肺结核:诊断和未诊断为死亡原因

S. Gandhi, Pinal Shah
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摘要

目的:本研究旨在了解肺结核的发病率、肺结核的组织病理学模式分析以及相关的非肿瘤性变化,以及在死亡原因中的作用。方法:根据2017年1月至2017年12月在古吉拉特邦南部三级护理医院病理科诊断的23例病例的组织形态学评估,进行了一项回顾性横断面研究。我们收到了肺、心脏、肝脏、肾脏、脾脏和大脑的大体标本,用于所有尸检病例的尸检。在一年的时间里,我们对所有进行组织病理学检查的尸检病例进行了大体病理学和组织病理学分析。结果:在本研究的656例尸检病例中,23例(3.5%)为肉芽肿性炎症。诊断的平均年龄为38岁。男性(65.2%)受影响程度高于女性。在死亡前的23例病例中,只有21.7%被诊断为肺结核。在所有病例的肺部都有发现,同时还观察到扩散到肝、脾、肾和大脑。Zeihl-Neelson染色显示抗酸杆菌的存在,在91%的病例中证实了结核性炎症的诊断。结论:肺结核在尸检中并不罕见。缺乏尸检诊断可能是由于世界某些地区存在社会污名,阻碍人们及时寻求医疗援助,或者是肺结核病例的非典型表现。事实上,即使是尸体解剖也可能在帮助改善社区卫生服务方面发挥作用。
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Tuberculosis: Diagnosed and Undiagnosed as a Cause of Death
Aims and Objectives: This study has been conducted to find out the frequency of tuberculosis, histopathological pattern analysis of tuberculosis along with associated non-neoplastic changes and there role in the cause of death. Methodology: A retrospective cross-sectional study is done based on a Histomorphological evaluation of 23 cases diagnosed at Department of Pathology, tertiary care hospital of south Gujarat from January 2017 to December 2017. We received the gross specimen of the lungs, heart, liver, kidney, spleen, and brain for post-mortem examination in all autopsy cases. We did gross pathological and histopathological analysis of all the autopsy cases sent for histopathology over a period of one year. Results: In the present study out of 656 autopsy cases, 23 cases (3.5 %) were of granulomatous inflammation. Mean age of diagnosis was found to be 38 years. Males (65.2%) were more affected than females. Tuberculosis was diagnosed in only 21.7 % of total 23 cases before death. Findings were found in the lung in all cases while spread to the liver, spleen, kidney, and brain was also observed. Zeihl Neelson stain showing the presence of Acid Fast Bacilli confirms the diagnosis of tuberculous inflammation in 91% of cases. Conclusion: Tuberculosis is not an uncommon finding at autopsy. The lack of diagnosis pre mortem might be attributable to either the presence of social stigma in some parts of the world that dissuades people from seeking timely medical assistance, or non-typical presentations of tuberculosis cases. Indeed, even autopsies potentially have a role in helping improve community health services.
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