Tuberculosis of the larynx and the tonsil were not relatively uncommon diseases in the past, but they have become rare disease with the advent of effective antituberculous chemotherapy. Especially cases secondary to tuberculosis elsewhere in the body are indeed uncommon. We have recently seen a case of tuberculosis of the larynx associated with that of the tonsil which is thought to have developed secondary to miliary tuberculosis.
Adult ; Case Report ; Female ; Human ; *Tonsil ; Tuberculosis, Laryngeal/diagnosis/*etiology ; Tuberculosis, Miliary/complications/diagnosis

Aortic Diseases ; complications ; etiology ; Esophageal Fistula ; complications ; etiology ; Female ; Hematemesis ; etiology ; Humans ; Middle Aged ; Tuberculosis, Miliary ; complications ; Vascular Fistula ; complications ; etiology

Aortoesophageal fistula is a rare and lethal disorder that may result from primary diseases of aorta or esophagus, aortic bypass graft, ingestion of foreign body, trauma, surgical procedure or instrumentation. Tuberculous fistula is extremely rare. We present a 27-yr-old female patient with aortoesophageal fistula associated with tuberculous mediastinitis. The patient experienced massive hematemesis and esophagoscopy revealed a small mucosal defect with exudate-coated blood vessel like Dieulafoy 's lesion on about 25 cm from the incisor teeth. Despite two sessions of endoscopic hemostatic procedures, active massive hemorrhage recurred and was controlled effectively with a prompt insertion of Sengstaken-Blakemore tube. The patient underwent open thoracotomy, which revealed aortoesophageal fistula. Numerous white-yellowish, millet seed-like tubercles were scattered in pleural and abdominal cavity. Division of fistular tract and esophageal resection with Ivor-Lewis anastomosis were performed. Histopathologic study confirmed tuberculous pleuritis and peritonitis. The patient died of postoperative pulmonary complication.
Adult ; *Aorta, Thoracic/pathology/surgery ; Aortic Diseases/*etiology/pathology/surgery ; Esophageal Fistula/*etiology/pathology/surgery ; *Esophagus/pathology/surgery ; Fatal Outcome ; Female ; Hematemesis/etiology/pathology/surgery ; Humans ; Mediastinitis/pathology ; Tuberculosis, Miliary/*complications

We studied retrospectively 17 patients(<19 years old), who received living-donor renal transplantation between Nov. 1982 and May. 1994. Recipients were composed of 10 males and 7 females, with mean age of 16.5 years old(range: 7-19). The causes of renal failure were chronic glomerulonephritis in 6 patients(2 focal segmental glomerulosclerosis, 2 IgA nephropathy, 1 membranoproliferative glomerulonephritis, 1 nephrotic syndrome), urinary tract anomalies in 2 patients(vesicoureteral reflux and anterior urethral valve in each) and unknown cause in 9 patients. The incidence of urologic anomalies in children was more frequent than adult. Immunosuppression after transplantation was with cyclosporine-A and prednisolone in all patients. Acute rejection occurred in 4 patients, who were recovered after steroid pulse therapy. One patient lost the graft because of chronic rejection. Postoperative complications were 2 perirenal hematoma, 2 bacterial urinary tract infection, 2 avascular necrosis of hip joint, 1 cytomegalovirus(CMV') pneumonia, 1 miliary tuberculosis, and 1 hirsuitism. There were 2 deaths, and the causes of death were CMV pneumonia and pulmonary edema. The results of renal transplantation in children were not satisfactory in comparison to those achieved in adults. Although successful renal transplantation in children with end stage renal disease appears to permit the maximal opportunity for growth and development, some problems such as dosage of immunosuppressants, fluid and electrolyte balance, nutritional support remain a persistent obstacle to long term survival. So more research to these problems will be necessary to improve of graft salvage and survival in children.
Adult ; Cause of Death ; Child* ; Female ; Glomerulonephritis ; Glomerulonephritis, IGA ; Glomerulonephritis, Membranoproliferative ; Glomerulosclerosis, Focal Segmental ; Growth and Development ; Hematoma ; Hip Joint ; Humans ; Immunosuppression ; Immunosuppressive Agents ; Incidence ; Kidney Failure, Chronic ; Kidney Transplantation* ; Male ; Necrosis ; Nutritional Support ; Pneumonia ; Postoperative Complications ; Prednisolone ; Pulmonary Edema ; Renal Insufficiency ; Retrospective Studies ; Transplants ; Tuberculosis, Miliary ; Urinary Tract ; Urinary Tract Infections ; Water-Electrolyte Balance

PURPOSE: Traditionally, renal transplant in children with end stage renal failure has poorer outcome compared to adult renal transplants. The objective of this study was to evaluate the results of childhood renal transplantation. MATERIALS AND METHODS: Twenty eight renal transplants were performed in children aged 18 years and younger in our institute. The follow up periods ranged from 15 to 217 months (mean 73.2). The cause of the end stage renal disease, postoperative complications, graft survival, and growth status were investigated retrospectively. RESULTS: The causes of renal failure were chronic glomerulonephritis in 13 cases, FSGS in 4, IgA nephropathy in 4, VUR in 2, renal dysplasia in 2, and hemolytic uremic syndrome in 1, posterior urethral valve in 1 and Alport syndrome in 1. The postoperative complications included perirenal hematoma in 2, bacterial infection in 2, lymphocele in 2, avascular necrosis of the hip joint in 2, CMV pneumonia in 1, miliary tuberculosis in 1 and hirsuitism in 1. The graft and patient survival rate at 1, 5 and 10 years was 81% and 64%, 40% and 88%, and 81% and 72%, respectively. The mean body weight distribution of the 10 cases under the age of 15 years who had no graft failure was in the 10.2 percentile (3-25 percentile) at transplantation and it increased to the 18.2 percentile (3-50 percentile) 46 months after the transplant. CONCLUSIONS: Childhood renal transplantation was less successful than adult renal transplantation. Early transplantation is recommended to maximize the growth of the children and more effective immunosuppressive therapy is needed for this age population.
Adult ; Bacterial Infections ; Body Weight ; Child ; Follow-Up Studies ; Glomerulonephritis ; Glomerulonephritis, IGA ; Graft Survival ; Hematoma ; Hemolytic-Uremic Syndrome ; Hip Joint ; Humans ; Kidney Failure, Chronic ; Kidney Transplantation* ; Lymphocele ; Necrosis ; Nephritis, Hereditary ; Pneumonia ; Postoperative Complications ; Renal Insufficiency ; Retrospective Studies ; Survival Rate ; Transplants ; Tuberculosis, Miliary