191/291. Surgical treatment of bronchial obstruction in primary tuberculosis in children: report of seven cases. Seven children, aged 4 months to 10 years, with bronchial compression due to tuberculous hilar lymphadenitis have been treated surgically since 1974. The indications for surgical treatment were lack of response to chemotherapy and in particular the development of respiratory distress. Excision or curettage of the affected nodes was found to be a safe and sure method of relieving the acute symptoms and preventing permanent damage to the lung. ( info) |
192/291. Surgical repair of tracheobronchial compression by tuberculous lymph nodes. We describe a patient with a tuberculous lymph node pressing on the trachea and right lobe of the bronchus who was managed with resection of the node and Dacron patch closure of a defect in the tracheobronchial tree. ( info) |
| A patient in whom a single lymph node contained Kaposi's sarcoma, tuberculosis and Hodgkin's lymphoma is reported on. Kaposi's sarcoma was also present in the skin of the legs, and serum antibody titres to cytomegalovirus were elevated. This case may represent acquired immunodeficiency syndrome in a Black South African male. ( info) |
194/291. Takayasu's arteritis: the relationship with tuberculosis. A 12-year-old girl developed Takayasu's arteritis (pulseless disease) within a month of the appearance of tuberculous cervical adenitis. This unusual form of arteritis is common in japan and korea but has rarely been reported in individuals born in the united states. The etiology is unclear. The literature currently hypothesizes an autoimmune basis and treatment with steroids. Although a tuberculin sensitization pathogenesis has been suggested, a close temporal relationship with the onset of a tuberculous process has not previously been documented. The likelihood of uncovering tuberculin sensitivity or active tuberculosis in patients with Takayasu's arteritis is substantially higher than in the general population in all countries analyzed. The natural history of this arteritis is highly variable. The adolescent described in this paper has demonstrated complete symptomatic remission as well as return of pulses simultaneous with antituberculosis therapy. ( info) |
195/291. Paradoxical expansion of intracranial tuberculomas during chemotherapy. 4 patients with tuberculosis, 3 of whom had tuberculous meningitis, were noted to have tuberculomas on computed tomographic scanning. During antituberculous chemotherapy the intracranial lesions increased in size in all 4 patients at a time when the clinical state and cerebrospinal-fluid abnormalities were improving; in 2 of the patients the regional lymph nodes also enlarged greatly. Though the expansion of the cerebral lesions caused anxiety and led to some changes in chemotherapy, the lesions eventually diminished in size. ( info) |
196/291. Tuberculous mediastinal lymphadenopathy in adults. Three cases of paratracheal and hilar lymph node enlargement without parenchymal lung lesion simulating sarcoidosis, lymphoma, and metastasis were finally proved to be tuberculous lymphadenitis. Although it is not a common manifestation of tuberculous infection in the adult, this possibility should be considered in the differential diagnosis of mediastinal lymphadenopathy, especially in non-whites. ( info) |
| A patient with histiocytic lymphoma who developed a Hickman catheter exist site infection due to mycobacterium fortuitum is described. Due to the risk of dissemination in immunosuppressed patients and the resistance to antibiotic therapy, rapid-growing mycobacteria should be considered when gram-positive bacilli are associated with infections in patients with these catheters. ( info) |
| lymphadenitis is a relatively common complication following intradermal BCG vaccination, and usually occurs 6 to 9 months after injection. However, lymphadenitis following BCG given by the scarification method is rare. We report a case of BCG lymphadenitis occurring 11 and 18 years after vaccination by the scarification method. ( info) |
199/291. Cervicofacial mycobacterial infections presenting as major salivary gland disease. mycobacterium tuberculosis and atypical mycobacterium are well-known causes of cervical lymphadenopathy, most often presenting without symptoms of systemic infection. These organisms may also directly involve the parenchyma of the major salivary glands and their periglandular or intraglandular nodes. The diagnosis of mycobacterial infections of the major salivary glands, compared to cervical lymph nodes, is equally--if not more--difficult to make. The differential must include the same spectrum of inflammatory and neoplastic diseases as well as lesions unique to the salivary glands. Selected cases are presented and discussed to show that principles established for the treatment of cervical mycobacterial infections must also be applied to major salivary gland infections. In particular, cutaneous fistulas may result from incisional biopsy or incision and drainage of the involved gland. Partial parotidectomy or submaxillary gland excision may be required, followed by multidrug, antituberculous chemotherapy for one to two years. Culturing of the organisms is extremely difficult, and the diagnosis of either mycobacterium tuberculosis or atypical mycobacterial infection must be based on a combination of history and clinical examination, skin testing, histopathology, acid-fast stains, culture, and response to surgery and antituberculous chemotherapy. ( info) |
200/291. Isolated paratracheal mass of tuberculous origin in an adult patient. A 40-year-old man presented with a solitary mediastinal (right paratracheal) mass which proved to be due to mycobacterium tuberculosis. While the incidence of tuberculosis has diminished in our countries, such unusual manifestations of tuberculosis as the present case, are still encountered. Tuberculosis, the "perfect imitator", should be included in the differential diagnosis of a mediastinal mass. Excision for therapeutic, as well as histological and bacteriological diagnostic, purposes should be supplemented by appropriate antituberculous chemotherapy. ( info) |