Tuberculosis epidemiology in six provinces of Vietnam after the introduction of the DOTS strategy.

SETTING: Six provinces in Vietnam where the DOTS strategy was introduced in 1989. OBJECTIVE: To assess the impact of improved tuberculosis (TB) control on TB epidemiology in Vietnam. METHODS: Data from the surveillance system in the period 1990-2003 were analysed to assess trends of notification rates and the mean ages of notified cases. Data from repeated tuberculin surveys in the period 1986-2002 were estimated to assess the prevalence of TB infection, the annual risk of infection and its trend using various cut-off points in those with and without bacille Calmette-Guérin (BCG) scar. RESULTS: Age-standardised notification rates in the period 1996-2003 declined significantly, by 2.6% to 5.9% per year, in five provinces. However, in four provinces notification rates in the age group 15-24 years increased significantly, by 4.5% to 13.6% per year, during this period. The mean age of newly diagnosed patients with smear-positive TB increased up to 1995 but decreased thereafter. The annual risk of TB infection showed a significant annual decrease (4.9% per year) in one province in surveys performed between 1986 and 1997, and in two provinces (6.6% and 4.7%) in surveys conducted between 1993 and 2002. CONCLUSION: These data suggest limited impact to date of the DOTS strategy in Vietnam.

[Calcitonin treatment of metabolic bone disease induced by parenteral nutrition]. / Behandling med kalsitonin ved metabolsk beinsykdom på grunn av parenteral ernaering.

After a near total small bowel resection for an acute thrombosis of the mesenterial artery, a 61 year-old man was treated with total parenteral nutrition at home for five years. The treatment was complicated by episodes of sepsis, anaemia and uremia. After four years he developed pain in long bones and the back and grave hypercalcuria. Roentgenogram showed demineralisation. There was no hyperparathyroidism and serum phosphate and serum calcium were normal. His chronic metabolic acidosis was treated continuously with enteral acetate. He received basal amounts of vitamin D and amino acids. By administering calcitonin we were able to cure his progressive bone pains and normalize his calcium urinary output. No side effects were observed. Therefore, calcitonin may contribute to the treatment of bone disease associated with total parenteral nutrition.

[Enlarged iliopsoas bursa. A rare cause of inguinal mass]. / Forstøorret bursa iliopsoatica. Sjelden årsak til kul i lysken.

Bursa iliopsoatica is a well-defined anatomical structure lying under the corresponding muscle on the pelvis and hip joint. If it becomes large, it can be an uncommon cause of an inguinal mass with symptoms from compressed neighbour structures. An enlarged bursa can be associated with arthritis and arthrosis of the hip. We describe a patient with an inguinal tumour, with radicular pain, and discuss the diagnostic approach, pathogenesis and treatment.

Hematemesis due to fistula between aorta and esophagus and later to fistula between left common carotid artery and esophagus. Case report.

A case of massive hematemesis due to an aortoesophageal fistula is presented. The diagnosis was made intraoperatively. The patient died 39 days postoperatively of an additional, previously unidentified fistula between the left common carotid artery and the esophagus. This fistula combination does not seem to have been reported previously.

[Blood pressure observation during renal cyst decompression--case report on a benign solitary renal cyst as a cause of hypertension]. / Blutdruckverlaufsbeobachtung bei Nierenzystendekompression--Kasuistischer Beitrag zur benignen solitären Nierenzyste als Ursache der Hypertonie.

In patients with solitary renal cysts and only borderline hypertension for the exclusion of a connection a clarification by side-separated renin determination of the renal veins has been recommended (6). This investigation would finally clarify whether the affected kidney is responsible for the hypertension. However, this somewhat cumberous diagnostics is reserved for larger clinics. It is astonishing that in literature is scacely or not at all referred to the double diagnostic possibility of the puncture of the renal cyst: apart from the exclusion of malignity by cytologic investigation of the fluid and contrast representation of the cystic cavity a decrease of blood pressure after this relatively small intervention might refer to the necessity of further diagnostics. When at the same time a hypertension exists in punctures of the renal cysts one should therefore always use careful measurings of blood pressure before and after puncture, in order possibly to gain a valuable reference to a connection between the solitary renal cyst and the hypertension.