RESUMO
Objective To investigate the clinical significance of the expression of lymphocytes and cytokines in patients with laryngeal tuberculosis.Methods 96 cases of laryngeal tuberculosis were selected as the research objects.Of which 42 cases of infiltrating type,31 cases of ulcer type,mass type in 23 cases,the other 50 cases of healthy persons were selected as the healthy control group,all the research objects,extracting the morning fasting venous peripheral blood for detection of T lymphocyte subsets and cytokines were detected,and the results were compared.Results Invasive laryngeal tuberculosis CD3+ index (63.10 ± 5.33) ％ (t =1.922),CD4+ (40.32 ± 5.06) ％ (t =1.758),CD8+ (24.41 ± 4.59) ％ (t =1.710),compared with the control group,CD4+,CD3+ index significantly reduced,CD8+ index increased significantly,the differences had statistical significance (t =1.922,1.758,1.710,all P ＜ 0.05),and the ulcer type and mass type results compared with invasive had significant difference(all P ＜0.05).In the analysis of laryngeal tuberculosis pathological types,reduced the mass type CD3+,CD4+ T index and CD8+ index of lymphocyte increased obviously the most significant;all laryngeal tuberculosis in patients with IL-4,IL-10 and TNF-alpha significantly increased compared with the control group,while the IFN-gamma was significantly reduced,and the mass in the type of change was the most significant,the differences had statistical significance(all P ＜ 0.05).Conclusion The use of lymphocytes and cytokines detection can improve the laryngeal tuberculosis patients with the clinical diagnosis rate,with the detection results of different degree and different pathological types of laryngeal tuberculosis patients,can be used for preliminary assessment of laryngeal tuberculosis disease and pathological type,the choice of treatment modality for patients with guidance value,with in-depth clinical study and promotion application of value.
RESUMO
La tuberculosis pulmonar es la enfermedad infecciosa que mayor número de muertes produce a nivel mundial, unidad al Síndrome de Inmunodeficiencia Adquirida y la Malaria. Se estima que un tercio de la población mundial está infectada por la Mycobacterium tuberculosis. Aunque su localización más frecuente es pulmonar, puede afectar todos los órganos y sistemas, produciendo las mayores complicaciones en los niños menores de cinco años. Presentamos un caso de tuberculosis amigdalina en un paciente de 74 años de edad, que fue atendido en el nivel primario de atención y en el Hospital General Comandante Pinares del municipio San Cristóbal, en el año 2012, por presentar dificultad respiratoria progresiva, pérdida de peso, odinofagia y crecimiento bilateral de las amígdalas palatinas. Se realizaron los estudios clínicos, imagenológicos, microbiológicos y anatomopatológicos correspondientes que confirmaron el diagnóstico, concluyendo que estamos en presencia de una tuberculosis extrapulmonar de rara localización, la que curó con el tratamiento establecido en el Programa Nacional de Control de la Tuberculosis en Cuba.
Pulmonary tuberculosis is the infectious disease having the greatest rates of death all over the world along with Acquired Immunodeficiency Virus and Malaria. It is estimated than a third part of the population al over the world is affected by Mycobacterium tuberculosis. Although lungs are more frequent affected, it can involve all the organs and systems provoking the major complications in children younger than 5 years old. A case of a 74-year old patient attending to the Primary Health Care at "Comandante Pinares" General Hospital in San Cristobal municipality presented progressive respiratory distress, loss of weight, odynophagia and bilateral growth of palatal tonsils. To determine it: clinical, imaging, microbiological and pathological studies were performed, the diagnosis confirmed the presence of extra pulmonary tuberculosis of rare location, the patient recovered from the illness with the treatment established by the National Program for the Control of Tuberculosis in Cuba.
RESUMO
A tuberculose é uma doença que esteve presente durante toda história. No século XIX o bacilo causador da doença foi descoberto e denominado bacilo de Koch. A tuberculose laríngea é uma das complicações da tuberculose pulmonar, e o sintoma mais comum é a rouquidão, decorrente ao processo cicatricial das lesões laríngeas. Sendo assim, o objetivo deste estudo foi verificar a efetividade da fonoterapia em um caso de disfonia pós-tratamento medicamentoso da tuberculose laríngea. A metodologia utilizada foi o estudo de caso do paciente J.O.B.S, 39 anos, gênero masculino, recepcionista de hotel, com jornada de oito diárias e ex-fumante, que trouxe como queixas principais rouquidão, cansaço e falta de ar durante a fala. Após as avaliações fonoaudiológica e otorrinolaringológica iniciaram-se as sessões de fonoterapia, com objetivo de diminuir a tensão à fonação, induzir o afastamento de pregas vestibulares, favorecer a mobilidade das pregas vocais, instaurar a respiração com apoio abdominal e melhorar a coordenação pneumofonoarticulatória. Após as 12 sessões previstas na metodologia desse estudo, diversos parâmetros vocais apresentaram melhoras, dentre eles a diminuição da tensão à fonação, respiração com apoio abdominal, melhoria da coordenação pneumofonoarticulatória, aumento da loudness e diminuição do ataque vocal brusco, que refletiram em uma emissão com menor esforço e mais aceita socialmente. A terapia fonoaudiológica, apesar das limitações decorrentes aos processos cicatriciais das lesões, mostrou-se importante no caso apresentado e o paciente ficou satisfeito com os resultados obtidos, os quais refletiram de forma positiva na comunicação oral e no convívio social do paciente.
Tuberculosis is a disease that has been present throughout history. In the XIX century the agent that causes the disease was discovered and named mycobacterium tuberculosis. Laryngeal tuberculosis is one of the possible complications from pulmonary tuberculosis, and the most common symptom is hoarseness, as a result of the healing process of ulcerative laryngeal lesions. The purpose of this study was to verify the effectiveness of speech-language therapy in a case of voice disorder following anti-tuberculosis drug treatment. The methodology used was the case study of the patient J.O.B.S, 39 years old, male, hotel receptionist with an eight-hour workday, former smoker, who had hoarseness, tiredness and dyspnea during speech as main complaints. Speech-language therapy sessions started after Speech-Language Pathology and otolaryngological evaluations, with the aims to reduce the laryngeal tension during phonation, induce supraglottic vocal fold separation, help the smooth movement of the vocal folds, install abdominal breathing, and improve pneumophonic coordination. After 12 sessions, several vocal parameters improved, including decrease of vocal tension during speech, use of abdominal breathing, improvement of pneumophonic coordination, loudness increase, and reduction of the abrupt vocal attack, which reflected in vocal emissions with less effort and more socially accepted. In spite of the limitations caused by the healing of the ulcerative lesions, speech-language therapy was important in this case study, and the patient was satisfied with the results obtained, which had positive influences on his oral communication and social life.