Pancreatic tuberculosis: A systematic review of symptoms, diagnosis and treatment.

INTRODUCTION: Although pancreatic tuberculosis (TB) is traditionally considered to be a rare clinical entity, in recent times, an increase in the number of reports of pancreatic TB has been noted. We conducted a systematic review in order to summarise currently available data on pancreatic TB. METHODS: A comprehensive literature search of Medline, Scopus and ISI Web of Science databases was conducted in order to identify papers reporting cases of pancreatic TB. The eligibility criteria for inclusion in the review required that the studies reported patient(s) affected by pancreatic TB and that individual data on age, sex, clinical presentation and outcome were available. RESULTS: In total, 116 studies reporting data on 166 patients were included in the analysis. The majority of patients were males (62.1%) diagnosed at a mean age of 41.61 ± 13.95 years. Most cases were diagnosed in Asia (50.0%), followed by North America (22.9%), Europe (20.5%), Africa (4.2%) and South America (2.4%). Human immunodeficiency virus (HIV) infection was diagnosed in 25.3% of those affected. Pancreatic TB most frequently presented itself in the form of a pancreatic mass (79.5%) localised mainly in the head (59.0%) and less frequently in the body (18.2%) and tail (13.4%). Extrapancreatic TB involvement most frequently affected the peripancreatic lymph nodes (47.3%). More than half of patients (55.2%) were subjected to laparotomy, while 21.08% underwent endoscopic ultrasound fine-needle aspiration biopsy. The presence of TB was identified most frequently through histological analysis (59.6%), followed by culture (28.9%), staining (27.7%) and, in a smaller number, by polymerase chain reaction (9.6%) and cytology (6.6%). Almost all patients received anti-tubercular pharmacological therapy (98.2%), while 24.1% underwent surgery. Despite treatment, 8.7% of patients died. CONCLUSION: Increased awareness of pancreatic TB is needed, not only in endemic areas but especially in relation to HIV infection and other clinical conditions associated with immunoincompetence.

[A clinical assessment of the detoxifying effect of enterosorption in treating tuberculosis of the respiratory organs in children]. / Klinichna otsina detoksykatsiinoho efektu enterosorbtsiï pry likuvanni tuberkul'ozu orhaniv dykhannia u ditei.

Effects were studied of a complex treatment combined with enterosorption on the clinical course of tuberculosis of the respiratory organs in children. The results obtained showed that the use of enterosorbents "Carbolong" or "Carbosfer" against the background of the chemotherapy adopted leads to a significant shortening of periods of detoxication, which fact is manifested by a quicker and more marked positive dynamics of intoxicative symptomatology by comparison with those patients having received a conventional course of chemotherapy only. In a comparative evaluation of the natural enterosorbent Carbolong versus synthetic enterosorbent Carbosfer they were shown to be of similar therapeutic activity.

Importancia de la correlación clínico patológica para el pronóstico y tratamiento de la tuberculosis ganglionar de evolución prolongada / Importance of clinico*pathological correlation for the prognosis and treatment of the tuberculosis of lymph nodes of prolonged evolution

Se revisó 125 casos de tuberculosis ganglionar atendidos en el Hospital Nacional `Guillermo Almenara Irigoyen', Instituto Peruano de Seguridad Social, entre 1976 y 1985; el 16.8 por ciento reactivó la enfermedad. Se analizó estas historias clínicas con evolución hasta 1990. En cada biopsia de ganglio se estudió: registro cuantitativo y cualitativo de los componentes del granuloma y elementos celulares de las áreas cortical y paracortical no afectadas por la lesión. Se clasificó los casos según el estado de reacción del paciente en el espectro de tuberculosis humana propuesto por Lenzini. Se concluye que 16.8 por ciento de pacientes tuvo características de NO REACTIVO INTERMEDIO (UI), 50 por ciento de ellos abandonó el tratamiento. Al diagnosticar la enfermedad, debe evaluarse el estado de reacción del paciente por correlación clínico patológica. El informe anátomo patológico debe incluir: diagnóstico de la lesión y características de las áreas cortical y paracortical no afectadas por la lesión. Los pacientes clasificados como UI, deben recibir el tratamiento indicado para casos con reactivación de la enfermedad, aún cuando sea su primer estudio biópsico

[Health care channels for new cases of respiratory tuberculosis in Seine Saint-Denis in 1984-1986]. / Les filières de soins des nouveaux cas de tuberculose respiratoire en Seine Saint-Denis en 1984-1986.

The purpose of this study was to observe routine practice in the care of tuberculosis cases treated in the Seine Saint-Denis department in 1984, with reference to the recent recommendations of the French Pneumology Society. The pathway of each patient through the care network was established for 336 adult cases being treated for respiratory tuberculosis for the first time. The social and economic cost of each pathway was evaluated. The results show the multiplicity of health services intervening in the care of these patients, the persistence of hospitalization, sanatorium care, and long sick-leaves from work, together with major differences in the care pathways according to the nationality, sex, and socio-economic group of the patients. The cost of tuberculosis treatment is shown to be high for both patients and the community.