Abstract:
:Tuberculous infection of the oesophagus is rare. This is confirmed by our present review of cases managed in our teaching hospitals over a period of 18 years which uncovered only 11 patients. The main presentation is that of dysphagia whose algorithm of investigation should seek to differentiate tuberculosis from carcinoma, the more common cause of this symptom. Of the 11 patients, 9 presented with dysphagia while 2 had haemorrhage; 7 had an abnormal plain chest radiograph, of whom 4 had a mediastinal mass lesion (3 were lymphadenopathy and one an abscess). All but one had an abnormal radio-contrast oesophagogram, including a mediastinal sinus in two and a traction diverticulum in another two. The mainstay of investigation was oesophagoscopy through which diagnostic biopsy material was obtained in half of the patients. In the other half diagnosis was by either biopsy of associated mediastinal (3) or cervical (1) lymph node masses or by acid fast bacilli positive sputum (1). The diagnosis was established post-mortem in one patient. Treatment was primarily non-operative with standard anti-tuberculosis drug therapy. Two patients underwent a diagnostic thoracotomy and one a drainage of mediastinal abscess together with resection and repair of oesophago-mediastinal sinus during the early part of the series. Outcome of management was very rewarding in 9 patients and death occurred in 2 patients, one of whom had his anti-tuberculosis drug therapy interrupted by severe hepatitis B virus infection. The other death occurred in a patient whose haemorrhage from an aorta-oesophageal fistula was not established ante-mortem. It is recommended that when biopsy material of the oesophagus is unobtainable or non-diagnostic in patients with dysphagia, especially with an abnormal chest radiograph or human immunodeficiency virus infection, effort should be made to obtain biopsy material from associated lymph nodes, even by thoracotomy if necessary, or culture of biopsy from the radiologically abnormal part oesophagus and sputum for mycobacteria, in order to establish the diagnosis of this rare but eminently treatable cause of dysphagia. Clinicians should be aware of tuberculosis of the oesophagus as a possible cause of haematemesis in patients with otherwise unexplained upper gastrointestinal haemorrhage.
journal_name
Postgrad Med Jjournal_title
Postgraduate medical journalauthors
Mokoena T,Shama DM,Ngakane H,Bryer JVdoi
10.1136/pgmj.68.796.110subject
Has Abstractpub_date
1992-02-01 00:00:00pages
110-5issue
796eissn
0032-5473issn
1469-0756journal_volume
68pub_type
杂志文章abstract::Exacerbations of chronic obstructive pulmonary disease impose a considerable burden of morbidity, mortality, and health care cost. Management guidelines outlining best practice, based largely on consensus expert opinion, were produced by a number of organisations during the last decade. Current interest in the field i...
journal_title:Postgraduate medical journal
pub_type: 杂志文章,评审
doi:10.1136/pgmj.2004.019182
更新日期:2004-09-01 00:00:00
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journal_title:Postgraduate medical journal
pub_type: 杂志文章,多中心研究
doi:10.1136/pgmj.2004.026930
更新日期:2005-06-01 00:00:00
abstract:OBJECTIVE:To analyse the clinicopathological presentation, outcome and importance of bone marrow haemophagocytosis in patients with infection-associated haemophagocytic lymphohistiocytosis (IA-HLH) in a tertiary care hospital in Northern India. STUDY DESIGN:Between January 2007 and December 2009, 26 consecutive patien...
journal_title:Postgraduate medical journal
pub_type: 杂志文章
doi:10.1136/postgradmedj-2012-130955
更新日期:2013-04-01 00:00:00
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journal_title:Postgraduate medical journal
pub_type: 杂志文章
doi:
更新日期:1985-01-01 00:00:00
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journal_title:Postgraduate medical journal
pub_type: 杂志文章,评审
doi:10.1136/postgradmedj-2014-132686
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doi:10.1136/pgmj.55.648.765
更新日期:1979-10-01 00:00:00
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journal_title:Postgraduate medical journal
pub_type: 杂志文章,评审
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journal_title:Postgraduate medical journal
pub_type: 杂志文章
doi:10.1136/pgmj.65.768.738
更新日期:1989-10-01 00:00:00
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journal_title:Postgraduate medical journal
pub_type: 临床试验,杂志文章,随机对照试验
doi:
更新日期:1985-01-01 00:00:00
abstract:OBJECTIVE:To audit the current UK outpatient workload and compare this to the national standards as set out by the British Association of Urological Surgeons (BAUS) in A Quality Urological Service for Patients in the New Millennium published in October 2000. PARTICIPANTS:520 UK (NHS) and 21 Republic of Ireland (non-NH...
journal_title:Postgraduate medical journal
pub_type: 杂志文章,多中心研究
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更新日期:2005-01-01 00:00:00
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journal_title:Postgraduate medical journal
pub_type: 杂志文章
doi:10.1136/pgmj.60.707.636
更新日期:1984-09-01 00:00:00
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journal_title:Postgraduate medical journal
pub_type: 杂志文章
doi:10.1136/pgmj.73.859.283
更新日期:1997-05-01 00:00:00
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journal_title:Postgraduate medical journal
pub_type: 杂志文章
doi:10.1136/pgmj.62.730.727
更新日期:1986-08-01 00:00:00
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pub_type: 杂志文章,多中心研究
doi:10.1136/pgmj.2004.024885
更新日期:2005-04-01 00:00:00
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pub_type: 杂志文章
doi:10.1136/pgmj.54.629.225
更新日期:1978-03-01 00:00:00
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journal_title:Postgraduate medical journal
pub_type: 杂志文章
doi:10.1136/postgradmedj-2012-130818
更新日期:2013-07-01 00:00:00
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journal_title:Postgraduate medical journal
pub_type: 杂志文章
doi:10.1136/pgmj.55.643.340
更新日期:1979-05-01 00:00:00
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journal_title:Postgraduate medical journal
pub_type: 临床试验,杂志文章,随机对照试验
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更新日期:2004-03-01 00:00:00
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journal_title:Postgraduate medical journal
pub_type: 临床试验,杂志文章,随机对照试验
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更新日期:1993-02-01 00:00:00
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journal_title:Postgraduate medical journal
pub_type: 杂志文章
doi:10.1136/pgmj.64.748.110
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journal_title:Postgraduate medical journal
pub_type: 杂志文章
doi:10.1136/pgmj.2003.013797
更新日期:2004-10-01 00:00:00
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journal_title:Postgraduate medical journal
pub_type: 杂志文章,评审
doi:10.1136/pgmj.2004.024737
更新日期:2005-03-01 00:00:00
abstract::Seventy-eight clinically euthyroid patients with atrial dysrhythmias, either established or paroxysmal, and sixty-three patients in sinus rhythm with coronary disease were screened for hyperthyroidism using thyroid function tests including the thyroid-stimulating hormone (TSH) response to thyrotrophin-releasing hormon...
journal_title:Postgraduate medical journal
pub_type: 杂志文章
doi:10.1136/pgmj.54.636.658
更新日期:1978-10-01 00:00:00
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journal_title:Postgraduate medical journal
pub_type: 杂志文章
doi:10.1136/postgradmedj-2015-133542
更新日期:2016-10-01 00:00:00
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journal_title:Postgraduate medical journal
pub_type: 临床试验,杂志文章,随机对照试验
doi:
更新日期:1986-01-01 00:00:00
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journal_title:Postgraduate medical journal
pub_type: 杂志文章
doi:10.1136/pgmj.73.864.653
更新日期:1997-10-01 00:00:00
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journal_title:Postgraduate medical journal
pub_type: 杂志文章
doi:10.1136/postgradmedj-2014-132821
更新日期:2014-11-01 00:00:00
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journal_title:Postgraduate medical journal
pub_type: 杂志文章
doi:10.1136/pgmj.65.768.779
更新日期:1989-10-01 00:00:00
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journal_title:Postgraduate medical journal
pub_type: 杂志文章
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更新日期:2003-09-01 00:00:00
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journal_title:Postgraduate medical journal
pub_type: 杂志文章
doi:10.1136/pgmj.63.736.135
更新日期:1987-02-01 00:00:00