Three psychobiological paths toward death: cardiovascular disease, tuberculosis, and cancer.
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Tuberculous valvular endocarditis is exceptionally rare. It is usually manifest in the context of miliary tuberculosis, and in all but one case the diagnoses have been made at necropsy. Because of its rarity there is still uncertainty as to whether true tuberculous endocarditis exists as a clinical entity. This paper describes a case of miliary tuberculosis with aortic valvulitis that resolved on antituberculous therapy.
A 71-year-old Chinese male presented as sudden death and autopsy revealed miliary tuberculosis with tuberculous myocarditis. Though miliary tuberculosis is not as common as in the past, it remains one of the possible causes of sudden cardiac death.
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Tuberculous aneurysm of the descending thoracic aorta is a rare entity. To our knowledge the present case is the sixth on record to have been successfully treated surgically. These aneurysms present the usual difficulties of surgical therapy of the thoracic aorta: spinal cord and renal circulatory protection and the choice between distant or in situ revascularization. This case is of particular interest for its evolution and its treatment: resection of the aneurysm without shunting and insertion of a graft in situ covered by a flap of omentum.
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Certain medical aspects of advanced head and neck cancer observed in 191 patients referred to a medical oncology service over a 14-year period are presented in this review. While these tumors constitute an uncommon group of advanced neoplasms, the disability and impairment associated with this disease are great. Infections, folate deficiency, and hypercalcemia are frequent complications and generally detected. The occurrence of pulmonary tuberculosis, cardiovascular and neurologic sequelae were infrequent but may be generally under-recognized. Additionally, head and neck cancer patients were found to develop second malignancies in remote sites with surprising frequency as well as demonstrating the predilection to develop second primary tumors within the same area.
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Now aneurysmectomy and graft replacement is the most popular surgical method of aortic aneurysm, but there are many opinions about surgical methods and assist circulation for emergency operation of ruptured aortic aneurysm. We experienced the case of ruptured thoracoabdominal aortic aneurysm with tuberculosis, and rescued the patient by extra-anatomic bypass (EAB). A 60-year-old woman, who had been treated with tuberculosis for about 40 years, was operated on for cold abscess of her left psoas muscle by other orthopedic surgeons. At that time, massive bleeding happened, and she was transferred to us under diagnosis of ruptured thoracoabdominal aortic aneurysm. EAB, as emergency operation, was done because we considered it was dirty and dangerous to replace the prosthesis beside the abscess. The postoperative course was almost uneventful except the evidence of Gaffky's first stage. We considered EAB was an useful method for emergency cases and some infectious aortic aneurysms.
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Mycotic aneurysm secondary to Mycobacterium tuberculosis is extremely unusual. We describe a 28-year-old female patient with tuberculosis who developed synchronous mycotic aneurysms of the abdominal aorta and the innominate artery. The pathogenesis, diagnosis, and treatment of tuberculous mycotic aneurysm is reviewed.
Three cases of tuberculosis of serous membranes (1 pleuritis, 1 pericarditis, 1 meningitis) are reported in the absence of detected superinfection, all of them characterized by a purulent effusion. Even in tuberculosis endemic zones, the purulent character of the puncture liquid of tuberculotic serositis appears to be rare or exceptional. Tuberculosis has to be systematically considered among the causes of pleuritis, pericarditis or purulent meningitis when any current investigations are negative.