• Annals of Clinical Neurophysiology
• /
• 제4권2호
• /
• pp.140-145
• /
• 2002

Neurologic sequelae of tuberculous meningitis include hemiparesis, paraparesis, quadriparesis, aphasia, developmental delay, dementia, blindness, visual field defect, deafness, cranial nerve palsies, epilepsy, and hypothalamic and pituitary dysfunction. But cervical epidural abscess and cervical spondylitis are rare. A 64-year-old woman who was diagnosed as tuberculous meningitis presented a severe neck pain and stiffness after 3 weeks of anti-tuberculous medication. Electromyography and cervical X-ray showed a cervical spondylosis with polyradiculopathy. But cervical MRI showed an acute cervical epidural abscess and mild cervical spondylitis. After continuous anti-tuberculous medication with supportive care, she showed a slow clinical improvement. But about 1 month of anti-tuberculous therapy, she presented a more aggravation of neck pain, neck stiffness, radicular pain, and neck motion limitation. Follow-up cervical MRI showed an more advanced cervical spondylitis. Afterthen she has recovered slowly by cervical laminectomy with posterior stabilization and continuous anti-tuberculous medication.

• 대한기관식도과학회지
• /
• 제5권1호
• /
• pp.7-13
• /
• 1999

Background and Objective： The tuberculous lymphadenitis of neck is one of the most common extra-pulmonary tuberculosis in Korea. Although the incidence of pulmonary tuberculo-sis has decreased recently, that of cervical tuberculous lymphadenitis has not decreased. In spite of great efforts and diversity of study, the exact criterias of diagnosis and optimal therapeutic methods of cervical tuberculous lymphadenitis have been the subject of much debate and still remain unclear. So we intend to enucleate clinical manifestations and suggest the optimal therapeutic manners. Material : The 483 cases, diagnosed as cervical tuberculous lymphadenitis by fine needle aspiration biopsy during the past 10 years from Jan. 1987 to Dec. 1996 Method : Retrospective study Results 1) The overall rate of tuberculous cervical lymphadenitis was 23.4% of neck mass. 2) Incidence ratio of male to female was 1：2.7 3) The frequent location of tuberculous lymphadenitis was posterior cervical area, supraclavicular area, jugular chain in order. 4) The response rate of medical treatment in tuberculous cervical lymphadenitis was 84.9%. 5) The duration of medical treatment in remissioned group was 18.6 months in average. 6) Surgical intervention was needed in 15.1%. 7) The duration of post operative medical treatment was 18.4 months in average. Conclusion : Tuberculous cervical lymphadenitis is prevalent in women, age of 20-40 years and mainly involve posterior cervical area. Fine needle aspiration biopsy is a very useful method for early detection of cervical tuberculous lymphadenitis. After diagnosis is made, anti-tuberculosis medication is recommended for more than 18 months. Unless the size of neck mass is decreases inspite of the thorough anti-tuberculosis medication for more than 1 month or if complication like as abscess or fistula occurs, surgery is needed with post operative medical treatment for more than 12 months.

• 대한두경부종양학회지
• /
• 제18권2호
• /
• pp.192-196
• /
• 2002

Objectives: Tuberculous cervical lymphadenitis is a frequently recurring disease when treated with chemotherapy alone without enough surgical removal of the tuberculous lesions. Authors reviewed retrospectively the treatment result of antituberculous chemotherapy following almost complete surgical removal of tuberculous foci in the neck. Materials and Methods: A retrospective clinical review and analysis was made in 127 cases of tuberculous cervical lymphadenitis patients treated during the past 10 years from 1989 to 1998 at the Department of General Surgery, Inje University Paik Hospital, Pusan. Results: 1) The peak age incidence was the 2nd decade(37.8%), and female was predominated over male by 2.3:1. 2) The time interval from the onset of symptoms to the first visit was less than 3 months in 60.6% of the patient. 3) The location of lymphadenitis was the right neck in 60%, the left neck 34%, and bilateral in 6% of the patient. 4) Signs on the first visit showed solitary masses(60%), abscess(25%) and both mixed(15%). 5) 25 patients(19%) had present or past history of tuberculosis; pulmonary tuberculosis 12 patients, tuberculous lymphadenitis 10 patients, and others 3 patients. 6) Locations of tuberculous lymphadenitis were posterior cervical triangle 70, supraclavicular 51, submandibular 19, anterior triangle 16 and others 4 cases. 7) The principle of treatment of cervical lymphadenitis was surgical management followed by chemotherapy. Surgical procedures were excision(s), curettage and drainage of abscess, combination of both, and biopsy in 60%, 22%, 12% and 6% respectively. Mean duration of antituberculous medication was 9 months after surgery. 8) The rate of recurrent and persistent tuberculous lymphadenitis was 9% in 4 years follow up. Conclusion: Tuberculous cervical lymphadenitis is a frequently recurring disease in young adult when only antituberculous chemotherapy was employed without almost complete removal of the lesions. It is considered that antituberculous medications for 6-9 months after removing the foci at a maximal extent by surgical excision and curettage will reduce the recurrence rate or persistence of tuberculous lymphadenitis.

• 대한두경부종양학회지
• /
• 제11권1호
• /
• pp.3-8
• /
• 1995

Tuberculous cervical lymphadenitis is one of common cause of neck mass in young adult in Korea. Tuberculous cervical lymphadenitis known as scrofula was being treated by the 'Royal Touch' in the 5th century and by surgery in the 17th century, yet the principle of the treatment is still controversal. We report the clinical evaluation and therapeutic result about 121 tuberculous cervical lymphadenitis. The result were as follows: 1) The annual incidence(1985-1994) was 30.5 % (37 cases: 1985-1986), 17.7 % (21 cases: 1990-1992). 19.8%(24 cases: 1994). 2) The age of highest incidence was 20-29 year old age group in 41.3% (50 cases) and female predominated over male by 1.8 : 1. 3) The duration of disease was less than 6 months, in 85.9% (104 cases). 4) The most commonly involved LN group was superficial cervical group in 69.4% (84 cases), and difference between Rt & Lt, was not significant. 5) The most common symptom and local finding(P/E) were, painless swelling of LN in 74.3 % (90 cases) and single mass in 59.5 % (72 cases). 6) In seasonal variation, 85.9% (104 cases) was spring and summer. 7) Procedures except biopsy for evaluation were chest PA, AFB smear & culture(sputum), Mantoux test, USG, CT and, Associated extracervical tuberculous lesions were lung, axilla, breast. 8) In operation method (involving biopsy), Excision was 68.5 % (83 cases), neck dissection was 6.6% (8 cases). 9) The Modality, Duration and side effect of antituberculous medication: INH-Rifampin­Ethambutol was 66.1 % (88 cases), duration was 1 year in 84.3% (102 cases), side effects were severe GI trouble (24.8%), liver function damage (3.3%). 10) 3 cases recurred on the same site after 2 yrs(2 cases) and 4 months(1 case) and its treatment was curretage or I & D, with antituberculous medication.

• Tuberculosis and Respiratory Diseases
• /
• 제43권3호
• /
• pp.434-439
• /
• 1996

저자들은 경부에 결핵성의 단일 한성농양을 보인 환자를 경험하였으며, 이 환자에서 결핵성 흉막염 치료시 소방형성으로 인해 흉수액의 배액이 안되었으나 도관을 통한 유로키나제의 주입으로 별다른 합병증없이 만족할만한 결과를 얻었기에 문헌고찰과 함께 보고하는 바이다.

• Tuberculosis and Respiratory Diseases
• /
• 제42권1호
• /
• pp.35-41
• /
• 1995

연구배경: 결핵성 경부임파선염의 진단은 임상소견, 흉부 X-선검사, 튜베르큘린검사의 비관혈적 방법으로 내리기 어려워, 경부 임파절 생검을 필요로 하는 경우가 많다. 저자들은 종합효소연쇄반응(polymerase chain reaction, PCR) 기법을 이용하여 결핵성 경부임파선염을 진단할 수 있는지 알아보고, 가능하다면 그 유용성을 평가해 보고자 본 연구를 시행하였다. 방법: 경부 종물로 내원한 환자의 생검 조직과 세침흡인 검체 29예에서 DNA를 추출하여, 결핵균 DNA인 IS6110의 일부를 복제하기 위한 IS-1,-2를 primer로 사용하여 PCR을 시행하였다. 결과는 임상적 진단 및 병리, 세균학적 진단과 비교하였다. 결과: 평균 107.5mg의 생검조직과 2회 세침흡인 검체에서 추출한 DNA의 양은 각각 평균 $32.46{\pm}17.22mg$과 $220{\pm}140ng$이었고 $OD_{260}/OD_{280}$은 각각 $2.11{\pm}0.23,\;2.76{\pm}0.39$이었으며, 상존유전자인 $\beta$-actin 유전자를 목표로 하는 PCR은 전예에서 양성이었다. 병리학적으로 결핵으로 진단한 8예중 8예 전예에서, 병리소견상 확진되지 않았으나 임상적으로 결핵성 경부임파선염으로 진단한 8예중 5예에서, 병리학적으로 악성 임파절전이나 갑상선낭종으로 진단되어 결핵성 경부임파선염이 배제된 6예중 0예에서, 그리고 임상적으로 결핵성 경부임파선염이 배제된 7예중 2예에서, 결핵균 DNA를 목표로 한 PCR 결과가 양성이었다. 결론: 경부 임파절 조직과 세침흡인 검체의 결핵균 PCR 기법은 결핵성 경부임파선염의 진단에 유용한 방법이라고 생각한다.

• 대한두경부종양학회지
• /
• 제8권2호
• /
• pp.91-96
• /
• 1992

The efficacy of the fine needle aspiration biopsy and cytological examination(FNABC) under ultrasonographic(US) guides for the diagnosis of cervical tuberculous lymphadenitis was assessed. There were one hundred and one patients whose neck masses were proven to be tuberculous lymphadenites with cytologic and/or histologic diagnosis. The physical characteristics shown by US revealed that all the cases were multiple lesions. Multiregional lesions were found in 80 cases(79.1%) and 19 cases(18.8%) were the bilateral lesion. The region V was the most prevalent site(n=69, 68.3%). US findings revealed 92 cases(90.9%) showed hypoechoic lesions and 9(9.1%) showed mixed echo patterns. There was no hyperechoic lesion (p<0.05). The sensitivity of FNABC was 77.2% and specificity was 99.0%. Diagnostic accuracy was 85.0%. There was no complication during the procedures. FNABC for the diagnosis of cervical tuberculous lymphadenitis is a safe, convinient procedure and has a high specificity. The pitfall of FNABC the low sensitivity, seemed to be compensated by US evaluations.

• Tuberculosis and Respiratory Diseases
• /
• 제44권6호
• /
• pp.1225-1233
• /
• 1997

연구배경 : 폐결핵은 세계적으로 발병율이 점차 추세에 있으나 결핵성 임파선염은 그 빈도가 그대로 유지되고 있다. 하지만 아직도 치료기간을 어느 정도로 해야할 지, 임파선이 줄지 않을 경우 치료에 반응이 있는 것인지 판단하기가 어렵다. 그리고 다른 부위의 결핵과의 연관성도 많이 알려져있지 않아 결핵성 임파선염의 임상양상과 치료기간, 타 장기의 결핵과 관련성에 대하여 후향적 고찰을 시행하였다. 방 법 : 1990년 1월 1일부터 1996년 8월 30일 까지 본원 흉부내과에 내원하여 임파선의 세침홉인검사를 통해 결핵성 경부임파선염으로 진단 받은 환자 120명을 대상으로 후향적 고찰을 시행하여 다음과 같은 결과를 얻었다. 결 과 : 1) 결핵성 경부 임파선염은 20 대에서 53.3% 로 가장 호발하였으며 여지에서 2.5배 더 많았다. 경부의 종괴촉진을 주소로 내원하는 경우가 80.0%로 가장 많았다. 경부 임파선염은 후경부에 가장 호발하였으며 좌우측에 침범하는 빈도는 비슷하였다. 2) 침범된 임파선염의 세침홉인검사를 시행하여 조직학적 검사상 결핵성 임파선염으로 진단된 경우는 82.3%이었고 홉인검체물로 항산균도말검사를 시행하여 양성은 38.6%, 결핵균배양에서 17.6%가 양성이었다(p<0.001). 3) 폐결핵은 79예(65.8%)에서 동반되었으며 대부분 경증폐결핵이었다(53.8%). 폐외결핵은 14명(11.7%)에서 동반되었으며 그중 결핵성 늑막염이 6명(42.8%)으로 가장 많았다. 4) 치료는 항결핵제복용(1차약, EHRZ)을 원칙으로 하였으며 평균치료기간은 18.5개월이었다. 치료기간동안 75.8%는 점차 크기가 줄어들었으며 30.4%에서 새로운 임파선이 발생하였고 26.8% 에서 농양이 형성되었으며 17.0%에서 누공이 형성되었다. 결 론 : 결핵성 임파선염은 젊은 여자에서 호발하는 질병으로 경부 임파선을 가장 많이 침범한다. 결핵성 임파선염은 전신적인 질환의 한 표현으로 여겨지며 타 장기의 결핵과 동반되는 경우도 빈번하다. 이는 대부분 항결핵제치료로 완치될 수 있으며 치료기간은 약 18~24개월을 요한다. 항결핵제를 계속 복용함에도 불구하고 크기가 커지거나 새로운 임파선염이 생가고 농양, 누공이 형성될 수 있으나 항결핵제로 지속적인 치료를 요하며 임파선의 세침흡인검사를 반복하여 결핵균이 있는지 여부를 보는 것도 치료효과를 판정하는데 도움을 주리라 생각한다. 충분한 결핵약 치료에도 불구하고 계속 커지거나 농양, 누공이 생겨 환자에게 불편을 초래하는 경우에는 완전절제생검를 고려해본다.

• Journal of Yeungnam Medical Science
• /
• 제1권1호
• /
• pp.135-138
• /
• 1984

결핵성 척추압박골절등 결핵성 척추 골성변화나 결핵성 농양의 흔적이 전혀없이 척수강 배면에 발생한 아주 희귀한 단순성 단발성 경 척수강의 결핵성 육아종에 의해서 초래된 척수신경 압박증예를 치험하고 해부병리학적으로 확진한 후 문헌고찰과 함께 보고한다.

• 대한치과의사협회지
• /
• 제25권2호통권213호
• /
• pp.106-106
• /
• 1987