ABSTRACT
Local hepatic tuberculosis is an unusual form of extrapulmonary tuberculosis. The authors describe the case of a 39-year-old woman with this disease who posed diagnostic difficulties. She presented with abdominal pain, minimal constitutional symptoms, hepatomegaly and radiologic findings of a focal hepatic lesion. Laparotomy was required for diagnosis. A literature review revealed that most individuals with local hepatic tuberculosis have fever, night sweats and weight loss. Hepatomegaly is often the only abnormal physical sign. Minimally elevated serum bilirubin and alkaline phosphatase levels are common. Ultrasonography and computerized tomography will demonstrate a lobulated, hypoechoic liver mass. Definitive diagnosis requires demonstration of acid-fast bacilli in biopsy material obtained by percutaneous techniques or at laparotomy. Cultures of the diseased liver are usually negative. Antituberculous drug therapy appears to be the preferred method of treatment.
Subject(s)
Tuberculosis, Hepatic/diagnosis , Abdomen , Adult , Antitubercular Agents/therapeutic use , Diagnosis, Differential , Female , Humans , Laparotomy , Mycobacterium tuberculosis/isolation & purification , Pain/etiology , Tomography, X-Ray Computed , Tuberculosis, Hepatic/drug therapy , Tuberculosis, Hepatic/physiopathology , UltrasonographyABSTRACT
Adrenal hemorrhage is uncommon and usually associated with severe stress, sepsis, or anticoagulant therapy. The association of adrenal hemorrhage and acute ulcerative colitis is rare, and is probably related to exogenous therapy with ACTH. The case of a 29-year-old woman who was hospitalized with severe ulcerative colitis, treated with ACTH, and who developed bilateral adrenal hemorrhage is presented. The difficulties of diagnosis and management are discussed. A review of the relevant literature concerning the pathophysiology of adrenal hemorrhage is presented also.
Subject(s)
Adrenal Gland Diseases/chemically induced , Adrenocorticotropic Hormone/adverse effects , Colitis, Ulcerative/drug therapy , Hemorrhage/chemically induced , Adrenal Gland Diseases/pathology , Adrenocorticotropic Hormone/therapeutic use , Adult , Colitis, Ulcerative/pathology , Female , HumansABSTRACT
The effects of a beta 2-sympathomimetic (salbutamol or fenoterol) and the anticholinergic SCH 1000 administered both in combination and with placebo were compared in a double-blind random crossover design. Thirty-three patients with atopic, non-atopic and psychogenic asthma were studied. After inhalation of the sympathomimetic in combination with SCH 1000 or placebo the increase in FEV1 was significantly better for three hours (p less than 0.05) than after inhalation of SCH 1000 alone. There was no difference in the response to SCH 1000 in the atopic or non-atopic groups. However, in patients with a major psychogenic component to their asthma the FEV1 response to SCH 1000 was significantly better (p less than 0.05) than in other asthmatics from four to seven hours past inhalation. These findings suggest that SCH 1000 might be a valuable therapeutic agent in patients with psychogenic asthma.
