Analysis of cases with tuberculous peritonitis: a single-center experience.

BACKGROUND/AIMS: Tuberculous peritonitis (TP) is a rare form of tuberculosis and is caused by peritoneal involvement with Mycobacterium tuberculosis. A distinctive correlation exists between socioeconomic state and disease prevalence. We aimed to evaluate the clinical, laboratory, and radiological findings of patients with TP. MATERIALS AND METHODS: We conducted a retrospective study in patients with peritoneal tuberculosis from January 2004 to October 2008 at Yuzuncu Yil University Medical School Education and Research Hospital. During this time, the data of 21 patients (17 females) with TP were reviewed. RESULTS: Fever, abdominal pain, and anorexia were the most common symptoms. An analysis of ascites showed lymphocyte predominance and low albumin gradient in all patients. Patients with TP had a median ascites adenosine deaminase (ADA) level of 139 U/L (range, 25 to 303U/L). Peritoneal involvement (wet peritonitis) was seen in all the cases. Following 6-month administration of combined anti-TBC treatment, mean serum CA-125 levels were within the normal range among patients who had previously higher serum CA-125 level. Mortality rate in the total cases was 4.6%. CONCLUSION: Peritoneal tuberculosis should be considered in the differential diagnosis of exudative ascites in eastern Turkey. A high level of suspicion is required, especially in high-risk populations living in rural areas. ADA seems to be a sufficient, safe, and inexpensive method to perform the diagnosis of peritoneal tuberculosis. Serum CA-125 levels may play a key role to support the diagnosis as well as disease management of TP.

Extraovarian conditions mimicking ovarian cancer: a single center experience of 15 years.

OBJECTIVE: This study aims to review cases of extra-ovarian conditions that resembled ovarian malignancy and thus, to evaluate the distribution of primary pathology mimicking ovarian malignancy. METHODS: A retrospective review of women, with final pathology of extra-ovarian diseases mimicking ovarian malignancy, which were managed at Zekai Tahir Burak Women's Health Education and Research Hospital, from January 1995 to April 2010 was undertaken. RESULTS: Among the 2,210 women treated during the study period, extra-ovarian diseases accounted for 5.11% (113/2,210) of all the cases. Of the 113 extra-ovarian diseases, 42 (37.17%) were peritoneal tuberculosis, 25 (22.13%) were gastrointestinal malignancies, 20 (17.70%) were pelvic abscess, 8 (7.08%) were pelvic echinococcosis, 8 (7.08) were schwannoma and other retroperitoneal tumors, 4 (3.53%) were malignant lymphoma, 2 (1.77%) were chronic ectopic pregnancy, gossypiboma, and mesenteric cyst, respectively. CONCLUSION: Medical awareness of infectious diseases such as peritoneal tuberculosis, pelvic abscess, and pelvic echinococcosis in the differential diagnosis of ovarian malignancy is still lacking, especially in developing countries. In addition, in case of a pelvic mass, gastrointestinal and retroperitoneal tumors and malignant lymphoma should always be considered to avoid pitfalls in diagnosis and therapy.

[The level of cytokines in the ex vivo infection of murine macrophages with Mycobacterium tuberculosis complex].

To study whether the genotype of a mycobacterial strain might affect the ability of macrophages (MP) to produce the key cytokines, we determined the synthesis of interferon-gamma (IFN-gamma), tumor necrosis factor-gamma (TNF-gamma), and interleukin-6 (IL-6) in the infection of murine MP with M. tuberculosis H37Rv and M. bovis BCG, the strains that belong to the same genetic group (M. tuberculosis complex) but are opposite in virulent properties. MP infection with a virulent and attenuated M. tuberculosis complex strain was shown to differently affect the synthesis of IFN-gamma, TNFaalpha-, and IL-6. MP infection with M. tuberculosis H37Rv activated the generation of IFN-gamma and that with M. bovis BCG substantially increased the levels of TFN-alpha and IL-6. The findings suggest that this model may be used to investigate the specific features of mycobacterial strains of various genotypic clusters with eukaryotic cells.

Tuberculosis peritonitis: diagnostic value of the ascitic/blood glucose ratio.

In a study of 25 consecutive patients presenting with ascites, the use of the ascitic/blood glucose ratio in assisting in the diagnosis of tuberculous peritonitis was investigated. In all 13 patients with histologically confirmed tuberculous peritonitis the ratio was less than 0.96, and in 10 patients with non-tuberculous ascites the ratio was greater than 0.96, this difference being statistically significant (P less than 0.001). In 2 patients with probable non-tuberculous ascites but with pulmonary tuberculosis the results were excluded from statistical analysis, as they had received anti-tuberculosis therapy in addition to their other treatment. The conclusion drawn from this study is that the ascitic/blood glucose ratio is a useful test in the differentiation of tuberculous peritonitis from ascites due to other causes.