[State of the retroperitoneal lymph nodes in women with genital tuberculosis according to direct lymphography findings].
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Tuberculosis lesions were found in 193 (1.7%) of 11,322 buffaloes examined during routine post-mortem inspection at 2 export abattoirs. The prevalence of tuberculosis in buffaloes supplied from 17 separate farms ranged from 0.3% to 8.22%, with the highest levels occurring on the coastal plains. Lesions were confirmed to one major body region in 50 of 72 randomly chosen cases of tuberculosis and to 2 or more regions in 22 cases. Thoracic lesions occurred in 65 of the 72 cases, abdominal lesions in 19, head lesions in 18 and carcase lesions in 9. In the thoracic cavity, lesions occurred most frequently in mediastinal and bronchial lymph nodes. In the head region the retropharyngeal lymph node was most frequently involved, in the abdominal cavity, the liver, and in the carcase, the deep inguinal lymph node. Tuberculosis lesions in buffaloes had a lardaceous consistency and were paler in colour and less calcified than those normally exhibited by cattle. Mycobacteria were isolated from 30 to 31 lesion samples submitted for bacteriological examination. Of the isolates, 25 were identified as Mycobacterium bovis, 3 as M. avium-intracellulare-scrofulaceum complex, one as M. fortuitum and one as M. flavescens. The M. bovis isolates from buffaloes showed minor cultural differences to those normally characteristic of bovine isolates.
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Rifampin, isoniazid, and ethambutol were administered in single daily dose for nine months to 91 patients with pleural effusion and 45 patients with lymphadenitis, both of tuberculous etiology. Clinical and roentgenographic clearance of pleural effusion was successfully achieved in all cases at the end of nine months of treatment. Followup of 80 cases of pleural effusion up to nine months, in 55 cases up to one year, and up to two years in 30 cases after completion of therapy, showed no recurrence. In the cases of tuberculous lymphadenitis, resolution of lymph nodes occurred in 31 cases (68.8 percent) at the end of nine months of treatment. Therapy had to be extended for varying periods for achieving successful response, and in five cases, medical treatment had to be supplemented with surgical drainage and excision of the nodes. Short course chemotherapy can be used to treat pleural effusion, but the same mode of treatment is less effective for cases of tuberculous lymphadenitis.
Outcomes of shorter periods of treatment of patients with tuberculosis of the peripheral lymph nodes are presented. It is possible to reduce the period of treatment provided early surgical intervention is performed to remove the affected nodes. One recurring case detected after the long-term therapy. The counterindications for reduction of treatment periods of the above disease are generalization of the process and Mycobacterium resistance to tuberculostatic drugs.
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A survey of all notifications of tuberculosis in children (aged less than 15 years) in England and Wales in 1983 showed a decline of 35% in the estimated annual number of previously untreated children notified since the previous survey in 1978-9. Of the 452 children in the 1983 survey, 217 (48%) were of white, 79 (17%) of Indian, and 104 (23%) of Pakistani or Bangladeshi ethnic origin. The decline in the number of Indian children notified (46%) was much greater than that for Pakistani and Bangladeshi children (16%). In both surveys the estimated annual notification rate was much higher for the Indian and the Pakistani and Bangladeshi ethnic groups (32 and 52/100,000, respectively in 1983) than for the white group (2.4/100,000 in 1983). The mean annual decline in rate between the two surveys was 14% for the Indian, 10% for the Pakistani and Bangladeshi, and 7% for the white children. In both surveys the rates for the children of Indian subcontinent (Indian, Pakistani, and Bangladeshi) ethnic origin born in the United Kingdom were considerably lower than for those born abroad. Of the 452 children in the 1983 survey, 342 (76%) had respiratory disease (including 26 (6%) with a non-respiratory lesion as well). Less than half (134, 45%) had a pulmonary lesion at independent assessment of chest radiographs, a further 115 (38%) had only enlarged intrathoracic nodes. Only 60 (19%) of the children with respiratory disease only had a positive culture from a respiratory specimen, but the culture positivity rate in those tested was 45%. Almost two thirds of the children with non-respiratory disease had lesions of the extrathoracic nodes, nearly all cervical. There were 20 children with tuberculosis meningitis in the 12 months, including 12 (6%) of the 217 white and six (3%) of the 183 children of Indian subcontinent ethnic origin.
In young patients tuberculosis has, in this country, become a rare and well treatable disease. Hence, BCG vaccination is justified only in cases of known danger of exposure to infection of newborn tuberculin-negative subjects. General BCG vaccination is no longer warranted in the Federal Republic of Germany because of its side effects, especially loss of tuberculin diagnosis, vaccination ulcers and BCG lymph node tuberculosis.
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We report a case of a patient with sickle cell disease who presented with mesenteric nodes and pulmonary TB and who subsequently relapsed on triple therapy and presented with disseminated tuberculous osteomyelitis and cervical lymphadenopathy. We emphasize the difficulty of establishing the diagnosis at all stages of presentation.
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