A case of tubercular Granulomatus tumour developed by koch's infection

Posted by Dr . Bhaskar Ganpat Hambardikar on Sun, Nov 29, 2009  
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A case report of tubercular granuloma in the cranial cavity behind the left eye

         The patient is Dr.Anuradha Devendra Hambardikar

         Age : 48 yrs

Following are the observations of Dr. B. G. Hambardikar M.M.B.S. D.Ortho.

I, Dr. B. G. Hambardikar treated the following two patients in 1959 by using sublingual tablets that time marketed as tablets veridase (streptokinase and streptodornase). Later on these tablets disappeared from the market. They were not available afterwards.

  1. A case of urinary bladder calculus of 2 inch in diameter :

I thought that time pathologically this calculus might have been formed by bricks of calcium oxalate crystals fibrin dead materials , dead WBC’s and dead RBC’s cemented together by proteinous mucoid and mucus material plus some amount of pus entangling them to form a mask that means a calculus and so I used this enzyme tablet  thinking that proteinous , fibrinous, muciod and mucinous cementing materials can be dissolved by these enzymes and calculus can be broken down

And so I dissolved sublingual tablets after sterilizing in spirit in distilled water. The solution thus prepared was introduced into the bladder by catheter. The process was continued for five successive days. The patient was asked to drink plenty of water , nearly five litres a day. For four days the urine passed by the patient was collected in white glasses. The urine thus passed was very turbid in the samples for four days continuously. But on the fifth day the urine was clear with no residue at the bottom of the glasses. After few days the patient was asked to take x ray for evidence urinary bladder calculus , but no calculus was detected .

  1. A case of cerebral thrombosis :

A case of hemiplegia due to cerebral thrombosis was seen by me after nearly ten days of occurance . I used sublingual veridase tablets (streptokinase and streptodornase) sublingually , one tablet eight hourly. The patient was improved within four days of treatment.

Now , the present case of tubercular granuloma :

         A tubercularous granulomatous tumour is similar to the construction of a wall using bricks and cement. tubercular granuloma consists of debris of dead tissues , dead WBC’s , dead RBC’s and fibrin produced by infection entangled and cemented by the proteinous materials of mucin , mucoid materials and purulent materials.

         Breaking of the tubercular granulomatus tumour mass – It can be done by dissolving and liquefying the cementing proteinous materials along with the proteins present in the debris of dead tissues  , dead WBC’s , dead RBC’s and fibrinous materials. The remaining elements of the tubercular mass and liquefied cementing proteinous materials will be removed by the phagocytes from the infected area. This breaking down process of tubercular mass can be effected by the proteolitic enzyme streptokinase given intravenously by drip method or sublingual method by using sublingual streptokinase tablets(if available)

         Above patient , initially suffered from continuous fever , tooth ache and alveolar abscess of left maxillary molar tooth. She consulted the dental surgeon for tooth trouble. He opened the alveolar abscess and dressed for 10-15 days with no effect on rise of temperature. The rise of temperature was persisted during this period and later on also.

         For continuous fever, the above patient consulted a physician. The physician admitted her in the hospital , investigated her for haemogram , E.S.R. , widal test and tuberculin test. Widal test was negative , tuberculin test was negative , there was lymphocitosis and high E.S.R.

         Treatment :

         The patient was given heavy dosages of intravenous ampicillin , intravenous amicacin and orally tablets of ciprofloxacin for nearly ten days. The temperature persisted throughout this period. Then we had discussion about it and decided to remove the affected tooth. The dental surgeon was called upon in the hospital. He removed the affected molar tooth in the hospital. The above antibiotic treatment was still continued. After removal of the tooth and with the above treatment , temperature was brought down to normal in the mornings. It was 95 F in the morning and 101 F in the evenings daily for ten days. Again we held a discussion about it. but because of evening rise of temperature ,we thought that tubercular focus somewhere in the body might have started it’s activity, and so the doctor stopped the above treatment and started anti-tubercular treatment.

         After about four weeks of treatment , the temperature came to normal and the treatment continued for one year. During the two and three months anti-tubercular treatment , the patient started getting paresis of the left eye muscles. After a month or so , complete paralysis of the left eye muscles and eye lid muscles was observed. This time because of this complication , brain scanning was done. It showed a mass about 0.5 inch diameter in the intracranial cavity behind the left eye. The brain scanning was done every six months. Second time scanning showed calcification in the granuloma and so the diagnosis of tubercular granuloma was confirmed. The patient was advised to take steroids for reduction of inflammation but the patient developed generalized oedima and oedima of the brain , compressing the brain and the vessels supplying brain. As the cranial cavity is not expandable , pressure on the brain and vessels in the cranium reduced blood supply, food supply and oxygen supply to the brain tissues. And the patient showed effects of compression of the brain and blood vessels as drowsiness , weakness of the whole body , forgetfulness and loss of memory. For this purpose , the doctors started the steroids , it increased the oedima of the brain and medulla oblongata producing paresis of right sided upper and lower extremities.

         For this purpose, the patient was admitted in the hospital and given two bottles of manitol intravenously and the doctor advised prednisolone instead of dexamethosone and diuretics to reduce the oedima. But the patient did not show as much improvement as much expected.

         Upto this time the doctors have given anti-tubercular treatment along with steroids but never thought of giving any medicine for breaking down the tubercular granuloma. In my opinion , doctors would have advised proteolitics enzymes for breaking down the tubercular granuloma by giving streptokinase by intravenous drip method or sublingual tablets by sublingual method as given above.

         I put it forward before the medical experts for thinking over and discussing over this aspect of treatment as suggested by me and they should try to use this method in every tubercular granulomatous case and other chronic infectious granulomas and other chronic infections to have good and early results. These medical experts may give advice on this case to have a good relief on this disease for the above patient. I will be greatly obliged to them if they take pains for improving above patients. So their suggestions are expected by us. It is also requested for the pharmaceutical companies to send the pamphlets and therapeutic indices of use of streptokinase in various diseases at the same time please let us know the sublingual tablets of streptokinase are available with them .

                                                                                             Yours faithfully ,

                                                                                             Dr. B. G. Hambardikar

                                                                                            

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