ABSTRACT
During the 2016 Kumamoto earthquake, 10 hospitals took responsibility for complete evacuation, in what has become regarded as one of the largest evacuations of patients in 1 seismic disaster. We aimed to examine the reasons for evacuation and to assess hospital vulnerability as well as preparedness for the earthquake. A multidisciplinary team conducted semi-structured interviews with the hospitals 6 months after the earthquake. The primary reasons for the decision to evacuate hospitals were categorized into 3: 1) Concern for structural safety (4 facilities), 2) Damage to the facility water system (7 facilities), and 3) Cessation of regional water supply (5 facilities).All hospitals decided on immediate evacuation within 30 hours and could not wait for structural engineers to inspect the affected buildings. Damage to sprinklers or water facilities caused severe water shortages and flood, thus requiring weeks to resume inpatient care. The earthquake revealed the vulnerability of rapid building-inspection systems, aging buildings, and water infrastructure.
ABSTRACT
A 27-year-old man with a 4-month history of treatment for miliary tuberculosis at another hospital was admitted to our hospital for continued treatment. Computed tomography showed new lesions in the S8 area of the liver and spleen, despite resolution of chest radiographic findings. Because these new lesions were still present after 8 months of treatment, we performed laparoscopic drainage of the liver abscess. Purulent material drained from the lesion revealed positive polymerase chain reaction results for Mycobacterium tuberculosis, and identification of granuloma with infiltrating lymphocytes and plasma cells confirmed the diagnosis of tubercular liver abscess. Pathological changes in the spleen over the clinical course were also regarded as representing tubercular abscess. Postoperative course was good, and tuberculosis treatment ended after 12 months. Tubercular liver abscess subsequently showed prominent reduction, and the tubercular splenic abscess disappeared on abdominal ultrasonography. Tubercular hepatosplenic abscesses appearing during tubercular treatment are rare. We report this valuable case in which laparoscopic drainage of a liver abscess proved useful for diagnosis and treatment.
Subject(s)
Liver Abscess/etiology , Liver Abscess/therapy , Splenic Diseases/etiology , Splenic Diseases/therapy , Tuberculosis, Miliary/complications , Tuberculosis, Miliary/drug therapy , Tuberculosis/etiology , Tuberculosis/therapy , Abscess/diagnosis , Abscess/etiology , Abscess/therapy , Antitubercular Agents/administration & dosage , Drainage/methods , Humans , Laparoscopy , Liver Abscess/diagnosis , Male , Mycobacterium tuberculosis/isolation & purification , Splenic Diseases/diagnosis , Treatment Outcome , Tuberculosis/diagnosis , Tuberculosis/microbiologyABSTRACT
A 49-year-old male who had been treated for pulmonary tuberculosis and tuberculous pleurisy in 2007 was referred to our hospital with the complaint of dyspnea on exertion in Nov. 2009. Chest X-ray showed increased pleural effusion compared with that remaining after the previous treatment of pleurisy in 2008. A chest CT revealed that fluid collection was surrounded by thickened pleura. Thoracocentesis was performed, and yellow milky liquid was obtained. The pleural effusion contained few cells. The triglyceride concentration was 83 mg/dl, and the cholesterol level was very high at 628 mg/dl. Based on these findings we diagnosed this case as chyliform pleural effusion. Both smear of acid-fast bacilli and PCR-TB test of the pleural effusion were positive, but culture was negative for mycobacterium, suggesting that this chyliform pleural effusion was produced by the former episode of tuberculous pleurisy, not by the recent reactivation of tuberculous pleurisy. The ADA concentration in the pleural effusion was high at 91.7 IU/l. No increase in the amount of pleural effusion was observed after thoracocentesis without any anti-tuberculosis therapy.
Subject(s)
Pleural Effusion/etiology , Tuberculosis, Pleural/complications , Chyle , Humans , Male , Middle AgedABSTRACT
A 24-year-old man who had been treated 3 months for tuberculous pleurisy presented with thoracic back pain. Chest CT showed a new lesion abutting the pleura, despite the disappearance of pleural effusion. Two weeks later, the mass abutting the pleura progressed to form a new intrapulmonary infiltrative shadow. A transbronchial lung biopsy was performed and the histopathologic examination of the specimen from this lesion revealed granulomatous inflammation without caseous necrosis or acid-fast bacilli. No acid-fast bacilli were cultured from the bronchoalveolar lavage fluid. Anti-tuberculosis medication was continued without change, and the lesions finally resolved. More than 3 years have passed since the completion of anti-tuberculosis chemotherapy, and no recurrence has been observed. We believe that these lesions were pulmonary tuberculomas and transient intra-pulmonary infiltration due to non-specific inflammation, caused secondarily by an excessive immune response, as in paradoxical worsening.
