RESUMO
Small or shrivelled wheat kernels (screenings) that reduce crop value are commonly produced in terminal drought environments. The aim of this study was to establish whether the incorporation of the tiller inhibition (tin) gene would contribute to maintenance of kernel weight and reductions in screenings under terminal water deficit. Five Silverstar near-isogenic lines contrasting in high and low tiller potential and their recurrent Silverstar parent were established at two plant densities under managed terminal water deficit (mild and severe) and irrigated conditions. With irrigation (grain yield of 5.6 t ha(-1)), kernels of all lines weighed ~31 mg, with restricted-tillering (R-tin) lines producing an average 15% lower grain yield. Under both mild and severe terminal water deficit (4.1 t ha(-1) and 2.8 t ha(-1)), free-tillering lines had relatively high screenings ranging from 11.9% to 16.2%. Compared with free-tillering lines, R-tin lines maintained large kernel weight (~29 mg kernel(-1)) and had 29% and 51% fewer screenings under the two stresses, and a significantly greater (+11%) grain yield under mild stress. Higher kernel weights in tin lines were realized even with the greater kernel number per spike. The higher kernel weight of the R-tin lines under stress conditions was associated with greater anthesis biomass and increased stem water-soluble carbohydrates, ensuring more assimilate for later translocation to filling grain. The incorporation of the tin gene into genetic material adapted to the target environments provides scope for improvement in both grain yield and kernel weight, and a reduction in screenings in terminal water deficit environments.
Assuntos
Grão Comestível/crescimento & desenvolvimento , Grão Comestível/metabolismo , Proteínas de Plantas/metabolismo , Triticum/crescimento & desenvolvimento , Triticum/metabolismo , TemperaturaRESUMO
High-fidelity transfers of genetic information in the central dogma can be achieved by a reaction called editing. The crystal structure of an enzyme with editing activity in translation is presented here at 2.5 angstroms resolution. The enzyme, isoleucyl-transfer RNA synthetase, activates not only the cognate substrate L-isoleucine but also the minimally distinct L-valine in the first, aminoacylation step. Then, in a second, "editing" step, the synthetase itself rapidly hydrolyzes only the valylated products. For this two-step substrate selection, a "double-sieve" mechanism has already been proposed. The present crystal structures of the synthetase in complexes with L-isoleucine and L-valine demonstrate that the first sieve is on the aminoacylation domain containing the Rossmann fold, whereas the second, editing sieve exists on a globular beta-barrel domain that protrudes from the aminoacylation domain.
Assuntos
Isoleucina-tRNA Ligase/química , Isoleucina/metabolismo , Valina/metabolismo , Monofosfato de Adenosina , Sítios de Ligação , Cristalografia por Raios X , Escherichia coli/enzimologia , Ligação de Hidrogênio , Hidrólise , Isoleucina-tRNA Ligase/metabolismo , Modelos Químicos , Modelos Moleculares , Dados de Sequência Molecular , Mutagênese , Conformação Proteica , Dobramento de Proteína , Estrutura Secundária de Proteína , RNA de Transferência de Isoleucina/metabolismo , Especificidade por Substrato , Thermus thermophilus/enzimologia , Aminoacilação de RNA de TransferênciaRESUMO
We report a rare case of desmoid tumor of the chest wall. A 75-year-old female visited our hospital due to a feeling of oppression in the left chest. A chest X-ray, computed tomography (CT) and magnetic resonance imaging (MRI) revealed a large mass in the left thorax. Surgical resection of the tumor was performed under the left standard thoracotomy. The tumor was 90 x 80 x 75 mm in size and diagnosed pathologically as desmoid tumor which showed proliferation of spindle shape cells and collagen fibers. Immunohistochemistry revealed that the tumor cells were positive for vimentin, alpha-smooth muscle actin and negative for CD34. The patient has been well without recurrence for 2 years and 2 months after surgery.
Assuntos
Fibromatose Agressiva/diagnóstico , Neoplasias Torácicas/diagnóstico , Idoso , Feminino , Fibromatose Agressiva/cirurgia , Humanos , Imageamento por Ressonância Magnética , Radiografia Torácica , Neoplasias Torácicas/cirurgia , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND: The AU binding homolog of enoyl-CoA hydratase (AUH) is a bifunctional protein that has two distinct activities: AUH binds to RNA and weakly catalyzes the hydration of 2-trans-enoyl-coenzyme A (enoyl-CoA). AUH has no sequence similarity with other known RNA binding proteins, but it has considerable sequence similarity with enoyl-CoA hydratase. A segment of AUH, named the R peptide, binds to RNA. However, the mechanism of the RNA binding activity of AUH remains to be elucidated. RESULTS: We determined the crystal structure of human AUH at 2.2 A resolution. AUH adopts the typical fold of the enoyl-CoA hydratase/isomerase superfamily and forms a hexamer as a dimer of trimers. Interestingly, the surface of the AUH hexamer is positively charged, in striking contrast to the negatively charged surfaces of the other members of the superfamily. Furthermore, wide clefts are uniquely formed between the two trimers of AUH and are highly positively charged with the Lys residues in alpha helix H1, which is located on the edge of the cleft and contains the majority of the R peptide. A mutational analysis showed that the lysine residues in alpha helix H1 are essential to the RNA binding activity of AUH. CONCLUSIONS: Alpha helix H1 exposes a row of Lys residues on the solvent-accessible surface. These characteristic Lys residues are named the "lysine comb." The distances between these Lys residues are similar to those between the RNA phosphate groups, suggesting that the lysine comb may continuously bind to a single-stranded RNA. The clefts between the trimers may provide spaces sufficient to accommodate the RNA bases.
Assuntos
Enoil-CoA Hidratase/química , Proteínas de Ligação a RNA/química , Sequência de Aminoácidos , Sítios de Ligação , Catálise , Cristalografia por Raios X , Análise Mutacional de DNA , DNA Complementar/metabolismo , Dimerização , Glutationa Transferase/metabolismo , Humanos , Lisina/química , Modelos Moleculares , Dados de Sequência Molecular , Peptídeos/química , Ligação Proteica , Conformação Proteica , Estrutura Terciária de Proteína , RNA/metabolismo , Proteínas Recombinantes de Fusão/metabolismo , Homologia de Sequência de AminoácidosRESUMO
In 3-cases in which lung cancer had occurred in the right upper lobe bronchus and had infiltrated the carina, the right upper lobe (including the lower part of the trachea, the carina, and the right main bronchus) was resected, and a new carina was created by anastomosing the trachea with the left main bronchus and the right intermediate trunk. Surgical techniques and the method for anesthesia were described in these 3 cases. To evaluate the function of the reconstructed trachea and bronchus, we made cinebronchograms at the high speed of 100 or 150 frames per second. This bronchographic movie film helped us to determine the state of the reconstructed trachea and bronchus.
Assuntos
Neoplasias Pulmonares/cirurgia , Brônquios/fisiologia , Brônquios/cirurgia , Broncografia , Humanos , Masculino , Métodos , Pessoa de Meia-Idade , Traqueia/fisiologia , Traqueia/cirurgiaRESUMO
Delayed hypersensitivity reactions before therapy in 137 patients with lung cancer and in 50 patients with benign thoracic lesions were evaluated by 2,4-dinitrochlorobenzene (DNCB) contact sensitization using the patch test. Ninety-eight percent (49/50) of control patients and 46 percent (62/137) of patients with lung cancer were sensitized by 250 mug of DNCB. There was an excellent correlation between the initial reactivity to DNCB and resectability. In patients with resectable lung cancer, preoperative DNCB reactivity has no prognostic value. However, an excellent correlation was found between postoperative reactivity and 2 year survival, i.e., conversion from unresponsive to responsive status was observed on sequential testing. In 15 of 74 patients with resectable disease, the conversion was noted postoperatively, and among 12 patients followed for 2 years, only two patients had died. Conversion from a reactive to nonreactive status to DNCB occurred only in the terminal stage of the disease. From these observations, we found that, in order to evaluate the afferent limb of cellular immunity in patients with lung cancer who have once expressed reactivity to DNCB, one must use some new sensitizing agents which show no cross-sensitivity with each other thereafter.
Assuntos
Dinitroclorobenzeno/imunologia , Neoplasias Pulmonares/imunologia , Nitrobenzenos/imunologia , Adulto , Humanos , Hipersensibilidade Tardia/imunologia , Imunidade Celular , Neoplasias Pulmonares/mortalidade , Neoplasias Pulmonares/cirurgia , Testes do Emplastro , Prognóstico , Neoplasias Torácicas/imunologia , Neoplasias Torácicas/mortalidade , Neoplasias Torácicas/cirurgiaRESUMO
The following report presents an unusual case of a patient with a recurrent parathyroid carcinoma that grossly invaded the lumen of the trachea with a polypoid appearance and brought about severe airway obstruction. The three rings of the upper trachea, including the lower part of the cricoid cartilage, were resected with the tumor, and the airway was reconstructed by end-to-end anastomosis. The present case demonstrates that parathyroid carcinoma can become an intratracheal hazard, as can carcinomas of the thyroid gland, esophagus, lung, or larynx.
Assuntos
Obstrução das Vias Respiratórias/etiologia , Carcinoma/complicações , Neoplasias das Paratireoides/complicações , Adulto , Carcinoma/patologia , Carcinoma/cirurgia , Feminino , Humanos , Recidiva Local de Neoplasia , Neoplasias das Paratireoides/patologia , Neoplasias das Paratireoides/cirurgia , Traqueia/cirurgiaRESUMO
Topographic processes of brain activity during stereopsis were investigated by means of two different principles, with a real stereo target and a computer stereogram. Use of either principle produced the same tendency: an electrically negative focus started from the central region of the scalp and moved to the parietal and occipital regions. These flows of excitation were seen during a period of 90 to 170 ms. The difference between these two stimulus represented a return of the negative focus from the occipital pole to the parietal region in the real stereo target and a spread of the negative focus to the temporal region in the computer stereogram. Since monocular viewing of a real stereo target produces a similar visually evoked potentials wave form but with less intensity, the negative focus in binocular viewing may be due to the enhancement of binocular cells and disparity sensitive neurons in a wide area of the brain cortex. Thus stereoptic brain responses start from the central and parietal regions and move to the occipital region, making a flow of excitation.
Assuntos
Encéfalo/fisiologia , Percepção de Profundidade/fisiologia , Adulto , Mapeamento Encefálico , Computadores , Eletroencefalografia , Potenciais Evocados Visuais , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
The features of optokinetic nystagmus (OKN) suppression were investigated in various kinds of visual disturbances including those of optical, retinal, higher cortical and psychogenic etiologies. A new OKN suppression device was developed, modifying the principle of Ohm. Objective visual acuities were calculated using the visual angle of OKN suppression dots which were arranged in 12 steps corresponding to the visual acuity from 0.03 to 1.0 as determined by Landolt's method. A total of 286 cases were tested. Results were classified into four types of coincidence between objective and subjective visual acuities. The first group showed equivalent acuities. Normal subjects, cases of corneal opacity, aphakia with intraocular lens implantation and functional amblyopia belonged to this category. In the second group, objective acuity could not be determined because of fixation disturbance due to cortical lesion. The subjective acuity better than the objective acuity was obtained in the third group which consisted of cases with macular hole, central serous retinopathy and optic neuritis with central scotoma. Disturbance of foveal fixation to the OKN suppression dot seemed to be the reason for this difference in the acuities. In the fourth group, the objective acuity was better than the subjective acuity. This occurred in cases of psychogenic visual disturbance and malingerer.
Assuntos
Nistagmo Fisiológico , Transtornos da Visão/fisiopatologia , Acuidade Visual , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Eletronistagmografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Testes Visuais/instrumentaçãoRESUMO
The spatio-temporal nature of presaccadic spike potentials (SP) associated with the visually evoked saccade and with the fast phase of optokinetic nystagmus was investigated by means of moving electroencephalographic topography. In both cases, SPs were recognized about 15-25 msec before the quick eye movements (peak time 3-7 msec). The amplitude of SPs was +5 to +7 microV for the visually guided saccade and +3.5 to +4.5 microV for optokinetic nystagmus. The location of the SPs was the mid-parieto-occipital region on the scalp, but their topographical character was that of a brainstem potential. In the case of the visually guided saccade, before the appearance of SP, an antecedent potential in the form of a slow positive charge appeared in the parietal region. From their spatio-temporal characteristics, the SPs investigated in this study were interpreted as mass potentials of the brainstem nuclei which generate eye movements.
Assuntos
Mapeamento Encefálico/métodos , Encéfalo/fisiologia , Movimentos Oculares , Nistagmo Fisiológico , Movimentos Sacádicos , Visão Ocular/fisiologia , Potenciais de Ação , Computadores , Eletroencefalografia , HumanosRESUMO
Visual evoked cortical potentials induced by alternate stimulation of checkerboard pattern with the use of liquid crystal phase difference haploscope were investigated. The synchronization ratio of brain response was determined both in the group of normal binocularity and in the group with binocularity defect. The synchronization ratio of the group of normal binocularity (N = 30) is 100% at 1 Hz x 2, 98.5% +/- 3.9% at 5 Hz x 2, and 83.7% +/- 15.8% at 10 Hz x 2. On the other hand, in the group with binocularity defect, strabismus without amblyopia shows a reduction of the ratio only at the frequency of 10 Hz x 2. Anisometropic amblyopia shows a significant reduction of the ratio at 10 Hz x 2 and strabismus with amblyopia shows a remarkable reduction at 5 Hz x 2 and 10 Hz x 2. As for strabismus with or without latent binocularity, the latter cases show a significant reduction of the synchronization ratio. The reduction of synchronization ratio of VECP seems to have some relationship to the binocularity.
Assuntos
Ambliopia/diagnóstico , Potenciais Evocados , Estrabismo/complicações , Adolescente , Adulto , Ambliopia/complicações , Ambliopia/fisiopatologia , Criança , Pré-Escolar , Percepção de Profundidade/fisiologia , Humanos , Pessoa de Meia-Idade , Estimulação Luminosa/instrumentação , Estimulação Luminosa/métodos , Erros de Refração/complicações , Estrabismo/fisiopatologiaRESUMO
Quantitative analysis of electromyograms (EMGs) of the extraocular muscles (EOMs), which contain fast fibers, like all skeletal muscles, but also slow fibers, was carried out in healthy subjects and a patient with external ophthalmoplegia. Interference EMGs of normal extraocular muscles demonstrated a relatively higher power spectrum in the higher frequency domain than those of the biceps brachii (BB). In the case of ophthalmoplegia, the lateral rectus (LR) and medial rectus (MR) muscles demonstrated a power spectrum with a wide ranging distribution up to 2,000 Hz in the early stage of recovery. Conservative treatment led to an improvement in the patient's ocular motility accompanied by a gradual shift of the spectrum towards lower frequencies within 265 days, during which time EMG examinations were performed four times. The results imply that the electrical activity of the slow fibers proper in the extraocular muscles affects the high frequency domain of the power spectrum and that the those fibers synchronously improve with fast fibers.
Assuntos
Eletromiografia/métodos , Olho , Músculos Faciais/fisiologia , Fibras Nervosas/fisiologia , Oftalmoplegia/fisiopatologia , Potenciais de Ação/fisiologia , Adolescente , Adulto , Braço , Músculos Faciais/fisiopatologia , Feminino , Humanos , Músculos/fisiologia , Estrabismo/fisiopatologiaRESUMO
Long-term observation of binocular function was carried out in 30 postoperative cases of infantile esotropia. The period of observation was 5 to 12 years and the targets used for evaluation were deviating angle and stereo acuity. In the successful group, 20 cases out of 30 (67%) achieved a stereo acuity of 60 seconds or better. Among the remainder, partial improvement was seen in 20% and no improvement in 13%. Preexisting amblyopia and ARC improved in the successful group, and the final deviating angle was a mean of 2.3 prism diopter. There were 2 types of cure processes in the successful group. The first group achieved a good binocular function in a relatively early postoperative stage (7 cases), while the second group had delayed development of binocular function over a period of several years (13 cases). The former cases had sufficient orthoptic treatment during admission and the latter showed a gradual improvement of stereo acuity accompanied by good eye position. It has been generally accepted that the rate of binocular function recovery is very poor among cases of infantile esotropia, but our study revealed that skillful orthoptics administered by a selected member of our team over an extended period enabled the achievement of good binocular function in infantile esotropia.
Assuntos
Esotropia/fisiopatologia , Visão Binocular , Criança , Pré-Escolar , Esotropia/cirurgia , Feminino , Seguimentos , Humanos , Lactente , Masculino , Período Pós-Operatório , Fatores de TempoRESUMO
When botulinum therapy was used for esotropia with abnormal retinal correspondence, the esotropia improved effectively and binocular function recovered. Transient overcorrected deviation appeared in 92% of different cases of retinal correspondence. Patients without binocular function and abnormal retinal correspondence of various types were the subjects of this study. There were 18 congenital esotropes and 12 acquired esotropes. Before treatment, there was normal retinal correspondence > abnormal retinal correspondence (NRC > ARC) in 5 cases, abnormal retinal correspondence > abnormal retinal correspondence (ARC > NRC) in 8 cases, abnormal retinal correspondence (ARC) in 16 cases, and lack of retinal correspondence (LRC) in 1 case and the binocular function was incomplete in all cases. Botulinum toxin (0.25-0.5 U) injected into the medial rectus muscles showed hypertonic action. The dose was adjusted according to the deviation angle. We found some changes in retinal correspondence caused by the botulinum therapy in 24 of the 30 patients (80%). Of these there was NRC in 6, NRC > ARC in 11, and ARC > NRC in 7. Secondary esotropia was found in 92% of the 24 cases. We believe that improvement of retinal correspondence is due to suppression of anomalous retinal areas with the change of the overcorrected deviation after the usual visual direction disappears. Our results suggest that normal retinal correspondence has a relatively wide range of correspondence area.
Assuntos
Toxinas Botulínicas/uso terapêutico , Esotropia/fisiopatologia , Esotropia/terapia , Retina/fisiologia , Adolescente , Adulto , Criança , Pré-Escolar , HumanosRESUMO
PURPOSE: To examine the factors which affect changes in the position of the eyes following the strabismus surgery. METHODS: The postoperative position of 240 eyes with concomitant strabismus was examined. The factors which seemed to have an effect on the position of the eyes were enumerated, and a logistic regression analysis of the results was done. RESULTS: In comparison with esotropia, in exotropia the eyes showed a tendency to return gradually to a normal position. There was no remarkable improvement in stereoscopic vision following strabismus surgery. Based on the standards of the Japanese Association of Strabismus and Amblyopia [the cure standard for strabismus], the results of strabismus surgery were as follows: Grade 1(cosmetically satisfactory) was mainly observed for esotropia, and Grade 3(good) for exotropia. The factors which had a significant effect on the postoperative position of the eyes were as follows: esotropia amblyopia, muscle movement, and operative methods; exotropia: retinal correspondence, operative methods, and the necessity of inferior oblique muscle surgery. CONCLUSIONS: There was little correction of the position of the eyes. In individual cases, the factors which affect position of eyes were examined, and it was considered necessary to increase the amount of correction. Age is a factor which has an effect, but the effect on esotropia and exotropia is small.
Assuntos
Movimentos Oculares/fisiologia , Estrabismo/cirurgia , Adolescente , Adulto , Fatores Etários , Idoso , Criança , Pré-Escolar , Humanos , Pessoa de Meia-Idade , Período Pós-Operatório , Valor Preditivo dos Testes , Análise de Regressão , Estrabismo/fisiopatologia , Visão OcularRESUMO
The dose-response relationship between botulinum toxin and the alteration of ocular alignment of 15 esotropia cases (ET) and 15 exotropia cases (XT) was evaluated. We began with a dose of 0.25 units (U) per injection and stepped it up to 2.5 U per injection in ET and to 10 U per injection in XT. The average number of injections was 3.6 and 5.2, respectively. The maximum effect on ocular alignment developed 7 to 14 days after injection, and following recurrences ceased within 2 to 6 months, indicating a lasting effect. The maximum effect of each injection was within the limits of 10 to 30 prism diopters (delta). The maximum effect per unit dose of the small dose injection was greater than that of the large dose injection. In each dose, a greater effect was observed in the ET than in the XT, Recurrence was within the limits of 8 to 21 delta with both small dose injection and large dose injection. The recurrence amount per unit dose was greater with small dose injection than with large dose injection. The larger the dose injected, the more lasting was the effect obtained. This tendency was more prominent in ET than in XT. A roughly linear relationship between the dose and the ocular alignment was obtained on logarithmic graph paper, and the recurrence was reduced when the dose was increased. These findings suggest that repetitive injection effectively accumulates, resulting in a lasting effect.
Assuntos
Toxinas Botulínicas/administração & dosagem , Estrabismo/tratamento farmacológico , Adolescente , Adulto , Criança , Pré-Escolar , Relação Dose-Resposta a Droga , Esotropia/tratamento farmacológico , Exotropia/tratamento farmacológico , Feminino , Humanos , Injeções , Masculino , RecidivaRESUMO
It has been well known that tuberculous meningitis cases have moderate pleocytosis with mononuclears as predominating cell type in cerebrospinal fluid (CSF). But there are some reports of tuberculous meningitis in which polymorphonuclears was predominant in CSF. In this study, we investigated differential cell counts of CSF in 4 tuberculous meningitis cases. In 3 of the 4 cases, the CSF had a polymorphonuclears preponderance on admission. The elevated ratio of polymorphonuclears seemed to relate with the severity of the disease, and the ratio declined promptly after the initiation of chemotherapy. The 2 cases, which showed extremely high ratio of polymorphonuclears, showed poor prognosis, one died and the other had the severe sequelae such as notable disturbances of consciousness with hydrocephalus. This study suggests that differential cell counts of CSF is a useful measures to predict the prognosis and to follow up patients with tuberculous meningitis. The finding of a polymorphonuclears preponderance in CSF would suggest the severity and activities of the disease and should be considered as an alarm sign in tuberculous meningitis.
Assuntos
Líquido Cefalorraquidiano/citologia , Neutrófilos/patologia , Tuberculose Meníngea/patologia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tuberculose Meníngea/líquido cefalorraquidianoRESUMO
We evaluated the cause of death in patients with pulmonary tuberculosis who died within one year after diagnosing as tuberculosis. Of 325 bacillary patients during the past seven years, 43 (13.2%) died within one year. Twenty-three patients (53.5%) died directly of tuberculosis. In this group, 13 patients died in emaciation state. Most of them were aged and under a poor nutritional condition. Some patients died in spite of improvement of tuberculosis. The fact indicates the need to detect tuberculosis as early as possible in elderly persons, and treatment should be initiated immediately. Eight patients died of respiratory failure and their chest X-ray film showed wade-spread tuberculosis. Seven of the patients died in spite of initiating treatment within one month after the onset of symptoms. This fact suggests the importance of regular check up by chest X-ray to detect tuberculosis early. Two patients died of massive hemoptysis. They had an episode of bloody sputum and the laboratory examination showed anemia. On the other hand, 20 patients died due to coexisting diseases unrelated to tuberculosis. Ten patients died of malignant diseases and most of them were lung cancer. Two patients died of hepatic failure possibly caused by the adverse reaction of TB chemotherapy. The interval between the onset of the treatment and death was less than a month, and the fact suggests the need to observe carefully for adverse reactions especially in the early stage of treatment.
Assuntos
Tuberculose Pulmonar/mortalidade , Idoso , Causas de Morte , Feminino , Humanos , Masculino , Neoplasias/complicações , Neoplasias/mortalidadeRESUMO
A 46-year old man was admitted to a hospital because of cough and dyspnea. He was diagnosed as interstitial pneumonia and was treated with prednisolone (PSL) and antibiotics. The symptoms improved temporarily but he soon developed acute respiratory failure and was transferred to our hospital. Chest X-ray and CT revealed ground-glass opacities in both lung fields. He was treated with methyl PSL, antibiotics, and antimycobacterial drugs but he died on the fourth hospital day. Retrospectively, hematologic laboratory examinations revealed that CD4+ cell count was 0/microliter and serological tests for HIV were positive by both EIA and Western blot methods. The culture of the bone marrow specimens was positive for mycobacteria other than M. tuberculosis, and the bacilli were identified as Mycobacterium avium. Thus, his disease was eventually diagnosed as disseminated Mycobacterium avium complex (MAC) infection. In the past reports, the diagnosis of disseminated MAC infection was most often made by blood cultures, however, the isolation of MAC from bone marrow is another sensitive and specific method for the diagnosis of this infection. In some cases, bone marrow examination would be useful to diagnose disseminated MAC infection.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/microbiologia , Medula Óssea/microbiologia , Complexo Mycobacterium avium/isolamento & purificação , Infecção por Mycobacterium avium-intracellulare/microbiologia , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
A 39-year old male visited the hospital complaining of perianal pain, swelling and redness. Under the diagnosis of an anal abscess, drainage was performed repeatedly. As the wound failed to heal and fistulae were detected, excision of entire tract was performed. On histopathological examination of the resected fistulae, caseous necrosis, Langhans giant cells, and epithelioid cell infiltration were found and diagnosed as anal tuberculosis. Chest X-ray showed cavitary lesion with infiltrative shadow in right upper lobe. Acid-fast bacilli were positive in sputum, and the diagnosis of pulmonary tuberculosis was confirmed. Anti-tuberculosis therapy was immediately started with good response to treatment. As tuberculosis of anal region is so rare recently and there is no characteristic clinical picture, it is very difficult to diagnose it pre-operatively. In some cases such as ours, pulmonary or other tuberculosis is accompanied with anal tuberculosis. Therefore, accurate diagnosis of anal tuberculosis is needed to find other tuberculosis early. As anal tuberculosis is rarely diagnosed correctly before operation on the basis of the clinical picture, the histopathological examination of the excised fistula is mandatory for the correct diagnosis of anal tuberculosis.