Во-первых, у нас тут три дня подряд штормит с громом-молниями (такими, что мы помчались вырубать им доступ к наших электронным приборам!) и проливным дождём-и-градом типа "Ой, мама, не надо!"
по 30-40 минут... А потом - радуга
Такого раньше не было - "гады физики на пари" чё то ни то накрутили...
Во-вторых, я просился на работу по 5 часов 4 раза в неделю, но мне таки всучили работу на полную ставку...
Без дежурств, понятно..
Вот мои мальчики:
мои ребята.1.jpg
У нас прошлая неделю была абсцессная...
После месяца мастурбирования терапевты подарили нам тётю вот с такой картиной в печени ..
Абсцессы печени 20%.jpg
Сейчас я на них не в обиде..
Не только потому, что я дренировал коммунальную-квартиру-из-многих-сообщающихся-комнат и получил более литра гноя...
А потому, что я впервые в жизни встретил туберкулёзный абсцесс печени
-Это было подтверждено сегодня утром результатом посева гноя..
Литература:
1.
Liver International. 2003;23(5)
Isolated Tuberculous Liver Abscesses With Multiple Hyperechoic Masses on Ultrasound: A Case Report and Review of the Literature
Hsiang-Cheng Chen, You-Chen Chao, Rong-Yuan Shyu, Tsai-Yuan Hsieh
Primary hepatic TB is rare. Although liver TB is more commonly encountered in Asian nations, it is occurring more frequently in Western countries, probably due to increased immigration as well as to an increase in patients with the acquired immunodeficiency syndrome (AIDS).[5] In other words, increased susceptibility to infection is a well-known feature of uremia and liver cirrhosis. In two prospective reviews involving 171 non-AIDS patients with hepatic TB, no isolated tuberculous liver abscess was described.[6,7]
Rolleston and McNee[8] classified hepatic TB into the miliary and local forms in 1929. Since then, researchers have described three morphologic types of hepatic TB: (1) miliary TB of the liver associated with generalized miliary TB; (2) primary miliary TB of the liver without involvement of other organs; and (3) a primary nodular lesion termed tuberculoma or a frank abscess.[9]
Of these, primary tuberculous abscess of the liver is the rarest, and has been reported sporadically, with only 17 cases previously reported in the literature until 1991.[10] Hepatic involvement was found clinically in 50-80% of all patients dying of pulmonary TB and in up to 91% at autopsy.[11,12] However, the focal or nodular form presenting as tuberculoma or abscess without extrahepatic manifestations is much less common. Severe liver dysfunction and jaundice are uncommon in primary TB abscess of the liver. An elevated alkaline phosphatase level, however, is the most commonly noted abnormality.[8,13] Korn et al.[13] studied hepatic function in 50 patients with extrapulmonary TB and found that the most frequent abnormalities were hypoproteinemia, elevated alkaline phosphatase, and hyperglobulinemia. Hyperbilirubinemia, if present, is mild. Reversed albumin and globulin (A/G) ratio and disproportional elevation of the serum alkaline phosphatase level were characteristic biochemical features.[8,9]
2.
PastedGraphic-1.tiff
Primary tubercular liver abscess in an immunocompetent adult: a case report
CP Baveja*, Vidyanidhi Gumma, Monica Chaudhary and Himanshu Jha
Introduction
Isolated primary tubercular abscess is one of the rare forms of extrapulmonary tuberculosis. A greater awareness of this rare clinical entity may help in commencing specific evidence-based therapy quickly and preventing undue morbidity and mortality.
Case presentation
A 30-year-old man, of Asian origin, developed a hepatic tubercular abscess which was not associated with any pulmonary or gastrointestinal tract foci of tuberculosis. An ultrasonogram of the abdomen showed an abscess in the right lobe of his liver which was initially diagnosed as an amoebic liver abscess. Subsequently, the pus from the lesion yielded Mycobacterium tuberculosis using the BACTEC TB 460 instrument and Mycobacterium tuberculosis deoxyribonucleic acid by polymerase chain reaction. The patient was started on systemic antitubercular therapy to which he responded favorably.
Conclusion
This report emphasizes the fact that, although a tuberculous liver abscess is a very rare entity, it should be included in the differential diagnosis of unknown hepatic mass lesions.
Introduction
Though hepatic tuberculosis is not a rare disease entity, tubercular liver abscess (TLA) is extremely rare even in a country where tuberculosis is an alarming public health problem. It is usually associated with foci of infection either in the lung and/or gastrointestinal (GI) tract [1], or with an immunocompromised state. An isolated or primary TLA with no evidence of tuberculosis elsewhere is even rarer. The diagnosis is difficult in most instances and is frequently confused with hepatoma, pyogenic liver abscess or amoebic liver abscess [2-4]. The rarity of this clinical entity prompted us to present this case which involves an immunocompetent adult with an isolated hepatic tubercular abscess and with no foci of infection in the lungs or GI tract.
