Proximal Descending Thoracic Aortic Pseudoaneurysm Secondary to Pott's Spine

Tuberculous pseudoaneurysm of the descending thoracic aorta is quite rare, life-threatening, and fatal if not diagnosed in time. This lesion exposes patients to a very high risk of unpredictable rupture. We describe a case of tuberculous pseudoaneurysm of the aorta in association with tuberculosis of the spine (Pott's spine). A 73-year-old man presented with a 2-month history of back pain. Chest roentgenography and contrast-enhanced computed tomography showed a descending thoracic aortic pseudoaneurysm with destruction of the fourth and fifth thoracic vertebrae (T4-T5). We suspected that the pseudoaneurysm was due to direct extension of tuberculous vertebral osteomyelitis. The patient was managed with antituberculous chemotherapy. The post–antitubercular therapy course was uneventful and he remained well 12 months after completion of treatment.

Laryngeal Tuberculosis in a Child (A Case Report)

Since the advent of effective antituberculous chemotherapy, laryngeal tuberculosis has become relatively uncommon, and there is a real possibility that the diagnosis may be delayed or overlooked. Data from the ENT outpatient clinic Dr. Soetomo Hospital showed a significant decrease in the prevalence of laryngeal tuberculosis, from 4. 72 o/oo in 1980 to 0.28 o/oo in 1986. This condition is usually found in adult males who have pulmonary tuberculosis. A girl with laryngeal tuberculosis is the objective of the present report. The patient was admitted with a history of chronic hoarseness. With a presumptive diagnosis of papilloma of the larynx, some biopsies were performed. The histopathologic exmamintaions suggested laryngeal tuberculosis. Additional examinations revealed a positive tubercullin test, diffuse infiltrates on both lungs and positive acid fast bacilli. Her condition improved after chemotherapy administration.

Frequency and nature of complications after lung resections for tuberculosis in HIV-infected patients

The objectiveof this work was to study the frequency and nature of complications after lung resections for tuberculosis in HIV-infected patients.Material and methods. Retrospective and prospective analysis of complications after lung resections for tuberculosis in 80 HIV-infected and 117 HIV-negative patients was carried out. Developed complications are divided into nonspecific and specific complications, according to the modified Russian classification of postoperative complications on the basis of Accordion classification.Results. It was noted that among the operated HIV-infected patients, XDR-TB (extensive drug-resistant tuberculosis) and clinically significant concomitant diseases were more common. Differences in the frequency of intraoperative complications in groups have not been established. Postoperative complications were mostly disposable, the frequency of deaths in the main group did not differ from that in the comparison group.Conclusion.Surgical treatment of pulmonary tuberculosis in HIV-infected patients is reasonable and justified, in general for patients with pulmonary tuberculosis, with adequate antituberculous chemotherapy and antiretroviral therapy.

IMPACT OF TUBERCULOSIS AND ANTITUBERCULOUS CHEMOTHERAPY ON LIPID COMPOSITION OF THE BLOOD PLASMA

Tuberculosis is an infectious disease caused by tuberculosis mycobacteria of human or bovine types and is characterized by multiple organs failure and chronic recurrent course. The blood plasma lipid spectrum state is one of the antituberculous chemotherapy toxic effect markers. The important role of the ratio of various fractions of general and blood phospholipids for the evaluation of the state of the organism in infectious pathology is proved. The purpose of this work is to study the features of the lipid spectrum of blood plasma in patients with pulmonary tuberculosis prior to treatment and at the end of the intensive phase of antituberculous chemotherapy. Three hundred and eight young and middle-aged patients with pulmonary tuberculosis were examined. The lipid and phospholipid spectrum of blood was determined prior to initiating the antituberculous chemotherapy and after the end of the intensive phase. The absolute content of general lipids and total phospholipids of blood plasma, as well as all their fractions, in patients with pulmonary tuberculosis were higher than in healthy volunteers. In this regard, the representation of the lipid spectrum in absolute units does not reflect all the features of lipid metabolism disruption, which is primarily manifested in the plasma lipids main classes ratio violation. It is shown that the spectrum of lipid and phospholipid composition of blood plasma in patients with pulmonary tuberculosis differs significantly from the spectrum in healthy people. Antituberculous chemotherapy with bactericidal and bacteriostatic action comes with normalization of a number of lipid metabolism indicators such as free fatty acids, triglycerides, cholesterol esters and phosphatidylserine. However, such indicators as total phospholipids, free cholesterol and lysophospholipids show negative dynamics, which is probably caused by the antituberculous drug’s effect.

IMPACT OF TUBERCULOSIS AND ANTITUBERCULOUS CHEMOTHERAPY ON LIPID COMPOSITION OF THE BLOOD PLASMA

Tuberculosis is an infectious disease caused by tuberculosis mycobacteria of human or bovine types and is characterized by multiple organs failure and chronic recurrent course. The blood plasma lipid spectrum state is one of the antituberculous chemotherapy toxic effect markers. The important role of the ratio of various fractions of general and blood phospholipids for the evaluation of the state of the organism in infectious pathology is proved. The purpose of this work is to study the features of the lipid spectrum of blood plasma in patients with pulmonary tuberculosis prior to treatment and at the end of the intensive phase of antituberculous chemotherapy. Three hundred and eight young and middle-aged patients with pulmonary tuberculosis were examined. The lipid and phospholipid spectrum of blood was determined prior to initiating the antituberculous chemotherapy and after the end of the intensive phase. The absolute content of general lipids and total phospholipids of blood plasma, as well as all their fractions, in patients with pulmonary tuberculosis were higher than in healthy volunteers. In this regard, the representation of the lipid spectrum in absolute units does not reflect all the features of lipid metabolism disruption, which is primarily manifested in the plasma lipids main classes ratio violation. It is shown that the spectrum of lipid and phospholipid composition of blood plasma in patients with pulmonary tuberculosis differs significantly from the spectrum in healthy people. Antituberculous chemotherapy with bactericidal and bacteriostatic action comes with normalization of a number of lipid metabolism indicators such as free fatty acids, triglycerides, cholesterol esters and phosphatidylserine. However, such indicators as total phospholipids, free cholesterol and lysophospholipids show negative dynamics, which is probably caused by the antituberculous drug’s effect.

Paradoxical Tuberculomas Complicating Tuberculous Meningitis: About Two Cases

Paradoxical tuberculomas in patients with tuberculous meningitis during antituberculous chemotherapy is an unusual phenomenon. This reaction is due to the immune response of the host to antituberculous drugs. It is commonly seen in the intensive phase of chemotherapy. We report the cases of two patients with tuberculous meningitis who had developed tuberculomas during adequate and appropriate antitubercular therapy. Tuberculous meningitis requires the regular clinical and radiological follow-up to detect paradoxical response.

Pleural tuberculosis

Pleural effusions in tuberculosis are commonly seen in young adults as an immunological phenomenon occurring soon after primary infection. However, the epidemiology and demographics of tuberculous pleurisy are changing due to the impact of HIV co-infection and the increasing number of pleural effusions seen as part of re-activation disease. Pleural biopsy for histology and culture is the mainstay of diagnosis with closed needle biopsy adequate in the majority of cases. Techniques such as PCR of biopsy specimens and the role of pleural fluid ADA are still being evaluated as a diagnostic aid. Tuberculous empyema is less commonly seen in the western world and the diagnostic yield from pleural fluid here is greater than in “primary” effusions. Treatment with appropriate antituberculous chemotherapy is generally successful though there is currently insufficient evidence to recommend the routine use of corticosteroids in this condition.

TUBERCULOUS KYPHOSIS — EVOLVING CONCEPTS IN PREVENTION AND TREATMENT

In spinal tuberculosis, children bone is easily destroyed, and as a result spinal deformity complicates in higher rates in comparison with the adult tuberculous spine. However, the pediatric spine with tuberculosis is more flexible than those of the adult-spine, because spontaneous intercorporal fusion of the diseased segments in children never occur. Thus, prevention and/or correction of the tuberculous kyphosis is easier than those of the adults. Also in particular by posterior tethering instrumentation surgery the formed kyphosis can be corrected gradually during growth period. The key message is that in pediatric spinal tuberculosis, spontaneous intercorporal fusion of the diseased segment hardly takes place even under the posterior instrument-aided stabilization and the coverage of antituberculous chemotherapy. Therefore, tuberculous spine in children even after cure should be observed until growth maturity.