Tabes Mesaraica

TABES MESARAICA, or atrophia mesaraica, a term used by older authors for severe atrophy in children, explained as being due to tuberculous lesions of the mesenteric glands. There was a time when almost all atrophic conditions in children were explained by 'enlargement and obstruction of the mesenteric glands, hindering the movement of chyle' and thus affecting the nutritional state in children. Subsequently, under the influence of Behring's teaching on the enterogenous route of tuberculosis infection in children, lesions of the mesenteric glands as a frequent form of tuberculous localization in children, occurring under the guise of general atrophy, were also given great importance. The development of knowledge in both the field of digestive and nutritional disorders in infants and young children and in the field of childhood tuberculosis led to the abandonment of this concept. The rarity of primary localization in the intestine with corresponding lesions of regional mesenteric glands, noted by Gohn on his own material and on reliable material from older authors (2,114 autopsies in children - 1.14% primary localization in the intestine with 95.93% primary localization in the lung), has recently been disputed by many (Engel-5-14%, Blumenberg-10%, Hübschmann-28%). Nevertheless, it is quite undisputed that enterogenous infection with tuberculosis is significantly less frequent than aerogenous infection. At the autopsy table in tuberculous infants and young children, with almost every case showing lesions of intrathoracic lymph glands, lesions of the mesenteric glands are also very frequently found simultaneously. This caseous degeneration of the mesenteric glands is most often found in combination with tuberculous-ulcerative lesions of the intestinal mucosa. Cases of isolated lesions of the mesenteric glands without simultaneous intrathoracic localization are rare. Of interest are those cases where the pulmonary localization is slight and recedes into the background, and in the presence of marked atrophy and signs of severe toxemia, one must think of a hidden localization, particularly an intra-abdominal localization in the form of lesions of the mesenteric glands. In these cases, there is usually a universal caseous degeneration of intrathoracic, mesenteric, and sometimes peripheral lymph glands. Despite the exceptional frequency of mesenteric gland lesions in the picture of generalized tuberculosis in children, especially infants and young children, recognizing this localization presents great difficulties. In markedly tumor-like lesions, especially when the peritoneum is involved in the process with the formation of adhesions and infiltrates, it is possible to palpate tumor-like masses containing packets of mesenteric glands (see Peritonitis). Palpation of enlarged and altered mesenteric glands is hindered by tension of the abdominal coverings and meteorism, and it is always necessary to differentiate palpable gland packets from fecal masses and tumors in the abdominal cavity. Sternberg notes as a symptom in tuberculosis of the mesenteric glands *э 2fiS tenderness on palpation in the right hypochondrium and a tender point to the right of the spine at the level of the Lii vertebra. Sternberg's symptom has not yet been finally verified and confirmed. The difficulties in recognizing tuberculosis of the mesenteric glands are even greater than in recognizing tuberculous lesions of intrathoracic glands (see Bronchoadenitis, Tuberculosis, tuberculosis in children). This forces attention to be fixed on cases with marked atrophy in tuberculous infants and young children without clinically and radiologically expressed localization of the process. It is in these cases that we usually speak of a peculiar generalization of the process without significant pulmonary spread with universal caseous degeneration of intrathoracic, mesenteric, and sometimes peripheral glands, often in combination with metastases in various organs: solitary tubercles of the brain, liver, spleen, kidneys, tuberculosis of the middle ear, etc. This peculiar form of generalized tuberculosis can be characterized as a general visceral tuberculosis of the lymph glands, occurring under the picture of atrophy (Finkelstein). Regarding the rarely occurring and difficult to diagnose isolated tuberculosis of the mesenteric glands, there is an opinion that this form has a benign course, without a tendency to generalize the process. Therapy-see Tuberculosis, tuberculosis in children.

I. Tsviler.