[A case of lymph node-pulmonary tuberculosis in 65-year-old woman].
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41 cases of intraparotid lymph node tuberculosis and 51 cases of parotid tumors were studied. The authors suggest the following points for differential diagnosis: Clinically, intraparotid lymph node tuberculosis has a rapid onset, pustulation, regional lymphade nopathy, with a history of TB or contact with tuberculosis and low-grade fever. In most cases, the nerves function normal. Sialograms show no signs of branch ducts twist and irregular stricture and dilation. The diameter of exudative contrast mass could be more than 1 cm, but it does not exudate along the ducts. The posterior margin of ascending ramus does not show deformity. Calcification of cervical lymph nodes could be seen. If the tuberculosis mass is small, it is hard to be distinguished from tumor on sialograms. The clinical features are important in the diagnosis.
Tuberculosis was spread from a 15-year-old girl, treated for pneumonia with antibiotics for months and not separated from school, with open disease to a further 77 children. A 2 1/2-year-old niece developed open perforating bronchial lymph node tuberculosis, 34 companions from school and sports developed closed active lymph node tuberculosis and 42 pupils showed suspect chest radiographs with positive tuberculin tests. All of them had to be treated. Contact investigations in more than 1000 children became necessary in 3 steps. One student with open tuberculosis was found as source for a further 5 infected persons found by contact assessments. Proper individual prophylaxis can only be assured by BCG immunisation preventing such spread (disposition prophylaxis). It should be done as extensively as possible in newborn infants and in tuberculin negative children prior to leaving school.
30 lymph nodes with tuberculous changes from slaughter animals were investigated, comparing radiometric and usual cultural methods for presence of mycobacteria. Mycobacteria were isolated with help of radiometric method (BACTEC 460-TB) from 24 lymph nodes ("sensitivity" 96%, "specificity" 83.3%), and with help of usual cultural method from 22 lymph nodes ("sensitivity" 88%, "specificity" 62.5%). The radiometric method is suitable for isolating of mycobacteria in veterinary medicine diagnostic also.
It is suggested to judge on the activity of intrathoracic lymph node tuberculosis by intoxication assessed from the levels of low- and middle-mass substances in blood plasma and red cells. 44 children were examined: 12 children infected with M.tuberculosis, 15 children with active tuberculosis of intrathoracic lymph node tuberculosis, 17 children treated for this disease by routine methods. Higher levels of the above substances were found in children with specific active process. Etiopathogenetic treatment for at least 4 months led to reduction of intoxication which, however, did not reach control concentrations.
A patient with a peripancreatic lymph node tuberculosis mimicking pancreatic pseudocyst is reported, which was diagnosed on exploration to be a tuberculous cold abscess. The patient responded to antituberculous drugs after drainage of the cold abscess.
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A case of a true mycotic aneurysm of the aortic arch secondary to mediastinal lymph node tuberculosis is presented. This was promptly recognized by aortography, treated by surgery, diagnosed by pathology, and followed by antituberculous therapy. The early diagnosis is emphasized as a prerequisite to successful treatment.
A rare case of tuberculosis of axillary lymph nodes occurring with primary breast cancer is presented. A 78-year-old woman with no history of pulmonary tuberculosis was admitted to our hospital to undergo examination for a lump in her right breast. The tumor was in the upper outer quadrant of the right breast. On palpation, the tumor was 1.2 cm in diameter and axillary lymph node swelling was noted. Mammography disclosed a spiculated mass and swelling and calcification of the axillary lymph nodes. Sonography showed an irregular hypoechoic mass in the right breast and lymph node swelling in the right axilla, indicating breast cancer with axillary lymph nodes metastases. Chest X-ray showed clustered calcifications in the right axilla and a granular shadow in the right upper lobe. Breast conserving therapy was carried out. Invasive papillotubular carcinoma of the right breast and granulomas with calcification of lymph nodes, compatible with tuberculosis, was diagnosed. Tubercle bacillis were detected by culture of lymph nodes. This case suggests that X-ray is useful for diagnosing lymph node tuberculosis. Lymph node tuberculosis should be suspected when lymph node swelling is noted and X-ray shows clustered calcifications in axillary lymph nodes.
Lymphadenitis with persisting fistualas in children is almost always conditioned by specific inflammation, tuberculosis, zoonoses, actinomycoses. Tuberculosis of the lymph nodes can either be primary or post-primary. In this case report we have dealt with a case of a rare primary lymph node tuberculosis that arose as a result of vaccination complications. Disturbance of cellular immunity was the reason for BCG lymphadenitis. In references, the reasons for BCG-itis as well as vaccination contra-indications have been described.
We report a case of keloidal basal cell carcinoma (BCC) that developed after radiation therapy. A 67-year-old Japanese man had received radiation therapy of an unknown amount for three years for the treatment of right cervical lymph node tuberculosis at the age of 7. Within the area of chronic radiation dermatitis, on the right preauricular region, he presented with a skin-colored to erythematous, firm nodule. Histopathologically, this nodule showed features of keloidal BCC. The stroma characteristically demonstrated the prominent, keloidal, thickened collagen bundles standing out against the surrounding actinic-damaged dermis, and well-circumscribed, keloidal collagen bundles that proliferated in a nodular form almost corresponding to a clinically firm, nodular lesion. There was no radiation fibrosis around the keloidal BCC. We discuss the differences between keloidal BCC and morpheiform BCC, and consider keloidal BCC to be a rare variant of BCC from a clinico- pathological basis.
A new case of hemoglobin G Georgia (alpha95 Pro yields Leu) is described in a portuguese patient with lymph node tuberculosis. The patient had a slight anaemia with haemolytic crises and moderate splenomegaly. The electrophoretic mobility of this unstable, abnormal haemoglobin was slower than that of Hb S. The percentage of the major (alpha2 G beta2) and the minor (alpha2 G delta2) abnormal components was determined by DEAE-sephadex chromatography and was 18% and 1% respectively. Structural analysis showed the replacement of a proline residue in position 95 (G) in the alpha chain by a leucine residue. This residue alpha 95 interferes with the alpha 1-bêta 2 contact. Functional studies have shown an increased oxygen affinity, a reduced hem-hem interaction and a normal Bohr effect.
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HISTORY AND CLINICAL FINDINGS: A 73-year-old woman was hospitalised because of increasing dyspnoea and hoarseness after a bout of acute tracheobronchitis. She had been receiving levothyroxine for a growing grade III nodular goitre. At the ages of 26 and 29 she had been treated for cervical lymph node tuberculosis with local excision and percutaneous radiotherapy of 8 Gy each time. On examination she was found to have a bulging neck profile and a hard, practically immobile node in the left lobe of the thyroid. INVESTIGATIONS: Laboratory tests showed a euthyroid metabolic state, while ultrasound demonstrated a mass. 40 mm in diameter, scintigraphically a cold nodule. A fine-needle biopsy was cytologically highly suspicious of neoplasm. TREATMENT AND COURSE: Surgical exploration of the neck and mediastinum revealed an insular follicular carcinoma (10 cm in diameter), involving the right recurrent laryngeal nerve and surrounding the brachiocephalic trunk. The latter had to be removed and a Gore-Tex graft was interposed. Postoperative radiotherapy was given (150 mCurie I131). CONCLUSION: An enlarging nodular goitre, occurring after a latent period of years following radiotherapy to the neck region for benign and (or) malignant disease, especially when it had been administered in childhood or young adulthood, should raise the suspicion of a radiogenic thyroid carcinoma. Definitive diagnosis by fine-needle biopsy is essential.
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