Tropical Doctor, July 1992
129
of colostomy training and care", This is much easier in children whose parents are taught simple and inexpensive methods of care; faecal soiling is controlled by using a pad of clean cloth over the stoma and a larger one is wrapped over it to hold it in place by tying the limbs of this other 'covering cloth' at the back. When soiled, these are replaced and the soiled ones washed for re-use. Bags are usually used by adults - and a disposable bag can be used many times for as long as 2 weeks or more. Our approach towards encouraging acceptance has been to have prospective patients interact freely with another patient who has a successful colostomy. Our preference in infants and children is for a right transverse colostomy. It has less smell. It is better
managed by mothers, because faeces is easier to collect higher up in the trunk using the 'wrapping method' than from colostomies placed lower down. There was a high overall morbidity of 188 complications (Table 1). This is higher than in series from Europe and North America",
Clinical characteristics of tuberculous lymphadenitis in Tanzania
December 1988. All biopsies had been interpreted by pathologists at the department of histopathology at MMC. All available corresponding clinical case notes of these patients were also reviewed. The patients' age, sex, main presenting symptoms and signs and results of histological and bacteriological evaluation were recorded on special data forms. Where appropriate, the data were analysed by the chi-squared test with Yates' correction for 2 x 2 tables, and by a multivariate logistic regression analysis.
Clemens Richter MDI Joseph S Kimara'
James N Kitinya MB ChB2 , Karim F Hirji PhD 3
Departments of "Medicine, 2Pathology and 'Epidemiology/ Biostatistics, Muhimbi/i Medical Centre, PO Box 65001, University of Dar es Salaam, Tanzania TROPICAL DOCTOR,
1992,22, 129-130
INTRODUCTION
A rising incidence of tuberculous (TB) lymphadenitis and other forms of extrapulmonary tuberculosis has been noted in developed and developing countries in the recent years. This has been associated with the spread of the HIV virus infection!">. Data from Tanzania indicate that between 1984and 1988extrapulmonary tuberculosis increased by 94%, while pulmonary tuberculosis rose by 32070 5 • Limited facilities in developing countries can make it difficult to distinguish TB lymphadenitis from other forms of lymphadenopathy. In such a situation it would be useful if TB adenitis could be distinguished from other forms of adenitis on clinical grounds. PATIENTS AND METHODS
We performed a 5 year retrospective study by reviewing the results of all lymph node biopsies of patients done at Muhimbili Medical Centre (MMC), Dar es Salaam, between 1 January 1984 and 31
REFERENCES
Miles RM, Greene RS. Review of colostomy in a Community Hospital. Dis Colon Rectum 1983;49:182-6 2 Henry HM and Everett WG. Loop colostomy closure. Br J Surg 1979;66:275-7 3 Mabogunje OA. Management of carcinoma of the colon and rectum in Nigeria. A review. E Afr Med J 1988;65:423-9 4 Abrams SL, Alsikafi FH, Waterman NG. Colostomy: a new look at morbidity and mortality. Am Surg 1979;45:462-4
RESULTS
Of the 730 lymph node biopsies which were available for review, TB lymphadenitis was the most common diagnosis (36%), followed by non specific adenitis (32%), metastatic carcinoma (16%), Hodgkin's and non Hodgkin's lymphoma (12%), lymphatic Kaposi's sarcoma (3%) and others (1%). Two hundred and forty-two case notes were available for analysis, making possible a detailed comparison of 159 cases of TB adenitis and 83 cases of non-tuberculous lymphadenopathy. We noted the following features of the patients: age, sex, self-reported fever, presence and duration of weight loss and cough, temperature at admission, chest signs, hepatomegaly, splenomegaly, localization of lymphadenopathy, and the characteristics of the lymph nodes on physical examination. These characteristics included consistency, mobility (not fixed to surrounding or deeper tissue), being discrete or matted (fixed to each other), tenderness and discharge. The following factors were significantly associated with TB adenitis when each factor was considered by itself: age (P< 0.(01); self reported fever (P< 0.(01); self-reported weightloss (P= 0.045);
Tropical Doctor, July 1992
130 Table 1. Difference of clinical features between the patients with tuberculous lymphadenitis and patients with other causes of lymphadenopathy TB adenitis Clinical age < 50 years age < 30 years Self-reported fever Self-reported weight loss Cervical lymphadenopathy Hard/matted lymph nodes Mobile lymph nodes Tender nodes Discharging lymph nodes
Non- TB adenitis
(159 patients) (83 patients) n
070
n
070
P value
149 III 80
94 70 50
64 41 17
77 49 20
129
of colostomy training and care", This is much easier in children whose parents are taught simple and inexpensive methods of care; faecal soiling is controlled by using a pad of clean cloth over the stoma and a larger one is wrapped over it to hold it in place by tying the limbs of this other 'covering cloth' at the back. When soiled, these are replaced and the soiled ones washed for re-use. Bags are usually used by adults - and a disposable bag can be used many times for as long as 2 weeks or more. Our approach towards encouraging acceptance has been to have prospective patients interact freely with another patient who has a successful colostomy. Our preference in infants and children is for a right transverse colostomy. It has less smell. It is better
managed by mothers, because faeces is easier to collect higher up in the trunk using the 'wrapping method' than from colostomies placed lower down. There was a high overall morbidity of 188 complications (Table 1). This is higher than in series from Europe and North America",
Clinical characteristics of tuberculous lymphadenitis in Tanzania
December 1988. All biopsies had been interpreted by pathologists at the department of histopathology at MMC. All available corresponding clinical case notes of these patients were also reviewed. The patients' age, sex, main presenting symptoms and signs and results of histological and bacteriological evaluation were recorded on special data forms. Where appropriate, the data were analysed by the chi-squared test with Yates' correction for 2 x 2 tables, and by a multivariate logistic regression analysis.
Clemens Richter MDI Joseph S Kimara'
James N Kitinya MB ChB2 , Karim F Hirji PhD 3
Departments of "Medicine, 2Pathology and 'Epidemiology/ Biostatistics, Muhimbi/i Medical Centre, PO Box 65001, University of Dar es Salaam, Tanzania TROPICAL DOCTOR,
1992,22, 129-130
INTRODUCTION
A rising incidence of tuberculous (TB) lymphadenitis and other forms of extrapulmonary tuberculosis has been noted in developed and developing countries in the recent years. This has been associated with the spread of the HIV virus infection!">. Data from Tanzania indicate that between 1984and 1988extrapulmonary tuberculosis increased by 94%, while pulmonary tuberculosis rose by 32070 5 • Limited facilities in developing countries can make it difficult to distinguish TB lymphadenitis from other forms of lymphadenopathy. In such a situation it would be useful if TB adenitis could be distinguished from other forms of adenitis on clinical grounds. PATIENTS AND METHODS
We performed a 5 year retrospective study by reviewing the results of all lymph node biopsies of patients done at Muhimbili Medical Centre (MMC), Dar es Salaam, between 1 January 1984 and 31
REFERENCES
Miles RM, Greene RS. Review of colostomy in a Community Hospital. Dis Colon Rectum 1983;49:182-6 2 Henry HM and Everett WG. Loop colostomy closure. Br J Surg 1979;66:275-7 3 Mabogunje OA. Management of carcinoma of the colon and rectum in Nigeria. A review. E Afr Med J 1988;65:423-9 4 Abrams SL, Alsikafi FH, Waterman NG. Colostomy: a new look at morbidity and mortality. Am Surg 1979;45:462-4
RESULTS
Of the 730 lymph node biopsies which were available for review, TB lymphadenitis was the most common diagnosis (36%), followed by non specific adenitis (32%), metastatic carcinoma (16%), Hodgkin's and non Hodgkin's lymphoma (12%), lymphatic Kaposi's sarcoma (3%) and others (1%). Two hundred and forty-two case notes were available for analysis, making possible a detailed comparison of 159 cases of TB adenitis and 83 cases of non-tuberculous lymphadenopathy. We noted the following features of the patients: age, sex, self-reported fever, presence and duration of weight loss and cough, temperature at admission, chest signs, hepatomegaly, splenomegaly, localization of lymphadenopathy, and the characteristics of the lymph nodes on physical examination. These characteristics included consistency, mobility (not fixed to surrounding or deeper tissue), being discrete or matted (fixed to each other), tenderness and discharge. The following factors were significantly associated with TB adenitis when each factor was considered by itself: age (P< 0.(01); self reported fever (P< 0.(01); self-reported weightloss (P= 0.045);
Tropical Doctor, July 1992
130 Table 1. Difference of clinical features between the patients with tuberculous lymphadenitis and patients with other causes of lymphadenopathy TB adenitis Clinical age < 50 years age < 30 years Self-reported fever Self-reported weight loss Cervical lymphadenopathy Hard/matted lymph nodes Mobile lymph nodes Tender nodes Discharging lymph nodes
Non- TB adenitis
(159 patients) (83 patients) n
070
n
070
P value
149 III 80
94 70 50
64 41 17
77 49 20
