Tubercle disease make a diagnosis standard _'s treatment

Tubercle disease make a diagnosis standard _'s treatment
Tubercle Definition: Tubercle (Sarcoidosis) Many systems that it is the unidentified reason are disorderly, its characteristic is immunoreaction of enhanced cell of sick position and the cheese a kind of granulation is swollen to exist. Diagnostic standard Corresponding clinic or chest X-ray indication It is not that a kind of granulation of cheese is swollen that histology is checked and shown The bacterium, fungi check negatively Except other granulation swelling disease Diagnose the step: X-ray HR-CT Lung function VC, FEV1, DLco ECG, UCG, myocardium phenomenon PPD tests, ACE, blood calcium, urine calcium, liver enzyme Eye inspection The fibrous bronchus mirror checks, lives by the bronchus wall lung and examines (TBLB) , the bronchus alveolus is irritated and washed (BAL) Acute tubercle (Lofgren' s syndrome) Characteristic ? Enlargement of lymph nodes of one pair of lungs door ? Arthritis ? Nodular erythema In addition often with generate heat and muscle ache, uncomfortable, 85% of the patients relieve in one year naturally Subnormal temperature chronic tubercle Symptom behaves: There is not symptom 45% Cough, have difficulty in breathing, uncomfortable in chest 30% The unable, weight is lightened, uncomfortable 10% Eyes, parotid gland, skin, peripheral enlargement of lymph nodes 15% What is not histology does not check and set up diagnosing is accorded with enough Lofgren' s syndrome Panda + Lambda (gallium scans) BAL: CD4/CD4>3.5 Histology does not check the dependability (clinical +X thread) diagnosed The tubercle I stage: 98% The tubercle II stage: 89% The tubercle III stage: 52% 0 issues tubercles: 13% Differential diagnosis: Malignant lymphoma, tuberculosis, bronchus lung cancer, the quality among other source anaphylactic alveolus inflammation or other lungs is ill, cancer lymphangitis The treatment is pointed out: ? Obvious symptom ? Serious or the going on function is damaged ? Does the chest slice show going on and ooze out and change? ? Behaving needs treating outside the lung: ? Heart (rhythm of the heart is not normal, the heart is depleted) ; Eyes; Nerve; Hypercalcemia disease, high calcium urine; The skin out of shape changes Regular treatment of of lung tubercle Begin the dosage: The intersection of prednisone and 20-40mg/day, 1-3Mon, according to react, appraise slowly decrement to 5-10 mg/day, keep June - December, park behind the medicine recuring 16-74%. Substitute the treatment: Sulphur thiazole purine Azathioprine 100-150mg/day First ammonia butterfly purine Methotrexate 10-25mg/w; Chloroquine Hydrochloroquine 400mg/day Indication of glucocorticoid with therapeutic part Iris inflammation grape and membrane inflammation Nasal polyp The bronchus is oozed out Other and complication treatment Song mould bronchiectasis: The operation excises, bronchus artery thromboembolism The bone is loosened disease: Vitamin D, calcium, lower calcium plainly Rehabilitation, oxygen are treated The lung is transplanted Natural course of disease Relieve 60-70% naturally Chronic going on 10-30% of course Involve 4-7% outside the serious lung 10-20% permanently Mortality is 1-5% (breath, centre, heart) Bad factor of the prognosis Lupus, chronic grape and membrane inflammation, 40 over the 40 Follow and observe The tubercle I stage: Every June; Other one: Every March - June; At least 3 years. In if X-ray normalization 2, needn't continue following!; The patient that relieves to the hormone treatment wants to strengthen and follow observing.
|