months of surgery

La chirurgie de la tuberculose pulmonaire aux Cliniques Universitaires de Kinshasa : etude de 322 cas

La revue de 322 cas de tuberculose pulmonaire operes dans leur service permet aux auteurs de relever les 3 types de lesions qui ont fait indiquer les gestes chirugicaux a savoir les lesions pleurales (17 pour cent); bronchiques (8 pour cent) et parenchymateuses (75 pour cent). Allies au traitement medical; les actes chirurgicaux des plus simples (drainage pleural p.e.) aux plus mutilantes exereses parenhymateuses ont abouti a de nombreuses guerisons avec un taux de mortalite de 7 pour cent. L'association de plus en plus frequente entre le SIDA et la tuberculose pulmonaire souleve des problemes ethiques qui pesent sur la decision chirurgicale

Tuberculosis abdominal / Abdominal tuberculosis

The authors studied the symptoms, signs and diagnostic procedures in 9 cases of abdominal tuberculosis, six in women, three in men, 17 to 84 and average of 43 years old, who were treated in the Social Security Arnulfo Arias Madrid Hospital Complex in Panama City. In 8 cases the diagnosis was confirmed by biopsy with laparotomy, in 5 with laparoscopy in 1 case because by concomitant lung tuberculosis and improvement with antituberculosis drugs. They present the clinical histories of 2 patients in order to discuss the presenting complaints in abdominal tuberculosis, review the pathology and arouse interest in the study of this entity precisely now that since the initiation of the AIDS epidemic in Panama in 1984 until July 1992 there have been a total of 369 confirmed cases of which 18% had tuberculosis as the first or second opportunistic infection

La toracoplastia / Thoracoplasty

La toracoplastia disenada por Sehede, es la reseccion parcial o total de la pared toracica, usada para el tratamiento de secuelas de tuberculosis pleuropulmonar, reduccion de cavidades residuales, o exceresis de neoplasias de pulmon con invasion a pared o tumores de pared toracica. Las indicaciones pueden ser pulmonares, pleurales o en cavidades residuales postoperatorias. En nuestra casuistica, fueron sometidos a toracoplastia 5 pacientes de sexo masculino por secuelas sangrantes de tuberculosis pulmonar y supurativas pleurales; se hizo reseccion entre 3 o 4 costillas. Los resultados fueron satisfactorios en tres pacientes y fracasaron en dos. Esto nos hace ver que a pesar de lo antiguo del procedimiento en la actualidad aun podemos contar con el para los casos de secuelas bacilares sin condiciones de reseccion pulmonar.

Tuberculose ano-retal / Anorectal tuberculosis

Foram estudados 8 pacientes com tuberculose ano-retal, avaliando-se o quadro clinico, criterio de diagnostico, frequencia da tuberculose pulmonar associada, tipo macroscopico da lesao e tratamento clinico e cirurgico. Houve predominio do sexo masculino (3:1), e a idade esteve acima dos 38 anos na maioria dos pacientes com tuberculose anal, e foi de 33 e 38 anos na tuberculose retal. A dor ao evacuar foi o sintoma mais frequente na forma anal, e dor abdominal, nauseas, vomitos e emagrecimento predominaram na forma retal. Realizamos pesquisa BAAR no escarro (50 por cento), biopsia da lesao ano-retal (25 por cento), histopatologia do trajeto fistuloso ressecado (50 por cento), transito delgado (37,5 por cento), enema opaco (50 por cento), Mantoux (100 por cento), e raio X simples de torax (100 por cento), como criterios de diagnostico. A associacao com tuberculose pulmonar estava presente em 62,5 por cento dos casos. O exame microscopico, revelou 1 caso de tuberculose retal ulcerativa, e outro de ulcero-hiperplastica. Todos os casos de tuberculose anal foram do tipo ulcerativo. A cura foi observada em 100 por cento dos casos com o tratamento especifico. O tratamento cirurgico foi realizado em 4 pacientes, portadores de fistula anal.

Surgical abdominal tuberculosis in Nigerians: a series of 17

Seventeen cases of abdominal tuberculosis were seen over a period of thirteen years in the surgical units of the University of Benin Teaching Hospital. There were 9 males and 8 females and their ages ranged from 15 to 60 years with a median age of 38.9 years. There were 7 cases of tuberculous mesentric lymphadenitis; 3 of gastric tuberculosis; 2 each of tuberculous peritonitis and ileo-ccaecal tuberculosis fistula-in-ano. The common presenting clinical faetures were abdominal pain; fever; vomiting; weight loss; abdominal distension and abdominal mass which were not always diagnostic. Laparotomy was mostly used to obtain tissues for diagnosis in which there was histological confirmation of tuberculosis in all 17 cases and positive bacterial examination in only 5 patients. [abstract terminated]

TBC genitourinaria: 10 años de experiencia / Genitourinary tuberculosis: review over 10 years

Entre 1979 y 1989 hemos tratado a 129 pacientes portadores de TBC génitourinaria, con 3 esquemas de quimioterapia acortada, con duración aproximada de 7-8 meses cada uno. Todos incluyen RMP, HIN, SM y PZ. Lográndose un 98% de éxito bacteriológico. El tiempo de seguimiento promedio fue de 3 años con un rango entre 3 meses y 6 años, 27 pacientes necesitaron algún tipo de cirugía: en 13 con fines diagnósticos antes del tratamiento y en 14 durante o luego de finalizada la quimioterapia; en 8 de ellos fue de tipo reparadora o conservadora y en 6 fue resectiva. En general los efectos adversos de la quimioterapia fueron menores, siendo los más frecuentes alergia a alguno de los fármacos, gastritis y ototoxicidad. Concluímos que con la quimioterapia acortada se pueden obtener buenos resultados, en tuberculosis génitourinaria, similares a los obtenidos previamente utilizando la quimioterapia clásica

Otite média tuberculosa: aspectos diagnósticos; relato de um caso / Tuberculous otitis media: diagnostics aproaches; a case report

O presente artigo tem como objetivo relatar as dificuldades diagnósticas frente a um caso de otite média tuberculosa ressaltando a importância do estudo anátomo-patológico, e a necessidade de se estar atento em todos os casos de otite supurativa que evoluem de maneira incomum