http://chineseinput.net/에서 pinyin(병음)방식으로 중국어를 변환할 수 있습니다.
변환된 중국어를 복사하여 사용하시면 됩니다.
역설적 반응에 의하여 동시에 결핵성 뇌농양 및 결핵성 복막염이 발생한 증례 1예
안태홍 ( Tae Hong Ahn ),박민범 ( Min Bum Park ),이기조 ( Key Jo Lee ),정은호 ( Eun Ho Jung ),김진우 ( Jin Woo Kim ),서상렬 ( Sang Yeol Suh ),강석우 ( Seok Woo Kang ),김은나 ( Eun Na Kim ),한윤주 ( Yoon Ju Han ),조삼권 ( Sam Kwon C 대한결핵 및 호흡기학회 2009 Tuberculosis and Respiratory Diseases Vol.66 No.6
역설적 반응은 감수성 있는 항결핵제를 복용중인 결핵환자에서 치료시작 당시의 병변이 악화되거나 새로운 병변이 생기는 현상이고 이는 치료실패와 감별을 요한다. 일반적으로 역설적 반응은 기존 항결핵 치료로 좋은 결과를 보이므로, 이러한 임상 경과를 잘 이해함으로써 불필요한 검사나 치료약제 변경 등을 하지 않고 적절히 치료할 수 있게 될 것이다. 저자들은 적절한 항결핵제 치료 중에도 역설적 반응으로 결핵성 뇌농양, 결핵성 복막염이 연속적으로 병발한 환자 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다. While receiving appropriate treatment, patients with tuberculosis occasionally have unusual, paradoxical reactions, with transient worsening of lesions or the development of new lesions. This report is a case of tuberculosis brain abscess and tuberculosis peritonitis with intra-abdominal abscess that developed during appropriate anti-tuberculosis chemotherapy. A 45-year-old male patient had been diagnosed as with all-drug susceptible pulmonary tuberculosis with pleurisy. Subsequently, the patient underwent standard treatment with anti-tuberculosis therapy; the pulmonary lesions improved. Three months after initial treatment, the patient developed brain abscesses and peritonitis. With the addition of corticosteroid treatment, the patient`s neurologic symptoms were relieved. Exploratory laparotomy with surgical drainage was performed and a diagnosis of tuberculosis peritonitis was confirmed on biopsy. Anti-tuberculosis therapy was continued for 19 months, the patient improved eventually without further complications, although the therapeutic regimen had not been altered. In this case, the paradoxical response to treatment may have been involved in the pathogenesis of disease.
장결핵 및 결핵성복막염 - 최근 5년간 ( 1989년 - 1994년 ) 의 임상분석
유선경(Sun Kyung Liu),김진천(Jin Cheon Kim),김해련(Hae Ryeon Kim),김우성(Woo Sung Kim),김석구(Suk Ku Kim) 대한소화기학회 1997 대한소화기학회지 Vol.29 No.4
N/A Background/Aims: We must consider intestinal and peritoneal tuberculosis among differential diagnosis of inflammatory bowel disease regardless of pulmonary tuberculosis, The purpose of this study is to characterize the clinical feature of intestinal and peritoneal tuberculsis at the time of decreasing pulmonary tuberculosis. Methods: From June 1989 to December 1994, 130 cases of intestinal and peritoneal tuberculosis were diagnosed at the Asan Medical Center. Chest X-ray, colon study, colonofiberscopy, peritoneoscopy, and biopsy were used as diagnostic tools. Results: The sex ratio was 1:1.4 in favor of females. The peak incidence was among the fourth decade. Chief complaints were abdominal pain in the half of the cases, followed by abdominal distension, diarrhea, abdominal discomfort, abdominal rnass, and indigestion in descending order. The average symptom duration lasted 4.1 months. Fifty-seven percent of the patients had synchronous pulmonary tuberculosis. The sensitivity of barium enema and colonofiberscopy were 84.3% and 89.8% respectively. The ileocecal area was the most frequent location, and then ascending colon, sigmoid colon, transverse colon, rectum, jejunum, and descending colon in descending order. Thirty-two of the patients(23.9%) had an operation. The ileocecal lesion was prone to need surgical intervention than other lesions(P<0.0001). Surgery of intestinal and peritoneal tuberculosis did not affect comp]ication rate. Conclusions: We must consider intestinal or peritoneal tuberculosis in patients with atypical abdominal symptoms because intestinal and peritoneal tuberculosis is frequently met with the decrement of pulmonary tuberculosis. The colonofiberscopy was the most efficient diagnostic tool. Medical treatment must precede surgery and surgical intervention is used as indicated to treat complications. (Korean J Gastroenterol 1997;29:547-564)
원발성 복막암 혹은 난소암으로 의심된 결핵성 복막염 2예 복강경을 이용한 감별진단
이승미 ( Seung Mi Lee ),유원정 ( Won Jeong Yoo ),김혜진 ( Hye Jin Kim ),유종우 ( Chong Woo Yoo ),박상윤 ( Sang Yoon Park ),서상수 ( Sang Soo Seo ) 대한산부인과학회 2006 Obstetrics & Gynecology Science Vol.49 No.8
Peritoneal tuberculosis is a rare presentation of tuberculosis. The presenting signs and symptoms, imaging examinations and CA-125 status in peritoneal tuberculosis sometimes resemble that of ovarian cancer. Thus, the possibility of peritoneal tuberculosis should be considered in the differential diagnosis of ovarian carcinoma. We report two cases of peritoneal tuberculosis initially suspected as ovarian carcinoma but diagnosed as peritoneal tuberculosis with laparoscopy. Using diagnostic laparoscopy unnecessary laparotomy was avoided. We suggest that diagnostic laparoscopy can be helpful in differential diagnosis between peritoneal tuberculosis and ovarian carcinoma.
윤수영 ( Soo Young Yoon ),최소래 ( So Rae Choi ),강이화 ( Ea Wha Kang ),구영석 ( Young Seok Goo ),김범석 ( Beom Seok Kim ),윤현진 ( Hyun Jin Youn ),강신욱 ( Shin Wook Kang ),최규헌 ( Kyu Hun Choi ),이호영 ( Ho Yung Lee ),한대석 ( 대한신장학회 2003 Kidney Research and Clinical Practice Vol.22 No.1
목적 : 우리나라 투석 환자에서의 결핵의 특징적인 임상 양상을 알아보고자 후향적으로 본 연구를 시행하였다. 방법 : 1982년 1월부터 2001년 12월까지 세브란스병원에서 투석을 시작한 환자 중 결핵으로 확진된 34예를 대상으로 그 임상 양상을 조사하였다. 결과 : 대상 환자는 남자가 16명, 여자가 18명이었으며, 평균 연령은 52.4세였고, 평균 투석기간은 36.4개월이었다. 혈액투석 환자가 14명, 복막투석 환자는 20명이었고, 원인 신질환으로는 당뇨가 9명 (26.5%)으로 가장 많았다. 부위별로는, 폐결핵이 14명으로 41.2%였고, 폐 외 결핵 20명 중 임파선 결행기 10명 (50%), 복막염이 4명 *20%), 속립성 결핵이 3명 (15%), 그 외척축, 심낭과 하지 근육의 결핵이 각각 1명씩이었다. 폐결핵의 경우 호흡곤란과 권태감이 뚜렷하였고, 임파선 결핵을 제외하고는 발열, 체중 감소 등 결핵 환자의 전형적인 증상을 보이는 경우는 드물었다. 백혈구의 증가는 없었으나, 빈혈, 체중간소 등 결핵 환자의 전형적인 증상을 보이는 경우는 드물었다. 백혈구의 증가는 없었으나, 빈혈, 저알부민혈증과 더불어 급성기 반응 물질의 증가가 현저하였다. 결핵균이 동정된 경우 3명 (8.8%0이었고, 폐 외 결핵의 경우는 조직검사로 진단된 경우가 가장 많았다. 항결핵제 복용 중단의 원인은 소화 장애가 가장 많았다. 10명은 완치되었고, 12명은 현재 치료 중이며, 4명이 사망하였고 1명에서 재발이 관찰되었다. 결론 : 투석 환자에서의 결핵은 폐 외 결핵의 발생 빈도가 높고, 임상 양상이 전형적이지 않아 진단이 어려우나, 적절히 치료하면 재발은 흔하지 않으므로 결핵이 의심되는 환자에서는 적극적인 진단 및 치료가 요구된다. Background : A retrospective study of the clinical features of tuberculosis in patients undergoing maintenance dialysis was performed. Methods : We reviewed medical records of patients. Results : Among thirty-four patients, fourteen were on hemodialysis and twenty were on peritoneal dialysis. Mean age was 52.4±13.8 years, and interval between initiation of dialysis and onset of tuberculosis ranged from 1 to 146 months. There were 14 cases of pulmonary tuberculosis, 10 cases of tuberculous lymphadenitis, 4 cased of tuberculous peritionitis, 3 cases of miliary tuberculosis, 1 case of spinal tuberculosis, 1 case of tuberculosis of thigh. Patients with pulmonary tuberculosis usually presented with dyspnea and malaise. But typical symptoms of tuberculosis such as fever, cough, sputum, and weight loss were rarely observed. Leukocytosis was absent but anemia, hypoalbuminemia and significant increase in acute phase reactants such as ferritin and C-reactive protein was obvious. Diagnosis was established by positive AFB in 3 patients, and in cases of extrapulmonaty tuberculosis, 13 among 20 patients were diagnosed by typical histologic characteristics on a tissue biopsy. Antituberculous treatment consisted of isoniazid, rifampicin, pyrazinamide, and occasionlly ethambutol. And in several cases, incision and drainage, pericardiocentesis, or removal of peritoneal catheter were performed. Among the patients, just one recurrence was observed and four patients died while on antituberculous treatment. Conclusion : In dialysis patients, extrapulmonary tuberculosis is common and diagnosis of tuberculosis is difficult for its atypical manifestations. Therefore, early diagnosis and prompt initiation of treatment is needed in patients with high suspicion of tuberculosis.
폐결핵이 동반된 투석환자에서 결핵성 복막염으로 오인된 경화성 복막염 1 예
김영옥(Young Ok Kim),정명선(Myung Son Chung),신우승(Woo Seung Shin),문진성(Jin Seong Moon),윤선애(Sun Ae Yoon),김남일(Nam Il Kim),최의진(Euy Jin Choi),방병기(Byung Kee Bang) 대한내과학회 1998 대한내과학회지 Vol.55 No.2
Sclerosing peritonitis (SCP) is a syndrome of multiple causes that is characterized by the thickening of peritoneal membrane and subsequent ultrafiltration failure and intestinal obstruction. We report a case of sclerosing peritonitis initially suspected of tuberculous peritonitis in a patient with pulmonary tuberculosis. A 35-year-old man presented with recurrent exudative ascites of unknown origin. He had been switched from peritoneal dialysis to hemodialysis because of recurrent peritonitis 6 months ago. Laparoscopic peritoneal biopsy revealed excessive formation of capillaries and monocyte infiltration without evidence of tuberculosis. He was discharged without further treatment. Four months later, he was readmitted with intestinal obstruction. Exploratory laparotomy revealed that the whole small intestine was encased in a thick and fibrous peritoneal capsule. Pathologic examination of peritoneal membrane showed absence of mesothelium and extensive proliferation of fibroconnective tissue, which was compatible with sclerosing peritonitis.
이진호(Jin Ho Lee),김관엽(Kwan Yup Kim),신원창(Won Chang Shin),이희승(Hee Sung Lee),전수영(Su Young Jeon),조혜제(Hae Je Cho),고일향(Il Hwyang Koh) 대한소화기학회 1993 대한소화기학회지 Vol.25 No.2
Tuberculosis rarely involve the mammry gland. This gland appears to have peculiar resistance to tuberculous infection. Active tuberculosis is present in other sites of the body, in 25-84% of patients with tuberculosis. of the breast. We report a case of tuberculous peritonitis accompanied with mammary tuberculosis in a 33-year-old woman.
김경수 ( Kyoung Soo Kim ),편유장 ( You Jang Pyon ),성기철 ( Ki Cheol Seong ),박창영 ( Chang Young Park ),김병익 ( Byung Ik Kim ),이승세 ( Seung Se Lee ),이상종 ( Sang Jong Lee ),금주섭 ( Joo Seob Keum ) 대한소화기학회 1997 대한소화기학회지 Vol.29 No.6
Although peritonitis is an unusual form of tuberculosis, it is one of the most important diseases of the peritoneum in this country. Chylous ascites is developed by the various etiologies, but it is rarely caused by tuberculosis. We experienced a case with chylous ascites following tuberculous peritonitis with lymphadenitis which had not responded to a longterm antituberculous medication. In the findings of the second laparoscopy after six months` treatment, milky-turbid chylous ascites has still resided in the peritoneal cavity with some nodules newly developed over the hepatic surface. Significantly elevated triglyceride level in ascites was identified. The patient was much improved with conservative treatment. So we report it with a review of the literature.(Korean J Gastroenterol 1997;29:847-852)
강직성 척추염 환자에서 Infliximab 사용 후 발생한 결핵성 복막염
강진영 ( Jin Young Kang ),박성환 ( Sung Hwan Park ),곽승기 ( Seung Ki Kwok ) 대한내과학회 2015 대한내과학회지 Vol.89 No.5
Infliximab is a chimeric monoclonal antibody against tumor necrosis factor-alpha (TNF-α) that is used to treat chronic inflammatory diseases such as ankylosing spondylitis (AS). Side effects include greater susceptibility to severe infections, such as tuberculosis. Positive diagnosis of tuberculous infections, such as tuberculous peritonitis, are often difficult due to the nonspecific nature of symptoms and the rarity of the infection, with definitive diagnoses requiring either a positive culture or histological biopsy. Here, we describe a case of tuberculous peritonitis during infliximab therapy in a 71-year-old man with AS, the disease was confirmed via histopathological examination. (Korean J Med 2015,89:593-597)
( Amol Sonyabapu Dahale ),( Amarender Singh Puri ),( Sanjeev Sachdeva ),( Anil K Agarwal ),( Ajay Kumar ),( Ashok Dalal ),( Pritul D Saxena ) 대한소화기학회 2021 대한소화기학회지 Vol.78 No.3
Background/Aims: Although peritoneal tuberculosis (TB) is one of the important differential diagnoses among cirrhotic patients with ascites, a peritoneal biopsy is not always available. High ascitic fluid adenosine deaminase (ADA) has been indicative of peritoneal TB. On the other hand, studies to assess its diagnostic utility based on the confirmation of peritoneal biopsy in cirrhotic patients are scarce. Methods: Patients with new-onset ascites were enrolled prospectively from a tertiary hospital. Peritoneal biopsy was applied according to clinical judgment when required. Based on pathology diagnosis of the peritoneum, the diagnostic efficacy of ascitic fluid ADA for peritoneal TB was evaluated in total and cirrhotic patients, respectively. Results: Among 286 patients enrolled, 78 were diagnosed with peritoneal TB. One hundred and thirty-two patients had cirrhosis, and 30 of those were diagnosed with peritoneal TB. The mean ADA was 72.2 U/L and 22.7 U/L in the peritoneal and non-peritoneal TB group, respectively, among the total study population, and 64.0 U/L and 19.1 U/L in the peritoneal and non-peritoneal TB group, respectively, among the subgroup with cirrhosis. The area under the curve for ADA to diagnose peritoneal TB was 0.96 in the total study population with a cutoff value of 41.1 U/L, and 0.93 in cirrhotic patients with a cutoff value of 39.9 U/L. Conclusions: The ascitic fluid ADA measurements showed high diagnostic performance for peritoneal tuberculosis in patients with ascites regardless of cirrhosis at a similar cutoff value. (Korean J Gastroenterol 2021;78:168-176)