RESUMEN
OBJECTIVE: To conduct a clinical investigation of patients with multidrug-resistant (MDR) tuberculosis who received either drug therapy alone or drug therapy in combination with surgery. SUBJECTS AND METHODS: A total of 56 patients with MDR tuberculosis who were admitted to hospitals of the National Hospital Organization in the Kyushu region between January 2004 and September 2009 and received drug therapy either alone or in combination with surgery were investigated. RESULTS: As surgery could not be performed in patients with advanced age or with bilateral extensive lesions, only 12 patients (21%) were able to undergo surgery. Initial drug resistance was seen in 10 patients (23%) in the drug therapy group and four patients (33%) in the combination therapy group. Underlying diseases included diabetes in 15 patients (34%) in the drug therapy group and in 6 patients (50%) in the combination therapy group. Negative conversion of the sputum culture result was observed in 43% in the drug therapy group and in 75% in the combination therapy group. The death within three years was seen in 20 patients (45%) in the drug therapy group and 1 patient (8%) in the combination therapy group. In the drug therapy group there were more cases with resistance to 5 drugs, resistance to levofloxacin (LVFX), and/or kanamycin (KM) in those who died of tuberculosis than in non-tuberculous death cases. CONCLUSION: Resistance to 5 drugs, resistance to LVFX, and resistance to KM were contributing factors of tuberculous death. Patient's operability was one of the factors associated with a good prognosis.
Asunto(s)
Farmacorresistencia Bacteriana Múltiple , Tuberculosis Resistente a Múltiples Medicamentos , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Pacientes Internos , Masculino , Persona de Mediana Edad , Tuberculosis Resistente a Múltiples Medicamentos/tratamiento farmacológicoRESUMEN
A 77-year-old man was admitted to our hospital complaining of general fatigue. Serum sodium was 116 mEq/l and serum antidiuretic hormone (ADH) was elevated. Radiologic examination revealed nodules in the brain as well as in both adrenal glands. Based on the findings of fluorine-18 fluorodeoxyglucose positron emission tomography (FDG-PET), we had considered that the cause of the hyponatremia was syndrome of inappropriate secretion of antidiuretic hormone (SIADH) due to active extrapulmonary tuberculosis. Against our expectations, the patient's condition got worse just after he began antituberculous therapy; we finally diagnosed Addison's disease by additional hormonal tests. His condition recovered immediately with the administration of high-dose hydrocortisone, and the tuberculous lesions became smaller with antituberculous medications. Although tuberculous Addison's disease has been decreasing markedly in recent years, we have to consider the possibility of adrenal insufficiency when hyponatremia is observed in patients with active tuberculosis or those having a past history of tuberculosis.
Asunto(s)
Enfermedad de Addison/diagnóstico , Síndrome de Secreción Inadecuada de ADH/diagnóstico , Mycobacterium tuberculosis , Tuberculosis Endocrina/diagnóstico , Enfermedad de Addison/diagnóstico por imagen , Enfermedad de Addison/tratamiento farmacológico , Anciano , Antituberculosos/uso terapéutico , Encéfalo/diagnóstico por imagen , Diagnóstico Diferencial , Humanos , Hidrocortisona/uso terapéutico , Síndrome de Secreción Inadecuada de ADH/diagnóstico por imagen , Masculino , Tomografía de Emisión de Positrones , Tomografía Computarizada por Rayos X , Tuberculosis Endocrina/diagnóstico por imagen , Tuberculosis Endocrina/tratamiento farmacológicoRESUMEN
OBJECTIVE: The objective of this study was to describe the computed tomography (CT) findings of 5 adult patients with a combination of partial anomalous pulmonary venous return (PAPVR) and major bronchial anomaly. METHODS: A computerized search of the radiological database records of 4886 consecutive patients who underwent chest CT from April 2005 to May 2007 described 2 patients with a combination of PAPVR and tracheal bronchus (TB). Three additional patients with a combination of PAPVR and TB or accessory cardiac bronchus (ACB) were obtained by reviewing the CT images of the patients initially diagnosed as having PAPVR, TB, or ACB at our institution during the same period. The CT findings of these 5 patients were analyzed. RESULTS: Four patients had a combination of right PAPVR and right TB, and 1 patient had a combination of left PAPVR and ACB. These combinations were found in 42% (5/12) of patients with PAPVR, 16% (4/25) of patients with TB, and 14% (1/7) of patients with ACB. In 4 patients with a combination of right PAPVR and right TB, the anomalous vein was draining the right upper lobe and draining into either the posterior aspect of the superior vena cava (SVC) or the terminal portion of the azygos arch. The origin of the TB was the trachea in 1 patient and the carina in 2 patients. Two distinct TBs presented in 1 patient; the first TB was from the lower trachea, and the second was from the right main bronchus. The right upper lobe affected by PAPVR included the territory ventilated by the TB in all 4 patients. CONCLUSION: A combination of right PAPVR draining to the superior vena cava or azygos arch and right TB is most common. The possibility that the PAPVR and a major bronchial anomaly might coexist in 1 patient should be considered whenever either of them is encountered on CT.