Unusual Presentation of Miliary Tuberculosis
Kyoung Tae KoDong Jib NaSang Hoon HanSung Soo JungKyoung Min MoonDong Jin KimYang Deok LeeYong Seon ChoMin Soo Han
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Abstract:
결핵은 일차적으로 폐에 주로 발생하지만 혈행성 전파를 통하여 모든 기관에 나타날 수 있으며 면역 억제자의 경우 특 히 가능성이 높다. 저자들은 평소 건강했던 속립성 폐결핵 환자에서 간, 비장, 신장, 뇌막 및 뇌실질에 동시에 나타난 다발성 결핵을 보고한다. (Tuberc Respir Dis 2007; 63: 67-71)Key Words: Miliary tuberculosis, Multiorgan, Immunocompetent.Address for Correspondence: Dong Jib Na, M.D. Division of Pulmonary Medicine, Department of Internal Medicine, Eulji University School of Medicine, 1036 Dunsan 2-dong, Seo-gu, Daejeon, 302-799, Korea. Phone: 82-42-611-3154, Fax: 82-42-611-3853 E-mail: djna13@gmail.comReceived: Apr. 20. 2007Accepted: Jun. 14. 2007Keywords:
Miliary tuberculosis
Presentation (obstetrics)
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Seperti pada dewasa, teknik regional anestesi pada pediatrik kini makin popular digunakan oleh ahli anestesikarena keuntungannya. Namun demikian selalu ada risiko dan kemungkinan timbulnya komplikasi dari setiap tindakan yang dilakukan, termasuk tindakan anestesi regional pada pediatrik. Insidensi komplikasi anestesi regional pada pediatrik tidak banyak, dan kalaupun terjadi komplikasi adalah minor. Komplikasi bisa diakibatkan dari identifikasi ruang saraf, alat, obat, teknis tindakan anestesi regionalnya dan komplikasi lainnya.Walaupun tidak banyak kejadian komplikasi regional anestesi yang dilaporkan pada pediatrik, dan bukanlah komplikasi yang fatal, teknik regional anestesi pada pediatrik harus dilakukan dengan lebih hatihati, pertimbangan risiko dan keuntungannya untuk menghindari terjadinya komplikasi, terlebih karena kebanyakan komplikasi dapat dihindari dengan mempelajari teknik yang benar, menggunakan peralatan yang sesuai, dan sangat menerapkan prinsip keamanan pada pasien dengan baik.
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Genentech is partnering with the German cancer company Affimed to develop immunotherapies for multiple kinds of solid and blood cancers. Affimed is developing therapies that engage natural killer cells of the innate immune system to help direct them to attack cancer cells. Genentech will pay Affimed $96 million up front and up to $5 billion more in potential payments.
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Abstract. Three elderly patients admitted to hospital because of suspected malignancy have been diagnosed as disseminated tuberculosis during life. Classical features of disseminated tuberculosis such as miliary mottlings on the chest roentgenogram and choroidal tuberculosis were absent in two of the patients. The difficulties hindering the establishment of the diagnosis of “cryptic” disseminated tuberculosis are emphasized by the patient records. Response to treatment with isoniazide and para‐amino‐salicylic acid is in some cases the only evidence of tuberculosis. Moreover, the early institution of such therapy when other evidence of tuberculosis is lacking may cure the disease before it enters an irreversible state, and is strongly recommended.
Miliary tuberculosis
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Background: Active tuberculosis has been associated with false negative interferon gamma release assay (IGRA) results. This may relate to a suppression of the interferon gamma response associated with a more extensive Mycobacterium (M.) tuberculosis infection. Objective: To determine whether disseminated M. tuberculosis infection is associated with a higher rate of false negative IGRA results compared to localized tuberculosis. Methods: In a systematic review of published individual patient data we compared IGRA results in patients with disseminated tuberculosis as evident from a diagnosis of miliary and/or central nervous system (CNS) tuberculosis with interferon gamma release assay results in patients with lymphnode tuberculosis. Results: We identified 38 reports from Pubmed, EMBASE and Cochrane Library data bases containing individual patient data on 68 patients, 19 with lymph node tuberculosis and 49 with miliary and/or CNS tuberculosis. There was do difference in mean age, immunosuppressive co-morbidity or medication or confirmation by culture or PCR testing between the two groups. In patients with miliary and/or CNS tuberculosis 26.5% had a false negatie IGRA result compared to 5.2% of patients with lymph node tuberculosis (p<0.05). There was no difference in indeterminate results between groups. Conclusions: Disseminated tuberculosis may be associated with an increased rate of false negative interferon gamma release assay results compared to localized tuberculosis.
Miliary tuberculosis
Tuberculosis diagnosis
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