Chinese Medical Journal

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CURRENT CHINESE MEDICAL LITERATURE 98

Clinical Study of 35 Cases of Tuberculous Meningitis in Adults. Wei Pei-Hai and Kuo_ Hsien-Chien. Chinese J. Tuberc. 4(1):13-17, 1956.

From 1951 to September 1954 there were 35 adult cases of tuberculous meningitis in the authors’ hospital, constituting 2.4 per cent of the total number of patients admitted and around 1 per cent of medical patients during the same period. The numbers of male and female patients were roughly equal. Fifteen of the 35 patients were from 15 to 24 years of age; 8 patients were older than 40 years.

Among the 35 patients, 16 (45.7 per cent) suffered from pulmonary tuberculosis at the same time, including 5 with military tuberculosis; 8 had extrapulmonary tuberculosis and 11 showed no-evidence of tuberculosis elsewhere in the body.

All the patients had headache and fever, and in 17 of them headache was the earliest symptom. Nausea occurred in 80 per cent, vomiting in 60 per cent and mental cloudiness of varying degrees in 57 per cent. Stiffness of the neck occurred in 97 per cent and Kernig’s reactions in 88.5 per cent. Increased white blood count occurred in 80 per cent of the patients, and polymorphocytosis in 60 per cent. :

Spinal fluid findings. Except for 1 patient who had only 9 cells per cu mm all the rest had an increased count, 80 per cent showed chlorides of 700-600 mg per cent and 20 per cent showed below 600 mg per cent. Sugar: 22.8 per cent showed 40-50 mg per cent, 45.7 per cent 40-20 mg per cent, and 17.1 per cent showed 20 mg per cent or less. All were Pandy positive. Among 19 spinal fluid specimens examined, 63.1 per cent were positive for pellicle formation, and 37.9 per cent were positive for tubercle bacilli.

Treatment. Streptomycin 1-gm_ daily was first given intramuscularly; when the body temperature became normal it was reduced to 1 gm every three days. INH 300 mg daily orally and 30-50 mg per day intraspinally. PAS 12-15 gm daily. Treatment was divided into three stages of about three months each: streptomycin and INH in the first stage, streptomycin and PAS in the second and INH and PAS in the third.

Result. Seven patients died within ten days of treatment, 1 died during the first stage and another in the third stage of treatment: a total of 9 deaths (25.7 per cent) and, of these, 6 patients came to the hospital unconscious. Tet Cha

Clinical Study of 80 Cases of Tuberculous Peritonitis in Adults. Ch’ien Yuan-Fu, Hsieh Yi-Jung, Ch’i Jen-An, Lin Hstian and Ch’iu Shao-Chen. Chinese J. Tuberc. 4(1):29-33, 1956.

The material of this study was collected from the chest surgery and gynecological services of the authors’ hospital from 1951 to 1954. The male and female cases were about equal in number. The cases were divided on a pathological basis into three groups: exudative or ascitic, 39 cases (48.7 per cent); adhesive or plastic, 38 cases (47.5 per cent) ; and caseous or ulcerative, 3 cases (3.8 per cent).

The diagnosis of tuberculous peritonitis is difficult. Except in a few cases where tubercle bacilli were demonstrated in the ascitic fluid or sputum, diagnosis of most of the cases in this series was made from general findings or the presence of tuberculosis in the lung or elsewhere in the body. Ascitic fluid, when obtainable, generally had specific gravity above 1.018, protein contents above 2.5 gm per cent and WBC above 5,000 -per cu mm with preponderance of lymphocytes.

X-ray examination gave valuable information particularly with the adhesive type where adhesion and narrowing of the intestines could be seen. Of 62 cases of the present series thus examined, half of them showed positive findings.

Acute and chronic cases were particularly difficult to diagnose. With the former, differentiation from other forms of acute abdomen could only be made when the abdomen was surgically explored. There were 10 such cases in this series. With the chronic cases, there were a few patients who were mildly sick for one to two years before admission.

The most common complications were tuberculosis elsewhere in the body. There were in this series 32 cases (40 per cent) with tuberculosis of the lung, 20 cases (25 per cent) with tuberculosis of the pleura, and 13 cases (16 per cent) with tuberculosis of the intestine.