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Titolo:
Tuberculous peritonitis - reports of 26 cases, detailing diagnostic and therapeutic problems
Autore:
Demir, K; Okten, A; Kaymakoglu, S; Dincer, D; Besisik, F; Cevikbas, U; Ozdil, S; Bostas, G; Mungan, Z; Cakologlu, Y;
Indirizzi:
Istanbul Fac Med, Div Gastroenterohepatol, Dept Internal Med, Istanbul, Turkey Istanbul Fac Med Istanbul Turkey l, Dept Internal Med, Istanbul, Turkey
Titolo Testata:
EUROPEAN JOURNAL OF GASTROENTEROLOGY & HEPATOLOGY
fascicolo: 5, volume: 13, anno: 2001,
pagine: 581 - 585
SICI:
0954-691X(200105)13:5<581:TP-RO2>2.0.ZU;2-G
Fonte:
ISI
Lingua:
ENG
Soggetto:
ADENOSINE-DEAMINASE ACTIVITY; HEPATOTOXICITY; RIFAMPIN;
Keywords:
diagnosis; laparoscopy; triple therapy; tuberculous peritonitis;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Citazioni:
35
Recensione:
Indirizzi per estratti:
Indirizzo: Demir, K Rhode Isl Hosp, Liver Res Ctr, Providence, RI 02903 USA Rhode IslHosp Providence RI USA 02903 Providence, RI 02903 USA
Citazione:
K. Demir et al., "Tuberculous peritonitis - reports of 26 cases, detailing diagnostic and therapeutic problems", EUR J GASTR, 13(5), 2001, pp. 581-585

Abstract

Objective To evaluate the clinical presentation, biochemical (ascites and serum) and laparoscopic findings, and to assess the efficacy of triple antituberculous therapy without rifampicin for 6 months in patients with tuberculous peritonitis. Methods Twenty-six tuberculous peritonitis patients (11 male, 15 female) with a mean age of 34.8 +/- 3.4 years (range 14-77) were assessed with regard to diagnostic and therapeutic features. Results The most common symptoms and signs were abdominal pain (92.3%) andascites (96.2%), respectively. Tuberculin skin test (TST) was positive in all patients. An abnormal chest radiography suggestive of previous tuberculosis was present in five patients (19.2%), and two patients (7.7%) had extra-peritoneal (cerebral, pericardial) active tuberculous involvement. In 24 of the 25 patients who underwent laparoscopy with directed biopsy, whitish nodules suggested tuberculous peritonitis; 76% of the biopsy specimens revealed caseating, 20% non-caseating granulomatous inflammation, and 4% non-specific findings. The ascitic fluid of one patient (3.8%) was positive for acid-resistant bacilli, and culture was positive in two patients (7.7%). Twenty-four of the patients were treated for 6 months with isoniazid, streptomycin (total dose 40 g) and pyrazinamide (for the first 2 months and then substituted with ethambutol). Eighteen patients also received methyl prednisolone, initially 20 mg/day, for 1 month. The follow-up period was 19 +/- 1.7months after the end of therapy (range 6-36). Ascites and abdominal pain abated earlier in patients on steroid therapy. AII but two of the 24 patients responded to treatment. Conclusion Non-invasive tests such as acid-fast stain and culture of the ascitic fluid are usually insufficient, hence invasive laparoscopy and peritoneal biopsy are necessary for the diagnosis of tuberculous peritonitis if non-invasive tests such as ascites adenosine deaminase activity measurementare not easily available. Triple therapy without rifampicin for 6 months is sufficient to treat tuberculous peritonitis. for J Gastroenterol Hepatol 13: 581-585 (C) 2001 Lippincott Williams & Wilkins.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 06/04/20 alle ore 00:31:30