Bronchoesophageal fistulae are a rare complication of tuberculosis. Traditionally they are managed by either thoracotomy with resection and closure of the fistulous tract or by taking a more conservative approach of giving standard treatment for tuberculosis while ensuring nutritional support through a nasogastric tube. We report a young student with disseminated tuberculosis complicated by a bronchoesophageal fistula. He was managed conservatively with anti-tuberculous chemotherapy and nutrition administered through a percutaneous endoscopic gastrostomy tube. This approach was associated with a relatively good quality of life and he was able to pursue his studies uninterrupted at the local university.
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Low dose glucocorticoids, mycophenolate mofetil and hydroxychloroquine in IgA nephropathy, an update of current clinical trials.
Nephrology (Carlton)
September 2024
Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China.
Article Synopsis
- This mini-review examines the role of glucocorticoids, mycophenolate mofetil (MMF), and hydroxychloroquine (HCQ) in the treatment of IgA nephropathy (IgAN).
- It highlights conflicting results from key clinical trials, particularly regarding the efficacy of glucocorticoids, and suggests that lower-dose treatments might offer safer alternatives.
- The review notes that while MMF shows effectiveness in certain populations like Chinese patients, results are mixed elsewhere, and HCQ appears to reduce proteinuria with ongoing studies assessing its long-term advantages.
Corticosteroid Therapy in Immunoglobulin A Nephropathy: A Friend or Foe?
Kidney Blood Press Res
December 2023
Concord Clinical School, University of Sydney, Concord, New South Wales, Australia.
Background: The administration of corticosteroids in addition to supportive care to delay progressive immunoglobulin A nephropathy (IgAN), the most common primary glomerulonephritis worldwide, remains controversial. This is partly due to the paucity of well-designed randomized controlled trials and well-known corticosteroid-related side effects. As a result, clinical equipoise in corticosteroid therapy exists depending on geographical regions and the clinician's preference.
View Article and Find Full Text PDFShould we STOP immunosuppression for IgA nephropathy? Long-term outcomes from the STOP-IgAN trial.
Kidney Int
October 2020
Department of Cardiovascular Sciences, University of Leicester, Leicester, UK; John Walls Renal Unit, University Hospitals of Leicester NHS Trust, Leicester, UK. Electronic address:
The role of immunosuppression in the management of IgA nephropathy remains highly controversial. The Supportive Versus Immunosuppressive Therapy for the Treatment of Progressive IgA Nephropathy (STOP-IgAN) trial suggested that there was no benefit with the addition of immunosuppression to intensive supportive care, in terms of renal outcome. In this edition of Kidney International, Rauen et al.
View Article and Find Full Text PDFSingle versus dual blockade of the renin-angiotensin system in patients with IgA nephropathy.
J Nephrol
December 2020
Division of Nephrology and Clinical Immunology, RWTH Aachen University, Pauwelsstr. 30, 52057, Aachen, Germany.
Background: Inhibitors of the renin-angiotensin system (RAS) are cornerstones of supportive therapy in patients with IgA nephropathy (IgAN). We analyzed the effects of single versus dual RAS blockaQueryde during our randomized STOP-IgAN trial.
Methods: STOP-IgAN participants with available successive information on their RAS treatment regimen and renal outcomes during the randomized 3-year trial phase were stratified post hoc into two groups, i.
After ten years of follow-up, no difference between supportive care plus immunosuppression and supportive care alone in IgA nephropathy.
Kidney Int
October 2020
Division of Nephrology and Clinical Immunology, RWTH Aachen University, Aachen, Germany. Electronic address:
The randomized, controlled STOP-IgAN trial in patients with IgA nephropathy (IgAN) and substantial proteinuria showed no benefit of immunosuppression added on top of supportive care on renal function over three years. As a follow-up we evaluated renal outcomes in patients over a follow-up of up to ten years in terms of serum creatinine, proteinuria, end-stage kidney disease (ESKD), and death. The adapted primary endpoint was the time to first occurrence of a composite of death, ESKD, or a decline of over 40% in the estimated glomerular filtration rate (eGFR) compared to baseline at randomization into STOP-IgAN.
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