Although the incidence of tuberculosis of the bone and joints is being decreased with good nutrition, hygine and the development of preventive medicine, it is still a common disease in our clinic. One hundred and ninty-eight cases of tuberculosis of the bone and joints were studied in the Department of Orthopedic Surgery, Seoul National University Hospital for 10 years from January, 1966 to December. 1975. The results were as follows: 1. Total cases of tuberculosis of the bone and joints were 588 Among them, peripheral bone and joints excluding the spine occupied 198 cases (34%). 2. Sex ratio was 1.7 : 1 (male : female). Age distribution showed the group below 10 years was 78 cases (39%). On the other hand, 7 cases were over 51 years old. 3. More than 50% of patients visited hospital after one year from the onset. 4. One-third of all cases had been given some management before admission and the most common treatment was anti-tuberculous chemotherapy (25%). 5. Erythrocyte sedimentation rate was definitly increased in 41%. 6. Associated tuberculous lesionsoe of extraskeletal system were confirmed in 66 cases (33%). Among them, active pulmonary tuberculosis were 51 cases (77%) 7. Various treatments (conservative, curettage, synovectomy, arthrodesis, etc.) had been carried out. However, surgical managements for saving the range of motion must be considered always before arthrodesis.
Age Distribution ; Arthrodesis ; Blood Sedimentation ; Clinical Study ; Curettage ; Drug Therapy ; Hand ; Humans ; Incidence ; Joints ; Orthopedics ; Preventive Medicine ; Range of Motion, Articular ; Seoul ; Sex Ratio ; Spine ; Tuberculosis ; Tuberculosis, Pulmonary

BACKGROUND: Chitotriosidase is an accepted marker of macrophage activation. In this study, we investigated serum chitotriosidase levels in pulmonary tuberculosis (PTB). METHODS: Forth-two patients with PTB and 30 healthy subjects were enrolled in the study. The radiological extent of PTB, radiological sequela after treatment, and the degree of smear positivity were assessed. Chitotriosidase levels were measured by a fluorometric method. RESULTS: The serum chitotriosidase levels of the PTB patients were significantly higher than those of the control subjects (39.73+/-24.97 vs. 9.63+/-4.55 nmol/mL/h, P<0.001). After completion of the standard 6-month antituberculous treatment, chitotriosidase levels in PTB patients significantly decreased (10.47+/-4.54 nmol/mL/h, P<0.001). Chitotriosidase levels correlated significantly with the radiological extent of PTB, degree of smear positivity, and post-treatment radiological sequela score (r=0.439, r=0.449, and r=0.337, respectively). CONCLUSIONS: This study demonstrated that serum chitotriosidase levels increase in PTB; therefore, chitotriosidase can be used as a marker of disease activity, severity, and response to treatment.
Adult ; Antitubercular Agents/therapeutic use ; Biological Markers/blood ; Fluorometry ; Hexosaminidases/*blood ; Humans ; Male ; ROC Curve ; Severity of Illness Index ; Tuberculosis, Pulmonary/drug therapy/*enzymology/radiography ; Young Adult

We report a 63-years-old woman who developed a nodular lesion in right upper lobe (RUL) of lung after achieving a partial response with salvage chemotherapy for relapsed non-Hodgkin's lymphoma (NHL). Previously, she had been diagnosed as NHL and tuberculous lymphadenitis resulting a complete response with 8 cycles of CHOP regimen and anti-tuberculosis medication for 1 year. CT scan of the chest showed an irregular marginated soft tissue density in RUL with internal punctate calcifications and this lesion was difficult to discriminate between pulmonary tuberculosis and parenchymal involvement of NHL. Because the pulmonary infiltrations progressed despite empirical anti-tuberculosis medication, we performed bronchoscopic biopsy, showing diffuse large B-cell lymphoma. Thereafter, the pulmonary infiltrations were markedly improved with salvage chemotherapy. However, she died of refractory NHL despite high-dose chemotherapy with autologous peripheral blood stem cell transplantation.
Biopsy ; Diagnosis ; Drug Therapy ; Female ; Humans ; Lung ; Lymphoma ; Lymphoma, B-Cell ; Lymphoma, Non-Hodgkin* ; Pathology ; Peripheral Blood Stem Cell Transplantation ; Thorax ; Tomography, X-Ray Computed ; Tuberculoma* ; Tuberculosis ; Tuberculosis, Lymph Node ; Tuberculosis, Pulmonary

BACKGROUND: The human immune response to Mycobacterium tuberculosis is mediated by macrophages and T-lymphocytes. The alveolar macrophage phagocyting mycobacterium produces interleukin (IL) -1 as an inflammatory mediator, and IL-8 as a cytokine for leukocyte recruitment and granuloma formation. Interleukin-1 receptor antagonist (IL-1ra) is an internal antagonist of IL-1. METHODS: Plasma levels of IL-1ra and IL-8 and other serologic markers were measured in 18 patients with active tuberculosis before treatment and after 2 months and 6 months of treatment. RESULTS: During treatment with antituberculous medication, patients showed significant changes in hemoglobin, hematocrit, white blood cells (WBC), platelet, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), ferritin and plasma IL-1ra. After 2 months of treatment, ESR and CRP diminished significantly; after 6 months, hemoglobin increased while WBC, platelet, ESR, CRP and ferritin decreased significantly compared to their pre-treatment levels. There were two groups: patients with delayed therapeutic responses, and patients with early responses. At each point of observation, the former group of patients showed lower body weight and lower levels of hemoglobin and hematocrit, and higher levels of WBC, platelet, ESR, IL-8 and IL-1ra than the latter group. During the course of the treatment, we observed considerable differences in body weight, body mass index, hemoglobin, hematocrit, WBC and platelet counts, ESR, CRP and ferritin in both the early-response and delayed-response groups. CONCLUSION: We believe that the plasma concentrations of IL-1ra and IL-8, which showed different peaks during the course of treatment, reflected their different functions and patterns of secretion. Moreover the concentrations did not seem as sensitive as other inflammatory markers to evaluate disease activity during antituberculosis treatment. However, IL-1ra can be considered a marker for disease activity and response to treatment.
Adult ; Aged ; Aged, 80 and over ; Antitubercular Agents/therapeutic use ; Biological Markers/*blood ; C-Reactive Protein/analysis ; Comparative Study ; Female ; Human ; Interleukin-8/*blood ; Male ; Middle Aged ; Receptors, Interleukin-1/*antagonists & inhibitors ; Sialoglycoproteins/*blood ; Tuberculosis, Pulmonary/*blood/*drug therapy

BACKGROUND: Although various standard anti-tuberculosis chemotherapy regimens were suggested by World Health Organization in pulmonary tuberculosis, as yet, treatment regimen has not been established in intractable pulmonary tuberculosis. Also those surveys for intractable pulmonary tuberculosis were few. Therefore, the purpose of this study is to investigate the clinical course of radiological finding and pulmonary function pattern in intractable pulmonary tuberculosis, to assess the factors that affect the fate and so to make some suggestions for the management of intractable pulmonary tuberculosis. METHODS: This study population was composed of 40 patients with culture-proven pulmonary tuberculosis hospitalized. Although all 40 patients were received regular standard anti-tuberculosis chemotherapy which was individualized on the basis of susceptibility results, all patients were chronic excretors of mycobacterium tuberculosis bacilli (chronics), whose sputum cultures tested positive at both 11 and 12 months after admission. RESULTS: The rate of male and female was about 6:1 and mean age was 47.8+/-14.6 years old. Resistance to most of anti-tuberculosis drugs was observed and especially high degree resistance of isoniazid (95%), rifampicin (92.5%), ethambutol (87.5%), prothionamide and ofloxacin was found. Irrespective of the type of anti-tuberculosis chemotherapy and use of sensitive drug, clinical course was not significantly changed. On the pulmonary function test, most represented restrictive (57.5%) or combined pattern (27.5%) and had no significant interval change. Also arterial blood gas analysis finding was not changed. On chest X-ray findings, 80% had cavitary lesions, 87.5% showed far advanced stage and most (85%) had no significant interval change. However, 15% has changed to aggravation state, which had high frequency in patient with more than 3 susceptible drugs and significant decrease of FEV1 and FEV1/FVC on pulmonary function test findings that did not affect the mortality. The mortality rate was 30%, the average interval from diagnosis to death was 30.6+/-20.3 months and the fate was not associated with radiological findings, arterial blood gas analysis findings and pulmonary function test findings but only body weight at diagnosis of intractable pulmonary tuberculosis. CONCLUSIONS: The clinical course of intractable pulmonary tuberculosis that had no specific treatment did not depend on radiological findings and pulmonary function test findings but nutrition state at diagnosis. Therefore, in addition to anti-tuberculosis treatment, intractable pulmonary tuberculosis patient is recommended to be received aggressive conservative treatment that focuses on nutrition balance. Also it is probably essential to prevent the spread of intractable pulmonary tuberculosis to healthy person.
Blood Gas Analysis ; Body Weight ; Diagnosis ; Drug Therapy ; Ethambutol ; Female ; Humans ; Isoniazid ; Male ; Mortality ; Mycobacterium tuberculosis ; Ofloxacin ; Prothionamide ; Respiratory Function Tests ; Rifampin ; Sputum ; Thorax ; Tuberculosis, Pulmonary* ; World Health Organization

BACKGROUND: The human immune response to Mycobacterium tuberculosis is mediated by macrophage and T-lymphocyte. The alveolar macrophage phagocyting mycobacterium produced interleukin (IL)-1 as an inflammatory mediator and IL-8 as a cytokine for leukocyte recruitment and granuloma formation. Interleukin-1 receptor antagonist (IL-1ra) is an internal antagonist of IL-1. METHODS: Plasma levels of IL-1ra and IL-8 and other serologic markers were measured in 18 patients with active tuberculosis before treatment and after 2 months and 6 months of treatment. RESULTS: During treatment with antituberculous medication, patients showed significant changes of hemoglobin, hematocrit, white blood cell (WBC), platelet counts, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), ferritin and plasma IL-1ra. After 2 months of treatment, ESR and CRP were significantly diminished as compared with those before treatment. After 6 months of treatment, hemoglobin was increased and WBC, platelet counts, ESR, CRP and ferritin decreased significantly as compared with those before treatment. At each point of observation the group of delayed therapeutic response showed lower body weight, hemoglobin and hematocrit and higher WBC, platelet counts, ESR, IL-8 and IL-1ra than those of early responsive group. During the time course of treatment, significant differences were observed in body weight, body mass index, hemoglobin, hematocrit, WBC, platelet counts, ESR, CRP and ferritin for each group of early and delayed response. CONCLUSION: Plasma concentrations of IL-1ra and IL-8 might indirectly reflect their different patterns of secretion and functions with different peaks during the course of treatment and they seemed not so sensitive as other inflammatory markers to evaluate the disease activity during antituberculous treatment. However, IL-1ra can be considered a marker of disease activity and response of treatment.
Blood Sedimentation ; Body Mass Index ; Body Weight ; C-Reactive Protein ; Drug Therapy* ; Ferritins ; Granuloma ; Hematocrit ; Humans ; Interleukin 1 Receptor Antagonist Protein ; Interleukin-1* ; Interleukin-8* ; Interleukins ; Leukocytes ; Macrophages ; Macrophages, Alveolar ; Mycobacterium ; Mycobacterium tuberculosis ; Plasma* ; Platelet Count ; T-Lymphocytes ; Tuberculosis ; Tuberculosis, Pulmonary*

OBJECTIVETo evaluate of therapeutic efficacy of deoxyribouncleotidum on pulmonary tuberculosis.

METHODSEighty patients with pulmonary tuberculosis sustaining hepatic lesion after treatment with antituberculosis drugs were randomized into therapeutic group and control group. Patients in the control group received regular treatment and those in the therapeutic group had additional deoxyribouncleotidum injection.

RESULTSALT, AST, ALP and TBIL levels were significantly higher in the therapeutic group than in the control group 4 weeks after treatment. IgG, IgA, IgM levels, and CD3(+) and CD8(+) lymphocytes were significantly increased in the therapeutic group after treatment (P<0.05).

CONCLUSIONdeoxyribouncleotidum can improve hepatic function and immunity in patients with pulmonary tuberculosis.

Adjuvants, Immunologic ; administration & dosage ; therapeutic use ; Adult ; Alanine Transaminase ; metabolism ; Antitubercular Agents ; adverse effects ; therapeutic use ; Aspartate Aminotransferases ; metabolism ; CD3 Complex ; immunology ; CD8-Positive T-Lymphocytes ; cytology ; drug effects ; immunology ; Chemical and Drug Induced Liver Injury ; Deoxyribonucleotides ; administration & dosage ; therapeutic use ; Female ; Humans ; Immunoglobulin A ; blood ; Immunoglobulin G ; blood ; Immunoglobulin M ; blood ; Injections ; Liver Diseases ; blood ; drug therapy ; Male ; Middle Aged ; Treatment Outcome ; Tuberculosis, Pulmonary ; blood ; drug therapy

The correlation between serum anti-tuberculosis (TB) drug levels and the drug-induced hepatotoxicity (DIH) remains unclear. The purpose of this study was to investigate whether anti-TB DIH is associated with basal serum drug levels. Serum peak levels of isoniazid (INH), rifampicin (RMP), pyrazinamide (PZA), and ethambutol (EMB) were analyzed in blood samples 2 hr after the administration of anti-TB medication. Anti-TB DIH and mild liver function test abnormality were diagnosed on the basis of laboratory and clinical criteria. Serum anti-TB drug levels and other clinical factors were compared between the hepatotoxicity and non-hepatotoxicity groups. A total of 195 TB patients were included in the study, and the data were analyzed retrospectively. Seventeen (8.7%) of the 195 patients showed hepatotoxicity, and the mean aspartate aminotransferase/alanine aminotransferase levels in the hepatotoxicity group were 249/249 IU/L, respectively. Among the 17 patients with hepatotoxicity, 12 showed anti-TB DIH. Ten patients showed PZA-related hepatotoxicity and 2 showed INH- or RMP-related hepatotoxicity. However, intergroup differences in the serum levels of the 4 anti-TB drugs were not statistically significant. Basal serum drug concentration was not associated with the risk anti-TB DIH in patients being treated with the currently recommended doses of first-line anti-TB treatment drugs.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Alanine Transaminase/blood ; Antitubercular Agents/adverse effects/*blood/therapeutic use ; Aspartate Aminotransferases/blood ; Drug-Induced Liver Injury/*blood ; Ethambutol/adverse effects/blood/therapeutic use ; Female ; Humans ; Isoniazid/adverse effects/blood/therapeutic use ; Liver/*pathology ; Liver Function Tests ; Male ; Middle Aged ; Pyrazinamide/adverse effects/blood/therapeutic use ; Retrospective Studies ; Rifampin/adverse effects/blood/therapeutic use ; Tuberculosis, Pulmonary/drug therapy ; Young Adult

The correlation between serum anti-tuberculosis (TB) drug levels and the drug-induced hepatotoxicity (DIH) remains unclear. The purpose of this study was to investigate whether anti-TB DIH is associated with basal serum drug levels. Serum peak levels of isoniazid (INH), rifampicin (RMP), pyrazinamide (PZA), and ethambutol (EMB) were analyzed in blood samples 2 hr after the administration of anti-TB medication. Anti-TB DIH and mild liver function test abnormality were diagnosed on the basis of laboratory and clinical criteria. Serum anti-TB drug levels and other clinical factors were compared between the hepatotoxicity and non-hepatotoxicity groups. A total of 195 TB patients were included in the study, and the data were analyzed retrospectively. Seventeen (8.7%) of the 195 patients showed hepatotoxicity, and the mean aspartate aminotransferase/alanine aminotransferase levels in the hepatotoxicity group were 249/249 IU/L, respectively. Among the 17 patients with hepatotoxicity, 12 showed anti-TB DIH. Ten patients showed PZA-related hepatotoxicity and 2 showed INH- or RMP-related hepatotoxicity. However, intergroup differences in the serum levels of the 4 anti-TB drugs were not statistically significant. Basal serum drug concentration was not associated with the risk anti-TB DIH in patients being treated with the currently recommended doses of first-line anti-TB treatment drugs.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Alanine Transaminase/blood ; Antitubercular Agents/adverse effects/*blood/therapeutic use ; Aspartate Aminotransferases/blood ; Drug-Induced Liver Injury/*blood ; Ethambutol/adverse effects/blood/therapeutic use ; Female ; Humans ; Isoniazid/adverse effects/blood/therapeutic use ; Liver/*pathology ; Liver Function Tests ; Male ; Middle Aged ; Pyrazinamide/adverse effects/blood/therapeutic use ; Retrospective Studies ; Rifampin/adverse effects/blood/therapeutic use ; Tuberculosis, Pulmonary/drug therapy ; Young Adult